Long-term effects of pravastatin on serum lipid levels in elderly patients with hypercholesterolemia

The purpose of this study was to evaluate the long-term efficacy and tolerability of pravastatin, a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, in elderly patients with hypercholesterolemia. Pravastatin was administered for 12 months at a mean final dose of 9.9 mg/d to 208 elderly patients (mean [+/- SD] age, 70 +/- 7 years) with levels of total serum cholesterol greater than 5.69 mmol/L. The mean total cholesterol level was significantly decreased from 6.85 +/- 0.80 mmol/L to 5.59 +/- 0.70 mmol/L after 3 months, and this decrease was maintained thereafter. A similar change was observed in the mean serum level of low-density lipoprotein cholesterol. Although the mean serum level of high-density lipoprotein cholesterol in all the patients did not change significantly, the level in 34 patients with a value lower than 1.03 mmol/L was significantly increased after 3 months and thereafter. The serum level of triglycerides in all patients was significantly decreased after 3 months and thereafter and the decrease was more marked in 101 patients with levels greater than 1.73 mmol/L. In 168 elderly patients receiving 10 mg/d of pravastatin, there were significant negative correlations between the percent decrease in total cholesterol and both baseline total serum cholesterol level (r = -.354, P < 0.001) and age (r = -.208, P = 0.007). No serious side effects were observed. These results indicate that long-term administration of pravastatin is beneficial in the treatment of hypercholesterolemia in elderly patients.

Fetal liver length measurement does not provide a superior means for prediction of a small for gestational age fetus

To assess the growth of the fetal liver in normal pregnancies and evaluate the ability of fetal liver length measurement for prediction of small for gestational age fetuses, ultrasonographic examinations were performed on 162 normal fetuses, ranging from 15 to 40 weeks menstrual age. The optimal mathematical function and normal range of liver length were generated. The liver length was obtained in 21 small for gestational age fetuses between 34 and 40 weeks, and the ability to use fetal liver length measurement for prediction of small for gestational age fetuses was investigated. A curvilinear relationship was found between the menstrual age and liver length (R2 = 91.9%), and a normal range of liver length measurement for estimating the growth of the fetal liver during normal pregnancy was generated. The liver length was normal in 19 of 21 small for gestational age fetuses (90.5%). The fetal liver length measurement does not provide a superior means for identifying the small for gestational age fetus.

Mathematical modeling of fetal organ growth using the Rossavik growth model: III. Cardiac ventricle

Growth of the fetal cardiac ventricle has been monitored by total cardiac diameter (TCD), left ventricular systolic (LVSD) and diastolic diameter (LVDD), right ventricular systolic (RVSD) and diastolic diameter (RVDD), left ventricular width (LVW), interventricular septal width (IVSW), and right ventricular width (RVW) from 19 to 39 weeks, menstrual age, in 114 normal Japanese fetuses. Growth curves for these parameters have been determined using a Rossavik growth model [P = c(t)k+s(t)]. R2 values of 89.7, 58.0, 65.3, 77.9, 80.3, 31.1, 30.1, and 26.9 were obtained for TCD, LVSD, LVDD, RVSD, RVDD, LVW, IVSW, and RVW, respectively. Variability analysis indicated a progressive increase in variability with fetal age for these eight parameters. Variability data were used with the growth curve models to determine standard curves for these parameters. These standard curves provide a superior means for evaluating the normal fetal cardiac growth in the fetus and for identifying congenital heart anomalies in utero.

An accurate antenatal diagnosis of vasa previa with transvaginal color Doppler ultrasonography

We describe a case of vasa previa diagnosed antenatally with transvaginal color Doppler ultrasonography. The diagnosis was confirmed at cesarean delivery. The benefits and advantages of the use of transvaginal color Doppler ultrasonography to diagnose vasa previa in utero are discussed.

