RESUMEN
The authors describe a rapidly enlarging, pedunculated brown tarsal lesion in a 34-year-old man with a history of chalazia. Following excision, histopathologic analysis showed the features of a necrotic pyogenic granuloma. This unique case expands the differential diagnosis of conjunctival malignant melanoma.
Asunto(s)
Conjuntiva/irrigación sanguínea , Neoplasias de la Conjuntiva/diagnóstico , Granuloma Piogénico/diagnóstico , Melanoma/diagnóstico , Adulto , Conjuntiva/patología , Neoplasias de la Conjuntiva/cirugía , Diagnóstico Diferencial , Granuloma Piogénico/cirugía , Humanos , Infarto , Masculino , Procedimientos Quirúrgicos OftalmológicosRESUMEN
A 45-year-old patient presented with bilateral orbital abscesses. He was found to have Lemierre syndrome, a condition involving septic thrombophlebitis of the internal jugular vein. The patient developed severe proptosis, sepsis, and cavernous sinus thrombosis. Despite aggressive antibiotic and anticoagulation therapy, visual loss was rapid, and the patient ultimately died. Lemierre syndrome, previously thought to be rare, is now becoming more commonly reported. Its prompt diagnosis and treatment are essential for patient survival.
Asunto(s)
Absceso/microbiología , Bacteriemia/microbiología , Síndrome de Lemierre/microbiología , Enfermedades Orbitales/microbiología , Infecciones Estreptocócicas/microbiología , Streptococcus milleri (Grupo)/aislamiento & purificación , Absceso/diagnóstico , Absceso/terapia , Bacteriemia/diagnóstico , Bacteriemia/terapia , Trombosis del Seno Cavernoso/diagnóstico , Trombosis del Seno Cavernoso/microbiología , Resultado Fatal , Humanos , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/terapia , Masculino , Persona de Mediana Edad , Celulitis Orbitaria/diagnóstico , Celulitis Orbitaria/microbiología , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/terapia , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/terapia , Tomografía Computarizada por Rayos XRESUMEN
RATIONALE: Non-adherence with medication remains the major correctable cause of poor outcome in schizophrenia. However, few treatments have addressed this major determinant of outcome with novel long-term delivery systems. OBJECTIVES: The aim of this study was to provide biological proof of concept for a long-term implantable antipsychotic delivery system in rodents and rabbits. MATERIALS AND METHODS: Implantable formulations of haloperidol were created using biodegradable polymers. Implants were characterized for in vitro release and in vivo behavior using prepulse inhibition of startle in rats and mice, as well as pharmacokinetics in rabbits. RESULTS: Behavioral measures demonstrate the effectiveness of haloperidol implants delivering 1 mg/kg in mice and 0.6 mg/kg in rats to block amphetamine (10 mg/kg) in mice or apomorphine (0.5 mg/kg) in rats. Additionally, we demonstrate the pattern of release from single polymer implants for 1 year in rabbits. CONCLUSIONS: The current study suggests that implantable formulations are a viable approach to providing long-term delivery of antipsychotic medications in vivo using animal models of behavior and pharmacokinetics. In contrast to depot formulations, implantable formulations could last 6 months or longer. Additionally, implants can be removed throughout the delivery interval, offering a degree of reversibility not available with depot formulations.
Asunto(s)
Antipsicóticos/administración & dosificación , Antipsicóticos/farmacocinética , Nivel de Alerta/efectos de los fármacos , Haloperidol/administración & dosificación , Haloperidol/farmacocinética , Inhibición Psicológica , Reflejo de Sobresalto/efectos de los fármacos , Estimulación Acústica , Anfetamina/antagonistas & inhibidores , Anfetamina/farmacología , Animales , Apomorfina/antagonistas & inhibidores , Apomorfina/farmacología , Nivel de Alerta/fisiología , Materiales Biocompatibles , Implantes de Medicamentos , Ácido Láctico , Cuidados a Largo Plazo , Masculino , Ratones , Ratones Endogámicos C57BL , Ácido Poliglicólico , Copolímero de Ácido Poliláctico-Ácido Poliglicólico , Polímeros , Conejos , Ratas , Ratas Sprague-Dawley , Reflejo de Sobresalto/fisiologíaRESUMEN
We compare the rate of drug release through the degradation of 50:50 polylactic-co-glycolic acid polymer pellets, for six different drugs: Thiothixene, Haloperidol, Hydrochlorothiozide, Corticosterone, Ibuprofen, and Aspirin. Despite using the same polymer matrix and drug loading (20% by weight), we find that the rate of polymer degradation and the drug release profile differ significantly between the drugs. We conclude that the design of biodegradable polymeric drug carriers with high drug loadings must account for the effect of the drug on the polymer degradation and drug release rate.
