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  • 1
    ISSN: 0340-1855
    Keywords: Schlüsselwörter Undifferenzierte Kollagenose –¶Antiphosholipidsyndrom –¶Pulmonale Hypertonie –¶Iloprosttherapie ; Key words Undifferentiated connective tissue disease –¶antiphospholipid syndrome –¶pulmonary hypertension –¶iloprost therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Undifferentiated connective tissue disease with secondary antiphospholipid syndrome was diagnosed in a 33 year old woman after recurrent arterial thromboses, two miscarriages and myocarditis. Despite effective immunosuppression and anticoagulation her initially mild precapillary pulmonary hypertension progressed in the absence of thromboembolic events, cardiopulmonary disease or other systemic disorders. With continuous i.v. ¶iloprost in a dosage of up to ¶4.5 ng/kg/min for a total of 15 months, her 6 min walking-distance improved from 210 to 315 m, the pulmonary vascular resistance decreased from 1710 to 1111 dyn×s×cm–5 and the mean pulmonary arterial pressure decreased from 64 to 54 mmHg. This partial success of conservative treatment enabled a reassessment of the necessity for heart and lung transplantation.
    Notes: Zusammenfassung Eine 33-jährige Patientin, bei der vor zwei Jahren eine undifferenzierte Kollagenose mit sekundärem Antiphospholipidsyndrom bei arteriellen Thrombosen, zwei Aborten und Myokarditis diagnostiziert worden war, hatte trotz effektiver Immunsuppression und Antikoagulation eine deutliche Progredienz der initial milde ausgeprägten präkapillären pulmonalen Hypertonie. Hinweise auf thrombembolische Ereignisse, kardiopulmonale oder andere systemische Erkrankungen als Ursache der pulmonalen Hypertonie fanden sich nicht. Nach Einleitung einer kontinuierlichen intravenösen Iloprost-Therapie mit Dosissteigerung bis 4,5 ng/kg/min zeigte sich nach insgesamt fünfzehnmonatiger Therapie sowohl eine verbesserte Belastbarkeit im Gehstreckentest über sechs Minuten (von 210 auf 315 m) als auch eine Reduktion des pulmonalvaskulären Widerstandes (von 1710 auf 1111 dyn×s×cm–5) und des pulmonalarteriellen Mitteldrucks (von 64 auf 54 mmHg). Durch den partiellen Erfolg der konservativen Therapie konnte die Indikation für eine kombinierte Herz-Lungentransplantation zunächst relativiert werden.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1912
    Keywords: Motor nerve ; Nicotine autoreceptors ; Positive feed-back mechanism ; Desensitization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The effects of 1,1-dimethyl-4-phenylpiperazinium (DMPP) and of nicotine receptor antagonists on [3H]acetylcholine release from the rat phrenic nerve preincubated with [3H]choline were investigated in the absence and presence of cholinesterase inhibitors (presynaptic effects). Additionally, the effects of hexamethonium and tubocurarine on the muscle contraction of the indirectly stimulated diaphragm were examined (postsynaptic effects). DMPP (1–30 μM) increased (76–92%), whereas hexamethonium (0.001–1 mM) and tubocurarine (1–10 μM) decreased (52–60%) the release of [3H]acetylcholine following a train of 100 pulses at 5 Hz. The release caused by a longer train (750 pulses at 5 Hz) was only slightly affected by DMPP and tubocurarine. In the presence of neostigmine (10 μM) neither tubocurarine nor DMPP significantly modulated the evoked [3H]acetylcholine release. High DMPP concentrations (10 and 30 μM) enhanced the evoked release only when the pretreatment interval was reduced from 15 min to 20 s. Tubocurarine and hexamethonium concentration-dependently inhibited the end-organ response. Hexamethonium was 250-fold more potent on presynaptic than on postsynaptic nicotine receptors. It is concluded that the motor nerve terminals are endowed with presynaptic nicotine receptors. These autoreceptors mediate a positive feed-back mechanism that can be triggered by previously released endogenous acetylcholine. Receptor desensitization can be produced by high agonist concentrations (endogenous or exogenous agonists) and is probably one mechanism to limit the autofacilitatory process. The presynaptic receptors appear to differ in their pharmacological properties from the post-synaptic receptors.
    Type of Medium: Electronic Resource
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