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...on medical aspects
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www.ProjectCork.org
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Fall 2003
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Acupuncture for alcohol withdrawal: A randomized controlled
trial.
Trumpler F; Oez S; Stahli P; Brenner HD; Juni P. Alcohol and
Alcoholism 38(4): 369-375, 2003. (30 refs.)
Background and Aims: Previous trials on acupuncture in alcohol addiction were
in outpatients and focused on relapse prevention. Rates of dropout were high
and interpretation of results difficult. We compared auricular laser and needle
acupuncture with sham laser stimulation in reducing the duration of alcohol withdrawal.
Methods: Inpatients undergoing alcohol withdrawal were randomly allocated to
laser acupuncture (n = 17), needle acupuncture (n = 15) or sham laser stimulation
(n = 16). Attempts were made to blind patients, therapists and outcome assessors,
but this was not feasible for needle acupuncture. The duration of withdrawal
symptoms (as assessed using a nurse-rated scale) was the primary outcome; the
duration of sedative prescription was the secondary outcome. Results: Patients
randomized to laser and sham laser had identical withdrawal symptom durations
(median 4 days). Patients randomized to needle stimulation had a shorter duration
of withdrawal symptoms (median 3 days; P = 0.019 versus sham intervention), and
tended to have a shorter duration of sedative use, but these differences diminished
after adjustment for baseline differences. Conclusions: The data from this pilot
trial do not suggest a relevant benefit of auricular laser acupuncture for alcohol
withdrawal. A larger trial including adequate sham interventions is needed, however,
to reliably determine the effectiveness of any type of auricular acupuncture
in this condition.
Copyright 2003, Medical Council on Alcoholism.
Acute leukoencephalopathy after inhalation of a single dose of heroin.
Vella S; Kreis R; Lovblad KO; Steinlin M. Neuropediatrics 34(2): 100-104,
2003. (15 refs.)
We describe extended and repeat magnetic resonance (MR) examinations in the case
of a 16-year-old male who developed acute left-sided sensorimotor hemiplegia
after a single dose of inhaled heroin. MRI revealed symmetrical hyperintense
signals in T-2-weighted images and massive diffusion disorders in the diffusion
weighted images predominantly in parieto-occipital subcortical white matter and
both ventral globi pallidi with preservation of U fibers and no brain oedema.
MR spectroscopy data were compatible with combined hypoxic and mitochondrial
damage resulting in axonal injury without demyelination. Normal values and variations
had been obtained from spectra of five age-matched subjects. This is the first
reported MR follow-up study of leukoencephalopathy occurring acutely after a
first inhaled dose of heroin. We postulate that toxic spongiform leukoencephalopathy
in heroin addicts may be the outcome of a complex mechanism directly triggered
by heroin and causing mitochondrial as well as hypoxic injury in specific and
limited areas of white matter.
Copyright 2003, Hippokrates Verlag.
Alcohol affects executive cognitive functioning differentially on the ascending
versus descending limb of the blood alcohol concentration curve.
Pihl RO; Paylan SS; Gentes-Hawn A; Hoaken PNS. Alcoholism: Clinical and Experimental
Research 27(5): 773-779, 2003. (29 refs.)
Background: Executive cognitive functioning (ECF), a construct that includes
cognitive abilities such as planning, abstract reasoning, and the capacity to
govern self-directed behavior, has been recently researched as an antecedent
to many forms of psychopathology and has been implicated in alcohol-related aggression.
This study was designed to examine whether differential ECF impairments can be
noted on the ascending versus the descending limbs of the blood alcohol concentration
curve. Methods: Forty-one male university students participated in this study.
Twenty-one subjects were given 1.32 ml of 95% alcohol per kilogram of body weight,
mixed with orange juice, and the remaining 20 were given a placebo. Participants
were randomly assigned to either an ascending or descending blood alcohol group
and were tested on six tests of ECF. Subjective mood data were also collected.
Results: Intoxicated participants on both limbs demonstrated ECF impairment;
the descending-limb group showed greater impairment than their ascending-limb
counterparts. Intoxicated subjects were significantly more anxious at baseline
than placebo subjects. The introduction of this covariate nullified any significant
differences in subjective mood found on either limb of the blood alcohol concentration
curve, but ECF impairments remained robust. Conclusions: Results support the
con-clusion that alcohol negatively affects cognitive performance and has a differential
effect on the descending versus the ascending limb of the blood alcohol concentration
curve. The latter finding may have important ramifications relating to the detrimental
consequences of alcohol intoxication.
Copyright 2003, Research Society on Alcoholism.
Alcohol consumption and HIV disease progression: Are they related?
