[Current data on methamphetamine]

Methamphetamine is an illicit drug used in North America, Asia, and East European countries. Methamphetamine addiction is a serious public health problem in those countries. it is a very powerful psychostimulant drug. It is derived from amphetamine and illegally manufactured from ephedrine. Cause of abuse and dependence it causes significant somatic, psychiatric and cognitive complications. Because of its vasoconstrictor properties, methamphetamine is the cause of cardiovascular diseases but also pulmonary, neurological, dental diseases... Its neurotoxicity is responsible for significant cognitive impairment. It also causes acute psychotic disorders, depressive disorders and suicidal behavior. Treatment of somatic or psychiatric complications should be integrated within a global addiction treatment. To date, no pharmacological therapeutic is specific. However, recent studies with naltrexone, modafinil and bupropion show promising leads. More, dopamine agonist drugs (dextroamphetamine, methylphenidate) are proposed as possible replacement medications. Despite those pharmacological treatments, psychotherapy has to be associated to offer a combined approach with pharmacological treatments.

[Abstinence in alcohol-dependence: critical and updated approach of the 2001 national guidelines]

2001 French guidelines on the modalities of post-detoxification care for alcohol-dependent patients recommend life-long abstinence from alcohol. Though experts of this conference have used a methodological tool based on the analysis of the literature for each specific issue, the recommended goal of abstinence only follows from expert advice and does not seem to be evaluated with the aforementioned methodological tool. Moreover, from 2001, several scientific works of higher level of evidence than expert advice show that a small but significant proportion of alcohol-dependent patients could maintain non-problematic drinking stably in time. The outcome discrepancies between patients could result from social, clinical and biological factors. Today, it seems necessary not to consider alcohol-dependent patients as a homogeneous population anymore, but on the contrary to delimit subgroups with different outcome profiles. Better knowledge about these subgroups of patients could allow the diversifying and personalising of care schemes, including in some cases temporary abstinence or controlled-drinking patterns.

Catatonia and alcohol withdrawal: a complex and underestimated syndrome

AIMS

Catatonia is a neuropsychiatric syndrome characterized by alterations in motor behavior, vigilance, thought and mood. Catatonia syndrome occurs in many neuropsychiatric and medical conditions, but it is very rarely mentioned as occurring during alcohol withdrawal. We think that this co-occurrence could be underestimated in clinics because alcohol withdrawal symptoms may distract from its identification.

METHODS

We report the case of a patient presenting with catatonia during the benzodiazepine reduction period of alcohol detoxification.

RESULTS

A 65-year-old woman presented with a 15-year history of alcohol dependence and developed catatonic episodes several times during alcohol withdrawal treatment. Misdiagnosis delayed specific treatment. Symptoms of episodes dramatically improved 48 h after treatment with diazepam and revealed an anxiety disorder.

CONCLUSION

This report confirms that catatonia is a non-specific response to psychological, physical and psychosocial stress factors. Recent alcohol withdrawal may sensitize the patient to benzodiazepine withdrawal catatonia, and this phenomenon is probably underestimated. Catatonia Rating Scales can be useful when diagnosis is complicated as in alcohol and benzodiazepine withdrawal. In that situation, misdiagnosis is common and may delay specific treatment.

Body mass, tobacco smoking, alcohol drinking and risk of cancer of the small intestine--a pooled analysis of over 500,000 subjects in the Asia Cohort Consortium

BACKGROUND

The evidence for a role of tobacco smoking, alcohol drinking, and body mass index (BMI) in the etiology of small intestine cancer is based mainly on case-control studies from Europe and United States.

SUBJECTS AND METHODS

We harmonized the data across 12 cohort studies from mainland China, Japan, Korea, Singapore, and Taiwan, comprising over 500,000 subjects followed for an average of 10.6 years. We calculated hazard ratios (HRs) for BMI and (only among men) tobacco smoking and alcohol drinking.

RESULTS

A total of 134 incident cases were observed (49 adenocarcinoma, 11 carcinoid, 46 other histologic types, and 28 of unknown histology). There was a statistically non-significant trend toward increased HR in subjects with high BMI [HR for BMI>27.5 kg/m2, compared with 22.6-25.0, 1.50; 95% confidence interval (CI) 0.76-2.96]. No association was suggested for tobacco smoking; men drinking>400 g of ethanol per week had an HR of 1.57 (95% CI 0.66-3.70), compared with abstainers.

CONCLUSIONS

Our study supports the hypothesis that elevated BMI may be a risk factor for small intestine cancer. An etiologic role of alcohol drinking was suggested. Our results reinforce the existing evidence that the epidemiology of small intestine cancer resembles that of colorectal cancer.

