Carotenoid and vitamin E status are associated with indicators of sarcopenia among older women living in the community

BACKGROUND AND AIMS

Oxidative stress may play a role in the pathogenesis of sarcopenia, and the relationship between dietary antioxidants and sarcopenia needs further elucidation. The aim was to determine whether dietary carotenoids and alpha-tocopherol are associated with sarcopenia, as indicated by low grip, hip, and knee strength.

METHODS

Cross-sectional analyses were conducted on 669 non-disabled to severely disabled community-dwelling women aged 70 to 79 who participated in the Women's Health and Aging Studies. Plasma carotenoids and alpha-tocopherol were measured. Grip, hip, and knee strength were measured, and low strength was defined as the lowest tertile of each strength measure.

RESULTS

Higher plasma concentrations of alpha-carotene, beta-carotene, beta-cryptoxanthin, and lutein/zeaxanthin were associated with reduced risk of low grip, hip, and knee strength. After adjusting for potential confounding factors such as age, race, smoking, cardiovascular disease, arthritis, and plasma interleukin-6 concentrations, there was an independent association for women in the highest compared with the lowest quartile of total carotenoids with low grip strength [Odds Ratios (OR) 0.34, 95% Confidence Interval (CI) 0.20-0.59], low hip strength (OR 0.28, 95% CI 0.16-0.48), and low knee strength (OR 0.45, 95% CI 0.27-0.75), and there was an independent association for women in the highest compared with the lowest quartile of alpha-tocopherol with low grip strength (OR 0.44, 95% CI 0.24-0.78) and low knee strength (OR 0.52, 95% CI 0.29-0.95).

CONCLUSIONS

Higher carotenoid and alpha-tocopherol status were independently associated with higher strength measures. These data support the hypothesis that oxidative stress is associated with sarcopenia in older adults, but further longitudinal and interventional studies are needed to establish causality.

Severe myopathy and psychosis in a patient with Cushing's disease macroadenoma

Cushing's disease is most commonly caused by a corticotrope adenoma of the pituitary. Between 50 and 70% of patients with spontaneous hypercortisolism have ACTH-producing pituitary adenomas. The tumors are usually microadenomas with approximately 20% of patients with the disease showing no evidence of tumor on CT-scans or MR imaging of their pituitary glands. In contrast to patients with ectopic ACTH production, plasma ACTH concentrations in patients with spontaneous disease are generally within the normal range. We describe here a patient with a pituitary macroadenoma that showed evidence of necrosis on MRI. The patient had an atypical clinical presentation with plasma ACTH levels considerably higher than that seen in patients with non-ectopic ACTH-secretory syndrome, markedly elevated urine free cortisol, lack of phenotypical signs of hypercortisolism such as wide purplish striae, and whose most prominent and distressing symptom was severe myopathy that resulted in the patient becoming bed-ridden. Psychosis was another striking feature in this patient who during his hospital course developed multiple opportunistic infections that contributed to his demise.

Effect of 14 days of bed rest on urine metabolite excretion and plasma enzyme levels

After one week of ambulatory baseline measurement, a group of eight men 19-26 years of age remained continuously recumbent for 14 days. Studies were continued for one week following the prolonged recumbency. Urine excretion rates for a number of constituents were determined 2 days before bed rest, on day 14 of bed rest, and day 6 after bed rest. Blood plasma samples were also obtained at these times, and analyzed for several enzymes. On day 14 of bed rest significant increases were observed in urine excretion of total osmotically active substances, magnesium, calcium, phosphate, creatinine, hydroxyproline, and 17-OH corticosteroids. A decrease occurred in urinary glucose excretion. Plasma levels of alkaline phosphatase and LDH-3 were depressed, while plasma GPT was elevated. Many of these changes persisted on day 6 after bed rest, and are interpreted as concomitants of the disuse atrophy of the musculoskeletal system that characterizes prolonged bed rest and weightlessness.