[Efficacy of benzimidazole-type drugs on alveolar echinococcosis (AE)]

AE patients can be cured only by complete excision of the lesions. In Europe and the United States, however, benzimidazole-type drugs have been reported to be effective. We treated 37 patients (20 males and 17 females, mean age of 45.9 years) with mebendazole (MBZ) (n = 17) or albendazole (ABZ) (n = 20) according to the WHO chemotherapy protocol, and compared adverse reactions, drug concentrations, serological parameters, and measurable lesions by CT scan and/or X-ray examination. In the MBZ group, serological parameters were unaffected. One patient each had hepatic disorder and alopecia (12%), and 5 lesions in the liver and 3 in the lung gradually increased in size (105% in 1 year, 112% in 2 years), and showed NC (no response) in 6, PD (progressive disease) in 2. One case of released biliary obstruction were judged as PR (partial response) (Response rate: 11.1%). In the ABZ group, no adverse reactions were found and ELISA level decreased significantly in 10 out of 12 patients. One lesion in the liver, 3 in the lung, 1 in the chest wall and 1 in the retropancreatic region reduced in size significantly (Mean: 56%) (PR 3, NC 3; Response rate: 50.0%). ABZ was safer and more effective than MBZ.

Milbemycin derivatives: epoxidation of milbemycins

Epoxidation reactions (MCPBA epoxidation and Sharpless epoxidation) were examined as a means of chemically modifying milbemycins as part of our program for discovering anthelmintics. 8,9-Epoxy-, 14,15-epoxy-, 8,9-14,15-diepoxy-, and 3,4-8,9-14,15-triepoxymilbemycin A4 were selectively obtained from milbemycin A4 and its derivatives, in which either the C-5 and C-7 hydroxyl groups or C-5 alone were protected as appropriate by a silyl ether (in the former case) or a carbonyl group. Further silylation or epoxidation on these epoxidized compounds indicated that the configuration of each epoxide moiety of the mono- and diepoxides is in accord with that of the corresponding epoxide moiety of the triepoxide. Furthermore, in order to confirm the absolute configurations of these epoxide functionalities, an X-ray analysis of a carbamate derivative from the triepoxymilbemycin was conducted.

[Reoperations for valvular heart disease through repeated median sternotomy incision]

One thousand and three hundred patients underwent open heart surgery for acquired valvular diseases in our hospital from 1952 through December 1993. There were 105 reoperative cases through repeated median sternotomy incision and 52 cases of prosthetic valve replacement by the same operator in the last 5 years. We studied technical procedures by these reoperative experience. There was only one case (1.9%) of hospital death in replacement cases. We believe that repeated open heart surgery for acquired valvular diseases should be done prior to deterioration of patient's clinical condition. We had to pay attention to facilitate mobilization of right atrium and aortic root in the aortic and mitral valvular reoperations. To decrease operative mortality of prosthetic valve replacement, each operative techniques were necessary by the reasons for reoperation.

Prediction of neonatal crown-heel length in normal singletons, twins, and triplets using individualized growth assessment

In groups of normally growing singletons (20), twins (20), and triplets (13), predicted femur diaphysis length (FDL) values at birth were obtained using Rossavik growth models specified from second-trimester ultrasound studies of fetal growth. Six previously published functions were utilized to obtain predicted crown-heel length (CHL) values from predicted FDL values. These values were compared to the actual CHL values and the percent differences calculated. Based on their systematic (mean percent difference) and random (standard deviation of percent difference) prediction errors, the functions of Vintzileos (singletons), Hadlock (twins), and Brown (triplets) were found to give optimal results (no systematic error; random error: +/- 6%). Using predicted CHL values obtained with these optimal functions, growth potential realization index values for CHL (GPRICHL) were determined for singletons, twins, and triplets. In all three groups, the mean GPRICHL value was 100% with a range of approximately 95% to 105%. These results indicate that the CHL can be predicted from second-trimester growth patterns and evaluated using individualized growth assessment methods.

