Recurrent alien hand syndrome in a multiple sclerosis case

Alien hand syndrome is the strange feeling of one's hand behaving independently. This syndrome has rarely been reported in multiple sclerosis (MS) patients. Herein, we present a 34-year-old female MS patient who had recurrent symptoms of alien hand syndrome that were evaluated as MS attacks based on cranial magnetic resonance imaging that showed demyelinating lesions in the corpus callosum. Alien hand syndrome is classified according to the location of the lesion and the presenting symptoms. As such, our patient can best be classified as a callosal alien hand case.     

Gynaecomastia in a man and hyperoestrogenism in a woman due to ingestion of nettle (Urtica dioica)

Nettle (Urtica dioica) is commonly sold as a herbal tea in Turkey. We report a case of gynaecomastia in a man (in which the only aetiologic factor identified was nettle tea consumption) and a case of galactorrhoea in a woman (in which the only aetiologic factor identified was also nettle tea ingestion).     

A clinically isolated syndrome: A challenging entity

Abstract   Acute isolated neurological syndromes, such as optic neuropathy or transverse myelopathy, may cause diagnostic problems since they can be the first presentations of a number of diseases such as multiple sclerosis (MS) and collageneous tissue disorders. In the present study, particular systemic lupus erythematosus (SLE) and primary Sjogren syndrome (pSS) patients, who were followed up with the initial diagnosis of possible MS with no evidence of collagen tissue disorders for several years, are described. Five patients with the final diagnosis of SLE and five pSS patients are evaluated with their neurologic, systemic and radiologic findings. Over several years, all developed some systemic symptoms like arthritis, arthralgia, headache, dry mouth and eyes unexpected in MS. During the regular and close follow-up laboratory evaluations of vasculitic markers revealed positivity, leading to the final definite diagnosis of SLE or pSS. Patients with atypical neurological presentation of MS, a relapsing remitting clinical profile, or lack of response to the regular MS treatment should be evaluated for the presence of a connective tissue disease. Various laboratory tests, such as cerebrospinal fluid findings, autoantibodies profile, markers, cranial and spinal magnetic resonance imaging, can be helpful for the differential diagnosis. Lack of response to the regular multiple sclerosis treatment, even increasing rate of relapses can force the clinician for the differential diagnosis. In particular cases an accurate diagnosis can only be made after close follow-up.     

Adrenal insufficiency, heart rate variability, and complex biologic systems: a study of 1,871 critically ill trauma patients

BACKGROUND: Reduction in integer heart rate variability (HRVi), one potential measurement of complex biologic systems, is common in ICU patients and is strongly associated with hospital mortality. Adrenal insufficiency (AI) and reduced HRVi are associated with autonomic dysfunction. Failure of the autonomic nervous system can be associated with loss of biologic complexity. We hypothesize decreased HRVi is associated with AI, and HRVi improves after treatment of AI, suggesting "recomplexification" (resumption of normal stress response to injury). STUDY DESIGN: Of 4,116 trauma ICU admissions from December 2000 to November 2005, 1,871 patients had sufficient physiologic, laboratory, pharmacy, and demographic data for analysis. Seventy-five patients failing cosyntropin-stimulation testing were defined as AI; the remaining 1,796 were defined as no AI. HRVi was calculated as integer heart rate standard deviation over 5-minute intervals. HRVi 10th, 50th (median), and 90th percentiles were calculated over the 72 hours pre-, or poststeroid, or both administration (AI). HRVi percentiles in non-AI patients were evaluated at the same interval and compared with AI using Wilcoxon's rank-sum test. In patients with AI, daily HRVi was computed 3 days before and after steroid administration, and compared between survivors and nonsurvivors. RESULTS: There were 2.9 million heart-rate intervals measured. HRVi stratified patients with AI (cosyntropin failure), and without AI. HRVi was similar in AI survivors and nonsurvivors before steroid treatment, but differed after treatment. HRVi increased substantially in survivors after steroid administration, yet did not change in nonsurvivors. HRVi does not increase in patients who are unresponsive to steroids and die. CONCLUSIONS: Reduced heart-rate variability, a potential measurement of complex biologic systems, is associated with cosyntropin-confirmed AI; improved in patients responding to steroid therapy; and is a noninvasive, real-time biomarker suggesting AI.     

Alterations in ocular surface and corneal thickness in relation to metabolic control in patients with chronic renal failure

AIM: Ocular surface changes and ocular symptoms may be encountered in patients with chronic renal failure (CRF) undergoing haemodialysis. The ocular surface changes and its relationship with metabolic control in CRF patients were aimed to be emphasized in this study. METHODS: Thirty-eight CRF patients (75 eyes) undergoing haemodialysis were enrolled. Patients underwent a complete ocular examination together with Schirmer, tear break-up time tests, pachymetric measurements and conjunctival impression cytologies. Blood calcium, phosphate levels and total body volume changes after haemodialysis were recorded. RESULTS: The most common findings were conjunctival calcification with red eye (81.3%) and dry eye (62.7%, according to tear break-up time test) in 75 eyes of 38 patients. Impression cytologies were graded as 0 in 57.3% of eyes and 2-3 in 40% of eyes showing positive correlation with the extent of conjunctival calcification (R = 0.486, P = 0.0001). Serum calcium and phosphate levels were also positively correlated with the degree of conjunctival calcification (R = 0.684, P = 0.0001 and R = 0.428, P = 0.0001, respectively) as well as with the grades of impression cytology (R = 0.587, P = 0.0001 and R = 0.385, P = 0.0001, respectively). Furthermore, the mean corneal thickness decreased significantly (9.31 +/- 26.9 mum) following haemodialysis (Paired t-test, P = 0.002). CONCLUSION: Dry eye and irritational symptoms are major ocular symptoms in CRF patients. Serum calcium and phosphate levels seem to have a prognostic importance for the ocular findings and symptoms in patients with CRF.