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PubMedDate not supplied

Corneal epithelial basement membrane after experimental anterior stromal puncture in guinea pigs: immunohistochemical study.

We investigated alterations in the immunolocalization of the components of epithelial basement membrane (BM), type IV collagen, and laminin in guinea pigs subjected to anterior stromal puncture (ASP) of the cornea performed with a standardized needle. Localization of BM components beneath the corneal epithelium was indicated by laminin immunoreactivity. The BM was interrupted by needle punctures immediately after ASP. During healing, type IV collagen immunoreactivity was detected transiently in the BM of some of the ASP-treated corneas, but no reactivity was observed in normal epithelial BM. Development of type IV collagen immunoreactivity was probably caused by an alteration of the alpha-chains or by an unmasking of the antigenicity of this collagen type, which may be related to an increase in the adhesiveness of the epithelium following ASP.

Animals↗
PubMed1975

Percutaneous renal cyst puncture: unusual results in 2 cases.

Percutaneous puncture and aspiration were used successfully in 2 cases: 1) a calcified benign renal cyst and 2) a grossly infected benign renal cyst. Percutaneous aspiration might be a useful procedure in either calcified or infected renal cyst. If percutaneous puncture is contemplated in a calcified ring lesion, preliminary angiography is strongly recommended to exclude possible renal artery aneurysm or arteriovenous malformation.

Abscess↗
PubMed2000

Fang tip spread, puncture distance, and suction for snake bite.

We measured the distance between fang tip punctures in defensive bites by western diamondback rattlesnakes (Crotalus atrox) and the distance between their retracted fangs. Because the fang tips at penetration average 112% further apart than their bases at rest, The Extractor, a device widely marketed in the United States for snake bite first aid, will not simultaneously cover both punctures of most adult New World pitvipers.

Animals↗
PubMed2003

Clinical experience of contrast venography guided axillary vein puncture in biventricular pacing.

BACKGROUND AND OBJECTIVES: Biventricular pacing is a new modality of treatment for patients with drug-refractory heart failure and ECG evidence of dyssynchronous ventricular contraction. A third lead is required to be placed in a coronary vein through the coronary sinus for left ventricular pacing, in addition to the atrial and right ventricular leads. Subclavian crush phenomenon is associated with lead placement using subclavian puncture. Cephalic venous cutdown, free of this complication, provides vascular access which is probably too small for multiple leads placement in biventricular pacing. Contrast venography guided axillary vein puncture (AP) is an alternative approach. This study reports on clinical experience of this technique in biventricular pacing. METHODS: AP is the method of choice for biventricular pacing in Princess Margaret Hospital and Stanford University Medical Center. Patients' clinical characteristics, effectiveness and safety of the technique were analysed. RESULTS: AP was performed in 35 patients, 29 male and six female with mean age 57.1 +/- 14.7 years from 1 January 2000 to 30 June 2001. Six patients had biventricular pacing alone and 29 patients had biventricular implantable cardioverter defibrillator (ICD) implanted. Twelve (34.3%) patients have ischaemic cardiomyopathy, 22 (62.9%) patients have dilated cardiomyopathy and one (2.9%) patient has hypertrophic cardiomyopathy. Six (17.1%) patients were in NYHA Class II heart failure, 21 (60.0%) patients were in Class III and eight (22.9%) patients were in Class IV. The mean EF was 23.1 +/- 7.6%. AP was attempted for placement of all three leads in all patients. AP was successful in 34 (97.1%) patients. The single failure was due to small size of the axillary vein. There were no AP, lead or contrast-related complications with a follow up of 12 months. CONCLUSIONS: AP is both effective and safe for biventricular pacing. It may be the method of choice in biventricular pacing.

Adult↗
PubMed1980

Needlestick and puncture wounds: definition of the problem.

During 1979, all hospital personnel who were victims of needlestick or puncture wounds completed an incident questionnaire so that the epidemiology of these events could be determined. The attack rate varied from a high of 20 to a low of 0.8 incident/100 employee years worked (mean 7.5) for different employee groups. Personal carelessness accounted for 55% of the 81 incidents, whereas 35% of the involved personnel were innocent victims. Needles were responsible for 58% of the incidents. Screening for hepatitis B surface antigen (HBsAg) revealed no positive patient or employee associated with needlestick or puncture wounds. Only 2 of 45 employees were hepatitis B surface antibody (anti-HBs) positive. Hepatitis B immune globulin (HBIG) was recommended for 4 employees, immune serum globulin (ISG) for 13, and no globulin for 65. The estimated cost of this surveillance program and globulin therapy was $60 per incident. This data is being used as the basis for in-service training of high-risk personnel in order to decrease the number of incidents.

Cross Infection↗
PubMed2001

Cardiac tamponade following sternal puncture in two patients.

Sternal puncture for harvesting bone marrow is a procedure with potentially lethal complications. Both the occurrence of pneumothorax and sternal fracture are reported. We present two patients with a cardiac tamponade following elective sternal puncture. (See Editorial p. 4).

Adult↗
PubMed2001

[Intracranial subdural hematoma after obstetric dural puncture].

The authors report a case of subdural haematoma (HSD), which occurred following epidural analgesia for labour, complicated by post dural puncture headache (PDPH). A 26-year-old woman displayed a typical PDPH following epidural anaesthesia. On the sixth day, she was given a blood patch (BP), which was partially efficacious. Because of worsening of the headache, of disappearance of the postural characteristics, and of vomiting without focal neurological signs on the 9th day, a CT-scan was done. The CT-scan showed a small hemispheric subdural haematoma. The recovery was complete with only medical treatment. HSD is a rare serious complication of dural puncture. When the characteristics of PDPH change, HSD should be evoked even without focal neurological signs. An early diagnosis and the small size of the haematoma may allow HSD to be treated medically and avoid surgical evacuation.

Adult↗
PubMed1994

Infected false aneurysm after puncture of an aneurysm of the deep femoral artery.

Pseudoaneurysm of the femoral artery is a well known complication after diagnostic and therapeutic catheterisation. We report a case of voluminous postcatheterisation false aneurysm, which developed on a pre-existing deep femoral artery aneurysm. Infection by Staphylococcus aureus was demonstrated. After surgical exploration, rupture and external haemorrhage occurred before reconstructive surgery was possible. Due to the septic conditions only a lateral aneurysmorraphy was performed. Postoperative angiogram showed an acceptable result. An aneurysm of the deep femoral artery was also demonstrated on the contralateral side. This was scheduled for elective surgery. In conclusion, this complication could have been avoided by accurate puncture technique. Surgical exploration under local anaesthesia is ill-advised. Especially in patients with advanced vascular disease, non-invasive studies of the puncture site is recommended.

Aged↗
PubMed1997

Factors involved in the incidence of post-dural puncture headache with the 25 gauge Whitacre needle for obstetric anesthesia.

Parturients have the greatest risk of postdural puncture headache. use of a pencil-point needle, such as the 25 gauge Whitacre, has been associated with a lower incidence of PDPH. This observational study of 1009 obstetrical patients assessed possible factors related to the incidence of PDPH and other complications associated with spinal anesthesia using the 25 gauge Whitacre needle. The independent variables included procedure, maternal position at insertion, ease of insertion, intraoperative i.v. analgesia supplementation, use of intrathecal narcotics, parity and type of local anesthetic. Patients were followed daily during their hospitalization and questioned specifically about the presence of headache, its nature, onset and treatment. Two hundred and twenty-nine patients developed a headache postperatively but only 25 had postdural puncture headaches (overall incidence 2.5%). The PDPH typically presented on day 2 (median), range 1-4). Six patients (0.59%) required epidural blood patch. There were eight (0.8%) failed finals which were converted to general anesthesia. None of the factors evaluated were significant in predicting the occurrence of PDPH.

Journal Article↗
PubMedDate not supplied

Streptococcal toxic shock syndrome from a puncture wound to the foot.

Puncture wounds to the foot are a common occurrence. If treated properly, the majority will be resolved without major complications. Toxic shock syndrome and streptococcal toxic shock-like syndrome are devastating complications of some staphylococcal and streptococcal infections. This paper discusses the similarities and differences between the two toxic states, reviews the pathophysiology, and presents a case report of near-fatal streptococcal toxic shock-like syndrome secondary to a puncture wound of the foot.

Adult↗
PubMed2003

Specially designed needle-guide for intercostal puncture of hepatocellular carcinoma seen on computed tomography and not visualized on ultrasonography.

