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PubMedDate not supplied

Resistance of fetal membranes to concentrated force applications and reconciliation of puncture and burst testing.

To further the characterization of the chorioamniotic membrane's physical properties, we assessed its ability to withstand a concentrated force. Probes of various diameters were used to puncture 275 specimens from 11 membranes. Values for "strength"/thickness, "stiffness"/thickness, and "toughness"/thickness all showed positive linear correlations (p < 0.001) with the increase of d/D, the ratio of probe diameter to specimen diameter. "Ductility" was independent of diameter, though a logarithmic regression did fit the data marginally (p < 0.05). The separate fracture of the amnion and chorion, which is reflected in ductility measurements, results in an increase in the distance the membrane can be deflected in vitro. In vivo, this behavior would translate to a reduction of pressure exerted on the remaining membrane, while the integrity of the protective sac is maintained. The data pool of mechanical characteristics was enlarged by reconciling data that were gathered by either of two testing methods: puncturing or bursting; the latter method involves the application of force over the entire surface of the test specimen.

Elasticity↗
PubMed1987

Belt device for simplified CT-guided puncture and biopsy: a technical note.

A new radiolucent device for increased accuracy of CT-guided fine-needle punctures permits precise determination of the optimum angle, depth, and position of the fine needle, which can be preset from the data supplied on the CT monitor. Puncture and repeat scans for controlling the tip of the needle can be performed with the patient in a stationary position. The device is designed as a belt that holds a needle holder sheath and a goniometric scale, both of which can be moved to varying positions around the patient.

Biopsy, Needle↗
PubMed2005

Expectant management of postdural puncture headache increases hospital length of stay and emergency room visits.

PURPOSE: This retrospective cohort study examined hospital length of stay (LOS) and emergency room (ER) visits in parturients diagnosed with postdural puncture headache (PDPH) following recognized dural puncture (DP). All cases were managed expectantly. Outcomes were compared with matched controls with uneventful labour epidurals. METHODS: After Ethics Committee approval, the hospital perinatal database was used to identify healthy parturients with recognized DP during labour epidural placement from 1996-2001. Women developing PDPH after expectant management were matched with women with uneventful epidurals and no evidence of PDPH, as well as by parity, delivery mode and admission date. All women delivered term singletons. The primary outcome was LOS (hours) from delivery to discharge. Secondary outcomes included: number (#) nights in hospital, #ER visits for PDPH, epidural blood patch (EBP) timing (pre vs post discharge), EBP location (ward vs ER) and blood volumes used. RESULTS: 26 cases and 26 controls were identified. Precise discharge times were found for 23 cases and 23 controls. In cases, the LOS was increased by a mean of 17 +/- 23.8 (SD) hours; [95% conficence interval (CI) = 8, 26; P = 0.0012] and # nights in hospital was increased by a mean of 0.62 +/- 0.94 nights (95% CI, 0.26, 0.98, P = 0.0027). Nineteen cases (73% 19/26) received at least one EBP. Sixteen cases received at least one EBP prior to discharge with 38% (6/16) returning to ER for re-assessment/repeat EBP. Forty-four percent (4/9) of cases without an EBP prior to discharge returned to ER for further assessment/EBP. CONCLUSION: PDPH leads to a significant increase in hospital LOS and ER visits. Studies of preventive therapy are warranted.

Adult↗
PubMed1994

[Epidural blood patch for the treatment of postspinal puncture headache. Successful therapy after 6 weeks following accidental dura perforation in obstetric PDA].

