The chain that saves life. Prehospital treatment of myocardial infarction

A 53-year old woman living in a rural area 220 km from the nearest hospital experienced an acute myocardial infarction. The local doctor contacted the emergency service and requisitioned an air ambulance. 29 minutes later the physician-manned helicopter arrived, and thrombolytic treatment was started after 15 minutes. The patient arrived at the county hospital 35 minutes later, after having been electroconverted three times because of ventricular fibrillation. The patient was discharged from hospital ten days later with no cerebral sequelae, and left ventricular ejection fraction 49%. This example shows that active use of emergency communications systems and air ambulances enables both prompt thrombolytic treatment and the effective treatment of complications associated with myocardial infarction to be accomplished.     

The case for a heroin substitution treatment trial in Canada

A patient with malaise, uveitis and a nodular infiltrate in the left lower lobe of the lung is described. An open lung biopsy established the diagnosis of necrotizing sarcoid granulomatosis. The differential diagnosis of necrotizing sarcoid granulomatosis with sarcoidosis and angiocentric granulomatosis (Wegener's disease) is extensively discussed. Our case illustrates that NSG and sarcoidosis could be pathogenetically related.     

Implosive therapy treatment of heroin addicts during methadone detoxification.

Examined the effectiveness of implosive therapy with heroin addicts during detoxification from methadone. 24 Ss with comparable histories of heroin addicition and similar maintenance levels of methadone were assigned to an implosive therapy, eclectic counseling, or control group. The 2 treatment groups received 12 sessions of implosive therapy or eclectic counseling and were followed for a subsequent 6-wk period. The implosive therapy Ss were the only ones to reduce significantly their methadone level during treatment and the follow-up period. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alterations of immune functions in heroin addicts and heroin withdrawal subjects

Conflicting results, both decreased and increased, have been reported concerning the function of T-lymphocytes in heroin addicts. We investigated the alterations of T-lymphocyte proliferative responses and immunophenotypic markers on lymphoid cells in heroin addicts and during different periods of heroin withdrawal in addicted subjects. This study has demonstrated a decrease in the response of T-lymphocytes to 1.2, 2.5, 5 and 10 microg/ml of phytohemagglutinin stimuli in heroin addicts and 1- to 5-day heroin withdrawal subjects compared with controls. Similarly, in an in vitro study, 10(-4), 10(-6) and 10(-8) M concentrations of morphine were shown to suppress 0.6 and 2.5 microg/ml of PHA-stimulated T-lymphocyte obtained from naive subjects. This inhibitory effect of morphine on PHA stimulation was completely abolished by 100 microM naloxone. The immunological parameters of total T-lymphocytes (CD3), T-helper cells (CD4), cytotoxic T-cells (CD8), B-cells and natural killer cells that are the immunophenotypic markers studied by flow cytometric analysis were altered in heroin addicts, 15- to 21-day and 6- to 24-month heroin withdrawal subjects, when compared with controls. These results suggest that heroin addicts and short period (15 to 21 days and 6 to 24 months) of heroin withdrawal have decreases in their immune system functioning and that the heroin withdrawal subjects seem to gradually reverse their immunological parameters to normal levels when withdrawal was sustained >/=2 years. This is the first report examining immune function in heroin withdrawal subjects using the "cold turkey" method. The results are beneficial for further study of the mechanism responsible for the opioid-induced changes in immune function.     

Pathogenesis and treatment of liver fibrosis in alcoholics: 1996 update

Fibrosis is a common end stage for most chronic liver diseases. It results from an imbalance between collagen production and degradation. One promising approach for prevention and treatment is the stimulation of collagenolytic processes. In nonhuman primates it was found that polyenylphosphatidylcholine (PPC), extracted from soybeans, protects against alcohol-induced fibrosis and cirrhosis and prevents the associated hepatic phosphatidylcholine (PC) depletion by increasing 18:2-containing PC species; it also attenuates the transformation of lipocytes into collagen-producing transitional cells. Furthermore, it increases collagen breakdown, as shown in cultured lipocytes enriched with pure dilinoleoyl PC (18:2-18:2 PC), the main PC species present in the extract, which may be the active ingredient. Since PC appears to promote the breakdown of collagen, there is reasonable hope that this treatment may affect not only the progression of the disease, but may also reverse preexisting fibrosis, as demonstrated for CCl4-induced cirrhosis in the rat. Therefore, PPC may be useful for the management of fibrosis of alcoholic and nonalcoholic etiologies as well. S-Adenosylmethionine opposes CCl4-induced fibrosis and can affect some of the consequences of the ethanol-induced oxidative stress in experimental animals and in man. Anti-inflammatory medications (corticosteroids, colchicine) are also being used and agents that interfere with collagen synthesis, such as inhibitors of prolyl-4-hydroxylase and antioxidants, are being tested.     

Venous thromboembolism--incidence and risk factors in Oslo

Over a period of three years, 378 patients with objectively verified venous thromboembolism were treated at Aker University Hospital. Below the age of 60, men and women had about the same incidence of venous thromboembolism, but that age the incidence was significantly higher among men than among women. Incidence increased exponentially with age, from about 1:10,000 at age 20 to about 1:1,000 at age 50. The incidence found here is lower than in earlier Nordic studies. The great majority of the patients (93%) had deep venous thrombosis in the lower extremities, 11% had symptomatic and verified pulmonary embolism, and 1% had their thrombus in an inner organ vein. 23% of patients were previously treated for venous thromboembolism, and 22% had cancer. Seven women were on oral contraception, and 22 used postmenopausal hormone substitution. An obvious temporary precipitating factor was present in 42% of the patients, while 36% had a spontaneous venous thromboembolism. Hereditary thrombophilic disorder was found in 32% of patients below the age of 60.     

Cognitive interpersonal problem-solving skills and the maintenance of treatment success in heroin addicts.

Discusses an unexpected outcome of heroin addiction treatment; namely, the failure inherent in successfully removing patients from illicit drug use, only to find that in doing so, expectations on the part of clients regarding their ability to effectively function in society have risen beyond their ability to realistically attain their goals. Recidivism becomes likely when addicts cannot cope with the stress of low status employment, specific situations of the nondrug world, recreational drug use of straight co-workers, and the effort of maintaining gains made in treatment. Cognitive interpersonal problem-solving skills are recommended as a means of focusing the addict on developing habitual thinking on alternatives, consequences, means and ends, different perspectives, and social influences on the addict's own actions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influenza in 1996

An original one-puncture technique of performing laparoscopic gastrostomy is described. The implications are analysed. The results of five operations are presented and the advantages and limitations are discussed in the light of current available methods.     

The bases and indications for the staged combined treatment of heroin addicts as outpatients

Combined and staged treatment is a new clinical methodology for the orientation of drug addiction cases within families. This methodology resorts to several techniques in a combined way, such as: family therapy and counselling; the use of psychopharmacology and opioide antagonists; as well as individual and group psycho-therapeutics. These are all linked to a personal psycho-social rehabilitation program. This treatment is based on family accessibility and therapeutic community programs. The authors review different contributions and the evolution of different therapeutic modalities. Finally they propose a list for inductions and another for the formal contra-indications for this kind of treatment.