Pharmacokinetics of verapamil and its metabolite norverapamil from a buccal drug formulation

Pharmacokinetics of verapamil and its metabolite norverapamil, from buccal drug formulation administered in a dose 20 mg in relation to conventional tablets of verapamil 40 mg, used in medical practice, was determined. Buccal formulation has previously been designed as an alternative form of dosing verapamil. Bioavailability was determined by a crossover method in 12 healthy volunteers. Drug concentration in plasma was determined by means of HPLC with a fluorescence detector. For buccal formulation the average values of C(max) and AUC(0-24 h) for verapamil were much higher than for the reference Staveran tablets and amounted to 51.28 and 320.23 ng/ml h, respectively. However, for norverapamil the corresponding values for buccal formulation were much lower than for a conventional tablet. It has been demonstrated that the proposed buccal verapamil dosing ensures different metabolism of the drug as compared to tablets. Better parameters of bioavailability of verapamil from buccal formulation of twice a smaller dose than that in the tablet, prove that this new drug might be form more effective clinically than the conventional one.

Preoperative discrimination between malignant and benign adnexal masses with transvaginal ultrasonography and colour blood flow imaging

BACKGROUND

Ovarian cancer is one of the causes of death in women, and in about 70% of cases is recognized only in advanced stages. This study was undertaken to evaluate distinctive values of transvaginal and color Doppler ultrasonography in differentiating malignant and benign adnexal masses through analysis of ultrasonic morphological features of malignancy and estimation of location and intensification of angiogenesis as well as values of resistance of flow in examined masses.

PATIENTS AND METHODS

329 women with malignant and benign adnexal masses underwent ultrasonographic and colour Doppler examination 1-5 days before surgery (laparotomy, laparoscopy) thus allowing histological verification of diagnosis. The ultrasonographic structure was assessed using a morphological scoring system devised by Sassone, Jain and Benacerraf. Regions showing vasculature, especially within septae and solid parts of tumours were examined by means of transvaginal colour Doppler. Location and intensification of angiogenesis as well as resistance index (RI) were investigated. Sensitivity, specificity, PPV and NPV of both techniques were assessed. Statistical analysis of obtained data were based on the Student's t test; p < 0.05 level was considered significant.

RESULTS

Postoperatively 255 (77.5%) benign and 74 (22.5%) malignant tumours were seen. In the group of benign masses the average age of women was 42.6+/-12.3 and in the malignant it was 53.1+/-12.6 (p<0.0001). The transverse dimension of benign lesions was 77.2+/-19, whereas for malignant it was 107.0+/-31 (p<0.0001). Benign tumours in 63.0% were cystic, in 26.0% mixed cystic-solid and in 11.0% solid echostructures while in malignant they were respectively, 6.8%, 56.8% and 36.4% (p<0.0001). Doppler flow within the tumour was 74.5% in benign and 98.6% in malignant masses (p<0.0001). In benign lesions homogenous superficial or peripheral vasculature was visualized, and in the majority of cases (82.7%) it was of medium intensification. However in malignant central, peripheral or mixed vascularisation. in the majority intensified character was found. Average value of the resistance index in all benign masses amounted to 0.77+/-0.14, however in malignant it was 0.39+/-0.07 (p<0.0001).

CONCLUSIONS

We contend that complete ultrasonographic estimation of ovarian neoplasms outside the qualification of structural details should include Doppler analysis of vasculature parameters. Most important is the qualification of resistance of flow, and location and intensification of vascularisation in examined masses which permit the differentiation of malignant and benign lesions. Preoperatively recognizing malignant processes with colour Doppler ultrasonography shows higher accuracy, specificity and PPV.

Computer identification of neoplastic urothelial nuclei from the bladder

OBJECTIVE

To introduce computer-based analysis of Feulgen-stained urinary bladder cell nuclei from voided urine to identify neoplastic urothelial nuclei.

