Esophageal function in chronic alcohol abuse

1. In our patients the chronic overindulgence in alcohol led to an increased appearance of a pathological gastrooesophageal reflux. Thereby the group with normal liver findings or steatosis showed a slightly pathological, the group with alcoholic liver cirrhosis a severe pathological reflux behaviour. 2. The manometric findings in form of a decreased resting pressure in the inferior oesophageal sphincter, a slightly increased duration as well as of a decreased speed of the contraction wave were certainly insignificant in functional respect. They could not explain the pathological reflux behaviour. 3. The chronic abuse of alcohol did not lead to erosive changes of the mucous membrane in the distal oesophagus.     

Serum free sialic acid as a marker of alcohol abuse

BACKGROUND: Previous studies have shown that serum total sialic acid (TSA) concentration significantly increases during alcohol abuse. Chronic ethanol consumption impairs glycosylation of many proteins. The increased desialylation rate of serum glycoproteins is one of the effects of alcohol abuse. The aim of this study was to investigate the diagnostic value of free sialic acid (FSA) as a marker of alcohol abuse. METHODS: We determined serum FSA concentrations in the group of 156 alcoholic subjects and 35 healthy control subjects by means of a modification of the thiobarbituric acid method. The alcoholic group was divided into subgroups according to their history of abuse. RESULTS: The FSA concentration was significantly higher in alcoholic subjects than in healthy controls. The subjects who consumed alcohol for longer than a week showed significantly higher FSA level than those who consumed alcohol for a shorter period. The serum FSA concentration was significantly higher in alcoholic subjects with elevated markers of liver dysfunction. The diagnostic accuracy of FSA was high, although it did not differ from TSA, and was limited by its low sensitivity. CONCLUSIONS: This study shows that FSA concentration in the sera of alcoholic subjects is increased. The low diagnostic sensitivity is accompanied by high specificity, however the accuracy is high and similar to the accuracy of TSA. Free sialic acid does not seem to be a better marker of alcohol abuse than TSA and current markers.     

Cognitive ability as a factor in engagement in drug abuse treatment

This study examined correlates of high (HCA) and low (LCA) cognitive ability among substance dependent individuals who participated in an ongoing study of early engagement strategies. Participants (55% male; 98% African American), were administered the ASI, Shipley Institute of Living Scale, Beck Hopelessness scale, and TCU Motivation Scales at intake. Analyses were limited to 416 participants whose IQs fell within the upper and lower thirds of the sample. HCA participants reported more prior treatment episodes and longer durations of voluntary abstinence than LCA participants. There were no differences in retention, although HCA participants expressed significantly greater motivation and hopefulness at intake than LCA participants. Results indicate that clients with higher cognitive ability may present with a greater capacity to engage in treatment than individuals with lower cognitive ability.     

Prenatal alcohol exposure predicts continued deficits in offspring size at 14 years of age

BACKGROUND: Growth deficits are among the cardinal features for the diagnosis of fetal alcohol syndrome. Growth deficits have also been noted among those who were exposed to alcohol prenatally but who do not have fetal alcohol syndrome. Few studies have observed subjects past early and middle childhood, however, to evaluate the longer-term effects of prenatal alcohol exposure on growth in adolescence. This is a report of the effects of alcohol exposure during gestation on the size of the offspring at 14 years of age. METHODS: Women were recruited in their fourth prenatal month. These women were interviewed in the fourth and seventh months of pregnancy and at delivery. The women and their children were seen when the offspring were 14 years of age. RESULTS: Growth deficits associated with prenatal alcohol exposure were identified among the offspring at 14 years of age. Weight, height, head circumference, and skinfold thickness continued to be significantly affected by prenatal alcohol exposure after controlling for other significant predictors of size. These effects exhibited a dose-response pattern, and significant effects were found at levels below one drink per day. For example, first trimester alcohol exposure predicted weights of 152 lbs for the offspring of abstainers, 149 lbs for the offspring of light drinkers (>0 and <0.2 drinks per day), 143 lbs for the offspring of moderate drinkers (>0.2 and <0.89 drinks per day), and 136 lbs for the offspring of heavy drinkers (>0.89 drinks per day). CONCLUSIONS: Prenatal alcohol exposure continues to affect size at age 14 years in this cohort of children followed since their fourth month of gestation.     

