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D J Morgan

Publications and source records attributed to D J Morgan.

At least 55 records · Page 3Linked to original sources
PubMed1998

Relationships among liver and kidney volumes, lean body mass and drug clearance.

AIMS: To determine whether lean body mass (LBM), a possible surrogate of liver and kidney volumes, correlates with hepatic and renal drug clearances. METHODS: Twenty-one disease-free patients with a history of cancer and with normal hepatic and renal function were studied. Salivary pharmacokinetics of oral antipyrine (1200 mg) and 24 h creatinine clearance were determined following the determination of LBM by dual energy X-ray absorptiometry and the determination of liver and kidney volumes by helical CT scanning. RESULTS: Liver volume correlated with LBM (r2=0.21, P=0.04), body surface area (BSA) (r2=0.54, P<0.001), and total body weight (TBW) (r2=0.61, P<0.001). Kidney volume correlated with LBM (r2=0.49, P<0.001), BSA (r2=0.43, P=0.002) and TBW (r2=0.24, P=0.03). Stepwise multiple regression analysis, incorporating the independent variables of age, height, weight, sex, BSA, LBM, alcohol consumption, smoking status and liver volume and the dependent variable antipyrine clearance, indicated that LBM was the only independent correlate of antipyrine clearance. A stepwise multiple regression analysis with kidney volume in the independent variables, and creatinine clearance as dependent variable, showed that kidney volume and age were the only independent correlates of creatinine clearance. A nomogram using serum creatinine and LBM was comparable with the Cockcroft and Gault nomogram in calculating creatinine clearance. CONCLUSIONS: Of the anthropometric variables tested, LBM was the only determinant of antipyrine clearance, but this was not due to a relationship between LBM and liver volume. By contrast, the relationship between creatinine clearance and LBM appeared to be due to a relationship between LBM and kidney volume.

Adult↗
PubMed1998

A priming dose of propranolol reduces the availability of a subsequent dose in the isolated perfused rat liver preparation.

1. A 50 microL bolus dose containing (+/-)-propranolol hydrochloride (200 microg) and [14C]-sucrose, or antipyrine (2 mg) and [14C]-sucrose, or [14C]-taurocholate sodium was injected into the portal vein of the isolated perfused rat liver preparation and perfusate outflow samples were collected frequently for the next 30 min. After a 20 min washout period this procedure was repeated. 2. [14C]-Sucrose, antipyrine and [14C]-taurocholate each eluted as a single peak at 18, 31 and 28 s, respectively, after each dose. In contrast, propranolol eluted with two peaks at approximately 18 and 128 s after dosing. 3. There was no significant difference in dose-corrected area under the outflow curve (AUC) for [14C]-sucrose, antipyrine or [14C]-taurocholate between the first and second doses whereas the mean propranolol AUC for the second dose was only 0.577+/-0.439 that for the first dose (P<0.05). 4. Unmetabolized propranolol accounted for more than 80% of the drug in hepatic tissue for the first and second doses at 18 s and greater than 50% at 128 s, and there was no significant difference in these values at each time between the first and second doses. 5. These findings suggest that for an avidly extracted drug, such as propranolol, systemic availability of orally administered drug will be highly dependent on factors that influence the hepatic tissue binding of the drug.

Adrenergic beta-Antagonists↗
PubMed1998

Studies of the surgical scrub.

BACKGROUND: To evaluate the effectiveness of various scrub techniques in reducing bacterial skin flora, the present study was developed in three stages. METHODS: Each stage involved fingertip bacterial colony counts measured before, immediately after and 30 min after a variety of handwashing techniques using 10% povidone iodine solution. The first compared 1, 2 or 3 non-timed washes from fingertips to elbows in 10 volunteers. The second compared two volunteers scrubbing for equal durations with or without friction rubbing, while the third involved 15 volunteers who each scrubbed for different time intervals. RESULTS: The first stage showed that a single wash episode failed to provide lasting bacterial colony count reductions on fingertip cultures. The second showed that enduring colony count reductions occur whether friction rubbing of the hands was used or not, and the third showed that a 30 s wash was as effective as washing for longer periods in reducing fingertip flora. CONCLUSIONS: These findings suggest that prolonged vigorous pre-operative scrubbing is unnecessary, although more than a cursory wash is required to produce lasting fingertip antisepsis.

