[Neuropsychological outcome following intrauterine exposure to valproate]. / Neuropsychologisches Outcome nach intrauteriner Valproat-Exposition: Eine Stellungnahme der Deutschen Gesellschaft für Epileptologie.

A number of recent studies suggest a link between in utero exposure to valproate (VPA) and low IQ and behavioural disorders in children of mothers with epilepsy. In this review, a commission of the German Section of the International League Against Epilepsy discusses the evidence in the literature and practical recommendations for the use of VPA in women of childbearing potential. It is concluded that despite methodological shortcomings--largely due to the complexity of the problem and small case numbers in prospective studies--the existing data are sufficiently alarming to require great caution in the use of VPA in women who could become pregnant. The underlying mechanisms of how antiepileptic drugs may lead to neurodevelopmental problems are unclear. Further prospective studies are urgently needed to clarify this clinically important issue, and a collaborative study is suggested based on the international network established by the European Registry of Antiepileptic Drugs and Pregnancy.

[Optimizing epilepsy therapy in children and adolescents with lamotrigine]. / Optimierung der Epilepsietherapie von Kindern und Jugendlichen mit Lamotrigin.

Lamotrigine is a broadly effective antiepileptic drug in mono- and add-on therapy for children and adolescents with focal and generalized epilepsies. Some epileptologists consider lamotrigine as the drug of primary choice in older school children and adolescents because of its good tolerability (no increase of body weight, no impairment of cognitive functions, due to new data probably no teratogenic properties). Lamotrigine can be used with good efficacy in numerable epilepsy diseases, such as tuberous sclerosis, juvenile neuronal lipofuscinosis and Rett syndrome. The first studies show that lamotrigine is also effective in children under 2 years of age. For therapy of difficult-to-treat epilepsies the combination of lamotrigine with valproate has proved as especially useful. This clinical observation is supported by new results of animal experiments. The dose-dependant and typical CNS side effects vertigo, ataxia, nausea, tremor and diplopia are found most frequently. The rate of allergic skin rashes which was very high before 1998 has decreased markedly by new dosage guidelines and is now as low as in older antiepileptic drugs. Lamotrigine does not impair cognitive functions, especially not memory and language. It has mood-stabilizing features and may improve quality of life. In animal experiments lamotrigine shows antiepileptogenic and neuroprotective effects.

Nurse recruitment and retention in the 19th century London teaching hospitals.

'One of the greatest difficulties which occurs in completing the arrangements of a hospital is the procuring of proper persons to act as nurses; since as much perhaps depends on the humane endeavours of a kind and attentive female as upon the ability of the medical attendant', Benjamin Golding wrote in 1819. He had just qualified as a doctor at St Thomas' and was impressed by the way a skilful nurse could often secure a patient's recovery when the doctor had given up all hope. This article addresses the problem which Golding identified, the recruitment and retention of nurses in the London teaching hospitals during the 19th century. The recruitment and retention of sisters and matrons was much less difficult, and I therefore confine my discussion to the problems involved in finding what Golding called 'proper persons to act as nurses'.

The passing of the night watch: night nursing reform in the London teaching hospitals, 1856-90.

At the beginning of the nineteenth century a separate team of women called the "night watch" was responsible for the night nursing in the London teaching hospitals. Rough, uneducated, and frequently the "scrubbers," or charwomen, who cleaned the halls and stairways in the hospitals in the daytime, the night watchers came to be closely identified with Dickens's Sarah Gamp. As the century progressed, the expanding capabilities of the new academic medicine forced an improvement in the standard of nursing. The difficulty in finding clinically experienced nurses who were willing to work nights at an affordable price, however, made it possible for the night watchers to remain in the new professionally organized hospital long after such unskilled and undisciplined workers had been phased out of other areas of the late Victorian workforce. By the end of the century when hospitals began rotating partially trained probationer, or student, nurses onto nights, the night watchers finally disappeared from the teaching hospitals.

Nursing care of pituitary surgery: an example of advanced clinical practice.

Because we have one of the leading pituitary surgeons in Canada, Dr. Harley Smyth, on our neurosurgical service we have nursed over 53f cases of pituitary tumor resection at the Wellesley Hospital. This series of patients represents a major ongoing international research project in Endocrinology and Neurosurgery and involves close teamwork between these two services and the nursing service. The paper gives a brief overview of pituitary surgery from its beginnings with Sir Victor Horsley in 1904 and details major breakthroughs since the 1960's. The three principal clinical groups of pituitary problems treated at the Wellesley are then outlined. The preoperative work-up on the endocrinology ward delineating clinical symptoms and precise hormonal values, the operation with the new anatomical approach developed by Dr. Smyth, and postoperative care with precise monitoring of fluid and electrolyte balance, methods of nasal packing, treatment of cerebrospinal fluid leaks and tracking of hormone levels are all examined in detail. We explain new developments such as the move to less steroid coverage and the better understanding of the ultrastructure and functional microbiology of pituitary tumors. We conclude by pointing out the excellent management of these patients, with a short hospital stay and much of the preoperative work-up done on an outpatient basis. As well these patients are an extremely satisfying group to nurse because of the high correction rate achieved. Finally, as nursing protocols constantly change and as we continually learn more from this research project, we emphasize the need for the flexibility and knowledge of the advanced nursing practitioner.