An Australian survey of the procedures used for the treatment of opiate users

Drug and alcohol agencies across Australia were asked to describe the services they offer to opiate users. Of the 284 agencies identified as providing treatment, 229 (81%) responded. A standard assessment procedure was used in 72% of agencies. Eighty (35%) agencies offered detoxification and had assisted 7883 clients with detoxification in the 12 months prior to March 1990. Methadone maintenance was offered in 20% of agencies with 5234 clients currently receiving this treatment. Daily doses of methadone in the range of 40-80 mg were described for most (51%) clients receiving methadone and concurrent counselling was provided in 45% of cases. Standard psychosocial interventions were provided by 60% of agencies. Out-patient or non-residential settings were most common (36%), with residential therapeutic communities being the setting for 21% of programmes. Supportive counselling was the most commonly used individual approach, and cognitive-behavioural or 12-step approaches were the most commonly used group approaches. Brief support or referral to Nar-Anon were the most popular family interventions. Procedures aimed at reducing the risk of HIV were in place at 85% of agencies. These findings are discussed in light of research evidence. Briefly, there is a diversity of treatment options available from different treatment agencies which is not reflected within the agencies, little aftercare is offered despite high rates of relapse, and doses of methadone are lower than has been found to be optimal.     

Denervation increases clenbuterol sensitivity in muscle from young rats.

Clenbuterol has been shown to ameliorate denervation-induced atrophy and, therefore, clearly has therapeutic potential in the treatment of muscle wasting conditions in man. Previous studies have used dosages in rats which would be unacceptable in clinical practice, but the present results show that denervated muscle has a greater sensitivity to the drug than innervated or cardiac muscle. Fiber hypertrophy and an increase in protein and RNA content could be observed in denervated muscles but not in innervated muscles at a dose of 10 micrograms/kg body weight. When considered on a metabolic body weight basis, the effective dose in rats and the "safe" dose in man are surprisingly comparable. The observations imply that there is good reason to suppose that clenbuterol could be effective in ameliorating similar wasting conditions in man.     

A REVIEW OF CASUALTY PENSIONARY AWARDS : ENTITLEMENT AND ASSESSMENT

Armed Forces personnel and their families are entitled to causalty pensionary awards in the form of disability pension, special or family pension when disability or death has been due to service factors. In this article an effort has been made to make the medical officers in general and medical boards in particular aware of the existing entitlement rules, assessment guidelines, channel of processing and various authorities empowered to decide these claims. Some of the areas needing special consideration by medical boards have been highlighted.KEY WORDS: Casualty pensionary awards, Medical adviser (pensions), Entitlement, Disability, Assessment     

Relationship of ovarian stromal volume to serum androgen concentrations in patients with polycystic ovary syndrome

The aim of this study was to investigate of the relationship of ovarian stromal volume, measured using three-dimensional ultrasound, to serum androgen concentrations in patients with polycystic ovaries. Serum gonadotrophin, oestradiol and androgen concentrations and ovarian volume measurements were obtained in the early follicular phase from 100 women undergoing assisted conception treatment cycles. Group 1 contained 50 women with regular menstrual cycles and normal ovarian morphology, group 2 contained 24 women with regular menstrual cycles and polycystic ovaries seen on ultrasound scan and group 3 contained 26 women with polycystic ovary syndrome. Statistical analysis included analysis of variance, Scheffe's procedure and Pearson's correlation. Total ovarian volume (15.7-16.1 versus 11 ml, P < 0.05), stromal volume (14.5 versus 9.4 ml, P < 0.05) and thecal steroid concentrations were significantly greater in groups 2 and 3. Stromal volume was positively correlated with serum androstenedione concentrations (r = 0.45, P = 0.0019 in group 3) but was not correlated with any other endocrine parameter. It was concluded that polycystic ovaries are characterized by increased ovarian stroma with associated overproduction of theca- derived steroids, particularly androstenedione.