Samet JH; Horton NJ; Traphagen ET; Lyon SM; Freedberg KA. Alcoholism: Clinical
and Experimental Research27(5): 862-867, 2003. (41 refs.)
Background: The relationship between alcohol consumption and HIV disease progression
has received limited attention in the era of highly active antiretroviral therapy
(HAART). Methods: We assessed CD4 cell count, HIV RNA levels, and alcohol consumption
in the past month, defined as none, moderate, and at risk, in 349 HIV-infected
people with a history of alcohol problems. We investigated the relationship between
alcohol consumption and HIV disease markers CD4 cell count and HIV RNA level,
stratified by HAART use, using multivariable regression. Results: No significant
differences in CD4 cell count or HIV RNA level were found across the categories
of alcohol consumption for patients who were not receiving HAART. However, among
patients who were receiving HAART, log HIV RNA levels were significantly higher
in those with moderate (2.17 copies/ml) and at-risk (2.73 copies/ml) alcohol
use compared with none (1.73 copies/ml; p=0.006). CD4 cell counts in those with
moderate (368 cells/mul) and at-risk (360 cells/mul) alcohol use were lower than
for subjects who reported none (426 cells/mul; p=0.07). Conclusion: Among patients
who have a history of alcohol problems and are receiving antiretroviral treatment,
alcohol consumption was associated with higher HIV RNA levels and lower CD4 counts.
No comparable association was found for similar patients who were not receiving
HAART. Addressing alcohol use in HIV-infected patients, especially those who
are receiving HAART, may have a substantial impact on HIV disease progression.
Copyright 2003, Research Society on Alcoholism.
Alcohol intoxication increases allopregnanolone levels in female adolescent
humans.
Torres JM; Ortega E. Neuropsychopharmacology 28(6): 1207-1209, 2003. (17
refs.)
Teenage drinking is a cause of growing concern in industrialized countries, where
almost 35% of alcohol drinkers are under 16 years old. Increased anxiety, irritability,
and depression among adolescents may induce them to seek the anxiolytic and rewarding
properties of alcohol. We studied the effects of acute alcohol intoxication (AAI)
on the plasma levels of progesterone and allopregnanolone in female adolescents.
Blood samples were drawn from female adolescents who arrived at the emergency
department. One study group was formed by those who arrived with evident behavioral
symptoms of AAI and the other by those arriving for mild trauma (contusions,
sprains) after no consumption of alcohol (controls). Our results demonstrate
that AAI significantly increases serum progesterone and allopregnanolone levels
in both follicular and luteal phases of the ovarian cycle. Since alcohol and
allopregnanolone positively modulate gamma-aminobutyric acid type A (GABA(A))
receptors, allopregnanolone may play a major role in the anxiolytic and rewarding
effects of alcohol, either directly or by influencing the sensitivity of GABA(A)-receptors
to alcohol.
Copyright 2003, American College of Neuropsychopharmacology.
Biphasic stimulant and sedative effects of ethanol: Are children of alcoholics
really different?
Erblich J; Earleywine M; Erblich B; Bovbjerg DH. Addictive Behaviors 28(6):
1129-1139, 2003. (30 refs.)
Children of alcoholics (COAs) have an increased risk of developing alcoholism
themselves. The mechanisms responsible are not yet known. One compelling theory
postulates that COAs may have an increased sensitivity to the stimulant effects
of alcohol during the ascending limb of the blood alcohol curve combined with
a decreased sensitivity to the putatively undesirable sedative effects of the
drug during the descending limb, providing a particularly strong motivation to
drink. Consistent with this theory, we hypothesized that compared to children
of nonalcoholics (CONAs), COAs would display higher levels of ascending limb
stimulation and lower levels of descending limb sedation. In the present study,
100 college students, who were either COAs (n=18) or CONAs (n=82), completed
the Biphasic Alcohol Effects Scale (a self-report measure of stimulation and
sedation): (1) before consuming 0.85n ml/kg ethanol; (2) during the ascending
limb of their BAC, and; (3) during the descending limb of their BAC. Although
findings indicated that COAs and CONAs had comparable levels of sedation at each
time point, a significant Group-Time interaction (P<.02) indicated that COAs
had greater increases in stimulation from baseline than CONAs, providing partial
support for our hypothesis. Interestingly, simple effects analyses revealed that
COAs had lower baseline levels of stimulation but almost identical levels of
ascending and descending limb stimulation as CONAs, suggesting that increased
sensitivity to alcohol among COAs may be the result of baseline understimulation.
Findings suggest that theorized differences between COAs and CONAs may be due
in part to broader trait differences or other nonpharmacological factors.
Copyright 2003, Elsevier.
