Should the exercise test (ET) be performed at discharge or one month later after an episode of unstable angina or non-Q-wave myocardial infarction?

The diagnostic and prognostic value of symptom limited exercise tests (ET) performed before discharge and after one month were compared in men admitted to hospital after an episode of unstable angina or a non-Q-wave myocardial infarction (MI). A 'Positive ET' was defined as either a maximal work load below 100 W or ST-depression greater than or equal to 0.1 mV in 1-2 leads below 130 W or ST-depression greater than or equal to 0.1 mV in more than 2 leads at any load at the ET. During follow-up, severe angina was the only indication for coronary angiography and revascularization. There were no significant differences in diagnostic findings between the tests--Positive ET in 47% and Negative ET in 25% at both ETs. The occurrence of MI or death and the need of revascularization were related to signs of ischemia at both ETs. There were no differences in prognostic value between the early and late tests regarding MI or death or future severe angina during the 11 months' follow-up after the one month ET. However, half (10%) of the overall event rate (20%) during the one year follow-up occurred during the first months. The risk of these events could be identified by the predischarge but, for obvious reasons, not by the one month ET. Therefore, the present study suggests that a symptom limited ET should be performed before discharge in men stabilized after an episode of unstable angina or non-Q-wave MI.

Evidence for diabetic encephalopathy

Auditory brain stem responses were recorded in 20 normoacoustic long-duration Type 1 diabetic patients (duration of diabetes 26 (range 13-46) years, age 44 (25-66) years) with peripheral neuropathy and retinopathy and in 19 sex-matched normoacoustic short-duration Type 1 diabetic patients (duration of diabetes 2 (0-6) years, age 23 (18-50) years) without clinical signs of neuropathy or microangiopathy. Abnormal brain stem auditory evoked responses were demonstrated in 40% of the long-duration and in 5.3% of the short-duration diabetic patients (p less than 0.01). Interpeak latencies Jv-JI and JIII-JI were significantly prolonged in both patient groups compared with the non-diabetic control group (p less than 0.01). Magnetic resonance imaging was performed in 16 of the long-duration patients and in 40 age-matched healthy volunteers on a whole body MR-scanner. Subcortical and/or brain stem lesions with abnormally high signals were seen in 69% of the long-duration Type 1 patients and in 12% of the healthy volunteers (p less than 0.02). Neuropsychological examination including 17 tests for intelligence and cognition were performed in the 20 long-duration Type 1 diabetic patients. The results indicated a performance close to that seen in a control group of healthy age-matched control subjects. Our study demonstrates that a considerable proportion of long-duration Type 1 diabetic patients suffering from retinopathy and peripheral neuropathy additionally have signs but no symptoms of central nervous system affection, diabetic encephalopathy.

Partial pronase digestion of rat gastric mucosa isolates cells undergoing replicative DNA synthesis

A pronase digestion procedure for the isolation of gastric mucosal cells was evaluated for its usefulness in measuring unscheduled DNA synthesis (UDS). The method has been claimed to be suited for assessing the genotoxicity potential of compounds. Compounds were given orally to rats. After 13 h [3H]thymidine was injected and after another hour the animals were killed. The dissected stomachs were treated with pronase for 45 min and the incorporation of radioactivity into DNA was determined. Autoradiography was also performed both on the mucosa and on the isolated cell suspension. The cell suspensions were found to include cells undergoing normal replicative (S phase) DNA synthesis. Of all cells isolated, 4.8 +/- 0.6% consisted of S phase cells. The total amount of DNA recovered (corresponding to the number of cells isolated) was variable and ranged from 20 to 671 micrograms DNA, i.e. approximately 30-fold variation. Neither omeprazole (10, 30 and 80 mg/kg) nor ranitidine (215 mg/kg) had any effect on [3H]thymidine incorporation. The known carcinogen 1-methyl-3-nitro-1-nitrosoguanidine (MNNG) increased incorporation. Refeeding of fasted animals increased incorporation of [3H]thymidine almost 4-fold, showing that animal feeding status influences incorporation. Hydroxyurea, the selective inhibitor of S phase DNA synthesis, inhibited [3H]thymidine incorporation in control and omeprazole-treated animals as well as that induced by MNNG by 92-98%. The results clearly show that the pronase digestion procedure used releases cells undergoing normal, replicative DNA synthesis and can therefore neither be used for measurements of UDS nor for the assessment of the genotoxic potential of drugs.

Long-time follow-up after UPPP for obstructive sleep apnea syndrome. Results of sleep apnea recordings and subjective evaluation 6 months and 2 years after surgery

Fifty unselected consecutive patients with obstructive sleep apnea syndrome (OSAS) underwent uvulopalatopharyngoplasty (UPPP). The diagnosis was based on the patient's history and recording of respiration movements (Static Charge Sensitive Bed. SCSB) and oximetry, alone or combined with polysomnography. Renewed SCSB oximetry recordings were used to evaluate the success of the treatment. Six months postoperatively 40% of the patients were classified as non-responders, i.e. their oxygen desaturation indices (ODI) were reduced by less than 50% or were still above 20. The mean body mass index (BMI) was significantly higher in the non-responder group. A second recording with complete data was obtained in 45 patients after an average of 21 months. It was found that 9 patients who had been responders in the first postoperative recording had become non-responders. Only 18 of the patients with complete data could be verified as responders after 2 years. The patients who relapsed showed a significant increase in mean BMI between the first and second postoperative recordings compared to the patients who remained responders. There were no significant differences between responders and non-responders concerning age or preoperative severity of OSAS expressed as ODI, nadir SaO2 and percentage of obstructive periodic breathing. Of the non-responders, 47% in the first postoperative recording and 52% in the second reported complete recovery from excessive daytime sleepiness. This subjective improvement was not correlated to the objective results. The conclusions of this study are thus that one postoperative recording is not enough to estimate the outcome of UPPP and that statements of the patient's subjective recovery alone must not be used for this purpose.

A limited diagnostic investigation for obstructive sleep apnea syndrome. Oximetry and static charge sensitive bed

A simplified sleep apnea investigation consisting of combined oximetry and respiration movement monitoring was compared with conventional polysomnography. These two types of recordings were performed simultaneously during one night in 77 patients with suspected obstructive sleep apnea syndrome (OSAS). A static charge sensitive bed (SCSB) was used in the simplified recording because it provides a comfortable and reliable means of recording respiration movements. Periods of obstructive apneas gave a diamond-shaped periodic respiration movement pattern in the SCSB, usually accompanied by repetitive oxygen desaturations. The average number of desaturations greater than or equal to 4 percent per sleeping hour was termed the oxygen desaturation index (ODI) and compared with the apnea index (AI). In the whole population they were well correlated (p less than 0.0001, R2 = 0.41), but in individual cases there were considerable discrepancies. Patients with periodic respiration movements less than 18 percent of total sleeping time and ODI less than 2 never had AI greater than or equal to 5, whereas patients with periodic respiration greater than 45 percent and ODI greater than 6 always had AI greater than or equal to 5. Fifty-one of the 77 patients fulfilled these criteria. A bradycardia response to apneas was absent in 29 percent of patients with AI greater than or equal to 5. A combination of respiration movement and oximetry recording thus seems to give sufficient information to confirm or negate a diagnosis of OSAS in a majority of patients with clinical symptoms. In borderline patients, further investigations should be performed.

