Chlordiazepoxide vs. methadone in opiate withdrawal: a preliminary double blind trial.

A double blind trial of chlordiazepoxide vs. methadone in the management of the opiate withdrawal syndrome was conducted in a group of 24 regular heroin takers. Subjective and objective measures including physiological parameters were recorded to compare the severity of opiate withdrawal between the two groups. No significant difference was found in terms of subjective withdrawal distress between the two treatment conditions, although there was a tendency to a return of withdrawal symptoms in the methadone group towards the end of treatment. A nurse rating scale demonstrated a significantly higher level of withdrawal signs in the chlordiazepoxide group on day 3. Physiological measures suggested that neither group experienced a severe withdrawal illness. A similar number in each group (37%) became completely drug free.

Quantitative electrophysiological study of alcoholic neuropathy.

Thirty-one chronic alcoholic patients were investigated using quantitative electrophysiological techniques. Estimates of the numbers of functioning motor units in the extensor digitorum brevis muscles and measurements of the parameters of the potentials of these units are presented along with the values for motor nerve conduction velocities in the innervating lateral popliteal nerves. Motor conduction velocities and sensory nerve action potential amplitudes were also measured in the ulnar nerves. The results and their inter-relationships lead us to conclude that the slowing of motor nerve conduction and reduction in sensory nerve action potential amplitudes in alcoholic neuropathy are a consequence of axon loss. We found no evidence of pathological slowing of conduction in surviving axons. Reinnervation by functioning motor axons is poor compared to a number of other neuropathic conditions. In our patients there was no evidence of preferential involvement of sensory axons. The results support a predominant axonal dysfunction in alcoholic neuropathy.

Acute lead poisoning: an unusual cause of hepatitis.

Four patients, aged 17 to 25 years, obtained lead and opium pills which had been stolen from retail pharmacists. They crushed them, suspended them in water an injected them intravenously. They developed general malaise, vomiting and constipation, and blood tests several weeks after injection of the pills showed raised alkaline phosphatase and aspartate transaminases. All four patients had negative tests for the hepatitis B surface antigen. Liver biopsy specimens showed persistent hepatitis in one and resolving hepatitis in the remaining three. Liver lead levels were grossly elevated in every case. The liver lead levels found it the patients described here were up to 35 times greater than levels which have been reported in industrial lead poisoning. It is postulated that the livers of patients with chronic lead poisoning are able to withstand this insult whereas in the cases described the overwhelming dose of lead was sufficient to cause hepatic damage.

Psychiatrists and a computer as interrogators of patients with alcohol-related illnesses: a comparison.

A computer-administered 'interview' was developed for eliciting evidence relating to alcohol problems. Thirty-six volunteer male patients on their first visits to a specialist alcohol clinic were interviewed three times, by two psychiatrists and by the computer; information was sought about 72 pre-defined indicants concerning alcohol consumption, drinking behaviour, and symptoms. Each patient was asked to complete an attitude questionnaire anonymously. The extent of agreement between the evidence elicited by the computer and by the psychiatrists was quite high, and their estimated error rates were very similar, all between 10 per cent and 12 per cent in total. With respects to amounts of alcohol consumed, patients reported significantly greater amounts to the computer than they reported to the psychiatrists. The median amounts of pure ethanol consumed ranged from 1-19 kg per week calculated from reports made to one of the psychiatrists, up to 1-58 kg per week calculated from reports made to the computer. The results from the attitude questionnaire indicated a high level of acceptability to patients of computer interrogation.

Successful prolonged heparinless venoarterial bypass in sheep.

