Long-term (5 year) experience with transdermal clonidine in the treatment of mild to moderate hypertension

The long-term safety and efficacy of transdermal clonidine (C-TTS) was evaluated in 102 patients with mild to moderate hypertension over a mean treatment period of 4.9 +/- 1.4 years. C-TTS size 1 was used by 29.4%, C-TTS size 2 by 35.3%; in 35.3% of the patients a diuretic agent was given in addition. The baseline blood pressure of 168/100 mmHg was reduced to 150/85 mmHg at the end of titration and remained stable during long-term treatment. After 5 years seated blood pressure was 147/83 mmHg. Systemic side-effects, e.g. 4.9% dry mouth, were reported mainly during the first month. Transient local side-effects occurred mainly between weeks 4-26, thereafter the incidence clearly diminished and did not cause any withdrawal due to skin reactions from 1 year up to 6.5 years. Overall the long-term transdermal clonidine treatment was highly accepted by the patients, was effective and was well tolerated.

Recent advances in the treatment of childhood obesity

The multidisciplinary, four-phase approach, which includes PSMF, BEM, and MPE is successful in treating mild, moderate, and severe degrees of childhood and adolescent obesity. The MPE program is appropriate for use with PSMF and BEM due to its progressive nature, variety of options, and moderate intensity level. In addition, the MPE program is of sufficient intensity, duration, and frequency to promote a significant increase in estimated aerobic capacity (VO2max) and to promote the maintenance of lean body mass and resting energy expenditure. The short-term intervention of PSMF, BEM, and MPE also results in an improvement in body composition, lipid profiles, and IGF-1 and T3 levels. The 1200-calorie balanced diet, MPE, and BEM also provide a successful method of weight maintenance in children and adolescents, as indicated by further improvement in body composition at the 26-week measure. Additional studies are needed to assess the contribution of exercise to the maintenance of lean body mass and resting energy expenditure in obese children and adolescents. In addition, it will be important to assess long-term weight maintenance in obese adolescents who effectively lose weight in this multidisciplinary program.

HS-142-1 inhibits testosterone production and guanosine-3':5'-cyclic monophosphate accumulation stimulated by atrial natriuretic peptide in isolated mouse Leydig cells

In this report, we describe the effects of a recently described atrial natriuretic peptide (ANP) antagonist, HS-142-1, on the action of ANP on Percoll-purified mouse Leydig cells. Incubation of the Leydig cells with 10(-8) M ANP for 3 h resulted in a 16-fold stimulation of testosterone production over basal. Addition of HS-142-1 in a concentration range of 0.1 to 5 micrograms/ml resulted in a dose-dependent inhibition of ANP-induced testosterone production, a nearly complete inhibition being achieved with 5 micrograms/ml antagonist. Testosterone production by unstimulated cells or in cells stimulated with hCG was not affected by the antagonist. HS-142-1 was also able to inhibit the ANP-stimulated cyclic guanosine monophosphate (GMP) formation in the cells, in a dose-dependent manner. However, cyclic AMP level in cells stimulated with either forskolin or hCG remained unaffected by HS-142-1 even when added at a concentration of 5 micrograms/ml. Results obtained from 125I-ANP binding experiments showed that HS-142-1 is able to competitively inhibit the binding of the radioligand to its receptors on the Leydig cells. Thus evidence obtained in this study permit us to conclude that HS-142-1 is a potent and specific antagonist of ANP, has no toxic effect on the cells and is able to inhibit competitively the binding of ANP to its guanylate cyclase coupled receptors. Availability of such antagonists are likely to facilitate research on the physiology of ANP.

Stimulation of testosterone production by atrial natriuretic peptide in isolated mouse Leydig cells results from a promiscuous activation of cyclic AMP-dependent protein kinase by cyclic GMP