Treatment of severe colitis in Behçet's syndrome with thalidomide (CG-217)

A 35-year-old male patient, known in our department since 1979 on account of a severe and complete Behçet's syndrome, was treated with thalidomide (CG-217) as a final pharmacological measure to avoid colectomy during a severe attack of Behçet colitis. Prior to the administration of thalidomide, the patient had been treated for 7 weeks with full parenteral nutrition and high doses of steroids intravenously without a satisfactory effect on the colitis. Treatment with sulphasalazin was unsuccessful because of a decreasing number of platelets on this drug. After a few days on thalidomide, 300 mg given once daily at bedtime, the patient's stools were normalized and without reaction for blood, his oral ulcers and pleural effusion disappeared, and his steroid doses could be reduced. Gradually he was put on oral nutrition again, and his rectal mucosa became normalized. The dose of thalidomide was reduced to 200 mg, and then to 100 mg daily when the patient was discharged from hospital, less than 3 weeks after institution of the drug treatment. After 5 months as an out-patient his condition is still satisfactory and without symptoms of his former disease. Thalidomide has previously been reported to be of value in treatment of Behçet's syndrome, but to my knowledge never with such a dramatic effect on a severe colitis as reported in this case.

Changes in the functional state of the erythrocyte membrane: significance for red cell filterability and blood viscosity

Blood samples from nine healthy men were studied to determine the effect of ouabain and elevated serum calcium concentration on blood viscosity, measured by a rotational viscometer, and on red cell filterability by the St George's Filtrometer, giving values for clogging particles (CP) and red cell transit time (RCTT). Blood viscosity at a standardized haematocrit of 45% and red cell filterability was investigated in blood samples incubated for 1 h with Ringer's solution only (control), with ouabain (0.70 mmol/l) in plasma, or with serum calcium concentration increased by 3.0 mmol/l by addition of CaCl2. Incubation with ouabain significantly reduced erythrocyte K+ concentration and increased that of Na+. Ouabain caused a decrease in blood viscosity (p less than 0.05-0.005) compared to controls, although there was no decrease in red cell filterability parameters. When incubating with calcium, CP and RCTT increased significantly indicating 'stiffer' red cells, but there was no increase in blood viscosity. It is concluded that blood viscosity may be influenced by red cell factors not detected by CP or RCTT, which in turn appear to reflect red cell deformability with greater sensitivity and specificity than blood viscosity. It is concluded also that the functional state of the cell membrane may be of significance for the rheological properties of erythrocytes.

In vivo 1H spectroscopy of the human brain at 1.5 tesla. Preliminary experience at a clinical installation

In vivo localized water suppressed proton spectroscopy of human brain was carried out on 15 healthy volunteers and 2 patients suffering from a brain tumour and an infarction, respectively. The measurements were performed on a whole body MR system, operating at 1.5 tesla using the stimulated echo technique. Our preliminary results indicate that it is possible to detect a number of metabolites in the brain within a total measurement time of one hour. The dominant peaks in the spectra from healthy volunteers are N-acetyl aspartate, choline and creatine/phosphocreatine. The spectra obtained from the brain tumour and the infarct, respectively, differed very much from those obtained in healthy brain tissue. Our preliminary results indicate that localized proton spectroscopy may contribute to non-invasive brain tumour classification and possibly also to the differentiation between tumours and infarcts in clinically doubtful cases.

The role of gastric mucosal histamine in acid secretion and experimentally induced lesions in the rat

The role played by histamine from enterochromaffin-like (ECL) cells and mast cells in gastric acid secretion and in the development of ethanol-induced gastric lesions was studied in the rat. This was done by examining the effects of inhibition of the histamine-producing enzyme histidine decarboxylase (HDC) with alpha-fluoromethylhistidine (alpha-FMH) and the effects of degranulation of the mucosal mast cells with dexamethasone. A single dose of alpha-FMH (50 mg/kg p.o.) inhibited the HDC activity by 94% but did not affect histamine levels in the gastric mucosa 2 h after dose. Repeated treatment resulted in an almost complete inhibition of HDC activity and in a reduction of histamine levels by 75%. Pentagastrin failed to stimulate acid secretion after 4 days treatment with alpha-FMH, whereas the acid response to histamine was unaffected in chronic gastric fistula rats. Ethanol failed to induce gastric lesions in rats pretreated for 4 days with dexamethasone whereas 4 days pretreatment with alpha-FMH did not influence ethanol-induced lesion formation. The present results show that histamine synthesis is required for pentagastrin-stimulated gastric acid secretion and that mucosal mast-cell histamine plays a role in the development of ethanol-induced gastric lesions.

Tritiated thymidine incorporation into DNA in rat gastric mucosal cells

The parietal cell acid pump inhibitor, omeprazole, has undergone numerous genotoxicity studies, the conclusions of which have all been negative. A recent report by Burlinson described a method which is claimed to measure unscheduled DNA synthesis (UDS) in gastric mucosa, based on the incorporation of tritiated thymidine (3H-TdR) into DNA. In a subsequent letter it was concluded that omeprazole induces a significant increase in UDS, and it was suggested that 'for omeprazole, a genotoxic action cannot be discounted'. The Burlinson method of measuring UDS relies upon selective separation of non-dividing oxyntic mucosal surface cells from the stem cells located in the proliferative zone. These stem cells undergo normal cell division, subsequently migrate to the top and bottom of the gland, differentiating into the various specialized cells of the gland such as surface, parietal and chief cells. In the oxyntic mucosa the majority of stem cells are located at a level corresponding to one fifth of the mucosal thickness from the surface. The purpose of this study was to evaluate the Burlinson method, which depends upon the selective isolation of non-dividing surface cells by pronase digestion. The fraction used for measurement was investigated in terms of 3H-TdR uptake, the cellular distribution of 3H-TdR by autoradiography, the number of parietal cells and the sensitivity of 3H-TdR uptake for hydroxyurea (an inhibitor of normal, scheduled DNA synthesis). The results show that pronase digestion did not selectively isolate surface epithelial cells and that the digest contained both parietal cells (15 +/- 1.5%) and glandular fragments.(ABSTRACT TRUNCATED AT 250 WORDS)

A method for MR quantification of flow velocities in blood and CSF using interleaved gradient-echo pulse sequences

The aim of this study was to establish a rapid method for in vivo quantification of a large range of flow velocities using phase information. A basic gradient-echo sequence was constructed, in which flow was encoded along the slice selection direction by variation of the amplitude of a bipolar gradient without changes in sequence timings. The influence of field inhomogeneities and eddy currents was studied in a 1.5 T interleaved sequences for calibration and in vivo flow determination were constructed, and flow information was obtained by pairwise subtraction of velocity-encoded from velocity non-encoded phase images. Calibration was performed in a nongated mode using flow phantoms, and the results were compared with theoretically calculated encoding efficiencies. In vivo flow was studied in healthy volunteers in three different areas using cardiac gating; central blood flow in the great thoracic vessels, peripheral blood flow in the popliteal vessels, and flow of cerebrospinal fluid (CSF) in the cerebral aqueduct. The results show good agreement with results obtained with other techniques. The proposed method for flow determination was shown to be rapid and flexible, and we thus conclude that it seems well suited for routine clinical MR examinations.