Toxicokinetics of zenarestat, an aldose reductase inhibitor in animals and man

1. The relationship between dose and plasma concentrations is important in extrapolating toxicity between species. Therefore, we determined this relationship for zenarestat in animals and man. 2. The biopharmaceutics of zenarestat was assessed prior to toxicity testing. The bioavailability of zenarestat in rat administered zenarestat in 0.5% (w/v) methyl cellulose suspension and aqueous solution was similar. Bioavailability in dog administered zenarestat treated with excipients and in aqueous solution was similar. 3. Cmax increases dose-relatedly both in animals and man. AUC increased almost in proportion to the dose in mouse, rat and man, but increased to a greater extent at the highest dose in dog. Cmax, AUC and C24h were not significantly different during/after multiple dosing. 4. After 13 and 53 weeks of toxicity testing, plasma concentrations were not significantly different between the days and sexes except at 560 mg/kg in the female rat and at 56 mg/kg in the female dog in 13 week toxicity tests. 5. The exposure of zenarestat in man, administered 300 mg b.i.d., seemed to be no more than that in animals at non-toxic doses.

[Effects of pravastatin administration for 12 months on serum lipid levels in aged patients with hypercholesterolemia]

To evaluate long-term efficacy of pravastatin, we administered this HMG-CoA reductase inhibitor at a mean dose of 9.9 mg/day to 208 aged patients with serum levels of total cholesterol (TC) over 220 mg/dl (mean +/- SD aged of 70 +/- 7 years; 62 males and 146 females) for 12 months. The mean serum value of TC significantly decreased from the basal level of 265 mg/dl to 216 mg/dl in the 3rd month, and this decrease was maintained throughout the observation period. Similar change was observed in the serum level of low density lipoprotein-cholesterol (LDL-C). Although the mean serum level of high density lipoprotein-cholesterol (HLC-C) in all patients did not change significantly, the HDL-C level in 34 patients with a HDL-C level below 40 mg/dl significantly increased from the 3rd month. The mean serum level of triglyceride (TG) in all patients significantly decreased from the 3rd month, and this decrease in the TG was more prominent in 101 aged patients with TG levels higher than 150 mg/dl. In 168 aged patients on 10 mg/day of pravastatin throughout the period, there were significant negative correlations between the ratio of the decrease in TC in basal serum and each of the basal serum TC levels (r = -0.345, p < 0.001) and age of the subjects (r = -0.208, p = 0.007). These results indicate that long-term administration of pravastatin is effective treatment for lipid metabolism even in aged patients.

Long-term therapy with terazosin may improve glucose and lipid metabolism in hypertensives: a multicenter prospective study

The effects of long-term monotherapy with terazosin, an alpha-1 blocker, on blood pressure, glucose tolerance, and serum lipid profiles were prospectively investigated in 53 hypertensive patients: 19 with normal glucose tolerance (NGT) and 34 with impaired glucose tolerance (IGT). The plasma glucose, serum lipids, fructosamine, and glycosylated hemoglobin A1c (HbA1c) levels were determined before and during long-term (6 months) therapy with terazosin. A 75-g oral glucose tolerance test was performed before and during long-term terazosin therapy. Significant falls in both systolic and diastolic blood pressure in both patient groups were maintained during the long-term therapy with terazosin. Neither fasting nor postglucose-load venous plasma glucose levels were altered in either group of patients, and diabetes mellitus did not develop in any patient with NGT during the study. There was no significant change in the insulinogenic index (delta IRI/delta BS at 30 minutes after glucose load) in either patient group. In patients with IGT, glucose intolerance was slightly improved with significant reductions in HbA1c and fructosamine during terazosin therapy. Serum total cholesterol (TC) and triglyceride levels were significantly decreased in patients with IGT. In addition, TC and low density lipoprotein (LDL) cholesterol were significantly decreased in patients with hypercholesterolemia (TC > 220 mg/dL). These results suggest that long-term therapy with terazosin may improve glucose and lipid metabolism in hypertensive patients and terazosin seems to be an antihypertensive agent with beneficial effects for hypertensive patients with either dyslipidemia or impaired glucose metabolism.