STUDY DESIGN

Nuclei from 23 healthy people and 33 patients with urinary bladder cancer were analyzed. The nuclei from 9 cancer patients with grade G1 (stage Ta), 17 with grade G2 (stages Ta, T1, T1a and T2) and 7 with grade G3 (stages Cis, Ta + Tis, T1 and T3b) were analyzed. Image analysis was carried out by means of a digital image processing system designed by the authors. Features describing nuclei were selected as the first step of the procedure. Then a multistage classifier was constructed to identify positive and negative cases.

RESULTS

The results of this pilot study of a group of 56 patients yielded a 71% correct classification rate in the control group, while a 66% rate was obtained among the cancer patients. The sensitivity of the method was 100% and the specificity was 77%.

CONCLUSION

This approach to the identification of neoplastic urothelial nuclei may be sufficiently well developed to be used successfully both in screening high-risk populations and in clinical practice.

First cases of acute human granulocytic ehrlichiosis in Poland

The first three cases of acute human granulocytic ehrlichiosis in Poland are described. Blood samples were tested by an indirect immunofluorescence method to detect specific serum antibodies, and the polymerase chain reaction was used to detect ehrlichial DNA. Additionally, peripheral blood smears were examined for the presence of morulae. According to criteria of the Centers for Disease Control and Prevention, all three cases can be classified as confirmed granulocytic ehrlichiosis. Using the criteria recommended by a consensus group, however, two cases can be classified as confirmed granulocytic ehrlichiosis and one case as probable granulocytic ehrlichiosis.

Embryotoxicity of magainin-2-amide and its enhancement by cyclodextrin, albumin, hydrogen peroxide and acidification

BACKGROUND

The channel-forming antimicrobial peptide, magainin-2-amide, interacts preferentially with negatively charged, non cholesterol-containing membranes, including those of sperm, oocytes and cells of pre-implantation embryos. Cyclodextrin and albumin remove membrane cholesterol and together with hydrogen peroxide (H2O2) are potential enhancers of embryotoxicity.

METHODS

Two-cell murine embryos were cultured in vitro with magainin-2-amide at a high effective concentration (250 microg/ml) and at subthreshold concentrations (166 and 200 microg/ml). Embryos treated with sub-threshold concentrations of magainin were additionally treated with cyclodextrin, bovine serum albumin or H2O2 or were cultured under acidified conditions. Cell viability was verified with propidium iodide and fluorescein diacetate.

RESULTS

The embryotoxic effect of magainin and H2O2 was dose- and time-dependent. Cyclodextrin, H2O2, acidification of the medium, and to a lesser extent albumin, enhanced the embryotoxicity of magainin at sub-threshold concentrations.

CONCLUSION

Magainin on its own is highly embryotoxic. Its embryotoxicity is enhanced by cyclodextrin, albumin, H2O2 and acidification. Thus, magainin which has antibacterial, antifungal and antiprotozoal activity may also have a potential role as a contraceptive agent. The harmful effects of various concentrations of the exogenous H2O2 on 2-cell stage mouse embryos are reported here, to the best of our knowledge, for the first time.

A validated method for the determination of verapamil and norverapamil in human plasma

The aim of the study was to develop a simple and sensitive analytical method to determine verapamil (V) and its metabolite norverapamil (N) in human plasma with use of an HPLC isocratic system with fluorescence detection, following fast extraction of the investigated compounds. Extraction recovery was 92.12% and 89.58% for V and N, respectively. Internal standard in HPLC was propranolol. Its recovery was 82.50% on the average. Limit of detection was 0.924 ng/ml and limit of determination was 3,080 ng/ml for V, what corresponds concentration in plasma 1.232 ng/ml. For N limit of detection was 0.030 ng/ml and limit of determination was 1.001 ng/ml what corresponds 0,4 ng/ml in plasma. Parameters of validation prove that precision of the presented method is very good. The method is fast and one chromatogram separation lasts about 8 minutes. 30-40 manual (without autosampler) analyses per day were done. It was used successfully in pharmacokinetic and bioavailability studies of verapamil administration in drug formulations alternative to tablets: buccal and flotation ones.

