High Diastolic Blood Pressure: Common Among Women Who Are Heavy Drinkers

The present study evaluates the relationship of different alcohol consumption levels to blood pressure among women. Blood pressure values were compared between four groups of women consuming different amounts of alcohol. Three groups were formed from the middle-aged female population participating in a health survey ( n = 219): 15 consecutive alcohol abstainers, 136 consecutive moderate drinkers, and 68 consecutive heavy drinkers. Also, 78 consecutive female alcoholics reporting for treatment were included, forming the fourth group. The prevalence of systolic blood pressure ≥160 mm Hg did not increase in relation to alcohol consumption. In contrast, the percentage of women showing diastolic blood pressure ≥90 mm Hg clearly increased ( p = 0.004) from abstainers (7%) to moderate drinkers (18%), to heavy drinkers (32%), and to alcoholics (37%). The highest blood pressure values were found among heavy drinkers. Compared with abstainers, the mean difference in systolic blood pressure was –12 mm Hg, with a 95% confidence interval from –2 to –23 mm Hg. For diastolic blood pressure, the difference was –6 mm Hg with a 95% confidence interval from 1 to –13 mm Hg. Among alcoholics, the blood pressure values had returned essentially to normal after 4 days of abstinence. It is concluded that alcohol consumption increases both systolic and diastolic blood pressure values among women. However, only diastolic blood pressure values increase enough to be clinically significant. Moderately elevated diastolic blood pressure, combined with normal systolic blood pressure, might thus be a possible sign of alcohol abuse among women. Abstinence should be emphasized as an inexpensive and rapidly effective treatment for mild hypertension among female alcohol abusers.     

Biphasic alcohol response differs in heavy versus light drinkers

BACKGROUND: Most studies of risk factors for alcohol-related problems have focused on biological family history as a primary risk factor. However, other factors, such as early-age heavy drinking, are also risk factors for sustained or progressive heavy consumption. Little is currently known about the mechanisms underlying binge or heavy drinking. METHODS: This study examined the acute subjective and objective effects of ethanol in heavy drinkers versus light drinkers. Thirty-four subjects participated in this within-subjects study consisting of three early-evening testing sessions in which subjects consumed a beverage containing either 0.8 or 0.4 g/kg ethanol or placebo. RESULTS: Compared with lighter drinkers, heavy drinkers were more sensitive to the positive stimulant-like effects of ethanol (p < 0.05), especially during the increasing limb of the blood alcohol curve. Heavy drinkers also showed less sedation and cortisol response after alcohol than the light drinkers (p < 0.05). CONCLUSIONS: The results indicate that young adult binge drinkers show a biphasic alcohol response, with heightened sensitivity to stimulant-like alcohol effects and greater tolerance to sedative alcohol effects compared with their light-drinking counterparts.     

Outcomes of Small Nodular Lesions in Heavy Drinkers

Background Increased detection of nodular lesions in patients not yet definitively diagnosed with hepatocellular carcinoma (HCC) has occurred with the use of advanced imaging techniques. In heavy drinkers, decrease in the size of nodular lesions during on-going observation, and negation of diagnoses of HCC after surgical resection have been reported, suggesting the need for caution in diagnosis in such cases.
Methods The subjects were eight heavy drinkers with small nodular lesions, 20 mm or less in diameter. All patients were male, with a mean age of 53 years. Five had single and three had multiple nodular lesions. Five of the eight patients were followed up for more than 4 years after an initial biopsy, while three patients were recent cases. Of the three recent cases, two were positive for antibody to hepatitis C virus (HCV) and two had hypervascular nodular lesion. Biopsies were performed percutaneously, under ultrasonography, for histological diagnosis of all cases, and the recent cases were also assessed using a variety of imaging techniques.
Results On initial biopsy, no atypism (NO) was found in two patients, and borderline lesions (Border) were present in six patients. Of the five cases followed up long-term, only one of the two with NO progressed to HCC, and the three with Border showed disappearance, decrease, and no change, respectively, during the follow-up period. Of the three recent cases, no changes in size or morphology as revealed by imaging were observed following biopsy.
Conclusions In heavy drinkers, no fixed relationship was observed between initial biopsy finding and clinical course, suggesting that indication for biopsy requires reassessment, refinement, and discussion. Furthermore, tumor staining may occur in hyperplastic nodules, which are histologically similar to early HCC by needle biopsy, and care needs to be exercised for diagnosis in heavy drinkers.     

