Intravenous levetiracetam in clinical practice--Results from an independent registry.

PURPOSE: Most common clinical studies with antiepileptic drugs do not reflect medical everyday practice due to their strict in- and exclusion criteria and specifications of treatment regimens. Here we present a large non-interventional registry with the intention to evaluate the spectrum of applications in daily use and the efficacy and tolerability of intravenously given levetiracetam (LEV-iv). METHODS: In a prospective approach of 17 neurological and neuropediatric centres in Germany LEV-iv treated patients of all ages were included over a period of 10 months. The observational period was 10 days with daily documentation of LEV-iv administration, type and frequency of seizures, currently used drugs and doses, and adverse events (AEs). In addition, treatment efficacy and tolerability were assessed by patients and physicians at study end as well as practicability of LEV-iv using a five-step scale. RESULTS: In 95 patients LEV-iv was administered, 93 were included into the analysis. The median LEV-iv dose was 1500 mg (range 110-6000 mg) per day. Median age was 66 years (range 0.7-90.3 years). The majority of patients (n=70, 75%) suffered from status epilepticus (SE, n=55, 59%) and acute seizure clusters (n=15, 16%). Of those with SE, 41 patients (75%) had SE for the first time. Acute seizure clusters and SE terminated in 83% after LEV-iv administration. A total of 29 adverse events were reported in 17 of the 95 patients from the safety set. Ten of these were at least possibly related to LEV-iv treatment. Slight decrease of blood pressure during the infusion (3 patients each) was captured most frequently. No serious side effect was observed. Physicians rated the efficacy and tolerability of LEV-iv treatment as good or very good in 78% and 82% of the cases, respectively. CONCLUSION: In this large observational study of everyday practise the use of LEV-iv exhibited a remarkable good response and tolerability in patients with acute onset seizures (mostly SE). Further randomized controlled studies, like the established status epilepticus trial (ESET) are needed to confirm these findings.

QAlign: quality-based multiple alignments with dynamic phylogenetic analysis.

Integrating different alignment strategies, a layout editor and tools deriving phylogenetic trees in a 'multiple alignment environment' helps to investigate and enhance results of multiple sequence alignment by hand. QAlign combines algorithms for fast progressive and accurate simultaneous multiple alignment with a versatile editor and a dynamic phylogenetic analysis in a convenient graphical user interface.

[Grand mal series after Ecstasy abuse]. / Grand-mal-Serie nach Ecstasy-Einnahme.

The consumption of the jet set drug Ecstasy (3,4-methylenedioxymetamphetamine, abbreviated to MDMA) by young people is increasing markedly. Parallel to this development, there is a large number of reports on severe neurological, psychiatric and medical complications following the use of Ecstasy. Seizures are among the most common clinical complications of the CNS following the ingestion of Ecstasy. Our report presents the case of a 21-year-old patient, who had a series of grand mal seizures after taking 12 tablets of Ecstasy. 36 hours after ingestion the substance MDMA was demonstrated at a level of 300 ng/ml in the serum and CSF. Following treatment with Clonazepam and under an adequate level of carbamazepine, no further seizures occurred. The diagnosis was difficult because the patient initially denied the consumption of drugs and the routine toxicological screening does not contain the substance MDMA.

[Death in inverted head position]. / Tod in Kopftieflage.

A 56 year old man was found suspended in a sack in a head down position. Circumstances and autopsy findings are discussed. The leading pathophysiological mechanisms causing death are thought to be asphyxia due to compression of the chest and insufficient blood supply to the heart due to the head down position. The pathophysiological dysregulation of circulation in a head down position is discussed.

[Sonographic visualization of the pancreatic duct before and after secretin stimulation: an aid in the diagnosis of chronic pancreatitis]. / Sonographische Darstellung des Pankreasganges vor und nach Sekretinstimulation: hilfreich in der Diagnose der chronischen Pankreatitis.

In 34 patients the diameter of Wirsung's duct was measured by real-time sonography before and after intravenous application of secretin. 25 of these patients, meeting special criteria, were chosen as normal controls; 9 patients had chronic pancreatitis. Normal subjects with an average duct diameter of 1.8 mm showed an average dilatation by about 89% to a mean value of 3.4 mm, mostly within five minutes. No dilatation was seen in patients with chronic pancreatitis (average duct diameter 2.9 mm), with the exception of one patient. The authors discuss the possibility of assessing pancreatic function and of detecting the presence of a rigid duct in a fibrotic pancreas by sonography. This confirms the usefulness of the sonographic secretin test as a reliable aid in the diagnosis of chronic pancreatitis.

[Icteric hepatitis in listeriosis?]. / Ikterische Hepatitis bei Listeriose?

Icteric hepatitis was observed in a 21-year-old female patient. Titres of the agglutination reaction for listeria monocytogenes supported the likelihood of listeria infection. Further serological studies of potentially relevant viruses and bacteria remained negative.

[Ultrasonic tumor diagnosis of the stomach and intestines]. / Ultraschall ermöglicht Tumordiagnose in Magen und Darm.

A cockade-like structure, consisting of an echo-free periphery and bright central echos, is often a typical sonographic sign of a gut-wall infiltration in the gastrointestinal tract. On principle, no distinction based on contour or structure can be made sonographically between neoplastic and inflammatory tissue. The recognition of such a cockade-like structure is of importance in patients, in whom no gut-wall infiltration is suspected. Within a period of 12 months cockade-like structures have been detected in the gastrointestinal tract of 20 patients. By extensive diagnostic methods (X-ray examination, endoscopy, laparotomy) a colon carcinoma could be detected in seven, a gastric carcinoma in seven, a pancreatic carcinoma, encroaching circularly upon the duodenum, in one, and a small intestine metastasis of an ovarian carcinoma in one instances. Three typical cockade-like structures in different parts of the intestinal tract are illustrated.

[The significance of dietary fat and fiber for the aetiology of colon cancer (author's transl)]. / Zur Bedeutung des Fett- und Rohfasergehalts der Nahrung für die Entstehung des Kolonkarzinoms.

Dietary habits of 49 patients with colorectal carcinoma or precancerous adematous polyps were investigated and compared with age- and sex matched, healthy controls. The dietary fiber intake of the tumor group was not significantly lower than control. Tumour patients were found to eat more animal fat than controls, the difference not reaching statistical significance. By contrast, we found a highly significant difference in the ratio of daily dietary fat/fiber intake (p less than 0.001). The ratio was 19.1 +/- 1.1 in tumour patients and 14.5 +/- 0.6 in controls. It is concluded that in the genesis of colorectal carcinoma, the relation of dietary fat to fiber might be more important than the intake of these two dietary constituents in absolute terms.

A new quinoline-carbamate aphicide.

We found that it was nearly impossible to apply the quinoline-carbamate aphicide per os by means of synthetic diets, owing to its high feeding-deterrent-effect. After application via the roots of the host plant, this systemic compound is deposited on the leaf surface. The results suggest that the toxic effect is not the result of the oral uptake of phloem sap, but of the tarsal contact with the toxicant. Sensitivity of aphids to this compound and LD50-values were determined after topical applications.