Monitoring of laboratory parameters during carbamazepine therapy in psychiatric patients

In recent years, carbamazepine has increasingly also been used in psychiatric indications. However, the manifold action of this drug also manifests itself in a number of adverse effects. In a prospective study including 46 patients, who were given carbamazepine for psychiatric indications and most of whom were also treated with one or several other psychotropic drugs, the following laboratory parameters were determined at two-weekly intervals: red and white blood count, platelets, SGOT, SGPT, gamma GT, alkaline phosphatase, serum calcium, serum sodium, IgA, IgG, IgM. Statistically significant changes were found in erythrocytes, leucocytes, platelets (decrease), Gamma GT (increase), serum calcium (decrease), IgA, IgM (decrease). The clinical relevance of these changes is discussed.

Collaborative research with a family support organization

Technical assistance on seven self-surveys was provided to a statewide family support organization. The collaborative approach increased client involvement, offered significant economies, and reduced barriers to dissemination, at the same time requiring trade-offs between methodological rigor and utility to the group.

Segmentation gene expression in the housefly Musca domestica

Drosophila and Musca both belong to the group of higher dipteran flies and show morphologically a very similar early development. However, these two species are evolutionary separated by at least 100 million years. This presents the opportunity for a comparative analysis of segmentation gene expression across a large evolutionary distance in a very similar embryonic background. We have analysed in detail the early expression of the maternal gene bicoid, the gap genes hunchback, Kruppel, knirps and tailless, the pair-rule gene hairy, the segment-polarity gene engrailed and the homoeotic gene Ultrabithorax. We show that the primary expression domains of these genes are conserved, while some secondary expression aspects have diverged. Most notable is the finding of hunchback expression in 11–13 stripes shortly before gastrulation, as well as a delayed expression of terminal domains of various genes. We conclude that the early developmental gene hierarchy, as it has been defined in Drosophila, is evolutionary conserved in Musca domestica.

Asterixis as a side effect of carbamazepine therapy

A patient developed asterixis 13 weeks after starting a therapy with carbamazepine. Serum concentration of carbamazepine was within the therapeutic levels. Further factors which might have provoked asterixis were an impairment of pulmonary function and the combination with a neuroleptic and lithium. Since the latter risk factors had already been present for a long time, it may be assumed that the addition of carbamazepine triggered the development of asterixis.

Family advocacy and the mental health system: the recent rise of the alliance for the mentally ill

The family consumer movement arose as a response to deinstitutionalization and the removal of stigma from parents of mental health clients. In many states the families are a dynamic force in mental health policymaking. If mental health professionals are to collaborate in support and advocacy programs, they should be aware of the origins and goals of the movement. Through their national organization (AMI), families advocate a biological view of mental illness causation and increased power for the mental health system. If the system is unable to meet parent expectations, it is likely that families will place themselves in competition with existing agencies for available resources.

[UV-inactivation of microorganisms in water]

UV-Inactivation of Escherichia coli, Bacillus subtilis spores, Staphylococcus-Phage A 994, Poliovirus type Mahoney and Rotavirus SA 11 was tested under controlled physical conditions. B. subtilis-spores were found to be the most resistant of these microorganisms, followed by Rotavirus, Bacteriophage and Poliovirus. E. coli required the lowest irradiation dose for inactivation. Causes and meaning of these dose-survival-reactions are discussed.

Atypical epithelial thymomas in rats

The histopathological features of 2 atypical epithelial thymomas found in female Han: SPRD rats are described. The neoplasms were characterized by well-circumscribed epithelial nests and islands. One tumour showed local invasion in lymph vessels.

[Gentamicin dosage in newborn infants]

Sixty nine pairs of trough and peak serum levels of gentamicin were determined in sixty three cases of gentamicin therapy of suspected sepsis in newborn babies (dosage 3.46 +/- 0.42 mg/kg/day given once a day). Eighty four percent of the trough levels were below 2 mg/l (mean: 1.39-0.60 mg/l). Ninety three percent of the peak levels were between 4 mg/l and 12 mg/l (mean: 7.38-2.35 mg/l). Three peak levels (four percent) were in the potentially toxic range (above 12 mg/l) and eleven trough levels (sixteen percent) were in the potentially toxic range (above 2 mg/l). On the basis of these observations the recommended gentamicin doses during the first two weeks of life is 3-4 mg/kg/day applied once a day. In immature babies with birth weights below 1500 g the daily doses should not exceed 3 mg/kg were as term babies especially during the second week of life should be treated with a daily gentamicin doses of near to 4 mg/kg/day.

