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T Haak

Publications and source records attributed to T Haak.

At least 37 records · Page 2Linked to original sources

The effects of interleukin-2 treatment on endothelin and the activation of the hypothalamic-pituitary-adrenal axis.

OBJECTIVE: Recent reports suggest that complex interactions exist between the neuroendocrine and immune systems. It has been shown for example that cytokines are able to stimulate the hypothalamo-pituitary-adrenal axis. In addition, some studies present evidence that endothelin is able to modulate the activity of several hypothalamic-pituitary axes, e.g. by inducing the ACTH production. DESIGN: We investigated the effects of interleukin-2 on endothelin levels and the hypothalamo-pituitary-adrenal axis. We determined the interleukin-6, big-endothelin, endothelin-1, ACTH, cortisol and AVP responses to intravenously and subcutaneously administered interleukin-2 in 8 cancer patients in a randomized placebo controlled trial. PATIENTS: 8 Patients (2 female and 6 male), age 44 +/- 4.8 years, were enrolled. All patients had a World Health Organization performance status of 1 or less and a Karnofsky Index of at least 80%. MEASUREMENTS: Blood-samples were taken before and 15, 30, 45, 60, 120, 180, 240, 300 and 360 min after interleukin-2 injection. Cytokine serum levels and the plasma levels of big-endothelin, endothelin, ACTH and AVP were analysed using radioimmuno-assays. Cortisol was assayed by an enzyme-linked immunosorbent assay. RESULTS: Interleukin-2 treatment significantly increased plasma big-endothelin levels (P < 0.01 vs basal) and endothelin-1 levels (P < 0.05 vs basal) within two hours and this was followed by an increase in ACTH (P < 0.01 vs basal) and cortisol (P < 0.05 vs basal) within three hours. Interleukin-6 levels increased two hours after interleukin-2 administration (P < 0.01 vs basal). Interleukin-2 had no detectable effect on AVP, blood pressure or heart rate. CONCLUSIONS: Our data demonstrate that cytokines are able to activate the human hypothalamo-pituitary-adrenal axis in vivo. On the basis of the observed time kinetics and in connection with previous findings from in vitro and animal models, we conclude that endothelin may be a link between cytokines and corticotrophin-releasing hormone, most probably functioning as a cytokine-induced neuromodulator controlling pituitary functions.

Adrenocorticotropic Hormone↗

New developments in the treatment of type 1 diabetes mellitus.

Treatment of type 1 diabetes mellitus has made tremendous advances within the last decades. With concern to insulin delivery there are two promising new approaches. One is the intrapulmonary insulin delivery which has become feasible by the development of new inhalation devices which provide a sufficient degree of intrapulmonary drug retention. Also oral insulin delivery seems feasible when surface active substances are used to cross the mucosal membrane in the gut. Clinical research has also focussed on coatings for the insulin molecules to solve the problem raised by the proteolytic activity of the digestive system. A very new agent produced by a fungus called Pseudomassaria has been demonstrated to reverse the clinical signs of diabetes mellitus in mice. The compound diffuses through the cell membrane, binds to the inner part of the insulin receptor and activates the insulin typical biological effects. Nowadays a variety of insulin analogs are designed and tested for their clinical use. By shifting the isoelectric point towards to a slightly acidic pH, HOE 901 precipitates at physiologic pH resulting in a constant and peakless insulin delivery. NN 304 is a 14-carbon aliphatic fatty acid acylated analog that binds to serum albumin resulting in a flatter time-action profile than NPH insulin. Also rapid acting insulin analogs are or will be launched in the near future aiming to ensure an improved postprandial glucose regulation. Glucagon-like peptide-1 (GLP-1) improves metabolic control by a variety of effects, e.g. the enhancement of insulin secretion and inhibition of glucagon secretion. Moreover, GLP-1 reduces food and water intake controlled by the brain, and inhibits gastric emptying. A disadvantage of GLP-1 is its very short half-life. Novel derivatives with the beneficial effects of GLP-1 but a better resistance against degradation have been designed. In addition substances have been developed inhibiting GLP-1 degradation or augmenting GLP-1 release from its abundant endogenous pool. Finally, there is a variety of interesting approaches aiming to improve or ease blood glucose self-monitoring. One is the development of subcutaneous catheters for continuous blood glucose control. In another system reverse iontophoresis is used for sampling interstitial fluid which reflects capillary blood glucose levels. Instead of using an electric current, a brandnew system creates micropores in the skin by a laser ablation system. Through these micropores a specific device performs a mild suction to obtain intersitial fluid. Further systems which measure blood glucose by near infrared spectroscopy are still investigated in order to improve their technical function and to reduce their weight. This article intends to give an overview over the new developments in the treatment and management of type-1-diabetes mellitus.

