Systolic Indentation of the Left Ventricular Outflow Tract in Eisenmenger Syndrome

Marked bulging of the interventricular septum toward the left ventricle has been described as a reliable index of right ventricular systolic hypertension. We report a patient with Eisenmenger syndrome who has systolic aneurysmal protrusion of the interventricular septum into the left ventricular outflow tract. To our knowledge, this is the first report of systolic indentation of the left ventricular outflow tract in a patient with right ventricular pressure/volume overload.     

A method for producing alcohol placebos

A method for producing placebo drinks that are hard to discriminate from alcoholic drinks is described. Subjects received a series of paired comparisons, each involving a distinctively flavoured alcoholic drink and one of six different placebo versions of it. Following each such comparison, rating scales were used to record the ‘alcoholic strength’ and ‘sensory intensity’ of a placebo drink relative to the alcoholic drink. The procedure was replicated using another distinctive alcoholic drink and another set of placebos. Based upon a multivariate analysis of subjects' ratings, the version of the placebo that was most difficult to discriminate from it's corresponding alcoholic drink was identified for both alcoholic drinks. The method is intended to be a general one for producing placebo versions of alcoholic drinks which do not differ on any dimensions which can be shown to be important in producing a response.     

Review; post-marketing surveillance of the safety of cimetidine—the problems of data interpretation

Experience obtained during post-marketing surveillance of the safety of cimetidine emphasizes the difficulties in interpretation posed by the high background frequency of disease of all types in drug takers. The multiple sources of confounding factors, and their high prevalence, make it impossible to detect adverse events which mimic ordinary disease, particularly when a consistent relationship between adverse event and drug exposure is not observed. The inclusion of controls emphasizes the difficulties but does not ease interpretation.     

Conditioned learning in alcohol dependence: implications for cue exposure treatment

A review of the literature pertinent to cue exposure treatment in alcohol dependence is presented. Psychological models of relapse, based on conditioning and social learning theories, are critically evaluated. In particular, attention is drawn to the potential implications for cue exposure research and treatment of an interaction between Pavlovian and operant conditioning, problems with the application of the concepts of arousal and craving and the importance of a systems model to understand physiological responses. It is concluded that no study has so far demonstrated a link between conditioned responses to alcohol-related cues and relapse, an assumption on which cue exposure treatment is based. Further, the evidence for the effectiveness of cue exposure as a treatment is lacking. Promising research directions are identified.     

A COMPARISON OF HOME DETOXIFICATION AND MINIMAL INTERVENTION STRATEGIES FOR PROBLEM DRINKERS

The Home Detoxification Service (HDS) established in centralScotland was introduced in response to a high admission rateof problem drinkers to the acute psychiatric wards in BellsdykeHospital. This paper reports the results of a comparison oftwo types of management for people referred to the HDS by localgeneral practitioners (family doctors). Ninety-five patientsreferred to the HDS were randomly allocated to two groups ofdiffering treatment intensities. With one group, the home detoxification(HD) programme was utilized and with the other, minimal intervention(MI) strategies were employed. Post-treatment outcome informationcollected after 6 months was examined in relation to drinkingbehaviour, changes in levels of alcohol-related problems anduptake of on-going support from other alcohol agencies. Themajority of patients in both treatment groups demonstrated somedegree of improvement in relation to these criteria and themost striking factor was that patients in the HD group remainedabstinent twice as long after treatment as those in the MI group.     

RECENT DEVELOPMENTS IN DISULFIRAM TREATMENT

This paper reviews the controlled studies which have led tothe increasing recognition that supervised disulfiram is oneof the few demonstrably effective interventions in alcoholism,both alone and as an adjunct to psychoscial methods. The specificallybehavioural implications of disulfiram treatment are also noted.It examines techniques for maximising disulfiram's therapeuticeffectiveness and reviews recent research into its pharmacokineties,mode of action, toxicology and bioavailability. Finally, theprospects for an effective depot preparation are discussed.     

HISTOPLASMOSIS IN THE ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

This case report describes a 50-year-old man from South America with AIDS who developed disseminated histoplasmosis with focal lymph node involvement. Treatment with ketoconazole was initially successful. Six weeks after cessation of ketoconazole he died of what was thought to be relapse of histoplasmosis.     

EFFECTS OF TREATMENT WITH OESTRADIOL/LEVONORGESTREL ON BONE, LIPOPROTEINS AND HORMONE STATUS IN POSTMENOPAUSAL WOMEN

The aim of the study was to investigate the effects of an oestradiol/levonorgestrel regimen, administered parenterally, on bone metabolism, bone density, lipoprotein metabolism and hormone status. Twenty-five women who had undergone a surgical menopause had an oestradiol/levonorgestrel-containing vaginal ring pessary in situ for 6 months. Within the first month there were sustained changes in the biochemical indices of bone metabolism in keeping with a marked reduction in bone turnover and decrease in bone resorption. Bone mineral content in the distal forearm was measured in 14 patients and a small increase was noted in every patient. Levonorgestrel was well absorbed and the serum levels remained almost constant throughout treatment. There was a gradual increase in serum total oestradiol which became significant at 6 months. Dialysable oestradiol levels rose from 2.6% of total oestradiol at 0 time to 3.3% at 1 month with no further change thereafter. SHBG levels were 23% of pretreatment levels at 6 months. There were sustained decreases in triglyceride, VLDL and HDL cholesterol levels and a transient fall in LDL cholesterol. Total HDL, HDL2 and HDL3 cholesterol levels were reduced by 25, 40 and 21% respectively. The results suggest that levonorgestrel exerts a protective influence on bone either directly or by its effect on the proportion of oestradiol circulating in the free, physiologically active form. The effects on lipoproteins were predominately those of the progestogen component, the lipoprotein risk factors for coronary heart disease being adversely affected.