Biomedical subjects

M Turunen

Publications and source records attributed to M Turunen.

At least 19 recordsLinked to original sources

PubMed2005

High success rate and low incidence of headache and neurological symptoms with two spinal needle designs in children.

BACKGROUND: In children, only a few trials have evaluated the use of spinal needles with special tip designs. In this study, we compared the success rate and incidence of post-dural puncture complaints of two small-gauge spinal needle designs used in children undergoing spinal anaesthesia (SA). METHODS: Three hundred and three children aged 9 months to 17 years presenting for subumbilical surgery were randomly assigned to have a 26G Atraucan (n = 156) or 27G Whitacre (n = 147) spinal needle for SA. The number of attempts to obtain successful cerebrospinal fluid (CSF) return and the success rate of SA were recorded. The first week of recovery was recorded by a diary. RESULTS: Both groups had a similar one-attempt success rate: 80% in the Atraucan group and 81% in the Whitacre group. Failure to obtain CSF occurred in one patient in the Atraucan group and in two patients in the Whitacre group. Paraesthesia was observed more commonly in the Whitacre group (10%) than in the Atraucan group (2%) (P = 0.004). The success rate of SA was 96%, with no differences between the two needles; one child was given general anaesthesia and 11 children (3%) a single dose of supplemental analgesia for the skin incision. Forty-one children (15%) developed a headache, 13 of which were classified as post-dural puncture headache (PDPH), seven cases (5%) in the Atraucan group and six (4%) in the Whitacre group; none of the children required a blood patch. Fifteen children (10%) in the Atraucan group and nine (7%) in the Whitacre group developed low back pain. Two children (1%) in the Atraucan group and four (3%) in the Whitacre group developed transient neurological symptoms (TNSs). CONCLUSION: Both needles were associated with a high success rate and a low incidence of complaints.

Adolescent↗

PubMed2003

Non-endoscopic diagnosis of atrophic gastritis with a blood test. Correlation between gastric histology and serum levels of gastrin-17 and pepsinogen I: a multicentre study.

BACKGROUND AND AIMS: Serum levels of gastrin-17 (S-G-17) and pepsinogen I (S-PGI) are biomarkers of gastric antral and corpus mucosa, respectively. In a prospective multicentre investigation, we determined whether these tests, together with the assay of Helicobacter pylori antibodies, are a non-endoscopic tool for the diagnosis of atrophic gastritis. MATERIALS AND METHODS: The series comprised 404 consecutive adult outpatients undergoing diagnostic upper-gastrointestinal endoscopy for various dyspeptic symptoms in five outpatient clinics. Gastric biopsies from the antrum and corpus (at least two biopsies from both sites) were available from all patients, and they were evaluated according to the guidelines of the updated Sydney system. S-PGI and S-G-17 were assayed with ELISA methods using monoclonal antibodies to pepsinogen I and amidated gastrin-17. In addition to the fasting level (S-G-17(fast)), a postprandial S-G-17 (S-G-17(prand)) level was measured 20 min after ingestion of a protein-rich drink. H. pylori antibodies were determined using a polyclonal EIA method. RESULTS: S-G-17(prand) (and S-G-17(fast)) and S-PGI levels decreased with increasing grade of atrophy of the antrum or corpus, respectively. S-G-17(prand) levels were significantly lower in patients with advanced (moderate or severe) atrophic antral H. pylori gastritis than in those with non-atrophic H. pylori gastritis. All patients with a resected antrum demonstrated S-G-17(prand) levels that were almost undetectable. Of the nine patients with an H. pylori-positive moderate or severe atrophic antral gastritis, six had S-G-17(prand) levels below 5 pmol/l. Similarly, S-PGI levels were significantly lower in patients with advanced corpus atrophy than in those without. Of the 45 patients with moderate or severe corpus atrophy in endoscopic biopsies, 35 patients had S-PGI levels < 25 microg/l. By using the cut-off levels for S-G-17(prand) and S-PGI with the best discrimination, the sensitivity and specificity of the blood test panel in delineation of patients with advanced atrophic gastritis (either in the antrum or the corpus, or both) were 83% and 95%, respectively. The predictive values of the positive and negative test results were 75% and 97%, respectively. In the diagnosis of atrophic gastritis, the application of S-G-17(fast) showed a slightly lower sensitivity and specificity than the application of S-G-17(prand) as a biomarker for antral atrophy. CONCLUSIONS: The diagnosis of atrophic gastritis obtained with the blood test panel of S-G-17, S-PGI and H. pylori antibodies is in good agreement with the endoscopic and biopsy findings. The panel is a tool for non-endoscopic diagnosis and screening of atrophic gastritis.

