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Flow-through sol-gel optical biosensor for the colorimetric determination of acetazolamide.

An optical biosensor based on immobilised carbonic anhydrase and its application to the determination of the anti-glaucoma agent acetazolamide by enzyme inhibition measurements, is described. The enzyme and a pH indicator dye, cresol red, were physically immobilised in overlapped sol-gel thin films, in a dual-layer format. Carbonic anhydrase catalyses the dehydration of HCO3-, which in turn causes a change of pH in the microenvironment of the sensor. By following the colour transition of cresol red, the enzymatic reaction as well as its inhibition by acetazolamide can be monitored. The sensor was integrated in a flow cell and coupled to a continuous flow system operating on a multicommutation and binary sampling approach. Measurements were made at pH 6.0 at the wavelength of 570 nm. Linear response was obtained for acetazolamide concentrations between 1.0 and 10.0 mmol l(-1), with a sampling frequency of 22 samples h(-1) and a detection limit of 0.2 mmol l(-1). The results obtained in the analysis of real samples were in good agreement with those obtained by a reference method, showing no significant differences at a confidence level of 95%.

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[The value of the acetazolamide stimulation test with 99mTc-HMPAO-SPECT in reversible cerebrovascular insufficiency].

Regional cerebral blood flow reduction was measured in 84 patients with CVI using 99mTc-HMPAO-SPECT. 53 patients received 1 g acetazolamide to evaluate cerebrovascular reserve capacity. Differentiating between hemispheric (87%) and vertebrobasilar ischaemia (64%) revealed markedly increased sensitivity for the provocative test with acetazolamide. In 62% of high grade but asymptomatic carotid stenoses a haemodynamic effect was demonstrated with acetazolamide and thereby the indication for surgery was supported.

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Studies on the avian shell gland during egg formation: the effect of acetazolamide on the composition of the mucosa.

The effect of acetazolamide, an inhibitor of carbonic anhydrase activity, on the intracellular composition of the shell gland mucosa was determined. The normal cyclic hydration of the mucosal cells was found to be reduced when the egg was in the uterus and the partition of the water between the intra- and extracellular compartments was modified. Acetazolamide decreased the accumulation of Na+ within the cells, inhibited the Na+-independent movement of Cl- and reduced the transfer of Cl- linked with Na+. It is concluded that acetazolamide blocks the intracellular generation of HCO3- and the reabsorption of Cl-.

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Studies on the avian shell gland during egg formation: the effect of acetazolamide on the transfer of ions to the albumen.

Twenty-five laying hens were fed on a diet containing 100 mg acetazolamide/kg in order to determine the effects of a decrease in the activity of carbonic anhydrase on the transfer of minerals to the egg albumen. Treatment with acetazolamide decreased the rate of shell formation by 44%; reduced the concentrations of water and Na+ in the albumen at the beginning of the plumping stage but increased the accumulation of water during plumping; increased the concentration of Cl- in the albumen after the 6-h stage without any appreciable change in K+ and Ca2+ concentrations. The computed relationships between the concentrations of different ions also showed that the transfer of water and Na+ were linked during egg formation, that a water-independent, acetazolamide-sensitive reabsorption of Na+ occurred after the 10-h stage and that Na+ and Cl- moved simultaneously up to 14 h but with the ratio of Cl- to Na+ three times higher in the treated group. It is concluded that acetazolamide impairs the transfer of Na+ and Cl- between the albumen and the extracellular fluid and that secretion of Ca2+ into the uterine lumen seems to depend on Na+ and Cl- reabsorption.

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Aging and sleep apnea: action of benzodiazepine, acetazolamide, alcohol, and sleep deprivation in a healthy elderly group.

Ten nonobese, healthy elderly adults (M = 73.3 years) were monitored polygraphically during sleep for sleep state changes, breathing, and the development of cardiac arrhythmias. All participated in 2 baseline nights and 1 night of flurazepam 30 mg ingestion; six underwent 1 night of sleep deprivation; four received ethyl alcohol (.6 mg/kg); and four whose apnea worsened significantly with flurazepam 30 mg were pretreated for 3 days with acetazolamide, taking acetazolamide and flurazepam 30 mg on the fourth night. Elderly adults with an Apnea Index (the number of apneas per sleep hour) between 5 and 7 at baseline experienced a worsening of their apnea with each manipulation. Acetazolamide did not protect individuals whose Apnea Index increased after flurazepam ingestion. One person developed premature ventricular contractions in conjunction with an increased Apnea Index after each manipulation.