The effect of androgen status on skeletal muscle myosin heavy chain mRNA and protein levels in rats recovering from immobilization

Immobilization rapidly alters skeletal muscle. The aim of the present study was to determine whether testosterone administration or, in contrast, hypogonadism affects the recovery of muscle mass and myosin heavy chain (MHC) profile at both the mRNA and protein level, after 1 week of immobilization. Male rats were assigned to one of five groups: control (C), hindlimb-immobilized (IMM), and recovery (REC; where animals were allowed 2 weeks of free cage-activity after immobilization). The recovery group was further divided to eugonadal (REC-C), castrated (REC-GDX), and a testosterone-treated (REC-T). In all groups except REC-T, the body masses after immobilization were smaller than in C, although after immobilization the body mass in REC-T recovered at a slower rate than in the other two REC groups. The gastrocnemius mass and the amount of type IIa MHC mRNA decreased during immobilization, but the control levels were regained after recovery. The amount of type IIb mRNA was reduced in REC-GDX compared to C and IMM. The changes in the relative distribution of MHC mRNA were in line with these results. After recovery, the proportion of type IIx MHC protein increased and type IIb protein decreased, although in REC-T the changes were not statistically significant. The proportion of type IIa MHC protein increased only in REC-GDX. In summary, during recovery from immobilization it seems that muscle mass increases and the MHC mRNA and protein profile tend to change toward a slower phenotype, primarily as a result of the decrease in type IIb MHC. However, these changes occur rather independently of the testosterone status.

Masticatory and skeletal muscle myositis in canine leishmaniasis (Leishmania infantum)

Twenty-four dogs with a parasitologically and serologically established diagnosis of leishmaniasis were studied to investigate the atrophy of the masticatory muscles which commonly occurs in this disease, and to compare the lesions in the masticatory muscles with those in the cranial tibial muscles. The 24 animals were divided into three groups of eight, group A dogs with no muscular atrophy, group B dogs with different degrees of atrophy in the masticatory and skeletal muscles, and group C dogs with similar degrees of atrophy in the masticatory and skeletal muscles. Increased activities of creatine phosphokinase and lactate dehydrogenase were recorded in only some of the dogs in groups B and C, but there were no significant differences between the mean activities in the three groups. Electromyographic changes indicating myopathy and involving both the temporalis and cranial tibial muscles, were observed in two of the dogs in group A, seven of those in group B, and in all the dogs in group C. Muscle histopathology revealed a variable degree of muscle fibre necrosis and atrophy, mononuclear infiltrates and neutrophilic vasculitis in all the dogs except two in group A. Leishmanial amastigotes were found within macrophages and myofibres in 16 of the dogs, some in each group. IgG immune complexes were detected in muscle samples, and circulating antibodies against myofibres were detected in serum samples from all the 24 dogs.

The dose-dependent effects of testosterone on sexual function and on muscle mass and function

Testosterone dose-response relationships are central to the issue of testosterone replacement therapy, within the context of both hypogonadal men and older men with declining testosterone levels. Dosages are also important when considering anabolic applications of testosterone for treating sarcopenia associated with chronic illness. The critical issue is whether increases in muscle mass and function can be achieved with dosages that will not adversely affect lipid profile, cardiovascular risk, and the prostate. The dose-response relationship and mechanisms of androgen action on the muscle for controlling it are being investigated.

Biochemical alterations secondary to disuse atrophy in the rat's serum and limb tissues

Disuse atrophy has been the subject of research studies of an animal model in which single-limb immobilization induces atrophic changes in the immobilized limb. These reveal systemic changes in the experimental animals that go far beyond the local response expected in that situation and are not fully understood as yet. We therefore performed a biochemical study on the effect of hind-limb immobilization on the serum and tissues of rats. The experiment was carried out on 70 young Sprague-Dawley male rats. In one group of 35 rats, the left hind-limb was immobilized for 3 weeks. Another group of 35 rats served as controls. Serum total protein, albumin, urea, creatinine, and calcium were found to be reduced during immobilization. Serum cholesterol levels, on the other hand, increased to a considerable extent. No changes were recorded with phosphate, bilirubin, and magnesium. Serum alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were both reduced in activity. The activity of muscle aspartate aminotransferase (AST) and bone alkaline phosphatase (ALP) was also decreased. Lactate dehydrogenase (LDH) remained unchanged in both serum and muscle. We discuss our findings in the light of previous knowledge regarding the atrophic process.

