Role of pentobarbitone anaesthesia and sympathetic tone in the haemodynamic effects of isosorbide dinitrate in rats with cirrhosis

The haemodynamic effects of nitrovasodilators and their mechanisms of action on portal hypertension remain unclear. The splanchnic and systemic haemodynamic response to the infusion of isosorbide dinitrate (100 μg/kg per min), a nitrovasodilator, was investigated in cirrhotic rats. The role of the conscious state in the haemodynamic response to isosorbide dinitrate was examined using rats that were anaesthetized with pentobarbitone. The role of sympathetic tone in the haemodynamic response to isosorbide dinitrate was examined using rats pretreated with the ganglion blocker hexamethonium. Isosorbide dinitrate had no haemodynamic effects in conscious, unblocked normal and cirrhotic rats. Isosorbide dinitrate had no haemodynamic effects in normal and cirrhotic rats treated with hexamethonium. In normal anaesthetized rats, isosorbide dinitrate significantly decreased systemic vascular resistance (414±25 vs 290±26 dyn.s/cm⁵ per 100 g). In cirrhotic anaesthetized rats, isosorbide dinitrate significantly decreased mean arterial pressure (98±6 vs 79±7 mmHg), systemic vascular resistance (318±30 vs 207±10 dyn.s/cm⁵ per 100 g), portal pressure (14.0±1.0 vs 11.3±0.9 mmHg) and portal territory vascular resistance (1362±163 vs 1031±182 dyn.s/cm⁵ per 100 g). In conclusion, this study shows that the portal hypotensive effects of isosorbide dinitrate depend upon the alterations of vascular tone by pentobarbitone.     

A 90-Day Chloroform Inhalation Study in F-344 Rats: Profile of Toxicity and Relevance to Cancer Studies

Composition of diet may influence growth, diseases, tumor rates,and responses to chemical treatment. Since 1980 the NIH–07open formula nonpurified diet has been the selected diet forthe National Toxicology Program (NTP) toxicity and carcinogenicitystudies in rodents. Studies with nonpurified experimental dietswith lower protein and higher fat and fiber than the NIH-07diet indicated that the diet for Fischer-344 (F344) rats inlong-term studies could be modified to decrease the severityof chronic diseases and to decrease/delay the development ofspontaneous tumors. Based on the results of these studies anew open formula nonpurified diet designated as NTP-2000 wasformulated to contain 14.5% protein, 8.5% fat, and 9.5% fiber.Corn, wheat, and wheat middlings contribute to about 60% ofthe ingredients; soybean meal, fish meal, and alfalfa meal arethe additional sources of protein; purified cellulose, oat hulls,and alfalfa meal are the major sources of fiber; and soy oiland corn oil are the major sources of fat in the NTP-2000 diet.The Ca:P ratio and mineral and vitamin concentrations were reformulatedbased on AIN-93 and NRC-95 recommendations. The NIH-07 and theNTP-2000 diets were fed to groups of 6-week-old F344 rats for13 weeks and evaluated for growth patterns, food and water consumptions,hematology and clinical chemistry parameters, and organ weightsand pathological changes. Growth patterns and body weights weresimilar for both diets. Food consumptions were slightly higherand water consumptions were slightly lower for the groups fedNTP-2000 diet. There were no differences in hematological parametersbetween the groups fed the above diets. Serum levels of cholesterol,alkaline phosphatase, and 5' nucleotidase were slightly higherin groups fed the NTP–2000 diet possibly due to higherfat content of this diet. However, the serum triglyceride levelswere slightly lower in groups fed the NTP–2000 diet andit may be related to higher fiber content of the NTP–2000diet. The liver and kidney weights of the groups fed NTP–2000diet were significantly lower possibly due to lower proteincontent of this diet and lower protein consumption associatedchanges in Phase I and Phase II drug metabolizing enzyme systems.The adrenal weights were also lower in groups fed the new diet.The NTP–2000 diet prevented nephrocalcinosis and decreasedthe severity of nephropathy and cardiomyopathy, the common lesionsof F344 rats in 13–week studies. These results indicatethat the NTP–2000 diet is adequate for growth and maintenance of rats and appears to prevent or decrease the severityof diet-associated lesions.     

