1/30. Inability to obtain formal informed consent in the face of a standard surgical indication.A thirty-eight-year-old intoxicated man was admitted to the surgical trauma service following a single motor-vehicle accident. He had a severe closed head injury, bilateral pulmonary contusions, a fracture-dislocation of the right acetabulum, and an open injury of the right knee joint. The acetabular fracture pattern was an associated both-column fracture with the femoral head dislocated into a widely displaced posterior-column fracture line. The treating physicians agreed that it would be in the patient's best interest to take him to the operating room for emergent debridement and irrigation of his knee wound. At surgery, the patient also underwent attempted closed reduction of the acetabular fracture and placement of a skeletal traction pin. Radiographs obtained with the patient in traction showed reduction of the femoral head beneath a displaced superior dome fragment, but there remained a 12-mm gap in the posterior column, greater than 3 mm of step incongruity, and a large articular fragment entrapped in the anterior aspect of the hip joint. The patient remained intubated and sedated for several days. Upon weaning from the ventilator, it became evident that his head injury would prevent him from being able to give informed consent in the foreseeable future. The patient's family members refused to become involved with his care or medical decision-making, as he had become completely estranged from them as a result of his chronic alcohol abuse. Further delay in surgical treatment for the acetabular fracture would be associated with greater difficulty in obtaining an anatomic reduction, the potential for additional articular damage to the femoral head, and an increased risk of surgical complications. The question that arises is whether it is in the patient's best interest for the surgeon to proceed with open reduction and internal fixation of the acetabular fracture without having had the opportunity to fully inform him of the treatment options or the risks associated with an extensive surgical exposure.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/30. Alcohol-related problems among adolescents: Part I.adolescent alcohol use and abuse is a problem of growing concern for physicians who treat this population. This article describes current data reflecting adolescent alcohol use and abuse nationally and in oklahoma and its resultant problems. A description of risk and protective factors, the physician's role in detecting adolescent problems with alcohol, and suggestions of recommendations to the family are included. To aid in early detection and prevention of a worsening alcohol problem, the physician is encouraged to screen for alcohol use during the routine history and physical exam and is given a very specific developmentally appropriate screening tool to use with adolescents.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
3/30. porphyria cutanea tarda, hepatitis c, alcoholism, and hemochromatosis: a case report and review of the literature.porphyria cutanea tarda (PCT) is associated with estrogen, certain medications, alcohol abuse, hepatitis viruses, and iron overload. Numerous studies have demonstrated an increased incidence of hepatitis c in patients with PCT; therefore, hepatitis screening should be routinely performed on these patients. On the other hand, although studies have long suspected hereditary hemochromatosis (HH) to be an underlying condition of PCT, many physicians have a low index of suspicion. Also, diagnosis of HH has been difficult until recently, when the gene mutation was identified. We present a case of a patient with PCT, hepatitis c, and alcoholism who was homozygous for the HH gene mutation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/30. Complete and prolonged suppression of symptoms and consequences of alcohol-dependence using high-dose baclofen: a self-case report of a physician.AIMS: To test whether the dose-dependent motivation-suppressing effect of baclofen in animals could be transposed to humans, and suppress craving and sustain abstinence. methods: Neurologists safely use up to 300 mg/day (10 times the dosage currently used for alcohol dependence) of high-dose oral baclofen, to control spasticity, in order to avoid invasive therapy. I am a physician with alcohol dependence and comorbid anxiety. I self-prescribed high-dose baclofen, starting at 30 mg/day, with 20 mg increments every third day and an (optional) additional 20-40 mg/day for cravings. RESULTS: Cravings became easier to combat. After reaching the craving-suppression dose of 270 mg/day (3.6 mg/kg) after 5 weeks, I became and have remained free of alcohol dependence symptoms effortlessly for the ninth consecutive month. anxiety is well controlled. Somnolence disappeared with a dosage reduction to 120 mg/day, now used for the eighth consecutive month. CONCLUSIONS: High-dose baclofen induced complete and prolonged suppression of symptoms and consequences of alcohol dependence, and relieved anxiety. This model, integrating cure and well-being, should be tested in randomized trials, under medical surveillance. It offers a new concept: medication-induced, dose-dependent, complete and prolonged suppression of substance-dependence symptoms with alleviation of comorbid anxiety.- - - - - - - - - - ranking = 5keywords = physician (Clic here for more details about this article) |
