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PubMed2002

Image distortion in US-guided liver tumor puncture with curved linear array.

Our objective was to systematically examine the influence of probe geometry, puncture route, and composition of the abdominal wall on the deviation error with needle display. We made a simplified simulation model of the puncture needle passing to the liver tumor, using a microcomputer system, and visualized the degree of distortion of the puncture needle, changing the thickness and component of the abdominal wall as well as the radius of the probe, site, and angle of puncture. The puncture needle exhibited a displacement error of -10.9 to 3.8 mm (center hole) and -11.3 to 3.8 mm (side attachment). The shift was less accentuated when the radius of the probe was large. The displacement error was less accentuated in the center and accentuated in the left side of the field of view. It is recommended that liver puncture under US guidance be generally performed using a probe with a larger radius through the center hole with the most obtuse puncture angle possible, but when the tumor is localized in the hepatic dome, a more tightly curved probe should be used with an acute angle. We must consider a possible large error in display of the puncture needle during liver puncture and try to prevent hazardous complications.

Abdominal Wall↗
PubMed2006

Unilateral transpedicular percutaneous vertebroplasty using puncture simulation.

PURPOSE: The aim of this study was to improve the accuracy of puncture to the median vertebral body using the unilateral transpedicular approach on percutaneous vertebroplasty (PVP). We have developed and evaluated a simple puncture simulation method based on the puncture angle determined by preoperative computed tomography (CT). MATERIAL AND METHODS: Two groups were evaluated. The first (group A) comprised 23 patients (34 vertebral bodies) who had undergone PVP without preoperative puncture simulation before May 2004, and the second group (group B) comprised 24 patients (39 vertebral bodies) who had undergone preoperative puncture simulation and PVP after May 2004. CT in the prone position was performed, and the puncture angle on CT (PAC) via the vertebral arch pedicle targeting the anterior one-third median site of the vertebral body was determined. Puncture was performed by targeting the isocenter established on a fluoroscopic monitor based on the PAC. Determinations were made of the success rate (SR) of the median puncture of the vertebral body, the effect of treatment using the visual analogue score, and the overall procedural time between groups A and B. RESULTS: The SR was 56% (19/34 vertebral bodies) in group A, and 97% (37/38 vertebral bodies), including only one vertebral body in which it was difficult to perform the unilateral approach on CT images, in group B, with the difference being significant by Student's t-test (P < 0.001). Among patients with available follow-up data, the unipedicular and bipedicular approaches achieved adequate pain relief with mean decreases in pain severity of 5.1 +/- 2.6 and 5.9 +/- 2.8, respectively. No significant differences in the treatment effect between the two groups was observed (P = 0.811). The overall procedure time per puncture was shorten for the simulation group (36.0 min) than for group A (73.1 min), as shown by regression analysis. CONCLUSION: The preoperative PAC determination for PVP under fluoroscopy increased the completion rate of PVP by the unilateral transpedicular approach. This method should be accepted from the viewpoint of burden reduction on patients and surgeons.

Adult↗
PubMed2007

Suprapapillary puncture of the common bile duct for selective biliary access: a novel technique (with videos).

BACKGROUND: Selective cannulation of the bile duct while avoiding the potential mechanisms that initiate the cascade of pancreatic injury may prevent or minimize post-ERCP pancreatitis. This could be accomplished by suprapapillary needle puncture of the bile duct with a specially designed needle. OBJECTIVES: The aim of this study is to describe a new technique to perform selective biliary cannulation by using a novel needle-puncture device and its outcome in 28 patients with suspected biliary pathology. DESIGN: This is a single-center, prospective pilot study of suprapapillary puncture of bile duct for both diagnosis and therapy of biliary pathology. SUBJECTS: Thirty patients were enrolled: 28 patients underwent suprapapillary puncture to gain biliary access, and 2 patients with a large periampullary diverticulum were excluded. INTERVENTIONS: After successful biliary cannulation by using a suprapapillary puncture technique and balloon dilation of the tract if necessary, stone removal, plastic stent insertion, and metal stent insertion were attempted. MAIN OUTCOME MEASUREMENTS: Successful biliary cannulation, time for cannulation, outcome of therapy (clearing the stones or providing stent drainage with stent insertion), and complications were recorded. At 60 days, the suprapapillary puncture was evaluated to check the status of drainage. RESULTS: Suprapapillary puncture was successful in 25 of the 28 patients, and, in 1 patient, it was successful after a week. It was useful in demonstrating a normal bile duct in 9 of 11 patients with suspected biliary pathology. Subsequent therapy was successful in the management of 11 patients with stones, benign biliary pathology in 2 patients, and malignant biliary pathology in 3 of 4 patients. None of the patients developed post-ERCP pancreatitis. Complications included small perforations that resolved with conservative management (n = 2), minor bleeding (n = 2), and submucosal injection (n = 1). At 60 days, all the puncture sites healed in patients who did not undergo dilation, while those with dilation of the tract had a patent orifice, with excellent flow of bile. CONCLUSIONS: Suprapapillary puncture for biliary cannulation is a useful technique for selective cannulation of the bile duct and avoids injury to the pancreas but with higher complication rates. Further studies will be needed to define its safety and its relative benefits compared with conventional access methods.

