Patients’ predisposition to hyponatremia and consecutive seizures

Patients’ predisposition to hyponatremia and consecutive seizures despite anticonvulsant, treatment may be increased.51 Other newer substances, eg, MDV3100 research buy gabapentin and topiramate, show promise from case studies; however, randomized studies are still lacking.28-52 Smoking cessation A very recent

field with potential usefulness of some new anticonvulsants is smoking cessation. Due to 2-(aminomethyl)phenylacetic acid AMPA/kainate antagonism, topiramate has been assumed to be a potential candidate medication. A small open study by Khazaal et al53 supports this assumption; however, in briefly abstinent smokers topiramate may also enhance withdrawal and rewarding effects when Inhibitors,research,lifescience,medical relapsing, thus calling into question its usefulness.54 Anxiety disorders and post-traumatic stress disorder (PTSD) A broad area for the use of antiepileptic drugs in psychiatry is anxiety disorders, especially generalized anxiety (GAD), social phobia and panic attacks, as well as post-traumatic stress disorder (PTSD). This area has been most recently Inhibitors,research,lifescience,medical comprehensively reviewed by Mula et al.16 Repetitive activation and kindling of brain structures Inhibitors,research,lifescience,medical involved in fear responses, such as the amygdala and the hippocampus, may result in an inadequate, excitatory output, similar to that observed in epilepsy.

Thus, ACs could be of potential value by limiting this excessive activation. Open studies provide some limited evidence for the usefulness of carbamazepine in PTSD,55-57 whereas for other Inhibitors,research,lifescience,medical anxiety syndromes the evidence is vague or negative (eg, for panic disorder58). For valproate, one controlled study and several open studies reported efficacy in panic disorder alone or when accompanied by mood symptoms.59 Lum60 compared valproate with placebo for 6 weeks. He observed Inhibitors,research,lifescience,medical a significant reduction in the intensity and the duration of panic attacks. However, this

study is clearly limited by the small number of patients (n=12). Also of interest is an open study by Keck.61 In patients with a history of panic attacks, panic attacks were induced by lactate infusions. After treatment, with valproate for 1 month, almost half of the patients were free of spontaneous panic attacks, and 10 out of 12 patients tested no longer developed panic attacks provoked by lactate infusions. For other anxiety syndromes and PTSD, evidence is again restricted of to open-label trials (eg, ref 62) and case series. Moderate evidence stemming from a small, but controlled study exists for the use of lamotrigine in PTSD63; however, no proper-sized randomized studies have been conducted so far. Another double-blind, placebo-controlled trial assessed efficacy and safety of topiramate monotherapy in civilian posttraumatic stress disorder and found evidence supporting topiramate’s efficacy.

While the extent of immune enhancement

While the extent of immune enhancement ABT-737 ic50 of susceptibility/infectiousness by different infection sequences has been more difficult to estimate, there is some evidence to suggest that it might also vary between serotypes [14]. Furthermore, recent work suggests that such immune enhancement is important for serotype persistence in the presence of transmission heterogeneity [20]. The potential impact of vaccination on dengue transmission dynamics in Thailand and Vietnam has been explored in two recent publications by Chao et al. [21] and Coudeville et al. [22] using an agent-based model and an age-specific compartmental model, respectively. Both of these studies found that

vaccines with efficacy of 70–90% against all serotypes have the potential to significantly reduce the frequency and magnitude of epidemics on a short to medium term. However, while both of these models do account

for some sources of heterogeneity between serotypes, for example, differences between the serotypes in transmission intensity, they do not systematically examine the potential impact of these heterogeneities in the context of partially effective vaccines. Here, we use an age-stratified dengue transmission model to assess the potential impact of vaccines with high efficacy against dengue serotypes 1, 3 and 4 and low efficacy against dengue serotype 2 in a hyperendemic Thai population. We explore multiple disease/transmission scenarios to identify those that might lead to increases in clinically apparent cases and to identify the potential reductions in disease. Crucially, we evaluate the effects that certain serotype Pictilisib purchase heterogeneities may have in the presence of mass-vaccination campaigns. We also explore overall, direct and indirect effects of reducing (or in some cases increasing)