Anti-Infective Agents, Local↗
PubMed1998

Phase I and pharmacokinetic study of KRN8602 alone and with filgrastim in patients with advanced cancer.

PURPOSE: To determine the recommended dose, toxicity profile, and pharmacokinetics of KRN8602 (MX2-hydrochloride), a novel morpholino anthracycline with potent cytotoxicity against anthracycline-sensitive and resistant experimental tumors in vitro and in vivo. PATIENTS AND METHODS: KRN8602 was administered alone in increasing doses to patients with advanced cancer or high-grade gliomas until dose-limiting toxicity (DLT) was observed in three or more of five patients treated in a dose level. Because neutropenia was dose limiting, further escalation was investigated with filgrastim support. RESULTS: Fifty-six assessable patients completed at least one cycle of chemotherapy. The recommended dose of KRN8602 alone was 40 mg/m2. Dose escalation was limited by neutropenia. The recommended dose of KRN8602 with filgrastim was 70 mg/m2, and limiting toxicities were neutropenia, diarrhea, and vomiting. The most commonly experienced nonhematologic toxicity was nausea and vomiting. Alopecia and mucositis were infrequent and mild. Pharmacokinetic parameters showed substantial variation, although the area under the plasma concentration-time curve (AUC) and maximum concentration both increased with dose. There was no relationship between pharmacokinetic parameters and toxicity. CONCLUSION: KRN8602 at doses of 40 mg/m2 when administered alone and 70 mg/m2 when administered with filgrastim appeared to be manageable. The major DLTs were neutropenia and, at higher doses, diarrhea and vomiting. The efficacy of this drug is currently being tested in phase II studies.

Adult↗
PubMed1998

Propranolol elimination by right and left fetal liver: studies in the intact isolated perfused fetal sheep liver.

Propranolol extraction in vivo by the left lobe of the fetal sheep liver is greater than that by the right lobe, and this may be due to the fact that oxygenation of the left lobe is greater than that of the right lobe. To explore this hypothesis, we studied the elimination of (R)-(+)-propranolol (PROP) by right and left lobes of the intact isolated perfused fetal sheep liver model, in which there is equal oxygenation of both liver lobes. After isolation of the liver, near-term fetal sheep livers (n = 11) were perfused (2.68 +/- 1.05 ml/g liver/min) in situ via the umbilical vein in a 1-liter recirculating system. PROP was infused (1.2 mg/hr) into the reservoir after an initial bolus dose (2.3 mg). Perfusate samples were taken from the common and right and left hepatic veins every 10 min for determination of PROP concentrations and oxygen consumption over the 180-min experimental period. Mean ductus venosus shunt through the liver was 42 +/- 21% of perfusate flow. Oxygen consumption was not significantly different between the left and right lobes of the liver (0.79 +/- 0.46 and 0.67 +/- 0.44 micromol/g liver/min, respectively, P > .05), nor was there any significant difference between lobes in PROP hepatic extraction at steady state (0.25 +/- 0.20 and 0.25 +/- 0.23, respectively, P > .05). This supports the hypothesis that the difference between lobes in PROP extraction in vivo may be due to the difference in degree of oxygenation of the left and right lobes that is known to be present in vivo.

Animals↗
PubMed1997

Relationship between hydrogen peroxide-producing strains of lactobacilli and vaginosis-associated bacterial species in pregnant women.

This study was conducted to determine the relationship between lactobacilli and bacterial species associated with bacterial vaginosis in pregnancy and the prevalence of H2O2-producing and non-producing strains of lactobacilli in pregnant women whose vaginal flora had already been analysed. Information was available for 174 pregnant women whose vaginal flora had been evaluated previously by examining gram-stained vaginal smears: 50 had grade III flora (bacterial vaginosis). 50 grade II flora, 41 flora graded as abnormal which then reverted to grade I (revertants) and 33 normal flora (controls). Lactobacilli were isolated from 19 of 50 women whose vaginal flora was grossly abnormal culturally and categorised as grade III by Gram staining. In 6 of these 50 women lactobacilli were isolated in large numbers, i.e. 10(5)-10(6) cfu/ml. H2O2-producing strains of lactobacilli were isolated from 11 of 12 women with grade III flora who were randomly selected from this group. Thus, in those 11 women it appears that H2O2-producing lactobacilli had not protected them from developing bacterial vaginosis. Bacterial species associated with vaginosis were isolated in high numbers from a large proportion of women in the revertant and grade II groups in association with high counts of lactobacilli. Thus, in some women it is possible that a change to an abnormal flora could occur before the complete disappearance of lactobacilli. It is concluded that bacterial vaginosis may develop in some women despite the presence of H2O2-producing strains of lactobacilli and that other factors, as yet unidentified, might be conducive to the appearance of abnormal bacterial flora with progression to vaginosis.

