Behçet's disease: diagnostic and prognostic aspects of neurological involvement

This study was conducted to describe clinical and prognostic aspects of neurological involvement in Behçet's disease (BD). Patients referred for neurological evaluation fulfilled the criteria of the International Study Group for Behçet's Disease. We analyzed disability and survival by the Kaplan-Meier method, using Kurtzke's Extended Disability Status Scale (modified for BD) and the prognostic effect of demographic and clinical factors by Cox regression analysis. We studied 164 patients; of the 107 diagnostic neuroimaging studies: 72.1% showed parenchymal involvement, 11.7% venous sinus thrombosis (VST) and the others were normal. CSF studies were performed in 47 patients; all with inflammatory CSF findings (n=18) had parenchymal involvement. An isolated increase in pressure was compatible with either VST or normal imaging. The final diagnoses were VST (12.2%), neuro-Behçet's syndrome (NBS) (75.6%), isolated optic neuritis (0.6%), psycho-Behçet's syndrome (0.6%), and indefinite (11%). VST and NBS were never diagnosed together. Ten years from onset of BD 45.1% (all NBS) reached a disability level of EDSS 6 or higher, and 95.7±2.1% of the patients were still alive. Having accompanying cerebellar symptoms at onset or a progressive course is unfavorable. Onset with headache or a diagnosis of VST is favorable. Two major neurological diagnoses in BD are NBS and VST. These are distinct in clinical, radiological, and prognostic aspects, hence suggesting a difference in pathogenesis.     

Hepatitis B vaccine related‐myelitis?*

We present four incidental cases that developed partial myelitis following the administration of hepatitis B vaccine in 1998. The first two cases, a 33-year-old man and a 42-year-old woman developed progressive sensory symptoms without motor involvement within 4 weeks following the vaccination. Their magnetic resonance imaging (MRI) disclosed similar lesions consistent with myelitis at their cervical spinal cord. A comparable inflammatory lesion was seen at the T9-T10 levels of the spinal cord in the third case, who was a 40-year-old woman presenting with numbness in her legs and urinary retention following the vaccination. The fourth case who was a 42-year-old woman, presented with sensory symptoms in her left extremities, which developed 3 months after the vaccination. Her MRI showed a hyperintense lesion at C6. She also had two tiny lesions in her cranial MRI. In all cases, there was no history of preceding infections and no clinical evidence suggestive of any other disorders that may cause myelopathy. All patients recovered completely within 3 months with the exception of the third patient who developed new neurological symptoms after 12 months. Similar clinical and imaging presentation of myelitis following hepatitis B vaccination within a 1 year period with no other demonstrable clinical and laboratory evidence for any other disorder raise the probability of a causal link between these two events.     

Asthma Control and Patient Satisfaction Among Early Pediatric Users of Montelukast

Objective: To assess asthma control and patient satisfaction among pediatric users of montelukast in a clinical practice setting.

Study Design: A prospective study of 175 children with persistent asthma, 6 to 14 years of age, who initiated treatment with montelukast between Feb-1998 and Aug-1998, in primary care and pediatric offices across the United States. Data on asthma control and satisfaction with treatment was collected in physicians' offices after enrollment and by survey to the patients' homes at 1 month of treatment.

Results: Across the study population, improvements in mean scores for asthma control and parent satisfaction were observed at the 1-month follow-up compared with baseline. At 1 month, 57.7% of patients had none of four issues indicative of poor asthma control, compared with 19.4% at baseline. Similarly, after 1 month of treatment with montelukast, 2.7 times as many parents reported being very satisfied with asthma therapy (using montelukast) compared with the previous controller therapy regimen at baseline. During the 1-month follow-up period, montelukast was used as the only controller medication by 18.3% of patients, and in combination with another controller medication by 81.7%.

Conclusions: Observations from this study over one month suggest that a significant percentage of pediatric patients successfully managed their asthma with montelukast and their parents were satisfied with their medication, compared to baseline.     

Flat foot and femoral anteversion in children—A prospective study

BackgroundFlat foot in children during the first years of life evokes significant parental concern. Flat foot, intoeing and femoral anteversion may well be differential dimensions of developmental pathodynamics with potential for inter-related developmental correction. While correlation of femoral anteversion with intoeing is documented, its relationship with flat foot remains unclear.ObjectiveThe aim of this prospective study is to investigate the relationship between flat foot and internal rotation of hip, indirectly femoral anteversion.Methods651 Children, 339 boys and 312 girls, aged 3–6 years, were examined and Contact Index II for flat foot as well as internal rotation of hip measured. 82 children with other foot and leg deformities were excluded from further analysis.ResultsOut of 569 children, 95 (16.7%) had flat feet – 56 bilateral, 39 unilateral – with Contact Index II of 0.88 or above. All children with flat feet (and none of the normal 474) had raised internal rotation of hip (mean 69.9°, range 62–80°).ConclusionRegression analysis established an unequivocal and highly significant statistical relationship between flat foot and increased internal rotation of hip (F = 168.1, p < 0.001, r = 0.53) in children between 3 and 6 years.     

Changes in the inflammatory and oxidative stress markers during a single hemodialysis session in patients with chronic kidney disease

Background: Cardiovascular disease (CVD) is a common cause of morbidity and mortality in end-stage renal disease (ESRD) patients on hemodialysis (HD) among whom it is 5–20 times higher than in the general population. Some of the nontraditional risk factors such as oxidative stress and inflammation are related to the progress of CVD in HD patients. Several, but not all studies, reported that inflammatory and oxidative stress markers are increased during a single session of HD, mimicking changes that occur during acute immune activation. This study was taken up to evaluate the changes in the inflammatory and oxidative stress markers during a single HD session in patients with chronic kidney disease.

Methods: Twenty-five ESRD patients on maintenance HD and 25 controls were included in the study. Blood samples were obtained from the patients before starting of hemodialysis (pre-HD) and after completion of hemodialysis (post-HD). The changes in serum Pentraxin-3, hs-CRP, malondialdehyde (MDA) and ferric reducing ability of plasma (FRAP) levels were measured in pre- and post-HD ESRD patients and compared with healthy control group.

Results: This study found increased levels of Pentraxin-3, hs-CRP, MDA, and decreased level of FRAP in HD patients compared to controls.

Conclusions: Hemodialysis procedure contributes to inflammation and oxidative stress.     

Acute neuropathic pain after surgery: Are we treating them early/late?

Acute neuropathic pain (ANP) is now recognised as a cause of post surgical pain. We describe an 80 year old female who presented with sciatic nerve injury following a total hip replacement surgery. Clinical presentation included acute neuropathic pain, numbness, paraesthesia and foot drop. Symptoms and signs of nerve injury and pain were confirmed by neurophysiological studies to be due to a proximal sciatic nerve lesion. Its aetiology, pathogenesis, diagnosis and pharmacotherapy is discussed.In conclusion, we had a patient who demonstrated acute post operative neuropathic pain in combination with post surgical nociceptive pain after hip surgery. ANP responded well to Amitriptyline and Gabapentin. Early diagnosis and treatment with antineuralgics is recommended to prevent progression to chronic post operative neuropathic pain.However, clinical trials are required to confirm efficacy of these treatments in acute neuropathic pain.