Relapse and recovery: special issues for chemically dependent physicians.
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Biomedical subjects
Publications and source records attributed to C A Martin.
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A case of diethylpropion-induced psychosis in a 26-year-old woman is reported. The patient's psychosis recurred while she was receiving phenelzine. It is postulated that chronic stimulant use leads to increased sensitivity to the psychosis-inducing effects of monoamine oxidase inhibitors.
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The gas-chromatographic assay for methylphenidate described here involves isolation by solid-phase extraction and quantification by thermionic nitrogen-phosphorus detection. Methylphenidate and the internal standard, ethylphenidate, are extracted from plasma by partition onto C2 reversed-phase packing. Methylphenidate and ethylphenidate are eluted, dried, derivatized with trifluoroacetic anhydride, and gas-chromatographed, with nitrogen-sensitive detection. The standard curve for the assay is linear in the range 5-100 micrograms/L. The within-run CV is less than 4%, the between-run CV less than 6%. Mean analytical recovery of methylphenidate was greater than 90%. The smallest measurable concentration is 2 micrograms/L. The sensitivity, reproducibility, and economy of this assay make it suitable for clinical monitoring and pharmacokinetic studies.
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Patients registered by the 1971 Perth Coronary Register as having suffered a myocardial infarction were followed up for 9 years. The Register was a community-based study that used standard methods and criteria as part of a World Health Organization collaborative investigation. Of the 1078 patients studied, 77% survived the first 24 hr and 62% the first 28 days; 0.3% were lost to follow-up. For the 666 patients alive at 28 days, the crude 1, 5, and 9 year survival rates were 88%, 67%, and 52%, respectively. The relationship between 54 variables and the survival of patients alive 28 days after myocardial infarction was examined by life-table methods and the log rank test, and then by fitting a proportional hazards model to the data. The important prognostic factors were age, sex, past history of myocardial infarction, stroke, diabetes and hypertension, tachycardia at presentation, hypotension at presentation, and the occurrence of arrhythmias as short-term complications. The most appropriate mathematical description of the joint effects of the prognostic factors was a multiplicative model with no interaction.
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We have recently encountered two additional examples of non-red cell-stimulated naturally occurring anti-Kelly antibodies in ther sera of two apparently healthy male blood donors. Neither of these donors was previously transfuse. Both antibodies were initially detected using a low ionic medium. Additionally, these two antibodies decreased in reactivity within a seven month period of time. Further documentation of these unusual cases may assist in the understanding of the Kell blood group system.
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