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At least 955 records · Page 53Linked to original sources
PubMed1989

Left heart catheterization by direct ventricular puncture: withstanding the test of time.

If retrograde arterial catheterization of the left ventricle fails because of a stenosed native or tissue valve or is contraindicated because of the presence of a mechanical aortic prosthesis, then alternative routes of access to the left ventricle are either transseptal or direct (transapical) left ventricular puncture. The transseptal approach is contraindicated in the presence of a mechanical mitral valve prosthesis. Under these circumstances we have used direct transapical left ventricular puncture in the treatment of 112 patients and have found this technique to be successful with little associated risk. A major complication occurred in 3% of the patients, but the study provided the required data in 95%, and these figures compare favorably with the reported results of transseptal catheterization.

Adult↗
PubMed1992

Initial experience with a new compression device for hemostasis after femoral arterial puncture.

We evaluated a new hemostasis device to maintain focused pressure over the femoral artery puncture site for 2-6 hours in 330 cases after diagnostic catheterization or coronary angioplasty. No patient developed later hematoma or vascular complications. The initial favorable experience suggests that this hemostasis device has advantageous features of stability and site visualization and is a suitable adjunct to current methods of maintaining puncture site pressure after brief manual compression following arterial catheterization.

Cardiac Catheterization↗
PubMed1993

Collagen plug hemostatic closure of femoral arterial puncture sites following implantation of intracoronary stents.

Recently a new adjunct to achieving arterial hemostasis has been developed. The device consists of a purified bovine collagen plug which when inserted adjacent to the arterial wall induces the formation of a hemostatic cap directly over the arterial puncture. We have utilized collagen plug hemostasis in 32 patients on 35 occasions undergoing implantation of intracoronary stents while attempting to maintain continuous full anticoagulation. Initial hemostasis was successfully achieved in all patients. Moderate sized (5 to 10 cm) hematomas were noted in 4 patients and large hematomas (> 10 cm) in 3, of whom 2 required vascular repair and transfusion. One patient developed a purulent discharge from the puncture site which resolved with a brief course of antibiotics. No patient suffered femoral arterial occlusion, distal embolization, or venous thrombosis. There were no long term access site problems at a mean follow up of 6 months. Repeat catheterization utilizing the same femoral artery was performed in 16 patients without difficulty. In five of these patients angiography was performed early after stent implantation without discontinuation of full anticoagulation and collagen closure was utilized a second time. Collagen plug hemostasis is feasible after coronary stenting, may allow more aggressive anticoagulation than might otherwise be achieved, and may facilitate angiographic restudy early after stenting without the need to discontinue anticoagulation.

Aged↗
PubMed1995

Left heart catheterization by direct puncture with two-dimensional echocardiographic guidance: a case report.

In patients with mechanical valves in both the mitral and aortic positions, direct ventricular puncture is the recommended approach to catheterization. We report a case in which two-dimensional (2D) echocardiography was used to guide left heart catheterization by direct ventricular puncture and propose that the use of 2D echocardiography might reduce the risks historically associated the procedure.

Cardiac Catheterization↗
PubMed2005

Transcatheter creation of atrial septal perforation using a radiofrequency transseptal system: novel approach as an alternative to transseptal needle puncture.

Indications for the transseptal approach to the left side of the heart have recently broadened, as it provides a therapeutic access for both left-sided catheter ablation and also percutaneous transvenous valvular intervention. Despite rising demand for transseptal procedures, the technique and device used for this purpose have remained essentially unchanged over the past 4 decades. The possibilities of failure of puncturing distorted and thickened atrial septal tissue or risks of complications related to cardiac perforation remain limitations of the technique. A new radiofrequency catheter provides an alternative approach to create a controlled transseptal perforation. We applied this technique to a series of patients and evaluated its feasibility as an alternative to conventional transseptal needle puncture.

Aged↗
PubMed1997

Rapid hemostasis of arterial puncture sites with collagen in patients undergoing diagnostic and interventional cardiac catheterization.

