Trends of bisphenol A occurrence in canned food products from 2008-2020.

It is known that the industry already abandoned the use of bisphenol A (BPA)-based epoxy resins as internal coatings for some canned food products (e.g. infant formula, soups). The presence of bisphenol A (BPA) in foods has also been extensively investigated, especially since late 2000. However, information on temporal trends of BPA occurrence in foods is very limited. It is not clear if BPA-based epoxy resins are still being used in internal coating for many other canned foods and if the overall exposure to BPA through consumption of canned foods has significantly decreased. As part of the Canadian total diet study (TDS) program, we have been analysing food samples for BPA since 2008. In this study, results of BPA in samples of different composite canned foods from 2008-2020 TDS were reported. Clear temporal trends were observed for canned fish and soups, with BPA levels being significantly reduced since 2014 for canned fish products and 2017 for canned soups. Temporal trends were not observed for canned evaporated milk, luncheon meats, and vegetables, with even the highest levels of BPA being detected in recent samples for evaporated milk (57 ng/g), luncheon meats (56 ng/g), and baked beans (103 ng/g). This seems to indicate that BPA-based epoxy resins are still being used in the internal coatings for these canned foods products. Thus, analysis of canned food samples for BPA should be continued for exposure assessment.

New Insights into the Fouling of a Membrane during the Ultrafiltration of Complex Organic-Inorganic Feed Water.

This paper presents an analysis of the fouling of a ceramic membrane by a mixture containing high concentrations of humic acid and colloidal silica during cross-flow ultrafiltration under various operating conditions. Two types of feed water were tested: feed water containing humic acid and feed water containing a mixture of humic acid and colloidal silica. The colloidal silica exacerbated the fouling, yielding lower fluxes (109-394 L m-2 h-1) compared to the humic acid feed water (205-850 L m-2 h-1), while the retentions were higher except for the highest cross-flow rate. For the humic acid feed water, the irreversible resistance prevails under the cross-flow rate of 5 L min-1. During the filtration of an organic-inorganic mixture, the reversible resistance due to the formation of a colloidal cake layer prevails under all operating conditions with an exception. The exception is the filtration of the organic-inorganic mixture of a 50 mg L-1 humic acid concentration which resulted in a lower flux than the one of a 150 mg L-1 humic acid concentration under 150 kPa and a cross-flow rate of 5 L min-1. Here, the irreversible fouling is unexpectedly overcome. This is unusual and occurs due to the low agglomeration at low concentrations of humic acid under a high cross-flow rate. Under lower transmembrane pressure and a moderate cross-flow rate, fouling can be mitigated, and relatively high fluxes are yielded with high retentions even in the presence of nanoparticles. In this way, colloidal silica influences the minimization of membrane fouling by organic humic acid contributing to the control of in-pore organic fouling.

Temporal trend of bisphenol S occurrence in meat samples from 2008-2020 Canadian total diet study.

In our previous study, bisphenol S (BPS) was detected unexpectedly and at high levels in meat samples from 2016 and 2020 Canadian total diet study (TDS). In this study, samples of meat and meat products from 2008-2015 and 2017-2019 TDS were also analysed to investigate the consistency of BPS occurrence in meat and identify possible trends and provide some information on the potential sources for BPS in meat. BPS was detected again with the highest levels observed in samples of fresh pork (105 ng/g) and veal cutlets (140 ng/g) from the 2008 TDS. This indicates that the occurrence of BPS in meat is not a recent phenomenon but rather an existing one since 2008 or even earlier. BPS concentrations in meat samples from the 2008 to 2020 TDS varied significantly, e.g. 1.2-118 ng/g in roast beef, 1.8-140 ng/g in veal cutlets, but no trend was observed. The lack of trend for BPS over the period of 13 years (2008-2020) does not support the speculation that BPS is being used to replace BPA in food packaging, and sources other than food packaging may be possible and should be investigated for BPS.

Bisphenol S in individual and composite meat and meat products and implication for its sources.

