[Two elderly patients with thoracic herpetic pain and post herpetic neuralgia treated with continuous thoracic sympathetic ganglion block through a placed catheter].

Epidural block is very useful in the treatment of herpetic pain and post herpetic neuralgia. However, in the elderly patients with cardiac disease or diabetes mellitus, severe cardiovascular changes may occur by epidural block. Epidural block caused severe hypotension in two elderly patients with herpetic pain and post herpetic neuralgia who had diabetes mellitus or hypertension. Continuous thoracic sympathetic ganglion block with local anesthetics through a placed catheter reduced their pain and caused almost no changes in cardiovascular system.

Wegener's granulomatosis with dural involvement as the initial clinical manifestation.

We treated a patient with an atypical presentation of Wegener's granulomatosis (WG) with dural involvement as the initial clinical manifestation. A 37-year-old man had a dural lesion without lower respiratory tract or renal manifestations in the initial clinical course. His only initial symptom was headache, and at disease onset computed tomography (CT) and magnetic resonance imaging (MRI) of the head revealed bilateral abnormal subdural masses. The diagnosis of WG was made based on the results of needle biopsy of the nasal polyps and the finding of positive circulating antineutrophil cytoplasmic antibodies (c-ANCA). He achieved remission on daily prednisone and cyclophosphamide with the later addition of sulfamethoxazole-trimethoprim.

[Prostaglandin E1 at low-doses improved right ventricular ejection fraction in anesthetic management for CABG].

A 52-year-old male for CABG developed a severe right heart failure, because of the direct injury to the right ventricular wall, after cardiopulmonary bypass. The volume loading therapy could not improve the cardiac function, then we used an infusion of low-dose prostaglandin E1 (0.02-0.04 micrograms.kg-1.min-1) for the acute right heart failure with increased pulmonary vascular resistance. After continuous infusion of this dose, the pulmonary vascular resistance decreased quickly, the right ventricular ejection fraction increased, and the stroke volume index also improved. These hemodynamic changes are the result of the potent vasodilating effect of PGE1, that especially could decrease selectively the pulmonary vascular resistance, and increase the preload of the left ventricle. This dose of PGE1, did not cause a severe systemic hypertension that is a serious complication during vasodilating therapy with any vasoactive drugs. In the present case, we speculated that the low-dose PGE1, is effective to improve the right ventricular function during the acute right heart failure which resulted from the intrinsic right ventricular dysfunction.

[Perioperative managements of a mentally retarded child with obstructive sleep apnea syndrome for adeno-tonsillectomy].

We describe a mentally retarded child with obstructive sleep apnea syndrome (OSAS) in whom it was difficult to maintain upper airway in the perioperative period. The child underwent awake intubation, because the preanesthetic evaluation of the airway with a direct fiberoptic visualization revealed a very narrow airway. Also we considered that if we used an anesthetic agent, a perioperative airway management would be very troublesome. Postoperatively we continuously monitored for apnea and arrhythmias. When the child was sleeping, we found frequently that her thoratic movements were getting weak and percutaneous oxygen saturation went down to about 70 percent. The preoperative direct fiberoptic visualization of the upper airway is effective for the evaluation of the degree of airway obstruction in this child. We also recommend the continuous intensive postoperative monitorings including pulse oximetry, ECG, and apnea monitor which are very important to avoid life-threatening complications such as upper airway obstruction and serious arrhythmias in patients with obstructive sleep apnea syndrome.

[Calcitonin gene-related peptide and human atrial natriuretic hormone levels in response to cardiac operation under high dose fentanyl anesthesia].

To elucidate a role of calcitonin gene-related peptide (CGRP) in anesthesia and surgery with cardiopulmonary bypass (CPB), we measured CGRP which is reported to be a marker for fluid overload, simultaneously with HANP (human atrial natriuretic hormone) in 12 patients during high dose fentanyl anesthesia (50-70 microgram. kg-1). Plasma concentration of CGRP increased to 3 times of the value during preanesthetic phase at 30 min after initiation of CPB. A 3-fold increase compared with control in CGRP occurred 30 min after initiation of CPB. A 3-fold increase in HANP also occurred just before termination of CPB. But, there was no correlation between plasma levels of CGRP and HANP. The changes in CGRP did not relate with those of pulmonary capillary wedge pressure. The results of the present study suggest that the mechanism for the increase is unclear, and CGRP could be influenced during cardiac or coronary artery surgery using CPB.

Determination of acetylcholine release in the striatum of anesthetized rats using in vivo microdialysis and a radioimmunoassay.

