[A study of the connection between coercive measures used in a closed acute psychiatric ward and the socio-demographic and clinical characteristics of the patients involved]. / Dwang- en drangmaatregelen binnen een gesloten acute psychiatrische opnameafdeling; relatie met socio-demografische en klinische kenmerken.

BACKGROUND: Admission at a closed acute psychiatric ward is a severe and possibly life changing experience for a patient. Sometimes admission is accompanied by coercive measures. Despite the impact that these measures may have on the patient, very little research has been published concerning this patient population. AIM: To obtain insight into the connection between the socio-demographic characteristics of patients admitted to a closed acute psychiatric ward and the coercive measures to which they were subjected. METHOD: For a year a database was compiled to give us information about the socio-demographic and clinical characteristics of patients admitted to a closed acute psychiatric ward in The Hague in the Netherlands. This record enables us to analyse the relation between these characteristics and coercive measures. RESULTS: The majority of patients admitted were male, single, childless and were unemployed or not in education but were receiving some form of welfare payment. 33% of admissions were in fact re-admissions. 20% of the admissions/re-admissions were secluded during the admission procedure - for the following reasons: symptoms of a psychotic disorder, a manic episode and/or aggression. Secluded patients were younger and had more serious psychiatric problems; they functioned less well and had been in hospital longer than patients who had not been secluded upon admission. During the admission procedure 14% of patients received emergency medication. CONCLUSION: These results have given us more insight into the connection between the use of coercive measures in psychiatry and the socio-demographic characteristics and clinical characteristics of the patients involved. This information could serve as reference material for future research.

Detection of single-nucleotide polymorphisms in Plasmodium falciparum by PCR primer extension and lateral flow immunoassay.

The resistance of Plasmodium falciparum to some antimalarial drugs is linked to single-nucleotide polymorphisms (SNPs). Currently, there are no methods for the identification of resistant parasites that are sufficiently simple, cheap, and fast enough to be performed at point-of-care, i.e., in local hospitals where drugs are prescribed. Primer extension methods (PEXT) were developed to identify 4 SNPs in P. falciparum positioned at amino acids 86, 184, and 1246 of the P. falciparum multidrug resistance 1 gene (pfmdr1) and amino acid 76 of the chloroquine resistance transporter gene (pfcrt). The PEXT products were visualized by a nucleic acid lateral flow immunoassay (NALFIA) with carbon nanoparticles as the detection labels. PCR-PEXT-NALFIAs showed good correlation to the reference methods, quantitative PCR (qPCR) or direct amplicon sequence analysis, in an initial open-label evaluation with 17 field samples. The tests were further evaluated in a blind study design in a set of 150 patient isolates. High specificities of 98 to 100% were found for all 4 PCR-PEXT genotyping assays. The sensitivities ranged from 75% to 100% when all PEXT-positive tests were considered. A number of samples with a low parasite density were successfully characterized by the reference methods but failed to generate a result in the PCR-PEXT-NALFIA, particularly those samples with microscopy-negative subpatent infections. This proof-of principle study validates the use of PCR-PEXT-NALFIA for the detection of resistance-associated mutations in P. falciparum, particularly for microscopy-positive infections. Although it requires a standard thermal cycler, the procedure is cheap and rapid and thus a potentially valuable tool for point-of-care detection in developing countries.

[Manic-psychotic symptoms as clinical manifestation of hyperparathyroidism]. / Manisch-psychotische verschijnselen in het kader van hyperparathyreoïdie met aspecifiek beloop.

We discuss the case history of a woman aged 49 years who displayed manic-psychotic symptoms as a clinical manifestation of hyperparathyroidism. Following resection of the parathyroid she developed severe depression. Primary hyperparathyroidism (PHPT) is characterised by an increase of the parathyroid hormone (PTH), which in turn leads to an increase in the plasma calcium. PHPT can be accompanied by various psychiatric symptoms ranging from personality changes and severe depression to obsessive-compulsive and paranoid symptoms.