In this study, the occurrence of bisphenol S (BPS) in the meat and meat products from a recent Canadian Total Diet Study (TDS) was investigated in more detail. In addition to their composite samples, the individual raw meat and meat products were also analysed for BPS to investigate the variations of BPS levels and provide some information on the potential sources for BPS in meat. BPS was detected in all the 11 composite samples of different meat and meat products, with the highest level in roast beef (118.23 ng/g) and lowest in cured pork (0.14 ng/g) and cold cuts luncheon meats (0.18 ng/g). BPS was also detected in all the 84 individual raw meat and meat products, with the highest level of 257.61 ng/g in roast beef, followed by 190.41 ng/g in organ meats, 110.15 ng/g in beef steak, 27.91 ng/g in veal cutlets, 17.63 ng/g in wieners & sausages, and 15.27 ng/g in ground beef. However, significant variations of BPS levels were observed in the individual meat and meat product samples under the same category collected from different stores. This may indicate that packaging is unlikely the sources for BPS in meat otherwise BPS levels would have been more or less the same with the same type of packaging (Styrofoam and cling film) regardless where they were collected. Thus, sources other than food packaging, such as the contaminated feed and farming environment (e.g. grass) for animals (e.g. cow), may be possible and should be investigated in future studies.

Teaching Initiated Question Asking to Children with Autism Spectrum Disorder Through a Short-Term Parent-Mediated Program.

This study investigated whether a brief parent-mediated intervention would increase the frequency of question asking in children with ASD. Mothers participated in a 3-week training consisting of 2-h sessions twice weekly. Data were collected in the context of concurrent multiple baseline design. Results demonstrate all three children increased frequency of question asking with two children maintaining gains. All three children demonstrated generalization of question asking to novel items, family members, and/or settings. Affect improved for two of the three children. Overall, mothers were able to reach Fidelity of Implementation during most sessions and rated the intervention as highly acceptable. Results are discussed in regard to the feasibility of providing a short-term parent-implemented intervention to increase social initiations through question asking.

LC-MS/MS analysis of bisphenol S and five other bisphenols in total diet food samples.

It is already known that bisphenol S (BPS) has been used as a substitute for BPA in thermal papers in recent years. It is not clear, however, if BPS has also been used to replace BPA in can coatings as currently being speculated due to a lack of credible studies on migration of BPS from can coatings and occurrence data of BPS in foods. In this study, an LC-MS/MS method was developed for the analysis of BPS, along with several other bisphenols, and method detection limits for BPS varied from 0.0017 to 3.1 ng/g depending on the type of sample matrix and the amount of sample analysed. This method was used to analyse 159 different food composite samples from a recent Canadian total diet study. Bisphenol E (BPE), bisphenol B (BPB), and bisphenol AF (BPAF) were not detected in any of the 159 food composite samples, bisphenol F (BPF) was detected in only three samples (25-2360 ng/g), and bisphenol A (BPA) was detected in 10 samples (5.3-41 ng/g) which were all prepared from canned foods. BPS was not detected in any of the canned food composite samples but was detected in nine food composite samples prepared from meat and meat products (1.2-35 ng/g), indicating sources for BPS other than can coatings may be possible, which will be investigated in future studies.

Solid phase extraction of large volume of water and beverage samples to improve detection limits for GC-MS analysis of bisphenol A and four other bisphenols.

Solid phase extraction (SPE) of large volumes of water and beverage products was investigated for the GC-MS analysis of bisphenol A (BPA), bisphenol AF (BPAF), bisphenol F (BPF), bisphenol E (BPE), and bisphenol B (BPB). While absolute recoveries of the method were improved for water and some beverage products (e.g. diet cola, iced tea), breakthrough may also have occurred during SPE of 200 mL of other beverages (e.g. BPF in cola). Improvements in method detection limits were observed with the analysis of large sample volumes for all bisphenols at ppt (pg/g) to sub-ppt levels. This improvement was found to be proportional to sample volumes for water and beverage products with less interferences and noise levels around the analytes. Matrix effects and interferences were observed during SPE of larger volumes (100 and 200 mL) of the beverage products, and affected the accurate analysis of BPF. This improved method was used to analyse bisphenols in various beverage samples, and only BPA was detected, with levels ranging from 0.022 to 0.030 ng/g for products in PET bottles, and 0.085 to 0.32 ng/g for products in cans.

Levels and temporal trend of bisphenol A in composite food samples from Canadian Total Diet Study 2008-2012.

