73 research outputs found
Technical performance and diagnostic utility of the new Elecsys (R) neuron-specific enolase enzyme immunoassay
No full textThis international multicenter study was designed to evaluate the technical performance of the new double-monoclonal, single-step Elecsys neuron-specific enolase (NSE) enzyme immunoassay (EIA) and to assess its utility as a sensitive and specific test for the diagnosis of small-cell lung cancer (SCLC). Intra and interassay coefficients of variation, determined in five control or serum specimens in six laboratories, ranged from 0.7 to 5.3 (interlaboratory median: 1.3%) and from 1.3 to 8.5 (interlaboratory median: 3.4%), respectively. Laboratory-to-laboratory comparability was excellent with respect to recovery and interassay coefficients of variation. The test was linear between 0.0 and 320 ng/ml (highest measured concentration). There was a significant correlation between NSE concentrations measured using the Elecsys NSE and the established Cobas Core NSE EIA II in all subjects (n=723) and in patients with lung cancer (n=333). However, NSE concentrations were systematically lower (approximately 9%) with the Elecsys NSE than with the comparison test. Based on a specificity of 95% in comparison with the group suffering from benign lung diseases (n=183), the cutoff value for the discrimination between malignant and benign conditions was set at 21.6 ng/ml. NSE was raised in 73.4% of SCLC patients (n=188) and was significantly higher (p<0.01) in extensive (87.8%) as opposed to limited disease (56.7%). NSE was also elevated in 16.0% of the cases with non-small cell lung cancer (NSCLC, n=374). It is concluded that the Elecsys NSE EIA is a reliable and accurate diagnostic procedure for the measurement of NSE in serum samples. The special merits of this new assay are the wide measuring range (according to manufacturers declaration up to 370 ng/ml) and a short incubation time of 18 min
Francisco Núñez Muley, Memorial (Granada, 1566)
No full textNúñez-Muley abstract
The Edict of 1567, or Anti-Morisco Edict, was promulgated by Spanish King Philip II on January 1, after being approved in Madrid on November 17, 1566. Its purpose was to eliminate specific Morisco customs, such as their language, dress, and dances. Núñez Muley’s Petition is an attempt to persuade Christian authorities to delay enforcing the 1567 Edict. The author lists each of the prohibitions and refutes their effectiveness. He compares Morisco customs to those of other Christian and Muslim communities in the Mediterranean and argues that the prohibitions will not eradicate any putative Islamic practices but instead erase Morisco cultural identity. Moriscos, he claims, are sincere Christians and loyal subjects who support the king’s decisions.
This unit contains a Spanish-language introduction and notes by Lisette Balabarca Fataccioli, and the original Spanish text, followed by a short bibliography of suggested readings
Carpal tunnel syndrome with equivocal electrophysiological findings: Additional testing may improve diagnostic sensitivity
No full textChronic inflammatory demyelinating polyradiculoneuropathy and multifocal motor neuropathy
No full textDiabetic and non-diabetic lumbosacral radiculoplexus neuropathy
No full textBackground: Lumbosacral radiculoplexus neuropathy (LRPN) originally described in diabetic patients is a distinct clinical condition characterized by debilitating pain, weakness and atrophy most commonly affecting the proximal thigh muscles asymmetrically. The syndrome is usually monophasic and preceded by significant weight loss (at least more than 10 lbs). Though a self-limited condition, recovery is gradual with some residual weakness. Recent advances and research has provided new insights in the pathogenesis and thereby management of this syndrome. In this paper, we review the clinical and diagnostic features as well as discuss recent insights and treatment strategies along with our experience in the management of patients with diabetic and non-diabetic LRPN. Materials and Methods: Literature in English published between 1953 and 2008 was searched in the MEDLINE and Pubmed database, maintained by the US National library of medicine and National institutes of health, using key words of diabetic amyotrophy, lumbosacral radiculoplexus neuropathy, diabetic proximal neuropathy, diabetic radiculopathy and diabetic lumbosacral plexopathy. In addition, literature reported in various textbooks on peripheral neuropathy was reviewed as well. Observation: The diagnosis relies mostly on clinical suspicion and characteristic electromyographic findings. The exact pathogenesis of the illness remains unknown, but there seems to be a component of immune-mediated inflammatory microvasculitis which causes secondary ischemia of the lumbosacral plexus. This has prompted a trial of immunosuppressive agents (like steroids) with an attempt to alter the course of the illness. A few reports have noted that immunosuppression when instituted early in the course of the illness (within three months of symptom onset) may hasten the recovery and improve symptoms. Conclusion: Though the exact mechanism of LRPN in diabetic and non-diabetic patients remains unknown, new evidence alludes to an underlying inflammatory vasculitic process. Early treatment with immunosuppressants may be beneficial in some cases, although the data available at this time is limited to a small cohort of patients. The decision is individualized weighing the risks and benefits in a given patient. Future research in this direction with double-blinded case-controlled studies is required to investigate this further
Treatment of chronic inflammatory demyelinating polyneuropathy with pulsed oral steroids