Despite the continuous reduction of sheath sizes in diagnostic and interventional cardiac catheterizations and the discontinuation of coumadin use after coronary stent implantation, a challenging role remains for hemostatic devices in the sealing femoral puncture sites. Since the introduction of the vascular hemostatic device (VHD) in 1991 and the hemostatic puncture closing device (HPCD) in 1992, numerous studies investigating these devices have been published. The deployment success rates reported in 2,292 patients for VHD is 97%, ranging from 88 to 100%. For HPCD, the mean deployment success rate resulting from 622 published patients leads to an identical result of 97%, ranging between 91 and 100%. For time to hemostasis, data have been analyzed according to the four different clinical situations, depending on level of anticoagulation (none or full) and the time of sheath removal (immediate or delayed). In randomized studies, when compared with the manual control groups, both devices revealed a statistically significant reduction in time to hemostasis: 12 to 16 minutes less for diagnostic catheterization and 14 to 30 minutes less for PTCA. As for minor local complications, no clinically relevant differences seem to exist. None of these devices has been proven to reduce major local complications. Prospective trials addressing early mobilization after percutaneous transluminal coronary angioplasty and the cost effectiveness of arterial closure devices in defined subgroups are warranted.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Embolization of a life-threatening mandibular vascular malformation by direct percutaneous transmandibular puncture.

Vascular malformations of the mandible are uncommon, but often present with significant hemorrhage. Transarterial vessel occlusion has become a valuable primary or adjunctive treatment for such lesions, as well as for most other symptomatic congenital and acquired head and neck vascular anomalies. Permanent embolic obliteration of the malformation requires placement of occlusive material directly into the nidus (core) of the lesion. Prohibitively complex proximal vasculature may prevent successful catheter positioning and lead to failure of traditional embolotherapy. Even optimal placement of arterial embolic material may fail to fully obliterate the nidus, allowing eventual restoration of flow to the lesion due to arterial recanalization. Under such circumstances it may be possible to obliterate the malformation and control lesional hemorrhage by occlusion of the malformation or its venous drainage by direct percutaneous mandibular puncture. In our case, multiple transarterial embolizations failed to sufficiently manage a symptomatic vascular malformation. Successful embolotherapy was performed via direct puncture of the venous side of the malformation through the mandibular cortex. Venous thrombosis induced concomitant occlusion of abnormal arteriovenous shunts, resulting in long-term control of life-threatening oral hemorrhage.

Arteriovenous Malformations↗
PubMedDate not supplied

Noninvasive measurement of the pressure of esophageal varices using an endoscopic gauge: comparison with measurements by variceal puncture in patients undergoing endoscopic sclerotherapy.

Measurements of variceal pressure with a noninvasive endoscopic pressure gauge and by direct variceal puncture were performed in 20 cirrhotic patients with portal hypertension in the course of the first session of therapeutic sclerotherapy following an episode of variceal bleeding. Endoscopic gauge measurements of the pressure of esophageal varices gave similar values (15.5 +/- 2.7 mm Hg) than measurements by variceal puncture (15.4 +/- 2.4 mm Hg; not statistically significant), and there was a highly significant linear correlation between both measurements (r = 0.9, p less than 0.001). Azygos blood flow, that was markedly increased in these patients (852 +/- 399 ml per min), was directly related to variceal pressure (r = 0.73, p less than 0.01). Variceal pressure was significantly lower than portal pressure (18.8 +/- 5.0 mm Hg) (p less than 0.05), indicating that measurements of variceal pressure cannot substitute measurements of portal pressure. The study demonstrates that the noninvasive endoscopic gauge technique allows an accurate estimation of variceal pressure in patients with portal hypertension. This technique may provide additional useful information in the evaluation of portal hypertension as well as on the mechanism of variceal bleeding.

Adult↗
PubMedDate not supplied

The sonographic appearance and contrast enhancement of puncture needles.

Investigations on the ultrasonic appearance of puncture needles in vitro and in vivo are reported. The images from the waterbath phantom correspond closely to those seen in the human body. The surfaces of smooth puncture needles reflect the ultrasonic beam so that, in most cases, the shaft is not visible. Surface roughnesses and small air bubbles enhance echogenicity and contrast of such needles. These roughnesses or inhomogeneities may be extraluminal or intraluminal. The phenomenon of the needle tip echo and its modifications are interpreted as physical and technical artifacts.

Contrast Media↗
PubMed2006

Use of recombinant factor VIIa prior to lumbar puncture in pediatric patients with acute leukemia.

