[Circadian dependency of ibuprofen gastropathy and the protective effect of ranitidine. An endoscopic, controlled double-blind pilot study]

Circadian Dependency of Ibuprofen Gastropathy and Protective Effect of Ranitidine/An endoscopic, controlled double-blind pilot study. In a randomized parallel double-blind study, the gastric and duodenal effects of 600 mg S(+)-ibuprofen (CAS 15687-27-1) daily in the presence and absence of 300 mg ranitidine (CAS 66357-35-5) was evaluated in 20 healthy volunteers undergoing upper GI-endoscopy. Drugs were taken over a period of 7 days either at 8 a.m. (n = 10) or at 8 p.m. (n = 10). Endoscopic controls were performed at entry and repeated after 7 days of treatment. A damage score according to Lanza et al. was used. At entry both groups showed comparable mucosal damages. 8 a.m.-group: ibuprofen/placebo (stomach) 0.9 +/- 0.1 and 0.0 +/- 0.0 (duodenum); ibuprofen/ranitidine 0.8 +/- 0.1 (stomach) and 0.1 +/- 0.1 (duodenum). 8 p.m.-group: ibuprofen/placebo 0.9 +/- 0.1 (stomach) and 0.2 +/- 0.1 (duodenum); ibuprofen/ranitidine 0.9 +/- 0.1 (stomach) and 0.1 +/- 0.1 (duodenum). After 7 days of treatment the lesion score increased in the ibuprofen/placebo-group in the 8 a.m.-group to 3.2 +/- 1.2 (stomach) and to 0.7 +/- 0.5 (duodenum), and in the 8 p.m.-group to 8.4 +/- 1.9 (stomach) and to 2.9 +/- 1.2 (duodenum). The corresponding values in the ibuprofen/ranitidine-group were 1.8 +/- 0.8 (stomach) and 0.1 +/- 0.1 (duodenum) (8 a.m.-group) as well as 5.1 +/- 1.4 (stomach) and 0.1 +/- 0.1 (duodenum) (8 p.m.-group). The difference between the morning and the evening dose of ibuprofen as well as ranitidine protection reached statistical significance when the corresponding data were pooled (p < 0.05). Our data suggest that the gastrolesive effects of S(+)-ibuprofen are dependent of the time of drug ingestion; protection by ranitidine, however, was time-independent.

Early neuroleptic intervention in schizophrenia: are prodromal symptoms valid predictors of relapse?

All recently completed controlled two-year studies on intermittent, early neuroleptic intervention treatment have failed to compare favourably with studies on maintenance treatment concerning relapse prevention. The reason for this failure is still unclear. Therefore the implicit, but as yet unproven, hypothesis that a relapse can be predicted from prodromal symptoms was tested from the perspective of our German multicentre study. Results demonstrate that this is not the case. Possible reasons for and clinical implications of this negative finding are discussed.

[Cryopreservation of embryos in the in vitro fertilization/embryo transfer program]

An ultra-rapid method for cryopreservation of human embryos, using 1,2-propane-diol, was developed. 280 spare embryos obtained in the IVF program were frozen by this method. 91 embryos were thawed and 68 of them (74.7%) survived the procedure with more than half the blastomeres intact. 65 embryos were transferred in 28 cycles. Two pregnancies developed (7.1%), one of which ended by the birth of a healthy girl (the first birth after transfer of a frozen/thawed embryo in the Czech Republic). The other pregnancy is ongoing.

[Circadian aspects of diclofenac gastroduodenopathy and the protective effect of roxatidine]

The gastrointestinal side-effect profile of non-steroidal anti-inflammatory drugs should follow a circadian rhythm. In a randomized, parallel, double-blind study the gastric duodenal effects of 100 mg diclofenac retard daily in the presence and absence of 150 mg roxatidine was evaluated in 20 healthy volunteers undergoing upper GI-endoscopy. Drugs were taken over a period of 14 days either at 8 a.m. (n = 10) or at 8 p.m. (n = 10). Endoscopic controls were performed at entry and repeated after 14 days of treatment. A damaging score according to Lanza et al. was used. At entry both groups showed comparable mucosal damages: 8 a.m.-group: placebo 0.9 +/- 0.1 (+SEM), roxatidine 0.9 +/- 0.1; 8 p.m.-group: placebo 1.0 +/- 0.0, roxatidine 0.9 +/- 0.1. After 14 days of treatment the lesion score increased in the diclofenac retard/placebo-group in the 8 a.m.-group to 7.6 +/- 1.9 and in the 8 p.m.-group to 7.2 +/- 1.1. The corresponding values in the diclofenac/roxatidine-group were 2.1 +/- 0.9 (8 a.m.-group) and 1.4 +/- 0.4 (8 p.m.-group). This protection afforded by roxatidine was significant when compared with placebo (p < 0.05). Our data suggest that the gastrolesive effects of diclofenac retard are independent of the time of drug ingestion; in addition protection by roxatidine was also time-independent.

