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Biomedical subjects

R R Heffner

Publications and source records attributed to R R Heffner.

At least 37 records · Page 2Linked to original sources

Abnormal spontaneous electrical activity and gross enlargement of muscle.

In a patient with congenital hypertrophy of the right leg, there developed progressive enlargement of the extremity and inflammatory pseudotumor and electrical myotonia within the enlarged muscle. In three other reported cases, progressive muscle enlargement was associated with abnormal spontaneous electrical and mechanical activity of muscle. In all four cases, the muscle enlargement was probably due to a combination of work hypertrophy secondary to the abnormal mechanical activity and stretch-induced hypertrophy of denervated muscle.

Adult↗

Limited benefit to genetically dystrophic chickens from a synthetic proteinase inhibitor: Ep475.

Chickens with inherited muscular dystrophy (Line 413) were treated in two separate trials with daily intraperitoneal injections of 10% DMSO-water solutions containing the proteinase inhibitors, Ep475 and E64. Drug therapy in each case significantly prolonged the functional ability of the treated chickens. Diluent control chickens around day 35 ex ovo characteristically reached a maximum ability to right from the supine position in a standardized functional test for muscle weakness. Subsequently, the control chickens were found to decline progressively in their ability to right. Treatment with the proteinase inhibitors had no effect on the typically elevated levels of plasma creatine kinase activity. In a histological analysis of the affected pectoralis major muscle, drug treatment had no effect on the relative distribution of degenerating, and vacuolated fibers, inflammatory cells, and abnormal fiber diameters. An exception was seen in decreased necrotic fibers of chickens treated with high doses of Ep475. Moreover, both inhibitors had positive effects on two biochemical abnormalities common to the dystrophic pectoralis muscle: increase in noncollagen protein, and reduction in total calcium.

Animals↗

Polymyositis beginning as a focal process.

Six patients with polymyositis initially complained of a single, localized, painful mass involving an extremity. The mass enlarged during the course of a two- to six-week period. Biopsy of the lesion revealed myopathic changes with inflammation, and the diagnosis of benign inflammatory pseudotumor was considered. The mass regressed, but during the next three to six months, a rapidly progressive generalized myopathy developed that caused weakness of the trunk and extremities in association with malaise and weight loss. Subsequent muscle biopsy specimens obtained from a site remote from the original mass were again characterized by lymphocytic infiltration, fiber necrosis, and regenerative activity. Our experience indicates that polymyositis may begin as a focal process that mimics a localized inflammatory pseudoneoplastic reaction. An essential clue to the diagnosis of polymyositis at this early stage is the elevation of ESR and serum creatine phosphokinase levels that does not occur in pseudotumor. The muscle biopsy further serves to distinguish polymyositis from pseudotumor.

Adult↗

In vivo effects of protease inhibitors on chickens with hereditary muscular dystrophy.

Beginning on day 4 ex ovo, and every 3 d thereafter, genetically dystrophic Line 413 chickens were given intraperitoneal injections (4 mg/kg body wt) of a protease inhibitor, leupeptin, pepstatin, or antipain. Experimental chickens received protease inhibitors dissolved in a water:ethanol:dimethyl sulfoxide solution (50:40:10, vol:vol:vol). Control untreated animals received diluent injections. Untreated dystrophic chickens typically reach around day 30 ex ovo a maximum ability to right from the supine position in a standardized functional test for muscle weakness. After day 30 ex ovo, the dystrophic chickens are found to decline progressively in their ability to right, compared with normal, nondystrophic controls, which have an unimpaired ability to right. Concomitantly, dystrophic chickens exhibit characteristically high levels of plasma creatine phosphokinase enzyme activity. In addition, an increased frequency of degenerating, regenerating, and vacuolated myofibers, and inflammatory cells appear in the affected pectoralis major muscles from the dystrophic chicken. Throughout the duration of the trial, there was no major enhancement in the functional righting ability of dystrophic chickens receiving any one of the protease inhibitors tested. However, there was a significant reduction in the abnormally high levels of plasma creatine phosphokinase in the treated chickens. Also, there was an apparent reduction in the mean number of vacuolated fibers in the pectoralis muscle from the protease inhibitor-treated birds. No significant reductions were observed in the relative frequency of degenerating and regenerating myofibers or inflammatory cells. In addition to the plasma creatine phosphokinase decrease, however, therapeutic benefit was seen in 31.0, 30.5, and 14.8% increases in the wet weight (and total noncollagen protein) of pectoralis muscle from dystrophic chickens receiving leupeptin, pepstatin or antipain, respectively.

Animals↗

An eye movement disorder in amyotrophic lateral sclerosis.

Defective pursuit eye movements were recorded by electrooculography (EOG) in 11 of 18 patients (61%) with amyotrophic lateral sclerosis. Pursuit defects consisted of a breakdown of smooth tracking into saccadic motions that were grossly in excess (frequencies and amplitudes) of saccadic interruptions of pursuit in normal subjects. In nine patients, defective pursuits cogwheeling) were obvious by visual inspection as well as by EOG; in two, this abnormality was seen only by EOG. In eight patients, the pursuit defect was the only abnormality of oculomotor function; in three, there were also saccadic defects (optokinetic nystagmus or conjugate gaze) discerned by EOG. Autopsy revealed neuronal degeneration in substantia nigra and demyelination in integral capsule in one patient with the pursuit defect but not in another patient without the defect. The pursuit defect may be a sign of extrapyramidal or supratentorial pyramidal involvement in ALS.

Adult↗

Primitive neuroectodermal tumors of childhood. An approach to therapy.

Primitive neuroectodermal tumors are found in the cerebrum of children and young adults. The are clinically highly malignant and have rapid course from diagnosis to death. Their microscopic pathology reveals 90% to 95% nondifferentiation, frequent mitoses, and small dark cells with no observable cytoplasm. This paper discusses the treatment of three children with this tumor with a combination of surgery irradiation, and combination chemotherapy. The results of this approach are compared with previous reports in the literature. The average survival in this series is 24 months versus approximately 8 months reported in the literature.

Adolescent↗

Denervating changes in focal myositis, a benign inflammatory pseudotumor.

Focal myositis is a benign pseudotumor of skeletal muscle, the cause of which is obscure. It usually appears as a steadily enlarging mass within the muscle of an extremity. The pathologic features are those of an inflammatory myopathy in which lymphocytic infiltrates, muscle cell necrosis, and regeneration are seen. Four cases of focal myositis were studied using enzyme histochemistry and electron microscopy. The changes of denervation atrophy, reinnervation, and fiber hypertrophy were found. Intramuscular nerve damage manifested by axonal swelling, demyelination, and endoneurial fibrosis was evident. The findings suggest that a denervating process plays an important role in the pathogenesis of focal myositis.

Adult↗

Continuous muscle fiber activity: a case with unusual clinical features.

A patient with continuous muscle fiber activity is described. From our search of the literature, we believe this is the oldest patient with a reported case of this disorder, and the symptoms and treatment varied from previously reported cases in these respects: symptoms remained confined to the lower extremities after 18 months had elapsed, there was no response to phenytoin sodium or carbamazepine, and the patient required a full dose of tubocurarine chloride to stop the abnormal myoelectric potentials. A site of dysfunction in the unbranched motor axon is suggested as the locus of generation of the stimulus for the abnormal myoelectric activity.

Aged↗

A familial mitochondrial myopathy with central defect in neural transmission.

A family was found to exhibit progressive external ophthalmoplegia, congenital cataracts, variable somatic weakness, gonadal dysgenesis, and, in one member, an abnormal chromosomal pattern. Muscle biopsy specimens showed "ragged-red" fibers; electron microscopy showed widespread paracrystalline mitochondrial inclusions. Orbicularis oculi reflex testing in the propositus showed bilateral absence of the late response. The family was evaluated in relation to other familial mitochondrial myopathies; a central defect in brain stem neural transmission was suggested as a mechanism for the progressive external ophthalmoplegia.

Adult↗

Skeletal muscle in polymyositis. Immunohistochemical study.

Thirty-two patients with adult-onset polymyositis uncomplicated by cancer or systemic connective tissue disease were studied. Muscle biopsy specimens were examined with direct immunofluorescence microscopy and results were compared with those in 94 control subjects. Sarcolemmal and sarcoplasmic staining were observed in both groups and considered to be nonspecific. Immune deposits in the muscle microvasculature were present in some cases of systemic lupus erythematosus and dermatomyositis but were not present in polymyositis. Our data suggest that the finding of vascular immunofluorescence excludes the diagnosis of adult polymyositis and implies that the pathogenesis of this disease and other idiopathic inflammatory myopathies may differ.

