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in ammatory, vasculitic, and amyloid neuropathies In children, the nerve biopsy may reveal the histologic features of metachromatic or globoid leukodystrophy, giant axonopathy, or neuroaxonal dystrophy However, nerve biopsy is relatively unhelpful in most other polyneuropathies and should be used prudently because the procedure is not without complications, such as the occasional occurrence of wound infections, painful stump neuromas, persistent dysesthesias of the lateral foot or heel, and thrombophlebitis Indeed, in a prospective study of 50 consecutive cases with sural nerve biopsy reported by Gabriel and colleagues, nerve biopsy served only to con rm the clinical diagnosis in 70 percent of cases and altered the diagnosis in only 14 percent Nevertheless, in some instances of idiopathic polyneuropathy that are not clari ed by clinical and electrophysiologic testing, and particularly if a treatable chronic in ammatory polyneuropathy is suspected, many neuromuscular experts resort to sural nerve biopsy as a nal diagnostic step Although the sural nerve is typically chosen for biopsy, the super cial peroneal nerve and the adjacent peroneus brevis muscle gives a higher yield in cases of vasculitis (see Collins et al) In diseases that involve only the motor nerves, it is sometimes useful to sample a fascicle of the super cial radial nerve or the nerve to the extensor digitorum brevis, which may be taken with the muscle itself Chronic in ammatory neuropathy and vasculitic neuropathy may be disclosed by this type of biopsy when the sural nerve is unaffected Also, in selected circumstances we have undertaken biopsy of small radicles of upper lumbar roots (L1 or L2) to establish the diagnosis of an in ltrative lymphoma Little de cit occurs from the removal of nerves from these alternative sites if the procedure is done by an experienced surgeon Additional techniques that are utilized in the study of muscle biopsies and speci c pathologic ndings that characterize the many individual diseases, of both muscle and peripheral nerve, are discussed in the chapters that follow Other Laboratory Tests in the Study of Muscle and Nerve Disease None of the diagnostic procedures previously described may be taken as an infallible diagnostic index of a speci c disease of muscle or nerve Each procedure is subject to technical error and the ndings to misinterpretation A biopsy specimen may be taken from an unaffected muscle or portion of a muscle, and such a sampling error causes the sample to be normal in the face of obvious clinical evidence of disease This is particularly true of the in ammatory myopathies that affect muscle in heterogeneous and spotty manner Rough excision and improper xation and staining may produce artifacts that may be misinterpreted as marks of disease when, in fact, the muscle (and nerve) is microscopically normal Similarly, EMG study may fail to record brillations in obviously denervated muscle, particularly in slowly progressive disorders Also, in some of the muscles of the feet, brillations and fasciculations may be found in normal asymptomatic older individuals (Falck and Alaranta) As in the study of all disease, laboratory data have signi cance only if evaluated in the light of the clinical ndings. excel code 39 barcode Follow these 7 Steps to Install a Barcode Font in Excel + Word
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