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At least 1,261 records · Page 70Linked to original sources
PubMed1993

[A new method for the localization of atrial septal puncture by using atrial septal electrocardiogram].

A new method for the localization of atrial septal puncture was reported, which is the key technique for percutaneous balloon mitral valvuloplasty. When the exploratory electrode was laid against the fossa ovalis floor (FOF), the atrial septal electrocardiogram registered only a slight or no injury curve; when the exploratory electrode pressed on any other area of the atrial septum or atrial walls, a bizarre monophasic injury curve was elicited in the atrial septal electrocardiogram. Based on different patterns of the atrial septal electrocardiogram between the muscular atrial septum and FOF, the sites of atrial septal puncture were successfully localized by using a Brockenbrough needle as an exploratory electrode in all of the 10 cases without any complication. By using this technique, no cardioangiography is needed to show the outline of the left atrium and also the bilateral projection catheterization bed. So this method is convenient, practical and precise.

Adolescent↗
PubMed1977

Fetal puncture during midtrimester amniocentesis.

Four cases of fetal puncture during midtrimester amniocentesis are reported; in one instance the baby apparently sustained temporary neurologic damage. None of the lesions was detected at the initial neonatal examination. From our data and a review of the literature, we estimate that fetal puncture occurs in 1-3% of midtrimester amniotic taps. The implications of the accident are not clear. We conclude that midtrimester amniocentesis should not be considered a routine benigh procedure; and whenever the use of this diagnostic modality is being considered, the prospective parents should be informed of its hazards.

Adult↗
PubMed1993

[Echo-guided puncture of intraprostatic cysts].

The occurrence of an obstruction of the ejaculatory ducts, in spite of its rarity, must be considered by the Urologists in the screening of the etiologic causes of obstructive azoospermia. Nowadays, the diagnostic approach, which includes the biochemical study of seminal plasma and prostatic ultrasound, often leads to the preoperative recognition of the site of obstruction. Various surgical and endoscopic techniques have been adopted for the treatment of ejaculatory duct obstructions in different historical periods. Herein we describe our experience that starts from 1979. 17 infertile patients with intraprostatic cysts and 2 with a stenosis of the veru montanum were treated by us following these criteria: 9 azoospermic patients underwent scrototomy and endoscopy; 10 patients with a severe oligozoospermia underwent echo-guided puncture of an intraprostatic cyst. The patients were placed in the lithotomy position, a 16 G needle was adopted and by means ultrasound was possible to follow the needle entering the cyst. When no spermatozoa was detected in the cystic liquid, sclerosing agents (Sodium-tetradecyl-sulphate 30 mg in 1 l.) was introduced. This easy procedure was carried out on outpatients in local anaesthesia. One out of ten oligozoospermic patients had to repeat the echo-guided puncture of intraprostatic cyst as the first attempt had been followed by recurrence. Eight out of ten subfertile patients who had undergone percutaneous echo-guided treatment had longer than 1 year follow-up: in seven cases an increase in sperms number and motility was obtained; in one case sperm count remained unmodified. In three cases the partners became pregnant.

Adult↗
PubMed1977

Lumbar puncture in infants and young children.

Lumbar puncture is an important diagnostic procedure in infants and young children, particularly to rule out acute meningitis. Special problems are presented to the physician with respect to technique and interpretation in this age group. This paper discusses lumbar puncture in infants and young children with attention given to certain procedural details (including the use of the Butterfly Infusion Set) and to significant differences in interpretation of findings in the cerebrospinal fluid in the newborn.

Age Factors↗
PubMedDate not supplied

Prolonged placement of spinal catheters does not prevent postdural puncture headache.

OBJECTIVE: To determine whether leaving an intrathecal catheter in place in the postoperative period prevents postdural puncture headache (PDPH). METHODS: Lumbar puncture was performed with an 18-gauge Tuohy needle. 0.5% bupivacaine spinal anesthesia was given through a 20-gauge catheter in 87 patients having orthopedic surgery. Postoperatively, patients were allocated randomly to have the catheter immediately withdrawn (group 1, N = 47) or kept in place for 12 to 24 hours (group 2, N = 40). Patients were questioned by a blinded observer, about PDPH twice a day on postoperative days 1, 2, 3, and 8. RESULTS: The incidence of PDPH was 9.2%, and this was comparable in the two groups (5 patients in group 1 and 3 patients in group 2). CONCLUSION: Leaving the intrathecal catheter in place in the postoperative period for 12 to 24 hours does not prevent PDPH.

Adult↗
PubMed1996

[Local vascular complications after iatrogenic femoral artery puncture].

