The present study investigated the neurobehavioral outcomes of fetal cocaine exposure. Attempts were made to control, by design or statistical analysis, for significant confounders. Timing and amount of drug exposures were considered, and biologic measures of exposure were quantified to classify exposure severity. One hundred sixty-one non-cocaine and 158 cocaine-exposed (82 heavily and 76 lightly exposed) infants were seen at a mean-corrected age of 43 weeks post-conception and administered the Neurobehavioral Assessment (NB Assessment). Heavily cocaine-exposed infants had more jitteriness and attentional problems than lightly and non-exposed infants. They also had more movement and tone abnormalities, and sensory asymmetries than non-exposed infants. Heavily exposed infants were more likely to be identified with an abnormality than non-exposed infants and there was a trend toward heavily exposed infants being more likely to be identified with an abnormality than lightly exposed infants. Furthermore, there was a trend for heavily exposed infants to be less likely to be testable than non-exposed infants. After the confounding and mediating factors were considered, heavily cocaine-exposed infants were four times as likely to be jittery and nearly twice as likely to demonstrate any abnormality than lightly and non-exposed infants, but all other effects were no longer significant. Higher concentrations of the cocaine metabolites of cocaine, cocaethylene, and benzoylecgonine (BZE) were related to higher incidence of movement and tone abnormalities, jitteriness, and presence of any abnormality. Higher cocaethylene levels were related to attentional abnormalities and higher meta-hydroxybenzoylecgonine (m-OH-BZE) was related to jitteriness. Drug effects on attention were mediated by maternal psychological distress, suggesting that this factor should be considered in future studies of drug exposure effects.

Adolescent↗

PubMedDate not supplied

Management of sporadic gastrinomas.

Experiences with medical and surgical treatment modalities in 13 patients with a sporadic ZES, followed up for 1-16 yrs., are presented. Gastric hypersecretion can effectively be controlled by H2-blockers or Omeprazol. Insufficiently adjusted drug dose and drug effect escape are the main reasons of complications from insufficiently suppressed gastric hypersecretion. A tumor-like lesion could be detected by angiography in 8 and by CT scanning in 6 out of 9 patients, US was of no use in detecting solitary adenomas. 8 patients underwent surgery for tumor resection, 4 could be cured definitely with a non-metastatic primary adenoma in the pancreas (2), the liver (1) and a peripancreatic lymphnode (1). Gastrin-producing endocrine tumors as the cause of an unusually virulent ulcer disease due to excessive gastric hypersecretion were first described by Zollinger and Ellison nearly 30 years ago. Albeit rare, they deserve our special attentiveness because they pose specific therapeutic problems unknown in common peptic ulcers and other kinds of tumors. Because the patients are, above all, endangered by their ulcer complications, management of patients with Zollinger-Ellison-Syndrome (ZES) has to aim first and foremost at eliminating the excessive gastric hypersecretion and only secondly at removing the hormonproducing tumor. Management of patients along these guidelines has changed decisively during the last years: Previously, elimination of gastric hypersecretion was only achieved by total gastrectomy, whereas now gastric acid excess can effectively be controlled by antisecretory drugs. More over, being no longer under deadline pressure by ulcer complications and having improved imaging techniques at our disposal search for gastrinomas has become more successful.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