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Biomedical subjects

R J Quinn

Publications and source records attributed to R J Quinn.

At least 19 recordsLinked to original sources

Synthesis and structure-activity relationship of pyrazolo[3,4-d]pyrimidines: potent and selective adenosine A1 receptor antagonists.

A series of 12 substituted 1-phenylpyrazolo[3,4-d]pyrimidines were synthesized and evaluated for rat brain adenosine A1 and A2a receptor binding affinity. Substituents at C-4 and C-6 were varied in order to define these regions in terms of molecular recognition by the receptor subtypes. At C-4, the effects of a mercapto, methylthio, and amino substituent were evaluated, while at C-6, amides with varying alkyl groups extending from the alpha-carbon were examined. This study identified both potent and selective adenosine A1 receptor antagonists. The most potent of the 12 compounds was alpha-[(4-amino-1-phenylpyrazolo[3,4-d]pyrimidin-6-yl)thio]hexanamide (14); with an A1 Ki of 0.939 nM and an A2a Ki of 88.3 nM, this compound is 94-fold A1 selective. The most selective of the 12 compounds was alpha-[[4-(methylthio)-1-phenylpyrazolo[3,4-d]pyrimidin-6-yl]thio]hex anamide (10); with an A1 Ki of 6.81 nM and an A2a Ki > 40 000 nM, this compound is > 5900-fold A1 selective. The structure-activity relationships for the complete series has identified discrete structural differences between the A1 and A2a receptors with respect to the binding of pyrazolo[3,4-d]pyrimidines. This study resulted in prediction that increased A1 affinity could be achieved by incorporation of NH-alkyl substituents at C-4. This was confirmed by synthesis of alpha-[[4-(methylamino)-1-phenylpyrazolo[3,4-d]pyrimidin-6-yl]thiol] hexanamide (15) which was found to have an A1 Ki of 0.745 nM.

Adenosine

Pulmonary embolism in patients with intermediate probability lung scans: diagnosis with Doppler venous US and D-dimer measurement.

PURPOSE: To test the usefulness of lower limb Doppler venous compression ultrasound (US) and serum D-dimer measurements in diagnosis of pulmonary embolism in patients in whom ventilation-perfusion (V-P) scans indicate intermediate probability of pulmonary embolism. MATERIALS AND METHODS: V-P scanning, pulmonary angiography, US, and D-dimer measurements were performed in 36 patients without known deep venous thrombosis but with intermediate probability of having a pulmonary embolism. RESULTS: Pulmonary angiography demonstrated pulmonary embolism in 15 (41%) of 36 patients. US demonstrated deep venous thrombosis in only two patients, both with pulmonary embolism. Sensitivity of US was only 13%, but specificity was 100%. Five (14%) of the 36 patients had normal (< 220 micrograms/L) D-dimer levels; none of the five had pulmonary embolism. Sensitivity and specificity of D-dimer values were 100% and 16%, respectively, with a negative predictive value of 100%. CONCLUSION: Combined D-dimer measurement and US were helpful in correctly diagnosing pulmonary embolism in only seven (20%) of 36 patients. Pulmonary angiography is still required to diagnose pulmonary embolism in the majority of patients.

Enzyme-Linked Immunosorbent Assay

Incidence of pulmonary embolism in single segmental mismatch on lung scanning.

UNLABELLED: Controversy exists as to whether patients with single segmental mismatch (SSM) on a ventilation/perfusion (VQ) lung scan should be given a low or an intermediate probability of pulmonary embolism (PE). METHODS: Pulmonary angiography was used to evaluate the incidence of PE in SSM at the authors' institution. From January 1991 to January 1993, 1449 VQ scans were performed. RESULTS: With modified Biello criteria, 283 were high probability; 628, low probability; 273, normal; and 273, intermediate probability. Of the intermediate probability scans, 61 had SSM. Forty of these patients underwent pulmonary angiography. Twelve patients had PE in the area of the SSM, giving an incidence of PE of 30%. The risk of PE in SSM in the different lung regions was also analyzed. Twenty-three SSM were in the bases of the lung with a 22% incidence of PE; 17 SSM were either in the midzone or apex with a 41% incidence of PE (p = not significant). CONCLUSION: SSM carries a 30% risk of PE. Accordingly, SSM should be given an intermediate probability of PE and not a low probability of PE.