[Folie à famille: a Surinamese-Hindustani family with a shared paranoid delusion and severe undernourishment]. / Folie à famille: een Surinaams-Hindoestaans gezin met een gedeelde paranoïde waan en ernstige ondervoeding.

Folie à famille is a rare psychiatric condition in which several family members develop similar psychotic symptoms. We describe the case of a family of four with a shared paranoid delusion, who all obtained complete remission after being treated with antipsychotics on different psychiatric wards.

Direct blood PCR in combination with nucleic acid lateral flow immunoassay for detection of Plasmodium species in settings where malaria is endemic.

Declining malaria transmission and known difficulties with current diagnostic tools for malaria, such as microscopy and rapid diagnostic tests (RDTs) in particular at low parasite densities, still warrant the search for sensitive diagnostic tests. Molecular tests need substantial simplification before implementation in clinical settings in countries where malaria is endemic. Direct blood PCR (db-PCR), circumventing DNA extraction, to detect Plasmodium was developed and adapted to be visualized by nucleic acid lateral flow immunoassay (NALFIA). The assay was evaluated in the laboratory against samples from confirmed Sudanese patients (n = 51), returning travelers (n = 214), samples from the Dutch Blood Bank (n = 100), and in the field in Burkina Faso (n = 283) and Thailand (n = 381) on suspected malaria cases and compared to RDT and microscopy. The sensitivity and specificity of db-PCR-NALFIA compared to the initial diagnosis in the laboratory were 94.4% (95% confidence interval [CI] = 0.909 to 0.969) and 97.4% (95% CI = 0.909 to 0.969), respectively. In Burkina Faso, the sensitivity was 94.8% (95% CI = 0.88.7 to 97.9%), and the specificity was 82.4% (95% CI = 75.4 to 87.7%) compared to microscopy and 93.3% (95% CI = 87.4 to 96.7%) and 91.4% (95% CI = 85.2 to 95.3%) compared to RDT. In Thailand, the sensitivity and specificity were 93.4% (CI = 86.4 to 97.1%) and 90.9 (95% CI = 86.7 to 93.9%), respectively, compared to microscopy and 95.6% (95% CI = 88.5 to 98.6%) and 87.1% (95% CI = 82.5 to 90.6) compared to RDT. db-PCR-NALFIA is highly sensitive and specific for easy and rapid detection of Plasmodium parasites and can be easily used in countries where malaria is endemic. The inability of the device to discriminate Plasmodium species requires further investigation.

Carbon nanoparticles in lateral flow methods to detect genes encoding virulence factors of Shiga toxin-producing Escherichia coli.

The use of carbon nanoparticles is shown for the detection and identification of different Shiga toxin-producing Escherichia coli virulence factors (vt1, vt2, eae and ehxA) and a 16S control (specific for E. coli) based on the use of lateral flow strips (nucleic acid lateral flow immunoassay, NALFIA). Prior to the detection with NALFIA, a rapid amplification method with tagged primers was applied. In the evaluation of the optimised NALFIA strips, no cross-reactivity was found for any of the antibodies used. The limit of detection was higher than for quantitative PCR (q-PCR), in most cases between 10(4) and 10(5) colony forming units/mL or 0.1-0.9 ng/µL DNA. NALFIA strips were applied to 48 isolates from cattle faeces, and results were compared to those achieved by q-PCR. E. coli virulence factors identified by NALFIA were in very good agreement with those observed in q-PCR, showing in most cases sensitivity and specificity values of 1.0 and an almost perfect agreement between both methods (kappa coefficient larger than 0.9). The results demonstrate that the screening method developed is reliable, cost-effective and user-friendly, and that the procedure is fast as the total time required is <1 h, which includes amplification.

Intraoperative ultrasound guidance in breast-conserving surgery shows superiority in oncological outcome, long-term cosmetic and patient-reported outcomes: Final outcomes of a randomized controlled trial (COBALT).

