In search of the pathogenesis of refractory cervicobrachial pain syndrome.
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Cumulative Trauma Disorders↗
Biomedical subjects
M L Cohen
Publications and source records attributed to M L Cohen.
Epidemiology of drug resistance: implications for a post-antimicrobial era.
In the last several years, the frequency and spectrum of antimicrobial-resistant infections have increased in both the hospital and the community. Certain infections that are essentially untreatable have begun to occur as epidemics both in the developing world and in institutional settings in the United States. The increasing frequency of drug resistance has been attributed to combinations of microbial characteristics, selective pressures of antimicrobial use, and societal and technologic changes that enhance the transmission of drug-resistant organisms. Antimicrobial resistance is resulting in increased morbidity, mortality, and health-care costs. Prevention and control of these infections will require new antimicrobial agents, prudent use of existing agents, new vaccines, and enhanced public health efforts to reduce transmission.
Bacterial Infections↗
Presence of beta- but not alpha-adrenoceptors in the rat jugular vein: autoradiographical evidence.
Previous functional studies with the rat jugular vein have shown alpha-adrenergically mediated contraction was minimal to nonexistent, yet this tissue relaxed in response to norepinephrine via beta 1 and to isoproterenol via beta 2-receptor activation. Unlike the rat jugular vein, the rat aorta markedly contracted to norepinephrine and relaxed to beta-adrenoceptor stimulation. This study qualitatively examined the alpha- and beta-receptor distributions in the rat jugular vein, as compared to the rat aorta, with autoradiographical methods. Cross-sections of blood vessels were labelled with the alpha-receptor ligand, [125I]HEAT ([beta-(4-hydroxy-3-iodophenyl)-ethyl-aminomethyl]-tetralone) and the beta-receptor ligand, [125I]ICYP (iodo-cyanopindolol), and subsequently were opposed to emulsion coated coverslips. Specific binding of both alpha- and beta-receptors was demonstrated in the rat aorta. While specific beta-receptor binding was demonstrated in the rat jugular vein, this tissue showed no detectable alpha-receptors. These autoradiographic studies indicate that the lack of alpha-adrenergically mediated contraction in the rat jugular vein is likely due to a virtual absence of alpha-receptor binding sites, rather than poor functional alpha-receptor coupling.
Animals↗
In search of the pathogenesis of refractory cervicobrachial pain syndrome. A deconstruction of the RSI phenomenon.
OBJECTIVE: To discuss the clinical and social phenomenon of refractory cervicobrachial pain, more popularly known as repetitive strain injury (RSI), from the standpoint of medical knowledge and to present the phenomenon as a problem of chronic musculoskeletal pain in which clinical clues suggest a neuropathic pathogenesis. DATA SOURCES: Published articles from both medical and non-medical literature, primarily since 1980, were integrated with our clinical experience and observations. DATA SYNTHESIS: Three sets of formal responses to the issue--medical, psychiatric and sociological--were identified and analysed with respect to the validity of their conclusions, which formed the conventional wisdom. Clinical observation revealed clues to disturbed nociception in a carefully defined set of subjects with chronic cervicobrachial pain. Theoretical pathophysiological correlations of these led to the formulation of an hypothesis. CONCLUSIONS: We doubt that clinical method and diagnostic logic were rigorously applied to the RSI phenomenon, which helped to produce an unresolved controversy with widespread ramifications. Our hypothesis is that there is a central disturbance of nociception in this syndrome, induced by continual afferent barrage from nociceptors in anatomically relevant sites in the neck and upper limbs. Initial and proposed testing of this hypothesis are discussed.
Cumulative Trauma Disorders↗
Sumatriptan and 5-benzyloxytryptamine: contractility of two 5-HT1D receptor ligands in canine saphenous veins.
