Subcutaneous recording using electroencephalography (EEG) has the potential to enable ultra-long-term epilepsy monitoring in real-life conditions because it allows the patient increased mobility and discreteness. This study is the first to compare physiological and epileptiform EEG signals from subcutaneous and scalp EEG recordings in epilepsy patients. Four patients with probable or definite temporal lobe epilepsy were monitored with simultaneous scalp and subcutaneous EEG recordings. EEG recordings were compared by correlation and time-frequency analysis across an array of clinically relevant waveforms and patterns. We found high similarity between the subcutaneous EEG channels and nearby temporal scalp channels for most investigated electroencephalographic events. In particular, the temporal dynamics of one typical temporal lobe seizure in one patient were similar in scalp and subcutaneous recordings in regard to frequency distribution and morphology. Signal similarity is strongly related to the distance between the subcutaneous and scalp electrodes. On the basis of these limited data, we conclude that subcutaneous EEG recordings are very similar to scalp recordings in both time and time-frequency domains, if the distance between them is small. As many electroencephalographic events are local/regional, the positioning of the subcutaneous electrodes should be considered carefully to reflect the relevant clinical question. The impact of implantation depth of the subcutaneous electrode on recording quality should be investigated further. NEW & NOTEWORTHY This study is the first publication comparing the detection of clinically relevant, pathological EEG features from a subcutaneous recording system designed for out-patient ultra-long-term use to gold standard scalp EEG recordings. Our study shows that subcutaneous channels are very similar to comparable scalp channels, but also point out some issues yet to be resolved.

SUMMARYEosinophilic cystitis (EC) is a rare disease. We describe three cases, where presentations of the disease are similar. To highlight probable causes of the disease, symptoms, clinical findings and treatment modalities, we reviewed 56 cases over a 10-year period. The most common symptoms were frequency, dysuria, urgency, pain and haematuria. Common clinical findings were presence of bladder mass, peripheral eosinophilia and thickened bladder wall. A variety of medical treatments were used, most frequently steroids, antibiotics and antihistamines. Recurrence occurred in patients on tapering or discontinuing prednisone, among other reasons. There is no consensus about the treatment of EC, but In light of our findings in this review, the treatment of choice in our department will be tapered prednisone over 6-8 weeks in combination with antihistamine.

BackgroundPain has a wide spectrum of effects on the body and inadequately controlled postoperative pain may have harmful physiologic and psychological consequences and increase morbidity. In addition, opioid anesthetic agents in high doses can blunt endocrine and metabolic responses following surgery and are associated with side effects including dizziness, nausea, vomiting, constipation, and respiratory depression.ObjectivesThe current study aimed to investigate if unilateral ultrasound-guided transverse abdominal plane block (TAP-block) could reduce pain and postoperative use of patient requested analgesics following nephrectomy compared to local injection of the same ropivacaine dose in the surgical wound.Patients and MethodsRetrospective chart reviews were performed in 42 consecutive patients who received TAP-block in conjunction with nephrectomy from November 2013 to August 2014 (group A). For comparison, data were used from 40 other nephrectomy patients registered as part of a previous study (group B). In this group the patients had received local ropivacaine injection in the surgical wound. On univariate analyses, the groups were compared by t-test and the Fisher exact test. Multivariate analyses were conducted by multiple linear regression.ResultsMean surgical time was 162 minutes in group A and 92 minutes in group B (P < 0.0001). The means of visual analogue scale (VAS) were 3.05 and 1.55 in A and B groups, respectively (P = 0.001). The means of morphine consumption were 5.2 mg and 5.9 mg in groups A and B, respectively (P = 0.58); while the means of sufentanil use were 9.8 μg and 6.0 μg in groups A and B, respectively (P = 0.06). When controlling for age, tumor size and American society of anesthesiologists classification (ASA) score on multivariate analysis, TAP-block was associated with a significant increase in VAS (+1.4 [95% CI, 0.6 - 2.3], P = 0.001) and sufentanil use (+6.2 μg [95% CI, 2.3 - 10.2], P = 0.003). There was no difference in morphine use on multivariate analysis (P = 0.99).ConclusionsTAP-block in conjunction with laparoscopic nephrectomy did not reduce pain or opioid consumption. On the contrary, it seemed to prolong surgical time.

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BACKGROUND AND AIMS Renal cell carcinoma (RCC) is the most common malignant kidney tumour, with clear cell RCC (ccRCC) accounting for 70–80% of all cases.1 Approximately 15–20% of patients have primary metastatic RCC at diagnosis, and 15–20% of those who receive curative treatment for localised tumours will experience recurrence within 5 years of follow-up.2 Despite standard radiological imaging follow-up protocols, 30% of recurrences are found outside these protocols, and only 10% of patients with recurrent disease have curable tumours.3,4 The search for prognostic biomarkers in RCC has led to investigations of the soluble urokinase-type plasminogen activator receptor (suPAR), a non-specific marker of systemic inflammation.5,6 suPAR has been associated with detection and survival in various diseases, including RCC.7-9 In this study, the authors’ aim was to investigate the prognostic accuracy of pre-operative plasma suPAR in predicting recurrence and survival in patients who received curative intent treatment for localised ccRCC. The authors hypothesised that an elevated pre-operative suPAR would be correlated with poorer overall survival and recurrence-free survival. MATERIALS AND METHODS Plasma from 235 patients with pathologically confirmed ccRCC and stored in a Danish National Biobank were identified for this study. Demographic and pathological data were extracted from patients’ electronic medical records. The level of suPAR, along with other factors such as age, gender, method of treatment, T-stage, Fuhrman grade, Charlson Comorbidity Index (CCI) score, presence of hypertension, level of C-reactive protein, level of haemoglobin, and presence of symptoms were analysed. The concentration of suPAR was measured using the commercial suPARnostic® (ViroGates, Birkerød, Denmark) assay kit and analysed through spectrophotometry. Descriptive statistics and the area under the curve operator were used to indicate the overall performance of the diagnostic test of suPAR. Analyses were performed using MedCalc® Statistical Software (MedCalc, Ostend, Belgium). RESULTS This study included 235 patients with ccRCC. The analysis showed that pre-operative plasma suPAR levels of ≥6 ng/mL were significant negative predictors of both overall survival (hazard ratio: 1.69; 95% confidence interval [CI]: 0.99–2.89; p=0.050) and recurrence-free survival (hazard ratio: 1.91; 95% CI: 1.03–3.57; p=0.041) (Figure 1). Furthermore, suPAR levels of ≥6 ng/mL remained a negative predictor of overall survival in multiple regression analyses (odds ratio: 5.18; 95% CI: 1.50–17.93; p=0.009). The prognostic performance of suPAR was 0.576, and adding suPAR measurements did not significantly improve the diagnostic accuracy of the Leibovich scoring system, but the combination of suPAR and T-stage had the same diagnostic performance as the Leibovich scoring system alone (area under the curve: 0.735). These findings suggest that pre-operative plasma suPAR may be a useful prognostic biomarker in predicting recurrence and survival outcomes in patients with ccRCC.CONCLUSION This study highlights the importance of measuring suPAR as a predictive tool in the progression of RCC, identifying a two-fold difference in recurrence risk when circulating suPAR exceeds 6 ng/mL. When adjusted for the most relevant clinical and histological parameters associated with RCC, this showed for the first time that pre-operative plasma suPAR has the potential of being prognostic for recurrence and overall survival. Pending external prospective validation and standardisation, the authors see promise in suPAR as a liquid biomarker for RCC.

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