- Keywords
- belantamab mafodotin, konjugát protilátka-léčivo,
- MeSH
- Molecular Targeted Therapy * MeSH
- Antibodies, Monoclonal, Humanized pharmacology adverse effects therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- B-Cell Maturation Antigen MeSH
- Multiple Myeloma * drug therapy complications MeSH
- Vision Disorders chemically induced MeSH
- Antineoplastic Agents pharmacology adverse effects therapeutic use MeSH
- Antineoplastic Combined Chemotherapy Protocols MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Glaucoma chemically induced therapy MeSH
- Humans MeSH
- Drug-Related Side Effects and Adverse Reactions * classification MeSH
- Eye pathology drug effects radiation effects MeSH
- Vision Disorders * chemically induced classification MeSH
- Antimetabolites, Antineoplastic adverse effects MeSH
- Antineoplastic Agents classification adverse effects MeSH
- Radiotherapy adverse effects MeSH
- Tamoxifen adverse effects MeSH
- Vision, Ocular * drug effects radiation effects MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Cíle: Cílem práce bylo stanovit morfologický a funkční nález ve zrakové dráze u nemocného po prodělané otravě metanolem. Kazuistika a metody vyšetření: U pacienta (muž, 38 let), který prodělal otravu metylalkoholem před osmi lety (2012), byly kromě standardního očního vyšetření provedeny následující testy: vyšetření zorného pole – centrální test 0–30° na perimetru Medmont M700, analýze vrstvy nervových vláken (RNFL), Ganglion cell complex (GCC) a peripapilární vessel density (VD) využitím přístroje Avanti RTVue XR, dále pak vyšetření pattern elektroretinogramu (PERG) a pattern zrakových vyvolaných odpovědí (PVEP) - dle metodiky ISCEV na přístroji Roland Consult instrument) a vyšetření magnetickou rezonanci (MRI) na přístroji Philips Achieva Dstream 3 T. Výsledky: Největší změny byly prokázány v RNFL a VD. PERG rovněž poukázalo na poškození axonů gangliových buněk sítnice. Na levém oku, ve srovnání s kontralaterálním (odpovědi v normě), byl zaznamenán i pokles kmitu N35-P50 a P50-N95, VEP byly oboustranně výrazně snížené, vlevo až nevýbavné. Prodloužení latence P100 nebylo zaznamenáno. Funkční MR prokázala oboustranné výrazné snížení voxelové aktivity s větším poklesem vlevo. Na MR byly postmalatické změny dorzálních částí putamen. Šíře zrakového nervu i chiasmatu byla normální. Závěr: Výsledky prokázali asymetrické poškození hlavně RNFL i korových ústředí v mozku. Velké patologické změny jsme registrovali ve VD, které jsou nejspíše zodpovědné i za prohlubování exkavace a další úbytek nervových vláken gangliových buněk sítnice, které zatím v literatuře nebyly popsány. Dle těchto nálezů můžeme uvažovat o přímém poškození nervových struktur a cév toxickými produkty metabolizmu metanolu v akutním stadiu. V dalším období pak jejich reparačními procesy.
Aim: The aim of the study was to determine the morphological and functional findings in a patient after methanol poisoning. Examination methods: The patient (male, 38 years old) was suffered methanol poisoning in eight years ago (2012). The following tests and examinations were performed: neurological visual field XR test (Medmont M700), retinal nerve fibre layer (RNFL), ganglion cell complex (GCC) and peripapillary vessel density (all using Avanti RTvue, Optovue), pattern electroretinography (PERG) and pattern visual evoked potential (PVEP) examination according to ISCEV methodology (Roland Consult Instrument) and brain MRI examination (Philips Achieva Dstream 3 T). Results: The biggest changes were found in RNFL and VD. PERG also showed damage to retinal ganglion cell axons. In left eye we determined decrease in oscillations (in comparison with contralateral eye) at N35-P50 and P50-N95. VEPs in both eyes were significantly reduced, almost inconspicuous in the left eye. Extension of latency time of P100 was not identified. Functional MRI showed a bilateral decrease in voxel activity with a greater decrease in the left eye. There were postmalatical changes in the dorsal parts of the putamen on MRI. The width of the optic nerve and chiasm was physiological. Conclusion: Asymmetric damaging of RNFL and cortical centres of the brain were determined. We registered large pathological changes in VD, which are probably responsible for the deepening of optic nerve excavation and further loss of nerve fibers of retinal ganglion cells, which have not yet been described in the literature. Following these results is possible to define direct damage of nerve structures and blood vessels by toxins of methanol metabolism in the acute stage and upcoming reparation processes in following periods.
