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PubMedDate not supplied

Puncture of the seminal vesicles guided by a transrectal real-time linear scanner.

An interventional technique using a transrectal real-time linear scanner has been applied to the transperineal puncture of the seminal vesicles in 143 patients. The composition of this group was as follows: seminal vesiculitis, 98; hemospermia, 20; and prostatic cancer, 25. The aspiration of fluid and the injection of antibiotics and/or steroid drugs into the vesicles were performed for the diagnosis and treatment of seminal vesiculitis and hemospermia. Clinical symptoms improved in 62% of the former and in 50% of the latter cases. Cancer cells were detected in aspirated vesicular fluid in 7 out of 17 cases with prostatic cancer. A remarkable improvement in the diagnosis of prostatic cancer invasion into the seminal vesicles can be expected from this new diagnostic procedure.

Aged↗
PubMed2004

Prevalence of viral infection markers by polymerase chain reaction amplification and interferon-alpha measurements among patients undergoing lumbar puncture in an emergency department.

Aseptic meningitis is a frequent diagnosis in emergency departments. Nevertheless, viral investigations are not carried out currently and the viral etiology in adult population has not been studied extensively. We conducted a prospective study including all consecutive patients undergoing lumbar puncture during a 15 months period in an adult emergency department. Bloody and purulent cerebrospinal fluid (CSF) were excluded. The main tests undertaken were: CSF genomic amplification by the polymerase chain reaction (PCR) for neurotropic viruses and serum and CSF interferon-alpha (IFN-alpha) measurements. Among 194 patients included, 45 had and 149 did not have aseptic meningitis. Of 45 patients with aseptic meningitis, 10 had alternative non-virological final diagnosis, and 35/45 were presumed to have neurological disorders of viral origin. Patients (27/35) completed virological analysis: 21/27 (78%) had either positive viral PCR (enterovirus: 8 patients, Varicella zoster virus (VZV): 5, Epstein-Barr virus (EBV): 2, herpes simplex virus (HSV): 1, human herpes virus 6: 1) or only raised serum or CSF IFN-alpha (4 patients). Overall, 59% of patients with a positive viral PCR had either CSF or serum raised IFN-alpha. Twentyone patients without meningitis had either positive viral PCR (enterovirus: 3 patients) or only high serum IFN-alpha level (18 patients). In the setting of aseptic meningitis diagnosed in an adult emergency department, viruses are the most common agents encountered, with enterovirus and VZV as the two main etiological agents. Current CSF viral genome amplification and IFN-alpha measurement are informative and could be useful to confirm the viral origin of various neurological disorders, although the sensitivity and specificity of IFN-alpha measurement for the diagnosis of viral infection need further confirmation.

Adolescent↗
PubMed2002

Vascular parkinsonism: clinical correlates predicting motor improvement after lumbar puncture.

Vascular parkinsonism (VP) is a poorly defined entity which has clinical, and perhaps pathological, overlap with other diagnoses. Although classical VP involves lesions of the basal ganglia, the majority of cases actually show diffuse subcortical white matter changes (SCWMC) on imaging. The exact pathologies of these white matter changes are debated and likely heterogeneous, but are generally thought to represent areas of chronic or recurrent partial ischemia. Cerebrospinal fluid (CSF) drainage is the treatment for NPH and has been reported to improve symptoms in some patients with idiopathic NPH and associated SCWMC. To determine whether historical, clinical, or radiographic factors predict improvement in VP patients after CSF drainage, we removed 35-40 ml of CSF via lumbar punctures (LP) from 40 patients and compared responders with nonresponders for a variety of demographics, clinical features, and blindly interpreted magnetic resonance images (MRI). Fifteen patients (37.5%) reported "significant and irrefutable" gait improvement after LP. Twelve (30.0%) reported no effect and 13 (32.5%) reported mild or very transient improvement. Timed gait in a subset of patients improved (P < 0.05) immediately after LP. Clinically, improvement after CSF removal was predicted by any positive response to levodopa (P < 0.001), the lack of vertical gaze palsies (P < 0.05), the lack of a pure freezing gait (P < 0.05), and the lack of hypotensive episodes (P < 0.05). Blinded MRI interpretation did not find features which clearly predicted response. Some patients diagnosed with VP improved after LP. Clinically, these patients tended to resemble idiopathic PD, whereas nonresponders more closely resembled progressive supranuclear palsy (PSP). These results warrant further investigation and also raise the possibility of testing CSF drainage in patients with idiopathic PD complicated by SCWMC.

