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At least 1,153 records · Page 64Linked to original sources
PubMed1999

[Lumbar puncture in a pediatric emergency department: something more than a diagnostic technic].

OBJECTIVE: The aim of this study was to know the incidence of serious bacterial infections (SBI) in children without sepsis or intracranial infection in which spinal puncture (LP) was performed in an Emergency Department. PATIENTS AND METHODS: A retrospective study of all 471 previously healthy children between 1 month and 14 years of age in which a lumbar puncture was performed between July 1995 and March 1997 in the Emergency Department of our hospital was performed. RESULTS: Two hundred and three children (43%) had sepsis, meningitis or encephalitis (aseptic meningitis 149, 31.6%; sepsis-bacterial meningitis 26, 5.5%; nonspecific meningitis 26, 5.5%; encephalitis 2, 0.4%) and 14 (5.2%) had pneumonia. Of the other 254 children, 36 (14.1%) had a SBI: 19 urinary tract infections (E. coli), 11 bacteremia (Streptococcus pneumoniae 8, Salmonella enteritidis 1, Proteus mirabilis 1, E. coli 1, the latter two also having a positive urine culture) and 6 bacterial gastroenteritis (salmonella 5, Campylobacter jejuni 1). The incidence of SBI was significantly higher in the group of children younger than 5 years old (32/175, 18.2%) than in the older group (4/79, 5.0%, p = 0.009). Two patients died (one with pneumococcal meningitis and one with meningococcal sepsis). CONCLUSIONS: Children with fever and a normal result in the LP must be carefully examined and, especially in younger patients, urine, blood and stool (if stool abnormalities) cultures should be collected. These children must be closely observed in the hospital or at home and must be re-evaluated by their pediatrician in the following 24 hours.

Adolescent↗
PubMed1994

Puncture site hemostasis.

The Angio-Seal hemostatic puncture closure device was designed to provide diagnostic as well as post-complex angioplasty hemostasis in coronary and peripheral procedures without compromising blood flow to the distal extremity: 1) by allowing immediate removal of the introducer sheath, and 2) by providing puncture hemostasis without the need for manual pressure. The Angio-Seal is currently in clinical trials and is being evaluated by the FDA. We are hopeful that its future use will reduce the cost of medicine while greatly enhancing the quality of patient care as initial clinical trial results indicate.

Animals↗
PubMed1999

[Lumbar puncture headache. Routines of Danish hospital departments compared with recommendations found in the literature].

Numerous studies have not been able to identify any benefit of bedrest or excessive intake of fluids in order to prevent post-lumbar-puncture headache. The benefits from using finer and blunt needless are well-established. In this study we carried out a survey of the procedures of all Danish departments concerning lumbar-puncture. We found that a number of Danish clinicians do not consistently follow these conclusions. We present data and a short review of the literature, and conclude that an updating of the routines in the various departments would save time and discomfort for the patients as well as saving work and money for the departments.

Denmark↗
PubMed1999

Treatment for postdural puncture headache associated with late postpartum eclampsia.

Postdural puncture headache (PDPH) is the most common complication of accidental or deliberate dural puncture. It also occurs after epidural or spinal analgesia for labor and delivery. Treatment may be conservative with analgesics and/or caffeine. Definitive treatment can be accomplished with an epidural blood patch (EBP). We present a case of postpartum convulsions which were temporally related to a caffeine infusion and an EBP.

Acetaminophen↗
PubMed1999

[Efficacy of hemostatic puncture closing device for hemostasis and early ambulation after coronary angiography and angioplasty: results of a multicenter trial].

