Context Observational studies suggest that heavy alcohol consumption may increase the risk of stroke while moderate consumption may decrease the risk.Objective To examine the association between alcohol consumption and relative risk of stroke.Data Sources Studies published in English-language journals were retrieved by searching MEDLINE (1966-April 2002 using Medical Subject Headings alcohol drinking, ethanol, cerebrovascular accident, cerebrovascular disorders, and intracranial embolism and thrombosis and the key word stroke; Dissertation Abstracts Online using the keywords stroke and alcohol; and bibliographies of retrieved articles. Study SelectionFrom 122 relevant retrieved reports, 35 observational studies (cohort or case control) in which total stroke, ischemic stroke, or hemorrhagic (intracerebral or total) stroke was an end point; the relative risk or relative odds and their variance (or data to calculate them) of stroke associated with alcohol consumption were reported; alcohol consumption was quantified; and abstainers served as the reference group.Data Extraction Information on study design, participant characteristics, level of alcohol consumption, stroke outcome, control for potential confounding factors, and risk estimates was abstracted independently by 3 investigators using a standardized protocol. Data SynthesisA random-effects model and meta-regression analysis were used to pool data from individual studies. Compared with abstainers, consumption of more than 60 g of alcohol per day was associated with an increased relative risk of total stroke, 1.64 (95% confidence interval [CI], 1.39-1.93); ischemic stroke, 1.69 (95% CI, 1.34-2.15); and hemorrhagic stroke, 2.18 (95% CI, 1.48-3.20), while consumption of less than 12 g/d was associated with a reduced relative risk of total stroke, 0.83 (95%, CI, 0.75-0.91) and ischemic stroke, 0.80 (95% CI, 0.67-0.96), and consumption of 12 to 24 g/d was associated with a reduced relative risk of ischemic stroke, 0.72 (95%, CI, 0.57-0.91). The meta-regression analysis revealed a significant nonlinear relationship between alcohol consumption and total and ischemic stroke and a linear relationship between alcohol consumption and hemorrhagic stroke. ConclusionsThese results indicate that heavy alcohol consumption increases the relative risk of stroke while light or moderate alcohol consumption may be protective against total and ischemic stroke.

Drug induced pulmonary toxicity is a well documented complication of treatment with cytotoxic agentsbleomycin, methotrexate, cyclophosphamide, and busulphan being most commonly implicated.' This report documents a severe alveolitis associated with administration of procarbazine.Case report A 44 year old man, an ex-smoker, presented with swelling in the neck, increasing fatigue, and night sweats. Supraclavicular lymph node biopsy showed lymphocyte depleted Hodgkin's disease stage IIIB, with hilar, right paratracheal, and para-aortic lymphadenopathy and splenic disease. The haematological and biochemical abnormalities were: erythrocyte sedimentation rate (ESR) 20 mm in one hour, alkaline phosphatase activity 120 IU/I (normal range 20-90 IU/l). Pulmonary function was normal except for a low Kco of 0-9 mmol min-' kPa-' 1-l (predicted normal 1.3-1-8 mmol min-' kPa-I l-l).MOPP chemotherapy was given (mustine 10 mg and vincristine 2 mg intravenously on days 1 and 8, prednisolone 40 mg'and procarbazine 150 mgdaily for 14 days). After an interval of 14 days a second course was given. There appeared to be a good clinical response after completion of the second course but the patient complained of arthralgia in the arms and knees, breathlessness on exertion, and night sweats of a week s duration. A chest radiograph showed a soft mid-zonal infiltrate. The third MOPP course, begun 14 days after the end of the second, contained reduced dosages of mustine (5 mg) and procarbazine (50 mg daily) and on this treatment these symptoms remitted. Twenty four hours after completion of the course, however, arthralgia recurred, and during the follo,wing two weeks he developed a dry cough, pains in the fingers and wrists, night sweats, and breathlessness at rest. At this time he was afebrile and had no signs of cardiac failure, but he was cyanosed and tachypnoeic and bilateral basal fine mid and late inspiratory crackles were audible. Haematological investigation showed: haemoglobin concentration 10-2 g/dl; white blood cells 2-2 x 109/l; neutropenia and eosinophilia (308/,ul figure 2.After completion of chemotherapy, restaging showed total resolution of the previous chest radiographic abnormalities and no evidence of lymphoma. 206 on 11 May 2018 by guest. Protected by copyright.

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