The structure of hexaaquaaluminium(III) bromate trihydrate, [Al(H2O)6](BrO3)3.3H2O. Hexaaquaaluminium(III) bromate trihydrate, [Al(H2O)6](BrO3)3.3H2O, M(r) = 572.84, triclinic, P1, a = 9.536 (2), b = 11.095 (4), c = 9.291 (2) A, alpha = 106.58 (2), beta = 100.42 (2), gamma = 113.01 (2) degrees, V = 818.1 (4) A3, Z = 2, Dx = 2.33 g cm-3, lambda(Mo K alpha) = 0.71073 A, mu = 74.58 cm-1, F(000) = 560, T = 296 K, R = 0.050 for 3777 unique reflections having I greater than sigma 1. The single type of Al ion is coordinated by six inequivalent water O atoms which form a slightly distorted octahedron. The average Al--O distance within the octahedron is 1.872 (11) A. Each of the three inequivalent bromate groups has three inequivalent O atoms. The average Br--O distances and O--Br--O angles for these ions are: 1.652 (25) A and 104.1 (17) degrees for Br(1)O3; 1.650 (9) A and 104.4 (18) degrees for Br(2)O3; 1.643 (9) A and 103.6 (14) degrees for Br(3)O3. The aluminium-oxygen complex conformed to rigid-body behavior but the bromate groups did not. Corrected for rigid-body motion, the average Al--O distance becomes 1.880 (10) A. Least-squares refinement of the positional parameters of the 18 inequivalent H atoms permitted a detailed analysis of the hydrogen bonding.


The absolute configuration of an intermediate in the asymmetric synthesis of unusual amino acids. (4R)-3-[(2'R,3'R)-2'-Bromo-3'-(phenylbutanoyl)]-4-(phenylmethyl)-2 - oxazolidinone, C20H20Br-NO3, M(r) = 402.30, monoclinic, P2(1), a = 11.542 (2), b = 7.625 (1), c = 11.667 (1) A, beta = 113.97 (1) degrees, V = 938.2 (2) A3, Z = 2, Dx = 1.42 g cm-3, lambda(Mo K alpha) = 0.71073 A, mu = 21.8 cm-1, F(000) = 412, T = 296 +/- 1 K, final R = 0.028 for 2369 observed reflections. Since a D-chiral auxiliary was used the configuration at the alpha-carbon was R as expected. The two carbonyls are aligned in opposite directions to each other to overcome van der Waals repulsions.


Structure of difluorotriphenylphosphorane. C18H15F2P, M(r) = 300.29, orthorhombic, Pbcn, a = 6.105 (2), b = 16.634 (3), c = 14.356 (3) A, V = 1458 (1) A3, Z = 4, Dx = 1.368 Mg m-3, lambda(Mo K alpha) = 0.71069 A, mu = 0.194 mm-1, F(000) = 624, T = 294 K, R = 0.045 for 729 observed independent reflections. Difluorotriphenylphosphorane [(C6H5)3PF2] displays a trigonal bipyramidal geometry about the P atom, with the two F atoms occupying axial positions. The three phenyl groups in the equatorial positions are not 'geared' in a regular propeller arrangement; one of the three rings is twisted in the opposite direction to that of the other two.


Structure of L-phenylalanine L-phenylalaninium formate. C9H11NO2.C9H12NO2+.CHO2-, M(r) = 376.41, monoclinic, P2(1), a = 11.507 (6), b = 5.638 (3), c = 14.610 (5) A, beta = 100.65 (4) degrees, V = 932 (1) A3, Z = 2, Dx = 1.342 g cm-3, lambda(Mo K alpha) = 0.7107 A, mu = 0.94 cm-1, F(000) = 400, T = 295 K, final R = 0.047 for 2693 observed reflections. The phenylalanine zwitterion and the phenylalanine cation form a Speakman-salt-type hydrogen bond [O ... O = 2.496 (3) A]. Aromatic side chains constitute a thick hydrophobic layer with edge-to-face interactions between the phenyl rings.


Structure of tetralithium 1,4,5,8-naphthalenetetracarboxylate dodecahydrate. 4Li+.C14H4O8(4-).12H2O, M(r) = 544.18, triclinic, P1, a = 9.608 (2), b = 10.034 (2), c = 7.033 (1) A, alpha = 94.29 (1), beta = 96.95 (1), gamma = 64.52 (1) degree, V = 607.4 (2) A3, Z = 1, D chi = 1.49 g cm-3, lambda (Mo K alpha) = 0.71073 A, mu = 1.29 cm-1, T = 295 K, F(000) = 284, R = 0.039 for 2781 unique reflections having I greater than sigma I. The two inequivalent carboxyl groups adopt a non-planar arrangement with respect to the naphthalene core, making dihedral angles of 52.7 (1) and 54.6 (1) degree with it. The Li+ ions are tetrahedrally coordinated by carboxyl and water O atoms. The Li-O distances are in the range 1.906 (3)-2.041 (3) A, averaging 1.97 (4) A; O-Li-O angles are 101.5 (1)-123.9 (1) degree, averaging 109 (6) degrees. Each of the 12 inequivalent water H atoms is involved in hydrogen bonding. Of these bonds, 11 are typical two-centered hydrogen bonds with an average H...O (acceptor) distance of 1.92 (11) A and an average O-H...O (acceptor) angle of 172 (5) degrees. One water H atom is involved in a three-centered hydrogen bond with an average H...O (acceptor) distance of 2.61 (4) A and an average O-H...O (acceptor) angle of 120 (3) degrees. Adjacent organic anions are separated by the Li+ ions and their coordination polyhedra, with the water molecules occupying positions above and below the naphthalene rings and participating in a three-dimensional hydrogen-bonded network.


Structure of bis(2-chloroethyl)ammonium hexachlorostannate. [(ClCH2CH2)2NH2]2SnCl6, M(r) = 617.48, monoclinic, C2/c, a = 15.67 (2), b = 13.54 (2), c = 13.24 (2) A, beta = 127.9 (2) degrees, V = 2217 A3, Z = 4, D chi = 1.85 g cm-3, lambda(Mo K alpha) = 0.71073 A, mu = 23.70 cm-1, F(000) = 1208, T = 295 K, R = 0.058, wR = 0.071 for 1231 unique reflections. The structure consists of discrete (ClCH2CH2)2NH2+ cations and octahedral SnCl6(2-) anions with the Sn sitting on the twofold axis.


Folding, aggregation and molecular recognition in peptides. In past years, most of the X-ray structure determinations of oligopeptides were for cyclic peptides or for short linear peptides. Longer peptides usually presented many difficulties in obtaining suitable crystals since the molecules are intrinsically very flexible. More recently, it has been appreciated that the aminoisobutyric acid residue (Aib), which occurs naturally in many peptides of microbial origin, initiates helix folding. Several score of 7- to 15-residue linear peptides containing Aib have been synthesized, crystallized and had their structures determined to high resolution. Many of the peptide structures have been determined in more than one crystalline form. These peptide structures have yielded a plethora of information on types of helices, modes of hydration, water penetration into helical backbones, helices bent by Pro residues, parallel and antiparallel association of helices, effects of Leu residues on association of peptides, an example of a zipper assembly by side chains, and an example of a possible ion channel with a gating mechanism.


Structural studies of oxygen-bridged iron compounds. Compound (I): cis-dichloro[mu-[bis[mu-[[2,6-diacetylpyridine dioximato](2-)-O:O']]dihydroxodiphenyl-diborato](3-)]- mu- mithoxydiiron, [Fe2(C30H29B2N6-O6)Cl2(CH3O)], M(r) = 804.9, monoclinic, Cc, a = 21.228 (6), b = 8.020 (2), c = 20.865 (5) A, beta = 105.2 (1) degrees, V = 3428 (2) A3, Z = 4, Dx = 1.56 g cm-3, lambda(Mo K alpha) = 0.7107 A, mu = 10.6 cm-1, F(000) = 1648, T = 275 K, R = 0.055 for 3018 unique reflections. Compound (I) contains a pseudo-twofold axis relating the two pyridine dioxime groups bound to the Fe atoms. In addition, two O atoms from the phenylborate moieties bridge the iron atoms, as does a methoxide. The two Cl atoms are bound to the seven coordinate metals axial to the methoxide. Compound (II): cis-dichloro[mu-[bis[mu-[[2,6-diacetylpyridine dioximato](2-)-O:O']]dihydroxodiphenyldiborato](3-)]-mu- hydroxodiiron, [Fe2(C30H29B2N6-O6)Cl2(OH)].H2O.2C2H3N, M(r) = 891.0, monoclinic, P2(1)/n, a = 11.860 (2), b = 20.911 (5), c = 16.175 (3) A, beta = 92.88 (1) degrees, V = 4006 (3) A3, Z = 4, Dx = 1.48 g cm-3, lambda(Mo K alpha) = 0.7107 A, mu = 9.1 cm-1, F(000) = 1832, T = 275 K, R = 0.051 for 7034 unique reflections. Compound (II) contains a hydroxide group replacing the methoxide in compound (I). The crystals also contain two acetonitriles of solvation. The bond lengths in the complex and the hydrogen-bonding pattern in the crystals are consistent with one of the bridging borate O atoms being protonated.(ABSTRACT TRUNCATED AT 250 WORDS)


Structure of a pepsin/renin inhibitor complex reveals a novel crystal packing induced by minor chemical alterations in the inhibitor. The structure determination by molecular replacement methods of a monoclinic pepsin/renin inhibitor complex crystal, with two molecules in the asymmetric unit, is presented. The atomic model, consisting of two liganded pepsin molecules and 110 water molecules, has been refined to a final crystallographic R value of 0.139 for data between 8 and 2.9 A resolution. The structure reveals a previously undescribed pepsin dimer formed predominantly by polar interactions. Inhibitor binding induces global structural changes in the native enzyme similar, but not identical, to the ones observed in other chemically similar pepsin/renin inhibitor complexes crystallized in an orthorhombic form. A region of the polypeptide chain (residues 292-297) which was not visible in the orthorhombic crystal is well ordered in the presently described structure; possibly induced by crystal contacts. The crystal packing of native pepsin is compared with the two different crystal forms of the inhibited enzyme.


Structure determination of the bacteriophage phiX174. The structure of the single-stranded DNA phage phiX174 has been determined to 3.4 A resolution. The crystal space group was P2(1) with one icosahedral particle per asymmetric unit, giving 60-fold noncrystallographic redundancy. Oscillation diffraction photographs were collected using synchrotron radiation at various wavelengths. The particle orientations in the unit cell were determined with a rotation function. Because cowpea mosaic virus has a similar external envelope to phiX174, it was used as a search model to find the approximately positions of the phiX174 particles in the unit cell relative to the crystallographic symmetry axes. An initial phase set to 12 A resolution was then based on the cowpea mosaic virus atomic structure. These phases were improved by 20 cycles of real-space molecular replacement averaging. The phase information was gradually extended to 3.4 A resolution by molecular replacement electron density averaging. One reciprocal lattice point was used for each extension followed by four cycles of averaging. The unusual particle capsid, with its 12 pentameric spikes, required the careful determination of a precise molecular envelope. This was redetermined at regular intervals, as was the particle center. The resultant electron density map was readily interpreted in terms of the F, G and J polypeptides in the capsid. A difference electron density map between full and partially empty particles showed some ordered DNA structure.


