Treatment of unstable angina pectoris (European experience)

Unstable angina pectoris is used to describe accelerated angina, new onset of angina, or prolonged angina. The natural history of the angina varies according to clinical presentation. The 1-year mortality rate ranges from 2% to nearly 40%. Specific therapy includes nitrates, beta-adrenergic blockers, and/or calcium antagonists as well as antithrombotic therapy in the form of aspirin. Patients with severe angina at rest and ST- and T-wave changes should be admitted to a coronary care unit where full-dose heparin is administered. Coronary angiography should be performed in individuals who fail to respond to the conventional therapy in order to evaluate other therapeutic options, including percutaneous transluminal coronary angioplasty (PTCA) and coronary bypass surgery. In some cases, especially in patients with intracoronary thrombus, thrombolytic therapy may be beneficial.

Normative data for adrenal steroidogenesis in a healthy pediatric population: age- and sex-related changes after adrenocorticotropin stimulation

The normal response to a single 0.25-mg dose of ACTH-(1-24) is not well established in infancy or childhood. We report the adrenal steroidogenic responses of 17-hydroxypregnenolone (17OH Preg), 17-hydroxyprogesterone (17OH Prog), 11-deoxycortisol, cortisol, deoxycorticosterone, dehydroepiandrosterone (DHEA), DHEA sulfate, androstenedione (A'dione), and testosterone in 102 healthy children who were divided into 5 groups: group 1 (less than 1 yr old; n = 22), group 2 (1-5 yr old; n = 22), group 3 (6-12 yr old; n = 15), group 4 (early-midpuberty; n = 21), and group 5 (late puberty; n = 22). Baseline and stimulated levels of 17OH Preg were significantly higher in group 1 infants than in group 2 children (P less than 0.01). Baseline levels of 17OH Prog increased in late puberty (P less than 0.01). Baseline and stimulated levels of DHEA rose in late puberty (group 5 vs. group 3, P less than 0.01). DHEA levels in late pubertal females were higher than those in their male counterparts (P less than 0.01). DHEA sulfate levels did not change after ACTH administration in any age group. Baseline and stimulated levels of A'dione rose significantly before the onset of puberty in female children (group 2 vs. group 3, P less than 0.01). The calculated ratio of 17OH Preg/17OH Prog in group 1 was significantly higher than that in other groups of children (P less than 0.01). The calculated, baseline DHEA/A'dione ratio was higher in group 1 than in older children (P less than 0.01). Stimulated ratios were higher in late pubertal females than in males (P less than 0.01). In both sexes baseline and stimulated ratios of 17OH Prog/deoxycorticosterone increased in puberty, such that late pubertal children had higher levels than prepubertal children (P less than 0.01). These data confirm the need for interpretation ACTH stimulation test data to be based upon age- and sex-specific norms.

Cancer risk after iodine-131 therapy for hyperthyroidism

Cancer incidence was studied in 10,552 patients (mean age, 57 years) who received 131I therapy (mean dose, 506 MBq) for hyperthyroidism between 1950 and 1975. Follow-up on these patients was continued for an average of 15 years. Record linkage with the Swedish Cancer Register for the period 1958-1985 identified 1543 cancers occurring 1 year or more after 131I treatment, and the standardized incidence ratio (SIR) was 1.06 (95% confidence interval = 1.01-1.11). Significantly increased SIRs were observed for cancers of the lung (SIR = 1.32; n = 105) and kidney (SIR = 1.39; n = 66). Among 10-year survivors, significantly elevated risks were seen for cancers of the stomach (SIR = 1.33; n = 58), kidney (SIR = 1.51; n = 37), and brain (SIR = 1.63; n = 30). Only the risk for stomach cancer, however, increased over time (P less than .05) and with increasing activity administered (P = not significant). The risk for malignant lymphoma was significantly below expectation (SIR = 0.53; n = 11). Overall cancer risk did not increase with administered 131I dose or with time since exposure. The absence of any increase in leukemia adds further support to the view that a radiation dose delivered gradually over time is less carcinogenic than the same total dose received over a short time. Only for stomach cancer was a possible radiogenic excess suggested.

Delayed neurological adaptation in infants delivered by elective cesarean section and the relation to catecholamine levels

We have studied the effect of mode of delivery and catecholamine (CA) surge at birth on neurobehaviour 1, 2 and 5 days after birth. Fifteen full-term infants were delivered by elective cesarean section (CS) and 15 full-term control infants were born vaginally. Infants born after elective CS were less excitable and had significantly reduced number of optimal responses during the first 2 days after delivery, compared to the controls. On the 5th day no significant neurological differences were found between the groups. Adrenaline and noradrenaline (NA) in umbilical arterial plasma were analysed in all infants. The mean values of NA were lower in the CS infants as compared to the vaginally delivered infants. Statistically significant correlations were found between low CA levels and poor muscle tone and/or lower grade of excitability in the CS infants. These results suggest that the high CA surge at birth might be of importance for the neurological adaptation after birth.

