Postdural Puncture Headache: Incidence and Risk Factors in Children Following Intrathecal Chemotherapy

How to Cite this Article: Bani hashem A, Heydarian F, Gharavi M, Khoshnod M. Postdural Puncture Headache: Incidence and Risk Factors in Children FollowingIntrathecal Chemotherapy. Iranian Journal of Child Neurology 2012;6(1):19-22.ObjectiveTo evaluate the incidence and risk factors of development of postdural puncture headache in children who had intrathecal chemotherapy injection.Materials & MethodsTwo-hundred eighty patients (mean age, 7.23±3.92 years) who had intrathecal chemotherapy injection were studied prospectively during 2008-2009 in the pediatric ward of Dr. Sheikh hospital in Mashhad. Patients who had lumbar puncture for their chemotherapy drug injections were assessed daily for four days to detect postdural puncture headache.ResultsThere were 172 (61, 4%) male patients and the remainder were female. Postdural puncture headache was detected in 41 patients (14.6%). The body mass index did not show any significant difference between the two groups. Lumbar puncture (LP) attempts had a significant association with postdural puncture headache. The size and shape of the needle did not have a significant association with postdural puncture headache.ConclusionLP attempts have a significant relationship with postdural puncture headache. References:1. Bolder PM. Postlumbar puncture headache in pediatriconcology patients. Anesthesiology. 1986;65:696-8.2. Ozyalcin NS, Menda F. Regional anesthesia and analgesiaapplications in children and infants – II. Agri 2004;16:29-34, 37-42.3. Oilver A. Dural punctures in children: what should wedo? Paediatr Anaesth. 2002;12:473-7.4. Kokki H, Hendolin H, Turunen M. Postdural punctureheadache and transient neurologic symptoms in childrenafter spinal anaesthesia using cutting and pencil pointpaediatric spinal needles. Acta Anaesthesiol Scand1998;42:1076-82.5. Lowery S, Oliver A. Incidence of postdural punctureheadache backache following diagnostic therapeuticlumbar puncture using a 22G cutting spinal needle, andafter introduction of a 25G pencil point spinal needle.Pediatr Anesth. 2008;18:230-46. Apiliogulari S, Duman A, Gok F, Akilliouglu L.Spinal needle design and size affect the incidence ofposdural puncture headache in children. Pediatr Anesth2010;20:177-82.7. Kokki H, Heikkinen M, Turunen M. Needle design doesnot affect the success rate of spinal anaesthesia or theincidence of postpuncture complications in children. ActaAnaesthesiol Scand 2000;44:210-3.8. Hammond ER, Wang Z, Bhulani N, McArthur JC, LevyM. Needle Type and the risk of post-lumber punctureheadache in the outpatient neurology. Clin J Neurol Sci;306(2011):24-8.9. Lybecker H, Djernes M, Schimidt JF. Postdural punctureheadache (PDPH): onset, duration, severity and associatedsymptoms. An analysis of 75 consecutive patients withPDPH. Acta Anaesthesiol Scand 1995;39:605-12.10. Seeberger MD, Kaufman M, Staender S, Schneider M,Scheidegger D. Repeated dural punctures increase theincidence of postdural puncture headache. Anesth Analg1996;82:302-5.11. Thomas SR, Jamison DR, Muir KW. Randomizedcontrolled trial of atraumatic versus standard needles fordiagnostic lumbar puncture. BMJ 2000;3210:986-90.12. Strupp M, Schueler O, Straube A. Atroumatic Sprotteneedle reduces the incidence of post-lumbar punctureheadaches. Neurology 2001;57:2310-2.13. Kleyweg RP, Hetzberger LI, Carbat PA. Significantreduction in post-lumber puncture headache using an atraumatic needle. Cephalalgia 1998;18:635-7.14. Lybecker H, Moller JT, May O. Incidence and predictionof postural puncture headache. A prospective study of1021 spinal Anesthesias. Anesth Analg 1990;70:389-94.15. Helper S, Preston R. Postdural puncture headache andspinal needle design. Meta analyses. Anesthesiology1994:81:1376-83.16. Parker RK, White PF. A microscopic analysis of cutbevelversus pencil-point spinal needles. Anesth Analg1997;85:1101-4.17. Reina MA, de leon Casasola OA, Lopez A. An in vitrostudy of dural lesions produced by 25-gauge Quinckeand Whitacre needles evaluated by scanning electronmicroscopy. Reg Anesth Pain Med 2000;393-402