Aged↗
PubMed2001

Lumbar puncture in pediatric oncology: conscious sedation vs. general anesthesia.

BACKGROUND: Lumbar punctures (LP) generally have been performed with conscious sedation (CS) but are increasingly performed using general anesthesia (GA) owing to the belief that this is less distressing. The aim of this study was to compare these two methods concerning distress, discomfort, pain, well-being and security after the LP, and problems with the LP. PROCEDURE: Twenty-five children with cancer participated in this prospective, randomized, crossover study. Children, parents, and nurses completed a visual analogue scale questionnaire to evaluate the efficacy of CS and GA. In addition, sedation and anesthesia protocols were reviewed. RESULTS: The two methods seemed to be equivalent concerning distress, discomfort, pain, well-being and security after the procedure, and procedure problems. Most children (80%), parents (66%), and nurses (58%) preferred LP in CS. However, the LP was not performed in CS in five cases because the child did not cooperate. Younger children less often preferred CS. CONCLUSIONS: Outcomes for CS and GA in LP were similar. Although there were failures with the CS model, most preferred it to GA. LP in CS also saved time and medical resources. An alternative approach would be to have a pediatric anesthesiologist available at the oncology ward for these elective LPs to provide the sedation or anesthesia required by each individual.

Adolescent↗
PubMed1991

Midazolam premedication for pediatric bone marrow aspiration and lumbar puncture.

The ability of midazolam, a benzodiazepine, to reduce the distress associated with lumbar puncture and bone marrow aspiration was examined in 23 children with acute lymphocytic leukemia. Patients were randomized to receive 0.2 mg/kg midazolam HCl or placebo intravenously 3-5 min before the procedures, under double-blind conditions. Based on prior experiences, children in both groups anticipated severe pain from these procedures. Postprocedure pain ratings by patients were markedly reduced in the midazolam but not the placebo group. Both physicians and parents judged the midazolam group as significantly less distressed than controls during and after the procedures. Trained observers recorded significantly fewer pain- and anxiety-related behaviors in the midazolam group immediately before and after, but not during the procedures. The amnestic effects of midazolam, confirmed in a visual recall/recognition test, appear to account for the decreased pain ratings since the behavioral manifestations were similar in the two groups. There were no adverse drug reactions or significant changes in vital signs. Midazolam warrants further investigation as a premedication for painful diagnostic and treatment procedures in children with cancer.

Adolescent↗
PubMed2005

Painful procedures in children with cancer: comparison of moderate sedation and general anesthesia for lumbar puncture and bone marrow aspiration.

BACKGROUND: The study was conducted to compare moderate sedation (MS) with general anesthesia (GA) in the management of frequently performed lumbar puncture or bone marrow aspiration (BMA) during the treatment of childhood cancer. PROCEDURE: The MS (14 patients for 30 procedures) was managed by non-anesthesiologists (combined nitrous oxide-midazolam +/- non-pharmacological techniques). The GA was managed by anesthesiologists (17 patients for 30 procedures). A neutral observer recorded side effects, use of sedative antagonists, recovery time, oncologist's evaluation, procedure behaviors check list (PBCL); subjective perceptions during the procedure with a questionnaire administered to children (>6 years) and their parents; drugs costs and professional resources. P-values <0.05 were considered significant. RESULTS: We had two inadequate sedations in MS (6.6%) versus 0 in GA. We had no significant differences in side effects (7.10% MS vs. 8.6% in GA), use of antagonists (2.90% GA vs. 0 MS), PBCL, oncologist evaluation and questionnaire data or drugs costs. We observed significant differences in recovery times (MS, mean 43 +/- SD min vs. GA, mean 117 +/- SD min) and professional resources costs. The effects of non-pharmacological techniques on anxiety were perceived very positively by both children and parents (on 0-4 scale, mean scores 3.57 for the children; 3.53 for the parents). CONCLUSIONS: Our study suggests that MS compared favorably to GA with respect to both safety and efficacy. When performed by non-anesthesiologists, MS may be associated with better compliance and cost-effectiveness as it relies on the contribution of non-pharmacological techniques.

