Steady-state plasma concentrations of cis- and trans-10-OH amitriptyline metabolites

Plasma concentrations of the geometric isomers of 10-OH amitriptyline (10-OH AT) and 10-OH nortriptyline (10-OH-NT) were determined by reversed-phase high-pressure liquid chromatography. Steady-state concentrations of At, NT, and the four 10-OH metabolites were measured in 27 patients taking AT for depression. All of the unconjugated hydroxylated metabolites were usually detectable and trans-10-OH NT always predominated. Mean concentrations, expressed as percentage of the sum of all six compounds, were: AT 30%, NT 27%, cis-10-OH AT 1.1%, trans-10-OH AT 4.0%, cis-10-OH NT 4.0%, and trans-10-OH NT 33%. Repeated measurements on 10 patients over several weeks indicated that interindividual variations in absolute and relative 10-OH metabolite concentrations are much greater than day-to-day variations. Five patients who also received a phenothiazine had a lower proportion of 10-OH metabolites.

Treatment of Methaqualone overdose with resin hemoperfusion

We recently utilized the technique of resin hemoperfusion (employing an Amberlite XAD-4 resin cartridge) to remove drug from a patient i deep coma after an estimated ingestion of greater than 4.5 grams of methaqualone. At plasma flow rates of 204 ml/min, the mean value for plasma clearance of methaqualone was 179 ml/min. The amount of methaqualone recovered from the cartridge at the end of the 10-hour procedure was 1,565 mg measured by gas chromatography. The patient became responsive to deep pain by the end of the procedure. The only complication encountered was a transient decrease in the formed blood elements. The present study verifies that a large, pharmacologically significance quantity of methaqualone can be removed in a short time using resin hemoperfusion.

Antisecretory actions of aminophylline in the rat and dog

The effect of aminophylline on gastric acid secretion has been studied in the rat and dog. Aminophylline was shown to possess antisecretory activity when given either by oral or parenteral administration in an acute gastric fistula rat preparation. In the chronic gastric fistula dog aminophylline at 50 mg/kg intragastrically induced a small but significant stimulation of basal acid secretion. This dose of aminophylline also significantly inhibited acid secretion induced by gastrin tetrapeptide, and 2-deoxy-D-glucose but did not block acid secretion induced by histamine.

Evaluation of histoplasmin for the presence of H and M antigens: some difficulties encountered in the production and evaluation of a product suitable for the immunodiffusion test

The development of a single histoplasmin suitable for use in immunodiffusion testing of a variety of human histoplasmosis sera depends not only upon the presence of both antigens, but on relative concentration of one to the other, and perhaps on the chemical characteristics of the H and M antigens of a given strain.

Renal homotransplantation in pediatric patients

Fifty-seven patients were treated with renal homotransplantation from 1½ to 7⅔ years ago; 23 patients were 12 years or younger and the other 34 patients were 13 to 18. Family members (usually parents) were the primary donors in 45 cases. Unrelated volunteers or cadavers donated the other 12 homografts. Immunosuppression was with azathioprine and prednisone, and in some cases also with ALG. Forty-two of the 57 recipients survived for at least 1 year. Additional deaths occurred at 17½ and 19 months leaving 40 recipients (70.2%) alive. Six survivors had successful retransplantation following late failure of their original homografts. Control of rejection was not particularly different than in adult cases. “Homograft glomerulonephritis” was found in chronically tolerated transplants, but no more frequently than in older patients. Many postoperative problems in the pediatric age group were the consequence of retardation of growth caused either by pre-existing uremia or by the need for high dose postoperative steroid therapy, orthopedic accidents such as femoral and vertebral fractures, and psychiatric complications which led to two suicides. In spite of these difficulties, the meaningful rehabilitation that was obtained in the chronic survivors makes us regard pediatric patients as favorable candidates for therapy with renal transplantation.

Sound-pressure correlates of the aortic ejection sound. An intracardiac sound study

The sound-pressure correlates of the aortic ejection sound (AES) were studied in six patients without aortic valve disease (group 1) and in nine patients with valvular aortic stenosis (group 2) during diagnostic left heart catheterization. Aortic root sound and pressure events were recorded by a catheter-tip micromanometer simultaneously with the external phonocardiogram, indirect carotid pulse, and electrocardiogram. The AES in group 1 patients was coincident with the onset of pressure rise in the aortic root. This relationship was not altered by drug administration, although variations in the amplitude of the AES occurred. It was concluded that the AES in patients without aortic valvular disease is an exaggerated ejection component of the normal first heart sound, and that it is a root phenomenon related to the forceful ejection of blood into the aorta. The AES in group 2 patients was delayed 24 to 40 msec after the onset of pressure rise in the aortic root, was coincident with the anacrotic notch, and introduced the aortic ejection murmur. Aortic root sound and pressure were recorded simultaneously with aortic valve motion during angiography in two patients utilizing a cine trace system. The AES occurred when the domed valve reached its maximal excursion, and the interval between the onset of aortic pressure rise and the AES was equal to the total time required for the piston-like ascent of the dome. It was concluded that the AES in valvular aortic stenosis is valvular in origin. The amplitude of the valvular AES correlated best with valve mobility on the angiogram, and no correlation existed between its presence and the severity of the valvular stenosis.

Left atrial rhythm. Experimental production in man

Various criteria have been proposed for the diagnosis of left atrial rhythm (LAR) in previous experimental and electrocardiographic studies. Differentiation from A-V junctional rhythms remains ill-defined. In order to assess the left atrial (LA) P wave and to define LAR, the P wave and loop were studied by direct LA pacing in 11 patients undergoing diagnostic transseptal left heart catheterization. Experimental LAR produced changes in P-wave configuration and polarity. These changes were most obvious in lead V 1 and indicated reversal of the sequence and direction of activation with left atrial preceding right atrial depolarization. A typical "dome and dart" P wave occurred in two studies. P-wave configuration in leads I and V 6 was highly variable; frequent orientation of the LA P vector within the transitional zone of the horizontal electrical axis was thought to be responsible. The LA P loop showed reversal of the direction of inscription of the initial forces, indicating a change in the pattern of atrial depolarization. Stimulation of the appendage produced left-to-right spread of atrial depolarization, whereas activation of the main body was directed primarily anteriorly. Impulse formation in the right side of the posterior wall was usually directed from right to left. When the postero-inferior area was activated, the anterior P vector became directed superiorly, and resembled that of coronary sinus rhythm (CSR) in the frontal plane.

This study indicates that the P wave in lead V 1 is most important in the diagnosis of LAR; inversion of the P wave in lead V 6 is not essential. LAR can usually be differentiated from CSR, since in the horizontal plane, activation of the LA main body is more anteriorly directed than the spatial P vector of CSR.