Structure-activity relationships of the delta-opioid-selective agonists, deltorphins

Deltorphins are naturally occurring peptides with high affinity and selectivity for delta-opioid receptors. They share with dermorphin, another mu-selective opioid agonist, the same N-terminal tripeptide Tyr-D-Xaa-Phe, where D-Xaa is a D-Ala or a D-Met residue. This common sequence appears to be essential for the best fitting of the peptides to both mu- or delta-opioid sites. We studied the changes in receptor affinity and selectivity and in biological potency of deltorphins due to shortening of the sequence, C-terminal deamidation or single amino acid substitutions. The results support the view that a code addressing the molecule towards delta-opioid sites is expressed in the C-terminal region of these peptides. This addressing domain confers high delta-selectivity to the ligand in the following two ways: (i) increased affinity for delta-sites; (ii) decreased affinity for mu-sites. The sequence of the C-terminal tripeptide appears to be responsible for the high delta-affinity of the molecules. Negatively charged side chains inhibit mu-binding and enhance delta-selectivity.

cDNAs encoding [D-Ala2]deltorphin precursors from skin of Phyllomedusa bicolor also contain genetic information for three dermorphin-related opioid peptides

We present the structure of four precursors for [D-Ala2]deltorphins I and II as deduced from cDNAs cloned from skin of the frog Phyllomedusa bicolor. These contain the genetic information for one copy of [D-Ala2]deltorphin II and zero, one, or three copies of [D-Ala2]deltorphin I. In each case, the D-alanine of the end product is encoded by a normal GCG codon for L-alanine. In addition, the existence of three peptides related to dermorphin was predicted from the amino acid sequence of the precursors. These peptides were synthesized with a D-alanine in position 2 and their pharmacological properties were tested. Two of them, [Lys7]dermorphin-OH and [Trp4,Asn7]dermorphin-OH, were found to have roughly the same affinity and selectivity for mu-type opioid receptors as dermorphin.

[Opioid analgesia during extracorporeal shockwave lithotripsy of gallstones]

Gallstone lithotripsy is a new and noninvasive therapeutic option for approximately 20% of patients who harbor cholesterol gallstones. Technologically advanced second-generation lithotripters such as the Dornier MPL 9000 device have greatly simplified biliary lithotripsy with a consecutive reduction in anesthetic requirements. Despite these technical improvements, patients still can experience considerable pain and discomfort during biliary ESWL. Due to its relatively predictable pharmacokinetic profile and its short duration of action, alfentanil appeared to be a suitable drug for pain relief during stone fragmentation. In order to analyze the degree and distribution of pain during gallstone lithotripsy and to evaluate pain control by alfentanil, 44 consecutive patients (ASA I-II) with no previous ESWL therapy were studied. Pain intensity and degree of opioid-induced sedation during shock wave application were evaluated according to 5-point verbal scales that ranged from 0 = no pain to 4 = unbearable pain and 0 = patient awake to 4 = patient asleep. All patients were treated while in the prone position and received oxygen at 6 l/min. After stone focusing, an alfentanil infusion at an initial rate of 2.5 micrograms/kg min was started. Single shock waves were released as test shocks after approximately 2 min. If they were well tolerated, stone fragmentation was begun. If not, more alfentanil was allowed to accumulate until continuous treatment was tolerated. Further in- or decreases of the infusion rate were titrated according to patient response. Registered variables included the required alfentanil loading dose, maintenance and total doses, and the applied shock wave energy approximated by multiplication of shock wave number and voltage squared.(ABSTRACT TRUNCATED AT 250 WORDS)

Deltorphins: a family of naturally occurring peptides with high affinity and selectivity for delta opioid binding sites

Deltorphins are endogenous linear heptapeptides, isolated from skin extracts of frogs belonging to the genus Phyllomedusa, that have a higher affinity and selectivity for delta opioid binding sites than any other natural compound known. Two deltorphins with the sequence Tyr-Ala-Phe-Asp(or Glu)-Val-Val-Gly-NH2 have been isolated from skin extracts of Phyllomedusa bicolor. The alanine in position 2 is in the D configuration. These peptides, [D-Ala2]deltorphins I and II, show an even higher affinity for delta receptors than the previously characterized deltorphin, which contains D-methionine as the second amino acid. These peptides show some similarity to another constituent of Phyllomedusa skin, dermorphin, which is highly selective for mu-opioid receptors. These peptides all have the N-terminal sequence Tyr-D-Xaa-Phe, where D-Xaa is either D-alanine or D-methionine. While this structure seems to be capable of activating both mu and delta opioid receptors, differences in the C-terminal regions of these peptides are probably responsible for the observed high receptor selectivity of dermorphin and deltorphin.