Analgesics, Non-Narcotic↗
PubMed1994

Tissue tumor necrosis factor mRNA expression following cecal ligation and puncture or intraperitoneal injection of endotoxin.

Tumor necrosis factor (TNF) has been implicated as a key mediator of the septic response. Although very high serum levels of TNF are detected in animal models of endotoxemia or gram-negative bacteremia, human patients with sepsis rarely have greatly elevated TNF serum levels. It has therefore been postulated that TNF may act in a paracrine fashion to cause local injury. In order to examine the role of locally produced TNF in sepsis, we compared serum TNF levels and TNF messenger RNA (mRNA) expression in various tissues following cecal ligation and puncture (CLP) or intraperitoneal injection of a sublethal dose of endotoxin. TNF mRNA expression was determined by the reverse transcription differential polymerase chain reaction using beta-actin as an internal standard. Serum levels of TNF were threefold higher after endotoxin administration compared to CLP. TNF mRNA in peritoneal macrophages rose fourfold after both endotoxin injection and CLP, with rapid return to normal in endotoxin-treated animals. There was a significant increase in TNF mRNA in the liver and lung, but not the spleen, during the first 24 hr after CLP. An increase in TNF mRNA was seen in all three tissues after injection of endotoxin. These results support the concept of locally produced TNF as a contributing factor in tissue damage and multiple organ failure during sepsis.

Animals↗
PubMed2005

A complete augmented reality guidance system for liver punctures: first clinical evaluation.

We provided in an augmented reality guidance system for liver punctures, which has been validated on a static abdominal phantom. In this paper, we report the first in vivo experiments. We developed a strictly passive protocol to directly evaluate our system on patients. We show that the system algorithms work efficiently and we highlight the clinical constraints that we had to overcome (small operative field, weight and sterility of the tracked marker attached to the needle...). Finally, we investigate to what extent breathing motion can be neglected for free breathing patient. Results show that the guiding accuracy, close to 1 cm, is sufficient for large targets only (above 3 cm of diameter) when the breathing motion is neglected. In the near future, we aim at validating our system on smaller targets using a respiratory gating technique.

Allantoin↗
PubMedDate not supplied

Endoscopic ultrasonographic-guided punctured pancreatic ductography: an initial and successful trial.

A 71-year-old male suffering from an intraductal papillary tumor of the pancreas was admitted to our hospital for further investigation. Diagnostic trials, including endoscopic retrograde pancreatography, did not produce an adequate ductography because of a large amount of mucinous fluid. Therefore, we performed endoscopic ultrasonographic-guided punctured pancreatic ductography (EPPD). This procedure was safely performed without any complications. We report this initial and successful trial of EPPD.

Aged↗
PubMed1995

Intraventricular blood after "traumatic" lumbar puncture: a report of two cases.

Blood was detected in the lateral ventricles on head computed tomograms performed after "traumatic" lumbar punctures in two children. This finding has not previously been observed or reported. The likely mechanisms by which blood from the spinal thecal sac reached the ventricles are discussed. This potentially confusing observation, if not correctly accounted for, may lead to an unnecessary, fruitless search for the site of a supposed "primary" intraventricular haemorrhage.

Cerebral Hemorrhage↗
PubMed1978

Cervical metrizamide myelography by lumbar puncture.

Cervical myelography with metrizamide administered by a lumbar puncture is described. Diagnostic information in the cervical region was obtained in 8 of the 8 patients studied. No major complications were encountered.

Adolescent↗
PubMed1997

Multiple communicating intradural arachnoid cysts: usefulness of myelography and myelo-computed tomography using both lumbar and cervical punctures. Case report.

We report a case of multiple communicating intradural cystic lesions. Magnetic resonance imaging did not demonstrate the lesions. Neuroradiological diagnosis of the intradural arachnoid cysts was made from myelography and myelo-computed tomography using both lumbar and cervical punctures. These procedures give us useful information about flow dynamics in the spinal subarachnoid space.