The aim of this study was to examine the possibility that atrial natriuretic peptide-stimulated testosterone production by mouse Leydig cells results from an activation of cAMP-dependent protein kinase (kinase A) by cGMP. In these cells, both 8Br-cGMP and 8Br-cAMP could stimulate testosterone production, though the latter was approximately 50-fold more potent. Following the stimulation of the cells with the atrial peptide, a dose-related decrease in the cellular protein-bound cAMP accompanied by a concomitant increase in the protein-bound cGMP was observed. The steroidogenesis stimulated by both human chorionic gonadotrophin (hCG) and atrial peptide was inhibited in a dose-dependent manner by a cAMP antagonist, adenosine 3',5'-cyclic monophosphothioate, Rp-isomer (RpcAMPS). In a cell-free [3H]cAMP binding assay, we have shown that unlabelled cGMP and RpcAMPS could competitively inhibit the [3H]cAMP binding, confirming that cAMP, RpcAMPS and cGMP could bind to the same binding protein. Finally, in a cell-free kinase A assay system, we have demonstrated that in lysates prepared from either atrial peptide or hCG-stimulated cells, the cellular kinase A was activated to an equal extent. We conclude from the data obtained that cGMP can bind to the cAMP-binding sites of kinase A and thereby brings about a promiscuous activation of this kinase. This appears to be an underlying mechanism by which atrial peptide hormone is able to stimulate the steroidogenesis in mouse Leydig cells.

beta-lactamases in Shigella

The occurrence of resistance and production of beta-lactamases was investigated in 60 Shigella strains. Ampicillin resistance was found in 28 (47%) of the isolates, the resistance being more frequent in Sh. flexneri than in Sh. sonnei. All strains were susceptible to cefotaxime, mecillinam, and ciprofloxacin. The beta-lactamases produced by Shigella were similar to TEM-1, OXA-1, or the low-level chromosomally mediated cephalosporinase produced by Escherichia coli. The beta-lactamases produced by Sh. flexneri were most often the OXA-1-like enzymes.

In vitro effects of tumor necrosis factor-alpha on human thyroid follicular cells

Tumor necrosis factor-alpha is assumed to be an important mediator in thyroid autoimmunity. In the present study we have shown that human thyrocytes possess a single specific binding site for recombinant tumor necrosis factor-alpha with an average of 9,300 receptors/cell (Kd = 1.9 x 10(-10) mol). The effects of the cytokine on thyroid cell proliferation were assessed by 3H-thymidine uptake as well as by the protein and DNA content of cell monolayers. Low dose tumor necrosis factor-alpha resulted in a moderate stimulation of cell proliferation with an increase of 3H-thymidine incorporation from 44,613 +/- 7,989 cpm under basal conditions to 63,326 +/- 6,822 cpm after 100 U/l tumor necrosis factor-alpha (p < 0.01). Higher doses of the cytokine were less effective. On average, bTSH stimulated cAMP production of human thyrocytes was significantly augmented after preincubation with recombinant tumor necrosis factor-alpha. The maximum effect was observed after 1,000 U/l tumor necrosis factor-alpha (281.5 +/- 107.0 vs 114.5 +/- 33.6 fmol cAMP/micrograms protein under basal conditions: p < 0.05), whereas higher doses of the cytokine were again less effective. This phenomenon could at least partly be explained by a cytokine-mediated downregulation of tumor necrosis factor-alpha binding. We conclude that in vitro tumor necrosis factor-alpha modulates in addition to its well known synergistic effect on interferon-gamma induced HLA class II expression the function and proliferation of human thyroid follicular cells as well. These effects are mediated via specific cell surface receptors.

[Exercise performance after long-term administration of enalapril or metoprolol. A randomized double-blind study of hypertensive leisure-time sportsmen]

A randomized double-blind trial was conducted in 36 leisure-time sportsmen (mean age 40.1 +/- 5.4 years) with mild or moderate essential hypertension (WHO groups I or II) to find out whether an 8-week antihypertensive treatment with daily 10-20 mg enalapril or 100-200 mg metoprolol changed their exercise performance. This was measured by bicycle spiroergometry together with determination of lactate levels, before and at the end of the treatment period. Maximal oxygen uptake rose by 1.86 ml/kg.min during enalapril administration and by 1.06 ml/kg.min at the individual anaerobic threshold. But under metoprolol these parameters fell by 6.57 ml/kg.min and 4.61 ml/kg.min, respectively. After treatment with these two drugs 3 and 15 patients, respectively, had the sensation of greater exercise performance at identical exercise levels. The differences in exercise between the two drugs using the stated three primary criteria were statistically significant. The Watt-time product decreased in only one of the patients of the enalapril group, but in 17 of the metoprolol group. Only metoprolol significantly reduced exercise heart rate. Both drugs caused a similar fall in systolic blood pressure during exercise.