A note on the conformational flexibility of the antiestrogenic drug tamoxifen: preferred conformations in the free state and bound to the protein calmodulin. The conformational properties of the antiestrogenic drug tamoxifen, a triphenylbut-1-ene derivative, have been studied using molecular mechanics. Four distinct conformers have been identified, and the energy barriers between them have been established. The orientation of the ethyl group substituent has been examined in particular, since the lowest-energy conformers have this group orientated 180 degrees away from its position in the crystal structures of tamoxifen and its derivatives. These differences have implications for the interactions of tamoxifen with the calcium-binding protein calmodulin; relevant results from a molecular-modelling study of this protein-drug complex are presented.


Crystallization and preliminary data analysis of Flock House virus. Flock House virus, purified from infected cultured Drosophila cells, crystallizes into three different forms under identical growth conditions. Two crystal forms grow in the trigonal space group R3, both with equivalent cell constants a = 323.6 A, alpha = 61.7 degrees. The difference between the two trigonal crystal forms is 1.1 degrees in the orientation of the virus particle as determined from the rotation function. Early crystal setups grew in one form, while recent crystals grew in the other form. The third space group, which accounts for 5% of the observed crystals and grows with both trigonal forms, is orthorhombic I222 with cell parameters a = 416.7, b = 332.1, c = 351.2 A. The trigonal crystal forms contain one virion per unit cell and the orthorhombic form contains two particles per cell. All three crystal forms diffract X-rays to 2.8 A resolution.


Structure determination of a dimeric form of erabutoxin-b, crystallized from a thiocyanate solution. Erabutoxin-b, M(r) = 6861.1, a single 62 amino-acid chain folded by four disulfide bridges, was crystallized in a new orthorhombic form by using thiocyanate as crystallizing agent. The space group is P2(1)2(1)2(1) with a = 53.36 (4), b = 40.89 (4), c = 55.71 (5) A, V = 121533.1 A and Z = 8. X-ray diffraction data were recorded at the LURE synchrotron facility (lambda = 1.405 A). The structure was solved by molecular replacement and shows a dimeric association through an anti-parallel beta-sheet around the twofold non-crystallographic axis. The two independent molecules, one SCN- ion and 97 associated water molecules were refined by molecular dynamics and annealing techniques to R = 19.6% (10,913 Fobs, resolution 5-1.7 A). The thiocyanate ion is located at the interface of the dimer and close to the non-crystallographic twofold axis.


The structure determination of Sindbis virus core protein using isomorphous replacement and molecular replacement averaging between two crystal forms. The structure of Sindbis virus core protein has been determined by a combination of multiple isomorphous replacement and molecular replacement averaging techniques. The multiple isomorphous replacement phase determinations were made for two crystal forms (P2(1) and P4(3)2(1)2) of the core protein. The real-space molecular replacement averaging was subsequently carried out between two copies of the protein per asymmetric unit in the monoclinic form and one copy in the tetragonal form. This greatly improved the quality of the electron density maps. The Sindbis virus core protein polypeptide could be traced and related to the known amino acid sequence. The averaging procedure between different crystal forms, as described in this paper, should be generally applicable to other systems.


Dynamical scattering and electron crystallography--Ab initio structure analysis of copper perbromophthalocyanine. Electron diffraction intensity data were collected at 1200 kV from thin epitaxially oriented crystals of copper perbromophthalocyanine (C32Br16CuN8) in a projection down molecular columns. Measured cell constants for the projection with cmm symmetry are d100 = 17.88 (9), b = 26.46 (15) A. The structure was determined by Fourier refinement after three heavy-atom positions were identified in an initial potential map. In addition to the copper and halogens, all light-atom positions were found. Although the final R value for all data is 0.41, n-beam dynamical calculations for crystal thicknesses corresponding to the estimated sample dimension account for the observed amplitudes that deviate most from their kinematical values.


Conjugate-direction minimization: an improved method for the refinement of macromolecules. A novel method of function minimization that combines the power of the diagonal approximation to the normal matrix with conjugate directions is described. This method approaches closer to the local minimum than the methods that are commonly used in macromolecular refinement. The weakness of the current methods are analyzed to explain the advantage of the conjugate-direction method.


A consistent model of insulin-dependent diabetes mellitus hypertension. Hypertension is frequently seen in insulin-dependent diabetes mellitus (IDDM), but the mechanism of the hypertension is unknown. An animal model of IDDM hypertension could be helpful in determining the mechanism, but experimental IDDM has been infrequently and irregularly associated with hypertension. In an attempt to develop a consistent model of IDDM hypertension, we superimposed streptozotocin (STZ)-induced IDDM on surgical reduction of renal mass (RRM) in Wistar rats. Seven groups of rats were studied: 1) 60% RRM receiving 65 mg/kg body weight (BW) STZ; 2) 60% RRM receiving 40 mg/kg BW STZ; 3) 25% RRM receiving 65 mg/kg BW STZ; 4) two kidney normal rats receiving 65 mg/kg BW STZ; 5) 60% RRM receiving vehicle (control for group 1); 6) 60% RRM receiving vehicle (control for group 2); and 7) 25% RRM receiving vehicle. STZ produced diabetes and hypertension within 1 to 2 weeks in all three groups of RRM rats but blood pressure was unaffected by 60% or 25% RRM alone. STZ alone had no effect on blood pressure until the 5th week when the blood pressure increased slightly. Progressive weight loss resulted from 65 mg/kg BW STZ combined with 60% RRM; the animals had to be terminated after 5 weeks. In only 60% of animals with 40 mg/kg BW STZ plus 60% RRM was IDDM produced. On the other hand, 65 mg/kg BW STZ in rats with 25% RRM regularly produced IDDM and hypertension without excessive loss of body weight. In these rats, albuminuria developed in 2 weeks. Extracellular fluid volume was elevated and plasma renin activity was depressed. The animals were healthy and hypertensive when killed at the 13th week. We suggest that the 25% RRM rat receiving 65 mg/kg BW STZ is a consistent model of IDDM hypertension, which may be useful in probing the mechanism of this type of hypertension.


Chronic magnesium administration enhances oxidative glucose metabolism in thiazide treated hypertensive patients. In newly-diagnosed untreated (n = 24) and thiazide treated (n = 18) hypertensive patients erythrocyte ion content and plasma ion and metabolite levels were determined. Thiazide treated patients had lower arterial blood pressure, plasma ion levels, erythrocyte magnesium and potassium content but higher fasting plasma insulin (66 +/- 7 v 87 +/- 8 pmol/L P < .02), triglycerides (1.88 +/- 0.24 v 2.34 +/- 0.44 mmol/L P < .05), free fatty acids (0.68 +/- 0.11 v 0.81 +/- 0.18 mmol/L P < .05). Subsequently, in a double-blind fashion and in random order thiazide diuretic treated patients were assigned to two groups: the first (n = 9) taking magnesium (15.8 mmol/day) and the other (n = 9) a placebo. Each treatment period lasted 8 weeks. At the end of each treatment period, each patient underwent blood sampling for determination of erythrocyte ion content and plasma ion and metabolite levels and was submitted to an euglycemic hyperinsulinemic (1 mU/kg/min for 120 min) glucose clamp. In this latter test D-3-H glucose infusion and indirect calorimetry allowed determination of glucose turnover parameters and substrate oxidation respectively. Chronic magnesium administration (CMA) raised fasting plasma (0.79 +/- 0.03 v 0.83 +/- 0.02 mmol/L, P < .05) and erythrocyte (1.98 +/- 0.08 v 2.35 +/- 0.03 mmol/L, P < .01) magnesium content. Along with insulin infusion, CMA improved glucose uptake, glucose metabolic clearance rate, and oxidative glucose metabolism. In the multiple linear regression analysis of the pooled basal data (n = 42), erythrocyte magnesium content displayed an independent correlation with basal plasma insulin levels (t = -2.08, P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)


Effects of aging and hypertension on plasma angiotensin II and platelet angiotensin II receptor density. Plasma renin activity (PRA) declines with age in normal individuals, but the effect of age on plasma angiotensin II (ANG II) is less clear. A decline in plasma ANG II with age could result in altered platelet ANG II receptor density since plasma hormone levels influence their target organ receptors. To investigate this possibility, PRA, plasma ANG II, and platelet ANG II receptor density were examined in 17 young, 12 middle-aged, and 14 elderly healthy normotensive volunteers. To assess whether hypertension altered receptor density, these variables were also examined in 23 hypertensive patients. In normotensives, there was a negative correlation between age and PRA (r = -0.43, P < .05), no significant change in basal plasma ANG II with age, and a weak positive correlation between age and ANG II receptor density (r = 0.34, P < .05). Multiple regression analysis revealed that the relationship between age and ANG II receptor density was independent of the associated rise in mean arterial pressure with age (P < .05). Platelet ANG II receptor density was not significantly related to PRA or plasma ANG II. ANG II receptor affinity did not change with age. Neither PRA nor ANG II receptor density or affinity differed between hypertensives and normotensives of similar mean age, but plasma ANG II was significantly lower in hypertensives compared with normotensives. We concluded that aging is associated with a decline in supine PRA. The small decrease in plasma ANG II was not significant. Platelet ANG II receptor density increased with age primarily due to a small group of elderly subjects with elevated receptor density. There was no change in ANG II receptor density or affinity in hypertensives despite apparently lower plasma ANG II in these patients.


Insulin resistance, hyperinsulinemia, and dyslipidemia in nonobese individuals with a family history of hypertension. Various facets of glucose, insulin, and lipid metabolism were compared in 76 normal volunteers--38 with and 38 without a family history of hypertension. The two groups were comparable in terms of age, gender distribution, and degree of obesity (both generalized and abdominal). Although the plasma glucose response to oral glucose was similar in both groups, glucose-stimulated insulin concentrations were significantly greater in volunteers with a family history of hypertension (P < .001). Furthermore, the steady state plasma glucose concentration during a constant infusion of glucose, insulin and somatostatin was significantly greater in subjects with a family history of hypertension (8.1 +/- 0.6 v 6.2 +/- 0.6 mmol/L, P < .001). Since the steady-state plasma insulin levels during the infusion were similar, these results indicate that normotensive individuals with a family history of hypertension are relatively insulin resistant. Finally, plasma very low density lipoprotein (VLDL) triglyceride and VLDL cholesterol were higher in those with a family history of hypertension, as was the ratio of total to high density lipoprotein cholesterol. Thus, normotensive individuals with a family history of high blood pressure are insulin resistant, hyperinsulinemic and dyslipidemic when compared to a matched group of healthy volunteers without a family history of hypertension.


