Tour d'horizon des tests de diagnostic recommandés dans le Manuel des tests de diagnostic et des vaccins pour les animaux terrestres de l'Organisation mondiale de la santé animale

To provide a standardised approach to the diagnosis of diseases and to facilitate health certification for trade, the World Organisation for Animal Health (OIE) standards, described in the Manual of Diagnostic Tests and Vaccines for Terrestrial Animals (Terrestrial Manual), include internationally agreed laboratory diagnostic techniques. This review examines the type of tests recommended in the disease-specific chapters of the Terrestrial Manual for the six most common purposes of diagnostic techniques, including certification for movement, confirmation of clinical cases and disease surveillance. The most frequently recommended tests for all six purposes are enzyme-linked immunosorbent assay and/or polymerase chain reaction, for which there are detailed validation guidelines in the OIE Terrestrial Manual. This is true for all species and no species-specific barriers to validation related to test type were identified. Classical techniques continue to be well represented in the Terrestrial Manual recommendations whereas novel technologies are slow to gain acceptance. These classical tests can present challenges for validation as there may be a dearth of international standard reagents and harmonised protocols.

Pseudomonas aeruginosa infection in augmented care: the molecular ecology and transmission dynamics in four large UK hospitals

BACKGROUND

Pseudomonas aeruginosa is a common opportunistic pathogen and molecular typing in outbreaks has linked patient acquisition to contaminated hospital water systems.

AIM

To elucidate the role of P. aeruginosa transmission rates in non-outbreak augmented care settings in the UK.

METHODS

Over a 16-week period, all water outlets in augmented care units of four hospitals were sampled for P. aeruginosa and clinical isolates were collected. Outlet and clinical P. aeruginosa isolates underwent whole-genome sequencing (WGS), which with epidemiological data identified acquisition from water as definite (level 1), probable (level 2), possible (level 3), and no evidence (level 4).

FINDINGS

Outlets were positive in each hospital on all three occasions: W (16%), X (2.5%), Y (0.9%) and Z (2%); and there were 51 persistently positive outlets in total. WGS identified likely transmission (at levels 1, 2 and 3) from outlets to patients in three hospitals for P. aeruginosa positive patients: W (63%), X (54.5%) and Z (26%). According to the criteria (intimate epidemiological link and no phylogenetic distance), approximately 5% of patients in the study 'definitely' acquired their P. aeruginosa from their water outlets in the intensive care unit. This study found extensive evidence of transmission from the outlet to the patients particularly in the newest hospital (W), which had the highest rate of positive outlets.

CONCLUSIONS

The overall findings suggest that water outlets are the most likely source of P. aeruginosa nosocomial infections in some settings, and that widespread introduction of control measures would have a substantial impact on infections.

The pulsed light inactivation of veterinary relevant microbial biofilms and the use of a RTPCR assay to detect parasite species within biofilm structures

The presence of pathogenic organisms namely parasite species and bacteria in biofilms in veterinary settings, is a public health concern in relation to human and animal exposure. Veterinary clinics represent a significant risk factor for the transfer of pathogens from housed animals to humans, especially in cases of wound infection and the shedding of faecal matter. This study aims to provide a means of detecting veterinary relevant parasite species in bacterial biofilms, and to provide a means of disinfecting these biofilms. A real time PCR assay was utilized to detect parasite DNA in Bacillus cereus biofilms on stainless steel and PVC surfaces. Results show that both Cryptosporidium and Giardia attach to biofilms in large numbers (100-1000 oo/cysts) in as little as 72 hours. Pulsed light successfully inactivated all test species (Listeria, Salmonella, Bacillus, Escherichia) in planktonic and biofilm form with an increase in inactivation for every increase in UV dose.

Investigation of critical inter-related factors affecting the efficacy of pulsed light for inactivating clinically relevant bacterial pathogens

AIMS

To investigate critical electrical and biological factors governing the efficacy of pulsed light (PL) for the in vitro inactivation of bacteria isolated from the clinical environment. Development of this alternative PL decontamination approach is timely, as the incidence of health care-related infections remains unacceptably high.