Pharmacokinetics of droloxifene in mice, rats, monkeys, premenopausal and postmenopausal patients

The pharmacokinetics of droloxifene have been studied in female mice, rats, monkeys, and premenopausal and postmenopausal patients. Droloxifene was rapidly and almost completely absorbed after oral dosing. The bioavailability was 8% in mice, 18% in rats and 11% in monkeys due to extensive first-pass metabolism. Droloxifene is widely distributed as demonstrated by its large volume of distribution and the fact that radioactivity in most tissues and organs was higher than in the blood. After oral dosing, the serum and plasma concentrations of unchanged drug declined with terminal half-lives of 1.6 h in mice, 4.3 h in rats, 10.6 h in monkeys and 25 h in patients. The systemic clearance was in the order of mice > rats > monkeys, and nearly equalled the hepatic blood flow in each species. Most of the 14C from [14C]-droloxifene administered orally and i.v. to rats and monkeys was excreted in the faeces. Droloxifene was metabolized extensively by phase I and phase II metabolism. 3-methoxy-4-hydroxy droloxifene was the major metabolite in rat faeces. The metabolites in rat and monkey faeces were not so different qualitatively. Pharmacokinetic parameters were not significantly different between premenopausal and postmenopausal patients.

Development of a novel drug release system, time-controlled explosion system (TES). I. Concept and design

A novel controlled drug release system. Time-Controlled Explosion System (TES) has been developed. TES has a four-layered spherical structure, which consists of core, drug, swelling agent and water insoluble polymer membrane. TES is characterized by a rapid drug release with a precisely programmed lag time; i.e. expansion of the swelling agent by water penetrating through the outer membrane, destruction of the membrane by stress due to swelling force and subsequent rapid drug release. For establishing the concept and development strategy, TES was designed using metoprolol and polystyrene balls (size: 3.2 mm in diameter) as a model drug and core particles. Among the polymers screened, low-substituted hydroxypropylcellulose (L-HPC) and ethylcellulose (EC) were selected for a swelling agent and an outer water insoluble membrane, respectively. The release profiles of metoprolol from the system were not affected by the pH of the dissolution media. Lag time was controlled by the thickness of the outer EC membrane; thus, a combination of TES particles possessing different lag times could offer any desired release profile of the model compound, metoprolol.

[Treatment of acute lymphoblastic leukemia in adults by the modified protocol of L-10M (Sloan-Kettering): long-term outcome]

From January 1984 to April 1988, we treated 20 patients with adult lymphoblastic leukemia (ALL) and 2 patients with lymphoblastic lymphoma with a protocol which we modified L-10M of Sloan-Kettering Cancer Center. Since the median follow up time is now over 5 years, we report the most recent outcome. Thirteen patients were male and 9 were female. The median age was 31, ranging from 15 to 71 years of age, and there were no Ph1 positive patients. The complete remission (CR) rate was 81.8%. Median CR duration was 32 months and the 5-year continuous CR rate was 33.3%. No significant prognostic factor for CR rate was found. Age at achievement CR and duration were significant prognostic factors. The 5-year continuous CR rate of patients below 35 years old was 54.5%. In this group the leukocyte count was a significant prognostic factor. All patients with a leukocyte count above 1 x 10(4)/microliters relapsed. However, in patients with a WBC below 1 x 10(4)/microliters, the 5-year continuous CR rate was 75%. Based on these results, it seems reasonable to treat patients with ALL by different therapeutic strategies according to the risk factors.

