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Cocaine addiction is a chronic relapsing disorder associated with severe medical and psychosocial complications. However, there are no approved medications for cocaine dependent individuals. Modafinil, a medication that differs chemically and pharmacologically from other central nervous system stimulants, has been suggested to be potentially useful for this complex disorder. The present paper aims to critically review the published evidence from laboratory and clinical studies on modafinil for cocaine addiction, including discussion of its pharmacological characteristics and how it may relate with cocaine neurobiology. Whilst its exact mechanism of action remains to be elucidated, different neurotransmitter systems have been implicated, including modulation on dopamine, glutamate/GABA, noradrenaline and the hypocretin/orexin system, but it is possible that modafinil acts by a synergistic combination of mechanisms. With a favourable pharmacokinetic profile, it appears to have a low abuse potential. Laboratory and clinical studies provide consistent, albeit preliminary, evidence of the potential usefulness of modafinil for cocaine dependent patients. Not only there is no evidence of pharmacokinetic interactions between modafinil and cocaine, but in addition cocaine induced euphoria and cardiovascular effects appear to be attenuated by modafinil. Furthermore, modafinil has been shown to decrease cocaine self-administration. In addition, modafinil treated patient are more likely to achieve protracted abstinence than placebo treated patients. However, further research is needed to confirm these findings.

There is an increasing interest to find efficacious treatments for patients with post-traumatic stress disorder (PTSD) and comorbid substance use disorder (SUD). Therefore, in this paper the studies published on the psychological and pharmacological treatment for the management of comorbid PTSD and SUD will be discussed, as these are highly prevalent and shown in part I. The few studies published to date suggest that patients benefit most form an integrated treatment approach for the comorbid disorders. Psychological treatments based on cognitive behavioural strategies appear to be useful for patients with PTSD and comorbid SUD disorder. Medications such as SSRIs and particularly sertraline that efficacious for PTSD, seem to be as well for this dual disorder. In addition, pharmacological options, among them quetiapine or bupropion have shown promising results in preliminary studies.

Vestibular neurotomy remains the surgical procedure of choice in the management of peripheral vertigo resistant to the usual medical treatment, for patients with preserved hearing. Menière's disease generally sums up most of the surgical indications. The authors report a personnel series of patients who underwent vestibular neurotomy during the last five years, from January to December 1998. The aim of this study was to assess with a 6 months to 3.5 years follow-up, postoperative complications and functional results, particularly the improvement of dizziness, residual unsteadiness and its impact on quality of life, and the recovery of socio-professional and physical activities. Of a total of 41 patients, 21 were evaluated by both an otoneurologic and physical medicine approach, to analyze the main sensory components of equilibrium (vestibular, proprioceptive, cervical, visual). In most of the cases, the results show disappearance of vertigo which was the main complaint. However, disabling residual instability is common in those patients who was present both a cervical pathology and binocular visual impairment or a defect in convergence, often unrecognised. The authors emphasise the necessity of a cervical examination and orthoptic investigations in addition to the vestibular assessment. This multi-disciplinary approach allows better identification of the different factors (vestibular, cervical, orthoptic) and lead to specific rehabilitation which can permit the patient with residual unsteadiness to return to work and lifestyle, the real measure of success of vestibular neurotomy.

In a European multicenter study all the suicide attempts in the city and agglomeration of Berne which came under medical treatment during a 12-month period were surveyed. There were 243 females and 153 males, corresponding to a rate of 177.1 and 128.6 per 100,000 respectively. The investigated region can be regarded as representative of Switzerland. Comparison with other centers shows that the incidence of attempted suicide in Switzerland--unlike that of suicide--is approximately in line with the European average. The usual method is overdose of drugs, in particular benzodiazepines. Nearly all the drugs involved in the overdoses were obviously prescribed by physicians. The choice of drugs suggests that many suicidal people deliberately take anxiety-and tension-reducing agents, a fact which points to a relationship between anxiety states and attempted suicide. Both are to be regarded as the expression of acute emotional stress and require an appropriate therapeutic approach.

During 1986 and 1987, electroencephalographic examinations were done on 8 dogs with intracranial mass lesions confirmed by computerized tomography, biopsy, necropsy, or a combination of these techniques. Tumor types included 1 astrocytoma, 1 undifferentiated glioma, 2 mixed gliomas, 2 meningiomas, 1 choroid plexus papilloma, and 1 cholesterol granuloma. It was found that no EEG pattern was pathognomonic for tumor type or location. Slow-wave activity was observed in the EEG of most of the dogs; asymmetry in amplitude or frequency was observed in approximately half the cases.

Electroencephalograms of 20 dogs given succinylcholine and concurrent artificial respiration were recorded. The amplitudes of the fast activity of the electroencephalograms were approximately one-fifth that observed in awake dogs. In addition, the occurrence of slow waves (6 to 8 Hz) was more marked in those dogs treated with succinylcholine. Succinylcholine caused a low amplitude dominant activity with increased moderate amplitude low frequency waves.

