How Do Physicians Define “Light,”“Moderate,” and “Heavy” Drinking?

Although widely used, terms associated with consumption of alcohol–such as "light,""moderate," and "heavy"—are unstandardized. Physicians conveying health messages using these terms therefore may impart confusing information to their patients or to other physicians. As an initial attempt to assess if informal standardization exists for these terms, the present study surveyed physicians for their definitions of such terms. Physicians operationally defined "light" drinking as 1.2 drinks/day, "moderate" drinking as 2.2 drinks/ day, and "heavy" drinking as 3.5 drinks/day. Abusive drinking was defined as 5.4 drinks/day. There was considerable agreement for these operational definitions, indicating there is indeed an informal consensus among physicians as to what they mean by these terms. Gender and age did not influence these definitions, but self-reported drinking on the part of physicians was a factor. We also asked physicians for their opinions regarding the effects of "light,""moderate," and "heavy" drinking on health in general and specifically on health-related implications for pregnant women, and whether they felt their patients shared these beliefs.     

Cardiac resynchronization therapy: “Nonresponders” and “hyperresponders”

BACKGROUND: Cardiac resynchronization therapy (CRT) is a recognized treatment modality for patients with dilated cardiomyopathy (DCM), left bundle branch block, and severe cardiac failure. However, 30% of patients are "nonresponders." Intriguingly, the opposite case has not been reported until recently: Do some patients treated with CRT have a "complete" recovery and thus can be considered "hyperresponders"? OBJECTIVE: The purpose of this study was to investigate patients treated with CRT who have a "complete" functional recovery, with normalization of left ventricular function after therapy. METHODS: Eighty-four consecutive patients with DCM, sinus rhythm, and left bundle branch block in New York Heart Association functional class III and IV who were implanted with a CRT device were prospectively followed. Patients were considered to be "hyperresponders" if they concurrently fulfilled two criteria: functional recovery and left ventricular ejection fraction > or = 50%. RESULTS: Among the 84 patients with DCM, 11 (13%) were "hyperresponders" within 6 to 24 months after CRT (left ventricular ejection fraction increased from 25% +/- 8% to 60% +/- 6.5%, P = .001). Comparison of baseline parameters between "hyperresponders" and the remaining patients showed that only etiology of the DCM was statistically discriminative. All "hyperresponders" belonged to the group of patients with nonischemic DCM (18% vs 0%, P = .05). CONCLUSION: In a subset of patients successfully implanted with a CRT device, "complete" functional recovery associated with normalization of LV function was observed, giving rise to the concept of "hyperresponders." This finding is observed exclusively in the subgroup of patients with nonischemic DCM and suggests that left bundle branch block may be the causal factor of DCM in this subgroup of patients.     

The mysterious “double” arch

A child with cyanosis and heart failure was noted to have two different vascular arches of similar caliber on echocardiography. A systematic analysis of the rhythm and flow patterns revealed the mysterious “double” arch.     

The other “Midnight Express”

The “Renal Disaster Relief Task Force” was founded around 8 years ago, after the earthquake in Armenia, under the direction of Professor Lameire from the UZ Gent (Ghent University Hospital). This task force was set up in the bosom of the “International Society of Nephrologists” (ISN). The objective was to offer nephrological help in case of disasters, in the region encompassing Europe and the Western part of Asia. In Belgium, this organisation works together with ORPADT (the association of dialysis personnel). Together with a medical company (Baxter) 2 tonnes of aid material is kept in readiness at all times, in Brucargo in Zaventem. Personnel are sent in cooperation with Médecins sans Frontières (MSF). They take care of the logistic support and the organisation. Three of us enrolled right from the start (Gina De Brouwer, Stefaan Demeulenaere and myself) to stand in, in the case of a disaster occurring. The years went by and the Task Force was only ever sporadically mentioned. At the start of this year an update of available volunteers was made. Again, the three of us enrolled. Then the 17th August came along…     

“Bacteroides” bacteremia

Clinical and bacteriologic data relating to 250 patients with bacteremia due to anaerobic, nonsporulating, gram-negative bacilli, “bacteroides,” were analyzed. A total of 433 human blood culture specimens submitted included nine Bacteroides species and four species of Fusobacterium; twenty-nine were mixed with other microorganisms. The characteristic clinical syndrome consisted of hectic fever, rigors and diaphoresis. The gastrointestinal tract was the probable portal of entry for the majority of Bacteroides, the lung and oropharynx for Fusobacterium species. Prior surgery, malignant neoplasms, diabetes mellitus, and steroid, immunosuppressive or cytotoxic therapy were common associated factors. Emboli, thrombophlebitis, endocarditis and metastatic abscesses were common complications. The over-all mortality of the patients was 32 per cent. The mortality of patients with B. fragilis bacteremia, the most common organism involved, was 34 per cent. The death rate of patients with B. oralis and B. variabilis was approximately 70 per cent, but none of the patients with B. melaninogenicus bacteremia died. Patients treated with tetracyclines, sulfonamides, incision and drainage, or a combination of these, showed the highest survival rate.