Neuroleptic malignant syndrome with trifluperidol.

In a case of NMS subsequent to administration of trifluperidol to a young man, the patient responded remarkably quickly to bromocriptine. The authors point out the deficiencies in the diagnostic criteria, which need further refinement for a better understanding of the syndrome.

Plasma catecholamine levels in the postoperative period in complication-free and "paralytic" ileus patients.

Plasma catecholamine concentrations were compared in a group of postoperative "paralytic" ileus patients and in another group of patients, who had undergone medium-size abdominal operations followed by uneventful recovery. The plasma epinephrine level was significantly in the former group, whereas no such difference was observed in the norepinephrine concentration. The data appear to confirm that the epinephrine released from the adrenal medulla appreciably contributes to the development of "paralytic" ileus. The therapeutically effective major tranquillizer and alpha-receptor blocking drug, trifluperidol, was found to reduce both epinephrine and norepinephrine levels in "paralytic" ileus patients. The decrease of the plasma epinephrine level was the higher, the greater its initial concentration. These findings seem to support the decisive role of increased catecholamine release in the development of postoperative motor inhibition ("postoperative" ileus) and also explain the success of sympatholytic treatment in such cases, i.e. the return of normal peristalsis.

Six cases of Gilles de la Tourette's syndrome.

Six cases of Gilles de la Tourette's syndrome are discussed in the light of conflicting views on the aetiology of the condition. It is hypothesized that the onset of coprolalia in patients with persistent childhood tics indicates a disturbances of the normal balance between a need for tension relief by swearing and a capacity to control such vocal activity. Some conclusions are drawn on the management of the syndrome by the use of butyrophenones, massed practice of tics, and the promotion of personality development. A flexible approach geared to the individual patient's particular needs is recommended.

Screening procedure for detecting butyrophenone and bisfluorophenyl neuroleptics in urine using a computerized gas chromatographic-mass spectrometric technique.

A method for the identification of butyrophenone and bisfluorophenyl neuroleptics and their predominant basic metabolites in urine after acid hydrolysis is described. The acetylated extract is analysed by computerized gas chromatography-mass spectrometry. An on-line computer allows rapid detection using mass fragmentography with the masses m/e 112, 123, 134, 148, 169, 257, 321 and 189, 191, 223, 233, 235, 245, 287, 297. The identity of positive signals in the reconstructed mass fragmentograms is established by a comparison of the entire mass spectra with those of standards. The mass fragmentograms and the underlying mass spectra are documented.

[Treatment of functional ileus: adrenergic blockade and stimulation (author's transl)]. / Behandlung funktioneller Ileusformen: Sympathikolyse und Stimulation.

Intestinal stimulation is among the basic therapeutic procedures in functional ileus. But the majority of cases of functional ileus is due not to paralysis but to adrenergic inhibition. Thus the primary treatment should not be to stimulate but to act against the inhibition. In over 100 patients a combined treatment schedule consisted of primary adrenergic blockade (trifluperidol, dihydroergotamine or chlorpromazine) followed by low doses of stimulants (ceruletide, neostigmine). 52 patients who had not responded to high doses of peristalsis-stimulating drugs acted as their own controls: in 48 of them intestinal function was restored by sympathicolysis. If indications and application are properly observed the method has a low risk and provides effective treatment of functional ileus, especially in cases resistant to other forms of treatment.

Analysis of the mechanism of the protective activity of some sympathomimetic amines in experimental ulcers.

Apomorphine administered in reserpine-induced as well as in restraint ulcers in rats, failed to afford protection. Pimozide, moperone, trifluperidol and chlorpromazine fail to influence the development of the experimental ulcers. Pimozide and moperone although antagonizing the behavioral changes of amphetamine, maintained its antiulcer activity. Amitryptiline, cocaine and morphine had a protective activity. L-Dopa afforded a significant protection which was abolished if this compound was administered together with FLA-63, a specific dopamine-beta-hydroxilase inhibitor. These results were explained by admitting that not dopamine, but noradrenaline was responsible for the antiulcer activity. alpha-Methyl-dopa produced a significant protection in both experimental models.

Implications of phenothiazine side effects: a study of antiparkinsonian agents in an older population.

A study of anti-Parkinsonism agents in prolonged phenothiazine therapy seeks to clarify some anecdotal misconceptions. Antiparkinsonian agents do not appear to affect the therapeutic efficiency of phenothiazines, nor does using them on a "demand" basis increase the problems of control of parkinsonian side effects. Older patients, however, appear to require the extended usage of antiparkinsonian agents rather more than some studies would suggest. Sustained release antiparkinsonian agents may yet further simplify the management of schizophrenia.