Effect of extracellular magnesium on platelet activation and intracellular calcium mobilization. A dose-dependent effect of magnesium on the inhibition of platelet aggregation and release of ATP from dense granules was observed in human platelets (in whole blood, platelet-rich plasma, or washed platelets) against various aggregation agents (ADP, U46619, collagen, or thrombin). The synthesis and release of the proaggregatory cyclooxygenase (CO) and lipoxygenase (LO) products, thromboxane A2 (TXA2) and 12-hydroxyeicosatetraenoic acid (12-HETE), respectively, in platelets were also inhibited by Mg in a dose-dependent manner (IC50 4 to 6 mmol/L). These Mg-mediated activities were further enhanced when platelets were preincubated with insulin (100 microU/mL). The effect of extracellular Mg on the change of intracellular calcium concentration ([Ca2+]i) was assessed using Fura-2/AM loaded cells in the presence or absence of extracellular Ca. Thrombin-stimulated influx of Ca ions decreased from 194 +/- 30 nmol/L to 156 +/- 21 nmol/L in the presence of 5 mmol/L Mg and to 111 +/- 16 nmol/L in 10 mmol/L Mg. However, the intracellular Ca release (as determined in the presence of 5 mmol/L EGTA) was not affected by Mg. The intracellular Ca-dependent protein kinase C and myosin light chain kinase activities on the phosphorylation of endogenous p47 and p20 proteins studied after 2 min of thrombin addition decreased only 10 to 25% in the presence of 5 to 10 mmol/L Mg. Similar results were obtained when EGTA was added prior to the initiation of protein phosphorylation. We conclude that Mg can dose dependently inhibit a wide variety of agonists on platelet aggregation. Furthermore, insulin can potentiate the inhibitory effects of Mg on platelet activation.(ABSTRACT TRUNCATED AT 250 WORDS)


Higher salt consumption, digoxin-like factor, and nifedipine response are associated with salt sensitivity in essential hypertension. In addition to demonstrating evidences of increased sympathetic nervous system activity and marked left ventricular hypertrophy in salt-sensitive hypertensives, our group has also reported increased weight gain with salt overload in these patients. The increased weight gain suggests volume expansion, a situation already shown to increase plasma levels of a Na, K-ATPase inhibitor. Therefore, in the present study, digoxin-like factor (DLF) serum levels, spontaneous salt ingestion, nifedipine hypotensive effect, and plasma renin activity were evaluated in essential hypertensive subjects. Thirteen essential hypertensive outpatients were studied sequentially on an ad lib diet, a low salt diet (LSD = 30 mEq Na/day), and a high salt diet (HSD = LSD + 171 mmol/L NaCl/day), 1 week each. On the seventh day of LSD and HSD, DLF levels, mean blood pressure (MBP) response to nifedipine (10 mg sublingual), and plasma renin activity were measured. The MBP percent change from the seventh day of LSD to the seventh day of HSD (salt sensitivity) ranged from -13.7 to 20.9%. A positive correlation (r = 0.64, P < .01) was observed between salt sensitivity and 24-h urinary sodium excretion with an ad lib diet. The DLF serum levels correlated with the salt sensitivity both on LSD (r = 0.50, P < .05) and on HSD (r = 0.53, P < .05). Salt sensitivity was positively correlated with the difference of response to nifedipine between HSD and LSD (r = 0.78, P < .001). Plasma renin activity correlated inversely with DLF on LSD (r = -0.51, P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)


The effect of acute and chronic hematocrit changes on cardiovascular hemodynamics in spontaneously hypertensive rats. Heparin given over a long term by a subcutaneous route consistently lowers blood pressure in the hypertensive rat models. The decrease in blood pressure is accompanied by a parallel decrease in hematocrit suggesting a causal relationship between hematocrit and blood pressure. The aim of this study was to define the relationships between acute and chronic hematocrit changes and blood pressure in the normotensive and hypertensive states. Normotensive Wistar (NWR) and spontaneously hypertensive (SHR) rats were used. Hematocrit was decreased acutely by blood-letting, and chronically by treatment with either heparin (H) or phenylhydrazine (P) for 4 weeks. Acute and chronic hematocrit increase was accomplished by packed cells transfusion. Systolic blood pressure was measured weekly; and at the end of the experimental period, plasma volume, cardiac output, and mean arterial pressure were obtained. Acute hematocrit decrease or increase (hematocrit ranging from 25 to 65%) did not affect blood pressure in either strain of rats; whereas chronic hematocrit changes (hematocrit ranging from 35 to 61%) significantly affected blood pressure only in SHR. Thus, chronic hematocrit decrease induced by H or P resulted in a significant fall in blood pressure compared to control (201 +/- 3 v 175 +/- 4, 167 +/- 4 mm Hg, respectively; P < .05). Conversely, a chronic hematocrit increase resulted in a significant rise in blood pressure (201 +/- 3 v 219 +/- 4 mm Hg; P < .05). Similar hematocrit changes produced in NWR, as in SHR, did not affect blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)


The accuracy and performance of the A&D TM 2421, a new ambulatory blood pressure monitoring device based on the cuff-oscillometric method and the Korotkoff sound technique. The accuracy and performance of the A&D TM 2421, a new ambulatory blood pressure (BP) monitoring device using both the cuff-oscillometric method (O) and the Korotkoff sound method (K) were evaluated. The device was tested for accuracy under static and dynamic conditions by simultaneous comparison with two observers using a standard mercury column sphygmomanometer (standard method) and by the objective recording method (ORM). The performance of the device was also evaluated under ordinary ambulatory conditions. The mean differences in BP of standard method from K-method were -1.2 +/- 4.7 mm Hg systole and 1.3 +/- 4.7 mm Hg diastole (n = 323, mean +/- SD) and those of standard method from O-method were -0.4 +/- 5.3 mm Hg systole and 1.4 +/- 5.1 mm Hg diastole (n = 323). The agreement between each of the two methods of the device and the standard method was within 10 mm Hg for more than 90% of both systolic and diastolic readings. During bicycle exercise, the mean differences in BP of standard method from K-method were -3.4 +/- 4.8 mm Hg systole and 1.8 +/- 5.2 mm Hg diastole (n = 71) and those of standard method from O-method were -1.1 +/- 7.3 mm Hg systole and 1.7 +/- 7.8 mm Hg diastole (n = 67). There was a greater scatter in the individual comparisons of the device and the standard method during exercise, especially in diastolic BP. The relation between the device and ORM was almost similar to that between the device and the standard method.(ABSTRACT TRUNCATED AT 250 WORDS)


A randomized, placebo-controlled, double-blind comparison of amlodipine and atenolol in patients with essential hypertension. The efficacy and safety of amlodipine (2.5 mg, 5 mg, or 10 mg) once daily was compared with atenolol (50 mg to 100 mg) once daily in patients with mild-to-moderate essential hypertension in a randomized, double-blind, parallel, placebo-controlled study. One hundred and twenty-five patients were randomly allocated at the end of a 4-week run-in placebo period to 8 weeks' double-blind treatment with amlodipine (n = 41), atenolol (n = 43), or placebo (n = 41). The mean changes from baseline in blood pressure 24 h postdose for amlodipine (mean daily dose 8.8 mg) were -12.8/-10.1 mm Hg for supine and -11.5/-9.8 mm Hg for standing blood pressure (P < .001). For atenolol (mean daily dose 83.7 mg) the changes were -11.3/-11.7 mm Hg for supine and -13.3/-12.3 mm Hg for standing blood pressure (P < .001). There were no statistically significant differences between treatments. The responder rates for amlodipine, atenolol, and placebo were 61.1%, 64.9%, and 11.1%, respectively. Determinations taken over the 24-h period at the final visit revealed that amlodipine and atenolol maintained the group mean supine blood pressure at or below 140/90 mm Hg throughout the period of observation; the corresponding time-effect curve for the placebo group was clearly in the hypertensive range. Heart rate was significantly lowered by atenolol only. Both amlodipine and atenolol were well-tolerated. Only one patient was withdrawn because of the development of peripheral edema, arthralgia, and fatigue after treatment with amlodipine. This study demonstrates that once-daily administration of amlodipine or atenolol to mild-to-moderate hypertensive patients was well-tolerated and provided adequate blood pressure control throughout the 24-h dosing interval.


NMR measurement of intracellular potassium in the perfused normotensive and spontaneously hypertensive rat aorta by a multinuclear subtraction procedure. Intracellular free potassium ion concentrations have been measured in the isolated perfused aortae from Wistar-Kyoto and spontaneously hypertensive rats by a novel multinuclear NMR procedure, which allows the estimation and subtraction of the extracellular potassium signal from the total 39K+ resonance. When tested on a sample of erythrocytes, the method yielded an intracellular potassium concentration of 149 mmol/L cell water, which is similar to the previously reported average of 140 mmol/L cell water, indicating full (100%) NMR "visibility" of red cell 39K+. In contrast, the 39K+ resonance of the perfused rat aorta preparation indicated very low (approximately 15%) NMR visibility of intracellular potassium in the aortic tissue, similar to that previously reported for perfused hearts. More importantly, aortae from spontaneously hypertensive rats yielded a corrected (for low NMR visibility) intracellular potassium concentration of only 90 +/- 10 (mean +/- SE; n = 6) mmol/L cell water, which was significantly lower (40%; P = .02) than that in aortae from normotensive rats. The NMR data thus reveal a significant depletion of intracellular potassium in hypertensive arterial smooth muscle cells.


Noninvasive automatic blood pressure monitoring does not attenuate nighttime hypotension. Evidence from 24 h intraarterial blood pressure monitoring. Automatic ambulatory blood pressure monitoring makes use of repeated cuff inflations throughout the day and night. This may interfere with the cardiovascular effects of sleep and thus alter the 24 h blood pressure profile. The possibility that intermittent automatic blood pressure measurements prevent nocturnal hypotension was examined in 17 mild or moderate essential hypertensive patients in whom blood pressure was recorded intraarterially for 48 h by the Oxford technique. During the first or the second 24 h period, blood pressure was also monitored noninvasively by the SpaceLabs (Redmond, WA) 5300 (n = 10) and by the Sandoz Pressure System SPS 1558 (Lavanchy Electronique, Prilly, Switzerland) (n = 7) devices, automatic measurements being performed at 15 min intervals during the day and at 30 min intervals during the night. Separate computer analysis of 24 h intraarterial tracings obtained in absence and in concomitance of contralateral automatic blood pressure monitoring showed that the occurrence of automatic measurements had not interfered with the day-night intraarterial blood pressure and heart rate profiles. Thus the frequent cuff inflations that characterize automatic blood pressure monitoring do not attenuate nighttime hypotension and bradycardia. This finding supports use of the noninvasive approach in assessing blood pressure profiles.


Decreased rates of release of atrial natriuretic peptide from isolated hearts from aging hypertensive rats. We tested the hypothesis that in genetically hypertensive New Zealand rats left ventricular hypertrophy predisposes to left atrial disease and should be associated with a decreased release of atrial natriuretic peptide (ANP) in response to acute left atrial stretch. Abrupt distention of the left atrium was achieved by the acute onset of left atrial distention in Langendorff-perfused isolated rat hearts, which resulted in a rapid release of ANP in all groups of hearts. Comparisons were made between normotensive and hypertensive hearts using rats aged 2 months, 8 months, 12 months, and 16 months. Rates of release of ANP from normotensive and hypertensive hearts were similar at 2 months. Thereafter, there was a progressive impairment of ANP release, until in rats aged 16 months, rates of release achieved in hypertensive hearts 2 min after the onset of left atrial distention were only about half of those of normotensive hearts (55%, P < .005). At all ages above 2 months, hypertensive hearts failed to increase the concentration of ANP in the coronary effluent at the onset of increased heart work. Therefore, in rats with genetic hypertension, there is an impairment of release of ANP from the isolated heart in response to left atrial distention.


