Scalp Vein Research Articles

Absceso epidural intracraneal en neonato secundario a catéter cutáneo

Intracranial epidural abscesses are uncommon lesions, being more frequents in older children and adults. They commonly arise as a result of direct extension of a preexisting infection and rarely present with focal deficit. We present a case of a 11-days old preterm infant who developed an intracranial epidural abscess as a result of an infected scalp vein catheter. The diagnosis was made on the basis of the cranial ultrasound and CT scan images. An identified strain of Enterococcus faecium was cultured from all the samples. The patient underwent a right frontal craniotomy with drainage of the abscess and a 2-week total course of intravenous antibiotics was administrated. CT scan imaging 3 week after the procedure demonstrated no evidence of residual lesion. When present, a scalp vein catheter, in absence of others predisponing factors, must be considered as an etiologic agent for an intracranial epidural abscess in this age-group.

Superficial suppurative thrombophlebitis in children, caused by anaerobic bacteria

Objective: The purpose of this study was to present the microbiology and clinical features of six children with superficial suppurative thrombophlebitis (SST) caused by anaerobic bacteria. Methods: A retrospective review of microbiological and clinical data was undertaken. Results: Anaerobic bacteria alone were recovered in four instances, and they were mixed with facultative bacteria in two. There were 12 bacterial isolates (10 anaerobic and 2 facultatives). The bacteria were Peptostreptococcus species (four isolates), Prevotella species (three), and one isolate each of Fusobacterium nucleatum, Propionibacterium acnes, Staphylococcus aureus, and Staphylococcus epidermidis. SST at an intravenous infusion site developed in all but one patient. One patient sustained trauma to the leg, and cellulitis developed. Anaerobes of oral origin ( Prevotella and Fusobacterium species) were recovered in scalp vein SST, and of gastrointestinal origin ( Bacteroides fragilis) in a lower extremity SST. Conclusion: This study highlights the potential importance of anaerobic bacteria in children with SST.

Electro-ureterogram: Canine Study of the Electromechanical Activity of the Ureter

The purpose of this investigation was to study the electromechanical activity of the ureter aiming at characterizing an “electro-ureterogram” that might be of diagnostic significance. Eighteen mongrel dogs were used in this study. Under anesthesia the ureter was exposed and three electrodes (monopolar, silver-silver chloride, 0.8 mm in diameter) were sutured to the ureteric adventitia, 2-3 cm apart. The intraureteric pressure was measured by a scalp vein needle inserted into the ureteric lumen and connected to a pressure transducer. The ureteric electric activity and pressure were recorded 30 min daily for 15 days. The electric activity was also registered after having performed ureteric myotomy in 12 out of 18 dogs. Monophasic negatively deflected slow waves or pacesetter potentials were recorded. Their frequency, amplitude, and velocity were identical in the three electrodes and reproducible. The pacesetter potentials were followed by fast activity spikes or action potentials that occurred randomly and were inconsistent. The action potentials were associated with ureteric pressure increase. After ureteric myotomy, both the pacesetter potentials and action potentials were recorded proximally to the myotomy but not distally to it, indicating a caudal spread of the waves. In conclusion, a normal electro-ureterogram could be characterized. It might show changes in various pathologic conditions of the ureter and could thus be included as an investigative tool in the diagnosis of ureteric diseases.

Air in the cavernous sinus following scalp vein cannulation

A 7-month-old infant was found to have air in the cavernous sinus during a CT scan under general anaesthesia. An anterior scalp vein had been used to administer atracurium and contrast. The anatomy and precautions to prevent air embolism during scalp vein cannulation are discussed.

Syringe suction drain

A mini suction drain made up of a 20 cc glass syringe, a stainless steel spring and a scalp vein cannula (whose needle end has been cut off and multiple holes made in the distal 2.5–5 cm) is described. It is very useful in preventing postoperative haematoma formation, in nasogastric tube suction, in easy drawing up of fluids from vials, and in exploration of deep seated abscesses and collections. It is inexpensive, as syringe and spring can be re-used after sterilisation by autoclaving.

Simple Suction Drainage: An Adjunct to Septal Surgery

Postoperative hematoma is a complication of septal surgery that can be associated with significant morbidity and possibly even mortality in some cases. A simple suction drainage technique using a scalp vein cannula and vacuum tube can prevent a septal hematoma without the need for bulky nasal packing (with its attendant nasal obstruction and risk of bleeding on removal). The technique is also useful for postoperative drainage of an established septal hematoma or abscess secondary to trauma.