Adult↗

PubMed2002

Regulatory aspects of coenzyme Q metabolism.

A number of factors are involved in the regulation of the amount and distribution of coenzyme Q in cells and tissues. These factors modify preferentially the biosynthetic mechanism in order to keep up an optimal tissue concentration of the lipid. The amount of substrate provided by the mevalonate pathway is able to both up- and down-regulate the velocity of synthesis. At the translation level, regulation occurs by receptor-mediated ligand binding and appears most clearly upon treatment with hormones and peroxisomal inducers. There are a number of pathophysiological conditions when these mechanisms of regulation are modified and explain the decreased coenzyme Q tissue concentrations. It is of considerable interest to establish appropriate physiological, hormonal and drug-mediated conditions in order to counteract disturbed cellular functions caused by coenzyme Q deficiency

Aging↗

PubMed2000

Thymidine kinase gene therapy for human malignant glioma, using replication-deficient retroviruses or adenoviruses.

Herpes simplex virus thymidine kinase (HSV tk) gene therapy combined with ganciclovir (GCV) medication is a potential new method for the treatment of malignant glioma. We have used both retrovirus-packaging cells (PA317/tk) and adenoviruses (Adv/tk) for gene therapy for malignant glioma. Retrovirus-packaging cells were used for eight tumors in seven patients and adenoviruses were used for seven tumors in seven patients. As a control group, seven tumors in seven patients were transduced with lacZ marker gene 4-5 days before tumor resection. Safety and efficacy of the gene therapy were studied with clinical evaluation, blood and urine samples, MRI follow-up, and survival of the patients. Four patients with adenovirus injections had a significant increase in anti-adenovirus antibodies and two of them had a short-term fever reaction. Frequency of epileptic seizures increased in two patients. No other adverse events possibly related to gene therapy were detected. In the retrovirus group, all treated gliomas showed progression by MRI at the 3-month time point, whereas three of the seven patients treated with Adv/tk remained stable (p < 0.05). Mean survival times for retrovirus, adenovirus, and control groups were 7.4, 15.0, and 8. 3 months, respectively. The difference in the survival times between the adenovirus and retrovirus groups was significant (p < 0.012). It is concluded that HSV tk gene therapy is safe and well tolerated. On the basis of these results further trials are justified, especially with adenovirus vectors.

Adenoviridae↗

PubMed2000

Influence of peroxisome proliferator-activated receptor alpha on ubiquinone biosynthesis.

The control of ubiquinone biosynthesis by peroxisome proliferators was investigated using peroxisome proliferator activated receptor alpha (PPARalpha)-null mice. Administration of 2-(diethylhexyl)phthalate to control mice resulted in elevated ubiquinone levels in the liver, while dolichol, dolichyl-P and cholesterol concentrations remained unchanged. In PPARalpha-null mice, the level of these lipids were similar to control levels and administration of the peroxisome proliferator did not increase the levels of ubiquinone. The increase in ubiquinone levels was the result of increased synthesis. Induction was most pronounced in liver, kidney and heart, which have relatively high levels of PPARalpha. When the tissue concentration of hydrogen peroxide was elevated by inhibition of catalase activity with aminotriazole, the amount of ubiquinone was not increased, suggesting that the induction of ubiquinone synthesis occured through a direct mechanism. The activities of branch-point enzymes FPP-synthase, squalene synthase, cis-prenyltransferase, trans-prenyltransferase and NPHB-transferase were substantially increased in control but not in PPARalpha-null mice after treatment with peroxisome proliferators. These data suggest that the induction of ubiquinone biosynthesis after administration of peroxisome proliferators is dependent on the PPARalpha through regulation of some of the mevalonate pathway enzymes.