Disparate effects of weight loss on insulin sensitivity and erythrocyte sodium-lithium countertransport activity. Previous investigations have demonstrated an association between impaired insulin sensitivity and elevated erythrocyte sodium-lithium countertransport (Na(+)-Li+ CT) activity. It has been speculated that insulin resistance and endogenous hyperinsulinemia are causally related to the development of elevated Na(+)-Li+ CT activity. To test this hypothesis, we measured insulin sensitivity (euglycemic insulin clamp technique) and Na(+)-Li+ CT activity in eight obese women before (weight = 102 +/- 5 kg) and after (weight = 88 +/- 5 kg; P < .001) a 10 week weight reduction program. Maximal velocity of Na(+)-Li+ CT activity did not change (0.50 +/- 0.09 v 0.49 +/- 0.10 mmol/L red blood cells/h; P = NS) despite the significant improvement in insulin sensitivity (73 +/- 12 vs 110 +/- 7 mg/m2/min; P < .0025) and reduction in fasting insulin levels (17 +/- 2 v 10 +/- 2 microU/mL; P < .05) that accompanied weight loss. These results suggest that insulin resistance and hyperinsulinemia are not linked pathophysiologically to the development of elevated Na(+)-Li+ CT activity.


Cellular basis of ventricular remodeling in hypertensive cardiomyopathy. This review summarizes the effects of long-term pressure overload hypertrophy on the right and left ventricular myocardium. In particular, the role that the fundamental processes of myocyte growth plays in the remodeling of the wall is analyzed quantitatively. Moreover, emphasis is placed on the observation that the duration of the overload is an important component of the onset, development, and progression of time-dependent myocardial dysfunction associated with hypertensive cardiomyopathy. The deterioration in ventricular pump function is postulated to be accompanied by myocyte cellular hyperplasia and capillary proliferation in an attempt to increase the thickness of the ventricular wall and, consequently, to decrease the magnitude of systolic and diastolic stress generated by the elevation in ventricular systolic and end-diastolic pressures. Myocyte cellular hyperplasia constitutes an essential growth reserve mechanism of the heart. Regeneration of damaged and lost myocardium may be accomplished by hyperplasia of myocytes, a phenomenon considered not feasible for several decades.


Mild essential hypertension in nonobese premenopausal women is characterized by low renin. The pathophysiological mechanisms in hypertension may differ in men and women. Plasma renin activity was measured in 27 premenopausal, never-treated hypertensive women (blood pressure 141 +/- 2/93 +/- 1 mm Hg) and in 18 age-matched normotensive women (blood pressure 113 +/- 2/71 +/- 2 mm Hg). All subjects were unaware of their blood pressure status. The hypertensive women had on average lower plasma renin activity (0.21 +/- 0.03 nmol/L/h) than their normotensive controls (0.42 +/- 0.07 nmol/L/h, P less than .01). Serum estradiol was also lower in the hypertensive women (0.57 +/- 0.06 v 0.81 +/- 0.09 nmol/L, P less than .05). No difference in epinephrine, norepinephrine, atrial natriuretic peptide, or vasopressin was found between the groups. Plasma renin activity was positively correlated to plasma norepinephrine in the hypertensive women only (r = 0.41, P less than .05). Since low renin hypertension is associated with less cardiovascular complications, this may offer an explanation for the better prognosis of hypertension in women.


High sucrose diets increase blood pressure of both salt-sensitive and salt-resistant rats. We examined the effects of a diet relatively high in sugar and low in protein content on systolic blood pressure (SBP) in rats with known pressure responses to salt (NaCl) in order to compare "sugar/protein sensitivity" to "salt sensitivity." Dahl salt-sensitive (DSS) and salt-resistant (DSR) rats were fed one of two low salt diets containing either high sugar (sucrose 51.5% w/w)/low protein (14.6% w/w) or low sugar (sucrose 12.5% w/w)/high protein (52.2% w/w) content. After 3 weeks, the DSS ingesting the high sugar diet/low protein diet developed significantly elevated SBP relative to DSR eating the same high sugar/low protein diet and the DSS and DSR consuming the low sugar/high protein diet. After 2 to 3 months, the SBP of DSR eating the high sugar diet began to rise markedly and eventually both DSS and DSR ingesting the high sugar/low protein diet maintained similarly elevated SBP, significantly higher than DSS and DSR ingesting the low sugar/high protein diet. When Fischer 344 rats, a normotensive, salt-resistant rat strain, were fed the high sucrose/low protein diet, SBP also rose significantly into hypertensive ranges over 2 to 3 months. Since the SBP of DSR and Fischer 344 rats are not influenced to any great extent by high salt intake, even after prolonged exposure, the SBP rise associated with the high sugar/low protein diet may be via a mechanism different from salt-induced hypertension. However, it is also possible that the high sugar/low protein diet creates in DSS and DSR the situation responsible for salt induction in DSS.(ABSTRACT TRUNCATED AT 250 WORDS)


Natriuretic hormones in young hypertensives and in young normotensives with or without a family history of hypertension. The behavior of plasma atrial natriuretic factor (ANF) and digoxin-like substance (DLS), and the daily urinary excretion of kallikrein (uKK) were evaluated in young hypertensives and in young normotensives with or without a family history of essential hypertension. Each group was also evaluated, separating those with low plasma renin activity from the total sample. The sample group was made up of 75 young males; 31 hypertensives (mean age 22.7 +/- 2.5 years), 28 normotensives with hypertensive heredity (normotensives F+) (mean age 22.2 +/- 1.9 years) and 16 normotensives (mean age 22.0 +/- 2.1 years). An inverse correlation between ANF and PRA was shown in all groups. In hypertensives, ANF was inversely correlated with uKK (r = -0.664, P less than .0001). Plasma ANF (P less than .012) and DLS (P less than .0001) were higher in hypertensives than in normotensives, while uKK excretion was lower (P less than .0001). Plasma levels of DLS were higher in F+ normotensives than in normotensives (P less than .003). Low renin hypertensives showed the lowest uKK excretion (P less than .0001 v normal-high renin hypertensives). Furthermore, low renin hypertensives showed the highest plasma levels of ANF (P less than .0001 v normal high renin hypertensives) and DLS (P less than .012 v normal-high renin hypertensives). Plasma ANF (P less than .0001) was higher, while uKK was lower (P less than .045) in low renin F+ normotensives than in normal-high renin ones. In conclusion, our data indicate that plasma ANF and DLS are elevated since the early phase of hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)


Community-based epidemiological study on hypertension in Pu-Li, Taiwan. A community-based study was carried out by the Yang-Ming Crusade in 1987-1988 in Pu-Li Town, Taiwan. We interviewed 1738 out of 2573 registered residents more than 30 years old and their fasting blood samples were drawn and tested. The prevalences of definite hypertension (greater than or equal to 160/95 mm Hg) and borderline hypertension (140/90 to 160/95 mm Hg) were 18.7% and 16.0%, respectively. To study factors associated with hypertension, univariate analysis was applied first. Stratified analyses by age and sex were used for interaction assessment. Logistic regression was used for multivariate analysis. According to the final model, the significant factors related to definite hypertension were age (greater than or equal to 50 v less than 50 years of age, odds ratio [OR] 2.6, 95% confidence interval [CI] 1.6 to 4.3), physical activity (frequent v infrequent, OR 0.4, 95% CI 0.2 to 0.6), alcohol intake (yes v no, OR 2.3, 95% CI 1.1 to 4.6), and cholesterol (greater than or equal to 240 v less than 240 mg/dL, OR 1.7, 95% CI 1.0 to 2.9). Significant factors related to borderline hypertension were age (only for those cholesterol greater than or equal to 240 mg/dL, greater than or equal to 50 v less than 50 years of age, OR 4.1, 95% CI 2.1 to 7.9), cholesterol (only for those age less than 50, greater than or equal to 240 v less than 240 mg/dL, OR 3.6, 95% CI 1.6 to 7.8), physical activity (frequent v infrequent, OR 0.4, 95% CI 0.2 to 0.7), and alcohol intake (yes v no, OR 2.3, 95% CI 1.1 to 4.6).(ABSTRACT TRUNCATED AT 250 WORDS)


Ambulatory blood pressure monitoring in a nonacademic setting. Effects of age and sex. Twenty-four-hour ambulatory blood pressure measurements (ABPM) are likely to eliminate the stress of visits and observer bias in office blood pressure (BP) recordings, allow consideration of the circadian variability in BP, and correlate well with target organ damage. To define the prevalence of "white coat" hypertension in a rural community to a nonacademic setting, and to assess age and sex related differences, we studied 131 patients who had more than two prior office diastolic BP measurements greater than 90 mm Hg and less than 115 mm Hg. Blood pressure was measured every 10 to 60 min for 24 h using the SpaceLabs 90207 device. Office BP readings were higher than ABPM in the group as a whole, in individual age groups, and in both sexes. The differences were more pronounced at night. Average differences between office and ambulatory BP ranged between 14.4 +/- 1.7/2.9 +/- 2.0 (ABPM at 10:00), and 33.8 +/- 2.3/22.8 +/- 1.5 mm Hg (systolic/diastolic +/- SE) (ABPM at 01:00). The nighttime drop in systolic BP was not apparent in subjects more than 65 years old. Women had a proportionately higher mean office BP than men (115.0 +/- 0.9 office v 110.2 +/- 1.3 mm Hg ABPM in women and 112.3 +/- 0.9 v 104.3 +/- 1.1 mm Hg in men) (P = .013), and the elderly did not display the relationship between ambulatory and office mean BP seen in younger subjects (r = 0.15, P = .30 v r = 0.36, P = .0004, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)


Mechanisms involved in the progression to glomerular sclerosis induced by systemic hypertension during mild puromycin aminonucleoside nephrosis. To evaluate the contribution of systemic hypertension in the progression of nephropathies to glomerular sclerosis, a mild form of puromycin aminonucleoside (PAN) nephrosis was associated with Goldblatt hypertension and studied after 18 weeks. We studied four groups: Group I, controls; Group II, Goldblatt hypertension; Group III, PAN nephrosis; and Group IV, both conditions. Systolic blood pressure, 24-h proteinuria, serum cholesterol, triglycerides, glomerular hemodynamics, and histological studies were compared among the groups. Rats in groups II and IV developed systemic hypertension, but only group IV rats showed persistent proteinuria. No alterations in lipid metabolism were present in any of the groups. The most striking findings in the micropuncture studies were a significant increase of glomerular capillary pressure in group IV rats (63.15 +/- 1.34 mm Hg) as compared to controls (48.74 +/- 0.97 mm Hg) and to groups II and III (55.31 +/- 2.11 and 48.17 +/- 1.23 mm Hg, respectively), and a marked fall in Kf in groups III and IV. Only group IV showed significant histological alterations such as glomerular sclerosis, interstitial damage, and increased glomerular area. These results suggest that, in the presence of an underlying nephropathy, a greater fraction of systemic pressure is transmitted to the glomerular capillaries when systemic hypertension is present; the resulting elevation in glomerular pressure and proteinuria seems to be responsible for the progression to glomerular sclerosis.