Development of a novel drug delivery system, time-controlled explosion system (TES). IV. In vivo drug release behavior

Time-Controlled Explosion System (TES) has the time-controlled drug release property with a pre-designed lag time. The drug release from the system is initiated by destruction of the membrane. In this study, metoprolol tartrate was used as a model drug. After five types of TES with different in vitro lag times were orally administrated to dogs, plasma metoprolol concentration was monitored. There existed a good correlation between in vitro and in vivo lag time, while the extent of absorbed metoprolol decreased with prolongation of lag time. Next, the in vivo drug release behavior was directly investigated using five different colored TES with a lag time of two hours. Each TES was consecutively administrated to the fasted dogs at predetermined intervals. The amount of metoprolol released was monitored by recovering the administered TES from the gastrointestinal trace. The in vivo release profile corresponded with the in vitro one. It is demonstrated that TES can release the drug in in vivo conditions similarly to in vitro. Based on these results, the decrease of the absorption is suggested to be caused by increased hepatic first-pass metabolism of the drug due to the retarded release rate with longer lag time.

Fetal circulatory system in growth-retarded fetus with late decelerations and oligohydramnios

We present 4 cases of growth-retarded fetuses with fetal heart rate late decelerations and oligohydramnios. Doppler ultrasound revealed significantly decreased pulsatility index (PI) values of the middle cerebral artery; however, the PI values of the renal artery, femoral artery and umbilical artery were within normal ranges in all fetuses. Relative redistributions in the fetal circulatory system were shown with fetal hypoxemia without acidosis.

Regulation of cardiac sarcolemmal Ca2+ channels and Ca2+ transporters by thyroid hormone

In order to examine the regulatory role of thyroid hormone on sarcolemmal Ca(2+)-channels, Na(+)-Ca2+ exchange and Ca(2+)-pump as well as heart function, the effects of hypothyroidism and hyperthyroidism on rat heart performance and sarcolemmal Ca(2+)-handling were studied. Hyperthyroid rats showed higher values for heart rate (HR), maximal rates of ventricular pressure development +(dP/dt)max and pressure fall -(dP/dt)max, but shorter time to peak ventricular pressure (TPVP) and contraction time (CT) when compared with euthyroid rats. The left ventricular systolic pressure (LVSP) and left ventricular end-diastolic pressure (LVEDP), as well as aortic systolic and diastolic pressures (ASP and ADP, respectively) were not significantly altered. Hypothyroid rats exhibited decreased values of LVSP, HR, ASP, ADP, +(dP/dt)max and -(dP/dt)max but higher CT when compared with euthyroid rats; the values of LVEDP and TPVP were not changed. Studies with isolated-perfused hearts showed that while hypothyroidism did not modulate the inotropic response to extracellular Ca2+ and Ca2+ channel blocker verapamil, hyperthyroidism increased sensitivity to Ca2+ and decreased sensitivity to verapamil in comparison to euthyroid hearts. Studies of [3H]-nitrendipine binding with purified cardiac sarcolemmal membrane revealed decreased number of high affinity binding sites (Bmax) without any change in the dissociation constant for receptor-ligand complex (Kd) in the hyperthyroid group when compared with euthyroid sarcolemma; hypothyroidism had no effect on these parameters. The activities of sarcolemmal Ca(2+)-stimulated ATPase, ATP-dependent Ca2+ uptake and ouabain-sensitive Na(+)-K+ ATPase were decreased whereas the Mg(2+)-ATPase activity was increased in hypothyroid hearts. On the other hand, sarcolemmal membranes from hyperthyroid samples exhibited increased ouabain-sensitive Na(+)-K+ ATPase activity, whereas Ca(2+)-stimulated ATPase, ATP-dependent Ca2+ uptake, and Mg(2+)-ATPase activities were unchanged. The Vmax and Ka for Ca2+ of cardiac sarcolemmal Na(+)-Ca2+ exchange were not altered in both hyperthyroid and hypothyroid states. These results indicate that the status of sarcolemmal Ca(2+)-transport processes is regulated by thyroid hormones and the modification of Ca(2+)-fluxes across the sarcolemmal membrane may play a crucial role in the development of thyroid state-dependent contractile changes in the heart.

Reverse end-diastolic umbilical artery velocity in a case of intrauterine fetal death at 14 weeks' gestation

A case of intrauterine fetal death at 14 week's gestation in a mother with systemic lupus erythematosus is described. Doppler ultrasonography performed within 24 hours before fetal death showed reverse end-diastolic flow velocities on umbilical artery velocity waveforms. The placental alteration causing this early gestation is discussed.

