Risk of anaphylaxis in opioid dependent persons: effects of heroin versus substitution substance.

BACKGROUND: Across Europe, illicit drug-related mortality has not declined despite ever increasing prevention measures. The cause of these deaths has traditionally been associated with overdose. Previous findings have revealed the appearance of non-lethal opioid concentrations, leading us to investigate a further cause of death. The symptoms of heroin intoxication with asphyxia and/or cardiovascular involvement resemble anaphylaxis, and therefore it has been speculated that such deaths might be caused by an allergic reaction. The study´s aims were to investigate levels of allergic mediators in long-term injecting drug users (IDU) compared to healthy controls and to determine if oral opioid substitution therapy (OST) resulted in similar allergic symptoms to those reported by IDU after intravenous (IV) heroin use. METHODS: We quantified the concentrations of histamine, diamine oxidase (DAO), tryptase and lipoprotein-associated phospholipase A2 (LpPLA2) at baseline and 1 h after administration of Substitol®retard (482 ± 220 mg) in 56 patients at a withdrawal centre (Austria) and compared them with healthy controls (n = 103). Questionnaires and face-to-face interviews were used to assess allergic symptoms and side effects in IDU. Descriptive statistical analyses of quantitative data were performed by using SPSS. RESULTS: Baseline histamine, tryptase and LpPLA2 were significantly elevated in IDU compared to the healthy control group, while DAO decreased. Blood levels showed no significant change after oral substitution uptake. Self-reported allergic symptoms and side effects after IV heroin use were reported in 55 cases (98.2%), minimal symptoms were documented after OST (12.5%, 7/56). CONCLUSIONS: This study revealed that baseline histamine concentrations were elevated in chronic IDU, although only relatively small changes in tryptase plasma levels occurred. After IV heroin application the reported allergic symptoms were mostly mild and did not lead to clinically relevant side effects. The substitution substance was clearly better tolerated than IV administered heroin. Elevated levels of allergic mediators such as histamine in IDUs may place them at greater risk of severe or fatal anaphylaxis when exposed to heroin; however, this requires further investigation.

Correlation of grading and duration of periventricular echodensities with neurodevelopmental outcome in preterm infants.

BACKGROUND: Transient periventricular echodensities (PVE) in preterm infants affect neurodevelopmental outcome. OBJECTIVE: To correlate the duration and grading of PVE with neurodevelopmental outcome. MATERIALS AND METHODS: A retrospective, single-centre cohort study of infants with PVE diagnosed by ultrasonography from 1995 to 2000 with blinded grading and recognition of duration of PVE. RESULTS: A total of 72 infants (median gestational age 32 weeks, median birth weight 1,668 g) were diagnosed as having PVE. Minor neurological abnormalities were diagnosed in seven (10%), cerebral palsy in six (8%), developmental delay in seven (10%), and mild mental retardation in two (3%) of the infants. Differences regarding adverse outcome were not significant between infants with severity grade 1 compared to severity grade 2 (16% and 22%, respectively). There was a significant increase in adverse neurodevelopmental outcome with increasing duration of PVE. Of 33 infants with duration of PVE<7 days, 1 (3%) had an adverse neurodevelopmental outcome, compared to 6 (24%) of 25 infants with a duration of PVE of 7-14 days, and 6 (43%) of 14 infants with a duration of PVE>14 days (P<0.002, RR 7.920, 95% CI 1.017-61.661; P<0.001, RR 14.143, 95% CI 1.871-106.895, respectively). CONCLUSION: The duration, but not the grading, of transient PVE was significantly correlated with neurodevelopmental outcome.

Minor neurological dysfunction, cognitive development and somatic development at the age of 3 to 11 years in very-low-birthweight infants with transient periventricular echodensities.

AIM: To determine, using strict exclusion criteria, whether transient periventricular echodensities (TPE) in very-low-birthweight infants lead to minor neurological dysfunction and problems in cognitive and somatic development in children without major neurological impairments. METHODS: 23 children with TPE were matched to 23 children without TPE. Exclusion criteria were small for gestational age, microcephaly at birth, diplegia, asphyxia, psychomotor retardation, intraventricular haemorrhage grade III/IV, major surgical interventions and malformations. The Kaufman Assessment Battery for Children, Draw-a-Man Test and neuropaediatric examination were used for evaluation. RESULTS: There were no differences in demographic data, growth and socio-economic status. Significant differences with lower results in the TPE group were found in fine motor skills and in the Draw-a-Man Test. In the Kaufman Assessment Battery for Children, all subscales were below average in the TPE group, except the sequential processing scale. In the control group, all subscales were within the average range. CONCLUSION: By using strict exclusion criteria to eliminate other risk factors for minimal neurological dysfunction and poor cognitive development, we were able to focus on the effect of TPE. TPE seem to affect cognitive development and cause minor neurological dysfunction.

[Etiologies of cerebral palsy and classical treatment possibilities]. / Ursachen der Zerebralparese und klassische Behandlungsmöglichkeiten.

Cerebral palsy is a non-progressive disorder of the developing brain with different etiologies in the pre-, peri- or postnatal period. The most important of these diseases is cystic periventricular leukomalacia (PVL), followed by intra- and periventricular hemorrhage, hypoxic-ischemic encephalopathy, vascular disorders, infections or brain malformations. The underlying cause is always a damage of the first motor neuron. Prevalence of cerebral palsy in Europe is 2-3 per 1000 live births with a broad spectrum in different birth weight groups. Our own data concerning only pre-term infants in the NICU with birth weight below 1500 g (VLBW) are between 10%-20%. Established classical treatment methods include physiotherapy (Bobath, Vojta, Hippotherapy), methods of speech and occupational therapists (Castillo-Morales, Sensory Integration) and other therapeutical concepts (Petö, Affolter, Frostig).

[Cerebral hemorrhage in term newborn infants--an analysis of 10 years (1989-1999)]. / Hirnblutung beim reifen Neugeborenen--eine Analyse von 10 Jahren (1989-1999).

About 1 out of 100 full term born infants develops intracranial hemorrhage. The study represents an analysis of intracranial hemorrhage over a ten-years period. Diagnosis was based on ultrasound scan. A division into five major bleeding types was done according to the location of the hemorrhage. The neurological outcome was reviewed. Patients were classified into three groups according to their neurological outcome: normal neurological development, mild neurological impairment, and severe neurological impairment. Between 1989-1999, 2019 full-term newborn infants were treated at the neonatal intensive care unit in Graz. 54 of them (2.7%) developed intracranial hemorrhage, of whom 13 (24%) suffered from subdural hemorrhage, 1 (2%) from primary subarachnoid hemorrhage, 14 (26%) from hemorrhage within the choroid plexus, 6 (11%) from intraventricular hemorrhage grade I (IVH I), 11 (20%) from intra- and periventricular hemorrhage (IVH III/PVH), 6 (11%) from hemorrhage within the basal ganglia, and 3 (6%) from intracerebellar hemorrhage. Considering the neurological outcome, 34 (63%) were diagnosed as being developed normally, 15 (28%) developed any neurological impairment, 3 (5%) died, whereas 2 (4%) did not participate our follow up program.