Penetration of verapamil hydrochloride in the presence of sodium glycocholate as penetration enhancer through mucous membrane

A model buccal drug formulation (BDF) with verapamil hydrochloride (VH) is in the form of a thin elastic disk made of two layers. The aim of this paper was to determine the influence of sodium glycocholate (SG) as a penetration enhancer in a BDF on the in vitro penetration rate of VH through pig oesophageal mucosa. It was found that VH penetrates mucosa. In 6 h 10.35 mg/cm2 of drug diffused from saturated solution in a buffer of pH 5.3 white from diffused only 7.78 mg/cm2 and 4.68 mg/cm2 of VH, respectively saturated buffers of pH 6.8 and 7.3. In 6 h approximately 1.3 mg/cm2 of VH penetrate the mucosa from the control BDF model which does not contain the penetration enhancer. Conversely the content of SG in the model BDF contributes to the increase in drug penetration rate.

Cyclodextrin enhances spermicidal effects of magainin-2-amide

Magainins are antimicrobial peptides with known spermicidal activity. Their activity is inhibited by cholesterol present in eukaryotic cell membranes. Pretreatment of spermatozoa with methyl-beta-cyclodextrin, which extracts cholesterol from cell membranes and induces capacitation, sensitizes them to magainin-2-amide as shown by a decrease in human sperm motility determined by computer-assisted sperm analysis and a concomitant decrease in sperm viability, as measured by MitoTracker(R) Red CMXRos labeling. Magainin-2-amide affects mainly the fast progressive spermatozoa inducing them directly into an immotile state, without an increase in motile non-progressive and slow progressive spermatozoa. We conclude that methyl-beta-cyclodextrin highly potentiates the deleterious effect of magainin-2-amide on human spermatozoa. Most probably, this effect can be explained by cholesterol extraction from sperm cell membranes.

Fractional curettage, hysteroscopy and imaging techniques: transvaginal sonography (TVS), magnetic resonance imaging (MRI) and computed tomography (CT) in the diagnosis of cervical canal involvement in cases of endometrial carcinoma

The value of preoperative diagnostic procedures (FC, hysteroscopy, TVS, MRI, CT) used to evaluate cervical canal involvement in cases of endometrial carcinoma was assessed. The results of these diagnostic methods were compared to postoperative pathologic examination results. Evaluation of the cervix by CT was limited. High NPV of the rest of the methods together with their negative results allowed us to exclude cervical infiltration with a high probability. Alas, none of them was adequate to confirm the presence of cervical involvement because of their low PPV which ranged from 8.3% (hysteroscopy) to 50% (MRI). Among all these diagnostic procedures TVS was relatively efficient (77.8%), specific (78%), sensitive (75%) and inexpensive. This method is preferable in the evaluation of possible cervical infiltration.

[Evaluation of research--reality and illusions]

Productivity and effectiveness of research are defined and their indicators discussed. Particularly, citation index (CI) and impact factor (IF) as the measures of research quality are analysed. Citation index despite its drawbacks and pitfalls is the best, among applying at present, measure of research quality. Impact factor due to its severe drawbacks is not recommended as a measure of research quality, particularly for the matching. The mixture of criteria excluding IF are propose to evaluate research quality.

[Preoperative evaluation of the invasiveness of myometrial and pelvic lymph nodes in patients with endometrial cancer]

Transvaginal sonography (TVS), computed tomography (CT) and magnetic resonance imaging (MRI) were used for preoperative diagnosis of myometrial and pelvic lymph nodes invasion in patients with endometrial cancer. Results of examinations were compared with histopathological findings. Sensitivity, specificity, efficacy, positive and negative prognostic values of these imaging techniques were compared. TVS and MRI had similar efficacy in the evaluation of depth of myometrial invasion (78.8% vs 67.6%). In the evaluation of deep invasion TVS in spite of lower sensitivity had higher specificity and positive prognostic value. Efficacy of all methods for evaluation of lymph nodes metastases was similar (80-82%), but TVS had higher positive prognostic value than MRI. CT in comparison with TVS and MRI was less useful in the diagnosis of myometrial invasion.

