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anaging a patient with chronic alcohol abuse who is beginning to withdraw is a situation in which to expect the unexpected. A 61-year-old man with a 40-year history of alcohol abuse was admitted to the hospital after presenting with a 6-month history of weakness and increasing frequency of falls, as well as a 2-day history of myalgias and fatigue. He had anorexia and chronic diarrhea, and he reported an unintentional 100-lb weight loss over the past year. He consumed at least three to five alcoholic drinks daily, including a daily “eye-opener,” and his diet was essentially devoid of meat, bread, fruits, and vegetables. His last drink had been on the morning of admission. On physical examination, his vital signs were no-table for marked orthostatic hypotension. He had an-gular cheilitis, an erythematous, scaly facial rash, and poorly healing severe sunburn on the dorsal surface of the left forearm, acquired 1 month earlier after mini-mal sun exposure while driving his car (

To evaluate Gd-DTPA contrast enhancement of brain tumors over time and to describe the dispersion of contrast into the zone of peritumoral edema. We performed MR imaging with a dose of 0.4 mmol Gd-DTPA/kg on eleven patients diagnosed with 5 different supratentorial tumors. MR imaging was done at five intervals between 5 min and 6 h. The change in zone of enhancement was measured for each time point, and a linear measurement was made of the furthest dispersion of contrast from the original volume of enhancement. An increase in the zone of enhancement over time was seen for all tumors; the average increase in volume of contrast was 14.76 +/- 3.35 cm(3) (mean +/- standard deviation). The largest changes in the zone of contrast enhancement, 18.6 +/- 4.63 cm(3), were seen in glioblastoma multiforme. The expansion of contrast enhancement assumed the morphology of the surrounding edema. The dispersion of Gd-DTPA over time into the zone of peritumoral edema is a potential source of error in clinical settings when there is a delay between Gd-DTPA injection and scanning.

Objectives: To describe the impacts of Virginia AIDS Drug Assistance Program’s elimination of diabetes and hyperlipidemia medication on disease outcomes in people living with HIV. Methods: Data were collected on two groups of people living with HIV who were prescribed medications for diabetes and/or hyperlipidemia; one group received medications from AIDS Drug Assistance Program (ADAP) and the other group received medications from another source. Data were collected for 13 months before and after the policy change. Diabetes, hyperlipidemia, and HIV control were compared using standard laboratory measures. Results: During the pre-policy-change time period, non-ADAP patients had better diabetes control than ADAP patients, but with multivariate analysis, ADAP status was no longer a statistically significant predictor. Otherwise, no significant differences between groups were identified. Discussion: ADAP patients had worse diabetes control compared to the non-ADAP group before the policy change. It is possible that this is due to the AIDS Drug Assistance Program population’s poor access to non-HIV primary care, including care for diabetes. It is reassuring that, even during a time of flux in AIDS Drug Assistance Program resources, the AIDS Drug Assistance Program patients’ co-morbid and HIV outcomes were not negatively impacted.

A study of sediment alteration on the west flank of the West Hackberry dome, Louisiana Gulf Coast, has documented the existence of ∼5 x 10 10 kg of authigenic calcite-pyrite cement in Miocene sands at depths of 1.4 to 2.1 km in a 1.5 by 1.5 km area adjacent to the dome. The Sr, C, and S isotopic compositions of the cements support the hypothesis that Ca and S were derived from dissolution of salt-dome anhydrite and that carbonate was derived by thermochemical oxidation of methane and by sulfate reduction, possibly at temperatures as low as 70 °C. Constraints on the maximum aqueous concentrations of Ca that could be produced by dissolving diapiric salt require that >5 x 10 9 m 3 of aqueous fluid, equivalent to a fluid volume/ pore volume ratio of >250:1, were involved in destroying salt, transporting Ca and SO 4 , and precipitating these cements. The presence of such cements requires a dynamic subsurface mass-transport regime involving either large volumes of fluid or fluids that are extensively recirculated.

Whereas calcite and sulfide cements have been previously documented by other workers in shallow cap rock above salt domes, recent studies in the Louisiana Gulf of Mexico Coast, U.S.A., demonstrate the presence of additional pervasive carbonate and sulfide cements in deep sedimentary strata along the margins of some salt domes. Miocene sediments along the southwest flank of the West Hackberry salt dome in southwest Louisiana, for example, are cemented by calcite, pyrite and pyrrhotite over the depth range of 1.4–2.1 km. Textural evidence indicates the sands were initially cemented by calcite and then by iron sulfides which aggressively replaced both calcite cement and silicate framework grains. Carbon isotopic composition of the calcites document derivation from a methane reservoir. Sr isotopic data suggest the calcite precipitated during burial and is not derived directly from Miocene seawater or coeval carbonates. The spatial distribution of the calcite cements can be determined by the high resistivity response of these zones on geophysical logs. The relative thickness of cemented sands decreases away from the dome, and the cement occurs preferentially in the basal portion of individual sand units in more sparsely cemented sequences. The systematic distribution of cemented sands with respect to the salt diapir suggests the presence of this structure may have controlled paleohydrology and thus the cementation patterns.