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PubMed1984

Transurethral puncture in management of ectopic ureteroceles.

In the past, treatment of ectopic ureteroceles with duplicated collecting systems with little or no function in the upper pole segment has been heminephrectomy, often followed by reconstruction of the ureterovesical junction. Herein we review our initial use of transurethral puncture of ureteroceles to initiate drainage with potential return or improvement of function to the upper pole segment. The initial goal was to do pyelopyelostomy rather than heminephrectomy with less potential morbidity to the patient and preservation of functional renal tissue.

Drainage↗

PubMed1993

Cecal ligation and puncture is associated with pulmonary injury in the rat: role of cyclooxygenase pathway products.

The present studies evaluated the role cyclooxygenase products play in bacterial sepsis induced pulmonary injury in the rat. Lung injury was assessed by determining the pulmonary capillary filtration coefficient (Kf) and the lung lavage protein concentration four and 18 hours after cecal ligation and puncture. Four hours after cecal ligation, the Kf was unchanged from control, however, by 18 hours, the Kf was increased 171% (p < .05). Similarly, lung lavage protein levels were unchanged four hours after cecal ligation but were significantly (p < .05) elevated at 18 hours. On the other hand, pulmonary lavage immunoreactive thromboxane B2 (iTXB2) levels were increased both four and 18 hours after the initiation of sepsis. In order to determine if cyclooxygenase products played a role in the sepsis associated lung injury, ibuprofen was administered prior to cecal ligation. Ibuprofen pretreatment prevented the sepsis associated increase in both Kf and lung lavage protein concentration. These studies suggest that bacterial sepsis in the rat is associated with pulmonary injury and that early administration of ibuprofen ameliorates this damage.

Animals↗

PubMed1988

Neurobiological effects of lumbar puncture stress in psychiatric patients and healthy volunteers.

Several existing laboratory-based stress paradigms have significant shortcomings for assessing neurobiological correlates of stress in healthy volunteers and severely ill psychiatric patients. We have examined neuroendocrine effects of stress associated with the lumbar puncture (LP) procedure in drug-free depressed and schizophrenic patients and healthy volunteers. Healthy volunteers and depressed patients had significant stress-induced elevations in plasma levels of adrenocorticotropic hormone (ACTH), cortisol, and growth hormone associated with LP. In contrast, schizophrenic patients had no significant elevations in any of the neuroendocrine parameters. Depressed patients' cerebrospinal fluid norepinephrine levels were negatively correlated with stress-induced activation of the hypothalamic-pituitary-adrenal axis. In addition, depressed patients' basal plasma cortisol levels were strongly predictive of stress-related elevations in ACTH, cortisol, and growth hormone. Furthermore, stress-induced changes in schizophrenic patients' cortisol and ACTH levels were not correlated.

Adrenocorticotropic Hormone↗

PubMed1983

An experimental study of hematoma formation after arterial and venous puncture.

Hematoma formation following the puncture of femoral veins or arteries of dogs was determined using mercury-filled strain gauges. Arterial bleeding always produced a hematoma. The duration of the swelling was prolonged if heparin was previously administered. Bleeding from the femoral vein did not produce a hematoma unless venous pressure was elevated by venous occlusion. The results indicate that the rapidly developing hematoma occasionally seen in dental practice following the administration of local anesthetics is of arterial origin.

Animals↗

PubMed1990

Evaluating the efficacy of EMLA in alleviating pain associated with lumbar puncture; comparison of open and double-blinded protocols in children.

Potential benefit of the topical anesthetic EMLA prior to lumbar puncture was studied in children with cancer. Comparison was made between 2 types of study: the first one involved 10 children who were enrolled in a double-blind placebo-controlled study and in the second, 18 children in an open crossover study. Although both studies suggested the favourable effects of EMLA in alleviating pain associated with LP, they illustrated the need to perform such studies in a controlled blinded fashion; the effect in the double-blind study was not apparent in some cases, whereas it was clear cut in all open cases.

Adolescent↗

PubMed1994

Cognitive-behavioral interventions for children's distress during bone marrow aspirations and lumbar punctures: a critical review.

