• The Korean Journal of Pain
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• v.1 no.2
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• pp.203-206
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• 1988

Evaluation of inadvertent dural puncture occuring among 308 epidural blocks done for the relief of pain from various conditions was performed. Dural puncture was suspected in 5 out of 308 epidural bloks. (1.6%) Aspiration of CSF was negative in 3 cases in which dural puncture was suspected only after developing spinal anesthesia. Of the 3 negative CSF aspirations, one case had a history of laminectomy. Adhesions of the adjacent tissues might result in the loss of flexibility and a decrease in potential epidural space which might cause dural tearing during injection and subarachoid injection of the local anesthetic followed by high spinal anesthesia. In another case, the needle tip was obstructed by tissue which led to negative aspiration of CSF and failure to feel loss of resistance. The second injection at the same site may cause subarachnoid injection of the local anesthetic through the previously perforated dura mater and in turn, lead to spinal anesthesia. In the last case, there was no reason to suspect dural puncture since the loss of resistance plus air rebound were definite and aspiration of CSF was negative, but dural puncture was suspected after the patient developed spinal anesthesia.

• Journal of Korean Neurosurgical Society
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• v.65 no.2
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• pp.224-235
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• 2022

Objective : Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, neurointerventionists have been increasingly concerned regarding the prevention of infection and time delay in performing emergency thrombectomy procedures in patients with acute stroke. This study aimed to analyze the effects of changes in mechanical thrombectomy protocol before and after the COVID-19 pandemic on procedure time and patient outcomes and to identify factors that significantly impact procedure time. Methods : The last-normal-to-door, first-abnormal-to-door, door-to-imaging, door-to-puncture, and puncture-to-recanalization times of 88 patients (45 treated with conventional pre-COVID-19 protocol and 43 with COVID-19 protection protocol) were retrospectively analyzed. The recanalization time, success rate of mechanical thrombectomy, and modified Rankin score of patients at discharge were assessed. A multivariate analysis was conducted to identify variables that significantly influenced the time delay in the door-to-puncture time and total procedure time. Results : The door-to-imaging time significantly increased under the COVID-19 protection protocol (p=0.0257) compared to that with the conventional pre-COVID-19 protocol. This increase was even more pronounced in patients who were suspected to be COVID-19-positive than in those who were negative. The door-to-puncture time showed no statistical difference between the conventional and COVID-19 protocol groups (p=0.5042). However, in the multivariate analysis, the last-normal-to-door time and door-to-imaging time were shown to affect the door-to-puncture time (p=0.0068 and 0.0097). The total procedure time was affected by the occlusion site, last-normal-to-door time, door-to-imaging time, and type of anesthesia (p=0.0001, 0.0231, 0.0103, and 0.0207, respectively). Conclusion : The COVID-19 protection protocol significantly impacted the door-to-imaging time. Shortening the door-to-imaging time and performing the procedure under local anesthesia, if possible, may be required to reduce the door-to-puncture and door-to-recanalization times. The effect of various aspects of the protection protocol on emergency thrombectomy should be further studied.

• Composites Research
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• v.21 no.5
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• pp.23-30
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• 2008

Stab threats using sharp edged or pointed Instruments could be easily encountered by police officers or soldiers. In this study, the shear thickening fluids (STF) was impregnated into Kevlar fabrics to improve the stab protection and the resistance of STF impregnated Kevlar fabrics was experimentally investigated. The puncture and cut resistance were tested using a drop test machine withspike and knife indenters fabricated based on the National Institute of Justice (NIJ) standard. The STF was filled with spherical $SiO_2$ particles having an average diameter of 100nm, 300nm, and 500nm. The effect of particle size on puncture and cut resistance of STF impregnated Kevlar fabrics was also investigated. The measured impact load histories showed that STF impregnation into fabric leads to withstand higher peak loads than that of neat fabrics under spike test. The test results showed that Kevlar impregnated with STF exhibit remarkable improvements in puncture resistance while it is slightly influential on the cut resistance. Specifically, particle size is the one of the dominant factors controlling fabric resistance to puncture under spike impact test.

