Coagulation factor and hemostatic protein content of canine plasma after storage of whole blood at ambient temperature.

BACKGROUND: Standard practice in canine blood banking is to produce fresh frozen plasma (FFP) by separating and freezing plasma produced from blood within 8 hours of collection. Within canine blood donation programs, this can limit the number of units collected. HYPOTHESIS/OBJECTIVES: The aim was to compare the coagulation factor and hemostatic protein content (CF&HPC) of plasma produced from blood stored at ambient temperature for 8, 12, and 24 hours. Another aim was to compare the CF&HPC between Greyhound types and other breeds. ANIMALS: None. METHODS: In vitro study. A convenience sample of 58 units of canine blood from a blood donor pool was processed to prepare and freeze plasma 8, 12, or 24 hours following collection. RESULTS: Regardless of time of processing, the units contained therapeutic CF&HPC. Frozen plasma prepared after 24 hours had significantly higher factor VIII (P = .014) and factor X (P = .03) when compared with the frozen plasma prepared at 8 hours. Factor X (P < .01), fibrinogen (P < .01), and vWF (P = .04) were significantly lower in plasma collected from Greyhound types than in plasma collected from other breeds. CONCLUSIONS AND CLINICAL IMPORTANCE: Storing whole blood for up to 24 hours is a suitable method for producing FFP. Lower values for some coagulation factors and hemostatic proteins in plasma produced from Greyhound types would not preclude these dogs as FFP donors.

Lack of evidence of pregnancy-induced alloantibodies in dogs.

BACKGROUND: It is controversial whether or not pregnant bitches become sensitized to red blood cell (RBC) antigens. HYPOTHESIS: Bitches do not develop alloantibodies to RBC antigens during gestation and can be used safely as blood donors. ANIMALS: The study group included 35 healthy female dogs with a prior history of 1 (n = 12), 2 (n = 14), or >or= 3 (n = 9) pregnancies. The control group consisted of 15 healthy female dogs without any history of pregnancy. METHODS: All dogs were blood typed for dog erythrocyte antigens (DEA) 1.1, 1.2, 3, 4, 5, and 7 using ethylenediaminetetraacetic acid blood samples and polyclonal antisera. Antibody screening was performed with serum and canine RBC panels of known blood type. An autocontrol and direct antiglobulin test were performed to rule out the presence of autoantibodies. RESULTS: The only alloantibodies identified were those against DEA 7 and the prevalence of anti-DEA 7 alloantibodies was similar in dogs with known history of pregnancy (11.4%) and in the control group (13.3%). CONCLUSIONS AND CLINICAL IMPORTANCE: These results confirm previous studies and clinical transfusion medicine experience. Naturally occurring anti-DEA 7 alloantibodies have been reported but their clinical relevance has not been shown. Pregnancy does not appear to sensitize dogs to RBC antigens. Consequently, dogs with prior history of pregnancy can be used safely as blood donors. Conversely, no additional pretransfusion compatibility studies would be required should these dogs themselves need to be transfused.

Collection and preparation of blood products.

Blood-component therapy has become an integral part of veterinary practice. Although access to veterinary blood banks has increased, practitioners may prefer to create their own blood-donor program to provide for their blood-product needs or to respond to an emergent need. Before embarking on such an endeavor, it is important to understand the techniques and requirements for such a program. This article will discuss issues in donor selection and management, supplies and techniques of blood-component acquisition, and supplies and techniques of blood-component preparation.

Erotomania induced by venlafaxine: a case study.

OBJECTIVE: To describe a never previously reported case of erotomania induced by venlafaxine and highlight the effect of antidepressants on the dopaminergic system. METHOD: A case of erotomania is described. RESULT: Erotomania occurring in two separate occasions developed after treatment with high doses of venlafaxine. The episode remitted only after lowering the dose of the venlafaxine. CONCLUSION: Erotomania may occur with agents such as antidepressants. The dopamine neurotransmission of mood can provide further evidence for the development of newer classes of antidepressants.

Treating pancreatitis in the acute care setting.

Acute pancreatitis is associated with significant complications and mortality. This article describes the pathophysiology and complications of, and treatments for acute pancreatitis, and the nurse's role in caring for a patient in the acute care setting.

A review of the safety and tolerability of sertindole.

The safety and efficacy of sertindole have been established in three double-blind randomized controlled studies conducted in the United States, North America and Europe. In these three studies the tendency for sertindole to cause extrapyramidal side effects (EPS), a critical factor affecting compliance, was investigated. At 12-24 mg/day, sertindole was associated with placebo levels of EPS, which were significantly lower than for all doses of haloperidol. In the European study, 24 mg sertindole demonstrated slightly, but statistically significantly, more EPS than 8 mg (P = 0.05). However, the incidence of EPS-related events was comparable with that reported for placebo in the United States and North American studies. The frequency of use of anti-EPS medication was also comparable in the sertindole and placebo groups. Slight prolongation of the Q-T interval was seen with sertindole in early clinical trials. Although no patients reported any clinical problems related to Q-T prolongation in these three studies, its use is contraindicated in patients suffering from underlying cardiac diseases or hypokalaemia and in those patients undergoing concomitant treatment with other medication known to prolong the Q-T interval. Most of the other adverse events reported for sertindole are related to its alpha, antagonistic activity.

