1/404. Long-term follow-up of relapsed acute leukemia treated with immunotherapy after allogeneic transplantation: the inseparability of graft-versus-host disease and graft-versus-leukemia, and the problem of extramedullary relapse.Long-term outcome of 23 acute myeloid (AML, n=16) or lymphoblastic (ALL, n=7) leukemia patients who had received immunotherapy for treatment of persistent or recurrent disease 1.5-26 (median 4) months after allogeneic transplantation was studied to determine eventual survival. Immune manipulation comprised donor leukocyte infusion (n=18), interferon-alpha2b and/or interleukin-2 (n=15), and cyclosporine withdrawal (n=11) in various combinations. Graft-versus-host disease (GVHD) developed in 12 patients. Thirteen of 20 evaluable patients responded; 6 relapsing again. Eight patients died of toxicity, and 10 of progressive disease at 3-206 weeks (median 11). Five patients (3 AML, 2 ALL) are alive in remission with GVHD 2-46 months (median 23) after immunotherapy with Karnofsky scores of 70-100% (median 80). The overall survival of the whole group is 1-206 weeks (median 12), with an actuarial survival of 22% at 2 years. The development of GVHD was associated with superior survival in multivariate analysis (P=.007). Seven patients received immunosuppression because of the severity of GVHD (grade III/IV acute or extensive chronic): 3 died of GVHD, 3 improved but relapsed concomitantly, and 1 is alive in remission with extensive chronic GVHD. Four episodes of extramedullary relapse (granulocytic sarcomas) were seen in 3 patients with AML whose marrow remained in remission. We conclude that GVHD appears to be inseparable from graft-versus-leukemia in relapsed acute leukemia patients undergoing immunotherapy with a high proportion of patients dying due to toxicity or progressive disease, and isolated extramedullary relapse seems to be unusually common.- - - - - - - - - - ranking = 1keywords = median (Clic here for more details about this article) |
2/404. Thoracic disc herniation mimicking acute lumbar disc disease.STUDY DESIGN: Case report of a 49-year-old woman with a lower thoracic disc herniation mimicking acute lumbosacral radiculopathy. OBJECTIVE: To describe an unusual case of thoracic disc herniation mimicking acute lumbar disc disease. SUMMARY OF BACKGROUND DATA: Symptomatic thoracic disc herniation is rare and its clinical manifestations differ widely from those of cervical and lumbar disc herniations. Midline back pain and signs of spinal cord compression progressing over months or years are the predominant clinical features. Acute and subacute thoracic disc herniation occurs in less than 10% of patients, and isolated root pain is unusual. methods: A 49-year-old woman had acute low back pain radiation into the left buttock and the lateral aspect of the left leg and left foot. magnetic resonance imaging study showed a bulging disc and posterior osteophytes at T11-T12. RESULTS: Surgical removal of the herniated disc and osteophytes rapidly relieved her symptoms and neurologic deficits. A follow-up neurologic examination 3 years later showed normal motor and sensory functions, although low back soreness was noted occasionally. CONCLUSION: A case of thoracic disc herniation mimicking an acute lumbosacral radiculopathy is presented. Compression of the lumbosacral spinal nerve roots at the lower thoracic level after exit from the lumbar enlargement may be the mechanism for this unusual presentation.- - - - - - - - - - ranking = 0.51380695112805keywords = nerve (Clic here for more details about this article) |
3/404. Acute inflammatory neuropathy in charcot-marie-tooth disease.The authors report an association between acute inflammatory neuropathy and previously undiagnosed Charcot-Marie-Tooth 1A disease in a 15-year-old girl. sural nerve biopsy study showed hypertrophic neuropathy with endoneurial infiltrates of macrophages and lymphocytes. This association may be coincidental, but a particular susceptibility to damage of these peripheral nerves cannot be excluded. This report confirms the importance of pes cavus as a sign of long-standing sensorimotor neuropathy.- - - - - - - - - - ranking = 1.0276139022561keywords = nerve (Clic here for more details about this article) |
4/404. Sight-threatening acute orbital swelling from peribulbar local anesthesia.Severe allergic reactions to peribulbar local anesthesia are extremely rare. A 70-year-old woman presented with acute orbital swelling and optic nerve dysfunction after a peribulbar local anesthetic injection. The patient was treated with acute orbital decompression as well as intravenous antibiotics and methylprednisolone; she made a good recovery. An allergy, probably to lignocaine, was the most likely cause. Urgent recognition and treatment of this condition may prevent potentially serious visual consequences.- - - - - - - - - - ranking = 0.51380695112805keywords = nerve (Clic here for more details about this article) |
5/404. Post-transplant acute myeloid leukemia (PT-AML).Acute myeloid leukemia following organ transplantation (PT-AML) is a rare event with only a few published cases in the literature. We present three patients who developed AML (FAB M1, M5, M4) after renal, double lung or liver transplantation. Molecular analysis detected a t(9;11) in one patient and documented the recipient origin of AML in a second patient. All patients were treated with chemotherapy. immunosuppression was reduced to cyclosporin A (CsA) and prednisone in two patients and to prednisone alone in one patient. Two patients achieved a complete remission (CR), with a remission duration of 4.6 months in one patient, the other patient died from septicemia after 15.2 months in CR. One patient was refractory to chemotherapy and died from septicemia. This report together with the documented cases in the literature suggests that PT-AML (1) develops after a median interval of 5 years after transplantation with variable latency (range, <1-17 years); (2) is heterogeneous with respect to FAB classification; (3) shows chromosomal and molecular changes typical of therapy-related AML (t-AML: -7, 8, 11q23, inv16, t(15;17)); (4) standard chemotherapy is feasible after reduction of immunosuppression and produces a CR rate of 56% with a median remission duration of 4.6 months and an overall survival of 2.6 months; (5) the major complications are early death (25%), gram-negative septicemia, progressive disease or relapse. This review provides diagnostic and therapeutic experiences and guidelines for the management of this increasing group of post-transplant patients.- - - - - - - - - - ranking = 0.4keywords = median (Clic here for more details about this article) |
