Intramuscular olanzapine vs. intramuscular short-acting antipsychotics: safety, tolerability and the switch to oral antipsychotic medication in patients with schizophrenia or acute mania.

BACKGROUND: This study compared the safety, tolerability and switch to oral medication in patients with bipolar disorder or schizophrenia who received intramuscular (IM) olanzapine or other IM antipsychotics for the treatment of acute agitation. METHODS: Patients (N = 2011) from 15 countries participated in this prospective, observational, non-interventional study. Inpatients requiring treatment with at least one IM injection of a short-acting antipsychotic were assessed at baseline and within 7 days after the first IM injection. Treatment groups comprised: (i) patients prescribed IM olanzapine at baseline; and (ii) patients prescribed any other IM antipsychotic medication at baseline. Outcome measures included: treatment-emergent adverse events, concomitant psychotropic medication and the time taken to switch to oral medication. RESULTS: Fewer patients in the IM olanzapine group experienced an adverse event than patients in the other IM antipsychotic group (34.4% vs. 46.2%, p < 0.001). The most frequently reported adverse events in both groups were: sedation, Parkinsonism, disturbance in attention, akathisia, dystonia and orthostatic hypotension. Fewer patients in the IM olanzapine group used anticholinergics (13.9% vs. 42.5%, p < 0.001) or anxiolytics/hypnotics (47.6% vs. 51.6%, p = 0.023). Patients in the IM olanzapine group switched to oral medication earlier than patients in the other IM antipsychotic group (median time = 46.5 vs. 48.0 h, p = 0.009). CONCLUSIONS: These findings suggest that IM olanzapine may have a favourable impact on individual patients. However, the high rate of oral concomitant medication used throughout the study limits these findings from being associated with IM olanzapine alone.

The relation of fetal growth to plasma glucose in young men.

In a study of men aged 59 to 70 years plasma glucose levels 30 min and 2 h after a 75-g glucose load were inversely related to birthweight. To determine whether there are similar relations at a younger age the 30-min plasma glucose levels of 40 men aged 21 years, who were born in one hospital in the United Kingdom, were measured. Lower birthweight was associated with higher 30-min plasma glucose levels. This trend was independent of gestational age, and current body mass, height and social class.

Who cares for the patient with diabetes? Presentation and follow-up in seven Southampton practices.

A notes survey was undertaken by a group of eight general practitioners in seven Southampton practices to study the mode of presentation and follow-up of the diabetic patients on the lists of 24 doctors. The 431 known diabetic patients were classified as non-insulin-dependent (67%), insulin-dependent (20%), or, if they had commenced their insulin more than a month after the diagnosis had been made, 'insulin-treated' (13%). This classification allowed characterization of the truly insulin-dependent and non-insulin-dependent patients.Non-insulin-dependent diabetics were older than insulin-dependent diabetics and had first presented at a greater age. Most patients in each treatment group presented with classical diabetic symptoms, diabetes-related infections, or recognized complications. The majority of these were diagnosed in general practice. However, over half of the asymptomatic non-insulin-dependent diabetic patients had been diagnosed by routine blood or urine testing in hospital. After 1979 fewer non-insulin-dependent diabetic patients were referred to hospital for follow-up at diagnosis than before 1975.Most non-insulin-treated diabetics were followed up in general practice whereas most patients treated with or dependent on insulin were followed up in hospital clinics. Twenty-two per cent of all patients received diabetic care from both their general practitioner and hospital outpatient departments but 20% received no regular diabetic follow-up at all. One year after the initial study, 4% of patients were still without regular review, and 27 more patients had been identified who would have qualified for the original audit.

The frequency distributions of biochemical variables: Gaussian or log-Gaussian?

Serum sodium and total calcium concentrations were measured in 677 apparently healthy Caucasian men aged 30-39 years. The frequency distributions of these variables could be described equally satisfactorily as either Gaussian or log-Gaussian. Since other biochemical variables (for example, serum bilirubin and alkaline phosphatase) have frequency distributions which are much better described as log-Gaussian, the unifying hypothesis is proposed that all biochemical variables have basically log-Gaussian distributions, and that the apparently Gaussian distributions of certain variables (such as sodium and calcium) arise because of the relatively narrow ranges of values encountered in the healthy population.

Colour tagging of medical records and age-sex cards.

The colour tagging of medical records and age-sex cards is described. The system of eight colour tags originally recommended by the Royal College of General Practitioners was used as a basis but was modified and the number of colour tags extended to 13. These tags were applied to medical records and age-sex cards. The colour-coded age-sex registers thus serve as effective chronic morbidity and at-risk registers.

Effect of intravenous sodium lactate on renal tubular reabsorption of phosphate in man.

1. The effects of sodium DL-lactate and sodium chloride (2.5 mg/kg as 865 mmol/l solutions given by intravenous infusion over 20 min) on the renal tubular reabsorption of phosphate have been compared in five normal adults. 2. Sodium lactate produced a marked but transient increase in urinary phosphate excretion due to a reduction in net renal tubular reabsorption of phosphate; the mean value of the maximum rate of renal tubular reabsorption of phosphate/unit of glomerular filtration rate (TmP/GFR) decreased from 1.14 to 0.82 mmol/l. 3. This effect was not due simply to expansion of the volume of the extracellular fluid, since the reduction in TmP/GFR after sodium chloride infusion was less marked, nor did it seem to be due entirely to alkalinization of the urine since the maximum increase in urinary pH occurred 20--40 min after the maximum decrease in TmP/GFR.

