Autonomic nervous system and the eye.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
R J Guy
Publications and source records attributed to R J Guy.
Evaluation of thermal and vibration sensation in diabetic neuropathy.
Sensory evaluation of diabetic neuropathy was undertaken by a new technique for assessment of thermal sensitivity. The method is simple and reproducible, and the mean normal value of the lateral border of the foot was 6.0 degrees C (3.6-9.8 degrees C, 95% confidence limits). Four groups of patients with diabetic neuropathy were examined: 22 with neuropathic ulcers and/or Charcot joints (groups 1 and 2); all showed severe abnormalities (range 10.8- greater than 30 degrees C), frequently more than three times the upper limit of normal. In contrast thermal sensitivity in 15 patients with painful neuropathy (group 4) varied from normal to grossly abnormal (range 3.9- greater than 30 degrees C) confirming this form of neuropathy as a distinct entity. The majority of those 10 patients with autonomic neuropathy alone (group 3) had abnormal thermal sensitivity (range 6.4- greater than 30 degrees C). Comparison of thermal sensitivity (a small fibre modality) with vibration perception threshold (a large fibre modality) showed that thermal sensitivity is sometimes selectively affected, especially in those with painful neuropathy, suggesting that the small fibres are more vulnerable in diabetes. Frequent involvement of the hands confirms the "stocking and glove" distribution of diabetic neuropathy. We conclude that impairment of thermal sensitivity is the rule in symptomatic diabetic neuropathy and its assessment provides a simple quantitative measurement suitable for long-term studies of its natural history.
Adult↗
Extremity reconstruction using the free deltoid flap.
The deltoid fasciocutaneous flap is a thin, reliable flap that is easily dissected from the posterolateral arm. It has large-caliber vessels and is capable of sensory reinnervation to portions of the flap above the deltoid/triceps groove through the lateral brachial cutaneous nerve. There is little sensory return to the large vascular territory, which can be extended inferiorly below the deltoid triceps groove. The donor site can be closed primarily or skin grafted and when large may be objectionable to some patients. The flap is an excellent choice for extremity soft-tissue reconstruction on the plantar or palmar surfaces. Protective sensibility has returned to all reinnervated flaps. We present our experience in 10 patients with extremity problems.
Adult↗
Diabetic autonomic neuropathy and iritis: an association suggesting an immunological cause.
Of 47 insulin requiring diabetics aged 21-40 years with autonomic neuropathy (heart rate variability less than 10), 14 had previously developed iritis. In all except two cases the iritis preceded the autonomic symptoms. The autonomic neuropathy was very severe, 10 patients having two or more characteristic symptoms. Ten of the patients with iritis were women. The association of iritis (itself an immune disorder) with severe symptomatic autonomic neuropathy raises the possibility of an underlying immunological basis for autonomic neuropathy.
Adult↗
Diminished bronchial reactivity to cold air in diabetic patients with autonomic neuropathy.
To investigate the role of neural pathways in the nonasthmatic response to eucapnic hyperventilation with below freezing air five diabetic patients with severe symptomatic autonomic neuropathy were studied. Their responses were compared with those shown by five diabetic patients without autonomic neuropathy and five non-diabetic controls. After bronchial provocation testing with cold air the diabetic patients with autonomic neuropathy did not show a significant fall in specific airways conductance (mean (SE) maximum percentage fall 2.0 (3)%), whereas conductance fell in the diabetic patients without neuropathy by 30.8 (2.0)% (p less than 0.001) and in the non-diabetic controls by 22.7 (4.6)% (p less than 0.02). In subjects who do not have asthma the bronchial response to cold air is mediated largely via neural mechanisms.
Adult↗
A study of nail bed injuries: causes, treatment, and prognosis.
Two hundred ninety-nine nail bed injuries were studied over a 5 1/2-year period. Methods of repair were described. Follow-up was obtained for 184 injuries. The injuries were defined, categorized, and analyzed according to defined result categories and results were graded from excellent to poor. Ninety percent of the repaired nail beds were graded good to excellent. Poorer results occurred with crush or avulsion injuries, with injuries of both nail bed and nail fold, and with associated infection.
Accidents↗
Diabetic gastroparesis from autonomic neuropathy: surgical considerations and changes in vagus nerve morphology.
Two cases with intractable vomiting due to gastroparesis, a rare feature of diabetic autonomic neuropathy, are described. Both required surgical treatment. In the first a gastroenterostomy was complicated by reflux gastritis requiring a revision operation; in the second a gastrojejunostomy was successful. Electron microscopic studies of the vagus nerve in one of the cases showed a severe reduction in the density of unmyelinated axons, the surviving axons tending to be of small calibre. The severity of the abnormalities supports the view that diabetic gastroparesis is related to vagal denervation.
Adult↗
Three-years' experience in a regional burn center with burns of the eyes and eyelids.
A retrospective three-year study of lid and ocular burn injuries in a regional burn center revealed no major complications. The management program was based on cooperation between the burn unit and ophthalmological staff and included: 1. A high index of suspicion for eye injuries of the burned patient; 2. Early ophthalmologic consultation and examination; 3. Aggressive early treatment; 4. Rigorous follow-up and re-examination; and 5. Multiple and frequent grafting of lids, as needed.
Burns↗