Seasonal occupational asthma in an agricultural products merchant — a case report

A 52-year-old agricultural products merchant reported mild occupational asthma and rhinitis throughout the year, with severe asthma from February to May. He had been exposed to various substances, particularly grain, insecticides, fungicides, and fertilizers over 35 years. We identified a castor-bean-containing fertilizer as the cause of the disease by skin prick test and bronchial provocation test. Specific IgE against castor bean was detected by enzyme allergosorbent test, and proteins with mol. mass of less than 14.4 kDa and masses of 15.5, 29.5, and 30.5 kDa were identified as allergens by Western blot analysis. The seasonal character of symptoms could be explained by a more frequent use of the fertilizer during spring. Six months after avoidance of the allergen, the patient reported chronic bronchitis without asthma. Occupational allergy to castor bean should be considered in subjects with seasonal asthma and exposure to "natural" fertilizers.     

Friedreich ataxia: an overview

Friedreich ataxia, an autosomal recessive neurodegenerative disease, is the most common of the inherited ataxias. The recent discovery of the gene that is mutated in this condition, FRDA, has led to rapid advances in the understanding of the pathogenesis of Friedreich ataxia. About 98% of mutant alleles have an expansion of a GAA trinucleotide repeat in intron 1 of the gene. This leads to reduced levels of the protein, frataxin. There is mounting evidence to suggest that Friedreich ataxia is the result of accumulation of iron in mitochondria leading to excess production of free radicals, which then results in cellular damage and death. Currently there is no known treatment that alters the natural course of the disease. The discovery of the FRDA gene and its possible function has raised hope that rational therapeutic strategies will be developed.     

脊髓小脑共济失调一家系的遗传学研究

脊髓小脑共济失调是一种以运动失调为主要症状,以小脑及其传入、传出途径变性为主的疾病,具有很强的遗传异质性,目前已定位的遗传位点超过20个,但目前只有12个基因被成功克隆。文章报道一脊髓小脑共济失调家系,出现患者4代15人,发病年龄在35~50岁左右,家系成员有早发现象。部分成员未到发病年龄,以后有可能出现更多的患者。经遗传分析,该家系的遗传方式为常染色体延迟显性遗传。     

Autosomal recessive spinocerebellar ataxia 20: Report of a new patient and review of literature

Inherited ataxias are an extremely heterogeneous group of disorders. Autosomal recessive spinocerebellar ataxia 20 (SCAR20) is a recently described disorder characterized by intellectual disability, ataxia, coarse facial features, progressive loss of Purkinje cells in the cerebellum and often hearing loss and skeletal abnormalities. Mutations in the gene SNX14, which plays an important role in autophagy, have been found to cause SCAR20. The unique clinical findings of progressive coarsening of facial features makes the clinical phenotype recognizable among the various hereditary ataxias. Here we report on a child with a novel missense mutation in the SNX14 gene that appears to be debilitating for protein conformation, function and review the previously reported cases from 15 families.     

晚发型脊髓小脑性共济失调3型一例

患者女,58岁,因"行走不稳、左眼睑下垂5年,声音改变3年"于2018年1月13日就诊于聊城市人民医院神经内科。患者5年前无明显诱因出现走路不稳,行走时偏侧倾斜,左上眼睑下垂;3年前开始出现声音改变,表现为声音变细、变小、发音困难。大约半年前开始出现不能行走,站立不稳,言语不清,进食、饮水时易呛咳,期间出现一过性睡眠障碍,持续约2周缓解,体质量减轻15 kg。该患者既往身体健康,无糖尿病、高血压病及冠心病史。家族中无近亲婚配史,先证者外祖父及母亲有类似临床表现(图1)。神经系统检查:患者神志清晰,精神尚可,智力正常。构音障碍,可回答简单词组,爆破样发音,对话切题。左眼裂直径约5 mm,右眼裂直径约7 mm,左眼睑下垂;双眼球未见明显突出,未见K-F环,双眼各向运动灵活,直接及间接对光反射正常,双眼水平眼震;左侧肢体肌力5级,右侧肢体肌力5-级,肌张力正常;右侧肢体较左侧纤细、力量差,右手掌第一骨间肌萎缩;双侧上肢腱反射、下肢膝反射亢进,跟腱反射消失。指鼻试验欠稳准;跟膝胫试验阳性;Romberg征阳性,站立不稳,宽基底步态。深浅感觉查体正常;双侧Babinski征、Chaddock征阳性;脑膜刺激征阴性。     

Niemann Pick disease A: a case report

The Niemann Pick disease is a rare lysosomal storage disease responsible for numerous cytological abnormalities of blood cells and bone marrow. The diagnosis requires enzymatic dosages, which can be long and difficult. In this context, the detection of inconstant cytologic anomalies in blood and bone marrow smears, allowing a rapid screening, is an important step in the diagnostic approach. We report the case of a 6?year-old child who presents with abdominal distension; medullogram was performed and revealed the presence of vacuolated cells overload. Correlated with clinical and biochemical data, medullogam results confirmed the diagnosis of type A?Niemann Pick disease.     

