Faculty Bibliography

The alcohol withdrawal syndrome is common in elderly individuals who are alcohol dependent and who decrease or stop their alcohol intake. While there have been few clinical studies to directly support or refute the hypothesis that withdrawal symptom severity, delirium and seizures increase with advancing age, several observational studies suggest that adverse functional and cognitive complications during alcohol withdrawal do occur more frequently in elderly patients. Most elderly patients with alcohol withdrawal symptoms should be considered for admission to an inpatient setting for supportive care and management. However, elderly patients with adequate social support and without significant withdrawal symptoms at presentation, comorbid illness or past history of complicated withdrawal may be suitable for outpatient management. Although over 100 drugs have been described for alcohol withdrawal treatment, there have been no studies assessing the efficacy of these drugs specifically in elderly patients. Studies in younger patients support benzodiazepines as the most efficacious therapy for reducing withdrawal symptoms and the incidence of delirium and seizure. While short-acting benzodiazepines, such as oxazepam and lorazepam, may be appropriate for elderly patients given the risk for excessive sedation from long-acting benzodiazepines, they may be less effective in preventing seizures and more prone to produce discontinuation symptoms if not tapered properly. To ensure appropriate benzodiazepine treatment, dose and frequency should be individualised with frequent monitoring, and based on validated alcohol withdrawal severity measures. Selected patients who have a history of severe or complicated withdrawal symptoms may benefit from a fixed schedule of benzodiazepine provided that medication is held for sedation. beta-Blockers, clonidine, carbamazepine and haloperidol may be used as adjunctive agents to treat symptoms not controlled by benzodiazepines. Lastly, the age of the patient should not deter clinicians from helping the patient achieve successful alcohol treatment and rehabilitation.

It is important for people to stay active and get plenty of exercise. However, one must not push oneself too hard. There is a significant difference between "good" and "bad" pain

Transplant surgeons who once concentrated on vital organs like hearts, livers and kidneys are branching out, transplanting an array of body parts with surprising success, and possibly heralding a day when tissues not essential to life are routinely given to others. To the astonishment of many experts, the two men recently given new hands in Lyon, France, and Louisville, Ky., are progressing well, without rejection crises. With less publicity, surgeons elsewhere have successfully performed experimental knee, larynx, trachea, femur, nerve and muscle transplants. Still, as word of the early successes spreads, doctors are beginning to stretch their imaginations. Leading transplant surgeons envision a future where they can put new faces on burn patients; give a woman new breasts, or even a uterus; transplant penises; and reconstruct jaws and neck tissues for patients with cancer, gunshot wounds, dog bites or accident injuries

Smallpox, the ancient disease, was eradicated 20 years ago. Smallpox, the virus, is on death row, frozen in two highly protected laboratories in the United States and Russia. Like lawyers filing last-minute briefs, scientists have come up with new arguments for reprieve. Until Russia's secret stores were exposed, scientists elsewhere had virtually abandoned smallpox research. But now scientific leaders in the United States, Russia, and elsewhere have begun to seriously question why WHO should insist on destroying a virus that might still exist secretly in other countries. The most compelling reason for keeping variola is to discover potentially lifesaving drugs in case the virus ever reappears, either naturally or as an act of war. Few potential anti-variola drugs exist, and scientists are handicapped in developing new ones because the virus naturally infects only humans and by lack of an animal model for drug tests

For example, research using the virus might yield drugs against the disease, or improved vaccines to prevent it. These would be of no use, in effect, unless some rogue nation unleashed hidden stores of smallpox virus in a biological terror attack, a prospect no longer regarded as outlandish. Or use of new techniques might decipher some of smallpox's distinctive features, providing clues to help fight other diseases. But attitudes began to change in recent years when a shocked world learned that Russia had secretly stockpiled tons of smallpox virus and manipulated it for use as a possible weapon. During that period, Moscow supported the disease's eradication. North Korea and other countries are believed to have clandestine supplies of smallpox virus as well. ''The sense was that it was out of our hands, that it was a done deal between W.H.O. and the C.D.C.,'' said Dr. Ronald Luftig of Louisiana State University, referring to the World Health Organization and the Centers for Disease Control and Prevention in Atlanta. Dr. Luftig is an official of the American Society for Virology and American Society for Microbiology, both of which officially support destruction of variola

Thanks to scientific research with heroin and cocaine addiction, a new concept of alcoholism treatment is evolving

Prompted by fears of a new outbreak of one of the world\'s deadliest scourges, the World Health Assembly in Geneva effectively decided yesterday to defer eradicating the world\'s known remaining stocks of the smallpox virus until at least 2002. While virtually all member states said they remained committed to the elimination of the smallpox stocks as soon as possible, the action taken by a key committee acting on consensus, without a formal vote, reflected widespread agreement that more time is needed to study smallpox before it is irrevocably destroyed. The decision reflects a major shift in scientific thinking about the virus since 1996, when the Assembly decided it should be destroyed at the end of June 1999. It highlighted the existence of increasingly rare political common ground between the United States and Russia, the two remaining repositories of the deadly stocks. Both Washington and Moscow have publicly opposed eradication of the virus, at least until more research is done