Contrasting child and adolescent psychiatry services in Szeged, Hungary, and Glasgow, Scotland.

International comparisons of child and adolescent psychiatry services are rarely reported in the literature. The present study arose out of a TEMPUS collaborative project between the University Departments of Child and Adolescent Psychiatry in Szeged, Hungary, and Glasgow, Scotland. Using the Glasgow Audit Questionnaire, a profile of each service was obtained, including basic demographic data, types of disorders referred, treatment modalities used, and a measure of outcome. The results of this descriptive study indicate that although the two centres were broadly similar, there were major differences in the treatment modalities used. Reasons for the findings are discussed, as are the limitations of the study.

Interaction between tricyclic psychopharmacons and some antibiotics.

The tricyclic psychopharmacons, e.g. clozapine, promethazine and imipramine cure plasmids and inhibit plasmid transfer among bacteria due to the inhibition of supercoiling activity on DNA gyrase. In addition an interaction was found between clozapine, imipramine, promethazine and some antibiotics, e.g. penicillins and tetracycline in vitro. The nature of interaction is based on a charge transfer complex, which is formed between clozapine, imipramine, promethazine and penicillins. Differential spectrophotometry showed that ampicillin reduced the highest energy peaks of clozapine, promethazine and imipramine. Streptomycin did not alter the spectrum of clozapine; however, tetracycline somewhat reduced all the peaks of clozapine. Clozapine and promethazine exhibited a synergistic effect with ampicillin, tetracycline and gentamicin on Escherichia coli cells in in vitro. This kind of interaction was missing in the case of imipramine.

Comparison of two calcium antagonists, verapamil and fendiline, in an experimental model of myocardial ischaemia mimicking classical angina on effort.

1 The effects of verapamil (0.15/kg) and fendiline (3 mg/kg) were studied in anaesthetized, thoracotomised dogs with a critical constriction of the left anterior descending coronary artery, paced in excess of the initial rate by 60-70 beats/min. Epicardial ST-segment elevation and changes in lactate uptake were used to assess the severity of myocardial ischaemia. 2 Both drugs prevented the ST-segment elevation and the reduced lactate uptake that resulted from atrial pacing. 3 The anti-ischaemic effect of fendiline is mainly due to its negative chronotropic action, whereas that of verapamil is due in part to bradycardia and in part to the reduced preload and afterload. In addition, both agents increase coronary flow to the ischaemic area and thus improve the myocardial oxygen supply/oxygen requirement ratio.

The effect of beta-adrenoceptor blocking drugs on free fatty acid and glucose utilization of the isolated canine heart with normal and restricted flow in the presence and absence of noradrenaline.

Effect of adrenergic beta-receptor blockade on the myocardial utilization of the main substrates by the isolated fibrillating dog heart perfused with constant volume of blood from a donor animal was studied at normal and restricted flow, and in the presence of noradrenaline. A direct metabolic action of the beta-blockade by increasing glucose uptake in the normal and reducing it in the ischemic heart, furthermore moderating the ischemic diminution of the lactate uptake could be shown. The intervention reduced elevated serum free fatty acid level and increased myocardial free fatty acid uptake observed in the presence of noradrenaline.

Drug-induced augmentation of coronary flow in vessels with maximum ischemic dilatation.

The possibility of drug-induced augmentation of coronary flow in vessels with maximum ischemic dilation has been investigated in anesthetized dogs. The auotperfused left anterior descending coronary artery was gradually narrowed to a "critical" degree at which hyperemic response to coronary occulsion was completely abolished...

Nitroglycerin and dipyridamole on cardiac metabolism and dynamics in a new experimental model of angina pectoris.

An experimental model of angina pectoris has been developed in order to study the hemodynamic, metabolic and electrophysiological alterations of the heart assumed to occur in the human disease and to analyze the influence of nitroglycerin and dipyridamole on the above changes. In anesthetized and thoractomized dogs, the left anterior descending coronary artery was autoperfused from the subclavian artery. Coronary blood flow was reduced until the epicardial monopolar electrocardiogram recorded from the myocardial segment supplied by the constricted coronary artery was just short of ischemic changes. O2 consumption and lactate uptake of the same segment were determined from the arteriovenous difference by sampling venous blood draining this area. Increasing heart rate by 50 to 70 beats/min by electrical pacing of the right atrium evoked a reversible and reporducible elevation of the ST segment and T wave of the electrocardiogram. Blood flow to the area perfused by the constricted coronary artery as well as the O2 uptake of the same area failed to increase on pacing. A concomitant decrease of lactate uptake, sometimes becoming even negative, was indicative of ischemia of that area. These changes could be reduced or prevented by a 10-minute infusion of a total dose of 20 mug/kg of nitroglycerin but not by 60 mug/kg of dipyridamole. Since the changes are fully reversible and readily reproducible, and the response also appears to show parallelisms with those observed in the human patient during an acute angina pectoris attack, use of this model for the assay of antianginal drugs seems to be warranted.

Importance of haemodynamic, metabolic and electrocardiographic alterations in the detection of coronary failure.

Haemodynamic, metabolic and ECG alterations due to a "critical" stenosis of the left anterior descending coronary artery (LAD) with and without additional work load induced by pacing and the changes due to a total obstruction of the artery have been investigated in anaesthetized open-thorax dogs. Direct ECG recording was done from the epicardial surface of the area perfused by the constricted coronary artery; blood samples were collected from the same area for estimation of metabolites. It was shown that ischaemic biochemical changes (decrease of myocardial lactate uptake and of the ratio myocardial O2 supply/myocardial O2 demand) can be detected along with a reduction of flow in the constricted artery long before the appearance of ischaemic ST-segment elevation in the epicardial ECG. This change can be evoked by an additional work load induced by pacing but even at the stage of manifest ischaemia, left ventricular end-diastolic pressure (LVEDP) is unaffected. It increases only after complete obstruction of the LAD. Accordingly, ischaemic metabolic changes in the area with restricted blood supply seem to be the most sensitive indicator of an incipient coronary insufficiency. ECG and particularly LVEDP changes are limited value, since they only appear if the ischaemic damage and/or the ischaemic area is sufficiently large.