- Keywords
- elektrofyziologické vyšetření, OCT,
- MeSH
- Adult MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Methanol * poisoning MeSH
- Poisoning * complications physiopathology MeSH
- Vision Disorders chemically induced MeSH
- Treatment Outcome MeSH
- Visual Fields MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
CONTEXT: Methanol poisoning induces acute optic neuropathy with possible long-term visual damage. OBJECTIVE: To study the dynamics and key determinants of visual pathway functional changes during 4 years after acute methanol poisoning. METHODS: A total of 42 patients with confirmed methanol poisoning (mean age 45.7 ± 4.4 years) were examined 4.9 ± 0.6, 25.0 ± 0.6, and 49.9 ± 0.5 months after discharge. The following tests were performed: visual evoked potential (VEP), retinal nerve fiber layer (RNFL) measurement, brain magnetic resonance imaging (MRI), complete ocular examination, biochemical tests, and apolipoprotein E (ApoE) genotyping. RESULTS: Abnormal VEP P1 latency was registered in 18/42 right eyes (OD) and 21/42 left eyes (OS), abnormal N1P1 amplitude in 10/42 OD and OS. Mean P1 latency shortening during the follow-up was 15.0 ± 2.0 ms for 36/42 (86%) OD and 14.9 ± 2.4 ms for 35/42 (83%) OS, with maximum shortening up to 35.0 ms. No significant change of mean N1P1 amplitude was registered during follow-up. A further decrease in N1P1 amplitude ≥1.0 mcV in at least one eye was observed in 17 of 36 patients (47%) with measurable amplitude (mean decrease -1.11 ± 0.83 (OD)/-2.37 ± 0.66 (OS) mcV versus -0.06 ± 0.56 (OD)/-0.83 ± 0.64 (OS) mcV in the study population; both p < .001). ApoE4 allele carriers had lower global and temporal RNFL thickness and longer initial P1 latency compared to the non-carriers (all p < .05). The odds ratio for abnormal visual function was 8.92 (3.00-36.50; 95%CI) for ApoE4 allele carriers (p < .001). The presence of ApoE4 allele was further associated with brain necrotic lesions (r = 0.384; p = .013) and brain hemorrhages (r = 0.395; p = .011). CONCLUSIONS: Improvement of optic nerve conductivity occurred in more than 80% of patients, but evoked potential amplitude tended to decrease during the 4 years of observation. ApoE4 allele carriers demonstrated lower RNFL thickness, longer P1 latency, and more frequent methanol-induced brain damage compared to non-carriers.
- MeSH
- Apolipoprotein E4 genetics MeSH
- Time Factors MeSH
- Adult MeSH
- Gene Frequency MeSH
- Genetic Predisposition to Disease MeSH
- Middle Aged MeSH
- Humans MeSH
- Longitudinal Studies MeSH
- Methanol poisoning MeSH
- Follow-Up Studies MeSH
- Optic Nerve Diseases chemically induced diagnosis genetics physiopathology MeSH
- Optic Nerve drug effects physiopathology MeSH
- Vision Disorders chemically induced diagnosis genetics physiopathology MeSH
- Prognosis MeSH
- Prospective Studies MeSH
- Reaction Time MeSH
- Risk Factors MeSH
- Case-Control Studies MeSH
- Vision, Ocular drug effects genetics MeSH
- Evoked Potentials, Visual MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
Hromadné otravy metanolem se vyskytují celosvětově relativně často, avšak jen vzácně jsou při nich k dispozici kompletní klinická a laboratorní data pacientů. V České republice bylo dokumentováno přibližně 138 případů otrav, 107 pacientů bylo hospitalizováno. Dalších 31 osob zemřelo mimo nemocnice. Asi 60 % hospitalizovaných pacientů přežilo intoxikaci bez následků, ze zbylých 40 % přibližně polovina zemřela a polovina přežila s poškozením CNS a/nebo zraku. V české studii se podařilo využít moderních diagnostických metod. Byl prokázán pozitivní efekt přednemocniční první pomoci perorálním antidotem a srovnatelný efekt účinek etanolu a fomepizolu při nemocniční terapii. Byla zjištěna vyšší účinnost terapie intermitentní než kontinuální hemodialýzy. Nebyla nalezena žádná souvislost mezi mozkovým krvácením a systémovou antikoagulací během hemodialýzy. Vyšetření zobrazením magnetickou rezonancí odhalilo mozkové léze u více než 50 % vyšetřených osob. Při následném sledování pacientů za měsíce a roky bylo nalezeno zlepšení poškození zrakového nervu u pacientů s lézí mírného až středního stupně. Ojedinělé otravy se stále objevují.
