Understanding and treating alcohol dependence

This article represents the proceedings of a symposium presented at the 158th Annual Meeting of the American Psychiatric Association held in Atlanta, Georgia, on May 24, 2005. The organizer/chairman was Bankole A. Johnson, DSc, MD, PhD. The presentations included the following: (1) Neuropharmacological Basis of Alcohol Dependence, by George F. Koob, PhD; (2) Recent Developments in the Genetics of Alcohol Dependence, by Marc A. Schuckit, MD; (3) New Pharmacological Strategies for Treating Alcohol Dependence, by Barbara J. Mason, PhD; (4) New Medications: The Use of Anticonvulsants, Both Alone and in Combination, with Various Forms of Psychotherapy, by Bankole A. Johnson, DSc, MD, PhD; and (5) Differential Effects of Pharmacological Agents on Craving, by Nassima Ait-Daoud, MD.     

Challenges and opportunities for medications development in alcoholism: an international perspective on collaborations between academia and industry

This article represents the proceedings of a symposium presented at the 12th Congress of the International Society for Biomedical Research on Alcoholism held in Heidelberg/Mannheim, Germany, on September 30, 2004. The organizers and cochairs were Bankole A. Johnson, DSc, MD, PhD, and Karl Mann, MD. The presentations included the following: (1) A Perspective from Academia, by Bankole A. Johnson, DSc, MD, PhD; (2) A Perspective from NIAAA, by Mark L. Willenbring, MD; (3) A Perspective from US Clinical Practice, by Robert M. Swift, MD, PhD; (4) A European Perspective on Medications Development, by Otto M. Lesch, MD, PhD, and (5) A Scandinavian Perspective on Evidence-Based Addiction Treatment, by Mats Berglund, MD.     

Book Reviews

Book reviewed in this article:
Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths BARBARA S. LYNCH & RICHARD J. BONNIE (Eds)
Nicotine Addiction: Principles and Management C. TRACY ORLEANS & JOHN SLADE (Eds)
Alcohol Treatment: A Study of Therapists and Clients J. KEENE
Drinking Careers: A Twenty-Five-Year Study of Three Navajo Populations STEPHEN J. KUNITZ & JERROLD E. LEVY
Drug and Alcohol Abuse MARC A. SCHUCKIT
Preventing AIDS: Theories and Methods of Behavioral Interventions RALPH J. DICLEMENTE & JOHN L. PETERSON     

Bench to Bedside: Mechanisms and Consequences of Alcohol-Altered Host Defenses

This article presents the proceedings of a symposium presented at the 2004 ISBRA meeting in Mannheim, Germany, October 1, 2004. The organizers and chairpersons were Joseph H. Sisson, MD, and Claudia Spies, MD. The presentations were as follows: “Alcohol: Impact on Mucociliary Clearance”; “Alcohol and Alveolar Epithelial Dysfunction”; “The Reluctant Neutrophil in Lung Bacterial Host Defense During Alcohol Abuse”; “Prevalence, Diagnosis, and Relevance of Alcohol Use Disorders in Surgical Patients”; and “Intervention in Alcohol‐Use Disorders: How Can We Meet the Challenge to Reduce Postoperative Complications?” Alcohol is known to alter pulmonary host defenses, thus putting the lung at risk for severe infection. Alcohol is also recognized as a major risk factor for developing acute respiratory distress syndrome. These dreaded pulmonary complications pose especially difficult management challenges to the clinician during surgery and after trauma, because the prevalence of alcohol abuse is very high in these settings. Particularly common in this perioperative context is pneumonia, which, despite advances in antimicrobial therapy, remains a major cause of morbidity and mortality in the alcoholic. In this symposium, we explored recent advances in our knowledge of both the mechanisms by which alcohol puts the lung at risk in these settings and the consequences that these impairments cause. We approached this important topic from a “bench‐to‐bedside” perspective by linking the mechanisms by which alcohol impairs lung defenses to the perioperative consequences of lung impairment. Using this approach, the speakers in this symposium highlighted recent advances from the “bench” in our understanding of the mechanisms of alcohol‐mediated lung impairment and from the “bedside,” where understanding the consequences of these impairments impact patient outcomes. We also examined ways to detect and monitor patients at risk for alcohol‐related complications and how clinical systems are being developed to minimize risk. Better clinical outcomes in these alcohol‐consuming patients depend on a heightened awareness of patients at risk, understanding of the mechanisms that put them at risk, and applying appropriate prevention and treatment strategies.     

