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Cigarette smoking, alcohol abuse and stroke--the material consisted of 272 patients (169 men and 103) women aged between 25-65 years. There were 221 patients with ischemic stroke and 51 patients with haemorrhagic stroke. The control group consisted of 400 healthy subject of the same age and sex. In the stroke group excessive consumption of alcohol was reported by 61 patients (5 women and 56 men). Excessive smoking was reported by 130 patients (41 women and 89 men). It was found in both types of stroke alcohol was not an independent risk factor. In addition, the study revealed that alcohol and cigarette smoking did not increase the risk of developing stroke in patients with diabetes and hypertension. Excessive cigarette smoking was found however, to be an independent risk factor in haemorrhagic stroke.
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PMID:[Cigarette smoking and alcohol abuse effects on stroke development]. 765 87

Among hospitalized patients, it is estimated that between 20% and 35% have significant alcohol problems that remain largely undetected. Alcohol abuse is a risk factor for a variety of disorders, including diabetes mellitus, gastrointestinal problems, hypertension, liver disease, and stroke. In an era of health care cost containment, early detection, intervention, and referral of alcohol-abusing or -dependent patients by the CNS may significantly impact the cost effectiveness of hospital care. In this article, a guideline is described that can be used by the CNS relative to the assessment, intervention, and referral of alcohol-abusing or -dependent patients in the general hospital setting.
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PMID:Early detection and intervention for the hidden alcoholic: assessment guideline for the clinical nurse specialist. 770 65

The purpose of this study was to determine the respective contributions of microcirculatory dysfunction and mechanical stresses to the pathogenesis of neurogenic trophic lesions. All patients with polyneuropathy complicated by cutaneous or osteoarticular trophic lesions (perforating forefoot ulcers, neurogenic osteoarthropathy) were eligible for the study. Patients with vascular, articular or neurological disorders other than the polyneuropathy were excluded. Digital photoplethysmography was used to evaluate microcirculatory reactivity. Electronic podometry was performed for static and dynamic foot pressure studies. A technetium-99m bone scan was done to look for evidence of neurogenic osteoarthropathy. The study included 35 patients (16 with alcohol abuse, 7 with diabetes mellitus, 10 with both disorders, one with Charcot-Marie-Tooth disease, and one with neuropathy of unknown etiology). Cutaneous or osteoarticular trophic lesions were correlated with the presence of static podoscopic abnormalities (dynamic abnormalities apparently had no influence per se). Digital vasoplegia was found in 8 of 35 patients (23%) and was closely correlated (p < 0.0001) with severity of the osteoarthropathy. These data suggest that mechanical factors play the central role in the production of neurogenic trophic lesions and that microcirculatory dysfunction may be a marker for severe neurogenic osteoarthropathy rather than a causative factor.
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PMID:[Respective evaluations of mechanical and vascular factors in the pathogenesis of neuroacropathy]. 781 87

Two patients with chronic disease (diabetes mellitus type I, hyperuricemia and alcohol abuse, respectively) were hospitalized with persistent diarrhea and severe abdominal cramps. Using routine methods, the only pathogen isolated in stool specimens was Arcobacter butzleri. In both cases acute symptoms subsided quickly after antibiotic therapy. After termination of antibiotic treatment, Arcobacter butzleri could no longer be detected in stool specimens. Although very little is known about the clinical significance of Arcobacter butzleri infections in humans, it is highly likely that in both cases Arcobacter butzleri played a major causative role in acute disease.
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PMID:Severe diarrhea associated with Arcobacter butzleri. 781 98