To assess the efficacy and safety of a hemostatic puncture closing device for reducing patient immobilization after cardiac catheterization from a percutaneous femoral artery approach, we conducted a prospective, randomized trial at 4 participating centers. A total of 240 patients (183 men, 57 women, mean age 61 +/- 10 yr; 157 patients underwent diagnostic angiography, 83 patients underwent coronary angioplasty) were randomized to either the device group (n = 120) or the manual compression group (n = 120). There were no statistical differences in age, gender, weight or sheath size between the 2 groups. A 7, 8F sheath was used in 53 patients of the device group and in 43 patients of the manual compression group. One hundred and two patients (85%) in the device group and 96 patients (80%) in the manual compression group received heparin. Protamine was used in one patient of the device group and 23 patients of the manual compression group. Activated clotting time just prior to sheath removal was 206 +/- 64 sec in the device group and 170 +/- 47 sec in the manual compression group (p < 0.01). Successful placement of the device was achieved in 118 of 120 patients (98%). Time to hemostasis was significantly shorter in the device group (0.8 +/- 3.2 vs 12.2 +/- 5.3 min, p < 0.01). Time to ambulation could be reduced in the device group (5.3 +/- 3.7 vs 10.9 +/- 5.1 hr, p < 0.01). The following complication rates occurred in the device group as compared with the manual compression group: hematoma, 16% vs 10%; bleeding, 8% vs 3%; pseudoaneurysm, 0% vs 1%, respectively. None of these differences was statistically significant. These results indicate that early ambulation using a hemostatic puncture closing device is feasible without significantly increasing the risk of peripheral vascular complications.

Adult↗
PubMed2000

[Cerebral venous thrombosis after lumbar puncture and intravenous steroids in two patients with multiple sclerosis].

Two patients affected with a multiple sclerosis developed cerebral venous thrombosis after lumbar puncture and treatment with intravenous methylprednisolone. In one case, the course was favorable. The second patient died in spite of intracerebral thrombolysis. The autopsy confirmed the diagnosis of cerebral venous thrombosis and multiple sclerosis. We discuss the relationship between lumbar puncture, steroid treatment and cerebral venous thrombosis.

Adrenal Cortex Hormones↗
PubMed2000

Studies of the mechanism of amniotic sac puncture-induced limb abnormalities in mice.

The principal advantage of chorionic villus sampling (cvs) over amniocentesis for the determination of the genetic constitution of the embryo is that it may be undertaken earlier in pregnancy. If carried out too early in pregnancy, it has the risk of inducing craniofacial and limb abnormalities, a condition termed the oromandibulofacial limb hypogenesis (OMFL) syndrome in genetically normal infants. It is believed that the defects observed have a vascular origin, possibly due to anoxia of tissues due to fetal blood loss or thrombus formation at the site of biopsy with distal embolization. We believe that this does not adequately explain the findings from the experimental animal literature involving amniotic sac puncture (ASP). Based on these experimental findings, we have hypothesised that (i) the defects observed following cvs may result from the consequences of oligohydramnios following the inadvertent puncturing of the amniotic sac during this procedure, and (ii) that cleft palate and the postural limb defects observed (e.g., clubfoot and clubhand) are secondary to embryonic/fetal compression. Our experimental studies shed new light on the mechanism of induction of the limb defects seen, but particularly syndactyly. Evidence of hypoperfusion of the peripheral part of the developing limb bud is observed, which interferes with apoptosis that occurs in the digital interzones, or induces an abnormal degree of cellular proliferation and/or tissue regeneration in these sites, possibly because of over-expression of critical genes involved in limb pattern specification. Cleft palate, tail abnormalities and abnormalities of sternal ossification are also observed in our model.

Amniocentesis↗
PubMed2000

A prototype haptic lumbar puncture simulator.

Lumbar punctures (LP) are complex, precise procedures done to obtain cerebro-spinal fluid from a patient for diagnostic purposes. Incorrect techniques resulting from inadequate training or supervision can result in sub-optimal outcomes. As tactile feedback is crucial for a successful lumbar puncture, this procedure serves as an ideal candidate for the development of a haptic training simulator. The intent of this project is to engineer a force feedback LP simulator that provides a safe method of training students (medical students, residents, or trained physicians) for an actual LP procedure on a patient.

Computer Graphics↗
PubMed2000

[Puncture-drainage sanation of abdominal abscesses: is it sufficient treatment?].

