scholarly journals Arsenic Neurotoxicity in Humans

2019 ◽  
Vol 20 (14) ◽  
pp. 3418 ◽  
Author(s):  
Hitoshi Mochizuki
Keyword(s):  
Peripheral Nerves ◽  
Clinical Information ◽  
Nerve Biopsy ◽  
Exposure Dose ◽  
Sural Nerve Biopsy ◽  
Number Of Patients ◽  
Central Nervous System Impairment ◽  
High Concentrations ◽  
Sensory Fibers

Arsenic (As) contamination affects hundreds of millions of people globally. Although the number of patients with chronic As exposure is large, the symptoms and long-term clinical courses of the patients remain unclear. In addition to reviewing the literature on As contamination and toxicity, we provide useful clinical information on medical care for As-exposed patients. Further, As metabolite pathways, toxicity, speculated toxicity mechanisms, and clinical neurological symptoms are documented. Several mechanisms that seem to play key roles in As-induced neurotoxicity, including oxidative stress, apoptosis, thiamine deficiency, and decreased acetyl cholinesterase activity, are described. The observed neurotoxicity predominantly affects peripheral nerves in sensory fibers, with a lesser effect on motor fibers. A sural nerve biopsy showed the axonal degeneration of peripheral nerves mainly in small myelinated and unmyelinated fibers. Exposure to high concentrations of As causes severe central nervous system impairment in infants, but no or minimal impairment in adults. The exposure dose–response relationship was observed in various organs including neurological systems. The symptoms caused by heavy metal pollution (including As) are often nonspecific. Therefore, in order to recognize patients experiencing health problems caused by As, a multifaceted approach is needed, including not only clinicians, but also specialists from multiple fields.

Diagnostic and therapeutic value due to suspected diagnosis, long-term complications, and indication for sural nerve biopsy

2005 ◽  
Vol 107 (3) ◽  
pp. 214-217 ◽  
Author(s):  
Albert Ruth ◽  
Frank J. Schulmeyer ◽  
Manuela Roesch ◽  
Chris Woertgen ◽  
Alexander Brawanski
Keyword(s):  
Sural Nerve ◽  
Nerve Biopsy ◽  
Sural Nerve Biopsy ◽  
Therapeutic Value ◽  
Suspected Diagnosis

scholarly journals Increased Radiation Dose Exposure in Thoracic Computed Tomography in Patients with Covid-19

Radiation ◽  
2021 ◽  
Vol 1 (2) ◽  
pp. 153-161
Author(s):  
Massimo Cristofaro ◽  
Nicoletta Fusco ◽  
Ada Petrone ◽  
Fabrizio Albarello ◽  
Federica Di Stefano ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Age Groups ◽  
Exposure Dose ◽  
Long Term Outcomes ◽  
Thoracic Computed Tomography ◽  
Younger Age ◽  
Number Of Patients ◽  
Radiation Dose Exposure ◽  
Insufficient Knowledge

The CT manifestation of COVID-19 patients is now well known and essentially reflects pathological changes in the lungs. Actually, there is insufficient knowledge on the long-term outcomes of this new disease, and several chest CTs might be necessary to evaluate the outcomes. The aim of this study is to evaluate the radiation dose for chest CT scans in COVID-19 patients compared to a cohort with pulmonary infectious diseases at the same time of the previous year to value if there is any modification of exposure dose. The analysis of our data shows an increase in the overall mean dose in COVID-19 patients compared with non-COVID-19 patients. In our results, the higher dose increase occurs in the younger age groups (+86% range 21–30 years and +67% range 31–40 years). Our results show that COVID-19 patients are exposed to a significantly higher dose of ionizing radiation than other patients without COVID infectious lung disease, and especially in younger age groups, although some authors have proposed the use of radiotherapy in these patients, which is yet to be validated. Our study has limitations: the use of one CT machine in a single institute and a limited number of patients.

scholarly journals Small-fiber polyneuropathy in leprosy without skin changes: study of 17 cases

2003 ◽  
Vol 61 (3A) ◽  
pp. 542-546 ◽  
Author(s):  
Marcos R.G. de Freitas ◽  
Osvaldo J.M. Nascimento ◽  
Ernestina A.M. Quaglino ◽  
Andréia Oliveira ◽  
Myrian D. Hahn
Keyword(s):  
Peripheral Nerves ◽  
Sural Nerve ◽  
Nerve Biopsy ◽  
Nerve Fibers ◽  
Sural Nerve Biopsy ◽  
Skin Changes ◽  
Small Fiber ◽  
Individual Variations ◽  
Inflammatory Infiltrates ◽  
Tendon Reflexes