Women, Alcohol, and Red Cells

Alcohol abuse is known to increase erythrocyte mean cell volume mainly as a consequence of direct toxic effect on the developing red cell. The influence of alcohol on other red cell parameters is unclear. The objective of this cross-sectional survey was to examine the consequences of different alcohol amounts on red cell parameters among women.
We compared red cell parameters between female alcoholics, heavy drinkers, and controls. Controls ( n = 138) and heavy drinkers ( n = 65) consisted of consecutive 40- and 45-year-old women participating in the health screening, and alcoholics ( n = 73) of consecutive women coming to a detoxification clinic.
Alcoholics had significantly smaller erythrocyte counts ( p < 0.01), and higher erythrocyte mean cell volume values ( p < 0.001), reticulocyte counts ( p < 0.01), and red cell distribution width values ( p < 0.001) than controls. No difference between these groups was found, however, in hemoglobin distribution width value. The only red cell difference between controls and heavy drinkers was erythrocyte mean cell volume, which was significantly higher among heavy drinkers ( p < 0.001). In alcoholics, red cell distribution width values were even more often increased (in 44%) than erythrocyte mean cell volume values (in 34%). This increase in red cell distribution width was not solely explained by iron deficiency or liver disease.
Chronic alcohol abuse not only affects erythrocyte mean cell volume values, but also leads to anisocytosis seen in blood count as an increased red cell distribution width value.     

Clinical Characteristics of Patients in Their 40s With HCV Antibody-Positive Hepatocellular Carcinoma

Background: We investigated the clinical characteristics of hepatitis C virus (HCV) antibody-positive hepatocellular carcinoma (HCC) patients who developed HCC at a relatively young age. Methods: Clinical characteristics of patients in their 40s were investigated and were compared with those of patients 50 years and older. The subjects were 648 HCC patients, 469 men (72%) and 179 women (28%), who were treated at our hospital between 1991 and 1997. Results: No patient was under 40 years of age. Eighteen patients (3%) were in their 40s, 137 patients (21%) were in their 50s, 338 patients (52%) were in their 60s, 143 patients (22%) were in their 70s, and 12 patients (2%) were in their 80s. Fifteen of the patients (83%) in their 40s were male. The proportion of men in their 40s was higher than that of all men. Eight of the 15 men in their 40s (53%) were heavy drinkers, and 2 (14%) were habitual drinkers. Three of the 15 men (20%) were HBV carriers, and these 3 HBV carriers were not drinkers. The proportion of heavy drinkers and HBV carriers was significantly higher among the patients in their 40s than in the 60 patients randomly sampled from the patients 50 years of age and older. The mean ages of male patients with HCC who were heavy drinkers, habitual drinkers, occasional drinkers, or nondrinkers were 52.3, 58.9, 62.0, and 61.7 years, respectively. HCC occurred significantly earlier in heavy drinkers than in the other 3 groups. We compared laboratory data of the patients in their 40s with data of all of the patients of 50 years and older. Serum total bilirubin, prothrombin time, and platelet counts were significantly worse in the patients in their 40s. Conclusions: Logistic regression analysis revealed that heavy drinking and presence of HBV infection were independently related to HCV antibody-positive HCC development at a younger age.     

