Assessment of the Coupling Between RTapex and RR Interval as an Index of Temporal Dispersion of Ventricular Repolarization

To evaluate the dynamic characteristics of the relationlship between the RT and RR intervals we analyzed the RR/RT_apex variability interaction with a dynamic parametric model whose parameters can be directly estimated from the beat-to-beat series RR and RT_opex intervals. The model is designed to separate the fraction of RT_apex variability driven by RR changes from that independent of RR variations and to quantify the gain and phase of the relationship between RR and RT_apex intervals. The percentage of RT_apex variability driven by RR variability was significantly greater in young normal subjects in comparison with postmyocardial infarction patients as well as with agematched control subjects. This new approach based on the quantification of the RT_apex variability dependent and independent of beat-to-beat RR interval changes could be used to quantify the degree of uncoupling between the two signals thus providing a new and noninvasive index of temporal dispersion of ventricular repolarization.     

URINE ETHANOL ASSESSMENT: A HELPFUL METHOD FOR CONTROLLING ABSTINENCE IN ALCOHOLIC LIVER DISEASE

The usefulness of a urine-alcohol determination in the evaluationof abstinence in alcoholic liver disease has been investigatedin 181 patients. Alcohol was tested in morning urine samplescollected on a follow-up visit in 103 patients, and the resultswere compared with those in 78 patients, where three sampleswere collected within the same week; one in the morning andtwo in the evening. Although the percentage of urine samplescontaining alcohol measured in a morning sample was similarto the patients' self-report (31% and 34%, respectively), urineanalysis identified an additional 7% of patients who deniedalcohol intake. Alternatively, serial urine-alcohol determinationswere significantly more effective than patient reports (54%and 35.9%, respectively, P < 0.01), particularly when urinewas collected in the evenings. This difference was due mainlyto the reluctance of women to admit drinking (7.4% of positiveself reports vs 51% of women with alcohol positive urine samples,P < 0.001). We conclude that serial measurements of alcoholin urine were useful tests which should be used to complementpersonal interview in the control of abstinence in patientswith alcoholic liver disease.     

Success and Failure at Inpatient Heroin Detoxification

Predictors of either detoxification success or failure were evaluated during an inpatient trial that compared the efficacy of methadone, clonidine and guanfacine for rapid heroin detoxification. The analysis of such predictors was stimulated by the fact that in order to achieve 90 patients who completed the study (30 in each group), a total of 170 patients had to be included. Of 80 detoxification failures, 10 occurred in the methadone group, 32 in the guanfacine group, and 38 in the clonidine group. Voluntary request for discontinuation of the detoxification schedule was the first cause of failure. There were not statistically significant differences with regard to sociodemographic characteristics and pattern of drug consumption among patients in the three groups who completed detoxification with success or failure. The treatment drug, the type of schedule and the score obtained from the Symptom Checklist-90/Revised (SCL-90/R) were the only predictors of either detoxification success or failure. Inpatient opioid detoxification would be a useful strategy for patients with more severe psychological symptoms.