Inferior olivary nucleus hypertrophy results from a pathologic lesion in the Guillain-Mollaret triangle. The relationship between inferior olivary nucleus hypertrophy and the medullary lesion is obscure. To the best of our knowledge, only 1 autopsy case with unilateral medial medullary infarction that was associated with ipsilateral inferior olivary nucleus hypertrophy

has been reported. We describe a rare case Entinostat with acute infarction in the bilateral medial medulla oblongata accompanied by subacute bilateral inferior olivary nucleus hypertrophy and panmedullary edema. The hypertrophy appeared to have been caused by local ischemic damage to the termination of the central tegmental tract at the bilateral Defactinib ic50 inferior olivary nucleus.”
“Endometrial thickness is one of the parameters contributing to the outcome of assisted reproduction treatment. The aim of the current study was to investigate the pregnancy rate and the outcome when the endometrial thickness was <7 null during a treatment cycle. Treatments conducted between January 2000 and December 2004 at the German Hospital

in Istanbul were reviewed retrospectively. A total of 175 embryo transfer cycles with all endometrial thickness of <7 mm oil the day of oocyte retrieval were assessed. The 175 oocyte retrieval-embryo transfer cycles resulted in 53 pregnancies (30%). of which 11% were biochemical pregnancies. 26% were miscarriages and 59% were delivered. The clinical pregnancy rate was 26%. miscarriage rate was 31% and live birth rate was 17%. However, the results were quite good when the patient age was <35 years or the number of oocytes retrieved was over five or the number of available embryos to transfer was three or more. In conclusion. when the endometrial thickness is <7 mm during in treatment cycle, the couple should be informed about the chance of pregnancy and the outcome. In a young normoresponder woman with at least three embryos available for transfer,

transfer www.sellecn.cn/products/ly2835219.html could be carried out, otherwise embryo freezing should be recommended.”
“The ever-increasing requirement for determination of environmental pollutants and studies of comprehensive metabolite networks in complex real-life samples parallel advancements in solid-phase microextraction (SPME). The availability of state-of-the-art analytical instrumentation offering higher sensitivity and specificity has contributed to an increased range of applications covered by SPME.

This review summarizes the most basic aspects in SPME development, addresses some of the challenges encountered in the analysis of food and environmental samples, and particularly emphasizes complex sample analysis. We also outline the development of new extracting materials, novel sampling configurations and approaches compatible with complex sample and/or on-site determinations.

SETTING:

Royal Victoria Hospital, Barrie, Ontario, Canada.

METHODS: Cataracts were selleck graded using Scheimpflug imaging (Pentacam) in consecutive patients. In Group 1, surgery was performed with no change in parameters. In Group 2, adjustments were made preoperatively in fluidics and phaco power to reflect the cataract grade determined by Scheimpflug imaging. Parameters assessed in both groups included effective phaco time (EPT), balanced salt solution (BSS) use, and needle time to remove the cataract.

RESULTS: There were 200 patients in each group. Emulsification and aspiration of higher and lower grades of cataract took statistically significantly less EPT and BSS in Group 2 (preoperative parameter adjustments) than in Group 1. The needle time for the higher grades of cataract was statistically significantly less in Group 2. For cataracts of a middle grade (2 to 3; 63% of cases), there was no statistically significant difference between standard phaco settings and adjusted settings. The cataract was effectively aspirated in both groups.

CONCLUSION: Preoperatively adjusting phaco

parameters based on cataract grade helped improve overall efficiency by reducing the amount of energy and fluid used in the eye and reducing overall phaco time.”
“Chitosan (CS) can be used as adsorbent in the treatment of effluents from the textile industry, especially for negatively charged dyes, due to its cationic polyelectrolyte nature. In this work, the adsorption of a model Combretastatin A4 purchase dye, methyl orange, xylenol orange on hollow CS microsphere is analyzed. Adsorption of methyl orange, xylenol orange onto cross-linked CS is realized by means of analysis of pH influence, agitation time, and initial concentration of the dye. The results obtained from the experiment shows that the adsorption capacities of the two dye-hollow CS microsphere mTOR inhibitor systems are higher than those stated in other literature using CS particles. The difference in the degree of adsorption may also be attributed to the size and chemical structure of the dye molecule. The

results have demonstrated that monovalent and smaller dye molecular sizes have superior capacities due to the increase in dye/CS surface ratio in the system and deeper penetration of dye molecules into the internal pore structure of hollow CS microsphere. (C) 2010 Wiley Periodicals, Inc. J Appl Polym Sci 119: 2065-2071, 2011″
“The electronic scattering rates in metals after ultrashort pulsed laser heating can be drastically different than those predicted from free electron theory. The large electron temperature achieved after ultrashort pulsed absorption and subsequent thermalization can lead to excitation of subconduction band thermal excitations of electron orbitals far below the Fermi energy.

