Alcohol consumption and risk of gastric cancer: a cohort study of men in Kaunas, Lithuania, with up to 30 years follow-up

BACKGROUND

Gastric cancer is the second most common cause of death from cancer in the world. Epidemiological findings on alcohol use in relation to gastric cancer remain controversial. The aim of this study was to examine the effect of alcohol consumption on the risk of gastric cancer.

METHODS

The association between alcohol intake and the risk of gastric cancer was examined in a population-based cohort of 7,150 men in Kaunas, Lithuania, who were enrolled during 1972-1974 or 1976-1980. After up to 30 years of follow-up, 185 gastric cancer cases were identified. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (95% CI). The attained age was used as a time-scale.

RESULTS

After adjustment for smoking, education level and body mass index, the HR of gastric cancer was 2.00 (95% CI: 1.04-3.82) for the highest alcohol consumption frequency (2-7 times per week) compared with occasional drinking (a few times per year) and 1.90 (95% CI: 1.13-3.18) for ≥ 100.0 g ethanol/week versus 0.1-9.9 g ethanol/week. A stronger effect of alcohol consumption on gastric cancer risk was observed during the second half of the study (1993-2008). In the analysis of gastric cancer risk by alcoholic beverage type, all beverages were included simultaneously in the model. The multivariate HR for men who consumed ≥ 0.5 litre of wine per occasion (compared with those who consumed <0.5 litre) was 2.95 (95% CI: 1.30-6.68). Higher consumption of beer or vodka was not statistically significantly associated with gastric cancer risk. After adjustment for smoking, education level, body mass index and ethanol, we found no excess risk of gastric cancer in association with total acetaldehyde intake.

CONCLUSIONS

This study supports a link between alcohol consumption (primarily from ethanol) and the development of gastric cancer in the Lithuanian population. Although an association with heavy wine consumption was observed, the effect of exposure to acetaldehyde on the development of gastric cancer in this cohort was not confirmed. Further research is needed to provide a more detailed evaluation of alcohol drinking and gastric cancer risk.

Botulism from drinking prison-made illicit alcohol - Utah 2011

Foodborne botulism is a rare, potentially fatal paralytic illness caused by eating food contaminated by Clostridium botulinum toxin. It occurs most often as a single case not linked to others by a common food source. As a result of improvements in food canning, when outbreaks do occur, they typically involve fewer than five persons. During October 2-4 2011, eight maximum security inmates at the Utah State Prison in Salt Lake County were diagnosed with foodborne botulism. An investigation by Salt Lake Valley Heath Department, Utah Department of Health, and CDC identified pruno, an illicit alcoholic brew, as the vehicle. The principal ingredients in pruno are fruit, sugar, and water. Many additional ingredients, including root vegetables, are sometimes added, depending on the availability of foods in prison. A baked potato saved from a meal served weeks earlier and added to the pruno was the suspected source of C. botulinum spores. Many of the affected inmates suffered severe morbidity, and some required prolonged hospitalizations. Knowing the link between pruno and botulism might help public health and correctional authorities prevent future outbreaks, respond quickly with appropriate health-care to inmates with acute descending paralysis and/or other symptoms, and reduce associated treatment costs to states.

Evaluation and referral for child maltreatment in pediatric poisoning victims

OBJECTIVE

Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear. Therefore the objective of this study was to determine the percentage and characteristics of young poisoning victims who were evaluated for child maltreatment by the hospital team (social work and/or child protection team) and/or referred to CPS.

METHODS

Retrospective study of poisoning victims<6 years old seen at an urban children's hospital from 2006 to 2008. Logistic regression was performed to evaluate the associations between the outcomes (evaluation for maltreatment by hospital team and/or referral to CPS) and predictor variables (demographics and circumstances, type and severity of poisoning).

