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At least 757 records · Page 42Linked to original sources
PubMed2001

[Severe and prolonged post-dural puncture headache: from pathological basis to therapeutic role and correct timing for epidural blood patch].

Believed to be due to unbalance between cerebrospinal fluid (CSF) production rate and its loss through the spinal dural puncture hole, post-dural puncture headache (PDPH) is often considered as a physiological syndrome, usually reversible without pathological sequelae after dural hole's closure. The clinical case here presented (incapacitating headache associated with diagnostic dural puncture in a leukaemic young female patient who underwent bone marrow transplantation) shows potentially fatal pathological sequelae following prolonged headache (untreated, due to the severe postransplant immunodeficiency and coagulopathy). The observed RMI lesions suggest interesting conclusions about the clinical indications and correct timing of autologous epidural blood patch (EBP). We also suggest the ways to preventing rebound intracranial hypertension following autologous epidural blood patch in patients suffering from incapacitating and prolonged headache.

Adult↗
PubMed1999

[Light puncture combined with longhu xingnao granules in treating acute traumatic intracranial hematoma].

OBJECTIVE: To confirm the clinical therapeutic effectiveness of Longhu Xingnao Granule (LHXNG) medicated after light puncture in treating acute traumatic intracranial hematoma. METHODS: Patients were randomly divided into two groups, 30 patients of the tested group were treated with LHXNG after light puncture and 20 patients of the control group treated with western medicine alone. RESULTS: The effect of the tested group was evidently superior to the control group (P < 0.05) and with a markedly shortened resuscitation time (P < 0.05). CONCLUSION: LHXNG has the function of promoting blood circulation and arresting bleeding, and improving resuscitation. In coordination with light puncture, it could improve the living quality of patients, shorten the resuscitation and treatment time, so as to reduce the maim and death rate.

Adult↗
PubMed1975

[Complications during puncture of the subclavian vein].

Based on the data of pertinent literature and personal author's material the technic and complications in cannulation of the subclavian vein are analysed. There were 39 complications among 1309 punctures (pleural puncture--in 11, puncture of the subclavian artery-in 20, and thrombophlebitis-in 8). All these complications were not serious and easily liquidated.

Adult↗
PubMed2002

[Ultrasound-assisted puncture method of treatment of hepatic hydatid cysts].

Results of treatment of 31 hepatic hydatid cysts in 28 patients were analyzed. The size of the s ranged from 3 to 25 cm. In 26 cases the cysts contained flive es, in 2 cases they were suppurated after US-assisted intraoperative puncture. Simple hydatid cysts (type I by M. Milcevic) were diagnosed in 24 patients (solitary--in 22, multiple--in 2), solitary cysts of type II--in 2 patients. In 23 cases aspiration-catheter treatment with complete removal of chitin membrane by one-stage (4) or two-stage (19) methods was performed. After removal of chitin membrane in 3 patients lateral fistula between spurious cysts cavities and peripheral branches of intrahepatic bile ducts were revealed which spontaneously. Glue composition "Rabrom" was used in 2 cases for closure of the residual cavity. In 4 patients who had cysts less 6 cm in size puncture irrigation of chitin cavity with 30% NaCl (PAIR technique) without it removal was performed. In one patient transcutaneous catheter (PAIR-PD technique) was used for irrigation of the cyst larger than 6 cm. The duration of two-stage aspiration-catheter treatment with removal of chitin membrane was 25.6 +/- 9.6 days. In moderate calcinosis of the fibrous membrane and bile fistulas period of hospitalization was 34 +/- 8.1 days. Treatment with PAIR and PAIR-PD took 1 and 3 days respectively. Complications of percutaneous methods were regarded as mild: hyperthermia (12), right-sided hydrothorax (6), subcapsular hematoma (1), urticaria (1). All the complications were treated conservatively and with US-assisted punctures. Long-term (from 6 months to 9 years) results of treatment were followed up in 26 patients: there were no recurrences. Suppuration of the residual cavity 6 months after the glue occlusion was eradicated by transcutaneous catheter drainage. One lethal outcome was not associated with complications of aspiration-catheter treatment. Both methods of transcutaneous treatment of hepatic hydatid cysts are effective and safe. A hypertonic solution of NaCl I produces a reliable antiscolecidal and sclerosis effect.

