Evaluation of intraarticular opioid analgesia for the relief of articular pain in the domestic fowl

An experimental paradigm, based on the microcrystalline sodium urate-induced arthritis pain model, was used to investigate the potential peripheral analgesic properties of a variety of opioid agonists. The response criteria were changes in behavioral profiles and pain-related behaviors over 60 min commencing 1 h after intraarticular injection. The testing system was used to determine the potential optimum dose of intraarticular application of morphine sulphate (1-3 mg), fentanyl citrate (0.5-3 mg), and buprenorphine hydrochloride (0.05-1 mg). None of the opioid analgesics used had any effect on pain behavior, and it was concluded that opioids with a high affinity for the mu receptor when injected intraarticularly were unlikely to be of use in the treatment or diagnosis of inflammatory arthritic pain in the strain of domestic fowl chosen.

Assessment of pain during locomotion and the welfare of adult male turkeys with destructive cartilege loss of the hip joint

1. An assessment was made of the potential pain and stress from musculo-skeletal disease at 54 weeks of age in large male-line turkeys fed ad libitum or on restricted amounts of food. Males from traditional turkey lines were used as a negative control. 2. Traditional turkeys were fed ad libitum and male-line turkeys were fed ad libitum or restricted to 0.5 during rearing and subsequently to 0.8 of sex-specific ad libitum-fed body weight or fed ad libitum to 18 weeks and 0.8 of ad libitum thereafter. 3. Pain was assessed at 54 weeks of age by the change in number of steps taken by turkeys with or without musculo-skeletal disease after a course of betamethasone, a steroid anti-inflammatory agent with analgesic properties. 4. The numbers of steps over 24 h were recorded using a pedometer and were similar in all 4 treatments before and after treatment with the analgesic. It was concluded that there was no evidence for pain associated with musculo-skeletal disease among the turkeys in this experiment. 5. Musculo-skeletal disease was not associated with raised heterophil-lymphocyte ratio, a recognised index of stress.

Interaction of age, strain, sex and food restriction on plasma creatine kinase activity in turkeys

1. Plasma creatine kinase activity was determined at 4, 8, 12, 16, 20, 24, 28, 38 and 48 weeks of age in male and female traditional turkeys fed ad libitum, in male and female turkeys of a sire-line fed ad libitum or restricted to 0.5 during rearing and subsequently to 0.8 of sex-specific ad libitum-fed body weight, and in sire-line males fed ad libitum to 18 weeks and 0.8 of ad libitum body weight thereafter. 2. Plasma creatine kinase activity was low in traditional turkeys and increased rapidly after 12 weeks of age in males and females of the sire-line of turkeys. 3. Food restriction decreased the activity of plasma creatine kinase. 4. There was no difference in plasma creatine kinase activity between the sexes during rearing. After the onset of lay, the activity in plasma from females decreased at 38 weeks of age and rose dramatically in restricted females at 48 weeks when the birds had ceased laying. 5. The changes in plasma creatine kinase activity in females were associated with concomitant changes in ovarian activity as reflected in altered plasma triglyceride concentrations.

Comparative development of antitrochanteric disease in male and female turkeys of a traditional line and a contemporary sire-line fed ad libitum or with restricted quantities of food

The prevalence of musculoskeletal disease at eight, 16, 24, 34, 44 and 54 weeks of age in male and female turkeys was determined by dissecting 688 limbs from traditional lines and sire-line turkeys fed to achieve different bodyweights. Traditional turkeys were fed ad libitum and sire-line turkeys were fed ad libitum or restricted to 0.5 during rearing and subsequently to 0.8 of ad libitum-fed bodyweight of birds of the same strain and sex. A group of male sire-line turkeys was also fed ad libitum to 18 weeks and 0.8 of ad libitum thereafter. Lameness during the rearing period was usually associated with joint infection. Ruptured ligaments were an occasional finding in sire-line turkeys before sexual maturity. The major finding at 34, 44 and 54 weeks of age was degeneration of the antitrochanter in both sexes of the sire-line. The prevalence and severity of disease increased with age but was not generally associated with lameness. Antitrochanteric degeneration in the sire-line was diminished by decreasing bodyweight through food restriction. Antitrochanteric degeneration did not occur in traditional turkeys.

Transgenic mice expressing human Bcl-2 in their neurons are resistant to 6-hydroxydopamine and 1-methyl-4-phenyl-1,2,3,6- tetrahydropyridine neurotoxicity

The protooncogene bcl-2 inhibits neuronal apoptosis during normal brain development as well as that induced by cytotoxic drugs or growth factor deprivation. We have previously demonstrated that neurons of mice deficient in Bcl-2 are more susceptible to neurotoxins and that the dopamine (DA) level in the striatum after systemic 1-methyl-4-phenyl-1,2,3,6 tetrahydropyridine (MPTP) administration was significantly lower than in wild-type mice. In the present study we have used transgenic mice overexpressing human Bcl-2 under the control of neuron-specific enolase promoter (NSE-hbcl-2) to test the effects of the neurotoxins 6-hydroxydopamine (6-OHDA) and MPTP on neuronal survival in these mice. Primary cultures of neocortical neurons from normal and transgenic mice were exposed to these dopaminergic neurotoxins. Addition of 6-OHDA resulted in cell death of essentially all neurons from normal mice. In contrast, in cultures generated from heterozygous NSE-hbcl-2 transgenic mice, only 69% of the cells died while those generated from homozygous transgenic mice were highly resistant and exhibited only 34% cell death. A similar effect was observed with neurons treated with MPP+. Moreover, while the striatal dopamine level after MPTP injections was reduced by 32% in the wild type, the concentration remained unchanged in the NSE-hbcl-2 heterozygous mice. In contrast levels of glutathione-related enzymes were unchanged. In conclusion, overexpression of Bcl-2 in the neurons provided protection, in a dose-dependent manner, against neurotoxins known to selectively damage dopaminergic neurons. This study provides ideas for inhibition of neuronal cell death in neurodegenerative diseases and for the development of efficient neuroprotective gene therapy.

