Past History Of Alcohol Abuse Research Articles

Madelung's Disease: Revision of 59 Surgical Cases.

Madelung's disease (MD) is a rare disease, more common in Mediterranean countries and associated with alcohol abuse. However, MD etiology remains not completely understood. The aim of this study was to investigate clinical features, treatment options and outcomes in patients with MD treated in our plastic surgery department. We retrospectively reviewed 59 cases of MD operated on between 2004 and 2013. Demographic information, location of the deposits, associated pathology and habits, number and type of surgeries performed, surgical complications and disease evolution were analyzed. Ninety percent of the patients were males. Active or past history of alcohol abuse was reported by 86%. The main affected areas were anterior and posterior neck. A total of 230 surgical procedures were performed. Open surgery was used on 192 occasions (83.5%), liposuction alone on 30 procedures (13%) and lipectomy combined with liposuction on 8 interventions (3.5%). Surgical complications were found in 41 procedures (17.8%). Twenty-three patients (39%) were identified as having disease recurrence of the operated site in a mean time of 3.8years. Alcohol consumption was not clearly associated with disease recurrence. Demographic characteristics of the studied cohort stand for published data. It is our opinion that lipectomy/dermolipectomy provides better aesthetic and functional results. Lipectomy procedures allow a thorough excision, correct identification of noble structures and careful hemostasis. Liposuction techniques, even ultrasound-assisted ones, had limited efficacy for the treatment of large masses. A long follow-up period is recommended considering the high propensity and mean time to recurrence. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Predictive factors of brain death in severe stroke patients identified by organ procurement and transplant coordination in Lorrain, France.

There are no established predictive factors to identify patients at the acute phase of severe stroke with a high probability of presenting brain death (BD). We retrospectively collected clinical and paraclinical data of consecutive patients at the acute phase of severe stroke with a potential progression to BD through the hospital organ procurement and transplant coordination system in five centres in Lorrain (France) between 1 January 2012 and 31 December 2013. Final endpoint was adjudicated BD. Of 400 included patients, 91 (23%) presented adjudicated BD. Initial Glasgow Coma Scale score ≤6 (P=0.008), herniation (P=0.009), hydrocephalus (P=0.019), initial systolic blood pressure >150mmHg (P=0.002), past history of alcohol abuse (P=0.019) and stroke volume >65ml (P=0.040) were significantly associated with BD progression. Two prognostic scores for stroke with unquantifiable or quantifiable volume were built according to the number of risk factors presented. Following internal validation, the respective bias-corrected predictive performance (c-index) of the two scores was 72% (95% confidence interval: 67-78%) and 77% (95% confidence interval: 72-82%). These scores could form the basis of a simple tool of six criteria to help physicians make the difficult decision of intensive care unit management to preserve organs in potential donors.

Profile of litigators with chronic limb pain in a predominantly Hispanic workers'-compensation population

Litigators have characteristics that are identifiable with psychosocial testing in the outpatient setting. We conducted a secondary analysis of retrospective data in a subset of patients who were treated for neuropathic pain in a specialty clinic and sought litigation. We reviewed medical records that included reports from the first author, a hand surgeon, and a psychologist. Analysis consisted of descriptive statistics and correlations and Chi Square using SPSS statistical program. Thirty of the 91 patients in the original sample (33%) sought litigation. Litigators tended to be females with an average age of 40 who had moderate difficulty in social and occupational functioning (i.e. few friends and conflicts with peers/co-workers). About 27% had prior history of psychological dysfunction and 16% had a family history of emotional problems. When compared with the larger sample, litigators experienced more thoughts of harm including suicidal ideation and attempt (47% vs. 32%), had longer duration of pain measured at last follow-up treatment visit (6.5 years vs. 3.5 years), and were more likely to consume tobacco and alcohol. Of interest, two of the three patients with a past history of alcohol abuse were in the litigation group and there were more non-Hispanics in the litigation group than in the total group (23% vs. 19%). Seventy percent of litigators (n=30) returned to work as compared to 87% of total sample. With psychosocial testing litigators in this population have identifiable characteristics in the outpatient setting. They tend to have more psychosocial stressors and consume tobacco and alcohol in greater amounts than non-litigators. Of greatest concern is the high rate of thoughts of harm, including suicidal ideation and attempt.

