As a topical agent, capsaicin reportedly blocks pain without otherwise impairing sensation. Ten s... more As a topical agent, capsaicin reportedly blocks pain without otherwise impairing sensation. Ten subjects underwent blinded, multiple-dose application of topical 0.025% capsaicin or control emollient to skin test sites in order to evaluate capsaicin effectiveness and toxicity. Clinical changes in somesthetic perception of pinprick, heat and cold developed, but neurogenic flare responses were unchanged. Clinical and electrophysiologic measures of large fiber and autonomic function were unaffected by capsaicin. This study indicates that 0.025% capsaicin is a safe topical agent with demonstrable clinical effects on small fiber function but not on large fiber or autonomic function.
Summary: Purpose:Laryngeal dystonia is a chronic neurologic disorder characterized by intention-i... more Summary: Purpose:Laryngeal dystonia is a chronic neurologic disorder characterized by intention-induced spasms of the vocal folds driven by aberrant central motor processing. The use of in-office transcervical botulinum toxin injection for the treatment of laryngeal disorders, such as laryngeal dystonia, has been deemed safe and efficacious. There is, however, no available data outlining the hemodynamic changes experienced by patients undergoing this frequently performed procedure.Methods:One hundred and one patients diagnosed with laryngeal dystonia were enrolled in this prospective study. These patients underwent transcervical laryngeal botulinum toxin injection to address their dysphonia. Vital signs where acquired prior to, and at the time of injection. Alterations in these parameters were then evaluated for statistical significance.Results:Statistically significant increases in mean heart rate (5.8 ± 10.8 bpm, p <0.0001), systolic and diastolic blood pressure (7.0 ± 9.5mmHg, p <0.0001; 8.7 ± 14.7 mmHg, p < 0.0001) were discovered. No statistically significant difference in oxygen saturation was noted and no patients in the study faced major adverse outcomes.Conclusion:Though these findings may not have related to clinically significant complication, our study demonstrates the importance of understanding potential stressors in a procedure routinely performed by laryngologists. This may result in more careful patient selection, alterations in procedure, and improved safety by acting in a timely fashion if alarming changes in hemodynamic parameters are noted.
A previously healthy 35-year-old Sudanese woman was admitted with new-onset right hemispheric sei... more A previously healthy 35-year-old Sudanese woman was admitted with new-onset right hemispheric seizures with secondary generalization. The patient's vital signs were temperature 100.2°F, blood pressure 133/96 mm Hg, pulse 83 beats per minute, respirations 18 per minute, and oxygen saturation 100% on room air. Additionally, a complete neurologic examination was within normal limits. She was discharged on phenytoin and levetiracetam but returned 4 days later with repeated generalized tonic-clonic seizures and altered behavior. Shortly after admission, she became progressively confused with severe insomnia, amnesia, cognitive decline, and delirium, which included bouts of hypersexuality, hyperreligiosity, and auditory hallucinations; her neurologic examination continued to be unremarkable other than mental status fluctuations. Continuous EEG revealed several subclinical seizures along with 3 clinically evident seizures. These seizures progressed to become bilateral with 10-Hz rhythmic spike-and-wave complexes involving the left frontotemporal head region, and this spread to the left hemisphere and evolved to 4-to 5-Hz theta activity with amplitude of 60 mV.
