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To assess the smoking cessation efficacy of transdermal nicotine patches an adjunct to low-intervention therapy, we conducted a double-blind, placebo-controlled trial in 158 smokers. Participants were randomly assigned to one of the following three study regimens that required daily application of two 15-cm2 patches: 1) 24-hour nicotine delivery, 2) nicotine delivery during wakeful hours only, and 3) placebo. The impact of the three regimens on smoking cessation rates and tobacco withdrawal symptoms was examined. During the last 2 weeks of the trial, 39% of the 24-hour nicotine regimen delivery group, 35% of those on wakeful hour nicotine regimens, and 13.5% of the placebo treatment group achieved abstinence. Self-reported quit rates for the two nicotine patch-wearing regimens, as compared with that for the placebo group, continued to be significantly higher at 6 months. Moreover, compared with placebo, the transdermal nicotine patches significantly reduced tobacco withdrawal symptoms during the first few weeks of quitting. The differences in quit rates and tobacco withdrawal symptoms between the to active groups were not statistically significant. The patches were well tolerated both topically and systemically. We concluded that transdermal nicotine, when used as an adjunct to low-intervention therapy, significantly reduced tobacco withdrawal symptoms and enhanced smoking cessation rates.

Headache induced by ergotamine-abuse was described 40 years ago. More recently there is ample evidence suggesting that chronic headache may also be provoked by analgesic abuse. A recent Classification of the International Headache Society has defined this kind of headache as an autonomous disease. It consists in a daily chronic headache with paroxysmal attacks associated with daily or almost daily assumption of analgesics and/or ergotamine. It is debated whether the term "abuse" or "dependence" is correct. Almost 5% of patients of the Headache Centres in Italy were found to be drug abusers. Most of these patients originally suffered from migraine. The therapeutic approach consists in hospitalization, withdrawal of analgesics and/or ergotamine, treatment of the withdrawal headache (which appears within 48 hours and lasts even 1-2 weeks) and finally in a prophylactic therapy. Although several treatments have been suggested for the abstinence syndrome, only fluid replacement, antiemetics, hypnotic-sedative drugs and rarely mild analgesics are necessary. A review of the literature shows the following success rates in the relief of the headache: above 50% relief in more than 60% of patients within a follow up period of 1 to 3.5 years as mean. Even if caffeine and barbiturates, which are often contained in the analgesic and ergotamine preparations, might be considered the cause of the abuse and withdrawal syndrome, they don't seem to play a fundamental role in this syndrome. An impairment of the central antinociceptive system was hypothesized to be involved in the pathogenesis of the headache associated with analgesic and/or ergotamine abuse. Recently there has been evidence of a possible hyposensitivity of the adrenergic and serotoninergic receptors of the central nervous system. It is still to be proved whether drug abuse is the cause or the consequence of the headache chronicization. The remarkable improvement of headache after analgesic withdrawal suggests a causal factor.

During hospitalization a patient with acute pulmonary oedema caused by myocardial dilation and chronic kidney failure presented high blood pressure and repeated episodes of supraventricular tachycardia. The complication was attributed to the withdrawal of clonidine and was treated by reintroduction of the drug combined with nifedipine, nitroderivates and antiarrhythmic drugs.

Seven cases of convulsive seizure occurring after abrupt withdrawal of Lorazepam in non epileptic patients are reported. Five ot of them had an important cerebral damage occurred in perinatal period. All patients, before withdrawal, had been taking Lorazepam, 5-15 mg/day, for at least six months. It is stressed that in similar cases there is no need to start an anticonvulsive therapy because usually there is not a spontaneous recurrence of convulsive seizures. It is suggested that withdrawal of long term treatments with high doses of benzodiazepines be accomplished carefully and very slowly especially in patients with a previous cerebral damage.

After briefly recalling the professional pathology characteristics of workers exposed to nitro derivatives and the perplexities surrounding the actual pathogenetic mechanism of the "Withdrawal hazard", the AA report the results of an investigation carried out among the workers of a dynamite producing plant. In the study, the NG and EGDN environmental levels were checked and the workers were submitted to ECG tracings, ECG D according to Holter, and monitoring of postural pressure changes both during exposure to the substances and during time-outs. The results obtained showed that the concentrations found in the plant were practically within the recommended TLV values, with no pathological modifications of the parameters examined. The AA put forward a pathogenetic hypothesis based on these findings and analyzing epidemiologic data on coronary sudden death as well as the mechanisms regarded as responsible for the disorders described in the literature in professionally exposed subjects. According to such hypothesis, the "Withdrawal hazard" (if any) would not be due to the cessation of the vasodilation effect of the nitro derivatives but would be a "rebound" phenomenon following the NG - and EGDN - inhalation induced stimulation to the production of endothelial prostaglandins, and of EDRF in particular, in exposed workers. The withdrawal of nitro derivatives inhalation would thus eliminate a vascular and coronary protection mechanism in the case of pathogenetic noxae at cardiovascular level. Such an interpretation would at last account for the time elapsing between cessation of work and occurrence of the disorders, which would not be justified by the cessation of the mere vasodilating action, since this wears out within a few hours.(ABSTRACT TRUNCATED AT 250 WORDS)

The neuroactive drugs taken by pregnant women have two principals side effects: a teratogenic effects and a postnatal withdrawal effect. Three are the characteristic syndromes: the hydantoin-barbiturate syndrome, the trimethadione-paramethadione syndrome, the fetal alcohol syndrome. The prenatal exposure to heroine and to morphine interfere mainly with the cerebral development. Drug addiction, like postnatale withdrawal syndrome, are mainly due to passive exposure to drug narcotic (heroine, methadone), to sedative-hypnotic agents (barbiturates Diazepam Chlordiazepoxide) and to alcohol. The cigarette smoke is responsible for third group of side effects, namely for the reduced fetal growth and for the premature labor. No side effects on the human fetus were observed due to abuse of coffee or to use of marihuana during pregnancy.

The clinical features, etiology and treatment of tardive dyskinesia, a neurological syndrome observed during or after withdrawal of long term neuroleptic therapy, are discussed in reference to the literature records and to the contributions drawn out from 16 new cases.

The Authors, starting with the hypothesis that could exist a correlation between the opiate withdrawal and the migraine crisis, used the naloxone, opiate pure antagonist, in order to induced the migraine crisis. 30 patients affected by migraine were studied; naloxone was administered acutely (2 mg e.v.) during the asintomatic period. The naloxone administration never caused the migraine crisis. The patients didn't complain variations regarding the psycho-physical status or the monitored clinical parameters.

Ninety-seven newborns of drug addicted mothers observed in the period 1978-1986 were compared with the same number of controls. Pregnancies are at risk and newborns suffer a higher incidence of tainted amniotic liquid, low birth weight and preterm gestation. The withdrawal syndrome is the most commonly encountered pathology of such newborns.

A case of delirium tremens caused by the suppression of barbiturates is reported and the hypothesis is upheld that DTs should be considered an aspecific syndrome of exogenous reaction.