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The paper discusses how to perform transthoracic puncture of peripheral lung tumors of various sizes by using different controlling techniques (X-ray television and computed tomography). It also analyzes whether an adapter can be used to reduce the incidence of a puncture-induced complication, such as traumatic pneumothorax.
To establish a minimally invasive technique to perform ovarian cystectomy, the authors applied a single umbilical puncture method. A 2-month old female infant was admitted to the hospital because of an ovarian cyst that showed no spontaneous shrinkage after her birth. An umbilical semicircular incision was made to insert a 10-mm trocar, into which a 3-mm laparoscope was inserted. The ovarian cyst was grasped using forceps inserted through an operating channel of the scope, and the cyst was removed through the incision. After aspiration of the cyst, the free cyst wall was resected, leaving the intact ovarian tissue. The operation was performed without difficulty or complication. The postoperative course was uneventful. The wound was inconspicuous, and the result was cosmetically excellent. The case demonstrated the feasibility of the minimally invasive technique using a single umbilical puncture for ovarian cystectomy in an infant.
Mayor complications of 1000 percutaneous liver biopsies, performed with Menghini's needle for 20 years period (1981-2000) are reported. Five severe complications (0.5%) were observed. Operation was unavoidable in three patients. Four of the major complications were caused by bleeding. Two patients had hematological diseases, and one--chronic kidney failure waiting for kidney transplantation. One patient collapsed immediately after the liver biopsy with bile aspiration. That forced urgent operation in one hour. The possible cause of the complication and the limited theoretical potentialities of ultrasonography and laparoscopy to establish it are discussed. Aspiration of bile during liver biopsy was observed in 0.9% of cases despite the exact keeping of contraindications and technics of examination. Transhepatic puncture of the gallblader is also possible in some of those cases. The necessity to check by ultrasonography the chosen point for biopsy is also emphasized. We recommend to name that biopsy "percutaneous" or "puncture" but not "blind". In this way the second reason (after bleeding) for death after liver biopsy--biliary peritonitis will be reduced to the absolute minimum.
Results of diagnosis of thyroid nodes in 404 patients are analyzed. Ultrasonic examination and US-assisted puncture biopsy were carried out before operations. Their results were compared with ones of morphologic study performed after surgery. Solitary nodes were diagnosed in 171 (42.3%) patients, multiple--in 233 (57.7%). The most specific ultrasonic symptoms of different forms of thyroid nodes were revealed. Thyroid cancer is imaged as hypoechogenic node with clear and unclear contour, heterogeneous structure, multiple zones of hyperechogenicity and calcification. Adenomas are presented as isoechogenic homogenic nodes with clear border and cystic cavities. Colloid nodes picture is the same. Rathen often different morphologic forms of nodes are similar, thus ultrasonic examination permits to detect morphologic structure of nodes hypothetically only. Sensitivity of puncture biopsy for goiter, adenomas and cancer was 87.1, 92.9 and 69.7% respectively. Cancer was not diagnosed before surgery in 30.3% cases when colloid goiter or adenomas were suspected. In these cases small cancer was located amidst colloid nodes and didn't differ by ultrasonic symptoms. Diagnosis of malignant tumor in nodular goiter was highly precise. Morphologic form of cancer was verified cytologically in majority of cases.
Puerperal women are reported to have a rate of cerebral infarction 13 times greater than non-pregnant females. We report a case of cerebral ischaemia in a 30-yr-old healthy parturient after epidural analgesia for labour, complicated by dural puncture treated with two epidural blood patches. Investigations showed the development of cerebral ischaemia on postpartum day 14. A transcranial Doppler ultrasonography showed vasospasm of the left middle cerebral artery still present at 3-month follow-up. At 1-yr follow-up, the patient had homonymous hemianopsia. We discuss the possible causative mechanism of the cerebral ischaemia in relation to the dural puncture and epidural blood patch.
In about 60 cases demonstrating a tentative diagnosis of a palpable recidivation (cancer of the cervix), a puncture of the parametrium and of the pelvic wall was carried out with the biopsy needle "Tru-Cut". The modalities of procedure are described. Verification of cancer suspicion was achieved to a rate of 50 per cent, this percentage having increased for about 20% when the puncture was repeated. Ten per cent of the carcinomas could not be listed, and in 20% of the cases a recidivation could be excluded. There were no complications.
