[Alcohol-related liver diseases in the aged]

In these last years the authors have devoted themselves to chronic alcoholism rehabilitation. They have studied 99 over 65 years old subjects. In these subjects gastrointestinal pathology alcohol correlated incidence has been studied. An abdominal echography and an esophagogastroduodenoscopy have been performed in all these subjects. In some subjects, on the guide line of these tests, the authors have put through more tests: hepatosplenic scintigraphy, hepatic biopsy, laparoscopy, colonoscopy. Statistic elaboration was performed by chi-square test. The conclusions of this study are: 1) the diagnostic importance of association between echography and scintigraphy; 2) the low prevalence of severe hepatic alcohol related lesions in the elderly; 3) the importance of alcohol in hepatocarcinoma etiopathogenesis; 4) the incidence and the importance of phlogistic and ulcerous gastroduodenal lesions in elderly alcoholics.

[Integrated treatment of alcoholism. Evaluation of its efficacy]

Patients with alcohol addiction are analyzed after one year from the beginning of therapy. Treatment is carried out by an Anti-addiction Service working in territory, an Hospital medical ward, anti-alcoholic clubs and Hospital voluntary groups. The method is described at first, then the answers of investigated patients, the abstinence period, the attendance to help groups, the use of drugs (disulfiram) and the emerged problems are considered and analyzed. More than one year later, patients with alcohol addiction who have followed this method are still in abstinence and have changed their habit from alcoholic to unalcoholic one, as just they have done for the behaviour and the relationship.

[Alcoholism and the elderly: the importance of blood chemistry parameters for the diagnosis]

This paper again affirms the epidemiological significance of alcoholism in the elderly. The results of a study on 99 chronic alcoholic patients sixty-year older have been reported.

CONCLUSIONS

The laboratory tests for diagnosis normally used for screening of alcoholism are not enough considered in the elderly. In those patients more parameters have to be evaluated.

Hypoparathyroidism in chronic alcohol intoxication: a preliminary report

It is well known that osteoporosis is more common in chronic alcoholists than in age-matched controls. Possible aetiological factors could be: malabsorption of calcium and vitamin D, liver disease, abnormal parathyroid function. With this study, the authors investigated parathyroid hormone (PTH) behaviour in thirteen selected patients with alcohol abuse, free from any clinical or humoral sign of hepatopathy, and in ten healthy subjects as a control group. In alcohol abusers a significant reduction of plasmatic PTH, compared to normal calcium levels were found. A possible direct interaction effect between ethyl alcohol and PTH may be suggested, even if further studies are required.

[Radiotherapy in the treatment of Merkel cell tumors]

Merkel cell carcinomas are very rare (80 cases up to 1986) and very malignant; they have been known for 20 years only as "trabecular carcinomas". They do not rise from neural crests, and therefore are not apudomas, but from a staminal cell of the skin with neuroendocrine evolution. Merkel cell carcinomas must be distinguished from undifferentiated carcinomas of the skin, lymphomas, and oat cell carcinomas. Eight patients (46 to 86 years old) are presented, 4 males and 4 females, with 1 gluteal (the younger female patient), 3 head and 4 limb localizations of Merkel cell carcinoma. Radiotherapy was carried out after surgery in 7 patients and after biopsy in 1; local recurrences were already present in 3 cases, and lymph node metastases in 5; tumor doses were 36-65 Gy, administered with different techniques, i.e. roentgen therapy, telecobalt therapy, 192Ir curietherapy. Chemotherapy was used in 2 metastatic patients only. Four patients are alive and free of disease and 4 are dead; 3 of the living patients have been followed 3-26 months. The high risk of radiation damage (1 necrosis, 2 giant edemas, 1 severe fibrosis) recommends that large fields and high single and/or total radiation doses be avoided. In conclusion, surgery is diagnostic but not curative on account of the high risk of recurrence; radiotherapy is important because Merkel cell carcinomas are very radiosensitive. Due to easy lymphatic spread of this type of cancer, radiotherapy must include the regional lymph nodes (dose: 40-50 Gy). The role of chemotherapy is still to be assessed but many antiblastic drugs are effective.

[Cranial irradiation in acute lymphoblastic leukaemia (author's transl)]

Recent literature is reviewed an 48 personal cases of cranial irradiation in treating acute lymphoblastic leukaemia in infancy are reported.