Electroencephalography and Clinical Neurophysiology/Electromyography and Motor Control, 1995
While it is well known that splenius capitis rotates the chin to the same side and the sternoclei... more While it is well known that splenius capitis rotates the chin to the same side and the sternocleidomastoid rotates it to the opposite side, the action of trapezius has been the subject of some confusion. Most, but not all, textbooks describe no rotational activity of trapezius. Some monographs have advocated botulinum toxin injections in the trapezius on the same side as the chin rotation in torticollis, citing improvements in patients with injections in this area; others authors cite success in injecting contralateral trapezius. Using sonography and electromyography, we investigated head turning in normal subjects and patients with cervical dystonia to clarify the rotational actions of the trapezius. In all subjects, ipsilateral rotation of the head led to sonographically-apparent thickening of the ipsilateral splenius capitis and the contralateral trapezius. Similarly, needle recordings in subjects turning their head ipsilaterally showed activation of the ipsilateral splenius capitis and contralateral trapezius. Three patients with pure rotational torticollis were studied, and the ipsilateral splenius capitis and contralateral trapezius activated with involuntary head rotation. Cadaveric studies confirmed that anatomic variation in trapezius fiber orientation was minimal, and that it acted to rotate the chin contralaterally. Our findings confirm that the trapezius rotates the head contralaterally. This indicates that both major muscles innervated by the spinal accessory nerve have complementary actions on head rotation, an arrangement that may minimize the consequences of misdirected regeneration of nerve fibers following injury. In pure rotational torticollis, the contralateral, not ipsilateral, trapezius should be injected with botulinum toxin.
Farmworkers are at risk for health consequences of pesticide exposure. While acute exposure cause... more Farmworkers are at risk for health consequences of pesticide exposure. While acute exposure causes immediate symptoms, most exposure is likely low level and chronic, with possible health effects manifest years later as neurodegenerative diseases. We hypothesized that subclinical effects might be detected in current farmworkers to provide evidence of early stage neurodegeneration. From animal studies, olfactory function, an early sign of Parkinson's disease, is known to be sensitive to pesticide exposure. The study objective was to compare olfactory function in comparable samples of exposed and non-exposed workers. Migrant farmworkers (n=304) and a comparison sample of non-farmworkers (n=247) 18+ years and self-identified Latino/Hispanic were recruited in North Carolina with the help of community partners. Non-farmworkers were restricted to those with no occupational pesticide exposure in the previous 3 years. Odor identification and odor threshold tests were administered in a cl...
Movement disorders : official journal of the Movement Disorder Society, Jan 15, 2010
Coenzyme Q10 (CoQ(10)), a potential neuroprotective compound, was previously investigated at a do... more Coenzyme Q10 (CoQ(10)), a potential neuroprotective compound, was previously investigated at a dosage of 600 mg/day in Huntington's disease (HD) patients and demonstrated a trend toward slowing disease progression. Higher CoQ(10) dosages may prove beneficial. We investigated the tolerability and blood levels associated with 1,200, 2,400, and 3,600 mg/day of CoQ(10) in HD and healthy subjects. Twenty-eight subjects (20 HD, 8 healthy) enrolled in a 20-week open-label trial. Subjects started on 1,200 mg/day of CoQ(10), increasing every 4 weeks by 1,200 mg to a maximum dosage of 3,600 mg/day. Monthly evaluations included review of adverse events and CoQ(10) blood levels. Twenty-three subjects (82%) achieved the target dosage of 3,600 mg/day. Six subjects (2 healthy, 4 HD) withdrew prematurely (gastrointestinal (GI) symptoms in 3, worsening HD in 2, and 1 because of a fall). All three serious adverse events occurred in a single subject, and were deemed unrelated to CoQ(10). The most ...
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine, Jan 3, 2015
Farmworkers experience significant work-related health risks including pesticide-associated cogni... more Farmworkers experience significant work-related health risks including pesticide-associated cognitive impairment. Practice effect is a surrogate for learning ability. This study examined differences in cognitive function and learning capacity in Latino farmworkers and nonfarmworkers. Tasks of learning and short-term memory, executive function and working memory, perceptual coding, and psychomotor function were assessed at baseline and 3-month follow-up in 136 farmworkers and 116 nonfarmworkers. Farmworkers had better performance on visuospatial learning and short-term memory at baseline (P < 0.05). Nevertheless, nonfarmworkers showed more practice effects, or improvement on cognitive performance, at 3-month follow-up relative to farmworkers. Furthermore, the amount of improvement on visuospatial learning ability, short-term visuospatial memory, and perceptual coding ability was significantly higher in nonfarmworkers than in farmworkers. Practice effects may serve as an additional...