Sumatriptan and 5-benzyloxytryptamine are ligands with high affinity for 5-HT1D receptors in the caudate nucleus. Both compounds contracted canine saphenous veins, in vitro. Benzyloxytryptamine was less potent as a contractile agonist than sumatriptan which was less potent than serotonin. In high concentrations (greater than 10(-5) M) serotonin-induced contraction resulted, in part, from activation of alpha-adrenoceptors as determined by blockade of contraction with prazosin (10(-6) M) and idazoxan (10(-6) M). Likewise, benzyloxytryptamine but not sumatriptan also activated contractile alpha-receptors in the canine saphenous vein. Furthermore, benzyloxytryptamine antagonized contraction to sumatriptan in an apparently non-competitive fashion. Thus, benzyloxytryptamine, although possessing some alpha-receptor agonist activity, like sumatriptan, can interact with serotonin receptors in canine saphenous veins. Although effects of sumatriptan and benzyloxytryptamine quantitatively differed in canine saphenous veins, both agents showed similar affinity and agonist efficacy at 5-HT1D receptors in brain. These studies may reflect potential differences between the 5-HT1D receptor in brain and the 5-HT1-like receptor in canine saphenous veins.
Animals↗
Zatosetron, a potent, selective, and long-acting 5HT3 receptor antagonist: synthesis and structure-activity relationships.
Antagonists of 5HT3 receptors are clinically effective in treating nausea and emesis associated with certain oncolytic drugs, including cisplatin. Moreover, these agents may be useful in pharmacological management of several central nervous system disorders, including anxiety, schizophrenia, dementia, and substance abuse. Our studies on aroyltropanamides led to the discovery that dihydrobenzofuranyl esters and amides are potent 5HT3 receptor antagonists. Simple benzoyl derivatives of tropine and 3 alpha-aminotropane possessed weak 5HT3 receptor antagonist activity, as judged by blockade of bradycardia produced by iv injection of serotonin (5HT) to anesthetized rats. Within this series, use of benzofuran-7-carboxamide as the aroyl moiety led to a substantial increase of 5HT3 receptor affinity. The optimal 5HT3 receptor antagonist identified via extensive SAR studies was endo-5-chloro-2,3-dihydro-2,2-dimethyl-N-(8-methyl-8-azabicyclo[3.2.1]oc t- 3-yl)-7-benzofurancarboxamide (Z)-2-butenedioate (zatosetron maleate). The 7-carbamyl regiochemistry, dimethyl substitution, chloro substituent, and endo stereochemistry were all crucial elements of the SAR. Zatosetron maleate was a potent antagonist of 5HT-induced bradycardia in rats (ED50 = 0.86 micrograms/kg i.v.). Low oral doses of zatosetron (30 micrograms/kg) produced long-lasting antagonism of 5HT3 receptors, as evidenced by blockade of 5HT-induced bradycardia for longer than 6 h in rats. Moreover, this compound did not produce hemodynamic effects after i.v. administration to rats, nor did it block carbamylcholine-induced bradycardia in doses that markedly blocked 5HT3 receptors. Thus, zatosetron is a potent, selective, orally effective 5HT3 receptor antagonist with a long duration of action in rats.
Animals↗
mCPP but not TFMPP is an antagonist at cardiac 5HT3 receptors.
The prototypic arylpiperazines, meta-chlorophenylpiperazine (mCPP), meta-trifluoromethylphenylpiperazine (TFMPP) and quipazine are widely studied serotonergic ligands with nonselective effects at 5HT1 and 5HT2 receptor subtypes. The present study was designed to compare the affinities of these arylipiperazines at 5HT3 receptors, and to determine agonist or antagonist activity at 5HT3 receptors. Quipazine showed high affinity at brain 5HT3 receptors (IC50 = 4.4 nM) and was a potent agonist of the von Bezold-Jarisch reflex in anesthetized rats, a response mediated by cardiac 5HT3 receptors. In concentrations that activated 5HT3 receptors, quipazine also antagonized serotonin-induced bradycardia in anesthetized rats. Taken together, these data suggest that quipazine is an agonist/antagonist with high affinity at 5HT3 receptors in both brain and cardiac tissue. Although mCPP also showed relatively high affinity at brain 5HT3 receptors (IC50 = 61.4 nM), it did not activate the von Bezold-Jarisch reflex; instead, mCPP potently antagonized serotonin-induced bradycardia. Thus, mCPP acts as an antagonist at 5HT3 receptors in the periphery. Although both quipazine and mCPP possessed relatively high affinity at brain 5HT3 receptors, TFMPP did not bind appreciably to 5HT3 receptors in brain (IC50 = 2373 nM) and neither activated nor inhibited cardiac 5HT3 receptors. That TFMPP did not interact with 5HT3 receptors, whereas quipazine and mCPP did, is in marked contrast to the similar effects of all three arylpiperazines at other serotonin receptors. The selectivity of TFMPP for 5HT1 and 5HT2 receptors (i.e., its minimal affinity for 5HT3 receptors) suggests that this arylpiperazine may be a preferred ligand relative to mCPP when studying 5HT1 or 5HT2 receptor mediated responses.