Animals↗

Fenofibrate improves microcirculation in patients with hyperlipidemia.

In order to investigate the effect of fenofibrate on microcirculation, 16 patients (5 female, 11 male, age 58 +/- 8 years) were studied with the aid of nailfold capillaroscopy before and after treatment with 200 mg fenofibrate per day over six weeks. Fenofibrate resulted in a significant decrease in triglycerides, total and LDL-cholesterol and apolipoprotein B and an increase in apolipoprotein A. As a parameter of an improved microcirculation the time to peak capillary blood cell velocity during postreactive hyperemia (occlusion of the lower arm for 2 minutes, 200 mmHg) decreased markedly from 45 +/- 5 to 16 +/- 3 s, p < 0.0001). Fibrinogen levels were significantly decreased (p < 0.04) in contrast to other parameters with a possible impact on microvascular perfusion (hemoglobin, hematocrit, mean platelet volume, total protein) and to blood pressure and heart rate. These findings suggest that fenofibrate treatment improves microcirculation in patients with hyperlipidemia. This beneficial effect of fenofibrate may arise from two leading mechanisms. One of these might be the decrease in fibrinogen levels reducing plasma viscosity, the other mechanism might be an indirect effect on functional abnormalities of the vascular endothelium arising from hyperlipdidemia. By lowering plasma lipids fenofibrate is likely to restore the impaired formation or efficacy of the endothelium derived relaxing factor (nitric oxide, NO).

Adult↗

Microcirculation in hyperglycemic patients with IDDM without diabetic complications--effect of low-dose angiotensin-converting enzyme inhibition.

In patients with insulin-dependent diabetes mellitus (IDDM) angiotensin-converting enzyme inhibitors (ACEI) have been demonstrated to have beneficial effects in the secondary prevention of microvascular complications. There are only few data available regarding the effect of ACEI on microcirculation in patients with IDDM without any microvascular complications. In addition, there is little knowledge about ACEI action during acute hyperglycemia. In a pilot study nine patients with IDDM without any clinical signs of diabetic complications (5 females, 4 males, aged 33.3 +/- 1.0 years, duration of diabetes 11.4 +/- 3.0 years, HbA1 7.2 +/- 0.2% [normal range 4.8-7.4%], BMI 21.4 +/- 0.5 [kg/m2]) received 1.25 mg of the ACEI ramipril (Delix, Hoechst Marion Roussel, Frankfurt) over 4 weeks. Nine healthy volunteers (4 females, 5 males, age 27.4 +/- 1.1 years, HbA1 5.9 +/- 0.2% (p < 0.01 vs patients), BMI 22.2 +/- 0.9 [kg/m2]) served as controls. Using nailfold capillaroscopy we determined capillary blood cell velocity (CapiFlow, Lawrenz Electronics, Sulzbach, Germany) before and during post-occlusive hyperemia (200 mmHg for 3 minutes) as a provocative test. Before and after treatment patients were studied during hyperglycemia (blood glucose 250-350 mg/dl). Treatment with low-dose ramipril resulted in a significant decrease in the time to peak capillary blood cell velocity during post-occlusive hyperemia (17.8 +/- 7.7 vs 57.4 +/- 12.8 s, p < 0.01) in hyperglycemic patients. This effect was absent in healthy volunteers. Hemodynamic and metabolic parameters remained unchanged throughout the study in both groups. These data demonstrate that low-dose therapy with the ACEI ramipril is able to improve microcirculation in hyperglycemic patients with type 1 diabetes mellitus also before microvascular complications are evident. Prospective studies are necessary to evaluate whether this effect might be clinically relevant in the primary prevention of diabetic microangiopathy.