Huntington&amp;amp;amp;amp;#39;s disease may present at any age, but most typically manifests... more Huntington&amp;amp;amp;amp;#39;s disease may present at any age, but most typically manifests between the ages of 35 and 45 years as a slowly progressive neurodegenerative movement disorder with cognitive and behavioral impairment. It is an autosomal-dominant disorder that has a substantial impact on family structure and dynamics in terms of providing care for affected family members and, for the offspring of an affected parent, dealing with at-risk status. Therapy that slows the progressive neuronal dysfunction or degeneration is unavailable, so pharmacotherapy is currently aimed primarily at managing behavioral and psychiatric symptoms, and, in selected cases, controlling severe chorea. Effective intervention by clinicians is possible, however, in terms of providing patients and families with accurate information about the disease, counseling them about availability of genetic testing at specialized centers, and in giving them sound advice regarding work, driving, relationships, finances, research participation, and support groups.
We have all marveled at the gifts of talented clinicians at work, individuals who can put trouble... more We have all marveled at the gifts of talented clinicians at work, individuals who can put troubled patients at ease with a few simple words or make a complex diagnosis at a glance. Understanding how they acquired excellence and how to pass it on to others, however, poses a challenge. The timeless inquiry into human excellence constitutes the branch of philosophy known as virtue ethics. 1 Virtue ethics identifies the individual as a central moral agent and characterizes those dispositions that predispose to right or excellent actions as virtues, and those that predispose to wrong or poor actions as vices. Aristotle used physicians-as well as ship captains-as one of his central models for a virtuous person. 1 Both make decisions based on complex and sometimes conflicting observations, and both exemplify the value of virtues such as courage, judgment, fidelity, and prudence. Physicians are well suited to the study of virtue ethics because clinical care provides them an unadulterated view of human virtues and vices, ready familiarity with the language people use to describe them, and direct experience with their consequences. So how do we learn excellence? The great medical virtues-compassion, fidelity (trust), justice, and integrity-develop gradually and frequently build on simpler virtues such as tact, self-awareness, good humor, reverence, and simplicity. These simpler virtues are less celebrated and often overlooked.
To characterize the time course of intramuscular botulinum toxin–induced paresis, we serially per... more To characterize the time course of intramuscular botulinum toxin–induced paresis, we serially performed electrophysiological measurements and recorded the sonographic size of an extensor digitorum brevis (EDB) muscle in 10 human subjects before and after injecting the EDB with 10 units of botulinum‐A toxin. All EDB CMAPs decreased within 48 h, with peak decline at day 21 (8.3 ± 3.1 mV to 3.0 ± 0.9 mV). Decline of mean rectified voltage during maximal voluntary contraction of the EDB paralleled the change in CMAP amplitude. Average decrements to 2‐Hz repetitive stimulation never exceeded 6% (day 42) and exercise failed to facilitate Significantly CMAP amplitude. Atrophy peaked at day 42. The F‐wave to M‐wave ratio increased at day 2; silent periods did not change. Our findings confirm a primary peripheral action of the toxin, but a superimposed, transient central effect of the drug cannot be excluded. Intramuscular injections into EDB provide a useful model for studying chemodenervat...
Rossi A, Decchi B, Vecchione V. Supraspinal influences on recurrent inhibition in humans. Paralys... more Rossi A, Decchi B, Vecchione V. Supraspinal influences on recurrent inhibition in humans. Paralysis of descending control of Renshaw cells in patients with mental retardation.