GABAergic and glutamatergic modulation in binge eating: therapeutic approach

Lifetime prevalence estimates for binge eating disorder (BED) and bulimia nervosa (BN) are 3.5% and 1.5% among women and 2.0% and 0.5% among men, respectively. Night eating syndromes (NES) affect 1.1%-1.5% of the general population. All of these disorders induce an impaired quality of life and significant disability. Symptom overlaps are reported between substance use disorders and eating disorders such as BED, BN and NES. A growing body of evidence suggests that γ-amino-butyric acid (GABA) and glutamate modulation pathways might be useful targets in the treatment of alcohol and substance use disorders. Their involvement in the reward process and in the regulation of food intake could be the source of new pharmacological strategies for the treatment of eating disorders. We review published data on the efficacy and safety of drugs targeting the GABA and glutamate modulation pathways for the treatment of BED, BN and NES. Preliminary results indicate that baclofen and topiramate are effective in reducing binge eating, craving and weight gain. However, the potential clinical drug-placebo difference is not detected for acamprosate and lamotrigine. Limitations of these studies are discussed. In view of these data, first- and second-line pharmacological interventions are proposed.

Are gait initiation parameters early markers of Huntington's disease in pre-manifest mutation carriers?

Huntington's disease (HD) pre-manifest mutation carriers (PMCs) present early-onset gait disturbances. Gait initiation encompasses the preparation and execution of the first step. By using paradigms with and without external cues, a gait initiation analysis can highlight the interaction between motor and cognitive aspects of movement preparation and execution. Hence, gait initiation disorders may constitute particularly interesting early markers of HD. The objective of the present study was to quantify gait initiation in PMCs. In a case-control study, 17 PMCs (median age: 36.5) were compared with a group of 25 healthy controls (HCs, median age: 36) for gait initiation and a group of 57 HCs (median age: 38) for gait. Presymptomatic mutation carriers displayed a shorter first step duration and lower-amplitude postural adjustments. For the first step duration and speed, these impairments were more pronounced under self-triggered (ST) conditions. The PMCs displayed a lower gait speed, cadence and stride length and higher stride-to-stride variability. The latter parameter seemed capable of differentiating between PMCs and HCs with adequate sensitivity (0.81) and specificity (0.87). We confirmed the early-onset impairment of gait in general and first step execution in particular in PMCs (particularly under ST conditions). The temporal parameters of step execution (e.g. duration) and spatial parameters of postural adjustment (e.g. a backward shift in the centre of pressure) may be worth investigating as early markers of HD. However, two such parameters (stride-to-stride variability and first step duration under ST conditions) already appear to be sufficiently reliable diagnostic tools for differentiating between PMCs and HCs.

[A system of prescriptions without drug approval: example of baclofen]

Baclofen is an anti-spastic drug that acts as an agonist of GABA-B receptors. It also seems to decrease the appetence for alcohol (anti-craving effect), although this effect has not been certified by Authorities for drug approval in France (AMM). However, baclofen receives a great deal of demand by patients hoping to reduce their alcohol consumption. Nonetheless, the lack of AMM and the high doses of baclofen supposed to exert an anti-craving effect often discourage practitioners from prescribing this drug in current medical practice. Therefore, it is preferable for a drug like baclofen to be prescribed under specific regulations. As such, certain criteria similar to those required in clinical trials are necessary to protect patients as well as the prescribing doctors. The criteria that are proposed here are: the use of drugs without AMM approval as a last resort (all other treatments must have failed), the collegiate decision for the drug prescription, good knowledge of the potency of the drug as well as good record keeping of patients and proper supervision. The departments of addiction, pharmacology and pharmacovigilance of the University Hospital of Lille, France present here a medical process named "multidisciplinary consultations for resort treatments of addictions" (CAMTEA). This process is designed to meet all the above mentioned criteria and to allow the use of baclofen as an anti-craving drug in safest conditions. If this proves to be successful with baclofen, it is possible to extend the use of CAMTEA to other drugs without AMM approval in addictologic pathologies.

Radiological consequences of the extreme flooding on the lower course of the Rhone valley (December 2003, south east France)

In early December 2003 unusual weather conditions led to major flooding of the lower Rhone valley. When it floods, the Rhone carries large masses of solid matter in suspension, which potentially includes associated artificial (anthropogenic) radioactive contaminants from soil drainage in the catchment area and from re-uptake of sedimentary matter that has been contaminated with low-level radioactive liquid effluents from almost twenty nuclear facilities situated along the Rhone valley. A sampling campaign was carried out to investigate the level and spread of both sediment mass and associated radioactive contamination across the flooded areas. An attempt was made to assess the radiological consequences of such an extreme event on contamination of the food chain. Our results show that almost 700,000 tons of sediment was transported onto the floodplain, of which 80% were coarse and fine sands. These materials transferred 6660 MBq of 137Cs, 93 MBq of (239+240)Pu, 13 MBq of 238Pu and 204 MBq of 60Co over a surface area of 60 km2. More than 90% of deposited sediments are concentrated in a 10 km2 area of agricultural soils, and we estimated that 18% were plowed into the soil. Nevertheless, the level of activity measured in the vegetable crops and milk was not significantly different from the level measured in similar samples from regions that were not affected by the December 2003 floods.