Gamma-interferon-mediated down-regulation of electrolyte secretion by intestinal epithelial cells: a local immune mechanism?

Active chloride (Cl-) secretion by intestinal crypt enterocytes is the central pathophysiological disturbance in most cases of acute diarrhoea. We examined monolayers of the human intestinal cell line T84 mounted in Ussing chambers to see whether the T-cell lymphokine gamma interferon (IFN-gamma) might affect the Cl- secretory properties of these cells, which morphologically and functionally resemble native crypt enterocytes. Pretreatment of T84 cell layers with IFN-gamma for 24 h (but not for 3 h) markedly decreased the Cl- secretory response to vaso-active intestinal polypeptide (VIP) and to cholera toxin and carbachol without appreciably affecting the overall morphology, electrical resistance, or cyclic AMP response of the T84 cell monolayer. The IFN-gamma treatment, however, did induce subtle changes in the T84 cell membrane protein composition which might have affected ion channels regulating Cl- secretion. Our results may indicate a possible novel 'cell-mediated' immune mechanism through which activated gut T cells could modulate the extent of intestinal electrolyte and fluid secretion in, for example, enteric infections.

Omeprazole and ranitidine, antisecretagogues with different modes of action, are equally effective in causing hyperplasia of enterochromaffin-like cells in rat stomach

Female rats were treated for 28 days with high doses of the gastric acid secretion inhibitors omeprazole and ranitidine. Omeprazole, which is long-acting, was given orally once daily. Ranitidine, which is short-acting, was given by continuous infusion (via osmotic minipumps, implanted subcutaneously). The aim was to produce a similar degree of acid inhibition with the two drugs. The inhibition of acid secretion over the day and night was more pronounced in the omeprazole-treated rats (maximal inhibition 100%, minimum 85%) than in those receiving ranitidine (mean 70%). In both groups, there was a great increase in plasma gastrin, somewhat greater after omeprazole than after ranitidine. The gastrin concentration in the antrum was almost doubled by both treatments and there was a moderate increase in the number of antral gastrin cells in the omeprazole-treated rats. The number of enterochromaffin-like (ECL) cells (per visual field) increased in the oxyntic mucosa to the same extent (greater than 100%) in the ranitidine- and omeprazole-treated rats. Apart from the gastrin cells in the antrum and the ECL cells in the corpus no other gastric endocrine cell type seemed to respond to treatments with antisecretagogues. We conclude that, regardless of the type of antisecretagogue used, effective and long-term suppression of gastric acid secretion results in sustained hypergastrinemia and increased number of ECL cells. Conceivably therefore, the ECL cell hyperplasia reflects the trophic effect of gastrin.

Correlation between inhibition of gastric acid secretion, plasma gastrin, and oxyntic mucosal histidine decarboxylase activity in the rat

Female rats were treated for 1 week with ranitidine (125-1700 mumol/kg.day, given subcutaneously by means of osmotic minipumps), the proton pump inhibitor omeprazole (10-400 mumol/kg.day orally), or vehicle. Acid secretion, plasma gastrin levels, and oxyntic mucosal histidine decarboxylase (HDC) activity were determined. Both compounds dose-dependently inhibited maximally stimulated gastric acid secretion and caused a parallel increase in plasma gastrin levels. There was very good correlation between plasma gastrin levels and HDC activity for both compounds, although higher oxyntic mucosal HDC activity was found during ranitidine treatment. The higher HDC activity in the ranitidine-treated rats indicated the presence of a histamine H2-receptor on the ECL cells. It is concluded that, regardless of what kind of antisecretory agent is used, a dose-dependent inhibition of gastric acid secretion results in a parallel increase in plasma levels of gastrin, and as a consequence the HDC activity in the rat oxyntic mucosa is increased.

Omeprazole and cimetidine versus pentagastrin in canine ex vivo gastric chamber

The effects of acid inhibitory doses of omeprazole were compared with equieffective doses of cimetidine in the canine ex vivo stomach model (n = 30). Systemic blood pressure, temperature, stomach fluid and ion fluxes, potential difference, blood flow rates, and arterial and venous blood gases were monitored during each of nine 30-min periods. Two resting periods preceded seven periods of pentagastrin stimulation. During the last four of these, the drug effect was recorded (cimetidine 1.2 or 4.8 mumol.kg-1.h-1; omeprazole 0.3, 0.6, or 1.2 mumol/kg). Omeprazole (1.2 mumol/kg) produced 100% inhibition of stimulated acid efflux, no significant decrease in total gastric blood flow (venous outflow), 90% return of potential difference (PD) toward resting values, and a 55% reduction in stimulated oxygen consumption. Omeprazole also showed a dose-dependent K+ efflux at the two lower doses. Cimetidine (4.8 mumol.kg-1.h-1) given during pentagastrin stimulation showed a 70% decrease in total gastric blood flow, a 40% return of PD toward resting, and a 77% reduction in stimulated oxygen consumption. Neither drug showed significant changes in mucosal blood flow from resting values, thus supporting the principle that changes in gastric acid secretion and changes in blood flow are not necessarily correlated.

Time-course of development and reversal of gastric endocrine cell hyperplasia after inhibition of acid secretion. Studies with omeprazole and ranitidine in intact and antrectomized rats

In intact rats plasma gastrin levels were increased during a 20-wk treatment course with either omeprazole or ranitidine. Although plasma gastrin levels were the same during treatment, the enterochromaffinlike (ECL) cell density increased approximately linearly with time at a rate correlated to the plasma gastrin level. Antrectomy prevented the ECL cell hyperplasia seen in omeprazole-treated rats, suggesting that it was not caused by omeprazole per se. Changes in ECL cell density roughly paralleled changes in oxyntic mucosal histidine carboxylase activity and histamine concentration. Treatment with omeprazole also raised stomach weight and antral gastrin and gastrin cell density, reduced antral somatostatin cell density, but did not affect enterochromaffin cell density. Within 19 days of cessation of a 10-wk treatment course, plasma gastrin levels, oxyntic mucosal histidine decarboxylase activity, and antral gastrin and somatostatin cell densities had returned to control levels. The stomach weight was normal within 5-10 wk, antral gastrin concentration within 10 wk, and oxyntic mucosal ECL cell density and histamine concentration within 20 wk. After renewed treatment with omeprazole for 10 wk starting 10 wk after completion of the first omeprazole treatment period, changes in all parameters were of similar magnitude in animals previously treated with omeprazole and those previously treated with vehicle. The results suggest that the effects described are reversible and that gastrin cells turn over more rapidly than ECL cells.

