Neurosurgery in the malignant hyperthermia-susceptible patient

Malignant hyperthermia is a seemingly rare genetic myopathy. Hypermetabolic crisis accompanied by a rise in body temperature to as high as 44 degrees C is its hallmark. Malignant hyperthermia is usually triggered by potent inhaled anesthetics or depolarizing muscle relaxants. Because of the extraordinary risk of death in patients who are susceptible, neurosurgeons may be reluctant to operate on these patients. Three such patients were referred to the Neurosurgery Service and the UCLA Malignant Hyperthermia Center after neurosurgical procedures aborted for first episodes of malignant hyperthermia. They were anesthetized with nitrous oxide, barbiturates, opiates, tranquilizers, and nondepolarizing muscle relaxants. The patients were not treated prophylactically with dantrolene. Cardiac monitoring, end-tidal pCO2, and rectal temperatures were followed. After completion of the neurosurgical procedures, all three patients had a vastus lateralis muscle biopsy and subsequent caffeine/halothane contracture studies. The contracture study was positive in all patients. No anesthetic or surgical complication was encountered. This study demonstrates that neurosurgical procedures can be performed safely in patients at risk of developing malignant hyperthermia while they undergo appropriately selected general anesthesia.

Polydrug abuse among Ethiopian university students with particular reference to khat (Catha edulis)

The pattern of use of khat (Catha edulis Forsk), alcohol, cigarettes and tranquillizers among 479 medical and paramedical students in a boarding college in northwestern Ethiopia was studied by an anonymous self-administered questionnaire. The survey coverage rate was 98.8%. The majority of students were males (82.6%) and their average age was 21.2 years. The prevalence rate of current use of alcohol, cigarettes, khat and tranquillizers was 31.1%, 26.3%, 22.3% and 7.7%, respectively. These substances were also used in combinations, the most frequent involved khat, alcohol and cigarettes. Use of khat varied by the type of training (medical/paramedical) and by phase of medical education (preclinical/clinical). These variations were also apparent when data were analysed by sex and frequency of khat use. It appears that the pattern of khat use among university students is similar to that reported for substance abuse in other countries. Because of the economic importance of khat in the Ethiopian economy, its control may be difficult at present.

Long-term changes in medication during pregnancy

The Finnish Register of Congenital Malformations, established in 1963, rendered possible the study of changes in medication during pregnancy. The study consisted of 659 control mothers who had delivered a healthy child during the years 1964-1984. The data of this long-term follow-up study were collected by interviews at Maternal Health Care Centers after delivery and were completed by filed antenatal data. The results show a continuous decreasing trend in the usage of analgesics and tranquilizers but not in the usage of antiemetics, antibiotics, and vitamins. We believe that in Finland the publicity aimed at unnecessary medication during pregnancy has affected both the mothers and the health personnel.

Drug abuse among medical students at a Nigerian university: Part 1. Prevalence and pattern of use

Using a structured pro forma, 728 out of 775 medical undergraduates at a Nigerian university were surveyed for the prevalence and pattern of drug use. An operational definition of substance abuse was made, and 28 percent of students fell within that criterion. Male abusers (81 percent) exceeded female abusers (19 percent). Substances most commonly abused were alcohol (60 percent), minor tranquilizers (48 percent), tobacco (35 percent), and narcotics (29 percent), particularly codeine. Only 11 percent abused cannabis. While most students were polydrug users, there was a low frequency of daily drug use. A general lifetime (occasional use) prevalence of substance use of 56 percent was found. Drugs consumed on a daily basis were alcohol (2 percent) and tobacco (6 percent). The prevalence of drug use was highest among the fourth and final year students. The majority of students were occasional abusers; there was no evidence of physical dependence.

Effects of dopamine receptor antagonists on gastrin and vomiting responses to apomorphine

Apomorphine (0.05 mg/kg intravenously) was given to conscious dogs, and gastrin levels were measured in peripheral venous blood with a radioimmunoassay. Apomorphine induced an increase of gastrin levels which peaked at 5 min. The peripheral dopamine D-2/DA2 receptor antagonist domperidone (0.2 mg/kg), but not halopemide (0.1-1 mg/kg) nor the D-1/DA1 receptor antagonist SCH 23,390 (0.1 mg/kg), blocked the gastrin response to apomorphine. Both domperidone and halopemide, but not SCH 23,390, blocked the apomorphine-induced vomiting. These results suggest that apomorphine increases gastrin levels by an action at D-2/DA2 receptors, which are situated outside the blood brain barrier and differ from the receptor inducing the vomiting.

