Fibrous Mass Complicating Epidural Morphine Infusion

Neurosurgery ◽  
1985 ◽  
Vol 16 (1) ◽  
pp. 68-70 ◽  
Author(s):  
Bruce A. Rodan ◽  
Fred L. Cohen ◽  
William J. Bean ◽  
Stephen N. Martyak
Keyword(s):  
Computed Tomography ◽  
Drug Toxicity ◽  
Epidural Morphine ◽  
Surgical Decompression ◽  
Morphine Infusion ◽  
Pump Delivery ◽  
Catheter Tip ◽  
Surgical Implantation ◽  
Intractable Cancer Pain ◽  
Fibrous Reaction

Abstract The benefits of continuous epidural morphine infusion using an implanted pump delivery system to control intractable cancer pain have recently been described. Most articles on this subject relate to dosage, technique, degree of pain relief, and tolerance. There are some anticipated complications of the treatment related to the surgical implantation of the system and drug toxicity. We present a complication presumably related to the epidural catheter. A fibrous reaction that developed around the catheter tip progressed into a mass. This caused a significant displacement of the spinal cord with the development of long tract symptoms. Identification of this abnormality using myelography and computed tomography led to prompt surgical decompression resulting in improvement of the patient's condition. (Neurosurgery 16:68–70, 1985)

Spinal Epidural Compression Secondary to Osteoblastic Metastatic Vertebral Expansion

Neurosurgery ◽  
1988 ◽  
Vol 23 (5) ◽  
pp. 662-665 ◽  
Author(s):  
Alan Hirschfeld ◽  
William Beutler ◽  
Juliet Seigle ◽  
Herbert Manz
Keyword(s):  
Computed Tomography ◽  
Radiation Therapy ◽  
Spinal Canal ◽  
Surgical Decompression ◽  
The Other ◽  
Precise Nature ◽  
Osteoblastic Metastasis ◽  
Neurological Improvement ◽  
Epidural Compression ◽  
Spinal Epidural

Abstract We present two cases in which spinal epidural compression was caused by the expansion of bony elements into the spinal canal as a result of osteoblastic metastases. The precise nature of the compression was appreciated only on computed tomography. One patient had immediate and sustained neurological improvement after laminectomy. The other benefited temporarily, but widespread involvement of his spine ultimately led to paraplegia despite two more decompressive procedures. We think that bony expansion of the spine secondary to osteoblastic metastasis is not reversible with radiation therapy alone and is, therefore, an absolute indication for surgical decompression.

Central venous catheterization for acute trauma resuscitation: Tip position analysis using routine emergency computed tomography

2018 ◽  
Vol 19 (5) ◽  
pp. 461-466 ◽  
Author(s):  
Manuel F Struck ◽  
Sebastian Ewens ◽  
Wolfram Schummer ◽  
Thilo Busch ◽  
Michael Bernhard ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Central Venous Catheter ◽  
Injury Severity ◽  
Venous Catheter ◽  
Trauma Patients ◽  
Trauma Resuscitation ◽  
Central Venous ◽  
Catheter Tip ◽  
Tip Position ◽  
Multiple Trauma Patients

Purpose: Central venous catheter insertion for acute trauma resuscitation may be associated with mechanical complications, but studies on the exact central venous catheter tip positions are not available. The goal of the study was to analyze central venous catheter tip positions using routine emergency computed tomography. Methods: Consecutive acute multiple trauma patients requiring large-bore thoracocervical central venous catheters in the resuscitation room of a university hospital were enrolled retrospectively from 2010 to 2015. Patients who received a routine emergency chest computed tomography were analyzed regarding central venous catheter tip position. The central venous catheter tip position was defined as correct if the catheter tip was placed less than 1 cm inside the right atrium relative to the cavoatrial junction, and the simultaneous angle of the central venous catheter tip compared with the lateral border of the superior vena cava was below 40°. Results: During the 6-year study period, 97 patients were analyzed for the central venous catheter tip position in computed tomography. Malpositions were observed in 29 patients (29.9%). Patients with malpositioned central venous catheters presented with a higher rate of shock (systolic blood pressure <90 mmHg) at admission (58.6% vs 33.8%, p = 0.023) and a higher mean injury severity score (38.5 ± 15.7 vs 31.6 ± 11.8, p = 0.041) compared with patients with correctly positioned central venous catheter tips. Logistic regression revealed injury severity score as a significant predictor for central venous catheter malposition (odds ratio = 1.039, 95% confidence interval = 1.005–1.074, p = 0.024). Conclusion: Multiple trauma patients who underwent emergency central venous catheter placement by experienced anesthetists presented with considerable tip malposition in computed tomography, which was significantly associated with a higher injury severity.