Dry reagent immunoassay for measuring phenobarbital in serum and plasma

A reagent strip has been developed for measuring phenobarbital concentrations in serum or plasma. This strip utilizes the apoenzyme reactivation immunoassay system (ARIS) and is designed for use with the Ames Seralyzer reflectance photometer. The test takes 85 s and compares strip reactivities with a two-point calibration line that is stored in the instrument. Within-run precision coefficient of variation ranges from 2.4 to 4.1% over five concentrations while the between-run precision ranges from 2.3 to 4.9%. Results obtained with clinical serum samples correlated well (r greater than 0.99) with those obtained by a fluorescence polarization immunoassay (TDx). The strips crossreact with other barbituric acid derivatives that are not coadministered with phenobarbital. Crossreactivity to the metabolite p-hydroxyphenobarbital is sufficiently low as to not interfere in the usual specimens. Samples that are hemolyzed, highly icteric, or from uremic patients should be avoided. This assay is a rapid and convenient method for monitoring serum or plasma phenobarbital concentrations. It is particularly well suited for decentralized test sites, such as emergency rooms, urgent care centers, and physician's offices.

Spontaneous nonneoplastic gastric lesions in female Han:NMRI mice, and influence of food restriction throughout life

A life span study of 900 female virgin Han:NMRI mice (300 outbred controls, 300 of a fat subline, and 300 of a lean subline) was done to determine the occurrence of spontaneous disease with ad libitum or restricted feeding. Major nonneoplastic lesions in the glandular stomach were erosions, ulcers and adenomatous hyperplasia of the fundus. Ulcers, ranging in incidence with ad libitum feeding from 5 to 9% and with food restriction from 13 to 34%, either occurred secondary to other diseases or were due to stress associated with food restriction, causing death mainly in the lean subline. Adenomatous hyperplasia was most common in the control group (41%); the frequency increased with age and was significantly reduced by food restriction. The etiology of adenomatous gastric hyperplasia is yet unknown. However, a lack of antiparietal cell antibodies, as determined by an immunofluorescent technique, indicates that an autoimmune disorder is not involved and an increase in antral gastrin cells, as determined by avidin-biotin peroxidase immunocytochemistry, suggests a hormonal involvement in pathogenesis.

Cloning and expression in Escherichia coli of a synthetic DNA for hirudin, the blood coagulation inhibitor in the leech

A 235-bp DNA coding for the leech blood coagulation inhibitor, hirudin, was chemically synthesized. The synthesis involved preparation of seven long oligodeoxyribonucleotide pairs which were assembled and cloned using a rapid and simple procedure. More than half of the transformed Escherichia coli cells expressed a biosynthetic polypeptide having biological properties which were very similar to authentic hirudin from the leech Hirudo medicinalis. To achieve efficient expression, we fused the hirudin DNA to a truncated C1 repressor gene of bacteriophage lambda to create a hybrid protein. An additional methionine at the fusion point allowed the active hirudin to be cleaved off by cyanogen bromide.

Patient housing options as viewed by parents of the mentally ill. Housing Committee, California Alliance for the Mentally Ill

The housing committee of the California Alliance for the Mentally Ill, an organization of parents of mentally ill adults, surveyed 350 members on the housing needs of their sons and daughters. The parents reported that their offspring had a high degree of residential instability, and parents expressed the need for wider choices in housing options and more vocational and rehabilitation programs. Parents reported that patients were most satisfied with living at home or in semi-independent living situations and least satisfied with living on the streets or in state hospitals.

Dry-reagent strips for measuring phenytoin in serum

A new reagent strip has been developed for measuring phenytoin in serum or plasma. It utilizes the chemistry of the Apoenzyme Reactivation Immunoassay System (ARIS) and is designed for use with the Seralyzer reflectance photometer. The 90-s test relies on comparison of strip reactivities with a two-point calibration line, which can be validly stored in the instrument for two weeks. Within-run CVs for controls at five concentrations ranged from 2.7 to 5.6%, between-run CVs from 2.3 to 6.3%. Phenytoin values obtained for clinical serum samples correlated well (r greater than 0.99) with those obtained by liquid chromatography or substrate-labeled fluorescent immunoassay. The speed and convenience of this assay for monitoring phenytoin in serum make it well suited for decentralized test sites such as emergency rooms, urgent-care centers, and physician's offices.