Gastric acid antisecretory effect of two different dosage forms of omeprazole during prolonged oral treatment in the gastric fistula dog

Two series of experiments have been performed in gastric fistula dogs to test the antisecretory effect of two different oral dosage forms of omeprazole: 2 mumol x kg-1 x day-1 as a methylcellulose suspension for 8 weeks and 0.5 mumol x kg-1 x day-1 in enteric-coated granules (ECG) for 3 weeks. There was an increasing inhibitory effect during the first days of repeated administration of omeprazole, which is in accordance with its long duration of action. The steady-state inhibitory level was reached after five doses. During the 8-week treatment with the omeprazole suspension (2 mumol x kg-1) the mean maximal inhibitory level (3 h after dose) was 82%, and the mean minimal inhibitory level (24 h after dose) was 35%. With omeprazole in ECG (0.5 mumol x kg-1) the steady-state maximal inhibition (4th h) was 60%, whereas 40% inhibition remained after 24 h. Thus, a more even inhibitory level over day and night seems to be obtained with the ECG formulation than with the suspension. Basal and food-stimulated plasma gastrin levels were not significantly affected by the treatment with 0.5 mumol x kg-1, whereas food-stimulated gastrin levels were slightly increased during treatment with 2 mumol x kg-1. Control levels of acid secretion were reached within 4 days of stopping treatment. In the present studies, in which the inhibition of acid secretion varied over 24 h between approximately 80% and 35% (maximum and minimum), no rebound effects could be detected as measured up to 1 month after cessation of treatment.

Ataxic hemiparesis: three different locations of lesions studied by MRI

We report three cases of ataxic hemiparesis, studied by MRI. The lesions were all contralateral and located in three different sites: the posterior limb of the internal capsule, the midpons, and the red nucleus. None of the CTs demonstrated the lesions.

The effect of divalent cations on the interaction between calf spleen profilin and different actins

The interaction between calf spleen profilin and actin depends critically on the status of the C-terminus of the actin, and in the case of profilin, the C-terminus is of great importance for the physiochemical behaviour of the protein. Both proteins easily lose their C-terminal amino acids during the preparation, and special care has to be taken to ensure the isolation of the proteins in the intact form. Another factor that may seriously influence the study of the interaction of profilin with actin is the presence of varying amounts of an activity that causes an apparent stabilization of the complex even at later stages of its purification. We have found conditions for the isolation of intact profilin and actin, and studied the interaction between the two proteins, including the determination of the Kdiss for the complex formed under various ionic conditions. The complex formed between profilin and actin from calf spleen was found to be significantly stronger (Kdiss less than or equal to 10(-8) M in 50 mM KCl, and Kdiss = 4.10(-7) M in 50 mM KCl, 1 mM MgCl2) than that formed between profilin and muscle alpha-actin (Kdiss = 10(-6) M in 50 mM KCl, +/- 1 mM MgCl2). The profilactin complex formed in the mammalian system was stronger than the complex formed between Acanthamoeba actin and the profilin-like protein isolated from this organism. Analysis of the formation of the calf spleen complex in the presence of varying concentrations of divalent cations gave evidence for the presence of a high-affinity divalent-cation-binding site on the spleen actin (beta, gamma) which appears to regulate the interaction with profilin.

Omeprazole: its influence on gastric acid secretion, gastrin and ECL cells

The H+,K+-ATPase inhibitor omeprazole is a highly effective gastric antisecretory agent, both in animals and man, with a long duration of action. These properties are shared by a number of recently described histamine H2-receptor antagonists. In life-long oncogenicity studies of these H2-receptor antagonists, as well as with the H+,K+-ATPase inhibitor omeprazole, gastric enterochromaffin-like cell (ECL cell) hyperplasia and carcinoids have been found. The purpose of this paper is to summarize available evidence for the "Gastrin Hypothesis" to explain the development of ECL-cell hyperplasia. The hypothesis may be outlined as follows: 1) Inhibition of gastric acid secretion leads to elevated antral pH and, secondarily, to release of gastrin from the antral gastrin cells into the blood stream. 2) Gastrin causes both general hypertrophy of the oxyntic mucosa and hyperplasia of the ECL cells in the oxyntic mucosa. That this sequence of events occurs not only with omeprazole but also with other effective gastric antisecretory agents has been verified in the rat by giving the H2-receptor antagonist ranitidine as a continuous infusion. Ranitidine caused a hypergastrinemia of a similar magnitude as that seen after omeprazole, provided that the acid secretion was inhibited to a similar degree. At similar gastrin levels, ECL-cell hyperplasia of the same magnitude developed during both ranitidine and omeprazole treatment. Antrectomy prevented the development of ECL-cell hyperplasia during omeprazole treatment, indicating that the hyperplasia was not due to the drug treatment per se, but rather to the hypergastrinemia. Both the hypergastrinemia and the ECL-cell hyperplasia were found to be reversible.(ABSTRACT TRUNCATED AT 250 WORDS)

Rat parietal cell function after prolonged inhibition of gastric acid secretion

Female rats were treated orally for 3 mo with omeprazole (40 and 400 mumol/kg). Both doses caused total inhibition of gastric acid secretion and recovery was parallel to that of H+-K+-ATPase activity (30-50 and 60-80% inhibition 24 h after doses, respectively). The H+-K+-ATPase activity returned to control levels within 1 wk after the last dose. Plasma gastrin levels were dose-dependently increased during treatment but reversed to control levels within 9 days after the last dose. Parallel with a general increase in corpus mucosal mass, both pepsinogen and H+-K+-ATPase total content increased. However, their tissue concentrations did not differ from control values, suggesting that neither parietal nor chief cell density are changed by omeprazole treatment and also that their growth is parallel to the general hyperplasia. In contrast, the oxyntic mucosal histamine concentration was increased, indicating an increase in the enterochromaffin-like (ECL) cell density. Maximal capacity of the mucosa to secrete acid increased in parallel with the increase in mucosal mass and total H+-K+-ATPase content. However, basal acid secretion did not differ between treatment groups. Increased capacity slowly declined toward control levels over the 70-day recovery period after withdrawal of omeprazole. These results suggest that hypergastrinemia, induced in the rat by pharmacological inhibition of gastric acid secretion, causes a hyperplasia of oxyntic mucosal cells, ECL cells growing faster than the others. The hyperplastic mucosa has an increased capacity to produce acid and is functionally normal.