Physiological and induced neuronal death are not affected in NSE-bax transgenic mice

Bax, a family member of the survival protein Bcl-2, is expressed in the nervous system during development and throughout adulthood. Bax deficiency has been demonstrated to prevent developmental and trophic factor deprivation-induced neuronal death. To further clarify the role of Bax in naturally occurring neuronal death and in neuronal death following apoptotic stimuli, we generated several lines of transgenic mice expressing the human Bax protein specifically in neurons, under the control of the neuron-specific enolase promoter. Transgene expression was first detected around E10.5 and E12.5, depending on the transgenic line. The total number of ganglion cells in the retina and of pyramidal cells in the hippocampus, both expressing the transgene, was similar in control and transgenic mice. In addition, in our model system, Bax overexpression did not appear to influence the in vitro survival of sensory neurons isolated from dorsal root ganglia after nerve grwoth factor (NFG) deprivation or the apoptotic death of motor neurons following axotomy.

Comparative development of the ovary and production, fertility and hatchability of eggs from traditional turkeys and a contemporary male-line fed ad libitum or restricted

1. Ovarian function was assessed at first egg and at 44 and 54 weeks of age in traditional turkeys and in a male-line fed ad libitum or restricted to 0.5 of ad libitum during rearing. Egg production was recorded daily and fertility and hatchability were determined at 2 ages. 2. Age at sexual maturity did not differ between the 3 treatments. 3. The number of follicles at first egg in the male line averaged 16.3 compared with 8.9 in traditional turkeys. Food restriction in the male line decreased the number of yellow follicles to 14.6 at first egg and restricted birds were largely in a non-reproductive state from 44 to 54 weeks of age. 4. The total number of recorded ovipositions to 54 weeks of age in male line fed ad libitum or restricted and traditional turkeys respectively were 40.1, 25.2 and 70.7; comparable productions of normal shelled eggs were 28, 20 and 66.3. 5. There were no differences between treatments in fertility after a single insemination at 2 different ages. Hatch of fertiles after the first inseminations were 71.4, 45.5 and 90.3 respectively for male line fed ad libitum or restricted and traditional turkeys.

Evaluation of a protocol for determining the effectiveness of pretreatment with local analgesics for reducing experimentally induced articular pain in domestic fowl

An experimental paradigm based on the microcrystalline sodium urate-induced arthritis model was developed for determining the effectiveness and optimum dose of drugs with potential local analgesic properties for the diagnosis and alleviation of musculoskeletal pain in birds. The optimum intra-articular injection of sodium urate was 6 mg in 0.2 ml diluent in 12-week-old male domestic fowl of 1.5 kg live weight. The response criteria were changes in behavioural profiles over 60 minutes commencing one hour after intra-articular injection. The testing system was used to determine the optimum rate of intra-articular application of the local anaesthetic bupivacaine hydrochloride. The behavioural profile of treated birds was restored to that of the controls at a minimal injection of 3 mg in 0.3 ml saline. It was concluded that the optimum intra-articular dose of bupivacaine for the treatment of musculoskeletal pain in the domestic fowl was 3 mg bupivacaine in 0.3 ml saline.

Effects of dietary crude protein content and food intake on the production of semen in two lines of broiler breeder males

1. The effects of dietary crude protein (CP) concentration and feeding rate on semen production and quality from 21 to 66 weeks of age were assessed in a factorial experiment with 48 caged broiler breeder males from 2 strains. 2. The probability of obtaining semen and semen volume were lower in one of the two strains but the concentration and yield of spermatozoa were similar. 3. There was no evidence that males which were fed on an increasing quantity of food produced more semen or a greater concentration of spermatozoa than males on a fixed allocation of 120 g/d food. 4. The concentration of spermatozoa was lower in males fed on a diet containing 160 compared with 120 g CP/kg. On termination of the experiment, average testes size was small and testicular function was absent in a large proportion of the males on the high protein diet.

Effects of male body weight, strain and dietary protein content on fertility and musculo-skeletal disease in naturally mated broiler breeder males

1. The effects of male body weight at mating and different rates of gain on overall fertility were studied in two strains of broiler breeder males fed on a diet containing 160 or 120 g crude protein/kg. Sexual activity, musculo-skeletal disease and culling were also assessed. 2. There were no differences in early fertility between males weighing 3.0 or 3.5 kg at the start of the mating period, or between males gaining 1.0 or 1.5 kg body weight from mating to 60 weeks of age. 3. There were no differences in fertility between males fed on the two diets differing in crude protein content. 4. One strain of male had lower fertility than the other and this was associated with a greater weight of breast muscle, lower frequency of observed copulations and a higher number of incompleted matings. 5. Sexual activity declined and the number of spermatozoa trapped on the perivitelline membrane increased with age. 6. There were no differences among the treatments in the prevalence of musculo-skeletal lesions (destructive cartilage loss). As a proportion destructive cartilage loss occurred in 0.67 of the males at 66 weeks of age. Degeneration of the antitrochanter was present in 3 of 50 females examined and a cartilage flap in the medial condyle of the tibiotarsus occurred in 15 of these birds. 7. Beak lesions were the most important cause of male culling which averaged 0.24 as a proportion of the males at the start of the experiment.

