Handyvideos als diagnostisches Instrument anfallsartig auftretender Ereignisse

Clinical Epileptology - In der Differenzialdiagnostik anfallsartig auftretender Ereignisse können Handyvideos ein wichtiger diagnostischer Baustein sein. Ziel dieser Übersichtsarbeit ist...     

Simultaneous determination of glipizide and glimepride by Rp-Hplc in dosage formulations and in human serum

In this article, simple, liquid chromatographic method has been developed and validated for the determination of glipizide and glimepride in pharmaceutical formulations and in human serum. Chromatographic separation was carried out on a Nucleosil, C₁₈ (10?μm, 25?×?0.46?cm) column using the mobile phase 80:20 methanol:water with pH adjusted to 3.5 at a flow rate 1?ml?min^?1. Peak intensity of the drugs was recorded at 230?nm with UV detection. The linearity of the method was studied over the concentration range of 0.15–5?μg?ml^?1 (r?=?0.9979) and 0.5–7.5?μg?ml^?1 (r?=?0.9988) for glipizide and glimepride, respectively. Detection and quantitation limits were found to be 20 and 46?ng?ml^?1 and 70 and 141?ng?ml^?1 for glipizide and glimepride, respectively. There was no significant interference of extra pharmacopeial ingredients and serum observed in the assay of these two drugs.     

Contact force sensing in ablation of ventricular arrhythmias using a 56-hole open-irrigation catheter: a propensity-matched analysis

Purpose

The effect of adding contact force (CF) sensing to 56-hole tip irrigation in ventricular arrhythmia (VA) ablation has not been previously studied. We aimed to compare outcomes with and without CF sensing in VA ablation using a 56-hole radiofrequency (RF) catheter.

Methods

A total of 164 patients who underwent first-time VA ablation using Thermocool SmartTouch Surround Flow (TC-STSF) catheter (Biosense-Webster, Diamond Bar, CA, USA) were propensity-matched in a 1:1 fashion to 164 patients who had first-time ablation using Thermocool Surround Flow (TC-SF) catheter. Patients were matched for age, gender, cardiac aetiology, ejection fraction and approach. Acute success, complications and long-term follow-up were compared.

Results

There was no difference between procedures utilising either TC-SF or TC-STSF in acute success (TC-SF: 134/164 (82%), TC-STSF: 141/164 (86%), p?=?0.3), complications (TC-SF: 11/164 (6.7%), TC-STSF: 11/164 (6.7%), p?=?1.0) or VA-free survival (TC-SF: mean arrhythmia-free survival time?=?5.9 years, 95% CI?=?5.4–6.4, TC-STSF: mean?=?3.2 years, 95% CI?=?3–3.5, log-rank p?=?0.74). Fluoroscopy time was longer in normal hearts with TC-SF (19 min, IQR: 14–30) than TC-STSF (14 min, IQR: 8–25; p?=?0.04).

Conclusion

Both TC-SF and TC-STSF catheters are safe and effective in treating VAs. The use of CF sensing catheters did not improve safety or acute and long-term outcomes, but reduced fluoroscopy time in normal heart VA.

     

Epileptic activity is a surrogate for an underlying etiology and stopping the activity has a limited impact on developmental outcome

The concept of epileptic encephalopathy is important in clinical practice, but its relevance to an individual must be assessed in the appropriate context. Except in rare situations, epileptic activity is a surrogate for an underlying etiology, and stopping the activity has a limited impact on developmental outcome. Labeling a group of epilepsies as “the epileptic encephalopathies,” risks minimizing the impact of epileptic activity on cognition and behavior more widely in epilepsy. Similarly, describing the encephalopathy associated with many infantile onset epilepsies as “epileptic” may be misleading. Finally, concentrating on the epileptic activity alone and not considering the wider consequences of the underlying etiology on cognitive and behavioral development, may focus research efforts and the search for improved therapies on too narrow a target. Therefore, epileptic encephalopathies should not be considered as a specific group of epilepsies but, rather, the concept of epileptic encephalopathy should be applicable to all types of epilepsies and epilepsy syndromes, whenever it is relevant in the clinical course of a particular individual, at any age.     

Hepatic coma culminating in severe brain damage in a child with a SCN1A mutation

An 11 months old boy, developed liver failure after febrile status epilepticus while being treated with valproic acid for myoclonic epilepsy and recurrent partial and generalized seizures. The diagnosis of Alpers-Huttenlocher disease was considered. A muscle biopsy showed mitochondrial dysfunction. Mitochondrial DNA depletion was ruled out. Sequencing of the polymerase gamma gene (POLG1) did not detect any mutations.Sequencing of the alpha-1 subunit gene of the voltage-gated neuronal sodium channel (SCN1A) revealed a novel, de novo amino acid change p.Val 1637 Glu.This case expands the spectrum of clinical presentations related to mutations in SCN1A. We warn that children with SCN1A mutations may be at risk for developing liver failure following status epilepticus, due to mitochondrial dysfunction.