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PubMed1995

Flexible endoscopic tracheo-oesophageal puncture under local anaesthetic.

Blom-Singer valve prosthesis is an increasingly popular technique for voice rehabilitation in alaryngeal patients. Although primary voice puncture is being practised, the creation of the tracheo-oesophageal fistula is performed in the majority of patients as a secondary procedure. We describe a technique of secondary tracheo-oesophageal puncture using the flexible endoscope which can be performed under local anaesthetic and sedation. The technique overcomes the difficulty of passing a rigid oesophagoscope or forceps to the level of the tracheostome in a scarred and irradiated neck. The new technique also obviates the need for general anaesthesia. We have successfully used the technique in three patients.

Anesthesia, Local↗
PubMed2002

Treatment of intracranial hypertension and aspects on lumbar dural puncture in severe bacterial meningitis.

BACKGROUND: Brain stem herniation due to raised intracranial pressure (ICP) is a common cause of mortality in severe bacterial meningitis, but continuous measurements of ICP and the effects of ICP-reducing therapy in these patients have, to our knowledge, not been described. METHODS: During a four-year period, an ICP-monitoring device was implanted in patients admitted to our hospital with severe bacterial meningitis and suspected intracranial hypertension. ICP above 20 mmHg was treated using the Lund Concept, which includes antihypertensive therapy (beta1-antagonist,alpha2-agonist), normalization of the plasma colloid osmotic pressure and the blood volume, and antistress therapy. RESULTS: ICP above 20 mmHg was found in all 12 patients studied. It was effectively reduced in all but two patients, who died. Both patients had a low cerebral perfusion pressure (<10 mmHg), dilated pupils at start of therapy and were beyond recovery. Radiological signs of brain swelling were present in only five patients. Seven patients recovered fully, while mild audiological impairment was observed in two and minor neurological sequelae in one patient. Eight patients showed signs suggesting imminent brain stem herniation before start of ICP-reducing treatment, seven of whom had been subjected to diagnostic lumbar dural puncture shortly before development of the brain stem symptoms. These symptoms gradually regressed after initiation of therapy, and in one patient reversal of brain stem herniation was documented by MRI. CONCLUSIONS: Severe bacterial meningitis can be associated with increased ICP, which can be reduced using the Lund Concept. The high survival rate, the low frequency of sequelae and the reversal of signs of imminent brain stem herniation in these high-risk patients indicated beneficial effects of the intervention. The study confirms earlier observations that lumbar dural puncture is potentially hazardous in patients with intracranial hypertension, because it may trigger brain stem herniation. A normal CT brain scan does not rule out intracranial hypertension.

Adolescent↗
PubMed2001

Perils and pitfalls of lumbar puncture in the emergency department.

Lumbar Puncture is a procedure commonly performed in the emergency department. It provides important diagnostic information but has a significant number of limitations and complications. This article reviews the role of lumbar puncture in the emergency department based on an extensive review of the current literature, focusing on the recognized contraindications and complications of the procedure and how they can be minimized. The interpretation of diagnostic tests performed on cerebrospinal fluid is also examined, highlighting those tests most commonly ordered from the emergency department.

Central Nervous System Diseases↗
PubMed2001

Intralesional cryosurgery using lumbar puncture and/or hypodermic needles for large, bulky, recalcitrant keloids.

BACKGROUND: Keloids are notoriously difficult to treat. A variety of treatment modalities are currently in use, indicating that none is totally satisfactory. Surface cryosurgery is effective for smaller keloids, but not for larger ones. It often results in widespread depigmentation over the surface of the keloids, which may not be desirable, especially in patients with dark skin. OBJECTIVES: To determine the efficacy of intralesional (IL) cryosurgery in large, bulky keloids unresponsive to IL steroids, and to observe the extent of depigmentation and other complications produced by the technique. METHODS: Twelve patients with large, bulky, symptomatic keloids unresponsive to at least five injections of IL triamcinolone acetonide were included in the study. The age of the patients and the duration of the keloids were in the range 19-50 years and 1-12 years, respectively. The IL cryosurgery device was assembled using a small liquid nitrogen Dewar cylinder, a rubber and a plastic tube taken from a drip-set, adhesive tape, and hypodermic and lumbar puncture needles. The lumbar puncture or injection needle was introduced through the lesion until it appeared at the other side. Liquid nitrogen was then passed through the needle. The freezing time was between 20 and 30 s. The procedure was repeated for a second freeze-thaw cycle in the same session. RESULTS: The patients underwent a minimum of five up to a maximum of 10 sessions of IL cryosurgery. Seven out of 12 patients showed > 75% flattening. Depigmentation was observed along the tracks of the needles in all the patients, which improved during follow-up due to pigment spread from the normally pigmented areas in between. At the end of follow-up, 1-25% of the area remained hypo- or depigmented in four patients, 26-50% in six patients, and 51-75% in the remaining two patients. CONCLUSIONS: IL cryosurgery should be the preferred mode of therapy for large, bulky keloids, which are unresponsive to IL steroids.

