Effect of valproate and carbamazepine on visual evoked potentials in epileptic children

The effects of carbamazepine (CBZ) and sodium valproate (SV) monotherapy on visual evoked potentials (VEP) were studied in 18 epileptic children receiving CBZ and nine epileptic children receiving SV. Pattern reversal VEP were determined before the administration of antiepileptic drugs (AED) and 1 year later during which time the patients had received AED. The VEP amplitude showed no consistent changes after 1 year of CBZ and SV therapy, but VEP P-100 latencies were significantly prolonged after 1 year of CBZ therapy. We conclude that CBZ causes a slowing down of central impulse conduction and that VEP is useful to evaluate the effects of AED within the central nervous system.     

Return to Work following Limb Injuries

Motivation for work, level of physical disability, period ofincapacity, completion of an employment rehabilitation courseand unemployment in the general population are the major determinantsof an early return to stable employment in the disabled. Ina study of 350 men and 29 women with limb injuries who weredischarged from three rehabilitation centres, those with onlysoft tissue injuries were less disabled, incapacitated for shorterperiods and completed employment rehabilitation courses comparedwith those with fractures, dislocations or amputations. Therewas, however, no association between the type of injury andmotivation for work. Return to work after rehabilitation wasunrelated to the type or site of injury. In this group of patients,motivation for work appeared to have a greater influence onthe outcome of rehabilitation than other known predictors Requests for reprints should be addressed to:Dr K. Sheikh, Department of Epidemiology, School of Public Health, University of Michigan, 109, Observatory Street, Ann Arbor, Michigan 48109, USA.     

Is it Safe to Close ASD with the Guidance of Transthoraxic Echocardiography in Pediatric Population “Ten Years' Experience of a Single Center”

Objective

Main purpose of this study is to emphasize the usage and safety of transthoracic echocardiography (TTE) in percutaneous atrial septal defect (ASD) closure in appropriate pediatric cases.

Background

Nowadays, percutaneous closure is preferred as treatment modality for ASD in pediatric age group.

Methods

Between the dates December 2003–August 2013; 340 patients whose ASD were closed included in this study. Physical examination, electrocardiogram, TTE were done before the procedure, at the 24th hour, 1st and 6th month after the procedure. After the 6th month, routine control was done annually. Transesophageal echocardiography (TEE) was performed in 184 cases with large, multifenestrated ASD and when TTE views were poor in quality. We selected the 201 patients whose ASD diameter between 10–20 mm and formed 2 homogeneous groups according to the type of echocardiography used (TEE or TTE) in order to compare the role of echocardiography.

Results

The demographic features of patients of 2 groups were similar. There was not any statistically difference between ASD, balloon sizing diameters between the groups. No statistically significant difference in the success, complication, and residual shunt rates was found between the groups. Procedure, fluoroscopy time, and amount were significantly higher in TEE group. When hemodynamic variables except pulmonary blood flow to systemic blood flow (Qp/Qs; right–left atrium mean pressure, pulmonary vascular resistance, and peak‐mean pulmonary arterial pressure) were compared, there was not statistically difference.

Conclusion

TEE is an invasive procedure and requires general anesthesia, therefore, it should not be done routinely in ASD but only in selected cases. If the size and the anatomy of ASD is appropriate, TTE should be preferred primarily in percutaneous ASD closure.

     

Two different doses of caudal neostigmine co-administered with levobupivacaine produces analgesia in children

Background: This study was aimed to evaluate the analgesic efficacy, duration of analgesia, and side effects of two different doses of caudal neostigmine used with levobupivacaine in children. Methods: Sixty boys, between 5 months and 5 years, undergoing genito‐urinary surgery were allocated randomly to one of three groups (n = 20 each). Group I patients received caudal 0.25% levobupivacaine (1 ml·kg^?1) alone. Groups II and III patients received neostigmine (2 and 4 μg·kg^?1 respectively) together with levobupivacaine used in the same dose as Group I. Pain scores were assessed using Children’s and Infant’s Postoperative Pain Scale (CHIPPS) at 15th (t₁) min after arrival to postanesthetic care unit, and 1st (t₂), 2nd (t₃), 3rd (t₄), 4th (t₅), 8th (t₆), 16th (t₇), and 24th (t₈) hour postoperatively. Duration of analgesia, amount of additional analgesic (paracetamol), score of motor blockade and complications were recorded for 24 h postoperatively, and compared between groups. Results: CHIPPS scores were higher during t₂, t₃, t₆, t₇ and t₈ periods, duration of analgesia was shorter, and total analgesic consumption was higher in Group I compare to neostigmine groups (P < 0.05). Duration of postoperative analgesia and total analgesic consumption were similar in Groups II and III (P > 0.05). Adverse effects were not different between three groups. Conclusions: Caudal neostigmine in doses of 2 and 4 μg·kg^?1 with levobupivacaine extends the duration of analgesia without increasing the incidence of adverse effects, and 2 μg·kg^?1 seems to be the optimal dose, as higher dose has no further advantages.     

ACUTE EFFECT OF ENDOTHELIN-1 ON LUNG OEDEMA INDUCED BY ALPHA-NAPHTHYLTHIOUREA (ANTU)

Alpha-naphthylthiourea when injected intraperitoneally to rats (10mgkg⁻¹i.p.) produced lung oedema as indicated by an increase in lung weight/body ratio and pleural effusion reaching a maximum within 4 hours. Prior intravenous single bolus injection of endothelin-1 elicited a significant and dose-dependent inhibition in both parameters. However, prior i.v. injection of angiotensin II using relatively higher doses did not alter the oedema-producing effect of alpha-naphthylthiourea indicating a characteristic for endothelin-1. The inhibitory effect of endothelin-1 on pleural effusion is more prominent than lung weight/body weight ratio. The resolution of lung oedema by single bolus i.v. injection of endothelin-1 is probably due to the acute long-lasting and potent vasoconstrictor effect of the peptide and its large accumulation in lung tissue. Phosphoramidon, an inhibitor of endothelin converting enzyme, did not alter the oedema producing effect of alpha-naphthylthiourea indicating the lack of the participation of endothelin-peptide cascade to this pathological event. Bosentan, a non-selective receptor blocker of endothelin-1, did not inhibit the preventive effect of the peptide against alpha-naphthylthiourea-induced lung oedema. Possible mechanisms of the acute effect of endothelin-1 on lung oedema are discussed.     

A case of the cardiofacial syndrome (Cayler's syndrome)

An infant whose face appears asymmetrical at rest and whose mouth is pulled downward to one side when crying is said to have an ‘asymmetric crying fades’ (ACF). The association of ACF with congenital cardiac anomalies is known as cardiofacial syndrome (Cayler's syndrome). The present report describes a case with cardiofacial syndrome and ACF associated other congenital anomalies, and provides criteria for differentiating absence of the depressor anguli oris muscle (DAOM) from palsy of the seventh cranial nerve and its central connections.