Skeletal muscle disease in alcoholism

Acute alcoholic myopathy, a syndrome of sudden muscle necrosis, occurs as a result of binge drinking, whereas chronic alcoholic myopathy is a more indolently evolving syndrome of proximal weakness and muscle atrophy that accompanies prolonged alcohol abuse. The characteristic features and management of these disorders are highlighted.     

The management of severe alcoholic liver disease and variceal bleeding in the intensive care unit

PURPOSE OF REVIEW: To address recent advances in the understanding and management of alcohol-related chronic liver disease and its acute complications. RECENT FINDINGS: Refinements have been made in the prognosis and treatment of alcoholic hepatitis, and new insights have been gained into the pathophysiology of the hepatorenal syndrome. Further trial evidence has emerged concerning therapy in the hepatorenal syndrome, and there has been some clarification of the benefits and risks relating to albumin dialysis/extracorporeal liver support, and consensus in the early management of variceal haemorrhage. SUMMARY: Recent developments have led to modifications in the standard of care of patients with severe alcoholic liver disease, many of which are highly applicable to the general critical care setting. These changes apply specifically to alcoholic hepatitis, the hepatorenal syndrome and variceal bleeding, common conditions with a high mortality rate, upon which changes in practice can have a significant impact.     

Effects of alcohol on the central nervous system: implications for the neuroscience nurse

Alcoholism is a chronic, progressive disease that devastates the patient and family. The chronic abuse of alcohol results in a multitude of pathological changes, particularly in the central nervous system. The toxic effects of acetaldehyde, a metabolic by-product of alcohol, and alcoholic beverage congeners have been associated with pathological changes in the central nervous system. Toxic effects of alcohol and addiction to alcohol reflect central nervous system changes. The alcohol withdrawal syndrome poses a potential life-threatening complication for the alcoholic patient. This paper discusses the pathological changes in the central nervous system, pharmacology of alcohol, and the alcohol withdrawal syndrome. Nursing implications to assist the neuroscience nurse in providing a highly specialized plan of care for the alcoholic patient are presented.     

Diagnostic significance of determining the blood content of lactic and uric acids in chronic liver lesions of alcoholic and viral etiologies

The concentration of lactic and uric acids in blood serum was measured in 115 patients with chronic liver lesions of virus (30 patients) and alcoholic (85 patients) etiology. The highest rise of lactic and uric acid concentrations was recorded in patients with alcoholic hepatitis and active alcoholic liver cirrhosis. The blood concentration of lactic and uric acids in alcoholic hepatopathy increased in parallel with an increment of the gravity of the pathological process, being the highest in patients with alcoholic hepatitis (lactic acid) and liver cirrhosis associated with the edematous ascites syndrome (uric acid). In inactive liver cirrhosis of alcoholic etiology, the concentrations of lactic and uric acids tended toward reduction, however, they were significantly higher than in the group of patients with virus liver lesions. Normal or negligible rises in the content of lactic and uric acids were seen in the groups of patients with chronic liver diseases of virus etiology. It is concluded that the measurement of the content of lactic and uric acids plays a diagnostic part in different patterns of alcoholic hepatopathies.     

Alcohol-induced Cushingoid syndrome.

A 35-year-old woman with alcoholic liver disease presented with physical stigmas and laboratory confirmation of Cushing's syndrome. With discontinuance of alcohol, her signs of Cushing's syndrome resolved and the urinary free cortisol and the urinary 17-hydroxycorticosteroid response to dexamethasone returned to normal. These findings broaden the spectrum of deranged glucocorticoid chemistry that can occur in alcohol-induced cushingoid syndrome.     

Transketolase abnormality in cultured fibroblasts from familial chronic alcoholic men and their male offspring.

