Repeat Puncture Research Articles

Analgesic utility of automatic lancing device for heel prick in neonates: a systematic review and meta-analysis.

Background: This systematic review and meta-analysis assessed the benefits of an automatic lancing device compared with a manual lancet or a hypodermic needle in neonates.Materials & methods: We followed the Cochrane Handbook methodology, used the RoB-2 tool for risk of bias assessment, RevMan 4.1 for meta-analysis and GRADE framework for certainty assessment. We searched the databases and gray literature on 15 November 2023.Results: Six eligible studies enrolling 539neonates were included. An automatic lancing device reduced pain scores during and after heel prick, sampling time and the need for repeat puncture. The certainty of evidence was very low to moderate.Conclusion: An automatic lancing device is preferred for heel pricks in neonates, given less pain and higher efficiency.PROSPERO registration number: CRD42023483189.

Potential Contribution of Ultrasonography Assistance for the Safe and Steady Procedure of Endoscopic Intracerebral Hematoma Evacuation: A Retrospective Cohort Study.

Endoscopic hematoma evacuation is one of the most promising procedures for the treatment of intracerebral hemorrhage (ICH) to avoid severe outcomes, such as death or dependency. However, the effect of the procedure on the functional outcome remains controversial. Thus, standardization and sophistication are required to enhance the surgical results. This study aimed to evaluate the potential efficacy of ultrasonography (US) in endoscopic hematoma evacuation. This study included 39 consecutive patients with spontaneous supratentorial ICH who underwent endoscopic hematoma evacuation between April 2019 and July 2021. The patients were divided into two groups, namely, surgery with or without US assistance. Rebleeding and evacuation rate were set as the primary endpoints, and operation time, requirement for repeat puncture, and modified Rankin scale at discharge were set as the secondary endpoints. During surgery, the burr hole was placed, and the dura mater was widely opened. The US probe was applied on the brain surface via the burr hole to detect the depth and direction of the hematoma cavity. With US assistance, the hematoma cavity was punctured with a cannula, and the transparent port was introduced into the hematoma cavity along the tract. The hematoma was gently evacuated with the irrigation-suction instrument. Of the 39 cases, 9 underwent endoscopic hematoma evacuation with US assistance. Rebleeding was noted in 0 and 2 (6.7%) patients with and without US assistance, respectively (p = 0.43). The mean hematoma evacuation rates were 78.6 and 80.6% in patients with and without US assistance, respectively (p = 0.80). In all cases with US assistance, the cavity could be reached with a single tap. However, repeat puncture was required in 20 (66.7%) cases without US assistance (p = 0.04). In one case, an unexpected residual hematoma was detected using US, which was applied after hematoma evacuation and before wound closure. The operation time was not extended even if US was used during the surgery. US-assisted hematoma evacuation is an effective procedure that can assist in the precise insertion of the puncture cannula and exclusion of the residual hematoma. US might contribute toward improving the accuracy of each step of the procedure, thus leading to better clinical outcomes.

Retrospective Evaluation of Safety and Effectiveness of the EXOSEAL Vascular Closure Device for Single Vascular Closure and Closure after Repeat Puncture in Diagnostic and Interventional Radiology: Single-center Experience

PurposeTo retrospectively evaluate the safety and effectiveness of the EXOSEAL vascular closure device (VCD) for first or repeated closure after retrograde percutaneous femoral arterial access. Materials and MethodsA retrospective analysis of 417 patients (271 men; mean age, 64.1 y±12.8; age range, 22–94 y) who had undergone arterial closure with the EXOSEAL VCD was performed. Procedures with retrograde femoral access and closure with the 5-F, 6-F, or 7-F EXOSEAL VCD according to the manufacturer’s instructions were included. The clinical indications included the full procedural portfolio of a radiologic department with a focus on transarterial hepatic procedures. After EXOSEAL VCD closure, patients were restricted to bed rest for 4 hours. ResultsFrom August 2010 to March 2012, a total of 682 EXOSEAL VCDs (5-F, n = 276; 6-F, n = 394; 7-F, n = 12) were used in 659 procedures with a total of 404 repeated closures. The EXOSEAL VCD was used successfully in 676 of 682 procedures (99.1%). Hemostasis was achieved in 651 of 682 procedures (95.5%). No major complications were encountered. There were eight cases (1.17%) of minor complications despite a successful vascular closure procedure, none requiring further therapy. There were no complications in any of the 404 cases of repeated vascular closure. ConclusionsThe results of this study suggest that the EXOSEAL VCD is safe and effective in single and repeated closure of retrograde percutaneous femoral arterial access in interventional radiology cases.