The frequency of postspinal headaches after accidental puncture of the subarachnoid space with 16-18 G Tuohy needles is reported at 59-85%. A case of postspinal headache syndrome persisting over a period of 6 weeks following epidural anaesthesia during labour is described. The treatment is discussed. CASE REPORT. A 30-year-old woman had severe postspinal headache for 6 weeks after epidural anaesthesia during labour. Conservative therapy for 3 days and 4 days of bedrest followed by crystalloid infusions during a 3-week hospital stay and a subsequent 3-week period of bedrest at home did not lead to lasting pain relief. Intracranial haematoma and other abnormal processes were excluded by CCT. A pathologic EEG was not confirmed by cranial MRT. A lumbar epidural blood patch of 15 ml of autologous blood was performed at L3/4. The patient stayed in bed for 12 h. After 3 h free of pain the patient complained of recurring headache. After a further 48 h of bedrest she had recovered. Because of lumbar pain 4 days after the epidural blood patch a MRT was performed, which showed the blood at L4 to S3 in the epidural space. DISCUSSION. The diagnosis of a cerebrospinal fluid leakage was based on the history and the main symptom of postspinal headache: the pain onset in the supine position. Such possible treatments as diminishing subarachnoidal pressure by bedrest, increasing cerebrospinal fluid production by infusions, increasing epidural pressure by epidural infusions and closing the cerebrospinal fluid leakage by epidural blood patch are discussed. The average success rate with the epidural blood patch is 93%. Volumes ranging from 5 to 20 ml are discussed for the autologous blood. We chose 15 ml of blood, to take account of the possibility that blood might settle in the wide sacral space. We were able to document the position of the blood patch as L4 to S3 on MR tomography (the injection site was L3/4). Most patients are free of headache 1 h after epidural blood patch. Our patient had to be confined to bed for another 48 h because of recurring headache. The blood patch alone was not immediately sufficient to prevent all further cerebrospinal fluid leakage. Probably more than one subarachnoidal puncture had been made during the difficult epidural anaesthetic procedure. On the other hand, the leak was probably only diminished because of the blood patch descending down to the wide sacral space. The combination of the large-volume blood patch, which diminished the leakage, and conservative treatment, which narrowed the transdural pressure difference, was successful: the 6-week postspinal headache was cured. CONCLUSION. Prolonged postspinal headache should be treated by epidural blood patch. The use of over 10 ml cannot be generally recommended, although in this case most of the blood patch of 15 ml was localized caudally. Careful monitoring for side effects is necessary with blood volumes larger than 10 ml. If there is no immediate relief, conservative therapy with 24-48 h of bedrest is recommended. If the headache persists a second blood patch should be performed, with the volume and the probable caudal spreading of the first taken into account.

Adult↗
PubMed1996

[Detection of tyrosinase mRNA using reverse transcription/polymerase chain reaction with fine needle punctures of melanoma metastases].

Tyrosinase mRNA produced by melanoma cells can be detected by reverse transcriptase-polymerase chain reaction (rt-pcr) with fine-needle tissue punctures. Fine-needle punctures from six suspected skin and lymph node metastases in three patients with malignant melanoma were analysed via rt-pcr for tyrosinase mRNA. All the suspected metastases were surgically removed and histologically examined separately. In each case the rt-pcr results and the histological diagnosis corresponded. This less invasive and highly sensitive method could prove to be a useful alternative in the diagnosis of melanoma metastasis.

Aged↗
PubMed2001

Treatment of a cavernous sinus dural arteriovenous fistula by deep orbital puncture of the superior ophthalmic vein.

In a patient with progressive ophthalmological problems, including uncontrolled intraocular pressure related to a cavernous sinus dural arteriovenous fistula, urgent intervention may be necessary to prevent permanent visual loss. We report a case in which inadequate transarterial embolisation and lack of access for transvenous catheterisation, including a direct approach through the superior ophthalmic vein, preceded percutaneous puncture of the superior ophthalmic vein deep within the orbit, permitting venous occlusion without complications. This case demonstrates that deep orbital puncture of the vein is feasible for occlusion of a cavernous sinus dural arteriovenous fistula.

Arteriovenous Fistula↗
PubMed2003

Ultrastructure and bacterial infection of wounds in honey bee ( Apis mellifera) pupae punctured by Varroa mites.