Dry-reagent strips for measuring phenytoin in serum

A new reagent strip has been developed for measuring phenytoin in serum or plasma. It utilizes the chemistry of the Apoenzyme Reactivation Immunoassay System (ARIS) and is designed for use with the Seralyzer reflectance photometer. The 90-s test relies on comparison of strip reactivities with a two-point calibration line, which can be validly stored in the instrument for two weeks. Within-run CVs for controls at five concentrations ranged from 2.7 to 5.6%, between-run CVs from 2.3 to 6.3%. Phenytoin values obtained for clinical serum samples correlated well (r greater than 0.99) with those obtained by liquid chromatography or substrate-labeled fluorescent immunoassay. The speed and convenience of this assay for monitoring phenytoin in serum make it well suited for decentralized test sites such as emergency rooms, urgent-care centers, and physician's offices.

[Transitory pseudohypoparathyroidism in the newborn infant]

This is a report on two young infants suffering from transitory pseudohypoparathyroidism. Therapy with vitamin D in high doses was not helpful but metabolic changes were promptly corrected by the administration of 1.25-(OH)2-D3 (Rocaltrol). The typical pretreatment findings were: hypocalcemia, hyperphosphatemia, reduced clearance of phosphate. Parathormone in serum was normal. Treatment with 0.25 and 0.5 micro-Gram 1.25-(OH)2-D3 respectively resulted in prompt correction of serum calcium- and serum-phosphate-changes. The observation of the urinary-cAMP-excretion during the course of the disease enables one to differentiate between the permanent and the transient form of the disease: values reaching 5-10 nmol/mg Creatinine indicate the time when treatment can be discontinued in the transitory form.

A survey of the California Alliance for the Mentally Ill

Family groups are becoming increasingly active in providing support to family members and in mental health advocacy. The authors report the results of a survey that assessed the concerns of members of the California Alliance for the Mentally Ill and the treatment history of disabled family members. The 199 respondents were typically the parents of a schizophrenic son between the ages of 24 and 34 whose illness was first noticed in the late teens and for whom assistance had been sought for at least a decade. The respondents indicated that medication, family support, socialization centers, community residential treatment, and locked facilities had most helped the family member to improve. The most important additional needs were housing, vocational, and social opportunities and research.

[Acquired immunologic deficiency syndrome (AIDS) in an infant from Austria]

Manuel born in June 1984 is presented for the first time at the age of 6 months with the following symptoms: Otitis purulenta, enlargement of lymph-nodes, swelling of liver and spleen, enteritis, failure to thrive and candida albicansdermatitis. Immunoglobulins and the total serumprotein are elevated. At the age of 9 months a new Hospital admission was necessary. The following symptoms are present: severely enlarged lymph-nodes at different sites, enlargement of liver and spleen, interstitial pneumonia and enteritis. Body weight is below the third percentile. Tine-Test negative. The baby was BCG vaccinated after birth and at 3 months the Tine-Test was positive. The serologic antibody tests (Elisa and Western Blot) for HTLV III are positive, the index helper: suppressor T cells is 1,1 (normal above 1,5). The antibody titers in the maternal blood are higher than in the child. The mother was a regular drug user. A vertical perinatal transmission from the affected mother to her baby is postulated. The start of clinical illness was the 5th month of life. AIDS was fully developed at 9 months of age. Cotrimoxazol treatment resulted in clinical improvement.

[Early diagnosis and early treatment of hypophosphatemic vitamin D-resistant rickets]

This is a report on two children with hypophosphatemic vitamin D-resistant rickets born to affected mothers diagnosed at the age of one and three months, respectively. The most important diagnostic criterium is the reduced value of the transport maximum of phosphorus in relation to glomerular filtration rate. At the age of one and six months, respectively, therapy with 1.25 (OH)2D3 and phosphate was started with the result of normal growth of length, radiological healing of rickets and normalisation of alkaline serum-phosphatase, but persistently low fasting values of serum-phosphorus during the time of observation up to twelve and twenty-four months of age, respectively in both children. The therapy with 1.25 (OH)2D3 and phosphate has a positive effect on intestinal absorption of phosphorus, because the serum-phosphorus is significantly elevated to the age corrected normal range two hours after oral administration of phosphate. There were no negative effects during therapy. It seems, therefore, that early diagnosis and therapy with 1.25 (OH)2D3 and phosphate is successful in healing this rare form of rickets.

