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At least 973 records · Page 54Linked to original sources
PubMed2006

The effect of epidural needle type on postdural puncture headache: a randomized trial.

PURPOSE: A prospective, randomized trial in labouring parturients was undertaken to assess whether the 18G Special Sprotte epidural needle is associated with a lower incidence of accidental dural puncture (ADP) in comparison with the 17G Tuohy needle. A secondary purpose was to determine if the incidence of postdural puncture headache (PDPH ) differed between groups when ADP occurred. METHODS: Following Institutional Review Board approval 1,077 parturients requesting epidural analgesia at three tertiary obstetrical units were randomized to epidural catheter insertion with a 17G Tuohy or 18G Special Sprotte needle. Patients were followed for seven days by a blinded assessor to determine the occurrence of PDPH using standardized criteria. If postural headache or neck ache presented, an ADP was diagnosed even if cerebrospinal fluid (CSF) was not observed at insertion. This subgroup was followed daily to assess headache characteristics and response to blood patch. RESULTS: Six Tuohy group patients, and two patients in the Sprotte group were excluded. One of the six excluded in the Tuohy group had an ADP. Twenty-eight ADPs occurred, nine unrecognized by CSF visualization (1.8% Tuohy, 3.4% Sprotte, P = 0.12). The incidence of unrecognized ADPs was higher in the Sprotte group (40% Sprotte vs 20% Tuohy, P < 0.05). If ADP occurred, the incidence of PDPH was lower in the Sprotte group (100% Tuohy vs 55% Sprotte, P = 0.025). The ease of use, and user satisfaction were higher in the Tuohy group (84 +/- 17.3% Tuohy vs 68.2 +/- 25.3% Sprotte, P < 0.001). CONCLUSION: The incidence of ADP was not reduced with the Special Sprotte epidural needle in comparison with the Tuohy needle, but PDPH after ADP occurred less frequently in the Sprotte group.

Adult↗
PubMed1999

The Angio-Seal hemostatic puncture closure device. Concept and experimental results.

The Angio-Seal hemostatic puncture closure device is the culmination of development efforts dating from 1986. Development was driven to solve problems of delivering a multi-piece bioabsorbable puncture closure assembly through an introducer, the precise placement of the device in the vessel, the mastery of molding tiny absorbable polymer components, the manufacture of collagen hemostatic sponges having strong tear strength, and the testing of very large samples to establish safety and efficacy. Improvements included in the new 6F device to improve deployment reliability are also discussed.

Animals↗
PubMed1996

[Ultrasound guided puncture of the portal vein in transjugular intrahepatic portasystemic stent shunt (TIPSS)].

Successful completion of a transjugular intrahepatic portosystemic stentshunt (TIPSS) relies on knowledge of the individual hepatic vascular anatomy. The patients referred for TIPSS have an increased risk of contrast-medium-induced renal failure, and therefore the potential for a complete angiographic work-up during the procedure is limited. The same patient population also carries an increased risk of bleeding, which necessitates a rather accurate guiding technique for portal punctures. We have established transcutaneous sonographic guidance as a standard technique for transjugular portal puncture, reducing complication rates and intervention time. Competing imaging modalities for guidance are discussed.

Humans↗
PubMed2002

Cerebral venous and sinus thrombosis with cerebrospinal fluid circulation block after the first methotrexate administration by lumbar puncture.

We report a patient treated for small lymphocytic lymphoma/leukemia with cerebral venous and sinus thrombosis (CVST) after lumbar puncture with intrathecal administration of methotrexate (MTX). He also developed a cerebrospinal fluid flow block. This is the first report of an association between lumbar puncture and intrathecally administered MTX and the development of CVST. Intrathecal treatment in this patient was discontinued and he was successfully treated with high-dose low-molecular-weight heparin subcutaneously.

Antimetabolites, Antineoplastic↗
PubMedDate not supplied

Catheter dislodgement of percutaneous transhepatic biliary drainage: identification of role of puncture sites and catheter sheath.

BACKGROUND: To identify the appropriate puncture points in the bile duct to avoid catheter dislodgement. METHODS: Percutaneous transhepatic biliary drainage catheters (n = 300) were placed in 242 patients. The frequency of dislodgement (complete dislodgement or bending of the catheter) was prospectively investigated. The puncture site of the bile duct was classified on the ultrasonographic findings as follows: Main-B3, main branch of the lateral inferior segment; peripheral-B3, peripheral branch of the lateral inferior segment; B2, lateral superior segment; left hepatic duct, proximal portion of the left hepatic duct; B8, anterior superior segment; B5, anterior inferior segment; B5 + 8, main bile duct of the anterior segment; B6, bile duct of posterior inferior segment; and right hepatic duct, proximal portion of the right hepatic duct. RESULTS: When a catheter without an outer sheath was used, catheter dislodgement in peripheral-B3 (2/11, 18%) was more common than in main-B3 (0/32, 0%; p < 0.05). In B5, catheter dislodgement (6/12, 50%) was more frequent than in B8 (3/20, 15%; p < 0.05) and in B6 (0/14, 0%; p < 0.005). When a catheter with an outer sheath was used, catheter dislodgement (2/207, 1%) was rare. CONCLUSION: Drainage from B5 and peripheral-B3 is associated with a high risk of dislodgement of the catheter. A catheter with an outer sheath was useful to prevent catheter dislodgement.

