Pharmacokinetics of reboxetine in healthy volunteers. Single oral doses, linearity and plasma protein binding

The pharmacokinetics of reboxetine, a new antidepressant agent, were found to be close to linear in a crossover study comparing administration of single 2, 3, 4, and 5 mg capsule doses in 15 healthy male volunteers, and in the same study the capsules were bioequivalent to the proposed therapeutic tablet formulation (4 mg). Kinetic analysis was based on HPLC assay of reboxetine in plasma and urine collected up to 72 h after each administration. Plasma levels indicated a rapid absorption (tmax approximately equal to 2 h) and an elimination half-life of about 13 h. Clearance and volume of distribution were modest (ratios to bioavailability: CL/F approximately equal to 29 mL min-1; Vz/F approximately equal to 32 L); urinary excretion was approximately 9% of dose, corresponding to a renal clearance of only 3 mL min-1 (a value consistent with the rate of glomerular filtration of unbound drug). In vitro, binding to plasma proteins, estimated from radioactivity levels following dialysis of 14C-labelled reboxetine, appeared to be dominated by alpha 1-acid glycoprotein without marked saturation up to plasma concentrations of over 500 ng mL-1 (2.8-3.1% unbound with human plasma from three additional volunteers; 1.8-2.0% for 2 gL-1 orosomucoid alpha 1-acid glycoprotein, and 46.4-47.4% for 40 g L-1 albumin), whilst the mean Cmax in the current study was much lower (164 ng mL-1 after a 5mg dose).

Neuroendocrine responses to intravenous infusion of arecoline in patients with Alzheimer's disease

We have reported that arecoline, a muscarinic receptor agonist replicably enhanced verbal memory in five of nine subjects with Alzheimer's disease (AD). To investigate the mechanism of cognitive improvement, circulating hormone measurements were made during high-dose acute and low-dose chronic intravenous (i.v.) arecoline administration to AD patients. Acute hormone responses were measured during, and for 6 h after, infusion of arecoline 5 mg i.v. over 30 min. Chronic responses were measured in cognitive responders during continuous i.v. infusion of arecoline escalating over 2 weeks (0.5-40 mg/day) and then during a 1 week infusion of the dose optimizing cognition (4-16 mg/day). Acute arecoline administered to 14 subjects produced unpleasant side-effects (e.g. nausea, vomiting), mean adrenocorticotrophic hormone (p = .0006), cortisol (p = .0001) and beta-endorphin (p = .0001) levels were elevated. During chronic arecoline treatment, no side-effects occurred and plasma cortisol, adrenocorticotrophic hormone and beta-endorphin levels were unchanged in nine subjects overall and in five cognitive responders. Thus, high-dose arecoline activates the hypothalamic-pituitary-adrenal (HPA) axis and may increase other anterior pituitary hormone levels, likely representing a 'stress response', but cognition-enhancing, low doses of arecoline do not produce a glucocorticoid response. Hence, arecoline-induced memory improvement is not due to the induction of 'stress' nor to the elevation of peripheral corticosteroid levels.

Anterior cruciate ligament mechanoreceptors. Histologic studies on lesions and reconstruction

The fate of mechanoreceptors was studied in torn and reconstructed anterior cruciate ligaments in animals and in humans. In untreated anterior cruciate ligament lesions in humans, morphologically normal mechanoreceptors remained in the ligament for 3 months after the injury. After that time, their number gradually decreased. By the 9th postinjury month, only a few free nerve endings were present. Even free nerve endings were totally absent in the biopsy specimens from 1-year-old lesions. In experimental animals, anterior cruciate ligament reconstruction with autologous patellar tendon resulted in the presence of mechanoreceptors in the reconstructed anterior cruciate ligament. When an artificial ligament was used, no mechanoreceptors were found. Morphologically normal mechanoreceptors were present in 2 patients with a lax biologic anterior cruciate ligament reconstruction 9 and 10 years after the operation.

