Critical illness polyneuropathy in a patient with Parkinson disease: a case report and review of the literature / 南方医科大学学报

<p><b>OBJECTIVE</b>To report a case of critical illness polyneuropathy (CIP) with Parkinson disease and discuss the development, clinical features and early diagnosis of this condition.</p><p><b>METHODS</b>The clinical data of a patient with CIP and Parkinson's disease and the relevant literature were reviewed.</p><p><b>RESULTS</b>This case showed no typical disease course of sepsis, and the condition exacerbated rapidly. The patient presented initially with abnormal homeostasis, followed by rapid onset of respiratory muscle weakness to require mechanical ventilation, but no limb weaknesses were detected. Intravenous antibiotics and aggressive treatment of sepsis did not produce any positive responses to wean from mechanical ventilation. Examinations of creatine kinase and cerebrospinal fluid showed no abnormalities. Electromyography and nerve conduction studies demonstrated declined nerve conduction velocity and decreased sensory and motor muscle action potentials, suggesting the possibility of CIP.</p><p><b>CONCLUSION</b>In patients with Parkinson disease, the occurrence of sepsis with prolonged mechanical ventilation and limb weakness indicates the necessity of neurophysiological examination, muscle biopsies and laboratory tests, which may help detect CIP in the early phase. Proper interventions of sepsis may reduce the likeliness of CIP. Elimination of the risk factors and aggressive management of sepsis can be effective measures for preventing CIP.</p>

Short -term therapeutic efficacy and safety of kallikrein in patients with acute anterior circulation cerebral infarction / 中华神经医学杂志

Objective To evaluate the short-term therapeutic efficacy and safety of kallikrein in patients with acute anterior circulation cerebral infarction. Methods Sixty-one patients with anterior circulation cerebral infarction, admitted to our hospital from October 2006 to April 2009, were enrolled in the randomized single-blind control trail. These patients were assigned to kallikrein treatment group (n=31) and control group (n=30). They were both treated by identical basis therapy, such as antiplatelet,dilute blood viscosity, neurotrophy therapy and symptomatic treatment. The patients in the treatment group were treated by intravenous infusion administration of 0.15 PNA kallikrein diluted in 100 mL 0.9% saline at 30-40 drops /min once daily for 14 consecutive days. On the pretherapy and 21st post-treatment day, the National Institutes of Health Stroke Scale (NIHSS), activity of daily living (ADL) of modified Rankin Scale (mRS) in these patients were performed;blood routine examinations and urinalysis,hepatorenal function, levels of blood glucose and lipid, and ECG were assessed;blood pressure and pulse rate were monitored. CT scan was employed for ICH if necessary. Drug relative hemorrhage and adverse drug reaction (ADR) were recorded in detail. Results As compared with those in the control group,significantly reduced NIHSS scores and obviously improved ADL scores in the kallikrein treatment group were noted (P=0.022, P=0.032, respectively). According to the mean rank (kallikrein treatment group:23.86, control group: 35.93), the efficacy in the treatment group was better than that in the control group.Except that asthmatic attack happened to 2 patients (having the history of asthma) during treatment period, no other ADRs were noted in all the patients. No abnormal changes of blood routine examinations, urinalysis, hepatorenal function, levels of blood glucose and lipid, and ECG and head CT features in the kallikrein treatment group were detected before and after the treatment;no drug relative hemorrhage was noted either. Conclusion Kallikrein is safe and effective in treating patients with acute anterior circulation cerebral infarction, through reducing the neurologic function impairment and improving ADL.