BACKGROUND: The multicenter randomized controlled COBALT trial demonstrated that ultrasound-guided breast-conserving surgery (USS) results in a significant reduction of margin involvement (3.1% vs. 13%) and excision volumes compared to palpation-guided surgery (PGS). The aim of the present study was to determine long term oncological and patient-reported outcomes including quality of life (QoL), together with their progress over time. METHODS: 134 patients with T1-T2 breast cancer were randomized to USS (N = 65) or PGS (N = 69). Cosmetic outcomes were assessed with the Breast Cancer Conservative Treatment cosmetic results (BCCT.core) software, panel-evaluation and patient self-evaluation on a 4-point Likert-scale. QoL was measured using the EORTC QLQ-C30/-BR23 questionnaire. RESULTS: No locoregional recurrences were reported after mean follow-up of 41 months. Seven patients (5%) developed distant metastatic disease (USS 6.3%, PGS 4.4%, p = 0.466), of whom six died of disease (95.5% overall survival). USS achieved better cosmetic outcomes compared to PGS, with poor outcomes of 11% and 21% respectively, a result mainly attributable to mastectomies due to involved margins following PGS. There was no difference after 1 and 3 years in cosmetic outcome. Dissatisfied patients included those with larger excision volumes, additional local therapies and worse QoL. Patients with poor/fair cosmetic outcomes scored significantly lower on aspects of QoL, including breast-symptoms, body image and sexual enjoyment. CONCLUSION: By significantly reducing positive margin status and lowering resection volumes, USS improves the rate of good cosmetic outcomes and increases patient-satisfaction. Considering the large impact of cosmetic outcome on QoL, USS has great potential to improve QoL following breast-conserving therapy.

[Candy sprays and -gels: effect on salivary flow and pH]. / Snoepsprays en -gels: invloed op speekselsecretie en zuurgraad.

After seeing a child with dental erosion in a pediatric dental clinic the fondness and use of sweets were asked. With a questionnaire it became clear that recently various candy sprays and -gels are available to keep a sweet and fresh taste in the mouth at school. The buffer capacity of a number of sprays and gels were determined and they were tested in the mouth. The taste determines the increase in salivary flow rate. The effects of a taste stimulus on increasing the flow rate and decreasing the pH disappear within 2 until 3 minutes. Concluding: the Candy sprays and particularly the Juicy Drop Pop belong, from the dental point of view, to children sweets with high risk for dental caries and erosion. The use of these fluid sweets has to be reduced as much as possible.

Transfer of cholesterol and oxysterol derivatives by the nonspecific lipid transfer protein (sterol carrier protein 2): a study on its mode of action.

The nonspecific lipid transfer protein (nsLTP) facilitates the transfer of both phospholipids and cholesterol between membrane interfaces. In this study, we have investigated the transport of 14C-labelled cholesterol, 7-ketocholesterol, 7 alpha-hydroxycholesterol and 25-hydroxycholesterol from a mixed lipid monolayer at the air/water interface to acceptor vesicles in the subphase. In the absence of nsLTP the transport of cholesterol was virtually nil, whereas the spontaneous transport of the oxysterol derivatives increased in the order 7-ketosterol less than 7 alpha-hydroxycholesterol less than 25-hydroxycholesterol. In the presence of nsLTP, the transport of both cholesterol and the oxysterol derivatives was greatly enhanced; the highest rate of transport was observed for 25-hydroxycholesterol. In the absence of vesicles, binding of cholesterol and of 25-hydroxycholesterol from the monolayer to nsLTP was negligible. Similarly, nsLTP did not bind cholesterol from radiolabeled bovine heart mitochondria under conditions where it stimulated the transfer of cholesterol to vesicles. In agreement with this failure to bind, nsLTP was unable to carry cholesterol between two separate monolayers. From the monolayer experiments it became apparent that nsLTP is highly surface-active. Measurement of the transport of cholesterol and of oxysterol derivatives by the monolayer-vesicles assay and of a series of pyrene-labeled phosphatidylcholine species by the fluorescent transfer assay showed a high correlation between the spontaneous and the nsLTP-mediated lipid transport. This supports the notion that nsLTP lowers the energy barrier for the lipid monomer-membrane interface equilibration process. In view of the above observations, we propose that nsLTP may facilitate the transfer of lipids by being part of a transient collisional complex between donor and acceptor membrane.

