Effect of therapeutic plasma exchange on phenytoin plasma concentration in patients receiving intravenous fosphenytoin therapy

We report for patients with encephalitis treated with plasma exchange (PE) and fosphenytoin. In patient 1, phenytoin levels decreased on the maintenance dose, and the phenytoin concentration was <10 μg/mL on day 12 of administration. In patient 2, the phenytoin levels was <10 μg/mL on day 4. Increasing the fosphenytoin dose pushed the phenytoin level into therapeutic range. There were no differences between the areas under the concentration-time curve of phenytoin with and without PE. We previously reported a decline in phenytoin levels after prolonged use of fosphenytoin. Therefore, dose adjustment of fosphenytoin in patients undergoing PE may be unnecessary.

[Tropical eosinophilia in a man from Sri Lanka]

A 21-year-old man from Sri Lanka came to Japan in August 1992 and worked as a painter. He had often complained of dyspnea on exertion before coming to Japan. He was admitted to Ogaki Municipal Hospital in June 1993 for further examination of persistent coughing, dyspnea, and fever. A chest X-ray film showed bilateral diffuse reticulonodular shadows. Blood examinations revealed marked eosinophilia (9440/mm3) with elevation of the serum IgE level (4982 IU/ml). IgG enzyme-linked immunosorbent assay showed a high titer against Dirofilaria immitis. Microfilaria were not detected in blood sampled at night. He was given a diagnosis of tropical eosinophilia. We could not give diethyl-carbamazine. Filariasis is seldom encountered in Japan, but we emphasize that parasitic disease such as tropical eosinophilia must be considered in the differential diagnosis if the patient is from a tropical area where filariasis is common.

Versatility of the free or pedicled superficial cervical artery skin flaps in head and neck burns

The usefulness of the free or pedicled superficial cervical artery skin flap in reconstructive surgery of head and neck burns is reported. This flap can be made with the pivot point near the cervical region. Moreover, it can be elevated as a free or long vascular pedicled flap. Therefore, it is widely applicable in reconstructing the scar contractures of the head and neck, particularly in extensively and deeply burned patients.