Inflammatory pathology of the genital tract and male infertility. A short review

The relationship between non-specific infections of the male genital tract (i.e. infections other than gonorrhea and genital tuberculosis) and male or couple infertility/subfertility still reassess various problems related to this important subject and to complement it with some original observations from our clinical experience. The reader is also invited to refer to a previous paper by Gattuccio et al. (1988), which more specifically addresses the question of the inflammatory diseases of the prostate gland.

Deltorphin, a novel amphibian skin peptide with high selectivity and affinity for delta opioid receptors

With a cDNA library prepared from skin of Phyllomedusa sauvagei, the sequence of the precursor of dermorphin was elucidated recently. The sequence suggested the existence of another peptide, distantly related to dermorphin. Two variants of this peptide have now been synthesized containing either L- or D-methionine as the second amino acid. The peptide containing the D-methionine exhibited high-affinity and selectivity for delta opioid receptors in the mouse vas deferens and in rat brain homogenates. Moreover, using the synthetic peptide as marker, we could isolate small quantities of the corresponding natural peptide containing D-methionine as the second amino acid from skin extracts of Phyllomedusa sauvagei. The name deltorphin is proposed for this new peptide and its sequence is Tyr-D-Met-Phe-His-Leu-Met-Asp-NH2.

Sulbactam/ampicillin versus cefotetan in the treatment of obstetric and gynecologic infections

In an open, randomized clinical study, the safety and efficacy of sulbactam/ampicillin was compared to that of cefotetan in 95 hospital patients with gynecologic or obstetric infections. Sulbactam/ampicillin (1 g:2 g), was administered intravenously every 8 h to 46 patients, and cefotetan (2 g) was administered intravenously every 12 h to 49 patients. All 23 patients with obstetric infections and 18 of the 23 patients with gynecologic infections treated with sulbactam/ampicillin were evaluated as cured. All 21 patients with obstetric infections and 23 of the 28 patients with gynecologic infections treated with cefotetan were evaluated as cured. No side effects requiring discontinuation of therapy or reduction of the dose administered, were observed.

Doppler examination in varicocele. A standard method of evaluation

Doppler sonography is considered a reliable method for detecting reflux due to venous valvular incompetence, which occurs in varicocele. It is, however, a matter of debate whether the characteristics of this reflux can be correlated quantitatively in a clinical setting. In this study, a two-step method was utilized to identify reflux in basal conditions with the patient standing and breathing spontaneously and to determine the time of centrifugal secondary venous reflux of the distal spermatic cord during the squeezing and relaxing maneuver. This method is closely related to that used by the vascular surgeon to detect valvular incontinence of the saphenous vein. Since Doppler sonography is much more reproducible than Valsalva's maneuver, it is therefore much more reliable. In a 12-month period, 625 patients with pathologic findings in at least two spermiograms were studied. Thirty percent showed constant basal reflux not influenced by respiratory exhilation. The squeezing and relaxing maneuver induced secondary reflux longer than 1.6 seconds in 17%, between 0.8 and 1.6 seconds in 17% and less than 0.8 seconds in 36% of the patients. The higher sensitivity and specificity of Doppler examination compared with thermography and angiography, as well as its low cost and noninvasiveness, make this the procedure of choice in the diagnosis of venous reflux in varicocele.

Serum and salivary CEA and GICA levels in oral cavity tumours

The gastrointestinal cancer-associated antigen (GICA) is recognised by a monoclonal antibody in both serum and tissues of patients with neoplasm of the GI tract. This study compared the serum and saliva values of carcinoembryonic antigen (CEA) and GICA in 19 healthy subjects, 43 patients with benign oral cavity lesions and 26 with histologically confirmed squamous-cell carcinomas. Serum CEA levels were much the same in all three groups, whereas salivary values were significantly higher (p less than 0.001) in both patient groups than in the controls. Serum GICA gave the opposite result: lower in carcinoma than in controls (p less than 0.001) and benign lesions (N.S.), while salivary GICA was significantly lower in carcinoma than in both the other two groups (p less than 0.001). The meaning of this difference between the values for the two antigens is discussed.

