Surgical determinants, perioperative course and outcome of a representative patient cohort with acute appendicitis undergoing appendectomy over 3 decades.

Unlabelled: Acute appendicitis, one of the most frequent emergencies in general surgery, has been repeatingly investigated with regard to specific aspects such as medical history, clinical symptoms, the perioperative management and follow up. The aim of the study was to investigate relevant and combined determinants for the perioperative management of acute appendicitis a systematic clinical prospective unicenter observational study was conducted. A representative patient cohort was studied (n=9,991; middle Europe) to reflect daily surgical practice through a time period of 27 years divided into 3 separate periods and the frequency of specific categories (e.

Efficacy and safety profile of dronedarone in clinical practice. Results of the Magdeburg Dronedarone Registry (MADRE study).

Background: Dronedarone is a new antiarrhythmic agent that has only recently been approved for the therapy of atrial fibrillation (AF). Results regarding a broader spectrum of patients and experience accumulated in clinical practice are still very scarce. Therefore, we prospectively investigated the efficacy and tolerance of dronedarone in a real life setting.

Ultrasound guided thrombin injection of pseudoaneurysm of the radial artery after percutaneous coronary intervention.

Thrombin injection is frequently used to occlude iatrogenic pseudoaneurysms in larger vessels, but has never successfully been used in the radial artery location. Here we report the use of this treatment in a patient with radial artery pseudoaneurysm following coronary intervention. After Doppler sonographic visualization of the pseudoaneurysm cavity and its neck, an ultrasound-guided transcutaneous injection of thrombin was carried out.

Balanced steady-state free precession vs. segmented fast low-angle shot for the evaluation of ventricular volumes, mass, and function at 3 Tesla.

Purpose: To compare balanced steady-state free precession (SSFP) and segmented fast low angle shot (FLASH) for quantification of left and right ventricular volumes and function and for left ventricular mass at high field (3 Tesla).

Materials And Methods: A total of 33 patients (19 male, mean age 54 years) with various forms of heart disease underwent ventricular function studies using cine SSFP and FLASH sequences with identical slice orientations.

Results: Using SSFP, left ventricular end-diastolic (+10 mL [4.

Comparison of SSFP and IR GRE techniques for measurement of total myocardial mass-influence of applied contrast dosage and implication for relative infarct size assessment.

Objective: To compare total left ventricular mass assessment using steady state free precession (SSFP) and inversion recovery fast gradient echo (IR GRE) imaging and further to assess the influence of contrast dosage on mass by IR GRE and its implications on relative infarct size assessment with both methods.

Methods: Forty-three patients with first documented myocardial infarction and single vessel disease underwent measurement of total myocardial mass using SSFP technique and an IR GRE sequence. As part of a Phase 2 multi-center dose ranging study for infarct identification patients received 1 of 4 possible dosages (0.

Volume measurement by CARTO compared with cardiac magnetic resonance.

Aims: The CARTO electrophysiological mapping system has demonstrated accurate results for end-diastolic ventricular volumes in casts and animals. However, in humans, a comparison with cardiac magnetic resonance (CMR), the non-invasive gold standard for volumetric analysis, has not yet been performed.

Methods And Results: A total of 34 (29 male) heart failure patients (NYHA class III/IV) underwent an electrophysiological mapping procedure with the CARTO system in the left ventricle (LV) (n = 34) and right ventricle (RV) (n = 12) and CMR for RV and LV end-diastolic volume (RVEDV and LVEDV) measurements another day.

Oxcarbazepine-induced hyponatremia and the regulation of serum sodium after replacing carbamazepine with oxcarbazepine in children.

While severe hyponatremia is reported to be more frequent in adults treated with oxcarbazepine (OXC) than with carbamazepine (CBZ), there is not sufficient data about the incidence of hyponatremia in childhood during treatment with OXC. We evaluated changes in serum electrolyte balance in 75 children with epilepsy before and during treatment with OXC and after replacing carbamazepine (CBZ) therapy with OXC therapy. All patients had normal sodium serum levels at the onset of OXC.

Multiple pterygium syndrome, bilateral periventricular nodular heterotopia and epileptic seizures--a syndrome?

We present the clinical, neurophysiological and radiographic findings in a boy with coexisting multiple pterygium syndrome, bilateral periventricular nodular heterotopia (BPNH), mental retardation and epileptic seizures. This constellation has not been previously reported. We discuss the possibility of a new BPNH syndrome associated with multiple pterygium syndrome in our patient.

Effective and safe but forgotten: methsuximide in intractable epilepsies in childhood.

