The insulin receptor in myotonic dystrophy.

Insulin binding was studied using circulating monocytes obtained from seven patients with myotonic dystrophy and seven control subjects. During an oral glucose tolerance test the 2 h plasma glucose value was significantly higher in patients with myotonic dystrophy compared to controls, and 5 out of the 7 patients demonstrated hyperinsulinemia. This combination of abnormal glucose tolerance and hyperinsulinemia suggests insulin resistance. There was no difference in insulin binding to monocyte receptors between the two groups. These results suggest that no abnormality exists in the insulin receptor in myotonic dystrophy.

Upper arm radial nerve palsy after muscular effort: report of three cases.

Three healthy men were engaged in continuous repetitive arm exercise when a sudden forceful contraction and stretch of the arm muscles led to a delayed upper arm radial nerve palsy. Radial nerve "entrapment" at the lateral head of the triceps muscles is a recognizable occupational nerve injury.

Ulnar-to-median nerve anastomosis in the forearm: electromyographic studies.

A patient with muscle weakness was studied electromyographically. An ulnar-to-median-nerve communication in the forearm on one side was an incidental finding. The electrophysiologic features are described and contrasted to those seen in the common Martin-Gruber anastomosis.

Distal ulnar neuropathy as a cause of finger tremor: a case report.

A secretary/typist developed work-related pain along the hypothenar aspect of the dominant hand. This was later followed by involuntary, finally continuous tremorous movements of the 4th and 5th fingers. Electromyographic abnormalities were limited to myokymia of 3rd and 4th interossei muscles. Surgical decompression of Guyon's canal with removal of the pisiform bone resulted in a complete cure.

Value of helical computed tomography, angiography, and endoscopic ultrasound in determining resectability of periampullary carcinoma.

BACKGROUND: High-quality preoperative radiographic evaluation is crucial in selecting patients with periampullary carcinomas who are candidates for surgical exploration and tumor resection while minimizing the rate of unnecessary laparotomy. METHODS: Twenty-one consecutive patients were prospectively investigated using helical computed tomography (CT) scanning, endoscopic ultrasonography (EUS), and selective visceral angiography (SVA) to determine tumor resectability. All patients were explored and resectability determined. RESULTS: Helical CT had a sensitivity of 63%, a specificity of 100%, and an overall accuracy of 86%. EUS had a sensitivity of 75%, a specificity of 77%, and an overall accuracy of 76%. SVA had a sensitivity of 38%, a specificity of 92%, and an overall accuracy of 71%. CONCLUSIONS: Helical CT scanning is the best preoperative imaging test to determine tumor resectability. EUS is more sensitive than CT for tumor detection, but underestimates resectability. SVA is no longer helpful in the preoperative evaluation of these malignancies.

Toe extensor weakness resulting from trivial athletic trauma. Report of three unusual cases.

Three patients exhibited variable weakness of toe extensors after trivial injuries. The first patient suffered an acute, partial anterior compartment syndrome during a prolonged motorbike ride; the second a traction injury of the deep peroneal nerve while slipping during a racquetball game. The third patient developed a compression injury of the peroneal nerve on the basis of a generalized demyelinating polyneuropathy. The major clues for diagnosis and management came from electromyographic (EMG) examination.

Distal ulnar neuropathy. Clinical and electrophysiologic aspects.

Nine patients with distal ulnar neuropathy were studied. Weakness of the hand muscles was the only abnormality in six patients; abnormal sensation was present in two patients. The cause was known in seven patients: chronic "occupational" nerve compression occurred in three meat packers and two long-distance bicyclists--acute blunt trauma to the palm of the hand in two patients. Our study indicates that electromyographic abnormalities in distal ulnar neuropathy are more variable than reported. The electromyographic findings indicated predominant axonal degeneration of motor nerve fibers, contrasting also to electromyographic abnormalities seen in entrapment neuropathies. The reasons for these differences are discussed.

Weight loss and foot drop.

Prolonged or crash dieting should be recognized as a cause of peroneal neuropathy or foot drop. The author presents seven examples in patients.