Patients with cirrhosis of the liver often complain of tiredness and a lack of strength at physical exercise. Other investigators have found that muscle strength, work capacity, and maximal oxygen consumption are reduced in cirrhosis. We hypothesized that mitochondrial maximal rate of ATP synthesis in skeletal muscle may be impaired in these patients. This was tested with 31 P nuclear magnetic resonance spectroscopy in anterior tibial muscle of cirrhotic patients and healthy controls at rest, during exercise, and subsequent recovery. In patients with Child-Pugh class B and C cirrhosis resting PCr/P i ratio (8.3 ؎ 1.0; n ؍ 7) was lower than in patients with Child-Pugh class A cirrhosis (12.1 ؎ 2.1; n ؍ 7) and controls (11. 7 ؎ 1.1; n ؍ 6; P ؍ .03), while the resting P i /␥ATP ratio was higher in Child-Pugh class B and C patients (0.43, 0.30, and 0.27, respectively; P ؍ .03). Maximal rate of mitochondrial adenosine triphosphate ( Patients with cirrhosis often complain of tiredness and weakness at physical exercise. In cirrhotic patients isokinetic muscle strength and work capacity have been found to be severely reduced. [1][2][3][4][5][6] Fatigue and loss of muscle strength can be related to both central and peripheral phenomena. 7-9 The central components are largely unknown, but probably include psychologic factors such as the mental condition and motivation of the person, as well as metabolic disturbances, e.g., hypoglycemia, hyperammoniemia, and changes in amino acid composition. 9 In cirrhosis the peripheral components possibly include decreased skeletal muscle mass, hemodynamic changes, decreased hepatic glycogenolysis, and insulin resistance. 10 There may, however, also be more fundamental metabolic changes such as impaired mitochondrial function. It appears that in cirrhosis maximal oxygen consumption is decreased, 2,3 which at least to some extent is a result of the decreased muscle mass in the cirrhotic patients, but which may also be the result of decreased mitochondrial oxidative capacity and/or reduced number of mitochondria in the muscle tissue. In accordance with this notion the content of adenosine triphosphate (ATP), phosphocreatine (PCr), and total Mg 2ϩ were reported to be decreased in biopsy specimens of skeletal muscle in patients with cirrhosis. 11-13 A reduced ATP/ ADP ratio was also found. 11,12 In contrast to the static data available after biopsy the technique of 31 P nuclear magnetic resonance spectroscopy (NMRS) allows a dynamic examination of the relative concentrations of ATP, PCr, and inorganic phosphorus (P i ) at rest, during, and after exercise. We used this technique to study the hypothesis that mitochondrial capacity for ATP synthesis is reduced in the skeletal muscle of the cirrhotic patient. The study indicated that this was indeed the case for patients with cirrhosis of Child-Pugh class B and C. PATIENTS AND METHODSThe study included 14 patients with stable cirrhosis of the liver. Clinical data are shown in Table 1. The controls were 6 healthy individuals with simil...
Little is known about sleep disorders in spinal cord injured (SCI) patients. Three SCI patients who reported severe daytime sleepiness and sleep complaints were evaluated with nocturnal polysomnography and oxygen saturation with pulsoximeter on several occasions at home. In addition respiratory registration was preformed during overnight stay in the hospital. Two patients who had sleep apnoea episodes with reduced oxygen saturation during sleep were treated with continuous positive airway pressure with good results on sleep architecture, oxygen saturation, and daytime sleepiness. One obese patient was advised to lose weight and to reduce smoking and alcohol consumption, and following this advice his sleep related problems were reduced with no further treatment necessary. It is suggested that SCI patients who complain about sleep related disorders should be appropriately screened, with inclusion of nocturnal polysomnography, oxygen saturation, and respiratory registration and, depending on the screening results, appropriate advice/ treatment applied.
In a controlled study, the effects of THIP (a synthetic gamma-aminobutyric-acid-agonist) on respiratory function (ventilatory response to CO2), first detection of stimulation (electrical stimulation of a tooth), pain threshold, magnitude of maximal tolerated pain stimulation, and plasma cortisol, prolactin and glucose were investigated in six normal men. Intramuscular injection of THIP in dosages of both 10 mg and 20 mg increased the magnitude of stimulus before first detection, and the pain threshold as well as the maximal tolerance of pain stimulation. THIP did not lead to changes in respiratory function, or in plasma cortisol, prolactin or glucose, suggesting an analgesic action independent of opiate receptors.
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