NSE-bcl-2 transgenic mice, a model system for studying neuronal death and survival

Bcl-2 is a crucial regulator of cell survival and death. We have recently demonstrated that transgenic mice overexpressing the human Bcl-2 protein specifically in their neurons have an increased number of neuronal cells which can survive in tissue culture in the absence of neurotrophic factors. In order to understand why only some neurons can be rescued from developmental and neurotrophic factor deprivation-induced death, we have studied the expression pattern of the transgene during embryonic development an in adulthood. We have demonstrated that transgene expression starts in embryos at E12.5 and that only half of the sensory neurons of the dorsal root ganglia expressed detectable levels of the human Bcl-2. These results may explain why only 40% of the sensory neurons survived in tissue culture in the absence of neurotrophic factors.

Nonpeptide angiotensin II receptor antagonists: in vivo inhibition of [125I-Sar1,Ile8]angiotensin II binding by losartan, EXP597 and L-159,282 in rats

Effects of losartan, L-159,282 and EXP597 on the in vivo binding of [125I-Sar1,Ile8]angiotensin II to kidney cortex and adrenal were examined in rats. Losartan, an AT1 receptor antagonist, completely blocked [125I-Sar1,Ile8]angiotensin II binding to the kidney cortex which contains only AT1 binding sites with an ID50 of 0.06 mg/kg. Losartan partially inhibited [125I-Sar1,Ile8]angiotensin II binding to the adrenal which contains equal amounts of AT1 and AT2 binding sites. Blockade by the AT1 receptor antagonist L-159,282 sufficiently increased the plasma levels of angiotensin II to block the AT2 receptor. EXP597 inhibited [125I-Sar1,Ile8]angiotensin II binding to the kidney cortex and adrenal almost totally with ID50s of 0.05 and 0.06 mg/kg, respectively. This result suggests that EXP597 exhibits almost equal binding affinity for AT1 and AT2 binding sites in vivo in rats.

Contrast matching techniques for digital subtraction radiography: an objective evaluation

Digital subtraction radiography (DSR) enables the detection of subtle early detrimental effects of periodontal disease as well as the evaluation of the effects of therapy. However, the differences between two radiographs due to alignment and contrast errors must be kept at minimum. In the present in vitro study we test the efficacy of three basic contrast correction methods in the reduction of contrast mismatches which can adversely affect a subtracted image. The ODTF (Optical Density Thickness Function) method, which is based on a function relating grey level values of the aluminium wedge image and the corresponding thickness of the wedge, induced less contrast correction error than the CDF (Cumulative Density Function) and the LSQA (Least Square Quadratic Approximation) methods. Moreover, CDF, ODTF, and LSQA functions obtained from the reference structure density distribution may be applied for objective contrast enhancements and for standardisation of image quality, while the ODTF function allows also bone change volume estimations.

Comparative development of the antitrochanter in three strains of domestic fowl

Lameness and musculoskeletal disease were more frequent in two strains of broilers (selected [S] and relaxed [R]) than in an unselected layer (J). Defective fibrocartilage accounted for 0.15 of the total area of antitrochanteric cartilage at 29 weeks of age in the S-strain birds. There was more retained hyaline cartilage in the R- and S-strain birds at 15 weeks, and at 22 and 29 weeks there was delayed ossification. Occluded blood vessels, death of chondrocytes and degenerate areas of fibrocartilage occurred only in the broiler strains; they were worse in the S-strain and degenerate fibrocartilage occurred more frequently and in larger amounts. The area, length and depth of cartilage were larger in the heavier strains but the differences were considerably smaller than the difference in their relative bodyweights. The degeneration of the antitrochanter appeared to be associated with a reduction in the blood supply to the underlying hyaline cartilage and with the death of chondrocytes and the degeneration of matrix within the fibrocartilage of the antirochanter.

Pharmacology of XR510, a potent orally active nonpeptide angiotensin II AT1 receptor antagonist with high affinity for the AT2 receptor subtype

The angiotensin II (Ang II) type 1 receptor (AT1) mediates all known physiological effects of ANG II, whereas functions of the type 2 (AT2) receptor are not clear. Should undesirable AT2 effects be identified, it may be advantageous to combine antagonism of AT1 and AT2 receptors. XR510 was shown to inhibit the specific binding of [125I]Sar1,Ile8-Ang II for AT1 and AT2 subtype binding sites in rat adrenal membranes with IC50 of 0.26 and 0.28 nM, respectively, and in human tissues with subnanomolar binding affinity. In isolated rabbit aorta, XR510 exerted insurmountable Ang II antagonism with a Kb value of 4 nM. In conscious renal hypertensive rats, XR510 decreased blood pressure (BP) with intravenous (i.v.) and oral (p.o.) ED30 of 0.08 and 0.27 mg/kg, respectively. In spontaneously hypertensive rats (SHR), repeated daily oral dosing of XR510, losartan, and enalapril at 30 mg/kg/day decreased BP similarly. In conscious furosemide-treated dogs, XR510, given either intravenously or orally, decreased BP. These results suggest that XR510 is an orally active and selective Ang II receptor antagonist with equal binding affinities for AT1 and AT2 receptor binding sites.

