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PubMedDate not supplied

[Transformation of cystic into diffuse epithelial ingrowth caused by laser-puncture. Report on four patients].

BACKGROUND: Epithelial ingrowth to the anterior chamber is a rare event after ocular injury or intraocular surgery. We report on four patients with primary cystic epithelial ingrowth (with primary curative cystic formation when treated with block excision) who underwent Nd:YAG-laser puncture of the cysts elsewhere. This treatment led to a change from a cystic to a diffuse form with a poor prognosis for the eye. PATIENTS: Three women and one man were seen in our outpatient department. Cystic epithelial ingrowth happened after intraocular surgery (1 x goniotomy, 2 x cataract surgery) or perforating injury (1 x). All four patients were treated elsewhere with puncture of the cysts (by Nd:YAG-laser). At first presentation in our department a change of cystic to diffuse epithelial ingrowth was noticed. Curative treatment by block excision was no longer possible. Diffuse epithelialisation of the anterior chamber resulted in secondary glaucoma with a poor prognosis. CONCLUSIONS: In our experience puncture of intraocular epithelial cysts may lead to a transformation to diffuse epithelial ingrowth with possible loss of the eye. Surgical opening of the cyst or subtotal excision is therefore contraindicated from our point of view. In case of cystic epithelial ingrowth of less than 5 hours of the limbal circumference, block excision in toto is indicated.

Adolescent↗
PubMed1989

[Sonographic-controlled puncture and its effect on further diagnosis and therapy].

Results of 127 sonographically guided punctures performed during 1982 to 1987 were evaluated retrospectively and the results of coarse needle and fine needle punctures were compared. In 74 punctured focal liver changes the superiority of coarse needle biopsy was particularly evident whenever a definitive histological confirmation of the diagnosis is aimed at. No therapy was initiated in 82 of the 127 patients after the biopsy finding had been established, and surgery was performed in 22 cases. 18 patients were given cytostatic treatment, and tumour embolisation was performed twice. 3 patients with non-malignant disease were successfully treated conservatively in pancreatic abscess, intraabdominal tuberculosis and actinomycosis.

Adenoma, Bile Duct↗
PubMed1988

[Ultrasound controlled kidney cyst puncture: significance for diagnosis and therapy].

Renal cyst puncture under ultrasonic guidance has proved an excellent and safe method in the differential diagnosis of cystic renal masses. The use of ultrasound in the follow-up of patients with renal cyst puncture is mandatory for evaluation of complications and results. The therapeutic success of renal cyst puncture is poor and estimated at about 25%. New percutaneous techniques with resection of the cystic wall lead us to expect much better results than with open surgical management.

Catheters, Indwelling↗
PubMed1986

[Abscess therapy by ultrasound-guided fine needle puncture. 2].

29 intraabdominal abscesses were punctured with sonographic guidance. 26 cases were treated by an evacuating needle puncture which was curative in 23 cases (88%). The complications were temporary bacteraeminas in two cases, which were managed conservatively. Sonographically guided fine needle puncture is a simple and effective procedure for the treatment of abdominal abscesses and should be considered as an alternative to surgery and percutaneous drainage.

Abscess↗
PubMed1996

The effects of fetal blood sampling and placental puncture on umbilical artery and fetal arterial vessels blood flow velocity waveforms.

This study was performed to investigate whether fetal blood sampling and/or transplacental puncture are associated with changes of blood flow velocity waveforms in umbilical artery and fetal circulation. The pulsatility index (PI) was measured from umbilical artery, thoracic descending aorta, renal artery, and middle cerebral artery immediately before and after fetal blood sampling (n = 28) or third trimester amniocentesis (n = 32). No significant changes in PI values were evidenced after amniocentesis performed either transamniotically (n = 21) or transplacentally (n = 11). Fetal blood sampling induced a significant decrease of PI values in all the vessels investigated. However, in presence of a transplacental procedure (n = 15) the amplitude of the decrease of PI in umbilical artery was significantly higher than after a transamniotic procedure (n = 13), while no differences were evidenced in the other vessels tested. These findings indicate that umbilical cord puncture at the time of fetal blood sampling is associated with a decrease in PI in umbilical artery and several peripheral arterial vessels. The isolated placental puncture does not induce Doppler-detectable hemodynamic effects, while in conjunction with cord needling, it increases the amplitude of the effects in umbilical artery.

