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PubMed1985

[Accuracy of ultrasound-guided fine needle biopsy in pancreas cancer--effect of puncture frequency and character of puncture material].

There is no agreement upon the number of punctions guided by ultrasonography needed to establish cytologically the diagnosis of pancreas carcinoma. Therefore reliability of the method as being dependent upon the number of punctions in 43 maligne tumors of the pancreas was evaluated. Performing two to five punctions yielded significantly better results than just one. In addition the macroscopic aspect of the aspirate is important.

Biopsy, Needle↗
PubMed1983

[Reliability of cytologic puncture. Who should perform the puncture of breast tumors?].

In a period of 18 months, 187 cytology aspiration biopsies of the breast were performed at the Centre François Baclesse by clinicians and radiologists, using the conventional technique. Comparison of the results with clinical, radiological and histological findings by different specialists showed that one out of two aspiration biopsies gave an erroneous diagnosis. The authors believe that this failure was due to the fact that the biopsies were not performed by a cytologist. This prime condition of success should be more clearly expressed in the literature.

Biopsy, Needle↗
PubMedDate not supplied

[Ultrasound-guided puncture-biopsy of the liver could replace blind puncture-biopsy in diffuse hepatopathies. Retrospective study of 1293 patients].

OBJECTIVES: The aim of this retrospective study was to compare the efficiency and complications of percutaneous hepatic biopsy either guided by ultrasonography in the left lobe, or blindly by the intercostal route in the right lobe, in the diagnosis of diffuse liver diseases. PATIENTS AND METHODS: Liver biopsy was performed in 1,293 patients for 5 years. In group 1 (289 patients, including 140 out-patients), liver biopsy was guided by ultrasound. In group 2, blind intercostal liver biopsy was performed in 1,004 patients. Patients were observed for 6 hours after biopsy in both groups. RESULTS: The failure rate of liver biopsy was significantly lower in group 1 (1.7%) than in group 2 (9.25%, P < 0.01). The prevalence of the histological lesions was similar in both groups. No related-biopsy death occurred. Complications were more serious after blind biopsy (1 acute pancreatitis with a hematoma of the liver, 1 bile leakage around the gallbladder, 1 hemoperitonitis, 1 large intrahepatic hematoma), than after guided biopsy (1 small hematoma of the liver, 1 acute biliary pain on the 10th day). CONCLUSION: Hepatic biopsy guided by ultrasonography could replace blind biopsy in the diagnosis of diffuse liver diseases.

Biopsy, Needle↗
PubMed1996

[Complications of fine needle puncture. DEGUM survey II].

AIM: In a follow-up survey of the members of the German Society for Ultrasound in Medicine (DEGUM), the use of several fine-needle puncture techniques as well as the frequency and nature of the complications were assessed. METHOD: A questionnaire was sent to all 3364 members of the society. RESULTS: 95070 fine-needle punctures were reported. Of these, 66379 were done to obtain cytological material (69.8%), 19633 (20.7%) to obtain histological material and 9057 (9.5%) for therapeutic reasons. 38.6% of the punctures were guided by ultrasound (i.e. performed without ultrasonic observation of the puncture process), 35.1% were conducted under ultrasonic view and 26.3% with a special puncture probe. The punctures for cytology were generally done without direct ultrasonic observation (45.6%); the punctures for histology were performed for the most part with puncture probes (56.7%). The therapeutic punctures were monitored with a puncture probe in 52.5%. In 95070 punctures, 765 complications were observed (0.81%), one death (0.0011%) and six metastases in the puncture canal (0.0063%); 0.71% slight and 0.095% severe complications were recorded. The punctures for cytology caused the fewest complications with 0.59%. Those for histology had a complication rate of 0.99% and the therapeutic punctures one of 1.98%. In comparison to our first survey in 1988, complications increased from 0.51% to 0.81% primarily because of increased slight complications, which rose from 0.44% to 0.71%. The severe complications rose from 0.057% to 0.095%. Deaths decreased from 0.0075% to 0.0011%. Metastases in the puncture canal were likewise observed more frequently than in the first survey (0.0063% versus 0.003%). The increase in frequency of complications was predominantly the result of a more careful registration, but also by a wider use of the techniques. CONCLUSION: Ultrasonically guided fine-needle puncture is a method with a low rate of complications, but even this slightly invasive method requires stringent indications.