METHODS AND RESULTS

Predetermined cell numbers of clinically relevant Gram-positive and Gram-negative bacteria were inoculated separately on agar plates and were flashed with <or=60 pulses of broad-spectrum light under varying operating conditions, and their inactivation measured. Significant differences in inactivation largely occurred depending on the level of the applied lamp discharge energy (range 3.2-20 J per pulse), the amount of pulsing applied (range 0-60 pulses) and the distance between light source and treatment surface (range 8-20 cm) used. Greater decontamination levels were achieved using a combination of higher lamp discharge energies, increased number of pulses and shorter distances between treatment surface and the xenon light source. Levels of microbial sensitivity also varied depending on the population type, size and age of cultures treated. Production of pigment pyocynanin and alginate slime in mucoid strains of Pseudomonas aeruginosa afforded some protection against lethal action of PL; however, this was evident only by using a combination of reduced amount of pulsing at the lower lamp discharge energies tested. A clear pattern was observed where Gram-positive bacterial pathogens were more resistant to cidal effects of PL compared to Gram negatives. While negligible photoreactivation of PL-treated bacterial strains occurred after full pulsing regimes at the different lamp discharge energies tested, some repair was evident when using a combination of reduced pulsing at the lower lamp discharge energies. Strains harbouring genes for multiple resistances to antibiotics were not significantly more resistant to PL treatments. Slight temperature rises (<or=4.2 degrees C) were measured on agar surfaces after extended pulsing at higher lamp discharge energies. Presence of organic matter on treatment surface did not significantly affect PL decontamination efficacy, nor did growth of PL-treated bacteria on selective agar diminish survival compared to similarly treated bacteria inoculated and enumerated on nonselective agar plates.

CONCLUSIONS

Critical inter-related factors affecting the effective and repeatable in vitro decontamination performance of PL were identified during this study that will aid further development of this athermal process technology for applications in health care and in industry. Very rapid reductions (c. 7 log(10) CFU cm(-2) within <or=10 pulses) occurred using discharge energy of 20 J for all tested clinically relevant bacteria under study when treated at 8 cm distance from xenon light source. While no resistant flora is expected to develop for treatment of microbial pathogens on two-dimensional surfaces, careful consideration of scale up factors such as design and operational usage of this PL technique will be required to assure operator safety.

SIGNIFICANCE AND IMPACT OF THE STUDY

Findings and conclusions derived from this study will enable further development and optimization of this decontamination technique in health care and in food preparation settings, and will advance the field of nonthermal processing technologies.

The PANDAS subgroup: recognition and treatment

A subgroup of patients with childhood-onset obsessive-compulsive disorder (OCD) has been identified who share a common clinical course characterized by dramatic symptom exacerbations following Group A beta-hemolytic streptococcal (GABHS) infections. The term PANDAS has been applied to the subgroup, to indicate the postulated etiology of their symptoms: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. Five clinical characteristics define the PANDAS subgroup: presence of OCD and/or tic disorder, prepubertal symptom onset, sudden onset or abrupt exacerbations (sawtooth course), association with neurological abnormalities (presence of adventitious movements or motoric hyperactivity during exacerbations), and temporal association between symptom exacerbations and GABHS infections. Post-streptococcal symptom exacerbations are typically quite dramatic, with patients reporting that their symptoms "...came on overnight" or "...appeared all of a sudden a few days after I had a sore throat." The post-streptococcal inflammatory nature of the neuropsychiatric symptoms provides novel opportunities for treatment and prevention, including immunomodulatory therapies such as therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG). A recently completed placebo-controlled trial revealed that both IVIG and TPE were effective in reducing neuropsychiatric symptom severity (40% to 55% reductions, respectively) for a group of severely ill children with OCD and/or tic disorders. Further research is required to determine why the treatments are helpful, as well as to ascertain whether or not antibiotic prophylaxis can help prevent post-streptococcal symptom exacerbations.