Ultrasound (US)-guided ethanol injection therapy is becoming popular as a therapeutic tool for treating hepatocellular carcinoma (HCC); however, there are some HCCs seen on computed tomography (CT) and not visualized on US. The aim of this study was to learn whether ethanol could be injected into such tumors correctly using a specially designed needle-guide for intercostal puncture on US. We developed a new needle-guide attachment for US. In vitro experiments were done with gelatin gel and porcine liver to evaluate the accuracy of the puncture depth. We calculated the difference between the distance from the surface to the needle tip and the set depth as errors. Fifteen patients with HCC in which CT revealed a tumor but US did not were subjected to US-guided ethanol injection using this needle-guide, and the entry of ethanol into tumors was confirmed by subsequent enhanced CT. The errors were within 1.0 mm in the in vitro experiments using gelatin gel and porcine liver. In all HCC patients, ethanol was injected accurately. This new needle-guide may be useful for needle insertion to HCCs seen on CT and not visualized on US.

Journal Article↗
PubMed1987

Impact of a rigid, puncture resistant container system upon needlestick injuries.

Needlestick injuries in a 720-bed tertiary care hospital were analyzed before and after the introduction of a rigid, puncture resistant, needle disposal system. Following implementation of the system, disposal-related injuries decreased from 0.9 per 100 full-time equivalent employees/year to 0.3 per 100 full-time equivalent employees/year (p less than .005). However, needlesticks associated with procedures (2.2 vs. 4.4 per 100 full-time equivalent employees/year, p less than .0005), and those resulting from loose needles (0.5 vs. 1.9 per 100 full-time equivalent employees/year, p less than .0005), increased. Injuries occurring during needle recapping or the carrying of needles were not significantly altered. Total needlestick injuries increased from 6.0 to 8.7 per 100 full-time equivalent employees/year (p less than .0005). We concluded that a rigid, puncture resistant, needle disposal system can reduce disposal-related needlestick injuries, but must also be perceived as convenient to impact substantially upon needlesticks associated with other activities.

Accidents, Occupational↗
PubMed1999

Determination of retinol, antioxidant vitamins and homocysteine in skin puncture blood.

For determination of the vitamin status via mass screening, simple and rapid methods are required. Additionally, blood samples should be obtained using simple and low invasive sampling techniques. To fulfill this existing methods have been modified to analyze retinol, tocopherols, beta-carotene, vitamin C and homocysteine in 20 microliters plasma. Blood samples were obtained via skin punctures. HPLC measurements were carried out with isocratic separation and precolumn derivatization. Intra and interday variation coefficients were below 8% and regression coefficients better than 0.99 for all measurements. The difference between venous and capillary samples were < 5%. In conclusion, the methods employed proved satisfactory for the determination of important nutritional parameters in blood samples obtained via skin punctures. These methods are therefore well suited for mass screening, especially under field conditions in developing countries.

Antioxidants↗
PubMed1986

Airway resistances of Blom-Singer and Panje Low Pressure tracheoesophageal puncture prostheses.

Airway resistances were calculated for two newly commercialized tracheoesophageal (TE) puncture prostheses: the Panje Low Pressure Voice Button and the Blom-Singer Low Pressure device. The airway resistances of newly commercialized Panje Low Pressure devices could not be distinguished from those calculated for previously commercialized, Regular Pressure Voice Button devices. Airway resistances of Blom-Singer Low Pressure devices increased systematically as a function of flow rate. Findings are compared with existing data to provide readers with an opportunity to evaluate the relative efficiency of air shunting among contemporary TE puncture prostheses. Results are interpreted in relation to their implications for selecting surgical-prosthetic options for laryngectomized patients.

Airway Resistance↗
PubMed2001

The importance of sex, age, needle size, height and body mass index in post-lumbar puncture headache.

