[Multiple sclerosis and familial Mediterranean fever: a case report]. / Sclérose en plaques et fièvre méditerranéenne familiale : un cas et revue de la littérature.

INTRODUCTION: Few cases of patients with both Familial Mediterranean Fever (FMF) and Multiple Sclerosis (MS) have been reported, mainly from Turkey. Central nervous system manifestations are rare in FMF. CASE REPORT: We report the case of a 37-year-old right-handed man with FMF diagnosed at 17 the age of years and successfully treated with colchicine. The patient was born in Algeria and lived in France since he was four years old. He had a brother who had multiple sclerosis. When the patient was 23 years old, he experienced diplopia and leg numbness that resolved spontaneously without treatment. Ten years later, new neurological events appeared every six months and were treated with corticoid-steroids. The diagnosis of MS was made. In 2006, he was hospitalized for new explorations in order to search for neuro-Behçet's disease, because of the development of a canker sore. There was no argument for neuro-Behçet's disease. DISCUSSION: Neurological complications of FMF are rare. It is important to rule out a neuro-Behçet disease in a FMF patient with neurological disorders. Previous studies and case reports on the association between FMF and MS have failed to draw a clear conclusion as to whether this is a true association or a simple coincidence. In our patient's clinical situation, we found no argument for changing the treatment of MS and FMF.

Gamma scintigraphic comparison of eyedrops containing pilocarpine in healthy volunteers.

The aim of the present study was to compare, in healthy human volunteers (male and female), the corneal contact time of various formulations, each containing one viscosity enhancer from the following list: a phase-transition system (gellan gum, Gelrite), a heteropolysaccharide (xanthan gum) and currently used polymers hydroxyethylcellulose, hydroxypropylmethylcellulose, or poly(vinyl alcohol). These different solutions were compared to a reference solution containing no viscosity enhancers. The corneal contact time of the formulations was evaluated over more than 20 minutes by gamma scintigraphy using Technetium-99m (Tc-99m DTPA) as a radioactive label. An eyedrop containing pilocarpine salts (25 microliters) was instilled in one eye only. Each volunteer received 4 formulations, the interval between the instillations being one week. The protocol has been approved by the relevant institutional human experimentation committee. One minute after instillation, only 23% of the reference solution remained on the ocular surface, whereas the novel formulations maintained, respectively, 77% (xanthan gum) or 82% (Gelrite) of the tracer on the ocular surface. Twenty-one min after instillation, 12% (reference solution), 25% (xanthan gum solution), and 39% (gelrite solution) of the tracer remained on the ocular surface. The results confirm that an increase in viscosity of the formulation (xanthan) delays the clearance of the instilled solution by the tear flow. The effect of the gelation mechanism is superior, especially at the later time points. In this respect, xanthan gum and, particularly, Gelrite are suitable vehicles for ophthalmic drugs.

Anti-sulfoglucuronyl paragloboside IgM antibodies in amyotrophic lateral sclerosis.

We report here our results on IgM anti-sulfated glucuronyl paragloboside (SGPG) antibodies in sera from patients with amyotrophic lateral sclerosis (ALS). Studies by enzyme linked immunosorbent assay on 72 ALS sera showed IgM polyclonal reactivity towards SGPG in 25 cases. The titer was high in 16 cases. Thin-layer chromatography immuno-overlay showed that reactivity with SGPG was associated to reactivity towards GM1 in five cases and to GM1 and GD1b in one case. Anti-SGPG reactivity was not found in controls and in multifocal motor neuropathy with conduction blocks, in contrast to anti-GM1 antibodies. The presence of anti-SGPG antibodies in ALS patients sera raise again the question of autoimmunity in this pathology.

Mucoadhesion of copolymers and mixtures containing polyacrylic acid.

