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Biomedical subjects

W Schady

Publications and source records attributed to W Schady.

At least 37 records · Page 2Linked to original sources
PubMed1991

The relationship between sural nerve morphometric findings and measures of peripheral nerve function in mild diabetic neuropathy.

The morphological findings in sural nerve biopsy specimens from 15 diabetic patients with mild neuropathy were compared with control biopsies from eight non-neuropathic, non-diabetic subjects, and correlations were sought with electrophysiological studies and quantitative sensory tests for vibration, thermal, and current perception thresholds. Myelinated fibre density was reduced compared with control biopsies (4042 +/- 2090 (+/- SD) vs 6800 +/- 1100 mm-2; p less than 0.01). A strong correlation existed between myelinated fibre density and sural sensory conduction velocity (r = 0.84, p less than 0.001), sural action potential amplitude (r = 0.74, p less than 0.001), peroneal motor conduction velocity (r = 0.58, p less than 0.02), and median sensory amplitude (r = 0.64, p less than 0.01) but there was no correlation between myelinated fibre density and any quantitative sensory test. We conclude that conventional electrophysiological tests in the lower limb are reliable surrogate measures for structural abnormalities in early diabetic neuropathy.

Biopsy↗
PubMed1991

Central motor conduction studies in hereditary spastic paraplegia.

Central motor conduction (CMC) studies were carried out in 25 patients with hereditary spastic paraplegia (HSP). Responses evoked in the lower limbs by transcranial magnetic stimulation of the motor cortex were bilaterally absent in 33% of the patients and, when recordable, were delayed in 75% of cases. Responses in the upper limbs were mostly normal except for those from the five members of one family, which were considerably delayed. There was no correlation between CMC parameters and age, duration of disease or upper limb hyperreflexia. CMC time to the tibialis anterior correlated with disability in patients with juvenile-onset HSP. It is concluded that CMC studies are not useful in detecting subclinical lesions in hereditary spastic paraplegia but may be of value in identifying subgroups of the disease.

Adolescent↗
PubMed1991

Peripheral nerve dysfunction in scleroderma.

Peripheral neuropathy in patients with scleroderma is thought to be rare. We have undertaken a quantitative assessment of peripheral nerve function in 29 patients with either limited cutaneous scleroderma or progressive systemic sclerosis. Tactile thresholds were raised in the fingers in 28 per cent of patients and in the foot in 50 per cent. Two-point discrimination was abnormal in 10 patients, thermal thresholds were abnormal in five and vibration thresholds were abnormal in one. Nerve conduction studies showed abnormalities in six patients, five of whom had clinical signs of a mild peripheral neuropathy: the mean duration of disease in these six patients was 10 years longer than that in the remainder of the patients. There was electrophysiological evidence of a subclinical carpal tunnel syndrome in two patients. The sympathetic skin response was recorded in 16 patients who had not been subjected to sympathectomy for Raynaud's phenomenon, and was abnormal in four. These results indicate that peripheral nerve dysfunction in scleroderma, though mild, is not as uncommon as previously thought. The abnormal cutaneous sensory thresholds may be partly due to altered viscoelastic properties of the skin, but abnormal responses in the lower limbs to tests of tactile sensitivity, the clinical findings and the disturbances of nerve conduction argue in favour of an additional neuropathic process in some patients. Low grade distal nerve trunk ischaemia may be responsible.

Adult↗
PubMed1990

A quantitative study of sensory function in hereditary spastic paraplegia.

Somatic sensation was studied in 23 patients from 14 families with hereditary spastic paraplegia. Quantitative sensory testing revealed significantly raised thermal, heat pain, vibratory and tactile thresholds in patients as compared with normal controls. Cutaneous sensitivity was more severely impaired in the feet than in the hand. All patients had at least one elevated sensory threshold. Sensory nerve conduction studies were abnormal in 6 patients, 5 of whom were members of the same family. Somatosensory evoked potentials were reduced on average to half the size of those of controls. Although the clinical picture is dominated by a spastic paraparesis, subclinical sensory impairment is common in hereditary spastic paraplegia and may reflect involvement of peripheral nerves, afferent pathways in the spinal cord or both.

Adult↗
PubMed1989

Rheumatoid arthritis and motor neurone disease--an association?

Three patients with rheumatoid arthritis and motor neurone disease are presented. The neurological syndrome supervened after 2, 19 and 23 years of polyarthritis and led to death within 4 years. The diagnosis of motor neurone disease was confirmed at post mortem in one case. Common immunological mechanisms may account for this previously unreported association.

Adult↗
PubMed1988

Hereditary progressive chorea without dementia.

A family with hereditary non-Huntington's chorea is presented. Transmission was autosomal dominant with variable penetrance. Chorea commenced in childhood and affected predominantly the head, face and upper limbs. Dysarthria appeared later, followed in two family members by elements of an axial dystonia. There was no intellectual impairment. Unlike previously described families, symptoms progressed steadily up to the eighth decade, causing considerable physical disability.

Aged↗
PubMed1987

The incidence of craniocervical bony anomalies in the adult Chiari malformation.

