The cerebrospinal fluid lactate is decreased in early stages of multiple sclerosis

BACKGROUND: The purpose of this study was to investigate if the concentration of lactate can provide additional information for pathologies that need examination of the cerebrospinal fluid (CSF) in their diagnostic controls or protocols. METHODS: A prospective study carried out in the year 2001 at the University Hospital of Bellvitge (Barcelona), on 92 samples of CSF from patients who needed this examination. The concentration of lactate, glucose, and the cell count was determined. One year later, the diagnosis revealed from the previous analyzed samples were sorted into groups according to the diagnosis. RESULTS: In the group with multiple sclerosis (MS) (n = 30), there was a significant decrease in lactate concentration (1.52 +/- 0.19 mmol/L) compared to the control group (1.89 +/- 0.11 mmol/L) (p < 0.001). The glucose concentration remained within the normal range and the cell count was < 4 cell/microL even in the relapses. CONCLUSIONS: In the early stages of MS, the lactate concentration in CSF is decreased and this could be related to alterations in sensitivity observed in those patients. Further studies are needed to evaluate if this lactate concentration is a prognostic indicator of the disease.

The effect of supplementation with n-3 fatty acids on the physical performance in subjects with spinal cord injury.

A global physical evaluation was performed in 21 males with spinal cord injury (SCI), at the beginning and at three and six months of omega-3 fatty acid (FA) supplementation. A significant increase in the proportion of eicosapentaenoic acid and docosahexanoic acid in plasma was observed in response to the supplementation (p<0.05). After six months of FA supplementation, strength endurance time increased from 127.7+/-19.0 s to 215.2+/-45.6 s in the right arm, and from 139+/-27.6 s to 237.7+/-48.7 s, in the left arm. The time to perform 20 repetitions of 70% maximum workload showed a reduction of 41% between the first and the third test. The time taken to cover a 90 meter long track, with a 6% slope, was reduced from 66.9+/-8.0 s to 59.3+/-6.7 s, at the end of the study (p<0.05). In conclusion, omega-3 FA supplementation could contribute to improve the functional capabilities in SCI subjects.

Creatine supplementation and performance in 6 consecutive 60 meter sprints.

Creatine is an ergogenic aid used in individual and team sports. The aim of this study is to analyze the effect of monohydrate creatine supplementation on physical performance during 6 consecutive maximal speed 60 meter races, and the changes induced in some characteristic biochemical and ventilatory parameters. The study was carried out on nineteen healthy and physically active male volunteers, and randomly distributed into two groups: Group C received a supplement of creatine monohydrate (20 g/day for 5 days) and group P received placebo. Tests were performed before and after supplementation. No significant changes were observed in weight or body water measured by bioimpedance or the sum of 7 skinfold or performance during the 60 meter races. Group C showed a statistically significant increase in plasma creatinine from 69.8 +/- 12.4 to 89.3 +/- 12.4 micromol x L(-1) (p<0.05). In group C in the second control day (after creatine supplementation), expiratory volume V(E), O2 uptake and CO2 production were lower after 2 minutes of active recovery period. These results indicate that creatine monohydrate supplementation does not appear to improve the performance in 6 consecutive 60 meter repeated races but may modify ventilatory dynamics during the recovery after maximal effort.

Long-term evolution of blood lipid profiles and glycemic levels in patients after spinal cord injury.

OBJECTIVE: To analyze the lipid and glycemic profiles in relation to age, time elapsed post injury and the level of injury in a group of patients with SCI. SUBJECTS: 2135 subjects with SCI were recruited during the annual routine health check-up carried out at the Institut Guttmann of Badalona, in Spain. The patients were classified according to the level of SCI and their age. METHODS: Serum lipid profiles and glycemic (glucose) levels were determined. Data was collected between 1996 and 2001, all biochemical analysis being performed by the same laboratory. RESULTS: Serum cholesterol levels show a statistically significant correlation with patient's age(P<0.001) and with time elapsed after injury (P<0.05). Differences can be observed between the values obtained from the different injury level groups (F=22.14; P<0.001). LDL-c shows a statistically significant difference between the four different age groups (F=3.51, P<0.05). There is an increase in plasma triglycerides related to the increase in age of the patients without observable differences between the injury level groups. The concentration of serum glucose increases with age (P<0.001) and also with the time elapsed after injury (P<0.05). CONCLUSION: There is a direct relationship between various biochemical parameters (total cholesterol, LDL-c and glucose) and the age of the patients, but not with the severity or time of evolution of the spinal cord injury.