• Journal of Trauma and Injury
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• v.28 no.4
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• pp.292-294
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• 2015

Central venous catheterization is one of the most important procedures for initial resuscitation of hemodynamically unstable patients including multiple trauma patients. Inadvertent arterial placement of the large caliber central venous catheter can results in resuscitation failure as well as unnecessary invasive treatment. Here, we report an arterial puncture during central venous catheterization which may lead to inadvertent arterial catheterization. We recommend that arterial catheterization should be evaluated before dilator insertion during Seldinger's method. Ultrasound can help in preventing the inadvertent arterial catheterization of central venous catheter.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2006.11a
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• pp.76-84
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• 2006

석회화 건염은 회전근 개중 극상근 건에 석회가 침착되는 질환으로서 진행 양상에 따라 Formative, Resting, Resorptive phases로 나눈다. 치료는 물리 치료, Puncture, 국소 steroid 주사, 체외 충격파 등 보존적 치료에 반응을 잘 하며, 특히 resorptive phases때의 극심한 통증은 석회 침착 부위에 puncture나 needling lavege를 실시하면 즉각적인 동통 감소 효과와 함께 석회 침착의 자연 소실을 기대할 수 있다. 이러한 보존적 치료에 효과가 없을 경우 수술적 처치를 고려할 수 있는데 최근에는 대부분 관절경을 이용한 석회 제거술을 시행한다. 수술전 견관절 충돌 징후가 있거나 수술 소견상 이를 의심할 만한 소견이 있을 경우 견봉하 성형술을 함께 실시하기도 한다.

• The Korean Nurse
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• v.6 no.6 s.32
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• pp.102-103
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• 1967

• Journal of Yeungnam Medical Science
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• v.15 no.1
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• pp.159-163
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• 1998

Percutaneous nephrostomy was performed using 18 guage pucture needle under ultrasonic guidance in 58 patients, 98 cases with hydronephrosis (bilateral; 15 cases, repeat nephrostomy; 25 cases). The causes of the hydronephrosis were malignancy(33 patients, 65 cases), benign diseases(18 patients, 25 cases), and unknown causes(7 patients, 8 cases). Successful nephrostomy was achieved in a11 cases. Major complication was not found, but seven(7.1%) minor complications, such as gross hematuria(four cases), perirenal urine leakage(two cases), and fever(one cases) were developed. The complication rate in our study was similar to that of other studies using 21 guage puncture needle. In conclusion, we think that the percutaneous nephrostomy using 18 guage puncture needle is a simple, safe, and cost and time effective procedure and it can replace the method using 21 guage puncture needle.

• Journal of Chest Surgery
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• v.16 no.2
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• pp.190-198
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• 1983

The management of cardiac arrhythmias by cardiac pacing has increased greatly since the treatment of complete heart block with an external transcutaneous pacemaker in 1952, followed by the use of myocardial wires connected to an external pulse generation, by external transvenous pacing, and then by transvenous pacing with implantable components in thoracic wall.By now, the three bases of modern cardiac pacing for bradyarrhythmias had been established [1] an implantable device [2] the transvenous approach [3] the ability of the pacemaker to sense cardiac activity and modify its own function accordingly. In transvenous implantation of a pacemaker, any one of four vessels at the root of the neck is suitable for passage of the electrode - cephalic vein, external jugular vein, internal jugular vein, costo-axillary branch of the axillary vein. The new technique of direct puncture of the subclavian vein, either percutaneously or after skin incision only has been made, is invaluable & is used routinely. We have experienced one 25 years old patient who had rheumatic mitral stenosis & minimum aortic regurgitation with sinus bradycardia associated with premature atrial tachycardia & another 54 years old female patient who was suffered from sick sinus syndrome with sinus bradycardia & sinus arrest. The 1st patient was taken open mitral commissurotomy & aortic valvuloplasty and then was taken atrlal pace-maker implantation through If subclavian puncture method in post-op 14 days, and the second patient was taken atrial pacemaker implantation through If subclavian puncture method. Their postop course was in uneventful & were discharged, without complication. Their condition have been good to now.

