PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Punctures”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,621 records · Page 90Linked to original sources
PubMed1999

Tracheo-oesophageal puncture by retrograde passage of a gastroscope via mini-laparotomy and gastrotomy.

Secondary tracheo-oesophageal puncture is frequently used for voice restoration after laryngectomy. A method utilizing a flexible gastroscope passed via a mini-laparotomy and gastrotomy in a retrograde manner is described in a patient where extensive pharyngeal resection made it impossible to cannulate the upper aerodigestive tract. The patient suffered minimal morbidity and produced reasonable speech.

Carcinoma, Squamous Cell↗
PubMed2006

Dextran 40 (Rheomacrodex) or Polygeline (Haemaccel) as an epidural patch for post dural puncture headache: a neurotoxicity study in a rat model of Dextran 40 and Polygeline injected intrathecally.

BACKGROUND AND OBJECTIVE: Although an epidural autologous blood patch is considered the most effective treatment for post dural puncture headache, which sometimes occurs following spinal or inadvertent spinal anaesthesia, there remains a need for alternative materials for epidural patches. We investigated the potential neurotoxicity of Dextran 40 (Rheomacrodex) and Polygeline (Haemaccel) used for this purpose in a rat model. METHODS: Repeated boluses of 10% Dextran 40, 3.5% Polygeline or 0.9% saline were injected intrathecally over a period of 1 month in three groups of rats. RESULTS: No behavioural or clinical derangements were observed in any of the three groups during this period. After sacrifice of the animals at the end of the experiment, no significant differences in the histopathological appearances of the spinal cords in the three groups were observed. No toxic effects diminishing viability of spinal cord cells were evident. Similarly, viability of renal, hepatic and peripheral blood mononuclear cells remained unaffected (98% +/- 2%). CONCLUSIONS: No deleterious effects, clinical or cellular, were evident in this rat model when Dextran 40 or Polygeline were injected intrathecally. Thus, both substances can be considered as possible alternative materials for epidural patches.

Animals↗
PubMed1982

Respiratory arrest and cervical spinal cord infarction following lumbar puncture in meningitis.

A 6-year-old child with meningitis had a respiratory arrest 20 minutes after a lumbar puncture. Thereafter she required maintenance on a ventilator, had a flaccid quadriplegia, and died 12 days later. Necropsy showed infarction of the central portion of the cord at the level of the decussation of the pyramids. The suggested mechanism of damage is compression of the arterial supply to the cord at the level of the foramen magnum by herniated cerebellar tonsils; concomitant hypotension may have contributed to production of the damage. Four similar cases, who survived with residual deficit, have also been reported. Other separate mechanisms by which the cord can be damaged in meningitis are vasculitis, thrombosis and arachnoiditis.

Cerebellum↗
PubMed2004

Spatial characteristics of cisterna magna in rats and novel technique for puncture with a stereotactic manipulator.

The actual size and sites for puncture of the cisterna magna in adult Wistar rats were estimated on acrylic models. We proposed a new method for obtaining cerebrospinal fluid from narcotized rats. This method consists in controlled introduction of a needle into the cisterna magna through the skin and/or dura mater above this structure using a stereotactic micromanipulator. Experiments on rats with focal and global cerebral ischemia showed that this technique ensures single and repeated sampling of at least 50 microl liquor not containing blood admixtures.

Animals↗
PubMed2002

Local vascular complications after use of the hemostatic puncture closure device Angio-Seal.

BACKGROUND: As an alternative to manual pressure techniques new systems for achieving arterial hemostasis after cardiac catheterization were developed. Here we report about the diagnosis and therapy of femoral artery complications after use of the closure device Angio-Seal, consisting of an intraarterial anchor and extravascular collagen plug. PATIENTS AND METHODS: Angio-Seal was deployed in 350 patients undergoing cardiac catheterization. Vascular investigations after device application consisted of ankle/brachial-pressure-index measurement, duplex sonography, and angiography. RESULTS: Vascular complications occurred in 10 of 350 patients. In two patients complete occlusions of the superficial femoral artery required immediate vascular surgery. Stenoses of the superficial (five patients) and the common (three patients) femoral arteries were diagnosed in 8 cases. Of these 10 patients eight were obese, in 2 cases there was a further catheterization with Angio-Seal device application via the same femoral approach. Until now six patients underwent successful surgery: in 4 cases the whole Angio-Seal device was located intraarterially, there was 1 case of intima-dissection, and 1 case remained unclear due to a diagnostic delay of 7 months. In three patients with stenoses of the common femoral arteries without hemodynamic relevance no therapy was required. CONCLUSIONS: Occlusions or stenoses of femoral arteries after use of Angio-Seal can be diagnosed easily by duplex sonography. All hemodynamic relevant complications (n = 7 of 350 [2%]) concerned a puncture of superficial femoral arteries. In these patients vascular surgery seems to be an adequate therapy.

