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PubMed1976

[Transvenous kidney puncture. New procedure for withdrawal of kidney tissue].

A transvenous catheter technique for renal puncture is described which was successful in 9 of 11 punctures performed in 8 dogs. Macrohematuria was not observed in any case. Autopsy revealed only small subcapsular hematomas. The advantage of this procedure is the reduced risk of bleeding achieved by peripheral puncture and by-passing of the great central vessels with aid of phlebographic controls. Moreover localization of kidneys by excretion urography--impossible in patients with renal insufficiency--is unnecessary.

Animals↗
PubMedDate not supplied

[Post-lumbar puncture syndrome--its pathogenesis, prophylaxis and treatment].

Post-lumbar puncture syndrome (PLPS) is a frequent and important complication of diagnostic lumbar puncture. PLPS is primarily caused by perforation of the dura mater, leading to persistent leak of the cerebrospinal fluid, and, as a result, intracranial hypotension. Effective therapeutic options are limited to symptomatic treatment until natural improvement occurs, or, in cases of prolonged complaints, invasive treatment (epidural blood patch with patient's own venous blood), which makes prophylaxis of PLPS essential. Prophylactic measures of confirmed efficacy are: reducing needle size, positioning the needle bevel parallel to the long axis of the spine, re-inserting the stilet before withdrawal of the needle, and, if possible, using a so-called "atraumatic" needle, minimizing the perforation of the meninx. The volume of the cerebrospinal fluid collected and the position of the patient after the procedure do not have a significant influence on PLPS frequency.

Blood Patch, Epidural↗
PubMed1993

The effectiveness of lumbar puncture in the evaluation of delirium and fever in the hospitalized elderly.

OBJECTIVE: To determine the value of the cerebrospinal fluid examination in the evaluation of hospitalized; elderly patients with delirium and fever. DESIGN: A retrospective case series of consecutive events during a 15-month period. SETTING: Tertiary care center. PARTICIPANTS: Elderly patients admitted to the University of Cincinnati (Ohio) Hospital between July 1, 1988, and October 1, 1989, who had a lumbar puncture and cerebrospinal fluid evaluation to evaluate fever and mental status changes. MAIN OUTCOME MEASURES: Primary intracranial causes and the clinical characteristics of delirium and fever. RESULTS: Eighty-one hospital admissions were reviewed. Fifty-seven (70%) of the lumbar punctures were performed as part of the admitting workup, and the remaining 24 (30%) were performed during the hospitalization. Eighty of the 81 cerebrospinal fluid cultures were negative for bacterial growth. The primary origins for fever and delirium included urinary tract infections (25%), pneumonia (22%), viral causes (17%), and metabolic causes/dehydration (14%). One case of bacterial meningitis was diagnosed in an alcoholic, 73-year-old man who was unresponsive in the emergency department. One case of presumed aseptic meningitis was diagnosed in a 65-year-old man who presented with fever and headaches and a blood pressure of 230/100 mm Hg. CONCLUSIONS: Most hospitalized, older patients with fever and delirium have primary causes of the confusion outside the central nervous system and may not require a routine evaluation of their cerebrospinal fluid.

Aged↗
PubMed1986

Intraspinal epidermoid tumors caused by lumbar puncture.

It is well known that congenital intraspinal epidermoid tumors, while rare, do occur. That they may also be related to spinal puncture is less well understood. In the present article, four such cases are described, including one in which an earlier myelogram performed because of lumbar disk disease showed that no tumor was present prior to the spinal puncture. The pertinent literature is reviewed, and the probable mechanism of formation of such tumors and the means for avoiding it are discussed.

Adult↗
PubMed1996

Anterior stromal punctures for bullous keratopathy.