Food composite samples from the Canadian Total Diet Study which was conducted each year from 2008 to 2012 rotating between different cities were analysed for bisphenol A (BPA). The overall levels of BPA in the composite food samples from each of the five years from 2008 to 2012 were similar in general with averages (range) of 7.7 ng/g (0.20-106 ng/g), 7.8 ng/g (0.26-110 ng/g), 6.9 ng/g (0.20-84 ng/g), 7.7 ng/g (0.20-105 ng/g) and 9.0 ng/g (0.15-90 ng/g) for 2008, 2009, 2010, 2011 and 2012, respectively. Levels of BPA in most of the non-canned food composite samples were low and no particular trends were observed. In contrast, the trend of BPA levels in canned food composite samples over the five years (2008-2012) varies. BPA levels in most of the canned food composite samples from 2008 to 2012 were consistent in general (e.g. canned luncheon meat: 10-18 ng/g, canned baked beans: 18-25 ng/g). While BPA levels over the five years were found to decrease for some canned food composite samples (e.g., canned fish: 109 ng/g in 2009 vs. 51 ng/g in 2012), they were also found to increase for some other canned food composite samples (e.g. canned meat soups: 90-104 ng/g in 2011-2012 vs. 29 ng/g in 2008). Thus, recent changes in can coating for food packaging to BPA-free alternatives may have not been fully reflected in all canned food products over the period from 2008 to 2012. Continued monitoring is necessary to more fully assess the potential impact on dietary exposure by the use of BPA alternatives in food contact materials.

Bisphenol A and Three Other Bisphenol Analogues in Canned Fish Products from the Canadian Market 2014.

A sensitive and selective gas chromatography-mass spectrometry method was developed and validated for simultaneous analysis of bisphenol A (BPA) and three other bisphenols, bisphenol B (BPB), bisphenol E (BPE), and bisphenol F (BPF). This method was used to analyze samples of 52 canned fish products to follow up a previous study conducted 5 years ago to investigate any changes in BPA levels since then and levels of other bisphenols due to possible changes in can coating formulations. BPB and BPE were not detected in any of the 52 canned fish products, and BPF was detected in only four products at low levels from 1.8 to 5.7 ng/g, indicating that BPA is likely still the dominant bisphenol used in current can coating formulations. BPA was detected in all 52 canned fish products, but at much lower levels compared with a previous study; levels ranged from 0.96 to 265 ng/g (average, 28 ng/g). The few products with high BPA levels (>100 ng/g) are exclusively from a new brand that has become available on the market only recently. Further analysis of canned fish products is planned in the future to capture any changes in BPA levels in these products and to update the exposure assessment of BPA due to consumption of canned fish products.

Determination of free and total bisphenol A in human milk samples from Canadian women using a sensitive and selective GC-MS method.

A sensitive and selective GC-MS method was developed and used to analyse human milk samples for both free and total bisphenol A (BPA). Total BPA was detected in 72 of the 278 human milk samples (25.9%) at concentrations from < 0.036 to 2.5 ng g(-1) with a geometric mean (GM) of 0.13 ng g(-1) and median of 0.11 ng g(-1), while free BPA was detected in fewer samples, 46 of the 278 samples (16.5%) at concentrations ranging from < 0.036 to 2.3 ng g(-1) with a GM of 0.11 ng g(-1) and median of 0.10 ng g(-1). Ratios of [free BPA]/[total BPA] for the positive samples ranged from 7.9% to 100% with a GM of 57.2% and median of 70.3%. Concentrations of free and total BPA in most samples were low with 0.39 and 0.65 ng g(-1) at the 95th percentile for free and total BPA, respectively, and they are also lower than those reported in other countries. Based on the low frequency of detection of free BPA in human milk samples, in general, dietary exposure to BPA for Canadian breast-fed infants is expected to be somewhat lower compared with exposure among formula-fed infants.

Headspace solid-phase microextraction with gas chromatography-mass spectrometry determination of naphthalene in the composite food samples from the 2011 Canadian total diet study in Ottawa.

A method based on isotope dilution headspace solid-phase microextraction, followed by gas chromatography and mass spectrometry, was developed for the determination of naphthalene in foods. Optimum method sensitivity was achieved by the addition of NaCl in water at saturation and with the sample solution incubated at 30°C for 15 min. The method had good repeatability, with relative standard deviations of 3.5 and 1.5% at 5 and 30 ng/ml, respectively. This method was used to determine naphthalene in 159 food composite samples collected from the 2011 Canadian Total Diet Study. Naphthalene was detected in 93 (58.9%) food composite samples, mostly in products of meat and cereal, fast food, and miscellaneous foods. Among the 93 samples, only 51 (54.8%) samples were found to contain naphthalene at levels above 1 ng/g, with a maximum of 35 ng/g found in the herbs and spices composite sample. Method detection limits, estimated for each one of the food composite samples by using the lower-abundance ionm/z 127, varied considerably because of the matrix effect, ranging from as low as 0.0022 ng/g for water to as high as 16 ng/g for fatty sample, with an average of 1.6 ng/g.