Immortalization of different precursors of glial cells with a targeted and temperature-sensitive oncogene

Different types of glial precursor cell lines were obtained after stable transfection of brain cells with the pJC-SVLTtsA vector carrying the tsA58 simian virus 40 large T (SVLT) gene driven by the promoter of a gliotropic strain of JC papovavirus. The immortalized cells were conditional for growth: they expressed the SVLT antigen and proliferated at 34 degrees C, but their growth was either reduced or arrested when they were shifted to 39 degrees C. The differentiation characteristics of four representative lines were more extensively studied. The CR15 and CM8 lines displayed properties of bipotential glial progenitors: they were able to express oligodendrocyte markers at both temperatures, but could differentiate into astrocytes only at 39 degrees C. In contrast, the CR19 and CM3r lines corresponded to more committed oligodendrocyte precursors: they expressed various oligodendroglial markers but they could not synthesize the glial fibrillary acidic protein. More particularly, the CM3r mouse cells displayed a typical oligodendrocyte progenitor morphology and expressed the proteolipid protein mRNA.

Plasma growth hormone and insulin-like growth factor-I (IGF-I) concentrations at the onset of lay in ad libitum and restricted broiler breeder fowl

1. Plasma concentrations of growth hormone (GH) and insulin-like growth factor I(IGF-I) were determined in individually caged broiler breeder females from 17 to 30 weeks of age. The birds were fed ad libitum or restricted during rearing in a randomised block design. Restricted birds were fed ad libitum after laying an egg and egg production was recorded to 54 weeks. 2. GH concentrations were higher in restricted compared with ad libitum-fed birds at 17 to 21 weeks of age and were similar thereafter. Plasma IGF-I concentrations were higher in restricted compared with ad libitum-fed birds throughout the sampling period of the experiment. 3. The age at first egg was delayed by about two weeks in restricted birds. At 54 weeks of age they had laid 114 compared with 67 eggs in birds fed ad libitum throughout and had produced less than half the number of eggs with defective shells. 4. It was suggested that differences in egg production between ad libitum and restricted broiler breeder females could be related to changes in the pattern of GH and/or IGF-I secretion.

Grafting of fast blue labeled glial cells into neonatal rat brain: differential survival and migration among cell types

Cultures of oligodendrocyte progenitor cells, ERD 1.1 cells, a nontransformed immortalized cell line of oligodendrocyte progenitors and C6 glioma cells were labeled with the fluorescent dye Fast Blue and transplanted into brains of 4 day postnatal Wistar rat pups. The localization of fluorescent cells within host brain was examined at various times post-transplantation to determine patterns of cell migration as well as survival and integration among the host tissue. Oligodendrocyte progenitors migrated mainly along white matter tracks, integrating successfully into the host parenchyma. High survival rates were found between 5 and 27 days post grafting. ERD 1.1 cells survived and migrated between 1 and 5 days after transplantation. However, by 27 days survival had dropped from 60 to 20% of the initial cell population. The surviving cells were mainly localized to subventricular and subependymal regions at 27 days. C6 cells migrated extensively rostrally and caudally from the site of injection in the hippocampus and were tumorogenic. This finding confirmed previous reports on the survival and migration patterns of oligodendrocyte progenitors grafted into neonatal brain. However, they show that two cell lines that share phenotypic properties of oligodendrocyte progenitors markedly differ from these cells with respect to migration patterns and integration within host parenchyma. Fast Blue dye was still detectable after repeated cell division in grafted C6 cells, enabling us to track single cells as well as tumor formation. This dye should be useful not only to address issues of development, but also of tumor biology and therapeutic treatment.

Proliferation and differentiation properties of bipotent glial progenitor cell lines immortalized with the adenovirus E1A gene

Bipotent glial progenitors have been immortalized by the transfer of the adenovirus E1A gene into primary cultured cells from embryonic rat brain. The lines obtained are phenotypically untransformed, retain growth contact-inhibition, and are able to differentiate, unless they are surtransfected with transforming oncogenes. Depending on the growth conditions, these immortalized cells express differentially either oligodendrocyte or astrocyte-specific markers and genes. After being seeded in serum-free medium, they display gangliosides recognized by A2B5 monoclonal antibody, and then they express sequentially O4 epitopes, galactocerebroside, and the myelin protein DM20. When grown in serum-supplemented medium, the cells express at first A2B5 epitopes, and then transiently O4 and galactocerebroside; after reaching confluence, O4 and galactocerebroside become undetectable, whereas the cells begin to coexpress glial fibrillary acidic protein and glutamine synthetase. These results indicate that the cell lines can undergo a differentiation reminiscent both of O-2A progenitors and of plastic process-bearing glial subpopulations. The cells were also genetically marked by the stable introduction of the nlslacZ reporter gene. Thus, the lines could be useful for studying direct interactions in vitro, or for post-grafting investigations. They should also provide a model for studying the mechanisms involved in the commitment and in the control of proliferation and differentiation of this cell lineage. This suggestion is consistent with the data indicating a growth arrest-dependent differential expression of a novel gene encoding a protein with a helix-loop-helix domain.

