Diagnostic Validity of the Drug Abuse Screening Test in the Assessment of DSM-III Drug Disorders

Diagnostic validity of the DAST was assessed using a clinical sample of 501 drug/alcohol patients. Various DAST cut-points were validated against DSM-III drug abuse/dependence criteria, as assessed by the Diagnostic Interview Schedule, The DAST attained 8S% overall accuracy in classifying patients according to DSM-III diagnosis. This accuracy was maintained between DAST score cut-points of 5/6 through 9/10. Receiver Operating Characteristic analysis indicated that 5/6 was the optimum threshold score. The DAST was also correlated with demographic variables, psychiatric history, and drug use. The results showed very good concurrent and discriminant validity. This study concluded that fairly accurate estimation of DSM-III drug criteria could be made using a brief self-adminstered questionnaire (DAST). However, caution must be expressed when generalizing these findings to other contexts (e.g. the justice system) where subjects may have stronger motivation to under-report drug involvement.     

CIRCULATING ANTIDIURETIC HORMONE DURING LABOUR AND IN THE NEWBORN

Abstract. Leung, A., McArthur, R., McMillan, D., Ko, D., Deacon, J., Parboosingh, J. and Lederis K. (the Divisions of Paediatrics, Pharmacology and Obstetrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada). Circulating antidiuretic hormone during labour and in the newborn. Acta Paediatr Scand, 69: 505, 1980.—Using a high specificity radioimmunoassay, antidiuretic hormone (ADH) concentrations were measured in the plasma of 33 expectant mothers during labour, in cord arterial and venous plasma of their infants at the time of delivery (19 delivered vaginally; 14 delivered by Cesarean section) and in the plasma of the same infants in the first few days of life. Extremely high concentrations of ADH (about 50 times higher than adult basal concentrations) were present in cord arterial blood indicating active fetal production of ADH. Plasma ADH decreased rapidly within an hour after birth and usually fell to adult basal levels during the first day of life. Stressed babies and babies subjected to difficult deliveries had higher plasma levels of ADH.     

Central Nervous System Sarcoidosis

The presenting features, clinical course and outcome of 19 patientswith a diagnosis of CNS sarcoidosis are described. In two-thirdsof the patients the initial features of sarcoidosis were neurological,half of them had an acute monophasic illness and half a chronicprogressive or relapsing course. A favourable outcome was recordedunexpectedly during a study period of one to 16 years for two-thirdsof the patients. The course of the disease in four patientssuggested multiple selerosis thus emphasising the importanceof considering the possibility of CNS sarcoidosis in patientswith suspected demyelinating disease.     

RUPTURE OF DIAPHRAGM ASSOCIATED WITH SPINAL CORD INJURY

A review of 1,007 patients treated at a spinal Injuries unit revealed 11 instances of rupture of the diaphragm. In five patients It took more than 48 hours before the ruptured diaphragm was diagnosed. The hazards of delay In diagnosis and treatment were highlighted by three Instances of gastric perforation - two due to attempted pleural aspiration and one spontaneous. There Is a need for the greater use of contrast radiology In the assessment of these patients.     

CLINICAL USE OF THE WIDE FIELD SPECULAR MICROSCOPE

The Pocklington (Keeler-Konan) wide field specular microscope has been in use for 18 months at the Corneal Diseases Unit, The Royal Victorian Eye and Ear Hospital, Melbourne.
In this study, the microscope has been applied clinically to assess the state of the corneal endothelium and to evaluate comparative endothelial cell density and morphology in certain anterior segment microsurgical procedures. The clinical conditions studied are primary posterior chamber intraocular tens implantatbn, secondary intraocular lens implantation, intraocular lens exchange, and penetrating keratoplasty.     

Human endothelial cell proliferation inhibiting activity in the sera of patients suffering from 'shock' or 'sepsis'

Abstract. The response of DNA-synthesis of human endothelial cells to sera derived from twenty-five patients suffering from 'sepsis' or 'shock' was measured by autoradiographic methods. In eight cases a constant decrease in proliferative response was found compared to that of sera from healthy donors. These proliferation values were shown to lie below the '60%-of-control-line'. The difference between the means of control and of corresponding 'low-response' values was significant ( P <0.05). In three cases a diminished response was caused only by some of several serum samples taken at different times. These results correlated well with the clinical state and outcome of patients but not with any of the over sixty clinical, therapeutic, laboratory and post-mortem parameters of investigation. Evidence is presented for a proliferation inhibiting activity in sera of patients in clinically poor states, and some physico-chemical properties of this 'factor' are described. Lethal injury to the cells or an impairment of cellular migration could not be observed within the observation periods used in this study.     

SEDATION FOR UPPER GASTRO-INTESTINAL ENDOSCOPY: A comparison of oral temazepam and i.v. diazepam

Temazepam 20 mg orally was compared with titrated doses of i.v.diazepam as sedation for elective upper gastro-intestinal endoscopy.The mean time from taking oral temazepam to endoscopy was 66min, and from i.v. diazepam to endoscopy was 10 min. The endoscopistsfound that the sedation achieved was the same in both groupsand allowed adequate examination of the upper alimentary tract.The oral presentation, avoiding the pain of injection and thepossible shorter duration of action, made oral temazepam preferableto i.v. diazepam.