Myotonic dystrophy treated with selenium and vitamin E

We have previously reported the successful treatment of a patient with myotonic dystrophy with selenium and vitamin E. This paper deals with the treatment of a further five patients with myotonic dystrophy in different stages. All five patients improved subjectively and objectively in two or more respects. All improved their grip strength according to vigorimeter measurements (Martin), two normalized their gait, another two can now sit down on their heels and stand up, one patient can now walk on his toes, one can now get up from lying on the floor without using a chair and two patients have improved their physical capacity. Patients in early stages of the disease improved faster and more markedly than those in late stages. Electromyographical measurements also showed improvements, in that the myotonic discharges had diminished. The daily dose was 4 mg of Na2SeO3 and 600 mg of vitamin E. Serum concentration of selenium increased in all patients at the beginning of the treatment, but stabilized at a level slightly above the normal. No side-effects were observed.

The effect of acute and chronic exercise on thyroid hormones in obesity

Thyroid hormones were measured before, during and after acute exercise (60 min) or physical training (3 months) in obese women. Thyroid stimulating hormone concentration increased during acute work and decreased immediately after. No changes were seen during the two following days. An increase was seen after ten days as well as after three months of physical training. Thyroxine concentrations showed no changes. 3,5,3'-Triiodothyronine decreased slightly immediately after acute exercise, and after three months of physical training, 3,3',5'-triiodothyronine (reverse triiodothyronine) increased slowly during and after acute exercise. A negative correlation was found between changes in fasting insulin and thyroxine and a positive correlation between changes in blood pressure and triiodothyronine after training. Lack of agreement in previous reports is probably due to methodological differences such as methods more or less susceptible to fatty acid interference, and thyroid hormones changing differently during acute work and before and after physical training. The duration of the study may also be of importance, even 3 months possibly being too short for attaining equilibrium in thyroid homeostasis.

Physical capacity and dyspnea in patients with asthma-like symptoms but negative asthma tests

Ten female patients with asthma-like symptoms but negative asthma tests (study group) were compared with 10 female asthmatics in an exercise test with and without pretreatment with beta 2-stimulants. The aim was to determine whether the asthma-like symptoms in the patients of the study group could be explained by bronchoconstriction, circulatory abnormalities, or physical unfitness when provoked physically, and whether the exercise test could be used to distinguish these patients from asthmatics. Without pretreatment, the asthma group reacted with bronchoconstriction, as indicated by postexercise systematic changes in PEFR, FEV1, FVC, and SaO2, which were not seen in the study group. The groups differed in the ratings of "difficulty in getting air", as only the asthma group had significantly lower ratings when pretreated. The study group's mean test performance was 94 W; the asthma group's was 106 W. The low performance was not explained by disturbances in heart rate, electrocardiogram, or blood pressure or physical unfitness. The exercise test was found to distinguish between the groups, especially for bronchoconstriction, oxygen saturation, and ratings of dyspnea. It could be used complementary to lung function tests to eliminate bronchoconstriction, circulatory abnormalities, and physical unfitness as a cause of the asthma-like symptoms.

Endurance training effect on individuals with postpoliomyelitis

OBJECTIVE

To determine the effects of an endurance training program on the exercise capacity and muscle structure and function in individuals with postpolio syndrome.

DESIGN

Preexercise and postexercise testing was performed with muscle strength evaluations using isokinetic testing as well as hand-held Myometer. Muscle fatigue was determined by use of isokinetic testing, and endurance was determined by exercise testing. Enzymatic evaluation was performed with muscle biopsies taken at the same site; preexercise and postexercise muscle cross-sectional area was measured by computed tomography. Disability and psychosocial evaluation was performed by a Functional Status Questionnaire.

SETTING

A university.

SUBJECTS

Seventeen postpolio subjects ranging in age from 39 to 49 years volunteered for a 6-month combined endurance and strength training program. They had a history of acute poliomyelitis at least 25 years earlier and were able to walk with or without aid.

INTERVENTION

Twelve of the subjects (mean age 42 years) completed the program, attending an average of 29 sessions, which were offered for 60 minutes twice a week.

MAIN OUTCOME MEASURES

Strength, endurance, enzymatic activity, and cross-sectional area were measured 3 months before the beginning of training, just before training, and at the completion of the exercise program.

RESULTS

Knee extension was reduced to an average of 60% of control values and did not change with training. Strength measured with a hand-held Myometer increased significantly for elbow flexion, wrist extension, and hip abduction. Exercise test on a bicycle-ergometer showed significant reduction (6beats/min) in heart rate at 70W and increase (12beats/min) in maximal heart rate with training. The training program could be performed without major complications and resulted in an increase in muscle strength in some muscle groups and in work performance with respect to heart rate at submaximal work load.

