Oxcarbazepine adjunctive therapy in infants and young children with partial seizures

OBJECTIVE

To evaluate the efficacy, safety, and pharmacokinetics of oxcarbazepine as adjunctive therapy in infants and young children (1 month to < 4 years).

METHODS

Children 1 month to < 4 years of age with inadequately controlled partial seizures taking up to two concomitant antiepileptic drugs (AEDs) were enrolled in this rater-blind, randomized, parallel-group study. Patients received either high-dose (60 mg/kg/day) or low-dose (10 mg/kg/day) oxcarbazepine as oral suspension. The primary efficacy variable was the absolute change in electrographic partial seizures with a behavioral correlate (type 1 seizure) frequency per 24 hours during the last 72 hours of continuous video-EEG monitoring in the treatment phase compared with baseline seizure frequency.

RESULTS

Of 191 patients screened, 128 were randomized: 64 to both oxcarbazepine dose groups. The median absolute change in type 1 seizure frequency per 24 hours was more effective for the high-dose group (-2.00) compared with the low-dose group (-1.37; p = 0.043). The median percentage reduction in type 1 seizure frequency per 24 hours was also greater in the high-dose group (83.33%) than in the low-dose group (46.18%; p = 0.047). The most frequent adverse events (> or = 10%) were somnolence and pyrexia, and most were mild in severity.

CONCLUSIONS

In this study, high-dose oxcarbazepine was significantly more effective than low-dose oxcarbazepine in controlling partial seizures in infants and very young children.

Can a living kidney donor become a kidney recipient?

The living kidney donor represents a good resource for kidney transplantation. These grafts display better function and long-term graft survival at 5 and 10 years of follow-up. Furthermore, living donors prefer the possibility to increase kidney donation for a large waiting list of patients with end-stage renal disease (ESRD). However, kidney donation is a major surgical procedure associated with benefits and risks. The risks of donation have been studied in large series of living donors to focus on morbidity and mortality rates associated with the surgical procedure. New surgical laparoscopic techniques promote living kidney donation. While the benefits to the recipient are obvious, those for the donor are subjective and not quantifiable. However, donors describe donation as a great experience in life. The risk of kidney donation may be divided into the perioperative and the long-term risks. The evaluate the long-term risks for kidney donors requires a long follow-up. The main source of kidney donors in our transplant center has been living-related and -unrelated donors, with a minor percentage of cadaveric donors. In this report we present four kidney donors who developed ESRD thereafter, three becoming kidney recipients.

[In relation to Cleopatra and snake bites]

Cleopatra VII, one of the last Egyptian sovereigns of the ptolomeic dynasty, is envisioned as a mythic figure, surrounded by intrigues and mystery. her mysterious death was caused, according to history, by a snake bite. This article shows some instances of great Cleopatra's life and the state of the art on snake venoms. Even at the present time, snake bites are a public health problem in Asia, Africa, Central and South America, causing more than 25,000 deaths every year. Most snake venoms have a protein structure and cause neurotoxic and hemolytic effects, altering coagulation and fibrinolysis. The mortality due to snake bites fluctuates between 1 and 22%. Specific treatment includes the use of specific antiserums with highly purified components.

Developing a media- and school-based program for substance abuse prevention among Hispanic youth: a case study of Mirame!/Look at Me!

Mirame!/Look at Me! is a substance abuse prevention program for low-income Mexican-American youth aged 9-13 years. The theory-driven curriculum, developed for mass distribution via a satellite television network, features social models who demonstrate cognitive-behavioral skills and display conservative norms regarding substance abuse. An 18-session curriculum contains 5-min videos that are assigned to be followed by discussion and social reinforcement from a teacher or volunteer. This case study reports the program development process and experiences in the initial dissemination of the program through national networks for schools and cable television subscribers.

[Metachronous pancreatic metastasis of a renal cell carcinoma. 3 new cases]

We report two males and one female, aged 71, 81 and 73 years old respectively, previously operated of a renal cell carcinoma. During the follow up of the 71 years old male, the CAT scan showed three lesions in the pancreas. Also, the CAT scan in the female showed one lesion in the tail of the pancreas. The 81 years old male was admitted to the emergency room due to a upper gastrointestinal bleeding. Endoscopy showed a proliferating lesion in the second portion of the duodenum whose biopsy showed a clear cell carcinoma. The CAT scan showed also a tumoral mass in the head of the pancreas. All three patients were subjected to surgical resection of the tumors without postoperative complications or mortality.