Adult↗
PubMed2007

Effects of pyrrolidine dithiocarbamate on healing of colonic anastomoses in the cecal ligation and puncture model of intraperitoneal sepsis in rats.

INTRODUCTION: Pyrrolidine dithiocarbamate (PDTC) is a low-molecular thiol antioxidant and potent inhibitor of nuclear factor-kappaB (NF-kappaB) activation. In recent animal studies, the delaying effect of intraperitoneal sepsis on healing of colonic anastomoses has been demonstrated. In this study, we aimed to investigate the effects of PDTC on healing of colonic anastomoses in the presence of intraperitoneal sepsis induced by a rodent model of cecal ligation and puncture (CLP). METHODS: Anastomosis of the left colon was performed on the day following CLP in 30 rats that were divided into three groups: sham-operated control (laparotomy and cecal mobilization, group I, n =10), cecal ligation and puncture (CLP) (group II, n = 10), PDTC-treated group (100 mg/kg IV before construction of the colonic anastomosis) (group III, n = 10). On postoperative day 6, all animals were sacrificed, and anastomotic bursting pressures were measured in vivo. Tissue samples were obtained for further investigation of colonic anastomotic hydroxyproline (HP) contents, perianastomotic myeloperoxidase (MPO) activity, and malondialdehyde (MDA) and glutathione (GSH) levels. RESULTS: There was a statistically significant increase in the activity of MPO and MDA levels in the CLP group (group II) along with a decrease in GSH levels, colonic anastomotic HP contents, and bursting pressure values when compared to controls (group I). However, PDTC treatment led to a statistically significant increase in the tissue HP contents, GSH levels, and colonic anastomotic bursting pressure values, along with a decrease in MPO activity and MDA levels in group III (p < 0.05). CONCLUSIONS: This study showed that PDTC treatment significantly prevented the delaying effect of CLP-induced intraperitoneal sepsis on anastomotic healing in the colon. Further clinical studies are needed to clarify whether PDTC may be a useful therapeutic agent to increase the safety of the anastomosis during particular operations where sepsis-induced injury occurs.

Anastomosis, Surgical↗
PubMedDate not supplied

Use of a puncture needle for recanalization of an occluded right subclavian vein.

We report a patient in whom we used a puncture needle to initiate percutaneous recanalization of a chronic occlusion of the junction between the right subclavian vein and the right brachiocephalic vein. Under fluoroscopic guidance, an 18-gauge needle was used to puncture the right subclavian vein. When contrast material injected through the needle confirmed intravascular location, the needle was advanced until it deflected and perforated an occlusion balloon target positioned within the right brachiocephalic vein. This technique may be useful in patients with central venous occlusions that are refractory to traversal using traditional catheter and guidewire techniques.

Aged↗
PubMed2002

Subdural hematoma in two hematopoietic stem cell transplant patients with post-dural puncture headache and initially normal CT brain scan.

Subdural hematoma (SDH) is a rare complication in patients after lumbar puncture. We report two patients receiving hematopoietic stem cell transplantation (HSCT) who developed post-dural puncture headache (PDPH) and SDH following intrathecal methotrexate (MTX). Both patients initially had normal computed tomography (CT) scan findings at the onset of headache. The diagnosis was established only when a repeat CT brain scan was performed for deteriorating neurological signs coinciding with improving platelet counts. These cases demonstrate the importance of continued vigilance for the early recognition of this salvageable entity. A normal initial CT finding and platelet count do not exclude the occurrence of SDH. A repeat CT scan, or even magnetic resonance imaging (MRI), are indicated if the clinical suspicion remains strong.

Adult↗
PubMed1998

Incidence of post-lumbar puncture syndrome reduced by reinserting the stylet: a randomized prospective study of 600 patients.

