The Mary Walker effect: Mary Broadfoot Walker.

Mary Broadfoot Walker (1888-1974) was the first to demonstrate the 'Mary Walker effect' describing the weakness of other muscle groups following release of the arteriovenous occlusion of an unrelated exercising muscle group in patients with myasthenia gravis, which led to the search for a circulating causative agent for myasthenia gravis. She was the first to clearly demonstrate that strength temporarily improved in patients with myasthenia gravis with physostigmine or Prostigmin (neostigmine). This dramatic treatment response has been erroneously termed the 'Mary Walker effect'. Further, she noted hypokalaemia during attacks of weakness in familial periodic paralysis, pioneering treatment with potassium chloride. Although Mary Walker practiced in a nonacademic setting and trained at a time when women were not allowed to train alongside men, she was the first to convincingly demonstrate three life-changing treatments in the field of neuromuscular medicine, a feat that few physicians of any era can claim.

Low frequency repetitive nerve stimulation in anti-muscle specific tyrosine kinase receptor antibody positive myasthenia gravis / 中华神经科杂志

Objective To describe the repetitive nerve stimulation ( RNS) in anti-muscle specific tyrosine kinase (anti-MuSK) receptor antibody positive myasthenia gravis (MG), and compare with anti-acetylcholine receptor ( AChR ) positive myasthenia gravis , to figure out characteristics of anti-MuSK receptor MG.Methods We analyzed clinical and RNS data of nine anti-MuSK receptor MG and 19 age-and sex-matched anti-AChR MG.RNS was performed to the abductor digiti minimi , orbicularis oculi or musculus frontalis and trapezius .Results In anti-MuSK receptor MG , abnormal RNS in facial nerve was seen in 6/9 and in trapezius was 5/9, in limbs was 0.In anti-AChR MG, abnormal RNS in facial nerve was seen in 13/19, in trapezius was 18/19 and in limbs was 7/19.Abnormal in any of three parts was 8/9 and 19/19 in anti-MuSK receptor MG and anti-AChR MG, respectively.The RNS decrementing was more obvious in facial nerve in anti-Musk receptor MG than in anti-AChR MG.Negative prostigmin test was independently associated with anti-MuSK receptor MG (OR=4.25,95% CI 2.19 -15.25, P=0.015). Conclusions Abnormal RNS in any of three parts is more pronounced in anti-AChR MG compared with anti-MuSK receptor MG.RNS decrementing in facial nerve is more obvious in anti-AChR MG.Negative prostigmin test can aid in early suspicion in anti-MuSK receptor MG.

Low frequency repetitive nerve stimulation in anti-muscle specific tyrosine kinase receptor antibody positive myasthenia gravis / 中华神经科杂志

Objective To describe the repetitive nerve stimulation ( RNS) in anti-muscle specific tyrosine kinase (anti-MuSK) receptor antibody positive myasthenia gravis (MG), and compare with anti-acetylcholine receptor ( AChR ) positive myasthenia gravis , to figure out characteristics of anti-MuSK receptor MG.Methods We analyzed clinical and RNS data of nine anti-MuSK receptor MG and 19 age-and sex-matched anti-AChR MG.RNS was performed to the abductor digiti minimi , orbicularis oculi or musculus frontalis and trapezius .Results In anti-MuSK receptor MG , abnormal RNS in facial nerve was seen in 6/9 and in trapezius was 5/9, in limbs was 0.In anti-AChR MG, abnormal RNS in facial nerve was seen in 13/19, in trapezius was 18/19 and in limbs was 7/19.Abnormal in any of three parts was 8/9 and 19/19 in anti-MuSK receptor MG and anti-AChR MG, respectively.The RNS decrementing was more obvious in facial nerve in anti-Musk receptor MG than in anti-AChR MG.Negative prostigmin test was independently associated with anti-MuSK receptor MG (OR=4.25,95% CI 2.19 -15.25, P=0.015). Conclusions Abnormal RNS in any of three parts is more pronounced in anti-AChR MG compared with anti-MuSK receptor MG.RNS decrementing in facial nerve is more obvious in anti-AChR MG.Negative prostigmin test can aid in early suspicion in anti-MuSK receptor MG.

Study of Peritoneal Dialysis: I. Observation of Intestinal Movement in Peritoneal Dialysis through abdominal Window / 대한비뇨기과학회지

Observation of intestinal movement in rabbits were performed through use of an abdominal window in peritoneal dialysis. The causes of an adequate drainage were also observed, through the abdominal window, and better drainage was obtained as a result of clear vision and catheter adjustment. Generally it was observed that the amount of small intestinal movement diminishes after dialysis solution was introduced into the peritoneal cavity, and the larger the amount of solution, the slower the small intestinal movement. The smaller dosage is better for effecting a diminished intestinal movement; however, the effect of the dialysis is not so great, because all the surface of the peritoneum can not be used. On the other hand, the larger dosage brings on a slowing down of the intestinal movement; yet its effect on the peritoneal dialysis is greater. Our observation lead us to conclude that 200cc of solution is more popular for rabbit experiment and that dosage above this should be avoided. Less influence to the small intestinal movement was noticed when the temperature of the solution remained a little higher than body temperature. The nephrectomized rabbits and the anuric rabbits show less intestinal movement than the normal rabbits. The possible causes of ilus and abdominal distension in peritoneal dialysis were noted and discussed. After giving prostigmin in dialysate the frequency of intestinal movement increased almost to normal. Judging from the result of this experiment, it is advisable to use small doses of prostigmin in dialysate routinely in peritoneal dialysis.