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PubMed1992

Sources of variability in halothane and caffeine contracture tests for susceptibility to malignant hyperthermia.

In vitro contracture tests for susceptibility to malignant hyperthermia (MH) were performed in 96 patients according to the protocol of the European MH Group. In addition, tests were performed with halothane 0.44 mmol l-1 and 0.66 mmol l-1, and caffeine 2 mmol l-1, each added as a single bolus dose to fresh specimens. For all tests the size of contractures were recorded, and for the diagnostic tests the halothane and caffeine threshold concentrations were determined (i.e. the minimal concentrations eliciting a contracture of 0.2 g). The caffeine specific concentration (CSC, i.e. the concentration increasing force 1.0 g) and the % increase with caffeine 2 mmol l-1 were calculated from the dose response curves. Various diagnostic criteria in use by the North American MH Group were applied, and diagnostic outcome compared with the result obtained by the protocol of the European MH Group. Thirty-five patients were susceptible to MH (MHS), 33 were non-susceptible (MHN), and 28 had equivocal results of the tests (MHE). Additional tests were made in 34 MHS, 32 MHN, and 26 MHE patients. Contractures elicited by bolus addition of halothane or caffeine were significantly larger than those observed following the same dose of drug added cumulatively (P less than 0.05). Contractures greater than or equal to 0.7 g following halothane 3% (bolus dose) were seen in 78% of MHS patients and 18% of MHN patients, A CSC less than 4 mmol l-1 was elicited in 86% of MHS and 30% of MHN patients, whereas an increase in force greater than or equal to 4% or greater than or equal to 7% was seen in 71% and 34% of MHS patients, respectively, and in none of the MHN patients. Using the criterion of greater than or equal to 0.7 g in the halothane test and greater than or equal to 4% increase in the caffeine test gave the best agreement between diagnostic outcome with the European and North American protocols: All 34 MHS patients (100%) were positive to one or more tests, but so were eight of 32 MHN patients (25%), giving an overall diagnostic agreement of 88%. We conclude that, in our laboratory, the results obtained with the two major protocols for investigation of MH susceptibility are not identical. Patients surviving fulminant MH, however, react abnormally to nearly all the tests. For validation and possibly further standardization of the tests each laboratory must investigate a large number of normal controls and as many patients surviving fulminant MH as possible.

Adolescent↗
PubMed2004

[The treatment of deformity of axillary scar contracture after burns].

OBJECTIVE: To explore the best methods to repair the deformity of axillary scar contracture after burns. METHODS: Ninety cases in 78 patients with axillary scar contracture after burns from January 1998 to January 2002 were analyzed. According to the severity of the deformity and its influence on the function of the shoulder joint. 46 cases suffered from mild degree axillary scar contracture, 26 cases with moderate and 18 with severe degree. The deformities of axillary scar contracture were repaired by Z plasty (18 cases), five-flap plasty (14 cases), skin graft (23 cases), Z plasty and skin graft (14 cases), transfer of scapular skin flaps (5 cases), lateral throatic skin flaps (4 cases) and scar flaps (12 cases), respectively. Exopexy, anti-scar drug and functional exercises were applied postoperationally. RESULTS: All the flaps were survived with first intention, except for necrosis of the split skin graft occurring in 4 cases. The function and configuration in all the cases were satisfactory after 6 months to 4 years follow-up. CONCLUSION: Appropriate methods should be chosen to restore the function and configuration of the shoulder joint and improve patients' living condition according to the size, degree of the deformity of axillary scar contracture after burns.

Adolescent↗
PubMed2006

[Diagnosis and treatment of deltoid contracture in children].

OBJECTIVE: To reinforce the recognization of deltoid contracture in children and probe its causes, pathomechanism, diagnosis and treatments. METHODS: The Clinical data were summarized and analysed, including etiological factors, clinical situations, examinations and treatments from 9 child patients with deltoid contracture from 1992 to 2004. The 9 child patients were followed up to evaluate therapeutic efficacy. RESULTS: Nine child patients with deltoid contracture included 4 boys and 5 girls, who aged from 5 to 14 years. The main clinical features were presented as abductive deformity, limitation of adduction of the shoulder, winging of the scapula, and dimpling of the skin with a palpable fibrous hard band in deltoid muscle. Four cases had a history of intramuscular injections in deltoid and 1 case was accompanied with bilateral gluteul contracture. Among the 9 patients, 8 cases were misdiagnosed before correct diagnosis and treatment. The misdiagnosis rate was up to 90%. All the cases received the operative treatments to release fibrous bands and were followed up for 8 months to 12 years. Abductive deformity disappeared and functions of the shoulders recovered in all patients, except 1 patient who had a lightly winged scapula. CONCLUSION: Deltoid contracture may be caused by multiple factors, but its clinical features are conductive to correct diagnosis and excellent therapeutic efficacy can be acquired by operation early.

