Sodium valproate -- induced skeletal myopathy.

The authors report a case of skeletal myopathy in a four-year-old boy on long-term sodium valproate therapy for secondary epilepsy due to neurocysticercosis. He presented with clinical features of limb girdle weakness. EMG revealed features of myopathy. Carnitine deficiency due to sodium valproate was suspected and plasma carnitine levels were found to be low. Sodium valproate was withdrawn. L-carnitine supplementation resulted in marked clinical recovery as well as rise in plasma carnitine levels.

Inflammatory myofibroblastic tumor.

Inflammatory myofibroblastic tumors are well described in lung and upper respiratory tract of young adults and children. Intra-abdominal forms of the disease are reported to occur most frequently in the liver, followed by stomach, bowel and spleen. A 13-year-old girl who had intermittent fever ranging from 99-101 degrees F of three months period and significant weight loss was referred as a case of pyrexia of unknown origin. The patient was subjected to laparotomy. A solid mass was found arising from the mesentery, four feet from the iliocaecal junction and was adherent to the wall of ileum. The patient became afebrile after the removal of the mass and has gained weight and remained well during the ten months since discharge.

Therapy and drug resistance in malaria.

The aim of this study was to highlight the high degree of clinical resistance of P. falciparum and also of P. vivax to chloroquine and also the importance of early diagnosis and prompt treatment. Ninety cases of smear positive malaria aged between 6 months to 14 years were studied with regards to clinical manifestations, management and outcome. Criteria for drug resistance were absence of clearance of parasitemia and/or persistance of fever after 72 hours of therapy. Chloroquin resistance was noted in 15 (62.5%) cases of falciparum malaria and 15 (51.7%) cases of vivax malaria. The resistant and complicated cases were treated with quinine. Four (6.6%) cases were resistant to quinine and responded to artemether. There was no mortality. Early reporting of cases, frequent sampling malarial parasite, prompt diagnosis of falciparum malaria, early institution of appropriate therapy and awareness of choloquine and/or quinine resistance helps in salvaging lives.

Central pontine myelinolysis.

A 9 year old boy presented with fever, drowsiness, quadriparesis and facial myokymia. MRI showed demyelination in the pontine region. A diagnosis of central pontine myelinolysis was made. Literature review revealed the rarity of uneventful recovery as has been seen in our case.