Calcifying periarthritis of the shoulder may have either an acute or a chronic course. In both cases, direct puncture of the calcification shortens the natural history and facilitates and accelerates resorption in 50% of cases. The addition of a small amount of corticosteroid relieves the painful syndrome, with 80% good and very good results. The use of low doses of corticosteroid is particularly important in diabetics, patients with peptic ulcer and sportsmen. The puncture technique and the necessary precautions are described.
Halotherapy was applied for non-puncture treatment of 45 patients with acute purulent maxillary sinusitis. The response was evaluated by changes in clinico-immunological, cytological, x-ray and bacteriological parameters. Halotherapy was found effective in the treatment of acute purulent maxillary sinusitis without puncture.
In a series of 120 closed abdominal trauma the authors compare the reliability of the abdominal symptomatology (60%), of puncture-lavage with an Intracath (92.5%) or with a Diacath (98%) and of laparoscopy (100%). Laparoscopy and puncture-lavage with a Diacath have the same advantages: rapid execution, safeness, reliability. However the preference of the authors goes to the catheter and peritoneal dialysis because of its simplicity and feasability by the surgeon himself. This technique discloses visceral lesions: if positive it allows an earlier diagnosis and operation; if negative it avoids unnecessary laparotomies especially in cases of multiple trauma.
One case of schwannoma of the stomach diagnosed with ultrasound-guided biopsy puncture is reported. This diagnosis is usually not established with radiographic and endoscopic examinations. A preoperative diagnosis allows partly predicting the type of exeresis to be performed. On the other hand, guided biopsy puncture seldom allows establishing a prognosis, for which the criteria are based on the analysis of the whole tumor and the possible discovery of synchronous or metachronous metastases.
The results were compared of different programs of rehabilitation in 45 patients aged 5 to 18 years with spinal deformities and vertebrobasilar failure. Control patients received only basic therapy, the study group received also EHF-puncture. The efficacy of rehabilitation was confirmed by electropuncture diagnosis and rheoencephalogram. The patients with high tonicity of small vessels demonstrated a significantly improved regional circulation. This favours differential use of EHF puncture in the complex of rehabilitative measures.
The paper presents the results of treatment in 15 patients with aggressive hemangiomas of the vertebral bodies, operated on by puncture vertebroplasty. The authors analyze current approaches to treating patients with this pathology, present criteria for aggressiveness of hemangiomas. The results of the treatment indicate that puncture vertebroplasty is highly effective and safe in treating patients with hemangiomas of the vertebral bodies.
OBJECTIVES: Cardiac catheterization is increasingly used for the diagnosis or treatment of coronary artery disease. Previous studies that revealed the incidence of complications such as arteriovenous fistula and pseudoaneurysm were based on retrospective analysis of cohorts referred to vascular surgery. This study was designed to determine the incidence of arteriovenous fistula and pseudoaneurysm after percutaneous transluminal angiography. METHODS: All 557 consecutive patients undergoing cardiac catheterization were examined by ultrasonography from March 1, 2001 to April 1, 2002, to investigate the occurrence of arteriovenous fistula and pseudoaneurysm at the puncture site. RESULTS: Pseudoaneurysm was found in 16 patients (2.9%), and arteriovenous fistula in 12 patients (2.2%). Pseudoaneurysm in 7 patients (43.8%) and arteriovenous fistula in 6 patients (50.0%) were diagnosed only by ultrasonic examination. There were more female patients (9 patients, 56.3%) than male with pseudoaneurysm (p < 0.01). The puncture site was located after the division of the deep femoral artery and superficial femoral artery in all patients with complications. CONCLUSIONS: Ultrasonic examination was useful for diagnosis of complications such as arteriovenous fistula and pseudoaneurysm after cardiac catheterization.