Arachnoid Cysts↗
PubMed1987

Evaluating the possibility of uterine transfer by ultrasonically guided transabdominal puncture.

Ultrasonically guided transvesical puncture of the uterine endometrial cavity was carried out in 16 patients to evaluate the feasibility of embryo transfer by this procedure. Instillation of fluid into the uterine cavity was achieved in all cases and easily performed in 15 patients. In one patient the fundal endometrium was reached in the third attempt. Instillation of fluid within the endometrium was attempted unsuccessfully in four patients, as the fluid leaked into the uterine cavity. In 12 patients 2-4 ml of fluid was injected. The fluid passed down through the cervix in patients in the luteal phase (nine patients) when 3 ml or more was injected. When a smaller amount of fluid was instilled it remained inside the cavity. In one patient in the preovulatory phase the fluid was actively pumped by uterine contractions into the vagina. Two cases in the proliferative phase showed no leakage from the cervix when 1.5 and 2 ml of fluid was injected, respectively.

Embryo Transfer↗
PubMedDate not supplied

Alpha-hemolytic streptococci: a major pathogen of iatrogenic meningitis following lumbar puncture. Case reports and a review of the literature.

Iatrogenic meningitis following lumbar puncture is a rare complication of myelography, spinal anesthesia, intrathecal chemotherapy, and epidural anesthesia. Sporadic cases and clusters of iatrogenic meningitis have been reported after intrathecal therapy, but most incidental cases are reported after myelography. Four cases of iatrogenic meningitis caused by viridans streptococci and a review of the literature are presented here. Observations and a case control study implicated a single anesthesiologist as the source. Probable cause of this cluster is non-observance of infection control measures as to the routine wearing of masks during the procedure. New infection control guidelines were implemented. A review of the literature on iatrogenic meningitis is given. Viridans streptococci have emerged as major pathogens of this complication. These findings underline the need to wear face masks since these bacteria are commensals of the oral cavity.

Adult↗
PubMed1988

Echo-guided percutaneous puncture: a safe and valuable therapeutic tool for amebic liver abscess.

To clarify the therapeutic role of echo-guided percutaneous puncture (EPP) in management of amebic liver abscess, 20 patients (24 abscesses) received metronidazole plus EPP. Fluid was aspirated through Chiba needles under real-time sonographic guidance so as to reduce cavity size to less than 3 cm. Not more than two EPPs were necessary in the majority of cases and no complication followed the procedure. This scheme resulted in a shortening of time of both hospitalization (less than or equal to 20 days) and liver lesion healing as assessed by ultrasound (less than or equal to 4 months). It is concluded that EPP is a valuable and safe therapeutic tool for hepatic amebic abscess.

Adult↗
PubMed1990

Routine lumbar punctures in the newborn--are they justified?

The records of 62,107 neonates cared for at three neonatal referral units between 1979 and 1985 were analysed with regard to the number of lumbar punctures (LP) performed and the results obtained. The mean perinatal mortality rate was 9.3/1000 live births and the neonatal mortality rate was 5.9/1000. The units were comparible in this respect. Two hundred and sixty three (0.4%) babies weighed less than 1.0 kg at birth and 510 (0.8%) babies weighed 1.0-1.5 kg. A total of 1554 LPs were performed on 1084 babies, 1.7% of the whole population. Seventeen babies were diagnosed as having meningitis following CSF examination; 5 weighed less than 1.5 kg (VLBW) (incidence of meningitis 6.5/1000 births) and 12 weighed more than 1.5 kg (incidence 0.2/1000 live births). An LP was performed on 44% of VLBW babies and 1.2% of babies weighing more than 1.5 kg. In both groups approximately 1.5% of CSF samples were positive. Eight of the 17 positive results were obtained during the first 3 postnatal days. Only one VLBW baby had meningitis on the 1st day of life (1.3/1000). In view of the low incidence of meningitis and the risk factors associated with an LP it is questionable whether this procedure should be a routine investigation in the VLBW newborn.

Humans↗