PURPOSE: The aim of the present study was to investigate the effect of single dose imipramine on nocturnal urine output in patients with nocturnal enuresis. METHODS:A total of 6 monosymptomatic enuretic patients of more than 5 years of age were enrolled in this study. We measured nocturnal urine output, urine osrnolality, creatinine clearance, osmolal clearance, excretion rate of solutes, fractional excretion of sodium and potassium, and plasma vasopressin with and without a single oral dose of imipramine(lmg/kg of body weight) at 8 p.m. RESULTS: The administration of imipramine was followed by a significant decrease in noctumal urine output(P=0.02). Urine osmolality was not significantly increased(P>0.05), but osmolal clearance was significantly decreased during imipramine medication(P=0.03). Urinary excretion rate of sodium and potassium showed a statistically insignificant trend toward lower values during imipramine administration in nocturnal enuretics. Fractional urinary excretion of sodium and potassium was significantly decreased during imipramine medication(P<0.05). There was no significant difference in plasma vasopressin level and creatinine clearance in nocturnal enuretics after imipramine. CONCLUSION: Imipramine has a vasopressin independent antidiuretic effect in patients with nocturnal enuresis. The antidiuretic effect of imipramine can be attributed prirnarily to increased a-adrenergic stimulation in the proximal tubules with secondary increased urea and water reabsorption more distally in the nephron. (J Korean Pediatr Soc 2000;43:792 - 797)
Antidiuretic Agents ; Creatinine ; Enuresis ; Humans ; Imipramine* ; Nephrons ; Nocturnal Enuresis* ; Osmolar Concentration ; Plasma ; Potassium ; Sodium ; Urea ; Vasopressins

The most common form of genetic nephrogenic diabetes insipidus(NDI), a rare inherited disorder, is congenital and is transmitted in an X-linked recessive mode. It is refractory to the antidiuretic effect of normal to moderately increased levels of plasma arginine vasopressin(AVP) but, in some cases, may respond to high levels of the hormone or its analogue, deamino-D-arginine vasopressin(DDAVP). X-linked congenital NDI has now been linked to over 128 different mutations in diverse coding regions of the AVP receptor 2(AVPR2) gene. The functional effects of these mutations vary from complete loss of responsiveness to a simple shift to the right in the dose response curve. We report a case of congenital partial NDI, with transversion of A to G at codon 280 of the AVPR2 gene, resulting in a subsequent change of amino acid from tyrosine to cysteine, and that has been effective with hydrochlorothiazide and high dose of DDAVP.
Antidiuretic Agents ; Arginine ; Clinical Coding ; Codon ; Cysteine ; Deamino Arginine Vasopressin ; Diabetes Insipidus, Nephrogenic* ; Hydrochlorothiazide ; Plasma ; Tyrosine

BACKGROUND: Thiazides have been used in nephrogenic diabetes insipidus (NDI) patients to decrease urine volume, but the mechanism of antidiuretic effect is not known yet. Recently, it has been demonstrated that abundance of aquaporin-2 (AQP2) was decreased in lithium induced NDI. We performed this study to investigate the effect of hydrochlorothiazide (HCTZ) in lithium induced NDI rats and the change of AQP2 expression. METHODS: NDI was induced in 7 male Spraque- Dawley rats by feeding lithium carbonate containing rat chow (40 mmol/kg) for 5 weeks. 4 rats were control group. HCTZ 3.75 mg/day (n=3 among lithium treated; Li+TZ) or vehicle (n=4 among lithium treated and control; Li and Control, respectively) was infused to the rats through osmotic minipump for the last 7 days. Urine volume and urine osmolality were measured. Kidneys were processed for immunohistochemistry and immunoblotting using antibody to AQP2. RESULTS: Li+TZ showed decreased urine volume (46+/-11 mL/day for Li+TZ vs. 127+/-1 mL/day for Li, p<0.05) and higher urine osmolality (557+/-139 mmol/kgH2O for Li+TZ vs. 207+/-9 mmol/kgH2O for Li, p<0.05) comparing to Li. In semi-quantitative immunoblotting using whole kidney homogenate, Li+TZ showed increase in AQP2 expression comparing to Li (39+/-2% for Li+TZ vs. 20+/-9% for Li, p<0.05, % of normal controls). In immunohistochemistry, AQP2 expression in cortex was markedly decreased after lithium treatment. But, AQP2 expression was slightly increased after HCTZ treatment. CONCLUSION: HCTZ treatment partially increased urine concentrating ability and AQP2 expression in rats with lithium induced NDI. We concluded that partial improvement in urine concentrating ability might be associated with upregulation of AQP2.
Animals ; Antidiuretic Agents ; Aquaporin 2* ; Diabetes Insipidus, Nephrogenic* ; Humans ; Hydrochlorothiazide* ; Immunoblotting ; Immunohistochemistry ; Kidney ; Kidney Concentrating Ability ; Lithium Carbonate ; Lithium* ; Male ; Osmolar Concentration ; Rats* ; Thiazides ; Up-Regulation

OBJECTIVETo clarify the resource of medicinal plants of genus Polygonum s. lat. distributed in Anhui Province.