Clinical manifestations, therapy and outcome of pandemic influenza A (H1N1) 2009 in hospitalized patients.

BACKGROUND/AIM: Increasing number of epidemiological and clinical studies to date showed that the pandemic influenza A (H1N1) 2009, by its characteristics, significantly differs from infection caused by seasonal influenza. Therefore, the information about clinical spectrum of manifestations, risk factors for severe form of the disease, treatment and outcome in patients with novel flu are still collected. METHODS; A total of 98 patients (mean age 32 +/- 15 years, range 14-88 years) with the signs and symptoms of novel influenza were treated in the Clinic for Infectious and Tropical Diseases, Military Medical Academy. There were 74 (75.5%) patients with suspected influenza A (H1N1) 2009, 10 (10.2%) with the likelihood and 14 (14.3%) with the confirmed influenza. In all the patients we registered the basic demographic data, risk factors for severe disease, symptoms and signs of influenza, laboratory tests and chest radiography. We analyzed antiviral therapy use and disease outcome (survived, died). RESULTS: The average time from the beginning of influenza A (H1N1) to the admission in hospital was 3 days (0-16 days) and from the moment of hospitalization to the Intensive Care Unit (ICU) admission was 2 days (0-5 days). There were 49 (50.0) patients, 20-29 years of age and 5 (5.1) patients older than 65. A total of 21 (21.4%) patients were with underlying disease, 18 (18.4%) were obese, 19 (19.4) were cigarette smokers. All of the patients had fever, 81 (82.6%) cough, while dyspnea and diarrhea were registered in 4 of the patients. In more than 75% of the patients laboratory tests were within normal limits. The real-time polymerase chain reaction (PCR) test for identification of influenza A (H1N1) 2009 was positive in 14 (77.8%), while pneumonia was verified in 30 (30.7%) of the patients. Six (6.1%) patients, mean age of 45 +/- 14 years (31-59 years) were admitted to the ICU, of whom five (5.1%) had Adult Respiratory Distress Syndrome (ARDS). Risk factors were registered more frequently in the patients with acute respiratory failure (14.2% vs 4.9%, p < 0.05). A total of 67 (68.4%) patients received oseltamivir, 89 (90.1%) was applied to antibiotics and 64 (65.3%) were treated with a combined therapy. Antiviral therapy was applied to 43 (43.3%) patients in the first 48 hours from the onset of the disease, of whom only one (3.4) developed ARDS. Fatal outcome was noted in 2.0% of the patients (2 of 98 patients) and in 33.3% of the patients treated in the ICU. CONCLUSION: Novel influenza A (H1N1) is most commonly manifested as a mild acute respiratory disease, which usually affects young healthy adults. A small number of the patients develop severe illness with acute respiratory failure and death. Patients seem to have benefit from antiviral therapy especially in first 48 hours.

Effect of cooking on concentrations of ß-estradiol and metabolites in model matrices and beef.

Because beef food products are generally cooked prior to consumption, the behavior of chemicals in these cooked foods is important in estimating human exposure. The heat stability of the natural estrogen ß-estradiol (ß-E2) and its metabolites α-estradiol (α-E2), estrone (E1), and several catechol estrogens was examined in heated vegetable oil and aqueous solutions. The chemicals were also incorporated into regular and extra lean ground beef and subjected to cooking. E1 and E2 were stable in aqueous solutions at 100°C, whereas the catechol estrogens exhibited first-order decay curves with half-lives of 2-10 min. Their stability improved to the same level as the other test chemicals when an antioxidant was added to the solution, suggesting that their disappearance was due to oxidation rather than thermal degradation. E1 and E2 were also stable in heated vegetable oil (160-180°C), whereas catechol estrogen decreased 30-50% over the 2 h duration of the experiments. Chemical losses from cooked beef appear to be related to the fat content of the beef, with greater losses occurring in regular ground beef (25-30%), compared to extra lean ground beef (5-20%). This study shows that cooking reduces but does not eliminate the potential for dietary exposure to growth promoters in ground beef.

Sources of low concentrations of bisphenol A in canned beverage products.

