Intramyocardial small-vessel disease in chronic alcoholism

A morphologic study of the small (50 to 200 micron) intramyocardial coronary arteries was performed. The cases chosen for study were selected from a relatively young group of patients without clinical evidence of alcoholic cardiomyopathy or pathologic evidence of large coronary artery disease, in order to evaluate alterations in the small vessels which could possibly be attributed to the chronic alcoholic state. Five basic vascular abnormalities were described. The most common alteration found in all nine cases was vascular wall edema (48 per cent), followed by perivascular fibrosis (42 per cent), vascular sclerosis (36 per cent), subendothelial humps (13 per cent), and vascular wall inflammation (11 per cent). The significance and pathogenesis of these changes were discussed. Primary endothelial cell damage was proposed as a common pathogenic mechanism for all five types of vascular abnormality. It was suggested that following endothelial damage, fluid and macromolecules penetrate into the vessel wall or into the perivascular space where, by incompletely understood processes, they induce vascular wall myocytes to produce collagen, elastin, and basement membrane-like substances. Evidence supporting this mechanism was derived from the common observation of vascular wall edema, from the occasional presence of erythrocytes and leukocytes within the vessel wall, and from experimental data in the literature. Several possible etiologic agents were implicated in the pathogenesis of endothelial and vessel wall injury. These included alcohol itself, acetaldehyde, biogenic amines, and magnesium deficiency. It is probable, however, that there are multiple etiologic factors which affect the small cardiac vessels of the chronic alcoholic. Finally, the proposal was advanced that the nonspecific pathology of the myocardium in chronic alcoholism may be a result of ischemia secondary to disease of the small intramyocardial coronary ateries.     

Changes of carbohydrate-deficient transferrin in chronic alcoholism

Compared with other well established liver enzyme parameters, carbohydrate-deficient transferrin (CDT) offers a new method for the identification of chronic alcoholism. The dependence of CDT and alcoholism/abstinence was studied in 29 controls and 64 alcoholics (both groups comprising men and women). In contrast to the currently used parameters GOT, GPT, gammaGT, LDH and MCV, CDT measures chronic alcoholism exclusively. CDT is dependent on sex but not age. In chronic alcoholism its rate increases significantly, but drops quickly after a short time of abstinence. CDT variations may be a specific and sensitive indicator of alcoholism or abstinence and possibly the duration.     

Behavioral analysis of chronic alcoholism in four women

Observed the behavior of 4 female 38-50 yr old alcoholics over a 22-day period at the Alcoholic Behavior Research Laboratory, Rutgers University. A 12-day drinking period was preceded by a 6-day predrinking baseline assessment period and followed by a 4-day postdrinking withdrawal phase. Points earned for operant responding at a button-pressing task were spent to purchase alcohol, relief from programmed social isolation, or both during specified periods. Ss emitted high operant rates during predrinking, largely to accumulate socialization points. Operant rate declined when alcohol became available. When Ss resumed operant responding, they tended to work for and spend about the same number of alcohol points each day. Ss resumed working for socialization points when they ran out of them; they continued to earn these points into the postdrinking period. Ss consumed consistent amounts of alcohol each day in a cyclic pattern, almost always reaching their highest blood alcohol level at the midnight reading. Drink preference, sip magnitude, and consumption time resembled more closely those behaviors reported for male social drinkers than for male alcoholics. Ss reported generally improved affect when drinking began. No changes in psychopathology were noted during drinking. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurocognitive dysfunction in patients diagnosed with schizophrenia and alcoholism.

The authors administered the Halstead–Reitan Neuropsychological Test Battery to schizophrenic groups with (n?=?54) and without (n?=?217) coexisting alcoholism, nonschizophrenic groups with alcoholism (n?=?231), and a patient comparison group (n?=?145) to determine the extent of additive cognitive impairment in schizophrenia associated with alcoholism and to compare cognitive function in alcoholism and schizophrenia. The additive effects of alcoholism on cognitive dysfunction in schizophrenia were subtle but were consistently identifiable. Cognitive dysfunction in alcoholism was less severe than in schizophrenia with or without alcoholism. The magnitude of additive effects of alcoholism on cognitive dysfunction in schizophrenia was age related with a significant interaction between age and presence or absence of alcoholism on a global index of cognitive dysfunction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Antral gastritis in chronic alcoholism. Role of cirrhosis and Helicobacter pylori

OBJECTIVES: Antral gastritis is frequent in alcoholics. The role of H. pylori in the pathogenesis of gastritis in these patients is not well known. The aim of our study was to study the role of H. pylori and cirrhosis in the pathogenesis of antral gastritis in alcoholic patients. METHODS: Seventy-nine patients were included in the study. All underwent upper gastrointestinal tract endoscopy with antral biopsies, independently of the presence of abdominal pain, and had serological examination for H. pylori antibodies. RESULTS: Cirrhosis and gastritis were present in 50 and 40 patients respectively, H. pylori serological assay and histological identification of the bacterium were positive in 35 (44%) and 19 (24%) patients respectively. Discrepancy between the 2 tests were observed more frequently in cirrhotic patients. A positive serology with a negative histologic examination for H. pylori was present for 18 cirrhotic and 4 noncirrhotic patients (p < 0.05). A gastritis without evidence of H. pylori was more frequent in cirrhotic than in noncirrhotic patients. H. pylori was histologically present in 11 of 29 cirrhotic patients and in 8 of the 11 noncirrhotic patients with a gastritis (p < 0.05). CONCLUSIONS: Discrepancies between histological examination and H. pylori serology in patients with cirrhosis might be due to the inhospitable environment for H. pylori in case of portal hypertension; the positive serology could be in relation with a past infection.     

