Single-puncture myelographic evaluation of epidural block in the young infant.
A single lumbar puncture myelographic technique is described to evaluate long segment epidural block in the young infant.
Humans↗
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Echo guided percutaneous transhepatic cholangiography with puncture transducer.
Conventional percutaneous transhepatic cholangiography (PTC) has some disadvantages because it is customarily performed blindly. If the bile duct is made visible, these disadvantages are eliminated. The biliary tree, if dilated, can be clearly delineated by ultrasound technique. By combining the B-mode examination of the biliary tract with the ultrasonic puncture transducer, percutaneous transhepatic cholangiography was performed successfully in 16 examinations on 12 patients. PTC needle could be inserted directly into the lumen of the bile duct without appreciable difficulty. The echo guided PTC was found to be an easier, safer, and more reliable method than the conventional blind technique.
Aged↗
Intraspinal epidermoid after lumbar puncture.
An intraspinal epidermoid tumour developed six years after a lumbar puncture in a woman aged 30 years. This rare complication possibly arose from implanted cutaneous tissue.
Adult↗
Isolation of Neisseria gonorrheae and concomitant bacterial microflora from urine obtained by suprapubic bladder puncture in women with gonococcal urethritis.
The authors examined 38 non-pregnant women with gonococcal urethritis. Thirty-three (86.8%) of them suffered also from endocervical gonorrhea. Neisseria gonorrheae (N. go) was isolated from the midstream of urine in a quantity of 1 x 10(2) to 9 x 10(8) in 1 ml of urine with an average of 5.08 x 10(4) N. go per 1 ml of urine and S. E. M. +/- 3.85 x 10(4) N. go per 1 ml of urine. On the basis of suprapubic puncture ascendent propagation of bacteria to the bladder was observed by cultivation in 13 (34.2%) patients, with isolation of N. go in 5 cases.
Bacteria↗
Antegrade popliteal puncture: technical note.
Percutaneous transluminal angioplasty was performed via an antegrade popliteal puncture. This technique was utilized because the patient had a superficial femoral artery occlusion and coexistent popliteal stenoses, with the occlusion unable to be traversed in the usual common femoral artery antegrade approach. To our knowledge, this technique has not been described in the literature. The clinical utility of this approach and important anatomical considerations will be discussed.
Angioplasty, Balloon↗
Biochemical and cytological analyses of cystic fluid aspirated by percutaneous puncture under ultrasonic guidance in cystic diseases of the pancreas.
Ultrasonically guided percutaneous puncture of pancreatic cyst was performed on 4 patients with ultrasonically scanned cystic mass lesions in the left upper quadrant, and biochemical and cytological analyses of the aspirated cystic fluids were proved fairly diagnostic. In pseudocyst, the aspirated fluid revealed very high concentration of amylase, malignant cells being not recognized cytologically. In cystadenocarcinoma, the aspirated fluid revealed low concentrations of amylase and high concentrations of LDH and CEA, malignant cells being definitely recognized. This method is of great value for differential diagnosis of cystic diseases of the pancreas.
Adult↗
Three-layer closure of a tracheoesophageal puncture site: a technical note.
A tracheoesophageal voice prosthesis is highly effective in promoting good speech after total laryngectomy. However, long-term use of this device occasionally results in the development of fistulas that must be closed, usually at the request of the patient, because of leakage of saliva and food around the prosthesis. This report describes a technique for simple 3-layer closure of the tracheoesophageal puncture site; other procedures are discussed in light of the current literature.
Humans↗
Suprapubic transvesical puncture and sclerotization of a müllerian duct cyst under US guidance.
Abdominal, ultrasonography (US) performed on a middle-aged patient who presented with partial urinary retention, long lasting lower back pain, and abdominal pain revealed a cyst in the midline of the prostate. The cyst, which protruded into the bladder, was punctured under US guidance transvesically and sclerotized with 1% Aethoxysklerol. Following this procedure, the patient became steadily free of his complaints and is voiding without retention.
Cysts↗
Efficacy of prior skin puncture in preventing i.v. catheter damage.
