We evaluated 44 old patients (mean age 84 years) in order to study the frequency of hedaches. The frequency found in our sample is higher in comparison to other studies. Further studies including a larger number of patients are needed to obtain more incisive results.

Backgrounds/Aims: The World Health Organization estimates the annual worldwide incidence of death by drowning to be about 400,000. Deaths from drowning are more common in young children, representing 27% of deaths at 1–4 years from unintentional injury in the US.Drowning victims develop hypoxaemia related to the acute lung injury as a result of surfactant disruption. The severe lung dysfunction leads to alveolar collapse, atelectasis and intrapulmonary shunting and often progresses to acute respiratory distress syndrome (ARDS). Surfactant replacement therapy has been shown to reduce mortality and complications in prematures and neonates with severe respiratory distress syndrome(RDS). Administration of surfactant to adults with ARDS has received great attention and specific patients may benefit from surfactant treatement; however more studies are needed.This Case report describes our experience with a 18 months child affected by a severe ARDS from freshwater near-drowning and treated with a single dose of surfactant (Curosurf).Methods: While she was unatended, a little 18 months girl fell in a big basin full of freshwater. Her face remained under water for 3–5 min. Her parents rescued her and started a basic CPR. They transported her to the nearest hospital where she was intubated and ventilated. Medical staff continued CPR and started acidosis correction, noradrenaline infusion (0,1 mcg/kg/min), antibiotics and corticosteroids therapy. Finally both pupils reacted to light. The patient had severe combined acidosis whith pH 7.09, but normal electrolytes. On ICU admission, 270 min after the submersion, her GCS was 8, BP 100/60mmHg, HR 120. A chest X-Ray showed bilateral infiltrates, subatelectasis and an increased cardiothoracic ratio.The rectal temperature was almost normal.The pulse oximetry revealed a saturation 100% with FiO2 =1. After repeated suctioning and recruitment manoevres a 240 mg dose of Surfactant (Cursurf) in volume of 50 ml of normal saline was injected intratracheally during a fiberoptic broncoscopy (mg/5ml). The ET tube was connected to the pressure controlled ventilation. The patient was also treated with antibiotics (ceftriaxone and amikacin), corticosteroids (desametasone), ranitidine, phenobarbital, fluids therapy and rewarming.Results: The first blood gas 3 hours after surfactant administration showed PaO2/FiO2 ratio of blood gas analysis 0h (144) -3 h (407), 6h (431), 12h (471), -18h (474).and chest X-Rays were checked at 6–12-18 hours and revealed a rapid improvement of oxygenation and respiratory distress. Electroencephalography and neurological evaluation were normal. An Echocardiography revealed normal ventricular function and minor ventricular septal decreased contractility.Conclusions: The key pathophysiological feature in drowning is hypoxia. In our experience surfactant replacement had drammatically improved oxygenation. Prompt resuscitation is crucial for optimal survival: that means good neurological outcome.

The potential efficacy of temporal and extratemporal resection in patients with partial epilepsy uncontrolled by anti-epileptic drugs is undisputed. However, there are still uncertainties about which patients will benefit most. A systematic review of the available literature has been undertaken by four pairs of reviewers to assess the overall outcome of epilepsy surgery and to identify factors better correlated to seizure outcome. A Medline search for studies on epilepsy surgery published since 1984 was performed. Studies were included if they had a well-defined population and design, a sample size of at least 30 patients, an MRI performed in least 90% of cases, an expected duration of follow-up of at least one year, and a post-operative outcome measured as seizure remission. A good outcome was considered as seizure control or seizure-free status for at least one year or Engel class I. Based on the review of 47 articles meeting all the eligibility criteria, febrile seizures (odds ratio, OR, 0.48; 95% confidence interval, CI, 0.27-0.83), mesial temporal sclerosis (OR 0.47; 95% CI 0.35-0.64), tumors (OR 0.58; 95% CI 0.42-0.80), abnormal MRI (OR 0.44; 95% CI 0.29-0.65), EEG/MRI concordance (OR 0.52; 95% CI 0.32-0.83), and extensive surgical resection (OR 0.24; 95% CI 0.16-0.36) were the strongest prognostic indicators of seizure remission (positive predictors); by contrast, post-operative discharges (OR 2.41; 95% CI 1.37-4.27) and intracranial monitoring (OR 2.72; 95% CI 1.60-4.60) predicted an unfavorable prognosis (negative predictors). Firm conclusions cannot be drawn for extent of resection, EEG/MRI concordance and post-operative discharges for the heterogeneity of study results. Neuromigrational defects, CNS infections, vascular lesions, interictal spikes, and side of resection did not affect the chance of seizure remission after surgery. Despite a number of limitations, the results of the review provide some insight into the selection of the best surgical candidates in clinical practice but raise concerns on the quality of published reports, and may serve as the basis for the identification of better standards to assess surgical outcome in observational studies.