Journal of the American Academy of Dermatology, 1993
Background: Dermatomyositis sine myositis may have various connotations. Controversyexists as to ... more Background: Dermatomyositis sine myositis may have various connotations. Controversyexists as to nomenclature, degree of evaluation required, therapy, and course (e.g., does true dermatomyositis of the skin only exist?). Objective: The purpose of this study was to assess prospectively patients with the clinicopathologic features of dermatomyositis and normal muscle enzyme serum levels to determine their course in terms of the onset of muscle disease. Methods: Thirteen patients were studied by complete history and clinical examination, laboratory studies, electromyography, and skin and muscle biopsy. They were observed for I to 6 years. Results: Patients were classifiable into three groups: (1) cutaneous changes only, (2) cutaneous changes only at baseline with subsequent development of myositis, and (3) cutaneous changes with normal muscle enzyme serum levels at baseline but with myositis demonstrated by electromyography and/or muscle biopsy specimens. Conclusion: Significantly different prognostic and therapeutic implications are present in patients with dermatomyositis with normal muscle enzyme serum levels depending on the results of electromyography, muscle biopsy, and clinical observation.
Journal of Developmental & Behavioral Pediatrics, 2002
ABSTRACT. Background. Focal spasticity of the gas- trocnemius-soleus muscles causes equinus gait ... more ABSTRACT. Background. Focal spasticity of the gas- trocnemius-soleus muscles causes equinus gait in chil- dren with cerebral palsy (CP). Botulinum toxin type A (BTX-A), a neuromuscular blocking agent, reduces mus- cle tone/overactivity in dystonia, stroke, and CP. Objective. A prospective, open-label, multicenter clinical trial evaluated the long-term safety and efficacy of repeated intramuscular injections of BTX-A on equi- nus gait
A 63-year-old female with the classical clinical and histological features of malignant angioendo... more A 63-year-old female with the classical clinical and histological features of malignant angioendotheliomatosis with disease limited to the skin is reported. Immunohistochemical studies revealed the presence of an intravascular large cell lymphoma of B cell origin. The recent literature regarding the histogenesis and nomenclature of this disease is reviewed.
... tests selected by the authors because they are the most commonly used procedures in their lab... more ... tests selected by the authors because they are the most commonly used procedures in their laboratory at the University of Vic-toria, British ... edited by JS Chopra, IMS Sawh-ney, 678 pp, with illus, ISBN 81-7042-121-7, New Delhi, India, BI Churchill Livingstone Pvt Ltd, 1999. ...
As a topical agent, capsaicin reportedly blocks pain without otherwise impairing sensation. Ten s... more As a topical agent, capsaicin reportedly blocks pain without otherwise impairing sensation. Ten subjects underwent blinded, multiple-dose application of topical 0.025% capsaicin or control emollient to skin test sites in order to evaluate capsaicin effectiveness and toxicity. Clinical changes in somesthetic perception of pinprick, heat and cold developed, but neurogenic flare responses were unchanged. Clinical and electrophysiologic measures of large fiber and autonomic function were unaffected by capsaicin. This study indicates that 0.025% capsaicin is a safe topical agent with demonstrable clinical effects on small fiber function but not on large fiber or autonomic function.
Summary: Purpose:Laryngeal dystonia is a chronic neurologic disorder characterized by intention-i... more Summary: Purpose:Laryngeal dystonia is a chronic neurologic disorder characterized by intention-induced spasms of the vocal folds driven by aberrant central motor processing. The use of in-office transcervical botulinum toxin injection for the treatment of laryngeal disorders, such as laryngeal dystonia, has been deemed safe and efficacious. There is, however, no available data outlining the hemodynamic changes experienced by patients undergoing this frequently performed procedure.Methods:One hundred and one patients diagnosed with laryngeal dystonia were enrolled in this prospective study. These patients underwent transcervical laryngeal botulinum toxin injection to address their dysphonia. Vital signs where acquired prior to, and at the time of injection. Alterations in these parameters were then evaluated for statistical significance.Results:Statistically significant increases in mean heart rate (5.8 ± 10.8 bpm, p <0.0001), systolic and diastolic blood pressure (7.0 ± 9.5mmHg, p <0.0001; 8.7 ± 14.7 mmHg, p < 0.0001) were discovered. No statistically significant difference in oxygen saturation was noted and no patients in the study faced major adverse outcomes.Conclusion:Though these findings may not have related to clinically significant complication, our study demonstrates the importance of understanding potential stressors in a procedure routinely performed by laryngologists. This may result in more careful patient selection, alterations in procedure, and improved safety by acting in a timely fashion if alarming changes in hemodynamic parameters are noted.