Adult↗

Weakness in malignancy: evidence for a remote effect of tumor on distal axons.

Malignant tumors are known to have a "remote" or nonmetastatic effect on the central and peripheral nervous systems. Eight patients were seen with proximal muscle weakness in association with bronchogenic carcinoma (5), carcinoma of breast (2), and leukemia (1). Electromyography demonstrated small polyphasic motor unit potentials. Muscle biopsy, however, showed evidence of denervation. Electron microscopy revealed morphological abnormalities in the intramuscular segments of axons. This combination of EMG and biopsy findings is presented as evidence for a remote effect of tumor on the intramuscular distal axons.

Axons↗

The early effects of ischemia upon skeletal muscle mitochondria.

The effects of early ischemia were studied in the anterior tibial muscle of Sprague-Dawley rats after 2--24 hr of tourniquet compression at the thigh. Ragged-red fibers, moth-eaten fibers, cores and targets were seen in tissue examined by enzyme histochemistry and electron microscopy. Giant mitochondria, abnormalities of cristal arrangement, crystalloids, osmiophilic inclusion bodies and myeloid figures were dominant features of the mitochondrial reaction. The results of this experiment indicate that early ischemia induces a variety of changes described in other neuromuscular conditions such as dystrophy and the "mitochondrial myopathies". The pathogenesis of these changes and their relationship to human disease of muscle is discussed.

Adenosine Triphosphatases↗

Focal myositis.

Focal myositis, a new distinct clinicopathologic entity, is a benign inflammatory pseudotumor of skeletal muscle. Based on a study of 16 cases, the disease which affects both children and adults typically evolves over a period of several weeks as a localized painful swelling within the soft tissue of an extremity. At surgery the lesion is frequently considered a neoplasm, appearing pale in color and poorly demarcated from the surrounding muscle. Histologically there is lymphocytic infiltration of the perimysial and endomysial spaces, scattered muscle fiber necrosis and regeneration, and interstitial fibrosis. The etiology is unknown, but a history of trauma or family background of a similar disease was specifically excluded. Although polymyositis may be suspected initially because of muscle pain and inflammation, the process remains confined to a single area and signs of systemic disease are not encountered. Follow-up information obtained 2--6 years after surgery indicates no recurrence of the lesion in any of 16 cases.

Adult↗

Capillary telangiectasis of the brain in chimpanzee.

The occurrence of capillary telangiectasis of the brain in a chimpanzee is reported. The telangiectases were multiple and diffusely scattered throughout the brain although the cerebral and cerebellar cortex were particulary affected. Hemorrhage into surrounding gliotic parenchyma was present. The were associated neuroligic sings, most significantly paralysis and convulsions, and the outcome was fatal. A Case of this nature has not previously been reported.

Animals↗

A demyelinating disorder associated with cerebrovascular amyloid angiopathy.

Five patients with a demyelinating disorder and associated amyloid angiopathy are presented. The disease affected middle-aged individuals, pursued a fluctuating course, and ended in progressive, fatal deterioration of the central nervous system. Neurologic findings indicated multiple lesions within the neuraxis; profound dementia was prominent in all cases. Pathologically, numerous demyelinated plaques, similar to those in multiple sclerosis, were found in the cerebral white matter, and less consistently in other locations such as optic nerve, brain stem, and spinal cord. Amyloid accumulated massively in and around blood vessels, usually in the immediate vicinity of the plaques. At least one similar case is reported in the literature, but the nosologic status of the condition is uncertain.

Amyloidosis↗

Autopsy correlations of computerized tomography: experience with 6,000 CT scans.

Seventy-nine autopsy correlations of CT scans showed (1) excellent correlations in normal brains, but the size of the lateral ventricles consistently larger during life than after death; (2) a distinctive pattern differentiating obstructive from nonobstructive hydrocephalus; (3) infarctions appearing as areas of decreased densities of parenchyma in vascular distributions; (4) distinctive high density appearances of hemorrhages that differentiated them from infarctions and, in general, all other pathologic processes; (5) supratentorial, intraventricular, and posterior fossa tumors appearing as masses that displaced, distorted, collapsed, and enlarged normal spaces and structures such as ventricles and pineal gland; (6) 11 false-negative CT scans in some cases of brain stem infarction, brain stem hemorrhage, and small metastasis; and (7) an overall accuracy of 86.2 percent of CT scanning in correctly identifying pathology of the brain.

Brain Diseases↗