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Synacthen Depot for the treatment of postdural puncture headache.

We conducted a prospective, randomised, double-blind trial to study the effect of Synacthen Depot in 18 parturients with postdural puncture headache following deliberate or accidental dural puncture. Women were randomly allocated to receive either Synacthen Depot 1 mg (1 ml) or 0.9% saline 1 ml intramuscularly. Using a 10-cm visual analogue scale, severity of headache was measured before and at intervals until 48 h after injection. There was no difference in the severity of headache or requirement for epidural blood patch. We conclude that there is no advantage to the use of Synacthen Depot 1 mg for the treatment of postdural puncture headache.

Adult↗

Venous and skin puncture blood counts compared.

Venous and skin puncture blood counts were compared in 80 paired samples from 33 children, aged 6 months to 14 years, and 10 adults. Significantly higher mean values for Hb, RBC, haematocrit and neutrophils were found in skin puncture blood in children whereas platelet values were slightly higher in venous blood. Similar results were found in adult samples. Only occasionally were differences likely to be of clinical importance. The excellent comparability of paired platelet counts, at variance to that found in some previous studies, indicates that skin puncture blood can be used for platelet estimation providing an appropriate counting method is used.

Adult↗

Infection emanating from an 'innocent' facial puncture wound. Case reports.

All accidental wounds are contaminated by bacteria. The factors involved in the conversion of a wound from contaminated to infected are identical, irrespective of the site and classification of the wound, although puncture wounds are particularly suited for the growth of anaerobic organisms. A case is presented of facial infection emanating from an 'innocent' puncture wound. The management of orofacial puncture wounds is discussed and illustrated with a second case.

Child↗

Antagonism by indomethacin of neurogenic hyperthermia produced by unilateral puncture of the anterior hypothalamic/preoptic region.

1. In unanaesthetized rats, restrained at an ambient temperature of 24 degrees C, the anterior hypothalamic/preoptic (AH/PO) region was lesioned unilaterally by acute mechanical puncture.2. In control (no pre-treatment) rats, unilateral AH/PO puncture produced a neurogenic hyperthermia which began immediately, reached its peak magnitude (mean peak magnitude = +2.3 degrees C) within 60-90 min and persisted usually for 8-16 hr. At defervescence, core temperature fell to a level near that of the pre-lesioning base line.3. The prostaglandin synthesis inhibitor, indomethacin, administered I.P. at doses of 5 and 15 mg/kg 1 hr before puncture of the AH/PO region, attenuated the lesion-induced hyperthermia in a dose dependent fashion. The higher dose reduced peak magnitude by 80% and the 6 hr Fever Index by 88%. The vehicle used to dissolve the indomethacin (60% DMSO/40% saline) did not significantly attenuate the hyperthermia.4. In rats that were hyperthermic after AH/PO damage, indomethacin (10-15 mg/kg I.P.) caused core temperature to fall promptly to near the prelesion base line. Reversal occurred whether the indomethacin was injected while core temperature was still rising or late in the plateau phase of the hyperthermia.5. It is suggested that the neurogenic hyperthermia elicited by unilateral lesioning of the AH/PO region was mediated by prostaglandins released from injured tissue and possibly from extravasated blood. Evidence is cited indicating that the most likely sites of action of the released prostaglandins are the surviving portion of the AH/PO region on the punctured side and the intact contralateral AH/PO region.

Animals↗

Factor VIII inhibitor assay using skin puncture blood samples.

A method was developed for the measurement of factor VIII inhibitors by the Bethesda technique using small volumes of skin puncture blood. Human and porcine inhibitor concentrations on paired venous and skin puncture samples measured on 10 occasions were highly correlated, with no significant difference between them. Assays on four inhibitor negative haemophiliac patients were also negative by the skin puncture method. Sample dilution at the collection stage results in loss of sensitivity to inhibitor concentrations below 1 unit/ml, but the technique will be of value in monitoring higher concentrations when venous access is difficult and must be saved for parenteral treatment.

Animals↗

Distance of cecum ligated influences mortality, tumor necrosis factor-alpha and interleukin-6 expression following cecal ligation and puncture in the rat.