Detailed linear, angular and surface area measurements were undertaken on the lateral skull radiographs of 32 patients with proven idiopathic adult Chiari type 1 malformation. Basal angles were larger, the clivus was shorter and Klaus' index was reduced in patients compared to normal controls. The size of the posterior fossa was smaller in patients than in controls. By discriminant analysis of the skull X-ray data it was possible to identify correctly two thirds of patients as belonging to the patient group. The findings indicate that craniocervical bony anomalies in the adult Chiari malformation are commoner than was previously realised, and they support the view that tonsillar herniation in these patients results from bony occipital dysplasia.

Adolescent↗
PubMed1987

Computing in clinical departments: implications for the design of hospital information systems.

Information technology is of increasing importance to the health service. Two main types of system have grown up, those in clinical departments and central administrative systems. It is important to consider their inter-relationships. A clinical system in the Renal Unit at Manchester Royal Infirmary is described, which is typical of many departmental systems. Further work is reported demonstrating an impressive commonality in the requirements of different clinical disciplines and supporting the view that departmental systems are a valuable source of accurate management data. The experience gained from designing departmental systems is reviewed. It is concluded that the participation of users is essential to the successful design and implementation of systems in the National Health Service and that departmental systems have a crucial role to play in the development of district information systems.

Computers↗
PubMed1984

Central effects of zomepirac on pain evoked by intraneural stimulation in man.

The central analgesic activity of zomepirac was studied in six healthy subjects by means of intraneural electrical stimulation. Pain elicited by selective activation of nociceptive fibers was inhibited by the administration of a single oral dose of 100 mg zomepirac. Pain relief in this double-blind crossover study was significantly greater after zomepirac than after placebo. Maximal analgesic effect was observed between 30 and 90 minutes after ingestion. Since peripheral receptors are bypassed by this technique, it is postulated that the observed effect reflects a central action of zomepirac, possibly as a result of inhibition of prostaglandin synthesis in the central nervous system.

Adolescent↗
PubMed1984

Referred pain from intraneural stimulation of muscle fascicles in the median nerve.

Microelectrode recordings were obtained from 118 cutaneous and 26 muscle fascicles in the intact median nerves of healthy human subjects. The exploring electrodes were also used for painful electrical stimulation of the identified fascicles. Cutaneous pain was accurately projected to fields within the median innervation territory. Deep pain was projected to muscles innervated by the median nerve, but in 7 experiments it was also segmentally referred to muscles in the ipsilateral upper arm, axilla or chest. Reaction time measurements indicated that referred pain was conveyed by afferent group III fibres from muscle, but did not exclude a possible contribution by group IV fibres. Referred pain was influenced by temporal and spatial summation of the afferent inflow. The magnitude of referred pain was positively correlated to the stimulation frequency of deep nociceptive fibres. The results from this study on experimentally induced pain confirm clinical observations of proximal referral of pain in patients with median nerve entrapment, and prompt consideration of possible involvement of nerve fascicles supplying deep structures in the forearm or hand in the differential diagnosis of pain in the chest and upper arm.

Adult↗
PubMed1984

A new method for demonstration of central effects of analgesic agents in man.

A new method of eliciting experimental pain in man is described. Microelectrodes are inserted percutaneously into the peripheral nerves of awake subjects, and are positioned close to nociceptive fibres in order to elicit pain during intraneural electrical stimulation. Under fixed stimulation conditions the estimated magnitude of evoked pain remains relatively stable, unless a high stimulus frequency is used, which may lead to excitation failure of nociceptive fibres. This method can be employed to test for possible central modulation of pain, for instance by analgesic agents, since peripheral receptors are bypassed.

Adult↗
PubMed1984

Sensory correlates of somatic afferent fibre activation.

This paper reviews advances in our knowledge of mechanoreception and nociception. Conventional microneurography has been used in combination with a new method of intraneural microstimulation to classify and activate single myelinated or small groups of unmyelinated sensory units in intact peripheral nerves in alert subjects. The results indicate exquisite capacity of the human brain to detect, localise, delineate, classify and quantify specific sensations from the input of certain types of single sensory units, particularly in fingertips. Application of the powerful technique of microstimulation has improved our understanding of the mechanisms underlying clinical tests such as two-point discrimination and point localization, and has shed new light on peripheral and central modulation of pain.

Afferent Pathways↗
PubMed1983

Peripheral projections of fascicles in the human median nerve.

Intraneural microstimulation combined with microneurography was employed to study the degree of mixing of muscle and skin nerve fibres at two levels in the human median nerve, and to delineate the area of skin supplied by a fascicle. It was found that about half the fascicles at upper arm level appeared to supply exclusively skin or muscle, while the remainder were considerably committed to one or the other. Further, the projection territories of skin nerve fascicles, both at the wrist and in the arm, tended to be discrete, confluent areas covering no more than 20 per cent of the median nerve territory. At the wrist fascicular territories usually resembled the innervation area of a single palmar digital nerve while in the upper arm they tended to cover a digital interspace. These findings suggest that most of the rearrangements of spinal root fibres into terminal nerve branch groupings occur at brachial plexus level, while the intraneural fascicular plexus may act as a safety mechanism allowing for nondermatomal overlap at proximal level.

Adult↗