Creatine monohydrate in muscular dystrophies: A double-blind, placebo-controlled clinical study.

The authors assessed the safety and efficacy of creatine monohydrate (Cr) in various types of muscular dystrophies in a double-blind, crossover trial. Thirty-six patients (12 patients with facioscapulohumeral dystrophy, 10 patients with Becker dystrophy, 8 patients with Duchenne dystrophy, and 6 patients with sarcoglycan-deficient limb girdle muscular dystrophy) were randomized to receive Cr or placebo for 8 weeks. There was mild but significant improvement in muscle strength and daily-life activities by Medical Research Council scales and the Neuromuscular Symptom Score. Cr was well tolerated throughout the study period.

A placebo-controlled crossover trial of creatine in mitochondrial diseases.

To test the efficacy and safety of creatine (Cr) monohydrate in mitochondrial diseases, 16 patients with chronic progressive external ophthalmoplegia or mitochondrial myopathy were randomized in a crossover design to receive double-blind placebo or 20 g Cr/day for 4 weeks. Cr was well tolerated, but there were no significant effects with regard to exercise performance, eye movements, or activities of daily life. The power of this pilot study was limited and future multicenter trials are needed.

APC resistance in an elite female athlete.

In a routine checkup the family history of an elite female mogul skier was found to contain an unusually high number of thrombotic incidents. This prompted us to do diagnostic thrombophilia studies, which revealed a resistance to activated protein C, a heterozygous factor V Leiden disorder. This is the first documented case of APC resistance in an elite female athlete. Since high performance sports are known to carry an increased risk of thrombogenesis, measures to avoid thrombosis or a thromboembolic event must be initiated in case of known APC resistance. Suitable measures are early anticoagulation during periods of immobilization, a single dose of low molecular weight heparin, leg muscle exercises for long distance flights, and avoidance of hemoconcentration with a sufficient oral fluid intake.

Effects on bone mineral density of low-dosed oral contraceptives compared to and combined with physical activity.

A cross-sectional study was designed to examine the influence of exercise compared to and in combination with low-dosed oral contraceptives (OCs) on bone mineral density (BMD). One hundred twenty-eight women (20 to 35 years of age) were assigned to four groups with respect to the years of exercise and OC intake. Influence factors were determined by a detailed questionnaire and interview. BMD for L2-4 and the femoral neck was assessed by DXA. The highest BMD values were found in the group of women characterized by long-term exercise (9.45 +/- 4.32 yr) and short use of OC (1.6 +/- 1.69 yr). No beneficial effect of exercise on BMD was found in the group with a long exercise period (10.4 +/- 4.14 yr) and long-term intake of OC (8.2 +/- 4.14 yr). Differences in mean BMD values between the two groups were significant in all regions assessed (p < 0.05). No differences in mean BMD were found in the groups with short-term exercise but long or brief histories of OC. The question arises as to whether active women taking low-dosed OC at an earlier age will develop an adequate BMD.

[Hemodynamics and ergometric performance modified by low dosage oral contraceptives]. / Hämodynamik und ergometrische Leistung unter Einfluss eines niedrigdosierten oralen Kontrazeptivums.

In this pilot study hemodynamic parameters under base-line and performance conditions during a cycle without (N) and with low-dosed oral contraceptives (OC) were of interest. A group of 6 women (age 23.2 +/- 2.1 years) underwent 8 bicycle ergometry sessions each in both a normal cycle and in a cycle on OC. Testing was done in 3 phases of each cycle. Data were obtained on the maximum watt performance, the pulse work capacity at a heart rate of 170 beats per minute (PWC170), as well as on blood pressure and heart rate at rest and at various levels of exercise. No significant differences were found between the N and OC cycles during the follicular phase or in mid-cycle. During the luteal phase, however, faster heart rates and higher blood pressure levels were found for N cycles than in the corresponding phase under OC (p < 0.05).

Endoscopic small intestinal biopsy in infants and children: its usefulness in the diagnosis of celiac disease and other enteropathies.

Forty-seven endoscopic small intestinal biopsies were performed in children with chronic diarrhea and malabsorption and suspected celiac disease. The purpose of this study was to reach the distal duodenum or proximal jejunum with large channel panendoscopes in order to get adequate samples for histopathological diagnosis. Patients younger than 8 years of age were anesthetized with ketamine. Time required for the full procedure was less than 10 min in most cases. There were no failures or complications. In all 47 endoscopic examinations, histologically adequate specimens of small bowel mucosa were obtained. These results suggest that this is a safe, quick, and easy method to obtain high-quality samples for histopathological diagnosis of enteropathies.

[Intestinal amebiasis in Antofagasta, Chile]. / Amibiasis intestinal en Antofagasta, Chile.

In January 1989--December 1991 period we verified 35 cases of symptomatic intestinal amebiasis in Antofagasta, the main city of the North of Chile. Out of the total number of studied patients 23 were adults (77.1% males and 22.9% females) and all of them were permanent residents of Antofagasta. E.histolytica was frequently detected in association with other parasites and/or commensals, and observed alone in only seven cases. The clinical and epidemiological aspects of these 35 cases are discussed.