Penile arterial Doppler evaluation in basal condition and after intracavernous injection of papaverine

In diagnostic screening, 73 impotent patients were submitted to a Doppler study of the deep penile arteries under basal conditions and after oral nitroglycerin (Basal-DOPPLER) and after intracavernosal injection of 30 mg of papaverine (ICIP-DOPPLER), as well as other tests. The results of the Basal-DOPPLER and the erectile response to intracavernosal administration of 30 mg papaverine (ICIP-30), indicative of the condition of the deep penile arteries, were in total agreement for 33 cases, partial agreement for 29 cases and totally in disagreement for 11 cases. The agreement between the results of the ICIP-DOPPLER and the ICIP-30 was total for 40 cases, partial for 24 and totally lacking for 9. In many of the cases for whom the response to ICIP-30 was less than would have been expected from the ICIP-DOPPLER, abnormal venous outflow was later shown. Our data support the hypothesis that papaverine acts on the venous component of erection. The ICIP-DOPPLER was found to be apparently more reliable than the Basal-DOPPLER for evaluating the arterial component of erection, but Basal-DOPPLER is still the basic screening test before any such invasive test as the ICIP are used, since these latter are not always accepted immediately by the patients.

Satiety and scratching; effects of bombesin-like peptides

Two novel amphibian peptides, [Ser7]litorin-like peptide (Ser-LIT) and [Ser7]bombesin-like peptide (Ser-BN), recently isolated from the skin of the South American frog Phyllomedusa sauvagei, are characterized by the occurrence of a Ser residue in place of His7 in the C-terminal tripeptide. For testing on food intake in fasted rats the peptides were injected intraperitoneally (i.p.) and intracerebroventricularly (i.c.v.) and their activity compared with that of bombesin (BN) and litorin (LIT). Ser-LIT was completely ineffective on food intake while Ser-BN was about ten times less potent than LIT by i.p. injection; given i.c.v., Ser-BN inhibited food intake in the first 15 min after injection but its effect faded within 60 min. The i.c.v. administration of both [Ser7]-substituted peptides, elicited intense scratching with a potency equal to or higher than that of BN or LIT. The existence of two different kinds of receptors for BN-like peptides may be hypothesized: the first, specific for the C-terminal tripeptide sequence, is apparently involved in the inhibition of feeding; the second, responsible for the stimulating activity on the urinary bladder and for scratching, shows higher affinity for the N-terminal portion of the biological active sequence.

Evoked sacral potentials in subjects with true premature ejaculation

Evoked sacral potentials were used to study the bulbo-cavernous reflex in 85 patients with true premature ejaculation (TPE) and in 52 subjects as a control group. In the perineal and perianal recordings the amplitudes of the evoked responses (means +/- SD) were 70 +/- 91.1 microV and 35.6 +/- 36 microV in the TPE patients, and 39.2 +/- 36.8 microV and 26 +/- 21.6 microV in the controls, respectively. Both these differences resulted significant (P less than 0.01 and P congruent to 0.05, respectively). Our results suggest a reflex hyperexcitability, or an impaired "modulation" of the motor neurons of the pudendal nucleus by the regulating upper centers in the TPE patients.

Combined cryosurgical, chemotherapeutic, and radiotherapeutic management of T1-4N0M0 oral cavity cancers

Eighty-four previously untreated patients (69 males, 15 females) with squamous carcinoma of the tongue (30 patients), floor of the mouth (30), cheek (16), and retromolar region (8) were treated using a protocol comprising cryosurgery + chemotherapy, followed by external 60Co radiotherapy. The follow-up period was at least 6 months (median, 50 months). Cryosurgery (1-2 sessions in 49 T1-2 cases; 2-4 in 35 T3-4 cases) was accompanied by a CMF (cyclophosphamide, methotrexate, 5-fluorouracil) schedule (T1-2, two courses; T3-4, three courses). Radiotherapy was given 15 to 20 days after combined cryochemotherapy (T1, 50 Gy on tumor and lymph nodes; T2-3-4, same with an extra dose of 10 to 15 Gy on the primary lesion). Complete remission was reached 4 months after treatment in 76 of 84 patients (90.5%). Survival with no evidence of disease (NED) in the 57 patients (27 T1-2, 30 T3-4) with a follow-up of more than 3 years was 59.6% for the series as a whole, 70.3% for T1-2, and 50.0% for T3-4; 78.2% for the tongue, 52.6% for the floor, 66.6% for the cheek, and 0% for the retromolar region. The picture was much the same after 5 years. Actuarial survival at 6 years was 66% in the series as a whole, 75.5% in T1-2, and 57.5% in T3-4 (tongue 86.9%, floor 56.1%, cheek 68.4%, and retromolar region 0%). It is believed that the results obtained in tumors of the tongue, floor and cheek, coupled with the conservative aspects of the protocol, make it a suitable subject for a controlled trial.

