[Effects of morphine on adenylate cyclase activity in lymphocytes of healthy subjects and patients with alcoholism and opiate addiction]

The morphine dose 10(-7) M had practically no effect on adenylate cyclase (AC) activity in lymphocytes of healthy controls (n = 20). The same dose of morphine had a pronounced stimulating effect on the AC activity in lymphocytes of alcoholics in withdrawal (n = 16). In the group of opiate addicts in withdrawal (n = 9) morphine had also a stimulating effect, which differed significantly from controls (33.7 +/- 13.8; P. 0.02). The range of fluctuation of morphine influence on AC activity during the first week of hospitalization was 162.9 +/- 33.0% in alcoholics and 30.4 +/- 4.6% in opiate addicts (P 0.01).

Carbohydrate-deficient transferrin in serum: a new marker of potentially harmful alcohol consumption reviewed

During the last 16 years an increasing number of studies have indicated a new diagnostic marker of alcohol abuse, unrelated to any of the conventional markers of alcoholism. This marker, now called carbohydrate-deficient transferrin, consists mainly of one or two isoforms of transferrin that are deficient in their terminal trisaccharides. Such isoforms have so far been detected by methods based on charge, i.e., isoelectric focusing, chromatofocusing, and anion-exchange chromatography of various designs combined with immunological detection techniques. This transferrin abnormality measures an accumulated effect of alcohol consumption, appearing after regular intake of 50-80 g of ethanol/day for at least one week and normalizing slowly during abstinence (half-life = about 15 days). To summarize all studies to date, approximately 2500 individuals have been examined, with a total clinical sensitivity of 82% and a specificity of 97%. False-positive results have only occasionally been reported: in a few patients with severe liver disease, usually primary biliary cirrhosis and chronic active hepatitis; in patients with genetic D variants of transferrin; and in patients with (and some carriers of) a recently identified inborn error of glycoprotein metabolism. The mechanism behind the transferrin abnormality is unknown but an acetaldehyde-mediated inhibition of glycosyl transfer has been suggested. Carbohydrate-deficient transferrin may thus offer a new possibility of diagnosing alcohol-related disorders. Its measurement is little affected by other conditions and, contrary to conventional markers of alcohol abuse, is apparently largely independent of concomitant liver disease.

With regards to the presence of iron granules in plasma cells

We report on the occasional presence of iron granules in plasma cells in two male patients respectively 64 and 71 years old, both with excessive drinking habits. One patient also had liver cirrhosis. In both patients the bone-marrow biopsy showed a macrocytic anemia without megaloblasts. We refer the morphologic data because the cases reported are not many and the presence of iron granules in plasma cells was a curious and rare aspect. The most important feature appearing from the data issued is the gap concerning both the source and mechanism that cause this phenomenon. Some investigations have suggested that the plasma cell iron is located in mitochondria, others have noted that iron granules were located between the Golgi region and the rough endoplasmic reticulum. Moreover, the morphologic data are not related to the number of plasma cells in the bone-marrow and there is no causal relation between alcoholic abuse and plasma cell iron. The first problem is common, the second is rare.

[Osteocalcin in chronic alcoholism]

In order to investigate the mechanism by which the inorganic content of the bone is reduced in chronic alcoholism, the authors assayed osteocalcin in 60 chronic alcoholics. The level was significantly lower than in control subjects. There was no significant difference between levels in cirrhotics and in non-cirrhotic alcoholics. There was a negative correlation between osteocalcin and gamma GT levels. There was no correlation between osteocalcin and blood calcium, blood phosphorus, ALAT, ASAT, alkaline phosphatase, 5'-nucleotidase, albumin or bilirubin levels, or with the prothrombin time. These results suggest a direct impact of alcohol on the osteoblast.

The effect of chronic alcohol intake on prognosis and outcome in paracetamol overdose

1. In a retrospective study, we stratified 79 patients with paracetamol hepatotoxicity into two groups according to weekly alcohol consumption below (n = 49) or above (n = 30) Royal College of Physicians' guidelines of 21 units week-1 for males and 14 for females. 2. Survival was lower (33%) and serum creatinine on admission higher (median 207 mumol) in patients whose alcohol consumption was above recommended guidelines than in those whose drank less than this (65.9% and 138 mumol, P less than 0.01 and P = 0.027, respectively). An arterial blood pH less than 7.30 on admission was also more common in those patients with a higher alcohol consumption (30% v 12.2%, P = 0.05). 3. In all patients whose alcohol consumption exceeded the guidelines, paracetamol overdose was fatal if associated with a serum creatinine greater than 300 mumol in conjunction with a prothrombin time over 100 s and grade 3 or 4 encephalopathy or a peak prothrombin time over 180 s. 4. Chronic alcohol intake above suggested limits is an adverse prognostic feature in cases of severe paracetamol overdose. This effect is partly related to increased nephrotoxicity.