Medial patellar synovial plica syndrome: the influence of associated pathology on long-term results

The results obtained after 4-8 years in 42 patients submitted to arthroscopy for the treatment of medial patellar synovial plica syndrome are analyzed. There was a considerable difference in the values obtained depending on whether the plica was isolated, or associated with meniscal or cartilaginous lesion. In fact, based on the Lysholm score, treatment of isolated plica obtained 17 excellent or good results in 21 patients, while in the 21 cases where the lesion was associated with other pathologies excellent or good results were observed in only 9 subjects. Thus, associated lesions definitely influence long-term results.

Central nervous system imaging in reevaluation of patients with neurofibromatosis type 1

We report the results of the reevaluation of 24 patients with neurofibromatosis type 1 (NF1) using central nervous system (CNS) imaging techniques. The first examination by computed tomography (CT) or magnetic resonance imaging (MRI) indicated the presence of optic glioma in three cases, "unidentified bright objects" (UBOs) in six, and a suspected right frontal tumor in one. In two patients optic glioma and UBOs were both present and in one of them a bulbar tumor was also suspected. Later imaging examinations revealed the appearance of optic glioma in three more cases and UBOs in nine. In two of these patients both optic glioma and UBOs were present. This study indicates that the likelihood of detecting imaging abnormalities in patients with NF1 increases when systematic follow-up is performed. Optic gliomas are characteristic of pediatric patients; they rarely give rise to clinical manifestations (1/6 cases) and in general progress very slowly. For these reasons, therapeutic strategy must be carefully considered and individually decided. UBOs are very frequent findings in pediatric patients with NF 1 and therefore they must be considered diagnostically relevant. They are not related to clinical manifestations and spontaneous regression has been observed. The nature of these imaging abnormalities is still unknown, but because they do not behave like tumors, useless and dangerous therapeutic procedures should not be employed.

Relationship between café-au-lait spots as the only symptom and peripheral neurofibromatosis (NF1): a follow-up study

We re-examined 21 children with the possible diagnosis of peripheral neurofibromatosis (NF1) based on the presence of café-au-lait (CAL) spots as the single clinical finding. We evaluated whether "typical" or "atypical" appearance of the spots was important for the final diagnosis and whether the co-existence of other non-specific signs (e.g. pectus excavatum) were of any significance for the final diagnosis. In 8/14 (57.1%) cases with "typical" CAL spots, the diagnosis of NF1 was finally established on the basis of other criteria. For the other 6 patients the diagnosis is not yet definitive but highly probable on the basis of the presence of macrocephaly, pectus excavatum and/or MRI findings. Only one patient among five with "atypical" CAL spots possibly has NF1.

Diagnosis of neurofibromatosis type 1 using RFLPs tightly linked to gene

This study reports the results of a linkage analysis in nine families with members who had neurofibromatosis type 1 (NF1), using five restriction fragment length polymorphisms (RFLPs) tightly linked to the NF1 locus. The purpose of this analysis was to determine whether the at-risk individuals were carrying the NF1 allele and whether the nine families would be informative for prenatal testing. The families included 25 patients with NF1, 3 individuals at risk for NF1, and 11 unaffected subjects, with a total of 39 family members and 12 matings. In 6 matings two or more flanking probes were informative, in 3 matings only one probe was informative, and in the other 3 no probe was informative. DNA linkage analysis showed with more than 98% probability that the 3 at-risk individuals did not carry the NF1 mutation. No recombination events were observed. In 6 families it will be possible to do a DNA prenatal diagnosis if this type of test is requested. The NF1 gene has been identified and direct testing for the NF1 mutation is now possible. Linkage testing, however, will probably remain useful and complementary to direct analysis of the NF1 gene to reveal intragenic recombination events and for diagnosis in families in which the detection of mutation is difficult.

Memory improvement without toxicity during chronic, low dose intravenous arecoline in Alzheimer's disease

Arecoline, a cholinergic agonist, administered at low doses by continuous intravenous infusion for up to 2 weeks, significantly and replicably improved memory in five of nine subjects with mild-moderate Alzheimer's disease. During dose finding, performance on a verbal memory task improved with an inverted U-shaped relation to dose. Six of nine subjects were classified as responders. During blinded, placebo-controlled, individualized optimal dosing for 5 days, verbal memory again improved in five of six responders but not in any non-responder. No adverse drug effects occurred. Arecoline, and possibly other cholinergic agonists, can safely improve memory in Alzheimer's disease at doses much lower than previously studied.

