Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome. Zurich Study Team

OBJECTIVE

To assess procedures and outcomes in deliveries planned at home versus those planned in hospital among women choosing the place of delivery.

DESIGN

Follow up study of matched pairs.

SETTING

Antenatal clinics and reference hospitals in Zurich between 1989 and 1992.

SUBJECTS

489 women opting for home delivery and 385 opting for hospital delivery; the women comprised all those attending members of the study team for antenatal care and those attending the reference hospital for antenatal care who could be matched with the women planning home confinement.

MAIN OUTCOME MEASURES

Need for medication and incidence of interventions during delivery (caesarean section, forceps, vacuum extraction, episiotomy), duration of labour, occurrence of severe perineal lesions, maternal blood loss, and perinatal morbidity and death.

RESULTS

All women were followed up from their first antenatal visit till three months after delivery. Referrals during pregnancy (n = 37) and labour (70), changes of mind (15 home to hospital, eight hospital to home), and 17 miscarriages resulted in 369 births occurring at home and 486 in hospital. During delivery the home birth group needed significantly less medication and fewer interventions whereas no differences were found in durations of labour, occurrence of severe perineal lesions, and maternal blood loss. Perinatal death was recorded in one planned hospital delivery and one planned home delivery (overall perinatal mortality 2.3/1000). There was no difference between home and hospital delivered babies in birth weight, gestational age, or clinical condition. Apgar scores were slightly higher and umbilical cord pH lower in home births, but these differences may have been due to differences in clamping and the time of transportation.

CONCLUSION

Healthy low risk women who wish to deliver at home have no increased risk either to themselves or to their babies.

PLUSH TACSY: Homonuclear planar TACSY with two-band selective shaped pulses applied to C(α),C' transfer and C (β),C (aromatic) correlations

A new homonuclear Hartmann-Hahn-type mixing scheme is introduced that effects coherence transfer between resonances in two separated frequency bands. The mixing scheme relies on the irradiation of two-band selective shaped pulses that are expanded in an MLEV-16 supercycle. Similar to heteronuclear Hartmann-Hahn experiments, a planar effective coupling tensor is created. This novel mixing scheme is applied to C(α),C' transfer and to the transfer between C(β) and aromatic carbon spins.

Benign biliary obstruction: is treatment with the Wallstent advisable?

PURPOSE

To evaluate the effectiveness of the self-expanding Wallstent in the treatment of benign biliary strictures.

MATERIALS AND METHODS

Twenty patients with benign biliary strictures were included in this retrospective study. Seven patients had chronic pancreatitis, two had fibrous papillary stenosis, one had primary sclerosing cholangitis, and 10 had postsurgical strictures, including four who had a stenosed bilidigestive anastomosis. Primary and secondary patency of the stents and clinical outcome after stent insertion were evaluated.

RESULTS

Stent placement was successful in all patients. At the end of the observation period, which lasted 3-78 months (mean, 31.2 months +/- 4.5 [standard error]), 10 patients were alive. Median primary patency was 32 months +/- 8.7. In 10 patients, patency was preserved during the observation period (two with secondary patency). Six patients had a good clinical result. Among the other four patients, one had recurrent cholangitis, one had a biliary abscess, and two had stent revisions. In the other patients, stents became occluded after 3-55 months. The reason for stent occlusion was a stone in one patient; in the others, the causes were not proved.

CONCLUSION

Results of stent placement for treatment of benign biliary strictures are not encouraging. However, the patient population is too limited to allow final conclusions.

Pharmacological disruption of hair follicle pigmentation by cyclophosphamide as a model for studying the melanocyte response to and recovery from cytotoxic drug damage in situ

Here we show that cyclophosphamide induces disruption of follicular melanogenesis, which is characterized by abnormal transfer of pigment granules to ectopic hair bulb locations, extrafollicular melanin incontinence, disordered formation of melanosomes, and inhibition of melanosome transfer into precortical keratinocytes. This is in contrast to dexamethasone-induced termination of follicle melanogenesis, which activates premature but predominantly normal catagen development. Cyclophosphamide-induced pigmentation disruption was accompanied by significant alterations of biochemical and biophysical markers of melanogenesis, compared to control mice treated either with vehicle or with topical dexamethasone. Electron paramagnetic resonance spectroscopy shows a decline in the melanin signal and predominant eumelanin production. Tyrosine hydroxylase activity of tyrosinase and dihydroxyphenylalanine oxidation drop rapidly, while DOPAchrome tautomerase activity increases and dihydroxyindole carboxylic acid conversion factor activity remains unchanged in cyclophosphamide-treated mice compared to controls. These observations emphasize the key role of tyrosinase as opposed to postdihydroxyphenylalanine oxidase steps in normal and pathological termination of melanogenesis and shows that tyrosinase is the most sensitive target of the melanogenic apparatus for pharmacological regulation. Follicle pigmentation recovers only during the subsequent hair cycle, i.e., after a new anagen hair bulb has been constructed, which points to the existence of a relatively chemoresistant melanoblast-like cell population residing in the noncycling part of the hair follicle.