Half-life of single-chain urokinase-type plasminogen activator (scu-PA) and two-chain urokinase-type plasminogen activator (tcu-PA) in patients with acute myocardial infarction

The pharmacokinetics of urokinase (two-chain urokinase-type plasminogen activator, tcu-PA) and single-chain urokinase-type plasminogen activator (scu-PA) were studied in 20 patients with acute myocardial infarction (AMI). Ten consecutive patients received 2.5 million units tcu-PA by bolus injection within 5 min during the first 6 h after AMI (group I). Ten further consecutive patients received 250,000 U tcu-PA within 5 min, followed by 4.5 million U scu-PA by intravenous infusion over 40 min (group II). An enzyme immunoassay was developed for urokinase antigen determinations, and a fibrin plate assay for determinations of fibrinolytic activity was applied. Using a 3-compartment model, in group I 98% of urokinase antigen were cleared with a half-life of 60.8 min. After scu-PA, urokinase antigen was cleared with half-lives (area under the curve in parentheses) of 6.9 min (74.8%), 26.5 min (23.6%), and 329.7 min (2.2%). The half-disappearance times of fibrinolytic activity were 18 and 8 min in group I and II, respectively. A more pronounced decrease of plasminogen was observed after tcu-PA.

KCl potentiation of the virucidal effectiveness of free chlorine at pH 9.0

In studies at 5 degrees C and pH 9.0, poliovirus 1 was inactivated about 15 times more rapidly by free chlorine (FC) in purified water in the presence of 1,262 mg of KCl per liter (approximately 0.0169 M) than in the absence of KCl. In the presence of 526 mg of KCl per liter, the virus was inactivated about seven times more rapidly by FC than in the absence of KCl. At a level of 21 mg/liter, KCl did not significantly potentiate the virucidal activity of FC in purified water. Although poliovirus 1 was inactivated almost three times more rapidly by FC in borate-buffered purified water than in purified water, the presence of the buffer did not alter the extent of potentiation by KCl. Most of FC exists as OCl- at pH 9.0. Tap water has been shown to markedly potentiate the polivirucidal effectiveness of FC at pH 9.0. For the same degree of virucidal potentiation of FC at this pH, a considerably greater quantity of KCl was required in purified water than the total salt content that appeared to be present in the tap water.

Influence of elective cesarean section and breech delivery on neonatal neurological condition

Fifty-three infants born after elective cesarean section (CS), and 28 infants born vaginally in breech presentation were compared with 45 full-term controls. A quantitative neurological assessment consisting of 31 items was performed on days 1, 2 and 5 after birth. A tonus score, an excitability score and the number of optimal responses were calculated. A follow-up examination was done at 6 months of age, with a standardized neurological and developmental examination. The results showed that infants born after elective CS in both vertex and breech presentation had significantly reduced number of optimal responses during the first five days after delivery, compared to controls. They were more hypotonic and less excitable than the control infants during the first 2 days. There were no significant differences in neurological results between infants born after CS with general or epidural anaesthesia. The infants born in vaginal breech presentation showed no differences neurologically as compared to the controls on the first day. On days 2 and 5, however, they were less excitable and showed a reduced number of optimal responses. There were few differences in neurological condition between the infants born after elective CS and the infants born vaginally in breech presentation. Growth, psychomotor development and neurological status at 6 months did not differ significantly between the three groups. Our findings indicate that infants born after elective CS and vaginal breech presentation have a delayed neurological adaptation during their first days of life. These differences did not affect the physical well-being of the infants, which showed normal growth, neurology and development at the follow-up at 6 months of age.

Bacterial conjugation betweenEscherichia coli andPseudomonas spp. donor and recipient cells in soil

Experiments conducted in microcosms containing loam soil samples inoculated with either E. coli or Pseudomonas spp. donor and recipient cells showed that bacterial cells survived and conjugated over a 24-h incubation period. E. coli transconjugants were detected 6 h after donor and recipient strains were introduced into sterile soil samples. In non-sterile soil samples, transconjugants were detected between 8 and 24 h incubation. Pseudomonas transconjugants were recovered from sterile soil samples between 6 and 12 h after their introduction and as early as 2 h in non-sterile soil. The results show that genetic interactions occur in non-sterile soil in relatively short periods of time at relatively high transfer frequencies (10(-3) to 10(-4]. Studies on genetic interactions in soil are becoming necessary in risk assessment/environmental impact studies prior to the release of genetically engineered or modified organisms into uncontained environments.

