Rectal absorption of oxcarbazepine.

Physicians regularly challenge the hospital pharmacy departments to find alternative routes for the administration of drugs, which can't be withhold, e.g. anti-epileptic drugs. In our hospital we were confronted with the question whether it was possible to administer oxcarbazepine rectally. In the present report data on the absorption of rectally administered oxcarbazepine is presented. No therapeutic bloodlevels were attained after rectal administration. Administration via the oral route, however, gave within the same period of time a therapeutic bloodlevel. It is concluded that the absorption after rectal administration of oxcarbazepine at least in this dose and frequency used is too low to justify application in practice.

[A patient with tetanus without an obvious point of entry]. / Een patiënt met tetanus zonder aantoonbare porte d'entrée.

A 59-years-old man with oesophageal cancer (T3NXMo) presented with trismus, dysarthria and diaphoresis. Later, he developed opisthotonus and generalized spasms. Despite negative blood cultures and sufficiently high anti-tetanus-titres, tetanus was suspected, on clinical grounds. He was intubated and treated with tetanus toxoid, human antitetanus immunoglobulin, benzylpenicillin, propofol, benzodiazepines, vecuronium, and sufentanil, and recovered gradually. Tetanus is caused by Clostridium tetani, a Gram-positive rod capable of remaining present latently in the body for years. Absence of a visible external wound suggests that the oesophageal mucosal cancer lesion could have served as portal of entry or that endogenous reactivation of latent tetanus bacteria had taken place.