Irritable bowel syndrome in office-based practice in the United States.

United States estimates of the frequency of visits to physicians and patterns of medical care for the diagnosis of the irritable bowel syndrome were derived from the 1975, 1980-1981, and 1985 National Ambulatory Medical Care Surveys. These surveys of office-based physicians allow national estimates of various aspects of ambulatory care. The overall rate of visits with the diagnosis of irritable bowel syndrome in 1980-1981 and 1985 were 10.6 per thousand U.S. population. Women had 2.4 times the rate of visits by men and rates rose in both sexes until middle-age. Irritable bowel syndrome was the leading digestive disease diagnosis among gastroenterologists but only the seventh leading diagnosis among all physicians. Gastrointestinal symptoms, association with mental disorders, prescriptions, and disposition were also examined in patients with visits for irritable bowel syndrome. Among records with digestive tract symptoms and a first listed diagnosis of irritable bowel syndrome, stomach or abdominal pain was listed on only about one half of records and disorders of bowel function were listed on fewer than 40%. In 1975 and 1985, irritable bowel syndrome was noted approximately twice as often as other digestive diseases at visits with mental disorder symptoms and diagnosis, although mental disorder symptoms and diagnoses were noted at fewer than 15% of visits with irritable bowel syndrome. Medications were prescribed at approximately 75% of visits for irritable bowel syndrome; the most common were gastrointestinal medications followed by combination gastrointestinal-psychoactive medications. Subsequent appointments were scheduled following at least 50% of the visits of patients with irritable bowel syndrome.

Psychiatric complications of long-term interferon alfa therapy.

Ten (17%) of 58 patients with chronic viral hepatitis treated with a four- to 12-month course of recombinant human interferon alfa developed psychiatric side effects. The psychiatric side effects fell into three categories: an organic personality syndrome characterized by irritability and short temper; an organic affective syndrome marked by extreme emotional lability, depression, and tearfulness; and a delirium marked by clouding of consciousness, agitation, paranoia, and suicidal potential. These psychiatric side effects appeared after one to three months of therapy, usually improved within three to four days of decreasing the dose of interferon alfa, and invariably resolved once therapy was stopped. The organic personality and affective syndromes tended to occur in patients who received the highest dose of interferon alfa, who had relatively mild hepatitis, and who lost weight during interferon treatment. Delirium tended to occur in patients with severe hepatitis who had previous evidence of organic brain injury or dysfunction or previous drug and alcohol abuse. Failure to recognize these side effects quickly and to treat them with supportive therapy and modification of the dose of interferon alfa could result in limitation of therapy and serious personal and interpersonal consequences.

Treatment of heroin-dependent persons with antagonists: current status.

Naltrexone is an important new pharmacologic adjunct to the treatment of heroin dependence. The development of naltrexone has been nurtured in the mature recognition that simple detoxification or simple opiate replacement therapy is not appropriate for every heroin addict. Our current data indicate that naltrexone is safe and effective. Its use may be limited to a minority of addicts, those who are highly motivated and opiate free, because patient compliance has been a major problem with which clinicians using naltrexone have had to contend. Patient compliance is a problem, because there are no immediate consequences to the patient for stopping his naltrexone regimen. Side effects from naltrexone have been minimal and have occurred in a minority of patients. They consist primarily of gastrointestinal symptoms, including nausea and occasionally abdominal pain.

A comprehensive psychiatric approach to drug dependence.

A comprehensive approach to the treatment of drug-abusing and dependent persons is proposed based on a knowledge of the psychopathology and the psychodynamics of drug abuse and psychological dependence. The role of psychiatric understanding of drug dependence is historically developed. The recent contributions of clinicians and researchers evolving from psychoanalytic ego theory as well as psychopharmacological orientation are discussed. The authors argue that categorizing people in terms of overt behavior - drug abuse or dependence - is not sufficient. Specific psychopathological and/or psychodynamic conditions should be diagnosed and utilized as the basis for treatment.

[Congenital cyst of the common hepatic duct. Adenocarcinoma of the gall bladder and of the stomach (author's transl)]. / Kyste congénital du canal hépatique commun. Adénocarcinome vésiculaire et adénocarcinome gastrique.

The authors report an unusual case of coexistence in the same patient of a congenital cyst of the common bile duct, a mucous adenocarcinoma of the stomach and a gall bladder adenocarcinoma. There was a favourable short term course after gastrectomy, cholecystectomy and resection of the cyst followed by bilio-digestive anastomosis on a long jejunal Y-shaped loop. The authors review recent literature.

