Brain metastasis diagnosis

Conversely, a retrospective study of 40 patient records (diagnosis unspecified) indicated that dexamethasone reduced serum phenytoin levels the serum phenytoin levels of 6 patients receiving fixed doses of phenytoin were halved by dexamethasone. Another report describes a patient with brain metastases who required over 8 mg/kg of phenytoin (6(X) mg) to achieve therapeutic phenytoin levels in the presence of dexamethasone 16 mg. When the dexamethasone was increased to 28 mg daily he experienced seizures, and an increase in his phenytoin dose from 600 mg to 1 g only resulted in an increase in his levels from 13.9 to 16.4 micrograms/mL. Another patient, also with a brain metastasis, needed a large dose of phenytoin (greater than 10 mg/kg) while taking dexamethasone. He had an almost fourfold rise in serum phenytoin levels when dexamethasone was stopped."... 

Pancreaticoblastoma, or infantile adenocarcinoma, is a rare tumor in children (Monte marano et al. 2000 Roebuck et al. 2001). It usually presents in the fourth year of life with males being more affected than females. This tumor conunonly arises from the head or tail of the gland, and has been associated with Beckwith-Wiedemann syndrome. Microscopic analysis will show proliferation of poor differentiated squamous cells surrounded by a fibrous capsule. Although it has a better prognosis than the adult adenocarcinoma, metastases can occur and are commonly present at the time of the initial exam or diagnosis. Common sites for metastases include the liver and lymph nodes. Lung and brain metastasis are rarely seen. Usually, vanillylmandelic acids (VMA) are not elevated but the alpha-fetoprotein is. 

---