Aged↗
PubMed1990

Changes in cerebral haemodynamics in cases of post-lumbar puncture headache: a prospective transcranial Doppler ultrasound study.

We used transcranial Doppler ultrasonography in 45 patients to investigate if changes in haemodynamics in the major arteries of the brain base occurred after lumbar puncture and whether or not patients with or without post-lumbar puncture headache differ with respect to their cerebral haemodynamic parameters before and after lumbar puncture. Before lumbar puncture, patients with post-lumbar puncture headache differed from patients without post-lumbar puncture headache in that they showed significantly higher flow velocities and significant asymmetry of flow velocities with lateralization to the right (p less than or equal to 0.05). Patients without post-lumbar puncture headache, on the other hand, showed non-significant flow velocity lateralization to the left. Forty-eight hours after lumbar puncture, both groups demonstrated symmetrical flow velocities. In addition, only patients with post-lumbar puncture headache showed a significant reduction in the flow velocity of the right middle cerebral artery (p less than or equal to 0.05). These findings suggest that it is not only absolute flow velocity that plays a part in the event of headache, the interhemispheric relation of cerebral haemodynamics also plays a fundamental role.

Adult↗
PubMed1997

Retrospective analysis: are fever and altered mental status indications for lumbar puncture in a hospitalized patient who has not undergone neurosurgery?

Although nosocomial meningitis is rare in nonsurgical patients, lumbar punctures are frequently performed on hospitalized medical patients who develop delirium and/or fever. A retrospective review was undertaken to determine the yield of lumbar puncture in this setting and to compare it with the yield for suspected community-acquired meningitis. Of 232 lumbar punctures studied, 51 (22%) were performed to rule out nosocomial meningitis, while 181 (78%) were done to rule out community-acquired meningitis. No lumbar puncture performed for suspected nosocomial meningitis was positive, while results of 26 (14%) of those done for suspected community-acquired meningitis were abnormal (P < .01). Patients whose lumbar punctures were positive more often had headache or meningeal signs than those whose lumbar punctures were negative, and only 11 patients (22%) who had lumbar punctures performed for suspected nosocomial meningitis had headache or meningeal signs. We conclude that lumbar punctures performed for suspected nosocomial meningitis in nonsurgical patients have a low yield and that in some low-risk patients without headache or meningeal signs, lumbar puncture may be unnecessary.

Adult↗
PubMed1998

Laparoscopic renal cryotherapy in swine: comparison of puncture cryotherapy preceded by arterial embolization and contact cryotherapy.

