Patterns of illicit drug use in the Army.

The authors collected detailed histories of illicit drug use in the Army in individual interviews with a stratified random sample of 262 enlisted men at six military posts across the United States. Approximately half of the sample (N equals 128) were classified as drug users; 90 of these individuals were identified as career multiple-drug users. Most of these subjects used a variety of drugs in frequently changing patterns. The authors emphasize the individualistic nature of drug use and question the appropriateness of an addiction model for most users of illicit drugs.

Acute necrotizing myopathy of intensive care: electrophysiological studies.

A series of recent reports have identified cases of a quadriplegic myopathy characterized by myofiber necrosis and loss of myosin filaments associated with the use of nondepolarizing muscle blocking agents and glucocorticoids. We report electrophysiological findings in 7 intensive care unit patients who developed evidence of an acute myopathy in association with the use of nondepolarizing muscle blocking agents. Several important features were identified: (i) a neuromuscular transmission deficit was observed in 3 patients up to 7 days following withdrawal of vecuronium; (ii) motor M potentials were of low amplitude, there was mild abnormal spontaneous activity on needle electromyography, and sensory conduction was relatively preserved; (iii) not all patients received glucocorticoids or were asthmatic; (iv) 2 patients given vecuronium had very high creatine kinase levels and developed acute renal failure associated with myoglobinuria; and (v) rises in motor M potentials accompanied clinical recovery. This complication of intensive care may be severe, but is reversible and possibly avoidable. Our findings implicate nondepolarizing muscle blocking agents in the development of the myopathy. Electrophysiological studies provide important prognostic guidance.