Follow-up assessment of medication-treated dysthymia

1. The objective was to assess long-term efficacy of antidepressant medications in dysthymia. 2. In a naturalistic study, patients with DSMIII-R dysthymia who had participated in previous antidepressant trials with fluoxetine and trazodone were evaluated at a mean of 40.0 weeks of follow-up to assess whether medication response persisted over time. A multivariate analysis was performed for patients on vs. off medication. Relapse rates (with relapse defined as HDRS score > 13) were also compared for these two groups. 3. Of 40 patients, the 24 still on medication showed significantly lower scores on most rating scales (HDRS, Cornell Dysthymia Rating Scale, and CGI, but not on the SCL-58) than the heterogeneous group of 16 patients not taking medication. Relapse was low (17.4%) among patients remaining on medication. 4. These preliminary findings suggest that dysthymia patients who remain on medication maintain improvement over time.

Comparison of antegrade with antegrade/retrograde cold blood cardioplegia for myocardial revascularization

There has been increasing interest in the use of retrograde coronary sinus perfusion for delivery of cardioplegic solution during myocardial revascularization. Despite evidence of improved cardiac protection, it is unclear if a combined antegrade/retrograde approach to myocardial preservation offers significant clinical benefits. One hundred twenty patients undergoing elective 1st-time coronary bypass surgery for 3-or-more-vessel disease received aortic root, antegrade cold blood cardioplegia (Group I, n=52) or combined antegrade/retrograde cardioplegia via coronary sinus cannulation (Group II, n=68). All preoperative variables were similar, including age, severity of coronary artery disease, functional status, and ejection fraction. Intraoperative and postoperative variables, including the degree of hypothermia, temperature of infusion solution, number of bypass grafts, defibrillation attempts and spontaneous return to sinus rhythm, the use of intraaortic balloon pump counterpulsation, and inotropic support during weaning from cardiopulmonary bypass, were not statistically different. Cardioplegia infusion time was longer in Group II than in Group I (2.5 +/- 0.8 vs 1.7 +/- 0.7 min, p < 0.05). The postoperative cardia output, electrocardiographic and cardiac enzyme evidence of ischemia, the need for temporary pacing, and 30-day morbidity were similar for both groups. The data indicate that in this non-risk-stratified group of patients, the route of cardioplegia administration is not a determinant of clinical outcome.

Embolization of biologic glue during repair of aortic dissection

A 72-year-old patient was operated on because of an acute type A aortic dissection with the primary entry located in the aortic arch and with retrograde involvement of the ascending aorta. Complete replacement of the aortic arch and the ascending aorta was performed after the dissected aortic layers had been readapted and sealed with gelatin-resorcin-formaldehyde biologic glue. Postoperative neurologic status was judged to be normal. The patient died 3 weeks postoperatively of septic shock. Postmortem examination of the brain revealed several small lesions, and microscopy showed very small particles of polymerized glue in the afferent vessels of ischemic cerebral and meningeal regions.

Mast cells as modulators of hair follicle cycling

While the central role of mast cells (MC) in allergy and inflammation is well-appreciated, much less is known about their physiological functions. The impressive battery of potent growth modulatory MC products, and increasing evidence of MC involvement in hyperproliferative and fibrotic disorders suggest that tissue remodelling may be one of those, namely in the skin. Here, we delineate why this may best be studied by analysing the potential role of MC in hair growth regulation. On the background of numerous, yet widely under-appreciated hints from the older literature, we summarize and discuss our recent observations from the C57BL/6 mouse model for hair research which support the concept that MC are functionally important modulators of hair follicle cycling, specifically during anagen development. This invites to exploit the murine hair cycle as a model for dissecting the physiological growth modulatory functions of MC and encourages the exploration of MC-targeting pharmaceutical strategies for the treatment of hair growth disorders.