Expandable tubular stents for treatment of arterial occlusive diseases: experimental and clinical results. Work in progress

The balloon-expandable vascular prosthesis consists of a flexible, knitted tantalum wire mesh tube. To demonstrate its pliability, this prosthesis was tested experimentally in 10 mongrel dogs by implanting it into the proximal femoral arteries. The maximum follow-up time was 1 year. On the basis of the experimental results, in which there was no relevant stenosis, occlusion, or migration of the vascular prosthesis, nine patients were treated: one with iliac artery occlusive disease and eight with superficial femoral artery (SFA) occlusive disease (four reocclusions after angioplasty and four unsatisfactory primary angioplasty results). One SFA lesion was treated with the crossover method from the contralateral side. All implants remained patent without hemodynamically significant stenoses, with the longest observation time being 6 months. Flexible, expandable vascular prostheses are promising adjuncts to angioplasty.

Does physical exercise influence the frequency of postmenopausal hot flushes?

The frequency of moderate and severe hot flushes was investigated in a group of women (n = 142) who took part in organized physical exercise on a regular basis, and a control group of all women 52 and 54 years old in the city of Linköping, Sweden (n = 1,246). Only women with natural menopause and without a history of hormonal replacement treatment were statistically compared in the study. It appeared that moderate and severe vegetative symptoms with hot flushes and sweatings were only half as common among the physically active postmenopausal women (21.5%) as in the control group (43.8%). Although this could be due to a positive selection of these physically active women, it might also be due to the fact that exercise may affect the mechanisms that elicit hot flushes in peri- and postmenopausal women.

Binding of four oxytocin analogues to myometrial oxytocin and arginine-vasopressin binding sites in pregnant women

The binding of 3H-oxytocin (3H-OT) and 3H-arginine-vasopressin (3H-AVP) and the displacement from binding sites by four oxytocin analogues were studied in myometrial membrane preparations from full-term pregnant women. Specific 3H-OT binding was saturable with a maximal binding capacity of 76.1 fmol/mg DNA, and a dissociation constant of 0.5 pM. Corresponding values regarding 3H-AVP was 148.6 fmol/mg DNA and 0.7 pM. The oxytocin analogues tested demonstrated a high specific binding to the OT and AVP receptor sites; in fact, the affinity of the analogues to the 3H-AVP binding sites was higher than to the 3H-OT binding sites. The order of potency between the analogues was CAU greater than CAM greater than CAP greater than CAO and CAP greater than CAU greater than CAO greater than CAM for the OT and AVP binding sites, respectively. The displacement of oxytocin and arginine-vasopressin, respectively, from the myometrial receptor sites indicate partly separate binding sites for oxytocin and AVP and might implicate that AVP can be of importance in regulating myometrial activity in pregnancy. The results on oxytocin analogues imply that other pharmacological tests must be performed for quantification of the relaxing effects on the uterus and to determine the optimal analogue for clinical trials in preterm labor and dysmenorrhoea.

Quantitative comparison of cerebral glucose metabolic rates from two positron emission tomographs

The rapid progress in positron emission tomography technology has created the dilemma of how to compare data from old and new tomographs. We examined cerebral metabolic data from two scanners, with different spatial resolutions and methods of attenuation correction, to see if data from the lower resolution tomograph (ECAT II) could be "corrected" and then compared to data from the higher resolution scanner (Scanditronix PC1024-7B). Nine subjects were scanned on both tomographs after a single injection of [18F]2-fluoro-2-deoxy-D-glucose. Regional and lobar gray matter metabolic rates for glucose were obtained from comparable images from each scanner. Ratios of lobar to global gray matter metabolism also were calculated. Regression coefficients and percent differences were computed to compare ECAT II and PC1024 data. Twenty-four of the 36 regions showed significant regression slopes, and PC1024 measures of glucose utilization ranged from 30% to 120% higher than those from the ECAT II. Lobar differences between the two machines were less variable (50% to 80%), and ratios generally differed by only +/- 5%. Since there was no simple and consistent relation between regional metabolic rates on the two tomographs, an overall adjustment of regional ECAT values for comparison to PC1024 values would be impossible. A region-by-region adjustment would be necessary. On the other hand, ratios are sufficiently similar that direct comparisons could be made.

