Can medical students identify recreational drugs by name?

BACKGROUND: Recreational drug toxicity is a common reason for presentation to the Emergency Department. Knowledge of recreational drug names is important to allow targeted assessment of patients presenting with recreational drug toxicity. AIMS: To assess final year medical student knowledge of proper and street names for recreational drugs. DESIGN: Questionnaire survey of final year medical students attending a revision lecture. METHODS: There were two questionnaires used in this study. The first contained either proper names of recreational drugs or names sounding similar to recreational drugs or licensed pharmaceutical products; students were asked to identify which of these were recreational drugs. The second contained street names of recreational drugs and the students were asked to identify which recreational drug the street name referred to. RESULTS: One hundred and thirty-five students completed the questionnaire 1. The mean total score (+/-SD) of correct answers was 7.15 +/- 2.26 (range 2-13) out of a maximum of 15. One hundred and fifteen students completed questionnaire 2. The mean total score (+/-SD) of correctly identified street names was 11.0 +/- 2.6 (range 0-17) out of a maximum of 24. No individual student was able to correctly identify all the street names for the recreational drugs listed in the survey. CONCLUSION: We have shown that final year medical students have variable knowledge of both the proper and street names of recreational drugs. There is a need for improved education of medical students in the names of recreational drugs and the sources of information available to assist them in identifying what drugs an individual has taken.

Waldenström's macroglobulinemia in young African-American adults.

We have identified five African-American patients with Waldenström's macroglobulinemia (WM) diagnosed at a young age (ages 35, 38, 38, 40, 51; 4 males, 1 female). All had a history of intravenous heroin abuse and four also used cocaine. Their manner of presentation and clinical course were typical. Three of three patients tested for the hepatitis C virus (HCV) were positive and three of three patients tested were HIV negative. The potential relationship between intravenous drug abuse and/or HCV to development of WM in this group of young patients is provocative, especially since a polyclonal increase in serum IgM is commonly seen in chronic intravenous heroin addicts. More recently, the contribution of HCV is being evaluated in lymphoproliferative disorders. Although WM is typically a disease of older people, it should also be considered in the differential in a young patient with a suggestive clinical picture.

Continuous infusion ABDIC therapy for relapsed or refractory Hodgkin's disease.

BACKGROUND: Patients whose Hodgkin's disease is refractory to standard combination chemotherapy usually have a poor prognosis. These patients are generally considered for bone marrow transplantation if the disease is still sensitive to chemotherapy. METHODS: Between May 1988 and January 1992, 19 patients with refractory or relapsed Hodgkin's disease were treated with a regimen of doxorubicin, bleomycin, dacarbazine, lomustine, and prednisone (ABDIC). The ABDIC regimen as modified for continuous infusion by Hagemeister consisted of doxorubicin 25 mg/m2 by continuous infusion daily for 2 days, dacarbazine 200 mg/m2 by continuous infusion daily for 5 days, bleomycin 5 U/m2 intravenously on days 1 and 5, CCNU 40 mg/m2 on day 1, and prednisone 40 mg/m2 daily on days 1-5. Treatment was repeated every 28 days. RESULTS: At the time of treatment, mean age was 30.5 years (range 19-70), and time to ABDIC from initial diagnosis was 5.6 years (range 1-14). The mean number of prior chemotherapy regimens was 2.7 (range 1-5), and three of the patients had had autologous bone marrow transplantation before ABDIC: All patients had earlier received either mechlorethamine, vincristine, procarbazine, and prednisone or a regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine, and 16 had received both. The mean number of ABDIC cycles was 3.9 (range 2-12). Total response rate was 63%, with 10 patients having partial response and 2 having complete response of 12 and 27 months' duration. Seven patients subsequently underwent bone marrow transplantation; two of these are free of disease at 35 and 41 months. The treatment was well tolerated; major toxicities were nausea and bone marrow suppression. CONCLUSION: ABDIC is an active and well tolerated therapy in patients with relapsed or refractory Hodgkin's disease, including those previously treated with ABVD. More importantly, perhaps, ABDIC as cytoreductive therapy followed by bone marrow transplantation offers the possibility of long term disease free survival in this heavily pretreated patient population.

