Biomedical subjects
Publications and source records attributed to D M Gross.
Current pediatric literature suggests that in sinus tachycardia the heart rate rarely exceeds 200 beats per minute. Three infants had heart rates of 240 to 270 beats per minute in whom the diagnosis was sinus tachycardia. We report these cases and offer diagnostic and therapeutic suggestions for the clinician who encounters an infant with a heart rate between 200 and 300 beats per minute.
A series of 2-[4-[3-(substituted-amino)-2-hydroxypropoxy]phenyl]imidazoles is described. The compounds were investigated in vitro for beta-adrenoceptor antagonism, and several examples were found to be selective for the beta 1-adrenoceptor. The structure--activity relationship exhibited by this series of compounds is discussed. (S)-2-[p-[3-[[2-(3,4-dimethoxyphenyl)ethyl]amino]-2-hydroxypropoxy]phenyl]-4-(2 -thienyl)imidazole [(S)-13] was over 100 times more selective than atenolol for the beta 1-adrenergic receptor and has been selected for in-depth studies.
In order to determine if an increase in heart rate is associated with an increase of left ventricular contractile function during the neonatal period we recorded phasic and mean aortic blood pressure, left atrial mean or left ventricular end diastolic pressure, phasic left ventricular blood pressure, aortic blood flow velocity and the instantaneous first derivatives of left ventricular blood pressure (dP/dt) and aortic blood flow velocity (dV/dt) during pacing-induced tachycardia in conscious newborn and adult sheep. There was a significant positive linear correlation between heart rate and both indices of contractility (dP/dt and dV/dt) in both age groups. Left ventricular end diastolic pressure was unchanged except for a decrease at the most rapid heart rate in the newborns. There was no change in aortic mean blood pressure during the study. Our data demonstrate that an increase of heart rate is associated with an increase of left ventricular contractile function in conscious neonatal and adult sheep. Investigations of the effects of potential inotropic agents on left ventricular contractile performance in newborns and adults must evaluate the independent effect of any simultaneously occurring increase in heart rate.
High-frequency real-time sonography has enhanced accuracy in the diagnosis of scrotal abnormalities. Results of 48 scrotal scans of 92 testes are presented. There were 22 testicular lesions, nine seminomas, four embryonal cell carcinomas, one case of metastatic prostatic carcinoma, one benign "keratin cyst," three testicular infarcts, three atrophied testes, and one case of testicular torsion. Hypoechoic tumors and infarcts have a similar appearance. Extratesticular abnormalities included spermatoceles, varicoceles, epididymitis, hydroceles, and a scrotal hematoma. Sonography accurately distinguished between testicular and extratesticular masses in all cases in this series and pathologic correlations were obtained for all testicular masses. Simultaneous real-time contact scanning and palpation facilitated accurate diagnosis.
The clinical spectrum of neonatal endocarditis, including bacterial and nonbacterial types, is examined in five case reports that were drawn from nursery experiences over a recent 2-year period. In contrast to previous reports of 100% mortality from neonatal endocarditis, one patient survived. Changing heart murmur and hematuria were most frequently associated with bacterial and nonbacterial endocarditis in four of the five cases. Pulmonary hypertension, thrombocytopenia, and coagulopathy were also associated with nonbacterial endocarditis. Echocardiograms were performed on four of the patients; only one was suggestive of endocarditis. Staphylococcus aureus was isolated from both cases of bacterial endocarditis, including the single survivor. Thus, it is suggested that the initial antibiotic coverage of any neonate with the clinical syndrome of sepsis, hematuria, and a heart murmur include antistaphylococcal coverage for the possibility of bacterial endocarditis.
The automation of an isolated atria assay is described. Data acquisition, operation of the strip chart recorder, data reduction and manipulation and generation of notebook pages showing final EC50's, dose-ratios and local pA2's has been completely automated. The data are acquired via a SYM-1 (6502 CPU) 8-bit single board computer running an assembly language program stored on an EPROM chip. The data from a physiological recorder system are stored by the SYM-1 and, at the conclusion of the experiment, transmitted to a DEC MINC-11 microminicomputer running a sequence of programs in BASIC for the mathematical manipulation of the data and the automatic generation of lab notebook pages. The automated system totally eliminates hand transcription of data, manual plotting of curves and mathematical errors.
Two synthetic approaches were used to prepare, in chirally pure form, the beta-adrenoceptor antagonist 9-[[3-(tert-butylamino)-2-hydroxypropyl]oximino]fluorene (1a). One of these employed the oxazolidine (S)-6 generated from D-mannitol, while the other utilized (S)-[[(trifluoromethanesulfonyl)oxy]methyl]oxirane (4) as the chiral three-carbon fragment. This latter synthesis was designed to incorporate the amino function in the last step. In vitro, a beta 2 selectivity of only 2.2 was observed for 1a. The example, (S)-9-[[3-(tert-amylamino)-2-hydroxypropyl]oximino]fluorene (1b), was also prepared and found to be selective for the beta 1 receptor by a factor of 2.5. In contrast to other beta-adrenoceptor antagonists, the enantiomers of 1a exhibited no chiral preference; i.e., (S)-1a and (R)-1a possessed a similar order of beta-adrenoceptor antagonistic activity.
