A preliminary study of serotonergic antidepressants in treatment of dysthymia

There is increasing evidence that antidepressants may alleviate symptoms of dysthymia, but few prior studies on selective serotonergic agents. Twenty patients meeting criteria for dysthymia, but not meeting criteria for major depression, received open label trials of a serotonergic antidepressant, either fluoxetine or trazodone. Seventeen (85%) completed three-month medication trials, and of these, twelve (70.6% of completers) responded to treatment. Seven (41.2% of completers) were still in remission on follow-up at five months. Both fluoxetine and trazodone were well tolerated in dysthymics, and showed similar short-term effectiveness in treating dysthymic symptoms.

HLA DR2 in narcolepsy with sleep-onset REM periods but not cataplexy

To determine the association of HLA DR2 in patients with narcolepsy without cataplexy, a case-control study was performed. Patients receiving the diagnosis of narcolepsy without cataplexy had excessive daytime sleepiness (EDS) and polysomnographic findings consistent with narcolepsy but no clinical evidence of cataplexy. Of 28 patients identified, 12 agreed to return for HLA typing. Respondents did not differ from nonrespondents in demographic, clinical, or sleep laboratory data. The comparison group was 503 individuals, those 30 years and older, on the Michigan Kidney Transplant Registry. The odds ratio obtained from logistic regression indicated a strong association between narcolepsy without cataplexy and HLA DR2. To control for potential confounding variables, multivariate models were constructed to explore the joint effects of HLA DR2 and each one of the covariates (age, sex, and race), their possible combinations, and the effect of all three covariates. The odds ratios decreased minimally and the association between the disease and HLA DR2 remained significant.

Comparison of once daily felodipine 10 mg ER and hydrochlorothiazide 25 mg in the treatment of mild to moderate hypertension

The efficacy of extended release felodipine 10 mg (ER) o.d., a new dihydropyridine calcium antagonist, and 25 mg hydrochlorothiazide (HCTZ) o.d. have been compared in a randomized, double-blind, crossover trial in 28 mildly to moderately hypertensive subjects (supine diastolic blood pressure, BP, greater than or equal to 95 mm Hg and less than or equal to 110 mm Hg on three separate occasions). Both drugs significantly reduced systolic and diastolic BP in the sitting position felodipine from 157.1/93.8 mm Hg at baseline to 133/78.9 mm Hg 2.5 h after medication and to 138/82.7 mm Hg after 2 weeks of treatment, and HCTZ from 156/95.6 mm Hg to 147/88.4 mm Hg 2.5 h after medication and to 149/89.5 mm Hg also after 2 weeks. A decrease of the same magnitude in standing systolic and diastolic BP was observed after both treatment regimens with the exception of diastolic BP 2.5 h after dosing with HCTZ, which was not significantly lower. At all times (2.5 h and 2 weeks), the reduction in systolic and diastolic BP was greater after felodipine compared to HCTZ. Heart rate was significantly increased after felodipine in both the sitting and standing positions, and both 2.5 h following medication and after 2 weeks of treatment. The difference between the regimens was significant only 2.5 h after dosing. Overall, felodipine 10 mg ER o.d. was superior to 25 mg HCTZ o.d. in lowering BP.

Effects of fiber-containing liquid diets on colonic structure and function in the rat

Dietary fiber plays a role in maintaining colonic structure and function. Recently, fiber-supplemented liquid diets containing primarily soy polysaccharide have been marketed. However, the effects of these diets on the colon, particularly absorptive function, are not well documented. We compared Jevity (containing 1.4% soy polysaccharide) to fiber-free Osmolite. In addition, we were interested in comparing the effects of soy polysaccharide to that of pectin, which has previously been shown to facilitate adaptation. A 1% pectin-supplemented rat liquid diet was compared to the liquid diet alone. After 2 weeks of dietary treatment, rats were anesthetized and in vivo colonic absorption measured. Both Jevity and the pectin-containing diets led to a significantly greater (p less than 0.01) basal and butyrate stimulated water absorption as well as 20 mM butyrate absorption compared to their fiber-free fed controls. After perfusion, rats were killed and parameters of colonic mass measured including mucosal weight, protein, and DNA. The fiber-containing diets produced a modest, nonsignificantly greater colonic mass compared to their fiber-free controls. A commercial diet containing soy polysaccharide seems to be equally effective as pectin in maintaining colonic absorptive function.

