The anterior chamber paracentesis has its history about 4 centuries long in the ophthalmic operations. Author recently applied this method to 31 clinical cases consisting of hypopyon, hyphema, juvenile cataract and foreign body in anterior chamber. Attempt was made via the subconjunctival route on the cases of hyphema and lens material in the anterior chamber, in contrast with the ordinary corneal limbus puncture on the discission of anterior lens capsule, or irrigation of hypopyon. Application of paracentesis in my series was selected on the cases of blood over a half of anterior chamber, and large amount of hypopyon, etc., and the favorable rasults were achieved.
Anterior Chamber* ; Cataract ; Foreign Bodies ; Hyphema ; Limbus Corneae ; Paracentesis* ; Punctures

Eleven cervical myelograms were perfomed by lateral cervical puncture using Metrizamide. So, following resultswere obtained: 1. Site of lateral cervial puncture; Posterior one third of bony cervical canal at C 1-2 level. 2.Advantages as compared with lumbar puncture for cervial myelogram; 1) Small amount of contrast media 2) Excellentimage 3) Less position change 4) Short time 5) Well visualization of superior margin of obstructive lesion inspinal canal 3. Cessation of lateral cervical puncture, when; 1) Pain during injection of contrast media 2)Localized collection of contrast media
Contrast Media ; Metrizamide ; Myelography ; Punctures ; Spinal Puncture

We report a case of digital mucous cyst with longitudinal groovings of the nail distal to the cyst which was treated by multiple puncture method described by other authors. The digital mucous cyst was cured without any sequelae and no recurrence has developed within 2 years. Also the nail groovings returned to normal.
Punctures* ; Recurrence

PURPOSE: To evaluate the hemostatic effect of N-butyl 2-cyanoacrylate(NBCA) injection and RF electrocauterization of the tract after fine needle biopsy of the liver, and the histopathologic changes of the liver. MATERIALS AND METHODS: Three lobes of rabbit liver were selected and separately punctured four times with 21 gauge biopsy needles. According to the hemostatic procedure on fine needle biopsy, three groups (1, 2, 3) were formed : group 1, in which there was no maneuver for bleeding control, was the control group ; group 2, in which NBCA was injected into the puncture tract while slowly removing the needle ; group 3, in which RF electrocauterization of the tract was carried out. After completely removing the needle, each group was evaluated for amount of bleeding and histologic change. RESULTS: The amount of bleeding was 0.407gm+/-0.245 in group 1,0.028gm+/-0.036 in group 2 and 0.035gm+/-0.028 in group 3. As compared with the control group(group 1), injecting NBCA into the biopsy tract(P=0.0002) and RF electrocauterization of the tract(P=0.0003) significantly reduced the amount of bleeding after liver biopsy. The amount of bleeding was not statistically different between group 2 and 3, however (P=0.58). In Group 1, the tract was fully filled with blood. Group 2 showed NBCA embolized in the biopsy tract, adhering to hepatocytes and mixed with blood; small vessels adjacent to the puncture tract were filled with NBCA. Group 3 showed tissue degeneration, including necrosis of hepatocytes, vacuolation and neutrophil infiltration. CONCLUSION: Injection of NBCA and RF electrocauterization of the tract after puncture of the liver for biopsy efficiently controlled bleeding. In particular, the efficiency of NBCA injection was due to its effect of plugging the tract and causing the embolization of adjacent small vessels. With regard to procedural handling, RF electrocauterization of the tract is superior to injection of NBCA.
Animals ; Biopsy* ; Biopsy, Fine-Needle ; Hemorrhage* ; Hepatocytes ; Liver* ; Necrosis ; Needles ; Neutrophil Infiltration ; Punctures

Equipment Design ; Humans ; Needles ; standards ; Paracentesis ; instrumentation ; methods ; Pleural Effusion ; therapy ; Pneumothorax ; therapy ; Punctures ; instrumentation ; methods ; Treatment Outcome

