LL Patients Research Articles

Evolution of Subjective Visual Vertical Perturbation After Stroke

Objective. The perception of visual verticality is often perturbed after stroke and might be an underlying component of imbalance. The aim of this study was to describe the evolution of visual vertical (VV) perturbation and to investigate the factors affecting it. Methods. Thirty patients with hemiplegia after a single hemispheric stroke (17 left lesioned [LL] and 13 right lesioned [RL]) were studied. Visual verticality was tested within 45 days of stroke, and then at 3 and 6 months. Subjects sat in a dark room and adjusted a luminous rod to the vertical position. The differences between patients’ adjustments and vertical were calculated. The effects on VV evolution of the side, size, type, and location of the lesion were tested. Results. Sixty percent of the recent stroke patients had an initial inaccurate perception of verticality, and 39% of these patients recovered during the 1st 3 months after stroke. The evolution of VV tilt depended on the side of the lesion (P = 0.01), with better recovery in LL patients. None of the other factors studied affected VV normalization. Conclusions. The poorer recovery of vertical perception after right-side stroke might be due to the predominant role of the right hemisphere in spatial cognition, and might be involved in the poorer recovery of balance after stroke in RL patients.

Epilepsy in patients with spina bifida in the lumbosacral region

This study aimed to assess the relevance of epilepsy and spina bifida in the lumbosacral region. We evaluated 75 patients with spina bifida admitted to the Kyushu University Hospital from 1980 to 2004. Patients were classified as having meningocele (MC, 4 cases), myelomeningocele (MMC, 6), myeloschisis (MS, 45), and lumbosacral lipoma (LL, 20). Nine cases had epileptic disorders, and all showed MS. Meticulous neuroradiological investigations revealed cerebral abnormalities such as polymicrogyria or hypogenesis of the corpus callosum in all epileptic cases. Locations of cerebral abnormalities topographically correlated with areas of interictal EEG abnormalities. Although all epileptic cases had ventriculoperitoneal (VP) shunt for hydrocephalus before the onset of epilepsy, interictal EEG abnormalities could not be explained by location of the VP shunt. In all LL patients, neither history of epilepsy nor cerebral abnormalities were noted on magnetic resonance imaging (MRI). Epileptogenesis in spina bifida patients seemed to correlate with coexisting cerebral abnormalities in MS patients rather than with the VP shunt. However, not all spina bifida patients associated with cerebral abnormalities had epilepsy, and not all cerebral abnormalities were epileptogenic, suggesting that epilepsy in spina bifida patients was multifactorial.

Daytime Sleepiness and the COMT val<sup>158</sup>met Polymorphism in Patients with Parkinson Disease

A preliminary study by our group suggested an association between daytime sleepiness and the catechol-O-methyltransferase (COMT) val158met polymorphism (rs4680) in patients with Parkinson disease (PD). We sought to confirm this association in a large group of patients with PD. Genetic association study in patients with PD. Movement disorder sections at 2 university hospitals. PD patients with and without episodes of suddenly falling asleep matched for antiparkinsonian medication, disease duration, sex, and age, who participated in a previous genetic study on dopamine-receptor polymorphisms. Not applicable. In this study, 240 patients with PD (154 men; age 65.1 +/- 6.1 years; disease duration 9.4 +/- 6.0 years) were included. Seventy had the met-met (LL), 116 the met-val (LH), and 54 the val-val (HH) genotype. In the combined LL+LH group (featuring reduced COMT activity), the mean Epworth Sleepiness Scale (ESS) score was 9.0 +/- 5.9 versus 11.0 +/- 6.1 in the HH (high COMT activity) group (P = .047). Forty-seven percent of the LL and LH patients had sudden sleep onset compared with 61% of the HH patients (P = .07). Logistic regression, however, showed that both pathologic ESS scores (i.e., > 10) and sudden sleep onset were predicted by subjective disease severity (P < .001 each) but not by the COMT genotype. Our previous finding that the L-allele may be associated with daytime sleepiness could not be confirmed in the present study. Altogether, our data do not support a clinically relevant effect of the COMT genotype on daytime sleepiness in PD.

The Relapse Rate in MB Leprosy Patients Treated with 2-Years of WHO-MDT is Not Low1

A group of multibacillary patients is clearly at high risk for relapse following 2-yr WHO-MDT. Relapse is largely confined to BL or LL patients with a high BI initially, and occurs long after the discontinuation of therapy. This important group of patients at risk for treatment failure presents several important issues: the need to identify those at risk and the operational requirements needed for their long term follow-up. Also, this group of patients might well benefit from an alternative antimicrobial regimen from the outset, as well as upon relapse.

