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Puncture Site (puncture + site)
Selected AbstractsIn reference to A Novel Approach for Dilation of Neopharyngeal Stricture Following Total Laryngectomy Using the Tracheoesophageal Puncture SiteTHE LARYNGOSCOPE, Issue 5 2009William J. Richtsmeier MD No abstract is available for this article. [source] Autogenous Fat Injection for the Incontinent Tracheoesophageal Puncture SiteTHE LARYNGOSCOPE, Issue 8 2002Ollivier Laccourreye MD No abstract is available for this article. [source] Pyoderma gangrenosum following isotretinoin therapy for acne nodulocysticINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 9 2008Maria Paula Tinoco MD A 19-year-old man with nodulocystic acne on baseline was treated with isotretinoin therapy. After 1 month on the medication, he developed pyoderma gangrenosum on his pubis area, arms and legs, and pathergy on a puncture site. Possible underlying diseases were excluded. The patient was started on steroids (prednisone 1 mg/kg/d) and isotretinoin therapy was withdrawn. Later the prednisone was tappered and dapsone 100 mg/daily was initiated. After 10 months of follow-up all lesions had healed and no underlying diseases developed. [source] The clinical effectiveness of length of bed rest for patients recovering from trans-femoral diagnostic cardiac catheterisationINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2008Sek Ying Chair RN MBA PhD Background, Cardiac catheterisation plays a vital role in the diagnosis and evaluation of cardiac conditions. The goal of management of patients after cardiac catheterisation is to reduce the risk of development of any local or prolonged vascular complications, in particular bleeding and haematoma formation at the puncture site. Bed rest and immobilisation of the affected leg are recommended practices to ensure adequate haemostasis at the femoral arterial puncture site and prevent complications. Objectives, The objective of this review was to present the best available evidence for the optimal length of bed rest after trans-femoral diagnostic cardiac catheterisation. The main outcome of interest was the incidence of bleeding and haematoma formation following varying periods of bed rest. Search strategy, We searched the following databases: CINAHL, Medline, Cochrane Library, Current Contents, EBSCO, Web of Science, Embase, British Nursing Index, Controlled clinical trials database, Google Scholar. Reference lists of relevant articles and conference proceedings were searched. We also contacted key organisations and researchers in the field. Selection criteria, All randomised and quasi-randomised controlled trials that compared the effects of different lengths of bed rest following trans-femoral diagnostic cardiac catheterisation on patient outcomes were considered for inclusion in the review. Data collection and analysis, Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials were assessed independently by two reviewers. Odds ratios (OR) for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, trials were considered separately. Main results, Eighteen trials involving a total of 4294 participants were included in the review. One trial included three treatment groups. In seven trials among 747 people there was no significant difference in the incidence of bleeding following six or less than 6 h of bed rest (OR 1.47; 95% CI 0.60, 3.64). Likewise, there was no significant difference in the incidence of bleeding following bed rest at other time periods. In eight trials involving 2272 patients there was no significant difference in the incidence of haematoma formation following 6 or less than 6 h of bed rest (OR 0.82; 95% CI 0.59, 1.16). Significantly fewer patients randomised to less than 6 h of bed rest complained of back pain. The odds of developing back pain at 4 (OR 24.60; 95% CI 1.29, 469) and 24 h (OR 2.47; 95% CI 1.16, 5.23) following coronary catheterisation was significantly higher among patients randomised to 6 compared with 3 h of bed rest. Authors' conclusions, There is evidence of no benefit relating to bleeding and haematoma formation in patients who have more than 3 h of bed rest following trans-femoral diagnostic cardiac catheterisation. However, there is evidence of benefit relating to decreased incidence and severity of back pain and cost-effectiveness following 3 h of bed rest. There is suggestive but inconclusive evidence of a benefit from bed rest for 2 h following trans-femoral cardiac catheterisation. Clinicians should consider a balance between avoiding increased risk of haematoma formation following 2,2.5 h of bed rest and circumventing back pain following more than 4 h of bed rest. [source] Ultrasound-guided central venous cannulation in infants and childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2002P. Åsheim Background: Percutaneous central venous cannulation in infants and children is a challenging procedure. Traditionally, an external landmark technique has been used to identify puncture site. An ultrasound-guided technique is now available and we wanted to evaluate this method in children and infants, looking specifically at the ease of use, success rate and complications. Methods: Forty-two consecutive infants and children (median 16.5 [0,177] months and 10 [3,45] kg) scheduled for central venous catheter placement were registered. An ultrasound scanner made for guiding puncture of vessels was used. After locating the