Clinical sciences and orthopaedics: case report homozygous APC resistance in an elite athlete.

We report the case of a 31 year old female elite athlete. During a routine check-up including a search for hereditary hemostatic risk factors for thrombosis, resistance to activated protein C was detected. Molecular analysis of the factor V gene revealed homozygosity for the factor V Leiden mutation. This is the first documented case of an elite athlete who is a homozygous carrier of factor V Leiden. Elite athletes may be exposed to several circumstantial thrombogenic risk factors and, therefore, special preventive measures in carriers of a congenital risk factor such as APC resistance are indicated. Essential measures are early anticoagulation during periods of immobilisation e.g. after sports-related injuries, a single dose of low-molecular-weight heparin specially for individuals with several thrombotic risk factors and/or leg muscle exercises for long-distance (air) travels and avoiding haemoconcentration with a sufficient oral fluid intake.

[Systematic strength training in the postmenopause: accompanying densitometric control with DXA]. / Systematisches Krafttraining in der Postmenopause: Begleitende densitometrische Kontrolle mit DXA.

Of all the forms of osteoporosis, the postmenopausal type is the most important in social medicine due to the potentially high fracture risk in aging. The positive effects of physical activity on bone density have been emphasized in several studies. In this study on 31 female volunteers (minimum age 50 years), who had been postmenopausal for at least 2 years, 16 underwent systematic strength building (training group). They were compared with a control group consisting of 15 female volunteers. The parameters of success were physical strength and bone mineral density (BMD) before and after training. BMD was measured by dual-energy X-ray absorptiometry. The subjects in the control group showed significant decrease in bone density after 6 months: between 6.7 and 22.3% of the values measured at the beginning. The loss was more evident in the proximal femur than in the lumbar spine. In contrast, the subjects in the training group only showed a marginal decrease in bone density in the proximal femur: 0.8 to 3.8% of the earlier values. In the lumbar spine there was even a slight increase (+0.3%) in bone density.

Systematic strength training as a model of therapeutic intervention. A controlled trial in postmenopausal women with osteopenia.

Physical exercise is often recommended as a therapeutic tool to combat pre- and postmenopausal loss of bone density. However, the relationship between training dosage (intensity, duration, frequency) and the effect on bone density still is undergoing discussion. Furthermore, the exercise quantification programs are often described so inadequately that they are neither quantitatively nor qualitatively reproducible. The aim of this investigation was to determine whether a clearly defined training of muscle strength, under defined safety aspects, performed only twice weekly, can counteract bone density loss in women with postmenopausal osteopenia. Data from 16 women in the training group (age, 63.6 +/- 6.2 yr) and 15 women in the control group (age, 67.4 +/-9.7 yr), of comparable height and weight, were evaluated. Strength training was performed for 6 mo as continually adapted strength training, providing an intensity of about 70% of each test person's one repetition maximum. Bone mineral density of lumbar vertebrae 2 to 4 and the femoral neck was measured by dual-energy x-ray absorptiometry. Maximum performance in watts and parameters of hemodynamics were controlled with a bicycle ergometer test to maximal effort. In addition, metabolic data were assessed. In the lumbar spine and femoral neck, the training group showed no significant changes, whereas the control group demonstrated a significant loss of bone mineral density, especially in the femoral neck (P<0.05). The strength increase was highly significant in all exercised muscle groups, rising to about 70% above the pretraining status (P<0.001). Heart rate and blood pressure data indicated a slight economization, metabolism was not significantly influenced. Based on these findings, we conclude that continually adapted strength training is an effective, safe, reproducible, and adaptable method of therapeutic strength training, following only two exercise sessions per week.

Functional impact of unvarying exercise program in women after menopause.

Low bone mass, functional impairment, low muscle strength, and postural instability are predictors of the risk of fracture in an elderly person. The purpose of this study was to investigate the functional impact of an unvarying long-term exercise program to be carried out at home. The exercises had been shown to delay bone loss in an elderly population. At the Department of Physical Medicine and Rehabilitation, University of Vienna, postmenopausal women who had been stratified into exercise or control groups 5 to 10 yr ago were called in for a follow-up examination. Frequency of training, habits, and pain causing disability in activities of daily living were recorded. Walking velocity, muscle strength, and postural stability were measured. Functional assessment, blood analysis, and x-rays of the spine were performed additionally. One hundred twenty-four women aged 68.3 +/- 6.8 yr (mean +/- SD) underwent a follow-up investigation at the outpatient clinic. After 7.7 +/- 1.1 yr the compliance of the training group was still 36%. Self-chosen gait velocity was slightly higher in the regular exercisers than in the controls. No intergroup differences were found for pain induced disability, muscle strength, body sway, and fracture rate. The pain disability index was significantly associated with corrected self-chosen gait velocity. The results suggest that an unvarying home-based exercise program may support general agility but does not yield enough force to improve muscle strength and postural stability in healthy, nondisabled, postmenopausal women who start exercising at the age of 60 yr. Further studies are needed to define more appropriate exercise programs for a comprehensive improvement of functional outcome in a population at high risk for osteoporosis.