['Ecstasy-light' - not as light as its name suggests: toxic effects of 4-fluoroamphetamine]. / 'Ecstasy-light': niet zo onschuldig als het lijkt.

BACKGROUND: The use of 4-fluoroamphetamine (4-FA) has shown a marked increase, especially because users perceive its effects to be relatively mild. 4-FA is also known as ecstacy-light, but is probably not as light as its name suggests. From April 2017 its use has therefore been forbidden in the Netherlands. CASE DESCRIPTION: In a short time, we saw three patients at our emergency department who had signs of a severe intoxication with 4-FA. A 21-year-old male developed a tonic-clonic seizure, bruxism, mydriasis, and rhabdomyolysis. A 19-year-old female was confused and was longing for death. A 22-year-old male needed to be admitted to intensive care to be intubated, sedated and cooled due to tachycardia, hypertension and hyperthermia. CONCLUSION: Because of its relatively mild effects, 4-FA is gaining in popularity in the Netherlands. However, the use of this designer drug can lead to severe problems such as severe confusion, hyperthermia and tonic-clonic seizures.

beta-Endorphin and cortisol abnormalities in spinal cord-injured individuals.

Plasma beta-endorphin-like immunoreactivity (BEP-ir) and cortisol levels were measured by radioimmunoassay (RIA) in nine patients who were at least 12 months status post spinal cord injury (SCI). Plasma levels were obtained at 8:00 am and 4:00 pm to determine circadian rhythm, and on the day following administration of 1 mg dexamethasone, levels were again obtained at 8:00 am and 4:00 pm. The mean morning levels of plasma BEP-ir were significantly lower than control values for this laboratory (6.2 +/- 1.2 v 12.0 +/- 2.3 pg/mL). The morning BEP-ir values were lowest in patients who were closer to the time of injury (described by a second-order polynomial regression, R = .89; P less than .01). Mean morning cortisol levels were not significantly different from controls, but showed greater variability (mean, 15.1; range, 0.7 to 22.7 micrograms/dL v control, 15.5; range, 7 to 35). Dexamethasone suppressed cortisol secretion in all patients and BEP-ir levels in six of nine patients. Failure to detect BEP-ir suppression occurred in patients whose BEP-ir levels were less than 4.5 pg/mL and close to the minimum detection limit of the assay. Depression was present in five of nine patients as measured by the Beck Depression Inventory (BDI) and in three of nine patients as measured by the Hamilton Depression Scale (HSRD). However, the depression indices did not correlate with the neuroendocrine measures.

Neuroendocrine changes during functional electrical stimulation.

This study examined the effects of a computerized functional electrical stimulation exercise program on plasma beta-endorphin-like immunoreactivity (BEP-ir), cortisol levels and depression parameters in spinal cord-injured individuals. Nine subjects from 1.2 to 33.5 yr postinjury with both motor and sensory complete lesions between C5 and T12 participated. It was determined that patients who sustained spinal cord-injuries less than 5 yr before this study had lower than normal baseline levels of BEP-ir and flattened circadian rhythms. Patients who sustained their injury greater than 5 yr before this study had higher baseline levels of BEP-ir with some return to normal circadian rhythmicity. Baseline cortisol levels, regardless of time since injury, appeared to be dysregulated. Regular exercise with computerized functional electrical stimulation caused significantly (P less than 0.05) sustained increases in BEP-ir in all patients and improved the regulation of cortisol. Furthermore, the more strenuous the exercise training, greater increases in BEP-ir levels were seen. Last, depression scores improved, which suggests a possible association between subjective mood and BEP-ir levels.

Acrocyanosis in a spinal cord injured patient--effects of computer-controlled neuromuscular electrical stimulation: a case report.

This case report documents the treatment of a spinal cord injured patient with acrocyanosis of both feet. The 37-year-old white male patient sustained a traumatic spinal cord injury at the age of 16 years, which resulted in an incomplete vertebral fracture of the C5-C6 level. He was treated with computerized neuro-muscular electrical stimulation (NMES) of the quadriceps femoris muscle with weights applied to the ankles an average of two times per week for six weeks. Improvements in the color of the patient's skin and toe ulcers, stronger pedal pulses bilaterally, decreased swelling bilaterally, and subjective reports of less discomfort were noted. The empirical findings of this case report suggest that computerized NMES may be effective for improving circulation in the spinal cord injured individual with acrocyanosis. Further study, however, is needed to determine whether a relationship may exist between blood flow and computerized NMES.

Physical therapy management of the patient with post-polio syndrome. A case report.

This case report documents the treatment of a patient who experienced progressive muscle weakness and a decrease in function over time that did not appear to be related to any secondary neuromuscular disease. We discuss the relationship between age and maximal muscle function in addition to some general guidelines for rehabilitation. This type of patient can represent a challenge for the physical therapist. This case report, however, illustrates the degree of muscular and functional recovery that can result with a physical therapy program aimed at reducing levels and intensity of exercise, daily activity, and stress. Such a combination of short-term goals appears to be essential to the successful management of a patient with post-polio syndrome.

Effects of a wrapping technique on passive range of motion in a spastic upper extremity.

Limited range of motion (ROM) and subsequent soft tissue contractures resulting from spasticity are common developments in patients with acquired hemiplegia from cerebrovascular accidents. The purpose of this study was to examine the effects of a wrapping technique on ROM in patients with a spastic upper extremity. Four adult patients, postcerebrovascular accident of less than one year, received wrapping of the upper extremity for three hours, three times a week on alternating days for a total of two to four weeks. Baseline passive range-of-motion (PROM) measurements were established for shoulder flexion, shoulder abduction, shoulder external rotation, and wrist extension; these movements were commonly limited in all patients. The PROM was recorded after each wrapping session. The results showed a significant change in PROM for all motions in all patients (p = less than .01). In addition, all patients reported a decrease in pain in the upper extremity. Comparisons of videotapes of two patients at baseline and after 12 wrappings revealed an increase in ROM and a decrease in spasticity in the upper extremity during ambulation. These findings should encourage clinicians to experiment further with the wrapping technique and to report their findings.