硬脊膜动静脉瘘磁共振成像的特点

目的分析硬脊膜动静脉瘘(SDAVF)脊髓病变的MRI特点,探讨脊髓病变与畸形血管和临床症状的关系。方法经DSA证实的SDAVF患者32例,应用场强3.0T超导型MRI扫描仪于术前行常规脊髓MRI平扫和增强扫描。按照脊髓病变的范围,分为局限(1～4个椎体)、中度(5～7个椎体)和广泛(8～10个椎体)病变三组。按照改良的Aminoff和Logue步态与排尿障碍法,于术前对患者进行临床评分,<6分为轻症者,≥6分为重症者。结果①30例病变中心位于下胸段(94%,30/32)。32例中病变局限组8例(25%),临床轻症者6例,重症者2例;中度组19例(59%),临床轻症者5例,重症者14例;广泛组5例(16%),轻症者1例,重症者4例。②32例患者髓内均可见T2WI高信号,31例高信号位于脊髓中心,呈"铅笔样"改变,1例呈弥散状分布;2例髓内可见T1WI低信号。增强扫描后,31例脊髓强化,1例未见强化。③瘘口位于脊髓病变范围内12例,位于脊髓病变范围外20例。④31例引流静脉范围≥相应脊髓病变范围,且引流静脉与脊髓病变部位一致;1例脊髓病变>引流静脉范围,引流静脉与脊髓病变部位部分一致。结论①SDAVF脊髓病变范围...     

Hypervascular Liver Nodules in Heavy Drinkers of Alcohol

Background: Three cases of hypervascular nodules in the liver, without hepatitis B or C virus infection and with a history of alcohol abuse (120 ml/day for 15 to 30 years), are presented.
Results: Ultrasound examination revealed hypoechoic nodules in segment 6 (2 cm in diameter, case 1), in the right and left lobes (1–2 cm multiple type, case 2), and in segment 4 (4 cm, case 3). Hepatic angiography and computed tomography during arteriography revealed hypervascular nodules in the three cases. First, hepatocellular carcinoma, focal nodular hyperplasia, hemangioma, hemangioendothelioma, inflammatory pseudotumor, and pseudolymphoma were diagnostically differentiated. Histologically, there was no evidence of hepatocellular carcinoma or of any of the pathologies considered in the differential diagnosis by imaging studies. In case 1, the lesion was composed of an irregular, thin, trabecular-patterned hepatic acinus with slighter hypercellularity than in the nonnodular area. In cases 2 and 3, the lesions were composed mainly of fibrosis without hyperplasia, showing stellate scar–like fibrosis septa dividing the nodule. Marked pericellular fibrosis, neutrophilic infiltration, and Mallory bodies in the cytoplasm were also observed. In cases 1 and 2, small unpaired arteries explaining the hypervascularity of the nodules were observed.
Conclusion: These hypervascular nodules were classified as regenerative, not neoplastic, nodules according to the classification of the International Working Party.     

脊髓损伤大鼠胃肠动力障碍及其可能机制

背景：胃动素（MTL）和生长抑素（SST）是对胃肠动力有兴奋和抑制作用的脑肠肽,在胃肠动力障碍中起重要作用。目的：研究脊髓损伤大鼠胃肠动力的变化及其可能的作用机制。方法：将138只大鼠随机分为模型组和对照组,采用重物坠落法建立脊髓损伤模型。造模后第1d,7d分别处死大鼠,行HE染色观察脊髓组织,并检测胃排空和小肠推进率。采用RT—PCR法检测MTL—R1A和SSTR：mRNA表达。结果：造模后第1d、7d,模型组脊髓组织形态学发生明显变化。造模第7d,与对照组相比,模型组胃内核素残留率明显增加（76．66％±11．84％对55．32％．4-10．88％,P〈0．01）,小肠推进率明显减少（31．64％±5．47％对43．56％±7．00％,P〈0．01）;MTL—R1AmRNA表达明显降低（0．21±0．07对0．47±0．13,P〈0．01）,SSTR2mRNA表达明显升高（1．12±0．21对0．62±0．13,P〈0．01）。结论：脊髓损伤后胃肠动力障碍的发生可能与胃组织MTL-R1ArnRNA表达下调以及结肠组织SSTR：mRNA表达匕调有关。     