Catecholamines and the renin-angiotensin-aldosterone system during treatment with felodipine ER or hydrochlorothiazide in essential hypertension

The neurohumoral responses after 10 mg of felodipine extended release (ER), a new dihydropyridine calcium antagonist, and 25 mg of hydrochlorothiazide (HCTZ) were compared in a randomized, double-blind, crossover trial in 28 mild to moderate hypertensives. Antihypertensive drugs were gradually discontinued. Felodipine ER, 10 mg was given once daily for 2 weeks; after another washout period of 1 week, patients were switched to 25 mg of HCTZ once daily and vice versa. Blood pressure (BP) was measured at baseline, 2.5 h after medication, and after 2 weeks of treatment (24 h postdosing) using an oscillometric device. Felodipine ER and HCTZ both lowered BP effectively. However, felodipine ER was superior in reducing systolic and diastolic BP during the short term and medium term. Treatment with felodipine ER over 2 weeks increased sympathetic outflow as indicated by elevated plasma norepinephrine levels, whereas plasma epinephrine was mainly unaffected, as were plasma renin and aldosterone levels. On the other hand, 25 mg of HCTZ increased plasma renin and aldosterone, but left catecholamines unchanged. Despite persistent increased sympathetic activity, the reduction in BP in this study was more pronounced after felodipine ER as compared to HCTZ. The lack of a difference between heart rates under both medications after 2 weeks of treatment suggests a resetting of the baroreflex by felodipine ER and furthermore that the increased norepinephrine levels may not be clinically relevant, but demonstrate the maintained baroreflex activity. HCTZ, in doses as low as 25 mg, is still capable of stimulating the renin-angiotensin-aldosterone system.

The psychiatric discharge summary: a tool for management and audit

The aims of this study were to review the information needs of general practitioners in relation to the discharge of mentally ill patients; to design a discharge summary that would meet these needs and evaluate its use by junior hospital staff; and to assess the usefulness of this summary for audit. The information needs of general practitioners were identified from a review of the literature and from discussions with local general practitioners. A prototype discharge summary was designed and reviewed by a panel of general practitioners, regional advisors and course organizers from the south east Thames region. It was used for all patients discharged from the acute psychiatric ward in Hither Green Hospital over a 10 month period. One copy was given to the patient to take to the general practitioner, one was posted to the general practitioner and a final copy was kept in the patient's hospital records. The senior house officers found the summary easy to complete. It reduced uncertainty about what data to provide, and helped to focus on the most critical information needed by general practitioners for continuity of care. Using a pre-coded data collection sheet, analysis of the information on the summaries was easily done. It provided a rapid audit of caseload, diagnoses, therapy, methods of admission and discharge, length of stay, risk factors and roles of all involved in future management. This information can be of use to the psychiatric team, general practitioners and hospital managers and could be the first step towards the development of shared care.

Effects of felodipine ER and hydrochlorothiazide on blood rheology in essential hypertension--a randomized, double-blind, crossover study

The haemorheological effects of felodipine extended release (ER), a new dihydropyridine calcium antagonist, were compared with hydrochlorothiazide (HCTZ) in 28 mild to moderate hypertensives (18 men and 10 women, aged 30-70 years) in a randomized, double-blind, crossover trial. Antihypertensive drugs were gradually discontinued. Felodipine Er, 10 mg, was given once daily for 2 weeks, and after another wash-out period of 1 week, patients were switched to 25 mg HCTZ, once daily, and vice versa. Whole blood viscosity (BV) at three different shear stresses, haematocrit (Hct), plasma viscosity (PV), red blood cell (RBC) aggregation, RBC deformability, and fibrinogen were measured under standardized conditions 2.5 h after medication, and after 2 week of treatment (24 h post-dosing). Felodipine ER improved BV acutely, but not during treatment over a 2-week period. By contrast, HCTZ did not affect BV, but decreased RBC deformability 2.5 h after medication intake. After 2 weeks of treatment, the negative effect on RBC deformability had increased slightly. Furthermore, fibrinogen and PV were significantly elevated at this stage. In summary, felodipine ER did not improve blood rheology over a 2-week treatment period in this study. HCTZ exhibited marginal but significant negative effects on fibrinogen, PV and indices of RBC deformability, but not on RBC aggregation.

