Natalizumab induced blood eosinophilia: A retrospective pharmacovigilance cohort study and review of the literature.

OBJECTIVE: To describe frequency of natalizumab related eosinophilia and clinical symptoms of eosinophilic disease in our monocentric cohort. METHODS: Comparison of clinical characteristics of 115 natalizumab treated and 116 untreated RRMS patients and review of literature. RESULTS: 38% of natalizumab treated patients had eosinophilia, which occurred significantly more frequently compared to untreated MS patients (3%, p-value<0.001). In symptomatic patients, mean eosinophil counts were significantly higher than in asymptomatic patients and symptoms developed within one year. DISCUSSION: Eosinophilia is a side effect of natalizumab and mostly asymptomatic. However, few patients develop within one year after start of natalizumab an eosinophilic disease as severe side effect.

A prospective ultrasound biomicroscopy evaluation of changes in anterior segment morphology following laser iridotomy in European eyes.

PURPOSE: The aim of this study is to quantify changes in anterior segment morphology by the use of ultrasound biomicroscopy (UBM) after Nd:YAG laser iridotomy in primary angle closure (PAC) and PAC glaucoma (PACG) in European eyes. METHODS: A total of 35 eyes of 28 consecutive patients presenting with PAC or PACG were examined by UBM at presentation, and 1 week after Nd:YAG laser peripheral iridotomy (LPI). Mean age of patients was 63.5+/-14.4 (SD) years. Seventeen patients were females (60%). The trabecular-iris angle (TIA) was measured in the superior, nasal, inferior, and temporal quadrants. Baseline measurements were made under light and dark conditions. MAIN OUTCOME MEASURE: UBM measurements of the trabecular-iris angle (TIA) and the angle opening distance (AOD). DESIGN: Consecutive observational case series. RESULTS: All measurements were made in four quadrants. Before LPI, mean superior TIA was 3.59+/-4.5 degrees (mean+/-SD), nasal TIA was 6.37+/-4.9 degrees , inferior TIA was 9.33+/-7.6 degrees , and temporal TIA was 8.65+/-7.3 degrees in light conditions. After LPI, these values increased, respectively, to 12.58+/-6.9 degrees (P<0.05), 15.40+/-6.8 degrees (P<0.05), 16.37+/-7.4 degrees (P<0.05), and 15.95+/-11.3 degrees (P<0.05), showing a significant widening of the angle in all four quadrants. Superior AOD increased from 0.060+/-0.07 to 0.107+/-0.07 mm (P=0.09). No serious LPI-related complications were encountered. CONCLUSIONS: Dimensions of the anterior chamber angle can be significantly influenced by Nd:YAG laser iridotomy in narrow angle European eyes. UBM examination is a viable tool for the quantitative evaluation of the anterior chamber angle before and after laser iridotomy.

Interference of metamizol (dipyrone) on the determination of creatinine with the Kodak dry chemistry slide comparison with the enzymatic method from Boehringer.

In order to eliminate positive interferences that take place with the Jaffé technique, the Kodak Ektachem and Boehringer Mannheim Companies have chosen an enzymatic method for the determination of creatinine in serum and urine. Pathological and clinical samples often contain metabolites in elevated concentrations or exogenous compounds such as drugs or toxic compounds. We noticed that patients receiving metamizol-containing drugs showed unusually low values of creatinine when determined with an Ektachem analyser. We investigated the effect of the main metabolites of this prodrug on the creatinine enzymatic methods of Kodak and Boehringer. We concluded that methyl-amino-antipyrine, the active substance after administration of metamizol (prop. INN) was responsible for the interference, and that no reliable determination of creatinine could be performed with these methods in the serum of patients receiving this drug.

Enrichment of complexing analytes on a copper-loaded silica surface and on-line coupling with high-performance liquid chromatography, using L-tryptophan and L-tyrosine as model compounds.

A chemically modified silica (bisdithiocarbamate) strongly binds copper and has a loading capacity of 0.5 mmol g-1 for the copper ion. This new metal-loaded silica, packed in a short stainless-steel pre-column, is highly selective for the enrichment of two amino acids chosen as model compounds. On-line coupling of this pre-column with an analytical RP-18 column allowed the separation and detection of L-tryptophan and L-tyrosine at parts per billion levels in aqueous media with good accuracy. Separation was achieved by ion-pair chromatography and the solutes were detected by fluorescence. The ions generally present in natural aqueous media did not interfere.

