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Biomedical subjects

W F Friedman

Publications and source records attributed to W F Friedman.

At least 73 records · Page 4Linked to original sources

Isoproterenol-induced restoration of contraction in K+-depolarized hearts: relationship to cAMP.

The action of isoproterenol on inotropic state, cAMP concentration, and phosphorylase b-to-a conversion was studied under conditions that are known to alter membrane properties in guinea pig papillary muscles. In accord with the results of other investigators, contractile events induced by electrical stimulation were abolished by tetrodotoxin (10 microM) or 22 mM K+ and were subsequently restored by the addition of isoproterenol (10 nM-100 microM). However, in the presence of 22 mM K+, but not tetrodotoxin, the dose-response and temporal relationships between isoproterenol and elevations in cAMP concentration were shifted to the right, whereas those for phosphorylase activation were shifted to the left. Thus the low concentrations (less than 10 nM) of isoproterenol that restored tension development did not produce a measurable increase in cAMP. Contractile responses induced by 10 nM isoproterenol were blocked by (--)-propranolol but not by (+)-propranolol or phentolamine. Methoxamine did not restore contractile events in 22 mM K+-treated muscles or induce changes in cAMP content or phosphorylase activation. These results show that conditions can be obtained (e.g., partial depolarization of cardiac cell membranes) in which beta-adrenergic receptor activation leads to restoration of inotropic state in guinea pig myocardium without an obligatory increase in tissue cAMP content. The restoration of contractile events and enhancement of phosphorylase response under these conditions suggest that beta-adrenergic receptor activation may lead to Ca2+-channel activation directly or by increasing a small pool of cAMP and thereby altering localized protein phosphorylation in the cell membrane.

Animals↗

Effects of indomethacin on fetal rat lungs: a possible cause of persistent fetal circulation (PFC).

Indomethacin, because of its prostaglandin inhibition, may cause constriction of the ductus arteriosus and affect the pulmonary circulation. To study this possibility, we gave indomethacin daily by gavage to two groups of pregnant rats from the 17th day of pregnancy through delivery (group 1, 2 mg/kg/day; group 2, 4 mg/kg/day). Group 3, untreated control pregnant rats received saline. The pups were killed 30 min after birth and heart-lung preparations were perfused with glutaraldehyde. Appropriate blocks were processed for quantitative morphometry of the pulmonary arteries and arterioles. For analysis, the vessels were grouped by external diameter, i.e., less than 30, 30 to 50, and 50 to 100 micron. Groups 1 and 2 showed an increased medial smooth muscle mass in both 30 to 50 and 50 to 100-micron vessels as indicated by media thickness and medial areas (P less than 0.05). Muscularized arterioles, less than 30 micron, were present in groups 1 and 2, but not in controls. The relative mass of lung parenchymal components were determined by point counting. Indomethacin-treated animals had an increased saccular wall mass, decreased airspace mass, and a decreased capillary to saccular wall ratio (P less than 0.05). These results show that the fetal pulmonary circulation's response to indomethacin comprises the appearance of medial hypertrophy and newly muscularized arterioles. When these changes occur in lungs with immature, thick saccular walls, there is a decreased surface for oxygen exchange and an increased pulmonary vascular resistance resulting in a persistent fetal circulation.

Animals↗

Maturation of energy metabolism in the lamb: changes in myosin ATPase and creatine kinase activities.