Alkyl and Aryl Transferases↗

PubMed2000

Radiobiological depth of subcutaneous induration.

The incidence of subcutaneous induration in 23 breast cancer patients with postmastectomy radiotherapy was investigated. The patients were treated with three different radiotherapy schedules 7. 9-9.8 years ago. The incidence was correlated with the biological effective dose (BED) at different depths from the skin surface and a best fit was obtained using an alpha/beta ratio of 2 Gy. The most representative depth at which to assess dose for subcutaneous induration was 2 mm which is near the subcutaneous fat/dermis interface.

Aged↗

PubMed2000

Needle design does not affect the success rate of spinal anaesthesia or the incidence of postpuncture complications in children.

BACKGROUND: In adults, pencil-point spinal needles are believed to be less traumatic and therefore to be superior compared to cutting-point needles with respect to success rate and postpuncture complications. The aim of this randomised, parallel groups and prospective study was to record the success rate and to evaluate the incidence of complications following spinal anaesthesia with the two types of needles in children. METHODS: We studied 215 children aged 1 to 18 years. A 25-gauge needle was used in children up to 7 years (n=96) and a 27-gauge needle in older children (n=119). During lumbar puncture with either a cutting-point (n=109) or a pencil-point (n=106) spinal needle, we recorded puncture characteristics and the success of cerebrospinal fluid (CSF) aspiration. Hyperbaric bupivacaine 5 mg ml(-1) at a dose of 0.3-0.4 mg kg(-1) was used for the spinal anaesthesia. The incidence of postdural puncture complications was recorded from diaries completed by the children and parents one week after the lumbar puncture. RESULTS: The success rate of the spinal anaesthesia was 97% without difference between the needles. The success rate was higher when the aspiration of CSF was easy compared to if it was difficult (98% vs. 88%, P=0.02). Two hundred and seven diaries were returned (97%). Twenty-four children developed a headache, 8 of which were classified as a postdural puncture headache (PDPH), 6 with the cutting-point needle and 2 with the pencil-point needle (n.s.). Nine children developed signs of transient radicular irritation with no difference between the needles. CONCLUSION: Both types of spinal needles can be used in children, and a free aspiration of CSF results in a high success rate of the spinal block. Postpuncture complications are as common in children as in adults.

Adolescent↗

PubMed2000

Herpes simplex virus thymidine kinase gene therapy in experimental rat BT4C glioma model: effect of the percentage of thymidine kinase-positive glioma cells on treatment effect, survival time, and tissue reactions.

