Polydipsia in chronic psychiatric patients: therapeutic trials of clonidine and enalapril.

A six month long double-blind, placebo-controlled, crossover design pharmacological study was conducted on 14 chronically psychotic, institutionalized patients who suffered from chronic water abuse ("psychogenic polydipsia"). Effects of clonidine and enalapril administered separately and individually were assessed for possible beneficial effects on both physiological parameters such as diurnal weight gain, urine output, and serum sodium levels and on signs of delirium as measured by neurobehavioral testing. Improvement, particularly in tests reflecting fluid consumption, was found with either or both drugs in approximately 60% of test subjects, although no behavioral improvement was demonstrated. As a result of evidence for delayed and carry-over effects the authors recommend that future studies employ phases longer than one month and/or include washout periods.

Serum cytokine levels in patients with neutropenia.

Serum samples from 76 patients with neutropenia and 34 control subjects were analyzed for levels of granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, interleukin 1 alpha, and tumor necrosis factor beta. Clinical correlates and duration of neutropenia were determined insofar as possible. Systemic acute inflammatory disease was present in only two patients. In most cases, the neutropenia was considered idiopathic or medication related. Significantly elevated serum granulocyte colony-stimulating factor levels were found in the patient group, regardless of the apparent cause of the neutropenia. Increased levels of granulocyte-macrophage colony-stimulating factor, interleukin 1, and tumor necrosis factor were seen in only one patient with sepsis.

Serum levels of erythropoietin and selected other cytokines in patients with anemia of chronic disease.

Serum levels of erythropoietin and five other cytokines potentially operational in erythropoiesis were determined in patients with anemia of chronic disease. No correlation between erythropoietin levels and severity of anemia was found. A spectrum of abnormality was encountered among patients in whom there was less than expected erythropoietin response to increased levels of erythropoietin and among others in whom the erythropoietin levels were subnormal for their degree of anemia. Increased serum levels of interleukin-3, granulocyte colony-stimulating factor, and granulocyte-macrophage colony-stimulating factor were encountered in limited numbers of patients, especially those with increased erythropoietin levels. Deficient erythropoietin production is concluded to be the major cause of anemia of chronic disease.

Cost analysis. Bedside blood glucose testing.

Cost analysis of the bedside blood glucose testing program at a Veterans Affairs medical center indicated a per-test cost of $11.50, as opposed to the conventional laboratory testing cost for serum glucose of $3.19. Extrapolated to the 172 Veterans Affairs hospitals, the extra cost of the procedure is estimated to be in excess of $3 million each year.

Treatment of behavioral problems with pindolol.

A study was conducted on a group of chronically hospitalized, brain-damaged male patients to assess the effectiveness of treatment with pindolol on behavioral problems. The study was conducted in two parts. The first was a double-blind, placebo-controlled analysis of the effect of pindolol on assaultive behavior, both verbal and physical. The second part was open and sought to determine whether pindolol would diminish such behaviors as resistance to care, sexual preoccupation, or provocation of others, which were sufficient to preclude placement at a lower level of care. These target behaviors and nursing interventions were monitored and clinical global assessments of improvement in behavior and of suitability for lower levels of care were developed. Eight of 13 patients were considered improved. Those with significant premorbid personality disorders showed little benefit. Pindolol appears to ameliorate some management problems and, by inference, improve the quality of life in many patients with behavioral pathology due to organic brain disease.

Effect of pindolol administration on serum levels of thioridazine, haloperidol, phenytoin, and phenobarbital.

Twenty-six male patients with intermittent explosive disorder secondary to organic brain disease were studied. Each had been treated with long-term administration of thioridazine, haloperidol, phenytoin, and/or phenobarbital, either singly or in combination. The effect of adding increasing doses of pindolol--a beta-adrenergic blocking agent previously demonstrated to be effective in the treatment of intermittent explosive disorder--on serum levels of each long-term medication was determined. Moderate, dose-related increases in serum levels of thioridazine and two of its metabolites were found when pindolol was added. Conversely, higher-than-expected serum pindolol levels occurred in patients receiving thioridazine. No serum level increases were found for haloperidol, phenytoin, or phenobarbital when pindolol was added to each of these drugs individually, but serum phenytoin levels did rise in two patients receiving all three drugs simultaneously when pindolol was added. Three treatment failures with pindolol occurred in association with low serum pindolol levels.

