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Chordoma, a rare malignant tumour of early adulthood, rarely presents in children. We report such a case of rare malignant tumour which was diagnosed in the first decade of life.

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We report three sibs with mild autosomal recessive variety of osteopetrosis. The prominent clinical features were short stature, malocclusion of teeth, hepatosplenomegaly and a typical facial appearance. The only atypical features were microcephaly, a normal upper segment to lower segment ratio and a normal arm span.

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An eleven year old boy presented with sudden onset right-sided hemiplegia and ipsilateral lower facial weakness. Two-dimensional echo revealed the diagnosis of idiopathic dilated cardiomyopathy with multiple intracardiac clots. MRI scan of head showed infarctions in the area of caudate nuclei, putamen, brain stem and cerebellum. On anticoagulation therapy, all thrombi, except one, disappeared. The child died 2.5 months later due to resistant cardiac failure.

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The clinical profile of typhoid fever in an infant is variable and non-specific. A rare case of typhoid fever in a 7 month old infant is reported. The child presented with only a day's history of fever and loose motions which resulted in severe dehydration, acute tubular necrosis and death. The diagnosis of typhoid fever was made only on post-mortem study. The problem in diagnosing typhoid fever in a young infant is highlighted with a brief literature review on the subject.

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In 108 epileptic children referred for Therapeutic Drug Monitoring (TDM), 60 (56 per cent) had epilepsy for over 2 years. At first estimation among 79 (73 per cent) children on monotherapy, only three out of 23 on phenytoin, 20 out of 31 on phenobarbitone, and 15 out of 25 on carbamazepine had plasma levels within the therapeutic range. After TDM, only nine (8 per cent) were advised to continue the original prescription. Only 35 (32 per cent) followed up beyond 6 months and 15 (14 per cent) who benefited had a significantly shorter duration of epilepsy before referral (P < 0.001). Eventually, 12 (11 per cent) followed up beyond 2 years, and five (5 per cent) had achieved a probable cure. The study highlights the urgent need for setting up TDM clinics for epileptic children in India.

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In 28 children, with bacteriologically and/or serologically diagnosed typhoid fever treated at KEM Hospital, Bombay in 1991, initially one of the three recommended drugs (viz. chloramphenicol, amoxycillin or co-trimoxazole) was given for 7 days for defervescence to occur. In those who failed to respond, a second trial of therapy with one of the other two drugs was initiated, after omitting the first drug. A second failure of therapy was taken as an indication to use ciprofloxacin singly. Eventually, 18 (64.3%) cases responded to chloramphenicol or amoxycillin or co-trimoxazole. Ciprofloxacin was used in 19(35.7%) cases. the failure rate of treatment with chloramphenicol was 50%, with amoxycillin 71.4%, with co-trimoxazole 75% and 0% with ciprofloxacin. An analysis of the 28 cases revealed that apart from fever (in 100%), splenomegaly (in 82.1%) was the most important clinical pointer to diagnosis, along with absolute eosinopenia (in 71.4%). There were no major complications, except 2 cases with typhoid hepatitis who responded to choramphenicol and co-trimoxazole, respectively. Blood culture grew Salmonella typhi in 7 cases, of which 5 (72%) were multidrug resistant S. typhi. There were no characteristic clinical features to identify multi-drug resistant typhoid fever.

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A 2 1/2 month old male child was admitted with loose motions and mild dehydration. He was full term normal delivery, born of a non-consanguinous marriage. On examination, he had trigonocephaly; anteverted nostrils, long philtrum and hypoplastic supraorbital ridges. X-ray showed sutural separation. Karyotyping confirmed deletion of short arm of chromosome 9 distal to band p22.

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Fifty-four consecutively referred patients with uncontrolled epilepsy were subjected to Therapeutic Drug Monitoring on an out patient basis. Regular 2 weekly follow up for a minimum period of 2 months was done, after altering the drug dosage and bringing plasma level(s) within therapeutic range. Plasma levels of Phenobarbitone, Phenytoin and Carbamezepine were done by High Pressure Liquid Chromatography. Eventually, 24 patients were controlled and 30 remained uncontrolled. Significant differences between these 2 groups were found, as regards, duration of epilepsy (p < 0.01), associated mental retardation (p < 0.02), initial carbamazepine dosage and plasma levels in patients on carbamazepine montherapy (p < 0.02 and P < 0.01, respectively) and final phenytoin plasma levels in patients on combined therapy with phenobarbitone and phenytoin (p < 0.05). This study emphasizes the importance of early diagnosis and treatment of epilepsy with the help of plasma level monitoring of anti-epileptic drugs.

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Ciprofloxacin, a fluoroquinolone antibacterial agent, is not recommended in pediatric population on account of its possible adverse effect on growing cartilage. It is being commonly used for treatment of variety of infections in children in our country and very little information is available on the risks involved in its use. A questionnaire was sent to 750 pediatricians in the last week of November 1990, to retrospectively judge over the previous 2 month period the extent of its use and identify the adverse drug reactions (ADRs). One hundred and fifty-four pediatricians replied, of which 147 had prescribed ciprofloxacin in a total of 3341 patients under 18 years of age, enteric fever being the commonest indication for its use. One hundred and fifty-nine ADRs were reported in 104 (3.1%) patients. They were: gastrointestinal in 50% of these 104 patients, CNS in 23%, skin and allergic in 19.1%, musculoskeletal in 8.6%, hematological in 3.8%, CVS in 2.9% and nephrological in 0.9% cases. Of 159 ADRs, 8 (5%) were severe, 76 (47.8%) were moderate and 75 (47.2%) were mild. Therapy needed discontinuation in only 9 (0.3%) patients. Two new ADRs were identified, viz., sudden death after intravenous ciprofloxacin and sinus nodal arrest causing bradycardia.

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A prospective survey of laboratory records was carried out to identify the extent of drug induced hepatotoxicity in a hospital population. Eleven of 1000 (1.1%) abnormal liver function tests were due to drug induced hepatotoxicity. Anti-tubercular drugs, viz isoniazid, rifampicin and pyrazinamide were responsible for all cases of serious hepatotoxicity.

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