Changes in drug behavior from the middle to the late twenties: initiation, persistence, and cessation of use

Patterns of initiation, persistence, and cessation of use of licit, illicit, and prescribed drugs are presented for a longitudinal cohort from their middle to the late twenties. The cohort is representative of adolescents formerly enrolled in public secondary high schools in New York State. No additional initiation of cigarettes, alcohol, and illicit drugs occurred in the four-year follow-up interval, except for cocaine and pills. The largest proportional increase of new users occurred for prescribed psychoactive drugs. Alcohol showed the most persistence of use, followed by cigarettes and marijuana. As the cohort ages, those who continue to use illicit drugs actively do so at lower levels of intensity than at younger ages. For each drug class, the persistence of use is strongly related to earlier intensity of involvement. By age 29, men have accumulated almost twice as many months of use of illicit drugs as women.

The sedative effects of climazolam and climazolam with fentanyl-fluanisone in rats (Rattus norvegicus)

A trial of the sedative effects of a novel benzodiazepine, climazolam, and of a mixture of climazolam and fentanyl-fluanisone was undertaken in male and female Sprague Dawley and Lewis strain rats (Rattus norvegicus) of different ages. At the recommended intravenous therapeutic dosage of 0.25 mg/kg, climazolam sedated the rats but failed to inhibit the righting reflex or responses to painful stimuli. Even at 25 times the recommended dosage, there was no anaesthetic effect. Predictable and satisfactory surgical anaesthesia was not obtained with the mixture of climazolam and fentanyl-fluanisone administered intraperitoneally. In contrast with diazepam and midazolam, climazolam failed to potentiate the sedative analgesic properties of fentanyl-fluanisone: indeed many animals retained their tail and pedal pinch reflexes. The results also revealed significant differences in effect related to strain and age but not to sex.

Injectable anesthetics and anesthetic adjuncts

The purpose of this article is to review the use of selected anesthetics and anesthetic adjuncts in horses. Emphasis is placed on the pharmacologic bases of their use.

The use of neuroleptanaesthesia for experimental orthopaedic surgery in the rabbit

The anaesthesia of the rabbit used as a laboratory animal in experimental orthopaedics may present problems. The anaesthetic method should be easy and safe. Preferably it should not be expensive and should not include sophisticated devices. The anaesthesia has to include all the components: complete analgesia, muscular relaxation, and sedation. The application of the anaesthesia should not cause anxiety and pain to the animal, e.g. rigorous restraint has to be avoided.

[Steps in the recovery from severe depression. On the psychosomatic aspects of a convalescent process]

In retrospect, several phases of the healing process are easily distinguishable: Initiated with a terminal inpatient antidepressant therapy, continued by a tranquilizer-hypnotic withdrawal treatment, the psychotherapeutic mastering of the life-crises which provoked the mental disturbance in the first place, then the patient's going back to work, and, finally, the total mental stabilization on a mature level. The psychopathologic and psychosomatic symptoms appearing in the process are interpreted as expressions of spontaneous healing and not to be confounded with symptoms of withdrawal and/or relapse. The transition of the disturbance suffered and vanquished into a new self-image terminates the process of healing and recovery.

Substance use among females in New York State: catching up with the males

Epidemiologic surveys of the New York State population over the past several years show substance use rates for females that are approaching the higher use rates for males. Surveys of the secondary school population show similar rates of use for girls and boys over time as well as a similar intensity of involvement. Surveys of adults show a dramatic increase of use for females, ages 18 to 34 years, in recent years, and a more modest increase for females, ages 35 years and older. An analysis of substance use by sex, age, marital status and employment identifies disparate rates of use among subgroups. For instance, among younger adults, single full-time employed women have considerably higher rates of use than housewives for illicit substances as well as psychoactive prescription drugs used medically as well as nonmedically.

Volkmann's ischaemic contracture due to limb compression in drug-induced coma

A case of Volkmann's contracture secondary to prolonged compression of the limb is presented. The events developed in a patient who had been comatose following an overdose of alcohol and a sedative drug.

Analgesics and sedation in plastic surgery

The use of analgesic and sedative medications in plastic surgery can be divided into two main categories: premedication for general and local anesthesia and intraoperative sedation as an adjunct to local anesthesia. The actions and applications of specific agents are discussed.

[Neurochemical analysis of the mechanism of action of serotoninergic substances on avoidance behavior in situations of acute stress]

The mechanism of action of 5-hydroxytryptophan (5-HT, 10 mg/kg), quipazin (7 mg/kg), zimelidin (15 mg/kg) and m-chlorophenylpiperazine (5 mg/kg) was examined with the aid of some analyzer substances. The avoidance behavior under stress was used as criterion of estimation. The optimizing effect of 5-HT on the avoidance behavior was demonstrated to be a consequence of serotonin synthesis activation and its release with activation of postsynaptic 5-HT-1-receptors. An adverse effect of quipazin on the avoidance behavior was, to a greater degree, due to the activation of 5-HT-2-autoreceptors rather than of dopamine receptors. The inhibitory effect of m- chlorphenylpiperazine was reversed by administration of pyrenepyrone , a blocker of 5-HT-2-receptors. The inhibitory effect of zimelidine on the avoidance behavior was not removed by clonidin . The positive effect on the avoidance behavior under stress occurs as a result of exposures that activate the synthesis and release of 5-HT as well as of activation of postsynaptic 5-HT-1 receptors.

