1/3. Paraneoplastic sensorimotor neuropathy associated with breast cancer.Paraneoplastic sensorimotor neuropathy occurs in association with many different types of cancer. The clinical findings are heterogeneous, and the pathogenesis is unknown. We have encountered 9 women with breast cancer and shared neurological features that suggest a distinct paraneoplastic syndrome. The syndrome is characterized by upper and lower extremity paresthesias and numbness, itching, muscle weakness and cramps, and in some, radicular symptoms and signs. serum and CSF inflammatory changes suggested an immune pathogenesis but none had detectable antibodies directed at nervous system elements. Six patients presented with neuropathy 2 months to 8 years before the discovery of the breast cancer. In 7 the neoplastic disease was localized to the breast and axillary lymph nodes. The neurologic course was chronic in all, and while symptoms were annoying, disability was minimal until late. One improved transiently with plasmapheresis, and three had mild transient improvement with treatment of the cancer. Recognition of this paraneoplastic syndrome may forewarn the physician of an underlying breast malignancy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. black widow spider bite in a child.An 8-year-old boy who was bitten by a black widow spider was seen in the emergency department twice, as well as by his private family physician, within a 24-hour period of time before being admitted to the hospital. This patient should have been observed for a longer period of time in the emergency department or admitted to the hospital on the day of presentation for observation with conservative management. The current literature is reviewed with special emphasis on the pediatric patient, and management guidelines are recommended.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/3. quinine-induced hepatotoxicity.OBJECTIVE: To report a case of quinine-induced hepatotoxicity presenting within 24 hours following the ingestion of the first dose. DATA SOURCES: Case report information was obtained from the medical record, the patient, and the physicians involved in this patient's case. medline and Index Medicus were searched to obtain relevant published literature from January 1942 to May 1997 using the terms quinine, muscle cramps, liver disease, and hepatotoxicity. CASE SUMMARY: A 57-year-old Native American woman presented with symptoms of nausea, vomiting, generalized myalgia, headache, fever, chills, and rigor. The alkaline phosphatase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltranspeptidase concentrations were dramatically elevated. quinine was suspected as the cause after several days of hospitalization and continued therapy. With discontinuation of the quinine, the patient's symptoms resolved within 48 hours and the liver enzyme concentrations declined within 72 hours. CONCLUSIONS: Documented hepatotoxicity has occurred with quinidine, the optical isomer of quinine. Limited awareness of quinine-induced hepatotoxicity may result in an unrecognized adverse effect.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |