Skeletal muscle metabolism in two Pavulon treated tetanus patients.

In two patients with severe tetanus the skeletal muscle metabolism was studied. Muscle biopsies were taken 4-6 weeks after the development of tetanus. The patients were treated during this time with a neuromuscular blocking agent. In one of the patients a biopsy was also taken before treatment, 2 days after the first symptoms of the disease. Enzyme activities representative for glycogen synthesis, glycogen greakdown, glycolysis, fatty acid beta-oxidation and respiratory chain, and fluxes of glucose, palmitate and leusine in vitro, and the concentrations of glycogen, triglycerides, phospholipids, cholesterol, proteins and RNA were determined in the muscle tissue. The enzyme activities in the muscle tissue examined 2 days after the development of tetanus were close to normal, excep for decreased activities of phosphofructokinase and glycogen synthase. After 4-6 weeks of treatment the fluxes of glucose and palmitate and the corresponding enzyme activities were low in both patients. These findings are consistent with muscular inactivity. In contrast the activity of glucose-6-phosphate dehydrogenase, the incorporation rate of leucine-carbon into proteins and the RNA content were high, indicating a high protein synthesis as a probable manifestation of active repairative processes. It is concluded that the skeletal muscle metabolism in these patients was affected in a degenerative manner and that this effect was attributed more to the treatment than to the disease per se. Dynamic physical training under supervision is recommended for the period after the generalized spasms to overcome the "disuse" effects in the skeletal muscles.