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Biomedical subjects

M Swash

Publications and source records attributed to M Swash.

At least 145 records · Page 8Linked to original sources
PubMed1989

Intrathecal baclofen and the H-reflex.

Baclofen was given intrathecally to six patients with severe lower limb spasticity due to traumatic spinal cord injury. The effects of the drug on spasticity and the ratio between the maximum amplitude of the H reflex and the M response from the soleus (Hmax/Mmax ratio) were assessed. In each patient, spasticity was reduced following intrathecal baclofen and in four patients there was a reduction in the amplitude of the H reflex and Hmax/Mmax ratio. These results suggest that the Hmax/Mmax ratio may be helpful in establishing optimum drug dosage, particularly when the drug is used on a chronic basis.

Adult↗
PubMed1989

Sarcoidosis presenting with stroke.

A 25-year-old black man with sarcoidosis presented with transient ischemic attacks followed by sudden, persistent right hemiparesis. He gave a history of recent, recurrent lower motor neuron facial palsy. Computed tomography demonstrated an infarct in the left internal capsule. Chest x-ray film showed bilateral hilar and mediastinal lymphadenopathy and multiple opacities in the lung fields. Serum angiotensin converting enzyme concentration was raised, and a Kveim test was positive for sarcoidosis. Despite clear pathologic reports of cerebral vasculitis in neurosarcoidosis, the occurrence of stroke is extremely rare.

Adult↗
PubMed1989

Relative efficacy of intravenous methylprednisolone and ACTH in the treatment of acute relapse in MS.

To compare the efficacy of high-dose intravenous methylprednisolone with intramuscular ACTH in the treatment of acute relapse in multiple sclerosis, we undertook a double-blind, randomized, controlled study involving 61 patients. There was a marked improvement in both groups in the course of the study, but no difference between them in either the rate of recovery or the final outcome. High-dose IV methylprednisolone is a safe alternative to ACTH in the management of acute relapse in MS.

Acute Disease↗
PubMed1989

The muscle biopsy in clinical practice.

Histological examination of muscle tissue is used to establish a diagnosis of neuromuscular disease, to investigate patients with systemic disease, to exclude treatable diseases in patients with progressive muscular wasting, and allows biochemical investigations of muscle tissue. The choice of muscle biopsy is important. Deltoid, biceps brachii and quadriceps femoris muscles are mostly used and specimens are usually obtained by an open biopsy. The interpretation of the muscle biopsy must be considered in relation to the clinical problem. Enzyme histochemical methods allow study of sub-cellular structures and are therefore particularly useful in diagnosis. They are standardized and a routine series should be used in each specimen. In routine diagnostic work electron microscopy is of relatively little value. It is first important to inspect the size, shape and fibre type distribution to get an impression of whether the biopsy is normal or abnormal. Then more characteristic features of either neuropathies or myopathies are looked for. Regarding prognosis it is difficult to draw conclusions from the muscle biopsy. Biochemical assays may be useful in establishing precise diagnosis, especially in glycogenoses and mitochondrial disorders.

Biopsy↗
PubMed1988

Ubiquitin deposits in anterior horn cells in motor neurone disease.

A polyclonal antiserum to ubiquitin, a low molecular weight protein involved in the ATP-dependent removal of abnormal cytoplasmic proteins, has been used to stain spinal cord from 10 cases of motor neurone disease and from 12 control spinal cords. All 10 cases of motor neurone disease exhibited antiubiquitin-immunoreactive deposits in a proportion of the surviving anterior horn cells but these deposits were not seen in any of the 12 controls. These ubiquitin deposits do not correspond to previously described neuronal inclusions in motor neurone disease. The ubiquitin deposits represent, therefore, a new neuronal inclusion which possibly reflects previously unrecognised degradative events occurring in the vulnerable neurones.

Humans↗
PubMed1988

Neurologic cause of idiopathic incontinence.

