The effect of an intravenous infusion of human endothelin-1 on blood pressure and plasma concentrations of endothelin-1, potassium, sodium, renin, aldosterone, and atrial natriuretic factor was investigated in six healthy, sodium-loaded men. During the peptide's exogenous application (1.0, 2.5, and 5.0 ng/kg* min), its plasma concentrations rose from a basal value of 1.2+0.3 to 3.2+1.9, 9.9±7.6, and 56.5±50.3 pmol/l (p<0. medication was permitted for at least 4 weeks before the study. All subjects were fasting overnight, and alcoholic beverages, coffee, and cigarette smoking were discontinued for at least 12 hours. On the day of the study, the subjects were in the supine position for at least 2 hours. Indwelling catheters were inserted into an antecubital vein of each arm -one for infusion and the other for blood sampling. Human endothelin-1 (Peptides International, Louisville, Kentucky) that had been shown to be chromatographically pure and nonpyrogenic was dissolved in Haemac/cel (Behring Werke, Marburg/Lahn, Marburg, FRG) and infused at a rate of 1.0, 2.5, and 5.0 ng/kg min (equivalent to 0.4, 1.0, and 2.0 pmol/ kg . min) for 15 minutes each. Arterial blood pressure was measured by the same person with a cuff sphygmomanometer every 5 minutes for 30 minutes before and until 60 minutes after the infusion of endothelin-1. Mean blood pressure was calculated as diastolic blood pressure plus one third of the pulse height. Basal blood pressure was defined as the mean of all blood pressure readings obtained in the 30-minute preinfusion period. Blood samples were drawn for the determination of potassium and sodium before and 60 minutes after the termination of the infusion of endothelin-1. Samples for the determination of the plasma concentrations of renin, aldosterone, and atrial natriuretic factor (ANF) were obtained at -15, 0, 15, 30, 45, 60, 75, 90, and 105 minutes. To define more closely the time course in plasma, endothelin-1 concentration samples for the determination of peptide's plasma concentrations were obtained at -15, -5, 0, 14, 15, 29, 30, 44, 45, 50, 55, 60, 75, 90, and 105 minutes. To determine the plasma concentrations of endothelin-1, 5 ml blood was collected into tubes

Endothelin-1 (ET-1), a potent vasoconstrictor peptide produced by endothelial cells and degraded predominantly in the pulmonary vasculature, has been implicated in the development of various organ dysfunctions. To determine the pathophysiologic role of ET-1 in adult respiratory distress syndrome (ARDS) and the impact of impaired lung function on transpulmonary peptide handling, we compared plasma levels and pulmonary ET-1 balance in 14 patients with ARDS and in seven healthy control subjects. To obtain comparable conditions in both groups, the ET-1 level was raised in the control group by exogenous infusion (0.4 pmol/kg/min) to 9.4 +/- 0.8 pmol/L. ARDS was accompanied by a hyperdynamic circulatory pattern with increased cardiac output and depressed total vascular resistance but, simultaneously, pulmonary hypertension. Venous ET-1 concentration was massively increased in ARDS (9.8 +/- 1.2 versus 2.1 +/- 0.2 pmol/L, p < 0.001). In control subjects, the lung cleared the major fraction of ET-1 (fractional extraction 43 +/- 8.8%, uptake 12.5 +/- 2.5 pmol/min). In contrast, in ARDS there was a pronounced pulmonary releases into the circulation (32.8 +/- 10.3 pmol/min). We conclude that ET-1 concentrations are elevated in ARDS as the result of both increased formation and decreased disposal. Lung failure affects not only gas exchange but also nonrespiratory, metabolic pulmonary functions.

Synthetic human atrial natriuretic peptide (hANP) was administered to six normal sodium- and fluid-replete men A) as an iv bolus dose of 25 micrograms followed by an infusion of 25 micrograms/h for 6 h; B) as an iv bolus dose of 175 micrograms; C) as an iv bolus dose of 175 micrograms followed by an infusion of 100 micrograms/h for 6 h; or D) as a continuous infusion of 100 micrograms/h for 6 h plus an iv bolus dose at 240 min. Although urinary flow rates and excretion rates of sodium and chloride increased during protocols B, C, and D, this effect either disappeared (protocol B) or waned (protocols C and D) at the end of the 6-h infusion period. A consistent decrease in blood pressure occurred only during protocols C and D. Serum concentrations of Na+, K+, and Cl- and plasma renin concentrations did not change, while plasma aldosterone concentrations declined after the administration of 175 micrograms hANP or more. These data confirm that hANP exerts a diuretic and natriuretic action in man. These effects are transient and are not maintained by prolonged continuous hANP administration.

1. The effect of an intravenous infusion of insulin [2.5 units h-1 (m2 of body surface area)-1] on the rise in blood pressure and plasma aldosterone after intravenous angiotensin II (5, 10, and 20 ng min-1 kg-1) was investigated in six healthy, sodium-loaded men. 2. Serum insulin reached 96.8 +/- 18.1 mu-units/ml (control: 7.0 +/- 1.5 mu-units/ml) and serum potassium fell from 4.2 +/- 0.2 mmol/l to 3.6 +/- 0.2 mmol/l (P less than 0.005). 3. Hyperinsulinaemia increased (P less than 0.05) the secretion of aldosterone during the largest dose of angiotensin II (20 ng min-1 kg-1), but had no effect on the rise in blood pressure after angiotensin II.

In a prospective, randomized study of 135 newly diagnosed patients with hyperthyroidism due to Graves' disease we compared the effect on remission rates of additional triiodothyronine (T3) with conventional antithyroid drug therapy. To this end 114 patients were followed for at least 12 months (15.7+/-4.9, mean+/-s.d.) after the discontinuation of any therapy. After return of thyroid function to normal (8.5+/-7.4 weeks, mean+/-s.d.) patients were maintained on antithyroid medication for 9.0+/-2.5 months. They were then randomly assigned to one of three groups: group 1 (n=44) stopped methimazole, groups 2 (n=39) and 3 (n=31) continued with exogenous T3 (not exceeding 75 microgram/day in any patient) for a further 6 months either with (group 2) or without (group 3) a fixed dose of 10mg methimazole daily. The T3 dose was kept variable to keep TSH suppressed (<0. 1mU/l), which could be achieved in 82% of patients on 100% of their monthly visits. No serious side-effect requiring the discontinuation of the study occurred in any patient. Total T3, TSH-receptor antibodies and some previously suggested potential predictors of relapse including thyroid size by ultrasound, 24h urinary iodine excretion, history of cigarette smoking and ophthalmopathy were determined at the outset of the study and subsequently every 6 months (and total T3 every 4 weeks). No significant difference (P>0.05, Chi square) was seen in relapse of hyperthyroidism after a mean follow-up of 16 months (range: 12-31 months; groups 1:52%, 2:44% and 3:42%) in an area of low-to-moderate iodine intake (prevalence of 24h urinary iodine excretion <100 microgram/24h: 17 and 25% at two different measurements respectively). Concomitantly, no predictor of recurrence of disease could be identified, irrespective of treatment modality.