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  • 1
    Electronic Resource
    Electronic Resource
    Inzidenz des Postmyelographiesyndroms (PMS) und postmyelographischer Beschwerden nach lumbaler Punktion mit der bleistiftförmigen Nadel nach Sprotte im Vergleich zur Nadel nach Quincke (1996)
    Springer
    Der Radiologe 36 (1996), S. 921-927 
    Details
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Myelographie ; Postpunktionelles Syndrom ; Nadelspitze ; Iotrolan ; Key words Myelography ; adverse effects ; Iotrolan ; Spinal puncture instrumentation ; Needle-stick injuries
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Purpose: Myelography in combination with a postmyelography CT is an important presurgical examination because of its excellent visualisation of the disc, the bone and the contrast-filled dura. Side effects after myelography can be observed in up to 50 % of patients. The pathophysiological mechanism is thought to be increased cerebrospinal fluid leakage at the puncture site. Since the introduction by Sprotte in 1979 of the pencil-point needle, a modification of Whitacre's needle, fewer complaints after lumbar puncture have been reported. The aim of the study was to examine the influence of two types of needle points and the temperature (37 °C vs 21 °C) of the contrast medium (CM; iotrolan, Isovist) on the incidence of side effects of lumbar puncture for myelography. Material and methods: In a prospective randomized trial the incidence of complaints after lumbar puncture with intrathecal CM application was evaluated by the use of a 21-G pencil-point needle as modified by Sprotte compared to our usual 22-G needle with a Quincke bevel. Some 412 patients (201 female, 211 male; mean age 54.05 ± 7.4 years) were investigated. Directly after examination and 1, 3 and 5 days later the patients were questioned about complaints (headache, neck stiffness nausea, vomiting, buzzing in the ear and dizziness). The results were tested by the chi square test. Results: A significantly lower incidence of complaints was seen after lumbar puncture with the pencil-point needle/Quincke needle (headache: 6.3 %/18.9 %, P 〈 0.0001; headache lasting 3 days: 0.5 %/7.8 %, P 〈 0.0001; headache lasting 5 days: 0 %/2.4 %, P = 0.0305; nausea: 0 %/4.9 %, P = 0.0009; vomiting: 0 %/4.9 %, P = 0.0009; dizziness: 0 %/3.4 %, P = 0.0074; neck stiffness: 0 %/3.4 %, P = 0.0074). The temperature of the CM had no influence on the complaints. No influence was seen on the quality of the myelogram. No relation to sex and age was found. Conclusion: Complaints after lumbar puncture and myelography are caused by the cerebrospinal fluid leakage at the puncture site. The incidence of side effects related to this leakage can be reduced by using a pencil-point needle. The temperature of the CM has no influence on the complaints.
    Notes: Zusammenfassung Die Myelographie zusammen mit der Postmyelographie-CT ist eine wichtige Untersuchungsmethode in der präoperativen Diagnostik. Bei nahezu der Hälfte der Patienten können postpunktionelle Beschwerden bis zu einem Postmyelographie-Syndrom (PMS) auftreten. Pathophysiologisch kann dies durch ein Punktionsleck mit anschließendem Liquorverlust erklärt werden. Ziel der Studie ist es, den Einfluß zweier Nadeltypen (21 G Nadel nach Sprotte vs 22 G Nadel nach Quincke) auf die Inzidenz postpunktioneller Beschwerden zu überprüfen. In einer prospektiven randomisierten Studie wurden bei 412 Patienten nach lumbaler intrathekaler Kontrastmittelapplikation (Iotrolan, Fa. Schering) die Häufigkeit des PMS und postpunktioneller Nebenwirkungen in Abhängigkeit vom verwendeten Nadeltyp untersucht. Die Häufigkeit postpunktioneller Beschwerden nach lumbaler Punktion mit der bleistiftförmigen Nadel nach Sprotte im Vergleich zur geschliffenen Nadel nach Quincke lag deutlich niedriger (Kopfschmerzen: 6,3 % vs 18,9 %, p 〈 0,0001; Kofschmerzen für mindestens drei Tage: 0,5 % vs 7,8 %, p 〈 0,0001; Kopfschmerzen für mindestens 5 Tage: 0 % vs 2,4 %, p = 0,0305; Übelkeit: 0 % vs 4,9 %, p = 0,0009; Erbrechen: 0 % vs 4,9 %, p = 0,0009; Schwindel: 0 % vs 3,4 %, p = 0,0074; Nackensteife: 0 % vs 3,4 %, p = 0,0074; PMS: 0 % vs 3,4 %, p = 0,0074). Die Temperatur des Kontrastmittels beeinflußte die postmyelographischen Beschwerden nicht. Schlußfolgerung: Die Inzidenz des PMS und postpunktioneller Beschwerden kann durch den Einsatz einer „atraumatischen“Nadel nach Sprotte deutlich gesenkt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001170050159
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  • 2
    Electronic Resource
    Electronic Resource
    Cardiac effects of high-dose epirubicin and cyclophosphamide in women with poor prognosis breast cancer (1999)
    Springer
    Annals of oncology 10 (1999), S. 53-58 
    Details
    ISSN: 1569-8041
    Keywords: breast cancer ; cardiotoxicity ; cyclophosphamide ; epirubicin ; high dose
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: To prospectively evaluate the long term cardiac effects of high-dose epirubicin and cyclophosphamide given to women with early stage, poor prognosis breast cancer. Patients and methods: Women with stage 2 breast cancer and 10+ nodes or 4+ nodes and estrogen receptor negative tumor, or stage 3 breast cancer received three cycles of epirubicin 200 mg/m2 and cyclophosphamide 4 gm/m2 with peripheral blood progenitor cell and filgrastim support. Treatment was given every 28 days (n = 79) or 21 days (n = 20). Fifty patients received radiotherapy to the chest wall or breast, 25 of to the left side. Patients were assessed clinically regularly during chemotherapy and at least three times yearly after completion of treatment. Cardiac left ventricular ejection fraction (LVEF) was assessed by radionuclide scan before therapy, after each cycle of chemotherapy, three months and six months after completion of chemotherapy, and yearly thereafter until relapse. Results: Ninety-nine women were treated, and 92 completed all three cycles of chemotherapy. The median age was 43 years (range 24 to 60 years). All patients were included in this analysis. The median relapse-free survival was 39 months (11 to 68 months). There was a significant fall in LVEF during chemotherapy. In general, there was no further deterioration in cardiac function from the third month after cessation of treatment, however there was substantial variation between individuals. 35 patients had at least one LVEF measure less than normal (〈50%), but the LVEF returned to normal in 20 of these with further follow-up. Cardiac dysfunction was not increased in women who received radiotherapy and was not different between cohorts given chemotherapy every three or every four weeks. One patient died of acute myocardial necrosis following the third cycle of chemotherapy. Two patients developed clinical evidence of cardiac failure, and another had radiological signs but was asymptomatic. One woman died of progressive cardiac failure, one recovered clinically but also developed recurrent breast cancer, while the third recovered after commencement of medical therapy. Conclusions: During follow-up after high-dose epirubicin and cyclophosphamide as delivered in this study, the LVEF fell to below normal in approximately one third of patients. However, in over half of these patients the LVEF subsequently recovered to the normal range, and the incidence of clinically evident chronic cardiac failure was low. Further follow-up is required to assess the long- term safety. A randomized comparison with standard-dose anthracycline-based chemotherapy is needed to determine whether this regimen is associated with an increased risk of clinical cardiac toxicity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008390203340
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