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PubMedDate not supplied

Transjugular intrahepatic portosystemic shunt creation in Budd-Chiari syndrome: percutaneous ultrasound-guided direct simultaneous puncture of the portal vein and vena cava.

Budd-Chiari syndrome (BCS) is an uncommon disorder that can be life-threatening, depending on the degree of hepatic venous outflow obstruction. Transjugular intrahepatic portosystemic shunt (TIPS) provides decompression of the congested liver but the hepatic vein obstruction makes the procedure more difficult. We describe a modified method that involved a single percutaneous puncture of the portal vein and inferior vena cava simultaneously for TIPS creation in a patient with BCS.

Adult↗
PubMedDate not supplied

Complications in percutaneous vertebroplasty associated with puncture or cement leakage.

Due to the minimally invasive character and excellent clinical outcome of percutaneous vertebroplasty (PVP), the procedure is being performed in greatly increasing numbers. While PVP has a low complication rate in general, severe complications can occur. We focus on the imaging appearance of complications of PVP associated with puncture or cement leakage--from harmless to life-threatening.

Aged↗
PubMed2003

Safety of lumbar puncture for adults with acute leukemia and restrictive prophylactic platelet transfusion.

No data exist on the trigger for platelet transfusions in adult thrombocytopenic patients with acute leukemia undergoing lumbar puncture (LP). We reviewed the records of 66 patients with acute leukemia (median age 38 years, range 18-68) who have been treated in our institution for 6 years. A total of 195 LPs were performed. No serious hemorrhagic complications occurred, but there was a significant trend towards a higher percentage of traumatic procedures, defined as the occurrence of >500 erythrocytes per high-power field, in patients with lowest platelet counts ( p<0.005). Although not associated with serious clinical bleeding events in this study, the increased occurrence of traumatic procedures may indicate an increased risk for more serious hemorrhagic complications, implying a trigger not lower than 20x10(9)/L for prophylactic transfusions of platelets in adult patients with acute leukemia undergoing LP.

Adolescent↗
PubMed1999

Real-time MR-guided joint puncture and arthrography: preliminary results.

The purpose of this study was to evaluate interactive MR-guided joint puncture with intra-articular application of contrast agent. MR-guided arthrography of the shoulder joint was successfully performed in three patients using an interactive guidance system implemented in an open-configuration MR system. Visualization of the needle pathway and contrast inflow was comparable to that with conventional X-ray fluoroscopy. The position of the intra-articular needle tip was accurately confirmed and subsequent MR arthrography was diagnostic in all cases.

Adult↗
PubMed1998

Single-puncture laparoscopic gastrostomy in children.

An original one-puncture technique of performing laparoscopic gastrostomy is described. The implications are analysed. The results of five operations are presented and the advantages and limitations are discussed in the light of current available methods.

Adolescent↗
PubMed2002

[Occlusion by catheter intervention in patent foramen ovale via additional transseptal puncture].

In patients with a cryptogenic cerebral ischemia, the percutaneous closure of a patent foramen ovale (PFO) has gained increasing acceptance as an alternative strategy to prevent paradoxical embolism. Promising data with low recurrence rates have been reported for several self-expanding double disk devices. The implantation of the device is usually performed by passing the PFO. However, in one patient with a TIA (m, 43 years) transesophageal echocardiography (TEE) revealed an atrial septum abnormality with a hypermobile septum and a very small distance (approximately 12 mm) between the PFO channel and the anterior mitral valve leaflet, which was too short to accommodate the regular implantation procedure of the device via the PFO-channel itself. In this particular case the device (PFO-Star TSD) was advanced to the left atrium via an additional transseptal puncture--performed under TEE guidance--to allow for complete closure of the PFO without impairment of the mitral valve function. No periinterventional complications were observed. During the follow-up period of 9 months the patient was completely asymptomatic with no functional impairment of the mitral valve and no residual intracardiac shunt.

Adult↗
PubMed1997

Laparoscopic cecal ligation and puncture in the rat. Surgical technique and preliminary results.

BACKGROUND: We describe a technique of laparoscopic cecal ligation and puncture (CLP) in the rat analogous to open CLP which may facilitate the study of minimally invasive surgery (MIS) and peritonitis. METHODS: Forty-four rats were randomized to either laparoscopic or open CLP and their 3-day mortality was recorded. Autopsies were performed for peritoneal fluid cultures, measurement of the length of ligated cecum, and scoring of the degree of cecal necrosis. RESULTS: Laparoscopic CLP required slightly longer operating times compared to open CLP (average 15.6 vs 13.1 min, p = 0.002). Three-day postoperative mortality was 36.4% and 22.7% for open and laparoscopic CLP, respectively (p = NS). There were no differences in the length of ligated cecum or the cecal necrosis score between the open and laparoscopic CLP groups. CONCLUSION: Laparoscopic CLP is feasible and produces a fecal peritonitis with similar characteristics to those of traditional open CLP.

Animals↗
PubMed1999

Umbilical one-puncture laparoscopic-assisted appendectomy in children.