Left-Sided Portal Hypertension Caused by an Accessory Spleen

Purpose: Left-sided portal hypertension (LSPH) is a localized form of portal hypertension that usually occurs as a result of isolated obstruction of the splenic vein. The incidence of LSPH has increased over the past three decades due to increased awareness of this entity. Most cases are secondary to splenic vein thrombosis. Nonetheless, we are reporting a very unusual cause for LSPH. Case: A 55 year old female presented to the Emergency room with three days history of hematemsis, melena and weakness. She has remote past history of alcohol abuse, however she denied any similar episodes in the past. On presentation she was hypotensive and tachycardic, otherwise the physical examination was essentially unremarkable. In particular, there was no stigmata of chronic liver disease. Her initial hemoglobin was 5.4 (g/dL) and she had normal platelet count. Her liver function tests and INR were within the reference ranges. She was resuscitated with crystalloids and packed red blood cells transfusion. The initial gastroscopy showed isolated gastric varices with stigmata of recent hemorrhage. An ultrasound of her abdomen with doppler showed no hepatic masses, patent hepatic vasculature and splenic vein. A computed tomography of her abdomen showed normal liver and pancreas, patent splenic, hepatic, portal veins without evidence of hepatic steatosis. However, it showed a 6.5 × 5.9 cm rounded mass in the left upper quadrant anterior to the pancreatic tale, most consistent with an accessory spleen. The hepatobiliary surgery team was consulted and the patient underwent laparoscopic resection of the accessory spleen with ligation of the short gastric veins. The patient had an uneventful postoperative course without recurrence of bleeding. A repeat gastroscopy in six months showed disappearance of the gastric varices. Conclusion: Most cases of LSPH are related to splenic vein thrombosis in the context of chronic pancreatitis. However, in this case the LSPH was due to the presence of an accessory spleen. The venous drainage of the accessory spleen into the short gastric veins is probably the reason for development of the varices. To our knowledge, no similar cases have been reported in the literature.Figure: CT abdomen showing the accessory spleen.

Functional neuroimaging for clinical evaluation of mild‐to‐moderate toxic encephalopathic brain disease: A study of seven patients

Purpose. Numerous studies have found that exposures to neurotoxins such as solvents, pesticides, heavy metals, carbon monoxide and mycotoxins can cause many neuropsychiatric deficits. Neuropsychological test batteries are often useful in diagnosing and treating neurotoxin exposed patients; however, these batteries have a number of shortcomings. Increasingly, brain scans with SPECT (Single Photon Emission Computed Tomography) are being used to diagnose neurotoxin‐exposed patients. The purpose of this study is to measure specific regional brain functional findings with SPECT on seven patients with various encephalopathic diseases and occupational and/or environmental chemical exposure.Design. Case series.Methods and materials. Detailed exposure/occupational histories were made of seven patients exposed to neurotoxins. Some patients had possible confounding factors such as a past history of alcohol abuse or mild trauma brain injury. SPECT scans were taken with a triple headed SPECT camera on patients injected with 99Tc‐HMPAO and brain blood perfusion was analysed digitally by the Hermes BRASS system.Results. A variety of significant hypoperfusion defects were seen in brain SPECT scans in six of these patients including frontal, parietal and cerebellar regions as well as thalamic hyperperfusion seen in six patients.Conclusions. With additional research and analytical refinement, SPECT studies have the potential to become an important tool for the differential diagnosis and treatment of encephalopathic patients with toxic chemical exposure.

