[Cardiac surgery in severe haemorrhagical diseases]. / Kardiochirurgische Eingriffe bei schweren Blutungsdiathesen.

Cardiovascular diseases are the most common disorder in the developed countries. Invasive cardiological and cardiosurgical techniques are known therapies. Yet, patients with severe hereditary haemorrhagical diseases (haemophilia, rare deficiencies of coagulation factors) have an increased bleeding risk by the use of anticoagulants. Therefore, the treatment of these patients requires a concomitant therapy. This article shows eight patients with a severe bleeding diathesis and cardiosurgical interventions in the years 2006 to 2011. This case report shall demonstrate that an adequate therapy can be accomplished with the help of a good cooperation between haemostaseologists and colleagues of the cardioinvasive/cardiosurgical disciplines.

Inhibition of autonomic storm by epidural anesthesia does not influence cardiac inflammatory response after brain death in rats.

BACKGROUND: After brain death (BD) donors usually experience cardiac dysfunction, which is responsible for a considerable number of unused organs. Causes of this cardiac dysfunction are not fully understood. Some authors argue that autonomic storm with severe hemodynamic instability leads to inflammatory activation and myocardial dysfunction. OBJECTIVES: To investigate the hypothesis that thoracic epidural anesthesia blocks autonomic storm and improves graft condition by reducing the inflammatory response. METHODS: Twenty-eight male Wistar rats (250-350 g) allocated to four groups received saline or bupivacaine via an epidural catheter at various times in relation to brain-death induction. Brain death was induced by a sudden increase in intracranial pressure by rapid inflation of a ballon catheter in the extradural space. Blood gases, electrolytes, and lactate analyses were performed at time zero, and 3 and 6 hours. Blood leukocytes were counted at 0 and 6 hours. After 6 hours of BD, we performed euthanasia to measure vascular adhesion molecule (VCAM)-1, intracellular adhesion molecule (ICAM)-1, interleukin (IL)-1ß, tumor necrosis factor (TNF)-α, Bcl-2 and caspase-3 on cardiac tissue. RESULTS: Thoracic epidural anesthesia was effective to block the autonomic storm with a significant difference in mean arterial pressure between the untreated (saline) and the bupivacaine group before BD (P < .05). However, no significant difference was observed for the expressions of VCAM-1, ICAM-1, TNF-α, IL-1ß, Bcl-2, and caspase-3 (P > .05). CONCLUSION: Autonomic storm did not seem to be responsible for the inflammatory changes associated with BD; thoracic epidural anesthesia did not modify the expression of inflammatory mediators although it effectively blocked the autonomic storm.

A comparison of motives for marijuana and alcohol use among experienced users.

Motivational models suggest that individuals use substances to achieve desired effects. Given different pharmacological effects across drug classes, and variations in social context, one would expect that the motives instigating use differ by drug class. However, commonalties in motives across drugs have also been observed. The purpose of this study was to examine similarities and differences across a common set of motives for alcohol and marijuana among experienced users of both drugs. Participants were 46 college students (21 women) who completed a motives assessment twice, once for marijuana and once for alcohol. All had used each drug 60 or more times in their lifetime. Social motives were more highly endorsed for alcohol than marijuana. Expansion motives were more highly endorsed for marijuana. Enhancement motives were more highly endorsed for marijuana than alcohol among women but not men. Endorsement of coping and conformity motives did not differ across drugs. Experienced users of marijuana and alcohol discriminate between their reasons for using the two drugs. These findings are discussed with regard to the differentiation between and commonalties among substances of abuse.

Severe mental illness and addictions: assessment considerations.

This article provides a selective overview of the empirical literature on substance use assessment for persons with severe mental illness. We organize the review around key questions related to three assessment goals. With regard to screening, we address what screening tools are appropriate for use in psychiatric settings, and what methodological concerns arise regarding their use in these contexts. With regard to diagnosis, we discuss why diagnosing comorbid disorders is difficult and how clinicians can enhance the reliability and validity of their diagnoses. With regard to the related goals of treatment planning and outcome evaluation, we consider what are appropriate outcome measures, and how assessment information can assist in treatment planning. Finally, we outline three promising directions for future research: (a) evaluating the psychometric properties of established substance-related measures in persons with severe mental illness, (b) identifying the conditions under which self-report information is more or less accurate, and (c) improving the population relevance of substance assessment instruments.

Predicting drug use: application of behavioral theories of choice.

The current study sought to test the utility of Herrnstein's (1970) matching law in predicting drug use occurring in the natural environment. Participants were 206 college students. Behavioral allocation was measured across two concurrently available sets of activities: those engaged in while using or under the influence of drugs and/or alcohol (drug related) and those engaged in when drug free. Results from regression analyses indicate that predictions of drug use are improved with the addition of reinforcement received from drug-free activities, which enters the model with a negative coefficient value. The addition of a reinforcement ratio, based on matching law equations, also accounted for unique variance. Results demonstrate the utility of applying behavioral theories of choice to drug use and highlight the importance of viewing behaviors within their broader environmental context.

Drinking motives predict alcohol-related problems in college students.

OBJECTIVE: Drinking motives have frequently been linked to both the quantity of alcohol consumption and the likelihood of negative consequences. For motivational models of drinking to be useful, however, drinking motives must have predictive power independent of other variables typically associated with alcohol-related problems. Thus, this study evaluated the relationship between drinking motives and alcohol-related problems, after first accounting for high-risk alcohol consumption and gender, METHOD: Subjects were 139 male and female (61%) college undergraduates, who completed a battery of self-report questionnaires as part of a course requirement. RESULTS: Using hierarchical regression techniques, we found that the combination of maximum daily quantity and negative reinforcement reasons for drinking accounted for 61% of the variance on a measure of lifetime alcohol-related problems. Contrary to earlier research, neither gender nor positive reinforcement motives were significant predictors in the complete model. Follow-up analyses, conducted separately for negative and positive reinforcement motives, indicated that maximum daily quantity partially mediated the relationships between both types of motives and drinking problems; however, both positive and negative reinforcement motives retained unique predictive power. CONCLUSIONS: Motives operate both indirectly through heavy drinking and directly to account for drinking problems. Results support the utility of motivational models of alcohol use in understanding alcohol-related problems in college students.