METHODConducting field investigation and consulting related specimens and data.

RESULT AND CONCLUSIONThe distribution, growing environment and medicinal use of 32 taxa have been clarified. A scientific basis for further study for these medicinal plants has been provided.

Analgesics, Non-Narcotic ; pharmacology ; Antidiuretic Agents ; pharmacology ; China ; Conservation of Natural Resources ; Drugs, Chinese Herbal ; isolation & purification ; pharmacology ; Ecosystem ; Pharmacognosy ; Plants, Medicinal ; anatomy & histology ; chemistry ; classification ; Polygonum ; anatomy & histology ; chemistry ; classification

OBJECTIVEApplying three treatment methods for enuresis in children with primary nocturnal enuresis (PNE) in a randomized controlled clinical trial (RCT) to compare the curative effects and characteristics of the three methods.

METHODSIf the parents and children consented to accept the treatment for 4 months and to keep on follow-up, the children diagnosed as primary nocturnal enuresis in the department of developmental and behavioral pediatrics in Shanghai Children's Medical Center from April 2003 to August 2004 were randomized into three groups: 52 children were in physio-psychological treatment group and were treated by utilizing the conditioning training role of alarm and other psychological and behavioral training programs; 46 children were in drug treatment group and were treated by taking DDAVP tablets orally; 40 children were in combined treatment group who were treated by applying the former two methods simultaneously. If the parents and children did not accept treatment, they were enrolled into the control group and were followed-up. Then, the curative effects of the four groups were compared statistically when the 4-month treatment was over and compared again 3 months later.

RESULTSApplying the physio-psychological treatment for 4 months, the short-term cure rate of children with enuresis was 75.0%. Three months after the end of the treatment, the long-term cure rate was 71.2%. As for drug treatment group, the short-term cure rate of children with enuresis was 47.8%, the long-term cure rate was 28.3%; As for combined treatment group, the short-term cure rate of children with enuresis was 85.0%, the long-term cure rate was 80.0%. The short-term and long-term curative effects of physio-psychological treatment group and combined treatment group were better than that of drug treatment group (P < 0.01). However, the short-term and long-term curative effects were not significantly different between physio-psychological treatment and combined treatment group (P > 0.05). Physio-psychological treatment exerts effects slowly, but showed sustained curative effects. While Drug treatment exerts effects rapidly, but the relapse rate was very high after discontinuation of the medication.

CONCLUSIONSPhysio-psychological treatment and drug treatment are currently generally recognized the best ways to treat enuresis, both of them are suitable for Chinese enuresis children, both of them showed good curative effects. Physio-psychological treatment develops children's ability to control nocturnal micturition, its curative effects were better than that of the drug treatment whilst its relapse rate is lower as compared to drug treatment. So, physio-psychological treatment is more suitable for widespread use to treat PNE in China.

Adolescent ; Antidiuretic Agents ; therapeutic use ; Behavior Therapy ; Child ; Child, Preschool ; Combined Modality Therapy ; Deamino Arginine Vasopressin ; therapeutic use ; Female ; Humans ; Male ; Nocturnal Enuresis ; drug therapy ; psychology ; therapy ; Treatment Outcome

Diabetes insipidus (DI) is characterized by excessive urination and thirst. This disease results from inadequate output of antidiuretic hormone (ADH) from the pituitary gland or the absence of the normal response to ADH in the kidney. We present a case of transient central DI in a patient who underwent a cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG). A 44-yr-old male underwent a CABG operation. An hour after the operation, the patient developed polyuria and was diagnosed with central DI. The patient responded to desmopressin and completely recovered five days after surgery. It is probable that transient cerebral ischemia resulted in the dysfunction of osmotic receptors in the hypothalamus or hypothalamus-pituitary axis during CPB. It is also possible that cardiac standstill altered the left atrial non-osmotic receptor function and suppressed ADH release. Therefore, we suggest that central DI is a possible cause of polyuria after CPB.
Adult ; Antidiuretic Agents/therapeutic use ; Coronary Artery Bypass/*adverse effects ; Coronary Vessels ; Deamino Arginine Vasopressin/therapeutic use ; Diabetes Insipidus, Neurogenic/*diagnosis/drug therapy/etiology ; Humans ; Hypothalamus/radionuclide imaging ; Magnetic Resonance Imaging ; Male ; Pituitary Gland/radionuclide imaging ; Polyuria/diagnosis/etiology ; Postoperative Complications/*diagnosis/drug therapy/etiology

