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Heat shock is the consequence of malignant hyperthermia triggered by general anaesthesia, the use of neuroleptic drugs, or strenuous muscular exercise. Chronic alcoholism could be a contributing factor by facilitating the triggering of malignant hyperthermia. We describe two cases of malignant hyperthermia which occurred during the summer in undernourished chronic alcoholics showing withdrawal syndrome during their stay in hospital. General anaesthesia and neuroleptics were excluded as the origin of their malignant hyperthermia, and we looked for new mechanisms to explain the heat shock, other than shivering associated with the withdrawal syndrome or the high temperature of the season. These two patients were considered deficient in thiamine on admission, their plasma pyruvic acid level being sharply increased (185 mumol/l and 304 mumol/l respectively; normal range: 45.6-91.2 mumol/l). This deficiency can lead to disregulation of thermal centres. Other metabolic disorders, frequently observed in alcoholics, could facilitate heat release during withdrawal syndrome shivering. The risk of heat shock during abrupt alcohol withdrawal should not be underestimated.

Obstructive hypertrophic cardiomyopathy is a complex pathology. The understanding of its physiopathology and, notably, of the SAM phenomenon (Systolic Anterior Motion), is crucial for all available treatments. Amongst the most efficient therapies, one can cite the septal myectomy and its most recent technical updates, as well as the alcohol septal ablation. The choice between these two methods depends on the general state of the patient, the thickness of the interventricular septum and the coronary anatomy of the patients.

The aim of study was to assess the role of hepatitis C virus (HCV) infection in 164 alcoholic cirrhotic patients. We studied the prevalence of anti-HCV antibodies using ELISA and RIBA first and second generation tests. Twenty-two % of the patients had anti-HCV antibodies detected by ELISA 2, RIBA 2 test was positive in 10% of the patients and indeterminate in 3%. We compared epidemiological, biological and histological characteristics according to the results of the tests. By comparing ELISA 2-RIBA 2 positive patients to ELISA 2 negative patients, we observed, in the former, a) a higher serum aminotransferase activity, b) a lower serum gammaglutamyl transpeptidase activity, and c) a lower histological score of alcoholic hepatitis. In addition, in a group of ELISA 2 positive RIBA 2 negative patients, the values were intermediate between those of the two former groups. However, most of these patients had a negative third generation ELISA test. The whole results suggest that HCV is likely to play a role in the pathogenesis of liver damage in a high number of alcoholic cirrhotic patients.

Using a standard test (sherry 40 ml 12 hours and 36 hours after 250 mg chlorpropamide), chlorpropamide-alcohol flush (CPAF) prevalence was 34 p. 100 (19/56) in non insulin-dependent diabetics (NIDD), 10 p. 100 (3/30) in insulin-dependent diabetics and 7 p. 100 (2/27) in controls. Family history of diabetes was not associated with CPAF trait. Conflicting results in the literature might be explained by bias in patients selection or methodology.

After its modest beginnings focusing on arctic Quebec in 1999, the Quebec research programme on health and climate change became interested in the remainder of the province around 2002. The European heat wave in 2003 accelerated the pace of this programme and prompted the Quebec health sector's participation in the Ouranos Research Consortium. The research findings from the 2003-2006 period have directly fed into the health component of the Quebec government's climate change action plan (2006-2012), financed through the first carbon tax in the Americas. This component is planning for a series of adaptations to the health network and to some other public networks, which will apply to construction, the built environment and outdoor developments, clinical management methods and practices, public health surveillance as well as emergency preparedness. In this article, the authors describe how research is supporting action and implementation, while also preparing for the future, and how this interaction has progressively established itself over the last 10 years.

A resolving form of Marchiafava-Bignami disease is reported. This patient with a history of chronic alcoholism was hospitalised for a recent demential syndrome. Clinical examination did not show any signs of interhemispheric disconnection LP and EEG were normal. CT examination showed a low density area in the corpus callosum without any other anomaly. MRI examination confirmed the cystic area of the corpus callosum. The Marchiafava-Bignami disease was easily suggested on the basis imaging and clinical signs. Interhemispheric disconnection is not always found so MRI and CT examinations seem to be very useful tools for early diagnosis of Marchiafava-Bignami in the same way as neuropsychological tests.

The effect of antidepressants cannot be explained by the classical monoaminergic theory. In particular, that model does not explain the delay in clinical response with antidepressants. Many hypotheses have been developed to understand the mechanism of action of antidepressants, each of them involving the regulation of different receptors. In parallel, functional brain imaging and neurobiological techniques have revealed specific neuroanatomical lesions in affective disorders. Depression in particular is associated with a neuronal loss in specific brain regions. These anatomical changes are reduced after antidepressant treatment. In the last decade, a new pathophysiological concept of affective disorders has emerged, integrating preferentially molecular and cellular antidepressant-induced changes leading to rehabilitation of synaptic activity. In the present review, we will summarize recent crucial data that establish the link between depression and neuroplasticity.

The alcohol misuse is associated with a wide range of medical and social problems. This is why it is very important to detect early-stages alcohol misuse. The early detection and the diagnosis of chronic alcohol consumption require simple to use, relevant tools. Alcoholisation behaviours are classified according to 5 categories: no use, use, and three types of misuse, at risk drinking, abuse or harmful drinking, and dependence. This screening of early-stage alcohol misuse is at first based on the clinical interview with the patient. It evaluates the alcohol consumption reported by the patient, specially the number of drinking days, the number of drinks per drinking day, the lapses, the type of alcoholic drinks, the way of drinking, and the events that influence it. Screening questionnaires can be usefull: CAGE and especially AUDIT. They can be used as auto-questionnaires. Three biological markers can be helpful to detect chronic alcohol consumption: GGT, MCV and CDT.

Various indications of benzodiazepines in the treatment of chronic alcoholism are discussed. They are prescribed in the treatment of Delirium Tremens and other acute withdrawal syndromes, often by intramuscular injections or intraveinous infusions. Their efficacy is particularly marked on withdrawal seizures, agitation, more inconstant on confusion, hallucinations and even on tremor symptoms. They more prevent withdrawal symptoms than they reverse severe ethanol withdrawal symptomatology, on humans like on experimental animals. Most authors recommend short prescriptions of BZD in alcoholic patients: the main difficulty is not the problem of the pharmacological interactions between alcohol and BZD, only observed during acute and important ingestions of alcohol and more linked to summation than to potentialisation , but the risk of an abuse and even a psychological and physical dependency to BZD. Such a dependence syndrome would probably develop more frequently in alcoholic patients. One must not overrate its importance; the extended prescription of BZD must not be therefore prohibited when they seem useful in the maintain of alcohol abstinence.

We report here the long term follow-up of the first french case, at our knowledge, of alcohol septal transcoronary ablation in March 1998 in Clinique Ambroise Paré in an 76 year-old woman. This patient was in NYHA III-IV functional class and at control outflow gradient was 100 mmHg. She was prior treated with high dosis of beta-blockers then DDD-pacemaker with no effects on symptoms. The technique used was the one described by Sigwart and al., with injection of 3 cm3 of ethyl alcohol in the first septal branch, after checking decrease of gradient during occlusion of septal branche with balloon angioplasty. After alcohol ablation, the gradient decreased immediately to 15 mmHg and disappeared at long-term follow up. Three years and half after the procedure, no complication occurred, the patient remains asymptomatic and the control echocardiography shows interventricular septal reduction of thickness from 22 to 12 mm.