Attitudes Toward Problem Drinkers, Revisited: Patient-Therapist Factors Contributing to the Differential Treatment of Patients with Alcohol Problems

Although there are many treatment alternative open to people with drinking problems, health professionals still exhibit negative attitudes towards alcoholics. In a previous study, the author demonstrated that those patients who were self-labelled alcoholics were treated in a less preferential manner than those who did not identify as such. This study used both overt and unobtrusive measures to determine whether negative attitudes of intake interviewers towards problem drinkers were elicited by the patients' self-label as an alcoholic or by other variables related to perceived treatment outcome. Pre- and postinterview data on patient likability, doctor's eagerness to work with the patient, interview content, treatment disposition, and patient compliance were collected from first-time patients, and from their interviewers, in the walk-in psychiatry and alcohol treatment units of a large, urban teaching hospital. The results elucidate how stereotypes interact with patient characteristics to influence both professional behavior and patient compliance.     

经纤支镜气道灌洗治疗重度吸入性损伤

目的探讨床边纤维支气管镜气道灌洗治疗大面积烧伤伴重度吸入性损伤的治疗效果。方法将172例大面积烧伤伴重度吸入性损伤患者完全随机分为两组,两组病人均早期气管切开,常规抗感染、化痰、加强烧伤创面处理,吸氧及呼吸机辅助呼吸,治疗组给予早期床边纤维支气管镜气道灌洗治疗,对照组给予定期吸痰护理,观察两组治疗效果。结果治疗组疗效明显优于对照组,差异有显著性(P<0.01)。结论经纤支镜气道灌洗治疗重度吸入性损伤可有效提高治愈率,值得临床推广。     

Efficacy and Tolerability of Prucalopride in Patients with Constipation due to Spinal Cord Injury

Background: Chronic constipation (CC) often occurs after spinal cord injury (SCI). Prucalopride is a novel, highly selective, specific serotonin 4 receptor agonist with enterokinetic properties. We evaluate the tolerability and pilot efficacy of prucalopride in the treatment of CC due to SCI. Methods: Double-blind, placebo-controlled, pilot, phase II, dose-escalation study. After 4 weeks' run in, patients received prucalopride 1 mg ( n = 8) or placebo ( n = 4); 11 new patients were randomized to prucalopride 2 mg ( n = 8) or placebo ( n = 3) once daily for 4 weeks. Patients recorded bowel function (diary) and assessed constipation severity and treatment efficacy (visual analogue scale (VAS) 0-100 mm). Colonic transit times were determined. Results: Compared with run in, mean changes in constipation severity (VAS) increased with placebo, but decreased with prucalopride 1 and 2 mg. The VAS score for treatment efficacy showed a clear dose response (medians 4, 52 and 73 for placebo, 1 and 2 mg, respectively). Diary data showed an improvement in average weekly frequency of all bowel movements over 4 weeks within the 2 mg group (median 0.6; 95% CI 0.2; 1.2). There was a significant reduction in median colonic transit time with 2 mg ( n = 4; -38.5 h (95% CI-80; -5)). Four patients (2 mg) reported moderate/severe abdominal pain, and two of these discontinued treatment. There were no clinically relevant effects on any of the safety parameters. Conclusion: This pilot study indicates that prucalopride can play an important role in the management of patients with CC due to SCI.     

Microheterogeneity of Serum Glycoproteins in Alcoholics: Is Desialo-transferrin the Marker of Chronic Alcohol Drinking or Alcoholic Liver Injury?

