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At least 1,279 records · Page 71Linked to original sources
PubMed1997

Pneumocephalus and respiratory depression after accidental dural puncture during epidural analgesia--a case report.

A case of pneumocephalus and respiratory depression after dural puncture during lumbar epidural analgesia is reported. The loss of resistance to air technique was employed to identify the epidural space. Severe respiratory depression and stuporous consciousness developed one hour after a bolus of 2 mg morphine was given epidurally at the end of operation. With computerized tomographic brain scanning and continuous observation of clinical course, the neurologic symptoms were thought to be a mixed complication of pneumocephalus and possible intrathecal morphine overdose. We suggest that in order to avoid iatrogenic pneumocephalus by inadvertent dural puncture in the attempt to identify the epidural space the use of the loss of resistance to normal saline technique or the hanging-drop technique is more reliable than the loss of resistance to air technique. A small test dose prior to a full dose is given and should not be omitted to further confirm the proper placement of the epidural catheter during epidural analgesia.

Aged↗
PubMed1997

[Puncture sclerosing treatment of nonparasitic liver cysts].

The article describes the method and results of the puncture sclerotherapy of nonparasitic liver cysts in 30 patients. Cooled to -28 degrees C 96% ethyl alcohol was used as a sclerosing agent. The total destructive effect of the agent was obtained due to the combination of its chemical and physical (temperature) factors. Complete recovery was obtained in 86.6% of the patients. The puncture sclerotherapy can be used as a medical alternative for nonparasitic liver cysts.

Cysts↗
PubMed1998

Blood gas measurement during exercise: a comparative study between arterialized earlobe sampling and direct arterial puncture in adults.

Sampling arterialized earlobe blood is thought to be easier and less painful than direct arterial puncture, and to allow measurement of blood gas values during exercise without the need to insert an arterial cannula. However, arterialized earlobe oxygen tension (PO2) often underestimates arterial PO2 at rest, and is not fully validated during exercise. We have therefore conducted a prospective study to compare values of PO2 and carbon dioxide tension (PCO2) and the discomfort experienced by adult subjects undergoing the two methods of blood sampling during exercise. Seventy consecutive adult patients were studied. Blood samples were drawn simultaneously from the radial artery and arterialized earlobe of each patient during the last minute of an 8 min exercise. Values of PO2 and PCO2 were measured by means of blood gas electrodes. The correlation coefficients between the two samples were 0.92 for PO2 and 0.91 for PCO2. However, the bias and the limits of agreement between the two methods were wide for PO2 (mean+/-2SD of the differences between the two methods: 0.63+/-1.50 kPa (4.7+/-11.2 mmHg)). The bias and the limits of agreement were smaller for PCO2. Patients felt that the earlobe method was not associated with less discomfort than radial artery puncture. We conclude that arterialized earlobe blood oxygen tension is not a good substitute for arterial oxygen tension during exercise, and should not be used to assess arterial oxygen tension in adults during exercise.

Adult↗
PubMed1998

The effect of fibrin glue patch in an in vitro model of postdural puncture leakage.

UNLABELLED: We studied the possibility of stopping a continuing transdural leakage with fibrin glue, a biologic adhesive, in an in vitro model. The model was made by sealing the bottom of a tube filled with saline to a height of 50 cm with a human lyophilized dural specimen. Dural punctures were performed with a 17-gauge Tuohy needle. The needle was then withdrawn, and 0.8 mL of fibrin glue was injected through the same needle to seal the defect. The column was refilled 3 min after sealing. The pressure in the intrathecal chamber was measured during the procedure. Macroscopic and microscopic histological studies of the dura and the fibrin plug were performed. In the five cases studied, the leak was sealed by the fibrin plug at closing pressures of 25-35 cm H2O, and no further leakage was detected after refilling. The dural specimens showed a fibrin glue plug stuck at the edges of the hole. We conclude that fibrin glue stops leakage of fluid from dural holes created by a 17-gauge Tuohy needle in an in vitro pressurized model. IMPLICATIONS: We explored the possibility of repairing a cerebrospinal fluid leak produced by an accidental dural puncture during epidural anesthesia by percutaneously injecting tissue adhesive in vitro. This technique seems promising for the prophylaxis and treatment of the headache associated with this leakage but requires further study in vivo.

Dura Mater↗
PubMed1988

Squamous cell papilloma at the tracheoesophageal puncture stoma.

Over 140 tracheoesophageal punctures were performed at the Cleveland Clinic Foundation, Department of Otolaryngology and Communicative Disorders over the last seven years. In all cases the Blom-Singer duckbill prosthesis was utilized for alaryngeal voice restoration. Of these patients, two examples were noted where squamous cell papilloma was found at the tracheoesophageal stoma site. The preoperative evaluation and surgical laser technique for surgical excision of the papilloma with postoperative care are described. The case reports of each of the patients that have been diagnosed as having squamous cell papilloma of the tracheoesophageal puncture site are reviewed.

Esophagostomy↗
PubMed1989

Secondary tracheoesophageal puncture for voice rehabilitation after laryngectomy.

Since the introduction of the tracheoesophageal puncture technique for restoration of voice in 1980, 125 secondary punctures have been performed in 117 patients at the Cleveland Clinic Foundation. Preoperative evaluation, pharyngeal preparation, and their relation to final speech results were reviewed retrospectively. Critical factors in the rehabilitation of these patients are discussed based on our experience and a review of the literature.

Adult↗
PubMed2003

Effect of patient position on size and location of the subclavian vein for percutaneous puncture.

HYPOTHESIS: Large-bore subclavian intravenous access is important during trauma resuscitation and to provide central access in the intensive care unit. Controversy exists as to the patient position that best facilitates the insertion of this line. Duplex scanning of the subclavian vein in different body positions may help define which provides the largest vein size and distance from the clavicle. DESIGN: Prospective comparison study in healthy humans. SETTING: Clinical research laboratory. SUBJECTS: Ten healthy volunteers. INTERVENTIONS: We examined the left subclavian vein diameter, position from clavicle, and flow in subjects placed in 5 different positions advocated for subclavian vein puncture. A duplex scanner was used to image the subclavian vein with B-mode ultrasonography and to detect flow rates with a Doppler probe. The different subject positions were as follows: (1) flat (or supine), head and shoulders neutral; (2) flat, head neutral, shoulders arched; (3) flat, head opposite, shoulders arched; (4) Trendelenburg, head opposite, shoulders arched; and (5) Trendelenburg, head and shoulders neutral. RESULTS: The mean (SEM) diameter of the subclavian vein is largest in position 5 (0.99 [0.06] cm) and smallest in position 2 (0.84 [0.05] cm). The distance of the vein from the clavicle is greatest in position 1 (0.94 [0.08] cm) and least in position 4 (0.75 [0.07] cm). Using an analysis of variance with Dunnett's comparison, all positions were compared with position 5. For vein diameter, all positions had significantly smaller size. In position 4, the vein was significantly closer to the clavicle. There was no statistical difference in flow rates among all positions. CONCLUSIONS: These data demonstrate that arching of the shoulders and turning of the head may reduce target size and provide an unsatisfactory position for subclavian puncture. The Trendelenburg position with no other positioning maneuvers may be helpful.

Adult↗
PubMedDate not supplied

Secondary tracheoesophageal puncture: factors predictive of voice quality and prosthesis use.

OBJECTIVE: To identify factors predicting prosthesis use and final speech quality in patients undergoing secondary tracheoesophageal puncture (TEP) for voice restoration alter laryngectomy. METHODS: We undertook a retrospective study of 168 patients who underwent secondary TEP at the Cleveland Clinic between June 1980 and October 1993. Factors examined were: patient demographics, extent of initial surgery, method of pharyngeal preparation, history of irradiation, insufflation test results, pharyngeal stricture, and concurrent medical conditions. Univariate and multivariate statistical analyses were performed to identify predictive factors. RESULTS: At last evaluation, 73.8% (124) of the patients were still using the prosthesis. Quality of speech was the only predictor of prosthesis use (p < .001). Phonation on the first day was achieved in 90% (151) of patients. Speech result improved significantly over the first 6 months (p < .001). Univariate analysis found that the need for reconstruction at laryngectomy (p = .04), the presence of pharyngeal stricture (p = .001), and continued prosthetic use (p < .001) were associated with the speech result. There was no significant advantage to the lack of approximation of the pharyngeal constrictors (p = .31). Stepwise logistic regression showed that only the absence of pharyngeal stricture was associated with a better-quality voice (p = .001). CONCLUSION: Tracheoesophageal puncture is a reliable method for restoring voice after laryngectomy. Prosthesis use decreases with time, and good voice quality is the only predictor of continued prosthesis use. In this series the absence of pharyngeal stricture was the only significant predictor of good to excellent speech.

Adult↗
PubMed1984

Puncture marks on early African anthropoids.

Field studies of living primates have shown that primate predation is a rare event. This must also have been true for past primate communities. In the Fayum Oligocene of Egypt, specimens of all four species of Upper Fossil Wood Zone primates show evidence of tooth puncture marks. Of the four potential groups of primate predators--the snakes, the raptors, the crocodiles, and the primitive carnivores or creodonts--only the crocodiles and the creodonts could have made these puncture marks. When one compares the feeding habits of living crocodiles and mammalian carnivores with the evidence from the Fayum, it appears that the Fayum primates were preyed upon and/or scavenged by mammalian carnivore-like animals. The dismemberment of the Fayum primates by Oligocene predators indicates, in part, why the Fayum fossil material is rarely articulated. Bone damage by predators may well set limits on what bone associations can be discovered in the Fayum even before the bones are scattered and buried by depositional processes.