A study in a Polish ataxia cohort indicates genetic heterogeneity and points to MTCL1 as a novel candidate gene

Inherited ataxias are a group of highly heterogeneous, complex neurological disorders representing a significant diagnostic challenge in clinical practice. We performed a next-generation sequencing (NGS) analysis in 10 index cases with unexplained progressive cerebellar ataxia of suspected autosomal recessive inheritance. A definite molecular diagnosis was obtained in 5/10 families and included the following diseases: autosomal recessive spastic ataxia of Charlevoix-Saguenay, POLR3B-related hypomyelinating leukodystrophy, primary coenzyme Q10 deficiency type 4, Niemann-Pick disease type C1 and SYNE1-related ataxia. In addition, we found a novel homozygous MTCL1 loss of function variant p.(Lys407fs) in a 23-year-old patient with slowly progressive cerebellar ataxia, mild intellectual disability, seizures in childhood and episodic pain in the lower limbs. The identified variant is predicted to truncate the protein after first 444 of 1586 amino acids. MTCL1 encodes a microtubule-associated protein highly expressed in cerebellar Purkinje cells; its knockout in a mouse model causes ataxia. We propose MTCL1 as a candidate gene for autosomal recessive cerebellar ataxia in humans. In addition, our study confirms the high diagnostic yield of NGS in early-onset cerebellar ataxias, with at least 50% detection rate in our ataxia cohort.     

Spinocerebellar ataxia type 7 without retinal degeneration: a case report

A 60-yr-old man developed progressive gait disturbance and limb ataxia at the age of 52. Family history was absent for neurological disorders. Examinations showed pure cerebellar syndrome. There was no retinal degeneration for 7 yr. A brain MRI done at the age of 56 showed atrophy of the cerebellar hemispheres and vermis. Genetic test confirmed the spinocerebellar ataxia type 7 with CAG repeat number of 42.     

弥漫型胃黏膜皱襞肥大症一例

患者男,55岁。2个月前无明显诱因出现双下肢水肿同时稍感上腹部不适,进食后尤其明显,食欲减退,于200年6月19日入院。入院前于外院CT检查示:胃壁平滑肌瘤可能性大,胃腔变小,胃镜检查未见明显异常。上消化道造影提示:胃癌、右侧胸膜肥厚。外科查体:腹平坦,全腹无压痛、反跳痛及肌紧张,左上腹可触及一8cm×9cm×15cm大小的肿块,无触痛,双下肢出现凹陷性水肿。实验室检查:白蛋白25g/L。病理检查:全胃组织,大弯长39cm,小弯长21cm,胃体直径12cm,胃角直径6.5cm,网膜面积为23cm×16cm,沿胃大弯剪开胃组织,可见弥漫性黏膜皱襞粗大,弥漫至胃底、大小…     

Camurati-Engelmann's disease: a case report

Camurati-Engelmann's disease is a rare condition worldwide. No cases have been documented in Uganda. A 26 year old female presented with a history of grinding pain in the limbs for over 20 years. Strong painkillers would temporally relieve the pain. She had an asthenic stature with generalised reduction in muscle bulk. Plain x-rays revealed the characteristic symmetrical thickening and sclerosis of the diaphyses of the appendicular skeleton and skull base, which is pathognomonic of Camurati-Engelmann's disease. Involvement of the metaphyses of these long bones as well as the metacarpal bones makes this an unusual case.     

Chinese patients with Huntington's disease initially presenting with spinocerebellar ataxia

Recent studies have described Huntington's disease (HD) patients with atypical onset of ataxia. Symptoms in these patients can overlap with those of spinocerebellar ataxia (SCA). We retrospectively examined clinical data for 82 HD probands and found 7 had initially been clinically diagnosed as SCA cases. Clinical features in these patients were further investigated and the number of CAG repeats in the huntingtin (HTT) gene was determined by direct sequencing. Genetic screenings for SCAs in the 7 patients were all negative. By contrast, HTT was heterozygous in each patient. The distribution of CAG number in the 7 patients was statistically the same as that in the other 75 patients. Each of 7 HD patients had presented with atypical onset of ataxia. The mean time from onset to HTT genetic testing was 5.6 ± 5.52 years. Three of the patients developed chorea, but the others did not. Our observations confirm the clinical heterogeneity of HD in Han Chinese. Based on these findings, testing for HTT expansions should be considered for clinically diagnosed SCA patients who test negatively in genetic screening of SCA genes.     