Spinal evoked potentials (SpEP) were recorded on an electromyograph from electrodes placed percutaneously in the ligamentum flava at the lumbosacral junction and between the 10th and 11th thoracic vertebrae following tibial nerve stimulation in 31 anesthetized dogs with acute compressive spinal cord injuries. The neurologic status of each dog was determined by clinical examination before SpEP recordings, and the neurologic status was monitored for 2 months in dogs that had surgical or conservative treatment. Two months after spinal injury, the response to treatment (outcome) of each dog was evaluated and graded as favorable (ambulatory and urinary continent) or unfavorable (nonambulatory, urinary incontinent, or euthanatized with confirmation of myelomalacia). Onset latencies, conduction velocities, amplitudes and durations of the wave forms, and the ratio of conduction velocity to combined durations of the first positive (P1) and first negative (N1) waves (CV/DPN index) were determined and were compared with reference data from clinically normal (control) dogs. Single SpEP recordings were of value in determining the prognosis for recovery. Significant differences were not found in the L7-S1 recordings between the reference (control) and spinal injury groups. Analysis of data from the T10-11 recordings indicated significant differences between the reference and spinal injury groups and between the favorable and unfavorable outcome groups within the spinal injury group. A CV/DPN index was less than 30 in dogs with unfavorable outcomes and greater than 30 in dogs with favorable outcomes. Stepwise discriminant analysis of data from the spinal injury group predicted outcome correctly in all dogs.

Electroencephalograms were recorded from 10 dogs before, immediately after, and every 10 minutes (for 60 minutes) after IV injection of 0.005 ml of a fentanyl citrate and droperidol combination/kg of body weight. Narcosis was adequate for recording. At 30 to 40 minutes after injection, tail wagging was the only adverse reaction (EEG artifact) observed. The only changes in EEG activity observed were a slight increase in amplitude of the dominant activity and an increase in spindle-like activity. Daily repetition for 5 days did not alter the EEG pattern or the behavior of the dogs.

The latencies and latency rates of H and F waves were determined by percutaneous stimulation of the ulnar and the tibial nerves of healthy cats. In the ulnar and tibial nerves, the latency rates of H wave evoked compound action potentials were 49.1 +/- 7.3 and 44.1 +/- 2.7 m/s, respectively, and of F waves were 68.1 +/- 9.6 and 57.1 +/- 6.2 m/s, respectively. The H wave response of cats was more variable in latency and amplitude than that reported in the dog.

Signs of a central nervous system disorder were observed following 2 instances of accidental ingestion of glucocorticoid in a young female Doberman Pinscher. The signs included transient aggressive and paranoid behavior, amaurosis, disorientation, ataxia with circling backward, and depression. Vomiting, weight loss, and abnormal drinking behavior persisted for several weeks following recovery from the acute illness.

The voltage and duration of electrical rectangular pulsed stimuli needed to produce an F wave and a monosynaptic reflex (H wave) and the characteristics of these responses were recorded in clinically normal dogs. Optimal stimulus to produce H waves was 0.1 to 0.2 ms and less than 80 volts. F waves were variable in appearance and were most evident following 0.5 ms and 125 to 150 volt stimulation. F waves had shorter latency than comparable H waves.

Eleven dogs with signs of lead poisoning were examined. The principal clinical signs were neurologic and included ataxia, tremors, clonic-tonic seizures, amaurosis, and deafness. Basophilic stippling and circulating nucleated red cells were not common findings in blood films. Blood lead values varied from 0.22 ppm to 0.63 ppm before treatment. Electroencephalographic changes in nonsedated dogs were marked by intermittent high-amplitude slow wave activity.

Emergency splintage is a variety of first aid. The procedures which one might expect to find performed before the patient enters the hospital for definitive diagnostic treatment are too often ignored in a busy and otherwise excellent veterinary practice. Simple entrance in the hospital and cage confinement do not appreciably lessen the likelihood of increased self-trauma. The manipulation inherent in physical and radiographic examination of the injured and painful animal is an even greater indication for immobilization to prevent additional trauma. The clinician is dutybound to place a proper splint on the affected animal to lessen subsequent trauma and to prevent edema. The techniques presented allow this application with minimal time and expense and maximal support and protection to the patient.

A new fascial technique was used to repair artificially induced rupture of the cranial cruciate ligament in 20 dogs. Although technically simple to perform, the procedure resulted in only 12 animals free of lameness. In addition, a drawer sign was present in the stifle of 14 animals 31 days after surgery. Arthritis changes typical of cruciate ligament instability were observed in 16 joints; changes were slight to moderate in 10 joints.