Alligators and Crocodiles↗
PubMedDate not supplied

Tracheogastric puncture for vocal rehabilitation following total pharyngolaryngoesophagectomy.

Speech rehabilitation postpharyngolaryngoesophagectomy has not received significant emphasis. We describe our experience with five patients who underwent a delayed tracheogastric puncture (TGP) after pharyngogastric anastomosis. When compared to patients who had undergone tracheoesophageal puncture (TEP) after laryngectomy, speech intelligibility and fluency were adequate for conversational speech, but voice quality was characterized by lower pitch, reduced intensity, slower rate, and a "wet" quality. There were no complications related to the TGP. TGP is a safe and often useful procedure for voice and speech restoration in patients who have undergone total pharyngolaryngoesophagectomy and pharyngogastric anastomosis.

Aged↗
PubMed1991

Effect of vascular puncture on blood gases in the newborn.

Continuous monitoring methods have shown changes of oxygenation in neonates during various procedures. However, actual changes in blood gases during vascular punctures have not been reported. We studied the effect of vascular puncture on arterial blood gases during routine venipuncture in 17 neonates who had indwelling arterial catheters. Arterial blood gases were analyzed before, during, and following recovery from venipuncture. Ventilator settings were not changed during the study, though oxygen concentration (FiO2) was adjusted as indicated by continuous PO2 or saturation monitors. During venipuncture, there was a significant fall in PaCO2 from 38 +/- 5 to 32 +/- 7 mmHg (P less than 0.0001) and in PaO2 from 75 +/- 21 to 58 +/- 23 mmHg (P less than 0.0001). Following venipuncture, both values returned to baseline. The results of this study imply that blood gases obtained by intermittent arterial sticks may provide data that do not accurately reflect the neonates' respiratory status.

Blood Gas Monitoring, Transcutaneous↗
PubMed1989

Isolated phrenic nerve injury after apparently atraumatic puncture of the internal jugular vein.

Vascular lesions due to subclavian and internal jugular vein puncture may result in hematomas, which are usually clinically evident. While mostly benign, some of these hematomas can cause compression of the surrounding structures. When the hematoma is obvious, straightforward correlation can be made between the symptoms, for instance nerve compression, and the clinical signs. We present a case where we missed the diagnosis of phrenic nerve paralysis, which occurred after an unsuccessful, but apparently atraumatic attempt to puncture the internal jugular vein, prior to cardiac surgery. At the time the diagnosis was made (8 days post-op), the radiographic appearance of the neck was normal, and further investigation (i.e., CT-scan) had become pointless. A retrospective study of serial chest X-rays disclosed a space occupying lesion in the right lateral neck that displaced the nasogastric tube. This abnormality could only be seen on the first film and disappeared on the following. Since phrenic nerve paralysis is extremely rare in our institution, even after cardiac surgery, and as there was no clinical evidence of hematoma, our attention was not been drawn to the only definite sign that could have led to an early diagnosis.

Adult↗
PubMed1982

Percutaneous puncture of spinal cysts in the diagnosis and therapy of syringomyelia and cystic tumors.

The experience with percutaneous puncture of intraspinal cystic lesions is reported in four cases: an extradural cyst demonstrated with air, a spinal cord tumor with lipiodol and two cases of syringomyelia with metrizamide. Percutaneous puncture of cystic lesions makes possible an accurate delineation of the lesion and a histological approach through biochemical and cytological analysis of the aspirated cystic fluid, while aspiration of the fluid of cystic tumors decompresses the spinal cord and thus plays a therapeutic role.

Adult↗
PubMed1982

Cell puncturing with a step motor driven manipulator with simultaneous measurement of displacement.

A small angle stepping motor was used for construction of a micropositioner. Linear movements are produced by direct coupling of the rotor axis to high precision microdrive. The linearly moving system is constructed from stainless steal prismatic guides with hardened surfaces and permits precise steps in the 100 nm range. Extreme reduction of the moving masses and minimal friction of the radial thrust bearing enables strong acceleration of the electrode. During simultaneous measurements of step performance motoneurons in the frog spinal cord, CA 1 cells of hippocampal brain slices and glia cells in tissue culture were punctured with single electrodes (tip less than l micron and double barrelled ion-sensitive microelectrodes (phi 1,5-2 micron). In all three preparations, cell penetration could be performed by means of both types of electrodes with a high yield when the step velocity reached or exceeded 4 mm/s. Steps with lower velocity resulted in less successful cell penetrations and were accompanied by typical dimpling effects. The results indicate that a critical velocity is required for cell puncturing with a minimum of damage.

