1/18. CT halo sign in pulmonary metastases from mucinous adenocarcinoma of the pancreas.The CT halo sign was first described in immunocompromised patients with invasive pulmonary aspergillosis. Although the halo sign was originally thought to be specific for invasive pulmonary aspergillosis, it has been reported in a wide variety of pulmonary abnormalities in both immununocompromised and immunocompetent patients. We report a case of mucinous adenocarcinoma of the pancreas metastatic to the lungs in which there were multiple pulmonary nodules showing the halo sign. This case further illustrates the nonspecific nature of the CT halo sign and the need to consider malignancy as a cause in immunocompetent patients.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/18. Changes in P300 latency during the early withdrawal period in chronic alcohol-dependent patients: two case reports.AIMS: The present study focused on changes in P300 of the event-related potential (ERP) in two patients with alcohol dependence recorded throughout their alcohol withdrawal period. RESULTS: As a result of this investigation, the peak latency of P300 in each patient was significantly shorter 2 or 3 days after abstinence from alcohol, when marked neurological manifestations appeared, compared to that of the control obtained from 8 to 10 days after cessation of drinking. CONCLUSIONS: It seems reasonable to conclude that the shortening of P300 latency reflects the enhancement of brain activity during the early withdrawal period and that an investigation of changes in P300 would be helpful to clarify the nature of neural activity in the brain associated with alcohol withdrawal.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/18. Acute ethanol intoxication after consumption of hairspray.A 61-year-old woman with a history of alcohol dependence came to the emergency department with ethanol intoxication. Her serum ethanol concentration was 322 mg/dl. When questioned, she admitted to consuming a 14-oz bottle of hairspray mixed with water because of its denatured alcohol content. The woman had used nonbeverage sources of alcohol on a regular basis for a number of years after learning of the practice from fellow attendees of alcoholics anonymous meetings. Her primary reason for this behavior was to hide her continued alcohol abuse from her family. She consumed hairspray that contained 50% denatured alcohol by volume; the amount she ingested was equal to 7 fluid oz of ethanol, the equivalent of 14 1.25-oz shots of 80-proof liquor. Her serum ethanol concentration was consistent with that predicted by pharmacokinetic equations based on the consumption of one bottle of hairspray. The hairspray product contained specially denatured alcohol 40-B, which consists of ethanol and small quantities of t-butyl alcohol and denatonium benzoate. ethanol is the substance of primary toxicologic concern. Clinicians need to be aware that numerous nonbeverage sources of alcohol exist and should be considered when a patient presents with acute intoxication. The source and its components should be identified as soon as possible in order to assess other potential toxicities.- - - - - - - - - - ranking = 3keywords = nature (Clic here for more details about this article) |
4/18. 2,3-Butanediol in plasma from an alcoholic mistakenly identified as ethylene glycol by gas-chromatographic analysis.2,3-Butanediol was mistakenly identified as ethylene glycol in plasma specimens from two alcoholic patients. The cyclic phenylboronate ester derivatives of 2,3-butanediol and ethylene glycol had the same retention time when OV-17 was used as the stationary phase for gas chromatography. This led to incorrect diagnosis of ethylene glycol poisoning and unnecessary invasive therapy. plasma from two chronic alcoholics contained 2,3-butanediol at 3.5 and 3.4 mmol/L. The elimination half-life of 2,3-butanediol was 3.9 days when ethanol was administered during therapy for suspected ethylene glycol poisoning. Low concentrations of 2,3-butanediol might be present in blood of chronic alcoholics as a result of a novel pathway of intermediary metabolism associated with some forms of alcoholism. However, a more likely explanation for fairly high concentrations of 2,3-butanediol is enzymatic production from 2-butanone. This ketone occurs in denatured alcohol preparations often consumed by alcoholics in sweden.