Significance of macrocytosis as an indicator of chronic alcohol abuse

On the basis of a retrospective study the importance of the haematological parameter MCV (mean corpuscular volume) for the recognition of chronic alcohol addicts was investigated. It was shown that in males a macrocytosis of the erythrocytes (MCV greater than or equal to 100 fl) refers to a daily alcohol abuse of more than 80 to 100 g, when diseases disturbing the blood formation and medicamentous injuries have been excluded. The sensitivity of this haematological screening method lies in the same order of magnitude as the sensitivity in the determination of the gamma-glutamyl transpeptidase. The daily abuse of high per cent spirits seems to have a larger effect on the development of a macrocytosis than the daily abuse of equivalent quantities of beer.     

Cognitive deficits 3 to 6 years before dementia onset in a population sample: the Honolulu-Asia aging study

OBJECTIVE: To determine the type of cognitive deficits occurring 3 to 6 years before onset of dementia in a population sample. DESIGN: A prospective study in which cognitive deficits in participants who had incident dementia at the 6-year follow-up were examined at baseline and 3 years. SETTING: Honolulu, Hawaii. PARTICIPANTS: Three thousand seven hundred thirty-four Japanese-American men aged 71 to 93 at baseline. At the 6-year follow-up, there were 52 incident cases of dementia, and 1,559 controls. MEASUREMENTS: The Cognitive Abilities Screening Instrument (CASI) and a questionnaire on subjective memory problems were administered at baseline. Dementia was assessed at baseline and at 3-year and 6-year follow-ups. RESULTS: Subjects who had incident dementia at 6-year follow-up, had showed deficits 3 to 6 years earlier in the CASI domain of episodic memory and in the questionnaire covering subjective memory problems. Up to 3 years before onset, there was worsening of the episodic memory deficit from baseline and new deficits in language, verbal fluency, and orientation. CONCLUSION: Cognitive deficits and awareness of memory problems are frequently present several years before dementia onset. The predictive value of these deficits is not large enough to allow earlier diagnosis of dementia, but information about such deficits may be useful as criteria for mild cognitive impairment.     

Maternal age, alcohol abuse history, and quality of parenting as moderators of the effects of prenatal alcohol exposure on 7.5-year intellectual function

BACKGROUND: In contrast to the extensive literature documenting IQ deficits in patients with fetal alcohol syndrome, effects on IQ have not generally been reported for children with alcohol-related neurodevelopmental disorder (ARND). This study examined the role of maternal age, MAST, and quality of parenting in moderating the effects of prenatal alcohol exposure on the WISC-III IQ test in moderate-to-heavily exposed children. METHODS: A total of 337 inner-city African American children whose mothers were recruited prenatally were administered the WISC-III at 7.5 years. Alcohol exposure was assesed with a timeline follow-back interview administered at every prenatal clinic visit. Moderating effects of the three risk factors were examined by adding interaction terms to regression analyses and dichotomizing the moderators and performing separate regressions on the two groups. RESULTS: Prenatal alcohol exposure was related to WISC-III Freedom from Distractibility but not to Full Scale IQ for the sample as a whole. However, among children born to older mothers, an alcohol effect emerged on Full Scale IQ and five of seven composite IQ scores. Similarly, adverse effects were seen among children of MAST-positive mothers and children whose parents provided less optimal cognitive stimulation. Each additional ounce of absolute alcohol consumed per day during pregnancy was associated with a 2.9-point decrease in Full Scale IQ and a 5.6-point decrement on Freedom from Distractibility. CONCLUSIONS: This study is the first to demonstrate IQ effects among children with ARND born to older and MAST-positive mothers, particularly in relation to first-trimester drinking. These findings suggest that there are subgroups of more vulnerable and severely affected children whose intellectual performance is compromised. A moderate- to heavy-drinking mother who has given birth to an unaffected child when she was younger needs to be warned that her risk of having an adversely affected child increases as she grows older.     