Variable results of open, percutaneous, and laparoscopic cryosurgery of the kidney have been reported. Minimally invasive approaches to lower-pole renal ablation were prospectively compared in swine: laparoscopic puncture cryoablation preceded by arterial embolization, laparoscopic contact cryosurgery, and arterial embolization alone. Eighteen kidneys in nine domestic pigs were randomized to one of three treatment groups of six organs each: (1) puncture cryotherapy preceded by selective lower-pole arterial embolization; (2) contact cryotherapy alone; and (3) arterial embolization alone. Under general anesthesia, appropriate animals underwent selective arterial embolization of the lower pole via femoral cutdown using Gelfoam pledgets. Animals randomized to cryotherapy underwent dissection of the lower pole of the kidney using a single 12-mm umbilical and two midclavicular-line ports in the lateral position. Under external ultrasound guidance, two 3-mm cryoprobes (Cryomedical Sciences, Rockville, MD) were positioned in the lower pole of the kidney, and double-freeze technique to -190 degrees C was performed using puncture or contact application. Ultrasonography was used to guide probe insertion during puncture cryotherapy only. Kidneys were harvested 11 to 14 days after the procedure. Both puncture and contact kidneys demonstrated cell death and subsequent necrosis by light microscopy and electron micrography. On average, puncture lesions were heavier than contact lesions, 19.3 g v 10.1 g (P = 0.02; unpaired t-test), whereas the kidneys were equivalent in weight: 74.1 g v 74.1 g. Puncture lesions represented 26.4% of total kidney weight v 13.5% in the contact group (P = 0.002; unpaired t-test). Only focal infarcts were identified in the embolization group. No evidence of adjacent visceral injury was identified in any of the groups, and no animal required conversion to open laparotomy. One kidney bled after contact cryotherapy, and hemostasis was achieved laparoscopically. Laparoscopic cryotherapy is reproducible and effective using either the puncture technique preceded by arterial embolization or the contact technique, without evidence of damage to adjacent structures. Contact lesions were less voluminous and more peripheral than puncture lesions. Embolization alone produces focal infarcts and focal zones of cell death.

Animals↗
PubMed2002

The mechanisms of intracranial pressure modulation by epidural blood and other injectates in a postdural puncture rat model.

UNLABELLED: The epidural blood patch is considered effective in treating postdural puncture headache. We have developed a postdural puncture model in rats for quantitative evaluation of the magnitude and duration of changes in cerebrospinal fluid (CSF) pressure in the cisterna magna in response to the administration of epidural blood or other moieties. This model was used to compare the efficacy of various methods of epidural injection for restoring and maintaining CSF pressure for up to 240 min. After lumbar dural puncture, CSF pressure declined 3.6 +/- 0.2 mm Hg. Epidural saline (100 microL) injected at the puncture site initially increased pressure by 7.2 +/- 0.7 mm Hg, but it rapidly (7.8 +/- 0.6 min) returned to postdural puncture baseline. A similar initial increase of CSF pressure was observed with equal volumes of all other epidural injectates, but the duration of pressure increase varied greatly. Hetastarch and dextran 40 produced results similar to saline. Only whole blood or fibrin glue consistently increased CSF pressure for the entire 240-min observation period. Whole blood mixed with anticoagulant or injected 20-mm cephalad to the puncture site did not sustain pressure. After laminectomy, direct application of blood or adhesive to the dural defect caused no pressure increase. Continuous infusion of saline after bolus could maintain pressure increase for 180 min, but within 60 min of stopping infusion, pressure returned to baseline. These results confirm the efficacy of the epidural administration of blood or fibrin glue to correct CSF hypotension after dural puncture and also provide insight into the mechanisms of intracranial pressure modulation. Sealing the dural defect does not effectively correct CSF pressure unless an epidural tamponade effect is also maintained. IMPLICATIONS: A rat model was developed to evaluate different drugs that may be injected epidurally to treat postdural puncture headache. Epidural injection of blood or fibrin glue was the most effective method of maintaining increased cerebrospinal fluid pressure after dural puncture. Sealing the dural defect does not effectively correct cerebrospinal fluid pressure unless an epidural tamponade effect is maintained.

Animals↗
PubMed2006

Postdural puncture headache.

PURPOSE OF REVIEW: Postdural puncture headache remains the most frequent complication of neuraxial anesthesia. It can occur following uncomplicated spinal anesthesia as well as unintended dural puncture during epidural anesthesia. RECENT FINDINGS: The incidence following accidental dural puncture is not as high as previously thought--approximately 50%. There are not many maneuvers that prevent postdural puncture headache. The most promising is an intrathecal catheter as it avoids further dural puncture and seals the hole during the time it is in place, decreasing cerebrospinal fluid loss. Several means to treat a postdural puncture headache exist. Medications that increase cerebral vascular resistance are the ones advocated. Methergine (methylergonovine maleate) has been advocated for postdural puncture headache following spinal anesthesia; it has not been studied for accidental dural puncture with a large bore needle. Epidural blood patch remains the treatment of choice. SUMMARY: An epidural blood patch should not be performed until 24 h after dural puncture to increase its success; however, it should not be delayed beyond that period in the symptomatic patient, as this delay increases the amount of time the patient suffers.

