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Query: UMLS:C0011570 (depression)
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The data reviewed in this paper indicate that spontaneous fibrillations do not involve a cholinergic mechanism since non-depolarizing anticholinesterase drugs such as Mestinon fail to increase spontaneous fibrillations in denervated muscle. Fibrillation potentials are related to the changes in electrical properties of the membrane of denervated muscle fibres which lead to the appearance of spontaneous subthreshold depolarizations, sometimes triggering a propagated potential. Fibrillations seem to appear in cycles and this may depend on the depression of spontaneous depolarization by muscle activity itself. Fibrillations are also an important feature of Duchenne muscular dystrophy and polymyositis, but they have not been found in Landouzy-Dejerine muscular dystrophy. These "myopathic" fibrillations probably arise from subthreshold depolarizations in the membrane of muscle fibre segments which have been functionally or anatomically isolated from the end-plate by a pathological lesion (Fig. 4). Experimental demonstration of spontaneous fibrillations in baboon biceps muscles after extrajunctional myotomies indicates that such an isolated muscle fibre segment can indeed develop and sustain spontaneous fibrillation activities. Studies of motor unit potentials in myopathies by "coherent" electromyography disclose linked potentials after the main potential in Duchenne dystrophy, but not in Landouzy-Dejerine muscular dystrophy. The linked potentials are signs of collateral innervation by sprouts of the motor axons. The fact that linked potentials occur in Duchenne dystrophy, including in obviously dystrophic motor units (Fig. 5), shows that such motor axons are quite healthy and able to sprout efficiently. The muscle fibres thus innervated collaterally are probably the ones which fibrillated and were deprived of trophic motor control as a result of myopathic lesions of the type considered in Fig.4. This correlation receives support from the finding that both spontaneous fibrillations and linked potentials are lacking in Landouzy-Dejerine muscular dystrophy, which obviously presents a different type of muscle lesion.
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PMID:Muscular dystrophy contrasted with denervation: different mechanisms underlying spontaneous fibrillations. 10 83

Two cases of manifesting carriers of Duchenne muscular dystrophy (DMD) were described. Case 1. The 41 year-old woman presented gait disturbance at the age of 40. She had two sons. The first son died of pneumonia soon after birth. The second son developed DMD and died of heart failure when he was 17 years old. Neurological examination revealed mild muscle weakness in neck flexors, gluteus maximus (left side dominance) and hamstrings (right side dominance) as well as bilateral calf pseudohypertrophy. Electromyography showed myopathic changes and serum creatine kinase (CK) was elevated (1941IU/l). The karyotype was 46XX. Computed tomography (CT) of skeletal muscles showed that the following muscles were partly replaced by fatty tissue: bilateral paravertebral muscles, left gluteus maximus, left quadriceps femoris, right adductor magnus, long head of right biceps femoris, bilateral peroneus longus and medial head of left gastrocnemius. Histological examination of left quadriceps femoris revealed only minimal change of focal endomysial proliferation and fiber size variation, demonstrating no necrotic fiber or no abnormalities in fiber type. Case 2. The 42 year-old woman was admitted to the hospital complaining of dyspnea and palpitation. The disease was initially diagnosed as myocardial infarction based on cardiomegaly, ECG abnormality (Q in aVL, V5,6., ST depression and negative T in V5,6, ST elevation in I, aVL) and elevated serum CK. However, the diagnosis was rejected due to the lack of subsequent changes in ECG and the continued elevation of serum CK even after her complaints had disappeared.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Asymmetrical patchy muscle involvement in manifesting carriers of Duchenne muscular dystrophy--computed tomographical and histological study]. 274 85

Investigated the personality profiles (MMPI) of 44 adolescents with progressive (Duchenne Muscular Dystrophy) and nonprogressive (mixed orthopedic) physical impairment to determine the relationship among personality correlates, disability type, functional level of impairment, and rapidity of decline in those with progressive disease. Both groups of males evidenced many similarities to severe physical limitations regardless of diagnosis or progression of their physical status. Common personality characteristics of increasing social inhibition, passiveness, and depression were identified as a response to the realities imposed on mobility and lifestyle. Little evidence was presented that supported clear and linear relationships between physical impairment and adjustment status as reflected by MMPI endorsement. Rapidity of decline in physical status in the progressive group was associated with increased report of social withdrawal and a constellation of behaviors suggestive of increased stress. Methodological problems in studying adjustment status in multihandicapped-heterogeneous disabilities were discussed.
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PMID:Personality correlates and degree of impairment in male adolescents with progressive and nonprogressive physical disorders. 622 50