To perform a laparoscopic appendectomy, three trocars are usually needed. In order to reduce abdominal wall trauma, we have adopted an umbilical one-puncture laparoscopic-assisted appendectomy (UOPLAA). We did a retrospective study of UOPLAA performed during last 2 years on 200 children aged from 5 to 18 years (median, 9 years). The patients were selected after clinical examination. No child with advanced generalized peritonitis or an abscess with a palpable mass was a candidate for this technique. UOPLAA was successful in 184 patients (92%). In 16 cases (8%), an additional trocar was required to manage perforated or retrocecal appendicitis. The mean operative time was 15 min, and the mean hospital stay was 2 days. There were no intraoperative complications. There were 10 (5%) postoperative complications (three parietal and seven intraabdominal). Four patients (2%) needed reoperation under general anesthesia. The UOPLAA is our preference in cases of acute nonperforated appendicitis because it is simple and fast, with good cosmetic results; but in 8% of our cases, an intraoperative difficulty (retrocecal location, abnormal adhesive band, peritonitis, etc.) arose that required the introduction of additional devices to ensure the safety of the laparoscopic procedure.

Acute Disease↗
PubMed2004

A new diagnostic approach to pancreatic pseudocyst fine-needle puncture: three-dimensional sonography.

BACKGROUND/PURPOSE: We evaluated the usefulness of three-dimensional (3D) sonography in percutaneous fine-needle pancreatic pseudocyst puncture. METHODS: We examined 52 patients diagnosed as having pancreatic pseudocysts on the basis of clinical symptoms and two-dimensional (2D) ultrasonography findings. The decision to qualify certain patients for percutaneous fine-needle aspiration guided by ultrasonography was made on the basis of 2D and 3D scan results. Spiral computed tomography was done when the presence of connections between pseudocyst and pancreatic duct was suspected. In these cases diagnosis was confirmed in operative procedures. 3D sonography was used to monitor the tip of the needle making its way to the pancreatic pseudocyst and later inside the fluid collection. RESULTS: Pancreatic pseudocysts were diagnosed in all 52 cases; 48 patients underwent percutaneous fine-needle biopsies. CONCLUSIONS: 3D presentation can better visualize irregular shapes, local thickenings, and calcification of pseudocyst walls than classical 2D ultrasound scans. The use of subtraction in 3D scans of blood vessels increases the safety in performing biopsies. We have shown that 3D sonography collects extremely useful information about the status of the pseudocyst structure, and it should become a complementary method to classical ultrasonography. This technique when used on a routine basis should help us change the inclusion criteria for guided biopsies.

Adult↗
PubMed2005

Mucormycosis spondylodiscitis after lumbar disc puncture.

Vertebral osteomyelitis due to mucormycosis is a rare but fulminant and fatal disease. Only one case has been reported in literature, with postmortem diagnosis. The present paper reports a female case of mucormycosis spondylodiscitis and vertebral osteomyelitis after lumbar disc puncture and radio frequency nucleoplasty. She subsequently underwent two surgical debridements, continuous local irrigation and drainage, together with local and systemic Amphotericin B treatments. The infection was controlled 4 months after the second debridement; however, there was no improvement in the neurological function at the most recent follow-up, 16 months after the surgery. The experience of this patient, though a single case, supports early recognition, surgical debridement, systemic and local antifungal treatment, closed irrigation and drainage as the keys to successful treatment.

Antifungal Agents↗
PubMed2007

The positive role of lumbar puncture in the diagnosis of Vogt-Koyanagi-Harada disease: lymphocyte subsets in the aqueous humor and cerebrospinal fluid.

PURPOSE AND METHODS: Activated T cells are believed to be important at the inflammatory sites in the pathogenesis of Vogt-Koyanagi-Harada disease. Patients are often affected by meningitis and uveitis. In this work, to examine the positive role of lumbar puncture in the diagnosis of VKH disease, we analyzed and compared the surface markers of aqueous humor cells, cerebrospinal fluid cells, and peripheral blood lymphocytes by use of flow cytometry. RESULTS: Most lymphocytes were T cells. In aqueous humor and cerebrospinal fluid, numbers of CD3(+), CD4(+), and CD4(+)CD45RO(+) cells were significantly greater than in peripheral blood lymphocytes (P < 0.01). The CD4(+)/CD8(+) ratio for aqueous humor and cerebrospinal fluid was significantly higher than that for peripheral blood cells (P < 0.01). Four weeks after starting systemic corticosteroid treatment, numbers of CD4(+) and CD4(+)CD45RO(+) cells in cerebrospinal fluid were significantly lower than before treatment. CONCLUSIONS: Profiles of surface markers were similar for cerebrospinal fluid and aqueous humor, but apparently different from that for peripheral blood cells. This suggests that cerebrospinal fluid may reflect the active local immunological reaction at sites affected by the disease, i.e. the uvea and the meninges.