Adult↗
PubMedDate not supplied

The "temporalis-inhibitory reflex" in post-lumbar puncture headache.

Nausea and rigidity of the neck muscles, typical symptoms of post-lumbar puncture syndrome (PPS), may also be found in patients suffering from chronic headache of the tension-type. A decreased duration of the late suppression period of temporal muscle activity indicating a central disturbance of pericranial muscle control, can be observed in these patients. We have studied the temporalis-inhibitory reflex in 47 neurological inpatients requiring lumbar puncture. There were no significant differences of latencies or durations of temporalis silent periods between patients with and without PPS before, and 48 h following, lumbar puncture.

Adolescent↗
PubMed2003

[Comparison of the intracranial pressure value in patients with hypertensive intracerebral hemorrhage treated with traditional craniotomy and puncture drainage].

OBJECTIVE: To compare the difference of intracranial pressure (ICP) in patients with hypertensive intracerebral hemorrhage (HICH) treated with two surgical procedures, traditional craniotomy and puncture drainage. METHODS: One hundred and twelve cases with HICH were randomly divided into two groups. In one group, 60 patients were operated by traditional craniotomy and in another group, 52 cases by puncture drainage and urokinase treatment. In the meantime, ICP was monitored by placing catheter in lateral ventricle on the contralateral side of the hemorrhage. ICP values were recorded after operation at once, at 24 hours, 72 hours and 1 week. RESULTS: Although all the patients showed increased ICP, the increasing degree in patients treated with traditional craniotomy had lower ICP values (P<0.05 or P<0.01). CONCLUSION: Traditional craniotomy has advantages over puncture drainage for patients with HICH at least with respect to decreasing ICP.

Adult↗
PubMed2003

Using left atrial esophagus impression after a barium swallow to determine the optimal septal puncture site during percutaneous balloon mitral valvuloplasty.

BACKGROUND: Transseptal catheterization is the key to a successful percutaneous balloon mitral valvuloplasty (PBMV). The primary aim of the study was to investigate new methods of transseptal catheterization for PBMV. METHODS: Eighty-four patients with rheumatic mitral stenosis were randomized into two groups for PBMV. In the study group, the left atrial (LA) impression on the esophagus after a barium swallow was used as a reference of LA silhouette to determine the septal puncture site. In the control group, the LA silhouette under a normal fluoroscopic view was used for the determination of septal puncture site. RESULTS: In the study group, the average length of esophagus impression after a barium swallow was similar to the size of the left atrium measured by angiography (43.8+/-0.6 mm versus 44.1+/-0.7 mm, n=42, P>0.05). The success rate of atrial septum puncture in the study and control groups were 100% and 64.3%, respectively (P<0.01). Transseptal catheterization was subsequently achieved using the barium swallow approach in the 15 initially unsuccessful patients from the control group. PBMV was successful in the 84 patients with significant reduction in LA pressure and improvement of clinical symptoms. CONCLUSIONS: Transseptal catheterization in patients undergoing PBMV can be safely and effectively performed using the barium swallow approach.

Adult↗
PubMed2004

Use of FemoStop system for arterial puncture site closure after coronary angioplasty.