Low serum calcidiol concentration in older adults with reduced muscular function

OBJECTIVE

To examine the association between muscular function and the serum concentrations of 25-hydroxyvitamin D (calcidiol) and 1,25-dihydroxyvitamin D (calcitriol).

DESIGN

A randomized population survey. Baseline measurements of serum calcidiol and calcitriol concentrations and assessment of muscular function (hand grip strength, ability to climb stairs, outdoor activity, and fall occurrence).

SETTING

The Medical department, Aker University Hospital, Oslo, and subjects' homes.

PARTICIPANTS

Two hundred forty-six recently hospitalized older patients and 103 randomly selected older people living at home.

MEASUREMENTS

Serum concentration of calcidiol and calcitriol in relation to muscle function.

MAIN RESULTS

Reduced muscle function was associated with low calcidiol levels. In both the hospital group and the home group, calcidiol concentrations correlated positively to arm muscle strength (r = .22, P < .001; r = .37, P < .001), ability to climb stairs (r = -.16, P < .05; r = -.42, P = < .001), physical activity (r = -.27, P < .001; r = -.31, P < .001), and the absence of fall occurrences (r = -.27, P < .001; r = -.31, P = .004). Calcitriol showed an association with physical activity in the hospital group (r = -.19, P < .05), and with fall last month in the home group (r = -.22, P < .05).

CONCLUSIONS

Older people with reduced muscle function often had reduced levels of calcidiol serum concentration. Low levels of calcidiol were not associated with signs of general undernutrition, such as low body mass, or with reduced arm-muscle circumference or triceps skinfold thickness. This finding may suggest a physiological role for calcidiol in muscle function. Reduced muscle strength increased disability in our older subjects, which may be improved by vitamin D supplementation in vitamin D-deficient subjects.

Protective effect of glutamine from glucocorticoid-induced muscle atrophy occurs without alterations in circulating insulin-like growth factor (IGF)-I and IGF-binding protein levels

We investigated whether the prevention of glucocorticoid-induced muscle atrophy by glutamine infusion is associated with alterations in serum levels of insulin-like growth factor (IGF)-I and its binding proteins (IGFBPs). Hormone (cortisol acetate [CA], 100 mg/kg body wt/day) and vehicle (carboxymethyl cellulose [CMC])-treated female rats were infused with either saline or glutamine (240 mM, 0.75 ml/hr) for a 7-day period. Glutamine infusion prevented over 70% of the skeletal muscle mass loss due to the glucocorticoid injections. Serum IGF-I concentrations, which were measured by radioimmunoassay (RIA) after acid solid-phase extraction of IGFBPs, were not significantly different among groups (range of means: 373-395 ng/ml). Saline/CA treatment resulted in a 2-fold increase in circulating levels of IGFBP-3 (38- to 50-kDa bands from ligand blotting measurements) versus the saline/CMC group. Levels of 30- to 32-kDa bands were increased by approximately 3-fold in the CA-treated rats. Immunoprecipitation studies suggested that the increase in the 30- to 32-kDa binding proteins were not due to elevated levels of IGFBP-1, -2, or -5. None of the treatments significantly modified circulating levels of IGFBP-4 (24 kDa). Glutamine infusion did not reverse the effects of glucocorticoids on circulating levels of 38- to 50- and 30- to 32-kDa IGFBPs. We conclude that the attenuation of glucocorticoid-induced muscle atrophy by glutamine infusion is not associated with changes in circulating levels of IGF-I or IGFBPs.

Muscle atrophy and hormonal regulation in women in 120 day bed rest

It is known, that exposures to real and simulated weightlessness results in pronounced reduction of the cross-sectional area (CSA) of slow-twitch(ST) and fast-twitch(FT) fibers of mammalian muscle. After space flights of various durations, head-down tilt bedrest, and 7-days of dry immersion sufficient [correction of isufficient] reductions of CSA of both fiber types were observed in man and in the majority of these cases the atrophy levels of ST and FT fibers were similar. It is well-known, that elevated contractile activities of muscle system attenuate muscle atrophy development. It remains still unclear which fiber type is more susceptible to training effects. Among physiological mechanisms involved in the process of microgravity-induced atrophy development which are supposed to be the most important are the profound decrease of a mechanical tension of muscle fibers in situ and alterations in hormonal control of muscle protein metabolism. But it is not known yet if the hormonal changes in the course of exposure to gravitational unloading match somehow the time-course of muscle fiber size reduction. The aim of the study was to investigate the time-course of muscle fiber atrophy development and changes in plasma hormone levels in the course of long-duration BR with and without high-intensity locomotor interval physical training.