Adolescent

Evaluation of white cell scintigraphy using indium-111 and technetium-99m labelled leucocytes.

Indium-111 oxine labelled leucocyte (111In oxine leucocyte) scintigraphy is the test of choice in detecting occult infection and localising focal inflammation. 111In oxine labelling is technically difficult and expensive and leucocyte labelling with technetium-99m stannous colloid (99mTc Sn colloid) has been considered to be an alternative. Leucocytes from 40 cases referred for investigation of occult infection or localisation of inflammation were simultaneously labelled with 111In oxine and 99mTc Sn colloid with dual isotope acquisition performed at 1, 3 and 24 h. Twenty-four hour 99mTc Sn colloid scans were corrected for 111In downscatter. Each case was independently interpreted by two experienced observers. Twenty-one patients demonstrated positive 111In oxine leucocyte scans. Using 111In oxine leucocyte scans as the gold standard, 99mTc Sn colloid leucocyte scanning had an overall sensitivity of 86% and a specificity of 95%. Clinical follow-up verified that three patients had false negative 99mTc Sn colloid leucocyte scans and one patient had a false positive. Further clinical evaluation of 99mTc Sn colloid labelled leucocytes is required before they can become a reliable replacement for 111In oxine leucocytes.

Colloids

Avid thallium-201 uptake in hepatic carcinoid metastases.

While radiolabelled somatostatin analogues sensitively detect extrahepatic carcinoid tumour, intrahepatic metastases are frequently not visualised due to somatostatin accumulation in normal hepatic tissues. We report a case of avid thallium-201 uptake in multiple hepatic carcinoid metastases using single-photon emission tomography (SPET) and compare this to a SPET technetium-99m sulphur colloid scan in the same patient. The 99mTc sulphur colloid images demonstrate multiple focal defects at the site of known metastases in the hepatic right lobe (confirmed on both CT and surgery). However, there is avid uptake of thallium in the metastases on comparative SPET slices. 201Tl may be a useful agent for the detection and localisation of carcinoid tumour and in particular of intrahepatic carcinoid metastases.

Adult

The three binding domain model of adenosine receptors: molecular modeling aspects.

Using molecular modeling, adenosine receptor ligands were fitted together to maximize correlations between the three most important factors controlling binding to the receptor, namely steric, hydrophobic, and electrostatic complimentarily. Structure-activity relationships can be explained by three binding domains on the receptors. These are hydrophobic, aromatic, and ribose binding domains. We propose that the N6, C2, and C8 hydrophobic binding domains are not discreet but occupy the same region of the receptor.

Adenosine

Critical micelle concentration and hemolytic activity--a correlation suggested by the marine sterol, halistanol trisulfate.

The marine natural product, halistanol trisulfate, has a relatively low critical micelle concentration of 0.001% m/v (14.5 microM) and strong hemolytic potency with an EC50 of 0.00046% m/v (6.67 microM). As expected of a detergent, it inhibits the growth of gram-positive but not gram-negative bacteria. The hemolytic activity of halistanol trisulfate and other detergents has been shown to correlate with critical micelle concentration. This correlation may have important implications in the mechanism of membranolytic bioactivity.

Animals

The effect of the Valsalva maneuver on the diameter of the common hepatic duct in extrahepatic biliary obstruction.

The internal diameter of the common hepatic duct as measured by ultrasonography is an imperfect predictor of extrahepatic biliary obstruction. This study examined the effect of the Valsalva maneuver on the diameter of the duct in 25 consecutive patients (12 with obstruction; 13 without obstruction) who underwent endoscopic retrograde cholangiopancreatography (ERCP). A normal response was defined as a decrease in the diameter of greater than 1 mm at the level of the portal vein. The response to the Valsalva maneuver improved the predictive outcome (sensitivity, 100%; specificity, 92.3%) suggesting that this maneuver should be part of the routine assessment of the common hepatic duct.

Cholestasis, Extrahepatic

Synthesis and adenosine receptor affinity of a series of pyrazolo[3,4-d]pyrimidine analogues of 1-methylisoguanosine.

