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[PMID]:28450307
[Au] Autor:Chee J; Lau TP
[Ad] Endereço:Department of emergency medicine, National University Health System, Singapore cheejeremy@gmail.com.
[Ti] Título:Severe postpartum headache.
[So] Source:BMJ;357:j1856, 2017 04 27.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Cefaleia/complicações
Cefaleia Pós-Punção Dural/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Diabetes Gestacional/diagnóstico
Diagnóstico Diferencial
Diplopia/diagnóstico
Diplopia/etiologia
Feminino
Cefaleia/epidemiologia
Cefaleia/etiologia
Seres Humanos
Incidência
Cefaleia Pós-Punção Dural/epidemiologia
Cefaleia Pós-Punção Dural/terapia
Período Pós-Parto
Gravidez
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j1856


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[PMID]:28778448
[Au] Autor:Stüve O; Cataldi F; Pradhan V; Gorelick KJ
[Ad] Endereço:Neurology Section, VA North Texas Health Care System, Medical Service Dallas, VA Medical Center, United States; Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, United States; Department of Neurology, Klinikum rechts der Isar, Tech
[Ti] Título:Normal intrathecal leukocyte cell number and composition do not decrease the incidence of post-lumbar puncture headache.
[So] Source:J Neuroimmunol;310:69-71, 2017 Sep 15.
[Is] ISSN:1872-8421
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:The pathogenesis of post-lumbar puncture headache (PLPH) has remained unclear. A beneficial role of CSF cells in the repair of a post-traumatic dural CSF leak has been suggested. The primary purpose of this study was to investigate the effects of 8weeks of induction therapy with high-dose PF-00547659 on the cellular elements of CNS immune surveillance in patients with active Crohn's Disease and a history of immunosuppressive therapy (Clinicaltrials.govNCT01387594). PF-00547659 is a human monoclonal antibody that binds to mucosal addressin-cell adhesion molecule 1 (MAdCAM-1) on endothelial cells and blocks its interaction with beta7-integrin expressing lymphocytes. The study was executed in three parts or cohorts under two protocols. The incidence of a PLPH was 35% after the initial lumbar puncture, and 26% following the second lumbar puncture. After initiation of PF-00547659 anti-MAdCAM-1 therapy, there was a small and non-significant increase in the numbers of overall CSF leukocytes, and in lymphocyte subsets (CD3+, CD4+, and CD8+ T cells). The lymphocyte composition was unaltered by PF-00547659 anti-MAdCAM-1 therapy. Our observations suggest that normal numbers and composition of intrathecal leukocytes do not decrease the incidence of PLPH.
[Mh] Termos MeSH primário: Leucócitos/patologia
Cefaleia Pós-Punção Dural
[Mh] Termos MeSH secundário: Anticorpos Monoclonais Humanizados/uso terapêutico
Antígenos CD/metabolismo
Molécula 1 de Adesão Celular
Moléculas de Adesão Celular/metabolismo
Estudos de Coortes
Doença de Crohn/tratamento farmacológico
Feminino
Seres Humanos
Imunoglobulinas/metabolismo
Fatores Imunológicos/uso terapêutico
Incidência
Leucócitos/efeitos dos fármacos
Masculino
Cefaleia Pós-Punção Dural/líquido cefalorraquidiano
Cefaleia Pós-Punção Dural/tratamento farmacológico
Cefaleia Pós-Punção Dural/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Monoclonal, Humanized); 0 (Antigens, CD); 0 (CADM1 protein, human); 0 (Cell Adhesion Molecule-1); 0 (Cell Adhesion Molecules); 0 (Immunoglobulins); 0 (Immunologic Factors); 0 (PF-00547659)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170806
[St] Status:MEDLINE


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[PMID]:28678882
[Au] Autor:Deng J; Wang L; Zhang Y; Chang X; Ma X
[Ad] Endereço:Department of Anesthesia, Jiaxing Maternity and Child Health Hospital, School of Medicine, Jiaxing University, Jiaxing, Zhejiang, China.
[Ti] Título:Insertion of an intrathecal catheter in parturients reduces the risk of post-dural puncture headache: A retrospective study and meta-analysis.