25-hydroxy vitamin D deficiency with reduction of intestinal calcium absorption and bone density in chronic alcoholism

Plasma levels of 25-hydroxycalciferol (25-OH-D), 47-calcium intestinal absorption, bone mineral content and the biologic parameters of phospho-calcium metabolism were studied in 30 chronic alcoholics, 15 with Laennec's cirrhosis (group A) and 15 without (group B). These patients were compared with 27 normal subjects. In group A, the mean 25-OH-D plasma level was 23.7 +/- SD 18.5 microgram/l and in group B 35.2 +/- SD 21.8 microgram/l. These mean levels were lower than those of the control group, which were 57.2 +/- SD 22.5 microgram/l (p less than 0.001). The mean value of the 47Ca intestinal absorption, measured as the percentage of the ingested dose per litre of plasma and multiplied by the body weight, was also significantly lower in group A, which was 140 +/- SD 47 (p less than 0.01), and in group B, which was 145 +/- SD 69 (p less than 0.05), compared with the normal subjects whose average was 182 +/- SD 45.6. Similarly, the total plasma calcium was low: 1.99 +/- SD 0.24 mmol/l in all the alcoholics, while that of the control group was 2.22 +/- SD 0.18 mmol/l (p less than 0.001). For the 30 chronic alcoholics there was a positive correlation between 25-OH-D and 47Ca intestinal absorption, (r = 0.484; p less than 0.004). This suggests that in chronic alcoholism the deficiency of 25-OH-D induces a diminution of the intestinal absorption of calcium which, in the long term, can result in bone demineralization evidenced in the patients studied by a bone mineral content lower than normal (p less than 0.001).     

Association of tuberculosis with alcoholism

To define the extent of the association between tuberculosis and alcoholism, all cases of tuberculosis reported in 1972 to the Fulton County Health Department (Georgia) were reviewed. Alcoholics accountered for 49% of all adult cases. Because of this high association, alcoholics should be screened regularly for possible tuberculosis.     

Dinitrochlorobenzene test in patients with chronic nephritis

The effect of passive immunization with hetero and isoimmune antiovary antiserum on the fertilization of mouse, rat, and hamster eggs was determined. Fertilization of the eggs could be inhibited by a single ip injection of respective antiovary antiserum obtained from rabbits. The antiovary antisera absorbed with the ovary did not prevent fertilization but antisera absorbed with the liver and kidney inhibited fertilization was not inhibited by a single ip injection of antiovary antiserum obtained from rats and mice, respectively. Fertilization in vitro of mouse eggs was low in the presence of control serum but was significantly reduced in the presence of antiserum (p less than .001).     

Frontal lobe dysfunctions in Korsakoff's syndrome and chronic alcoholism: Continuity or discontinuity?

The effect of long-term heavy alcohol consumption on brain functions is still under debate. The authors investigated a sample of 17 Korsakoff amnesics, 23 alcoholics without Korsakoff's syndrome, and 21 controls with peripheral nerve diseases, matched for intelligence and education. Executive functions were examined for word fluency, the modified Wisconsin Card Sorting Test, an alternate response task, and an "n-back" working memory task. Korsakoff amnesics, but not alcoholics, showed a marked memory impairment. They also scored lower in each of the executive tasks--the alcoholics only in the alternate response task. This task also correlated with the years of the alcohol dependency. First, the authors conclude that Korsakoff's syndrome is associated not only with a memory impairment but also with a global executive deficit. Second, the decline in the ability to alternate between different responses argues for a restricted neurotoxic effect of alcohol on some frontal lobe areas (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Open heart surgery in patients with chronic dialysis

From January, 1986 to May, 1995, twelve patients with dialysis (11 hemodialysis; HD, and one continuous ambulatory peritoneal dialysis; CAPD) received open heart surgery. They consist of 10 males and two females aged between 35 and 66 with a mean of 58.8. The duration of dialysis was 6.8 years in a mean (the shortest for 2 months and the longest for 16 years). They classified into an equal number of four in NYHA class II, III and IV. Two of them had isolated coronary artery bypass grafting, four had aortic valve replacement (AVR) and two had mitral valve replacement (MVR). Others were each one of AVR and MVR, AVR plus MVR with tricuspid annuloplasty (TAP), AVR plus TAP, and removal of left atrial myxoma. All patients except for one of CAPD were dialysed daily 2 or 3 days before operation. Three patients were managed postoperatively with HD, one with PD, six with continuous hemodiafiltration, and two with continuous hemofiltration. The operative mortality was 25% (3/12). The causes of death were left ventricular rupture, bronchospasm, and respiratory failure. All patients who died were in class in III and IV. For the improvement of the results we emphasize the necessity of early operation that should be scheduled in class II period.     

Taste acuity in patients with chronic renal failure

One of the responsibilities of cochlear implant centers is to counsel deaf patients regarding the potential for transmitting deafness of their children. Diagnostic studies should be made to determine if deafness is an isolated event or part of a syndrome. We report the criteria used in our center for genetic counseling of the deaf.