Bacteria↗
PubMed1997

Pharmacokinetics and pharmacodynamics of MX2 hydrochloride in patients with advanced malignant disease.

The purpose of the present study was to investigate the pharmacokinetics and pharmacodynamics of the new morpholino anthracycline drug MX2. A total of 27 patients with advanced cancer participated in a dose-escalation study in the first cycle of treatment with drug given i.v. at doses of 10-50 mg/m2 (total dose 16.8-107.5 mg). The mean total systemic plasma clearance (CL) of MX2 was 2.98 +/- 1.68 l/min, the mean volume of distribution at steady state was 1460 +/- 749 l and mean elimination half-life was 10.8 +/- 5.1 h. The area under the plasma concentration-time curve (AUC) of MX2 was linearly related to the dose per kilogram and the dose per body surface area (r2 = 0.43, P < 0.01 and r2 = 0.44, P < 0.01, respectively). CL did not correlate with total body weight, lean body mass or body surface area. The mean elimination half-lives of the metabolites M1, M2, M3 and M4 were 11.8 +/- 5.0, 21.9 +/- 11.8, 19.0 +/- 11.3 and 12.3 +/- 6.3 h, respectively. The fractional Emax model produced a much better fit to the relative nadir neutrophil count versus dose data (r2 = 0.42) than to the relative nadir neutrophil count versus AUC or peak concentration (Cmax) data (r2 = 0.15 and 0.09, respectively). There seemed to be a threshold dose of about 65 mg of MX2 at or above which a large proportion of patients had a nadir neutrophil count of less than 0.5 x 10(9)/l. This study shows that the pharmacokinetics of MX2 are similar to those of other anthracyclines. With other anthracyclines the degree of myelosuppression seems to depend more on the AUC and Cmax than on the delivered dose; however, with MX2 the degree of myelosuppression depends more on the dose given than on drug exposure expressed as the AUC or Cmax.

Adult↗
PubMed1997

Vascular abnormalities associated with long-term cigarette smoking identified by arterial waveform analysis.

PURPOSE: Consistent changes in the arterial pulse contour are found with aging and disease states that impair the compliance characteristics of blood vessels that buffer pulsatile phenomena in the arterial tree. We assessed whether vascular adaptation in structure or tone of blood vessels associated with long-term cigarette smoking would influence steady state or pulsatile hemodynamics at a preclinical stage. PATIENTS AND METHODS: We analyzed intraarterial brachial artery waveforms in 35 healthy long-term cigarette smokers and 32 nonsmoking control subjects matched for age and gender. The diastolic pressure decay was segmented into two components: an exponential decay that reflects the compliance characteristics of the large arteries and an oscillatory diastolic waveform generated principally by pulse-wave reflections from small arteries and arterioles. RESULTS: Resting heart rate was higher in smokers than nonsmokers, mean +/- SD (66 +/- 9 versus 60 +/- 10; P < 0.05). Systolic, diastolic, and mean arterial pressures were lower in smokers compared with nonsmokers (P < 0.01 for all). No differences in cardiac output, large artery compliance, or systemic vascular resistance estimates where apparent between groups. A decrease in the amplitude and duration of the diastolic wave, produced by peripheral pulse-wave reflections in the arterial system, was found in smokers compared with nonsmokers (0.04 +/- 0.02 versus 0.7 +/- 0.03; P < 0.001). CONCLUSIONS: Quantitative changes in the arterial waveform were found in long-term smokers compared with nonsmoking control subjects. The altered arterial wave shape marks the presence of abnormal structure or tone in the peripheral vasculature that affects pulsatile arterial function. This measure of vascular injury is detectable at a preclinical stage and may relate to the subsequent risk of morbid events in chronic smokers and aid in clinical risk stratification.