Plasma propranolol levels and their effect on plasma thioridazine and haloperidol concentrations.

The relationship between chronic oral dosage with a long-acting formulation of propranolol and plasma propranolol levels 22 to 23 hours later is described in 12 adult male patients with organic brain disease. Separately, the effects on plasma levels of thioridazine plus metabolites with concomitant rising dose long-acting propranolol administration were studied in five patients. Significant dose-related increases in levels of thioridazine and metabolites were found when long-acting propranolol was given. No changes in haloperidol levels were found in three patients studied in a similar protocol.

Therapeutic effects of pindolol on behavioral disturbances associated with organic brain disease: a double-blind study.

A double-blind, placebo-controlled crossover study was conducted to examine the effects of pindolol for the treatment of 11 patients with impulsive, explosive behaviors and other emotional-behavioral abnormalities as a consequence of brain disease or injury. Pindolol treatment was associated with significant therapeutic benefits without sedation and without the use-limiting side effects that occur with propranolol.

Propranolol treatment of assaultive patients with organic brain disease. A double-blind crossover, placebo-controlled study.

A double-blind, placebo-controlled crossover study was conducted to examine the effects of long-acting propranolol in the treatment of violent behavior associated with organic brain disease in 10 patients whose symptoms had proved refractory to various conventional medications. Long-acting propranolol treatment was associated with reductions of assaultive behavior without apparent sedative effects. Cautions are noted regarding potential undesirable side effects which may necessitate careful patient monitoring during treatment.

A comparison of differential white blood cell counts using manual technic and the Coulter S-Plus IV.

The results of 100-cell and 500-cell manual differential white blood cell counts were compared with those obtained using a Coulter S-Plus IV electronic particle counter. Significant (P less than 0.001) correlations were observed between the manual and instrument-derived data for percentages of granulocytes and lymphocytes.

Propranolol in the treatment of assaultive patients with organic brain disease.

Propranolol in doses up to 520 mg/day was administered to eight patients with organic brain disease characterized by violent and assaultive behavior refractory to conventional treatment. Improvement was demonstrated in the seven patients able to tolerate adequate drug dosages. Hypotension, bradycardia, and interactions with other medications constituted complications.

A comparison of six procedures for compatibility testing.

Six procedures for compatibility testing were compared, using red blood cells sensitized in normal saline, albumin or low-ionic strength saline (LISS) combined with either broad spectrum or anti-IgG antiglobulin testing (AGT). Despite shortened incubation times, tests employing LISS were as sensitive as those with albumin and broad spectrum AGT and more sensitive than the other four combinations. No false positive results were found. LISS technique with broad spectrum AGT appears to be suitable and superior for routine antibody detection and compatibility tests.

Quality assurance in the blood bank. Studies of technologist performance.

A series of experiments was conducted to assess the performance of technologists in the blood bank, with particular reference to precision and accuracy in the technical and mechanical aspects of routine work, including preparation of erythrocyte suspensions, pipetting, interpretation of hemagglutination, detection of mixed-field agglutination, detection of weak alloantibodies, and antibody titration and scoring. The authors conclude that use of semiquantitative technics contributes significantly to imprecision in blood bank work. A plea is made for expediture of increased effort in quality assurance programs directed toward the technical staff.

Quantitative studies of specific and nonspecific second antibody uptake by sensitized erythrocytes.

Experiments were conducted using the technique of quantitative hemagglutination with an electronic particle counter to study the specific and nonspecific uptake of blood group antibodies by previously sensitized erythrocytes. Specific attachment of a second antibody was impaired by prior RBC sensitization. It was found possible to quantitate simultaneously the amount of both specific and nonspecific second antibody uptake.

Ocurrence of anti-Wr a in blood donors and in selected patient groups, with a note on the incidence of the Wr a antigen.

The occurrence of the Wr a antigen on the red blood cells of 5,000 primarily Caucasian New York State blood donors was shown to be 1:1,000. Anti-Wr a was detected in sera from random blood donors with a frequency of 1:56 and with progressively increasing frequency in postpartum women, patients undergoing open-heart surgery, hemodialysis subjects, and random persons with other alloantibodies. Anti-Wr a was found in one fourth of sera from patients with positive direct antiglobulin tests, including 12 of 23 in whom the positive test was associated with alphamethyldopa treatment.