Alcohol consumption, alcohol abuse and alcohol dependence. The United States as an example

This paper presents national estimates of alcohol consumption and DSM-IV alcohol abuse and dependence in the United States, Fifty-nao percent of the adults surveyed were classified as current drinkers and nearly 9.0% met criteria for DSM-IV akohol abuse or dependence. Greater percentages of males and whiles were classified as current drinkers and as alcohol abusers or dependent, compared with females and non-whites., respectively. There is a need for future epidemiological research to collect belter data on drinking patterns as an aid to interpreting socio-demographic differentials and to estimate more precisely the association between alcohol consumption and abuse and dependence in multivariate statistical environments. The critical need to examine the unprecedented reversal of the abuse-to-dependence ratio resulting from the application of the DSM.-IV classification is emphasized. The role of future longitudinal alcohol epidemiological research in elucidating the initiation and maintenance of consumption patterns and alcohol use disorders is stressed.     

Effects of chronic alcohol abuse on alveolar epithelial barrier function and glutathione homeostasis

BACKGROUND: An association between the development and severity of the acute respiratory distress syndrome has been described in individuals who abuse alcohol chronically, possibly through a mechanism involving the deficiency of pulmonary glutathione. In a rodent model of chronic alcohol abuse, this antioxidant contributes to the maintenance of alveolar-capillary membrane integrity. We postulated that humans who chronically abuse alcohol will have similar alterations in alveolar-capillary barrier function. METHODS: Bronchoalveolar lavage was performed in 18 healthy chronic alcoholics and 18 control subjects; total protein and glutathione concentrations were measured within the epithelial lining fluid. To examine possible protracted effects of alcohol abuse, a subset of 11 chronic alcoholic subjects underwent a second bronchoalveolar lavage after a week of abstinence. RESULTS: Chronic alcoholic subjects had significantly elevated protein concentrations compared with controls (8.64 microg protein/ng immunoglobulin A vs. 5.91 microg protein/ng immunoglobulin A, p = 0.01). After a week of abstinence, no significant increase in either the glutathione levels or normalization of the protein concentrations in the epithelial lining fluid was demonstrable. CONCLUSIONS: Increased protein levels in the epithelial lining fluid of individuals who abuse alcohol chronically may signify abnormal alveolar epithelial barrier function that does not appear to readily reverse after a period of abstinence.     

Substance abuse as a precipitant of wife abuse victimizations

This study examines the question of whether drug and alcohol use by victims constitutes a risk factor increasing the chances of their being assaulted by their partners. Data from a subsample of the 1985 National Family Violence Survey consisting of the 2,033 female respondents who were currently married or living in a male-female couple relationship are used as the basis of the analysis. The logistic analysis revealed that, of the ten variables in the model, the most important for distinguishing abused from nonabused women are husband's drug use, a history of paternal violence in womens' family or origin, husband's drunkenness, low income, and wife's drunkenness. Women who abuse alcohol are more likely to be victims of minor marital violence, but female substance abuse of any type is not a significant factor in severe violence.     

Bone disease in alcohol abuse

We evaluated bone disease in eight white men between the ages of 49 and 61 years who had been abusing alcohol for at least 10 years. The mean density of vertebral cancellous bone was 58% of normal, whereas the mean density of appendicular cortical bone was 90% of normal. Marked reduction in active bone resorption and bone formation was seen without evidence of osteomalacia. Serum levels of calcium and magnesium were in the lower range of normal; serum levels of phosphorus, calcifediol, and calcitriol were normal; and serum levels of parathyroid hormone and nephrogenous cyclic adenosine monophosphate were in the higher range of normal. These data suggest that bone disease in these subjects is not due to inhibition of parathyroid hormone secretion or function, or abnormal vitamin D metabolism, but to an inhibition of bone remodeling by a mechanism independent of the calciotropic hormones.