[A comparison of the gastroduodenal tolerance of ticlopidine and acetylsalicylic acid]

Changes in the gastroduodenal mucosa caused by 250 mg ticlopidine twice daily (group 1; n = 12) or 300 mg aspirin daily (group 2; n = 12) were compared in a randomized double-blind trial of 24 healthy men, aged 20 to 35 years. An oesophago-gastroduodenoscopy was performed before and after either drug had been taken for 7 days. Results were tabulated according to a uniform scoring system (normal mucosa, erythema, petechiae, erosions, ulcer, and blood in the lumen). Both groups had identical scores at the start of the trial (group 1: 0.9 +/- 0.1; group 2: 0.8 +/- 0.1). After the seven days, the score in group 2 had risen to 9.7 +/- 1.5 (median 9.0), while it had hardly changed in group 1 (1.7 +/- 0.5; median 1.0), a statistically significant difference (P < 0.05). The data indicate that ticlopidine is better tolerated by the gastroduodenal mucosa than low dosage aspirin.

Mathematical modelling of lipid transbilayer movement in the human erythrocyte plasma membrane

A model is presented to simulate transverse lipid movement in the human erythrocyte membrane. The model is based on a system of differential equations describing the time-dependence of phospholipid redistribution and the steady state distribution between the inner and outer membrane monolayer. It takes into account several mechanisms of translocation: (i) ATP-dependent transport via the aminophospholipid translocase; (ii) protein-mediated facilitated and (iii) carrier independent transbilayer diffusion. A reasonable modelling of the known lipid asymmetry could only be achieved by introducing mechanism (iii). We have called this pathway the compensatory flux, which is proportional to the gradient of phospholipids between both membrane leaflets. Using realistic model parameters, the model allows the calculation of the transbilayer motion and distribution of endogenous phospholipids of the human erythrocyte membrane for several biologically relevant conditions. Moreover, the model can also be applied to experiments usually performed to assess phospholipid redistribution in biological membranes. Thus, it is possible to simulate transbilayer motion of exogenously added phospholipid analogues in erythrocyte membranes. Those experiments have been carried out here in parallel using spin labeled lipid analogues. The general application of this model to other membrane systems is outlined.

Influence of age and hemodynamics on myocardial blood flow and flow reserve

BACKGROUND

Aging is associated with changes of the systolic blood pressure that may increase cardiac work and myocardial blood flow at rest and reduce the myocardial flow reserve. This might be misinterpreted as age-related impairment of the coronary vasodilator capacity.

METHODS AND RESULTS

Myocardial blood flow was quantified at rest and after administration of intravenous dipyridamole in 40 healthy volunteers (12 women and 28 men) with 13N-ammonia and positron emission tomography. Eighteen of the normal subjects were less than and 22 were older than 50 years (31 +/- 9 versus 64 +/- 9 years). The resting rate-pressure product was lower in the younger than in the older subjects (6895 +/- 1070 versus 8634 +/- 1890; P < 0.01). Myocardial blood flow at rest averaged 0.76 +/- 0.17 mL.min-1.g-1 in the younger volunteers and 0.92 +/- 0.25 mL.min-1.g-1 in the older volunteers (P < 0.05). Hyperemic blood flows did not differ between younger and older subjects (3.0 +/- 0.8 versus 2.7 +/- 0.6 mL.min-1.g-1; P = NS); however, minimal coronary resistance was higher in the older subjects. Corrected for indexes of coronary driving pressure, hyperemic flow was lower in older than in younger normal subjects. The higher resting blood flows combined with similar hyperemic flows resulted in a lower myocardial flow reserve in the older than in the younger normal subjects (4.1 +/- 0.9 versus 3.0 +/- 0.70; P < 0.0001). The flow reserve was more closely correlated with resting than with hyperemic blood flows.