Reversal of brain metabolic abnormalities following treatment of AIDS dementia complex with 3'-azido-2',3'-dideoxythymidine (AZT, zidovudine): a PET-FDG study

Brain glucose metabolism was evaluated in four patients with acquired immunodeficiency syndrome (AIDS) dementia complex using [18F]fluorodeoxyglucose (FDG) and positron emission tomography (PET) scans at the beginning of therapy with 3'-azido-2',3'-dideoxythymidine (AZT, zidovudine), and later in the course of therapy. In two patients, baseline, large focal cortical abnormalities of glucose utilization were reversed during the course of therapy. In the other two patients, the initial PET study did not reveal pronounced focal alterations, while the post-treatment scans showed markedly increased cortical glucose metabolism. The improved cortical glucose utilization was accompanied in all patients by immunologic and neurologic improvement. PET-FDG studies can detect cortical metabolic abnormalities associated with AIDS dementia complex, and may be used to monitor the metabolic improvement in response to AZT treatment.

Potentiation of the virucidal effectiveness of free chlorine by substances in drinking water

At 5 degrees C, poliovirus 1 was inactivated by free chlorine (FC) at pH 9.0 more than 10 times as rapidly in drinking water as in purified water. Because ions that comprise many salts potentiate the virucidal effectiveness of FC, we believe that ions and possible other substances in the drinking water potentiated the virucidal effectiveness of FC. Since viruses may be much more sensitive to chlorination in drinking waters than laboratory tests in purified waters have heretofore led us to believe, it may be possible to reduce the amounts of FC applied to many water supplies for disinfection and thereby perhaps reduce the quantities of halomethanes and other toxic compounds produced in these supplies by the chlorination process.

Potentiation of the poliocidal effectiveness of free chlorine by a buffer

Poliovirus 1 was inactivated by free chlorine at pH 9.0 three times more rapidly in boric acid (0.05 M)-NaOH buffer than in purified (carbon-filtered, deionized) water. Thus, at a given concentration of free chlorine, it took three times longer to inactivate the same fraction of the poliovirus in purified water than in the boric acid-NaOH buffer. Conversely, in a given period of time, three times more chlorine was required to inactivate a given percentage of the virus in purified water than in the boric acid-NaOH buffer. Buffers are almost always used to control pH in disinfection studies with free chlorine and with other chlorine compounds also. The use of buffers for pH control in such disinfection studies may distort the resulting data and, at least for waters that contain little salt, may cause serious overestimation of the rates at which viruses are inactivated.

Glucose uptake, lactate release, ketone body turnover, metabolic micromilieu, and pH distributions in human breast cancer xenografts in nude rats

Glucose uptake, lactate release, ketone body utilization, spatial distribution of glucose, lactate, and ATP concentrations as well as tissue pH distributions were systematically investigated in s.c. and/or "tissue-isolated" human breast cancer xenografts in T-cell-deficient rnu/rnu rats. Large variations in all parameters were detected within and between tumors indicating a very nonuniform substrate turnover. Glucose was taken up by all xenografts. Glucose consumption rates increased with increasing glucose availabilities, implying that the glucose uptake is mainly determined by the efficiency of nutritive tumor blood flow. The average glucose uptake was 0.37 mumol/g/min in medullary and 0.26 mumol/g/min in squamous cell carcinomas of the breast. At wet weights below 5 g, medullary breast cancers consumed more glucose than squamous cell carcinomas (2P less than 0.05). Most tumors (97%) released lactate in an amount linearly related to glucose consumption. The lactate production of medullary (0.33 mumol/g/min) and squamous cell (0.31 mumol/g/min) breast cancers was similar. In general, the xenografts utilized ketone bodies. beta-Hydroxybutyrate was consumed by 82% and acetoacetate by 73% of the tumors, the uptake rates being linearly related to the respective availabilities. The mean uptake of beta-hydroxybutyrate was 3.48 nmol/g/min and that of acetoacetate 2.56 nmol/g/min. No significant differences were seen between medullary and squamous cell breast cancers. The beta-hydroxybutyrate/acetoacetate ratio in the tumor-venous blood rose with decreasing tumor blood flow indicating the development of hypoxia at advanced growth stages. Glucose, lactate, and ATP levels were all very heterogeneously distributed in medullary and squamous cell tumors as compared with normal tissue. No relationship was evident between the spatial distribution of concentrations of these three substrates. The xenografts were acidotic compared with pH values in normal subcutis. The mean tissue pH in medullary breast cancers was 6.81 +/- 0.25 (SD). Compared with these values, the tissue pH distribution in squamous cell breast cancers was shifted to significantly higher values. The mean pH of the latter tumors was 7.04 +/- 0.19 (2P less than 0.001). From the experimental data presented there is clear indication that the metabolism of the xenografts investigated was mainly determined by the efficiency of nutritive blood flow, i.e., by substrate availability, and not by the metabolic demand of the cancer cells.

