Alcohol consumption and mortality in an American male population: recovering the U-shaped curve--findings from the normative Aging Study.

Several prospective studies have suggested that moderate alcohol consumption may offer protection against total and coronary heart disease (CHD) mortality. These studies have been criticized for failing to control for changes in drinking and the influence of comorbidity on consumption decisions. In the present study, we examined whether rates of death from all causes and from CHD were related to overall consumption as well as variability in or problems with drinking. In 1973, a drinking questionnaire was completed by 1,823 male subjects participating in a longitudinal study who were prescreened for absence of serious or chronic disease. After 12 years of follow-up per subject (21,716 man years of follow-up in all), 159 men have died, 74 from CHD. Incidence rates of overall mortality were lowest for moderate drinkers in each of three age groups. CHD death rates for moderate drinkers were similar to those of non-drinkers except in the oldest men where rates were lower for moderate drinkers. Proportional hazards models testing several measures of consumption consistently showed moderate or regular drinkers to have lower risk of death than teetotalers. Regular drinkers had lower overall and CHD mortality than lifetime abstainers. For all-cause and CHD mortality, drinking heavily in the past, ever having tried to quit drinking and having had problems with alcohol were not related to increased risk. These results lend support to the hypothesis of the beneficial effect of moderate drinking, with respect to mortality.

Predictors of reduction and cessation of drinking in community-dwelling men: results from the normative aging study.

As part of a longitudinal study of health and aging, the conditions and motivational factors that prospectively predicted either cessation or reduction in alcohol consumption were compared. Data were from 1,517 community-dwelling men who in 1973 (Time 1) and 1982 (Time 2) completed mailed questionnaires about their drinking behaviors. Time 2 quitters (n = 62) had consumed no alcohol for at least the 6 months before that survey; reducers (n = 255) had decreased their yearly alcohol consumption by at least one-half. Compared to 971 controls, quitters reported more drinking problems at Time 1; reducers reported higher consumption at Time 1, which was the only factor predictive of subsequent reduction (p less than .001). Regression analyses considering contextual-motivational factors for drinking showed that at Time 1 quitters were less likely than controls to have consumed alcohol during evenings out (p = .008), in family-home settings (p = .013), or for salutary reasons (p = .084); conversely, they were more likely to have consumed alcohol to reduce negative affect (p = .011). Reducers cited more social-situational reasons for curtailing drinking; quitters cited more personal reasons related to health and alcohol effects. These findings indicate that in a community sample of men, problematic drinking behaviors tend to predict subsequent abstention rather than reduced drinking.

Drinking by alcoholic cirrhotic patients under medical care: a literature survey.

In order to gain a broader perspective on the natural course of drinking by alcoholic cirrhotic patients receiving medical care, the medical and surgical literature from 1963 through 1982 was surveyed for prospective studies of patients with alcoholic cirrhosis in which follow-up drinking data were reported. Eleven studies with 1,039 patients were summarized. The patients were mostly urban men, averaging about 50 years old, treated in municipal, Veterans Administration, and university hospitals for either decompensated cirrhosis or for portal hypertension and bleeding varices; follow-up periods ranged from less than 1 to 10 years. The clinical investigators in the studies used various means to assess drinking and to categorize drinking behaviors, and expressed caution regarding validity. Between series, from 20 to 53% of the patients were reported to be abstinent from alcohol during the clinical follow-up periods. In five studies (373 patients) where the extent of drinking was determined, from 21 to 35% of the patients were reported to be drinking in a reduced or moderate manner, and from 17 to 42% to have resumed heavier drinking. The rates of improvement in drinking reported for the cirrhotic patients under medical care compare favorably to those for middle-aged male clients after alcoholism treatment, but the variables that predict course and outcome cannot be fairly compared between "medical" and alcoholism treatment populations. The substantial reduction or cessation of drinking reported in these large series of alcoholic cirrhotic patients over long follow-up periods may simple represent the natural, terminal course of alcoholism in the presence of severe liver disease; concomitantly, improvement may reflect the favorable impact of an alcohol-related disease and continued medical care on changing drinking behaviors.

Social contexts and motives for drinking in men.

