Use of the direct magnification technique in dental radiology.

OBJECTIVE: To investigate the potential use of the direct magnification (DIMA) technique in dental radiology. METHODS: Radiographs of anatomical specimens and extracted teeth were prepared under clinical conditions using a microfocus (8 and 16 microns focal diameter) X-ray tube. Entrance dose was measured using an ionization chamber. Image quality was assessed in a single-blind test of pairs of images of extracted teeth with and without caries by ten observers. RESULTS: At 7.3 x magnification the values for exposure time and entrance dose were comparable with those for conventional intraoral radiography, 0.1 and 0.25 s and 1.5 and 2.9 mSv respectively. Diagnostic accuracy using the DIMA images was significantly (P < 0.0001) better compared with dental radiographs. CONCLUSION: DIMA images with significantly enhanced diagnostic accuracy can be obtained at comparable exposure times and entrance doses to conventional intraoral radiographs.

Adverse effects in a newborn infant breast-fed by a mother treated with doxepin.

OBJECTIVE: To report adverse effects in a newborn infant whose mother had been treated with doxepin during pregnancy and while breast-feeding. CASE SUMMARY: The nine-day-old white boy was admitted because of poor sucking and swallowing, with muscle hypotonia and vomiting. He was drowsy and had lost 150 g. At the time of admission, he was breast-fed by his mother who was being treated with doxepin 35 mg/d. Samples of plasma and breast milk were taken and analyzed by HPLC and fluorescence polarization immunoassay. The amount of doxepin and N-desmethyldoxepin (DDP) ingested via breast-feeding was approximately 10-20 micrograms/kg/d (i.e., only 2.5% of the weight-adjusted dose of the mother). Doxepin was detectable in small amounts in the infant's plasma (approximately 10 micrograms/L); DDP was below the lower limit of detection of 10 micrograms/L. All adverse effects subsided within 48 hours after breast-feeding was stopped. DISCUSSION: Despite the small doses of doxepin and its active metabolite ingested by breast-fed babies, there is a risk of accumulation and resultant adverse effects. In newborns, the metabolic activity is considerably decreased and may be further reduced by hyperbilirubinemia. CONCLUSIONS: Available data suggest that women treated with doxepin should breast-feed their infants with great caution, if at all, although much larger databases are needed to confirm this.

Comparison of phenytoin serum concentrations in premature neonates following intravenous and oral administration.

OBJECTIVE: To compare the serum concentrations attained following intravenous and oral administration of phenytoin in premature neonates. DESIGN: A prospective, uncontrolled study was conducted over 6 years. Phenhydan concentrate for infusion (Desitin, Hamburg, Germany) was used for intravenous infusion, and Epanutin suspension (Parke-Davis, Freiburg, Germany) was used for oral therapy. Blood samples were analyzed by using a fluorescence polarization immunoassay analyzer TDx model by Abbott Laboratories. SETTING: A university-affiliated district hospital. PARTICIPANTS: Twenty premature neonates who were administered intravenous and/or oral phenytoin between February 1991 and February 1997. MAIN OUTCOME MEASURES: Serum phenytoin concentrations on intravenous and oral phenytoin. RESULTS: Nine patients received intravenous (group A) and 15 patients received oral (group B) therapy. Mean +/- SD postnatal age (41 +/- 8.7 vs. 48 +/- 17 d; p = 0.03) and actual body weight (1.56 +/- 0.38 vs. 1.88 +/- 0.75 kg; p = 0.02) were slightly higher in group B. There were no significant differences between the groups in mean +/- SD gestational age (26.1 +/- 1.37 vs. 26.9 +/- 3.30 wk), 5-minute Apgar score (8.7 +/- 1.11 vs. 7.7 +/- 2.26), daily dosage (8.1 +/- 3.86 vs. 8.1 +/- 4.21 mg/kg/d), and phenytoin serum concentration (8.7 +/- 7.36 vs. 9.6 +/- 5.83 micrograms/mL). CONCLUSIONS: Contrary to data in the current literature, reliable serum concentrations in premature neonates were achieved by oral administration of phenytoin suspension. Oral therapy offers a number of advantages and considerably reduces the cost of therapy. Due to substantial variations in phenytoin pharmacokinetics in neonates, close monitoring of serum concentrations is required. Further investigation is required to confirm these results, especially in neonates younger than 20 days' postnatal age and those receiving products other than Epanutin.

[Cardiac symptoms in 2 patients with Seckel syndrome]. / Kardiale Symptomatik bei 2 Patienten mit Seckel-Syndrom.

Seckel's Syndrome is a rare (< 1:10,000) malformation, presumably inherited as an autosomal-recessive trait. It is characterized by failure to thrive, mental retardation, bird-like malformation of the face and further abnormalities. Cardiac anomalies have not been described so far. We report two patients with cardiac malformations, a complex defect and a patient ductus arteriosus.

[Lithium-intoxication in a newborn (author's transl)]. / Lithium-Intoxikation beim Neugeborenen.

A newborn, whose mother had been treated with lithium carbonate for a manic-depressive illness suffered from hypotonia, poor feeding, weak Moro reflex, hyperexcitability, thyroid enlargement and cyanosis. Symptoms resolved within a few weeks. No malformations could be detected. The psychomotor development of the child was normal up to the age of 18 months.