Intellectual and neuropsychological functions in young men with heavy and long-term patterns of drug abuse.

The authors attempted to determine the long-term effects of heavy drug abuse in 87 male prisoners. The sample was divided into the following groups: 1) nondrug users; 2) users of cannabis and hallucinogens; 3) users of cannabis, hallucinogens, and amphetamines; and 4) users of cannabis, hallucinogens, amphetamines, and opiates. Intellectual and neuropsychological tests sensitive to brain dysfunction revealed no intergroup differences. This finding casts some doubt on other reports suggesting that long-term drug abuse results in neuropsychological disorders. However, the authors caution that one should not conclude that no organic changes occurred in their sample.

Focal cerebral hypoperfusion in children with dysphasia and/or attention deficit disorder.

The neural mechanisms involved in learning disorders are largely unknown. We studied three-dimensional regional cerebral blood flow (rCBF) in 13 children with dysphasia and/or attention deficit disorder (ADD), using xenon 133 inhalation and emission computed tomography. The rCBF distribution was abnormal in both hemispheres in all patients, as compared with the mean CBF distribution of nine normal children. Regions of hypoperfusion and, by inference, low metabolic activity were predominantly seen in the periventricular white matter and in border zones between major arterial territories. In patients with dysphasia, parts of both perisylvian regions were hypoperfused, and object-naming tasks failed to produce an increased flow in relevant cortical regions. Patients with different dysphasic syndromes appeared to have different patterns of rCBF. All 11 patients with ADD had hypoperfusion in the white matter of the frontal lobes and seven also in the caudate nuclei region. Methylphenidate hydrochloride increased perfusion in the central region, including the mesencephalon and the basal ganglia, and decreased perfusion of motor and primary sensory cortical areas. The location of hypoperfused structures in cognitive disorders of childhood is consistent with a role for an early hypoxic-ischemic event in their origin.

Striatal dysfunction in attention deficit and hyperkinetic disorder.

We have previously reported that periventricular structures are hypoperfused in attention deficit and hyperactivity disorder (ADHD). This study has expanded the number of patients, who were divided into two groups: six patients with pure ADHD, and 13 patients with ADHD in combination with other neurologic symptoms. By using xenon 133 inhalation and emission tomography, the regional cerebral blood flow distribution was determined and compared with a control group. Striatal regions were found to be hypoperfused and, by inference, hypofunctional in both groups. This hypoperfusion was statistically significant in the right striatum in ADHD, and in both striatal regions in ADHD with other neuropsychologic and neurologic symptoms. The primary sensory and sensorimotor cortical regions were highly perfused. Methylphenidate increased flow to striatal and posterior periventricular regions, and tended to decrease flow to primary sensory regions. Low striatal activity, partially reversible with methylphenidate, appears to be a cardinal feature in ADHD.

Nefazodone and cyclosporine drug-drug interaction.

Depression is a significant post-transplant complication often necessitating drug therapy. Many of the newer selective serotonin reuptake inhibitor (SSRI) antidepressants are metabolized by the same cytochrome P450IIIA isoenzyme system that is responsible for the metabolism of cyclosporine, and these agents pose an interactive risk in transplant patients. We have observed nearly a 10-fold increase in whole blood cyclosporine concentrations in a cardiac transplant patient shortly after the addition of nefazodone antidepressant therapy. We suggest there is a clinically significant drug-drug interaction between nefazodone and cyclosporine due to inhibition of cytochrome P-450 IIIA4 isoenzymes by nefazodone.

Aniracetam tested in chronic psychosyndrome after long-term exposure to organic solvents. A randomized, double-blind, placebo-controlled cross-over study with neuropsychological tests.

In order to examine if the nootropic drug, aniracetam, was capable of improving cognitive performance, 44 subjects suffering from chronic psychosyndrome after long-term exposure to organic solvents were included in a randomized, double-blind, placebo-controlled, cross-over study. The treatment periods were 3 months with aniracetam 1 g daily and 3 months with placebo. Neuropsychological tests as well as a physical and neurological examination were performed at entry into the study and after each treatment period, together with an evaluation of the subjects' overall condition. Neither the doctors' nor the subjects' own assessment of the overall condition indicated that the trial medication had had any effect. No significant changes in neuropsychological symptoms were observed. A statistically significant difference in favour of antiracetam was found in only 1 of the 19 neuropsychological test measures, namely a test for constructional ability. However, in another test on visuo-spatial function, a statistically significant result was found in favour of placebo. Thus, aniracetam was found to be ineffective in the treatment of subjects suffering from chronic psychosyndrome after long-term exposure to organic solvents.

Emergent applications of cardiopulmonary support: a multiinstitutional experience.

The use of emergent portable bypass systems is increasing. Because of limited patient use in any one institution, a combined experience can better determine the applicability of these systems. A total of 187 patients from 17 centers were analyzed. Causes leading to bypass initiation were cardiac arrest (125 patients), cardiogenic shock (44), profound hypothermia (7), pulmonary insufficiency (9), and miscellaneous (2). Weaning from bypass was successful in 30.5% (57 patients). Sixty-four patients (34.2%) were transferred to standard bypass or other modes of circulatory assist. Of the total population, 40 patients (21.4%) were alive greater than 30 days. There were no survivors of unwitnessed arrests. Major diagnostic or therapeutic interventions were carried out on bypass in 74.9% of all patients. In survivors, 77.1% (37/48) had major therapeutic interventions as compared with 50.0% (67/135) of nonsurvivors. Emergency portable bypass systems can successfully resuscitate and support cardiac hemodynamics, although the underlying causes necessitating bypass remain difficult to correct. When corrective intervention can be performed, there is an increased chance of survival. Unwitnessed arrest, prolonged cardiopulmonary resuscitation, and lack of treatment options are relative contraindications. Appropriate patient selection and early application of these systems should lead to improved survival.

Interhospital transport of the patient on extracorporeal cardiopulmonary support.

Portable extracorporeal cardiopulmonary support systems have enhanced the resuscitation and support of moribund patients outside of the operating room environment. The literature documents the successful application of emergency cardiopulmonary support within the hospital setting. Clinicians have reported the use of helicopter and ground ambulance to transport patients requiring intraaortic balloon counterpulsation and fixed-wing transport of neonates requiring extracorporeal membrane oxygenation. As medical transport capabilities extend the sphere of tertiary care to outlying medical facilities, there is a role for extracorporeal cardiopulmonary support in the initial stabilization and safe transport of critically ill patients, via air or ground ambulance. Potentially, the early application of life-sustaining technology can lower mortality and morbidity in patients with a survivable pathology. This is a report on the experience with the resuscitation and interhospital transport of patients on extracorporeal cardiopulmonary support.

Reaction time variability in epileptic and brain-damaged patients.

Median reaction times and intra-individual variability were studied in epileptic (N = 63), brain-damaged (non-epileptic) (N = 25) and control patients (N = 25) using a six and one half minute visual, continuous reaction time task. Epileptic and brain-damaged groups were significantly slower than control patients on median reaction times at the 10th, 50th, and 90th percentiles and on the differences between the 10th and 90th percentiles. Thus both general slowing and greater intra-individual variability were found in the epileptic and brain-damaged patients. Reaction times were not related to presence, type and severity of EEG abnormality or to age of onset of epilepsy. Grand mal patients did have significantly greater variability than other types of seizure patients. Epileptic and brain-damaged patients did not differ significantly on any reaction time variables. Both groups were discriminated significantly from the controls on all reaction time measures, especially on the intra-individual variability measure.

Stillbirth. A humanistic response.

A predictable pattern of grief follows every perinatal death. Because of their lack of training in the area of death and bereavement, physicians have traditionally avoided acknowledging the grief process in patients who have experienced such a loss. Obstetricians must begin to recognize the appropriate intervention that needs to be instituted in the delivery room and postpartum period to help facilitate the normal grieving process. Physicians must also acknowledge and accept their own feelings of grief and helplessness following a perinatal death.

Biocompatible circuits: an adjunct to non-cardiac extracorporeal cardiopulmonary support.

The utilization of cardiopulmonary bypass systems, for circulatory and/or pulmonary support of patients undergoing non-cardiac procedures, has been previously reported. There is, however, a sub-group of patients for whom total systemic anticoagulation for cardiopulmonary support is extremely undesirable or contraindicated altogether, due to the presenting pathology or procedure to be performed. Clinical and experimental reports have suggested that with the use of heparin-bonded bypass circuits, the amount of heparin required for anticoagulation of the patient may be substantially reduced, or eliminated, safely. This allows the resuscitation and/or support of patients in whom bypass would otherwise be contraindicated. We present our clinical experience with heparin-bonded, biocompatible circuits, for support of patients undergoing non-cardiac procedures. In each case, low-dose or no heparin was administered. The group includes patients with trauma related pulmonary insufficiency, pulmonary embolism, hypothermia, neurosurgery, aortic aneurysm, aortic transection, respiratory distress syndrome, pericardiectomy, and cardiogenic shock.

Freeze concentration for enrichment of nutrients in yellow water from no-mix toilets.

Separately collected urine ("yellow water") can be utilized as fertilizer. In order to decrease storage volumes and energy consumption for yellow water transport to fields, enrichment of nutrients in yellow water has to be considered. Laboratory-scale batch freeze concentration of yellow water has been tested in ice-front freezing apparatus: a stirred vessel and a falling film freeze concentrator (coolant temperatures: -6 to -16 degrees C). With progressing enrichment of the liquid concentrate, the frozen ice was increasingly contaminated with yellow water constituents (ammonia, total nitrogen, total phosphorus, TOC, and salts determined as conductivity). The higher the initial salinity of the yellow water and the lower the mechanical agitation of the liquid phase contacting the growing ice front, the more the frozen ice was contaminated. The results indicate, that in ice-front freezing devices multistage processes are necessary, i.e. the melted ice phase has to be purified (and the concentrates must be further enriched) in a second or even in a third stage. Energy consumption of this process is very high. However, technical scale suspension freeze concentration is reasonable in centralized ecological sanitation schemes if the population exceeds 0.5 million and distance of yellow water transportation to fields is more than 80 km.

AIDS and dementia: a quantitative neuropsychological study of unselected Danish patients.

Retrospective studies of hospitalized patients with the acquired immune deficiency syndrome (AIDS) have indicated that dementia occur in the majority of cases. In order to study the occurrence of dementia among AIDS patients, we conducted a controlled study of 16 unselected cases with a battery of neuropsychological tests known to be sensitive to brain damage of various etiologies. Except for fatigue, mental complaints and neuropsychiatric signs of dementia were generally sparse. As a group, the AIDS patients' performance in the neuropsychological tests did not differ from that of matched, healthy controls. Based on analyses of individual test results only one patient performed significantly inferior to what should be expected. The diagnosis of dementia should not be ascribed to AIDS victims on account of non-specific psycho-behavioral deviations that may represent a normal psychologic reaction to the disease, extreme fatigue, or both. Further, frequency measures of dementia in AIDS, based on large, unselected groups and with sufficient control, are still lacking. However, our study indicates that dementia is a less frequent complication of AIDS than so far assumed.

Controlled trial of EMG feedback in muscle contraction headache.

Twenty-eight patients suffering from severe, longstanding muscle contraction headache were randomly assigned to two groups, one receiving electromyographic (EMG) feedback therapy and the other, "most suitable alternative therapy." Headache intensity and severity as well as drug intake were reduced in the feedback group (p less than or equal to 0.01) as opposed to no improvement in the control group. The positive treatment effect in the feedback group persisted through a three-month follow-up period. EMG feedback therapy is effective in the treatment of muscle contraction headache even in its chronic, severe form, which is resistant to traditional treatment methods.

[HLA-antigens in patients with rheumatoid arthritis]. / HLA-Antigene bei Patienten mit Rheumatoid-Arthritis.

109 patients with rheumatoid arthritis (RA) from the north of the GDR were HLA typed and the antigen frequencies compared with those of a control group. Even in our patients the HLA-DR4 association was demonstrable. But in all studies DR4 association is not strong enough for taking HLA typing as a diagnostic test for RA. There was an immunogenetic heterogeneity in correlation to side effects of therapy with sodium aurothiomalate or D-penicillamine. HLA-DR5 was significantly increased in patients with side effects in comparison to patients without side effects in therapy. Before recommending HLA-DR typing for selection of high risk patients in D-penicillamine therapy these results should be proven in a large patient group or in a second study.