Measurement of lung volume by sulfur hexafluoride washout during spontaneous and controlled ventilation: further development of a method

An open circuit tracer gas washout method for measurement of lung volume in patients during anesthesia and intensive care is described and tested. The method employs a device for dispensing the tracer gas, sulfur hexafluoride (SF6), a fast SF6 analyzer, a pneumotachograph, and a computer. The dispensing device delivers SF6 into the airway in proportion to instantaneous inspiratory flow so that inspiratory SF6 concentration is held constant, usually at about 0.5%, regardless of the inspiratory flow pattern. The amount of SF6 present in the lungs at the end of a washin is calculated during washout from signals representing expired SF6 concentration and expired flow. From this, lung volume is derived. Accurate and reproducible results were obtained in lung model tests during ventilation with air, N2O in O2, and halothane in O2. Functional residual capacity (FRC) was measured both with SF6 washout and nitrogen washout in five mechanically ventilated patients. This gave the regression equation: FRCSF6 = 10 ml + 1.04 x FRCN2, r = 0.99. A similar close agreement was observed for total lung capacity (TLC) and residual volume (RV) measurements in eight healthy, spontaneously breathing subjects: TLCSF6 = 91 ml + 1.01 x TLCN2, r = 0.99; RVSF6 = -32 ml + 0.97 x RVN2, r = 0.95. Comparison with body plethysmography in eight healthy, sitting subjects gave the regression equation: FRCSF6 = 180 ml + 0.96 x FRCbox, r = 0.99. The median (range) for the coefficient of variation at duplicate determinations in 10 anesthetized, paralyzed, and mechanically ventilated adults was 3.0% (0.2-6.6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Gastric acid secretion in the totally isolated, vascularly perfused rat stomach. A selective muscarinic-1 agent does, whereas gastrin does not, augment maximal histamine-stimulated acid secretion

The gastric acid secretion in response to graded doses of gastrin, histamine, impromidine (a selective H2-receptor agonist), and the muscarinic-1 agonist McN-A-343 was studied in the totally isolated, vascularly perfused rat stomach. Combinations of stimulants at doses giving maximal acid secretion for each secretatogue were thereafter tested. All stimulants increased the gastric acid output significantly compared with the base-line output (7.2 +/- 2.0 mu eq/h). Gastrin induced significant increases in acid outputs at very low and physiologically relevant concentrations with a threshold concentration of 65 pM. Nevertheless, maximal gastrin-stimulated acid secretion represented only 55% of the maximal histamine-stimulated acid output of 154.8 +/- 10.0 mu eq/h. Impromidine and McN-A-343 induced a maximum 59% and 34% of maximal histamine-stimulated acid output, respectively. Adding gastrin to the maximal histamine of impromidine-stimulated stomachs did not increase the acid secretion further. Histamine and McN-A-343 in combination, however, induced a more than additive increase in the gastric acid output (232.0 +/- 14.7 mu eq/h) than did histamine and McN-A-343 separately (154.8 +/- 10.0 and 53.0 +/- 6.7 mu eq/h, respectively). The results indicate that in the rat, gastrin stimulates the parietal cell indirectly via histamine release, whereas muscarinic agents (cholinergic stimulation) act directly via a separate receptor.

Effects of omeprazole on gastric mucosal blood flow in the conscious rat

Regional blood flow in the gastrointestinal tract (forestomach, corpus, antrum, duodenum, jejunum, and colon) was determined in the conscious rat by means of the microsphere technique. The effects on blood flow were determined after omeprazole (orally and intravenously) and cimetidine (intravenously) during both basal and pentagastrin-stimulated gastric acid secretion. Under basal conditions neither omeprazole nor cimetidine decreased the blood flow in the gastrointestinal tract in spite of pronounced inhibition of acid secretion. On the contrary, there was a tendency towards an increased blood flow in the mucosal layer of the corpus after the oral (80 mumol/kg) and the high intravenous (10 mumol/kg) dose of omeprazole. When omeprazole was given intravenously to rats during pentagastrin-stimulated acid secretion, blood flow in the gastric mucosa was unaffected in spite of complete or almost complete inhibition of acid secretion. In contrast, cimetidine decreased the mucosal blood flow, indicating that the pentagastrin-induced increase in blood flow to some extent is mediated by H2 receptors.

Covalent binding of proteins to grafted plastic surfaces suitable for immunoassays. I. Binding capacity and characteristics of grafted polymers

A method for the introduction of chemically reactive groups onto polymeric surfaces, suitable for immunoassays, is described. The method, referred to as grafting, uses gamma irradiation from a 60Co source to initiate the free radical reaction. Polystyrene and polyvinyl chloride surfaces were grafted with crotonic acid and characterized with ESCA. 2 nmol/cm2 of carboxylic groups were added during the method. Increased hydrophilic properties of the carboxylated surfaces were recorded by contact angle measurements. The grafting reaction did not impair the optical quality of the polymers studied. Various proteins were covalently linked to the modified surfaces of microtiter plates and tubes by means of a water-soluble carbodiimide. A significantly enhanced total capacity and strength of binding to grafted surfaces was demonstrated as compared to passive adsorption of the proteins to untreated surfaces.

Evaluation of visual pathways in multiple sclerosis. I. After-images compared to visual evoked potentials

The value of flight of colours (FOC), i.e. the succession of coloured afterimages following light stimulation, in diagnosing and following visual impairment was evaluated in 65 patients with multiple sclerosis (MS). Previous optimistic reports of the use of a pocket flashlight (PFL) method could not be confirmed, and are ascribed to inadequate methods. An electronic flashlight (EFL) method developed by us, proved a significantly better diagnostic tool (61% abnormal versus 18% abnormal). The EFL method was diagnostically less sensitive than pattern reversal visual evoked potential (PR-VEP) (80% abnormal). It did, however, add to PR-VEP by diagnosing 16 eyes with normal PR-VEP latency. The EFL method reflected the degree of degenerative changes in the central visual pathways and may be of value in following the disease activity in MS. The potential of the EFL method may be further improved by proposed modifications.

Evaluation of the visual system in multiple sclerosis. II. Colour vision

A study of colour vision (CV) in 65 patients with multiple sclerosis (MS), (30 patients had had previous optic neuritis) and 51 controls was carried out with Ishihara's pseudoisochromatic plates (I-test), Farnsworth's panel D-15 test (F-test), and Lanthony's desaturated 15-hue test (L-test). CV defects were classified as to type and severity. Error scorings were calculated by Bowman's computerized method and our own simple proposal for scoring, which was found of equal value. Results were compared with pattern-reversal (black/white) visual evoked potentials (PR-VEP) (80% of eyes abnormal). The I-test (56% of eyes abnormal) was a more sensitive indicator of demyelination than the L-test (47%) and F-test (26%). In 14 eyes CV defects (10 blue-yellow, 4 red-green) were only revealed with the L-test. Abnormal CV, mostly blue-yellow defects, occurred in 16 patients (19 eyes) having normal VEP latencies; 29 patients were re-tested within one week. It is proposed that the performance of the I-test, which showed the highest reproducibility, could be improved by adding more cards, particularly blue-yellow, to the test.