Insulin-stimulated vascular relaxation. Role of Ca(2+)-ATPase. We have recently described defects in vascular smooth muscle Ca2+ transport in insulin-resistant states. Since insulin stimulates plasmalemmal Ca(2+)-ATPase activity in some tissues, loss of this stimulation in insulin resistance may result in reduced Ca2+ efflux, and, consequently, increased intracellular Ca2+ and vascular tone. Consequently, the present studies were conducted to determine the effects of insulin on vascular smooth muscle Ca2+ efflux and vascular relaxation following vasoconstriction, and to determine whether these effects are attributable to insulin stimulation of Ca(2+)-ATPase. Endothelium-denuded rat aortic strips were incubated for 1 h in the presence or absence of insulin (0.1 mU/mL), and 45Ca2+ efflux was measured. In some experiments, either a low Na+ (3 to 5 mmol/L) medium was used to inhibit Na+/Ca2+ exchange, vanadate (1 mmol/L) was added to inhibit Ca(2+)-ATPase activity, or the insulin level was varied (0.01 to 1.00 mU/mL) to establish dose dependence. To determine the effects of insulin on vascular relaxation, endothelial denuded aortic strips were suspended in a muscle bath and connected to an isometric force transducer. The strips were incubated with insulin (0.1 U/mL) or vehicle for 1 h, contracted with phenylephrine, and the rate of spontaneous relaxation following phenylephrine washout was measured. Insulin (0.1 mU/mL) stimulated both Ca2+ efflux (efflux rate constant = 0.288 +/- 0.038 v 0.361 +/- 0.036 min-1 in control and insulin-treated strips, respectively; P less than .005) and relaxation rate (3.97 +/- 0.35 v 4.63 +/- 0.31%/min; P less than .01), and both of these effects were inhibited by vanadate.(ABSTRACT TRUNCATED AT 250 WORDS)


Facilitatory effects of diltiazem on dopamine release in the central nervous system. Focus on interactions with D2 autoreceptors and guanosine triphosphate binding proteins. The purpose of the present study was to investigate the effects of a Ca antagonist (diltiazem) on dopamine release in the central nervous system. Rat striatal slices prelabeled with [3H]dopamine (DA) and superfused with Krebs-Ringer solution were stimulated electrically at a frequency of 1 Hz. Exposure to diltiazem (3.3 x 10(-7) to 1 x 10(-5) mol/L) significantly increased both the basal and stimulation-evoked [3H]DA release in a dose-dependent manner. Exogenously applied unlabeled DA inhibited the stimulation-evoked [3H]DA release. Diltiazem significantly antagonized the capacity of the unlabeled DA to inhibit stimulation-evoked [3H]DA release. The blockade of D2 receptors by a preferential D2 antagonist, sulpiride, reduced the facilitatory effect of diltiazem on stimulation-evoked [3H]DA release. Pretreatment with pertussis toxin, which interferes with the coupling of the inhibitory guanosine triphosphate-binding proteins to adenylate cyclase, significantly diminished the effects of diltiazem on stimulation-evoked [3H]DA release. These results show that diltiazem increased DA release in rat striatum, at least partially by interactions with the D2 autoreceptors and pertussis toxin-sensitive guanosine triphosphate-binding proteins.


AT1 receptors mediate the release of prostaglandins in porcine smooth muscle cells and rat astrocytes. Angiotensin II (AII) can release arachidonic acid metabolites such as prostacyclin (PGI2) and PGE2 from cells in cultures. It has recently been reported that the AT1 selective nonpeptide AII receptor antagonist losartan had similar effects. The present study was undertaken to further evaluate the effects of AII and losartan on cells which synthesize prostaglandins, including vascular smooth muscle, endothelial, and glial cells. Inhibition of specific [125I]AII binding was demonstrated in porcine smooth muscle cell (PSMC) suspensions with unlabeled AII and losartan. The IC50 values were 1.3 x 10(-9) mol/L and 7.7 x 10(-9) mol/L, respectively. PD123177 (an AT2 selective antagonist) had no effect on binding. AII produced a concentration-related increase in calcium mobilization (fura-2 fluorescence) which was blocked by losartan (IC50 = 8.4 x 10(-8) mol/L) but not by PD123177 (10(-6) mol/L). AII (10(-7) to 10(-5) mol/L) stimulated the basal release of PGI2 by 100%. This response was blocked by losartan (10(-6) to 10(-5) mol/L) but not by PD123177 (10(-6) to 10(-5) mol/L) and neither agent stimulated basal release in PSMC. Similar effects of AII and antagonists were observed upon receptor binding and PGE2 release in primary rat astrocyte (RA) cultures. AII did not release PGI2 from porcine endothelial cells, bovine pulmonary arterial endothelial cells, or rat C6 glioma cells. Losartan had no significant effect at 10(-5) mol/L. By contrast, bradykinin or the calcium ionophore A23187 dramatically increased PGI2 release in each of these cells.(ABSTRACT TRUNCATED AT 250 WORDS)


Low sodium diet in essential hypertension. Effect on blood cell ions and hemodynamic parameters. The influence of salt restriction for 3 months on blood pressure, peripheral vascular resistance (observed by occlusive plethysmography), erythrocyte sodium, platelet calcium, and pH, was studied in eight untreated essential hypertensive patients. A low salt diet decreases blood pressure, vascular resistances, erythrocyte sodium, and platelet calcium, but not platelet pH. A strong positive correlation was noted between baseline platelet calcium and vascular resistances (r = 0.95, P less than .01). But during the salt restriction period, a negative correlation has been observed between the changes in these parameters, which casts doubt on the use of the platelet as a model of the smooth muscle cell.


Effects of 3,N,N'-trimethyl-2-phenyl-1,4-piperazine diastereomers on monoamine uptake and monoamine oxidase in rat brain. The diastereomers of 3,N,N'-trimethyl-2-phenyl-1,4-piperazine dihydrochloride (TPP) were tested for their effects on NA, DA and 5-HT uptake in synaptosomes prepared from hypothalamus, corpus striatum, and frontal cortex, respectively. The diastereomers differed with respect to their inhibitory properties. (2 R, 3 R)-TPP was more potent than the other diastereomers on NA and DA uptake, whereas (2 S, 3 S)-TPP was least potent. In contrast, the (2 S, 3 S)- and (2 S, 3 R)-diastereomers of TPP were more potent than (2 R, 3 R)- and (2 R, 3 S)-TPP as inhibitors of 5-HT uptake. None of the diastereomers affected monoamine oxidase activity. The findings show that the diastereomers of TPP interact stereoselectively with neuronal mechanisms for monoamine uptake, and that the (S)-configuration at the 2 carbon is important for inhibitory actions of TPP on 5-HT uptake.


Differential potentiation by calcium antagonists of neuromuscular blockade induced by pancuronium and succinylcholine in cats in vivo. The effects of several calcium antagonists (verapamil, nicardipine and two diltiazem isomers, d-cis and l-cis diltiazem) alone and associated to non-depolarizing (pancuronium) and depolarizing (succinylcholine) neuromuscular blockers, were evaluated on sciatic nerve-tibialis anterior muscle preparations from cats in vivo. The calcium antagonists used (at 0.1 and 0.5 mg/kg iv) did not modify the height of muscular twitches elicited indirectly. However, these agents potentiated in a dose-dependent way the neuromuscular blockade induced by iv pancuronium (2-40 micrograms/kg) and succinylcholine (6-200 micrograms/kg). The order of potency in increasing the effects of pancuronium was nicardipine much greater than d-cis diltiazem greater than or equal to verapamil, whereas the order of potency in enhancing succinylcholine effects was d-cis diltiazem greater than or equal to verapamil much greater than nicardipine. The effects of diltiazem were stereoselective, thus the potentiation induced by d-cis diltiazem was significantly greater in all cases than that induced by l-cis diltiazem, which suggests that calcium channel blockade plays a role in these interactions. However, other mechanisms such as calcium antagonists-induced nicotinic receptor desensitization may also be involved.


Disappearance of hypothalamic TRH asymmetry in suicide patients. The aim of the present study was to investigate the functional and/or pathological significance of the hemispherical lateralization of TRH using radioimmunoassay to determine the TRH concentration of nuclei and areas within the hypothalamus of suicide patients, with matching measurement being carried out on control subjects. In suicide patients, we found no significant difference in TRH concentration between the left and right intrahypothalamic structures, while the group used as control subjects (see Borson-Chazot, 1986) showed a significant left side predominance in the ventromedial nucleus, paraventricular nucleus and area dorsalis. As regards the TRH concentration in the right intrahypothalamic structures, no significant difference was found between the suicide patients and the control subjects. The absence of the left TRH predominance for the three intra-hypothalamic structures in question may be of pathological significance.


Increased binding of 3H-L-deprenyl in spinal cords from patients with amyotrophic lateral sclerosis as demonstrated by autoradiography. The present investigation has applied quantitative autoradiography and histochemistry to study the regional distribution of MAO-B and its relation to the number of cells in respective regions. L-deprenyl binds irreversibly and quantitatively to the B-form of monoamine oxidase, MAO, and is an ideal 3H-ligand to measure the MAO-B enzyme protein in tissues by means of in vitro autoradiography. The investigation is performed on spinal sections from five controls and five cases with amyotrophic lateral sclerosis (ALS) on cervical, thoracic and lumbar level. The highest density of 3H-L-deprenyl binding was found around the central canal (lamina X). MAO-B was markedly increased (up to 2.5 times of values in controls) specifically in regions of neurodegeneration e.g. motor neuron laminae and corticospinal tracts. There was a high correlation between glial cell count and 3H-L-deprenyl binding with a relation indicating enhanced MAO-B protein in glial cells within areas of neurodegeneration. In contrast the increased microglial cell number in ALS did not show any correlation with 3H-L-deprenyl binding.


The effects of deprenyl on methamphetamine-induced dopamine depletions. The effects of deprenyl on methamphetamine-induced dopamine depletions were studied in mice. Four SC injections of 12.5 mg/kg of methamphetamine at two-hour intervals caused substantial (72-82%) and long-lasting depletions of striatal dopamine. Pretreatment with either 25 or 40 mg/kg of deprenyl did not significantly alter the magnitude of this depletion. These results indicate that, unlike what is observed following MPTP, there is no protection afforded dopaminergic cells by deprenyl pretreatment in the methamphetamine model of parkinsonism.


Effect of the selective MAO-A inhibitors brofaromine, clorgyline and moclobemide on human platelet MAO-B activity. MAO-B activity was compared in healthy volunteers following oral treatment with clinically effective doses of the selective MAO-A inhibitors brofaromine (100 mg q.d. for 14 days), moclobemide (150 mg t.i.d. for 14 days) and clorgyline (5 mg t.i.d. for 10 days). Brofaromine and clorgyline did not alter platelet MAO activity. Following moclobemide treatment, MAO-B activity was reduced by 32% (p less than 0.05). It recovered during the 5 subsequent days after discontinuation of treatment. These results confirm earlier findings. The explanation for this finding may be that metabolites of moclobemide are active inhibitors of MAO-B.


Effect of serum on adrenal PNMT activity. Humoral mechanism should be responsible for activation of PNMT (phenylethanolamine N-methyltransferase) by CRF (corticotropin-releasing factor) in vivo (Lima and Sourkes, 1987). Small amounts of serum (10 microliters) caused a sig. dose dependent activation of bovine PNMT activity (19.0 +/- 1.8%) changing in Km and Vmax values in vitro. Human/rat or ovine CRF--in high amounts (8.4 nmol) only--increase at the rate of just 10% bovine PNMT activity in vitro. At the moment, we do not know which factor in serum is responsible for the increase in A (adrenalin) synthesis in vitro.