Dyspnoea in chronic primary fibromyalgia

We investigated the prevalence of dyspnoea, according to a 5-grade score proposed by the World Health Organization (WHO), among 87 consecutive women (age 44.0 +/- 8.4, range 26-65 years), with severe chronic primary fibromyalgia (CPF). In total 73 women (84%) were dyspnoeic, 47, 17, six and four patients reported dyspnoea corresponding to WHO grades 1, 2, 3 and 4, respectively. In multivariate analysis WHO dyspnoea grade was the most important determinator of exercise capacity. The higher WHO dyspnoea grade reported, the lower exercise capacity and heart rate were reached at graded bicycle exercise tests (r = -0.48, P less than 0.001 and r = -0.40, P less than 0.001). WHO dyspnoea grade correlated directly to breathing frequency at rest (r = 0.45, P less than 0.001) and inversely to maximum inspiratory pressure (r = -0.29, P less than 0.01). It did not correlate with maximum expiratory pressure, nor with spirometric measurements of pulmonary function. It is concluded that dyspnoea is common among CPF patients and is not explained by cardiac or pulmonary causes, but may partly be due to diaphragmatic muscular insufficiency and physical inactivity.

Effect of a training programme for pensioners on condition and muscular strength

Physical training was performed by 22 women aged between 63 and 84 yr and 4 men aged between 74 and 86 yr twice a week for 10 mths. Some subjects had moderate disorders but all of them lived in their own homes. Apart from using body weight and elastic bands, no special equipment was used as resistance. Emphasis was laid on training muscular strength and not especially on endurance training. The effect of the training on physical fitness and muscular strength is presented in the 15 women who, according to predetermined criteria, were able to perform the tests adequately. A conditioning effect was detected by using a product of watts and minutes. The static and dynamic (isokinetic) muscular strength in the knee-extensors increased (6-13%) and, parallel with this, there was an increase in the relative FTa fibre area in the vastus lateralis muscle. The training programme in this study seems to be safe for an older population with diverse disorders, as only one negligible medical incident occurred. The present findings, with objective improvement in physical fitness with training combined with feelings of increased vigour, supports the use of gymnastic activity for pensioners and other means of stimulating the elderly to keep physically active even when they have moderate disorders. Improved physical fitness may help to prevent age-dependent impairments.

Effects of a training programme for elderly people on mineral content of the heel bone

Physical inactivity can cause rapid bone loss. Different forms of physical activity are recommended for osteoporosis. The scientific background for such recommendations, however, is usually weak. This study was performed to evaluate whether it is possible to influence bone mineral content in elderly people by regular exercise. A total of 15 women with a mean age of 72 yr took part in a study in which they were given 1 h of training twice a week for 9 mth. Physically inactive patients from an outpatient geriatric unit served as a control group. They were matched in age and did not suffer from diseases that affect the locomotor system. After 10 mth of training no significant increase in bone mineral content, measured in the heel bone, could be found among the participants in the training group. Bone mineral content in the trained subjects was however, significantly higher after this training period than in the control group. The decrease in bone mineral content in the control group was almost the same as in a representative group of the population aged 70 to 79 yr. The cause of the decreased loss of bone mineral content in the physically-active subjects in the study could not be determined, but some contributing factors are discussed. Thus, it appears that physical activity diminishes bone loss due to age and that physical training has a positive effect on bone mineral content compared to that of nonactive controls of the same age. As there are no negative side effects, it has advantages over other forms of therapy, such as pharmacological treatment.

Intramedullary pressure of the patella in Chondromalacia

Degenerative changes in load-bearing joints are often combined with altered intramedullary circulation. This may cause an alteration in intramedullary pressures. It has been said that articular symptoms are connected with a change in intramedullary pressures being high they are suspected to cause pain. In this investigation the intramedullary pressure has been evaluated in chondromalacia and osteoarthrosis of the patella. A comparison has been made with normal patellae. A biopsy needle was drilled into the intramedullary bone of the patella and connected with a registering unit. In a control group an average value of 19 mm Hg was registered. In the condromalacia group the mean intramedullary pressure was 44 mm Hg and in osteoarthrosis 37 mm Hg.