6/404. Acute herpetic neuralgia and postherpetic neuralgia in the head and neck: response to gabapentin in five cases.BACKGROUND AND OBJECTIVES: The clinical presentations and pharmacologic management of three patients with acute herpetic neuralgia (AHN) and two patients with postherpetic neuralgia (PHN), confined to the head and neck region, are described. methods: Two patients had pain in the ophthalmic division of the trigeminal nerve, two had pain confined to the C2-C4 dermatomes, and one patient had C2 pain with radiating and referred pain to the second and third divisions of the trigeminal nerve. RESULTS: Gabapentin, an anticonvulsant drug, was effective in treating these patients, including the two cases of AHN. All patients reported complete pain relief after titration with gabapentin up to 1,800 mg/d. The patients noted a dose-dependent decrease in pain almost immediately after starting gabapentin. Specifically, reduction in the frequency and intensity of allodynia, burning pain, shooting pain, and throbbing pain were noted. None of the patients experienced side effects from the drug. CONCLUSIONS: In view of the results in these patients, blinded, controlled studies are needed to determine the efficacy of gabapentin for treating AHN and PHN.- - - - - - - - - - ranking = 1.0276139022561keywords = nerve (Clic here for more details about this article) |
7/404. Acute compartment syndrome of the triceps and deltoid.Compartment syndrome is a condition in which the circulation and function of tissues within a closed space are compromised by increased pressure within that space. We report on the rare occurrence of compartment syndrome of the upper arm and deltoid in a professional power-lifter. This case stresses the importance of heightened awareness and expedient measures to prevent ischemic muscle necrosis and nerve injury.- - - - - - - - - - ranking = 0.51380695112805keywords = nerve (Clic here for more details about this article) |
8/404. Acute necrotizing otitis media in an infant: a case report.Acute necrotizing otitis media (ANOM), an uncommon but severe form of bacterial otitis media, frequently causes distressing sequelae if not properly diagnosed and treated. A four-month-old female infant initially became ill with intermittent fever, followed by left facial nerve paralysis and left otorrhea four days later. Microscopic examination of the left ear revealed congestion and swelling of the external ear canal, perforation of the eardrum and erosions on the malleus. culture of pus from the otic lesion grew pseudomonas aeruginosa. The patient's condition did not improve despite systemic administration of antibiotics; thus, surgical intervention was arranged. During the operation, near-total perforation of the eardrum, a dislodged incus, cholesteatoma-like matrix around the stapes, and granulation tissue occupying the middle ear and mastoid cavities were noted. Radical mastoidectomy was conducted and pathologic examination of the surgical specimen disclosed necrotic changes in both soft and bony tissues. The patient recovered soon after surgery. Her fever subsided one day after surgery and the patient was discharged in a stable condition 12 days later. However, she still had left facial nerve paralysis six months later.- - - - - - - - - - ranking = 1.0276139022561keywords = nerve (Clic here for more details about this article) |
9/404. Acute measles encephalitis of the delayed type.An acute measles encephalitis with epilepsia partialis continua occurred three months after measles in a previously healthy child with no detectable immunological defect. Levels of measles antibodies in serum and cerebrospinal fluid were high, and tubular inclusions of the type seen in subacute sclerosing panencephalitis were found in nerve cell nuclei. A communicating high-pressure hydrocephalus developed in the later stage of the disease. This case demonstrates that measles encephalitis of the delayed type should systematically be considered in children with acute encephalitis.- - - - - - - - - - ranking = 0.51380695112805keywords = nerve (Clic here for more details about this article) |
10/404. Immunoadsorption plasmapheresis in acute ataxic neuropathy.Acute ataxic neuropathy is characterized by sensory ataxia and areflexia. There is no established treatment. We tried immunoadsorption plasmapheresis 15 days after the onset for a 46-year-old woman suffering from this neuropathy. She could not walk even with assistance because of sensory ataxia. A sural nerve biopsy revealed active axonal degeneration and loss of myelinated fibers. We tried 5 sessions of plasmapheresis during 2 weeks. She could walk with assistance 12 days after the beginning of the plasmapheresis treatment. It took 3 months for her to be able to walk over 5 m without assistance, and she had severe sensory ataxia over a 17 month follow-up period. Immunoadsorption plasmapheresis started within 2 weeks after the onset of acute ataxic neuropathy may have beneficial effects if the axonal degeneration is mild. The plasmapheresis, however, should be continued for a longer period. A double blind study is necessary to clarify the effectiveness of this treatment on acute ataxic neuropathy.- - - - - - - - - - ranking = 0.51380695112805keywords = nerve (Clic here for more details about this article) |
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