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H Refsum

Publications and source records attributed to H Refsum.

At least 163 records · Page 9Linked to original sources
PubMed1991

[Antiarrhythmic agents. Receptor hypothesis explains mechanisms of action].

Antiarrhythmic drugs are usually classified according to Vaughan Williams' classification I-IV. Class I includes the membrane stabilizers, class II includes the beta-blockers, drugs in class III lengthen the cardiac action potential and refractory period and class IV includes the calcium blockers. The effect of most antiarrhythmic drugs changes with heart rate and the level of myocardial depolarization, and these changes in effect can be explained by the modulated receptor hypothesis. Most class I antiarrhythmic drugs have greatest antiarrhythmic effect during periods of fast heart rate and in depolarized ischemic myocardium, and this might be attributed to greater affinity of the drugs for open or inactivated sodium channels. Most class III antiarrhythmic drugs have greatest effect during periods of slow heart rates, which may be attributed to greater affinity for closed potassium channels.

Anti-Arrhythmia Agents↗
PubMed1991

[Determination of homocysteine and methylmalonic acid in cobalamin deficiency. Diagnostic problem with a solution?].

Conditions with cobalamin deficiency are common and may represent a considerable diagnostic challenge. This deficiency state may result in a wide range of uncharacteristic symptoms, and the traditional laboratory assays may give inconclusive or even misleading results. This article briefly reviews the biochemistry, normal homeostasis, pathology, symptoms and signs resulting from cobalamin deficiency. Homocysteine and methylmalonyl-CoA are substrates in the two cobalamin-dependent pathways. Recent research suggests that measurements of homocysteine and methylmalonic acid in blood may constitute a simple, sensitive, and specific tool in the diagnosis and follow-up of the cobalamin-deficient patient.

Homocysteine↗
PubMed1991

Plasma homocysteine in children with acute lymphoblastic leukemia: changes during a chemotherapeutic regimen including methotrexate.

Plasma homocysteine was determined in 12 children with acute lymphoblastic leukemia. The patients were investigated prior to chemotherapy (stage I), during seven weeks of induction chemotherapy (stage II), and thereafter during intermittent high-dose methotrexate (HD-MTX) therapy (stage III). The patients were followed for a period of three to 15 months, and the study included a total of 80 HD-MTX courses. Before start of chemotherapy (stage I), the average plasma homocysteine level in the children with leukemia was 13.18 +/- 6.23 (SD) mumol/liter, which is significantly (P less than 0.001) higher than the level in control children (6.52 +/- 1.21 mumol/liter). The plasma homocysteine level in the patients was positively correlated with the peripheral white blood cell count (P less than 0.01) and negatively correlated with serum folate (P less than 0.02). The serum folate was normal or subnormal in these patients. During induction therapy with cytotoxic drugs such as vincristine, asparaginase, and intrathecal MTX (stage II), there was a drastic change in plasma homocysteine as a function of time. A reciprocal alteration in serum folate was observed, suggesting fluctuating intracellular folate status at this stage of therapy. At the end of stage II (about seven weeks), there was a significant (P less than 0.01) reduction in total homocysteine (to 7.08 +/- 3.84 mumol/liter). HD-MTX (8 g/m2) therapy with 5-formyltetrahydrofolate "rescue" (stage III) was usually begun about seven weeks after start of chemotherapy, and the patients were followed for two to eight courses separated by three to eight weeks. Plasma homocysteine showed a transient increase (26-64%) following each MTX infusion. After three MTX infusions, basal total plasma homocysteine was reduced to 5.56 +/- 1.12 mumol/liter. During most MTX infusions, there was a variable reduction (17-56%) in plasma methionine followed by a rebound increase. It is concluded that plasma homocysteine in children with acute lymphoblastic leukemia is elevated prior to therapy, probably because of occasional folate deficiency and increased burden of proliferating cells. During induction therapy, monitoring plasma homocysteine and serum folate both suggest a labile folate homeostasis, usually a deficiency state. HD-MTX induced a temporary intracellular folate depletion before 5-formyl-tetrahydrofolate was administered, as judged by a transient homocysteinemia. The methionine depletion may interfere with the antileukemic effect of MTX.

Adolescent↗
PubMed1991

Homocysteine export from cells cultured in the presence of physiological or superfluous levels of methionine: methionine loading of non-transformed, transformed, proliferating, and quiescent cells in culture.

