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31.
Incidence of post-lumbar puncture syndrome reduced by reinserting the stylet: a randomized prospective study of 600 patients 总被引:1,自引:0,他引:1
The post-lumbar puncture syndrome (PLPS) can best be explained by prolonged spinal fluid leakage owing to delayed closure
of a dural defect. Its incidence after spinal anaesthesia is much lower than after diagnostic lumbar puncture (LP). This difference
could be caused by a strand of arachnoid, which might enter the needle with the outflowing cerebrospinal fluid (CSF) during
diagnostic LP and upon removal of the needle be threaded back through the dura to produce prolonged CSF leakage. To find a
technique that further reduces the incidence of PLPS, this hypothesis was tested by evaluating the effect that reinserting
the stylet before removing the needle had on the incidence of PLPS. By reinserting the stylet to the tip of the needle, the
hypothesized strand would be pushed out, thereby reducing the frequency of PLPS. Sprotte’s “atraumatic needle” (21 gauge)
was used for LP. A total of 600 patients participated in the prospective study. They were randomized into two groups and questioned
about their complaints every day for up to 7 days after the LP. All LPs were performed by two experienced neurologists (T.B.,
M.S.). In 300 patients, the stylet was reinserted to the tip of the needle; in the other 300 it was not reinserted. Whereas
49 of the 300 patients without reinsertion developed PLPS, only 15 of the 300 patients with reinsertion did. This significant
difference (16.3 vs 5.0%, P < 0.005, chi square test) supports our hypothesis. On the basis of our results, we recommend reinserting the stylet before
removing the needle in order to reduce the incidence of PLPS.
Received: 30 September 1997 Received in revised form: 9 March 1998 Accepted: 20 March 1998 相似文献
32.
Kohei Hashizume Hideo Kawarasaki Tadashi Iwanaka Yutaka Kanamori Kiyoshi Tanaka Tadahito Utsuki Hiroaki Komuro Kaoru Uno 《Surgery today》1993,23(4):293-297
It has been well documented that piriform sinus fistulae often cause suppurative thyroditis; however, when a piriform sinus fistula does not present this symptom, making a correct diagnosis is very difficult. We have experienced 11 cases of a piriform sinus fistula. The conventional operational approach was performed in the initial eight patients, among which there were four recurrences in two patients. Therefore, a new operational approach was introduced for the three most recent cases and one recurrent case. First, the existence of the internal orifice of the fistula is confirmed with a laryngoscope, after which a transverse incision on the neck is made and the abscess dissected. The side wall of the piriform sinus is then opened with the help of a laryngoscope and the bottom part of the mucosa of the sinus transected with the internal orifice of the fistula, after which the fistula is removed en bloc with the bottom part of the sinus and abscess cavity. Using this operation, we experienced no complications and there has been no recurrence so far.This paper was presented at the 23rd Annual Meeting of Pacific Association of Pediatric Surgeons, June 1990 in Kona, Hawaii. 相似文献
33.
Amir Kimia MD John S. Brownstein PhD Karen L. Olson PhD Victor Zak PhD Florence T. Bourgeois MD MPH Kenneth D. Mandl MD MPH 《Academic emergency medicine》2006,13(7):767-773
Background: The Centers for Disease Control and Prevention is incorporating laboratory data into real-time surveillance systems. When normal patterns of laboratory test orders and results are modeled, aberrations can be detected. Because many test orders are available electronically well before results, atypical patterns of test ordering may signal outbreaks.
Objectives: The authors sought to characterize baseline patterns in the ordering and early results of lumbar punctures, motivated by the possibility of using these data for real-time surveillance for early detection of meningitis or encephalitis outbreaks.
Methods: Retrospective cohorts of pediatric emergency department patients at a single hospital (1993–2003) and from the National Hospital and Ambulatory Medical Care Survey (1992–2000) were used for analysis.
Results: Test ordering exhibits seasonal patterns, with monthly peaks in January and August (p < 0.0001). For the hospital cohort, the rate of cerebrospinal fluid pleocytosis exhibits seasonal patterns (p < 0.0001), with a peak from August to October. This is strongly associated with the rate and pattern of clinical neurologic disease (p < 0.0001). A long-term secular decline in daily test ordering is evident, dropping from 5.3 to 2.9 in the hospital sample, and from 371.8 to 185.3 in the national sample (p < 0.001). The long-term rate of pleocytosis has declined (p < 0.0001), though the yield of testing for pleocytosis has improved (p = 0.0104).
