Pseudocoarctation of the aortic arch associated with bicuspid aortic valve lesion: is it a surgical entity?

Three patients with bicuspid aortic valve lesion associated with pseudocoarctation of the aortic arch are presented. At operation, 2 had a bicuspid calcified stenotic aortic valve, and one a bicuspid non-calcified incompetent aortic valve. All required replacement of the diseased aortic valve. The pseudocoarctation was not corrected because it caused no hemodynamic abnormality.

Effect of glycaemic control and duration of disease on overnight albumin excretion in diabetic children

Urine albumin excretion rates were measured in overnight timed samples from diabetic and non-diabetic schoolchildren. The excretion rates in the diabetics were significantly higher than those in the controls and were positively correlated with age, duration of diabetes, and glycaemic control. Diabetic children aged 12 years and older had significantly higher albumin excretion rates than younger diabetic children matched for duration of disease. Among the non-diabetic controls there was no correlation between albumin excretion rate and age and the girls excreted significantly more albumin than the boys. Measurement of the overnight albumin excretion rate may provide a useful early indicator of the progression to clinical proteinuria in diabetes and is free from random variations such as that due to exercise.

Cervical thymectomy in the treatment of myasthenia gravis

A retrospective review of 22 patients undergoing cervical thymectomy for myasthenia gravis is presented. Their ages ranged from 19 to 67 years. The male and female ratio as well as the severity of illness prior to operation were similar to other reported series. All patients were evaluated from the standpoint of clinical response to thymectomy, and the number and dosage of anti-myasthenic drugs required after operation. There was a statistically significant improvement in clinical status in the immediate postoperative period (P less than 0.05) and a further significant improvement was noted at six months (P less than 0.05). In addition, significant reductions in postoperative drug therapy were noted (P less than 0.05). Complications from cervical thymectomy were minimal and mortality was zero. An attempt was made to correlate histological findings with clinical results. Comparison is made to other series in the literature and the advantages of the cervical technique as the initial surgical approach are described. The data presented support a useful role for cervical thymectomy in the treatment of myasthenia gravis.

The effect of afferent stimuli on steadily discharging single motor units in man

The effect of afferent stimuli on the firing pattern of single motor units has been studied in the human first dorsal interosseous muscle of the hand. A reproducible series of changes in the probability of motor unit firing was seen. There was evidence for an excitatory spinal reflex involving median nerve muscle afferent fibres and ulnar nerve motor fibres. Cutaneous and muscle afferent pathways expected to be important in the control of fine movement of the first digit produced an excitatory reflex response at about 70 ms. All sites stimulated in the ipsilateral limb gave rise to a profound reduction in motor unit firing from about 70-130 ms.

Comparison between continuous flow and intermittent flow transurethral resection in 40 patients presenting with acute retention

Forty patients admitted with acute retention of urine were treated by transurethral resection of the prostate by either the continuous or intermittent flow resectoscope. No significant differences or trends were demonstrated between the 2 techniques in respect of speed of resection, blood loss and amount of glycine absorbed. There was a marked degree of haemodilution during surgery in some patients.

Late sequelae of paralytic poliomyelitis: a clinical and electromyographic study

A prospective study was carried out on 24 volunteers who had suffered from paralytic poliomyelitis up to 51 years earlier. A quantitative EMG was carried out in each subject. Grossly raised mean amplitudes of the interference patterns were found in many strong muscles as well as in weak muscles. Such muscles frequently showed "contraction fasciculation", a manifestation of loss of normal small motor units. In many subjects the clinical and EMG evidence of chronic partial denervation were more widespread than the subjects had realised. It is suggested that if, with advancing age, minor damage occurs to the peripheral nervous system and the complement of motor neurones is already depleted by poliomyelitis, there will be an exaggerated response with increase in the lower motor neurone signs.

Automatic analysis of the electromyogram in healthy subjects of different ages

The technique of automatic analysis of the electromyogram is reviewed in detail. Observations on new series of healthy subjects which may serve as a control series for comparisons with subjects with neuromuscular disease are reported. The advantages to clinical practice of using fixed standard loads for the examination are stressed. Increase in the mean amplitude of the interference pattern wasfound with increasing age in biceps brachii and tibialis anterior (but not in vastus medialis). There was no corresponding increase in mean turns count. It is suggested that this change is due to increasing mild chronic partial denervation in these 2 muscles with advancing age.

Automatic analysis of the electromyogram in patients with chronic partial denervation

The technique of automatic analysis of the electromyogram has been applied to patients with chronic partial denervation due to a wide variety of causes. Elevation of the mean amplitude more than 2 SD above the control group mean without significant change in the mean turns count was a consistent index of chronic partial denervation. The degree of elevation was linked to the severity of the weakness in motor neurone disease. Elevation of mean amplitude of comparable degree was found in patients with motor neuropathies of long duration. The elevation of mean amplitude is considered to be due to increase in the density of muscle fibres in the motor units due to reinnervation.

Chequerboard pattern reversal using a modified television display to measure visual evoked responses

The clinical value of visual evoked response measurement is noted with particular reference to the stimulus source used. The complexities of response to brief flashes of light has led to the increased use of chequerboard reversal as a stimulus source. Thus far, the chequerboard reversal has been produced by opto-mechanical means. This paper presents the results of using a television display as the stimulus generator, and some of the advantages of such a purely electronic source of pattern reversal are discussed.

Polyneuritis cranialis associated with industrial trichloroethylene poisoning

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