Sons and daughters of parents in a support organization

Earlier surveys of a parents' support organization revealed a 3:1 ratio of parents of sons to parents of daughters. Three possible explanations for this ratio were considered based on differential onset, behavioral differences, and marital status. A re-analysis of survey data indicated that the most reasonable explanation of the gender difference is the greater propensity for anti-social behavior on the part of sons, leading to increased parental needs for support and outside assistance.

[HPLC method for determination of vitamin C in milk, whey and whey beverages]

A method is described for the estimation of L-ascorbic acid and L-dehydroascorbic acid in milk, whey, and whey drinks by paired-ion reversed-phase HPLC using a C18-column. L-ascorbic acid is detected UV-spectrophotometrically at 248 nm, L-dehydroascorbic acid is determined spectrofluorometrically with excitation at 350 nm and emission at 430 nm, after derivatisation into a quinoxaline fluorophor.

Dry-reagent strips used for determination of theophylline in serum

A reagent strip for quantifying theophylline in serum or plasma has been developed for use with the Apoenzyme Reactivation Immunoassay System (ARIS) with the Ames Seralyzer reflectance photometer. The test takes 80 s and involves comparison with a two-point calibration line, which can validly be stored in the instrument for two weeks. Results for theophylline in clinical serum samples correlate well (r greater than 0.98) with results by liquid chromatography, fluoroimmunoassay, and enzyme immunoassay procedures. The within-run CV for four concentrations of controls ranged from 3.5 to 6%; the between-run CVs ranged from 3 to 5%. This assay for use in therapeutic drug monitoring is convenient, rapid, and simple, and thus is appropriate for use in emergency rooms, physician's offices, and small laboratories.

Dry-reagent strips used for determination of theophylline in serum

A reagent strip for quantifying theophylline in serum or plasma has been developed for use with the Apoenzyme Reactivation Immunoassay System (ARIS) with the Ames Seralyzer reflectance photometer. The test takes 80 s and involves comparison with a two-point calibration line, which can validly be stored in the instrument for two weeks. Results for theophylline in clinical serum samples correlate well (r greater than 0.98) with results by liquid chromatography, fluoroimmunoassay, and enzyme immunoassay procedures. The within-run CV for four concentrations of controls ranged from 3.5 to 6%; the between-run CVs ranged from 3 to 5%. This assay for use in therapeutic drug monitoring is convenient, rapid, and simple, and thus is appropriate for use in emergency rooms, physician's offices, and small laboratories.

The schizophrenic no-society revisited

Twenty years ago in an article in this journal ( Sommer and Osmond 1962), we introduced the concept of the schizophrenic no-society, chracterizing the social organization of long-term mental hospital wards as a society in hich no voluntary social organization occurred among residents. In the intervening years, voluntary social organizations among schizophrenic persons which were lacking in mental hospitals in the 1960s or whether the concept of the schizophrenic no-society is still a valid one.

Zinc and cadmium in 5-aminolevulinic acid dehydratase. Equilibrium, kinetic, and 113Cd-nmr-studies

5-Aminolevulinic acid dehydratase (ALAD) from bovine liver contains zinc that is partially lost during the isolation of the enzyme. ALAD has its maximal activity at 10(-5) M ZnCl2. It binds 7.4 Zn per octameric protein with an association constant of 5.3 X 10(6)M-1. ALAD is inactivated by 1,10-phenanthroline or ethylenediaminetetraacetic acid (EDTA) but not by monodentate anions like cyanide or sulfide. After removal of zinc by chelating agents, the enzyme activity may be restored by Zn2+ or Cd2+. Removal of zinc by EDTA increases KM 60-fold and decreases Vmax to about 1/2 of its original value. The 113Cd nuclear magnetic resonance spectrum of the enzyme reconstituted with 113Cd-acetate exhibits a single sharp resonance signal at 79 ppm. It does not change by the addition of substrate but disappears when the inhibitor lead acetate is added. Therefore, an immediate interaction between the metal ion of the enzyme and the substrate is excluded, whereas lead changes the environment of cadmium and probably of zinc too.

Effects of pleasant and unpleasant verbal stimuli upon perceptual learning in young children

Children who were told pleasant stories about one part of an ambiguous figure were more likely to see that figure when it was paired with a second aspect that had previously been associated with an unpleasant story. The experiment was subsequently repeated using six experimenters, three who had been previously told that the children they tested would perceive the pleasant-associated figure, and three of whom had been told that children would perceive the negative-associated figure. Children tested by both groups of experimenters were more likely to see the positive-associated figure than the negative-associated figure.