Conclusions: Laboratory test patterns correspond with those of clinical disease and are a promising source of surveillance data. Using such data for real-time monitoring requires specific adjustments for patient age, periodicities, and secular trends. 相似文献
Objectives: The authors sought to characterize baseline patterns in the ordering and early results of lumbar punctures, motivated by the possibility of using these data for real-time surveillance for early detection of meningitis or encephalitis outbreaks.
Methods: Retrospective cohorts of pediatric emergency department patients at a single hospital (1993–2003) and from the National Hospital and Ambulatory Medical Care Survey (1992–2000) were used for analysis.
Results: Test ordering exhibits seasonal patterns, with monthly peaks in January and August (p < 0.0001). For the hospital cohort, the rate of cerebrospinal fluid pleocytosis exhibits seasonal patterns (p < 0.0001), with a peak from August to October. This is strongly associated with the rate and pattern of clinical neurologic disease (p < 0.0001). A long-term secular decline in daily test ordering is evident, dropping from 5.3 to 2.9 in the hospital sample, and from 371.8 to 185.3 in the national sample (p < 0.001). The long-term rate of pleocytosis has declined (p < 0.0001), though the yield of testing for pleocytosis has improved (p = 0.0104).
Conclusions: Laboratory test patterns correspond with those of clinical disease and are a promising source of surveillance data. Using such data for real-time monitoring requires specific adjustments for patient age, periodicities, and secular trends. 相似文献
34.
神经导航在经单鼻孔入路垂体腺瘤切除术的应用 总被引:3,自引:0,他引:3
目的 探讨神经导航系统在经单鼻孔入路垂体腺瘤切除术中的应用技术及对鞍区解剖结构识别的价值。方法 对39例垂体腺瘤使用StealthStation神经导航系统进行指导定位、识别入路相关的解剖结构并引导手术操作。结果 平均注册误差为2.3mm(1.6~3.3mm),肿瘤全切除32例,次全切除4例,大部切除2例。部分切除1例。未全切除病例主要是肿瘤巨大、向海绵窦侵袭性生长、质地坚硬或血供异常丰富者。结论 神经导航系统提供了准确可靠的定位,能够准确指示中线结构、鞍底和颈内动脉,有效地减轻了创伤,使之成为良好的手术辅助工具。 相似文献
35.
目的 评价超声心动图对主动脉窦瘤破裂合并畸形的诊断价值,探讨漏诊原因,以提高诊断阳性率。方法 回顾分析23例主动脉窦瘤破裂合并畸形的超声心动图特征,比较超声心动图与手术诊断结果。结果 超声心动图对主动脉窦瘤破裂合并畸形诊断符合率为86.95%(20/23),漏诊率为13.04%(3/23)。结论 超声心动图检查对诊断主动脉窦瘤破裂合并畸形有重要的临床价值,全面掌握超声知识,仔细认真地检查可避免漏诊。 相似文献
36.
上矢状窦旁脑膜瘤致上矢状窦阻塞时侧支静脉通路的意义 总被引:9,自引:2,他引:7
目的 分析上矢状窦旁脑膜瘤致上矢状窦(SSS)阻塞时其侧支静脉通路的建立情况,确定其在肿瘤切除术中的意义。方法 总结归纳86例上矢状窦旁脑膜瘤行MRA及DSA检查时的静脉系表现。结果 27例发生SSS完全阻塞,59例部分阻塞。18例在阻塞的SSS周围出现了由表浅皮层静脉所形成的侧支静脉环;通过表浅皮层静脉与蝶顶窦及小脑幕静脉系建立端—端吻合的16例;通过与Troland或Labbe静脉建立吻合的14例;通过大脑镰与下矢状窦吻合的9例;通过脑膜静脉并经板障静脉引流到颈外静脉系的17例;混合型12例。结论 上矢状窦旁脑膜瘤致SSS阻塞时,肿瘤周围存在广泛侧支静脉通路,术中应注意保护。脑DSA及MRA检查对术前了解SSS通畅性及侧支静脉通路建立有帮助。 相似文献
37.
目的 :评价鼻腔鼻窦恶性肿瘤的治疗方法及其效果。方法 :83例原发于鼻腔、上颌窦、筛窦、蝶窦及额窦的恶性肿瘤 ,分别施行上颌骨次全与全切除术 ,前额开窗 -鼻锥翻转进路额筛蝶眶肿瘤大块切除及颅面联合切除术 ,部分病例实施冷冻切除 ,颌颈联合根治等手术 ,术后常规放疗。结果 :3年生存率为 4 7.5 %(36 76 ) ,5年生存率为 36 .2 %(2 5 6 9)。结论 :鼻腔鼻窦恶性肿瘤通过手术及采用术后放疗等综合治疗 ,可提高疗效 ,但仍需进一步改进治疗方法 ,以提高患者生存率。 相似文献
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