Drug-Induced Ectropion

PURPOSE

To review cases of possible drug-induced ectropion and recommend what we consider to be best practice.

DESIGN

Retrospective observational case series.

PARTICIPANTS

Thirteen consecutive outpatients.

METHODS

Records of 13 outpatients on topical medication presenting with topical drug-induced ectropion were retrospectively analyzed.

MAIN OUTCOME MEASURES

Eyelid position, topical agent causing the allergy, and medical and surgical management options.

RESULTS

In all 13 patients, the ectropion resolved partially or completely after discontinuing the offending topical agent. Dorzolamide (53%) was the most common offending agent, followed by brimonidine (23%). One of the 13 patients underwent failed ectropion surgery correction before referral, but improved once the topical agent was discontinued. Two of the patients successfully underwent surgical correction for ectropion after discontinuing their topical therapy. Those patients who discontinued the topical therapy and had a short course of steroid therapy did not require surgical correction.

CONCLUSIONS

This study demonstrates that sensitivity to topical agents can induce ectropion in more than 1 manner. Chronic exposure to the causative agent leads to cicatricial changes in the anterior lamella of the eyelid in susceptible individuals, and can manifest as contact dermatitis leading to tissue edema and mechanical ectropion. Early recognition of this condition and discontinuation of therapy is of paramount importance; it may lead to complete resolution. Topical steroids are a necessary adjunct in the management of drug-induced ectropion. Based on our experience, we propose a management algorithm for drug-induced ectropion.

Distal adenomatous polyps are rare in patients with inflammatory bowel disease

OBJECTIVE

There is an increased risk of colorectal cancer in patients with inflammatory bowel disease (IBD). The aim of this study was to compare the prevalence of left sided adenomas in patients with IBD aged 55-64 years with a local age matched control population.

METHOD

A review of clinical notes. The prevalence of adenomas in patients with IBD attending for either sigmoidoscopy or colonoscopy was compared with local age matched controls that participated in the national screening trial for colorectal cancer with flexible sigmoidoscopy.

RESULTS

Of 106 patients (61 male, 45 female, mean age of 59 years), 80 suffered from ulcerative colitis, 20 from Crohn's disease, and six from indeterminate colitis. All patients had undergone at least one flexible sigmoidoscopy and 75 had a colonoscopy. Distal adenomas were found in three patients with ulcerative colitis compared with 67 of 749 controls (2.8% v 8.9%, chi(2) = 4.6, p = 0.03).

CONCLUSIONS

The results suggest that distal adenomatous polyps are rare in patients aged 55-64 years with IBD compared with a control population. This supports the hypothesis that lesions other than polyps are important for the development of colorectal cancer in patients with IBD.

Anti-VEGF antibody bevacizumab (Avastin) with 5FU/LV as third line treatment for colorectal cancer

BACKGROUND

To evaluate the activity and safety of bevacizumab when given with standard 5FU/leukovorin (LV) regimens in patients with metastatic colorectal cancer who have failed irinotecan and oxaliplatin-based treatments.

METHODS

Bevacizumab was given at 5 mg/kg as an IV infusion every 2 weeks. Patients received 5FU according to Roswell Park or the de Gramont regimen.

RESULTS

Nineteen patients enrolled, median age 60, median PS: 1. Most common toxicity attributable to bevacizumab was mild hypertension, epistaxis and mild proteinuria; 1 patient had a CNS haemorrhage. The median number of cycles was 1 (8 weeks). Clinical benefit as disease stabilisation lasting 2-6 months was noted in 9 patients, whereas 10 progressed (median f/u: 5 months). TTP was 16 weeks, and the overall survival has not been reached (24+ weeks).

CONCLUSIONS

Bevacizumab may result in growth arrest and clinical benefit in a substantial proportion of patients with colorectal cancer and no alternative treatment.

Validation of binary ethyleneimine (BEI) used as an inactivant for foot and mouth disease tissue culture vaccine

The complete inactivation of Foot and Mouth Disease (FMD) virus is a critical requirement in the production of FMD vaccine to ensure the safety of the product. Binary ethyleneimine (BEI) is an aziridine compound, produced from bromoethylamine hydrobromide (BEA) commonly used for the inactivation of FMD virus during vaccine manufacturing. The validation of BEI, when used as an inactivant, is essential to ensure the quality of the inactivating agent and the validity of the process. In the present study, the inactivation kinetics of Foot and Mouth Disease virus (O, A and Asia-1 serotypes) were determined for different concentrations of BEI (0.4 mM, 0.8 mM, 1.2 mM, 1.6 mM and 2.0 mM). Statistically significant differences in the inactivation kinetics were observed between 0.4 mM and 1.6 mM of BEI. The results indicated that BEI at 1.6 mM was able to inactivate the FMD virus within 8-10 h. Increasing the concentration of BEI beyond 1.6 mM did not appreciably improve the inactivation process. No differences in the inactivation kinetics were found between the various serotypes studied. This study can be used as a guideline for routine procedures for validating the quality of BEA and the inactivation process.

Sodium channel 1-subunit mutations in severe myoclonic epilepsy of infancy and infantile spasms

BACKGROUND

Mutations in SCN1A, the gene encoding the alpha1 subunit of the sodium channel, have been found in severe myoclonic epilepsy of infancy (SMEI) and generalized epilepsy with febrile seizures plus (GEFS+). Mutations in SMEI include missense, nonsense, and frameshift mutations more commonly arising de novo in affected patients. This finding is difficult to reconcile with the family history of GEFS+ in a significant proportion of patients with SMEI. Infantile spasms (IS), or West syndrome, is a severe epileptic encephalopathy that is usually symptomatic. In some cases, no etiology is found and there is a family history of epilepsy.

METHOD

The authors screened SCN1A in 24 patients with SMEI and 23 with IS.

RESULTS

Mutations were found in 8 of 24 (33%) SMEI patients, a frequency much lower than initial reports from Europe and Japan. One mutation near the carboxy terminus was identified in an IS patient. A family history of seizures was found in 17 of 24 patients with SMEI.

CONCLUSIONS

The rate of SCN1A mutations in this cohort of SMEI patients suggests that other factors may be important in SMEI. Less severe mutations associated with GEFS+ could interact with other loci to cause SMEI in cases with a family history of GEFS+. This study extends the phenotypic heterogeneity of mutations in SCN1A to include IS.