Objective: To evaluate the value of alternative monotherapy versus adjunctive therapy in partial epilepsy refractory to single antiepileptic drug (AED) therapy. Design and methods: In a multicentre, parallel-group, open-label study, patients with cryptogenic or symptomatic partial epilepsy not controlled after single or sequential AED monotherapies were randomised to monotherapy with an alternative AED or to adjunctive therapy with a second AED. The AED to be added/substituted and dose adjustments were determined by the physician’s best judgement. Patients were followed up until withdrawal from the allocated treatment or for 12 months, whichever first. Outcome measures included proportion of patients continuing on the assigned treatment strategy, proportion of patients seizure-free after achieving the target maintenance dose, and adverse effects rates. Data were analysed by actuarial life tables, Kaplan–Meier survival analysis and Cox proportional hazard regression model. Results: Of a total of 157 patients (including 94 previously exposed to only one AED), 76 were randomised to alternative monotherapy and 81 to adjunctive therapy. The two groups were balanced in clinical characteristics. The 12-month cumulative probability of remaining on the assigned treatment was 55% in patients randomised to alternative monotherapy and 65% in those randomised to adjunctive therapy (P=0.74). The 12-month probability of remaining seizure-free was 14 and 16%, respectively (P=0.74). Adverse effects were similar in the two groups. No significant differences in outcome within or between groups were identified based on etiology of epilepsy and previous AED exposure. Conclusions: Although these findings should be interpreted with caution due to the low statistical power resulting from the relatively small sample size, alternative monotherapy and adjunctive therapy were associated with similar outcomes. Further work is required to determine whether outcome could be improved through identification of specific AED combinations with synergistic activity.

The use of a laryngeal mask airway (LMA) on two occasions, in a 53-day-old and 270-day-old male infant with Tessier N.3 and N.4 facial defects, using sedation and topical anaesthesia is described. The LMA was used to manage the airway and facilitate inhalation induction of anaesthesia as the facial deformities were thought to be too extensive for the safe use of a facemask. The LMA is an alternative to a facemask and secures the airway and facilitates the inhalation induction of anaesthesia in paediatric patients with severe facial deformities.

Laparoscopic surgery is an emerging procedure in the treatment of many surgical pathologies. Laparoscopy in the paediatric patient reduces surgical trauma and improves cosmetic RESULTS. Physiological changes during laparoscopic surgery are mainly related to the increased intra-abdominal pressure (IAP) associated with CO2 insufflation of the abdomen, the patient's postural modifications (head-up or head-down) and CO2 absorption and its general effects. Increases in IAP affect both ventilation and circulation. Increased IAP induces a mechanical compression of the diaphragm that reduces pulmonary compliance, vital capacity, functional residual capacity (FRC) and total lung volume. Pneumoperitoneum in children has a major impact on cardiac volumes and function, mainly through the effect on ventricular load conditions. The acute increase in IAP affects both preload and afterload, while the systolic cardiac performance remains unchanged. During anaesthesia for videolaparoscopy it is important not to exceed an intrabdominal pressure of 6 mmHg in newborns and infants and 12 mmHg in older children. In our clinical experience the respiratory, cardiocirculatory and temperature parameters have been slightly influenced during laparoscopy, but have always been maintained within the normal ranges. Laparoscopic videosurgery in newborns, infants and paediatric age group patients can be performed safely and with satisfactory clinical results.

Objective: To establish whether chronic alcoholism and alcohol consumption are risk factors for developing a first symptomatic epileptic seizure.Methods: Multicentre case-control study of 293 patients (160 men, 133 women) with a first seizure symptomatic (either acute or remote) of head trauma, stroke, or brain tumour, matched to 444 hospital controls for centre, sex, age ( 5 years), and underlying pathology.Results: The risk of first seizure in alcoholics was no higher than in non-alcoholics for men (odds ratio 1.2, 95% confidence interval 0.4 to 3.2) or women (1.5, 0.1 to 54.4). The odds ratio (both sexes) was 1.2 (0.8 to 1.7) for an average intake of absolute alcohol of 1-25 g/day, 0.9 (0.5 to 1.5) for 26-50 g/day, 1.6 (0.8 to 3.0) for 51-100 g/day, and 1.4 (0.5 to 3.5) for > 100 g/day.Conclusions: We found no evidence of an association between alcohol use or alcoholism and a first symptomatic seizure.

