Levetiracetam (LEV) is effective for treating localisation-related epilepsy, but it is uncertain whether it is effective for treating idiopathic generalised epilepsy. We compared 12-week baseline and LEV treatment periods for patients with generalised seizure types-myoclonic, tonic-clonic and absence seizures--who had failed other anticonvulsants. The majority of 55 patients (76%) had >50% seizure reduction with LEV therapy, 40% became seizure-free; 15% discontinued LEV due to adverse events, mostly sedation. This is preliminary evidence that LEV is effective for treating idiopathic generalised epilepsy.

The purpose of this study was to evaluate the effect of different flow rates and pressures on the degree of shunting of blood flow by the arterial filter purge line in a simulated neonatal cardiopulmonary bypass circuit. The circuit was primed with heparinized bovine blood (hematocrit 24%) and postfilter pressure was varied from 60-180 mm Hg (20 mm Hg increments) using a Hoffman clamp. Trials were conducted at flow rates ranging from 200-600 ml/min (100 ml/min increments). During trials conducted at a postfilter pressure of 60 mm Hg, 42.6% of blood flow was shunted through the purge line at a flow rate of 200 ml/min, whereas only 12.8% of flow was diverted at a flow rate 600 ml/min. During trials conducted at a postfilter pressure of 180 mm Hg, 82.8% of blood flow at 200 ml/min and 25.9% of blood flow at 600 ml/min was diverted through the open arterial purge line. The results of this study confirm that a significant amount of flow is diverted away from the patient when the arterial purge line is open. Shunting of blood flow through the arterial purge line could result in less effective tissue perfusion, particularly at low flow rates and high postfilter pressures. To minimize hypoperfusion injury, a flow probe (distal to the arterial filter) may be used to monitor real-time arterial flow in the setting of an open arterial filter purge line.

The objective of this study was to evaluate the effect of flow rate and perfusion mode on the delivery of gaseous microemboli in a simulated pediatric cardiopulmonary bypass (CPB) circuit with an open arterial filter purge line using a novel ultrasound detection system. The circuit was primed with 450 ml fresh, heparinized bovine blood plus 200 ml Lactated Ringer's solution (total volume 650 ml, corrected Hct 25%). After the injection of 5 ml air into the venous line, an Emboli Detection and Classification (EDAC) Quantifier (Luna Innovations, Inc., Roanoke, VA) was used to simultaneously record microemboli counts at postpump, postoxygenator, and postarterial filter sites. Trials were conducted at four different flow rates (500, 750, 1,000, 1,250 ml/min) and two perfusion modes (pulsatile, nonpulsatile). Microemboli counts uniformly increased with increasing pump flow rates. In all trials, the majority of gaseous microemboli detected in the simulated pediatric CPB circuit were<20 microm in diameter. At the lowest flow rate tested (500 ml/min), all microemboli (>10 microm) were cleared from the circuit by the oxygenator and arterial filter. Clearance efficiency was decreased at higher flow rates (750-1,250 ml/min). Over 98% of microemboli detected at the postoxygenator site were <40 microm in diameter. In general, pulsatile flow delivered more microemboli to the circuit at postpump and postoxygenator sites than nonpulsatile flow. The results of this study confirmed that entrained air from the venous line could be delivered to the systemic circulation (as represented by our pediatric pseudo patient) at flow rates from 750 to 1,250 ml/min, despite the presence of an arterial filter and open arterial filter purge line. All of the microemboli distal to the arterial filter were smaller than the conventional detectable level of 40 microm.

PurposeWe sought to report outcomes and toxicity in patients with hepatocellular carcinoma (HCC) who received resin yttrium-90 selective internal radiation therapy (90Y-SIRT) and to identify factors associated with declining liver function.MethodsPatients treated with 90Y-SIRT were retrospectively evaluated. Radiographic response was assessed using RECIST 1.1. Median liver progression-free survival (LPFS) and overall survival (OS) were calculated using the Kaplan–Meier method. Bivariate analysis was used to examine associations between change in Child-Pugh (CP) score/class and patient characteristics and treatment parameters.ResultsTwenty-seven patients with unresectable HCC underwent SIRT, 52% were CP Class A, 48% were Class B, 11% were BCLC stage B, and 89% were stage C. Forty-four percent of patients had portal vein thrombus at baseline. One-third of patients received bilobar treatment. Median activity was 32.1 mCi (range 9.18–43.25) and median-­absorbed dose to the liver was 39.6 Gy (range 13.54–67.70). Median LPFS and OS were 2.5 and 11.7 months, respectively. Three-month disease control rate was 63 and 52% in the target lesions and whole liver, respectively. New onset or worsened from baseline clinical toxicities were confined to Grade 1–2 events. However, new or worsened Grade 3–4 laboratory toxicities occurred in 38% of patients at 3 months and 43% of patients at 6 months following SIRT (six had lymphocytopenia, three had hypoalbuminemia, and two had transaminasemia). After 3 months, six patients had worsened in CP score and five had worsened in class from baseline. After 6 months, four patients had worsened in CP score and one had worsened in class from baseline. Pretreatment bilirubinemia was associated with a 2+ increase in CP score within 3 months (P = 0.001) and 6 months (P = 0.039) of 90Y-SIRT. Pretreatment transaminasemia and bilirubinemia were associated with increased CP class within 3 months of SIRT (P = 0.021 and 0.009, respectively).Conclusion90Y-SIRT was well-tolerated in patients with unresectable HCC, with no Grade 3–4 clinical toxicities. However, Grade 3–4 laboratory toxicities and worsened CP scores were more frequent. HCC patients with pretreatment bilirubinemia or transaminasemia may be at higher risk of experiencing a decline in liver function following 90Y-SIRT.

Patients with primary and secondary liver cancers generally have a poor prognosis with limited potentially curative options. Liver-directed, intra-arterial therapies such as selective internal radiotherapy (SIRT) and trans-arterial chemoembolization (TACE) are taking a larger role in the management of these patients. The current standard of therapy is for delivery of SIRT or TACE particles through an end-hole microcatheter. Antireflux microcatheters (ARM) are a novel class of microcatheters designed to enhance intra-arterial therapies. These catheters are designed with a flexible tip at the end of the microcatheter, which partially collapses during systole and expands during diastole, reducing antegrade and retrograde particle reflux while allowing for forward flow. Initially designed to reduce the risk of particle reflux during SIRT, there is evidence that ARMs may lead to improved particle distribution to tumors during SIRT. Furthermore, ARMs improve embolization efficiency which may lead to improved disease response from TACE for patients with hepatocellular carcinoma.