infection and disease in vaccinated individuals vs. reductions in transmission population wide. We formulated a deterministic, age-stratified compartmental dengue transmission model that includes explicit vector dynamics as well as cross-protection and infectiousness enhancement between dengue serotypes. Humans are assumed to be born susceptible and can undergo up to two infections by heterologous serotypes. Mosquito vectors are classified ever as susceptible or infected by each of the circulating serotypes. We focus on the dengue vaccine being developed by Sanofi-Pasteur that requires three doses to achieve high protection. Vaccination reduces the inhibitors susceptibility of vaccinated humans to dengue infection. We also allow for immune mediated vaccine induced enhancement in transmissibility. Since the main objective of our study was to explore changes in the number of clinically apparent dengue cases, upon mass-vaccination, we made assumptions about the probability of developing clinically apparent disease following infection. These assumptions also allowed us to calibrate our model with data from surveillance systems.

Similarly described were situations in which physicians ignored p

Similarly described were situations in which physicians ignored patients’ rights: “… we have AZD6244 in vitro patients that are quite elderly that have a cancer diagnosis and the doctors are very aggressive in their treatment in providing chemotherapy and that they wait way too long before they get hospice involved so the patients can actually have that good death and be at home like they want to be. I am challenged with that almost every Inhibitors,research,lifescience,medical day in trying to be a patient advocate … even recently a patient said, ‘Will you please be there when the doctor makes rounds tomorrow so that he doesn’t talk me out of this,

again. Will you please be there? I just want to go home …’ … it’s not about what I want, it’s about what the patient wants, and so I try to make sure the patient has all the information and that the doctor knows what the patient wants, and the patient is clear Inhibitors,research,lifescience,medical about that and we’re all on the same page with it.” This is another example of mindfulness or self-awareness achieved by creating a communication process for re-examining one’s own and others’ values. When the patient Inhibitors,research,lifescience,medical felt that the physician was trying to impose his/her

own values, s/he asked the nurse to assume a supportive role as a mediator, bringing the value conflict out in the open and then placing the patient’s values first. When faced with these types of situations, many narrators took it upon themselves to advocate for patients’ rights. This story also illustrates Inhibitors,research,lifescience,medical how a value-challenging situation can reach a resolution where everyone feels comfortable with the outcome. Resolutions were reached only in one-sixth of all the challenging

stories. Going Above and Beyond Most of the WLNs that were categorized as ‘going above and beyond’ were related to self/patient and the organization. These stories Inhibitors,research,lifescience,medical included advocating on patients’ behalf, fighting for preserving good-quality care, and being creative in finding ways to help in spite of organizational rules and regulations. As opposed to value-affirming nearly WLNs of going above and beyond that were creative and fun, the value-challenging WLNs included violating hospital regulations to assist a patient, as illustrated in the following example: “I think sometime you have to kind of walk the line versus hospital politics, like possibly a patient leaving the hospital knowing they don’t have resources, maybe you can help them out, there are things that you have to do that is not protocol, but it’s in the best interest of the patient or person. So you do it. One example is that you are never supposed to go to a person’s house to do something. We had an IV line still in him that we forgot to take out and the family said they couldn’t bring their loved one back to the hospital.

1978) Although none of the participants met the criteria for maj

1978). Although none of the participants met the criteria for major depressive episodes and other psychiatric disorders, we further investigated the presence of depressive and anxiety symptoms using the Beck Depression Inventory and the Hamilton Rating Scale Anxiety, respectively (Hamilton 1959; Beck and Steer 1987). In PD patients, these cognitive functions were only evaluated Off-therapy given the short half-life of apomorphine (see next section). Inhibitors,research,lifescience,medical Overall, the neuropsychological session lasted approximately 1 h. Demographic and neuropsychological data were analyzed using independent two-sample t-tests within SPSS (Statistical Package for Social

Sciences, Apomorphine test in PD patients To prevent vomiting and/or nausea, patients were administered domperidone (60 mg/daily) for 48 h before Inhibitors,research,lifescience,medical the apomorphine test (Bowron 2004). Fourteen hours prior to scanning, all medications except domperidone were withdrawn.