RESULTS

Among 928 poisonings, 41% were from household products, 20% from over-the-counter drugs, 7% from prescription narcotics/sedatives, 29% from other prescription drugs, and ≤ 1% each from ethanol, illicit drugs, or other substances. Most children were asymptomatic (69%) or stable (28%); 3% were critically ill. Only 13% were evaluated by the hospital team and 4% were referred to CPS. Demographic characteristics were not associated with referral to CPS. Higher clinical severity was associated with increased referral (p<0.001). Compared to poisonings with over-the-counter drugs, referrals were more likely for poisonings with ethanol and prescription narcotics/sedatives, but not other prescription drugs or household products (p<0.001). All illicit drug poisonings and 44% of ethanol poisonings were referred. The majority of referrals to CPS were for concerns for illicit drugs, poor supervision or multiple forms of maltreatment; 6% were secondary to concerns for intentional poisoning.

CONCLUSIONS

Evaluations and referrals to CPS for maltreatment are uncommon in young poisoning victims. Referrals occurred consistently for illicit drugs but not ethanol. Although referrals were more likely for higher severity poisonings, it is unclear if the severity of poisoning is associated with the level of supervisory neglect or a marker of ongoing risk to the child. These findings suggest the need to identify risk factors for ongoing harm and the development of clinical guidelines used to determine which poisoning victims should be referred to Child Protective Services.

Hemodialysis for methyl alcohol poisoning: a single-center experience

Methanol is a cheap and potent adulterant of illicit liquors. Hemodialysis (HD) is the best method to rapidly remove both toxic acid metabolites and parent alcohols, and it plays a fundamental role in treating severely poisoned patients. This retrospective study was carried out on 91 patients with detectable serum methanol levels who underwent HD. Because toxic alcohol levels were not immediately available, the initial diagnosis and treatment was based on clinical history with evidence of toxic alcohol intake, presence of high anion metabolic acidosis and/or end organ damage. Patients received bicarbonate, ethanol, according to clinical features and blood gases. Patients underwent HD in the setting of known methanol ingestion with high anion gap metabolic acidosis, or evidence of end-organ damage, regardless of methanol level. HD prescription included large surface area dialyzer (≥ 1.5 m²), blood flow rate of 250-350 mL/min and dialysate flow rate of 500 mL/min for 4-6 h. Between 9 and 11 July 2009, 91 males with mean age 40 ± 8.5 years underwent HD, and 13 patients required a second HD session. Patients consumed 100-500 mL illicit liquors, and symptoms appeared six and 60 h later. Clinical features were gastro-intestinal symptoms (83.5%), visual disturbances (60.4%), central nervous system symptoms (59.3%) and dyspnea (43.9%). Before HD, mean pH was 7.11 ± 0.04 (range 6.70- 7.33) and mean bicarbonate levels were 8.5 ± 4.9 mmol/L (range 2-18). Three patients died due to methanol intoxication. Mortality was associated with severe metabolic acidosis (pH ≤ 6.90), ventilator requirement and coma/seizure on admission (P < 0.001). Timely HD, bicarbonate, ethanol and supportive therapy can be life-saving in methanol intoxication.

Drugs used in child maltreatment

Between 2000 and 2008, the American Association of Poison Control Centers recorded 1439 cases in which drugs or alcohol were used to mistreat children under 7 years of age, representing an average of 160 reports per year. Median age was 2 years, and 57% of victims were boys. The substances included psychotropic drugs, analgesics, cold remedies, alcohol, and illicit drugs. 18 children died, while 32 children experienced life-threatening effects or residual disability. It is not clear whether these results can be extrapolated to the French population. In France, a yearly survey of the Centres for Evaluation and Information on Pharmacodependence (CEIP) identified 162 cases of "chemical submission", 3 of which involved children. In practice, it is often difficult to recognise when a child is being maltreated, especially when medications, illicit drugs or alcohol are used. Taking into consideration the known adverse effect profile of a drug may provide a clue, help to limit harms to the child and allow appropriate management.