Effects of TGF beta 1 on the proliferation and differentiation of an immortalized astrocyte cell line: relationship with extracellular matrix

The astrocyte cell line (C.LT.T.1.1.), which is immortalized and has retained a normal density-dependent regulation of growth, is a suitable model for studying the relationships between proliferation, differentiation, and the production of extracellular matrix. The growth factor TGF beta 1 was used to modulate these processes. When added to proliferative cells, it inhibited growth and caused morphological changes. It also suppressed the growth arrest at confluence, so that the cells formed multilayers of parallel spindle-shaped cells. Whereas untreated control cells expressed progressively the glial fibrillary acidic protein (GFAP) after arrest of multiplication, the addition of TGF beta 1 to proliferative cells prevented GFAP expression and accumulation of its mRNA. Concomitantly, it increased the amounts of laminin, fibronectin, and collagens synthesized during the growth phase and greatly altered the composition and the structure of the matrix deposited at confluence. In contrast, when added after cell differentiation had begun, TGF beta 1 did not alter the appearance of the matrix whereas it still stimulated, but to a lesser extent, extracellular matrix components production. The results show that TGF beta 1 prevents the transition from the proliferating to the differentiating state and correlatively alters the composition and structure of the extracellular matrix.

Effect of blocking angiotensin II receptor subtype on rat sympathetic nerve function

This study examined effects of nonpeptide angiotensin II (Ang II) receptor subtype antagonists on the interaction of sympathetic function and Ang II in pithed rats. Effects of spinal cord stimulation (0.5-4 Hz) and norepinephrine (0.3-3 micrograms/kg i.v.) on mean arterial pressure (recorded with a carotid arterial catheter), cardiac output (measured with an electromagnetic flowmeter and flow probe around the thoracic ascending aorta), total peripheral resistance, and heart rate were determined. The subtype 1-selective Ang II receptor antagonist losartan (previously known as DuP 753) at 10 mg/kg i.v. blocked the hemodynamic responses to Ang II at 1 microgram/kg i.v. It inhibited mean arterial pressure and total peripheral resistance responses but not cardiac output and heart rate responses to spinal cord stimulation. In contrast, it reduced mean arterial pressure and cardiac output responses but not total peripheral resistance and heart rate responses to intravenous norepinephrine. Given at 100 mg/kg i.v., the subtype 2-selective receptor antagonist PD123177 did not reduce hemodynamic responses to intravenous Ang II, spinal cord stimulation, and intravenous norepinephrine. These results suggest that endogenous Ang II facilitates the release of norepinephrine from sympathetic nerve terminals in the vasculature of pithed rats. Similar to the Ang II receptor in vascular smooth muscle, the prejunctional Ang II receptor in pithed rats appears to be of subtype 1.

Pyruvate dehydrogenase activity is stimulated by growth hormone (GH) in human mononuclear cells: a new tool to measure GH responsiveness in man

Human peripheral mononuclear cells (PMC) were used to examine the effects of hGH and insulin on the activity of the pyruvate dehydrogenase (PDH) complex. Incubation of PMC with 10(-7) mol/L hGH or insulin increased basal PDH activity. Hormonal effects were maximal (50-60% above control values) at 15 min. Later on, activation progressively decreased and was no longer detectable at 30 min. Total PDH activity was unaffected by hormonal treatment. PMC were subfractionated into lymphocytes and monocytes to assess the sensitivity of each cell types to the hormones. hGH significantly increased basal PDH activity in lymphocytes and monocytes (38% and 70% above control values, respectively), whereas insulin increased basal PDH activity only in monocytes (151% above control value). PMC from healthy subjects aged 1-45 yr were incubated for 15 min with 10(-7) mol/L hGH or insulin before PDH measurement. An increase of enzyme activity higher than 20% was observed in 26 patients out of 29 with hGH, and in 15 out of 18 with insulin. In conclusion, hGH is able to stimulate PDH activity of human mononuclear cells. This hormonal effect allows rapid evaluation of the cellular responsiveness of hGH in various pathophysiologic situations.

[Value of serum immunoglobulin assays in early myocardial infarction]

Serum immunoglobulin (Ig) levels were assayed in 672 patients admitted for acute myocardial infarction with onset within 24 hours of hospitalization. Supranormal Ig levels (A > or = 300, G > or = 1,200) or subnormal Ig levels (M < 40 mg/100 ml) were seen in patients with one or several risk factors (diabetes mellitus, alcohol abuse) or a history of previous myocardial infarction. Patients with one or more Ig anomalies were more likely to exhibit unfavorable outcomes, including early death, suggesting that increased viscosity due to aggregation of Ig molecules may occur.

[Thrombolysis in the acute stage of myocardial infarction]

The authors recall the conditions in which intravenous thrombolysis is justified, and the mode of action of the various thrombolytic products. They show the efficacy and the utility of thrombolysis and also its complications. The success of this treatment is closely linked to the time interval after thrombosis, which should be reduced as much as possible.

[Refractory arterial hypoxemia and interatrial right-left shunt in myocardial infarction of the right ventricle]

The authors report the case of a 63 year old woman who developed refractory arterial hypoxemia due to a right-to-left interatrial shunt through a patent foramen ovale during the acute phase of right ventricular infarction. The precarious haemodynamic condition of the patient contra-indicated surgical intervention and so the effects of the shunt were reduced by obstructing the atrial septal defect with the balloon of a Swan-Ganz catheter. The management of this type of shunt is discussed based on the degree of hypoxemia and the patient's haemodynamic status with reference to this particular case and a review of the literature.