Sliced glands were examined with wavelength ranges of 330-760 nm. The ESS portable system used a new fiber-optic probe with integrated cutting tool, designed specifically for ex vivo pathology applications. ESS spectra were grouped by diagnosis from standard histopathological procedure and then classified

using linear support vector machine. Preliminary data are encouraging. ESS data showed strong spectral trends correlating with the histopathological assignments. The classification results showed a sensitivity of 0.83 and specificity of 0.87 for selleck chemicals distinguishing dysplastic prostatic tissue from benign prostatic tissue. Similar results were obtained for distinguishing dysplastic prostatic tissue from prostatitis with a sensitivity and specificity of 0.80 and 0.88, respectively. The negative predictive values obtained with ESS are better than those obtained with transrectal ultrasound (TRUS)-guided core-needle biopsy.”
“The purpose of these recommendations is to provide a standard format for reporting treatment results and standardised epidemiologic

data after aortic vascular graft infection to improve the comparison of clinical outcomes between different therapeutic approaches and different study populations. Analytical reporting standards for patients’ characteristics, type and extent of the disease, type of treatment and study design are described. Adherence to these recommendations will improve clinical selleck compound relevance, quality and comparability of future studies dealing with aortic vascular graft infections. (C) 2011 European Society for Vascular Surgery. Published RG-7112 molecular weight by Elsevier Ltd. All rights reserved.”
“Context: Sulfur mustard

(SM) is a highly reactive vesicating agent that can induce severe ocular injury. The clinical features of this injury have been well documented, but the molecular basis for this pathology is not well understood. Identification and validation of specific targets is necessary in the effort to develop effective therapeutics for this injury. Currently used rabbit models are not well suited for many molecular studies because the necessary reagents are not widely available. However, these reagents are widely available for the mouse model. Objective: Our objective is to develop a mouse model of SM-induced ocular injury suitable for the study of the molecular mechanisms of injury and the evaluation of therapeutics.

Materials and Methods: Ocular exposure to sulfur mustard vapor was accomplished by using a vapor cup method. Dose response studies were conducted in female BALB/c mice. An exposure dose which produced moderate injury was selected for further study as moderate injury was determined to be amenable to studying the beneficial effects of potential therapeutics. Histopathology and inflammatory markers were evaluated for up to 28 days after exposure, while clinical injury progression was evaluated for 1 year post-exposure.

We show that when the molar ratio of Au salt to dendrimer was equal to or larger than 75: 1, the acetylated Au DENPs showed a significant aggregation after lyophilization, and the addition of glucose was able to preserve the colloidal stability of the particles.

X-ray absorption measurements showed that the attenuation of the acetylated Au DENPs was much higher than that of the iodine-based contrast agent at the same molar concentration of the active element (Au vs iodine). In addition, the acetylated Au DENPs enabled X-ray computed tomography (CT) imaging of mice after intravenous injection of the particles. These findings suggest a great potential for acetylated MK-8776 Au DENPs as a promising contrast agent for CT imaging applications. (C) 2010 Wiley Periodicals, Inc. J Appl Polym Sci 119: 1673-1682, 2011″
“In situ observations of phonon Raman and Boson scattering were performed in high-Nb2O5-content barium-sodium aluminophosphate glass, which crystallizes tungstenbronze-type Ba2NaNb5O15 (BNN), during

heating and subsequent cooling processes in order to examine the BNN crystallization dynamics and phase transitions. It is suggested that NbO6 clusters/cohesive regions are present and are subjected to stress by the surrounding aluminophosphate network prior to crystallization of the BNN phase. Furthermore, in the cooling period, a successive phase transition (4/mmm -> 4mm -> Captisol manufacturer mm2) of the BNN phase was observed in the glass-ceramics, implying the possibility of producing functional glass-ceramics with ferroelastic properties. (C) 2010 American Institute of Physics. [doi:10.1063/1.3512909]“
“Objective. This study aimed to investigate the level of vascular endothelial growth factor (VEGF) in the temporomandibular joint (TMJ) synovial fluid (SF) and the severity of arthroscopically observed synovitis before and after visually guided TMJ irrigation (VGIR) in Vadimezan patients with chronic closed lock (CCL). In addition,

the findings were correlated with the clinical outcome.

