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Biomedical subjects

W Schady

Publications and source records attributed to W Schady.

7 recordsLinked to original sources
PubMed1992

Endoneurial capillary abnormalities in mild human diabetic neuropathy.

Microvascular factors have been implicated in the pathogenesis of human diabetic neuropathy. The extent of microangiopathy was assessed in 15 diabetic patients with clinically mild neuropathy and compared with eight age matched control subjects. Endoneurial capillary density was reduced (p less than 0.04) and correlated significantly with reduced myelinated fibre density (p less than 0.01). Both basement membrane area (p less than 0.0001) and endothelial cell profile number per capillary (p less than 0.002) were significantly increased in diabetic patients and correlated significantly with both neurophysiological and neuropathological measures of neuropathic severity. There was no evidence of endothelial cell hypertrophy as assessed by either cross sectional endothelial cell area or a reduction in luminal size. Furthermore, the percentage of closed vessels did not differ between diabetic patients and control subjects and failed to relate to measures of neuropathic severity. It was concluded that microvascular abnormalities are prominent in patients with clinically mild human diabetic neuropathy, and that these data provide further support for the role of endoneurial capillary disease in the development of this condition.

Adolescent↗
PubMed1992

On the choice of muscle in the electrophysiological assessment of myasthenia gravis.

We performed repetitive nerve stimulation on 38 adult patients with generalised myasthenia to compare the relative diagnostic yield from deltoid and trapezius. The decrement was consistently greater in deltoid, both before and after maximum voluntary contraction. In 12 patients the test was negative in trapezius but diagnostic in deltoid, whereas the converse occurred in only one. The yield from facial muscles was comparable to that from trapezius while that from hand muscles was very low. Post-tetanic exhaustion often enhanced the decrement but the use of stimulus frequencies greater than 2-3 Hz did not. We conclude that deltoid provides the highest diagnostic yield in myasthenia when doing decremental studies.

Accessory Nerve↗
PubMed1991

The relationship between sural nerve morphometric findings and measures of peripheral nerve function in mild diabetic neuropathy.

The morphological findings in sural nerve biopsy specimens from 15 diabetic patients with mild neuropathy were compared with control biopsies from eight non-neuropathic, non-diabetic subjects, and correlations were sought with electrophysiological studies and quantitative sensory tests for vibration, thermal, and current perception thresholds. Myelinated fibre density was reduced compared with control biopsies (4042 +/- 2090 (+/- SD) vs 6800 +/- 1100 mm-2; p less than 0.01). A strong correlation existed between myelinated fibre density and sural sensory conduction velocity (r = 0.84, p less than 0.001), sural action potential amplitude (r = 0.74, p less than 0.001), peroneal motor conduction velocity (r = 0.58, p less than 0.02), and median sensory amplitude (r = 0.64, p less than 0.01) but there was no correlation between myelinated fibre density and any quantitative sensory test. We conclude that conventional electrophysiological tests in the lower limb are reliable surrogate measures for structural abnormalities in early diabetic neuropathy.

Biopsy↗
PubMed1991

Central motor conduction studies in hereditary spastic paraplegia.

Central motor conduction (CMC) studies were carried out in 25 patients with hereditary spastic paraplegia (HSP). Responses evoked in the lower limbs by transcranial magnetic stimulation of the motor cortex were bilaterally absent in 33% of the patients and, when recordable, were delayed in 75% of cases. Responses in the upper limbs were mostly normal except for those from the five members of one family, which were considerably delayed. There was no correlation between CMC parameters and age, duration of disease or upper limb hyperreflexia. CMC time to the tibialis anterior correlated with disability in patients with juvenile-onset HSP. It is concluded that CMC studies are not useful in detecting subclinical lesions in hereditary spastic paraplegia but may be of value in identifying subgroups of the disease.

Adolescent↗
PubMed1991

Peripheral nerve dysfunction in scleroderma.

Peripheral neuropathy in patients with scleroderma is thought to be rare. We have undertaken a quantitative assessment of peripheral nerve function in 29 patients with either limited cutaneous scleroderma or progressive systemic sclerosis. Tactile thresholds were raised in the fingers in 28 per cent of patients and in the foot in 50 per cent. Two-point discrimination was abnormal in 10 patients, thermal thresholds were abnormal in five and vibration thresholds were abnormal in one. Nerve conduction studies showed abnormalities in six patients, five of whom had clinical signs of a mild peripheral neuropathy: the mean duration of disease in these six patients was 10 years longer than that in the remainder of the patients. There was electrophysiological evidence of a subclinical carpal tunnel syndrome in two patients. The sympathetic skin response was recorded in 16 patients who had not been subjected to sympathectomy for Raynaud's phenomenon, and was abnormal in four. These results indicate that peripheral nerve dysfunction in scleroderma, though mild, is not as uncommon as previously thought. The abnormal cutaneous sensory thresholds may be partly due to altered viscoelastic properties of the skin, but abnormal responses in the lower limbs to tests of tactile sensitivity, the clinical findings and the disturbances of nerve conduction argue in favour of an additional neuropathic process in some patients. Low grade distal nerve trunk ischaemia may be responsible.

Adult↗
PubMed1990

A quantitative study of sensory function in hereditary spastic paraplegia.

Somatic sensation was studied in 23 patients from 14 families with hereditary spastic paraplegia. Quantitative sensory testing revealed significantly raised thermal, heat pain, vibratory and tactile thresholds in patients as compared with normal controls. Cutaneous sensitivity was more severely impaired in the feet than in the hand. All patients had at least one elevated sensory threshold. Sensory nerve conduction studies were abnormal in 6 patients, 5 of whom were members of the same family. Somatosensory evoked potentials were reduced on average to half the size of those of controls. Although the clinical picture is dominated by a spastic paraparesis, subclinical sensory impairment is common in hereditary spastic paraplegia and may reflect involvement of peripheral nerves, afferent pathways in the spinal cord or both.

Adult↗