A necklace of telangiectases: an early clinical sign of alcohol abuse.

The prevalence of a necklace of telangiectases increases with the quantity and duration of regular alcohol intake. The necklace was present in 7%, 61.4%, 88.6%, and 98.5% of four groups of patients acknowledging less than 27 grams of ethanol intake per day for ten years, 77 grams per day for seven years, 112 grams per day for 11 years, and 113 grams per day for 15 years, respectively. The necklace first appeared after three to eight years of drinking 77 grams of ethanol (five to six drinks) per day, seems to be permanent and to appear before other skin changes associated with alcohol abuse such as `gooseflesh', palmar erythema, and spider nevi. Recognition of the necklace indicates the need for further assessment, to determine if alcohol abuse is contributing significantly to any other symptoms or signs (e.g., hypertension, intellectual impairment, or gastrointestinal disease). If the patient is taught to recognize the necklace, he or she may be able to differentiate `social drinking' from `alcohol abuse', and be motivated to seek treatment early.

The brief alcoholism rating scale: a new test for diagnosing.

A new scale, comprising 100 criteria based on medical history, physical examination and routine laboratory data, independent of a drinking history, can help physicians in the detection, diagnosis and early treatment of alcoholism. The scale also permits objective classification of alcoholism into mild, moderate and severe categories and overcomes the patient's denial-a major obstacle to early diagnosis. Results suggest that the instrument is accurate: 94% of patients were classified correctly by the scale. Further validation studies in clinical practice are necessary.

Influence of alcohol and tobacco use on sodium thiopental requirements in general anesthesia: a retrospective study of 700 patients.

Hospital charts of 700 patients who had undergone upper gastrointestinal surgery were reviewed to examine the relationship between alcohol abuse and dose of intravenous sodium thiopental (Pentothal) required to induce general anesthesia. Patients who required a high sodium thiopental dose (greater than 6.08 mg/kg) exhibited a higher incidence of alcoholism, heavy drinking, and heavy smoking, compared to patients who required low sodium thiopental dose (greater than 3.42 mg/kg and less than 4.75 mg/kg). Alcoholics and heavy drinkers, the majority of whom were heavy smokers, required a greater mean sodium thiopental dose than heavy smokers who were neither alcoholics nor heavy drinkers. Possible future research into the apparent cross tolerance between alcohol and sodium thiopental is discussed, particularly the possibility that the family physician may be able to use sodium thiopental dose requirement as a marker for early detection and diagnosis of alcoholism.