Letters to the Editor
Wolf SM, Carr AC, Hanson RA, Dale EP, Davis DC, Goldenberg ED, Lulejian P, Sharpe KS, Treitman P, and Weinstein AW: Parenteral complicance in the continuous administration of phenobarbital for the prevention o f febrile seizures, J PEDIATR 83:1085, 1973.
Twinning and cleft lip and~or palate
The Journal of Pediatrics February 1976
over chloroquine, 2 and metronidazole in the absence of other drug therapy gives results equal to those o f combined therapy? If metronidazole had been used for the hepatic abscess of this child, brain amebiasis probably would not have developed. Alain Bachy, M.D. Service de P~diatrie Hbpital Farhat Hached Sousse Tunisia, North Africa REFERENCES
To the Editor: Armendares and Lisker 1 report that individuals with cleft lip (with or without cleft palate) whom they studied in Mexico were five times more likely to be twins than were the normal siblings. During a study of children with cleft lip/palate born to mothers with epilepsy receiving anticonvulsant drugsJ I found a high incidence o f twinning. Of 32 children with cleft lip (with or without cleft palate) six were the result of twin pregnancies (two monozygotic, one dizygotic). This apparently high rate of twinning differed from other British studies of children with cleft lip/ palate born to mothers who did not have epilepsy; for instance, in LiverpooP and Edinburgh ~ the twinning rate was not significantly higher than in the general population. It remains possible that twinning is a factor which contributes to the development o f cleft lip and palate only in the presence o f certain other adverse environmental factors. S. R. Meadow Senior Lecturer and Consultant Paediatrician Department o f Paediatrics & ChiM Health University o f Leeds 27, Blundell St. Leeds LS1 3ET England REFERENCES 1. Armendares S, and Lisker R: Twinning and cleft lip with or without cleft palate, J PEDIATR 86:479, 1975. 2. Meadow SR: Congenital abnormalities and anticonvulsant drugs, Proc R Soc Med 63:12, 1970. 3. Smithells RW: Personal communication, 1975. 4. Drillien CM, Ingram TTS, and Wilkinson W: The causes and natural history of cleft lip and palate, New York, 1966, Tile Williams & Wilkins Company,
Cerebral abscesses in amebiasis To the Editor: In the January issue of THE JOURNAL OF PEDIATRICS' Hughes and associates reported a case of multiple cerebral abscesses complicating hepatop~almonary amebiasis. As mentioned by the authors, metronidazole is an effective agent for the treatment of amebic dysentery and hepatic amebiasis. But they used chloroquine phosphate to cure the amebic liver abscess o f their child. Metronidazole combined with dehydroemetine has advantages
1. Hughes FB, Faehnle ST, and Simon JL: Multiple cerebral abscesses complicating hepatopulmonary amebiasis, J PEDIATR 86:95, 1975. Scragg JN, and Powell SJ: Metronidazole and niridazole combined with dehydroemetine in treatment of children with amoebic liver abscess, Arch Dis Child 45:193, 1970. Scragg JN, and Powell SJ: Metronidazole in treatment of children with amoebic liver abscess, Arch Dis Child 48:91 l, 1973.
Reply To the Editor: We appreciate the opportunity to comment on Dr. Bachy's letter regarding our article? As Dr. Bachy has noted, chloroquine phosphate therapy did not protect our patient from amebic involvement of the brain even though the pulmonary and hepatic lesions were resolving as demonstrated by chest roentgenograms and liver scan. When metronidazole was added to the treatment regimen, gradual resolution of the intracerebral lesions occurred. One can only speculate whether an initial course of metronidazole would have prevented cerebral lesions in our patient. Recent reports have demonstrated the failure of metronidazole to eradicate hepatic amebic abscesses2-:', even with surgical drainage2 Cerebral amebiasis is rare in children. We were unable to find a report of a child who had survived this infection, nor were guidelines for treatment of this uncommon complication found in the literature. The successful outcome of the present case was most gratifying. Frank B. Hughes, M.D. U.S.P.H.S. Hospital Norfolk, Va. 235O8 Stephen T. Faehnle, Lt. Cmdr. (MC) USNR Naval Station, Adak FPO Seattle, Wash. Jimmy L. Simon, M.D. Chairman, Dept. of Pediatrics Bowman Gray School of Medicine Winston-Salem, North Carolina REFERENCES 1. Hughes, FB, Faehnle ST, and Simon JL: Multiple cerebral abscesses complicating hepatopulmonary amebiasis, J Pz~iAre 86;95, 1975. 2. Griffin, FM: Failure of metronidazole to cure hepatic amebic abscess, N Engl J Med 288:1397, 1973.