[Preoperative evaluation of cervical involvement in endometrial cancer]

Usefulness of fractionated curettage, histeroscopy, transvaginal sonography and MR-imaging in the preoperative diagnosis of cervical involvement of endometrial cancer was studied. Sensitivity, specificity, efficacy, positive and negative prognostic value of above-mentioned examinations were compared. None of examinations was adequate for diagnosis of presence of cervical invasion because of their low positive prognostic values. Negative prognostic value of all examinations was high. MR-imaging and transvaginal sonography had the highest efficacy and comparatively high sensitivity and specificity. Authors suggest, that transvaginal sonography--considering its simplicity and relative cheapness--should be obligatory in the diagnosis of endometrial cancer advancement.

Transvaginal colour flow imaging in assessment of ovarian tumor neovascularization

Localization and intensity of angiogenesis in benign and malignant ovarian neoplasms recorded by color Doppler transvaginal ultrasound has been assessed. Increased intratumoral angiogenesis has been affirmed in 60% of malignant and only in 9% of benign lesions.

[Evaluation of endometrial changes in women with cyclical mastalgia]

Cyclical mastalgia which almost 40% of women suffer from is caused by inadequate ovarian hormones secretion. There are reports regarding increased number of endometrial steroid receptors in this group of women. The possibility of higher risk of endometrial cancer development in these women is very probable. 119 women with cyclical mastalgia aged 16-55 (means age 35.4 years) were investigated. Anovulatory cycles occurred in 63%. Increased estrogen action in vaginal smears was found in 24.1%, also decreased progesterone effect had been seen in 20.3% of our cases. Serum estradiol levels were elevated in 10.6% and 39.1% of the patients had lower serum progesterone levels. Mean progesterone--estrogen luteal index value was decreased to 0.99. Irregular uterine bleedings occurred in 16.8 of women (aged 41-48 years). Histological endometrium examinations revealed changes due to insufficient progesterone action.

[Cardiac arrhythmias during extracorporeal shock wave lithotripsy]

Holter monitoring was performed in 55 patients (24 women, 31 men), mean age 50.7 +/- 11.3 who underwent ECG-triggered extracorporeal shock wave lithotripsy (ESWL). Patients were divided into two groups A--30 with history of cardiac disease and B--25 control. The heart rate was significantly higher before and after ESWL in the first group. The number of premature ventricular contractions was higher during ESWL in the same group. No other cardiac complication was observed.

[Ectopic spleen in pelvis minor--a case report]

A case of ectopic spleen diagnosed as a left adnexal tumor in a 19 year old female was presented. Considering the rareness and lack of typical symptoms, diagnosis of this pathology still is very difficult, and establish most often intraoperatively. In every case of ascertainment irregular mass in minor pelvis one should differentiate it among: colonic diverticulosis, wandering kidney, coproliths, colon and mesentery tumors and ectopic spleen. We consider that ultrasonography plays the special role in these cases. In every case of stating the pathologic structure in minor pelvis it seems advisable not to content only with estimation of genital organs, but also locate such as: kidneys, liver, spleen. Such a procedure allows to state preoperative diagnosis more precisely.

Health, art, and culture: the juggling cultures program

At a time in life when establishing self-identity is most important, multicultural youth experience special stress as they try to juggle living in two or more cultures on a daily basis. The use of art as a vehicle for communication - a creative and innovative challenge to service providers such as family physicians - often proves very rewarding for both client and practitioner.

Fourier analysis of the nuclear and cytoplasmic shapes of living two-cell murine embryos

Living two-cell mouse embryos were flushed out from the oviduct 17, 24 and 36 hours after fertilization in order to obtain cells in the G1S, early G2 and late G2 phases of the second cell cycle. The nuclei of the living cells were stained with Hoechst 33342. The coordinates of the contour shapes of the entire cells (cellular contours) were registered by contour image processing with a TV camera coupled with a computer; the contours of the nuclei were computed by means of a digitizer coupled with the computer. Fourier analysis of the cellular and nuclear contours revealed systematic modifications in the folding of the cells and nuclei in the course of the murine second cell cycle. The progression of cells through the second cell cycle was correlated with an increasing diversification of cellular and nuclear shape, with the diversification being much more pronounced in the nuclear shapes.

