Emphysematous gastritis is a rare disease characterized by air in the wall of the stomach due to gas-forming microorganisms. This lethal entity was first described by Fraenkel in 1889. Forty-six cases have been reported so far in the literature. The predisposing factors include corrosive ingestion, immunocompromized state, alcohol abuse, cancer, diabetes and so on. Computed tomography is the procedure of choice for early diagnosis. Only prompt diagnosis and treatment can avoid mortality. Initial antibiotic therapy should cover gram-negative organisms and anaerobes. We report a case of emphysematous gastritis in a 41-year-old man with Klatskin's tumor.
Adult ; Alcoholism ; Causality ; Diagnosis ; Early Diagnosis ; Eating ; Gastritis* ; Humans ; Klatskin's Tumor* ; Mortality ; Rare Diseases ; Stomach

Alcohol abuse is related to a wide variety of medical complications including liver diseases, pancreatitis, cardiovascular diseases, immunological abnormalities, malignant neoplasms, endocrine disturbances, and kidney problems. The liver is the organ most severely affected by alcoholism. Alcoholic liver disease (ALD) remains a major cause of morbidity and mortality in Korea. The mainstay of therapy for alcohol-related medical problems is cessation of drinking. This article summarizes alcohol-related medical complications and treatment with focus on alcoholic liver injury.
Alcoholics ; Alcoholism* ; Cardiovascular Diseases ; Drinking ; Humans ; Kidney ; Korea ; Liver ; Liver Diseases ; Liver Diseases, Alcoholic ; Mortality ; Pancreatitis

BACKGROUND: Community-acquired pneumonia(CAP) remains a leading cause of morbidity and mortality worldwide. Recently, the evolution of drug-resistant microorganisms has become a serious problem in CAP management. Specific antimicrobial therapy is the cornerstone of CAP management. However, obtaining an accurate etiologic diagnosis clinically is not easy and empirical antimicrobial treatment is usually administered prior to the correct microbiologic diagnosis. In this study, the clinical usefulness of empirical CAP treatment was investigated. METHODS: A total 35 cases were studied prospectively over a 16-month period in Mokpo Catholic Hospital from Dec. 1995 to Mar. 1997. The microbiologic diagnosis was made by sputum, blood culture, a specific serum antibody test and an immunologic study. RESULTS: The causative organisms were isolated in 10 (30%) out of 33 cases: 8 cases and 1 case on the sputum culture and blood culture respectively, and 1 case by an indirect hemagglutinin test. 12 cases had underlying diseases: pulmonary tuberculosis 4, alcoholism 4, diabetes mellitus 3, and liver cirrhosis 1. Antimicrobial treatment was given empirically and all cases recovered. CONCLUSION: A definite microbiologic diagnosis before commencing the appropriate treatment in CAP is not straightforward. Empirical therapy according to a clinical assessment is important and helpful. However, every effort to make the correct etiologic diagnosis should be taken.
Alcoholism ; Diabetes Mellitus ; Diagnosis ; Hemagglutinins ; Jeollanam-do* ; Liver Cirrhosis ; Mortality ; Pneumonia* ; Prospective Studies ; Sputum ; Tuberculosis, Pulmonary

Fournier's gangrene is a rare infection with high mortality rate. it consists of a mixed bacterial infectin of the skin, subcutaneous tissues and superficial fascia of the perinium and genitalia. Old patients especially with diabetes mellitus, alcoholism and maligancy are more affected. This disease requires prompt treatment: early diagnosis, broad spectrum antibiotic therapy, nutritional support and immediate extensive surgial debridement are necessary We report one case of Fournier's gangrene associated with diabetes mellitus.
Alcoholism ; Debridement ; Diabetes Mellitus ; Early Diagnosis ; Fournier Gangrene* ; Genitalia ; Humans ; Mortality ; Nutritional Support ; Skin ; Subcutaneous Tissue

