Robert W. Hillman

Alcoholism and Malnutrition

The patient is an alcoholic; therefore, he is malnourished. This aphorism, while credible and convenient, no longer deserves the deference reserved for traditional stereotypes. As a device for the clinical delineation of the alcoholic, it may have been a useful indicator in the past. However, the classic stereotype of the malnourished, downtrodden alcoholic is no longer entirely functional. In current times the physician, while still mindful of the stereotype, is increasingly aware of his antithesis-obviously well groomed, ostensibly well nourished, and only occasionally a patient. The long-accepted association between malnutrition and alcoholism has been identified chiefly in terms of the local and systematic manifestations that suggest a deficiency state. Hepatic, neuromuscular, cardiovascular, and hematologic disorders especially have served both to establish clinical diagnoses and to elucidate basic metabolic and epidemiologic attributes of this relationship. The principal pathological conditions afflicting the alcoholic, including nutritional aspects, are discussed in depth in separate chapters of this volume.

Sulfhydryl Inhibition as a Mechanism in the Effects of ACTH and Cortisone.

Conclusion Evidence has been presented to suggest that ACTH and cortisone produce their inhibitory action on the skin-spreading effect of the hyaluronidase enzyme system thru the agency of sulfhydryl deprivation. This finding warrants further exploration of enzyme systems known to be inhibited or depressed by the C11-oxygenated adrenal-cortical steroids for sulfhydryl deficiency created by these steroids as a common denominator in the inhibitory effect. The humoral (whole-blood) content of -SH groups after clinically effective therapy with cortisone does not necessarily reflect a sufficiency of this factor in the fixed tissues where its influence on the intracellular enzyme systems would be registered by the functional integrity of these systems.

Oral cytologic patterns in relation to smoking habits: Some epithelial, microfloral, and leukocytic characteristics☆

Papanicolaou smears from the cheeks and tongues of 790 alcoholic patients were evaluted for possible associations between cytologic features and cigarette consumption. The findings appear consonant with the view that microscopic changes are frequent in clinically unremarkable areas of the mouth and that tobacco induces some of the cellular changes to which its use has been clinically and epidemiologically related.

Oral cytologic patterns and nutritional status: Some relationships in alcoholic subjects

Exfoliative cytologic preparations from the cheeks of 790 alcoholic patients were evaluated for relationships between microscopic features and selected indicators of nutritional status. Significant associations were observed between the cell/nucleus ratio, degree of cornification, relative concentrations of leukocytes and microorganisms, and poor dietary patterns, as well as body weight statua and serum albumin and blood hemoglobin levels. Microscopic examination, as an adjunct to gross inspection of the mouth, may be of value in the clinical assessment of nutriture.