Influence of admixed citric acid on the release profile of pelanserin hydrochloride from HPMC matrix tablets

Pelanserin is a weakly basic experimental drug with a short half-life and a prolonged release formulation was developed using hydroxypropyl methylcellulose (HPMC) and citric acid to set up a system bringing about gradual release of this drug. For this purpose powder mixtures were wet granulated with water and compressed with a hydraulic press at 55 MPa. Dissolution studies were made using 900 ml HCl 0.1 N, the first 3 h, and phosphate buffer pH 7.4, h 3-8. Dissolution curves were described by M(t)/M(inf)=kt(n), applied separately for each dissolution medium. The dissolution mechanism involved a coupled diffusion/relaxation with a trend favoring the diffusion mechanism with increasing citric acid concentrations. Increasing concentrations of citric acid produced increasing values of the kinetic constants, in a cubic relationship. Higher HPMC proportions produced slower dissolution rates but with a citric acid compensating more clearly a decreased solubility of pelanserin at pH 7.4. Individually calculated dissolution curves showed experimental 8 h pelanserin dissolution in a range of 65-99% for matrices with 100 mg HPMC/tab., while those with 200 mg HPMC/tab. were in the range 57-73%.

[Traumatic rupture of thoracic aorta and non operative treatment of concomitant splenic lesion. Case report]

We report a 26 years old male that suffered a motorcycle accident resulting in a traumatic aortic rupture and splenic laceration. He was subjected to a surgical repair of the aortic lesion under complete heparinization. The splenic rupture was non operatively managed successfully.

[Birth weight difference in 3 biological variables in normal newborns]

BACKGROUND

The most important determinant of birth weight is gestational age. However, other biological variables may influence this parameter.

AIM

To study the influence of maternal parity, height and neonatal gender on the birth weight of normal newborns in a public Hospital of Southern Chile.

MATERIAL AND METHODS

A computer registry of all deliveries attended in Temuco Hospital between 1993 and 1998 was analyzed. Normal deliveries giving birth to newborns of more than 2,500 g and from women who did not suffer from conditions that could influence birth weight, such as hypertension, undernutrition or smoking, were selected.

RESULTS

From 27,736 deliveries, 12,580 were selected for the study. Male newborns with gestational ages from 37 to 42 weeks, had a higher weight than their female counterparts. Multiparous women and those with a height over 154 cm gave birth to newborns with a higher weight than nulliparous women or than those with a height of less than 154 cm.

CONCLUSIONS

According to these results, birth weight must be corrected by gender and maternal features, to define those newborns that have a low birth weight for their gestational age.

[Massive epistaxis associated with trauma. An indication for superselective angiography and embolization. Clinical case]

We report a 23 years old male admitted to the hospital after a fall from a great altitude with severe trauma. During the second week of hospitalization he presented a severe nosebleed that did not respond to conventional tamponade. A selective angiography was performed and the branches of the internal maxillary artery were embolized in two occasions, stopping the bleeding. The patient was discharged from the hospital after 71 days of hospitalization.

[Emergency consultations of foreign tourists in Paris in the month of August. 5 years of prospective surveillance (1992-1996)]

For five consecutive years, five major Parisian institutions in charge of emergencies have participated in a prospective collection of medical data for foreign patients visiting Paris in August; 4093 subjects have been studied. Gastroenteritis represented the main cause in calling on emergency medical care (14.5 to 21.9%), followed by traumatology, ear-nose-throat problems, syndromes labelled as viral, skin problems: these five categories represented 60 to 64% of all the serious problems encountered by tourists. The statistical frequency of different causes in calling on emergency care varied significantly according to two variables: the tourists' age and nationality. The incidence of gastroenteritis is estimated at between 13 and 30 per 100,000 visitors and the incidence of pathological problems taken all together--at 80 to 100 per 100,000.