Leprosy is one of the most common diseases of the peripheral nerves. In some cases there is only neural involvement without skin changes (neuritic form). The neuropathy has often a distal stocking and glove distribution with thermal and pinprick anesthesia and preservation of proprioception. There is no weakness, the tendon reflexes may be preserved and sometimes the nerves are thickened. We reported 17 patients with a predominantly small-fiber polyneuropathy due to leprosy. All patients had distal temperature and pain anesthesia with different individual variations. The tendon reflexes were normal in seven patients and in eight there was thickening of the nerves. The nerve conduction was normal in three patients. Sural nerve biopsy consisted of: 1) inflammatory infiltrates, 2) vacuolated "foamy" cells, 3) fibrosis of endoneurium, perineurium, and epineurium, 4) partial or total loss of nerve fibers, 5) large number of bacilli. We concluded that in countries where leprosy is frequent, nerve biopsy is an obligatory procedure in patients with predominantly small-fiber polyneuropathy.

THE NEUROPATHY SPECTRUM IN WALDENSTRöM'S MACROGLOBULINAEMIA

2015 ◽  
Vol 86 (11) ◽  
pp. e4.60-e4
Author(s):  
Aisling Carr ◽  
Zane Jaunmuktane ◽  
Sebastian Brandner ◽  
J Kothari ◽  
Julian Blake ◽  
...  
Keyword(s):  
Peripheral Nerves ◽  
Sural Nerve ◽  
Axonal Neuropathy ◽  
Diagnostic Algorithm ◽  
Nerve Biopsy ◽  
Sural Nerve Biopsy ◽  
Tumour Invasion ◽  
Cellular Infiltrate ◽  
Leucocytoclastic Vasculitis ◽  
Large Fibre

BackgroundUK WM Guidelines recognise 2 mechanisms of nervous system involvement either direct tumour invasion of the CNS or antibody mediated damage to peripheral nerves. We present 5 cases illustrating an extended diversity of PNS involvement in WM with implications for treatment and outcome.CasesA 73 year-old man (IgMκ WM) developed progressively disabling tremor with stable WM. Neurophysiology was demyelinating with disproportionate DMLs; anti-MAG antibodies were strongly positive. He was treated with DRC with symptom stabilisation.A 64 year-old woman (IgMκ) with typical anti-MAG neuropathy developed severe episodic foot pain and ulceration. Skin biopsy confirmed leucocytoclastic vasculitis. She was treated with DRC but died from sepsis.A 43 year-old man (IgMκ WM) with rapidly progressive sensorimotor neuropathy had lymphplasmacytoid cellular infiltrate in sural nerve. He was successfully treated with IDARAM.A 59 year-old man (IgMλ WM) developed small then large fibre axonal neuropathy with autonomic symptoms within 2 years. A SAP scan showed moderate kidney uptake. MRI neurography directed biopsy and confirmed amyloid. Palliative treatment was offered.A 70 year-old woman (IgMλ WM) developed severe burning pains in her feet and became ataxic 2 months later. Sural nerve biopsy confirmed endoneurial amyloid. DRC was given.DiscussionThese cases highlight the importance of accurate diagnosis in WM-associated neuropathy. We propose a novel diagnostic algorithm.

scholarly journals Necrotizing Lymphocytic Vasculitis Limited to the Peripheral Nerves: Report of Six Cases and Review

2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
José Félix Restrepo ◽  
Federico Rondón ◽  
Eric L. Matteson ◽  
Carlos H. Colegial ◽  
Gerardo Quintana ◽  
...  
Keyword(s):  
Blood Vessels ◽  
Peripheral Nerves ◽  
Sural Nerve ◽  
Clinical Manifestations ◽  
Case Series ◽  
Nerve Biopsy ◽  
Sural Nerve Biopsy ◽  
Response To Treatment ◽  
Motor Deficits ◽  
Primary Vasculitis