A vertical-type in vivo microdialysis probe and a sensitive, specific radioimmunoassay (RIA) were used to study the mechanism of acetylcholine (ACh) release in the striatum of anesthetized rats. Without the use of physostigmine, a cholinesterase inhibitor, our RIA could still detect the amount of ACh present in the perfusate (5.6 +/- 0.6 fmol/min, n = 16). Tetrodotoxin (1 microM) produced a significant decrease in the amount of ACh collected in the perfusate, suggesting that basal ACh determined under the present experimental conditions was related to cholinergic neural activity. Atropine (0.1-1 microM) applied topically via the dialysis probe did not affect the amount of ACh recovered in the perfusate in the absence of physostigmine. Addition of physostigmine (10 microM) to the perfusion fluid produced about a 100-fold increase in the amount of ACh collected. In the presence of physostigmine, topical administration of atropine and pirenzepine (0.01-1 microM) through a dialysis probe produced a further three- to fourfold increase in ACh output, whereas a slight increase was produced by AF-DX 116 at the highest concentration (1 microM). These results indicate that presynaptic modulation of ACh release in the striatum does not occur under basal conditions, and that presynaptic M1 muscarinic receptors are involved in the modulation of ACh release when the ACh concentration is raised under certain conditions.

Regional differences in extracellular choline dependency of acetylcholine synthesis in the rat brain.

Acetylcholine (ACh) synthesis under conditions of restricted extracellular choline uptake was investigated in order to clarify the procurement of choline for ACh synthesis using slices of several regions of the rat brain. Extracellular choline-independent ACh synthesis was observed in the hippocampus, frontal cortex and caudate putamen, which contain cholinergic nerve terminals, whereas little or no synthesis was observed in the medial septum or basal nucleus of Meynert, which contain cholinergic cell bodies. These results indicate that cholinergic nerve terminals, but not the cell bodies, may be able to synthesize choline for ACh biosynthesis. Extracellular choline-dependent ACh synthesis was observed in all regions examined. In the presence of 10 microM choline, the highest content of newly synthesized ACh and the proportionate increase in ACh compared with the unreleasable fraction (basal level) were observed in the caudate putamen. In the frontal cortex, although the level of synthesized ACh was low, the proportionate increase in ACh was high. In contrast, in the medial septum and basal nucleus of Meynert, high levels of ACh with a low proportionate increase compared with basal levels were observed. In the presence of hemicholinium-3, extracellular choline was also taken up for ACh synthesis in all regions examined, the level being especially high in the frontal cortex and medial septum. The present results indicate that the manner of choline procurement for ACh synthesis is heterogeneous among the various regions of the rat brain.

Antihypertensive effect of synthetic tetrandrine derivatives in SHR rats.

1. Effects of oral administration of synthetic tetrandrine (TD) derivatives (20 mg/kg per day) for 9 weeks on blood pressure, heart rate, plasma renin concentration (PRC) and vascular reactivities to pressor substances were studied in spontaneously hypertensive (SHR) rats. 2. 7-O-Ethyl fangchinolin (7-O-EFC) and 7-O-isopropyl fangchinolin (7-O-IFC) produced a significant and sustained reduction in blood pressure from the first week of administration. 7-O-EFC reduced heart rate when determined under restraint conditions, but not under unanesthetized, freely moving conditions. 3. TD derivatives produced no effect on PRC. 4. Pressor response to phenylephrine was reduced significantly whereas the response to angiotensin II was enhanced after prolonged administration of 7-O-EFC and 7-O-IFC. 5. These results demonstrate that TD derivatives are potential antihypertensive drugs, and that attenuation of the pressor response to phenylephrine may contribute at least in part to its antihypertensive effect.

Antihypertensive and diuretic effects of YM-09730-5, a new calcium antagonist, in stroke-prone spontaneously hypertensive rats.

1. Effects of consecutive administration of YM-09730-5, (3S)-1-benzyl-3-pyrrolidinyl-methyl (4S)-2,6-dimethyl-4-(m-nitrophenyl)-1,4-dihydropyridine-3,5-dicarboxy lat e hydrochloride, a new calcium antagonist, for 9 wk on blood pressure and urinary excretion of electrolytes were studied in stroke-prone spontaneously hypertensive (SHRSP) rats. 2. YM-09730-5 (1 and 3 mg/kg per day, p.o.) prevented development of hypertension and produced a significant reduction in blood pressure from the first week of the experiment. Nicardipine (15 mg/kg per day, p.o.) produced almost the same degree of antihypertensive effect as YM-09730-5 at a dose of 3 mg/kg. 3. YM-09730-5 produced significant diuresis and increased urinary excretion of electrolytes throughout the experiment. 4. Chronic administration of YM-09730-5 (3 mg/kg) reduced the severity of glomerular lesions in the kidney and vasculitis in the mesenteric artery. 5. These results demonstrate that YM-09730-5 is a potential antihypertensive drug with a potency about 5 times higher than that of nicardipine.

