Prospective study of the modified Atkins diet in adult drug-resistant epilepsy: effectiveness, tolerability, and adherence.

INTRODUCTION: Drug-resistant epilepsy presents high worldwide prevalence and is difficult to control despite the wide variety of available antiepileptic drugs (AED). The modified Atkins diet (MAD) is an additional treatment alternative. Several studies have addressed the use of the ketogenic diet and MAD in children with drug-resistant epilepsy, but insufficient research has been conducted into adults with the same condition. OBJECTIVE: To evaluate the effectiveness and tolerability of, and adherence to, the MAD in adults with drug-resistant epilepsy. MATERIAL AND METHODS: We conducted a 6-month pre-post prospective study at a reference hospital. Patients were prescribed the MAD with limited carbohydrate intake and unlimited fat intake. We conducted clinical and electroencephalographic follow-up according to the relevant guidelines, and assessed adverse effects changes in laboratory findings, and adherence. RESULTS: Thirty-two patients with drug-resistant epilepsy were included in the study. Patients' mean age was 30 years, mean disease progression time was 22 years, and all patients had focal or multifocal epilepsy. Thirty-four percent of patients presented > 50% decreases in overall seizure frequency (P =  .001); seizure control was greater in the first month and subsequently declined. These patients presented weight loss (RR: 7.2; 95% CI, 1.3-39.5; P = .02), good to fair adherence only in the first and third months (RR: 9.4; 95% CI, 0.9-93.6; P = .04 and RR: 0.4; 95% CI, 0.30-0.69; P = .02, respectively). Tolerability data showed that the MAD is safe: adverse effects were minor and short-lived in most cases, with the exception of mild to moderate hyperlipidaemia in one-third of patients. The adherence rate was 50% at the end of the study. CONCLUSIONS: In adults with drug-resistant focal epilepsy, the MAD showed adequate tolerability and moderate but decreasing effectiveness and adherence, probably due to a preference for a carbohydrate-based diet.

Ultrasound-guided fine-needle aspiration biopsy. Study of the cost per patient and comparison with computed tomography-guided biopsy.

Between February 1992 and July 1995, we performed 222 ultrasound-guided fine-needle aspiration biopsies (FNAB) in abdominal space-occupying lesions. The sensitivity was 90% and the specificity, 100%, with an overall diagnostic precision of 93%. We also determined the cost of each procedure (2,550 pesetas) and compared it with the cost of computerized tomography (CT)-guided biopsy (22,500 pesetas). These results and those reported in the literature indicate that there is no significant difference with respect to diagnostic yield, but that the difference in terms of expense is considerable. We believe that, in the assessment of abdominal lesions. CT-guided FNAB should be reserved for those lesions that prove inaccessible to ultrasound.

[Splenic rupture in acute pancreatitis]. / Rotura esplénica en una pancreatitis aguda.

The case of a 42-years-old male with acute pancreatitis of ethanol origin and formation of pseudocysts in the tail of the pancreas is presented. The patient suddenly presented a picture of hypovolemic shock caused by rupture of the spleen. Emergency splenectomy with resection of necrotic tissue was performed and thrombosis of the splenic vein was observed. The patient evolved satisfactorily following surgery.

[Ultrasonographic diagnosis of intestinal fistulae associated with Crohn disease]. / Diagnóstico ultrasonográfico de fístulas intestinales asociadas a enfermedad de Crohn.

In two patients with Crohn's disease, abdominal mass and fever, abdominal ultrasound disclosed enteroenteric fistula in one, and intestinal fistula associated to subcutaneous abscess in the second. We emphasize the role of ultrasound in the diagnosis of active Crohn's disease, especially as a complementary method for the detection of intraabdominal complications.