Antiepileptic drugs with mood stabilizing properties and their relation with psychotropic drug use in institutionalized epilepsy patients with intellectual disability.

A large number of patients with epilepsy and intellectual disability take medication, amongst which antiepileptic and psychotropic drugs, often simultaneously. Certain antiepileptic drugs have mood-stabilizing properties, e.g. carbamazepine, valproic acid and lamotrigine. The aim of this study was to investigate whether the use of these mood-stabilizers is associated with a different use of psychotropic drugs in a population of institutionalized epilepsy patients with intellectual disability. We performed a retrospective, cohort study of adults with intellectual disability and epilepsy at the long-stay department of an epilepsy centre in The Netherlands. 246 residents were included. In patients using lamotrigine we found a statistically significant lower use of antidepressants. We also found significant less prescriptions of anxiolytics in patients using AEDs with mood-stabilizing properties (carbamazepine, valproic acid and lamotrigine). When considering the effect of gender, we found that male patients took significantly more antipsychotics. Most important, we found an inverse relation between the drug load of carbamazepine and/or valproic acid and/or lamotrigine and the use of psychotropic drugs. In a population of institutionalized epilepsy patients with intellectual disability, higher drug loads of mood-stabilizing antiepileptic drugs correspond with less use of psychotropic drugs.

Structure and function of periplasmic chaperone-like proteins involved in the biosynthesis of K88 and K99 fimbriae in enterotoxigenic Escherichia coli.

The nucleotide sequence of faeE and fanE, two genes involved in the biosynthesis of K88 and K99 fimbriae, respectively, was determined and the amino acid sequence of the FaeE and FanE proteins was deduced. Immunoblotting of subcellular fractions with an antiserum raised against purified FaeE confirmed that FaeE is located in the periplasm. Indications were obtained that FaeE functions as a chaperone-like protein. Its interaction with the fimbrial subunit (FaeG) in the periplasm stabilized this polypeptide and prevents its degradation by the cell-envelope protease DegP. Furthermore, FaeE prevents the formation of FaeG multimers which cannot be incorporated into fimbriae. The reactions of the FaeE/FaeG dimers with a set of monoclonal antibodies directed against the various epitopes present on K88 fimbriae revealed that the fimbrial subunits associated with FaeE were present in a conformation resembling their native configuration. Indications about the domains in FaeG involved in the interaction with FaeE are discussed.

Detection and identification of FaeC as a minor component of K88 fibrillae of Escherichia coli.

A tribrid gene containing ompF, faeC, and lacZ sequences was constructed by subcloning a large central segment of the K88ab gene encoding the fibrillar subunit-like protein FaeC into the open reading frame expression vector pORF2. The resulting tribrid protein was isolated and used to raise antibodies against the FaeC protein. These antibodies were then used for the detection and subcellular localization of the FaeC protein in Escherichia coli harbouring the K88ab-encoding plasmid pFM205 or mutant derivatives. Immunoblotting of subcellular fractions and of purified fibrillae, and agglutination experiments using whole cells revealed that the FaeC protein is present in the periplasm and as a minor component in the K88ab fibrillae. FaeC was also detected in purified K88ac and K88ad fibrillae. Immunoelectron microscopy confirmed the presence of FaeC in K88ab fibrillae, particularly at the tips of the longer fibrillae.

Pulmonary vascular responsiveness in cold-exposed calves.

The pulmonary vascular responses to acute hypoxia and to infusions of histamine and 5-hydroxytryptamine (5-HT) were recorded in unanesthetized standing bull calves under neutral (16-18 degrees C) and cold (3-5 degrees C) temperature conditions. Cold exposure alone resulted in a significant increase in pulmonary arterial wedge pressure from 10.2 +/- 3.5 to 15.9 +/- 4.9 Torr (1 Torr = 133.322 Pa). Resistance to blood flow between the pulmonary wedge and the left atrium significantly increased from 0.50 +/- 0.51 to 1.21 +/- 0.78 mmHg . L-1 . min-1 (1 mmHg = 133.322 Pa) with cold exposure. This apparent pulmonary venoconstrictor response to cold exposure was further evaluated to determine if hypoxia, histamine, or 5-HT responsiveness was altered by cold exposure. Twelve minutes of hypoxia increased pulmonary arterial and systemic arterial pressures, heart rate, and respiratory rate similarly in cold and neutral temperatures. Cold exposure did not alter the dose-related reductions of systemic arterial and pulmonary arterial pressures in response to histamine. Similarly, the decreases in systemic arterial pressure and heart rate and increases in pulmonary arterial and left atrial pressures in response to 5-HT were not significantly different in cold and neutral conditions. It was concluded that acute, mild cold exposure results in an increase in resistance to blood flow in the pulmonary venous circulation without a general increase in pulmonary vascular reactivity, as measured by responses to hypoxia, histamine, and 5-HT.

Photoaffinity labeling of DNA-dependent RNA polymerase from Escherichia coli with 8-azidoadenosine 5'-triphosphate.

