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PubMed1997

Responsibility for crime and injury when drunk.

The aim of this paper is to highlight the complexity in the connection between alcohol intoxication and responsibility for crime from a multidisciplinary approach comprising medical, legal and criminological perspectives. There is no doubt that there is a connection between violent behaviour and alcohol intoxication. However, several investigations show that alcohol heightens aggressiveness only when the drunken person is provoked. A case which may serve as a model when discussing legal responsibility for acts carried out when drunk is outlined. Ethical considerations are discussed and exemplified concerning the motive, as well as the principles, of punishing an intoxicated perpetrator. However, there are no definite solutions concerning what is right or wrong, and each reader will have his own opinion, which may well differ from that of the author.

Adult↗
PubMed2003

Signs of intoxication and server intervention among 18-39-year-olds drinking at licensed premises in New South Wales, Australia.

AIMS: To estimate the extent of responsible service of alcohol (RSA) practice to young adults showing signs of alcohol intoxication on licensed premises in New South Wales. DESIGN: Telephone-based cross-sectional survey. SETTING: New South Wales, Australia. PARTICIPANTS: A total of 1090 people aged 18-39 years old. FINDINGS: Seventy-five per cent of males and 64% of females reported that they had consumed at levels for acute alcohol-related harm during the previous 12 months, with 34% of males and 24% of females reporting doing so weekly; 54% (95% CI: 51-58%) of both males and females who had consumed at acute-risk levels, reported that this last drinking occasion occurred at a licensed premises. Of these, 56% (95% CI: 51-61%) reported that they had exhibited at least one sign of overt alcohol intoxication, while 19% (95% CI: 15-23%) reported showing three or more signs of intoxication. Among those reporting at least one sign of intoxication, only 10% (95% CI: 7-15%) reported that the licensed premises staff had provided at least one of seven different responsible service initiatives, while 55% (95% CI: 48-61%) reported that they were continued to be served alcohol. While these results suggest that intoxicated patrons are not being refused service as often as they should, there was evidence for some degree of responsible service provision with around half of the 'non-intoxicated' patrons reporting that they had seen licensed premises staff intervene in some way with other 'intoxicated' patrons. CONCLUSIONS: While the majority of 18-39-year-olds report showing signs of intoxication while drinking at licensed premises in NSW, only a small minority report experiencing RSA initiatives from bar staff in response to these signs.

Adolescent↗
PubMed1986

Alcohol-related diseases associated with ischaemic heart disease: a three-year follow-up of middle-aged male hospital patients.

Mortality and morbidity from ischaemic heart disease (IHD) was studied in 5404 Finnish males aged 35-64 years who had been hospitalised for alcohol-related disease in 1972 without any admissions for IHD during that same period. By record-linkage, morbidity and mortality were followed up to the end of 1975. The mortality of patients with alcohol-related diseases was compared to 1120 patients with acute appendicitis by calculating indirectly age-standardised mortality ratios (SMR). The mortality and morbidity of 5963 patients with acute myocardial infarction or angina pectoris was also studied. The following SMRs for IHD mortality, non-fatal-IHD-hospitalisation and for mortality from all causes respectively, were found: acute myocardial infarction 11.6, 7.2 and 7.2; alcohol intoxication 6.0, 4.5 and 4.5; angina pectoris 5.2, 10.5 and 3.4; liver cirrhosis 2.2, 2.5 and 11.8; alcoholism 1.9, 1.9 and 3.6; pancreatitis 1.8, 1.2 and 4.4; alcohol psychosis 1.7, 2.5 and 4.2. IHD mortality and morbidity appeared to be more prevalent in patients hospitalised with alcohol intoxication than in patients with other alcohol-related diseases. This suggests that rapid drinking predisposes both to serious intoxication and to fatal disturbances of cardiac rhythm.

Adult↗
PubMed1993

[Genotypes of alcohol dehydrogenase and aldehyde dehydrogenase and their significance for alcohol sensitivity].

Genotypes of alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) loci were determined, using allele specific oligonucleotides. Gene frequencies of ADH2(1) and ADH2(2) were 0.29 and 0.71, respectively, in the Japanese control group. No significant difference was found in the ADH2 genotype between the patients and the control group. Gene frequency of ALDH2(1) and ALDH2(2) were 0.65 and 0.35 in the control group, while 0.93 and 0.07, respectively in the patient group. Most of the patients, 20 out of 23, were homozygous Caucasian type. All individuals with homozygous atypical ALDH2(2)/ALDH2(2) and most of those with heterozygous atypical ALDH2(1)/ALDH2(1) were alcohol flushers, while all of the usual ALDH2(1)/ALDH2(1) were nonflushers. The results indicate that Japanese with the atypical ALDH2(2) allele are at a much lower risk in developing alcoholic liver disease than those with usual ALDH2(1)/ALDH2(1), presumably due to their sensitivity to alcohol intoxication.

