Catecholamine metabolism during heroin use.

The authors examined urinary levels of catecholamines and metabolites during a 10-day period of heroin use in 9 subjects. Catecholamine and metabolite excretion increased over baseline values on the first day of heroin use, but markedly different patterns of change emerged later. In contrast to the significant increase in normetanephrine and decrease in metanephrine excretion in all 9 subjects during heroin use, only 4 subjects showed an increase in 3-methoxy-4-hydroxyphenyl glycol (MHPG) excretion. Moreover, it appeared that the increase in MHPG excretion in this subgroup began on the day before heroin administration, which suggests the possibility of an anticipatory or conditioned response.

MHPG as a predictor of antidepressant response to imipramine and maprotiline.

To explore the hypothesis that depressed patients with low pretreatment levels of urinary 3-methoxy-4-hydroxyphenylglycol (MHPG) respond more favorably to antidepressant drugs which act on noradrenergic neuronal systems than do patients with high MHPG levels, the authors administered 150--200 mg/day of imipramine or maprotiline to 13 depressed patients. All of the 5 patients with low pretreatment MHPG levels responded to treatment compared with 1 of the 14 patients with high MHPG levels; 4 patients dropped out of the study.

Opiates, catecholamines, behavior, and mood.

Indirect evidence has linked opioid reinforcement with changes in noradrenergic metabolism secondary to drug administration. Methodological precedents for biobehavioral correlations in depressive illness have suggested an important association between changes in mood and biogenic amine excretion patterns in the urines of patients during depression and recovery. This paper presents preliminary data on the possible relationship between changes in catecholamine excretion that were observed and the changes in behavior, mood, psychiatric status, and cardiorespiratory physiology secondary to heroin administration and methadone-assisted withdrawal. This study focuses on the urinary excretion of MHPG, since an appreciable fraction of this metabolite is probably derived from norepinephrine originating in the brain. The subjective changes in mood associated with heroin use, the decrease in respiratory rate, and the behavioral and mental status effects associated with opiate intoxication were observed only in the individuals whose MHPG excretion increased during the period of opiate administration.

New fee schedule tests staff skills. The Health Care Group.

The Medicare Fee Schedule (MFS) picture is quite incomplete, with myriad details unsettled. But one thing is clear: the shift to a new reimbursement system is loaded with significant practice management implications and challenges. Now, before the MFS is implemented, physicians should evaluate their management operations and business systems, to meet the challenges ahead. Most physicians understand that practice viability will depend on increasing their patient base and the scope of services delivered to non-Medicare patients. Yet many do not understand the marketing and management challenges implied in such growth. The issues are these: how can a practice attract more non-Medicare patients? And how can such growth be accommodated without disproportionately increasing costs or inconveniencing patients and staff?

[Metabolic behavior and utilization of parenterally administered carbohydrates in the postoperative phase]. / Stoffwechselverhalten und Verwertung parenteral zugeführter Kohlenhydrate in der postoperativen Phase

60 patients who had to undergo the same operation were subdivided at random into five groups. Each group obtained in respect to the part of carbohydrates a different infusion solution (5% glucose, 5% fructose, 5% xylitol, 5% xylitol-glucose-fructose, 5% sorbitol) with an always constant part of electrolytes, the dosage of which was 60 ml/kg body weight on the day of operation and 40 ml/kg body weight during the first 3 postoperative days being continuously distributed over 24 hours. From the day before the operation until the third postoperative day the effects on metabolic parameters (lactate, uric acid, blood glucose and others) as well as the utilization of the different energy carriers were investigated. While after a glucose infusion, due to a reduced utilization, no change of the lactate level could be proved in the postoperative phase, the effect of fructose on the lactate concentration was most evident. The administration of xylitol was followed by a small increase of the serum uric acid on the first and second postoperative day, whereas in the other groups its decrease could be proved - there was no change after the administration of sorbitol. The highest blood glucose levels were found in the group to which glucose and the three-part solution of xylitol-glucose-fructose were administered. About the utilization of the different energy carriers only a limited information could be given. Altogether the results allow the conclusion that a combination of xylitol, glucose, and fructose or alternatively sorbitol can be considered the most favourable carbohydrates for preparing an isotonic base electrolyte solution.

Determination of urinary normetanephrine and metanephrine by radial-compression liquid chromatography and electrochemical detection.

A procedure has been developed for determining the O-methylated catecholamine metabolites, normetanephrine and metanephrine, in urine by use of radial-compression liquid chromatography followed by electrochemical detection. Normetanephrine and metanephrine are isolated from hydrolyzed urine by ion-exchange on small, commercially available, disposable columns and preconcentrated by solvent extraction. They are then separated by reversed-phase ion-pair chromatography, with use of a radial compression cartridge and radial compression module, and quantified with 3-methoxy-4-hydroxybenzylamine as internal standard. Normetanephrine, metanephrine, and the internal standard are separated from interfering peaks in about 15 min. The method is applicable to the relatively low amounts of normetanephrine (100-600 micrograms/24 h) and metanephrine (50-400 micrograms/24 h) found in normal subjects and patients with depressive disorders or hypertension. Within-day CVs ranged from 1.1 to 2.2% for normetanephrine and 1.2 to 6.9% for metanephrine; the corresponding between-day CVs were 4.9 and 5.7% over these ranges.

The effects of heroin on catecholamine metabolism in man.

In a study of the effects of heroin administration in nine human subjects, urinary catecholamines and metabolites were examined during an initial drug-free baseline period, a ten-day period of heroin administration and a subsequent period of methadone detoxification. All catecholamines and metabolites tended to be increased over baseline values on the first day of heroin administration. However, markedly different patterns of change emerged on subsequent days of heroin administration. Norepinephrine and normetanephrine remained increased throughout heroin administration. Epinephrine was increased during the early phase of heroin administration but returned to baseline values during the latter phase of heroin administration. After the increase on the first day of heroin administration, metanephrine decreased and substantial decrements below baseline values occurred during the latter phase of heroin administration. After increasing on the first day of heroin administration, 3-methoxy-4-hydroxy-mandelic acid (VMA) returned to approximately baseline values. During heroin administration, an increase in 3-methoxy-4-hydroxyphenylglycol (MHPG) excretion was observed in a subgroup of four of the nine subjects studied. This is in contrast to the increase in normetanephrine excretion and the decrease in metanephrine excretion that was observed in the entire group of nine subjects. It is conceivable that persistance of, or development of, tolerance might account for the failure to observe an increase in MHPG excretion in all of the subjects. It appeared as if the increase in MHPG excretion began on the day prior to the administration of heroin in the subgroup of patients with increased MHPG excretion during heroin administration, suggesting the possibility of an anticipatory or conditioned response, with the anticipation of heroin producing an increase in MHPG excretion.