Animals↗
Adverse effects of topical capsaicin in refractory cervicobrachial pain.
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Administration, Topical↗
Hemispheric supratentorial low-grade astrocytoma.
The records of 57 patients who were operated on at the Beilinson Medical Center from 1970 through 1982 for supratentorial low-grade astrocytomas were reviewed. The management of these patients was correlated with survival. Our study demonstrates that a younger age at onset and a negative radionuclide uptake on isotope scan, were the most important factors associated with a better survival rate. Extensive tumor resection combined with radiation therapy also exercised a beneficial effect in prolonging survival.
Adolescent↗
Characterization of the contractile serotonergic receptor in guinea pig trachea with agonists and antagonists.
5-Hydroxytryptamine (5-HT)2 receptors can be partially characterized by their sensitivity to ketanserin blockade and increase in phosphoinositide turnover upon stimulation. Previously, the contraction of guinea pig trachea to 5-HT was shown to be antagonized by the 5-HT2 receptor antagonists ketanserin and LY53857. However, 5-HT did not dramatically increase phosphoinositide turnover in guinea pig trachea, suggesting that the contractile receptor may be different from the classically defined 5-HT2 receptor. The present in vitro studies better characterize this receptor, using diverse serotonergic agonists and antagonists to profile in more detail the contractile serotonergic receptor in guinea pig trachea. With regard to agonists, the 5-HT2 receptor agonists DOI and alpha-methyl-5-HT contracted guinea pig trachea with greater potency than quipazine, 5-methoxytryptamine, 5-carboxamidotryptamine, 8-hydroxy-2-(di-N-propylamino)tetralin and 2-methyl-5-HT. Sumatriptan and 1-(3-chlorophenyl)-piperazine (10 nM-100 microM) were inactive as agonists. A strong correlation between agonist potency (EC50) and reported 5-HT receptor binding affinities was found for both the 5-HT1C (r = 0.890) and 5-HT2 (r = 0.831) receptor. Ketanserin, spiperone, ritanserin, LY53857, 1-napthylpiperazine, 1-(3-chlorophenyl)-piperazine, rauwolscine, ICS 205-930, cyanopindolol and sumatriptan all blocked 5-HT-induced contractions in guinea pig trachea. As occurred with agonist potencies, strong correlations were found between reported 5-HT1C (r = 0.814) and 5-HT2 (r = 0.912) receptor binding affinities in brain membranes and apparent dissociation constants (KB) for the 10 antagonists of 5-HT induced contraction in guinea pig trachea.(ABSTRACT TRUNCATED AT 250 WORDS)
Amphetamines↗
Molecular cloning, functional expression, and pharmacological characterization of a novel serotonin receptor (5-hydroxytryptamine2F) from rat stomach fundus.