Adult↗

[Therapy of diabetic nephropathy. Effects of ACE inhibition on microcirculation].

The development of diabetic microangiopathies is of decisive importance for the long-term prognosis of diabetes mellitus. For example, diabetic nephropathy is one of the the most common causes of terminal kidney failure. Primary prevention of diabetic nephropathy is best achieved by establishing good metabolic control. To ensure early pharmacological intervention of incipient diabetic nephropathy, screening for microalbuminuria is recommended at least once a year. A major element in the pathogenesis of diabetic nephropathy is a disordered microcirculation characterized by abnormal hemodynamics with elevated capillary pressure and microvascular resistance. Angiotensin converting enzyme inhibitors (ACE inhibitors) effectively act on these pathophysiological events by dilation of the vasa efferentia of the glomeruli. By means of videocapillaroscopy and laser doppler imaging also distinct changes in microcirculation can be detected. Investigations with these methods provided evidence that ACE inhibitors might also be useful in the primary prevention of diabetic nephropathy. Therefore, ACE inhibitors are useful pharmaceutical agents in the treatment of diabetic nephropathy.

Angiotensin-Converting Enzyme Inhibitors↗

Clinical evidence for a neuromodulator action of endothelin in the hypothalamic-pituitary-adrenal axis in man.

In order to investigate whether the ubiquitous signalling peptide endothelin might also act as a neuromodulator in the stimulation of the hypothalamic-pituitary-adrenal axis, 15 patients (4 female, 11 male, aged 35-67 years) with hypopituitarism were investigated and the results were compared to those of 8 healthy male volunteers (aged 24-31 years). Patients and controls received double-blind in random order either 0.1 IE per kg body weight regular insulin (insulin induced hypoglycemia) or 1 ml 0.9% sodium chloride (placebo) on 2 separate days. Control subjects only received on an additional day 0.1 IE per kg body weight regular insulin plus glucose 10% (euglycemic hyperinsulinemic glucose clamp). In control subjects hypoglycemia resulted in a significant increase in adrenocorticotropin (ACTH) and cortisol which was preceded by an increase in circulating endothelin levels (p < 0.01 vs placebo and euglycemic clamp) while endothelin, ACTH and cortisol remained unchanged both after placebo and in the euglycemic hyperinsulinemic clamp. In contrast, patients with hypopituitarism showed neither changes in circulating endothelin levels nor a stimulation of the hypothalamic-pituitary-adrenal axis during insulin-induced hypoglycemia. These data demonstrate that 1) endothelin levels are enhanced by metabolic stress 2) the responsiveness of endothelin levels to metabolic stress is linked to the presence of an intact pituitary gland and 3) endothelin might be involved in the stimulation of the hypothalamic-pituitary-adrenal axis.

Adrenocorticotropic Hormone↗

Hormonal modifications in patients admitted to an internal intensive care unit for acute hypoxaemic respiratory failure.

To clarify which endocrine modifications can be observed in acute hypoxaemic respiratory failure, 15 severely ill male patients [PAT; median age: 61 (range: 48 years); median height: 173 (range: 12) cm; median mass: 73 (range 31) kg] were investigated immediately upon admission to an intensive care unit (ICU) for this clinical disorder. Before starting treatment, the blood gases were measured and a number of selected hormones with special relevance for an ICU setting were determined. These are known to be modified by acute hypoxaemia in healthy subjects and to possess glucoregulatory properties, or an influence upon cardiocirculation or the vascular volume regulation: insulin, cortisol, adrenaline, noradrenaline, atrial natriuretic peptide, renin, aldosterone, angiotensin converting enzyme, and endothelin-I (ET). To elucidate whether potential endocrine changes resulted from acute hypoxaemia alone, the underlying disease, or unspecific influences connected with the ICU setting, all measurements were compared to those of a completely healthy reference group (REF) with comparable acute experimental hypoxaemia. The latter state was achieved by having the REF breathe a gas mixture with the oxygen content reduced to 14% (H). In the REF, neither the medians nor the distribution of endocrinologic measurements were modified significantly by acute hypoxaemia. In the PAT, the medians were increased considerably, yet with a slight diminution of ET. The distribution of individual values was considerably broader than in the REF with H. In conclusion, considerable increases in the means of the above hormones, with the exception of ET, can be registered in severely ill patients admitted to ICUs with acute hypoxaemic failure. However, such modifications cannot be considered attributable exclusively to acute arterial hypoxaemia. The underlying clinical disorders, such as septicaemia or an unspecific endocrine epiphenomenon, including severe and not only hypoxaemic stress, seem to be predominant.