Adult↗
PubMed2000

The effect of repeated follicular puncture on ovarian function in dairy heifers.

Three dairy heifers were examined during three consecutive oestrous cycles (control period, CP). Subsequently, the animals were subjected to 4 and then 5 weeks of twice-weekly ovum pick-up (OPU) (FPP1 and FPP2, respectively) with a recovery period (RP) of two consecutive oestrous cycles between FPP1 and FPP2. After FPP2, the animals were slaughtered and the ovaries were macroscopically examined. Throughout, ovarian activity was monitored by transrectal ultrasonography and concentrations of plasma progesterone. During CP, all the heifers showed normal cyclicity. During FPPs, the heifers occasionally presented oestrous activity. Corpus luteum (CL)-like structures developed from punctured follicles with diameters and life-spans varying from smaller and shorter than those in the CP (P > 0.05) to equal to those in the CP. There was a tendency for a lower number of emerging and punctured follicles in the presence of a CL-like structure. Subsequently to FPP1, all heifers regained normal cyclicity. A thickening of the ovarian tunica albuginea and a slight hardening of the ovaries were found postmortem. In conclusion, dairy heifers can occasionally show cyclic activity and form CL-like structures during twice-weekly OPU. Further, OPU did not seem to cause any major negative effects on ovarian structure and subsequent ovarian function.

Animals↗
PubMed1998

The use of lumbar puncture and laboratory tests for sepsis by Australian neonatologists.

OBJECTIVE: To ascertain the current use of lumbar puncture (LP) and laboratory tests for possible or suspected sepsis by Australian neonatologists. METHODS: A self administered anonymous response questionnaire. RESULTS: Sixty-nine (73%) of 94 neonatologists responded. None performed LP routinely in preterm infants with respiratory distress syndrome (RDS) or asymptomatic term infants with maternal Group B streptococcus (GBS) colonisation. One (1.6%) performed LP in term infants with respiratory distress, and only 35 (51%) performed LP in preterm infants with suspected late-onset sepsis (LOS). Twenty-one percent did not perform LP on all preterm infants with RDS and septicaemia and 24% did not perform LP on all preterm infants with late-onset septicaemia. Sixty-six percent and 85% did not perform LP for laboratory evidence suggestive of sepsis in preterm infants with RDS and preterm infants with LOS, respectively. Forty-nine percent investigated asymptomatic term infants with maternal GBS colonisation. CONCLUSIONS: Lumbar puncture and laboratory tests for possible or suspected sepsis are not used uniformly by Australian neonatologists. The presently available information in the scientific literature is ambiguous and systematic review and further scientific study are required to determine best practice guidelines.

Australia↗
PubMed1988

Post-lumbar-puncture headache: the significance of body posture. A controlled study of 300 patients.

In this single-blind, randomized study of post-lumbar-puncture headache (PPH) in 300 neurologic inpatients the significance of body posture after lumbar puncture (LP) was evaluated. Immediate mobilization was compared with bed rest for 6 h (3 h prone followed by 3 h supine posture). Contrary to the widely held belief, this investigation did not show significant differences between recumbent and ambulant patients as to frequency of PPH in the total material (39% versus 35%) or when men (31% versus 29%) and women (48% versus 41%) were evaluated separately. Headache associated with nausea was significantly more frequent in the recumbent than in the ambulant patients both in the total material (23% versus 13%) and in women (35% versus 16%). Thus, immediate mobilization seems to be preferable after LP.

Adolescent↗
PubMed1989

The significance of age, sex, and cerebrospinal fluid pressure in post-lumbar-puncture headache.

