Problematic behavior of drug-dependent patients in the general hospital. A clinical and administrative approach to management

Drug-dependent patients in general hospitals behave in ways that are difficult for medical and surgical staff to manage. Common problems include drug-seeking, states of intoxication and withdrawal, poor compliance, and behavior that is disruptive or dangerous to others. The authors describe an approach to these problematic behaviors based upon early recognition, a clinical perspective, and administrative action. Institutional initiatives are needed to overcome the practical and conceptual obstacles to effective management of these patients.     

Toxicosis from and possible adaptation to Galega officinalis in sheep and the relationship to Verbesina encelioides toxicosis

Galega officinalis L (goatsrue), a plant introduced from Europe and found in abundance in northern Utah, was tested for toxicity in ewes (Ovis aries). Clinical signs of poisoning induced by doses as small as 0.8 g of dried plant/kg body weight/day included dyspnea, anoxia, and foaming nasal discharge. Pathologic signs in animals that died following overdose of the plant included severe hydrothorax, generalized lung congestion, foamy exudate in bronchioles and trachea, epicardial and endocardial petechiation, and pericardial effusion in severely affected ewes. Microscopic lesions included a severe diffuse alveolar and interlobular edema. No significant alterations in blood constituents were observed in treated animals. Ewes administered the plant on several consecutive days developed an apparent adaptation to the toxin of the plant and were thereby able subsequently to tolerate levels 5-10 times the pre-treatment lethal dose with no discernible adverse clinical or pathological effects.     

The effects of betamethasone on maternal cellular resistance to infection

Antenatal administration of glucocorticoids is often used to facilitate fetal lung maturation in cases of prematurity; however, the effects of betamethasone on maternal immune function have not been established. Therefore maternal immune function was assessed with the use of in vitro techniques. Transient and incomplete suppression of the proliferative response to the T-cell mitogen phytohemagglutinin was demonstrated as early as 24 hours after administration of betamethasone. The magnitude and duration of suppression showed a corresponding increase with advancing gestational age, but these effects were not cumulative and were always short-lived (less than 72 hours). No such suppression of the B-cell mitogen lipopolysaccharide was detected. The nonspecific cellular resistance to infection of maternal monocytes was determined through coincubation with the facultative intracellular pathogen Listeria monocytogenes. Increased phagocytic activity with a normal bactericidal effect was measured in the cell preparations obtained from recipients versus nonrecipients of betamethasone. Taken together, these findings clearly show that both specific and nonspecific immune function are intact in the preterm gravid woman after administration of betamethasone and should allay concerns over its use for reasons of infection control alone.     

Local complications of self administered anabolic steroid injections.

In addition to the pharmacological side effects of anabolic steroids, complications may also result from the injection technique used in self administration. Two cases are presented where anabolic steroid injections resulted in knee joint sepsis and radial nerve palsy.     

Abstracts

Purpose: To analyse trends in the incidence of registered age-related macular degeneration (ARMD) in the UK since 1950 and to compare these to trends in registration of other blinding diseases —cataract, glaucoma and optic atrophy over the same time period. Methods: Calculation of standardised registration ratios for ARMD, cataract, glaucoma and optic atrophy using published registratoin data from 1950 onwards. SRRs for each sex separately were calculated, adjusting for age in 5 year age-groups. Results: The absolute number of people registered blind annually has more than doubled since 1950. After adjustment for age, annual registration rates for blindness have fallen over the past 40 years, particularly with respect to cataract and glaucoma. Standardised registration ratios for ARMD exhibit a different pattern, increasing, but not consistently, over the same time period. Conclusions: These oberservations are consistent with the hypothesis that the incidence of registrable ARMD is increasing. Changes in the diagnosis and detection of this disease, however, cannot be excluded as an alternative explantation. Analysis of trends in national registration statistics may be useful for monitoring changes in the distribution of blinding eye disease in the population.