We have investigated a thiamine-dependent enzyme, transketolase, in cultured fibroblasts from 41 human subjects, including patients with alcoholism-associated Wernicke-Korsakoff syndrome (n = 3), familial chronic alcoholic males (n = 7), their sons (n = 7), nonalcoholic men (n = 7), their male offspring (n = 7), and three generations of an Amish family (n = 10) without any history of alcoholism. This study was undertaken to delineate whether transketolase abnormality (i.e., high Michaelis Menton constant (Km) for thiamine pyrophosphate), previously reported in patients with Wernicke-Korsakoff syndrome is prevalent among familial chronic alcoholic men and their sons without prior history of alcohol abuse but who are at high risk for alcoholism. Our data suggest that an inborn error (i.e., high Km of transketolase for thiamine pyrophosphate) predisposing to thiamine deficiency diseases similar to those reported in Wernicke-Korsakoff syndrome may occur in the general population. However, for some as yet unexplained reason(s) this variant seems to occur more frequently among familial chronic alcoholic men and their male offspring without any history of alcoholism. The inheritance pattern of this enzyme variant as revealed from an Amish pedigree study may be autosomal recessive as previously suggested.     

Aeromonas hydrophila: Myofascial necrosis and sepsis

An alcoholic patient with ascites was admitted to the intensive care unit for gastrointestinal bleeding. He subsequently developed spontaneous myonecrosis of the extremities culminating in sepsis syndrome. This was a unique, non-traumatic presentation ofAeromonas hydrophila soft tissue injury.     

ACUTE ENCEPHALOPATHY DUE TO COEXISTENT NICOTINIC ACID AND THIAMINE DEFICIENCY

SUMMARY We report the case of an alcoholic woman with confusion, catatonia and extrapyramidal signs, who developed features of the Wernicke-Korsakoff syndrome after treatment with intravenous high potency vitamins. We emphasise that this should arouse the suspicion of nicotinic acid deficiency even in the absence of gastrointestinal symptoms or skin lesions.     

Homœopathic treatment of alcohol withdrawal

The authors report their experience of the treatment of alcohol withdrawal syndrome and delirium tremens (DTs). In a series of 30 alcoholic men (5 with DTs) results appeared favourable. The main homœopathic medicine used was Sulphur.     

Neurologic sequelae of chronic alcoholism

Chronic alcohol abuse causes several distinct diseases of the central and peripheral nervous system. Widely known are the alcohol withdrawal syndrome, alcohol-induced epileptic seizures, alcoholic polyneuropathy and myopathy, and Wernicke's encephalopathy. Beside these complications, less common syndromes have been identified, including Marchiafava-Bignami syndrome, subacute encephalopathy with seizure activity (SESA syndrome), and tobacco alcohol amblyopia. These syndromes can be diagnosed by their characteristic features in cranial MRI or in EEG. Moreover, certain disorders in which alcohol abuse is only indirectly involved in the pathogenesis are more frequent in alcoholics than in nonalcoholics. In daily practice, it is important to differentiate these disorders when encountering patients with chronic alcohol abuse.     

Alcohol consumption and the prevalence of the Metabolic Syndrome in the US.: a cross-sectional analysis of data from the Third National Health and Nutrition Examination Survey

OBJECTIVE: The aim of this study was to examine the relations of alcohol consumption to the prevalence of the metabolic syndrome and its components in the U.S. population. RESEARCH DESIGN AND METHODS: We performed a cross-sectional analysis on data from 8,125 participants from the Third National Health and Nutrition Examination Survey who were evaluated for each component of the metabolic syndrome, using the National Cholesterol Education Program criteria, fasting insulin, and alcohol consumption. Current alcohol consumption was defined as > or =1 alcoholic drink per month. RESULTS: After adjustment for age, sex, race/ethnicity, education, income, tobacco use, physical activity, and diet, subjects who consumed 1-19 and > or =20 drinks of alcohol per month had odds ratios (ORs) for the prevalence of the metabolic syndrome of 0.65 and 0.34, respectively (P <0.05 for all), compared with current nondrinkers. These findings were particularly noteworthy for beer and wine drinkers. The association of > or =20 alcoholic drinks per month with the prevalence of the metabolic syndrome was consistent across ethnicities but was most striking in white men and women (ORs 0.35 and 0.22, respectively; P <0.05). Alcohol consumption was significantly and inversely associated with the prevalence of the following three components of the metabolic syndrome: low serum HDL cholesterol, elevated serum triglycerides, high waist circumference, as well as hyperinsulinemia (P <0.05 for all). CONCLUSIONS: Mild to moderate alcohol consumption is associated with a lower prevalence of the metabolic syndrome, with a favorable influence on lipids, waist circumference, and fasting insulin. This association was strongest among whites and among beer and wine drinkers.     