Serum albumin for estimating creatinine clearance in the elderly with muscle atrophy

The present study was conducted to develop a special formula to predict creatinine clearance (CCr, ml/min) in the elderly with chronic muscle atrophy using serum albumin (Alb, g/dl). We obtained 90 data sets including actual body weight (BW, kg), urinary creatinine excretion (UCr, mg/24 h), serum creatinine (SCr, mg/dl), and Alb from 90 inpatients aged 60-92 years. Regression equations were determined between the dependent variable of UCr/BW and the explanatory variable of Alb as follows: For males Ucr/BW = 2.695 Alb + 4.665 For females Ucr/BW = 1.827 Alb + 4.146. Then, the new predictive formula was derived from the equations: For males CCr = (19Alb + 32)BW/(100 x SCr) For females CCr = (13Alb + 29)BW/(100 x SCr). Evaluations for the predictive error (predicted CCr- measured CCr) showed that the new formula could provide more accurate and less biased estimates of CCr than the Cockcroft and Gault formula could, even in patients with renal insufficiency and in those with Alb < or = 2.8 g/dl.

Carnitine and weakness in haemodialysis patients

Weakness in haemodialysis patients has been attributed to several factors including carnitine deficiency. Malnutrition, neuropathy, uraemic myopathy and parathyroid hormone excess may all be important. Six haemodialysis patients were shown to have reduced muscle power compared with a normal population, and to be malnourished by dietary assessment, and features of their weakness were investigated. Total carnitine was normal in plasma but elevated in muscle, with an excess of esterified carnitine in both plasma and muscle and diminished free plasma carnitine. Muscle biopsy showed no features of carnitine deficiency and electromyography showed a non-specific neuropathy with additional myopathic changes in some. Dietary supplementation with L-carnitine (2 g/day) for 6 weeks in a placebo-controlled trial showed a redistribution of carnitine fractions but no subjective or objective improvement in muscle function. There was no improvement in the plasma lipid profile. The weakness of haemodialysis patients is multifactorial. We have not demonstrated total carnitine depletion in either muscle or plasma, and oral supplementation of L-carnitine has no demonstrable effect in this group.

Chorea-amyotrophy with chronic hemolytic anemia: a variant of chorea-amyotrophy with acanthocytosis

We studied two siblings with chorea and amyotrophy of adult onset and spherocytic hemolytic anemia. Autopsy revealed an atrophic striatum with iron deposition and spheroid bodies. Degeneration of the substantia nigra and spinal cord anterior horns was seen without iron deposition. The disorder seems to be a variant of the chorea-amyotrophy-acanthocytosis syndrome, and the pathology may account for evidence of parkinsonism and amyotrophy in that syndrome. Acanthocytosis may not be the only hematologic abnormality in this disorder.

Amyotrophic choreoacanthocytosis: is it really a very rare disease?

Amyotrophic choreoacanthocytosis (ACA) is a hereditary disease characterized by adult onset, hyperkinesias (with tongue and/or lip biting), neurogenic muscular atrophies, acanthocytosis and normal blood lipoprotein pattern. In this paper we cite 8 patients belonging to three families, describing 6 patients of two of the families. We query the supposed rarity of the disease.

Dietary essential fatty acids, vitamin E, and Charcot-Marie-Tooth disease

Twenty patients with type I Charcot-Marie-Tooth disease received dietary supplementation with the essential fatty acids (EFA), linoleic and gamma-linolenic acids, and vitamin E. A 3-month blinded trial of placebo (paraffin oil and vitamin E, 81.6 IU/d) was followed by 1 year of 3 grams daily of EFA and vitamin E. Serum fatty acid values doubled, but total esterified fatty acid proportions did not change. Arachidonic acid proportions correlated with the amount of prostaglandin-mediated lymphocyte suppression measured at the same times. Improvement demonstrated at the end of the placebo period by neuropsychological tests and neurologic examination was maintained during the 1 year of EFA supplementation. This effect may reflect a membrane stabilization benefit of vitamin E.

