[The role of clinical investigations in the study of mechanisms of development of acquired demyelinating polyneuropathies].
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Biomedical subjects
Publications and source records attributed to M I Samoĭlov.
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The conditions of postganglionic fibers and parasympathetic fibers of vagus nerve were studied in 102 patients with varioustypes of polyneuritis and in 43 healthy individuals. In the control group the amplitude of evoked cutaneous sympathetic potential (ECSP) on the hand was 330 +/- 102 microV with 1.42 +/- 0.12 s latency, on the foot 230 +/- 81.7 microV with 2.04 +/- 0.17 s latency. Respiration arrhythmia at rest amounted to 45 +/- 14.7 ms and in forced ventilation 80.6 +/- 28.5 ms. Substantial changes of ECSP parameters and heart periods are characteristics of polyneuropathies. The disorders are especially severe in axonal polyneuropathies of various genesis: hand ECSP amplitude decreased to M + 107.5 +/- 118.3 microV, foot ECSP M-61.9 +/- 79.2 microV. Latencies increased on hand to M-1.8 +/- 0.55 s and on foot to M-2.29 +/- 0.71 s. Heart periods are also changed: M-27.9 +/- 1.1 ms at rest, M-66.9 +/- 56.4 ms in forced ventilation. Demyelinating polynephropathies elicit less pronounced changes in ECSP and respiratory arrhythmia. No clear correlations were detected between heart periods or ECSP parameters and clinical signs.
On the basis of clinical and electrophysiological examinations of 23 patients with an impaired secretion of the mediator, the following 5 groups of patients with myasthenic syndromes (MS) characterized by disturbances of the neuromuscular transision were identified: patients with bronchogenic carcinoma of the lung; males with a clinical picture closely resembling the one described in bronchogenic cancer of the lung; young males and females with an abnormal thyroid gland; patients with a mild subcortical syndrome and with ataxia; patients with chronic botulinic intoxication. Correlation of the results of electrophysiological examination did not reveal any specificity for any of the identified groups of patients.
The clinical data and findings of thorough electrophysiological and morphohistochemical examinations of the muscles of 13 patients with the myasthenic syndrome associated with terminal polyneuropathy are presented. Correlation of the clinical and electrophysiological data to the clinical manifestations of the disease and the magnitude of the block of the neuromuscular transmission disclosed a number of characteristic features of the clinical course of the disease (a predominantly oculodistal type of damage, a diminution or the absence of tendon and periosteal reflexes, the presence of atrophies of distal muscular groups) and of the EMG pattern (the presence of enlarged PDDE, an increase in residual latency, the inverse ratio of the decrement of electric and mechanical responses upon indirect stimulation of the muscle at a frequency of 3/sec) and in the histochemical picture (the presence of groupings of type I and II muscular fibrils, which are not characteristic of myasthenia). On the basis of the evidence obtained, a conclusion is drawn that the described syndrome is an independent clinical form rather than a myasthenia variant.
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