Altered phenytoin clearance with febrile illness

A prospective study was performed of antiepileptic drug levels in 14 boys resident in a pediatric chronic care facility. Blood samples and 24-hour urine collections were obtained monthly. During febrile illness (temperature greater than 101 degrees F for more than 24 hours), six additional blood samples and two urine collections were obtained for each child. During 8 of 10 febrile illnesses, phenytoin (PHT) decreased more than 40% from pre-illness baseline. Mean PHT level before illness was 16.7 (+/- 4.5 micrograms/ml) and during illness, 8.2 (+/- 3.6 micrograms/ml), significantly lower (p less than 0.001). Neither PHT binding nor absorption was altered by illness, so the most probable cause of the drop in PHT levels was induction of the hepatic oxidative enzyme system.     

Successful Treatment of Severe Rh Iso-Immunization with Immunosuppression and Plasmapheresis

Nine patients with severe Rh iso-immunization were treated by plasma exchange combined with immunosuppression. Apart from 3 abortions, previous pregnancy losses consisted of 7 intra-uterine and 5 neonatal deaths. Only 2 patients had had no previous pregnancy loss. Differences in the optical density of the amniotic fluid of 8 patients fell into the upper Liley zone. There was one intra-uterine death due to abruptio placentae but no neonatal deaths. When the outcome of the pregnancy immediately preceding the treatment pregnancy was compared to the treatment pregnancy, the fetal loss was reduced from 6 to 1. No adverse fetal effects were encountered.     

Cervical carcinoma: treatment results and complications of extended- field irradiation

The authors studied treatment complications, recurrence patterns, and survival in 18 patients with histologically proved metastases to the paraaortic lymph nodes from invasive cervical carcinoma treated with extended-field irradiation. Complications following treatment developed in five of 10 patients who underwent transperitoneal nodal biopsy or dissection and in two of eight patients in whom an extraperitoneal approach was used (overall complication rate of 39%); however, only one had a gastrointestinal complication (small bowel obstruction after transperitoneal nodal biopsy and irradiation). Fourteen patients had persistent or recurrent disease within the abdominal or pelvic cavity; only one had distant metastases without recurrence in the abdomen or pelvis. Two of the 14 patients had a recurrence in the surgical scar following extraperitoneal nodal biopsy, possibly due to placement of the scar outside the radiation field. After a minimum follow-up of 48 months, only three of 18 patients (17%) were alive and well.     

Molecular basis and prenatal diagnosis of beta-thalassemia

The molecular characterization of mutations producing beta-thalassemia in world populations is nearing completion. We expect that new rare alleles in thoroughly studied groups and other alleles in less studied groups, eg, inhabitants of New Guinea, Latin America, and certain Pacific Islands, will be found. Knowledge of the molecular basis of the disease and new technology that allows rapid detection of single nucleotide changes in genomic DNA have led to the reality of prenatal diagnosis by direct mutation detection even in the heterogeneous US population. Programs aimed at prevention of beta-thalassemia should be facilitated by these developments.