In this study of 300 neurological inpatients aged between 18 and 60 years the incidence of post-lumbar-puncture headache (PPH) was 37.3%. The more severe the headache, the more frequently it was associated with dizziness, nausea, vomiting, and tinnitus. If PPH occurred during the first day after lumbar puncture (LP), it was more severe, and lasted longer than PPH, which started later. The incidence of PPH and associated symptoms decreased with increasing age, and was much higher in females than males. The sex difference was nearly exclusively explained by a marked preponderance of PPH in females below 40 years of age, i.e. women in the fertile age. Furthermore, there was a decreased incidence of PPH and associated symptoms in patients with an initial higher than average cerebrospinal fluid (CSF) pressure (162 mm H2O). All these differences were statistically significant. Particularly high frequencies of PPH were found in young women with an initial CSF pressure lower than mean.

Adolescent↗
PubMed1990

Lumbar iohexol myelography and diagnostic lumbar puncture. Headache and associated side effects in relation to neurological signs and diagnosis, previous mental symptoms and pain history.

Various possible risk factors for postlumbar puncture (and postiohexol-myelographic) headache and associated side effects were analysed. Headache and nausea occurred significantly more often in patients without clinical findings than in those with findings. We found significantly different incidences of severe headache and nausea between diagnostic subgroups after a lumbar puncture. The greatest headache incidence was found in patients without a definite neurological diagnosis, while nausea occurred most frequently in patients with various painful disorders. Following iohexol myelography, nausea occurred most often in patients who had a history of previous mental symptoms and in patients with a history of previous headache disorders. Mental symptoms were more frequently reported in patients who also had experienced mental symptoms previously. The relationship between side effects and negative clinical findings was stronger than the relationship between side effects and previous mental symptoms.

Adult↗
PubMed2003

Site-selective atrial septal puncture.

Atrial transseptal puncture is a technique that provides pervenous access to the left heart. The aim of this technique is to provide catheter access to the left atrium and ventricle for mapping, as well as stable electrode-endocardial contact for ablation energy application. In the present report, "site-selective" atrial septal puncture is described and illustrated using case reports.

Adult↗
PubMedDate not supplied

Does primary tracheoesophageal puncture reduce complications after laryngectomy and improve patient communication?

The charts of 96 patients who had a laryngectomy at the University of Minnesota and affiliated hospitals were reviewed to assess the benefit of primary tracheoesophageal puncture (TEP). Patients were stratified into those with primary TEP and those without. There was no statistical difference in rates of esophageal stenosis, stomal stenosis, or wound breakdown without fistula. No fistulas developed in 33 patients who received primary TEP. 52% Of those with primary TEP, used their prosthesis for speech long-term. Only 5 of 63 patients whose surgery did not include primary TEP, received a secondary TEP, and only 2 retained the prosthesis for speech. There was no increased morbidity or incidence of complications after laryngectomy when performing a primary TEP. Patients will maintain the initial form of speech rehabilitation, even if it is less comprehensible. The early postoperative period is convenienced by using the puncture site as the entrance for nutrition during wound healing.

Communication↗
PubMed1996

[Ileus in late pregnancy--sequela of follicle puncture within the scope of in vitro fertilization?].

Complications in connection with the puncture in in-vitro fertilisation (IVF) occur normally relatively soon after the operation. This is a report on a patient in her 28th week of gestation, operated on by laparotomy for ileus. Retrospectively this acute event must be seen as a very rare late complication connected with the puncture. It must be stressed that patients should be informed about this eventually.

Abdomen, Acute↗
PubMed1981

[Lateral suboccipital puncture of the cisterna magna (author's transl)].

Lateral puncture of the cisterna magna cerebellomedullaris offers a more efficient conception of the lateral approach for the use of positive and negative contract medium in myelography and cisternography. The extracranial part of the cisterna magna cerebellomedullaris gives enough space to ensure the definite fixation of the needle without any major risk after puncture through the atlanto-occipital membrane. Positioning of the needles tip is possible without x-Ray control. Injury of the spinal cord is most unlikely to occur.

Cisterna Magna↗
PubMed1991

[Coronary angiography with a 5F catheter after percutaneous puncture of the right brachial artery. Technique and experience in 70 patients].