CONCLUSIONS

Aging does not alter significantly dipyridamole-induced hyperemic flows; although coronary vascular resistance after dipyridamole was somewhat increased in older subjects. The gradual decline of the myocardial blood flow reserve correlates with an age-related increase of baseline myocardial work and blood flow. These findings suggest that the reduced flow reserve with age is primarily due to increased cardiac work and blood flow at rest rather than to an abnormal vasodilator capacity.

Synergism and antagonism between N-methyl-N'-nitro-N-nitroso-guanidine and 9-aminoacridine in mutation induction in Escherichia coli K12

When bacteria were treated simultaneously with N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) and low concentrations of 9-aminoacridine (9AA), the yield of frameshift mutations was much greater than that expected on the basis of independent action of both mutagens. In combination with a high concentration of 9AA, however, MNNG had an antagonistic effect upon the induction of frameshift mutations. There was no synergistic interaction between the two mutagens in bacteria in which the adaptive response to methylating agents had been induced. 9AA not only induced frameshift mutations, but also caused a small increase in reversions of a nonsense (ochre) mutation and, in combination with low MNNG concentrations, it had a small synergistic effect.

[Nizatidine in therapy and prevention of non-steroidal anti-rheumatic drug-induced ulcers in rheumatic patients]

269 patients with various rheumatic disorders who had been treated with non-steroidal anti-inflammatory drugs (NSAID) for at least three weeks, were enrolled in this randomised double-blind multicenter trial. Entry criteria were both the presence of an ulcer in gastric and/or duodenal mucosa (> 3 mm and < 20 mm in diameter) as well as dyspeptic symptoms. The patients had been treated with 150 mg nizatidine nocte (n = 86), 2 x 150 mg/d (n = 93) and 2 x 300 mg/d (n = 90) nizatidine. All patients continued to take their original NSAID-medication. The three nizatidine-groups had been well matched with respect to important patient characteristics. After 8 weeks of treatment more than 90% of gastric and duodenal ulcers had been healed under all three nizatidine-dosages. There was a tendency for higher healing rates in case of gastric ulcers after 4 weeks following the higher dose of nizatidine. Erosions in stomach and duodenum as well as esophagitis had been improved to a similar degree with all nizatidine doses. The same holds with respect to improvement of clinical symptoms such as epigastric pain, heartburn etc. Consumption of additional antacids was similar in all three groups. In the subsequent prophylactic trial 237/221 patients had been followed for 3/6 months. 116/107 received in addition to their continued antirheumatic medication nizatidine 150 mg nocte and 121/114 patients 2 x 150 mg nizatidine daily. The cumulative relapse rates within 6 months averaged 5.5% in the low and 1.8% in the high dose group (n.s.).(ABSTRACT TRUNCATED AT 250 WORDS)

[Selective reduction of multiple pregnancy in the 1st trimester: results and experience in 10 cases]

Ten patients with multiple gestations, all resulting from in vitro fertilization, underwent multifoetal pregnancy reduction. In four cases transvaginal puncture was performed, six patients underwent transabdominal pregnancy reduction. Seven women delivered, all three pregnancy losses occurred in the transvaginal punction group--there was one early loss after the procedure and two abortions in the late second trimester. There were 5 sets of twins and two singletons were delivered. Multifoetal pregnancy reduction represents an important addition to the management of unplanned multifoetal pregnancy resulting from infertility treatment. The procedure is not without risks and these must be weighted against expected benefits.

On the confounding effects of phosphor persistence in oscilloscopic displays

Phosphor persistence has been a source of confounding in studies of temporal integration in vision. We examined the confounding by assessing the effects of the persistence of two commonly-used phosphors (P15 and P31) on performance of a temporal-integration task. In one experiment we eliminated the visibility of phosphor persistence by closing two mechanical shutters upon display termination. In a second experiment we estimated the duration of phosphor persistence by displaying the image behind closed shutters which opened upon display termination. No detectable persistence was every produced by P15 phosphor. By contrast, P31 phosphor produced persistence that lasted several hundred milliseconds even when a veiling light was projected on the screen. We ascribe the earlier instances of confounding to inadequate interpretation of the technical data on phosphor decay.