Although migration from can coatings is likely the source of bisphenol A (BPA) for the canned soft drink products with relatively high BPA concentrations, questions have been raised concerning the exact sources of BPA for those canned soft drink products with low BPA concentrations. Information is also needed for BPA concentrations in canned beer products to conduct proper exposure assessment for BPA under the Government of Canada's Chemicals Management Plan. In this work, 22 soft drink samples and 16 beer samples in both cans and plastic and/or glass bottles were analyzed for BPA. BPA was not detected in any of the soft drink samples in either plastic or glass bottles except for one product with a BPA concentration (0.018 microg/liter) close to the limit of quantification (0.015 microg/liter). BPA was detected in all of the corresponding soft drink products in cans, indicating that migration from can coatings is the likely source for BPA in canned products. Because considerable interference with ions m/z 213 and m/z 228 from sample matrices was observed for all beer samples, BPA concentrations in beer samples were measured using the ion m/z 270 instead. BPA was detected in only one of the seven beer products in glass bottles (0.054 microg/liter) but was detected in all corresponding beer samples in cans at low concentrations ranging from 0.081 to 0.54 microg/liter, indicating that migration from can coatings is likely the source of BPA in canned beer products.

Background bisphenol A in experimental materials and its implication to low-dose in vitro study.

In vitro low-dose studies are important to understand the mechanisms of bisphenol A (BPA) action. BPA doses used in current in vitro studies varied considerably, and doses as low as 10(-15)M have been reported. The actual doses of BPA used in the in vitro low-dose studies were rarely checked analytically, and the background BPA levels in experimental materials, which will determine the lowest BPA dose to be used, should be investigated or considered. In this study, the background BPA levels in various materials typically used in in vitro low-dose studies for BPA were investigated. Background BPA levels from the use of disposable pipettes and pipette tips were low (<0.20 ng mL(-1) or 0.88 nM). BPA was also detected in several commercial buffer solutions at levels close to the method limit of quantification (LOQ) (0.02 ng mL(-1); 0.088 nM). However, BPA was detected in all cell culture media obtained from various sources at levels ranging from 0.080 to 4.26 ng mL(-1) (or 0.35 to 19 nM) with an average of 0.83 ng mL(-1) (3.5 nM). We suggest that culture media used for low-dose BPA studies should be analysed for background BPA levels prior to use, and the medium with the lowest BPA levels should be used.

Bisphenol a in canned food products from canadian markets.

A method based on solid phase extraction followed by derivatization and gas chromatography-mass spectrometry analysis was validated for the determination of bisphenol A (BPA) in canned food products. This method was used to analyze 78 canned food products for BPA. Concentrations of BPA in canned food products differed considerably among food types, but all were below the specific migration limit of 0.6 mg/kg set by the European Commission Directive for BPA in food or food simulants. Canned tuna products had the highest BPA concentrations in general, with mean and maximum values of 137 and 534 ng/g, respectively. BPA concentrations in the condensed soup products were considerably higher than those in the ready-to-serve soup products, with mean and maximum values of 105 and 189 ng/g, respectively, for the condensed soups and 15 and 34 ng/g, respectively, for the ready-to-serve soups. BPA concentrations in canned vegetable products were relatively low; about 60% of the products had BPA concentrations of less than 10 ng/g. Canned tomato paste products had lower BPA concentrations than did canned pure tomato products. The mean and maximum BPA concentrations were 1.1 and 2.1 ng/g, respectively, for tomato paste products and 9.3 and 23 ng/g, respectively, for the pure tomato products.

Migration of bisphenol A from can coatings to liquid infant formula during storage at room temperature.

Information on migration of bisphenol A (BPA) from can coatings to foods during storage at room temperature is very limited, and the conclusions from the available studies are not always consistent. To investigate the effect of storage time on BPA migration from can coatings to liquid infant formula at room temperature, samples of 21 canned liquid infant formula products from different cans but the same lot as those analyzed for BPA previously were analyzed for BPA again after storage at room temperature for 10 months. Additional migration of BPA from can coatings to liquid formula during the 10-month storage period at room temperature was observed for 9 of the 21 products, with increases in BPA levels ranging from 29.8 to 110%. Significant differences between the 2007 and 2008 results (P = 0.026) were observed for only one brand of product, which had the lowest BPA levels in the 2007 survey. The BPA levels in the milk-based formula products analyzed in 2008 (mean, 6.8 ng/g) were significantly higher (P = 0.00023) than those in the milk-based formula products analyzed in 2007 (mean, 5.0 ng/g), whereas the differences in BPA levels between the soya-based formula products analyzed in 2008 (mean, 5.3 ng/g) and those analyzed in 2007 (mean, 5.8 ng/g) were not significant (P = 0.097). No obvious correlation between the product expiration date and the level of BPA migration from can coatings was observed.