The features of regional wall motion abnormalities of the left ventricle were analysed in 11 patients of congestive cardiomyopathy (CCM) in comparison with 22 patients of progressive muscular dystrophy (DMD) of Duchenne type who showed an abnormal motion of the left ventricle by echocardiography. Real time two-dimensional echocardiographic study demonstrated the following results: I) In CCM, (1) only 2 or less of 11 cases preserved a normal motion in each left ventricular segment, and the depression of wall motion of the left ventricle were thought to be generalized; (2) there were 9 cases with segmental wall motion abnormalities and 3 of them demonstrated ventricular aneurysms, and (3) the localizations of the segmental abnormalities varied in each case, and there was no apparent accumulation to any segments. II) In DMD, (1) all the cases showed depressed motions and 8 of them demonstrated a ventricular aneurysm in the posterior wall of the left ventricle (LVPW), (2) while, there was no case showing ventricular aneurysm in the segments other than LVPW, and about one third of all cases showed normal motion in those segments. From these results, we concluded as follows: 1) Although the depression of a wall motion of the left ventricle was generalized in CCM, this was not always uniform and the segmental abnormalities of a wall motion were frequently observed. The localization of the most severely disturbed segment varied in each case. 2) On the other hand, in DMD, the wall motion was disturbed more frequently and more severely in LVPW than in other ventricular segments.
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PMID:[Regional wall motion of the left ventricle in congestive cardiomyopathy: in comparison with progressive muscular dystrophy of Duchenne type (author's transl)]. 734 27

A new sign in Duchenne muscular dystrophy is described. The sign demonstrates a unique characteristic of this disorder: selective hypertrophy and wasting in different muscles of the same region. The patients were asked to abduct their arms to about 90 degrees with elbows flexed to 90 degrees and hands directed upwards. Those who could not abduct the arm to 90 degrees were asked to do so to the maximum that they could. In this posture, all patients had examination of pectoral girdles from behind. Some patients with spinal muscular atrophy and other forms of muscular dystrophies were also examined in the same manner. In this posture, patients with Duchenne muscular dystrophy demonstrated a linear or oval depression (due to wasting) of the posterior axillary fold with hypertrophied or preserved muscles on its 2 borders (i.e., infraspinatus inferomedially and deltoid superolaterally), as if there were a valley between the 2 mounts. The sign was specific to Duchenne muscular dystrophy with sensitivity of about 90%. It was most remarkable in patients 8-11 years of age.
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PMID:New clinical sign in Duchenne muscular dystrophy. 770 89

The clinical significance of an abnormal signal-averaged electrocardiogram (SA-ECG) in time- and frequency-domain analyses was assessed in patients with Duchenne muscular dystrophy (DMD). Twenty-four DMD patients and 20 age-matched healthy volunteers were studied. The SA-ECG was recorded by time-domain signal processing using the vector-magnitude method and frequency-domain signal processing using the fast-Fourier transform. Abnormal SA-ECGs were based on comparison with controls and eight abnormal SA-ECGs were detected among 24 DMD patients, seven by frequency-domain analysis and four by time-domain analysis. The end-diastolic left ventricular volume was larger in the patients with abnormal SA-ECG than in those with normal SA-ECG (136 +/- 32 ml vs. 77 +/- 43 ml, p < 0.01). Compared with patients with normal SA-ECGs, the DMD patients with abnormal SA-ECGs had a lower left ventricular (LV) ejection fraction (54 +/- 6 vs. 61 +/- 8%, p < 0.05), as an index of LV contractility, and less LV posterior wall velocity (46 +/- 9 mm/min vs. 62 +/- 16 mm/min, p < 0.01), as an index of LV relaxation. The sensitivity and specificity of frequency-domain analysis for predicting malignant ventricular arrhythmias was 60 and 85%, respectively, compared with 30 and 92%, respectively, for time-domain analysis. The combination of time- and frequency-domain analyses can facilitate identification of DMD patients with ventricular tachyarrhythmias associated with depression of cardiac performance.
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PMID:Abnormal signal-averaged electrocardiogram in patients with Duchenne muscular dystrophy: comparison of time and frequency domain analyses from the signal-averaged electrocardiogram. 822 85