The persistence of abnormal coagulation test results after standard treatment with fresh frozen plasma (FFP) poses significant problems in children with acute leukemia requiring a diagnostic lumbar puncture and intrathecal chemotherapy. We report the prophylactic use of a single dose of 90 microg/kg recombinant activated factor VII (rFVIIa) in three children and the rapid correction of abnormal coagulation test results previously not corrected by FFP. Administration of rFVIIa was useful in avoiding a delay of diagnostic lumbar punctures and intrathecal chemotherapy. Hemorrhagic complications and adverse effects of rFVIIa were not observed. Prospective evaluation of this indication and dose appears warranted. (c) 2005 Wiley-Liss, Inc.

Adolescent↗
PubMed2007

Intraspinal and intracranial hemorrhage after lumbar puncture.

Two cases of spinal epidural hematoma and two cases of intracranial subdural hematoma after lumbar puncture (LP) are reported in children receiving chemotherapy for acute lymphoblastic leukemia and non-Hodgkin lymphoma. The bleeding was asymptomatic but interfered with treatment in one case, and caused either severe backache or headache but no neurological deficit in the other three patients. The platelet counts were 8 and 46 x 10(9)/L in two patients and were normal in the other patients at the time of LP. All recovered without surgical treatment. There is an inherent, albeit uncommon, risk of bleeding into the central nervous system associated with LP in children with cancer and should be distinguished from postdural puncture headache (PDPH). Thrombocytopenia is not always an accompanying factor.

Adolescent↗
PubMed1988

Treatment of carotid-cavernous fistulas by embolization of the cavernous sinus through venous affluents or direct puncture.

Eight patients with nine carotid-cavernous fistulas (CCF), one of them bilateral, have been treated in our Department by embolization of the venous components of the cavernous sinus, either through one of its venous effluents or by direct puncture of the sinus, in an effort to preserve the internal carotid artery (ICA). Five of the fistulas were of traumatic origin and four were spontaneous. In two cases the cavernous sinus was embolized through bridging temporal veins, and in another two cases embolization was carried out by catheterization of the cavernous sinus via the superior ophthalmic vein, while in the remaining five cases it was performed by direct puncture of the lateral wall of the sinus. The embolizing materials employed were bone wax mixed with an oily iodised contrast media, small pieces of oxidized cellulose or gelfoam vehicled by saline solution, and fibrin sealant. Obliteration of the CCF was complete in all but one case, in which this was accomplished only partially. On six occasions carotid patency was maintained, while in two patients failure of the technique made trapping of the ICA necessary. In one patient the ICA was ligated prior to the embolization of the cavernous sinus. The surgical techniques employed and the results achieved are exposed.

Adult↗
PubMed1995

Percutaneous needle trephination for external CSF drainage: experience with 226 punctures.

We report on our experience with 226 percutaneous needle trephinations in a total of 192 consecutive patients. Trephination was performed with a hand-driven drill. A special puncture needle was inserted into the anterior horn of the lateral ventricle. The main indication for this procedure was the treatment of occlusive hydrocephalus in an emergency. Duration of drainage ranged from 1 to 34 days and was 7 days on the average. We encountered 14 cases of infection (6.2%) and one case of symptomatic bleeding (0.4%). All these complications eventually resolved without permanent sequelae. In our opinion, ventricle puncture with this device is a simple and effective method and can especially be recommended for external CSF drainage in cases of emergency.

Adolescent↗
PubMed1988

Incidence of post-lumbar puncture headache is independent of daily fluid intake.

The clinical practice of advising patients to increase their daily fluid intake after lumbar puncture in order to increase CSF production by re-hydration and thus try to prevent post-lumbar puncture headache (PLPH) has not yet been shown to be effective. In 100 patients the different effects of re-hydration on the incidence of PLPH (1.51 compared with 3.01 oral fluid per day over a period of 5 days) were tested prospectively. The incidence of PLPH was independent of the amount of fluid intake in both groups (18, 36%), as was the duration of PLPH. The physiology of CSF production and resorption suggests that PLPH is not a problem of CSF dynamics but a simple mechanical problem of how to close the dural rent and thereby stop the continuous leakage. It is no longer justifiable to advise patients to drink more than usual since there is no physiological or empirical basis for this and it does not seem to have even a placebo effect.

Adolescent↗
PubMed1985

Is obligatory bed rest after lumbar puncture obsolete?