Books Received

DRUG USE IN THE WORKPLACE Michael D. Newcomb Auburn House Publishing Company, Dover, Massachusetts, 1988

ALCOHOLISM TREATMENT Donald I. Davis, MD Gardner Press, Inc., 19 Union Square West, New York, New York 10003, 1987

BASIC CONCEPTS of HELPING: A HOLISTIC APPROACH, 2nd ed. Carolyn Cooper Hames and Dayle Hunt Joseph Appleton-Century-Crofts, Division of Prentice-Hall Inc., Norwalk, Connecticut, 1986

HOW TO STAY SOBER: RECOVERY WITHOUT RELIGION James Christopher Prometheus Books, 700 E. Amherst St., Buffalo, New York 14215, 1988

HEAVY DRINKING: THE MYTH of ALCOHOLISM AS A DISEASE Herbert Fingarette University of California Press, 2120 Berkeley Wy., Berkeley, California 94720, 1988

ALCOHOL AND SEXUALITY Carlotta Schuster, MD Praeger Publishers, One Madison Ave., New York, New York 10010, 1988

NATIONAL WOMEN'S DIRECTORY of ALCOHOL AND DRUG ABUSE TREATMENT AND PREVENTION PROGRAMS Human Services Institute Human Services Institute, Inc., 512 33rd Street, Court West, Bradenton, Florida 34205, 1988

COUNSELOR CHARACTERISTICS: HOW THEY AFFECT OUTCOMES Dorothy Fahs Beck Family Service America, 11700 W. Lake Park Dr., Milwaukee, Wisconsin 53224, 1988

WHAT BEHAVIORAL SCIENTISTS KNOW AND WHAT THEY CAN DO ABOUT ALCOHOLISM Peter E. Nathan, PhD Center for Alcohol Studies Pamphlet Series Alcohol Research Documentation, Inc., Center for Alcohol Studies, Rutgers University, New Brunswick, New Jersey, 1988     

