Effect of molindone on weight change in hospitalized schizophrenic patients

A retrospective review was conducted to assess the effect of molindone on weight. Monthly weights and neuroleptic dosages during the first three months of psychiatric hospitalization were compared between matched groups of patients receiving molindone, a combination of molindone and other neuroleptics, or other neuroleptic drugs. We found no significant differences in weight gain among the three groups. Our results challenge the common opinion that molindone can be associated with a lack of weight gain compared to other antipsychotics.

A new inherited variant of the 3 beta-hydroxysteroid dehydrogenase-isomerase deficiency syndrome: evidence for the existence of two isoenzymes

The clinical and endocrine features of a unique form of adrenal insufficiency secondary to an inherited deficiency of 3 beta-hydroxysteroid dehydrogenase-isomerase (3-HSD) were studied. The propositus was a 19-yr-old man with a history of repeated episodes of acute adrenal crisis. Family study disclosed that a 6-yr-old female sibling also was affected, and a third sibling had died during the course of an adrenal crisis. The diagnosis of adrenal insufficiency was established on the basis of extremely low serum cortisol levels and urinary 17-hydroxycorticosteroid excretion with concomitantly elevated serum ACTH levels and lack of cortisol response to ACTH administration. Impairment of C-21 steroid 3-HSD activity was strongly suggested by persistency elevated serum 17-hydroxypregnenolone to 17-hydroxyprogesterone and pregnenolone to progesterone ratios, their significant increase after ACTH administration, and their return to normal during cortisol therapy in both patients. Nevertheless, the serum dehydroepiandrosterone to androstenedione ratio, both basally and after ACTH and/or hCG stimulation, was normal. These findings coupled with the normal phenotypic development and onset of puberty in the two patients indicated intact C-19 steroid 3-HSD activity. The overall results indicate an inherited impairment of 3-HSD activity confined only to C-21 steroid substrates and, thus, suggest the existence of at least two 3-HSD isoenzymes under independent genetic regulation.

Pursed lips breathing training using ear oximetry

Pursed lips breathing (PLB) training is often used in the management of patients with chronic obstructive lung disease (COLD). Previous clinical studies have demonstrated that PLB improves arterial oxygen saturation (SaO2) and CO2 removal as well as relieving dyspnea. Twelve hypoxemic subjects with stable COLD were randomly assigned to either the pursed lips (P) or control group consisting of general relaxation (R). The SaO2 was monitored via ear oximetry, and respiratory rate and tidal volume were monitored using a strain gage transducer and the minute volume was calculated. The PLB was taught by an experienced instructor using the ear oximeter as a monitoring display with a goal toward increasing SaO2. The subject was taught general relaxation (Rlx) with the aid of pleasant music. We compared PLB and Rlx treatments using an A-B-A crossover study design. In both groups, PLB significantly improved SaO2 over baseline (p less than 0.001) whereas Rlx did not. We conclude that patients can learn to increase their SaO2 by PLB using ear oximetry adjunctively.

Low plasma zinc and androgen in insulin-dependent diabetes mellitus

Plasma zinc and pituitary and testicular hormone concentrations were measured in two groups of male adolescents. One group comprised insulin-dependent diabetes mellitus patients, aged 14-19 years; the other, as control, included 12 healthy youngsters aged 13-19 years. Plasma concentration of zinc, prolactin, testosterone, and dihydrotestosterone were lower in diabetics than in controls, whereas the ratios of androstenedione and androstenedione to testosterone + dihydrotestosterone were higher. Plasma FSH and LH were normal. These results suggest a diminished conversion of androstenedione to testosterone and relate zinc with the 17-beta-hydroxysteroid dehydrogenase enzyme activity.

Response to acute protein load in kidney donors and in apparently normal postacute glomerulonephritis patients: evidence for glomerular hyperfiltration

25 kidney donors who had undergone nephrectomy 1-11 years ago, 35 patients followed up for 13 years after poststreptococcal glomerulonephritis, and 44 controls were investigated for their capacity to increase their glomerular filtration rate after an acute oral load of 100-150 g of protein. Their mean baseline creatinine clearances (Ccrl, ml/min +/- SEM) were similar (controls 108.5 +/- 6.1; kidney donors 115.4 +/- 8.54; postacute nephritis 82.0 +/- 6.45), but the postmeal filtration rates (Ccr2) were significantly (p less than 0.05) lower in the two patient groups (kidney donors 137.4 +/- 11.60; postacute nephritis 90.3 +/- 5.30) than in the controls (161.5 +/- 9.39), as was the Ccr2/Ccr1 ratio (p less than 0.01, controls 1.58 +/- SEM 0.10; kidney donors 1.20 +/- 0.07; postacute nephritis 1.18 +/- 0.08). In normal individuals the degree of change was inversely related to the initial creatinine clearance and varied from 135.6% +/- 43.0 when Ccrl was less than 70 ml/min to 32.7% +/- 9.50 when Ccrl was 130 ml/min or higher. This relative response was decreased in kidney donors and postacute nephritis patients. Kidney donors and apparently normal postacute nephritis patients thus have diminished renal reserve capacity.