[So] Source:PLoS One;12(7):e0180504, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This study aimed to determine whether insertion of an intrathecal catheter following accidental dural puncture (ADP) in obstetric patients can reduce the incidence of post-dural puncture headache (PDPH) and the requirement of a therapeutic epidural blood patch (TEBP). This was also compared with relocating the epidural catheter at a different vertebral interspace. A retrospective study was performed, as well as a meta-analysis of the literature to further validate our findings. We reviewed the records of 86 obstetric patients who suffered from ADP during epidural anesthesia or combined spinal-epidural anesthesia from October 2015 to November 2016 at our institution. Although, there was no significant decrease in the incidence of PDPH (P = 0.08), the requirement for a TEBP (P = 0.025) was significantly reduced in the intrathecal catheter group compared with the relocated group. In the meta-analysis, 13 eligible studies including 1044 obstetric patients were finally identified. To estimate the pooled risk ratios (RRs), fixed or random effect models were used depending on the heterogeneity. We initially found that an intrathecal catheter significantly reduced the incidence of PDPH (pooled RR = 0.823; 95% CI = 0.700-0.967; P = 0.018) and the requirement of a TEBP (pooled RR = 0.616; 95% CI = 0.443-0.855; P = 0.004). Our study shows that insertion of an intrathecal catheter following ADP might be an effective and dependable method for reducing the risk of a PDPH and requirement for a TEBP in obstetric patients.
[Mh] Termos MeSH primário: Anestesia Epidural/efeitos adversos
Cefaleia Pós-Punção Dural/prevenção & controle
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Cefaleia Pós-Punção Dural/etiologia
Gravidez
Estudos Retrospectivos
Comportamento de Redução do Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170706
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0180504


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[PMID]:28625304
[Au] Autor:Peralta F; Devroe S
[Ad] Endereço:Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E. Huron St., F5-704, Chicago, IL 60611, USA. Electronic address: feyce.peralta@northwestern.edu.
[Ti] Título:Any news on the postdural puncture headache front?
[So] Source:Best Pract Res Clin Anaesthesiol;31(1):35-47, 2017 Mar.
[Is] ISSN:1878-1608
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Unintentional dural puncture followed by postdural puncture headache is a well-known complication following neuraxial labor analgesia. Risk factors for the development of postdural puncture headache may be related to the patient's history and characteristics, the neuraxial technique, and obstetrical events. The diagnosis of postdural puncture headache is usually made depending on the clinical presentation (orthostatic headache after a neuraxial procedure). Occasionally, neuroimaging and neurological consultation are warranted. Complications following postdural puncture headache may include transient or permanent hypoacusis, cranial nerve palsies, subdural hematoma, and chronic headache. Evidence is limited regarding the safety and effectiveness of different interventions aimed to prevent or treat postdural puncture headache.
[Mh] Termos MeSH primário: Cefaleia Pós-Punção Dural/etiologia
[Mh] Termos MeSH secundário: Doenças dos Nervos Cranianos/etiologia
Feminino
Transtornos da Cefaleia/etiologia
Perda Auditiva/etiologia
Hematoma Subdural/etiologia
Seres Humanos
Trabalho de Parto
Cefaleia Pós-Punção Dural/diagnóstico
Cefaleia Pós-Punção Dural/prevenção & controle
Gravidez
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170620
[St] Status:MEDLINE


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[PMID]:28535561
[Au] Autor:Zorrilla-Vaca A; Makkar JK
[Ad] Endereço:Faculty of Health, Universidad del Valle, School of Medicine, Cali, Colombia; Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
[Ti] Título:Effectiveness of Lateral Decubitus Position for Preventing Post-Dural Puncture Headache: A Meta-Analysis.
[So] Source:Pain Physician;20(4):E521-E529, 2017 May.