Children with cancer often have difficulty coping with the invasive medical procedures that are part of diagnosis and treatment. Bone marrow aspirations and lumbar punctures are painful and cause some children severe anxiety and distress. The increased risk and expense of general anesthesia and the relative ineffectiveness of sedatives and anxiolytics has prompted clinicians to examine nonpharmacologic methods for controlling pain and distress. This report critically examines intervention studies that focus on cognitive-behavioral strategies such as distraction, imagery, or hypnosis for reducing procedural distress in children with cancer.

Analgesia↗

PubMed1995

The effect of epidural blood patch on hearing loss in patients with severe postdural puncture headache.

STUDY OBJECTIVE: To determine the immediate effect of epidural blood patch (EBP) on the hearing loss that can accompany postdural puncture headache (PDPH). DESIGN: Prospective open study. SETTING: Anesthetic and otolaryngologic departments at a university hospital. SUBJECTS: 16 patients who developed severe PDPH following either myelography or spinal anesthesia. INTERVENTIONS: Epidural injection of 15 ml of autologous blood. MEASUREMENTS AND MAIN RESULTS: Audiometry at 250, 500, 1,000, 2,000, 4,000, and 8,000 Hz before and one hour after the epidural blood patch was performed. Hearing was significantly improved in 12 of the 16 patients studied. The improvement was at least 10 dB at two or more consecutive frequencies, or 5 dB at four or more consecutive frequencies. CONCLUSION: Epidural blood patch improves hearing within one hour in the majority of patients with severe PDPH.

Adult↗

PubMed2004

EPs do not accept the strategy of "lumbar puncture first" in subarachnoid hemorrhage.

It has been proposed that the workup of suspected subarachnoid hemorrhage should begin with lumbar puncture (LP) rather than computed tomography (CT) scan. We investigated whether EPs would in fact advocate this strategy in an index hypothetical case and in variations of the index case. An eight-question survey was distributed to EM physicians attending national continuing medical education meetings. Questions included whether the responders would advocate "LP first" in the following scenarios: (1) the index case in which the patient's symptoms had been present for more than 12 hours, other diagnoses were very unlikely, the patient was fully insured, and CT scan was available immediately; (2) a case in which the patient is not insured; (3) a case in which the respondent is the patient; and (4) a case in which there is a delay in obtaining a CT scan. Two hundred forty-one of 275 surveys were completed for a response rate of 88%. Given the index scenario, only 22.8% of the respondents would advise patients to have an LP first versus 17.9% if they themselves were the patient (P=.11). Compared with the index scenario, 34.0% of respondents would advise LP first if their patient did not have insurance (P<.0001); a majority, 57.1%, would advise LP first if the CT were delayed (P<.0001). The "LP first" strategy for workup of subarachnoid hemorrhage was rejected by most EM physicians except when the CT scan would entail delay. Compared with the index case, an added number of physicians would advocate this strategy if the patient was uninsured. The ethical implication of advocating a strategy because of financial concerns and that most physicians would not favor for themselves or their patients merits attention.

Emergency Service, Hospital↗

PubMed2004

Treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysms: translumbar puncture and injection of thrombin into the aneurysm sac.

OBJECTIVES: The aim of this article is to report our experience in the use of a new technique for the treatment of type II endoleaks which appear after the endovascular treatment of abdominal aortic aneurysms. MATERIALS AND METHODS: In three patients with secondary type II endoleaks, we performed a translumbar puncture, introducing a 22-Gauge needle into the aneurysm sac under CT guidance. Once intrasac pressure had been registered, 1000U (2 ml) of human thrombin were slowly injected into the sac. RESULTS: Complete sealing of the endoleak was achieved in all three patients, confirmed by the lack of contrast filling of the sac in the CT scans performed 5 min and 24 h after the procedure. Initial intrasac pressure was equal to systolic arterial pressure in the three patients. After the procedure, the pressure decreased by 30-40 mmHg. There were no complications during the procedure, which lasted 45-90 min. No endoleak recurrence has been observed in any of the three cases 6 months later. CONCLUSIONS: We present an alternative method of treating type II endoleaks, which could become the treatment of choice if and when a wider experience confirms our initial good results.