Brief screens for mental disorders in primary care

We evaluated a set of diagnostic screens for mental disorders in primary care. A self-administered screening questionnaire containing 26 items testing for multiple mental disorders was completed by 1,001 patients. Brief diagnostic modules, structured for psychiatric diagnoses, were subsequently administered to each patient by a research nurse. Operating characteristics of the screens were as follows: alcohol dependence (sensitivity [SE] 0.75; positive predictive value [PPV] 0.58; [κ] 0.63), drug dependence (SE 0.50; PPV 0.50; κ 0.50), generalized anxiety disorder (SE 0.74; PPV 0.44; κ 0.44), major depressive disorder (SE 0.71; PPV 0.52; κ 0.50), obsessive compulsive disorder (SE 0.71; PPV 0.15; κ 0.21), and panic disorder (SE 0.71; PPV 0.43; κ 0.48). Other chance-corrected measures of agreement are also reported, and criterion validity of the screens is examined. The results provide evidence that the screens discriminate between patients with symptomatology meeting established diagnostic criteria and those without. They detected previously unrecognized cases in this study and may prove to be valuable tools for psychiatric diagnosis in primary care. This work was supported by a grant from the Upjohn Company, Kalamazoo, Mich. Gerald L. Klerman, MD, was the initial principal investigator on the SDDS-PC project until his death in 1992. W. Eugene Broadhead, MD, PhD, was principal investigator from 1992 to 1995. Roger Kathol, MD, is currently the principal investigator. The Upjohn Company, Kalamazoo, Mich., sponsored and supported the development of the SDDS-PC through its Pharmacosurveillance Unit, Mr. James A. Coleman, Director, and Andreas Pleil, PhD, Senior Health Economist. Drs. Leon, Olfson, Weissman, Blacklow, Broadhead, and Hoven have served as consultants to Upjohn. Allen Frances, MD (Duke University), and Michael Leibowitz, MD (Columbia University), provided advice, Carrie Miller, PhD, was project manager at Kaiser Permanente. Lena Verdeli, MA, MSc, trained the nurses and assisted in the coordinating of the QAP. Laura Portera assisted in data analysis, and Joy Pelayo assisted in data management. The participating physicians and nurses and the Scientific Advisory Committee members who met with investigators and provided input into the project are listed below. Scientific Advisory Committee: Macaran Baird, MD, SUNY Health Science Center; Dave Baron, DO, American Osteopathic Association; Susan Blumenthal, MD, Assistant Surgeon General; Jorge A. Costa e Silva, World Health Organization; Leah Dickstein, MD, University of Louisville School of Medicine; Mary Jane England, MD, Washington Business Group on Health; Shervert H, Frazier, MD, McLean Hospital; Roman H, Hendrickson, MD, American Academy of Family Physicians; Norman B. Kahn, MD, American Academy of Family Physicians; Kathryn Magruder, PhD, National Institute of Health; Harold A. Pincus, MD, American Psychiatric Association; Darrell A. Regier, MD, MPH, National Institute of Mental Health; Rene Rodriguez, MD, National Confederation of Hispanic American Medical Association; Richard Rupper, MD, American Society of Internal Medicine; Norman Sartorius, MD, World Health Organization; Richard Steinhilber, MD, Cleveland Clinic Foundation; William Van Stone, MD, Department of Veteran Affairs; Elinor Walker, Agency for Health Care Policy and Research; and Paul Young, MD, American Board of Family Practice. Their presence on the Advisory Council in no way signifies an endorsement by these individuals or organizations. SDDS-PC is a registered trademark of the Upjohn Company.     

The relationship of major depressive disorder and gender to changes in smoking for current and former smokers: longitudinal evaluation in the US population

Aims Although depression and smoking are correlated highly, the relationship of major depressive disorder (MDD) to smoking cessation and relapse remains unclear. This study compared changes in smoking for current and former smokers with and without current and life‐time MDD over a 3‐year period. Design Analysis of two waves of longitudinal data from the National Institute on Alcohol Abuse and Alcoholism's National Epidemiologic Survey on Alcohol and Related Conditions (wave 1, 2001–02; wave 2, 2004–05). Setting Data were collected through face‐to‐face interviews from non‐institutionalized United States civilians, aged 18 years and older, in 50 states and the District of Columbia. Participants A total of 11 973 adults (54% male) classified as current or former daily smokers at wave 1 and completed wave 2. Measurements Classification as current or former smokers at wave 1 and wave 2. Findings Smoking status remained stable for most participants. Wave 1 current daily smokers with current MDD [odds ratio (OR) = 1.38, 95% confidence interval (CI): 1.03, 1.85] and life‐time MDD (OR = 1.52, 95% CI: 1.15, 2.01) were more likely than those without the respective diagnosis to report continued smoking at wave 2. Wave 1 former daily smokers with current MDD (OR = 0.44, 95% CI: 0.26, 0.76) were less likely to report continued abstinence at wave 2. None of the gender × MDD diagnosis interactions were significant. Patterns of results remained similar when analyses were limited to smokers with nicotine dependence. Conclusions Current and life‐time major depressive disorders are associated with a lower likelihood of quitting smoking and current major depressive disorder is associated with greater likelihood of smoking relapse.     