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Acetazolamide and amiloride inhibit pentobarbital-induced facilitation of nocifensive reflexes.

BACKGROUND: Neuronal excitation may result from stimulation of gamma-aminobutyric acid A (GABA(A)) receptors that prolong the channel opening, depolarizing the postsynaptic membrane. Drugs such as acetazolamide or amiloride can block GABA depolarization. Barbiturates facilitate nociceptive reflexes and also prolong the GABA(A) channel open-time. To evaluate the possible mechanism, the authors studied the impact of acetazolamide and amiloride on pentobarbital-induced nocifensive reflex facilitation. Because nitric oxide (NO) is a mediator of reflex facilitation, the authors evaluated the effects of NO synthase inhibition. METHODS: Nocifensive reflex thresholds were quantified with the hind paw withdrawal latency from radiant heat (HPW latency) in the rat. Nocifensive reflexes were facilitated with intraperitoneal injection of pentobarbital (30 mg/kg). The authors tested the roles of GABA-mediated depolarization and NO in reflex facilitation by pretreatment with acetazolamide and amiloride and inhibition of NO synthase with L-NAME and 7-NI, respectively. Sedative effects of pentobarbital were evaluated with the righting reflex, the response to vibrissal stimulation, and plasma drug concentrations. RESULTS: Pentobarbital decreased the hind paw withdrawal latency from 11.2+/-1 to 8.3+/-1 s (P < 0.001). Pretreatment with each of the four test drugs limited the reduction in reflex facilitation after pentobarbital to 1.3 s or less, similar to the reduction seen after saline injection, without altering sedation. L-NAME increased plasma pentobarbital concentrations by 10% without changing the concentration associated with return of responsiveness. CONCLUSIONS: Pentobarbital-induced nocifensive reflex facilitation was inhibited by all four tested drugs without evidence of increased sedation. The results are consistent with a role for GABA(A) receptor-mediated depolarization in barbiturate-induced hyper-reflexia.

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Vasoreactive effect of acetazolamide as a function of time with sequential PET 15O-water measurement.

The accurate assessment of vascular flow reserve is crucial for the evaluation of risk among patients with cerebrovascular disease. In six patients with unilateral occlusion of the internal carotid artery and one patient with unilateral occlusion of the middle cerebral artery (mean +/- S.D. age = 68 +/- 3 years), we measured cerebral blood flow (CBF) after the administration of 940 MBq 15O-water using a remotely controlled power injector. Studies were performed at rest, after 10 min, and then 10, 20 and 30 min after the administration of 1 mg acetazolamide to evaluate the vasoreactive effect, as reflected by an increase in CBF. Sixteen regions of interest (ROIs) were drawn over the CBF images. These ROIs were as follows in each hemisphere: Area I, four areas in the cortical middle cerebral arterial territory (superior frontal, frontal, temporal and parietal areas); Area II, four areas of the deep middle cerebral and vertebral arterial territory (occipital area, basal ganglia, thalamus and cerebellum). Taking normalized resting CBF to be 100%, the mean CBF measured 10, 20 and 30 min post-injection using sequential positron emission tomography was as follows: Area I, 141.4 +/- 16.3, 127.7 +/- 15.3 and 128.2 +/- 17.4% for non-occluded sites and 116.3 +/- 22.8, 112.7 +/- 16.4 and 114.9 +/- 17.1% for occluded sites; Area II, 143.4 +/- 14.5, 126.2 +/- 10.4 and 125.0 +/- 12.9% for non-occluded sites and 141.9 +/- 28.9, 126.0 +/- 20.5 and 124.1 +/- 17.1% for occluded sites. A significant difference in mean CBF was noted between the non-occluded and occluded sites in Area I, the most marked difference of 25.1% being observed 10 min after the administration of the acetazolamide. We conclude that for an accurate assessment of vascular reserve in patients with cerebrovascular disease, CBF should be measured 10 min post-administration of the acetazolamide.

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Intraoperative acetazolamide in the prevention of intraocular pressure rise after pars plana vitrectomy with fluid-gas exchange.