Out of a total of 1640 consecutive left heart catheterizations, 70 (58 males and 12 females; mean age 56 +/- 8 years) were performed via the right brachial artery, in most instances because of occlusive disease of the arteries in the pelvic region. 5F catheters were then successfully used for both the coronary and left-ventricular angiographies. Noninvasive examinations after two days (Doppler ultrasound, oscillography at rest and on exercise, acral plethysmography and colour-coded duplex sonography) revealed small haematomas in the region of the arterial puncture in four and a haemodynamically insignificant fistula between brachial artery and vein in one patient but no aneurysm, stenosis or thrombosis at the puncture site. This procedure is thus a valuable addition to invasive cardiological diagnosis.

Angiography↗
PubMed2003

Utility of the peripheral blood white blood cell count for identifying sick young infants who need lumbar puncture.

STUDY OBJECTIVE: We assess the utility of the peripheral blood WBC count as a screen for lumbar puncture among young infants evaluated for serious bacterial infections. METHODS: We performed logistic regression modeling and receiver operating characteristic curve analysis of peripheral blood WBC count and cerebrospinal fluid WBC count for results obtained from 3- to 89-day-old infants undergoing a full sepsis evaluation. RESULTS: Twenty-two of 5,353 (4.1 per 1,000) infants had acute bacterial meningitis. For diagnosing acute bacterial meningitis, the peripheral blood WBC count was poorly discriminating and significantly inferior to the cerebrospinal fluid WBC count. This was true both when the odds of meningitis were modeled to vary linearly and as a U-shaped function of the peripheral blood WBC count. When relying on single and interval-based high-risk thresholds of peripheral blood WBC counts alone, the majority of infants with acute bacterial meningitis would have been missed. CONCLUSION: Decisions to perform or withhold lumbar puncture should not be based on prevailing interpretations of the total peripheral blood WBC counts to maximize detection of bacterial meningitis in young infants.

Humans↗
PubMed2002

Maxillary sinus puncture and culture in the diagnosis of acute rhinosinusitis: the case for pursuing alternative culture methods.

OBJECTIVE: Traditional assessments of the microbial flora associated with acute bacterial rhinosinusitis have relied on maxillary sinus punctures (taps) and culture. These taps are now considered the gold standard for obtaining cultures and are used as the method of identifying bacterial pathogens in antimicrobial trials. Maxillary sinus taps are limited by discomfort to the patients and technical concerns. Because of these factors, the standard of performing taps has limited antibiotic trials and microbial surveillance. Alternatives to maxillary sinus taps have been explored. STUDY DESIGN: We conducted a retrospective, systematic review of the literature from 1950 to 2000 of articles comparing culture techniques in the nose and paranasal sinuses for acute bacterial rhinosinusitis. RESULTS: Nasal cultures have poor correlation to maxillary sinus cultures, whereas there is 60% to 85% concordance between endoscopically guided middle meatal cultures and maxillary sinus cultures. These studies, however, are all limited by small sample sizes and therefore are inadequate to make any concrete recommendations regarding the relative role of endoscopically guided middle meatal cultures as a formal method of pathogen identification in acute bacterial rhinosinusitis. CONCLUSION: A formal prospective study with sufficient sample size to assess the concordance between the microbial flora of the maxillary sinus punctures and middle meatal cultures in acute rhinosinusitis is recommended.

Acute Disease↗
PubMed1982

Suprapubic bladder puncture in a private pediatric practice.

Suprapubic bladder puncture was performed 185 times in 126 girls in a private pediatric practice. Cultures of urine obtained by aspiration confirmed symptoms as indicative of urinary tract infection in 59% of instances and confirmed positive cultures of urine obtained by voiding in 57% of instances. Since suprapubic bladder puncture avoids the problem of contamination, it enables a certainty in diagnosis that voided specimens cannot. The procedure was easily accomplished in the office and was readily accepted by parent and child. No complications were observed.

Adolescent↗
PubMed1986

Lumbar puncture. Technique, indications, and complications.

Lumbar puncture is a safe and simple procedure that can be performed with little risk of major complication if proper technique and indications are followed. As an emergency diagnostic procedure, spinal puncture is indicated when CNS infection is suspected or to establish the diagnosis of subarachnoid hemorrhage when results of cranial computed tomography are normal. The major contraindication is elevated intracranial pressure with evidence of a mass lesion.

Adult↗