Bisphenol a in baby food products in glass jars with metal lids from Canadian markets.

A method based on solid phase extraction and derivatization with acetic anhydride followed by gas chromatography-mass spectrometry was validated for the determination of bisphenol A (BPA) in baby foods. The average method detection limit (MDL) was 0.18 ng/g for a 5 g sample. Method repeatability was demonstrated with the replicate analyses of various different types of baby foods; relative standard deviations (RSD) ranged from 1.2 to 16.1% with an average of 8.7%. Extraction recoveries ranged from 93.5 to 102.5% for different types of baby foods spiked at levels of 1-8 ng/g. This method was used to analyze 122 baby food products of 7 brands in glass jars with metal lids for BPA. The presence of BPA could not be confirmed and quantified for 23 of the 122 products due to interference from sample matrices. For the other 99 products, 15% had BPA levels of less than the average MDL, about 70% had BPA levels of less than 1 ng/g, and the average BPA levels in all 99 products was 1.1 ng/g. The average BPA level in the baby food products from brand E (3.9 ng/g) is higher than the average BPA levels in the products from the other brands (0.54-1.1 ng/g). The highest level of BPA, 7.2 ng/g, was found in two products from brand E as well. The average BPA level in the fruit products from all brands (0.60 ng/g) is lower than those in the mixed-dish products (1.1 ng/g) and the vegetable products (1.2 ng/g).

Levels of bisphenol A in canned soft drink products in Canadian markets.

The method developed previously for the determination of bisphenol A (BPA) in liquid infant formula was adapted and validated for determination of BPA in soft drink products. This method was based on solid phase extraction and derivatization with acetic anhydride followed by gas chromatography-mass spectrometry in selected-ion monitoring mode. The average method detection limit was 0.045 microg/L for a 10 mL sample. The average extraction recoveries were 101 and 99.9% obtained with seven different soft drink products spiked with BPA at 0.5 and 2.5 microg/L, respectively. Good repeatability of the method was observed with replicate analyses of seven different soft drinks; relative standard deviations ranged from 1.3 to 6.6%. This method was used to analyze samples of 72 canned soft drink products for BPA. Except for three products from which BPA-d16 could not be recovered at all due to interference of product compositions (e.g., quinine hydrochloride in tonic water), BPA was detected in samples of all the other products at levels ranging from 0.032 to 4.5 microg/L. About 75% of the products had BPA levels of <0.5 microg/L, and 85% of the products had BPA levels of <1 microg/L. Exposure to BPA through consumption of canned soft drink products is low; dietary intake of BPA was estimated at 0.027 microg/kg of body weight/day on the basis of the consumption of one canned soft drink with the highest BPA level (4.5 microg/L) for an adult with a 60 kg body weight, well below the provisional tolerable daily intake of 25 microg/kg of body weight/day established by Health Canada.

[Lambert-Eaton myasthenic syndrome--a rare manifestation of paraneoplastic syndrome in ovarian cancer--case report].

INTRODUCTION: Paraneoplastic neurological syndromes are rare non-metastatic complications of cancer that have an immune-mediated etiology. The Lambert-Eaton myasthenic syndrome (LEMS) is a neuromuscular disorder, often associated with small cell lung carcinoma (SCLC), which is characterized by reduced quantal release of acetylcholine from the motor nerve terminals. LAMBERT-EATON MYASTHENIC SYNDROME: The Lambert-Eaton Myasthenic Syndrome (LEMS) is characterized by proximal muscle weakness initially affecting gait, autonomic symptoms (dry mouth, constipation, erectile failure) and augmentation of strength during initial voluntary activation. Symptomatic treatment of the junctional disorder is based on cholinergic drugs, immunosuppression, immunomodulation and physical therapy useful in case of unsuccessful antineoplastic therapy. CASE REPORT: A rare case of ovarian cancer with Eaton-Lambert syndrome is reported. A 50-year-old woman was admitted to the gynecologic department, complaining of weakness and pain in her arms and shoulders. Physical therapy resulted in partial improvement. Treatment of paraneoplastic syndrome markedly improves the quality of life of cancer patients. Patients presenting with this syndrome should undergo a careful evaluation for the presence of an occult malignancy.