Animals↗
PubMed1986

Transvaginal sonographically controlled ovarian puncture for oocyte retrieval for in vitro fertilization.

Two hundred twenty-two patients took part in a trial of follicle puncture via the transvaginal route under sonographic control for the purpose of in vitro fertilization (IVF). Induction protocols were mainly human menopausal gonadotropin (hMG) + human chorionic gonadotropin (hCG) and clomiphene + hMC + hCG. In 79.7% oocyte aspiration could be achieved without difficulty via the transvaginal route. An average number of 4.7 oocytes per attempt was obtained; 10.7% evolutive pregnancies were obtained. No major incident was noted. This technique offers several crucial advantages: it reduces surgical risk, reduces the length of the patient's stay in hospital as well as the overall cost of the procedure, and it also makes possible puncture in some cases hitherto regarded as excluded.

Female↗
PubMed1997

Flow characteristics of soft-tissue vascular anomalies evaluated by direct puncture scintigraphy.

Soft-tissue vascular anomalies such as haemangioma and vascular malformation are treated by surgical resection, arterial embolization or sclerotherapy. Because the effect of sclerotherapy, i.e. the percutaneous injection of sclerosing agents, depends on intralesional haemodynamics, estimation of flow characteristics of soft-tissue vascular anomalies is essential when determining appropriate patient management. However, lesions are at present divided into only two groups: high flow and low flow. We have developed a new method, direct puncture scintigraphy, to evaluate in detail the haemodynamics of vascular anomalies under conditions simulating sclerotherapy. Twenty-six soft-tissue vascular anomalies in 21 patients were studied. After 30 MBq of technetium-99m Sn colloid was injected percutaneously into the intravascular space of the lesion, dynamic imaging was performed for 5 min. A time-activity curve for the lesion was generated, with the infiltrated activity on injection subtracted. A monoexponential curve was fitted to the declining phase of the time-activity curve, and mean vascular transit time (MTT) was obtained. The lesions were classified into high-flow and low-flow lesions based on radionuclide angiography with intravenous injection of 99mTc-labelled red blood cells, and estimates of MTT in the two groups were compared. The imaging procedures were carried out with no major complications, and broad intralesional diffusion of 99mTc-Sn colloid was achieved in most lesions. The high-flow lesions (six lesions) had a short MTT, ranging from 1.6 to 3.4 s, while the low-flow lesions (20 lesions) had a longer MTT, with no overlap between the groups. MTT showed a wide range in low-flow lesions: it was less than 30 s in six lesions and more than 10 min in five other lesions. Direct puncture scintigraphy provides a quantitative indicator of the flow characteristics of soft-tissue vascular anomalies, and may aid in determining treatment strategies for patients with vascular anomalies.

Adolescent↗
PubMed1996

Hook-needle puncture. A new technique of local anesthesia for anorectal surgery.

PURPOSE: Anorectal surgery has been increasingly performed as an ambulatory procedure using general, regional, and local anesthesia. Local anesthesia is classically performed through infiltration of four quadrants around the anal verge, which renders the procedure painful and uncomfortable for most surgeons and patients. We present a new, painless technique of local anesthesia for anorectal surgery. METHODS: Patients with surgical risk Classes I and II (American Society of Anesthesiologists) bearing anorectal pathologies were sedated and placed on the operating table in the prone jackknife position. After local antisepsis, the anal canal was lubricated with 2 percent lidocaine gel, and the mucosa was punctured by a hook-shaped, curved, 22-gauge needle just above the pectinate line. A solution of local anesthetics was slowly infused in all four quadrants to the submucosal level. If needed, more anesthetics were infused during the operation. RESULTS: This technique was easily and painlessly applied in more than 60 patients and permitted execution of several ambulatory anorectal procedures with comfort and safety. CONCLUSIONS: The hook-needle puncture for local anesthesia is an effective and safe procedure and may be routinely used for ambulatory anorectal surgery in selected patients.

Ambulatory Surgical Procedures↗
PubMed1984

Results of 317 transrectal puncture biopsies of the prostate.

The results of 317 transrectal puncture biopsies of the prostate, performed during eight years, are reported. In applying the method even in cases of the slightest suspicion of prostatic carcinoma arising on digital examination, the rate of positive findings in 45.4%. Complications are few and mild. The advantages which make transrectal puncture biopsy of the prostate the method of choice in a large number of cases are discussed.

Adenoma↗