The frequency of narcotic use before and after admission to a methadone maintenance program

A total of 453 program participants of the Narcotic Abuse Treatment Program, San Diego Country, a methadone maintenance program, were asked to report their use of heroin prior to and after program participation. Results indicated a significant reduction in reported heroin use, suggesting that the program has affected change in the quantity of heroin used by participants and that heroin use of program participants is not sufficient by itself to motivate other criminal involvement. A program may be effecting a reduction in heroin use by clients as well as criminal activity, but the effects may be totally unrelated.     

Effect of sodium valproate in three patients with organic brain syndromes

Three patients with organic and affective symptoms related to multiple sclerosis or systemic lupus erythematosus responded dramatically to sodium valproate after other treatments had failed.     

In-111-labeled leukocyte scintigraphy in suspected orthopedic prosthesis infection: comparison with other imaging modalities

When infection of prosthetic orthopedic implants is suspected, optimal management requires accurate confirmation or exclusion of infection. The authors retrospectively studied 98 patients with possible infection who underwent scanning with indium-111-labeled white blood cells (WBCs) and subsequently underwent surgery within 14 days. At surgery, 50 patients had infections, as determined by means of culture or histologic results. The diagnostic accuracy of In-111 scanning was compared with that of plain radiography, arthrography, three-phase bone scanning, and various clinical and laboratory findings classically associated with infection. Positive findings on In-111 WBC scans and elevated erythrocyte sedimentation rates were found to be the most predictive variables in the diagnosis of septic prostheses (P less than or equal to .001 and P less than or equal to .002, respectively). Likelihood ratio analysis more clearly demonstrated the superiority of In-111 WBC scanning, with positive and negative scans yielding likelihood ratios of 5.0 and 0.16, respectively.     

Dental health in children with cancer

This study investigated the dental health of children (aged 1-14 years) diagnosed with cancer 4-36 months earlier. Sixty patients were examined and interviewed; 43% had untreated decay and only 35% had seen a dentist since their malignancy had been diagnosed. A significant source of bacterial infection is not being treated in this at risk population. The level of dental disease and lack of dental prevention indicates a need to integrate medical and dental care.     

Apparent cross-reactivity of airborne molds and the dermatophytic fungi

Forty-one asthmatic children, 10 to 16.5 years of age, were studied for evidence of infection with dermatophytic fungi. No evidence of past or current infection could be obtained, yet 16, or 39 per cent, showed an immediate allergic reaction to a galactomannan peptide (trichophytin) extracted from Trichophyton mentagrophytes. Thirteen of these 16 children (81 per cent) also had immediate allergic reactions to antigens extracted from nonpathogenic, airborne molds. The antibody, presumably IgE, responsible for type I allergic reactions to airborne molds, apparently crossreacts with antigens from the fungi pathogenic for human skin.     

Determinants of IDDM and perinatal mortality in children of diabetic mothers

Offspring of women with insulin-dependent diabetes mellitus (IDDM) have a lower risk of developing IDDM than offspring of men with IDDM (1). To determine whether the risk of diabetes in offspring of diabetic mothers has changed after dramatic improvements in perinatal survival of these infants, we undertook a follow-up study of 1602 pregnancies of 739 women with IDDM who were patients at the Joslin Diabetes Center. Improvements in perinatal survival were abrupt rather than gradual. During the two decades before 1961, perinatal mortality was stable around 23%. After a sudden drop in 1961, it stabilized around 14% until 1975, when it was brought down to 4%, where it has remained. Of the 1391 offspring who survived the neonatal period, IDDM has developed in 21, a cumulative risk of 2.1 +/- 0.5% (SE) by age 20 yr. This is one-third the risk previously reported for offspring of fathers with IDDM and is independent of the calendar time of the births (1). The risk of diabetes in offspring of diabetic mothers is increased in young mothers and is otherwise independent of risk factors for perinatal mortality in this series. We conclude that there is no evidence that selective loss of diabetes-susceptible fetuses in perinatal deaths is a mechanism for the lower incidence of IDDM in the offspring of mothers with IDDM than in those of fathers with IDDM. The principal alternative mechanism is that exposure in utero to an affected mother can protect a fetus from developing IDDM later in life. Induction of immunologic tolerance to the autoantigens of the beta-cells is a plausible mechanism for this protective effect.     

Primary malignant lymphoma of the spleen in systemic lupus erythematosus

Malignant lymphoma has been infrequently reported in the course of systemic lupus erythematosus (SLE). We report a case of primary malignant lymphoma of the spleen, an unusual site of primary lymphoma, complicating the course of systemic lupus erythematosus (SLE). Our patient had been treated with low dose prednisone and hydroxychloroquine only, and her lupus was quiescent at the time of presentation with the lymphoma. Thus primary malignant lymphoma should be considered in the differential diagnosis of splenomegaly in SLE.