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At least 1,009 records · Page 56Linked to original sources
PubMed1995

Voice failure after tracheoesophageal puncture: management with botulinum toxin.

Primary or secondary tracheoesophageal puncture with a speaking prosthesis has provided rehabilitation of speech in most patients after total laryngectomy. Persistent constrictor spasm is thought to be responsible for a small percentage of these patients' inability to speak with the prosthesis. Management of these patients has included bougienage and pharyngeal myotomy and/or pharyngeal neurectomy. Botulinum toxin injections of the cricopharyngeus muscle complex in six patients have been successfully used diagnostically and therapeutically for tracheoesophageal puncture failures. The assessment, technique, and results are discussed.

Aged↗
PubMed1993

Post-dural-puncture headache: characteristics, management, and prevention.

Post-dural-puncture headache is a common complication after both diagnostic and therapeutic procedures. Prompt recognition of the clinical syndrome, followed by supportive and corrective actions, can decrease the morbidity in those afflicted. The most useful preventive measure during dural puncture in adult patients is the use of smaller cannulae with the bevel aimed parallel to the long axis of the spine.

Adolescent↗
PubMed1994

[Arterial puncture in Spain. A follow-up of the SEPAR 1987 guideline. Sociedad Española de Neumología y Cirugía Torácica].

This study sought to evaluate the procedures used for measuring arterial gases in our hospitals and determine the level of compliance with the 1987 SEPAR guidelines. Questionnaires covering the obtention, transport, storage and analysis of samples, as well as familiarity with the guidelines were distributed to 150 pneumology, internal medicine, intensive care and emergency services; 78 centers responded (71% from pneumology departments). General information obtained was as follows: arterial puncture is carried out by nurses without anesthesia and using syringes for gases; the radial artery is used; with post-puncture pressure provided by the patient; the sample is analyzed within 15 minutes and cold storage is used. The department's own automatic analyzer is used. Buffered gases and solutions are used for calibration and quality control measures are rare. Some aspects of the guidelines are unfamiliar. We believe that an effort should be made to extend application of the guidelines in order to improve arterial blood gas analysis.

Arteries↗
PubMed2001

[Early deambulation following cardiac catheterization by the use of 6 Fr Angio-Seal, a new hemostatic percutaneous puncture closure device].

INTRODUCTION AND OBJECTIVES: Efficacy of the hemostatic puncture closure 8 Fr Angio-Seal device for percutaneous puncture closure after a catheterism has been previously demonstrated, but the experience provided has been obtained with 8 Fr devices. At present the device has been modified and its size reduced to 6 Fr. In this pilot study we evaluate the efficacy of the new hemostatic 6 Fr Angio-Seal device and its safety when early deambulation post-diagnostic and/or therapeutic catheterization is established. PATIENTS AND METHODS: Prospective study of 150 consecutive patients randomized either for application of the 6 Fr Angio-Seal device (group A; n = 75), in which early ambulation was indicated, or manual compression (group B; n = 75), with ambulation 12 h after cardiac catheterization. Basal data, including clinical and angiographic characteristics and previous treatment with heparin and platelet aggregation inhibitors were similar in both groups. RESULTS: The time of hemostasia was significantly shorter in group A than in group B (118 +/- 210 s in A vs 1320 +/- 370 s in B; p (3/4) 0,001), and with early ambulation (3,1 +/- 0,4 h in A vs 12,3 +/- 3,1 h in B; p (3/4) 0,001) no local complications were observed. CONCLUSIONS: The 6 Fr Angio-Seal hemostatic device diminished the hemostasia time and early ambulation could be achieved. In this pilot study no complications due to early movilization were observed, but the safety of the new hemostatic device after diagnostic or therapeutic catheterizations needs to be evaluated in greater series.

Absorbable Implants↗
PubMed1999

Hemostasis of punctured vessels using Doppler-guided high-intensity ultrasound.

The use of Doppler ultrasound was investigated to determine if it would aid in guiding the application of high-intensity focused ultrasound (HIFU) to stop bleeding from punctured vessels. Major vessels (abdominal aorta, illiac, carotid, common femoral and superficial femoral arteries and the jugular vein) were surgically exposed, punctured and treated in anesthetized pigs. Treatment was applied when the Doppler sounds indicated the focus coincided with the bleeding site. In 89 treatment trials, the average time to achieve major hemostasis (a point where bleeding was reduced to a level of only oozing) was 8 s, and for complete hemostasis was 13 s. These times were significantly shorter than those of an identical former study in which only visual guidance was used. In that study, the average times for major and complete hemostasis were 40 and 62 s, respectively. The advantage of Doppler guidance in applying HIFU in treating bleeding vessels was demonstrated.

Animals↗
PubMed2002

Abducens palsy after lumbar puncture.