OBJECTIVE: To evaluate the therapeutic effects of anterior stromal punctures (ASP) in patients with bullous keratopathy (BK). PATIENTS AND METHODS: Twenty-seven patients awaiting penetrating keratoplasty with a diagnosis of BK were examined. They were seen before treatment with ASP and 1, 4, and 12 weeks after treatment. The examination included slit-lamp examination, photography of the cornea, ultrasonic pachymetry, central esthesiometry, and pneumotonometry. Subjective evaluations of pain, discomfort, and photophobia were also done using a visual scale model. Photographs were analyzed by computer-assisted planimetry and used to measure the corneal surface covered by bullae and microcysts. Pretreatment and posttreatment values (mean +/- SEM) were compared using the Student paired t test. RESULTS: At 3 months, a significant reduction in pain was noted. A decrease in the mean corneal surface covered by bullae (BKPreASP = 2733 +/- 553 microns2; BK3mo = 1006 +/- 356 microns2, P = .004) was observed. A decrease in the esthesiometry (E) measurement (EPreASP = 3.5 +/- 0.4 cm; E3mo = 1.3 +/- 0.3 cm, P < .001), an increase in corneal thickness ([CT] CTPreASP = 869 +/- 24 microns; CT3mo = 902 +/- 21 microns, P < .001), and a decrease in the number of quadrants through which iris (I) details could be seen (IPreASP = 1.7 +/- 0.3; I3mo = 1.2 +/- 0.3, P = .015) were also noted. These findings corroborate the clinical observation of increased subepithelial fibrosis following ASP. CONCLUSIONS: Anterior stromal punctures reduce bullae formation and alleviate pain in patients with BK, and they constitute a valuable alternative to penetrating keratoplasty should surgery be delayed or contraindicated.

Adult↗
PubMed1990

Tracheostoma diverticulum following tracheoesophageal puncture.

Although the initial reports of tracheoesophageal puncture after total laryngectomy reported little to no morbidity, subsequent studies with longer follow-up have reported a significant number of complications. We present the first reported case (to our knowledge) of prolapse of the posterior tracheal wall with diverticulum formation developing 6 years after continuous use of tracheoesophageal puncture speech. Preoperative assessment with a barium esophagogram and rigid esophagoscopy aided in the successful surgical treatment of this disorder. The pathogenesis of this complication and method of repair are discussed.

Diverticulum↗
PubMed1994

The outcome and techniques of primary and secondary tracheoesophageal puncture.

OBJECTIVES: To evaluate the outcome of primary vs secondary tracheoesophageal puncture (TEP), in particular the effects of preoperative and postoperative radiotherapy on success and complication rates in primary TEPs, and to highlight modified surgical and management techniques. DESIGN: Retrospective study of case series. SETTING: Chevalier Jackson-Norris Center-Department of Otorhinolaryngology and Bronchoesophagology at Temple University Health Sciences Center Hospital, Philadelphia, Pa. PATIENTS: One hundred six consecutive patients underwent primary TEPs and 30 underwent secondary TEPs for voice restoration after laryngectomy for cancer over a period of 8 years with follow-ups ranging from 6 months to 8.5 years. The group given primary TEP also includes 19 patients who received radiation for cure and salvage laryngectomy and 75 who received full-course postoperative radiotherapy. INTERVENTION: Tracheoesophageal puncture and Blom-Singer prosthesis. MAIN OUTCOME MEASURES: Speech measures including (1) voice intensity, (2) pitch of speech, (3) duration of sustained phonation, and (4) rate of speech. RESULTS: A success rate of 93% was achieved in the group of patients given primary TEP regardless of radiotherapy. An 83% success rate was achieved with patients given secondary TEP. There were no major complications related to TEPs. CONCLUSIONS: Primary TEP for patients requiring total laryngectomy is highly recommended since a second operative procedure can be avoided and speech obtained rapidly. Postoperative radiotherapy does not increase the complication rate from TEP.

Adult↗
PubMed1977

Bacterial meningitis. Limitations of repeated lumbar puncture.

A retrospective chart review of 47 pateints with bacterial meningitis was conducted with respect to current guidelines used to define an adequate duration of antimicrobial therapy. Fifty percent (19/38) of patients had an inadequate response to therapy as defined by repeated lumbar puncture (LP) findings (ie, a cerebrospinal fluid (CSF) blood cell count greater than 50/cu mm and/or a CSF glucose value less than 45 mg/100 ml) at the end of therapy. No cases of relapse were seen. Persistent CSF abnormalities were not associated with the presence of complicating disease but were associated with prolongation of antimicrobial therapy beyond 13 days. Patients having persistent CSF abnormalities at the time antibiotics were stopped had a higher CSF blood cell count and a lower glucose value on initial lumbar puncture than those not having persistent abnormalities (P less than .001). These results emphasize the limitations of the role of repeated LP in defining an adequate duration of antimicrobial therapy.

Adolescent↗
PubMed1992

Uses and technique of pediatric lumbar puncture.