The appearance of desialo-transferrin (De-TF) in serum has been reported to be a biochemical marker of chronic alcoholism. However, conclusive evidence of whether De-TF is a marker for chronic alcohol drinking or for alcoholic liver disease (ALD) has not yet been obtained. Glycoproteins can be divided into two groups, a transferrin (TF) group and an al-acid glycoprotein (Al-AG) group, based on the characteristics of microheterogeneity (M-HTG) of each protein. In the present study, the appearance of M-HTG in serum TF and A1-AG in alcohol drinkers was compared. In 96 patients with ALD, M-HTG of TF was found in 66 patients (68.6%), and M-HTG of A1-AG was found in 61 patients (63.5%). In 20 patients with alcoholic pancreatitis, the detection rate of M-HTG of A1-AG was significantly higher than that of TF. In six patients with pancreatitis but not liver disease, M-HTG of TF was not detected. In 14 alcoholics without liver or pancreas disease, M-HTG of TF was not detected, whereas M-HTG of A1-AG was detected in 6 cases-a significant difference. The amount of alcohol consumed was not different in patients with and without liver disease. In non-ALD, M-HTG of both proteins was detected only in patients with decompensated liver cirrhosis. The detection rate of M-HTG in TF was significantly higher than in A1 - AG. These results suggest that M-HTG of serum TF is a marker of ALD and that of serum A1-AG is a marker of chronic alcohol drinking.     

Complex regional pain syndrome (CPRS type I) after a burn injury of the hand

Complex regional pain syndrome (CRPS) type I is a clinical condition characterized by persistent pain in one part or the entire extremity after a minor trauma, fracture, or after an operation which does not involve nerve damage and/or sympathetic hyperactivity. Despite large-scale studies on the complications that arise after burns, literature reveals few reports on neurological problems and CRPS developing after burns. It is a rare complication of a burn injury to an extremity. Its early signs and symptoms are similar to those of burn wound itself. This study describes an unusual cause of complex regional pain syndrome in burn patients. The report highlights physical examination findings, the new diagnostic criteria of complex regional pain syndrome, and difficulties in diagnosis.     

Pelvic floor function in patients with clinically complete spinal cord injury and its relation to constipation

PURPOSE: Constipation is a common problem in patients with spinal cord injury. The aim of this study is to analyze the role of pelvic floor dysfunction in the development of constipation. METHODS: Twenty-five patients with clinically complete supraconal spinal cord injury were studied by means of colonic transit time, anal manometry, electrophysiologic testing, and sensory-evoked potentials. RESULTS: Sixteen patients had prolonged total and segmental colonic transit times (Group C), and nine patients had normal colonic transit times (Group NC). Basal pressure and anal pressure during coughing, Valsalva's maneuver, and rectal distention were diminished in all patients, but no differences were observed between Group C and Group NC. Rectal sensation was preserved in eight patients, but this was not related to the absence of constipation. In seven of these eight patients, somatosensory-evoked potentials could be recorded, which indicated an incomplete cord lesion. Synergic relaxation of the pelvic floor during straining was never observed; dyssynergia was seen in ten (7 in Group C and 3 in Group NC;P = not significant) patients. Associated peripheral nerve damage was present in 40 percent of patients but did not predispose these patients to constipation. CONCLUSIONS: Loss of rectal sensation, dyssynergic pelvic floor contraction during straining, associated peripheral nerve damage, and insufficient rise of intra-abdominal pressure could not be held responsible for constipation as a result of spinal cord injury. A prolongation of the colonic transit time is the most important mechanism, and therapy should be directed toward it.Supported by a grant from the Flemish Society of Gastroenterology 1994 and awarded the 1996 Nationaal Fonds voor Wetenschappelijk Onderzoek Prize.Presented in part at the annual meetings of the American Gastroenterological Association in New Orleans, Louisiana, May 15 to 18, 1994, and San Francisco, California, May 19 to 22, 1996, and published in abstract form (Gastroenterology 1994; 106:A485 and Gastroenterology 1996;107:A655).