Acute myelomonocytic leukemia with multifocal manifestation and spinal cord infiltration in a dog

INTRODUCTION

Few cases of myelomonocytic leukemia associated with neurological signs have been described in dogs; none have been related to intraparenchymal spinal cord infiltration by neoplastic cells. This short communication describes a case of acute myelomonocytic leukemia subtype M4 in a dog with spinal cord infiltration. A 3-year-old male Golden Retriever was presented with a history of hyperthermia, lymphadenomegaly, leukocytosis with circulating blast cells, anemia and thrombocytopenia, and acute onset paraplegia. Immunophenotyping of peripheral blood by flow cytometry was consistent with acute myelomonocytic leukemia subtype M4. The dog was euthanized because of clinical deterioration and unfavourable prognosis. Postmortem examination revealed multi-organ neoplastic infiltration, including the spinal cord. To our knowledge, this is the first case of acute myelomonocytic leukemia subtype M4 in a dog with spinal cord infiltration. Our findings hold importance for including myelomonocytic leukemia in the differential diagnosis of patients with neurological signs due to spinal cord localisation.

[Palliative Care in Neurology]

Palliative Care in Neurology Abstract. Neurology as a discipline clearly overlaps with palliative care. Nevertheless, an early integration of palliative care accompanying neurological treatment rarely takes place, and there are still misunderstandings with regard to the timing of the inclusion of palliative care and its role beyond pure end-of-life care and hospice care. A further expansion and use of synergies should become an integral part of both disciplines in the coming years, and training should focus on appropriate training, especially for our young medical colleagues.

[Neurological complications of coitus: Review of literature]

INTRODUCTION

Sexual activity is composed of different phases (excitation, plateau, resolution). Each phase is associated with cardiovascular, respiratory, muscular and hormonal modification which can have an influence on the nervous system. This impact has been studied many times in literature, but no study has synthetized the complications related to coitus or orgasm.

METHOD

Systematic review of literature on neurological complications, except headache, of coitus based on Medline and Embase.

RESULTS

We screened 1424 articles and selected 46 for this review. 7 (15 %) were clinical or epidemiologic studies, 6 (13 %) were reviews of literature and 33 (72 %) were cases or series of cases reports. 12 articles (26 %) talked about strokes, 10 (22 %) about subarachnoid hemorrhage, 9 (20 %) about reversible cerebral vasoconstriction syndrome. We found 3 (7 %) articles for each of the following complication: intraparenchymal, hematoma and epilepsy. Autonomic hypereflexia was treated in 3 articles (7 %). Only 1 article was included concerning ictus, spinal cord injury, neuralgia and cataplexia. These events can be considered as rare as emergencies related to sexual activity represent only 0.1 % of all emergencies and among these, 12 % are neurological. 31 of the reported cases concerned vascular events (stroke or hemorrhage) and 18 (58 %) of these patients had a patent malformation (aneurism, intracardiac shunt, foramen ovale).

CONCLUSION

This is one of the first review of literature trying to synthetise the neurological complications of coitus. Many articles exist in literature. It is necessary to prevent the occurrence of these complications in a population already at risk of neurological events.

Scientific habilitations as an indicator of research productivity in Germany - a comparative analysis of several clinical specialties

BACKGROUND

As a part of the German academic system the scientific habilitation is a significant individual qualification in research and teaching. In a pilot project, we recently reported the number of habilitations in anesthesiology, visceral surgery, gynecology and internal medicine. Here, we analyze habilitations from 13 additional clinical specialties.

METHODS

Habilitations in clinical specialties published in the German Medical Journal (Dtsch Arztebl) between 2010 and 2017 were quantitatively analyzed. For data validation, the dean offices of all German medical schools were requested to forward all accomplished habilitations. The percentage of women and the numbers with respect to the specialty were analyzed for each university hospital. Data are presented as medians (interquartile ranges).

RESULTS

In this study, 2,264 accomplished habilitations were analyzed. Annually, 45 (36-56) habilitations were reported in orthopedic/trauma surgery, 40 (36-48) in radiology and 37 (29-46) in neurology, while the medians in the other analyzed specialties were lower. The highest percentage of women earning a habilitation degree was reported for pediatrics (37 %), dermatology (33 %), and ophthalmology (32 %).

