Hematologic Toxicity of AZT and ddC Administered as Single Agents and in Combination to Rats and Mice

Hematologic Toxicity of AZT and ddC Administered as Single Agentsand in Combination to Rats and Mice. THOMPSON, M. B., DUNNICK,J. K., SUTPHIN, M. E., GILES, H. D., IRWIN, R. D., AND PREJEAN,J. D. (1991). Fundam. Appl. Toxicol. 17, 159-176. Toxicity studiesof 3'-azido-2',3'-dideoxythymidine (AZT) and 2',3'-dideoxycytidine(ddC) were conducted in F344/N rats and B6C3F, mice. The drugswere administered as single agents and in combination. In allstudies, animals were treated by oral gavage twice a day, 7days a week. In studies of the individual compounds, each wasadministered for 13 weeks at the following concentrations; AZTin rats, 0, 125, 250, 500, 1000 mg/kg and in mice, 0, 25, 50,100, 400, 1000 mg/kg; ddC in rats and mice, 0, 250, 1000, 2000mg/kg. Additional male rats and female mice that were treatedwith 0, 250, 1000, or 2000 mg/kg ddC and male and female micetreated with 0, 50, 400, 1000 mg/kg AZT were maintained for30 days after treatment was stopped (at 94 days) to evaluatethe reversibility of toxic effects. Hematologic variables weremeasured on Days 5, 23, and 94 (last day of dosing), and onDay 123 (after a 30-day period without treatment). AZT and ddCproduced dose-related, poorly regenerative, macrocytic anemiasas evidenced by decreases in erythrocyte counts, he-matocrits,and hemoglobin concentrations and increases in mean corpuscularhemoglobin and mean corpuscular volume. Bone marrow samplesin rats treated with AZT were hyperplastic whereas those inmice treated with AZT and rats and mice treated with ddC werehypoplastic. The hematologic toxicity of AZT was more severethan that of ddC. Generally, toxic effects of either chemicalwere greater in mice than in rats and more pronounced in femalethan in male animals. After 30 days without dosing, hematologiceffects either resolved or dramatically improved. In studiesin which ddC and AZT were administered in combination for 4weeks at concentrations of 0/0, 0/500, 500/0, 10/500, 100/500,500/500, and 500/1000 mg/kg ddC/AZT, there was macrocytic anemiain animals in the lower doses and marked microcytic anemia insurviving male mice in higher dose groups. Most female micedied in the 500/500 and 500/1000 mg/kg ddC/ AZT dose groups.At lower concentrations (100/500, 500/1000 mg/kg ddC/AZT), effectsof the two drugs were similar to those in the single drug studies.At higher concentrations (500/500 and 500/1000 mg/kg ddC/AZT),the combination treatment produced enhanced hematopoietic toxicity.These studies demonstrated the early and progressive time courseof toxicity of AZT and ddC, species differences in sensitivitiesand responses, and reversibility of effects after terminationof treatment. Based on these findings, a chronic toxicity studyis being conducted with AZT in mice.     

Effectiveness of Oximes 2-PAM and HI-6 in Recovery of Muscle Function Depressed by Organophosphate Agents in the Rat Hemidiaphragm: An in Vitro Study

Effectiveness of Oximes 2-PAM and HI-6 in Recovery of MuscleFunction Depressed by Organophosphate Agents in the Rat Hemidiaphragm:An in vitro Study. REDDY, V. K., DESHPANDE, S. S., CINTRA, W.M., SCOBLE, G. T., AND ALBUQUERQUE, E. X. (1991). Fundam. Appl.Toxicol. 17, 746–760. Phrenic nerve diaphragm musclesof young adult rats were used to study the ability of the oximes2-PAM and HI-6 to recover muscle function depressed by organophosphate(OP) agents. The single twitch of diaphragm muscles which wereexposed to soman (0.2 mm) recovered after washing with salinefor 3 hr, but the muscles pretreated with sarin (0.4 µM),VX (0.2 µM), or tabun (0.4 µM) showed only partialrecovery. In addition, after 3 hr washing, the muscles pretreatedwith soman as well as with tabun did not recover the tetanussustaining ability (TSA), yet complete recovery was observedwith muscles pretreated with sarin and VX. These results indicatethat the OPs have different effects on muscle contractile propertiesand that VX- and sarin-pretreated muscles recover equally wellafter wash with physiological solution. The recovery of twitchtension of diaphragm muscles by 2-PAM and HI-6 was similar tothat achieved by washing with saline for 3 hr for sarin- andsoman-exposed muscles. The most remarkable differences wereseen in the recovery of TSA. Both 2-PAM and HI-6 recovered theTSA of muscles that were pretreated with sarin and VX. Although2-PAM recovered the TSA after tabun pretreatment, HI-6 had nodiscernible effect. On the other hand, HI-6 recovered the TSAof soman-pretreated muscles but 2-PAM did not. The effectivenessof muscle function recovery was not related to the oximes' abilityto reactivate AChE, thus indicating that the recovery of musclecontractility may be attributed to a direct effect of thesecompounds on the muscle.     

