No improvement was demonstrated clinically so it was discontinued. D-Pen did not improve or worsen our patient's renal function or proteinuria. Full thickness skin to muscle biopsy. A A. Epidermis is to the left. There is significant thickening of the fascia.
Muscle occupies the right upper portion of the figure and fascia the left lower.
The flexion contractures of his right hand became intolerable and in March 1994 he requested amputation of his right ring and little fingers because they interfered with use of this hand. He can now make a tight fist with both hands and he is playing tennis and bicycling for the first time in 5 years. Echocardiogram and renal sonogram were normal. Medications were adjusted to enalapril 20 mg po daily plus felodipine 5 mg po daily with good blood pressure control. The clinical and pathological features of EF are well characterized but the etiology is unknown 5,1013 .