Biochemical characterization of canine blood group antigens: immunoprecipitation of DEA 1.2, 4 and 7 and identification of a dog erythrocyte membrane antigen homologous to human Rhesus.

Despite the clinical significance of the canine blood group antigens, relatively little is known of the biochemistry of these molecules. In this study the canine blood group antigens DEA (dog erythrocyte antigen) 1.2, 4 and 7 were immunoprecipitated from red blood cells (RBC) bearing the corresponding blood group, and molecular weights of 85 kD (DEA 1.2), 32-40 kD (DEA 4) and 53-66 kD (DEA 7) assigned. DEA 1.2 and DEA 4 each appeared as a single band, whereas DEA 7 comprised three distinct bands (53, 58 and 66 kD). Polyclonal antisera specific for two peptides derived from the sequence of the human Rhesus blood group (Rh30A-C and Rh50A-C) were used in western blotting against canine and human erythrocyte membranes. The Rh30A-C antiserum identified a band of molecular weight 32 kD in both human and canine RBC, and the antiserum specific for Rh50A-C identified a band of 38-60 kD in human membranes and of 40-53 kD in canine RBC. This finding is consistent with conservation of areas of the Rhesus protein sequence between human and canine erythrocytes.

Olanzapine.

Olanzapine is a newly introduced atypical neuroleptic, with a broad receptor profile similar to that of clozapine. It is as effective as haloperidol against the positive symptoms of schizophrenia, and more effective against negative symptoms, with significantly fewer extrapyramidal side-effects. Side-effects include somnolence and weight gain. It may show efficacy in treatment-resistant schizophrenia.

Canine blood groups and their importance in veterinary transfusion medicine.

Over 13 canine blood groups have been described. Eight DEA types are recognized as international standards. Typing sera produced by canine alloimmunization exists for six DEA types: 1.1, 1.2, 3, 4, 5, and 7. Naturally occurring antibody is found against DEA 3, 5, and 7. DEA 1.1 and 1.2 antibody-antigen interactions result in acute hemolytic transfusion reactions. DEA 3, 5, and 7 antibody-antigen interaction in vivo results in permanent red blood cell sequestration and loss in 3 to 5 days. DEA 4 antibody-antigen interactions produce no effect on red blood cell survival in vivo. A dog possessing DEA 4 and no other antigen is considered a "universal" donors. Veterinary transfusion medicine has advanced beyond uncrossmatched, untyped red blood cell transfusion. Whenever possible, transfusion should be between typed and crossmatched individuals. "Universal" donors and crossmatch should be utilized when typing of the recipient is not feasible. Canine blood typing is routinely performed in service laboratories across North America. In-clinic assays are not available for all canine blood group antigens. Recent production of monoclonal antibodies will lead to biochemical definition of the canine blood groups DEA 1.1 and 3. Additional efforts to define the erythrocytes on a molecular level are underway. Advances efforts in this areal will allow for more rapid and uniform testing of the canine red blood cell. Future exploration of DEA type and disease association is needed. A known association exists between DEA 1.1 and neonatal isoerythrolysis. Further screening of the dog population for DEA type may yield markers for autoimmune and neoplastic disease.

Critical flicker fusion threshold and anticholinergic effects of chronic antidepressant treatment in remitted depressives.

The persistence of deficits in cognitive performance in major depressive patients taking maintenance antidepressant medication was assessed by examining groups of patients in clinical remission, stable on one of a range of tricyclics or selective serotonin re-uptake inhibitors (SSRIs) for at least 3 months, compared with controls. Measures of critical flicker fusion (CFF), choice reaction time (CRT), subjective sedation, and anticholinergic side-effect score were made. Tricyclic antidepressants (TCAs) produce a significant deficit in critical flicker fusion threshold compared both to controls and SSRIs. Similar effects were seen with choice reaction times which were significantly affected by age. Sedation scores were significantly higher with TCAs than SSRIs. Anticholinergic side effects were strongly related to CFF, less so to visual analogue sedating scales and not significantly to CRT. The effect measured by CFF is different from sedation, and may be related to the anticholinergic potency of the drug; it may be considered a drug-induced pseudodementia. This effect represents a risk factor for accidents during maintenance therapy and may impair work and leisure performance. The relative risk of weight gain with TCAs compared to SSRIs in women was 5.92 (95% CI 1.79-19.50).

