Neonatal withdrawal syndrome following in utero exposure to paroxetine, clonazepam and olanzapine.

We describe a full-term infant with failed respiratory effort and decerebrate posturing following in utero exposure to paroxetine. All signs and symptoms associated with the paroxetine exposure were resolved by the second day of life. Upon discharge, the infant revealed a normal neurodevelopmental examination.

Sporadic Creutzfeldt-Jakob disease with cerebellar ataxia at onset in the UK.

OBJECTIVE: To determine the frequency, in the UK, of sporadic Creutzfeldt-Jakob Disease (sCJD) with a cerebellar ataxic onset, and to describe the clinical features of the syndrome. METHODS: A retrospective review of autopsy-proved cases of sCJD cases in the UK, 1990-2005, identifying those presenting with cerebellar features without early cognitive decline. RESULTS: 29 of 618 (5%) patients with sCJD had an isolated cerebellar onset. Mean illness duration was 9 months. Subsequently, 21 (72%) developed myoclonus and 23 (79%) developed pyramidal features. Magnetic resonance imaging showed high signal in the basal ganglia in 11 of 14 (79%) patients. 7 of 15 (47%) patients were valine homozygotic at prion protein gene (PRNP)-129. Only 8 (28%) cases were referred to the surveillance unit after death. CONCLUSION: A better definition of sCJD presenting with an isolated cerebellar syndrome might improve future case recognition and contribute to the determination of its cause.

Isolated visual symptoms at onset in sporadic Creutzfeldt-Jakob disease: the clinical phenotype of the "Heidenhain variant".

BACKGROUND: The Heidenhain variant of sporadic Creutzfeldt-Jakob disease (sCJD) is commonly understood to represent cases with early, prominent visual complaints. The term is clarified to represent those who present with isolated visual symptoms. This group may pose diagnostic difficulties and often present to ophthalmologists where they may undergo needless invasive procedures. METHOD: A retrospective review of 594 pathologically proved sCJD cases referred to the UK National CJD Surveillance Unit over a 15 year period to identify Heidenhain cases. RESULTS: 22 cases had isolated visual symptoms at onset with a mean illness duration of 4 months. The mean age at disease onset was 67 years. Most displayed myoclonus, pyramidal signs, and a delay in the onset of dementia for some weeks. 17 (77%) were referred initially to ophthalmology. Two underwent cataract extraction before diagnosis. All tested cases were homozygous for methionine at codon 129 of the prion protein gene. CONCLUSIONS: This rare, but clinically distinct, group of patients with sCJD may cause diagnostic difficulties. Because ocular intervention carries with it the risk of onward transmission awareness of this condition among ophthalmologists is important.

Efficacy and pattern of use of sputum cytology as a diagnostic test.

Sputum cytology is regarded by many clinicians as a noninvasive, cheap and simple test for the diagnosis of bronchogenic carcinoma. Since the introduction of fibre-optic bronchoscopy and more easily obtained bronchial biopsies reliance on sputum cytology has diminished. However, in Edinburgh it was perceived that sputum samples were still being sent as well as, rather than instead of, bronchoscopic specimens. This retrospective study was undertaken to determine whether or not cytological examination of sputum is an efficient and sensitive test in the investigation of patients with suspected bronchogenic carcinoma. It demonstrated that the Lothian University Hospitals NHS Trust Pathology Directorate receives many sputa from departments not specializing in respiratory disease when there is no indication for the test. In addition, we have shown that the absolute sensitivity of the test is only 5% and that when there is a strong clinical suspicion of bronchogenic carcinoma the results of sputum cytology do not play a significant role in the management of the patient. We recommend that sputum cytology is restricted to those patients under the care of Respiratory Units in whom bronchoscopy is inappropriate or unsuccessful.

Occult lymph node metastases in patients with 'node negative' breast carcinoma treated with conservation surgery and axillary node sample and who subsequently developed axillary recurrence.

We examined axillary lymph nodes from 26 patients with node-negative breast cancer managed by axillary node sampling and no further axillary treatment, but who subsequently developed axillary recurrence after a mean follow-up of 7 years to determine the incidence of micrometastatic disease in these patients. Twenty-six matched controls with an identical length of follow-up who were node-negative on an axillary node sample, but have not developed axillary recurrence, also underwent node examination and the incidence of metastases in the two groups were compared. Lymph nodes were sectioned at two additional levels 100 microm apart. Sections at each level were stained with haematoxylin and eosin (H&E) and antibodies to PanCK and MUC1 protein. The original H&E section from each node was reviewed and additional sections from each lymph node were examined by a pathologist who was blinded to outcome. Review of the original H&E sections of the nodes revealed metastases that had been overlooked at the time of diagnosis in two (8%) patients from the recurrence group. A further two (8%) patients from the recurrence group and three (12%) from the control group had axillary nodes which contained micrometastases. Immunocytochemistry was important in identifying all micrometastases. There was no significant difference in the incidence of axillary node micrometastases between patients with and without axillary node recurrence. Although the number of cases was small, this study suggests that axillary recurrence following a negative sampling procedure is not commonly due to missed axillary node metastases.