Acute Disease↗
PubMed1994

Diagnostic lumbar puncture in HIV-infected patients: analysis of 138 cases.

PURPOSE: This study was designed to describe the cerebrospinal fluid (CSF) findings and neurologic diagnoses observed in human immunodeficiency virus (HIV)-infected adults undergoing diagnostic lumbar puncture (LP) and to correlate the results of LP with indications and CD4 counts. DESIGN: Retrospective cross-sectional chart review study. SETTING: University hospital clinic for patients with HIV infection. PATIENTS: All patients of the University of California, San Francisco (UCSF) AIDS Clinic who underwent LP between mid-1987 and mid-1990 for headache, fever, altered mental status, or a combination of these indications. Sixty-seven percent had an AIDS diagnosis at the time of LP; the median CD4 count was 0.091 x 10(9)/L. RESULTS: A total of 138 LPs was analyzed. Elevation of CSF protein and leukocytes occurred in 33% and 27% of specimens, respectively. Seventy-two new neurologic diagnoses were established in 67 patients, but only 30 diagnoses were the result of CSF analysis. Of these 30 diagnoses, 18 were of aseptic meningitis attributed to HIV. None of the 12 treatable diagnoses established by LP occurred in patients known to have a CD4 count of 0.200 x 10(9)/L or greater. Patients undergoing LP because of headache had a lower incidence of new diagnoses than those with altered mental status (35% versus 72%), but LP revealed a higher proportion of diagnoses in the group with headache. CONCLUSIONS: CSF abnormalities were common at all stages of disease. LP was diagnostic in 22% of cases, but fewer than half of the diagnoses were of treatable secondary complications. Patients with a CD4 count higher than 0.200 x 10(9) have a very low incidence of opportunistic complications. The relatively low yield of LP in patients with altered mental status suggests that other testing modalities should be used prior to LP.

Adult↗
PubMed1975

Renal artery stenosis: a complication of needle puncture for manometry. Case of subintimal dissection with spontaneous resolution.

After aortorenal bypass for renovascular hypertension secondary to atherosclerosis of the renal artery of a solitary left kidney a high-grade stenosing lesion developed distal to the site of insertion of a Dacron graft. In the immediate postoperative period the blood pressure was restored to normal, but one week later hypertension recurred. An arteriogram disclosed an area of stenosis 1 cm distal to the site of insertion of the graft in the renal artery. During the next year, serial arteriograms were made, renal function remained normal, and hypertension gradually abated. One year after the discovery of the postbypass stenosis, an arteriogram showed disappearance of the constricting lesion. The postoperative stenosis was, in all probability, caused by subintimal dissection secondary to needle puncture for strain gauge manometry.

Arteriosclerosis↗
PubMed1986

Primary tracheoesophageal puncture for voice restoration.

A 93 percent success rate of voice restoration after primary tracheoesophageal puncture was achieved in 15 patients. Patients were usually able to talk within 3 weeks after laryngectomy. Male patients without chronic obstructive lung disease achieved better results. The incidence of complication after this procedure were not significantly different from a group of 111 patients who underwent laryngectomy alone. Finally, early speech acquisition provides a substantial psychologic boost for the patient undergoing total laryngectomy.

Adult↗
PubMed1992

Interleukin 1 beta improves survival following cecal ligation and puncture.

Despite antibiotic therapy intra-abdominal sepsis following major surgery is a significant cause of mortality. We sought to determine if interleukin-1 beta (IL-1) could improve survival in a murine model of intra-abdominal infection. Groups of 10 BDF1 mice received a single subcutaneous (sc) injection of recombinant human IL-1 beta 24 hr prior to cecal ligation and puncture (CLP) and were assessed twice daily for survival. Mice that received a single injection of IL-1 beta 24 hr prior to CLP had a dose-dependent improval in survival compared to controls. The beneficial effect of IL-1 treatment may have been related to its ability to stimulate myelopiesis. The addition of indomethacin, in an effort to limit possible toxicity of IL-1, did not further improve survival. Appropriate timing of specific immunomodulators may provide an additional strategy for the treatment of infections.

Abdomen↗
PubMed1976

Complications of renal cyst puncture.

One hundred nineteen renal cyst punctures have been reviewed. There have been four complications (3.4 per cent), three requiring surgery. This should be expected, as all invasive diagnostic procedures are accompanied by some morbidity. The relative benefit of nonoperative diagnostic procedures in differentiating benign renal cyst from adenocarcinoma is discussed.

Aged↗
PubMed1980

Diagnosis and treatment of fluid-filled renal structures in children with ultrasonography and percutaneous puncture.

The application of ultrasonographic and percutaneous needle puncture techniques in the diagnosis of various fluid-filled renal anomalies has permitted rapid delineation of anatomic detail, more definitive physiologic evaluation, and drainage, when necessary, in a safe and cost-effective manner. Its usefulness in children is emphasized in 6 illustrated cases of male infants with minimally or nonopacified renal anomalies, one of the more difficult diagnostic problems in pediatric urology.

Adolescent↗