John H. Moyer

A Comparison of the Cerebral Hemodynamic Response to Aramine and Norepinephrine in the Normotensive and the Hypotensive Subject

Previous observations have demonstrated a depression in cerebral blood flow during controlled hypotension with ganglionic blocking agents. Cerebral blood flow is also decreased when normotensive individuals are made hypertensive by the administration of vasopressor agents. The opposite response is observed when hypotensive individuals are made normotensive by the administration of these same agents, in which circumstance cerebral blood flow is increased.

Renal Hemodynamic Response to Vasopressor Agents in the Treatment of Shock

Norepinephrine, when administered to normotensive subjects by continuous intravenous infusion produces a marked renal vasoconstriction and a reduction in renal blood flow. The opposite response is observed when this drug is given to patients in whom glomerular filtration rate and renal blood flow are already depressed due to shock. When the blood pressure in these patients is returned to normal with norepinephrine, there is an increase in both glomerular filtration rate and renal blood flow. There is also an increase in water and electrolyte excretion which is secondary to the increase in glomerular filtration rate.

Some Pharmacological Properties of Three New Mercurial Diuretics.

Summary The compounds, 3–chloromer–curi–2–methoxypropylurea (1347Ex), 3–car–boxymethylmercaptomercuri − 2 – methoxypro–pylurea (1353 Ex), and. 3 – (α–carboxye thylmer–captomercuri) − 2 –methoxypropylurea (1431–Ex), had 3 or 4 times the diuretic potency of meralluride in the dog. Twenty–four and 48 hour mercury excretion rates were comparable to that of meralluride at the same dosage level. Chronic toxicity studies indicated no essential difference between meralluride and the other compounds, if the greater diuretic potency of the new compounds was considered and the dosage adjusted accordingly. Large amounts of 1353Ex and 1431 Ex were infused intravenously without disturbing cardiac function, but the acute cardiac toxicity of 1347Ex, although greater than the other 2 compounds, appeared to be less than meralluride.

Pheochromocytoma in a four-year-old child: renal hemodynamic, pharmacologic, and radiographic studies.

Summary The clinical course and management of a 4-year-old child with hypertension due to a functionally active pheocromocytoma is described. The tumor was localized by intravenous pyelography and presacral air insufflation. Renal function was studied by the clearance technique in the pre- and postoperative periods. The diagnostic response of our patient to both piperoxan and Regitine is described. Subsequent to successful operative removal of the tumor, the patients abnormal signs and symptoms disappeared. Sixteen cases of hypertension due to pheochromocytoma collected from the literature are reviewed. The typical findings in children appear in every aspect similar to those found in adults with functionally active pheochromocytoma, as described by various authors.

Effect of Morphine and n-Allylnormorphine on Cerebral Hemodynamics and Oxygen Metabolism

The cerebral metabolic response to intravenously administered morphine was studied in human volunteers. Cerebral blood flow and cerebral vascular resistance were not altered by this drug although cerebral oxygen uptake was markedly depressed as a result of a decreased extraction of oxygen from the blood circulating through the brain. This response was rapidly reversed following the administration of n-allylnormorphine.

Laboratory and Clinical Observations on Mecamylamine as a Hypotensive Agent.

Summary and Conclusions Mecamylamine produced the same cardiovascular and renal hemodynamic effects on dogs as have been previously observed with such autonomic blocking agents as hexamethonium and pento-linium. When given to patients with hypertension, it produced a consistent reduction in blood pressure which was most marked in the upright position. The effect was about equivalent when given orally as when given parenteral^ the average daily dose being approximately 19 mg. The onset of action ranged from 1/2 to 2 hours, and lasted 12 to 48 hours. The response was quite variable from patient to patient, but within the same patient, it was reproducible, thus minimizing one of the chief objections to ganglionic blocking agents for the treatment of hypertension.