Prevention and treatment of cerebrospinal fluid leakage in anterior cervical surgery for severe ossification of posterior longitudinal ligament

Objective To investigate prevention and treatment of cerebrospinal fluid leakage (CSFL)in anterior cervical spine surgery for severe ossification of posterior longitudinal ligament (OPLL).Methods A retrospective analysis of 47 patients with severe cervical OPLL (thickness of the ossified mass ＞ 5 mm,spinal stenosis ＞50％),who had undergone anterior cervical surgery between January 2008 and May 2011,was conducted.Fifteen cases of dural defect were found intraoperatively,including 11 males and 4 females,aged from 40 to 68 years (average,55.6 years).Preoperative CT scans were earefully analyzed.During the operation,the ossified mass was excised or floated and the arachnoid was reserved in order to reduce dural damage.Dural defects were repaired by suturing or covering with muscle.After surgery,patients were confined to bed rest to allow for drainage or puncture.Results All 15 patients were followed up for 12 to 18months (average,14.8 months).After operation,10 patients recovered fully without CSFL.Five patients developed CSFL,including 4 cases of spinal dural mater injury that healed within 4-6 days with bed rest and pressure dressing,and 1 case of cerebrospinal fluid pseudocyst that disappeared within 3 weeks with repeat puncture and aspiration treatment.No cases required secondary operations or shunt placement.All cases exhibited good neurological improvement.Conclusion During anterior surgical treatment for severe cervical OPLL,CSFL can be effectively prevented through eareful analysis of preoperative CT images,meticulous operative technique,reasonable handling of the ossified mass and positive repair of dural damage.Moreover,postoperative bed rest and drainage are effective to treat CSFL. Key words: Cervical vertebrae; Subdural effusion; Postoperative complications

Ultrasound-Guided Drainage of Deep Pelvic Abscesses: Experience With 33 Cases

The aim of this study was to demonstrate and evaluate the ultrasound-guided drainage of deep pelvic abscesses in which transabdominal percutaneous access could not be performed because of overlying structures. A retrospective analysis of 32 consecutive patients with 33 deep pelvic abscesses was performed. The underlying causes of the abscesses included postsurgical fluid collection or surgical complications in 18 of the 32 patients, and 11 of these patients underwent recent rectal cancer surgery. The locations of the abscesses, which had a median diameter of 6 cm (range 2–10 cm), were as follows: perirectal ( n = 13), presacral ( n = 9), pouch of Douglas ( n = 7), internal genitals ( n = 2) and between the bowel loops ( n = 2). The abscesses were all drained using ultrasound (US) guidance with a transrectal ( n = 18), transvaginal ( n = 11), transperineal ( n = 2) or transgluteal ( n = 2) approach. Of the larger abscesses (median diameter 7 cm), 19 were treated with catheter drainage and 18 of these cases resulted in favorable clinical outcomes. Of the smaller abscesses (median diameter 4 cm), 14 were treated with needle drainage. In two of these cases, follow-up US showed that a repeat puncture and drainage was necessary. All needle drainages resulted in favorable clinical outcomes. Sixteen of the 29 transrectal or transvaginal drainage procedures were performed without any anesthesia (10 were performed with a needle and six were performed with a catheter). Apart from minor discomfort during the drainage procedure and the subsequent in-dwelling catheter period, there were no serious complications related to the drainage procedures. We conclude that ultrasound-guided transrectal, transvaginal, transperineal and transgluteal drainage of deep pelvic abscesses are safe and effective treatment approaches. Based on our findings, needle drainage will be our most common first-line treatment approach because of the simplicity of the procedure, improved patient comfort and reduced costs. Catheter drainage will be reserved for large multiloculated abscesses.(E-mail: tlo@dadlnet.dk)

Clinical Features, Neuroimaging and Treatment of Spontaneous Intracranial Hypotension and Magnetic Resonance Imaging Evidence of Blind Epidural Blood Patch

Background and Purpose: Spontaneous intracranial hypotension (SIH) is an uncommon, but not rare, cause of headache. We analyzed a series of patients with SIH and attempted to establish a clinical procedure. Methods: We retrospectively reviewed 11 patients with SIH who were admitted between January 2004 and May 2007. Data recorded from patients included basic data, clinical symptoms, neurological imaging studies and treatment. Results: Orthostatic headache was the most common symptom, but there were still 2 patients without orthostatic headache. Diffuse pachymeningeal enhancement was the most common finding in brain MRI study and engorgement of the spinal epidural venous plexus was the most common finding in spinal MRI study. Eight of our patients received epidural blood patches in the lumbar area and 6 of these were symptom-free within 2 weeks. Two patients received spinal MRI immediately after administering the epidural blood patch, and this revealed that most of the blood had spread to the upper cervical area from the lumbar injection. Conclusion: A blind epidural blood patch from the lumbar area is an acceptable procedure even if the area of leakage is unknown. A reasonable clinical procedure for the patients of SIH may minimize the rate of repeat puncture.