• The Korean Journal of Physiology and Pharmacology
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• v.22 no.3
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• pp.291-300
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• 2018

The purpose of the present work is to establish an ultra-minimal invasive percutaneous puncture inoculation method for a VX2 orthotopic lung cancer rabbit model with fewer technical difficulties, lower mortality of rabbits, a higher success rate and a shorter operation time, to evaluate the growth, metastasis and apoptosis of tumor by CT scans, necropsy, histological examination, flow cytometry and immunohistochemistry. The average inoculation time was 10-15 min per rabbit. The tumorbearing rate was 100%. More than 90% of the tumor-bearing rabbits showed local solitary tumor with 2-10 mm diameters after two weeks post-inoculation, and the rate of chest seeding was only 8.3% (2/24). The tumors diameters increased to 4-16 mm, and irregularly short thorns were observed 3 weeks after inoculation. Five weeks post-inoculation, the liquefaction necrosis and a cavity developed, and the size of tumor grew further. Before natural death, the CT images showed that the tumors spread to the chest. The flow cytometry and immunohistochemistry indicated that there was less apoptosis in VX2 orthotopic lung cancer rabbit model compared to chemotherapy drug treatment group. Minimal invasive percutaneous puncture inoculation is an easy, fast and accurate method to establish the VX2 orthotopic lung cancer rabbit model, an ideal in situ tumor model similar to human malignant tumor growth.

• Journal of Korean Neurosurgical Society
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• v.64 no.1
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• pp.60-68
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• 2021

Objective : Until recently, the transfemoral approach (TFA) was used as the primary method of arterial approach in acute ischemic stroke (AIS). However, TFA resulted in longer reperfusion times and worse outcomes in the mechanical thrombectomy (MT) of patients with complex aortic arches and significant carotid tortuosity. We found that the transradial approach (TRA) is a more favorable alternative approach for MT in such cases. Methods : We performed a retrospective review of our institutional database to identify 202 patients who underwent MT for AIS between February 2015 and December 2019. Patient characteristics, cause of TFA failure, procedure time, intra-procedural complications, and outcomes were recorded. Results : Eleven (5.4%) of 202 patients, who underwent MT for AIS, crossed over to TRA for recanalization, and eight (72%) of 11 achieved successful recanalization (≥modified Treatment in Cerebral Infarction 2b). The mean age (mean±standard deviation [median]) was 82.3±6.6 (76) years, and five of the 11 patients were male. The last seen normal to puncture time was 467.9±264.72 (264) minutes; baseline National Institutes of Health Stroke Scale score was 28.9±14.5 (16). Six (55%) of the 11 patients had right vertebrobasilar occlusions, and the remaining five (45%) had anterior circulation occlusive disease. The time from groin puncture to final recanalization time (overall procedural time) was 78.0±20.1 (62) minutes. The mean crossover time from TFA to TRA was 45.2±10.5 (41) minutes. The mean time from radial puncture to final recanalization was 33.8±10.5 (28) minutes. Distal thrombus migration events in previously unaffected territories occurred in 3/8 patients (37%). At 90 days, three patients (28%) had a favorable clinical outcome. Conclusion : Although rare, failure of TFA has been known to occur during MT for AIS. Our results demonstrate that TRA may be an alternative option for AIS intervention for select patients with subsequent timely revascularization. However, the incidence of distal thrombus migration was high, and the first puncture to reperfusion time was prolonged because of the time taken for the crossover to TRA after failure of TFA. This study provides some evidence that the TRA may be a viable alternative option to the TFA for MT of AIS.