Pharmacotherapy of psychiatric emergencies

The psychiatric emergency service has become a major provider of psychiatric care over the past decade. Concomitant with this growth has been an emphasis on pharmacological treatment. While rapid tranquilization is the best known and most frequently used intervention, a growing diagnostic awareness has led to a variety of other chemotherapeutic approaches. The current reviews of pharmacologic intervention in the psychiatric emergency service do not detail the variability of treatment approaches or examine alternative treatment approaches. The goal of this article is to critically review current pharmacologic treatments and address areas in which there is no consensus in treatment approach. From this review the authors suggest guidelines for pharmacotherapy of psychiatric emergencies. The authors discuss rapid tranquilization, the treatment of alcohol and drug intoxication and withdrawal, and anxiety disorders.     

Characterization of prorenin activation using a synthetic peptide substrate.

Human renin is synthesized as an inactive zymogen (prorenin) which is processed to the active form. We synthesized an 11-amino acid peptide which spans the human prorenin processing site in order to develop a simple assay to study human prorenin activation. Six enzymes which are capable of activating recombinant prorenin in vitro were studied. Four of these enzymes digested the synthetic peptide in a specific fashion, as analyzed by reverse-phase high-performance liquid chromatography. Amino acid analysis of the purified digestion products revealed that trypsin cleaves between Arg-Leu, the authentic processing site, while kallikrein, plasmin and elastase all cleaved at alternate sites. On the other hand, pepsin and cathepsin D did not cleave this substrate, suggesting that the activation of prorenin by these proteases might occur at a site distinct from the authentic processing site. Our data suggest that this synthetic peptide may be used as a simple and specific assay for prorenin activation.     

A leg ulcer as manifestation of metastatic squamous cell vaginal carcinoma

Cutaneous metastasis of vaginal carcinoma is extremely rare. So far, the total number of reported skin metastasis of vaginal carcinoma is only one. We present another case with an unusual manifestation of vagina carcinoma metastasis: skin metastasis presenting as a leg ulcer on the lower leg.     

STUDIES OF UROBILIN ELIMINATION IN THE NORMAL AND ANEMIC DOG

1. The output of urobilin is increased in experimental trypanosome anemia presumably as a result of the increased blood destruction. 2. The administration of salvarsan (arsenobenzol) during the anemic period, if it checks the blood destruction, reduces the urobilin elimination, but this result does not follow unless the blood picture improves. 3. Following splenectomy in the normal dog an increase in the urobilin elimination of varying degree occurs, the significance of which is doubtful. 4. Splenectomy during the period of anemia does not cause a decrease in urobilin elimination. The experiments support the view that the elimination of urobilin may be considered as an index of blood destruction, but they do not explain the decrease in the elimination occurring in man in certain forms of hemolytic anemia following splenectomy.