Prevalence of severe cardiovascular disease in patients with schizophrenia.

OBJECTIVES: We assessed the prevalence of severe cardiovascular (CV) disease requiring hospitalization among patients with schizophrenia in France. METHOD: We included patients hospitalized with schizophrenia or psychotic disorder during 2015, in five French psychiatric hospitals. Patients with CV disease were defined as those with a correspondent ICD-10 code during a hospital stay in any general hospital, five years before or three years after the psychiatric hospitalization. CV disease included myocardial infarction (MI), stroke, heart failure (HF), coronary artery disease (CAD) or peripheral artery disease. Risk factors such as hypertension, obesity and diabetes were recorded. RESULTS: In total, 4424 patients with schizophrenia were included. Overall, 203 (4,6%) patients were diagnosed with CV disease, 93 (2.1%) with CAD, 86 (1.9%) with HF and 49 (1.1%) with stroke. The prevalence of hypertension, obesity and diabetes was 11.3%, 9.7% and 7.8%. The median (interquartile range) age of patients with MI and diabetes was 57 (49-70) and 56 (48-66) years. CONCLUSION: Patients with schizophrenia develop severe CV disease requiring hospitalization at an early age. These severe events are associated with a high prevalence of risk factors. Early screening and treatment of CV disease and risk factors is important to improve life expectancy and quality of life of these patients.

Protection of U937 cells against oxidative injury by a novel series of iron chelators.

A new series of iron chelators designed to protect tissues against iron-catalysed oxidative damage is described. These compounds are aminocarboxylate derivatives bearing pendant aromatic groups. They were designed to have a relatively low affinity for both ferrous and ferric iron and to be site-specifically oxidizable by hydrogen peroxide through intramolecular aromatic hydroxylation into species with strong iron binding capacity which do not catalyse hydroxyl radical formation. Thus, at the cellular level, oxidative injury is used to convert weak iron chelators into strong iron chelators in order to promote cell survival. The purpose of this local activation process is to minimise toxicity compared to strong iron chelators which may interfere with normal iron metabolism. Compounds within this series were evaluated in vitro in view of their capacity to undergo intramolecular hydroxylation and to protect cultured cells against oxidative injury. Results show that the intramolecular aromatic hydroxylation capacity is critically dependent upon the amino carboxylate chelating moieties and the substituents of the aromatic rings. Cell protection against oxidative injury is only observed with compounds possessing sufficient lipophilicity. The monohydroxylation product of N,N'-dibenzylethylenediamine N,N'-diacetic acid, protects cells against both H2O2 and tBuOOH toxicity with IC50's of 12 and 60 microM, respectively, in agreement with the oxidative activation concept. These results represent the first step toward the development of a new strategy to safe iron chelation for the prevention of oxidative damage.

Amplitudes of visually evoked potentials to patterned stimuli: age and sex comparisons.

Electrophysiological age and sex differences in visual pattern responsivity were investigated. Pattern reversal evoked potentials (PREPs) and visual evoked potentials (VEPs) to patterned and unpatterned flashes were recorded from 20 normal subjects in each of 4 groups: young females and males aged 25-35 years and older females and males aged 55-70 years. PREP waves N70-P100 and P100-N150 from the older women were significantly larger than those from subjects in the other groups; mean amplitudes for the young females, young males and older males were not different. A similar effect, unusually large potentials for the older women, was obtained for VEPs, but only for VEPs elicited by patterned flashes and recorded from occipital scalp, i.e., an area overlying visual cortex which is sensitive to lines and edges. Our findings suggest that the visual system of older females is unusually responsive to patterned stimuli.

[Oral contraception and troleandomycin]. / Contraception orale et troléandomycine. Un nouveau cas d'ictère.

PIP: A case of jaundice appearing after 7 days of treatment with troleandomycin 1.5 g/24 hours in a 21-year old woman who had taken an oral contraceptive (OC) for 3 years is described. The young woman had tolerated Ovariostat and later Miniphase, and had never taken troleandomycin. Mild digestive trouble appeared after 48 hours, and on the 7th day the appearance of pruritus and early jaundice caused interruption of the troleandomycin and the OC. Examination disclosed hyperbilirubinemia and increased alkaline phosphatases and transaminases. Pruritus and jaundice regressed about 1 month later but did not disappear completely for 2 months. No evidence of viral hepatitus was found. Although combined pills and troleandomycin are both known to be associated with hepatic effects, jaundice is rare in both cases. From 1977-81 about 60 cases similar to the present one have been published in France. If simultaneous treatment with troleandomycin and combined OCs is the cause of the jaundice, the mechanism may be inhibition of troleandomycin metabolism by the estrogen, inhibition of estrogen metabolism by the troleandomycin, or simply the accumulation of toxicities of 2 hepatotoxic substances. Until careful, large scale studies are undertaken it seems prudent to avoid the prescription of troleandomycin in women who are taking combined oral pills or are pregnant.^ieng

Influence of propranolol and acebutolol on isoprenaline-induced changes in heart rate and peripheral blood flow in man.