Connective tissue growth factor, steatosis and fibrosis in patients with chronic hepatitis C

Both steatosis and insulin resistance have been linked to accelerated fibrosis in chronic hepatitis C. Connective tissue growth factor (CTGF) plays a major role in extracellular matrix production in fibrotic disorders including cirrhosis, and its expression is stimulated in vitro by insulin and glucose. We hypothesized that CTGF may link steatosis, insulin resistance and fibrosis. We included 153 chronic hepatitis C patients enrolled in the Swiss Hepatitis C Cohort Study and for whom a liver biopsy and plasma samples were available. CTGF expression was assessed quantitatively by immunohistochemistry. In 94 patients (57 with genotypes non-3), plasma levels of glucose, insulin and leptin were also measured. CTGF synthesis was investigated by immunoblotting on LX-2 stellate cells. Connective tissue growth factor expression was higher in patients with steatosis (P=0.039) and in patients with fibrosis (P=0.008) than those without these features. CTGF levels were neither associated with insulinaemia or with glycaemia, nor with inflammation. By multiple regression analysis, CTGF levels were independently associated with steatosis, a past history of alcohol abuse, plasma leptin and HCV RNA levels; when only patients with genotypes non-3 were considered, CTGF levels were independently associated with a past history of alcohol abuse, plasma leptin levels and steatosis. Leptin stimulated CTGF synthesis in LX-2 cells. In patients with chronic hepatitis C and steatosis, CTGF may promote fibrosis independently of inflammation. CTGF may link steatosis and fibrosis via increased leptin levels.

Acetone poisoning - a diagnostic dilemma

EDITOR: Acetone intoxication is a rarely reported substance involved in poisoning [1-3]. A literature search indicated that, in all cases reported, a clear history of acetone ingestion was obtained, thus facilitating management. We present a case where this information was not immediately available, and subsequent difficulties presented in the diagnosis and management. Case report A 47-yr-old female presented to A&E with respiratory distress. She had a past history of alcohol abuse and deliberate self-harm and was receiving citalopram for depression. She had no other medical problems of note. On physical examination, she had a slim build and was drowsy but rousable with a Glasgow coma scale of 12/15 and no focal neurological signs. She had a sinus tachycardia of 120 min−1 and a blood pressure of 180/120 mmHg. She had a respiratory rate of 40 min−1 with a fruity odour on her breath and SPO2 of 94% on air. Chest was clinically and radiologically clear with no signs of cardiac, hepatic or renal failure. She was hypothermic (35°C). Arterial blood gas analysis showed pH 6.9, PaCO2 1.4 kPa, PaO2 18.5 kPa and base excess −28.8 mmol L−1. There was negative toxicology screen involving ethanol, salicylate, paracetamol and barbiturates. The blood glucose was 15 mmol L−1 and a peripheral blood smear showed neutrophil leucocytosis and white cell count of 26 × 109 L−1. The calculated serum osmolarity was 288 but the measured osmolality was 310, giving an osmolar gap of 22. While the anion gap was 38, the blood lactate level was normal and urinanalysis was mildly positive for ketones. She did not require ventilation, but a bolus of intravenous (i.v.) sodium bicarbonate was administered, and she was transferred to intensive treatment unit (ITU) for further supportive care and management of her profound metabolic acidosis by haemofiltration. The National Toxicology Centre was contacted and suggested methanol or ethylene glycol, but not acetone as a potential aetiological agent. Treatment with i.v. ethanol was recommended. Gas chromatography of the patient's urine and blood confirmed the presence of acetone. The acidosis improved within hours of haemofiltration and i.v. ethanol was not administered. The osmolar gap, anion gap and pH were completely corrected by 18 h. She was transferred out of ITU after 30 h and subsequently sent home after a few days. Discussion Alcohol misuse is associated with concurrent intentional ingestion of acetone as well as methanol, ethylene glycol and acetonitrile (a common component of cosmetic nail varnish remover) [4]. In all of these, the presenting laboratory features of acidosis, with a high anion and osmolar gap, are similar and non-specific. Though acetone alone is a relatively non-toxic compound, methanol and ethylene glycol are converted to the highly toxic breakdown product formaldehyde, and acetonitrile is metabolized to cyanide. The toxicity of acetone is identical to ethanol, although the anaesthetic potency of acetone is much greater [5]. The main route of elimination of acetone is through the lungs. Both acetone and ethanol produce respiratory failure due to central nervous system depression in toxic doses [5]. The elimination of both at high doses follows zero order kinetics. The few reported signs of acetone poisoning, which may help to clinically differentiate ethanol from acetone ingestion, include red and swollen pharynx and soft palate erosions [5,6], but were not seen in this patient. It is likely that the acetone was diluted with another liquid and probably taken over a period of time. Acetone is metabolized to glucose [5,6], and the high blood sugar levels and ketonuria were in keeping with this. Diabetic keto-acidosis was considered as a possible diagnosis but was not in keeping with the overall clinical picture. Measurement of serum osmolality and osmolar gap have limited sensitivity and specificity. Gas chromatography, if available, offers the possibility of a definitive diagnosis. This case illustrates several interesting points: acetone containing nail polish removers are readily found at home, and acetone ingestion should be kept in mind when considering possible aetiological agents. Unless there is a clear history, it can be very difficult to distinguish clinically between all these agents. Finally, the recommended treatment of methanol, as well as ethylene glycol poisoning, is 100% ethanol. Ethanol administration will exacerbate acetone toxicity. It is important to consider acetone in the differential diagnosis of unexpected metabolic acidosis, especially in the presence of hyperglycaemia.