[Ultrasound velocity measurement in the diagnosis of postmenopausal osteoporosis]

We evaluated ultrasound transmission velocity as an indicator for osteoporosis at the os calcis of both feet and at the proximal phalanges of DII and DIII of both hands in 74 female subjects (22 premenopausal, 29 postmenopausal non-osteoporotic and 23 postmenopausal osteoporotic). In addition dual x-ray absorptiometry (DXA) of the lumbar spine was performed in 30 women and a combined cortical thickness index (CCT-index) of os metacarpale II was calculated from hand radiographs in 29 women. Ultrasound velocity at all sites slightly decreased in premenopausal women with age and declined significantly after menopause. At the hand postmenopausal osteoporotic women had significantly lower velocities than normal postmenopausal or premenopausal women while no difference could be seen at os calcis. An only poor or moderate correlation between ultrasound velocity at all sites and DXA of the lumbar spine and a good correlation between the CCT-index and velocity at the fingers indicate that ultrasound velocity is not only affected by bone density but even more by structural properties.

Genetic analysis of the Rhizobium meliloti exoYFQ operon: ExoY is homologous to sugar transferases and ExoQ represents a transmembrane protein

The nucleotide sequence of a 4.8-kb ClaI-EcoRI DNA fragment of megaplasmid 2 of Rhizobium meliloti Rm2011 involved in succinoglucan (EPS I) synthesis and nodule infection was determined. Four open reading frames (ORFs) were identified on this fragment. A mutational analysis revealed that these ORFs represent genes that were termed exoX, exoY, exoF, and exoQ. The locations of transposon insertions in these exo genes were determined at the nucleotide level. Plasmid integration mutagenesis revealed that the genes exoY, exoF, and exoQ are organized in an operon. The exoX gene running in opposite direction forms a monocistronic transcriptional unit. The exoX gene was shown to negatively influence the amount of EPS I synthesized. The exoY gene is coding for a membrane associated protein homologous to the C-terminal part of the Xanthomonas campestris glucosyltransferase GumD and the Salmonella typhimurium galactose transferase RfbP. ExoF, a probable periplasmatic protein, is nearly identical to the protein encoded by ORF1 of Rhizobium sp. strain NGR234. ExoQ is most probably a membrane associated protein as deduced by its hydrophobic structural features. All three genes of the exoYFQ operon were shown to be essential for succinoglucan synthesis and nodule infection.

[High-dose ranitidine protects stomach and duodenum completely against piroxicam. An endoscopic double-blind pilot study]

In a randomized placebo-controlled parallel and double-blind study the gastroduodenal effects of 20 mg piroxicam daily was evaluated endoscopically in the presence of ranitidine 150 mg bid or 300 mg bid in 31 healthy volunteers. Drugs were taken over a period of 14 days. Endoscopies were performed at entry and repeated after 14 days of treatment. A damage-score according to Lanza was used. At entry, all groups showed comparable mucosal damages in the stomach and in the duodenum. After 14 days the mean lesion score increased in the piroxicam/placebo group (group A) to 4.5 +/- 1.6 (+/- SEM) in the stomach and to 2.7 +/- 0.8 (+/- SEM) in the duodenum. The corresponding values in the piroxicam/ranitidine 150 mg bid group (group B) were 3.3 +/- 1.2 (stomach) (p > 0.05 vs. group A) and 1.4 +/- 0.7 (duodenum) (p < 0.05 vs. group A). The values in the piroxicam/ranitidine 300 mg bid group (group C) averaged 1.0 +/- 0.0 (stomach) and 0.3 +/- 0.1 (duodenum) (for both p < 0.05 vs. group A). Our data suggest that profound acid inhibition--achieved by doubling the usual dose--afforded complete protection of human stomach and duodenum against piroxicam.

Dose-range finding study with the proton pump inhibitor pantoprazole in acute duodenal ulcer patients

Pantoprazole is a newly developed benzimidazole derivative with strong inhibitory actions on gastric acid secretion by blocking H(+)-K(+)-ATPase. This randomized double-blind multicenter trial investigated the efficacy of 20 mg, 40 mg and 80 mg pantoprazole o.m. on ulcer healing and symptomatic relief in 219 out-patients with endoscopically assessed acute duodenal ulcer. After 2 weeks complete ulcer healing was achieved in 58%, 89% and 82% of the patients with 20 mg, 40 mg and 80 mg pantoprazole o.m., respectively. After 4 weeks, corresponding figures were 93%, 99% and 100%; the difference of the healing rates between the 20 mg and 40 mg groups at 2 weeks was statistically significant (p < 0.0001). A rapid pain relief was achieved in all treatment groups: 72% of the 20 mg group, 89% of the 40 mg group, and 84% of the 80 mg group were pain-free after 2 weeks. The difference between 20 mg and 40 mg was statistically significant (p < 0.05). Pantoprazole was well tolerated. Adverse events occurred in 13 patients; headache, skin alterations, and diarrhea were reported most frequently. Severity and frequency of adverse events did not reveal any dose-dependence. In conclusion, pantoprazole provides fast healing of acute duodenal ulcer as well as rapid improvement of ulcer symptoms. For further clinical trials in peptic ulcer disease a daily dose of pantoprazole 40 mg o.m. is recommended.