Longitudinal study of the early neuropsychological and cerebral metabolic changes in dementia of the Alzheimer type

To examine the progression of neuropsychologic and metabolic changes in the early stages of dementia of the Alzheimer type (DAT), we studied 11 midly demented patients longitudinally. Three aspects of neuropsychological function were measured: memory, attention to complex sets and abstract reasoning, and lateralized functions, i.e., language and visuoconstruction. Regional cerebral metabolic rates for glucose were measured in frontal, parietal, and temporal association cortices. Our results show that, in general, memory deficits are the first neuropsychological impairments to occur in DAT, followed by problems with attention to complex cognitive sets and abstract reasoning, which are followed in turn by deficits in language and visuospatial abilities. In addition, neocortical metabolic abnormalities usually precede impairment of neocortically mediated attention and abstract reasoning by 8 to 16 months, and precede impairment of neocortically mediated language and visuospatial function by 12 to 37 months. These findings suggest that the first nonmnestic neuropsychological consequence of neocortical physiological dysfunction in DAT is a loss of attentional capacity. Since neocortical metabolic changes generally precede the appearance of neocortically mediated neuropsychological dysfunction, physiologic dysfunction may exist for some time before cognition is affected.

Climacteric symptoms among women aged 60-62 in Linköping, Sweden, in 1986

By means of a simple postal questionnaire, all women aged 60, 61 and 62 (n = 2015) living in the community of Linköping, Sweden, were screened for vasomotor symptoms and local vaginal complaints. After one reminder, answers were received from 73% of the women. At the time of the survey (April 1986) all the women were post-menopausal, the median period since menopause being 11 yr. Slightly over one in four of the women (27%) were suffering from sweating and hot flushes. Ten percent (10%) of the women who were more than 15 yr post-menopausal still had moderate to severe climacteric symptoms. Vasomotor symptoms were significantly more common among oophorectomized women than among those whose ovaries were intact. Local vaginal symptoms were positively correlated with urinary problems, repeated urinary tract infections and a high risk of disturbance of sexual activity. It was concluded that climacteric symptoms often persist for more than 15 yr after the menopause.

Group therapy with schizophrenic patients in outpatient departments

Twelve schizophrenic patients were treated with neuroleptic drugs and psychoanalytically oriented group therapy during a period of 2 years. Twelve other patients, matched with regard to the state of their disease, sex, age, civil status and social situation, were given neuroleptic drugs and contact therapy during the same period. All patients were evaluated by the same test procedures. The Rorschach test, the Defence Mechanism Test (DMT), interviews and a self-evaluation test, were performed before and after 2 years of treatment. The dates of discharge, number of days in hospital and neuroleptic drugs prescribed were recorded for all patients over a 2-year period before, during and after treatment. Half of the patients improved, regardless of the treatment they received. No evaluation instrument used before the start of treatment could predict the patients who later improved. After 2 years of treatment, it was assessed that the patients who improved required a further period of insight therapy.

Optimum pH levels for eluting enteroviruses from sludge solids with beef extract

This study demonstrates that elution of enteroviruses from a mixture of primary- and activated-sludge solids with beef extract at pH 9.2 +/- 0.2 may be less efficient than elution with beef extract at pH 7.2 +/- 0.2 and that elution of enteroviruses from extended-aeration-sludge solids with beef extract is at best no more efficient at pH 9.2 +/- 0.2 than at pH 7.2 +/- 0.2. Thus, the common practice of adjusting the pH of beef extract used for eluting enteroviruses from the natural neutral level of the elutant to alkaline levels is unnecessary and probably undesirable.

Variable bioavailability of papaverine

The plasma concentration curves of papaverine have been studied in nine healthy males and seven patients after administration of single intravenous (80 mg) and oral (80 mg) doses. The bioavailability of the drug was highly variable with a mean of 28% (range 5-99%) but reproducible within the same individual (4 of the volunteers) after a repeated (80 mg) oral dose. The calculated half-life after intravenous administration ranged between 1.2-6.6 hours (mean 3.0). The mean apparent volume of distribution was 3.1 l/kg and the mean total plasma clearance was 836 ml/min. It is concluded that papaverine shows an unacceptable inter-individual variation in the bioavailability after oral administration of 80 mg tablets.