Utility of drug leaflets for elderly consumers

A mail survey of 1,650 elderly consumers evaluated prescription drug leaflets for antihypertensives, tranquilizers, and arthritis medicines. Of those who said they received the leaflet, 95 per cent read it, 76 per cent kept it, and 56 per cent discussed it with another person. Respondents taking antihypertensive medicine were more apt to keep the leaflet and say they learned new information from it. Those taking tranquilizers were less likely to say the leaflet made them feel better about using the drug.

Determinants of drug use: a test of the coping hypothesis

This paper uses a national probability sample to examine major correlates of drug use among American adults. Demographic correlates of alcohol, cigarette, marijuana, tranquilizer, sleeping pill and stimulant use are explained in terms of a self medication or coping perspective of drug use. Two analysis procedures are used. In the first, respondents were asked to list strategies they use when they have problems. These responses are 'broken down' by drug use categories or 'taking pills'. In the second procedure, attempts are made to interpret the correlations between age, sex, marital status, education and drug use by introducing variables which measure how respondents were experiencing fundamental aspects of their lives (role stress items) and mental health variables. A substantial portion of the variance in drug use that is explained by demographic variables appears to operate through social role and mental health variables, that is, these latter variables interpret the demographic/drug use relationships in a way that is consistent with a coping perspective. The authors conclude that these data and this analysis provided cautious support for a coping perspective.

Medical misinformation: communication between outport Newfoundland women and their physicians

A middle-aged woman in a Newfoundland outport fishing village visits the doctor at a local medical clinic and complains of a case of bad nerves. Because he neither adequately understands the subtleties of the village concept of nerves nor the local etiquette of disease disclosure, the physician misinterprets the women's complaint and treats her for an ailment she does not have. The incident discourages the woman and other villagers from seeking medical care in the future. Any outport doctor should be familiar with the character of nerves as effectors of temperament, as conversation capital, and as female status enhancers and also with the role that 'women the worrier' plays in the local fishery. Features of village life which the physician, in this case study, fails to understand include: the complex patterns of social interaction behind the woman's decision to seek medical aid, the outporter's reluctance to ask for help or become obligated to others, and the local fear of persons in positions of authority. Most importantly the doctor is ignorant of the local view of the physician as a kind of moral adjudicator with the power to undermine the patient's reputation as a good woman in the community.

Sex differences in the use of alcohol and tranquilizers: testing a role convergence hypothesis

Research on adult alcohol and tranquilizer use provides strong evidence of fundamental sex differences in the use of the two types of drugs. Current explanations posited for these differences center around differential sex roles and sex role expectations. Much of the discussion of these differences suggests that as male and female roles converge, these behavioral differences should decrease. Using data from a statewide survey of Illinois adults, we provide a preliminary test of a sex role convergence hypothesis for alcohol and tranquilizer use. To do so, we use a multinomial extension of logistic multiple regression. After controlling for demographic and sex role characteristics, the results show that females have a much higher probability of using tranquilizers rather than alcohol than men do. Thus, the role convergence hypothesis is not supported for the use of these two types of drugs.

Over-the-counter drugs: factors in adult use of sedatives, tranquilizers, and stimulants

Despite a growing research interest in over-the-counter (OTC) drug use, little information has been available about the determinants of use for this category of medications. The researcher examined the effects of demographic, need, and physician utilization measures on the use of 10 OTC drugs that were categorized as sedatives, tranquilizers, or stimulants. A statewide survey in 1975 of drug-using behavior in the previous year by Illinois adults ages 18-59 resulted in 2,738 questionnaires that could be analyzed. Thirteen variables, representing the demographic, need, and physician utilization characteristics of the respondents, were entered as predictors into logistic multiple regression models to estimate their effects on drug use. Only 10.37 percent of the respondents indicated that they had used any of the OTC drugs in the previous year. Sedative use was found to be increased in persons who were tense or were having trouble sleeping. Having trouble sleeping also increased the probability of using OTC tranquilizers and stimulants. Women had a much higher probability of using OTC tranquilizers than men, and men had a higher probability of using stimulants. Non-whites had a higher probability of using tranquilizers than did whites. Stimulants were more likely to be used by younger adults and unmarried adults. Physician utilization, measured by the number of visits to physicians, did not significantly affect OTC drug use.

