Safety and Cost-Effectiveness of a Simplified Method for Lumbar Puncture in Patients with Hematologic Malignancies

Flores-Jiménez, Juan Antonio; Gutiérrez-Aguirre, César Homero; Cantú-Rodrı́guez, Olga Graciela; Jaime‐Pérez, José Carlos; González-Llano, Óscar; Sánchez-Cárdenas, Mónica; Sosa-Cortez, Ana Cecilia; Gómez‐Almaguer, David

doi:10.1159/000363405

Cited by 5 publications

(3 citation statements)

References 31 publications

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“…Although LP is a routine procedure in hematology, it is sometimes difficult to carry out, requiring repeated attempts, even when performed by experienced physicians 11 . ALL and some lymphomas require periodic LP during treatment 12 , 13 , and increased risk of CNS relapse in adults with ALL sustaining a traumatic lumbar puncture (TLP) has been reported 14 .…”

Section: Introductionmentioning

confidence: 99%

Impact of Obesity on Lumbar Puncture Outcomes in Adults with Acute Lymphoblastic Leukemia and Lymphoma: Experience at an Academic Reference Center

Jaime‐Pérez

Sotomayor-Duque

Aguilar-Calderón

et al. 2019

IJHOSCR

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Background: Lumbar puncture (LP) is a hematology procedure that can require repeated attempts leading to traumatic LP (TLP), which has been related to the central nervous system (CNS) relapse. LP success can depend on the size and anatomy of the patient and the skill of the hematologist. The main objective was to determine the influence of body mass index (BMI) on LP outcomes. Materials and Methods: Adults with lymphoid malignancies requiring LP were included prospectively over one year; hematology residents performed most procedures. A 22-gauge Quincke needle was employed. Comparison between non-traumatic vs. traumatic LPs according to BMI, CNS relapse, and residents’ year was performed. Results: Fifty-four patients with a mean age of 31.5±15.57 years were included. Diagnosis was Acute Lymphoblastic Leukemia-B (74%), Acute Lymphoblastic Leukemia-T (13%) and Non-Hodgkin Lymphoma (13%). 227 LPs were performed, 121 (53.3%) successful, 98 (43.2%) traumatic, 11 (11.2%) TLPs were macroscopically detectable and 87 (88%) microscopic; 8 (3.5%) were dry-taps. Median time between punctures was 11 days (1-202). Median BMI was 25 (22.8-39.6). Main indication for LP was prophylactic (74.5%); 39.2% were performed by first-year, 35.2% by second-year, 19.6% by third-year hematology residents. No difference (p = 0.145) for a TLP was found among residents. A BMI ≥30 (p = 0.040), non-palpable intervertebral space (p = 0.001) and more than one attempt (p = 0.001) were significant for TLP. TLP was not associated with CNS relapse (p = 0.962). Conclusion: Obesity predicted a TLP. A traumatic puncture did not increase the risk of CNS relapse at one-year follow-up.

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Section: Introductionmentioning

confidence: 99%

Impact of Obesity on Lumbar Puncture Outcomes in Adults with Acute Lymphoblastic Leukemia and Lymphoma: Experience at an Academic Reference Center

Jaime‐Pérez

Sotomayor-Duque

Aguilar-Calderón

et al. 2019

IJHOSCR

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“…2,[16][17][18][19][20][21][22] A successful first attempt would be crucial since performing LP properly with a single skin penetration contributes to the lower incidence of TLPs in adults. 16,17,26,28 A preceding TLP increases not only the probability of a TLP in the successive LP procedure but also the risk of post-dural puncture headache (PDPH). 16 PDPH is among the most common complications of the LP procedure, which causes notable, post-procedural discomfort to the patient for several days, affecting from 3.5% to 33% of patients of all ages.…”

Section: Discussionmentioning

confidence: 99%

Incidence of traumatic lumbar punctures in adults: the impact of a patient's first procedure

Sievänen¹,

Kari²,

Eskola

et al. 2023

Clinical Medicine

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“…Rare complications are brain herniation, cardiorespiratory compromise, local or referred pain, hemorrhage, subarachnoid epidermoid cyst, and CSF leak. Serious adverse events caused by infectious agents (e.g., meningitis) occur in <1% (70). When comparing the medical risks and the financial cost with the benefits of routine lumbar puncture in psychotic patients, the benefits overweigh, especially since CSF analysis offers the possibility for an effective, causal treatment.…”

Section: Ethical Issues Of the Mild Encephalitis Hypothesismentioning

confidence: 99%

Ethical Implications of the Mild Encephalitis Hypothesis of Schizophrenia

Müller

2017

Front. Psychiatry

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Schizophrenia is a serious mental disease with a high mortality rate and severe social consequences. Due to insufficient knowledge about its etiopathogenesis, curative treatments are not available. One of the most promising new research concepts is the mild encephalitis hypothesis of schizophrenia, developed mainly by Karl Bechter and Norbert Müller. According to this hypothesis, a significant subgroup of schizophrenia patients suffer from a mild, but chronic, form of encephalitis with markedly different etiologies ranging from viral infections, traumas to autoimmune diseases. This inflammatory process is thought to occur in the beginning or during the course of the disease. In this article, we investigate the consequences of the mild encephalitis hypothesis of schizophrenia for the scientific community, and evaluate these consequences ethically. The mild encephalitis hypothesis implies that schizophrenia would no longer be considered an incurable psychiatric disorder. Instead, it would be considered a chronic, but treatable, neurological disease. This paradigm shift would doubtlessly have significant consequences: (1) major reforms would be necessary in the theoretical conceptualization of schizophrenia, which would challenge the psychiatric diagnostic systems, Diagnostic and Statistical Manual of Mental Disorders version 5 and ICD-10. (2) Psychotic patients should be treated in interdisciplinary teams, optimally in neuropsychiatric units; additionally, specialists for endocrinology, diabetology, and cardiology should be consulted for the frequently occuring somatic comorbidities. (3) Current diagnostic procedures and (4) therapies would have to be modified significantly. (5) There might be repercussions for the pharmaceutical industry as well: first, because old drugs with expired patent protection could partly replace expensive drugs and, second, because there would be a demand for the development of new anti-inflammatory drugs. (6) Legal evaluation of compulsory treatment orders might have to be reconsidered in light of causal therapies; leading to increased legal approval and reduced need for compulsory treatment orders due to better patient compliance. (7) The social inclusion of patients might improve, if treatment became more effective regarding cognitive and social functioning. (8) The stigmatization of patients and their relatives might decrease.

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Safety and Cost-Effectiveness of a Simplified Method for Lumbar Puncture in Patients with Hematologic Malignancies

Cited by 5 publications

References 31 publications

Impact of Obesity on Lumbar Puncture Outcomes in Adults with Acute Lymphoblastic Leukemia and Lymphoma: Experience at an Academic Reference Center

Impact of Obesity on Lumbar Puncture Outcomes in Adults with Acute Lymphoblastic Leukemia and Lymphoma: Experience at an Academic Reference Center

Incidence of traumatic lumbar punctures in adults: the impact of a patient's first procedure

Ethical Implications of the Mild Encephalitis Hypothesis of Schizophrenia

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