Abnormal neurologic maturation in adolescents with early-onset schizophrenia

OBJECTIVE

This study evaluated neurologic functioning in adolescents with schizophrenia with onset of psychosis before age 13.

METHOD

The authors administered a structured neurologic examination to 21 adolescents with early-onset schizophrenia and 27 healthy age- and sex-matched comparison subjects.

RESULTS

The adolescents with schizophrenia had a high frequency of neurologic abnormalities. Neurologic signs decreased with age in the healthy comparison subjects but not in the subjects with schizophrenia.

CONCLUSIONS

The adolescents with schizophrenia had a high burden of neurologic impairment and a pattern of abnormalities similar to that of adults with schizophrenia. The persistence of neurologic signs in the adolescents with schizophrenia, which faded with age in the healthy comparison adolescents, supports earlier evidence of a delay in or failure of normal brain development during adolescence.

Postinfectious and other forms of obsessive-compulsive disorder

The search for subtypes of OCD has led to increased appreciation of the importance of distinguishing early (prepubertal) versus later on-set, and of tic-related versus non-tic related subtypes, as well as postinfectious forms of the disorder. How these apparent typologies relate to each other remains to be elucidated. Careful longitudinal clinical descriptive studies, as well as the ongoing application of genetic, neuroimaging, and immunologic techniques, promise to advance our understanding of how genotype and environmental factors interact to produce the diverse clinical forms of OCD and to point the way to more effective treatment.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases

OBJECTIVE

The purpose of this study was to describe the clinical characteristics of a novel group of patients with obsessive-compulsive disorder (OCD) and tic disorders, designated as pediatric autoimmune neuropsychiatric disorders associated with streptococcal (group A beta-hemolytic streptococcal [GABHS]) infections (PANDAS).

METHOD

The authors conducted a systematic clinical evaluation of 50 children who met all of the following five working diagnostic criteria: presence of OCD and/or a tic disorder, prepubertal symptom onset, episodic course of symptom severity, association with GABHS infections, and association with neurological abnormalities.

RESULTS

The children's symptom onset was acute and dramatic, typically triggered by GABHS infections at a very early age (mean = 6.3 years, SD = 2.7, for tics; mean = 7.4 years, SD = 2.7, for OCD). The PANDAS clinical course was characterized by a relapsing-remitting symptom pattern with significant psychiatric comorbidity accompanying the exacerbations; emotional lability, separation anxiety, nighttime fears and bedtime rituals, cognitive deficits, oppositional behaviors, and motoric hyperactivity were particularly common. Symptom onset was triggered by GABHS infection for 22 (44%) of the children and by pharyngitis (no throat culture obtained) for 14 others (28%). Among the 50 children; there were 144 separate episodes of symptom exacerbation; 45 (31%) were associated with documented GABHS infection, 60 (42%) with symptoms of pharyngitis or upper respiratory infection (no throat culture obtained), and six (4%) with GABHS exposure.

CONCLUSIONS

The working diagnostic criteria appear to accurately characterize a homogeneous patient group in which symptom exacerbations are triggered by GABHS infections. The identification of such a subgroup will allow for testing of models of pathogenesis, as well as the development of novel treatment and prevention strategies.

Strategies to maintain the credibility of sham acupuncture used as a control treatment in clinical trials

Many clinical trials concerning acupuncture are flawed by methodological problems. One of the major difficulties is the appropriate selection and use of a placebo control. This article evaluates the use of sham acupuncture as a placebo control and analyzes its credibility as a control treatment. Sixty-four subjects were assessed for their perception of whether they were receiving sham or real acupuncture while participating in a clinical trial of acupuncture. It was found that if used under specific experimental conditions, sham acupuncture can function as a credible control. Specific strategies are suggested to maintain the credibility of sham acupuncture as a placebo control.

