Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0026850 (muscular dystrophy)
 5,870 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Muscular dystrophy patients fall in respiratory failure in the terminal stage. Erythrocyte 2,3-diphosphoglycerate (2,3-DPG) is an important regulator of oxygen release, as it affects the position of the oxyhemoglobin dissociation curve. In order to survey the internal respiration in these patients, we studied the erythrocyte 2,3-DPG which regulates oxygen transport function. The concentration of erythrocyte 2,3-DPG was determined in 27 cases with Duchenne type muscular dystrophy and 10 cases with myotonic dystrophy (MyD). We analyzed the relation of erythrocyte 2,3-DPG to spirogram, arterial blood gas and acid-base analysis in these patients. 14 normal males were used as controls. In control subjects, the mean concentration ratio of 2,3-DPG and hemoglobin (DPG/Hb) was 0.880 +/- 0.072. 18 cases of DMD and 9 of MyD, which showed more than 45 torr of Pco2 in arterial blood gas, revealed 0.823 +/- 0.053 and 0.814 +/- 0.092 of DPG/Hb respectively. These values were significantly lower than that of controls. DPG/Hb correlated to % VC, Pao2, Paco2, pH, HCO3 and BE in DMD, but no relation to these parameters in MyD. The low ratio of DPG/Hb in erythrocyte was considered to be metabolic compensation of respiratory failure in DMD. On the other hand, 2,3-DPG of MyD seemed to be also affected by any other factors in addition to respiratory failure.
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PMID:[Erythrocyte 2,3-diphosphoglycerate in muscular dystrophy]. 275 52

Mechanical ventilation is now considered a therapeutic option for respiratory failure associated with Duchenne's muscular dystrophy (DMD). Through the monitoring of forced vital capacity and PCO2, prediction of impending respiratory failure is possible. This knowledge allows the patient to choose institution of mechanical ventilation before acute respiratory failure or no intervention and preparation for a natural death. To assist patients and families in this decision making, a special clinic was established. Thirty adolescent boys with DMD were followed up. Eighteen boys reached the end stage of their disease. Three died of cardiac failure. Prediction of respiratory failure was possible in 14 of the remaining 15; 11 of the 15 were able to make educated choices regarding respirator assistance or a natural death. The clinic has shown that in the majority of cases, when properly educated, patients and families can be active participants in life-and-death decisions.
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PMID:Patient and family participation in the management of respiratory failure in Duchenne's muscular dystrophy. 292 May 77

The effects of noninvasive nasal mask-assisted ventilation were studied in two patients with chronic respiratory failure due to Duchenne's muscular dystrophy. Observations were made with continuous recordings of transcutaneous CO2 and O2 and ear oximetry. In one case, the mean tcPCO2 fell from 72 mm Hg to 43 mm Hg. The tcPO2 increased from 38 mm Hg to 62 mm Hg without supplementary oxygen. In the second case, hypercapnia associated with supplementary oxygen was corrected, and at five months' follow-up, hypoxemia was corrected without supplementary oxygen. Prolonged therapy during sleep has resulted in sustained clinical improvement for more than 18 months.
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PMID:Noninvasive nasal mask-assisted ventilation in respiratory failure of Duchenne muscular dystrophy. 328 48

Both granular and multiocular periadrenal brown adipose tissue (BAT) was present in 16 patients with Duchenne's progressive muscular dystrophy (PMD). In 12 cases (75%), diffusely distributed periadrenal BAT was observed. The common cause of death was respiratory failure, and blood gas level showed marked hypoxia. Scattered myocardial fibrosis was seen in all cases of PMD. We suspected that chronic hypoxia and cardiac fibrosis might be largely responsible for BAT transformation in patients with PMD.
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PMID:Brown adipose tissue in Duchenne's progressive muscular dystrophy. 335 57

Right heart catheterization was performed in 8 patients with progressive muscular dystrophy of the Duchenne type (DMD) at the advanced stage. A mean pulmonary arterial pressure in excess of 20 mmHg was observed in all cases. Five of them showed severe pulmonary hypertension with a mean pressure above 40 mmHg. Since pulmonary hypertension was relieved by correction of hypoxemia, this represented a precapillary pulmonary hypertension caused by constriction of the pulmonary artery. Furthermore, elevation of the mean right atrial pressure above 5 mmHg was observed in 6 of the 8 cases, indicating the possible presence of right ventricular failure. Despite the presence of left ventricular dysfunction as assessed by echocardiogram, no manifestations of left ventricular failure, such as dyspnea and pulmonary rales, were noted in any of the patients. In conclusion, it can be said that even in the terminal stage of DMD, the left ventricular function may, in fact, still remain not markedly involved, and that respiratory failure, as well as right ventricular failure caused by precapillary pulmonary hypertension, will tend to occur frequently and may play a determinant role in prognosis of the advanced DMD patient.
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PMID:Pulmonary hypertension in progressive muscular dystrophy of the Duchenne type. 338 14

