Chronic medical problems

The problems of alcohol dependence and alcoholism are dealt with in Chapter 10. Suffice it to say here that problem drinkers risk numerous psychological problems, such as anxiety and depression, and may experience physical withdrawal symptoms. There are also numerous medical problems related to heavy, chronic alcohol consumption these include increased risk of coronary heart disease, liver cirrhosis, impotence and infertility, cancer and stroke (Chapter 10). It is estimated that alcohol plays a part in up to 33,000 deaths per year in the UK (DoH, 2001). Within the last year 1 in 4 adults will have experienced loss of memory following an alcoholic binge, injured themselves or... 

Any life has problems. Any relationship has problems. If your spouse comes down with a medically recognized chronic illness, dealing with chronic medical problems becomes a part of the relationship... 

It is claimed that chronic deficiency of arachidonic acid can lead to a number of medical problems that can be overcome by supplementation of a normal diet with evening primrose oil. Supplementation is claimed to lead to an alleviation of eczema reduction in premenstrual tension and breast pain during menstruation improvement in some chronic inflammatory and autoimmune diseases reduction in blood pressure in hypertensive patients and reduction in blood cholesterol levels. As might be expected, these claims are controversial, but they serve to illustrate how basic biochemical information can lead to a considerable lay interest in a subject. 

Only one report of human death attributed to 1,4-dichlorobenzene exposure has been located in the literature. A 60-year-old man and his wife died within months of each other due to acute yellow atrophy of the liver (also known as massive hepatic necrosis or fulminant hepatitis) (Cotter 1953). Their home had been "saturated" with 1,4-dichlorobenzene mothball vapor for a period of about 3-4 months, but no air measurements were available. Clinical symptoms included severe headache, diarrhea, numbness, clumsiness, slurred speech, weight loss (50 pounds in 3 months in the case of the husband), and jaundice. The wife died within a year of the initial exposure however, it was not clear if 1,4-dichlorobenzene was the primary cause of death. This case study did not address whether these individuals consumed excessive amounts of alcohol or had previous medical problems, such as a chronic liver infection. 

Hyperuricemia-associated medical problems are clinical manifestations of gout by recurrent attacks of inflammatory arthritis, chronic tophaceous gout, uric acid urolithiasis, renal impairment, end stage renal disease and early mortality. These manifestations... 

Pharmaceutical therapy of acute arthritis of crystal-deposition disease is effective, in particular for gout and hyperuricemia. Treatment is directed towards termination of acute arthritis, prevention of recurring attacks and prophylaxis and reversal of complications of chronic gout. Such complications include tophi, urolithiasis, nephropathy and with hyperuricemia associated medical problems that can be prevented, inhibited, and sometimes reversed. 

Chronic dysthymia followed by major depressive disorder ( double depression ) Prompt relapse following prior treatment discontinuation Strong positive family history of recurrent mood disorders Coexisting medical problems or complication of aging that would make a future episode hazardous... 

Chronic medical problems, such as asthma, may become uncontrolled.30... 

The scope of the medical problems which require the use of anticoagulant drugs cannot be overstated. Arterial thrombosis is a major contributor to the number one (acute myocardial infarction), number three (stroke) and number four (renal) causes of death in the United States (1J. Venous thromboembolism is the most common non-surgical cause of death in patients hospitalized for major orthopedic procedures, the most frequent non-obstetrical cause of postpartum death, and a major cause of death in patients with chronic cardiac and pulmonary disease (1 ). Venous thrombosis is estimated to lead to the hospitalization of approximately... 

A second difficulty raised by mandatory vaccination requirements is that some individuals may react adversely to vaccinations, particularly individuals who have other health conditions or who are taking medications for chronic illnesses. States often recognize this problem and provide exceptions to their mandatory vaccination laws for those who are susceptible to adverse reactions. These provisions vary from state to state. The proposed MSEHPA contains a provision that requires the vaccination must not be such as is reasonably likely to lead to serious harm to the affected individual (MSEHPA, 2002, 603(a)). 

Acute renal insufficiency has been reported after the use of rofecoxib in patients with predisposing conditions, such as chronic renal insufficiency, renal transplantation, heart disease, liver cirrhosis, and dehydration (2-5). COX-2 inhibitors should be used with great caution, if at all, in patients with medical problems that are associated with prostaglandin-depen-dent renal function. From this point of view they do not differ from traditional NSAIDs (6). 

Chronic heavy use of alcohol can lead to physical dependence on it. The alcohol withdrawal syndrome is a serious medical problem that can result in death if not treated properly. 

Because of the bewildering variety of substances associated with inhalant abuse, it is difficult to characterize the hazards completely. A number of deaths have been due to cardiovascular collapse or suffocation related to the inhalation of butane, toluene, and gasoline (Cairney, Maruff, Burns, Currie, 2002 Garriott, 1992). Chronic use of inhalants has been linked to a variety of medical problems, including psychotic behavior, movement disorders, kidney failure, and damage to the brain s cortex and cerebellum (Cairney et al., 2002 Cairney, Maruff, Burns, Currie, Currie, 2005). 

As most of the harmful effects of inhalant abuse are not felt immediately, chronic abuse of inhalants is associated with a variety of medical problems with a real risk of death. There are a number of solvents that have become the target for abuse. A great number of them are known to be toxic (see Table 1). 

Zinc is an essential trace element and is commonly ingested as a nutritional supplement. Divalent zinc is one of the most important of the micronutrients. More than 100 enzymes are zinc dependent for example, carboxypeptidase, carbonic anhydrase (which is responsible for the exchange of carbonic acid in the blood and the exhalation of carbon dioxide), and the alcohol dehydrogenase (which metabolizes alcohol). Deficiency of zinc, especially in newborns, results in impaired growth, loss of hair, skin eruptions, and often impaired or delayed sexual maturation. Many medical problems are also associated with zinc deficiencies (e.g., ulcerative colitis, chronic renal disease, and anemia). 

Patients with lung cancer frequently have numerous concurrent medical problems. Such problems may be related to invasion of the primary tumor and its metastases, paraneoplastic syndromes (see clinical presentation, above), chemotherapy and radiotherapy toxicity, or concomitant disease states (e.g., cardiac disease, renal dysfunction, chronic obstructive pulmonary disease, asthma, or diabetes). Depression is also common and sometimes persistent in patients with SCLC and NSCLC and should be treated. Identification, diagnosis, and treatment of the patient as a whole may improve the patient s overall quality of life and tolerance to cancer treatments. 

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