Methadyl acetate and methadone. An open comparison.

Heroin addicts were recruited for a 14-week open clinical comparison of methadone hydrochloride and methadyl acetate. Patients were randomly assigned to a methadyl acetate clinic in which methadyl acetate was dispensed to patients three times per week or to a methadone clinic in which methadone was dispensed six days per week. No statistically significant differences were observed between groups in retention rates, illicit drug use, employment rates, or arrest rates. The group treated with methadyl acetate had more dropouts in the first seven weeks than the second seven weeks: this pattern was reversed for the methadone-treated group. The differences were significant (P = .01). Spontaneously reported symptoms suggest that induction with methadyl acetate may be a more clinically variable phenomenon than induction with methadone. The reduction of number of clinic visits in the group treated with methadyl acetate was not a source of variance in treatment effectiveness.

Neurological assessment of patients on prolonged methadone maintenance.

Medical histories, neurological examinations and electroencephalograms of 25 methadone-maintained subjects were compared with those of 25 abstinent controls. Comparisons on all measures failed to show significant differences between groups. The incidence of abnormalities was low for all subjects. None of the observed conditions appeared to involve methadone in their etiology.

A mild restraint and chronic venous catherization system for cats.

An inexpensive and minimally restrictive restraint system for cats is described which protects any temporary connections to chronic physiological implants during recording sessions and permits free movement of the head and extremities for behavioral studies. Procedures for constructing and implanting a chronic indwelling venous catheter device are also described which allows, directly with a syringe of via a connector system, for intravenous drug infusions in cats. These catheters have remained intact and relatively free of infection for a period of months before tissue rejection begins at the site of the subcutaneous implant.

Modification of human gastric acid secretion with operant-conditioning procedures.

In an attempt to control gastric acid secretion with operant-conditioning techniques, four normal women were given visual feedback on gastric pH plus money reinforcers. When money was made dependent on increased secretion in a differential-reinforcement-of-high-rates schedule, the rate of secretion of three of the four subjects increased to three times baseline. When money was then made dependent on decreased secretion in a differential-reinforcement-of-other-behaviors schedule, the rate of secretion of these three subjects returned to baseline levels. Heart rate, respiratory frequency, abdominal electromyographic activity, and stomach motility (measured by the electrogastrogram method) were not consistently correlated with acid secretion across subjects, although individual subjects showed substantial correlations between acid secretion and one or more other physiological response.

Effects of marihuana in laboratory animals and in man.

1 The pharmacological potencies of the resins from three different samples of Brazilian marihuana (A, B and C) were determined through corneal areflexia in rabbits, decrease of spontaneous motor activity and induction of catatonia in mice, and decrease of rope climbing performance of rats.2 The Delta(9)-tetrahydrocannabinol (Delta(9) THC) content of the marihuanas, measured by gas chromatography, was 0.82, 2.02 and 0.52%, respectively, for samples A, B and C. Approximately 2% cannabinol was present in samples A and B whereas the content of cannabidiol was approximately 0.1%.3 The petroleum ether extraction of the samples A, B and C yielded, respectively, 12.06, 14.56 and 4.26% of resin.4 In all animal tests resin B was nearly twice as active as resin A, whereas C was the weakest.5 The smoke of the marihuana samples was inhaled by 33 human subjects, under a double-blind standardized procedure. Pulse rate, a time production task and an evaluation of psychological effects were recorded.6 The smoke of 250 mg of sample B provoked disruption of the time production task, increased pulse rate, and induced strong psychological reactions in four of the six subjects who received it. Similar effects, although slightly smaller, were obtained with 500 mg of sample A. On the other hand, 500 mg of sample C did not differ from placebo.7 It is suggested that it is possible by means of animal tests to predict the potency of a marihuana sample in man.8 In parallel experiments, Delta(9)-THC was administered to other human subjects and to laboratory animals in a manner similar to that in which the marihuana samples were administered.9 Comparison of the results between the marihuanas and Delta(9)-THC showed that in man and in the laboratory animals marihuanas A and B induced effects two to four times greater than expected from their Delta(9)-THC content.10 It is suggested that there may be potentiation of the effects of Delta(9)-THC by other substances present in these marihuana samples.