PURPOSE: Hepatic hydrothorax is a complication of decompensated liver cirrhosis that is difficult and complex to manage. Data concerning the optimal treatment method, other than liver transplantation, are limited. This study aimed to compare the clinical features and outcomes of patients treated with various modalities, while focusing on surgical management and pigtail drainage. MATERIALS AND METHODS: Forty-one patients diagnosed with refractory hepatic hydrothorax between January 2013 and December 2017 were enrolled. RESULTS: The mean Child-Turcotte-Pugh and model for end stage liver disease scores of the enrolled patients were 10.1 and 19.7, respectively. The patients underwent four modalities: serial thoracentesis (n=11, 26.8%), pigtail drainage (n=16, 39.0%), surgery (n=10, 24.4%), and liver transplantation (n=4, 9.8%); 12-month mortality rate/median survival duration was 18.2%/868 days, 87.5%/79 days, 70%/179 days, and 0%/601.5 days, respectively. Regarding the management of refractory hepatic hydrothorax, surgery group required less frequent needle puncture (23.5 times in pigtail group vs. 9.3 times in surgery group), had a lower occurrence of hepatorenal syndrome (50% vs. 30%), and had a non-inferior cumulative overall survival (402.1 days vs. 221.7 days) compared to pigtail group. On multivariate analysis for poor survival, body mass index <19 kg/m², refractory hepatic hydrothorax not managed with liver transplantation, Child-Turcotte-Pugh score >10, and history of severe encephalopathy (grade >2) were associated with poor survival. CONCLUSION: Serial thoracentesis may be recommended for management of hepatic hydrothorax and surgical management can be a useful option in patients with refractory hepatic hydrothorax, alternative to pigtail drainage.
Body Mass Index ; Brain Diseases ; Drainage ; End Stage Liver Disease ; Fibrosis ; Hepatorenal Syndrome ; Humans ; Hydrothorax ; Liver Cirrhosis ; Liver Transplantation ; Methods ; Mortality ; Multivariate Analysis ; Needles ; Punctures ; Thoracentesis

BACKGROUND/AIMS: To compare the diagnostic yield of 20-gauge forward-bevel core biopsy needle (CBN) and 22-gauge needle for endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of solid pancreatic masses. METHODS: The use of 20-gauge CBN was prospectively evaluated for 50 patients who underwent EUS-FNA from June 2016 to December 2016. Data were compared with those obtained by a retrospective study of 50 consecutive patients who underwent EUS-FNA using standard 22-gauge needles between December 2016 and April 2017. At least two punctures were performed for each patient; the sample from the first pass was used for cytology with or without histology and that from the second pass was used for histology. Sample quantity was evaluated using the sample obtained from the second pass. RESULTS: There was no significant difference in the diagnostic accuracy rate between the first and second passes (20-gauge CBN: 96% [48/50]; standard 22-gauge needle: 88% [44/50]). Samples >10× power fields in length were obtained from 90% (43/48) and 60% (30/50) of patients using the 20-gauge CBN and standard 22-gauge needle, respectively (p=0.01). Technical failure occurred for two patients with the 20-gauge CBN. CONCLUSIONS: Diagnostic accuracy of the 20-gauge CBN was comparable to that of the 22-gauge needle. However, two passes with the 20-gauge CBN yielded a correct diagnosis for 100% of patients when technically feasible. Moreover, the 20-gauge CBN yielded core tissue for 90% patients, which was a performance superior to that of the 22-gauge needle.
Biopsy ; Biopsy, Fine-Needle ; Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Humans ; Needles ; Pancreas ; Prospective Studies ; Punctures ; Retrospective Studies ; Ultrasonography