[Surgical treatment of inguinal hernias with local anesthesia]

Fifty-nine cases of inguinal hernia repair with local anesthesia are shown. The authors stress the advantages of this safe technique permitting an immediate postoperative ambulation and an early discharge of patients, thus reducing complications related a long term bed-stay.

Evaluation of four different methods for platelet freezing. In vitro and in vivo studies

This report describes our experience with various techniques for the freezing of platelet-rich plasma, removed from the final product after leukapheresis procedures performed on 14 hematological patients. A total of 194 platelet units were frozen for subsequent autologous transfusion, by the following four methods: (1) 6% dimethyl sulfoxide (DMSO); (2) a combination of 5% DMSO/6% hydroxyethyl starch; (3) 3% glycerol; (4) 5% glycerol/4% glucose. Each technique was evaluated by measuring the percentage of platelet recovery, malondialdehyde (MDA) production, and lactate dehydrogenase release. To investigate the safety and therapeutic effectiveness of the previously frozen platelets, in vivo comparison of four platelet freezing methods was made in 8 thrombocytopenic patients, using corrected platelet increment (CCI), determined at 24 h. Our in vitro results indicate that the cryopreservation with 6% DMSO, without controlled cooling rate, provides significantly (p less than 0.05) greater platelet recovery (75%) as compared to other systems. The decrease of MDA production and the increase in plasma lactate measured after the thawing process was less in the DMSO-frozen units than in the other platelet units. When platelets, cryopreserved by this method, were subsequently transfused into patients, a significantly better CCI (greater than 5,000/microliters) was obtained. In our series, 6 patients were entirely supported with frozen autologous platelets. It appears from this study that a better understanding of the physical and biochemical events occurring during the freezing process will improve platelet cryopreservation, allowing a more systematic use of frozen platelets in the support of thrombocytopenic patients.

Density gradient separation of hematopoietic stem cells in autologous bone marrow transplantation

Recently, the principles of density gradient cell separation have been transferred to the marrow fractionation, and the Ficoll technique by using a COBE 2991 blood cell processor has been developed and widely employed as well. This method is particularly useful in view of a chemical antineoplastic purging intended for autologous marrow transplantation. Forty marrows, which derived from patients suffering with leukemia and lymphoma, were fractionated with Ficoll on a COBE machine and in vitro purged with Mafosfamide at a dose of 50 micrograms/ml/1 x 10e7 MN cells. The density gradient separation enables to reduce the initial volume to 10%, the contaminating RBC to less than 1%, the total nucleated cells to 25% (greater than 80% of MNC) sparing about 80% of the CFU-GM. After purging, the surviving hemopoietic progenitor cells were 2.5%. The clinical effects of the fractionated purged cells were studied in 11 autotransplanted patients and compared with 14 transplants performed with untreated buffy-coat marrow derived cells. Ficoll cells produced less adverse effects at the time of reinfusion, while, as expected, the time of hematopoietic recovery was delayed in these patients (mafosfamide treated cells). These results confirm the usefulness of the gradient density cell separation to reduce the side effects of the DMSO and to make reliable the Mafosfamide purging manoeuvre, preventing the interference of contaminating RBC aldehyde dehydrogenase.

Effects of acute infusion of the muscarinic cholinergic agonist arecoline on verbal memory and visuo-spatial function in dementia of the Alzheimer type

1. Treatment of patients with dementia of the Alzheimer type (DAT) with arecoline, a muscarinic cholinergic receptor agonist, reportedly improves performance on a picture recognition memory task, but not on other memory measures. To examine further possible performance improvements following arecoline treatment, patients with DAT were treated with a 30 min intravenous infusion of arecoline (5 mg). 2. Psychometric testing was done at five time points (two before and three following the infusion). Patients were tested on a memory task (Buschke selective reminding) and a test of visuo-spatial performance (figure copying). 3. No net change from baseline was seen in mean scores following arecoline infusion. However, the changes in performance on the two tasks were correlated (p less than 0.02) over subjects at 10 min but not at 1.5 or 5.5 hr following the infusion. 4. This result suggests that although individual patients vary in their response to a given dose of arecoline, their responses are consistent across types of tasks. Thus the lack of a mean drug effect may be due to individual differences in response rather than to a lack of response.

