Pediatrics: Diagnosis,Treatment, and Follow-up of Newborns Addicted to Cocaine

The Scientific Board of the California Medical Association presents the following inventory of items of progress in pediatrics. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, or scholars to stay abreast of these items of progress in pediatrics that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Pediatrics of the California Medical Association, and the summaries were prepared under its direction.     

Treatment in England of Canadian Patients Addicted to Narcotic Drugs

The method of treatment and the results obtained from the treatment of 50 Canadian patients addicted to narcotic drugs who went to England are recorded. These patients were first stabilized on the minimal dose of narcotic drug which permitted them to work, and to acquire security and self-respect. Then, after psychiatric treatment dealing with the basic problem of their personality disorder, complete withdrawal treatment of the narcotic drug was undertaken.Nine of 10 patients aged between 20 and 30, of good social and cultural background, have been relieved of dependence on drugs for over two years.The other 40 patients came from a different background. Nearly all had been imprisoned for drug offences and they had come to England to obtain treatment and to avoid further prison sentences in Canada.The 31 patients whose prison sentences had been directly connected with drug offences are working steadily and leading an apparently normal life.The remaining nine patients had been convicted of criminal acts before becoming addicted to narcotic drugs and, with two exceptions, the results of their treatment compare unfavourably with the other patients, seven having been convicted and imprisoned in London.     

Application of Urine Analysis to Diagnosis and Treatment of Heroin Addiction

Experience with urine analysis for morphine using thin-layer chromatography in 310 cases of real or possible heroin abuse showed that it was valuable not only in detecting improper drug use but also in monitoring treatment. The results of this test can be available routinely in 24, and exceptionally in five hours. A negative result implies that the subject has taken less than 10 mg. of heroin in the past 24 hours.     

Follow-up to

In an earlier study the authors reported on the relative effectiveness of three psychological methods of treating tension headache. This paper reports follow-up data on each procedure and focuses on variables seemingly related to long-term success. Follow-up occurred at 3, 6, and 12 months and involved I week of self-report records of headache activity and medication dosage. For the 30 original subjects, follow-up information was available for 23, 20, and 18 subjects, respectively, at each of the three follow-up periods. Questionnaire and physiological data indicated that the type of treatment offered was relevant only in explaining initial success. Continued practice of relaxation procedures seemed more important in explaining long-term outcomes. The relationship between type of training and continuing practice seemed to involve seveal heretofore unspecified placebo variables, which were explored and found to influence long-term success rates. Treatment procedures can presumably be modified to include these new variables, thus strengthening this therapeutic process.     

The Use of Propoxyphene Napsylate in the Treatment of Heroin and Methadone Addiction

The use of methadone in the treatment of heroin addiction continues to be controversial. Propoxyphene napsylate (Darvon N®) is a possible alternative and a pilot study was conducted to test its acceptability, safety and clinical efficacy in treating long term, “multi-relapse” heroin addicts.Findings indicate that propoxyphene napsylate suppresses many of the symptoms associated with opioid withdrawal phenomena. It should be viewed as a very promising therapeutic tool to be used in conjunction with psychological counseling and socio-vocational rehabilitation in detoxification and maintenance therapy for heroin or methadone addiction.     

The Functional State of Athletes Addicted to Exercises during Exercise Deprivation

The objective of this study is to identify markers of the addictive condition developing in athletes during exercise deprivation by analyzing electroencephalograms (EEGs), electromyograms (EMGs), skin temperature measurements, sympathetic nervous system activity, levels of anxiety and depression (by psychological tests). A cohort of professional football players (N = 50) voluntarily participated in the study. The athletes were tested under two test conditions: during active training sessions and during exercise deprivation (for seven days). The analyzed results have shown that the functional state of athletes with exercise addiction (due to exercise deprivation), compared with athletes showing no addictive behavior, was characterized by lower brain bioelectric activity (a decrease in the α-rhythm amplitude and power), growth in the muscular tension, increased sympathetic activity, and elevated levels of anxiety and depression. We have concluded that an athlete’s functional state during exercise deprivation is an important predictor for exercise dependence. A prolonged exercise deprivation causes intense psychophysiological changes in the body of athletes inclined to exercise addiction. The obtained results may be useful for experts in the field of sports medicine, as well as for further studies in different types of addictions.     

晚期癌症病人镇痛疗法成瘾的观察与护理

目的:对晚期癌症病人实施镇痛疗法后其成瘾性的观察和护理.方法:观察给药后患者的临床表现,针对患者情况提出护理措施.结果:约60%病人出现了戒断症状,需加强护理.结论:出现麻醉药成瘾时,权衡舒适度与药物的副作用,以照顾镇痛效果为主.在镇痛过程中应加强观察和护理.     

儿童及青少年卵巢肿瘤治疗进展

：青少年卵巢肿瘤临床上较为少见,但却是青少年人群最常见的妇科肿瘤。其中生殖细胞肿瘤占首位,以畸胎瘤居多,交界性卵巢肿瘤较少见,恶性肿瘤更为少见,约占1％。青少年卵巢肿瘤较之成年人卵巢肿瘤有其特殊性及复杂性,治疗以手术为主,并尽量保留性腺功能及生育功能。随着以铂类为主联合化疗的实施,恶性生殖细胞肿瘤患者的5年生存率超过90％,因此保留生育能力成为临床医生必须面对的另一问题。     

Asymptomatic Significant Bacteriuria in the Non-pregnant Woman: II. Response to Treatment and Follow-up

Short courses of nitrofurantoin and ampicillin produced an immediate cure in 80% of adult non-pregnant bacteriuric women. Of the subjects so treated, 55% remained cured at the end of one year. Over the same follow-up period 36% of untreated bacteriuric women developed a spontaneous remission of bacteriuria. Treatment failed to prevent the development of symptomatic infection, and the reinfections which followed successful treatment were more commonly associated with the development of symptoms than the persistent or relapsing infections in untreated or unsuccessfully treated subjects.It is concluded that a search for bacteriuria in non-pregnant women is unlikely to be of value as a preventive measure, since in many instances it fails to detect urinary tract infection at an early stage and since treatment by methods suitable for large-scale use is ineffective.     

Self-perception and Experiential Schemata in the Addicted Brain

This study investigated neurophysiological differences between recovering substance abusers (RSA) and controls while electroencephalogram (EEG) was continuously recorded during completion of a new assessment instrument. The participants consisted of 56 total subjects; 28 RSA and 28 non-clinical controls (C). The participants completed the self-perception and experiential schemata assessment (SPESA) and source localization was compared utilizing standardized low-resolution electromagnetic tomography (sLORETA). The data show significant differences between groups during both the assessment condition and baselines. A pattern of alpha activity as estimated by sLORETA was shown in the right amygdala, uncus, hippocampus, BA37, insular cortex and orbitofrontal regions during the SPESA condition. This activity possibly reflects a circuit related to negative perceptions of self formed in specific neural pathways. These pathways may be responsive to the alpha activity induced by many substances by bringing the brain into synchrony if only for a short time. In effect this may represent the euphoria described by substance abusers.