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Biomedical subjects

R Greenstein

Publications and source records attributed to R Greenstein.

15 recordsLinked to original sources
PubMed1979

Management of asparaginase induced hemorrhagic pancreatitis complicated by pseudocyst.

Asparaginase induced hemorrhagic pancreatitis is a rare but serious development occurring in less than 0.5% of patients treated with this drug. Severe pancreatitis with progressive abdominal distention, toxemia, hypotension and respiratory insufficiency occurred in an 18-year-old patient with acute lymphoblastic leukemia following treatment with asparaginase. There was a dramatic response to high flow peritoneal lavage with rapid recovery within 24 hours from a moribund state. The subsequent development of a pseudocyst, with progressive increase in size and development of obstructive symptoms, required surgical decompression. Transgastric cystogastrostomy was successfully carried out.

Adolescent↗
PubMed1979

Effects of contingent payment on compliance with a naltrexone regimen.

The effects of several schedules of payment on duration and patterns of compliance with a naltrexone regimen were examined. Patients were paid under contingencies based on either number of doses ingested or on a fixed time schedule. Reinforcement schedules based on number of doses ingested produced more consistent treatment-oriented behavior than a time-based schedule. Covariation between behavior and alternating contingencies (A-B-A) indicated that the schedules contributed to increased duration of treatment compared to previous noncontingent payment. The issue of using extrinsic reinforcers such as monetary payment to enhance compliance is discussed and additional procedures are suggested.

Adult↗
PubMed1978

Clinical pharmacology of narcotic antagonists.

Both naloxone and naltrexone are effective narcotic antagonists with minimal agonistic effects and a wide margin of safety. Naloxone is useful in the treatment of narcotic overdose and it is helpful in the quantification of physical dependence. Naltrexone is pharmacologically successful as an orally effective, long-acting antagonist but its clinical usefulness in the prevention of relapse is still being determined.

Animals↗
PubMed1978

Radiographic evaluation of tibial plateau fractures.

Thorough radiographic evaluation of tibial plateau fractures is necessary in order to determine the extent and type of injury. Routine anteroposterior and lateral radiographs should be supplemented by oblique and horizontal beam lateral views. Tomography most accurately delineates fracture anatomy and thus plays a key role in planning treatment; the surgical approach is determined by the tomographic localization of the fracture fragments. The radiologist's understanding of tibial plateau fractures aids the orthopedic surgeon in the management of these patients.

Adolescent↗
PubMed1978

Multimodality treatment of narcotic addiction: an overview.

In closing, it seems important to add that, when viewed longitudinally, addiction resembles a chronic medical disease. Rehabilitaiton may take several years and improvement rather than cure may be the most reasonable goal. Disappointment at the lack of success in finding an effective cure is common, but a relapsing and remitting course does not necessarily imply failure. Return to treatment may signal continuing efforts and progression toward abstinence. Improvement in current techniques may make remissions longer and relapses shorter. Current work on endogenous opiates (endorphins) may lead to tests which will identify those patients who can achieve drug-free status and those who can function only when maintenance opiates are applied.

Ambulatory Care↗
PubMed1978

Update of naltrexone treatment.

To summarize, then, our work with naltrexone in a multi-modality treatment program indicates that it appeals to about 5-10 percent of narcotic addicts--those who conciously want to obtain drug-free status. It does significantly attentuate the effect of narcotics to the extent that they lose their reinforcing properties, and it has minimal side effects. Although we treated a self-selected population, it is noteworthy that about 10 percent of those who remained on naltrexone for more than a week were still opiate free 6 months after cessation of treatment. For some it appeared to be a turning point in their lives. It was the first time in years that they could live in their neighborhood and not be either intoxicated or occupied with the pursuit of narcotics. Our behavioral studies have identified a number of conditioned psychophysiological responses associated with the self-injection ritual. So far, although we have succeeded in extinguishing some of these responses, this has not resulted in an improved clinical outcome. We are currently working on more comprehensive behavioral treatments, but the clinical significance of these conditioned responses is uncertain at present.

Adult↗
PubMed1975

Misuse and abuse of diazepam: an increasingly common medical problem.

Misuse and abuse of diazepam among addiction-prone individuals is reported. The most common pattern of abuse appears to be periodic ingestion of 30 to 80 mg of diazepam in one dose, either alone or in conjunction with methadone or other narcotics. Two cases of physical dependency to diazepam have been observed. Many addict patients using diazepam are buying it on "the streets". All physicians should know that diazepam abuse and misuse is occurring, and careful attention should be given to prescribing, transporting and storing this drug.

Adult↗
PubMedDate not supplied

Conditioning in human opiate addicts.

Eight volunteers maintained on daily methadone participated in a classical conditioning procedure to determine which if any of the elements of narcotic withdrawal could be conditioned; The unconditioned stimulus was the injection of a small dose of naloxone. The unconditioned response was a brief precipitated withdrawal syndrome. The conditioning stimulus was a tone, odor, and injection of saline. Conditioning was successful in the pilot study in 5 of 8 subjects. The conditioned response consisted of tearing, yawning, lacrimation, systolic blood pressure increase, respiratory irregularities and subjective feelings of narcotic withdrawal sickness (nausea, muscle aches, chills). A second group of 8 subjects showed, in addition to the above, evidence of conditioning of heart rate, respiratory rate, respiratory, rate and skin temperature decrease. These laboratory findings support the clinical reports of a conditioned withdrawal syndrome and suggest ways to improve treatment results by detecting and extinguishing or modifying conditioned responses.

Adult↗