Pharmacological mobilization of haemopoietic progenitor cells in human peripheral blood

We investigated Prednisone (PRD) and Folinic Acid (FA) ability to recruit stem cells (CFU-S) into the circulating compartment, evaluating CFU-GM, BFU-E and CFU-GEMM count increases in peripheral blood (PB). Fifteen healthy donors were administered 75 mg PRD in one trial, and 15 mg FA p.o. through 5 consecutive days in another trial. We observed a significant expansion for BFU-E and CFU-GEMM compartments, though not parallelled by CFU-GM expansion. FA determined a significant increase in CFU-GM on the 5th day of administration, as well as in BFU-E on day 7. It fails to raise CFU-GEMM. The authors suggest a less empiric persuing for such attempts to optimize the use of non-chemotherapic drugs to recruit hemopoietic precursors into PB, so that these can suit to meet stem cell needs for autologous and allogeneic transplantations.

Collection of peripheral blood stem cells in normal donors

Although committed progenitor cells have been harvested during the standard plateletpheresis, only few experiences were specifically carried out in normal donors. The major drawback is the very low number of circulating haemopoietic stem cells and, besides a donor manipulation, a good harvesting technology is a fundamental prerequisite. To verify the effectiveness of an automate system, twenty normal volunteer donors were randomly assigned to four protocols of simultaneous PBSC and platelet collection. A Baxter separator CS 3000 was employed and we compared the yields and the efficiency of the modified Program 1 plus isoradial chamber (Protocol A), the modified Program 1 plus granulo chamber (Protocol B), the standard Program 3 plus isoradial chamber (Protocol C) and the standard Program 3 plus granulo chamber (Protocol D). The absolute yields for WBC (x10(9)), MNC (x10(9)), platelets (x10(11)) and CFU-GM (x10(4)) were respectively: 10.4, 10.1, 6.5 and 29.5 for Protocol A; 10.1, 9.9, 5.2 and 14.7 for Protocol B; 10.0, 9.9, 5.2, 14.7 for Protocol C, and 12.7, 12.4, 6.8 and 57.4 for Protocol D. The best CFU-GM efficiency was achieved with Protocol D (33%) vs. Protocol A (27.5%), Protocol B (14.5%) and Protocol C (27%). The above differences, although remarkable, were not statistically significant. Though preliminary, this study demonstrates the feasibility of a combined platelet and PBSC collection in normal donors.

Human bone marrow processing using Cobe 2991 and CS 3000 blood cell separators for further ex vivo manipulation

Several automated procedures are now available to enrich stem cells from large bone marrow (BM) volumes prior to ex vivo treatment or cryopreservation. This report details our experience using a ficoll-hypaque (F/H) gradient on Cobe 2991 cell washer and a CS 3000 continuous flow separator, on 90 BM processed for allogeneic and autologous transplantation. In the Cobe series, from 70 BM aspirates, 89 +/- 5% of the original mononuclear cells (MNC) was found in the light density fraction with a erythrocytes (RBC) and granulocytes (PMN) removal of 98 +/- 1 and 97 +/- 4.5%, respectively. Over 80% of the initial myeloid precursors (CFU-GM) were recovered in a small final volume. Twenty BM processing were performed with a CS 3000 separator using program "3" and granulo chamber. This technique yielded 86 +/- 9% of the initial MNC while 85 +/- 10% of RBC and 90 +/- 1.1% of PMN was removed. Over 75% of the original CFU-GM was recovered in the final product. Both techniques are effective to large-scale purification of progenitor cells and readily available as routine procedures for marrow processing.

