Lack of evidence of pregnancy-induced alloantibodies in dogs.

BACKGROUND: It is controversial whether or not pregnant bitches become sensitized to red blood cell (RBC) antigens. HYPOTHESIS: Bitches do not develop alloantibodies to RBC antigens during gestation and can be used safely as blood donors. ANIMALS: The study group included 35 healthy female dogs with a prior history of 1 (n = 12), 2 (n = 14), or >or= 3 (n = 9) pregnancies. The control group consisted of 15 healthy female dogs without any history of pregnancy. METHODS: All dogs were blood typed for dog erythrocyte antigens (DEA) 1.1, 1.2, 3, 4, 5, and 7 using ethylenediaminetetraacetic acid blood samples and polyclonal antisera. Antibody screening was performed with serum and canine RBC panels of known blood type. An autocontrol and direct antiglobulin test were performed to rule out the presence of autoantibodies. RESULTS: The only alloantibodies identified were those against DEA 7 and the prevalence of anti-DEA 7 alloantibodies was similar in dogs with known history of pregnancy (11.4%) and in the control group (13.3%). CONCLUSIONS AND CLINICAL IMPORTANCE: These results confirm previous studies and clinical transfusion medicine experience. Naturally occurring anti-DEA 7 alloantibodies have been reported but their clinical relevance has not been shown. Pregnancy does not appear to sensitize dogs to RBC antigens. Consequently, dogs with prior history of pregnancy can be used safely as blood donors. Conversely, no additional pretransfusion compatibility studies would be required should these dogs themselves need to be transfused.

New antidepressants: use in high-risk patients.

This paper will review evidence on the safety and efficacy of new antidepressants in high-risk patients. Where available, data will be reviewed on the serotonin selective reuptake inhibitors (SSRIs), including fluoxetine, fluvoxamine, paroxetine, sertraline, and citalopram, and on the new reversible inhibitor of monoamine oxidase-A moclobemide.

Tyramine-conjugation deficit as a trait-marker in endogenous depressive illness.

Patients with endogenous unipolar depressive illness show a highly significant decrease in ability to metabolize an oral load of tyramine to its sulphate conjugate compared with controls and neurotic depressives. As this biochemical lesion persists after clinical recovery and is present in about half the non-depressed first degree relatives of endogenously depressed probands, it is likely that the abnormality is a trait marker for depressive illness. It may thus be useful in practice as a predictor of vulnerability to depressive illness. The tyramine test is superior to the dexamethasone suppression test in both sensitivity to, and specificity for, endogenous depression.

Tyramine conjugation test distinguishes unipolar from bipolar depressed patients and controls.

Tyramine sulphate conjugation following oral tyramine administration (the tyramine test) has previously been found to distinguish endogenous unipolar from neurotic depression and appears to be a trait marker. In this study, the test was used in 24 unipolar depressed patients compared with similar sized matched groups of bipolar depressed patients and normal controls. Most of the depressed patients in each group showed endogenous features. The study found that whereas tyramine sulphate conjugation was significantly impaired in unipolar patients, values in the bipolars were similar to those of controls. These results provide further evidence for the biological difference between unipolar and bipolar depression.

Platelet high affinity adrenoceptor binding sites labelled with the agonist [3H]UK-14,304, in depressed patients and matched controls.

Increased numbers of platelet high affinity alpha 2-adrenoceptors binding sites have been reported in depressed patients using the agonist radioligand [3H]clonidine, whereas no differences from controls have been found using antagonist radioligands. We have measured platelet high affinity alpha 2-adrenoceptors in 13 depressed patients and 14 well-matched controls using a new selective agonist radioligand, [3H]UK-14,304. Unlike previous studies using [3H]clonidine, we find no differences in Bmax or KD of the high affinity alpha 2-adrenoceptor binding sites between the 2 groups.

[3H]yohimbine binding to platelet alpha 2-adrenoceptors in depression.

[3H]Yohimbine binding to platelet alpha 2-adrenoceptors was studied in depressed patients and healthy volunteers. Where possible platelet binding measurement was repeated in depressed patients following treatment. Bmax of [3H]yohimbine binding did not differ significantly between depressed patients and control subjects and did not change with treatment in depressed patients. KD was significantly lower in female depressed patients, particularly in those who were post-menopausal. Multivariate analysis showed significant effects on KD of depression, season of testing and assay protein concentration.

Critical flicker fusion threshold and anticholinergic effects of chronic antidepressant treatment in remitted depressives.