Association Between Fennell Phase Inventory Scores and Immune and RNase-L Parameters in Chronic Fatigue Syndrome

AbstractAll patients suffering from a chronic condition, are challenged to manage the reality of their disease, the accompanying anxiety, the problems of daily living, and the effect on relationships. Therefore, when confronted with debilitating complaints, patients suffering from chronic fatigue syndrome (CFS) need to adapt to a new way of living during the course of their illness. Fennell developed an integrated model to manage CFS. This article is a follow-up of a study by Jason et al. (9, 10) to verify the existence of the different phases. Although not all differences are statistically significant, a clear distinction is made according to the conclusions drawn by Jason et al. (9, 10). Relationships between these distinctions and measures of symptoms, disability, psychological distress, coping, and immune parameters were revealed using non-parametric statistical tests.

Long-term treatment of rectovaginal fistulas in Crohn's disease: Response to infliximab in the ACCENT II trial

I c ackground & Aims: The ACCENT II study (A Crohn’s isease Clinical Trial Evaluating Infiximab in a New ong-term Treatment Regimen in Patients With Fistulizng Crohn’s Disease) evaluated the efficacy and safety of nfliximab maintenance treatment in patients with fistuizing Crohn’s disease. This post hoc analysis was conucted to determine the efficacy and safety of infliximab herapy in women with rectovaginal fistulas. Methods: ll patients received 5 mg/kg infliximab intravenously at eeks 0, 2, and 6. Patients who achieved response at eeks 10 and 14 then were randomized as responders f they had at least 50% of baseline fistulas closed, or as onresponders, to receive placebo or infliximab 5 g/kg every 8 weeks through week 54. Results: Of 282 atients in the ACCENT II study, 25 of 138 (18.1%) omen had a total of 27 draining rectovaginal fistulas at aseline. After infusions of infliximab at weeks 0, 2, and , 60.7% (17 of 28) and 44.8% (13 of 29) of rectovagial fistulas were closed at weeks 10 and 14, respecively. Among responders, 72.2% (13 of 18) of rectovagial fistulas were no longer draining at week 14. The uration of rectovaginal fistula closure was longer in the nfliximab 5-mg/kg maintenance group (median, 46 wk) han in the placebo group (33 wk). Conclusions: Inflixmab is effective in short-term closure of rectovaginal stulas and maintenance treatment was more effective han placebo in prolonging rectovaginal fistula closure.

Phosphomannomutase Deficiency: The Molecular Basis of the Classical Jaeken Syndrome (CDGS Type Ia)

CDGS is a group of autosomal recessive, metabolic iseases, described for the first time by Jaeken et al. 1). The observation of unusual serum glycoprotein bnormalities led to the inference that a defect in he glycosylation of these proteins was involved in he etiology of the disease (2). The descriptive name carbohydrate-deficient glycoprotein syndrome” is erived from this feature. This mouthful definitely eeded an acronym or synonym: CDGS or Jaeken yndrome (see Ref. 3 for most recent review). The classical clinical picture of CDGS type I (or DGS1) includes three main features: a moderate to evere neurological disease, more or less typical dysorphic signs, and variable involvement of different rgan systems (3,4). The neonatal period is characerized by a severe failure to thrive and acute, lifehreatening problems caused by liver failure, cariac insufficiency, and/or nephrotic syndrome in ome infants. Later in infancy, the involvement of he central nervous system becomes more obvious. ll patients are moderately to severely mentally etarded, and most suffer from epilepsy and some rom stroke-like episodes. The disease is largely nonrogressive, be it that skeletal deformities present t later age and an overt premature aging is apparnt in some adults (5). Actually, very few adult cases ave been described, and the disease is definitely q p m m

Imaging for cochlear implants

All patients in the Birmingham Cochlear Implant Programme underwent computerized tomography (CT) scanning and were assessed and images interpreted by the main author. Of the first 100 cases, 20 were considered to have abnormalities of the inner ears by CT imaging. It is concluded that the commonest abnormality was cochlear otospongiosis followed by labyrinthitis ossificans. Otospongiosis is well shown by CT which gives a good predicator of luminal patency. However, labyrinthus obliterans, although usually apparent on CT, is not reliably shown in all cases and T2 weighted magnetic resonance imaging (MRI) is better.