[Indication of gastrojejunostomy in unresectable pancreatic cancer]

BACKGROUND

Up to 20% of patients with pancreatic carcinoma subjected to a bilio digestive diversion, develop a delayed gastric emptying due to duodenal infiltration. However the role of prophylactic gastrojejunoanastomosis is not well defined.

AIM

To compare the effects of gastrojejunoanastomosis performed as prophylaxis or as treatment for duodenal infiltration, in patients with unresectable pancreatic carcinoma.

PATIENTS AND METHODS

Between 1983 and 1994, 44 gastrojejunoanastomosis were performed in patients with pancreatic carcinoma. In 24 patients the procedure was done as prophylaxis and in 20 as treatment of duodenal infiltration. Of these, three had been subjected previously to a bilio digestive diversion. Postoperative outcome and mortality of both groups of patients were compared.

RESULTS

Both groups of patients had similar sex and age. Operative morbidity and mortality were 33% and 0% in the group with the prophylactic procedure and 35 and 10% in the group with duodenal infiltration. Oral feeding was started 6.5 and 6.9 days after operation, and hospital stay was 10.7 and 11.4 days in either group. At the moment of the analysis, 95.5% of patients had died. Survival was significantly longer in the group with the prophylactic procedure (337.2 and 116.9 days respectively, p < 0.01). Thirty eight percent of patients required a further admission to the hospital, but only 4.8% due to gastric retention.

CONCLUSIONS

Gastrojejunoanastomosis is a good palliative procedure in patients with unresectable pancreatic carcinoma. It should be performed in every such patient who is subjected to a bilio digestive diversion and in whom a survival of some months can be predicted.

[Treatment results in 588 patients with multiple trauma]

BACKGROUND

Ten to fifteen million wounded and 700,000 deaths each year, around the world, are the consequences of accidents, according to the World Health Organization. In Chile 2,269 deaths occur each year due to accidents. The successful treatment of these patients requires a schematized initial management, that is taught in the Advanced Trauma Life Support Course.

AIM

To review the results of trauma treatment using this model at Hospital del Trabajador in Santiago.

PATIENTS AND METHODS

A retrospective review of patients with trauma treated between 1984 and 1994. The severity of trauma was classified according to the Injury Severity Score.

RESULTS

Five hundred eighty eight patients (60 female) aged 35.4 +/- 14 years old were treated in the period. Vehicular accidents accounted for 62% of trauma. The most frequently injured corporal segments were limbs and pelvis in 79%, head and neck in 66% and thorax in 44%. There were 2.45 lesions per patient. Mortality was 8% and, among survivors, 79% had a complete recovery and were reintegrated to their usual activities. Fifteen percent of patients were severely injured. Among these, mortality was 28% and 43% of survivors had some sequel. Head injuries had a predominant role in mortality and post traumatic disabilities.

CONCLUSIONS

These results confirm the efficacy of Advanced Trauma Life Support system in the treatment of patients with multiple trauma.

Prolonged nosocomial outbreak of hepatitis A arising from an alcoholic with pneumonia

From April to June 1996, an outbreak of hepatitis A virus (HAV) infection affecting 15 nurses, patients and household contacts occurred in the Department of Internal Medicine at Aker University Hospital, Oslo. The index case was a homeless alcoholic who was hospitalized in March 1996 with pneumonia while simultaneously incubating HAV infection. Four secondary cases were infected by the index case, while another 10 cases were caused by a continuous spread of infection within the department during the following months. Sequence of the VP1/P2A junction of HAV was obtained from 9 patients, including the index case, and all sequences were identical to each other. Mass vaccination of hospital employees with a formalin-inactivated HAV-vaccine took place in late May, and following this the outbreak stopped. Several factors probably combined to account for this unusual outbreak, e.g. an index case unsuspected of incubating with HAV infection, and a low prevalence rate of protective antibodies to HAV among the hospital staff.