Humans↗
PubMedDate not supplied

Safety and acceptability of the research lumbar puncture.

Three hundred forty-two subjects underwent 428 research lumbar punctures for studies of cerebrospinal fluid (CSF) biomarkers. Subjects were 67 Alzheimer disease or mild cognitive impairment (AD/MCI) patients and 275 cognitively normal adults aged 21 to 88. Lumbar puncture was performed in the lateral decubitus or sitting position using the Sprotte 24 g atraumatic spinal needle. Up to 34 ml of cerebrospinal fluid were collected. Anxiety and pain experienced during lumbar puncture were rated on a visual analog scale. The frequency of any adverse event (11.7%), clinically significant adverse events (3.97%), and typical post-lumbar puncture headache (PLPHA) (0.93%) was low. Risk of post-lumbar puncture headache was unrelated to age, gender, position during lumbar puncture, ml of cerebrospinal fluid collected, or minutes of recumbent rest following lumbar puncture. The frequency of post-lumbar puncture headache was lower in AD/MCI (P = 0.03) than any other subject group. Anxiety and pain ratings were low. Younger subjects reported more anxiety than old (P = 0.001) and AD/MCI subjects (P = 0.008) and more pain than older normal subjects (P = 0.013). Pain ratings for women were higher than those for men (P = 0.006). Using the Sprotte 24 g spinal needle, research lumbar puncture can be performed with a very low rate of clinically significant adverse events and with good acceptability in cognitively impaired persons and cognitively normal adults of all ages.

Adult↗
PubMed1999

CT fluoroscopy-assisted needle puncture and ethanol injection for hepatocellular carcinoma: a preliminary study.

OBJECTIVE: We assessed the usefulness of real-time CT fluoroscopy for needle guidance and evaluated the clinical usefulness of a unified CT fluoroscopy and angiography system in the treatment of hepatocellular carcinoma. SUBJECTS AND METHODS: A single-session percutaneous ethanol injection was performed with CT fluoroscopy guidance and monitoring for 15 hepatocellular carcinomas with an average size of 2.5 cm (range, 0.7-4.7 cm) in 10 consecutive patients. Of these, seven lesions were not seen on sonography. To mark the lesion for puncture, we performed CT arteriography or arterial injection of iodized oil. A puncture guide was applied to 12 lesions. RESULTS: The average depth from the skin's surface to the lesion was 9.3 cm (range, 4.5-11.5 cm), and the puncture route was transthoracic in five lesions and transabdominal in 13. The overall success rate in puncturing the lesions was 94.4% (17/18 sessions). The average number of punctures was 3.3, and it significantly decreased after introduction of a puncture guide compared with freehand puncture (p < .01). The average amount of injected ethanol was 12.7 ml (range, 4-27 ml). The ratio of injected ethanol dose to calculated ethanol dose was 0.6. Local recurrence occurred in four (26.7%) of 15 lesions after an average of 5 months. CONCLUSION: Using CT fluoroscopy for guidance of the needle and for monitoring ethanol infusion in the target lesion, we have found single-session percutaneous ethanol injection to be possible for hepatocellular carcinomas smaller than 5 cm or not revealed by sonography. The puncture guidance equipment was helpful for accurate insertion of the needle into the lesion, allowing a minimum number of punctures and minimal radiation exposure.

Aged↗
PubMed1992

[Ventricular puncture; is it a safe procedure?].

Four hundred and fifty patients underwent 755 ventricular punctures as a procedure for continuous ventricular drainage (CVD), or ventriculoperitoneal/ventriculoatrial shunt (shunt) between April, 1983 and March, 1990. In all patients, postoperative findings on CT scan and related clinical manifestations were studied. Of the total of 755 punctures in 100 cases (13.2%) some high density areas (HDA) (i.e. intracerebral hemorrhage) appeared on CT scans, and, of these, HDA larger than 3 cm in diameter (Type C) was seen in 12 cases (1.6%). On the other hand, some low density areas (LDA) appeared in 448 cases (59.3%), and, of these, an extensive LDA (Type C) was seen in 65 cases (8.6%). LDA on CT scan tended to improve gradually with time, and in one third of the cases it was undetectable one year after puncture. Nine percent of the LDA decreased in density, and they were regarded as areas of infarction or porencephalus. The factors considered to affect postoperative HDA were 1) old age, 2) puncture in the occipital region, 3) puncture in a previously damaged brain area, 4) repuncture using the same tract within a short interval from the previous puncture, 5) CVD. Conversely, factors that affected the LDA were 1) low age, 2) puncture in the occipital region, 3) puncture to normal, non-damaged brain, 4) puncture using a new tract. Ten out of 12 patients with large HDA (Type C) showed deterioration of consciousness level or epilepsy as an acute manifestation, and a prolonged disturbance of consciousness. Mental change and/or homonymous hemianopia were seen in all surviving patients in the chronic phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