PD patients attended two distinct sessions (i.e., Off- and On-apomorphine). The apomorphine test was executed either at the first or second fMRI session in a counterbalanced order across patients (sessions were separated by at least 1 day). This protocol ensured a complete Inhibitors,research,lifescience,medical drug clearance in case apomorphine was administered at the first session (apomorphine half-life is ~45 min; Bowron 2004; LeWitt 2004). Apomorphine was subcutaneously injected 10 min before Inhibitors,research,lifescience,medical scanning at the dose of 0.04 mg/kg (mean dose ~3 mg). This schedule and dosage allow us to study apomorphine effects on cognitive functions approximately at drug peak dose and under a strong postsynaptic pharmacological action (Bowron 2004; LeWitt 2004). Motor symptoms were assessed via UPDRS before and after apomorphine injection. Inhibitors,research,lifescience,medical To account for nonspecific drug effects on arousal, patients were also asked to report their arousal level via a specific questionnaire (Mackay et al. 1978) before and after apomorphine injection. fMRI task Participants executed a modified version of a verbal working-memory paradigm that

has been click here previously validated Casein kinase 1 in PD patients and that evokes robust activations within the PFC and striatum (Lewis et al. 2003, 2004). There were three types of trials: (1) high-load working memory: subjects were instructed to remember a string of six uppercase letters presented for 2 sec and followed by a 3-sec delay of blank screen. Next, a lowercase probe letter was displayed for 2 sec and subjects were asked, within this time-window, to press a button when the probe matched any of the letters previously displayed in the string. Alternatively, no response was required. A 1-sec delay of blank screen concluded the trial that lasted 8 sec in total; (2) medium-load working memory: trials were identical to previous ones except for a string that contained three letters intermixed to three abstract symbols (#).

Conflict of Interest None declared
Traditionally, both ast

Conflict of Interest None declared.
Traditionally, both astrocytes and microglia have been thought to act as supportive cells in the central nervous system (CNS). It is now widely appreciated that astrocytes and microglia are not only involved in virtually every aspects

of neural function in the mature brain (Fields and Stevens-Graham 2002) but also play important roles during CNS development. For example, both astrocytes and microglia are involved in neuronal differentiation, migration, programmed cell death, neurite growth, axon guidance, as well as ABT 888 synaptic formation (Deverman and Patterson 2009). On the other hand, oligodendroglia or oligodendrocyte (OL) appears to resemble more closely to neuron rather Inhibitors,research,lifescience,medical than to astrocyte or microglia, in terms of developmental programs and susceptibility to injury. For instance, OL progenitor cells (OPCs) and neurons arise from similar regions of the neuroepithelium, and their fate determination is driven by similar transcription factors (Bradl and Lassmann 2010). Both OPCs and neurons are born in Inhibitors,research,lifescience,medical excess, but their numbers are reduced dramatically through programmed cell death (Barres et al.1992; Buss et al. 2006). As for cell survival, certain neurotrophic factors are critically involved Inhibitors,research,lifescience,medical for both types of cells, while most of those factors are known to be secreted by astrocytes and microglia (Althaus et al. 2008). In addition

to these similarities in developmental features, both neuron and Inhibitors,research,lifescience,medical OLs are susceptible to certain insults including glutamate excitotoxicity, inflammatory cytokines, and reactive oxidative stress (Leviton and Gressens 2007; Volpe et al. 2008; Volpe 2009). At present, OL lineage development is well characterized, especially in rodents (Miller 2002; Emery 2010a). Initially, OPCs proliferate in regions where they are generated from multipotent neural progenitor cells, and then migrate to their destination. To ensure that the number of OPCs matches with their corresponding axons, excessive Inhibitors,research,lifescience,medical OPCs are eliminated through apoptosis, and the survived cells then undergo terminal differentiation and start

to myelinate axons. One of the important features of OL development is that it is largely controlled by extracellular cytokines, most of which STK38 are known to be secreted by astrocytes and microglia. Although extensive studies have been conducted to understand the role of individual cytokine on OL development, it is most likely that OLs are exposed to multiple cytokines/growth factors in vivo, thus their biological responses depend on the types of the final signaling pathways activated. However, this is very difficult to assess in vivo. The conditioned medium from astrocytes or microglia offers some aspects of the in vivo environment and may provide information to better elucidate the roles of astrocytes and microglia during OL development.

