I am essentially in agreement with the comment by Dr Hershkowitz, except for an inaccuracy in his quotation from my article. I stated that "The observation of gynecomastia on an addict's chest roentgenogram may be the clue to deranged liver function." Gynecomastia as a concomitant of intravenous narcotic addiction was first reported by Camiel et al,1 who mentioned the inability of the malfunctioning liver to deactivate circulating estrogens as the pathogenetic mechanism. This phenomenon is certainly more likely to be encountered in chronic narcotic addicts with long-standing liver damage than in patients with acute hepatitis.Dr Messer's letter also contains a minor misquotation from my article. I stated that in hematogenous osteomyelitis of narcotic addicts, Pseudomonas aeruginosa is frequently (rather than most frequently) the offending organism. In the series of Kido et al,2P aeruginosa was recovered in 28 of 32 cases. The report by Holzman
Stern WZ. Roentgenographic Aspects of Narcotic Addiction-Reply. JAMA. 1977;237(1):24. doi:10.1001/jama.1977.03270280026005
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