Purification of nonspecific lipid transfer protein (sterol carrier protein 2) from human liver and its deficiency in livers from patients with cerebro-hepato-renal (Zellweger) syndrome.

The nonspecific lipid transfer protein (i.e., sterol carrier protein 2) from human liver was purified to homogeneity using ammonium sulfate precipitation, CM-cellulose chromatography, molecular sieve chromatography and fast protein liquid chromatography. Its amino acid composition was determined and found to be very similar to that of the nonspecific lipid transfer protein from bovine and rat liver with, as main feature, the absence of arginine, histidine and tyrosine. By way of a specific enzyme immunoassay using affinity-purified antibodies, the levels of nonspecific lipid transfer protein were determined in human livers. Levels varied from approximately 150 ng nonspecific lipid transfer protein per mg 105,000 X g supernatant protein for juvenile and adult humans to 40 ng per mg supernatant protein for a young infant. Levels of nonspecific lipid transfer protein in livers of infants with cerebro-hepato-renal (Zellweger) syndrome were extremely low (i.e., 2 ng per mg supernatant protein). Immunoblotting revealed the presence of crossreactive proteins of molecular masses of 40,000 and 58,000. The 40 kDa and 58 kDa proteins occurred in control livers, whereas only the 40 kDa protein was present in Zellweger livers. As in rat the 58 kDa protein could be demonstrated in a peroxisomal preparation isolated from an adult liver. A possible link between the occurrence of nonspecific lipid transfer protein and the presence of peroxisomes is discussed.

Nonspecific lipid transfer protein (sterol carrier protein 2) is bound to rat liver mitochondria: its role in spontaneous intermembrane phospholipid transfer.

In the present study we have investigated the transfer of phospholipids between vesicles and rat liver mitochondria. Transfer was measured by electron paramagnetic resonance spectroscopy using vesicles that contained spin-labeled phospholipids. A spontaneous transfer was observed which could be strongly inhibited by treating the mitochondria with the thiol reagent mersalyl. Transfer was also greatly reduced after a saline wash of the mitochondria; the transfer activity was then recovered in the wash. This activity was inhibited by tryptic digestion and mersalyl. By gel chromatography, enzyme immunoassay and immunoblotting it was demonstrated that the activity in the wash was due to the nonspecific lipid transfer protein (sterol carrier protein 2). We could estimate that up to 85% of the spontaneous phospholipid transfer between vesicles and rat liver mitochondria was mediated by this transfer protein.

The subcellular distribution of the nonspecific lipid transfer protein (sterol carrier protein 2) in rat liver and adrenal gland.

The distribution of the nonspecific lipid transfer protein (i.e., sterol carrier protein 2) over the various subcellular fractions from rat liver and adrenal gland was determined by enzyme immunoassay and immunoblotting. This distribution is very different in each of these two tissues. In liver, 66% of the transfer protein is present in the membrane-free cytosol as compared to 19% in the adrenal gland. In the latter tissue, the transfer protein is mainly found in the lysosomal/peroxisomal and the microsomal fraction at a level of 1093 and 582 ng per mg total protein, respectively (i.e., 17% and 35% of the total), and to a lesser extent in the mitochondrial fraction (11% of the total). Of all the membrane fractions isolated, the microsomal fraction from the liver and the mitochondrial fraction from the adrenal gland have the lowest levels of the transfer protein (i.e., 168 ng and 126 ng per mg total protein, respectively). These low levels correlate poorly with the active role proposed for this transfer protein in the conversion of cholesterol into bile acids and steroid hormones in these fractions. Using immunoblotting, it was demonstrated that in addition to the transfer protein (14 kDa) a cross-reactive 58 kD protein was present in the supernatant and the membrane fractions of both tissues. Cytochemical visualization in adrenal tissue with specific antibodies against the nonspecific lipid transfer protein showed that immunoreactive protein(s) were present mainly in the peroxisome-like structures.

