ABSTRACT
Resumen La polineuropatía desmielinizante inflamatoria crónica (CIDP por sus siglas en inglés) corresponde a un espectro de diferentes fenotipos clínicos caracterizados por lesiones de naturaleza autoinmune, inflamatoria y desmielinizante, que afectan primariamente nervios periféricos y raíces nerviosas. Generalmente, los pacientes con CIDP presentan un curso crónico de discapacidad neurológica, pero hasta un tercio de los casos puede exhibir un curso remitente-recidivante. El fenotipo clásico involucra compromiso simétrico de la fuerza muscular y la sensibilidad proximal y distal, asociado a arreflexia generalizada. El diagnóstico requiere la demostración de la desmielinización de nervios mediante electromiografía o biopsia de nervios. Debido a la afectación de personas relativamente jóvenes, laboralmente activos, y a la gran discapacidad neurológica que puede generar, el tratamiento debiera ser iniciado precozmente. Los pilares de la terapia en su fase inicial son los corticoides intravenosos en altas dosis, inmunoglobulina intravenosa y la plasmaféresis, mientras que la terapia de mantención se basa, principalmente, en el uso de corticoides orales a bajas dosis. Este artículo presenta el caso de un paciente evaluado en nuestro hospital y diagnosticado con CIDP, y expone una revisión bibliográfica actualizada de la enfermedad.
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) can be defined as a spectrum of different clinical phenotypes which are characterized by autoimmune, inflammatory and demyelinating injuries, primarily affecting the peripheral nerves and nerve roots. Most patients with CIDP have a chronic course of neurological disability, but about a third of cases exhibit a relapsing-remitting course. Classic phenotype of CIDP involves symmetric compromise of proximal and distal muscle strength and sensitivity, associated with generalized areflexia. For an accurate diagnosis, demonstration of nerve demyelination by electromyography or nerve biopsy is required. Due to the affectation of relatively young, labor-active people and the high risk for neurological disability by the disease, treatment should be initiated early. The predominant lines of therapy, in its initial phase, are high-dose intravenous corticosteroids, intravenous immunoglobulin and plasmapheresis, while the maintenance therapy is mainly based on low-dose oral corticosteroids. This article presents a case report of a patient evaluated in our hospital and diagnosed with CIDP and exposes an updated literature review about this disease.
Subject(s)
Humans , Male , Middle Aged , Peripheral Nerves , Polyneuropathies , Autoimmune Diseases , Demyelinating DiseasesABSTRACT
Ciliary membrane fragment fusion to planar lipid bilayers resulted in the insertion of four ion channel types. cAMP-activated, cation-selective channels could be detected only in the absence of Ca2+ and had a conductance of 23 pS. They exhibited an apparent dissociation constant (Kd) for the cyclic nucleotide of approximately 30 microM and an estimated permeability ratio (PNa/PK) of 2.4. The cAMP cation-selective channel coinserted with a K(+)-selective channel refractory to cAMP, Ca2+, and D-myo-inositol 1,4,5-trisphosphate. This K+ channel was voltage independent and exhibited open-conductance substates of 60 and 112 pS. cAMP was also found to modulate a novel K+ channel with a Kd = 140 microM. It displayed three nearly equally spaced open substates with conductances of 34, 80, and 130 pS. In the absence and in the presence of cAMP the probability of occurrence of the open substates was binomially distributed. A fourth channel type was a Ca(2+)-activated K+ channel with a conductance of 240 pS. It was blocked by charybdotoxin at nanomolar concentrations (Kd = 3 nM). These results add support to the idea that, besides cAMP-activated cation-selective channels, vertebrate chemosensory olfactory membranes possess an arrangement of ion channels.
