Effect of H2 blockers on the circadian rhythm of intragastric acidity

Most patients with peptic ulcer or gastro-oesophageal reflux disease develop nocturnal pain (epigastric and retrosternal pain from midnight to early morning), which often disappears before breakfast. Such pain may be related to a disturbance of the circadian rhythm of gastric acid secretion. Helicobacter pylori is a known aetiological agent of peptic ulcer disease and patients with gastritis or ulcers now undergo infection eradication therapy. However, this can result in the onset or exacerbation of gastro-oesophageal reflux disease. There has been a marked increase in the number of patients with oesophagitis rather than peptic ulcer and because most are negative for H. pylori, attention has centred on the status of their gastric acid secretion. Some patients with oesophagitis complain of nocturnal pain despite treatment with a proton pump inhibitor, and in those cases a short course of an H2 blocker can be very effective. We used a portable pH meter to study, in a cross-over fashion, the changes in the circadian rhythm of gastric acid secretion caused by two H2 blockers, laftidine and famotidine, in 10 H. pylori-negative subjects. There was a significant difference in the rhythm between baseline (no treatment) and when laftidine or famotidine were administered, with mean values for amplitude of 28.1, 13.80 and 10.82, respectively; for the midline estimating statistic of rhythm (MESOR), 22.7, 10.80, and 11.54; and for acrophase, 324.0. 312.3, and 274.5 (p < 0.001). The H2 blockers suppressed the normal circadian rhythm of intragastric acidity, which rises in the evening until the middle of the night and then drops in the morning.

Associations by signatures and coherences between the human circulation and helio- and geomagnetic activity

Helio-geomagnetic influences on the human circulation are investigated on the basis of an 11-year-long record from a clinically healthy cardiologist, 35 years of age at the start of monitoring. He measured his blood pressure and heart rate around the clock with an ambulatory monitor programmed to inflate an arm cuff, mostly at intervals of 15-30 minutes, with only few interruptions, starting in August 1987. While monitoring is continuing, data collected up to July 1998 are analyzed herein by cosinor rhythmometry and cross-spectral coherence with matching records of solar activity, gauged by Wolf numbers (WN) and of the geomagnetic disturbance index, Kp. A direct association between heart rate (HR) and WN is found to be solar cycle stage-dependent, whereas an inverse relationship between heart rate variability (HRV) and WN is found consistently. An inverse relation is also observed between WN and the variability in systolic blood pressure (SBP), and to a lesser extent, diastolic blood pressure (DBP). Moreover, HR is cross-spectrally coherent with WN at a frequency of one cycle in about 7.33 months. The results support previously reported associations on morbidity and mortality statistics, extending their scope to human physiology monitored longitudinally.

Intragastric acidity and circadian rhythm

Most patients with peptic ulcers or gastroesophageal reflex disease develop subjective symptoms of epigastralgia and retrosternal pain during the period of time from the middle of the night to the early dawn (nocturnal pain). Such pain often disappears before breakfast. Disturbed circadian rhythm of gastric acid secretion may have a close relationship with the onset and aggravation of acid-related diseases. On the other hand, Helicobacter pylori has been considered to be an etiological agent of duodenal ulcer, and H. pylori eradication has been conducted in patients with gastritis and peptic ulcers. However, such eradication therapy sometimes results in the onset or deterioration of gastroesophageal reflux diseases. In this context, the question of whether the circadian rhythm of gastric acid secretion varies in accordance with the presence or absence of H. pylori infection is of interest. In the present study, we examined the fluctuation in intragastric acidity via a portable pH meter in 10 H. pylori-positive and 10 H. pylori-negative subjects. As a result, a significant difference in the circadian rhythmicity was observed between the H. pylori-negative and the H. pylori-positive group, with mean values for each parameter of 28.1 and 13.3 for amplitude, 22.7 and 12.4 for the midline-estimating statistic of rhythm (MESOR), and 324.0 and 321.0 for acrophase, respectively (P < 0.001). In both H. pylori-positive and negative groups, a tendency was observed toward an increase in intragastric acidity during the time period from the middle of the night to the early dawn, and toward a decrease in intragastric acidity during the early morning. In the H. pylori-positive group, the values for intragastric acidity over time were lower, and the degree of amplitude was smaller as compared to the H. pylori-negative group. Further, H. pylori-positive individuals were at a more advanced stage of the disease.