Circadian Variations in Minute Ventilation Can Be Reproduced by a Pacemaker Sensor

Special software allowing the memorization of 24-hour minute ventilation can be loaded into the memoiy of the Chorus RM, a DDDR pacemaker driven by minute ventilation. This feature was tested in the postimplant period in 13 patients. Measurements of minute ventiiation, respiratory rate, and respiratory amplitude were analyzed according to prospectively defined diurnal and nocturnal time periods. Minute ventilation decreased by 39% (P < 0.001) from the diurnal to the nocturnal phase, while respiratory rate and amplitude decreased by 18% and 28%, respectively (P < 0.001 each). Thus, minute ventilation allowed discrimination between sleep and waking hours. This information could be utilized to modulate the backup rate of the pacemaker.     

Plasma concentrations of cyclic 3',5'-guanosine monophosphate in patients with cirrhosis: Relationship with atrial natriuretic peptide and haemodynamics

Little is known about the plasma concentrations of cyclic 3',5'-guanosine monophosphate (cGMP) in patients with cirrhosis. However, plasma cGMP concentrations provide information on cellular cGMP production by particulate guanylyl cyclases (which are stimulated by natriuretic peptides, such as atrial natriuretic peptide; ANP). In contrast, because intracellular cGMP elicits vasorelaxant mechanisms, plasma cGMP concentrations may be related to haemodynamic alterations in patients with cirrhosis. The aim of the present study was to measure plasma cGMP concentrations in patients with cirrhosis and controls and to examine the relationship between cGMP levels and plasma ANP concentrations and haemodynamic values. Plasma concentrations of cGMP and ANP and splanchnic and systemic haemodynamics were measured in 23 subjects; 13 subjects had cirrhosis and 10 were controls. All subjects had normal glomerular filtration. Plasma cGMP concentrations were significantly higher in patients (6.5±0.8 pmol/mL) than in controls (2.7±0.4 pmol/mL), while plasma ANP concentrations did not significantly differ between the two groups (127±22 and 123±27 pg/mL, respectively). In patients with cirrhosis, no significant correlation was found between plasma cGMP concentrations and plasma ANP concentrations, hepatic venous pressure gradient, cardiac output or systemic vascular resistance. In conclusion, in patients with cirrhosis, increased plasma cGMP concentrations may be due to an activation of particulate guanylyl cyclases by natriuretic peptides other than ANP. The present study suggests that plasma cGMP concentrations are not related to cirrhosis-induced haemodynamic alterations.     

Relationship between hepatic blood flow,liver tests,haemodynamic values and clinical characteristics in patients with chronic liver disease*

Although hepatic blood flow (HBF) has been measured in patients with liver disease for many years, the results of these studies have not provided clear information concerning the usefulness of this measurement. Hepatic blood flow was measured in 392 patients with either cirrhosis (n= 356) or hepatic fibrosis (n= 36). The control group included 59 subjects with normal liver architecture. Hepatic clearance of indocyanine green (ICG) was markedly reduced in patients with cirrhosis and hepatic fibrosis compared with controls (182±5, 276±22 and 421±25 mL/min, respectively). In patients with cirrhosis, ICG clearance and extraction were significantly correlated, but were not correlated to HBF. Although HBF did not differ between patients with cirrhosis and controls (1.26±0.04 vs 1.35±0.07 L/min, respectively), patients with hepatic fibrosis had lower HBF (1.04±0.07 L/min; P< 0.05). In patients with cirrhosis, no correlation was observed between HBF and cardiac output, mean arterial pressure, azygos blood flow, the hepatic venous pressure gradient or Pugh's score. However, a significant difference in HBF was observed in patients with and without hepatic encephalopathy (1.00±0.09 vs 1.28±0.03 L/min, respectively; P<0.05). In conclusion, the present study shows that, in patients with cirrhosis, HBF is normal and is not related to other haemodynamic values or liver tests. These results discourage the measurement of HBF in the evaluation of patients with cirrhosis.     