[Development of fetal semiology in North America]

A survey of the emergence of fetal semiology in the 17 editions of the Williams' Textbook of Obstetrics used by North-American medical students since 1900 was carried out. Three periods were identified: 1906-1950: the fetus, seen as a part of its mother, is ignored until birth and is of no interest to the obstetricians. From the fifties', the decrease in maternal mortality and progress in physiology and therapeutics permitted to study the fetus and a greater attention given to the care of the sick newborn. Since 1970, the availability of ultrasonography has contributed in making the fetus the second patient for obstetricians. It is now possible to study its growth, integrity, health, and well-being. Furthermore, the fetus is now accessible to establish a prenatal diagnosis.

[The effects of pressotherapy on cardiovascular hemodynamics]

Right auricular and pulmonary pressures increase during pressotherapy particularly in heart failure patients.

Pimobendane (UD-CG 115 BS) in chronic congestive heart failure. Short-term and one-month effects of a new inotropic vasodilating agent

We studied the effects of oral administration of pimobendane on hemodynamics, blood gas levels, the renin-angiotensin system, and plasma catecholamines in 11 patients who were affected by severe chronic congestive heart failure. Following the administration of 5 mg, the cardiac index increased from 2.0 +/- 0.2 to 2.5 +/- 0.2 L/min/m2 (p less than 0.01), and the pulmonary wedge pressure decreased from 28 +/- 3 to 17 +/- 4 mm Hg (p less than 0.01). The maximal changes were noted five hours after intake of the drug. In spite of a significant decrease in arterial oxygen pressure (PaO2) (from 81 +/- 4 to 67 +/- 5 mm Hg; p less than 0.05), a significant increase in the oxygen delivery index was seen (from 322 +/- 32 to 436 +/- 38 ml/min/m2; p less than 0.01). The patients who were submitted to long-term treatment (5 mg twice daily) and who were reassessed after at least one month exhibited an improved cardiac index from 1.9 +/- 0.2 to 2.5 +/- 0.1 L/min/m2 (p less than 0.01), as well as a decreased pulmonary wedge pressure from 26 +/- 2 to 14 +/- 4 mm Hg (p less than 0.01). The norepinephrine levels were significantly reduced after one month (from 1,496 +/- 185 to 678 +/- 95 pg/ml; p less than 0.01), whereas the plasma renin activity was not. One patient died suddenly during the one-month follow-up period. With the exception of one case, which was also treated with heparin, a transient cutaneous rash and a drop in the level of blood platelets were observed, pimobendane was well tolerated. This new inotropic and vasodilating drug thus seems to have promise for the treatment of chronic congestive heart failure.

Pimobendane (UD-CG 115 BS) in the treatment of severe congestive heart failure. An acute haemodynamic cross-over and double-blind study with two different doses

1. We compared the effects of two doses (5 and 10 mg) of oral pimobendane (UD-CG 115) on haemodynamics in eight patients suffering from chronic congestive heart failure. The two doses were given according to a randomized cross-over double-blind protocol; haemodynamics and plasma levels of pimobendane and its main metabolite UD-CG 212, were determined 1, 2, 3, 5, 7, 9, 11 and 12 h after each dose. 2. Both doses significantly improved the left and right ventricular functions of these patients, with a peak action 3 h after drug intake and long duration (more than 12 h). A significant dose-effect relationship was observed only for pulmonary wedge pressure and right atrial pressure. Significant correlations were found between UD-CG 212 plasma levels and cardiac index (r = 0.54, P less than 0.05), and pulmonary wedge pressure (r = 0.74, P less than 0.001); no correlation was found between these haemodynamic variables and pimobendane plasma levels. 3. One patient developed a transient drop in blood platelets together with a cutaneous rash, while three others had a transient and mild decrease of thrombocytes. 4. In conclusion, pimobendane improved right and left ventricular functions in severe heart failure. Both doses (5 and 10 mg) were effective. The higher dose induced marked improvement of the haemodynamic variables but the difference between doses was only significant for right atrial and pulmonary wedge pressures.

[Comparison of the effects of intravenous diltiazem and a placebo on hemodynamics and blood gases in the acute phase of myocardial infarction]

We compared the effects on hemodynamics and blood gases of an intravenous perfusion of diltiazem vs placebo, administered randomly and in a double-blind fashion, to 20 patients with acute myocardial infarction (less than 24 hours). After 130 minutes, we noted a significant reduction of the arterial blood pressure and the systemic vascular resistances; the other hemodynamic variable are not significantly modified. Diltiazem causes a slight but significant decrease of PaO2 after 130 minutes in intravenous perfusion. This effect is secondary to an increase of the arterio-alveolar gradient in O2, reflecting an increase of the pulmonary shunt. This has no clinical consequence since the oxygen transfer remains stable. In conclusion, intravenous diltiazem administered red in the acute phase of myocardial infarction is well tolerated hemodynamically and clinically. It may induce a minimal arterial hypoxemia by increasing the arterio-alveolar gradient in oxygen.