Adolescent↗
PubMed2006

[Combined scapular/parascapular bilobar flaps for reconstruction of severe neck contracture].

OBJECTIVE: To discuss the reconstruction of severe neck contracture by transplanting combined scapular/parascapular bilobar flaps, and the probability to reestablish three-dimensional movement of the neck. METHODS: From January 2003 to November 2004, 9 cases of sustained severe neck contractures were treated (aged 9-32 years). The combined scapular/parascapular bilobar flaps, pedicled on the circumflex scapular vascular bundle, were microsurgically used to cover the soft tissue defect after excision of hypertrophic scar and release of contracture. The maximum size of the combined bilobar flap was 20 cm x 8 cm to 20 cm x 11 cm, while the minimum one was 15 cm x 4 cm to 15 cm x 6 cm. RESULTS: The combined scapular/parascapular flaps were successfully used to treat 9 cases of severe neck contracture. All patients were satisfied with the final functional and aesthetic results. There was no recurrence during 3-9 months follow-up for 8 patients. The cervicomental angle was 90-105 degrees. CONCLUSION: The combined bilobar scapular/parascapular flap, providing a large area of tissue for coverage in three dimensions with a reliable blood supply by only one pedicle anastomosis during operation, is a good option for reconstruction of the severe neck contracture.

Adolescent↗
PubMed1987

Association of limited joint mobility with Dupuytren's contracture in diabetes mellitus.

Limited joint mobility is a relatively recent addition to the list of other well known rheumatic disorders that may be associated with diabetes mellitus. In our study of 109 patients with diabetes, a higher prevalence of Dupuytren's contracture was found compared to nondiabetic subjects, but the difference was not statistically significant (p less than 0.1). An association between limited joint mobility and Dupuytren's contracture was shown. Patients with diabetes with Dupuytren's contracture showed no difference compared to those without Dupuytren's contracture with regard to sex, insulin dosage, metabolic control and presence of shoulder capsulitis. Limited joint mobility and Dupuytren's contracture may be associated with retinopathy.

Adolescent↗
PubMed1983

Reversal of myocardial ischemic contracture and the relationship to functional recovery and tissue calcium.

We subjected isolated rat hearts to normothermic ischemia until contracture developed, then reperfused them for 30 min. Recovery of developed pressure, rate of change in left ventricular pressure (dP/dt), and changes in end-diastolic pressure measured after 30 min of reperfusion were compared with preischemic values for each heart. Values after untreated ischemic arrest were compared with those after potassium arrest, potassium reperfusion (both oxygenated and deoxygenated), and combined potassium arrest and potassium reperfusion. Potassium arrest lengthened the time to the onset of contracture and thus lengthened the total ischemic time. Functional recovery was not improved over that in the untreated hearts, most likely due to this additional ischemic time. The use of buffer with a high potassium content for the first 5 min of reperfusion, however, significantly improved functional recovery if the perfusate was oxygenated, but did not improve functional recovery if the perfusate was deliberately deoxygenated. Combined potassium arrest and reperfusion delayed the onset of contracture and thus increased total ischemic time, yet improved recovery. Tissue calcium was elevated in all hearts undergoing contracture and reperfusion. Our results suggest that contracture can be reversed and that functional recovery can be improved in spite of increased tissue calcium.

Animals↗
PubMed1981

[Pathogenesis and the prevention of hypoxic heart contracture].