Hepatic injury during doxorubicin therapy

Six patients with acute lymphoblastic leukemia manifested liver dysfunction related to doxorubicin hydrochloride therapy. Other causes, eg, infection, hepatitis, posttransfusion reaction, and leukemic infiltration were ruled out. There was close correlation between the administration of doxorubicin and the appearance of hepatic dysfunction. Doxorubicin may produce an idiosyncratic reaction and must be considered a drug with potential liver toxicity.

Modifications in the testis steroidogenic pathways in rats fed with cottonseed flour

Suppression of the testicular T production by effect of the CSF has been previously reported. Changes in the testicular content of intermediates and precursors of T biosynthesis were determined in rats fed during 28 days with diets containing 25,35 and 50% of CSF and compared with a defated cottonseed flour diet group and a control Purina-chow diet group. Also described were modifications during a six wk post CSF diet period. The results showed a diminution in pregnenolone and progesterone testicular content to a third and a half of the control values (21.5 and 19.3 pg/mg of protein respectively). Other compounds in the delta 5 pathway, 17 hidroxypregnenolone and dehydroepiandrosterone were undetectable since the 35% CSF diet, the 17 hidroxyprogesterone diminished to undetectable values only with the maximal (50%) CSF content diet. During the post CSF diet period all the steroids showed a tendency toward the control values. The 25% CSF content diet group reached the initial contents; other groups presented different recovery degrees. The most affected was the 50% diet group with a direct effect of the CSF on the testicular androgen steroidogenesis affecting both the delta 4 and the delta 5 pathways.

Cottonseed flour effects on androgen testicular content and serum levels in rats

Natural gossypol present in the whole cottonseed flour (CSF) has clear antifertility properties, decreasing the number and motility of spermatozoa. In this study the endocrine function of the testes was evaluated, measuring by specific radioimmunoassays the testicular content and the serum levels of androstenedione (A), testosterone (T), and 5 alpha-dihydrotestosterone in male rats fed with different and nontoxic concentrations of CSF along with Purina chow for 4 weeks, followed by 6 weeks of a recovery period. The testicular content of A, T, and DHT decreased 63%, 90%, and 38%, respectively, in comparison with their control. The serum levels of the three androgens diminished as follows: A 74%, T 95%, and DHT 60%. All the steroids measured in the recovery period showed a tendency towards the control values in both testicular content and serum. The most affected steroid was testosterone, which, after the recovery period, did not reach the control values. A also decreased, suggesting a blockade in testicular steroidogenesis caused by the initial diet.

Hypergonadotrophic hypogonadism in an XX female subject due to 17,20 steroid desmolase deficiency

A 22 year old XX female patient with primary amenorrhoea and sexual infantilism was studied. Persistently elevated serum LH and FSH concentrations and exaggerated LRH pituitary responsiveness indicated deficient ovarian hormonal production. Serum levels of C21 and C19 steroids measured by specific radioimmunoassays before and after appropriate stimulations demonstrated an impairment of adrenal and ovarian steroid biosynthesis. Baseline levels of androstenedione (delta 4-A), testosterone (T), and oestradiol-17 beta (E2) were persistently below the normal range for healthy women at early follicular phase, whereas progesterone (P) and 17 alpha-OH-progesterone (17-OH-P) serum levels were significantly higher than those observed for normal women. Adrenal and gonadal stimulation with ATCH and hCG, respectively, resulted in a considerable rise in serum P and 17-OH-P without any significant change in circulating levels of delta 4-A, T, and E2. These findings were consistent with the diagnosis of 17,20 steroid desmolase deficiency at both adrenal and ovarian levels. This is the first report of a 17,20 desmolase deficiency in an XX individual, and is in line with previous suggestions that familial occurrence of the disorder would fit an autosomal recessive pattern of inheritance.

Morphophysiological correlation of boar Leydig cell development during postnatal stage

To analyze the possible correlation between steroidogenic activity of the Leydig cells and their morphology and ultrastructure in the boar testes at different ages, testes from six Yorkshire boars were obtained by orchidectomy at 8,14,28,40,70,78,86,94 and 100 days of age. Using representative sections of testicular parenchyma, light as well as transmission electron microscopic studies were performed. Homogenized, albuginea-free tissue was further used for quantitative estimation of total proteins and metabolic pools of androstenedione (A), testosterone (T) and 5 alpha-dihydrotestosterone (DHT). Under light microscopy, abundant hyperplastic Leydig cells were observed from 14 to 40 days, thereafter was a decrease in their size and number. Spermatogenesis remained in the spermatogonia stage while the tubules increased in diameter until age 80 days; from 90 days on, pachytene primary spermatocytes could be found. A well developed smooth endoplasmic reticulum was observed in Leydig cells from the 8th postnatal day. Metabolic pools from age 8 to 28 days showed a decrease for T and A from 4.33 to 1.78 and 2.51 to 0.48 microgram/mg protein respectively, maintaining thereafter the same levels throughout the age-span studied. However, DHT was found at low levels from the beginning of neonatal period (from 0.07 to 0.38 microgram/mg protein).

