Naltrexone augments the effects of nicotine replacement therapy in female smokers.

BACKGROUND: There is increased recognition that gender differences may influence outcomes and may modify vulnerability to tobacco addiction, severity of course and response to different treatments. We hypothesized that naltrexone, which has been used to successfully treat opioid and alcohol dependence, when combined with nicotine replacement therapy (NRT) and psychosocial therapy (PT) may enhance smoking cessation rates in women. METHODS: Forty-four adult female smokers meeting DSM-IV criteria for nicotine dependence with expired carbon monoxide content of > or = 15 ppm were randomly assigned in a double blind placebo controlled clinical trial of naltrexone 50 mg + NRT patch + psychosocial therapy (N + NRT + PT)(N = 12) or placebo + NRT patch + psychosocial therapy (P + N + PT)(N=12) for 12 weeks. RESULTS: Twelve weeks of treatment was completed by 54.5%. Smoking cessation among females who completed the 12 weeks for N + NRT + PT was 91.7% (11/12) and for P + NRT + PT was 50% (6/12). CONCLUSION: Naltrexone combined with NRT and psychosocial therapy appears to have a positive cessation effect on women and may be a new treatment option for recidivist female smokers.

Occupational exposure and addictions for physicians: case studies and theoretical implications.

Risk of addiction through occupational exposure to drugs of abuse is an important but relatively neglected public health problem. Stress and access may have much less of a role in addiction among certain populations than originally was thought. Risk of addition may be increased dramatically by unintentional exposure in the workplace to potent substances that sensitize the brain. Everyone knows that second-hand inhalation of crack vapors is a very dangerous proposition, but rarely has alarm been raised about exposing anesthesiologists to second-hand fentanyl. Additional studies of the relationship between exposure in the workplace and addiction are necessary. These studies should include biological measures, such as blood levels in exposed workers, and sensitive assays that quantitatively assess levels of exposure in the workplace.

Alcohol-induced performance impairment in heavy episodic and light social drinkers.

OBJECTIVE: The purpose of this study was to examine performance effects of alcohol in young adult heavy drinkers (HDs) and light drinkers (LDs). Prior research has shown that HDs have alterations in subjective alcohol response in comparison with LDs, with greater reported stimulant-like effects and reduced sedative-like effects. It is unclear whether these quantitative differences extend to performance and objective effects. METHOD: Thirty-four subjects participated (20 HDs and 14 LDs) in three early evening individual alcohol challenge sessions. Subjects were examined on eye movement and psychomotor performance tasks before and several times after consuming either 0.8 g/kg or 0.4 g/kg ethanol or placebo beverage. RESULTS: Alcohol produced similar impairment for the groups in psychomotor performance and saccadic velocity measures, with blood alcohol concentration dependent group differences on the smooth pursuit task and a marginally lower threshold for impairment for HDs on the saccadic latency task. Covarying for personality differences (i.e., disinhibition and boredom susceptibility traits) and family history of alcoholism did not significantly alter the findings. CONCLUSIONS: Despite prior findings of differential subjective response to alcohol in HDs and LDs, alcohol-induced performance impairment was comparable between the groups. Our findings suggest HDs may be particularly at risk for alcohol-related consequences because their greater sensitivity to positive alcohol effects and/or tolerance to sedative effects may not be accompanied by a lesser degree of alcohol-induced performance impairment.

Substance abuse may be a risk factor for earlier onset of Huntington disease.

Environmental factors may contribute as much as one-third of the variance in Huntington disease (HD) age of onset. Substance abuse is a risk factor for other neurodegenerative disorders; however, whether substance abuse influences HD age of onset is not well established. This study investigated the relationships between alcohol, drug, and tobacco abuse and HD age of onset in 136 participants with symptomatic HD. CAG repeat length was used as a covariate in all analyses, as it represents the most significant determinant of HD age of onset. The relationship between substance abuse, HD age of onset, and sex was also examined, as women may experience greater medical harm from substance abuse. Lifetime alcohol abuse and lifetime drug abuse were associated with earlier age of HD onset; a similar trend was seen for current tobacco abuse. For women, lifetime alcohol abuse was associated with earlier onset of HD, with a similar trend for lifetime drug abuse. However, alcohol, drug, and tobacco abuse were not significantly associated with age of onset in men. Further work is needed to determine whether substance abuse is a causative risk factor for earlier onset of HD, and why the environmental factors associated with age of onset vary by sex.

Estimating premorbid functioning in huntington's disease: the relationship between disease progression and the wide range achievement test reading subtest.

The estimation of premorbid abilities is an essential part of a neuropsychological evaluation, especially in neurodegenerative conditions. Although word pronunciation tests are one standard method for estimating the premorbid level, research suggests that these tests may not be valid in neurodegenerative diseases. Therefore, the current study sought to examine two estimates of premorbid intellect, the Wide Range Achievement Test (WRAT) Reading subtest and the Barona formula, in 93 patients with mild to moderate Huntington's disease (HD) to determine their utility and to investigate how these measures relate to signs and symptoms of disease progression. In 89% of participants, WRAT estimates were below the Barona estimates. WRAT estimates were related to worsening memory and motor functioning, whereas the Barona estimates had weaker relationships. Neither estimate was related to depression or functional capacity. Irregular word reading tests appear to decline with HD progression, whereas estimation methods based on demographic factors may be more robust but overestimate premorbid functioning.

Diabetic myonecrosis in an orthotopic heart transplant recipient.

Diabetic myonecrosis or muscle infarction (DMI) is a rare cause of lower extremity pain that usually occurs in patients with poorly controlled diabetes. Although most patients recover with opiate analgesics and anti-inflammatory medications, this type of myonecrosis is associated with the presence of serious vascular disease. Consideration of this diagnosis and use of soft-tissue imaging are especially important in diabetic organ transplant recipients to prevent erroneous treatment for presumed infection. We describe what we believe is the first reported case of diabetic myonecrosis occurring in a patient with iatrogenically induced diabetes after orthotopic heart transplantation.

Short-term atorvastatin treatment enhances specific antibody production following tetanus toxoid vaccination in healthy volunteers.

Statins possess anti-inflammatory and immunomodulatory properties beyond their cholesterol-lowering effects. To determine whether short-term atorvastatin treatment affects the acute phase and humoral immune responses to tetanus toxoid (TT) in normal healthy volunteers, we conducted a randomized, double blind, placebo-controlled trial. Twenty healthy volunteers were assigned a 10-day treatment with atorvastatin (40 mg) or placebo. All volunteers received a TT booster on the fifth day. Subjects in the atorvastatin group had a significant reduction in total and low-density lipoprotein cholesterol (both p<0.001). Unexpectedly, the production of anti-TT antibodies (predominately IgG1) was three-fold higher in the atorvastatin group 15 days post-vaccination (2306 +/- 468 versus 713+/-21 units, p = 0.008). Atorvastatin also suppressed the post-vaccination rise in platelet and lymphocyte counts (both p<0.05). Acute phase parameters did not change significantly in either group. This study illustrates a novel immunomodulatory effect of atorvastatin raising the possibility of using HMG-CoA reductase inhibitors to enhance humoral responses to vaccination.