The authors studied the development of hypoxic contracture of an isolated isovolumic rat heart and the effect of a water-soluble antioxidant of the class of oxypyridines, OX YP-6, on such a contracture. It was established that a contracture manifested by a rise of diastolic pressure from 5 to 40 mm Hg develops regularly in the isolated heart of control animals after 20 minutes of hypoxia. Administration of the antioxidant OX YP-6 to animals for 3 days preceding the experiment prevented the contracture completely and caused fuller and more rapid restoration of heart contractility during reoxygenation. On the grounds of these facts it is suggested that activation of lipid peroxidation in the membranes of the heart muscle plays the key role in the origin of hypoxic and reoxygenation contracture of the heart. The possibilities of using the antioxidant in the prevention of hypoxic and reoxygenation disorders of heart activity in patients are discussed.

Animals↗
PubMedDate not supplied

[Collagen metabolism in Dupuytren's contracture].

Impairments in collagen metabolism were observed in patients with Dupuytren's contracture. These impairments were manifested as an increased excretion of hydroxyproline with urine and a decrease in content of the amino acid in tissues of aponeurosis palmaris of the patients. The alterations correlated with the damage caused by contracture. Increased catabolism of collagen appears to be the main reason of the metabolic impairments observed in Dupuytren's contracture, considering the opposite direction of changes in hydroxyproline content in urine and in aponeurosis palmaris of the patients. Impairments in collagen metabolism were of considerable importance in Dupuytren's contracture as demonstrated by the correlation between biochemical alterations and severity of the pathology. The Dupuytren's contracture might be considered as a disease affecting the connective tissue.

Adult↗
PubMed1995

[The influences of local anesthetics on ryanodine-induced contracture in rat skeletal muscle].

One hundred and fifty paired extensor long digital muscles were excised from Wistar rats and each muscle was prepared in Krebs-Ringer's solution (K-R solution) then gassed with a mixture of 95% O2-5% CO2. The medium for the control muscles was replaced with K-R solution containing 10(-6) M ryanodine and that for the experimental muscles was replaced with medium containing 10(-6) M ryanodine and local anesthetic (LA) (procaine, tetracaine, benzocaine, lidocaine or bupivacaine at various concentration). Isometric contracture tension was recorded throughout the experiment. The ratios of the maximal contracture tension (C-ratio) and the elapsed time (T-ratio) of the muscles treated with LA compared to those of control muscles were calculated. Tetracaine (0.125-1.0 mM) specifically reduced the C-ratio. Procaine (0.5-1.0 mM) and tetracaine (10-60 microM) increased the T-ratio. Procaine (8-16 mM), benzocaine (4-8 mM), lidocaine (0.5-4 mM) and bupivacaine (0.125-1 mM) reduced the T-ratio. The influences of LAs on ryanodine-induced contracture could be explained in terms of their effects on the Ca(2+)-induced Ca2+ release mechanism, direct Ca2+ efflux from sarcoplasmic reticulum (SR), activity of Ca2+ uptake into SR and ryanodine-receptor binding. The complexity of LA effects on ryanodine-induced contracture will affect the results of ryanodine contracture tests for malignant hyperthermia when the muscle specimen is excised under local anesthesia.

Anesthetics, Local↗
PubMed1996

Acquired thumb flexion contracture in children: congenital trigger thumb.

We examined prospectively 4719 newborn infants to determine the congenital incidence of trigger thumb. No cases were found. Fifteen other children aged from 15 to 51 months had surgery for this condition. The anomaly had not been seen at birth and all thumbs presented with a flexion contracture without triggering. The condition is usually seen after birth as a flexion contracture of the interphalangeal joint. The term 'congenital' is a misnomer because patients acquire the deformity after birth. The term 'trigger' is inaccurate as most thumbs show a fixed-flexion contracture without triggering. We suggest that rather than 'congenital trigger thumb' a more appropriate description of this disorder is 'acquired thumb flexion contracture in children'. If the contracture persists after one year of age, treatment by dividing the A-1 pulley is simple and effective.

Child, Preschool↗
PubMed1976

Management of the thumb-index web space contracture.

This paper focuses on the management of the thumb-index web space contracture, a contracture that can interfere significantly with hand function. The anatomy of the thumb-index web space and the contracture mechanism are reviewed. Contractures frequently result from traumatic hand injuries involving the web space or peripheral nerves. Exercises and splinting techniques for preventing or correcting these contractures are directed at achieving and maintaining maximum range of motion and strength of the thumb. Case reviews are reported that show improvements in range of motion measurements of 31 patients treated with the described techniques.

Adult↗
PubMed1986

Caffeine contracture in the cultured chick myotube.

