Search

Here, we present a case of right eyelid drooping in a 79-year-old man. Neurological examination revealed ptosis of the right eye without severe painful eyelid swelling and redness. An ocular motility examination of the right eye revealed upward limitation and downward overshoot. The results of routine blood examinations were within normal limits, and no autoantibodies were detected. Orbital magnetic resonance images revealed mild right eyelid swelling and lacrimal gland enlargement, indicating orbital inflammation. The ocular discharge was positive for Staphylococcus hominis by culture and the patient was diagnosed as having acute dacryoadenitis. Treatment with topical and systemic administration of antibiotics rapidly improved symptoms. Ocular infection is not usually suspected in the absence of local severe painful swelling and redness, and painless acute dacryoadenitis presenting as ophthalmoplegia and ptosis may be misdiagnosed. Orbital inflammation may rapidly progress to orbital cellulitis with treatment delay, which may also lead to aggravation of ophthalmic prognosis. Therefore, neurologists should be aware of the possibility of acute dacryoadenitis occurring without the local severe inflammatory findings mimicking neurological diseases, and acute dacryoadenitis should be considered in patients with ophthalmoplegia even in the absence of severe painful eyelid swelling and redness.

Cetuximab is a monoclonal antibody that binds to the EGFR, and is used in patients with colorectal cancer. The most common toxicities associated with the use of cetuximab are rash and hypomagnesemia. Hypomagnesemia is a major adverse event, but it has often been ignored in past studies and its management has not been characterized. The aim of this study was to obtain a better understanding of the overall incidence of hypomagnesemia and to evaluate the usefulness of our original treatment guidelines for hypomagnesemia in patients receiving cetuximab-based therapy. We investigated 15 patients who were treated with cetuximab(with or without combined chemotherapy)between October 2008 and November 2010. Thirteen patients developed hypomagnesemia: 11 patients had Grade 1, one patient had Grade 2, and one patient had severe hypomagnesemia(Grade 3). Grade 1 hypomagnesemia was observed after an average of 7. 5±4. 8 weeks of treatment. None of the patients developed Grade 2 or higher hypomagnesemia after the implementation of our treatment guidelines. In conclusion, cetuximab treatment is associated with a significant risk of hypomagnesemia. The early monitoring and effective management of hypomagnesemia are important for patients receiving cetuximab-based therapy.

Amrubicin is a new anticancer drug that has been shown to exert efficacy against small cell lung cancer. The pharmacokinetic parameters of amrubicin have not yet been investigated in hemodialysis patients, although it had been expected that amrubicin might not be cleared by hemodialysis because of its high lipid solubility, high protein binding rate and low urinary excretion rate. We encountered a case of small cell lung cancer on hemodialysis who was treated with amrubicin. We assayed the plasma concentrations of amrubicin and amrubicinol (its active metabolite) and analyzed the pharmacokinetic parameters of the drug in this hemodialysis patient. The results revealed that the pharmacokinetic parameters of the drug in this patient undergoing hemodialysis were similar to those in patients not on hemodialysis. Our results suggest that amrubicin and amrubicinol are cleared by hemodialysis, and that dose adjustment of amrubicin might not be required in hemodialysis patients.