Water-soluble polymers were synthesized from dextran and polyacrylic acid and their ocular mucoadhesion was evaluated. One series had polyacrylic acid grafted onto the polysaccharide backbone of dextran, and another series had dextran grafted onto the polyacrylic acid backbone. Mucoadhesion of these copolymers was investigated using a tensile apparatus and compared with that of polyacrylic acid/dextran mixtures prepared in different proportions. Whatever the copolymer structure, no synergistic effects were seen and mucoadhesion was not markedly increased compared to dextran. The adhesion of copolymers was the same as that of mixtures having a similar polyacrylic acid content and was always less than that of polyacrylic acid alone. Formation of an interpolymer complex occurred at concentrations up to 60% polyacrylic acid, and only above this value did bioadhesion increase above that of dextran. When this complex was dissociated by neutralization of the carboxyl groups of polyacrylic acid, the mucoadhesion of the copolymers and the mixtures was improved. These experiments demonstrated that copolymers and mixtures of dextran and polyacrylic acid did not produce polymers with improved ocular mucoadhesion.

[Role of percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis]. / Place de la gastrostomie endoscopique percutanée dans la sclérose latérale amyotrophique.

Percutaneous endoscopic gastrostomy (PEG) is an enteral nutritional assistance technique using a simple device compatible with conventional feeding and thus enabling the patient to be integrated into his or her social and familial surroundings. This inexpensive device is quickly and easily inserted under local anaesthesia. It causes little morbidity and virtually no mortality and has many advantages for patients with amyotrophic lateral sclerosis (ALS). We report the results of PEG in 28 ALS patients with bulbar involvement. Three of these patients developed minor complications during 6 consecutive months of PEG-assisted nutrition (2 had periostomial infection, 1 had mild haematemesis). There were no major complications, and mortality directly ascribable to PEG was nil. All patients put on weight or had their weight stabilized, and GEP was well accepted in all cases.

Scintigraphic assessment of an ophthalmic gelling vehicle in man and rabbit.

Studies of the rate of clearance of a gellan gum formulation (Gelrite) radiolabelled by the inclusion of technetium-99m labelled diethylenetriaminepentaacetic acid were carried out in volunteer subjects and in rabbits. Disposition was followed by gamma scintigraphy and compared with 0.5% w/v hydroxyethylcellulose (HEC) solution and isotonic saline administered to the same subjects. Clearance of all solutions was found to follow bi-exponential kinetics with differences in clearance rates between the two species studied. A significant retention of the gellan gum formulation compared to HEC (p = 0.006) or saline (p = 0.009) was noted in man, but not in the rabbit. In this latter species the HEC showed greater retention compared to Gelrite. The species-specific differences in the precorneal residence of the formulations are attributed to the different physiological responses following instillation of solutions into the eye.

Corneal endothelial changes with azone, a penetration enhancer.

Azone has been used to enhance percutaneous absorption. Its ability to improve penetration makes it an attractive candidate for incorporation into ophthalmic formulations to increase therapeutic action of a drug or achieve an equivalent effect with a lower concentration of the active ingredients. Ophthalmic vehicles containing 0, 1, or 2% Azone were studied to determine their ocular irritation potential in the rabbit. The vehicle ingredients were poloxamer 188, hydroxy-ethylcellulose, benzalkonium chloride and phosphate buffer. Rabbits received 30mcl topically of each of the test products three times daily for 29 days. Clinical and histopathological evidence of ocular toxicity occurred in eyes treated with the vehicle containing 1 or 2% Azone, but not in the vehicle without Azone. Clinical signs of ocular irritation were transient and included redness of conjunctivae and iris, discharge and corneal edema. Scanning electron microscopy and semi-thin sections revealed corneal changes characterized by ballooning and vacuolation of endothelial cells resulting in distortion of the typical polygonal appearance. These results indicate that instillation of ophthalmic vehicles containing 1 or 2% Azone damages corneal endothelial cells of the rabbit. It is not clear, however, if this irritation is due to the direct action of Azone on the endothelium or the enhanced penetration of potential irritants in the formulation such as benzalkonium chloride.