Effects of exogenous MSH on the transformation from phaeo- to eumelanogenesis within C57BL/6J-Ay/a hairbulb melanocytes.

The extent to which alpha melanocyte-stimulating hormone (MSH) is a true in vivo regulator of melanogenesis in mice is unknown. The objective of this study was to determine if MSH-induced eumelanogenesis in hairbulb melanocytes of yellow (Ay/a) mice mimics the natural program of eumelanogenesis occurring in genetically black (a/a) hairbulb melanocytes. We conducted quantitative transmission electron microscopy on melanosome differentiation within MSH-treated regenerating 9-d hairbulbs of Ay/a and a/a mice. Results of exogenous alpha-MSH injections (5 d at 0.15 mM MSH) showed that the striking visual darkening of hair was accompanied by an incomplete transformation of phaeo- to eumelanogenesis. Ontogenetic data on developmental stages I-IV of 3678 melanosomes based on geometric considerations (length, width, shape, and area) showed that MSH did not induce a complete transformation from spherical phaeomelanosomes to elliptical eumelanosomes. Also, observations on the number of vesiculoglobular bodies and matrix organization reveled that MSH-treated Ay/a melanosomes retained distinct features of phaeomelanogenesis even after 5 d of MSH treatment. Thus, MSH induced a partial but incomplete pattern of eumelanogenesis in regenerating hairbulb melanocytes of Ay/a mice. The continued investigation of the dynamics of melanin synthesis in MSH-induced Ay/a mice melanocytes possessing "mosaic" melanosomes could be productive in understanding fundamental relationships between tyrosinase activity, matrix function, matrix structure, and regulation of melanin (phaeo- and/or eumelanin) synthesis.

Localization and hormonal regulation of the non-specific lipid transfer protein (sterol carrier protein2) in the rat testis.

In testis tissue from mature rats the non-specific lipid transfer protein (nsLTP), also called sterol carrier protein2 (SCP2), is concentrated in the Leydig cells and cannot be detected in Sertoli cells or germinal cells. Conclusions were reached after cell fractionation studies with normal testis tissue and after selective destruction of Leydig cells or germinal cells in vivo. The amount of nsLTP (SCP2) in testis tissue increased twofold 48 h after two daily injections of human chorionic gonadotrophin (100 i.u., s.c.) and decreased twofold after plasma luteinizing hormone levels were suppressed to almost undetectable levels with silicone elastomer implants containing testosterone. The specific localization in the Leydig cells and the luteinizing hormone-dependent cellular concentration of nsLTP/SCP2 support the possibility that this protein could play a role in the regulation of steroidogenesis by regulating the availability of cholesterol for the P450 side-chain cleavage enzyme in the mitochondria of Leydig cells.

Regulation of sterol carrier protein2 (SCP2) levels in the soluble fraction of rat Leydig cells. Kinetics and the possible role of calcium influx.