Aortic Aneurysm, Abdominal↗

PubMed2006

Lower limb ischemic complications after the use of arterial puncture closure devices.

We report three cases of lower limb ischemia occurring after the use of arterial puncture closure devices (APCDs). In two patients, who have undergone percutaneous angioplasty of lower limb arteries, the Angio-Seal APCD led to thrombosis of the common femoral artery. In another patient who has undergone coronary angiography, this device has led to dissection of the common femoral artery. Since these observations seem to not be merely sporadic, radiologists and cardiologists as well as vascular surgeons should be aware of their possible occurrence in order to avoid these complications and to provide promptly an adequate treatment.

Aged, 80 and over↗

PubMed2005

Post-lumbar puncture arachnoiditis. The need for directed questioning.

The inflammation of the arachnoid mater may produce a fibrinous exudate around the roots that causes them to adhere to the dural sheath. We report the case of a man aged 23 years who suffered from acute inflammatory truncated sciatica. The diagnosis of adhesive arachnoiditis was made in front of clinical arguments associated to typical signs on Myelo CT Scan and MRI. The only explanation ever found was a traumatic lumbar puncture at the age of 6 years for suspected meningitis. Sequelae of arachnoiditis are difficult to diagnosis. When MRI or myelography suggests it as a possibility, precise directed questioning is necessary to seek a history, albeit distant, of spinal or meningeal events.

Adult↗

PubMed2005

Jet-induced skin puncture and its impact on needle-free jet injections: experimental studies and a predictive model.

Needle-free jet injections constitute an important method of drug delivery, especially for insulin and vaccines. This report addresses the mechanisms of interactions of liquid jets with skin. Liquid jets first puncture the skin to form a hole through which the fluid is deposited into skin. Experimental studies showed that the depth of the hole significantly affects drug delivery by jet injections. At a constant jet exit velocity and nozzle diameter, the hole depth increased with increasing jet volume up to an asymptotic value and decreased with increasing values of skin's uniaxial Young's modulus. A theoretical model was developed to predict the hole depth as a function of jet and skin properties. A simplified model was first verified with polyacrylamide gels, a soft material in which the fluid mechanics during hole formation is well understood. Prediction of the hole depth in the skin is a first step in quantitatively predicting drug delivery by jet injection.

Biomechanical Phenomena↗

PubMed2004

Anterior stromal puncture in Brown-McLean syndrome.

We describe 2 cases of Brown-McLean syndrome with corneal edema successfully treated by anterior stromal puncture (ASP). Ophthalmologic examinations showed peripheral edema and aphakia in both patients. The patients had ASP to control the severe foreign-body sensation. The procedure was effective over a long-term follow-up, suggesting that peripheral ASP may be an effective therapeutic option for patients with symptomatic Brown-McLean syndrome.

Corneal Edema↗

PubMed2005

Subarachnoid hemorrhage diagnosis by computed tomography and lumbar puncture: are fifth generation CT scanners better at identifying subarachnoid hemorrhage?

This study sought to determine the sensitivity and specificity of modern computed tomography (CT) scans for the diagnosis of subarachnoid hemorrhage (SAH). No studies have been done recently with fifth generation CT scanners to look at the diagnosis of SAH. A retrospective chart review was done of Emergency Department (ED), laboratory, and hospital records at Pitt County Memorial Hospital in Greenville, North Carolina over 1 year from January 1, 2002 to December 31, 2002. Patients presented with headache and had a CT scan of the head with a fifth generation multi-detector CT scanner followed by a lumbar puncture (LP) to rule out SAH. There were 177 patients who presented to the ED with headache and went on to have a CT scan and an LP to rule out SAH. No patients who had a negative CT were found to have a subarachoid hemorrhage. It is concluded that fifth generation CT scanners are probably more sensitive than earlier scanners at detecting SAH.

Emergency Medicine↗

PubMed2004

Iatrogenic meningitis after lumbar puncture-a preventable health hazard.