Acute Disease↗

Release of endogenous vasopressors during and after cardiopulmonary resuscitation.

OBJECTIVE: To assess whether plasma endothelin, adrenaline, noradrenaline, arginine vasopressin, adrenocorticotropin, and cortisol concentrations were higher during cardiopulmonary resuscitation in patients in whom resuscitation was successful than in those in whom it failed, and to measure the concentrations of these hormones in the immediate post-resuscitation phase. DESIGN: Prospective, descriptive study. SETTING: Emergency medical service at a university hospital. PATIENTS: 60 patients with cardiac arrest out of hospital. INTERVENTIONS: Blood samples were drawn and blood pressure and heart rate were measured during cardiopulmonary resuscitation, before and after the first dose of adrenaline was given and at 5, 15, 30, and 60 minutes after the restoration of spontaneous circulation. Plasma hormone concentrations were measured by radio-immunoassays. RESULTS: 24 of the 60 patients were successfully resuscitated and admitted to hospital: 36 were not. During cardiopulmonary resuscitation before adrenaline was given, the plasma concentration of endothelin (mean (SEM)) in resuscitated and in not resuscitated patients was 4.3 (0.9) pg/ml and 5.5 (0.4) pg/ml respectively (NS), adrenaline was 14.1 (2.0) ng/ml and 25.3 (3.6) ng/ml (P < 0.01), noradrenaline was 5.0 (0.9 ng/ml) and 8.4 (1.1 ng/ml) (P < 0.05), arginine vasopressin was 193 (28) pg/ml and 70 (9) pg/ml (P < 0.001), adrenocorticotropin was 128 (34) pg/ml and 57 (6) pg/ml (P < 0.05), and cortisol was 18 (3) microgram/dl and 15 (2) microgram/dl (NS). During cardiopulmonary resuscitation after adrenaline was given endothelin in resuscitated and in not resuscitated patients was 4.0 (1.0) pg/ml and 5.3 (0.5) pg/ml (NS), adrenaline was 145 (16) ng/ml and 201 (21) ng/ml (P < 0.05), noradrenaline was 3.9 (0.9) ng/ml and 8.3 (1.1) ng/ml (P < 0.01), arginine vasopressin was 177 (27) pg/ml and 58 (9) pg/ml (P < 0.001), adrenocorticotropin was 234 (92) pg/ml and 85 (9) pg/ml (P < 0.001), and cortisol was 17 (2) microgram/dl and 13 (2) microgram/dl (NS). CONCLUSIONS: Despite a tremendous adrenosympathetic response, the lower arginine vasopressin and adrenocorticotropin concentrations during cardiopulmonary resuscitation in patients in whom resuscitation failed may influence vital organ perfusion and hence the success of resuscitation. Plasma concentrations of arginine vasopressin and adrenocorticotropin may have a more important effect on outcome than previously thought.

Adrenocorticotropic Hormone↗

Modification of the responses of endothelin-1 to exhaustive physical exercise under simulated high-altitude conditions with acute hypoxia.

To assess whether acute alveolar hypoxia leads to the release of endothelin-1 (ET) in vivo, ET, cortisol (CORT), and lactate (LA) levels were determined in 15 healthy subjects at rest and during exhaustive incremental cycle ergometry on two separate test days. The subjects were to breathe a gas mixture with reduced O2 content ([H] fraction of inspired O2, 0.14) on one day and normal air on the other (N). Modified responses of LA and CORT to exhaustive incremental cycle ergometry on the H day indicated elevated anaerobic tissue metabolism and increased physical stress. With acute alveolar hypoxia, the response of ET to exhaustive physical labor was found to be augmented.