Herpes simplex virus thymidine kinase (HSV-tk) gene transfer and ganciclovir (GCV) administration have been suggested for the treatment of malignant gliomas. To understand tissue responses and possible ways to improve the treatment effect, we studied tumor growth, tissue reactions, and survival time after HSV-tk/GCV treatment in a syngeneic BT4C rat glioma model by mixing various ratios of stably transfected HSV-tk-expressing BT4C-tk glioma cells with wild-type BT4C glioma cells (percentage of BT4C-tk cells: 0%, 1%, 10%, 30%, 50%, and 100%), followed by injection into BDIX rat brains (n = 79). With the exception of some animals with end-stage tumors, very little astroglia or microglia reactivity was detected in the wild-type tumors as analyzed by immunocytochemistry using glial fibrillary acid protein (GFAP)-, vimentin-, human histocompatibility leukocyte antigen-DR-, OX-42-, and CD68-specific monoclonal antibodies. After 14 days of GCV treatment, tumors induced with > or = 10% BT4C-tk cells showed a significant reduction in tumor size (P < .05) and prolonged survival time (P < .01). Astrogliosis, as indicated by a strong GFAP and vimentin immunoreactivity, was seen in the tumor scar area. GFAP and vimentin reactivity was already present after the GCV treatment in tumors induced with 1% BT4C-tk cells. Much less human histocompatibility leukocyte antigen-DR-positive microglia was seen in the treated animals, indicating low microglia reactivity and immunoactivation against the tumor. However, GCV-treated tumors were positive for apoptosis, indicating that apoptosis is an important mechanism for cell death in the BT4C-tk glioma model. Our results suggest that > or = 10% transfection efficiency is required for a successful reduction in BT4C glioma tumor size with HSV-tk/GCV treatment in vivo. Tissue reactions after 14 days of GCV treatment are characterized by astrogliosis and apoptosis, whereas microglia response and immunoactivation of the brain cells appear to play a minor role. Stimulation of the microglia response by gene transfer or other means might improve the efficacy of the HSV-tk/GCV treatment in vivo.

Animals↗

PubMed1999

Quantitative assessment of protein content in irradiated human skin.

PURPOSE: Radiation-induced fibrosis is a common late reaction of radiation therapy. Due to a lack of feasible noninvasive techniques to assess this reaction, the long-term development of radiation fibrosis is not well described. In order to develop quantitative means for the purpose, subcutaneous fibrosis of breast cancer patients after postmastectomy radiotherapy was evaluated by clinical scoring and a new technique based on dielectric properties of the skin. METHODS AND MATERIALS: Dielectric properties of biological tissues at radiofrequencies are principally determined by tissue water content. The major skin components are proteins, proteoglycans, and water either free or bound to the surface of proteins and proteoglycans. Since the MR studies have shown that bound water is tightly attached onto the surface of collagen, a dielectric measurement sensitive to bound water could be related to the protein content. Therefore, the dielectric constant of human skin was measured in vivo with an open-ended coaxial probe at electromagnetic (EM) frequencies in the range of delta-dispersion. Since the in vitro experiments with protein-water solutions have indicated that the slope of the dielectric constant vs. the EM frequency is a measure of the protein concentration, a respective slope was determined with irradiated skin of 14 breast cancer patients 2 years after postmastectomy radiotherapy at 63, 100, 300, and 500 MHz. Irradiated skin sites were clinically scored for subcutaneous fibrosis using a scale: none, slight, moderate, or severe fibrosis. RESULTS: A statistically significant correlation was found between the slope and the clinical score of subcutaneous fibrosis at 63, 100, and 300 MHz but not at 500 MHz. The correlation was best at 100 and 300 MHz. CONCLUSIONS: Considerable changes in the dielectric constant of the irradiated skin were found. The correlation between the dielectric constant and clinical score suggests that this novel technique is a potential tool for the follow-up and quantitative assessment of radiation-induced subcutaneous fibrosis.

Adult↗

PubMed1999

Induction of endogenous coenzyme Q biosynthesis by administration of peroxisomal inducers.

A large number of chemical compounds have been identified which cause peroxisomal proliferation and induce a number of enzymes, mainly those participating in lipid metabolism. Administration of these drugs/chemicals to rats increased coenzyme Q levels in the blood and most of the organs. Levels were raised in all cellular membranes of such organs. The extent of induction of this lipid was 8-fold in young animals but decreased during aging and was absent at 1.5 year of age. One of the regulating factors of the mevalonate pathway is farnesol, which is produced by dephosphorylation of farnesyl-PP and eliminated by phosphorylation including two kinases. Future research will involve a search for modified intermediary metabolites, which increase coenzyme Q synthesis and thereby efficiently elevate the level of this lipid in conditions of deficiency.

Aging↗

PubMed1999

Low efficacy of gene therapy for rat BT4C malignant glioma using intra-tumoural transduction with thymidine kinase retrovirus packaging cell injections and ganciclovir treatment.