Study design. Twenty-four patients with unilateral CCL, who underwent a second VGIR either as a repeated therapeutic TMJ irrigation or as a follow-up arthroscopy, were enrolled in the study. They were divided into either successful (s-group; n = 11) and unsuccessful (u-group; n = 13) groups. The VEGF level in the aspirated SF and the severity of synovitis were compared between the s- and u-groups. In each group, the same parameters were compared before and after VGIR. The correlation of the VEGF level with the severity of synovitis was also studied.

Results. At the first VGIR, the VEGF levels showed no significant differences when comparing s- and u-groups. At the second VGIR, the VEGF level was significantly higher in the u-group.

The phase boundary, composed of the intersections and separating the superconducting states from the insulating state, is shown to be a generic consequence of granularity. (C) 2010 American Institute of Physics. [doi: 10.1063/1.3437653]“
“Purpose To describe the psychometric properties and identify the minimally important difference (MID) of the hepatitis C virus patient-reported outcomes (HCV-PRO) instrument. Chronic HCV infection and associated treatments negatively affect PROs of function and well-being.

In a phase 2 trial, HCV-infected patients received direct-acting

FDA approved Drug Library cell line antivirals (DAAs) for 12 weeks with peg-interferon/ribavirin (peg-IFN/RBV) for 48 weeks, or placebo plus peg-IFN/RBV. The HCV-PRO total score, SF-36 PCS and MCS scores, EQ-5D-3L, and EQ VAS were measured at baseline, week

8, end of DAA treatment (EODT), end of peg-IFN/RBV treatment (EOT), and posttreatment week 24 (SVR24). Convergent validity of the HCV-PRO was assessed by Pearson’s correlation coefficients. Discriminant validity was assessed by analyzing mean HCV-PRO total scores by EQ-5D anxiety/depression and pain/discomfort domain scores (none vs. some) and presence/absence of depression or fatigue adverse events. MID was identified through effect size (ES) and receiver-operating FRAX597 nmr characteristic (ROC) curve analyses (HCV-PRO response vs. SF-36 PCS/MCS and EQ VAS MID thresholds).

In 74 patients (22 % female; 81 % White; 51 % a parts per thousand yen50 years), correlations (0.64-0.96) between HCV-PRO total scores, SF-36 PCS/MCS scores, and EQ VAS scores at all time

points supported convergent validity. HCV-PRO total scores were reduced to 10-30 points in patients impaired by depression, pain, or fatigue symptoms. Impact of peg-IFN/RBV regimen on HCV-PRO ES increased over time (EODT -0.76; EOT -0.93). ES and ROC curve analyses indicated an MID of -10 points.

The HCV-PRO was valid and responsive in the population studied. An MID of -10 points represented a threshold of clinical significance for the HCV-PRO.”
“The Pinometostat cell line microstructures and electrical properties of Aurivillius phase ferroelectric solid solutions of (CaBi2Nb2O9)(1-x)(BaBi2Nb2O9)(x) (0 <= x <= 1) have been studied. X-ray diffraction analyses revealed a bismuth layered structure for all compositions. Scanning electron microscope images showed randomly oriented and platelike grain morphology. The Curie point T-c or the maximum permittivity temperature T-m decreased with increasing x. The (CaBi2Nb2O9)(1-x)(BaBi2Nb2O9)(x) ceramics exhibited a ferroelectric-paraelectric phase transition at small x values (x <= 0.5), whereas a relaxor behavior was observed at high x values (x >= 0.8). The d(33) value of CaBi2Nb2O9 ceramics was enhanced by Ba2+ doping on the A-sites (x <= 0.3). A combination of high d(33) values and high T-c points (>700 degrees C) suggests that compositions with x <= 0.

