1H-n.m.r. investigation of conformational features of cyclic,penicillamine-containing enkephalin analogs

Conformational features of a series of cyclic, penicillamine-containing enkephalin analogs, all of which display selectivity for the delta opioid receptor, were studied by ¹H n.m.r. in aqueous solution. Comparison of chemical shifts, coupling constants, and temperature dependence of amide proton chemical shifts suggests different conformational features among the analogs, some of which can be related to the different primary sequences of these peptides. The observation that some of the analogs display disparate individual conformational features while exhibiting similar opioid potency and receptor selectivity suggests that such analogs may share a similar overall topography or at the least maintain the same relative orientations of key portions of the molecule.     

Randomized, Evaluator-Blind, Split-Face Comparison Study of Single Cross-linked versus Double Cross-linked Hyaluronic Acid in the Treatment of Glabellar Lines

BACKGROUND At present, various hyaluronic acids are being used to rejuvenate facial skin. There is no comparative study of single cross-linked hyaluronic acid (SCHA) versus double cross-linked hyaluronic acid (DCHA). The objective of our study is to compare the effectiveness and complications of SCHA versus DCHA in the treatment of glabellar lines.
METHODS Ten female patients were enrolled in this randomized, evaluator-blind study. One side (left vs. right) of each patient's glabellar lines was treated with SCHA and the other side was treated with DCHA. Two independent blinded observers reviewed the clinical photographs at 3, 6, 9, and 12 months after the treatment and assessed for degree of improvement as well as complications.
RESULTS The two products were equally effective in producing an optimal cosmetic result, although at 6, 9, and 12 months posttreatment, a higher proportion of patients showed over 50% improvement with DCHA than with SCHA. At 12 months posttreatment, DCHA was considered superior in 70% of patients, whereas SCHA was superior in 10% of patients.
CONCLUSIONS Both SCHA and DCHA are equally effective in producing an optimal cosmetic result. DCHA provides a more durable esthetic improvement when compared to SCHA in the treatment of glabellar lines.     

The Clinical Utility of Pacemaker Follow-up Visits

Because of the increased complexity of modern pacemakers, pacemaker follow-up visits in specialized centers become more and more indispensable. In this study, the results of 15,000 outpatient visits to the cardiac pacing center between the years 1983–1985 are presented. In most cases (92.8%), verification of normal function was made; however, mandatory reprogramming was required in 1.2%, and hospitalization for various reasons was required in 6% of visits. Careful outpatient monitoring of pacemakers is therefore very important for detecting early or late pacemaker complications.     

Clodronate Treatment in Patients with Malignancy-associated Hypercalcemia

ABSTRACT. Rastad J, Benson L, Johansson H, Knuutila M, Pettersson B, Wallfelt C, Åkerström G, Ljunghall S (Departments of Surgery and Internal Medicine, University Hospital, Uppsala, Sweden). Clodronate treatment in patients with malignancy-associated hypercalcemia. Acta Med Scand 1987; 221:489–94. The possibility of reducing symptomatic hypercalcemia and of maintaining total serum calcium concentrations <2.8 mmol/1 with clodronate (dichloromethylene bisphosphonate) was evaluated in 28 patients with various types of malignant tumors. Four episodes of hypercal-cemic crisis with mean serum calcium concentrations of 4.43 mmol/1 were controlled within 4–6 days of intravenous clodronate (4 mg/kg BW/day). This was accompanied by a moderate increase in serum creatinine values which, however, returned to pretreatment levels after therapy withdrawal in all but one case. Oral clodronate successfully reduced a mean serum calcium concentration of 3.16 mmol/1 in 22 out of 25 patients after 3–12 days (800–3 200 mg/ day). After reversal of the hypercalcemias oral clodronate controlled the serum calcium concentration for up to 42 weeks in six out of 15 patients After discontinuation of initial therapy five of seven recurrent hypercalcemias were successfully treated with oral or intravenous clodronate. Hypocalcemia and subjective side-effects were uncommon. It is concluded that clodronate is a valuable clinical tool in the management of patients with malignancy-associated hypercalcemia.     

Clinical aspects of LHRH analogues in gynaecology: a review

Summary. LHRH agonists are synthetic peptide analogues of hypothalamic luteinizing hormone releasing hormone (LHRH) with superior potency and longer duration of gonadotrophin release. Paradoxically, repeated administration causes pituitary desensitization with diminished gonadotrophin and oestradiol secretion. A state of hypogonadotrophic hypogonadism is reversibly induced; plasma oestrogen can be reduced to castrate levels. LHRH agonists reliably induce anovulation but are unlikely to replace existing contraceptive methods in most normal women. By contrast these agents offer, for the first time, the prospect of inducing a reversible pseudomenopause essentially free of side-effects. LHRH analogues promise to have a profound impact upon the management of a diverse range of oestrogen-dependent gynaecological diseases both benign and malignant. In particular, they may shortly become the gynaecological treatment of choice in endometriosis, as well as becoming part of the management of common gynaecological disorders such as dysfunctional uterine bleeding and uterine fibroids.     

Diastolic Potentials Recorded by Surface Electrocardiographic Signal Averaging During Sustained Ventricular Tachycardia: Possible Origin From the Reentrant Circuit

ECG signal averaging can detect low amplitude diastolic potentials in sinus rhythm. We, therefore, recorded signal-averaged ECGs during eight episodes of inducible uniform sustained VT with coincident atrial pacing to look for continuous diastolic electrical activity. Simultaneous AV pacing in seven patients served as controls. The number of QRS complexes averaged (187 +/- 47 vs 183 +/- 63), the noise level (1.26 +/- 0.88 vs 1.39 +/- 0.47) and cycle length (385 +/- 52 vs 404 +/- 40) did not differ between VT and paced recordings. In each lead the difference in onset between the unfiltered surface recording and the filtered data (40 Hz bidirectional) was significantly greater in VT than the paced recordings (25 +/- 16 vs 11 +/- 8 msec, P = 0.0012). These late diastolic (pre-QRS) potentials were greater than 15 msec duration in 65% of the leads in VT versus 20% of paced recording (P = 0.021). The maximum value was greater than 20 msec in six VT (75%) versus one (14%) paced recording (P = 0.019). The earliest filtered onset in any lead preceeded the earliest surface activity by greater than 12 msec, in 6 VT versus one paced recording (P = 0.019). Early diastolic (post-QRS) potentials were also longer in VT than pacing (49 +/- 40 versus 5 +/- 20, P = 0.001) and exceeded 38 msec in seven of the VTs but none of the paced recordings (P = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)