Drug and Alcohol Education in the Medical Profession

Abstract: This paper defines some of the issues that underlie the reluctance of many doctors to identify and treat patients with alcohol and drug problems. Ways of overcoming the negative feelings doctors have towards this field are suggested. Some general principles for developing medical education and training in drug and alcohol problems are outlined, and some “core” topics in diagnosis and treatment are proposed. Finally the organisation and power structure of medical institutions are discussed and the various levels at which developments in alcohol and drug education can be promoted are identified.     

Sarcoidosis presenting as an osteolytic skull lesion: a case report and review of literature on skull sarcoidosis

Bone sarcoidosis of the skull is an infrequent presentation of sarcoidosis. We describe a 51-year-old man who consulted due to inflammatory-appearing nodulation in the right supraorbital region. Images showed a solitary osteolytic lesion extending to soft tissues with increased scintigraphic uptake. The anatomopathological study revealed the presence of non-caseating epithelioid granulomas, compatible with sarcoidosis. Steroid treatment led to a marked remission of the lesion, without evidence of relapse during a follow-up period of 1 year. The literature dealing with skull sarcoidosis is reviewed.     

Mild hyperhomocysteinemia and low folate concentrations as risk factors for cervical arterial dissection

BACKGROUND AND PURPOSE: Elevated homocysteine (Hcy) plasma levels are associated with an increased risk of spontaneous cervical artery dissection (sCAD). We examined the potential association between Hcy, folate, vitamin B(12) levels and 5,10-methylenetetrahydrofolate reductase (MTHFR) polymorphisms in patients with cerebral infarct caused by sCAD. PATIENTS AND METHODS: 39 patients who survived a cerebral infarct caused by sCAD [20 (51%) women; 24 (61.5%) vertebral and 15 (38.5%) internal carotid arteries], and 76 healthy control subjects were included. Hcy plasma levels (fasting and after methionine load), folate and vitamin B(12) levels were measured. We also performed polymorphisms of MTHFR. Hcy, vitamin B(12), folates and polymorphisms of MTHFR were assessed and any associations were analyzed using multivariate statistics. RESULTS: Mean plasma fasting Hcy level was 9.81 mumol/l for cases and 6.38 for controls (p = 0.001). The occurrence of sCAD was associated with elevated fasting Hcy levels (>95th percentile over the control group) with an adjusted odds ratio of 7.9 (95% CI 1.66-35). The association between low plasma folate values (<5th percentile) and the presence of CAD was 7.9 (95% CI 1.6-31) after adjusting for confounding variables. The distribution of the MTHFR genotype showed a higher TT mutant frequency among CAD patients (p = 0.034). CONCLUSIONS: High plasma concentrations of Hcy and low plasma levels of folate were associated with an increased risk of sCAD in the sample studied. We conclude that deficiencies in nutritional status may contribute to the relatively high incidence of CAD in Mexico.     

Early results with the new internal fixator systems LCP and LISS: a prospective study

The Locking Compression Plate (LCP) and the Less Invasive Stabilisation System (LISS) are new implants with angular stability developed by the AO/ASIF. They offer an alternative for internal fixation in complex intra-articular fractures and high-energy diaphyseal fractures of the long bones. The new system was used in a prospective study to treat 113 patients (76 women, 37 men; average age: 53.1 years) with 122 injuries (multifragment shaft fractures or complex intra-articular, delayed/ non-union, malunion) from October 2002. Of these, 13 affected the humerus, 20 the radius, 2 the ulna, 21 the femur, 42 the tibia, 10 the fibula, 2 the acetabulum and 12 the calcaneus. Because of severe concomitant injuries, 18 fractures were first treated with an external fixator and definitively stabilised more than two weeks after the injury. Thirty-one patients were operated on after failure of other implants and non-union. Clinical and radiographic findings as well as complications were followed prospectively over a mean period of 20 months (range: 13 to 30). One patient was lost to follow-up. A total of 112 patients underwent a standardised follow-up examination. The outcome correlated with the severity of the fracture, anatomic reduction, adequate positioning of the plate and concomitant injuries. Despite the large number of open and comminuted fractures, no serious complications such as deep infections, vascular lesions, deep venous thrombosis or non-unions were noted. We found the new internal fixator system to be a safe and reliable procedure. It offers numerous fixation possibilities and has proven its value in complex fracture situations and in revision operations. A good knowledge of biomechanics is essential as well as precise preoperative planning.