CONCLUSIONS

Here, the output of completed habilitations from 13 medical specialties was analyzed for each German medical school. As a habilitation stands for a sustainable scientific contribution, this study may help to identify further career development needs for junior and for female scientists.

[Nurse-performed screening to identify dysphagia for neurological patients]

Nurse-performed screening to identify dysphagia for neurological patients Abstract. Background: Dysphagia is often underestimated, although it can have serious consequences if it is not treated. In the literature a multidisciplinary approach is often recommended in the diagnosis of dysphagia, with care playing an increasingly major role. A quick and easy assessment of the risk of dysphagia is absolutely essential. Aim: Identification of screening tools for the detection of neurogenic dysphagia by nurses and to describe the psychometric characteristics. Method: A literature review was carried out in 2017 between June and the end of July, resulting in 14 included studies. Results: A total of seven screening tools were identified. Due to its good practicability and psychometric properties, the RBWH DST appears to be particularly suitable for the use of screening in the nursing context, especially when the studies are given differentiated consideration. Conclusion: The relevant validation of already existing tools, aimed at creating a standard for the early detection of dysphagia, is not yet available. When this is concluded, the nursing staff need to be trained in the correct use of the tools.

[Urethral pain during clean intermittent self catheterization: Retrospective analysis of 77 patients]

OBJECTIVE

Clean self-intermittent catheterization (CIC) is the gold standard of the therapeutic approach of chronic urinary retention. Usually, CIC are safe, effective but in some cases catheterization can determine urethral pain during catheter insertion or withdrawal leading to poor adherence and compliance. To determine prevalence of pain during CIC and verify its impact on adherence to treatment.

METHOD

Retrospective study with evaluation of pain during CIC one month following CIC teaching session by means specific and validated questionnaires: ICDQ (Intermittent Catheterization Difficulties Questionnaire), InCasaq (Intermittent Catheterization Satisfaction Questionnaire), I-CAS (Intermittent Catheterization Adherence Scale).

RESULTS

Seventy-seven patients were recruited and 28 (36%) described pain during CIC. There is a strong relationship between pain and poor adherence (P<0.01). Female patients had a higher risk of urethral pain during CIC and in contrary BMI>25kg/m² seems to be a protective factor of pain.

CONCLUSION

In this series, urethral pain was associated with low compliance and adherence to CIC.

LEVEL OF EVIDENCE

4.

A video-game group intervention: Experiences and perceptions of adults with chronic stroke and their therapists: Intervention de groupe à l'aide de jeux vidéo : Expériences et perceptions d'adultes en phase chronique d'un accident vasculaire cérébral et de leurs ergothérapeutes

BACKGROUND

Ongoing physical activity is important for maintaining the functional level of individuals with chronic stroke. Video games in a group setting might be a cost-effective way for providing mobility and preventing physical inactivity.

PURPOSE

This study explores the experiences and perceptions of individuals with chronic stroke who participated in a novel community-based video-game group intervention and their therapists.

METHOD

A qualitative study, nested in a randomized controlled trial, was conducted using semistructured interviews with eight individuals with chronic stroke (four men and four women) ages 29 to 69 and a focus group of their three occupational therapists, following a video-game intervention. Data were analyzed using content analysis.

FINDINGS

Three main categories were identified by the study participants: (a) using video games, (b) the group/team experience, and (c) intervention outcomes/evolving understandings following the intervention.

IMPLICATIONS

Playing video games was perceived not as treatment but as a motivating tool to facilitate whole-body movement. Therefore, this intervention might be suitable to be used in the community for ongoing intervention.

[Primary central nervous system lymphoma]

Primary central nervous system lymphoma is a rare cancer, with immunosuppression as sole known risk factor. However, it affects today mostly old immunocompetent patients. It usually presents with brain involvement, but ocular or meningeal involvement must be ruled out. Corticosteroids should be withheld if possible until the completion of brain biopsy, to obtain a histological diagnosis. PCNSL is highly chemosensitive and potentially curable. Remission can be achieved in the majority of cases using a high dose intravenous methotrexate-based polychemotherapy. Recent data suggests a benefit of adding rituximab. Relapses are frequent, but because of toxicity, consolidation treatment with either radiotherapy or high dose chemotherapy with autologous stem cell transplant is an option only in younger patients. Patients with primary central nervous system lymphoma must be treated by a specialized multidisciplinary team. In France, a network of expert centers covering the territory was created with the National Cancer Institute.

