Cases reported "Alcoholism"

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1/11. Acute renal failure due to nontraumatic rhabdomyolysis following binge drinking.

    Nontraumatic rhabdomyolysis is an important but under-recognized cause of acute renal failure. In alcoholics, rhabdomyolysis most frequently develop following muscle necrosis during alcohol-induced coma, but has also been described rarely in those without prolonged coma or seizures. We describe a patient who developed myoglobinuric acute renal failure requiring dialysis following binge drinking in the absence of convulsions or coma. The renal biopsy showed acute tubular necrosis with pigment casts.
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2/11. Acute liver failure: a message found under the skin.

    Acute liver failure is a rare syndrome with rapid progression and high mortality. It is characterised by the onset of coma and coagulopathy usually within six weeks but can occur up to six months after the onset of illness. Viral hepatitis, idiosyncratic drug induced liver injury, and acetaminophen ingestion are common causes. This report describes the case of a 35 year old man who presented with acute liver failure shortly after binge drinking. Repeated history taking disclosed a gluteal disulfiram implant that the patient had received to treat his alcohol dependence. The patient recovered with maximum supportive care after surgical removal but without liver transplantation. This case illustrates that only meticulous history taking will disclose the sometimes bewildering causes of acute liver failure.
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3/11. A case study on osteoporosis in a male athlete: looking beyond the usual suspects.

    After presenting with chronic low back pain, a male track athlete was diagnosed with bilateral lysis at L5, slight listhesis at L5 on S1; asymmetrical lysis at L4; and right L5/S1 disc bulge with minimal S1 nerve root contact. Conservative treatment was chosen.After participating in a bone density pilot study using dual-energy X-ray absorptiometry (DEXA) investigating alcohol consumption patterns in intercollegiate athletes, he was diagnosed with osteopenia and osteoporosis in his lumbar spine. Therapeutic drug intervention and rehabilitation were initiated.athletes with normal physiologic functions can have idiopathic osteoporosis, which may or may not be related to alcohol consumption. Although the relationship among chronic alcoholism (South-Paul, 2001), weight-bearing exercise (Kalsson, 2001), and bone density have been established, the relationship among binge drinking, intercollegiate athletic participation, and bone density has not. Despite suspected normal presentation, nonresponsive low back pain should be investigated thoroughly for advanced bone conditions.
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4/11. Using the EDAC test to monitor abstinence and relapses during outpatient treatment.

    The main objective of this study is to show the performance of the EDAC test in monitoring alcohol consumption during outpatient treatment. The EDAC is a new approach that uses routine laboratory tests to identify binge drinking as well as chronic drinking. The overall diagnostic performance of the EDAC fluctuates around 80 to 90% for both specificity and sensitivity. Close to two thousand subjects have been tested by the EDAC since the early eighties; 300 of these were patients undergoing treatment at different institutions across the U.S. This article selected five case studies to represent examples of classical drinking behaviors encountered in most outpatient clinics. The first four cases illustrate the use of the EDAC alone and the last case represents the use of the EDAC combined with CDT. These five case studies illustrate the use of the EDAC to detect relapse episodes, to monitor abstinence during outpatient treatment and to recognize a slip early enough to prevent more severe drinking. The use of biomarkers to monitor drinking behavior in alcohol dependent patients is gaining popularity because they provide objective information on a patient's drinking status when used as an adjunct to self-report.
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5/11. rhabdomyolysis and myoglobinuria associated with violent exercise and alcohol abuse: report of two cases.

    Two cases of acute rhabdomyolysis with myoglobinuria and high levels of serum enzyme are presented. The first patient developed acute renal insufficiency in the context of a binge and heavy alcohol drinking lasting several days. He was treated with haemodialysis for three weeks, and survived. The second patient developed rhabdomyolysis and heavy myoglobinuria after playing squash vigorously. Forced mannitol-alkaline diuresis therapy for prophylaxis against hyperkalaemia and metabolic acidosis was performed. He did not develop renal failure. The clinical features, pathology and treatment of rhabdomyolysis and myoglobinuria are summarized.
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6/11. Alcohol-associated haemolysis in Zieve's syndrome: a clinical and laboratory study of five cases.

    In 1958 Zieve described a syndrome of jaundice, hyperlipidaemia, and transient haemolytic anaemia associated with alcohol abuse. The clinical and laboratory features of five cases are reviewed. All patients presented with acute abdominal pain and fever. Four had a history of a recent alcohol binge. Hyperlipidaemia was present in two patients; this subsided before the onset of haemolysis. The red cells showed features of an acquired pyruvate kinase deficiency: an increased autohaemolysis with only partial correction with glucose, low red cell ATP, and instability of pyruvate kinase when haemolysate was heated to 55 degrees C. These changes were not observed in a control group of chronic alcoholics without haemolysis.
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7/11. Relapsing eosinophilic myositis--a cause of pseudothrombophlebitis in an alcoholic.

    A 51-year-old chronic alcoholic man presented with recurrent calf and thigh swelling and was investigated on several occasions for possible deep venous thrombosis. The episodes were precipitated by binge drinking. Muscle biopsy was performed on 3 occasions, revealing an inflammatory myopathy. On one of these occasions eosinophils were prominent in the interstitial infiltrate. Eosinophilic infiltrates in skeletal muscle may be a transient phase of the cellular process in the inflammatory myopathy and perhaps do not denote a specific nosological entity.
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8/11. Binge stroke. A case report.

    cerebral infarction developed in a 33-year-old normotensive coloured male after an alcoholic binge. This sequence of events has been described in scandinavia and may occur in southern africa more often than is realized.
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9/11. Acute alcoholic myopathy.

    Muscle disease associated with alcohol abuse is more common than is generally realized. The chronic painless form of alcohol myopathy is thought by some to be an atypical neuropathy. patients with the acute painful variety have pain, swelling, tenderness, cramps and weakness in one or more muscle groups, usually after an alcoholic binge. Clinical differentiation of this form of myopathy from deep vein thrombosis can be challenging. ethanol and its metabolite, acetaldehyde, have direct pathologic effects on skeletal muscle.
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10/11. Fetal alcohol syndrome. A great paediatric imitator.

    Twenty children affected by prenatal exposure to alcohol are described. Their mothers either suffered from chronic alcoholism, or were binge or heavy drinkers while pregnant. Only in nine mothers (45%) was alcohol abuse recognized and associated with their babies' anomalies in the first months after birth; in some, the diagnosis of fetal alcohol syndrome was delayed for many years. Alcohol abuse in pregnancy is probably a significant cause of birth and developmental defects in Australian children.
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