Oral occlusion pressure, a neuro-muscular index of the activity of the respiratory centers, was measured in 2 groups of children: one of 43 "healthy" children, in order to establish a predictive equation according to age (Y = 1.23 + 8.30 X A-1) and another of children presenting with respiratory failure, either due to an impairment of the thoracic cavity (10 dorsal scoliosis) or to an impairment of the respiratory muscles (29 children with muscular dystrophy or spinal muscular atrophy). The occlusion pressure increases with the degree of the ventilation deficiency in children with scoliosis. It remains paradoxically normal in children with neuro-muscular disease, irrespective of the ventilation deficiency. In the latter, the respiratory centers activity being considered as normal, this situation would indicate their muscular incapacity to correctly express this activity. It would show a severe muscular deficiency with a high risk of occurrence of respiratory distress accidents.
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PMID:[Oral occlusion pressure in scoliosis and neuromuscular syndromes]. 361 64

Five men with degenerative neuromuscular diseases (three with amyotrophic lateral sclerosis [ALS] and two with Duchenne's muscular dystrophy [DMD]) who had respiratory failure were treated with intermittent negative pressure ventilation (NPV). One patient with ALS in severe acute respiratory failure was successfully treated with NPV alone. This patient and two other ALS patients in chronic respiratory failure with PaCO2 elevation stabilized or improved their vital capacity (VC) and lowered their PaCO2 after 5 to 11 weeks of therapy. Finally, intermittent NPV was used to replace 24-hour positive pressure ventilation in two patients with DMD. It is concluded that intermittent NPV may stabilize or temporarily improve the respiratory status in patients with progressive neuromuscular diseases.
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PMID:Intermittent negative pressure ventilation in the treatment of respiratory failure in progressive neuromuscular disease. 368 80

Patients with progressive muscular dystrophy rarely survive beyond the second or third decades: the commonest causes of death are respiratory failure and cardiac failure. An easily repeatable method for early recognition of cardiac dysfunction and its follow-up would therefore be valuable. We performed a polycardiographic study of systolic time intervals in 11 patients with dystrophy (each subject representing an age from 7 to 17 years) in a group comprising 10 of their mothers and in control groups matched for age and sex. The mean values of QS2, PEP and QS1 were significantly higher in patients compared to controls (QS2 : 543 +/- 26 msec compared to 519 +/- 19 msec; PEP : 142 +/- 21 msec compared to 123 +/- 18 msec, and QS1 : 105 +/- 22 msec compared to 75 +/- 12 msec) whilst mean ICT was shorter (36 +/- 11 msec, compared to 49 +/- 5 msec). Mean LVET was comparable in patients and control. These results indicate a reduction in compliance and an increase in end diastolic left ventricular tension. When the systolic time intervals were analysed in each child, an increase in PEP and reduction in LVET were characteristic of the more serious phases of the disease with cardiac failure. It is emphasized that early stages of the disease are characterised by restrictive changes resulting in a reduction in ICT whilst terminal stages with reduced cardiac output cause a reduction in LVET and an increase in PEP. No significant changes were found in the mothers of patients compared to the control group. These results indicate that systolic time intervals may be useful in following up patients with Duchenne's cardiomyopathy.
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PMID:[Evaluation of systolic intervals in Duchenne cardiomyopathy]. 681 20

The most common cause of death in patients with rapidly progressive neuromuscular disease has been respiratory failure. The medical community and society as a whole have not yet recognized the possibilities for markedly extended life expectancy and prolonged productivity in severely disabled neuromuscular patients with proper medical management and rehabilitation. In a population of 120 patients with early childhood onset, rapidly progressive muscular dystrophy, 29 were in the most advanced stage requiring mechanical ventilation 24 hr/day and had vital capacities of less than 10% predicted for age and height. Of these patients with severely weakened bulbar innervated muscles, 10 have been receiving positive pressure ventilation via indwelling tracheostomy tubes for an average of 3 years. The average age of the 29 patients is 27 years with a range of 15 to 54 years. Of the 29 patients, 24 live in the community. Three are married and have a total of 5 children. Some patients are in professional careers, or active in political and community organizations. The management of and potential for improved quality of life and increased longevity in these patients are discussed.
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PMID:Long-term rehabilitation in advanced stage of childhood onset, rapidly progressive muscular dystrophy. 694 47

Respiratory impairment in patients with Steinert's muscular dystrophy is known to lead to respiratory failure. Both the blunted chemical drive of breathing and the respiratory muscle weakness have been cited in the pathophysiology of premature death in these patients. To further assess the chemical control of breathing in these patients, we measured their respiratory responses to hypoxia (Weil's method), hyperoxia (Dejours' method), and hypercapnia (Read's method). In response to the stimuli from these respiratory centers, minute ventilation (VE), tidal volume (VT), respiratory frequency (F), mean inspiratory flow rate (VT/Ti), and occlusion pressure (P0.1) were measured in 12 patients and in 12 normal persons matched to the patients on the basis of age, sex, and arm span. The patients were similar to the control subjects in occlusion pressure results. However, they differed significantly (P less than 0.01) in ventilatory responses by a lower VE, lower VT, higher F, and lower VT/Ti in response to the hypercapnia and hypoxia tests. The responses of patients and control subjects were similar during the hyperoxia tests. Our study, therefore, established that the chemosensitivity of the respiratory centers, as measured by P0.1, is well preserved in Steinert's myotonic dystrophy, but the output to breathing (VE, VT, F, VT/Ti) is modulated by the impaired respiratory mechanics causing a tachypneic breathing pattern, even in the absence of restricted lung volume.
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PMID:Control and modulation of respiration in Steinert's myotonic dystrophy. 736 35


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