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.     

2-甲酰(乙酰)取代喹啉缩氨基硫脲的合成

缩氨基硫脲类化合物有抗肿瘤、抗病毒和抗菌等多种药理活性。Barret等首次报道了乙二醛二缩氨基硫脲(Ⅰ)的抗疟活性。Klayman等研究了缩     

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.     

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.     

The effect of D-galactosamine on plasma protein synthesis by the perfused rat liver from turpentine-stimulated donors.

D-galactosamine (100 mg) was added to the reconstituted blood during 4h perfusion of livers isolated either from control rats or those injected with turpentine 20 h or 5 h earlier. This dose of galactosamine administered 30 min before [3H]lysine significantly inhibited the incorporation of the label into liver proteins, and even more into plasma proteins, but albumin and acute-phase reactants (fibrinogen, seromucoid fraction, Concanavalin A-adsorbed glycoproteins) were all similarly affected. When galactosamine was administered in vivo simultaneously with turpentine, and the liver was isolated 5 h later, trauma-induced fibrinogen synthesis was selectively inhibited. This can be explained either by a differential control of synthesis of various acute-phase reactants, or by augmentation of catabolism of fibrinogen in galactosamine-treated rats. Crossed immunoelectrophoresis of the full perfusate or Concanavalin A-adsorbed glycoproteins did not reveal any significant effect of galactosamine on the protein pattern obtained from control or turpentine-stimulated liver donors.     

Effect of Percoll wash on sperm motion parameters and subsequent fertility in intrauterine insemination cycles

Purpose This study examined sperm motion parameters as measured by computerized automated semen analysis before and after a Percoll wash and determined if differences in any parameter were correlated with fertility subsequent to intrauterine insemination (IUI).Results Total motile sperm decreased following the washing procedure from 79.0 ± 9.0 to 37.2 ± 7.6 million sperm. Motility increased from a mean of 43.4% to 61.7% (P<0.001). Other motility parameters also changed significantly (P<0.001) as follows: curvilinear velocity (VCL), 43.4 to 61.7 m/s; straight-line velocity (VSL), 21.3 to 26.7 m/s; linearity 53.1 to 45.2%; lateral head displacement (ALH), 2.97 to 3.94 m. Similar changes occurred following a swim-up preparation, although changes in mean motility, VCL, and ALH were significantly greater when compared to Percoll. The postwash changes were not accounted for merely by time lapse in preparation since reanalyzed untreated controls did not show the same changes in motion parameters. Prewash linearity in those specimens which resulted in pregnancies was greater than in those which did not (P=0.28). No other significant differences in pre-or post-Percoll washed sperm motion parameters were found between pregnant vs nonfertile cycles.Conclusion Following Percoll wash all CASA-generated motility parameters were significantly altered, but there was little association between these parameters and pregnancy achieved in IUI cycles.Presented at the 50th Annual Meeting of the American Fertility Society, San Antonio, Texas, November 5–10, 1994.     

Frozen semen -- a poor form of fertility insurance.

Two previously fertile males have requested surgical vasectomy reversal after divorce and failure of their new younger wives to conceive by repeated inseminations with their stored frozen semen. The sperm had been preserved for six and five years, respectively, as "fertility insurance" prior to sterilization by bilateral vasectomy. It is clear that the storage of fertile semen does not guarantee future fertility.     

Human chorionic gonadotrophin therapy in male infertility

A response to a doctor's question regarding the therapeutic use of human chorionic gonadotropin (HCG) in a 24-year-old male with primary infertility is presented. The subject had only scattered spermatogenesis, but low-normal follicle stimulating hormone (FSH) and testosterone (T) levels. In reply, the therapeutic injection of 4000 units HCG twice a week for 10 weeks is reported. Generally, improvement in semen quality should begin about 3 months after completion of the injection series. Frequently, treatment will be accompanied by an increase in libido and improved sexual performance. Transient nipple tenderness and gynecomastia was noted in less than 5% of the patients toward the end of treatment.