Effect of inhibition of acid secretion on the regulatory peptides in the rat stomach

The effect of inhibiting acid secretion by pharmacologic agents on the gastric content of regulatory peptides has been determined by radioimmunoassay and immunocytochemistry. Plasma, antral, and fundic concentrations of gastrin were elevated in rats rendered virtually achlorhydric by treatment with high-dose omeprazole (400 mumol/kg daily for 10 wk). This was associated with an increase in the number and staining intensity of gastrin immunoreactive cells. A clear reciprocal relationship was observed between antral gastrin and somatostatin as assessed by both quantitative and qualitative methods. These changes had disappeared 10 wk after treatment was stopped. No alteration was found in the concentrations of other regulatory peptides proposed as important in control of acid secretion. Plasma and antral gastrin concentrations were elevated in rats treated with high-dose ranitidine (700 mumol/kg daily), but to a lesser extent than during omeprazole therapy, and somatostatin concentrations were unchanged.

Hypergastrinaemia produces trophic effects in stomach but not in pancreas and intestines

Hypo- or anacidity, caused by antisecretagogues, stimulates gastrin release and leads to hypergastrinaemia. If drug treatment is maintained over a period of time, the hypergastrinaemia can be expected to give rise to trophic effects. We examined the trophic consequences of the very marked hypergastrinaemia produced by long-term treatment (16-20 weeks) of rats with large doses of the substituted benzimidazole, omeprazole, a potent and long-acting blocker of acid secretion. The weight of the stomach and the oxyntic mucosal thickness were increased, whereas the weight of the pancreas and the intestines and the thickness of the mucosa of the antrum and small and large intestine were unaffected. The number of exocrine cells (parietal, zymogen and mucous cells) were uniformly increased by 25-30%. The density of parietal and zymogen cells, expressed as number of cell nuclei per mm2 epithelium, was unchanged. The volume density of parietal cells, expressed as % of epithelial volume, was also unchanged, implying that the volume of the individual parietal cell had not increased. The density of endocrine ECL cells in the stomach increased 5-fold. Thus, the findings demonstrate a growth-promoting effect of the hypergastrinaemia on the oxyntic mucosa, the ECL cells in particular, and the lack of such an effect on the antrum, pancreas and intestines.

Plasma gastrin and gastric enterochromaffinlike cell activation and proliferation. Studies with omeprazole and ranitidine in intact and antrectomized rats

Unoperated female rats were subjected to daily oral treatment with omeprazole (10 or 400 mumol/kg body wt), ranitidine (175 + 175 + 350 mumol/kg body wt), or vehicle and antrectomized rats were treated with omeprazole (400 mumol/kg body wt) or vehicle. After 10 wk of treatment, plasma gastrin levels were high in unoperated rats treated with the high omeprazole dose and with ranitidine, and low in antrectomized controls. Plasma gastrin levels were slightly higher in the low-dose omeprazole group than in the intact controls. In antrectomized rats treated with the high dose of omeprazole, the plasma gastrin level was in the same range as in intact control rats. A close correlation (r = 0.89, p less than 0.0001) was found between the plasma gastrin level and the oxyntic mucosal enterochromaffinlike cell density (as well as the tissue levels of histidine decarboxylase and histamine in the oxyntic mucosa) in all groups. The somatostatin cell density in the oxyntic mucosa was not altered by the various treatments. During a recovery period of 10 wk after the 10-wk treatment, the enterochromaffinlike cell density and histamine concentration decreased by 30%-40% in the rats treated with the high dose of omeprazole, whereas the corresponding values increased by 50% and 40%, respectively, in the control rats. The difference between the two groups, however, was still statistically significant. Plasma gastrin levels and gastric histidine decarboxylase activity returned to control values during recovery. The results suggest that the observed changes in enterochromaffinlike cell density are related to the plasma gastrin levels and that they are reversible. it is concluded that neither omeprazole nor ranitidine per se is likely to induce proliferation of enterochromaffinlike cells.

Gastric regulatory peptides in rats with reduced acid secretion

Gastric acid secretion is known to be controlled by a complex system of interacting factors. Amongst these, regulatory peptides make a significant contribution. In the present study, immunocytochemistry and radioimmunoassay were used to investigate gastric regulatory peptides in animals with pharmacologically reduced gastric acid secretion. Increased numbers of densely immunostained antral gastrin-immunoreactive (G) cells were seen in rats which had been rendered virtually achlorhydric by administration of high-dose (400 mumol/kg daily) omeprazole over a 10-week period. These morphological changes were accompanied by increases in the plasma, antral and fundic concentrations of gastrin, as measured by radioimmunoassay. In contrast, antral somatostatin-containing cells were reduced, and there was a corresponding fall in the tissue content of the peptide. Ten weeks after treatment had ceased, the peptide profiles had returned to normal. No other regulatory peptide, whether endocrine or neural, appeared to alter during treatment with high-dose omeprazole. Treatment with high-dose (700 mumol/kg daily) ranitidine also caused an elevation in the G cell population and the antral and plasma content of gastrin, but to a lesser extent than that observed during omeprazole treatment. Somatostatin cells and tissue levels did not alter in these animals, and no other morphological changes could be detected. Radioimmunoassay, however, measured reduced quantities of vasoactive intestinal peptide, peptide histidine isoleucine and calcitonin gene-related peptide. Achlorhydria, induced by omeprazole at a dosage of 250-500 times that required for effective acid inhibition in man and animals, therefore resulted in reciprocal changes in gastrin and somatostatin cells. These changes are support for the postulated roles of these peptides in the control of gastric acid secretion.

Inhibition of gastric acid secretion by omeprazole and ranitidine. Effects on plasma gastrin and gastric histamine, histidine decarboxylase activity and ECL cell density in normal and antrectomized rats

Female rats were subjected to various treatments for 10 weeks to study effects on plasma gastrin levels. Intact rats were treated orally with omeprazole, 10 or 400 mumol/kg, ranitidine, 175 + 175 + 350 mumol/kg, or vehicle; antrectomized rats were treated with omeprazole, 400 mumol/kg, or vehicle. In addition to plasma gastrin levels, histidine decarboxylase (HDC) activity, histamine levels and ECL cell density in the oxyntic mucosa were determined. Gastrin levels were increased in unoperated rats treated with the high omeprazole dose and with ranitidine, whereas they were lowered in antrectomized controls. A small increase in plasma gastrin was seen in the low-dose omeprazole group. In antrectomized rats treated with omeprazole, the plasma gastrin level was the same as in intact control rats. The ECL cell density, the activity of HDC and the concentration of histamine in the oxyntic mucosa were found to reflect the plasma gastrin concentration. The results suggest that the changes in ECL cell density are secondary to the changes in plasma gastrin, induced by inhibition of acid secretion or antrectomy. It is concluded that neither omeprazole nor ranitidine per se is likely to induce proliferation of ECL cells.