Recognizing the exciting potential for new STI vaccine developmen

Recognizing the exciting potential for new STI vaccine development to address the impact of STIs on global sexual and reproductive health Adriamycin price and the need for new prevention strategies, the World Health Organization (WHO) and the U.S. National Institute of Allergy and Infectious Diseases (NIAID) co-edited this special issue of the journal Vaccine. To catalyze interest and action related to STI vaccine research and development, this special issue provides state of the art reviews on vaccine development for five priority STIs: HSV-2, chlamydia, gonorrhea, trichomoniasis,

and syphilis. Manufacturing and programmatic considerations for STI vaccine development and introduction are also addressed. The first article by Gottlieb et al. provides an overview of the global burden of STIs and their sexual, reproductive, and maternal-child health consequences [2]. The article also addresses the limitations of available interventions to control STIs, emphasizing the need for new STI vaccines for Sorafenib purchase effective STI prevention and control. In the following article, Garnett describes mathematical modeling related to the theoretical impact of STI vaccines and demonstrates that these vaccines would be cost-effective and their development a worthwhile investment [8]. The next articles address the scientific advances

underpinning development of the five specific STI vaccines. First, Brotman et al. describe the unique immunological characteristics of the reproductive tract, providing insight into the compartmentalization of the mucosal immune responses, the role of the microbiome, the impact of sex hormones, and the interactions among all of these factors [9]. Two articles stress the urgent need as well as significant opportunities for the development of vaccines against HSV: (1) Johnston et al. review previous HSV vaccine trials and outline new scientific

findings offering new directions for HSV vaccine development [10]; and (2) Knipe et al. report on an NIAID workshop on the next generation of HSV vaccines [11]. In addition, two articles outline the scientific advances providing new hope for development of a chlamydia vaccine. Hafner et al. describe current knowledge and future vaccine directions for control of genital chlamydial through infection [12], while Mabey et al. review the lessons learned from efforts to develop a vaccine against ocular chlamydia (trachoma) [13]. Increasing gonococcal antimicrobial resistance has led to new urgency to develop a vaccine against gonorrhea, and Jerse et al. summarize technological advances that could lead to Libraries making this vaccine a reality [14]. Smith and Garber give an update of prospects for development of a vaccine against Trichomonas vaginalis infections [15], and Cameron and Lukehart discuss challenges and opportunities for development of an effective vaccine against syphilis [16]. Finally, an article by Dochez et al.

Sensitivity of various Q-EMG criteria

according to biopsy

Sensitivity of various Q-EMG criteria

according to biopsy findings. In the pure M4 category (the most subtle of the myopathic abnormalities), the amplitude outlier method was significantly more sensitive than the duration outlier (p = 0,000 and p = 0.000 respectively). Discussion The primary aim of the study was to correlate QEMG and pathological findings in the biopsy of the contralateral muscle in patients with muscle disease. Although ideally the correlation should have been done in the same muscle this would not have been pragmatic since current practice is to perform Inhibitors,research,lifescience,medical the EMG on one side and do the biopsy on the contralateral muscle to avoid the risk of needle myopathy. We also examined the spectrum of histological abnormalities that are associated with abnormalities on QEMG. We have found the amplitude outlier method to be the most sensitive in identifying myopathic abnormalities with a sensitivity of 69%.The positive predictive value of QEMG i.e. the likelihood of Inhibitors,research,lifescience,medical abnormal biopsy if the QEMG is abnormal is very high (87.5-100%). The number of patients with a normal biopsy is perhaps too small to perhaps Inhibitors,research,lifescience,medical give valid negative predictive values. For the outlier methods of

analyses we have arbitrarily used the cut of reference values from Oh which are the values we normally use for qualitative MUAP analysis (13). We are aware that the method we have used to extract MUAP introduces a bias towards low threshold motor units but we made a special effort to vary the window trigger to capture Inhibitors,research,lifescience,medical MUAP of various amplitudes as long as the rise time was < 500μsec. The latter requirement ensured that the needle was very close to the firing muscle fiber and the MUAP amplitude greatly influenced by the diameter of the closest fiber. Although different

absolute values for the outliers have been used, derived using the multi-MUAP extraction method other studies have also identified the amplitude outlier analysis as a sensitive method for myopathies. A recent study on facioscapulohumeral muscular dystrophy found that in the milder affected vastus lateralis the amplitude outlier method was 33% sensitive compared to a 10% of Inhibitors,research,lifescience,medical the duration outlier method (15). Similarly, in a smaller study of 8 patients with myopathies the amplitude outlier method was 75% sensitive compared to 25% and 37,5% of the duration outlier and mean duration methods (12). This difference in sensitivity between the various QEMG methods Phosphoprotein phosphatase in our study could perhaps be explained by the PF-01367338 nmr sequence of histological changes commonly seen in the biopsy of most slowly evolving myopathies. Initially there is increasing variability in fibres size due to round atrophy involving both fibre types (16). As the myopathy becomes more severe there is gradual loss of muscle fibres and replacement with endomysial connective tissue (17). In addition to fibre loss there may be compensatory increase in the diameter of surviving fibres (work hypertrophy) (16).