Creatine supplementation does not improve physical performance in a 150 m race.

Creatine supplementation has been shown by several authors to improve physical performance in very high intensity, intermittent, exercises. The effect on performance, as well as in plasma creatine and lactate concentrations has been studied in a group of twelve sprinters of national class when running a distance of 150 m on two occasions, before and after creatine (or placebo) supplementation for the previous three days. The most important differences in the biochemical parameters analyzed have been in plasma creatinine concentration, which increased substantially both before and after the race in the group that had received a daily supplement of 25 grams of creatine monohydrate for the previous three days. Creatine supplementation, therefore, did not improve physical performance, in the conditions, when running a 150 m distance.

A new approach to the assessment of anaerobic metabolism: measurement of lactate in saliva.

OBJECTIVE: To test the hypothesis that saliva lactate concentrations may reflect those present in blood and that saliva lactate can be used as a very convenient and useful variable in the study of anaerobic metabolism. METHODS: Parallel determinations were made of lactate in saliva and in capillary blood samples, obtained at 3 min intervals from nine individuals during the performance of a maximum graded exercise test on a cycle ergometer against increasing workloads (from 25 up to a maximum of 300 W). Lactate determinations were done by means of an electroenzymatic method using 25 microliters samples in both types of fluids. RESULTS: For each situation, the concentration of lactate in saliva was shown to be about 15% of that in plasma but it followed the same pattern of evolution during the exercise test. A good correlation (r = 0.81) between blood and saliva lactate concentrations was found. The precision of the method was very good, with a coefficient of variation ranging (n = 10) between 2.2% for samples with very low lactate concentrations and 0.7% for sample with moderate lactate concentrations. Lactate appeared to be very stable in saliva over a period of 40 days after collection, when kept at 4 degrees C. The values obtained after this period were virtually identical to those shown in fresh samples. CONCLUSIONS: Determination of lactate in saliva can be used as an alternative to determination in blood, overcoming most of the drawbacks of the procedures being used at present, since the collection of the samples required no special expertise.

[Application of bidimensional echocardiography in the diagnosis of ventricular septal defect]. / Aplicación de la ecocardiografía bidimensional en el diagnóstico de la comunicación interventricular.

Between 1985-1990 we studied by means of two-dimensional echocardiography 286 patients with isolated ventricular septal defect (VSD). A hundred and sixty three being male and 123 female, as a mean age of 5 +/- 3 months. Sixty two cases (22.3%) reveales associated anomalies and in other 63 (22.4%) there was in the evolution an aneurysm of the septum membranous. The projections used were apical 4-chamber, with or without aortic root; parasternal long-short axis of great arterias or at ventricular level; subcostal 4-chamber; right oblique outlet right outflow tract and left oblique outlet left and right outflow tracts. Patients with VSD smaller than 3 mm were excluded. Perimembranous defects, 189 cases (66%), were more frequent than muscular, 91 31.8%), and subarterial defects, 6 (2.1%). Only 19 (9 apical muscular, 6 perimembranous outlet and 4 perimembranous trabecular) were initially misclassified. The diameter of the VSD was large in subarterial (0.85 +/- 0.1 cm) and perimembranous outlet VSD (0.75 +/- 0.5 cm) compared with the rest. Each group of defects was more easily shown by one particular projection except trabecular muscular defect. In conclusion, we are able to state that two-dimensional echocardiography enables us to discover the size and situation of isolated ventricular defects.

[Heart malformations in trisomy 13 and trisomy 18]. / Malformaciones cardíacas en las trisomías 13 y 18.