The Cochrane Collaboration (CC) is an international organization involving 16 national centers around the world, set up in response to the need for collecting all randomized controlled trials on health care interventions, with the aim of facilitating and coordinating the preparation, maintenance and dissemination of periodic systematic reviews of these trials. These are prepared by Collaborative Review Groups (CRGs) working together in an area of common interest under the guidance of an editorial team, supported by national Cochrane centers. Nine CRGs are involved in each neurological field, with more than 300 reviewers and members of editorial teams. For a review to be called a ‘Cochrane review’, it must be structured in the format outlined in the Cochrane Handbook. It is then published and disseminated through the Cochrane Database of Systematic Reviews (CDSR) in the Cochrane Library (CL). Each Cochrane review is prepared using the Review Manager software distributed to CRGs by CC. The editorial team is responsible for assembling an edited module of reviews prepared by CRGs for incorporation and dissemination using electronic media through the CDSR located in the CL. The CL contains information about the CC and 4 other databases: the Database of Abstracts of Reviews of Effectiveness, the Cochrane Controlled Trials Register, the Cochrane Review Methodology Database and the NHS Economic Evaluation Database. The authors use an example of Cochrane reviews about cerebrovascular disorders to illustrate that the CL is a powerful source of evidence for answering clinical questions and providing information as a basis for therapeutic decisions, for the improvement of neurological practice. A new initiative, the Cochrane Neurological Network, has recently been set up with the aim of improving communication among neurological CRGs, and between them and health care professionals interested in neurological diseases so as to update neurologists on the activity of the CC.

BACKGROUND:Latex intraoperative allergy is more and more frequent, especially in at groups risk (patients with spina bifida or congenital genitourinary abnormalities, pluri-operated patients, atopic subjects) and in pediatric age. The main problem of this allergy consists in the necessity of a strict collaboration of many specialists, in order to identify and safeguard the patient.METHODS:Our experience has pointed out an interdisciplinary perioperative management able to: 1. identify patients affected by latex allergy; 2. submit them to a latex-safe perioperative proceeding; 3. check their conditions with periodical tests. Selecting patients through a history and a list of questions, identifying profiles of typical risk patients, organizing the operating room with latex-free materials and equipment were the most important issues. Since November 1997 to December 1999 eighteen latex-safe perioperative proceedings have been carried out on 8 subjects (2 with esophageal atresia, 4 with bladder exstrophy and 2 with cloacal exstrophy); 2 of them were emergency cases.RESULTS:No allergic reactions and no proceeding-linked complications have been registered. Operators have always been satisfied by materials and equipment. Anesthesiological and surgical times resulted equal to those without latex-safe management.CONCLUSIONS:This perioperative management of potential or verified latex allergic patients turned out to be valid, safe and easy in practical application.

The paediatric diaphragmatic disease can be corrected by laparoscopic approach in patients with good cardiorespiratory conditions and mild symptoms. Since 1998 we have treated 4 patients affected by different diaphragmatic lesions: two Morgagni-Larry hernias, one recurrent left Bochdalek hernia and one diaphragmatic dysontogenetic cyst. All the desfects were sutured without the use of a mesh. At the follow up,all the children stay well and there are no signs of recurrence at chest x-rays. Therefore,we can affirm on the basis of our experience the use of laparoscopic technique is a valid alternative to laparotomy in selected patients.

Summary: Purpose: The social implications of epilepsy are ill‐defined, and there are no comparative findings from different countries. A multicenter cohort study has recently been completed on the risk of morbidity and accidents. The main social issues in the study population (patients with epilepsy and control subjects) are investigated and correlated to the clinical features of the disease.

Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare disease. It is about an abnormal proliferation of mesenchymal elements and failure of maturation of bronchiolar structures, characterized by the replacement of normal pulmonary tissue with "cysts" in variable size and number. These lesions communicate with the tracheobronchial tree. During fetal period hydrops and polyhydramnios can be associated with CCAM. A cystic adenomatoid malformation can be detected by antenatal ultrasound, and, at the birth, it is confirmed by chest radiography. From January 1990 to December 1998, 24 cases with CCAM came to our observation; 16 of these patients underwent surgery and 14 have come to a complete recovery. The newborns, with CCAM, can show early acute respiratory distress for rapid expansion of the cysts leading to compression of normal lung and mediastinal shift. Conventional mechanical ventilation may cause further expansion of the involved lobe with a ball-valve effect: this take a clinical deterioration. Perioperative ventilatory management with high frequency oscillation (HFO) is useful to stabilize and to improve arterial blood gases of this patients. At the moment, thanks to the early prenatal sonographic diagnosis, it is possible, and strongly advisable, after adequate serial checkings during the pregnancy, to refer CCAM cases to a tertiary centre that is properly equipped, where a poly-specialist team consisting of obstetrician, neonatologist, pediatric anesthetist and pediatric surgeon, will be able to plan and arrange in the best treatment necessary for the newborn.

EpilepsiaVolume 37, Issue 10 p. 917-921 The Cochrane Collaboration: Systematic Reviews and Their Relevance to Epilepsy A. Marson, Corresponding Author A. Marson The Walton Centre for Neurology and Neurosurgery, Liverpool, U.K.Address correspondence and reprint requests to Dr. A. Marson at Department of Neurological Science, Faculty of Medicine, Walton Hospital, Rice Lane, Liverpool L9 1AE, U.K.Search for more papers by this authorE. Beghi, E. Beghi Istituto “Mario Negri,” Milan ItalySearch for more papers by this authorA. Berg, A. Berg School for Allied Health Professions, Illinois, U.S.A.Search for more papers by this authorD. Chadwick, D. Chadwick The Walton Centre for Neurology and Neurosurgery, Liverpool, U.K.Search for more papers by this authorC. Tonini, C. Tonini The Walton Centre for Neurology and Neurosurgery, Liverpool, U.K.Search for more papers by this author A. Marson, Corresponding Author A. Marson The Walton Centre for Neurology and Neurosurgery, Liverpool, U.K.Address correspondence and reprint requests to Dr. A. Marson at Department of Neurological Science, Faculty of Medicine, Walton Hospital, Rice Lane, Liverpool L9 1AE, U.K.Search for more papers by this authorE. Beghi, E. Beghi Istituto “Mario Negri,” Milan ItalySearch for more papers by this authorA. Berg, A. Berg School for Allied Health Professions, Illinois, U.S.A.Search for more papers by this authorD. Chadwick, D. Chadwick The Walton Centre for Neurology and Neurosurgery, Liverpool, U.K.Search for more papers by this authorC. Tonini, C. Tonini The Walton Centre for Neurology and Neurosurgery, Liverpool, U.K.Search for more papers by this author First published: October 1996 https://doi.org/10.1111/j.1528-1157.1996.tb00526.xCitations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat REFERENCES 1 Antman EM, Lau J, Kupelnick B, Mosteller K, Chalmers TC. A comparison of results of randomized control trials and recommendations of clinical experts. JAMA 1992; 268: 240–8. 2 Dickersin K, Scherer R, Lefebvre C. Identifying relevant studies for systematic reviews. Br Med J 1994; 309: 1286–91. 3 Cochrane AL. Effectiveness and efficiency: random reflections on health services. Cambridge : Cambridge University Press, 1989. 4 Chalmers I, Enkin M, Keirse MJNC. Effective care in pregnancy and childbirth. Oxford : Oxford University Press, 1989. 5 MW Enkin, MJNC Keirse, MJ Renfrew, JP Neilsen, C Crowther, eds. Pregnancy and childbirth module. The Cochrane database of systematic reviews; Oxford: update software, 1996. London : BMJ Publishing Group, 1996. 6 ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988; 2: 349–60. 7 Crowley P. Corticosteroids prior to preterm delivery (revised August 19, 1994). In: MW Enkin, MJNC Keirse, MJ Renfrew, JP Neilson, C Crowther, eds. Pregnancy and childbirth module. The Cochrane Pregnancy and Childbirth Database; issue 2, Oxford: update software; 1995. Available from London : BMJ Publishing Group, 1995. 8 Dickersin K, Hewitt P, Mutch L, Chalmers I, Chalmers TC. Perusing the literature: comparison of MEDLINE searching with a perinatal trials database. Controlled Clin Trials. 1985; 6: 306–17. 9 Teo KK, Yusuf S, Collins R, Held PH, Peto R. Effects of intravenous magnesium in suspected myocardial infarction: overview of randomized trials. Br Med J 1991; 303: 1499–503. 10 ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group ISIS-4. A randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction. Lancet 1995; 345: 669–85. 11 Light JL, Pillemer DB, Summing up; the science of reviewing research. Boston : Harvard University Press, 1984: 50–103. 12 Vickery BG, Hays RD, Engel J Jr, et al. Outcome assessment for epilepsy surgery: the impact of measuring health related quality of life. Ann Neurol 1995; 37: 158–66. 13 Commission on Epidemiology and Prognosis, International League Against Epilepsy. Guidelines for epidemiologic studies on epilepsy. Epilepsia 1993; 34: 592–6. 14 Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989; 30: 389–99. 15 Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 1981; 22: 489–501. 16 Coatsworth JJ. Studies on the efficacy of marketed antiepileptic drugs. Bethesda , MD : U.S. Department of Health, Education and Welfare, 1971. 17 Gram L, Bentsen KD, Parnas J, Flachs H. Controlled trials in epilepsy: a review. Epilepsia 1972; 23: 491–519. 18 Mumford JP, Dam M. Meta analysis of European placebo controlled studies of vigabatrin in drug resistant epilepsy. Br J Clin Pharmacol 1989; 27(suppl): 101s–7s. 19 Richens A, Yuen AW. Overview of the clinical efficacy of lamotrignine. Epilepsia 1991; 32(suppl): S13–6. 20 Haines ST, Casto DT. Treatment of infantile spasms. Ann Pharmacother 1994; 28: 779–91. 21 Newton RW. Randomised controlled trials of phenobarbitone and valproate in febrile convulsions. Arch Dis Child 1988; 63: 118–91. 22 Berg AT, Shinnar S, Hauser WA, Leventhal JM. Predictors of recurrent febrile seizures: a meta-analytic review. J Pediatr 1990; 116: 329–37. 23 Berg AT, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review [Review]. Neurology 1991; 41: 965–72. 24 Berg AT, Shinnar S. Relapse following discontinuation of antiepileptic drugs: a meta-analysis. Neurology 1994; 44: 601–8. 25 Marson AG, Chadwick. How easy are randomized controlled trials in epilepsy to find?: the sensitivity and precision of two Medline searches. Epilepsia 1996; 37: 377–80. Citing Literature Volume37, Issue10October 1996Pages 917-921 ReferencesRelatedInformation