Diagnosing pedal osteomyelitis

Objective: To compare the efficacies and cost-effectivenesses of four strategies for the management of suspected pedal osteomyelitis in the setting of vascular impairment: 1) therapeutic trial of short-term antibiotics for presumed cellulitis without osteomyelitis (short); 2) technetium bone scanning followed by either short-term therapy if negative or either a biopsy or aggressive long-term intravenous therapy if positive (scan); 3) bone biopsy followed by long-term intravenous therapy if positive or short-term therapy if negative (biopsy); and 4) immediate long-term intravenous antibiotics for presumed osteomyelitis (long). Design: Decision analysis and cost-effectiveness analysis with sensitivity analyses. The main outcomes states are amputation and the resource expenditures associated with bone scans, biopsies, and therapies. Data sources: The authors obtained estimates of test accuracy from literature review and summarized them using newly developed meta-analytic techniques. Main results: The optimal decision depends heavily on the estimated probability of osteomyelitis at presentation. At very low probabilities, the short-term strategy is preferred. When the probability of osteomyelitis is from 2% to 8%, the lowest amputation rate occurs when one does a diagnostic scan. From 8% to 50%, the best outcomes follow biopsy. At probabilities higher than 50%, the preferred strategy is long-term antibiotics. However, the differences in outcomes are quite small even when osteomyelitis is a virtual certainty. Conclusions: Over the whole range of prior probabilities, the short-term strategy is the least expensive. At very low probabilities, it dominates the other strategies. When the likelihood of osteomyelitis is higher (10–20%), scanning results in outcomes and cost-effectiveness ratios comparable to those of immediate biopsy and is less invasive. When the probability of osteomyelitis is 50%, biopsy is quite cost-effective compared with all the other strategies (cost-effectiveness ratio = $15,502 per amputation averted) and is preferred to the scan strategy. When the confidence that a patient has osteomyelitis is very high (>90% probability), the improved outcomes associated with long-term antibiotics are achieved with little additional expense and with favorable cost-effectiveness ratios compared with those of the other strategies. Supported by a grant from the John A. Hartford Foundation. Dr. Littenberg is an American College of Physicians George Morris Piersol Teaching and Research Scholar. Reprints are not available. The Consortium included: Dartmouth-Hitchcock Medical Center: W. Blair Brooks, MD, Terry Hurlbut HI, MD, Benjamin Littenberg, MD, Andre Midgette, MD, MPH, David Smith, MD, Harold C. Sox, Jr., MD, and Carole Toselli, MD; Massachusetts General Hospital: Albert Mulley, Jr., MD; Stanford University: Lincoln E. Moses, PhD; University of Pennsylvania: Bruce Kinosian, MD, and J. Sanford Schwartz, MD; University of Rochester Medical Center: Daniel Kido, MD, Alvin I. Mushlin, MD, and Charles E. Phelps, PhD; and University of Washington: Richard Hoffman, MD, Dan Kent, MD, and Eric Larson, MD.     

Nicotine modulates alcohol-seeking and relapse by alcohol-preferring (P) rats in a time-dependent manner

Background: Alcohol is frequently co‐abused with smoking. In humans, nicotine use can increase alcohol craving and consumption. The objectives of the current study were to assess the acute effects of nicotine on alcohol seeking and relapse at 2 different time points. Methods: Adult female alcohol‐preferring (P) rats were trained in 2‐lever operant chambers to self‐administer 15% ethanol (EtOH) (v/v) and water on a concurrent fixed‐ratio 5–fixed‐ratio 1 (FR5‐FR1) schedule of reinforcement in daily 1‐hour sessions. Following 10 weeks of daily 1‐hour sessions, rats underwent 7 extinction sessions, followed by 2 weeks in their home cages. Rats were then returned to the operant chambers without EtOH or water being present for 4 sessions (Pavlovian Spontaneous Recovery [PSR]). Rats were then given a week in their home cage before being returned to the operant chambers with access to EtOH and water (relapse). Nicotine (0, 0.1, 0.3, or 1.0 mg/kg) was injected subcutaneously immediately or 4 hours prior to PSR or relapse testing. Results: Injections of nicotine immediately prior to testing reduced (5 to 10 responses PSR; 50 to 60 responses relapse), whereas injections of nicotine 4 hours prior to testing increased (up to 150 responses for PSR; up to 400 responses for relapse with 1.0 mg/kg dose) responses on the EtOH lever during PSR and relapse tests. Conclusions: The results of this study demonstrate that acute effects of nicotine on EtOH‐seeking and relapse behaviors may be time dependent, with the immediate effects being a result of nicotine possibly acting as a substitute for EtOH, whereas with a delay of 4 hours, priming effects of nicotine alterations in nicotinic receptors, and/or the effects of nicotine’s metabolites (i.e., cotinine and nornicotine) may enhance the expression of EtOH‐seeking and relapse behaviors.     

