The clinical management of HIV-related dementia and other memory disorders in the residential drug treatment environment.

Human immunodeficiency virus (HIV)-related dementia and other memory and attention disorders are described in terms of etiology, incidence, and symptoms. Assessment for cognitive impairment includes basic screening (examples are given), or a thorough neuropsychological evaluation. Implications for treatment within the residential drug treatment environment include: (a) providing accurate information to staff and residents; (b) identifying residents' anticipatory anxiety; (c) supportive counseling of residents; (d) coaching residents in the use of coping strategies; (e) creating environmental support; and (f) frequent reassessment of treatment goals, including the appropriateness of independent living. Helpful concrete suggestions are listed.

Continuous spinal anaesthesia in acute respiratory failure.

A patient with an obstructed femoral hernia and intercurrent respiratory failure was successfully anaesthetised with a continuous spinal technique. The technique provided excellent intra-operative anaesthesia and early postoperative analgesia, whilst avoiding further respiratory compromise. Disconnection of the catheter hub from the catheter prevented prolonged provision of postoperative analgesia by this route. Fixing of both the catheter and the hub to the patient are advocated to avoid this problem.

Effects of omeprazole, with and without metoclopramide, in elective obstetric anaesthesia.

We report the results of a study comparing two dose regimens of the gastric antisecretory agent, omeprazole, used as prophylaxis against pulmonary aspiration of gastric contents during general anaesthesia for elective Caesarean section. Since antisecretory agents do not clear stomach contents already present at the start of treatment, two groups of patients who had received both omeprazole and a prokinetic drug, metoclopramide, were also studied. Thirty patients received oral omeprazole 40 mg on the evening before and on the morning of the operation (group 1), 33 received oral omeprazole 80 mg on the morning of the operation (group 2), and 15 (group 3) and 16 (group 4) patients respectively received the oral omeprazole doses stated above and in addition metoclopramide 10 mg given intramuscularly at least 20 min before induction of anaesthesia. Gastric aspirate pH and volume were measured at induction of anaesthesia and on completion of surgery. At induction of anaesthesia, treatment was judged successful (pH > or = 2.5 and volume < 25 ml) in 87%, 73%, 100% and 81% of patients in groups 1-4 respectively. The corresponding results on completion of surgery were 100%, 88%, 100% and 100%. While omeprazole is useful as prophylaxis against pulmonary aspiration during general anaesthesia for elective Caesarean section, the addition of a prokinetic agent seems to be necessary to maximise its effects.

Preanaesthetic medication with clonidine.

The purpose of this study was to evaluate oral clonidine in a dose of 0.3 mg as a routine premedicant. Sixty-nine normotensive female patients were studied in a randomized double-blind investigation in which clonidine was compared with an inert treatment. Clonidine produced a significant reduction in anxiety (P less than 0.05) and sedation and a reduction in the sleep dose of methohexitone (P less than 0.05). Tachycardia in response to intubation was attenuated by clonidine (P less than 0.05). However, the magnitude of the increase in arterial pressure after intubation was not affected. Intraoperative and postoperative hypotension were common after premedication with clonidine 0.3 mg and caution is urged in its use as a premedicant.

Body image, self-esteem, and depression in burn-injured adolescents and young adults.

The present study was conducted to clarify the effects of burn-related variables (specifically, age at time of burn, years elapsed since burn, locus of burn, and percent of total body surface area burned), demographics, and perceived social support variables on psychological adjustment after injury within a well-defined sample. Subjects were 121 patients, currently 14 to 27 years old, burned within the past 10 years. They completed the following: Semantic Differential Measure of Body Image, Rosenberg Self-Esteem Scale, Beck Depression Inventory, Perceived Social Inventory--Friends, and Perceived Social Inventory--Family. The mean age of the subjects was 17.8 years; the mean percent total body surface area burned was 27.3%, with 75% of the subjects having burns on a visible or socially sensitive area. Correlational and multiple regression analyses showed that subjects perceiving more social support (friends more than family) had more positive body images (p less than 0.01), greater self-esteem (p less than 0.01), and less depression (p less than 0.01) than others, with a significant impact from difference in subjects' gender.