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Biomedical subjects

J R Higgins

Publications and source records attributed to J R Higgins.

At least 55 records · Page 3Linked to original sources
PubMed1986

Automatic burst extrastimulus pacemaker to treat recurrent ventricular tachycardia in a patient with mitral valve prolapse: more than 2,000 documented successful tachycardia terminations.

An automatic burst pacemaker (Cybertach-60) was used to treat drug-resistant recurrent ventricular tachycardia in a patient with mitral valve prolapse. The arrhythmia was associated with multiple syncopal episodes and aborted sudden death. During a 23 month follow-up period the patient has remained asymptomatic and more than 2,000 episodes of ventricular tachycardia have been successfully terminated by the pacemaker.

Adult↗
PubMed1986

Detection and differentiation by sandwich enzyme-linked immunosorbent assay of human T-cell lymphotropic virus type III/lymphadenopathy-associated virus- and acquired immunodeficiency syndrome-associated retroviruslike clinical isolates.

Monoclonal antibodies can be used in sandwich enzyme-linked immunosorbent assays to measure viral antigens. Such an assay was developed to detect the core protein, p24, of human T-cell lymphotropic virus type III and lymphadenopathy-associated virus, etiologic agents of the acquired immunodeficiency syndrome (AIDS). Another AIDS-associated virus, AIDS-associated retrovirus type 2 (ARV-2) could not be detected in this assay because of the low affinity of one of the monoclonal antibodies to ARV-2 p24. Detection of ARV-2 was accomplished with a monoclonal antibody-rabbit polyclonal antibody sandwich enzyme-linked immunosorbent assay. These two assays were used to efficiently detect AIDS-related viruses in lymphocyte cell cultures and to distinguish strains of the viruses.

AIDS-Related Complex↗
PubMed1985

Automatic scanning extrastimulus pacemaker to treat ventricular tachycardia.

Many investigators have reported the use of various permanent pacemaking modes in the long-term management of patients with recurrent ventricular tachycardia. The three general types of antitachycardic pacemakers are: (1) underdrive; (2) burst; and (3) scanning pacemakers. Such devices have been activated externally or have had automatic activation. Each antitachycardic pacemaking modality has known technical and physiologic limitations. A serious limitation of dual-demand underdrive pacemakers is that they are usually successful only for tachycardias with a rate below 160 bpm because a random stimulus is needed for conversion. Therefore, this modality is seldom useful in patients with symptomatic sustained ventricular tachycardia in which rates are generally greater than 160 bpm and/or hemodynamic compromise occurs rapidly. Although others have reported the successful use of burst pacemakers in the control of ventricular tachycardia, this technique may cause acceleration of ventricular tachycardia and induction of ventricular fibrillation. Programmable automatic scanning pacemakers have been used successfully to treat paroxysmal supraventricular tachycardia and have been used recently in combination with antiarrhythmic agents to control ventricular tachycardia. This report outlines the use of an automatic scanning pacemaker alone for the treatment of symptomatic ventricular tachycardia in a patient who was unable to tolerate conventional antiarrhythmic medications.

Adult↗
PubMed1982

Constrictive pericarditis: techniques for differential diagnosis.

Although the incidence of constrictive pericarditis is low, the increasing number of patients receiving chronic dialysis, aggressive radiotherapy, or cardiovascular surgery has caused an increase in the iatrogenic incidence. The most common symptoms are dyspnea, fatigue, weight gain, peripheral edema, and abdominal swelling and discomfort. They may be present for years before the diagnosis is made. Physical examination, x-ray studies, electrocardiography, echocardiography, cardiac catheterization, and angiography are all helpful in the differential diagnosis. Pericardiectomy, the only treatment, has a success rate of up to 90%. Untreated, the condition progresses to an incapacitating state.

Angiography↗
PubMed1979

Antihypertensive effect of progesterone in rats with mineralocorticoid-induced hypertension.

Uninephrectomized, saline-fed male Sprague-Dawley rats were given DOCA 5 mg per week alone or together with progesterone 20 mg per week for 6 weeks (phase I). Subsequently, the doses of DOCA and progesterone were doubled and the rats were studied for an additional 6 wk (phase II). Progesterone prevented DOCA-induced hypertension during phase I. Phase II blood pressures were higher in DOCA-progesterone-treated animals than in controls, but remained lower than in animals treated with DOCA alone. At the end of phase II the animals were killed, and blood samples and skeletal muscle samples were taken for analysis of electrolyte content. DOCA-treated animals were found to have an increased rate of potassium excretion, an increase in muscle sodium concentration, and a decrease in muscle potassium concentration compared to the controls. Progesterone treatment significantly blunted the DOCA-induced changes in muscle electrolyte concentrations and increased the rate of sodium excretion. No hypotensive effect was observed when progesterone in doses similar to those of phase I was administered to spontaneously hypertensive rats. Thus, in experimental mineralocorticoid hypertension, the hypotensive effect of progesterone appears to correlate closely with its mineralocorticoid antagonistic properties.

