Lithium therapy associated with hidradenitis suppurativa: case report and a review of the dermatologic side effects of lithium.

Lithium is frequently used in the management of several psychiatric disorders including acute mania, bipolar (manic-depressive) disorder, and recurrent depression. We describe a patient in whom hidradenitis suppurativa developed while the patient was receiving lithium. The cutaneous side effects of lithium are reviewed. The most frequent are psoriasis, acneiform lesions, folliculitis, alopecia, and a maculopapular/macular eruption. Many of these side effects respond less readily to conventional therapy while the patient is receiving lithium.

Substance abuse among adolescents with chronic mental illnesses: a pilot study of descriptive and differentiating features.

Twenty-six adolescents with a chronic mental illness (schizophrenia or schizoaffective disorder of at least 1.5 years' duration) were assessed for the presence or absence of comorbid substance abuse. The two groups were compared on a number of variables believed to identify or predict substance abuse. The substance abusing subgroup were significantly different in levels of social functioning, school achievement, premorbid substance abuse, having parents or siblings who abused substances, dysfunctional families, cigarette smoking, number of hospital admissions, and emergency room visits. These findings are discussed in the context of clinical issues regarding the management of adolescents with chronic mental illnesses.

The effect of cigarette smoking on the long term success rates of aortofemoral and femoropopliteal reconstructions.

Cigarette smoking is a recognized causative factor in the genesis of arterial insufficiency, but the precise effect of nonsmoking on the success of the operation is not well documented. Three hundred and twenty-six patients who underwent aortobifemoral bypass (209) or femoropopliteal bypass (117) between 1969 and 1978 were observed to determine whether or not the discontinuation of cigarette smoking affected the long term results of these grafts. Patients were divided into three groups: group 1 smoked preoperatively and postoperatively; group 2 smoked preoperatively but not postoperatively, and group 3 did not smoke at all. The five year cumulative success rates for aortobifemoral bypass in the groups were: 42 per cent for group 1 (130 patients); 77 per cent for group 2 (67 patients), and 71 per cent for group 3 (12 patients) (p less than 0.001). In the femoropopliteal group, the variation with regard to the known patency rates of autogenous and prosthetic grafts made the results more difficult to assess. For all grafts the five year cumulative success rates were: 38 per cent of group 1 (57 patients); 33 per cent for group 2 (40 patients), and 70 per cent for group 3 (20 patients) (p less than 0.001). Subdivision of groups 1 and 2 into autogenous and synthetic grafts gave identical success rates of 54 per cent for long saphenous vein grafts (66). Prosthetic grafts were successful at five years in 19 per cent of the patients in group 1 (16 patients) and 43 per cent in group 2 (15 patients). These results were not significant. These results clearly favor the postoperative nonsmoker over the smoker in the aortofemoral group but the distinction in the femoropopliteal group is less clear, although there is a similar trend.