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CALCIUM AND MAGNESIUM CONTENTS OF MALIGNANT HYPERPYREXIA-SUSCEPTIBLE HUMAN MUSCLE
Br.J. Anaesth. (1977) 49, 979
CALCIUM AND MAGNESIUM CONTENTS OF MALIGNANT HYPERPYREXIA-SUSCEPTIBLE HUMAN MUSCLE D. BENNETT, P. A. CAIN, F. R. ELLIS, C. F. LOUIS AND M. STANTON SUMMARY
The calcium and magnesium contents of muscle obtained by muscle biopsy of patients referred for malignant hyperpyrexia screening were determined. The susceptibility to malignant hyperpyrexia was made on the basis of the halothane contracture test. No difference in cation concentrations was found between the normal and malignant hyperpyrexia-susceptible groups.
MATERIALS AND METHODS
Anaesthetic and surgical techniques
The patients were selected for investigation if they required screening for malignant hyperpyrexia following the occurrence of malignant hyperpyrexia in the family. The screening procedure involved muscle biopsy of the left vastus internus muscle of the thigh in the vicinity of the motor innervation; this muscle is an approximately equal mixture of type 1 and type 2 fibres. The surgical procedure was conducted under general anaesthesia comprising thiopentone, fentanyl
and 50% nitrous oxide in oxygen; local anaesthetics were not used. The muscle was exposed surgically and, using a sterile electrode attached to a stimulator, the motor point was defined. In all, 4-5 g of muscle was removed piecemeal from each patient and individual portions were used for in vitro halothane contraction testing (Ellis et al., 1971), histopathological study (Harriman, Sumner and Ellis, 1973) and biochemical analysis. The samples for biochemical analysis were placed directly into dry, ice-cooled, sealed flasks in which they were transported to the laboratory. The results of the first two investigations determined whether the patient was malignant hyperpyrexia-susceptible. All biochemical measurements were performed without knowledge of the result of the other tests. Sample preparation for atomic absorption spectrometry
All glassware was immersed in 1 mol litre" 1 hydrochloric acid for 3 h and rinsed with doubledistilled water before use. Double-distilled water was used in the preparation of all solutions. Each muscle specimen was blotted dry on paper tissue and frozen at —10 °C in a sealed container until required. Samples weighing 300-500 mg were ashed in a platinum crucible in a muffled oven at 600 °C for a minimum of 6 h. The ash was dissolved in 0.5% lanthanum chloride containing 100 mmol litre" 1 hydrochloric acid and the calcium and magnesium contents of this solution were determined using a Pye Unicam atomic absorption spectrophotometer SP 90 calibrated with a standard solution of calcium chloride and magnesium sulphate.
D. BENNETT, B.SC.; C. F. LOUIS, B.A., D.PHIL.; M. STANTON,
B.SC, M.SC, PH.D.; Department of Biochemistry; P. A. CAIN, M.B., CH.B., F.F.A.R.C.S.; F. R. ELLIS, M.B., CH.B.,
PH.D., F.F.A.R.C.S., D.OBST.R.c.o.G.; Department of Anaesthesia, University of Leeds. Correspondence to F. R. E.
RESULTS AND DISCUSSION
The individual calcium and magnesium contents of 20 malignant hyperpyrexia and 18 normal muscle samples are reported in table I. The mean value for
Downloaded from http://bja.oxfordjournals.org/ at Karolinska Institutet on July 25, 2015
The importance of calcium metabolism in malignant hyperpyrexia is well established (Bianchi, 1973). Britt and others (1975) have suggested that, because the calcium uptake activity of vesicles isolated from the sarcoplasmic reticulum of malignant hyperpyrexia muscle is inhibited by halothane (Britt et al., 1973), " . . . a reduction in the amount of calcium [stored]... would be expected to have a significant effect in lowering total muscle calcium content." They have reported (Britt et al., 1975) that, in an unstated number of patients, there is a decreased calcium content in human malignant hyperpyrexia muscle. We wish to present the results of measuring calcium and magnesium contents of muscle obtained from 38 patients referred for malignant hyperpyrexia screening. Twenty found to be malignant hyperpyrexiasusceptible were indistinguishable from the 18 found to be normal.
BRITISH JOURNAL OF ANAESTHESIA
980
TABLE I. Calcium and magnesium contents (iLmolg'1 wet weight tissue) of malignant hyperpyrexiasensitive and normal human muscle Malignant hyperpyrexia-sensitive
Normal
Age
Age
(yO
Sex
A. G. F. M. R. M. B. H. I.E.
8 45 35 14 49 53 34 20 40 20 11 59 13 38 37 36 28 25 24 26
F M M F
D.J.
H. K. H.I. T. R.
J.E.
M. B. T. W. B. M. D. M. M. B.
J.H.
A. B. V. B.
J.B.
P.P.
F
M F
F F M M M F M F
F M
M F
M
Calcium Magnesium 1.54 0.93 1.00 • 1.01 0.78 1.29 1.43 0.71 0.94 1.25 1.41 0.74 0.85 2.45 1.77 1.06 1.72 2.11 1.36 1.37
7.94 7.72 8.25 8.38 8.23 — —
7.73 8.43 8.80 9.29 8.86 8.36 7.71 8.62 6.80 —
9.93 8.09 7.36
calcium content of normal muscle (1.39 ±0.08 (xmol g" 1 wet weight (table II) is in good agreement with previously reported values of 1.6-1.8 |xmol g" 1 wet weight (Spector, 1956). Similarly, the magnesium content (8.65 ± 0.12 (xmolg"1 wet weight) is in agreement with the reported value of 7.6-8.8 fjtmol g" 1 wet weight (Specter, 1956). When these values are compared with those obtained for malignant hyperpyrexia muscle (table II) the means are indistinguishable.
Patient
(yr)
Sex
F. L. S. M.
55 34 43 45 12 15 21 12 6 17 45 50 49 33 5 40 28 49
M F F M M M M M
i.e.
G. T. C. H. D. H. K. W. A. H. R. T.
R.J.
B. S. D. H.
B. T. M. T.
J.H. A.J.
R. S. E. M.
M
M M F
F F M M M F
Calcium Magnesium 1.20 1.60 1.36 1.34 0.80 1.95 1.17 0.98 1.61 1.03 1.88 1.75 1.00 1.00 1.36 1.75 1.47 1.84
—
8.75 7.87 8.76 9.11 8.27 8.43 8.49 8.53 9.06 9.53 8.40 8.35 9.01 7.96 9.20
standard error in proportion to the mean. Thus the much larger standard error in proportion to the mean in calcium content is most likely a result of a genuine variation between patients rather than an error introduced in sampling. These results concerning calcium concentrations in malignant hyperpyrexia muscle do not support the conclusions of Britt and others (1975), who have reported a significantly lower calcium content in malignant hyperpyrexia muscle compared with TABLE II. Mean values and SEMfor calcium and magnesium normal muscle. However, the standard errors reported contents (\unolg~1) of malignant hyperpyrexia sensitive and in their work were rather large and they concluded normal human muscle that it was not possible to use this measurement as a diagnostic technique for malignant hyperpyrexia. Calcium Magnesium The actual values they quoted (Britt et al., 1975) of Malignant hyperpyrexia1.29±0.10 8.26 + 0.18 calcium 57.7 ± 9.0 mg g" 1 wet weight of muscle sensitive muscle (calcium 1.41 + 0.22 mmol g" 1 wet weight) for normal Normal muscle 1.39±0.08 8.65 + 0.12 and calcium 31.6 ± 2.75 mg g" 1 wet weight of muscle (calcium 0.79 ± 0.47 mmol g" 1 wet weight) for maligThe major error that could have arisen in this type nant hyperpyrexia are ambiguous for two reasons.1 y.g g" of measurement is that "wet" muscle could contain The values must actually have been calcium 1 significant and variable amounts of water. Thus, any wet weight rather than calcium mg g" wet weight, 3 differences in cation content could be masked by this as their values are too great by a factor of 10 . In error. We would like to suggest that this did not occur addition, they do not report the number of patients in the work reported here, since the magnesium from whom biopsy specimens were taken, and this contents of both normal and malignant hyperpyrexia also could have affected their mean values. This last muscle were surprisingly constant having a very small comment is particularly pertinent when the data in
Downloaded from http://bja.oxfordjournals.org/ at Karolinska Institutet on July 25, 2015
Patient
CATION CONCENTRATIONS IN HYPERPYREXIA MUSCLE table I are expressed in a frequency histogram (fig. 1). It is clear from this that there is considerable spread in the values for calcium content for both normal and malignant hyperpyrexia muscle. Thus, if only a small number of samples were analysed, artefactual differences in calcium contents between normal and malignant hyperpyrexia muscle samples might have been observed.
25
(A)
2015-
5-
3 o- 25-
(B)
it 20
as not only was the anaesthetic treatment different, but also the muscle type. This could account for the lower calcium content of human malignant hyperpyrexia muscle observed by Britt. In addition, the halothane-induced reduction in sarcoplasmic reticulum calcium uptake activity of malignant hyperpyrexia muscle (Britt et al., 1973) could be modified by these factors also. Dhalla and others (1972) have reported also that as the halothane concentration is increased, the calcium uptake activity of sarcoplasmic reticulum isolated from malignant hyperpyrexia muscle is decreased. Unfortunately, they did not describe the anaesthetic technique used to prepare their patients for the biopsy. Thus the work reported here does not support the concept that there is a reduced calcium content in the muscle in malignant hyperpyrexia, as previously reported by Britt and others (1975). In fact, we conclude that both the magnesium and the calcium contents of human malignant hyperpyrexia muscle are very similar to those of normal human muscle treated identically with respect to muscle type and surgical treatment. We also question whether calcium pumping activity of sarcoplasmic reticulum isolated from human malignant hyperpyrexia muscle is altered by halothane.
15 ACKNOWLEDGEMENTS
We thank the Muscular Dystrophy Group of Great Britain for a grant supporting D. B. and M. S. and the Leeds General Infirmary Endowment Fund for supporting P. A. C.
105-
REFERENCES
0.5 Ca
1.0 1.5 26 25 wj mol g- muscle)
FIG. 1. Calcium contents of (A) normal and (B) malignant hyperpyrexia-susceptible muscle expressed as a frequency histogram. Data from table I.
Moreover, we note that, in the surgical preparation the Toronto patients with malignant hyperpyrexia, before biopsy for calcium content measurement, procaine anaesthesia was used as a field block. It is possible that procaine could reach the biopsy site, • and procaine is known to modify the ability of the sarcoplasmic reticulum to store calcium (Feinstein, 1963). Additionally, it is inconceivable that all their control subjects were treated with a similar anaesthetic technique as some were having hip surgery for which procaine infiltration would be inappropriate. Thus it is clear that the control group was non-homogeneous
Bianchi, C. P. (1973). Calcium and malignant hyperpyrexia; in International Symposium on Malignant Hyperthermia (eds R. A. Gordon, B.A. Britt, and W. Kalow), p. 147. Springfield: Charles C. Thomas. Britt, B. A., Endrenyi, L., Barclay, R. L., and Cadman, D. L. (1975). Total calcium content of skeletal muscle isolated from humans and pigs susceptible to malignant hyperthermia. Br.J. Anaesth., 47,647. Kalow, W., Gordon, R. A., Humphrey, J. G., and Rewcastle, N. B. (1973). Malignant hyperthermia—an investigation of five patients. Can. Anaesth. Soc. J., 20, 431. Dhalla, N. S., Sulakhe, P. V., Clinch, N. R., Wade, J. G., and Naimark, A. (1972). Influence of fluothane on calcium accumulation by the heavy microsomal fraction of human skeletal muscle: comparison with a patient with malignant hyperpyrexia. Biochem. Med., 6,333. Ellis, F. R., Harriman, D. G. F., Keaney, N. P., KyeiMensah, K., and Tyrrell, J. H. (1971). Halothane-induced muscle contracture as a cause of hyperpyrexia. Br. J. Anaesth.,43,721. Feinstein, M. B. (1963). Inhibition of caffeine rigor and radio-calcium movements by local anaesthetics in frog sartorial muscle J. Gen. Physiol., 47,151.
Downloaded from http://bja.oxfordjournals.org/ at Karolinska Institutet on July 25, 2015
10-
981
BRITISH JOURNAL OF ANAESTHESIA
982 Harriman, D. G. F., Sumner, D. W., and Ellis, F. R. (1973). Malignant hyperpyrexia myopathy. Quart. J. Med., 42, 639. Spector, W. S. (1956). Handbook of Biological Data, p. 72. Philadelphia: W. B. Saunders.
maligne Hyperpyrexie untersucht wurden. Die Anfalligkeit auf maligne Hyperpyrexie wurde auf der Basis des HalothanKontrakturtests bestimmt. Zwischen normalen und auf maligne Hyperpyrexie anfalligen Gruppen wurden keine Unterschiede in den Kationen-Konzentrationen festgestellt.
TENEUR EN CALCIUM ET EN MAGNESIUM DU MUSCLE HUMAIN PREDISPOSE A L'HYPERPYREXIE MALIGNE
CONTENIDO DE CALCIO Y MAGNESIO EN MUSCULO HUMANO SUSCEPTIBLE A HIPERPIREXIA MALIGNA SUMARIO
Se determino el contenido de calcio y magnesio en miisculo obtenido por biopsia muscular de pacientes senalados para examenes de hiperpirexia maligna. La susceptibilidad a hiperpirexia maligna se determino mediante la prueba de contraccion de halotano. No se descubrieron diferencias en concentraciones de cationes entre el grupo normal y el susceptible a hiperpirexia.
KALZIUM- UND MAGNESIUMGEHALT VON MUSKELN, DIE AUF MALIGNE HYPERPYREXIE ANFALLIG SIND ZUSAMMENFASSUNG
Festgestellt wurde der Kalzium- und Magnesiumgehalt in durch Biopsie entfernten Muskeln von Patienten, die auf
Downloaded from http://bja.oxfordjournals.org/ at Karolinska Institutet on July 25, 2015
RESUME
On a determine la teneur en calcium et en magnesium du muscle grace a une biopsie du muscle des malades envoyes pour depistage de l'hyperpyr&tie maligne. La predisposition a l'hyperpyrexie maligne a ete bas6e sur le test de contraction a l'halothane. On n'a trouve aucune difference dans les concentrations de cations entre les groupes predisposes a l'hyperpyrexie maligne et les groupes normaux.
CALCIUM AND MAGNESIUM CONTENTS OF MALIGNANT HYPERPYREXIA-SUSCEPTIBLE HUMAN MUSCLE D. BENNETT, P. A. CAIN, F. R. ELLIS, C. F. LOUIS AND M. STANTON SUMMARY
The calcium and magnesium contents of muscle obtained by muscle biopsy of patients referred for malignant hyperpyrexia screening were determined. The susceptibility to malignant hyperpyrexia was made on the basis of the halothane contracture test. No difference in cation concentrations was found between the normal and malignant hyperpyrexia-susceptible groups.
MATERIALS AND METHODS
Anaesthetic and surgical techniques
The patients were selected for investigation if they required screening for malignant hyperpyrexia following the occurrence of malignant hyperpyrexia in the family. The screening procedure involved muscle biopsy of the left vastus internus muscle of the thigh in the vicinity of the motor innervation; this muscle is an approximately equal mixture of type 1 and type 2 fibres. The surgical procedure was conducted under general anaesthesia comprising thiopentone, fentanyl
and 50% nitrous oxide in oxygen; local anaesthetics were not used. The muscle was exposed surgically and, using a sterile electrode attached to a stimulator, the motor point was defined. In all, 4-5 g of muscle was removed piecemeal from each patient and individual portions were used for in vitro halothane contraction testing (Ellis et al., 1971), histopathological study (Harriman, Sumner and Ellis, 1973) and biochemical analysis. The samples for biochemical analysis were placed directly into dry, ice-cooled, sealed flasks in which they were transported to the laboratory. The results of the first two investigations determined whether the patient was malignant hyperpyrexia-susceptible. All biochemical measurements were performed without knowledge of the result of the other tests. Sample preparation for atomic absorption spectrometry
All glassware was immersed in 1 mol litre" 1 hydrochloric acid for 3 h and rinsed with doubledistilled water before use. Double-distilled water was used in the preparation of all solutions. Each muscle specimen was blotted dry on paper tissue and frozen at —10 °C in a sealed container until required. Samples weighing 300-500 mg were ashed in a platinum crucible in a muffled oven at 600 °C for a minimum of 6 h. The ash was dissolved in 0.5% lanthanum chloride containing 100 mmol litre" 1 hydrochloric acid and the calcium and magnesium contents of this solution were determined using a Pye Unicam atomic absorption spectrophotometer SP 90 calibrated with a standard solution of calcium chloride and magnesium sulphate.
D. BENNETT, B.SC.; C. F. LOUIS, B.A., D.PHIL.; M. STANTON,
B.SC, M.SC, PH.D.; Department of Biochemistry; P. A. CAIN, M.B., CH.B., F.F.A.R.C.S.; F. R. ELLIS, M.B., CH.B.,
PH.D., F.F.A.R.C.S., D.OBST.R.c.o.G.; Department of Anaesthesia, University of Leeds. Correspondence to F. R. E.
RESULTS AND DISCUSSION
The individual calcium and magnesium contents of 20 malignant hyperpyrexia and 18 normal muscle samples are reported in table I. The mean value for
Downloaded from http://bja.oxfordjournals.org/ at Karolinska Institutet on July 25, 2015
The importance of calcium metabolism in malignant hyperpyrexia is well established (Bianchi, 1973). Britt and others (1975) have suggested that, because the calcium uptake activity of vesicles isolated from the sarcoplasmic reticulum of malignant hyperpyrexia muscle is inhibited by halothane (Britt et al., 1973), " . . . a reduction in the amount of calcium [stored]... would be expected to have a significant effect in lowering total muscle calcium content." They have reported (Britt et al., 1975) that, in an unstated number of patients, there is a decreased calcium content in human malignant hyperpyrexia muscle. We wish to present the results of measuring calcium and magnesium contents of muscle obtained from 38 patients referred for malignant hyperpyrexia screening. Twenty found to be malignant hyperpyrexiasusceptible were indistinguishable from the 18 found to be normal.
BRITISH JOURNAL OF ANAESTHESIA
980
TABLE I. Calcium and magnesium contents (iLmolg'1 wet weight tissue) of malignant hyperpyrexiasensitive and normal human muscle Malignant hyperpyrexia-sensitive
Normal
Age
Age
(yO
Sex
A. G. F. M. R. M. B. H. I.E.
8 45 35 14 49 53 34 20 40 20 11 59 13 38 37 36 28 25 24 26
F M M F
D.J.
H. K. H.I. T. R.
J.E.
M. B. T. W. B. M. D. M. M. B.
J.H.
A. B. V. B.
J.B.
P.P.
F
M F
F F M M M F M F
F M
M F
M
Calcium Magnesium 1.54 0.93 1.00 • 1.01 0.78 1.29 1.43 0.71 0.94 1.25 1.41 0.74 0.85 2.45 1.77 1.06 1.72 2.11 1.36 1.37
7.94 7.72 8.25 8.38 8.23 — —
7.73 8.43 8.80 9.29 8.86 8.36 7.71 8.62 6.80 —
9.93 8.09 7.36
calcium content of normal muscle (1.39 ±0.08 (xmol g" 1 wet weight (table II) is in good agreement with previously reported values of 1.6-1.8 |xmol g" 1 wet weight (Spector, 1956). Similarly, the magnesium content (8.65 ± 0.12 (xmolg"1 wet weight) is in agreement with the reported value of 7.6-8.8 fjtmol g" 1 wet weight (Specter, 1956). When these values are compared with those obtained for malignant hyperpyrexia muscle (table II) the means are indistinguishable.
Patient
(yr)
Sex
F. L. S. M.
55 34 43 45 12 15 21 12 6 17 45 50 49 33 5 40 28 49
M F F M M M M M
i.e.
G. T. C. H. D. H. K. W. A. H. R. T.
R.J.
B. S. D. H.
B. T. M. T.
J.H. A.J.
R. S. E. M.
M
M M F
F F M M M F
Calcium Magnesium 1.20 1.60 1.36 1.34 0.80 1.95 1.17 0.98 1.61 1.03 1.88 1.75 1.00 1.00 1.36 1.75 1.47 1.84
—
8.75 7.87 8.76 9.11 8.27 8.43 8.49 8.53 9.06 9.53 8.40 8.35 9.01 7.96 9.20
standard error in proportion to the mean. Thus the much larger standard error in proportion to the mean in calcium content is most likely a result of a genuine variation between patients rather than an error introduced in sampling. These results concerning calcium concentrations in malignant hyperpyrexia muscle do not support the conclusions of Britt and others (1975), who have reported a significantly lower calcium content in malignant hyperpyrexia muscle compared with TABLE II. Mean values and SEMfor calcium and magnesium normal muscle. However, the standard errors reported contents (\unolg~1) of malignant hyperpyrexia sensitive and in their work were rather large and they concluded normal human muscle that it was not possible to use this measurement as a diagnostic technique for malignant hyperpyrexia. Calcium Magnesium The actual values they quoted (Britt et al., 1975) of Malignant hyperpyrexia1.29±0.10 8.26 + 0.18 calcium 57.7 ± 9.0 mg g" 1 wet weight of muscle sensitive muscle (calcium 1.41 + 0.22 mmol g" 1 wet weight) for normal Normal muscle 1.39±0.08 8.65 + 0.12 and calcium 31.6 ± 2.75 mg g" 1 wet weight of muscle (calcium 0.79 ± 0.47 mmol g" 1 wet weight) for maligThe major error that could have arisen in this type nant hyperpyrexia are ambiguous for two reasons.1 y.g g" of measurement is that "wet" muscle could contain The values must actually have been calcium 1 significant and variable amounts of water. Thus, any wet weight rather than calcium mg g" wet weight, 3 differences in cation content could be masked by this as their values are too great by a factor of 10 . In error. We would like to suggest that this did not occur addition, they do not report the number of patients in the work reported here, since the magnesium from whom biopsy specimens were taken, and this contents of both normal and malignant hyperpyrexia also could have affected their mean values. This last muscle were surprisingly constant having a very small comment is particularly pertinent when the data in
Downloaded from http://bja.oxfordjournals.org/ at Karolinska Institutet on July 25, 2015
Patient
CATION CONCENTRATIONS IN HYPERPYREXIA MUSCLE table I are expressed in a frequency histogram (fig. 1). It is clear from this that there is considerable spread in the values for calcium content for both normal and malignant hyperpyrexia muscle. Thus, if only a small number of samples were analysed, artefactual differences in calcium contents between normal and malignant hyperpyrexia muscle samples might have been observed.
25
(A)
2015-
5-
3 o- 25-
(B)
it 20
as not only was the anaesthetic treatment different, but also the muscle type. This could account for the lower calcium content of human malignant hyperpyrexia muscle observed by Britt. In addition, the halothane-induced reduction in sarcoplasmic reticulum calcium uptake activity of malignant hyperpyrexia muscle (Britt et al., 1973) could be modified by these factors also. Dhalla and others (1972) have reported also that as the halothane concentration is increased, the calcium uptake activity of sarcoplasmic reticulum isolated from malignant hyperpyrexia muscle is decreased. Unfortunately, they did not describe the anaesthetic technique used to prepare their patients for the biopsy. Thus the work reported here does not support the concept that there is a reduced calcium content in the muscle in malignant hyperpyrexia, as previously reported by Britt and others (1975). In fact, we conclude that both the magnesium and the calcium contents of human malignant hyperpyrexia muscle are very similar to those of normal human muscle treated identically with respect to muscle type and surgical treatment. We also question whether calcium pumping activity of sarcoplasmic reticulum isolated from human malignant hyperpyrexia muscle is altered by halothane.
15 ACKNOWLEDGEMENTS
We thank the Muscular Dystrophy Group of Great Britain for a grant supporting D. B. and M. S. and the Leeds General Infirmary Endowment Fund for supporting P. A. C.
105-
REFERENCES
0.5 Ca
1.0 1.5 26 25 wj mol g- muscle)
FIG. 1. Calcium contents of (A) normal and (B) malignant hyperpyrexia-susceptible muscle expressed as a frequency histogram. Data from table I.