Echocardiographic changes after successful renal transplantation in young nondiabetic patients

Eighteen young nondiabetic patients with chronic renal failure were studied by M-mode echocardiography before and three to 67 weeks after a successful renal transplant. Left ventricular mass (LVM), cardiac output (CO), and stroke work, which were increased before the operation, decreased afterward, in some cases to normal values. Both regression of the LVM and normalization of CO were detected as early as three weeks postoperatively and probably resulted from changes in the end-diastolic volume, mean systemic blood pressure, and hematocrit as a consequence of normal renal function. Because all the patients had normal left ventricular function and only moderate dilatation of the left ventricle, it is not known whether these striking beneficial changes after SRT also will occur in patients with significant dilatation or dysfunction of the left ventricle.

Endocrine profile in patients with chronic renal failure under zinc replacement

The plasma levels of androstenedione (A), testosterone (T), dihydrotestosterone (DHT), follicle stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) were studied in 15 men (aged 24-50 years) with chronic renal failure under periodic peritoneal dialysis, before and after 50 mg of elemental zinc (Zn) orally, twice a day for three weeks. Before treatment, they were divided into three groups: group I, plasma A above normal and PRL less than 100 ng/ml; group II, low or normal A levels with PRL less than 100 ng/ml; and group III, normal or high A levels with PRL greater than 100 ng/ml. After oral Zn, plasma FSH, LH, and PRL were unchanged in all groups; however, in groups I and II plasma A was within normal T and DHT rose significantly, the A/(T+DHT) ratio decreased to normal, and the T/DHT ratio rose above normal. In group III plasma androgens remained low and androgen ratios were unchanged. Oral Zn seems to improve the conversion of A to T and also uncovered the possibility that plasma PRL levels greater than 100 ng/ml might cause a blockade in the 5 alfa-reductase.

Testicular function in men with chronic renal failure and transplant recipients under bromoergocriptine therapy

Plasma zinc (Zn), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), and androgens concentrations were determined in 15 male patients with chronic renal failure who were successful recipients of kidney transplant. After 25 +/- 8.5 months of the renal transplant, Zn levels were (88 +/- 4 g/dl) lower than in the control group (116 +/- 5 micrograms/dl). Normal concentrations for androstenedione (A) (0.63 +/- 0.05 ng/ml) and testosterone (T) (3.31 +/- 0.15 ng/ml) were found. Dihydrotestosterone (DHT) levels (0.38 +/- 0.01 ng/ml) were lower than normal (1.11 +/- 0.09 ng/ml), suggesting a blockade in the conversion of T to DHT. Eleven of the 15 patients showed higher PRL levels (9.5 +/- 0.8 ng/ml) in contrast with the normal group (3.6 +/- 0.3 ng/ml). Ten patients received orally 2-alpha-bromoergocriptine (BEC) 2.5 mg/day for ten days. Plasma PRL decreased to 2.6 +/- 1.0 ng/ml (p less than 0.001), but A and T levels did not significantly change; however, DHT increased from 0.38 +/- 0.02 ng/ml to 0.72 +/- 0.04 ng/ml (p less than 0.01). All patients showed an increase in both gonadotropins before BEC without significant changes after treatment. The high PRL levels may be responsible for the impaired conversion of T to DHT, possibly by interference with the enzyme 5 alpha-reductase.

Zinc, prolactin, gonadotropins, and androgen levels in uremic men

This study correlates plasma levels of Zinc (Zn) and some pituitary and testicular hormones in 20 uremic men (aged 17-58 years) on a weekly peritoneal dialysis program. Patients were compared to 12 healthy male volunteers (aged 28-40 years). In uremic men, plasma androstenedione (A) was elevated, while testosterone (T), dihydrotestosterone (DHT), and Zn were low. On a group basis, plasma follicle stimulating hormone (FSH) and luteinizing hormone (LH) were normal while prolactin was increased. A negative correlation was observed between plasma A and LH levels, as well as between the A/T+DHT ratio and plasma Zn concentrations. Our results suggest a diminished A-to-T conversion and point to the possible role of Zn in the enzyme activity of the 17 beta-hydroxysteroid dehydrogenase.