Acute Disease↗

Circulating endothelin in patients undergoing coronary artery bypass grafting.

Increased synthesis of endothelin, (a powerful physiological vasoconstrictor), is a uniform response to endothelial injury and has been associated with myocardial ischemia and reperfusion. This study tests the hypothesis that coronary artery bypass grafting (CABG) affects endothelin plasma concentrations in various vascular beds. Twenty-four CABG patients were included in this study. Endothelin was determined in multiple plasma specimens obtained from superior vena cava, aortic root and coronary sinus (CS). Venous endothelin plasma concentrations collected in CABG patients before surgery were 1.16 +/- 0.18 pg/ml. They increased after sternotomy (1.71 +/- 0.12 pg/ml) and during (2.97 +/- 0.27 pg/ml) and after cardiopulmonary bypass (CPB, 2.72 +/- 0.21 pg/ml). There is no net release of endothelin from the coronary circulation before (aorta 2.26 +/- 0.13 pg/ml vs CS 2.44 +/- 0.17 pg/ml, not significant (n.s.), during (cardioplegia 2.55 +/- 0.17 pg/ml vs CS 2.45 +/- 0.15 pg/ml, n.s.), and after aortic cross-clamping (aorta 2.95 +/- 0.23 pg/ml vs coronary sinus 2.71 +/- 0.18 pg/ml, n.s.). Pulmonary endothelin clearance is preserved on partial bypass (aorta 2.26 +/- 0.13 pg/ml vs vena cava 2.86 +/- 0.18 pg/ml, P < 0.003), but remains inhibited even 10-30 min after release of the aortic cross-clamp (aorta 2.95 +/- 0.23 pg/ml vs vena cava 2.97 +/- 0.27 pg/ml, n.s.). Two out of 24 patients had severe myocardial ischemia. These patients showed particularly high endothelin concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Increase of serum insulin and stable c-peptide concentrations with exhaustive incremental graded exercise during acute hypoxia in sedentary subjects.

Hypoxia was shown to reduce insulin concentrations at rest and during exercise. However, some studies have also demonstrated increases in the hormone associated with arterial desaturation. This study was conducted in order to decide [1] whether acute alveolar hypoxia increased or decreased the circulating insulin levels, and [2] to elucidate whether interactions of insulin with other hormones were of relevance in this respect. Glucose (GLU), insulin (INS), c-peptide (CP), adrenaline and noradrenaline (CATs), atrial natriuretic peptide (ANP) and cortisol (CORT) as well as the capillary blood gases were determined in 15 healthy fasting male volunteers (age: 26.2 +/- 2.8 years, body mass index: 22.4 +/- 2.7 kg.m-2). On two separate test days the subjects breathed, in random order, either normal air (N) or a gas mixture with reduced oxygen content (H; FIO2: 0.14). Measurements were made at rest as well as during an incremental cycle exercise in a supine position (increments of 6 min and 50 W) at 100 W and 150 W, at volitional exhaustion (N: 227 +/- 36 W; H: 200 +/- 32 W) as well as in the 5th min of recovery. Arterial desaturation was seen throughout on H-day. At rest all hormones and GLU were normal and showed no influence of H. During exercise INS remained constant on N-day, increased on H-day and was significantly higher with H than with N, most pronounced at 150 W and at volitional exhaustion with 20%, respectively. For CP and GLU no significant exercise-induced changes were seen on either test day and no influence of H was detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

Endothelin during cardiovascular surgery: the effect of diltiazem and nitroglycerin.