Low-temperature stability of viruses in sludges

Enteroviruses survived for up to 38 days without diminishing in numbers in extended-aeration sludges maintained at 5 degrees C. In oxidation ditch sludges similarly maintained, enteroviruses survived for up to 17 days without diminishing in numbers. The pHs of the sludges in this study were well inside the pH 6 to 8 corridor in which destruction of enteroviruses by the detergents and ammonia present in sludges reportedly does not occur. Unexplained, however, was the survival of large numbers of enteroviruses in sludges at pH 3.5, a pH at which some anionic detergents commonly present in sewage are rapidly virucidal. The long survival of enteroviruses in these sludges at 5 degrees C indicates that such sludges can probably be stored under refrigeration in the laboratory for extended periods while awaiting processing without suffering significant losses in enterovirus numbers.

Long-term administration of 3'-azido-2',3'-dideoxythymidine to patients with AIDS-related neurological disease

3'-Azido-2',3'-dideoxythymidine (AZT) has been administered to 7 patients with human immunodeficiency virus-associated neurological disease: 3 with dementia, 2 with peripheral neuropathy, 1 with dementia and peripheral neuropathy, and 1 with T-10 paraplegia. Six of the patients showed improvement in their neurological dysfunction on being administered AZT, as assessed by clinical evaluation, neuropsychological testing, nerve conduction studies, and/or positron emission tomographic scans. Three of these 6 patients showed sustained improvement 5 to 18 months after the initiation of AZT therapy. These results suggest that certain human immunodeficiency virus-associated neurological abnormalities are at least partially reversible following the administration of antiretroviral therapy and provide a rationale for further studies using antiretroviral chemotherapy.

Low back pain during pregnancy

All pregnant women from a well defined area (the central district of the County of Ostergötland, Sweden) attending antenatal clinics over a period of seven months were interviewed with regard to low back pain during pregnancy. Of 862 women who answered the questionnaires, about half developed some degree of low back pain. Seventy-nine women who were unable to continue their work because of severe low back pain were referred to an orthopedic surgeon for an orthoneurologic examination. The most common reason for severe low back pain was dysfunction of the sacroiliac joints. Physically strenuous work and previous low back pain were factors associated with an increased risk of developing low back pain and sacroiliac dysfunction during pregnancy.

[Experimental research with a new percutaneously insertable and expandable vascular prosthesis]

Restenosis and occlusion are the most common reasons why transluminal balloon angioplasty may fail to provide long-term benefit. To prevent restenosis and occlusion of diseased arteries after angioplasty an arterial endoprosthesis has been developed which is positioned to the balloon of an angioplasty catheter and which consists of a stainless steel pliable and elastic tube. With the inflation of the balloon the endoprosthesis will dilate and give the arterial wall a new mechanical support. This new device has been implanted in 12 experimental dogs in arteries of different size and lumen. The longest patency rate of nine months was observed with the completely developed method.

Effects of different phosphodiesterase-inhibiting drugs on human pregnant myometrium: an in vitro study

The phosphodiesterase (PDE)-inhibiting and smooth muscle relaxing effects of theophylline, enprofylline, papaverine and moxaverine have been studied in vitro on spontaneous contracting human, pregnant myometrium. All drugs showed a close correlation between the PDE-inhibiting and smooth muscle relaxing effect. The order of smooth muscle relaxing potency was papaverine greater than moxaverine greater than enprofylline greater than theophylline. The most potent PDE-inhibitors were moxaverine and papaverine with a 50% PDE-inhibiting concentration (IC50) of 3.3 and 3.8 microM as compared to the least potent PDE-inhibitor, theophylline, with an IC50 of 665 microM. It is concluded that PDE-inhibiting drugs show a close correlation between PDE-inhibiting and relaxing effect on spontaneously contracting pregnant myometrium and that the newly developed drug enprofylline might be of interest in the treatment of premature uterine contractions.

Effects of enprofylline, a new xanthine derivate, on human pregnant myometrium

The recently developed xanthine derivate, enprofylline, was studied in an in vitro system with human pregnant myometrium, in particular its effect on spontaneous myometrial contraction, cyclic adenosine monophosphate content, cyclic adenosine monophosphate protein kinase, and cyclic adenosine monophosphate-and cyclic guanosine monophosphate-dependent phosphodiesterase activity. Enprofylline was shown to be a rather potent smooth muscle relaxant [inhibitory concentration that decreases response by 50% (IC50) = 3 X 10(-5) mol/L] and an almost equally potent cyclic adenosine monophosphate-dependent phosphodiesterase inhibitor (IC50 = 10(-4) mol/L), whereas it was a less potent cyclic guanosine monophosphate-dependent phosphodiesterase inhibitor. Enzyme kinetic studies revealed that enprofylline is a competitive cyclic adenosine monophosphate phosphodiesterase inhibitor. Enprofylline increased the cyclic adenosine monophosphate content in a dose-dependent way with subsequent increased activity of cyclic adenosine monophosphate-dependent protein kinase. It is suggested that enprofylline relaxes myometrial smooth muscles and that this is at least partly the result of interference with the cyclic adenosine monophosphate system.