Erythrocyte membrane abnormalities in patients with amyotrophic chorea with acanthocythosis. Part 2. Abnormal degradation of membrane proteins

Bands 2.1, 3 and 4.2 of the erythrocyte membrane proteins in chorea-acanthocytosis are self-digested faster than those in normal controls. The junction between spectrin and band 3 protein at the cytoplasmic side of the patients' erythrocyte membranes may have some conformational defects. The conformational defects of the proteins may be responsible for the low fluidity in the interior of the patients' erythrocyte membranes. These basic molecular defects may be widespread in other extraneural cell membranes as well as in neuronal cell membranes.

Erythrocyte membrane abnormalities in patients with amyotrophic chorea with acanthocytosis. Part 1. Spin labeling studies and lipid analyses

Low fluidity was observed in the erythrocyte membranes of familial chorea-acanthocytosis by spin labeling with 12NS. The high content of the saturated fatty acids support the finding of low fluidity. Other lipid contents (cholesterol and phospholipids) and the cholesterol/phospholipid ratio were within normal ranges. The sharp decrease in the parameter, (h0/h-1)1/2, suggests phase separation deep inside the patients' erythrocyte membrane matrix. This distortion of the membrane matrix may be caused by membrane components other than the lipid components.

Levels of blood-bourne factors and cytosol glucocorticoid receptors during the initiation of muscle atrophy in rodent hindlimbs

When only 1 hindlimb of the adult mouse was immobilized for 13 h, the immobilization-induced failure of insulin to stimulate 2-deoxyglucose uptake was observed in the immobilized soleus muscle. 2-deoxyglucose uptake was unchanged in the contralateral, nonimmobilized muscle. In the rat, protein synthesis rates decreased in the one immobilized limb as compared to rates measured in the contralateral nonimmobilized limb of the same animal. The synthesis rates in the contralateral nonimmobilized limb of a rat with one immobilized limb were not significantly different from rates of muscle protein synthesis observed in rats with no hindlimb immobilization. Specific binding of 3H-dexamethasone, as determined by exchange assay in the gastrocnemius muscle cytosol, increased after 7 days of immobilization, but not after only 6 h of immobilization. Changes in the level of blood-bourne factors or in cytosolic glucocorticoid levels do not by themselves initiate muscle atrophy in immobilized rodent limbs.

Thyrotoxic myopathy associated with subacute thyroiditis

We report a case of subacute thyroiditis complicated by thyrotoxic myopathy. Previously thyrotoxic myopathy has been described as being associated with Graves' disease. The patient in this study was a 35-year-old man who developed proximal dominant muscular weakness and atrophy during the course of subacute thyroiditis. His myopathic symptoms regressed as his serum thyroxine and triiodothyronine levels returned to normal, however it took a relatively long period of time for them to do so. This suggests that marked myopathy may develop even in cases of subacute thyroiditis if the thyrotoxic state persists for a long period of time.

Induced muscular work overload and disuse on the serum carbohydrate metabolism of dog, Canis domesticus

Serum carbohydrate metabolism was analysed in control, control stimulated, denervation atrophied and denervation stimulated dogs, Canis domesticus. The muscular training has resulted in the hypoglycemia through the mobilization of glucose into both hexose mono- and diphosphate pathways. The denervation atrophy, on the contrary, resulted in hyperglycemia because of exactly opposite changes in the carbohydrate metabolism in the serum and also possibly due to the lack of uptake by the muscle. The training programme of electrical stimulation applied to this denervated muscle has wiped off the hyperglycemia. The importance of muscular work in modulating the serum carbohydrate metabolism was indicated.

H-reflex studies in a family with possibly X-linked neuronal Charcot-Marie-Tooth disease

The neuronal type of Charcot-Marie-Tooth disease (hereditary motor and sensory neuropathy, type II) was found to be present in ten of thirty-two members of one family. Motor nerve conduction velocities in this type of the disease may be normal in persons who are only mildly affected. Hoffmann-reflex investigation was effective in discriminating between affected and non-affected subjects. The mode of inheritance seemed to be X-linked, but this remained doubtful, because the outcome of the Hoffmann-reflex investigations was abnormal in one clinically non-affected boy. Xg(a)-typing gave no information as to linkage with the gene-locus of CMT. Close linkage between the loci for deutan anomaly and for CMT appeared to be very unlikely.

