No abstract

We assessed previously undiagnosed thrombophilia-hypofibrinolysis in 11 testosterone (T)-taking men, five of whom developed deep venous thrombosis (DVT), four pulmonary embolism, one spinal cord infarction, and one osteonecrosis 3.5 months (median) after starting T gel (50-160 mg/day) or T intramuscular (50-250 mg/week). In the order of referral because of thrombosis after starting T, thrombophilia-hypofibrinolysis was studied in 11 men, and, separately, in two control groups without thrombosis - 44 healthy normal male controls and 39 healthy men taking T. Nine men had DVT or DVT-pulmonary embolism after 3.5 months (median) on T, one spinal cord infarction after 5 days on T, and one had osteonecrosis (knee and then hip osteonecrosis after 6 and 18 months on T). Four of the 11 men (36%) had high factor VIII (≥150%) vs. one of 42 (2%) controls (P = 0.005), and vs. one of 25 (4%) T-controls, (P = 0.023). Of the 11 men, two (18%) had factor V Leiden heterozygosity vs. none of 44 controls, (P = 0.04) and vs. none of 39 T-controls(P = 0.045). Of the 11 men, three had 4G4G plasminogen activator inhibitor-1 homozygosity, one prothrombin G20210A heterozygosity, one low protein S, and one high factor XI. When T was continued, second DVT-pulmonary embolism recurred in three of 11 men despite adequate anticoagulation. T interacts with thrombophilia-hypofibrinolysis leading to thrombosis. Men sustaining DVT-pulmonary embolism-osteonecrosis on T should be studied for thrombophilia. Continuation of T in thrombophilic men appears to be contraindicated because of recurrent thrombosis despite adequate anticoagulation. Before starting T, to prevent T-associated thrombosis, we recommend measures of factor V Leiden, factor VIII, and the prothrombin gene.

No abstract

It is now clear that methadone maintenance is not the ultimate answer for heroin addiction.The search for a heroin substitute has been and still is intense. This paper is a preliminary report of a community-based experiment with a non-narcotic, non-addictive, long lasting, inexpensive heroin antagonist named haloperidol.The setting is in a middle-American community, the Triple Cities area of Binghamton, Johnson City, and Endicott in Broome County, New York.Haloperidol is a neuroleptic drug of the butyrophenones class, and is thus quite distinct from tranquilizers, anti-depressants, and other classes of psychotropic drugs. Haloperidol was first introduced in Denmark for use "in states of agitation of any type and origin."1In 1971, Karkalas and Lal at the Rhode Island Institute of Mental Health found haloperidol could relieve severe withdrawal symptoms within twelve to forty-eight hours.2 Half of their ten inpatient subjects experienced significant recovery and did abstain from heroin completely. The abstinence syndrome was considerably diminished in one other case, and the four other high dosage addicts in the 25-30 bag a day range, required some methadone for detoxification. This study, it should be noted, dealt only with detoxification using haloperidol.Our efforts were motivated by the desire to test the effectiveness of haloperidol for both the alleviation of the abstinence syndrome and the therapeutic aspects of the opiate addiction problem, Further, inasmuch as the literature shows a preponderance of clinical inpatient withdrawal studies,3 we desired to see a community-based experiment in keeping with the trends in community health in general, and community mental health in particular.The maintenance emphasis of this experiment marked the first time haloperidol had been tested for this milieu. Our emphasis on maintenance was based on two premises: Karkalas and Lal had shown that haloperidol