Factors Affecting Post-Lumbar Puncture Back Pain in Children

PURPOSE: Lumbar puncture is an essential and commonly practiced diagnostic tool and post-lumbar puncture headache and post-lumbar puncture back pain are common neurological complications. The aim of this study is to identify the factors that might cause post-lumbar puncture back pain and to reduce those complaints by eliminating the causes. METHODS: From June 5, 2013 to July 29, 2013, we studied 155 patients, male and female between the age 1 and 18,who received diagnostic or therapeutic lumbar puncture at Pusan National University Hospital and Pusan National University Yangsan Hospital. We collected data of variable aspects that may influence post-lumbar puncture back pain, by reviewing the medical records retrospectively. The independent variables were sex, age, symptoms, diagnosis, number of trials to successful lumbar puncture, year of the resident who carried out the procedure, opening pressure of cerebrospinal fluid(CSF), spinal level of punctured site, duration of strict bed rest, and use of sedatives for the procedure. RESULTS: Among the 155 patients whounderwent lumbar puncture, 36 (23.2%) experienced back pain after the procedure. Back pain subsided within 48hours in 24 ofthe 36 patients. Only one patient suffered from post-lumbar puncture back pain for more than 5days. There is no clear causality between the occurrence rate of post-lumbar puncture back pain and the independent variables which includeage, sex, duration of bed rest, symptoms, diagnosis, number of trials, skill, opening pressure, anatomic location, and use of sedatives. CONCLUSION: Back pain was a frequent complication of lumbar puncture. Various factors we expected to influence on the incidence of post-lumbar puncture back pain had no statistical significance. Further studies should be performed to investigate the causes and risk factors of post-lumbar puncture back pain.

Significance of serum total bilirubin as a prognostic factor for hemophagocytic lymphohistiocytosis in childhood / 영남의대학술지

BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease. Despite of proper treatment and improving treatment regimens, HLH patients still show a fatal prognosis. Therefore the evaluation of prognostic factor is important and there are many studies about hyperbilirubinemia as a prognostic factor in HLH. So we studied the prognostic value of hyperbilirubinemia in HLH children. METHODS: A retrospective analysis was performed about 33 patients who were diagnosed with HLH at Pusan National University Hospital and Yangsan Pusan University Hospital between January 2000 to December 2012. We reviewed the clinical characteristics, laboratory findings, and results of treatment to identify hyperbilirubinemia as a prognostic factor in HLH patients. RESULTS: The median age of patients at diagnosis was 32 months. Most of patients presented with fever, pale appearance, abdominal pain and jaundice. Forty-eight point five percentage of patients showed normal serum bilirubiln level ( or =2.0 mg/dL). In normal serum bilirubin group, 1 patient (6.3%) was relapsed and 1 patient (5.9%) was relapsed in hyperbilirubinemia group. In the hyperbilirubinemia group, the mortality was higher than the normal bilirubin group but, there was no statistical significance. CONCLUSION: As a prognostic factor serum bilirubin at diagnosis in HLH patients, there was no significant correlation between hyperbilirubinemia and poor outcome. But, our study has a limitation that the number of patients is too small and almost showed good prognosis.