ABSTRACT
The clinical features of Guillain-Barré syndrome (GBS) are highly variable, according to the type of antecedent infection. Although a major GBS phenotype, Fisher syndrome (FS), has been shown to be preceded by infections similar to those preceding GBS, whether or not the clinical features in FS also vary according to antecedent infection remains unclarified. Frequent antecedent infections among this study of 70 FS patients included Haemophilus influenzae [n = 15 (21%)], Campylobacter jejuni [n = 10 (14%)], and cytomegalovirus (CMV) [n = 6 (8.6%)]. Compared with other FS patients, H. influenzae-seropositive FS patients more frequently had a history of prior upper respiratory tract infection; double vision as the initial symptom; and, except for oculomotor disturbance, more rarely showed cranial nerve involvement. C. jejuni-related FS occurred predominantly in younger male patients and characteristically presented with blurred vision. According to GBS disability scale, CMV-related FS tended to be more severe, although every patient received immunotherapy. Serum anti-GQ1b IgG antibodies were detected in most cases, regardless of antecedent infection type. At the nadir of illness, the most frequent diagnosis in H. influenzae-related cases was "pure FS" without limb weakness or central nervous system involvement (71%), in C. jejuni-related cases "incomplete FS" such as acute ophthalmoparesis with or without ataxia (60%), and in CMV-related cases (50%) advanced conditions such as GBS overlap and Bickerstaff brainstem encephalitis. These findings indicate that the type of preceding infection determined the neurological features of FS. CMV-related FS appeared to be similar to H. influenzae- and C. jejuni-related FS regarding anti-GQ1b antibody-mediated pathogenesis, as opposed to CMV-related GBS.
Subject(s)
Campylobacter Infections/diagnosis , Cytomegalovirus Infections/diagnosis , Guillain-Barre Syndrome/diagnosis , Haemophilus Infections/diagnosis , Miller Fisher Syndrome/diagnosis , Adolescent , Adult , Aged , Biomarkers/blood , Campylobacter Infections/blood , Campylobacter Infections/epidemiology , Child , Child, Preschool , Cytomegalovirus Infections/blood , Cytomegalovirus Infections/epidemiology , Female , Guillain-Barre Syndrome/blood , Guillain-Barre Syndrome/epidemiology , Haemophilus Infections/blood , Haemophilus Infections/epidemiology , Humans , Male , Middle Aged , Miller Fisher Syndrome/blood , Miller Fisher Syndrome/epidemiology , Retrospective Studies , Young AdultABSTRACT
OBJECTIVE: To clarify the performance of liquid-based cytology (LBC) and conventional methods of preparing cervical specimens for cytological screening. STUDY DESIGN: We studied 236,511 patients who participated in a population-based cervical cancer screening program conducted in the Niigata prefecture between 2005 and 2008. The percentage of unsatisfactory specimens and the disease detection rate were compared between specimens prepared by LBC and conventional methods. RESULTS: (1) The LBC method demonstrated a significantly lower percentage of unsatisfactory specimens than the conventional method (1.38 and 11.45%, respectively; p < 0.01). (2) Among the initial women, tumor lesions were detected in 0.57% of those examined with the LBC method, which was significantly higher than the positivity rate of those examined with the conventional method (0.25%; p < 0.05). Among the women with repeat screening, disease was detected in 0.08% of those examined with LBC twice, which was significantly lower than the positivity rates for those examined with the conventional method followed by the LBC method (0.11%) or the conventional method twice (0.16%; p < 0.05). CONCLUSION: The LBC method is significantly more useful than the conventional method in terms of the low adequacy rate and the high detection rate of cancer in cervical cancer screening in a localized area in Japan.
Subject(s)
Cytodiagnosis/methods , Early Detection of Cancer/methods , Uterine Cervical Neoplasms/diagnosis , Vaginal Smears/methods , Adult , Female , HumansABSTRACT
A 61-year-old man developed double vision subsequent to diarrheal illness. Mixed horizontal-vertical gaze palsy in both eyes, diminution of tendon reflexes, and gaze nystagmus were noted. His horizontal gaze palsy was accompanied by gaze nystagmus in the abducent direction, indicative of the disturbance in central nervous system. Neither limb weakness nor ataxia was noted. Serum anti-GQ1b antibody was detected. Brain magnetic resonance imaging (MRI) findings were normal. The patient was diagnosed as having acute ophthalmoparesis. The ophthalmoparesis and nystagmus gradually disappeared in 3 months. The accompanying nystagmus suggests that central nervous system disturbance may also be present with acute ophthalmoparesis.
Subject(s)
Nystagmus, Pathologic/etiology , Ophthalmoplegia/etiology , Acute Disease , Biomarkers/blood , Gangliosides/immunology , Humans , Immunoglobulin G/blood , Male , Middle Aged , Miller Fisher Syndrome/complications , Miller Fisher Syndrome/diagnosisABSTRACT
Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) is a rare primary headache syndrome. The diagnostic criteria include attacks of unilateral orbital, supraorbital or temporal stabbing pain accompanied by one of the following: conjunctival injection and/or tearing, nasal congestion and/or rhinorrhea, and eyelid edema. The duration of pain is 2 seconds to 10 minutes, and the frequency of attacks is described as once a day or more. The etiology and pathology of SUNA has yet to be documented. We report an 18-year-old man with SUNA. Lomerizine hydrochloride which is used as a preventive medicine for migraine, improved his headaches.
