Inpatient and outpatient patterns of psychotropic drug prescribing by nonpsychiatrist physicians.

The authors found that among 228 general hospital patients, minor tranquilizers were prescribed most often and with the least justification and that major tranquilizers were prescribed sparingly and by and large judiciously. Antidepressants were given less often than would be justified by the incidence of depressive illness among these patients. Nonrecognition of depression in patients with somatic complaints and autonomic signs of depression contributed to this lack of treatment.     

A method of monitoring drugs for adverse reactions I. α-methyldopa and haemolytic anaemia

Summary Existing methods of detecting adverse drug reactions are reviewed and an information system whereby the total number of patients exposed to a drug and the total number of patients developing an adverse reaction can be ascertained is described. Its potential as a monitoring system was tested by investigating, in 204 patients identified as receiving -methyldopa, the known association of haemolytic anaemia with that drug. — Patients remaining on -methyldopa were repeatedly screened and in this series one patient had developed haemolytic anaemia and 10 patients had antibodies to -methyldopa as evidenced by a positive direct antiglobulin test. Follow-up effectively determined the frequency of haemolytic anaemia which appeared to be a relatively small hazard and should not prejudice the use of the drug. This study has highlighted the difficulties in the adequate assessment of hypertension prior to commencing treatment and has shown that drug monitoring for adverse reactions may have an important role in the establishment of criteria for the more effective use of drugs.     

Magnification renal arteriography.

Magnification selective renal arteriograms were performed on 24 patients, 12 of whom were hypertensive, and compared with non-magnification arteriograms by two observers independently. The magnification angiograms were performed on a Siemens Microfocus Bi 125/3/50 RG tube with a 0.1 mm focal spot. Of the 24 patients examined, information crucial to the diagnosis was found only on the magnification films in three patients (12.5%). Extra information compared with the nonmagnification films was found in the magnification films in 12 patients (50%). No additional information was discovered in the remaining nine patients (37.5%). The magnification angiograms enabled the interlobular vessels to be visualized--this was not possible on the non-magnification films. Against the additional information gained must be weighed the disadvantages of magnification arteriography which include increased radiation dose and lengthening of procedure time plus additional injections of contrast. In conclusion, there is a place for magnification renal arteriography and the advantages seem to outweigh the disadvantages.     

Cyclic nucleotides in platelet function.

Inhibition of adenylate cyclase in intact platelets by addition of compounds such as 2', 5' - dideoxyadenosine prevented the inhibition of platelet aggregation by PGE1 but did not affect the responses of platelets to aggregating agents in the absence of PGE1. This confirms that cyclic AMP mediates the effects of PGE1 but indicates that the level of cyclic AMP in unstimulated platelets is too low to affect the actions of aggregating agents. Studies on the phosphorylation of proteins in intact 32P-labelled platelets showed that PGE1 increased the phosphorylation of a membrane-bound polypeptide (P24) and prevented the increased phosphorylation of other polypeptides (P47 and P20) that occurred on addition of inducers of the release reaction. It is suggested that the cyclic AMP-dependent phosphorylation of P24 stimulates the active transport of Ca(2+) out of the platelet cytosol, so preventing phosphorylation of P47 and P20, reactions which may be involved in the release mechanism. As increases in platelet cyclic GMP could be dissociated from both platelet aggregation and the release reaction, it is proposed that the bidirectional regulation of platelet function is achieved primarily by the opposing actions of increases in the concentrations of Ca(2+) and cyclic AMP.