The post-lumbar puncture syndrome (PLPS) can best be explained by prolonged spinal fluid leakage owing to delayed closure of a dural defect. Its incidence after spinal anaesthesia is much lower than after diagnostic lumbar puncture (LP). This difference could be caused by a strand of arachnoid, which might enter the needle with the outflowing cerebrospinal fluid (CSF) during diagnostic LP and upon removal of the needle be threaded back through the dura to produce prolonged CSF leakage. To find a technique that further reduces the incidence of PLPS, this hypothesis was tested by evaluating the effect that reinserting the stylet before removing the needle had on the incidence of PLPS. By reinserting the stylet to the tip of the needle, the hypothesized strand would be pushed out, thereby reducing the frequency of PLPS. Sprotte's "atraumatic needle" (21 gauge) was used for LP. A total of 600 patients participated in the prospective study. They were randomized into two groups and questioned about their complaints every day for up to 7 days after the LP. All LPs were performed by two experienced neurologists (T.B., M.S.). In 300 patients, the stylet was reinserted to the tip of the eedle; in the other 300 it was not reinserted. Whereas 49 of the 300 patients without reinsertion developed PLPS, only 15 of the 300 patients with reinsertion did. This significant difference (16.3 vs 5.0%, P < 0.005, chi square test) supports our hypothesis. On the basis of our results, we recommend reinserting the stylet before removing the needle in order to reduce the incidence of PLPS.

Adult↗
PubMed1991

Precision of skin prick and puncture tests with nine methods.

New devices for puncture tests have been proposed recently, but their precision by comparison to the prick test method is poorly known. Seven puncture tests (Allerprick, Morrow Brown standardized needle, Phazer, Pricker, Stallerpointe, Stallerkit, and Wyeth bifucated needle) were compared with the modified prick test performed with hypodermic or intradermal needles in eight carefully selected normal volunteers. Skin tests with histamine hydrochloride (10 mg/ml) were only performed when there was no factor that might interfere with their interpretation. The site of skin tests on the forearm was demonstrated not to significantly influence the reaction size. The coefficient of variation of the tests ranged from 8.4% to 21.7%. Modified skin prick tests are satisfactory since they are highly reproducible (coefficient of variation: 13.4% and 16.5%) and there is no subject effect. Phazet was found to be more reproducible without subject effect. Pricker is satisfactory since it has no subject effect and a reproducibility similar to that of modified prick tests. Other tests are less reproducible (Stallerkit or Morrow Brown) or vary between subjects (Allerkit, Stallerkit, Stallerpointe, and Wyeth Needle).

Adult↗
PubMed1989

Cranial puncture, a simple procedure requiring no preparatory surgery: validation by observation of drinking and salt appetite evoked by intracerebroventricular renin.

A non-surgical procedure, "cranical puncture" (CP), for pulse intracerebroventricular (p.i.c.v.) injection of solutions in adult rats is described. The injections are made by pushing a needle through the scalp and skull while the rats are under brief carbon dioxide narcosis from which behavioral recovery is rapid. The method was validated by comparing the effects of renin injected either by CP or through conventional chronic ventricular cannulas. Renin injections by either procedure evoked copious drinking of water (224 +/- 23 ml/24 h) and 3% NaCl (44 +/- 9.1 ml/24 h) at smaller doses than previously reported. Cranial puncture is proposed as a simple method of i.c.v. injection for behavioral experimentation in rats, and its advantages are discussed.

Animals↗
PubMed1993

Immediate sealing of arterial puncture sites after cardiac catheterization and coronary angioplasty using a biodegradable collagen plug: results of an international registry.

OBJECTIVES: The aim of this study was to evaluate the safety and efficacy of a biodegradable collagen plug that has been developed to reduce the arterial compression time required to achieve hemostasis at the arterial puncture site after diagnostic and interventional coronary procedures. BACKGROUND: After diagnostic and interventional coronary catheterization procedures, local arterial compression is required to achieve hemostasis and complications may ensue, especially in patients on full anticoagulation. METHODS: Between March 1991 and July 1991, 252 patients admitted for routine coronary angiography or angioplasty to four large hospitals received such a hemostatic device immediately after the procedure. Hemostasis was achieved with collagen in 87% of patients after a mean compression time of 4.8 min. Time to hemostasis was independent of the heparin load. A total of 54 hematomas (21%) was reported; all but 2 resolved without additional treatment. Two patients had a severe hematoma, requiring blood transfusion, and two patients required surgery to repair a pseudoaneurysm. During a follow-up period of 4 weeks no severe late complications were reported. CONCLUSIONS: We conclude that the collagen plug appears to be a safe device to achieve hemostasis at the arterial puncture site, independent of anticoagulation.

Adult↗
PubMed1987

Emergency department lumbar puncture: clinical application and utility of laboratory testing.