Predictors of stroke after cardiac surgery

From January 1, 1988 to September 30, 1993, 44 of 2,455 patients undergoing cardiac surgery for acquired heart disease at our institution sustained an intraoperative or postoperative cerebrovascular accident (CVA). Demographic data, atherosclerosis risk factors, past medical history, cardiac catheterization reports, and intraoperative findings were retrospectively reviewed. The highest rate of CVA was in the sub-group of patients undergoing simultaneous myocardial revascularization and carotid endarterectomy (18.2%). The lowest rate was in a group of patients who underwent aortic valve replacement (0.9%). Severe aortic arch atherosclerosis with the presence of atheromatous material or calcinosis at the cannulation site was identified intraoperatively in 43.2% of patients with neurological complications and in 5% of the group without CVA (x2 = 18.1, p = 0.0001). Of 44 patients with CVA, 13.6% had a history of preoperative completed stroke. CPB time was 90.1 +/- 4.9 min vs. 71.6 +/- 3.7 min (p = 0.004), and aortic cross-clamping time was 54.5 +/- 3.2 min compared to 39.8 +/- 2.7 min (p = 0.001) in groups with and without postoperative stroke, respectively. Hypertension was an independent risk factor of postoperative CVA (x2 = 9.5, p = 0.02), but age was not. Neurological complications correlated with high operative mortality (38.6%) and prolonged postoperative hospital stays (35.1 +/- 5.3). These data describe predictors for the development of post-cardiopulmonary bypass CVA and identify a high-risk subgroup for neurological events. The preoperative recognition of risk factors is an essential step toward the reduction of morbidity and mortality.

A simultaneous (15)N, (1)H- and (13)C, (1)H-HSQC with sensitivity enhancement and a heteronuclear gradient echo

New pulse sequences are introduced and discussed that allow for simultaneous acquisition of (15)N,(1)H-and (13)C,(1)H-HSQC correlations for fully (13)C,(15)N-labeled biomacromolecules in combination with hetero-nuclear gradient echoes and sensitivity enhancement. The pulse sequence experimentally found to be optimal can be used as a building block, especially in time-consuming multidimensional NMR experiments. Due to the excellent solvent suppression obtained by employing heteronuclear gradient echoes, which allows detection of resonances under the water resonance, it would be possible to record two sensitivity-enhanced 4D experiments simultaneously on one sample dissolved in H(2)O, e.g. a 4D (13)C,(1)H-HSQC-NOESY-(15)N, (1)H/(13)C,(1)H-HSQC.

Melanogenesis during the anagen-catagen-telogen transformation of the murine hair cycle

Melanin synthesis of follicular melanocytes is strictly coupled to the growth stage of the hair cycle (anagen), ceases during follicle regression (catagen), and is absent throughout the resting stage (telogen). Having previously characterized the expression and activity of melanogenesis-related proteins during the telogen-anagen transition of the murine hair cycle (JID 96:172, 1991), we here report a biophysical and biochemical analysis of follicular melanogenesis during the anagen-catagen-telogen transformation of the C57 BL-6 mouse hair cycle. Tyrosinase activity and concentration as well as dopachrome tautomerase activity were compared with melanin synthesis, as measured by electron paramagnetic resonance spectroscopy (EPR). The visible changes in skin color and the histologically appreciable switch-off of melanin formation during the anagen-catagen transformation were accompanied by a steep decline in 1) the melanin-associated EPR signal of full-thickness mouse skin, 2) tyrosinase and dopachrome tautomerase activities, and 3) the skin concentration of 80-85-kD melanogenesis related protein and 66-68-kD tyrosinase protein. Telogen skin displayed a minimum of the EPR amplitude as well as of tyrosinase and dopachrome tautomerase activity detected. By EPR, only eumelanin was identified during all hair cycle stages. The gradual switch-off of melanogenesis during anagen VI started with an unexpectedly early decline of the EPR melanin signal, followed by dopachrome tautomerase activity and the concentration of 80-85-kD melanogenesis related protein. The initiation of catagen was characterized by a significant and rapid decrease in activity and concentration of tyrosinase, and was accompanied by a second drop in dopachrome tautomerase activity. Together, these biochemical and biophysical parameters of follicular melanogenesis serve as novel and differential markers for the imminent termination of anagen and the development of catagen. They also show that the switch-off of melanogenesis during the anagen-catagen-telogen transition is a stochastic process commencing already in mid anagen VI.