Inverse relationship between CSF TRH concentrations and the TSH response to TRH in abstinent alcohol-dependent patients

The authors performed the thyrotropin-releasing hormone (TRH) stimulation test and measured CSF concentrations of TRH in 13 abstinent alcohol-dependent subjects. They found an inverse correlation between the thyrotropin (TSH) response to TRH and endogenous CSF TRH concentrations. This finding supports the hypothesis that as the concentration of CSF TRH increases, anterior pituitary TRH receptor density decreases, resulting in a blunted TSH response to TRH stimulation.

[The structural organization of the erythrocyte membranes of representatives of different ethnic groups following a single drink of ethanol]

Comparative data of phospholipids and fatty acids contents in erythrocytes of the people working in the North after the single uptake of ethanol are given. The increase of the fatty acids saturation index in all groups was noted. The modifications of the polyunsaturated fatty acids from omega-6-series for Europeans and omega-3-series for Mongolians was also found.

[Methanol kinetics in chronic alcoholism]

Blood tests from 39 persons, who had been admitted to a local hospital for alcoholics, were analysed. The methanolconcentrations at the reception time lay between 10 and 82 mg/kg and the BAC between 2.00 and 3.83%. In all cases, when Ethanol existed in a sufficient concentration the Methanolconcentration showed a horizontal trend. A Methanolelimination was not observed. Only after exceeding a limiting value of Ethanol, which fluctuated between 0.8 and 0.2%, in most of the cases under 0.2%, the Methanolcurves increased significantly. An Ethanolelimination was observed between 0.15 and 0.25% per hour, the average was about 0.19%.

In thiamine deficiency, activation of erythrocyte transketolase by thiamine in vivo exceeds activation by cofactor in vitro

In 60 thiamine deficient patients, the mean erythrocyte transketolase activity after activation by thiamine diphosphate cofactor in vitro, representing the apparent sum of holoenzyme and apoenzyme activities, was 0.609 (SD 0.166) U/g Hb before thiamine therapy and rose to 0.772 (SD 0.152) U/g Hb immediately after the administration of thiamine to the patients. The difference between these values, 0.163 (SD 0.130) U/g, is the mean activity of transketolase protein which can be activated by thiamine in vivo but not by thiamine diphosphate in vitro. This difference correlated with low initial erythrocyte transketolase activity in these patients, but not with their alcohol intake, liver function or diagnoses.

Effects of ethanol on phospholipid acylation in rat erythrocytes: a model for a biochemical approach to membrane adaptation

Challenging intact erythrocytes from naive rats with ethanol resulted in dose-dependent decreases in rates of acylation of phosphatidylcholine and phosphatidylethanolamine. In erythrocytes from ethanol-treated animals, the responses were of lesser magnitude, indicating a lower sensitivity to ethanol. This relative resistance, typical of the state of tolerance, was not associated with increased baseline rates of acylation of PC and PE, nor with changes in fatty acid specificity of acylation reactions. Taken together, the data suggest that (1) intact rat erythrocytes represent a reliable and easily reproducible model for studying biochemical correlates of the adaptive response to ethanol; (2) phospholipid acylation reactions are implicated in the initial sensitivity and subsequent acquisition of tolerance to ethanol in membrane erythrocytes; (3) on the basis of the measured acylation reactions, rat erythrocytes appear to develop tolerance, but not dependence, to ethanol.

Predicting alcohol use by adolescent males

An attempt was made to predict alcohol use among 101 American white boys aged 13-16. The model combined genetic and social variables. The analysis revealed evidence of a genotype-environment interaction and thus the use of either the biological or social variables alone poorly predicts alcohol use.

