Both acute transverse myelitis (ATM) and Guillain-Barré syndrome (GBS) occur as rare associations with mumps viraemia but to our knowledge, concurrent ATM and GBS related to mumps has only been reported once previously. We describe the case of a young woman presenting with confusion and collapse 2 weeks after a flu-like illness. An initial diagnosis of transverse myelitis was made on the basis of the clinical findings and radiological evidence of a swollen spinal cord with uniform high signal change on T2 weighted MRI. The patient was treated with intravenous methylprednisolone without significant recovery. The diagnosis was later revised to include GBS on the basis of worsening facial diplegia in the setting of a flaccid tetraparesis, and neurophysiological evidence of a sensorimotor axonal polyradiculoneuropathy. Acute mumps viraemia was confirmed on serological grounds. The patient made an improvement in ventilatory capacity with intravenous immunoglobulin treatment.
Following pregnanc y. adve rse re act ions are descr ibed in 7 patients su ffe ri ng from border line (d im orphous ) lep rosy . Th e re acti ons in most cases we re sudden and se ver e; ne rve da mage often occu rre d within the space of a day or 50, with re sultant pa ralysis an d anaesthesia. Some of th ese patients were seen in re mo te ar eas, and on clini cai si gns al one it was not po ssible to di stinguish between immun olo gi cally bene fic iaI (upgrading. re ve rsal). an d immuno lo gi cally de tr imental (do wngrad ing) re actions. Howe ver, thei r spontaneous occu rrence following pr egnan cy and the fa ct that cell -mediated (no t humoral) immune fa ct ors ar e kn ow n to be invol ve d in this type of re action. ra ise the po ssibility that they may have been pr ecipitated by a re turn of ce ll-mediated competence following pr egnan cy. Th ese re actions fre qu ently cause tissue damage . an d this is mo st important in periphe ral nerves; their pathogenesis is as yet poorly understood. The possible significance of their occu rrence in or following the puerperium is discussed in re 1ati on to re ce nt re sea rch on de pr ession of ce ll -mediated immune re sp onses in pr egnancy, and in wo men ta king the cont rac eptive pill.
This regimen was associated with a high rate of compliance and induction therapy had an acceptable toxicity profile. The R0 resection rate and 3-year survival data are similar to recently reported studies. While active, gemcitabine and paclitaxel induction therapy was associated with an increased rate of postoperative complications, but no increase in survival. Patterns of failure continue to demonstrate the need for regimens incorporating greater emphasis on systemic therapy for locally advanced esophageal cancer.
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