ABSTRACT
Phenytoin, one of the most widely prescribed anticonvulsants, and steroids are routinely utilized for seizure prophylaxis in patients with various intracranial tumors. We report a case of severe Stevens-Johnson syndrome (SJS), documented by biopsy, which occurred in a patient, with metastatic squamous cell carcinoma receiving phenytoin, whole-brain radiation therapy (WBRT), and a tapering steroid dose. The pathogenesis and implications are then briefly discussed.
Subject(s)
Anticonvulsants/adverse effects , Brain Neoplasms/radiotherapy , Carcinoma, Squamous Cell/radiotherapy , Cranial Irradiation/adverse effects , Phenytoin/adverse effects , Stevens-Johnson Syndrome/etiology , Anticonvulsants/therapeutic use , Brain Neoplasms/secondary , Carcinoma, Squamous Cell/secondary , Chemoprevention , Dexamethasone/administration & dosage , Dexamethasone/therapeutic use , Female , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Humans , Lung Neoplasms/radiotherapy , Middle Aged , Phenytoin/therapeutic use , Seizures/etiology , Seizures/prevention & control , Spinal Neoplasms/radiotherapy , Spinal Neoplasms/secondary , Stevens-Johnson Syndrome/pathologyABSTRACT
Electroconvulsive therapy (ECT), regarded as safe, well tolerated, and one of the most effective treatments for depression, is used frequently in patients with underlying coronary artery disease. ECT has been associated with ST depression and arrhythmias probably due to increased myocardial demand in patients with coronary artery disease. This report describes a case of transient new T-wave inversions in precordial leads V2 and V3 and flattening of T waves in leads III, V3, V4, V5, and a VF after two courses of ECT in a patient with minimal cardiac risk factors, normal echocardiogram, and normal pre-ECT electrocardiogram (ECG). These T-wave changes may represent increased sympathetic activity induced by ECT. Previous prospective studies of 26 and 21 patients undergoing serial ECT found only one new T-wave inversion and no pathologic Q waves on serial ECGs, suggesting that this is a rare finding.
Subject(s)
Depression/therapy , Electrocardiography , Electroconvulsive Therapy/adverse effects , Depression/physiopathology , Humans , Male , Middle AgedABSTRACT
Logarithmic proliferation rate (Days 1 to 6) of gingival fibroblasts derived from 15 pairs of monozygotic (MZ) and 9 pairs of dizygotic (DZ) human twins was compared under optimal and suboptimal growth conditions. Cell proliferation rates exhibited considerable variability among strains. For Caucasian donors (13 MZ, 6 DZ pairs) DZ twins demonstrated significantly greater (P less than 0.01) within-pair variance in cell proliferation rate compared to MZ twins when evaluated under optimal growth conditions. Heritability analysis indicated strong genetic control of proliferation rate of human gingival fibroblasts (HGF) under optimal growth conditions (1.0 +/- 0.67), whereas proliferation rate of HGF under suboptimal growth conditions revealed less genetic control (0.42 +/- 0.61). These findings emphasize the importance of carefully matching control and test HGF in assays dependent on cellular proliferation.
