A randomized controlled trial of trypsin to treat brown recluse spider bites in Guinea pigs.

Brown recluse spider bites result in necrotic skin lesions for which there is no known antidote. Since venom toxins are proteins, a proteolytic enzyme like trypsin might be effective in reducing toxicity. The aim of this study was to conduct a randomized controlled trial of trypsin to treat brown recluse spider bites in guinea pigs. Subjects were 18 female guinea pigs. Anesthesia for injections was inhaled isoflurane. Analgesia was 0.05 mg/kg of buprenorphine twice a day as needed. Intervention was intradermal injection of 30 µg of brown recluse venom (Spider Pharm, Yarnell, AZ). Immediately after envenomation, subjects were randomized to two groups of nine: trypsin 10 µg in 1 mL normal saline and 1 mL of normal saline. The primary outcome was lesion area over a 10-day time period. Statistical analysis was performed with repeated measures ANOVA. Mean lesion area was smaller but not statistically different in the placebo group. Maximum lesion size occurred at day 4 in both groups, when lesion area was 76.1 ± 108.2 mm(2) in the placebo group and 149.7 ± 127.3 mm(2) in the treatment group. P value was 0.15 for placebo vs. treatment. This study did not establish a role for trypsin as a treatment for brown recluse spider bites in a guinea pig model.

What is the diagnostic value of repeating a nondiagnostic video-EEG study?

Repeat video-EEG (VEEG) may increase diagnostic yield, but the test is resource intensive, time-consuming, and expensive and poses some potential risks to patients. It is also relatively common to monitor a patient for several days without capturing any clinical events. The purpose of this study was to determine the diagnostic value of repeat admissions for VEEG and to determine if the commonly available clinical information could predict the diagnostic outcome, "diagnostic" or "nondiagnostic," of a repeat study. A study was deemed diagnostic if the admission resulted in a definitive diagnosis of the patient's typical events. The authors retrospectively reviewed the charts of 3,727 patients completing scalp VEEG at the University of Alabama at Birmingham Epilepsy Center from 2002 to 2009. Minors, mentally retarded patients, and patients readmitted for surgical procedures or presurgical localization were excluded. Single and multiple regressions were used to determine if any of the parameters could predict the diagnostic outcome of a repeat VEEG study. Only younger age was independently predictive of a diagnostic readmission (P < 0.05), while longer total duration of monitoring was suggestive (P = 0.07). A repeat VEEG study was useful in 55.2% of patients, most of whom were diagnosed after only 1 additional admission. In the patient population studied, 82.4% were diagnosed on the first admission (2,622 of 3,183), 52.9% on the second (46 of 87), and 40% on the third (2 of 5). Repeat VEEG admissions are useful, and clinical expertise may be the best tool for planning potential readmissions.