Using the polymerase chain reaction amplification technique in conjunction with conventional cloning techniques, we have isolated a novel member of the serotonin [5-hydroxytryptamine (5-HT)] 1C/2 receptor subfamily (designated 5-HT2F) from rat stomach fundus. Two DNA fragments were amplified from cDNA synthesized from rat stomach fundus poly(A)+ RNA using the polymerase chain reaction technique with degenerate oligonucleotide primers derived from sequence comparisons of the second, third, and sixth putative transmembrane domains of known 5-HT receptors. These fragments were used as hybridization probes to isolate full length cDNA clones from rat stomach fundus cDNA libraries. Full length cDNA clones contained one open reading frame encoding a 479-amino acid protein with seven hydrophobic domains, characteristic of members of the guanine nucleotide-binding protein-coupled receptor superfamily. Within these seven putative transmembrane domains, the 5-HT2F receptor shared greatest homology with the rat 5-HT1C and 5-HT2 receptor subtypes (70% and 68%, respectively). Cell lines stably expressing the 5-HT2F receptor were established and demonstrated functional coupling to phosphatidylinositol hydrolysis upon 5-HT stimulation analagous to that observed for the 5-HT1C and 5-HT2 receptors. Membranes from the stably transfected cell lines (but not the untransfected parental lines) exhibited high affinity (Kd = 7.9 nM), saturable binding of [3H]5-HT. Maximum binding ranged from 0.1 to 2.4 pmol/mg of protein, depending on the clonal isolate. Using [3H]5-HT as the basis for a radioligand binding assay, the relative affinities of several tryptamine and piperazine derivatives for the cloned 5-HT2F receptor correlated with their relative potencies to contract the rat stomach fundus. These data suggest a probable relationship between this novel 5-HT2F receptor and the serotonin contractile receptor of the rat stomach fundus.
Amino Acid Sequence↗
Serotonin-induced relaxation in canine coronary artery smooth muscle.
Serotonin (5-HT) is a potent contractile agonist in canine coronary artery devoid of endothelium; however, in higher concentrations 5-HT produces concentration-dependent relaxation by activating an as yet uncharacterized receptor. This study explored the possibility that 5-HT-induced relaxation was mediated by interaction with a member of the 5-HT1, 5-HT2, 5-HT3, or 5-HT4 receptor family. 5-HT, 5-carboxamidotryptamine and 5-methoxytryptamine produced concentration-dependent relaxation in vitro in tissues precontracted with prostaglandin F2 alpha (10 microM). The agonist rank order potency for relaxation was 5-carboxamidotryptamine > 5-HT > 5-MeOT. 8-hydroxydipropylaminotetralin (8-OH-DPAT), dipropyl-5-CT, 5-methyltryptamine, sumatriptan, alpha-methyl-5-HT and 2-methyl-5-HT did not produce significant relaxation. The 5-HT1/beta adrenergic receptor antagonist propranolol (1 microM) did not antagonize 5-HT-induced relaxation. 5-HT-induced relaxation was not blocked by tetrodotoxin (0.3 microM), suggesting that neuronal depolarization to release mediators from nerves was not responsible for the relaxation. Neither ketanserin (1 microM) nor ritanserin (1 microM) antagonized 5-HT-induced relaxation, suggesting that 5-HT2 and 5-HT1C receptors do not mediate relaxation. ICS 205-930 (10 microM), a 5-HT3/5-HT4 receptor antagonist, shifted the 5-HT concentration-response curve modestly to the right (pKB = 5.1 +/- 0.1). Cisapride, a 5-HT4 receptor agonist, was not effective either as an agonist (up to 10 microM), or as an antagonist (1 microM) of 5-HT-induced relaxation.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
LY215840, a potent 5-hydroxytryptamine (5-HT)2 receptor antagonist, blocks vascular and platelet 5-HT2 receptors and delays occlusion in a rabbit model of thrombosis.