The safety and efficacy of the Angio-Seal closure device in diagnostic and interventional neuroangiography setting: a single-center experience with 1,443 closures

We evaluated the safety and efficacy of the Angio-Seal closure device used to close arterial puncture sites in patients who had undergone diagnostic cerebral angiography and neurointerventional procedures. A total of 1,443 Angio-Seal devices were placed in 1,099 patients in the Interventional Neuroradiology Unit between May 2005 and August 2006. Of these, 670 were interventional and 745 were diagnostic cerebral angiographic procedures. In 28 patients bilateral puncture of the femoral arteries was performed for endovascular treatment. In 167 patients 286 repeat diagnostic procedures were performed and 30 interventional procedures were followed by re-closure with an Angio-Seal device at the time of repeat puncture. The procedural success rate for antegrade closures was 99.7% for all procedures. The device failed in 5 of 745 diagnostic procedures (0.7%). Major complication occurred in one patient only (0.13%) in the diagnostic group. No minor complications were observed in this group. In the interventional group, the major complication rate was 1.4% (10 of 698 closures) and the minor complication rate was 2.4% (17 of 698 closures). However, in the subgroup of patients with cerebral aneurysms who received heparin in combination with antiplatelet agents after the procedure, the major complication rate was 5.3%, but in the carotid/vertebral stenting group it was 0.8%. Our experience in a relatively large series of patients shows that the use of the Angio-Seal STS vascular closure device is safe and effective in patients undergoing cerebral diagnostic angiography and neurointerventional procedures with an acceptable rate of complications, although the complication rate was higher in the group of patients who received heparin and/or antiplatelet medication.

The Heart - An Easily Accessible and Safe Target for Endoscopic Ultrasound and Fine Needle Intervention?

The Heart An Easily Accessible and Safe Target for Endoscopic Ultrasound and Fine Needle Intervention? Annette Fritscher-Ravens, C Alexander Mosse, Paul C. Swain Background: The proximity of cardiac structures to the wall of the esophagus might allow guided fine-needle aspiration (FNA) and other interventions such as coronary angiography or injection therapy into the cardiac muscle under endoscopic ultrasound control. Concerns about arrhythmia, bleeding or other complications made this organ a feared target. EUS-FNA of near-by mediastinal lymph-nodes has proven to be safe and easy. In rare occasions arterial vessels may have been punctured by accident without complication. Transesophageal EUS guided access to the heart may help to enable new therapies such as the injection of growth factor into the damaged cardiac wall after heart infarction. Aim: To investigate the feasibility and safety of trans-esophageal punctures and further interventions of structures within the heart and coronary arteries in experimental studies in 6 pigs, and also EUS-FNA of cardiac structures in 2 patients. Methods and Procedures: Linear array endoscopic ultrasound and 22/19 gauge Wilson Cook EUS needles were used to puncture the myocardium but also the aortic valve or the coronary artery in six 30-35kg anaesthetised pigs. In 3 of the pigs additional coronary angiography was performed and in the other three thermal ablation of the aortic valve through the left atrium. All procedures were closely monitored using permanent ECG and pulse-oxymetry. Results: Repeat puncture of the wall of the left atrium and ventricle and injection of up to 5ml saline or water soluble contrast medium into these structures did not show any effect on the ECG-tracing or pulse oxymetry monitoring, nor did thermo ablation of the aortic wall. In 3 animals it proved feasible to forward a 22 gauge EUS needle into the coronary artery by passing through the left atrium and inject 5 ml contrast medium for coronary angiography without any complications. Specialist physicians monitored the 2 patients punctured for intra-artrial tumors during the entire procedure. The patients did not show any signs of further decompensation, arrhythmia or any other complications. Conclusions: These pilot studies suggest that trans-esophageal puncture of structures within the heart may be feasible. This may be specifically interesting for the injection of growth factor into the damaged muscle after heart infarction. Cautious extension of these preliminary experiments and experiences may be warranted.