Different protocols exist concerning the method and timing of post-coronary angioplasty arterial puncture site closure. Easy handling and good effectiveness are well-documented for the Femostop femoral artery compression system; however, no hard data exist concerning the relationship between heparin anticoagulation level and femoral artery compression time (FSCT). Thus, we prospectively randomized 267 patients after elective percutaneous transluminal coronary angioplasty (PTCA) into two groups [group A (n=137) had early sheath removal 6 to 8 hours after PTCA; group B (n=130) had late sheath removal 14 to 16 hours after PTCA] and analyzed the dependence of the FSCT on the heparin anticoagulation level (aPTT) and the incidence of vagal reactions and puncture site complications. FSCT was significantly longer in group A (69+/-27 minutes versus 45+/-15 minutes; p<0.001) with high heparin anticoagulation level (aPTT, 88+/-46 seconds) in comparison to group B with low heparinization (aPTT, 59+/-34 seconds). Vagal reactions occurred more frequently in group A (15.3% versus 10.0%; p<0.01) and the incidence of minor hemorrhage at the arterial puncture site was also increased (9.5% versus 3.1%; p<0.05). In the clinical setting of intensive heparin anticoagulation and early sheath removal after PTCA (<8 hours), the FemoStop system cannot be recommended due to prolonged femoral artery compression times.

Angioplasty, Balloon, Coronary↗
PubMed2004

[Cyst puncture aspiration in 40 cases of abdominal echinococcosis].

OBJECTIVE: To evaluate the efficacy of cyst puncture aspiration in treating abdominal echinococcosis. METHOD: A retrospective analysis was performed in 40 cases of abdominal echinococcosis with formation of isolated single cyst in close adhesion with the abdominal wall, for which cyst puncture aspiration was carried out under ultrasound guidance. RESULTS: No death occurred in these patients and only 15 developed mild fever. The days for antibiotic use, jaundice resolution, bile secretion, time of extubation and hospital stay were 2.88+/-0.65, 3.50+/-0.71, 4.25+/-0.96, 5.38+/-0.98 and 9.35+/-1.08 days, respectively. Ultrasound examination in the follow-up showed no relapse in these patients, with the time of the residue adhesive cyst closure and calcification of 4.50+/-1.13 and 13.90+/-2.38 months, respectively. CONCLUSION: Cyst puncture aspiration under ultrasound guidance produces good therapeutic effects on abdominal echinococcosis with isolated single cyst closely adhering to the abdominal wall.

Abdomen↗
PubMed2004

Post-dural puncture headache in the obstetric patient: an old problem. New solutions.

More than 100 years have passed since the initial description of the postdural puncture headache (PDPH). However, this unique clinical entity still continues to fascinate anesthesiologists, and numerous studies on its pathophysiology, prevention, and treatment, have been published. There is considerable variability in the incidence of PDPH, which is affected by many factors such as age, gender, pregnancy, and needle type and size. The obstetric patient is at particular risk of dural puncture (and the subsequent headache) because of sex, young age, and the widespread application of regional anesthesia. The incidence of epidural needle-induced PDPH in parturients following dural puncture with a large bore needle has been reported to range 76-85%. Although a few measures have been proposed to prevent PDPH (intrathecal injection of saline, insertion of the epidural catheter into the subarachnoid space through the dural hole), none have been shown to work with certainty to date. This article reviews the latest developments (maintaining cerebrospinal fluid volume) aimed at prevention of PDPH.

Adult↗
PubMed1992

[Questions concerning transhepatic gallbladder puncture].

Development and spread of several diagnostic and therapeutic procedures focuses the radiologists' attention on the percutaneous gall-bladder puncture. Percutaneous rapid gall-stone dissolution is one of these important questions. Authors studied the anatomical situation of the liver and gall-bladder regarding the possibilities of the percutaneous gall-bladder puncture. Authors have concluded that the transhepatic approach is possible in every case. The extra-peritoneal approach cannot be avoided. On the basis of the results lateral direction of puncture on the so-called one-stick-introduces system is recommended by the authors.

Cholangiography↗
PubMed1992

[Treatment of pancreatic pseudocysts with ultrasound-guided percutaneous puncture and drainage].