In vivo staining of mouse preimplantation embryos with Hoechst 33342

Female mice bearing secondary oocytes or preimplantation embryos of various stages were injected with Hoechst 33342 (H 33342), either intravenously or intraperitoneally and sacrificed at various intervals afterward. The dye penetrated through the wall of oviduct and stained the nuclei of its cells as well as mitotic chromosomes of secondary oocytes, the pronuclei of one-cell embryos, and nuclei of blastomeres and polar bodies. The nuclear fluorescence was observed in living cells flushed out of the oviduct as well as in those fixed in oviduct, embedded in paraffin, and sectioned. H 33342 injected in a dose of 10 micrograms/g of body weight failed to interfere with preimplantation development of stained embryos as indicated by the number of blastocysts per mouse and number of cells per blastocyst.

Heterogeneity of cytoplasmic and nuclear shape of lymphocytes during progression of chronic lymphocytic leukemia

Peripheral blood from ten healthy subjects and from 44 patients at stages 0, I, II, III, IV of chronic lymphocytic leukemia (CLL), type B, was routinely smeared, fixed and stained by the May-Grunwald-Giemsa method. Fourier analysis of nuclear and cytoplasmic shape of smeared lymphocytes was carried out for the range 1-20 of harmonics (describing the pattern of contour folding in quantitative terms). In addition the roughness coefficients (describing the summarized measure of contour folding of an individual cell) were calculated and computer evaluated. Cytoplasmic contour shape of smeared lymphocytes in the 6-10 harmonic range discriminates well between lymphocytes of healthy subjects and those of each CLL stage. This discrimination was the result of richer folding of CLL lymphocytes. Nuclear contour shape of lymphocytes in the 6-10 harmonic range fails to discriminate between lymphocytes of healthy subjects and those of CLL, but it discriminates well between lymphocytes of various stages of CLL, with the exception of stages I/II and III/IV. When Fourier analysis was carried out on lymphocytes of combined stages I + II and III + IV, the shape differences were even more accentuated. We conclude that nuclear and cytoplasmic contour shape is a phenotypic feature of lymphocytes that is markedly modified in the course of CLL progression; this feature may be used as a new parameter in CLL.

Hoechst 33342 staining coupled with conventional histological technique

Hoechst 33342 was injected either intravenously or intraperitoneally into mice which were killed 1 or 24 hr or 7, 14 or 28 days later. Various organs were fixed and paraffin embedded. Visual inspection showed that independently of the route of dye administration or survival time, distinct fluorescence of nuclei was observed in organs other than cerebral cortex. Even formic acid decalcification of bone failed to abolish the fluorescence of osteocytes. In vivo staining with Hoechst 33342 is proposed as an alternative for staining after sectioning. Cells from spleens of Hoechst 33342-injected mice or stained in vitro were injected intramuscularly into mice. Hoechst 33342-stained splenocytes could be found in deparaffinized sections at the site of injection 24 hr later.

Bioavailability of isosorbide dinitrate from an oral therapeutic system and from tablet Sorbonit Prolongatum 20,0 in human volunteers

The bioavailability of isosorbide dinitrate from an oral therapeutic system (OTS) and from tablet Sorbonit Prolongatum 20,0 mg in 6 volunteers employing a crossover method was studied. Concentrations of isosorbide dinitrate (1),2-mononitrate (2) and 5-mononitrate (3) are plotted as mean concentrations for all volunteers. As evident, the concentration-time curves are similar after administration of both OTS and tablet Sorbonit Prolongatum. Concentration of the nitrates in the serum is close to the maximum level starting 2 h after the drugs were administered. Such concentration is nearly constant for 7 h in the case of nonmetabolized 1 and for 9 h for its metabolites. 24 h after administration metabolites 2 and 3 were found in the serum of 5 subjects. Based on the experimental data, we calculated the areas under curves (AUC). The observed differences in AUC appeared statistically insignificant at the 95% confidence level for the two preparations studied in the case both 1 and its metabolites.