Hypergastrinemia after blockade of acid secretion in the rat: trophic effects

The availability of potent and long-acting blockers of acid secretion, such as omeprazole, has paved the way for experimental studies on the long-term effects of permanently raised levels of circulating gastrin without the complication of surgical intervention. We have examined rats given high doses of the antisecretagogues omeprazole and ranitidine during 10 or 20 weeks for general trophic effects on the gastrointestinal tract and pancreas and for the effects on endocrine cells such as the somatostatin cells and the enterochromaffin-like (ECL) cells, which are present in the oxyntic mucosa. The ECL cells, which in the rat produce and store histamine (in addition to an as yet unidentified peptide hormone), are known to be activated by gastrin. In rats given high doses of omeprazole, the serum gastrin levels rose about 10-fold. General trophic effects were restricted to the stomach; the weight was increased, as was the thickness of the oxyntic mucosa. Omeprazole treatment resulted in a 3- to 5-fold increase in the ECL cell density. A close correlation was found between plasma gastrin levels and the ECL cell density as well as the levels of histidine decarboxylase and histamine in the oxyntic mucosa. The somatostatin cell density was unaffected by the hypergastrinemia. During a 10-week recovery period after discontinuation of the omeprazole treatment, the ECL cell density diminished, but was still significantly higher than in age-matched control rats. Plasma gastrin levels and gastric histidine decarboxylase activity rapidly returned to control values. The results suggest that the observed general trophic effects on the oxyntic mucosa and on the ECL cells are related to the plasma gastrin levels and not to an action of the antisecretagogues per se.

Pharmacology and toxicology of omeprazole--with special reference to the effects on the gastric mucosa

Omeprazole is a long acting inhibitor of gastric acid secretion in different species including rat and dog. Due to the long duration of action, steady state inhibition at repeated once daily administration is reaches within 4-5 days in dogs and in about 3 days in rats. Daily dosing at high dose levels results in virtually complete 24-hour inhibition of acid secretion in experimental animals. The elimination of the inhibitory feedback effect of acid on gastrin secretion leads to hypergastrinaemia. Because gastrin has a trophic effect on the oxyntic mucosa, the hypergastrinaemia results in a reversible hypertrophy of the oxyntic mucosa and an increased capacity to produce acid following maximal stimulation with exogenous secretagogues after discontinuing treatment. Despite the increased capacity to produce acid, basal acid secretion seems to be unchanged. The pronounced hypergastrinaemia which occurs during long-term treatment with high doses rapidly normalizes after discontinuing treatment. The hyperplasia of the oxyntic endocrine ECL cells, and the eventual development of gastric ECL cell carcinoids after lifelong treatment of rats with high doses, can also be attributed to the hypergastrinaemia developing after almost complete elimination of gastric acid secretion in these animals.

The relationship between gastric acid secretion and gastric H+,K+-ATPase activity

The H+,K+-ATPase has been postulated to be the enzyme responsible for H+ secretion by the parietal cell. Omeprazole has been shown to be an inhibitor of acid secretion in vivo, but also in in vitro test models for acid secretion, including partly purified H+,K+-ATPase, the inhibitory action of omeprazole has been demonstrated (Wallmark, B., Jaresten, B. M., Larsson, H., Ryberg, B., Brändström, A., and Fellenius, E. (1983) Am. J. Physiol. 245, G64-G71). It was thus possible to use this compound to demonstrate a correlation between H+,K+-ATPase activity in rat oxyntic mucosa and in vivo H+ secretion. Two results were found. (a) Increasing oral doses of omeprazole progressively inhibited acid secretion, H+,K+-ATPase activity, and phosphoenzyme formation of a microsomal fraction isolated from the inhibited rat mucosa. Furthermore, a Mg2+-stimulated ATPase activity, associated with the H+,K+-ATPase membrane fraction, was not affected by the omeprazole treatment. (b) Recovery of H+,K+-ATPase activity following complete omeprazole inhibition was correlated with the appearance of acid secretion. The results indicate a strict relationship between the activity of the gastric H+,K+-ATPase in the microsomal fraction and gastric acid secretion.

Pulmonary blood flow determination with selective rebreathing of CO2

A new CO2-based non-invasive method for pulmonary blood flow has been developed. Selective rebreathing of CO2 was obtained in an open-circuit system by measuring the expired instantaneous CO2 flux in the expired air and by mixing pure CO2 into the inspired air. The time course of the inspired PCO2 was altered so that end-tidal PCO2 changed as a linear function of time (ramp). Pulmonary blood flow was computed as the ratio between the rate of change in net CO2 elimination (or uptake) and the concomitant rate of change of estimated arterial CO2 content. In comparison to simultaneously determined cardiac output by means of the O2 Fick method, the proposed CO2 ramp method underestimated cardiac output by some 20 per cent in 22 supine sedated patients with valvular heart disease. Differences in PCO2 between end-tidal gas and the gas in perfused alveoli are thought to be the main cause of this underestimation.

Animal pharmacodynamics of omeprazole. A survey of its pharmacological properties in vivo

In the present paper, a collection of experimental data is presented describing the pharmacological profile of omeprazole mainly in dogs and rats. Omeprazole potently inhibited gastric acid secretion in different experimental models. In the dog, for instance, omeprazole was 2-7 times more potent than cimetidine, depending on the route of administration, and in the rat the difference was even greater. Omeprazole was equally potent against different types of stimulation, whereas cimetidine was not, indicating differences in their mechanisms of action. In the dog, the duration of the antisecretory effect was long and lasted for 3-4 days after a single maximal dose of omeprazole. The inhibitory effect after repeated, daily administration of submaximal doses therefore gradually increased and attained a steady-state level after five doses. Treatment up to one year with very high oral doses did not affect the duration of effect. During long-term treatment with high doses of omeprazole a 10-fold increase in meal-stimulated plasma gastrin levels was recorded. This was probably due to a nearly complete inhibition of acid secretion over 24 hours during the study. The gastrin values returned to control levels within eight days after the end of the treatment. Omeprazole was rapidly absorbed (peak plasma levels were reached within one hour) and the elimination half-life was approximately one hour. In the dog, the gastric antisecretory effect was related to the total dose and the area under the plasma concentration curve, whereas the peak level or the shape of the curve was of minor importance. Omeprazole, given orally to rats, dose-dependently prevented experimentally induced gastric lesions. Neither inhibition of acid secretion, stimulation of gastric bicarbonate secretion nor interference with the synthesis of endogenous prostaglandins seems to be of any great importance for the gastric protective effect of omeprazole. Omeprazole seems to be very specific in its gastric acid antisecretory and gastric protective actions since, apart from a decrease in the rate of gastric emptying found after very high oral doses in the rat, no other general pharmacological effects of omeprazole have been observed. Thus, omeprazole was devoid of histamine H2-receptor blocking properties, did not affect the intestinal transport rate, pancreatic secretion, autonomic control of the cardiovascular system or kidney excretion of hydrogen ions.

