Case of cystoid macular edema induced by systemic administration of paclitaxel: evaluations with electroretinograms

Purpose

To report abnormal full-field electroretinograms (ERGs) in a patient with cystoid macular edema (CME) induced by systemic paclitaxel.

Methods

This is an observational case report. Full-field ERGs were recorded to evaluate the retinal function using the RETeval system and conventional ERGs using contact lens electrodes with built-in white light-emitting diodes. Optical coherence tomography (OCT) was also used to assess the retinal morphology.

Results

A 70-year-old man, who was diagnosed with gastric cancer, had undergone gastrectomy. Subsequently, systemic paclitaxel was administered once a week as an adjuvant therapy. After the tenth course of paclitaxel, he experienced blurred vision in both eyes and visited our department of ophthalmology. OCT revealed the presence of CME in both eyes, and the RETeval flicker ERGs showed a marked reduction in the amplitudes and a prolongation of the implicit times in both eyes. Conventional ERGs showed that the amplitudes of the oscillatory potentials (OPs) were also severely attenuated. The abnormal OCT findings and reduced visual acuity recovered to normal at 1 and 2 months, respectively, after the discontinuation of paclitaxel. However, the flicker ERGs did not recover to normal values until 4 months after the discontinuation of paclitaxel.

Conclusion

These results suggest that the ERGs can be used to monitor the changes in the overall retinal function in patients receiving paclitaxel.

     

pH-Switchable LCST/UCST-type thermosensitive behaviors of phenylalanine-modified zwitterionic dendrimers

Thermosensitive polymers are useful as intelligent materials. Dendrimers have well-defined structures, which can work as multifunctional polymers. In this study, we designed and synthesized various phenylalanine (Phe)-modified zwitterionic dendrimers as pH- and thermo-sensitive polymers. First, polyamidoamine (PAMAM) dendrimers were modified with Phe and succinic anhydride (Suc) to prepare carboxy-terminal Phe-modified dendrimers (PAMAM-Suc-Phe and PAMAM-Phe-Suc). Both these dendrimers showed upper critical solution temperature (UCST)-type thermosensitivity. Interestingly, PAMAM-Phe-Suc demonstrated lower critical solution temperature (LCST)-type thermosensitivity at lower pH, but PAMAM-Suc-Phe did not. This indicates that PAMAM-Phe-Suc can switch LCST/UCST-type thermosensitivity according to the solution''s pH. PAMAM-Phe-SO₃Na with sulfonic acid termini also demonstrated LCST/UCST-type thermosensitivity switched by pH, with a higher sensitivity than PAMAM-Phe-Suc. Coacervation occurred during the phase separation. The quaternized dendrimers (QPAMAM-Phe-Suc and QPAMAM-Phe-SO₃Na) and dendrimers conjugating isoleucine or 4-(amino methyl)benzoic acid did not show the unique thermosensitive properties, indicating that the tertiary amines in the dendrimer core and the Phe residues at the termini are indispensable. PAMAM-Phe-SO₃Na could separate a model compound (rose bengal) from an aqueous solution because of its encapsulation ability. This is the first report of pH-switchable LCST/UCST-type thermosensitive dendrimers.

We synthesized phenylalanine-modified zwitterionic dendrimers as pH- and thermo-responsive polymers. This is the first report of pH-switchable LCST/UCST-type thermosensitive dendrimers.     

Successful treatment of infliximab-associated immune-mediated sensory polyradiculopathy with intravenous immunoglobulin

Infliximab, a tumor necrosis factor-alpha antagonist, is used to treat many inflammatory diseases. Various forms of demyelinating neuropathies have been reported as neurological complications associated with infliximab use. There have been few reports of pure sensory neuropathy associated with infliximab. We report the clinical, electrophysiological, and pathological findings of a patient with subacute sensory polyradiculopathy 1 month after infliximab therapy for psoriasis vulgaris. Immune-mediated pathogenesis was suggested by positive anti-ganglioside antibodies and rapid response to intravenous immunoglobulin. This is the first reported case of sensory polyradiculopathy with positive anti-ganglioside antibodies following infliximab therapy. Our findings suggest the clinical importance of immunological investigations and treatment in demyelinating neuropathies following infliximab therapy.     

Pediatric granulomatous orchitis: Case report and review of the literature

An 11‐year‐old boy presented with fever and abdominal pain, and was diagnosed with retroperitoneal lymphadenitis. At the same time, a painless right scrotal mass was observed. On imaging the testis and the epididymal mass both had abundant blood flow, although tumor markers were negative. Although the right testis had shrunk after antibiotic treatment, swelling was persistent and incisional biopsy was therefore performed, resulting in diagnosis of granulomatous orchitis (GO). No recurrence was found. In cases of scrotal swelling in both the testis and the epididymis of an older child, it is necessary to consider the possibility of inflammatory GO, and orchiectomy should not be performed without careful consideration.