Characteristics of the sequence effect in Parkinson's disease

The sequence effect (SE) in Parkinson's disease (PD) is progressive slowing of sequential movements. It is a feature of bradykinesia, but is separate from a general slowness without deterioration over time. It is commonly seen in PD, but its physiology is unclear. We measured general slowness and the SE separately with a computer‐based, modified Purdue pegboard in 11 patients with advanced PD. We conducted a placebo‐controlled, four‐way crossover study to learn whether levodopa and repetitive transcranial magnetic stimulation (rTMS) could improve general slowness or the SE. We also examined the correlation between the SE and clinical fatigue. Levodopa alone and rTMS alone improved general slowness, but rTMS showed no additive effect on levodopa. Levodopa alone, rTMS alone, and their combination did not alleviate the SE. There was no correlation between the SE and fatigue. This study suggests that dopaminergic dysfunction and abnormal motor cortex excitability are not the relevant mechanisms for the SE. Additionally, the SE is not a component of clinical fatigue. Further work is needed to establish the physiology and clinical relevance of the SE. © 2010 Movement Disorder Society.     

The role of the duodenal microflora as a determinant of persistent diarrhoea

It has been suggested that proliferation of enterobacteriaceae and/or anaerobes in the duodenum of some children with acute diarrhoea determines whether the episode becomes persistent. A review of published studies and the comparison of cultures of duodenal aspirates from Peruvian children with acute and persistent diarrhoea and diarrhoea-free children did not support this hypothesis. Although many children had enterobacteriaceae and/or anaerobes cultured there was no correlation with clinical and nutritional outcome. Age, nutritional status, the environment and the aetiology of the episode were determinants of the duodenal microflora independent of diarrhoea. Culture of the duodenal aspirates did not increase the yield of enteropathogens which were isolated more frequently from stools than from the duodenum. Despite the presence of a single strain or serotype of enterobacteriaceae suggesting that these bacteria were colonizing the duodenum, we were unable to demonstrate any adherence mechanisms in the majority of them. Two often bacteria with no other evidence of virulence caused diarrhoea in the RITARD rabbit model.     

Serum hormones and their receptors in women with normal and inadequate corpus luteum function

The purpose of this study was to attempt to characterize women with a luteal phase defect (LPD) by cytosol estrogen and progesterone (P) levels and peroxidase activity in endometrial biopsy samples. These values were correlated with circulating serum estradiol, P, testosterone, and dehydroepiandrosterone sulfate measurements. Similar data were obtained from women during the proliferative phase of the cycle. Midluteal phase P values were significantly greater in women with normal luteal function than in those with LPD; however, some overlap of values existed. Furthermore, because no significant differences between this group and normal women were seen, we were unable to characterize women with LPD by estrogen or P receptor levels or endometrial peroxidase activity.     

Escitalopram H Lundbeck

Lundbeck and Forest have developed and launched escitalopram, the therapeutically active (S)-enantiomer of citalopram, as an improved follow-up compound for the potential treatment of depression. In December 2001, Lundbeck received Swedish approval for the treatment of depression and panic disorder [433058], and in January 2002, the product was approved in Switzerland for the treatment of depression [434736]. By May 2002 it had been approved in Belgium, Denmark, the UK, France, Iceland, Luxembourg, Norway and Austria, as a result of the European Mutual Recognition Procedure. Independently, regulatory authorities in Lithuania had also approved the drug for the treatment of depression. Launch in these countries will begin immediately after price and reimbursement negotiations are completed [450860]. By June 2002, it had been launched in Switzerland, Sweden and the UK [454488]. Based on the approvals in the EU, national applications are being submitted in several Central and Eastern European countries, where review and the first approvals were expected in the second half of 2002. At this time, the approval of escitalopram in Australia and Canada was expected in the second half of 2002 and the first half of 2003, respectively [450860]. It became evident in May 2002, that Portugal, Greece, Italy, Spain, Finland and Germany did not intend to approve escitalopram for marketing within the 90-day timeframe, and, at this time, Lundbeck, in accordance with the advice of the reference country, Sweden, chose to withdraw the registration applications from these six countries. At this time, the company still expected escitalopram to be approved in these countries [450860]. In the US, Forest submitted an NDA in March 2001 [402983] and in January 2002, Forest received an approvable letter from the FDA for escitalopram; at this time, US launch was expected in mid-2002 [437487], [444243]. By March 2002, Lundbeck had started to supply escitalopram to Forest [442326]. Lundbeck and Morchida entered a Japanese development and marketing agreement in May 2002, replacing a collaboration with Mitsui [453377].     