The damage to western honey bee, Apis mellifera, colonies caused by the originally Asian ectoparasitic mite Varroa destructor is mainly a consequence of the infestation of host bee pupae. In the capped brood cell, female mites puncture the host's integument at preferred sites in order to suck haemolymph. Due to repeated feeding by the mother mite and her progeny, these perforations are kept open until shortly before the imaginal moult of the bee. Thereafter scarring takes place, thus preventing microbial infection after the adult bee has emerged from the protected environment of the sealed brood cell. However, colonies of various bacteria were found in the open wounds of about 15-30% of all inspected host pupae with an abundance depended on the level of host brood cell infestation by the mite. The small punctures of the pupal integument are difficult to detect but, by vital staining with trypan blue, the wounds can be visualised. The ultrastructure of the pupal wounds, the bacterial colonies and the scarring process are documented by a series of scanning electron micrographs.

Animals↗
PubMed2005

[Pain assessment in invasive diagnostic procedures. Comparison of an eleven-point numerical rating scale and a six-point verbal rating scale for pain measurement in bone marrow puncture].

BACKGROUND AND OBJECTIVE: Pain measurement during diagnostic procedures is an accepted prerequisite for appropriate therapy. In this study, the agreement between rankings of pain intensity on a numerical and a verbal rating scale was analyzed. METHODS: Patients attending a haematological outpatient clinic who underwent bone marrow puncture were requested to assess pain intensity perceived during the procedure on a elen-point numerical and a six-point verbal rating scale. RESULTS: Analysis of patients' pain ratings in 263 bone marrow punctures showed a very good correlation between numerical and verbal rating scale (Spearman correlation coefficient 0,86). By means of a transfer instruction categories of the verbal rating scale were assigned to figures of the numerical rating scale (0 - no pain, 1 or 2 - mild p., 3, 4 or 5 moderate p., 6 or 7 severe p., 8, 9 or 10 - very severe and worst possible pain). The resulting transfer table showed a good agreement with a weighted kappa of 0.72 (95% confidence interval: 0.66-0.79). CONCLUSION: Both scales can be employed efficiently for pain assessment during diagnostic procedures. Verbal categories can be assigned to numerical values and vice versa numerical values to verbal categories. However, in view of the inter-individual variations it appears appropriate to re-assure pain perception with each patient in order to avoid over- or undertreatment.

Biopsy↗
PubMed2001

Postdural puncture headache: the role of prophylactic epidural blood patch.

Prophylactic epidural blood patch may prevent postdural puncture headache that develops after intentional or inadvertent dural puncture. However, despite earlier reports that this procedure was of value, subsequent studies have failed to show it has significant advantages over delayed blood patch. Reports that were supportive of this technique were based on nonrandomized observational studies with significant selective bias. At the present time, most centers do not routinely offer prophylactic blood patches, and those that do report a variable success rate. A recent case study of permanent neurologic deficit after prophylactic epidural blood patch has also raised some concern about the safety of this prophylactic technique.

Blood Patch, Epidural↗
PubMed1989

The risk of adverse reactions from percutaneous prick-puncture allergen skin testing, venipuncture, and body measurements: data from the second National Health and Nutrition Examination Survey 1976-80 (NHANES II).

A sample (N = 16,204) of the U.S. population, 6 to 74 years of age, was examined in NHANES II with a variety of routine medical procedures, including prick-puncture allergen skin testing (AST), venipuncture, and body measurements. Eight unstandardized extracts licensed by the Food and Drug Administration, a positive and negative control, were used. AST was performed to screen the population for immediate hypersensitivity responses to common aeroallergens. No anaphylactic reactions after AST were observed. One asthmatic reaction occurred during venipuncture. Other adverse reactions (ARs) were limited to syncope, near syncope, and malaise. The rates for any AR were venipuncture, 0.49% (95% confidence interval [CI], 0.38% to 0.60%); AST, 0.04% (95% CI, 0.01%-0.08%); body measures, 0.006% (95% CI, 0 to 0.018%). Sex or fasting status had little effect on the occurrence of AR. The age group 20 to 49 years had the highest occurrence of any AR to venipuncture (0.87%; 95% CI, 0.633% to 1.107%). The risk of prick-puncture AST with eight extracts licensed by the Food and Drug Administration is low and similar to other routine medical procedures.