Bussel, Madhavi Lakkaraja Is B-cell depletion still a good strate

Bussel, Madhavi Lakkaraja Is B-cell depletion still a good strategy for treating immune thrombocytopenia? Bertrand Godeau, Roberto Stasi Novel treatments for immune thrombocytopenia Andrew Shih, Ishac Nazi, John G. Kelton, Donald M. Arnold Warm autoimmune hemolytic anemia: advances in pathophysiology and treatment Marc Michel Autoimmune neutropenia Aline Moignet, Thierry Lamy “
“L’artériopathie oblitérante des membres inférieurs (AOMI) est un important facteur de risque cardiovasculaire. La prévalence de l’AOMI en médecine interne

est élevée. “
“Le taux des personnes du régime général de Sécurité sociale ayant eu un remboursement en 2000 d’un

anxiolytique, MI-773 research buy d’un antidépresseur ou d’un hypnotique était respectivement de 17,4 % ; 9,7 % et 8,8 %. Dans une population de travailleurs indépendants en activité (artisans, commerçants, Libraries industriels et professions libérales) le taux de personnes ayant eu en 2009 un remboursement d’anxiolytique, d’antidépresseur ON-01910 clinical trial ou d’hypnotique était respectivement de 9 %, 5,5 % et 4,4 %. “
“Le syndrome d’Asperger appartient aux troubles envahissants du développement. La version française de 3 questionnaires de dépistage only du syndrome d’Asperger et de l’autisme sans déficience intellectuelle. “
“Modification de la loi dite « Huriet–Sérusclat » en 2004 Précisions sur les critères de qualification des recherches portant sur les soins courants (RSC) “
“Dans l’article « Fibrillation atriale : qui anticoaguler ? » d’Olivier Césari paru dans le numéro de juin 2010 de La Presse Médicale, une erreur s’était glissée dans l’acronyme du score HEMORR2HAGES : la dernière lettre S correspondant à Stroke (accident vasculaire

cérébral) n’a pas été mentionnée. Il fallait donc lire « HEMORR2HAGES » quand le score était cité dans l’article et dans la figure 2. Le tableau VII comprend donc une ligne supplémentaire. Par ailleurs, la ligne des plaquettes a été détaillée. Nous prions nos lecteurs de nous excuser pour cette regrettable erreur. “
“Le dispositif des directives anticipées tel qu’introduit dans la loi française depuis 2005. Une vision de terrain sur la façon dont sont perçues les directives anticipées par la population. “
“L’arrivée de nouveaux anticoagulants oraux (NACO) bouleverse une pratique médicale qui s’appuyait depuis plus de 50 ans sur les anti-vitamines K (AVK), et depuis au moins 25 ans sur les héparines de bas poids moléculaire (HBPM).

In 1993,44 the group reported results from 96 patients who were a

In 1993,44 the group reported results from 96 patients who were admitted to an open trial of clozapine for treatment-resistant schizophrenia at the University

Hospital of Cleveland, and demonstrated that quality of life scores only improved in patients who continued clozapine treatment for at least 2 years, which means an improvement of 242%. Rosenheck et al16 conducted a comparative study of clozapine and haloperidol in refractory schizophrenic inpatients. They carried out a randomized, 1-year double-blind study at 15 Veterans Affairs medical centers. A total of 423 patients (clozapine = 205 and haloperidol = 218) Inhibitors,research,lifescience,medical were assessed using the QLS.35 After 1 year, 117 clozapine-treated patients and 61 haloperidol-treated patients continued their assigned treatment. In these patients, clozapine was significantly better than haloperidol in improving patients’ quality of life. In 1996, Essock et al17 failed to find superiority of clozapine over conventional Inhibitors,research,lifescience,medical antipsychotics on patients’ quality of life. Their study was the Inhibitors,research,lifescience,medical first randomized costeffectiveness trial of clozapine. It was a 2-year open-label randomized study comparing clozapine with usual care in schizophrenic

