Sarcoplasmic ionic calcium concentration in neuroleptic malignant syndrome

The neuroleptic malignant syndrome (NMS) is an uncommon but serious adverse effect of antipsychotic medication. Similarities in the clinical picture, and muscle alterations, between NMS and susceptibility to malignant hyperthermia (MH) suggest common mechanisms underlying both disorders. Sarcoplasmic ionic calcium concentration ([Ca2+]i) was measured by means of Ca2+ selective microelectrodes in intact intercostal muscle fibers isolated from NMS patients and from subjects with no evidence of neuromuscular disease, who served as controls. The mean resting membrane potential and [Ca2+]i were -84 +/- 0.4 mV and 0.11 +/- 0.01 microM (mean +/- SEM) in the control subjects, while they were -84 +/- 0.6 mV and 0.51 +/- 0.02 microM in NMS muscle fibers. Only the difference in [Ca2+]i is significant (P less than 0.001). The incubation of control and NMS muscle bundles in dantrolene (10(-6) M) induced a reduction of [Ca2+]i to 0.06 +/- 0.01 microM and 0.20 +/- 0.04 microM respectively. These results show an alteration in sarcoplasmic ionic [Ca2+] in NMS muscle fibers, suggesting that a dysfunction in skeletal muscle plays some role in the pathogenesis of NMS.     

Angioimmunoblastic lymphoma in a 73-year-old woman

We describe the case of a 73-year-old woman with constitutional disorder and pain in the lower limbs, leading to initial suspicion of multiple myeloma. During the diagnostic process, there were discrepancies between the clinical course and findings of complementary tests. After a fulminant clinical course for a few days, the patient died, and a postmortem diagnosis of angioimmunoblastic lymphoma was established. We review the main aspects of this highly infrequent disease, the pathogenesis of which remains uncertain.