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31.
32.
Prof. Dr. Bernhard Schmitt Prof. Dr. Michael Albani Priv.-Doz. Dr. Thomas Bast Prof. Dr. Ulrich Brandl Prof. Dr. Rudolf Korinthenberg Prof. Dr. Gerhard Kurlemann Prof. Dr. Bernd Neubauer Prof. Dr. Ulrich Stephani Dr. Markus Wolff 《Zeitschrift für Epileptologie》2007,20(3):113-119
Zusammenfassung
Der richtige Zeitpunkt für das Absetzen der Antiepileptika (AE) im Kindesalter ist unbekannt. Anl?sslich ihrer Jahrestagung
haben die Mitglieder des K?nigsteiner Arbeitskreises (KA) eigene und publizierte Absetzstrategien diskutiert. Da Studien zu
diesem Thema rar und widersprüchlich sind, wurde beschlossen, die Diskussionsergebnisse im Sinne einer Meinungs?u?erung zu
publizieren.
Bei Neugeborenen besteht übereinstimmung, AE innerhalb von 2 bis 12 Wochen nach dem letzten Anfall abzusetzen. Bei BNS-Epilepsie
wird Vigabatrin nach 6 bis 12 und Sultiam nach 6 bis 36 Monaten abgesetzt. Nach erfolgreicher Steroidtherapie setzt die Mehrheit
des KA die AE-Therapie für zwei Jahre fort. Für die Rolando-Epilepsie sind 1 bis 3 Jahre Anfallsfreiheit ausreichend, auch
wenn fokale Spike-Waves persistieren. Im Falle einer symptomatisch fokalen Epilepsie ist die Grunderkrankung mitentscheidend
für das Absetzen. Die Behandlung der Absencen-Epilepsie kann nach zwei Jahren beendet werden, w?hrend bei myoklonisch- astatischer
Epilepsie meist eine 2- bis 5-j?hrige Anfallsfreiheit vorausgesetzt wird. Konsens besteht darüber, dass die Juvenile- Myoklonus-Epilepsie
ein sehr hohes Rückfallrisiko birgt. Dennoch ziehen einzelne neurop?diatrische Mitglieder einen Absetzversuch nach 2- bis
3-j?hriger Anfallsfreiheit in Betracht. Die überwiegende Mehrheit des KA führt aber bei gesicherter Diagnose keinen Absetzversuch
durch. Bezüglich der Absetzgeschwindigkeit wird ein langsames (3 bis 12 Monate) Ausschleichen favorisiert. Nur zwei Mitglieder
praktizieren ein rascheres Absetzen (<3 Monaten). Das EEG spielt für die Entscheidung eine untergeordnete Rolle und bleibt
auf bestimmte Epilepsieformen (z. B. Absencen-Epilepsie) beschr?nkt.
Das vorliegende Papier gibt die Meinung des KA wieder und eignet sich nicht im Sinne einer Leitlinie. Für die Entscheidung
AE abzusetzen, ist immer eine individuelle Abw?gung von Grunderkrankung, Epilepsieform und psychosozialen Umst?nde erforderlich.
相似文献
33.
Heike Friedrich Bernd Fussnegger Karl Kolter Roland Bodmeier 《European journal of pharmaceutics and biopharmaceutics》2006,62(2):171-177
The dissolution rate of the model drugs carbamazepine and nifedipine was improved by adsorbing solutions of the drugs in hydrophilic non-volatile or volatile solvents onto carriers with a large surface area. This was accomplished by dissolving the drug in methanol or the non-toxic hydrophilic liquids PEG 400 or 2-pyrrolidone, and adsorbing these solutions onto the surface of silica (Aerosil) or crosslinked polyvinylpyrrolidone (Kollidon CL-M). The solvent binding capacities decreased in the order of methanol, PEG 400, 2-pyrrolidone for Aerosil 200, 300, 380 and for Kollidon CL-M. Kollidon bound less liquid than Aerosil because of the smaller surface area. Differential scanning calorimetry measurements showed higher interactions between drugs and Kollidon compared to Aerosil, suggesting a low aggregation of precipitated drug particles. The drug release from the adsorbent systems was enhanced when compared to micronized drug and independent of the drug loading in the investigated range. The drugs were also dissolved in various liquid, paste-like or solid solubilisers (polyoxyl-40-hydrogenated castor oil (Cremophor RH 40), macrogol-15-hydroxystearate (Solutol HS), poloxamers (Lutrol F68, Pluronic F87NF and Pluronic L44NF) and adsorbed onto Kollidon. These adsorbent systems also exhibited an increased dissolution rate when compared to pure drug. 相似文献
34.
