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report a similar proportion but point out that several anti-Purkinje antibodies besides the highly characteristic one may be found by special techniques Death occurred in 4 to 18 months In an equal number of cases without antibodies, half are men with lung cancer and a few have circulating antibodies of another type ( anti-Hu ) that are more closely linked to the paraneoplastic encephalomyelitis discussed further on This leaves a proportion who have no circulating antibody but nonetheless are found to have a concealed tumor that must be sought by other ancillary tests In another small group, it must be conceded that no underlying tumor can be found despite extensive examinations and even at autopsy (Ropper) The death rate in these cases has varied widely from 6 months to several years and depends on the behavior of the underlying tumor Whether the anti-Yo antibodies are merely markers of an underlying tumor or the agents of destruction of the Purkinje cells is not known They have been found to bind to a C-myc protein that initiates a degeneration of Purkinje cells Regardless of the pathogenic signi cance of the antibodies, nding them in a patient with the typical neurologic disorder has considerable diagnostic significance As mentioned above, their presence strongly suggests that there is an underlying breast or ovarian cancer, which may be asymptomatic and small enough to be resected successfully Other antibodies besides anti-Yo and anti-Hu are found on occasion, such as those against a glutamate receptor in patients with Hodgkin disease (Smitt et al) The differential diagnosis is broad as indicated in Table 5-1 The main considerations are a variant of CreutzfeldtJakob disease, postinfectious cerebellitis, and various intoxications Treatment Little can be done to modify the cerebellar symptoms, although there are on record several cases in which there was a partial or complete remission of symptoms after removal of the primary tumor (Paone and Jeyasingham) Further, in some cases associated with Hodgkin disease, there has been spontaneous improvement of the cerebellar symptoms Preliminary reports of aggressive plasma exchange or intravenous immunoglobulin treatment early in the course suggest some bene t, but it should not be assumed that this approach will succeed in most patients, and our own experience in over 10 cases has been discouraging. birt code 128 Barcode using font CODE 128 — OpenText - Forums
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qr code generator microsoft word free Barcode for Eclipse BIRT helps users generate standard PDF 417 barcode in Eclipse BIRT . EAN/UPC Barcodes, Postal Barcodes. EAN- 128 . EAN-13. UPC- ... Figure 31-21 Paracarcinomatous cerebellar degeneration MRI showing subtle diffuse enhancement of the cerebellar cortex cell loss has been described in the Purkinje cell layer, inferior olives, and brainstem, with mild in ammatory changes (Luque et al) Besides breast cancer, we have observed the opsoclonusmyoclonus syndrome in a middle-aged woman with bronchial carcinoma and also in a man with gastric carcinoma Similar cases occur with both cerebellar ataxia and an irregular tremor, which we have interpreted as myoclonic in character These patients were found to have marked degeneration of the dentate nuclei The prognosis in this syndrome is somewhat better than that for the other paraneoplastic diseases, but besides a trial of ACTH, there is little that can be done but search for the tumor and resect it if possible The occurrence of regional and bilateral encephalomyelitic changes in association with carcinoma has been described by several authors (Corsellis et al, Henson and Urich, Posner) In most of the reported cases, the encephalitic process has been associated with carcinoma of the bronchus, usually of the small-cell type but all types of neoplasm may be implicated Histologically, this group of paraneoplastic disorders is characterized by extensive loss of nerve cells, accompanied by microglial proliferation, small patches of necrosis, and marked perivascular cuf ng by lymphocytes and monocytes Foci of lymphocytic in ltration have been observed in the leptomeninges as well These pathologic changes may involve the brain and spinal cord diffusely, but more often they predominate in a particular part of the nervous system, notably in the medial temporal lobes and adjacent nuclei ( limbic encephalitis, Fig 3122), the brainstem (particularly in the medulla), the cerebellum (see above), and the gray matter of the spinal cord The symptoms will, of course, depend on the location and severity of the in ammatory birt code 128 Java Code - 128 Generator, Generating Barcode Code 129 in Java ...
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