Baclofen-induced sexual dysfunction.
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Biomedical subjects
Publications and source records attributed to Joseph E Hornyak.
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Becker's muscular dystrophy (BMD) is associated with abnormal cardiac findings in 75% of cases; up to one third will develop ventricular dilatation leading to congestive heart failure, at times necessitating cardiac transplant. Candidates are selected from a base of heart failure patients who are usually New York Heart Association (NYHA) class III or IV. Treatment in a phase II cardiac rehabilitation program after transplantation is associated with functional improvement in patients without BMD, but there are no reports of patients with this disorder. We present the case of a 38-year-old man diagnosed with BMD with associated dilated cardiomyopathy. The patient was a NYHA class IIIa and underwent orthotopic cardiac transplantation for intractable heart failure followed by treatment in a phase II cardiac rehabilitation program. At the end of cardiac rehabilitation, his 12-minute walking distance had improved from 716.28 to 929.64 m (30% improvement), he had increased his conditioning metabolic equivalent level from 3.5 to 5.5 (55% improvement), he had a weight loss from 81.65 to 78.93 kg, and his body mass index changed from 23 to 22 kg/m2. The patient now has returned to work, is using a stationary bicycle once a day for 30 minutes, and is walking 1 hour a day. This suggests that treatment in a cardiac rehabilitation program is effective in patients with BMD after cardiac transplant.
An inverse relationship between initial level of physical capacity and the magnitude of response to training is termed the principle of initial value. We tested the operation of this principle under experimental conditions of minimal genetic and environmental variation. Inbred rat strains previously identified as genetic models of low [Copenhagen (COP)] and high [Dark Agouti (DA)] intrinsic (untrained) exercise capacity were trained for 8 wk on a treadmill using two disparate protocols: 1) a relative mode where each rat exercised daily according to its initial capacity, and 2) an absolute mode where both strains received the same amount of training independent of initial capacity. Response to exercise was the change in running capacity as estimated by meters run to exhaustion before and after training. When trained with the relative mode, COP rats gained 88 m (+21%; NS) whereas DA rats increased distance run by 228 m (+36%; P < 0.001). When each strain trained with the same absolute amount of training, the COP strain showed essentially no change (-6 m, -2%) and the DA strain gained 325 m (+49%; P < 0.009). Differences in response to exercise between the COP and DA could not be explained by body mass differences, oxidative enzyme activity (citrate synthase or ATP), or spontaneous behavioral activity. Our data demonstrate that genetic factors causative of high response to exercise are not uniquely associated with genetic factors for low intrinsic capacity and thus are not in accord with the principle of initial value.
OBJECTIVE: To determine if amantadine use in pediatric patients with traumatic brain injury is well tolerated and to attempt to assess its effectiveness. DESIGN: This was a retrospective, case-controlled study. RESULTS: Of the 54 patients, aged 3-18 yrs, who were administered amantadine, five (9%) had side effects that might have been related to the drug. These included hallucinations, delusions, increased aggression, and nausea/vomiting. The side effects were reversed when the medication was stopped or the dosage decreased. Patients in the amantadine group had a greater increase in Ranchos Los Amigos level during their admission than those in the control group (median, 3 vs. 2; P < 0.01). This difference may be, at least in part, explained by the fact that the amantadine group started at a lower Ranchos Los Amigos level (median, 3 vs. 4; P < 0.01). There were subjective improvements noted in 29 of the 46 patients (63%) in the amantadine group whose full charts were available for review. CONCLUSION: Amantadine is a well tolerated medication when it is used in pediatric patients with traumatic brain injury. Subjective improvements were noted in the majority of the patients administered amantadine, and the amantadine group showed a greater improvement in Ranchos Los Amigos level during admission, suggesting that it may be effective.