Use of pregabalin for nonconvulsive seizures and nonconvulsive status epilepticus

PurposeTo determine the efficacy of pregabalin (PGB) in treatment of frequent nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE) in critically ill patients.MethodsIn this retrospective study, 21 patients were identified as having received pregabalin for the treatment of NCS as determined by continuous electroencephalographic monitoring. The patients were considered to be responders if their seizures were terminated within 24 h of initiation of PGB without the addition of another antiepileptic agent.ResultsOf the 21 patients who received PGB for treatment of NCS or NCSE, 11 (52%) were responders. PGB was administered via a nasogastric tube or orally and was the 2nd to 4th agent used. The average initial dose and total daily dose of PGB was similar in the responders and non-responders (342 mg vs. 360 mg, respectively). PGB was more effective in aborting NCS (9 patients, 82%) than NCSE (2 patients, 18%). Of the 9 brain tumor patients, PGB resulted in seizure cessation in 67% (6 patients). In contrast, all patients with hypoxic injury (4) did not respond to PGB. The responders were noted to have better clinical outcome (64% vs. 9% discharged home). Most of the patients tolerated the medication without any significant short term adverse effects, except two patients who were noted to have dizziness and sedation.ConclusionsPregabalin may be safe option for add-on treatment for nonconvulsive seizures in critically ill patients when conventional therapy fails.     

Levetiracetam in children with refractory status epilepticus

The objective of this study was to investigate the utility of levetiracetam (LEV) in children with refractory status epilepticus (RSE). Records of children with RSE who received LEV as adjunctive therapy were reviewed. Over a 7-year period, 11 children had received LEV for RSE. Age ranged from 2 days to 9 years (median = 2.5 months). Prior to administration of LEV, the number of anticonvulsants used to treat RSE ranged from 2 to 7 (median = 3). Starting doses of LEV ranged from 15 to 70 mg/kg (median = 30 mg/kg). LEV was felt to be of benefit in 45% (5/11) of cases, resulting in either resolution of RSE or successful weaning of patients off continuous infusions of other anticonvulsants. In 27% (3/11), response to LEV was unclear as other medications were either added or increased concomitantly with LEV use. The median latency to cessation of RSE following LEV initiation was 1.5 days (range = 1-8 days). All responding patients were on LEV doses >or= 30 mg/kg/day (median 40 mg/kg/day). No significant adverse effects of LEV were reported. LEV may be an effective and safe adjuvant therapy in children with RSE.     

Adrenocortical carcinoma with endocrine syndromes

Adrenocortical carcinoma is a rare disease. A 32 years old lady presented with complaints of hypertension, abdominal swelling, weight gain, hirsutism and bone pains. She was found to have a large adrenocortical carcinoma with associated Cushing's and virilization syndromes. Radical adrenalectomy was done with subsequent plan for Mitotane and radio frequency ablation for hepatic metastasis. However, she succumbed to respiratory failure due to ARDS, a month after operation.     

Giant osteochondroma of the talar neck

Giant osteochondroma is an uncommon entity and it is rare in the foot and ankle region. It is extremely rare to originate from the talus. In this case report we present a case of giant osteochondroma arising from the talar neck measuring 100 mm × 90 mm × 30 mm It is unique because of the size, site and the age at presentation.     

Delayed visual maturation associated with auditory neuropathy/dyssynchrony

Delayed visual maturation is a term used to describe infants who initially seem blind but subsequently have a marked improvement. The mechanism of visual loss and the subsequent improvement remains unknown. Auditory neuropathy/dyssynchrony is a condition of hearing impairment associated with absent or severely abnormal brainstem auditory evoked potentials but normal cochlear functions as measured by otoacoustic emissions. In this report, a 9-month-old infant who had no visual fixation for the first 3 months of life and congenital hearing impairment is described. Her brainstem auditory evoked potential study at 2.5 months of age showed no response to click stimuli presented at 90 dB nHL, whereas her otoacoustic emissions were normal. Subsequently, her vision and hearing improved. A brainstem auditory evoked potential study at 9 months of age showed reproducible waveforms. This case suggests the need for a detailed hearing evaluation of children with delayed visual maturation. Furthermore, this case highlights the need for follow-up brainstem auditory evoked potential testing prior to pursuing any audiologic intervention.     

Dental Applications of Natural‐Origin Polymers in Hard and Soft Tissue Engineering

Clinical advances in the treatment of dentoalveolar defects continue to evolve with the introduction of new innovations in regenerative medicine and tissue bioengineering. Recent developments in tissue engineering are aimed at safely and effectively regenerating a damaged or necrotic area by replenishing its cells and increasing surrounding gene expression. Various techniques have successfully given rise to porous scaffolds being used by clinicians to treat the defect and initiate the repair process. Tissue reconstruction using bioengineered scaffolds is advantageous over traditional autografting, since it prevents the instigation of pain and donor site morbidity while ultimately creating both the environment and machinery needed to induce cell proliferation, migration, and reattachment within the affected area. This review article aims to describe and review the available literature regarding the regenerative capacity of natural polymers used for the treatment of dentoalveolar defects. The repair mechanisms, advantages of protein and polysaccharide derivatives, and the potential of stem cell therapy are discussed.     

Traumatic left ventricle-right atrial communication. A case report

The authors report the case of an acquired left ventricle-right atrial communication after open chest trauma. The initial clinical presentation was a haemothorax and haemopericardium responding well to emergency surgical drainage. Secondarily, a systolic murmur suggesting a ventricular septal defect and signs of right heart failure were observed. Colour Doppler echocardiography led to the diagnosis of a left ventricle-right atrial communication associated with tricuspid regurgitation with dilatation of the right heart chambers and pulmonary hypertension. At surgery, a defect in the membranous interventricular septum was confirmed with rupture of the septal tricuspid leaflet causing tricuspid regurgitation. The surgeon closed the defect with a patch and performed a De Vega tricuspid valvuloplasty. The postoperative outcome was uneventful.