Tolerance and physical dependence induced by dermorphin in rats

Rats chronically implanted with osmotic minipumps in the left lateral ventricle were used to study the ability of dermorphin to produce tolerance and physical dependence. The development of tolerance, assessed by evaluating the time reduction of analgesia, catalepsy and rigidity, occurred in a dose-dependent fashion over a maximum period of 48 h. After 3 days of peptide infusions into the rat brain, the dependent state was established and was revealed by precipitating the withdrawal syndrome with intraperitoneal naloxone injections. Escape behavior, shaking, salivation and rhynorrhea were the main symptoms, qualitatively similar to those obtained in rats made dependent on morphine. Considering that dermorphin displays strong analgesic activity, the well-known combination of antinociception tolerance and dependence capacities of opiates also seems to be valid for dermorphin.

Effects of sauvagine, urotensin I and CRF on food intake in rats

Sauvagine (SV) is a forty amino acid peptide, isolated from the skin of the South American frog Phyllomedusa sauvagei and structurally related to fish Urotensin I (U1) and to mammalian corticotropin releasing factor (CRF). Intracerebroventricular (ICV) injections of SV (0.3-2.0 micrograms/rat), CRF (1.0-15.0 micrograms/rat) and U1 (0.5-2.0 micrograms/rat) inhibited feeding in 18 hr food deprived rats. By subcutaneous (SC) route, only SV (3.0-10.0 micrograms/kg) and U1 (10.0-20.0 micrograms/kg) exhibited anorexogenic effects, CRF being completely inactive up to a dose of 200 micrograms/kg. Vagotomy did not prevent the feeding inhibition by SC SV. In ICV injected rats, CRF increased grooming in comparison with both food deprived and satiated controls, while SV and U1 increased grooming only in comparison with fasted controls. Compared to satiated animals, food deprived rats when injected ICV with anorexogenic doses of the peptides showed decreased resting and increased moving. Rats given SC injections of SV and U1 significantly decreased grooming in comparison with both food deprived and satiated controls, while increased resting only in comparison with fasted controls. CRF by the SC route did not affect the behaviour of the rat.

Distribution and metabolism of dermorphin in rats

Dermorphin distribution and metabolism were studied in rats injected with high doses of the peptide and with 125I-dermorphin, using RIA methods, HPLC extraction and -counting. Dermorphin rapidly disappeared from plasma (half-life: 1.3 min). In vivo and in vitro experiments demonstrated that the peptide was destroyed in liver and kidney. The highest percent (11%) of injected dermorphin has been found in the bile collected over 1 hour. HPLC analysis showed that bile contained also breakdown products (di, tri, and tetra N-terminal peptide fragments). Reported data suggested that intact dermorphin can be eliminated more slowly than breakdown products.

Dermorphin stimulates prolactin secretion in the rat

The effect of dermorphin, a new opioid peptide originally isolated from amphibian skin, on the release of prolactin (Prl) was studied in vivo and in vitro. In vivo experiments: subcutaneous administrations of different doses of dermorphin ranging from 0.1 to 5 mg/kg body weight to normal male rats induce a statistically significant, dose-related increase in serum Prl levels. Pretreatment with the specific opioid antagonist, naloxone (2 mg/kg i.p.) completely prevents the rise in serum Prl, induced by 2 mg/kg of dermorphin. In normal male rats, the intraventricular injection of 0.25 micrograms/kg of dermorphin is not able to induce any significant changes in serum Prl levels 10 min after injection. Serum Prl levels show a significant enhancement 30 min after the administration of this dose of dermorphin, and return to control values at 60 min. On the contrary, 1 microgram/kg of dermorphin significantly elevates Prl concentrations 10 min after injection, leaving serum Prl levels unchanged 30 and 60 min after the administration. Naloxone (25 and 100 micrograms/kg) alone does not substantially modify serum Prl concentrations at any time interval considered. Treatment with either dose of naloxone performed together with either 0.25 or 1 microgram/kg of dermorphin completely counteracts the stimulatory effect of the peptide at all time intervals in which dermorphin was active when given alone. In orchidectomized (3 weeks) rats, the intraventricular administration of dermorphin at the dose of 0.25 micrograms/kg appears effective in enhancing Prl levels only 30 min after treatment. No statistically significant modifications are observed at 10 and 60 min with this dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Specific immunological stimulation induced by cryosurgery in patients with squamous-cell carcinoma of the oral cavity

