Improper Diagnostic Test May Account for High Incidence of Malignant Hyperthermia Associated with Masseter Spasm

1986 ◽  
Vol 64 (2) ◽  
pp. 291-291 ◽  
Author(s):  
F. R. ELLIS ◽  
P. J. HALSALL
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Asensio Gonzalez ◽  
Tinen L. Iles ◽  
Paul A. Iaizzo ◽  
Oliver Bandschapp

Abstract Background Statin intake is associated with muscular side effects, among which the unmasking of latent myopathies and of malignant hyperthermia (MH) susceptibility have been reported. These findings, together with experimental data in small animals, prompt speculation that statin therapy may compromise the performance of skeletal muscle during diagnostic in vitro contracture tests (IVCT). In addition, statins might reduce triggering thresholds in susceptible individuals (MHS), or exacerbate MH progression. We sought to obtain empirical data to address these questions. Methods We compared the responses of 3 different muscles from untreated or simvastatin treated MHS and non-susceptible (MHN) pigs. MHS animals were also invasively monitored for signs of impending MH during sevoflurane anesthesia. Results Muscles from statin treated MHS pigs responded with enhanced in vitro contractures to halothane, while responses to caffeine were unaltered by the treatment. Neither agent elicited contractures in muscles from statin treated MHN pigs. In vivo, end- tide pCO2, hemodynamic evolution, plasma pH, potassium and lactate concentrations consistently pointed to mild acceleration of MH development in statin-treated pigs, whereas masseter spasm and rigor faded compared to untreated MHS animals. Conclusions The diagnostic sensitivity and specificity of the IVCT remains unchanged by a short-term simvastatin treatment in MHS swine. Evidence of modest enhancement in cardiovascular and metabolic signs of MH, as well as masked pathognomonic muscle rigor observed under simvastatin therapy suggest a potentially misleading influence on the clinical presentation of MH. The findings deserve further study to include other statins and therapeutic regimes.


Anaesthesia ◽  
1998 ◽  
Vol 53 (11) ◽  
pp. 1111-1116 ◽  
Author(s):  
J. A. Ramirez-R ◽  
E. D. Cheetham ◽  
A. S. Laurence ◽  
P. M. Hopkins

1984 ◽  
Vol 61 (2) ◽  
pp. 230-230 ◽  
Author(s):  
J. Michael Badgwell ◽  
James E. Heavner

1986 ◽  
Vol 64 (2) ◽  
pp. 291-291 ◽  
Author(s):  
ABRAHAM F. L. VAN DER SPEK ◽  
PAUL M. SPARGO ◽  
MICHAEL L. NAHRWOLD

2002 ◽  
Vol 97 (5) ◽  
pp. 1067-1074 ◽  
Author(s):  
Nicole Monnier ◽  
Renée Krivosic-Horber ◽  
Jean-François Payen ◽  
Geneviève Kozak-Ribbens ◽  
Yves Nivoche ◽  
...  

Background Malignant hyperthermia susceptibility (MHS), an uncommon syndrome often inherited as an autosomal dominant trait, is characterized by a genetic and clinical heterogeneity. In this article, the authors described six pedigrees in which both parents of MHS patients were diagnosed with MHS by an diagnostic test. Haplotype and mutation analysis revealed that more than one MHS genetic trait was present in these families. Methods A panel of 104 MHS families were investigated with a caffeine halothane contracture test on muscle biopsy specimens. When possible, blood creatine kinase concentrations of MHS patients were measured. Haplotyping studies were conducted with chromosome 19q13.2 polymorphic markers and mutations were searched for in patients' DNA. Results In six families, the diagnostic test and genetic studies demonstrated that both, apparently unrelated, parents of MHS patients were MHS. In three families, homozygous or compound heterozygous individuals for RYR1 mutations were characterized at a molecular level. In one family, a compound heterozygous patient harboring a RYR1 mutation and a CACNA1S mutation was identified. While patients with two mutated alleles did not show differences in their muscle response to halothane or caffeine, their creatinine kinase concentrations were significantly elevated compared with the heterozygous patients. Conclusions Based on genetic and diagnostic test data, more than one MHS allele associated with the MHS phenotype was evidenced in four families. These data should be considered in view of the use of genetics for the diagnosis of MHS and when reaching conclusions of genetic heterogeneity in MHS families. Taking into account the usual dominant mode of transmission of MHS and the size of the investigated population, the authors propose an evaluation of the incidence of the MHS in the general population based on genetic data.


2013 ◽  
Vol 41 (01) ◽  
pp. 16-22
Author(s):  
A. Rosé ◽  
R. Neiger

SummaryTo find the most common diagnoses of dogs where vomiting was the main reason for referral and to determine the usefulness of various diagnostic investigations.213 dogs referred for vomiting as main or one of the main causes were analysed retrospectively. Diagnosis was reassessed and categorized into six groups, namely gastrointestinal, systemic, non-gastrointestinal abdominal, neurological, miscellaneous or no diagnosis. All diagnostic investigations were reviewed to assess their usefulness to reach a diagnosis. The usefulness of a diagnostic investigation was scored into the following four groups: enabled a diagnosis; assisted a diagnosis; no assistance, diagnosis reached by another procedure; no assistance, no final diagnosis made.In 203 dogs (95.3%) a diagnosis was reached and was categorised as gastrointestinal (43.7%), systemic (27.7%), non-gastrointestinal abdominal (16.4%), neurological (1.4%) and miscellaneous (6.1%). Laboratory tests enabling or assisting a diagnosis as blood tests in 12.2%; 26.8%, as faecal analysis in 6.6%; 1.4%, as ultrasound in 5.2%; 17%, as cytology in 3.3%; 4.2%, as urinalysis in 2.3%; 9.9% and as radiographs in 1.9%; 8.5% of all cases.Overall, there was a high incidence of dogs referred for vomiting with non-gastrointestinal diseases. Amongst them, renal problems were most commonly seen, which emphasises the need to perform a urinalysis in most dogs with vomiting as major complaint. However, vomiting can be due to a large variety of underlying pathophysiological mechanisms and no single problem seems to be much more common compared to other problems in a referral institution.Based on this investigation it is not possible to clearly state a most useful single diagnostic test in dogs with emesis, however, it could clearly been shown that more than one test is often needed to reach a final diagnosis. This is important for owners to understand but also for referring veterinarians.


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