An integrated approach to the treatment of chiasmatic-hypothalamic gliomas

The treatment of visual pathway gliomas is controversial. The many retrospective studies reporting outcome data for patients with chiasmatic/hypothalamic gliomas are difficult to interpret for several reasons. First the natural history of these tumors is erratic with some reports suggesting that most visual pathway gliomas are hamartomas and follow an indolent course, and others reporting 10-year survival rates of close to 60%. Second, earlier studies did not clearly indicate which patients had neurofibromatosis type 1 (NF1) and recent evidence suggests that the natural history of optic gliomas is more favorable in patients with NF1. Third the methods and accuracy of diagnosis have changed dramatically and patients diagnosed before and after the advent of CT/MR imaging have often been included in the same series. While surgical resection is usually not a viable option for definitive treatment of these tumors, recent studies have shown favorable results after subtotal resection in selected patients. The efficacy of radiotherapy has not been unequivocally demonstrated and treatment-related morbidity has become a major concern, in particular, adverse effects on cognition and growth. Chemotherapy has been advanced as an viable alternative to avoid or delay the adverse affects of RT, but the long-term outcome benefits and adverse effects of treatment are just being defined. Despite the limitations of currently available information, sufficient data are now available to rational management quotelines for the majority of children with chiasmatic/hypothalamic gliomas.

Long-term follow-up after a drug trial for panic disorder

BACKGROUND

This study investigates the naturalistic course of panic disorder over four years and attempts to identify predictors for outcome.

METHOD

423 DSM-III-R panic disorder patients who had taken part in an international multicentre drug trial were selected for follow-up; we were able to re-interview 367 (87%). For panic attacks, phobic avoidance and disabilities the same rating scales were administered as had been used for the clinical trials.

RESULTS

While 61% of all patients experienced at least occasional panic attacks at follow-up, few suffered from serious phobic avoidance (16.7%) or serious disabilities (work 7.9%); family 8.7%; social 13.9%). Panic attack frequency at baseline, original trial medication and continuous use of psychotropic medication during follow-up are not related to outcome, whereas longer duration of illness and more severe phobic avoidance at baseline are unfavourable.

CONCLUSION

The course of panic disorder is not uniform. Since long duration of illness and severe phobic avoidance at baseline are predictors for an unfavourable outcome, more rigorous efforts should be undertaken to detect and treat panic disorder at an early stage.

Spontaneous palpebromandibular synkinesia: a localizing clinical sign

In the classical corneomandibular reflex (CMR), corneal stimulation elicits a bilateral eyelid blink and a brisk anterolateral jaw movement. We here describe 14 patients with a spontaneous palpebromandibular (eyelid-jaw) synkinesia (SPMS) in whom jaw movements, similar to those in CMR, regularly accompanied spontaneous eye blinks without an external corneal stimulus. Eleven of the patients with SPMS also had CMRs on corneal stimulation. Four patients had clinical and imaging evidence of brainstem lesions above the mid-pons, 5 patients had autopsy or imaging evidence of both bilateral cerebral and upper brainstem lesions, and 5 patients had clinical or imaging evidence of bilateral cerebral dysfunction. Topical corneal anesthesia administered to patients who had both CMR and SPMS blocked the CMR but had no effect on the SPMS. In patients with both SPMS and CMR, measurements of latency from onset of orbicularis oculi electromyographic activity to onset of lateral pterygoid EMG activity, and mandibular kinesiography of jaw velocity and direction showed that the eyelid-jaw synkinesias of CMR and SPMS had similar characteristics. We conclude that SPMS is pathophysiologically the same as the eyelid-jaw synkinesia of CMR and both synkinesias originate centrally, probably in the pons. In CMR, the jaw movement is primarily related to the blink rather than the corneal stimulus, but corneal stimulation may be necessary to overcome a higher threshold for expression of the synkinesia than in patients with SPMS. Like CMR, SPMS emerges in patients with upper brainstem or bilateral cerebral lesions and SPMS may therefore be a useful localizing clinical sign.