PURPOSE: This study was designed to evaluate the difference in the degree of patient pain during an ultrasoundguided fine-needle aspiration biopsy (US-FNAB) with the use of a one-needle puncture for thyroid nodules with the application of local anesthesia. MATERIALS AND METHODS: We prospectively examined patients who simultaneously received US-FNAB for two thyroid nodules, for one nodule in the right lobe and one nodule in the left lobe, where the nodules were larger than 10 mm in the maximum diameter. US-FNAB with or without local anesthesia was performed with the use of a 23-guage needle in all patients. The degree of pain after performing US-FNAB was evaluated by the use of an 11-point numeric rating scale. RESULTS: For all 20 patients, US-FNAB was performed with an alternative selection of the nodules. There were 14 patients with a higher pain score where local anesthesia was administered, two patients with a higher pain score where local anesthesia was not administered and four patients with the same score where both methods were used. There was a statistically significant difference in the pain score between the use of the two methods (Wilcoxon sign rank test, p = 0.014). The mean value of the pain score was 3.1 in patients who received local anesthesia and 2.1 in patients that did not receive local anesthesia, respectively. CONCLUSION: The use of local anesthesia is not superior to the use of no anesthesia regarding pain relief if USFNAB is performed with a one-needle puncture.
Anesthesia ; Anesthesia, Local ; Biopsy, Fine-Needle ; Humans ; Needles ; Prospective Studies ; Punctures ; Thyroid Gland ; Thyroid Nodule

PURPOSE: Newborns routinely experience pain associated with invasive procedures such as blood sampling, venipuncture, heelstick, or venous cannulation. This study was done to provide data for a nursing intervention to alleviate newborn pain clinically by investigating the effect of local anesthetic cream during venipuncture. METHODS: Participants were 70 newborns hospitalized in the nursery. Informed Consent was obtained from parents of the newborns. Venipuncture for regular blood sampling was carried out for a test on 2 groups; the experimental, placebo group. The neonatal infant pain scale (NIPS), and duration of crying were measured to assess pain reaction. All neonatal behaviors were recorded on videotape. RESULTS: There were significant differences in pain behavior during venipuncture (t=-4.752, p<.001), immediately after sampling (t=-5.591, p<.001), 3 minutes after puncture (t=-2.469, p=.017), and in duration of crying (t=-3.005, p=.004). CONCLUSION: Results show that local administration of EMLA cream before venipuncture causes a reduction in neonatal pain response, indicating that the EMLA cream has the effect of pain relief.
Catheterization ; Crying ; Humans ; Infant ; Infant, Newborn ; Informed Consent ; Lidocaine ; Nurseries ; Parents ; Phlebotomy ; Prilocaine ; Punctures ; Child Health

Anesthesiologists prefer the intemal jugular vein (IJV) for central venous cannulation. Most approaches use the sternocleidomastoid muscle as a landmark but, a new approach for internal jugular venipuncture is using bony rather than soft tissue landmarks that was developed by Nobukata et al. in 1991. The landmarks of Nobukata's method consist of four bony landmarks the notch, which was located just above the medial end of the clavicle; the sternal end of clavicle; the mastoid process; and the cricoid cartilage. In order to compare Nobukata's method with Central approach, we evaluated 100 patients prospectively. We allocated randomly two hundreds ASA physical status 1, 2 and 3 patients to two groups. Central approach was employed for central venous cannulation in group 1 and Nobukata's method was done in group 2. In both group, two attempts were employed to right IJV and one attempt was done left IJV if right venipuncture was failed or hematoma formation occured. Successful cannulation rate on the 2nd attempt was 97% in group 1 and 96% in group 2, and overall success rate was 100% in both groups. Complications included arterial puncture in 3 cases (3%) and in 2 cases (2%) in group 1 and group 2 respectively, and hematoma formation in 2 cases (2%) in group 2. From the above results, in some cases of anesthetized patients, short neck, obese patients whose soft tissue landmarks are less t, and during cardiac arrest, Nobukata's method can be used alternatively to Central approach.
Catheterization* ; Clavicle ; Cricoid Cartilage ; Heart Arrest ; Hematoma ; Humans ; Jugular Veins* ; Mastoid ; Neck ; Phlebotomy ; Prospective Studies ; Punctures