Certain ergolines are potent and selective 5-hydroxytryptamine (5-HT)2 receptor antagonists. Previous studies with two ergoline esters, LY53857 and sergolexole, documented their potency as 5-HT2 receptor antagonists and their metabolism in rats to a less active metabolite, 1-isopropyl dihydrolysergic acid. LY215840, an ergoline amide, has been identified as a potent 5-HT2 receptor antagonist that is not hydrolyzed to 1-isopropyl dihydrolysergic acid. In the rat jugular vein, LY215840 (3 x 109-10) to 10(-8) M) blocked 5-HT2 receptors mediating contraction to 5-HT in vitro. After i.v. and p.o. administration to rats, LY215840 was a potent 5-HT2 receptor antagonist, documented by its ability to block the pressor response to 5-HT administered i.v. Furthermore, after i.v. and p.o. administration of LY215840, blockade of vascular 5-HT2 receptors persisted in excess of 2 and 6 hr, respectively. LY215840 also blocked vascular 5-HT2 receptors in doses that did not affect alpha-1, beta-1 receptors or angiotensin II pressor responses, documenting the selectivity of LY215840 as an inhibitor of 5-HT2 and not other vascular receptors that modulate vasoconstriction. In addition to inhibiting vascular 5-HT2 receptors, LY215840 also inhibited 5-HT-amplified, ADP-induced aggregation (another 5-HT2 receptor-mediated response) in both rabbit and human platelets. Because of its ability to block both platelet and vascular 5-HT2 receptors, we studied the effectiveness of LY215840 in the rabbit carotid artery model of vascular occlusion. Low i.v. doses of LY215840 markedly prolonged time to vascular occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)
Administration, Oral↗
Comparison of the serotonin receptors that mediate smooth muscle contraction in canine and porcine coronary artery.
Serotonin (5-HT) is one important mediator of the coronary vasospasm and occlusion associated with thrombosis and atherosclerosis. 5-HT concentration-dependently contracted both canine and porcine coronary artery rings in vitro. In the dog, 5-HT-induced contraction was not blocked by either LY53857 (1 microM) or ketanserin (1 microM), but was blocked by the nonselective 5-HT receptor antagonist 1-naphthylpiperazine (1-NP) (100 nM), indicating 5-HT receptor involvement. Unlike the dog, both LY53857 (1 microM) and ketanserin (30 nM) antagonized 5-HT-induced contraction in pig arteries. Dissociation constants for LY53857 and ketanserin in porcine arteries were compared with those in rat jugular vein, a tissue possessing a well characterized 5-HT2 receptor. Both LY53857 (3 nM) and ketanserin (3 nM) antagonized 5-HT-induced contraction in rat jugular vein; however, the affinities of LY53857 and ketanserin in the rat jugular vein were significantly higher than those in the pig coronary. The rank order contractile potency for 5-HT, (alpha Me-5-HT) and sumatriptan in porcine coronary artery was consistent with that established for a 5-HT2 receptor, whereas the rank order potency in canine coronary artery indicated non-5-HT2 receptor involvement. Sumatriptan, a 5-HT1D receptor-selective agonist, was equieffective to 5-HT in contracting the canine coronary artery, a response inhibited by 1-NP (100 nM). Sumatriptan failed to contract either the pig coronary or rat jugular vein. In summary, significant differences exist in the 5-HT receptors that mediate contraction between the canine and porcine coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Characterization of rat platelet serotonin receptors with tryptamine agonists and the antagonists: ketanserin and SCH 23390.
Current literature suggests that the platelet 5-HT2 receptor, thought to be the only active platelet serotonin (5-HT) receptor, may be both heterogeneous and not the sole 5-HT receptor subtype on platelet membranes. The present studies used more selective tryptamine agonists, and the antagonists ketanserin and SCH 23390 to characterize rat platelet 5-HT receptors in vitro. The present studies also addressed anticoagulant effects (citrate versus heparin) on platelet 5-HT aggregation in the rat. 5-HT was less potent at enhancing ADP-induced aggregation in heparinized rat platelet rich plasma (PRP) as compared to citrated PRP. However, potency and maximum aggregation to ADP were greater in heparinized platelets. In citrated rat PRP, the selective tryptamine agonists, 5-carboxamidotryptamine (5-CT) and 2-CH3-5-HT, produced little change in the baseline ADP-induced aggregation and induced platelet shape change only in higher concentrations (greater than 1 microM). In contrast, alpha-CH3-5-HT-induced shape change and enhancement of ADP aggregation were superimposable with that of 5-HT itself suggesting 5-HT2 receptor activation. The antagonists, ketanserin and SCH 23390, inhibited 5-HT enhancement of ADP-induced aggregation with affinity constants consistent with the presence of 5-HT2 receptors as well. Studies with heparinized rat PRP did not unmask activity to 5-CT or 2-CH3-5-HT. Thus, although reports of multiple platelet 5-HT receptors exist, the only detectable, functional 5-HT receptor to enhance aggregation in rat platelets was probably of the 5-HT2 type.