Studies have been carried out to assess maturation of myofibrillar and mitochondrial proteins in fetal (113 to 140 days gestation), neonatal (30 min to 21 days postpartum), and adult sheep hearts. Ca++-activated myosin ATPase activity was approximately 20% lower in fetal than in adult left ventricular myocardium (1.13 +/- 0.06, n = 12, versus 1.36 +/- 0.07, n = 9, mumoles P1 per g protein per sec; P less than 0.025). In fetal and neonatal hearts (but not in adult hearts), myosin ATPase activity was slightly higher (approximately 14%; P less than 0.001) in right ventricular tissue than in left ventricular tissue. In contrast to these small changes in myosin ATPase activity, large changes indicative of maturation of energy metabolism occurred in the creatine kinase system: between 115 days gestation and 21 days postpartum, total creatine kinase activity increased nearly 8-fold (0.2 to 1.6 IU/mg cardiac mass), the MM-creatine kinase isozyme increased 7-fold (0.2 to 1.5 IU/mg wet weight), and mitochondrial creatine kinase increased more than 25-fold (less than 0.01 to 0.27 IU/mg wet weight). The total creatine pool, but not the ATP pool, increased (from approximately 6 to approximately 15 nmoles/g tissue). Neither the concentration nor isozyme distribution of lactate dehydrogenase, a glycolytic enzyme, changed during this 7-wk period of development.

Adenosine Triphosphatases↗

The disposition of indomethacin in preterm babies.

Limited pharmacokinetic data are available concerning the disposition of indomethacin in preterm infants. Since oral absorption of the drug may be poor or incomplete, the current report provides pharmacokinetic data on 37 premature infants who received indomethacin intravenously. Each of these infants had a hemodynamically significant patent ductus arteriosus. Findings included variable serum indomethacin concentrations from four to 12 hours after a single dose of 0.2 mg/kg. Female preterm infants generally had lower serum drug values at 12 hours and beyond when compared to males. An extrauterine age dependence was found of serum indomethacin levels. Total body clearance, serum half lives and volumes of distribution also bore a direct relationship to extrauterine age. Thus, when indomethacin is administered shortly after birth, one may anticipate a longer duration of action after a single dose and a relatively greater risk of accumulation of the drug when more than one dose is required for treating a duct al patency.

Age Factors↗

Assessment of patent ductus arteriosus in preterm infants by single lateral film aortography.

Differentiation of a hemodynamically significant cardiovascular abnormality from lung disease in the newborn infant may remain problematic after clinical, radiographic, and echocardiographic evaluation. Single-view aortography was performed in 38 preterm and one full term infant in the neonatal special care nursery. Special lateral views were obtained consisting of either a horizontal x-ray beam with oblique angulation of the supine patient or a vertical bean with 30 degree head-up angulation of the patient. These views projected the ductus caudal to the aortic arch and enabled visualization of the entire length of the ductus and focal constrictions of the ductus. The severity of patent ductus arteriosus was judged by anatomic (diameter of the ductus compared to the descending aorta) and physiologic (preferential opacification of the aortic arch or pulmonary circulation) criteria.

Aortography↗

The influence of inhibition of prostaglandin synthesis on hippurate extraction in conscious, newborn lambs.

The influence of indomethacin (INDO) on the renal extraction of hippurate (EH) was studied in 12 conscious, newborn lambs divided into two groups based upon age. EH was measured before and after INDO (7.5 mg/kg i.v.) by collecting blood samples from both the abdominal aorta (opposite the renal artery) and renal vein (under fluoroscopy). In the youngest group (0--4 days, n = 5), control EH was 18 +/- 8% (mean +/- SE) and increased to 29 +/- 6% following INDO (p = NS). In the older animals (2--3 weeks, n = 7) control EH was 66 +/- 5% (p less than 0.001), compared to the 0--4-day-olds) and decreased to 57 +/- 4% following INDO (p less than 0.02). The results suggest that EH increases during the first weeks of life and that prostaglandins may play a role in regulating the tubular transport of hippurate.

Animals↗

Influence of indomethacin on renal function in conscious newborn lambs.