Radiographic screening at four months of infants at risk for congenital hip dislocation

We report on a radiographic screening programme at four months of age for infants who were clinically normal at neonatal examination but were considered to be 'at risk' for congenital dislocation of the hip because of their family history, breech presentation, or a persistent click. From a total population of 13,662 live births over a two-year period, 357 (2.6%) infants at risk were identified. Of these 46 had abnormal radiographs (six subluxations, 40 acetabular dysplasia). In 12 infants treatment resulted in a normal hip; 34 required no treatment but were followed up until their radiographs were normal and walking had begun. Of the 311 infants with normal radiographs, 256 (82%) were examined after 15 months of age; none had any detectable abnormality. We suggest that radiography of the hip at four months is a valuable adjunct to neonatal screening for infants at increased risk of congenital dislocation of the hip.

Benzodiazepines for panic disorder. Are they safe?

The incidence of benzodiazepine dependence in properly selected patients with panic disorder appears to be very low. Patients with a history of drug abuse should not be given benzodiazepines. Physical dependence manifested by withdrawal symptoms occurs in 5% to 45% of patients who discontinue benzodiazepine therapy. Withdrawal symptoms are usually mild and attenuated by use of a tapering schedule of several weeks' duration. Physical dependence should not be confused with substance dependence, a disorder characterized by multiple problems in daily life caused by use of a particular substance.

Is there a relationship between MHPG and anxiety in depressed patients?

Previous studies of the relationship between anxiety and 3-methoxy-4-hydroxyphenylglycol (MHPG) in depression have produced conflicting results. The possibility that different definitions of anxiety may have created these discrepant findings was explored. There was no convincing evidence that MHPG was associated with any of a wide range of different anxiety measurements that encompassed the anxiety concepts of somatic anxiety, psychic anxiety, agitation, or situational stress. The relationships of anxiety ratings to each other were also examined.

Response of depression to very high plasma levels of imipramine plus desipramine

Forty-five depressed patients were treated with imipramine for 6 weeks. Seven of 7 patients (100%) who had plasma levels of imipramine plus desipramine greater than 500 ng/ml showed a 50% or greater improvement in Hamilton depression scores compared with 23 of 38 patients (60%) with plasma levels less than 500 ng/ml (p less than 0.057).

Examination of comorbid anxiety in psychiatric inpatients

Seventy-three percent of 90 psychiatric inpatients had a coexisting anxiety disorder. There were few differences between patients with or without coexisting anxiety on more than 100 clinical and demographic variables that were tested. Patients who had an anxiety syndrome before the onset of their major psychiatric disorder also showed few differences when compared with patients whose anxiety started coincident to or after another DSM-III axis I disorder. The concept of primary/secondary anxiety disorder may not be useful when applied to a cross-section of psychiatric inpatients.

Does 24-h urinary MHPG predict treatment response to antidepressants? II. Association between imipramine response and low MHPG

Thirty depressed patients collected 24-h urine samples for a 3-methoxy-4-hydroxyphenylglycol (MHPG) determination prior to imipramine treatment. Patients responding to treatment had lower levels of MHPG than did non-responders.

Does 24-h urinary MHPG predict treatment response to antidepressants? I. A review

The ability of pretreatment 3-methoxy-4-hydroxyphenylglycol (MHPG) to predict response to various antidepressants is reviewed. MHPG appears to be a modest predictor of treatment response to imipramine but does not appear to be a reliable predictor for other antidepressants.

