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P D Clouston C B Saper T Arbizu I Johnston B Lang J Newsom-Davis J B Posner 《Neurology》1992,42(10):1944-1950
We studied nine patients with a subacute onset of a pancerebellar syndrome. Six had known cancer (three small-cell carcinoma of the lung [SCLC], one metastatic small-cell carcinoma, one small-cell carcinoma of the prostate, and one non-Hodgkin's lymphoma). Six of eight who had neurophysiologic testing, including the three patients without detectable cancer, had coexistent Lambert-Eaton myasthenic syndrome (LEMS). In two of the patients, LEMS was discovered only by neurophysiologic testing. We looked for anti-Purkinje cell autoantibodies in all patient's sera and in four patients' CSF. We also looked for autoantibodies to voltage-gated calcium channels (VGCCs) in seven patients' sera and two patients' CSF, using the 125I-omega-conotoxin radioimmunoassay. We were unable to detect anti-Purkinje cell autoantibodies in any patients' serum or CSF. However, there were raised titers of anti-VGCC autoantibodies in five of seven patients' serum, including one patient with SCLC who did not have LEMS, and in the CSF of one of two patients. We conclude that the frequency of presentation of a pancerebellar syndrome with LEMS is higher than expected by chance and is usually associated with cancer. In some of these patients, LEMS may be clinically occult. The presence of LEMS and raised titers of anti-VGCC autoantibodies in some patients with subacute cerebellar degeneration is suggestive of an autoimmune etiology even though anti-Purkinje cell antibodies could not be detected. Anti-VGCC autoantibodies are not confined to LEMS. They may be found at high titer in CSF as well as serum. 相似文献
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The famous question, "Are you talking to me?," was coined by Robert DeNiro in his lead role as Travis Bickle in the Martin Scorsese classic, Taxi Driver . The phrase also characterizes the troubling encounters that many headache-treating professionals confront as they attempt to discuss serious matters of care and compliance with some of their headache patients. Although most headache patients are eager to take professional advice and guidance, there exists a minority of patients whose behavior undermines a collaborative relationship between doctor and patient. In these cases, the physician may need to directly confront this behavior in order to overcome behavioral barriers that interfere with desirable treatment outcomes. This article offers explicit means and strategies to engage difficult patients, increase the likelihood of program adherence and improvement, and develop a more satisfying doctor-patient relationship, based on clinical experience in a national referral center for difficult-to-manage headache patients. 相似文献
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Sequence Analysis of the RNA Polymerase Gene of Foot-and-Mouth Disease Virus Serotype Asia1 总被引:1,自引:0,他引:1
George M Venkataramanan R Pattnaik B Sanyal A Gurumurthy CB Hemadri D Tosh C 《Virus genes》2001,22(1):21-26
The complete nucleotide (nt.) sequence of the RNA polymerase (3D) gene and 81 nt. in the 3-untranslated region of foot-and-mouth disease virus (FMDV) serotype Asia1 (IND63/72) was determined and compared with the sequence of other FMDV serotypes. The 3D genomic region was 1410 nt. long encoding 470 amino acids with an inframe stop codon (TAA) at nt. position 1411–1413. The deduced amino acid sequence of the protein showed 8 conserved motifs as reported in other picornaviruses, 2 of which are 100% identical across the serotypes. Antigenic regions in the polymerase protein were predicted and found to be located at the N-terminus of the protein. The phylogenetic analysis showed that the FMD viruses were segregated into different clusters based on geographical origin; the Asia1 virus did not cluster tightly with any of the geographical groups. 相似文献
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Comparison of ultrasonographic findings in spontaneous abortions with normal and abnormal karyotypes 总被引:2,自引:2,他引:2
To determine whether ultrasonographic findings can predict the karyotype of
spontaneous abortions, 137 pregnancies (54 spontaneous, 83 assisted
ovulatory cycles) that subsequently aborted and had chromosome analysis
performed on the products of conception were studied ultrasonographically.
Transvaginal ultrasound was performed using an Acuson 128XP/10 with 7.5 MHz
probe. The numbers of empty gestational sacs, small and normal for
gestational size, embryonic poles and embryos with documented cardiac
activity were calculated. The frequency of each of these findings in
pregnancies with normal and abnormal karyotypes was compared. Of the 137
spontaneous abortions, 51 had normal chromosome analyses and 86 had
abnormal karyotypes (68 aneuploidies and 18 polyploidies). Ultrasonographic
findings in the 51 karyotypically normal pregnancies included 16 (31%) with
empty gestational sacs, and 35 (69%) with embryonic poles, of which 24
(69%) were at least 1 week smaller than expected for gestational age and 11
(31%) were the expected size. Embryonic cardiac activity was documented in
22 (63%) of the 35 embryonic poles. Amongst 86 pregnancies with abnormal
karyotypes, similar frequencies of ultrasound findings were found: 23 (27%)
with empty gestational sacs, 42 (67%) with embryonic poles smaller than
expected for gestational age, and 50 (79%) embryos lost after documentation
of embryonic cardiac activity. No differences in the frequency of
ultrasonographic findings of empty gestational sacs, small embryonic pole
and embryonic cardiac activity were observed between karyotypically normal
and abnormal spontaneous abortions. Ultrasonographic findings cannot
predict the karyotype of spontaneous abortions.
相似文献