Effect of combined substance use on laboratory markers of alcoholism.

This article examines the commonly used laboratory indicators of heavy alcohol use (elevated MCV, GGTP and AST values) in subgroups of drug-using and non-drug-using alcoholic men admitted to an inpatient alcoholism treatment program. A total of 380 consecutive admissions meeting DSM-III diagnostic criteria for alcohol use or dependence were studied. Of these subjects, 75% used both alcohol and drugs. The most frequently used drugs were marijuana, cocaine, amphetamines and tranquilizers. Overall, subjects who used drugs with alcohol had significantly lower MCV and GGTP values than subjects who used alcohol alone. More specifically, cocaine use was associated with lower MCV values, marijuana use with lower AST values and heroin use with higher AST and GGTP values. These differences between drug-using and non-drug-using alcoholics were significant even after controlling for variables that affect the laboratory values such as age, quantity, frequency and duration of alcohol consumption. These findings indicate that any study of laboratory markers of alcoholism needs to consider concomitant illicit drug use patterns.

Three new low-osmolality contrast agents: a comparative study of patient discomfort.

Relative patient discomfort resulting from carotid injections of three new low-osmolality contrast agents was assessed in 78 patients. Omnipaque-300 (iohexol), Isovue-300 (iopamidol), and hexabrix (ioxaglate) were sequentially injected into both common carotid arteries of each patient. Patients were asked to rank the relative intensities of the three injections on each side. Mean patient rankings revealed that Hexabrix was preferred most often, Omnipaque-300 next, and Isovue-300 the least. The differences are statistically significant. We conclude that while patients usually tolerated all intracarotid low-osmolality contrast agents rather well, the agent preferred most often was Hexabrix.

Pulmonary arteriography: comparison of cough stimulation effects of diatrizoate and ioxaglate.

Twenty-five patients were observed in a prospective crossover study to determine whether the new low-osmolality contrast agents would be less prone than conventional agents to produce coughing during pulmonary arteriography. Selective left and right pulmonary arteriography (two views of each side) was performed with alternating administrations of diatrizoate sodium meglumine and ioxaglate sodium meglumine. Twenty-one patients had all four injections while four patients received injections on only one side. Sixteen of 25 patients coughed on at least one injection of diatrizoate, with three of these experiencing explosive coughing. One of 25 patients coughed with ioxaglate, and that was only minimally. This difference is statistically significant (P less than .001, on the basis of McNemar chi 2 test for paired data). When no coughing occurred, the quality of the diatrizoate and ioxaglate radiographs was indistinguishable. We conclude that ioxaglate is useful in pulmonary arteriography because of its lack of cough stimulation.

A cause of right ventricular dysfunction after cardiac operations.

We examined the impact of mediastinal healing on right ventricular performance in three groups of five piglets by performing gated blood pool scans in two planes to determine right ventricular ejection fraction. Animals in Group I then had sternotomy and excision of anterior pericardium. Group II animals had a similar operation plus insertion of a silicone rubber sheet as a pericardial substitute. Group III animals (controls) had no operation. Each group was followed up for 60 days, after which gated blood pool scans were repeated in a manner identical to the initial study. Experimental animals in Groups I and II were then put to death and autopsied. Adhesion formation between the right ventricle and sternum was graded on a 0 to 3 scale. Group I animals showed a significant average decline in right ventricular ejection fraction of 19.2% (p less than 0.02). Group II animals demonstrated an average decrease in ejection fraction, although not significant, of 12.2%. Groups I and II combined showed a significant average loss in ejection fraction of 15.7% (p less than 0.01). Severity of adhesions between the right ventricle and sternum correlated well with loss of right ventricular ejection fraction (p less than 0.01). Group III controls demonstrated no significant change in ejection fraction. Mediastinal healing and fibrous attachment of the right ventricle to the sternum may play a significant role in loss of right ventricular ejection fraction after cardiac operations. Variability in loss of right ventricular ejection fraction is related to intensity of the mediastinal healing process.