Evidence for acid-induced transformation of omeprazole into an active inhibitor of (H+ + K+)-ATPase within the parietal cell

The chemical reactions of omeprazole, leading to inhibition of gastric acid secretion, were investigated. In acid buffer solutions, omeprazole was found to be labile, whereas at physiological pH it was stable (t1/2 greater than 17 h at pH 7.4). The stability of omeprazole was also studied in isolated, acid producing, gastric glands under conditions where acid formation was either stimulated or inhibited. The rate of transformation of omeprazole was high (t1/2 approximately 3 min) under stimulation. Inhibition of acid formation in the gland greatly retarded the decomposition of omeprazole (t1/2 approximately 73 min). The time-course for inhibition of acid formation by omeprazole was parallel to that for decomposition. The major product formed from omeprazole was the reduced form, H 168/22. The inhibitory action of omeprazole was shown to depend on acid-induced transformation, since no inhibition was obtained when omeprazole was incubated under neutral conditions, both in the isolated gastric mucosal- and the (H+ + K+)-ATPase preparations. Despite the fact that H 168/22 was the major product formed in the glandular preparation, it was found to be virtually inactive in both the glandular- and (H+ + K+)-ATPase preparations. Therefore, a model is proposed in which the inhibition of acid formation by omeprazole is mediated by a compound formed during the reduction of omeprazole to H 168/22 within the acid compartments of the parietal cell. Furthermore, mercaptanes, such as beta-mercaptoethanol, were found to prevent as well as reverse inhibition by omeprazole in both the glandular- and (H+ + K+)-ATPase preparations. This indicates that -SH groups are most likely involved in the chemical reactions leading to inhibition of acid secretion.

In vitro and in vivo evaluation of controlled-release and enteric-coated formulations of sodium salicylate

The bioavailability and pharmacokinetics of salicylic acid (SA) were studied after single and multiple doses of a new slow-release formulation, based on porous membrane diffusion of sodium salicylate (NaSA). A solution of NaSA and an enteric-coated tablet of NaSA were used for comparison. Dissolution rate studies were carried out at various pH values, and both solid formulations showed pH-dependent release rates. The enteric-coated tablet released its content rapidly at intestinal pH but slowly and irregularly at gastric pH. The dissolution from the controlled-release formulation at intestinal pH was completed after 6h and the drug was delivered at a constant rate. At gastric pH the release rate was lower but complete release was obtained within 24h. The novel formulation appeared to offer complete bioavailability of SA and an even and sustained release of SA, allowing twice-daily medication without increased fluctuations in SA concentrations.

Effect of omeprazole on gastric secretion in H+,K+-ATPase and in pepsinogen-rich cell fractions from rabbit gastric mucosa

In order to study the effects of the substituted benzimidazole omeprazole on gastric secretory functions, parietal cells and chief cells from rabbit gastric mucosa were separated and enriched by density gradient centrifugation in Percoll. H+,K+-ATPase activity, as well as a 100,000 dalton protein, was found to copurify with a cell fraction morphologically characterized as mainly parietal cells (purity approximately 65%), while pepsinogen copurified with a cell fraction morphologically characterized as chief cells (purity approximately 90%). A spontaneous pepsinogen release (9.9 micrograms/mg cell dry wt X 2 hr), unaffected by both atropine and omeprazole, was found in the chief cell fraction. The release was approximately doubled by both carbacholine (4 X 10(-5)M) and dibutyryl cAMP (db-cAMP, 10(-3)M). The cholinergic stimulation was selectively blocked by atropine, while omeprazole had no effect on pepsinogen release induced by either of the secretagogues. On the other hand, omeprazole inhibited both db-cAMP- and histamine-stimulated acid secretion quantified as [14C]aminopyrine (AP) accumulation in the parietal cell fraction. Cimetidine counteracted only acid secretion induced by histamine. These findings indicate that omeprazole has a specific effect on acid secretion, and are consonant with the hypothesis that the effect is due to H+,K+-ATPase inhibition.

Effects of omeprazole and cimetidine on gastric acid secretion and right atrial beating frequency in isolated organ preparations from the guinea pig

The effects of omeprazole , a substituted benzimidazole, on gastric acid secretion and on right atrial beating frequency have been investigated in guinea pig preparations in vitro. Cimetidine was used as a reference compound. Omeprazole , at 10(-6) mol/l, inhibited basal acid secretion, whereas cimetidine, at 10(-5) mol/l, did not. There were also differences in the effects on stimulated secretion. Cimetidine (10(-5) mol/l) competitively inhibited histamine-stimulated acid secretion without affecting the maximal histamine response. In contrast, omeprazole concentration dependently depressed (EC50 approximately 5 X 10(-7) mol/l) the maximal histamine response without any effect on the histamine sensitivity. Furthermore, dibutyryl-cAMP-stimulated acid secretion was inhibited by omeprazole but not by cimetidine. The inhibitory effect of omeprazole (2 X 10(-6) mol/l) on histamine-stimulated acid secretion was reversed by repeated washing of the serosal side of the mucosa. Omeprazole was devoid of histamine H2 receptor antagonistic activity, since it had no effect on the chronotropic response to histamine in the guinea pig right atrium. It is concluded that omeprazole inhibits gastric acid secretion by a non-histaminergic, reversible mechanism and that the site of action is beyond the cAMP step within the parietal cell.

Inhibition of gastric acid secretion by omeprazole in the dog and rat

The gastric antisecretory properties of omeprazole, a new potent substituted benzimidazole, have been evaluated in dogs and rats. Omeprazole was compared with another benzimidazole, picoprazole (H 149/94), and with the histamine H2-receptor antagonist cimetidine. The intravenous or intraduodenal administration of omeprazole in the gastric fistula dog inhibited histamine- and pentagastrin-stimulated acid secretion. The intravenous and intraduodenal, ED50 values for inhibition of histamine-stimulated secretion were 0.35 and 0.26 mumol/kg, respectively. Omeprazole was found to be approximately 5-10 times more potent than both picoprazole and cimetidine. After oral omeprazole administration in the Heidenhain pouch dog, the ED50 on histamine-stimulated acid secretion was found to be 1.2 mumol/kg, which corresponded to a potency 2 and 3.5 times greater than that of cimetidine and picoprazole, respectively. Measurement of the plasma concentration of unchanged omeprazole revealed an intraduodenal bioavailability of approximately 70% whereas the oral bioavailability was only approximately 15%. This variation is probably a result of partial degradation of omeprazole in the acid gastric juice. Single intraduodenal doses of omeprazole had a long-lasting inhibitory effect on histamine-stimulated acid secretion in the dog. After a dose of omeprazole, which produced total inhibition initially, the antisecretory effect was detectable for 3-4 days. Omeprazole inhibited basal and stimulated acid secretion in the rat. The intravenous ED50 was calculated to be 1.5 mumol/kg, whereas the oral potency was about 10 times lower. The effect in the rat was also of long duration. After a dose giving maximal inhibition, control acid secretion was restored after approximately 13 h.

Studies of blood viscosity with a newly constructed rotational viscometer which operates via a desk top computer

Increasing interest is being shown in blood viscosity and the whole field of haemorheology. This study presents a newly constructed rotational Couette type viscometer which operates via a commercially available desk top computer and a digital plotter. The influence of haematocrit on blood viscosity is shown and the study also presents blood viscosity values of six to eight healthy men at 24 degrees C and 37 degrees C. At 37 degrees C values are shown both at natural haematocrit and at haematocrit 45%.