Mast cell involvement in murine hair growth

We have examined the possibility that an involvement in hair growth regulation is one of the still obscure physiological roles of mast cells (MC) in normal skin. Using the murine hair cycle as a model, we first studied the number, localization and granulation status of skin MC during the hair cycle of C57 BL-6 mice. Shortly after the induction of hair growth (anagen) in the back skin of mice with resting (telogen) follicles, a sharp decline in the number of Giemsa-stainable MC was detected by morphometry. This was evident in depilation-induced, pharmacologically induced, and spontaneous anagen. By light and electron microscopy, the anagen-associated decline was correlated with the occurrence of substantial MC degranulation. In vivo, the IgE-independent MC secretagogues, compound 48/80 and ACTH, induced anagen in mouse telogen follicles after intracutaneous administration, while inhibitors of mast cell degranulation (cromoglycate, tiacrilast) and antagonists of selected MC products (clemastin, ranitidine, ketanserin) significantly retarded the induced development of anagen follicles in these mice. It is suggested that MC act via their secretory products as stimulators of anagen development in mice and that the murine hair cycle is an excellent model for studying growth regulatory functions of MC in developmentally regulated systems.

Murine skin as a target for melatonin bioregulation

Specific binding sites for 3H-melatonin were detected in membrane fractions prepared from C57 BL-6 mouse skin, and were localized to the epidermis and the epithelial bulb of the hair follicle by in situ autoradiography. In skin organ culture, melatonin stimulated DNA synthesis by the epidermal keratinocytes at concentration 0.1-10 nM, while at > or = 1 microM it inhibited tyrosinase activity. We concluded that murine skin is a target for melatonin bioregulation.

A randomized double-blind study of fluoxetine versus placebo in the treatment of dysthymia

OBJECTIVE

The purpose of this study was to assess the efficacy of fluoxetine, a selective serotonergic antidepressant, in the treatment of dysthymia.

METHOD

Thirty-five patients who met criteria for dysthymia, but not major depression, began randomized, double-blind 8-week trials of fluoxetine or placebo.

RESULTS

Of 32 patients who completed the study, 10 (62.5%) of the 16 patients given fluoxetine and three (18.8%) of the 16 given placebo responded to treatment. Response was defined as 1) 50% or greater decrease in Hamilton Rating Scale for Depression score and 2) a score of 1 or 2 on the Clinical Global Impression (CGI) improvement subscale. Fluoxetine subjects showed significantly greater improvement at week 8 than placebo subjects on the Hamilton depression and CGI scales, but not on the Hopkins Symptom Check-list (58-item) or the Cornell Dysthymia Rating Scale.

CONCLUSIONS

When compared to placebo, fluoxetine showed short-term effectiveness in treating dysthymic symptoms.

Issues related to informed consent

With advances in technology has come the promise for improved patient care. However, new and aggressive treatments can carry unexpected and unpredictable risks. Informed consent--a relatively recent concept--ensures that the patient is provided with ample information to make decisions about treatment.

CENP-C, an autoantigen in scleroderma, is a component of the human inner kinetochore plate

We have isolated and characterized a set of overlapping cDNA clones that encode the human centromere autoantigen centromere protein C (CENP-C). The identity of these clones has been established using several criteria. First, they were shown to encode a polypeptide that migrates at the expected position for CENP-C on SDS-polyacrylamide gel electrophoresis. Second, we have demonstrated that this polypeptide shares at least two epitopes with human CENP-C. Polyclonal antibodies were raised to fusion proteins encoded by nonoverlapping regions of the cDNA clones. These antibodies were shown to recognize a protein at a position appropriate for CENP-C on immunoblots of human chromosomal proteins. In addition, we used indirect immunofluorescence to demonstrate that these antibodies recognize centromeres of HeLa chromosomes in the expected pattern for CENP-C. Localization of CENP-C by immunoelectron microscopy reveals that this protein is a component of the inner kinetochore plate.

[The value of imaging techniques in the diagnosis of non-specific abdominal pain in young patients]

In a retrospective study the use of imaging modalities in the diagnosis of non-specific abdominal pain in patients under 31 years was evaluated. 253 patients with primarily non-specific abdominal complaints were analysed. For further investigation one of the following methods had to be applied: abdominal sonography and/or upper gastrointestinal tract roentgenograms and/or enteroclysis and/or barium enema. In 66% (167/253) of all cases abdominal pain remained non-specific. Clinical history and physical examination led to the final diagnosis in 66/86 (76.7%) of patients with pathologic findings. 21/561 (3.7%) radiographic examinations revealed abnormalities of clinical importance. In 10/253 (4%) patients the final diagnosis could be established only with the help of radiologic and/or endoscopic examinations. The low efficacy of conventional radiology justifies the demand for a stricter indication in the young patient suffering from non-specific abdominal pain.

Improved neonatal survival following multiple doses of bovine surfactant in very premature neonates at risk for respiratory distress syndrome

To determine whether multiple doses of bovine surfactant would improve neonatal mortality in very premature neonates, we conducted two multicenter controlled trials under identical protocols; the results were combined for analysis. Four hundred and thirty neonates born between 23 and 29 weeks gestation and weighing 600 to 1250 g at birth were assigned randomly at birth to receive either 100 mg of phospholipids/kg of Survanta, a modified bovine surfactant (n = 210), or a sham air placebo (n = 220) within 15 minutes of birth. Neonates who developed respiratory distress syndrome and required mechanical ventilation with at least 30% oxygen could be given up to three more doses in the first 48 hours after birth. Dosing was performed by investigators not involved in the clinical care of the neonates; nursery staff were kept blinded as to the treatment assignment. Cause of death was determined by a panel of three independent, board-certified neonatologists after blindly reviewing case report forms and autopsy reports. Fewer Survanta-treated neonates died of any cause (11.4% vs 18.8%, P = .031), died of respiratory distress syndrome (1.9% vs 15.6%, P less than .001), and either died or developed bronchopulmonary dysplasia due to respiratory distress syndrome (39.5% vs 49.1%, P = .044). The incidence of respiratory distress syndrome was also lower in Survanta-treated neonates (28.0% vs 56.9%, P less than .001), and the Survanta-treated neonates' oxygenation and ventilatory status were improved significantly at 72 hours. Survanta-treated neonates were also at lowered risk of developing pulmonary interstitial emphysema (23.3% vs 36.9%, P = .002) and other forms of pulmonary air leaks (9.6% vs 20.8%, P .002).(ABSTRACT TRUNCATED AT 250 WORDS)

Intrastriatal infusions of ascorbate antagonize the behavioral response to amphetamine

Compared to saline, bilateral infusions of ascorbate (AA) into the neostriatum of freely moving rats attenuated rearing, head bobbing, and sniffing at various times after systemic amphetamine administration. Comparable AA infusions into overlying cerebral cortex failed to alter the amphetamine behavioral response. Intrastriatal AA also enhanced the ability of haloperidol to antagonize amphetamine-induced forepaw shuffling and locomotion. Voltammetric measurements in separate animals revealed a linear increase in neostriatal AA that remained within reasonable physiological limits over the course of the AA infusion. Thus, endogenous AA may modulate behavior via mechanisms intrinsic to the neostriatum.

Delta-9-tetrahydrocannabinol shows antispastic and analgesic effects in a single case double-blind trial

A double-blind study was performed comparing 5 mg delta-9-tetrahydrocannabinol (THC) p.o., 50 mg codeine p.o., and placebo in a patient with spasticity and pain due to spinal cord injury. The three conditions were applied 18 times each in a randomized and balanced order. Delta-9-THC and codeine both had an analgesic effect in comparison with placebo. Only delta-9-THC showed a significant beneficial effect on spasticity. In the dosage of THC used no altered consciousness occurred.

ELISA with enzyme amplification for sensitive detection of staphylococcal enterotoxins in food

A highly sensitive amplified ELISA in microtitre plates for the detection of staphylococcal enterotoxins compared favourably with a commercially available kit. The amplified ELISA demonstrated a reduced effect of the food sample matrix and an ease of handling. Using the amplified ELISA, the influence of different parameters (pH, time, temperature, re-extraction, concentration procedure) on the recovery efficiency and assay reliability was tested on foods implicated in food poisoning outbreaks as well as on spiked foods containing low levels of enterotoxins.

Cytotoxic protein from Pseudomonas aeruginosa: formation of hydrophilic pores in Ehrlich ascites tumor cells and effect on cell viability

Increased plasma membrane permeability induced by a purified cytotoxic protein from Pseudomonas aeruginosa was studied using mouse Ehrlich ascites tumor cells in incubation medium containing an osmotic stabilizer. In the presence of serum albumin, 40 nM of the cytotoxin was required for cationic imbalance of 2.7 X 10(7) cells per ml at pH 7.4. The rate of passive flux of water-soluble markers with a molecular radius range between 0.3 and 4 nm was used to calculate the size of functional transmembrane pores. Within a short time of intoxication pores of 1 nm in radius were formed. Their stability is inferred from the constant rate of leakage of the most restricted marker during intoxication (60-90 min). The cytotoxin-induced plasma membrane damage led to loss of essential low molecular weight substances and was associated with a decrease of tumor propagation rate in mice. Regression analysis of these functional parameters indicate the reversibility of plasma membrane disorganization up to complete breakdown of the Na+/K+ gradient. The cell can even tolerate partial loss of larger cytosolic compounds under conditions of limited intoxication.

Comparison of AMP system and comprehensive psychopathological rating scale with regard to contents

Using a sample of 170 patients the psychopathological contents of the AMP system and the Comprehensive Psychopathological Rating Scale (CPRS) were compared by canonical correlations. The nine primary AMP scales predict 86% of the variance of the three CPRS scales. 64% of the variance of the nine AMP scales is explained by the CPRS scales. The secondary scales are nearly equivalent. The univariate analysis showed that all AMP scales with the exception of the 'hostility syndrome' and the 'catatonic syndrome' correlate highly with one of the psychopathological CPRS scales.

Comparison of the AMP system and the CPRS with regard to interrater reliability

The interrater reliability of the AMP system and the Comprehensive Psychiatric Rating Scale (CPRS) was compared in a sample of 30 hospitalized schizophrenic or depressive patients. The CPRS proved to have on average a slightly higher reliability on both the level of items and primary scales. The reliability of the secondary scales was nearly identical.

Sucking behaviors of normal 3-day-old female neonates during a 24-hr period

Feeding behaviors were measured during six feeding sessions distributed throughout a 24-hr period in 10 normal 3-day-old female infants. Infants were individually videotaped during feeding sessions at 13:00, 17:00, 21:00, 01:00, 05:00, and 09:00 hours. Total mealtime, nutritive sucking time, pause time, number of nutritive sucks, and amount of nutrient consumed were measured. None of these feeding variables were affected by the time of day an infant was fed. Maternal interactions with their infants such as auditory stimulation, caretaking touches or tender touches were unaffected by the time of a feed. These maternal behaviors did not correlate with any of the feeding variables. These findings suggest that 3-day-old infants experiencing routine nursery care do not express specific day-night feeding differences and that certain maternal behaviors do not influence the infants' feeding pattern.

Antibacterial effects of cefroxadine, cephalexin and cephradine in a new in vitro pharmacokinetic model

A pharmacokinetic model has been developed, by means of which all possible time courses of the concentrations of antibiotics in the plasma of treated individuals can be exactly simulated in vitro without diluting the test organism and affecting the growth curves. Equieffective concentrations in the system corresponded to the plasma concentrations in man produced by cefroxadine in a single oral dose of 250 mg and cephalexin and cephradine in a single oral dose of 500 mg.

[Scale construction of the German version of the Comprehensive Psychopathological Rating Scale (CPRS)]

170 hospitalised patients (96 schizophrenic, 71 depressive, and 3 manic) were examined during the German version of the CPRS. Based on factor analytical results four subscales ('manic syndrome', 'schizophrenic syndrome', 'depressive syndrome', and 'side-effects') and two second-order scales ('manic-depressive syndrome' and 'schizophrenic syndrome') were constructed. The first three subscales show a good reliability. The fourth subscale ('side-effects') has an insufficient internal consistency, mainly due to the small number of items (6). The two subscales 'schizophrenic syndrome' and 'depressive syndrome' and the two second-order scales can differentiate very well between schizophrenic and depressive syndromes. The validity of the first and fourth subscale could not be examined in this study.

[Interrater reliability of the German version of the Comprehensive Psychopathological Rating Scale (CPRS)]

The interrater reliability of the German version of the CPRS was examined in 30 patients (18 schizophrenic, 11 depressive and 1 manic). All patients were examined by the same two raters. The agreement of 55 out of 65 items was determined using the kappa coefficient. Kappa was calculated concerning symptom present/not present and differences less than or equal to 2/difference greater than 2.49 or 54 items show a moderate to excellent agreement. Items based on self-rating have a better interrater reliability than items based on the rating of the psychiatrists. The interrater reliability of the syndromes was calculated, using the rank correlation coefficient. The agreement concerning the 4 primary and the 2 second-order factors is high or excellent. The good results show the usefulness of the CPRS for the assessment of psychopathological findings.