Pyrazolo[3,4-d]pyrimidines are pyrazolo analogues of purines. They have been shown to be a general class of compounds which exhibit A1 adenosine receptor affinity. Two series of pyrazolo[3,4-d]pyrimidine analogues of 1-methylisoguanosine have been synthesized. The first involved substitution of the N1-position while the second involved substitution of the N5-position. Both alkyl and aryl substituents were examined. All compounds were tested for A1 adenosine receptor affinity by using a (R)-[3H]-N6-(phenylisopropyl)adenosine binding assay. The 3-chlorophenyl group showed the greatest activity in the N1-position and the butyl group produced the greatest activity in the N5-position. Combination of the best substituent in each of these positions enhanced the overall activity. The most potent compound was 4-amino-5-N-butyl-1-(3-chlorophenyl)-1H-pyrazolo[3,4-d]pyrimidin-6(5H)- one with an IC50 of 6.4 x 10(-6) M. Selectivity at the receptor subclasses was examined by performing an A2 adenosine receptor affinity assay with [3H]CGS 21680. This series of compounds were slightly less potent at A2 receptors. 4-Amino-5-N-butyl-1-(3-chlorophenyl-1H-pyrazolo[3,4-d]pyrimidin-6(5H)-one was the most potent compound with an IC50 of 19.2 x 10(-6) M.

Animals

Value of ultrasound in differentiating causes of persistent vomiting in infants.

A prospective study of abdominal ultrasound was undertaken in 100 consecutive infants who presented with a history of persistent vomiting aged 5 to 90 days. Each infant had a 'test feed' followed by an ultrasonographic scan of the pylorus at the cotside. On test feeding a palpable tumour was evident in 38 infants. On real time ultrasound using the criteria for diagnosing pyloric stenosis, these 38 infants as well as six others were documented as having pyloric stenosis. In the other 56 patients the vomiting settled in six and a barium examination was performed on the remaining 50. This confirmed gastro-oesophageal reflux in 46, two of whom had an associated hiatus hernia, one with a duodenal malrotation, and three were reported as normal. Ultrasound of the abdomen is an accurate, reliable, and rapid screening method to differentiate the causes of severe vomiting in infancy.

Diagnosis, Differential

A decision analysis approach to the treatment of patients with suspected pulmonary emboli and an intermediate probability lung scan.

There remains no clear consensus as to the appropriate further investigation and management of the patient suspected of pulmonary embolism (PE) who has an intermediate lung scan. Clinical assessment is documented as unreliable, yet many of these patients are unlikely to be treated or to have further tests despite a 36% chance of having PE. Using Medical Decision Analysis, four management strategies for such patients have been examined in terms of mortality and morbidity up to 6 mo post-presentation. The strategies were: (1) treat all patients; (2) treat no patients; (3) perform pulmonary angiography; and (4) perform contrast venography. In the last two strategies, the patients with positive examinations are treated; those with negative examinations are not treated. An extensive literature review was performed to provide probability estimates of chance events and outcomes. If all patients are treated, there is 96.8% chance of survival, with an 85.8% chance of survival with no major complications. If no patients are treated, survival is 89.3% and complication-free survival is 89.3%. Angiography and venography results were 96.7%, 93.1% and 94.6% and 89.6%, respectively. We conclude that in patients suspected of PE who have intermediate lung scan results, the optimal strategy is pulmonary angiography since this results in the highest survival with the lowest complications.

Algorithms

Pyloric stenosis: congenital or acquired?

Pyloric muscle dimensions were measured in 1400 consecutive newborn infants. Nine of these subsequently developed pyloric stenosis. Their pyloric measurements at birth were all within the normal range. Congenital preformed muscular hypertrophy does not appear to be present in babies who later develop pyloric stenosis.

Humans

Long-term use of somatostatin analogue SMS 201-995 in the treatment of hypoglycaemia due to nesidioblastosis.

An infant presented with hypoglycaemia secondary to nesidioblastosis. Subtotal pancreatectomy failed to prevent recurrent post-operative hypoglycaemia. Subcutaneous somatostatin analogue (SMS 201-995) was shown to increase the blood concentrations of glucose and B-hydroxybutyrate while lowering serum insulin levels. Regular use of somatostatin analogue was helpful in long term management without causing significant side effects.

Female