The persistence of deficits in cognitive performance in major depressive patients taking maintenance antidepressant medication was assessed by examining groups of patients in clinical remission, stable on one of a range of tricyclics or selective serotonin re-uptake inhibitors (SSRIs) for at least 3 months, compared with controls. Measures of critical flicker fusion (CFF), choice reaction time (CRT), subjective sedation, and anticholinergic side-effect score were made. Tricyclic antidepressants (TCAs) produce a significant deficit in critical flicker fusion threshold compared both to controls and SSRIs. Similar effects were seen with choice reaction times which were significantly affected by age. Sedation scores were significantly higher with TCAs than SSRIs. Anticholinergic side effects were strongly related to CFF, less so to visual analogue sedating scales and not significantly to CRT. The effect measured by CFF is different from sedation, and may be related to the anticholinergic potency of the drug; it may be considered a drug-induced pseudodementia. This effect represents a risk factor for accidents during maintenance therapy and may impair work and leisure performance. The relative risk of weight gain with TCAs compared to SSRIs in women was 5.92 (95% CI 1.79-19.50).

Detoxified alcoholics, major depressives and tyramine sulphate excretion.

The excretion of tyramine sulphate after challenge with an oral load of tyramine was assessed in recently detoxified, clinically depressed alcoholics and a matched group of major depressives. Tyramine excretion in the alcohol group (mean 5.95 ± 3.28 mg/3 h SD) was in the range previously observed in controls and was significantly higher than in the matched depressives (mean 3.43 ± 2.37 mg/3 h SD). Tyramine sulphate excretion has been suggested as a genetic vulnerability marker for major depression. This study suggests that depression associated with alcohol withdrawal is not characterised by decreased tyramine sulphate excretion after oral tyramine challenge, such decreased conjugation only being present, perhaps, in those patients with pre- existing endogenous depressive vulnerability. Although a genetic link between alcoholism and depression exists, these results support the absence of such a link to major depression.

The importance of accidents in evaluating the cost of SSRIs: a review.

Economic studies attempting to justify the increased cost of new antidepressants such as the SSRIs are often difficult to interpret, marginal benefits hinging on minute differences in assumptions and interpretation. Studies to date have focused largely upon the costs of treatment failure, which in turn relates to compliance rates. A missing factor is the cost of accidents, especially serious road traffic accidents. Most tricyclic antidepressants seriously impair driving performance, even more so than alcohol or benzodiazepines, whilst SSRIs do not. With moves towards maintenance and continuation therapy for depression, patients on tricyclics remain at long-term risk for such accidents. Cost savings from reducing the rate of accidents could more than pay for the increased costs of SSRIs.

A review of the safety and tolerability of sertindole.

The safety and efficacy of sertindole have been established in three double-blind randomized controlled studies conducted in the United States, North America and Europe. In these three studies the tendency for sertindole to cause extrapyramidal side effects (EPS), a critical factor affecting compliance, was investigated. At 12-24 mg/day, sertindole was associated with placebo levels of EPS, which were significantly lower than for all doses of haloperidol. In the European study, 24 mg sertindole demonstrated slightly, but statistically significantly, more EPS than 8 mg (P = 0.05). However, the incidence of EPS-related events was comparable with that reported for placebo in the United States and North American studies. The frequency of use of anti-EPS medication was also comparable in the sertindole and placebo groups. Slight prolongation of the Q-T interval was seen with sertindole in early clinical trials. Although no patients reported any clinical problems related to Q-T prolongation in these three studies, its use is contraindicated in patients suffering from underlying cardiac diseases or hypokalaemia and in those patients undergoing concomitant treatment with other medication known to prolong the Q-T interval. Most of the other adverse events reported for sertindole are related to its alpha, antagonistic activity.

3H-imipramine binding to freshly prepared platelet membranes in depression.

3H-Imipramine binding was measured in freshly prepared platelet membranes from 47 drug-free major depressives and 46 healthy controls. Where possible, platelet binding in depressed subjects was repeated following treatment. A significant negative correlation was found between Bmax and assay protein concentration and Bmax values were corrected for this effect. Adjusted Bmax was significantly lower (by 14%) in female depressed patients than in female control subjects, and the difference was of similar magnitude premenopausally and postmenopausally. No such difference was found in males. Kd did not differ significantly between depressed and control subjects. Multiple regression analysis confirmed significant effects on Bmax of presence of depressive illness, age (positive correlation), and season (higher in summer). Within the depressed sample, Bmax was significantly lower in those subjects with obsessional features. Endogenicity (Research Diagnostic Criteria or Newcastle), dexamethasone suppression test result, drug-free interval, family history of depression, depressive psychosis, suicidal ideation, and past history of suicide attempts were not significantly related to Bmax. Paired comparisons revealed no significant effect on Bmax of 6 weeks' treatment with imipramine, maprotiline, or BRL 14342 or of a course of electroconvulsive therapy.