[Hypohidrotic ectodermal dysplasia as the cause of recurrent hyperthermia in a young infant]

Fever--the most frequent symptom of diseases in children--points diagnostically to an infection. We report on a child who presented with recurrent high fever of unknown origin. Infectious diseases could be excluded. During a general medical checkup the results of repeated pilocarpine iontophoresis attracted attention by the minimal secretion of sweat. The diagnosis of hypohydrotic ectodermal dysplasia could be confirmed by dermal biopsy since all integumentary appendages were missing. Only 300 cases of this rare hereditary dysplasia can be found in the literature.

[Ultrasonic velocity measurements at weight-bearing and non-weight-bearing sites of the peripheral skeleton. The effect of physical activity in soccer players]

Ultrasound transmission velocity at the appendicular skeleton is determined by elastic properties of the bone as mass density. We evaluated ultrasound transmission velocity at the os calcis of both feet and at the proximal phalanges of DII and DIII of both hands in 51 male subjects. 28 of them were professional soccer players of the 1st German division, 11 subjects performed non-professional exercise in various athletic organisations regularly and 12 did not exercise at all. A significant difference in the speed of sound could be seen at os calcis, where the soccer players had higher velocities than the other groups. The differences between the groups at the upper and lower extremities suggest that changes in ultrasound transmission velocity are not only affected by structural changes in the aging skeleton, as it might be suggested by age differences, but by exercise. Physical exercise can change the properties (structure and/or density) of weightbearing bone and this can be detected by measuring ultrasound velocity.

The influence of age on the pharmacokinetics of aditoprim in pigs after intravenous and oral administration

Some pharmacokinetic parameters of aditoprim were determined in 3- and 6-month-old pigs. After intravenous administration of 5 mg/kg body weight, the mean total body clearance of the older pigs was smaller than that of the younger pigs. This difference was not reflected in the elimination half-life. After oral administration of 5 mg/kg body weight, the mean absorption rate constant was smaller and the mean absorption half-life was longer in the older pigs. The age-related changes in the pharmacokinetics of aditoprim were not sufficiently pronounced to suggest the necessity of modifying the oral dosage regimen in pigs of this age range. The favourable pharmacokinetics of aditoprim in pigs (large apparent volume of distribution, long elimination half-life and high bioavailability) may permit introduction of this drug into swine practice, after safety and residue depletion studies.

Life-threatening allergic reaction to clozapine

Clozapine, an 'atypical' antipsychotic drug, rarely induces allergic complications, which usually present as cutaneous reactions. We report the case of a 69-year-old woman, suffering from chronic schizophrenia, who developed an allergic asthmatic reaction following clozapine therapy. Intensive-care treatment was necessary. The reaction could be repeated by further exposure to the drug. Skin tests for hypersensitivity were negative.

[Effect of combined pharmaco- and psychotherapy in schizophrenia ambulatory care on rehospitalization incidents and treatment costs]

For a total of 89 outpatients of a schizophrenia outpatient clinic, the times of hospitalization up to 5 years before treatment in this institution, have been compared to the frequency of rehospitalization within up to 5 years of posthospital care. This treatment contained between 1 1/2 and 2 years neuroleptic medication (one half as long-term prophylaxis, the other half as interval medication) and psychotherapy in form of single talk of partly in groups for patients and their relatives. Thru this, the duration of hospitalization, before 10 weeks by average per anno, could be reduced to 2.1 weeks yearly. Time-intensive and multi-dimensional posthospital care able to reduce the duration of hospitalizations essentially. This has also a positive influence on the total costs of treatment. The positive effect lasts only in part, by the end of posthospital care the times of rehospitalization increase slightly, especially by repeated sick patients.