Venous sonography offers a reliable, noninvasive way of diagnosing deep venous thrombosis in the lower extremity, a condition with a potentially fatal consequence. It is possible that sonography may underestimate the degree of involvement of the veins. However this is not usually of clinical concern since systemic heparin therapy will be given regardless of the extent of the clot.
To summarize, patients with the "beer potomania" syndrome are characterized by 1) a history of chronic alcohol ingestion (in a hypotonic form); 2) protein malnutrition; 3) signs, symptoms and laboratory values consistent with water intoxication, including hyponatraemia, hypochloraemia and, usually, hypokalaemia; 4) no evidence of another cause of hyponatraemia such as steroid use, diuretic use, hyperlipidaemia, etc. The pathophysiology involves the inability to excrete sufficient free water, based on a loss of normal renal urea gradients. Patients may actually be total-body sodium depleted, yet have elevated urinary sodium and fractional sodium excretion due to this disorder of water metabolism. Attention to proper nutrition during the acute illness may obviate the need for potentially hazardous administration of hypertonic saline.
Since its inception five years ago, The Medical Society of Virginia's Impaired Physician Program has evaluated 140 physicians. Of these, 60 have completed treatment and aftercare monitoring, and 80 are being followed. Who are these physicians? the Editors asked Dr. David G. Fluharty, Jr., the program's medical director. What are they like? How about some case reports? The program's confidentiality prevented him from divulging any identifying information, Dr. Fluharty replied. He could say, however, that within the Virginia program's experience, impaired physicians fall into two distinct age groups. About a quarter of them are 28 years old +/- a few years; these younger doctors usually are dysfunctional due to "hard" drugs. The remaining three-quarters are 42 years old +/- a few years; in this group impairment is due most often to alcoholism. As for case reports, Dr. Fluharty continued, the program's compelling experience is that one case is pretty much like another, so similar are the historical patterns of birth, background, and behavior. To illustrate, he drew the following composite picture of an impaired physician in the larger, older, alcoholic group.
New pathologic techniques are improving the ability to detect malignancy and determine treatment modes. With immunohistochemistry the pathologist can make important distinctions, such as differentiating between carcinomas and lymphomas. With the flow cytometer various cell parameters and fluorescent labels can be measured. Still investigational are techniques for the detection of activated oncogenes and early viral infections.
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