Neuropsychological Functioning of Opiate-Dependent Patients: A Nonrandomized Comparison of Patients Preferring either Buprenorphine or Methadone Maintenance Treatment

Objectives: In the present study, we investigated whether buprenorphine as a partial μ -opioid receptor agonist is associated with less cognitive impairment than methadone. Methods: Neuropsychological functioning of opioid-dependent patients, previously assigned to methadone (MMP, n = 30) or buprenorphine (BMP, n = 26) maintenance treatment according to their own preference, was compared and dose effects were investigated. Results: MMP and BMP performed equally well on all measures of neuropsychological functioning including the trail making test, the continuous performance test, and a vigilance task. However, patients receiving a higher dose of methadone were impaired in a vigilance task. Conclusions: In a free-choice administration of methadone or buprenorphine, there seems to be no difference in cognitive functioning. Possible explanations are discussed.     

Diaphragmatic paresis as a manifestation of large artery vasculitis.

We describe the initial presentation and followup of a 54-year-old Caucasian woman who presented in 1995 with bilateral arteritis of the axillary arteries and acute onset dyspnea. Chest radiograph, chest fluoroscopy, and pulmonary function studies confirmed the diagnosis of right hemidiaphragmatic paresis. Prednisolone and methotrexate therapy and short term anticoagulation were initiated and she experienced no further sequelae during 2 years of followup.     

Influence of age, alcohol consumption and abstinence on the sensitivity of carbohydrate-deficient transferrin, gamma-glutamyltransferase and mean corpuscular volume.

Duration of abstinence before blood test, alcohol consumption and age was examined in 177 male alcohol-dependent patients as factors influencing serum carbohydrate-deficient transferrin (CDT), serum gamma-glutamyltransferase (GGT) and mean corpuscular volume (MCV). The strongest influence on all markers was the factor 'duration of abstinence before blood test'. In patients who had been abstinent for >4 days before the blood test, the markers had low sensitivities (GGT, 33%; CDT, 14%; MCV, 42%), whereas in patients with < or = 4 days of abstinence the markers had reasonably good sensitivities (GGT, 72%; CDT, 56%; MCV, 48%). GGT was more sensitive than CDT (P < 0.05) and MCV (P < 0.001). The combined use of CDT and GGT had sensitivity of over 90%. Mean alcohol consumption in the 30 days prior to the blood test had a significant effect on CDT and GGT, but not on MCV. Age did not have a clear effect on CDT and GGT. For MCV, a significant and linear increase with age was shown. We conclude that GGT is the most sensitive of these three markers. Using GGT and CDT combined, sensitivity can be enhanced to over 90%. The period of abstinence before the blood test has a strong influence on CDT and GGT. If a longer period of abstinence is suspected, MCV should also be measured, in order to detect evidence of earlier heavy drinking.     

Does the Extent of Operation Influence the Prognosis in Patients With Melanoma Metastatic to Inguinal Nodes?

Background: The role of pelvic lymphadenectomy in melanoma metastatic to the superficial inguinal region remains controversial. Some researchers advocate aggressive surgical management,whereas others feel that outcome depends more on extent of disease rather than extent of treatment.We reviewed our recent experience to investigate possible therapeutic effects of extended surgery.Methods: We performed a retrospective clinical and pathological review of 227 consecutive patients having superficial (SLND) or combined inguinal lymphadenectomy (CLND) for cutaneous melanoma.Results: A total of 174 SLNDs and 53 CLNDs were performed. Overall 5-year survival for node-positive patients was 39%. Survival for patients with positive superficial nodes was 40%; for those with positive deep nodes it was 35% (P = ns). In node-positive patients, number and size of involved lymph nodes and the presence of extranodal spread, failure to receive adjuvant therapy, and tumor ulceration were associated with poorer prognosis. Extent of surgery was not associated with differential survival, although CLND patients had worse pathological features. Subgroup analysis showed no significant survival difference between SLND and CLND.Conclusions: Some patients with deep nodal involvement apparently are cured by CLND. However, it is the biology of the disease and not the extent of surgery that primarily governs outcome. Patients with clinical or radiological evidence of pelvic nodal disease without evidence of systemic disease should have a CLND, but we find no evidence to support CLND if the pelvic nodes are clinically and radiologically negative.