Enoftalmia causada por uso tópico unilateral de Bimatoprost / Unilateral enophthalmos induced by the unilateral use of topical Bimatoprost

RESUMO O autor descreve o caso de uma paciente que apresenta o olho direito com o sulco palpebral profundo e enoftalmia deste lado, tratado durante uma década com Bimatoprost tópica. Concluem que os achados clínicos são provavelmente efeitos colaterais do medicamento.

ABSTRACT The author describes a case report of a patient with unilateral enophthalmia and deep palpebral sulcus probably induced by the topical use of Bimatoprost on the side of the collateral effects described.

Evaluation of palpebral fissure and orbital volume after bimatoprost 0.03% orbital injections. Experimental study in rats / Avaliação da fenda palpebral e do volume orbitário após aplicações orbitárias de bimatoprost 0.03%. Estudo experimental em ratos

Objective: To evaluate in experimental animals the changes of the palpebral fissure and the orbital volume after orbital injection of bimatoprost 0.03%. Methods: Two main groups of Wistar rats were analyzed, one after orbital injection of bimatoprost 0.03% and another, a control group, after orbital injection of saline solution. The calculation of the palpebral fissure was done on images by means of computer processing, using the program Image J. After taking photographs, the animals were submitted to bilateral orbital exenteration and the volume was calculated in all the animals by the water displacement method (Archimedes’ Principle). Results: While comparing the measurements of the palpebral fissure and the orbital volume among animals given an injection with bimatoprost 0.03% and the control group it was found that there were no statistically significant differences. Conclusions: In this study there were no statistically significant differences in the measurement of the vertical palpebral fissure and the orbital volume among animals given the orbital injection of bimatoprost 0.03% and the animals of the control group. .

Objetivo: Avaliar em modelos experimentais as alterações da fenda palpebral e do volume orbitário após aplicação orbitária de bimatoprost 0,03%. Métodos: Dois principais grupos compostos por ratos Wistar foram analisados, sendo comparados os animais submetidos à injeção orbitária de bimatoprost 0.03% com os submetidos à injeção orbitária de solução salina. O cálculo da fenda palpebral vertical foi obtido através de imagem computadorizada utilizando-se o programa Image J. Após serem fotografados os animais foram submetidos à exenteração bilateral e o volume orbitário foi calculado pelo método de deslocamento da coluna de água (Princípio de Archimedes). Resultados: Quando foram comparadas as medidas da fenda palpebral vertical e do volume orbitário entre os animais submetidos a injeção de bimatoprost 0.03% e o grupo controle não foi obsevada diferença estatisticamente significante. Conclusão: Neste estudo não houve diferença estatisticamente significante nas medidas da fenda palpebral vertical e no volume orbitário entre os animais submetidos à injeção orbitária de bimatoprost 0.03% e o grupo controle. .

Atrofia cerebelosa y uso crónico de fenitoína: revisión de la literatura y presentación de un caso clínico / Cerebellar atrophy and long-term phenytoin therapy: literature review and case presentation

Introduction: The most important chronic toxic adverse effect caused by phenytoin takes place in the cerebellum and may lead to irreversible cerebellar atrophy. Objective: Draw attention to the occurrence of cerebellar atrophy in patients undergoing long-term phenitoyn therapy Emphasize the need for and feasibility of early diagnosis. Update pathogenetic hypotheses. Development: Brief history of Phenytoin since it was first used in the treatment of epileptic seizures; acute, subacute, and chronic adverse effects, with emphasis on cerebellar atrophy. The case presented developed during long-term phenytoin treatment of an epileptic patient. The hypotheses so far raised on pathophysiological mechanisms involved in causing atrophy are described. Complete current review of literature is included and most relevant authors are listed. Conclusions: Cerebellar atrophy following long-term phenytoin therapy takes place in a minor, as yet indeterminate, number of patients; its occurrence, however, must be borne in mind in the case of patients under long-term therapy. CT and MR contributions to early diagnosis are underlined, as well as the current and potential support of new neuroimaging techniques. Recent hypotheses regarding pathophysiological mechanisms involved, direct toxic action, anoxia, and dysafferentation are discussed. The debate on future use of phenytoin as first-line drug is supported.