Animals↗
LY53857, a 5HT2 receptor antagonist, delays occlusion and inhibits platelet aggregation in a rabbit model of carotid artery occlusion.
The present study was designed to evaluate the effectiveness of the ergoline 5HT2 receptor antagonist, LY53857 in a rabbit model of vascular arterial occlusion. LY53857 (1 and 10 microM) inhibited serotonin amplified platelet aggregation responses to threshold concentrations of ADP in rabbit platelets in vitro. LY53857 (1 microM) not only inhibited the serotonin component of rabbit platelet aggregation, but also inhibited in vitro aggregation induced by ADP (48.7 +/- 16.7% inhibition), collagen (76.1 +/- 15.9% inhibition) and U46619 (65.2 +/- 12.3% inhibition). The effectiveness of this ergoline 5HT2 receptor antagonist in blocking aggregation to ADP, collagen and U46619 may be related to its ability to inhibit a serotonin component of platelet aggregation since rabbit platelets possess high concentrations of serotonin that may be released during aggregation produced by other agents. Based on the effectiveness of LY53857 to inhibit rabbit platelet aggregation, we explored the ability of LY53857 to extend the time to carotid artery occlusion in rabbits following electrical stimulation of the artery. Reproducible carotid artery occlusion was induced in rabbits by moderate stenosis coupled to arterial cross clamping, followed by electrical stimulation. With this procedure, occlusion occurred at 47.0 +/- 7 min (n = 30) after initiation of the electrical stimulation. Animals pretreated with LY53857 (50 to 500 micrograms/kg i.v.) showed a delay in the time to carotid artery occlusion (at 100 micrograms/kg i.v. occlusion time extended to 164 +/- 16 min). Furthermore, ex vivo platelet aggregation from animals treated with LY53857 (300 micrograms/kg i.v.) resulted in 40.5% inhibition of platelet aggregation in response to the combination of ADP (1 microM) and serotonin (1 microM).(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Meningioma presenting at a site of a previously aspirated brain abscess.
We report the case of a meningioma which developed in the parieto-occipital lobe at the site where a brain abscess had been aspirated 9 years previously. There was no history of head trauma. To the best of our knowledge this is the first reported case of a meningioma associated and possibly aetiologically related to a previous inflammatory process in the absence of head trauma. The association of chronic inflammation and the subsequent development of a meningioma is discussed.
Brain Abscess↗
Masculinizing sclerosing stromal tumor of the ovary during pregnancy.
Sclerosing stromal cell tumors of the ovary are an uncommon neoplasm that usually does not produce hormonal imbalances. Most patients showing a hormonal effect from this lesion have had menstrual cycle disturbances. Infertility and endometrial hyperplasia have also been described. One other reported case had masculinizing effects. Other authors have documented elevated levels of both estrogenic and androgenic hormones that corrected after surgery. A case of a pregnant 27-year-old Caucasian with hirsutism on her chin and neck and a male suprapubic hair pattern is presented. Elevated androstenedione, dehydroepiandrosterone, and free testosterone levels were present. A 3-cm left ovarian mass was excised and identified as a sclerosing stromal tumor. The histologic features included a pseudolobular pattern with focal areas of sclerosis and a two-cell population of spindled and polygonal cells. Immunohistochemical studies showed a positive vimentin reaction, weakly positive desmin and muscle-specific actin stains, and a negative cytokeratin stain. Following surgery the hormone levels returned to normal and the hirsutism resolved. A normal female infant without evidence of masculinization was delivered from the patient at term.
Adult↗