Biopsy, Needle↗
PubMed1998

Postdural puncture headache in paediatric oncology patients.

PURPOSE: Previous studies have not determined the correlation between dural puncture and postural headache in paediatric patients. Furthermore, no studies have evaluated the correlation between atypical headache and dural puncture in the paediatric population. Therefore, we prospectively analyzed the incidence of typical postdural puncture headache (PDPHA) and atypical headache in paediatric oncology patients following dural puncture. METHODS: The study population consisted of 66 paediatric patients undergoing 128 consecutive procedures, including 99 lumbar punctures and 29 bone marrow aspirations without concomitant lumbar puncture. Patients were prospectively randomized into four groups: Group I, preteens (< 13 yr) undergoing lumbar puncture, Group II, adolescents (13-21 yr) undergoing lumbar puncture, Group III, preteens undergoing bone marrow aspiration, and Group IV, adolescents undergoing bone marrow aspiration. The presence and description of headache was documented immediately after dural puncture or bone marrow aspiration, and on post-procedure days # 1, 3 and 5 by personnel blinded to the type of procedure. RESULTS: There was an increase in the incidence of headache (9.1%) after lumbar puncture in patients < 21 yr relative to patients undergoing bone marrow aspiration (P < 0.05). No difference was found between the incidence of typical PDPHA after dural puncture in preteens and adolescents. There was also no difference in the incidence of atypical headache after dural puncture or after bone marrow aspiration among preteens and adolescents. CONCLUSIONS: Paediatric patients experience an increased incidence of typical postdural puncture headache after dural puncture compared with age-matched patients undergoing bone marrow aspiration only. Atypical headache is relatively common in the paediatric population after dural puncture or bone marrow aspiration.

Adolescent↗
PubMed1997

[Clinical value of Doppler ultrasound controlled puncture of the inguinal vessels with the "Smart Needle" within the scope of heart catheter examination].

Due to the increasing number of diagnostic heart catheterizations, especially in elderly patients, as well as the increase of percutaneous transluminal coronary angioplasties, we are confronted with a rise in peripheral complications evolving from difficulties in the procedure of the puncture of the femoral artery or vene. The development of greater hematomas in the area of the puncture, the formation of arterio-venous fistulas and aneurysma spuria are the foremost complications. It was the aim of the study to investigate in as far an improved puncture technique could reduce the rate of peripheral complications. In this comparative study the vessel punctures were carried out by the conventional Judkins puncture technique and a new method using a special puncture needle. (Smart Needle" R), with an integrated ultrasonic sound device. In this study 114 patients--age 23 to 82 years--undergoing heart catheterization (91 diagnostics, 23 PTCAs) were examined. In all cases a puncture of the arterial and venous femoral vessel was done. 50 patients received a puncture via "Smart Needle" and the remaining 64 patients were punctured conventionally. In contrast to the group of patients receiving conventional puncture of the femoral artery, where in 72% more than one try was needed, in all patients of the "Smart Needle" group the first puncture was successive. Concerning the puncture of the venous vessels no significant difference between the two groups was observed. This difference between arterial and venous puncture outcome results from the difference between arterial and venous flow signals detected by the ultrasonic sound device. As to the bleeding complications hematomas following to "Smart Needle" puncture occurred less frequently-in 25%--and were significantly smaller than in the conventional group where hematomas were seen in 46%. The number of patients with hematomas with diameters of more than 5 cm was twice as high in the conventionaly punctured group (28%) than in the "Smart Needle" group (14%). However, patients suffering from arterial hypertension or hemostatic disorders showed an increased risk of vascular complications. In regard to the cost-benefit relation an indication for the use of the new technique is to be seen especially in overweight patients and patients suffering to aortic stenosis or cardiogenic shock.

Adult↗
PubMed1999

[Ultrasonography guided versus anatomically oriented puncture of the internal jugular vein for central venous catheterization].

