Seizures may occur after orthotopic liver transplantation. Antiepileptic drugs (AEDs) are used to treat these seizures, but the immunosuppressant regimen also may be altered. Levetiracetam is an attractive treatment because of its efficacy, lack of hepatic enzyme induction, and its rapid attainment of serum levels. Treatment with levetiracetam is efficacious, and levetiracetam-treated patients require significantly lower doses of immunosuppressant medications to achieve an equivalent antirejection effect.

Background: CD4+CD28– lymphocytes are implicated in the destabilization of atheromatous plaque, leading to acute coronary episodes. One may ask whether these cells play a similar role in ischemic stroke pathogenesis with an atherosclerotic background. Methods: Flow cytometry was applied to determine the percentage of CD4+CD28– lymphocytes in the peripheral blood of patients during the acute phase of their first ischemic stroke (group I) and in patients without a history of stroke but with two of the most important risk factors (hypertension, diabetes) for atherosclerosis-related ischemic stroke (group II). The results were compared with healthy controls. Results: The median percentages of CD4+CD28– lymphocytes in groups I and II did not differ significantly, but for each of these groups the percentage was higher than in the control group. The time of blood sampling from onset of stroke, presence of the ischemic focus in the CT brain scan and severity of neurological deficits did not correlate with the percentage of CD4+CD28– lymphocytes. Conclusions: We conclude that CD4+CD28– lymphocytes are implicated in mechanisms enhancing the risk of acute ischemic stroke and not a consequence of stroke.

Critically ill patients can present at any time and location, and they demand high quality care. Historical experiences from military, wilderness, and disaster medicine settings have helped shape the modern concept of caring for the most severely ill with limited available resources. We introduce a method to help design a successful critical care medical support endeavor, which includes properly defining components of Navigation, Environment, Resupply, Energy, Unconventional problems, and Support (NEREUS). Additionally, we provide recommendations for optimal team personnel composition, including utilization of paramedics, critical care providers, nurses, and respiratory therapists across the spectrum of care provided at point of injury, en route to definitive care, and definitive care. A review of critical care principles relevant to the austere setting proceeds with a systematic organization according to airway, breathing, circulation, and neurologic management. Lastly, we employ our proposed method of organizing a critical care medical support endeavor to a post-hurricane scenario. In summary, this review provides the historical background, modern definition, and practical framework for successfully administering critical care in scenarios with limited available resources. We emphasize the need to appropriately adapt critical care concepts to meet the unique demands of a specific scenario.

No abstract

No abstract