Adult↗
PubMed1997

Drug disposition in mother and foetus.

1. In pregnancy, plasma protein binding of certain drugs is reduced due to a reduction in serum albumin concentration. Due to an increase in cardiac output in pregnancy there is a 50% increase of effective renal plasma flow, glomerular filtration rate and creatinine clearance. This results in a corresponding increase in renal drug clearance. 2. Placental transfer of small lipophilic molecules from the mother to the foetus is efficient because the placental membrane is a very thin lipophilic membrane, with a large surface area for exchange and high maternal and foetal placental blood flow rates. Nevertheless, placental transfer of relatively hydrophilic molecules is slow and this may limit foetal exposure to the drug where a single maternal dose is concerned. 3. Once a drug has crossed the placenta it passes via the umbilical vein to the foetal liver and then to the systemic circulation of the foetus, which creates a potential foetal hepatic first-pass effect. The activity of most foetal hepatic drug-metabolizing enzymes studied is much less than the adult activity and some enzymes do not appear to be expressed at all. The circulation of the foetal liver is unique because 30-70% of umbilical vein flow is shunted via the ductus venosus. There is also a difference in oxygenation and enzyme content between the left and right lobes of the foetal liver. 4. The foetal kidney is not a very effective route of elimination because renally excreted drug enters the amniotic fluid and recirculates via foetal swallowing. Moreover, foetal renal blood flow is only 3% of cardiac output, compared with 25% in the adult, and renal tubular anion secretion is absent. In conclusion, the extent of foetal exposure of maternally administered drug depends on numerous factors, in particular maternal and foetal elimination mechanisms and placental permeability.

Female↗
PubMed1997

Effects of acute myocardial infarction on theophylline elimination in rats.

We investigated the effect of acute myocardial infarction (MI) on the hepatic clearance of theophylline in rats using the coronary artery ligation model. After 48 hr of ligation, there were significant changes in left ventricular performance in the MI rats, compared with controls, as indicated by elevated left ventricular end-diastolic pressure, reduced mean arterial pressure, and reduced left ventricular systolic pressure (20 +/- 2 vs. 12 +/- 3 mm Hg, p < 0.01; 90 +/- 6 vs. 101 +/- 6 mm Hg, p < 0.01; and 100 +/- 8 vs. 114 +/- 8 mm Hg, p < 0.01, respectively). Despite these changes, MI rats were able to maintain their cardiac output at rest (77.9 +/- 6.8 vs. 77.2 +/- 9.2 ml/min), and there was no change in mean central venous pressure (3 +/- 1 vs. 2 +/- 1 mm Hg). Although hepatic perfusion and oxygenation were preserved (17.3 +/- 2.2 vs. 18.7 +/- 3.3 ml/min and 127 +/- 27 vs. 125 +/- 19 mumol/min respectively), clearance of theophylline was reduced by 23% in the MI rats, compared with controls (0.86 +/- 0.20 vs. 1.12 +/- 0.17 ml/min, p = 0.01). There was no significant correlation between theophylline clearance and the infarct size (r = -0.038, p > 0.05). These findings demonstrate that the elimination of theophylline is impaired after acute MI, independent of any changes in hepatic perfusion or oxygenation.

Animals↗
PubMed1996

CD8(+) T cell-mediated spontaneous diabetes in neonatal mice.

Transgenic mice that express the influenza virus hemagglutinin (HA) on pancreatic islet beta cells (ins-HA) demonstrate tolerance of HA even after immunization with influenza virus. Surprisingly, when Ins-HA mice were mated with a transgenic mouse expressing a TCR specific for an epitope of HA that is restricted by MHC class I H-2Kd (Clone-4 TCR), the resulting double transgenic (Ins-HA x Clone-4 TCR)F1 neonates developed spontaneous autoimmune diabetes immediately after birth and died within 10 days. This represents a unique situation in which all safeguards within the immune system that normally maintain tolerance of self-antigens in the neonate are insufficient.

Animals↗
PubMed1996

Determination of (R)-(+)- and (S)-(-)-isomers of thiopentone in plasma by chiral high-performance liquid chromatography.