A photoaffinity analogue of adenosine 5'-triphosphate (ATP), 8-azidoadenosine 5'-triphosphate (8-N3ATP), has been used to elucidate the role of the various subunits involved in forming the active site of Escherichia coli DNA-dependent RNA polymerase. 8-N3ATP was found to be a competitive inhibitor of the enzyme with respect to the incorporation of ATP with Ki = 42 microM, while uridine 5'-triphosphate (UTP) incorporation was not affected. UV irradiation of the reaction mixture containing RNA polymerase and [gamma-32P]-8-N3ATP induced covalent incorporation of radioactive label into the enzyme. Analysis by gel filtration and nitrocellulose filter binding indicated specific binding. Subunit analysis by sodium dodecyl sulfate and sodium tetradecyl sulfate gel electrophoresis and autoradiography of the labeled enzyme showed that the major incorporation of radioactive label was in beta' and sigma, with minor incorporation in beta and alpha. The same pattern was observed in both the presence and absence of poly[d(A-T)] and poly[d(A-T)] plus ApU. Incorporation of radioactive label in all bands was significantly reduced by 100-150 microM ATP, while 100-200 microM UTP did not show a noticeable effect. Our results indicate major involvement of the beta' and sigma subunits in the active site of RNA polymerase. The observation of a small extent of labeling of the beta and alpha subunits, which was prevented by saturating levels of ATP, suggests that these subunits are in close proximity to the catalytic site.

Molybdenum cofactor from the cytoplasmic membrane of Proteus mirabilis.

Molybdenum cofactor was extracted from membranes of Proteus mirabilis by three methods: acidification, heat treatment and heat treatment in the presence of sodium-dodecylsulphate (SDS). Extracts prepared by the latter method contained the highest concentration of molybdenum cofactor. In these extracts molybdenum cofactor was present in a low molecular weight form. It could not penetrate an YM-2 membrane during ultrafiltration suggesting a molecular weight above 1000. During aerobic incubation of cofactor extracts from membranes at least four fluorescent species were formed as observed in a reversed-phase high performance liquid chromatography (HPLC) system. The species in the first peak was inhomogeneous while the species in the others seem to be homogeneous. In water, all fluorescent products had an excitation maximum at 380 nm and an emission maximum at 455 nm. Their absorption spectra showed maxima at around 270 nm and 400 nm. Fluorescent compounds present in the first peak could penetrate an YM-2 membrane during ultrafiltration, whereas the compounds in the other peaks hardly did. Using xanthine oxidase from milk as source of molybdenum cofactor apparently identical cofactor species were found. Cytoplasmic nor membrane extracts of the chlorate resistant mutant chl S 556 of P. mirabilis could complement nitrate reductase of Neurospora crassa nit-1 in the presence of 20 mM molybdate. However, fluorescent species with identical properties as found for the wild-type were formed during aerobic incubation of extracts from membranes of this mutant.

Management of the third stage of labour in the midwife obstetric units in Cape Town.

A revised scheme of management of the third stage of labour was recently introduced in the Midwife Obstetric Units in Cape Town. Patients received synthetic oxytocin (Syntocinon; Sandoz) 5 IU intramuscularly with the delivery of the anterior shoulder and ergometrine maleate 0.5 mg intramuscularly after delivery of the placenta. A significant decrease in the incidence of postpartum haemorrhage and retained placenta was observed, warranting continuation of the new regimen.

Malignant gastro-intestinal tumours. The frequency distribution by age, sex, race and site at Groote Schuur Hospital, Cape Town, 1974-1978.

The observed frequency distribution of 2023 primary malignant gastro-intestinal tumours recorded during the 5-year period 1974-1978 is reported. The two most common sites were stomach (29.6%) and colon and rectum (29.5%), and the third most common was the oesophagus (19.8%). Marked differences in the site of the tumours according to race were found; oesophageal carcinoma was the most frequent lesion in Black patients (62.1%), gastric carcinoma in Coloured patients (44.1%) and colorectal carcinoma in White patients (46.8%). Within the Black group rarely affected sites were the pancreas (5.1%) and colon and rectum (3.5%).

Pulmonary prostaglandin metabolism during normobaric hyperoxia.

Prostaglandin metabolism by rat lung tissue was measured following exposures of 6, 24 and 48 hours to either pure oxygen or air at one atmosphere. Tissue concentrations of PGE1, PGE2 and PGF2 alpha were not altered by oxygen exposures. Prostaglandin synthetase activity decreased between 24 and 48 hours but was not significantly different from control at 48 hours. Combined prostaglandin dehydrogenase/reductase activity decreased between 24 and 48 hours to 13% of control values and was significantly lower than in air at 48 hours. The plasma concentration of 13, 14 dihydro-15-keto PGF2 alpha, a catabolite of PGF2 alpha, was significantly lower in oxygen-exposed rats at 24 and 48 hours. We conclude that endogenous pulmonary prostaglandin concentrations are maintained during hyperoxia but that catabolism of prostaglandins by the lungs may be impaired.