The authors have treated 37 pancreatic pseudocysts in 36 patients by ultrasonically guided percutaneous puncture and drainage. The indication for intervention was rapid enlargement or threatening rupture of the acute (younger than 6-8 weeks) pseudocysts with recurring fever in 5 cases and chronic pseudocysts causing abdominal symptoms in 32 cases. After puncture six of seven patients were recuperated, but later in three of them the pseudocysts recurred. In one case as a complication of the puncture the pancreatitis exacerbated and led to death of the patient. The outcome of percutaneous drainage was successful in 26 of 32 pseudocysts. During the follow-up (6-54 months) recurrence were observed without symptoms in three cases. In four patients the treatment was ineffective, therefore cystogastrostomy was performed. During the time of the percutaneous drainage two pseudocysts had been infected and abscesses developed, which were treated by oncotomy. On the basis of their favourable experiences the authors recommend the US-guided percutaneous durable drainage as primer intervention for treatment of the pancreatic pseudocysts causing symptoms.

Aged↗
PubMedDate not supplied

The incidence of complications after canine fossa puncture performed during endoscopic sinus surgery.

BACKGROUND: Patients with extensive disease affecting the maxillary sinus may require a canine fossa approach for complete removal of disease. This study was designed to determine the complications associated with this procedure. METHODS: We performed a retrospective study of 21 patients who had undergone a canine fossa puncture at an academic hospital complex in Adelaide, Australia. RESULTS: A total of 37 canine fossa punctures were made in 21 patients. Twenty-eight of the 37 (75.7%) sides in which a canine fossa puncture was performed experienced a complication. The most common complaint was of cheek swelling in 14 (38%) followed by facial pain in 12 (32%), facial numbness in 11 (30%), cheek pain in 10 (27%), dental numbness in 10 (27%), gingival complications in 9 (24%), and facial tingling in 6 (16%) of sides. Most complications (75.5%) resolved within the 1st month after surgery. Six patients (28.6%) had persistent complications with facial tingling in 3 patients (50%) followed by facial numbness and tingling in 1 patient (11%), facial numbness alone in 1 patient (8.3%), and facial pain in 1 patient (7.1%). CONCLUSION: Canine fossa antrostomy is a technique that provides additional access to the maxillary sinus. Surgeons need to be aware that, although minor, a significant number of patients will experience both transient and long-term complications.

Adult↗
PubMed1992

Routine bone marrow punctures during remission of acute myelogenous leukemia.

To determine whether serial examinations of the peripheral blood can replace regular bone marrow punctures in the diagnosis of a relapse of acute myelogenous leukemia (AML), the peripheral blood of 40 AML patients in remission undergoing regular bone marrow punctures was studied. Within three months prior to bone marrow examination proving relapse in 97% of the relapses, at least one of the following values of the peripheral blood was pathological: blasts (84%), neutrophil granulocytes (72%), thrombocytes (64%), and hemoglobin (58%). The simultaneous appearance of abnormalities in the peripheral blood and the bone marrow occurs in such high incidence that routine bone marrow punctures are rendered obsolete in the follow-up of AML patients. Needless pain and anxiety can therefore be avoided for many AML patients.

Adolescent↗
PubMedDate not supplied

[The patients' care after lumbar puncture: hydration and bed rest?].

UNLABELLED: Headache after cervical or lumbar puncture has long been attributed to early mobilization; however, several trials and meta-analysis did not show any benefit from bed rest. AIM: The aim of the survey was to describe the patients' care after lumbar puncture. METHODS: A phone interview was administered to the head nurses of 50 neurological wards of Lumbardy and Veneto Region. RESULTS: All patients are kept at bed rest after the procedure from 3 to 24 hours. They are hydrated in 45 centres (i.v. or per os) with amounts of fluids ranging from 500 to 2500 ml. In 14 wards the patients fast until the afternoon, and are allowed only fluids. CONCLUSIONS: Although there is no evidence for the use of increased fluids or bed rest to prevent post dural puncture headache, these and other non evidence based practices continue to be used. Further research is warranted on strategies to implement an evidence based patients care.

Bed Rest↗
PubMed2004

A report of four cases of acute mediastinitis occurring following tracheoesophageal puncture in laryngectomees.