The utility of routinely collected data in evaluating important policy changes: the New Zealand alcohol purchasing age limit example

We used the recent lowering of the alcohol purchasing age in New Zealand to examine the proposition that routinely collected data are often insufficient in evaluating important policy changes. We estimated prechange and postchange incidence rate ratios for actual and hypothetical population sizes and hospital admissions related to alcohol poisoning and assaults. Even with a hypothetical youth population 10 times larger than New Zealand's actual youth population, comparisons were underpowered because there were too few observations. Governments should use the enactment of health legislation as an opportunity to build the research evidence base by ensuring that evaluations are initiated in advance.

Novel method for identification and quantification of methanol and ethanol in alcoholic beverages by gas chromatography-Fourier transform infrared spectroscopy and horizontal attenuated total reflectance-Fourier transform infrared spectroscopy

Numerous methods are being used to identify and quantify methanol and ethanol in alcoholic beverages, including country liquors. Some of the known methods are density and refractive index measurements, and spectrophotometric measurements using Schiff's reagent or chromatropic acid. Other advanced techniques involve head space gas chromatography (GC), GC-flame ionization detection, high-performance liquid chromatography, enzymatic reactions, and biosensors. However, identification and quantification of methanol and ethanol in beverages can be accurately done using GC-Fourier transform infrared spectroscopy (FTIR) and horizontal attenuated total reflectance (HATR)-FTIR. Identification of alcohols is possible from library matching of the IR spectra obtained from GC-FTIR. In water, methanol and ethanol show a very strong peak for C-O, stretching at 1015.3 and 1044.2 cm(-1), respectively. The strong absorption of vibrational stretching frequency of C-O present in alcohols was used for quantification purposes. The absorptions of C-O group frequency of alcohols in water mixtures were measured using HATR-FTIR with a zinc-selenide crystal. Samples were placed directly on the HATR crystal, with alcohol concentrations ranging from 0.2 to 50.0% (v/v). The plot of absorptions against concentrations of methanol and ethanol obeyed Beer's law (r2 = 0.9998 and 0.9987, respectively), from which alcohol in the mixtures was quantified. Propan-2-ol and n-butanol showed no interference. The method is validated from absorption measurements of known mixtures of standard ethanol in water. This is a simple, specific, rapid, accurate, and nondestructive method of identification and quantification of methanol and ethanol in mixtures. It can be used to ascertain methanol contamination in alcoholic beverages that can lead to death or methanol poisoning by alcohol consumption.

[Associations between mortality and alcohol consumption in Lithuanian population]

The objective of the study was to assess alcohol-related mortality that potentially might explain an increasing trend in overall mortality of Lithuanian population, which started after 2000 and peaked in 2005.

MATERIAL AND METHODS

An empiric analysis of national mortality and other statistical data as well as their international comparisons.

RESULTS

An analysis of available data clearly indicates that a decline in mortality in 1998-2000, i.e. during the beginning of the National Programme of Health, as well as its increase in 2001 and 2005 were predominantly determined by cause-specific deaths of two groups: deaths from diseases of the circulatory system (mainly ischemic heart disease) and alcohol consumption-related deaths (liver cirrhosis, accidental poisoning by alcohol, accidents, etc.). A certain proportion of deaths, which were caused by alcohol, were wrongly assigned to the deaths from diseases of the circulatory system due to uncertainties in filling-in death certificates. By approximate estimates, at least one-quarter of increase in all-cause mortality between 2002-2004 and 2005-2007 could be explained by an increase in alcohol consumption, accounting for additional 880 deaths on average per year. In the year 2007, 12.6% (n=5760) of all deaths were somehow related to alcohol consumption. A comparative analysis demonstrated that mortality and alcohol consumption trends were going in parallel over the last decade. The systemic decline in mortality observed in Lithuania from 1995 stopped in 2000 after a decrease in alcohol taxes, which resulted in an increase in alcohol accessibility and consumption. An average annual increase in alcohol consumption over the period of 2001-2004 was 7%; it increased up to 17% in 2005 and accounted for 12% annual increase on average within 2005-2007.

