ABSTRACT
Meningeal carcinomatosis (MC) is a malignant infiltration of the leptomeninges and subarachnoid space and can be a devastating complication of a systemic malignancy. Although often found in patients with known metastatic malignancies, MC can also be the initial manifestation of an underlying malignancy. We report four case studies where back pain, dizziness, cognitive decline, headache and headache with the cranial nerve VI palsy were the first signs of MC. In two cases, adenocarcinoma ventriculi was found, in other one, the markers of the gastrointestinal tract malignancy were highly positive but malignity was not found, and in the last one, there was a known breast carcinoma. The diagnosis of MC requires the finding of malignant cells in the cerebrospinal fluid, but sometimes several lumbar punctures are required to establish the diagnosis, and also MRI with gadolinium. Finally, we would like to highlight the fact that markedly decreased glycorrhachia in cerebrospinal fluid (CSF) can also be the first sign of MC (Fig. 6, Tab. 2, Ref. 23).
Subject(s)
Meningeal Carcinomatosis/secondary , Adult , Female , Humans , Meningeal Carcinomatosis/diagnosis , Meningeal Carcinomatosis/pathology , Middle AgedABSTRACT
BACKGROUND AND PURPOSE: Fatigue is frequent and important in the lives of Parkinson's disease (PD) patients. It is multidimensional, with physical and mental aspects. The aim of our study was to explore the impact of fatigue on quality of life (QoL) for PD patients. METHODS: The sample consisted of 175 PD patients from Eastern Slovakia (52% males, mean age 68.2 +/- 9.2, mean disease duration 7.4 +/- 6.7). The Multidimensional Fatigue Inventory (five dimensions), the Parkinson's Disease Quality of Life Questionnaire (eight dimensions) and the Unified Parkinson's Disease Rating Scale were used. Demographic data were obtained in a structured interview. Fisher's exact test, t-test, and multiple linear regression analysis were used. RESULTS: Different aspects of fatigue selectively explained different domains of QoL - physical dimensions of fatigue were connected with Mobility and Activities of daily living; mental fatigue dimensions affected Cognition, Emotional well-being, Communication and Activities of daily living; general fatigue was related to Bodily discomfort. The explained variances varied from 5% (Social support) to 65% (Activities of daily living). CONCLUSION: Fatigue combined with worse functional status appears to be a significant contributor to poor quality of life. Its multidimensional construct can be used to develop strategies for improving specific aspects of fatigue to improve QoL for PD patients.
Subject(s)
Fatigue/etiology , Fatigue/psychology , Parkinson Disease/complications , Parkinson Disease/psychology , Quality of Life , Aged , Female , Humans , Linear Models , Male , Middle Aged , Retrospective Studies , Sickness Impact Profile , Surveys and QuestionnairesABSTRACT
OBJECTIVES: The current review evaluates the safety and efficacy of desmopressin in patients with multiple sclerosis (MS) who suffer from both daytime and nocturnal voiding frequency and from incontinence. MATERIALS AND METHODS: A literature search was carried out looking for studies published between 1990 and 2003 which evaluated desmopressin in MS patients with bladder dysfunction. RESULTS: The grand total mean effect sizes show the following estimates of clinical relevant differences: desmopressin has a moderate effect on the number of voids during the day or during the night over a period of 6 h after taking the drug. A large effect associated with the use of desmopressin was detected by the mean difference in urine volume (ml) in 6 h. A small effect was detected in the mean 24-h urine volume. Serum sodium levels were combined with plasma osmolality in some studies and were found to be not significantly affected by desmopressin treatment.