Since Magnus Huss introduced the diagnosis of ‘chronic alcoholism’ into medical literature in 1849, two unsolved problems concerning classification have remained: (1) Differentiation between problem drinkers and chronic alcoholics fluctuates, whereby the cut point of differentiation between abuse and addiction remains differently defined by different authors. Some authors view alcohol-induced damage as a building-stone of diagnosis of chronic alcoholism whereas other authors define these damages as illnesses developed as a consequence of chronic alcohol intake. This fact is also mirrored in the different definitions of chronic alcoholism by different classification systems, like ICD-9, DMS-III or DMS-III-R. Valid and reliable questionnaires, like the Munich Alcoholism Test or the Problem Drinking Scale did not succeed in solving this problem of definition, either. (2) The fact that chronic alcoholics are sick – in the sense of a biological-medical approach – is undoubted. Our research group was able to prove that chronic alcoholic patients metabolize methanol in a different way from that of healthy persons. The biological, sociological and psychopathological heterogeneity of this illness has been stressed for more than a century. A prospective long-term study carried out over 4–7 years has led to the development of a new typology in chronic alcoholism that is able to differentiate subgroups of chronic alcoholic patients cross-sectionally in a clinical, biochemical and neurophysiological way. Diagnosis according to this typology qualitatively differentiates patients in many spheres other than drinking behavior. These subgroups also require correspondingly modified therapeutic strategies.

Failure of fixation is a common problem in the treatment of osteoporotic fractures around the hip. The reinforcement of bone stock or of fixation of the implant may be a solution. Our study assesses the existing evidence for the use of bone substitutes in the management of these fractures in osteoporotic patients. Relevant publications were retrieved through Medline research and further scrutinised. Of 411 studies identified, 22 met the inclusion criteria, comprising 12 experimental and ten clinical reports. The clinical studies were evaluated with regard to their level of evidence. Only four were prospective and randomised.Polymethylmethacrylate and calcium-phosphate cements increased the primary stability of the implant-bone construct in all experimental and clinical studies, although there was considerable variation in the design of the studies. In randomised, controlled studies, augmentation of intracapsular fractures of the neck of the femur with calcium-phosphate cement was associated with poor long-term results. There was a lack of data on the longterm outcome for trochanteric fractures. Because there were only a few, randomised, controlled studies, there is currently poor evidence for the use of bone cement in the treatment of fractures of the hip.With the steadily increasing proportion of elderly people in the population, osteoporosis, a disease process characterised by compromised bone strength predisposing to an increased risk of fracture, will become epidemic. By 2012, 25% of people living in Europe will be older than 65 years 1 and more than 40% of women and 14% of men over the age of 50 years will sustain osteoporotic fractures.2 Common sites affected by osteoporotic fractures include the wrist, spine, ribs, humerus and the proximal femur.

Histological stage, nephrotic syndrome, and comorbidity predict end-stage renal failure or death in idiopathic membranous nephropathy. Identification of the high-risk group at the time of diagnostic renal biopsy will permit appropriate treatment to be targeted to the patients who might benefit the most from the therapy in future clinical trials.

Results in studies on prognosis and treatment of membranous nephropathy are conflicting. The aim of this investigation was to analyze the methodology of the existing research and to identify sources of these conflicting results. Studies published on prognosis of membranous nephropathy from 1970 to 1995 were identified using a Medline database literature search. The criteria for inclusion in the methodologic analysis were: (1) original article; (2) cohort study or clinical trial with > or = 50 adults; (3) zero time near the diagnostic renal biopsy; and (4) follow-up > or = six months. Ten well-accepted methodologic standards for prognostic research were applied to each study and the compliance was evaluated. Among the 26 studies that met the inclusion criteria, the median number of standards fulfilled was 4 and the highest was 7. The proportion of studies adhering to the individual standards was: (1) adequate diagnostic criteria, 35%; (2) definite end point, 46%; (3) adequate analysis of a surrogate end point, 52%; (4) analysis of baseline severity, 0%; (5) indication of baseline frequency for candidate predictors, 35%; (6) reproducible classification of predictors, 85%; (7) multivariable analysis, 50%; (8) identification of the variables' importance in multivariable analysis, 38%; (9) evaluation of the effect of treatment on predictors, 19%; and (10) adequate analysis of censored patients, 58%. We conclude that basic methodologic principles have frequently been disregarded. The consideration of these standards in future research can improve the interpretability and applicability of results and help reconcile conflict when results are compared among different studies.

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