CONCLUSIONS

Negative trends in alcohol-related morbidity and mortality in Lithuanian population most notably registered in 2001 and 2005 were largely influenced by uncontrollable increase in alcohol consumption over the last decade. Economic and commercial arguments in decision-making process that neglected health interest of Lithuanian population (decrease of alcohol taxes in 1999, other factors increasing alcohol accessibility and consumption) were those counteracting the implementation of balanced health policy in the country.

[Clinical, laboratory, and morphological manifestations of fatal and non-fatal poisoning with surrogate alcoholic beverages]

Clinical and morphological signs of poisoning with surrogate alcoholic beverages and their effect on human internal organs are described. Acute respiratory failure is believed to be the key element in patho- and tanatogenesis of alcoholic intoxication, the immediate cause of death being hepatic and/or renal insufficiency. Histologic examination revealed marked dystrophic changes in all internal organs of the affected subjects.

[Forensic-medical evaluation of toxic hepatitis associated with surrogate alcohol poisoning]

Medical cards of 1,116 inpatient victims of surrogate alcohol poisoning and 242 cases of its fatal outcome associated with jaundice were available for analysis form Irkutsk Region and other regions of the Russian Federation in the second half of 2006 and early 2007. The study revealed differences in hepatic lesions depending on the chemical nature of toxicants. Mixtures containing guanidine derivatives caused highly specific irreversible disturbance of bile transport in hepatocytes and biliary capillaries in the absence of cholestasis at the level of biliary ducts. Changes in hepatocytes of different type and genesis appear to be due to other toxic components and may be of use for the establishment of causal relation between hepatic lesions and concrete toxic mixtures.

[The forensic medical diagnosis of intoxication of alcohol surrogates by morphological findings]

The pathomorphology of intoxication of alcohol surrogates is described. A high frequency rate of DIC-syndrome is shown for the condition. A majority of thrombi accumulates at places with the highest concentrations of toxic substances as well as at those places, through which poisoning substances are brought out of the body, i.e. in the liver (since toxic substances are introduced perorally) and kidneys. Thrombi were detected in all internals, including the brain, in lethal intoxication. The immediate toxic effect from methanol and from higher spirits can matter in the genesis of changes, including acute swelling and chromatolysis with subsequent cell death. Exclusively cerebral or coagulopathic-cerebral types of thanatogenesis were registered in studied case of intoxication.

[Analysis of mortality rate as a result of alcoholic poisoning]

The indices of mortality due to intoxication by alcohol and its surrogates in a region studied during the 90-ies essentially differ depending on an information source. An analysis of the alcoholic situation in the region and en elaboration of preventive measures cannot be limited to data on the consumption of alcohol (provided by the State Statistics Committee) showing only the volume of statistically registered sales of alcoholic beverages through the trade network. If this factor is ignored, erroneous conclusions can be made on both the volumes of average-per-capita consumption of alcohol and on the reasons of changes in people's health indices.

[A case of acute ethanol intoxication with remarkable hyperglycemia by "ume-shu", a Japanese apricot liquor made with a large amount of sugar]

A 19-year-old woman ingested 2.2 L of "umeshu", a Japanese apricot liquor made with a large amount of sugar. She was unconscious and in shock. The estimated blood ethanol concentration was 607 mg/dl, and the blood glucose level was 576 mg/dl. Because her respiration and circulation was highly suppressed, blood purification was indicated. Continuous hemodiafiltration (CHDF) was performed instead of hemodialysis because her hemodynamics was unstable. After CHDF was instituted, her blood glucose level reduced to normal range, and her consciousness became alert. CHDF was effective in eliminating ethanol and stabilizing her hemodynamics within an early stage. Though acute ethanol intoxication is known to inhibit glucogenesis, leading to hypoglycemia, marked hyperglycemia was seen in this case. Ingestion of a large amount of glucose-rich liquor and being in shock seemed to be the causes of hyperglycemia.