Mechanical and structural evaluation of friction stir welded 6061 aluminium alloy lap joints at different welding speeds

Lap joints of 6061-T6 aluminium alloy were produced by friction stir welding, and the influence of welding speed on their weld quality was investigated in terms of welding defects, micro- and macrostructures, hardness distribution, and tensile properties as well as effective plate thickness (EPT) by applying the welding speed in the range 20–60 mm min–1 at constant rotation speed of 1000 rpm. The results showed that although tensile shear strength, joint efficiency, and microhardness of the weld nugget zone (WNZ) rather than the heat affected zone (HAZ), and the EPT increased with an increase in welding speed, the average grain size in the WNZ rather than the HAZ decreased. Due to increasing welding speed, the hooking and thinning defects were gradually restricted from the WNZ to the WNZ/TMAZ interface. The fracture mode within the highest tensile shear strength joints was denoted as plate separation along the hook throughout the stir zone

Investigation of microstructure and mechanical properties of friction stir lap welded AA6061-T6 in various welding speeds

Friction stir welding of Aluminum alloys has been increasingly used in the industry on the ground of higher welding quality in comparison with conventional methods. However, not enough studies have been done on a lap joint of AA 6061-T6 which widely been used in aerospace industries. In this article, friction stir lap welding of 6061-T6 aluminium alloy with 5 mm thickness was carried out by using various welding speeds. The effect of welding speed on microstructure, lap shear performance, micro hardness, failure mode and effective plate thickness was investigated. Results showed that tensile shear strength of weld increased by the rising welding speed. Rising welding speed caused hooking and thinning approaches to two plate interfaces which in turn concluding in higher tensile shear strength. The fracture surface of welds was analyzed by field emission scanning electron microscopy (FE-SEM). Study of the fracture surface of the nugget zone by EDX indicated the Fe compounds in that region

Corrosion behavior of friction stir welded lap joints of AA6061-T6 aluminum alloy

In this work, the corrosion behaviors of friction-stir lap welding of 6061-T6 Al-alloy are studied. The friction-stir lap welding was performed under different welding conditions (rotation speed and welding speed). The corrosion behavior of the parent alloy, the weld nugget zone (WNZ), and the heat affected zone (HAZ) of each welded sample working as an electrode, were investigated by the Tafel polarization test in 3.5 wt. (%) NaCl at ambient temperature. The morphology of the corroded surface of each region was analyzed by scanning electron microscopy together with energy dispersive spectroscopy (SEM-EDS). The results showed that the corrosion resistance of the parent alloy was better than the WNZ and the HAZ in both welding conditions. Localized pit dissolution and intergranular corrosion were the dominant corrosion types observed in the parent alloy, WNZ, and HAZ. The parent alloy, WNZ, and HAZ exhibited similar corrosion potentials (Ecorr) after T6 heat treatment. This treatment had a better effect on the corrosion resistance of the welded regions than the parent alloy

Renal Function and Risk Factors of Moderate to Severe Chronic Kidney Disease in Golestan Province, Northeast of Iran

Introduction: The incidence of end-stage renal disease is increasing worldwide. Earlier studies reported high prevalence rates of obesity and hypertension, two major risk factors of chronic kidney disease (CKD), in Golestan Province, Iran. We aimed to investigate prevalence of moderate to severe CKD and its risk factors in the region. Methods: Questionnaire data and blood samples were collected from 3591 participants (≥18 years old) from the general population. Based on serum creatinine levels, glomerular filtration rate (GFR) was estimated. Results: High body mass index (BMI) was common: 35.0 of participants were overweight (BMI 25-29.9) and 24.5 were obese (BMI ≥30). Prevalence of CKD stages 3 to 5 (CKD-S3-5), i.e., GFR <60 mL/min/1.73 m2, was 4.6. The odds ratio (OR) and 95 confidence interval (95 CI) for the risk of CKD-S3-5 associated with every year increase in age was 1.13 (1.11- 1.15). Men were at lower risk of CKD-S3-5 than women (OR = 0.28; 95 CI 0.18-0.45). Obesity (OR = 1.78; 95 CI 1.04-3.05) and self-reported diabetes (OR = 1.70; 95 CI 1.00-2.86), hypertension (OR = 3.16; 95 CI 2.02-4.95), ischemic heart disease (OR = 2.73; 95 CI 1.55-4.81), and myocardial infarction (OR = 2.69; 95 CI 1.14-6.32) were associated with increased risk of CKD-S3-5 in the models adjusted for age and sex. The association persisted for self-reported hypertension even after adjustments for BMI and history of diabetes (OR = 2.85; 95 CI 1.77-4.59). Conclusion: A considerable proportion of inhabitants in Golestan have CKD-S3-5. Screening of individuals with major risk factors of CKD, in order to early detection and treatment of impaired renal function, may be plausible. Further studies on optimal risk prediction of future end-stage renal disease and effectiveness of any screening program are warranted. © 2010 Najafi et al