Effects of smoking, alcohol, and drugs of abuse on the outcome of "expectantly" managed cases of preterm premature rupture of membranes

We evaluated the outcome of pregnancies complicated by preterm premature rupture of membrane (PROM) in order to determine if tobacco, alcohol, or illicit drug usage were associated with alterations in pregnancy or neonatal outcome. Comparisons in outcome were made with respect to tobacco, alcohol, and/or illicit drug usage. Comparisons were made with gestational age (GA) of PROM, GA of delivery, latency period (LP), maternal age, initial cervical exam (by speculum), age, race, tocolytic use, chorioamnionitis, and birthweight. Student's t-test, Mann-Whitney test, and Chi-square analysis were used to evaluate for significant differences (significance set at P < 0.05). A total of 119 charts were evaluated. Differences were noted with respect to smokers vs. nonsmokers for latency period (6.0 days vs. 9.4 days, P < 0.03), age (29.1 years vs. 24.8, P < 0.001), and gravidity (4.2 vs. 2.8, P < 0.005). Differences were noted for use of alcohol and age (29.9 vs. 25.2, P < 0.006). Differences were also noted for the use of illicit drugs and the following variables: age (30.0 vs. 24.9, P < 0.001), gravidity (4.7 vs. 2.5, P < 0.006), latency (6.2 vs. 9.0, P < 0.009), and parity (2.6 vs. 1.2, P < 0.01). A difference was noted with respect to cocaine and latency period (5.8 vs. 9.0, P < 0.01), age (31.2 vs. 24.8, P < 0.001), gravidity (4.8 vs. 2.9, P < 0.01), and parity (2.6 vs. 1.2, P < 0.03), and the use of tocolytics (22% vs. 55.4%, P < 0.02). These relationships held after multivariate analysis was performed. There were no associations among use of tobacco, alcohol, drugs of abuse, or cocaine and respiratory distress syndrome, intraventricular hemorrhage, or necrotizing enterocolitis. The use of tobacco during pregnancy appears to shorten the latency period in pregnancies complicated by PROM. Cocaine abuse also appears to shorten the latency period. These shortened latency periods could potentially contribute to increased neonatal morbidity. Larger studies evaluating this are needed.

[Septic phlebitis: origin of severe septic condition]

We report two patients, an 82 years old female and a 71 years old male, who had a severe sepsis with positive blood cultures for Staphylococcus aureus and a superficial phlebitis as the only probable focus. In both the diagnosis of septic phlebitis was reached and an emergency phlebotomy was performed under local anesthesia. The clinical response was satisfactory and the pathological examination of excised veins showed an acute exudative leukocytic thrombophlebitis.

[Negative appendectomy: experience at a university hospital]

BACKGROUND

Acute appendicitis still constitutes a difficult diagnostic problem.

AIM

To assess the experience of an University Hospital in the diagnosis of acute appendicitis and to determine the rates of negative appendectomies.

PATIENTS AND METHODS

The charts of 1,075 patients operated with the diagnosis of acute appendicitis, between 1993 and 1995, were retrospectively reviewed. All resected appendices were pathologically examined. Those cases in whom pathology did not confirm the clinical diagnosis were considered as a negative appendectomy.

RESULTS

There was a 12.2% rate of negative appendectomies (18.9% in women and 6.2% in men). The difference between sexes disappears in patients over 40 years old. In 49% of patients, no abnormality was detected during the laparotomy. The most frequent differential diagnosis were gynecological illnesses or diseases of the colon.

DISCUSSION

The rate of negative appendectomies can be reduced with a close clinical observation of patients during their hospitalization and the judicious use of diagnostic laparoscopy.

Hantavirus pulmonary syndrome in a Chilean patient with recent travel in Bolivia

A case of hantavirus pulmonary syndrome (HPS) was serologically confirmed in a critically ill patient in Santiago, Chile. The patient's clinical course had many similarities to that of other HPS patients in North and South America but was complicated by acute severe renal failure. The patient's history included self-reported urban and probable rural rodent exposure during travel in Bolivia. Comparison of a viral sequence from an acute-phase serum sample with other known hantaviruses showed that the hantavirus nucleic acid sequence from the patient was very similar to a virus recently isolated from rodents associated with HPS cases in Paraguay.

Traumatic and nontraumatic perforation of hollow viscera

Hollow viscus injuries are usually managed with few complications. However, if their diagnosis is delayed, or if reparative suture closure should fail, the patient is placed at risk of multiple organ failure. This article presents diagnostic approaches, emphasizing imaging modalities, and therapeutic strategies for three clinical scenarios of hollow viscus perforation: 1) acute appendicitis, 2) gastroduodenal peptic ulcer disease, and 3) trauma.