A previously healthy 35-year-old Sudanese woman was admitted with new-onset right hemispheric sei... more A previously healthy 35-year-old Sudanese woman was admitted with new-onset right hemispheric seizures with secondary generalization. The patient's vital signs were temperature 100.2°F, blood pressure 133/96 mm Hg, pulse 83 beats per minute, respirations 18 per minute, and oxygen saturation 100% on room air. Additionally, a complete neurologic examination was within normal limits. She was discharged on phenytoin and levetiracetam but returned 4 days later with repeated generalized tonic-clonic seizures and altered behavior. Shortly after admission, she became progressively confused with severe insomnia, amnesia, cognitive decline, and delirium, which included bouts of hypersexuality, hyperreligiosity, and auditory hallucinations; her neurologic examination continued to be unremarkable other than mental status fluctuations. Continuous EEG revealed several subclinical seizures along with 3 clinically evident seizures. These seizures progressed to become bilateral with 10-Hz rhythmic spike-and-wave complexes involving the left frontotemporal head region, and this spread to the left hemisphere and evolved to 4-to 5-Hz theta activity with amplitude of 60 mV.
Electroencephalography and Clinical Neurophysiology/Electromyography and Motor Control, 1995
While it is well known that splenius capitis rotates the chin to the same side and the sternoclei... more While it is well known that splenius capitis rotates the chin to the same side and the sternocleidomastoid rotates it to the opposite side, the action of trapezius has been the subject of some confusion. Most, but not all, textbooks describe no rotational activity of trapezius. Some monographs have advocated botulinum toxin injections in the trapezius on the same side as the chin rotation in torticollis, citing improvements in patients with injections in this area; others authors cite success in injecting contralateral trapezius. Using sonography and electromyography, we investigated head turning in normal subjects and patients with cervical dystonia to clarify the rotational actions of the trapezius. In all subjects, ipsilateral rotation of the head led to sonographically-apparent thickening of the ipsilateral splenius capitis and the contralateral trapezius. Similarly, needle recordings in subjects turning their head ipsilaterally showed activation of the ipsilateral splenius capitis and contralateral trapezius. Three patients with pure rotational torticollis were studied, and the ipsilateral splenius capitis and contralateral trapezius activated with involuntary head rotation. Cadaveric studies confirmed that anatomic variation in trapezius fiber orientation was minimal, and that it acted to rotate the chin contralaterally. Our findings confirm that the trapezius rotates the head contralaterally. This indicates that both major muscles innervated by the spinal accessory nerve have complementary actions on head rotation, an arrangement that may minimize the consequences of misdirected regeneration of nerve fibers following injury. In pure rotational torticollis, the contralateral, not ipsilateral, trapezius should be injected with botulinum toxin.
Farmworkers are at risk for health consequences of pesticide exposure. While acute exposure cause... more Farmworkers are at risk for health consequences of pesticide exposure. While acute exposure causes immediate symptoms, most exposure is likely low level and chronic, with possible health effects manifest years later as neurodegenerative diseases. We hypothesized that subclinical effects might be detected in current farmworkers to provide evidence of early stage neurodegeneration. From animal studies, olfactory function, an early sign of Parkinson's disease, is known to be sensitive to pesticide exposure. The study objective was to compare olfactory function in comparable samples of exposed and non-exposed workers. Migrant farmworkers (n=304) and a comparison sample of non-farmworkers (n=247) 18+ years and self-identified Latino/Hispanic were recruited in North Carolina with the help of community partners. Non-farmworkers were restricted to those with no occupational pesticide exposure in the previous 3 years. Odor identification and odor threshold tests were administered in a cl...
