Nutritional assessment of drug addicts.

OBJECTIVE: To discern if factors such as organic pathology, sex, duration and/or intensity of drug addiction, alcohol abuse, hepatitis B infection, anorexia with poor food and drink consumption, or disturbance of social and familial networks, are related to an impaired nutritional status in hospitalized drug addicts. DESIGN: Cross-sectional prospective study. SETTING: Detoxication unit and internal medicine unit of a university hospital. PATIENTS: 140 drug addicts without acute organic pathology and 18 with acute organic pathology related to drug addiction. The immunological study was compared with a control group composed of 50 healthy and well-nourished individuals (26 women and 24 men), age-matched with our patients. RESULTS: Drug addicts without organic pathology were under-nourished: 92.4% weighed under the mean weight for the population and 55.7% had had a weight loss above 5%. The distribution of mid-upper arm circumference (MUAC), triceps skinfold (TSF) measurement and mid-arm muscle area (MAMA) compared with the percentiles for the population showed a shift towards lower values. We found a high percentage of patients with a high lymphocyte count (55%). Despite the high lymphocyte count, delayed hypersensitivity was depressed in our patients. Of our patients, 66.4% exhibited anorexia at admission. The mean calorific intake was 978 +/- 89 kcal/day in females and 1265 +/- 64 kcal/day in males. However, in most cases, malnutrition (usually marasmus-like malnutrition) was not very severe; only 30% of the drug addicts weighed less than 80% of the mean weight for the population, or admitted to a weight loss above 10%, and by subjective nutritional assessment, only 18% were deeply malnourished. Otherwise, the nutritional status was very poor in drug addicts with acute organic pathology. We also found a worse nutritional status in our patients related to female sex, intensity of drug addiction, anorexia with poor food and drink consumption, and disturbance of the social and familial networks. CONCLUSIONS: Many drug addicts suffer from calorie and protein malnutrition. This mainutrition is related to female sex, intensity of drug addiction, anorexia and poor food and drink consumption, and disturbance of the social and familial links. Acute organic pathology leads to a significant worsening of the nutritional status of drug addicts.

[Low grade non-Hodgkin's lymphoma after combined therapy for Hodgkin's disease]. / Linfoma no Hodgkin de bajo grado tras terapéutica combinada por enfermedad de Hodgkin.

The most serious complication of curative therapy for Hodgkin's disease is the development of a second malignancy. A patient who developed a low grade non-Hodgkin's lymphoma three years and a half after combined-modality therapy for Hodgkin's disease, is described. It is exceptional this type of non-Hodgkin's lymphoma as a second neoplasm after cytotoxic treatment for Hodgkin's disease. Pathogenic relationships between both processes are discussed.

Nutritional assessment of drug addicts. Relation with HIV infection in early stages.

OBJECTIVE: To assess the nutritional status of drug addicts without acute organic pathology, in order to determine the prevalence of malnutrition and to discern if early HIV infection is associated with a poor nutritional status in this group of patients. DESIGN: Prospective study. SETTING: Detoxication unit of a university hospital. PATIENTS: 140 drug addicts without acute organic pathology. 31 patients were HIV+. No one fulfilled the definition of AIDS. RESULTS: We found that drug addicts were undernourished: 92.4% weighed under the mean populational weight and 55.7% had a weight loss above 5%. The distribution of mid upper arm circumference (MUAC), triceps skinfold (TSF) and mid arm muscle area (MAMA) was lower than a reference normal population. Food intakes were poor; 66.4% of our patients complained of anorexia on admission. The mean caloric intake was 978 +/- 89 kcal/day in females and 1265 +/- 64 kcal/day in males. The mean protein intakes were 39.3 +/- 3.3 g/day in females (0.76 +/- 0.07 g/kg/day) and 49.7 +/- 2.7 g/day in males (0.77 +/- 0.04 g/kg/day). When we compared nutritional parameters between HIV+ and HIV- patients we found no differences. CONCLUSIONS: Nutritional impairment in drugs abusers with early stages of HIV infection should be attributed to drug abuse rather than to HIV infection.