Factor analysis identified nine distinct contextual-motivational factors for drinking in 1517 healthy men. These factors were significant predictors of level of alcohol consumption and discriminated subjects reporting drinking problems from those reporting no problems.

Recovery from alcoholism in cirrhotic patients: a study of 45 cases.

In order to determine factors that influenced their recovery from alcoholism, 45 men who attended a liver clinic were studied, employing a detailed questionnaire. All had shown classic signs of cirrhosis, and 84 percent were in frank hepatic failure at the time of hospitalization. In general, they were married, blue-collar workers who drank, on average, for 27 years and either abstained or sharply curtailed their alcohol intake for 3.7 years (range one to 11 yrs) following which their hepatic function improved steadily. They reported that severe medical illness was a critical factor in the decision to stop drinking (87 percent) and that continued medical care was very helpful in their recovery from alcoholism (73 percent). Formal alcoholism treatment seldom was employed. Most stated that they "did it on their own." Improvement in health, in psychologic state, in marital and social relations reinforced sobriety. The results indicate the potential impact of medical illness on the decision to stop drinking and the need to study further the factors that promote recovery from alcoholism in medical settings.

Cell proliferation in three types of Barrett's epithelium.

Barrett's epithelium is a columnar, possibly premalignant, metaplasia of the oesophagus. To study the pattern of epithelial renewal in this disorder, we localised the lower oesophageal sphincter by manometry in 12 patients with known Barrett's epithelium, obtained multiple suction biopsies above the sphincter, and organ cultured the biopsies over 3H-TdR-containing medium to label proliferating cells. Of 23 biopsies from the 12 patients, 13 were specialised columnar type, three were junctional type, and seven were fundic type. None of the patients showed clinical evidence of oesophageal carcinoma, and oesophageal cytological examinations were uniformly negative for neoplastic cells. When compared with control gastric fundic biopsies from normal volunteers, mean values for the labelling index and the proportion of the pit which was occupied by the proliferative zone in Barrett's biopsies were not significantly different. However, four individual Barrett's biopsies (three specialised columnar type and one junctional type) did have a proliferative zone which occupied a greater proportion of the pit than did the widest control zone. We propose that the pattern of epithelial proliferation in Barrett's epithelium in general is similar to that found in other gastrointestinal columnar epithelia. However, a minority of patients with Barrett's epithelium may have an expanded proliferative zone. The clinical implications of an expanded proliferative zone with regard to the subsequent development of oesophageal carcinoma require further investigation.

Paneth cells in Barrett's esophagus.

Paneth cells were identified in esophageal biopsies from 4 patients with Barrett's epithelium of the specialized columnar type. These cells were identical to human intestinal Paneth cells by light microscopy, electron microscopy, and histochemical staining reactions. Retrospective review of biopsies from 8 additional cases with esophageal specialized columnar epithelium yielded 2 further cases with Paneth cells. The presence of Paneth cells, along with goblet cells, suggests that specialized columnar type epithelium in the esophagus may be a form of highly differentiated intestinalization.

Barrett's esophagus. Clinical review of 26 cases.

Barrett's esophagus was diagnosed in 26 men in a five-year period by demonstrating esophageal specialized columnar epithelium in target biopsies obtained at endoscopy or in peroral suction biopsies of the esophageal mucosa. The clinical, radiologic and manometric features of these patients were reviewed retrospectively. Esophageal lesions associated with this epithelium included distal and midesophageal strictures and ulcers, alone or in combination, or simply esophagitis. One patient had an associated adenocarcinoma. Twenty of 26 (77%) had heartburn or regurgitation, 16 (62%) had easily elicited reflux of barium while supine and 16 of 17 tested had lower esophageal sphincter pressure in the incompetent range. Ninety-six percent had one or more of these parameters positive. This series demonstrates a wide spectrum of esophageal lesions in Barrett's esophagus, and supports the concept that this lesion occurs as a consequence of gastroesophageal reflux and erosive esophagitis. The case of adenocarcinoma in this series adds to the concern that the columnar lined lower esophagus may be a premalignant lesion.

Protective effect of metronidazole in experimental ulcerative colitis.