Movement disorders : official journal of the Movement Disorder Society, Jan 15, 2010
Coenzyme Q10 (CoQ(10)), a potential neuroprotective compound, was previously investigated at a do... more Coenzyme Q10 (CoQ(10)), a potential neuroprotective compound, was previously investigated at a dosage of 600 mg/day in Huntington's disease (HD) patients and demonstrated a trend toward slowing disease progression. Higher CoQ(10) dosages may prove beneficial. We investigated the tolerability and blood levels associated with 1,200, 2,400, and 3,600 mg/day of CoQ(10) in HD and healthy subjects. Twenty-eight subjects (20 HD, 8 healthy) enrolled in a 20-week open-label trial. Subjects started on 1,200 mg/day of CoQ(10), increasing every 4 weeks by 1,200 mg to a maximum dosage of 3,600 mg/day. Monthly evaluations included review of adverse events and CoQ(10) blood levels. Twenty-three subjects (82%) achieved the target dosage of 3,600 mg/day. Six subjects (2 healthy, 4 HD) withdrew prematurely (gastrointestinal (GI) symptoms in 3, worsening HD in 2, and 1 because of a fall). All three serious adverse events occurred in a single subject, and were deemed unrelated to CoQ(10). The most ...
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine, Jan 3, 2015
Farmworkers experience significant work-related health risks including pesticide-associated cogni... more Farmworkers experience significant work-related health risks including pesticide-associated cognitive impairment. Practice effect is a surrogate for learning ability. This study examined differences in cognitive function and learning capacity in Latino farmworkers and nonfarmworkers. Tasks of learning and short-term memory, executive function and working memory, perceptual coding, and psychomotor function were assessed at baseline and 3-month follow-up in 136 farmworkers and 116 nonfarmworkers. Farmworkers had better performance on visuospatial learning and short-term memory at baseline (P < 0.05). Nevertheless, nonfarmworkers showed more practice effects, or improvement on cognitive performance, at 3-month follow-up relative to farmworkers. Furthermore, the amount of improvement on visuospatial learning ability, short-term visuospatial memory, and perceptual coding ability was significantly higher in nonfarmworkers than in farmworkers. Practice effects may serve as an additional...
Huntington&amp;amp;amp;amp;#39;s disease may present at any age, but most typically manifests... more Huntington&amp;amp;amp;amp;#39;s disease may present at any age, but most typically manifests between the ages of 35 and 45 years as a slowly progressive neurodegenerative movement disorder with cognitive and behavioral impairment. It is an autosomal-dominant disorder that has a substantial impact on family structure and dynamics in terms of providing care for affected family members and, for the offspring of an affected parent, dealing with at-risk status. Therapy that slows the progressive neuronal dysfunction or degeneration is unavailable, so pharmacotherapy is currently aimed primarily at managing behavioral and psychiatric symptoms, and, in selected cases, controlling severe chorea. Effective intervention by clinicians is possible, however, in terms of providing patients and families with accurate information about the disease, counseling them about availability of genetic testing at specialized centers, and in giving them sound advice regarding work, driving, relationships, finances, research participation, and support groups.
We have all marveled at the gifts of talented clinicians at work, individuals who can put trouble... more We have all marveled at the gifts of talented clinicians at work, individuals who can put troubled patients at ease with a few simple words or make a complex diagnosis at a glance. Understanding how they acquired excellence and how to pass it on to others, however, poses a challenge. The timeless inquiry into human excellence constitutes the branch of philosophy known as virtue ethics. 1 Virtue ethics identifies the individual as a central moral agent and characterizes those dispositions that predispose to right or excellent actions as virtues, and those that predispose to wrong or poor actions as vices. Aristotle used physicians-as well as ship captains-as one of his central models for a virtuous person. 1 Both make decisions based on complex and sometimes conflicting observations, and both exemplify the value of virtues such as courage, judgment, fidelity, and prudence. Physicians are well suited to the study of virtue ethics because clinical care provides them an unadulterated view of human virtues and vices, ready familiarity with the language people use to describe them, and direct experience with their consequences. So how do we learn excellence? The great medical virtues-compassion, fidelity (trust), justice, and integrity-develop gradually and frequently build on simpler virtues such as tact, self-awareness, good humor, reverence, and simplicity. These simpler virtues are less celebrated and often overlooked.