Following earlier personal studies indicating that cryosurgery stimulates several non-specific immunological parameters, mainly those of the cell-mediated component, in patients with squamous-cell carcinoma of the oral cavity, inhibition of leukocyte migration (evaluated by means of the LIF test) was investigated, using a heterologous squamous-cell tumour extract, before and 7 and 14 days after a single cryotherapy session in 14 patients (11 in stages I and II, 3 in stages III and IV). Increased inhibition was observed after 7 days in 8 subjects (57.2%)-72.7% in stage I-II patients. In two cases, reactivity appeared for the first time. In 7/8 cases, this increase persisted, though at lower levels, until the 14th day. The conclusion is drawn that cryosurgery can stimulate specific delayed hypersensitivity in stage I-II squamous-cell carcinoma of mouth.

[The presence of CEA in spinocellular carcinoma of the oral cavity]

Using an immunoperoxidase method the Authors have demonstrated carcinoembryonic antigen (CEA) in 4/7 patients with benign oral lesion and in 9/10 patients with oral cancer. All 4 oral leukoplakias were positive for CEA. The histologic presence of CEA in oral cancer was related mainly to the formation of well differentiated tissue. The anaplastic carcinoma was negative. These findings indicate that CEA is a product of differentiated cells and should not be considered exclusively an oncofetal antigen or a marker of undifferentiated cells.

[Serum and salivary CEA in benign and malignant lesions of the oral cavity]

Serum carcinoembryonic antigen (CEA) and salivary CEA levels were determined for 18 patients with squamous oral carcinoma, 12 patients with oral leukoplakia, and 14 healthy volunteers. The determination of the CEA-serum levels has no diagnostic significance. Salivary CEA levels are not correlated with CEA-serum values, with cigarette consumption and clinical stage. Salivary CEA determination provides no additional information for the primary diagnosis. Serial determinations may have adjunctive value in monitoring oral cancer.

Sauvagine induces release of adrenocorticotropin, beta-endorphin and corticosterone in rats

The effect of sauvagine, a frog skin peptide, on ACTH, beta-endorphin and corticosterone secretion, was studied in rats. A subcutaneous injection of 5 micrograms kg-1 of sauvagine in rats produced a prompt increase in immunoreactive plasma concentration of ACTH and beta-endorphin, which reached a peak value 15-30 min after the peptide injection. The stimulatory action of sauvagine on ACTH and beta-endorphin secretion was dose related. Intensity and duration of corticosterone secretion, produced by sauvagine mediated ACTH release, was dose-dependent, the threshold dose being 0,5 microgram kg-1 s.c. Pretreatment of rats with dexamethasone-21-phosphate, prevented the corticosterone releasing effect of sauvagine. Sauvagine perfusion (2,1 nM/h) of biogel columns containing isolated and dispersed anterior pituitary cells induced a sharp increase of ACTH levels in the eluate. Considering the high corticotropin releasing potency of sauvagine and its chemical similarity to ovine CRF, it is interesting to hypothesize whether this peptide may represent, in lower vertebrates, an ancestral form of the mammalian hypothalamic releasing factor.

[Specific immunologic stimulation induced by cryosurgery of spinocellular tumors & of the oral cavity]

In previous works the Authors have shown that cryosurgical treatment of oral squamous cell cancer modifies numerous aspecific immunological parameters mostly concerning the cell-mediated component. In the present work the Authors have studied the leukocyte migration inhibition (LMI) response in vitro of peripheral blood leukocytes from patients affected by oral squamous cancer to oral tumor antigens using the leukocyte migration agarose test. The LMI was evaluated immediately before cryosurgical treatment of oral squamous cell carcinoma and 7 and 14 days after. The results suggest that cryosurgery is able to stimulate the specific cell-mediated response of patients affected by early stage carcinoma of oral cavity.