PURPOSE: To assess the effect of intraoperative acetazolamide (Diamox) on postoperative intraocular pressure (IOP) in gas-filled, vitrectomized eyes. METHODS: We conducted a prospective randomized clinical trial of 63 consecutive patients undergoing pars plana vitrectomy with total fluid-gas exchange and long-acting intraocular gas tamponade. Patients were randomized by a blind draw to receive either intravenous 500 mg acetazolamide (Diamox) (Group 1) or no treatment (Group 2) at the conclusion of the operative procedure. Intraocular pressures at the conclusion of surgery (IOP-1), 4-8 hours following surgery (IOP-2), and on the first postoperative day (IOP-3) were measured using an Oculab Tono-Pen. RESULTS: Patients in Groups 1 and 2 showed similar mean IOP on postoperative day 1 (20.48+/-7.84 mmHg versus 19.89+/-7.89 mmHg). A similar incidence of IOP-2 greater than 30 mmHg (1 versus 3 patients with high IOP) and IOP-3 greater than 30 mmHg (4 versus 3 patients with high IOP) was seen. Patients in Group 1 had a lower mean IOP at 4-8 hours postoperatively (16.25+/-6.47 mmHg) than those in Group 2 (20.13+/-6.33 mmHg). No correlation could be demonstrated between IOP-1 and subsequent IOP. However, IOP on the first postoperative day (IOP-3) was strongly correlated with IOP 4-8 hours after surgery (IOP-2) (P = 0.0001). No protective effect of Diamox could be demonstrated on either IOP-2 or IOP-3. CONCLUSIONS: No protective effect against pressure rise could be demonstrated for intraoperative acetazolamide (Diamox) in the prophylaxis of IOP rise following pars plana vitrectomy and total fluid-gas exchange with long-acting intraocular gas.

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Hemodialyzability of acetazolamide.

Because the dialyzability of acetazolamide is not known, we undertook a study to determine the in vivo dialysance of this drug and found it to average 22 ml per minute. The quantity of the drug removed by four hours of dialysis was approximately 30% of the dose administered intravenously one half hour before dialysis. Accordingly, considerable amounts of the drug are removed by dialysis, despite its high intraerythrocytic distribution and plasma protein binding properties. Therefore, hemodialysis may be effective in the management of acetazolamide overdose, particularly when complicated by the presence of renal failure. The dialysance can vary under different dialyzing conditions. An acetazolamide/urea nitrogen extraction ratio of 0.16 established in this study can be used to predict the acetazolamide dialysance in various dialyzing conditions.

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Metabolic changes after H(2) 15O-positron emission tomography with acetazolamide in a patient with moyamoya disease: case report and review of previous cases.

Perioperative ischemic complications not directly related to surgery require special attention in patients with moyamoya disease; positron emission tomography (H(2) 15O-PET) and single-photon emission computed tomography have been considered indispensable for evaluating pre- and postsurgical cerebral hemodynamics. The clinical records of 14 patients with moyamoya disease who underwent 26 extracranial-intracranial bypass operations were reviewed with special reference to perisurgical complications. One patient developed multiple postoperative ischemic infarctions and died of ischemic brain edema. The history of this patient with prolonged acidosis is analyzed, and the role of metabolic changes induced by H(2) 15O-PET with acetazolamide challenge is reviewed. Seven (77.8%) of nine patients operated on within 48 hours after H(2) 15O-PET with acetazolamide (group 1) developed metabolic acidosis, whereas only three (17.6%) of 17 patients operated on >48 hours (group 2) after the examination had intraoperative pH of <7.35. In group 1, the mean intraoperative pH was 7.328, which was significantly lower than the mean pH of 7.393 (P <.0001) in group 2. After H(2) 15O-PET with acetazolamide challenge, patients must be carefully observed concerning acidosis and volume state. We recommend at least 48 hours between examination and surgery for patients with moyamoya disease so that their conditions can stabilize. Furthermore, special care should be taken to avoid additional perioperative risk factors such as hypotension, hypocapnia, hypercapnia, and hypovolemia.

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Long-term effects of acetazolamide and sodium chloride loading on cisplatin nephrotoxicity in the rat.