“
“This study reports the antimicrobial resistance of Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes isolated from patients in Algeria, Morocco and Tunisia. 672 non-duplicate isolates were recovered from May 2006 to May 2007. The minimum inhibitory concentrations (MICs) were determined using the E-test and interpreted according learn more to EUCAST

guidelines. Among 236 S. pneumoniae, 47% were penicillin non-susceptible (PNSP) with 3% of strains being highly resistant; 20.4% and 17.4% had decreased susceptibility to amoxicillin and cefotaxime, respectively. Dual resistance to penicillin and erythromycin was observed in 30.1%. All isolates were susceptible to levofloxacin except one. Among 262 H. influenzae, 13.3% were amoxicillin-resistant and beta-lactamase producers.

Two isolates were beta-lactamase-positive and amoxicillin-clavulanate-resistant. All isolates were susceptible to cefixime, cefotaxime and levofloxacin. All S. pyogenes (17 4) were susceptible to beta-lactams with 5.7% LY2606368 price resistant to erythromycin. Five had decreased susceptibility to levofloxacin. These data on respiratory tract pathogens indicate the high prevalence of PNSP in North African countries.”
“Background : Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors in the gastrointestinal tract. Recently, many methods for the diagnosis of GIST have been developed including molecular diagnosis. Methods : We selected 90 cases of GIST that had presented at Kyungpook National University Hospital between 1998 and 2007. Tissue microarrays were made using core areas

of tumor tissues. Immunohistochemical staining for c-kit, protein kinase C-theta, and platelet-derived growth factor receptor alpha (PDGFRA) was done. Direct sequencing of hot spot exonal areas for c-kit and PDGFRA GSK2245840 were done using extracted DNAs of all 90 paraffin block tissues. Results : Among the 90 cases, 83.3% (75/90) were c-kit positive, 16.6% (15/90) were c-kit negative, 93.3% (84/90) were PDGFRA positive, and 6.6% (6/90) cases were PDGFRA negative. Fifteen cases of c-kit negative GIST included 1 case of PDGFRA negative and 5 cases of PDGFRA negative GIST were c-kit positive. The one case in which both c-kit and PDGFRA were negative, showed a c-kit mutation in exon 11. Conclusions : Combined immunohistochemical staining of c-kit, discovered on GIST 1 (DOG1) and PDGFRA is helpful for the diagnosis of GIST. When all staining tests are negative for immunoreactivity, c-kit mutation analysis for exon 11, 9 should be done. Genotyping of kit and PDGFRA do not need to be examined initially, if it is only for the diagnosis of GIST.”
“Aim To evaluate the effectiveness of a psychological preoperative program in reducing preoperative anxiety and in promoting compliance of pediatric participants with surgical procedures.

Capturing the molecular mechanisms of miRNA interacting with its target will not only reinforce the understanding of underlying RNA interference but also fuel the design of more effective small-interfering RNA strands. To address this, in the present work the RNA-bound (Ago-miRNA, Ago-miRNA-target) and RNA-free Ago forms were analyzed by performing both molecular dynamics simulations and thermodynamic analysis. Based on the principal component analysis results of the simulation trajectories as well as the correlation analysis in fluctuations of residues, we discover that: 1) three important (PAZ, Mid and PIWI) domains exist in Argonaute which define the global dynamics of the

protein; 2) the interdomain correlated movements are so crucial for Selleck TPX-0005 the interaction of Ago-RNAs that they not only facilitate p38 kinase assay the relaxation of the interactions between residues surrounding the RNA binding channel but also induce certain conformational changes; and 3) it is just these conformational changes that expand the cavity of the active site and open putative pathways for both the substrate uptake and product

release. In addition, by thermodynamic analysis we also discover that for both the guide RNA 5′-end recognition and the facilitated site-specific cleavage of the target, the presence of two metal ions (of Mg(2+)) plays a predominant role, and this conclusion is consistent with the observed enzyme catalytic cleavage activity in the ternary complex (Ago-miRNA-mRNA). Our results find that it is the set of arginine amino acids concentrated in the nucleotide-binding channel in Ago, instead of the conventionally-deemed seed base-paring, that makes greater contributions in stabilizing the binding of the nucleic acids to Ago.”
“This study investigated the potential use of reconstituted whey