Newly Designed Continuous Corneal Irrigation System for Chemical Burns

A newly designed continuous irrigation system has been applied in our clinic. Six cases of corneal chemical burns have been treated with this system from September 1988 to February 1989. The present system has been available in any clinics by materials such as a disposable intravenous tube and a scalp vein tube for infants. Compared with the methods previously reported, this system showed good results, simplicity for setting up, good patient tolerance and low cost of the equipment.

ITP in pregnancy: use of the bleeding time as an indicator for treatment.

ITP is a relatively common disorder seen in pregnancy. Current recommendations for management of patient with ITP recommend maintaining the platelet count above 50 x 10(9)/L and the bleeding time less than 20 min. It has been well documented that the bleeding time in ITP is disproportionately shortened in many patients relative to the platelet count. We present a prospective study of 24 ITP patients in whom the bleeding time was used as an indicator for therapeutic intervention in pregnancy. Indications for therapy with prednisone and/or intravenous gammaglobulin were the following: significant clinical hemorrhage due to thrombocytopenia; bleeding time of greater than 20 min at the baseline platelet count; for normalization of hemostasis prior to delivery or surgical procedure. Caesarean section was performed only in cases in which there were obstetrical indications for this mode of delivery or when the fetal platelet count (obtained by fetal scalp vein sample) was less than 50 x 10(9)/L. Of 24 patients with ITP, eight had significant thrombocytopenia (platelet count less than 50 x 10(9)/L) throughout pregnancy. Only two patients required prolonged prednisone therapy. Both suffered side effects of chronic prednisone administration. Four patients were treated with prednisone for a short course (10-14 days) at term to improve hemostasis for delivery. One patient was treated with intravenous gammaglobulin at term in an effort to prevent severe neonatal thrombocytopenia. Seven patients required caesarean section; the remaining 17 patients underwent vaginal delivery. Only one minor bleeding complication was seen - a small wound hematoma post caesarean section. In summary, using the bleeding time as an indicator for therapeutic intervention, treatment of ITP in pregnancy can be minimized. Thus, therapy related toxicity can be avoided.

ITP in pregnancy and the newborn: introduction.

Idiopathic thrombocytopenic purpura (ITP) occurs more commonly in young women and is one of the commonest immune mediated disorders in pregnancy. It may exist as an incidental finding in an otherwise healthy pregnant woman or may be associated with symptomatic reduction in the platelet count and varying degrees of clinical hemorrhage. The condition termed incidental thrombocytopenia of pregnancy is invariably associated with a platelet count of greater than 100 x 10(9)/L and a very low incidence of fetal thrombocytopenia. Symptomatic thrombocytopenia is more commonly associated with low platelet counts in the fetus (estimated between 20%-40%). It has recently been suggested that the incidence of fetal thrombocytopenia is substantially lower than this figure. The management of ITP in pregnancy is complicated by the fact that fetal thrombocytopenia is difficult to diagnose and carries substantial risks during the delivery process with rare cases of fetal hemorrhage occurring spontaneously in utero. Unfortunately there are no laboratory studies that can be performed precisely in the mother that may predict the occurrence of fetal thrombocytopenia. Maternal management is usually directed towards treatment of maternal symptoms. Maternal treatment or response to treatment is inconsistently associated with predictable changes in the fetal platelet count. Obstetric management is aimed at reducing the risks of life threatening fetal hemorrhage occurring at the time of delivery, and fetal management is directed towards the obtaining of fetal platelet samples in order to plan an appropriate strategy for obstetrical delivery. Fetal blood samples are obtained either by a scalp vein puncture at the time of delivery or earlier in gestation by the use of the newer technique termed percutaneous umbilical blood sampling. Fetuses with platelet counts of less then 50 x 10(9)/L are generally delivered by cesarean section whereas those with counts greater than 50 x 10(9)/L are allowed to proceed with vaginal delivery assuming no obstetrical contraindications exist. The use of IVIgG therapy during pregnancy has theoretical implications on improving platelet counts in the mother in situations of severe hemorrhage, however cannot be considered to be appropriate treatment for the prevention of fetal thrombocytopenia, since the exogenous transport of IVIgG across the placenta appears to be inconsistent and unpredictable.(ABSTRACT TRUNCATED AT 400 WORDS)

A splint for nonsurgical correction of cryptotia

A method for making an apparatus for nonsurgical correction of cryptotia from a paper clip and the tube of a scalp vein puncture needle is described. These materials can be found in any clinic or hospital and are easy to process without complex tools.