The efficacy and safety of methsuximide (MSM) was evaluated in children with intractable epilepsies in a prospective uncontrolled study. MSM was added to the therapeutic regimen of 112 children with intractable epilepsy under inpatient conditions, all of whom were therapeutically refractory to various first-line antiepileptic drugs (AED) or combinations of other AED. Titration of MSM was performed following a uniform protocol.

Carbamazepine-induced combined phonic and motor tic in a boy with Down's syndrome.

We report the occurrence of a tic in a boy with Down's syndrome. The movement disorder was induced by carbamazepine (CBZ) and resolved completely after discontinuation of CBZ. The development of tics seems to be a rare, idiosyncratic side effect of CBZ in children.

Seizure-inducing paradoxical reaction to antiepileptic drugs.

We report on an 18-month-old girl with a seizure frequency of five/day, receiving an antiepileptic polytherapy consisting of primidone, clonazepam and phenytoin. Following discontinuation of clonazepam and primidone, the patient has been seizure-free under monotherapy for 2 years and shows marked developmental progress. Possible mechanisms of this paradoxical effect of antiepileptic drugs and the implications for antiepileptic therapy are discussed.

Gabapentin in childhood epilepsy: a prospective evaluation of efficacy and safety.

Purpose: To evaluate the efficacy and safety of gabapentin (GBP) in partial epilepsy in children.

Methods: We performed a prospective open label add-on study in 52 children and adolescents (age 1.8-17.

[Recommendations for blood studies and clinical monitoring in early detection of valproate-associated liver failure. Results of a consensus conferences 9 May - 11 May 1997 in Berlin].

Valproate is a frequently used antiepileptic drug. It is associated with rare but serious adverse effects like liver failure. The first symptom is impairment of the patient's well being.

Hyponatremia induced by oxcarbazepine in children.

We report the case of a 12-year-old girl with severe clinically relevant hyponatremia (118 mmol/l) and hypochloremia (81 mmol/l) during treatment with oxcarbazepine (OCBZ). The adverse effects were rapidly reversible after discontinuation of OCBZ and did not occur when exposed to carbamazepine. We reviewed the charts of 48 patients who received OCBZ as in-patients in our epilepsy centre and found hyponatremia in nine and hypochloremia in four.

Influence of ethosuximide on valproic acid serum concentrations.

In the therapy of absence epilepsies, a combination of ethosuximide (ESM) and valproic acid (VPA) is sometimes necessary for a successful seizure control. Previous studies of the interaction between ESM and VPA revealed contradictory results. We investigated the influence of ESM on VPA serum concentrations in children with epilepsy.

Pharmacokinetics of sulthiame in epileptic patients.

Sulthiame is an antiepileptic drug that was introduced approximately 30 years ago for the treatment of epilepsy. Currently it is rarely used, but recent studies show its efficacy, especially in the treatment of focal epilepsies in children. Because there are hardly any pharmacokinetic studies of sulthiame in humans, we studied the dose-level relationship, the elimination half-life, and the daily fluctuations in the concentration of sulthiame among children and adults with epilepsy.

Use of intracranial neurophysiologic recording techniques in the evaluation for epilepsy surgery in children.

Resective surgery is an accepted treatment modality for medically intractable focal epilepsy in children as well as in adult. During the presurgical evaluation processes, intracranial neurophysiologic recording of epileptiform abnormalities have been used much more commonly in adults and older adolescents than in infants and children. However, as infants and children are increasingly referred for early surgery in many centres, it may be necessary to study complex cases in some children with invasive electrodes in order to plan a safe and effective resection.

Valproic acid-induced carbamazepine-10,11-epoxide toxicity in children and adolescents.

The study of 14 children and adolescents shows that the addition of carbamazepine (CBZ) to a basic valproic acid (VPA) therapy can result in unexpectedly high concentrations of carbamazepine-10,11-epoxide (CE) in the serum (up to 13 micrograms/ml). These concentrations were associated with marked side effects, especially vomiting and tiredness. The concentrations of CBZ were within the therapeutic range.

Discontinuation of clonazepam after long-term treatment.

Frequent unwanted side effects and development of tolerance are the main disadvantages of clonazepam (CZP) in long-term treatment of epileptic patients. A review of the literature shows that CZP tolerance more often appears in severe forms of childhood epilepsy (West and Lennox-Gastaut syndromes) than in other epileptic syndromes. We prospectively studied the consequences of CZP discontinuation in 40 consecutive children with difficult-to-treat epilepsies and multiple-drug therapy.

Steady-state pharmacokinetics of phenytoin from routinely collected patient data.

Previously reported routine phenytoin clinical pharmacokinetic data from Japan, England, and Germany were analysed to estimate population pharmacokinetic parameters. There were 780 steady-state phenytoin concentrations and associated dosage rates (mg/day) from 322 patients. The patient group spanned paediatric and adult ages, mean age being 18.