The protective effect of acetazolamide or sodium chloride loading on cisplatin nephrotoxicity was investigated in rats. After a single dose of cisplatin (5 mg kg-1 i.p.) kidney function was studied after 5, 28 and 84 days. Acetazolamide (75 mg kg-1 i.p.) was administered as a single dose prior (30 min) to the cisplatin injection. By the time of cisplatin administration, the rats were sodium depleted except the sodium-loaded group. Five days after the cisplatin administration all rats received a regular rat chow for the rest of the experiment. Cisplatin alone caused renal failure that could be observed for up to 12 weeks (ClCr 0.32 +/- 0.13 vs. 0.62 +/- 0.06 ml min-1 x 100 g BW-1) with polyuria (UVol 41.2 +/- 4.5 vs. 18.4 +/- 4.6 ml 24 h-1). Pretreatment with acetazolamide was the most protective manoeuvre tested. Five days after cisplatin, kidney function was significantly better than in rats treated with cisplatin alone (ClCr 0.21 +/- 0.06 vs. 0.03 +/- 0.01 ml min-1 x 100 g BW-1), after 28 days the only sign of nephrotoxicity was polyuria (UVol 28.9 +/- 3.7 vs. 19.0 +/- 2.6 ml 24 h-1) after 84 days no differences could be observed at all. Sodium chloride loading was less protective on cisplatin nephrotoxicity. Impaired renal function could still be observed after 12 weeks (ClCr 0.41 +/- 0.05 vs. 0.62 +/- 0.06 ml min-1 x 100 g BW-1) with no difference in comparison with the rats treated with cisplatin alone. However, since 12 rats died in the group having received cisplatin alone and only one rat in the high-salt group, sodium chloride loading is regarded as being advantageous over sodium depletion on cisplatin nephrotoxicity.

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A stability-indicating first-derivative spectrophotometric assay of acetazolamide and its use in dissolution and kinetic studies.

A simple, rapid, stability-indicating first-derivative spectrophotometric assay procedure for the determination of the degradation products of acetazolamide is described. The dissolution and kinetics of drug degradation in aqueous buffered solutions were studied using the proposed method. Acetazolamide solution exhibited optimum stability at pH 4. The influences of temperature and sonic energy on the degradation of acetazolamide in 0.01 M NaOH solution were also studied. The results showed first-order reaction kinetics, with a degradation rate constant and degradation half-life of 3.51 x 10(-3) day-1 and 8.23 days, respectively.

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Acidosis, acetazolamide, and amiloride: effects on 22Na transfer across the blood-brain and blood-CSF barriers.

Sprague-Dawley rats were given treatments, known to decrease 22Na movement into choroid plexus and CSF, to investigate their effect on 22Na transfer across the cerebral capillaries. Acidic salts, acetazolamide, or amiloride was injected intraperitoneally into bilaterally nephrectomized rats, and the rate of 22Na uptake into parietal cortex, pons-medulla, and CSF was determined at 12, 18, and 24 min. Severe acidosis (arterial pH 7.2), produced by HCl injection, decreased the rate of 22Na entry into both brain regions and CSF by 25%, whereas mild acidosis (pH 7.3) from NH4Cl injection reduced brain entry by 18%, but CSF entry by only 10%. Like HCl acidosis, amiloride reduced transport into both brain and CSF by 22%. Penetration of 22Na into parietal cortex was unchanged by acetazolamide, but that into CSF was slowed 30%. Since uptake of 22Na into cortical regions is primarily movement of tracer across the cerebral capillaries when tracer uptake time is less than 30 min, the results indicate that both metabolic acidosis and amiloride decrease Na+ permeativity at the cerebral capillaries as well as at the choroid plexus. Acetazolamide, on the other hand, alters Na+ movement only across the choroidal epithelium.

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Effect upon serum insulin, glucose and potassium concentrations of acetazolamide during attacks of familial periodic hypokalemic paralysis.

In four patients with periodic hypokalemic paralysis paralytic attacks were induced in the untreated state and later, after the patients had been treated with acetazolamide. There was a distinct, clinically favourable effect of acetazolamide upon the length as well as the severity of paralysis. The maximum fall in serum potassium was less marked during acetazolamide therapy. After treatment all four patients showed significantly reduced serum levels of glucose and insulin during induced attacks of paralysis as compared with the levels obtained during paretic attacks in the untreated state. These findings indicate that the prophylactic effect of this drug does not relate merely to metabolic acidosis. The hypothesis is advanced that the lower serum insulin and glucose levels might represent reduced absorption which would amount to an indirect prophylactic action.

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Morphometric and microscopic evaluation of the effect of solution of acetazolamide as an intracanal therapeutic agent in late reimplanted rat teeth.