Introducción: El efecto adverso tóxico crónico más relevante que puede ocasionar la fenitoína es producido sobre el cerebelo pudiendo causar una atrofia cerebelosa irreversible. Objetivo: Llamar la atención sobre la ocurrencia de atrofia cerebelosa en pacientes expuestos a la fenitoína en forma crónica. Resaltar la importancia y posibilidad de efectuar un diagnóstico precoz. Actualizar las hipótesis planteadas en su patogenia. Desarrollo: Breve síntesis histórica de la fenitoína desde su incorporación a la terapéutica de las crisis epilépticas, sus efectos adversos agudos, sub-agudos y crónicos, haciendo énfasis en la atrofia cerebelosa. Se presenta un caso clínico desarrollado durante el tratamiento a largo plazo con fenitoína en una paciente epiléptica. Describimos las hipótesis planteadas hasta ahora sobre los mecanismos fisiopatológicos involucrados en la producción de la atrofia. Se realiza una revisión actualizada y completa de la bibliografía y se citan los autores más pertinentes. Conclusiones: La Atrofia cerebelosa causada por el uso crónico de la fenitoína se produce en un porcentaje bajo de pacientes, aún no determinado; sin embargo, su ocurrencia se debe tener siempre presente en las personas tratadas con fenitoína en forma prolongada. Muy demostrativos de atrofia cerebelosa son algunos exámenes como la TAC y la RNM, cuyos hallazgos pueden preceder a las manifestaciones clínicas, lo que permite realizar un diagnóstico precoz, La aparición de nuevas técnicas neuroradiológicas, como la RNM con tensor de difusión (RNM-DT) prometen contribuir a dilucidar los mecanismos fisiopatológicos involucrados. Se revisan las hipótesis actuales postuladas en la patogenia, como acción toxica directa, anoxia y desaferentación.

Atrophy of the nitrergic myenteric neurons in the descending colon rats submitted to protein and vitamin deficiency / Atrofia en neuronas mientéricas nitrérgicas en el colon descendente de ratas sometidas a deficiencia de proteínas y vitaminas

Effects of protein and B-complex vitamin deficiency were assessed with respect to the morphometry of myenteric neurons in the descending colon of adult rats. Sixteen animals were divided into two groups: Control Group (CG, n=8) and Experimental Group (EG, n=8). The CG received 22 percent protein chow and the EG received 4 percent protein chow for 120 days. The descending colon was submitted to NADH- and NADPH-diaphorase technique in order to evidence nervous cells in the whole mounts preparations. In the EG, NADH-d positive neurons presented reduced nuclei, while NADPH-d positive neurons showed atrophy of the soma area (~41.7 percent) inducing an increase of the proportion occupied by the nucleus inside in the soma of these cells.

Esta investigación buscó evaluar los efectos de la desnutrición proteica y vitamínica delcomplexo B sobre aspectos morfométricos del plexo mientérico del colon descendente de ratones adultos. Dieciséis animales fueron distribuidos en dos grupos: control que recibieron ración comercial con 22 por ciento de proteína y experimental alimentados con ración de tenor proteico reducido para 8 por ciento, durante 120 días. Neuronas del plexo mientérico presentes en preparados totales fueron evidenciados a través de la técnica histoquímica de la NADH-diaforasa y de la NADPH-diaforasa. En el grupo experimental, las neuronas NADH-d positivos sufrieron reducción del núcleo celular, ya las neuronas NADPH-d sufrieron atrofia de 41,7 por ciento de la superficie de su pericarion, lo que hizo con que el núcleo celular pasase a ocupar una mayor proporción de la región trófica de las neuronas.

Retinal pigment epithelial atrophy following indocyanine green dye-assisted surgery for serous macular detachment.

To report subretinal migration of indocyanine green dye (ICG) and subsequent retinal pigment epithelial (RPE) atrophy during macular surgery for serous macular detachment. A 65-year-old woman presented with residual epiretinal membrane and serous detachment of the macula following vitreoretinal surgery for epiretinal membrane. She underwent resurgery with ICG-assisted internal limiting membrane peeling and intraocular tamponade. Intraoperatively a large area of subretinal ICG was seen with subsequent RPE mottling and atrophy of the macula in the area involved during follow-up. This case demonstrates that subretinal migration of ICG is possible and can be toxic to RPE.