OBJECTIVES: To review diagnostic and therapeutic indications, contraindications, complications, and technique of pediatric lumbar puncture with emphasis on diagnosis of bacterial meningitis in bacteremia, cellulitis, and fever with seizures and to discuss cerebrospinal fluid findings in partially treated infection and traumatic blood-contaminated spinal tap. RESEARCH DESIGN: Literature review. CONCLUSIONS: We recommend lumbar puncture for children younger than 1 year with bacteremia, children with Haemophilus influenzae type B cellulitis, and children with fever and seizures not classified as simple. Pretreatment with antibiotics rarely changes cerebrospinal fluid characteristics such that a diagnosis of bacterial meningitis would be obscured. In a traumatic spinal tap, the equation to predict cerebrospinal fluid pleocytosis based on the peripheral blood cell count is invalid. When used together, cerebrospinal fluid glucose level, Gram's staining, and observed-to-expected ratio of white blood cells are highly reliable in diagnosing bacterial meningitis.

Bacteremia↗
PubMed1996

Lidocaine for lumbar punctures. A help not a hindrance.

OBJECTIVE: To determine whether premedication for lumbar puncture (LP) with lidocaine hinders collection of cerebrospinal fluid (CSF) through either increased number of attempts or increased incidence of traumatic punctures. DESIGN: A randomized controlled trial. SETTING: The pediatric emergency department of an innercity teaching hospital. PATIENTS: A convenience sample of 100 children, younger than 3 years, who required an LP as part of their diagnostic workup. INTERVENTION: Patients were randomized to receive either lidocaine or no local anesthetic before undergoing an LP. MAIN OUTCOME MEASURES: Comparison of the number of attempts needed to obtain CSF and the number of traumatic LPs between the lidocaine-treated and no local anesthetic groups. RESULTS: The 51 patients randomized to receive lidocaine did not differ markedly in age from the 49 patients randomized to receive no local anesthetic. Ease of obtaining CSF, as measured by number of attempts, did not differ with 59% of the patients in each group requiring 1 attempt. Defining a traumatic LP as more than 1000 x 10(6)/L red blood cells in the CSF showed notably more traumatic LPs in the lidocaine-treated group. Defining a traumatic LP as one with more than 10,000 x 10(6)/L red blood cells in the CSF showed no significant difference in the number of traumatic LPs whether or not the patient was premedicated with lidocaine. The level of experience of the physician performing the LP did not affect the outcome. CONCLUSIONS: Premedication with lidocaine for an LP does not binder the ease of obtaining CSF. The clinical relevance of a greater number of traumatic LPs in the lidocaine-treated group is questionable because this finding is negated when traumatic is defined as more than 10,000 x 10(6)/L CSF red blood cells. Based on these results, we advocate premedication with a local anesthetic when an LP is performed in the pediatric emergency department.

Anesthetics, Local↗
PubMed1997

Direct right ventricular puncture for hemodynamic evaluation of a mechanical tricuspid valve prosthesis: a new indication for an old procedure.

The advent of transvenous right heart catheterization has relegated direct transthoracic right ventricular puncture largely to the role of "interesting historical footnote." However, in the case of a right ventricle that is "protected" by a mechanical tricuspid valve prosthesis, direct right ventricular puncture represents a reasonable alternative for obtaining accurate hemodynamic information.

Adult↗
PubMed1998

Summary of the Mayo Clinic experience with direct left ventricular puncture.

Hemodynamic assessment of patients with prosthetic valves can be challenging. Noninvasive techniques may be limited by interference from the prosthetic material, whereas access to the left ventricle for direct pressure measurements often is not possible using common methods. The technique of direct, percutaneous left ventricular puncture has been proven to be a safe method that often provides needed data to help manage difficult clinical situations. We report our 8-yr experience with this technique for assessment of patients with valvular prostheses. Direct left ventricular puncture is a safe technique in patients with prior cardiac surgery and provided significant diagnostic information in the set of patients with multiple valvular prostheses.

Aortic Valve↗
PubMed2000

Left ventricular apical puncture: a procedure surviving well into the new millennium.

We report two patients with a history of prior mitral valve and aortic valve replacement with St. Jude prosthetic valves, who were referred for repeat valve replacement after noninvasive assessment was suggestive of prosthetic valve malfunction. Both patients were managed medically after evaluation with direct left ventricular apical puncture revealed normal hemodynamics in the first and mild aortic stenosis in the second patient. These two cases illustrate that, despite the advancements in the noninvasive evaluation of prosthetic heart valves, left ventricular direct puncture continues to have an important value in the evaluation of patients referred for repeat valve replacement, and it can prevent unnecessary surgeries associated with a high risk of morbidity and mortality. Cathet. Cardiovasc. Intervent. 49:68-73, 2000.

Aortic Valve↗
PubMed2000

Laser ablation of granulation tissue at the tracheoesophageal puncture site.