OBJECTIVE: To evaluate the effect of absolute alcohol treatment for renal cyst with percutaneous puncture and catheterization. METHODS: This report presented 64 cases of renal cysts, 34 cases were treated with percutaneous puncture (A group) and 30 cases with percutaneous catheterization (B group). According to the size, the cysts were divided into 2 groups, more than 6 cm in diameter and less than 6 cm in diameter. RESULTS: All the patients were followed up for 3 - 12 months by CT or B ultrasonography. Striking difference of the therapeutic results were existed when cystS were more than 6 cm in diameter. CONCLUSION: Percutaneous catheterization is applicable to the sclerosing treatment of renal cyst whose diameter is more than 6 cm.
Possibilities of application of the fine-needle aspiration puncture biopsy (FNAPB) in diagnosis of suprarenal glands tumors were studied. Of 43 patients, to whom FNAPB was performed, in 27 the suprarenal gland tumor was diagnosed, in 11--renal tumor, in 5--the puncture biopsy material occurred noninformative. Of 27 patients with tumor of suprarenal gland in 15 it was malignant, in 11--benign adenoma and cyst of suprarenal gland were revealed. FNAPB of the suprarenal gland tumor is a safe, informative and in some situations curative method. FNAPB is recommended for diagnosis of primarily revealed tumors of suprarenal glands more than 2 cm in diameter. The procedure should be performed by specially trained physician, who determines technical conditions of its conduction by himself and possesses the method o fultrasonography. Data of cytological investigationspermits to differentiate benign and malignant tumor, to determine the tumor type, what constitutes diagnostic background for the tactic choice of surgical intervention and the disease prognosis.
Our aim was to evaluate practices of percutaneous liver biopsies over the last 11 years in our center in focal or diffuse liver disease. Records of 447 patients who underwent ultrasound-guided liver biopsy between 1998 and 1999 were reviewed. Three experienced physicians performed all liver biopsies with a Menghini needle or fine needle. In all cases the puncture site was determined using prebiopsy ultrasound. Liver biopsies were performed on 423 hospitalized patients and 24 outpatients. The suspicion of primary liver cancer was the indication in 72.7% of the cases. In 75.2% patients definitive or indicative pathological diagnosis were obtained. 208 biopsies out of 229 (90.8%) and 215 cytological punctures out of 239 (89.9%) were interpretable. Histological diagnosis obtained were primary malignamt tumor in 235 cases (58.2%), cirrhosis in 26 cases (6.4%), chronic hepatitis in 32 cases (7.9%), and normal tissue in 56 cases (13.9%). Only 2 hemorrhagic complications requiring blood transfusion (0.4%) and one needle-tract tumor seeding (0.2%) occured 42 months later. We concluded that ultrasound-guided percutaneous liver biopsy is a quick method of assessment increasing the diagnosis yield by this procedure and maintaining low complications.
OBJECTIVE: To evaluate the long-term results of tracheoesophageal puncture for Blom-Singer voice restoration after total laryngectomy and summarize our clinical experience of fifteen years. METHOD: From 1986 to 2001, one hundred and thirty four cases with Blom-Singer technique after total laryngectomy for voice restoration were analyzed retrospectively. MDVP of Kay Elemetrics was used to analyze the acoustic parameters of eighteen cases with Blom-Singer indwelling voice prosthesis for 2-14 years. RESULT: For all cases, the follow-up was two to fifteen years. From 1986 to 1989, seven of twelve cases were satisfied with their speech, the success rate was 58.3%. After the year of 1990, the success rate was 93.4% (114/122). The total success rate was 90.3% (121/134). The acoustic parameters of Blom-Singer indwelling voice prosthesis was far away from normal. The common complications included fistula granulations, infection, leakage. CONCLUSION: The procedure of tracheoesophageal puncture for voice restoration is relatively simple and has low complications, high phonation success, good phonation quality, and steady long-term results, which is the best way to make laryngectomeel to speak. Pharyngoesophageal sphincter myotomy can raise the success rate of voice restoration by Blom-Singer indwelling voice prosthesis.
A percutaneous visceral tumor puncture director is introduced in this paper, which can be used for needle biopsy and brush biopsy in kinds of visceral tumor. The clinical informations show that the application of the director can increase the positive ratio of puncture, and it has important clinical value. The director is safe, practical and easy to operate.