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Fast deterioration of the neurological status of patients with raised intracranial pressure after lumbar puncture is not rare. Cerebral coning or rebleeding occur in consequence of cerebrospinal fluid leak. An experimental model correlates leakage with needle gauge. Computed tomography is indicated for diagnosis at the time of the initial examination. Puncture with needles of small diameter (less than 0.5 mm) is recommended.
In 100 patients the bacteriological results of the urine got by suprapubic puncture of the urinary bladder were compared with the results of the mid-stream urine. In the vesicular urine the proportion of the urine samples infected as well as of the mixed flora is essentially lower so that, in contrast to the mid-stream urine, it gives more reliable findings. According to this the puncture of the urinary bladder should be used more frequently, particularly in certain groups of patients. A comparison of the bacteriological investigation of the vesicular urine with the semiquantitative investigation of the sediments of the mid-stream urine resulted in a large proportion of pathological sediments of the urine when the vesicular urine was sterile so that the reliability of this investigation appears restricted in its modern form of performance.
99 ultrasonographically-guided percutaneous nephropyelostomies (PNP) were done in 77 patients. Average age at operation was 60 years, most often PNP was done in cancer patients. In 26 cases compound-scanning technique and in 73 cases real-time technique was used. Real-time ultrasound imaging of the kidney is superior to compound-scan technique and allows dynamical imaging of percutaneously introduced canulas. Thus guidance of puncture technique and security of reaching the calix system have been optimized. Correct placement of nephrostomy catheter was achieved in 88.5% using compound-scanning technique compared to 92% using real-time ultrasonography. Moreover puncture of the calix system by needle was successful in every case using real-time ultrasonography. Complication rate was 2%. In one patient the calix system was perforated and one with macrohematuria required open surgery. Real-time ultrasound technique enables us to perform controlled percutaneous nephropyelostomy easily without hazardous complications.
Direct common bile duct puncture offers an alternative to cystic duct cannulation in performance of operative cholangiography. Materials are readily available; no unusual cannulas or clamps are needed. The technique is easily mastered and consistently successful. Multiple roentgenograms, including one obtained after aspiration of dye from the duct, are of great advantage in detecting small stones. Careful application of puncture of the common bile duct does not add to morbidity nor does it prolong the recovery period.
The authors describe in detail the technique they are employing for puncturing the canine fossa, for irrigation, sinuscopy and/or register of the antral pressures. Two trocars are introduced, one developed and the other modified by one of the authors (N.P.) A morbid entity named "glue-sinus" is commented. The pros and cons of the technique are discussed concluding that puncture in the canine fossa is a valid procedure and even more advantageous than the one in the nasal inferior meatus.
Significant reduction in size was obtained in 12 of 14 renal cysts treated by the instillation of iophendylate. The advent of noninvasive methods has increased the number of renal cysts detected radiologically and has limited the indication for diagnostic puncturing to problematic cases only. However, if it is decided to perform diagnostic puncture of a renal cyst, the combined instillation of iophendylate into the cyst seems to be therapeutically rewarding.
The authors have reviewed the records of 50 patients hospitalized for treatment of isolated cephalalgia and in whom lumbar puncture was the only investigatory procedure that initially provided some information. In 12 cases, CSF abnormalities reflected a progressive tumoral, vascular or inflammatory intracerebral lesion undetectable by the usual methods (fundus oculi, radiography of the skull, EEG), or by less common examinations (arteriography, scintiscans, CT scans). In 12 other cases, lumbar puncture provided evidence of a minimal meningeal inflammatory process. In 26 cases, the only biochemical change was an excess of CSF proteins which in 7 cases developed in a dome-shaped curve suggesting an independent disease, the significance of which is discussed.
A technique for percutaneous puncture is described which employs sectorial scanning real time ultrasonography without a mechanical system for needle control. The method has given satisfactory results in 200 punctures, including one case in which a liver metastasis 13 mm in diameter was detected and another case with a wirsung's duct of 4 mm diameter.