Evidence for clonal disease by magnetic resonance imaging in patients with hypoplastic marrow disorders.

Some patients with hypoplastic marrow disorders, including aplastic anemia (AA), are at risk for clonal evolution to myelodysplastic syndromes (MDS) and leukemia. Magnetic resonance imaging (MRI) of marrow of the spine, pelvis, and femurs was performed in 24 patients with hypoplastic marrow disorders. In 12 patients (three AA, nine MDS) MRI was compatible with the clinical and biopsy diagnoses and served to define the spectrum of marrow patterns in these disorders. In eight patients with hypocellular marrow biopsies and a clinical diagnosis of AA, MRI showed an unexpected inhomogeneous or diffuse cellular pattern. Concurrent or subsequent marrow or cytogenetic studies have led to diagnoses of hypoplastic MDS in seven of these patients. In four patients with prolonged hypoplasia after bone marrow transplantation for lymphoma, a speckled pattern superimposed on a fatty background appeared in serial MRI studies. One case evolved to AML, two developed megaloblastic foci, and one remains hypoplastic at 19 months. This study suggests that MRI is able to detect early clonal disease in patients with AA, and can distinguish AA from hypoplastic MDS.

Successful management of Ph chromosome chronic myelogenous leukemia with leukapheresis during pregnancy.

We report the successful management of a 25 year-old woman diagnosed in the second trimester of her pregnancy with chronic myelogenous leukemia (CML). She was treated with leukapheresis until her delivery at 38 weeks of gestation. The procedure was without significant adverse effects on the patient or the fetus. Following induced vaginal delivery, the patient underwent allogeneic bone marrow transplantation from her HLA-matched brother and is presently disease free 13 months following her transplant.

The value of immunoperoxidase studies in the diagnosis of 2 cases of acute leukaemia.

2 cases of acute leukaemia in which the precise diagnosis was established using the immunoperoxidase technique on particle sections, a method not usually employed for acute leukaemias, are reported. Morphologically and cytochemically these cases were initially diagnosed as acute megakaryoblastic (case 1) and acute monocytic (case 2) leukaemia. Based on the immunoperoxidase studies, these diagnoses were corrected to DiGuglielmo's disease (case 1) and plasma cell leukaemia (case 2).

Hand mirror cell leukemia--immunologic and ultrastructural studies.

Acute lymphoblastic leukemia (ALL) with hand mirror cell (HMC) variant was diagnosed in a 26-year-old black man in May 1978. Hemoglobin was 3.6 g/dl; the platelet count was 19.0 x 10(9)/l; leukocyte count was 8.4 x 10(9)/l with 40% blasts, 66% of which had HMC appearance. Cytochemical studies, terminal deoxynucleotidyl transferase level, and immunologic marker studies indicated a non-T/non-B lymphoblastic origin of the leukemic population. Electron microscopic studies confirmed the hand mirror appearance. Mitochondria were more numerous in these cells compared with other lymphoid cells. Cytogenetic studies showed a 46XY karyotype. Our studies confirmed the previous studies reported by Stass, et al of lymphoblastic origin of HMC leukemia. The patient responded to treatment with vincristine, prednisone and L-asparaginase and went into complete remission. It appears that this morphologic variant of ALL does exist and is not an artifact.

Acute myelofibrosis terminating in an acute lymphoblastic leukemia: a case report.

A patient with acute myelofibrosis developed acute leukemia during the course of her disease. Light microscopic examination showed that the cells were lymphoblasts. The presence of terminal deoxynucleotidyl transferase and T- and B-lymphocyte markers suggested that the malignancy was of immature lymphoid cell origin. Terminal leukemic transformation in some cases of acute myelofibrosis may be of a lymphoid nature and, thus, less toxic chemotherapy could be used with a better prognosis.

