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Neurology in the electronic information age
Busis, N A
This review discusses the state of neurology and the Internet at the turn of the millennium. First, some basic definitions about the Internet and its component protocols are presented. Next, ways neurologists and patients can use the Internet are enumerated. Internet resources or applications are available or are being created that can aid in the successful fulfillment of a neurologist's core professional activities: clinical care, teaching, research, and practice issues. Currently, the most useful categories of Internet resources for neurologists are electronic communication and access to knowledge bases. They fulfill needs that are not met by traditional, non-electronic media. There are many other types of Internet applications that supplement traditional medical methodologies. Finally, some problems and prospects concerning medical uses of the Internet are discussed: technological infrastructure including usability, security, meaning, validity/quality, value, outcomes, and responsibility. These issues must be successfully addressed if Internet computing is to become truly useful 'just in time' at the point of medical care. Solutions are actively under development today. The prospects are bright for neurology, and medicine in general, on the Internet. The Internet will become an essential medical device in the near future.
PMID: 10362892
ISSN: 1351-5101
CID: 4261602
Internet health ratings systems: knowledge vs Babel [Letter]
Malet, G F; Busis, N A
PMID: 9728636
ISSN: 0098-7484
CID: 4261792
Neurological manifestations of acute posterior multifocal placoid pigment epitheliopathy [Case Report]
Comu, S; Verstraeten, T; Rinkoff, J S; Busis, N A
BACKGROUND:Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a chorioretinal disease that causes acute visual symptoms with characteristic fundus findings. Although this entity has been associated with a variety of neurological complications, it has received little attention in the neurological literature. We wanted to emphasize the spectrum of neurological involvement, in particular the occurrence and management of strokes in patients with APMPPE. CASE DESCRIPTIONS/METHODS:We report three patients with APMPPE and neurological disease. All three presented with marked visual disturbances and headaches. One patient developed recurrent strokes involving different vascular territories of the brain and required immunosuppressive treatment for presumed cerebral vasculitis. The other two patients had cerebrospinal fluid pleocytosis and persistent headaches but recovered spontaneously. The review of the literature demonstrates a particular pattern of neurological complications in a subgroup of patients with APMPPE. CONCLUSIONS:APMPPE should be considered among the causes of stroke and aseptic meningitis in young adults. The diagnosis is critically dependent on a thorough ophthalmologic examination. Severe neurological complications are difficult to predict at the onset of the ophthalmologic disease. The patients should be monitored closely. If investigations suggest cerebral vasculitis, immunosuppressive treatment may be helpful to prevent recurrences.
PMID: 8623125
ISSN: 0039-2499
CID: 4261762
Myofibrillar myopathy with abnormal foci of desmin positivity. I. Light and electron microscopy analysis of 10 cases
Nakano, S; Engel, A G; Waclawik, A J; Emslie-Smith, A M; Busis, N A
A number of myopathies whose common denominator is abnormal foci of desmin positivity have been described under the rubrics of spheroid body myopathy, cytoplasmic body myopathy, Mallory body myopathy, myopathy with granulofilamentous inclusions, desmin storage myopathy, and intermediate filament myopathy. In this study we reevaluate the light microscopic and ultrastructural features of the myopathy with abnormal foci of desmin positivity. In 10 cases of the disease, ultrastructural analysis reveals 2 major types of lesions: (a) foci of myofibrillar destruction and (b) hyaline structures that appear as spheroidal bodies on electron microscopy. The foci of myofibrillar destruction consist of fiber areas containing disrupted myofilaments, Z-disk-derived bodies, dappled dense structures of Z-disk origin, and streaming Z-disks that are sometimes adjacent to lakes of dense material. The spheroid bodies are composed of compacted and degraded myofibrillar elements. Membrane-bound vacuoles harboring degenerating membranous organelles are a less frequent and probably secondary abnormality. None of the lesions in muscle comprise 8 to 10 nm intermediate filaments. The findings imply that spheroid body myopathy, cytoplasmic body myopathy, Mallory body myopathy, and myopathy with granulofilamentous inclusions are consequences of a single or closely related pathologic processes. Because the common denominator appears to be focal dissolution of the myofibrils followed by accumulation of the products of the degradative process, we propose the term myofibrillar myopathy to cover the observed spectrum of pathologic changes.