Iatrogenic meningitis (IM) is a rare complication of diagnostic and therapeutic lumbar puncture (LP). This study includes cases of IM managed in the Departments of Neurology, of two referral hospitals, in India between January 1984 and April 2002. The diagnosis of IM was made when symptoms of meningitis occurred 24 h to 21 days after LP. All the procedures were performed in the peripheral hospitals before they were referred to the two centres. There were 17(63%) women and 10(37%) men. The age range was 19-50 years with a mean age of 31. The precipitating event was spinal anaesthesia for pelvic and intra-abdominal surgeries (Caesarean section 11 cases, hysterectomy three cases, herniorraphy two cases, appendicectomy two cases, anal fissurectomy one case, varicocelectomy one case and hydrocelectomy one case) laminectomy in two and diagnostic myelogram in four patients. The cerebrospinal fluid (CSF) culture was positive in six (22%) patients. The organisms were Pseudomonas aeruginosa in one case, Staphylococcus aureus in three cases, Acinetobacter spp. in one case and Mycobacterium tuberculosis in one case. In five individuals, mycotic aneurysms with subarachnoid haemorrhage due to invasive aspergillosis was documented at autopsy. The mean follow-up was 10.6 months (range 1-18). Seventeen (63%) patients received conventional antibiotics alone, while 10 patients received antibiotics and anti-tuberculous drugs when the meningitis became chronic. The mortality was 36%. The poor prognostic factors were women who underwent Caesarean section (P < 0.04) presence of hemiplegia (P < 0.04) and altered mental status (P < 0.0004). This study shows high morbidity and mortality of IM after LP. Simple aseptic precautions under- taken before the procedure can prevent IM. The urgent need for increasing the awareness among medical personnel in peripheral hospitals of developing countries cannot be over emphasized.

Adult↗

PubMed2005

Lumbar puncture in the management of adults with suspected bacterial meningitis--a survey of practice.

OBJECTIVES: Assess the use of lumbar puncture (LP) in the management of suspected community acquired bacterial meningitis in adults. METHODS: A questionnaire was sent to secondary care clinicians (excluding junior house officers) in general internal and emergency medicine at three acute NHS healthcare trusts in the south west of England. The questionnaire recorded the experience of the clinician and asked questions related to case scenarios representing common presentations of bacterial meningitis or meningococcal disease. RESULTS: The response rate was 42% (108/260). Nearly all of the respondents (91%) reported regularly managing patients with suspected meningitis. Most respondents considered that (i) brain computerised tomography (CT) was necessary prior to undertaking LP (78%, 60/77), (ii) LP was a useful first line investigation in a patient with meningococcal shock.(80%, 84/105), (iii) LP could be performed safely in a man with a falling level of consciousness if the CT brain was normal (89/106, 84%). Early antibiotic administration was considered important, other management priorities such as oxygen therapy, volume resuscitation, and critical care involvement were not emphasised. CONCLUSIONS: Reported clinical practice in the investigation and management of meningitis in adults is not in line with current published guidance. Efforts to target interventions that promote consensus in practice are needed.

Adult↗

PubMed2004

Parents' attitudes toward performance of lumbar puncture on their children.

We studied the attitudes of 87 parents who had the choice to watch their children's single or multiple lumbar punctures (LPs). Anxiety scores were moderate, higher before LP than after, and were unaffected by the number or observation. Parents who observed the LP wished doing likewise in the future.

Adolescent↗

PubMedDate not supplied

[Early lumbar puncture and cutaneous rash: a clear CSF is not always a normal CSF].

The clinical and biological characteristics of adult bacterial meningitis are usually unequivocal, but more subtle clinical presentations can be observed. A 24-year-old woman was admitted with fever and abdominal discomfort, which had been developing for 24 hours. There were no meningeal signs, but a transient cutaneous rash was observed on admission. A clear CSF was obtained showing no cytological or biochemical abnormality. Ceftriaxone 2 g was administrated intravenously. In the following hours of admission, a frank meningeal syndrome with purpura appeared, leading to a second lumbar puncture, which revealed purulent CSF. The culture of the first CSF yielded Neisseria meningitidis, while the second CSF remained sterile. This case showed a probable meningococcal rash. This is a reminder that a normal CSF can be obtained early in the course of a proved bacterial meningitis, and that CSF bacterial eradication can occur very rapidly after a single dose of third-generation cephalosporin.

Abdominal Pain↗