[Is] ISSN:2150-1149
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Post-dural puncture headache (PDPH) is a relatively common complication of lumbar punctures for spinal anesthesia or neurologic diagnosis. For many years, a high number of drugs has been evaluated to treat PDPH, yet there is a minority to prevent this complication. The lateral decubitus position instead of sitting position during lumbar puncture has become an interesting approach because of its feasibility and patient satisfaction. OBJECTIVES: In this meta-analysis we hypothesized that lateral decubitus position is an effective manner to prophylactically reduce the incidence of PDPH. STUDY DESIGN: This meta-analysis pooled all data published in randomized controlled trials (RCTs) examining the impact of position (sitting versus lateral decubitus) during lumbar puncture and the incidence of PDPH. SETTINGS: This work was performed at Universidad del Valle, in Cali, Colombia, in collaboration with the Department of Anesthesiology at The Johns Hopkins Hospital. METHODS: Our group searched in PubMed, EMBASE, Cochrane Library and Google Scholar for relevant RCTs, dating from 1990 to July 2016, that compared the sitting and lateral decubitus position with regards to the incidence of PDPH in adult patients (age > 18 years) undergoing lumbar puncture for spinal anesthesia or neurologic diagnosis. RESULTS: Literature search identified 7 eligible RCTs (6 on spinal anesthesia and only one on neurologic diagnosis) with 1,101 patients, of which 557 had lumbar punctures in lateral decubitus position and 544 in sitting position. Only 3 (out of 7) RCTs favored the lateral decubitus position to significantly reduce the PDPH. Meta-analysis showed that the lateral decubitus position was associated with a significant reduction of the incidence of PDPH (risk ratio [RR] = 0.61, 95% confidence interval [CI] = 0.44-0.86, P = 0.004, I2 = 25%, P for heterogeneity = 0.24) compared with the sitting position. Subgroup analysis showed that lateral decubitus position is also associated with reduction of PDPH in spinal anesthesia (RR = 0.69, 95% CI = 0.50-0.95, I2 = 0%, P for heterogeneity = 0.42). We found no statistically significant association between lateral decubitus position and successful placement of spinal needle at first attempt (RR = 1.00, 95% CI = 0.92-1.09, P = 0.94, I2 = 73%, P for heterogeneity = 0.01). There was no evidence of publication bias in our analyses (Egger's bias = -0.05, P = 0.96). LIMITATIONS: The low number of RCTs might be an important limitation on our results. CONCLUSION: Our results indicate that lateral decubitus position during lumbar puncture seems to be a good alternative for preventing PDPH. Further research should focus on the new prophylactic alternatives to reduce the incidence of PDPH.
[Mh] Termos MeSH primário: Raquianestesia/efeitos adversos
Posicionamento do Paciente
Cefaleia Pós-Punção Dural/prevenção & controle
Punção Espinal/efeitos adversos
[Mh] Termos MeSH secundário: Seres Humanos
Agulhas
Postura
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170717
[Lr] Data última revisão:
170717
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170524
[St] Status:MEDLINE


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[PMID]:28388808
[Au] Autor:Arevalo-Rodriguez I; Muñoz L; Godoy-Casasbuenas N; Ciapponi A; Arevalo JJ; Boogaard S; Roqué I Figuls M
[Ad] Endereço:Cochrane Ecuador. Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador.
[Ti] Título:Needle gauge and tip designs for preventing post-dural puncture headache (PDPH).
[So] Source:Cochrane Database Syst Rev;4:CD010807, 2017 Apr 07.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Post-dural puncture headache (PDPH) is one of the most common complications of diagnostic and therapeutic lumbar punctures. PDPH is defined as any headache occurring after a lumbar puncture that worsens within 15 minutes of sitting or standing and is relieved within 15 minutes of the patient lying down. Researchers have suggested many types of interventions to help prevent PDPH. It has been suggested that aspects such as needle tip and gauge can be modified to decrease the incidence of PDPH. OBJECTIVES: To assess the effects of needle tip design (traumatic versus atraumatic) and diameter (gauge) on the prevention of PDPH in participants who have undergone dural puncture for diagnostic or therapeutic causes. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL and LILACS, as well as trial registries via the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal in September 2016. We adopted the MEDLINE strategy for searching the other databases. The search terms we used were a combination of thesaurus-based and free-text terms for both interventions (lumbar puncture in neurological, anaesthesia or myelography settings) and headache. SELECTION CRITERIA: We included randomized controlled trials (RCTs) conducted in any clinical/research setting where dural puncture had been used in participants of all ages and both genders, which compared different tip designs or diameters for prevention of PDPH DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 70 studies in the review; 66 studies with 17,067 participants were included in the quantitative analysis. An additional 18 studies are awaiting classification and 12 are ongoing. Fifteen of the 18 studies awaiting classification mainly correspond to congress summaries published before 