Studies on histamine metabolism in allergen-induced asthma

The excretion of histamine (Hi) and it metabolite methyhistamine (MeHi) was determined in separated fractions of urine up to 12h after standardized allergen provocations in 18 adult patients with defined extrinsic bronchial asthma. The main histamine metabolite, methylimidazoleacetic acid (MeImAA), was measured in six of the patients. After positive provocations (decrease in FEV1 greater than 20%) the excretion of Hi was significantly increased during 3h and that of MeHi during 4h after challenge. Negative provocations (decrease in FEV1 less than 20%) were not followed by any changes in the excretion of Hi and MeHi. MeImAA excretion increased in five out of six patients after positive provocation. It was calculated that the increased excretion of Hi and its metabolites after a positive provocation corresponded to a release of about 1 mg histamine in the body or about 1 microgram/g lung tissue if all histamine was liberated in the lung. Pretreatment with two anti-allergic drugs, disodium cromoglycate and ICI 74.917, giving significant allergen protection, resulted in a smaller increase of the excretion of both Hi and MeHi, indicating an inhibition of histamine release in vivo.

Studies on histamine metabolism in intrinsic bronchial asthma

Histamine metabolism was investigated in patients with intrinsic asthma, during the acute phase and in remission, by determination of the urinary excretion of histamine metabolites. During acute attacks the excretion of methylhistamine (MeHi) and 1-methyl-4-imidazoleacetic acid (MeImAA) was significantly increased compared with healthy subjects. The excretion of MeHi was significantly increased during acute attacks compared with remission. The excretion of MeImAA was also increased, but the difference was not significant. The correlation between the excretion of MeHi and MeImAA was highly significant. Corticosteroids, given to some patients during remission, did not affect the excretion of histamine and its metabolites. Smoking and respiratory infection during the acute attacks were both accompanied by increased excretion of MeHi. The results indicate that there is an increased histamine turnover in acute attacks of intrinsic bronchial asthma.

Effects of long-term physical training on body fat, metabolism, and blood pressure in obesity

Twenty-seven women with varying degrees of obesity were physically trained for 6 mo on an ad lib. diet. Body fat changes were positively correlated with the number of fat cells in adipose tissue. Obese women with fewer fat cells decreased in weight during training whereas women with severe obesity and an increased number of fat cells even gained weight. Blood pressure decreased consistently after training. Blood pressure elevation was not associated with body fat mass, nor was a decrease in blood pressure associated with a decrease in body fat or with pretraining blood pressure level. There were, instead, correlations between decreases in blood pressure on the one hand and initial concentrations and decreases in plasma insulin and triglycerides and blood glucose on the other. These results suggest an association between elevated blood pressure and metabolic variables. The possibility of treating and preventing early essential hypertension with methods that also correct the metabolic derangement, such as diet and exercise, should be given high priority in further research.

Histamine metabolism in normal pregnancy and in toxaemia of pregnancy

The urinary excretion of histamine and its metabolites, methylhistamine, methylimidazoleacetic acid and imidazoleacetic acid, was measured under standardized dietary conditions in 24 women with normal pregnancies and in eleven patients with toxaemia of pregnancy. In addition, histamine metabolism was studied in five healthy women at delivery and in four other healthy pregnant women during treatment with aminoguanidine, which is an inhibitor of diamino oxidase (histaminase). A slight increase in the urinary excretion of methylimidazoleacetic acid was observed in normal pregnancy as well as in toxaemia of pregnancy compared to non-pregnant women. In two toxaemic patients and in one of the healthy subjects the urinary excretion of unmetabolized histamine was moderately increased. Despite the very high diamino oxidase activity in the plasma and in the uterus during pregnancy, there were no signs of altered catabolism of endogenous histamine in the pregnant women. Smoking increased the urinary excretion of the quantitatively dominant histamine metabolite, methylimidazolacetic acid, in pregnant subjects as it also does in nonpregnant subjects. The necessity of standardized dietary conditions in the study of histamine metabolism in man was again emphasized.

Histamine metabolism and female sex hormones in women

Oral combined contraceptives did not seem to alter histamine metabolism in females. During treatment with gonadotrophic hormones in four amenorrhoeic patients there was a tendency towards increasing excretion of methylhistamine (MeHi) followed by a sudden decrease corresponding to changes in the urinary estrogen. The excretion of methylimidazoleacetic acid (MeImAA) seemed to parallel that of MeHi. The findings support the hypothesis that an endogenous surge of estrogen may influence histamine turnover in women. Women of post-menopausal age have about the same histamine metabolism as younger menstruating women. Estrogen medication relieved symptoms of hot flushes or sweats but did not seem to affect the histamine turnover.