Anticonvulsant activity of carbamazepine and diphenylhydantoin against maximal electroshock in mice chronically treated with aminophylline. The anticonvulsant activities of both carbamazepine and diphenylhydantoin alone (after a single intraperitoneal administration) or combined with aminophylline were studied against maximal electroshock-induced convulsions in male mice. Aminophylline (injected acutely at 50 mg/kg) significantly increased the ED50 values of both antiepileptics. Given for three days, aminophylline (50 mg/kg, twice daily) still impaired the potency of both antiepileptics and after chronic aminophylline administration a further decrease in the protective activity of carbamazepine and diphenylhydantoin was found. Specifically, after 14 days of aminophylline treatment, ED50s for carbamazepine and diphenylhydantoin were 26 and 19 mg/kg, respectively. These ED50s were significantly elevated compared to values determined after acute aminophylline treatment (21.2 and 14.9 mg/kg, respectively). Plasma levels of both antiepileptics were unaffected by chronic aminophylline which seems to exclude a pharmacokinetic interaction in terms of total plasma levels at least. The present results clearly indicate that the aminophylline-induced impairment of the anticonvulsant activity of carbamazepine and diphenylhydantoin is enhanced over time. This may render aminophylline a hazardous drug to epileptic patients who are prescribed this smooth muscle relaxant.


Antagonism by 8-OH-DPAT, but not ritanserin, of catalepsy induced by SCH 23390 in the rat. In the present experiments, it was shown that the catalepsy induced by the dopamine D1 antagonist SCH 23390 (0.2 mg kg-1 sc), was completely antagonised by the administration of 8-OH-DPAT (0.1 mg kg-1 sc) for the duration of the effect of SCH 23390 (approx. 120 min). Neither the catalepsy induced by raclopride (16 mg kg-1 sc) nor that induced by SCH 23390 (0.2 mg kg-1 sc) could be antagonised by treatment with the 5-HT2 receptor antagonist ritanserin (0.13-2.0 mg kg-1 sc). Administration of SCH 23390 (0.0125-0.2 mg kg-1 sc) produced a significant suppression of avoidance behavior at all doses, and also produced a significant decrease in the number of intertrial crosses. At the higher doses, 0.05 and 0.2 mg kg-1 sc, there were also escape failures. In contrast to the finding in our previous report that raclopride and 8-OH-DPAT in a synergistic manner produce a suppression of conditioned avoidance behavior, no such interaction was found between 8-OH-DPAT (0.1 mg kg-1 sc) and SCH 23390 (6 micrograms kg-1 sc) in the present study.


Decrease in mesencephalic dopamine autoreceptors in experimental herpes simplex encephalitis. Brain dopamine receptors were determined in experimental herpes encephalitis using an animal model, where herpes simplex virus type 1 was inoculated onto the cornea of rabbits. The animals exhibit an asymmetric posture and circling to the side of inoculation, which appears to be connected to the altered dopamine transmission in the mesostriatal system. In this study striatal and mesencephalic D-1 and D-2 dopamine receptors were measured by radioligand techniques using 3H-SCH 23390 and 3H-spiroperidol as ligands. In the striatal D-1 and D-2 receptors there were no significant differences between HSV-inoculated and control rabbits. In the substantia nigra-ventral tegmental area there was a significant decrease in the D-2 receptors (Bmax) on the side contralateral to the primary virus inoculation and the direction of the rotational behaviour, without any changes in the D-1 receptors. Thus experimental herpes simplex virus infection seems to affect the mesencephalic dopamine autoreceptors, leading to unilateral activation of the mesostriatal dopamine system and rotational behaviour.


Morphometric and neurosecretory changes in supraoptic neurons after D-amphetamine treatment. Several morphological and immunochemical characteristics of the neurosecretory neurons of the supraoptic nucleus (SON) have been studied of rats treated for 1 month with D-amphetamine sulfate (AMP) (8 mg/kg weight, daily). An increase of SON volume (11%) has been observed as a consequence of the growth of the dorsoventral axis. Neurosecretory neurons increased their nucleolar area (11.4%), their nuclear area (8.3%), and their cytoplasmatic area (18.3%). Vasopressin immunoreaction did not show any differences between treated and control animals, but oxytocin immunostaining displayed an important increase (23.7%) in the neuronal cytoplasm of the treated rats. The SON hypertrophy of the AMP-treated rats corresponded to the hypertrophy/hyperfunction of its oxytocinergic neurons, and could be considered as a new mechanism of the action of the AMP. The results are discussed in relation to the plastic features of the SON and its central (neuronal) and peripheral (hormonal) function.


[Tl-201 myocardial scintigraphic findings in patients with aortic regurgitation]. To evaluate the myocardial damage associated with aortic regurgitation, thallium-201 myocardial scintigraphy was performed in 13 patients with aortic regurgitation. The data obtained by thallium-201 single photon emission computed tomography were expressed as the extent score, and were compared with data by echocardiography. The results were as follows: 1. In 11 of 13 patients, there were moderate Tl defects in the distribution of bull's eye map, 80% in the apex, 50% in the inferior and lateral regions, 30% in the anterior region and 10% in the septal region. The mean extent score was 22.3 +/- 11.0%. 2. The extent score correlated with the increase in aortic regurgitant flow volume. The extent score according to the Sellers' classifications II, III, and IV was 13.8 +/- 3.7%, 20.1 +/- 9.8% and 31.9 +/- 10.2%, respectively. 3. There was a good negative correlation between the extent score and fractional shortening (r = -0.66, p < 0.01), however, no significant correlation was observed between the extent score and the left ventricular end-diastolic volume. These results suggest that Tl defects in patients with aortic regurgitation are mainly due to myocardial ischemia associated with a decrease in coronary perfusion pressure and that the extent score may sensitively reflect the severity of myocardial damage in cases with aortic regurgitation.


[Clinical significance of the click intervals for the diagnosis of dysfunction of the Medtronic-Hall prosthetic valve]. To investigate the clinical significance of click interval for evaluation of prosthetic valve dysfunction, 20 patients underwent Medtronic-Hall (MH) valve replacement (14 in the mitral position and 6 in the aortic position) were studied by simultaneous high-speed recordings of phonocardiogram, echocardiogram and/or Doppler echocardiogram. Two of the 20 patients, one in the mitral and the other in the aortic position, showed MH valve dysfunction. Eleven patients with normally functioning Björk-Shiley (BS) valve in the mitral position served as controls. Results were as follows: 1. There were usually 3 opening clicks (OC1, OC2, OC3) in patients with normally functioning MH valve in the mitral position. These 3 clicks coincided in timing with the beginning of opening, maximum opening and the end of sliding motion, respectively. Both OC1 and OC2 of the MH valve occurred in similar timing with those of the BS valve (A2-OC1 interval: MH = 65.4 +/- 11.8 msec vs BS = 72.3 +/- 17.2 msec; OC1-OC2 interval: MH = 31.2 +/- 7.7 msec vs BS = 27.3 +/- 6.1 msec). However, OC3 occurred significantly later in MH valve than in the BS valve (OC2-OC3 interval: MH = 32.3 +/- 7.5 msec vs BS = 16.4 +/- 3.8 msec, p < 0.01). 2. There were 2 closing clicks (CC1, CC2) in normally functioning the MH valve in the aortic position. These 2 clicks coincided in timing with the beginning and the end of the closing motion, respectively. Mean value of CC1-CC2 interval in 5 prosthetic patients with normal function was 31.0 +/- 9.6 msec. 3. A patient with malfunctioning MH valve in the mitral position showed a markedly prolonged OC1-OC2 interval, ranging from 66 to 140 msec, and she had multiple diastolic clicks after the OC2 phase. Prolonged OC1-OC2 interval was mainly caused by the delay of appearance of OC2, and it was thought to be due to temporary limitation of opening motion of the valve by valve thrombosis. 4. A patient with malfunctioning MH valve in the aortic position showed a markedly prolonged CC1-CC2 interval (100 msec), and he had a significant severe aortic regurgitation during this phase. At operation, fibrinoid thrombus was attached to the aortic annulus at the side of minor orifice of the valve. Closing motion of the valve was disturbed by this thrombus, and the completion of valve closure was markedly delayed.(ABSTRACT TRUNCATED AT 400 WORDS)


[Congenital bicuspid aortic valve: stenotic type and insufficient type]. Two-hundred and eighty-one patients underwent surgical treatment of the aortic valves during a 10-year period of 1981 to 1991, 32 of whom (11%) had bicuspid aortic valve. Bicuspid aortic valve is well known to cause calcified aortic stenosis, however, some of these cases develop pure aortic insufficiency of unknown etiology. In our studies of 32 patients with bicuspid aortic valve, 28 patients had aortic stenosis, 2 were aortic insufficiency and 2 were infective endocarditis. Pathogenesis of aortic insufficiency in patients with bicuspid aortic valves was discussed and compared with that of aortic stenosis.


[Prosthetic valve function evaluated by ultrafast computed tomography (Imatron C-100)]. Ultrafast computed tomography (UFCT) is a new diagnostic modality that includes not only imaging of cardiac structures, but also movement of cardiac muscles and valves. It can be useful in the evaluation of prosthetic valves, because the scan time is extremely short and whole cardiac structures are imaged with a slice thickness of 8 mm and within 7 cardiac cycles. We review our experience using UFCT to observe prosthetic valve function in 22 cases with various valvular diseases.


[A family of Marchesani syndrome with mitral valve prolapse and anuloaortic ectasia]. Marchesani syndrome consists of short statue, small spherical lens, glaucoma and brachydactyly, which are manifestations of hyperplastic connective tissue disease in systemic organs of mesodermal origin (Marchesani 1939). Among nearly 200 cases of Marchesani syndrome reported in the ophthalmology field, none has shown cardiac manifestations which typically characterize Marfan syndrome caused by hypoplastic connective tissue disorders. We experienced 2 cases which met the diagnosis of Marchesani syndrome and yet showed annuloaortic ectasia and mitral valve prolapse. A 30-year-old man and a 26-year-old woman who are siblings suffered from manifested brachydactyly, spherophakia, glaucoma and cardiac involvements. Their parents are in consanguinity. These unprecedented cases with mixed manifestations provide the evidence of possible gene-crossing between these 2 dystrophic mesodermal disorders.


[Vagal innervation in the human atrioventricular valves]. Innervation of the human atrioventricular (AV) valves is microscopically studied by histopathological methods. The tricuspid and mitral valves of 4 autopsied hearts of adult men (age range from 50 to 74 years old) without any cardiovascular diseases were stained for acetylcholine-esterase by histochemical method in the medium containing acetylthiocholine iodide. Acetylcholine-esterase positive nerve fibers of 2 to 50 microns in diameter were widely distributed in the subepicardial space of the atrial of the AV valve. They formed a coarse network of the nerve elements from the valve base to the anatomical edge. The nerve network was more dense at the valve ring and base, as well as at the commissure, than at the edge and body. Some thick nerve fibers ran in the chordae tendineae. The thick fibers were intercalated with varicose-like special structures at several places in the leaflets, which seemed to be a kind of sensory apparatus. The thin nerve fibers ended, as usual, at small dot or brush-like apparatus. It is widely accepted that the acetylcholine-esterase positive nerve fibers are identical with vagal nerves which are insisted on participating in development of mitral valve prolapse syndrome. We suggest that the vagal innervation in the AV valves could play an important role for valvular function.


