ABSTRACT
INTRODUCTION: Paraneoplastic syndromes are a rare cancer complication with a frequent subacute evolution. OBSERVATION: A 62-year-old man was admitted presenting with a cerebellar syndrome and orthostatic hypotension with dysautonomia. Anti-Hu antibody research was positive. A subcarinal adenopathy biopsy found out a small cell lung carcinoma. Despite a treatment with immunoglobulin and chemotherapy, the patient died suddenly, after a raise of dysautonomia symptoms. CONCLUSION: Sudden death observations represent exceptional complications of paraneoplastic syndrome. They might be secondary to arrhythmias, ictal asystol or laryngospasm. Systematic research of paroxystic heart arrhythmias with holter-ECG in paraneoplastic syndrome may prevent sudden deaths.
Subject(s)
Death, Sudden/etiology , ELAV Proteins/immunology , Lung Neoplasms/diagnosis , Paraneoplastic Cerebellar Degeneration/etiology , Paraneoplastic Syndromes, Nervous System/etiology , Shy-Drager Syndrome/etiology , Small Cell Lung Carcinoma/diagnosis , Antibodies/blood , Humans , Male , Middle AgedABSTRACT
INTRODUCTION: Craniocervical junction damages may result in a compression of the spinal cord. They may be caused by infectious, tumoral or inflammatory processes. Rheumatoid arthritis is probably among rheumatic diseases the most frequent cause of atlantoaxial arthritis. Nevertheless involvement of the craniocervical junction as the presenting symptom of rheumatoid arthritis is a very rare feature. EXEGESIS: We report the case of a 61 years old woman who presented with atlantoaxial involvement and spinal cord compression one year before the diagnosis of a seronegative rheumatoid arthritis. CONCLUSION: Symptomatic craniocervical junction damages may appear. Patients with damages of the craniocervical junction and negative investigations should be followed long-term; an underlying inflammatory disease may become evident after significant delay.
Subject(s)
Arthritis, Rheumatoid/complications , Spinal Cord Compression/drug therapy , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/immunology , Diagnosis, Differential , Female , Humans , Middle Aged , Serologic TestsABSTRACT
INTRODUCTION: Pachymeningitis is a fibrous inflammatory process with non-specific symptoms, involving the dura mater. Due to MRI development, diagnosis is both easier and earlier. CURRENT KNOWLEDGE AND KEY POINTS: We report seven cases and review current literature. Clinical features are headaches and cranial nerve palsies. CSF shows inflammatory changes, while MRI evidences thickening of the dura mater. Disease etiologies in the present study were tuberculosis in two cases, sarcoidosis, Lyme disease, lymphoma and dural puncture; in one case only the disease was of unknown origin. The condition of six patients improved with specific treatment. FUTURE PROSPECTS AND PROJECTS: Further MRI development should allow detection of new forms of pachymeningitis and standardization of patients' management through the study of more important series.
Subject(s)
Brain Diseases/diagnosis , Dura Mater/pathology , Meningitis/diagnosis , Adult , Aged , Brain Diseases/etiology , Brain Diseases/therapy , Female , Humans , Magnetic Resonance Imaging , Male , Meningitis/etiology , Meningitis/therapy , Middle AgedABSTRACT
A 33 year-old male homosexual infected with human immunodeficiency virus type I developed an asymmetrical and painful neuropathy in the lower limbs. Neuro-muscular biopsy showed a necrotizing vasculitis. There were no clinical features indicative of systemic vasculitis. Prednisone therapy dramatically improved the neuropathy, without adverse effects. Although rare, necrotizing arteritis must be considered in HIV-1 patients with neuropathy, especially in case of mononeuropathy multiplex and when immunodepression is mild or absent, since a successful corticosteroid therapy can be prescribed.
Subject(s)
HIV Infections/complications , HIV-1 , Peripheral Nervous System Diseases/etiology , Vasculitis/etiology , Adult , Humans , Male , Prednisone/therapeutic use , Vasculitis/complications , Vasculitis/drug therapy , Vasculitis/pathologyABSTRACT
A 79-year-old woman had chorea complicating polycythaemia. The polycythaemia and the chorea disappeared after surgical removal of a renal carcinoma. The literature on polycythaemic chorea is reviewed and its pathophysiology discussed.