[Hemodynamic instability and long-term lithium therapy]

Lithium is known to be responsible for many adverse events on the cardiovascular system. Among these events, it was experimentally noted that lithium could block the action of catecholamines on myocardium. The authors report the case of a patient under lithium therapy developing a myocardial infarction secondarily complicated of a severe cardiac failure. The inotropic support essential to balance hemodynamic could be raised only after lithium's stop. This example could be a clinical translation of the experimental effect previously observed.

Comparison of the efficacy and safety of valaciclovir and acyclovir for the treatment of herpes zoster ophthalmicus

OBJECTIVE

To compare the efficacy and safety of valaciclovir and acyclovir in immunocompetent patients with herpes zoster ophthalmicus.

DESIGN

A multicenter, randomized, double-masked study.

PARTICIPANTS

One hundred ten immunocompetent patients with herpes zoster ophthalmicus diagnosed within 72 hours of skin eruption were treated; 56 were allocated to the valaciclovir group and 54 to the acyclovir group.

METHODS

Patients randomized to the valaciclovir group received two 500-mg tablets of valaciclovir three times daily and one tablet of placebo twice daily. Patients in the acyclovir group received one 800-mg tablet of acyclovir five times daily and one tablet of placebo three times daily for 7 days.

MAIN OUTCOME MEASURES

Main outcome measures included the frequency, severity, and duration of ocular complications, patient reports of zoster-associated pain, and the outcome of skin lesions. Tolerance was also assessed on the incidence and types of adverse effects and changes in laboratory parameters. The analysis was mainly descriptive and performed on an intent-to-treat basis.

RESULTS

Ocular complications of herpes zoster ophthalmicus were similar in the valaciclovir and acyclovir treatment groups. The main complications were conjunctivitis (54% and 52%, respectively), superficial keratitis (39% and 48%, respectively for punctate keratitis; 11% in each group for dendritic keratitis), stromal keratitis (13% in each group), and uveitis (13% and 17%, respectively). The long-term outcomes of these ocular complications were favorable and similar in both treatment groups. Pain duration and severity and outcome of skin lesions were similar between groups. Most patients reported prodromal pain. After 1 month, 25% of patients in the valaciclovir group and 31% in the acyclovir group still reported pain. The percentage of patients experiencing postherpetic neuralgia decreased during follow-up. The tolerance to acyclovir and valaciclovir was comparable and considered good. The most frequent adverse events were vomiting and edema of the eyelids or face (3%-5%). Three serious adverse events not linked to the study drugs occurred.

CONCLUSIONS

Valaciclovir is as effective as acyclovir in preventing ocular complications of herpes zoster ophthalmicus, including conjunctivitis, superficial and stromal keratitis, and pain. Tolerability of the two drugs is similar, but the dosing schedule of valaciclovir is simpler.

Detection of the peripheral nervous system (PNS)-type glial fibrillary acidic protein (GFAP) and its mRNA in human lymphocytes

Glial fibrillary acidic protein (GFAP), an astroglial marker, has been detected in the peripheral nervous system (PNS) in a shorter version and its mRNA in a longer form (beta-type) than the brain alpha-type. To determine the characteristics of the GFAP gene expression in nonneural cells, we have investigated its in vivo transcription and translation products in human lymphocytes. Using RT-PCR, we demonstrate that the GFAP gene is transcribed in these cells. Most or all of the mRNA resulting from this transcription was longer than the brain-type at its 5' end and thus may correspond to the beta-type. In addition, immunoblotting of lymphocyte extracts with a monoclonal antibody revealed a 41 KDa fragment instead of the 50 KDa expected from brain GFAP. These results suggest that GFAP expression in lymphocytes is preferentially of the PNS beta-type giving rise to longer mRNA and shorter protein. However, compared to two other astroglial mRNAs (S-100beta and aldolase C) which were synthesized in significant amounts in lymphocytes, GFAP mRNA was detected in minute amounts representing 0.03% of the brain level. This low expression may subserve a special role in lymphocytes since it is translated.

High-volume, zero-balanced hemofiltration to reduce delayed inflammatory response to cardiopulmonary bypass in children

BACKGROUND

In previous studies, researchers suggested a beneficial role of hemofiltration performed during cardiopulmonary bypass in children. This study was performed to assess both clinical effects and inflammatory mediator removal by high-volume, zero-fluid balance ultrafiltration during rewarming (Z-BUF).