Factor structure of common drug usage

The correlated usage of commonly employed, legal drugs was examined in a sample of 377 American and 908 Swedish adults. Measures of alcohol, tranquilizer, sleeping pill, and coffee or tea consumption were submitted to a principal components factor analysis with Varimax rotation. The resultant three factors were characterized by (1) heavy drinking in general and beer consumption specifically (ALCFAC), (2) the use of tranquilizers and sleeping medications (TSFAC) and (3) the consumption of coffee and tea (CTFAC). Factor structure profiles for ALCFAC and TSFAC were more stable than CTFAC across nationalities, sexes, and cohorts. Profiles for Swedish smokers and never-smokers were very similar; for Americans, however, profiles for never-smokers were more similar to Swedish profiles than to those of American smokers. Factor scores were computed to examine the relationship between tobacco use and levels of the factors by means of analysis of variance. In Swedes, ALCFAC and CTFAC levels varied with smoking status, whereas ALCFAC and TSFAC levels with smoking status in Americans.

Measures to assess drug abuse and the health, social and economic consequences of such abuse: summary of information from 21 countries. United Nations Secretariat

This article summarizes the replies received from 21 Governments to a survey undertaken in June 1982 of measures to assess drug abuse and its consequences. A large number of programmes for the assessment of drug abuse were reported, and these were classified either as population surveys or as reporting systems of existing institutional data on drug abuse, depending on the methodology used. Each method was described as having certain advantages and limitations, which varied according to the aims of the assessment and the circumstances under which it was carried out. A well-established reporting system, which obtained data from law enforcement agencies, health services or other institutions that came into contact with drug abusers, was reported to be an effective means of assessing the consequences of drug abuse, but it provided information only on cases that were brought to the attention of the authorities. On the other hand, a survey covering, for example, the general population, students or conscripts, based on a probability sample, represented the population studied and detected cases of drug abuse that were not recorded by institutions. In many of the replies it was stated that drug abuse imposed a considerable burden on society in terms of health impairment and disabilities, as well as in terms of its social and economic consequences. Drug abuse diminished the ability and motivation of drug abusers to engage in the complex tasks required in modern society. Dropping out of school, performing poorly at work and losing employment were the most common consequences of drug abuse. It was also reported that drug abuse played an important role in the development of criminal, delinquent and anti-social behaviour.

Anesthetic and analgesic considerations in the experimental animal

Many new compounds and combinations of many of the more traditional drugs have been used in a wide range of species. This, plus the rapid development in equipment for inhalational anesthesia, has simplified the restraint, anesthetic, post-surgical, and analgesic management of experimental animals.

Self-reported use of alcohol, cigarettes, tranquillisers and sedatives in patients admitted to a general hospital

The relation between alcohol and hospital admissions and the patterns of use of cigarettes, tranquillisers and sedatives was studied in a sample of 339 consecutive admissions to Northland Base Hospital. Also examined was the usefulness of serum gamma glutamyl transferase (GGT) and blood ethanol as screening tests for high alcohol use in general hospital patients. A short multiple choice questionnaire was used, completed answers being obtained from 91.7 percent of the sample; GGT estimations were done on 64 percent and blood ethanol on 38 percent of the sample. Alcohol was considered to be a factor in the admission of at least 6.4 percent of the total sample. Blood ethanol estimations were not found useful as a screening test but GGT had a specificity of at least 27 percent for diagnosing high alcohol use in the general hospital situation. The regular use of tranquillisers and sedatives in elderly non-Maori patients was high but appears rare in Maoris of all ages.

Sales statistics in the control of drug abuse in Norway

The system of monitoring the patterns of prescription and consumption of addictive drugs by utilizing computerized data on prescriptions collected in pharmacies throughout Norway is described. The number of prescriptions for narcotic drugs issued in out-patient facilities substantially decreased in the period 1970-1980. Statistics also indicate a decrease in the sale of barbiturates and sedative-hypnotics during the period 1974-1980, while the sale of benzodiazepines increased during the same period. The monitoring system provides reliable information on the use of legally prescribed drugs, which proves useful to the authorities in undertaking appropriate control measures of such drugs.

Primary drug abuse among women: a national study

This study focuses on women's primary patterns of abuse for selected drugs (heroin, marijuana, barbiturates, amphetamines, sedatives, and tranquilizers) at treatment admission in relation to age at first use, marital status, education status, and race. The sample consisted of 51 390 women admitted to treatment during a recent 12 month period. The results indicated that heroin was the most abuse drug in relation to all the variables examined. Those clients who never married and those unemployed at the time of admission reported the greatest abuse of each of the primary drugs investigated. More than half of the sample had their first drug experience before age 18. This suggests the need to educate young women about drugs and to make professionals in schools and communities more aware of the nature of this problem in order that prevention and treatment programs can be developed to meet women's specific needs.