The relationship between the pudendal and perineal nerve terminal motor latencies and descent (weakness) of the perineum on straining was investigated in 31 patients with idiopathic fecal incontinence, and in 30 patients with double incontinence. Pelvic floor descent was correlated with increased pudendal nerve terminal motor latency in both groups of patients. In the patients with double incontinence, there was a less significant correlation between perineal descent and increased perineal nerve terminal motor latency. In the patients with fecal incontinence, but without urinary incontinence, there was no correlation between perineal descent and perineal nerve terminal motor latency. These data support the concept that pelvic floor weakness can result in damage to the pudendal and perineal nerves, leading to fecal and urinary incontinence. In patients with isolated fecal incontinence the perineal nerves are relatively spared. Thus these common types of incontinence probably have a neurologic cause, and neurophysiologic methods can be used in their assessment.

Adult↗
PubMed1988

Delayed external sphincter repair for obstetric tear.

In some patients with faecal incontinence due to an obstetric tear of the external and sphincter there is additional weakness of the anal sphincter muscles from damage to the innervation of these muscles during delivery. Of 19 patients who required surgical repair of an obstetric sphincter tear some months or years after injury, 9 (47 per cent) had evidence of pudendal nerve damage at pre-operative anorectal physiological investigation. The result of surgical repair was excellent or good in eight of the ten patients in whom there was no evidence of nerve damage, while this was the case in only one of the nine patients with nerve damage. These results are significantly different (P = 0.018). Thus the functional result of delayed anal sphincter repair after obstetric lesions is partly dependent upon whether the nerve supply is intact. Pre-operative physiological evaluation can give information on the probability of a successful surgical result.

Adult↗
PubMed1988

Increase in pudendal nerve terminal motor latency with defaecation straining.

The relationship between perineal descent and pudendal nerve damage was tested in 57 consecutive patients by measuring the left and right pudendal nerve terminal motor latency (PNTML) before and after a maximal defaecation straining effort. In 13 patients the PNTML was also measured 1 and 4 min later. The difference between the mean PNTML before and after straining (delta PNTML) was correlated with the amount of descent (r = 0.40, P less than 0.005), and with the perineal position during straining (r = -0.46, P less than 0.001). Four minutes after the straining effort the PNTML again approached the resting value in each subject. These findings support the concept that perineal descent causes pudendal nerve damage.

Adult↗
PubMed1988

Polysaccharide storage myopathy.

In a woman with a slowly progressive adult onset proximal myopathy, muscle biopsy showed storage of PAS positive material in type 1 fibers. This material consisted of a branched chain polysaccharide associated with a mucoprotein. No abnormality of glycogen-pathway enzymes was detected. This suggested that this polysaccharide accumulation occurred because the polysaccharide was laid down in a non-bioavailable form. The clinical and histochemical features in this patient and in the few similar reported cases indicate that polysaccharide storage myopathy is a distinct entity that is allied to the glycogen storage myopathies.

Electromyography↗
PubMed1988

Jitter correction: a computer algorithm for reduction of the velocity recovery function artifact.

The measurement of neuromuscular jitter in single fiber electromyography may be artifactually raised by a component of interdischarge interval (IDI)-dependent jitter caused by the velocity recovery function (VRF) in muscle fibers. We have developed a computer algorithm for on-line mathematical correction for this artifact, thus improving the reliability of neuromuscular jitter estimates. The method, based on a modeling technique, was validated using intramuscular stimulation in order to either exclude an IDI-dependent component (using regular stimulation) or to include an IDI-dependent component (using pseudorandom stimulation). In 10 normal subjects the distribution of 106 corrected jitter values obtained using voluntary activity showed no difference from the measured values. This finding implies that previously published values for normal jitter are not likely to have been influenced by the VRF effect.

Action Potentials↗
PubMed1988

Patterns of selective involvement of thigh muscles in neuromuscular disease.