Over a period of 5 years 81 vascular complications after 15,460 catheterizations of the femoral artery for diagnostic (n = 11,883) or therapeutic (n = 3577) procedures were registered. The following complications were observed in declining frequency: 1. False aneurysm (n = 65), 2. arterial occlusion (dissection, embolia, thrombosis) (n = 8), 3. vascular lesion causing profuse bleeding (n = 7), 4. AV-fistula (n = 1). The total complication rate was 0.52%. The complication rate was significantly higher in therapeutical procedures (1,03%) than in diagnostic investigations (0.37%). Pseudoaneurysms were complicated by thrombosis of the femoral vein (n = 3), lymphatic fistula (n = 3) and deep wound infection (n = 9); secondary complication rate 18.5%. Risk factors for local vascular complications are old age, female gender, high grade arteriosclerosis at the puncture site, overweight, manifest arterial hypertension and medication with cumarin, acetylsalicylic acid or heparin. Further complicating factors are connected with technical risks such as duration of the procedure. French size of the catheter, the catheter sheath and multiple punctures. Vascular repair was performed by simple angiography in most cases, but in 14.8% more extensive surgical procedures were required. In patients with signs of occlusive vascular disease the external iliac artery was replaced by a PTFE-vascular access graft in 4 cases and an arterioplasty of the deep femoral artery was performed in 2 patients. 36% of the operations were undertaken as emergencies. Reintervention was necessary for a postoperative bleeding complication in 1 case (surgical complication rate 1.2%). A female patient suffering from aortic valve stenosis died during emergency operation due to massive retroperitoneal hemorrhage after cardiac catheterization (mortality rate 1.2%). Over a median follow-up period of 37 months no late complications of the intervention were recorded, nor recurrences of peripheral arterial occlusive disease.

Aged↗
PubMed1995

[Lumbar puncture with a fine needle].

26-Gauge fine needle for lumbar puncture allows lower rate and intensity of post lumbar puncture syndrome. This technique drammatically decreases discomfort in patients who undergo myelography and helps in keeping this imaging modality indicated when necessary.

Headache↗
PubMed1996

Limb and other postcranial skeletal defects induced by amniotic sac puncture in the mouse.

A mouse model for studying the teratogenic effects of amniotic sac puncture has recently been established (MacIntyre et al. 1995), and the anomalies encountered included cleft palate, limb and tail abnormalities, and postural deformities. In order to investigate the underlying mechanism(s) involved, mouse embryos subjected to amniotic sac puncture on day 13 of gestation were examined externally on day 19, then 'cleared' and bulk stained with alizarin red S and Alcian blue to reveal, respectively, their bony and cartilaginous elements. This procedure allowed a comparison to be made between the incidence of soft tissue anomalies of the distal parts of the limbs and the appearance of the underlying skeletal elements. Despite a high incidence of soft tissue (principally digital) anomalies, relatively few skeletal anomalies were encountered. Measurements of intact long bones, and regions of ossification, were made in the major long bones of 'nonexperimental' and 'internal' controls and 'experimental' fetuses that displayed external morphological malformations to establish whether the experimental procedure had a greater effect on the proximal or distal components of the limb skeleton. No significant difference was observed when the ratios of proximal: distal length were compared with those obtained from the control series. The degree of severity of 'clubhand' and 'clubfoot' deformity was determined, and a comparison made between the severity observed on the right and left sides. This analysis revealed that for 'clubhand', the left forelimb was more severely affected than the right forelimb. The incidence of 'clubfoot' deformity was similar between the 2 sides. A possible explanation for this asymmetric effect is provided. An unexpected finding was the abnormal pattern of ossification seen in the sternum of two thirds of the 'experimental' fetuses that displayed external morphological malformations. This abnormal pattern was seen in none of the controls nor in fetuses in the 'experimental' series that displayed no external morphological malformations.

Amnion↗
PubMed1995

[The puncture of the knee].

Knee puncture for arthrography via a lateral parapatellar approach is described. Direct puncture of the femorotibial space, via a ventral approach, is more painful and should only be used when the lateral parapatellar route is not possible, namely in case of complete suprapatellar plica.

Arthrography↗
PubMed1996

[The usefulness of percutaneous transhepatic cholecyst puncture (PTCCP) with ultrasoundimage control for acute cholecystitis].

Percutaneous transhepatic cholecyst puncture (PTCCP) is a unique treatment for acute cholecystitis by using of 21 gauge PTC needle with ultrasoundimage control. The procedure is as follows. A percutaneous transhepatic puncture of the gallbladder is made with ultrasonic guidance. After suction removal of the contents of the gallbladder, saline with antibiotics is injected. Finally PTC needle is removed after removal of the injected saline. We carried out PTCCP in 35 patients with acute cholecystitis, and compared its clinical effect with those of PTCCD (46 cases) or conservative treatment of antibiotics administration (38 cases). The treatment of PTCCP removed the clinical symptoms of acute cholecystitis rapidly compared with the conservative treatment and it made the hospitalization shorter compared with the treatment of PTCCD. PTCCP was also performed without any severe complications for patients with underlying diseases. The curative rate of PTCCP was the same as those of other former treatments. It was concluded that PTCCP is a safe, convenient, and useful treatment of acute cholecystitis.

