Standard Treatment Program Research Articles

Pentothal Interviews in the Treatment of Alcoholism

• For the past twenty-five years we at the Shadel Hospital have regularly employed as part of our treatment program for alcoholism. Although the corner stone of our therapy is still aversion conditioning to alcoholic beverages,l,~ we have found the to be a valuable adjunct to treatment. The average patient receives five aversion treatments and five pentothal interviews during his initial period of hospitalization, The treatments are given on an alternate day schedule, so that on day one, the patient receives an aversion treatment, on day two a pentothal interview, on day three a second aversion treatment, on day four a second pentoth~l interview and so on, until the treatment series is completed. The patient is then discharged and scheduled to return for a minimum of two follow-up treatment periods, approximately one month apart. During the reinforcement treatment, the patient ordinarily receives one aversion treatment and one pentothal interview. This standard treatment program is, of course, altered to meet the needs of different patients. Although the procedure is generally referred to as a the medication used is ordinarily a mixture of equal parts of sodium pentothal and sodium amytal diluted to a concentration of 0,3% in normal saline. This mixture is administered by slow intravenous drip at a rate which keeps the patient in a deeply sedated state just short of sleep in which state the interview is conducted The average patient receives between 300 mgm to 400 mgm of each drug during the 20 to 40 minute interview. The amount given

Seminoma, Q.E.D.

The natural concern of the patient and concomitant interest of the physician have served to focus attention on testicular enlargement secondary to involvement by tumor. Early attempts at cure were logically by surgical extirpation of the primary lesion. The demonstration of radiosensitivity of seminoma as early as 1905 by Béclère (1) prompted consideration of the curative possibility of roentgen rays in these cases. Surgical extirpation, however, because of its relative simplicity and effectiveness, has continued to be the treatment of choice for the primary site. With the demonstration of the mode of dissemination of these tumors via the lymphatic drainage channels in sequential fashion by Chevassu in 1906 (2), possible methods of control of extension were soon explored. The removal of adjacent lymphatics suggested by Osler (14) and the subsequent description of extraperitoneal lymphadenectomy by Chevassu (3) stimulated interest in the surgical approach to the problem. During the subsequent decades, however, the relative ease and dramatic results of irradiation in the seminoma group of tumors engendered enthusiasm and wide adoption of this treatment. This enthusiasm was somewhat dampened by experience. Reports of significant morbidity and mortality from renal damage culminated in the comprehensive review and analysis by Kunkler et al. (13). These writers defined the limits of renal tolerance beyond which an actual decline of survival rates occurred as a result of mortality from radiation damage to the kidneys. With the limits of renal tolerance well established, the radiotherapy technics in the majority of subsequently reported series have provided for sparing, by dose or volume, of enough renal tissue to prevent clinically significant damage. Friedman and Moore (9) and Dixon and Moore (5) summarized the treatment of testicular tumors and its results in a large series of service personnel treated during World War II. These comprehensive reports, along with the review by Friedman (7), stimulated widespread adoption of standardized treatment programs for seminoma, utilizing irradiation to control metastatic extension. Even in the favorable seminoma group, however, recent reported series have indicated “cure” rates far less than optimal levels. Significant numbers of failures are described, but generally with information inadequate for interpretation of this experience. The usual explanations for failure are “aggressiveness,” “resistance,” or ”dissemination prior to institution of therapy.” The author's personal experience with a few cases of seminoma considered “incurable,” which responded in a surprisingly consistent fashion to logical individualized irradiation, prompted the present review.