Quantitative analysis of changes occurring in muscle vastus lateralis in patients with heart failure after low-intensity training.

OBJECTIVE: To quantitate the changes occurring in muscle vastus lateralis after exercise training of low intensity adopted for the rehabilitation of patients with chronic heart failure. STUDY DESIGN: Nine consecutive males with a clinical diagnosis of idiopathic dilated and ischemic cardiomyopathy underwent an eight-week period of training. The intensity of the work was calculated as 40% of peak VO2. The program consisted of 30 minutes of cycling three times per week. A cardiopulmonary exercise test, hemodynamic measurements and echocardiographic studies were carried out. Needle biopsies were taken from muscle vastus lateralis before starting and after completing training. Quantitative analysis was carried out on sections stained with ATPase at pH 9.5 for measurement of the lesser diameter of type 1 and 2 fibers (by using an image analyzer) and on UEA 1-stained sections for capillary density and capillary/fiber ratio (by using a frame in the eyepiece of the microscope). The Wilcoxon test was applied to identify significant differences before and after training. Spearman's rank correlation coefficient was also calculated to highlight any correlation between the morphologic data and results of clinical tests. RESULTS: After completing the training program, all the patients experienced an improvement in exercise tolerance and a significant increase (P < .004) in the VO2 and VCO2 peak. Skeletal muscle showed a significant (P < .02) increase in the capillary/fiber ratio. The changes were not significantly correlated with any of the clinical findings. CONCLUSION: Low-intensity training can improve the functional capacity of patients with heart failure while producing only mild morphologic changes in their muscles.

Skin abnormalities and autonomic involvement in the early stage of amyotrophic lateral sclerosis.

With the aim to evaluate skin abnormalities in patients affected by amyotrophic lateral sclerosis (ALS) with respect to the dermal ultrastructure, including autonomic termination, microcirculation and sweat glands, 13 ALS patients and 5 controls underwent a skin biopsy of the left forearm. Abnormalities of the collagen and elastic fibrils were found in 4 and 5 patients respectively; amyelinic axons and sweat glands showed ultrastructural abnormalities in most ALS patients but not in controls; a quantitative evaluation of the collagen fibrils showed greater diameter of fibrils, larger interfibrillar spaces and more consistent size variation in ALS patients than in controls. These results suggest autonomic involvement in ALS and changes in the collagen fibril organization during the early stages of the disease.

Quantitative analysis of quadriceps muscle biopsy in systemic sclerosis.

The lesser diameter of the fibers, separately of type 1 and type 2 fibers, and the capillary density evaluated as number of capillaries/area and number of capillaries/fiber were quantitatively estimated in muscle biopsies from 12 patients with systemic sclerosis. Nine patients with polymyositis or rheumatoid arthritis and six patients with muscle dystrophy and neurogenic atrophy served as controls. The results showed that patients with systemic sclerosis had low values of the lesser diameter of the fibers. This reduction was most obvious in type 2 fibers. The capillaries were also significantly reduced when compared with the control groups. When considering the capillaries/fiber ratio, seven out of eight patients with values lower than 0.7 belonged to the systemic sclerosis group. In systemic sclerosis the capillary density values were not significantly correlated with those of the lesser diameters of the fibers.

[Cardiovascular involvement and relative risk factors in systemic sclerosis. Personal contribution]. / L'impegno cardiovascolare e relativi fattori di rischio nella sclerosi sistemica. Contributo personale.

In systemic sclerosis (SS), cardiovascular commitment was recorded in an autopsy series, in widely different percentages, from 12 to 81%. On the other hand, clinical diagnosis of cardiopathy is made in far fewer cases. In addition, the coexistence of renal and/or pulmonary commitment makes difficult separation between primary and secondary heart damage. In 22 patients (2 m, 20 f) aged between 34 and 75 (average 55 +/- 11) with SS, a study has been made of the a) prevalence of cardiovascular commitment; b) the significance of the classic risk factors; c) the erythrocyte filtration time or TF (index of microangiopathic damage). Metabolic stability, fibrinogen, haematocrit and TF (Reid et al. method) were assessed in each patient. Nine patients (40.9%) presented ischaemic cardiopathy (myocardial infarction in three and effort angina in six), one (4.5%) presented hypertensive cardiopathy. Conduction disturbances were observed in five patients (22.7%). Whereas a statistically significant increase in TF was observed in cardiopaths, no differences in plasma levels of glucose, cholesterol or fibrinogen were observed. The incidence of smoking and the familial factor were also insignificant.

[The use of dynamic electrocardiographic monitoring in scleroderma patients]. / L'applicazione dell'elettrocardiografia dinamica nel monitoraggio del paziente sclerodermico.

A comparative analysis of arrhythmias by "basal" electrocardiogram (ECG) and by continuous 24-hour Holter electrocardiogram monitoring was performed in 17 patients with systemic sclerosis (16 women and one man). Our study confirms that rhythm disturbances are better detectable using Holter monitoring. In fact, no patients had ventricular arrhythmias detected by ECG; on the contrary, Holter monitoring revealed ventricular arrhythmias in nine patients (53.3%). This method also revealed a ventricular tachycardia, not detected by ECG. In two patients ventricular repolarisation abnormalities without symptoms was revealed.