A comparison of low-dose epidural morphine-bupivacaine infusion with low-dose morphine infusion

1996 ◽  
Vol 13 (2) ◽  
pp. 196-197
Author(s):  
D. Erdem ◽  
E. Erdem ◽  
N. Çanakçi ◽  
F. Tüzüner
Keyword(s):  
Epidural Morphine ◽  
Low Dose ◽  
Morphine Infusion

scholarly journals Huge abdominal cerebrospinal fluid pseudocyst following ventriculoperitoneal shunt: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Yasuhiro Koide ◽  
Takaaki Osako ◽  
Masahiro Kameda ◽  
Hiromi Ihoriya ◽  
Hirotsugu Yamamoto ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Abdominal Mass ◽  
Shunt Catheter ◽  
Ventriculoperitoneal Shunting ◽  
Distal Side ◽  
Old Japanese ◽  
Cerebral Computed Tomography ◽  
Catheter Tip

Abstract Introduction Abdominal pseudocysts comprising cerebrospinal fluid are an uncommon but significant complication in patients with ventriculoperitoneal shunt. We present a successfully treated 12-year-old boy with a history of ventriculoperitoneal shunting and a huge abdominal cerebrospinal fluid pseudocyst. Case presentation A12-year-old Japanese boy presented with a deteriorated consciousness and a palpable and elastic large lower abdominal mass. Computed tomography of his abdomen demonstrated a collection of homogenous low-density fluid near the catheter tip of the ventriculoperitoneal shunt. Cerebral computed tomography revealed an increased ventricular size. Based on the clinical diagnosis of abdominal pseudocyst, the peritoneal shunt catheter was secured and divided into two parts by cutting it on the chest; then, the proximal side of the peritoneal shunt catheter was externalized for extraventricular drainage. The cyst was percutaneously aspirated with ultrasound guidance, and the distal side of the peritoneal shunt catheter was removed. The distal side of the peritoneal shunt catheter was reinserted in another position into his abdomen after 3-week extraventricular drainage management. Conclusion Emergency physicians should know about this potential complication as an important differential diagnosis resulting from acute abdominal complaints in patients with ventriculoperitoneal shunts.

Intrathecal Catheterization and Drug Delivery in Guinea Pigs

2016 ◽  
Vol 125 (2) ◽  
pp. 378-394 ◽  
Author(s):  
Kelly A. Eddinger ◽  
Eric S. Rondon ◽  
Veronica I. Shubayev ◽  
Marjorie R. Grafe ◽  
Miriam Scadeng ◽  
...  
Keyword(s):  
Animal Model ◽  
Guinea Pigs ◽  
Ex Vivo ◽  
Intrathecal Morphine ◽  
Small Animal ◽  
Thermal Stimulus ◽  
Small Animal Model ◽  
Morphine Infusion ◽  
Catheter Tip ◽  
Intrathecal Infusion

Abstract Background Intrathecal infusion of opioids in dogs, sheep, and humans produces local space-occupying masses. To develop a small-animal model, the authors examined effects of intrathecal catheterization and morphine infusion in guinea pigs. Methods Under isoflurane, polyethylene or polyurethane catheters were advanced from the cisterna magna to the lumbar enlargement. Drugs were delivered as a bolus through the externalized catheter or continuously by subcutaneous minipumps. Hind paw withdrawal to a thermal stimulus was assessed. Spinal histopathology was systematically assessed in a blinded fashion. To assist in determining catheter placement, ex vivo images were obtained using magnetic resonance imaging in several animals. Canine spinal tissue from previous intrathecal morphine studies was analyzed in parallel. Results (1) Polyethylene (n = 30) and polyurethane (n = 25) catheters were implanted in the lumbar intrathecal space. (2) Bolus intrathecal morphine produced a dose-dependent (20 to 40 μg/10 μl) increase in thermal escape latencies. (3) Absent infusion, a catheter-associated distortion of the spinal cord and a fibrotic investment were noted along the catheter tract (polyethylene &gt; polyurethane). (4) Intrathecal morphine infusion (25 mg/ml/0.5 μl/h for 14 days) resulted in intrathecal masses (fibroblasts, interspersed collagen, lymphocytes, and macrophages) arising from meninges proximal to the catheter tip in both polyethylene- and polyurethane-catheterized animals. This closely resembles mass histopathology from intrathecal morphine canine studies. Conclusions Continuous intrathecal infusion of morphine leads to pericatheter masses that morphologically resemble those observed in dogs and humans. This small-animal model may be useful for studying spinal drug toxicology in general and the biology of intrathecal granuloma formation in particular.

Dural Plasmacytoma

Neurosurgery ◽  
1983 ◽  
Vol 12 (5) ◽  
pp. 576-579 ◽  
Author(s):  
Paul B. Pritchard ◽  
Robert A. Martinez ◽  
Douglas G. Hungerford ◽  
James M. Powers ◽  
Phanor L. Perot
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Immunoglobulin G ◽  
Unique Feature ◽  
Local Treatment ◽  
Clinical Findings ◽  
Clinical Syndrome ◽  
Surgical Decompression ◽  
Tentorium Cerebelli ◽  
Neurological Signs

Abstract Dural plasmacytoma is an unusual form of myeloma. We describe a woman with plasmacytoma of the tentorium cerebelli that was managed successfully with surgical decompression and radiotherapy. Computed tomography, not previously reported in cases of dural plasmacytoma, was useful in her management. Another unique feature was the restoration of a normal immunoglobulin G content in the blood and cerebrospinal fluid after local treatment of the neoplasm. Two previously reported cases showed similar normalization of cerebrospinal fluid immunoglobulin G after local radiotherapy. Dural plasmacytoma presents a characteristic clinical syndrome. The typical patient is a woman (92% of the reported cases) in the 5th decade of life. Clinical findings reflect intracranial hypertension, often with focal neurological signs, consistent with the usual dural or tentorial origin of the tumor. Immunoglobulin abnormalities may be found in serum or cerebrospinal fluid. The prognosis is good after surgical decompression and local radiotherapy.

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