Long-lasting binding of IT-066 to human histamine H2 receptor

Based on animal models, IT-066, a histamine H2-receptor antagonist, is reported to possess potent and long-lasting antagonisms on histamine H2 receptor (H2R) -mediated effects. However, no reports have been published concerning its interaction with the human H2R. The aim of this study is to characterize its interaction with human H2R. Chinese hamster ovary cell lines stably expressing human H2Rs were obtained. The effects of IT-066, famotidine, and ranitidine on tiotidine binding and histamine-stimulated cAMP production were analyzed. IT-066 inhibited [3H]tiotidine binding and histamine-stimulated cAMP production more potently than famotidine or ranitidine. In addition, preincubation with 10(-5) M IT-066, but not with 10(-5) M famotidine or 10(-4) M ranitidine, had marked inhibitory effects long after extensive washing. Paraformaldehyde fixation of the cells blunted inhibition of [3H]tiotidine binding induced by preincubation with IT-066, but not that by preincubation with famotidine or ranitidine. IT-066 has potent and long-lasting antagonisms on human H2R. At least one of the IT-066 binding sites is not shared by famotidine, ranitidine, or tiotidine and is affected by paraformaldehyde fixation.

Runaway pacemaker. A case report with a runaway rate of 2100 ppm

A case of runaway pulse generator is described. A Vitalith C-23 developed runaway on the 13th postoperative day, without any preceding changes in the rate or amplitude of the pulse generator spike. The rate of runaway was 2100 pulses per minute (ppm), one of the highest rates ever reported. The ventricle was not captured by the runaway pulse generator, but was paced effectively by a temporary demand pacemaker (Medtronic 5880A) which was left in case of displacement of the implanted pacing lead. The reasons why the temporary pacemaker was not inhibited are discussed.

Low-sulfated chondroitin sulfate in human blood and urine

Blood and urinary low-sulfated chondroitin sulfate from healthy young and aged volunteers have been characterized by gel chromatography, two-dimensional electrophoresis on cellulose acetate strips and by chemical and enzymatic analysis. No difference in content of the material (24 nmol hexosamine per ml plasma) was observed regardless of age. Chemical composition (approximately 40% sulfation at 4-position of galactosamine) and molecular weight (about 8000) of blood and urinary low-sulfated chondroitin sulfates were found to be the same, though urinary excretion of the material was much higher in the aged than in the young adults (Ohkawa et al. (1972) J. Biochem. 72, 1495--1501). Low-sulfated chondroitin sulfate in serum was in a bound form with a molecular weight of more than 100000, irrespective of age. These results suggest that increase in urinary excretion of low-sulfated chondroitin sulfate in the aged is mainly due to renal dysfunction. Low-sulfated chondroitin sulfate was also the main component of acidic glycosaminoglycans in blood from patients with Hurler's syndrome who excreted excessive amounts of dermatan sulfate and heparan sulfate in urine. This suggests that low sulfated chondroitin sulfate in blood is not merely a precursor of urinary glycosaminoglycans in the case of healthy young adults.

Sinus node recovery time and abnormal postpacing phase in the aged patients with sick sinus syndrome

The sinus node function was evaluated by rapid atrial pacing in 35 aged patients (mean age 78.2 years) including 10 aged controls, 12 cases with various degrees of AV block, 6 with bradycardia-tachycardia syndrome (BTS), and 7 with sinus bradyarrhythmia (SB). AV block was further divided into A-H block (7 cases) and H-V block (5 cases) by His bundle electrogram which was simultaneously recorded with 3 leads of surface electrocardiogram. Sinus node recovery time (SRT) was measured and its maximum value (SRTmax) was selected from SRTs obtained after pacing with various rates and durations in each patient. SRTmax was also expressed as percentage of the control P-P interval (%SRTmax). For patients in whom the study was repeated 3 to 8 months later, %SRTmax was reproducible in 9 of 14 instances. Prolongation of SRT was not always observed as the rate and/or duration of pacing was increased. SRTmax and %SRTmax were 1,363 +/- 188 msec and 147 +/- 19% (mean +/- SD), respectively, for aged controls, 1,597 +/- 442 msec and 156 +/- 31% for patients with AV block, 2,087 +/- 1,315 msec and 203 +/- 132% for those with BTS, and 3,069 +/- 1,287 msec and 247 +/- 115% for those with SB. SRTmax exceeding the range for aged controls was noted in 4 of 7 cases (57%) with A-H block, 2 of 6 (33%) with BTS, and 5 of 7 (71%) with SB; normal SRT was not infrequently observed in patients with sick sinus syndrome, especially in those with BTS. Analysis of 10 consecutive atrial cycles following cessation of pacing revealed that in 8 cases the first P-P interval (SRT) was followed by longer ones in some occasions (secondary suppression). It was observed almost exclusively in patients with sick sinus syndrome. The possibility of this phenomenon to reflect another feature of sinus node abnormality was discussed.