Hypoglycemic peripheral neuropathy in association with insulinoma: implication of glucopenia rather than hyperinsulinism. Case report and literature review

A syndrome of peripheral polyneuropathy associated with islet cell tumors and hypoglycemia has been reported in 28 patients. Despite varying features in these patients, the clinical characteristics of this syndrome are remarkably similar. These consist of the development of a sensorimotor neuropathy during a protracted course of recurrent severe hypoglycemia, related to underlying insulinoma. Cerebral symptoms dominate the clinical picture and a predominantly or entirely motor, distal and symmetric, peripheral neuropathy ensures. Upper limb involvement is more frequent, accompanied by severe weakness and distal wasting, usually without fasciculations. Painful distal paresthesias without objective sensory loss are characteristic. Direct relationship to a single hypoglycemic insult is often absent. This report describes the clinical features and laboratory investigation of a new case with this condition, reviews the literature and discusses the syndrome with special regard to the etiology.

[Phospholipid study of myopathy patients]

Distinct increase in content of blood serum total phospholipids, phosphatidyl choline, sphingomyelin and lysophosphatidyl choline was observed in 14 boys with the primary X-linkaged myopathy, Dushenne type, at the first phase of the disease. As the impairment developed, content of total phospholipids, phosphatidyl choline and phosphatidyl ethanolamine was slightly decreased but concentration of lysophosphatidyl choline and sphingomyelin was kept as high as the initial level.

Vitamin E deficiency in Werdnig-Hoffmann disease

Vitamin E levels were measured in the plasma of infants and children with various neuromuscular disorders. Seven of 8 infants with Werdnig-Hoffmann disease (WHD) had a significantly lower plasma vitamin E level (p less than 0.01) than age-matched normal controls, children with congenital myopathies, or children with muscular dystrophy. Vitamin E deficiency in WHD is not caused by malabsorption. A therapeutic trial of vitamin E in 3 patients with WHD did not change the natural course of the disease. Vitamin E deficiency may play a role in the pathogenesis of WHD.

Radioimmunoassay of serum myoglobin in neuromuscular diseases

Radioimmunoassay of serum myoglobin was performed in 85 patients with muscular symptoms. Elevated levels were found in 93% of patients with myogenic myopathy, in 54% with myasthenia gravis and in 50% with neurogenic myopathy. All 11 patients with polymyositis had elevated myoglobin concentrations. In six of seven patients with polymyositis, who were followed up with repeated determinations, a clear relationship between myoglobin levels and clinical course was found. In general serum myoglobin seemed to be a more sensitive indicator of muscle disease than creatine kinase.

Increased erythrocytic spermine in Duchenne muscular dystrophy

Erythrocytes of patients with Duchenne muscular dystrophy have been found to have elevated levels of spermine, a polyamine with a membrane-stabilizing action. Although a specific, increased spermine concentration is an additional biochemical abnormality documenting the involvement of erythrocyte membrane in Duchenne muscular dystrophy. Normal level of spermine were found in female carriers.

A pedigree of amyotrophic chorea with acanthocytosis

Several pedigrees of which some members showed a clinical syndrome consisting of mental changes, choreatic involuntary movements, limb muscles atrophy, and acanthocytosis have been reported in the United States and the United Kingdom. Such a case and some of the family members who had such abnormalities as acanthocytosis, hypo-beta-lipoproteinemia, convulsions, and confusion was observed. Results of biochemical analysis of catecholamines and their metabolites in CSF and urine showed an elevated value of norepinephrine in CSF and increased urinary secretion of DOPAC. The authors propose to designate this syndrome an amyotrophic chorea with acanthocytosis.