A controlled clinical trial of local anesthesia for lumbar punctures in newborns.

To evaluate the efficacy of subcutaneous administration of lidocaine for reducing physiologic instability in acutely ill newborns during clinically required procedures, 81 neonates who required lumbar punctures within the first month of life were stratified by birth weight and respiratory support and randomly assigned to an experimental or a control group. The experimental group received an injection of 0.1 mL/kg of 1% lidocaine prior to the lumbar puncture. The control group received a nonanesthetized lumbar puncture without placebo. Changes in heart rate, respiratory rate, transcutaneous oxygen and carbon dioxide tensions, and heart rate variability from baseline, preparatory (positioning/handling), lumbar puncture, and recovery periods were measured. The administration of lidocaine did not minimize physiologic instability in response to the lumbar puncture nor was it associated with any detectable adverse effects other than prolonging the duration of the lumbar puncture. Although significant physiologic changes were observed in response to preparatory procedures, few additional changes beyond those occurred in response to lumbar punctures in either the experimental or control group. It is concluded that local anesthesia failed to influence manifestations of physiologic instability during neonatal lumbar punctures and that preparatory procedures were more destabilizing than either the administration of lidocaine or the lumbar puncture itself. The results suggest that the management of newborns requires emphasis on minimizing the destabilizing effects of required and frequent handling procedures.

Anesthesia, Local↗
PubMed1994

Parents' views of lumbar puncture in children with febrile seizures.

A study was carried out to ascertain the views of parents regarding the performance of lumbar punctures on their children admitted for febrile seizures. One hundred and seventeen (117) children with febrile seizures were recruited over nine months. Either one of the parents was interviewed a day after admission. In most cases, this was usually the mother. The ethnic groups of the patients were Malays (62.4%), Indians (26.5%), Chinese (8.5%) and others (2.6%). Lumbar punctures were requested by the doctor in attendance in only 28 (23.9%) patients This showed that the rate of request for lumbar punctures in febrile seizures was low. Parents of eight of them refused. The main reasons for the refusal were: fears that the child might be paralysed, advice from relatives and fear that the child might die from the procedure, or might find it too painful. All the parents who refused were Malays. A lumbar puncture was also more likely to be refused in a girl. Those who consented to lumbar puncture did so because they wanted the doctor to get to the diagnosis. Another reason given was that it might be therapeutic. Parents whose children did not require a lumbar puncture also thought that lumbar puncture may cause paralysis. The main sources of information on lumbar punctures for the parents were their relatives and/or friends. In only 85% of the cases were the reasons for the lumbar puncture explained to the parent. In 71.4% of the time the explanation was done by the medical officer, and in only 4.8% of the time was the consultant involved.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMedDate not supplied

[Pathological study of the transseptal puncture site of interatrial septum in catheter interventions].

Pathological changes in the transseptal puncture site of the interatrial septum were studied in seven autopsy patients in whom transseptal puncture had occurred during catheter interventions under transesophageal echocardiography monitoring. 1. In one patient with chronic renal failure who had received hemodialysis for more than 10 years, the transseptal puncture was unsuccessful. The failure is attributable to the severe calcification of the left atrial wall and interatrial septum. The autopsy showed only a small scratch on the fossa ovalis in the right atrial side. 2. The puncture hole was round in five patients and a slit in one, without tearing or extension from the puncture hole. 3. Late closure of the transseptal puncture hole was observed in two patients who died 7 and 22 days after the intervention procedures. 4. Mild infiltration of red blood cells around the transseptal puncture hole was detected in two patients. One died immediately after left atrio-arterial bypass support and another died on the 24th day after percutaneous transvenous mitral commissurotomy. Both patients showed tendency to bleeding due to heparinization and/or coagulopathy treatment during the clinical course. 5. Autopsy specimens demonstrated that the transseptal puncture was performed just on the fossa ovalis in all patients. 6. Biplanar transesophageal echocardiography is a very effective guidance method for transseptal puncture during catheter interventions.

