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Biomedical subjects

J R Daube

Publications and source records attributed to J R Daube.

At least 91 records · Page 5Linked to original sources
PubMed1985

Anal sphincter electromyography after colectomy, mucosal rectectomy, and ileoanal anastomosis.

Electromyography (EMG) was used to evaluate the external anal sphincter in 27 patients following colectomy, distal mucosal rectectomy, and ileoanal anastomosis. The studies were conducted four months to 58 months (mean, 20 months) following the restoration of intestinal continuity. Nine patients underwent endoanal rectal mucosal stripping, while in 18 patients the rectum was everted to facilitate the stripping. Postoperative continence varied widely, from perfect to frequent and severe mucous of fecal leak. Abnormal motor-unit potentials were identified by EMG in nine patients and this finding was usually associated with poor continence. The sex of the patient, technique of mucosal stripping, and type of anastomosis did not influence the EMG result, but patients at least 40 years old all had abnormal EMGs. We conclude that poor continence after ileoanal anastomosis correlates with an abnormal EMG of the external anal sphincter. The cause of the EMG abnormality is unclear.

Adolescent↗
PubMed1985

Near normoglycaemia improved nerve conduction and vibration sensation in diabetic neuropathy.

Twelve C-peptide deficient Type 1 (insulin-dependent) diabetic patients with abnormal peripheral nerve function were randomly assigned to continuation of conventional insulin therapy (CIT) or to continuous subcutaneous insulin infusion (CSII). There were no statistically significant differences at entry to the study between the two treatment groups in nerve function assessed by neurologic disability score, computer assisted sensation examination and measurements of amplitudes, distal latencies, F-wave latencies and somatosensory evoked potential latencies over the spine and conduction velocities of motor and sensory fibers of ulnar, median, peroneal, tibial, plantar and sural nerves. In addition, mean plasma glucose from 24 h profiles (12.5 vs 10.6 mmol/l, respectively) and HbA1 (11.0 vs 11.6%, respectively) did not differ significantly between the two treatment groups at entry. Despite improved glycaemia from CSII in 5 patients (one dropped out of the study after 2 months) contrasted to CIT in 6 patients (5.3 vs 9.9 mmol/l, respectively, p = 0.002) and HbA1 (8.5 vs 10.7%, respectively, p = 0.002), there were no significant differences in measurements of peripheral nerve function after 4 months. After 8 months of improved glycaemia (4.4 vs 10.2 mmol/l, p = 0.004) and improved HbA1 (8.3 vs 10.5%, p = 0.002), nerve conduction (p = 0.03) and vibratory sensation threshold (p = 0.002) were significantly better in patients treated with CSII than those who received CIT. The improvements in nerve function, although small, provide further evidence that some clinical endpoints of neuropathy are favorably influenced by improved control of glycaemia.

Adolescent↗
PubMed1985

Electromyographic analysis of the thumb: a study of isometric forces in pinch and grasp.

An electromyographic study of thumb muscles was performed on eight subjects by means of integrated polyelectromyography and simultaneous recordings of isometric flexion-extension, abduction-adduction, and prehensile pinch and grasp of the thumb. The integrated electromyographic signal proved to be an excellent index of thumb muscle activity, with a linear relationship found at low to middle levels of muscle strength. To facilitate understanding of thumb function, thumb muscles can be classified as primary or secondary on the basis of electrical potential activity. In isometric flexion, the flexor pollicis longus (FPL) was primary, whereas in extension, the extensor pollicis longus (EPL) and abductor pollicis longus were primary. In adduction, the adductor pollicis and EPL were primary and the FPL was secondary. In abduction, the abductor pollicis brevis and opponens pollicis were primary. The adductor pollicis, and FPL were nearly equal during pinch and grasp, with significant electrical activity increasing with greater force requirements. The first dorsal interosseous and EPL contributed secondarily in both pinch and grasp. When surgeons consider tendon transfers for nonfunctioning thumb muscles, the primary muscles should be replaced first to best restore pinch and grasp strength.

Biomechanical Phenomena↗
PubMed1985

Electrophysiologic studies in the diagnosis and prognosis of motor neuron diseases.

The identification and characterization of motor neuron diseases, such as amyotrophic lateral sclerosis, can be much enhanced by electrodiagnostic testing. Combinations of needle electromyography, nerve conduction studies, and other techniques can not only confirm the diagnosis or identify the presence of unsuspected disease, but can also provide clues to the rate of progression and prognosis.

Amyotrophic Lateral Sclerosis↗
PubMed1984

Hereditary form of sustained muscle activity of peripheral nerve origin causing generalized myokymia and muscle stiffness.

