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Related post: In Diabetes Order Indapamide Online Insipidus, pituitary injections are said to reduce materially the volume of urine and the thirst. The output of solids is variable (Velden, 1913; Graul, 1915; Kleeblatt; Konschegg and Schuster, 1915; G. Hoppe-Seyler, 1915; Motzfeldt, 1916). The transformation of benzoic into hippiiric acid, in nephritis, is reported to be in- creased by pituitary, independent of any diuresis (Farini and Ceccaroni, 1915). Duration and Repetition of Action. The rise of blood pressure lasts for about half an hour after intravenous injection. (Mummery and Symes, 1908, state that it persists for several hours if the brain Generic Indapamide and cord have been destroyed.) The effect may be repeated after one-half to Order Indapamide three-fourths of an hour, or more frequently if small doses are used (0.06 to o.i c.c. of pituitrin for dog; Hoskins and McPeek, 1913). In this way, the blood pressure rise may be utilized for bio-assay (Hamilton, 1912). Frequently repeated injections of large doses, however, become less and less effective (Howell, Purchase Indapamide 1898) and may finally lower the pressure (Schafer and Vincent, 1908). The secondary depressor action does not occur as easily in dogs as in cats or rabbits (Hamilton, 1912). The mech- anism of this action has not been established. It is not due to cardiac effects, for these remain constant; nor is it due to fatigue of the vessels, for it does not occur in perfusion experiments (McCord, 1911). This obser- ver believes that a new dilator substance is formed by the action of blood on the pitui- tary principles; for he claims that mixtures of blood and pituitary have a dilator effect when injected or perfused. Action on Depressor. Pituitary injection Buy Cheap Indapamide decreases the efficiency of depressor stimu- lation, especially in rabbits, less in cats. The action is stronger than that of epinephrin, and occurs even when the blood pressure does not rise (Auer and Meltzer, 1913). Synergism with Epinephrin. This has been reported by Kepinow (Gottlieb, 1911). The pituitary rise is not due to stimulation of epinephrin secretion; for it is not modified by ligation of the adrenal vessels (Hoskins and McPeek, 1913). Primary Fall of Blood Pressure. This is cardiac, but not vagal, for it occurs after section of these nerves (Paukow, 1912). The fall is more pronounced with large doses (Sollmann; Auer and Meltzer, 1913). Schafer and Vincent, 1899, believe that it is due to a distinct depressor constituent. Circulatory Effects in Birds. These are different than in mammals. There is a marked fall of blood pressure by peripheral vasodilation, antagonized by epinephrin or barium. The ventricular and auricular contractions are stimulated (Patoii and Watson, 1912). CLINICAL USE IN SHOCK AND COLLAPSE Mummery and Symes found experimentally that the pituitary rise of pressure is more pronounced and sustained if the pressure has previously been lowered, as by hemor- rhage, traumatic shock, cholin, peritonitis, etc. Blair Bell, 1911, claimed similar beneficial results in patients. The usual dose (i c.c. of the commercial solution = about 0.2 Gm. of the moist gland, intramuscularly) may raise the blood pressure 10 to 40 mm. for an hour, with slightly slowed heart rate (Beck and O'Mally, 1909; Klotz, 1911); but the response is uncertain. This may explain why the drug has not commanded confidence. The slowing might be useful in cardiac irregularities (Werschinin, 1013). Hewlett, 1914, finds that the intramuscular injection of 1.5 c.c. converts the dicrotic febrile pulse into a normal pulse, with diminished pulse volume, but without definite change in blood pressure or blood flow in the arm; these changes corresponding to vaso- constriction. Wiggers, 1911, believes that it may be of some use in pulmonary hemor- rhage by depressing the heart. RESPIRATORY CENTER This is affected, both directly and through the circulatory changes. With intraven- ous injection, Paukow, 1912, describes a primary arrest during the fall of pressure, then an increase and a second stoppage during the rise. Nice, Rock and Courtright, 1914, describe the characteristic effects as primary increase of depth, followed by shallow and generally slow, but sometimes quickened respiration. These disturbances PITUITARY EXTRACTS 343 set in with Buy Indapamide Online the circulatory changes, but are not as lasting. They fail to occur after a few injections have been made. In frogs, tadpoles and fish, the center is paralyzed (Hepner, 1915). Bronchial Muscle and Asthma. Froehlich and Pick, 1913, find a fatal bronchial spasm in guinea pigs. This is peripheral, i.e., preventable by atropin, but not by section of vagi. It occurs also in the surviving lung of dead animals (Baehr and Pick, 1913). Titone, 1913, observed no effect on isolated bronchial muscle. Pituitary has been tried clinically in asthma (Brochardt, 1913); but the results are not promising. Lanari, 1915, even reports a patient in whom pituitary provoked asth- matic attacks. UTERUS In the body and on the excised organ, even very small doses of pituitary have a marked augmentary effect, and increases the excitability to hypogastric stimulation (Dale, 1907; Frankl-Hochwart and Froehlich, 1910). This occurs in all animals, pregnant or non-pregnant (Fuehner, 1913; Gunn and Gunn, 1914). The action has been used for a bio-assay (Dale andLaidlaw, 1912; Roth, 1914; U.S.P. IX). Excised Human Uterus. Lieb, 1914 and 1915, reports that the non-pregnant human uterus is not contracted, and may even be slightly depressed, by pituitary, the con- traction reactions appearing six weeks after impregnation and persisting throughout pregnancy. He believes that the change is Purchase Indapamide Online due to appearance of some substance that sensitizes the uterus specifically to pituitary. This difference between pregnant and non-pregnant uterus does not apply to histamin which produces contraction in both states. These results of Lieb must be viewed with some suspicion. Gunn, 1914, describes contraction response of the ordinary human uterus. The tubes did not respond (in distinction to epinephrin, which contracts both). Injection of pituitary into the virgin human uterus in situ certainly produced extreme contraction (Clarence Webster). The round ligament does not respond. USE IN OBSTETRICS This was introduced by Bell, 1909. Its efficiency for hastening de- livery and checking postpartum hemorrhage has been generally confirmed (also in animals; Lescohier and Closson, 1912). It fails in some cases (Boight, 1911). Excessive doses are dangerous, the powerful contrac- tions closing the cervix, preventing delivery and producing local necrosis (Grumann, 1913), and sometimes even rupture of Buy Indapamide the viscus (Espeut, 1913; Zuellig, 1915; also J.A.M.A., 1914, 62:1421). It may also pre- vent labor if injected during the first stage of labor. After this, and in proper doses (i c.c., repeated in an hour if necessary) it is not dangerous to mother or child. It does not produce abortion before term, and is most effective when the os begins to dilate (Malinowsky, 1914). Clarence Webster injects a few drops of pituitary extract directly into the uterine
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