Tracheoesophageal puncture is a simple procedure for speech rehabilitation of total laryngectomy patients. Despite its relative simplicity this is not an innocent technique without complications. The goal of this study was to determine the incidence of acute mediastinitis as an early postoperative complication related to this procedure and to present outcomes of non-surgical conservative management in this complication. Blom-Singer voice prosthesis was used for 51 secondary tracheoesophageal puncture procedures in 45 patients between 1994 and 2002 according to the technique described by Blom and Singer. In the postoperative period, four patients (7.8%) developed mediastinitis related to this procedure. Of these, one patient had iatrogenic perforation of the posterior esophageal wall. A false dissection plane occurred in the tracheo-esophageal party wall in three patients which subsequently resulted in mediastinitis. Mediastinitis was diagnosed by clinical and radiological findings. All of these patients required prolonged hospitalization, intravenous antibiotics, and chest tube insertion. Only one patient underwent major surgical procedure to treat this complication. In conclusion, tracheoesophageal puncture for voice restoration is now regarded as a routine procedure usually performed in outpatient conditions. However, our experience demonstrates that this technique may be associated with significant complications such as mediastinitis. If mediastinitis is recognised earlier, it may be treated with conservative measures in most of the cases.

Adult↗
PubMed2005

Conventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache.

Post dural puncture headache (PDPH) represents a complication of anesthesia (with an increased incidence in obstetric patients) or as the consequence of a diagnostic lumbar puncture. The aim of the present study was to evaluate the efficacy of the epidural blood-patch (EBP) versus the conventional medical treatment of post-anesthetic headaches also including the PDPH following a diagnostic puncture, a category of patients rarely referred to the anesthesia consultation in our hospital because it was believed that they might have equal benefit from conventional measures due to the smaller size of needles used. We studied in a prospective, randomized, double-blinded manner 32 obstetric and non-obstetric patients with PDPH having the onset of the symptoms 24 hours before the inclusion in the study. The patients were randomly divided in two groups: group A (16 patients) receiving conventional treatment (oral and intravenous fluid replacement, non-steroidal anti-inflammatory drugs--NSAIDs--, caffeine) and group B (16 patients) in whom an epidural blood-patch was performed. The intensity of the headache was evaluated using a visual analogue scale (VAS) from 0-10, before, 2 hours and 24 hours after the EBP. There were no statistical differences concerning the demographic data and the cause of PDPH between the groups (p > 0.05). The intensity of PDPH was similar before performing the EBP (p > 0.05), with a value on VAS of 8.2 +/- 1,4. in group A and 8,0 +/- 1.6 in group B. Two hours after the treatment, the intensity of headache on VAS diminished extremely significant (p < 0.0001): in group B the value was 1.0 +/- 0,18 versus 8.2 +/- 1.4 in group A. The difference recorded after 24 hours remained statistically significant (p < 0.0001): the VAS scores were 0.7 +/- 0,16 and 7.8 +/- 1.2 respectively. The epidural blood patch represents the first choice treatment of PDPH no matter the etiology, being significantly superior to the conventional treatment which did not affect pain scores. In severe PDPH there is no reason to delay the EBP more than 24 hours after the diagnosis as all except two patients of the conventional treatment group required blood patching following the study period.

Adult↗
PubMed2006

Management of postdural puncture headache by epidural saline delivered with a patient-controlled pump--a case report.

Unintentional dural puncture is the most frequent cause of postdural puncture headache (PDPH) in epidural anesthesia and analgesia. Conservative treatments of PDPH include bed rest, oral analgesics, and hydration. When conservative measures fail, epidural blood patch is an effective substitute. However, epidural blood patch carries some risks, such as subdural hematoma, pneumocephalus, exacerbation of PDPH and new dural puncture. Many patients may refuse the procedure due to the risks involved. We describe a female patient who had her PDPH successfully treated with epidural saline delivered by a patient-controlled analgesia device (Abbott Pain Management-APM) without molestation of her daily activities.

Aged↗