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PubMed1991

Postdural puncture headache: a literature review.

This is a review of literature from 1943 to mid-1989 on the postdural puncture headache. The article looks at the currently held thoughts on the cause, prevention, and treatments of this second most frequent side effect of spinal anesthesia. Postdural puncture headache (PDPH) is caused by vascular distension within the nondistensible cranium following the leakage of cerebral spinal fluid (CSF) into the epidural space. Prevention of PDPH can be accomplished by using small-gauge needles and possibly by using the lateral approach, as opposed to the midline approach. Luck plays a big part, because if the needle punctures a thicker portion of the dura, there is a reduced chance of PDPH. Epidural saline injection is effective only if it is used as a continuous infusion for 24 hours. The usefulness of caffeine sodium benzoate with a 70-80% success rate and epidural blood patching with a 90%-plus success rate are discussed.

Headache↗
PubMedDate not supplied

[Incidence of dural puncture headache after intradural anesthesia carried out by residents].

To evaluate dural puncture headache (DPH) after intradural anesthesia (IA) carried out by residents of anesthesiology and reanimation, and its relation with the degree of difficulty of the puncture, a sample of 81 patients with ages ranging between 48 and 88 years was evaluated. The incidence of DPH was 12.35%, and it was not statistically associated with age, sex, anesthetic approach, local anesthetic, or degree of difficulty of lumbar puncture.

Aged↗
PubMed1990

[Post-dural puncture headache].

Post dural puncture headache is one of the major complications of spinal anaesthesia. In order to establish this diagnosis, the headache must be dependent on the position of the patient. The symptoms are probably due to leakage of cerebro-spinal fluid from the subarachnoid space to the epidural space which results in intracranial hypotension and tension of the nociceptive intracranial structures. The incidence is highest in young patients and the complication is observed more frequently in women than in men. In all age groups, the frequency and severity of the condition depend upon the calibre of the puncture needle and, for this reason, the finest possible needle should be employed. The only well proved prophylactic and curative treatment consists of establishing an epidural blood-patch. This procedure should be considered as the primary method of treatment in patients in whom post dural puncture headache contributes to prolongation of the period of convalescence.

Adolescent↗
PubMed1990

[Colloid cysts of the third cerebral ventricle. Computed x-ray tomography, MRI and stereotaxic puncture. Apropos of 9 cases].

The authors report their experience with Colloid Cysts of the third ventricle (9 cases treated between 1983 and 1989). Eight of them were punctured using stereotactic approach; five cysts were completely evacuated and the patients are free of recurrence. In three cases, tapping was impossible or the cyst insufficiently evacuated and the patients were secondary operated on (open microsurgical approach). The last case was directly operated on. Colloid cysts cured by stereotactic puncture were all hypo or iso-dense at C.T. scan and had a diameter of more than 1 cm. All these cases have had a M.R.I. exploration and the image of the cyst was always the same increased T1 and T2 signal. Unfortunately, we did not have the opportunity to realize M.R.I. in colloid cysts of a small size and hyperdense at C.T. scan. These results can help to the indication of a stereotactic puncture at the first attempt in some well defined colloid cysts.

Adolescent↗
PubMed1990

Diagnostic cyst puncture of multicystic kidney in neonates.

In the neonatal period it is important to differentiate hydronephrosis from cystic disease of the kidney, since treatment of these entities differ. Early surgery in hydronephrosis may be indicated to salvage kidney function. We studied a group of 29 infants with renal cysts or hydronephrosis. In 10 cases some doubt about diagnosis remained after thorough diagnostic imaging. These infants were examined using percutaneous puncture of the kidney to verify the suspected diagnosis of multicystic renal disease. The studies were performed using local anesthesia and sedation. Ultrasonography was used for puncture and contrast medium was injected during fluoroscopy. The cysts communicated in 7 out of 10 cases, and a true renal pelvis was never seen. Irregular tubular structures joining the cysts were identified in 7 cases and seem to be characteristic of the multicystic dysplastic kidney. One instance of the hydronephrotic type of multicystic kidney was found at surgery. Large size of the cysts can make diagnosis difficult. Percutaneous puncture was successful and gave the diagnosis in all cases. No complications ensued.

Diagnosis, Differential↗
PubMed1990

Optimal sites and depths for skin puncture of infants and children as assessed from anatomical measurements.

Postmortem measurements were made of distances from skin surface to underlying bone/cartilage on 43 children (up to 8 y old; weights from 0.7 to 26.4 kg) to determine optimal sites and lengths of lancet tips for skin puncture of the heel, great toe, and middle finger. For measuring depths, a needle-like probe was devised that minimized disfigurement. As long as the infant's heel was available for puncture prior to callus formation (to about six months), it offered the greatest depth and the bone/cartilage of the lateral/medial sites was considerably deeper than posterior sites. At age six months, the mean distance of skin surface. At age six months, the mean distance of skin surface to bone/cartilage in the middle finger was 2.5 mm, the lower 95% prediction interval being 1.5 mm. Lengths of lancet tips for finger puncture should therefore be made less than 1.5 mm. To get the desired volumes of blood, a compromise must be reached between depth and width of the lancet tip.

