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[Celiac plexus block. Modeling study using images of computerized tomography].

To determine possible risks of the blind approach to the coeliac plexus, a method for simulating Bridenbaugh's "blind" coeliac plexus block by CT slices and scoutviews was employed. This mathematical simulation of the blind approach to the coeliac plexus was applied to CT images of 50 patients suspected of upper abdominal tumours. This simulation revealed that the following organs would have been punctured inadvertently: Spinal nerves, liver, kidney, aorta, aortic wall, pancreas, lymphomas. The total percentage of misdirected punctures according to this simulation would have been 41%. The importance of the coeliac plexus block in patients with chronic pain is stressed. Literature studies and the results of the present study indicate that CT-guided or ultrasound-guided techniques should be preferred in coeliac plexus block whenever the facilities are available.

Abdominal Neoplasms↗

Intraspinal and intracranial hemorrhage after lumbar puncture.

Two cases of spinal epidural hematoma and two cases of intracranial subdural hematoma after lumbar puncture (LP) are reported in children receiving chemotherapy for acute lymphoblastic leukemia and non-Hodgkin lymphoma. The bleeding was asymptomatic but interfered with treatment in one case, and caused either severe backache or headache but no neurological deficit in the other three patients. The platelet counts were 8 and 46 x 10(9)/L in two patients and were normal in the other patients at the time of LP. All recovered without surgical treatment. There is an inherent, albeit uncommon, risk of bleeding into the central nervous system associated with LP in children with cancer and should be distinguished from postdural puncture headache (PDPH). Thrombocytopenia is not always an accompanying factor.

Adolescent↗