1/9. Myasthenia in a patient with sarcoidosis and schizophrenia.A 44-year-old male patient was hospitalised with paranoid schizophrenia in 1985. Depot neuroleptic treatment was started which successfully prevented further psychotic relapses for the next ten years. His myasthenia gravis started with bulbar signs in 1997 and the symptoms soon became generalized. The diagnosis of myasthenia gravis was confirmed by electromyography, by positive anticholinesterase test and by the detection of anti-acetylcholine receptor antibodies in the serum. Mediastinal CT examination showed enlarged hilar lymph nodes on the left but no thymic pathology was observed. mediastinoscopy was performed and biopsies were obtained from the affected nodes. histology revealed sarcoidosis. The patient suffered respiratory crisis following the thoracic intervention (in September 1998). Combined oral corticosteroid (64 mg methylprednisolone/e.o.d.) and azathioprine (150 mg/day) treatment regimen was initiated and complete remission took place in both the myasthenic symptoms and the sarcoidosis. The follow-up CT scans showed no mediastinal pathology (January 2000). During steroid treatment a transient psychotic relapse occurred which was successfully managed by supplemental haloperidol medication added to his regular depot neuroleptics. The patient currently takes 150 mg/day azathioprine and receives 40 mg/month flupentixol depot i.m. His physical and mental status are stable and he has been completely symptom free in the last 24 months. The association of myasthenia gravis and sarcoidosis is very rare. To our best knowledge no case has been reported of a patient suffering from myasthenia gravis, sarcoidosis, and schizophrenia at the same time.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/9. An unusual localization of thymoma.A 41-year-old man with myasthenia gravis was referred to our clinic to undergo a thymectomy by video-assisted thoracic surgery. After physical examination of the thorax and evaluation by computed tomography, a mass lesion was noticed in the neck and thymectomy was performed by partial sternotomy combined with a cervical incision. The cervical thymoma was discontinuous with the thymus. thymoma in the neck has rarely been reported. In this case report we emphasize the possible presence of thymoma in the neck and the importance of neck evaluation in patients with myasthenia gravis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/9. Neuromuscular disorders in clinical practice: case studies.Neuromuscular disorders represent a large group of highly varied and interesting clinical disorders, many of which have major general medical manifestations. These disorders can be diagnosed largely based on the patient's history and physical examination with a little help from modern technology. Despite the outdated belief that neurologic conditions are diagnosed but rarely treatable, all cases discussed herein represent disorders for which there are extensive options and opportunities for meaningful management. These 16 brief case overviews challenge and refresh diagnostic skills and provide the framework for selected comments regarding management options.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/9. A false-positive edrophonium test in a patient with a brainstem glioma.We report a photographically documented false-positive edrophonium test in a patient with a histologically verified brainstem glioma. While a positive response to intravenous edrophonium should usually be regarded as confirmatory for myasthenia gravis, the possibility of a false-positive test must be considered in patients with atypical physical findings.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/9. diagnosis of misdiagnosis: on some of the origins and functions of psychophysical misdiagnosis.Four cases of Peripheral Neurological Disorders (PND) are reviewed as models of misdiagnosis. Weaknesses in the logical process of diagnosis formation, combined with the dismissive function of the diagnosis, may lead to psychiatric misdiagnoses such as hysteria. The same logical and emotional factors can prevent correction of misdiagnosis and thus the misery of the patient may continue. Comments are made about the dangers of misusing the diagnosis of hysteria.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
6/9. teratogens associated with congenital contractures in humans and in animals.An evaluation of over 350 patients in a study of congenital contractures of the joints (arthrogryposis) included a review of family, pregnancy, and delivery histories for teratogenic exposures. Fifteen out of the total 350 patients studied had a possible teratogenic exposure: an infectious agent (viral or bacterial), maternal drug or toxin ingestion, chronic maternal neurologic or muscular illness, or a direct physical insult such as a structural uterine anomaly. literature was reviewed for all human and animal cases reported with congenital contractures of the joints with an associated teratogenic insult. Those findings are discussed here.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/9. Multivariate determinants of the need for postoperative ventilation in myasthenia gravis.PURPOSE: Following transsternal thymectomy, up to 50% of patients may require postoperative ventilation. The aim of this study was to identify the variables most useful in predicting the myasthenic patient who needs postoperative mechanical ventilation. methods: We applied multivariate discriminant analysis to preoperative physical, historical, laboratory and intraoperative data of 51 myasthenic patients who underwent transcervical-transsternal thymectomy to select those variables most useful in predicting the postoperative need for mechanical ventilation. The receiver operating characteristic (ROC) curve was also used to describe the discrimination abilities and to explore the trade-offs between sensitivity and specificity of the model. RESULTS: discriminant analysis identified seven risk factors that correlated with the need for postoperative ventilation: FVC, FEF25-75%, MEF50% and their percentages of the predicted values, as well as, sex. The model correctly predicted the actual ventilatory outcome in 88.2% of patients. The area under the roc curve verified that our model correctly predicted the actual ventilatory outcome with a probability of 88.2%. CONCLUSIONS: This model can be used for predicting the need for postoperative mechanical ventilation in myasthenia gravis patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/9. multiple sclerosis and myasthenia gravis. A case report with single fiber electromyography.A 34-year-old woman with long-standing multiple sclerosis had a 2-year history and physical signs of myasthenia gravis. The edrophonium chloride (Tensilon) test was positive. Repetitive stimulation of the ulnar nerve at 3 Hz did not show evidence of myasthenic response; however, a single-fiber electromyography demonstrated evidence of neuromuscular block as seen in myasthenia gravis, which was reversed to normal after intravenously administered edrophonium. The patient improved on anticholinesterase medication. It is suggested that patients with multiple sclerosis who have unusual features such as in the patient reported here should be investigated for the presence of myasthenia gravis to ensure proper treatment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/9. myasthenia gravis with alopecia totalis.myasthenia gravis was diagnosed on the basis of a positive Tensilon test in a 4-year-old male child with alopecia totalis. His scalp hair and eyebrows had began to disappear at the age of 10 months. No other physical abnormalities such as motor paralysis, were seen except for left ptosis and alopecia totalis. His serum titer of anti-acetylcholine receptor antibody was elevated. No immune system abnormalities (C3, C4, CH50, c-reactive protein, antinuclear antibody or lymphocyte function disorders) were detected. Although alopecia areata and alopecia totalis are sometimes present in adults with autoimmune diseases and myasthenia gravis, this association is rare in children. The present case represents the youngest patient with myasthenia gravis associated with alopecia totalis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |