MORPHOLOGIC AND HISTOCHEMICAL EVALUATION OF MUSCLE IN PATIENTS WITH CHRONIC PULMONARY-EMPHYSEMA MANIFESTING GENERALIZED EMACIATION

Twelve severely emaciated patients with emphysema and a;control patien ts with mild emaciation were studied. Arterial blood gas analysis, pul monary function tests, and muscle biopsy were performed. According to the percentage of ideal body weight (%IBW), patients were divided into two groups of 6 patients each; one with %IBW values greater than 70.0 (group I) and the other with %IBW values less than 70.0 (group 2), an d 4 control patients with emphysema whose %IBW values were greater tha n 85.5. %FEV(1.0), PaO2 and Hugh-Jones scores in group, 3 patients wer e consistent with significantly greater deterioration as compared with those in group 1 patients and controls. In the muscle fibers of 11 pa tients and 4 controls, nicotinamide and adenosine dinucleotide tetrazo lium reductase activity was studded with spots, Nemalin rods were dete cted in 3 specimens in group 2 and in I specimen each in both group 1 and controls, These changes probably result from chronic hypoxemia. Fi ber type grouping accompanied by type II dominant fiber atrophy was de monstrated in 5 patients of group 2, whereas type II fiber atrophy was shown in specimens from patients of group I, Diameters of both types I and II fibers in group 2 were smaller than those in group 1 and cont rols. Significant correlations were observed between fiber diameters a nd %IBW, %FEV(1.0) and %IBW, and PaO2 and %IBW. Neurogenic and disuse muscular atrophy due to both hypoxic axonal disorder and disuse is lik ely to be the cause of the emaciation, and a 'vicious circle' between muscular atrophy, respiratory function and hypoxemia probably exists i n group 2. Since mild or moderate emaciation was observed in controls and group 1 in spite of the lack of fiber atrophy, involvement of fat and connective tissue should also be taken into consideration to deter mine the cause of emaciation.