Detoxified alcoholics, major depressives and tyramine sulphate excretion.

The excretion of tyramine sulphate after challenge with an oral load of tyramine was assessed in recently detoxified, clinically depressed alcoholics and a matched group of major depressives. Tyramine excretion in the alcohol group (mean 5.95 ± 3.28 mg/3 h SD) was in the range previously observed in controls and was significantly higher than in the matched depressives (mean 3.43 ± 2.37 mg/3 h SD). Tyramine sulphate excretion has been suggested as a genetic vulnerability marker for major depression. This study suggests that depression associated with alcohol withdrawal is not characterised by decreased tyramine sulphate excretion after oral tyramine challenge, such decreased conjugation only being present, perhaps, in those patients with pre- existing endogenous depressive vulnerability. Although a genetic link between alcoholism and depression exists, these results support the absence of such a link to major depression.

Psychosurgery: stereotactic subcaudate tractomy. An indispensable treatment.

BACKGROUND: Stereotactic subcaudate tractotomy (SST) is the only type of psychosurgery performed at the Geoffrey Knight Unit, London, where nearly 1300 operations have been done since 1961. Statistically reliable data are not available to prove the effectiveness of SST. A detailed statement about contemporary psychosurgery is given. METHOD: Relevant publications from the Unit and via Medline are discussed. The outcome figures are reviewed. The outcome is assessed at the Unit in global and clinical terms, associated with results of self-completed questionnaires. RESULTS: SST allows 40-60% of patients to live normal or near-normal lives, perhaps with continuation of medication. A reduction in suicide rate to 1% post-operatively, from 15% in cases of uncontrolled affective disorders is seen. CONCLUSION: As a treatment of last resort, no controlled trial against a comparable treatment is possible. It appears reasonable to offer SST to patients with suicidal and deluded depression or with frequently swinging moods, not responding to other treatments.

The importance of accidents in evaluating the cost of SSRIs: a review.

Economic studies attempting to justify the increased cost of new antidepressants such as the SSRIs are often difficult to interpret, marginal benefits hinging on minute differences in assumptions and interpretation. Studies to date have focused largely upon the costs of treatment failure, which in turn relates to compliance rates. A missing factor is the cost of accidents, especially serious road traffic accidents. Most tricyclic antidepressants seriously impair driving performance, even more so than alcohol or benzodiazepines, whilst SSRIs do not. With moves towards maintenance and continuation therapy for depression, patients on tricyclics remain at long-term risk for such accidents. Cost savings from reducing the rate of accidents could more than pay for the increased costs of SSRIs.

Exorcism-resistant ghost possession treated with clopenthixol.

BACKGROUND: An Indian man now in Britain explained his criminal behaviour as episodic ghost possession. Traditional exorcisms failed to help. METHOD: A 'Western' diagnosis of dissociative state or paranoid schizophrenia was made. Treatment commenced using trifluoperazine and clopenthixol. RESULTS: The patient underwent remission during neuroleptic treatment, despite previous evidence of genuine possession. CONCLUSIONS: Many cultures give rise to apparently genuine cases of ghost possession. Neuroleptics may relieve symptoms of exorcism-resistant possession.

The outcome of targeting community mental health services: evidence from the West Lambeth schizophrenia cohort.

OBJECTIVES: To report outcome of targeting community mental health services to people with schizophrenia in an inner London district who had been shown, one year after discharge, to have high levels of psychotic symptomatology and social disability but very low levels of supported housing and structured day activity. DESIGN: Repeat interview survey of symptoms, disability, and receipt of care four years after index discharge. SETTING: Inner London health district with considerable social deprivation and a mental hospital in the process of closure. SUBJECTS: 51 patients originally aged 20-65 years who satisfied the research diagnostic criteria for schizophrenia. MAIN OUTCOME MEASURES: Contact with services during the three months before interview, levels of symptoms (from present state examination), global social disability rating. RESULTS: 65% (33/51) of the study group had been readmitted at least once in the three years between surveys. Recent contacts with community psychiatric nurses and rates of hospital admission increased (8 at one year v 24 at four years, p < 0.01; 5 v 13, p < 0.06). Conversely, fewer patients were in contact with social workers (17 v 7, p < 0.03). Proportions in supported housing, day care, or sheltered work did not change. Unemployment rates remained very high. A considerable reduction (almost a halving) in psychiatric symptoms was observed, but there was no significant change in mean levels of social disability. CONCLUSIONS: The policy of targeting the long term mentally ill resulted in significant increases in professional psychiatric input to the cohort but failed to improve access to social workers or suitable accommodation. Improvements in social functioning did not follow from reductions in the proportions of patients with psychotic mental states. Social interventions are likely to be crucial to achieving the Health of the Nation target of improving social functioning for the seriously mentally ill, as improving mental state seems in itself to be insufficient.