Asunto(s)
Antiinflamatorios/química , Antipsicóticos/química , Materiales Biocompatibles/química , Portadores de Fármacos , Ácido Láctico/química , Ácido Poliglicólico/química , Polímeros/química , Aspirina/química , Corticosterona/química , Preparaciones de Acción Retardada , Difusión , Haloperidol/química , Hidroclorotiazida/química , Hidrólisis , Ibuprofeno/química , Cinética , Modelos Químicos , Copolímero de Ácido Poliláctico-Ácido Poliglicólico , Solubilidad , Tiotixeno/química , Factores de TiempoRESUMEN
BACKGROUND AND OBJECTIVE: To determine the effectiveness of spectral-domain optical coherence tomography (SD-OCT) as a screening tool for the evaluation of chloroquine or hydroxychloroquine retinal toxicity. PATIENTS AND METHODS: This is a prospective, case-control study. Subject eyes were divided into four groups (group I = eyes with bull's eye maculopathy, group II = eyes with early changes of toxicity, group III = eyes with exposure but no signs of toxicity, and group IV = eyes of age-matched controls). Retinal thickness was measured via SD-OCT 0.5 and 1.0 mm from the foveal center. RESULTS: Mean retinal thickness 1.0 mm from the fovea in group I eyes was significantly thinner when compared to group IV. Eyes in group II also showed retinal thinning 1.0 mm from the foveal center when compared to both groups III and IV. Mean retinal thickness 0.5 mm from the foveal center did not differ significantly between any groups. CONCLUSION: Significant retinal thinning occurred 1.0 mm, but not 0.5 mm, from the foveal center in patients with early and late chloroquine or hydroxychloroquine toxicity. Measuring retinal thickness 1.0 mm from the foveal center in patients receiving these medications may help screen for early toxicity.
Asunto(s)
Antirreumáticos/efectos adversos , Cloroquina/efectos adversos , Distrofias Hereditarias de la Córnea/inducido químicamente , Distrofias Hereditarias de la Córnea/diagnóstico , Hidroxicloroquina/efectos adversos , Enfermedades de la Retina/inducido químicamente , Enfermedades de la Retina/diagnóstico , Tomografía de Coherencia Óptica/métodos , Anciano , Animales , Estudios de Casos y Controles , Bovinos , Distrofias Hereditarias de la Córnea/patología , Femenino , Humanos , Degeneración Macular , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Enfermedades de la Retina/patología , Agudeza VisualRESUMEN
N-methyl-D-aspartate (NMDA) antagonists produce behavioral and electrophysiological effects similar to schizophrenia. The mouse P20, N40, and P80 event related potential (ERP) components were analyzed for genetic variance among inbred strains and ketamine-induced differences to model abnormalities in the P50, N100, and P200 in schizophrenia. Ketamine increased P20/N40 amplitude and decreased P80 amplitude. Therefore, the effects of ketamine in mice are inconsistent with alterations in the corresponding P50 and N100 in schizophrenia, suggesting that NMDA receptor dysfunction may not underlie abnormalities of these components in schizophrenia. However, the effects of ketamine on the mouse P80 were consistent with P200 ERP changes in schizophrenia and support the hypothesis that NMDA dysfunction may contribute to some neuronal abnormalities in schizophrenia. The current study lays the groundwork for defining the role of NMDA-mediated transmission for specific aspects of neuronal processing that vary with genetic background. Future studies could use transcription profiling to clarify such interactions between genetic background, specific neuronal circuits, and transmitter systems.