Role of the endogenous opioid system on the neuropsychopharmacological effects of ethanol: new insights about an old question

This article presents the proceedings of the symposium “Endogenous Opioids and Voluntary Ethanol Consumption: What Have We Learnt From Knock‐out Mice?” presented at the meeting of the International Society for Biomedical Research on Alcoholism held in Heidelberg/Mannheim, Germany, in September/October 2004. The organizers and chairpersons were Michael S. Cowen and Carles Sanchis‐Segura. The presentations were as follows: (1) Regulation of the Opioid System by Alcohol: Comparison of Alcohol‐Preferring and ‐Nonpreferring Strains by Michael S. Cowen; (2) Endogenous Opioids and Alcohol: Lessons From Microdialysis and Knock‐out Mice by M. Foster Olive; (3) From Neurochemistry to Neuroanatomy: The Hypothalamic Arcuate Nucleus as a Main Site for Ethanol‐Opioids Interaction by Carles Sanchis‐Segura; (4) Sensitivity to Ethanol Is Modulated by β‐Endorphin in Transgenic Mice by Judy E. Grisel, Amanda J. Roberts, and George F. Koob; and (5) The μ‐Opioid Receptor Modulates Acute Ethanol Sensitivity and Ethanol Withdrawal Severity by Sandra Ghozland.     

The effect of early and intensive statin therapy on ventricular premature beat or nonsustained ventricular tachycardia in patients with acute coronary syndrome

Retraction The following article from Clinical Cardiology, “The Effect of Early and Intensive Statin Therapy on Ventricular Premature Beat or Nonsustained Ventricular Tachycardia in Patients With Acute Coronary Syndrome,”¹ by Xian‐Zhi He, MD; Sheng‐Hua Zhou, MD; Xin‐Hong Wan, MD; Hai‐Yu Wang, MD; Qing‐Hua Zhong, MD; and Jian‐Fang Xue, MD, published online on December 10, 2010 in Wiley Online Library ( wileyonlinelibrary.com ), has been retracted by agreement between the journal Editor‐in‐Chief, Dr. A.J. Camm, and Wiley Periodicals, Inc. The retraction has been agreed due to significant overlap with a similar article² previously published by the same authors in the Cardiology Journal. References 1. He X.‐Z., Zhou S.‐H., Wan X.‐H., Wang H.‐Y., Zhong Q.‐H. and Xue J.‐F. The effect of early and intensive statin therapy on ventricular premature beat or nonsustained ventricular tachycardia in patients with acute coronary syndrome. Clin Cardiol. 34(1):59–63. doi: 10.1002/clc.20818 2. He XZ, Zhou SH, Wan XH, Wang HY, Zhong QH, Xue JF. The effect of early and intensive statin therapy on ventricular premature beat or non‐sustained ventricular tachycardia in patients with acute coronary syndrome. Cardiol J. 2010;17(4):381–385. The authors have no funding, financial relationships, or conflicts of interest to disclose.     

New Developments in Alcoholism Treatment Research in Europe

This article presents the proceedings of a symposium held at the meeting of the International Society for Biomedical Research on Alcoholism (ISBRA) in Mannheim, Germany, in October 2004. The organizers and chairs were Karl F. Mann, Fred Rist and Carrie L. Randall. The presentations were (1) Searching for the acamprosate and naltrexone responders, by Karl Mann on behalf of the Project Predict Research team (K. Mann, R. Brück, H. Gann, U. Zimmermann, A. Heinz, M. Smolka et al.), (2) Treatment outcomes from the United Kingdom Alcohol Treatment Trial (UKATT), by Nick Heather on behalf of the UKATT research team (N. Heather, A. Copello, Ch. Godfrey, R. Hodgson, J. Orford, D. Raistrick, I. Russell, G. Tober), and (3) Conjoint screening and Brief intervention for Alcohol and Nicotine misuse in primary health care (BrIAN), by Fred Rist on behalf of the BrIAN research team (Ralf Demmel, Ines Aulhorn, Jutta Hagen, Barbara Scheuren, Fred Rist).     