Amniocentesis↗
PubMed1982

[Perirenal masses following kidney transplantation. Ultrasonically guided punctures and aspirate analyses].

24 perirenal masses in renal allograft recipients were aspirated by means of ultrasonographically guided percutaneous fine needle puncture, analysed biochemically, bacteriologically and identified as 15 lymphoceles, 5 hematomas, 2 abscesses and 2 urinomas. The discrimination criteria, based on macroscopic findings and biochemical analysis, are previously described in detail. According to ultrasonographic and clinical characteristics the lymphoceles are divided into two groups: 1. Large lymphoceles without any sign of rejection, which seem to be caused by injury of lymphatic vessels in the pelvic region of the graft recipient. 2. Small lymphoceles with signs of rejection, which evidently result from increased secretion of lymph by the allograft. In 54 punctures a therapeutic effect was achieved in small abscesses and lymphoceles only, which were drained percutaneously. A repeated fine needle evacuation of lymphoceles did not result in an obliteration of the lymphocele in any case. Ultrasonographically guided fine needle puncture of perirenal masses is of great importance, since the perirenal fluid can be identified exactly and an immediate and definitive therapy is made possible.

Abscess↗
PubMed1993

[Fibrin agglutination of thyroid gland cysts after fine needle puncture].

Tolerance to and efficacy of a fibrin adhesive injected into thyroid cysts after their evacuation by fine needle puncture was investigated in 60 consecutive patients (52 women, 8 men; mean age 50 [18-82] years) with solitary thyroid cysts. The patients were randomly separated into two groups of 30 each. In group A patients the cysts were completely emptied by fine needle puncture under ultrasound control. In group B patients a fibrin adhesive (0.8-1.4 ml) was subsequently injected. 25 of 30 patients in group A had recurring cysts, twelve of which were larger than the original one. There were 13 recurrences in group B (P < 0.005), but only one was of a larger volume. In each group three patients reported a brief period of pain after the evacuation procedure. The described technique has proven to be reliable and well tolerated. Cysts obliterated by fibrin adhesive recurred less frequently and had a smaller volume than those only evacuated by needle puncture.

Adult↗
PubMed1992

[Needle tract metastasis following sonographically guided puncture of a mesenteric lymph node metastasis in Pancoast's tumor].

Peripheral bronchial carcinoma with infiltration of the right lateral thoracic wall (Pancoast tumour) was demonstrated in a 60-year-old man with breathing-related pain in the right thoracic wall of two months' duration. As part of tumour staging needle puncture of an intra-abdominal space-occupying lesion was performed, guided by ultrasonography. Histological examination confirmed it as a bronchial carcinoma metastasis. Combined radio- and chemotherapy hardly influenced tumour growth. Three months later a subcutaneous lesion became palpable in the area of the previous needle puncture which on excision proved to be a metastasis. The patient died 10 months later from the bronchial carcinoma. Percutaneous puncture of potentially malignant space-occupying lesions must be strictly indicated. The frequency of needle tract seeding is not exactly known.

Biopsy, Needle↗
PubMed1986

[Ultrasound-guided fine-needle puncture in the diagnosis and therapy of liver and spleen abscesses].

A total of 41 diagnostic and therapeutic fine-needle aspiration punctures were performed under ultrasound control in 28 patients with solitary or multiple abscesses of liver (26) or spleen (2). Nonoperative measures (drainage-fine needle puncture, local and systemic antibiotics) cured 19 patients; in nine, primary surgical abscess drainage was performed. One operated patient with multiple liver abscesses died of generalized sepsis (mortality rate 3.6%). All 14 hepatic or splenic abscesses in which percutaneous fine-needle drainage was performed, including local and systemic antibiotic administration, were treated successfully. In two of 41 fine-needle aspiration punctures bleeding complications were recorded but did not require any treatment. The method was reliable and effective in the definitive diagnosis and treatment of hepatic and splenic abscesses, with a lower complication and mortality rate than surgical drainage.

Abscess↗
PubMed1996

Puncture-mediated gene transfer to the skin.

Simple and efficient gene transfer to the skin would facilitate many local and systemic gene therapy applications. Here we report a novel approach that allows installation and expression of plasmid DNA without a particulate carrier into the skin for the purposes of gene therapy. A device with a constantly high-frequency oscillating bundle of fine metal needles allows puncturing of the skin and leads to DNA transfer to skin-associated cells and expression of reporter genes in mice. Furthermore, puncture-mediated instillation of an expression vector coding for a single T cell epitope induces specific cellular immune responses. If this approach could be optimized, puncture-mediated gene transfer might be useful for the treatment of large body areas with plasmid DNA for the purpose of somatic gene therapy.

