1/5. Neuroendocrine lung tumors and disorders of the neuromuscular junction.We report four cases of lambert-eaton myasthenic syndrome (LEMS) or myasthenia gravis (MG) associated with pulmonary neuroendocrine carcinoma having prolonged survival. The tumors were atypical carcinoid or large cell neuroendocrine carcinoma. LEMS is associated with several neuroendocrine carcinomas. Because some neuroendocrine carcinomas have a better prognosis, aggressive tissue diagnosis of lung cancer in LEMS is warranted. Whether the association between MG and atypical carcinoid is a significant co-occurrence is uncertain.- - - - - - - - - - ranking = 1keywords = neuromuscular junction, junction (Clic here for more details about this article) |
2/5. Lambert-Eaton myaesthenic syndrome: a possible association with Hodgkin's lymphoma.lambert-eaton myasthenic syndrome is a presynaptic neuromuscular junction disorder typically associated with small cell lung carcinoma. The characterstic electrophysiological abnormality is a low amplitude compound muscle action potential that shows a marked increment after maximal voluntary contraction or brief tetanic nerve stimulation. We describe a patient who had LEMS in association with Hodgkin's disease. A 61 year old woman presented with proximal muscle weakness 6 years following successful treatment of Hodgkin's disease. Her symptoms responded well to treatment with diaminopyridine. 9 additional patients have been described with LEMS in association with lymphoproliferative diseases. A systemic malignancy is usually found within 2 years of LEMS diagnosis but may present later. LEMS should be considered in patients with Hodgkin's disease presenting with muscle weakness.- - - - - - - - - - ranking = 0.25keywords = neuromuscular junction, junction (Clic here for more details about this article) |
3/5. Exacerbation of lambert-eaton myasthenic syndrome caused by an L-type Ca2 channel antagonist.A 74 year-old Japanese woman, who had suffered from lambert-eaton myasthenic syndrome (LEMS), Sjoegren's syndrome, and discoid lupus erythematosus for 10 years and had been successfully controlled by 3,4-diaminopyridine and prednisolone, began to suffer from chest discomfort at night. Stress-induced myocardial ischemia in the left ventricular anterior septum was detected by thallium-201 scintigraphy. After diltiazem was prescribed, she began to feel systemic malaise and weakness in both thighs. She stopped taking diltiazem and the symptoms improved. coronary angiography revealed 75% stenosis with calcification in the middle of the left anterior descending artery. After atherectomy with a lotablator and coronary stenting, diltiazem was prescribed. She felt malaise again, but continued taking diltiazem. After three months a follow-up coronary angiography showed no restenosis in the lesion and diltiazem was stopped. The weakness and malaise disappeared and her muscle strength recovered. LEMS is an autoimmune disorder of peripheral cholinergic transmission in which autoantibodies to the presynaptic P/Q-type voltage-gated calcium channels (VGCC) decrease the release of acetylcholine at the neuromuscular junction resulting in muscle weakness. P/Q-type VGCC regulates most of the neurotransmitter release and L-type VGCC regulates the remainder. L-type VGCC blockers are thought to have little effect on the neuromuscular junction. but they should be used very carefully. even in the remission stage of LEMS, because of preexisting neuromuscular blocking in transmission.- - - - - - - - - - ranking = 0.5keywords = neuromuscular junction, junction (Clic here for more details about this article) |
4/5. Lupus-like disease with anticardiolipin antibodies and lupus anticoagulant as a cause for atypical Eaton-Lambert syndrome and peripheral nerve disease: a case report.In the practice of neurology, the type of clinical involvement suggests the site of the lesion and the mechanism beneath. Sometimes, the symptoms can be delusive, turning the diagnostic approach to a wrong path and raising the necessity of an algorithm considering the less probable entities. Dysimmunity as mechanism of neurological disease involving both the neuromuscular junction and peripheral nerves is frequently insidious and difficult to suspect on clinical basis alone. We report the case of a 67-year-old male with atypical Eaton-Lambert syndrome and mononeuropathy probably in relation with lupus-like entity. The patient has also high titers of anticardiolipin antibodies and lupus anticoagulant. We are considering the diagnostic algorithm before an isolated and atypical neurological presentation and reviewing the main neurological manifestations in lupus-like and autoimmune systemic disease. We raise the difficulty to classify an inflammatory connective tissue disease in the absence of other pathologic features than autoantibodies and isolated neurological symptoms and discussing the main therapeutic issues.- - - - - - - - - - ranking = 0.25keywords = neuromuscular junction, junction (Clic here for more details about this article) |
5/5. lambert-eaton myasthenic syndrome in small cell lung cancer: nursing implications.PURPOSE: To describe the pathophysiology and nursing care of patients with lambert-eaton myasthenic syndrome (LEMS), a little-known paraneoplastic syndrome. DATA SOURCES: Published articles, books and book chapters, and clinical trial experience. DATA SYNTHESIS: LEMS most commonly is associated with small cell lung cancer. Clinical presentation is characterized by weakness of the proximal muscles of the pelvis, thighs, shoulders, and arms and a weakening or absence of deep tendon reflexes. These symptoms are the manifestations of an abnormality at the neuromuscular junction and may precede the diagnosis of lung cancer. CONCLUSIONS: The oncology nurse knowledgeable about the pathophysiology, clinical features, diagnostic evidence, and treatment of LEMS is better able to care for and teach patients with this disorder. NURSING IMPLICATIONS: nurses must assist patients in adjusting not only to a diagnosis of cancer and its treatment effects but also to the symptoms of LEMS, including impaired mobility, self-care deficits, and fatigue.- - - - - - - - - - ranking = 0.25keywords = neuromuscular junction, junction (Clic here for more details about this article) |