Histamine metabolism during the menstrual cycle

The urinary excretion of histamine and its metabolites methylhistamine (MeHi) and methylimidazoleacetic acid (MeImAA) was measured during the menstrual cycle in nine healthy women, one allergic woman and three non-pregnant women with anovulatory regular cycles. Simultaneous urinary analyses of luteinizing hormone (LH) and total estrogens were performed. The healthy women showed individual variations in the excretion of histamine, MeHi and MeImAA. This observation has been interpreted as an expression of minor individual differences in the catabolism of histamine. At midcycle an increase in the urinary excretion of histamine metabolites was sometimes evident and a statistically significant correlation could be established between MeHi and estrogen in urine. These results may support previous findings of histamine release by estrogens in uterine tissue but may also reflect an elevated histamine formation. The allergic woman excreted constantly increased amounts of histamine and its metabolites, especially when her allergic symptoms became aggravated pre-menstrually. She did not exhibit any change in MeImAA excretion at midcycle but the MeHi-excretion varied with the excretion of estrogens in the urine. The subjects with anovulatory menstrual cycles had low values of histamine and metabolites although within the normal variations.

Effect of lumbar sympathetic blockade and chlorpromazine-induced adrenergic alpha-receptor blockade on skin temperature in peripheral arterial diseases

The post-cooling toe temperature changes after lumbar sympathetic blockade and after intramuscular administration of an adrenergic alpha-receptor blocking substance (chlorpromazine) were studied in 14 patients with impending gangrene because of peripheral arterial insufficiency. The post-cooling temperature rise was similar after sympathetic blockage and chlorpromazine administration and significantly different from the basal toe temperature changes after cooling. It is concluded that administration of an adrenergic alpha-receptor blocking substance is as good as the lumbar sympathetic blockage for evaluation of a remaining sympathetic vasomotor tone in arterial disease patients.

Effects of female sex hormones on histamine metabolism in guinea-pigs

Determination of the urinary excretion of histamine and methylhistamine was performed in intact and gonadectomized male and female guinea-pigs. The excretion of methylhistamine varied more than that of histamine both in the same animal and between different animals. The urinary excretion of histamine and methylhistamine reflects fairly well the total histamine turnover in the animal, provided that aminoguanidine is administered to inhibit diamine oxidase activity. There was no sex difference in the excretion of histamine and methylhistamine and gonadectomy did not influence the urinary output. Female sex steroids had little ifany effect upon histamine turnover in the guinea-pig which is in contrast to the situation in rats and mice.

Histamine metabolism and gastric secretion in experimental burns in the rat

The urinary excretion of histamine and the histamine formation in vitro in burned and control male and female rats were measured. With increasing temperature, the histamine excretion increased in male and female rats. The histamine formation in vitro was increased in burned skin. The changes are presumably a result of the inflicted injury, which means that in the rat histamine is involved in the inflammatory reaction. A small and probably significant reduction in histamine forming capacity was observed in the stomach from burned and starved female rats. Female rats were provided with a gastric fistula. The secretion of hydrochloric acid and pepsin was measured before and after the rats had been burned. After burns, a small but not significant reduction in gastric secretion was seen. It is proposed that the burn injury in some way or another may inhibit the gastric function for a while.

A case of hereditary angioneurotic oedema, successfully treated with epsilon-aminocaproic acid. Studies on C'1 esterase inhibitor, C'1 activation, plasminogen level and histamine metabolism

A patient with clinical and laboratory findings characteristic of hereditary angioneurotic oedema was investigated. The patient was observed for a period of 5 weeks, during which he had four attacks. ε-Aminocaproic acid (EACA) was then given continuously for 5 months, during which time the patient had no attacks. Attacks reappeared on withdrawal of EACA. Trans-4-(aminomethyl) cyclohexane carboxylic acid (AMCA®) was found to be equally effective in later therapeutic trials.

C'1 esterase inhibitor was found in low concentration in defibrinated plasma also during attacks. ε-Aminocaproic acid (EACA) produced no significant change of the inhibitor content. C'1 esterase inhibitor disappeared on incubation of defibrinated plasma from the patient at 37°C for 40 min, and C'1 esterase was generated. The generation time of C'1 esterase increased with increasing the concentration of EDTA in the test solution. The C'1 esterase inhibitor content of defibrinated plasma from the patient, varied with the C'1 esterase generation time, the coefficient of correlation being higher in plasma sampled before treatment with EACA.

Plasminogen and α₂-macroglobulin were within the normal ranges, also during attacks. EACA markedly depressed the plasminogen level, which rapidly returned to normal on withdrawal of the drug.

The studies on histamine metabolism revealed no significant changes with the exception of the urinary excretion of histamine, which was moderately increased towards the end of the period studied.

On the days the patient received EACA the urine never contained 1-methylimidazole-5-acetic acid which was present in all the other specimens of urine examined. The basal gastric acid secretion was increased.

Right oblique transthoracic electrocardiogram

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