Hair chromium concentrations in adult insulin-treated diabetics.

Hair chromium concentrations have been measured in age- and sex-matched groups of insulin-treated diabetics and normal controls. Average concentration (+/- S.E.M.) was reduced in female (2.9 +/- 0.5 compared with 5.1 +/- 0.7 nmol/g) but not in male diabetics.

A head holder for operative serial angiography.

An apparatus was developed to combine two functions--a versatile neurosurgical head clamp and a compact film changer for operative serial angiography. The construction costs were +15,000, and provided a programmer, six cassettes, and attachments to position the film changer over much of the skull surface. Exposures are obtained by a mobile x-ray machine.

Improved metabolic profiles in insulin-treated diabetic patients given an alpha-glucosidehydrolase inhibitor.

An alpha-glucosidehydrolase inhibitor (acarbose; BAY g 5421) taken with food was compared with dummy tablets in seven insulin-treated diabetic patients over eight-hour periods that included breakfast, lunch, and two snacks. Acarbose diminished the postprandial increases in blood glucose, lactate, and pyruvate concentrations and may therefore be of value in the management of insulin-dependent diabetes.

A simple slide-rule method for the assessment of renal tubular reaborption of phosphate in man.

The activity of renal tubular reabsorption of phosphate in man is best expressed as the ratio of the maximum rate or reabsorption to the glomerular filtration rate (TmP/GFR). A slide-rule method based on existing data is described for the derivation of TmP/GFR from values of phosphate and creatinine concentrations in single samples of plasma and urine. This is a simple method which is suitable both for research and for clinical purposes.

Renal osteodystrophy in nondialysed adolescents. Long-term treatment with 1alpha-hydroxycholecalciferol.

The effects of small oral doses (1-2 microgram/day) of 1alpha-hydroxycholecalciferol, given for 1 to 2 years, have been examined in four nondialysed adolescents with chronic renal failure and bone disease. Treatment increased calcium retention and plasma calcium, and decreased plasma levels of alkaline phosphatase, hydroxyproline, and immunoreactive parathyroid hormone. X-ray abnormalities of bone regressed, and 2 patients underwent successful surgical correction of knock-knees; bone histology in these 2 was normal at the time of operation. 2 patients developed hypercalcaemia which promptly reversed when 1alpha-hydroxycholecalciferol was withdrawn. In one patient treatment was initially successful, but later there was biochemical, radiographic, and histological evidence of relapse. Long-term treatment of such patients with 1alpha-hydroxycholecalciferol may be effective and facilitate the surgical correction of deformities, but this is not invariable. Toxic effects are similar to those of vitamin D itself, but are more readily reversible.

Clinical and biochemical studies in Engelmann's disease (progressive diaphyseal dysplasia).

The clinical and biochemical features of four adults with Engelmann's disease (Camurati-Engelmann disease; progressive diaphyseal dysplasia) are presented. One young patient, with a particularly severe form of the disease, is discussed in detail. Biochemical abnormalities were found in three of the patients. In two of them, one with localized hyperostosis and one with generalized bone disease, the only changes were an increase in the plasma alkaline phosphatase and urinary total hydroxyproline excretion. The most severely affected patients, who had had progressive and generalized bone disease from age two and a half years, also had persistent hypocalcaemia and hyperphosphataemia, a positive calcium balance, and a very low urine calcium excretion. It is suggested that some patients with Engelmann's disease may have a previously unrecognized metabolic disorder associated with increased retention of calcium and excessive bone formation. The possible role of abnormal phosphate metabolism in this increased formation of bone, and the relationship of Engelmann's disease to other hyperostoses, are discussed.

Plasma calcitonin in Paget's disease of bone.

1. Plasma levels of immunoreactive calcitonin were measured in 22 patients with untreated Paget's disease of bone and in 22 control subjects matched for age and sex. 2. No significant differences in plasma calcitonin were found between patients and control subjects, and hormone levels did not correlate significantly with activity of plasma alkaline phosphatase. 3. These results suggest that Paget's disease of bone is not due to deficient of endogenous calcitonin.

Radiology services for one million people (1974 Diagnostic Radiology Services in the Province of Manitoba).

For the year 1974, in Manitoba, 905,586 x-ray examinations were performed. The services were provided in 154 facilities, using 332 x-ray units, conducted by 566.6 full-time equivalent individuals, at a cost of $11,117,183. The examinations per capita have increased from 0.52 to 0.86 in the past decade while the cost per examination rose only from $11.00 to $12.63.

Biochemical measurements in Paget's disease of bone.

In a group of eighty-three patients with untreated Paget's disease of bone, plasma alkaline phosphatase activity (AP), plasma non-protein-bound hydroxyproline concentration (PHP) and urinary excretion rate of total hydroxyproline (THP) were closely correlated with each other but not with fasting plasma concentrations of calcium or inorganic phosphate. Probit plots of AP and THP showed log-normal distributions overlapping the normal ranges.