Prevalence of clinically occult cardiomyopathy in chronic alcoholism

The mean absolute heart weight and mean heart weight to body weight ratio of a group of 43 alcoholics, screened from 1,970 consectuive autopsy reports at the Detroit General Hospital by selecting alcoholics with only ethyl alcohol abuse as an etiology of heart disease, are compared to those of a group of similarly selected age-matched nonalcoholic controls. None of the alcoholics was clinically suspected of having had cardiomyopathy. The statistically significant increased mean absolute heart weight and heart weight to body weight ratio of the alcoholic group reflected the presence of subclinical alcoholic cardiomyopathy. In addition, several of the patients in the alcoholic group displayed gross and microscopic cardiac pathologic changes consistent with alcoholic cardiomyopathy occurring in the absence of cardiomegaly.     

Clonidine (Dixarit) for menopausal flushing.

Clonidine, 0.05 mg twice daily, was evaluated in a multicentre, randomized, placebo-controlled, double-blind crossover study in 66 patients who had had menopausal flushing for less than 1 year. Although the placebo effect was substantial, clonidine reduced the frequency of attacks significantly more than did placebo. In three of the four trials the patients' comparisons of symptoms before and after crossover indicated significantly greater improvement when the crossover was from placebo to clonidine rather than the reverse. The frequency, severity and duration of attacks were reduced by clonidine in 78%, 89% and 88% of the patients respectively, and by placebo in 50%, 53% and 50%. Side effects were minimal and their pattern was the same for clonidine as for placebo. Clonidine's action as a peripheral vascular stabilizer makes it potentially useful for the treatment of menopausal flushing. It would be prudent to include clonidine at the beginning of treatment so that its efficacy could be assessed in each individual. Its use would enhance the effects of the usual management of the menopausal syndrome, which consists of explanation, reassurance and, sometimes, the use of tranquillizers. Clonidine is a symptomatic medication that makes flushing more tolerable and should reduce the number of patients who would otherwise be exposed to the risks of estrogens.     

Hereditary Telangiectasia Manifested as Gastrointestinal Bleeding without External Visible Telangiectasia

Gastrointestinal bleeding is one of the most common problems confronting the physician. In most instances, the source of the bleeding is easily identified, e.g., peptic ulcer disease, bleeding esophageal varices or a colonic lesion. Recurrent gastrointestinal bleeding, however, represents one of the major enigmas confronting the practicing physician. The patient experiences intermittent episodes of weakness, easy fatigability and anemia with occult blood in the stool. Multiple barium radiographic examinations and often endoscopy and exploratory laparotomy are unrevealing as to the etiology of the bleeding. We have had occasion to investigate three such patients. Multiple evaluations of these individuals did not reveal the source of the bleeding until many years later—Rendu-Osler-Weber Disease (ROW). At the time of their evaluations these patients did not reveal the usual telangiectatic areas present on the skin and oral mucous membrane. The diagnosis was suggested by the presence of multiple gastric mucosal telangiectasia identified by gastroscopic examination. This report emphasizes the need for thorough endoscopic evaluation of patients with gastrointestinal bleeding and describes the gastroscopic findings that indicated hereditary telangiectasia as the probable source of bleeding from the gastrointestinal tract.     

Lack of relationship between in vitro tumor cell growth and prognosis in extensive-stage small-cell lung cancer

The ability to establish a continuously growing tumor cell line from fresh tumor specimens has been associated with shortened survival in some human malignancies. Therefore, we assessed the relationship between survival and in vitro tumor cell growth from specimens obtained during routine staging procedures in 68 consecutive patients with untreated, extensive-stage small-cell lung cancer (SCLC) who received etoposide/cisplatin chemotherapy. Three groups of SCLC patients could be distinguished: (1) 23 patients in whom a tumor cell line was established in vitro; (2) 28 patients in whom tumor-containing specimens were cultured but in vitro growth did not occur; and (3) 17 patients in whom no tumor-containing specimen could be procured. No significant difference in response rates to chemotherapy of the three groups was noted. Poor performance status (P2 = .001), male gender (P2 = .0008), liver metastases (P2 = .0033), brain metastases (P2 = .0152), and the ability to obtain a tumor-containing specimen from the patient for laboratory culture (P2 = .0005) were all significant independent predictors of decreased survival in this patient population. While the ability to obtain a tumor cell specimen for cell culture using routine staging and diagnostic procedures identified patients with shortened survival, we found no significant survival differences between patients whose tumor cell specimens grew in cell culture v those that did not (median survival of 7 months v 11 months, P2 = .72). Our study indicates that the clinical outcome of extensive-stage SCLC patients from whom tumor cell lines can be established is not significantly different than in those cases from whom tumor-containing specimens could not be grown in vitro.     

CT of aortic aneurysms: the distinction between mural and thrombus calcification

Aortic calcification, either mural or thrombus, is a common finding in patients with abdominal aortic aneurysms. Differentiating between the two sites of calcification is necessary in order to avoid confusing simple thrombus calcification with displaced calcified intima in aortic dissection. The CT scans of 145 cases of abdominal aortic aneurysm and seven cases of abdominal aortic aneurysm with dissection were analyzed with respect to the location of the calcification: mural only or mural and thrombus. Mural calcification was seen in all 152 patients with aneurysms whereas thrombus calcification was identified in only 33 (24%) of the 136 patients with thrombus. Displaced intimal calcification caused by aortic dissection can either appear similar to or, at times, be indistinguishable from thrombus calcification. Thrombus calcification was present in four (57%) of the seven patients with abdominal aortic aneurysms and dissection. To avoid the possibility of a false-positive diagnosis of aortic dissection in patients with abdominal aortic aneurysm, other signs of aortic dissection should be sought such as separation of the true and false lumina by an intimal flap.