BACKGROUND: The purpose of this study was to test the use of Herpes Simplex virus thymidine kinase (HSVtk) retrovirus packaging cell injections in the treatment of malignant brain tumours. METHODS: Therapeutic effect and tissue responses were examined in vivo in a syngeneic BT4C rat glioma model after HSVtk-producing PA317 packaging cell injections and intraperitoneal ganciclovir (GCV) medication. MRI was used to visualise the tumours before and after the treatment. Immunohistochemical stainings were performed to study astroglia and microglia responses and apoptosis-mediated cell death. RESULTS: The results suggest that only a limited treatment effect can be achieved with HSVtk packaging cell injections with no prolonged survival rates. Histological examination showed a strong astroglia response but only a modest microglia response after the treatment. HSVtk and GCV-induced cell death was at least partially mediated by apoptosis. It is concluded that HSVtk packaging cell injections and GCV treatment do not lead to eradication of malignant cells in a syngeneic BT4C rat glioma model. The lack of efficacy is most likely due to low gene transfer efficiency and limited life span of the injected packaging cell inside the tumours. CONCLUSIONS: Improvements in gene transfer efficiency, and stimulation of immunoresponse against tumour cells might lead to a more effective therapeutic response in vivo.

Animals↗

PubMed1999

The effects of UV exclusion on the soluble phenolics of young Scots pine seedlings in the subarctic.

The characteristics of UV-absorbing compounds, particularly soluble phenolics, were studied in needles of 63-day-old seed-grown Scots pine (Pinus sylvestris L.) seedlings of two provenances in a UV exclusion field experiment at Pallas-Ounastunturi National Park in Finnish Lapland (68 degrees N, 270 m a.s.l.). The experiment used the following plastic filters in exclosure treatments to manipulate the spectral balance of natural irradiance: (1) 'control' (a polyethene plastic filter); (2) 'UV-B exclusion' (a clear polyester filter); and (3) 'UV-B/UV-A exclusion' (a clear acryl plate). Polyethene transmitted 89% of the ambient levels of total UV (280-400 nm), polyester transmitted 75% of the total UV, but only 0.6% of the UV-B (280-315 nm) component, while acryl plate transmitted 0.2% of UV (280-360 nm). The research also included (4) 'Ambient' plants that were not subjected to any treatment exclosures. After the 58 day UV exclusion, significant (p<0.0001) differences due to treatments were determined for a kaempferol derivative, kaempferol 3-glucoside, and a quercetin derivative, the quantities of which ranged from 0.23 to 0.45, 0.42 to 1.34 and 0.39 to 0.75 micromol g FW(-1), respectively, depending on treatment and provenance. Overall, Scots pine seedlings grown at ambient UV radiation (PAS300, Caldwell's generalized Plant Action Spectrum (PAS) normalized at 300 nm, 72 mW m(-2)) or under a control had significantly (p<0.05) higher quantities of soluble phenolics than seedlings grown under UV-B or UV-B/UV-A exclusion treatments. There were no significant differences in the quantity of soluble phenolics between the two exclosure treatments or between the two Scots pine provenances. The sums of diacylated flavonol glucosides ranging from 3.75 to 4.55 micromol g FW(-1) depending on treatment and provenance, were already present at very low UV-levels under the UV-B/UV-A exclusion treatment. The present study indicated that soluble phenolics, particularly the diacylated flavonol glucosides, may provide an effective preformed protection for young Scots pine seedlings against UV-B and UV-A radiation.

Journal Article↗

PubMed1999

Blood concentration of coenzyme Q(10) increases in rats when esterified forms are administered.

