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Hormonal and Para-Neoplastic Syndromes - also Skin Lesions.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Other patients experience general malaise, loss or weight, or neurological manifestations often preceding the discovery of neoplasm by several months and including (i) encephalopathy, (ii) cerebellar degeneration, (in) myelopathy and (iv) motor and or sensory neuropathy affecting the spinal cord and/ or the peripheral nerves. Others may have a progressive myopathy or the Eaton Lambert syndrome (see below).
Hematopoietic Stem Cell Therapy for Patients with Refractory Myasthenia Gravis
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
The diagnosis of MG is made by clinical manifestations, improvement to the anticholinesterase edrophonium chloride (Tensilon), and EMG. MG is characterized by weakness, often fluctuating, being worsened by exercise. Fatigue and weakness may occur in ocular, facial, bulbar, and/or limb muscles.9,10 Ocular ptosis, ophthalmoparesis, dysarthria, and dysphagia are common. In severe cases, respiratory muscles are affected. Electrophysiologic studies reveal loss of amplitude with repetitive nerve stimulation. Approximately 85% of patients with MG have anti-AChR antibodies. These patients may have other genetic or autoimmune-mediated problems with the nerve-muscle synapse. Achieving action potential threshold depends on clustering of the AChR at the motor endplate. A neuronal protein, agrin, activates muscle-specific kinase (MuSK) to cluster AChRs via rapsyn, a muscle cytoplasmic synapse protein (Fig. 1).24-26 Some MG patients without anti-AchR antibodies have antibodies to MuSK. Therefore, disruption of AChR clustering by either antibodies to AChR or MuSK results in the same clinical manifestations and EMG findings. MG must also be differentiated from other myasthenic syndromes such as Eaton Lambert syndrome, which is a malignancy-associated disorder with antibodies against PQ-type voltage-gated calcium channels.27 Eaton Lambert syndrome can be distinguished from MG by EMG.
Muscle
Published in Sarah Armstrong, Barry Clifton, Lionel Davis, Primary FRCA in a Box, 2019
Sarah Armstrong, Barry Clifton, Lionel Davis
Eaton-Lambert syndrome (myasthenic syndrome) Acquired autoimmune disorder (IgG mediated) of the voltage-gated calcium channels causing less ACh to be released into the synapseImproves with exerciseAffects proximal limb musclesIncreased sensitivity to depolarising and neuromuscular blocking drugs (NMBDs)
A rare case of metastatic small cell neuroendocrine carcinoma of the lung presenting as isolated thrombocytopenia
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Adreana DeMarinis, Fahad Malik, Tommy Matin, Zalmi Rahmany, Taylor Putnam, Jay Nfonoyim
Our patient presented to the emergency room with a chief complaint of dizziness, weakness, and progressive weight loss over the past six months. Patients may present with a paraneoplastic syndrome, which is a byproduct of the malignancy but unrelated to the invasion of the primary tumor. Examples pertaining to small cell lung carcinoma are the following: cushing syndrome, SIADH, eaton-lambert syndrome, and in extremely rare cases like our patient, microangiopathic hemolytic anemia (MAHA). MAHA is a non-immune hematologic process characterized by the destruction of red blood cells which can be seen hemolytic uremic syndrome (HUS), disseminated intravascular coagulation (DIC), and thrombotic thrombocytopenic purpura (TTP), and also malignancy. Cancer-related microangiopathic hemolytic anemia (CR-MAHA) is considered to have a prevalence of <6% in paraneoplastic syndrome in which thrombocytopenia and schistocytes on peripheral smear may be the only presenting clinical features of an underlying non-hematologic malignancy that has metastasized to the bone marrow, as in this particular case [2–4].
OnabotulinumtoxinA treatment of moderate to severe glabellar lines in Chinese subjects after laser therapy: A prospective, open-label, noncomparative study
Published in Journal of Cosmetic and Laser Therapy, 2018
Yan Wu, Zhong Lu, Yong Xie, Wei Zhang, Xiangdong Chen, Yuling Shi, Qin Li, Michael Halstead, John D Rogers, Michael Silberberg
Eligible subjects were men and women aged 18‒60 years with moderate to severe GL at maximum frown [grade 2 or 3 on the four-grade, physician-assessed Facial Wrinkle Scale with Asian Photonumeric Guide (FWS-A)]. Key exclusion criteria included previous treatment with botulinum toxin for any indication; any medical conditions that could place subjects at increased risk to the effects of onabotulinumtoxinA treatment (e.g., concurrent treatment with aminoglycosides; diagnosis of myasthenia gravis, Eaton–Lambert syndrome, amyotrophic lateral sclerosis, or any other condition that might interfere with neuromuscular function); specified treatments or procedures to the brow or forehead area (e.g., microdermabrasion, chemical peels, or filler injections); or presence of deep dermal scarring, skin infections or lesions, excessively thick sebaceous skin, and/or loss of skin elasticity. Women of childbearing potential were required to have a negative urine pregnancy test and to use adequate contraception during the study.
The role of chemotherapy in patients with small cell lung cancer and poor performance status
Published in Acta Oncologica, 2020
Vanita Noronha, Rahul Ravind, Vijay M. Patil, Smruti Mokal, Amit Joshi, Nandini Menon, Akhil Kapoor, Abhishek Mahajan, Amit Janu, Dipti Nakti, Leena Shah, Srushti Shah, Kumar Prabhash
Between June 2010 and August 2019, we enrolled 234 patients. The flowchart of patient recruitment and management is provided in Figure 1. There were 185 (79%) patients with SCLC and PS 3; 49 (21%) patients had a PS of 4. Demographic details are provided in Table 1. Baseline staging was done with CT scans in 171 patients (73.1%) and with PET-CT scans in 63 (26.9%). A paraneoplastic syndrome was present in 11 patients (4.7%) at presentation, including the syndrome of inappropriate ADH secretion in 7, polymyositis-1, dermatomyositis-1, Cushing’s syndrome-1, and Eaton Lambert syndrome-1. Spontaneous tumor lysis syndrome was noted in 26 patients (11.1%).