Nystagmus testing in intoxicated individuals.

BACKGROUND: Law enforcement officers routinely conduct psychophysical tests to determine if an impaired driver may be intoxicated or in need of medical assistance. Testing includes assessment of eye movements, using the Horizontal Gaze Nystagmus (HGN) and Vertical Gaze Nystagmus (VGN) tests, which are conducted at roadside by patrol officers. These tests previously have been validated when the subject is placed in a standing posture with head upright. However, certain conditions require that the subject be tested while seated or supine. Under these conditions, Positional Alcohol Nystagmus (PAN) could be induced and mistaken for HGN or VGN. METHODS: The study was conducted at law enforcement training academy alcohol workshops in the Pacific Northwest. Ninety-six volunteer drinkers were tested when sober and three times after drinking alcohol by 40 volunteer officers experienced in administering the tests. Blood alcohol concentration (BAC) was measured objectively with a calibrated breath analysis instrument each time a subject was tested. RESULTS: The number of eye movement signs observed during the HGN test at any posture increases with increasing BAC. The presence of VGN at any test posture occurs only in the presence of signs of HGN and only at high levels of impairment. PAN was most often observed at BACs of 0.08% and higher, but was never confused with the observation of HGN or VGN, regardless of test posture. CONCLUSIONS: The HGN test administered in the standing, seated, and supine postures is able to discriminate impairment at criterion BACs of 0.08% and 0.10%. The VGN test can identify high levels of impairment at any test posture. Therefore, these tests can be used by an officer to determine if a driver is impaired, regardless of whether the driver is standing, seated, or supine.     

BENIGN GASTROCOLIC FISTULA ASSOCIATED WITH PERITONITIS

SUMMARY Gastrocolic fistula is most often related to malignancy or previous gastric surgery. It is an uncommon complication of benign gastric ulceration in patients who have not had a previous operation. Benign gastrocolic fistula associated with peritonitis is extremely rare — this case is only the fourth ever reported. The patient presented with an acute abdomen, and subsequent investigations demonstrated a gastrocolic fistula of benign aetiology.     

Treatment of advanced uterine sarcoma with adriamycin

Between 1971 and 1979, 39 patients with clearly measurable metastatic or advanced recurrent sarcoma of uterine origin were treated with Adriamycin, either alone or in combination with other chemotherapeutic drugs. The median survival was 7.2 months. No patient lived beyond 32 months from the start of chemotherapy. The response rate was 10.3% (10.3% partial responses and no complete responses). The median duration of a partial response was 4 months. There was no difference between the median survival of the responders and nonresponders.     

Agreement rates between oral contraceptive users and prescribers in relation to drug use histories

A comparison between prescriber records and patient-reported oral contraceptive histories obtained during a case-control study of thromboembolism and oral contraceptive use served as the basis for evaluating the extent of agreement between these two sources of information. Agreement between oral contraceptive user and prescriber was highest on the name of the most recently-used product (89% agreement), and dropped to 62.5% on the name of the product taken before the more recent one. For total duration of oral contraceptive use (to within one month of hospital admission), agreement (defined as differences not exceeding one month) was 36%, while 39% showed the users reporting longer duration of use, and 25% showed users reporting shorter duration. Cases showed a higher rate of agreement with prescriber records than the controls on both the name of the product and the total duration of use. Disagreement from prescriber records in the direction of reporting longer duration of use was 45% for the controls compared to 27% for the cases. These results indicate that while user information in connection with the most recently used oral contraceptive can be acceptable in studies employing the case-control research strategy, user reports about previous oral contraceptive use may be less useful.