PMID: 8627346
ISSN: 0022-3069
CID: 4261772
Intracellular calcium and hormone secretion in clonal AtT-20/D16-16 anterior pituitary cells
Adler, M; Sabol, S L; Busis, N; Pant, H C
Intracellular ionized Ca2+ concentration was measured in clonal mouse anterior pituitary tumor cells with the fluorescent Ca2+ indicator Quin-2. In control physiological solution, free cytoplasmic Ca2+ concentration was found to be 139 +/- 11 nM. Replacement of 50 mM NaCl by 50 mM KCl in the extracellular fluid caused a 29 mV depolarization and a 4.2-fold increase in the concentration of free cytoplasmic Ca2+. Under comparable depolarizing conditions, a specific influx of 2.66 nmole of 45Ca2+ per mg protein was detected 1 min after addition of high K+, accompanied by a marked increase in the initial rate of beta-endorphin secretion. In the absence of external Ca2+, depolarization by K+ produced little or no increase in either intracellular free Ca2+ or hormone release. Incubation of AtT-20/D16-16 cells in the secretagogue norepinephrine led to a depolarization accompanied by an increase in spontaneous action potential frequency and a marked elevation in cytosolic Ca2+ concentration. Exposure of cells to somatostatin, an inhibitor of hormone release, led to only transient decreases in burst frequency and no significant reduction in intracellular Ca2+ levels. These results indicate that in addition to intracellular Ca2+, other factors also control secretory activity in AtT-20/D16-16 anterior pituitary cells.
PMID: 2575458
ISSN: 0143-4160
CID: 4372012
Stretch-induced spinal accessory nerve palsy [Case Report]
Logigian, E L; McInnes, J M; Berger, A R; Busis, N A; Lehrich, J R; Shahani, B T
Left spinal accessory nerve palsy occurred in a young man when he quickly turned his head to the right while his shoulders were pulled down by heavy hand-held objects. Electrophysiologic studies demonstrated partial axonotmesis of the spinal accessory nerve branches innervating the sternocleidomastoid and upper and middle trapezius and complete axonotmesis of spinal accessory branches to the lower trapezius. There was a separate, although functionally minor, cervical plexus innervation of the lower trapezius.
PMID: 3343990
ISSN: 0148-639x
CID: 4261672
Lumbrical sparing in carpal tunnel syndrome: anatomic, physiologic, and diagnostic implications
Logigian, E L; Busis, N A; Berger, A R; Bruyninckx, F; Khalil, N; Shahani, B T; Young, R R
Motor axons supplying lumbrical muscles are less severely affected than axons supplying thenar muscles in the carpal tunnel syndrome; sometimes lumbrical motor fibers are less affected than digit 2 sensory fibers. This pattern is consistent with compression of both the anterior and posterior aspects of the median nerve in the carpal tunnel because nerve fibers responsible for thenar, lumbrical, and digit 2 functions lie in an anterior-posterior gradient within the distal median nerve. Recognition of lumbrical sparing supports the electrodiagnosis of carpal tunnel syndrome when the distal latency to thenar muscles or the palm-to-wrist mixed median nerve conduction velocity is normal.
PMID: 3627450
ISSN: 0028-3878
CID: 4261682
Cervical root stimulation in the diagnosis of radiculopathy
Berger, A R; Busis, N A; Logigian, E L; Wierzbicka, M; Shahani, B T
Cervical root stimulation (CRS) was compared with conventional EMG, nerve conduction, and late response studies in 34 patients with possible cervical radiculopathy. Cervical roots were stimulated by monopolar needles inserted into paraspinal muscles, recording compound muscle action potentials in biceps, triceps, and abductor digiti minimi muscles. In 18 patients with clinical evidence of radiculopathy, EMG was abnormal in 11 (61%), but CRS was abnormal in all 18. Of 16 patients with symptoms but no signs of radiculopathy, EMG was abnormal in 5 (31%) and CRS was abnormal in 9 (56%).
PMID: 3808317
ISSN: 0028-3878
CID: 4261702
Electrophysiologic assessment of a median nerve injury in the palm [Case Report]
Busis, N A; Logigian, E L; Shahani, B T
In median nerve lesions of the hand, electrophysiologic evaluation of the second lumbrical muscle can help to differentiate between lesions of the common digital nerves and the proper digital nerves, as illustrated by this case report. Median nerve conduction studies to the second lumbrical muscle can be performed by placing an active recording electrode just radial to the midpoint of the third metacarpal and stimulating the median nerve at the wrist or elbow.
PMID: 3702910
ISSN: 0148-639x
CID: 4261692
Periodic leg movements of sleep (nocturnal myoclonus): an electrophysiological study
Wechsler, L R; Stakes, J W; Shahani, B T; Busis, N A
Six patients with periodic leg movements of sleep (PLMS) were studied electrophysiologically. All patients had normal results on routine nerve conduction studies and electromyography. In 5 patients the blink reflex consisted of three components, and in 1 patient it consisted of four components, with two components being normal. The second component of their blink reflex did not habituate. Other abnormalities included long-latency responses in the extremities in 2 patients, release of H-reflexes from flexor hallucis brevis muscle in 2 patients, and an Hmax/Mmax ratio of 98% in 2 patients. One patient's median nerve somatosensory-evoked response had a markedly enlarged P22 wave. These electrophysiological abnormalities suggest a disorder of the central nervous system producing increased excitability of segmental reflexes. To produce increased excitability of both brainstem and spinal cord reflexes, the disorder must be operative at the pontine level or rostral to it. Since long-latency components of blink reflexes occurred in all our patients, this may be a helpful diagnostic test when PLMS is suspected.
PMID: 3963759
ISSN: 0364-5134
CID: 4261732