OBJECTIVES: Alcohol withdrawal delirium is a serious clinical condition with high mortality rate if not treated. This study was to examine whether readily available clinical variables can predict the development of alcohol withdrawal delirium. METHODS: The authors performed a retrospective study by reviewing charts of 566 patients who had been admitted for alcohol dependence. The cases were divided into two groups: delirium group (n=40) and control group (n=40). We compared baseline characteristics and serum analysis data at admission between two groups. We used logistic regression to predict risk factors for alcohol withdrawal delirium among potential risk factors. RESULTS: The delirium group had significantly lower hemoglobin, hematocrit, platelet counts, and potassium level than countrol group. Presence of previous withdrawal delirium history, AST, GGTP, and bilirubin level of delirium group were significantly higher than those of control group. Among potential risk factors, past history of withdrawal delirium, decreased hemoglobin, elevated bilirubin level, and number of previous detoxification were predictable factors of the development of alcohol withdrawal delirium by 72.5%. CONCLUSION: Our results suggest that the infomation obtained at admission can be useful to predict the development of alcohol withdrawal delirium. Also, it makes the individualization of detoxification strategies possible.
Alcohol Withdrawal Delirium* ; Alcoholism ; Bilirubin ; Delirium ; gamma-Glutamyltransferase ; Hematocrit ; Humans ; Logistic Models ; Mortality ; Platelet Count ; Potassium ; Retrospective Studies ; Risk Factors

OBJECTIVES: Alcohol withdrawal delirium is a serious clinical condition with high mortality rate if not treated. This study was to examine whether readily available clinical variables can predict the development of alcohol withdrawal delirium. METHODS: The authors performed a retrospective study by reviewing charts of 566 patients who had been admitted for alcohol dependence. The cases were divided into two groups: delirium group (n=40) and control group (n=40). We compared baseline characteristics and serum analysis data at admission between two groups. We used logistic regression to predict risk factors for alcohol withdrawal delirium among potential risk factors. RESULTS: The delirium group had significantly lower hemoglobin, hematocrit, platelet counts, and potassium level than countrol group. Presence of previous withdrawal delirium history, AST, GGTP, and bilirubin level of delirium group were significantly higher than those of control group. Among potential risk factors, past history of withdrawal delirium, decreased hemoglobin, elevated bilirubin level, and number of previous detoxification were predictable factors of the development of alcohol withdrawal delirium by 72.5%. CONCLUSION: Our results suggest that the infomation obtained at admission can be useful to predict the development of alcohol withdrawal delirium. Also, it makes the individualization of detoxification strategies possible.
Alcohol Withdrawal Delirium* ; Alcoholism ; Bilirubin ; Delirium ; gamma-Glutamyltransferase ; Hematocrit ; Humans ; Logistic Models ; Mortality ; Platelet Count ; Potassium ; Retrospective Studies ; Risk Factors

Chylous effusion is an unusual complication of malignant neoplasm, usually lymphoma. In cases with cancer, the tumor was usually extensive, and the prognosis was invariably poor with a one year mortality rate of 80%. It was also reported that chylous effusion could also result from liver cirrhosis. The incidence of this complication was reported to be 0.5% in patients with liver cirrhosis and ascites. Here we report a case of 62 year old male with chronic alcoholism history who presented with abdom-inal distension and right cervical mass. He was subsequently diagnosed as non-Hodgkin's lymphoma and chylous ascites with liver cirrhosis and treated with chemotherapy. In spite of treatment, lymphoma progressed and the patient expired.
Alcoholism ; Ascites ; Chylous Ascites* ; Drug Therapy ; Humans ; Incidence ; Liver Cirrhosis* ; Liver* ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Male ; Middle Aged ; Mortality ; Prognosis

Adult ; Alcoholism ; epidemiology ; Biopsy ; Female ; Follow-Up Studies ; Humans ; Liver Cirrhosis ; epidemiology ; Male ; Middle Aged ; Mortality ; Singapore