Ginger Jake and the blues: a tragic song of poisoning

Prohibition, "The Noble Experiment", ushered in speakeasys, gangsters and bathtub gin in the 1920s. For many Americans, however, it led to a period of joblessness, hard times, and austerity. The story of Jamaican Ginger ("Jake") poisoning, in which batches of a cheap, alcoholic tonic were laced with tri-ortho cresyl phosphate (TOCP) is one of cynical despicable behavior on the part of those responsible and a tragic enduring legacy for the invisible group of Americans who were victimized. TOCP, a potent organophosphate, caused an axonal dying-back neuropathy affecting mainly large muscle groups. Jake poisoning struck about 50,000 adults, mostly poor middle-aged vagrants with little medical care or social standing. Their symptoms and stories were told not only in medical journals but also in song. Hillbilly jazzmen sang of the "Jake Leg Blues" with a resignation to the fate of their own undoing, brought on by the intemperance of a wasted life. The postscript is grim--those responsible received little punishment; many who drank "Jake" were left both uncompensated and crippled by irreversible paralysis.

Subclavian vein catheterisation for haemodialysis

Immediate access to the circulation for haemodialysis may be necessary in patients with acute renal failure or when end stage renal disease presents acutely. Vascular access may be required in patients treated by continuous ambulatory peritoneal dialysis if that technique is interrupted or, following failure of an arteriovenous fistula in patients on maintenance haemodialysis. Haemodialysis via a catheter in the subclavian vein meets these needs. Our experience with 67 patients over two years confirmed the safety and reliability of this means of access. Benefits included easy, rapid catheter placement, full patient mobility, allowing outpatient dialysis where appropriate, and the sparing of peripheral vessels for future access. With careful attention to technique by experienced personnel complications are largely preventable.

Deaths from drugs and poisons

In the eight years from 1975 to 1982, 11 262 ***coronial**autopsies were performed in the School of Medicine, Auckland. Three hundred and ninety-four of the deaths were due to the action of a drug or poison. In this paper we examine the motives and circumstances, age and sex distribution, drugs used and other aspects of these 394 deaths.

Homicide by barbiturates and alcohol

Death from the misuse of alcohol and barbiturates is frequently encountered in most medical examiner/coroner offices. The cause of death is often quite apparent from the pathological and toxicological findings; however, the manner of death often gives the examining official some difficulty. The usual dilemma is to unravel whether the dead individual intentionally took the lethal combination in order to cause his/her own death or whether the combination was unintentionally ingested without awareness of the potentially lethal combination. The manner of death in these cases is either suicidal, accidental, or undetermined. A case is presented in which alcohol and barbiturates are the causes of death, but the manner of death is somewhat unusual in that it was administered by a second party with premeditation, deliberation, and intent to kill.

The Jake Walk Blues. A toxicologic tragedy mirrored in American popular music

In 1930 thousands of cases of muscle pain, weakness of upper and lower extremities, and minimal sensory impairment occurred in the United States. The illness was caused by the consumption of an adulterated Jamaica ginger extract ("Jake"), an illicit beverage then popularly used in the southern and midwestern United States to circumvent prohibition statutes. The additive tri-ortho-cresyl phosphate caused severe, only partially reversible damage to the spinal cord and peripheral nervous tissue. Victims with resultant gait impairment, sometimes permanent, were said to have the "Jake Leg" or "Jake Walk." Twelve commercial phonographic recordings made between 1928 and 1934 by southern rural artists, white and black, refer to Jake or Jake-induced infirmity. These reveal preepidemic cultural familiarity with Jake, and the later, postepidemic performances reflect a whimsical, even cynical, cultural attitude that those with "Jake Leg" were suffering the wages of sin and should not be regarded as objects of pity or sympathy.

Post-mortem blood concentration of methanol in 17 cases of fatal poisoning from contraband vodka

Recently in Tehran 57 persons were poisoned and admitted to hospitals after consumption of vodka. Seventeen of the 57 died and two others became blind. Analyses of the remaining vodka samples showed that they were contraband and were mixtures of methanol and water. Post-mortem samples of blood from 15 victims' hearts and two samples of viscera were analysed for methanol, the concentrations ranging from 23 to 268 mg per 100 ml blood and per 100 g viscera, respectively.