Association between plasma viscosity and blood pressure. Results from the MONICA-project Augsburg

The relationship between determinants of blood viscosity and blood pressure (BP) variables was studied in a large sample of a population aged 25 to 64 years. Plasma viscosity, hemoglobin, and total serum protein were examined. Systolic and diastolic BP and the prevalence of hypertension showed a crude positive association with plasma viscosity levels in both sexes. Age, body mass index, and total serum protein appeared to have a confounding effect on this relationship, whereas hemoglobin, smoking behavior, and alcohol consumption did not. A crude positive association was also found between total serum protein levels and the prevalence of hypertension in men and women; however, since total serum protein was treated as a covariable, no further analyses were carried out. In contrast to findings reported in the literature, hemoglobin levels were not correlated with BP variables in either sex. After adjusting for all confounders, a significant main effect of plasma viscosity still was found. However, the magnitude of the effect was not as large as for body mass index, a well-established risk variable for hypertension. These results indicate that BP is positively associated with plasma viscosity. Whether increased plasma viscosity in hypertension constitutes a primary or a secondary phenomenon remains to be answered. Since plasma viscosity is significantly associated with hypertension but any BP variable, increased levels of plasma proteins (particularly fibrinogen as the main determinant of plasma viscosity) may represent the cause for elevated plasma viscosity. This might contribute to persistently increased resistance to blood flow on the microcirculatory level in arterial hypertension.

Acute monarticular arthritis. Sleuthing out the cause

The diagnosis of acute monarthritis depends heavily on a thorough history and physical examination. When these are combined with a few diagnostic tests, such as synovial fluid analysis, x-ray studies, complete blood cell count, and common blood chemical analyses, the majority of cases can be correctly diagnosed and properly treated.

Thyrotropin-releasing hormone: further extraction studies and analysis by fast protein liquid chromatography and radioimmunoassay

We describe the clinical application of a radioimmunoassay combined with fast protein liquid Chromatography (FPLC) for measuring TRH immunoreactivity (TRH-IR) in blood samples extracted previously with methanol or with Sep Pak C18 cartridges. Sensitivity of the RIA was 3 fmol/tube, displacement at 50% B/B0 was achieved by 55 fmol of unlabelled TRH. Our specific antibody K2B7 (km = 2.2 fM) showed no cross reaction with other peptides. No difference was observed between the mean values of TRH-IR in 19 euthyroid, 22 hyperthyroid, 18 hypothyroid and 10 hypophysectomised patients (45 +/- 17.8, 58 +/- 30, 40 +/- 22 and 36 +/- 12 fmol/ml, mean +/- SD, respectively), whereas TRH-IR was significantly lowered (p less than 0.05) in 6 euthyroid pancreatectomised patients (21 +/- 5 fmol/ml). The reversed phase FPLC analysis of the TRH-IR presented in the methanol extracts was shown to have the same retention time as synthetic TRH. TRH could not be measured in unextracted blood samples. TRH added in preincubated (60 min, at 37 C), before extraction, blood samples showed a loss of 83.4% of immunoreactivity. Our results demonstrate that this method is able to detect TRH-IR in human blood by whole methanol extraction and/or by Sep Pak C18 cartridges extraction. Furthermore the findings suggest that the main source of circulating TRH-IR may be of extrahypothalamic (pancreatic?) origin and that the basal peripheral TRH levels are not involved or they do not clearly represent a pathological condition.