The authors studied the variations in the effects of isoprenaline hydrochloride on heart rate (beta 1) and on peripheral blood flow of the upper extremity (beta 2), determined by plethysmography, in a group of 5 men with a mean age of 31 +/- 3 years. The trial was conducted on a single-blind cross-over basis, each subject being infused over 30 min with propranolol (30 microgram/kg), acebutolol (150 microgram/kg) or a placebo (isotonic glucose solution) with at least an 8-day interval between each administration. At the end of the infusion they received isoprenaline (0.01 to 0.075 microgram/kg, in logarithmic progression) every 15 min, for 1 hour. The doses of isoprenaline were injected randomly using a latin square design. The peripheral flow, assessed by the curve of the initial part of the plethysmogram for the first 10 sec, increased with the dose of isoprenaline in the placebo series (Tg alpha = 219.9 log d + 583.4; p less than .01), did not increase in the propranolol series and increased with the dose in the acebutolol series (Tg alpha = 221.5 log d + 567.7; p less than .01); the variations in flow with isoprenaline after placebo and after acebutolol, did not differ significantly. The hear rate increased with the dose of isoprenaline in the placebo series (+55%) although tachycardia was inhibited by propranolol and acebutolol. Under the experimental conditions of this trial, propranolol inhibited beta 1 and beta 2 receptors at the same time, whereas acebutolol inhibited only beta 1 receptors.

[Hypersensitivity of the beta-adrenergic receptors in patients considered as spasmophilic. Results of two stimulation trials with isoprenaline in 105 patients (author's transl)]. / Hypersensibilité des récepteurs bêta-adrénergiques chez des patients classés comme spasmophiles. Résultats de deux épreuves de stimulation par l'isoprénaline chez 105 patients.

Two stimulation trials with isoprenaline were performed in two groups of 50 and 55 patients considered as spasmophilic. The first trial was to check the sensitivity of the beta 1 type cardiac receptors : the average isoprenaline hydrochloride dose raising by 50 p. 100 the rest cardiac rate was equal to 0.147 +/- 0.09 micrograms/kg for 0.23 +/- 0.09 micrograms/kg in the control group. A second trial allowed to stabilize the cardiac rate between + 40 and + 50 p. 100 of its initial value : the symptoms, reappearing during stimulation, under the influence of isoprenaline, were studied. In 43 out of the 50 investigated patients the usual symptoms reappeared, particularly the acrocontractural attacks which were observed then in 46 p. 100 of cases, and sometimes an acute tetanic attack with opisthotonus. All these signs which are characteristic of "the spasmophilic state" seem to relate to vegetative regulation in which the beta-adrenergic component would show the most important : hypersensitivity of the beta receptors might be the common physiological base.

[Effects of beta blockaders on ventilatory function in chronic bronchitis]. / Action des bêta-bloqueurs sur la fonction ventilatoire dans la bronchite chronique.

This study was carried out to determine whether beta blockers could be prescribed for patients with coronary insufficiency and chronic bronchitis. The effects of intravenous infusions (30 mn) of propranolol (30 micrograms/kg), practolol 90 micrograms/kg), atenolol (90 micrograms/kg) and acebutolol (150 micrograms/kg) on vital capacity and expiratory flow rates were investigated in chronic bronchitics. Propranolol (n = 51) moderately reduced the vital capacity and FEV1, by an average 9% and a maximum of 20%. The three other infused agents given to groups of 10 patients did not change the ventilatory function. When the same patients were investigated by cross over with propranol bronchoconstriction was observed. This effect was seen in all stages of chronic bronchitis but was much less severe than in a group of 50 asthmatic patients (-23%). The respiratory tolerance of the cardioselective beta blockers seems to be better but there is considerable individual variation and the diagnosis between asthma and chronic bronchitis may itself be very difficult.

[Symptomatology in 162 patients with spasmophilia (chronic idiopathic or constitutional tetany). A statistical analysis using a computer (author's transl)]. / Symptomatologie observée chez 162 malades classés comme spasmophiles (tétanie chronique idiopathique ou constitutionnelle). Résultats d'une analyse statistique à l'aide d'un ordinateur.

A computer was used for a statistical analysis of the results of treatment in 162 patients (130 women and 32 men with an average age of 29 years), with chronic idiopathic tetany. Symptoms leading to diagnosis were mainly feelings of ill-health (27.2 %), motor disorders (19.7 %), and sensory problems (19.1 %). The onset of acute attacks is related, more especially, to psychogenic factors. The frequency of the various clinical manifestations, and their symptomatic grouping were analyzed. The clinical profile is similar in both sexes apart from 7 of the 89 items: lipothymia, abnormal feelings of warmth, pseudo-contraction of the larynx, abnormalities of the exoskeleton, and digestive disorders are more frequent in women, while precordalgia is more often present in men. Factorial analysis of correspondence between 38 variables reveals a very large dispersion of the variables, as the first three factors, which are the most significant, supply only 30% of the total information. Furthermore, very few variables share significant relationships in each factor. In spite of the amount of information collected, this dispersion of the symptomatology does not permit the definition of one or more profile-types of spasmophilia.