Synthesis and release of acetylcholine by cultured bovine arterial endothelial cells.

Using cultured endothelial cells prepared from bovine carotid artery, and a specific radioimmunoassay for acetylcholine (ACh), the synthesis and release of ACh by vascular endothelial cells were investigated directly. ACh content in the culture medium after 24 h of incubation in the presence of isoflurophate, a nonspecific cholinesterase inhibitor, was about 16 times higher than that in endothelial cells, indicating that ACh synthesized inside the cells was released rapidly. The presence of ACh in the culture medium was further confirmed qualitatively using high-performance liquid chromatography with an electrocapture detection. These results represent the first direct evidence that endothelial cells can synthesize and release ACh, suggesting the possibility that ACh acts not only as a neurotransmitter but also as an autacoid under certain conditions.

Pharmacological differentiation of presynaptic M1 muscarinic receptors modulating acetylcholine release from postsynaptic muscarinic receptors in guinea-pig ileum.

1. Effects of three muscarinic antagonists on electrically evoked ACh release and contractile response were investigated in longitudinal muscle strips of guinea-pig ileum suspended in an organ-bath and superfused with Krebs solution. ACh release was determined by a specific radioimmunoassay. 2. Telenzepine, a selective M1 muscarinic antagonist, increased the ACh release at a concentration of 100-fold less than that inhibiting the contractile response (10 vs 1000 nM). 3. AF-DX 116, a cardioselective M2 muscarinic antagonist, inhibited the contractile response at 10 microM, but did not affect the ACh release at this concentration. 4. (-)N-Methylscopolamine (NMS) did not affect the ACh release, but inhibited the contractile response at all concentrations tested (1-1000 nM), indicating (-)NMS can be used as an ileal specific postsynaptic muscarinic antagonist. 5. These data demonstrate that presynaptic muscarinic receptors modulating ACh release are distinct from postsynaptic ones involved in the contractile response and can be classified as M1 subtype.

Structure and hypotensive activity relationships of tetrandrine derivatives in stroke-prone spontaneously hypertensive rats.

1. Structure and hypotensive activity relationships of tetrandrine (TD), an alkaloid isolated from the Chinese herb Radix stephaniae tetrandrae and its derivatives were investigated in conscious stroke-prone spontaneously hypertensive rats (SHRSP). 2. Derivatives substituted at the 7-O position with various types of alkyl group produced varying degrees of hypotensive effect. 3. While the demethylated derivative, fangchinoline (FC), and its acetylated compound had no effect on blood pressure, 7-O-methyl FC (TD), and 7-O-ethyl and 7-O-isopropyl FC at oral doses of 25 and 50 mg/kg produced a gradual and sustained hypotensive effect without any significant effects on heart rate and plasma renin concentration. 4. Substitution at the 7-O position with longer side chains such as n-propyl, n-butyl and n-pentyl groups reduced both the degree and duration of hypotensive activity. 5. Substitution of N-methyl groups at the 2 and 2' positions with quaternary ammonium or N-oxide attenuated the hypotensive activity. 6. The results of this study suggest a possibility that 7-O-ethyl and 7-O-isopropyl derivatives as well as TD can be considered as potential antihypertensive drugs because of the gradual onset and long duration of their hypotensive action in SHRSP.

Extraneuronal localization of acetylcholine and its release upon nicotinic stimulation in rabbits.

A study was undertaken to examine the origin of plasma acetylcholine (ACh). The ACh content of blood cells was about 25 times higher than that of plasma in normal rabbits (3,722 vs 140 pg/ml blood, n = 7). Plasma ACh content in rabbits having antibody against ACh was about 80 times higher than in normal rabbits, while no difference was observed in the ACh content of blood cells between the groups. Nicotine (100 micrograms/kg, i.v.) produced a significant increase in plasma ACh content and a decrease in the ACh content of blood cells in normal rabbits. These data demonstrate that a large amount of ACh is localized in blood cells and that a considerable proportion of plasma ACh originates from blood cells, suggesting that ACh acts not only as a neurotransmitter but also as an autacoid.

Effects of TRH and DN-1417 on high potassium-evoked acetylcholine release from rat basal forebrain slices determined directly by radioimmunoassay.

1. High potassium (50 mM)-evoked acetylcholine (ACh) release from rat basal forebrain slices under conditions without an exogenous choline supply was determined using a radioimmunoassay for ACh. 2. A consistent amount of ACh release was observed at each repetitive stimulation and ACh content in brain slices was not altered by potassium stimulations. These results indicate the existence of a large intracellular releasable ACh store, which is independent of new synthesis from exogenous choline. 3. Atropine, even at a concentration of 10(-6) M, did not affect the potassium-evoked ACh release. Thus, modulation of ACh release by the muscarinic autoreceptor was not revealed under the conditions employed. 4. Thyrotropin-releasing hormone (TRH, 10(-4) M) caused a slight and statistically insignificant increase in potassium-evoked ACh release. DN-1417, a TRH analogue, at a concentration of 10(-4) M significantly increased potassium-evoked ACh release. These findings indicate that DN-1417 is able to enhance ACh output independently of ACh synthesis from exogenous choline.