BACKGROUND/AIM: A mainstay of laboratory research into new therapies for sepsis has been the cecal ligation and puncture (CLP) model in rodents. Previous data indicate that the number of punctures made in the cecum and needle size utilized are primary determinants of mortality. Despite this, variability exists in mortality from this model, even when needle size is held constant. The aim of the present study was to evaluate the influence of the length of cecum ligated, independent of needle size, as a determinant of mortality. MATERIALS AND METHODS: We evaluated this by ligating various cecal lengths in male Sprague-Dawley rats. A double puncture was then made with a 20-gauge needle, and mortality was analyzed. Plasma TNF-alpha and IL-6 expression was assessed at 6 h. Animals received no antibiotics, were not fasted, and fluid resuscitation was administered. RESULTS: We determined that mortality does not begin to occur until a distance of >5% of cecal length is ligated. Further, our findings indicate that in this model, 90-100% mortality occurs 4 days following CLP when a distance of >30% is ligated. TNF-alpha and IL-6 expression is markedly increased with increasing length of cecum ligated. CONCLUSIONS: Our data demonstrate that the length of cecum ligated is a major determinant of mortality in the CLP model of sepsis. These findings indicate that investigators must rigorously control the distance of the cecum ligated in order to generate consistent mortality and inflammation data when utilizing the CLP model in rats. Further, the mortality from this model can be adjusted to fit the individual needs of a particular experiment.

Animals↗

[Percutaneous puncture of renal cysts for diagnostic and therapeutic purposes (author's transl)].

Percutaneous needle puncture of space-occupying lesions is an innocuous procedure in the differential diagnosis of renal masses. In conjunction with intravenous urography, ultrasonography and CT-scan it is a method of considerable diagnostic value, which will lead to a nearly complete accurate diagnosis. In this study we will report our experiences with diagnostic and therapeutic puncture of renal cysts. The instillation of Lipiodol has been given up, since a follow-up study became impossible due to radiological problems. The diagnostic procedure to differentiate expanding lesions of the kidney and the technique of percutaneous needle puncture are described as well as indications for surgical exploration.

Adult↗

Vascular complications following needle puncture of the liver. Clinical angiography.

Angiography after liver puncture was performed at different intervals in 51 patients. Fourteen cases had abnormalities believed to be caused by the puncture. Most of these were small but there were also 4 cases with large liver hematomas and 1 case with an abscess between the liver and the abdominal wall, none requiring acute surgery. No certain correlation between the severity of the injury and the diameter of the puncture instrument could be assessed.

Adult↗

Ultrasound-guided percutaneous fine needle puncture of the gallbladder for studies of bile composition.

Ultrasound-guided percutaneous fine needle puncture of the gallbladder (PFNP-GB) is invaluable for diagnostic and research purposes, but there are few reports about its safety. We therefore describe the efficacy and side-effects of 43 consecutive gallbladder punctures in 39 patients. PFNP-GB was successful in 40/43 (93%), but failed in three. Bile was completely aspirated in 28 of the 40 (70%) successful procedures. After 36 of the 43 punctures (84%), the patients remained asymptomatic, although on seven occasions (16%) the patients complained of right upper quadrant pain 0.5-12 h after the procedure. In six of these, the pain resolved in 2-24 h, although one developed a leucocytosis (22 x 10(9) 1(-1)). The seventh patient developed pyrexia and signs of generalized peritonism, which settled with conservative therapy. Ultrasonographic abnormalities of the gallbladder wall were seen in five of the seven symptomatic patients, consisting of: (i) an increase in the thickness of the gallbladder wall (n = 5) from less than 2 mm to 4-14 mm; (ii) peri-cholecystic collections (n = 2) measuring 5 and 11 mm in diameter; (iii) an intraluminal mucosal flap (n = 1); (iv) an intraluminal echogenic layer (n = 1); and (v) a 12 cm intraabdominal haematoma in the patient with generalized peritonism. Predictors of pain were: (i) the number of needle "passes" (3.7 +/- 0.8, range 2-8, in patients with pain vs 2.0 +/- 0.2, range 1-6, in pain-free patients, p < 0.02); (ii) the absence of gallbladder stones (p < 0.03); and (iii) incomplete aspiration of bile from the gallbladder (p < 0.02). PFNP-GB is an effective way of sampling fresh gallbladder bile, although there is a 16% risk of inducing pain and/or ultrasonographic changes in the gallbladder.

Adult↗

Puncture perfusion of small tissue pieces for scanning electron microscopy.