Use of a Scalp Vein Infusion Set in Oculoplastic Surgery

The scalp vein infusion set is a sterile, readily available device which has been used in a variety of oculoplastic procedures. Segments of the infusion tubing have been employed as bolsters for eyelid traction, tarsorrhaphy, and skin sutures. The tubing may also be placed in wounds for improved drainage. The material has enhanced postoperative wound care and has not been associated with significant complications.

Strategies which reduced sepsis-related neonatal mortality.

The neonatal mortality rate (per 1000 live births) dropped from 36.6 in 1985 to 23.9 in 1986. Neonatal sepsis ranked as number 2 as a cause of neonatal mortality in 1985, while it dropped to rank 4 (even lower than major malformations) in 1986. The decline in the sepsis-related neonatal mortality was due to reduced incidence of sepsis (38.2 and 18.8 per 1000 live births during 1985 and 1986 respectively) and improved survival (case fatality rates of 24.6% vs 17.7% in 1985 and 1986 respectively). The strategies which reduced the incidence of nosocomial infections included decongestion of use of the nursery, discontinuation of use of heparinised saline for flushing intravenous lines and routine use of intravenous cannulas instead of metallic scalp vein needles.

Vascular changes during penile erection in the dog.

1. The vascular effects of pelvic nerve stimulation on the penis were studied in dogs anaesthetized with sodium pentobarbitone and halothane. Changes in pressure and blood flow were measured through scalp vein needles inserted into the erectile bodies. 2. The penis contains two types of erectile body, which responded independently during erection induced by pelvic nerve stimulation. Pressure in the corpus spongiosum increased immediately upon stimulation, but only reached one-third of the more delayed pressure response of the corpora cavernosa. 3. At rest, arterial inflow resistance into the corpora cavernosa was high, whereas venous outflow resistance was low. Pelvic nerve stimulation (10-50 V, 10-16 Hz, 1 ms) caused an immediate increase in arterial flow, an increase in corpus cavernosal pressure (CCP), and a decrease in venous outflow. Saline infusion experiments showed there was active venous occlusion. Upon cessation of stimulation, these parameters returned to pre-stimulation levels. 4. The time taken to reach 50% of maximum change in arterial inflow was significantly less than for CCP, which was significantly less than for venous outflow. Occlusion of the aorta 1 min after cessation of stimulation decreased the pressure in the arterial tree supplying the corpora cavernosa, but CCP remained elevated, indicating that both inflow and outflow resistances were high. Thus, inflow resistance had returned to its pre-stimulation state before outflow resistance. 5. Direct measurements of blood flow through the corpus cavernosum were made with a hydrogen probe. There was a transient increase in blood inflow as CCP increased during pelvic nerve stimulation. There was some blood flow while CCP was elevated, indicating that the venous occlusion was not complete. 6. Sympathetic chain stimulation caused an increase in arterial resistance, and a decrease in CCP and venous resistance. 7. Infusions of acetylcholine (330 micrograms min-1) and vasoactive intestinal polypeptide (1-3.3 micrograms min-1) decreased arterial resistance and increased CCP and venous resistance. 8. This study suggests that during pelvic nerve-induced erection, arterial flow into the corpus cavernosum increases, followed by an increase in CCP and an actively controlled decrease in venous outflow.(ABSTRACT TRUNCATED AT 400 WORDS)

Effect of estrogen on the growth hormone response to the alpha-adrenergic agonist clonidine in women with menopausal flushing