Amino Acid Sequence↗
PubMed1995

Diagnosis and treatment of hepatic hydatid cysts with the aid of echo-guided percutaneous cyst puncture.

The usefulness of echo-guided percutaneous cyst puncture in the diagnosis and treatment of hepatic hydatid cysts was assessed in a study of 45 patients referred to the Department of Tropical Medicine at Kasr El Aini Hospital in Cairo. All subjects had at least one hepatic cyst detected by ultrasonography (54 cysts in all), and 42 patients had positive results in serological tests for antibodies to Echinococcus granulosus. The majority of cysts were in the right hepatic lobe (40 cysts), were anechoic (51), and were rounded and smooth (49). All 45 active cysts (44 anechoic, rounded, and smooth; one anechoic and septated) yielded clear watery fluid containing scolices and exhibited elevated pressure on percutaneous puncture. In contrast, all nine inactive cysts yielded cloudy yellowish fluid without detectable scolices and did not display elevated pressure on puncture. The latter cysts were anechoic and elliptical (two cysts); anechoic and septated (one); anechoic with a calcified wall (one) or a detached germinal layer (two); or rounded with coarse echoes (three). Treatment by injection of a scolicidal agent (hypertonic saline) before withdrawal of the needle used for aspiration gave excellent results and was not associated with complications. Forty-three of the 45 patients had no clinical or ultrasonographic evidence of recurrent or new hepatic cysts after 3 years of follow-up.

Animals↗
PubMed2001

Nonaspiration puncture biopsy for suspected thoracic cavum tumor: experience of 2,010 clinical cases.

In our hospital from October 1980 to February 2000, 2,010 patients with suspected thoracic cavum cancer were diagnosed by nonaspiration puncture with multiple-hole type and surface trough-type biopsy needles. The positive rate of cytology or pathology examination for lesions in pleura, mediastinum, and lung tissue were 88.6% (148/167), 83% (297/358), and 80.2% (1,191/1,485), respectively. The mean positive rate in all cases was 81.4% (1,636/2,010). Complications rates for pneumothorax or hemoptysis were 1.3% and 0.8%, respectively, in this group. Such revised puncture needles have been used by us in various organs, such as brain tumors, metastatic lymph nodes of head and neck cancers, malignant disease of breast, liver, kidney, prostate, rectum and bone, etc. The use of such nonaspiration puncture needles is very simple, safe, and effective; even for beginners with this technique, the rate of successful diagnoses is fairly high.

Biopsy, Needle↗
PubMed2005

Dural puncture with a 27-gauge Whitacre needle as part of a combined spinal-epidural technique does not improve labor epidural catheter function.

BACKGROUND: This prospective, double-blind, randomized study was designed to examine whether the combined spinal-epidural technique without subarachnoid drug administration improved epidural catheter function when compared with the traditional epidural technique. METHODS: After institutional review board approval and informed consent, 251 healthy laboring parturients were randomly assigned to either group DP (combined spinal-epidural technique with 27-gauge Whitacre needle dural puncture but without subarachnoid drug administration) or group NoDP (traditional epidural technique). Patient-controlled epidural analgesia was initiated with 0.11% bupivacaine and 2 microg/ml fentanyl. Top-up doses in 5-ml increments of 0.25% bupivacaine were administered if needed. Previous power analysis revealed that a sample size of 108 patients/group was needed to show a clinically useful reduction of the catheter manipulation rate from 32% to 15%. RESULTS: In groups DP and NoDP, 107 and 123 evaluable patients, respectively, completed the study. Demographics and outcome variables measured, including epidural catheter manipulation and replacement rate, sacral sparing, unilateral block, number of top-up doses, average hourly epidural drug usage, highest sensory blockade level, and labor analgesia quality, were not different between groups. A subgroup of 18 patients without cerebral spinal fluid return during dural puncture had a higher catheter replacement rate than those of groups DP and NoDP, but it did not reach statistical significance. CONCLUSIONS: Dural puncture with a 27-gauge Whitacre needle without subarachnoid drug administration during combined spinal-epidural labor analgesia did not improve epidural labor analgesia quality or reduce catheter manipulation or replacement rate when compared with a traditional epidural technique.