Cocaine and the critical care challenge. (review).
Shanti CM; Lucas CE. Critical Care Medicine 31(6): 1851-1859, 2003. (83
refs.)
Objective. Cocaine, which first made its appearance >1,000 yrs ago, is now widely
used throughout the world. The physiologic responses to cocaine may cause severe
pathologic effects. This review highlights the many critical care challenges
resulting from these effects. Design: Historical vignettes, epidemiologic factors,
modes of preparation and delivery, and the physiologic and pharmacologic effects
of these agents are presented. Setting. Cocaine causes intense vasoconstriction,
which potentially causes damage to all organ systems. Examples of these toxicities
are presented. Patients, The adverse multisystern responses to cocaine exposure
produce organ failure, which challenges diagnostic accuracy and therapeutic intervention.
Organ system failure involves the brain, heart, lung, kidneys, gastrointestinal
tract, musculature, and other organs. Harmful effects are additive to pre-existing
organ dysfunction. Intervention: Recognition of associated cocaine injury alerts
the physician that organ dysfunction is more likely to be more severe. Such anticipation
helps plan for therapy in the critical care setting. Results and Conclusions.
Cocaine use is an expanding health hazard, despite intense governmental efforts
to contain its distribution and use. Recognition of the signs and symptoms of
cocaine toxicity help anticipate the subsequent organ dysfunction and implement
earlier organ system support.
Copyright 2003, Williams & Wilkins.
Cocaine use as a predictor of outcome in aneurysmal subarachnoid hemorrhage.
Howington JU; Kutz SC; Wilding GE; Awasthi D. Journal of Studies on Alcohol 64(4):
271-275, 2003. (29 refs.)
Object. The goal of this study was to analyze the relationship between cocaine
use and outcomes of aneurysmal subarachnoid hemorrhage (SAH).Methods. A retrospective
review was performed of the medical records of patients with intracranial aneurysms
treated at a single institution between January 1996 and December 2001. Only
patients who presented with SAH were included in the study. The covariates chosen
for the statistical analysis included the following: patient age, sex, and race;
systolic and mean arterial blood pressure measurements on hospital admission;
Hunt and Hess and Fisher grades; preexistent major systemic disease; and history
of alcohol, tobacco, or cocaine use. The Glasgow Outcome Scale (GOS) was used
to standardize outcome and was dichotomized such that a score between I and 3
was considered a poor outcome and a score of 4 or 5 was considered a favorable
outcome.The records of 151 patients were reviewed and 108 of these presented
with aneurysmal SAH. Of these 108 patients, 36 (33.3%) had used cocaine within
24 hours before presentation. A Hunt and Hess grade of IV or V was assigned to
20 (55.6%) of 36 patients who used cocaine, compared with eight (11.1%) of 72
patients who did not; this difference was found to be statistically significant
(p < 0.0001). Twenty-eight patients (77.8%) in the cocaine user group and 20
patients (27.8%) in the non-cocaine user group experienced clinically significant,
angiographically confirmed vasospasm during their hospital course (p < 0.0001).
Cocaine use was associated with a 2.8-fold greater risk of developing vasospasm
(95% confidence interval [CI] 1.86-4.22). A GOS score of 1, 2, or 3 was assigned
to 33 patients (91.7%) in the cocaine user group and to 20 patients (27.8%) in
the non-cocaine user group (p < 0.0001). Cocaine use was associated with a 3.3-fold
greater risk of poor outcome (95% CI 2.24-4.85). This association was found to
be independent of Hunt and Hess grade as well as of vasospasm. Conclusions. Cocaine
adversely affects both the presentation of and outcome in patients with aneurysmal
SAH who are undergoing treatment for this disease. The vasoactive properties
of the drug appear to aggravate the already tenuous situation of SAH and increase
both the occurrence and influence of cerebral vasospasm. Statistical analysis
demonstrates that cocaine directly affects both presentation and outcome in a
significant manner. It is the authors' interpretation of the results of this
retrospective review that cocaine use negatively affects outcome to such an extent
that it should be considered equal to the presence of a major systemic illness
when determining Hunt and Hess grade.
Copyright 2003, Alcohol Research Documentation, Inc.
Impact of lifestyle on perioperative smoking cessation and postoperative
complication rate.
Moller AM; Pedersen T; Villebro N; Norgaard P. Preventive Medicine 36(6):
704-709, 2003. (39 refs.)
Objective. The aim was to examine to what extent lifestyle, education, social
support, and comorbidity predict the ability of perioperative smoking, cessation,
and are associated with the development of important postoperative complications.