[Hepatitis B virus markers in alcoholics: clinical importance]

The prevalence of HBV markers is greater in alcoholics, with or without liver disease, than in general population. The high prevalence of HBsAg carriers in alcoholics suggests an inadequate immune response or a different expression of the HBV genome. Some studies suggest that in alcoholics HBsAg carriers, the HBV plays an important role in the progression of the liver disease, while others indicate that continuous alcohol consumption could intensify the liver damage caused by HBV. Active HBV infection has been demonstrated in alcoholics, even in absence of usual serologic markers. Finally, the integration of HBV in the hepatocites is frequent in alcoholics with liver disease; this could have importance in the development of hepatocellular carcinoma.

Macrocytosis as a consequence of alcohol abuse among patients in general practice

Macrocytosis, a common finding in patients without anemia or other hematologic abnormalities, is often ignored. The purpose of this prospective study was to investigate 300 consecutive, adult health-center patients with a mean cell volume (MCV) value greater than or equal to 100 fl. The incidence of macrocytosis was 2.4%. Of the 177 male and 123 female patients, only 14 (4.7%) were anemic; 80.2% of the men (89.3% of those under 60 years) and 34.1% of the women were alcohol abusers, representing the largest diagnostic group. The highest MCV value found in alcoholics without folate or vitamin B12 deficiency was 120 fl. The most useful laboratory test for identifying alcohol abuse among macrocytic patients was the measurement of serum gamma-glutamyltransferase. Of the several morphologic abnormalities in the marrow the only specific finding were vacuoles in the granulocyte or erythrocyte precursors. No underlying cause was found for macrocytosis in 6.8% of the men and 35.8% of the women. Even when it is not associated with anemia, macrocytosis should not be ignored. It may be the only indicator of a disease which often, particularly in young and middle-aged men, is alcohol abuse.

Haptoglobin levels among alcoholics in Alaska

The levels of haptoglobin, plasma proteins and amino acids were studied in a non-fasting population of alcoholics. In 25 subjects, only small differences were seen between the means when Native subjects were compared to non-Native. There did not appear to be any acute phase response differences between these two groups. This study did not substantiate other reports on the correlation of the severity of alcoholism with glycoprotein synthesis.

[A comparison between three questionnaires and laboratory tests for the detection of alcoholism in general practice]

By means of a case/control study, an attempt was made to identify the different questionnaires and biological tests which might be used in the General Practice consulting room for the detection of alcoholic patients. A comparison was made between the CABE, MALT, and Skinner questionnaires, and the MCV, AST, ALT, GGT triglyceride, cholesterol, uric acid, bilirubin and glycemia biological tests. Sensitivity, specificity, predictive value and diagnostic efficiency were studied in a group of 37 confirmed alcoholics and 25 controls making up a population with a high prevalence of alcoholism. Later we analysed the changes which affect the values of the different tests when applied to a population with a low prevalence of alcoholism, in other words, the utility of the tests in general practice was evaluated. The study concludes that the diagnostic performance of the questionnaires together with case history is higher than that of biological tests in general practice, and that the routine application tests in general practice, and that the routine application of the CAGE questionnaire and to a lesser extent of the Skinner questionnaire make it possible to identify those patients suspected of alcoholism and to improve the predictive value of the biological tests applied thereafter. Nevertheless further study is necessary to confirm the diagnostic effectiveness of these questionnaires in the general population of health centre patients.

Isoelectric focusing/western blotting: a novel and practical method for quantitation of carbohydrate-deficient transferrin in alcoholics

Carbohydrate-deficient transferrin (CDT) has been described as the single, most accurate marker of chronic alcohol consumption. Rapid, sensitive, and specific measurement of serum CDT levels can thus provide important clinical information concerning patient diagnosis and treatment. To date, however, methods used for assessing CDT concentrations [e.g., analytical isoelectric focusing combined with immunofixation and micro anion-exchange chromatography followed by radioimmunoassay (RIA)] have not been practical enough for widespread laboratory application. In the present study, we examined the use of a different technique, namely isoelectric focusing (IEF) combined with Western blotting (IEF/WB). Serum proteins (20-40 micrograms) were first focused according to isoelectric points (pI) on high-resolution agarose IEF gels (ampholyte pH range of 5-8) containing nonionic detergent. The focused proteins were transferred electrophoretically to nitrocellulose filters, and then stained immunochemically with antihuman transferrin IgG. IEF/WB completely resolved CDT (focusing at pI 5.7 and 5.9) from other serum transferring isoforms, as assessed with neuraminidase-generated CDT standards. Computerized densitometric scanning of the immunoblots allowed CDT levels to be quantitated directly rather than as a quotient. Serum CDT content determined by IEF/WB was highly correlated (r2 = 0.962; n = 17) with values determined previously by RIA. In a larger subject group, CDT levels (mg/liter) measured by IEF/WB were 139 +/- 54 in recently-drinking alcoholics (n = 58), 81 +/- 8 in abstaining alcoholics (n = 7), and 68 +/- 16 in healthy control subjects (n = 16).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of acetaldehyde on hemoglobin: HbA1ach as a potential marker of heavy drinking

