[Treating cocaine addiction]. / Behandlung der Kokainabhängigkeit.

Estimates assume approximately 100'000 occasional and 11'000 addicted cocaine consumers in Switzerland. Although there is no established «standard treatment¼, helpful pharmacological and psychotherapeutic treatment strategies for cocaine addiction and its consequences exist. A selection of the most relevant treatment options is presented in this review. Their application should be embedded within an individualized treatment plan, which usually includes several of the therapeutic elements presented hereafter, depending on the patient's current situation. The treatment of patients with cocaine dependence might encompass longer periods and multiple sequences of treatment in out- or inpatient setting, yet it is promising.

Interferon alpha-2a plus ribavirin 1,000/1,200 mg versus interferon alpha-2a plus ribavirin 600 mg for chronic hepatitis C infection in patients on opiate maintenance treatment: an open-label randomized multicenter trial.

BACKGROUND: Many intravenous opiate users are infected with hepatitis C virus (HCV) but few are treated. Although this complies with various guidelines, virtually no published evidence supports such a recommendation. PATIENTS AND METHODS: In a multicenter study, HCV-infected patients in opiate maintenance treatment programs received interferon plus high- or low-dose ribavirin (1,000/1,200 mg or 600 mg). HIV-coinfected patients were not included. Endpoints were feasibility, efficacy, side effects, and reasons for dropout. RESULTS: Of the 420 patients who tested positive for HCV, 27 (6%) were enrolled; 393 (94%) either failed to meet the inclusion criteria or refused treatment. Virologic end-of-treatment response was achieved in 12/27 patients, and sustained response in 13/27 (48%). Response depended on viral genotype, not ribavirin dose. The two doses of ribavirin did not differ in their side effects. CONCLUSION: In a small fraction of HCV-infected intravenous drug users in an opiate maintenance treatment program, antiviral therapy was feasible, safe, and effective. The success rate was comparable to that achieved in controlled studies that excluded drug users.

Methadone maintenance treatment and St. John's Wort - a case report.

St. John's wort, a popular over-the-counter drug for treatment of depression, might reduce concentrations of drugs such as cyclosporin and indinavir and lead to drug resistance and treatment failure. No studies as yet have examined its influence on methadone plasma levels. The trough methadone plasma levels were measured in four patients (2 males, median age: 31 years; range 19 - 40 years) in methadone maintenance treatment just before the introduction of St. John's wort (900 mg/d) and after a median period of 31-day treatment (range 14 - 47). The study was proposed to addict patients about to start an antidepressant therapy. Introduction of St. John's wort resulted in a strong reduction of (R,S)-methadone concentration-to-dose ratios in the four median patients included, with a median decrease to 47 % of the original concentration (range: 19 % - 60 % of the original concentration). Two patients reported symptoms that suggested a withdrawal syndrome. Thus, prescription of St. John's wort might decrease methadone blood levels and induce withdrawal symptoms which, if not correctly identified and handled (by changing the antidepressant or by increasing the methadone dose), might cause unnecessary discomfort to the patient, lead to resumption of illicit drug uses, or be a risk factor for discontinuation of the methadone or antidepressant treatment.

A comparison of leg-to-leg bioelectrical impedance and skinfolds in assessing body fat in collegiate wrestlers.

A comparison of the leg-to-leg bioelectrical impedance (BIA) system and skinfold analysis in estimating % body fat in a large number of National Collegiate Athletic Association (NCAA) collegiate wrestlers was conducted. A series of 5 cross-sectional assessments, including the NCAA Division I and III Championships, were completed throughout the 1998-1999 wrestling season with samples ranging from (N = 90-274). Body density was determined from the 3 skinfold measures using the Lohman prediction equation. BIA measurements were determined using the Tanita body fat analyzer, model 305. Significant correlations between methods ranging from (r = 0.67-0.83, p < 0.001) and low standard error of estimates (SEE) for % body fat ranging from 2.1-3.5% were found throughout the 5 assessment periods. This preliminary study demonstrated that the leg-to-leg bioelectrical impedance system accurately estimated % body fat when compared to skinfolds in a diverse collegiate wrestling population.

Blood and urinary measures of hydration status during progressive acute dehydration.