protein hydrolysate as an antibrowning agent in thermally processed foods and as a chemopreventive ingredient in biological systems. click here Hydrolysates were prepared by tryptic (EC 3.4.21.4) hydrolysis of whey protein concentrate (WPC) or heated (80 degrees C for 30 min) whey protein concentrate (HWPC). Tryptic hydrolysis of WPC and HWPC increased the oxygen radical absorbance capacity-fluorescein (ORAC(FL)) antioxidant capacity from 02 to 0.5 mu mol Trolox equivalent (TE)/mg protein in both whey protein hydrolysate (WPH) and heated whey protein hydrolysate (HWPH) (p < 0.05). The reconstituted WPH and HWPH could prevent the formation of Maillard reaction products (MRPs) induced by a thermal process employed on WPC suspensions between 80 and 121 degrees C in the presence of lactose up to 0.25 M (p < 0.05). The MRPs in HWPC were cytotoxic to both normal human intestinal FHs 74 Int cells and human epithelial colorectal carcinoma Caco-2 cells. The IC50 of HWPC was around 3.18-3.38 mg/mL protein. Nonetheless, when both cell types were grown in media supplemented with WPH prior to the uptake of MRPs in HWPC at 3.5 mg/mL, they were able to survive (p < 0.05).

The LMM is now more suitable for the use in malaria early warning systems as well as for malaria projections based on climate change scenarios, both in epidemic and endemic malaria areas.”
“We

present a case in which a polypropylene mesh was placed over the posterior vaginal wall and was fixed to the sacrospinous ligaments on both sides. Postoperative a rectal obstruction developed which was only resolved after splitting the entire mesh in the midline. It is hypothesised that the obstruction was due to the fixation of the mesh with irresolvable suture material to the sacrospinous ligaments acting as a hinge on which the bowel folded.”
“Patients dying from primary intracranial malignancy are a potential source of organs for transplantation. However, a perceived risk of tumor transfer Vistusertib purchase to the organ recipient has limited their use. We evaluated the risk of tumor transmission by reviewing the incidence in patients transplanted in the UK. Information from the UK Transplant ARN-509 mw Registry was combined with that from the national cancer registries of England, Wales and Northern Ireland to identify all organ donors between 1985 and 2001 inclusive with a primary intracranial malignancy and to identify the occurrence

of posttransplant malignancy in the recipients of the organs transplanted. Of 11 799 organ donors in the study period, 179 were identified as having had a primary intracranial malignancy, including 33 with high-grade malignancy (24 grade IV gliomas and 9 medulloblastomas). A total of 448 recipients of 495 organs from 177 of these donors were identified. No transmission of donor

intracranial malignancy occurred. Organs from patients dying from primary intracranial malignancy, including those with high-grade tumors, should be considered for transplantation and the small risk of tumor transmission should be balanced against the likely mortality for potential recipients who remain on the transplant waiting list.”
“Background: BMS-345541 manufacturer Home-management of malaria (HMM) strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa. However, limited data are available on the effectiveness of using artemisinin-based combination therapy (ACT) within the HMM strategy. The aim of this study was to assess the effectiveness of artemether-lumefantrine (AL), presently the most favoured ACT in Africa, in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania, when provided by community health workers (CHWs) and administered unsupervised by parents or guardians at home.

Methods: An open label, single arm prospective study was conducted in two rural villages with high malaria transmission in Kibaha District, Tanzania.

01 and p < 0.05, respectively).

Conclusion : BsmI and FokI polymorphic sites of VDR could be genetic determinants of BMD in TS patients.”
“As we have shown in the past, acute rejection-related TNF-alpha upregulation in resident macrophages in the tunica muscularis after small bowel transplantation (SBTx) results in local amplification of inflammation, decisively contributing to graft dysmotility.