AIM: Ultrasonography guided puncture (UGP) of the internal jugular vein (IJV) carried out by an expert is considered to be superior to the anatomically orientated puncture (AOP). Whether routine use of the UGP lowered the number of unsuccessful punctures and complications was unknown. Both puncture techniques were compared in a random study. METHOD: Between 10/93 and 3/94, 77 patients who needed central venous catheterisation for thorax or cardiac surgery were included in the study. 84 (42 vs 42) punctures were performed by seven anesthetists, all of whom had a great deal of experience with AOP, using either one or the other technique. The UGP was demonstrated and assisted once by an expert. A conventional ultrasound unit with a 7.5 MHz transducer was used. The number of unsuccessful first punctures, overall rate of unsuccessful punctures, morbidity and puncture time were compared. RESULTS: The unsuccessful first punctures using UGP occurred significantly less frequently (7 vs 19, p < 0.005). Fewer unsuccessful punctures were evidenced (9 vs 73, p < 0.001). One arterial puncture occurred with each of the puncture techniques. Five hematomas were observed in patients where AOP was used. Four of these patients were adipous and at least six unsuccessful punctures had already been carried out. The punctures lasted comparatively the same length of time (UGP: 59 s vs AOP: 60 s, p > 0.05). CONCLUSION: UGP is superior to AOP of the IJV also in routine use. It should be used more frequently in elective situations.

Cardiac Surgical Procedures↗
PubMed2003

A timesaving method to create a fixed puncture route for the buttonhole technique.

BACKGROUND: Up to now, for a successful buttonhole puncture of the vascular access vessel, the fistula should be punctured by the same experienced medical staff for 2-3 months, using sharp needles, until a fixed puncture route is established. METHODS: We developed a timesaving method to create the fixed puncture route for the buttonhole technique. In this method, after the usual haemodialysis (HD), a newly developed thumbtack-shaped polycarbonate peg is thrust toward the access vessel along the same path as the puncture needle that has just been removed. Then, at the beginning of the next HD, the peg is removed and a dull puncture needle is inserted along the track already formed by the peg left in place. These steps are repeated at each HD session for 14 days. Thereafter, the vascular access is achieved at HD sessions by inserting a dull puncture needle through the established puncture route. RESULTS: This buttonhole puncture approach was used in 37 patients for 3 months. While the polycarbonate peg was in place, patients experienced no restrictions in their normal activities of daily living, except during bathing and showering. As for puncture pain, no patient found the pain of the buttonhole technique to be greater than that of the conventional puncture technique. Moreover, no significant bleeding was noted during HD. With this buttonhole puncture approach, only one patient had enough erythema at the puncture site to suggest possible infection. After HD, the time for bleeding to stop was <10 min in 95% of patients. CONCLUSION: This study showed the new timesaving method for creating a buttonhole to be safe and useful.

Catheters, Indwelling↗
PubMed1988

[Risks of fine needle puncture--results of a survey in West Germany(German Society of Ultrasound in Medicine survey)].

The rate of complications in fine needle puncture was ascertained by an inquiry conducted among the members of the German Association of Ultrasound in Medicine (DEGUM). 337 complications had been registered in a total of 66,397 punctures, corresponding to a percentage of only 0.51%. 294 of these were mild, i.e. not requiring therapy (0.44%), 38 severe (0.057%) and 5 complications were fatal and resulted in death (0.0075%). Differences were slight in respect of the frequency of complications with reference to puncture technique and type of needle employed. Most complications were seen in fine needle puncture for obtaining histological material (0.67%) (cutting biopsy needles), compared with 0.54% in therapeutic puncture and 0.46% for obtaining cytological material. Among the puncture techniques, the use of a puncture transducer resulted in more complications (0.72%) compared with sonographically guided puncture (0.59%) and puncture in full view with 0.43%. Punctures with/fatal outcome had been conducted in 4 out 5 cases with so-called cutting biopsy needles. Results are identical with those obtained in the U.S.A. on a comparative basis. Compared with punctures with so-called coarse needles, fine needle puncture results in fewer complications on account of the smaller needle caliber. As with every intensive method, however, complications must be taken into account even with fine needle puncture.