The appeal cycle in early mother-child interaction: nature and implications of a finding from developmental research

The appeal cycle was observed and delineated through research on mother-child interaction during the second year of life. As a repeated, circumscribed unit of developmental interaction, it is conceived to be an agent of developmental process and psychic structure formation. The appeal cycle has four phases: the adaptational phase, the distress phase, the appeal phase, and the interactional phase. The progression from the adaptational into the distress and appeal phases evidences the child's separation anxiety and failure of self-regulation in response to the experimentally induced attenuation of the mother-child relationship. A successful interactional phase reestablishes the relationship, regulates and restores the child's emotional equilibrium, and enables a return to self-regulation and adaptation. Because the interaction reinforces the functions and structures being developed through identification with the mother, the interactional phase is conceived to be an instrumental event in the mediation of psychic structure formation. The appeal cycle is discussed in comparison with similar phenomena in earlier phases of development and with other studies addressing development during the first two years of life. Directions for future research are noted.

Aspects of chronic oral treatment with thyrotropin-releasing hormone: the hypothalamic-pituitary-thyroid axis in rats. A study with a pharmacological dose of thyrotropin-releasing hormone

The effects of 16 days of oral treatment with thyrotropin-releasing hormone (TRH, 1 mg/24 h) on serum levels of thyrotropin (TSH), thyroxine (T4) and triiodothyronine (T3) and the kinetics of TRH in the blood were studied in normal rats. A second group of animals served as controls. TRH was dissolved by sonification (10 mg/l) and was stable in tap water. TRH was measured by a radioimmunoassay procedure (normal range: 20-80 pmol/l, antiserum K2B9 1:120,000 final dilution). An increase in basal TSH (7,200 +/- 440 ng/l, mean +/- SD) was found after 2 days of treatment (11,420 +/- 810 ng/l), but a significant increase was observed after 5 days of treatment (12,530 +/- 640 ng/l, p less than 0.001). T4 serum concentrations remained in the normal range during the entire period of study, whereas T3 serum concentrations (0.76 +/- 0.1 micrograms/l) were increased to 1.22 +/- 0.2 micrograms/l on day 5 (p less than 0.001). A subsequent decline of TSH, T4 and T3 up to the end of the study was observed. TRHmax concentrations were registered on day 5 (790 +/- 24 pmol/l). The mean value of TRHmax was 723 +/- 34 pmol/l. To improve the stability of TRH in tap water, 1-ml samples of drinking water with dissolved TRH were measured. The mean TRH concentration in drinking water was 73 +/- 1.5% (SD). No significant correlations were found between the area under the curve of TSH (184,340 ng.l-1.24 h) and that of TRH (14,954 pmol.l-1.24 h).(ABSTRACT TRUNCATED AT 250 WORDS)

Superoxide dismutase activity is not affected by closed head injury in rats

Superoxide anion radicals are generated in association with prostaglandin production, and are implied in the mediation of secondary brain damage following cerebral ischemia or injury. In a model of closed head injury in rats we have demonstrated the activation of phospholipase A2 (PLA2) and the increased production of eicosanoids in the post-trauma period. In the present study we investigated the role of superoxide dismutase (SOD) in this model. Head trauma was induced over the left cerebral hemisphere of ether anesthetized rats by a calibrated weight drop device. Cortical tissue samples were taken 15 min, 4 and 24 h later. SOD activity was assayed by its ability to inhibit the xanthine oxidase-cytochrome c reduction. There was no significant change in SOD activity in any of the regions studied - the site of injury, and contralateral region as well as the remote frontal lobes of both hemispheres. Although intense PLA2 activity and production of eicosanoids was previously found in some of these regions, activity of SOD was unaffected. These results do not support an important role for endogenous SOD up to 24 h after head injury.