After lumbar puncture (LP) an epidural CSF leakage caused by delayed closure of a dural defect leads to a decrease in CSF pressure. The resultant venous dilatation as well as downward shift of the brain with traction on pain-sensitive blood vessels and nerves frequently evokes post-lumbar puncture headache (PLPH), when the patient assumes the upright position. In previous studies differing opinions have been expressed about the prophylactic value of the posture taken by the patient after LP. The present study was designed to evaluate the benefit of the decrease of hydrostatic CSF pressure on the dural rent, when the patient lies down in a prone position with the head tilted down at an angle of 10 degrees for 30 min immediately after LP: is it possible to accelerate the closure of the dural defect in this way and prevent PLPH? One group of patients (n = 78) lay in a prone position with the head tilted down at an angle of 10 degrees for 30 min, the other group (n = 82) rose immediately after LP. PLPH was found to be independent of the posture in both groups and affected 44% and 41% of the patients, respectively, so that there is no longer any justification for requiring patients to remain in bed after LP.

Adolescent↗
PubMed1980

Ultrasound-guided puncture of the subclavian vein.

The localisation of arteries or veins is facilitated by the use of an ultrasound Doppler unit. This method has proved particularly valuable when dealing with deep lying vessels which are neither visible nor palpable. Until recently, such vessels had to be punctured blindly. This technique employs the Doppler ultrasound-method, which is especially used in the diagnosis of diseases of the peripheral vessels. There also not only useful for the localisation but able to assist the puncture of the vessel.

Humans↗
PubMed1998

Postdural puncture headache after spinal anaesthesia in young orthopaedic outpatients using 27-g needles.

PURPOSE: Two large studies reported a very low rate (0.5-1.8%) of postdural puncture headache (PDPH) with the use of 27-G spinal needles. We suspected that it might be higher in young ambulatory patients. The purpose of this study was to establish the rate prospectively in such a patient population using two types of needles. METHODS: Two hundred male and female, outpatients, 18-45 yr, undergoing knee arthroscopy under spinal anaesthesia were randomly assigned to receive spinal anaesthesia with hyperbaric lidocaine 5% using either a Quincke or a Whitacre 27-G needle. Twenty patients choosing general anaesthesia formed a comparative group. Using a previously validated questionnaire, the incidence and nature of PDPH were evaluated by telephone three to five days after surgery by an anaesthetist unaware of the anaesthetic technique used. Once all data were collected, an anaesthetist not involved in the study determined in a blinded fashion which headaches were likely to be PDPH. Grading and classification of headaches were based on several criteria: postural nature, duration, intensity and confinement to bed. RESULTS: The overall incidence of PDPH in both spinal groups was 9.3%. The incidence in women, 20.4%, was higher than in men, 5.5%, (P < 0.05). Only one patient required a blood patch. Both types of needle were comparable with respect to the incidence, severity and duration of PDPH, number of dural punctures and failed spinal blocks. CONCLUSION: The rate of PDPH was higher than in large published studies with 27-G Quincke and Whitacre needles and greater in women than in men.

Adolescent↗
PubMed1999

Increased risk of unintentional dural puncture in night-time obstetric epidural anesthesia.

PURPOSE: To evaluate the experience of the operator and the time of epidural anesthesia as factors contributing to unintentional dural puncture (UDP). METHODS: In a prospective analysis of recorded cases of UDP the following variables were recorded: maternal height, weight, and weight gain, type of personnel providing epidural analgesia, number of attempts, and hour of the epidural procedure. Work time was divided into day-time (8 AM to 7 PM) and night-time (7 PM to 8 AM), according to the change of coverage of the delivery suite. Night-time was divided into first (7 PM to midnight) and second parts (midnight to 8 AM). Relative risk was used to compare the incidence of UDP among different work-times. RESULTS: A total of 1489 consecutive epidural procedures were considered. The incidence of dural puncture was 0.8% (12 cases). The relative risk was higher for night-time than day-time (risk ratio 6.33; 95% confidence interval, 1.39 to 28.80; P = 0.006). Seven cases were caused by three operators with poor expertise, and five by two skilled obstetric anesthesiologists. CONCLUSION: Operator experience and hour of procedure appear to be two important risk factors of UDP The increased risk of UDP in night-work could result from human factors such as fatigue, sleep deprivation or interruption.

Adult↗