Five-year survival predictive factors in patients with excessive alcohol intake and cirrhosis. Effect of alcoholic hepatitis, smoking and abstinence.

Aim: To evaluate 5-year survival predictive factors in hospitalised patients with excessive alcohol intake and cirrhosis, including in a multivariate analysis the severity of the liver disease, gastrointestinal bleeding, concomitant viral B or C infection, smoking status, presence of alcoholic hepatitis at inclusion and abstinence from alcohol during follow-up.

Methods: In a non-concurrent cohort study, 122 patients with excessive alcohol intake and cirrhosis were followed up at least five years or till death. Two patients were lost to follow-up.

Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH.

Background/aims: Controversy surrounding the efficacy of corticosteroids in severe alcoholic hepatitis (AH) persists.

The Aims Of Our Study Were: (a) to analyze individual data of patients with severe AH discriminant function (DF)> or =32 from the last three randomized controlled trials; and (b) to identify the independent prognostic factors associated with short-term survival.

Methods: Individual data were collected from the three principal investigators.

Cigarette smoking and hepatic lesions in patients with chronic hepatitis C.

A possible hepatotoxicity of cigarette smoke has been recently suggested by epidemiological and experimental studies. Our aim was to study the possible relationships between smoking and liver fibrosis and activity in patients with chronic hepatitis C. A cross-sectional study was performed in a group of 310 patients with chronic hepatitis C consecutively hospitalized for their first liver biopsy.

[Screening of cancerous and precancerous lesions of the oral mucosa in an at-risk population].

Early diagnosis of oral carcinomas allows a limitation of functional consequences of surgical treatment. A prospective study was designed in 270 alcoholic patients. We practiced a clinical examination of the oral cavity by a stomatologist followed by a Toluidin blue test.

[Evaluation of drug treatment of primary alcoholism].

Clinical improvement (abstinence and sobriety) can be obtained in 30% of alcohol dependent (primary) patients at one year when therapy consists of meetings and talking with physicians. The association of drugs led to 40% clinical improvement in controlled studies. These drugs are acamprosate (Aotal), which is well tolerated and shown to be beneficial at one year, naltrexone (Revia), also well tolerated with a follow-up of 3 months, and lithium (Téralithe), to be used more cautiously, with a follow-up of one year.

Effect of alcohol consumption on serum hepatitis C virus RNA and histological lesions in chronic hepatitis C.

The role of alcohol intake in the occurrence of severe liver disease in chronic hepatitis C virus (HCV) carriers is still debated. A cross-sectional study has been conducted in 233 chronic hepatitis C virus carriers. Weekly self-reported alcohol consumption (SRAC) was evaluated, serum HCV RNA levels were measured by a branched DNA technique (Quantiplex 2.

Survival and prognostic factors in patients with severe alcoholic hepatitis treated with prednisolone.

Background & Aims: Corticosteroids have been shown to significantly decrease short-term mortality in patients with severe alcoholic hepatitis. However, independent factors associated with a favorable outcome and long-term survival are unknown. The aim of this study was to examine prognostic factors and long-term survival in patients with biopsy-proven severe alcoholic hepatitis.

Improving hypertension control among excessive alcohol drinkers: a randomised controlled trial in France. The WALPA Group.

Objectives: To improve blood pressure control among hypertensive ( > 140/90 mmHg) excessive alcohol drinkers.

Design: Fourteen worksite physicians were randomised onto an intervention group and a control group. The intervention was based on training the worksite physicians and follow up of those hypertensive subjects defined as excessive drinkers.

Parental history of alcoholism: a risk factor for alcohol-related peripheral neuropathies.

The aim of this study was to identify the risk factors of alcohol-related peripheral neuropathies. A case-control study was performed to compare two groups of alcoholic patients, one with peripheral neuropathy and the other without, but with alcohol-related cirrhosis, pancreatitis or cardiomyopathy. Ninety patients were recruited in four in-patient units of a French hospital: 32 patients had a peripheral neuropathy and 58 patients did not.

Relationship between alcohol and tobacco dependencies among alcoholics who smoke.

Outpatients followed in an alcoholic clinic and who fulfilled DSM-III-R criteria for alcohol dependence and had used both tobacco (at least one cigarette every day) and alcohol in the preceding week were studied. For each patient, two experimenters assessed: (1) the amount of tobacco and alcohol used; (2) the severity of dependence for each product. Results showed that: (a) The prevalence of smoking in this population of current alcohol dependents was 88%; (b) 91.

Prompting alcoholics to be referred to an alcohol clinic: the effectiveness of a simple letter.

Many patients received in emergency units (EU) of hospitals present alcohol-related problems. Most are alcohol dependent or abusers and enter for drunkenness, stay a few hours and return home. To assess the effectiveness of a letter referring these patients to an outpatient alcoholism treatment clinic, we performed a randomized study.

Deleterious influence of pyrazinamide on the outcome of patients with fulminant or subfulminant liver failure during antituberculous treatment including isoniazid.