Prevalence of occult HBV infection among subjects with normal serum ALT levels in Korea

To investigate the prevalence of occult HBV infection among subjects with normal serum ALT levels in South Korea. A total of 195 serum samples were collected from subjects without a past history of alcohol abuse and with normal serum ALT levels. They were negative for HBsAg, anti-HCV, and anti-HIV. HBV-DNA was detected from sera by nested polymerase chain reaction (PCR) using specific primers of the surface antigen region of the HBV genome. We performed a quantitation assay using hybrid capture II test to determine the levels of serum HBV-DNA. HBV-DNA was detected in 31 of 195 subjects (16%). Prevalence of occult hepatitis B was significantly higher in the male subjects (23%) than in the female (8%), (P<0.05). We were able to detect HBV-DNA in 15% (7/47) even in which sera were all negative for anti-HBs and IgG anti-HBc. Serum HBV-DNA levels were as high as 10(5) copies/mL in 18 of 31 subjects (58%) with occult HBV infection. The prevalence of occult HBV infection and their HBV-DNA levels were significantly high among subjects with normal serum ALT levels in South Korea. Thus, more meticulous attention should be given to prevent HBV transmission by blood transfusion or organ transplantation in endemic areas, and further studies on clinical implication and mechanism of occult HBV infection are required.

The effect of previous alcohol abuse on cognitive function in HIV infection.

The authors' goal was to study the potential effect on cognitive function of an interaction of HIV infection and a history of alcohol abuse. The subjects were 30 HIV-negative and 50 HIV-positive men with and without a past history of alcohol abuse. Thirty-three of the men (12 HIV negative and 21 HIV positive) had a past history of alcohol abuse, and 47 (18 HIV negative and 29 HIV positive) had never abused alcohol. Each subject's history of alcohol use was obtained by using a syndromal approach based on the Structured Clinical Interview for DSM-III-R and a quantitative approach. Each subject was given a battery of neuropsychological tests assessing verbal reasoning, reaction time, intelligence, memory, and dexterity. The subjects were then compared on a summary neuropsychological impairment rating. There were no significant differences in CD4 level, age, education, depression, anxiety, or other drug abuse history between the HIV-positive and HIV-negative groups with and without a history of alcohol abuse. Significant effects on cognitive function were found for past alcohol abuse and HIV infection, with significant interactions in verbal reasoning, auditory processing, and reaction time. This demonstrates that HIV infection and a history of alcohol abuse have independent effects on some aspects of higher cognitive function but may have synergistic effects on other cognitive domains. In the HIV-negative subjects there were no differences in cognitive function between subjects with and without a history of alcohol abuse. Among the HIV-positive subjects, those with a history of alcohol abuse performed more poorly on tests of verbal IQ, verbal reasoning, and reaction time. There are both additive and interactive effects of previous alcohol abuse and HIV infection on cognition. Individuals with a history of past alcohol abuse may be at greater risk for cognitive dysfunction in the context of HIV infection.