Jürgen Vogt Torsten Schwarz Daniel Gras Johannes Sperzel Philippe Ritter Willem de Voogt Jean-Pierre Cebron Martin Seifert Bruce Tockman Bernd Schubert Eric Johnson Annette Doelger Thierry Pochet Elisabeth Mouton Christian Butter 《Journal of interventional cardiac electrophysiology》2007,19(1):61-68
Introduction Failure to enter the coronary sinus (CS) with a guiding catheter and entering its tributaries remains challenging in left
ventricle (LV) pacing lead implants for cardiac resynchronization therapy (CRT). A dual telescoping catheter system (8F outer/6F
inner) is designed to provide the ability to adjust the catheter curve size, shape and/or reach to the patients’ anatomy avoiding
the need for catheter change.
Methods Five different designs for CS cannulation were randomly tested in 64 patients scheduled for CRT device implant.
Results In 33 consecutive patients three adaptable telescoping guiding catheter systems were tested per patient, the adaptable catheters
had higher overall cannulation success rates (68, 63 and 62%) compared to the fixed shape catheter (46%) and an greater cannulation
success rate when the CS location was not known (70, 53 and 72% vs 33% for the fixed shape). In a second group of 31 CRT patients
the two telescoping catheters had similar high levels of success (71–80%), with or without using the inner catheter.
Conclusions The telescopic system is adaptable to a wide range of anatomical variations in patients and can result in a higher CS cannulation
success rate due to its adjustability in the RA in search for the CS ostium. On top of this the inner catheter allows for
sub-selecting the CS tributaries. 相似文献
35.
A 72-year-old man with increasing shortness of breath and atypicalangina pectoris received a chest radiograph 相似文献
36.
37.
Thompson Debra A.; Janecke Andreas R.; Lange Jessica; Feathers Kecia L.; Hubner Christian A.; McHenry Christina L.; Stockton David W.; Rammesmayer Gabriele; Lupski James R.; Antinolo Guillermo; Ayuso Carmen; Baiget Montserrat; Gouras Peter; Heckenlively John R.; den Hollander Anneke; Jacobson Samuel G.; Lewis Richard A.; Sieving Paul A.; Wissinger Bernd; Yzer Suzanne; Zrenner Eberhart; Utermann Gerd; Gal Andreas 《Human molecular genetics》2006,15(9):1559
Human Molecular Genetics 相似文献
38.
Safety of thrombolysis during cardiopulmonary resuscitation. 总被引:15,自引:0,他引:15
The prognosis is generally poor for patients who experience a cardiac arrest. The most common causes of sudden cardiac arrest are massive pulmonary embolism (PE) and acute myocardial infarction (MI). While thrombolysis is a first-line treatment option in massive PE and acute MI, cardiopulmonary resuscitation (CPR) has been regarded as a relative contraindication for thrombolysis because of the anticipated bleeding risk caused by traumatic cardiocompressions. However, an increasing number of case reports and clinical studies on thrombolysis during and after CPR highlight an increased frequency of the return of spontaneous circulation and a better neurological outcome of surviving patients. These effects are mainly due to the thrombolysis of macroscopic blood clots and the amelioration of microcirculatory reperfusion.This article reviews case reports and clinical studies of thrombolysis during and shortly after CPR in order to estimate the risk of severe bleeding events caused by CPR in association with thrombolysis compared with CPR without thrombolysis.Although thrombolysis per se can cause severe and potentially fatal haemorrhage, there is no evidence that severe bleeding events occur more often when thrombolysis is combined with cardiocompressions. In addition, by far the majority of bleeding complications can be treated effectively. Thus, in many cases, the possible benefit of thrombolysis during CPR seems to outweigh the potential risks. However, there may be a publication bias in some case reports and studies towards reporting successful rather than unsuccessful CPRs. In addition, not enough controlled clinical trials have yet been conducted. Therefore, data from large randomised, multicentre studies are needed to definitely answer the question of the relationship between safety and efficacy of this promising treatment option.We conclude that the currently available data do not indicate that thrombolysis contributes to a significant increase in bleeding complications when administered during CPR. 相似文献
39.
40.
Two systems allowing quantitative, objective analysis of sperm movement were compared: 1) the Hamilton-Thorn Motility Analyzer (HTM), in which sperm images are digitized automatically, and 2) the Image-80, a modified image-analysis system in which sperm movement is digitized manually by hand tracing from videotape (Tessler and Olds-Clarke, 1985). Videotapes were made of human spermatozoa obtained by a swim-up procedure. The same videotape frames were analyzed by both systems. The mean percentage of motile spermatozoa was similar as judged by eye with either the HTM or Image-80 monitors and as reported by the HTM. For every motile spermatozoon, two motility parameters were calculated: linearity (a measure of track shape) and curvilinear velocity at 30 frames/second (a measure of track speed). When samples from five donors were averaged, there were no significant differences in mean linearity between automatic and manual systems. Also, linearity as reported by the HTM and Image-80 systems for the same track was significantly correlated (r = 0.72; N = 80). Whereas the absolute values for curvilinear velocity were slightly but significantly higher for the Image-80 system than for the HTM system, their correlation was also significant (r = 0.91). Since the two systems provide comparable data on percentage of motile sperm as well as speed and path shape parameters, this suggests that the HTM automatic digitization is accurate for images of human spermatozoa. 相似文献