Doppler Echocardiographic Evaluation of Left and Right Ventricular Filling in Young Chronic Alcoholics / 대한내과학회지

OBJECTIVES: It is well known that many chronic alcoholics manifest diastolic dysfunction of left ven tricle in its early stage. But the effects of chronic alcohol drinking on right ventricular function are not well understood. Thus left ventricular filling impair ment and its effects to right ventricular diastolic function were evaluated in young chronic alcoholics. METHODS: For the evaluation of left and right ventricular diastolic function in chronic alcoholics, 30 young chronic alcoholics and 28 control subjects were studied by pulsed Doppler echocardiography at the left and right ventricular inflow. Peak E velocity, peak A velocity, E/A velocity ratio, acceleration time and deceleration time were measured as diastolic filling parameters. RESULTS: 1) In the chronic alcoholics, the interventricular septum and posterior wall were thicker and left ventricular muscle mass was significantly increased than that in controls. 2) Among 30 cases of chronic alcoholics, 8 cases(26.7%) showed that the E/A ratio of the left ventricle was less than 1.0 and the deceleration time of the left ventricle was more than 240msec, where as 12 cases(40.0%) showed that the E/A ratio of the left ventricle was less than 1.0. 3) Among 30 cases of chronic alcoholics, 8 cases (26.7%) showed that the E/A ratio of the right ventri cle was less than 1.0 and the deceleration time of the right ventricle was more than 232msec, whereas 14 cases(46.7%) showed that the E/A ratio of the right ventricle was less than 1.0. 4) The RV E/A ratio was significantly correlated with the LV E/A ratio(r=0.697, p<0.001). 5) Blood pressure, ejection fraction, left ventricular mass, E/A ratio and deceleration time of both ventricles were not significantly different in comparison with the daily average amount, duration of ingestion, and total lifetime dose of alcohol. CONCLUSION: In all chronic alcoholics less than 50 years of age, the left ventricular systolic function was normal. But Doppler echocardiography showed that diastolic dysfunction of the left and right ventricles was present in 8 cases of 30 chronic alcoholics. Right ventricular diastolic dysfunction was closely related with left ventricular diastolic dysfunction. In conclu sion, diastolic dysfunction of both ventricle in chronic alcoholics may be the earliest functional sign of preclinical alcoholic cardiomyopathy.

A case of endogenous bacterial endophthalmitis developed in alcoholics patient

Endpgenous bacterial endophthalmitis develops mainly in a extremely ill patient or a immunologically compromised patient. As reported earlier, early suspicion and careful diagnostic evaluation and early aggressive treatment are important to treat endophthalmitis and prevent poor visual acuity. The authors experienced a case of endogenous endophthalmitis developed from pneumonia in chronic alcoholics patient. The pathogen was proved to be a Staphylococcus aureus by the culture of specimen obtained from the aqueous. Systemic, topical, subconjunctival and intravitreal antibiotic therapy were done, but the patient's eye progressed to phthisis state.

Serum folate and vitamin B12 levels in chronic alcoholics.

Anemia is common in alcoholics. Folate deficiency occurs commonly in association with the chronic use of alcohol. The incidence of folate deficiency in chronic alcoholic patients varies considerably from country to country. The purpose of the present study was to report the incidence of folate and vitamin B12 deficiencies in Thai chronic alcoholics. Serum folate and vitamin B12 levels were determined in 75 chronic alcoholics as well as in 80 apparently healthy Thai subjects. The mean Hb, Hct and serum folate levels were significantly lower in the alcoholics. Thirty-five percent and 84 percent had serum folate levels lower than 3 ng/ml and 6 ng/ml, respectively. On the other hand, the mean value of serum vitamin B12 in the alcoholic patients was significantly elevated, with 49 percent of them having serum vitamin B12 over 1,000 pg/ml. These findings indicated that the incidence of folic acid deficiency in the chronic alcoholics was quite high, which was probably due to dietary deficiency, folate malabsorption and interference by alcohol in folate metabolism. All these patients had a tendency to have a high serum vitamin B12 level, probably as a result of the increased release of vitamin B12 from storage in the injured liver.