Potent in vivo and in vitro prolactin inhibiting activity of sauvagine, a frog skin peptide

The effect of sauvagine (SAU), a frog skin peptide, on prolactin (PRL) levels was studied in vivo and in vitro. Subcutaneous administration of SAU (20 micrograms/kg) reduced plasma PRL levels in normal adult male rats and suppressed the suckling-induced rise of PRL in lactating rats even at doses of 1 and 5 micrograms/kg. Perfusion of isolated and dispersed rat pituitary cells in vitro with increasing doses of SAU (from 5 x 10(-10) to 1.7 x 10(-8)M) induced a significant dose-related decrease of PRL secretion in the eluate. These results indicate that SAU is a potent PRL inhibiting factor and that its action is exerted at the pituitary level. If SAU or a SAU-related peptide is present in the mammalian brain, it can be tentatively hypothesized that this peptide plays an important role in the control of PRL secretion.

Feprazone: absence of hemolytic effects in glucose-6-phosphate dehydrogenase-deficient subjects

Some drugs, including nonsteroidal antiinflammatory compounds, can be hemolytic in glucose-6-phosphate dehydrogenase-deficient patients. We have studied the potential hemolytic activity of feprazone, a nonsteroidal antiinflammatory compound in vitro and in vivo. Agents that may be hemolytic for glucose-6-phosphate dehydrogenase-deficient erythrocytes will stimulate the hexose monophosphate shunt in normal erythrocytes. Eleven normal subjects were treated with feprazone and their erythrocytes were incubated in their own sera (containing active feprazone metabolites) and [1-14C]-glucose. Because no statistically significant increase in 14CO2 evolution was observed, 15 pediatric male patients with glucose-6-phosphate dehydrogenase deficiency who required antiinflammatory treatment were treated with feprazone. No hemolytic crises and no statistically significant changes of hematologic tests were observed.

[Secondary immunological response to cryosurgery in various stages of oral cavity neoplasms]

The authors have evaluated general immunocompetence after cryosurgical treatment of 33 patients affected by oral squamous carcinoma. Patients have been divided into two groups: 17 of them were classifiable in 1st and 2nd stage and 16 of them in 3rd and 4th stages. Serum immunoglobulin levels, C3 - C4, peripheral lymphocytes, E-rosette forming cells, lymphocyte response to PHA were analyzed before a single cryotreatment 7 and 14 days after. The results indicate that immunological parameters vary in a significant way and can be constantly observed in 1st and 2nd stages, while the 3rd and 4th stages undergo no variations. Cryosurgery in the 1st and 2nd stages is able to modify, in particular, the parameters concerning cell - mediate immunity, although the phenomenon seems transitory, showing itself most on the seventh day.

[Changes in salivary immunoglobulin levels after cryosurgery of benign and malignant lesions of the oral cavity]

The authors have evaluated variations in salivary IgA, IgG, IgM levels after cryosurgical treatment of benign and malignant oral lesions. Salivary immunoglobulin levels were measured by radial immunodiffusion before a single cryotreatment 7 and 14 days after. Seven days after cryosurgery of the lesions, there was a statistically significant increase in salivary IgG and IgM levels (p less than 0,02). These results suggest that, at the time of maximal oral cavity inflammation, 7 days after cryotreatment, there was a transudation of these immunoglobulins from serum into saliva. Salivary IgA levels decrease in a significant way (p less than 0,02) on the 14th day; this behaviour seems to be strictly connected with tumor regression after cryosurgery.

[Variations of serum BuChe activity during C M F therapy]

As the Authors and Others have already demonstrated, cyclophosphamide leads to a rapid and prolonged decrease in the serum cholinesterase activity. In this work, the behaviour of the serum cholinesterase in patients subjected to C M F polychemotherapy (CTX, VCR, FU) has been studied. The grouping of patients on the basis of serum cholinesterase values before treatment has demonstrated that the enzymatic activity decrease arrives at level practically homogeneous. A month after interruption of therapy values equal to those at starting point have been observed.

[Clinical and functional effects of domiodol and sobrerol in hypersecretory bronchopneumonias]

A double-blind study has been carried out in adult patients suffering from acute and chronic bronchitis, and acute exacerbation of chronic hypersecretory bronchitis, excluding the bronchorreic forms, in order to evaluate the mucolytic activity of orally given domiodol and sobrerol. Treatment with both drugs resulted in an improvement in the subjective measures of ease of expectoration, severity of coughing and sputum consistency; however, there was no improvement in respiratory functions. Moreover, domiodol resulted in a significant increase in sputum volumes, since the very first days of treatment.