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The effectiveness of Rivotril® (Clonazepam, Ro 5-4023) when used either as the sole anti-convulsant or in combination with other drugs in institutionalised mentally retarded children with epilepsy is reported. The material comprised 37 children—19 girls and 18 boys—aged 4 to 19 years. Minor motor seizures—especially akinetic-myoclonic attacks—were seen in 34 children either alone or in combination with other epileptic seizures. In 3 children the only seizure type was grand mal attacks. A history of infantile spasms preceding the actual symptoms was found in 9 children. In 3 children Valium® and in 22 children Mogadon® was the first drug of choice. These drugs were discontinued on account of pronounced drowsiness and in 2 cases also hypersalivation. Electroencephalographic registrations were performed in 31 children, a petit mal variant pattern being found in 20 cases and an equivocal pattern in 6 cases. Rivotril was instituted in gradually increasing doses. The final satisfactory dose varied between 0.03 and 0.33 mg/kg/day. In 4 children the akinetic seizures apparently diminished in frequency, the remaining attacks, however, being more violent. In these cases 0.25–0.50 g Diamox® provided partial relief. A drug interaction with phenytoin apparently occurred in 7 children (19 per cent) such that the serum concentration of phenytoin exceeded 20 μg/ml and symptoms of intoxication appeared. Side effects such as drowsiness were seen in 5 children, vertigo and ataxia in 1, hypersalivation in 1, and muscular hypotonia in 2 children. These side effects were transitory in all but 1 case with drowsiness and the 2 cases with hypotonia. In the first-mentioned one the drug was completely discontinued. Rivotril was judged to increase the anti-convulsive effect to complete or clearly improved seizure control, i.e. more than 50 per cent control, in 29 children (78 per cent). In comparison with other benzodiazepines Rivotril is the best anti-convulsant available for minor seizures. This fact is mainly based on the finding of minimal side effects. The anticonvulsive response was probably somewhat better than or did not significantly differ from that for Mogadon.

In order to assess the safety and some efficacy aspects of clozapine under UK conditions, 54 in-patients with severe treatment-resistant schizophrenic disorders were evaluated using several scales before and during treatment. Of the 54 evaluated, 26 completed the 26-week study. Of these patients, 20 showed improvement in psychopathology, often to a marked degree, involving both positive and negative symptoms. Some oral-facial extrapyramidal side-effects decreased as well. Two patients developed neutropenia, but recovered on discontinuation of clozapine. The most frequent adverse event was hypersalivation, and five patients suffered from seizures. It is concluded that clozapine is worth considering for the treatment of severe treatment-resistant patients in the UK.

PRESENT-DAY advances in psychotherapy have added impetus to investigations into the actions of drugs which affect the central nervous system and thus cause changes in behaviour patterns. One such psychomimetic agent, lysergic acid diethylamide (LSD-25), exerts both peripheral and central actions1. Some of these effects in various animals and humans are nausea, vertigo, hyperhydrosis, hypersalivation, mydriasis, vasodilation or vasospasm, hypotension or hypertension, bradycardia or tachycardia, and changes in the white blood cell count2.

Using the completely denervated iris of the cat as an indicator of circulating autonomic substances, it was found that constriction of the pupil ensued from 35 to 70 seconds following the intravenous administration of 1.0 cc of whole human blood. The blood of rabbit, guinea pig, mouse, monkey, hog and hemolyzed erythrocytes of cat also produced a constriction of the completely denervated iris of the cat. Identical amounts of blood from dog, sheep and ox were without significant effect on the same preparation. The most conspicuous reactions were obtained with rabbit's blood. Large quantities of dog, ox, or sheep blood sometimes produced a slight and slow constriction of the cat's denervated iris.Other effects caused by the intravenous injection of blood into the cat were a fall in blood pressure, as shown by Abramson, et al.,1 and Fuzii,2 decrease in heart rate, relaxation of anal and urinary sphincters and hypersalivation, all parasympathomimetic manifestations.The vaso depressor and miotic propertiesof t...

To the Editor. —A 63-year-old man with essential hypertension was given captopril, 12.5 mg three times a day, in August 1986. The tablets were taken in the morning, at midday, and at bedtime time. On the second day of treatment, he noticed an intermittent cough starting about half-an-hour to an hour after each dose and lasting from five to 30 minutes. The bedtime cough began on lying down and was worse than in daytime. The cough was productive, the sputum was clear, and had a distinctive taste of sulfur. The duration and intensity of the cough never bothered the patient enough to consider an alternate drug regimen. Around the fourth day on captopril, he experienced hypersalivation for about three hours after the morning dose, little after the afternoon dose, and none after the bedtime dose. The saliva had a slightly alkaline taste, different from the sulfurlike taste of the sputum.

A domestic-longhair cat presented due to lethargy, dyspnoea and hypersalivation. Radiographic examination revealed a bilateral pleural effusion, which was diagnosed as pyothorax based on cytological examination. Ultrasonographic examination revealed extensive loculations within the thoracic cavity. Exploratory sternotomy, under general anaesthesia, allowed the removal of approximately 100 ml of purulent fluid and debridement of a partially walled-off abscess and necrotic material from the pleural cavity. Postoperative positive-pressure ventilation was required due to severe respiratory depression. Intensive postoperative care, including intensive continuous monitoring, thoracostomy tube drainage and lavage of the pleural cavity and oesophagostomy tube feeding, was performed. Complete resolution of clinical signs had occurred by 15 days postoperatively. Clinical or radiographic abnormalities were not detected at a follow-up examination one year after surgery.

Canine leishmaniosis is a severe systemic disease caused by the kinetoplastid protozoan Leishmania infantum, an obligatory intracellular parasite of mammalian macrophages, transmitted by the bite of phlebotomine sandflies. The infection in dogs might occur without any clinical signs or might be characterised by chronic viscerocutaneous signs, such as lymphadenopathy, skin lesions, splenomegaly, onychogryphosis, and renal as well as ocular damage due to immunocomplex deposition. In atypical cases the parasites can be found in the striated musculature, the central nervous system, the endocrine glands or gonads, with or without functional damage. Leishmania infection might seldom induce oral lesions, particularly on the tongue. The authors describe the clinical case of a four-year old mongrel dog with tongue lesions caused by L. infantum. The dog was presented due to diarrhoea, lack of appetite and hypersalivation. Examination of the oral cavity revealed the presence of multiple red, nodular lesions on the dorsal and lateral surfaces of the tongue. Definite diagnosis of an infection with L. infantum was obtained by an indirect immunofluorescence antibody test (IFAT) and by the cytological identification of the parasite in nodular, lingual lesions and bone marrow aspirates. The dog was treated with a combination of miltefosine (Milteforan®, Virbac), 2 mg/kg orally once a day for four weeks and allopurinol (Ziloric®, GlaxoSmithKline), 10 mg/kg orally twice a day for six months. At the end of the treatment, the animal showed full remission of clinical signs. The authors outline the atypical manifestations in the oral cavity in combination with a L. infantum infection and discuss the therapeutic potential of the combination treatment of miltefosine and allopurinol in canine leishmaniosis.