Addition of carbamazepine to long-term treatment with neuroleptics may induce neuroleptic malignant syndrome.

BACKGROUND: Carbamazepine is an anticonvulsant, but also has an anti-manic effect, and recently it has been increasingly used in combination with neuroleptics. Nevertheless, there have been very few reports on the involvement of carbamazepine in the occurrence of neuroleptic malignant syndrome (NMS). METHODS: A case of NMS occurring after addition of carbamazepine to long-term neuroleptic administration is described. RESULTS: The patient had been treated with neuroleptics for about 30 years, and NMS developed when carbamazepine (400 mg/day) was added. CONCLUSIONS: This case suggests that clinicians should consider the risk of NMS when carbamazepine is administered to patients undergoing long-term treatment with neuroleptics.

[A case of advanced hepatocellular carcinoma with portal invasion resected after treatment by continuous intra-arterial chemotherapy with cisplatin and 5-fluorouracil].

A 67-year-old male diagnosed as having inoperable advanced hepatocellular carcinoma with portal invasion was able to undergo resection after continuous intra-arterial chemotherapy with 5-fluorouracil (5-FU) and cisplatin (CDDP). These were continuously administered for 24 hours at doses of 5-FU of 250 mg and CDDP of 5 mg/day, from day 1 to day 5 in a week, repeated 6 times. In additions to the reductions of the levels of AFP and PIVKA-II from 212.6 ng/ml and 16,100 mAU/ml to 11.8 ng/ml and 12 mAU/ml, respectively, the volume of the tumor and the portal invasion were diminished remarkably. As a result, a left extended hepatectomy could be performed. No sign of recurrence was seen during 16 months of follow-up after the operation. Given the above results, continuous intra-arterial chemotherapy with 5-FU and CDDP therapy may be effective for patients with hepatocellular carcinoma.

[Taste disturbance after tonsillectomy].

There are some patients, though few in number, who complain of taste disturbance after tonsillectomy. Actual measurement of the distance between the lingual branch of the glossopharyngeal nerve, which controls taste in the posterior portion of the tongue, and the lower pole of the palatine tonsil, using a cadaver, showed the distance to be only 2-4 mm, thereby suggesting the danger of direct or indirect disturbance of this nerve by tonsillectomy. Among the 3,583 outpatients complaining of taste disturbance whom we have treated at our taste disorder clinic in the last 15 years, 11 (0.31%) were found to be suffering from taste disorder triggered by tonsillectomy. Among these 11 causes, the causes of taste disturbance have been identified in 8 cases. In three cases, the taste disturbance was caused by direct or indirect damage to the lingual branch of the glossopharyngeal nerve, whereas in another two cases, the disturbance was attributable to medication following tonsillectomy. In the remaining three cases, the diagnosis was a taste disturbance initiated by tonsillectomy but actually caused by a lack of dietary zinc. It is therefore important that patients be informed of the risk of post-operative taste disorder following tonsillectomy, at the time informed consent for tonsillectomy is obtained. It is equally important to measure the taste threshold values for each taste nerve and the serum zinc value as part of the pre-operational examination, and to ask the patients what drugs, if any, they take habitually.