[Pneumothorax, Pneumocystis carinii, and AIDS]. / Neumotórax, Pneumocystis carinii y SIDA.

Spontaneous pneumothorax can be a complication of several pulmonary diseases, such as pulmonary emphysema, chronic bronchitis and interstitial pulmonary disease. Nevertheless, it is a rare complication of any pneumonia, there is no description of necrosis or abscess caused by Pneumocystis Carinii pneumonia. We present a case of spontaneous pneumothorax (which was not resolved), being a reason for admission, of a patient with AIDS who developed Pneumocystis Carinii pneumonia during the stay in hospital. We think that spontaneous pneumothorax can register bad evolution in patients with AIDS and pulmonary symptoms.

[Atypical relapsing polychondritis]. / Policondritis recidivante atípica.

Relapsing polychondritis is a disease of unknown etiology whose main characteristic is the chronic inflammation and destruction of the different cartilaginous structures of the body. A rare case is presented, the rareness being the fact that ear cartilage was not affected and that the destructive arthropathy was similar to that produced by rheumatoid arthritis.

Bone changes in alcoholic liver cirrhosis. A histomorphometrical analysis of 52 cases.

Bone biopsies of 52 histologically confirmed alcoholic cirrhotic patients and 15 age- and sex-matched controls have been histomorphometrically analyzed determining trabecular bone volume (TBV), mineralized bone volume (MBV), and osteoid volume (OV). We also determined serum PTH, 25-OH-D3, calcitonin, FSH, LH, estradiol, testosterone, T3 and T4, urine cortisol, routine liver function tests, serum and urinary calcium, phosphorus, and magnesium. We found a high prevalence of osteoporosis: TBV was significantly lower in cirrhotic patients (T = 7.23, P less than 0.001), 41 of them being in the range of osteoporosis; none of them had osteomalacia. Levels of all the above-mentioned hormones and electrolytes were almost normal, and no correlation was found between them and liver function tests, as occurred with the bone parameters.

Alcohol-induced hypogonadism: reversal after ethanol withdrawal.

Serum testosterone, FSH, LH and prolactin levels have been determined in a group of 32 non-cirrhotic heavy drinkers at 9 and 21 h of the 1st, 3rd, 6th, 11th and 15th days after the onset of a florid ethanol withdrawal syndrome. In addition, serum steroid hormone binding globulin (SHBG) levels were determined at the 1st and 15th days. Serum levels of all these hormones were also determined in a control group of 15 healthy male volunteers. Serum testosterone levels, significantly lower in alcoholics at the beginning of the study, progressively increased along the observation period, recovering the circadian rhythm at the end of it. A significant increase was also observed in serum prolactin levels, in the low and upper limits of the normal range at the beginning and at the end of the study respectively. Serum FSH and LH levels were significantly higher in the alcoholics at the beginning of the study, with no significant variations during the observation period. There was a strong relationship between FSH and LH levels, but not between these hormones and testosterone. Thus, our data suggest that ethanol-induced hypogonadism is primary in origin, functional in nature and transient in its evolution.

Hepatocyte and nuclear areas in alcoholic liver cirrhosis: their relationship with the size of the nodules and the degree of fibrosis.

The aim of the study in alcoholic cirrhotic patients was to determine if a relationship exists between the areas of hepatocytes and their nuclei and the area of the nodules to which these cells belong as well as the thickness of the fibrous tracts which delimit these nodules. It was found that hepatocyte and nuclear areas were enlarged the smaller the nodules and the thicker the surrounding fibrous tracts. Considering that oxygen supply in liver cirrhosis decreases with increasing fibrosis, our results permit the hypothesis that a low oxygen supply causes an increase not only in liver cell size but also in nuclear size, which is an index of nuclear activity.