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/18. From basic concepts to clinical reality. Unresolved issues in the diagnosis of dependence.This chapter discusses clinical and conceptual issues pertaining to the diagnosis of alcohol and drug dependence. Emphasis is given to the difficulties involved in moving from diagnostic concepts, such as those contained in the major psychiatric classification systems, to the clinical situation where diagnostic decisions are made. To illustrate how diagnostic concepts approximate clinical reality, a set of case histories is used to organize a discussion of unresolved issues in the diagnosis of dependence. These issues include the putative syndrome nature of dependence, the problem of diagnosing polysubstance use, the primary-secondary distinction, the presence of other psychopathology, and the use of multiaxial evaluation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/18. Non-convulsive status epilepticus after abrupt withdrawal of hypnotic-sedative drugs.Four patients with severe addiction to sedative-hypnotics and with acute withdrawal symptoms of these drugs are described. They developed latent confusional states with characteristic EEG patterns (bilateral slow and sharp waves of high amplitude). Following small doses of benzodiazepines the EEG became normal together with a reduction in the clinical symptoms. It is suggested that the confusional states were of an epileptic nature.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/18. Central pontine myelinolysis: correlation between CT and electrophysiologic data.Because of the nature and location of the lesion in central pontine myelinolysis, considerable difficulties in diagnosis may arise. Computed tomography (CT) and brainstem auditory-evoked potentials are useful in following the spread and regression of the pontine lesion. The correlation between clinical evolution, serial CT scans, and brainstem auditory-evoked potentials is considered in a patient with central pontine myelinolysis and subsequent complete recovery with special emphasis on the evolution of the CT scan after recovery.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/18. A model framework of alcoholism counseling: cyclic process of intensification, paradoxical shifting, and differentiation.While recent literature on individual and family therapy has increasingly focused on the nature and use of paradoxical styles of intervention, little has been published concerning the use of paradox in alcoholism counseling. alcoholism represents a type of problem that can lend itself to the use of such interventions. This paper first reviews the nature of paradoxical styles of intervention in relation to alcoholism. It then presents three developmentally determined paradoxical dynamics: intensification, paradoxical shifting, and differentiation. These are defined and examples from case studies are given for each. Therapists working with alcoholics are encouraged to consider the use of these patterns of response with their clients.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
9/18. Major gastrointestinal hemorrhage from peripancreatic blood vessels in pancreatitis. Treatment by embolotherapy.Seven cases of gastrointestinal bleeding originating from peripancreatic blood vessels seen between 1977 and 1982 are presented. The bleeding originated either from true aneurysms, formed when the pancreatic inflammatory processes weaken the walls of peripancreatic blood vessels, from pseudoaneurysms which occurred after vascular leakage into pancreatic pseudocyst, or from veins. Gastrointestinal bleeding occurs when these entities rupture into gastrointestinal viscera. Hemorrhage of this nature must be considered in the clinical setting of patients who have a history of alcoholism, chronic relapsing pancreatitis, and known pseudocysts. endoscopy, bleeding scans, and barium contrast studies are only occasionally helpful in diagnosis. Selective visceral angiography during acute hemorrhage is often diagnostic and concomitant arterial embolization techniques may offer a temporizing or permanent modality for hemostasis. This technique may be especially useful in the unstable, acutely ill patient with alcoholic hepatitis, sepsis, or an immature pseudocyst who poses a poor operative risk.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/18. A life history model of the alcoholic family.research and clinical interest in the alcoholic family has tended to outpace the development of family-oriented conceptual models of alcoholism. A family development perspective has been almost totally absent, despite the chronic, longitudinal nature of alcoholism. A life history model is proposed that uses the concepts of the "alcoholic system," family homeostasis, and the "family alcohol phase" as its building blocks. Chronic alcoholism tends to produce distortions in the normative family life cycle. These distortions and their clinical implications are discussed, using four case histories as illustrations of the concepts proposed. The model is also examined in the light of current research findings about the alcoholic family.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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