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Biomedical subjects

R Lang

Publications and source records attributed to R Lang.

At least 217 records · Page 12Linked to original sources
PubMed1983

A detailed evaluation of oral phosphate therapy in selected patients with primary hyperparathyroidism.

Recent studies have emphasized the pathophysiological importance of circulating 1,25-dihydroxyvitamin D ((1,25-(OH)2D] in the pathogenesis of hypercalciuria and renal stone formation in primary hyperparathyroidism. Reasoning that phosphate administration might be capable of reducing the plasma concentration of 1,25-(OH)2D in patients with a prominent 1,25-(OH)2D-mediated absorptive component to their disease, 10 carefully selected patients were treated with oral phosphate (1500 mg elemental phosphorus daily) for 1 yr. Phosphate treatment significantly reduced circulating 1,25-(OH)2D levels (84 to 56 pg/ml), the calciuric response to an oral calcium tolerance test (0.30 to 0.21 delta mg calcium/dl GF), and calcium excretion on an unrestricted calcium diet (438-269 mg/day), in essence reversing the absorptive pattern of abnormalities observed before treatment. This response, however, was accompanied by an increase in biochemical hyperparathyroidism, as assessed by circulating immunoreactive PTH and nephrogenous cAMP excretion. In patients with biochemical evidence of an increase in bone resorption before therapy, histomorphometric, radiographic, and biochemical data revealed a trend toward a reduction in bone turnover during phosphorus therapy, with an apparent maintenance of coupled bone resorption and bone formation. This trend, however, was of marginal statistical significance in the patient group as a whole. It is concluded 1) that phosphate therapy represents a viable medical alternative in selected patients with primary hyperparathyroidism, 2) that the net response in treated patients is multifaceted and complex, and 3) that the efficacy of phosphate therapy will ultimately depend upon its long term effects on skeletal homeostasis.

Bone and Bones↗
PubMed1983

Superiority of oral verapamil therapy to digoxin in treatment of chronic atrial fibrillation.

The efficacy and safety of oral verapamil, 240 mg, with or without digoxin were studied in 52 patients with chronic atrial fibrillation at rest, and during mild and maximal exercise. Twenty-four patients were studied during the following therapeutic modalities: no therapy; digoxin, 0.25 mg and 0.5 mg daily; digoxin, 0.25 mg and verapamil; and verapamil alone. Heart rate at rest and during all levels of exercise was decreased significantly (p less than 0.005), either by combining digoxin with verapamil or by verapamil therapy alone. In contrast, the excessive heart rate response to exercise was not prevented by digoxin even with good serum concentrations. The improved control of heart rate with verapamil was associated with a significantly improved exercise capacity. Verapamil is an important and safe modality of treatment, with or without digoxin, in the long-term control of heart rate in chronic atrial fibrillation. It is superior to digoxin in controlling the ventricular rate and in improving exercise capacity.

Administration, Oral↗
PubMed1983

Characterization of cloned cytotoxic lymphocytes with NK-like activity.