Stroke continues to have a great impact on public health in the United States. Stroke is frequent, recurring, and is more often disabling than fatal. The annual incidence of new strokes in the United States is nearly one half million, with over 3 million stroke survivors alive today. Identifying risk factors for initial ischemic stroke, as well as characterizing the determinants of outcome (stroke recurrence and mortality) after ischemic stroke, is the basis for stroke prevention strategies. Modifiable and nonmodifiable risk factors for ischemic stroke have been identified and include age; gender; race/ethnicity; heredity; hypertension; cardiac disease, particularly atrial fibrillation; diabetes mellitus; hypercholesterolemia; cigarette smoking; and alcohol abuse. New risk factors, such as hypercoagulable states and patient foramen ovale, are currently being investigated. Follow-up studies have quantified case-fatality rates, early recurrence risk, and long-term mortality and recurrence risks. Despite advances in stroke prevention strategies and treatments, stroke recurrence is still the major threat to any stroke survivor. A major goal set by the Public Health Service in its National Health Promotion and Disease Prevention Objectives for the year 2000 is "to reduce stroke deaths to no more than 20 per 100,000." Part of this can be achieved if the risk of stroke recurrence is reduced. However, the frequency and determinants of stroke recurrence are poorly understood. Data from epidemiologic studies can help identify risk factors and outcomes after ischemic stroke, as well as the selection of high-risk individuals for focused risk-factor modification. Current information on these topics is discussed.
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PMID:Risk factors and outcomes for ischemic stroke. 788 84

The term "necrotizing soft tissue infections" describes a group of limb and life-threatening infections. Depending on the tissue level, microbiology and clinical course the necrotizing soft-tissue infections are classified in primary located infections to the subcutaneous level and fascia--like hemolytic streptococcus gangrene, necrotizing fasciitis, gram-negative synergistic necrotizing cellulitis, clostridium-cellulitis, anaerobic non-clostridium-cellulitis and in primary located infections to the muscle--like clostridium myonecrosis and streptococcal myositis. Between 1989 and 1992, 17 patients with necrotizing soft-tissue infections were treated at the Department of Surgery, University Hospital of Zurich. These infections originated from small traumatic injuries or operative wounds ("neglected wounds"). 11 patients suffered from debilitating diseases like diabetes mellitus, drug or alcohol abuse or were compromised by tumors. The average age was 42 years (21-84 years). Following bacteria were found: Staphylococcus aureus, hemolytic Streptococcus, Enterococcus, E. coli, Streptococcus milleri. 2 patients had a mixed infection with more than 3 different bacteria, 6 patients with 2, and 9 patients had a monoinfection. In 14 patients the infection was on the subcutaneous and fascia level, 3 patients showed a myositis or myonecrosis. No patient died, amputation of the limb was necessary in 4 cases. The average hospitalisation was 41 days (13-137 days) whereas 10 patients required between 4 and 53 days intensive care (average 18.3 days). Necrotizing soft-tissue infections are severe illnesses which are underestimated in the primary phase due to atypical or minor primary signs. The infections can be caused by a variety of bacteria and are spreading rapidly.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Necrotizing soft tissue infection of the extremities]. 803 28

A 40-year-old man with a 3-year history of uncontrolled NIDDM, 2-pack/month cigarette smoking habit and alcohol abuse, was admitted to our university hospital. He presented with severe back pain, persistent cough and fever. A left lung infiltrate was noted on chest X-ray film. Staphylococcus aureus was isolated from arterial blood. Thoracic bone destruction with pleural mass lesion confirmed by computed tomography (CT) and magnetic resonance image (MRI). These findings mislead our diagnosis to pyogenic osteomyelitis associated with NIDDM. An absence of marked clinical and roentgenological improvement after antibiotic therapy and strict glycemic control with insulin was noted. This suggested to us the need for needle biopsy of the osteolytic and mass lesions confirmed by imaging techniques. This resulted in making the diagnosis of metastasis of small cell carcinoma from the left lung. The correlation between NIDDM and pulmonary small cell carcinoma possibly induced by genetic abnormality remains to be resolved. By making the most of imaging techniques and needle biopsy, the possibility of pulmonary small cell carcinoma complicating NIDDM can be appropriately evaluated.
Diabetes Res 1993
PMID:Vertebral bone metastasis of small cell carcinoma of lung in a diabetic patient, initially diagnosed as pyogenic vertebral osteomyelitis. 807 45

Many epidemiological studies show that alcohol-derived calories added to food intake of men and women in amounts of 0-25% of total energy do not appreciably alter the average daily intake of other macronutrients (carbohydrate, fat, and protein). With such lack of evidence for caloric compensation, alcohol and its calories seem to make little contribution to metabolic energy, body weight, or body composition (as indicated by the body mass index, BMI). In fact, a major study by Colditz et al. (Am. J. Clin. Nutr. 54:49-55; 1991) reported a clear inverse relationship between alcohol intake and BMI for women! Research on alcohol metabolism has left unresolved some apparent contradictions regarding the effect of alcohol on caloric control, appetite and satiation, and body mass and composition. To resolve those apparent contradictions, the National Institute on Alcohol Abuse and Alcoholism cosponsored with the National Institute of Diabetes and Digestive and Kidney Diseases and the Beltsville Human Nutrition Research Center of the U.S. Department of Agriculture an all-day workshop titled "Alcohol and Calories: A Matter of Balance" on January 27, 1993. The workshop included sessions on calorimetry and body mass maintenance, alcohol metabolism, thermoregulation, and an overview of energy balance. This report provides summaries of the four discussion sessions at the workshop.
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PMID:Alcohol and calories: a matter of balance. 812 95

Four patients meeting the "classical" criteria for spontaneous pyomyositis are reported. No local cause was found. Risk factors included diabetes mellitus (2 patients), hemopathy (one patient), and alcohol abuse (one patient). Causative organisms (Staphylococcus aureus in 3 cases and Salmonella sp in one case) were recovered from blood cultures, an unusual occurrence. CT scan studies ensured the diagnosis in every case. An additional case of pyomyositis due to Staphylococcus aureus illustrates the difficulties in the definition of disease. This patient, whose muscle lesions were remarkably well visualized by MRI with injection of gadolinium, developed infection of the sacro-iliac joint adjacent to the muscular focus of infection. This patient may have had either "primary" pyomyositis with spread to the adjacent joint or "secondary" pyomyositis caused by the joint infection which was recognized only later. Advances in medical imaging techniques suggest that the nosology of pyomyositis should be broadened using this terminology. This would underscore the unique characteristics of "classical", "primary" pyomyositis and emphasize imaging, diagnostic and therapeutic facets of the disease which are shared by both entities.
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PMID:[Pyomyositis. Apropos of 5 cases]. 824 27

Population aging is continuously increasing in Italy and in the World. Individuals aged 60 years or more are currently 10,500,000 and will be 13,000,000 in 2015. Life quality in geriatric ages includes the maintenance of sexual power: according to recent data (Carrol et al., 1992), 80% of impotence cases are due to organic causes. In addition, the use of drugs can cause impotence. Among them tiazidic diuretics may cause an increase of sexual disturbances. Other drugs with this potential are digitalis, antihypertensive drugs (particularly beta blockers), major and minor tranquillizers, antidepressant, H2 receptor antagonists, antiparkinsonian cholinergic drugs and estrogens employed in the treatment of prostate tumors. Diseases of geriatric age that can alter sexual power are diabetes mellitus, ischemic heart disease for the accompanying depression and for the use of antidepressants; severe hypertension is complicated by impotence in 15% of cases. Among neurological diseases Parkinson's disease and multiple sclerosis can be causes of sexual dysfunctions. Patients on hemodialysis can be impotent, with recent data (Soloh et al 1992) showing that erythropoietin treatment of anemia also improve sexual dysfunctions. Prevention from a geriatric standpoint should be base on action on known risk factor as smoking, alcohol abuse and dislipidemias and with the activation of a close drug vigilance.
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PMID:[Andrologic problems and internal pathology in the elderly]. 825 79


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