[Choice of a class I intravenous anti-arrhythmic drug in severe ventricular arrhythmias]

In the choice of a Class I intravenous antiarhythmic medication for the treatment of threatening ventricular extrasystoles, one must take into account the speed of action of the product, its effects on hemodynamics and conduction as well as its efficacy. The rapidity of action implies the ability to reach, without delay, a therapeutic plasma level which will depend upon the distribution volume and the dose injected. An effective plasma level may be quickly reached following the intravenous administration of lidocain, disopyramide, lorcainide, tocainide and flecainide. All antiarhythmic medications have an unfavorable effect on hemodynamics; xylocain and ajmaline seem to depress the least the left ventricular function, followed by lorcainide. Unfavorable effects on the atrio-ventricular conduction are observed with substances of type IC; the duration of QRS may be affected as well by antiarhythmic medications IA and IC, with a lengthening of QT being mostly noted type IA medications. Comparison of the efficacy of antiarhythmic medications requires a strict methodology and the current data from the literature do not permit to assert with certainty the superiority of one antiarhythmic medication over the others.

Central inhibition of sympathetic overdrive by clonidine in acute myocardial infarction with systolic hypertension. Haemodynamic study

Intravenous clonidine was used to treat systolic hypertension (systolic blood pressure greater than 160 mm Hg) in 15 patients with acute myocardial infarction and documented sympathetic overactivity (high plasma norepinephrine). Its effects on haemodynamics and blood gases were studied. After one hour, clonidine significantly reduced the systolic (195 +/- 7 to 137 +/- 7 mm Hg, p less than 0.01) and diastolic (81 +/- 4 to 60 +/- 3 mm Hg, p less than 0.01) blood pressures as well as the systemic vascular resistance (26 +/- 2 to 20 +/- 1 IU, p less than 0.01). The cardiac index was reduced from 2.8 +/- 0.2 to 2.4 +/- 0.2 l/min X m2, p less than 0.01. This change was related to a reduction of the heart rate (92 +/- 4 to 81 +/- 4 beats/min, p less than 0.01) as the stroke index was unchanged. Pulmonary wedge pressure (15 +/- 3 to 10 +/- 2 mm Hg, p less than 0.01) and rate pressure product (18.034 +/- 1.159 to 11.274 +/- 917 mm Hg, beats/min, p less than 0.01) were also significantly decreased. The arterial oxygen tension did not change significantly but there was a significant drop in the mixed venous oxygen saturation (63 +/- 2 to 61 +/- 2%, p less than 0.02) and oxygen transport (433 +/- 41 to 409 +/- 36, p less than 0.01). Clonidine is thus able to normalize blood pressure in acute myocardial infarction; this is accompanied by a reduction in myocardial oxygen requirements and pulmonary wedge pressure. Oxygen transport to the tissues, however, may be decreased.

Predictors of early death after acute myocardial infarction: two months follow-up

Clinical variables and the results of non-invasive tests (exercise test, echocardiogram, gated equilibrium radionuclide ventriculography and 24 h ECG) were recorded in a series of 202 patients who left the hospital alive after an acute myocardial infarction. The short term (two months) predictive value of all these data was prospectively assessed by uni- and multi-variate analysis. The best correlation with early death was observed with the variables related to the extent of infarction and left ventricular dysfunction, namely: early clinical signs of heart failure, high peak CK-MB level, complete bundle branch block, increased cardiothoracic ratio on chest X-Ray, number of Mets reached during the stress test, echocardiographic dyskinesia index, and decreased left ventricular ejection fraction as measured by radionuclide ventriculography. Using multi-variate stepwise discriminant analysis, the following independent prognostic factors appeared by order of entry: early clinical signs of heart failure, peak CK-MB level and cardiothoracic ratio on chest X-Ray. These results highlight the short-term predictive value of the data related to left ventricular dysfunction and especially of simple clinical data for patients surviving an acute myocardial infarction.

[Hemodynamic repercussions and clinical tolerance of 6 class I anti-arrhythmia agents in acute myocardial infarction]

Clinical safety and hemodynamic repercussions were studied after administration of six class I antiarrhythmics (xylocaine, ajmaline, mexiletine, lorcainide, indecainide and tocainide) to patients presenting acute myocardial infarction without complications. The hemodynamic parameters monitored generally followed the same trends. A significant decrease of more than 10 per cent of the initial value was seen in systolic blood flow after injection of lorcainide, indecainide and tocainide. Peripheral vascular resistance increased moderately. Pulmonary capillary pressure increased by more than 40 per cent of the starting value after administration of mexiletine, indecainide and tocainide (significant increase in case of mexiletine). These changes in patients presenting infarction without complications are not of clinical importance. There were, however, two very severe cases of hemodynamic reaction after administration of mexiletine. Other signs of intolerance were seen, but they were of minor importance and administration of the drugs was not interrupted. Xylocaine and ajmaline produced the smallest depression of left ventricular functional activity in these patients.

A comparison of the effects of combined or separate alpha- and beta-blockade in the treatment of hypertension in the acute stage of myocardial infarction

