[The thiamine index as an integral indicator of the body allowance of vitamin B1]. / Tiaminovyi indeks kak integral'nyi pokazatel' obespechennosti organizma vitaminom B1.

One of the most wide-spread methods of evaluation of thiamine content in the body is determination of the activity of the thiamine pyrophosphate-dependent enzyme--transketolase--and so-called TPP-effect (the quantitative measure of unsaturation of transketolase with coenzyme). Absence of distinct correlation between the parameters in a number of cases calls for a search for the integral coefficient less dependent on the original dynamics of the given markers. Thus, we propose to use the thiamine index calculated by means of division of transketolase activity index expressed in absolute units by TPP-effect index expressed in relative units. The examples of thiamine index calculation and peculiarities of its interpretation with consideration of dynamic state of chronic alcoholics in abstinence and of patients with acute alcohol psychoses are shown.

[The new "alcohol marker" carbohydrate-deficient transferrin (CDT). Value for neurologic-psychiatric diagnosis]. / Der neue "Alkoholmarker" carbohydratdefizientes Transferrin (CDT). Stellenwert für die neurologisch-psychiatrische Diagnostik.

Many alcoholics deny any abuse, and hence it is often difficult to diagnose alcohol abuse. Laboratory parameters, such as gamma-glutamyltransferase (gamma-GT) and the mean corpuscular volume of erythrocytes (MCV), are often used to diagnose recent high alcohol intake. However, these parameters indicate elevated alcohol consumption only indirectly, e.g. if the elevation is due to an organ lesion caused by alcohol. In recent literature, CDT (carbohydrate-deficient transferrin) has been suggested as a most promising laboratory parameter indicating noxious alcohol consumption. The clinical value of CDT is compared to other "alcohol markers". CDT has the highest sensitivity and specificity in selected samples taken from alcoholics. However, the sensitivity of CDT is rather low in population surveys. Thus, CDT cannot be recommended for the screening of alcoholics. Furthermore, in view of the high cost of measurement, a close indication for application is urgent. Some examples of an indication in neurological and psychiatric diagnostics are critically discussed.

[ Indicators of thiamine content and energy homeostasis in alcoholic psychosis]. / Pokazateli obespechennosti tiaminom i 'energeticheskogo gomeostaza organizma pri alkogol'nyx psikhozakh.

In dynamics of acute alcoholic psychoses--delirium and hallucinosis-- considerable deficit of thiamine in the organisms of ill people that can not be compensated while desintoxicative treatment and signs of energy homeostasis changes and of deterioration of tissues reserves depending on the type of psychoses were determined. Pathogenic peculiarities of the revealed disorders were analysed, possible compensative mechanisms connected in particular with the rise of pyruvate utilization speed and activation of glyconeogenesis while leaving the psychotic state were considered.

Assessment of diazepam loading dose therapy of delirium tremens.

The efficacy of the diazepam loading dose method of treatment of delirium tremens was assessed in comparison with the traditional therapy. The experimental group and the control group comprised 51 and 45 patients respectively. The clinical institute withdrawal assessment for alcohol (CIWA-A) scale was applied to assess the intensity of the symptoms. Diazepam doses in the experimental group oscillated from 40 to 210 mg (mean 86.9 +/- 47.2 mg). The control group was receiving diazepam and other psychotropic drugs in divided doses. In the experimental group deliric symptoms were present from 2 to 24 h (mean 6.9 +/- 4.8 h), and in the control group from 2 to 123 h (mean 33.8 +/- 25.7 h). The results show a large efficacy of the loading dose method corresponding to substantial reduction of the psychosis duration (fivefold in comparison to the control group). The method proved to be safe, with no significant complications.

Decrease in alcohol tolerance: clinical significance in alcohol dependence.

In 237 male inpatients with alcohol dependence, clinical, demographic and biochemical data were analyzed in relation to alcohol tolerance. All subjects had a history of marked tolerance. At the time of assessment, 46% of subjects continued to meet the criteria for marked tolerance and 54% of the subjects reported a loss or decreased tolerance. Subjects with decreased tolerance were older than those with high tolerance and had a longer duration of illness. The age of onset was similar in both groups. Patients with decreased tolerance had more mental confusion and psychotic symptoms, and were less likely to be currently married.

Spiperone binding capacity in lymphocytes of patients with alcohol- and drug-induced psychosis: preliminary results.

An increased spiperone binding capacity in lymphocytes has been proposed as a possible biological marker for schizophrenia while in previous studies patients with alcohol dependence were shown to have a normal binding capacity. In a pilot study the spiperone binding capacity was studied in 8 patients with alcohol hallucinosis, 11 patients with acute drug-induced psychosis and 12 patients with other organic psychosis. An increased binding capacity, defined as > 4 fmol/l E6 cells, was found in only 1 patient with alcohol hallucinosis, 3 patients with drug-induced psychosis and 2 patients with other organic psychosis. Possible implications of these findings for future research are discussed.

[The specific electric conductivity of erythrocyte ghosts and hemoglobin in alcoholism]. / Udel'naia élektroprovodimost' "tenei" éritrotsitov i gemoglobina pri alkogolizme.