puncture site, a sterile procedure was performed using an accompanying kit to aid puncture of the vessel. Results: Cannulation was successful in all patients and we had no complications during insertion of the catheters. The right internal jugular vein was preferred in most patients, and in 95% of the patients the vein was punctured at the first attempt. The median time from start of puncture to aspiration of blood was 12 (3,180) seconds. Conclusion: The ultrasound-guided technique for placement of central venous catheters was easy to apply in infants and children. It is our impression that it increased the precision and safety of the procedure in this group of patients. [source] Cordocentesis in multifetal pregnanciesPRENATAL DIAGNOSIS, Issue 12 2007Fuanglada Tongprasert Abstract Objective To describe the experiences in diagnostic cordocentesis in twin pregnancies at midpregnancy Methods The database and medical records of pregnant women attending Maternal Fetal Medicine Unit of the hospital for diagnostic cordocentesis at midpregnancy between January 1989 and September 2006 were retrospectively reviewed. Results During 17 years of experience, 4241 cordocenteses at midpregnancy were performed for prenatal diagnosis, including 59 procedures in 30 multiple pregnancies (29 twins and 1 triplet). The mean gestational age at the time of cordocentesis was 19.5 ± 1.6 weeks. Success rate of the samplings was 98.3% with one sample was maternal blood contamination. Averaged-time used of the procedures was 8.2 minutes (range 1,45 minutes). The procedure-related complications included transient bleeding at puncture site (8.5%) and transient fetal bradycardia (22.0%). The total fetal loss rate was 10.5% but there was no cordocentesis-related fetal loss (0.0%), defined as a fetal loss within 2 weeks after the procedure. Conclusion This study may provide a new insight on the safety of cordocentesis in multifetal pregnancies at midpregnancy. The procedure-related fetal loss is not as high as reported in the past. This study suggests cordocentesis be a relatively safe and highly successful in obtaining fetal blood samples. Copyright © 2007 John Wiley & Sons, Ltd. [source] Trapping of vascular clip closure device in previously accessed femoral puncture siteCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2007Steven J. Fowler MD No abstract is available for this article. [source] Fine-needle aspiration biopsy and other biopsies in suspected intraocular malignant disease: a reviewACTA OPHTHALMOLOGICA, Issue 6 2009Nils Eide Abstract. Ocular oncologists require a strong indication for intraocular biopsy before the procedure can be performed because it carries a risk for serious eye complications and the dissemination of malignant cells. The purpose of this review is to evaluate the extent to which this restricted practice is supported by evidence from previous reports and to outline our main indications and contraindications. The different intraocular biopsy techniques in the anterior and posterior segment are discussed with a focus on our preferred method, fine-needle aspiration biopsy (FNAB). In the literature, complications are typically under-reported, which reduces the possibilities of evaluating the risks correctly and of making fair comparisons with other biopsy methods. In FNAB, the exact placement of the needle is critical, as is an accurate assessment of the size of the lesion. Fine-needle aspiration biopsy is usually not a reliable diagnostic tool in lesions < 2 mm in thickness. It is very advantageous to have a cytopathologist present in the operating theatre or close by. This ensures adequate sampling and encourages repeated biopsy attempts if necessary. This approach reduces false negative results to < 3%. Adjunct immunocytochemistry is documented to increase specificity and is essential for diagnosis and management in about 10% of cases. In some rare pathological processes the diagnosis depends ultimately on the identification of specific cell markers. An accurate diagnosis may have a decisive influence on prognosis. The cytogenetic prognostications made possible after FNAB are reliable. Biopsy by FNA has a low complication rate. The calculated risk for retinal detachment is < 4%. Intraocular haemorrhage is frequently observed, but clears spontaneously in nearly all cases. Only a single case of epibulbar seeding of malignant cells at the scleral pars plana puncture site of transvitreal FNAB has been documented. Endophthalmitis has been reported and adequate standard preoperative preparation is obligatory. An open biopsy is still an option in the anterior segment, but has been abandoned in the posterior segment. Although vitrectomy-based procedures are becoming increasingly popular, we recommend using FNAB as part of a stepwise approach. A vitrectomy-assisted biopsy should be considered in cases where FNAB fails. In any adult patient with suspected intraocular malignancy in which enucleation is not the obvious treatment, the clinician should strive for a diagnosis based on biopsy. When the lesion is too small for biopsy or the risks related to the procedure are too great, it is reasonable to be reluctant to biopsy. The standards applied in the treatment of intraocular malignant diseases should be equivalent to those in other fields of oncology. Our view is controversial and contrary to opinion that supports current standards of care for this group of patients. [source] | ||||||||||