[Mitral valve prolapse associated with partial absence of commissural chordal insertion: report of two cases]. We reported 2 cases of mitral valve prolapse (MVP) associated with partial absence of the chordae tendineae. Case 1 was a 25-year-old man who was admitted to our hospital for further examinations of an apical pansystolic murmur (Levine 4/6) and the abnormal shadow on his chest radiograph. He was diagnosed as having grade 3 + mitral regurgitation (MR) by the Sellers classification and pulmonary varix by cardiac catheterization. Transesophageal echocardiography revealed MVP of the rough zone of the anterior mitral leaflet and MR blowing into the pulmonary varix. Case 2 was a 60-year-old man who was admitted to our hospital because of congestive heart failure and apical pansystolic murmur (Levine 4/6). Parasternal echocardiography revealed prolapse of both the anterior and posterior mitral leaflets and moderate MR. In both cases, absence of insertion of anterolateral commissural chordae was confirmed after surgery, and the abnormalities of chordal arrangement and insertion were considered as causes of MVP in these cases.


[Evaluation of left ventricular relaxation by mitral regurgitant curve]. To examine whether left ventricular (LV) isovolumic relaxation can be assessed noninvasively using a continuous-wave Doppler technique, we compared Doppler-determined parameters derived from mitral regurgitation (MR) velocity curve with micromanometer-derived indices of LV relaxation, peak negative dP/dt and tau, in 9 patients with MR (5 with dilated cardiomyopathy, 2 with old myocardial infarction and 2 with rheumatic MR). The rate of LV pressure decay (delta P/delta t) at aortic valve closure was calculated from the recordings of MR jet velocities based on the simplified Bernoulli equation. The time constant of LV pressure decay (tD) was determined as the time from the aortic valve closure to the point where the velocity declined by (1/e)1/2. Doppler-determined delta P/delta t correlated well with hemodynamic peak negative dP/dt (r = 0.97, p < 0.001), and tD with hemodynamic tau (r = 0.89, p < 0.005). Thus, we concluded that left ventricular isovolumic relaxation can be noninvasively assessed with a continuous-wave Doppler technique in the presence of mitral regurgitation.


[A clinicopathologic study of morphologic tricuspid valve prolapse in the aged: comparison with color Doppler evaluation]. Similar morphologic abnormalities have often been observed in the leaflets of tricuspid valve in patients with mitral valve prolapse. In the present study, morphologic tricuspid valve prolapse was analyzed in 500 consecutive autopsies of the aged over 60 years (mean 78.5 yrs, 266 men, 234 women). Additionally, the sensitivity and specificity of the color Doppler technique applied before death were assessed in 61 autopsy cases. The results were as follows: 1. The incidence of morphologic tricuspid valve prolapse was 22.2% at autopsy in 500 cases of the aged, however, tricuspid regurgitation had not clinically been detected in any of them. 2. The prolapse of 2- or 3-leaflets was common (78.5%). Among the 3 leaflets, the prolapse was more frequently observed in the anterior or posterior leaflet than in the septal leaflet. Combined tricuspid and mitral valve prolapses were observed in 22 cases (19.8%). 3. Among 61 cases examined by color Doppler echocardiography, autopsy showed that 16 cases had tricuspid valve prolapse and 14 cases tricuspid regurgitant flow signals (87.5%). 4. Regurgitant flow signals were also detected in 4 of 12 morphologically normal cases (33.3%). 5. In autopsy cases of the aged, generally, the incidence of morphologic tricuspid valve prolapse and tricuspid regurgitant flow signal were high, however, hemodynamically significant regurgitation due to prolapse was very rare.


[A case of cardiac lipoma of the anterior tricuspid leaflet]. A 42-year-old man with cardiac lipoma of the anterior tricuspid leaflet is reported. He had a chief complaint of epigastric discomfort, and a pansystolic murmur was heard at the left sternal border in the 4th intercostal space. Two-dimensional echocardiography disclosed a mobile high density stalkless mass having several areas of low density. Two-dimensional Doppler echocardiogram revealed a moderate degree of tricuspid regurgitation. These findings were more clearly visualized on transesophageal echocardiogram. MRI revealed a high signal intensity on the T1-weighted image and a high radiodensity surrounding the mass using a contrast medium of Gd-DTPA. A 2.0 x 1.3 x 0.8 cm hemispherical, lobulated and sessile yellow mass was excised by means of open heart surgery, and tricuspid valvuloplasty was performed. The mass was adipose tissue and was surrounded by fibrous tissue just under the lamina fibrosa. These findings were compatible with those of the preoperative examinations, although the preoperative diagnosis was not conclusive. This was our first case of cardiac lipoma in which the tricuspid valve was successfully excised.


[Long-term effect of medical treatment in patients with chronic aortic regurgitation]. We often experience patients with chronic severe aortic regurgitation (AR) whose cardiac function significantly improves by medications, especially by vasodilator therapy. To find the factors determining the response to pharmacologic treatment, we studied 20 patients with chronic AR with dilated left ventricle (end-diastolic dimension > or = 55 mm) using echocardiography; 9 patients with significant improvement (delta Ds < or = -3 mm: improved group) and 11 without improvement (unchanged group). In the initial evaluation, systolic blood pressure and left ventricular relative wall thickness (Thd/Dd) were greater and left ventricular end-diastolic dimension was smaller in the improved group than in the unchanged group. During the follow-up period, systolic blood pressure and end-systolic wall stress decreased significantly and absolute and relative wall thickness increased significantly in the improved group, however, they remained nearly the same in the unchanged group. Significant negative correlation was observed between Thd/Dd and delta Ds. In conclusion, cardiac function in some patients with chronic AR can be improved by pharmacologic treatment, and in such cases, the Thd/Dd ratio could be a parameter of the response to pharmacologic treatment.


[Doppler and echocardiographic study of normal systolic murmurs]. To elucidate the genesis of normal ejection systolic murmurs, we performed phono and Doppler echocardiography in 42 normal subjects. Individuals with hypertension, ST.T changes on ECG, anemia or other cases with definite cardiovascular findings were excluded from the study. Their ages ranged from 22 to 61 years with an average of 48.1 years. They were classified in 2 groups; 9 with Levine 2/6 systolic murmur and 33 without murmur or with 1/6 murmur. Fifteen patients with pure aortic regurgitation or with aortic prosthesis but without significant stenosis, and 7 patients with pulmonic valvular stenosis were served as control. We correlated the intensity and timing of murmur with maximal flow velocity, acceleration time and other parameters. All systolic murmurs were early systolic. Mid-systolic murmur was not noted. Peak of flow velocity increased at the aortic orifice than at the left ventricular outflow tract or pulmonary orifice. Left-sided peak flow velocity occurred earlier than the right-sided peak flow velocity. Early systolic maximal flow velocity of the aorta significantly increased in 9 subjects with murmur than in the remaining 33 without significant murmur. Ejection fraction, hematocrit and body surface area did not differ between the groups with and without significant murmur. Systolic blood pressure and age, however, were higher in subjects with murmur. In aortic valvular disease, systolic murmurs and peak flow signals were early systolic, but in pulmonary stenosis these were mid-systolic in timing. In conclusion, normal ejection systolic murmurs were early systolic and originated at the aortic orifice. Mid-systolic murmurs were unlikely as left-sided murmur in origin. Flow velocity was the most important determinant of the intensity of ejection murmur.


[Evaluation of aortic regurgitation by Doppler echocardiography]. To establish a method for evaluating aortic regurgitation (AR) using Doppler echocardiography, we studied 104 patients who were classified according to aortographic grading (Sellers). The severity of the AR was graded by measuring the length of AR jet within the left ventricle by pulsed Doppler mapping (mapping method) or by two-dimensional color Doppler echocardiography (length method). Also, color Doppler echocardiography was used to measure the width of AR jet just below the aortic valve (width method), and pulsed Doppler echocardiography to determine the fraction of integral of forward flow and reverse flow in the abdominal aorta (abdominal method). Although the diagnostic accuracy of grading by these Doppler techniques only ranged between 52% and 68%, the length method combined with the abdominal one enhanced the diagnostic accuracy to 89% in retrospective study and 80% in prospective study. In conclusion, the length method combined with the abdominal method appeared to be useful and reliable in evaluating AR.


Do central antiadrenergic actions contribute to the atypical properties of clozapine? Full neuropharmacological understanding of the atypical antipsychotic agent clozapine remains elusive. Antidopaminergic actions of most neuroleptics probably contribute to their antipsychotic benefits, but also to neurological side-effects. Clinical evidence of abnormalities of dopamine (DA) and serotonin (5-HT) in psychotic disorders is inconsistent, but there is substantial metabolic and post-mortem evidence for hyperactivity of noradrenaline (NA). Clozapine is only weakly antidopaminergic but is a potent antagonist at brain alpha 1-adrenergic, 5-HT2-serotonergic, and muscarinic receptors. Its apparent limbic-over-extrapyramidal neurophysiological selectivity can be mimicked by combining a typical neuroleptic with a central alpha 1 antagonist. Clozapine strongly upregulates alpha 1, but not DA, receptor abundance, and may supersensitise alpha 1 but not DA receptors in rat brain. Clozapine also selectively increases activity of NA neurons and metabolic turnover in NA more than DA areas of rat brain, and also increases NA, but not DA or 5-HT, metabolites in human CSF. Potential psychotropic effects of selective central antiadrenergic agents may deserve reconsideration.


Clozapine: a hypothesised mechanism for its unique clinical profile. Clozapine's clinical profile is unique among antipsychotic drugs. What makes it different? For almost two decades researchers have been attempting to answer this question. Based on various data, many hypotheses have been proposed. Using electrophysiological techniques we have found that clozapine, like typical antipsychotic drugs, inactivates most midbrain dopamine cells secondary to the induction of depolarisation block. However, unlike classical antipsychotic drugs, clozapine does not inactivate the nigrostriatal dopamine system. Based on these and other findings the hypothesis of 'depolarisation block' is reviewed and presented as an explanation for clozapine's unique clinical profile. Research data both for and against the hypothesis are then discussed.


Clozapine and D1/D2 antagonism in extrapyramidal functions. One of the main advantages of clozapine is that it rarely produces extrapyramidal syndromes and tardive dyskinesia. This advantage is linked to the atypical biochemical profile of clozapine, especially its combined and low blockade of D1 and D2 receptors. The level of D2 receptor blockade is too low to induce extrapyramidal side-effects, and D1 antagonists have a lower extrapyramidal side-effect potential than traditional D2 neuroleptics, especially with respect to dystonia. The combined and balanced D1/D2 receptor blockade may prevent the development of a dysbalance between D1/D2 receptor function (in favour of D1) which otherwise might lead to tardive dyskinesia.


Clozapine-associated agranulocytosis: risk and aetiology. This paper reviews the epidemiology and pathogenesis of clozapine-associated agranulocytosis. According to present clinical experience, granulocytopenia can be expected in approximately 3% of patients during clozapine treatment. The risk of serious sequelae of granulocytopenia can be minimised by regular white blood cell count monitoring. Although research suggests that some patient groups may be at higher risk of developing this serious adverse reaction, we cannot yet predict the susceptible patients, so all patients exposed to clozapine should receive regular blood monitoring throughout treatment. Because of the risk of agranulocytosis, clozapine should only be used in schizophrenic patients who are resistant to, or intolerant of, conventional antipsychotic medications. Unless compliance with blood monitoring is assured, clozapine treatment should not be recommended.


Clinical efficacy of clozapine in treatment-refractory schizophrenia: an overview. The treatment of patients with schizophrenia who fail to respond to antipsychotic medications remains a challenge. Despite numerous attempts to establish effective somatic treatment approaches for this population, clozapine appears to be the only well established alternative. Depending upon trial duration and response criteria, between 30% and 60% of previously unresponsive patients appear to derive clinically significant benefit from clozapine. Clozapine also has important advantages in terms of its reduced propensity to produce extrapyramidal side-effects. Agranulocytosis remains an important risk, so strategies to improve the benefit-to-risk ratio should be explored. Issues such as trial duration, dosage, blood levels and predictors of response require additional study.