2010, in which the available information does not allow the complete evaluation of all their risks of bias and characteristics. Our main outcome was prevention of PDPH, but we also assessed the onset of severe PDPH, headache in general and adverse events. The quality of evidence was moderate for most of the outcomes mainly due to risk of bias issues. For the analysis, we undertook three main comparisons: 1) traumatic needles versus atraumatic needles; 2) larger gauge traumatic needles versus smaller gauge traumatic needles; and 3) larger gauge atraumatic needles versus smaller gauge atraumatic needles. For each main comparison, if data were available, we performed a subgroup analysis evaluating lumbar puncture indication, age and posture.For the first comparison, the use of traumatic needles showed a higher risk of onset of PDPH compared to atraumatic needles (36 studies, 9378 participants, risk ratio (RR) 2.14, 95% confidence interval (CI) 1.72 to 2.67, I = 9%).In the second comparison of traumatic needles, studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH, with the exception of one study comparing 26 and 27 gauge needles (one study, 658 participants, RR 6.47, 95% CI 2.55 to 16.43).In the third comparison of atraumatic needles, studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH.We observed no significant difference in the risk of paraesthesia, backache, severe PDPH and any headache between traumatic and atraumatic needles. Sensitivity analyses of PDPH results between traumatic and atraumatic needles omitting high risk of bias studies showed similar results regarding the benefit of atraumatic needles in the prevention of PDPH (three studies, RR 2.78, 95% CI 1.26 to 6.15; I = 51%). AUTHORS' CONCLUSIONS: There is moderate-quality evidence that atraumatic needles reduce the risk of post-dural puncture headache (PDPH) without increasing adverse events such as paraesthesia or backache. The studies did not report very clearly on aspects related to randomization, such as random sequence generation and allocation concealment, making it difficult to interpret the risk of bias in the included studies. The moderate quality of the evidence for traumatic versus atraumatic needles suggests that further research is likely to have an important impact on our confidence in the estimate of effect.
[Mh] Termos MeSH primário: Agulhas
Cefaleia Pós-Punção Dural/prevenção & controle
Punção Espinal/efeitos adversos
[Mh] Termos MeSH secundário: Dor nas Costas/epidemiologia
Dor nas Costas/etiologia
Desenho de Equipamento
Cefaleia/epidemiologia
Cefaleia/etiologia
Seres Humanos
Parestesia/epidemiologia
Parestesia/etiologia
Cefaleia Pós-Punção Dural/epidemiologia
Ensaios Clínicos Controlados Aleatórios como Assunto
Sensibilidade e Especificidade
Punção Espinal/instrumentação
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170726
[Lr] Data última revisão:
170726
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170408
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD010807.pub2


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[PMID]:28383416
[Au] Autor:Xu H; Liu Y; Song W; Kan S; Liu F; Zhang D; Ning G; Feng S
[Ad] Endereço:Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin, People's Republic of China.
[Ti] Título:Comparison of cutting and pencil-point spinal needle in spinal anesthesia regarding postdural puncture headache: A meta-analysis.
[So] Source:Medicine (Baltimore);96(14):e6527, 2017 Apr.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Postdural puncture headache (PDPH), mainly resulting from the loss of cerebral spinal fluid (CSF), is a well-known iatrogenic complication of spinal anesthesia and diagnostic lumbar puncture. Spinal needles have been modified to minimize complications. Modifiable risk factors of PDPH mainly included needle size and needle shape. However, whether the incidence of PDPH is significantly different between cutting-point and pencil-point needles was controversial. Then we did a meta-analysis to assess the incidence of PDPH of cutting spinal needle and pencil-point spinal needle. METHODS: We included all randomly designed trials, assessing the clinical outcomes in patients given elective spinal anesthesia or diagnostic lumbar puncture with either cutting or pencil-point spinal needle as eligible studies. All selected studies and the risk of bias of them were assessed by 2 investigators. Clinical outcomes including success rates, frequency of PDPH, reported severe PDPH, and the use of epidural blood patch (EBP) were recorded as primary results. Results were evaluated using risk ratio (RR) with 95% confidence interval (CI) for dichotomous variables. Rev Man software (version 5.3) was used to analyze all appropriate data. RESULTS: Twenty-five randomized controlled trials (RCTs) were included in our study. The analysis result revealed that pencil-point spinal needle would result in lower rate of PDPH (RR 2.50; 95% CI [1.96, 3.19]; P < 0.00001) and severe PDPH (RR 3.27; 95% CI [2.15, 4.96]; P < 0.00001). Furthermore, EBP was less used in pencil-point spine needle group (RR 3.69; 95% CI [1.96, 6.95]; P < 0.0001). CONCLUSIONS: Current evidences suggest that pencil-point spinal needle was significantly superior compared with cutting spinal needle regarding the frequency of PDPH, PDPH severity, and the use of EBP. In view of this, we recommend the use of pencil-point spinal needle in spinal anesthesia and lumbar puncture.