Serum copper levels in non-Hodgkin's lymphoma.

Levels of serum copper in 34 patients with adult non-Hodgkin's lymphoma at different phases of the disease have been studied. All of the patients were evaluated with complete blood counts, sedimentation rate, gallium scintigraphy, liver and bone marrow biopsies, lymph node biopsy, and laparoscopy. The level of serum copper was significantly elevated in non-responding or relapsing patients (mean 191.06 micrograms/dl), and correlated with the estimated tumor burden. Serum copper levels within normal range were found in patients in complete remission (mean 114.76 micrograms/dl). Age- and sex-matched normal controls also showed serum copper levels within normal range (mean 112.81 micrograms/dl). It is proposed that serial measurements of serum copper level may be of use in: (1) monitoring the remission status of patients with non-Hodgkin's lymphoma, (2) detecting early relapse of non-Hodgkin's lymphoma, and (3) contrary to previous reports by Hrgovcic et al., the level of serum copper seems to be related to the disease activity of histiocytic lymphoma.

T cell leukemia--lymphoma in young adults.

The clinical, pathologic, immunologic and electron microscopic findings in three cases of young men who had T cell leukemia and lymphoma are presented. The disease in this older age group appears to have the same characteristics as that seen in children. It is an aggressive, rapidly fatal disease with a poor response to the usual chemotherapeutic regimens for acute leukemia or poorly differentiated lymphocytic lymphoma, with which this T cell disorder is frequently grouped. An example of Burkitt's lymphoma in another young man is presented briefly to illustrate the clinical, morphologic and immunologic similarities to and differences from an aggressive B cell lymphoma.

STimulation of granulocytopoiesis by a diffusible factor in vivo.

A millipore diffusion chamber system was used to cultivate mouse marrow in the abdomens of irradiated and unirradiated host mice for 24 hr. When the irradiated hosts were 72, 96, or 120 hr postirradiation, the number of blasts and promyelocytes in the implanted chambers after cultivation was greater than those in the same marrow cultivated in unirradiated hosts. These data indicate that in vivo, there is stimulation of granulocytopoiesis by a diffusible factor or factors.

Leukokinetic studies. XIV. Blood neutrophil kinetics in chronic, steady-state neutropenia.

The kinetics of blood neutrophils was investigated by means of the in vitro radioactive diisopropyl fluorophosphate method in 35 patients with a chronic, steady-state neutropenia. There were 17 patients in whom the half disappearance time of neutrophils was normal. In 10 of these patients, the production of neutrophils was low and in 7, production was normal. In 18 patients the half disappearance time of neutrophilic granulocytes was shorter than normal. The production of neutrophilic granulocytes was low in five of these patients, normal in eight patients, and increased in five. An attempt was made to correlate other laboratory measurements with the kinetic picture, but no relationship was found; the marrow neutrophil reserve as measured by endotoxin or cortisol injection; marrow cellularity on aspiration or biopsy; in vitro-labeling index with (3)HTdR; or serum lysozyme concentration proved of no value in identifying the various kinetic groups. The only finding that seemed to correlate with the kinetic picture was the presence or absence of splenomegaly. In 12 of the 18 patients with a short half disappearance time, splenomegaly was present whereas in 15 of 17 patients with a normal half disappearance time, there was no splenomegaly. Of 20 patients with greater than 1000 neutrophils per mm(3), 17 were found to have a normal total-blood neutrophil pool. Thus these patients, with many of their cells marginated, agree to have a "shift neutropenia."Myelocyte to blood transit time and myelocyte generation time, as measured in seven patients by in vivo labeling with diisopropy fluorophosphate, proved to be essentially normal. Thus, it appears that in chronic neutropenia, increased or decreased production of neutrophils is accomplished by increasing or decreasing early precursor input into the system.