Book Reviews

Books reviewed in this articles:
The Biology of Nicotine Dependence CIBA FOUNDATION SYMPOSIUM
Addictive Behaviours: Prevention and Early Intervention T. LOBERG, W. R. MILLER, P. E. NATHAN & G. A. MARLATT (Eds)
Drugs and Behaviour: Cause, Effects, and Treatment. BERNARD SEGAL
Drug Research and Policy in Britain. A Review Of The 1980s VIRGINIA BERRIDGE (Ed.)
Alcohol Education and Offenders STEVE BALDWIN (Ed.)
AIDS: Sexual Behaviour and Intravenous Drug Use CHARLES TURNER, HEATHER MILLER & LINCOLN MOSES (Eds)
Methadone in the Management of Opioid Dependence: Programmes and Policies Around the World A. ARIF & J. WESTERMEYER     

Effects of prazosin, an α1-adrenergic receptor antagonist, on the seeking and intake of alcohol and sucrose in alcohol-preferring (P) rats

Background: Previous studies show that prazosin, an α₁‐adrenergic receptor antagonist, decreases alcohol drinking in animal models of alcohol use and dependence [Rasmussen et al. (2009) Alcohol Clin Exp Res 3:264–272; Walker et al. (2008) Alcohol 42:91–97] and in alcohol‐dependent men [Simpson et al. (2009) Alcohol Clin Exp Res 33:255–263]. This study extended these findings by using a paradigm that allows for separate assessment of prazosin on motivation to seek versus consume alcohol or sucrose in selectively bred rats. Methods: Alcohol‐preferring (P) rats were trained to complete an operant response that resulted in access to either 2% sucrose or 10% alcohol. A 4‐week Seeking Test Phase examined responding in single, weekly extinction sessions when no reinforcer could be obtained. A 4‐week Drinking Test Phase consisted of rats lever‐pressing to “pay” a specified amount up front to gain access to unlimited alcohol (or sucrose) for a 20‐minute period. On Seeking and Drinking test days, prazosin (0.0, 0.5, 1.0, and 1.5 mg/kg) was administered intraperitoneally 30 minutes prior to behavioral sessions. Results: Rats were self‐administering an average of 0.9 (±0.09) g/kg alcohol on vehicle test day and had pharmacologically relevant blood ethanol concentrations. Prazosin significantly decreased alcohol seeking at all doses tested. The highest dose of prazosin also increased the latency to first response for alcohol and decreased alcohol intake. While sucrose‐seeking and intake were similarly affected by prazosin, the high dose of prazosin did not increase response latency. Conclusions: These findings are consistent with and extend previous research and suggest that prazosin decreases motivation to initiate and engage in alcohol consumption. The specificity of prazosin in attenuating the initiation of alcohol‐ but not sucrose‐seeking suggests that this effect is not because of prazosin‐induced motor‐impairment or malaise. Together with previous findings, these data suggest that prazosin may be an effective pharmacotherapy, with specific application in people that drink excessively or have a genetic predisposition to alcohol abuse.     

Favorable Effects of Vasodilators on Left Ventricular Remodeling in Asymptomatic Patients With Chronic Moderate‐Severe Aortic Regurgitation and Normal Ejection Fraction: A Meta‐Analysis of Clinical Trials

Background:

The role of vasodilator therapy in asymptomatic patients with chronic moderate to severe aortic regurgitation (AR) and normal left ventricular (LV) function is uncertain. We assessed the effects of vasodilator therapy (hydralazine, calcium channel blockers, and angiotensin‐converting enzyme inhibitors) in this subgroup of patient population.

Hypothesis:

Vasodilators have favorable effects on LV remodelling in asymptomatic patients with chronic moderate to severe aortic regurgitation and normal LV function.

Methods:

We performed a systematic literature search for randomized clinical trials using long‐term vasodilator therapy in asymptomatic patients with chronic severe AR and normal LV function. The magnitude of difference between the vasodilator and nonvasodilator groups was assessed by computing the mean difference (MD). Heterogeneity of the studies was analyzed by Cochran Q statistics. The MD for LV ejection fraction, LV end systolic volume index, and LV end diastolic volume index were computed by random effects model. The MD for LV end‐systolic diameter and LV end‐diastolic diameter were computed by fixed effects model. A 2‐sided alpha error <0.05 was considered to be statistically significant.