Moreover, we note that, in the surgical preparation the Toronto patients with malignant hyperpyrexia, before biopsy for calcium content measurement, procaine anaesthesia was used as a field block. It is possible that procaine could reach the biopsy site, • and procaine is known to modify the ability of the sarcoplasmic reticulum to store calcium (Feinstein, 1963). Additionally, it is inconceivable that all their control subjects were treated with a similar anaesthetic technique as some were having hip surgery for which procaine infiltration would be inappropriate. Thus it is clear that the control group was non-homogeneous
Bianchi, C. P. (1973). Calcium and malignant hyperpyrexia; in International Symposium on Malignant Hyperthermia (eds R. A. Gordon, B.A. Britt, and W. Kalow), p. 147. Springfield: Charles C. Thomas. Britt, B. A., Endrenyi, L., Barclay, R. L., and Cadman, D. L. (1975). Total calcium content of skeletal muscle isolated from humans and pigs susceptible to malignant hyperthermia. Br.J. Anaesth., 47,647. Kalow, W., Gordon, R. A., Humphrey, J. G., and Rewcastle, N. B. (1973). Malignant hyperthermia—an investigation of five patients. Can. Anaesth. Soc. J., 20, 431. Dhalla, N. S., Sulakhe, P. V., Clinch, N. R., Wade, J. G., and Naimark, A. (1972). Influence of fluothane on calcium accumulation by the heavy microsomal fraction of human skeletal muscle: comparison with a patient with malignant hyperpyrexia. Biochem. Med., 6,333. Ellis, F. R., Harriman, D. G. F., Keaney, N. P., KyeiMensah, K., and Tyrrell, J. H. (1971). Halothane-induced muscle contracture as a cause of hyperpyrexia. Br. J. Anaesth.,43,721. Feinstein, M. B. (1963). Inhibition of caffeine rigor and radio-calcium movements by local anaesthetics in frog sartorial muscle J. Gen. Physiol., 47,151.
Downloaded from http://bja.oxfordjournals.org/ at Karolinska Institutet on July 25, 2015
10-
981
BRITISH JOURNAL OF ANAESTHESIA
982 Harriman, D. G. F., Sumner, D. W., and Ellis, F. R. (1973). Malignant hyperpyrexia myopathy. Quart. J. Med., 42, 639. Spector, W. S. (1956). Handbook of Biological Data, p. 72. Philadelphia: W. B. Saunders.
maligne Hyperpyrexie untersucht wurden. Die Anfalligkeit auf maligne Hyperpyrexie wurde auf der Basis des HalothanKontrakturtests bestimmt. Zwischen normalen und auf maligne Hyperpyrexie anfalligen Gruppen wurden keine Unterschiede in den Kationen-Konzentrationen festgestellt.
TENEUR EN CALCIUM ET EN MAGNESIUM DU MUSCLE HUMAIN PREDISPOSE A L'HYPERPYREXIE MALIGNE
CONTENIDO DE CALCIO Y MAGNESIO EN MUSCULO HUMANO SUSCEPTIBLE A HIPERPIREXIA MALIGNA SUMARIO
Se determino el contenido de calcio y magnesio en miisculo obtenido por biopsia muscular de pacientes senalados para examenes de hiperpirexia maligna. La susceptibilidad a hiperpirexia maligna se determino mediante la prueba de contraccion de halotano. No se descubrieron diferencias en concentraciones de cationes entre el grupo normal y el susceptible a hiperpirexia.
KALZIUM- UND MAGNESIUMGEHALT VON MUSKELN, DIE AUF MALIGNE HYPERPYREXIE ANFALLIG SIND ZUSAMMENFASSUNG
Festgestellt wurde der Kalzium- und Magnesiumgehalt in durch Biopsie entfernten Muskeln von Patienten, die auf
Downloaded from http://bja.oxfordjournals.org/ at Karolinska Institutet on July 25, 2015
RESUME
On a determine la teneur en calcium et en magnesium du muscle grace a une biopsie du muscle des malades envoyes pour depistage de l'hyperpyr&tie maligne. La predisposition a l'hyperpyrexie maligne a ete bas6e sur le test de contraction a l'halothane. On n'a trouve aucune difference dans les concentrations de cations entre les groupes predisposes a l'hyperpyrexie maligne et les groupes normaux.