Embriopatía por isotretinoína: Un daño evitable / Isotretinoin embryophaty: Report of one case

Retinoic acid is a widely used drug in the treatment of cystic acné. It has teratogenic effects that depend on the gestational period in which it is used. We report a seven months of female whose mother was exposed to retinoic acid in both pregestational and gestational periods. She had a retardation of psychomotor development and a brain MRI showed frontal atrophy and a malformation of the posterior fossa. We discuss the mechanisms ofthe teratogenic effeets of retinoic acid.

Estudio histológico de los órganos reproductivos del ratón macho CF1 tratado con boro / Histological study on the male reproductive organs of mouse CF1 treated with boron

Boric acid and borate are abundant in the nature and widely used in industrial, agricultural and cosmetology applications. However it is informed as toxic in a high dose. Residents of Arica-Chile with boron-rich geology deposits are regularly exposed to higher levels in drinking water in concentrations of 6. 0 and 12.0 mg/L. The objective of this study was to analyze the damage in the masculine reproductive apparatus of mouse CF1, exposed to boric acid in concentrations of 0.54; 2.0-6.0 and 12.0 mg/L, after 60 days of treatment. Male gonad segments were fixed in Bouin's solution for 6 hours and embedded in paraffin, longitudinal sections (5 mm) were processed for histology using the hematoxyline/eosin method. The results observed in treated animals indicate a significant increase in the weight, volume and size of testicles and seminal vesicles. The histological analysis of testicle shows in treated an epithelium notoriously altered with vacuohzations, scarce gonias and few spermatids. Gonias present picnoticals nuclei, suggesting apoptosis. In conclusion boron in high dose produces important cytotoxics effects, with degeneration of epithelium of seminiferous tubules, possibly inhibiting the spermiation, causing testicular hypertrophy, altering the masculine reproductive patterns and a reduction in fertility of mice CF1.

El ácido bórico y el borato son abundantes en la naturaleza y con amplio uso industrial, agrícola y cosmetológico. Sin embargo, se informa como tóxico en alta dosis. Residentes de la ciudad de Arica-Chile, están expuestos a altos niveles de boro presente en el agua potable, con concentraciones 6.0 y 12.0 mg/1. El objetivo de este estudio fue analizar el daño en el sistema reproductivo masculino del ratón CF1, expuesto a ácido bórico en concentraciones de 0.54; 2.0-6.0 y 12.0 mg/1, por un período de 60 días de tratamiento. Los segmentos masculinos de las gónadas fueron fijados en solución de Bouin por 6 horas e incluidos en parafina, secciones longitudinales (5 /aa) fueron procesadas para histología usando el método hematoxilina/eosina. Los resultados observados en animales tratados indican un aumento significativo en el peso, el volumen y el tamaño de testículos y de vesículas seminales. El análisis histológico de testículo de individuos tratados, muestra un epitelio alterado con vacuolizaciones, escasas gomas y pocas espermátidas. Gonias presentan núcleos picnóticos, sugiriendo apoptosis. En conclusión el boro en alta dosis produce efectos citotóxicos importantes, con degeneración de epitelio de túbulos seminíferos, posiblemente inhibiendo la espermiación, causando hipertrofia testicular, alterando los patrones reproductivos masculinos y una reducción en la fertilidad de los ratones CF1.

Induction of seminiferous tubular atrophy by single dose of 5-fluorouracil (5-FU) in Wistar rats.

Antimetabolite, 5-fluorouracil (5-FU) is known to cause testicular damage by epithelial sloughing and cell killing. However, it is not known whether 5-FU induces tubular atrophy and the fate of exfoliated germ cells. Present study was conducted to evaluate these effects of 5-FU on rat testis. Animals were injected, single dose of 5-FU (10.50 & 100 mg/kg, i.p.) and sampled at 1, 3, 15 and 30 day following the treatment. The testes were perfusion fixed by Bouin's fluid. Five micron thick paraffin sections of testes and epididymis were stained with haematoxylin and eosin. Slides were examined for the incidence of abnormal tubules (per 200 tubules), tubular diameter (STD), epithelial height (SEH) and for the presence of germ cells in the epididymis. Data were analysed by Mann-Whitney 'U' test. The testes weight, STD, SEH were decreased (P < 0.05-0.01) in treated animals. The abnormal tubules were increased in a dose dependent manner with atrophic tubules seen on 30 d. The exfoliated germ cells have not blocked the post testicular ductal system and found in the epididymis in a dose dependent manner. The present study concludes that 5-FU causes tubular shrinkage and atrophy. Further, epididymis is involved in the phagocytosis of germ cells.