OBJECTIVE: We report the case of a 43-year-old patient with neuralgic shoulder amyotrophy who developed abducens palsy on the left 4 days after diagnostic lumbar puncture (LP), which recovered completely within 4 months. RESULTS: Side effects after spinal tap are due to prolonged spinal fluid leakage and delayed closure of a dural defect causing intracranial hypotension. Downward 'sagging' of the brain and traction on cranial nerves may lead to abducens palsy. This case and a review of the literature illustrate the higher risk with the use of large-size traumatic needles in LP for cranial sixth nerve palsies. CONCLUSION: The presented case emphasizes the use of atraumatic small-size needles for lumbar puncture.

Abducens Nerve Diseases↗
PubMed2003

Iatrogenic spinal epidermoid tumor. A complication of spinal puncture in an adult.

A case of an intraspinal epidermoid tumor following a lumbar puncture (LP) is described. This tumor developed 5 years after a LP in a man aged 31 years. The majority of epidermoid tumors reported are late complications of spinal puncture during the early neonatal period. To the best of our knowledge, this case is the third oldest patient, whose symptoms presented relatively early after the initial LP. He was successfully treated by surgery. Pathologic diagnosis revealed an epidermoid cyst. The relation between LP and epidermoid tumor and the possible risk factors involved are discussed.

Adult↗
PubMed2002

A procedure for direct lumbar puncture in rats.

We have set out to establish a fast, simple and innocuous method for repeatedly obtaining cerebrospinal fluid (CSF) samples from rats that are undergoing different experimental procedures or suffering pathological conditions. Here, we report a method that has been optimized to repeatedly collect 30-50 microl of CSF in rats by direct lumbar puncture using a procedure that generally takes 15-20 min to perform and presents very little hazard to the animal. The rats are anaesthetized with isofluorane and placed on a board in such a way that the spine is curved at the level of the L3-L5 vertebrae. After performing a small incision in the skin of the back, a neonatal lumbar puncture needle is introduced into the intrathecal space and CSF is passively collected in the needle cup (facilitating maneuvers are described herein). Moreover, we have further adapted this method to permit the intrathecal delivery of pharmacological agents and cell suspensions. In such experiments, behavioral tests can be conducted 10-15 min after the intrathecal injection and the activity of the implanted cells can be assessed by sampling lumbar CSF at later times.

Animals↗
PubMed2004

Anterior stromal puncture for recurrent corneal erosion after laser in situ keratomileusis.

A 55-year-old woman had bilateral laser in situ keratomileusis (LASIK). An epithelial defect was observed in the left eye after the flap was cut. Postoperatively, the patient developed recurrent corneal erosion in the left eye related to the traumatic epithelial defect sustained during LASIK. The erosion led to secondary diffuse lamellar keratitis (DLK). Anterior stromal puncture was required to treat the erosion after conventional treatment failed. The secondary DLK resolved quickly after the erosion healed, without the need for topical corticosteroids. Anterior stromal puncture may be a useful treatment for recurrent corneal erosions that do not respond to conventional therapy.

Corneal Diseases↗
PubMed1997

MRI meningeal enhancement with intracranial hypotension caused by lumbar puncture.

A 12-year-old girl with recent history of pseudotumor cerebri developed severe postural headache due to intracranial hypotension after lumbar puncture. Meningeal enhancement and thickening were demonstrated on magnetic resonance imaging. Repeated imaging 3 months later disclosed no abnormalities. This is the first report of a child with evident meningeal enhancement on magnetic resonance imaging related to lumbar puncture.

Child↗
PubMedDate not supplied

MRI findings in lumbar puncture headache syndrome: abnormal dural-meningeal and dural venous sinus enhancement.

Intracranial hypotension (IH) is a treatable cause of persistent headaches. Persistent cerebrospinal fluid (CSF) leak at a lumbar puncture (LP) site may cause IH. We present postcontrast MRI of a patient with post-lumbar-puncture headache (LPHA) showing abnormal, intense, diffuse, symmetric, contiguous dural-meningeal (pachymeningeal) enhancement of the supratentorial and infratentorial intracranial dura, including convexities, interhemispheric fissure, tentorium, and falx. MRI also showed abnormal dural venous sinus enhancement, a new finding in LPHA, suggesting compensatory venous expansion. Thus, IH and venodilatation may play a role in the development of LPHA.

Adult↗
PubMed1996

[Pain in lumbar puncture. Results of a 2-year discussion at the French Society of Pediatric Oncology].

BACKGROUND: Lumbar puncture is a common procedure in pediatric onco-hematology. Repeated invasive painful procedures may contribute to increase distress displayed during medical treatment, and cause regression, depression and other psychological disorders. MATERIAL AND METHODS: A two-year workshop of the Société française d'oncologie pédiatrique was reviewed through a questionnaire assessing changes in technical management of lumbar puncture, local anesthesia, sedation and cognitive-behavioral interventions. RESULTS: Significant changes were found for pain assessment, local anesthesia procedures, and nitrous oxide administration. The extensive use of the Emla cream largely contributed to reduce pain. Anxiety however remained an unsolved problem, particularly among young children. CONCLUSION: Pain in pediatrics remains a major challenge. This workshop is a model of reflexion to achieve a better management of pain during invasive medical procedures.