Biopsy, Needle↗
PubMedDate not supplied

Efficiency of 6- and 12-punctures biopsies to detect prostate cancer in patients with PSA </= 10 ng/mL and normal digital rectal examination.

OBJECTIVE: Establish the efficiency of 6- and 12-punctures transrectal ultrasound-guided needle biopsies in low risk patients for prostate cancer. Six-punctures (sextant) biopsies were compared to 12-punctures biopsies, assessing which is the best strategy to detect this neoplasm. MATERIALS AND METHODS: Among 240 patients submitted to prostate biopsy, 54 with suspected small and organ-localized tumors (prostatic specific antigen </= 10 ng/mL and digital exam of the prostate not suggesting cancer) in glands < 50 cm3 were selected, constituting a homogenous sample. These patients were submitted to standard 3-punctures (basal, mid, and apical) sextant biopsy in parasagittal midline of each prostatic lobe, with 3 additional lateral punctures, bilaterally. Each specimen was separately submitted to histological study. RESULTS: Twenty-two (40.7%) patients had prostatic cancer, and 28 presented prostatic hyperplasia, associated or not to inflammatory conditions. High-grade prostatic intraepithelial neoplasia (PIN) was detected in 4 patients. From 22 tumors detected by 12-punctures biopsies, 6-punctures biopsies in the parasagittal midline (sextant) diagnosed 50%of the cases, while isolated lateral punctures diagnosed 90.9% of the malignant neoplasms. Basal lateral punctures responded for 72.7% of the cancer diagnosis, while basal sextant punctures responded only for 9.1% of the cases. CONCLUSION: For low risk prostate cancer, patients' 12-punctures biopsy was more effective, for sextant biopsy failed to diagnose half of the cases of neoplasm. Three lateral punctures (basal, mid, and apical), with 2 additional punctures in the parasagittal midline (mid and apical) bilaterally are suggested as the best biopsy strategy.

Journal Article↗
PubMed2005

Diagnostic lumbar puncture. Comparative study between 22-gauge pencil point and sharp bevel needle.

Post-lumbar puncture headache is a frequent clinical problem. Needle design is expected to reduce post-puncture headache. In this study, we compared two different lumbar puncture needle designs in diagnostic lumbar puncture and analysed post-dural puncture headache (PDPH) and social and economical harm associated with the diagnostic lumbar puncture procedure. This prospective, controlled study consisted of 80 consecutive adult patients requiring elective diagnostic lumbar puncture due to various neurological symptoms. Lumbar puncture was completed either with Spinocan 22 G sharp bevel needle or Whitacre 22G pencil point needle. Patients were asked about previous headache symptoms and pain provoked by puncture. One week after the lumbar puncture all patients were interviewed by telephone and occurrence and type of headache, headache intensity, medication and frequency of impairment in activities of daily living were asked. Need for epidural blood patch was also recorded. Thirty-three of 78 (42%) patients experienced headache after diagnostic lumbar puncture and in 26 (33%) the headache could be classified as PDPH. There were no statistically significant differences between needle types in the frequency of common headache, PDPH, puncture pain intensity, need for epidural blood patch or sick leave. Also, there were no other complications except local back pain or headache. In this study, the needle design did not affect the frequency of PDPH. Also, PDPH was common, occurring in 33% cases and caused a considerable amount of disturbance in daily activities. Seeking help for this condition was insufficient and only part of these PDPH patients were treated with epidural blood patch.

Activities of Daily Living↗
PubMedDate not supplied

Accuracy of liver puncture under US guidance: re-evaluation by microcomputer simulation model.

