GP vs. specialist.
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Biomedical subjects
Publications and source records attributed to K E Wirth.
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Bombesin (BN) and the related mammalian peptides gastrin-releasing peptide (GRP), neuromedin C (NMC), and neuromedin B (NMB) suppress food intake in rats. Recent studies show two distinct receptor subtypes, GRP-preferring and NMB-preferring. BN interacts equally with both subtypes raising the possibility that one or both subtypes mediate the reduction of feeding by BN. To examine this issue, we compared suppression of intake produced by dose ranges (0-100 nmol/kg) of BN, GRP, NMC, and NMB and acetylated NMC and NMB. We found that all peptides elicited dose-dependent reductions of intake with overall differences in potency and efficacy. At intermediate doses, the rank order of potency for suppression was BN = AcNMC > NMC = GRP > NMB = AcNMB; however BN, GRP, and NMC were equipotent at the lowest and highest doses. Coadministration of NMC or GRP and NMB produced suppressions above that of either peptide alone and equivalent to BN. Taken together, these data support a role for both receptor subtypes in the suppression of food intake by BN and BN-like peptides.
P6e correlations between serum cholesterol, triglycerides and lipoproteins and serum vitamins A and E were tested in patients with age-related macular degeneration (AMD). Patients diagnosed as having "senile" macular degeneration who were not receiving medical treatment that would interfere with lipid or vitamin metabolism consecutively underwent-fundus photography and fluorescein angiography in a 6-month period. Cholesterol, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), vitamin A and E were assayed using conventional methods (enzymatic and high-performance liquid chromatography). Sixty-four angiographies from 64 patients were evaluated. The clinical diagnosis was: "hard" drusen (n = 5), geographic atrophy (25), "soft" drusen (10), subretinal neovascularization and disciform scar (24). The percentage of pathological data was calculated: HDL, 89%; cholesterol, 84%; vitamin A, 75%, LDL, 66%; Vitamin E, 33%; triglycerides, 23%. The data differed somewhat between groups. The high prevalence of hypercholesterolemia in older age groups [3, 34] prevents cholesterol from being identified as a risk factor for AMD. Elevated levels of atherogenic LDL and reduced vitamin A are discussed versus "protective" HDL and vitamin E. In many of the AMD cases described, the cardiovascular risks of dyslipoproteinemia demand adequate therapy.
In 33 healthy male volunteers, given a single oral and intravenous dose of cymarin (k-strophanthin-alpha), k-strophanthoside (k-strophanthin-gamma) and ouabain (g-strophanthin), enteral absorption and renal excretion of these glycosides and their metabolites were investigated by radioimmunoassay and HPLC. Cymarin was absorbed at 47% of the given dose. After intravenous injection 46% and after oral administration 21% of the given dose, i.e. the total amount as detected by radioimmunoassay which consisted of the unchanged glycoside and its metabolites, were excreted by the kidneys mainly as conjugated metabolites. The half-life of elimination, calculated from the total excreted amount was 13 h (i.v.) and 23 h (p.o.), respectively. k-Strophanthoside was absorbed at 16% of the given dose. After i.v.-injection 73% of the given dose was excreted by the kidneys with a half-life of elimination of 99 h. From this total amount about 70% was excreted as the unchanged drug, the remaining 30% as various metabolites. After oral administration 11% of the given dose were excreted with a half-life of elimination of 22 h. 80% of this amount consisted mainly of conjugated k-strophanthoside and conjugated metabolites as k-strophanthin-beta, cymarin, k-strophanthidin, cymarol and k-strophanthidol. Only 6% was excreted as the unchanged drug. Ouabain was absorbed after oral administration to a minimum of 1.4%. Given intravenously a total renal excretion of 33% of the given dose with a half-life of elimination of 23 h was measured. Of this 80% was unchanged ouabain.(ABSTRACT TRUNCATED AT 250 WORDS)
In 36 patients with cardiac arrhythmias (predominantly ventricular premature beats), who were on oral aprindine long-term therapy with 50 to 400 mg daily, plasma levels were measured by gas chromatography after 3.5 hours of the last administration. There was a general dependency of plasma levels on the given dose, however, with considerable overlapping in individual values. In 24 patients the arrhythmias ceased, in six patients there was a clear, in two a moderate improvement. There was no clear therapeutic effect in four patients who were treated with a daily dose of 50 and 100 mg, respectively. Among the 36 patients, three who had plasma levels exceeding 2 micrograms/ml developed tremor and dizziness. After dose-reduction these side effects disappeared. The present results suggest that therapeutic plasma levels of aprindine are in the range of 1.0 to 1.75 micrograms/ml. A plasma level of 2 micrograms/ml should not be exceeded because of the possibility of side-effects. In six healthy males time-concentration curves of aprindine and its metabolites in plasma and urine were measured by gas chromatography. From the results a two-compartment model may be applied, the half-life of elimination was calculated to be 37 hours (plasma) and 31 hours (urine). With respect to the metabolites, in plasma only des-ethyl-aprindine (DEAP), in urine DEAP, hydroxy-, des-phenyl- and des-indanyl-aprindine could be found. Unlike aprindine, the DEAP-concentration curve in plasma showed a very slight decrease until the end of the 96-hour period of determination.
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The effect of spironolactone on the metabolism of intravenously administered 3H-digitoxin (80 muCi) was investigated in eight patients. In three of them the labelled glycoside was given on a second occasion after spironolactone treatment had been discontinued for at least 65 days. Of total urinary radioactivity 79% was unaltered drug and 12% consisted of water soluble compounds. No digitoxigenin or digoxigenin and only trace amounts (less than 2 %) of digoxin and the bis- and monoglycosides of digoxigenin were found. After spironolactone total urinary radioactivity was unchanged but the fraction eliminated as unchanged digitoxin fell from 79 to 66 % and the water soluble compounds increased from 12 to 26 % (p less than 0.05). In addition spironolactone caused a 20 ( reduction in the half-life of serum radioactivity (p less than 0.01) and a 16 % reduction in the volume of distribution (p less than 0.05). Induction of hepatic enzymes by spironolactone is proposed to explain the alteration in the metabolism of digitoxin in man. Both the altered metabolic pattern and the reduction in the volume of distribution appear to contribute to the reduction in half-life.
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