Subject(s)
Adenocarcinoma/complications , Chorea/etiology , Kidney Neoplasms/complications , Polycythemia/etiology , Adenocarcinoma/surgery , Aged , Aged, 80 and over , Female , Humans , Kidney Neoplasms/surgery , Nephrectomy , Remission InductionABSTRACT
Epidermal growth factor receptor (EGF-R) were assayed by 125I-EGF binding in 28 surgical samples of human meningiomas. High affinity EGF-R were found in 26/28 tumors (92 p. 100) at concentrations ranging from 20 to 410 femtomoles per mg of membrane protein (fmol/mg prot. mb.). In 18/26 cases (64 p. 100), the EGF-R concentration was between 95 and 230 fmol/mg prot. mb. No relationship was found between the EGF-R level and the site or histopathology of the tumor. The only noticeable observations were the low levels of EGF-R in the 3 anaplasic meningiomas as compared to the whole population and the undetectable level of EGF-R in the angiomatous tumors. In addition, no correlation was found between EGF-R levels and the hormonal status of the patients, nor between EGF-R levels and the intratumoral concentration of progesterone receptors assayed simultaneously. The biological relevance of EGF-R in meningioma is discussed in this context.
Subject(s)
ErbB Receptors/metabolism , Meningioma/metabolism , Receptors, Steroid/metabolism , Adult , Aged , Epidermal Growth Factor/metabolism , Female , Humans , Iodine Radioisotopes , Male , Meningioma/pathology , Menopause , Middle Aged , Receptors, Estrogen/metabolism , Receptors, Progesterone/metabolismABSTRACT
The vital and functional prognoses of 19 patients admitted for herpes simplex encephalitis between rate was 26%, a figure close to those reported in the literature. Death occurred before the 4th month in patients with prolonged coma, and it was due to respiratory disorders. The functional prognosis was favourable in one-half of the survivors, but one-third of these remained with severe neurological and behavioural sequelae, predominantly Korsakoff's syndrome and Klüver-Bucy syndrome. Hemiplegia and aphasia, when present, usually regressed within a few months. The prognosis of herpes simplex encephalitis has improved owing to advances in intensive care and to the advent of antiviral treatments, notably acyclovir the effectiveness of which has been demonstrated by several therapeutic trials. In view of its low toxicity, acyclovir should be tried when the disease is suspected on clinical ground, without waiting for the diagnosis to be confirmed by serological tests; treatment can thus be instituted before the patient becomes comatose.
Subject(s)
Encephalitis/physiopathology , Herpes Simplex/physiopathology , Acyclovir/therapeutic use , Adolescent , Adult , Aged , Alcohol Amnestic Disorder/etiology , Encephalitis/mortality , Herpes Simplex/drug therapy , Herpes Simplex/mortality , Humans , Middle Aged , Prognosis , Retrospective StudiesABSTRACT
Two cases of cerebral amyloid angiopathy with transient ischemic attacks are reported. Both patients died of cerebral hemorrhage. Transient ischemic attacks seem to having been due to the cerebral angiopathy a disease in which small infarcts are frequently mentioned at post-mortem examination. However only 6 other cases of transient ischemic attacks with cerebral amyloid angiopathy have yet been reported.
Subject(s)
Amyloidosis/complications , Cerebral Arterial Diseases/complications , Ischemic Attack, Transient/etiology , Aged , Amyloidosis/diagnosis , Cerebral Arterial Diseases/diagnosis , Female , Humans , PrognosisABSTRACT
We report two cases of heparin-induced thrombocytopenia (H.T.) associated with a disseminated intravascular coagulopathy (DIC). Heparin was prescribed after a cerebral infarct in the first case and after an orthopedic surgical procedure in the second case. The DIC induced neurological complications and the death of both patients. Heparin-induced thrombocytopenia is common but is exceptionally associated with neurological symptoms. Heparin-induced DIC is quite uncommon, since only 20 cases have been reported but neurological complications (focal deficits or disturbances of consciousness) are noted in about one third of the cases and the outcome is fatal in 60 percent of the cases. The treatment of heparin-induced DIC and thrombocytopenia is disappointing. Monitoring of the platelets count is warranted during heparin treatment to prevent this severe complication.
Subject(s)
Disseminated Intravascular Coagulation/complications , Heparin/adverse effects , Paralysis/etiology , Thrombocytopenia/chemically induced , Exophthalmos/etiology , Facial Paralysis/etiology , Female , Hemiplegia/etiology , Humans , Male , Middle Aged , Ophthalmoplegia/etiologyABSTRACT
The authors report one case of pituitary abscess; the diagnosis of which was particularly difficult due to its association to a multiple sclerosis that began twelve years before. A review of thirty-one pituitary abscess reported in the literature from 1970 to 1985 is made. Opto-chiasmatic compression is observed in fifty-five per cent of the cases, pituitary insufficiency in fifty-five per cent, and meningitis in sixty per cent of the cases. Although the characteristic association of meningitis and pituitary tumor symptoms occur in thirty per cent of the cases, the diagnosis is made at surgery. Pituitary adenoma and craniopharyngioma were the most frequent preoperative misdiagnosis for pituitary abscess. The extended use of cerebral C.T. Scan will allow an easier recognition of this rare entity. The discussion includes life and visual prognosis. The etiology remains unexplained in nearly half of the cases.
