Salt-induced hypertension in chronic renal failure: evidence for a neurogenic mechanism.
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Biomedical subjects
Publications and source records attributed to L Volicer.
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Patients hospitalized for treatment of alcoholism were asked to provide information on family history of drinking problems, age at onset of drinking, and timing of the occurrence of problems due to use of alcohol in their lives, using a time scale. Analysis of data from 256 male patients indicated a strong association between a family history of problem drinking and development of alcoholism at a young age. Mean age at the time the patients could be defined as alcoholic, based on the chronological history of the time of occurrence of symptoms, ranged from 27.2 years for bilineal family history positive patients to 38.5 years for those with negative family history, and the difference could not be explained by differences in age at onset of drinking. The results indicate that the increased risk of alcoholism among individuals with family history of problem drinking, which has been postulated on the basis of many cross-sectional studies, is likely to be overestimated.
Administration of single doses of ethanol or presence of ethanol in the incubation medium does not change 3H-flunitrazepam binding in rat cerebral cortex, hippocampus and cerebellum. In rats made dependent on ethanol by three daily ethanol administrations for six days and sacrifices 1 hr after the last ethanol dose 3H-flunitrazepam binding is decreased in the cerebral cortex and cerebellum. This decrease is present only in membranes preincubated with Triton X-100 and is due to decreased number of binding sites. In rats sacrificed 16 hours after the last chronic ethanol dose the 3H-flunitrazepam binding returns to control levels.
Characteristics of receptor binding of diazepam and flunitrazepam in three brain areas were compared. It was found that in the cerebral cortex and cerebellum the number of sites was similar for both ligands and that the affinity of diazepam was four times lower than the affinity of flunitrazepam. In contrast, when binding in the hippocampus was analyzed (assuming the presence of homogeneous binding sites), it was found that the number of binding sites was higher and that the affinity was 17 times lower for diazepam than for flunitrazepam. This difference is due to the presence of two diazepam binding sites in this brain area, as demonstrated by a Scatchard analysis.
Hypertensives reported a greater incidence of daily use of alcohol and higher noncompliance in taking prescribed medicines by a randomized response technique with a dichotomous response as compared with direct response, and more mean drinks per week, but similar compliance in taking prescribed medicines, by a randomized response technique with a quantitative response as compared with direct response.
Adverse effects of alcohol drinking were investigated in 240 hypertensive patients. Perceived interaction between alcohol and antihypertensive medication was reported by 9.9% of patients but the symptoms were rather mild. Except for the fact that the patients who perceived drug-alcohol interaction had higher diastolic blood pressure than the rest of the patients there was no evidence that alcohol use decreased compliance with antihypertensive treatment. Most heavy alcohol users believed that they should take their antihypertensive medication while drinking and reported doing so. Indiscriminate emphasis on avoidance of drug-alcohol combination might decrease blood pressure control of these patients.
Sodium independent GABA receptor binding was measured in synaptosomes prepared from cerebral cortex of rats made ethanol dependent by three daily ethanol administrations. In rats sacrificed 1 hour after the last ethanol dose there was a lower number of low affinity binding sites and lower affinity of the high affinity binding than in controls. The decreased affinity was present only in rats who showed symptoms of ethanol withdrawal during the course of ethanol administration. In rats sacrificed during ethanol withdrawal the affinity of the high affinity binding was lower than in controls and other binding characteristics were unchanged. This decreased binding was normalized by repeated Triton X-100 incubations indicating involvement of an endogenous inhibitor in this ethanol effect. Acute ethanol administration did not change GABA receptor binding.
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Cyclic AMP and cyclic GMP levels were measured in seven brain areas of rats 4-30 months old. In several brain areas cyclic nucleotides were higher in 4-month-old rats than in rats 12 months old or older. On the other hand, in the hypothalamus cyclic GMP levels were decreased only in 30-month-old rats, a pattern of onset similar to that of senile deterioration.
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Cerebrospinal fluid levels of gamma-aminobutyric acid (GABA) and cyclic nucleotides were measured in alcoholic and control patients. Alcoholics without seizures had higher GABA levels than either alcoholics with seizures or controls. Levels of cyclic AMP and cyclic GMP in cerebrospinal fluid of controls and alcoholics with and without seizures were not significantly different.
Colonic temperature was measured in spontaneously hypertensive (SHR), Wistar Kyoto (WKY) and Wistar Charles River (WIS) rats. The SHRs had higher basal temperature and their temperature decreased more rapidly when exposed to 4 degrees C than temperature of controls. During exposure to 37 degrees C for 2 hrs no controls but majority of SHRs died. Treatment with clonidine (1 mg/kg, b.i.d., 14 days), hydralazine (10 mg/kg, b.i.d., 14 days) or diuretics (chlorothiazide 100 mg/kg + spironolactone 10 mg/kg, q.d., 21 days) decreased blood pressure of SHRs but did not normalize their body temperatures and heat sensitivity. These results indicate thermoregulatory dysfunction in SHRs which is probably of central origin.
Epinephrine (Epi) disposition in the human body was investigated in asthmatic and control subjects. After intravenous infusion of labeled catecholamines, asthmatics excreted less label than controls but the ratio of unchanged to changed catecholamines was similar in both groups. Further studies investigated retention of Epi in the lung after a bolus injection of labeled Epi and inulin. While in the controls the apparent volume of distribution of Epi was larger than that of inulin, in asthmatics the volumes were similar. The distribution volumes of both Epi and inulin were larger in asthmatics than in controls and the mid-expiratory maximal flow correlated negatively with both volumes. The results indicate that disposition of Epi is altered in bronchial asthma and may be related to pathological processes in the lung.
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The mechanism of recumbent hypertension induced by fludrocortisone was studied in seven patients with orthostatic hypotension. All showed increases in blood pressure in the recumbent and standing positions, and hypertensive levels were achieved on recumbency in four of them. Hypertensive retinopathy developed in two patients and cardiomegaly in one. Initial blood-pressure elevations were associated with sodium retention and plasma-volume expansion. However, with long-term treatment, plasma volume decreased to control levels despite further blood-pressure increases. Treatment did not affect plasma levels of catecholamines but did enhance pressor responsiveness to infused norepinephrine in some subjects. Hemodynamic studies indicated that hypertension in the recumbent position was related to increases in total peripheral-vascular resistance and not to changes in cardiac output. Clinically, hypertension in the recumbent position is an important risk of fludrocortisone treatment in patients with orthostatic hypotension. This unusual model of chronic mineralocorticoid-induced hypertension is not volume dependent but is related to increased peripheral-vascular resistance.
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Daily variation in the levels of cyclic nucleotides and GABA was examined in seven brain regions of male Sprague-Dawley rats. Significant daily rhythm of cyclic AMP levels was found in the cerebellum and pons medulla oblongata. Circadian variation of cyclic GMP levels was found in the cerebellum, cerebral cortex, striatum, and hypothalamus. Daily variation of GABA levels was found in the pons medulla oblongata and striatum. Cyclic GMP in the pons medulla oblongata and GABA in the hypothalamus were found to exhibit ultradian variation of levels. These observed daily fluctuations of baseline levels should be considered when examining the duration of action of various drugs upon these substances.