Determination of the transient increase in plasma homocysteine following administration of excess methionine is an established procedure for the diagnosis of defects in homocysteine metabolism in patients. This so-called methionine loading test has been used for 25 years, but the knowledge of the response of various cell types to excess methionine is limited. In the present paper we investigated homocysteine export from various cell types cultured in the presence of increasing concentrations (15-1,000 microM) of methionine. For comparison of homocysteine export, the export rates per million cells were plotted versus cell density for proliferating cells, and versus time for quiescent cells. The homocysteine export from growing cells was greatest during early to mid-exponential growth phase, and then decreased as a function of cell density. The export rate was higher from phytohemagglutinin-stimulated than non-stimulated lymphocytes, and higher from proliferating than from quiescent fibroblasts. The hepatocytes showed highest export rate among the cell types investigated. The enhancement of homocysteine export by excess methionine ranged from no stimulation to marked enhancement, depending on cell type investigated, and three different response patterns could be distinguished: 1) quiescent fibroblasts and growing murine lymphoma cell showed no significant increase in homocysteine export following methionine loading; export from human lymphocytes was only slightly enhanced in the presence of excess methionine; 2) the homocysteine export from proliferating hepatoma cells and benign and transformed fibroblasts was stimulated three to eightfold by increasing the methionine concentration in the medium from 15 to 1,000 microM; and 3) the response to methionine loading was particularly increased (about 15-fold) in non-transformed primary hepatocytes in stationary culture. The results outline a potentially useful procedure for the comparison of homocysteine export during cell growth in the presence of various concentrations of methionine. The results are discussed in relation to the special feature of homocysteine metabolism in various cell types and tissues including liver, and to the possible source of plasma homocysteine following methionine loading in vivo.

Animals↗
PubMed1991

Class III antiarrhythmic action of d-sotalol during hypothermia.

To investigate whether changes in temperature influence the electrophysiologic effects of the class III antiarrhythmic agent d-sotalol, we studied its effects on propranolol-pretreated guinea pig papillary muscles at temperatures ranging from 37 degrees to 27 degrees C by means of conventional microelectrode techniques. We also examined the rate-dependent effect of d-sotalol at 37 degrees and 27 degrees C. Before the addition of d-sotalol, reducing the temperature from 37 degrees to 27 degrees C increased the action potential duration recorded at 50% repolarization (APD50) from 112 +/- 7 msec to 271 +/- 15 msec and action potential duration recorded at 90% repolarization (APD90) from 136 +/- 7 msec to 325 +/- 10 msec. d-Sotalol (50 mumol/L) lengthened APD50 and APD90 to a greater degree at low temperatures. Thus at 37 degrees C d-sotalol lengthened APD50 and APD90 by 12 +/- 6 msec and 19 +/- 5 msec, and at 27 degrees C by 37 +/- 5 msec and 52 +/- 7 msec, respectively. d-Sotalol produced its greatest effect on APD at long pacing cycle lengths, thus demonstrating reverse dependence. This rate-dependent effect was more marked at 27 degrees C than at 37 degrees C. The greater effect of d-sotalol on APD at long pacing cycle lengths may be explained by the modulated receptor hypothesis, assuming that the drug has a higher affinity for closed potassium channels. Such a mechanism may also explain the accentuated class III antiarrhythmic action of d-sotalol observed during hypothermia.

Action Potentials↗
PubMed1991

Homocysteine levels in patients with rheumatoid arthritis treated with low-dose methotrexate.

Plasma homocysteine levels were determined in patients who participated in a randomized, double-blind placebo-controlled trial of folate supplementation (1 mg/day) during methotrexate therapy for rheumatoid arthritis. Plasma and red blood cell folate levels before methotrexate therapy were significantly negatively correlated with homocysteine levels. Homocysteine levels were not significantly correlated with the initial C1 index (an assay that measures the folate status of blood mononuclear cells) or the C1 index during methotrexate therapy. There was no significant difference in homocysteine levels between pretreatment and levels drawn at 3 or 6 months. Initial homocysteine levels were predictive of toxicities, such as gastrointestinal intolerance and elevations of liver enzymes in the placebo group. There was no significant correlation between occurrence of toxicity and initial homocysteine levels in the folic acid-supplemented group. Homocysteine levels were not predictive of the efficacy of methotrexate therapy. We conclude that plasma homocysteine levels are correlated with plasma and red blood cell folate levels before methotrexate therapy but is not correlated with folate status in blood mononuclear cells.

Arthritis, Rheumatoid↗
PubMed1991

Monitoring cobalamin inactivation during nitrous oxide anesthesia by determination of homocysteine and folate in plasma and urine.

