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Cases reported "Alcoholism"

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11/36. Parotid abscess due to salmonella enteritidis: A case report.

    BACKGROUND: Salmonella infection of the parotid gland is rare. CASE: An instance in a 50-year-old man of salmonella enteritidis parotiditis initially recognized by microbial culture of a fine needle aspiration cytology material is described. The identified predisposing factor was chronic alcoholic abuse. For the infection source, a carrier state of salmonella parotitis was postulated, which progressed to focal abscess and was subsequently complicated by bacteremia and hematogenous spread to the liver, spleen and lungs. CONCLUSION: Salmonella should be included in the differential consideration of head and neck abscesses in immunocompromised individuals and treated aggressively.
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12/36. Court based civil commitment of alcoholics and substance abusers.

    Problem. To study court ordered substance abuse commitment (SAC) in one jurisdiction. We investigated who was evaluated, by whom, and with what outcome. Is SAC primarily a purely civil procedure as originally intended? Are men and women being treated equally? Method: Questionnaire survey of court clinicians to determine demographic and clinical status of persons evaluated, the process of evaluation, and the disposition. Results: SAC is common and more frequent in criminal cases than in purely civil ones. SAC of women is clearly influenced by the restricted choices for disposition: either state prison or an unlocked facility. Conclusions: SAC is an important public health procedure, which courts are using in highly variable and at times unintended ways. SAC has emerged as an alternative to other dispositions in criminal cases involving substance-abusing defendants.
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13/36. Hypoxic right ventricular cardiomyopathy. A morphological and pathogenetic study on the myocardial atrophy and fatty infiltration.

    The autopsy report of an asymptomatic, non familial cardiomyopathy with widespread fatty infiltration of the right ventricular wall in two alcoholic subjects, who were also heavy smokers and suffering from a serious laryngeal obstruction, led the Authors to investigate, on the basis of a thorough review of the literature, the possibility that hypoxia, alcoholism and smoke could have caused the development of the cardiac lesion. The presence of myocardial fatty infiltration is explained, under conditions of high-flow hypoxia, by the reduced fatty acid oxidation. The higher tissue levels of fatty acyl-CoA, fatty acyl-carnitine and alpha-glycerophosphate thereby lead to the increased conversion of the FFA into tissue lipids. Under hypoxic conditions there is also an increased polyols synthesis. The reduced conversion of dyacylglycerol into phosphatidic acid causes its tissutal increase and the interaction with fatty acyl-CoA to produce triacylglycerol and CoASH. In alcoholic patients reduced oxidation and increased FFA synthesis is sustained by the altered mitochondrial respiratory control and excess of acetate, with the consequent increase in acetyl-CoA, fatty acyl-CoA and alpha-glycerophosphate concentration. In addition, fatty acid ethyl esters normally absent in the myocardium are formed. The fact that, in hypoxic or alcoholic subjects with cardiomyopathy, an impaired myocardial contractility has been noted as the most relevant haemodynamic factor may be explained by both the reduced energy production following the decrease in aerobic glycolysis and FFA oxidation, and specific genetic changes that lead to both the production of a myosin with lower Ca2 + ATPase activity and a reduced protein (and therefore myofibrillar) synthesis. This fact can result in a severe atrophy of the cardiac myocytes. The lower their contractile activity, the more evident the process of atrophy. The lesion principally affects the right ventricle for both metabolic and anatomical reasons. It has been shown how, under normal conditions, the RV metabolism is suited to a relatively reduced O2 supply situation, with a high lactate dehydrogenase and alpha-hydroxybutiratedehydrogenase activity. It is more likely to be affected therefore whenever there is a chronic state of high-flow hypoxia. While alpha-HBDH allows the RV extensive utilization of ketone bodies as an energy source, its notable increase under hypoxic conditions further increases the synthesis of fatty acids and therefore fatty infiltration of the myocardium. The relatively lower capacity for oxygen extraction and lower tissue perfusion of the RV compared with the left ventricle make an adequate oxygen supply in the case of increased O2 demand even more difficult.(ABSTRACT TRUNCATED AT 400 WORDS)
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14/36. Diagnostic results of psychiatric evaluations of state police officers.

    Twenty-six state police officers referred by their department or self-referred were evaluated by a university department of psychiatry over a 28-month period. The most common primary diagnosis was adjustment disorder, followed by substance abuse and personality disorder. Sixteen of the officers were assessed to be psychiatrically capable of returning to duty; concurrent outpatient treatment was recommended for most of them. The most challenging cases for evaluation were those involving psychiatric symptoms after trauma on duty, behavioral manifestations of personality disorder, and substance abuse.
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15/36. Addiction, helplessness, and narcissistic rage.

    In many cases addictive behavior serves to ward off a sense of helplessness or powerlessness via controlling and regulating one's affective state. Addicts have a vulnerability to feelings of powerlessness, which reflects a specific narcissistic impairment. The drive in addiction to re-establish a sense of power is, correspondingly, impelled by narcissistic rage. This rage gives to addiction some of its distinctive clinical properties. The narcissistic vulnerability in addicts is discussed. Several brief clinical cases are provided, and the view proposed is correlated with other psychoanalytic perspectives.
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16/36. ER "capture" of the skid-row alcoholic.

    In response to the spiraling anger and frustration voiced by the emergency room (ER) medical staff and the observed negative interactions between the alcohol-dependent patient and the ER staff, the author completed a 6-month retrospective review of all patients evaluated by the ER service with a complaint of alcohol abuse, chronic alcoholism, or requesting detoxification. As a result of that study, an ER-based comprehensive approach to the management of this population was proposed. Utilizing an existing connecticut state statute, a specific approach to manage the skid-row alcoholic arriving repeatedly in the ER was developed. I report on this ER-based model and an approach to "capturing" the skid-row alcoholic.
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17/36. Inpatient treatment of the mentally ill substance abuser: some medicolegal concerns.

    Alcohol and drug abuses complicate medicolegal issues in psychiatry by blurring the boundaries between medicine and law. Furthermore, the usual tests for the applicability of either legal or medical measures often cannot be applied to the dually diagnosed. Specific quandaries arise with involuntary hospitalization and treatment, and with evaluating patients for the courts. The author discusses these problems, introducing the concept of state-dependent competency, using a case vignette to illustrate several points. Legal theories of behavior assume freedom of action; medical theories assume determinism. Phenomena of addiction defy such distinctions and thus may pose difficulties that cannot reliably be assigned either a medical or a legal remedy.
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18/36. 'catatonia' due to disulfiram toxicity.

    In an alcoholic patient, catatonia developed while he was receiving disulfiram (Antabuse). Resolution of the question whether his state was classically catatonic required a detailed review of the literature on the subject. The conclusion reached is that the original definition still holds for psychiatric illness, but application of the term to neurological and metabolic states has often been based on imprecise criteria and failure to consider akinetic mutism and extrapyramidal motor disturbances as factors. The action of disulfiram as an inhibitor of dopamine beta hydroxylase provides a possible mechanism for the cerebral toxic effect, but nonetheless the various interpretations remain largely speculative.
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19/36. 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.
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20/36. Mesenteric vein thrombosis associated with Klinefelters syndrome--a case report.

    A case of mesenteric vein thrombosis presenting as gastrointestinal hemorrhage in a patient with Klinefelter's syndrome is reported, an association not previously described. The diagnosis was made preoperatively and was confirmed by angiography. The patient underwent a small bowel resection and made an uneventful recovery. A possible association between Klinefelter's syndrome and a hypercoagulable state, previously suggested elsewhere, is emphasized.
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Last update: April 2009
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