Liposomal amphotericin (AmBisome) is safe in bone marrow transplantation for primary immunodeficiency.

The use of conventional amphotericin B is limited by toxicity, side-effects, drug interactions and the need for large infusion volumes, especially for infants. Use of liposomal amphotericin B (AmBisome) in 15 paediatric BMT patients with primary immunodeficiency (PID) was therefore studied. Adverse clinical reactions to AmBisome and biochemical profiles were monitored daily for 2 weeks before, during and after each treatment episode. Fungal cultures were obtained weekly and when patients were pyrexial. There were 18 treatment episodes. Mean daily dose was 5 mg/kg (2-6 mg/kg). Mean duration of treatment was 25 days (5-90 days). Clinical reactions to AmBisome were observed in one infant who had a pyrexia of 38 degrees C. One of the 15 infants had a significant increase in creatinine level while on concomitant nephrotoxic therapy. Four developed mild hypokalaemia on AmBisome which resolved with increased potassium supplementation. AmBisome was well tolerated and without significant renal or hepatic toxicity in severely ill immunodeficient infants receiving multiple nephrotoxic and hepatotoxic drugs such as cyclosporin, vancomycin and foscarnet.

Fentanyl patches left on dead bodies -- potential source of drug for abusers.

We report a fatal case of fentanyl poisoning in which the decedent apparently obtained the drug from a used transdermal patch removed from a deceased nursing home patient. Fentanyl drug patches, even those previously used, contain a potentially lethal amount of this potent narcotic analgesic and provide a source of fentanyl for drug abusers. This case demonstrates the importance of proper disposal of these drug patches and the need for strict policies and guidelines in patient care settings regarding their disposal. Since fentanyl derivatives may not be detected on routine toxicologic analysis, specific assays should be utilized for the detection of fentanyl in cases of suspected drug overdose.

Primary squamous cell carcinoma of the endometrium: a first report of adjuvant chemoradiation.

Primary squamous cell carcinoma of the endometrium is very rare, with only 49 cases reported in the literature. In 1928 Fluhmann proposed three criteria to establish the diagnosis: (1) no coexisting endometrial adenocarcinoma, (2) no connection between the endometrial tumor and the squamous epithelium of the cervix, and (3) no squamous cell carcinoma of the cervix present. The median age at presentation is similar to adenocarcinoma of the endometrium. Although most patients have presented with FIGO stage I disease, long-term survival has been dismal despite surgery and radiation therapy. We report a new case treated with postoperative radiation and cisplatin and review the literature.

A fetus with sirenomelia, omphalocele, and meningomyelocele, but normal kidneys.

Sirenomelia, which has been reported for more than 450 years, is the most severe form of caudal dysplasia. This disorder is classically associated with agenesis or severe dysplasia of the urinary tract. A 27-year-old gravida 3 para 0020 presented at 19 weeks' gestation with monoamniotic twins, one normal and one with sirenomelia. The pregnancy miscarried following invasive diagnostic testing. Autopsy confirmed the findings of sirenomelia, meningomyelocele, omphalocele, persistent cloaca, and two normal kidneys. The abnormalities accompanying sirenomelia appear as a spectrum. The pathogenic theories of sirenomelia are reviewed in light of this case with normal kidneys.

Oleoresin capsicum (pepper) spray and "in-custody deaths".

Increasing use of oleoresin capsicum (OC) spray devices (i.e., pepper spray, pepper mace, OC, capsaicin) by law enforcement agencies as a means of sublethal force to control suspects has brought into question whether exposure to this noxious irritant (capsaicin) can cause or contribute to unexpected in-custody deaths. Capsaicin stimulates nociceptors in exposed mucous membranes to produce intense pain, particularly involving the conjunctiva, and generates systemic physiologic and behavioral responses consonant with such extreme discomfort. We describe two cases of in-custody death, both associated temporally with the use of pepper spray, to illustrate salient investigative considerations. As with any other in-custody death, a thorough autopsy and toxicologic analysis, coupled with evaluation of the premortem chain of events, postexposure symptomatology, and the extent of natural disease processes, will help to reveal the role of oleoresin capsicum spray as unrelated, contributory, or causative.