Results:

Seven studies with 460 patients were included. Meta‐analysis of the studies revealed a significant increase in LVEF (MD: 5.32, 95% confidence interval [CI]: 0.37 to 10.26, P = 0.035), a significant decrease in LV end diastolic volume index (MD: ?16.282, 95% CI: ?23.684 to ?8.881, P < 0.001), and a significant decrease in LV end diastolic diameter (MD: ?2.343, 95% CI: ?3.397 to ?1.288, P < 0.001) in the vasodilator group compared with the nonvasodilator group. However, there was no significant decrease in LV end systolic volume index (MD: ?6.105, 95% CI: ?12.478 to 0.267, P = 0.060) or in LV end systolic diameter (MD: 0.00, 95% CI: ?0.986 to 0.986, P = 1.0) in the vasodilator group compared with the nonvasodilator group.

Conclusions:

In asymptomatic patients with chronic severe AR and normal LV function, vasodilators have favorable effects on LV remodeling. Clin. Cardiol. 2012 doi: 10.1002/clc.22019 The authors have no funding, financial relationships, or conflicts of interest to disclose.

     

Pediatrics

Hoda M. Malaty , MD, PhD * , Danuta Celinska-Cedro , MD, PhD * , M. Dadalski , MD * , G. Oracz , MD * , David Y. Graham , MD * , M. Lenarczyk * .   * Medicine and Pediatrics, Baylor College of Medicine, Houston, TX and The Children's Memorial Health Institute, Warsaw, Poland.
Purpose: To investigate the incidence of GERD among children over the age of 2 years presenting to a tertiary care center in Poland and to examine the correlation between pH monitoring and risk factors for GERD.
Methods: Children referred to the Department of Gastroenterology at the Children's Memorial Health Institute, Warsaw, Poland during 2004 in whom a first diagnosis of GERD was made, underwent 24-hour pH monitoring (abnormal versus normal pH = reflux index >/< 4.2). The diagnosis of GERD was based on history and upon endoscopic examination. The number of reflux episodes longer than 5 minutes during the 24 hour observation as well as the children's weight and height were recorded. Using the growth standards published by the National Polish Center for Health Statistics (M. Krawczynski, 2000), we calculated the gender/age specific weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ) (standard deviation score).
Results: In one year (Jan 2004-to Jan 2005), 3852 children between the ages of 2–18 visited the GI Department; 295 had a first diagnosis of GERD (incidence 8%/year). Abnormal pH tests were present in 50%. The most common symptoms were regurgitation/vomiting; 38% of patients. Abnormal pH studies and the number of reflux episodes longer than 5 minutes were both significantly correlated with Wt/Age Z-score (  p = 0.008) (  p = 0.001).
Conclusions: GERD symptoms were a common cause for referral to a tertiary care center in Poland. Obesity as assessed by a high Wt/Age Z-score correlated with the presence of GERD in children.     

Reducing the risk of stroke through appropriate targets and treatments

On June 29, 2007, Michael H. Davidson, MD, of the University of Chicago, Chicago, IL, moderated a panel of participants, including Jan Basile, MD, Primary Care Service Line, Ralph H. Johnson VA Medical Center, and the Division of General Internal Medicine/Geriatrics, Medical University of South Carolina, Charleston, SC; Alan J. Garber, MD, PhD, Baylor College of Medicine, Houston, TX; and Robert A. Phillips, MD, PhD, University of Massachusetts Memorial Medical Center, Worcester, MA. With the publication of this first Expert Panel Discussion in Preventive Cardiology, we inaugurate a new educational feature. Periodically, we will gather a group of experts to exchange viewpoints on current issues relevant to the prevention of cardiovascular disease. It is our hope that the resulting discussion will provide the practicing clinician with data from recent trials, expert opinions on symptoms and diagnoses, and a variety of potential therapeutic approaches for the management of risk factors.