己酮可可碱和糖皮质激素治疗重症酒精性肝炎的meta分析

目的评价己酮可可碱和糖皮质激素治疗重症酒精性肝炎的疗效。方法采用Cochrane 系统评价方法,计算机检索Pubmed、Embase、Ovid、The Cochrane Library、谷歌学术、中国知网、万方、维普数据库等。检索时间截止至2016年4月。根据纳入与排除标准筛选文献、评价文献质量、提取资料,采用RevMan 5.3软件进行meta分析。结果在726篇文献中共纳入7篇文献,共998例重症酒精性肝炎患者。Meta分析结果显示：两种药物在改善重症酒精性肝炎早期（P=0.58）和中期病死率（P=0.19）、肝肾综合征(P=0.33)、消化道出血发生率(P=0.75)差异无统计学意义,而己酮可可碱可显著减少感染的发生率(P=0.001)。结论己酮可可碱和糖皮质激素在治疗重症酒精性肝炎时疗效没有显著的差异,但在合并感染的情况下推荐使用己酮可可碱。     

Pancreatic-portal vein fistula with disseminated fat necrosis treated by pancreaticoduodenectomy

I have reported the case of a 62-year-old man with chronic alcoholic pancreatitis and a rare pseudocyst-portal vein fistula. Even though he experienced no abdominal symptoms, he had severe metastatic fat necrosis manifested as subcutaneous fat necrosis, polyarthritis, medullary bone necrosis, and mental status changes. Remote tissue destruction continued until relief was gained by pancreaticoduodenectomy and repair of the necrotic portal vein. Disseminated fat necrosis is a rare syndrome that can be the only presenting feature in patients with pancreatitis and pancreatic cancer. Early recognition and treatment of the underlying pancreatic disease may decrease the high morality rate associated with this syndrome.     

Practical strategies for lifestyle modification in people with hyperuricemia and gout treatment through diet, physical activity, and reduced alcohol consumption

There has been an explosive increase in the prevalence of hyperuricemia and gout in Japan, suggesting the recent lifestyle change may be a key factor leading to this pathophysiological condition. In addition, people with hyperuricemia are often associated with various morbid conditions constituting the metabolic syndrome, such as abdominal obesity, hypertension, dyslipidemia and impaired glucose tolerance. Therefore, healthy lifestyle interventions would be a basic therapeutic approach not only to hyperuricemia but to metabolic syndrome, though it is not easy to promote behaviour changes. This review focuses on strategies for lifestyle intervention for clinical practice, including how we advise patients on appropriate diets, physical activity and alcoholic beverage consumption.     

Acute Withdrawal From Alcohol

Acute alcoholic withdrawal is a common clinical problem, and delirium tremens is its most severe form. Symptoms of withdrawal must be evaluated carefully and treated aggressively. The severity of the withdrawal syndrome cannot always be predicted on the basis of quantity or duration of alcohol ingestion. Sedation must be handled with extreme care, and special attention to fluid and electrolyte balance is of the utmost importance.     

Baclofen: a new drug for the treatment of alcohol dependence

Recent preclinical and clinical studies have suggested that baclofen, the prototypic gamma-aminobutyric acid B (GABA(B)) receptor agonist, is a promising pharmacological compound for use in the treatment of alcohol dependence. In particular, baclofen has been found to suppress symptoms of alcohol withdrawal syndrome with an efficacy comparable with that of the 'gold standard' diazepam. Moreover, baclofen has proven effective in the prevention of relapse due to its ability to reduce alcohol intake and craving in alcoholic patients. Baclofen proved to be manageable, producing no significant side effects and displaying no addictive properties. The efficacy of the drug in the management of both alcohol withdrawal syndrome and relapse prevention should entail a vastly simplified pharmacotherapy of alcohol dependence.     