Some anatomical grounds of postoperative extravisceral abscess formation, methods and results of their treatment, therapeutic policy in abscesses of parenchymatous organs are presented. 681 patients with abdominal abscess of various location were examined. Detailed analysis of ultrasonic and computed tomographic semiotics of postoperative extravisceral suppurative focus was carried out in 164 patients. The risk zones of extravisceral abscess formation in the conditions of changed visceral syntopy and destroyed ligamentic structures were determined. The efficiency of puncture-drainage treatment in different variants of subdiaphragmatic abscess was 89.4%, in abscess of omental bursa--83.3%. Intracavital prolonged proteolysis by immobilized proteinases (imosimase) was applied. The injection of imosimase in abscess cavity led to its content lysis, including the thick products of inflammation, improving their secretion through the drainage. In the majority of the patients, the puncture-drainage treatment of abscesses of various etiology and pathogenesis is an adequate method of sanation.

Abdominal Abscess↗
PubMed2001

Bleomycin in the treatment of keloids and hypertrophic scars by multiple needle punctures.

BACKGROUND: The treatment of keloids and hypertrophic scars has been difficult and a recent French study showed that bleomycin has been useful in the treatment of these lesions. OBJECTIVE: To determine the effectiveness and safety of bleomycin in the treatment of hypertrophic scars and keloids when this drug is administered through multiple superficial punctures. METHODS: We applied bleomycin to keloids and hypertrophic scars in 13 patients using a multiple-puncture method on the surface of the skin. All patients were given bleomycin at a concentration of 1.5 IU/ml. Clinical response after treatment was classified according to the following scale: complete flattening (100%), highly significant flattening (>90%), or significant flattening (75-90%). RESULTS: The clinical response was very positive in all cases: complete flattening in six cases, highly significant flattening in six cases, and significant flattening in one case. Two patients presented a recurrence as a small nodule 10 and 12 months after the last infiltration. CONCLUSIONS: These clinical findings show that administration of bleomycin in keloids and hypertrophic scars shows promise and needs further investigation.

Adolescent↗
PubMed2001

A new device for percutaneous suture-mediated closure of arterial puncture sites using exteriorized needles: initial experience.

PURPOSE: To assess the feasibility and initial clinical results of Closer (Perclose, Redwood City, California), a new device for percutaneous suture-mediated closure of arterial puncture sites. METHODS: Vascular interventions were performed using 6 and 7 French sheaths in 22 consecutive patients. All patients underwent suture-mediated percutaneous closure with the new device. Patients were followed by physical examination the day after the procedure. RESULTS: Immediate hemostasis was achieved in 20/22 patients (91%). In 3 out of 5 antegrade closures, only one suture was captured. In two cases, this was managed by reinsertion of a second device. In another patient, hemostasis was not achieved by the device due to knot entrapment. No major complications were observed. The overall rate of minor complications was 9% (2/22) due to hematomas without the need for blood transfusions. CONCLUSION: Percutaneous suture with this new device is an acceptably safe and effective method to achieve immediate hemostasis of the arterial access site after interventional procedures with minimized manipulation of the puncture track.

Adult↗
PubMedDate not supplied

Percutaneous fine-needle pancreatic pseudocyst puncture guided by three-dimensional sonography.

BACKGROUND/AIMS: At present a pancreatic pseudocyst puncture guided by ultrasonography is a treatment of choice in the majority of hospitals. A classical two-dimensional sonography is usually implemented in these cases. However, its shortcomings, mainly in differential diagnosis, are acknowledged by most physicians. The real time monitoring of a fine-needle pseudocyst procedure by two-dimensional ultrasonography is of questionable reliability. In our study we evaluated the usefulness of three-dimensional sonography in the percutaneous fine-needle pancreatic pseudocyst puncture. METHODOLOGY: We examined fifty-two patients diagnosed as having pancreatic pseudocysts on the basis of clinical symptoms and two-dimensional ultrasonography findings. Then the decision to qualify certain patients for the percutaneous fine-needle aspiration guided by ultrasonography was made on the basis of two- and three-dimensional scan results. The next step in our investigation was to implement color Doppler in order to visualize all blood vessels at the planned biopsy site. Three-dimensional sonography was used to monitor the tip of the needle making its way to the pancreatic pseudocyst and later inside the fluid collection. RESULTS: Pancreatic pseudocysts were diagnosed in all of the 52 cases. Three-dimensional sonography was more precise in visualizing the shape and size than two-dimensional ultrasound scans. CONCLUSIONS: Three-dimensional presentation can better visualize irregular shapes, local thickenings, and calcification of pseudocyst walls than classical two-dimensional ultrasound scans. The use of subtraction in three-dimensional scans of blood vessels increases the safety in performing biopsies. It makes the aspiration of cytologic materials much safer to perform. In our study we have shown that three-dimensional sonography collects extremely useful information about the status of the pseudocyst structure and it should become a complementary method to classical ultrasonography. This technique when used on a routine basis ought to help us change the inclusion criteria for guided biopsies.

