The contribution of cannabis use to the increased psychosis risk among minority ethnic groups in Europe.

BACKGROUND: We examined whether cannabis use contributes to the increased risk of psychotic disorder for non-western minorities in Europe. METHODS: We used data from the EU-GEI study (collected at sites in Spain, Italy, France, the United Kingdom, and the Netherlands) on 825 first-episode patients and 1026 controls. We estimated the odds ratio (OR) of psychotic disorder for several groups of migrants compared with the local reference population, without and with adjustment for measures of cannabis use. RESULTS: The OR of psychotic disorder for non-western minorities, adjusted for age, sex, and recruitment area, was 1.80 (95% CI 1.39-2.33). Further adjustment of this OR for frequency of cannabis use had a minimal effect: OR = 1.81 (95% CI 1.38-2.37). The same applied to adjustment for frequency of use of high-potency cannabis. Likewise, adjustments of ORs for most sub-groups of non-western countries had a minimal effect. There were two exceptions. For the Black Caribbean group in London, after adjustment for frequency of use of high-potency cannabis the OR decreased from 2.45 (95% CI 1.25-4.79) to 1.61 (95% CI 0.74-3.51). Similarly, the OR for Surinamese and Dutch Antillean individuals in Amsterdam decreased after adjustment for daily use: from 2.57 (95% CI 1.07-6.15) to 1.67 (95% CI 0.62-4.53). CONCLUSIONS: The contribution of cannabis use to the excess risk of psychotic disorder for non-western minorities was small. However, some evidence of an effect was found for people of Black Caribbean heritage in London and for those of Surinamese and Dutch Antillean heritage in Amsterdam.

Pharmacotherapy for cocaine-abusing methadone-maintained patients using amantadine or desipramine.

In a double-blind, placebo-controlled 12-week randomized clinical trial, we compared amantadine hydrochloride (300 mg/d; n = 33), desipramine hydrochloride (150 mg/d; n = 30), and placebo (n = 31) in the treatment of cocaine-abusing methadone-maintained patients. Treatment retention and medication compliance were excellent, with more than 75% of the patients completing the full 12-week trial. Although reported cocaine abuse was significantly lower in the medicated groups compared with the placebo group at week 4, this difference became nonsignificant at week 8, and no difference was found in cocaine-free urine samples. Future studies of amantadine and desipramine treatment in these patients should consider alternatives to methadone hydrochloride, such as buprenorphine hydrochloride, and the selection of more homogeneous patient subgroups, such as depressed cocaine abusers.

Effects of the 5-HT3 antagonist, ondansetron, on the behavioral and physiological effects of pentagastrin in patients with panic disorder and social phobia.

Pentagastrin, a cholecystokinin (CCK) agonist, produces anxiety and panic in patients with panic disorder and social phobia. Preclinical data suggests that pentagastrin-induced anxiogenesis may be mediated via 5-HT3 receptors. In the present study, 14 patients with panic disorder or social phobia underwent pharmacological challenge in three conditions: (1) pretreatment with saline followed by pentagastrin infusion; (2) pretreatment with ondansetron followed by pentagastrin infusion; and (3) pretreatment with saline followed by saline infusion. As expected, pentagastrin administration led to increased anxiety, physical symptoms of panic attacks, pulse, plasma adrenocorticotropic hormone (ACTH), and cortisol. Pentagastrin's behavioral effects were not blocked by ondansetron, and in fact, tended to be exaggerated. Ondansetron pretreatment did not alter the pentagastrin-induced cortisol increase but significantly prolonged the pentagastrin-induced increase in ACTH. These findings suggest that pentagastrin's behavioral effects are not mediated by 5HT3 receptors. Mechanisms by which peripherally administered CCK agonists lead to anxiety remain to be elucidated.

Linkage of autosomal dominant radial drusen (malattia leventinese) to chromosome 2p16-21.