Coenzyme Q levels decrease during aging in most tissues and in the target organs of a number of diseases. The uptake of this lipid into the blood and other tissues was investigated in 6-wk-old male Sprague-Dawley rats after 3 wk of dietary supplementation. In addition to the natural form of coenzyme Q(10), acetylated and succinylated forms were also administered. Coenzyme Q(10) was taken up into the blood, but uptake was significantly greater in rats given the succinylated ( approximately 40%), and particularly, the acetylated forms ( approximately 70%). All three forms increased significantly the total coenzyme Q concentration in both the liver ( approximately 100%) and spleen ( approximately 130%). Coenzyme Q(10) and its esterified forms were not taken up into kidney, heart, muscle or brain. Intraportal and intraperitoneal administration of succinylated coenzyme Q(10) gave results similar to those obtained in the dietary experiments. Uptake of the dietary coenzyme Q(10) into the liver and spleen did not down-regulate the endogenous synthesis, i.e., the amounts of isolated coenzyme Q(9) did not change in these tissues. Thus, esterification of coenzyme Q increases the uptake of dietary lipid into the blood; however, the derivatization does not contribute to the elevation of coenzyme Q levels in various organs.

Acetylation↗

PubMed1999

Analysis of macrophage scavenger receptor (SR-A) expression in human aortic atherosclerotic lesions.

The class A scavenger receptors (SR-As) are trimeric, integral membrane glycoproteins that exhibit unusually broad ligand-binding properties. A number of studies have suggested that these receptors may play an important role in host defense and in many macrophage-associated pathological processes, including atherosclerosis and Alzheimer's disease. The study of the expression and function of these receptors in human disease has been hampered by the lack of suitable antibodies recognizing human SR-A. This has generated questions regarding the nature of receptors responsible for scavenger receptor activity detected in a variety of cell types, including monocytes, macrophages, smooth muscle cells, and endothelial cells. To address these questions, we have produced high-titer antisera recognizing human SR-A by using mice deficient for SR-A (SR-A -/-). We show that SR-A -/- mice produce a significantly higher-titer immune response than do wild-type (SR-A +/+) littermates, with antisera of the former having a broad species reactivity and recognizing SR-A from humans, mice, and rabbits. The antisera recognize both type I and II SR-A in a wide range of immunological techniques. Using these antisera we show that the expression of SR-A protein is induced during monocyte to macrophage differentiation and that SR-A mediates 80% of the uptake of acetylated low density lipoprotein by human monocyte-derived macrophages. We also establish that human SR-A is expressed by tissue macrophages in liver and lung and by macrophage-derived foam cells within aortic atherosclerotic lesions, with little detectable expression by smooth muscle cells or aortic endothelium.

Actins↗

PubMed1998

Elevation of ubiquinone content by peroxisomal inducers in rat liver during aging.

The effect of di(2-ethylhexyl)phthalate (DEHP) on the induction of peroxisomes and the content of ubiquinone in the liver was studied in rats between 25 and 496 days of age. During this period, peroxisomal beta-oxidation of fatty acids was greatly decreased but it could be induced many-fold in all ages. The ubiquinone (UQ) content was increased upon induction 6-fold in the first weeks of life, but the extent of this elevation continuously narrowed and no induction could be observed in the oldest animals, even after prolonged treatment with the plasticizer. In contrast, the treatment decreased the amount of liver cholesterol in all age groups. Treatment with this peroxisomal inducer increased the biosynthesis of UQ while the breakdown rate was found to be unaffected, as the half-life of this lipid was 103 and 106 h in control and treated rats, respectively. These results indicate that treatment with peroxisomal inducers increases the liver UQ content by increasing the rate of biosynthesis and that this effect is not apparent in aged rats.

Aging↗

PubMed1998

A dielectric method for measuring early and late reactions in irradiated human skin.