Anesthetics, Local↗
PubMed2000

Direct graft puncture with use of a crossed catheter technique for thrombolysis of peripheral bypass grafts.

PURPOSE: To determine the efficacy and safety of direct graft puncture of peripheral arterial bypass grafts with placement of retrograde and antegrade catheters within the graft for thrombolytic therapy. This study also evaluated potential clinical benefit to patients. MATERIALS AND METHODS: A retrospective study was performed on 19 patients with 24 peripheral bypass grafts and lower extremity ischemia of less than 1 month duration. Thrombolysis was performed with a continuous high-dose infusion of urokinase. Successful lysis was defined as greater than 95% clot dissolution with antegrade flow within the graft. RESULTS: Technical success was achieved in 17 of 19 patients (89%). The complexity of operative intervention was diminished in 12 of 19 patients (63%). The major complication rate (16%) was significantly higher and, therefore, this technique has a role for patients in whom traditional access is not optimal, such as in those in whom access cannot be achieved or in those with long bypass grafts. CONCLUSION: Direct graft puncture with placement of catheters across the proximal and distal anastomoses of bypass grafts is a safe method of access, with a major complication rate similar to conventional access techniques. This mode of graft access demonstrates efficacious thrombolysis and acts as a conduit for ancillary procedures.

Aged↗
PubMed2000

Sparfloxacin for the treatment of acute bacterial maxillary sinusitis documented by sinus puncture.

PURPOSE: To evaluate the efficacy and safety of sparfloxacin in the treatment of patients with acute bacterial maxillary sinusitis, the microbiologic etiology of which was determined by maxillary sinus puncture. PATIENTS AND METHODS: Two hundred fifty-three patients enrolled in the open, noncomparative trial received sparfloxacin as a 400-mg loading dose followed by 200 mg once daily doses for a total of 10 days. One hundred ninety-eight patients were clinically evaluable and 82 were also bacteriologically evaluable. All treated patients were included in the safety analysis. Overall success was determined based on clinical success (resolution or reduction of signs and symptoms and sinus x-rays) and bacteriologic success (eradication and presumed eradication of baseline pathogens obtained by maxillary sinus puncture and aspiration). RESULTS: Overall success in the bacteriologically evaluable population at test-of-cure was 91.5% [75/82; 95% confidence interval (85.4%, 97.5%)]. For all pathogens, the eradication rate was 93.2% (109/117 baseline pathogens); individual pathogen eradication rates were 88.9% (16/18) for S. pneumoniae (including those strains exhibiting decreased susceptibility to penicillin); and 100% for H. influenzae (17/17), S. aureus (14/14), and M. catarrhalis (11/11). The majority of adverse events were of mild or moderate severity; the most frequently related adverse events were photosensitivity reaction, headache, nausea, and diarrhea. CONCLUSION: Sparfloxacin had an overall success rate of 91.5% for patients in this study and was generally well tolerated in the treatment of acute bacterial maxillary sinusitis.

Acute Disease↗
PubMedDate not supplied

The influence of the menstrual cycle in postdural puncture headache.

BACKGROUND AND OBJECTIVES: We performed a preliminary study to analyze the influence of the menstrual cycle on the incidence of postdural puncture headache (PDPH). METHODS: One hundred sixty female patients with regular menstrual cycles who received spinal anesthesia were observed. Based on the day within the menstrual cycle that they received the puncture, the patients were classified into period A (perimenstrual) or period B (postmenstrual). The possible relationship among headaches, lifestyle habits, and anesthetic technique, and the presence of PDPH were analyzed, as were the levels of female sex hormones with PDPH in comparison with a control group. RESULTS: Seven cases of PDPH (4.3%) were observed--one within the perimenstrual group and six in the postmenstrual group. No significant differences were observed between the two periods or were there any differences in relating PDPH to the other variables analyzed. CONCLUSIONS: According to our results, the menstrual cycle and hormonal levels may not have any influence on the appearance of PDPH in female patients, although a larger series is required to validate these results.

Adult↗
PubMed1991

Tracheo-oesophageal puncture without tears: the forceps technique.

Certain problems have been encountered using a rigid endoscopic technique for tracheo-oesophageal puncture in voice restoration following laryngectomy. An alternative method is described using a modified curved abdominal forceps which allows quicker and more predictable access to the puncture site.

Humans↗
PubMed1994

Technique of tracheo-oesophageal puncture under local anaesthesia.

Various techniques for performing a secondary tracheo-oesophageal puncture to enable insertion of a speech prosthesis in laryngectomized patients have been described. We describe a modification that allows a safe secondary tracheo-oesophageal puncture under local anaesthesia using standard equipment available in an ENT department.

Anesthesia, Local↗