Adult↗
PubMed1997

Evaluation of febrile infants under 3 months of age: is routine lumbar puncture warranted?

Fever may be the sole clinically evident presentation of serious bacterial infection (SBI) in a very young infant, and therefore lumbar puncture is still widely regarded as a mandatory procedure in the sepsis workup of febrile infants under 2 months of age. In this retrospective study, we evaluated the frequency and the diagnostic value of cerebrospinal fluid examination in 492 infants aged less than 3 months who were hospitalized because of fever during 1988-1994. The patients were categorized as being at "high risk" or "low risk" for SBI according to current clinical and laboratory criteria. Among the 492 infants, 196 (40%) were identified as "high-risk" for SBI, and 296 (60%) were at low risk. Among the overall series of infants, 60 babies (12%) were subsequently proven with bacterial infection. Among the 196 "high-risk" babies, 26% had bacterial infection, compared to only 3% of the 296 infants at low risk (p < 0.0001), denoting a sensitivity of 85% and a specificity of 65% of the clinical classification criteria. Lumbar puncture was done to 186 (46%) infants upon hospital admission; 176 punctures yielded satisfactory samples of cerebrospinal fluid (CSF). Sixteen (3%) patients had abnormal CSF findings: 2 of them had positive bacterial cultures and 14 were compatible with aseptic meningitis. The 2 patients with purulent meningitis were clinically very ill and were immediately recognized as deserving a lumbar puncture. Of the 14 patients with aseptic meningitis, 13 were initially screened as being at high risk for serious infection, and therefore underwent a lumbar puncture. Over the years of this survey, a declining trend for performing lumbar puncture in "low-risk" young febrile infants became evident: during 1988-1992, evaluation of sepsis included a lumbar puncture in 45% of the infants, compared to 27% during the following 2 years (p < 0.0001). Not one instance of purulent meningitis evolved among the infants in whom lumbar puncture was not performed. Our observations suggest that hospitalized young febrile infants may safely be spared a lumbar puncture when they do not meet the proposed criteria for being at high risk, or when their clinical and laboratory picture suggests being at low risk for SBI.

Age Factors↗
PubMed2003

[Vertical infraclavicular blockade of the brachial plexus (VIP). A modified method to verify the puncture point under consideration of the risk of pneumothorax].

INTRODUCTION: The vertical infraclavicular blockade of the brachial plexus (VIP) according to Kilka et al.is a technique which has gained more importance over the past years. This method distinguishes itself from other periclavicular techniques by a very low risk of pneumothorax (0.2%), which seems to be increased with asthenic patients. METHODS: In the study presented we examined 52 patients undergoing a vertical infraclavicular blockade of the brachial plexus, for an alternative method to determine the puncture point. With 31 of the 52 patients, who had a small distance (<20 cm) between the landmarks jugulum and anterior process of the acromion, the puncture point was moved 0.3 cm in a lateral direction for each centimeter less than 20 cm. Additionally we determined the "finger-point", i.e. the medial margin of the anesthetist's index finger, placed in the gap between the M. deltoideus and M. pectoralis with the finger tip touching the clavicle. RESULTS: In 54% of the patients, the "finger-point" corresponded to the measured puncture point. In 46% of the patients, these points varied by a maximum of 1 cm in the lateral or medial direction. In 53% of the patients, the plexus could be found at the measured puncture point,which applied especially to the patients with a small distance between the leading points (<20 cm) and as a consequence a lateralized puncture point. If a correction of the puncture point was necessary to find the plexus, the correction by skin movement would always be in the direction of the "finger-point". CONCLUSIONS: As a consequence, we assume that if the distance between the leading points jugulum and ventral process of acromion is smaller than 20 cm, the puncture point for a vertical infraclavicular blockade of the brachial plexus should be lateralized as described above; additionally, the "finger-point" should be determined in order to verify the puncture point and to finally give an idea of the direction, in case of a possible need for correcting the puncture point.