Acute Disease↗
PubMedDate not supplied

Microscopic analysis of the tips of thin spinal needles after subarachnoid puncture.

BACKGROUND AND OBJECTIVES: Foreign material may pass unrecognized with the spinal needle into the subarachnoid space. Therefore the tips of three clinically used types of spinal needles--Quincke (27-gauge), two-zone bevel (26-gauge), and Sprotte or pencil point (27-gauge)--were prepared for microscopic analysis after subarachnoid puncture in human cadavers. METHODS: Three cadavers were placed in the lateral position, the backs were scrubbed with disinfectant solution containing 0.1% fluorescein, and 12 needles of each type (half of them through an introducer) were inserted via interspaces L2-L5 into the subarachnoid space. Under visual control (spinal canal opened), the needle tips were cut and collected for fluorescence microscopy. Another eight needles of each type (half through an introducer) were inserted, the tips were collected into tubes filled with physiologic saline, and cytocentrifuged smears of the eluted material were made. RESULTS: On microscopy, only one of the two-zone bevel needles and two of the pencil point needles, placed through an introducer, were without attachments. All the others had variable amounts of fluorescence, and visible tissue particles adhered to the tip. The largest particles appeared on two of the Quincke needle tips. Bent tips were seen on 7 of the 12 two-zone bevel needles. The Quincke group had two and the pencil point group no bent needle tips. Clusters of epithelioid cells were seen in the cytocentrifugation smears of Quincke and two-zone bevel needle tips, but only very few cellular clusters were seen in the smears from the pencil point needle tips. CONCLUSIONS: Of the three needle types studied, the pencil point type has a tip that best withstands distortion and adherence of foreign material during experimental subarachnoid puncture.

Aged↗
PubMed1977

Acute spinal subdural hematoma following lumbar puncture.

A case of acute spinal subdural hematoma following lumbar puncture in a patient with a normal coagulation profile is reported. Lumbar myelography may be unsuccessful. Other methods of myelography (via cisternal or lateral cervical puncture) to corroborate a block may be made or a laminectomy at the proper clinical level without further studies may be indicated.

Aged↗
PubMedDate not supplied

An in vitro comparison of fluid leakage after dural puncture with Atraucan, Sprotte, Whitacre, and Quincke needles.

BACKGROUND AND OBJECTIVES: The study was designed to evaluate the influence of needle size and design on the rate of leakage following dural puncture. METHODS: An in vitro model and fresh human lumbar dura were used to examine the rate of fluid leakage after puncture with Sprotte (24-gauge and 26-gauge), Atraucan (24-gauge and 26-gauge), Quincke (26-gauge and 29-gauge), and Whitacre (22-gauge and 25-gauge) needles. RESULTS: The study confirmed that finer-gauge needles tend to produce less leakage and that traditional Quincke pattern bevels result in greater leakage than pencil-point designs of the same diameter. CONCLUSIONS: The comparably low leakage rate produced by the Atraucan, a new needle with a terminal opening, suggests that this needle is worthy of further clinical evaluation.

Anesthesia, Epidural↗
PubMed1996

[Post dural puncture headache (PDPH) which occurred after the removal of an epidural catheter].

A 57-year-old man received gastrectomy under general anesthesia combined with epidural anesthesia. He showed no signs of dural puncture and catheter migration into the subarachnoid space. Cardiovascular status was stable with epidural injection of lidocaine, morphine during the operation. Although epidural morphine and buprenorphine infusions were continued for 1 to 6 postoperative days, respiratory depression and other side effects were not observed. However, severe headache in the upright position occurred after stopping these infusions and the removal of the catheter on the 7th postoperative day. The headache was thought to be caused by unintentional dural puncture. PDPH persisted over a period of 30 days and was treated with an epidural blood patch and stellate ganglion blocks since the other conservative therapy had been ineffective. We consider that administration of continuous epidural opioids for postoperative analgesia helped to prevent PDPH until the 7th postoperative day. We also conclude that prolonged PDPH after using a thick needle like a Touhy needle should be treated by an epidural blood patch.

Anesthesia, Epidural↗
PubMed1996

[Forensic medical implications of vascular punctures and catheterization and radiologic procedures with diagnostic or therapeutic purpose].