Six patients in two unrelated families had a hereditary form of sustained muscle activity of peripheral nerve origin. Although varying in severity among affected family members, the disease was manifested clinically as generalized myokymia and muscle stiffness. Motor and sensory nerve conduction velocities and results of nerve biopsy were normal. Repetitive after-discharges followed each motor nerve stimulus. Needle electrode examination demonstrated spontaneous recurrent bursts of motor unit activity. The burst activity of a motor unit occurred rhythmically (0.5 to 4 bursts per second) and independently of the activity of other units. Within a burst, the firing rate was high (150 to 300 Hz). The clinical and electromyographic abnormalities improved considerably after treatment with carbamazepine or phenytoin.

Adolescent↗
PubMed1984

Spinal cord infarction: another cause of "lumbosacral polyradiculopathy".

An elderly woman with leg weakness and sensory loss had fibrillation potentials in her legs and at multiple lumbosacral levels of paraspinal muscles. Clinical and myelographic studies showed occlusion of an anterior spinal artery due to an arteriovenous malformation of the spinal cord. EMG aided in the diagnosis and localization of this anterior spinal cord lesion.

Aged↗
PubMed1983

Not 'indifference to pain' but varieties of hereditary sensory and autonomic neuropathy.

Three children, from different kinships, with generalized insensitivity to pain, showed unusual manifestations of congenital, presumably inherited, sensory and autonomic neuropathy. The first child appeared to have a syndrome resembling those previously described as congenital indifference to pain, congenital universal loss of pain sensation from infancy without other apparent neurological deficit. Unlike most types of hereditary sensory and autonomic neuropathies (types I, II, III), but like type IV, she had normal sensory nerve action potentials. Abnormalities of sudomotor function and of somatosensory evoked potentials were demonstrated. A severe decrease in the number of sural nerve A delta fibres and a small reduction in C fibres were demonstrated morphometrically. An abnormality of C fibres was confirmed by a marked reduction in nerve dopamine-beta-hydroxylase activity. The plasma and CSF concentrations of beta endorphins, substance P and several other neuropeptides and hormones were normal. Unequivocal evidence of a neuropathic lesion is provided by this patient; her disorder may be identified as the fifth type of hereditary sensory and autonomic neuropathy. The second patient had a congenital pansensory neuropathy and progressive retinitis pigmentosa. Whether the disorder is inherited and, if so, whether the retinitis pigmentosa results from the same or from a second genetic abnormality, is unclear. The third case has, in addition to what is usually seen in hereditary sensory and autonomic neuropathy, type II, an unusually severe kinaesthetic difficulty in oral food handling. The sural nerves of the second and third patients had fibre composition characteristic of hereditary sensory and autonomic neuropathy, type II, few or no myelinated fibres and reduced numbers of unmyelinated fibres.

Autonomic Nervous System Diseases↗
PubMed1983

Disorders of neuromuscular transmission: a review.

The neuromuscular junction is the site of a number of clinical disorders that are manifested primarily by weakness, including myasthenia gravis, the myasthenic syndrome, toxic disorders, congenital disorders, and botulism. The most common of these is myasthenia gravis, but the evaluation and treatment of all disorders require an understanding of normal neuromuscular mechanisms and the pathophysiology of the neuromuscular junction.

Acetylcholine↗
PubMed1983

Effect of blood glucose control on peripheral nerve function in diabetic patients.

A prospective, stratified, randomized 3-year clinical trial was conducted on the effect of rigorous versus conventional glucose control on peripheral nerve function in 33 insulin-treated diabetic patients with a duration of diabetes of less than 2 years. The goals for conventional glucose control were the mean of fasting and 80-minute postprandial plasma glucose of 150 mg/dl for non-insulin-dependent diabetes and 200 mg/dl for insulin-dependent diabetes. The goal of rigorous glucose control was an approximation of nondiabetic glucose control. No significant difference in glucose control or peripheral nerve function was observed between the rigorously and the conventionally controlled groups. Eight patients in the conventional-control group spontaneously achieved glucose control in the range that was the objective for the rigorous-control group, and five patients in the rigorous-control group never achieved the desired glucose control. In the remaining 20 patients, with similar baseline glucose control and peripheral nerve function characteristics, observed over a median of 2 years, improved blood glucose control (P less than 0.01) was not associated with any significant improvement in peripheral nerve function. Nevertheless, a significant (P less than 0.05) correlation was found between the degree of abnormal nerve function at entry into the study and change in nerve function during the study. If control of hyperglycemia benefits peripheral nerve function of diabetic patients, its demonstration may require a closer approximation of normoglycemia, a larger difference in glucose control between the two study groups, a longer duration of treatment, and the use of patients with more advanced peripheral nerve function abnormalities than those in this study.