OBJECTIVE: To evaluate, using microcomputer simulation models, the degree of distortion of the puncture needle in sonograms used during a liver puncture under ultrasound guidance. METHODS: We made a simplified simulation model of the puncture needle passing through the abdominal wall to the target lesion in the liver (cases without ascites), and additionally through ascites between the abdominal wall and the liver (cases with ascites), to evaluate the degree of distortion of the puncture needle in the sonogram. We considered the thicknesses and sound velocities of the abdominal wall and the ascites fluid, as well as the puncture angle, on the degree of distortion. RESULTS: (1) Cases without ascites: The puncture needle displayed on sonogram shifted predominantly anteriorly with a displacement error between 6 mm forward and 1 mm backward and with an angular error between 2.2 degrees forward and 0.1 degree backward when the abdominal wall was muscular, and the pattern of distortion had an inverted S-shape. It was displayed predominantly posteriorly with a displacement error between 14 mm backward and 2 mm forward and with an angular error between 3.7 degrees backward and 1.2 degrees forward when the abdominal wall was fatty, and the pattern was S-shaped. Regardless of the composition of the abdominal wall, when the abdominal wall was thin, the more obtuse the puncture angle was, the larger the shift was, and when the abdominal wall was thick, the more acute the puncture angle was, the larger the shift was. (2) Cases with ascites: (a) Regardless of the quantity and sound velocity of the ascites, the puncture needle shifted predominantly anteriorly with a displacement error between 7 mm forward and 3 mm backward and with an angular error between 3.1 degrees forward and 1.9 degrees backward when the abdominal wall was muscular, and showed the inverted S-shaped pattern. In contrast, it shifted predominantly posteriorly with a displacement error between 17 mm backward and 5 mm forward and with an angular error between 3.7 degrees backward and 3.9 degrees forward when the abdominal wall was fatty, and showed the S-shaped pattern. (b) Regardless of the sound velocity of the ascites fluid and the composition of the abdominal wall, the shift of the puncture needle changed little with differing amounts of ascites. CONCLUSION: It is highly recommended that a liver puncture under US guidance be performed taking into account the pattern of distortion of the puncture needle in each situation.

Artifacts↗
PubMed1996

Pain during arterial puncture.

STUDY OBJECTIVE: To quantify the level of pain reported by patients during arterial puncture with or without local anesthesia, and to compare the results with levels reported for venous puncture. DESIGN: Double-blind study of puncture with and without local anesthesia. SETTING: Pulmonary function laboratory, department of pneumology. PATIENTS: We studied 270 consecutive patients undergoing arterial puncture divided into two groups. In group A (n = 210), we assessed level of pain with and without local anesthesia and with placebo. In group B (n = 60), we compared pain of arterial and venous puncture. INTERVENTIONS: The arterial puncture was performed in the radial artery; venous puncture was in the median basilic vein. MEASUREMENTS AND RESULTS: The pain was quantified on a visual analog scale (10 cm). Mean level of pain for all arterial punctures without anesthesia or placebo was slight to moderate (3.01 +/- 1.94 cm). Subcutaneous anesthetic infiltration before arterial puncture significantly reduced pain by more than 50%, to 1.50 +/- 1.54 cm, a level that was significantly lower than the pain level reported after conventional venous puncture (1.80 +/- 1.10 cm). The pain reported by patients who received no anesthesia was not significantly different (p = 0.45) from that perceived by those who received subcutaneous infiltration of saline solution (placebo). CONCLUSIONS: Arterial puncture with prior infiltration of local anesthetic is the least painful procedure among those studied. Use of local anesthesia is indicated whenever conventional arterial puncture is required.

Anesthesia, Local↗
PubMed2001

Intrahepatic nuclear factor-kappa B activity and alpha 1-acid glycoprotein transcription do not predict outcome after cecal ligation and puncture in the rat.