The rate-determining step in steroidogenesis is the conversion of cholesterol to pregnenolone by the cholesterol side-chain cleavage enzyme. The transport of substrate for this reaction may be facilitated by sterol carrier protein2 (SCP2). In rat testis tissue SCP2 is specifically localized in the Leydig cells and tissue levels of SCP2 are regulated by luteinizing hormone (LH). The present study concerns short-term regulation of SCP2 in isolated rat Leydig cells. Levels of SCP2 in the membrane-free supernatant are increased 2-fold already after 2 min incubation with LH and remain elevated for 24 h. The same response occurs with cells preincubated in the presence of cycloheximide for 4 h. SCP2 levels are also 2-fold increased after incubation with dibutyryl cAMP or 4 beta-phorbol 12-myristate 13-acetate (PMA) whereas these compounds stimulate steroid production 5.5- and 2-fold respectively. Luteinizing hormone releasing hormone (LHRH), which can stimulate steroid production more than 3-fold, does not influence SCP2 levels, neither are SCP2 levels altered when LH is added in the presence of the Ca2+-channel blocker diltiazem or in the absence of extracellular Ca2+. A restoration of the LH effect on SCP2 levels was already obtained in the presence of 1 microM extracellular Ca2+. These results suggest that Ca2+ influx through the plasma membrane may play an important role in the control of SCP2 levels. In most of the experiments no correlation between steroid production and SCP2 levels could be observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Colloidal carbon particles as a new label for rapid immunochemical test methods: quantitative computer image analysis of results.

Colloidal carbon particles can serve as label in sol particle immunoassays. The universal applicability of these particles in qualitative and (semi)quantitative immunoassays has been demonstrated. Sol particle and/or dipstick immunoassays, not yet optimized in terms of sensitivity, are discussed. The colloidal label has been used successfully in a mouse immunoglobulin isotyping kit. Human serum albumin spotted onto nitrocellulose in a concentration range of 7.8 to 1000 ng could be detected using anti-albumin antibody absorbed onto colloidal carbon particles. It was also possible to perform a competitive assay with this conjugate for a concentration range of free human serum albumin varying from 0.25 to 6.75 micrograms. The Kunitz-type trypsin inhibitor from soybean was determined by a colloidal carbon based immunoassay in a range of 2.5 to 160 ng. In this assay, free and colloidal carbon-bound inhibitor competed for binding specific antibodies spotted onto a nitrocellulose membrane. An image- and data-processing procedure has been developed that enables a rapid and simple quantification of colloidal carbon sol particle immunoassays. The average grey level of a spot is taken as a measure for quantitative purposes. This so-called Sol-particle Image Processed ImmunoAssay (SIPIA) procedure is equally well applicable to assays using other colloidal particles.

Early MR features of hypoxic-ischemic brain injury in neonates with periventricular densities on sonograms.

BACKGROUND AND PURPOSE: In the early 1980s, diagnosing periventricular leukomalacia (PVL) in neonates by using cranial sonography was possible for the first time. Our purpose was to investigate the possibility of diagnosing PVL in the acute stage by using MR imaging. We evaluated early MR features of hypoxic-ischemic brain injury in neonates with periventricular densities (flares) on cranial sonograms to determine the added value of MR imaging over sonography alone for early diagnosis of brain damage. METHODS: In a prospective study, infants who showed flares and/or cysts on sonograms underwent MR imaging during the (sub)acute stage. RESULTS: Fifty infants were classified according to the highest sonographic grade up to the day of MR imaging: 23 infants had sonographic grade 1 (flares < 1 week), 15 had sonographic grade 2 (flares > or = 1 week), four had sonographic grade 3 (small localized cysts), and eight had sonographic grade 4 (extensive periventricular cysts); none had sonographic grade 5 (multicystic leukomalacia) on the day of MR imaging. Overall, the additional information provided by MR imaging (over sonography alone) consisted of the depiction of hemorrhagic lesions in 64% of the infants. Extent and severity of the hemorrhages varied from isolated punctate lesions to extensive hemorrhages throughout the white matter; the latter were followed by cystic degeneration at autopsy in two infants. In nine of the 12 infants with cystic PVL, MR images showed more numerous or more extensive cysts. In addition, in two infants, MR images showed cysts not present on sonograms. In 32% of the infants, MR imaging provided no additional information; in these children, all but one had flares on sonograms whereas MR images showed no abnormalities or a zone of mild periventricular signal change. CONCLUSION: MR imaging can depict the precise site and extent of hypoxic-ischemic brain injury at an earlier stage and allows a wider differentiation of lesions as compared with sonography alone. Hemorrhagic PVL is considered to be rare, but was present in 64% of our study population.