The effects of nitrous oxide-induced cobalamin inactivation on homocysteine and folate metabolism have been investigated. Plasma levels of cobalamin, folate, homocysteine, and methionine were determined in 40 patients before and after operation under nitrous oxide anesthesia (range of exposure time, 70 to 720 minutes). Twelve patients anesthetized with total intravenous anesthesia served as control subjects (range of exposure time, 115 to 600 minutes). Postoperative plasma levels of folate and homocysteine increased (p less than 0.001) up to 220% and 310%, respectively, in nitrous oxide-exposed patients, whereas plasma levels of methionine decreased (p less than 0.025). Response occurred after 75 minutes of nitrous oxide exposure. The percentage increase of plasma folate and homocysteine correlated significantly with exposure time (p less than 0.025 and p less than 0.0001, respectively). In eight patients receiving nitrous oxide anesthesia plasma homocysteine levels had not returned to preoperative levels within 1 week (p less than 0.01). Urinary excretion of folate and homocysteine increased during and after nitrous oxide exposure (p less than 0.01 and p less than 0.002, respectively) and correlated with exposure time (p less than 0.01 and p less than 0.005, respectively). It can be concluded that disturbance of homocysteine and folate metabolism by nitrous oxide develops with little delay and return to normal levels requires several days. Elevation of plasma homocysteine levels may therefore be used for monitoring nitrous oxide-induced cobalamin inactivation.

Adult↗
PubMed1991

Left and right ventricular diastolic function during acute pericardial tamponade.

The aim of the study was to determine the effect of acute pericardial tamponade on left (LV) and right ventricular (RV) intracavitary and transmural pressure-volume (P-V) relations and to assess the effect of changing blood volume during tamponade on LV and RV volumes. The experiments were done in 11 acutely instrumented anaesthetized dogs in which LV and RV volumes were determined by computed tomography (CT) (n = 5) and LV and RV diameters by sonomicrometry (n = 6). Pressures were measured in the pericardium (balloon transducer), in the aorta and in the ventricles. Incremental pericardial infusion (up to 180 ml) caused a progressive left and upward shift of the LV and the RV intracavitary P-V relationship. This shift was entirely due to increased pericardial pressure (PP). The induction of tamponade caused no change in the LV and RV transmural P-V relationship. During tamponade with ventricular filling pressures above 10-15 mmHg, blood volume expansion caused only minimal increase in LV and RV volumes. In conclusion, pericardial tamponade shifted the LV and the RV intracavitary diastolic P-V relation by increasing PP. However, there was no change in the transmural P-V relationship, indicating unchanged myocardial compliance. Volume loading caused only minimal increase in LV and RV volumes during tamponade.

Animals↗
PubMed1991

Negative chronotropic effect of a novel class III antiarrhythmic drug, UK-68,798, devoid of beta-blocking action on isolated guinea-pig atria.

1. The chronotropic effects of a novel class III antiarrhythmic drug, UK-68,798, and the beta-adrenoceptor blocker, propranolol, for comparison, were studied on spontaneously beating right atria isolated from guinea-pigs in the absence and presence of increasing concentrations of isoprenaline (10(-10)-10(-4) M). 2. UK-68,798 (10(-9)-10(-5) M) decreased spontaneous atrial rate by 6-21%. Propranolol (10(-8) -10(-6) M) also had a negative but significantly smaller chronotropic effect. 3. UK-68,798 dose-dependently reduced the maximal positive chronotropic effect induced by isoprenaline, but without significantly shifting the concentration-response curve for isoprenaline in a parallel fashion. A pD'2 value of 5.88 was obtained. As expected, propranolol displayed a competitive inhibition with a pA2 value of 8.21. 4. The results demonstrate a negative chronotropic effect of UK-68,798, which is not associated with a beta-adrenoceptor blocking action. We suggest that the negative chronotropic effect is linked with potassium channel blockade and thereby the class III antiarrhythmic action of UK-68,798.

Adrenergic beta-Antagonists↗
PubMed1991

Rate-dependent differences in dog epi- and endocardial monophasic action potential configuration in vivo.