Thyrotropin releasing hormone (TRH) immunoreactivity and thyroid function in obesity

Circulating TRH-immunoreactive levels, the thyrotropin response to a TRH intravenous stimulation (200 micrograms) and thyroid hormone concentrations have been determined in 43 overweight subjects (body mass index 45 +/- 12 kg/m2, mean +/- s.d.) and 46 (body mass index 22 +/- 2 kg/m2) normal weight controls. The TRH levels measured by a recently developed, highly specific radioimmunoassay were similar among both groups (44 +/- 16 vs 40 +/- 12 fmol/ml, n.s.). The pattern of response of TSH to TRH was normal in the obese and no significant difference was observed between the peak TSH values of the obese and the normal group (8.3 +/- 2.8 vs 8.7 +/- 2.2 microU/ml, n.s.). No correlations were found between the degree of obesity and the concentrations of TRH, TSH and peripheral thyroid hormone levels. Three obese patients showed a delta-TSH of 18, 19 and 21 microU/ml at normal thyroid hormone concentrations as sign of latent hypothyroidism. These data indicate that in obesity: (a) the TSH response to i.v. TRH is not impaired, (b) circulating TRH-IR levels are not significantly changed and (c) the incidence of overt hypothyroidism is not increased.

Efficacy of long-term fluoxetine treatment of obsessive-compulsive disorder

Ten outpatients meeting DSM-III-R criteria for obsessive-compulsive disorder completed a 32-week, open-label study with fluoxetine, a selective serotonin reuptake blocker. The patients were evaluated every four weeks for obsessive-compulsive symptomatology, anxiety, and depression. Significant improvement of obsessive-compulsive and anxiety measures were observed after four weeks, with maximal improvement at eight weeks. Depressed and nondepressed patients showed similar rates of improvement in obsessive-compulsive symptomatology. Overall, fluoxetine was tolerated well by all patients, and no serious side effects were observed. This study suggests that fluoxetine is an effective and safe treatment for obsessive-compulsive disorder, both for short-term alleviation and for long-term maintenance.

Angiotensin I-forming angiotensinogenases in extrarenal vasculature and in the kidney

The intention of this study was to characterize angiotensin I-forming angiotensinogenases (AIFAs) in rat extrarenal arterial walls and to clarify whether these enzymes are also present in the kidney. A further aim was to identify AIFAs in human vasculature and to establish whether they are affected in essential hypertension. Sprague-Dawley rats and vascular sections of patients undergoing corrective surgery were studied. Enzyme kinetic assays were performed using angiotensin I radioimmunoassay and purified natural angiotensinogens. Fast protein liquid chromatography was employed for biochemical characterization. A series of AIFAs with various isoelectric points, molecular weights and pH optima was detected in rat extrarenal vascular and, with differing distributions of enzyme activities, in renal tissues. In extrarenal arteries the main form of renal renin was present with a relatively low activity only. AIFAs were also demonstrable in human extrarenal vasculature and behaved like plasma renin in essential hypertension. The results indicate the existence of an intrinsic human vascular RAS in extrarenal (and renal) arteries. Extrarenal arterial AIFAs are not generally stimulated in essential hypertensives, as previously postulated.

Single-compartment model analysis of thyrotropin-releasing hormone kinetics in hyper- and hypothyroid patients. Kinetic studies using a combined system of RIA and FPLC

The pharmacokinetics of thyrotropin-releasing hormone (TRH) were assessed following an i.v. injection in blood of ten hyperthyroid, ten hypothyroid, and six normal subjects. A single-compartment model was employed. After methanol extraction, TRH concentrations were analyzed using a specific radioimmunoassay technique combined with fast protein liquid chromatography (FPLC). As for the basal levels of TRH, no differences were observed in either study group. Peak concentrations were always present two min after the injection of TRH. In the euthyroid subjects, TRH blood levels had a half-life (t1/2) of 6.5 +/- 0.41 min, mean +/- SD, while t1/2 was 7.2 +/- 0.62 min in the hyperthyroid and t1/2 was 12 +/- 1.67 min (p less than 0.001) in the hypothyroid patients. The metabolic clearance rate (MCR) (82.2 +/- 15.3 liters/m2/day vs. 89.8 +/- 17.2) and the volume of distribution (Vd) (7.1 +/- 4.2 liters vs. 7.3 +/- 3.4) were approximately the same in the normal subjects and in the hyperthyroid group. MCR (66.2 +/- 15.3 liters/m2/day) and Vd (6.2 +/- 3.3 liters) were found to be lower in the hypothyroid patients. In FPLC, when TRH was added to plasma, it eluted in one peak. Blood samples taken 5 min after TRH i.v. injection had an elution profile of 9.94 ml. These data indicate that 1) TRH has a very short half-life, 2) hypothyroidism can prolong the t1/2 of exogenous TRH, and 3) when TRH should be used in clinical studies, the function of the thyroid gland has to be taken into consideration.