Lumbar puncture is an emergency department procedure for evaluating patients with suspected central nervous system infection or hemorrhage. To determine whether extensive testing of cerebrospinal fluid (CSF) obtained from emergency department patients was useful, charts of 104 adult patients who underwent lumbar puncture in a university hospital emergency department were reviewed. Examination of the CSF disclosed pleocytosis in 25 (24%) of the patients; the presence of red blood cells was considered to be clinically significant in two patients. An abnormal level of CSF protein was present in 62% of patients, and abnormal levels of glucose in 32%. Fungal element testing was negative each of the 72 times it was performed; Gram stain disclosed a bacterial pathogen in one patient. Cultures for fungus and tuberculosis were uniformly negative, as were all immunologic tests. Bacterial cultures grew a pathogen in one patient. No patient with a normal neurologic examination and normal initial CSF analysis was diagnosed subsequently as having acute central nervous system disease. The preponderance of negative or normal results of testing of CSF suggests that extensive testing may not be necessary for all patients. Limitation of sophisticated testing to only those samples with abnormal cell counts or chemistries or from patients at high risk should result in substantial cost saving without compromising patient care.

Adolescent↗
PubMed1991

Puncture technique and portals of entry for diagnostic and operative arthroscopy of the temporomandibular joint.

Cadaveric research, expansion of successful arthrography techniques, and improved understanding of normal anatomy, pathology, and open surgery have led to the development of safe, repeatable, and effective puncture techniques and portals of entry in the temporomandibular joint. Single and multiple punctures are described. Two-year outcomes of operative procedures with favorable results are presented for 145 joints in 95 patients. Complications are discussed.

Arthroscopy↗
PubMedDate not supplied

Pneumocephalus following the treatment of a postdural puncture headache with an epidural saline infusion.

We report a case of pneumocephalus following the attempted treatment of a postdural puncture headache by a continuous epidural saline infusion. Within 1 hour of infusion, symptoms of a severe headache, nausea, and vomiting prompted a computerized tomographic scan of the head that showed 12 to 15 ml of air in the cranium. The epidural space was located easily with the loss-of-resistance technique using 3 ml of air. A saline bolus and infusion were initiated after confirmation of correct placement of the epidural catheter. We suggest that air passed from the negative-pressure epidural space through the dural puncture created by the diagnostic spinal tap, producing a pneumocephalus.

Adult↗
PubMedDate not supplied

The frequency of postdural puncture headache in obstetric patients: a prospective study comparing the 24-gauge versus the 22-gauge Sprotte needle.

STUDY OBJECTIVE: To compare the frequency of postdural puncture headache (PDPH) in obstetric patients when using the 24-gauge or the larger 22-gauge Sprotte needle. DESIGN: Prospective, randomized study. SETTING: Four hospitals. PATIENTS: 375 ASA physical status I and II cesarean section and postpartum tubal ligation patients. INTERVENTIONS: Obstetric patients were randomly assigned to receive spinal anesthesia via a midline dural puncture using the 24-gauge or the 22-gauge Sprotte needle. MEASUREMENTS AND MAIN RESULTS: The rate of PDPH was determined by a postoperative visit by the anesthesiologist as well as questioning patients by telephone 1 week or more after discharge. In the 24-gauge Sprotte needle group (n = 186), 2 mild and 1 moderate PDPHs were reported, for an overall rate of 1.61%. In the 22-gauge Sprotte needle group (n = 189), 2 mild and 1 moderate PDPHs were reported, for an overall rate of 1.59%. All headaches except 1 resolved within 72 hours with conservative treatment. One patient from the 22-gauge Sprotte needle group required an epidural blood patch. There were no failed blocks in either group. CONCLUSIONS: Our results suggest that the 22-gauge Sprotte needle, when compared with the smaller 24-gauge Sprotte needle, can be used in obstetric patients without increasing the frequency of PDPH.

Adult↗
PubMed2005

Lumbar puncture needle length determination.

INTRODUCTION: Appropriate lumbar puncture (LP) needle length selection may be more difficult for less experienced practitioners or for patients who are of unusually large or small body habitus. The purpose of this study is to determine if there is a relationship between body height and weight, and the percutaneous depth to the spinal canal, which can more reliably assist in selecting an LP needle length. METHODS: This is a retrospective cohort study of patients who received an abdominal computed tomographic scan (for any reason) from July 1999 to December 2000. Lumbar puncture depth was measured on the computed tomographic scan and was used to derive a formula. RESULTS: The final data pool consisted of 175 patients, aged 25 days to 80 years, with height of 48 to 181.5 cm, weight of 3.0 to 127.3 kg, and body mass index of 11.7 to 49.7 kg/m2. Using this data set, the formula for predicting the required LP depth is (weight in kilograms, height in centimeters): LP depth (cm) = 1 + 17 x weight/height. Using linear regression comparing the skin to mid-spinal canal depth measurements with the calculated LP depths, R2 was 0.81 (P < .001). This formula selected a needle that was too short in 6% (less than that of 4 other previously published LP needle length selection methods) and a needle that was too long in 31%. CONCLUSION: Compared with other formulas, this formula might be a more reliable predictor for estimating the required LP needle length, but this must be validated by further studies. It should be noted that none of the formulas were perfect.

Adolescent↗