A possible function of Ca store site in cultured chick myotubes was examined by recording contraction of the myotube with special reference to the effect of caffeine. Caffeine at low concentrations (below 1 mM), applied focally on the myotube through a micropipette with a pressure pulse, elicited focal contraction without membrane potential changes. Procaine inhibited the caffeine contracture. Deuterium oxide also inhibited the caffeine contracture at low concentrations, but enhanced the maximal contracture. These observations are similar to those in the mature frog muscle fiber in which the sarcoplasmic reticulum (SR) is a main site of caffeine action. On the basis of these similarities, it was considered that caffeine acts on SR to elicit contracture in the myotube. The ability of SR to accumulate and release Ca ion seemed to be low, because caffeine contracture decreased or disappeared in a Ca-free solution in many myotubes.

Acetylcholine↗
PubMed1988

Halothane-caffeine contracture testing in neuromuscular diseases.

The association of malignant hyperthermia (MH) with neuromuscular disorders has been recognized since 1970. These disorders include central core disease, Duchenne muscular dystrophy, myotonia congenita, myotonic dystrophy, nonspecific myopathies, and King-Denborough syndrome. In order to assess the anesthetic risk of MH in the neuromuscular population, we performed halothane and caffeine contracture testing for MH susceptibility on biopsied muscle removed from 25 consecutive neuromuscular patients during diagnostic evaluation. Positive contracture tests were found in 7 of 18 patients with myopathic disorders and 3 of 7 patients with neurogenic disorders. Two of our patients had anesthetic events suggesting MH. These findings suggest that myopathic and neuropathic disorders share pathogenic mechanisms with MH, resulting in positive contracture tests and possibly leading to clinical events during anesthesia. Although there is controversy regarding the interpretation of a positive contracture test, contracture testing remains the most widely accepted test for MH susceptibility. Thus, a variety of neuromuscular disorders may be associated with MH susceptibility, and caution should be exercised during anesthesia in this group of patients.

Biopsy↗
PubMed1996

On the roles of long-chain acyl carnitine accumulation and impaired glucose utilization in ischaemic contracture development and tissue damage in the guinea-pig heart.

It has been proposed that the presence of increasing concentrations of fatty acids may accelerate the development of ischaemic contracture and cardiac damage, and that this may be due to long-chain acyl carnitine accumulation and/or impairment of glucose utilization. In isolated guinea-pig papillary muscles, palmitoyl (DL) carnitine was found to have a positive inotropic effect, with a slow onset of action suggestive of an intracellular site of action, and with a maximal effect of about two-fold at a concentration of 5-10 microM; higher concentrations led to decreased contraction, probably due to increasing detergent-like effects. In isolated fura-2-loaded chick cardiomyocytes, palmitoyl carnitine increased intracellular [Ca2+]; it is proposed that this is the means by which it increases contraction. The main hypothesis above was studied using isolated guinea-pig hearts perfused with either 11.7 mM or 5 mM glucose, and either albumin alone (3%) or albumin bound palmitate (1.5 mM) during low-flow ischaemia (92% reduction in flow) for up to 60 min. With 11.7 mM glucose, the presence of palmitate caused contracture development and increased enzyme release during ischaemia. Contracture also developed when the glucose concentration was reduced to 5 mM in the absence of fatty acid, however, in its presence contracture developed to a greater extent and with increased enzyme release. Long-chain acyl carnitine accumulation was similar in both groups. These studies show that long-chain acyl carnitine accumulation has the potential to induce contracture during ischaemia, although a reduction in glucose availability may also contribute.

Animals↗
PubMed1976

Possible role of cyclic AMP in the relaxation process of mammalian heart: effects of dibutyryl cyclic AMP and theophylline on potassium contractures in cat papillary muscles.