We have assessed the benefit of separate or combined alpha- and beta-receptor blockade in the treatment of 33 patients suffering from acute (less than 48 hr) myocardial infarction complicated by sustained (greater than 6 hr) systolic hypertension (systolic blood pressure greater than 150 mm Hg). Eight patients have been treated with metoprolol, 7 with phentolamine and 18 with labetalol. We evaluated the effects of these drugs on hemodynamics and arterial and mixed venous blood gases. The patients were divided into two groups on the basis of the pulmonary wedge pressure. The first group had a pressure greater than 15 mm Hg. It included 9 patients treated with labetalol (1.8 mg/min for 1 hr) and 7 others with phentolamine (0.6 mg/min for 1 hr). The wedge pressure in the second group was less than 13 mm Hg. Nine patients in this group had been treated with labetalol (2.1 mg/min for 1 hr) and 8 others with metoprolol (0.2 mg/kg in 15 min). Labetalol normalized the blood pressure in both groups within 1 hr as did phentolamine. Metoprolol did not significantly reduce either the systolic or the diastolic pressures. The high wedge pressures in the first group were reduced by both labetalol and phentolamine. The cardiac index was increased following phentolamine administration while it was reduced by labetalol. In the group with low wedge pressure, labetalol and metoprolol induced a slight but significant reduction in cardiac index but the pulmonary wedge pressures were significantly increased for metoprolol only. The rate-pressure product was very significantly decreased by labetalol and metoprolol but not by phentolamine. The emergency treatment of systemic hypertension occurring in the setting of acute myocardial infarction would thus appear to be best achieved by combined alpha- and beta-blockade rather than with either pure alpha- or pure beta-blockade. Phentolamine, however, would be a good drug in the presence of a reduced cardiac index.

Criteria for intraventricular conduction disturbances and pre-excitation. World Health Organizational/International Society and Federation for Cardiology Task Force Ad Hoc

In an effort to standardize terminology and criteria for clinical electrocardiography, and as a follow-up of its work on definitions of terms related to cardiac rhythm, an Ad Hoc Working Group established by the World Health Organization and the International Society and Federation of Cardiology reviewed criteria for the diagnosis of conduction disturbances and pre-excitation. Recommendations resulting from these discussions are summarized for the diagnosis of complete and incomplete right and left bundle branch block, left anterior and left posterior fascicular block, nonspecific intraventricular block, Wolff-Parkinson-White syndrome and related pre-excitation patterns. Criteria for intraatrial conduction disturbances are also briefly reviewed. The criteria are described in clinical terms. A concise description of the criteria using formal Boolean logic is given in the Appendix. For the incorporation into computer electrocardiographic analysis programs, the limits of some interval measurements may need to be adjusted.

Randomised trial of intravenous recombinant tissue-type plasminogen activator versus intravenous streptokinase in acute myocardial infarction. Report from the European Cooperative Study Group for Recombinant Tissue-type Plasminogen Activator

In a single-blind randomised trial in patients with acute myocardial infarction of less than 6 h duration, the frequency of coronary patency was found to be higher after intravenous administration of recombinant human tissue-type plasminogen activator (rt-PA) than after intravenous streptokinase. 64 patients were allocated to 0.75 mg rt-PA/kg over 90 min, and the infarct-related coronary artery was patent in 70% of 61 assessable coronary angiograms taken 75-90 min after the start of infusion; 65 patients were allocated to 1 500 000 IU streptokinase over 60 min, and the infarct-related vessel was patent in 55% of 62 assessable angiograms. The 95% confidence interval of the differences ranges from +/- 30 to -2% (p = 0.054). Bleeding episodes and other complications were less common in the rt-PA patients than in the streptokinase group. Hospital mortality was identical in the 2 treatment groups. At the end of the rt-PA infusion the circulating fibrinogen level was 61 +/- 35% of the starting value, as measured by a coagulation-rate assay, and 69 +/- 25% as measured by sodium sulphite precipitation. After streptokinase infusion, corresponding fibrinogen levels were 12 +/- 18% and 20 +/- 11%. In the rt-PA group only 4.5% of the fibrinogen was measured as incoagulable fibrinogen degradation products, compared with 30% in the streptokinase group. Activation of the systemic fibrinolytic system was far less pronounced with rt-PA than with streptokinase.

Effects of molsidomine on hemodynamics and blood gases in acute myocardial infarction with left heart failure

We studied the effects of molsidomine on hemodynamic properties and blood gas levels in eight patients with acute myocardial infarction and left heart failure. One hour after an 8 mg intravenous bolus injection, pulmonary wedge pressure and right atrial pressure decreased, respectively, from 30 +/- 9 to 23 +/- 12 mm Hg (p less than 0.01) and from 10.4 +/- 3.6 to 7.8 +/- 4.0 mm Hg (p less than 0.05) without significant changes in heart rate, cardiac index, or systemic blood pressure. There was a mild decrease in arterial oxygen tension (from 61 +/- 15 to 56 +/- 6 mm Hg), but it was not significant. The drug induced no adverse effects. Intravenous bolus injection of molsidomine rapidly relieves pulmonary congestion in patients with acute myocardial infarction.

[Hemodynamic effects of phentolamine in acute and chronic mitral insufficiency after myocardial infarction]

The haemodynamic effects of phentolamine, a selective alpha blocker, were studied in patients with severe mitral regurgitation and cardiac failure in the acute (Group I, 7 cases) or chronic (Group II, 7 cases) phase of myocardial infarction. After 1 hour's treatment a rise in cardiac index (+29 p. 100, p less than 0.001 and +36 p. 100, p less than 0.01), and systolic index (+19 p. 100, p less than 0.001 and +19 p. 100, p less than 0.05) were observed; the V wave of the pulmonary capillary pressure recording decreased (-32 p. 100, p less than 0.005; -26 p. 100, p less than 0.01). Oxygen transport also increased by an average of 36 p. 100, p less than 0.001, without a significant change in arterial pp O2. These results show that phentolamine improves the haemodynamics and decreases mitral regurgitation in the acute and in the chronic phases of myocardial infarction.