Laparoscopic sterilization on a day-case basis.

A prospective series of 307 patients who underwent laparoscopic sterilization on a day-case basis is presented. Of these, 196 patients attended for the 6-month and 117 for the 1-year follow-up visit. There were 5 Blacks, 197 Coloureds and 105 Whites. Sterilization was done by means of tubal cauterization (137), Hulka-Clemens clips (34) and Falope rings (136). Although 18% of patients were under 30 years old, 16% were 40 years of age or older. A marked tendency to low parity was evident, 43% of Coloureds and 90% of Whites being para 3 or less. The main operative problem was uterine perforation. Of the patients 17% were not discharged on the day of operation. By the 5th postoperative day 86% had returned to normal working activities. Significantly more postoperative abdominal pain was reported in the clip and ring groups. Seven pregnancies occurred in the series, 6 after tubal cauterization and 1 after the application of Falope rings. On patient was probably pregnant at the time of the operation. Most patients reported no change in libido at the 1-year follow-up visit, and in 20% libido was increased Mild pelvic infection was the only significant finding at the 6-month and 1-year follow-up visits. Apart from the disturbingly high pregnancy rate and the relatively large number of patients who were not discharged on the day of operaton, the sterilization programme has been most acceptable.

A computerized report form for the Cardiac Intensive Care Unit (Cardiac Computer Report - B.M. Kennelly).

A report form is described which has been designed to cover the likely diagnoses of patients admitted to a cardiac intensive care unit. The information entered can readily be stored for computer retrieval and includes biographical and clinical data, information pertaining to medications, procedures, complications, arrhythmias, and electrocardiographic and serum enzyme values, with special reference to patients with acute myocardial infarction. The data is entered by the medical, nursing and secretarial staff prior to encoding and computer storage. The report from which has evolved from its prototype 7 years ago, is described in the hope that it may be a basis for modification to the needs of other cardiac intensive care units presently without a data retrieval system.

Interference of iodine-125 ligands in radioimmunoassay: evidence implicating thyroxine-binding globulin.

Although there is abundant published evidence that radioiodinated antigens interfere in digoxin radioimmunoassays, other radioimmunoassays are similarly affected. We investigated the relationship of radioiodinated antigen structure to its function in the immunoassay. Carrier-free 125I-labeled iodotyrosine and iodohistamine derivatives were incubated with human serum, and the bound and free fractions were separated. We demonstrated that diiodotyrosyl analogs bind avidly to serum proteins. Because protein binding could be reduced with competitors that inhibit thyroxine-binding globulin, such as 1,8-anilinonaphthalene sulfonate and thyroxine, thyroxine-binding globulin was clearly implicated. Diiodotyrosyl compounds also bound to solutions of purified thyroxine-binding globulin, and this binding was inhibited by the same two competitors. We postulate that thyroxine-binding globulin is the major source of the heretofore unexplained interference of radioiodinated haptens. We present recommendations for eliminating or minimizing such interference.

The duration of normal labour in Cape Town whites.

The durations of the various stages of normal labour in White patients delivered at Mowbray Maternity Hospital, Cape Town, have been estimated for parity groups 1, 2, 3 and 4 and over. A significant correlation between age and the duration of the second stage was found in the para 2 group (r = 0,23, P less than 0,05). Previous abortions, marital status and oxytocic augmentation had no significant effect. The mean durations of the 1st and 2nd stages in primigravidas were significantly longer than in multigravidas. The upper limits of normal for the durations of the 1st and 2nd stages and the duration of the active phase were calculated. The mean duration of the 3rd stage was approximately 5 minutes.

The five-year survival rate in urban patients with ovarian carcinoma.

The 5-year survival of 253 patients with ovarian malignancy of epithelial origin is reviewed. Although this is closely related to the clinical stage at presentation, the overall survival is poor, because the majority present with disease which has spread beyond the pelvis. There are more deaths in the first 2 years after diagnosis; thereafter the survival curve gradually flattens off and becomes almost horizontal during the 4th and 5th years.

The midwife obstetric unit.

The urgent need for an alternative to domiciliary delivery in Cape Town has been met by the development of midwife obstetric units (MOUs). These units are situated in suburbs with a high population density. They are staffed entirely by midwives and are linked by telephone to the base hospital. A flying squad service is available at the regional centre (the maternity block at Groote Schuur Hospital). Regular visits are made to the units by the medical staff. Strict criteria for delivery at the MOUs have resulted in a very low perinatal mortality rate, and the units have at the same time relieved the serious overcrowding in the teaching hospitals. The concept of the MOU is particularly suited to Africa and indeed to any developing country.

Fetal and early neonatal mortality.

A format setting out and comparing perinatal deaths is presented. It is not new, but has not previously been used in South Africa. Gestational age and birthweight are considered, and group predictions for mortality (and indirectly for morbidity) are made, and can be used for comparison.