To characterize the time course of intramuscular botulinum toxin–induced paresis, we serially per... more To characterize the time course of intramuscular botulinum toxin–induced paresis, we serially performed electrophysiological measurements and recorded the sonographic size of an extensor digitorum brevis (EDB) muscle in 10 human subjects before and after injecting the EDB with 10 units of botulinum‐A toxin. All EDB CMAPs decreased within 48 h, with peak decline at day 21 (8.3 ± 3.1 mV to 3.0 ± 0.9 mV). Decline of mean rectified voltage during maximal voluntary contraction of the EDB paralleled the change in CMAP amplitude. Average decrements to 2‐Hz repetitive stimulation never exceeded 6% (day 42) and exercise failed to facilitate Significantly CMAP amplitude. Atrophy peaked at day 42. The F‐wave to M‐wave ratio increased at day 2; silent periods did not change. Our findings confirm a primary peripheral action of the toxin, but a superimposed, transient central effect of the drug cannot be excluded. Intramuscular injections into EDB provide a useful model for studying chemodenervat...
Rossi A, Decchi B, Vecchione V. Supraspinal influences on recurrent inhibition in humans. Paralys... more Rossi A, Decchi B, Vecchione V. Supraspinal influences on recurrent inhibition in humans. Paralysis of descending control of Renshaw cells in patients with mental retardation.
Journal of the American Academy of Dermatology, 1993
Background: Dermatomyositis sine myositis may have various connotations. Controversyexists as to ... more Background: Dermatomyositis sine myositis may have various connotations. Controversyexists as to nomenclature, degree of evaluation required, therapy, and course (e.g., does true dermatomyositis of the skin only exist?). Objective: The purpose of this study was to assess prospectively patients with the clinicopathologic features of dermatomyositis and normal muscle enzyme serum levels to determine their course in terms of the onset of muscle disease. Methods: Thirteen patients were studied by complete history and clinical examination, laboratory studies, electromyography, and skin and muscle biopsy. They were observed for I to 6 years. Results: Patients were classifiable into three groups: (1) cutaneous changes only, (2) cutaneous changes only at baseline with subsequent development of myositis, and (3) cutaneous changes with normal muscle enzyme serum levels at baseline but with myositis demonstrated by electromyography and/or muscle biopsy specimens. Conclusion: Significantly different prognostic and therapeutic implications are present in patients with dermatomyositis with normal muscle enzyme serum levels depending on the results of electromyography, muscle biopsy, and clinical observation.
Journal of Developmental & Behavioral Pediatrics, 2002
ABSTRACT. Background. Focal spasticity of the gas- trocnemius-soleus muscles causes equinus gait ... more ABSTRACT. Background. Focal spasticity of the gas- trocnemius-soleus muscles causes equinus gait in chil- dren with cerebral palsy (CP). Botulinum toxin type A (BTX-A), a neuromuscular blocking agent, reduces mus- cle tone/overactivity in dystonia, stroke, and CP. Objective. A prospective, open-label, multicenter clinical trial evaluated the long-term safety and efficacy of repeated intramuscular injections of BTX-A on equi- nus gait
A 63-year-old female with the classical clinical and histological features of malignant angioendo... more A 63-year-old female with the classical clinical and histological features of malignant angioendotheliomatosis with disease limited to the skin is reported. Immunohistochemical studies revealed the presence of an intravascular large cell lymphoma of B cell origin. The recent literature regarding the histogenesis and nomenclature of this disease is reviewed.
... tests selected by the authors because they are the most commonly used procedures in their lab... more ... tests selected by the authors because they are the most commonly used procedures in their laboratory at the University of Vic-toria, British ... edited by JS Chopra, IMS Sawh-ney, 678 pp, with illus, ISBN 81-7042-121-7, New Delhi, India, BI Churchill Livingstone Pvt Ltd, 1999. ...
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Papers by Francis Walker