Small tissue pieces for scanning electron microscopy were punctured, before fixation, with a needle and perfused through the needle with Ringer solution. This puncture perfusion sufficiently eliminated blood and tissue fluid from the tissue and was of excellent value in cleaning the small samples which were hardly cannulated for vascular irrigation. Resin injection by this needle puncture method reproduced not the tissue spaces but, almost exclusively, the blood vessels.

Animals↗

Needle puncture of cystic renal masses: a survey of the Society of Uroradiology.

A survey of 114 members of the Society of Uroradiology provided data on the results of needle punctures of cystic renal masses in approximately 16,000 cases. The 73 respondents reported that cyst puncture is currently performed only for specific indications, that opacification is only occasionally performed after puncture, and that cytology is the laboratory procedure of choice for aspirated fluid. While all respondents accepted sonographic confirmation of cysts seen on nephrotomography, only 92% accepted sonography alone as diagnostic, compared to 100% for CT alone. Aspiration of clear fluid (usually an indicator of benignity) with positive or negative cytology, occurred in 19 cystic renal malignancies. Thus, gross and laboratory characteristics of aspirated fluid are not conclusive in diagnosing cystic lesions. CT should be the final arbiter in suspicious lesions.

Biopsy, Needle↗

Effects of repeated jugular puncture on plasma cortisol concentrations in loose-housed dairy cows.

In three experiments, the effects of venipuncture on plasma cortisol concentrations were studied in loose-housed dairy cows. In Exp. 1, two blood samples were collected 18 min apart on three alternate days from 20 dairy cows for studying their adrenocortical response to a single venipuncture. To further evaluate the effect of cows anticipating venipuncture, in Exp. 2, 15 dairy cows were sequentially venipunctured once daily on 12 successive days in a randomized order in groups of five, starting 15 min apart. In Exp. 3, 10 primiparous cows were used on three alternate days to study habituation to serial sampling (i.e., collection of five blood samples by venipuncture, 15 min apart). In cows accustomed to handling, jugular puncture did not affect cortisol concentrations in plasma collected 18 min later. Average daily cortisol concentrations varied between 2.07 +/- .38 and 3.81 +/- .56 ng/mL in the first (t = 0) and between 1.43 +/- .15 and 2.61 +/- .72 ng/mL in the second (t = 18) blood samples. Likewise, when cows were sampled sequentially once a day, the order of sampling between and within groups did not influence (P > .05) plasma cortisol concentrations. In contrast, primiparous dairy cows that were less used to being handled showed an average increase in cortisol concentrations when five samples were collected by venipuncture 15 min apart. During successive sampling sessions, however, the cows did not decrease or increase plasma cortisol concentrations in response to repeated serial sampling at the group level (P > .05). Between individuals, the maximum effect of repeated venipuncture on cortisol concentrations (4.5 to 22.6 ng/mL), the time at which the effect reached its maximum (30 to 60 min), and the consistency of the response pattern over successive series varied largely. The results of this study show that in cows that were accustomed to handling and to being restrained, baseline cortisol concentrations can be measured in single blood samples that are collected by jugular puncture within 1 min after first approaching the cow. When successive blood samples need to be collected within 15 to 20 min, jugular puncture may induce an increase in cortisol concentration, which seems to depend on the handling experience of the animals and on individual differences.

Animals↗

A newly designed puncture needle for suction decompression of giant aneurysms. Technical note.

A newly designed puncture needle for aspirating large or giant aneurysms is described. This puncture needle represents a modification of an intravenous catheter with an internal needle. It is designed to prevent blood from leaking when the internal needle is removed and has a lateral tube for aspiration. Following aneurysm puncture with the parent artery temporarily trapped, the catheter is positioned on the head frame with a brain spatula and a self-retaining retractor. Blood is suctioned through the lateral tube with a syringe or the suction system normally used in the operating room.

Equipment Design↗

Safety of transvaginal fine needle puncture of gynecologic masses: a report after 500 consecutive procedures.

Transvaginal sonographically guided puncture may be used for diagnostic and therapeutic purpose in general gynecology and in oncology. To define the complication rate of this technique, 500 consecutive procedures were reviewed; 289 procedures were on cystic masses, 146 on solid tumors, 34 on mixed tumors, and 31 on other lesions. No life-threatening complications occurred. Early mild and self-limited complications developed in eight procedures (1.6%). Short-term complications occurred in four cases (0.8%; two infections, one pelvic pain, one hemorrhage); two of these required surgery. Transvaginal sonographically guided puncture is safe and does not entail a higher risk of infection than transabdominal punctures.