Methadone levels and neonatal withdrawal

The purpose of this study was to observe the effects of methadone exposure in utero, with special reference to maternal and neonatal methadone concentrations and neonatal withdrawal. Two groups of mother-infant pairs were studied. In the first group, serum methadone concentrations were determined in infants at 1, 6 and 24 h after delivery. In the second group, blood was obtained at 24, 48, 72 and 96 h after birth. There was no correlation between neonatal serum levels and the intensity of withdrawal symptoms. There was no relationship between maternal methadone dose at delivery or maternal serum levels and neonatal methadone levels. The results of this study may be complicated by the prenatal exposure of the neonates to other drugs of abuse apart from methadone.     

Fetal umbilical artery velocity waveforms and subsequent neonatal outcome

Summary. Flow velocity waveforms (FVWs) from the fetal umbilical artery were recorded from 2178 pregnant women over a 6-year period. All of them had an obstetric factor indicating increased risk of fetal compromise. A total of 6749 studies was recorded. The systolic diastolic (AB) ratio was measured and classified as normal (<95th centile), elevated (95–99th centile), high (>99th centile) or extreme (absent diastolic flow). The results of these studies have been related to subsequent fetal and neonatal outcome. An abnormal umbilical artery FVW was associated with shorter gestation and infants with lower birthweight, shorter length and lower ponderal index. There was a highly significant association between an abnormal FVW and the birth of an infant small for gestational age. The significance of the association increased with the increased abnormality of the umbilical artery FVW and this was independent of gestational age. Preterm infants associated with high or extreme AB ratios spent twice as long in the neonatal nursery than those with normal AB ratios. Analysis of 794 pregnancies studies serially indicated that an abnormal FVW in which the AB ratio was increasing, in contrast to a decreasing AB ratio, predicted a poor outcome for both size at birth and duration of neonatal intensive care. We conclude that in high risk pregnancy Doppler umbilical artery FVW studies predict the most compromised fetuses in terms of growth retardation and requirements for neonatal intensive care.     

Fetal volume blood flow and umbilical artery flow velocity waveform analysis: a comparison

Summary. The estimation of fetal umbilical vein and aortic volume blood flow was compared with umbilical artery flow velocity-time waveform analysis in 42 pregnancies. The volume blood flow measurements were made with a combined linear array B-mode and pulsed Doppler ultrasound system. The umbilical artery flow velocity-time waveform analysis was made with either pulsed or continuous wave 2 MH_zDoppler ultrasound and the systolic/diastolic (A/B) ratio was used as an index of flow resistance. There was no difference when continuous wave was compared to pulsed Doppler ultrasound as a method of recording flow velocity waveforms. Analysis of the umbilical artery flow velocity-time waveform was more sensitive (100%-50%) than the measurement of umbilical vein volume blood flow (ml/kg/min) in the detection of the small-for-gestational age (SGA) fetus. The predictive value of a positive test was higher (71%-45%) while specificity was similar (88%-81%). Descending aortic volume flow was reduced in only one SGA fetus. The increase in umbilical placental downstream resistance (high systolic/ diastolic ratio) was associated with a reduction in the percentage of fetal aortic blood flow directed to the umbilical placental circulation.     

Clinical validation of a radionuclide detector to measure ejection fraction in critically ill patients

The use of a new non-imaging nuclear probe (Cardioscint) capableof continuous online monitoring of left ventricular functionis described in critically ill patients undergoing mechanicalventilation. Ejection fraction, measured by the Cardioscint,was compared with that measured by echo-cardiography. The meandifference was –1.1% (95% confidence interval –2.9to +0.6%). Mean difference±2 SD was +10.6 to –12.8%(95% confidence intervals +7.5 to + 13.6% and – 15.8 to–9.0%, respectively). Examples of fluid loading and inotropicsupport showed comparable changes in stroke counts measuredby the Cardioscint and stroke index measured by thermodilution.The Cardioscint is a practical bedside method for continuousor repeated measurement of ejection fraction and for assessingthe response to therapeutic interventions in critically illpatients. (Br. J. Anaesth. 1994; 72: 523–528)