Effektivität der ketogenen Diät bei therapierefraktären Epilepsien

Background.

While in the Anglo-American countries the ketogenic diet (KD) has shown to be efficient in the treatment of refractory epilepsy, an attempt of evaluation in Germany (Workshop 2000 in Essen) showed an unfavorable result (0% seizure-free, seizure reduction >50% in only 16%).

Objective.

As the evaluation in Germany (Workshop 2000 in Essen) did not include the results of our patients, we present the retrospective evaluation of the efficacy of the KD in our patients with refractory epilepsy.

Patients and Methods.

We report 24 patients with refractory epilepsy who have been treated with the KD between February 1997 and January 2002. When the KD was started median (range) of age was 6.0 years (0.8–13.2), number of antiepileptic drugs used previously was 7 (3–13), time since onset of epilepsy 53 months (5–159) and seizure frequency 140/week (250 myoclonic seizures/day up to 1 status epilepticus/month). 13 patients had symptomatic, 8 patients cryptogenic and 3 patients idiopathic epilepsy.

Results.

In 2 patients the KD was stopped during initiation due to side effects (vomiting, sleepiness). Reduction of seizures >50% was achieved in 59% of the patients, 2/22 (9%) have become seizure-free for 22 months respectively 3.8 years. Seizure reduction >90% was achieved in further 5/22 patients (23%) and seizure reduction between 50–90% in further 6/22 patients (27%). At the time of evaluation the responders with seizure reduction >50% have been on the KD for 116 weeks (13–221). There was no significant difference between responders and nonresponders regarding the number of antiepileptic drugs used before the KD, the age and time since onset of epilepsy when the KD was started nor the types of seizures.

Conclusion.

The Ketogenic diet is efficient in reducing seizure frequency in children with refractory epilepsy.     

Infectious disease surveillance in North Rhine-Westphalia: first steps in the development of an early warning system

It is often difficult to detect warning signals on infectious disease outbreaks from raw surveillance data. Data need to be used for a timely generation and distribution of information on the current state of infectious diseases. This offers the opportunity to detect outbreaks and to initiate preventive measures. To improve the surveillance system in North Rhine-Westphalia we have introduced an infectious disease barometer, a simple tool based on weekly notification data. The aim of this tool is not to provide in depth data analysis, but to help to detect clusters or outbreaks. This can be the first step in the development of an early warning system and can support epidemiological investigation and policy making.     

Scheimpflug photographic imaging following implantation of anterior and posterior chamber phakic intraocular lenses: preliminary results

BACKGROUND: For the correction of refractive errors lenticular procedures are increasingly used in addition to corneal refractive surgery. One of those techniques is the implantation of intraocular lenses into phakic eyes (pIOL). Due to the close neighborhood of the implant to delicate intraocular structures, exact positioning and high postoperative stability are required. Scheimpflug photography has been shown to be a suitable instrument for the biometry of the anterior eye segment and the examination of IOL position. PATIENTS AND METHODS: Four anterior chamber phakic IOLs (pIOLs) (Bausch & Lomb NuVita) and 7 posterior chamber pIOLs (Staar ICL) were examined 1 week, 1 month and 3-6 months following implantation. At each examination 1 Scheimpflug slit image and 1 infrared retroillumination image were taken using the anterior eye segment analysis system EAS-1000 (Nidek Co., Gamagori, Japan). Evaluation of the images was performed with a personal computer and the software provided by the manufacturer. The distance of the pIOL to cornea and human lens was calculated and incidence and amount of pIOL rotation around the optical axis and potential crystalline lens opacification were assessed. RESULTS: The distance between the anterior chamber pIOL and the cornea 1 week after implantation was 1.61 +/- 0.10 mm. The distances between the myopic posterior chamber pIOL and the human lens were 0.34 +/- 0.11 mm and between the hyperopic posterior chamber pIOL and the human lens 0.26 and 0.29 mm, respectively. The values were constant over a period of 3-6 months. The pIOL showed no movement or change of position around the optical axis. There was no detectable cataract formation in the human lens. CONCLUSIONS: All implanted phakic anterior and posterior chamber IOLs showed a stable position in the eye within the observation period. Scheimpflug photography is proved to be a useful technique for the postoperative evaluation of the positioning of phakic IOLs.     