Autologous blood stem cell transplantation as intensive consolidation therapy in hematological malignancies

Ten consecutive patients (pts), suffering from hematological malignancies (5 NHL, 3 ANLL and 2 HD), received high doses of radio-chemotherapy and autologous peripheral blood stem cell (PBSC) transplantation. Seven of them were in 1st CR, two in 3rd CR and one in refractory status. The recruitment of PBSC was performed during the conventional non-intensive schedule of therapy. The median interval between the remission and the transplant was 6 months (3-15). The pts received a median of 0.96 x10(9) MNC/Kg b.w. and of 3.8 x10(4) CFU-GM/Kg b.w. Hemopoietic recovery occurred promptly and the median number of days to reach WBC greater than 1.0 x10(9)/L was 10 (7-15), PMN greater than 0.5 x10(9)/L was 12 (10-34), platelets greater than 50 x10(9)/L was 13 (10-41) and reticulocytes greater than 20 x10(9)/L was 12 (10-15). Three pts relapsed after 14, 12 and 6 months, respectively. Two of them achieved a further remission and one died. The remaining seven, are alive and disease-free with a follow-up of 11 months (range 2-27).

Concomitant purification of prostatic carcinoma tumor markers from human seminal fluid under nondenaturing conditions

We report a protocol for concomitant purification to homogeneity of both prostatic acid phosphatase [orthophosphoric-monoester phosphohydrolase (acid optimum), EC 3.1.3.2] and prostate-specific antigen, from human seminal fluid. The method requires only two chromatographic steps: passage through an Affigel-Blue column and gel filtration HPLC. This is a fast, efficient procedure for purification of these two important tumor markers, which are specific for prostatic cancer.

Concomitant purification of prostatic carcinoma tumor markers from human seminal fluid under nondenaturing conditions

We report a protocol for concomitant purification to homogeneity of both prostatic acid phosphatase [orthophosphoric-monoester phosphohydrolase (acid optimum), EC 3.1.3.2] and prostate-specific antigen, from human seminal fluid. The method requires only two chromatographic steps: passage through an Affigel-Blue column and gel filtration HPLC. This is a fast, efficient procedure for purification of these two important tumor markers, which are specific for prostatic cancer.

Seven-day storage of single donor platelets in polyolefin bags: clinical, biochemical, morphological and microbiological evaluation

We compared the in vitro and in vivo function of fresh and stored platelet concentrates (PCs) collected by an automated continuous-flow blood cell separator (CS 3000 Fenwal) in a closed-system apheresis kit in order to evaluate the possibility of extending the storage time to seven days with the polyolefin container (PL-732). The initial 220 ml platelet volume (5.14 +/- 1.23 x 10(11) was divided into two parts. Half was transfused and the other half was stored for 7 days. All cultured units were negative for bacterial contamination. Mean counts for fresh and stored platelets were respectively 2.34 +/- 0.59 and 2.17 +/- 0.50 X 10(11)/100 ml of PCs (mean recovery 88.7 +/- 11.9%). The pO2 levels were maintained during storage (179.9 +/- 30.5 mmHg) but pCO2, pH, LDH, osmolality, glucose consumption, bicarbonates, ATP, and osmotic stress values changed significantly after 7 days storage. From a clinical point of view, in 14 patients receiving a total of 38 PC transfusions no statistically significant change in corrected post-transfusional levels was observed between fresh and stored PC. Biochemical and morphological data and clinical results suggest that PCs collected with CS-3000 blood cell separator in a closed system and stored for 7 days in polyolefin bags (PL-732) can be satisfactorily employed in clinical practice.

Enrichment of marrow hemopoietic progenitor cells using a blood cell processor

A total of 93 bone marrows (BM) from normal donors and patients were processed using the IBM-COBE 2991 blood cell washer to produce a concentrated buffy coat (BC) for either bone marrow transplantation (BMT) or cryopreservation for subsequent autologous BMT. The reduction in volume was 73.3 +/- 8.5% and nucleated blood cells (NBC) recovery was 87.1 +/- 9.1% of original marrow. Red blood cell (RBC) and platelet (PLT) contamination was reduced 64.5 +/- 10.9% and 41.2 +/- 24.1%, respectively. Clonogenic activity indicated that the NBC fraction was highly enriched in hematopoietic progenitor cells (greater than 100%) as assessed in vitro (CFU-GM). Results were not affected by diagnosis, initial marrow volume or cell count of the BM suspension. We conclude that this is a simple and reproducible method using blood bank, facilities and permits BC preparation from BM without significant loss of hematopoietic progenitor cells.