Are the French neurology residents satisfied with their training?

BACKGROUND

There have been dramatic changes in neurology over the past decade; these advances require a constant adaptation of residents' theoretical and practical training. The French Association of Neurology Residents and the College of Neurology Teachers conducted a national survey to assess the French neurology residents' satisfaction about their training.

METHODS

A 16-item questionnaire was sent via e-mail to French neurology residents completing training in 2014. Data were collected and processed anonymously.

RESULTS

Of eligible respondents, 126 returned the survey, representing approximately 40% of all the French neurology residents. Most residents (78%) rated their clinical training favorably. Seventy-two percent reported good to excellent quality teaching of neurology courses from their faculty. However, many residents (40%) felt insufficient their doctoral thesis supervision. All residents intended to enter fellowship training after their residency, and most of them (68%) planned to practice in a medical center.

CONCLUSION

French neurology residents seemed satisfied with the structure and quality of their training program. However, efforts are required to improve management of the doctoral thesis and make private practice more attractive and accessible during the residency. In the future, similar surveys should be scheduled to regularly assess neurology residents' satisfaction and the impact of the forthcoming national and European reforms.

Clinical implications of neuropharmacogenetics

INTRODUCTION

Pharmacogenetics aims to identify the underlying genetic factors participating in the variability of drug response. Indeed, genetic variability at the DNA or RNA levels can directly or indirectly modify the pharmacokinetic or the pharmacodynamic parameters of a drug. The ultimate aim of pharmacogenetics is to move towards a personalised medicine by predicting responders and non-responders, adjusting the dose of the treatment, and identifying individuals at risk of adverse drug effects.

METHODS

A literature research was performed in which we reviewed all pharmacogenetic studies in neurological disorders including neurodegenerative diseases, multiple sclerosis, stroke and epilepsy.

RESULTS

Several pharmacogenetic studies have been performed in neurology, bringing insights into the inter-individual drug response variability and in the pathophysiology of neurological diseases. The principal implications of these studies for the management of patients in clinical practice are discussed.

CONCLUSION/DISCUSSION

Although several genetic factors have been identified in the modification of drug response in neurological disorders, most of them have a marginal predictive effect at the single gene level, suggesting mutagenic interactions as well as other factors related to drug interaction and disease subtypes. Most pharmacogenetic studies deserve further replication in independent populations and, ideally, in pharmacogenetic clinical trials to demonstrate their relevance in clinical practice.

The Madrid School of Neurology (1885-1939)

The emergence of neurology in Madrid between 1885 and 1939 had well-defined characteristics. On foundations laid by Cajal and Río-Hortega, pioneers combined clinical practice with cutting-edge neurohistology and neuropathology research. Luis Simarro, trained in Paris, taught many talented students including Gayarre, Achúcarro and Lafora. The untimely death of Nicolás Achúcarro curtailed his promising career, but he still completed the clinicopathological study of the first American case of Alzheimer's disease. On returning to Spain, he studied glial cells, including rod cells. Rodríguez Lafora described progressive myoclonus epilepsy and completed experimental studies of corpus callosum lesions and clinical and neuropathology studies of senile dementia. He fled to Mexico at the end of the Spanish Civil War (1936-1939). Sanchís Banús, a sterling clinical neurologist, described the first cluster of Huntington's disease in Spain, and he and Río-Hortega joined efforts to determine that pallidal degeneration underlies rigidity in advanced stages of the disease. Just after the war, Alberca Llorente eruditely described inflammatory diseases of the neuraxis. Manuel Peraita studied "the neurology of hunger" with data collected during the siege of Madrid. Dionisio Nieto, like many exiled intellectuals, settled in Mexico DF, where he taught neurohistological methods and neuropsychiatry in the tradition of the Madrid School of Neurology.

[Neurological complications in cancer patients]

Neurological symptoms in cancer patients have a great impact on quality of life and need an interdisciplinary approach. They lead to significant impairment in activities of daily living (gait disorders, dizziness), a loss of patients independency (vegetative disturbances, wheel-chair dependency) and interfere with social activities (ban of driving in case of epilepsy). In this article we describe three main and serious neurological problems in the context of oncological patients. These are chemotherapy-induced polyneuropathy, malignant spinal cord compression and epileptic seizures. Our aim is to increase the awareness of neurological complications in cancer patients to improve patients care.