Whatever the aim of the procedure, puncture of a vessel can lead to local complications. Access to the artery carries a risk of hemorrhage, occlusion, stenosis, arteriovenous fistulization or pseudo-aneurysm. The same types of complications can occur in veins. Other complications include skin necrosis due to extravasation of the contrast medium, perforation of the superior vena cava after insertion of an infusion catheter and the risk of pericardial effusion. General complications occur immediately, usually caused by contrast media, or late. There are different examples of secondary legal procedures following punctures involving, with the exception of radiology cases, intraarterial injection at the elbow, perforation of the right atrium by a jugular catheter and acute ischemia of the foot after catheterization of the pedial artery. Legal procedures after radiological procedures were discussed in more detail. The personal experience of the authors and others concerns accidents occurring after arteriography, angioplasty or embolization. Finally, two legal cases after treatment for impotency are analyzed. We focus on a certain number of rules on patient information, preangiography consultation, participation of an anesthetist, careful post-operative follow-up and operation report. Finally, the possibility of radiation-induced arteriopathy is demonstrated by one case reported here.

Angiography↗
PubMed1997

The incidence of post dural puncture headache in Taiwanese patients undergoing cesarean section.

BACKGROUND: In Taiwan, there was only a retrospective study about the post-dural puncture headache (PDPH) resulting from spinal anesthesia for cesarean section (C/S), but it did not mention the relationship between the incidence of PDPH and the number of dural punctures, as well as between the gauge of spinal needle. Therefore, we designed a prospective study to investigate if the spinal needles for smaller gauges could decrease the incidence of PDPH in anesthesia for C/S. METHODS: From Jan. 1990 to June 1991 we prospectively observed 2,385 consecutive cases of spinal anesthesia for various types of surgical procedures, of which 584 were C/S. The spinal needles used were of gauges 24, 25 and 26. In practice, needles of these gauges were randomly applied. The PDPH was observed until its disappearance, and nonexistence of PDPH was also followed for at least one week. All of the data were analyzed using the Fisher exact test. RESULTS: The overall incidence of PDPH was 1.18%. The incidence of PDPH in C/S females was 3.08%, which was significantly higher than that in non-obstetric females (0.37%). Although the incidence in all females (1.31%) was significantly higher than that in males (0.71%), the incidence in non-obstetric females (0.37%) did not differ significantly compared with males. The incidence of PDPH relevant to the gauges of spinal needle used was not statistically different in C/S females. CONCLUSIONS: It appears that the incidence of PDPH does not differ between Taiwanese and Westerners. Pregnancy may be the key factor contributing to higher incidence of PDPH. The 26-gauge spinal needle may lower the incidence of PDPH to a greatest extent in C/S patients, although in comparison with 24- and 25-gauge needles the difference is not statistically significant.

Adolescent↗
PubMed1997

Post dural puncture headache in cesarean section: comparison of 25-gauge Whitacre with 25- and 26-gauge Quincke needles.

BACKGROUND: Our previous study showed that there were no significant differences in the incidence of post dural puncture headache (PDPH) relevant to the use of 24 to 26-gauge Quincke spinal needles in obstetric patients. Again, we were eager to know if the pencil-point spinal needle (Whitacre) would be able to decrease the incidence of PDPH compared to Quincke spinal needle. METHODS: We prospectively observed 94 spinal anesthesias for cesarean section performed during the period from May 1993 to July 1995. The 25-gauge Whitacre needles were used. In practice the insertion of needle was made through median line approach and the puncture was considered eligible only in one attempt. The PDPH was observed until its disappearance, and one without PDPH had also been observed for at least one week for likelihood of delayed occurrence. The data were compared with those of our previous study regarding the use of 25- and 26-gauge Quincke needles in obstetric patients. All of the data were analyzed using the Fisher exact test. RESULTS: The incidence of PDPH was 1.06%. In comparison there was no significant difference from that of 25- and 26-gauge Quincke needles (3.65% and 2.06%, respective). Only one case suffered from PDPH in the Whitacre group. It was mild and relieved with bed rest and hydration. CONCLUSIONS: Although the difference was not statistically significant, the 25-gauge Whitacre spinal needle caused a lower incidence and less severity of PDPH than the 25- and 26-gauge Quincke needles did.

Adult↗
PubMed1997

[Ultrasound-guided transvaginal puncture of ovarian cysts].

Ultrasound-guided transvaginal aspiration of ovarian cysts offers a simple outpatient strategy for immediate pain relief and effective treatment but bears the risk of an iatrogenic spread of malignant cells. This study evaluated the cellular composition of the cyst fluids in a group of 26 sterility patients, in all of whom one or more ovarian cysts had been diagnosed and punctured. None of the patients had complications or evidence of malignant cells on cytological examination after the puncture. Only in one case dyskariotic cells were diagnosed causing an operative exploration that revealed a benign tumour. In 9 patients the ovarian cysts recurred and therefore 2 patients finally underwent an exploratory operation. In our opinion transvaginal ultrasound aspiration of functional cysts is an easy and safe procedure and may be undertaken in sterility patients in the context of specific criteria.

Adult↗