An assessment of the value of midfinger smears in multibacillary leprosy patients

In view of the different opinions on fingers as sites for persisting bacilli in multibacillary leprosy patients, it was decided to examine the midfingers for the presence of acid-fast bacilli (AFB) and establish its usefulness. Sixty-nine multibacillary leprosy patients, [lepromatous (LL) and borderline lepromatous (BL)] treated with multidrug therapy for fixed duration (2 years) were analysed. The bacillary load in the midfinger sites was lower when compared to that in the 'compulsory' (both earlobes) and 'optional' (four active lesions) sites. The midfinger bacterial index (BI) was higher among LL patients when compared to BL patients (p < 0.001). However, the difference in mean BI in 'optional' and 'compulsory sites' was not significant. The overall fall in BI was gradual and on expected lines for all sites, including midfingers, during treatment and follow-up period. Except in one case, at no time were the smears from midfinger sites positive when all other sites were negative, and their inclusion did not contribute to the early detection of relapse. Furthermore, the collection of blood-free smears from this site is technically difficult and often painful for the patient. The inclusion of midfinger smears in this study in patients in South India did not contribute useful information to that which is routinely available from smears of earlobes and other active sites.

Aspiration Cytopathology of Lymphoblastic Lymphoma and Leukemia: The MCV Experience

Malignant lymphoma, lymphoblastic type (LL), and acute lymphoblastic leukemia (ALL) are two well-known pediatric malignancies whose diagnoses are typically established by surgical tissue biopsy and/or bone marrow examination. The status of fine-needle aspiration (FNA) biopsy in the diagnosis and management of these lymphoblastic malignancies is controversial. We present our experience from the past 7 years using FNA in children from 10 months to 15 years (mean age 10.5 years) of age with lymphoblastic cancers; in addition, two adult patients with ALL are included. Superficial FNA was performed in 16 cases (one patient had two aspirations 16 months apart). Eight patients were diagnosed with LL, six with ALL, and the one patient with two separate aspirates had lymphoblastic transformation of chronic myelogenous leukemia (CML). Five patients presented with the superior mediastinal syndrome. Sites of FNA included lymph node (nine cases), parotid gland (one), and soft tissues of the neck (four), buttock (one), and forehead (one). There were no complications from FNA. Except for one case (case 8), the patients with ALL and CML were previously diagnosed and treated for their disease, and FNA was performed primarily for the detection of disease recurrence. Conversely, in all eight children with LL, FNA was performed as the initial procedure to establish a primary diagnosis in previously well individuals. All eight LL patients responded-some dramatically-to chemotherapy. Two patients with LL and one with lymphoid blast crisis arising in CML had subsequent surgical biopsies that confirmed the FNA diagnosis. Immunophenotyping performed from 15 of 16 aspirates confirmed the T cell derivation of all cases of LL and 4 of 6 of ALL. Two of the ALL cases had a pre-B cell phenotype. Sufficient cells were obtained by FNA for flow cytometric DNA analysis in 9 of 16 cases. All cases but one were diploid, and 6 of 9 showed a high (> 6%) S phase. Our experience suggests that, when combined with immunologic phenotyping, definitive initial pathologic diagnosis of LL and recurrent ALL is possible and preferable using only aspiration cytopathology. It should be considered as part of the initial evaluation and management whenever a mass lesion appears in a child with a suspected lymphoblastic neoplasm. It can preclude the need for a surgically procured piece of tissue in those with a mediastinal mass and the superior mediastinal syndrome.

Addition of immunotherapy with Mycobacterium w vaccine to multi-drug therapy benefits multibacillary leprosy patients

Immunotherapy with a vaccine consisting of autoclaved Mycobacterium w, was given in addition to standard chemotherapy (multidrug therapy (MDT)) to 93 multibacillary (MB) leprosy patients. One hundred and seven patients with similar types of disease served as controls and received MDT + placebo injections. The study was a double-blind randomised trial. On opening the codes, results obtained were in concordance with those in a single-blind trial which has been extensively reported. Bacteriological clearances were significantly more rapid in vaccinated patients ( p<0.03). Thirty-five LL or BL patients with a high bacterial index (BI) of 6 were completely cleared of acid-fast bacilli (AFB) after eight doses of vaccine. Only 8 patients in the control group became bacteriologically negative in the same time period. They all had BIs <4. Associated with decreasing BI was accelerated clinical regression of lesions after vaccination and lepromin conversion rates of 100% for BB, 71% for BL and 70% for LL. A significant number of immunised patients showed histological improvement ( p<0.004). Thirty-six showed a complete disappearance of dermal granulomas and a picture of non-specific infiltration. The vaccine did not precipitate neuritis or deformities; episodes were noted in vaccinated patients as were incidences of Type 2 reaction. The overall improvement was reflected by a shorter duration of treatment and faster release of vaccinated patients.

