Serum aldolase in muscle disease

Management of muscular dystrophy during osteoarthritis disorder: A topical phytotherapeutic treatment protocol

Background:

Creatine kinase-muscle (CK-MM) and aldolase A (AldoA) levels are proven to be realistic biochemical markers to detect muscular dystrophy during osteoarthritic disorders (MD-OADs). The aim of this study is to normalize the MD-OADs characterized by muscle weakness, atrophy, inflammatory disorders, pain with chronic arthropathy by specialized topical phytotherapeutic treatment.

Methods:

Baseline data were collected and evaluated from 153 patients, aged 59.89±11.37years, and suffering with MD-OADs for 7.89±1.90 years. Serum CK-MM and aldoA levels were measured at baseline and after a six- week treatment using the appropriate kits. All patients underwent standardized physical, radiographic examinations and completed a questionnaire. All the patients were treated with topical application of phytoconstituents from the extracts of seven Indian medicinal plants namely Cissus quadrangularis, Calotropis gigantea, Zingiber officinalis, Rosemarinus officinale, Boswellia serratia, Curcuma longa andWithata somnifera mixed with sesame oil and beehives wax for six-week.

Results:

The elevated levels of biomarkers, CK-MM and aldoA, were reduced to their mean±SEM values 82.77±1.32 and 4.94±1.30U/L, respectively at the end of six-week treatment and the improvements of deranged anatomical features, Pearson’s correlation coefficients, international-approved pain related abnormalities (VAS, WOMAC, KPS and KOOS) and reduction of weight at the end of treatment were all highly significant (p<0.0001).

Conclusion:

It is firmly confirmed that MD-OADs resulted with the elevated levels of CK-MM, and AldoA, along with deranged anatomical features (KGB, DTM, DCM, DAP, DBP, SLR, KFS and KES) and pain related parameters (VAS, WOMAC-index, KPS, KOOS and BMI) can be successfully normalized by topical phytotherapeutic treatment protocol.

Myopathy in a 20-year-old female patient with D4ST-1 deficient Ehlers-Danlos syndrome due to a homozygous CHST14 mutation

We here report on a 20-year-old female patient with EDS due to a homozygous CHST14 single nucleotide deletion resulting in D4ST-1 deficiency, accompanied by muscle hypoplasia and muscle weakness. Findings of muscle ultrasound, electromyography, and muscle biopsy pointed to a myopathy, similarly as in other EDS types. This myopathy probably contributes to the gross motor developmental delay in this type of EDS.

Sensory Mononeuropathy Multiplex in Chronic Graft versus Host Disease

Graft versus host disease (GVHD) is a frequent complication of bone marrow transplantation (BMT). Peripheral neuropathies in association with chronic GVHD are uncommon. We report a patient with BHT for chronic myeloid leukemia, and chronic GVHD with severe sclerodermatitis resulting in bilateral medial antebrachial and saphenous sensory mononeuropathies.

Diagnostic yield of noninvasive high spatial resolution electromyography in neuromuscular diseases

High Spatial Resolution electromyography (HSR-EMG), a new kind of noninvasive surface EMG based on a spatial filtering technique, was evaluated with respect to the diagnosis of neuromuscular diseases. HSR-EMG measurements were recorded from 61 healthy subjects and 72 patients with different neuromuscular diseases and analyzed quantitatively. The results indicate that a few parameters such as muscular conduction velocity, dwell time over root mean square, autocorrelation function, and chi-value are sufficient to recognize and classify specific signal alterations due to neuromuscular disorders. A diagnostic evaluation procedure calculating automatically the most probable diagnosis from the parameter results could assign the correct diagnosis to about 81% of the investigated patients and healthy subjects. Myopathic disorders were recognized with a sensitivity of 85% (specificity: 97%), neuropathic disorders with a sensitivity of 68% (specificity: 98%). We conclude that HSR-EMG shows a diagnostic validity similar to that described in literature for needle EMG. Moreover, the noninvasive technique provides the advantage of a simple and painless application.