Transient renal dysfunction has been observed in some premature infants who received indomethacin to constrict patent ductus arteriosi, and it has been suggested that this complication may be dose related. Accordingly, the present study was designed to investigate the influence of high (7.5 mg/kg) and low (0.2 mg/kg) doses of indomethacin on effective renal blood flow, glomerular filtration rate, urine flow, sodium and potassium excretion and plasma levels of indomethacin in conscious newborn lambs studied continously over a 24-hour period. When compared to control lambs, both indomethacin doses reduced effective renal blood flow significantly at 2--4 h, but only high doses significantly reduced renal blood flow at 22--24 h (6.5 +/- 0.9 vs. 13.4 +/- 1.4 ml/min/kg, respectively; p less than 0.001). At 8-16 and 16-24 h after drug administration, urine flow was significantly lower than in the control group only in high-dose lambs (p less than 0.05). During the 16 to 24-hour period, urine flow for control, low- and high-dose animals was 0.15 +/- 0.01, 0.14 +/- 0.01, and 0.08 +/- 0.02 ml/min/kg, respectively. Glomerular filtration rate and sodium and potassium excretion rates were not affected by either indomethacin dose.

Animals↗

Heart failure in the neonate due to extreme abnormalities of heart rate: clinical and radiographic features.

Extreme variations of heart rate caused clinical and radiographic findings of heart failure in six neonates in the absence of structural heart disease. Two infants had heart block with heart rates below 50/min and four had paroxysmal atrial tachycardia with rates approaching 300/min. Each infant had interstitial or alveolar pulmonary edema and most had cardiomegaly. After restoration of a normal heart rate, there was rapid and dramatic resolution of pulmonary edema and reduction in cardiac size.

Arrhythmias, Cardiac↗

Effects of prostaglandins, thromboxanes, and inhibitors of their synthesis on renal and gastrointestinal function in the newborn period.

We have reviewed current thoughts concerning the interplay between prostaglandins and renal and gastrointestinal function with a focus on the possible alteration in the latter functions that would be expected when prostaglandin synthesis is inhibited in premature infants receiving indomethacin for closure of the patent ductus arteriosus. It would appear that administration of even small doses of indomethacin may be associated with transient oliguria. Although speculation exists about whether indomethacin may promote the development of necrotizing enterocolitis in these infants, there is no convincing evidence of a cause-effect relationship.

Adult↗

Two dimensional echocardiographic characteristics of double outlet right ventricle.

The reliability was evaluated of two dimensional echocardiography in distinguishing double outlet right ventricle from other anomalies of the great arteries. Accordingly, a combined retrospective and prospective study was conducted in 13 children with double outlet right ventricle, 12 with tetralogy of Fallot, 13 with complete d-transposition of the great arteries, 5 with congenitally corrected I-transposition and 2 with truncus arteriosus. Echographic findings using a standard long axis view in all subjects with double outlet right ventricle included (1) inability to identify a great artery arising from the left ventricle, and (2) lack of continuity between the anterior mitral leaflet and any semilunar valve. In the short axis view constant findings were (1) simultaneous imaging of both great arteries in an anterior location with the ventricular septum identified posteriorly on sweeping into the left ventricle, and (2) lack of a clockwise wraparound of the aorta by the right ventricular outflow tract. Imaging revealed that the great arteries were side by side in seven patients d-malposed in three and l-malposed in two. A modified left precordial tomographic view demonstrated both great arteries arising from the right ventricle in four of nine patients not treated surgically. In four patients with surgically repaired double outlet right ventricle, the left ventricular outflow tract had a tunnel-like configuration in the long axis view. These findings were diagnostic of double outlet right ventricle in all patients and accurately differentiated the malformation from other anomalies of the great arteries.

Adolescent↗

Patent ductus arteriosus treated with ligation or indomethacin: a follow-up study.

The course and complications of fifty-two infants with patent ductus arteriosus requiring closure were assessed prospectively. Twenty-six infants with a PDA received indomethacin for pharmacologic closure of the PDA, and 26 underwent ligation. The current study analyzes and compares the longitudinal follow-up with respect to somatic growth, neurologic function, psychomotor and mental development, and renal, ophthalmologic, and audiologic function in 21 infants in each group who entered the follow-up. No selective morbidity was attributable to PDA closure with indomethacin when compared to surgically treated infants.

Child Development↗