[Psychiatric consultation service: a 3-year review].
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Biomedical subjects
Publications and source records attributed to W Greil.
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The pharmacokinetics of lithium is reviewed in regard to the pattern of lithium concentration in plasma, red blood cells, saliva and urine and to a four-compartmental model of lithium distribution. An overview of lithium toxicology is given summarizing the gastrointestinal, cardiovascular, endocrine, hematological, dermatologic, teratogenic and neurological side effects of lithium. The results of two controlled studies are described in detail. The investigation of thyroid function in 88 patients under lithium treatment revealed abnormally high values of TSH and/or of TSH response to TRH in 50% of the subjects. By use of daily protocols of eating and drinking over a period of 14 days, a distinctly higher caloric intake (from solid food, not fluids) was found in 10 patients who gained weight during lithium therapy as compared to 10 lithium-treated patients without weight gain.
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In 62 out-patients under maintenance treatment with lithium, thyroid function was evaluated. 21% of the patients exhibited goiter II0; 34% showed elevated thyrotrophin (TSH) serum levels; in 42% exaggerated TSH response to intravenous thyrotrophin releasing hormone (TRH) was found.
Ten endogenous-depressive patients under lithium maintenance therapy participated in a group behaviour therapy program for the modification of behavioural problems that are typical for this group of patients. The problem intensity as measured individually through a "problem barometer" as well as the score on the Pt-scale of the MMPI were reduced significantly over the ten treatment sessions. Concurrently, patients' self image regarding depressive components and social resonance improved. The effects were still present after a 3-month follow-up period. It is concluded that in lithium treated patients behaviour therapy methods can be used in the modification of typical behaviour disorders.
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By digestion of rat liver nuclei with EndoR HaeIII, EndoR EcoRI, and EndoR Bam and subsequent lysis of the nuclei approx. 90%, 40%, and 45%, respectively, of the chromatin were solubilized. The plateau values of solubilization are in agreement with a model in which the chromatin strands are crosslinked and/or attached to a supporting structure. The distribution of DNA lengths in the soluble and insoluble chromatin fractions were determined. According to digestion experiments with restriction nucleases rat liver DNA contains highly repetitive sequences, some of which are arranged in tandem repeats of 95 and 380 nucleotide pairs, respectively. With EndoR EcoRI chromatin containing the repetitive RNA was preferentially solubilized and, by subsequent sucrose gradient centrifugation, purified to about 90%. The useful properties of chromatin prepared by the specific action of restriction nucleases are discussed.
Li+ net-transfer across cell membranes was studied on human erythrocytes and ghosts preloaded with 1-2 mM Li+ and incubated in saline media of varying composition at initial thermodynamic equilibrium for Li+. The following results were obtained: 1. Li+ is extruded from glycolyzing erythrocytes against an electrochemical gradient until a steady-state Li+ distribution is established after 24-28 h. 2. The initial rate of Li+ extrusion is not altered by ouabain or by reduction of ATP levels to less than 25% of the normal value. 3. Replacement of external Na+ by K+ or choline+ abolishes the establishment of an electrochemical Li+ gradient. 4. The Li+ distribution ratio Lie+/Lii+ increases proportional to the ratio Nae+/Nai+ at constant extravellular K+ concentrations. 5. In ghost suspension an uphill Li+ transport is driven by an oppositely directed Na+ gradient. The direction of the Li+ uphill transport can be reversed by reversing the Na+ gradient. From the results it is concluded that the Li+ uphill transport across human red cell membranes is mediated by a Na+-dependent Li+ counter-transport system. This system is not inhibited by ouabain and does not appear to be identical to the Na+-Na+ exchange system described by Garrahan and Glynn.
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In the course of digestions of rat liver nuclei with micrococcal nuclease the size of the nucleosomal DNA is shortened by 50-60 nucleotide pairs from starting lengths of about 200, 400, 600, 800, etc. nucleotide pairs in the monomeric and oligomeric nucleosomes, respectively. Acid soluble DNA material is created relatively slowly as compared to the rate of formation of subnucleosomal material. More DNA with lengths in between the 200, 400, etc. nucleotide pairs of nucleosomal DNA is formed when digestions with micrococcal nuclease are carried out at 0 to 10 degrees C compared to 40 degrees C. With DNAase II, on the other hand, formation of a 200 nucleotide pair pattern is favoured at the low temperatures. Apparently, the accessibility of potential cleavage sites in between and within nucleosomes depends strongly on the conditions of digestion. Possible reasons for this dependence are discussed.
The use of a new piezoresistive minature accelerometer as part of an electronic measurement system for the direct quantification of human finger tremor in physical units is described. The system was designed to yield digital values for the mean tremor amplitude in a given period of time. Reliability coefficients were computed for a smaple of 34 patients under lithium therapy. Coefficients ranged between 0.75 and 0.94 for test-retest intervals between 30 min and several days. Some of the usual indirect methods for the assessment of tremor showed very low correlations to the true tremor amplitude and seemed to be only of limited usefulness. It was further demonstrated that situational factors play a dominant role independently of the particular method of measurement.
Distribution ratiors of intracellular lithium (Lii) and extracellular Li (Lie) were determined in vitro after incubation of Li-free or Li-loaded red cells in media containing varying Li-concentrations (37 degrees C, pH 7.4). The distribution ratios Lii/Lie obtained in vitro after 24 h of incubation corresponded to those found in vivo. The results indicate that Li can be extruded from red cells against an electrochemical gradient. This Li extrusion is inhibited by replacing extracellular Na+ with K+ or choline+, but is not affected by ouabain or by glucose depletion.