Major Depressive Disorder in Adolescents Exposed to a Friend's Suicide

To evaluate whether the risk of DSM-III major depressive disorder (MDD) is uniform across the 6 months after adolescent exposure to a friend's suicide, and to examine potential moderating or mediating processes that may influence the risk of new-onset MDD. One-month incidence rates of MDD were compared between 129 adolescents who were exposed to a friend's suicide between December 1988 and March 1991 and 145 similar-aged, unexposed community controls participating in the Youth Exposed to Suicide study. Clinical, family, and social factors that antedated the exposure were examined as predictors of new-onset MDD within 1 month of the suicide. Exposed adolescents had a markedly increased risk of developing new-onset MDD that was restricted to a narrow period of time, within 1 month after exposure. In contrast, there were no differences in the incidence of MDD between the groups in months 2 to 6. Past history of alcohol abuse increased the risk of exposure to suicide, which subsequently increased the risk of new-onset MDD within 1 month of exposure. Exposed youths who had both a family history of MDD and feelings of accountability for the death were at considerably increased risk of new-onset MDD. For adolescents exposed to a friend's suicide, events surrounding the death interact with family history of MDD to greatly increase the risk for new-onset MDD.

Cases from the osler medical service at johns hopkins university

Abstract Presenting features A 41-year-old man with a past history of alcohol abuse, drug abuse, and smoking (>40 pack-years) presented with chronic epigastric pain and weight loss. During the preceding year, the epigastric pain had worsened progressively and was exacerbated by eating. For the past 3 months, his nausea and vomiting had worsened so that he was no longer able to tolerate solid food. Consequently, he had lost 50 lbs in 1 year. During the 3 weeks before admission, he had daily subjective fevers but no night sweats. He denied any melena, hematemesis, jaundice, or changes in stool color or consistency. His past medical history was remarkable for an episode of massive hematemesis, for which he was admitted to another hospital 3 months ago and found to have a bleeding gastric ulcer. Despite treatment with a proton pump inhibitor, his abdominal pain, nausea, and vomiting worsened after dis-charge. He stopped drinking alcohol after that hospitalization, and he stopped using intravenous drugs 1 month before this admission. On physical examination, the patient appeared wasted. His vital signs were notable for a normal blood pressure with resting tachycardia and an orthostatic increase in pulse rate. His jugular veins were flat. Cardiac and respiratory examinations were normal. The abdominal examination revealed guarding in the epigastric region with hypoactive bowel sounds and no rebound tenderness. His stool was guaiac negative. Laboratory studies revealed a total white blood cell count of 4180/mm 3 , a hematocrit of 33.1%, a platelet count of 239,000/mm 3 , a total protein level of 8.3 g/dL, an albumin level of 3.7 g/dL, and antibodies to human immunodeficiency virus (HIV). A computed tomographic scan of the abdomen showed thickening of the antrum with large gastric folds. What is the diagnosis?

Cases from the Osler Medical Service at Johns Hopkins University

Presenting features A 41-year-old man with a past history of alcohol abuse, drug abuse, and smoking (>40 pack-years) presented with chronic epigastric pain and weight loss. During the preceding year, the epigastric pain had worsened progressively and was exacerbated by eating. For the past 3 months, his nausea and vomiting had worsened so that he was no longer able to tolerate solid food. Consequently, he had lost 50 lbs in 1 year. During the 3 weeks before admission, he had daily subjective fevers but no night sweats. He denied any melena, hematemesis, jaundice, or changes in stool color or consistency. His past medical history was remarkable for an episode of massive hematemesis, for which he was admitted to another hospital 3 months ago and found to have a bleeding gastric ulcer. Despite treatment with a proton pump inhibitor, his abdominal pain, nausea, and vomiting worsened after dis-charge. He stopped drinking alcohol after that hospitalization, and he stopped using intravenous drugs 1 month before this admission. On physical examination, the patient appeared wasted. His vital signs were notable for a normal blood pressure with resting tachycardia and an orthostatic increase in pulse rate. His jugular veins were flat. Cardiac and respiratory examinations were normal. The abdominal examination revealed guarding in the epigastric region with hypoactive bowel sounds and no rebound tenderness. His stool was guaiac negative. Laboratory studies revealed a total white blood cell count of 4180/mm 3, a hematocrit of 33.1%, a platelet count of 239,000/mm 3, a total protein level of 8.3 g/dL, an albumin level of 3.7 g/dL, and antibodies to human immunodeficiency virus (HIV). A computed tomographic scan of the abdomen showed thickening of the antrum with large gastric folds. What is the diagnosis?