[Necessary visual information for restoring reading with a retinal implant in a blind patients with massive retinal degeneration of photoreceptors]. / Information visuelle nécessaire à la restauration d'une lecture au moyen d'un implant rétinien chez un aveugle par dégénérescence massive des photorécepteurs.

DEFINITION OF THE PROBLEM: Our goal is to determine the minimum of information necessary for elementary reading, using a retinal implant. This concerns particularly the fragmentation (pixellisation) of the presented image and its position in the visual field. Fragmentation corresponds to the number of electrodes available, the position of the image in the visual field is equivalent to the site of the implant on the retina. MATERIAL AND METHODS: 10 degrees x 10 degrees windows, containing isolated words or letters, were presented to six healthy subjects on a computer screen. A coupling between the computer and an eye tracker stabilizes these images in an area of the visual field. This coupling constantly corrects the position of the image on the screen according to the direction of gaze. RESULTS: 1) A rapid decrease of the performance is observed at a certain threshold of pixellisation, dependent on the eccentricity of presentation of the images. 2) In central vision, about 400 pixels are sufficient to recognize 80% of the four-letters words. At 10 degrees of eccentricity, about 1225 pixels are needed. 3) An acceptable comprehension of a text (identification of four words out of five), is impossible at eccentricities higher than 10 degrees 4) About 50 pixels are sufficient for a satisfactory recognition of isolated letters, independently of their eccentricity. CONCLUSION: These data validate the method of investigation and provide valuable indications regarding minimal visual requirements in prosthetic vision.

[Endogenous fungal endophthalmitis: results of antifungal treatment with and without vitrectomy]. / Endophtalmies fongiques endogènes: résultats après traitement anti-mycosique associé ou non à une vitrectomie.

BACKGROUND: Fungal endophthalmitis represents a significant cause of ocular morbidity, affecting in the majority of cases patients in poor general conditions. The eye is typically involved by hematogen dissemination, and the germ induces a chorioretinitis associated with an important panuveitis. PATIENTS AND METHODS: Four patients were examined. They complained of a progressive reduction of vision, associated with photophobia. Ophthalmologic examination disclosed an important panuveitis. Investigations showed a fungal chorio-retinitis in all cases. Risk factors were intra-venous toxicomania, longterm parenteral nutrition and traumatism of the sinuses. RESULTS: Vitreous cultures were positive for Candida albicans (3 patients) and for Aspergillus fumigatus (1 patient). Blood cultures were negative in the four cases. Three patients were treated with anti-fungal medication (fluconazole, itraconazole) associated with a vitrectomy by pars plana. One patient was treated by anti-fungal therapy only. Clinical evolution was satisfactory in all cases. Final vision was 10/10 in three cases and 5/10 in one. One patient developed a retinal detachment and an epiretinal membrane. Follow-up was 7 months (2-16 months). CONCLUSION: The evolution of these four cases suggests that a rapid anti-fungal therapy associated with or without a vitrectomy represent a favourable therapeutic option when a fungal infection is suspected.

Indocyanine green angiographic features in endogenous Candida chorioretinis.

BACKGROUND: To describe indocyanine green (ICG) angiography (ICGA) findings and clinical features of endogenous mycotic endophthalmitis. PATIENTS AND METHODS: Two patients (a female 62 years, a male 31 years) were addressed to investigate a progressive unilateral visual loss. Slit-lamp examination disclosed a macular chorioretinitis. A clinical work-up revealed a mycotic infection (Candida albicans). Before treatment an ICGA was performed. RESULTS: ICGA early frames disclosed hypofluorescent lesions. Progressively, the lesions were surrounded by a slight hyperfluorescence, although the centre of the lesions was still hypofluorescent. CONCLUSIONS: The presence and persistence of a hypofluorescent lesion after introducing a specific treatment, led us to suspect a necrotic/ischaemic process affecting the choroidal vascular bed. ICGA provided additional information regarding the pathophysiological process and the patient's functional visual recovery.