The significance of the estimation of serum myoglobin in neuromuscular diseases

The serum myoglobin concentration was determined and compared with the serum creatine kinase activity in 230 patients suffering from various neuromuscular diseases. No correlation was found between the two levels. In general serum creatine kinase activity estimation seemed more sensitive for the detection of neuromuscular disease than serum myoglobin estimation. In myotonic dystrophy, however, determination of serum myoglobin was distinctly the more sensitive method.

Blood selenium in chronic spinal muscular atrophy

The spinal muscular atrophies (SMA) of childhood comprise the second most common fatal recessive disease after cystic fibrosis, yet the nature of the biochemical defect causing the anterior horn cell degeneration is totally unknown. Recent reports of a cluster of adult motor neurone disease cases from a high seleniferous area in South Dakota have prompted the study of blood selenium in children with SMA in Australia. Eight children with chronic SMA were tested, in addition to 9 obligate heterozygote carriers of the gene. Blood selenium levels of patients and carriers did not differ significantly from that observed in controls. The mammalian effects of selenium toxicity are discussed.

Gyrate atrophy of the choroid and retina with hyperornithinemia: tubular aggregates and type 2 fiber atrophy in muscle

We studied 21 patients with gyrate atrophy of the choroid and retina and hyperornithinemia. Although the patients were not weak, type 2 muscle fibers were almost universally atrophic and had tubular aggregates. Gyrate atrophy is the first disease in which females are shown to have tubular aggregates; the sexes were affected equally. In gyrate atrophy the number of type 2 fibers decreases with age. The muscle and eye changes are probably related to abnormal creatine synthesis, caused, in gyrate atrophy, by the increased body pool of ornithine; muscle abnormalities may also be present in other tapetoretinal dystrophies.

[Aminoacid levels in Werding-Hoffmann and Kugelberg-Welander diseases (author's transl)]

The concentration of free aminoacids in plasma and urine were estimated in 10 patients suffering from Werdnig-Hoffmann's disease of long duration. The age of the patients was between 5 and 14 years. Estimations were also made in 10 patients with Kugelberg-Welander's disease aged between 11 and 34 years. The aminoacid concentrations were estimated on samples of plasma and 24 hours samples of urine by means of chromatography on ion-exchange resins. The data obtained were compared respectively with groups of thirty and ten healthy subjects of the same age. In the group of patients with Werdnig-Hoffmann's disease a significant increase of taurine (p less than 0.001) and of glutamic acid (p less than 0.001) was found in the plasma. The urinary excretion of glutamine was increased in the same group of patients (p less than 0.001) and in the group with Kugelberg-Welander's disease (p less than 0.005). These aminoacid levels are interpreted as an expression of a reduced oxygen metabolism and increased proteolysis in the skeletal muscles in conditions of chronic denervation.

[Glucose tolerance and neurogenic muscular atrophies (author's transl)]

Glucose tolerance is reduced in patients suffering from neurogenic muscular atrophies. In a group of 20 patients with myatrophic lateral sclerosis the extent of atrophy correlated significantly with the decrease in glucose tolerance. Creatinine excretion was used as a measure of functioning muscle mass. Insulin secretion was not reduced, on the contrary, it was strongly pronounced in these cases. The observations are not explained by a decrease in distribution volume of glucose. By testing glucose tolerance, functions of sceletal muscles are examined at the same time. In evaluating the results, the functioning muscle mass has to be taken into account.

Lipid abnormalities in hereditary neuropathy. Part 2. Serum phospholipids

The mean percentage of linoleate to total fatty acids in phosphatidylcholine and lysophosphatidylcholine fractions of serum phospholipids from neuropathic patients with HMN (hereditary motor neuropathy, also called distal type of progressive muscular atrophy), HMSN-I and HMSN-II (two types of peroneal muscular atrophy), and FA (Friedreich's ataxia) was reduced by approximately 10--20% (P less than 0.001). On the other hand, the mean percentage of nervonic acid in sphingomyelin was elevated by 9--20%. No significant difference was observed in phosphatidylethanolamine between neuropathic patients and control subjects. The mean concentration of phosphatidylcholine and sphingomyelin was also significantly reduced in neuropathic patients (except in HMN and HMSN-III). A significant correlation between endogenous 2-linoleoyl-sn-glycerol-3-phosphocholine and cholesteryl linoleate synthesis in vitro suggests that the decreased activity of phosphatidylcholine acyltransferase (EC 2.3.1.43; LCAT) in neuropathic patients is influenced by the fatty acid composition of their lipoprotein substrate. Furthermore, the reduction of phosphatidylcholine and of cholesteryl linoleate synthesis in vitro in neuropathic patients was affected by age and sex. It is unlikely that the reduced linoleate level in serum phosphatidylcholine for most, possibly all, of the inherited neuropathies studied here reflects a specific biochemical disorder. Possibly it reflects a more generalized biochemical alteration common to inherited neuropathy. One possibility is that biosynthesis of new membrane in axonal regeneration, segmental remyelination and Schwann cell hyperplasia may reduce the serum linoleate pool.