Screening method for beta-lactamase substrate profiles

A disc diffusion method, based on the idea of Klundert, for screening of substrate profiles of beta-lactamases was developed in order to perform epidemiological studies. The method was tested against 30 different reference beta-lactamases and 59 clinical isolates known to produce TEM-1, SHV-1 and BRO-1. The reproducibility and discriminating power of the disc diffusion method made it possible to differentiate between eight types of substrate profiles for the 30 reference beta-lactamases and to differentiate between TEM-1, SHV-1 and BRO-1 from clinical isolates. In combination with analytical isoelectric focusing the disc diffusion method gives a reliable identification of beta-lactamases.

Lymphoblastic crisis of chronic myelogenous leukemia. Hand mirror variant

We present, to our knowledge, the first extensively studied case of lymphoid L2 blast crisis of chronic myelogenous leukemia with a hand mirror cell (HMC) variant. Special stains revealed the leukemic cells to be terminal deoxynucleotidyl transferase positive by immunofluorescence and cytochemically positive for alpha-naphthyl acetate esterase and acid phosphatase (diffuse granular). Immunophenotyping identified the major leukemic cell population as B-cells that expressed CD10+, CD19+, and HLA-DR+. It was not possible to separate the HMC and the non-HMC leukemic population by gating various cell populations, dual staining, cytochemistry, or by terminal deoxynucleotidyl transferase. Gene rearrangements were observed in both Ig heavy-chain alleles and one T-cell antigen receptor gamma-subunit allele. The rearrangements occupied all of the cells, indicating that the HMC and non-HMC were of a common clonal origin. The patient had a mosaic karyotype, with 90% of the cells having t(9;22), t(8;14), and t(9;15) translocations, an additional chromosome 8, and deleted chromosomes 9 and 15. Antibodies to simian sarcoma-associated virus and baboon endogenous virus were isolated in the patient's peripheral blood plasma.

Implication of prior treatment with drug combinations including inhibitors of topoisomerase II in therapy-related monocytic leukemia with a 9;11 translocation

The present case, together with other reports reviewed herein, defines a new subtype of therapy-related acute myeloid leukemia (t-AML). This variant of t-AML is characterized by a short interval from initial drug therapy to bone marrow dysfunction and monocytic morphology without trilineage dysplasia. Unlike classic t-AML, which frequently has abnormalities of chromosomes 5 and/or 7, this new subtype is characterized by rearrangements involving band q23 of chromosome 11, most commonly a 9;11 translocation. The majority of patients with this subtype t-AML had prior cytotoxic therapy with topoisomerase II-reactive drugs including anthracyclines, epipodophyllotoxins, or actinomycin D, combined with either an alkylating agent or cisplatin. This association of prior therapy which includes topoisomerase II-reactive agents and a rapidly appearing t-AML involving the monocytic line and chromosome 11 requires additional study.

[Enoxacin concentration in seminal fluid, in prostate secretions and in prostatic adenoma tissue following oral administration or intravenous infusion]

In eleven volunteers and 39 patients undergoing transurethral resection of the prostate or bladder tumor, concentrations of enoxacin were measured in seminal fluid (volunteers), in prostatic fluid (volunteers, patients) and in prostatic adenoma tissue (patients) after oral (400 mg) administration and intravenous (428 mg) infusion (60 min) of enoxacin. Simultaneously 2.534 g of iothalamic acid was i.v. injected to identify possible urinary contamination. The concentrations of enoxacin in seminal fluid after 2-4 h and in prostatic tissue after about 1-4 h and 14-16 h exceeded plasma concentrations more than two-fold. The concentrations in prostatic fluid after 1-4 h were about half the plasma concentrations. Venous blood samples were taken after intravenous infusion at intervals of up to 24 h in a total of 14 patients. The mean plasma concentration of enoxacin decreased from its maximum of 6.9 mg/l at the end of infusion to 0.5 mg/l at 12 h after administration. A terminal half life of 6.65 h was calculated according to an open two-compartment model.