Cloned H-2b-restricted male antigen-specific cytotoxic T cells were kept in culture in the presence of IL 2 for over 2 yr. During this time, they lost their antigenic specificity and now exhibit high NK-like activity. Three separate clones HY 1, HY 2, and HY 3 and their subclones, when tested on a panel of NK-sensitive and NK-insensitive target cells, showed typical lysis patterns of NK cells. Three cytotoxicity-loss mutants were obtained by subcloning. At least one of these cytotoxicity-loss mutants still exhibited binding to NK-sensitive target cells. The various HY clones were compared with cloned alloreactive cytotoxic T cells of B10 anti-B10.D2 specificity with respect to surface markers, target specificity, kinetics of lysis, morphology, and influence of monoclonal antibodies and chemicals on cytotoxicity. Only one major difference between cloned NK-like and alloreactive T cells was detected: monoclonal anti-Lyt-2 antibodies inhibited cytotoxic activity of alloreactive T cells but not of NK-like cells, although both expressed Lyt-2 on their surface. Morphologically, HY cells were characterized by numerous lysosomal granules in their cytoplasm. Clones with NK-like activity differed from cytotoxicity-loss mutants by both ultrastructural appearance and enzyme histochemistry of lysosomes. Interaction of NK-like cells with YAC-1 cells induced membrane lesions of variable size in target cells. Effects of chemicals influencing lysosomal pathways such as monensin, NH4Cl, and chloroquine on cytotoxicity were investigated. Monensin as well as NH4Cl inhibited cytotoxicity of NK as well as alloreactive clones, whereas chloroquine did not. Spleen cells from acutely virus-infected mice with high NK reactivity showed the same behavior except for chloroquine, which was slightly inhibitory. The addition of monensin to the cells resulted in morphologic changes in the lysosomal granules. These data strongly suggest that NK-like killing is triggered by unknown substance(s) released from lysosomes of effector cells. Cloning of antigen-specific cytotoxic T cells under conditions of limiting dilution and continuous growing in medium containing Con A supernatant but not the relevant antigen often leads to loss of specificity and appearance of NK-like activity. The results presented are representative of a great amount of work in this and probably many other laboratories attempting to clone cytotoxic effector T cells.

Animals↗
PubMed1983

[Effect of co-dergocrine mesylate on catecholamines and prolactin in elderly hypertensive patients].

The antihypertensive efficacy of co-dergocrine mesylate (a mixture of dihydroergocornine mesylate, dihydroergocristine mesylate, and alpha- and beta-dihydroergocryptine mesylates; Hydergin) and its effects on heart rate, plasma catecholamines, catecholamine excretion and plasma prolactin was tested in 12 elderly hypertensive patients. Co-dergocrine mesylate (6 mg or 12 mg, 1 or 2 tablets once a day) caused a significant reduction of the blood pressure during rest and under physical stress without a reactive increase of the heart rate. Plasma norepinephrine and prolactin as well as urinary excretion of norepinephrine and epinephrine were not affected by co-dergocrine mesylate. The therapeutic advantage of co-dergocrine mesylate for the treatment of hypertension in the elderly is discussed.

Aged↗
PubMed1982

Studies on the mutagenic potential of the pesticide chlordimeforme and its principal metabolites in the mouse heritable translocation assay.

Chlordimeforme and its 2 principal metabolites, N-formyl-4-chloro-o-toluidine and 4-chloro-o-toluidine, were studied for induction of heritable translocations. Maximal tolerated doses of the compounds were given daily by gavage for 7 consecutive weeks. After mating with untreated females, about 1000 F1 male offspring per group--including vehicle control and positive control (Tretamine, TEM)--were tested for their reproductive performance by use of a sequential decision procedure on litter sizes to select males with translocation heterozygosity. Partially sterile, sterile and non-classifiable F1 males were examined cytogenetically by scoring meiotic chromosomes for translocation multivalents or analysing mitotic divisions for marker chromosomes. The 3 compounds tested at dose levels showing toxic effects did not induce translocation heterozygosity. Tretamine, the positive control, gave the expected mutagenic response.

Amidines↗
PubMed1982

Q-T prolongation and polymorphous ("torsade de pointes") ventricular arrhythmias associated with organophosphorus insecticide poisoning.

It is not generally appreciated in the Western world that organophosphorus poisoning may be associated with a serious and often fatal cardiac complication: Q-T interval prolongation with malignant ventricular arrhythmias of the "torsade de pointes" type. This insidious complication may lead to delayed, sudden death after the patients appears to be well on the way to recovery from the other, more dramatic respiratory and neurologic symptoms. In this study 15 patients with organophosphorus poisoning are described. Q-T prolongation was observed in 14 and malignant tachyarrhythmias in 6. In view of the dismal prognosis of these patients, ventricular pacing, previously used with success in other conditions associated with this syndrome, was tried in four patients and successfully shortened the Q-T interval and eliminated the arrhythmias. Isoproterenol did the same in a fifth patient. Awareness of this lethal, but preventable complication of organophosphorus poisoning is called for. Careful electrocardiographic monitoring is necessary until the Q-T interval returns to normal. Electrical pacing appears to be the treatment of choice for the tachyarrhythmias.