Comparison of German St. John's wort products according to hyperforin and total hypericin content

OBJECTIVES: To compare the hyperforin and hypericin content of currently available St. John's wort products and to determine their batch-to-batch reproducibility. DESIGN: Representative products were obtained either directly from the manufacturer or purchased from pharmacies in and around Frankfurt, Germany. For five batches from each of the eight manufacturers, 10 individual dosage forms (tablets or capsules) were analyzed for both hyperforin and hypericin content. SETTING: Laboratories of the Institute of Pharmaceutical Chemistry at Johann Wolfgang Goethe University, Frankfurt, Germany. PRODUCTS: Eight German St. John's wort products containing from 250 mg to 612 mg dry extract were studied. Three of these products are capsules, four are film-coated tablets, and one is a sugar-coated tablet. Two of the products (Jarsin 300 and Neuroplant 300) are also available in the United States. METHODS: Hyperforin concentrations were analyzed by high-performance liquid chromatography. Total hypericin concentrations were determined by polarography, an electrochemical method. Concentrations were compared among different batches of the same product and among products from different manufacturers. RESULTS: The products contained widely differing amounts of hypericin and hyperforin, even after correcting for differences in the amount of extract per dose. Some products demonstrated consistent concentrations of hyperforin and hypericin from batch to batch, others exhibited pronounced interbatch variability. CONCLUSION: The St. John's wort preparations studied exhibited large differences in hypericin and hyperforin content and are not interchangeable for the treatment of mild-to-moderate depression. Pharmacists should take this variability into account when counseling patients on the use of St. John's wort products.     

Manipulation of central GABAergic and dopaminergic systems alters stress responding in the rat

Activation of central GABA(A) systems with muscimol has been shown to facilitate stress responding and GABA is known to modulate central dopaminergic activity. To evaluate the possibility that this effect of muscimol may depend upon a dopamine mechanism we have tested the effect of intracerebroventricular coadministration of muscimol and the selective D(1) antagonist SCH 23390 on behaviors evoked by tail pinch stress. When injected by themselves muscimol (1.75 nmol) facilitated stress-evoked oral behavior while SCH 23390 (6-600 nmol) produced a dose-related suppression of oral behavior. Coadministration of muscimol and doses of SCH 23390 selected for producing no (6 and 30 nmol), or marginal (60 nmol), effects on stress responding resulted in a dose-related reversal of the increase in orality seen with muscimol alone. The results are consistent with the notion that stressful stimuli activate central GABA(A) systems which, in turn, enhance dopaminergic neurotransmission.     

南京医科大学七年制临床医学专业人才培养效果评价

通过对毕业生及其培养或用人单位的问卷调查,本文分析了南京医科大学七年制临床医学专业人才培养的成效,以及江苏省医疗卫生事业发展对高层次医学人才的需求.结果 显示,临床实践能力和科研创新能力是医疗卫生事业发展所需要的高层次医学人才的重要能力;在三级甲等医院工作,具有硕士/博士学位、在专业技术岗位的被调查者更加看重医学生的科研创新能力;而在"1年通识教育、4年医学专业教育(含1年临床课程及见习、1年临床通科实习)、2年二级学科轮转"模式下培养的七年制临床医学专业毕业生的临床实践能力较强,但是科研创新能力不足,且学业负担偏重.因此,应当加强对七年制临床医学专业学生科研创新能力的培养和临床实践能力的通科训练.

Abstract：

An evaluation of 7-year medical education program in Nanjing Medical University was performed via questionnaire survey to the graduates and the staff of hospitals in which the graduates work,and the demand for advanced quality of medical graduates in the field of medical health care in Jiangsu Province is further analyzed. The results showed that the capacity for clinical practice and the capacity for research and innovation are the most important, which can meet the demands of health service development for high-level medical talents. The staff working in advanced hospitals, possessing master or doctor degree,or working as medical experts put more emphasis on the ability of the graduates to do innovative scientific research. Through the completed procedure of the 7-year program includes college general education for 1 year, medical education for 4 years ( containing senior clinical clerkship for 1 year and internship for 1 year) and alternation for medical and surgery subspecialties for 2 years, the graduates showed higher ability to do clinical practice, but not showed the growth of capacity for research and innovation. The most staff investigated proposed an enhancement in training for the capacity for innovative research and general clinical practice.     

Pentobarbital attenuates the antinociceptive effect of intranigral morphine

This study was conducted to characterize the temporal relationship between intranigral injection of morphine and the onset of antinociception. The principal findings are: 1) morphine produces antinociception on the hot plate test within three minutes after intranigral injection, 2) the tail flick reflex cannot be measured within the first 30 minutes following intranigral morphine due to motor effects, and 3) pentobarbital suppresses the antinociceptive effect of intranigral morphine on the tail flick test. These findings support the conclusion that the antinociceptive effects of intranigral morphine are mediate by the substantia nigra.