Methanol mass poisoning occurs across the world quite frequently, but the complete clinical and laboratory data of the patients are only rarely available. Approximately 138 cases of poisoning were documented in the Czech Republic, 107 patients were hospitalized. Another 31 persons died out of hospital. About 60 % of the hospitalized patients survived intoxication without consequences, one half of the remaining 40 % died and the other half survived with the CNS and/or sight impaired. The Czech study successfully used modern diagnostic methods. A positive effect of the prehospital first aid with an oral antidote has been proven and a comparable effect of ethanol and fomepizole has been reached during hospital therapy. Higher efficiency of intermittent therapy has been determined as compared to continual hemodialysis. No connection was found between cerebral hemorrhage and systemic anticoagulation during hemodialysis. Magnetic resonance imaging revealed brain lesions in more than 50 % of the examined persons. During the follow-up visits over months and years improvement regarding the damage to the optic nerve was found in patients with a lesion of mild to medium degree. Isolated cases of poisoning still occur.
- Keywords
- poškození CNS,
- MeSH
- Acidosis chemically induced therapy MeSH
- Antidotes * therapeutic use MeSH
- Biomarkers blood MeSH
- Biotransformation MeSH
- Renal Dialysis methods MeSH
- Ethanol administration & dosage therapeutic use MeSH
- Fomepizole MeSH
- Formates blood MeSH
- Basal Ganglia Hemorrhage diagnosis chemically induced MeSH
- Humans MeSH
- Methanol * metabolism poisoning MeSH
- Poisoning * diagnosis physiopathology therapy MeSH
- Vision Disorders chemically induced MeSH
- Pyrazoles therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
Výzkumný tým pod vedením MUDr. Sergeje Zacharova, Ph.D., z Kliniky pracovního lékařství 1. lékařské fakulty UK a Všeobecné fakultní nemocnice v Praze provádí v určitém časovém odstupu sledování zdravotního stavu pěti desítek lidí, kteří se otrávili při tzv. metanolové aféře v letech 2012 a 2013. Jejich průměrný věk v době otravy byl 46 let.
CONTEXT: Visual disturbances due to the toxic effect of formic acid in acute methanol poisonings are generally transient. The subjective symptoms of visual toxicity may resolve within few weeks and fundoscopic signs of acute optic neuropathy subside within 1-2 months; therefore, the prevalence of long-term visual sequelae in the population of survivors of poisonings may be underestimated. OBJECTIVE: To study the prevalence and character of long-term visual sequelae of acute methanol poisonings based on the data from the Czech mass methanol outbreak in 2012. PATIENTS AND METHODS: A total of 50 patients with confirmed methanol poisoning were included in this longitudinal cross-sectional study, median age: 48 (range, 23-73) years. The following tests were performed: optical coherence tomography or OCT with evaluation of the retinal nerve fibers layer (RNFL), visual evoked potentials (VEP), magnetic resonance imaging (MRI) of brain, complete ocular examination (visual acuity/field, color vision, contrast sensitivity, and fundus), neurological examinations, and biochemical tests. RESULTS: Of 50 patients, 7/50 (14%) were discharged with diagnosed visual sequelae and 6/50 (12%) were discharged with both visual and central nervous system sequelae of poisoning. On the follow-up examination, 20/50 (40%) of the patients had long-term visual sequelae, with 8% of blindness. A total of 38% of the patients had abnormal (28% borderline) findings on RNFL, and 40% had abnormal (18% borderline) VEP. Among the patients discharged without detected visual sequelae, 8/37 (22%) had abnormal RNFL and VEP. Patients with visual sequelae had brain lesions more often (70% vs. 27%, p < 0.01). MRI identified optic nerve lesions in 2/20 cases with abnormal VEP only. The groups with and without visual sequelae differed in serum methanol, ethanol, HCO3-, formate, pH, anion gap, and base deficit (all p < 0.01). Visual disturbances on admission and coma were more prevalent in the patients with visual sequelae (p < 0.05). Patients with positive serum ethanol on admission were 93% less likely to have optical axonal damage (OR: 0.07 (95% CI: 0.01-0.8); p < 0.05). No association was found between visual sequelae and type of antidote administered, mode of hemodialysis, or folate substitution. Pre-hospital administration of ethanol seemed beneficial: these patients were 90% less likely to have abnormal RNFL findings (OR: 0.10 (95% CI: 0.02-0.52); p < 0.01). CONCLUSIONS: The long-term visual sequelae were clearly underestimated on discharge, suggesting a significantly higher amount of patients with long-term sequelae than earlier reported. Thorough examinations before discharge and during follow-up will likely uncover a higher morbidity also after methanol poisonings in general.