Congenital heart diseases were studied in children diagnosed of trisomy 13 and trisomy 18 in our hospital between January 1973 and July 1990. Twenty patients with trisomy 18 were diagnosed (18 females and two males). All had cardiac malformations. The findings were: ventricular septal defect in 16 cases (80%), valvular anomalies in 12 (63%), patent ductus arteriosus in nine (47%) and atrial septal defect or patent foramen ovale in 7 cases (36%). We found some complex congenital cardiac diseases: one atrioventricular canal, one tetralogy of Fallot, one hypoplastic left ventricle with mitral atresia and double outlet right ventricle, one case of univentricular heart with aortic outlet from a rudimentary cavity, a right ventricular atresia with pulmonary and tricuspid valves atresia. Nine cases of trisomy 13 were diagnosed (seven females and two males). We found: ventricular septal defect in 7 cases (77%), valvular disease in five (100% of the necropsy studies), secundum atrial septal defect in 4 patients (80%) and patent ductus arteriosus in two. Two cases presented hypoplastic left ventricle with aortic arch hypoplasia, one of them had subaortic stenosis and left superior vena cava being connected to the right atrium via coronary sinus; one case showed fibroelastosis. Our results have been similar to the previously reported and confirm the invariably presence of cardiac malformations in these syndromes. These malformations are an important sign of suspicion in fetal ultrasonography.

[Aortic coarctation in the first 3 months of life. Surgical results]. / Coartación de aorta en los primeros 3 meses de vida. Resultados quirúrgicos.

Between January 1973 and September 1989, 51 patients younger than 3 months with coarctation of the aorta underwent surgery. All of them had atrio-ventricular and ventriculo-arterial concordance with well developed ventricular cavities. Thirty-four were male and 17 female. Thirty five had associated anomalies and catheterism was done in 36 before surgical correction. The surgical procedures we used were 19 subclavian plasty (Waldhausen), 13 end-to-end anastomosis, 13 Alvarez technique and three goterex parch. Twelve died (23.5%), three during surgery and the others in a period of 3 to 20 days after surgery. Eight were younger than 17 days, seven had aortic arch hypoplasia associated and six had ventricular septal defect (five with pulmonary hypertension). Other ten developed recoarctation (gradient greater than 20 mmHg) between 10 days and 8 months after first intervention (media = 3 months). Five had previously end-to-end correction (41.6%), two angioplasty with parch (66%), two Alvarez (20%) and one Waldhausen (7%). The correction of the recoarctation required surgery in 4 patients (three with angioplasty with parch and one with end to end correction), and the other six underwent angioplasty with catheter-balloon. None of the 15 patients without previous catheterism died, and neither did those who underwent surgery during the last 4 years. The associated anomalies required a second time surgery. We conclude that morbimortality is related to the aortic arch hypoplasia, pulmonary hypertension and surgery during the first 2 weeks. We recommend surgery without previous catheterism. The recoarctation is more frequent in patients with end to end correction, without an increase of the mortality.

Deletion of chromosome 4: 46,XY, del(4) (q31.3) after gamete intrafallopian transfer and in vitro fertilization-embryo transfer.

It seems that assisted reproduction technology does not increase the rate of chromosome abnormalities, and up to now, a few cases have been reported. The case we describe here is the first one of monosomy 4q31 in a full-term liveborn after a combined GIFT-IVF procedure. Once more, this case raises the question of whether pregnancies resulting from IVF should be monitored for chromosome abnormalities or not.

Prognostic value of spontaneous hyponatremia in cirrhosis with ascites.

Spontaneous hyponatremia in cirrhosis with ascites is generally considered to be due to an impaired renal ability to excrete free water, to be a contraindication of diuretics, and to be a bad prognostic sign. These concepts are reviewed in this paper. 55 cirrhotics with ascites were divided into three groups. Group I consisted of 13 patients with hyponatremia and very low free-water clearance CH2O, 0.07 +/- 0.26 ml/min). These patients also had poor renal function: low inulin clearance (CINU, 40.6 +/- 25.9 ml/min) and paraaminohippurate clearance (CPAH, 383 +/- 275 ml/min). Group II consisted of 8 patients who also had hyponatremia. CH2O, CINU, and CPAH in these patients were fairly high: 5.85 +/- 1.53 ml/min, 85.7 +/- 26.2 ml/min, and 651 +/- 294 ml/min. These values are similar to those o7 +/- 4.27 ml/min, 94.7 +/- 33.1 ml/min, and 598 +/- 199 ml/min. Hyponatremia in Group I could be related to the impaired free-water clearance. The mechanism of hyponatremia in Group II patients is not clear. Patients with hyponatremia and low CINU and CPAH had a negative response to diuretics and a poor prognosis. Patients with hyponatremia but with relatively good renal function had a good prognosis, similar to Group III patients. They responded to diuretics with no worsening of their hyponatremia.