A method for the determination of R-(+)- and (S)-(-)-isomers of thiopentone in plasma was developed. Following liquid-liquid extraction, the separation of enantiomers of thiopentone and the internal standard (racemic ketamine) was achieved by high-performance liquid chromatography on an alpha1-acid glycoprotein (AGP) column with ultraviolet detection at 280 nm. The mobile phase consisted of 20 mM KH2PO4 buffer-2-propanol-methanol (93.5:5.0:1.5) at pH 5.0. The flow-rate was 0.9 ml/min. The limit of quantification for each isomer was approximately 10 ng/ml. The assay is suitable for pharmacokinetic studies of (R)-(+)- and (S)-(-)-isomers of thiopentone, following usual bolus intravenous clinical doses of the racemic drug.

Aged↗
PubMed1996

Myocardial uptake of thiopental enantiomers by the isolated perfused rat heart.

Myocardial uptake of thiopental enantiomers by an isolated perfused rat heart preparation was examined after perfusion with protein-free perfusate. Outflow perfusate samples were collected at frequent intervals for 20 min during single-pass perfusion with 10 micrograms/ml racemic thiopental (washin phase) and for another 45 min during perfusion with drug-free perfusate (washout phase). (+)- and (-)-thiopental concentrations were assayed by chiral high-performance liquid chromatography. Heart rate, perfusion pressure, and electro-cardiogram were also monitored. During the washin phase, there was no significant difference between the mean values of the equilibration rate constants of (+)- and (-)-thiopental enantiomers (0.44 +/- 0.07 min-1 and 0.43 +/- 0.09 min-1, respectively, P > 0.05). Mean volumes of distribution of (+)- and (-)-thiopental enantiomers were similar (6.34 +/- 1.20 and 6.45 +/- 1.29 ml/g for the washin phase and 7.22 +/- 0.71 and 7.47 +/- 0.81 ml/g for the washout phase, respectively, P > 0.05). This indicates that tissue accumulation of thiopental enantiomers in the isolated perfused rat heart was not stereoselective. Uptake of thiopental by the heart was perfusion flow rate-limited and independent of capillary permeability. These findings suggest that myocardial tissue concentration of racemic thiopental should be an accurate predictor of myocardial drug effect.

Anesthetics, Intravenous↗
PubMed1996

Effects of aging per se on arterial stiffness: systemic and regional compliance in beagles.

Although previous studies have suggested that aging results in an increase in vascular stiffness, diseases that increase in prevalence with advanced age may have confounded the results of some of this past research. The purpose of this investigation was to determine whether aging per se results in reduced arterial compliance by using animals that are resistant to atherosclerosis and do not develop hypertension or hyperlipidemias with advanced age. We evaluated systemic and regional (femoral) arterial compliance in older (110 +/- 8 months old) and in younger (27 +/- 2 months old) female beagle dogs by using a computer-based assessment of the diastolic decay of arterial pressure waveforms and a modified Windkessel model of the circulation. Although systemic arterial pressure was very similar in both age groups, cardiac output was 29% lower (p = 0.03) and systemic vascular resistance was 24% higher (p = 0.02) in the older dogs. Moreover, there was an age-related reduction in systemic arterial compliance, derived both from the exponential decay in the arterial pulse (C1) (p = 0.05) and that derived from the oscillatory component of the diastolic pulse wave (C2) (p = 0.04). By contrast, although femoral vascular resistance was 25% higher in the older dogs (p = 0.04), regional (femoral) vascular compliance measured after femoral arterial occlusion was also 25% reduced but was not significantly changed with age (p = 0.14). These results demonstrate that systemic arterial compliance is reduced with age in dogs, extending this finding to animals without age-related diseases that frequently occur in older human beings. Regional compliance, evaluated in the isolated femoral vascular bed, also tends to be reduced with age, but variability in this parameter in dogs reduces the significance of this finding.

Aging↗
PubMed1996

Increased sensitivity of propranolol clearance to reduced oxygen delivery in the isolated perfused cirrhotic rat liver.

