Clinicomycological study of tinea capitis in desert district of Rajasthan

The clinicomycological study was conducted on 200 cases of Tinea capitis in Jodhpur. Incidence of tinea capitis among superficial mycoses was 4.43 and male to female ratio being 1.8:1. Majority of patients were from urban area (88%) and positive family history of dermatophytoses was present in 29% of cases. Majority of patients attended hospital OPD from July to October (39.%%) and January to April (49%). Persons using mustard oil as hair applicant had single or less lesions as compared to individual using other oil. Endothrix involvement of hair was seen in 78% cases and Trichophyton violaceum was predominant fungus (88.5%) recovered on culture.

[Smoking cessation with the nicotine patch]

Smoking cessation programs have become much more effective since the transdermal nicotine delivery system is available. Nicotine patches are well tolerated, have little side-effect and reduce the withdrawal symptoms of nicotine abstinence. Short- and long-term abstinence rates increase when nicotine patches are combined with behavioral therapy. This paper reports current scientific literature on placebo-controlled trials and gives treatment advices for smoking cessation using nicotine patches by general practitioners. Although nicotine patches are now available in Germany without prescription, therapeutic support by physicians, pharmacists or psychologists is indispensable for successful smoking cessation.

[Results of integrated inpatient detoxification and motivation treatment of alcohol dependent patients]

During the course of the disease many alcoholic patients are detoxified on an inpatient basis. Detoxification lasts for some days to 2 or 3 weeks. The treatment goal of abstinence usually cannot be achieved by detoxification alone. Therefore a qualified detoxification should consist of a medical treatment, a careful (psychiatric) diagnostic process and a psychotherapeutic treatment aiming at motivation for further treatment. The described program integrates these components. The psychotherapeutic approach is emphatic and directive, trying to convince all patients to apply for further alcoholism treatment. Follow-up data of 120 of the initial 130 patients eight months after detoxification showed, that 68 patients (57%) started further treatment, most of them as inpatients. In the group of prognostic unfavourable patients, who had not received any disease related counseling before detoxification (77% of the sample), 47% started further alcoholism treatment.

[Psychiatric manifestations in patients with primary open-angle glaucoma]

In a comparative study, 21 in-patient and 27 out-patients with primary open-angle glaucoma and 18 cataract patients were investigated to determine whether psychiatric symptoms were more frequent in patients with primary open-angle glaucoma. In all three groups we used Beck's Depression Inventory, the Zerssen Symptom List and the Maudsley Personality Inventory. In addition, in the case of the glaucoma in patients we applied the unsteadiness Test, the Social Interview Schedule and a psychiatric interview. Two-thirds of the glaucoma inpatients showed psychiatric symptoms, had higher scores for depression and psychosomatic complaints and had reduced emotional stability. The glaucoma out-patients had statistically significantly high scores for psychosomatic complaints. The control group showed normal scores in all tests. The present tests seem to pick up psychiatric symptoms in patients with primary open-angle glaucoma. Therefore, we can recommend them as an aid to orientation in hospital and private practice.

[Community based management of alcohol dependent patients. Evaluation of a combined inpatient and ambulatory treatment concept]

For a long time, the standard treatment for alcoholics in Germany consisted of a six month inpatient treatment period. Only recently, shorter treatment modalities with more emphasis on outpatient treatment were proposed. We evaluate a community based treatment model which combines a six week inpatient period with one year of outpatient treatment. During eight years, we saw 790 patients. After one year, 68% were globally improved. Ten years after treatment half of the 1976 sample were abstinent. Thus, a subgroup of alcoholics seem to benefit from community based programs. They are characterized by fair social adaptation and the willingness of their relatives to actively participate in the treatment.

[Methanol level and methanol elimination in alcoholic patients]

A total of 54 male alcoholics aged between 26 and 57 years who had been admitted in an intoxicated state to a psychiatric hospital for acute care and subsequent detoxification were included in the study. The blood ethanol concentration (BEC) and serum methanol concentration (SMC) at the time of admission (n = 49) and the methanol elimination curve during ethanol elimination (n = 19) and after the ethanol concentration had fallen to zero (n = 4) were investigated. On admission, the BEC ranged from 0.21 g/kg to 3.26 g/kg and the SMC ranged from 5 mg/kg to 44 mg/kg. The gamma-alcoholics (n = 28) exhibited higher ethanol concentrations than the delta-alcoholics (n = 11) but no difference was found in the methanol concentrations. The methanol level was found to be related to the ethanol level in gamma-alcoholics (r = 0.671; p < 0.001), but not in d-alcoholics (r = 0.215; p > 0.05). The methanol content of the most recently consumed and generally preferred type of alcoholic beverage was found to influence the SMC in all the alcoholics. The SMC did not fall during ethanol oxidation (BEC > 0.2g/kg). After the ethanol concentration had fallen to zero, methanol elimination was found to follow first order kinetics; the elimination constants ranged from 0.592 h-1 to 0.209 h-1, corresponding to elimination half-life values of 1.2 h to 3.3 h. No differences were found between these values and those of non-alcoholic subjects.

