Effect of corticosteroids in a twin child with idiopathic localization-related epilepsy.

Corticosteroids have been used only in the treatment of special epileptic syndromes or epileptic encephalopathies, such as infantile spasms. We report an antiepileptic effect of corticosteroids that were used for treatment of nephropathy in a monozygotic twin child with idiopathic localization-related epilepsy (I-LRE). The patient and her monozygotic twin sister exhibited repeated partial seizures at two years of age and electroencephalogram (EEG) showed focal spikes in the occipital area and, on other occasions, the centro-parietal areas. After oral antiepileptic drugs were started, the twins still exhibited occasional seizures. The patient had IgA nephropathy at four years of age and intravenous methylprednisolone and oral prednisolone were administered. Her seizures and epileptiform discharges on EEG disappeared, while her sister continued to have seizures and EEG abnormalities. When the dose of oral predonisone was reduced, the seizures relapsed and EEG again revealed focal spikes. We conclude that corticosteroids exhibit efficacy towards seizures and epileptiform discharges on EEG in patients with I-LRE without epileptic encephalopathies.

The MRI findings of the right-sided fetal lung can be used to predict postnatal mortality and the requirement for extracorporeal membrane oxygenation in isolated left-sided congenital diaphragmatic hernia.

We evaluated whether a correlation existed between fetal pulmonary magnetic resonance imaging (MRI) findings and postnatal mortality, as well as the requirements for extracorporeal membrane oxygenation (ECMO) in infants with prenatally diagnosed, isolated left-sided congenital diaphragmatic hernia (CDH). Twenty-one pregnant women carrying fetuses with CDH underwent 30 MRI scans, and the right-sided fetal lung volume (FLV) was measured. In the control, a regression analysis was performed to associate FLV with gestational age. This yielded a formula that enabled the calculation of the expected right fetal lung volume (ERFLV). In cases with CDH, the right-sided observed FLV/ERFLV (= %RFLV) was compared with both the postnatal mortality and whether ECMO was required. Additionally, we investigated the relationship between the lung shape on MRI (whether there was a complete pulmonary baseline present) and postnatal mortality. The %RFLV was significantly lower in nonsurvivors compared with survivors. Among survivors, the %RFLV was significantly lower in infants who required ECMO compared with those who did not. The pulmonary baseline was completely present in 3 (38%) and 13 (100%) of the nonsurvivors and survivors, respectively. In isolated left-sided CDH, the %RFLV is a good predictor not only of postnatal mortality but also of the requirement for ECMO.

[Inter-observer agreement and validity of photographic dietary assessment].

PURPOSE: Estimation of nutritional intake from photographs of served meals has been proposed. We examined the inter-observer agreement and validity of this method for assessment of the daily diet. METHODS: Twenty-five family members (13 men and 12 women, mean age +/- SD: 47.3 +/- 5.6 years) of students in a dietetic course performed both meal photography and traditional weighed dietary records for four days. For the photo method, two observers independently identified foods and estimated their portion sizes from the photographs, converting them into energy and nutrient intake with a food composition table. The inter-observer agreement with the photo method was assessed in terms of inter-observer ratios, correlations, and coefficients of variation (CV), and the method was validated using the weighed dietary records as the reference. Its running cost was also calculated. RESULTS: The inter-observer ratios for estimation of mean daily nutritional intake ranged from 0.89 (magnesium) to 1.14 (retinol) with a median of 1.03. The correlation coefficients between observers varied from 0.65 (saturated fatty acids [SFA]) to 0.92 (vitamin C) on a daily basis (median, 0.79), and from 0.65 (SFA) to 0.96 (vitamin C) on an individual basis (median, 0.78). The CVs ranged from 7.9% (energy) to 23.8% (carotenc) (median, 13.3%), and from 5.2% (energy and magnesium) to 17.8% (carotene) (median, 8.8%) for daily and individual intake, respectively. Regarding validity, the ratios between methods (the photo method/weighed dietary records) ranged from 0.96 (potassium and SFA) to 1.11 (retinal and salt) with a median of 1.00. Correlations between the two methods were distributed from 0.40 (salt) to 0.82 (vitamin C and retinol) on a daily basis (median, 0.67), and from 0.47 (salt) to 0.90 (vitamin C) on an individual basis (median, 0.74). The CVs ranged from 10.5% (energy) to 39.6% (carotene) (median, 16.9%), and from 6.1% (protein) to 20.6% (carotene) (median, 11.2%), respectively. It was calculated to cost 105 Japanese yen per meal when using a lens-attached film for 25 shots. CONCLUSIONS: Inter-observer agreement and validity of the photo method, though varying with the nutrient, were generally acceptable. Although some modifications are needed for diners-out, the method appears to be useful as a dietary recording tool.