The electroencephalographic changes of 12 patients submitted to anaesthesia with low dosages of propofol (4-2 mg/kg/h + fentanyl) for peripheral vascular surgery have been studied. The standard induction dose of propofol was 2 mg/kg for all the patients. The EEG recording was carried out during the whole length of anaesthesia and the EEG changes were analysed during induction and maintenance phases. During surgical anaesthesia it was always easy to read EEG and also to detect eventual cerebral suffering. On the basis of our results we can suggest this anesthesiologic technique for surgery (for example: carotid surgery) requiring a continuous monitoring of the cerebral function during intra and postoperative phases.

The biochemical characteristics of the protein kinase (PK; adenosine triphosphate-protein phosphotransferase, EC 2.7.1.37) isozymes in subcellular preparations from normal human brain cortex and glioblastoma were investigated after chromatography on diethylaminoethyl cellulose, and the following results have been obtained. Two major isozyme forms, eluted by 50 and 200 mM phosphate buffer, are present in both cytosol and membrane-derived preparations from cerebral cortex. Furthermore, these isozyme forms have properties similar to those referred to as type I and type II cyclic adenosine 3':5'-monophosphate-dependent PK. In these chromatographic isozymes, cyclic adenosine 3';5'-monophosphate is more active in stimulating the basal PK enzyme than is cyclic guanosine 3':5'-monophosphate. In glioblastoma, the PK activity from cytosol and particulate preparations is resolved by diethylaminoethyl cellulose in four peaks. In cytosol, the major portion of the enzyme is eluted with a 300 mM buffer (about 50% of the total basal PK activity) and is cyclic nucleotide dependent. On the contrary, in glioblastoma particulate, the PK enzyme is mainly eluted at 50 and 100 mM buffer; neither of these isozymes is cyclic nucleotide dependent. As for cytosol, only the particulate isozyme eluted at 300 mM buffer is strongly activated by cyclic nucleotides. Finally, in both glioblastoma subcellular preparations, only a type II cyclic adenosine 3':5'-monophosphate-dependent PK is present.

The levels of the cyclic adenosine 3′,5′-monophosphate (cyclic AMP)-phosphodiesterase (PDE) and the biochemical properties of its endogenous protein activator (PDEA) obtained from the human brain cortex and from different types of human cerebral tumours have been evaluated.