5/30. Asymptomatic pontine myelinolysis.A 43-year-old lady presented with bilateral foot drop due to alcohol-related peripheral neuropathy. There was no history of electrolyte disturbance or altered consciousness. Cranial nerve, bulbar and pyramidal symptoms and signs were absent. Nerve conduction studies confirmed the neuropathy. Inadvertently requested neuroimaging of brain demonstrated signal change typical of central pontine myelinolysis. Asymptomatic pontine myelinolysis occurs rarely in alcoholics in the absence of bulbar dysfunction. It is important for physicians to be aware of the clinical entity of asymptomatic pontine myelinolysis to avoid misinterpretation of abnormalities detected on cerebral imaging in alcoholic individuals.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/30. Alcohol abuse in adolescents.Alcohol abuse among teenagers is an increasing problem with serious physical and social consequences. early diagnosis of adolescent alcoholism may be delayed for two reasons: the physical indicators of alcohol abuse seen in adults are often not identifiable in teenagers, and alcoholism is generally believed to be an adult problem. If the history is taken carefully, with respect and confidentiality, it can help the family physician determine the extent of a young person's alcohol abuse and begin the process of treatment for both the adolescent patient and the family.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/30. Intranasal abuse of prescribed methylphenidate by an alcohol and drug abusing adolescent with ADHD.A rare case is described where an adolescent with attention deficit hyperactivity disorder diagnosed in childhood subsequently developed alcohol and drug abuse. He later developed intranasal methylphenidate abuse and dependence after realizing that urine drug screens were expected to be positive for prescribed methylphenidate. This report is to alert physicians to the rare possibility of intranasal methylphenidate abuse in chemically dependent teenagers treated for ADHD and also to the possibility of group methylphenidate abuse at special education schools where many teenagers may be treated with stimulant medication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/30. Failure of physicians to recognize acetaminophen hepatotoxicity in chronic alcoholics.We encountered six alcoholic patients with severe acetaminophen hepatotoxicity during a 2-year period. All patients had marked elevations of aminotransferases and sometimes remarkably high prothrombin times at, or shortly after, presentation. In five of six cases the diagnosis was missed by the physicians initially caring for the patient. The apparent reasons for the missed diagnosis were insufficient history regarding the use of acetaminophen, an inappropriate reliance on blood acetaminophen levels, and lack of knowledge regarding typical aminotransferase elevations in alcoholic hepatitis vs acetaminophen toxicity. The initial clinical presentation of acetaminophen hepatotoxicity in chronic alcoholics is easily recognized clinically and is distinct from acetaminophen hepatotoxicity in suicide ingestions and from alcoholic hepatitis. Internists and other physicians should be aware of this entity and rely on the clinical picture and the history of acetaminophen use to confirm the diagnosis.- - - - - - - - - - ranking = 6keywords = physician (Clic here for more details about this article) |
9/30. Combined alcoholics anonymous and professional care for addicted physicians.The authors studied 100 impaired physicians who were successfully treated in a program that combined professionally directed psychotherapeutic treatment and peer-led self-help. An average of 33.4 months after admission they all reported being abstinent and rated alcoholics anonymous (AA) as more important to their recovery than professionally directed modalities. Feelings of affiliativeness to AA, which were very high, were strong predictors of the respondents' perceived support for their recovery. These feelings, and an identification with the role of care giver in addiction treatment, appeared to be central to their recovery process.- - - - - - - - - - ranking = 5keywords = physician (Clic here for more details about this article) |
10/30. But what if a patient gets hooked? Fallacies about long-term use of benzodiazepines.Is a person who needs a certain drug to function normally and has a relapse of symptoms when it is withdrawn addicted? Dr Talley says no. patients with a chronic anxiety disorder depend on benzodiazepines to enable them to live among the stresses of the real world, much like ulcer patients need ongoing drug therapy to subdue their problem. The fact that symptoms recur on withdrawal of the drug proves the continuing efficacy of the drug in controlling symptoms. Dr Talley gives advice on prescribing benzodiazepines for the long term that will help physicians and patients to avoid trouble.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |