Heterozygote advantage in Tay-Sachs carriers?

Chi-square analyses of new data as well as data previously reported by Myrianthopoulos have shown that grandparents of Tay-Sachs carriers die from proportionally the same causes as grandparents of noncarriers. It is unlikely that there is any advantage to being a Tay-Sachs carrier insofar as resistance to tuberculosis is concerned. Our results are further evidence to support Fraikor's claim that the high carrier frequency of the allele in Ashkenazi Jews is probably caused by a combination of founder effect, genetic drift, and differential immigration patterns.

MAO inhibition and control of anxiety following amitriptyline therapy. A pilot study

In a pilot study, 32 patients with mixed states of anxiety, depression, somatization and panic received amitriptyline for 4 weeks, the dose ranging from 50 to 300 mg/day. Steady-state plasma levels of the drug and activity of platelet monoamine oxidase were measured after 4 weeks. Clinical change was rated, using the SCL-90. Amitriptyline produced a small but significant inhibition of platelet monoamine oxidase activity (range 1.4--82%). A significant positive correlation was noted between MAO inhibition and improvement on somatization, and psychological and panic-phobic components of anxiety, but not for depression. No significant correlations were observed between improvement and combined or separate ami- + nortriptyline plasma levels.

Relationship between response to phenelzine and MAO inhibition in a clinical trial of phenelzine, amitriptyline and placebo

This report examines the hypothesis that for phenelzine to be more effective than placebo it is necessary to achieve at least 80% inhibition of platelet MAO activity. This hypothesis was examined in the context of a double-blind comparison of phenelzine, amitriptyline and placebo in depressed patients. When phenelzine became significantly more effective than placebo at 4 weeks, the average MAO inhibition was 85%. By the 5th week, with MAO inhibition greater than 90%, phenelzine was significantly more effective than amitriptyline. A highly significant correlation was noted between improvement and MAO inhibition within the phenelzine group.

Results of treatment of acetabular fractures

If it is not possible to achieve a satisfactory position by conservative methods, surgical treatment is indicated in displaced fractures of the acetabulum in order to restore and stabilize both the hip joint structure and the integrity of the pelvic ring. Restoration of the joint surfaces to as near normal as possible offers the best chance for a symptom-free hip. The postoperative recovery time is not hastened, but the conditions for early activity and restoration of function are improved. As demonstrated in 270 cases reported here, and as is well recognized in the past, a significant proportion of patients will require secondary or salvage surgery, i.e., total hip arthroplasty. Such treatment may not be possible if there is extensive residual disorganization of the hip joint. Preparation for future reconstructive surgery is important as an indication for operative reduction of the acetabulum.

A comparison of inpatients with primary unipolar depression and depression secondary to anxiety

Retrospective comparisons between primary unipolar depression and depression secondary to anxiety in 65 inpatients revealed a number of differences. Secondary depression was associated with a significantly higher incidence of neurotic traits in childhood, chronic unhappiness, and unsupportive family. Tricyclic antidepressants and ECT were both more effective in primary depression, and some secondary depressives became worse on ECt. When primary depression was sub-divided into familial, nonfamilial and spectrum types, the greatest differences were noted between familial and secondary depressions. In the former group a more stable life style was noted. Secondary and spectrum types differed on only two variables and several similarities were noted. Platelet monoamine oxidase activity was significantly higher in secondary depression.

Single case study. Complementary effects of phenelzine and psychotherapy in long term treatment of depression

A case report is described wherein the monoamine oxidase inhibitor phenelzine was administered for 10 months at different doses. Drug treatment in the initial part of the study was double blind. Weekly psychotherapy was instituted at the point of symptomatic recovery. At a reduced dose, in month 3, the patient experienced a relapse in depression. While platelet monoamine oxidase inhibition was greater than 80 per cent the patient was well, but at the point of relapse, inhibition was 14 per cent. Clinical ratings at relapse (Beck and SCL-90 scales) revealed greater readiness by the patient to report psychological discomfort compared with the original interview. The combined effects of psychotherapy and pharmacotherapy were felt to be responsible for this change. However, psychotherapy in this form and duration did not prevent relapse, which depended upon maintaining an adequate dose of phenelzine.

[Dopamine and dobutamine in the treatment of severe cardiac failure (author's transl)]

Ten patients in severe cardiac failure were treated with dopamine (4 microgram/kg . min) and dobutamine (7.5 microgram/kg.min). Both drugs brought about a similar increase in stroke volume and cardiac output of about 50% and 60%, respectively, accompanied by a fall in peripheral vascular resistance of about 33%. On dopamine the heart rate increased by 12%, but remained unaltered on dobutamine. There was a significant fall in the preload of both ventricles with dobutamine, while ventricular filling pressure during dopamine infusion was only slightly decreased, unchanged or even increased. The pulmonary (wedge) pressure during dopamine infusion averaged 9 mm Hg higher than during dobutamine (P less than 0.001). There is thus the potential danger with dopamine of aggravating pulmonary congestion. Furthermore, the improvement in cardiac function due to dopamine is at the expense of a higher oxygen demand than with dobutamine. Dobutamine is, therfore, preferable to dopamine in the treatment of advanced myocardial failure.

A comparison of electroconvulsive therapy and combined phenelzine-amitriptyline in refractory depression

Combined monoamine oxidase (MAO) inhibitor-tricyclic antidepressant therapy and electroconvulsive therapy (ECT) were compared in a population of refractory depressive patients. Seventeen patients were randomly assigned to either of the treatment groups, and an independent observer was used to rate overall progress. Between four and ten ECTs or a combination of phenelzine and amitriptyline were administered. Assays for MAO activity and plasma levels of amitriptyline and nortriptyline were performed. In both psychotic and neurotic depression, ECT was superior. When depression was accompanied by character disorder, the response was generally poor. Adequate levels of MAO inhibition were obtained, but tricyclic antidepressant levels were low. Electroconvulsive therapy is still considered to be the treatment of choice for severe depression, whereas the combination of low doses of phenelzine and amitriptyline are ineffective. This treatment modality needs further investigation.

Acetylation phenotype, platelet monoamine oxidase inhibition, and the effectiveness of phenelzine in depression

The authors treated 16 depressed patients with up to 90 mg/day of phenelzine. After acetylation phenotype was determined and platelet monoamine oxidase (MAO) activity measured, no significant relationship was observed between clinical improvement and acetylation phenotype or between MAO inhibition and acetylation. Discrepant findings regarding acetylation phenotype and the effects of phenelzine are discussed. The authors do not recommend a sulfamethazine phenotype test as a predictor of outcome for phenelzine.

Sixth interim progress report of the British Institute of Radiology fractionation study of 3F/week versus 5F/week in radiotherapy of the laryngo-pharynx

The results are reported of the multicentre BIR fractionation trial of 3F/week versus 5F/week in radiotherapy of the laryngo-pharynx. 687 patient records have been analysed with respect to survival rates, recurrence-free rates and laryngectomy-free rates. For the group as a whole these analyses show no difference between the two fractionation regimes. Analysis of the sub-group which had early disease confined to the vocal cords does, however, show a better recurrence-free and laryngectomy-free rate for those patients treated with 5F/week, though the survival rate for the two groups remains similar. Acute and late normal tissue reactions are reported for up to six years after treatment. It appears that treatment with 3F/week can be given safely to patients with advanced disease. The differences between the two treatment groups who had early disease of the vocal cords are discussed, but until more data become available in the future the problems raised cannot be resolved.

Inhibition of platelet monoamine oxidase in depressed subjects treated with phenelzine

The authors treated 19 depressive inpatients double-blind with a mean dose of 78 mg/day of phenelzine for 3 weeks to determine the possible relationship between monoamine oxidase (MAO) inhibition and the effectiveness of phenelzine. Clinical ratings made on the Hamilton Depression Rating Scale, the Beck Depression Inventory, and the SCL-90 indicated a minimum of 60% MAO inhibition had to be achieved for the drug to be consistently beneficial.