Adult↗
PubMed1991

Characteristics of bovine estrous cycles during repeated transvaginal, ultrasound-guided puncturing of follicles for ovum pick-up.

Repeated transvaginal ultrasound guided puncturing of visible follicles was performed for ovum pick-up (OPU) during Periods A and B, each of which lasted 3 mo. During Period A, 10 cows (A) were used in the study. Period B commenced 1 mo after Period A and two groups of animals were used. The first group (B1) consisted of 9 of 10 cows from Group A. The second experimental group of animals in Period B consisted of 11 cows (B2) which had not been submitted to previous puncture. During the study, all visible follicles larger than 3 mm were punctured and aspirated three times, on Day 3 or 4, Day 9 or 10 and Day 15 or 16 of the estrous cycle. The mean estrous cycle length (+/- SEM) after repeated follicle puncture did not differ among the three groups and was 22.3 +/- 0.4, 22.5 +/- 0.4 and 22.1 +/- 0.3 d for groups A, B1 and B2, respectively. The mean total number (+/- SEM) of punctured follicles per estrous cycle in Group A (13.1 +/- 0.5) was significantly larger than in Groups B1 (11.2 +/- 0.4) and B2 (11.6 +/- 0.4). The largest number of follicles punctured for ovum pick-up in all three groups was always on Day 3 or 4 of the estrous cycle: 4.9 +/- 0.3 follicles; the mean (+/- SEM) number of punctured follicles on Day 9 or 10 and Day 15 or 16 was significantly (P<0.05) lower: 3.4 +/- 0.2 and 3.9 +/- 0.2, respectively. In Period A, primarily 3- to 5-mm follicles were punctured per estrous cycle, while 6- to 10-mm follicles were predominantly punctured in Period B (P<0.05). Recovery rate of oocytes on Day 3 or 4, Day 9 or 10 and Day 15 or 16 were 53, 50 and 52%, respectively. Most oocytes (P<0.05) were aspirated from follicles smaller than 10 mm.

Journal Article↗
PubMed1997

Follicular dynamics, repeatability and predictability of follicular recruitment in cows undergoing repeated follicular puncture.

The aim of our study was to characterize follicular recruitment and growth in response to the repeated removal of follicles. All tertiary follicles (> 2 mm of diameter) in the ovaries of 10 non-lactating Holstein Friesian cows were punctured at midcycle (Day 0) by means of an ultrasound-guided needle. Puncture sessions were scheduled twice weekly at 3- or 4-d intervals over 3 mo. In the middle of the experiment, i.e., Week 7, the effects of 2- and 5-d intervals between follicular punctures were tested and compared with the previous 3- and 4-d intervals. After this period, 6 animals were slaughtered to study the effect of puncturing on gross ovarian morphology. The protocol of puncturing follicles with 3- to 4-d intervals was continued for an additional 3 mo in the remaining 4 animals. Twice-weekly puncturing of all tertiary follicles abolished estrous cycles and lead to an increase in follicular wave frequency without apparent negative effects on either the reproductive tract or ovaries. After puncture the new follicular wave attained full numerical development within 3 d. Two-day intervals resulted in a lower number of follicles than the 3-d interval (11.0 -/+ 3.8 vs 15.4 -/+ 6.1; P < 0.05). In contrast 4- and 5-d intervals between puncture resulted in an increase in follicle size when compared with that of the 3-d interval. The mean+SD number of recruited follicles varied between animals ranging between 78 +/- 2.5 to 19.2 -/+ 6.0. The mean number of follicles recruited increased from the first month (March) to the third month (May) of sampling (11.8 +/- 4.7 vs 16.4 +/- 6.5; P < 0.01), and then decreased between the third (May) and the sixth (August) month of sampling (21.5 +/- 4.7 vs 16.8 +/- 5.0; P < 0.01). During the experiment, the number of recruited follicles varied cyclically, with waves having a length of 6 puncture session (PS) or 3 wk (i.e., the mean length the bovine estrous cycle). Follicular recruitment after repeated ovum pick-up showed a high repeatability (r = 0.576) A model was also developed showing good predictability of the potential of animals to recruit follicles on the basis of the first 4 to 6 PS. Our results showed that despite large variation in follicular recruitment between animals, the high repeatability and good predictability of follicle recruitment demonstrates the possibility of characterizing animals on their potential for follicle growth.

Journal Article↗