Quantitative computer image analysis of a human chorionic gonadotropin colloidal carbon dipstick assay.

Colloidal particles are widely used in qualitative dipstick assays for the determination of various proteins and haptens. Recently, a new colloidal label has been introduced based on elemental carbon. With this carbon label we have prepared a human chorionic gonadotropin-specific dipstick assay with a sensitivity of 10 mIU/ml. In addition, an image- and data-processing procedure for the quantification of the dipstick assay has been developed. The sum of the pixel grey levels of a carbon line was taken as a measure for this quantitative purpose. The measurement range of the assay is almost three orders of magnitude, i.e. 10 mIU/ml to 500 mIU/ml. The deviation from the mean of two dipstick determinations was 1.22% on average. The within-run and between-run precision, expressed as coefficients of variation at 50 mIU/ml were 1.03% and 1.84%, at 150 mIU/ml 2.14% and 3.77% and at 450 mIU/ml 2.55% and 5.28%, respectively. We have correlated this quantitative sol particle immunoassay with a commercial human chorionic gonadotropin specific radioimmunoassay. In an experiment with 25 human urine samples containing the hormone in amounts from 5 to 300 mIU/ml the correlation coefficient was 0.999. The sol particle immunoassay quantified by computer image analysis has been termed Sol particle Image Processed ImmunoAssay (SIPIA).

A randomised, double-blind comparison of milnacipran and imipramine in the treatment of depression.

This multicentre, double-blind, randomised trial in 109 patients compared the efficacy and tolerance of the novel selective serotonin and noradrenaline reuptake inhibitor (SNRI) antidepressant milnacipran (50 mg twice daily, n=53) with the established tricyclic agent imipramine (75 mg twice daily, n=56) over a period of 6 weeks, in patients with major depression (Montgomery-Asberg depression rating score (MADRS) > or =25). Initiation of antidepressant medication was conducted during a 2-week period of hospitalisation, after a 3- to 7-day washout period. Concomitant psychiatric medication was limited to lorazepam, cyamemazine, chloral hydrate and long-term uncomplicated lithium therapy. Assessment for efficacy using the MADRS and Hamilton rating scales of depression, a visual analogue scale and global evaluation revealed both agents to be highly effective (P=0.0001) in this group of patients. Milnacipran was found to be of similar efficacy to imipramine. Tolerance, assessed by physiological and biochemical examinations with routine inventory and spontaneous report of adverse events, revealed a clear advantage for milnacipran. The incidence of anticholinergic events with milnacipran was about half that with imipramine and the overall incidence of adverse events by either reporting method was markedly lower with milnacipran than with imipramine. Furthermore, the patient drop-out rate with imipramine was double that experienced with milnacipran. Milnacipran appears to possess equal antidepressant efficacy to imipramine but with markedly superior tolerance. Therefore, milnacipran constitutes an important new treatment option in major depression.

Characterization of N alpha-acetyl-alpha-endorphin from rat neurointermediate lobe and its distribution in pituitary and brain.

N alpha-Acetyl-alpha-endorphin was characterized from rat neurointermediate lobe. The distribution of the acetylated and the non-acetylated form of alpha-endorphin in dissected areas of pituitary and brain appeared to be uneven. alpha-Endorphin appeared to be the main peptide in the anterior pituitary, whereas in the neurointermediate lobe N alpha-acetyl-alpha-endorphin accounted for most of the alpha-endorphin immunoreactivity. In the brain, the highest concentration of alpha-endorphin immunoreactivity was found in the hypothalamus. In hypothalamus and thalamus alpha-endorphin predominated, whereas in amygdala, hippocampus and septum N alpha-acetyl-alpha-endorphin represented most of the alpha-endorphin-immunoreactivity. In view of the non-opioid properties of acetylated endorphins, it is suggested that acetylation represents a mechanism allowing the organism to specifically select the non-opioid behavioral activities enclosed in the endorphin sequence.