Adolescent↗
PubMedDate not supplied

Conservative therapy of plantar puncture wounds.

In order to define the natural history and complication rate of plantar puncture wounds receiving conservative initial therapy, a prospective, uncontrolled case series study with standardized protocol was conducted in a university hospital emergency department. The eligible patients were between the ages of 18-59 years and presented within 24 hours of sustaining an uncomplicated plantar puncture wound without preexisting impediments to wound healing or wound assessment. Patients were treated with surface cleansing alone and were kept non-weight bearing for 24 hours. Patients were followed by telephone at 48 hours, 1 week, 1 month, and 6 months. Five infections and two retained foreign bodies occurred in 63 patients, for a complication rate of 11.9%. Only the presence of symptoms 48 hours postinjury was associated with a higher risk of complication. No findings at initial presentation predicted a subsequent complication.

Adolescent↗
PubMed1993

Epidural pressure and postdural puncture headache in the parturient.

Forty patients in whom the dura had been punctured accidentally and 10 patients who had received spinal anaesthesia required epidural blood patching for relief of severe postdural puncture headache (PDPH). Before injecting blood, the epidural pressure was measured, using an epidural catheter as a manometer. Mean epidural pressure in the left lateral position was 6.4 cm H(2)O (range 0.5-12 cm H(2)O). Epidural pressure was not related to the size of needle hole or prophylactic infusion of saline into the epidural space. In 5 patients with inadvertent dural tap, there was a statistically significant decrease (P<0.02) in epidural pressure from 14.9 cm H(2)O (range 11-22 cm H(2)O) before PDPH to 6.9 cm H(2)O (range 5-8.5 cm H(2)O) when they developed PDPH. The benefits of performing an epidural blood patch through a catheter placed in the epidural space are discussed.

Journal Article↗
PubMed2006

Ultrasonographic-guided percutaneous transabdominal puncture for oocyte retrieval in a rare patient with Rokitansky syndrome in an in vitro fertilization surrogacy program.

OBJECTIVE: To describe the option of ultrasonographic-guided percutaneous transabdominal puncture for ovum pickup in a rare case of Rokitansky syndrome with subcostal located ovaries and a right single kidney. DESIGN: Technique and instrumentation. SETTING: A university-based hospital IVF and Reproductive Medicine Unit. PATIENT(S): A woman with congenital agenesis of the uterus in a surrogate gestation program. INTERVENTION(S): Ultrasonographic-guided percutaneous transabdominal puncture for oocyte retrieval. MAIN OUTCOME MEASURE(S): Number of oocytes retrieved and fertilized. RESULT(S): Oocyte retrieval was feasible in four treatment cycles with subsequent embryo transfer to the surrogate mother. CONCLUSION(S): Ultrasonographic-guided percutaneous transabdominal oocyte collection is a feasible and efficacious procedure for IVF in a case of Rokitansky syndrome with elevated subcostal ovaries and a single kidney.

Abdomen↗
PubMed1996

Puncture wounds: normal laboratory values in the face of severe infection in diabetics and non-diabetics.

PURPOSE: Using infected puncture wounds as a basis for comparison, we pose the question of whether white blood cell count (WBC) and erythrocyte sedimentation rate (ESR) is lower in diabetic patients with foot infections as compared with nondiabetic patients. PATIENTS AND METHODS: This case control study consisted of two groups, both with infected puncture wounds of the foot, admitted to a 700-bed urban university teaching hospital between 1985 and 1992. The experimental group contained 77 patients with diabetes mellitus. The control group consisted of 69 patients without diabetes. All subjects received emergent incision and drainage of the affected site. RESULTS: Results revealed a normal WBC count in 57.6% of patients. The ESR was normal in 36.3% of admissions. More nondiabetic patients presented with normal ESR than diabetic patients (62.3% versus 13.7%, respectively; P < 0.0001). Diabetic patients had a significantly higher mean WBC count and ESR than did nondiabetic patients. Pain was the principal complaint more frequently in nondiabetic patients (92.9% NDM versus 70.1% DM, respectively; P < 0.005). Erythema (72.7% versus 51.4%; P = 0.008), and drainage (36.4% versus 7.1%; P < 0.001) were more common in diabetic patients. CONCLUSION: We conclude that, while a glaringly elevated WBC count or ESR should alert the clinician to the possibility of infection, normal values should not be relied upon to rule out a serious event.

