[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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The bioavailability of a phenytoin granule preparation (“Granule”) was studied in 58 epileptic children, and compared to that of other three phenytoin preparations (“Tablet”, “Powder” and “Powderized Tablet”) under a crossover design.
The S/D ratio of “Granule” was about 1.0 for each age group from 5 to 9 years, and about 1.5 for each age group from 10 to 16 years, with the dosis of 5 mg/kg/day. The difference between two age groups was statistically significant.
The S/D ratios of “Powderized Tablet”, “Tablet” and “Granule” were approximately the same and deli-nitely higher than that of “Powder”. Good correlation was found between the dissolution rate determined in vitro by the paddle method of Japanese Pharmacopoeia and in the S/D ratio in vivo.
The particle size measured by the sieving method suggested that a slightly large particlesize of “Powder” was responsible for its low bioavailability. However, many other factors including wettability, crystal forms, etc, seem to affect the difference of bioavailability considerably.

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A 3-month-old previously healthy female infant was admitted to our clinic because of sudden onset of frequent left hemiconvulsions. Physical examination disclosed a lethargic infant with bilateral pyramidal signs. Meningeal signs were absent. Lumbar puncture revealed watery clear CSF with mild pleocytosis (165/3) with mononuclear predominance (140: 25). Protein and glucose contents were normal. EEG on admission showed diffuse slow wave activities with spike discharges over the right hemisphere and the left central area. Four days later, EEG showed atypical periodic bi-spikes with 0.8 second intervals at the right temporal area. CT scan with enhancement revealed no abnormalities on admission, but 6 days later, a mild left to right shift of midline structures and a compression of the anterior horn of the right lateral ventricle were demonstrated. The following CT scans showed a large low density in bilateral temporal white matter, bilateral calcifications of basal ganglia, gyriform calcifications of bilateral parietal lobes, frontal lobe atrophy, and mild ventricular dilatation. The low densities and cortical atrophy subsided on CT at 29 weeks after the onset, but the clinical improvement was poor. Serum CF titers of herpes simplex virus (HSV) on 7 and 25 days after the onset showed an elevation from ×8 to ×1, 024. Unfortunately, the antibody determination in the CSF and viral isolation were not performed. Thirty days after, she developed left subdural effusion. Subdural tap revealed a xanthochromic fluid containing 197/3 white blood cells (192 mononuclear cells), 970 mg/dl protein, and 94 mg/dl sugar. HSV titer in effusion was ×4, 096 at the 56 th day, suggesting a possible production of antibody in the CNS.

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Two infants were reported with intracerebellar hemorrhage due to rupture of angiomatous malformations in the cererbellum.
Case 1. A 2-month-old girl with vomiting and disturbance of consciousness. A CT scan revealed the left intracerebellar hemorrhage, and an angiogram revealed small arteriovenous malformations in the left cerebellar hemisphere. The hematoma was resected immediately, and the postoperative course was favorable.
Case 2. A 2-year-old boy with vomiting and gait disturbance. Intracerebellar hemorrhage was suspected by a CT scan. Six days later he rapidly began to lose consciousness. A CT scan revealed recurrence of the hemorrhage, but an angiogram revealed no abnormal blood vessels. The hematoma was resected because of acute disturbance of consciousness. Angiomatous malformations were found by the histological examination of the wall of the hematoma. The postoperative course was favorable.
There have been only a few reports on intracerebellar hemorrhage due to angiomatous malformation in infants. Even if angiomatous malformation was not revealed by preoperative angiography, it was necessary to examine the wall of the hematoma carefully during the operation. The results of operations for intracerebellar hemorrhage in infants ware more favorable than those in adults. Even if the patient showed severe neurological symptoms preoperatively, an operation should be performed.

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[in Japanese]

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