ABSTRACT
INTRODUCTION: Non-pharmacological interventions preferably precede pharmacological interventions in acute agitation. Reviews of pharmacological interventions remain descriptive or compare only one compound with several other compounds. The goal of this study is to compute a systematic review and meta-analysis of the effect on restoring calmness after a pharmacological intervention, so a more precise recommendation is possible. METHOD: A search in Pubmed and Embase was done to isolate RCT's considering pharmacological interventions in acute agitation. The outcome is reaching calmness within maximum of 2 h, assessed by the psychometric scales of PANSS-EC, CGI or ACES. Also the percentages of adverse effects was assessed. RESULTS: Fifty-three papers were included for a systematic review and meta-analysis. Most frequent studied drug is olanzapine. Changes on PANNS-EC and ACES at 2 h showed the strongest changes for haloperidol plus promethazine, risperidon, olanzapine, droperidol and aripiprazole. However, incomplete data showed that the effect of risperidon is overestimated. Adverse effects are most prominent for haloperidol and haloperidol plus lorazepam. CONCLUSION: Olanzapine, haloperidol plus promethazine or droperidol are most effective and safe for use as rapid tranquilisation. Midazolam sedates most quickly. But due to increased saturation problems, midazolam is restricted to use within an emergency department of a general hospital.
Subject(s)
Anti-Anxiety Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Hypnotics and Sedatives/therapeutic use , Psychomotor Agitation/drug therapy , Psychotic Disorders/drug therapy , Aggression/drug effects , Benzodiazepines/adverse effects , Drug Therapy, Combination , Haloperidol/therapeutic use , Humans , Lorazepam/therapeutic use , Midazolam/therapeutic use , Olanzapine/therapeutic use , Promethazine/therapeutic use , Psychomotor Agitation/psychology , Psychotic Disorders/psychology , Treatment OutcomeABSTRACT
OBJECTIVE: The higher incidence of man-to-woman transsexuals compared to woman-to-man transsexuals varies markedly from country to country. This is the first survey of the sex ratio to be made in Germany. METHOD: It covers 1785 patients who between 1964 and 1998 were diagnosed as transsexual at the four largest German centres offering treatment. RESULTS: From 1970 to 1994 the sex ratio remained constant at 2:1 in favour of man-to-woman transsexuals. Over the past 4 years, however, it has altered considerably and reached 1.2:1. CONCLUSION: Up to 1994 our results do not support the assumption that transsexualism is gradually becoming equally prevalent in both sexes. The drop in the sex ratio after 1994 can be explained either as a reduction of an overhang of male-to-female transsexuals or as an artificial phenomenon caused by recent developments in therapy and by the views of transsexuals' groups on the treatment they are offered.
Subject(s)
Transsexualism/epidemiology , Adolescent , Adult , Aged , Cultural Characteristics , Female , Germany/epidemiology , Humans , Incidence , Male , Middle Aged , Patient Advocacy , Retrospective Studies , Sex RatioABSTRACT
Over the last two-and-a-half years a committee of experts, consisting of members of the three leading German sexology associations, developed guidelines for treating and assessing transsexuals. Their purpose is to improve the care for patients with sex identity disorders and to ensure that such care is of uniform quality to avoid erroneous decisions to the disadvantage of those affected. The guidelines are set out in full.
Subject(s)
Transsexualism/therapy , Diagnosis, Differential , Humans , Transsexualism/diagnosisSubject(s)
Expert Testimony/legislation & jurisprudence , Societies, Medical , Transsexualism/therapy , Female , Germany , Humans , MaleABSTRACT
The diffuse radiance outgoing from mirror-attenuator-mosaic diffusers is with in certain limits independent from the angle of the incident light. Such diffusers are useful as calibration sources for the Scanner for Radiation Budget radiometer and for similar purposes as well. Two techniques of production of directional diffusers (etching and diamond drilling) are compared. To measure the performance of the samples, a new measurement setup is introduced that permits the direct comparison of incoming and outgoing light with an accuracy of better than 0.5%. The diamond drilling technique shows a much better performance than the etching.
ABSTRACT
Since cryptococcosis is characterized by cryptococcoma formation, the antimycotic effect of amphothericin B was examined in view of such pathological-anatomical conditions. In white mice (NMRI), cryptococcoma formation was induced by intramuscular injection of Cryptococcus neoformans strain W71 into the hind leg (STAIB, 1962), using a suspension (0.2 ml) containing approximately 2.8 times 10-7 cells/ml. The mice were treated daily with 1 mg amphotericin B in 5% dimethyl sulfoxide by gastric intubation. Course of infection and effectivity of therapy were assessed by microbiological and patho-histological examination of the organs. In the present paper (2nd Communication) comparative patho-histological results in mice, treated with amphotericin B either immediately or from the 16th day p.i. or not at all, are reported. In the non-treated animals the course of infection we controlled by sacrificing 2 animals per day from the 2nd to the 25th day. Cryptococcoma found in the muscle, fat, and connective tissue in the hind leg of these animals were characterized by the two different patho-histological alterations: a) Masses of encapsulated cryptococci side by side were filling a paucireactive or non-reactive reticular structure with blood capillaries. b) Non-specific granulomatous tissue. The fungi were less abundantly found as non-encapsulated cells. On the 5th day after infection the first alterations due to dissemination were found in the lungs, then in other parenchymatous organs. Under immediate amphotericin B-therapy, no cryptococcoma was found at the place of infection; after a therapy of 30 days duration, C. neoformans could be detected in small conglomerates of non-encapsulated cells in muscle, fat and connective tissue. Histologically, a septic dissemination of the agent could not be found in this group. After a therapy of 25 days duration a shrinking of cryptococcoma was observed in animals treated from the 15th day after infection. Presumably this was caused by a loss of capsule and formation of non-specific granulomatous tissue. In the surroundings of blood vessels non-encapsulated cells were detectable. After therapy with amphotericin B, single cryptococci e.g. such disseminated into the lungs were increasingly showing morphological alterations which might be explained as forms of degeneration. The animal experiment in connection with microbiological and patho-histological follow-up studies is discussed with a view to the therapy of cryptococcosis in man. Because of the variable virulence of C. neoformans it has to be mentioned that this experiment was carried out with a strain of C. neoformans characterized by its capability to form cryptococcoma in mice.