Isoniazid and pyrazinamide are well-known hepatotoxic drugs, often used in combination. The aim of this study was to assess the prognostic influence of pyrazinamide on the outcome of fulminant or subfulminant liver failure caused by antituberculous therapy. Eighteen patients with fulminant or subfulminant liver failure due to antituberculous therapy were studied.

A multidimensional case-control study of dietary, alcohol, and tobacco habits in alcoholic men with chronic pancreatitis.

This study compared diet, type of alcoholism, and smoking in three groups of alcoholic men, with chronic pancreatitis (n = 56), with histological cirrhosis (n = 50), and without pancreatitis or cirrhosis (controls; n = 50) by a multidimensional analysis. Only patients in whom the first symptom of pancreatitis or cirrhosis was present for < 1 year before the interview were included. Patients with pancreatitis consumed more nonalcohol calories than cirrhotics (p < 0.

Effect of clonidine on liver oxygen extraction during alcohol withdrawal in man.

Since catecholamines can alter splanchnic oxygen transport and extraction, the suppression of sympathetic overactivity during alcohol withdrawal might improve hepatic oxygen extraction. Therefore, this study investigated the effects of clonidine, a centrally-acting alpha 2-agonist which reduces sympathetic nervous outflow, on splanchnic oxygen transport and extraction in 13 patients with chronic alcoholism during alcohol withdrawal. All patients had elevated transaminases and steatosis at liver biopsy and were withdrawn from alcohol 51 +/- 15 h (mean +/- SD) before the study.

Medical treatment for alcoholic liver disease.

The most effective treatment for alcoholic liver disease is abstinence from alcohol and it is the only treatment for patients with alcoholic fatty liver. Although many empirical therapeutic agents have been studied in the short-term and long-term treatment of alcoholic hepatitis, results have been mainly inconclusive. To date, only corticosteroids have proved to decrease the short-term mortality rate of patients with severe forms of acute alcoholic hepatitis.

Herpesvirus infection of the respiratory tract in patients with alcoholic hepatitis.

Respiratory herpesvirus infections have rarely been described in alcoholics. We report four cases of severe respiratory herpesvirus infections in patients with alcoholic liver disease. Two were related to Herpes Simplex Virus and two to Cytomegalovirus.

A randomized trial of prednisolone in patients with severe alcoholic hepatitis.

Background: Controlled trials have yielded inconsistent results with regard to the efficacy of corticosteroids in the treatment of alcoholic hepatitis. Three meta-analyses suggest that they may be effective in patients with encephalopathy who have severe liver disease.

Methods: We conducted a randomized, double-blind trial comparing 28 days of prednisolone treatment (40 mg per day) with placebo in 61 patients with biopsy-proved alcoholic hepatitis and either spontaneous hepatic encephalopathy (n = 19) or a discriminant-function value higher than 32.

[Atrium-related hepatitis. Report of four cases].

Four patients developed acute hepatitis after receiving Atrium, an association of phenobarbital, febarbamate and difebarbomate, for the treatment of tremor or for the prevention of alcohol withdrawal symptoms. Hepatitis occurred 1 to 3 months after treatment. Asthenia was the unique clinical manifestation.

[Prevalence of alcoholic diseases. At a teaching hospital of the Paris suburbs].

During the last 15 days of January 1989, the 757 patients admitted for more than 48 hours in any of the departments of Hôpital Beaujon (Clichy) were investigated for diseases that were certainly or probably related to alcoholism, and in order to detect drinkers at high risk, the amount of alcohol consumed in a week was recorded. The prevalence of alcohol-related diseases was 14.7 per cent (range: 12.

[Detection of alcoholic patients using the systematic CAGE autoquestionnaire. In out patients].

A French adaptation of the CAGE questionnaire was used as a self-administered test in 200 outpatients (heart clinic 100, gastroenterology clinic 100) from a French University Hospital. People with two positive items or more were regarded as potential "alcoholics", i.e.

Portal hypertension and ascites in acute hepatitis: clinical, hemodynamic and histological correlations.

We attempted to ascertain the mechanism of portal hypertension and ascites complicating acute hepatitis in 66 patients who underwent transvenous liver biopsy and measurement of hepatic venous pressure gradient. Increase in hepatic venous pressure gradient was related to the severity of acute hepatitis, as indicated by the significant correlation between the values for hepatic venous pressure gradient and serum bilirubin, serum albumin or coagulation factor V, and by its higher value in patients with, than in patients without, encephalopathy. Hepatic venous pressure gradient was higher in patients with, than in patients without, ascites (12.

Successful endoscopic obturation of gastric varices with butyl cyanoacrylate.

In 27 patients who had bled from esophagogastric varices, large-sized and/or actively bleeding gastric varices were endoscopically obturated with the tissue adhesive butyl cyanoacrylate. Active bleeding was stopped in six patients. Rebleeding occurred in 10 patients; in four patients, rebleeding was due to ruptured gastric varices, occurred early and was successfully treated by reinjection of gastric varices; in one patient, rebleeding was attributed to ulceration on an injected gastric varix.