In the last 16 years, 33 children have been treated for brain abscesses. Fifteen (45.5%) presented with cyanogenic congenital heart disease; eleven (33.5%) with E.N.T. infection. The standardized treatment protocol included puncture of the abscess, antibiotherapy and anti-edematous drugs. Postoperative permanent epidural ICP monitoring and, in the last 6 years, repeated CT scans indicated when it was necessary to tap the abscess again or to reinforce the anti-edematous treatment. However, in 3 of these 33 cases, the abscess had to be removed. Postoperative mortality rate was 3%. Overall mortality rate was 6%. Neurological sequelae were slight. Epilepsy occurred in 10%. Mental retardation (16%) was only found in children with cyanogenic congenital heart diseases. Repeated CT scans showed the progressive disappearance, within a few months, of the abscess membranes. This study shows an improvement in the results when brain abscesses in children are punctured rather than excised.
It is well known that blood access is essential for long-term hemodialysis treatment. Arteriovenouos fistula (AVF) is the most widely used method. However, this method of access frequently fails (access failure) as a result of stenosis. We attempt simple femoral vein puncture (FV-method) instead of AVF in such patients and have experienced 12 patients who were undergoing hemodialysis treatment using the FV-method, three times a week for more than one year. We devised special needles (18- and 19-gauge) for the FV-method. Generally, we use a 19-gauge needle with 4 side holes. We discuss here the results of 12 patients consisting of 4 males and 8 females with a mean age of 57.9 years, a mean duration of dialysis of 10.0 years, and a mean duration of FV-method of 3.5 years. Their underlying diseases were chronic glomerulonephritis (9 patients), diabetic nephropathy (2 patients) and nephrosclerosis (1 patient). Before the use of the FV-method, AVFs were attempted a man of 3.8 times and an artificial graft, 4 times in 3 patients. Ten patients were outpatients and 2 were inpatients. As for the indications of the FV-method, 11 patients had access failure and another had suffered from heart failure resulting from an over flow of blood through AVF. KT/V, PCR and TACBUN were measured monthly and were within the normal range in almost all of the patients. Concerning complications of the FV-method, hematoma formation after detachment of the needle at the end of dialysis and pain at needle puncture were sometimes noted.(ABSTRACT TRUNCATED AT 250 WORDS)
The purposes of this paper were to determine the indications, feasibility, outcome, complications and costs of laparoscopic hysterectomy utilizing the Pelosi single umbilical puncture technique and to introduce in Latinoamérica this minimally invasive and inexpensive alternative of laparoscopic hysterectomy. Ours results suggest that laparoscopic hysterectomy using a single umbilical puncture approach is a safe, inexpensive and effective alternative when compared with other techniques of laparoscopic hysterectomy.
OBJECTIVE: To determine the prevalence of abnormal neurologic findings and cerebrospinal fluid abnormalities in hospitalized patients with serologic evidence of latent syphilis. DESIGN: Cross-sectional survey. METHODS: Consecutively admitted hospital inpatients from an inner-city population were screened for serologic evidence of syphilis with reactive plasma reagin and confirmatory fluorescent treponemal antibody absorption assays. In those with reactive tests, such clinical findings as a history of treatment for syphilis, neurologic abnormalities, presence of human immunodeficiency virus infection, and rapid plasma reagin titer were correlated with cerebrospinal fluid white blood cell count, protein level, and VDRL result. RESULTS: Of 490 consecutive patients, 52 (11%) had serologic evidence of syphilis. Forty-three (83%) of these underwent lumbar puncture. Of the 43, 31 (72%) were seronegative for human immunodeficiency virus and 12 (28%) were seropositive. No patient had a reactive cerebrospinal fluid VDRL test. Cerebrospinal fluid abnormalities were seen in 32% of human immunodeficiency virus-seronegative patients and in 67% of human immunodeficiency virus-seropositive patients. Cerebrospinal fluid abnormalities were not predicted by history of treatment for syphilis, abnormal neurologic findings, or an elevated rapid plasma reagin titer. Cerebrospinal fluid IgG indexes in patients with elevated cerebrospinal fluid protein levels suggested that the protein abnormalities were not caused by local antibody production. Nonreactive cerebrospinal fluid fluorescent treponemal antibody absorption tests suggest that the cerebrospinal fluid abnormalities were not the result of neurosyphilis. CONCLUSIONS: There was a high prevalence of cerebrospinal fluid abnormalities in hospitalized patients with latent syphilis detected by routine screening. Because of the nonspecificity of the cerebrospinal fluid findings, routine lumbar puncture for such patients appears to contribute little to the treatment of latent syphilis.
The authors present the data on positive influence of demineralized osteomatrix (DOM) on the osteogenesis in the experimental conditions. On the basis of data received the method of puncture osteoplastic operation with DOM application was developed. Puncture method was applied in 38 children. In 6 months 31 children cyst were liquidated, osteoarchitectonics was reduced, in 7 children rough trabecular picture remains.