Effects of linoleic and gamma-linolenic acids (efamol evening primrose oil) on fatty acid-binding proteins of rat liver

We have studied the effects of Efamol evening primrose oil (EPO) on fatty acid-binding proteins (L-FABP) of rat liver. EPO contains 72% cis-linoleic acid and 9% cis-gamma linolenic acid. EPO has been clinically used for treatment of a number of diseases in humans and animals. EPO is also known to lower cholesterol level in humans and animals. Feeding of an EPO supplemented diet to rats (n = 9) for 2 months decreases the oleate binding capacity of purified L-FABP of rat liver whereas the palmitate binding activity was increased by 38%. However, EPO feeding did not alter the L-FABP concentrations significantly as measured by using the fluorescence fatty acid probe, dansylamino undecanoic acid. Endogenous fatty acid analysis of L-FABPs revealed significant qualitative and quantitative changes in fatty acid pattern after EPO feeding. EPO feeding decreased the endogenous palmitate level by 53% and oleate level by 64% in L-FABPs and also EPO feeding decreased the total endogenous fatty acid content from 62 nanomole per mg of protein to 42 nanomole per mg of L-FABP (n = 3).

Comparison of panic disordered patients with high versus low MHPG

Fourteen panic disorder patients with low 3-methoxy-4-hydroxyphenylglycol (MHPG) were compared to 14 patients with high MHPG. Patients with low MHPG were more likely during the preceding month to have experienced spontaneous panic attacks (P less than 0.008) than were patients with high MHPG. Patients with high MHPG had increased severity ratings on several individual symptoms of anxiety.

Elevated levels of N-acetyl-beta-glucosaminidase in affective disorders and chemical dependence

Levels of N-acetyl-beta-glucosaminidase (NAG) were examined in 575 patients with various psychiatric diagnoses and 38 non-ill controls. Ten percent of affectively disordered patients and 19% of chemically dependent patients had abnormal NAG levels, whereas none of the 38 controls did (P less than 0.05 and P less than 0.003 respectively). Other psychiatric diagnostic groups were not associated with abnormal levels of this enzyme.

Frequency of constipation in major depression: relationship to other clinical variables

A semistructured interview that evaluates 70 clinical variables, including constipation, was administered to 170 patients with major depression. Twenty-seven percent of the patients had depression-associated constipation. Constipation was not associated with any other clinical variable.

Reduction of gastrointestinal symptoms following treatment for panic disorder

Symptoms of gastrointestinal distress, including those of irritable bowel syndrome, were reported more frequently by patients with panic disorder than by nonanxious controls. Five of 30 subjects with panic disorder met criteria for irritable bowel syndrome, the onset of which coincided with the onset of panic disorder. Effective treatment for the anxiety disorder was accompanied by a reduction in gastrointestinal symptoms in all subjects.

The relationship of panic disorder and its treatment outcome to 24-hour urinary MHPG levels

Levels of 24-hour urinary 3-methoxy-4-hydroxyphenylglycol (MHPG) were not markedly elevated in a group of 35 panic disorder patients when compared to healthy controls (mean = 2,430 micrograms/day vs. 2,130 micrograms/day). There was a weak association between elevated pretreatment levels of MHPG and a positive treatment response to alprazolam or diazepam. Alprazolam and diazepam may differ in their effects on MHPG.

Comparison of major depressive patients with a predominantly sad versus anxious mood

One hundred and seventy-seven patients with major depressive disorder (MDD) experienced a mood disturbance that could be characterized as predominantly sad (55%), anxious (31%) or mixed (14%). Patients that had a predominantly sad mood were more likely to be hypersomnic, anhedonic, younger and seen in an outpatient setting. Predominantly anxious MDD patients were more likely to have been hospitalized, agitated, psychotic, incapacitated, insomnic, and to have had higher post-dexamethasone cortisol levels.

Lymphopenia in primary degenerative dementia

The central nervous and immune systems share a number of common properties, e.g. neurotransmitter receptors. In contrast to age matched healthy and/or hypertensive controls, the total lymphocyte count in 25 carefully diagnosed and staged patients with primary degenerative dementia were significantly reduced and also correlated with the severity of their dementia. Subjects' age, age of dementia onset, or duration of illness were unrelated. Total leukocyte counts were similar between groups. Nutritional status, ACTH, or plasma cortisol in dementia cohort were also not explanatory of their lymphopenia. These results are potentially significant in light of an immune hypothesis for primary degenerative dementia: Alzheimer's type and/or that population's high concomitant risk of infection.

