Preoperative evaluation using magnetoencephalography: Experience in 382 epilepsy patients.

OBJECTIVE: Identifying epilepsy patients for whom clinical MEG is likely to be beneficial avoids or optimizes burdensome ancillary investigations. We determined whether it could be predicted upfront if MEG would be able to generate a hypothesis about the location of the epileptogenic zone (EZ), and in which patients MEG fails to do so. METHODS: MEG recordings of 382 epilepsy patients with inconclusive findings regarding EZ localization prior to MEG were acquired for preoperative evaluation. MEG reports were categorized for several demographic, clinical and MEG variables. First, demographic and clinical variables were associated with MEG localization ability for upfront prediction. Second, all variables were compared between patients with and without MEG location in order to characterize patients without MEG location. RESULTS: Our patient group had often complex etiology and did not contain the (by other means) straightforward and well-localized cases, such as those with concordant tumor and EEG location. For our highly-selected patient group, MEG localization ability cannot be predicted upfront, although the odds of a recording with MEG location were significantly higher in the absence of a tumor and in the presence of widespread MRI abnormalities. Compared to the patients with MEG location, patients without MEG location more often had a tumor, widespread EEG abnormalities, non-lateralizing MEG abnormalities, non-concordant MEG/EEG abnormalities and less often widespread MRI abnormalities or epileptiform MEG activity. In a subgroup of 48 patients with known surgery outcome, more patients with concordant MEG and resection area were seizure-free than patients with discordant results. CONCLUSIONS: MEG potentially adds information about the location of the EZ even in patients with a complex etiology, and the clinical advice is to not withhold MEG in epilepsy surgery candidates. Providing a hypothesis about the location of the EZ using MEG is difficult in patients with inconclusive EEG and MRI findings, and in the absence of specific epileptiform activity. More refined methods are needed for patients where MEG currently does not contribute to the hypothesis about the location of the EZ.

Genetic analysis of dystrophic cardiac calcification in DBA/2 mice.

A DBA/2 x D2B6F1 backcross was produced in order to study the genetic background of pathological soft tissue calcification in the mouse. Calcification was assessed in the myocardium, kidney and tongue. Significant co-segregation was found with the genotype of microsatellite markers on the proximal end of Chromosome 7. This region contains a candidate gene, Hrc, coding for the histidine-rich calcium binding protein in the sarcoplasmatic reticulum. The results support the hypothesis that the gene previously reported to be responsible for DCC (dystrophic cardiac calcification) in C3H mice (1) causes generalized soft tissue calcification in DBA/2 mice.

[Presumed anaphylactic shock after infusion of Lipofundin]. / Formodet anafylaktisk shock efter Lipofundininfusion.

A case of anaphylactic shock in a 45 year old man with Hodgkin's disease following Lipofundin infusion is described. Lipofundin is a soybean oil based preparation for parenteral nutrition. Allergic reactions to lipid infusions are only very seldom described, but it is important to be aware of the possibility of anaphylaxis, as this case-story demonstrates. Allergy to soy-proteins is well-known, whereas soybean oil is not allergenic in soybean-sensitive individuals. Soy-protein, in small quantities, can be detected in soy-oil. A possible connection between the patient's reaction and soy-allergy is discussed.

Indomethacin in the management of postoperative pain.

We have examined the analgesic effects of indomethacin in a double-blind study of 56 patients undergoing surgery for lumbar disc prolapse. The patients were allocated randomly to receive either indomethacin 100 mg i.v. before surgery, followed by 100 mg rectally 6 and 12 h after surgery and at 08:00, 16:00 and 23:00 on the next day, or placebo. Postoperative pain was assessed using a 10-cm visual analogue scale at fixed times. Side effects and consumption of supplementary analgesics were recorded. Patients receiving placebo had significantly greater pain scores and significantly more patients in the placebo group required supplementary analgesics.

Treatment of ureteric colic. Intravenous versus rectal administration of indomethacin.

A randomised multicentre clinical trial was undertaken to compare the effect on pain of indomethacin administered either intravenously or rectally to 116 patients with ureteric colic. Adverse reactions were also assessed. Of the patients receiving the intravenous injection, 48/53 (91%) achieved good pain relief (i.e. no supplementary analgesia was required) 30 min after administration, compared with 46/63 (73%) receiving the enema. Significantly more side effects occurred in the group treated intravenously. It was concluded that indomethacin administered as an enema was less effective than the intravenous form, but it should be regarded as a good alternative in the treatment of ureteric colic.