Psychiatric symptoms as predictors of mortality in continuing care geriatric inpatients

AbstractAll patients (N = 74) in continuing care geriatric beds in a London health district were screened for psychiatric morbidity and physical dependency in 1990. The sample was followed up 1 year after screening, forty‐four percent were dead at follow‐up. The relationship between individual psychiatric symptoms and mortality is reported. Using these associations, two scales to predict mortality were constructed and their usefulness is discussed.

Physical dependency and dementia in nhs continuing care wards and contracted nhs beds in voluntary nursing homes

AbstractAll patients in hospital based and voluntary nursing home based National Health Service (NHS) continuing care geriatric beds in one London Health District were screened for psychiatric morbidity and physical dependency. They were followed‐up at one year. Patients in hospital based continuing care beds had more severe dementia and physical dependency and higher mortality rates than those in voluntary nursing home based NHS continuing care beds. The implications of these findings are discussed in the light of governmental policy to encourage growth of private and voluntary sector nursing homes.

Class-specific immunoglobulins and antibodies to mycobacterial sonicates and autoantigens in leprosy patients and contacts

A comprehensive analysis of the humoral immune response in leprosy patients and contacts was undertaken. Class-specific antibodies to four mycobacterial sonicates, three autoantigens and three haptens were estimated by ELISA. It was found that IgG levels varied more extensively than IgM or IgA and that total serum IgG was significantly higher in lepromatous bacterial index positive (LL+ve) and negative LL-ve) leprosy patients than in tuberculoid (TT/BT) patients and controls. The high levels of anti-mycobacterial antibodies found in untreated LL+ve patients were significantly reduced in LL-ve patients after effective chemotherapy. Considerable amount of anti-mycobacterial IgG was also detected in TT/BT patients. Each serum when assayed against sonicates of Mycobacterium leprae, Mycobacterium tuberculosis , ICRC bacilli and BCG gave a similar antibody profile suggesting that these antibodies were directed predominantly against cross-reactive antigens. Up to 75% of LL patients and 35% of TT/BT patients were found to be positive for antibodies to histone, collagen and fibronectin. However, antibodies to several haptens were not detected in any of the patients and controls studied. Taken together, these results suggested that the amount of IgG antibodies is directly correlated with the antigenic load in the system, and that there is no evidence for polyclonal activation. It may be speculated that the regulatory mechanism of antibody production is severely deranged in lepromatous leprosy patients.

Changes in the prevalence of hepatitis B and C infection in patients with hepatocellular carcinoma in the Nagasaki prefecture, Japan

The development of hepatocellular carcinoma (HCC) is very closely associated with chronic liver disease. In the present study, the prevalence of the hepatitis B virus (HBV) and hepatitis C virus (HCV) infection as a causative role in the development of HCC was analysed in 253 patients with HCC, who were admitted to our hospital during 1976-90. Among these patients, 68 (27%) were positive for HBsAg but negative for anti-HCV antibody (group I); in contrast, 147 (58%) were negative for HBsAg but positive for anti-HCV antibody (group II), 19 (7.5%) were both positive (group III), and 19 (7.5%) were both negative (group IV). To evaluate the serial changes in the prevalence of HBsAg and anti-HCV antibody, changes in the number of patients were compared between group I and group II. The number of group I patients reached a peak during 1982-84 and was thereafter followed by a decreasing trend, whereas the number of group II patients steadily increased and reached a plateau over 6 recent years. These results suggest that HCV infection recently seems to play a more important role in the development of HCC than chronic HBV infection, even in the Nagasaki Prefecture, where the HBV carrier rate is higher than elsewhere in Japan.