The serum GH response to the «2-adrenergic receptor agonist clonidine (0.15 mg, iv) was measured in 8 postmenopausal women with hot flushes before and during treatment with the conjugated estrogen premarin (1.25 mg, orally daily for 4 weeks), 9 normal premenopausal women, and 12 normal men. The men had a significantly greater GH response than did the age-matched premenopausal women (P < 0.05). The mean individual peak GH response was significantly higher in the premenopausal compared with the postmenopausal women (P < 0.05). Premarin decreased the number of hot flushes (P < 0.01), but had no effect on the GH response to clonidine. These results suggest that estrogens do not enhance a2-adrenergic mechanisms that regulate GH secretion and that improvement in menopausal flushing after estrogen therapy is not mediated by an effect on central a2-adrenergic function. (J Clin Endocrinol Metab 65: 6,1987) HOT FLUSHES are associated with a decline in circulating estrogen levels (1). Administration of estrogens improves the condition. The mechanism by which this amelioration takes place is unknown, although functional changes in estrogen-sensitive neurons linked to LHRH pulsatile release are believed to play a role (2). Improvement in menopausal flushing also occurs during treatment with the «2-adrenergic receptor agonist clonidine and a-methyldopa, a precursor of the a-adrenergic agonist a-methylnorepinephrine (1, 3, 4). These observations together with data that estrogens affect hypothalamic adrenergic mechanisms in animals (5-9) suggest that estrogens may improve menopausal flushing by enhancing a-adrenergic function (1). Clonidine, which binds to a2-receptors in the hypothalamus (10), increases GH secretion in animals (11) and man (12) by stimulating hypothalamic postsynaptic «2-adrenergic receptors (13, 14), but it has no effect on LH secretion in humans (3, 12). Several investigators have used this GH response to investigate a-adrenergic function in patients with various disorders (15, 16). The effect of estrogens on the GH response to clonidine in man is unknown. In this study we investigated the effect Received October 10,1986. Address all correspondence and requests for reprints to: Dr. T. Tulandi, M.D., Department of Obstetrics and Gynecology, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1. * This work was supported in part by the MRC of Canada. of estrogen on a-adrenergic function in women with menopausal flushes by evaluating the effect of premarin, a conjugated estrogen, on the GH response to clonidine. As gender is an important variable affecting the GH response to various stimuli of GH secretion (17), we also examined the effect of this variable on clonidine-induced GH secretion. Materials and Methods The GH response to clonidine was determined in 8 women, aged 27-57 yr, with menopausal flushing (6 spontaneous menopause, 1 surgical menopause, and 1 premature menopause) before and during treatment with the conjugated estrogen premarin (Ayerst Laboratories, Rouses Point, NY; 1.25 mg/day, orally, at 2000 h for 4 weeks). In addition, the GH response to clonidine was determined in 9 normal premenopausal women, aged 21-32 yr, in the follicular phase of their cycle and 12 agematched men, aged 21-33 yr. All subjects were healthy nonobese volunteers taking no medication. After an overnight fast a 19-gauge scalp vein needle was inserted into an arm vein at 0800 h and kept open with heparin-saline. Blood samples were taken at -30, 0,15, 30 45, 60, and 90 min commencing at 0900 h. Clonidine (Boehringer Ingelheim, Canada Ltd, Burlington, Ontario, Canada; 0.15 mg in 10 mL 0.15 M saline) was given iv in 10 min starting at 0 min. The last dose of premarin was administered at 2000 h the night before clonidine administration. The blood samples were centriruged, and the serum was stored at -20 C until assayed for GH (18). All samples from an individual subject were analyzed in the same assay. Specimens ESTROGEN-CLONIDINE-GH INTERACTION for RIA of serum LH (NIDDK anti-hLH-2), FSH (NIDDK anti-hFSH-6), estrone (Ei), and estradiol (E2) were taken at 0 min before and after 4 weeks of premarin treatment. The antisera for Ei and E2 were obtained from Endocrine Sciences (Tarzana, CA). The women used a diary to record the number of daily flushes for 8 weeks before and 4 weeks during premarin treatment. The interassay and intraassay variations for GH were both 10%. The minimal detectable level of GH was 1.0 ng/ml. The data were analyzed by repeated measures analysis of variance. The areas under the GH concentration-time curve (AUC) for the period 0-90 min were calculated by the trapezoidal method. Mean individual peaks, AUCs, changes in estrogen and gonadotropin levels, and number of flushes were compared using Student's t test (unpaired for independent groups and paired for dependent groups).

The GAPO syndrome

A new case of GAPO syndrome is described in a 4-year-old Algerian girl born of first-cousin parents. This patient also had a right pyelic kidney stone and cerebral venous circulation anomalies inducing scalp vein expansion.

Methods of Intravenous Therapy in Preterm Infants

The purpose of this study was to compare two methods for maintaining intravenous therapy in preterm infants. A quasiexperimental research design was used. The model for the study was Roy's adaptation model (1). The population for this study was all infants, in neonatal intensive care units, undergoing intravenous therapy. A convenience sample of all infants admitted to one neonatal intensive care unit was used. Two hundred infants were the subjects. One group (n = 100) of infants received intravenous therapy via scalp vein needle, and the other group (n = 100) of infants received intravenous therapy via teflon catheter. A data collection form was attached to each subject's chart. The number of attempts necessary to insert the intravenous cannula, the duration of time in hours that the cannula was in situ, and the reasons for cannula removal were compared. Statistical analysis by t-tests and chi-squares showed that the infants in the teflon catheter group were younger gestationally, weighed less, and spent...

Do Patients With Thromboembolic Disease Have Circulating Platelet Aggregates?

