RESUMO
Primary leptomeningeal gliomatosis (PLG) is a rare condition, with fewer than 50 patients reported. Our report illustrates the natural history of PLG in full, from the prodromal phase of subacute meningitis to the final stages characterised by extensive nerve root infiltration, cranial nerve palsies and widespread peripheral neurogenic muscle wasting. We provide correlative neuroimaging with serial MRI, and present the first published positron emission tomography imaging of this condition. We emphasise the importance of considering PLG in the differential diagnosis of chronic aseptic meningitis, the difficulties of making the diagnosis ante mortem, and the utility and potential limitations of early meningeal biopsy in this condition.
Assuntos
Glioma/patologia , Glioma/fisiopatologia , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/fisiopatologia , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Neoplasias Neuroepiteliomatosas/patologia , Neoplasias Neuroepiteliomatosas/fisiopatologiaRESUMO
BACKGROUND: IV lysine acetylsalicylate (aspirin) has been shown to be effective in the treatment of acute migraine attacks, but little is known about its effectiveness and safety in patients hospitalized for management of severe headache, typically arising from abrupt withdrawal of other acute attack medications. METHODS: We present an audit of our use of IV aspirin in 168 patients in a tertiary referral setting. RESULTS: The findings demonstrate subjective approval of this medication by the patients and objective improvements in pain scores, a decrease of ≥3 points on a 10-point visual analog pain scale being seen on >25% occasions on which the medication was administered. Further, side effect rates were low (5.9%), with no serious adverse events. CONCLUSION: IV aspirin is safe, effective, and useful in the inpatient management of headache.
Assuntos
Aspirina/uso terapêutico , Transtornos da Cefaleia/tratamento farmacológico , Medição da Dor/efeitos dos fármacos , Adolescente , Adulto , Idoso , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/administração & dosagem , Feminino , Transtornos da Cefaleia/induzido quimicamente , Humanos , Infusões Intravenosas , Pacientes Internados , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Seleção de Pacientes , Resultado do TratamentoAssuntos
Arterite do Sistema Nervoso Central Associada a AIDS/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade , Arterite do Sistema Nervoso Central Associada a AIDS/patologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Humanos , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos da Percepção/etiologia , Transtornos da Percepção/psicologia , Carga ViralAssuntos
Lidocaína/administração & dosagem , Metilprednisolona/análogos & derivados , Bloqueio Nervoso/métodos , Doenças do Nervo Trigêmeo/tratamento farmacológico , Idoso , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Injeções/métodos , Metilprednisolona/administração & dosagem , Acetato de Metilprednisolona , Lobo Occipital/efeitos dos fármacos , Resultado do TratamentoRESUMO
The roles of genetic and non-genetic factors in the haematology, growth and clinical features of sickle cell disease have been studied in nine identical twin pairs (six homozygous sickle cell disease, three sickle cell-haemoglobin C disease). A comparison group of 350 age-gender matched sibling pairs, selected to have an age difference of <5 years, was used for assessing the concordance of numerical data. Attained height, weight at attained height, fetal haemoglobin, total haemoglobin, mean cell volume, mean cell haemoglobin and total bilirubin levels showed significantly greater correlation in identical twins than in siblings. Twins showed similarities in the prevalence and degree of splenomegaly, susceptibility to priapism, and in onset of menarche, but other clinical complications were discordant in prevalence and severity. These findings suggest that physical growth and many haematological characteristics are subject to genetic influences, but that non-genetic factors contribute to the variance in disease manifestations.
Assuntos
Anemia Falciforme/genética , Anemia Falciforme/patologia , Adolescente , Adulto , Anemia Falciforme/complicações , Criança , Pré-Escolar , Feminino , Genótipo , Crescimento e Desenvolvimento , Testes Hematológicos , Humanos , Masculino , Fenótipo , Projetos Piloto , IrmãosAssuntos
Bioquímica/história , Vitaminas/história , História do Século XX , Humanos , Prêmio Nobel , Percepção Social , Reino UnidoRESUMO
This paper discusses the strategies used to construct scientific medicine in mid-Victorian Britain. An opening section considers why it was thought desirable to create a properly scientific medicine, and outlines the empirical and rational bases of the medical establishment's projects for this. The bulk of the paper concerns an alternative approach to making medicine scientific--that put forward by certain advocates of homoeopathy--and how this approach was excluded from those arenas where scientific medicine was being created, and thereby made unscientific. This process is illustrated by the clash between homoeopathy and establishment medicine that occurred in mid-Victorian Cambridge. The final section briefly considers the complementary process of educating the public in what was properly scientific medicine, and what was not, and suggests that the processes of building boundaries to exclude competing practitioners, while keeping patients inside, created the space in which modern scientific medicine has flourished so successfully.