Hormone replacement therapy

AbstractAll patients receiving hormone replacement therapy should be evaluated annually. During these evaluations, breast and pelvic examinations should be performed and a Pap smear taken, and attention should be directed to cholesterol, blood pressure, and the effectiveness of treatment. In women given adequate progestins (medroxyprogesterone acetate, 10 mg each day for 12 days a month), endometrial biopsy should be reserved for women with clinical problems such as excessive or prolonged bleeding. In women taking no progestins, pretreatment and yearly biopsies are required. In addition, annual mammograms should be obtained on women over the age of 50. Hormone replacement therapy, although not suited to all patients, can confer health benefits, enhance quality of life, and prolong life expectancy (46).

Does psychiatric morbidity predict mortality in continuing care geriatric inpatients?

AbstractAll patients in continuing care geriatric beds in a London Health District were screened for psychiatric morbidity and physical dependency in 1990. This sample was followed up 1 year after screening. Forty‐four per cent (32/72) were dead at follow‐up. Patients in hospital‐based continuing care beds had higher mortality than those in health authority beds in a private nursing home. Dementia, physical dependency and depression measured by Depressive Signs Scale (DSS) were associated with mortality. Using multivariate analysis, to partial out independent effects, depressive signs score measured by the DSS was the only significant predictor of mortality.

A histological study of the eye lesions in 12 leprosy patients with tuberculoid lesion in 4 eyes.

The histological reactions in 12 eyes of 12 leprosy patients were studied (5 BT, 1 BB, 1 BL and 5 LL). Granuloma lesions composed of epithelioid cells, Langerhans giant cells, macrophages and lymphocytes were found in various intraocular tissues, e.g. cornea, sclera, iris, ciliary body or retina in 4 patients (1 BT and 3 LL). Of the 3 LL patients, according to the records, 2 were cured and in the other patient the outcome of the treatment was not mentioned. In view of the finding of the granulomatous lesions in the clinically cured patients and tuberculoid granuloma in the intraocular tissues in the LL patients, could there be some peculiarities in the intraocular sites? Or perhaps the tuberculoid reaction is just a manifestation of an upgrading reaction? More examinations on human leprosy eye specimens will be needed to answer these questions.

Immunohistochemical analysis of cell surface markers in leprosy patients

Nine biopsy specimens from 3 tuberculoid (TT), 1 borderline tuberculoid (BT), 2 borderline (BB), 2 borderline lepromatous (BL), and 1 lepromatous (LL) patients were studied using immunoperoxidase procedures with monoclonal antibodies. In TT patients 4B4+, TCR alpha beta+, CD4+ T cells were dominant in dermal granulomas. In LL patient, dermal granulomas with 4B4+, TCR alpha beta+, CD4+ T cells and 2H4+, TCR alpha beta+, CD4+ T cells also had CD8+ T cells. The proportion of 4B4+ T cells increased in granulomas from LL to TT and 2H4+ T cells proportionately increased from TT to LL. TCR gamma delta+ T cells were detected only in BB and BL patients. However, there is no difference of staining pattern of ICAM-1 or LFA-1 antigen in any type of leprosy. These results indicate that the immunohistochemical pattern of T cells (CD4, CD8, 4B4, 2H4, TCR) may be useful in the diagnosis of the spectrum of leprosy.

Concurrent skin and nerve histology in leprosy and its role in the classification of leprosy.

Concurrent skin and nerve histology was evaluated in 60 leprosy patients (25 BT, 28 BL and 7 LL). The twin aims were to study the comparative histology and the usefulness of nerve histology in the classification of the disease. In BT patients, clinical and histological classification was in agreement in 11 (44%) skin and 17 (68%) nerve biopsies. Concurrent skin and nerve histology was in consonance in 14 (56%) BT patients, while in 6 (24%) patients, only nerve histology was helpful in the classification of the disease, the skin histology being non-specific. Nerve histology was classified as BL in 3 (12%) BT patients, the skin histology was non-specific. In the BL group, the histology of 23 (82.4%) nerve biopsies correlated with the clinical classification, in contrast to skin histology which correlated with clinical assessment in 19 (68%) patients only. In the LL patients, the histology of nerve correlated with the clinical classification in 5 patients (71.4%), compared to histology of the skin in 4 (57%) patients only. The GF was higher in the nerves than in the skin throughout the leprosy spectrum (BT, BL, LL); the difference was, however, marginal in BL leprosy. The average bacteriological index (BI) was higher in nerves (4+) compared to that of skin histology and slit skin smears (3+) in BL leprosy. There was, however, no difference in the BI of the slit skin smears, skin and nerve biopsies in lepromatous leprosy.(ABSTRACT TRUNCATED AT 250 WORDS)