The relationship between late ventricular potentials (LP) and myocardial ischemic changes or ventricular arrhythmias was investigated in patients with Duchenne muscular dystrophy (DMD). Twenty-six DMD patients aged 10-33 years (mean 18.2 years) and 27 age-matched healthy volunteers were studied. Ventricular arrhythmias were detected by 24-h Holter ECGs and LPs were determined using signal-averaged ECGs. In DMD patients filtered QRS duration, late duration, and low-amplitude signal under 40 microV were significantly prolonged compared with those of the controls. The root mean square voltage of the f-QRS complex in the last 40 ms was lower in DMD patients than in the controls. None of the control subjects had LP. However, LP was detected in 8 (31%) of the 26 DMD patients. The patients with LP had more frequent ST-T depression and ventricular arrhythmias than the patients without LP. LP had 60% sensitivity and 87% specificity for documented ventricular arrhythmias. It is concluded that LP in DMD patients indicates the presence of substrate for ventricular arrhythmias associated with local myocardial fibrosis, and is useful in identifying those at high risk for malignant ventricular arrhythmias.
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PMID:Clinical significance of late potential in patients with Duchenne muscular dystrophy. 825 94

We studied 23 DMD and eight BMD patients using cardiac echo, 24 h ECG and positron emission tomography (PET) with the radiotracers N-13 ammonia and F-18 fluorine deoxyglucose. The ECG was abnormal in 23 cases with alterations in the PR and/or QT intervals, abnormal Q waves in the lateral leads and ST segment depression. Twenty-four hour ECG showed that patients were more likely to produce premature ventricular ectopic beats with advancing age and 17 patients had paroxysmal ST segment depression. LV function was normal or mildly reduced in 24 cardiac echoes. PET studies were visibly abnormal in 15 patients. Regional perfusion defects involving the apex, lateral or anterior left ventricular walls were present, nine cases demonstrated a corresponding increase in glucose metabolism. Three out of 15 demonstrated matched perfusion/metabolism defects. One BMD had severe LV dilation with globally poor perfusion and metabolism. The abnormalities seen with PET were confirmed with both quantitative and semi-quantitative analysis of radioactive counts. Similar results were obtained for both DMD and BMD, where both groups demonstrated significant regional perfusion/metabolism mismatches. We have shown a reduced uptake of N-13 ammonia which is indicative of a reduction in myocardial perfusion. The use of N-13 ammonia to measure perfusion has been validated in animal studies. PET with either N-13 ammonia- or oxygen labelled water can be used to measure myocardial perfusion. We chose N-13 ammonia as this was most readily available to us.
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PMID:Cardiac function, metabolism and perfusion in Duchenne and Becker muscular dystrophy. 888 52

Quality of life and availability of services are important for boys with Duchenne muscular dystrophy (DMD) and their families. Families attending our neuromuscular clinic completed a questionnaire on parental perception regarding the importance of services, health issues, and quality of life issues both "now" and "in the future." Eighty-nine percent of the families (31/35) completed questionnaires. Services and health issues related to prolonging ambulation were most important, especially for the parents of younger boys. Mental health issues such as social isolation, anger, and depression were very important, particularly for the families of older boys and were anticipated to be more important in the future. Pediatricians should be aware of both the immediate needs of families to meet the physical and emotional challenges of DMD and the increasing requirement to address the social needs of these patients and their families as the boys become older.
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PMID:Duchenne muscular dystrophy--parental perceptions. 1193 26

Duchenne muscular dystrophy (DMD) is associated with cognitive deficits that may result from a deficiency in the brain isoform of the cytoskeletal membrane-associated protein, dystrophin. CA1 hippocampal short-term potentiation (STP) of synaptic transmission is increased in dystrophin-deficient mdx mice, which has been attributed to a facilitated activation of NMDA receptors. In this study, extracellular recordings in the hippocampal slice preparation were used first to determine the consequences of this alteration on short-term depression (STD). STD induction was facilitated in mdx as compared with wild-type mice in a control medium. Because brain dystrophin deficiency results in a decreased number of gamma-aminobutyric acid A (GABAA)-receptor clusters, we tested the hypothesis that neuronal disinhibition contributes to the enhanced synaptic plasticity in mdx mice. We found that the GABAA receptor antagonist, bicuculline, increased basal neurotransmission in wild-type, but not in mdx mice and prevented the enhanced STP and STD in the CA1 area of slices from mdx mice. The possibility that altered GABA mechanisms underlie the facilitation of NMDA receptor-dependent synaptic plasticity in mdx mice is discussed.
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PMID:Facilitated CA1 hippocampal synaptic plasticity in dystrophin-deficient mice: role for GABAA receptors? 1254 23


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