Familial occurrence of cerebral arteriovenous malformation in sisters: case report and review of the literature.

Cerebral arteriovenous malformations (AVMs) are considered to be congenital disorders. However, their familial occurrence has so far been described in only 19 families in the literature. The authors report on two cases in one family and review the literature. A 45-year-old female subject with sudden onset of headache and vomiting due to a subarachnoid haemorrhage from a small AVM in the posterior part of the corpus callosum near the midline on the left side was studied. Irradiation of the AVM using Leksell's gamma knife led to its complete obliteration. Her older sister presented with temporal seizures at the age of 49 and later also with left hemiparesis, left hemihypaesthesia and dizziness - caused by a large AVM in the right temporal lobe. This AVM was treated by a combination of embolization and irradiation by the Leksell's gamma knife.

Pharmacokinetics and pharmacodynamics of allopurinol in elderly and young subjects.

AIMS: The prevalence of hyperuricaemia and gout increases with age as does the incidence of adverse effects to allopurinol, the major uric acid lowering drug. The present study was performed to compare the disposition and effects of allopurinol and its active metabolite oxipurinol in elderly and young subjects without major health problems. METHODS: Ten elderly (age range 71-93 years) and nine young subjects (24-35 years) received an oral dose of 200 mg allopurinol in an open, single dose, cross sectional design. Four of these individuals were additionally dosed with 200 mg allopurinol intravenously. Plasma and urine concentrations of allopurinol, oxipurinol, hypoxanthine, xanthine, and uric acid were measured by h. p.l.c. RESULTS: Total clearance of allopurinol was not different in elderly (15.7+/-3.8 ml min-1 kg-1, mean+/-s.e. mean) and young subjects (15.7+/-2.1), whereas total clearance of oxipurinol was significantly reduced in the aged (0.24+/-0.03) compared with young controls (0.37+/-0.05) as was the distribution volume of oxipurinol (0.60+/-0.09 and 0.84+/-0.07 l kg-1, respectively). Oxipurinol was eliminated primarily by the kidneys, allopurinol by metabolism. Fractional peroral bioavailability of allopurinol was 0.81+/-0.16 (n=4, two elderly and two young subjects). Although maximal plasma concentrations of oxipurinol were significantly higher in elderly (5. 63+/-0.83 microgram ml-1 ) than in young persons (3.75+/-0.25) as was the area under the oxipurinol plasma concentration-time curve, AUC (260+/-46 and 166+/-23 microgram ml-1 h, respectively), the pharmacodynamic effect of oxipurinol was smaller in elderly than young subjects (time-dependent decrease of plasma uric acid 83+/-30 microgram ml-1 h in elderly compared with 176+/-21 in young controls). Oxipurinol increased the renal clearance of xanthine, suggesting inhibition of tubular xanthine reabsorption by oxipurinol. CONCLUSIONS: Although allopurinol elimination is not reduced in the aged, that of its active metabolite oxipurinol is because of an age-dependent decline in renal function. Xanthine oxidase inhibition by oxipurinol appears to be reduced in old age. In addition to its uricostatic action, oxipurinol has a xanthinuric effect which is also diminished in the elderly.

Pharmacokinetics and pharmacodynamics of the diuretic bumetanide in the elderly.

In a cross-sectional study of the pharmacokinetics and pharmacodynamics of peroral and intravenous bumetanide (0.5 mg, single dose), total and renal clearance of the diuretic was significantly lower in elderly persons than in young adults, resulting in higher bumetanide plasma levels in the aged. Nonrenal clearance, bioavailability, and the volume of distribution were not significantly changed. Together with the decreased delivery into the urine the diuretic and natriuretic effect of bumetanide was reduced in the elderly. Renal clearance of bumetanide was linearly related with creatinine clearance, hence the decreases in bumetanide clearance and diuretic efficacy in the elderly are attributed to the age-dependent decline in renal function. The bumetanide concentration in urine and the fractional sodium excretion were not different in the two age groups, suggesting that the decrease in diuretic response in the elderly is a result of a reduction in the number of functioning nephrons, whereas the response of the remaining nephrons to bumetanide is unaltered.

Frequency-dependent effects of amitriptyline and maprotiline on conduction in the guinea pig His-Purkinje-system in vivo.