Background. The systemic vasculitides are syndromes characterized by inflammation and injury (necrosis or thrombosis) of blood vessels, resulting in clinical manifestations according to the affected vascular bed, but not classically in stocking-glove neuropathy.Objective. To describe a form of primary vasculitis affecting strictly peripheral nerves manifesting as stocking-glove neuropathy.Methods. Case series of 110 patients seen in three centers in Bogotá who presented with symptoms and signs of polyneuropathy and/or were identified with vasculitis affecting only the peripheral nerves, and who underwent sural nerve biopsy.Results. Six patients had a vasculitis affecting only the peripheral nerves diagnosed on sural nerve biopsy which demonstrated a mixed infiltrate of monocytes/macrophages and lymphocytes especially in the small epineurial blood vessels. Over time, all had worsening of symptoms, with grip weakness and motor deficits in the hand and feet. Serologies and acute phase reactants were normal in all patients. Treatment response to immunosuppression was satisfactory in 5 patients; 1 patient had progressive neurologic damage.Conclusions. There is a distinct form of primary vasculitis of the peripheral nervous system characterized by distal sensory polyneuropathy with stocking-glove distribution with good prognosis, few and minor relapses and good response to treatment even after delayed diagnosis.

Chronic Inflammatory Demyelinating Polyradiculoneuropathy

2019 ◽  
Vol 39 (05) ◽  
pp. 596-607 ◽  
Author(s):  
Jeffrey Shije ◽  
Thomas H. Brannagan
Keyword(s):  
Peripheral Nerves ◽  
Autoimmune Disorder ◽  
Nerve Biopsy ◽  
Chronic Inflammatory Demyelinating Polyradiculoneuropathy ◽  
Nerve Roots ◽  
Hematopoietic Stem ◽  
Immunomodulatory Agents ◽  
Csf Analysis ◽  
Degree Of Disability

AbstractChronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a relatively common autoimmune disorder affecting the peripheral nerves and nerve roots, often causing progressive or recurrent weakness with diminished reflexes. Electrodiagnostic (EDx) studies, cerebral spinal fluid (CSF) analysis, and nerve biopsy may help provide supportive evidence for the diagnosis. Most cases have a favorable response to one of the three first-line treatments: corticosteroids, IV immunoglobulin (IVIG) and plasmapheresis. Responses to these treatments may vary among individual patients. There is evidence that a small percentage of CIDP patients with IgG class 4 (IgG4) autoantibodies to paranodal proteins have characteristic clinical features and poorer response to IVIG. Chemotherapy and other immunomodulatory agents, as well as hematopoietic stem cell transplantation, may be considered in refractory cases. The degree of disability varies, and most patients require ongoing treatment to maintain stable disease, although long-term remission or cure may be achieved in some patients.

scholarly journals Complications of Sural Nerve Biopsy in Diabetic versus Non-Diabetic Patients

1994 ◽  
Vol 21 (1) ◽  
pp. 34-37 ◽  
Author(s):  
James R. Perry ◽  
Vera Bril
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Daily Activity ◽  
Sural Nerve ◽  
Telephone Survey ◽  
Nerve Biopsy ◽  
Sural Nerve Biopsy ◽  
Diabetic Patients ◽  
Increased Risk

ABSTRACT:We compare complications from 66 sural nerve biopsies in 41 patients with diabetic peripheral neuropathy to 40 patients with neuropathy from other causes, using a retrospective telephone survey. Diabetic patients were followed for a mean of 6.8 years and non-diabetics for 5.6 years. Mild long-term pain was described by 18.9% of patients overall with no difference between groups. Mild persistent sensory symptoms, insufficient to interfere with daily activity or warrant medical therapy, were reported by 63.6% of diabetic and 27.5% of non-diabetic patients (p < 0.006). Wound infection and severe pain were uncommon in both groups and no different in diabetics. Significant complications of sural nerve biopsy occurred no more frequently in diabetic than in non-diabetic patients. While sural nerve biopsy plays no role in the routine evaluation of diabetic peripheral neuropathy, it may be performed without increased risk when indicated in these patients to exclude other causes of neuropathy and in the context of research trials.

