Treatment of cocaine abuse with buprenorphine.
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Biomedical subjects
Publications and source records attributed to C Morgan.
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Intravenous cocaine abuse is a major probel in opioid abusers including those treated in methadone maintenance. Studying 138 opioid addicts, we found that speedballing by combining opioid agonists with cocaine may be blocked by opioid antagonists such as naltrexone and by partial antagonists such as buprenorphine. With both these treatments cocaine abuse was five to eight times less than with methadone treatment.
We studied the effects of dopexamine hydrochloride in 14 patients following cardiopulmonary bypass for coronary revascularisation (12 patients) or valve replacement (2 patients). The drug was administered by intravenous infusion at rates of 1, 2, 4 and 6 micrograms/kilogram/minute for a period of 10 minutes at each dose. Measurements of heart rate, blood pressure, right atrial pressure, pulmonary arterial pressure, pulmonary arterial wedge pressure and cardiac output (thermodilution method) were made at the end of each period. There were significant increases in heart rate (P less than 0.05), cardiac index (P less than 0.05) and systolic blood pressure (P less than 0.05). There were significant falls in systemic vascular resistance (P less than 0.05) and pulmonary vascular resistance (P less than 0.05). There were no significant changes in pulmonary arterial or wedge pressure. No serious adverse effects were observed. Dopexamine hydrochloride appears to be a useful supportive agent in patients following cardiopulmonary bypass, although further trials need to be carried out in order to establish precise therapeutic indications for its use.
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A computerised database system for an intensive therapy unit is described. The system runs on an IBM-compatible personal computer. It provides data on the patients admitted to the unit, the bed occupancy and individual patient's discharge summaries.
In November 1987, a post-lingually deafened eight-year old became the first child to receive a cochlear implant in Britain. The case aroused considerable controversy and the following paper examines the decision to implant the child, the difficulties experienced and the favourable outcome of the procedure to date.
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Pumped continuous arteriovenous haemofiltration offers a means of managing oliguric renal failure. We report our experience with the use of this technique in the management of patients with oliguric renal failure complicating cardiothoracic surgery, and conclude that it allows management of this complication without transfer to a renal unit.
The estimation of the post mortem period, in cases where death occurred under suspicious circumstances, is usually attempted using temperature measurements taken at a single body site. Early investigations of the validity of such an approach use the abdominal skin surface, the axilla and the rectum as measurement sites (B.H. Knight, Forensic Sci. Int., 36 (1987) 47-55). However, it has recently become more common to use the rectum alone, though the ear and the nasal passages have also been utilized. Whatever site is employed, the estimates are frequently found to be inaccurate. There are several fundamental reasons for these inaccuracies, the most prominent being the unknown variation in the ambient temperature between the time of death and the commencement of measurements, and the unknown body temperature at the time of death. This paper proposes a method of overcoming the above difficulties by taking a series of measurements concurrently at a number of body sites, a technique used by several previous workers (B.H. Knight, Forensic Sci. Int., 36 (1987) 47-55). Initial investigations have shown that an improved estimation of post mortem period is obtainable by the application of a suitable decision-making algorithm.
The chick chorioallantoic membrane assay has been used for many years as an in vivo assay of angiogenic activity. However it has been plagued with the problem of a high incidence of false positive angiogenic responses. In this study the conventional chick chorioallantoic membrane assay was compared with a modification of this technique in a series of batches using a total of 100 eggs. False positive reactions were recorded in 32 out of 50 (64%) using the conventional method and only 11 out of 50 (22%) with the modified method (chi 2 = 17.992; p less than 0.001).
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To evaluate the preventive role of immunotherapy in severe perennial asthma, we investigated cockroach asthma as a model. Twenty-eight subjects with bronchial asthma due to cockroach hypersensitivity (BACR) were divided into two groups in alternating order: 15 were started with cockroach antigen immunotherapy (CRa-IT) and 13 were given control immunotherapy. Eleven in the former group and two in the latter group completed the study after 5 years. The changes in symptoms and medication scores were assessed; blocking antibody factor in the paired pre- and postimmune serum of the two groups was measured and compared. Cellular sensitivity (HR50) was measured using the basophil-rich leukocytes (BRLs) obtained from the two treated asthma groups, and the result was compared with that of the untreated cockroach asthmatic cells. The average symptom score changed from 7.2 +/- 2.7 to 1.2 +/- 0.4 in the CRa-IT group. The control-IT group showed no change. The medication score changed from 11.4 +/- 1.6 to 5.2 +/- 1.4 in the CRa-IT group only (p less than 0.01). The mean blocking antibody factor in the immune serum of the CRa-IT group showed a 2.5 x 10(2)-fold increase [1.3 +/- 0.3 x 10(-1) in postimmune serum/5.2 +/- 2.0 +/- 10(-4) in preimmune serum (p less than 0.001)]. No difference was noted in the HR50 of the BRLs in the post- and preimmune serum of the control-IT group. Antihuman IgG absorption of the post-CRa-IT serum reduced the blocking antibody to 1/1000-fold; no difference in the HR50 of the BRLs was noted between the post-control-IT and the pre-CRa-IT serum (p greater than 0.2). The BRLs of the CRa-IT asthmatics, however, showed blunted sensitivity not affected by the serum factor (5.8 +/- 1.5 x 10(-2) micrograms/ml in post-CRa-IT serum and 5.6 +/- 1.3 x 10(-2) micrograms/ml in pre-CRa-IT serum) (p greater than 0.2). The BRLs of the control-IT group retained their cell sensitivity as well as the blocking effect of the CRa-immune serum. This study thus demonstrated that CRa-IT reduces symptom and medication scores clinically in cockroach-asthmatic subjects, and the CRa-IT produces the CRa-specific blocking antibody of the IgG type. It also reduces anaphylactic leukocyte sensitivity, which is not affected by humoral factor.
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