OBJECTIVE: To identify the chromosomal location of the gene involved in the pathogenesis of autosomal dominant radial drusen (malattia leventinese). PATIENTS: Eighty-six members of four families affected with radial drusen; one family of American origin and three families of Swiss origin. METHODS: Family members were clinically examined for the presence of radial drusen. Affected patients and potentially informative spouses were genotyped with short tandem repeat polymorphisms distributed across the autosomal genome. The clinical and genotypic data were subjected to linkage analysis. RESULTS: Fifty-six patients were found to be clinically affected. Significant linkage was observed between the disease phenotype and markers known to lie on the short arm of chromosome 2. The maximum two-point lod score (Zmax) observed for all four families combined was 10.5 and was obtained with marker D2S378. Multipoint analysis yielded a Zmax of 12, centered on marker D2S378. The lod-1 confidence interval was 8 cM, while the disease interval defined by observed recombinants was 14 cM. CONCLUSIONS: The gene responsible for autosomal dominant radial drusen has been mapped to the short arm of chromosome 2. This is an important step toward actually isolating the disease-causing gene. In addition, this information can be used to evaluate other familial drusen phenotypes such as Doyne's macular dystrophy for a possible allelic relationship.

Idiopathic macular holes.

We monitored 132 patients (148 eyes) with idiopathic, full-thickness macular holes for a mean of 52 months. Ninety-six of the patients were women and 61 were in their 60s. The initial sizes of the macular holes correlated highly with initial visual acuity (P less than .0001). Although most macular holes enlarged during the study, long-term visual acuity was stable. Although these patients had a significantly (P less than .05) higher prevalence of cardiovascular disease, the incidences of hysterectomies and estrogen supplements were not unusually high. Seventy-one patients had some type of pigment epithelial disease (P less than .05).

Vitrectomy surgery in proliferative sickle retinopathy.

Visual loss secondary to vitreous hemorrhage or retinal detachment can occur in proliferative sickle retinopathy. Severe complications including a high incidence of anterior segment necrosis have been reported in both vitrectomy and scleral buckling operations in patients with this disease. We examined four patients with longstanding vitreous hemorrhages or retinal detachments that were treated successfully with standard vitrectomy surgery techniques or scleral buckling procedures without serious complications.

Retinal and choroidal vascular occlusion secondary to corticosteroid embolisation.

We report a case of visual loss following intranasal injection of triamcinolone acetonide and phenylephrine hydrochloride in a 22-year-old female with chronic sinusitis. Clinical examination and fluorescein angiography revealed vascular occlusions which involved multiple small branches of both the choroidal and retinal circulations. The mechanism of such a complication probably involves inadvertent intra-arterial injection into the anterior or the posterior ethmoidal artery, with retrograde flow into the opthalmic arterial system. Precautions can be taken to avoid such complications.

Aboriginal philosophy and its impact on health care outcomes.

Philosophical perspective is an important factor influencing the health and health care outcomes of Aboriginal Australians. To date, the nature of the Aboriginal perspective and its differences from mainstream European thinking have been poorly understood. The negative impact that this has on the health and health care of Aboriginal people has been seriously neglected. We outline some of the important features of the philosophical perspective of Aboriginal Australians. We suggest ways in which the recognition of these views can inform changes in treatment settings and methods that can contribute to improvements in the health care outcomes of Aboriginal Australians.

Subretinal neovascularization in systemic lupus erythematosus.

Choroidal involvement in systemic lupus erythematosus (SLE) occurs infrequently. We describe a patient with unusual manifestations of lupus oculopathy: prominent choroidal vasculopathy associated with multiple chorioretinal scars and subretinal neovascularization in the macular area. Choroidal disease was the primary feature of ocular involvement. SLE should be considered in the differential diagnosis in patients with inflammatory choroidal lesions.

The complication of pneumatic retinopexy.

There have been 26 published series with a total of 1274 detachments operated with pneumatic retinopexy. Eighty percent were reattached with a single procedure and 98% with reoperations. New breaks occurred in 13% and PVR in 4%. The complications published in 101 papers on pneumatic retinopexy in the last 5 years are analyzed as to frequency, prevention, management, and results.

Limited choroidal hemorrhage mistaken for a choroidal melanoma.

Considerable progress has been made during the last few years in evaluating patients with suspected choroidal melanomas but difficulties continue to persist. In this report, the authors describe three cases with an unusual localized posterior choroidal hemorrhage, which were thought to be choroidal melanomas and referred for proton beam irradiation. These limited hemorrhagic choroidal detachments presented as a dark brown mass of considerable elevation, but were discrete, well localized, and located posterior to the equator. Fluorescein angiography and ultrasonography may be of some value in differentiating these lesions from choroidal melanomas. Serial observations over time will establish the correct diagnosis.