Aging↗
PubMed1989

Orientation of fibers in human dorsal lumbar dura mater in relation to lumbar puncture.

Longitudinal insertion of a lumbar puncture needle bevel is less likely to cause post-lumbar puncture headache than is transverse insertion. The reason for this has not been entirely clear. We investigated the direction of dural fibers in posterior L3-4 dura mater obtained from three autopsies and tallied it in three orthogonal planes. Under low-power light microscopy the tissue appeared to be composed of lamellae branching irregularly and directed concentrically to the spinal cord. Electron micrographs (x5000) revealed that the lamellae consisted mainly of bundles of collagen fibers that pursued wavy courses in various directions. The lamellae also contained branching elastic fibers, many of which were directed longitudinally. This arrangement of fibers probably minimizes the tendency of a dural puncture hole to gape under tension if the needle bevel is directed longitudinally.

Dura Mater↗
PubMed1989

[CT-guided percutaneous puncture and drainage of pericardial effusion].

Pericardial fluid can impair cardiac function. If medication is ineffective, puncture and drainage of the fluid is necessary. Three cases of CT-guided puncture and drainage of pericardial fluid are reported. The described technique is quick, of little risk and effective. It is superior to the conventional puncture of the pericardium from the subxiphoidal direction.

Drainage↗
PubMed1987

[Comparison of the results of the measurement of O2 consumption with a conventional bacteriologic method for urine obtained by bladder puncture].

A method is described which utilizes the O2 consumption of aerobes and facultative aerobes from urinary tract infections for their detection. Urines obtained by puncture and the corresponding midstream urines were examined for verification. Irrespective of secondary contamination and the presence of non-causative organisms, the O2 consumption method permits the detection of a bacterial urinary tract infection within 1 h. When this method was used, a comparison between midstream urine and urine obtained by puncture showed a complete coincidence. The O2 method has shown a sensitivity of 96.9% at a specificity of almost 100% for bacterial concentrations of more than 10(5)/ml in the urine obtained by puncture.

Bacteria, Aerobic↗
PubMed1987

[Fetal blood sampling by liver puncture].

Fetal blood sampling has been performed in several ways; placentacentesis, fetoscopy, or umbilical code puncture. The problems with these methods are technical difficulties and contamination of maternal blood or amniotic fluid. To solve these problems, we have tried fetal blood sampling by fetal liver puncture with a 21 approximately 23 gauge needle through the maternal abdomen under real time scan guidance. 10 patients underwent this procedure. They ranged from 18 weeks to 22 weeks of gestation at the time of sampling. The sampling procedures were done easily and the samples taken were shown to be pure fetal blood by red blood cell sizing. All the patients continued pregnancy after the examination and none of the pregnancies was influenced by the puncture. 7 patients have been delivered with neither sampling scars nor damage to liver function. This method provides pure fetal blood, the procedure is simple and, in our experience, no complications have occurred.

Adult↗
PubMed1987

[Blood access puncture point pseudoaneurysms in two hemodialysis patients].

This is a report of blood access puncture point pseudoaneurysms which occurred in two hemodialysis patients. Case 1: A 58-year-old male had been undergoing hemodialysis treatment since June, 1975. In January, 1981 a subcutaneous mass had developed at the blood access puncture point above the previously superficialized left femoral artery. An operation was performed in February, 1981 and the mass was dissected. The same artery has been used since the operation for blood access without any problems. The dimensions of the egg-shaped dissected mass were 3.5 X 4 X 2.5 cm. A histological diagnosis of the wall of the mass showed that it was a pseudoaneurysm. Case 2: A 48-year-old female had been undergoing hemodialysis treatment since September, 1983. The left basilic vein, connected to the brachial artery, has been used for blood access. In April, 1984, a subcutaneous mass had developed at the blood access puncture point and an operation was performed within a few days. Operative findings revealed that the mass was a capsulized infected hematoma with a smooth but extremely thin and easily ruptured surface, and the section of the basilic vein surrounded by the mass showed evidence of necrotic change due to compression. The brachial artery was resutured at the region where it was previously connected to the basilic vein without disturbance of arterial blood flow. In July, 1985, an operation was performed in which a new blood access was constructed in the left thigh by superficializing the femoral artery and connecting its side to the end of the saphenous vein.(ABSTRACT TRUNCATED AT 250 WORDS)

Aneurysm↗
PubMed1985

Lumbar puncture in asymptomatic late syphilis. An analysis of the benefits and risks.