BACKGROUND: Tracheoesophageal fistula speech may be complicated by granulation tissue around the puncture site. Treatment includes antibiotics, antifungals, chemical or electrocautery, and surgical excision of the granulation tissue. Chemical cautery generally requires repeated treatment sessions. METHODS: We report our technique and results of CO(2) laser ablation of granulation tissue at the tracheoesophageal puncture site performed as an outpatient office procedure. RESULTS: Seven of 9 patients (78%) were cured with a single treatment. The prosthesis was replaced immediately after laser ablation of granulation tissue. Of the remaining 2 patients, 1 had a recurrence a year later, requiring repeated laser. The second patient had a large mass requiring 4 laser ablations. There were no complications. CONCLUSIONS: CO(2) laser has the following advantages compared with other methods of treating stomal granulation tissue: office procedure; 78% cured with single treatment; and the extent of tissue necrosis is predictable.

Aged↗
PubMed1992

Occult epidural chloroma complicated by acute paraplegia following lumbar puncture.

Acute paraplegia complicating lumbar puncture in a leukemic patient with an unsuspected epidural chloroma is described, including the postmortem findings. Lumbar puncture can precipitate irreversible injury to the spinal cord in the patient with an occult lesion causing subarachnoid block. This account, in addition to documenting this phenomenon, suggests a potential advantage to magnetic resonance imaging over myelography.

Acute Disease↗
PubMed1993

Oscillopsia and horizontal nystagmus with accelerating slow phases following lumbar puncture in the Arnold-Chiari malformation.

Oscillopsia and nystagmus began in a woman 2 weeks after an inadvertent lumbar puncture during anesthesia for childbirth. Examination showed horizontal-torsional jerk nystagmus in all positions of gaze. Magnetic-search-coil oculography revealed accelerating slow phases, with an increase in nystagmus amplitude in darkness. Magnetic resonance images showed type 1 Arnold-Chiari malformation. Three months after occipital decompressive surgery, nystagmus had almost disappeared. Accelerating slow phases should not be considered diagnostic of congenital nystagmus, especially with an onset of oscillopsia in adult life; imaging should be considered to exclude treatable hindbrain anomalies. Lumbar puncture in patients with the Arnold-Chiari malformation may accentuate craniospinal pressure dissociation and precipitate neurological signs.

Adult↗
PubMed2001

Early clinical experience with the 6 French Angio-Seal device: immediate closure of femoral puncture sites after diagnostic and interventional coronary procedures.

The objective of this study was to assess the early safety and efficacy of the novel 6 Fr Angio-Seal device for routine clinical use after diagnostic cardiac catheterization and coronary angioplasty. In a prospective study, we used the 6 Fr Angio-Seal device in 180 consecutive patients (131 male, 49 female, mean age 60.7 years) for closure of femoral arterial puncture sites immediately after diagnostic (n = 108) or interventional (n = 72) coronary procedures independent of the coagulation status. All patients were monitored for 24 hr after the procedure and followed for 30 days. The closure device was successfully deployed in 95.4% after diagnostic catheterization versus 98.6% after coronary angioplasty (P = 0.963). Immediate hemostasis was achieved in 91.5% versus 90.1% of the patients (P = 0.993). Major complications were observed 1.9% versus 2.8% of the patients (P = 0.885). During 30-day follow-up, no late events or complications were reported. The 6 Fr Angio-Seal device is a safe and effective device that allows for immediate closure of femoral puncture sites after both diagnostic and interventional procedures with a low rate of major complications.

Adult↗
PubMed1980

Safe transthoracic left ventricular puncture performed with echocardiographic guidance.

Retrograde aortic left ventricular pressure recording is difficult to obtain and often unreliable in the presence of a mechanical aortic valve prosthesis. Under echocardiographic guidance, we have safely performed transthoracic left ventricular puncture for pressure recording in seven patients with an aortic valve prosthesis. The transducer is placed at the left sternal border and then slid laterally until the right ventricular cavity and interventricular septal echoes disappear, but before the echoes from the left lung are recorded. The chest wall is marked and the transducer is angled until the mitral valve echoes are identified. The transducer angle and direction are recorded with external markers, and the left ventricular cavity depth is measured. An 18-gauge needle is then inserted the determined depth into the left ventricle, guided exactly by the echocardiographic external markers. The procedure was successful in each patient on the first attempt without a single complication. We conclude that this technique affords the operator greater control when left ventricular pressure must be recorded by transthoracic puncture and that it may reduce the risk of potentially serious complications.

Aortic Valve↗