Computer-Aided Diagnosis in Jaundice: Comparison of Knowledge-based and Probabilistic Approaches

1996 ◽  
Vol 35 (01) ◽  
pp. 41-51 ◽  
Author(s):  
F. Molino ◽  
D. Furia ◽  
F. Bar ◽  
S. Battista ◽  
N. Cappello ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Clinical Information ◽  
Diagnostic Value ◽  
Clinical Findings ◽  
Clinical Documentation ◽  
Data Set ◽  
Knowledge Based ◽  
Number Of Patients ◽  
Support Tools ◽  
Aided Diagnosis

AbstractThe study reported in this paper is aimed at evaluating the effectiveness of a knowledge-based expert system (ICTERUS) in diagnosing jaundiced patients, compared with a statistical system based on probabilistic concepts (TRIAL). The performances of both systems have been evaluated using the same set of data in the same number of patients. Both systems are spin-off products of the European project Euricterus, an EC-COMACBME Project designed to document the occurrence and diagnostic value of clinical findings in the clinical presentation of jaundice in Europe, and have been developed as decision-making tools for the identification of the cause of jaundice based only on clinical information and routine investigations. Two groups of jaundiced patients were studied, including 500 (retrospective sample) and 100 (prospective sample) subjects, respectively. All patients were independently submitted to both decision-support tools. The input of both systems was the data set agreed within the Euricterus Project. The performances of both systems were evaluated with respect to the reference diagnoses provided by experts on the basis of the full clinical documentation. Results indicate that both systems are clinically reliable, although the diagnostic prediction provided by the knowledge-based approach is slightly better.

Ixekizumab in the Management of Non-Selected Out Patients with Moderate to Severe Psoriasis -New Data and Personal Clinical Experience

2018 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Clinical Experience ◽  
Personal Experience ◽  
Therapeutic Response ◽  
Systemic Disease ◽  
Severe Psoriasis ◽  
Adequate Treatment ◽  
Scalp Psoriasis ◽  
Number Of Patients ◽  
Genital Psoriasis

Introduction: Too many patients with moderate to severe psoriasis do not receive adequate treatment. This means a vast undersupply in the treatment of patients with psoriasis. Only biologics fulfill the whole range of the treatment of psoriasis – psoriasis does not affect only skin but the whole organism: It is a systemic disease! Between the biologics are evident differences concerning the effect. Discussion: Based on broad personal experience in the management of patients with moderate to severe psoriasis new data from clinical studies with ixekizumab are examined. This contains new data on long-term-efficacy of ixekizumab, effectiveness in special localizations (scalp psoriasis, nail psoriasis, palmoplantar psoriasis, genital psoriasis) as well as safely data and experience on patients switched to ixekizumab from other biologics. Personal clinical experience is based on >300 non-selected outpatients with moderate to severe psoriasis, >250 patients on biological therapies, > 50 patients with ixekizumab. Conclusions: Focusing on a relevant number of patients switched from secukinumab to ixekizumab due to first or secondary loss of efficacy significant differences between both IL-17A-inhibitors mainly in terms of efficacy and speed of therapeutic response are shown. Finally the correlation between PASI-90-/PASI-100 response and significant changes in DLQI are highlighted.

Inflammatory disease of the womans reproductive system: modern trends in diagnosis and therapy (literature review)

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 35-41
Author(s):  
T Yu Pestrikova ◽  
I V Yurasov ◽  
E A Yurasova
Keyword(s):  
Genital Tract ◽  
Inflammatory Diseases ◽  
Diagnosis And Treatment ◽  
Long Term Results ◽  
Modern Approach ◽  
Pelvic Organs ◽  
Results Of Treatment ◽  
Number Of Patients ◽  
Diagnostic Approaches

Medical, social and economic relevance of inflammatory diseases of the woman's reproductive organs requires a very careful attitude to the diagnosis and treatment of this pathology. The number of patients with genital infections and inflammatory diseases of the pelvic organs can takes the first place in structure of gynecological morbidity, and is 60.4-65.0%, and this fact is not unique to Russia, but all over the world. Incidence rate of inflammatory diseases of the pelvic organs in the first decade of the twenty-first century is increased at 1.4 times in patients who are from 18 to 24 years old and at 1.8 times in patients aged 25-29 years. At the same time, the cost of diagnosis and treatment has increased, reaching 50-60% of the total cost of providing gynecological care for population. The inflammatory diseases of pelvic organs are a collective concept. It includes of various nosological forms. There are numerous contradictions in the views on diagnostic approaches and treatment tactics, the nature of screening and control over the long-term results of treatment, the etiological and pathogenetic significance of various microorganisms found in the genital tract in patients with inflammatory diseases of the pelvic organs. Currently, there are many opinions among specialists about diagnostic approaches and treatment tactics, the type of screening and monitoring the long-term results of treatment, the etiological and pathogenetic role of various microorganisms which can be found in the genital tract in patients with inflammatory diseases. This review presents the results of a modern approach to the diagnosis, management and rehabilitation of patients with inflammatory diseases of the pelvic organs.

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