Do hormonal (stress) and vascular (ischaemia) factors contribute to reflex muscle atrophy induced by chronic nociceptive stimulation in rats?

1. Reflex muscle atrophy was induced in rats by fracturing the metatarsal bones of one hind paw and injecting 0.02 ml turpentine oil into the planta under shortlasting ether anaesthesia. The atrophy thus evoked in the soleus and extensor digitorum longus (EDL) was compared with the contralateral muscles. 2. There was a twelvefold increase of plasma corticosteroid levels one hour after application of the above nociceptive stimulus and the levels were still somewhat enhanced at 3 days. Neither bilateral adrenalectomy nor administration of corticosteroid hormones or cold stress affected the development of reflex atrophy. 3. Restriction of the arterial blood supply (ligature of the common iliac artery) led to a slowly progressing atrophy with a maximum 10 days after the ligature. Reflex atrophy introduced at different times after ligature was not enhanced. 4. These results are interpreted as evidence that neither general stress (and the effect of catabolic hormones) nor local restriction of muscle blood flow (by reflex vasospasm, for example) are likely to play any appreciable role in the mechanism of reflex muscle atrophy.

[Serum lipids in various polyneuropathies]

Serum lipids were determined in 40 cases of polyneuropathy including 17 cases of Charcot-Marie-Tooth peroneal muscular atrophy, 7 cases of Dejerine-Sot-tas polyneuropathy, 7 cases of Guillain-Barré syndrome, 2 cases of diabetic polyneuropathy, 2 cases of toxic polyneuropathy and 5 cases of polyneuropathy of unclear aetiology. In the studied material shifts were observed in the composition of serum lipids, in particular, sphingomyelin and cholesterol esters. No correlation was found beteen the type of lipid pattern changes and the clinical syndrome, type of histological changes in the sural nerve, the age at onset, as well as the duration of the disease. The probable mechanism of development of changes is discussed.

Lipid disturbances associated with spiral muscular atrophy. Clinical, electromyographic, histochemical, and lipid studies

Twelve patients with juvenile- and adult-onset spinal muscular atrophy have been studied. Eleven of the twelve patients had either type II, type IV, or borderline abnormal phenotypes, suggesting a possible relationship between serum lipid abnormalities and neuronal degeneration in the spinal muscular atrophies. Muscle enzyme histochemical studies provided valuable diagnostic information. Extensor toe signs and talipes cavus were common clinical observations.

Wohlfart Kugelberg Welander syndrome

A family is described with two brothers suffering from the Wohlfart Kugelberg Welander syndrome, and seven unaffected siblings. Another brother died in infancy from “a spinal disorder”. Both affected males developed symptoms in the third decade with weakness of the lower limb girdle, followed by the upper limb girdle. Both showed fasciculations, hyporeflexia, and purely lower motor neuron findings. EMG showed evidence of denervation and muscle biopsy showed neurogenic atrophy. Terminal motor latencies were slightly prolonged and one showed an elevated serum aldolase while both had elevated C.P.K.’s. Laboratory studies on some of the normal siblings were normal. The younger brother who has been seen over two years seems to have become slightly stronger.

Dermatoglyphics and chromosomal analysis have been carried out on the patients and some of the normal siblings. All were normal except for the younger affected brother who has persistently showed a high percentage of abnormal cells, though the basic karyotype was normal, and abnormal dermatoglyphics. This is the only case we have found in the literature with chromosome abnormalities. This pedigree suggests a recessive inheritance, possibly x linked.