Neuromuscular reaction to paired stimuli

A modification of the twin pulse method is described, by which the nerve tested is stimulated at one proximal site percutaneously and the neuromuscular response to it is derived from a dependent muscle. An electronic subtraction procedure provides separation of the conditioned muscle action potential for measurement by means of a microcomputer. Several parameters were determined in the conditioned action potential and compared to the same criteria in an unconditioned single action potential. Changes of the conditioned action potential were measured at fixed stimulus intervals between 2 and 6 msec. Preliminary normal ranges interindividually and intraindividually were established. Their dependency on skin surface temperature was determined. In polyradiculoneuropathy, the data for motor nerve conduction velocity were characteristically pathologic, and neuromuscular reaction to paired stimuli data deviated minimally from normal. In vincristine neuropathy, motor nerve conduction velocity was normal, but neuromuscular reaction to paired stimuli data fell outside the normal range early in the clinical course. Since polyradiculoneuropathy is a primary demyelinating and remyelinating process and vincristine neuropathy is an example of axonal degeneration, neuromuscular reaction to paired stimuli can facilitate the differential diagnosis in polyneuropathy. Furthermore, this method seems apt to quantify axonal degeneration. In a mixed form of polyneuropathy, peroneal muscular atrophy, motor nerve conduction velocity, as well as neuromuscular reaction to paired stimuli, were abnormal, the latter resulting in abnormally high relative amplitudes. In muscle disorders such as Duchenne muscular dystrophy, neuromuscular reaction to paired stimuli data was abnormal, contrasting experiments using double stimulation of the diseased muscle itself.

Diagnóstico diferencial das distrofias musculares com referência especial às alterações enzimáticas

Depois de apresentar os dados clínicos e genéticos relativos a 221 casos de distrofia muscular progressiva (125 casos do tipo Duchenne, 63 do tipo cintura pélvica e 25 do tipo fácio-escápulo-umeral), os autores analisam os resultados das dosagens sôro-enzimáticas que fizeram; em alguns casos foram pesquisas também as atividades de 25 enzimas em homogeneizados de tecido muscular. Os mesmos exames foram feitos em casos de miopatias de outra etiologia e de distrofias musculares neuropáticas e mielopáticas. Foi verificado que o teor das sôro-enzimas aumenta em todas as formas de distrofia muscular progressiva hereditária. No tipo Duchenne as-atividades enzimáticas são elevadas desde o nascimento das crianças acometidas, precedendo o aparecimento da sintomatologia clínica. Com o progredir da moléstia e com o decorrer dos anos os teores sôro-enzimáticos tendem a diminuir, podendo reduzir-se aos valores normais nas fases finais da moléstia. No tecido muscular não existe diferença significante, no que respeita à composição enzimática, entre os diversos tipos de distrofia muscular progressiva e hereditária. Com exceção de poucas enzimas cuja atividade é maior nos tecidos conjuntivo e adiposo que progressivamente substituem o tecido muscular que entra em atrofia, o teor das mio-enzimas diminui com o progredir da moléstia, como expressão do crescente esgotamento do citoplasma da célula muscular. Nas distrofias musculares neuropáticas e mielopáticas as alterações são idênticas, embora de menor intensidade. Algumas diferenças quantitativas podem ser explicadas pela idade dos pacientes e pela intensidade do processo. A mesma diferença pode ser demonstrada mediante exames histopatológicos: nas formas que acometem crianças (Werdnig-Hoffmann) as fibras musculares ainda não denervadas se apresentam com aspecto normal, ao passo que, nas formas do adulto (Kugelberg-Welander), possivelmente pelo desgaste provocado pelos esforços musculares, tais fibras freqüentemente apresentam alterações idênticas às encontráveis nas distrofias musculares miopáticas hereditárias.

Alpha-hydroxybutyrate dehydrogenase activity in sex-linked muscular dystrophy

In two families with severe sex-linked muscular dystrophy, high levels of alpha-hydroxybutyrate dehydrogenase (HBD), lactate dehydrogenase (LD), aspartate transaminase (AspT), aldolase, and creatine phosphokinase (CPK) were found in the sera of three young affected males. In both families the mother had a raised level of HBD activity. Four sisters of the three affected boys had raised serum enzyme levels, and they are regarded as presumptive carriers of the disease. Biopsy specimens of dystrophic muscle had LD and HBD contents which were significantly lower than those of control specimens, while the HBD/LD ratios were markedly greater. Muscle from two unaffected members of the same family also exhibited high ratios, indicating the presence of the electrophoretically fast LD isoenzymes, and this was confirmed by acrylamide-gel electrophoresis.