Biochemical characterization of canine blood group antigens: immunoprecipitation of DEA 1.2, 4 and 7 and identification of a dog erythrocyte membrane antigen homologous to human Rhesus.

Despite the clinical significance of the canine blood group antigens, relatively little is known of the biochemistry of these molecules. In this study the canine blood group antigens DEA (dog erythrocyte antigen) 1.2, 4 and 7 were immunoprecipitated from red blood cells (RBC) bearing the corresponding blood group, and molecular weights of 85 kD (DEA 1.2), 32-40 kD (DEA 4) and 53-66 kD (DEA 7) assigned. DEA 1.2 and DEA 4 each appeared as a single band, whereas DEA 7 comprised three distinct bands (53, 58 and 66 kD). Polyclonal antisera specific for two peptides derived from the sequence of the human Rhesus blood group (Rh30A-C and Rh50A-C) were used in western blotting against canine and human erythrocyte membranes. The Rh30A-C antiserum identified a band of molecular weight 32 kD in both human and canine RBC, and the antiserum specific for Rh50A-C identified a band of 38-60 kD in human membranes and of 40-53 kD in canine RBC. This finding is consistent with conservation of areas of the Rhesus protein sequence between human and canine erythrocytes.

Hepatic imaging: a comparison of Tc-99m-sulfur colloid and PIPIDA in the detection of defects.

A prospective investigation comparing Tc-99m-PIPIDA with Tc-99m-sulfur colloid in the detection of defects of the liver was carried out in 30 volunteers. By acquiring images of 1 million counts from 5-10 minutes postinjection, high quality hepatic images could be obtained with PIPIDA. Separate interpretations by three nuclear physicians yielded similar results between paired PIPIDA and sulfur colloid studies (KAV = 0.95 +/- .09, P less than 0.001). Early multiview imaging of the liver in the course of hepatobiliary evaluation with PIPIDA may yield valuable information relative to the presence of lesions.

Canine blood groups and their importance in veterinary transfusion medicine.

Over 13 canine blood groups have been described. Eight DEA types are recognized as international standards. Typing sera produced by canine alloimmunization exists for six DEA types: 1.1, 1.2, 3, 4, 5, and 7. Naturally occurring antibody is found against DEA 3, 5, and 7. DEA 1.1 and 1.2 antibody-antigen interactions result in acute hemolytic transfusion reactions. DEA 3, 5, and 7 antibody-antigen interaction in vivo results in permanent red blood cell sequestration and loss in 3 to 5 days. DEA 4 antibody-antigen interactions produce no effect on red blood cell survival in vivo. A dog possessing DEA 4 and no other antigen is considered a "universal" donors. Veterinary transfusion medicine has advanced beyond uncrossmatched, untyped red blood cell transfusion. Whenever possible, transfusion should be between typed and crossmatched individuals. "Universal" donors and crossmatch should be utilized when typing of the recipient is not feasible. Canine blood typing is routinely performed in service laboratories across North America. In-clinic assays are not available for all canine blood group antigens. Recent production of monoclonal antibodies will lead to biochemical definition of the canine blood groups DEA 1.1 and 3. Additional efforts to define the erythrocytes on a molecular level are underway. Advances efforts in this areal will allow for more rapid and uniform testing of the canine red blood cell. Future exploration of DEA type and disease association is needed. A known association exists between DEA 1.1 and neonatal isoerythrolysis. Further screening of the dog population for DEA type may yield markers for autoimmune and neoplastic disease.

The outcome of targeting community mental health services: evidence from the West Lambeth schizophrenia cohort.