Administration of carrageenan to guinea pigs produces colonic lesions which are similar to those noted in idiopathic ulcerative colitis of human beings. This model was used to determine fecal flora changes and response to antimicrobial probes during the evolution of carrageenan-induced colitis. The results of fecal flora analysis showed that mean coliform concentrations increased from 10(2.7) to 10(7.4) per g during the initial stages of colonic ulceration. Pretreatment of carrageenan recipients with antimicrobials directed against coliforms reduced the concentrations of these organisms, but failed to attenuate the disease process. On the other hand, pretreatment with metronidazole, an antimicrobial primarily active against anaerobic bacteria, prevented carrageenan-induced colitis in a majority of animals. Delayed treatment with metronidazole until after colitis was established showed no salutory benefits. These results suggest that anaerobic bacteria play a role in the initial events of carrageenan-induced colitis in the guinea pig model.

Whipple's disease and ankylosing spondylitis simultaneous occurrence in HLA-B27 positive male.

A 57 year old male had recurrent arthritis and uveitis for 34 years, spinal symptoms for 10 years, and malabsorption for four months leading to the diagnosis of ankylosing spondylitis and Whipple's disease. HLA-B27 was positive. Out of the four cases of Whipple's and ankylosing spondylitis in the literature, only one had been tested for HLA-B27 and was found to be negative.

The columnar-lined esophagus--analysis of 26 cases.

A review of 26 cases of columnar-lined (Barrett's) esophagus suggests that this lesion is more common than generally appreciated, usually arising consequent to reflux esophagitis. The radiologically detectable lesions frequently do not support the idea that Barrett's esophagus presents only with high esophageal ulcer and/or stricture. Hiatal hernia, gastroesophageal reflux, stricture, ulcers, and even minor mucosal abnormalities may be present alone or in combination, and may be variably located.

Whipple's disease with minimal intestinal involvement.

An uncharacteristic case of Whipple's disease is reported, in which, although overt intestinal involvement was absent, and there was only a patchy histological lesion, the diagnosis was confirmed by electron-microscopic examination of peroral intestinal biopsies.

Endemic amebiasis in an Arkansas community.

Parasitologic, serologic, and epidemiologic studies were done during 1967 in Calion, Arkansas (population 544). Infection with Entamoeba histolytica was found to be endemic but was segregated along racial lines. Twenty-two (9.9%) black compared with only one (0.6%) white had E. histolytica demonstrated in one stool examination; only two blacks had symptoms suggestive of amebiasis. No positive amebiasis indirect hemaggulination titers were found in 135 white residents. In contrast, 41 (17.9%) blacks had positive titers. Age, sex, and geographic location were not associated with stool or seropositivity. Within the black population, clustering of stool and seropositivity occurred. Significantly higher rates of stool and seropositivity were seen in households with crowding and poor sanitation as evidenced by lack of indoor toilet facilities. The presence of contaminated water supplies did not correlate with stool or seropositivity. The probable importance of person-to-person transmission is suggested by the observed clustering of infection within households with crowding and unsanitary conditions. The absence of evidence for transmission by food or water further supports this hypothesis.

Structural features of the epithelio-mesenchymal interface of rat duodenal mucosa during development.

In fetal rats 5-7 days before birth, the duodenal epithelium is separated from mesenchymal cells by a well-defined basal lamina. By 3-4 days before birth, when small rudimentary villi are first seen, direct contact between epithelial and mesenchymal cells occurs by means of epithelial cell cytoplasmic processes which project through gaps in the basal lamina into the lamina propria. At contact sites, the epithelial and mesenchymal cell plasma membranes were less than 100 A apart but membrane fusion was not seen. In number and size these epithelial cell processes increase strikingly during the last 2 days of gestation, and they persist in large numbers until 7-10 days after birth. Thereafter, they decrease gradually in both number and size until 3-4 wk after birth, when the morphology of the epithelio-mesenchymal interface resembles that seen in adult rats, i.e., there are only rare epithelial cell processes which penetrate deeply into the lamina propria. The presence of a large number of epithelio-mesenchymal contact sites during the period of rapid growth and differentiation of duodenal mucosa may reflect epithelio-mesenchymal cell interactions which may facilitate the maturation of the duodenal mucosa.