Lance: a gay recovering alcoholic misdiagnosed as HIV-positive.

Lance is a 29-year-old gay alcoholic who was misdiagnosed as human immunodeficiency virus (HIV)-positive. In reaction to the diagnosis, Lance subsequently engaged in a series of destructive behaviors towards himself and others. When he was told that his diagnosis was in error, Lance was able to break out of his self-destructive cycle. This article explores the symbolic interactionist concepts of definition of the situation and of stigma and provides nursing implications for caring for people with HIV infection and the acquired immune deficiency syndrome.     

Spontaneous bacterial peritonitis: variant syndromes

Spontaneous bacterial peritonitis (SBP), a fascinating disease that had been reported perhaps 50 times in varying guises over the preceding century, suddenly burst forth in the 1960s and was recognized in clusters of cases almost simultaneously in Paris, London, and West Haven, Connecticut. The spectrum of the disease has broadened. Initially, it was associated almost exclusively with alcoholic cirrhosis, but it has now been found in association with posthepatitic cirrhosis, cryptogenic cirrhosis, chronic active liver disease, and, occasionally, in biliary cirrhosis and cardiac cirrhosis. Recently, it has been reported in alcoholic hepatitis and acute viral hepatitis. It occurs occasionally in malignant ascites and in pancreatitis in the absence of cirrhosis. It is surprisingly common in disseminated lupus, in which it occurs relatively more commonly than in alcoholic cirrhosis. A similar syndrome, primary peritonitis, occurs frequently in children with nephrotic ascites. The clinical pattern of SBP has broadened. Initially it consisted of abdominal pain, fever, rebound tenderness, hypoactive bowel sounds, hypotension, encephalopathy, and cloudy ascites with large numbers of polymorphonuclear leukocytes in ascitic fluid. Each and every symptom, sign, and laboratory abnormality may be absent; indeed, the syndrome can be completely silent. Initially, the causative bacteria appeared to be almost exclusively enteric, but now the list of bacteria isolated in cases of SBP looks like a bacteriology textbook. Anaerobes are rare. Multiple organisms usually suggest nonspontaneous origin such as perforation or vasopressin induction. The differentiation between spontaneous and nonspontaneous bacterial peritonitis is crucial in the differential diagnosis. The great majority of cases of SBP develop in the hospital, 80% more than one week after admission. It is therefore a nosocomial disease that may be precipitated by procedure-induced bacteremia, gastrointestinal bleeding, or diarrhea, and it tends to occur in patients with low ascitic fluid protein (complement) concentrations and severe portal-systemic shunting.     

A case of acute renal failure and compartment syndrome after an alcoholic binge.

A 25 year old man presented with anuria and bilateral leg pain two days after an alcoholic binge. He subsequently developed rhabdomyolysis causing acute renal failure, with compartment syndrome of both lower legs. This required urgent dialysis and fasciotomy respectively within six hours of admission. He remained dialysis dependent for three weeks and only after four months was he able to weight bear on both legs. Alcohol is a leading cause of rhabdomyolysis. Early recognition and prompt treatment is essential to prevent serious complications.     

A case of acute renal failure and compartment syndrome after an alcoholic binge.

A 25 year old man presented with anuria and bilateral leg pain two days after an alcoholic binge. He subsequently developed rhabdomyolysis causing acute renal failure, with compartment syndrome of both lower legs. This required urgent dialysis and fasciotomy respectively within six hours of admission. He remained dialysis dependent for three weeks and only after four months was he able to weight bear on both legs. Alcohol is a leading cause of rhabdomyolysis. Early recognition and prompt treatment is essential to prevent serious complications.