Cerebral metabolism, anatomy, and cognition in monozygotic twins discordant for dementia of the Alzheimer type

One pair of monozygotic twins discordant for dementia of the Alzheimer type (DAT) was studied using neuropsychological testing, quantitative x-ray computed tomography (QCT) and magnetic resonance imaging (MRI) of the brain. Cerebral glucose metabolism was measured using positron emission tomography (PET) and 2-[18-F]fluoro-2-deoxy-D-glucose (FDG). The affected twin had a seven year history of progressive cognitive impairment and was severely demented. Neuropsychological testing of the affected twin demonstrated marked deficits in all areas of cognitive function. The asymptomatic twin showed some impairment on tests of perceptual organisation and delayed recall. The affected twin had loss of gray matter and ventricular enlargement on QCT and MRI compared with healthy controls (p less than 0.05). He also had frontal and parietal lobe hypometabolism and increased asymmetry of metabolism on PET compared to both his twin and healthy age-matched controls (p less than 0.05). PET, QCT, and MRI distinguished changes in the twin with DAT compared with his brother and healthy controls. Although the subtle neuropsychological abnormalities of the asymptomatic twin may be signs of early DAT, they were not accompanied by any changes in regional cerebral metabolism or brain structure.

Longitudinal change in three brief assessments of SDAT

Previous research has shown that there is considerable interest in the development of brief indices for use in the diagnosis and staging of senile dementia of the Alzheimer's type (SDAT). Examples of such measures include the Blessed Dementia Scale (BDS) and Pfeiffer's Short Portable Mental Status Questionnaire (SPMSQ). A third measure used in the assessment of organic cognitive impairment is the Face-Hand Test (FHT). This study, which was part of a large longitudinal investigation of SDAT, examined the performance of 43 subjects with SDAT and 57 healthy controls over 30 months. The subjects were assessed three times during this period. In addition to the brief measures (BDS, SPMSQ, and FHT) all subjects were rated on a Clinical Dementia Rating (CDR) Scale based on a lengthy clinical interview. The data were analyzed by means of a series of univariate, repeated measures ANOVAs, and discriminant analysis. Results indicate: control scores did not change over time on any of the measures; when classified according to severity of SDAT, different patterns of performance emerged over time for each measure; and it is difficult to accurately predict progression of SDAT from the three scores.

Response of human-immunodeficiency-virus-associated neurological disease to 3'-azido-3'-deoxythymidine

Four patients with human-immuno-deficiency-virus-associated neurological disease were treated with 3'-azido-3'-deoxythymidine (AZT). Three (two with chronic dementia, and one with chronic dementia and peripheral neuropathy) improved as assessed by clinical examination, psychometric tests, nerve conduction studies, and/or positron emission tomography; there was no improvement in the fourth patient who presented with paraplegia. These results support the hypothesis that certain AIDS-virus-associated neurological abnormalities are reversible by antiretroviral chemotherapy.

Neuropsychological and cerebral metabolic function in early vs late onset dementia of the Alzheimer type

Differences in age at onset of dementia of the Alzheimer type (DAT) have been associated with differences in cognitive impairments and course of the disease. To investigate this, we examined cerebral metabolism and cognitive performance in early and late onset DAT patients, who had equivalent duration and severity of illness. Regional cerebral metabolic rates for glucose were measured in the resting state by positron emission tomography using [18F]2-fluoro-2-deoxy-D-glucose. A cross-sectional analysis showed no significant differences between the two groups in performance on neuropsychological tests, but the early onset patients showed significantly more parietal metabolic dysfunction than did the late onset patients. Longitudinal analysis showed no significant differences between early and late onset patients in rate of cognitive decline over a mean interval of 19 months. Thus, our results do not support the hypothesis of different subgroups in DAT based on age at onset, nor suggest a faster rate of cognitive decline in younger patients.

Stability of metabolic and neuropsychological asymmetries in dementia of the Alzheimer type

We examined right/left asymmetries in cerebral glucose utilization and neuropsychological performance in 16 patients with dementia of the Alzheimer type (DAT) who were studied twice over a mean interval of 15 months. Neuropsychological asymmetry was expressed as the difference between performance on a visuoconstructive task and a language task. Test/retest comparisons showed significant declines on the neuropsychological measures, but no significant changes in the neuropsychological and metabolic asymmetry indices. At both evaluations, significant correlations were found between neuropsychological asymmetry and metabolic asymmetry in frontal and parietal cortex. Individual patterns of metabolic and neuropsychological asymmetry in these patients with DAT seem to be stable.