THE MODERN ENDOSCOPIC APPROACH TO URETEROCELE

During the last 20 years the surgical approach to ureterocele has evolved from major open surgery to minimally invasive endoscopic puncture. We believe that the endoscopic approach decreases the need for open surgical procedures. We identified specific factors that predict the need for repeat surgery. We reviewed the charts of 60 new patients with ureterocele treated with primary endoscopic incision between 1991 and 1995. Followup ranged from 4 to 62 months (mean 20). Mode of presentation, ureterocele location, associated vesicoureteral reflux and association of the ureterocele with a duplex system were evaluated. Ureterocele wall thickness was assessed subjectively via radiographic and cystoscopic methods, and categorized as thin, intermediate and thick. All 9 patients with a single system ureterocele had an intravesical ureterocele. No patient had associated reflux nor did any require a secondary open procedure. In 3 cases new onset ipsilateral reflux into the ureterocele spontaneously resolved. Of the 51 patients with a duplex system and associated ureterocele 19 (37%) required a secondary open procedure. The ureterocele was intravesical and ectopic in 22 (43%) and 29 (57%) cases, respectively. Reflux was associated with the ureterocele in 27 patients (53%), and 12 (44%) required a secondary open procedure. A total of 11 patients underwent ureteral reimplantation of 15 refluxing renal units and only 2 renal units required ureteral tapering. Reflux is no longer present in 14 of the 15 renal units (93%). Patients with a thick walled ureterocele required repeat puncture more frequently than those with a nonthick ureterocele. With the use of modern endoscopic techniques children with intravesical and single system ureteroceles require secondary open surgery less frequently than those with ectopic and duplex system ureteroceles. The mode of presentation does not predict the need for a repeat open procedure. Thick walled ureteroceles require repeat endoscopic puncture more frequently than thin and intermediate walled ureteroceles.

LONG-TERM OUTCOME OF TRANSURETHRAL PUNCTURE OF ECTOPIC URETEROCELES: INITIAL SUCCESS AND LATE PROBLEMS

Purpose We studied the long-term outcome of transurethral puncture of ectopic ureteroceles specifically associated with duplex systems. Materials and Methods We retrospectively reviewed the records of patients who underwent transurethral puncture of an ectopic ureterocele. Study exclusion criteria were orthotopic, bilateral and prolapsing ureteroceles. Results We identified 19 girls and 2 boys, of whom 11 presented with prenatal hydronephrosis and 10 presented with urinary tract infection. Mean age at puncture was 5 months (range 0.5 to 60). Preoperatively voiding cystourethrography revealed no reflux in 7 patients, isolated ipsilateral lower pole reflux in 8, and bilateral and/or contralateral reflux in 6. Postoperatively studies initially showed no reflux in 8 cases but in 4 of the 8 reflux recurred up to 4 years after puncture. In 10 patients (48%) reflux developed into the ureterocele and upper pole segment. Repeat puncture was required 1 to 13 months after the initial procedure in 4 patients for persistent or recurrent upper pole hydroureteronephrosis. Subsequent open surgery was required in 15 of the 21 cases (71%), including ureterocele excision with ureteral reimplantation in 14. Of the children 10 and 4 underwent open surgery for recurrent urinary tract infection and progressive reflux, respectively, while 1 underwent ureteroureterostomy for progressive upper pole reflux. No patient underwent upper pole nephrectomy. Of the remaining 6 patients 4 have low grade reflux. Conclusions Transurethral puncture of ectopic ureteroceles provides effective short-term correction of upper pole obstruction but it is not definitive therapy in the majority of cases. Most children still require open surgery. In patients without reflux after the puncture procedure new onset, recurrent or progressive reflux may later develop with extended followup. Repeat puncture may be required to ensure adequate decompression in a minority of cases, as in the 20% in our series.

Long-term outcome of transurethral puncture of ectopic ureteroceles: initial success and late problems.

We studied the long-term outcome of transurethral puncture of ectopic ureteroceles specifically associated with duplex systems. We retrospectively reviewed the records of patients who underwent transurethral puncture of an ectopic ureterocele. Study exclusion criteria were orthotopic, bilateral and prolapsing ureteroceles. We identified 19 girls and 2 boys, of whom 11 presented with prenatal hydronephrosis and 10 presented with urinary tract infection. Mean age at puncture was 5 months (range 0.5 to 60). Preoperatively voiding cystourethrography revealed no reflux in 7 patients, isolated ipsilateral lower pole reflux in 8, and bilateral and/or contralateral reflux in 6. Postoperatively studies initially showed no reflux in 8 cases but in 4 of the 8 reflux recurred up to 4 years after puncture. In 10 patients (48%) reflux developed into the ureterocele and upper pole segment. Repeat puncture was required 1 to 13 months after the initial procedure in 4 patients for persistent or recurrent upper pole hydroureteronephrosis. Subsequent open surgery was required in 15 of the 21 cases (71%), including ureterocele excision with ureteral reimplantation in 14. Of the children 10 and 4 underwent open surgery for recurrent urinary tract infection and progressive reflux, respectively, while 1 underwent ureteroureterostomy for progressive upper pole reflux. No patient underwent upper pole nephrectomy. Of the remaining 6 patients 4 have low grade reflux. Transurethral puncture of ectopic ureteroceles provides effective short-term correction of upper pole obstruction but it is not definitive therapy in the majority of cases. Most children still require open surgery. In patients without reflux after the puncture procedure new onset, recurrent or progressive reflux may later develop with extended followup. Repeat puncture may be required to ensure adequate decompression in a minority of cases, as in the 20% in our series.

