Homogeneous preparation of fluorescent-derivatized insulin and its application to competitive chromatographic immunoassays.

A homogeneously labeled insulin sample was prepared using 6-aminoquinolyl-N-hydroxysuccinimidyl carbamate (AQC) as the fluorescent-labeling reagent, and this was successfully applied to a chromatographic immunoassay. This labeled insulin was prepared by tagging all the three amino groups with AQC. Both CE and chromatographic immunoassay experiments indicated that the prepared insulin still kept its immunoaffinity to its antibody. It was observed that appropriate concentrations of acetonitrile (ACN) were efficient in lowering the quenching of the fluorescent signal of tagged insulin, in keeping the dilute, tagged insulin in solution, and in improving its peak shape during a chromatographic immunoassay. The tagged insulin was found to be 20-400 times more sensitive than native insulin detected under ultraviolet detection conditions. A competitive chromatographic immunoassay system was set up and calibrated. The system was used for analyses of an insulin-spiked urine sample, with a 96% recovery obtained.

Factors affecting return of symptoms 1 year after treatment in a 62-week controlled study of fluoxetine in major depression.

BACKGROUND: In spite of impressive results in acute studies, the long-term treatment of major depression remains problematic. To explore the return of depressive symptoms and their interaction with social factors on long-term outcome, we assessed 55 patients whose depression had been treated during a 62-week, fluoxetine maintenance study, 1 year after the study's termination. METHOD: During the year following the study termination, patients were free to select treatment options. Assessments at the 1-year follow-up included measures of depressive symptoms (using the Hamilton Rating Scale for Depression [HAM-D]), social and marital impairment (using the Weissman Social Adjustment Scale [SAS]), personal stressors (using the Holmes Social Readjustment Rating Scale), and history of treatment during the past year. RESULTS: At the time of the naturalistic follow-up, 53% of patients sustained their improvement in mood. Factors associated with return of depressive symptoms included personal stresses, marital maladjustment, personal decision to discontinue antidepressants, and medication failure. Psychosocial variables were associated with poor outcome in over 90% of impaired subjects. Development of subsyndromal symptoms during the 50-week double-blind phase was predictive of poorer outcome at the long-term follow-up. CONCLUSION: The study demonstrates that no matter how effective initial pharmacologic therapy may be, without ongoing clinical monitoring and support, particularly in dealing with issues such as marriage and handling significant life stresses, and compliance with medications, it will not be successful in the long-term treatment for a significant portion of patients with depression.

Decline in structural examination compliance in the hospital medical record with advancing level of training.

A retrospective review of 115 randomly pulled hospital charts of patients admitted to the care of osteopathic physicians at an American Osteopathic Association-accredited primary care hospital revealed a significant decline in the frequency of structural examinations in history and physical examinations during a merger and relocation, as well as with increasing level of training of the examiner (chi 2 test, P < .001). Attending physicians completed fewer structural examinations (45% of their history and physical examinations) compared to house staff (70%) and students (92%). A follow-up anonymous survey of 100 osteopathic physicians and students (response rate, 58%) revealed that the low overall frequency of structural examination completion (60%) was due primarily to attending physicians who considered this examination less relevant or impractical for their hospitalized patients. These results indicate that education on relevance of structural examination and manipulative treatment for acutely ill patients needs to be directed not only to house staff and students but also to attending physicians to preserve and improve the use of osteopathic principles at osteopathic hospitals.

An open trial of nefazodone in adult patients with generalized anxiety disorder.

Generalized anxiety disorder (GAD) is a chronic disorder for which a variety of medications have been prescribed. Nefazodone is a recently released antidepressant that potently antagonizes the serotonin type 2A receptor and blocks uptake of norepinephrine and serotonin. It also antagonizes the serotonin type 2C receptor. Studies suggest this action may be anxiolytic. Twenty-one patients meeting DSM-IV criteria for GAD enrolled in an open 8-week trial of nefazodone were monitored by the Hamilton Rating Scale for Anxiety and the Clinical Global impressions scale. Fifteen of the 21 subjects completed the trial; 12 (80%) were rated as either very much or much improved, 1 (7%) as minimally improved, and 2 (13%) as unchanged. None was rated as worse. Nefazodone may be useful and well tolerated in the treatment of GAD. Theoretical questions about the neurobiological basis of GAD are also raised.

Large-volume therapeutic amniocentesis in the treatment of hydramnios.

OBJECTIVE: To evaluate the safety and outcome of large-volume therapeutic amniocentesis in the treatment of hydramnios. METHODS: Therapeutic amniocentesis was defined as an attempt to remove enough amniotic fluid (AF) in pregnancies complicated by symptomatic hydramnios to leave a normal volume of AF (AF index less than 25 cm). This report includes all therapeutic amniocenteses that were performed at Good Samaritan Regional Medical Center in Phoenix, Arizona, from 1988-1993. RESULTS: Ninety-four patients had 200 therapeutic amniocenteses. The most common condition treated with therapeutic amniocentesis was twin-twin transfusion syndrome (36 patients). The mean volume of fluid removed was 1666 +/- 1245 mL (mean +/- standard deviation). The median volume of fluid removed was 1500 mL (range 350-10,000). The fluid was removed at a mean rate of 54 +/- 22 mL/minute. Complications were limited to one patient with ruptured membranes one day after therapeutic amniocentesis, one patient who developed chorioamnionitis, and one patient with an anencephalic fetus who had an abruption following removal of 10,200 mL of fluid. CONCLUSION: Large-volume therapeutic amniocentesis can be used to treat hydramnios, with a 1.5% complication rate.