Possible involvement of oxygen-derived free radicals in abnormal hemostasis induced by SART stress (repeated cold stress) in laboratory animals

Abnormal hemostatic profiles indicating hemorrhagic tendency have been reported in rodents exposed to prolonged fluctuation in ambient temperature, known as SART (specific alternation of rhythm in temperature)-stressed animals. In this study, investigation was made of possible involvement of oxygen-derived free radicals in the development of stress-induced hemostatic alteration. SART-stressed rats and mice exhibited marked decrease in platelet count, fibrinogen level and factor VIII:C activity. Superoxide dismutase, when administered s.c. twice a day to mice for 7 days of stress exposure, inhibited the above alterations. Catalase given in the same manner, had essentially the same effect, though to a lesser extent. Allopurinol administered orally once daily during stress reduced stress-induced thrombocytopenia, but caused considerable increase in fibrinogen and factor VIII:C activity in stressed and unstressed mice. Lipid peroxide significantly increased in the heart but not in the plasma following stress exposure in rats and mice. Active oxygens would thus appear to be, at least partially, involved in the development of abnormal hemostasis induced by SART stress.

Oral absorption of FK506 in rats

The oral absorption of FK506 in solid dispersion formulation was studied in rats. The obtained area under the concentration versus time curve (AUC) increased in a nonlinear fashion with a small dose-dependent increase in the peak blood concentrations (Cmax). The peak concentration time (Tmax) was observed within 30 min after administration in all dosing groups (1-10 mg/kg) with or without feeding, whereas the oral absorption of FK506 was reduced to about 50% by gavage at a dose of 1 mg/kg. Participation of first-pass elimination was suggested by comparing the blood levels after infusion via the portal vein with those after infusion via the femoral vein. Further, in an in vitro stability study and an in situ loop absorption study, FK506 was fairly stable in the gastrointestinal juice and was absorbed predominantly from the upper part of the small intestine.

Studies on the synthesis of nucleotidyl-peptides. II. The preparation of a nucleotidyl-peptide having a 5'-nucleotidyl-(P-O)-serine phosphodiester bond

The preparation of a nucleotidyl-peptide having a thymidine-5'-yl-(P-O)-serine phosphodiester bond, [H-Ala-Ser(pTpT)-Phe-OH](24) is described. After condensation between the phosphorylated peptide component and an oligonucleotide component, all protecting groups could be removed under neutral conditions without beta-elimination of the pTpT from the serine moiety.

Role of endothelin in heart function in health and disease

A comprehensive review of the literature has revealed that endothelins belong to a family of vasoactive peptides which are formed and released from the endothelium. By producing constriction of the coronary arteries and peripheral blood vessels, endothelins are known both to reduce coronary bloodflow and increase blood pressure and thus can be seen to affect heart function adversely. On the other hand, endothelins are capable of producing positive inotropic and chronotropic effects by directly affecting both the myocardium and nodal tissues. Prolonged actions of high concentrations of endothelins can be seen to induce relative hypoxia in the myocardium which will eventually result in heart dysfunction. The mechanisms of actions of endothelin on smooth muscle cells and cardiomyocytes include interaction with endothelin receptors on the cell surface, activation of phospholipase C through G-proteins, and increase in the intracellular concentration of Ca2+ through the increase in phosphoinositol turnover. Endothelins were found to exert no effects on sarcolemmal Na+,K(+)-ATPase, Na(+)-Ca2+ exchange and Ca2+ pump systems nor on the sarcoplasmic reticular Ca2+ pump system and myofibrillar ATPase activities in the rat heart. Marked elevation in the levels of plasma endothelins and down-regulation of endothelin receptors in ischemia-reperfusion injury, hypertension and chronic diabetes indicate a significant role of endothelins in the genesis of heart dysfunction under different pathological conditions.