Adult↗
PubMed1976

Osteomyelitis following puncture wounds of the foot in children.

Review of the laboratory and clinical findings and treatment of eight patients with osteomyelitis of the foot after puncture wounds revealed that: 1) osteomyelitis after puncture wounds is a infrequent but potentially serious complication, with significant morbidity; 2) osteomyelitis is frequently preceded by inadequate primary care for simple puncture wounds, and when treatment is appropriate, osteomyelitis usually can be avoided; 3) P. aeruginosa is the most commonly recovered organism; 4) the clinical presentation is characterized by a lack of systemic toxicity, paucity of laboratory abnormalities, and evidence of a localized infection process and the patient may be asymptomatic for a few days to several months after the injury before presentation of the osteomyelitis; and 5) once the infection has become established, treatment must be aggressive, including surgical debridement.

Adolescent↗
PubMed1992

An update on the evaluation and management of plantar puncture wounds and Pseudomonas osteomyelitis.

The management of children who present to the ED with plantar puncture wounds is dependent upon the nature of the injury, the examination of the puncture site, and the potential risk of a retained foreign body. Not all patients will require wound enlargement and a search for a retained foreign body. Close follow-up of all children who are being treated as outpatients is of vital importance in detecting an early development of an infectious complication. Pseudomonas osteomyelitis should be suspected in all patients who present with foot pain, swelling, and a decreased ability to bear weight after sustaining a nail puncture through a sneaker. The current consensus favors open surgical débridement followed by a course of intravenous antibiotics. The exact duration of the postoperative antibiotic course is still being debated.

Anti-Bacterial Agents↗
PubMed2004

Effects of sesame oil on oxidative stress and hepatic injury after cecal ligation and puncture in rats.

Oxidative stress is known to be involved in the development of organ failure and death in sepsis. Sesame oil attenuates oxidative stress induced by endotoxin; however, whether sesame oil is still effective in rats with sepsis has never been investigated. The aim of the present study was to determine the effect of sesame oil on oxidative stress-associated hepatic injury in cecal ligation and puncture-induced rats with sepsis. We examined the effect of sesame oil (4 mL/kg daily for 1 week) on lipid peroxidation, hydroxyl radical, superoxide anion, and nitrite levels in rats with sepsis. In addition, hepatic injury was also assessed by blood biochemistry. Sesame oil significantly decreased lipid peroxidation and serum nitrite levels, but affected neither superoxide anion nor hydroxyl radical in cecal ligation and puncture-treated rats. Furthermore, sesame oil significantly attenuated cecal ligation and puncture-induced hepatic injury in rats. Nevertheless, oxidative stress and hepatic injury were not affected by corn oil or mineral oil in rats with sepsis. Thus, attenuation of oxidative stress and hepatic injury may be associated with inhibition of nitric oxide in sesame oil-associated protection in rats with sepsis.

Animals↗
PubMed1996

Delayed paraplegia following spinal anaesthesia. Spinal subdural haematoma following dural puncture with a 25 G pencil point needle at T12-L1 in a patient taking aspirin.

We report an extremely rare complication of regional anaesthesia, a spinal subdural haematoma, which resulted in permanent neurological damage occurring 8 days after dural puncture at T12-L1. Although spinal subdural haematoma following spinal anaesthesia and lumbar puncture has been described before, this is the first report of this complication occurring after dural puncture using a 25 G atraumatic pencil point (Whitacre) needle. Contributory factors might have been the perioperative intermittent low dose aspirin therapy and the fact that spinal anaesthesia was performed at the T12-L1 level.

Aged↗
PubMed1997

Postdural puncture symptoms in a child.

An 11-year-old boy suffered an inadvertent dural puncture during placement of an epidural catheter for postoperative analgesia. He developed symptoms of mild headache only, but severe and protracted orthostatic nausea and dizziness, which eventually resolved completely following epidural blood patch. His symptoms were atypical and could have been misinterpreted in the context of dural puncture for diagnosis, or for administration of intrathecal chemotherapy. The reported incidence of headache following dural puncture in children is low. It may be that the manifestations are different from those of adults and that the true incidence of symptoms related to leakage of cerebrospinal fluid is higher in children than currently recognised.

Analgesia, Epidural↗