[Hemodynamic effects of atrial overstimulation in patients with ischemic heart disease]

Auricular over-stimulation is used by some researchers to study patients under suspicion of coronary heart disease. In this paper we discuss the changes in telediastolic pressure of the left ventricle (PT-DVI), stimulating the right auricle with increasing frequencies sent through an external pacemaker. When the ventriculography and coronarography were over, the Sones catheter was left into the left ventricle. An electrode-catheter was introduced through vein in the right auricle, the distal end being very close to the sinusal node, where the electric catch as accomplished. Through this stimulator the cardiac frequency was increased in 20 heart beats more than the basal cardiac frequency and the PTDVI was simultaneously measured every 3 minutes. Through the coronarographic study, the patients were classified in: normal, bi-vascular and tri-vascular. The increase and decrease of PTDVI was calculated in relation to the results obtained during the last minutes of over-stimulation compared with the basal figures. Most of the patients showed a decrease in PTDVI no matter what the vascular engagement was. Our results show there is no difference between the response and the coronary obstruction degree so, this evidence is of no value to judge the functional situation of the left ventricle.

Elimination of nadolol by patients with renal impairment

1 Nadolol excretion was studied in 24 patients with chronic renal failure. 2 The amount of nadolol excreted during the 120-h period after receiving the drug ranged from less than 1% in functionally anephric, patients up to 11.5% in patients with average creatinine clearance of 57.9 +/- 3.6 ml/min/1.73 m2. 3 Renal clearance of nadolol was found to correlate with creatinine clearance; nadolol elimination is retarded in patients with renal failure. 4 Nadolol serum half-life is prolonged in proportion to the remaining renal function. Therefore, dosage intervals in renal patients receiving nadolol should be adjusted to creatinine clearance. 5 Haemodialysis effectively reduced serum concentration of the drug; it may therefore be a useful therapy for drug intoxication.

[Specific protection by sulfhydryl groups against inhibition of urease by hypoglycaemic drugs (author's transl)]

The effect of oral hypoglycaemic drugs, derivatives of sulphonylurea, upon urease has been studied. These compounds, structurally connected to urea, produce a competitive inhibition of enzyme activity with respect to substrate. Glutathioné (reduced form) and cysteine prevent inactivation of enzyme by sulphonylurea, whereas-oxidated glutathione and cysteine do not. The same phenomenon occurs in enzyme preparations inhibited by p-hydroxymercuribenzoate. The role of sulfhydryl groups in the formation of enzyme-substrate complex is discussed.

[Inhibition of urease by hypoglycaemic drugs (author's transl)]

The effect of oral hypoglycaemic drugs (derived from sulphonylurea) on urease activity in the quantitative determination of urea has been studied. These compounds have been found to produce a competitive inhibition of enzyme activity with respect to substrate. Possible interference of these antidiabetic agents upon urea analysis is discussed.

Retrolental fibroplasia: I. Clinical observations

The changes occurring in retrolental fibroplasia were studied in 97 premature infants with fundus photography and fluorescein angiography. The macrovascular lesion of proliferative retrolental fibroplasia was identified as a functioning arteriovenous shunt. The microvascular abnormalities were capillary tufts, collaterals, capillary-free zones, and neovascular membranes. Regression was signaled by the ingrowth of capillaries from the shunt into the avascular retina. Cicatrization was characterized by persistence of the vascular abnormalities of the proliferative phase and organization of the avascular retina into a contracting scar.

Role of molybdenum in nitrate reduction by chlorella

Molybdenum is absolutely required for the nitrate-reducing activity of the nicotinamide adenine dinucleotide nitrate reductase complex isolated from Chlorella fusca. The whole enzyme nicotinamide adenine dinucleotide nitrate reductase is formed by cells grown in the absence of added molybdate, but only its first activity (nicotinamide adenine dinucleotide diaphorase) is functional. The second activity of the complex, which subsequently participates also in the enzymatic transfer of electrons from nicotinamide adenine dinucleotide to nitrate (FNH(2)-nitrate reductase), depends on the presence of molybdenum. Neither molybdate nor nitrate is required for nitrate reductase synthesis de novo, but ammonia acts as a nutritional repressor of the complete enzyme complex. Under conditions which exclude de novo synthesis of nitrate reductase, the addition of molybdate to molybdenum-deficient cells clearly increases the activity level of this enzyme, thus suggesting in vivo incorporation of the trace metal into the pre-existing inactive apoenzyme.Competition studies with tungstate corroborate these conclusions and indicate that the only role played by molybdenum in Chlorella is connected with the reduction of nitrate to nitrite. Tungsten seems to act by replacing molybdenum in the nitrate reductase complex, thus rendering inactive the FNH(2)-nitrate reductase portion of the nicotinamide adenine dinucleotide nitrate reductase complex.