Design. A randomized clin-ical trial. Setting. University hospitals in Copenhagen,
Denmark, were the settings. Participants and methods. One hundred twenty patients
scheduled for primary elective hip or knee arthroplasty were randomized to either
smoking intervention or standard care. Tobacco and alcohol consumption, exercise
and eating habits, level of education, matrimonial status, and the presence of
social support were registered. The data gathered concerned smoking cessation/reduction
and severe postoperative morbidity. Results. Men and patients with a good social
network were more likely to successfully quit smoking. Smoking intervention successfully
reduced the incidence of postoperative complications, as did weekly exercise
exceeding 4 h, and having a high education level. Conclusion. This study emphasizes
that smoking intervention programs are highly effective in reducing postoperative
risks in hip and knee arthroplasty.
Copyright 2003, American Health Foundation.
Respiratory health effects of cannabis: Position statement of the Thoracic
Society of Australia and New Zealand.
Taylor DR; Hall W. Internal Medicine Journal 33(7): 310-313, 2003. (30
refs.)
Both the gaseous and the particulate phases of tobacco and cannabis smoke contain
a similar range of harmful chemicals. However, differing patterns of inhalation
mean that smoking a 'joint' of cannabis results in exposure to significantly
greater amounts of combusted material than with a tobacco cigarette. The histopathological
effects of cannabis smoke exposure include changes consistent with acute and
chronic bronchitis. Cellular dysplasia has also been observed, suggesting that,
like tobacco smoke, cannabis exposure has the potential to cause malignancy.
These features are consistent with the clinical presentation. Symptoms of cough
and early morning sputum production are common (20-25%) even in young individuals
who smoke cannabis alone. Almost all studies indicate that the effects of cannabis
and tobacco smoking are additive and independent. Public health education should
dispel the myth that cannabis smoking is relatively safe by highlighting that
the adverse respiratory effects of smoking cannabis are similar to those of smoking
tobacco, even although it remains to be confirmed if cannabis alone leads to
the development of chronic lung disease.
Copyright 2003, Royal Australian College of Physicians.
In utero cocaine exposure: A thorny mix of science and mythology. (review).
Vidaeff AC; Mastrobattista JM. American Journal of Perinatology 20(4):
165-172, 2003. (48 refs.)
Fetal cocaine exposure has proven to be an area of medicine that has generated
more heat than light. Although many reports associate cocaine with a variety
of isolated structural anomalies, there is no detectable syndromic clustering,
raising doubts about a real causal association or a specific teratogenic action.
Potential confounding variables, including the abuse of other drugs, pregnancy
deprivations, and socially patterned maternal behaviors, have limited the reliability
of observational studies, making it difficult to demonstrate effects solely attributable
to cocaine. The clinical expression of in utero cocaine exposure is contextual,
critically dependent on the biology/environment interplay. The present work summarizes
the fetal structural anomalies that have been associated in the literature with
cocaine use during pregnancy, and reviews the putative mechanisms of fetal impairment
secondary to cocaine exposure. The final discussion highlights the need for innovative
approaches to assure that the myths conjured up about "crack babies" are replaced
with reliable, high-quality scientific data.
Copyright 2003, Thieme Medical Publishers, Inc.
Does smoking during pregnancy affect sons' sperm counts?
Storgaard L; Bonde JP; Ernst E; Spano M; Andersen CY; Frydenberg M et al. Epidemiology 14(3):
278-286, 2003. (42 refs.)
Background. There has been an apparent decline in sperm density during the last
5 decades in Denmark, a country in which women have among the highest rates of
smoking in Europe. We examined semen quality and sex hormones in men in relation
to their mothers' tobacco smoking during pregnancy. Methods. Mate participants
were selected from the population-based Danish Twin Registry and the Danish Civil
Registration System as part of a study on hereditary and environmental determinants
of semen quality. From November 1999 to May 2000 we collected one fresh semen
and blood sample from each of 316 men. Data on prenatal tobacco exposure were
obtained for 265 of these men from a questionnaire filled in by their mothers.
Results. Adjusting for age, current-smoking status and other factors, sperm density
was 48% lower (95% confidence interval = -69% to -11) among sons of mothers who
smoked more than 10 cigarettes per day during pregnancy. Total sperm counts and
levels of inhibin-B were also reduced among this group, whereas follicuilar stimulating
hormone levels were somewhat higher (16% increase; 95% confidence interval -13%
to 54%). These effects were not seen in the lower smoking. category (1-10 cigarette's
per day). Conclusions. High levels of smoking (>10 cigarettes per day) during
pregnancy may be a partial explanation for the apparent secular decline and the
geographic differences in sperm counts.
Copyright 2003, Epidemiology Resources, Inc.
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