In-vitro activity of fleroxacin against isolates causing complicated urinary tract infections and concentrations in seminal and prostatic fluid and in prostatic adenoma tissue

Fleroxacin is a new fluoroquinolone with a broad antibacterial spectrum and a serum half-life of about 8-12 h. Eighty percent of 400 isolates from complicated or hospital-acquired urinary tract infections were inhibited by a concentration of 1 mg/l and 95% by 4 mg/l. As with other quinolones, fleroxacin is less active in acid urine (pH 5.4) than in Mueller-Hinton broth (pH 7.4). In 12 healthy volunteers the concentrations of fleroxacin were measured in plasma and seminal and prostatic fluid 2, 4 and 12 h after an oral dose of 400 mg. The mean plasma concentrations of three or four volunteers at each time were 4.2, 3.6 and 1.2 mg/l, respectively. The corresponding prostatic fluid/plasma ratios were 0.30, 0.27 and 1.96, respectively. By concomittant administration of ioxitalamic acid it could be demonstrated that in samples obtained 12 h after administration urinary contamination must be considered. Fleroxacin is concentrated in seminal fluid by a median ratio of 1.7. In 13 elderly patients the prostatic fluid and prostatic adenoma tissue concentrations were determined one to four hours following oral administration of 400 mg. The concentrations in prostatic fluid were similar to those of volunteers. The tissue concentrations exceeded plasma concentrations by only about 10% (median). Fleroxacin is very active against isolates causing complicated UTI. Concentrations in seminal and prostatic fluid and prostatic adenoma tissue are sufficiently high to treat bacterial prostatitis or vesiculitis caused by susceptible bacterial strains.

Penetration of fleroxacin into prostatic secretion and prostatic adenoma tissue

In 12 elderly patients, plasma, prostatic secretion and adenoma tissue concentrations of fleroxacin were determined 1-4 h following oral administration of 400 mg. The plasma concentrations ranged between 0.4 and 5.5 micrograms/ml (median 3.7 micrograms/ml), the mean tissue concentrations were slightly higher. The concentrations in prostatic secretion were about one third of the simultaneous plasma concentrations. High concentrations of the concomitantly administered ioxithalamic acid in prostatic secretion are considered as indicative of urinary contamination, and in this case the fleroxacin concentrations are questionable. The drug levels in prostatic adenoma tissue were similar to the concomitantly measured plasma levels.

[Antihypertensive pharmacotherapy with the vasodilators captopril and endralazine]

A comparative, controlled, open hypertension study using the direct vasodilator endralazine and the ACE-inhibitor captopril in combined therapy for severe and moderately severe hypertension is described. Both vasodilators cause an approximately 20% reduction in supine and upright blood pressure. Extreme side effects such as hematological alterations, autoimmune states or uncontrollable water retention were not observed. Subjective symptoms, particularly severe headaches, were especially evident after endralazine use. This side effect may possibly be eliminated by gradual titration over several weeks.

Prevention of experimental immune complex glomerulonephritis by specific inactivation of immunoreactive cells

In a previous experiment we were able to induce in rabbits a state of specific tolerance against bovine serum albumin (BSA) by pretreatment with highly hot labelled BSA-125 I thus preventing immune complex glomerulonephritis. Despite successful suppression of antibody production, the question remained to be answered if this was due to an nonspecific effect of immunosuppression by radio-iodinated BSA or caused by the elimination of the corresponding lymphocyte clone according to the clonal deletion theory. Therefore, rabbits, rendered tolerant BSA antigen were treated with another antigen, bovine gamma globulin (BCG) and developed classical immune complex glomerulonephritis and vice versa. These results strongly suggest a specific elimination of the effector cell clones only, the exact mechanism of which still remains to be elucidated.

Antigen-specific suppression of the experimental immune complex glomerulonephritis in rabbits by means of highly hot labelled antigen

We succeeded in suppressing almost completely the development of glomerular immune disease in a new experimental model, i.e. in the model of immune complex glomerulonephritis. Previous injection of highly hot labelled BSA was able to prevent very significantly the appearance of kidney injury. This result must be interpreted as the consequence of suppression of the synthesis of anti-BSA-antibody by means of previously applied highly hot labelled BSA. As a consequence of the lack of anti-BSA-antibodies there is no formation of antigen-antibody complexes, no deposition of these complexes in the glomerulus basement membrane, and no development of glomerular immune complex disease. Radioactivity alone (125I coupled to HGH) was not capable of modifying or suppressing the synthesis of antibody and consequently, the formation of antigen-antibody complexes.