Preliminary observations of Rauwiloid-hexamethonium combined therapy of hypertension

Abstract Twenty-five patients with essential hypertension have been subjected to combined Rauwiloid-hexamethonium therapy. This therapy resulted in a greater number of patients obtaining an adequate reduction of blood pressure than that from any single drug or combination of drugs previously reported from this investigative center. There was also a reduction in the frequency and severity of the unpleasant side reactions which have previously been observed when hexamethonium is used alone but the beneficial side effects of Rauwiloid have persisted. The dose of hexamethonium could be reduced on combined Rauwiloid-hexamethonium therapy, and the blood pressure was reduced further and was better stabilized. Thus, it is suggested that most patients with severe essential hypertension can be initially treated with Rauwiloid but those patients who do not respond within six to eight weeks should also be treated with hexamethonium.

Effect of Chlorpromazine on Cerebral Hemodynamics and Cerebral Oxygen Metabolism in Man

Cerebral blood flow frequently decreases following the intravenous administration of chlorpromazine, apparently a result of the reduction in arterial blood pressure. If arterial blood pressure does not decrease, cerebral blood flow is not altered. Chlorpromazine does not exert a depressant effect on cerebral oxygen consumption as morphine does.

Clinical diuretic studies on three new mercurial compounds

Abstract 1.1. Three new mercurial diuretics, 3-chloromercuri-2-methoxypropylurea (1347Ex), 3-carboxymethylmercaptomercuri-2-methoxypropylurea (1353Ex), and 3-(a-carboxyethylmercaptomercuri)-2-methylpropylurea (1431Ex), have been evaluated on 152 patients. The drugs were given twice per week, intramuscularly, in varying doses to 109 patients in the outpatient clinic. The diuretic effects of the drugs were compared to the previous responses of the patients to Mercuhydrin. 2.2. In doses equivalent to 10 and 20 mg. Hg of the experimental diuretics, none offered much of an advantage over Mercuhydrin. This is apparently due to the fact that a threshold amount of mercury must be presented to the renal tubules before any diuresis results, regardless of the mercurial compound. From clinical observations this amount appears to be between 10 and 20 mg. Hg. 3.3. When larger doses of the experimental diuretics (equivalent to 40 mg. Hg) were administered, they appeared to have a higher order of potency than Mercuhydrin when compared on the basis of mercurial content. When evaluated on a clinical basis, this ratio was greater than 2:2 and appeared to be about the same for all of the drugs under investigation. 4.4. Electrolyte studies were done on forty-three hospitalized patients. After all three of the diuretics there was a marked increase in urine and sodium excretion. The concentration of sodium per unit volume of urine was also increased. Potassium excretion was increased but this was erratic. 5.5. Of the three experimental diuretics studied, 1347Ex exhibited an increase in sodium and water excretion of highest order of statistical significance.

Renal hemodynamic studies in patients with extensive paralysis: The influence of weight loss, muscle atrophy, and immobilization☆

Abstract Renal hemodynamic studies were undertaken in 17 patients with extensive paralysis, muscle atrophy, and weight loss following poliomyelitis. Some of these patients presented clinical problems such as hypertension, hyposthenuria, and lability of water and electrolyte balance which led us to suspect they might have impaired renal function. However, the observed renal hemodynamic values when corrected to their present surface area were within or even exceeded the normal range in many subjects. Since the surface area of these patients was reduced by as much as 10 to 20 per cent at the time of study, the observed data were recalculated using the pre-illness surface area. This revealed additional patients whose renal function was reduced but did not offer an explanation for the observed clinical problems in certain other patients. The possibility that immobilization with extensive hypercalciuria and, in some instances, hypercalcemia had led to renal tubular calcium deposits which altered renal function is considered as an additional contributing factor particularly in the patients with reduced responsiveness to antidiuretic hormone and hyposthenuria. These studies would suggest that altered renal function in some of these patients is first manifest by reduced ability to concentrate urine (hyposthenuria) and only in more severe cases by reduction in renal hemodynamic values and the presence of arterial hypertension.