Alcohol Dehydrogenase↗
PubMed1999

Quantifying the performance impairment associated with fatigue.

The present study systematically compared the effects of fatigue and alcohol intoxication on a range of neurobehavioural tasks. By doing so, it was possible to quantify the performance impairment associated with fatigue and express it as a blood alcohol impairment equivalent. Twenty-two healthy subjects aged 19-26 years participated in three counterbalanced conditions. In the sustained wakefulness condition, subjects were kept awake for 28 h. In the alcohol and placebo conditions, subjects consumed either an alcoholic or non-alcoholic beverage at 30 min intervals, until their blood alcohol concentration reached 0.10%. In each session, performance was measured at hourly intervals using four tasks from a standardised computer-based test battery. Analysis indicated that the placebo beverage did not significantly effect mean relative performance. In contrast, as blood alcohol concentration increased performance on all the tasks, except for one, significantly decreased. Similarly, as hours of wakefulness increased performance levels for four of the six parameters significantly decreased. More importantly, equating the performance impairment in the two conditions indicated that, depending on the task measured, approximately 20-25 h of wakefulness produced performance decrements equivalent to those observed at a blood alcohol concentration (BAC) of 0.10%. Overall, these results suggest that moderate levels of fatigue produce performance equivalent to or greater than those observed at levels of alcohol intoxication deemed unacceptable when driving, working and/or operating dangerous equipment.

Adult↗
PubMed2000

Influence of alcohol exposure on S-100b serum levels.

Recent assessment of the glia cell-derived neuroprotein S-100b in serum has been considered as a screening method for possibly occult brain injury in patients with minor head trauma (MHT). Since MHT is associated with alcohol intoxication in up to 50% of patients requiring emergency treatment, the blood-brain barrier (BBB) as well as neuronal cell integrity may be also affected by alcohol abuse. So far, however, no valid data are available on the release of S-100b after alcohol exposure. Thus, the aim of our study was to investigate S-100b serum levels in a controlled alcohol exposure paradigm. 22 healthy volunteers were included in the study, blood samples were drawn prior to and about 90 minutes after drinking. The amount of alcohol was adjusted to the body weight. A mean of 66.7 +/- 14.81 g was consumed giving raise to a blood alcohol concentration of 0.827 +/- 0.158@1000. S-100b serum levels assayed by a luminescence immunoassay were compared with those of MHT patients. The still preliminary results suggest no increase of the serum S-100b levels (0.0509 +/- 0.048 ng/ml versus 0.0422 +/- 0.044 ng/ml) after moderate alcohol consumption. In contrast, MHT patients with alcohol intoxication (1.6 +/- 0.77@1000) revealed a significant up to 10fold elevation of S-100b serum levels. Because of the much higher blood alcohol concentration in the MHT patients compared to the control collective, a potential relationship between excessive alcohol consumption and the release of S-100b in minor head trauma can still not be excluded. Further investigations on this topic are in progress.

Adult↗
PubMed1990

[Diurnal correlation of criminal behavior].

In order to study the correlation between criminal acts and time of day we analyzed reports of the Federal Police Department in Salzburg covering 2 months as well as our own psychiatric expert-opinius in cases of robbery and homicide. Offences against property have the same day-time rhythm as does regular labour. Alcoholic intoxication hardly occurs with offences against property, although the activity of burglars goes over into the early hours of night. Aggressive offences are commonly accompanied by alcoholic intoxication, they are mainly observed at night. Less aggressive offences such as maltreatment or fighting generally occur during the late afternoon until midnight. Whereas aggressive offences of alcoholized persist throughout later hours of the night. The delinquency of robbery and homicide continues into the early hours of the morning. In cases of homicide there are differences concerning the individual conflict-situation. Homicides in connection with family tragedies or partnership conflicts usually occur during the afternoon or the early evening and show just a minor connection with alcoholization. Homicides in the course of primitive conflicts appear highly correlated to alcoholization and to the night hours. In cases of homicide of mental-patients there is no general connection with alcoholization nor can there be seen a day-time correlation.

Alcoholic Intoxication↗
PubMed1981

Acute alcohol ingestion and platelet function.