The use of substances that inhibit root resorption may be an alternative for cases of unsuccessful reimplants. Hence, the purpose of this study was to test a solution of acetazolamide, a resorption inhibitor, as an intracanal therapeutic agent for late reimplanted teeth. Thirty rat maxillary right central incisors were avulsed and kept dry for 30 min. The teeth were instrumented, and the root surfaces treated with 1% hypochlorite solution followed by application of 2% sodium fluoride. Thereafter, the teeth were divided into two groups according to the intracanal dressing: Group I, solution of acetazolamide and Group II, calcium hydroxide paste. Teeth were then reimplanted in their respective sockets. The animals were killed at 15, 30, and 60 days after reimplantation and the samples processed for morphometric and microscopic analysis. The results showed that calcium hydroxide paste limited root resorption, even though not avoiding it. In contrast, no root resorption was observed after 60 days in the acetazolamide group, confirming the efficacy of the substance in inhibiting root resorption.

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Extracranial intravascular vasodilatory response to acetazolamide and magnetic resonance angiography.

Cerebral vasodilatory testing provides an important measure of both the hemodynamic significance of arterial occlusive disease and the adequacy of collateral pathways. This study measured the extracranial intravascular volume flow rate response to acetazolamide using phase-contrast magnetic resonance angiography. From 10 patients with unilateral carotid transient ischemic attacks (TIAs), a total of 18 extracranial carotid arteries (10 symptomatic, 8 asymptomatic, 2 occluded) and 19 extracranial vertebral arteries were studied. Patients were free of large-vessel intracranial stenoses, evident areas of ischemic infarction, evident areas of nonspecific white matter change, and hemodynamic or low-flow induction of TIA symptomatology. Asymptomatic carotid volume flow rates rose from 151 +/- 19 (standard error of mean) to 220 +/- 26 ml/min while symptomatic flow rates rose from 106 +/- 22 to 145 +/- 25 ml/min. Dominant vertebral volume flow rates rose from 128 +/- 23 to 160 +/- 22 ml/min while nondominant rates rose from 40 +/- 12 to 61 +/- 15 ml/min. Carotid volume flow rates were inversely proportional to percent stenosis for both baseline (r = 0.51, p < 0.02) and acetazolamide (r = 0.81, p < 0.001) data. Baseline-plus-acetazolamide volume flow rate techniques safely measure intravascular vasodilatory responses. Intracranial measurement techniques are being developed to further study cerebrovascular reserve using phase-contrast magnetic resonance angiography.

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Gender-related differences in acetazolamide-induced cerebral vasodilatory response: a transcranial Doppler study.

Cerebrovascular reactivity, cerebrovascular reserve capacity, and velocity acceleration can be easily and reliably assessed by measuring acetazolamide-induced changes using transcranial Doppler. The authors' aim was to determine whether there are gender-related differences in these parameters. Fifty-six healthy subjects (27 males, 29 females) were examined using transcranial Doppler. Velocities in the middle cerebral artery on both sides were recorded before and at 5, 10, 15, and 20 minutes after intravenous administration of 1 g acetazolamide. The baseline mean flow velocity in the middle cerebral artery was significantly higher in women than in men (p < 0.02). After acetazolamide administration, significantly higher cerebrovascular reactivity, cerebrovascular reserve capacity, and velocity acceleration were observed in females than in males (p < 0.001 in all cases). Subgroup analysis showed that women before menopause responded with higher cerebrovascular reserve capacity and velocity acceleration than age-matched men (p < 0.01 and p < 0.001, respectively), but no significant difference was found between females after menopause and men of similar age.

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Acetazolamide on the ventral medulla of the cat increases phrenic output and delays the ventilatory response to CO2.

1. Acetazolamide (0.1 mM) applied to the surface of the rostral ventrolateral medulla or microinjected beneath the medullary surface in chloralose-urethane-anaesthetized, vagotomized, carotid-denervated, paralysed, servo-ventilated cats produced a long-lasting increase in integrated phrenic nerve activity. 2. Extracellular pH measured beneath the rostral ventrolateral medulla exhibited a long-lasting decrease after surface acetazolamide but was not a good predictor, in each individual animal, of changes in phrenic activity. 3. Medullary carbonic anhydrase inhibition reduced the slope and the half-time of the phrenic response to rapid step CO2 increases. Conversely, acetazolamide did not affect the phrenic response to steady-state CO2 increases. 4. These data indicate that localized inhibition of medullary carbonic anhydrase causes a centrally mediated increase in ventilation that we attribute to medullary tissue hypercapnia and acidosis. In addition, these data indicate that medullary carbonic anhydrase may play a role in central CO2 chemotransduction.

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