Adult↗
PubMed2000

[Percutaneous puncture treatment of hepatic cystic echinococcosis under ultrasound guidance].

Introducing of the alternative PAIR (puncture-aspiration-injection-reaspiration) method for treatment of hepatic echinococcosis in practice dates from 1992 year. A Working group dealing with the problems and standardization of the method has been created by WHO. The major aspects of this treatment are summarized in the bulletin of WHO of 1996 year. On the last World Congress of Ultrasound, held in Florence, Italy in 1999 this method was reported as safe and effective treatment modality. The necessity for further prospective studies was also emphasized. The aim of the Working group for performing of PAIR, created at the Clinical Centre of Gastroenterology, University Hospital "Queen Joanna" in 1999 is to report the preliminary results and declare the possibilities for its application. Nine patients (6 males, 3 females) with 11 cysts (I, II and IIIa types after Gharbi) measured 3-9 cm were punctured and followed up for a 6 months period. 95% ethanol was used as protoscolicidal agent with concomitant preventive oral treatment with Mebendazole. No serious complications were observed. In all patients separation of the germinative membrane was verified. 2/5 cysts < 3.5 cm completely disappeared, 7/11 diminished their size without signs of vitality, while 2/11 remained vital. One ofe the cysts had a biliary communication which necessitated the injection of 20% NaCl instead of ethanol. The serological ritres significantly decreased in all patients. The risk of anaphylaxis and seeding is negligible while keeping the technique of PAIR precisely. The PAIR treatment of hepatic echinococcosis presents great progress with its safety, low risk and excellent therapeutic results.

Adult↗
PubMed2002

[Indications and diagnosis efficiency of lumbar puncture in emergencies].

BACKGROUND: To know the frequency, indications and diagnosis efficiency of lumbar puncture (LP) in the Emergency Department (ED) when suspecting a central nervous system (CNS) infection. PATIENTS AND METHOD: We analyzed all the LP performed over a 2-year period in the ED. We compared the clinical characteristics of patients with and without CNS infection. We also reviewed all the cases of CNS infection diagnosed in the hospital in the same period. RESULTS: A LP was performed in 0.4% of emergencies. In 76% of cases, it was performed because of CNS infection suspicion, which was confirmed in 30% of cases. Fever, headache, nuchal rigidity and chronical otitis were all clinical variables associated with CNS infection. An 80% of CNS infections that were not diagnosed in the ED corresponded to HIV-infected patients. CONCLUSIONS: Lumbar puncture is frequently performed in the ED, mostly for suspicion of CNS infection, which is eventually confirmed in one third of cases. CNS infection cases which have not been suspected in the ED usually correspond to a subacute meningitis in a HIV-infected patient.

Central Nervous System Infections↗
PubMed2002

[Anterior stromal puncture for recurrent corneal erosion].

