Cutaneous eruptions in coma patients with nontraumatic rhabdomyolysis.

BACKGROUND: Rhabdomyolysis has been described most commonly after muscle injury but may also result from coma due to alcohol intake or drug abuse. Its clinical findings usually occur as muscular pain and swelling, but these symptoms are also seen in as many as 60% of patients with nontraumatic rhabdomyolysis. The diagnosis of slight nontraumatic rhabdomyolysis is often difficult to establish clinically. Few previous studies have reported cutaneous symptoms in nontraumatic rhabdomyolysis. OBJECTIVE: We attempted to elucidate a relationship between nontraumatic rhabdomyolysis and cutaneous eruption. METHODS: We studied 7 patients who were diagnosed as having massive to slight nontraumatic rhabdomyolysis with a cutaneous eruption in pressure areas at the first visit to our hospital between March 28, 1988, and June 27, 1998. RESULTS: They revealed wine-red-colored urine and elevated serum myogenic enzyme. Two patients complained of muscle pain. In all patients, cutaneous eruptions including well-demarcated erythema, bullae and deep ulcers were observed in areas of pressure. The pathological findings of 5 cutaneous eruptions revealed necrosis of sweat ducts and glands in the dermis. CONCLUSIONS: The pathogenesis of nontraumatic rhabdomyolysis and the cutaneous eruptions in coma patients has not been elucidated, but these conditions are due to similar factors; pressure and hypoxia are considered to be important causative factors for both. Cutaneous eruptions in the coma patient may be an important clinical symptom of nontraumatic rhabdomyolysis.

Development of low-turnover bone diseases after parathyroidectomy and autotransplantation.

Parathyroidectomy and immediate autotransplantation (PTX-AT) has been shown to decrease bone pain and increase bone mineral density. However, adynamic bone disease (ABD) has been predicted to develop if the serum intact parathyroid hormone (i-PTH) level remains lower than normal for a long period of time. Therefore, we investigated the bone histology of patients whose serum i-PTH levels did not increase over 70 pg/mL for 1 year after PTX-AT. Four chronic hemodialysis patients were investigated. The serum intact osteocalcin (i-OC) level was measured and histomorphometry for cancellous bone was performed 1 year after the operation. Tetracycline hydrochloride was administered in the 12 weeks after PTX-AT. The serum i-PTH levels were 20.5 +/- 15.0 pg/mL and i-OC levels were 19.5 +/- 0.9 ng/mL. Histomorphometric analyses showed the osteoclast surface to be 0.1% in two cases and 0% in the other two cases, the eroded surface was 7.7 +/- 6.1%, and the fibrosis volume and osteoblast surface were 0% in all four cases. Osteoid volume, osteoid surface and osteoid thickness were lower in cases 1-3, but higher in case 4. All tetracycline labelings were in contact with the mineralization front in cases 1 and 3, but some were not in cases 2 and 4. Serum i-PTH and i-OC levels indicated that ABD developed in these four cases. Histomorphometric analyses revealed that ABD developed in case 1, while either ABD or low-turnover osteomalacia developed in cases 2 and 4, and low-turnover osteomalacia was observed in case 3 after PTX-AT. In conclusion, i-PTH should not be maintained at lower levels to avoid low-turnover bone diseases.

Inhibitory effect of sympathetic stimulation on activities of masseter muscle spindles and the jaw jerk reflex in rats.

1. To evaluate sympathetic effects on jaw muscles, the discharges of masseter muscle spindle afferents, jaw muscle electromyographic (EMG) activities and blood flow changes were compared in anaesthetized decerebrate rats before and during electrical stimulation of the cervical sympathetic trunk. 2. To eliminate the possibility of efferent control from the trigeminal motoneurones, muscle spindle activity was recorded from the cut peripheral end of the masseter nerve. The absence of a sympathetic component in the masseter nerve was confirmed by the horseradish peroxidase method. 3. Electrical stimulation of the sympathetic nerve at frequencies within the physiological range reduced muscle spindle afferent discharges evoked by passive jaw opening. 4. Sympathetic stimulation also reduced the EMG activity evoked by the jaw jerk reflex, which may reflect a sympathetic effect on spindle afferents. After cessation of stimulation, a transient increase in EMG activity was observed, which may be due to efferent supply from the trigeminal motoneurones. During rhythmical jaw movements, no sympathetic effect on EMG activity was detected. 5. The above sympathetic effect on muscle spindle afferents and EMG activity was independent of blood flow changes.

Effect of salivation on neural taste responses in freely moving rats: analyses of salivary secretion and taste responses of the chorda tympani nerve.

The outer surface of the mammalian taste receptor cell is usually covered with saliva, which may affect the initial process of gustation. To ascertain the interaction between salivation and gustation, salivary secretion from the submandibular and parotid glands and taste responses to the chorda tympani nerve were analyzed in the rat, during grooming, eating, and licking of the four standard taste stimuli (sucrose, NaCl, HCl, and quinine hydrochloride). Regions of the tongue surface bathed by saliva secreted from the each gland were examined, and it was found that: (1) Rats frequently groomed, and the anterior part of the tongue, innervated by the chorda tympani nerve, was usually covered with a mixture of submandibular saliva and substances on the body surface. (2) Licking of acceptable sucrose and NaCl solutions elicited initial phasic and long-lasting tonic taste responses, and did not evoked saliva enough to wash away the stimuli from the oral cavity. Licking of rejectable quinine evoked only a small phasic taste response and was followed by taste rejection behavior, accompanied by maximum salivation which could wash out the stimuli. (3) When taste responses were compared under awake and anesthetized (the tongue adapted to water) condition, sucrose response was larger, while responses to other taste stimuli were smaller under the awake condition. Rise time of the phasic NaCl response was longer under the awake condition. These taste response alterations may reflect the effects of prolonged adaptation of the tongue to the mixture of submandibular saliva and body surface substances, and flow rate of licked taste stimuli on the tongue surface.