Six volunteers with class 2 New York Heart Association classified congestive heart failure had the concentration of the whole N-terminus (ie, aa 1-98), the midportion of the N-terminus (ie, aa 3167) and the C-terminus (ie, aa 99-126, ANF) of the 126 aa ANF prohormone measured in pleural fluid obtained from a diagnostic thoracentesis by our previously described methods.* A simultaneous plasma sample from the brachial vein was obtained for comparison of the concentration of the N-terminus in plasma and pleural fluid. These six patients had respiration of 12 to 18 per minute with heart rates of 76 to 92 beats per minute. Their blood pressures ranged from 110/68 to 138/88. None of these congestive heart failure patients had any discernible renal impairment with the serum creatinine values of all subjects being below 1.5 mg/dl. The size of the pleural effusions in these patients varied from one eighth to one half of one side of the chest based upon physical examination and confirmed by chest x-ray film. Four of these patients were receiving digoxin for therapy at the time of their thoracentesis but diuretics were discontinued in these patients for at least 24 hours prior to thoracentesis. The other two subjects presented to the hospital with symptoms of congestive heart failure for the first time. These subjects were receiving no medications, and their thoracentesis was performed before beginning any therapy. Informed consent was obtained from each of these congestive heart failure patients after the nature and possible consequences of the study were fully explained. This investigation was approved by the Human Use Committees of both the University of Arkansas for Medical Sciences and the John L. McClellan Memorial Veterans Hospital. buy levaquin online
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