In 14 patients with limb girdle muscular dystrophy, polymyositis, and type 3 spinal muscular atrophy, CT scans of the thigh muscles were correlated with single fiber EMG studies in vastus lateralis, semimembranosus and biceps femoris muscles. There was a relation between the extent of CT scan abnormality and increased fiber density in the three muscles studied, except in the most severely affected muscles in which in some muscles the fiber density values were lower than expected. These results were independent of the underlying pathology. Correlative CT/SFEMG studies provide insights into the pattern of selective involvement of certain muscles in neuromuscular disorders.

Adult↗
PubMed1988

Autopsy validation of MRI in central pontine myelinolysis.

In a fatal case of central pontine myelinolysis (CPM) a low field strength (0.08 Tesla) magnetic resonance image revealed reduction of image intensity in the pons with sparing of two central symmetrical areas in the ventral portion. The latter correlated with preservation of centrally located groups of longitudinal myelinated nerve fibres shown at autopsy. Although such sparing is well recognised in pathological studies of CPM it has never previously been demonstrated in life.

Adult↗
PubMed1988

Asymmetrical pudendal nerve damage in pelvic floor disorders.

Differences in the left and right pudendal nerve terminal motor latencies have been observed in patients with pelvic floor disorders. Until now the mean value of the left and right pudendal latencies has been used as the index of pudendal neuropathy. In 22 patients of a group of 156 patients studied the pudendal nerve terminal motor latency was abnormally raised on one side only. These patients are thought to have pudendal neuropathy whether or not the mean value of the left and right pudendal latencies is also raised. This observation may have therapeutic implications.

Adult↗
PubMed1988

Internal anal sphincter in neurogenic fecal incontinence.

In neurogenic fecal incontinence there is denervation of the external anal sphincter and pelvic floor muscles but the role of the internal anal sphincter is incompletely understood. We have evaluated the internal anal sphincter in 6 patients with neurogenic incontinence undergoing postanal repair and in 7 control subjects. All the incontinent subjects, but none of the controls, had evidence of pudendal neuropathy. Surface electromyography studies of the internal anal sphincter showed absence of electrical activity in 4 of 6 incontinent subjects; in the remaining 2 subjects and in 6 of 7 controls normal slow waves were present. Internal sphincter muscle strips from control subjects showed normal in vitro responses to noradrenaline, isoprenaline, dimethyl-phenylpiperazinium, and electrical field stimulation; muscle strips from the incontinent patients showed complete insensitivity except in 2 patients in whom there was contraction to noradrenaline and relaxation to isoprenaline. Electron microscopy showed normal smooth muscle in 5 control subjects and minor changes in 1 subject; all the incontinent patients showed abnormalities in the smooth muscle cells of the internal anal sphincter. These findings indicate that in neurogenic fecal incontinence neurogenic weakness of the external anal sphincter and pelvic floor muscles is associated with damage to the internal anal sphincter.

Adult↗
PubMed1988

Postural effects on F wave parameters in lumbosacral root compression and canal stenosis.

The effects of standing, and lying with the back extended, on F wave minimal latency and F chronodispersion were studied in patients with lumbar canal stenosis, lumbosacral root compression syndromes, and low back pain. Standing for 3 min produced increased F chronodispersion in lumbar canal stenosis and root compression syndromes but had less effect on the F minimal latency. In patients with low back pain these variables were unchanged by these postural manoeuvres. These observations illustrate the value of adapting electrophysiological investigations to those clinical features that induce symptoms in these disorders.

Adult↗
PubMed1988

Word fluency in patients with early dementia of Alzheimer type.

The relative fluency with which 15 patients with Alzheimer-type dementia (DAT) retrieved words with specified first letters and belonging to semantically defined categories was assessed. Patients with DAT were always less fluent than controls but, like the 12 normal elderly subjects, they were more efficient in accessing words belonging to semantic categories. Their deficit in retrieving words with specified first letters was greater than that predicted on the basis of verbal intellectual ability. No differences in word fluency were detected in presenile and senile patients. These data support the conclusion that word fluency may prove useful in the detection of early dementia.

Aged↗