BACKGROUND & AIMS: Capillarization of the sinusoids in cirrhosis is proposed to reduce oxygen availability to the hepatocyte, resulting in the patterns of altered drug metabolism observed in cirrhosis. If this were true, drug metabolism in cirrhotic livers would be expected to be more sensitive to reduced oxygen delivery than in noncirrhotic livers. The aim of this study was to compare the sensitivity of propranolol clearance with reduced oxygen delivery in isolated perfused livers from healthy and cirrhotic rats. METHODS: Propranolol clearance was measured at steady state in 5 normal and 5 cirrhotic weight-matched perfused rat livers under single-pass conditions with normal oxygen delivery (mean, 71.5 mumol/min) and with graded reductions in oxygen delivery (range, 58.1-18.8 mumol/min). RESULTS: In noncirrhotic livers, propranolol clearance was independent of oxygen supply for the oxygen delivery range of 73-45 mumol/min but decreased with further reductions in oxygen supply. In cirrhotic livers, propranolol clearance decreased linearly (r2 = 0.92; P < 0.005) for the entire oxygen delivery range (73.4-18.8 mumol/min). CONCLUSIONS: The increased sensitivity of propranolol clearance in perfused cirrhotic livers to reductions in oxygen delivery is consistent with impaired oxygen delivery to hepatocytes in cirrhosis. These novel findings potentially hold implications for clinical management of patients with cirrhosis.

Adrenergic beta-Antagonists↗
PubMed1996

Effect of erythrocyte binding on elimination of harmol by the isolated perfused rat liver.

The effect on the hepatic elimination rate of drug bound to erythrocytes and to albumin was compared with harmol, a relatively hydrophilic drug of high hepatic intrinsic clearance, in the single-pass isolated perfused rat liver preparation (n = 12). The steady-state hepatic extraction ratio (E) of harmol (50 microM) was measured during three consecutive 35-min periods with three different perfusates: Krebs-Henseleit buffer, buffer containing bovine serum albumin (2%), and buffer containing washed human erythrocytes (10%) perfused at 5 mL/min/g liver in randomized order. The mean unbound fraction (fu) of harmol in the latter two perfusates was 0.55 +/- 0.07 and 0.62 +/- 0.08, respectively, and the mean E for the three perfusates were 0.85 +/- 0.06, 0.62 +/- 0.07, and 0.71 +/- 0.08, respectively. The sinusoidal model fitted the relationship between E and fu better than the venous equilibrium model. Four further experiments, with perfusates of buffer, buffer + 2% albumin, and buffer + 4% albumin, confirmed that harmol elimination conformed to the sinusoidal model. For each of the 12 experiments that used erythrocyte perfusate, E and fu data from each of the two non-erythrocyte perfusates were used to predict E for the erythrocyte perfusate at the observed fu of 0.62, with the sinusoidal model. There was no significant difference between the observed (0.71 +/- 0.08) and predicted (0.68 +/- 0.10) E values (p > 0.05). This result suggests that release of harmol from erythrocytes is not a rate-limiting factor in the hepatic elimination of harmol, and that plasma membrane permeability does not contribute readily to a red cell carriage effect, at least with moderately polar and small molecules.

Animals↗
PubMed1996

Pharmacokinetics of thiopental and pentobarbital enantiomers after intravenous administration of racemic thiopental.

We studied the pharmacokinetics of thiopental enantiomers in 14 healthy patients aged 37-73 yr receiving racemic thiopental by intravenous (IV) bolus or IV infusion. Plasma concentration of each enantiomer was measured by chiral high-performance liquid chromatography. After IV bolus, the total plasma clearance (CL) (295 +/- 132 mL/min) and volume of distribution at steady state (Vss) (139 +/- 38.5 L) of R-thiopental were significantly greater than those of S-thiopental (230 +/- 104 mL/min and 114 +/- 47.5 L, respectively). The plasma unbound fraction (fu) was determined by ultrafiltration of plasma from six healthy volunteers. The fu of R-thiopental (12.4% +/- 0.6%) was significantly greater than that of S-thiopental (10.0% +/- 1.0%). When the CL and Vss of the two enantiomers were corrected for the difference in mean fu, there were no significant differences between enantiomers for these variables. As the 20%-30% difference between the enantiomers in total CL and total Vss could be accounted for by stereoselectivity in fu, these differences are not likely to be clinically significant. During 105-180 min IV infusion of racemic thiopental to the other patients, there was no difference between enantiomers in mean plasma concentrations of total or unbound thiopental or total pentobarbital, a major metabolite of thiopental (P > 0.05). Therefore, it is appropriate to relate pharmacodynamic effects to racemic plasma concentrations of thiopental during IV infusion of racemic thiopental.

Adult↗