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Biomedical subjects

M B Katirji

Publications and source records attributed to M B Katirji.

17 recordsLinked to original sources

Extraocular muscles are spared in advanced Duchenne dystrophy.

Fast-twitch extremity muscle fibers are preferentially affected in Duchenne's and Becker's muscular dystrophy. Since saccades are thought to be mediated by fast-twitch fibers, saccadic velocities would be expected to be decreased in these patients. Using infrared oculography, we found that the peak velocities of saccades in 3 patients with advanced Duchenne's or Becker's muscular dystrophy were normal. Clinical findings in 7 other patients with these forms of dystrophy were normal. This investigation is the first study of ocular motility in Duchenne's and Becker's muscular dystrophy. It demonstrates that extraocular muscle function is preserved and suggests that fast-twitch fibers in extraocular muscles possess properties that protect against degeneration.

Adult

Rapid response of syphilitic optic neuritis to posterior sub-tenon's steroid injection.

An HIV-positive man with subacute syphilitic meningitis developed severe bilateral visual loss from optic neuritis. His visual acuity improved remarkably within 24 hours after single posterior sub-Tenon's injections of triamcinolone (Kenalog) were given. Periocular steroid injections should be considered as an adjunctive treatment of syphilitic optic neuritis.

HIV Seropositivity

Femoral mononeuropathy after radical prostatectomy.

Femoral mononeuropathy is a recognized complication following abdominal and vaginal hysterectomy. Retractor injury and lithotomy position were postulated mechanisms. We report a femoral nerve lesion following a radical perineal prostatectomy.

Adenocarcinoma

Newer techniques of laryngeal reinnervation.

We relate the experience obtained in the use of the right superior laryngeal nerve (motor branch)--cricothyroid muscle pedicle flap in dogs in an attempt to reinnervate the right posterior cricoarytenoid muscle (PCA). The right vocal cord was paralyzed by severance and removal of 2.5 cm of the right recurrent laryngeal nerve. Evaluation 6 months postoperatively revealed the vocal fold remobilization on the right side to have an average of about one half the mobility of the left, normal side. After the recurrent laryngeal and superior laryngeal nerves on the left were severed, the vocal cord mobility dropped to only about one fourth. This suggests that the dogs had contralateral reinnervation. Nevertheless, the right vocal cord mobility, driven only by the right superior laryngeal nerve, was enough to secure an adequate airway without the need for a tracheotomy. This experiment was statistically significant on comparison with a control group. Electromyographic studies as well as PCA histochemistry were performed.

Animals

Newer technique of laryngeal reinnervation: superior laryngeal nerve (motor branch) as a driver of the posterior cricoarytenoid muscle.

This report analyzes the experience gained using two different techniques to reinnervate the paralyzed vocal cord. In the neurotization group, the superior laryngeal nerve (SLN) motor branch-cricothyroid muscle pedicle was used to reinnervate the posterior cricoarytenoid muscle. In the direct nerve anastomosis group, the SLN was anastomosed to the abductor branch of the recurrent laryngeal nerve (RLN), and the ansa hypoglossi (AH) to the adductor branch of the RLN. A third group of animals (control) had the right RLN sectioned without any anastomosis. About 5 to 6 months postoperatively the animals were killed painlessly and evaluated. The neurotization group revealed vocal fold mobilization on the right side to have an average of about half of the mobility of the left, normal side. After the RLN and SLN on the left were severed as well as the AH bilaterally, the vocal cord mobility was reduced to about one fourth. The direct nerve anastomosis group showed about fourfold less vocal cord mobility than the neurotization group. After the SLN, RLN, and AH were severed bilaterally, the control group showed no vocal cord mobility. The neurotization technique has been selected for further experimentation in human adults.

Anastomosis, Surgical

Brachial plexus injury following liver transplantation.

We examined 7 adults with brachial plexus injury following liver transplantation; they were among 120 transplants performed over a 10-month period (incidence, 5.8%). The lesion was right-sided in 5 patients, left-sided in 1, and bilateral in 1. The affected side correlated with the axillary veno-venous shunt in 3 lesions only. All noted weakness and sensory loss shortly after recovery from general anesthesia. The EMG examination indicated axonal lesions, and recovery was protracted.

Adult

Proximal ulnar mononeuropathy caused by conduction block at Erb's point.

We describe a young man with classic symptoms of isolated ulnar mononeuropathy, whose nerve conduction studies showed a severe conduction block of the ulnar nerve between the stimulation at the axilla and Erb's point. His clinical and electrophysiologic abnormalities resolved completely in eight weeks.

Action Potentials

The human cervical myotomes: an anatomical correlation between electromyography and CT/myelography.

To correlate the accuracy of electromyography in diagnosing the correct root involved in cervical radiculopathy, 20 patients with cervical radiculopathy, diagnosed by electromyography using strict inclusion and exclusion criteria, were studied. Metrizamide myelography/computerized tomography were evaluated in all 20 patients independently, and the involved root was defined. The root involved, using the EMG examination and the myotome chart of the Medical Research Council, was C5 in 3 patients, C6 in 6, C7 in 9 patients, and C8 in 2 patients. The overall correlation with myelography/CT was 65% (33.3, 66.6, 77.7, and 50% for C5, C6, C7, and C8, respectively). EMG done properly has a good correlation of myelography/CT. This correlation is higher (73.3%) for the commonly occurring cervical radiculopathies (C6 and C7).

Action Potentials

Common peroneal mononeuropathy: a clinical and electrophysiologic study of 116 lesions.

We analyzed the clinical and electromyographic (EMG) findings of 116 common peroneal mononeuropathies in 103 patients (13 with bilateral lesions). Prior to the EMG examination, the diagnosis was not clinically suspected or seriously considered in 44% of the lesions. Sensory manifestations were common (79%) but pain was rare (16.5%). The onset was acute in 57 patients, gradual in 35, and indeterminate in 11. Of the 116 lesions, 64 were solely axonal loss in type, 23 manifested as conduction block, presumably secondary to focal demyelination, and 29 were a mixture of the two. Contrary to common belief, the pathophysiology was predominantly axonal loss regardless of etiology, including those that developed perioperatively. The peroneal motor nerve conduction study, recording tibialis anterior muscle, was the single most important electrophysiologic study; it localized all 52 lesions causing conduction block at the fibular head. In contrast, peroneal motor conduction velocity along the knee-to-fibular head segment was seldom abnormal, with slowing in only five of the 52 cases.

Action Potentials

The Eaton-Lambert (myasthenic) syndrome in association with systemic lupus erythematosus.

We describe a case of the Eaton-Lambert (myasthenic) syndrome (ELS) in a 56-year-old woman with systemic lupus erythematosus. Treatment with successive courses of plasmapheresis produced clinical and electrophysiologic improvement in her ELS, without affecting her systemic lupus erythematosus. This case supports both the association of ELS with autoimmune disorders, and the use of plasmapheresis in the treatment of ELS.

Female

Stroke due to vertebral artery injury.

Minimal neck injury produced vertebral artery damage in two women and three men, 20 to 57 years of age. Serious neurologic deterioration occurred in two patients when positioned for roentgenographic procedures. Dissection or thrombosis of one or both vertebral arteries while in the transverse foramina occurred in three, one at the site of an osteophyte. The arteriogram of one patient showed a traumatic aneurysm at C-7, and a second patient had segmental arterial stenosis with bilateral traumatic aneurysms at C-5. The location of the arterial injury is not restricted to the occipitoatlantoaxial level but includes the course through the transverse foramina. The use of anticoagulation appears to be important in the immediate management of this process.

Adult