Reports of circulating platelet aggregates (ie, microemboli) in thromboembolism and other vascular disorders are based on a method (Wu and Hoak , 1974) in which venous blood is collected via scalp vein needle and tubing into either formaldehyde, which fixes aggregates, or EDTA, which disperses them. The ratio of platelet counts in platelet-rich plasma (PRP) from the two blood samples after centrifugation is interpreted as a measure of platelet aggregates in the circulation in vivo. We compared this standard Wu and Hoak technique with a modified one, in which blood was drawn directly into a syringe, and with a third method that avoided centrifugation by counting single platelets in whole blood. Both modified techniques could detect aggregates generated in vitro with adenosine diphosphate (ADP). In 12 normal subjects, the three methods were equivalent, but in 37 patients with thromboembolic disorders, the standard Wu and Hoak method gave a lower ratio than the other methods. Similar results were found in a subset of eight patients with myocardial infarction. Heparin treatment of patients did not influence the results. The data suggest that formation of platelet aggregates occurred during venipuncture. Platelets may be hyperactive in patients with thromboembolic disease and may form aggregates in vitro during collection, but the concept of chronic microembolism in such patients should be reassessed.

Do patients with thromboembolic disease have circulating platelet aggregates?

Reports of circulating platelet aggregates (ie, microemboli) in thromboembolism and other vascular disorders are based on a method (Wu and Hoak , 1974) in which venous blood is collected via scalp vein needle and tubing into either formaldehyde, which fixes aggregates, or EDTA, which disperses them. The ratio of platelet counts in platelet- rich plasma (PRP) from the two blood samples after centrifugation is interpreted as a measure of platelet aggregates in the circulation in vivo. We compared this standard Wu and Hoak technique with a modified one, in which blood was drawn directly into a syringe, and with a third method that avoided centrifugation by counting single platelets in whole blood. Both modified techniques could detect aggregates generated in vitro with adenosine diphosphate (ADP). In 12 normal subjects, the three methods were equivalent, but in 37 patients with thromboembolic disorders, the standard Wu and Hoak method gave a lower ratio than the other methods. Similar results were found in a subset of eight patients with myocardial infarction. Heparin treatment of patients did not influence the results. The data suggest that formation of platelet aggregates occurred during venipuncture. Platelets may be hyperactive in patients with thromboembolic disease and may form aggregates in vitro during collection, but the concept of chronic microembolism in such patients should be reassessed.

REAL TIME ECHOCARDIOGRAPHIC DEMONSTRATION OF INTRACARDIAC AND EXTRACARDIAC RIGHT TO LEFT SHUNT RESPIRATORY DISTRESS SYNDROME

It is not clear whether intracardiac or extracardiac (PDA) Rt to Lt shunt exists in respiratory distress syndrome. The purpose of this study is to use contrast echocardiography to demonstrate Rt to Lt shunt, if any, through foramen ovale (FO) and patent ductus arteriosus (PDA) in infants with RDS. ATL Mark III Real Time Ultrasound with 5 mHz scan head was used. The scan head was placed under xyphoid process to obtain a 4 chamber view. Two ml of normal saline was shaken before injecting into umbilical venous catheter placed at inferior vena cava (10 cases) or scalp vein when UV line was not available. The study was positive when both Rt and Lt atrium were opacified simultaneously. To study Rt to Lt PDA shunt, scan head was placed at lateral abdomen to visualize descending aorta. The study was positive when echodensity was visualized moving along aorta caudally. Twelve infants (m GA 30.3 wks, m BW 1607 gms) were studied. All were mechanically ventilated with FiO2 higher than 40%. Each patient was studied daily until shunt no longer existed. F.O. shunt was evident in all 12 patients who needed more than 40% of O2. Only 2 out of 12 patients had positive FO shunt at FiO2 of 30%, below which no shunt was visualized. PDA Rt to Lt shunt was visualized in 3 of 5 patients who required FiO2 >60%. No PDA shunts were seen below FiO2 of 60%. This study indicates that Rt to Lt shunting via FO and PDA exists in RDS.

Normal intraocular pressure during enucleation for choroidal melanoma.

A simple surgical technique for maintaining normal intraocular pressure during enucleation of eyes with a malignant melanoma of the choroid consists of making an incision into the anterior chamber through clear cornea with a microvitreo-retinal blade, followed by the introduction of a No. 21-gauge scalp vein needle or a No. 23-gauge sidewall-holed needle attached to a closed system filled with balanced salt solution. Measurements of pressure fluctuations during five enucleations are given. Such a system maintains the anterior chamber and keeps fluctuations in IOP to a minimum. This may be important in preventing hematogenous dissemination of tumor cells, resulting in metastatic disease.