We evaluated the treatment of asymptomatic patients with untreated syphilis of more than one year's duration (asymptomatic late syphilis) using a decision-analysis model. Two strategies were compared: treatment with 7.2 million units of penicillin G benzathine, or performing a lumbar puncture to test for asymptomatic neurosyphilis followed by penicillin and management based on cerebrospinal fluid analysis. Estimates of probabilities of disease prevalence, test sensitivity, and cure and complication rates were derived from published studies. Both strategies resulted in a cure rate of at least 99.7% using the best estimates. Although the strategy using lumbar puncture results in a 0.2% higher cure rate, its rate of complications (0.3%) exceeds its marginal benefit. We conclude that a lumbar puncture offers little additional benefit and may increase morbidity in patients with asymptomatic late syphilis.

Headache↗
PubMed1977

The need to repeat lumbar puncture.

Four patients with bacterial meningitis are reported. On initial examination 1 patient had a slightly abnormal cerebrospinal fluid (CSF), and in the other 3 patients the CSF was completely normal. An obviously purulent CSF was obtained when lumbar puncture was repeated 14-48 hours later. All 4 patients presented initially with pyrexia, and either neck stiffness or convulsions. In 3 of the 4 patients a cause for pyrexia was found on initial examination but lumbar punctures were done for neck stiffness or convulsions to exclude meningitis. The problems and the need to repeat a lumbar puncture, as well as the importance of blood cultures in a patient with suspected meningitis, are discussed. The fact that a normal specimen of CSF does not exclude meningitis is stressed.

Cerebrospinal Fluid↗
PubMed1979

[Anatomical considerations in sternal puncture].

The thickness of the manubrium, the width and thickness of the body of the sternum at the level of second intercostal space as well as the thickness of the spongiosa and outer and inner compact layers have been measured in 67 human cadavers. Consequently, it is recommended that sternal puncture be made at the level of the second intercostal space in the adult and at the manubrium in children. Depth of puncture should not exceed 4 mm. Sternal puncture can thereby be done with greater confidence of avoiding penetration of the sternum, a potentially serious complication.

Adult↗
PubMed1978

[Study of the multiple puncture method in smallpox vaccination of children].

In this work the multiple puncture method (in 76 cases) was compared with the scarification method--2 clinear cuts (in 70 cases). "Vaccine take" of the vaccines demonstrated a statistically significant difference: by the first method the percentage of personal "vaccine take" was 98.7, and by the second--86.4. The multiple puncture method produced a less pronounced local and general reaction. Immunological efficacy of the multiple puncture method (evaluated by hemagglutination inhibition test and neutralization test in the tissue culture) was quite satisfactory and failed to differ from such in vaccination by scarification.

Child, Preschool↗
PubMed1980

Postdural puncture headache in patients with chronic pain.

The incidence of headache after dural puncture in patients being treated for chronic pain was studied prospectively. Dural punctures were performed in 142 patients and headache developed in 13 (9.2%). Four of 32 patients (12.5%) who underwent diagnostic differential spinal and nine of 110 patients (8.2%) given intrathecal steroid injection developed headache. There was a 10.7% incidence of headache when a 22-gauge needle was used as compared to 5% with a 25-gauge needle. This difference was not statistically significant. The incidence decreased with increasing age. The incidence of postdural puncture headache in chronic pain patients does not differ significantly from that previously reported for surgical patients. All patients who developed headache responded to treatment which consisted of intravenous and oral fluids, analgesics, bed rest, and, if necessary, epidural blood patch.

Adult↗
PubMed1983

Should lumbar puncture be routinely performed in patients with suspected bacteremia?

In an attempt to develop a rational basis for performing lumbar puncture in sepsis workups, the hypothesis was tested that, for each of eight variables with a known association with bacteremia, the frequencies for patients having bacterial meningitis would be significantly greater than those in patients having bacteremia alone. In a one-year period, 168 lumbar punctures were performed in children having a mean age of 7.3 months. Patients were assigned to four groups: bacterial meningitis, bacteremia only, aseptic meningitis, and normal. Mean age, frequencies of symptoms, clinical appearances, ethnic groups, and sex ratio were determined for all groups. Frequencies of eight variables were determined and compared between Groups I and II.Results indicated that frequencies were not significantly different for groups I and II and that lethargy and petechiae, although distinguishing between groups I and IV, did not distinguish among the three groups having serious disease. It was concluded that since one cannot distinguish among groups having serious disease, all such patients suspected of sepsis should undergo lumbar puncture.

Adolescent↗
PubMed1981

Thoracic outlet syndrome: diagnostic evaluation by analgesic cervical disk puncture.

Thoracic outlet syndrome was treated by resection of the first rib in 19 patients, nine of whom were preoperatively evaluated by means of analgesic cervical disk puncture to discover whether the symptoms stemmed from diskogenic causes. The overall results after operation were excellent in 68% (13/19). In patients who had a positive test outcome of the analgesic cervical disk puncture, the symptoms remained unchanged after the operation, while in those who had a negative test result, late postoperative results were excellent in 100% (7/7). This was significantly better than the late results obtained in a group of patients evaluated and operated upon without the test. Analgesic cervical disk puncture may be a valuable differential diagnostic test in cases of suspected thoracic outlet syndrome.

Adolescent↗