METHODS

Twenty children undergoing cardiac surgery were assigned randomly to Z-BUF or a control group. Plasma C3a, interleukin (IL)-1, IL-6, IL-8, IL-10, tumor necrosis factor, myeloperoxidase, and leukocyte count were measured before (T1) and after (T2) hemofiltration and 24 h later (T3). The intensive care unit staff was blinded to the patient's group. Postoperative alveolar-arterial oxygen gradient, time to extubation, body temperature, and postoperative blood loss were monitored.

RESULTS

Ultrafiltration rate was 4,972 (3,183-6,218) mL/m2 (median [minimum-maximum]) in the Z-BUF group, where significant reductions were observed in postoperative blood loss, time to extubation (10.8[9-18] vs. 28.2 [15-58] h) and postoperative alveolar-arterial oxygen gradient (320 [180-418] vs. 551 [485-611] mmHg at T3). In the Z-BUF group, significant removal of tumor necrosis factor, IL-10, myeloperoxidase, and C3a were observed at T2. Interleukin 1, IL-6, IL-8, and myeloperoxidase were decreased at T3, suggesting earlier removal of factor(s) that may trigger their release.

CONCLUSIONS

These results suggest that hemofiltration exerts some beneficial clinical effects that are not due to water removal. The role of the early removal of factors triggering the inflammatory response, rather than a direct removal of cytokines, deserves further investigation.

Glutamine synthetase gene expression in a glioblastoma cell-line of clonal origin: regulation by dexamethasone and dibutyryl cyclic AMP

We investigated the expression of glutamine synthetase (GS), an enzyme involved in astroglial metabolism and marker of astroglial functional maturity, in a glioblastoma cell-line (GL-15) of clonal origin. In spite of their phenotypic immaturity, evidenced in a mosaic fashion by a poor glial fibrillary acidic protein (GFAP) expression, the level of GS-mRNA is high in GL15 cells and the considerable amount of GS biological activity can be further induced and stabilized by glucocorticoids. A correlation between the induction by dexamethasone of the GS-mRNA level and the GS biological activity suggests a transcriptional regulation of GS expression by the aforesaid hormone. Under this hormonal action, changes in cell morphology occur and they are correlated with an overexpression of the GFAP, a marker of astroglial differentiation. On the contrary, dibutyryl cyclic AMP (dbc AMP) down-regulates the GS-mRNA expression and decreases GS activity. These results suggest that GL-15 cells have a common glucocorticoid dependent mechanism able to induce GS and GFAP as well as morphological changes. However in these cells AMPc responsive elements are involved in the negative modulation of the GS expression, contrary to what occurs in normal astroglial cells.

In vivo evaluation of a trileaflet mechanical heart valve

Design goals for a mechanical heart valve include duplicating the hemodynamic performance of the natural valve, eliminating the need for anticoagulants, and maintaining safety. The Lapeyre-Dassault (Dassault-Aviation, Paris, France) prosthetic valve, undergoing development, addresses these goals. The unique trileaflet design consists of a solid titanium ring and three leaflets. Prototypes of the valve fabricated with Delrin leaflets were implanted in the mitral position in six calves (70-90 kg). Four calves (Studies 1, 2, 3, 5) had long-term survival of 165, 158, 219, and 281 days, respectively. Two calves were killed, one on Day 37 and one on Day 39, after complications unrelated to the valve developed. In all calves heparin was given intravenously to maintain partial thromboplastin time at 1.5 to 2.0 x baseline for approximately 1 week. In Studies 1 and 2 full anticoagulation and antiplatelet therapy was given (orally administered sodium warfarin to maintain prothrombin time at 1.5 to 2.0 x baseline, along with aspirin (1 g/day) and dipyridamole 400 mg/day). In Study 3, all anticoagulation and antiplatelet therapy was discontinued at 1 month after implant. In Study 5, no anticoagulation therapy was given after the initial week of intravenous heparin; however, antiplatelet therapy was started on the fifth postoperative month and maintained until the study's end at 9 months. At 1, 2, 3, and 5 months, the mean plasma free hemoglobin level in the four long-term animals was 5.0 +/- 2.16, 6.0 +/- 3.83, 8.5 +/- 4.93, and 11.3 +/- 6.74 mg/dl, respectively. Hemolysis was not a problem. Valve performance during normal activity was excellent in all the calves, as evidenced by echocardiography and the overall appearance of good health. In the four completed long-term studies, left heart catheterization showed a mean valve pressure gradient of 11.57 +/- 1.26 mmHg and no apparent valvular regurgitation. Histopathologic examination of major organs showed no evidence of thromboembolic events. This study shows that the innovative design of this trileaflet valve performed well in initial in vivo testing, justifying further development.