Porphyria cutanea tarda as a Predictor of Poor Response to Interferon Alfa Therapy in Chronic Hepatitis C

Background: Porphyria cutanea tarda (PCT) is sometimes associated with hepatitis C virus chronic infection. The aim of this study was to describe the effect of interferon alfa (IFN-a) in the treatment of patients with chronic hepatitis C and PCT. Methods: We treated a total of 66 patients with chronic hepatitis C with IFN-a 2b (5 MU t.i.w.) for 12 months. Twenty-two of these patients suffered from PCT as well. These patients differed from patients without PCT in that they were men, past history of alcohol abuse and HFE gene mutations were more common and the source of infection was almost always unknown. Results: Sustained virologie response was obtained in 19.7% of the 66 treated patients, 27.3% in the non-PCT group and 4.5% in the PCT group (P < 0.05). This difference could not be ascribed to the difference in sex of patients, history of alcohol abuse, HCV genotype or iron status. Conclusion: Multivariate logistic regression analysis revealed that PCT is independently and significantly associated with non-sustained response to IFNa therapy. In conclusion, patients with chronic hepatitis C and PCT rarely responded to IFNa treatment.

A fatal case of emphysematous gastritis and esophagitis

Emphysematous gastritis is a rare form of infectious gastritis characterized by intramural gas production by gas forming organisms. We report a fatal case of this disorder with involvement of both stomach and esophagus in a 76 yr old man who had a past history of alcohol abuse, and whose recent therapy included nonsteroidal anti-inflammatory agents.

Alprazolam in panic disorder: A retrospective analysis

1. 1. The charts of 78 panic disorder outpatients treated with alprazolam (mean dose 4.30 mg/day, mean duration 31.9 months) were reviewed for demographics, past history (including substance abuse and major depression), and evidence of alprazolam abuse. In addition, the patients were evaluated by Clinical Global Index for improvement at last contact. 2. 2. Moderate to significant recovery was found in 77% of patients. Major depression was seen in 41%. Depressed patients were more likely to have coexisting agoraphobia and a past history of alcohol abuse than non-depressives. 3. 3. There was no DSM-III-R anxiolytic abuse, but 12% showed unauthorized use of the alprazolam. These subjects were three times more likely to have a history of drug abusethan non-misusers. 4. 4. These results indicate that alprazolam is effective in the long-term treatment of panic disorder, but that prolonged management may be required. Further, the data raise concerns about use in panic patients with substance abuse histories.

Upper Abdominal Calcification in a Young Man

History A 17-year-old boy was admitted to the hospital for further evaluation of probable chronic pancreatitis. The patient had been undergoing basic training as a Marine Corps recruit when abdominal pain and malaise developed, lasting three days. Figure 1 is a plain film of the abdomen taken at that time. There was no past history of alcohol abuse or symptoms suggestive of gallbladder disease. The patient had had uncomplicated mumps at the age of 5 years and appendectomy at the age of 9 years. There was no history of abdominal trauma. The only other noteworthy history was prolonged cyanosis at birth requiring observation in an incubator for about one week. There were no apparent neurological sequelae. Findings from the physical examination were entirely within normal limits. Routine blood analysis, including determinations of levels of electrolytes, calcium, amylase, and cholesterol, as well as liver function tests, were normal, as was the