[Paraneoplastic subacute degeneration of the cerebellum in non-small cell lung cancer and positive anti-Tr3 antibodies]. / Paraneoplastische subakute Degeneration des Kleinhirns bei nichtkleinzelligem Bronchialkarzinom und positiven Anti-Tr3-Antikörpern.

Neurological disorders can occur before the diagnosis of a malignoma is set. These disorders are induced by a misguided immune response with antibodies against intracellular or cell surface antigens. One of the most common paraneoplastic diseases is the subacute degeneration of the cerebellum. In most of the cases antibodies against Anti Hu, CRMP5/CV2, Amphiphysin and Ma/Ta are found and small cell bronchial carcinoma, breast cancer and lymphoma are diagnosed. We report about a 67 years old man with cerebellar symptoms and a weight loss of 10 kg who was treated in our clinic. After our diagnostic work up we found a non small cell cancer and diagnosed a subacute degeneration of the cerebellum as a paraneoplastic disorder. We found a high positive titer for Anti-Tr3 antibodies while the rest of the paraneoplastic antibodies described as typically associated with the subacute degeneration of the cerebellum were negative. The Anti-Tr3 antibodies are usually found in patients with Hodgkin and less often Non-Hodgkin disease. After initiation of a tumor specific therapy and intravenous immunoglobulin therapy the cerebellar symptoms decreased. In future follow up examinations we will see if the anti-Tr3 antibodies were associated with the non small cell bronchial carcinoma or if a lymphoma will occur in our patient.

[Altered orientation and aggressiveness in an 89-year-old woman]. / Wechselnde Vigilanz und Fremdaggressivität bei einer 89­jährigen Patientin.

An 89-year-old woman with Alzheimer's dementia was admitted because of altered orientation, aggressiveness and inability to take care of herself at home. Her patient history indicated that 14 days ago the battery of the pacemaker had be renewed. During that time the patient suffered from psychomotor alterations. Therefore, melperone had been initiated. Inspection of the urine and laboratory findings pointed towards an acute exacerbation of acute intermittent porphyria as a possible cause of the delirium. After discontinuation of melperone with additional parenteral therapy with physiological fluids, the signs of delirium significantly improved.

[Sensory aphasia during therapy with metronidazole--an important differential diagnosis of acute cerebral ischemia]. / Sensorische Aphasie unter Therapie mit Metronidazol--eine wichtige Differenzialdiagnose der akuten zerebralen Ischämie.

HISTORY AND ADMISSION FINDINGS: A 74-year old man was admitted after neurosurgical treatment of a lumbar vertebral fracture. He had a slight paresis of the right leg in combination with bladder dysfunction. INVESTIGATIONS: There were signs of a postoperative anemia (hemoglobin 10.4 mg/dl) and mildly elevated infection parameters (CRP 2 mg/dl). Routine ECG and chest X-ray were normal. TREATMENT AND COURSE: Physical training was initiated, but diarrhea occurred 2 days after admission. As the patient had received antibiotics after the operation, a treatment with metronidazole was initiated under the suspicion of diarrhoea induced by clostridium difficile. At day 6 of treatment a hypertensive crisis (blood pressure 230/120 mmHg) developed, followed by sensory aphasia. Despite treatment at the stroke unit and blood pressure regulation, the clinical signs of aphasia persisted. MRI could not detect an acute cerebral infarction. After discontinuation of metronidazole complete reconstitution occurred within 72 h. CONCLUSION: Metronidazole should be taken into account as cause of severe neurological side effects including ischemia-like syndromes like aphasia.

Effect of inhomogeneities and source position on dose distribution of nucletron high dose rate Ir-192 brachytherapy source by Monte Carlo simulation.

BACKGROUND: The presence of least dense dry air and highly dense cortical bone in the path of radiation and the position of source, near or far from the surface of patient, affects the exact dose delivery like in breast brachytherapy. AIM: This study aims to find out the dose difference in the presence of inhomogeneities like cortical bone and dry air as well as to find out difference of dose due to position of source in water phantom of high dose rate (HDR) 192 Ir nucletron microselectron v2 (mHDRv2) brachytherapy source using Monte Carlo (MC) simulation EGSnrc code, so that the results could be used in Treatment Planning System (TPS) for more precise brachytherapy treatment. SETTINGS AND DESIGN: The settings and design are done using different software of the computer. METHODS AND MATERIALS: For this study, the said source, water phantom of volume 30 x 30 x 30 cm 3, inhomogeneities each of volume 1 x 2 x 2 cm3 with their position, water of water phantom and position of source are modeled using three-dimensional MC EGSnrc code. STATISTICAL ANALYSIS USED: Mean and probability are used for results and discussion. RESULTS: The % relative dose difference is calculated here as 5.5 to 6.5% higher and 4.5 to 5% lower in the presence of air and cortical bone respectively at transverse axis of the source, which may be due to difference of linear attenuation coefficients of the inhomogeneities. However, when the source was positioned at 1 cm distance from the surface of water phantom, the near points between 1 to 2 cm and 3 to 8 cm. from the source, at its transverse axis, were 2 to 3.5% and 4 to 16% underdose to the dose when the source was positioned at mid-point of water phantom. This may be due to lack of back scatter material when the source was positioned very near to the surface of said water phantom and overlap of the additional cause of missing scatter component with the primary dose for near points from the source. These results were found in good agreement with literature data. CONCLUSION: The results can be used in TPS.

Evolving and evaluation of 3LP FFBP deterministic ANN model for district level long range monsoon rainfall prediction.

In order to develop a forecasting model for monsoon rainfall over the districts of Chhattisgarh, 3LP (Three Layer Perception) FFBP (Feed Forward Back Propagation) Deterministic ANN models have been proposed. In the proposed model, eleven neurons in input layer, one hidden layer with eleven neurons, a single neuron in output layer, 132 trainable weights in three layers, transfer function sigmoid 1/(1+e -deltax+eta)) with slope ä = 1, threshold ç = 0 have been used to evolve networks. Training of the network is continued till the mean square error becomes less than a pre-assigned value ranging from 0.0005 to 0.001. Data for the years 1945-2006 have been used, out of which the data of first 51 years, i.e., (-deltax + eta) 1945-1995, are used for training the network and data for the remaining period, i.e. during the period 1996-2006 are used independently for validation. In the present study, it has been observed that the mean absolute deviation (% of mean) values for the independent period (1996-2006) are less than and half of the standard deviation (% of mean) for all the districts. The performances of these 3LP FFBP Deterministic ANN models have been found to be extremely good and better evaluated over statistical trend models also. The models developed and their evaluations have been presented in this paper.