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Biomedical subjects

Adam Czapliński

Publications and source records attributed to Adam Czapliński.

3 recordsLinked to original sources

Respiratory failure due to bilateral diaphragm palsy as an early manifestation of ALS.

BACKGROUND: Diaphragm palsy is common in the advanced stages of motor neuron disease and is a primary cause of fatal outcome However, respiratory failure is a presenting symptom of motor neuron disease in only a small number of patients. CASE REPORT: We present the case of a patient with dyspnea and orthopnea followed by subacute respiratory failure due to bilateral diaphragm paralysis as the first manifestation of amyotrophic lateral sclerosis. CONCLUSIONS: Failure of respiratory muscle function can be the first symptom of motor neuron disease, and may precede clinical manifestation in voluntary motor units in ALS. Therefore, in cases of unexplained acute respiratory failure or when respiratory support must be continued for no clear reason, a motor neuron disease such as amyotrophic lateral sclerosis, which leads to respiratory muscle weakness and diaphragm paralysis, should be taken into consideration.

Acute Disease↗

[Actual aspects of myasthenia gravis treatment].

This paper reviews treatment strategies of myasthenia gravis (MG) that are currently in use: 1. enhancement of neuromuscular transmission with acetylcholinesterase inhibitors; 2. short-term immunotherapies, including plasma exchange and intravenous immunoglobulin therapy; 3. immunosuppression; 4. surgical thymectomy and thymomectomy. Acetylcholinesterase blockers are still used as the first-line treatment of MG. Although most of patients benefit from these drugs, the improvement is usually incomplete and often wanes after weeks or months of treatment. When clinical symptoms are not adequately controlled by anticholinesterase drugs, immunosuppressive therapy is suggested, but indications for treatment take into account age and clinical symptoms (ocular versus generalised myasthenia). Steroids are the most commonly used and most consistently effective immunosuppressive agents for MG treatment but they also have the highest incidence of potential side effects. The use of azathioprine, for monotherapy in initial immunosuppression treatment of MG is controversial. However, data are available, including a randomised trial, to support the use of azathioprine as an adjunctive drug with corticosteroids. Retrospective analyses of the treatment of MG have shown that cyclosporine is also effective but renal toxicity and hypertension are the major factors limiting its use. Mycophenolate mofetil appeared also to be effective as adjunctive therapy in the treatment of refractory and steroid-dependent MG. Intravenous immunotherapy (IVIg) is recommended as an adjunct in the management of MG exacerbations. According to new publications, there are no pronounced differences in the efficacy of IVIg treatment and plasma exchange. Thymomectomy is beneficial and should be considered for all patients with thymoma-associated MG. However, in cases with non-thymomatous autoimmune MG, thymectomy is recommended only for patients below age 55-60 and within the first 6-12 months of disease duration.

Anti-Inflammatory Agents↗

[Tic syndrome].

A tic is an involuntary, sudden, rapid, recurrent, nonrrhythmic, stereotyped, motor movement or vocalization. This paper reviews clinical, pathophysiological, epidemiological and treatment issues of tic disorders. The clinical presentation of tic disorders with simple and complex motor or vocal tics is reviewed in detail. The most common psychiatric comorbid conditions, such as personality disorder (PD), Obsessive-Compulsive Disorder (OCD), Self-Destructive Behavior (SDB) and Attention Deficit Hyperactivity Disorder (ADHD) are presented too. All forms of tics may be exacerbated by anger or stress, but they are usually markedly diminished during sleep. Premonitory feelings or "sensory experiences", which are distinct from the actual motor or phonic tics and precede the tics, occur in over 80% of tic-patients and in 95% of patients with Gilles de la Tourette Syndrome (GTS). The American Psychiatric Association recognizes three types of tic disorders on the basis of clinical criteria: Transient Tic Disorder, Chronic Motor or Vocal Tic Disorder and GTS. The diagnostic criteria for these types are described. According to epidemiological data, up to 10% of children have at least somewhere a transient tic disorder. The onset of tics, whether simple or multiple, occurs at approximately 7 years of age. The accepted prevalence figure for GTS is 0.05-3%. Although tics can appear as the result of brain injury, Huntington chorea or encephalitis, they are most commonly idiopathic. Genetic factors appear to be present in many but not in all cases of tic disorders. Autosomal dominant, sex-linked models or semirecessive-semidominant-oligogenic models have been considered. Based on the review of the literature we believe that tic disorders are related to altered neurotransmitter function within the CNS, especially that the functional abnormality is somehow related to dopaminergic mechanism. Several authors have recently investigated the possible role of autoimmune response to streptococcal infection in the pathogenesis of tics. The differential diagnosis of tics is reviewed in detail. Above all tics represent a social disability. The ability to tolerate tics varies greatly from one individual to another, and the need for treatment is better defined by the patient than by the physician. Mild cases do not need be treated. Ideally, management should be multidisciplinary and can range from educative to supportive means or to intricate pharmacological interventions. The major form of treatment of the motor or vocal symptoms continues to be based on high-potency "typical" neuroleptics (tiaprid, pimozide, haloperidol), which induce a wide range of potentially serious side effects. In everyday practice we prefer to start with an "atypical" neuroleptic drug--for example, olanzapin (5-10 mg/day), risperidone or clozapine. Other drugs, such as clonidin or pergolid are widely used but their efficiency is still questionable. SSRIs (sertaline, citalopram, fluoxetin, fluvoxamine) or other antidepressants (clomipramine) have been used in treatment of psychiatric comorbid conditions, too. Botulinum toxin injections have proved useful in tics, targeting at the symptoms of blepharospasm, in neck and facial muscles.

Antidepressive Agents↗