The effect of dibutyryl cyclic AMP (DB-c-AMP; 3 X 10(-4)-3 X 10(-3) M) on electrically induced twitch and high potassium (142.4 mM KCl)-induced contracture tension was studied in papillary muscles from normal and reserpinized cats ([Ca]0 1.8 mM; 25 degrees C; pH 7.4). In both groups of preparations, the increase in twitch tension evoked by DB-c-AMP was accompanied by an abbreviation of the time to peak force and of relaxation time. In the same preparations, the high potassium contracture was markedly depressed by DB-c-AMP in a concentration-dependent manner. Similar results were obtained with the N6-monobutyryl derivative of cyclic AMP. The relaxing effects of the cyclic nucleotides on KCl contractures did not appear to be due to possible non-cyclic breakdown products: adenosine, 5'-AMP and sodium butyrate did not attenuate contracture tension at concentrations up to 3 X 10(-3) M. The same applies to ATP and non-cyclic N6-2'-0-3'-0-tributyryl-adenosine-monophosphate. Theophylline (10(-2) M) was found to prolong the relaxation time of the twitch and to enhance the high KCl contracture. It is concluded that cyclic AMP may be capable of modulating the relaxation process of mammalian heart and that not only the positive inotropic but also the relaxant effects of catecholamines on myocardium described before may be mediated by the cyclic AMP system. The relaxant effects of cyclic AMP derivatives on intact myocardial preparations are attributed to a stimulation by cyclic AMP of the calcium transport of the sarcoplasmic reticulum (SR) and are interpreted to be a corollary to the effects of cyclic AMP previously obtained on isolated SR preparations.

Animals↗
PubMed1982

Membrane potential and contractures in segments cut from rat fast and slow twitch muscles.

Contractile responses associated with depolarization caused by an increase in [K]0 or by voltage-clamp steps were compared for fast and slow mammalian twitch muscles. The contractions and contractures of isolated mammalian muscle fibres cut into 0.5-1.0 cm lengths are similar to those obtained from intact cells. The slope of the relationship between the membrane potential and the log [K]0 is similar in slow (46 mV +/- 0.8) and in fast fibres (48 mV +/- 1.1). This relation is not significantly modified in sodium-free or Cl-free solution. The K-contractures of cut sections of slow and fast fibres are transient and a full repriming of the response is only observed when the [K] x [Cl] product is kept constant. The contractile threshold in fast fibres is at 20-30 mM [K]0 (-52 to -43 mV) and in slow muscle at 10-15 mM [K]0 (-62 to -55 mV). Under voltage-clamp conditions, the contractile responses of both types of muscle show two components. In Na-free solution or in presence of TTX (5 x 10(-7) g/ml) the first component is abolished and the second remaining component is similar to that developing during K-contractures. In iliacus fibres, the contracture threshold is between -50.5 mV and -40.5 mV and in soleus fibres between -66 mV and -56 mV; these values are close to those obtained with K-rich depolarizing fluids. The S-shaped curve of the contracture vs membrane potential relation is similar to that found in frog muscles except that the contractile responses are graded over a larger range of membrane potentials (-50 to + 30 mV in fast and -55 to + 10 mV in slow muscle).

Animals↗
PubMed1983

Mammalian skeletal muscle: long-lasting contractures and potentiated tetani produced by conditioning with weak acid anions.

Reversible contractures can be induced in slow mammalian muscles by manipulations that probably generate a long-lasting alkalinization of the muscle cell interior. Such contractures reach about 1/4 of the tetanic force, P0, and last 10 times longer than potassium contractures. While in contracture, the muscle fibers have high resting potentials so that they can be electrically stimulated. Tetanic force is then increased and added to that of the contracture so that total force may reach 2 P0. This level of potentiation has not been reached by any previously-known method.

Animals↗
PubMedDate not supplied

Contracture type and fibrosis type of decreased myocardial distensibility. Different changes in elasticity of myocardium in hypoxia and hypertrophy.

Resting length-tension relationships were measured in rat trabecular muscle strips under control (O2) and contracture (N2) conditions as well as in preparations of Goldblatt II (8-week stage) and control rats. For the evaluation of the diastolic elastic properties, diastolic stress at 1max, stress-strain relationships, the relation between tangent modulus delta sigma divided by delta epsilon and stress sigma, and the function ln stress sigma = f (strain epsilon) were calculated and plotted. It was shown that the hypoxic contracture corresponds to the calcium-caffeine contracture--an experimental contracture model already investigated earlier. In contrast to these contracture-induced alterations, Goldblatt II hypertrophied myocardium corresponded to the fibrosis type. This type was already analyzed in an experimental model of myocardium-tendon tandem preparation. Additional investigations of hydroxyproline concentration of the same biological material showed in contrast to other studies that the collagen content may already be increased in this early stage of hypertrophy. Thus, altered distensibility of Goldblatt myocardium is certainly primarily due to increased connective tissue content.

Animals↗