Use of psychiatric referral by family physicians

The family physician occupies a critical place in the detection and management of mental health problems. Optimal case management requires an awareness of individual limitations and effective use of a psychiatric consultant. The consultant must understand the unique relationship between the patient and the family physician. Several historical biases may impede the physician's use of psychiatric consultation and the patient's acceptance of psychiatric treatment options.

Imipramine metabolism in recurrent depressive episodes

The long-term maintenance of major affective disorders with tricyclic antidepressants is of obvious interest. However, discrete predictors identifying subgroups 'at-risk' for higher recurrence rates have infrequently been cited. The clinical course of 32 major recurrent depressive patients was monitored over 2 years. Analysis of the total tricyclic concentration and the parent: desmethylated ratio revealed that those subjects in a depressive recurrence previously had had a lower imipramine: desipramine ratio (despite matched dosing and nonsignificant total plasma concentrations) than nonrecurrents. Several hypotheses are discussed.

Alprazolam-related digoxin toxicity

An elderly woman developed a high serum digoxin concentration resulting in toxicity when alprazolam was added to her digoxin therapy. The reduced renal clearance of digoxin is postulated as the mechanism for this interaction.

Dexamethasone suppression test: use of two different dexamethasone doses

The endocrinologic methods used in the dexamethasone suppression test (DST) for depression were examined, by employing two different doses of dexamethasone (0.5 or 1.0 mg) at 11 p.m. Nonsuppression to the 1.0 mg DST (plasma cortisol criterion value of 5 micrograms/dl) was seen in 33% of major depressives and in 15% of schizophrenics. A similar result was obtained with the 0.5 mg DST when 12 micrograms/dl was employed as the plasma cortisol criterion value. Plasma cortisol levels 33 hours postdexamethasone did not distinguish between major depressives and schizophrenics.

Loxapine versus chlorpromazine in paranoid schizophrenia: a double-blind study

Newly admitted paranoid schizophrenic patients (N = 68) were treated with either loxapine or chlorpromazine for up to 4 weeks. Mean maximum dosages were 84 mg/day of loxapine and 820 mg/day of chlorpromazine. Loxapine showed efficacy superior to that of chlorpromazine, confirming earlier retrospective findings. Adverse reactions were also less troublesome with loxapine.

Cardiovascular and renal effects of isoproterenol infusions in young swine

The cardiovascular and renal effects of intravenous (i.v.) and intra-arterial (i.a.) infusions of isoproterenol (ISP, 0.1-0.2 micrograms/kg/min) were evaluated in 17 two-week-old swine anesthetized with pentobarbital. The glomerular filtration rate (GFR) of each kidney and blood flow and vascular resistance (RVR) of the left kidney were determined in all animals. In the 8 animals given ISP i.v., right ventricular pressure and dP/dtmax were also determined via a thoracotomy. In 9 animals, ISP was given i.a. after stabilization of constant-flow perfusion of the left kidney in situ. During i.v. infusion of ISP, the positive inotropic and chronotropic effects and the decrease in arterial pressure were maintained; renal blood flow and GFR increased and RVR decreased. During i.a. infusion of ISP in the constant-flow perfused kidney, similar changes in RVR and GFR were observed despite the higher effective concentrations of drug reaching the kidney. We conclude that, at this stage of postnatal renal development, the infusion of cardiotonic doses of ISP lowers RVR and produces a small increase in GFR.

Physician marriages

A questionnaire study of physicians' ratings of various aspects of their marriage, was sent to 100 randomly selected physicians in Ramsey County (St. Paul, Minnesota). Eighty per cent of the sample responded. All 80 had been married at least once. There were fewer divorces reported compared with the general population. The group of 80 rated their marriages above average. Spouses who were considered extroverted correlated very significantly with a good marriage rating. The educational level of the spouse did not correlate with the marriage rating. Working long hours was not associated with poor marriage ratings or divorce. No significant relationship was revealed in examining the study variables for grouped medical specialties.