Cerebellar atrophy in an epileptic child: is it due to phenytoin?

A four and half year old epileptic child on phenytoin therapy since one year presented with signs of cerebellar dysfunction. Serum phenytoin level was high (33 mcg/ml) and computerised tomographic scan of the brain showed severe generalised cerebellar atrophy. The cerebellar signs represented drug over dosage and toxicity and persisted long after omission of phenytoin.

Relação dose-dependente do uso crônico de fenitoína e atrofia cerebelar em pacientes com epilepsia / Dose-related cerebellar atrophy in patients with epilepsy using phenytoin

O uso crônico da fenitoína ou intoxicação aguda por essa droga produzem lesão cerebelar permanente com atrofia do vermis e hemisférios cerebelares, que pode ser evidenciada através de exames de neuroimagem. O objetivo deste estudo foi avaliar a correlação entre a dosagem e o tempo de uso da fenitoína com a ocorrência de atrofia cerebelar. Foram realizados levantamento de prontuários para a obtenção de dados clínicos e análise de tomografias de crânio para avaliação de atrofia cerebelar. Dos 66 pacientes estudados, 18 apresentaram atrofia moderada a severa, 15 atrofia leve e 33 foram considerados normais. Os pacientes com atrofia cerebelar moderada a severa foram aqueles com maior exposição à fenitoína (uso prolongado e dose total), apresentando diferença estatisticamente significativa se comparados aos pacientes com atrofia leve ou sem atrofia (p=0.02). Além disso, no subgrupo de pacientes em uso de fenitoína, aqueles com atrofia moderada a severa possuíam níveis séricos de fenitoína significativamente mais elevados que os pacientes com atrofia leve ou sem atrofia (p=0.008). Não houve relação entre duração do tratamento e dose de outros anticonvulsivantes e presença e grau de atrofia cerebelar. Os pacientes mais velhos apresentaram maior grau de atrofia cerebelar, indicando que o fator idade ou tempo de epilepsia, ou ambos, pode ser importante na determinação de degeneração cerebelar. Concluímos que apesar da possibilidade de lesão cerebelar relacionada a crises epilépticas repetidas, a contribuição da fenitoína pode ser claramente estabelecida como um dos determinantes da atrofia cerebelar, sobretudo naqueles pacientes com altas doses por tempo prolongado e níveis séricos elevados.

Cerebellar atrophy related to chronic exposure to toluene: case report

Uma mulher de 31 anos desenvolveu síndrome cerebelar e neurastênica, de evoluçäo lentamente progressiva, após 14 anos de exposiçäo ocupacional a vapores de toluenos em baixas concentraçöes. Os únicos achados do exame neurológico e neuropsicológico foram sinais cerebelares (severos) déficit visuo-espacial e práxico-construcional (moderado). A neuroimagem tomográfica mostrava acentuada atrofía e a neuroimagem (TC) estavam inalteradas, enquanto a funçäo visuo-construcional havia parcialmente melhorado. Os autores chamam a atençäo para o possível risco neurotóxico relacionado a esse tipo de exposiçäo, numa tentativa de prevençäo de casos semelhantes

Effect of a single maximal and low multiple doses of testosterone propionate (TP) on male reproductive organs in Long Evans rats.

Testosterone as a male contraceptive agent was tried on two age groups of rats of Long-Evans strain and with two dosage schedule. A general increase in accessory organs weights like seminal vesicle and ventral prostate was observed in all groups of animals with all dosage schedule. The testicular weight was reduced particularly in low multiple dosage group. Gross atrophy with marked irregularity in germ cell pattern and population, suppression of spermatogenesis and atrophy of Leydig cells in the testis of low multiple dosage group were evident without affecting the potentiality to sex drive. A further study is suggested to examine the time period needed for testicular recovery and return of normal spermatogenesis before its possible trial on male volunteers in Bangladesh.