To investigate whether the vasoconstrictor peptide endothelin (ET) is elevated during cardiovascular surgery and might predispose to perioperative vasoconstriction and ischemia, we compared the effect of the calcium channel blocker diltiazem with that of the nitric oxide (NO) donor nitroglycerin on ET and hemodynamics in 32 patients undergoing coronary artery bypass grafting (CABG). Following a double-blind protocol, 16 patients (3 women, 13 men; ages 63 +/- 10 years) received 1 microgram/kg/min nitroglycerin and 16 patients (5 women, 11 men; ages 64 +/- 8 years) received 3 micrograms/kg/min diltiazem intravenously 30 min before until 12 h after CABG. ET was measured in the superior vena cava before, during, and 1 h after CABG. Compared with ET levels before CABG, ET was significantly elevated during CABG and further increased after CABG (p < 0.05). During and after surgery, ET levels were lower in patients receiving diltiazem than in those receiving nitroglycerin (both p < 0.01). Mean arterial blood pressure and heart rate were lower in patients receiving diltiazem compared with those receiving nitroglycerin (both p < 0.05). These data demonstrate that diltiazem is more effective than nitroglycerin in preventing ET increase during cardiovascular surgery. Studies using ET receptor antagonists may be useful in assessing the clinical relevance of ET levels with respect to the risk for perioperative vasoconstriction and ischemia.

Aged↗

[The nephroprotective effect of ramipril. Effect on blood pressure and metabolic control in insulin-treated patients with type-2 diabetes mellitus].

AIM: Investigation of the impact of blood pressure and metabolic control on the nephroprotective effect of ramipril in insulin-dependent diabetics. METHOD: Within the framework of an open prospective therapeutic trial, 18 hypertensive, insulin-treated diabetics received ramipril, 5 mg/day, for an average period of 11 months. All the patients had previously received various forms of antihypertensive medication, and had microalbuminuria. RESULTS: Urinary excretion of albumin and N-acetyl-beta-D-glucosaminidase decreased in 13 patients (group 1), but increased in the remaining five patients (group 2). Blood pressure clearly decreased in group 1, but remained constant in group 2. In terms of clinical and biochemical data, the group 2 patients differed from those in group 1, having a lower age, a shorter history of diabetes and higher hemoglobin A1c levels despite higher doses of insulin. CONCLUSIONS: The present observations show that inadequate metabolic control and refractory hypertension in type 2 diabetics accelerate progression of diabetic nephropathy, and may thus negate the nephroprotective effect of the converting enzyme inhibitor, ramipril.

Aged↗

Elevated endothelin levels in patients with hyperlipoproteinemia.

We determined lipoproteins, apolipoproteins, and endothelin in 98 patients (58 female and 40 male, age 18-72 years) with hyperlipidemia (plasma cholesterol > 2.5 g/l and/or triglycerides > 2.0 g/l) and in 50 healthy subjects (20 female, 30 male, age 19-68 years). In patients with hyperlipidemia endothelin levels were elevated compared to healthy controls. Patients with plasma cholesterol above 2.5 g/l had higher endothelin and lipoprotein(a) concentrations than patients with plasma cholesterol levels less than 2.5 g/l. A positive correlation was found between the concentrations of endothelin and apolipoprotein B (r = 0.2137; P < 0.013). Smoking patients with lipoprotein (a) above 300 mg/l had higher endothelin levels than both nonsmoking patients with lipoprotein (a) above 300 mg/l and smokers with normal lipoprotein(a). In smokers endothelin correlated positively with Lp(a) (r = 0.709; P < 0.01). No correlation was found between endothelin and triglycerides nor between endothelin and age or sex. The results suggest that the vasoconstrictor endothelin contributes to the increased vasal tone in hyperlipidemia. Because endothelin also has mitogenic properties, it may play a relevant role in the development of premature atherosclerosis in patients with hyperlipidemia.

Adolescent↗

[Perioperative endothelin, ACTH and cortisol plasma concentrations in coronary bypass patients].

