Venous Irritation Related to Intravenous Administration of Phenytoin versus Fosphenytoin

Study Objective . To compare the frequency, severity, and time course of venous irritation after administration of a single intravenous dose of phenytoin with an equimolar dose of fosphenytoin, a water-soluble phenytoin prodrug. Design . Randomized, double-blind, two-period, crossover study. Setting . University hospital clinical research unit. Patients . Twelve healthy volunteers within 15% of ideal body weight and with no clinically significant abnormalities on physical examination, medical history, or laboratory assessment. Interventions . Volunteers randomly received a 30-minute infusion of phenytoin sodium 250 mg (250 mg/5 ml) or an equimolar dose of fosphenytoin 375 mg (375 mg/5 ml). Subjects returned for the crossover treatment 14–21 days later. Measurements and Main Results . Subjects assessed venous irritation (pain, burning, itching), and investigators evaluated phlebitis (erythema, swelling, tenderness), induration, exudation, and cording. Phenytoin was associated with a significantly higher degree of pain at the infusion site in all subjects and a significant degree of phlebitis in eight subjects (p<0.05); cording occurred in six subjects. The time course of phenytoin-induced phlebitis was bimodal. Erythema and tenderness were prominent at the end of the infusion and again at 24 hours. Cording was first noted between 24 hours and 1 week after infusion. In contrast, fosphenytoin was associated with mild pain in two subjects, one incident of phlebitis, and no erythema or cording. Conclusions . Fosphenytoin administration resulted in significantly less venous irritation and phlebitis compared with an equimolar dose of phenytoin. The clinical use of this water-soluble phenytoin prodrug should minimize the frequency and severity of infusion-site reactions and should allow convenient, rapid, intravenous administration of drug, undiluted or admixed with intravenous solutions.     

A drug-induced cerebrospinal lipodystrophy in the domestic chicken (Gallus domesticus)

A drug-induced lipidosis of the central nervous system of chickens is reported. Membranous cytoplastic neuronal inclusions similar to those seen in Tay-sach's disease in man and in spontaneous or drug-induced disease in swine were seen by electron microscopy. Fat was demonstrated in frozen sections.     

Evidence for diploidy in metacyclic forms of African trypanosomes.

The DNA contents of bloodstream form trypanosomes (life cycle stages circulating in the blood of the vertebrate host) of four African Trypanosoma species and of metacyclic forms (the life cycle stage that is injected into the vertebrate by the tsetse fly during its bite) of the same four species were measured by cytofluorometry of individual cells or nuclei. The results showed unambiguously that the metacyclic forms cannot be considered to be products of meiosis containing only half of the DNA of bloodstream forms, in contrast to what was previously reported for Trypanosoma brucei [Zampetti-Bosseler, F., Schweizer, J., Pays, E., Jenni, L. & Steinert, M. (1986) Proc. Natl. Acad. Sci. USA 83, 6063-6064] during an attempt to localize the gametes in the life cycle after experimental evidence of sexual gene exchange in this parasite was reported.     

Caecal pH is a biomarker of excessive colonic fermentation

AIM:To ascertain whether caecal pH is different in patients with irritable bowel syndrome(IBS),whose primary symptoms are bloating and distension,to healthy controls.METHODS:Motility and pH data were reviewed from16 patients with RomeⅢdefined IBS and 16 healthy controls,who had undergone a wireless motility capsule(WMC)study using a standardized protocol.Motility measures were anchored around known anatomical landmarks as identified by compartmental pH changes.Sixty-minute epochs were used to quantify antral,duodenal,ileal,caecal and distal colonic contractility.The maximum and minimum pH was measured either side of the ileo-caecal junction.RESULTS:No differences were seen in motility parameters,compartmental transit times or maximal ileal pH between the two groups.Caecal pH was significantly lower in patients compared to controls(5.12±0.05vs 6.16±0.15,P<0.0001).The ileal:caecalΔchange was greater in patients than controls(-2.63±0.08 vs-1.42±0.11,P<0.0001).There was a significant correlation between caecal pH and right colonic contractility(r=0.54,P=0.002).CONCLUSION:Patients with bloating and distension have a lower caecal pH compared to controls.The measurement of caecal pH using the WMC provides a quantifiable biomarker of fermentation potentially identifying those patients that may preferentially benefit from antibiotic or dietary interventions.     

Use of DNA probes to identify Trypanosoma congolense and T. simiae in tsetse flies from The Gambia

Species- and strain-specific DNA probes were used to identify patent midgut infections in Glossina morsitans submorsitans and G. palpalis gambiensis captured at four sites in The Gambia. 52% of mature Nannomonas infections and 12% of immature infections were identified. Trypanosoma (Nannomonas) simiae accounted for the majority of identified infections in G.m. submorsitans, indicating the importance of distinguishing this species from the closely related T.(N) congolense when assessing the trypanosomiasis challenge to cattle. Both the savannah and riverine-forest groups of T. congolense were present, although the riverine-forest form was found only in G.p. gambiensis at Pirang, an isolated area of forest. Two-thirds of the samples remain unidentified by probes specific for: Trypanozoon; T. congolense savannah, riverine-forest and Kenya coast forms; T. simiae; and T. vivax, probably owing in part to low numbers of trypanosomes. However, the failure to identify several heavy Nannomonas infections, strongly suggests the presence of a further, as yet unknown, kind of Nannomonas.