Buprenorphine responders: a diagnostic subgroup of heroin addicts?

1. A 26-32 month follow-up of 16 heroin-dependent subjects who entered a pilot trial of treatment with buprenorphine (a mixed agonist/antagonist) suggests that positive response to treatment may identify a subgroup of untreated addicts whose levels of psychosocial functioning are intermediate between those for whom methadone (a pure agonist) or naltrexone (a pure antagonist) would be indicated. 2. Buprenorphine's pharmacologic profile provides a missing link in available modalities for opiate dependence treatment, making it acceptable for many addicts who will not accept methadone maintenance treatment, join a residential therapeutic community, or be successful on naltrexone treatment. 3. Eight of the 16 ss were abstinent from heroin while receiving 0.6-3.9 mg/day buprenorphine and counseling. Responders (mean age 34 yrs) had been heroin dependent for a mean of 9.5 years (range 6-17 yrs), all were self-supporting, 4 lived with a non-addicted spouse, 5 had no prior treatment for addiction and 3 had prior naltrexone treatment, but had discontinued it and relapsed. Non-responders (mean age 30 yrs) had been heroin dependent for a mean of 7.4 yrs (range 2-19 yrs), 7 had no regular employment, all were single and 7 had no prior treatment for addiction. 4. Levels of psychosocial functioning (work, home, leisure) and global assessments of functioning were significantly higher for buprenorphine responders than non-responders (p less than .001 and p less than .01 respectively). 5. A new formulation of buprenorphine needs to be developed for addiction treatment, ideally consisting of 0.5 mg and 2.0 mg sublingual tablets.     

Diagnoses of the relatives of schizotypal outpatients

Relatives of 22 schizotypal probands were evaluated for lifetime psychiatric diagnoses. Forty-four (N = 44) of the 97 available relatives were interviewed directly using the Diagnostic Interview Schedule. The rates of psychiatric diagnoses were compared with those of sixty-six (N = 66) of 140 relatives of 30 depressed patients. Family history of mental illness was ascertained by the informant method on the remainder of relatives of both proband groups. The rate of depression found in the relatives of schizotypal patients was 52% in those directly interviewed and 25.7% when informants' reports on unavailable relatives are pooled with direct interview data. These rates were not significantly higher than those found for the relatives of depressed probands (34.8% by direct interview and 21% including reports from informants). The high rates of depression in the relatives of schizotypal probands may indicate that schizotypal personality is associated with affective disorder and not only with schizophrenia. However, the high rates may be due to the presence of depressive character traits in relatives, which inflate the rates of dysthymic disorder and other chronic depressive disorders in the relatives of borderline patients.     

Polyostotic fibrous dysplasia of the cervical spine: case report and review of the literature.

BACKGROUND CONTEXT: Multiple lytic lesions of the spine usually represent metastatic or infectious disease processes. PURPOSE: To describe an extremely rare presentation of an uncommon disease process. STUDY DESIGN/SETTING: Case report/university hospital. METHODS: We describe the management of a patient who presented with a pathological fracture of C3 and multiple lytic lesions of the cervical spine. RESULTS: After reconstructive surgery, the final pathological diagnosis was fibrous dysplasia. CONCLUSION: Fibrous dysplasia is rarely seen in the cervical spine and may mimic other pathological processes. The surgical and medical management of spinal fibrous dysplasia is described.     

Localization of epileptogenic foci using a simple reference-subtraction montage to document small interchannel time differences

We present a modified EEG montage that detects small interchannel time differences and assists in localizing the epileptogenic focus. Regions with apparently synchronous epileptic discharges are displayed simultaneously in referential and subtraction derivations. The subtraction derivation is a bipolar configuration of two regions of interest that are not necessarily adjacent. The referential derivation reveals the polarity, voltage, and morphology of the two discharges, and the subtraction derivation detects asynchrony; the combined reference-subtraction derivation thus indicates the region that is activated first.     

Human immunodeficiency virus cultured from bone. Implications for transplantation

This study demonstrates by a virologic culture method that human immunodeficiency virus (HIV) resides in bone. After freezing, some initially positive specimens no longer yielded virus, but those that continued to yield virus were not further altered by subsequent washing, which removed essentially all marrow, or by freeze-drying. The safeguards against potential transmission of HIV by a bone allograft are principally the screening and testing methods previously described, although there may be a further reduction of the remote residual risk by the freezing step in the usual technical sequence for tissue banking by sterile techniques.     

The radiographic differential diagnosis of juvenile chronic arthritis

In conclusion, this short communication has emphasized that the well known radiographic features of juvenile chronic arthritis are by no means pathognomonic of this entity. A large differential diagnosis must be considered, including haemophilia, idiopathic multicentric osteolysis, the mucopolysaccharidoses, a variety of skeletal dysplasias, infection, and synovial haemangioma. Correlation of radiographic observations with clinical findings will permit the establishment of an accurate and specific diagnosis in most instances, underscoring the need for close communication between the paediatric radiologist and practising paediatrician.     

Knee joint hyaline cartilage defects: a comparative study of MR and anatomic sections.

The value of routinely used MR sequences in the detection of focal changes of femorotibial articular cartilage was studied. T1-weighted, proton density, and T2-weighted SE as well as gradient echo images were acquired in 20 cadaveric knees (56-88 years old, mean 73.8 years). Three hundred five coronal and sagittal (3 mm) anatomic sections were prepared, and 82 areas of cartilage defects were identified. Initially, in an unblinded fashion, correlation of MR scans and anatomic sections was performed. Fifty-nine lesions (72.0%) were detectable on T1-weighted images, 57 (70.0%) with meniscal windowing, 49 (60.0%) on proton density images, 56 (68.3%) on T2-weighted images, and 54 (65.9%) on gradient echo images. Sixty-eight (83.0%) were visible on at least one type of imaging sequence. Most defects presented as a focus of abnormal signal. Subsequently, images of a subset of 35 pathologic and 35 normal cartilage surfaces were blindly evaluated by two osteoradiology fellows. Sensitivity was 71.4% for the detection of focal cartilage changes, specificity was 68.6%, and accuracy was 70.0%. We conclude that the value of those MR sequences that are routinely used in the analysis of internal derangements of the knee in the detection of focal defects of the hyaline cartilage is limited.     

The deep lateral femoral notch: an indirect sign of a torn anterior cruciate ligament.

Magnetic resonance (MR) imaging has shown that tears of the anterior cruciate ligament (ACL) are frequently accompanied by meniscal and osseous injuries. Abnormalities of the cartilage overlying the lateral femoral condylopatellar sulcus (notch) also have been noted during arthrotomy of ACL-deficient knees. In this study, the appearance of this sulcus on MR images and the depth of the sulcus on conventional radiographs are compared in patients with normal and torn ACLs to determine whether a deep sulcus is a useful indirect sign of a torn ACL. In 62 patients with clinically and/or arthroscopically confirmed normal ACLs, the mean depth of the lateral femoral sulcus was 0.45 mm (range, 0.0-1.2 mm) compared with 0.89 mm (range, 0.0-5.0 mm) in 41 patients with clinically and/or arthroscopically confirmed ACL tears (significant at the 5% level). No patient with a normal ACL had a sulcus greater than 1.2 mm in depth. A sulcus deeper than 1.5 mm is equivalent to 3 standard deviations above the mean and was a reliable indirect sign of a torn ACL.