The appearance of a new acetaldehyde-induced hemoglobin fraction, HbA1ach, and the effect of alcohol consumption on it and on the ratio of HbA1ach and glycated hemoglobin, HbA1c, were studied in vivo by cation exchange liquid chromatography. The mean +/- SEM of blood HbA1ach level was 171 +/- 13.10(-3)% of total hemoglobin as measured in 34 male teetotallers. Blood HbA1ach levels of 127 social drinkers (182 +/- 6.10(-3)%) were compared with those of 72 heavy drinkers (213 +/- 8.10(-3)%, p less than 0.01), 79 alcoholics (209 +/- 6.10(-3)%, p less than 0.01) and 16 diabetics (419 +/- 28.10(-3)%, p less than 0.001). HbA1ach correlated positively with HbA1c (p less than 0.001) and negatively with HbAo (p less than 0.001). The ratio of HbA1ach/HbA1c was effective in detecting the alcohol-induced increase in the HbA1ach fraction because the ratio reduced the disturbing effect of glucose. The sensitivity of the HbA1ach/HbA1c ratio was 33% in the heavy drinker group as compared to 40% of gamma-glutamyltransferase and 24% of mean corpuscular volume. The HbA1ach fraction and the HbA1ach/HbA1c ratio seem to be valuable in detecting excessive alcohol consumption in its early phase.

The naturalistic oscillating patterns of alcohol consumption in alcoholic methadone patients

The present study examined the temporal patterns of ethanol self-administration in alcoholics. Blood alcohol concentrations (BACs) for 12 methadone maintenance patients were assessed five times per week for 2 to 8 weeks and for two additional subjects for approximately 1 year. BACs indicated periods of high consumption alternating with brief periods of abstinence. This oscillating temporal pattern was stable over time. This result is consistent with self-administration found in laboratory studies of human and non-human alcohol self-administration.

Degrees of alcohol intoxication in 117 hospitalized cases

The correlation among degrees of alcohol intoxication, facial flushing, blood alcohol concentration (BAC) and blood acetaldehyde level was studied in 117 male alcoholic patients who underwent various tests to assess alcohol influence. Blood samples were collected and alcohol and acetaldehyde levels were determined. BACs ranged from 29 to 577 mg/dl in all patients and from 200 to 299 mg/dl in 48 of them. Fifty-one patients could stand erect (mean BAC [+/- SD] = 189 +/- 80 mg/dl), while 48 showed apparently normal reaction to a walking and turning test (mean BAC = 192 +/- 78 mg/dl). Some of the cases having BACs over 300 mg/dl could still stand and walk while others with BACs under 100 mg/dl already showed psychomotor impairment. Facial flushing was recognized in 75% of the subjects. Acetaldehyde concentrations in 27 patients ranged from 24 to 147 micrograms/dl. Appearance of facial flushing was correlated with relatively high concentrations of blood acetaldehyde. Seven out of 10 healthy volunteers given 1.6 to 2.0 g/kg of alcohol as a control could do nothing but sleep after reaching peak BAC (mean = 232 +/- 21 mg/dl). These findings are taken to indicate a great difference in response to alcohol between alcoholics and healthy men. This study is the first to report the occurrence of facial flushing and raised blood acetaldehyde concentration among Japanese alcoholics.

[Hematological, biochemical and electroneurophysiological changes in asymptomatic drinkers: a sensitivity study]

An electro-neuro-physiological, biochemical and hematological study was carried out in 3 groups of non-symptomatic drinkers: those in group A had a daily alcohol intake of less than 40 grams of alcohol; group B had a daily intake of between 40 and 80 grams of alcohol and those in group C had an intake greater than 80 grams of alcohol per day. The aim of this study was to demonstrate that all the parameters evaluated show quicker alterations when the intake of ethanol is chronic. Electroneuro-physiological parameters were less sensitive than the following indexes: VCM, GGT, GOT, GPT. However, in 50.9% of the patients there were changes in conduction speed, which is an important point to take into account when making a therapeutic decision.