Self-survey of family organization

A self-survey was undertaken among 512 members of the California Alliance for the Mentally Ill (CAMI), a statewide family support organization. The typical CAMI member is the parent of a mentally disabled son or daughter who has been ill for an average of 13 years with multiple hospitalizations and therapists. The employment record of the disabled individuals was poor; more than two-thirds had been involuntarily committed at some time, and half had been in jail. Family members see the most serious unmet need to be social rehabilitation housing with planned programs.

A bibliography of mental patients' autobiographies, 1960-1982

First-person narratives contain an inside view of mental disorder that can be useful in teaching, theory, and research. To bring earlier bibliographies up to date, the authors list eight anthologies and 63 autobiographies of hospitalized mental patients published since 1960.

Calcification in the portal venous system demonstrated by computed tomography

The CT appearance of calcification in the portal venous system in a patient with chronic alcoholic cirrhosis is presented. Report cases of radiologically detectable calcification in the portal system are rare, and most of them have been associated with longstanding portal hypertension. We presume that with CT this diagnosis will be made more frequently. In the presence of calcification in the portal venous system, portal vein thrombosis is highly probable. This information is of obvious importance to the surgeon contemplating a portal decompressive shunt procedure.

Nutrition knowledge and preferences of food cooperative shoppers

Tests of nutrition knowledge and food preference were given to matched samples of food cooperative and supermarket shoppers. The food preferences of cooperative shoppers, but not their nutrition knowledge, differed significantly from the preferences of supermarket shoppers. Preferences of supermarket shoppers were greater for foods having a low index of quality, while those of the cooperative shoppers were greater for foods having a high index of quality.

Action research is formative: research at Saskatchewan Hospital, 1957-61

The author has examined the five lines of research started at a mental hospital between 1957-61 to determine their immediate effects upon practice and subsequent citations in the literature. Three lines of research combining basic and applied studies affected practice and research as measured by literature citations. One line of basic studies of perception and psychopathology influenced research but not practice. Applied studies of perception and psychopathology influenced research but not practice. Applied studies of staff organization had immediate application but disappeared from the professional literature in a short time.

[Rise in gamma-GT during anticonvulsive therapy]

There have been several reports of the isolated occurrence of raised serum gamma GT levels in the course of long-term anticonvulsive treatment. The findings concerning the correlation between this elevation of gamma GT and various dimensions of epilepsy or treatment regimens are equivocal. In a retrospective study of 158 epileptics, the mean values of the serum gamma GT level have been grouped according to anticonvulsive regimen and compared with one another, as well as correlated to the serum concentration of the antiepileptic drug. An elevation of serum gamma GT was found in 103 patients. Among the different subgroups the mean value for serum gamma GT was raised in cases under treatment with PHT, PB or PRM. No such elevation was found in cases under monotherapy with CBZ or VPR. The elevation of serum gamma GT is considered to reflect hepatic enzyme induction rather than hepatic impairment.

[The value of visually evoked response in diagnosis of multiple sclerosis ]

We investigated the reliability of visually evoked responses (VER) in 56 cases in diagnosing multiple sclerosis. We found 100% pathological VER in proved cases and 71% in probable/possible cases. Patients with a duration of illness less than one year had in 80% pathological VER, whereas in other conditions only 17% were pathological. Structural changes are usually found in definite multiple sclerosis patients with a disease progress lasting more than 1 year. Pathological VER are an important diagnostic aid in multiple sclerosis, especially in doubtful cases, whereas structural investigations are primarily useful in the exclusion of other conditions.

[Levels of lipoprotein fractions in ischaemic cerebral disease (author's transl)]

The significance of serum lipid levels in the assessment of risk in ischaemic cerebral diseases is controversial. The differential investigation of lipoproteins, however, showed that the high-density lipoprotein (HDL) fractions are absolutely or relatively decreased with respect to low-density lipoproteins (LDL) in cerebral infarcts and in transient ischaemic attacks. Raised LDL/HDL ratios were found in this study, as an expression of a relative lowering in HDL, in ischaemic cerebral disease associated with pathological disorders of the large or small cerebral vessels. Hence, it appears that HDL represents a protection factor, not only in the prevention of cardiovascular, but also cerebrovascular disease and a decrease in HDL may be a risk factor.