Heavy drinking and its correlates in young men.

This study examined the drinking behavior of a sample of 98 college men and the relationship to drinking of a variety of subject variables. The subjects reported drinking an average of nearly eight days a month, about five drinks each time, and were intoxicated more than three times monthly. Nearly half reported having experienced two or more drinking-related adverse consequences within the past year and over a third were intoxicated four or more times monthly. Forty percent of the subjects could be described as problem drinkers. Illicit drug use and the disinhibition factor of the sensation seeking scale were the most consistent correlates of drinking behavior and its adverse consequences, although belonging to a fraternity, consuming alcohol/drugs before age 15, the Macandrew Alcoholism Scale score, and a family member having received alcoholism treatment were also found to be consistently associated with drinking in the subjects. Sociodemographic characteristics, physical health, mental health treatment, childhood behavior problems, adolescent antisocial behavior, and familial alcoholism were by and large not found to be related to drinking behavior. A stepwise multiple regression analysis revealed that five variables accounted for 51% of the total variance in drinking behavior. The significant predictors included a heavy drug use factor, a smoking factor, fraternity membership, drug/alcohol use before age 15, and having a family member who had received alcoholism treatment. Thus, four of the five significant predictor variables were reflective of drug use in the subject or his family. The findings underline the need for further prospective longitudinal research to understand the origins of problem drinking and its relationship to alcoholism.

The detection of alcoholism in hospitalized schizophrenics: a comparison of the MAST and the MAC.

The Michigan Alcoholism Screening Test (MAST) and the MacAndrew Alcoholism Scale (MAC) were administered to forty-one schizophrenic inpatients also meeting DSM-III criteria for either alcohol abuse or alcohol dependence and 29 schizophrenic inpatients who did not qualify for an additional substance abuse diagnosis other than marijuana abuse/dependence. The MAC failed to differentiate between the alcoholic and nonalcoholic groups and both groups scored above the recommended cutting score. The MAST significantly differentiated the alcoholic and nonalcoholic schizophrenic patients and was as sensitive to a history of alcohol abuse as to alcohol dependence. Neither the MAST nor MAC was sensitive to recent versus more remote drinking. The overall classificatory accuracy of the MAST was found to be 80% and that of the MAC was 56%. A logistic regression analysis revealed that the use of just four MAST items can yield a group classificatory rate of 83%. It was concluded that the MAST exhibited sufficient sensitivity and specificity to be used as an initial screening instrument for alcoholism in schizophrenic patients.

Total hip arthroplasty using two different cementless tapered stems.

The authors report their 15-year experience with primary total hip arthroplasty using collarless, tapered, porous-coated femoral stems (Trilock and Taperloc) in patients with osteoarthritis, rheumatoid arthritis, and in octogenarians. Excellent clinical results were achieved in all groups at latest followup. For the patients with Trilock stems, Taperloc stems, and patients who were octogenarians and patients with rheumatoid arthritis, Charnley pain scores were 5.6, 5.5, 5.7, and 5.7; Charnley function scores were 5.2, 5.1, 4.2, and 5.3; Harris hip scores were 92, 92, 82, and 93 points, respectively. There was a 2% rate of thigh pain with the Trilock, 4% with Taperloc, 4% in octogenarians, and 2% in patients with rheumatoid arthritis. In 96% of the patients in the Trilock group, in 100% of the patients in the Taperloc group, in 100% of the patients who were octogenarians, and in 100% of the patients with rheumatoid arthritis, femoral components showed radiographic evidence of bone ingrowth. There were six (12%) femoral component revisions in the Trilock group (all secondary to nonmodularity of the component at the time of acetabular revision), one femoral component revision in the Taperloc group and no femoral component revisions in the patients who were octogenarians or who had rheumatoid arthritis. Design features (collarless tapered wedge fit, circumferentially porous-coated) virtually ensure bone ingrowth and are thought to be responsible for the excellent clinical results and longevity.

Heterotopic ossification. Incidence in cemented versus cementless total hip arthroplasty.

To resolve the debate whether cementless total hip arthroplasty (THA) carries an increased risk of heterotopic ossification (HO) as compared with cemented THA, 100 patients undergoing primary cemented THA (both acetabulum and femur) were individually matched to 100 patients undergoing primary cementless THA. Preoperative, 6-week postoperative, and 2-year postoperative radiographs were reviewed for the presence of HO using the Brooker classification. No subject in either group received any postoperative prophylaxis for HO. The matching parameters were age ( +/- 10 years), sex, weight ( +/- 10 lb.), diagnosis (all were osteoarthritis), Charnley class (A/B), and surgical approach (trochanteric osteotomy or modified Hardinge). The overall incidence of HO was 68% in the cemented group and 65% in the cementless group. The extent of HO (grade III) was significant in 9% of the cemented group and 5% of the cementless group. There was no grade IV HO (bone ankylosis) in either group. Neither the overall incidence nor the incidence of grade III HO was statistically different between the two groups. Patient sex and surgical approach had no interactive effect with type of component fixation on the incidence of HO. Fear of HO should not be a factor in the choice of fixation for THA.

Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome.

We compared the effectiveness, safety, and costs of outpatient (n = 87) and inpatient (n = 77) detoxification from alcohol in a randomized, prospective trial involving 164 male veterans of low socioeconomic status. The outpatients were evaluated medically and psychiatrically and then were prescribed decreasing doses of oxazepam on the basis of daily clinic visits. The inpatient program combined comprehensive psychiatric and medical evaluation, detoxification with oxazepam, and the initiation of rehabilitation treatment. The mean duration of treatment was significantly shorter for outpatients (6.5 days) than for inpatients (9.2 days). On the other hand, significantly more inpatients (95 percent) than outpatient (72 percent) completed detoxification. There were no serious medical complications in either group. Outcome evaluations completed at one and six months for 93 and 85 percent of the patients, respectively, showed substantial improvement in both groups at both follow-up periods. At one month there were fewer alcohol-related problems among inpatients and fewer medical problems among outpatients. However, no group differences were found at the six-month follow-up, nor were differences found in the subsequent use of other alcoholism-treatment services. Costs were substantially greater for inpatients ($3,319 to $3,665 per patient) than for outpatients ($175 to $388). We conclude that outpatient medical detoxification is an effective, safe, and low-cost treatment for patients with mid-to-moderate symptoms of alcohol withdrawal.