Corrosion behaviour of friction stir welded lap joints of 6061-t6 aluminum alloy

Friction stir welding (FSW) process is an emerging ―green‖ solid-state method in which is accepted as a favourable joining method for aluminium alloys and other engineering materials. The joining of metal plates is done at below their melting point temperature and based on a thermo-mechanical action used by a non-consumable welding tool onto metal plates. However, the microstructure of aluminium alloy and chemistry as well as dimension and distribution of the intermetallic particles in the matrix of aluminium alloy may be modified owing to heat generated and severe plastic deformation during the welding process. Accordingly, mechanical and corrosion properties of weldments can be changed after welding as opposed to the parent alloy. In this work, lap-welded joints of 6061-T6 aluminium alloy were produced by FSW, and the influence of process parameters on their welds quality of weldments in terms of welding defects, microstructure, hardness distribution, and tensile properties as well as effective plate thickness (EPT) by applying the rotation speed and welding speed in the range of 900-1200 rpm and 20-60 mm/min, respectively, have been investigated using visual inspection, CT-scan, optical microscopy, scanning electron microscopy (SEM) equipped with energy dispersive x-ray (EDX) facilities, and mechanical test such as microhardness test and lap shear tensile test on the lap-welded joints, as the first and second objectives. The welding results obtained showed that among all the welding conditions, two welding conditions including 1000 rpm–60 mm/min and 900 rpm-40 mm/min were acceptable and desirable weldments with the highest mechanical properties. Thus, corrosion behaviour of acceptable welded lap joints, which was marked as FSLW 1 with 1000 rpm–60 mm/min and FSLW 2 with 900 rpm-40 mm/min welding conditions, has been evaluated as the third objective by potentiodynamic polarization (Tafel and cyclic polarization) and Intergranular corrosion (IGC) tests as well as ex-situ SEM and atomic force microscopy (AFM) examinations. The IGC test results showed that Intergranular corrosion resistance of heat effect zone (HAZ) was poor compared to weld nugget zone (WNZ) in FSLW 1 and FSLW 2 samples. Tafel polarization test revealed that the corrosion resistance of parent alloy (PA) was higher than the weld regions in FSLW 1 and FSLW 2 samples. The PA, WNZ, and HAZ represented similar corrosion potential values after heat treatment (T6). Cyclic polarization test results for both FSLW 1 and FSLW 2 samples were good agreement with the previous results from the Tafel polarization test. Corrosion behaviour of different positions (top and bottom) of weld nugget zone revealed that the corrosion resistance of the top nugget zone was higher than that of bottom and parent alloy in both FSLW 1 and FSLW 2 samples. Finally, from these results, it is found that the welding process has a major effect on corrosion resistance of weld regions, which is attributed to the breaking down and dissolution of intermetallic particles

Corrosion behavior of Al6061 alloy weldment produced by friction stir welding process

In this work, the corrosion behavior of welded lap joints of AA6061-T6 aluminum alloy produced by friction stir welding process has been investigated. Corrosion properties of welded lap joints were studied by cyclic polarization and electrochemical impedance spectroscopy tests. All tests were performed in an aerated 0.6 mol L−1 NaCl aqueous solution with pH = 6.5 at a temperature of 30 °C to characterize corrosion morphology and realize corrosion features of weld regions as opposed to the parent alloy. The microstructure of weld nugget (WN), heated affected zone (HAZ), and parent alloy were analyzed using scanning electron microscopy and energy dispersive spectroscopy. The experimental results indicated that the welding process has a major effect on the corrosion resistance, which possibly associated to the break-down and dissolution of intermetallic particles. It is supposed that an increasing in intermetallic distributed throughout the matrix of weld regions increases the galvanic corrosion couples. Furthermore, by decreasing the grain size in the weld regions, the susceptibility to corrosion is enhanced. The pitting corrosion and intergranular attack are the dominant corrosion types in the weld regions and the parent alloy