Somatic mosaicism of the CAG repeat expansion in spinocerebellar ataxia type 3/Machado-Joseph disease

An expanded and unstable CAG repeat in the coding region of the MJD1 gene is the mutation responsible for spinocerebellar ataxia 3/Machado-Joseph disease. In order to determine whether there was a higher degree of instability in affected regions, the size of the expanded CAG repeat was analyzed in different regions of the central nervous system, in two unrelated SCA3/MJD patients. The degree of somatic mosaicism was quantified and compared to that in a SCA1 patient. Instability of the expanded CAG repeat was observed in peripheral tissues as well as in CNS of the three patients, but there was no correlation between the degree of mosaicism and the selective vulnerability of CNS structures. As in the other diseases caused by expanded CAG repeats, a lower degree of mosaicism was found in the cerebellar cortex of both SCA1 and SCA3/MJD patients, probably reflecting specific properties of this structure. In SCA3/MJD, the degree of mosaicism seemed to correlate with age at death rather than with the size of the expanded CAG repeat. Finally, somatic instability was more pronounced in SCA1 than in SCA3/MJD patients. Hum Mutat 11:23–27, 1998. © 1998 Wiley-Liss, Inc.     

Dermatomyositis associated with HIV-1 infection in a Nigerian adult female: a case report

Human immunodeficiency virus (HIV) infection has been implicated as a trigger for various autoimmune diseases, one of which is dermatomyositis. This is a very rare autoimmune disease characterised by myopathy, typical cutaneous signs and variable systemic manifestations. To our knowledge, the association of this rare disease with HIV infection has not been previously reported in Nigeria. We therefore decided to report the case of a 40 year old HIV-1 infected Nigerian female who presented to us with muscle, skin, and systemic manifestations of dermatomyositis. Our aim is to show the effect of HIV infection, as well as HAART-induced immune reconstitution on the clinical course of dermatomyositis.     

Fabry病一例

患者女,41岁。因发现蛋白尿1个月于2006年3月15日入院。患者1个月前因腰痛在当地医院就诊,尿常规检查提示蛋白＋＋,当时未予特殊处理,后多次查尿常规检查均提示有蛋白尿,为进一步诊治入本院肾内科。调查家族史,其父死于心脏病,其母、兄弟姐妹及儿女未发现类似病患。体检：各器官未见异常,全身皮肤末见皮疹。[第一段]     

Optic ataxia revisited:

Optic ataxia and visual agnosia have been proposed to constitute a double dissociation which provides the main argument for the assimilation of the anatomical distinction between a dorsal and a ventral visual stream to the functional distinction between perception and action. In the present review, we argue that insufficient evidence has been collected to argue for this double dissociation. Several criteria are reviewed: (1) exploration of the visuomotor behavior in central versus peripheral vision has not been matched for the two types of patients; (2) the temporal constraints of visual processes that are impaired in the two neurological conditions appear to play a crucial role in the apparent dissociation; (3) the necessary reductionism of experimental conditions used to study action has led to an overconsideration of optic ataxia as a global deficit for action. Altogether optic ataxia appears to result from a specific impairment of immediate visuomotor control rather than of visually guided action as a whole. These results are discussed in the light of recent research on optic ataxia and on motor control, and directions for future research are proposed.     

Cerebellar ataxia with normal intellect associated with a homozygous truncating variant in CA8

Biallelic pathogenic variants in CA8 cause cerebellar ataxia, mental retardation and dysequilibrium syndrome 3 (CAMRQ3), a rare form of hereditary ataxia characterised by cerebellar hypoplasia/atrophy, variable intellectual disability and often quadrupedal gait. The few cases reported in the medical literature are all caused by pathogenic homozygous or compound heterozygous missense variants in CA8. We report a 9 year-old boy with marked gross motor delay, ataxia and progressive cerebellar atrophy with limited bipedal gait, but without intellectual disability. Singleton whole exome sequencing was performed. A novel homozygous truncating variant in CA8 (c.232C>T) with a predicted premature termination codon at position 78 (p.Arg78*) was identified. Both parents and the proband's healthy sister are heterozygous for the variant. This variant is likely pathogenic and the cause of the condition in this child. Functional evidence in the form of a spontaneous mouse model involving homozygous intragenic deletion of the mouse analogue of CA8 with nonsense-mediated decay and similar clinical features to the proband support pathogenicity. Identification of this truncating variant broadens the genotypic and phenotypic spectrum of CA8-related cerebellar ataxia.     

一个遗传性共济失调7型家系的基因突变分析

目的 研究1个遗传性共济失调7型回族家系的临床表现与基因突变特点.方法 应用聚合酶链反应、分子克隆及测序等方法对1个临床诊断为遗传性共济失调的回族家系进行SCA7基因检测,对异常片段进行分子克隆测序.结果 证实该家系为遗传性共济失调7型家系,视网膜退行性变为其相对独特的临床表现.先证者父亲异常片段CAG重复为46次;先证者异常片段CAG重复次数为54次,发病年龄较父代提前22年.结论 报告1个遗传性共济失调7型回族家系,该亚型明显的遗传早现及病程进展与CAG重复次数的不稳定扩增相关.