Adult↗
PubMed1982

Prednisone improves chronic inflammatory demyelinating polyradiculoneuropathy more than no treatment.

Of 40 patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), 28 completed a controlled three-month trial of prednisone. Prednisone was shown to cause a small but significant improvement over no treatment in scored neurological disability, some measures of computer-assisted sensory detection threshold, graded muscle strength, and some attributes of nerve conduction. No subset of patients was more likely than another to be responsive to prednisone; those with a progressive course were as likely to be responsive as recurrent cases. This finding provides further justification for classifying progressive with recurrent cases as CIDP and demonstrates that prednisone treatment should not be withheld from patients with progressive disease.

Adolescent↗
PubMed1981

Effect of artificial pancreas treatment on peripheral nerve function in diabetes.

To determine whether the complete correction of hyperglycemia of diabetes can rapidly improve abnormal peripheral nerve function, eight hyperglycemic insulin-requiring diabetics underwent 3 days of glucose control with an artificial endocrine pancreas, the BIOSTATOR Glucose Controller. Comparison of neurologic assessment before and after BIOSTATOR treatment showed improvement only in ulnar sensory conduction velocity (+ 3.2 +/- 1.4 meters per second, p less than 0.032) and no significant changes in 24 other nerve conduction measurements, computer-assisted examination, and scored neurologic assessment. Any significant beneficial effect on nerve function resulting from correction of hyperglycemia probably requires more than 3 days to be manifested.

Adolescent↗
PubMed1981

A clinical and electrophysiological evaluation of myoclonus.

The records of 23 consecutive patients with myoclonus who were seen during a 16-month period were analyzed prospectively. The patients were divided into two groups: epileptic and nonepileptic. The epileptic patients had focal and stimulus-elicitable myoclonus with enlarged somatosensory evoked potentials and enhanced long-loop reflexes, and they responded well to anticonvulsants, especially clonazepam and valproic acid. The nonepileptic group had massive and spontaneous jerks with normal-sized somatosensory evoked potentials and long-loop reflexes, and they responded poorly to anticonvulsants. Evaluation of these clinical and electrophysiologic characteristics can help in the classification of obscure movement disorders and in predicting responses to therapy.

Adolescent↗
PubMed1981

The pronator teres syndrome: compressive neuropathy of the median nerve.

Thirty-nine patients with a clinical diagnosis of the pronator teres syndrome were seen during a seven-year period. They typically complained of aching discomfort in the forearm, weakness in the hand, and numbness in the thumb and index finger. Cyclic stress usually brought on the symptoms. The distinctive physical finding was tenderness over the proximal part of the pronator teres, which was aggravated by resisted pronation of the forearm, flexion of the elbow, and occasionally by resisted contraction of the flexor superficialis of the long finger. Electrophysiological testing of the median nerve showed abnormalities in a few patients, but localization of the abnormality was possible only rarely. Intraoperative recordings showed some improvement shortly after release of the median nerve in six of the ten forearms that were tested. Surgical exploration of thirty-six forearms in thirty-two patients showed intramuscular tendinous bands in the pronator, indentation of the muscle belly of the flexor superficialis in most forearms. Vascular and muscular abnormalities were seen occasionally. Of the thirty-six operations, twenty-eight gave good or excellent results; five, fair; and in three patients the symptoms were unchanged. The cause of failure was either inadequate decompression or misdiagnosis.

Adolescent↗
PubMed1980

Lumbosacral spinal evoked potentials in humans.

Evoked potentials in response to submaximal electrical stimuli to the peroneal or tibial nerves were recorded from the lumbosacral region in 18 normal subjects. Averaging of 128 responses from recording electrodes over spinous processes S1 to T11, with a reference electrode on the contralateral iliac crest, demonstrated potentials of 0.5 to 1.8 microV, with two well-defined negative peaks having latencies proportional to the distance between the stimulating and recording electrodes. The first peak originated from a traveling wave of depolarization in afferent fibers in the cauda equina, and the second peak originated in the spinal cord. F waves, H reflexes, microreflexes, and volume-conducted muscle responses did not contribute to these potentials.

Adolescent↗
PubMed1979

Facial myokymia with polyradiculoneuropathy.

Two patients had bilateral facial myokymia in association with polyradiculoneuropathy. Characteristic electromyographic findings allow polyradiculoneuropathy to be differentiated from other causes of facial movements, and support the possibility that extraaxial facial nerve involvement is another cause of facial myokymia.

Adult↗