Imaging of soft-tissue myxoma with emphasis on CT and MR and comparison of radiologic and pathologic findings

PURPOSE: To determine the imaging characteristics of soft-tissue myxoma, with emphasis on computed tomographic (CT) and magnetic resonance (MR) imaging findings and pathologic comparison. MATERIALS AND METHODS: Records of 45 pathologically confirmed soft-tissue myxomas in 44 patients were retrospectively reviewed. Patient demographics and radiographs (n = 20), bone scintigrams (n = 2), angiograms (n = 3), and ultrasonographic (US) (n = 6), CT (n = 14), and MR images (n = 33) were evaluated by two musculoskeletal radiologists with agreement by consensus for lesion location, lesion size, and intrinsic characteristics. RESULTS: Soft-tissue myxoma more commonly affected women (59%; average age 52 years) and manifested as a slowly enlarging (64%) painful (51%) mass. Lesions were most frequently intramuscular (82%) and involved the thigh (51%). An appearance similar to that of a cyst was seen at CT (at which the lesions demonstrated low attenuation) and at MR imaging (at which the lesions demonstrated markedly high signal intensity on T2-weighted images) in all cases because of the high water content of mucin that was seen histologically. The true solid architecture of these lesions was best depicted in all cases at US (at which the lesions were hypoechoic, not anechoic) and on MR images obtained with contrast material (at which the lesions demonstrated internal enhancement). A small amount of tissue similar to fat surrounding these intramuscular myxomas (71% at MR imaging) corresponded histologically (70%) to atrophy of surrounding muscle. CONCLUSION: Soft-tissue myxoma often demonstrates characteristic US, CT, and MR imaging findings, including intramuscular location, intrinsic high water content, and a surrounding rim of fat.     

Giant bronchial carcinoid tumors: a multidisciplinary approach

BACKGROUND: Bronchial carcinoid tumors account for approximately 2% of all lung tumors. Although they were considered benign lesions, they are now categorized malignant, occasionally with poor prognosis. The clinical symptoms can be highly variable and are often present for many years before diagnosis. Whereas some carcinoids are entirely asymptomatic, others are accompanied by carcinoid or paraneoplastic syndromes. METHODS: We describe the multidisciplinary management of a 34-year-old female patient with a massive actively secreting bronchial carcinoid tumor of the right lung. Furthermore, we provide a review of the literature regarding the operative treatment and the perioperative management of pulmonary carcinoid tumors with respect to surgical, anesthetic, radiologic, and pathologic considerations. RESULTS: In the reported case, the first symptoms were chronic watery diarrhea, skin flushing, progressive shortness of breath, and increasing right shoulder pain. When the patient initially presented at our institution, the tumor had already reached an enormous size and it involved the right and left atrium as well as the atrial septum. Using an evidence-based, multidisciplinary approach the patient was treated successfully with extended surgical resection. CONCLUSIONS: Carcinoid tumors are potentially curable even if they reach a significant size and thus an aggressive strategy is warranted. The management of such cases requires careful investigation, planning, and treatment with collaborative expertise provided by a multidisciplinary team. We demonstrated that this approach can lead to a favorable outcome in what first appeared to be a formidable and unresectable tumor.