Treatment of Status Epilepticus in Adults: Guidelines of the Italian League Against Epilepsy

Summary:  Status epilepticus (SE) is a medical emergency which can lead to significant morbidity and mortality and requires prompt diagnosis and treatment. SE is differentiated into generalized or partial SE on the basis of its electro-clinical manifestations. The guidelines for the management of SE produced by the Italian League against Epilepsy also distinguish three different stages of SE (initial, established and refractory), based on time elapsed since the onset of the condition and responsiveness to previously administered drugs. Treatment should be started as soon as possible, particularly in generalized convulsive SE, and should include general support measures, drugs to suppress epileptic activity and, whenever possible, treatments aimed at relieving the underlying (causative) condition. Benzodiazepines are the first line antiepileptic agents, and i.v. lorazepam is generally preferred because it is associated with a lower risk of early relapses. If benzodiazepines fail to control seizures, i.v. phenytoin is usually indicated, though i.v. phenobarbital or i.v. valproate may also be considered. Refractory SE requires admission to an intensive care unit (ICU) to allow adequate monitoring and support of respiratory, metabolic and hemodynamic functions and cerebral electrical activity. In refractory SE, general anesthesia may be required. Propofol and thiopental represent first line agents in this setting, after careful assessment of potential risks and benefits.     

IgA nephropathy and polycystic kidney disease

We report a patient with polycystic kidney disease, advanced renal failure, and nephrotic-range proteinuria. Kidney biopsy revealed IgA nephropathy with lesions of focal and segmental glomerular sclerosis. This association had not been previously described and is probably coincidental. This case supports the assumption that the nephrotic-range proteinuria observed in some polycystic patients could be the consequence of another superimposed glomerular disease. This glomerulopathy can worsen the course of azotemia in these patients.     

Iron nutrition in childhood malignancy

Status of iron nutrition along with demographic, anthropometric, dietary, and biochemical parameters were recorded in 98 pediatric cancer patients at the time of referral. Dietary intake in each patient was analyzed for calories, protein, and iron. Blood specimens were analyzed for hemoglobin (Hgb), hematocrit (Hct), iron, total iron-binding capacity (TIBC), transferrin, and ferritin. Dietary intake measures were assessed according to each subject's Recommended Dietary Allowance (RDA). The results were compared among three diagnostic groups, namely, benign, solid tumor, and hematopoietic. The nutrient lowest in intake was iron. The overall measures revealed significant differences between the benign and hematopoietic groups in all parameters except TIBC and transferrin. A correlation coefficient of 0.55 (p less than 10(-5) between transferrin and TIBC was generated in our patients. Significant differences were noted for ferritin in the acute lymphocytic leukemia (p = 0.0001) and lymphoma (p = 0.0007) groups when compared with the benign group. A correlation coefficient of 0.55 (p less than 10(-5) was generated in our patients. A 3-month follow-up assessment was conducted in order to document the effects of therapy. Tumor response and progression was compared to changes in ferritin levels from baseline to follow-up. Our results support the literature, that ferritin is a sensitive tumor marker in various malignancies.     

Histologic evaluation of radiofrequency ablation in renal cancer.

AIM: To report on the histologic evaluation of renal tumors after intraoperative radiofrequency ablation (RFA) performed immediately before surgical nephrectomy. MATERIALS AND METHODS: Ten patients with renal tumors were studied. All tumors were confirmed to be renal cell carcinoma before radio frequency ablation treatment. All specimens were stained with hematoxylin and eosin and nicotinamide adenine dinucleotide (NADH). RESULTS: Mean tumor size was 29 mm (range 14 to 48 mm). Of the 10 tumors 5 were completely devitalized with a treatment margin ranged from 1 to 20mm. One tumor needed two treatment sessions. No complication related to radiofrequency treatment was recorded. CONCLUSIONS: Our data indicate that RFA can completely destroy renal tumors. However, in our study, complete tumor cell death was obtained only in 50% of cases. More studies are needed to ensure that is technique is an effective and reproducible treatment.     

Tics moderate treatment outcome with sertraline but not cognitive-behavior therapy in pediatric obsessive-compulsive disorder.

BACKGROUND: The presence of a comorbid tic disorder may predict a poorer outcome in the acute treatment of pediatric obsessive-compulsive disorder (OCD). METHODS: Using data from the National Institute of Mental Health (NIMH)-funded Pediatric OCD Treatment Study (POTS) that compared cognitive-behavior therapy (CBT), medical management with sertraline (SER), and the combination of CBT and SER (COMB), to pill placebo (PBO) in children and adolescents with OCD, we asked whether the presence of a comorbid tic disorder influenced symptom reduction on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) after 12 weeks of treatment. RESULTS: Fifteen percent (17 of 112) of patients exhibited a comorbid tic disorder. In patients without tics, results replicated previously published intent-to-treat outcomes: COMB > CBT > SER > PBO. In patients with a comorbid tic disorder, SER did not differ from PBO, while COMB remained superior to CBT and CBT remained superior to PBO. CONCLUSIONS: In contrast to CBT outcomes, which are not differentially impacted, tic disorders appear to adversely impact the outcome of medication management of pediatric OCD. Children and adolescents with obsessive-compulsive disorder and a comorbid tic disorder should begin treatment with cognitive-behavior therapy alone or the combination of cognitive-behavior therapy plus a serotonin reuptake inhibitor.     

Infected chronic hematoma mimicking soft tissue neoplasm

A rare case of an infected chronic hematoma in a patient with immunodeficiency syndrome mimicking a soft tissue neoplasm is presented. There are few reported cases of hematogenous infection of chronic hematomas, which be difficult to differentiate from soft tissue neoplasms.     

Cognitive behavioral treatment for young children with obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a distressing and functionally impairing disorder that can emerge as early as age 4. Cognitive behavior therapy (CBT) for OCD in youth shows great promise for amelioration of symptoms and associated functional impairment. However, the empirical evidence base for the efficacy of CBT in youth has some significant limitations, particularly as related to treating the very young child with OCD. This report includes a quantitative review of existing child CBT studies to evaluate evidence for the efficacy of CBT for OCD. It identifies gaps in the literature that, when addressed, would enhance the understanding of effective treatment in pediatric OCD. Finally, it presents a proposed research agenda for addressing the unique concerns of the young child with OCD.     

Validation of a screening questionnaire for hip and knee osteoarthritis in old people

Background  

To develop a sensitive and specific screening tool for knee and hip osteoarthritis in the general population of elderly people.