Therefore, the aim of this study is to investigate the effectiveness of the chimeric-monoclonal-anti-TNF-alpha antibody infliximab as perioperative single shot treatment addressing inflammatory processes during acute rejection early after transplantation. Orthotopic, isogenic and allogenic ML323 nmr SBTx was performed in rats (BN-Lewis/BN-BN) with infliximab treatment. Vehicle and IV-immunoglobulin-treated animals served as controls. Animals were sacrificed after 24 and 168 h. Leukocyte infiltration was investigated in muscularis whole mounts by immunohistochemistry,

mediator mRNA expression by Real-Time-RT-PCR, apoptosis by TUNEL and smooth muscle contractility in a standard organ bath. Both, infliximab and Sandoglobulin (R) revealed antiinflammatory SRT1720 in vivo effects. Infliximab resulted in significantly less leukocyte infiltration compared to allogenic controls and IV-immunoglobulin, which was accompanied by lower gene expression of MCP-1 (24 h), IFN-gamma (168 h) and infiltration of CD8-positive cells. Smooth muscle contractility improved significantly after 24 h compared to all controls in infliximab treated animals accompanied by lower iNOS expression. Perioperative treatment with infliximab is a possible pharmaceutical approach to overcome graft dysmotility early after SBTx.”
“Introduction: Saturation prostate biopsy (SPBx) has been initially introduced to improve prostate cancer (PCa) detection rate (DR) in the repeat setting. Nevertheless, the optimal number and the most appropriate location of the cores,

together with the timing to perform a second PBx and the eventual modification of the PBx protocols according to the different clinical situations, selleckchem are matters of debate. The aim of this review is to perform a critical analysis of the literature about the actual role of SPBx in the repeat setting. Materials and Methods: We performed a systematic review of the literature since 1995 up to 2011. Electronic searches were limited to the English language, using the MEDLINE database. The key words ‘saturation prostate biopsy’ and ‘repeated prostate biopsy’ were used. Results: SPBx improves PCa DR if clinical suspicion persists after previous biopsy with negative findings and provides an accurate prediction of prostate tumor volume and grade, even if the issue about the number and locations of the cores is still a matter of debate.

34%, were click here characterized

and analyzed from room temperature (T = 300 K) up to high temperature (T = 382 K). The Seebeck coefficients of the n-type AlInN alloys show significant enhancement at higher temperature up to 382 K, in comparison to those measured at room temperature. Large Seebeck coefficients (602.0- 1233.2 mu V/K) were obtained for the lattice-matched Al(0.83)In(0.17)N alloy (n = 5.1 x 10(18) cm(-3)) from T = 300 K up to T = 382 K. The improvement of Seebeck coefficients for the n-type AlInN alloys will lead to similar to 1.5-4 times improvement of the thermopower at higher temperatures. (C) 2011 American Institute of Physics. [doi: 10.1063/1.3624761]“
“This study was undertaken to identify and characterize bacterial isolates obtained simultaneously from dead fish samples during a massive fish kill in Kuwait Bay and sewage water samples running into Kuwait Bay, using conventional and molecular techniques. Of the 71 bacterial isolates studied, 66 isolates were recovered from seven different fish species and five isolates were isolated from sewage selleck products samples. The species-specific identity of the isolates was established by phenotypic characteristics and by PCR amplification of the 16S rRNA gene, using Streptococcus agalactiae-specific primers.

The genotyping of 12 isolates from fish samples and all five isolates from sewage samples was performed by random amplification of polymorphic DNA ( RAPD) analyses. Culture methods identified 44 of 66 (67%) find more and 4 of 5 (80%) isolates obtained from fish and sewage samples, respectively, as S. agalactiae. The PCR amplification of 16S rRNA not only confirmed the results of conventional methods, but also resulted in additional identification of 14 of 66 (21%) isolates obtained from fish samples and the remaining isolate recovered from sewage sample as S. agalactiae. A total of nine RAPD patterns were observed among the 17 isolates studied and the RAPD patterns could be grouped into three clusters.

Interestingly, four of the isolates recovered from sewage samples produced nearly identical RAPD banding patterns (85-100% similarity) with some of the S. agalactiae strains isolated from Mullet kidney and brain specimens, indicating the possibility of sewage being the source of infection.”
“Idiopathic Parkinson’s disease (PD) and progressive supranuclear palsy (PSP) are distinct clinicopathological entities characterized by alpha-synuclein and tau pathology, respectively. They have occasionally been reported to co-exist in the same patient. We describe a rare case of a 73-year-old Caucasian woman diagnosed as idiopathic PD 5 years before her death yet at autopsy had not only PD, but also PSP. Although this patient fulfilled clinical criteria for idiopathic PD and did not have supranuclear ophthalmoplegia, she had several atypical features, including early postural instability with falls, early dysphagia, and a relatively rapid course.