A transient outward current (Ito), long considered to be a unique feature of Purkinje fiber tissue, has recently been demonstrated in dog ventricular tissue in vitro and most prominently in the epicardium. To investigate its possible contribution to ventricular repolarization in vivo, we recorded right ventricular endocardial and epicardial monophasic action potentials (MAP) simultaneously in pentobarbital-anesthetized open-chest dogs. Epicardial MAP had lower phase 1 than phase 2 amplitude at both spontaneous heart rate and paced cycle length of 300 and 400 ms. This "spike-and-dome" morphology of the epicardial MAP, possibly attributable to Ito, progressively disappeared at shorter extrastimulus intervals. In endocardium the phase 1 amplitude was always higher or equal to phase 2 amplitude and was not affected by shorter extrastimulus intervals. The action potential duration (APD) was shorter in epicardium than in endocardium. Both endocardial and epicardial APD shortened as the premature intervals were reduced, but the shortening was not parallel. The restitution curves converged so that, at the shortest intervals (160 ms), there were no longer any significant differences in APD between endocardium and epicardium. This study indicates that Ito contributes to ventricular repolarization in vivo, and most prominently in the epicardium. Unequal shortening of APD between endocardium and epicardium after progressively shorter diastolic intervals may thus partly result from uneven distribution of Ito across the ventricular wall.

Action Potentials↗
PubMed1991

An experimental model for the study of transcapillary fluid balance in hypothermia.

Disturbed fluid balance is a significant clinical problem in hypothermia and rewarming. We have therefore investigated whether the transcapillary fluid balance in rats exposed to hypothermia and rewarming could be studied with the use of a wick method. Double nylon wicks were sewn into the abdominal skin and left there for one hour, then removed to double-bottomed conic vials and centrifuged. Wick fluid was collected and colloid osmotic pressure measured. Blood samples were taken simultaneously for measurement of hematocrit, hemoglobin, red cell count and plasma colloid osmotic pressure. This was done at 37 degrees C (prehypothermic), 13 degrees C (hypothermic) and at 30 degrees C (during rewarming). Blood pressure was also recorded. The model provides a good method to investigate the colloid osmotic changes of both plasma and interstitium during hypothermic situations.

Animals↗
PubMed1991

Hemodynamic and metabolic effects of hypothermia and rewarming.

There is a lack of detailed knowledge of the pathophysiologic mechanisms initiated during and after rewarming. To study cardiac function after rewarming from hypothermia sodium pentobarbital anesthetized open chest-dogs were cooled to 25 degrees C and rewarmed. Myocardial blood flow was measured at different temperatures, and blood samples were drawn from the aorta and the coronary sinus for metabolic measurements. Mean aortic blood pressure (AOP) and aortic blood flow were recorded. Compared to precooling, AOP and heart rate were both significantly reduced during hypothermia. During rewarming stroke volume (SV) decreased significantly. At the end of rewarming AOP and SV were significantly lower than before cooling and myocardial blood flow, as well as oxygen and lactate uptake were only 50% of precooling levels. The present study demonstrated that hypothermia and rewarming depress cardiovascular function. Changes in peripheral vascular function, myocardial metabolism and contractility, may lead to the observed reduction in recovery upon rewarming.

Animals↗
PubMed1991

Cardiac electrophysiology during hypothermia. Implications for medical treatment.

Reduction in body temperature induces characteristic electrophysiological and mechanical alterations of the heart. The heart rate is markedly reduced. Myocardial conduction is slowed, partly due to reduced rate of depolarization of the action potential, and is reflected by widening of the QRS-complex in the ECG. There is also a fall in resting membrane potential. Action potential duration and refractory period are markedly lengthened during hypothermia, attributed to delayed repolarization. This is reflected by increased QT-time in the ECG. Since action potential duration changes significantly even after as small temperature changes as 1 to 2 degrees C, nonuniform cooling or rewarming of the heart may cause significant dispersion of conduction, action potential duration and refractoriness in the myocardium. This dispersion may cause unidirectional block, hence creating a substrate for reentry atrial and ventricular arrhythmias, and may be an important mechanism for explaining the hypothermia-associated arrhythmias. Class III antiarrhythmic drugs such as d-sotalol lengthen long action potentials at low temperatures to a greater extent than the shorter action potentials at higher temperatures. This may further increase dispersion and thereby the tendency towards arrhythmias. Sotalol as an example, shows that some antiarrhythmic drugs may have increased arrhythmogenic effect and should probably be contraindicated during hypothermia.

Electrocardiography↗
PubMed1991

Interaction between methotrexate, "rescue" agents and cell proliferation as modulators of homocysteine export from cells in culture.

Clinical studies on cancer and psoriasis patients have shown that plasma and urinary homocysteine (Hcy) responds to methotrexate (MTX) therapy, indicating that Hcy in extracellular fluids may be an indicator of the antifolate effect. However, the clinical data indicate that the burden of proliferating cells, cytotoxicity and the folate status are also determinants of extracellular Hcy. To evaluate this further, we investigated the modulation of cellular Hcy egress by MTX, rescue agents, cell proliferation and cytotoxicity. Nontransformed and chemically transformed fibroblasts and murine lymphoma cells, which are characterized by different growth behavior and MTX response, were used. The Hcy export rate was correlated positively with the proliferation rate in all cell types. 5-Formyltetrahydrofolate or 5-methyltetrahydrofolate added to fibroblasts not exposed to MTX reduced the Hcy export rate, whereas the export from the lymphoma cells was not affected. All cells types exposed to MTX were rescued by thymidine + hypoxanthine, and this allowed the assessment of Hcy export during MTX exposure without interference from cytotoxicity. In the fibroblasts, MTX with thymidine + hypoxanthine rescue induced a marked increase in Hcy export, and the dose-response paralleled the cytotoxicity curves obtained for MTX without rescue. Nontoxic concentrations of MTX without rescue enhanced the Hcy export. When MTX concentration was increased further, Hcy export was stimulated initially, and then declined rapidly as cell death ensued. MTX did not enhance the Hcy export from the lymphoma cells and, in the absence of rescue, the Hcy export from these cells declined in proportion to inhibition of cell growth.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Sodium addition to nonionic contrast media. Effects on cardiac monophasic action potentials and hemodynamics in a dog model.

In order to study the electrophysiologic and hemodynamic effects of sodium addition to low-osmolality contrast media during coronary arteriography, eight dogs with surgically opened thoraces were studied. Epicardial monophasic action potentials (MAP) were recorded from the contrast perfused area, using suction electrodes. Six milliliters of iohexol, iohexol with addition of 20 to 80 mmol/L Na+ and ioxaglate, were selectively administered into the left coronary artery. Only minor hemodynamic alterations occurred with the iohexol solutions, whereas ioxaglate decreased left ventricular (LV) inotropy and pressures initially. Iohexol and iohexol containing less than 40 mmol/L Na+ did not change MAP duration significantly. The addition of 80 mmol/L Na+ to iohexol lengthened MAP duration at 25%, 50%, and 90% repolarization by 14 +/- 2, 18 +/- 3, and 18 +/- 5 mseconds, respectively. Ioxaglate lengthened MAP duration by 14 +/- 3, 17 +/- 3, and 26 +/- 8 mseconds, respectively. Thus, during coronary arteriography in dogs, iohexol with sodium added, like ioxaglate, induced regional electrophysiologic changes in the contrast-perfused area of the myocardium, while sodium-free iohexol did not.

Action Potentials↗
PubMed1991

Left ventricular systolic and diastolic function during coronary arteriography before and after acute left ventricular failure in dogs. A comparison between iodixanol, iohexol and ioxaglate.

The hemodynamic side effects of intracoronary injection of low osmolality contrast media were studied in anesthetised dogs, both with and without left ventricular (LV) failure. LV failure was induced by microembolization of the area supplied by the left main coronary artery. LV pressure and volume, aortic pressure, and cardiac output were recorded. 6 ml iodixanol 320 mg I/ml containing 20 mmol Na+/l, a new non-ionic dimer, was compared to iohexol and ioxaglate. Iodixanol induced small systolic alterations both before and after LV failure. Iohexol increased LV inotropy while ioxaglate depressed myocardial function. Before failure iodixanol and ioxaglate impaired isovolumic relaxation, but early diastolic filling was not reduced. After failure the relaxation process was not affected, but ioxaglate reduced early diastolic filling. Ioxaglate also increased LV end-diastolic pressure and volume more than the non-ionic contrast media. In conclusion, iodixanol induced only small changes in systolic and diastolic function. Iodixanol should therefore be hemodynamically well tolerated during coronary arteriography, and also in acute ischemic heart failure.

Acute Disease↗
PubMed1990

[Do calcium antagonists protect the heart?].

There are several well-documented mechanisms by which calcium antagonists might reduce the size of an infarct and the complications that may result from it. They can improve flow, reduce demand, prevent calcium-induced damage and have an antiarrhythmic effect. In a large number of animal studies calcium antagonists have been shown to be cardioprotective, and some clinical trials have yielded encouraging results. These trials must be interpreted with some caution, however, since the relationship between various measures of infarct size, such as ECG changes and enzyme release, the amount of myocardial damage and the prognosis, may not be close. Furthermore, some trials yielded a negative result and further data are needed, based on large-scale double-blind controlled trials. Nevertheless, taken overall, the evidence suggests that calcium antagonists may play a cardio-protective role, and interest in this subject is certain to continue, and will probably increase.

Animals↗