PURPOSE: Assess the efficacy of corneal anterior stromal punctures as treatment for Recurrent Corneal Erosion (RCE) and relapse prevention. Two other treatments are compared: simple occlusion with antibiotic ointment, not manipulating the lesion and debridement of erosion previous to occlusion. MATERIAL AND METHOD: A retrospective study was performed on a total of 36 patients diagnosed with RCE where cases underwent different treatments and results were compared. Other general factors influencing the evolution of the illness are evaluated as well. RESULTS: No statistically significant differences were found comparing the effectiveness of these three treatments to decrease the risk of relapses in erosion. Presence of signs of map-dot-fingerprint dystrophy is common in RCE patients, however not associated with higher risk of relapse. The most frequent associated alteration is meibomitis. CONCLUSIONS: Treatment of RCE with erosion debridement previous to occlusion results in a high rate of healing and this treatment seems better than stromal punctures since it implies less potential risks. Pathogenesis of RCE still remains obscure. Association with certain dystrophys of the epithelial basal membrane could not be demonstrated in this study. However, it is possible that the presence of meibomitis, associated with lids contamination by certain strains of staphylococcus aureus, may play an important role in RCE pathogenesis (Arch Soc Esp Oftalmol 2002; 77: 257-262).

Adult↗
PubMed2002

[Treatment of post-dural-puncture headache with intravenous cortisone].

Postdural puncture headache (PDPH) is the most frequent complication of procedures involving dural penetration for spinal anesthesia or following unintentional dural puncture during attempted epidural anesthesia or analgesia. PDPH causes serious problems for women who have just given birth, as they are unable to give adequate care to their infants. The causes of PDPH are poorly understood and treatments are therefore various and symptomatic; most are empirical and not all are effective. When conservative measures fail, an alternative that may be proposed is the blood patch, an invasive technique which is not without risk and which many patients reject. We report three cases of incapacitating PDPH in women after vaginal or caesarian delivery in which symptoms resolved with intravenous hydrocortisone treatment. Hydrocortisone treatment for PDPH has never been reported in the literature, but given our results, we consider that clinical trials are warranted to establish the efficacy of this treatment and to determine if there is a chance that it might offer an alternative to the blood patch.

Acetaminophen↗
PubMedDate not supplied

Prospective randomised study of cephalic vein cut-down versus subclavian vein puncture technique in the implantation of subcutaneous venous access devices.

The aim of the present study was to evaluate the results of a prospective randomised trial comparing cephalic vein cut-down (CCD) versus percutaneous subclavian vein puncture with the Seldinger technique (PSP) in the implantation of subcutaneous permanent central venous access devices (SPCVAD) in order to better define the safer technique in outpatient surgery. Fifty patients were randomly divided into two groups: CCD--17 males, 8 females (age range: 35-75 years; mean: 60 years); PSP--17 males, 8 females (age range: 17-75 years; mean: 63 years). The two groups were compared in terms of implant morbidity, technical failure, operative time, patient acceptance, and healthcare costs. Data were analysed statistically using the chi-square test (P < 0.05 was considered significant) and Student's t-test. Technical failure occurred in 2 PSP patients (8%) and in 4 CCD patients (16%) (P = 0.663; chi 2 = 0.189). Mean operative time was 40 min in PSP (range: 35-70 min) and 50 in CCD (range: 35-60 min) (p = 0.108, T = -1.64). Patients were requested to define the pain experiences as a result of the operation as mild, moderate or severe: 23 PSP patients reported mild to moderate pain (92% of cases), and 2 patients severe pain (8%). The same figures were obtained in the CCD group, i.e. 23 (92%) and 2 (8%) patients, respectively (P = 0.377; chi 2 = 0.781). In our institute both types of implant cost $1260; in the case of PSP there is an additional cost of $120 for postoperative chest x-rays, making a total cost of $1380 per implant. The data of this randomised trial show that the implantation of a totally implantable vascular access device is a surgical procedure with a limited rate of morbidity in both cephalic vein cut-down and subclavian vein percutaneous puncture, with no statistically significant difference between the two in terms of associated morbidity, technical failure, operative time and patient acceptance.

Adolescent↗
PubMed2002

[Cerebrospinal fluid puncture, consent inform, and ethics in research: the Brazilian Academy of Neurology recommendations].

The Cerebrospinal Fluid (CSF) Scientific Department of the Brazilian Academy of Neurology (SD-BAN) suggests the use of consent inform for patients submitted to lumbar puncture. It should be explained to the patients the possible complications related to CSF puncture. The laws related to the research in human beings have also been discussed by the CSF SD-BAN.

Brazil↗