The efficacy, with respect to preventing i.v. catheter damage, of creating a skin entry site by first piercing the skin with a large gauge needle through which an over-the-needle teflon catheter is then placed was evaluated. In 50 adult volunteers two 22-gauge i.v. catheters and two 24-gauge catheters were placed through the forearm skin into the subcutaneous tissue. One catheter of each size was placed through an entry site created by piercing the skin with an 18-gauge disposable, stainless steel needle. One catheter of each size was inserted through nearby skin without creation of an entry site. Two to three weeks after insertion all catheters, along with 50 catheters of each size that had not been inserted, were examined under a microscope for evidence of damage. Intravenous catheter damage was more prevalent in the 24-gauge catheters than the 22-gauge catheters (P less than 0.05). No differences in frequency of damage were noted for either gauge catheter inserted through an entry site compared with those inserted without a prior skin puncture. Twenty-four-gauge catheters, but not 22-gauge catheters, placed into the subcutaneous tissue were damaged more frequently than were catheters that had never been inserted (control catheters). This study demonstrated that 24-gauge catheters are more likely to be damaged during insertion into the subcutaneous tissue than are 22-gauge catheters. We also demonstrated that creation of a skin entry site by piercing the epidermis with a needle of larger gauge than the catheter to be placed is not efficacious in preventing intravenous catheter damage during insertion.
Adult↗
Postdural puncture headache: a randomized prospective comparison of the 24 gauge Sprotte and the 27 gauge Quincke needles in young patients.
This study was designed to compare the frequency of postdural puncture headaches (PDPH) using the 24 gauge Sprotte and the 27 gauge Quincke spinal needles in a population of patients less than 45 yr of age undergoing spinal anaesthesia for non-obstetrical surgery. Patients were randomly assigned to receive spinal anaesthesia with either the 24 gauge Sprotte spinal needle (n = 46) or the 27 gauge Quincke spinal needle (n = 47). Patients were interviewed on either postoperative day one or two and on postoperative day three. A PDPH was defined as a headache involving the occipital or frontal areas that is made worse when assuming either the sitting or standing position. Ninety-three patients were included in the analysis of data. The overall incidence of PDPH was 14% (13 of 93), and no difference was found between the Sprotte (15.2%) and Quincke (12.8%) needles. The distribution of the PDPHs by severity was not different between the two groups. None of the 13 patients with PDPHs required on epidural blood patch for relief of symptoms. Both the Sprotte needle and the Quincke needles were judged as easy to use and both required the same number of attempts in order to locate cerebrospinal fluid (first attempt successful: 73.9% versus 66%). Neither patient satisfaction nor the acceptability of spinal anaesthesia for a future procedure was adversely affected by the occurrence of a PDPH. The results of this study suggest that the risk of PDPH after spinal anaesthesia in young patients is similar using either the 24 gauge Sprotte or the 27 gauge Quincke spinal needle.
Adult↗
Postdural puncture headache in a parturient with sickle cell disease: use of an epidural colloid patch.
PURPOSE: To report the injection of a colloid in the epidural space as an alternative to an epidural blood patch in a woman with sickle cell disease. CLINICAL FEATURES: A Cesarean delivery was performed under spinal anesthesia in a 32-yr-old woman with severe sickle cell disease and a past medical history of vaso-occlusive crisis. In the postoperative period, the patient complained of postdural puncture headache resistant to symptomatic treatment. Because there were no data concerning the safety of a blood patch in this condition, a colloid (a modified fluid gelatin heated to 37 degrees C) was injected in the epidural space instead of blood. Headaches decreased immediately after the epidural injection of the colloid and disappeared totally within 12 hr. CONCLUSION: Data concerning the safety of epidural blood patches in patients with sickle cell disease are lacking. Injection of colloids in the epidural space could be an alternative.
Adult↗
[Hemostatic closure of arterial puncture site using Angio-Seal after diagnostic heart catheterization or coronary intervention].
Conventional manual compression and subsequent application of pressure bandages is associated with prolonged immobility and significant patient discomfort. Routine anticoagulation as well as the use of new interventional devices and platelet inhibiting strategies lead to a higher incidence of local bleeding complications after diagnostic cardiac catheterization or coronary angioplasty. Immediate sheath removal increases patient comfort. The Angio-Seal system uses a biodegradable anchor and collagen plug for sealing of arterial puncture sites. Several studies showed the safety and efficacy of this device. Technical deployment success ranges between 88 and 100%. Significant reduction in time to hemostasis allows for earlier patient ambulation and shorter in-hospital stay compared to manual compression with peripheral complications not being increased.