In the Cardiac Arrhythmia Suppression Trial antiarrhythmic drug therapy with slow kinetic sodium channel blockers (class Ic antiarrhythmic drugs) was associated with excess mortality, presumably due to drug induced proarrhythmia. It has been suggested that the degree of rate-dependent conduction slowing produced by agents that have sodium channel blocking properties may be related to the proarrhythmic propensity of these agents. In the present study, rate-dependent conduction slowing by the antidepressants amitriptyline and maprotiline was investigated in anesthetized guinea pigs. After electrical ablation of the sinus node the left atrium was stimulated at cycle lengths between 200 ms and 500 ms. His bundle electrograms were registered by means of an epicardial electrode. Drugs were administered by i.v. infusion of 0.2 mg kg-1 min-1 for 30 min followed by 0.1 mg kg-1 min-1 for up to 30 min. Both drugs produced substantial rate-dependent conduction slowing within the His-Purkinje-system. The relationship between pacing rate and conduction slowing was well fitted by linear regression. The steepness of the regression line was significantly greater for amitriptyline than for maprotiline (slope factors: 9.10 x 10(-4) +/- 7.85 x 10(-5), n = 6, vs. 6.29 x 10(-4) +/- 2.97 x 10(-5), n = 6, P < 0.001), indicating that conduction slowing by amitriptyline exhibits a greater degree of rate-dependence than conduction slowing by maprotiline.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacokinetics of indomethacin in the elderly.

In a cross-sectional study the pharmacokinetics of indomethacin were studied in old and young adults without manifest organ failure. Total clearance of indomethacin after a single oral dose of 50mg was 0.8 ml/min/kg in elderly individuals (mean 79.5 +/- 1.3 years) compared with 1.4 ml/min/kg in younger individuals (mean 36.9 +/- 3.0 years). The apparent elimination rate constant averaged 0.23 h-1 in the aged and 0.32 h-1 in the young people. Oral bioavailability was close to 1 in the young but 0.77 in the elderly. The apparent volume of distribution was similar in each group. Based on these results it is suggested that the maintenance dose of indomethacin be reduced by 25% in the elderly.

[Cardiovascular pharmacology. An example of the need of clinically relevant pharmacological research]. / Herz- und Kreislaufpharmakologie. Ein Beispiel der Notwendigkeit kliniknaher pharmakologischer Forschung.

Like all other scientific disciplines, preclinical pharmacological research is subject to permanent changes. New measuring devices and the possibility of continuous on line data acquisition have markedly influenced basic research in this field. Another aim of modern cardiovascular pharmacology is the testing of promising drugs in clinically relevant animal models of disease, particularly under conditions, referring to the everyday situation in patients, e.g. physical activity. Investigations carried out in this way allow an exact assessment of the clinical efficacy of new drugs, and are, thus, clearly indispensable, also from the ethical point of view, before primary evaluation of the drug in man.

Sodium absorption and potassium secretion in rabbit colon during sodium deficiency.

Reducing the daily Na intake of rabbits from approximately 4.4 to 0.1 meq/kg body wt increases plasma aldosterone levels and the rate of amiloride-sensitive Na transport in the descending colon two- to threefold. The stimulation of Na transport is a result of an increase in the maximum transport capacity of the epithelium, whereas the affinity of Na to its transport system is not altered. Simultaneous with enhanced Na absorption, there is statistically significant K secretion of 0.25 mu eq . cm-2 . h-1 under short-circuit conditions. Transepithelial current-voltage relations in the absence and presence of amiloride were used to determine the Na permeability of the apical membrane and the intracellular Na activity of the Na-transporting cells. The Na content of the amiloride-sensitive cells was estimated from the kinetics of absorptive Na tracer fluxes. The stimulation of active Na transport under conditions of dietary Na restriction is associated with parallel increases in apical membrane Na permeability and the Na content of the amiloride-sensitive cells, but the intracellular Na activity and the activity of the epithelial Na-K-ATPase are not significantly altered. Taken together, these results suggest that endogenous aldosterone increases the number of conducting Na entry sites in the apical membrane of colonic epithelium and that there is activation of additional Na pump units in the basolateral membrane, brought about by cell swelling and possibly by an increase in the fraction of epithelial cells that participate in active Na transport.

Metabolism and disposition of 2',3'-di-O-nitro-adenosine-5'-(N-ethyl-carboxamide) in dogs.