Severe hypertension is rarely seen in children, but there is increasing evidence that childhood may be an appropriate time to consider measures for the prevention of hypertension later in life. The normal range for blood pressure in children and the significance of an "elevated" blood pressure are discussed. Evidence is reviewed which indicates that heredity obesity, and sodium intake are important determinants of blood pressure. There is a role for the nutritionist in the management and the possible prevention of essential hypertension.
The exact mechanism of action of angiotensin converting enzyme (ACE) inhibitors in reducing blood pressure is not known, although inhibition of angiotensin II formation is the generally accepted mechanism. Experiments were performed in two models of experimental hypertension to determine whether or not inhibition of the pressor response to angiotensin I, 300 ng/kg i.v., would correlate with the antihypertensive response to single oral doses of N-[(S)-1-(ethoxycarbonyl)-3-phenylpropyl]-L-Ala-L-Pro (MK-421), a new ACE inhibitor. Captopril, given as a single oral dose, was studied in spontaneously hypertensive rats (SHR) for comparative purposes. In SHR, MK-421 at 0.1-3 mg/kg p.o. and captopril at 0.1-3 mg/kg p.o. were approximately equipotent with regard to inhibiting the pressor response to angiotensin I (relative potency=1.7; 95% C.I.=0.7-4.5). The magnitude of ACE inhibition and onset of action were similar with both agents, but MK-421 had a longer duration of action. The decrement in systolic pressure following each ACE inhibitor consisted of an initial decrease in blood pressure corresponding to the maximal inhibition of angiotensin I pressor response and a secondary fall in blood pressure which was evident 5-6 h after treatment. At this time, the inhibition of the pressor response to angiotensin I was minimal. Thus, the time course for blockade of angiotensin I and the blood pressure reduction did not correspond. The dose-response regression lines for the antihypertensive effect of each inhibitor, unlike those for ACE inhibition, were flat. The potency ratio computed on the basis of the maximum fall in blood pressure over 6 h revealed that MK-421 was 11.5 times (P less than 0.05) more potent thant captopril. In 2-kidney Grollman renal hypertensive rats (RHR), MK-421 at 0.3-10 mg/kg p.o. inhibited the pressor response to angiotensin I by 65-95%, but produced significant decrements in blood pressure only at 10 mg/kg p.o. The finding that MK-421 was more potent than captopril in lowering blood pressure in SHR, yet equally active in its ability to block angiotensin I pressor responses, suggests that a mechanism(s) other than inhibition of plasma ACE is involved in the decrease in blood pressure was not reduced. However, a higher dose which produced a similar degree of blockade was associated with a significant decrease in blood pressure.
The parent diacid (N-[(S)-1-carboxy-3-phenylpropyl]-L-Ala-L-Pro of MK-421 inhibited hog plasma angiotensin converting enzyme (ACE) by 50% (I50) at a concentration of 1.2 nM and was 17 times more potent than captopril. In vitro the I50 for MK-421, an ethyl ester, was 1200 nM because de-esterification did not occur. Similarly in the guinea-pig ileum, the diacid inhibitor and MK-421 potentiated the contractile effects of bradykinin at an AC50 of 77 pM and 18 nM, respectively. Inhibition of the pressor effects of angiotensin I by the diacid ACE inhibitor occurred at an ID50 of 8.2 micrograms/kg i.v. in rats and 6.4 micrograms/kg i.v. in dogs. Thus, the diacid was approximately 12 times more potent than captopril. The ID50 for MK-421 was 14 and 278 micrograms/kg i.v. in rats and dogs, respectively, because of differences in the rates of de-esterification. Oral ACE inhibitory activity was determined by blockade of the pressor effects of angiotensin I in conscious rats and dogs. In rats, but not in dogs, the diacid inhibitor was poorly absorbed, whereas MK-421 was well absorbed in both species. MK-421 inhibited the pressor effects of angiotensin I at 0.1 to 3.0 mg/kg p.o. for at least 6 hr in rats and dogs, and compared to captopril was 8.6 times more potent in rats and 4.6 times more potent in dogs. These data demonstrate that MK-421 and its parent diacid are potent, long-lasting orally active inhibitors of ACE. In addition, the low activity of MK-421 in vitro contrasts with its substantial in vivo activity, and supports the hypothesis that MK-421 is a prodrug that first must be de-esterified to permit full expression of its significant in vivo pharmacological activity.