To investigate the efficacy and safety of desmopressin in patients with mixed nocturia, Patients aged > or =18 yr with mixed nocturia (> or =2 voids/night and a nocturnal polyuria index [NPi] >33% and a nocturnal bladder capacity index [NBCi] >1) were recruited. The optimum dose of oral desmopressin was determined during a 3-week dose-titration period and the determined dose was maintained for 4 weeks. The efficacy was assessed by the frequency-volume charts and the sleep questionnaire. The primary endpoint was the proportion of patients with a 50% or greater reduction in the number of nocturnal voids (NV) compared with baseline. Among 103 patients enrolled, 94 (79 men and 15 women) were included in the analysis. The proportion of patients with a 50% or greater reduction in NV was 68 (72%). The mean number of NV decreased significantly (3.20 to 1.34) and the mean nocturnal urine volume, nocturia index, NPi, and NBCi decreased significantly. The mean duration of sleep until the first NV was prolonged from 118.4+/-44.1 to 220.3+/-90.7 min (P<0.001). The overall impression of patients about their quality of sleep improved. Adverse events occurred in 6 patients, including one asymptomatic hyponatremia. Desmopressin is an effective and well-tolerated treatment for mixed nocturia.
Administration, Oral ; Adult ; Aged ; Aged, 80 and over ; Antidiuretic Agents/*administration & dosage ; Deamino Arginine Vasopressin/*administration & dosage ; Drug Administration Schedule ; Female ; Humans ; Male ; Middle Aged ; Nocturia/complications/*drug therapy ; Polyuria/complications/*drug therapy ; Prospective Studies ; Questionnaires ; Sleep/drug effects/physiology ; Urinary Bladder/*physiopathology ; Urodynamics/physiology

OBJECTIVETo investigate the impacts of Xuezhikang (XZK) or pravastatin combined with antihypertensive drugs on circulating endothelial progenitor cells (CEPCs) in essential hypertensive (EH) patients.

METHODSEighty-eight EH patients were enrolled into the study and randomly assigned to the antihypertensive drug treatment group (ATH group, 29 cases), the pravastatin treatment group (PRA group, 29 cases) and the Xuezhikang treatment group (XZK group, 30 cases). Patients in the 3 groups were treated with routine antihypertensive drugs. In addition, pravastatin and Xuezhikang were given to the patients in the PRA group and XZK group, respectively. After an eight-week treatment, CEPCs were counted using a laser scanning confocal microscope, and their proliferation function was evaluated by the MTT colorimetric assay and the adherent cell number was counted to estimate the adhesion function.

RESULTSAfter the treatment, CEPCs in the PRA group (116.60+/-5.70) and XZK group (114.40+/-6.55) was significantly higher than that in the ATH group (88.00+/-6.32, P<0.01). CEPCs proliferation capability and the adhesion function in the PRA group (0.406+/-0.016, 33.60+/-4.26) and XZK group (0.415+/-0.018, 34.30+/-3.77) were obviously superior to those in the ATH group (0.333+/-0.021, P<0.01; 23.30+/-3.19, P<0.01). No significant difference was found between the pravastatin group and the XZK group.

CONCLUSIONSCombined use of XZK or pravastatin with the anti-hypertensive therapy could increase the CEPCs number and improve their function in EH patients with the blood pressure controlled by antihypertensive drugs, leading to benefits independent of pressure-lowering effects.

Aged ; Anticholesteremic Agents ; administration & dosage ; Antidiuretic Agents ; administration & dosage ; Antihypertensive Agents ; administration & dosage ; Blood Cell Count ; Calcium Channel Blockers ; administration & dosage ; Cell Adhesion ; drug effects ; Cell Proliferation ; drug effects ; Cells, Cultured ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; Endothelial Cells ; drug effects ; pathology ; physiology ; Female ; Humans ; Hypertension ; blood ; drug therapy ; pathology ; physiopathology ; Integrative Medicine ; methods ; Male ; Middle Aged ; Pravastatin ; administration & dosage ; Stem Cells ; drug effects ; pathology ; physiology