[Mh] Termos MeSH primário: Raquianestesia/instrumentação
Agulhas
Cefaleia Pós-Punção Dural/prevenção & controle
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170503
[Lr] Data última revisão:
170503
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170407
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006527


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[PMID]:28372658
[Au] Autor:Bordlee JW; Beakley BD; Mody R; McConville AP; Weed JT; McClure BP; Foldes PJ; Ma JG; Kaye AD; Eskander JP
[Ad] Endereço:Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA. Electronic address: jbordlee@tulane.edu.
[Ti] Título:A case of paradoxical presentation of a postural postdural puncture headache after combined spinal-epidural anesthesia.
[So] Source:J Clin Anesth;38:156-157, 2017 May.
[Is] ISSN:1873-4529
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We report a case of paradoxical presentation of a postural postdural puncture headache secondary to dural puncture with a 25-gauge Whitacre needle for combined spinal-epidural anesthesia. This 27-year-old female patient presented to the emergency department with elevated blood pressure and a global headache 9 days after administration of epidural anesthesia for a spontaneous vaginal delivery after an uncomplicated pregnancy. The patient reported that the headache was more intense when lying down and immediately improved when she sat or stood up from a recumbent position. The patient was discharged from emergency department after an improvement following treatment with labetalol, ondansetron, ketorolac, and fluid resuscitation.
[Mh] Termos MeSH primário: Anestesia Epidural/efeitos adversos
Anestesia Obstétrica/efeitos adversos
Raquianestesia/efeitos adversos
Vazamento de Líquido Cefalorraquidiano/complicações
Cefaleia Pós-Punção Dural/diagnóstico
[Mh] Termos MeSH secundário: Acetaminofen/uso terapêutico
Adulto
Analgésicos Opioides/administração & dosagem
Anestésicos Locais/administração & dosagem
Bupivacaína/administração & dosagem
Parto Obstétrico/efeitos adversos
Combinação de Medicamentos
Feminino
Fentanila/administração & dosagem
Seres Humanos
Hipertensão/tratamento farmacológico
Hipertensão/etiologia
Cetorolaco/uso terapêutico
Labetalol/uso terapêutico
Agulhas
Ondansetron/uso terapêutico
Oxicodona/uso terapêutico
Cefaleia Pós-Punção Dural/tratamento farmacológico
Cefaleia Pós-Punção Dural/etiologia
Gravidez
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Anesthetics, Local); 0 (Drug Combinations); 0 (oxycodone-acetaminophen); 362O9ITL9D (Acetaminophen); 4AF302ESOS (Ondansetron); CD35PMG570 (Oxycodone); R5H8897N95 (Labetalol); UF599785JZ (Fentanyl); Y8335394RO (Bupivacaine); YZI5105V0L (Ketorolac)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170405
[St] Status:MEDLINE


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[PMID]:28362213
[Au] Autor:Schievink WI; Maya MM; Moser FG
[Ad] Endereço:Departments of 1 Neurosurgery and.
[Ti] Título:Digital subtraction myelography in the investigation of post-dural puncture headache in 27 patients: technical note.
[So] Source:J Neurosurg Spine;26(6):760-764, 2017 Jun.