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Much current attention focuses on the renin-angiotensin system in relation to mechanisms controlling blood pressure and renal function. Recent demonstrations (ref. 1, ref. 2 and refs therein) that angiotensin-converting enzyme inhibitors show promising clinical antihypertensive properties have been of particular interest. We now report on the design of a novel series of substituted N-carboxymethyl-dipeptides which are active in inhibiting angiotensin-converting enzyme at nanomolar levels. We suggest that these compounds are transition-state inhibitors and that extensions of this design to other metalloendopeptidases merit further study.
The erythropoietic effects in exhypoxic polycythemic mice of two endoperoxide and analogs were assessed and compared with PGE2. The 9 alpha, 11 alpha epoxymethano analog (U-44069) was found to be a much more potent erythropoietic stimulus than the 11 alpha, 9 alpha analog (U-46619) or PGE2.
The central antihypertensive properties of four gamma-aminobutyric acid (GABA) analogs were characterized in anesthetized cats with implanted intracerebroventricular cannulae. An intracerebroventricular infusion (icv) of muscimol, 0.1--0.5 microgram/min (total dose: 1--5 micrograms, icv), substantially reduced mean arterial pressure and slightly reduced heart rate. The compound was not hypotensive at 5 micrograms, iv (total dose) and only slightly hypotensive after an intracisternal injection (5 micrograms). Kojic amine (2-aminomethyl-5-hydroxy-4H-pyran-4-one) and baclofen were also hypotensive following an intracerebroventricular infusion, but they were less active than muscimol. GABA, at 15--150 micrograms/min, icv (total dose, 150--1500 micrograms, icv), was not hypotensive by itself and unlike muscimol its activity was not enhanced in cats pretreated with nipecotic acid, an uptake inhibitor of GABA. The ability of muscimol to interfere with baroreceptor reflexes was considered in experiments in which reflex vasoconstrictor (carotid occlusion) and reflex vasodilatation (acute elevation in mean arterial pressure with norepinephrine) was measured in the perfused hindlimb of cats previously prepared with intracerebroventricular cannulae. Muscimol significantly attenuated the response to bilateral carotid occlusion and completely abolished reflex vasodilatation. The results suggest that GABA agonists and analogs may regulate blood pressure centrally and, through an interaction with the central nervous system, may attenuate baroreceptor reflexes.
The effect of albuterol, a potent beta2-adrenergic agonist, on kidney production of erythropoietin (Ep) was studied. Its effects on erythroid colony (CFU-E) formation in vitro in rabbit bone marrow cultures were also assessed. Albuterol produced a significant increase in plasma Ep levels in conscious rabbits following 7 h intravenous infusion (50 (microgram/kg)/min). This effect was blocked by pretreatment of the rabbits with butoxamine (5 mg/kg ip), a potent beta2-adrenergic blocker. Albuterol in doses of 10(-10) to 10(-8) M in combination with Ep was also found to produce a significant increase in the numbers of CFU-E in the plasma clot culture system of rabbit bone marrow. This effect was blocked completely by DL-propranolol (10(-8) M) and by butoxamine (10(-8) M). The data presented suggest that albuterol, a potent activator of beta2-adrenergic receptors, increases kidney production of Ep in vivo and also produces a direct effect in combination with Ep on the proliferation of the erythroid progenitor cell compartment.
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Our hypothesis is that PGs released within the kidney play a role in the modulation of kidney production of Ep. PGs release probably at medullary and/or cortical sites following erythropoietic stimuli such as hypoxic hypoxia, anemic hypoxia, and ischemic hypoxia induced by renal artery constriction increase kidney production of Ep. PGs which are released probably activate a renal cortical adenylate cyclase thereby enhancing the production of intracellular cAMP. This initiates the cascade of events resulting in the production and/or secretion of Ep by the kidney. The endoperoxide analogs and PGE2 have been found to produce a dose-related and Ep-dependent increase in radioiron incorporation into newly formed red blood cells of exhypoxic polycythemic mice. Indomethacin, a potent PG cyclo-oxygenase inhibitior, attenuates Ep production and the appearance of PGE in the renal venous effluent of animals exposed to hypoxic hypoxia and renal artery constriction. Arachidonic acid (C20:4) and PGE2 infusion into the posthypoxic isolated perfused dog kidney produced a significant elevation in Ep titers in the perfusate. The increase in Ep production caused by arachidonate is blocked by indomethacin. It has been previously reported that PGs of the E series stimulate cAMP formation in several tissues. We have found that not only are renal cortical cAMP levels significantly elevated in rats following exposure to hypobaric hypoxia but that dibutyryl cAMP administration produces an increase in hematocrit and circulating red cell mass in normal mice. Our data thus far strongly support the hypothesis that the renal PGs and the cyclic nucleotides are intimately involved in the pharmacologic and/or pathophysiologic control of Ep production. Further work is necessary to determine whether the PGs and cyclic nucleotides are involved in the day-to-day control of Ep production by the mammalian kidney.
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