The 'pressures to change' approach to working with the partners of heavy drinkers

The ‘Pressures to Change’ approach to working with the partners of drinkers is a structured procedure for promoting change in resistant drinkers. In this study 22 women and one man were randomly allocated to two treatment conditions and one no-treatment waiting list control condition in an experimental evaluation of the procedure. Group 1 was treated individually and Group 2 was treated as a group. Almost two-thirds of the drinking partners of clients in treatment made a significant move towards change, compared with none of the drinkers in the waiting list control condition.     

Cognitive impairment among the dually-diagnosed: substance use history and depressive symptom correlates

Abstract The present study examined the effects of substance use history and depressive symptomatology on the cognitive functioning of 149 male and 72 female dually diagnosed inpatients. Logistic regression models examined the effects of life-time alcohol and cocaine use, previous month's alcohol and cocaine use and depression on abstract reasoning as assessed by the Shipley Institute of Living Scale (SILS) and neuropsychological functioning as measured by the Screening Test for the Luria-Nebraska Neuropsychological Battery (STLNNB). Results indicated differential effects of substance use across the two cognitive outcome measures. Specifically, a significant relationship was demonstrated for previous month's alcohol use on Shipley classification. However, after adjusting for possible borderline cases, previous month's alcohol use dropped to non-significance and in its stead an association between Shipley classification and life-time use was demonstrated. No significant effects were demonstrated for cocaine use, recent alcohol use, depressive symptoms or any of the interaction terms. The Luria-Nebraska performance classifications were significantly associated with both educational level and life-time cocaine use. No significant relationships were obtained for previous month's cocaine use, the alcohol use variables, depressive symptoms, or any of the interaction terms. The degree of classification agreement between the two outcome measures was slightly better than chance (k=0.24 for ST-LNNB and traditional or full scale SILS; k="0.35" for ST-LNNB and modified SILS). These kappa coefficients suggest that the SILS and ST-LNNB assess partially independent dimensions of cognitive functioning. The findings are discussed in light of previous research and implications for clinical assessment and treatment are outlined.     

Is the lecithin/sphingomyelin ratio outdated?

Summary. The lecithin/sphingomyelin (L/S) ratio in amniotic fluid is an excellent predictor of fetal lung maturity in most pregnancies but today its value is limited. A review of the use of the L/S ratio service in Manchester from 1975 to 1981 (inclusive) shows a dramatic and consistent fall in the number of requests made over the last 18 months of this period resulting in inconvenience and inefficiency in the laboratory service. Possible explanations for the declining use of the L/S ratio service are discussed with particular reference to St Mary's Hospital, Manchester and a regional re-organization of laboratory assessment of fetal lung maturity is proposed.     

Systemic and regional hemodynamics in cyclosporin A hypertension in the rat

SUMMARY: This study examined the hemodynamic effects of 21 days oral administration of cyclosporin A (CyA) in the male Wistar rat. Forty rats were randomly divided into four groups ( n =10). Group 1: Sham (olive oil 1 mL/kg/day by gavage ) with cardiac output (CO) measurement. Group 2: CyA (CyA 15 mg/kg/day in olive oil by gavage ) with CO measurement. Group 3: Sham as for group 1 with regional flow measurements. Group 4: CyA as for group 2 with regional flow measurements. Systolic blood pressure was measured every fourth day. After 21 days mean arterial blood pressure was measured by intra-arterial cannulation, and CO, and renal, mesenteric, and hindquarter blood flows (RBF, MBF, and HBF) were determined using transonic small animal flowmeters. Total peripheral resistance (TPR) and regional resistances were calculated. Oral CyA produced a sustained rise in systolic blood pressure. Olive oil did not affect blood pressure. CyA increased TPR ( P <0.05), renal vascular resistance (RVR, P <0.01) and MBF ( P <0.01), decreased RBF ( P <0.01), but did not change CO, HBF, mesenteric or hindquarter vascular resistance. We conclude that chronic oral administration of CyA produces hypertension with a hemodynamic profile characterized by rises in TPR and RVR without changes in CO or mesenteric or hindquarter vascular resistances in the Wistar rat.     

RAPID COMMUNICATION: ABNORMAL SUPPRESSION OF PLASMA CORTISOL DURING THE INTRAVENOUS INFUSION OF DEXAMETHASONE TO ALCOHOLIC PATIENTS

. In some cases the oral administration of dexamethasone to alcoholic patients has failed to cause a normal depression of plasma cortisol levels. Although alcoholics often show signs of intestinal malabsorption, the possibility that the dexamethasone was not fully absorbed has not previously been considered. To eliminate any question of malabsorption, ten male alcoholic patients were infused intravenously with dexamethasone (1mg/h). The plasma cortisol levels in blood samples withdrawn at half-hourly intervals during a 2-h infusion were compared with the values found in ten normal subjects similarly infused. Four of the alcoholics failed to show normal suppression of plasma cortisol levels, thus confirming that in some alcoholics there is a disturbance of pituitary-adrenal function similar to that found in Cushing's disease. In only one of the four cases was failure to suppress normally associated with the presence of clinical signs of Cushing's disease.     

DEMONSTRATION OF BASAL CELL IMMUNOFLUORKSCENCE IN DRUG-INDUCED TOXIC EPIDERMAL NECROLYSIS

Summary.— In 2 patients with toxic epidermal necrolysls due to penicillin and chlorpromazlne respectively, direct immunofluorescent studies revealed intercellular fixation of immunoglobulins and complement globulins confined to the basal cell Kiyer of the epidermis. These findings suggest that the drug binds to intercellular epidermal protein and that the basal cells are the target site of cellular damage in drug-induced epidermal necrolysls.     

Phase equilibria and stability characteristics of chlorpropamide-urea solid dispersions

Physical mixtures and melts of various compositions of chlorpropamide and urea have been prepared. The phase diagrams and the effects of ageing of the systems have been measured by differential scanning calorimetry. The eutectic composition was found to contain 89% w/w chlorpropamide. Greater concentrations of chlorpropamide produced solid solutions of urea in chlorpropamide, whereas solid solution formation did not occur at compositions less than 89%. Melts in the range 50–100% chlorpropamide, which included the eutectic, existed as glass solids. The effect of ageing produced generally an increase in the liquidus peak temperature which was considered to be due to a gradual increase in crystal size.     

51Cr EDTA determinations of the extracellular fluid volume in hemorrhage: a study with fed and starved rats

Extracellular fluid volumes have been determined in fed and 24–30 h starved rats, before and after 60 min of hemorrhagic hypotension at 70 mmHg. Bilateral renal vascular ligation was carried out to prevent clearance of the isotope tracer used, ⁵¹Cr EDTA. The time taken for a bolus of the tracer to distribute itself in its space, was determined in fed and starved animals after the standard period of hypotension. This was found to be 37 min for fed animals, and 50 min for those which had been starved. When the isotope ECF space was compared before and after hemorrhage in fed animals, it was unchanged, despite an estimated blood volume loss of 39%. The isotope ECF space was reduced 5.5% after hemorrhage in animals which had been starved. It is concluded that fed rats mobilised intracellular fluid to the interstitium in hemorrhage, whereas, starved animals did not. This finding of variable fluid homeostasis is ascribed to the different nutritional status of the animals investigated, and has considerable implications.