Biomedical subjects

E P Wilder-Smith

Publications and source records attributed to E P Wilder-Smith.

5 recordsLinked to original sources

PubMed2006

Symptoms associated with electrophysiologically verified carpal tunnel syndrome in Asian patients.

Sensory symptoms are crucial for the diagnosis of carpal tunnel syndrome (CTS). We have studied the spectrum of sensory symptoms in 67 cases of neurophysiologically confirmed CTS in Singapore and investigated the correlation of semi-quantitative clinical ('Historical-Objective') and neurophysiological ('Bland') scales. The range of sensory symptoms was large. The more frequent use of the terms 'woodenness' and 'aching' rather than 'pins and needles' suggests racial and cultural differences in symptom expression, or recognition of previously ignored descriptors. 'Numbness' (97%) was the most common descriptive symptom, followed by 'tingling' (81%), 'tightness' (60%), 'aching' (45%), 'woodenness' (39%) and 'pins and needles' (33%). Less common were 'deadness' (27%), prickling (24%), and cramp-like pain (18%). Uncommon sensations included 'jabbing' (10%), 'shooting pain' (10%), 'stabbing' (9%), 'tight-band like pressure' (9%), 'cold' (8%), 'crushing' (6%) and 'burning' (6%). The semi-quantitative clinical and neurophysiological scales correlated well (Pearson 0.645, P<0.001).

Adult↗

PubMed2006

Bickerstaff's brainstem encephalitis: can it recur?

Bickerstaff's brain-stem encephalitis is usually a monophasic post-viral inflammatory illness characterized by progressive ophthalmoplegia, ataxia and disturbance of consciousness (or hyper-reflexia). Since the clinical spectrum of Bickerstaff encephalitis may overlap with the Miller-Fisher and Guillain-Barré syndromes, the presence of anti- GQ1b antibodies and abnormal brain MRI can help to support its diagnosis. However, absence of anti-GQ1b antibodies and normal MRI do not exclude the diagnosis, which remains based on clinical criteria and exclusion of other etiologies. We report a case of recurrent Bickerstaff's brainstem encephalitis with no identifiable antecedent illness, and overlapping features of Miller Fisher and Guillain-Barré syndromes, in the presence of negative anti-GQ1b antibodies and repeatedly normal MRI of the brain.

Brain Stem↗

PubMed2005

Reflex vasoconstrictor responses of the healthy human fingertip skin. Normal range, repeatability, and influencing factors.

Skin vasoconstrictor reflexes (SVCRs) are mediated by sympathetic vasoconstrictor nerve fibers and used to test sympathetic function of the extremities. Since there is a dearth of published systematic data on inspiratory gasp-induced SVCR, we studied its range, repeatability, and influencing factors in 64 healthy subjects (mean age 41.9 years, range 20-78 years, 32 males). Mean vasoconstriction for the second digit was 54% (+/-19)/54% (+/-19) (right/left) and 69% (+/-16)/68% (+/-15) for the fourth digit. Forth digit vasoconstriction was significantly larger than the second digit (P < 0.01), but second and fourth digit correlation was good (Pearson: 0.521-0.741). Repeatability using single measure intraclass correlation was good with 0.62/0.69 for the second digit and 0.64/0.80 for the fourth digit (right/left). A trend for decreasing SVCR was seen with increasing age and weight, no effect was seen for gender, height, or blood pressure. The SVCR repeatability and range of variation seen in this study compare favorably with tests of heart rate variability, thermal threshold detection, and motor nerve conduction.

Adult↗

PubMed2004

Self-administered hand symptom diagram for carpal tunnel syndrome diagnosis.

In a prospective case series in Singapore we studied whether a hand symptom diagram can be used to predict carpal tunnel syndrome as defined by standardized clinical and neurophysiological protocol. Forty patients (mean age, 48 years, range 18-76) with carpal tunnel syndrome found it difficult to complete the hand diagram, and only four patients were able to mark it helpfully. There was no relation between drawings, clinical and neurophysiological parameters. A self-administered hand symptoms diagram is not useful for supporting a diagnosis of carpal tunnel syndrome amongst Singaporeans. Cultural factors may significantly influence subjective assessment scales such as the self-administered hand symptom diagram, which has been found effective in North American populations.

Adolescent↗

PubMed2000

Skin and muscle vasomotor reflexes in detecting autonomic dysfunction in leprosy.

There are few tests to assess the function of small unmyelinated nerve fibers. One established test is the skin vasomotor reflex (SVMR), which uses laser doppler flow velocimetry. The SVMR has the disadvantages of being susceptible to interference (from change of temperature and alerting stimuli) and of requiring expensive equipment. An ultrasound doppler method, which is less expensive, can be used to detect muscle vasomotor reflex (MVMR) activity. We sought to compare the efficacy of these two methods in detecting dysfunction of small unmyelinated nerve fibers in patients with leprosy. SVMR was shown to be less sensitive (P < 0.01) and specific (P < 0.001) than MVMR. The favorable results of MVMR may be attributed to its lesser susceptibility to interfering sympathetic vasoconstriction from alerting stimuli. MVMR also reflects larger areas of blood vessel innervation than the laser doppler method. In leprosy, nerve damage is typically patchy and may be missed by the smaller sampling of the laser method.

Adolescent↗