Extraction and replacement of permanent pacemaker leads through occluded vessels: use of extraction sheaths as conduits--balloon venoplasty as an adjunct.

Patients (pts) may present for lead extraction with symptomatic or asymptomatic subclavian vein or superior vena cava thrombosis. Replacement of permanent pacemaker leads (PPLs) in these pts may be difficult and may require accessing a new site. We examined the utility of replacing PPLs through completely occluded vessels using extraction sheaths as conduits through the total occlusion. Over six years, a total of 210 atrial and/or ventricular PPLs were extracted from 137 pts. Two pts presented with angiographically documented thrombotic occlusion of the subclavian vein. One additional pt. who had presented with a superior vena cava (SVC) syndrome, had a totally occluded innominate vein and SVC occlusion. Balloon venoplasty was used as an adjunct to dilate the SVC. In all pts, after PPLs were removed via a subclavian extraction sheath through the occluded vessel, the retained sheath was used to place a guide wire, then a peel away dilating sheath, to insert new PPLs, in each case on the side of total venous occlusion. Seven PPLs and two lead fragments were extracted, and five new PPLs replaced, ipsilateral to the venous occlusion. These data show that extraction of PPLs through thrombosed veins may be performed successfully and may not require replacing the leads through a new site. This technique spares the pt the need to access the opposite subclavian vein, and it avoids an excessive number of PPLs in the subclavian vein and SVC. The procedure illustrates an efficient means to reintroduce new PPLs with the potential to reduce associated morbidity, since repeat puncture of the subclavian vein is not required. Safety of the procedure as a whole must be considered with regard to the known risks of lead extraction, some complications of which may be substantial using current techniques.

A new serologic diagnostic method for malignant ovarian germ cell tumors: Detection of antibodies to large glycopeptides

bloody (n = 4), or unproductive and bloody (n = 2) punctures. In one patient the fetus, with diabetic macrosomia, was punctured in the arm and the needle was, therefore, reinserted. In one of the IO (5%) hemorrhagic liquor samples the presence of fetal blood was shown by the Kleihauer technique; in this case (amniotomy for assessment of surfactant at term) puncture was effected at the placental margin: no further attempts were made. In 12 (6%) cases liquor could not be obtained: In two only blood was aspirated, one subject was grossly obese, two had oligohydramnios, and in one a fibroid was present on the anterior aspect of the uterus. In at least three of the other six failures (in early amniocenteses) the liquor compartment had been reached: in one of these patients four insertions were of no avail, and this patient was the only one in whom even delayed repeat puncture remained unproductive. Three amniocenteses had to be repeated because of failure of the cell culture to proliferate. Four chromosomal anomalies (trisomy 18, Robertsonian translocation, two cases of monosomy 45,X0) were diagnosed and in one patient the diagnosis of hygroma colli could be corrected to encephalocele. There were six cases of pathologic a-fetoprotein values with (known) central nervous system defects. Apart from the interruptions, there were two (1%) fetal losses. One of these occurred 2 hours after an easy amniocentesis for the assessment of pulmonary surfactant (34 weeks) in a woman with a dorsally located placenta and was due to abruptio placentae. In the other patient placental solution occurred 2 weeks after an uncomplicated amniocentesis performed at 16 weeks for cell culture; vaginal bleeding started at 18 weeks and solution of the lower half of the dorsally located placenta was visualized echographically. The fetus died one week later, after a second episode of bleeding. In none of these cases was an etiologic relationship between the procedure and the fetal death apparent. No maternal complications were observed. In our hands, amniocentesis performed under continuous real-time echography yielded almost one sample per needle insertion. However, it remains to be shown whether this technique enhances fetal safety or whether the fetal risk is inherent in the clinical situation itself and, therefore, must be considered to be irreducible even when the insertion-to-sample ratio is brought down to one (l/l).