OBJECTIVES: To report outcome of targeting community mental health services to people with schizophrenia in an inner London district who had been shown, one year after discharge, to have high levels of psychotic symptomatology and social disability but very low levels of supported housing and structured day activity. DESIGN: Repeat interview survey of symptoms, disability, and receipt of care four years after index discharge. SETTING: Inner London health district with considerable social deprivation and a mental hospital in the process of closure. SUBJECTS: 51 patients originally aged 20-65 years who satisfied the research diagnostic criteria for schizophrenia. MAIN OUTCOME MEASURES: Contact with services during the three months before interview, levels of symptoms (from present state examination), global social disability rating. RESULTS: 65% (33/51) of the study group had been readmitted at least once in the three years between surveys. Recent contacts with community psychiatric nurses and rates of hospital admission increased (8 at one year v 24 at four years, p < 0.01; 5 v 13, p < 0.06). Conversely, fewer patients were in contact with social workers (17 v 7, p < 0.03). Proportions in supported housing, day care, or sheltered work did not change. Unemployment rates remained very high. A considerable reduction (almost a halving) in psychiatric symptoms was observed, but there was no significant change in mean levels of social disability. CONCLUSIONS: The policy of targeting the long term mentally ill resulted in significant increases in professional psychiatric input to the cohort but failed to improve access to social workers or suitable accommodation. Improvements in social functioning did not follow from reductions in the proportions of patients with psychotic mental states. Social interventions are likely to be crucial to achieving the Health of the Nation target of improving social functioning for the seriously mentally ill, as improving mental state seems in itself to be insufficient.

Community care for patients with schizophrenia one year after hospital discharge.

OBJECTIVES: To document the circumstances and care of patients with schizophrenia who had recently been discharged from local psychiatric inpatient services, and to establish the extent to which misgivings about community care might be justified. DESIGN: Cross sectional surveys with review of case notes. Follow up interviews with questionnaires administered one year after discharge. SETTING: Two inner London districts (West Lambeth and Lewisham) with high levels of social deprivation and at different stages of developing community services. PATIENTS: 90 and 50 patients in the two services respectively, aged 18 to 65, who satisfied the Research Diagnostic Criteria for schizophrenia and who were discharged from inpatient services. MAIN OUTCOME MEASURES: Diagnosis elicited by present state examination, global social disability rating, use of services during the three months before interview. RESULTS: 89 of the 140 patients (64%) had been ill for five or more years, yet few were former long stay inpatients. 55% (50/91; 95% confidence interval 45% to 65%) of those interviewed had current psychotic mental states and 22% (27/124; 16% to 31%) were functioning socially at very poor or severely maladjusted levels. 86% (107/124) were unemployed. The majority of patients had seen a mental health or social service professional, yet only 16% (20/124) were in specialised accomodation (excluding hospitals) and only 23% (17/73) of those eligible had used day care. Small numbers of people had experienced homelessness (two) or imprisonment (four over six months). CONCLUSIONS: Many schizophrenic patients leaving local psychiatric inpatient care have active symptomatology and profound social disabilities. Community care was characterised by high rates of contact with service professionals but little supported accommodation or day activity. This group of clients may require dedicated provision, which would actively encourage them to use services protected from the demands of those with less severe illness.

Collection and preparation of blood products.

Blood-component therapy has become an integral part of veterinary practice. Although access to veterinary blood banks has increased, practitioners may prefer to create their own blood-donor program to provide for their blood-product needs or to respond to an emergent need. Before embarking on such an endeavor, it is important to understand the techniques and requirements for such a program. This article will discuss issues in donor selection and management, supplies and techniques of blood-component acquisition, and supplies and techniques of blood-component preparation.

Treating pancreatitis in the acute care setting.

Acute pancreatitis is associated with significant complications and mortality. This article describes the pathophysiology and complications of, and treatments for acute pancreatitis, and the nurse's role in caring for a patient in the acute care setting.

Coagulation factor and hemostatic protein content of canine plasma after storage of whole blood at ambient temperature.

BACKGROUND: Standard practice in canine blood banking is to produce fresh frozen plasma (FFP) by separating and freezing plasma produced from blood within 8 hours of collection. Within canine blood donation programs, this can limit the number of units collected. HYPOTHESIS/OBJECTIVES: The aim was to compare the coagulation factor and hemostatic protein content (CF&HPC) of plasma produced from blood stored at ambient temperature for 8, 12, and 24 hours. Another aim was to compare the CF&HPC between Greyhound types and other breeds. ANIMALS: None. METHODS: In vitro study. A convenience sample of 58 units of canine blood from a blood donor pool was processed to prepare and freeze plasma 8, 12, or 24 hours following collection. RESULTS: Regardless of time of processing, the units contained therapeutic CF&HPC. Frozen plasma prepared after 24 hours had significantly higher factor VIII (P = .014) and factor X (P = .03) when compared with the frozen plasma prepared at 8 hours. Factor X (P < .01), fibrinogen (P < .01), and vWF (P = .04) were significantly lower in plasma collected from Greyhound types than in plasma collected from other breeds. CONCLUSIONS AND CLINICAL IMPORTANCE: Storing whole blood for up to 24 hours is a suitable method for producing FFP. Lower values for some coagulation factors and hemostatic proteins in plasma produced from Greyhound types would not preclude these dogs as FFP donors.