A substantial number of severely injured patients are under the influence of alcohol, making it important to understand the effects of acute alcoholic intoxication on the clotting mechanism. Twenty healthy volunteers ingested commercial liquor over a four-hour period and were observed for another three hours. Peak blood alcohol levels were above 200 mg/dL in four subjects and between 100 and 200 mg/dL in 12. Platelet counts, platelet aggregation, and bleeding times were not significantly altered over the seven hours. This study demonstrates that acute alcoholic intoxication in healthy persons does not alter platelet function.

Adult↗
PubMed1993

[Toxic alcohol-induced, acute intrahepatic cholestasis with reversible increase of the CA 19-9 tumor marker in chronic alcoholic hepatitis].

The case report on an acute intrahepatic cholestasis caused by alcoholic intoxication in a 52-year-old medical laboratory assistant is given. In addition to extreme pathologic cholestasis parameters the increase of the tumor marker CA 19-9 was remarkable. By means of laparoscopy and histology, chronic fatty liver hepatitis due to alcoholic intoxication was found. The tumor marker CA 19-9 returned to normal following abstinence from alcohol parallel to the deline of the cholestasis parameters, which means the diagnostic importance of tumor markers in diseases with intrahepatic cholestasis is to be seen in relative terms.

Alcoholic Intoxication↗
PubMed1992

The epidemiology of head injury in Cantabria.

The epidemiology of head injury was studied in Cantabria, Spain, using a methodological design consisting of a cross-selectional analysis of one year of duration and an additional one year follow-up of all the patients included in the initial sample. The 477 cases identified represent a rate of 91/100,000, with males showing a head injury rate 2.7 times higher that than for females. Sixty per cent of all cases involved traffic accidents, falls accounted for 24% and industrial accidents were the cause in 8%. The annual age-adjusted mortality rate was 19.7/100,000. Over 92% of all deaths occurred prior to hospital admission. The presence of alcohol intoxication was evaluated in 211 cases by determining the osmolar gap. It was found that 51% of all the cases examined presented clear evidence of acute alcohol intoxication.

Accidental Falls↗
PubMed2003

Noncompliance leading to drug accumulation resulting in phenytoin toxicity.

Phenytoin is effective in suppressing tonic-clonic and partial seizures, and is widely used for initial therapy, particularly in adults. Ninety percent of phenytoin is protein bound and entirely eliminated by hepatic metabolism. The major metabolite of phenytoin, 5-(p-hydroxyphenyl)-5phenylhy-dantoin (5HPPH) is excreted in the urine. Higher phenytoin levels for a given dose of phenytoin can be seen in alcohol intoxication, hepatic and renal failures, hypoalbuminemia, nephrotic syndrome, trauma, and AIDS. Noncompliance can lead to accumulation of the drug-causing toxicity. We present a patient with acute alcohol intoxication who developed phenytoin toxicity due to noncompliance with the drug.

Alcoholic Intoxication↗
PubMed1979

Self-poisoning treated in the ICU.

This retrospective study compares number and type of self-poisonings admitted to the intensive care units (ICU) at Sahlgren's Hospital, Gothenburg, during 1972 and 1976. The total number of patients requiring intensive care was unchanged, but a change in the pattern of self-poisoning was seen. In 1976 the number of patients requiring intensive care following acute alcohol intoxication had increased, whereas the number of barbiturate and methaqualone poisonings decreased. Tricyclic antidepressants formed the largest group in both years. Fewer patients needed endotracheal intubation and IPPV in 1976 than in 1972. Also, fewer complications were seen, and the death rate among ICU-treated patients decreased. In the Gothenburg area barbiturates accounted for one half of all deaths due to self-poisoning and tricyclic antidepressants for one fifth. Any expected decrease in intensive care as a result of fewer barbiturate and methaqualone poisonings was obscured by an increase in severe alcohol intoxication.

Alcoholic Intoxication↗
PubMed1989

[Renin-angiotensin system in sudden cardiac death: biochemical and morphological aspects].

The renin activity of the blood plasma (RAP), renal cortex (RARC), juxtaglomerular apparatus (JGA) and renal microcirculation were studied in 330 male patients after sudden death. The activity of the renin-angiotensin system (RAS) is shown to be increased in sudden cardiac death (SCD) particularly in patients dying in the presence of alcoholic intoxication. The values of RAP and RARC and their correlation depend on the ethanol concentration in the blood. In cases of SCD with chronic alcoholic intoxication the signs of JGA hyperfunction are found (diffuse hypertrophy of the JGA structural elements). The investigation of the kidney microcirculation revealed two main phenomena of the circulation disturbance--juxtamedullary shunting and congestion. The interconnection between the degree of RAS activity and the type of the microcirculatory damage is established. The congestion was more frequently observed at the low and medium RAP values while the juxtamedullary shunting--at the high levels of the renin activity.

Alcoholic Intoxication↗
PubMed1976

Misdiagnosis and delayed diagnosis in traumatic intracranial haematoma.

Out of 51 patients with traumatic intracranial haematoma admitted to a teaching hospital 11 (22%) died undiagnosed, and out of 307 such patients transferred to the West of Scotland Regional Neurosurgical Centre 111 (36%) had been deteriorating for more than 12 hours in another hospital. In two-thirds of these cases the delay was due to an erroneous diagnosis, either of cerebrovascular accident or of alcoholic intoxication.

Alcoholic Intoxication↗
PubMed1998

Myocardial infarction in young people with normal coronary arteries.

Myocardial infarction occurring in young people with angiographically normal coronary arteries is well described but the pathophysiology of this condition remains unknown. Coronary artery spasm in association with thrombus formation and minimal atheromatous disease or spontaneous coronary artery dissection are possible causes. Two young men presented with severe chest pain after acute alcohol intoxication and each sustained an extensive anterior myocardial infarction. Investigations including intravascular ultrasound showed no evidence of atherosclerotic coronary artery disease. Coronary artery spasm associated with acute alcohol intoxication as well as prothrombotic state and endothelial damage related to cigarette smoking may be mechanisms leading to acute myocardial infarction in these cases. Acute myocardial infarction occurs in young persons with normal coronary arteries and the diagnosis should be considered in young patients presenting with severe chest pain, particularly those abusing cocaine or alcohol, so that reperfusion therapy can be initiated promptly.

Adult↗
PubMed1978

Morphological research on the male gonad in long-lasting alcoholization of rats.

The research was carried out on 64 male rats of the Wistar strain aged between 3 to 4 weeks and of an initial body weight of 150 to 300 g. The observed animals were divided into 4 experimental groups and for each individual group of alcoholized rats there was a separate control group. 40 animals in the experimental group were given 40% of ethyl alcohol in a dose of 3 g/kg body weight throughout a period of 13 days the 1. group, 51 days the II. group, 102 days the III. group and 204 days the IV. group. The last dose of alcohol was given 24 h before they were killed. The macroscopic appearance and the weight of the testicles was determined. The sections of testicles were stained with hematoxyline and eosine with the Azan method according to HEIDEN-HAIN and with Masson's Three-coloured stain. In each group the diemater of the seminal tubules was measured. A gradual decrease in the size and weight of the animal testicles was ascertained together with the prolongation of the duration of alcoholization. On the basis of my own observations one can suggest that, the narrowing of the seminal tubules light is one of the first noticeable results of the negative influence of ethyl alcohol on the gonad. In the microscopic preparations of the testicles of chronically alcoholized animals an inhibition in the spermio- and spermatogenesis, degenerative changes in the periphery of the spermatogenic epithelium were noticed. The intensification of the above described changes were observed to be dependent on the duration period of alcohol intoxication.

Alcoholic Intoxication↗
PubMed2006

Microalbuminuria: a marker of endothelial dysfunction in thermal injury.

INTRODUCTION: Systemic endothelial dysfunction (SED) and capillary leak occur following severe burn. SED can be assessed as low-level albuminuria (microalbuminuria) detectable only by sensitive immunoassay. This study compared the magnitude and duration of microalbuminuria with burn surface area and associated aggravating factors. METHODS: Serial urine specimens were collected from 2 to 36 h after injury from 43 adult burn patients with a mean total body surface area (TBSA) of 32% (range 15-68%) and during 44 episodes of wound manipulation within the same period. Urinary albumin was expressed as the albumin/creatinine ratio (ACR, normal <2.3 mg/mmol). RESULTS: Median ACR was highest 2h after injury (12.3 range 1.8-118 mg/mmol) returning to normal within 6 h. Full thickness burns (mean 17%) showed a significant association with ACR between 3 and 7h after burn. ACR was higher for up to 8 h in the presence of inhalation injury, alcohol intoxication or accelerant (p<0.05). ACR rose within 30 min of escharotomy or wound scrubbing (p<0.01). CONCLUSION: Severe burn produces variable SED which recurs with wound manipulation. Inhalation injury, alcohol intoxication and accelerant all showed a stronger association with SED than TBSA. Microalbuminuria provides a means of monitoring microvascular integrity during the early after injury period.

Adolescent↗