Immunity of fetal mice to prenatal administration of the dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine

Subcutaneous injection of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) HCl (25 mg/kg) in pregnant female mice at the 17th day of gestation markedly depleted striatal dopamine (DA) concentrations in the mothers 24 h later and at 24 h and 28 days after delivery. By contrast, in the offspring of the female mice exposed to MPTP during pregnancy, fetal brain DA concentrations at 24 h after injection and at 24 h after birth and striatal DA levels at 14 and 28 days postnatally were unaffected and identical to those in age-matched controls. The postnatal ontogenesis of striatal DA levels was identical in offspring of control vehicle- and MPTP-treated pregnant mice. Also, prenatal challenge with MPTP did not make nigrostriatal DA neurons more vulnerable to a second postnatal treatment with the toxin. Striatal DA depletions were identical in 6-week-old mice given MPTP, whether they were exposed to MPTP or to vehicle in utero. Monoamine oxidase (EC 1.4.3.4; MAO) type B activity was extremely low in the fetal brain and, relatively, much lower than that of MAO-A. Prenatal MPTP administration reduced maternal striatal and also embryonal brain MAO-B activity at 24 h post treatment but did not alter the normal postnatal development of striatal MAO-A and -B activities in the offspring. Study suggests that resistance of fetal DA neurons to the DA-depleting effect of MPTP may be due, at least in part, to an absence in the embryonal brain of adequately developed MAO-B activity required for the conversion of MPTP to its toxic metabolite, 1-methyl-4-phenylpyridinium ion.

Comparative evaluation of the acute and chronic effects of cilazapril and hydrochlorothiazide on diastolic cardiac function in hypertensive patients

The effect of cilazapril, 2.5 to 5.0 mg and hydrochlorothiazide, 25 to 50 mg, on diastolic cardiac function was studied by echocardiography and radionuclide ventriculography, using a double-blind randomized parallel-group design with a placebo run-in period, in 30 hypertensive patients. The measurements were made before and three hours after the first dose, and after ten weeks of treatment. Both drugs lowered the elevated blood pressure and did not impair the normal systolic cardiac function. In the patients treated with cilazapril an improvement in indices of diastolic function was observed after the first dose. The normalized peak filling rate significantly increased from 2.4 +/- 0.7 to 2.7 +/- 0.7 counts and time to peak filling rate was shortened from 169.4 +/- 31.0 to 151.6 +/- 40.1 msec. This improvement was sustained or even enhanced during chronic therapy. In contrast hydrochlorothiazide acutely impaired one index of diastolic function, the normalised peak filling rate, and did not alter the other indices. Long-term treatment with cilazapril, but not with hydrochlorothiazide, caused regression of left ventricular hypertrophy.

IN CONCLUSION

cilazapril is superior to hydrochlorothiazide in its effect on diastolic cardiac function in hypertensive patients. The beneficial effect is partially related to regression of left ventricular hypertrophy.

Case-control study of in situ and invasive carcinoma of the vagina

A case-control study of 41 patients with carcinoma in situ (CIS) or invasive cancer of the vagina and 97 community controls was undertaken to identify potential risk factors. Although vaginal and cervical cancers often occur as multiple primaries, only a few common risk factors prevailed. Similar to cervical cancer, low education and family income were risk factors for vaginal CIS and invasive cancer. In addition, history of genital warts was strongly related (RR = 2.9), although other sexual factors were not. Previous genital abnormalities related to subsequent cancer risk, with significant associations seen for vaginal discharge or irritation (RR = 6.1), a previous abnormal Pap smear (RR = 3.8), or an early hysterectomy (RR = 6.7). In addition, there was some evidence that vaginal trauma might be involved, with nonsignificant and independent associations relating to regular douching with preparations other than water or vinegar (RR = 2.7) and frequent washing of the genital area (RR = 2.7). Further studies are needed to determine whether our findings persist among a larger series of cases.