Animals↗
PubMed1979

Interaction of synthetic progestagens with renal mineralocorticoid receptors.

Progesterone increases urinary sodium excretion at least in part by competition for renal mineralocorticoid receptors. In contrast, synthetic progestagens do not increase sodium excretion or even cause a slight sodium retention. We therefore compared the ability of progesterone and 12 progesterone like compounds to displace [3H]aldosterone from binding at cytoplasmic mineralocorticoid receptors in rat kidney. All synthetic progesteronelike steroids were less active than progesterone in competing with [3H]aldosterone for the receptor binding: progesterone 100%, 11 beta-OH progesterone 50%, 17 alpha OH-progesterone 24% and 16 alpha-methyl-progesterone 3%. Derivates of 17 alpha OH-progesterone (medrogestone 5%, dydrogestone 4%, medroxy progesterone-acetate 2% and chlormadinone-acetate 0.5%) were more potent than 19-nor-testosterone derivates: ethisterone 1%, norethisterone less than 1%, norethindrone less than 1%, norethyl-nodrel less than 1%, and ethynodiol-diacetate less than 1%. The decreased affinity of synthetic progestins for mineralocorticoid receptors explains in part the lack of natriuretic activity of these compounds.

Aldosterone↗
PubMed1978

Plasma aldosterone response to ACTH in primary aldosteronism and in patients with low renin hypertension.

ACTH alpha 1-24 was infused at incremental rates of 12.5-200 mIU/30 min in dexamethasone-suppressed hypertensive patients on a regular sodium diet. The plasma aldosterone response to this stimulus in 8 patients with hyperaldosteronism due to an adrenal aldenoma and 11 with adrenal hyperplasia was significantly greater at all infusion rates (P less than 0.05) when compared with the response in 6 normal subjects on a similar diet. This responsiveness to ACTH in the patients with primary hyperaldosteronism was similar to that of the normal subjects on a low sodium diet. Twelve patients with low renin and 6 patients with normal renin essential hypertension were similarly studied. There was no significant difference in the median aldosterone response between these 2 groups and the normal subjects on a normal diet, but the response was significantly lower compared with that in patients with primary hyperaldosteronism. These data show that patients with hyperaldosteronism from an adrenal adenoma or hyperplasia have a consistent and exaggerated response to ACTH. The hyper-responsiveness is not apparently shared by the majority of patients with low renin essential hypertension and does not support the concept that this group is an intermediate form of primary aldosteronism. Individual patients within this group, however, may have such a response and might be identified by this type of testing.

Adenoma↗
PubMed1977

Interaction of 16beta-hydroxydehydroepiandrosterone with renal mineralocorticoid receptors.

A previously unidentified mineralocorticoid, 16beta-hydroxydehydroepiandrosterone (16beta OH-DHEA) has recently been isolated from urine extracts of patients with low-renin hypertension and reported to possess one-fortieth the mineralocorticoid potency of aldosterone by bioassay. However, using a radioreceptor assay, we demonstrate the affinity of 16beta-OH-DHEA for renal 3H-aldosterone receptors to be only 0.011 per cent that of unlabeled aldosterone. 16beta-OH-DHEA therefore would not be expected to possess significant mineralocorticoid properties unless its mechanism of action involves binding to a unique class of renal receptors. Until these discrepancies between bioassayable mineralocorticoid activity and affinity for mineralocorticoid receptors can be resolved, the role of 16beta-OH-DHEA in the pathogenesis of low-renin hypertension remains speculative.

Aldosterone↗
PubMed1976

Circadian rhythms of serum renin activity and serum corticosterone, prolactin, and aldosterone concentrations in the male rat on normal and low-sodium diets.

