Tamoxifen retinopathy: does it really exist?

BACKGROUND: Tamoxifen retinopathy is known to be an adverse effect of high-dose tamoxifen treatment. Evidence of ocular toxicity at lower doses is less convincing: the aim of this study was to assess the prevalence of the above-mentioned retinopathy in a population treated with low-dose tamoxifen. METHODS: One hundred and twenty-nine women treated with low-dose tamoxifen (20 mg/day) were examined. Visual acuity measurement, slit-lamp biomicroscopy and fundus examination were performed. Patients were reexamined after 6-12 months. RESULTS: Refractile retinal opacities, similar to those previously described as tamoxifen retinopathy, were observed in four patients (prevalence 3.1%; mean duration of therapy 806 days). None of them revealed corneal opacities, papillary and/or macular edema, or visual impairment. The ophthalmoscopic aspect did not change after a mean follow-up of 215 days, although one of these patients had interrupted tamoxifen intake. Statistical analysis (Student's t-test) did not reveal any difference between patients with and those without refractile retinal opacities as far as age, treatment duration and ERG values were concerned. An early hyperfluorescence, reminescent of cuticular drusen, was demonstrated by fluorescein angiography in all four cases. CONCLUSIONS: The present study would seem to confirm that low-dose tamoxifen may induce retinal toxicity in a low proportion of patients, but we cannot be certain that the refractile retinal opacities observed are really caused by tamoxifen, as differentiation from age-related macular degeneration with cuticular drusen appears nearly impossible.

Factors related to drug consumption during pregnancy.

A survey on drug intake during pregnancy was carried out in a sample of 3268 women who delivered live-born infants in 11 hospitals located throughout Italy. A large questionnaire on drug use and other aspects of maternal life-style was administered within five days of delivery to 3112 women who consented to the interview. An overall mean consumption of 2.17 drugs per woman was reported. Apart from dietary supplements, the most used drugs were tocolytics, analgesics, and antibiotics. The proportion of women who did not use any drug was 17.3%. The role of some non-medical determinants of drug intake was evaluated as well. Geographic and socio-economic factors were seen to increase drug intake up to 44%, while the presence of anxiety provoked a 60% higher consumption of drugs other than dietary supplements. Other factors influencing drug use during pregnancy were rural vs. urban residence and smoking habits. The need for the recording of these socio-economic factors in surveys on drug use during pregnancy is emphasized.

Moderate maternal drinking and outcome of pregnancy.

The adverse effect of light or moderate maternal drinking during pregnancy on the well being of the newborn has been investigated. The study group included 2145 live births in the obstetric units of 11 Italian cities between February 1989 and July 1990. A detailed life style questionnaire was administered to the mothers. Information on the newborn was collected from clinical records as well as from a clinical examination. Both univariate and multivariate analyses were suggestive of a decrease in mean birth weight associated with maternal drinking pregnancy, especially in women who also smoked during pregnancy. This effect was higher in male newborns. The occurrence of low birth weight (< 2500 g.) was more frequent in women drinking during pregnancy in both smokers and non-smokers (for this latter group an effect is suggested only for a daily consumption of more than 10 grams of absolute alcohol). Maternal alcohol drinking of more than 20 grams of absolute alcohol per day also increased the risk of preterm delivery (OR = 2.35; 95% CI: .98-5.59). Finally, an increase in the rate of early jaundice was found, also associated with maternal drinking (OR = 3.30; 95% CI: 1.03-10.54).

[Paralysis of oculomotor nerves in diabetes mellitus. A retrospective study of 44 cases]. / Paralysies des nerfs oculomoteurs au cours du diabète. Etude rétrospective de 44 cas.

Data from the clinical charts of 44 diabetic patients with oculomotor palsy were studied. The sixth cranial nerve was involved in 55 p. 100 of cases, the third in 39 p. 100 and the fourth in 6 p. 100 of cases. Forty three patients had type II diabetes mellitus; in 19 the oculomotor palsy revealed diabetes, while in 25 patients diabetes mellitus had been diagnosed for 9.5 +/- 6.2 years. The oculomotor palsy resolved within an average of 93 days on average (range 156-39 days). Twenty eight patients had arterial hypertension and 23 ischemic cardiopathy of peripheral arteriopathy. There appeared to be no correlation between oculomotor palsy and the quality of glycemia control, renal function, the presence of diabetic retinopathy, or other diabetic neurological complications.

[Effects of moderate maternal drinking on some neonatal parameters]. / Effetti di un moderato consumo di alcol in gravidanza su alcuni parametri neonatali.

A cross-sectional study was conducted on 2415 mother/newborn pairs, in order to evaluate the relationship between maternal alcohol consumption and birth weight. The results of this study are consistent with previous reports, that pointed out the casual relationship between maternal drinking during pregnancy, and reduction in birth weight. This reduction was evident only on the subset of smokers. A further stratification by the sex of newborn, showed a heavier effect on male newborns, who experienced a significant reduction of 6.2 grams in birth weight for each g of absolute alcohol consumed daily during pregnancy by mother. The findings of this study support the evidence of neonatal functional damages due to alcohol, even at very low doses. A strong increase of early jaundice were found among the outcome of exposed women (OD = 3.30; 95% CI 1.03-10.54).

Effect of passive smoking during pregnancy on selected perinatal parameters.

A prospective study of 1004 consecutive deliveries was carried out to investigate the effect of passive smoking during pregnancy on a set of perinatal parameters. The data set was a cooperative study involving 11 Italian cities, distributed nationally. The study group was divided in three categories according to the mother's cigarette smoke exposure during pregnancy, ie, not smokers, passive smokers, direct smokers. Potential confounders, including paternal characteristics, were adjusted for by multiple linear regression analysis. A mean reduction of 16 g (p less than 0.07) in birthweight and a decrease in birth length of 0.05 cm (p less than 0.08) were found for each hour of antenatal passive smoke exposure. No or slight effects were reported for the other perinatal parameters considered.

Central vision impairment from optic disk drusen in the young.

Reduced visual acuity apparently due to the effects of drusen on the optic nerve is rare. We describe two young patients with central vision impairment from optic disk drusen: a man with a reduction of visual acuity to light perception, a women with a very fast evolution of the drusen, that, not visible at the clinical onset, could be documented in autofluorescence one month later. The appearance of drusen in disks initially diagnosed as pseudopapilledema is supposed to be related to axonal degeneration from abnormal axoplasmic flow.

[Severe neonatal cardiac insufficiency due to arteriovenous fistula of the vein of Galen]. / Grave insufficienza cardiaca neonatale da fistola artero-venosa della vena di Galeno. Considerazioni emodinamiche a proposito di 3 casi clinici.

The cerebral arteriovenous fistula is a rare cause of neonatal cardiac failure. We have recently observed three cases of severe cardiac failure associated with an arterio-venous malformation of the vein of Galen. At echocardiography and angiography the right cardiac chambers were seen to be more enlarged than the left ones. This may have resulted to some extent from an insufficient right-to-left shunt during foetal life due to a relatively small foramen ovale confronting an increased systemic venous return. Two of the neonates were operated upon and one survived. Based on our experience and on a review of the literature we feel that the diagnostic clues are: 1) severe cardiac enlargement; 2) a vascular bruit on the head; 3) hyperpulsatile neck vessels, sometimes with small peripheral pulses.