OBJECTIVE: Sepsis is the leading cause of death in critically ill surgical patients. Septic hepatic dysfunction, an important determinant of outcome, is poorly understood but includes inappropriate transcriptional down-regulation. This may be modulated by proinflammatory cytokines. We hypothesized that intrahepatic changes in tumor necrosis factor (TNF)/interleukin (IL)-1-linked processes, such as the activation of the p50 homodimeric and the p65/p50 heterodimeric isoforms of the transcription factor nuclear factor (NF)-kappaB or transcription of the acute phase reactant alpha1-acid glycoprotein (AGP), would correlate with recovery from sepsis. DESIGN: Prospective experimental comparison of sham operation and nonlethal and lethal sepsis in male Sprague-Dawley rats. INTERVENTIONS: Nonlethal sepsis was induced by using single-puncture cecal ligation and puncture (CLP). Lethal sepsis was induced via double-puncture CLP. NF-kappaB DNA binding activity was determined by using electrophoretic mobility shift analysis with differentiation of p50/p50 and p50/p65 isoforms by using appropriate antibodies. AGP transcription was assessed with transcription elongation analysis, intrahepatic IL-1beta, and TNF-alpha abundance by using immunohistochemistry, and serum IL-1beta was assessed by using ELISA. MAIN RESULTS: Overall NF-kappaB activity increased equivalently over time after both single- and double-puncture CLP, with a peak occurring 3 hrs after intervention. In single-puncture CLP, there was an increase in the binding of the p50 homodimer form over time. After double-puncture CLP, no such change was observed. AGP transcription was increased equivalently in both models. Intrahepatic IL-1beta was detected 16 and 24 hrs after single-puncture CLP and 6 hrs after double-puncture CLP. After double-puncture CLP, intrahepatic TNF-alpha was detected at 6, 16, and 24 hrs. Serum IL-1beta was undetectable after both single- and double-puncture CLP. CONCLUSIONS: Although AGP transcription was similar in mild and fulminant sepsis, double-puncture CLP increased the binding activity of the p50 homodimer relative to binding of the p50/p65 NF-kappaB heterodimer. These results imply that transcriptional activity not linked to acute phase responses is an important determinant of outcome in sepsis.

Animals↗
PubMed1995

Hypersensitivity to substance P in the etiology of postlumbar puncture headache.

OBJECTIVE: Postlumbar puncture headache may represent a model which could be used to test the hypothesis that headache pain is caused by the release of substance P in patients who are predisposed to headache due to hypersensitivity to substance P. METHODS: We measured substance P in CSF and plasma in 37 patients undergoing diagnostic lumbar puncture. In 9 patients, plasma samples were obtained before lumbar puncture, in 28 patients plasma was obtained after lumbar puncture. Patients were followed up by telephone to determine if they developed postlumbar puncture headache. Patients were also asked about a history of chronic or recurrent headaches. Substance P was determined by radioimmunoassay. RESULTS: The mean plasma substance P levels obtained before lumbar puncture was 1.0 +/- 0.1 pg/mL and 1.3 +/- 1.2 after lumbar puncture (P < 0.0005). The mean plasma substance P levels in subjects who developed postlumbar puncture headache was 0.6 +/- 0.6 pg/mL compared with 1.4 +/- 1.5 in subjects who remained headache-free (P < 0.05). The mean CSF substance P levels in subjects who developed postlumbar puncture headache was 0.7 +/- 0.5 pg/mL compared with 1.2 +/- 0.8 in subjects who remained headache-free (P < 0.05). There were no significant differences in substance P levels between chronic headache sufferers and nonheadache subjects. CONCLUSIONS: Postlumbar puncture headache may be mediated by the release of substance P triggered by lumbar puncture, in patients predisposed to headache by a hypersensitivity to substance P. Hypersensitivity to substance P may also represent a mechanism for headache pain in other headache disorders.

Adult↗
PubMed2003

[A study on puncturing the temporomandibular joint cavity of rabbits and withdrawing synovia].

OBJECTIVE: The purpose of this study was to study the methods of how to puncture the temporomandibular joint (TMJ) cavity of rabbits and get the synovia. METHODS: The authors punctured joint cavity and withdrew the synovia from bilateral TMJ cavities of 12 New Zealand rabbits with different methods, such as the traditional puncture method, improved puncture, puncture under X ray, puncture guided by ultrasonography and spiral CT, and withdrawing synovia by micropump. RESULTS: Only one cavity was successfully punctured using the traditional puncture method. A total of 4 cases were successfully punctured using the improved method. X ray and ultrasonography did not locate the TMJ cavity precisely. The spiral CT helped observation and puncture. However, the above methods did not work in collecting synovia. The method of micropump withdrew synovia successfully. CONCLUSION: The improved method and spiral CT are efficient methods to precisely puncture TMJ cavity. The technique of micropump successfully resolves the problem of withdrawing synovia.

Animals↗