Dimensions of outcome with clozapine.

Dimensions of outcome with clozapine. Various outcome measures following clozapine administration to neuroleptic-resistant schizophrenic patients are considered. The importance of a multidimensional perspective is emphasised. There was significant improvement in positive symptoms, some negative symptoms, quality of life, some types of cognitive function (e.g. semantic memory), extrapyramidal function, and tardive dyskinesia. Readmission to hospital, and family burden were markedly reduced, which achieved significant savings in the cost of treatment. Compliance with clozapine and weekly blood testing can be achieved in the majority of treatment-resistant cases. These benefits may occur independently of each other.


Activity and tolerability of tetridamine vaginal lavage in rats and women. Tetridamine (2-methyl-3-methylamino-4,5,6,7-tetrahydroindazole) is a well known analgesic and anti-inflammatory drug. Here the activity and the tolerability of a new 0.134% tetridamine formulation in rats and women, are reported. Anti-inflammatory and analgesic tests were performed in Sprague-Dawley rats with carrageenin oedema; topical application of 0.134% tetridamine solution showed a marked reduction of paw swelling (-54.4%) and pain sensibility (-81.0%). A 28 days vaginal tolerability study performed on Sprague-Dawley rats with tetridamine lavage (0.2 ml/rat/day) showed, in comparison with control group, no changes in haematology, coagulation, clinical biochemistry and in histological examinations of uterus and vagina. Clinical studies (4 open and 1 double-blind) were performed on 93 women suffering from vulvovaginitis and cervicitis by treatment of 0.134% tetridamine vaginal lavage, two times daily, for 7 days. Tetridamine lavage reduced or eliminated all inflammation symptoms like burning, leucorrhea, etc. and resulted very well tolerated. From these pharmacotoxicological and clinical results we can conclude that tetridamine vaginal lavage is a new formulation with high activity and good tolerability.


[Intranasal absorption of various calcitonin spray preparations]. In a cross-over study performed on 10 patients the intranasal absorption of calcitonin contained in three formulation spray was evaluated. One of them contained biliary acid (sodium taurocholate) as the absorption promoting factor while the other two drugs did not. The dosage of calcitonin in blood was effected by means of radioimmunoassay using salmon calcitonin marked with I126 in competition to the one present in the sample for a limited quantity of specific antibodies for salmon calcitonin. The minimum measurable quantity of calcitonin is 10 pg and the response is linear including values between 20% and 80%. It is observed that the plasmatic concentration of calcitonin dosed in different times after administration of the drug containing sodium taurocholate are always significantly higher (Student "t" test for unpaired data, p less than 0.005) than the measurements after administration of the other two drugs. They are about 8 times higher at the first half an hour, about 6 times after an hour and again double at the second hour. The AUC calculated for sodium taurocholate containing drug (1629 pg/ml/h) results significantly higher in relation to the other two drugs (1133 and 926 pg/ml/h) indicating a better bio-availability of calcitonin contained in that spray. The relative bioavailability between calcitonin spray with sodium taurocholate and the other two drugs in reference resulted to 144% and 176%. The presence of a transmucosal absorption promoting factor at the level of a nasal mucosa, represented in this case by sodium taurocholate, enhances significantly the absorption and the bioavailability of calcitonin present in the formulation spray.


Extracapsular spread and the perineural extension of squamous cell cancer in the cervical plexus. Extracapsular spread of squamous cell carcinoma in cervical lymph nodes is associated with approximately 50% decrease in survival and a twofold increase in regional recurrence. This study examines the hypothesis that increased regional recurrence may be, in part, due to unrecognized microscopic perineural invasion of the nerve rootlets of the cervical plexus. Thirty patients with head and neck squamous cell carcinoma with clinically N+ necks undergoing radical neck dissection were prospectively studied. Neck dissection specimens were evaluated for extracapsular spread, and the cervical plexus rootlets were histologically examined for perineural invasion. The incidence of extracapsular spread was 83% (25 of 30 patients). Only one (4%) of 25 had involvement of the cervical plexus, and this patient had gross as well as microscopic cervical plexus invasion. Microscopic perineural spread of squamous cell carcinoma in the cervical plexus occurs infrequently when extracapsular spread is present. Routine histologic evaluation of cervical rootlets for margins is warranted only when gross tumor is in close proximity to the cervical plexus.


Ampicillin-sulbactam vs clindamycin in head and neck oncologic surgery. The need for gram-negative coverage. This study was undertaken to assess whether gram-negative antimicrobial coverage is required in patients undergoing head and neck oncologic surgery. Ampicillin sodium-sulbactam sodium and clindamycin phosphate were compared in a prospective, randomized, parallel, double-blind trial of 212 patients undergoing head and neck procedures involving clean-contaminated wounds. Both antibiotics were given up to 1 hour before surgery and continued at 6-hour intervals after surgery for an additional eight doses. Fourteen infections occurred in the ampicillin-sulbactam-treated group (13.3%) and 29 infections in the clindamycin-treated group (27.1%). From patients receiving clindamycin, 29 gram-negative organisms were isolated, compared with six from those patients receiving ampicillin-sulbactam. This finding supports the need for gram-negative coverage in patients undergoing clean-contaminated head and neck oncologic surgery.


Transmandibular approaches to the oral cavity and oropharynx. A functional assessment. The records of patients undergoing transmandibular approaches to soft-tissue carcinoma of the oral cavity and oropharynx were reviewed retrospectively. Thirty-nine patients requiring lateral segmental hemimandibulectomy and 45 patients requiring a mandibulotomy were identified. None of the patients given mandibulectomy underwent bone reconstruction, while all of the patients with mandibulotomy had repair at the completion of the case. A total of 53 patients were available for recall and functional assessment. Patients with mandibulotomy did not experience significant dysfunction of the temporomandibular joint. Patients with mandibulectomy demonstrated increasing amounts of eccentric occlusion; however, this did not affect diet and was not reported to be uncomfortable by these patients. When feasible, preservation of the mandible yielded an improved aesthetic result; however, functional results in patients requiring mandibulectomy compare favorably with those obtained after mandibulotomy and repair.


Tumor necrosis factor and chemotherapeutic agents. Potentiation of cytotoxicity with interferon gamma. This study examined combinations of the recombinant human cytokines, tumor necrosis factor alpha and interferon gamma, with doxorubicin and dactinomycin as well as other drugs on six squamous cell carcinoma cell lines of head and neck origin using the 3(4,5-dimethylthiazol-2-yl)2,5-diphenyl-tetrazolium bromide proliferation assay. Interferon gamma significantly enhanced the cytotoxicity of tumor necrosis factor alpha with dactinomycin on all six cell lines investigated, while in four of six cell lines the cytotoxicity of tumor necrosis factor alpha with doxorubicin was significantly augmented by interferon gamma. Additional experiments showed no effect with either cytokine in combination with cisplatin, fluorouracil, methotrexate, or etoposide. These data demonstrate that human recombinant cytokines in concert with certain drugs improve in vitro cytotoxicity and may have a potential for improving in vivo therapy.


A study of the heterogeneity of the mucoepidermoid tumor and the implication for future therapies. Mucoepidermoid carcinomas are common head and neck neoplasms whose wide distribution includes the major salivary glands, especially parotid, the minor salivary glands within the oropharynx, sites within the larynx, and the submucosal bronchial glands. These tumors are heterogeneous neoplasms composed of intermediate, squamous, and mucous cell subpopulations and have been traditionally classified as low or high grade based on their histological nature and tendency for invasion and metastasis. To gain a better understanding of the heterogeneity of these tumors, we conducted in-depth studies of the different cellular subpopulations obtained from primary human mucoepidermoid carcinomas from various sites, and a derived cell line grown in monolayer culture and as a nude mouse xenograft. Flow cytometric and clonal dilution studies indicate that the intermediate cell behaves as a reserve cell capable of differentiating into either the squamous cell or mucous cell. Immunocytochemical studies of bromodeoxyuridine uptake and Ki-67 antigen expression indicate that whereas the squamous and mucous cells are terminally differentiated and permanently arrested in G0, the intermediate cell actively enters G1 and S. Studies of invasion utilizing a human amnionic membrane indicate that only the intermediate cell is capable of active invasion. Because the mucous and squamous cells are incapable of further division or invasion, therapeutic strategies aimed at differentiating the intermediate cell in vivo into either mucous or squamous directions would serve as useful adjuncts to surgery by reducing the rate of recurrence and the incidence of metastasis.


Lacrimal drainage system injury in functional endoscopic sinus surgery. Incidence, analysis, and prevention. Injury to the lacrimal drainage system with resultant epiphora is a complication of functional endoscopic sinus surgery. A study of 24 patients was conducted to determine the incidence and significance of lacrimal drainage system injuries during functional endoscopic sinus surgery. Intraoperative testing demonstrated seven occult injuries (15%) in 46 endoscopic procedures. Postoperative testing demonstrated diversion of lacrimal drainage into the middle meatus in two patients and spontaneous healing of the injured lacrimal drainage system with restoration of normal drainage in three of the patients available for follow-up testing. In no patient did epiphora develop. It is concluded that the nasolacrimal drainage system is in close proximity to the dissection cavity during functional endoscopic sinus surgery and, hence, is at risk for inadvertent injury. Occult damage to the nasolacrimal drainage system would appear to be a common event during functional endoscopic sinus surgery; however, the complication of postoperative epiphora is rare.


Relative effects of intraoperative tissue expansion and undermining on wound closing tensions. Intraoperative tissue expansion is advocated as a technique to facilitate closure of soft-tissue wounds with less tension than if they were closed primarily without expansion or, presumably, simple undermining. Few objective studies have been done, however, to validate the technique. We specifically questioned the relative effects of intraoperative tissue expansion and undermining on wound closing tensions in an animal model. Our data showed statistically significant reduction in the force required to close a wound after acute intraoperative tissue expansion when compared with baseline. However, when the degree of undermining achieved by the expander was matched in an equivalent defect, no difference in the resultant wound closing tensions could be discerned between techniques. This study should be viewed as an initial effort to understand the role of intraoperative tissue expansion in reconstructive surgery.


Facial paralysis reconstruction with Gore-Tex Soft-Tissue Patch. No procedure perfectly restores a face paralyzed by surgical ablation of the facial nerve. Although dynamic reconstructive procedures are preferred for treating patients with complete facial paralysis, various conditions contraindicate their use, making static suspension of the paralyzed face a reasonable surgical alternative. Expanded polytef soft-tissue patch (polytetrafluoroethylene; Gore-Tex Soft-Tissue Patch, Gore-Tex, W. L. Gore & Assoc Inc., Flagstaff, Ariz) was used to help correct midfacial and perioral asymmetries in 11 patients with complete unilateral facial paralysis. All patients had previous surgical ablation of the facial nerve and were not considered good candidates for dynamic facial reconstruction. Midfacial and perioral asymmetries were improved in all patients using this technique of static soft-tissue suspension. One postoperative infection and two cases of postoperative suture extrusion were observed in the patient population. Other complications associated with the use of Gore-Tex Soft-Tissue Patch for facial suspension were limited to technical factors.