Subject(s)
Abscess/diagnosis , Multiple Sclerosis/complications , Pituitary Diseases/diagnosis , Abscess/surgery , Adult , Female , Humans , Meningitis, Aseptic/etiology , Pituitary Diseases/surgeryABSTRACT
The association of Waldenström disease and glioblastoma was observed in two patients. Both diseases were diagnosed almost simultaneously. In the first patient the diagnosis of glioblastoma was made on cerebral biopsy. In the second case, the diagnosis was confirmed at autopsy. The association of Waldenström's disease and glioblastoma is rare but it does not seem to be coincidental. The physiopathological problems related to this coexistence are discussed.
Subject(s)
Brain Neoplasms/complications , Glioblastoma/complications , Glioma/complications , Temporal Lobe , Waldenstrom Macroglobulinemia/complications , Aged , Humans , Male , Middle AgedSubject(s)
Cochlea , Crohn Disease/complications , Keratitis/complications , Vestibule, Labyrinth , Adult , Female , Humans , Labyrinth Diseases/complications , SyndromeABSTRACT
The binding of diclofenac to human serum albumin (HSA) and to lipoproteins was studied in vitro by equilibrium dialysis. Binding to HSA is characterized by two classes of sites with one site each (K1 = 5 X 10(5) M-1 and K2 = 0.6 X 10(5) M-1). The binding to lipoproteins was shown to be saturable with a larger number of binding sites and low association constants. The evidence of two specific binding sites on HSA was confirmed by circular dichroism data. In addition, an identification of those sites was performed by displacement of fluorescent probes. The data show that the high affinity site (K1 = 5 X 10(5) M-1) is likely to be shared by benzodiazepines while the second one (K2 = 0.6 X 10(5) M-1) is common with the warfarin site.
Subject(s)
Diclofenac/metabolism , Lipoproteins/blood , Phenylacetates/metabolism , Serum Albumin/metabolism , Binding Sites , Circular Dichroism , Fluorescence , Humans , In Vitro Techniques , Protein BindingSubject(s)
Anti-Inflammatory Agents/metabolism , Arthritis, Rheumatoid/drug therapy , Aurothioglucose/analogs & derivatives , Gold Sodium Thiomalate/metabolism , Gold/analogs & derivatives , Antibody Formation/drug effects , Auranofin , Aurothioglucose/adverse effects , Aurothioglucose/metabolism , Aurothioglucose/pharmacology , Aurothioglucose/therapeutic use , Gold Sodium Thiomalate/adverse effects , Gold Sodium Thiomalate/pharmacology , Gold Sodium Thiomalate/therapeutic use , Humans , Immunity, Cellular/drug effects , KineticsABSTRACT
A 18 year-old man had a progressive paraparesis over a two months period due to a thoracic intramedullary epidermoid cyst. Surgical removal of the cyst was followed by a dramatic improvement. The frequency, the clinical manifestations and the congenital or acquired nature of the dermoid and epidermoid intraspinal cysts are reviewed. The possibilities and the limits of the surgical treatment of this rare intraspinal benign tumors are discussed.
Subject(s)
Epidermal Cyst/congenital , Spinal Cord Diseases/congenital , Adolescent , Dermoid Cyst/diagnosis , Diagnosis, Differential , Epidermal Cyst/diagnosis , Epidermal Cyst/surgery , Humans , Male , Myelography , Paraplegia/etiology , Spinal Cord Diseases/diagnosis , Spinal Cord Diseases/surgery , Spinal Cord Neoplasms/diagnosis , Tomography, X-Ray ComputedABSTRACT
Equilibrium dialysis, ultrafiltration, and ultracentrifugation were compared to determine their reliability and applicability in the study of binding of an anticonvulsant drug, valproic acid, by plasma proteins. We studied drug binding with pooled serum and with solutions of human serum albumin at physiological concentrations. We compared binding characteristics such as number of binding sites, affinity constants, and percent of binding as measured by each method in the therapeutic range for valproic acid. Results by ultracentrifugation differed from those by equilibrium dialysis and ultrafiltration, which agreed reasonably well with each other.