PURPOSE: The most common cause of acute pancreatitis is alcohol abuse, followed by gallstones and pancreatic trauma. Pancreatitis is treated nonoperatively by inhibiting the causes, which include prohibition of alcohol abuse and cholecystectomy for the removal of gallstones. However, in case of a pseudocyst formation, necrotizing pancreatitis or abscesses remained as the complications of severe pancreatitis. Adequate surgical drainage is very important for the treatment of the complications. Adequate surgical procedure for treatment of chronic pancreatitis, causing intractable pain, pseudocyst, and obstruction of pancreatic or bile ducts, should be considered, not only for the patients physical and psychological recovery from a chronically debilitating status, but also in its differentiation from a malignancy. METHODS: Between July 1997 and January 2002, a review and analysis was undertaken of 33 pancreatitis patients, who had been treated, by surgical intervention, for the complications of acute pancreatitis, chronic pancreatitis, and benign pancreatic disease. RESULTS: For the treatment of the various complications in the 33 patients, 20 drainage procedures and 13 surgical resections were used. There were minor complications in 6 patients (21%), and two mortalities, one from multiple organ failure, due to necrotizing pancreatitis, and the other from a surgical complication, due to a duodenum preserving pancreatic head resection. CONCLUSION: The timely surgical drainage, and/or debridement, is critical for patients with complications due to acute pancreatitis. It is difficult to differentiate chronic pancreatitis from a malignancy. Adequate surgical procedures for the different stati ('type oriented surgery') are required for chronic pancreatitis. A resection of cystic lesions, with the possibility of a malignancy, should be considered. We can confirm the diagnosis, and treat the disease, by adequate operative and drainage procedures, or by resection of the main lesion.
Abscess ; Alcoholism ; Bile Ducts ; Cholecystectomy ; Debridement ; Diagnosis ; Drainage ; Duodenum ; Gallstones ; Head ; Humans ; Mortality ; Multiple Organ Failure ; Pain, Intractable ; Pancreatic Diseases ; Pancreatitis* ; Pancreatitis, Chronic

Purpose: The mortality of patients with Fournier's gangrene remains at 15-50%, despite the improvement in critical care, the liberal use of broad spectrum antibiotics and the emphasis on aggressive surgical debridement. Therefore, the factors impacting on the survival and necessity for aggressive management were evaluated by comparing the medical records of survivors and non-survivors of Fournier's gangrene. Material and Methods: The medical records of 20 patients with Fournier's gangrene treated over a 12-year period were reviewed. The patients' ages ranged between 20 and 90 years (mean 55). The predisposing factors and extended surface area of necrosis were analysed by outcome. The number of surgical debridements and their timing, with respect to initial presentation and diversions, were analysed according to the extended surface area (3%). The outcome of the surgical treatments of patients with fever or sepsis at the time of the initial hospital visit was analyzed. Results: The predisposing factors included diabetes mellitus (10 cases, 50%), general weakness (7 cases, 35%), alcohol abuse (5 cases, 25%), malignant disease (3 cases, 15%) and hemiplegia (2 cases, 10%). Of the 20 patients, 3 (15%) died and 17 (85%) survived. One patient died due to septic shock before undergoing surgical debridement. The mean surface area involved with the disease among the survivors and non survivors were 3.6 and 3.7%, respectively. The patients with an extended surface below 3% (n=10) had 1.5 times the mean number of debridements. Of these, diversion was performed in one patient, three patients had complications and one patient died. The patients with an extended surface over 3% (n=9) had 2.3 times the mean number of debridements. Of these, five patient was performed diversion, tree patients had complication and one patient died. Of the 11 patient with fever or sepsis, 2 that did not undergone first debridement within 24hr of presentation died. However, all the patients who underwent first debridement within 24hr of presentation survived. Conclusions: The patient's physiological status influenced by the predisposing factors played the important role in the outcome. With aggressive treatment, including early and repeat surgical intervention and diversion, the disease has a reduced mortality.
Alcoholism ; Anti-Bacterial Agents ; Causality ; Critical Care ; Debridement ; Diabetes Mellitus ; Fever ; Fournier Gangrene* ; Hemiplegia ; Humans ; Medical Records ; Mortality ; Necrosis ; Prognosis ; Sepsis ; Shock, Septic ; Survivors