Neuromuscular changes in acute renal failure.
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Biomedical subjects
Publications and source records attributed to B C Katiyar.
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Proximal conduction studies by F-wave technique, with conventional distal motor and sensory conduction were performed along the ulnar nerves of 20 patients each with cervical spondylotic radiculopathy and/or myelopathy and with classical motor neurone disease (MND). Such F-wave parameters as shortest F-latency, F-conduction velocity, conduction time and F-ratio were calculated. Twenty-five age- and sex-matched healthy volunteers acted as controls. Proximal slowing associated with sensory conduction abnormalities and normal distal motor conduction favored cervical spondylosis (CS). Distal slowing with a normal proximal motor and sensory conduction was associated with motor neurone disease.
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Twenty-eight consecutive male patients with primary and secondary hypogonadism (14 each) were evaluated clinically and electrophysiologically for muscle dysfunction. Although generalised muscle weakness was initially reported by only 9 patients, on direct questioning, it was recorded in 19. Objective weakness was found in 13 patients and it involved both the proximal and distal limb muscles. Quantitative electromyography showed evidence of myopathy in the proximal muscle in 25 patients, i.e., reduced MUP duration and amplitude with increased polyphasia in the deltoid and the gluteus maximus. There were no denervation potentials. None of the patients showed clinical neuropathy or NCV abnormalities. Thus, the profile of muscle involvement in hypogonadism closely simulates limb-girdle muscular dystrophy and other endocrine myopathies. The incidence of muscle involvement was higher in secondary hypogonadism. Diminished androgens in primary hypogonadism and diminished growth hormone in the secondary hypogonadism are probably responsible for the myopathy.
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During the Indian EV 70 conjunctivitis epidemic in 1981, 79 patients with neurological complications were evaluated by clinical, electrophysiological, histopathological and virological studies. The disease was heralded by an attack of conjunctivitis and was followed, after a variable latent period, by a pre-paralytic, paralytic, and post-paralytic stage of slow recovery. The above events occurred in an orderly sequence. The paralysis affected the cranial nerves, limbs or both. The clinical course closely simulated poliomyelitis, without any evidence of radiculopathy or myelopathy. Cranial nerve palsies were seen in approximately half of the patients. The electrophysiological and histologicl studies pointed towards the affection of anterior horn cells. The raised neutralizing antibody titres to Enterovirus 70, confirmed the aetiology of the disease. On the available data, we believe that this nosological entity should be considered under the general title of "polio-like syndrome" following EV 70 conjunctivitis. On account of two epidemics in 1971 and 1981 with unfavourable prognosis and high resultant disability, and because of lack of specific therapy, it has become imperative to develop, as a top priority, a vaccine for immunization.
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Twenty unselected patients with hypothyroidism were evaluated by clinical and electrophysiological techniques for neuromuscular dysfunction. On clinical examination, muscle weakness was observed in four, paraesthesia in 11, carpal tunnel syndrome in three, and peripheral neuropathy in two of the patients. The electromyograms were abnormal in 14 of the patients. The average duration of motor unit potentials and the mean amplitudes in these patients were reduced, compatible with myopathy. There were no denervation potentials. The nerve conduction abnormalities were found in 13 patients, predominantly affecting the median (10) than the peroneal nerve (one). Subclinical carpal tunnel syndrome was observed in six patients. This was evidenced by increased sensory in five and motor distal latencies in one patient.
Relationship between the psychiatric diagnosis and the side of temporal EEG focus was analysed in 62 temporal lobe epileptics. Neurotics had right temporal foci significantly more frequently, while there was no such laterality effect in other psychiatric diagnostic groups.
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Twenty unselected consecutive patients of filarial chyluria were evaluated clinically, electromyographically, and histopathologically for neuromuscular dysfunction. None of the patients showed clinical evidence of muscle wasting or weakness suggesting myopathy, although generalized muscle weakness was complained by all of them particularly while climbing the stairs or on getting up or during lifting heavy weights. Electromyographic abnormalities were found in nine patients and slight histopathological abnormalities in two. The average duration of motor unit potentials and the mean amplitude were reduced, compatible with myopathy. There were no fibrillation potentials. Histological abnormalities consisted of a marked variation in muscle fibre size, sarcolemmal nuclear proliferation, and mild interstitial fatty infiltration. None of the patients showed evidence of clinical neuropathy, abnormalities in conduction velocity along the nerves or signs of segmental demyelination in the biopsy of the nerve. Our data suggest that muscle weakness in these patients is myopathic in nature without peripheral nerve involvement, and is possible due to hypoproteinaemia and hypolipidaemia, as these patients lose excessive amounts of protein and fat in their urine.
Seventy cases each of temporal lobe epilepsy and grand mal epilepsy were studied for their sexual functioning. The two groups were similar as regards age, sex, duration of illness, frequency of seizures and menstrual and marital history. A significantly greater number of temporal lobe epileptics were found to be hyposexual. They had a global loss of performance and interest in the sexual sphere and showed no concern over it. One case in the group of temporal lobe eiplepsy, as against none in the other group, was hypersexual. There were no cases of sexual deviations in either of the groups. The findings of the study are discussed in the light of the relevant literature.
Psychiatric disorder was studied in 62 patients with temporal lobe epilepsy (study group) and 70 patients with grand mal epilepsy (control group), both diagnosed electroencephalographically. The two groups were similar as regards age, sex, socio-economic status, duration and frequency of fits, family history and premorbid personality. A significantly greater number of temporal lobe epileptics had emotional disturbances in childhood and psychiatric abnormalities at the time of study. Neuroses, schizophrenia and behaviour disorder occurred more commonly in the study group, while epileptic personality and confusional psychosis were seen more frequently in the controls. The findings of the study are discussed in the light of relevant literature.
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