In this prospective study 37% of 239 patients developed a post-lumbar puncture headache (PPH) after a diagnostic lumbar puncture. PPH was more prevalent in females than males (46% vs. 21%; P = 0.0003) as were the severest form of PPH (64% vs. 23%; P = 0.02) and nausea (74% vs. 39%; P = 0.01) in those who developed PPH. Females scored their pain in the upright position more severe on a 100-mm visual analogue scale than males (median 60 mm vs. 47.5 mm; P = 0.02). The frequency of PPH was higher with the use of a 20-gauge compared with a 22-gauge needle in all patients (50% vs. 26%; P = 0.0002) and in females (57% vs. 36%; P = 0.02) and males (38% vs. 10%; P = 0.004), separately. Neither age, weight, height, nor body mass index (BMI), influenced the prevalence of PPH, but tinnitus was more prevalent in tall compared with smaller patients (53% vs. 17%; P = 0.02). Old age was associated with a long median pain delay upon rising, and also, small patients tended to report a longer median pain delay than tall patients. The pain intensity changed more slowly upon rising and reclining in patients with a high BMI than in those with a lower BMI (median 60 s vs. 12 s; P = 0.02). The results concerning height, BMI and needle size might be anticipated according to the leakage theory. In a multivariate analysis sex (P = 0.0003) and needle size (P = 0.0002) were related to the development of PPH on a statistically significant level. Furthermore, the pain severity was positively related to female sex (P = 0.03) and young age (P = 0.03). The pain delay increased with age (P = 0.008) and the pain decrease time increased with an increasing BMI (P = 0.04).

Adolescent↗
PubMed2002

Postdural puncture headache in obstetrics.

Postdural puncture headache (PDPH; or "spinal headache) is the most common significant complication from regional anesthesia or analgesia in obstetrics. Recent advances in spinal needle design have dramatically decreased the incidence of headache after spinal anesthesia, and now the most common cause of PDPH is inadvertent puncture of the dura with an epidural needle. The diagnosis and treatment of a PDPH should usually be the responsibility of the anesthesiologist, but it is important for the obstetrician to be familiar with the clinical course and options for therapy, and the usual treatment strategies. This article discusses the differential diagnosis of postdelivery headache, the current understanding of the pathophysiology of PDPH, options for medical treatment, and the controversial issue of whether and when to treat the headache with an epidural blood patch.

Analgesia, Epidural↗
PubMed2001

A survey of epidural technique and accidental dural puncture rates among obstetric anaesthetists.

Five hundred UK obstetric anaesthetists were surveyed to investigate retrospectively the relationship between experience, rotation of the epidural needle within the epidural space, choice of loss-of-resistance agent and accidental dural puncture (ADP) rate. Responses were received from 390 (78%) of the members surveyed. Anaesthetists with more than 15 years' experience are more likely to perform an epidural with the patient in the lateral position (P < 0.001), use loss-of-resistance to air to detect the epidural space (P < 0.001) and rotate the epidural needle after identifying the epidural space (P = 0.001) when compared to those of less experience. A reduced inadvertent dural puncture rate was found to be associated with increased frequency of performing the procedure (P = 0.012), greater experience of the practitioner (P = 0.049) and non-rotation of the epidural needle (P = 0.023). There are three components that can alter from case to case; patient positioning, loss-of-resistance agent and needle rotation. Loss-of-resistance agent and patient positioning in isolation did not significantly influence ADP rate. This study suggests that the combination of practising lateral patient positioning, loss-of-resistance to saline and non-rotation of the epidural needle significantly reduces ADP rate (P = 0.035).

Journal Article↗
PubMed2001

Management of accidental dural puncture in labour with intrathecal catheters: an analysis of 10 years' experience.

The records of 15030 labour epidural blocks were analysed. Seventy-two accidental dural punctures (ADP) were recognised at the time of the procedure. In 34 women an epidural catheter was inserted intrathecally through the Tuohy needle and continuous spinal analgesia provided. In a further 37 women the primary management of ADP was to resite an epidural catheter. One woman who received a microspinal catheter later in labour was excluded from analysis. There were no significant differences in maternal characteristics, quality of labour analgesia and anaesthesia, or mode of delivery between the groups. Three repeat ADPs occurred during attempts to resite the epidural. Two women developed high blocks after epidural resiting, one of whom required intubation and ventilation. There was one high block in the intrathecal catheter group. The incidence of postdural puncture headache was 71% in the intrathecal catheter group compared with 81% in the non-intrathecal catheter group (P = 0.45). Epidural blood patch was performed on 50% of women managed with intrathecal catheters compared with 73% of those managed without (P = 0.08). Following ADP in labour an intrathecal catheter is a simple and effective alternative to resiting an epidural. Recognition of ADP is important as it allows appropriate management avoiding possible complications of administering epidural top-ups in the presence of a dural tear.

Journal Article↗