Adolescent↗
PubMed1982

Prolonged dimethylsulphoxide treatment in 13 patients with systemic amyloidosis.

Continuous oral dimethylsulphoxide (DMSO) treatment (7-15 g/day) was given to 3 patients with amyloidosis of familial Mediterranean fever (FMF), 3 patients with idiopathic amyloidosis, and 7 patients with secondary amyloidosis. The nephrotic syndrome and various degrees of renal insufficiency were the major clinical manifestation in all case. Renal function was used as the main parameter for evaluation of therapy. DMSO treatment for 7-16 months produced no effect in the FMF patients and in the patient with idiopathic amyloidosis; they all ran the predictable clinical course of their disease and either died of cardiac failure or have been maintained on chronic haemodialysis. In the 7 patients with secondary amyloidosis an unequivocal improvement of renal function was observed following 3-6 months of DMSO treatment. It was shown by a 30-100% rise of creatinine clearance and a decline in proteinuria. This new equilibrium has been maintained as long as DMSO was administered. No serious side effects of DMSO wee encountered. Mild nausea and an unpleasant breath odour were the patients' main concern. We conclude that a therapeutic trial with oral DMSO is warranted in all patients with secondary amyloidosis. This treatment is unpleasant but bears no exceptional risks. It may significantly prolong life, though its effect on amyloid deposits themselves is doubtful.

Adult↗
PubMed1982

The influence of verapamil on serum digoxin concentration.

The effect of verapamil on the pharmacokinetics of digoxin was studied in 49 patients with chronic atrial fibrillation. A dose of 240 mg/day of verapamil was given to the patients who were receiving a stable dose of digoxin. Serum digoxin levels rose from 0.76 +/- 0.54 ng/ml (mean +/- SD) to 1.31 +/- 0.54 ng/ml during verapamil treatment (p less than 0.0005). This effect was dose-dependent, as shown in seven subjects who received 160 mg and then, 240 mg of verapamil: There was a stepwise rise in serum digoxin concentration from a control value of 0.60 +/- 0.11 ng/ml to 0.84 +/- 0.18 ng/ml and 1.24 +/- 0.40 ng/ml, respectively (p less than 0.01 for both steps). The effect of verapamil developed gradually within the first few days in seven subjects in whom serum digoxin concentration reached, within 7 days, 90% of the increase observed 14 days after onset of verapamil. Renal digoxin clearance decreased significantly (26.1 +/- 0.7 vs 55.1 +/- 12.3 ml/min, p less than 0.005) in six patients in whom serum digoxin concentration increased. It did not change in one patient in whom serum digoxin concentration was not influenced by verapamil. Creatine clearance did not change in any of these seven. The same effects on digoxin clearance were observed in three normal subjects. Among the 49 patients, verapamil resulted in the development of signs and symptoms that suggested digitalis toxicity in seven. Verapamil significantly increased serum digoxin concentration. The process is dose-dependent and gradual, and it is at least partially explained by reduced renal excretion without reduction in glomerular filtration. The dose of digoxin may need readjustment in patients who are concomitantly receiving verapamil.

Adult↗
PubMed1982

Recurrent venous thrombosis: the sole manifestation of an occult myeloproliferative disease.

A myeloproliferative disorder manifested by thrombocytosis, a high leukocyte alkaline phosphatase (LAP) score and an increased red blood cell mass was found in a 64-yr-old woman. During the previous 15 yr, recurrent venous occlusions had taken place, necessitating the resection of ischemic bowel segments and leading to extrahepatic portal venous obstruction. Numerous blood counts obtained during repeated hospitalizations were normal, and these thrombotic events remained unexplained. The sequence of events strongly suggests that the myeloproliferative disorder existed in an occult form during these years and was responsible for the venous occlusions. The possibility of a "smoldering" myeloproliferative disorder should be considered in patients with otherwise inexplicable thrombotic phenomena.

Female↗