Since 1986, we have treated 302 cases with hepatic and abdominal hydatid cyst (361 cysts) by the method of percutaneous puncture, drainage and curettage combined with systemic drug and local drug administration with 5 years' follow-up. The rate of success of percutaneous puncture, aspiration, drainage and curettage was 99%. Only one case presented allergic reaction. At 6 months after the PPDC, 97.2% (212/218) of the cysts had stopped growth. One year later, 84.4% (130/154) of the cysts had disappeared. Five years' follow-up revealed that 77.8% (14/18) of the cysts had disappeared. All of the above-mentioned cases have recovered except for two cases suffered from recurrence of primary cysts resulting from a drop of the cannulas. No serious complications or death had been found.
After transfemoral catheterization, pseudoaneurysms can occur in about 0.1-0.05% of cases, especially after the use of large instruments and a faulty puncture technique. Today, pseudoaneurysms can be easily and accurately diagnosed with the help of duplex and color Doppler ultrasound. Apart from its diagnostic application, color Doppler ultrasound also offers a noninvasive and cheap alternative therapy mode as compared to surgical repair. The purpose of our study was to evaluate the therapeutic efficiency of an ultrasound-guided compression technique for postpunctional pseudoaneurysms. Over a 12-month period, nine patients were sonographically diagnosed with postpunctional pseudoaneurysm of the femoral superficial artery. The compression therapy was only applied if no contraindications (e.g. rupture, retroperitoneal site of the lesion, infection, large haematoma with suspected ischaemia, and necrosis) were present. Two of the nine patients were primarily excluded from therapy because of a high risk of rupture or a large haematoma. Five patients of the remaining seven have been successfully treated. In one of the unsuccessfully treated patients, only a partial thrombosis of the aneurysm was obtained, followed by complete spontaneous thrombosis 4 days later. The second compression failed because of the 4-month time interval between angiography and compression therapy. A successful therapy clearly depended on the time interval between puncture and compression. We could not find any significant correlation between the aneurysm volume and the duration of compression. Color Doppler ultrasound-guided therapy is a noninvasive easily applicable, and cheap alternative to surgical repair of postpunctional pseudoaneurysms.
A case of a 51-year-old female suffering in polycystic liver disease is presented. The patient had bulging upper abdomen, pain in the right subcostal region originating perhaps from the stretching liver capsule and a considerably shortened prothrombin time. Only minor portions of liver tissue could be detected by imaging methods, therefore surgical solution was not suggested. In order to maintain the hepatic function by reducing the compression of the functioning tissue, US-guided multiple cyst punctures were performed with sclerotisation of the cysts. Following the multi-stage procedures the size of liver decreased, the hepatic function gradually improved. In accordance with the literature the authors recommend the multi-stage cyst puncture and sclerotisation as beneficial therapy of polycystic liver disease with minor risk, without burden general anesthesia and minimal on the patients.
Ultrasound-guided percutaneous puncture of renal cysts replaced by CO2 was performed on 9 renal cysts of 6 patients from May 1993 through September 1993. Puncture and aspiration of cysts was performed using a 5.5 Fr one-step fluid drain kit (pig tail stent) under ultrasonography inspection. Aspirated volume of cyst contents was 15-292ml (mean 115 ml), and the instilled CO2 volume was 15-150 ml (mean 73 ml). All patients were checked by CT scan. In one month, the reduction rate of cyst volume was 46-84% (mean 69%) and lumbago, their chief complaint, was improved in all patients. No complications were observed in patients treated by CO2 instillation. Although long-term followup is needed to draw a definite conclusion, this therapy may be useful for benign renal cystic lesions.
The incidence of post-lumbar puncture headache has been shown to be reduced by using a higher-gauge (smaller-bore) needle and orienting the needle bevel parallel to the dural fibers. Incidence of headache is the same in patients given bed rest as in patients who are mobilized immediately. Cerebrospinal fluid (CSF) examination of patients with seizures of unclear cause is indicated. However, pleocytosis can be a result of the seizure alone. Other causes of pleocytosis must be ruled out by clinical evaluation and CSF studies. Although lumbar puncture is often advocated for patients presenting with dementia, it usually is not helpful in finding a specific cause if the dementia is long-standing.