Neocortical metabolic abnormalities precede nonmemory cognitive defects in early Alzheimer's-type dementia

Neuropsychological function and resting regional neocortical glucose metabolism, as measured by positron-emission tomography, were studied in 22 patients with mild and moderate Alzheimer's-type dementia. Metabolic reductions in the parietal association cortex and increased left-right metabolic asymmetry were observed in patients with mild and moderate degrees of dementia. Five patients with mild dementia had no impairment of neocortically mediated neuropsychological function, yet they demonstrated these same neocortical metabolic abnormalities. Asymmetry of neocortically mediated, neuropsychological functions correlated with metabolic asymmetries in patients with moderate but not mild dementia. These results suggest that physiological dysfunction in the that physiological dysfunction in the association neocortex is evident in early Alzheimer's-type dementia before the neuropsychological consequences of that dysfunction are demonstrable.

Alpha-adrenergic receptors in human myometrium during pregnancy

The distribution and mechanisms of alpha-adrenergic receptors have been studied in myometrial preparations from women delivered by cesarean section at term. With the use of the radioligand tritiated dihydroergocryptine, the number of alpha-adrenergic receptors was 210 fmol/mg of protein in the uterine fundus and 195 fmol/mg of protein in the lower uterine segment. Competition experiments showed that 60% of the alpha-adrenergic receptors had properties as alpha 1-adrenergic receptors and 40% as alpha 2-adrenergic receptors. In vitro tension studies verified the existence of physiologically active alpha 1- and alpha 2-adrenergic receptors in the myometrial preparations. alpha 2-Adrenergic receptor stimulation resulted in lowered levels of intracellular cyclic adenosine monophosphate. The intracellular cyclic adenosine monophosphate was further reduced by additional alpha 1-adrenergic receptor stimulation, probably secondary to an activation of calcium-calmodulin-dependent phosphodiesterase.

Systemic lupus erythematosis presenting as isolated congestive heart failure

We describe a patient with systemic lupus erythematosus, who presented with congestive heart failure. The diagnosis and favorable response to corticosteroid therapy was confirmed by myocardial biopsy and cardiac catheterization.

[Influence of the volume of peridural morphine bolus injections on morphine concentration in the cisterna magna of the dog]

14 dogs received randomly a bolus injection of either 2 mg morphine in 10 ml isotonic saline solution or 2 mg morphine in 1 ml isotonic saline solution epidurally at T6. An epidural infusion of 0.16 mg morphine/0.06 ml/h was applied immediately following the 1 ml bolus injection of morphine. Cisternal cerebellomedullary CSF samples were taken at varying intervals to determine free morphine immunoreactivity by radioimmunoassay. Within 20 min after the 10 ml bolus injection the peak CSF morphine concentration of 3594 +/- 910 ng/ml was reached. Following this, CSF morphine levels decreased exponentially and after 48 h 8 +/- 3 ng/ml were measured. The peak CSF morphine concentration of 139 +/- 51 ng/ml was, however, reached only after 2 h following the 1 ml bolus injection plus the infusion treatment. Despite the additional infused amount of 7.68 mg over 48 h the CSF morphine concentrations decreased also exponentially and after 48 h 16 +/- 4 ng/ml were measured. One may conclude, therefore, that the risk of respiratory depression is negligible under epidural infusion treatment following an initial "Low-Volume"-bolus injection of 2 mg morphine, a recommendable method for treating post-operative pain. High-volume bolus injections of morphine should generally be abandoned in epidural treatment of pain.

Beta-adrenergic receptors in human myometrium during pregnancy: changes in the number of receptors after beta-mimetic treatment

The concentration of available beta-adrenoceptors has been studied in the myometrium of women treated with terbutaline for premature uterine contractions and in an untreated control group. Myometrial strips were taken at cesarean section from the lower uterine segment and the uterine fundus. The concentration of beta-adrenoceptors was determined with a radioligand binding assay. In untreated women we found no difference in the concentration of beta-adrenoceptors in the uterine fundus compared to that in the lower uterine segment. The cyclic adenosine monophosphate production after beta-adrenoceptor agonist stimulation in vitro was equal in both locations. In the terbutaline-treated women, the binding site concentrations in both the fundus and lower uterine segment were lower compared to those in the control group. The decrease was most pronounced in the fundus where receptor concentration was only half that found in the control group. The results suggest that treatment with beta-mimetics causes a desensitization in the beta-adrenoceptor system of human myometrium during pregnancy. This desensitization may partly explain the limited duration of the relaxant effect of beta-mimetics often seen in the treatment of preterm labor.