Pharmacokinetic study of valproic acid in a neonate.

Valproic acid was administered to a neonate (gestational age of 39 weeks) at 24 days post partum in an initial single dose of 7.5 mg/kg. Multiple serum samples were collected for 24 hours post dose. Valproic acid was continued and the study was repeated in the same child at 6 months of age at which time the dose had been increased to 13.5 mg/kg (27 mg/kg/day). Serum samples were collected for 12 hours post dose in this second study. A one-compartment model was assumed for calculation of the relevant pharmacokinetic parameters. The half-life (t 1/2) at 24 days of age was 17.2 hours, clearance (Cl) 0.18 ml/min/kg, and volume of distribution (Vd) 0.28 liter/kg. This t 1/2 was less than reported values in neonates younger than 10 days but longer than the average t 1/2 in adults. At 6 months of age, clearance had increased to 0.53 ml/min/kg, t 1/2 had decreased to 7.5 hours, while Vd was relatively unchanged (0.34 liter/kg). Factors possibly causing these changes include hepatic enzyme maturation and concomitant administration of anticonvulsant drugs.

Prepubertal gonorrhea.

Two cases of gonococcal urethritis in male children are presented and the records of 45 other children with gonorrhea are reviewed. The presentation, diagnosis and treatment are discussed. Data on the mode of transmission are presented with emphasis on the high incidence of gonorrhea in family members or close contacts of infected children, or a history of sexual abuse.

Bilateral testicular dislocation with unilateral rupture.

A case of bilateral luxation of the testes associated with testicular rupture is presented. Bilateral traumatic dislocation of the testes is uncommon and its association with testicular rupture has not been reported previously. The etiology, classification and treatment of testicular luxation are reviewed briefly. Reports in the literature have indicated initial non-operative management but our case demonstrates the need for early surgical exploration.