PURPOSE: To determine whether: a) plasma osmolarity (Posm) is sensitive to small incremental changes in hydration status, b) urine specific gravity (Usg) can accurately identify a state of euhydration, c) Usg is a sensitive indicator of a change in hydration status, and d) Usg correlates with Posm. METHODS: Euhydrated (Posm = 288 +/- 4 mOsm.L-1) subjects (N = 12) were dehydrated by 5% of their body weight via exercise in the heat (40 degrees C, 20% RH). Posm, urine osmolarity (Uosm), and Usg were measured at 1%, 3%, and 5% dehydration, and 30 and 60 min of recovery (rec). Subjects consumed water in recovery equal to their loss of body weight. RESULTS: Posm increased incrementally with each successive increase in percent body weight loss (%BWL). Usg was not significantly different from baseline until 3% BML. Uosm was not significantly different from baseline until 5% BWL. Usg correlated moderately (r = 0.46, P > 0.10) with Posm but reasonably well (r = 0.68, P < 0.02) with Uosm. CONCLUSIONS: Posm accurately identifies a state of euhydration and is sensitive to changes in hydration status during acute dehydration and rehydration. Usg and Uosm are also sensitive to changes in hydration status but lag behind during periods of rapid body fluid turnover and therefore correlate only moderately with Posm during acute dehydration.

New equations improve NIR prediction of body fat among high school wrestlers.

STUDY DESIGN: Methodologic study to derive prediction equations for percent body fat (%BF). OBJECTIVES: To develop valid regression equations using NIR to assess body composition among high school wrestlers. BACKGROUND: Clinicians need a portable, fast, and simple field method for assessing body composition among wrestlers. Near-infrared photospectrometry (NIR) meets these criteria, but its efficacy has been challenged. METHODS AND MEASURES: Subjects were 150 high school wrestlers from 2 Midwestern states with mean +/- SD age of 16.3 +/- 1.1 yrs, weight of 69.5 +/- 11.7 kg, and height of 174.4 +/- 7.0 cm. Relative body fatness (%BF) determined from hydrostatic weighing was the criterion measure, and NIR optical density (OD) measurements at multiple sites, plus height, weight, and body mass index (BMI) were the predictor variables. RESULTS: Four equations were developed with multiple R2s that varied from .530 to .693, root mean squared errors varied from 2.8% BF to 3.4% BF, and prediction errors varied from 2.9% BF to 3.1% BF. The best equation used OD measurements at the biceps, triceps, and thigh sites, BMI, and age. The root mean squared error and prediction error for all 4 equations were equal to or smaller than for a skinfold equation commonly used with wrestlers. CONCLUSION: The results substantiate the validity of NIR for predicting % BF among high school wrestlers. Cross-validation of these equations is warranted.

Wisconsin minimum weight program reduces weight-cutting practices of high school wrestlers.

OBJECTIVE: Winconsin high school wrestlers were surveyed 1 year before (90W) and 2 years after (93W) a new program was implemented to restrict weight loss for competition. The Wisconsin wrestling minimal weight program (WMWP) included a minimal weight limit determined from percent body fat and a nutrition education program. DESIGN: A retrospective survey of wrestlers was conducted, with schools stratified to reflect school size and quality of the wrestling program. PARTICIPANTS: Respondents surveyed in 1990 included 713 wrestlers from 45 schools; 368 wrestlers from 29 of the same schools responded to an identical survey in 1993. MAIN OUTCOME MEASURES: Measures of weight-cutting practices, weight-loss methods, bulimic behaviors, and nutritional knowledge. RESULTS: The most weight lost (MWL), the weight lost to certify (WLC), the weekly weight cycled (WWC), the longest fast (LF), and the frequency of cutting weight (FCW) all decreased significantly (chi 2, p < 0.05) among 93W wrestlers compared with 90W wrestlers. The results for the 90W group are as follows: MWL, 3.2 kg +/- 2.6; WLC, 2.8 kg +/- 2.8; WWC, 1.9 kg +/- 1.5; LF, 20.5 hours +/- 17.2; FCW, 6.2 +/- 6.4. The results for the 93W group are as follows: MWL, 2.6 kg +/- 2.6; WLC, 2.4 kg +/- 2.9; WWC, 1.6 kg +/- 1.4; LF, 16.5 hours +/- 15.6; FCW, 4.7 +/- 6.7. Weight-loss methods, including restricting food or fluids and use of rubber suits, declined significantly (chi 2, p < 0.05). Wrestlers exhibiting more than one of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R)-related bulimic behaviors decreased by 11% (chi 2, p < 0.05), but those exhibiting all five (1.6%) remained the same. CONCLUSIONS: The results suggest that the WMWP appeared to reduce unhealthy weight-loss behaviors among high school wrestlers. Other states should be encouraged to institute similar programs as recommended by the American Medical Association and the American College of Sports Medicine.