No full textBackground: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated neuropathy that responds to various immunosuppressive treatments. Oral daily prednisone therapy is effective and inexpensive, but the long-term treatment that is usually necessary leads to serious adverse effects. Consequently, intravenous immunoglobulin and plasma exchange have been widely used to treat CIDP, making treatment expensive and inconvenient. A steroid regimen that reduces adverse effects but preserves efficacy would simplify treatment. Pulsed steroids have nongenomic actions not seen with low-dose steroids, including rapid inhibition of arachidonic acid release and of calcium and sodium cycling across plasma membranes of immune cells. Objective: To study the efficacy, safety, and tolerability of pulsed oral methylprednisolone therapy in patients with CIDP. Design: Open-label prospective study. Setting: University of Minnesota Neuropathy Center, Minneapolis. Patients: Ten patients (3 women and 7 men) with CIDP followed up for at least 22 months. Main Outcome Measures: Neuromuscular score and Inflammatory Neuropathy Cause and Treatment (INCAT) disability score were used as outcome measures for efficacy; weight, blood pressure, changes in bone density, and steroid-related adverse effect questionnaire were used as outcome measures for safety. Results: This steroid regimen leads to significant improvement in weakness and disability in all patients treated and to off-treatment remission in 60% of patients. Treatment was fairly well tolerated, and only 1 patient discontinued treatment because of adverse effects. Steroid-induced osteoporosis remained a problem, especially in older patients. Conclusions: Pulsed oral methylprednisolone may be efficacious in the long-term treatment of CIDP and is relatively well tolerated. Remission can be induced in most patients, especially those with a shorter duration of disease. ©2008 American Medical Association. All rights reserved
Inflammatory demyelinating neuropathies
No full textEarly and effective treatment of chronic inflammatory demyelinating polyneuropathy (CIDP) is important to minimize axonal degeneration that occurs secondary to demyelination. The disease course is invariably chronic, so long-term treatment is often required, and adverse effects and costs are important considerations in devising a treatment plan. CIDP responds to prednisone, but long-term treatment can result in significant adverse effects. Azathioprine, mycophenolate mofetil, and cyclosporine can be used as steroid-sparing agents and may facilitate more rapid and successful tapering of prednisone. Intravenous immunoglobulin (IVIg) and plasma exchange are also effective in the treatment of CIDP and can be used in patients who are unresponsive to prednisone or develop steroid-related adverse effects. IVIg may also be used as a first-line treatment, but its cost can be a limiting factor. A few uncontrolled studies have suggested that pulsed weekly methylprednisolone is both effective and well tolerated in the long-term treatment of CIDP. Treatments based on rituximab or cyclophosphamide have also been used in resistant disease. Variants of CIDP have been described on the basis of their association with specific antibodies or immunoglobulins and their response to specific immunomodulatory treatments. Multifocal motor neuropathy with conduction block responds to IVIg in the majority of patients. However, weakness may slowly worsen over time, and some patients become unresponsive. Anecdotal reports suggest that rituximab may be useful in patients who develop progressive disease. Placebo-controlled trials in anti-myelin-associated glycoprotein neuropathy suggest that rituximab is effective and, with a combination of prednisone and cyclophosphamide, numbness and strength may improve. Other treatments that may be effective include plasma exchange and IVIg. Treatment is generally started with prednisone, IVIg, or plasma exchange. Rituximab and cyclophosphamide are used only in progressive, treatment-resistant disease because of the potential for serious adverse effects. © Current Medicine Group, LLC 2009
Diabetic and non-diabetic lumbosacral radiculoplexus neuropathy
No full textBackground: Lumbosacral radiculoplexus neuropathy (LRPN) originally
described in diabetic patients is a distinct clinical condition
characterized by debilitating pain, weakness and atrophy most commonly
affecting the proximal thigh muscles asymmetrically. The syndrome is
usually monophasic and preceded by significant weight loss (at least
more than 10 lbs). Though a self-limited condition, recovery is gradual
with some residual weakness. Recent advances and research has provided
new insights in the pathogenesis and thereby management of this
syndrome. In this paper, we review the clinical and diagnostic features
as well as discuss recent insights and treatment strategies along with
our experience in the management of patients with diabetic and
non-diabetic LRPN. Materials and Methods: Literature in English
published between 1953 and 2008 was searched in the MEDLINE and Pubmed
database, maintained by the US National library of medicine and
National institutes of health, using key words of diabetic amyotrophy,
lumbosacral radiculoplexus neuropathy, diabetic proximal neuropathy,
diabetic radiculopathy and diabetic lumbosacral plexopathy. In
addition, literature reported in various textbooks on peripheral
neuropathy was reviewed as well. Observation: The diagnosis relies
mostly on clinical suspicion and characteristic electromyographic
findings. The exact pathogenesis of the illness remains unknown, but
there seems to be a component of immune-mediated inflammatory
microvasculitis which causes secondary ischemia of the lumbosacral
plexus. This has prompted a trial of immunosuppressive agents (like
steroids) with an attempt to alter the course of the illness. A few
reports have noted that immunosuppression when instituted early in the
course of the illness (within three months of symptom onset) may hasten
the recovery and improve symptoms. Conclusion: Though the exact
mechanism of LRPN in diabetic and non-diabetic patients remains
unknown, new evidence alludes to an underlying inflammatory vasculitic
process. Early treatment with immunosuppressants may be beneficial in
some cases, although the data available at this time is limited to a
small cohort of patients. The decision is individualized weighing the
risks and benefits in a given patient. Future research in this
direction with double-blinded case-controlled studies is required to
investigate this further
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