Aged↗
PubMed2000

Postural post-dural puncture headache. A prospective randomised study and a meta-analysis comparing two different 0.40 mm O.D. (27 g) spinal needles.

BACKGROUND: To compare the incidence of postural post-dural puncture headache (PPDPH) after spinal anaesthesia using two different 0.40 mm O.D. (27 g) spinal needles: pencil-point needle and Quincke needle. In addition, a meta-analysis of studies comparing small bore spinal needles with regard to development of PPDPH was performed. METHODS: Clinical study: A prospective randomised double-blind study was set up to investigate PPDPH after using 0.40 mm pencil-point (Pencan, B. Braun) or Quincke (Spinocan, B. Braun) spinal needle. Postoperatively on day 5 to 7 a telephone interview was conducted in order to reveal postoperative complications such as headache and backache. PPDPH was considered present when the headache was new to the patient, and demonstrated posture dependence. Meta-analysis: Electronic database search and manual search of relevant literature were performed in order to find randomised control trials comparing equal sized (outer diameter, O.D.) spinal needles with different bevel shape. Only studies with a proper method and not merely presented as an abstract were included in addition to the present clinical study. RESULTS: Out of 313 patients randomised, 301 were completely followed up, 153 in the pencil-point group and 148 in the Quincke group. The two groups were comparable regarding surgical procedures and demographic data. Of 15 patients suffering from PPDPH, 12 were found in the Quincke group, and 3 in the pencil-point group. The difference was 6.1% (95% CI from 1.2 to 12.5%). The meta-analysis of 1131 patients gave a relative risk of developing PPDPH of 0.38 (95% CI from 0.19 to 0.75) in the pencil-point group compared to the Quincke group. CONCLUSION: A pencil-point-shaped spinal needle will significantly reduce PPDPH compared with Quincke-type spinal needles, also when small bore needles (0.40 mm O.D.) are used.

Adult↗
PubMed2001

How valuable is a lumbar puncture in the management of patients with suspected subarachnoid haemorrhage?

OBJECTIVE: The aim of the study was to determine the range of cerebrospinal fluid findings associated with emergency department disposition and treatment of patients with headache suspicious of subarachnoid haemorrhage but a negative or equivocal computed tomography head scan, in particular the role of xanthochromic index. METHODS: A retrospective review of medical records of 196 adult patients who underwent cerebrospinal fluid examination for red cell count and xanthochromia for suspected subarachnoid haemorrhage but had a normal or equivocal computed tomography scan. RESULTS: Included in the study were 196 patients. Only one patient out of 189 with a negative computed tomography scan was found to have a subarachnoid haemorrhage caused by a ruptured aneurysm (0.5%; 95% confidence intervals 0-2.9%). Three other patients were diagnosed with benign subarachnoid haemorrhage. Ninety-one patients were stratified into the lowest possible risk group for subarachnoid haemorrhage and discharged home from the emergency department. All patients with equivocal computed tomography head scans and a positive xanthochromic index were admitted for cerebral angiography. In many cases, cerebrospinal fluid findings did not appear to influence clinical decision-making. CONCLUSIONS: In the study institution, cerebrospinal fluid results appeared to have a variable influence on clinical decision-making for patients with suspected subarachnoid haemorrhage and a non-diagnostic computed tomography head scan. Of particular concern is the lack of validation of the tests used in this investigative approach, the frequency of patients having a lumbar puncture where the results did not influence their management, the inconsistency in the laboratory's technique for performing tests on cerebrospinal fluid and the very low yield of detecting patients with subarachnoid haemorrhage and a potentially treatable causative lesion.

Adolescent↗
PubMed2001

Hip flexion and lumbar puncture: a radiological study.

When lumbar puncture is performed in the sitting position, the patient's thighs are usually at an angle of approximately 90 degrees to the trunk, whereas in the lateral position, hip flexion is employed by flexing the patient's knees to the chest. We measured the presumed but hitherto unquantified widening of lumbar interspinous spaces resulting from hip flexion. Lumbar spine lateral radiographs were taken in volunteers in the sitting position with and without hip flexion, and interspinous space width was measured and compared. Mean lumbar interspinous space width at L2-3, L3-4 and L4-5 increased by 7%, 11% and 21%, respectively, with the hips flexed. Hip flexion in the sitting position will anatomically optimise lumbar interspinous space width for needle passage, and statistically significant increases in space width have been demonstrated increasing progressively from L2-3 to L4-5.

Aged↗
PubMed2002

Spinal anaesthesia for inguinal herniotomy in preterm infants sedated with nitrous oxide: a comparison of lumbar puncture in the lateral or sitting position.

This study compares spinal anaesthesia for inguinal herniotomy in preterm infants in the lateral or sitting position. Thirty patients were randomly divided into two equal groups. One hour before spinal anaesthesia, a eutetic mixture of local anaesthetic cream was applied to the lower lumbar spine. Sedation with nitrous oxide 50% in oxygen was given to all patients before and during induction of spinal anaesthesia, and throughout surgery. Lumbar punctures were performed at the L4-5 interspace using a 2.5 cm 22 G needle. Isobaric bupivacaine 0.5% with epinephrine 1 : 200 000 at a bupivacaine dose of 1 mg.kg-1 was injected in the lateral or sitting position. Measurements included heart rate, blood pressure, oxygen saturation, maximum sensory block height and duration of motor block and analgesia. There were no statistically significant differences between the groups in any measured parameters. Median [range] maximum block height was T5[T4-T7] in the lateral group and T5[T4-T5] in the sitting group. The median [range] duration of motor blockade was 67 [50-85] min in the lateral group and 63 [50-80] min in the sitting group. Our results indicate that in preterm infants sedated with nitrous oxide, spinal anaesthesia for inguinal herniotomy performed with isobaric bupivacaine 0.5% at a dose 1.0 mg.kg-1 in the lateral or sitting position is equally effective and is associated with minimal side effects.

Anesthesia, Spinal↗
PubMed2001

Topical formic acid puncture technique for the treatment of common warts.

BACKGROUND: Warts are a common chronic skin disorder that can be cosmetically disfiguring and, depending on the location, cause inhibition of function. The presence of dozens of topical and systemic treatments for warts is a testament to the lack of a rapid, simple, uniformly effective, inexpensive, nonscarring, and painless treatment. AIM: The purpose of this study was to determine the efficacy and safety of 85% formic acid application, an inexpensive therapy, for the treatment of warts. METHODS: A placebo-controlled, nonrandomized, open trial was performed in 100 patients with common warts attending Father Muller's Medical College Hospital, Mangalore. Fifty patients received 85% formic acid application and 50 patients received placebo (water) using a topical application/needle puncture technique every other day. RESULTS: Ninety-two per cent of patients who received formic acid application showed complete disappearance of warts after a 3-4-week treatment period, compared to 6% in the placebo group. CONCLUSIONS: The results show that 85% formic acid application is a safe, economical, and effective alternative in the treatment of common warts with few side-effects and good compliance. A multicenter trial is needed to examine the efficacy and safety of this treatment.

Administration, Topical↗
PubMed2003

Parenteral nutrition solution retrieved by lumbar puncture following left saphenous vein catheterization.

Two extremely preterm infants had silastic lines inserted via the left great saphenous vein for intravenous feeding. Clinical deterioration approximately 10 days later led to lumbar puncture as part of a sepsis screen. Parenteral nutrition solution was recovered in the cerebrospinal fluid and heralded potentially life-threatening catheter malposition. The cases illustrate another percutaneous central line-associated morbidity, which is avoidable by careful verification of line position. All previously reported cases of this unusual complication are reviewed and we describe its likely mechanism. We postulate that the phenomenon is a complication peculiar to percutaneous catheterization of the left lower limb.

Australia↗
PubMed2001

Lead insertion by supraclavicular approach of the subclavian vein puncture.

Total occlusion of the left subclavian vein was diagnosed in a 76-year-old patient, 6 years after implantation of an ICD with VVI pacing backup. Replacement of the ICD included upgrading of the ICD system because of the presence of pacemaker syndrome when the patient was VVI paced. Insertion of an atrial lead through the ipsilateral vein system was made possible by using the supraclavicular approach of the subclavian, enabling puncturing of the left subclavian vein medially to the obstruction.

Aged↗
PubMed2003

The management of a postdural puncture headache in a child.

We present a case of an 11-year old girl who underwent an elective pyeloplasty and had an epidural catheter placed for per- and postoperative analgesia. Postoperatively she developed a postural headache and severe nausea, and a diagnosis of postdural puncture headache (PDPH) was made. Her symptoms failed to respond to conservative management. An epidural blood patch was performed with immediate and complete resolution of her symptoms. We present this case to highlight the occurrence of PDPH in children and to outline the considerations for management.

Anesthesia↗
PubMed1994

Migrainous phenomenon precipitated by lumbar puncture headache.

This case report describes a patient without personal or family history of migraine or other recurrent headaches who developed a typical lumbar puncture headache leading to a characteristic migrainous visual field deficit. There was no history of analgesic or other medication use or other precipitant, and neither symptom recurred in years of follow-up. The sequence of symptoms suggests that mechanical distortion or irritation of cranial pain-sensitive structures can precede and precipitate the migrainous cortical dysfunction.

Adult↗
PubMed1998

The time course of post-lumbar puncture headache.

According to the leakage theory, the time taken for pain to develop upon rising to the upright position will increase during the time course of post-lumbar puncture headache (PPH) as a consequence of the decreasing size of the healing dural rent, and the pain will decline. The aim of the present prospective study was to test this hypothesis, and to describe the temporal course of time and pain variables in PPH. The study showed that the course was fairly stable for all variables except on the first day, the second last day, and the last day. In the recumbent position, the headache was more severe on the first day (p<0.05) and milder on the last day (p<0.001) compared with the interim days; maximal headache in the upright position was milder on the second last (p<0.005) and last days (p<0.0001). Compared with the interim days, the time prior to increase of pain upon rising was shorter on the first day (p<0.05) and longer on the last day (p<0.001), and from start of increase until maximum was longer on the last day (p<0.01). The time to pain relief upon lying down did not vary significantly throughout the PPH period. The mobility of the patient as expressed by the PPH grade was fairly stable throughout the course of PPH until it increased in the last 2 days. The results are in good accord with the leakage theory.

Female↗
PubMed1998

Pain location and associated symptoms in post-lumbar puncture headache.

In this prospective study of 239 patients, 88 (37%) suffered from post-lumbar puncture headache (PPH). The pain was located within the region innervated by the trigeminal nerve in 49% of the drawings, within the occipital and/or suboccipital region in 11%, and within the combined trigeminal/occipital region in 39%. The headache was unilateral at least once in 34% of the patients. Changes in pain location from one region to the other and/or between bilateral and unilateral headache were observed in 54% of the patients throughout the PPH period. Associated symptoms were experienced by 85%, nausea (73%) and dizziness (60%) being the most frequently reported. In the upright position, nausea, dizziness, and tinnitus tended to be present during a fairly large part of the PPH period (57-63% of the days), vomiting occurring only occasionally (28%). The intensity of associated symptoms was positively correlated to PPH severity. Pain in the combined trigeminal/occipital region was most severe and related to more associated symptoms than pain in other regions, and unilateral pain was milder than bilateral pain. Pain in the occipital and/or suboccipital region was mildest. The severity of nausea decreased significantly on the last 2 days of the PPH period, and the intensity of dizziness decreased when PPH was about to subside. Tinnitus is probably due to a cochlear dysfunction, and presents special characteristics. Its incidence was not clearly related to PPH severity and it increased with increasing duration of PPH; its intensity did not decline when PPH was about to wane.

Dizziness↗
PubMedDate not supplied

Survival of hydatid cysts after puncturing.

The release of antigens from hydatid cysts, essential for the induction of a detectable host antibody response, is considered to depend on alterations in the physical integrity of the cyst germinal membrane. This explanation, however, does not account for the detection of serologic responses in persons harbouring hyaline cysts unless it were possible for membrane microfissures to arise and provide an antigenic stimulus without adversely affecting cyst viability. The results of the present study have demonstrated that hydatid cysts are able to survive when experimentally punctured in vitro or in vivo. These findings on the capacity of hyaline cysts to repair or recuperate from a microfissure are consistent with the detection of antibody responses in persons harbouring hyaline hydatid cysts with apparently intact membranes and with the hypothesis of an association between integrity of cyst membranes and degree of host immunological responses.

Animals↗