Adolescent↗

Comparison of 25-gauge, Quincke and Whitacre needles for postdural puncture headache in obstetric patients.

OBJECTIVE: To compare the frequency of postdural puncture headache (PDPH) and failure rate of spinal anesthesia using 25-gauge Quincke and 25-gauge Whitacre needles in obstetric patients. DESIGN: Single blinded, interventional experimental study. PLACE AND DURATION OF STUDY: This study was conducted at the Department of Anesthesiology, Pain Management and Surgical Intensive Care Unit, Dow University of Health Sciences and Civil Hospital, Karachi from November 1, 2003-April 15, 2004. PATIENTS AND METHODS: One hundred females, aged 18-35 years, ASA physical status I and II, with singleton pregnancy undergoing elective or emergency cesarean section under spinal anesthesia were randomly allocated to receive spinal anesthesia either by using 25-gauge Quincke or 25-gauge Whitacre needles. Patients were followed for 3 days postoperatively. Headache, its relation with posture, onset, duration, severity and response to the treatment were recorded. RESULTS: Compared with the Whitacre group, frequency of postdural puncture headache was significantly higher in Quincke group (*p=0.015), while the overall occurrence of non-postdural puncture headache (NPDPH) did not differ significantly between two groups (p=0.736). Most of PDPH developed on 2nd postoperative day, were mild in nature and resolved within 48 hours of their onset. There was no significant difference in the failure rate of spinal anesthesia in both groups (p=0.149). CONCLUSION: It is suggested that use of 25-gauge Whitacre needle reduces the frequency of PDPH without increasing the failure rate of spinal anesthesia in obstetric patients.

Adolescent↗

[A comparative evaluation of the efficacy of the monotherapy of peptic ulcer using EHF-puncture and basic drug therapy].

20 patients with gastric ulcer and 82 ones with duodenal ulcer received basic chemotherapy. 23 patients with gastric ulcer and 97 patients with duodenal ulcer were treated with EHF-puncture. Pain and dyspeptic syndromes in EHF-puncture patients were relieved 2.5-3 times quicker than in chemotherapy. Time of scarring of ulcer defect reduced, on the average, 1.5-fold. Fibrogastroduodenoscopy detected mucosal erosions in 55% of patients with gastric and 26% of duodenal ulcer patients given ampicillin. In patients treated with EHF-puncture erosions were found in 2.2% of patients.

Acupuncture Points↗

[Diagnosis of parathyroid cysts: value of parathyroid hormone level in puncture fluid].

OBJECTIVE: Determine a means of establishing the diagnosis of parathyroid cysts preoperatively. PATIENTS AND METHODS: Classically, crystal-clear watery fluid removed by fine-needle aspiration of a suspected thyroid mass raises the suspicion of a parathyroid cyst. Immunoradiometric assay of parathyroid hormone level in the fluid may give the diagnosis sparing unnecessary surgery. RESULTS: Over the last 5 years, among the 12 patients presenting a suspected thyroid cyst containing a crystal-clear fluid, we were able to diagnose 3 cases of parathyroid cysts due to the considerable elevation of parathyroid hormone in the puncture fluid. None of these patients had hyperparathyroidism. In patients with a thyroid cyst, parathyroid hormone level in the puncture fluid was nil. CONCLUSION: The parathyroid nature of cervical cysts containing crystal-clear fluid can be established by assaying parathyroid hormone in the puncture fluid. Non-functional parathyroid cysts may be treated by repeated aspiration. Serum calcium level must be checked regularly to detect potential hyperparathryoidism.

Adult↗

Central venous catheterization through the basilic vein or by infraclavicular puncture? A controlled trial.

Central venous catheterization through the basilic vein and by infraclavicular puncture of the subclavian vein was compared in a trial with random allocation to 125 candidate patients. The catheters were inserted via the two routes with roughly equal success rates. Subclavian catheters were maintained better for the period required than were basilic catheters. The infraclavicular puncture caused initial, and basilic catheterization, late complications. Consequently, infraclavicular puncture is preferable for long-term, and basilic catheterization for short-term, needs.

Blood Pressure Determination↗