[Measuring opening pressure in lumbar puncture--a new method]. / Bestimmung des Eröffnungsdruckes während der Lumbalpunktion--ein neues Verfahren.

Determination of the opening pressure (OP) during diagnostic lumbar puncture (LP) yields additional information that may impact on treatment and prognosis in disorders affecting the central nervous system (e.g. meningitis). Established methods contain systematic errors as well as risks to the patient. We therefore present a new procedure that allows measurement of the OP by timing the flow of cerebrospinal fluid through a capillary attached to an LP needle. A resistance located between needle and capillary slows down the flow of cerebrospinal fluid so that it becomes independent of the capillary forces acting on it. The time required for the fluid to travel between two marks on the capillary (defining a given volume) can be used to calculate the flow. Since the combined resistance of needle and resistance can be calibrated, the pressure driving the flow--in this case the opening pressure--can be calculated. A simple model was used to evaluate the impact of different resistances and different needles on OP determination. The effects of cellular elements and proteins in the CSF are discussed.

[Transcatheter occlusion of the persisting arterial duct]. / Der Verschluss des persistierenden Ductus arteriosus Botalli mittels Herzkathetertechnik.

BACKGROUND: Transcatheter occlusion of the persisting arterial duct (PDA) is feasible using different techniques like coil-embolization (CE), Rashkind PDA occluder (Rash), Amplatzer Duct Occluder (ADO). Comparative studies with this devices in relation to the size of the PDA and the device are missing. Aim of this study was to evaluate the different systems at the own patient population. PATIENTS AND METHODS: From 1993 to 12/2001 transcatheter occlusion was attempted in 92 patients aged 4,13 years (range 0,07 to 14,39 years) using CE, Rash or ADO. All patients received echocardiographic examinations 24 hours before and after intervention, after 3, 6, and 12 months and than yearly. RESULTS: 91/92 PDAs could be successfully closed by 97 interventions. There were 63 CE, 25 Rash and 9 ADO performed. Primary closure rate was 75 % for Rash, 80 % for ADO and 80,8 % for CE (n. s.) and after 6 months 88 % for Rash, 92,3 % for CE and 100 % for ADO (p < 0,001), although the size of the PDA increased significantly from CE (2,14 + 1,1 min) to Rash (3,2 +/- 1,3 min) to ADO (4,9 +/- 1,9 min) (p < 0.05). In 6/7 pts with residual shunts complete occlusion could be achieved by second intervention. CONCLUSION: In dependency of the size of the PDA and the right choice of the occluder almost all PDAs are closable with transcatheter techniques.