Angioplasty, Balloon, Coronary↗
Lumbar puncture and the risk of herniation: when should we first perform CT?
Death following lumbar puncture (LP) is feared by physicians. Many opinions are found in literature on the question whether computed cranial tomography (CT) should be performed before LP, to prevent herniation. These opinions are mainly based on retrospective studies and pathophysiological reasoning. In this review the difficulties in the decision whether we should perform CT before LP are discussed. It is explained that the concept of "raised intracranial pressure" is confusing, and that the less ambiguous terms "brain shift" and "raised CSF pressure" should be used instead. Brain shift is a contraindication to LP, whether CSF pressure is raised or not, and whether papilloedema is present or not. Subsequently, recommendations are offered for indications to perform CT before LP, grouped according to the safety and clinical utility of LP.
Brain↗
Gadolinium enhancement of spinal subdural collection on magnetic resonance imaging after lumbar puncture.
We report a 35-year-old male with an unusual contrast-enhancing sterile spinal subdural collection on magnetic resonance imaging (MRI), apparently occurring as a complication of lumbar puncture. Follow-up MRI after 4 weeks demonstrated spontaneous resolution of the collection without intervening treatment.
Adult↗
Preoperative devascularization of a circumferential osteogenic metastasis to the upper cervical spine by direct percutaneous needle puncture: a technical note.
Direct percutaneous needle puncture (DPNP) for presurgical devascularization of head and neck as well as skull base tumours is an established, yet not widespread method. We present a case of a large and highly vascularized metastasis with partial destruction of the first two cervical vertebrae and encasement of the spinal cord that was successfully treated by DPNP for preoperative devascularization after an attempted endovascular embolization had failed. The lesion was safely and effectively devascularized, which facilitated the surgical removal. The case presented illustrates the technique and furthermore demonstrates its value.
Aged↗
Complications of lumbar puncture in a child treated for leukaemia.
Lumbar puncture may lead to neurological complications. These include intracranial hypotension, cervical epidural haematomas, and cranial and lumbar subdural haematomas. MRI is the modality of choice to diagnose these complications. This report documents MRI findings of such complications in a child treated for leukaemia.
Child↗
Diagnostic and interventional ultrasonography in neonatal and infant lumbar puncture.
BACKGROUND: Lumbar puncture (LP) may be unsuccessful clinically, prompting image-guided LP by radiologists. Objective. To investigate the utility of ultrasound (US) in diagnosing the cause of failed LP and in guiding LP. MATERIALS AND METHODS: Neonates and infants referred for image-guided LP underwent spine US of the thecal sac. When indicated, image-guided LP was performed. RESULTS: Forty-seven evaluations and interventions were performed in 32 patients. All patients were initially evaluated after failed blind LP attempts. Twenty-three of the initial US studies showed intrathecal and/ or epidural echogenic hematoma, which obliterated the CSF space; 5 showed minimal fluid, and 4 had normal examinations. LP was deferred or cancelled in 14 cases based upon initial US findings. Image-guided LP was performed 32 times in 19 patients. US guidance was used in 26, fluoroscopy in 3, and fluoroscopy with US assistance in 3. Using US, LP was performed in 9 patients with no visible CSF: 2 samples were sufficient for culture only. Six patients had minimal CSF US: 4 provided usable CSF samples. Clear CSF space was seen in 11: all had successful LP. CONCLUSIONS: US can disclose the cause of failed LP, can help determine whether or not to intervene further, and can provide guidance for LP.
Humans↗
Inadvertent puncture of the thoracic duct during attempted central venous catheter placement.
We report a case of puncture of the thoracic duct during left subclavian vein catheterization on the intensive care unit. Computed tomography and measurement of the triglyceride levels in the aspirated fluid proved the inadvertent penetration of the guidewire into the thoracic duct. Early recognition of central line misplacement avoided serious complications. Inadvertent central venous catheter placement into the thoracic duct may have the potential complications of infusion mediastinum and chylothorax.
Catheterization, Central Venous↗