Adult↗
PubMed1990

Laparoscopic ovarian puncture for correct staging of endometriosis.

Small, deep ovarian endometriomas are not easily diagnosed. In 52 infertile patients, laparoscopy demonstrated enlarged ovaries (maximum diameter 3.5 to 5 cm) with a smooth whitish surface and no mature follicles, corpora lutea, or other cysts. Ovarian puncture was performed, and endometriotic material aspirated in 25 women (48.0%). Cyst diameter was calculated using the geometric formula r = 3 square root of 3V/4 pi where r = radius and V = volume of liquid aspirated. Eight patients with apparently normal pelvis had endometriosis, and 14 with apparent minimal or mild endometriotic lesions were restaged. Laparoscopic ovarian puncture of enlarged ovaries was important for correct diagnosis and staging of endometriosis.

Adult↗
PubMed1989

Transfer of human sperm into the perivitelline space of human oocytes after zona-drilling or zona-puncture.

To evaluate the transfer of sperm from severely oligozoospermic men into the perivitelline space of mature oocytes, zona-drilling with acid phosphate-buffered saline (PBS) and direct zona-puncture in the presence of cytochalasin D were studied. Zona-drilling also was done for eggs from patients with previous failed in vitro fertilization (IVF). Forty-seven eggs from seven patients with oligozoospermia and three patients with failed IVF had a mean of between 2.6 and 3.6 sperm transferred into the perivitelline space. In the group whose eggs had zona-drilling with acid PBS, 1 of 13 eggs fertilized from the oligozoospermic category, while there was no fertilization from the failed IVF category. Karyotyping of the unfertilized eggs after zona-drilling revealed a high incidence (2/5 and 3/7, respectively) of possible arrest at anaphase II after reinitiation of meiosis. In the group whose eggs were directly punctured through the zona in the presence of cytochalasin D, there was no fertilization in 23 undamaged eggs. Two of the 15 interpretable karyotypes were aneuploid, but this incidence is within that observed for our unfertilized eggs after IVF. Hence, the use of acid PBS for zona-drilling is not advised. Moreover, transfer of sperm from men with previous failed fertilization resulted in poor fertilization rates.

Cytochalasin D↗
PubMed1998

EUS-guided, fine-needle aspiration biopsy using a new mechanical scanning puncture echoendoscope.

BACKGROUND: A new mechanical sector scanning echoendoscope designed for EUS-guided, fine-needle aspiration biopsy (FNAB) was prospectively evaluated. The technical feasibility, safety, and histocytologic FNAB results are reported. METHODS: Eighty-six patients underwent 106 FNAB procedures. The new echoendoscope has a 2.8 mm accessory channel and an elevator. Target sites: pancreas 58, lymph nodes 43, and miscellaneous lesions 5. Lesions were punctured with a 0.7 mm needle and submitted for cytologic and histologic examination. Definitive diagnosis was by surgery or clinical follow-up. RESULTS: The wide scanning field (250 degrees) enabled easy sonographic orientation for FNAB. Longitudinal needle visibility was "good" in 93% and 71% of transesophageal and transgastric procedures, respectively, but were compromised during most transduodenal procedures. Needle penetration of indurated pancreatic lesions failed in two patients, and in four additional patients pancreatic sampling succeeded only after a second attempt using an automated spring-loaded device. The mean number of passes was three. Ten percent of FNAB specimens were "inadequate"; excluding these, the diagnostic accuracy rate was 97%; sensitivity for malignancy was 88.5% and specificity was 100%. CONCLUSION: EUS-guided FNAB is feasible, safe, and accurate using the new mechanical puncture echoendoscope. Needle visibility needs to be improved, particularly for transduodenal FNAB.

Adult↗