In order to investigate the safety of prolonged heparinless venoarterial bypass (HL-VAB), we subjected 18 sheep to prolonged HL-VAB for up to 6 days. Three animals died of granulomatous lung abscess and one died from intra-abdominal abscess. One animal died of generalized thromboembolism secondary to mechanical damage of the nonthrombogenic coating occurring at the time of cannulation. HL-VAB was successfully carried out in 13 sheep. Although clots were found at all tubing connections where blood turbulence occurred, only the previously mentioned animal showed evidence of thromboembolism. Damage to the nonthrombogenic tubing exposed to the roller pump head was seen in all animals, and its severity appeared to be related to the duration of bypass. Scanning electron microscopic examination revealed scattered platelet aggregates on the nonthrombogenic coated surfaces without clinical evidence of embolization. Hematocrit values, leukocyte counts, platelet counts, prothrombin time (PT), activated partial thromboplastin time (PTT), thrombin time (TT), plasma fibrinogen levels, and factor V and VIII levels remained unchanged, whereas free plasma hemoglobin levels rose slightly during 6 days of HL-VAB. HL-VAB for up to 6 days appears to have little adverse effect on blood cells and blood coagulation factors. For current clinical use, the nonthrombogenic coated tubing circuit should be changed every 48 hours because of time-related trauma to the coated tubing from the roller pump.

Blood coagulation studies during six day heparinless venoarterial bypass in sheep.

Heparinless venoarterial bypass (HL-VAB) was carried out in 16 sheep for 6 days, by means of a closed circuit tubing coated with nonthrombogenic polyurethane-polyvinyl-graphite (PPG) and a roller pump. Nine experiments were completed uneventfully. Seven sheep died during bypass. The causes of death were pneumonia (2), caseous granulomatous lung abscess (3) or abdominal abscess (1), and thromboembolism (1). The last complication was caused by inadverten trauma to the PPG coating at the time of tubing connection. In the animals in which HL-VAB was uneventful, no significant changes were noted in the hematologic studies including white blood counts, platelet counts, hematocrit, plasma fibrinogen levels, prothrombin time, thrombin time, activated partial thromboplastin time, Factors V and VIII, and free plasma hemoglobin levels. Inconsistant changes in the above parmeters were noted in the animals which died of complications. In conclusion, prolonged HL-VAB has no adverse effects on blood coagulation mechanism.

Continuous percutaneous monitoring of muscle pH and oxygen pressure. A new technique for in vivo use.

Newly developed all solid state catheter oxygen pressure (PO2) and pH electrodes were evaluated in dogs in respiratory acidosis and hemorrhagic shock. The electrodes were inserted into the blood vessels and thigh muscle by a percutaneous puncture technique. In animals with respiratory acidosis, arterial, venous, and intramuscular pH decreased in parallel as arterial carbon dioxide pressure (PCO2) increased. During severe acidosis, arterial and venous PO2 did not change appreciably, but intramuscular PO2 decreased moderately, indicating decreased tissue perfusion. In animals with hemorrhagic shock, intramuscular PO2 decreased in proportion to the blood loss, whereas the reduction in intramuscular pH and blood pressure lagged behind blood loss. A similar finding was observed during reinfusion of shed blood in surviving animals. In the animals that died, intramuscular PO2 AND PH remained low after the reinfusion of all shed blood, although arterial blood pressure did return to base line levels.

Acute lead poisoning: Five cases resulting from self-injection of lead and opium.

Five cases of acute lead poisoning resulted from the self-injection of lead and opium pills which were crushed, heated and suspended in water. Two of the five patients died of illnesses in which hepatic failure and reversible acute tubular necrosis were prominent features. One of these two had a severe neuropathy, with flaccid quadriplegia and respiratory paralysis. The other three patients had relatively minor symptoms but unequivocal biochemical evidence of lead toxicity. Autopsy changes included hepatic degeneration with inclusion bodies, regenerating renal tubular epithelium and wasting of skeletal muscle. Hepatic lead content was extremely high in one case. Chelation therapy in the other fatal case resulted in a fall in blood lead to within normal limits and a clinical improvement, which was terminated by massive haemorrhage from a ruptured innominate artery.

Choreoathetotic movement disorder in alcoholism.

A syndrome of choreoathetosis in association with alcoholism has been found in 12 patients. It appeared to occur more often in women, was transient, and may have been associated with alcohol withdrawal. It was not associated with gross liver disease, phenothiazine administration, or familial chorea, and no consistent abnormalities in whole blood thiamine or nicotinic acid, in serum magnesium, or in serum vitamin B(12) levels were present.