Influence of attention-deficit/hyperactivity disorder symptoms on methadone treatment outcome.

A review of 687 consecutive admissions to a Midwestern methadone maintenance program was undertaken to establish the prevalence of ADHD symptoms and their association with treatment outcome. Of the 687 admissions, 396 (58%) patients self-reported experiencing one or more ADHD symptoms during the two weeks prior to admission, and 131 (19%) patients reported ADHD symptoms that significantly interfered with functioning in daily activities. At nine months post-admission, the patients who reported significant symptoms of ADHD were able to reduce their drug use but were less likely to have achieved abstinence than those who did not report significant symptoms (p < or = 0.001). The authors discuss the importance of screening for ADHD symptoms in methadone treatment programs and propose interventions believed helpful in improving management of ADHD symptoms and improving outcome.

Does pregnancy affect outcome of methadone maintenance treatment?

Studies of pregnant women receiving methadone maintenance have tended to focus on teratogenic, prenatal, and neonatal issues. We are not aware of any controlled studies comparing pregnant to non-pregnant heroin-addicted women in methadone treatment. This article presents findings from a study examining treatment outcome between pregnant and non-pregnant participants in a metropolitan methadone-maintenance program. Participants were 51 pregnant women and 51 non-pregnant women enrolled in a methadone maintenance program between 1994 and 2003. Groups were compared on demographic characteristics, psychiatric comorbidity, urinalysis results and retention rates. Groups were comparable in terms of most demographic characteristics and severity of addiction at intake. Groups did not differ significantly in terms of urinalysis results or retention rates. While most women reduced their drug use, a majority of both groups continued to use illicit drugs at least occasionally. Psychiatric comorbidity was significantly different with the non-pregnant group being more psychiatrically disordered. Clinical implications are discussed.

Balloon angioplasty as a treatment of failing infrainguinal autologous vein bypass grafts.

PURPOSE: The purpose of this study was to evaluate the role of balloon angioplasty in the treatment of failing infrainguinal vein bypass (IVB) grafts. METHODS: A retrospective chart review of patients undergoing revision of a failing IVB graft by vascular surgeons at a tertiary care center from 1990 to 2001 was performed. Failing bypass grafts were identified by routine duplex scan surveillance and physical examination. The criteria for endovascular intervention varied on the basis of surgeon preferences and time period; factors considered when choosing balloon angioplasty included significant comorbidities that precluded operative intervention, the lack of adequate conduit for surgical revision, or poor accessibility of the stenotic lesion. Data recorded included demographic patient data, type of IVB graft, patency status, further procedures performed, and all complications and mortalities. Cumulative primary and assisted patency rates were calculated by using Kaplan-Meier life-table analysis. RESULTS: A total of 45 balloon angioplasties were performed in 36 patients. There were 36 angioplasties of vein bypass grafts, and additional balloon angioplasties were performed on nine of these patients. Locations of IVB grafts included femoropopliteal (13 patients), femorodistal (13), and popliteal to distal (10). Initial success was achieved in 33 of 36 vein bypass grafts (91.7%). In these bypass grafts, the stenotic lesions were identified and treated at the proximal anastomosis (3 patients), mid-bypass graft (6 patients), and distal anastomosis (27 patients). Autogenous vein was used for all bypass grafts. Cumulative vein bypass graft (life-table analysis) primary patency rates (those free of occlusion or bypass graft threatening stenosis) were 74.2% at 6 months, 62.7% at 12 months, and 58.2% at 24 months. Repeat interventions included surgical thrombectomy with vein patch angioplasty or bypass graft revision, as well as repeat balloon angioplasty with or without thrombolysis. Cumulative assisted vein bypass graft patency rates (those free of occlusion or bypass graft threatening stenosis) were 87.0%, 83.2%, and 78.9% at 6, 12, and 24 months, respectively. Two patients (4%) developed thigh hematomas; no other procedure-related complications were noted, and there were no deaths in the perioperative period. CONCLUSION: Balloon angioplasty of failing infrainguinal vein bypass grafts can be successfully performed with a low rate of complications. Acceptable short-term patency can be achieved. This procedure should be considered as an initial option in failing IVB grafts.

Simulation of drug use and urine screening patterns.

Urine drug screens are used extensively in substance-abuse treatment, especially methadone maintenance treatment programs, as well as criminal-justice and clinical research settings. While positive urinalysis generally indicates drug use, no information is provided about the context or pattern of use. A computer generated model was created to examine the influence of drug use patterns and drug screen schedules upon urine test results. The results indicate that (1) when urine testing is performed at a rate of eight times per year, the probability of testing positive in a given month is little better than 50-50 even for daily use, (2) infrequent drug use is difficult to detect regardless of drug testing frequency, and (3) the benefits of more frequent drug testing are greatest with moderate drug use. The data presented provide a guide for clinicians to match drug screen schedules to frequency or pattern of suspected drug use.

Surgical thrombectomy: current role in thromboembolic occlusions.

Thromboembolic disease occurs in a heterogeneous group of patients with significant co-morbidities and variable presentations, resulting in high morbidity and mortality rates. To decrease these complications, multiple different endovascular modalities have been developed and used to treat this challenging problem. Physicians are now left with a broad array of endovascular and surgical options. Unfortunately, there are little data that accurately compare these modalities. Therefore, an individual approach to each patient with acute ischemia from thromboembolic disease must be employed. In order to tailor the treatment to the needs of each patient, the physician must be familiar with the techniques, complications, technology, and relative strengths and weaknesses of each treatment modality. This article will first outline the main technical considerations for performing surgical thromboembolectomy. The complications of operative thromboembolectomy will then be discussed followed by the data comparing operative and nonoperative therapy. Finally, clinical scenarios that are best treated by surgical intervention will be described.

A pilot, open clinical study of depakote in the treatment of cocaine abuse.

The effectiveness of increasing levels of valproic acid on cocaine abstinence was evaluated in an open-label trial of 55 subjects. Significantly lower percentages of individuals with valproate serum levels above 50 mcg/ml reported cocaine use and had less positive urinalyses as compared to those with serum levels less than 50 mcg/ml. The total number of days of cocaine use decreased significantly (p < 0.001) and improved levels of subject functioning were found with increasing serum levels of valproic acid. This pilot study offers confirmation that the divalproex sodium form of valproic acid, when used in sufficient serum levels, may provide an effective pharmacologic adjunct in the management and treatment of cocaine dependency. Copyright 2001 John Wiley & Sons, Ltd.