A 90-Day Chloroform Inhalation Study in Female and Male B6C3F1 Mice: Implications for Cancer Risk Assessment

High doses of chloroform induced liver cancer in male and femaleB6C3F₁ mice when administered by gavage, kidney cancer in maleOsborne-Mendel rats when given by gavage or in the drinkingwater, and kidney cancer in male BDF₁ mice when administeredby inhalation. The weight of evidence indicates that chloroformis acting through a nongenotoxic-cytotoxic mode of action. Thepresent study was designed to investigate the dose-responserelationships for chloroform-induced lesions and regenerativecell proliferation in B6C3F₁ mice as the basis for formulationof a biologically based risk assessment for inhaled chloroform.Different groups of female and male B6C3F₁ mice were exposedto atmospheric concentrations of 0, 0.3, 2, 10, 30, and 90 ppmchloroform 6 hr/day, 7 days/week for exposure periods of 4 daysor 3, 6, or 13 consecutive weeks. Some additional exposure groupswere exposed for 5 days/week for 13 weeks or were exposed for6 weeks and then examined at 13 weeks. Bromodeoxyuridine wasadministered via osmotic pumps implanted 3.5 days prior to necropsy,and the labeling index (LI, percentage of nuclei in S-phase)was evaluated iminunohistochemically from histological sections.Complete necropsy and microscopic evaluation revealed treatment-induceddose- and time-dependent lesions only in the livers and nasalpassages of the female and male mice and in the kidneys of themale mice. Large, sustained increases in the liver LI were seenin the 90-ppm groups at all time points. The female mice weremost sensitive, with a no-observed-adverse-effect level (NOAEL)for induced hepatic cell proliferation of 10 ppm. The hepaticLI in the 5 days/week groups were about half of those seen inthe 7 days/week groups and had returned to the normal baselinein the 6-week recovery groups. Induced renal histologic changesand regenerative cell proliferation were seen in the male miceat 30 and 90 ppm with 7 days/week exposures and also at 10 ppmwith the 5 days/week regimen. Nasal lesions were transient andconfined to mice exposed to 10, 30, or 90 ppm for 4 days. Ina previous cancer bioassay, a gavage dose of 477 mg/kg/day produced a 95% liver tumor incidence in female B6C3F₁ mice. Thisgavage dose is equivalent to a daily 6 hr/day inhalation exposureof approximately 80 ppm, based on the observed induced increasesin the LI as an internal dosimeter. The United States EnviromnentalProtection Agency currently uses the linearized multistage modelapplied to the mouse liver tumor data from the chloroform gavagestudy to estimate a virtually safe dose (VSD) as a one in amillion increased lifetime risk of cancer. The resulting valueis an airborne exposure concentration of 0.000008 ppm. Assumingthat chloroform-induced female mouse liver cancer is secondaryto events associated with necrosis and regenerative cell proliferation,then no increases in liver cancer in female mice would be predictedat the NOAEL of 10 ppm or below based on the results reportedhere. Applying an uncertainty factor of 1000 yields an estimateof a VSD at 0.01 ppm. This estimate relies on inhalation dataand is more consistent with the mode of action of chloroform.     

Treatment of Drug Refractory Ventricular Tachycardia by Biventricular Pacing

GARRIGUE, S., et al. : Treatment of Drug Refractory Ventricular Tachycardia by Biventricular Pacing. In a patient with severe congestive heart failure and ischemic disease, frequent episodes of ventricular tachycardia were completely suppressed by an implantable cardioverter defibrillator with biventricular pacing     

Electrocardiogram-Based Algorithm to Predict the Left Ventricular Lead Position in Recipients of Cardiac Resynchronization Systems

Introduction: Biventricular pacing is associated with various electrocardiographic patterns depending on the position of the left ventricular (LV) lead. We aimed to develop an electrocardiogram-based algorithm to predict the position of the LV lead.
Methods: The algorithm was developed in 100 consecutive recipients of cardiac resynchronization therapy (CRT) systems. QRS axis, morphology, and polarity were analyzed with a view to define the specific electrocardiographic characteristics associated with the various LV lead positions . The algorithm was prospectively validated in 50 consecutive CRT device recipients.
Results: The first analysis of the algorithm was the QRS morphology in V₁. A positive R wave in V₁ suggested LV lateral or posterior wall stimulation. A QS pattern was specific of anterior LV leads. In the presence of an R wave in V₁, V₆ was analyzed to distinguish between an inferior and anterior LV lead. Inferior leads were never associated with a positive V₆. To differentiate between lateral and posterior positions, we analyzed the pattern in V₂. Lateral leads were associated with an R morphology in V₁ and a negative V₂. Posterior leads were associated with an R morphology in V₁ and V₂. The algorithm allowed a reliable distinction between an inferior or anterior and a lateral or posterior lead position in 90% of patients. Inferior, anterior, lateral, and posterior positions were reliably distinguished in 80% of patients.
Conclusion: This algorithm predicted the position of the LV lead with a high sensitivity and predictive value.