STUDY OBJECTIVE: To follow up endothelin (ET), adrenocorticotropic hormone (ACTH), and cortisol levels in patients undergoing aortocoronary bypass grafting (CABG) and to determine whether these are extracted from plasma by the pulmonary circulation. DESIGN: Convenience sample trial. SETTING: University hospital. PATIENTS: Eight male routine CABG patients without appreciable concomitant disease. INTERVENTIONS: Patients were given anaesthesia in a strictly standardised manner using etomidate, flunitrazepam, fentanyl, and pancuronium. Nitroglycerin was administered prior to cardiopulmonary bypass (CPB) at 2 mg/h and dopamine as the only catecholamine starting from CPB weaning until the end of sampling at 3.5-5 micrograms/kg.min. Samples were drawn in rapid sequence from cannulated radial and a distal pulmonary arteries (Swan-Ganz catheter) at eight sampling times starting after induction of anaesthesia and catheter placement and finishing 22 h after the end of operation. MEASUREMENTS AND RESULTS: ET levels were determined by an ET-1, 2, 3-sensitive radioimmunoassay (RIA), ACTH and cortisol by commercially available RIA kits. There was significant (P = 0.032, linear regression analysis) correlation between ET and cortisol from pulmonary arterial samples. ET was significantly (P = 0.042, two-tailed Wilcoxon test) extracted by the pulmonary circulation after induction of anaesthesia. This pulmonary-systemic arterial difference nearly disappeared intraoperatively, but tended to be restored 22 h after the end of operation at an approximately twofold increased level. CONCLUSIONS: No interrelation between ET and the hypothalamic-pituitary-adrenal axis could be established by the ET, ACTH, and cortisol plasma levels. However, the significant correlation between perioperative ET and cortisol lends further support to the hypothesis of ET release by cortisol from vascular smooth-muscle cells. There is a net pulmonary clearance of ET in patients prior to CABG that is lost intra- and early postoperatively, but tends to be restored on the 1st day thereafter at an increased level.

Adrenocorticotropic Hormone↗

Elevated endothelin-1 levels after cigarette smoking.

The effect of short-term nicotine consumption on endothelin-1 (ET-1) levels was studied in 10 male healthy smokers. Volunteers smoked in random order on 3 separate days a low-tar cigarette or a high-tar cigarette, or were studied without having smoked (no-cigarette experiment). ET-1, corticotropin, and cortisol levels, heart rate, and blood pressure were determined before and 1, 3, 5, 10, 20, and 30 minutes after smoking. In contrast to results obtained after smoking a low-tar cigarette or not smoking, smoking a high-tar cigarette resulted in a significant increase in ET-1 levels within 10 minutes, followed by an increase in corticotropin levels within 20 minutes after smoking. Thirty minutes after smoking, cortisol levels were higher after a high-tar cigarette compared with a low-tar cigarette or no smoking. Increases in heart rate and systolic blood pressure were likewise higher after smoking a high-tar cigarette than after smoking a low-tar cigarette. In conclusion, it is tempting to speculate that ET-1 may indeed act as the long-searched-for link between vasopressin and corticotropin-releasing hormone (CRH) and thus play an essential role in the stimulation of the hypothalamic-pituitary-adrenal axis. In addition, these results suggest that the increase in the level of ET-1, a powerful vasoconstrictor and mitogen, may play an important part in the disease mechanisms of atherosclerosis arising from smoking.

Adrenocorticotropic Hormone↗

Quantitative evaluation of an experimental inflammation induced with Freund's complete adjuvant in dogs.

A chronic inflammation model in dogs was induced by intraarticular injection of Freund's Complete Adjuvant in the stifle. After a primary, acute response during the first 24 hr, a secondary subacute response was observed after a delay of approximately 3 weeks and persisted for several weeks. To evaluate the time course of the inflammatory process quantitatively, we tested more than 100 different parameters. Finally, only four parameters were selected based on practicability and metrological properties, namely, the body temperature, difference in skin temperature, difference in stifle diameter and vertical force exerted by arthritic hind limb measured using a force plate. The main results of the experimentation were the demonstration that these four parameters were sufficiently repeatable, reproducible, and appropriate to be used for quantitative evaluation of the inflammatory process, and that training of both animals and investigators was required. Finally, it was illustrated that an adjuvant periarthritis in dogs can be used to carry out a pharmacokinetic/pharmacodynamic modelling of an antiinflammatory drug.

Administration, Oral↗