[Is] ISSN:1547-5646
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Post-dural puncture headaches are common, and the treatment of such headaches can be complex when they become chronic. Among patients with spontaneous spinal CSF leaks, digital subtraction myelography (DSM) can localize the exact site of the leak when an extradural CSF collection is present, and it can also demonstrate CSF-venous fistulas in those without an extradural CSF collection. The authors now report on the use of DSM in the management of patients with chronic post-dural puncture headaches. METHODS The patient population consisted of a consecutive group of 27 patients with recalcitrant post-dural puncture headache that had lasted from 2 to 150 months (mean 26 months). RESULTS The mean age of the 17 women and 10 men was 39.1 years (range 18-77 years). An extensive extradural CSF collection was present in 5 of the 27 patients, and DSM was able to localize the exact site of the dural defect in all 5 patients. Among the 22 patients who did not have an extradural CSF collection, DSM showed a CSF-venous fistula in 1 patient (5%). Three other patients had a small pseudomeningocele at the level of the dural puncture. Percutaneous glue injection or microsurgical repair resulted in resolution of symptoms in 8 of the 9 patients in whom an abnormality had been identified on imaging. CONCLUSIONS Digital subtraction myelography is able to precisely localize the dural puncture site in patients with a post-dural puncture headache and an extensive extradural CSF collection, and it may rarely detect a CSF-venous fistula in such patients without an extradural CSF collection.
[Mh] Termos MeSH primário: Imagem por Ressonância Magnética
Mielografia/métodos
Cefaleia Pós-Punção Dural/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem
Vazamento de Líquido Cefalorraquidiano/cirurgia
Feminino
Seres Humanos
Masculino
Meia-Idade
Cefaleia Pós-Punção Dural/cirurgia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170626
[Lr] Data última revisão:
170626
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170401
[St] Status:MEDLINE
[do] DOI:10.3171/2016.11.SPINE16968


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[PMID]:28235535
[Au] Autor:Franz AM; Jia SY; Bahnson HT; Goel A; Habib AS
[Ad] Endereço:Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE MB.11.500, Seattle, WA 98105, USA. Electronic address: amber.franz@seattlechildrens.org.
[Ti] Título:The effect of second-stage pushing and body mass index on postdural puncture headache.
[So] Source:J Clin Anesth;37:77-81, 2017 Feb.
[Is] ISSN:1873-4529
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:STUDY OBJECTIVE: To explore how pushing during labor and body mass index affect the development of postdural puncture headache in parturients who experienced dural puncture with Tuohy needles. DESIGN: Retrospective cohort. SETTING: Obstetric ward and operating rooms at a university-affiliated hospital. PATIENTS: One hundred ninety parturients who had witnessed dural puncture with 17 or 18 gauge Tuohy needles from 1999-2014. INTERVENTIONS: Patients were categorized by pushing status and body mass index (kg/m ): nonobese <30, obese 30-39.99, morbidly obese 40-49.99, and super obese ≥50. MEASUREMENTS: Headache, number of days of headache, maximum headache score, and epidural blood patch placement. MAIN RESULTS: Compared with women who did not push, women who pushed during labor had increased risk of postdural puncture headache (odds ratio [OR], 2.1 [1.1-4.0]; P=.02), more days of headache (P=.02), and increased epidural blood patch placement (P=.02). Super obese patients were less likely to develop headache compared with nonobese (OR, 0.33 [0.13-0.85]; P=.02), obese (OR, 0.37 [0.14-0.98]; P=.045], and morbidly obese patients (OR, 0.20 [0.05-0.68]; P<.01). In a multivariate logistic regression model, lack of pushing (OR, 0.57 [0.29-1.10]; P=.096) and super obesity (OR, 0.41 [0.16-1.02]; P=.056] were no longer significantly associated with reduced risk of postdural puncture headache. CONCLUSIONS: Parturients who did not push before delivery and parturients with body mass index ≥50kg/m were less likely to develop postdural puncture headache in a univariate analysis. Similar trends were demonstrated in a multivariate model, but were no longer statistically significant.
[Mh] Termos MeSH primário: Anestesia Epidural/efeitos adversos
Anestesia Obstétrica/efeitos adversos
Parto Obstétrico/efeitos adversos
Obesidade Mórbida/complicações
Cefaleia Pós-Punção Dural/etiologia
Punção Espinal/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Placa de Sangue Epidural/estatística & dados numéricos
Índice de Massa Corporal
Feminino
Seres Humanos
Incidência
Modelos Logísticos
Medição da Dor
Cefaleia Pós-Punção Dural/epidemiologia
Gravidez
Estudos Retrospectivos
Fatores de Risco
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170226
[St] Status:MEDLINE



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