- MeSH
- Acute Disease MeSH
- Basal Ganglia drug effects physiopathology MeSH
- Time Factors MeSH
- Diagnostic Techniques, Ophthalmological MeSH
- Adult MeSH
- Disease Outbreaks * MeSH
- Risk Assessment MeSH
- Middle Aged MeSH
- Humans MeSH
- Linear Models MeSH
- Logistic Models MeSH
- Longitudinal Studies MeSH
- Methanol poisoning MeSH
- Young Adult MeSH
- Multivariate Analysis MeSH
- Optic Nerve drug effects physiopathology MeSH
- Recovery of Function MeSH
- Protective Factors MeSH
- Odds Ratio MeSH
- Poisoning diagnosis epidemiology physiopathology therapy MeSH
- Vision Disorders chemically induced diagnosis epidemiology physiopathology therapy MeSH
- Predictive Value of Tests MeSH
- Prevalence MeSH
- Cross-Sectional Studies MeSH
- Retina drug effects physiopathology MeSH
- Risk Factors MeSH
- Chi-Square Distribution MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Vision, Ocular drug effects MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
- Keywords
- dlouhodobé následky,
- MeSH
- Acute Disease MeSH
- Mass Casualty Incidents MeSH
- Humans MeSH
- Methanol * poisoning adverse effects MeSH
- Poisoning * diagnosis etiology mortality pathology MeSH
- Alcohol Drinking adverse effects MeSH
- Vision Disorders chemically induced MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
During the outbreak of methanol poisonings in the Czech Republic 2012, we studied the clinical effectiveness of folate therapy in preventing visual damage. Data were obtained from a combined prospective and retrospective study on 79 patients: folinic acid was administered in 28, folic acid in 35; 16 patients received no folates. The groups were comparable by age, time to treatment, laboratory findings, symptoms, and treatment. The number of patients with visual sequelae differed neither between the groups treated with folinic/folic acid, nor between the groups with/without folate administration. The patients with visual sequelae were more acidotic and differed in pH, HCO3−, base deficit, anion gap, but not in methanol, ethanol, osmolal gap, formate, and pCO2. Serum lactate, but not formate differed significantly. The higher serum glucose on admission was in the patients with visual sequelae. Regardless the rationale for folate administration in acute methanol poisoning, its clinical effectiveness in preventing visual damage was not demonstrated in our study. The detoxifying effect of the pathway of tetrahydrofolate-mediated formate conversion is secondary to the formate elimination by haemodialysis. The results of our study cannot promote folinic acid as more efficient than folic acid, but also cannot discount the possible utility of adjunct folate therapy.
- MeSH
- Adult MeSH
- Cohort Studies MeSH
- Folic Acid * analogs & derivatives therapeutic use MeSH
- Leucovorin therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Methanol * poisoning MeSH
- Poisoning * diagnosis etiology drug therapy blood therapy MeSH
- Vision Disorders * diagnosis etiology chemically induced prevention & control MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Keywords
- metanolová aféra,
- MeSH
- Basal Ganglia * pathology MeSH
- Inpatients * classification statistics & numerical data MeSH
- Humans MeSH
- Longitudinal Studies * MeSH
- Methanol * poisoning adverse effects toxicity MeSH
- Neurologic Examination * utilization MeSH
- Poisoning * diagnosis classification mortality therapy MeSH
- Parkinson Disease, Secondary * MeSH
- Peripheral Nerves * pathology MeSH
- Vision Disorders * diagnosis chemically induced MeSH
- Publications * MeSH
- Toxicology * MeSH
- Research Design * MeSH
- Check Tag
- Humans MeSH
- Geographicals
- Czech Republic MeSH