Reduction in blood pressure and vascular reactivities to pressor substances by chronic treatment with piretanide in spontaneously hypertensive rats.

1. Effects of treatment with piretanide (10 and 30 mg/kg per day p.o.) for 9 weeks on blood pressure, urinary excretion of electrolytes, and vascular reactivities to pressor substances were investigated in 10-week-old spontaneously hypertensive (SHR) rats. 2. Piretanide (30 mg/kg) prevented development of hypertension and produced a significant reduction in blood pressure from the 2nd week of the treatment. A slight decrease in blood pressure was observed in rats treated with the lower dose of piretanide. 3. Piretanide produced significant and dose-dependent diuresis throughout the experiment. Although significant natriuresis was observed in the 1st and 4th week of the treatment, natriuresis disappeared in the 8th week. Urinary excretion of potassium was decreased significantly by piretanide throughout the experiment. 4. Attenuation of pressor responses to phenylephrine and angiotensin II was observed after chronic administration of piretanide (30 mg/kg). 5. These data demonstrate the contribution of attenuated vascular reactivities to pressor substances as well as a diuretic action to the antihypertensive effect of piretanide during its long-term administration in SHR rats.

Direct determination of acetylcholine release by radioimmunoassay and presence of presynaptic M1 muscarinic receptors in guinea pig ileum.

Radioimmunoassay for acetylcholine (ACh) with a sensitivity of 10 pg/tube was applied to the direct determination of ACh output from the nerve endings in longitudinal muscle strips of guinea pig ileum. The strips were preincubated with an irreversible cholinesterase inhibitor and superfused with Krebs' solution under various experimental conditions. Pirenzepine (0.1-10 microM) and atropine (10-100 nM) produced an increase in electrically evoked ACh output through the inhibition of presynaptic muscarinic receptors. Contractile response to endogenous ACh released by electrical stimulation was enhanced by pirenzepine and atropine at lower concentrations, whereas the highest concentrations of pirenzepine (10 microM) and atropine (100 nM) caused a reduction in the enhanced contractile response and a significantly diminished response, respectively. These results demonstrate that the concentrations of pirenzepine and atropine, effective in inhibiting presynaptic muscarinic receptors, differ from those inhibiting postsynaptic muscarinic receptors and suggest the possibility that presynaptic M1 muscarinic receptors regulating ACh output may be present in the guinea pig ileum.

Presynaptic M1 muscarinic receptor modulates spontaneous release of acetylcholine from rat basal forebrain slices.

Spontaneous release of acetylcholine (ACh) from rat basal forebrain slices in the presence of cholinesterase inhibitor was directly determined using a specific radioimmunoassay for ACh. The release was calcium dependent. A consistent amount of ACh release was observed throughout the experiment. Atropine (10(-8) to 10(-5) M) and pirenzepine (10(-7) to 10(-5) M) enhanced spontaneous ACh release. These findings indicate the presence of an M1 muscarinic autoreceptor that modulates spontaneous release of ACh in the rat basal forebrain.

Plasma concentration of acetylcholine in young women.

A sensitive and specific radioimmunoassay was applied to the determination of acetylcholine (ACh) in plasma. The concentration of ACh in plasma sampled from 32 young women was 456.1 +/- 53.1 (mean +/- S.E.M.) pg/ml. No significant correlations were observed between plasma concentration of ACh and acetylcholinesterase (AChE) activity, or gonadal hormones. These data demonstrate that an amount of ACh measurable by radioimmunoassay is present in plasma and plasma ACh is not regulated by AChE activity and the menstrual cycle in young women. The origin and physiological as well as pathophysiological significance of ACh in plasma remain to be clarified.

Antihypertensive action of melatonin in the spontaneously hypertensive rat.

The effects of melatonin on blood pressure and heart rate were studied in 23-week-old male spontaneously hypertensive rats. Melatonin infused i.p. at a dose of 6 mg/rat per day for 5 days using an osmotic minipump produced a significant reduction of blood pressure and a slight but significant decrease of heart rate in the conscious and unrestrained state. These cardiovascular effects of melatonin developed gradually. Plasma renin concentration tended to decrease after melatonin treatment. These results demonstrate that melatonin has an antihypertensive action. The mechanism of the antihypertensive action of melatonin requires further study.