Clinical diagnosis and the order of information.

BACKGROUND: Information order can influence judgment. However, it remains unclear whether the order of clinical data affects physicians' interpretations of these data when they are engaged in familiar diagnostic tasks. METHODS: Of 400 randomly selected family physicians who were given a questionnaire involving a brief written scenario about a young woman with acute dysuria, 315 (79%) returned usable responses. The physicians had been randomized into two groups, and both groups had received the same clinical information but in different orders. After learning the patient's chief complaint, physicians received either the patient's history and physical examination results followed by the laboratory data (the H&P-first group) or the laboratory data followed by the history and physical examination results (the H&P-last group). The results of the history and physical examination were supportive of the diagnosis of UTI, while the laboratory data were not. All physicians judged the probability of a urinary tract infection (UTI) after each piece of information. RESULTS: The two groups had similar mean estimates of the probability of a UTI after learning the chief complaint (67.4% vs 67.8%, p = 0.85). At the end of the scenario, the H&P-first group judged UTI to be less likely than did the H&P-last group (50.9% vs 59.1%, p = 0.03) despite having identical information. Comparison of the mean likelihood ratios attributed to the clinical information showed that the H&P-first group gave less weight to the history and physical than did the H&P-last group (p = 0.04). CONCLUSIONS: The order in which clinical information was presented influenced physicians' estimates of the probability of disease. The clinical history and physical examination were given more weight by physicians who received this information last.

Running and its effect on family life.

OBJECTIVES: To determine the frequency with which commitment to running conflicts with family life, to distinguish between runners who experience conflict and those who do not based on their levels of commitment to the roles of runner and family member, and to determine whether runners who reported conflict receive less support for running from their significant other. DESIGN: A questionnaire was mailed to 1426 members of a running club. Personal demographics, running quantity, conflict, commitment to running, family commitment, and spouse support were measured. The Family APGAR scale was used to measure global family functioning, assessing adaptation, partnership, growth, affection, and resolve. RESULTS: There were 724 respondents for a response rate of 50.8%. Five hundred fifty-eight runners (356 men, and 202 women) lived with a partner. The mean score for conflict was 1.9. Only 32 (5.5%) had a score above 3 (high conflict). When evaluated together and separately, the women and men in the high-conflict groups had equal commitment to running, lower family commitment, lower spouse support, and a lower Family APGAR score compared with the low-conflict group. CONCLUSIONS: In this study running is not a major contributor to family conflict. Those runners who are experiencing conflict seem to have a more global conflict with their families that is independent of running, manifested by decreasing spouse support for the runner's activities. If a runner is an active, committed member of his or her own family and sets this commitment as a priority, it does not appear that the time and energy of running is by itself a source of conflict.

American College of Sports Medicine position stand. Weight loss in wrestlers.

Despite a growing body of evidence admonishing the behavior, weight cutting (rapid weight reduction) remains prevalent among wrestlers. Weight cutting has significant adverse consequences that may affect competitive performance, physical health, and normal growth and development. To enhance the education experience and reduce the health risks for the participants, the ACSM recommends measures to educate coaches and wrestlers toward sound nutrition and weight control behaviors, to curtail "weight cutting," and to enact rules that limit weight loss.

Patients' views about physician participation in assisted suicide and euthanasia.