BACKGROUND AND PURPOSE: To measure the dielectric constant of irradiated human skin in order to test the feasibility of the dielectric measurements in the quantitation of acute and late radiation reactions. MATERIALS AND METHODS: The dielectric constant of irradiated breast skin was measured at an electromagnetic frequency of 300 MHz in 21 patients during postmastectomy radiotherapy. The measurements were performed with an open-ended coaxial line reflection method. The irradiation technique consisted of an anterior photon field to the lymph nodes and a matched electron field to the chest wall using conventional fractionation of five fractions/week to 50 Gy. Fourteen out of the 21 patients were remeasured 2 years later and the skin was palpated for subcutaneous fibrosis. RESULTS: At 5 weeks the dielectric constant had decreased by 31 and 39% for the investigated skin sites of the photon and electron fields, respectively. There was a statistically significant inverse correlation between the mean dielectric constant and the clinical score of erythema. An unexpected finding was a decrease of the dielectric constant of the contralateral healthy skin during radiotherapy. Two years later a statistically significant positive correlation was found between the dielectric constant at the irradiated skin sites and the clinical score of subcutaneous fibrosis. CONCLUSIONS: Dielectric measurements non-invasively yield quantitative information concerning radiation-induced skin reactions.

Adult↗

PubMed1998

Pogosta disease: clinical observations during an outbreak in the province of North Karelia, Finland.

OBJECTIVE: To characterize the clinical picture of Pogosta disease. METHOD: The data of 73 patients who had had Pogosta disease in 1981 and who then had been seen by a local physician in North Karelia were analysed. RESULTS: The main manifestations were fever (23%), rash (88%) and joint symptoms (93%). The joint symptoms in some patients lasted for several months and were severe enough to cause immobilization. The clinical picture was identical in those patients who had a definite serological diagnosis and those who did not have a detectable antibody response. CONCLUSION: The symptoms of Sindbis virus-induced Pogosta discase consist of fever, rash and joint symptoms, whic may be severe and prolonged.

Adolescent↗

PubMed1998

Postdural puncture headache and transient neurologic symptoms in children after spinal anaesthesia using cutting and pencil point paediatric spinal needles.

BACKGROUND: In the last decade the use of spinal anaesthesia (SA) in paediatric anaesthesia has increased. In adults, pencil point spinal needles are supposed to be less traumatic and hence to be superior compared with cutting point needles in respect of postpuncture complaints. In children, the use of spinal needles with a special tip design have not been compared. The aim of this study was to study the clinical utility and postpuncture characteristics of four newly designed spinal needles in paediatric surgery. METHODS: In this open-randomised, parallel groups, prospective study we compared the puncture quality, success rate and postpuncture characteristics in 200 children aged 2 to 128 months. Two cutting point needles; a 50-mm-long 25G Quincke and a 25-mm-long 26G Atraucan were compared with two pencil point needles; a 37-mm-long 27G Whitacre and a 35-mm-long 24G Sprotte. The children were premedicated with oral diazepam and those anxious or uncomfortable after premedication were sedated with i.v. thiopentone or propofol. Bupivacaine 5 mg ml-1 0.3-0.5 mg kg-1 was used for the SA. RESULTS: The spinal puncture was successful with one or two skin punctures in 96% of children. The cutting point needles were easier to insert through the skin and ligaments (P = 0.001) but the pencil point needles gave a better (P = 0.001) indication of the dural passage. The success rate of the SA was 91% without differences between the needles. Five patients were given general anaesthesia and 13 children a single dose of i.v. fentanyl/sedative. The spinal block was completed in less than 3 min in 96% of the cases without differences between the needles. Seventeen children developed a headache, 10 of which were classified as a postdural puncture headache (PDPH), 3 with the Sprotte, 3 with the Quincke and 4 with the Atraucan needles. The youngest child developing PDPH was a 12-month-old boy. Eight of the PDPH were mild and 2 moderate. Ten children developed a low back pain, 2-3 in each study group. Three children in the pencil point groups developed signs of transient radicular irritation. CONCLUSION: SA using bupivacaine and the study needles produced smooth and safe anaesthesia for paediatric surgery with a high success rate. PDPH after SA is as common in children (5%) as in adults although most often mild and short lasting. SA using bupivacaine can cause transient radicular irritation.

Anesthesia, Spinal↗