or schizoaffective treatment-resistant inpatients. A total of 227 patients (138 in the clozapine group and 89 in the usual care group) were assessed using the Quality of Life Interview (QoLI).14 Clozapine did not significantly affect patients’ quality of life. By the 8th month of treatment, both groups experienced equivalent improvements in the QoLI global satisfaction score. Olanzapine Hamilton et al23 evaluated the impact of treatment with olanzapine compared with haloperidol and placebo on quality of life in schizophrenic inpatients. Inhibitors,research,lifescience,medical They conducted a double-blind randomized study, with a 6-week acute phase and an Regorafenib research buy extension Inhibitors,research,lifescience,medical phase of 46 weeks for the responders. A total of 335 patients were randomized to one of the following groups: olanzapine 5±2.5 mg/d, olanzapine 10±2.5 mg/d, olanzapine 15±2.5 mg/d, haloperidol 15±5 mg/d, and placebo. Data at extension

week 24 was reported in their paper. Quality of life was assessed employing the QLS.35 At end point, no significant changes in the QLS total and subscale scores were observed for the placebo, olanzapine low-dose, or haloperidol groups. Moreover, significant improvements were oxyclozanide observed for olanzapine medium and high doses. The olanzapine medium-dose group demonstrated significant greater improvements in all QLS scores than the placebo group. The olanzapine high-dose group showed greater improvement in QLS total score compared with the placebo treatment group. The impact of olanzapine on quality of life has also been compared with the impact of haloperidol in a 6-week, double-blind randomized multicenter trial with a longterm extension (46 weeks).

The article was sent to an Austrian periodical but it was rejecte

The article was sent to an Austrian periodical but it was rejected with commentary that the immunological analysis was too insufficient to allow the disease to be declared immunologic. We published the case in Extenso in 1984 (13). We continued to discover many patients with similar main symptoms: for example, there was a patient with hypoparathyroidism, generalized stiffness and abundant spontaneous electromyographic activity (14), then there was a baby and a child with neuromyotonia (15, 16) and four adolescent patients – two sporadic and two hereditary (17). All of them improved on carbamazepine. In the two sporadic adolescents, even an extensive Inhibitors,research,lifescience,medical remission on corticosteroids was recorded. In one hereditary case,

intensive Inhibitors,research,lifescience,medical contracture in the arm joint disappeared after a local curare test (18). Pronounced contractures in the wrist area and interphalangeal joints, in four adult patients with

dystrophic myotony improved also following a regional curare test. The result pointed to the possible origin in distal nerve irritation (19). Correctible contractures, with lasting extensive improvement The observed contractures developed in a short time, limited to the third, fourth Inhibitors,research,lifescience,medical and fifth finger and wrist, with some sensibility damage in the ulnar nerve innervation region. In two cases, the compression was differentiated in the elbow region; in the one, it was on the lower arm. Instead of tenotomy or an operation of the muscle, neurolysis was done. The location was indicated by MS-275 in vivo plurisegmental electroneurography. Contracture disappeared very soon after the operation (20). Persistent contractures Very precise differential diagnostics of a slowly progressive diffuse contracture of the spine (“rigid spine syndrome” Inhibitors,research,lifescience,medical ) was conducted, associated with thorax deformity, mainly proximal myopathy and delayed sexual maturity, in three unrelated patients (21). In 1989 (22), I published an article about progredient syndrome in two generations, when the syndrome had not yet been described in the literature.

It had been considered as joint Inhibitors,research,lifescience,medical disease. However, it was obviously a disease of the muscle. A very slow progredient contracture Calpain of the fingers is the dominant symptom. Percussion of muscle causes depression only on the tongue, while on the extremities it causes extreme high skin bulging. On forced, passive extension of muscles, repetitive EMG activity occurred as registered by special bipolar wire electrodes used in my other kinesiologic studies. On the local curare test the contracture disappeared and the percussion response was reduced. Paroxismal, generalised, very painful spasms in full consciousness After occurring for five days, at intervals of a few minutes, throughout the day and night, generalised spasms almost led to the death. Individually adjusted and prolonged therapy by methyl-prednisolone led to complete remission with the patient living a normal life for years afterwards.