OBJECTIVE: To elucidate the effect of physician participation in physician-assisted suicide and euthanasia on the physician-patient relationship. DESIGN: A questionnaire administered to 228 adult patients. SETTING: A university-based family practice training program. PATIENTS/PARTICIPANTS: We approached 230 individuals of at least 19 years of age who were patients in the study practice. These individuals were selected on the basis of age and gender to ensure a heterogeneous study population. Of these, 228 agreed to participate and completed the questionnaire. RESULTS: The majority of subjects felt that a physician who assists with suicide or performs euthanasia is capable of being a caring person (91% and 88%, respectively) and would still be able to offer emotional support to surviving family members (85% and 70%, respectively). Most also felt that a physician assisting in suicide or euthanasia would be as trustworthy as a nonparticipating physician to care for critically ill patients (90.5% and 84.6%, respectively). Five percent "likely would not" continue to see their physician if it was known that he or she assisted in suicide and 7.8% "likely would not" continue seeing their physician if it was known that this physician performed euthanasia. No individuals stated that they "definitely would not" continue seeing their doctor under either circumstance. Individuals who supported the ideas of physician-assisted suicide and euthanasia were more likely to think that a physician who assisted with suicide and euthanasia could perform well in the tasks noted above and would be more likely to continue seeing such a physician (p = .001). CONCLUSION: Participating in physician-assisted suicide and euthanasia does not markedly adversely affect the physician-patient relationship.

The Wisconsin wrestling minimum weight project: a model for weight control among high school wrestlers.

In 1989, the Wisconsin Interscholastic Athletic Association implemented a project including new rules and an educational program, consistent with ACSM and AMA guidelines, to curtail "weight cutting" among high-school wrestlers. The project included skinfold estimates of body fatness to determine a minimum competitive weight, a limit on weekly weight loss, and presentation of nutrition education information to help wrestlers diet effectively. Implementation of the project has overcome a variety of obstacles and has received widespread endorsement from parents, teachers, wrestlers, and coaches. The success of this project offers a model for other states to emulate and should encourage clinicians in other sports to initiate interventions addressing these unhealthy weight loss behaviors.

[Efficacy of 2 different leukocyte filters for erythrocyte concentrates]. / Wirksamkeit von zwei verschiedenen Leukozytenfiltern für Erythrozytenkonzentrate.

By leukocyte reduction in red blood cell concentrates to < 5 x 10(6) leukocytes per transfused unit, febrile non-hemolytic transfusion reaction as well as alloimmunization and transmission of certain viral diseases (CMV, HTLV-1) can be prevented. Using a Nageotte hemocytometer with a large-volume chamber, the residual leukocyte number after filtration of 40 buffy-coat free red blood cell units with the filters Pall RC100 and Sepacell R500 B1 was determined in a clinical routine setting. Both tested filters underscored the limit (< 5 x 10(6) leukocytes per unit) set by the American Association of Blood Banks. Hemoglobin loss accounted for 8.9 g (Pall RC100) versus 7.7 g (Sepacell R500 B1), which is about 15-18% of the hemoglobin content of a red blood cell concentrate.

Bulimic behaviors among interscholastic wrestlers: a statewide survey.

Wrestlers are known for their extreme weight-cutting practices including fasting, food and fluid restriction, and dehydration. Using a stratified statewide survey, this investigation elucidated weight loss practices, nutritional knowledge, and bulimic behaviors among 713 high school wrestlers in Wisconsin. Results showed that 1.7% of the wrestlers answered questions consistent with all five criteria for bulimia nervosa, a rate higher than expected for adolescent males. An additional 43% exhibited weight-cutting practices similar to those of the wrestlers who met all bulimia nervosa criteria. The average wrestler lost 3.2 kg to compete, cycled 1.8 kg weekly, and fasted 20 hours prior to weigh-in. More extreme behaviors occurred among the 45% who met two or more bulimia nervosa criteria on their questionnaire; 19% frequently fasted, 25% restricted fluids, 34% used rubber suits, and 8% vomited. These results are comparable with data published over the past 20 years. Efforts to curtail these behaviors through regulations restricting weight loss coupled with sound nutritional information are warranted. Physicians and health professionals should be alert to potential eating disorders within this population.

Reduction of plasma cold agglutinin titers by means of plasmapheresis to prepare a patient for coronary bypass surgery.

A 53-year-old man with abnormally elevated cold agglutinins was treated successfully by plasma exchange so that he was able to sustain coronary artery surgery and extracorporeal circulation. Two plasma exchanges, consisting in the exchange of one plasma volume with a 5% albumin solution each, were performed in our intensive care unit with careful monitoring of vital parameters. The plasma exchanges resulted in a reduction of the titer of the cold agglutinins and of the thermal amplitude as well. With the exception of postoperative bleeding requiring re-intervention, the patient was successfully operated and could be dismissed on the 16th postoperative day in good condition.