2',3'-Di-O-nitro-[8-3H]-adenosine-5'-(N-ethyl-carboxamide) (20 micrograms/kg) was denitrated completely within 1-3 hr in perorally and intravenously dosed dogs. Extremely rapid disappearance of the unchanged drug in serum was parallelled by the instantaneous appearance of mononitrates with 3'-mononitrate levels exceeding those of 2'-mononitrate three-fold. The mononitrates were eliminated with a half-life of 30-70 min, giving rise to the completely denitrated product, adenosine-5'-(N-ethyl-carboxamide) (NECA). The latter product was not further metabolized and was eliminated with a half-life of about 4 hr. Urinary excretion averaged 50% of the administered dose within 4 days and was represented essentially by the completely denitrated drug. Volatile 3H-label of the drug was found in serum and urine during in vivo experiments. Oral bioavailability of the drug was about 90%. In vitro studies indicated that thiols are involved in denitration and reactions are catalysed by glutathione S-transferases, which were partially purified from dog liver. Nitrate ester cleavage was more easily accomplished at the 2'-position than at the 3'-position of the drug and resulted in the liberation of inorganic nitrite. Comparison of in vitro denitration rates gave the following ranking order; 2',3'-di-O-nitro-NECA greater than isosorbide-2,5-dinitrate greater than 2'-nitro-NECA greater than 3'-nitro-NECA greater than isosorbide-2-mononitrate, while nitrate ester cleavage of isosorbide-5-mononitrate was not detectable.

Does tissue ATP content limit active sodium transport across intestinal epithelia in vitro?

The ATP content of isolated epithelia of rabbit descending colon, incubated in oxygenated Ringer solution containing glucose, is increased by addition of 1 mM adenosine from 10.9 +/- 1.4 to 22.2 +/- 2.3 pmoles/mg, but the transport rate of the Na pump is not altered. It is therefore concluded that epithelial ATP synthesis is not rate-limiting for Na transport in this tissue under conditions of in vitro aerobic incubation.

Induction of drug metabolism in the rat by taglutimide, a sedative-hypnotic glutarimide derivative.

Pretreatment with taglutimide significantly decreased the plasma dicoumarol level and shortened the duration of hexobarbital-induced narcosis in rats. Furthermore, taglutimide pretreatment accelerated the in vitro metabolism of dicoumarol, hexobarbital, o-nitrophenyl acetate and procaine, but not of 3,4-benzypyrene, as assayed in the 10,000xg supernatant fraction of rat liver homogenate. No definite increase was observed in liver wet weight, nor in the amount of microsomal and total liver protein in comparison with the control values. No marked differences were found between the effects of short- (4-day) and long-term (17-day) pretreatment on any of the studied parameters. The changes in drug metabolism and liver protein observed after taglutimide pretreatment differed from those observed after pretreatment with either phenobarbital or 3,4-benzypyrene. Taglutimide, like other inducing agents, is lipophilic, but differs from them in not being a substrate of monooxygenases.

Plasma level of the prodrug midodrine and its active metabolite in comparison with the alpha-mimetic action in dogs.

Midodrine, i.v. or orally administered, causes a prolonged elevation of blood pressure and a reduction in heart rate. These cardiovascular changes are not correlated to the plasma levels of the intact drug. On administration of either midodrine or its metabolite, ST-1059, formed by cleavage of the glycine residue, the elevation of blood pressure and the reduction in heart rate were significantly correlated to the plasma level of ST-1059. The results are in agreement with the assumption that the pressor activity of midodrine is mainly exerted by its metabolite ST-1059.

Weak electrolyte transfer in the guinea pig jejunum: secretion of trimethoxybenzoic acid.

In isolated epithelia of guinea pig jejunum the transcellular permeation of 10(-4) M (carboxyl-14C)-3,4,5-trimethoxybenzoic acid (TMBA) in the direction blood-lumen was more than 10 times greater the transcellular permeation of 10(-4) M (carboxyl-was reduced to less than 2 by anaerobiosis or by increasing TMBA concentrations of up to 10(-2) M. Under aerobic conditions the cellular uptake of TMBA (10(-4) M) from the blood side was twice as high as that from the lumen side. In anaerobiosis the percentage of TMBA taken up into the epithelium was enhanced, when TMBA was administered on the lumen side, while the percentage was unchanged after administration on the blood side; thereby the difference in cellular TMBA concentrations was abolished. Similar results were obtained under aerobic conditions, if the TMBA concentration was increased up to 10(-2) M. The results are consistent with a three-compartment model with an intermediate compartment distinguished by a high pH as compared to that of the outer compartments and by a luminal boundary highly permeable for the ionized form of the substrate in contrast to the contraluminal boundary.