Do women develop alcoholic brain damage more readily than men?

Chronic alcoholism is related to brain damage (i.e., volume changes) in both men and women. There is an open question whether the brains of women are more vulnerable than those of men to alcohol toxicity. The present follow-up study focuses on a direct comparison of sex-related differences in alcoholic brain shrinkage and its reversibility. In a prospective design, a random sample of 65 alcoholics of both sexes (51 males and 14 females) was studied. Computerized tomography brain scans before and after a 6-week inpatient treatment program with controlled abstinence revealed a significant re-expansion of the brain as assessed by linear measurements. By controlling for moderating variables such as age, mean daily alcohol consumption, liver dysfunction, etc. the degree of brain shrinkage was found to be similar in men and women despite significantly shorter ethanol expositions in the women. These findings corroborate the hypotheses of other investigators about basic biological differences between the two sexes as to the effects of alcohol. The hypothesis of an enhanced vulnerability of women to acute and chronic complications of alcoholism is supported.

[Statistical approach to forensic conversion values for alcoholics]

With collaboration of the study groups from Tübingen, Munich and Kiel and consideration of the results of Bonnichsen et al 1968, alcohol elimination curves of 98 alcoholics were subjected to a joint evaluation for determination of the beta 60 values. The average elimination rate was 0.21 g/kg/h (s = 0.05 g/kg/h). By analogy to average beta 60 values and back-conversion factors of nonalcoholics, the limit values for alcoholics were estimated as being between 0.12 g/kg/h (minimum value) and 0.29 g/kg/h (maximum value).

[Thiamine deficiency and brain atrophy in alcoholic patients]

CT brain scans of 65 alcohol-dependent inpatients were compared before and after 6 weeks of confirmed abstinence. Linear measurements revealed a significant reduction of the enlargement of the ventricular system in accordance with the re-expansion of the brain after alcohol abstinence (ANOVA, significant time effects). 22 patients showed a moderate or severe thiamine deficiency. CT findings on thiamine-deficient patients did not differ from those on patients without thiamine deficiency (ANOVA, no significant group effects). Correlations between thiamine deficiency and subcortical atrophy before treatment were not significant. The results are discussed in relation to the pathogenesis of reversible brain shrinkage in chronic alcoholics.

Ultrasonic variables in the diagnosis of intrauterine growth retardation

Ultrasonic biparietal diameter (BPD), femur length, abdominal circumference, femur length/abdominal circumference ratio, estimated fetal weight, ponderal index, estimated fetal length were measured within 72 h of delivery of 30 small-for-date (SFD) and 174 non-SFD newborns. Evaluation of each ultrasound variable in the antenatal diagnosis of SFD fetus was assessed. Abdominal circumference and estimated fetal weight were the best predictors in confirming SFD in 73.3 and 76.6 per cent respectively, followed by BPD (63.3%). Other variables (femur length, femur length/abdominal circumference ratio, estimated fetal length and ponderal index) were less accurate in diagnosis of SFD babies. For all variables studied negative predictive value was high (almost 90% or above). However, positive predictive value for abdominal circumference and estimated fetal weight were satisfactory. This study demonstrates the usefulness of abdominal circumference and estimated fetal weight in recognising SFD. It also shows that various growth variables could be used to rule out the diagnosis of IUGR with reasonable accuracy (negative predictive value greater than or equal to 90).

Fetal ponderal index in predicting growth retardation

Fetal ponderal indices were calculated by ultrasound examination and compared with the neonatal ponderal indices in 154 pregnancies. No significant difference was found between the prenatal and postnatal values of weight, length and ponderal indices of the entire sample as well as in babies with intrauterine growth retardation (IUGR). The fetal ponderal index had a sensitivity and specificity of 56.7 and 84.6 per cent respectively. These data suggest that fetal ponderal index could be used to rule out IUGR with reasonable accuracy (negative predictive value: 86%).

Ultrasonic intrauterine growth curves

Intrauterine growth was studied by serial ultrasonic measurements of biparietal diameter (BPD), femur length (FL) and abdominal circumference (AC) in 241 normal low risk obstetric patients. These measurements were used to construct normal ultrasonic fetal weight and length curve. The data correlate well with the already established, postnatal weight and length curves after 28 weeks of gestation. The fetal ponderal index curve was compared with postnatal ponderal index curves available. Antenatal recognition of fetal weight, length and ponderal index can be used to evaluate pregnancies at risk for altered fetal growth.