To investigate the control of aldosterone secretion, non-stress levels of serum aldosterone, corticosterone, and prolactin, and renin activity were determined at 4-h intervals during 24-h light-dark cycles in adult male rats on regular and low-sodium diets. Circadian rhythms of plasma aldosterone, prolactin, and corticosterone concentrations and of serum renin activity were demonstrated during a regular sodium diet. When the rats were on a low-sodium diet, a circadian rhythm of serum corticosterone and aldosterone concentration was observed, but there was no circadian variation in serum renin activity or in serum prolactin concentration. Serum aldosterone concentration correlated with serum corticosterone concentration (r = 0.48) and serum renin activity (r = 0.36) during a low-sodium diet. Serum prolactin concentration did not correlate with serum aldosterone concentration or serum osmolality. These data are compatible with a role for renin and ACTH, but not for prolactin, in the modulation of aldosterone secretion in the rat.

Aldosterone↗
PubMed1976

Mineralocorticoid activity of 16beta-hydroxydehydroepiandrosterone and related steroids.

16beta-Hydroxydehydroepiandrosterone (16beta-OH-DHEA) and related C19-steroids have recently been reported to be etiologic in low-renin essential hypertension. The mineralocorticoid potency of 16beta-OH-DHEA and several C19-steroids (16-oxo-A-diol, 16-oxo-testosterone, 16beta-OH-epiandrosterone, 5-androstene-3beta, 16beta,17beta-triol, 19beta-OH-testosterone, 18-OH-DHEA, and 16alpha-OH-DHEA) were investigated in two different rat bioassay systems under a variety of experimental conditions. In all but one instance, only negligible mineralocorticoid activity was observed, usually less than 0.1 per cent that of aldosterone. Since 16beta-OH-DHEA has negligible mineralocorticoid activity in the rat bioassay and the toad bladder assay (as reported by others), does not cause hypertension when injected chronically into the rat, and does not displace aldosterone from its renal receptors, it appears unlikely to be etiologic in low-renin essential hypertension. On the other hand, when 16-oxo-testosterone was injected intraperitoneally instead of subcutaneously, it demonstrated a slight increase in mineralocorticoid activity (from less than 0.1 per cent to 0.2 per cent) which equaled that of 18-hydroxydeoxycorticosterone (18-OH-DOC) injected subcutaneously. Thus, the possibility remains that 16-oxo-testosterone or a closely related metabolite may have sufficient mineralocorticoid activity to be involved in certain forms of hypertension in man.

Animals↗
PubMed1976

The role of ACTH in the episodic release of aldosterone in patients with idiopathic adrenal hyperplasia, hypertension, and hyperaldosteronism.

The relationship of plasma aldosterone concentration to its identified stimuli was examined in three patients with hypertension, hyperaldosteronism, and idiopathic adrenal hyperplasia. Four patients with hyperaldosteronism due to adrenal adenomas served as controls. Plasma aldosterone, cortisol, sodium, and potassium concentrations and renin activity were measured in blood samples taken at 20 minute intervals from 2 A.M. to 8 A.M. during recumbency and sleep. The tests were performed on all patients following a regular sodium diet both before and after short-term treatment with dexamethasone. Two of the three subjects with adrenal hyperplasia were re-examined after 2 weeks of dexamethasone therapy. All four control patients with adenomas had episodic increases of plasma aldosterone which were significantly correlated with those of plasma cortisol (r = +0.48 to +0.90). This confirms the previously reported relationship between aldosterone and ACTH in such patients. Two patients with idiopathic adrenal hyperplasia had a similar secretion pattern and a highly significant correlation of the two hormones (r = +0.76 and +0.77); one did not (r = 0.13). Short-term dexamethasone pretreatment attenuated the episodic release pattern and partially suppressed the mean plasma concentrations of aldosterone in the four patients with an adenoma and in the two patients with idiopathic hyperplasia whose plasma aldosterone and cortisol concentrations were positively correlated. There was no such effect in the third patient. The first two patients with idiopathic hyperplasia were subsequently retested following 2 weeks of dexamethasone treatment to determine if the episodic secretion pattern of plasma aldosterone would correlated with other stimuli following this period of ACTH suppression. One showed little change from the pattern observed after short-term glucocorticoid treatment. The second had a similarly blunted aldosterone response until ACTH secretion led to a resumption of episodic changes in plasma aldosteerone concentrations. These data indicate that ACTH frequently is the dominant stimulus of the episodic secretion of aldosterone in patients with either adrenal adenomas or hyperplasia. When ACTH is suppressed, the hypersecretion of aldosterone is presumably sustained by an intrinsic adrenal abnormality or by an as yet unidentified stimulus.

Adenoma↗