Changes of electric conductivity of red cell shadows and hemoglobin were measured in 36 alcoholics in various periods of abstinence. Electric conductivity varied as a function of temperature [sigma (T)]. It was compared with viscosity of red cell shadows suspensions and some indexes of red blood. The absolute values of red cell shadows and hemoglobin electric conductivity in alcoholics were higher than in controls in the whole temperature range (34-41 degrees C), being associated with decreased temperature coefficient (delta sigma/delta T). Over the treatment the absolute values of sigma decreased and delta sigma/delta T increased. In normal subjects the curves sigma (T) had a wave within the temperature range 37-38 degrees C which apparently reflected the phasic transition. In alcoholics the wave on the curves sigma (T) either disappeared or showed abnormal variations at 36 and 38 degrees C during the acute period of abstinence. Two weeks later the only variation at 37 degrees C appeared, its intensity increasing with prolongation of abstinent period. The changes seen in the curves sigma (T) correlated with peculiarities of red cell viscosity in the temperature range 34-41 degrees C.

[Value of serum immunoglobulin assays in early myocardial infarction]. / Intérêt du dosage des immunoglobulines sériques lors de l'installation d'un infarctus du myocarde.

Serum immunoglobulin (Ig) levels were assayed in 672 patients admitted for acute myocardial infarction with onset within 24 hours of hospitalization. Supranormal Ig levels (A > or = 300, G > or = 1,200) or subnormal Ig levels (M < 40 mg/100 ml) were seen in patients with one or several risk factors (diabetes mellitus, alcohol abuse) or a history of previous myocardial infarction. Patients with one or more Ig anomalies were more likely to exhibit unfavorable outcomes, including early death, suggesting that increased viscosity due to aggregation of Ig molecules may occur.

Effective pharmacotherapy of alcoholic amnestic disorder with fluvoxamine. Preliminary findings.

Ten patients with alcoholic chronic organic brain disease were categorized as having alcohol amnestic disorder, or Korsakoff's psychosis (n = 6), dementia associated with alcoholism (n = 3), or compensated alcoholic liver disease (n = 1). All patients had severe deficits in memory for recently acquired information (episodic memory). Patients with alcohol dementia also showed global intellectual decline, including decreased performance on measures of semantic (knowledge) memory and reduction in levels of cerebrospinal fluid somatostatin. In a 4-week double-blind crossover design, the serotonin-uptake blocker fluvoxamine maleate (100 to 200 mg/d) was found to improve episodic memory in only the patients with alcohol amnestic disorder. These improvements in memory were significantly correlated with reductions in levels of cerebrospinal fluid 5-hydroxyindoleacetic acid, suggesting that facilitation of serotonergic neurotransmission may ameliorate the episodic memory failure in patients with alcohol amnestic disorder.

Plasma opioids in alcoholics after acute alcohol consumption and withdrawal.

Beta-endorphin (beta-EP) and beta-lipotropin (beta-LPH) plasma concentrations were examined in ten chronic alcohol abusers, eight men and two women aged 25-56 years with histories of continuously elevated ethanol consumption dating from 5-30 years. Plasma levels of the two peptides were measured after acute alcohol consumption and then after 3, 6 and 9 days of forced abstinence, during chlordiazepoxide treatment. Beta-EP and beta-LPH concentrations were normal on all four occasions. A reduced sensitivity of opioid receptors to acute alcohol administration due to chronic alcohol consumption is suggested.

[Status of erythrocytes and erythropoiesis in alcoholics]. / Sostoianie krasnoi krovi i éritropoéza u bol'nykh alkogolizmom.

To identify changes in the status of red blood and erythropoiesis in alcoholism, the authors examined three groups of patients aged 18 to 60 years: (1) 146 patients with stage II alcoholism; (2) 97 patients with acute alcoholic hallucinosis; and (3) 76 patients with delirium tremens. The examination revealed a considerable tension of erythropoiesis and erythrodieresis, this being a compensatory response to prolonged and severe hypoxia. At the beginnings of the disease the amount of erythrocytes and total hemoglobin tended to increase, then with the development of psychoses it dramatically decreased resulting in anemia. With disease progression the mean volume of erythrocytes tended to increase consistently reaching the highest values in delirium. This may serve as one of the diagnostic markers of alcoholism to be used in combination with other laboratory tests and clinical findings. The identified decrease in the insulin depositing function of erythrocytes may also indicate that the pancreas has also been involved in the pathological process.

[Relationship between the cyclic nucleotide content of blood plasma and the clinical course of chronic alcoholism]. / Issledovanie zavisimosti mezhdu soderzhaniem tsiklicheskikh nukleotidov v plazme kvori i klinicheskim techeniem khronicheskogo alkogolizma.

In patients with chronic alcoholism out of abstinence the plasma cAMP concentration was shown to decrease and that of cGMP to increase, cAMP/cGMP ratio was 1.8 in contrast to control value of 4.2. During abstinence the plasma cAMP level was higher and cAMP/cGMP ratio in patients with abstinence was 3.1. In patients with acute hallucinosis the plasma cAMP level was lower but during delirium, on the contrary, as well as the plasma cGMP level, higher than in control. The treatment of alcoholic patients relieved clinical symptoms of abstinence but the plasma cyclic nucleotide levels didn't change significantly. In most patients after cessation of delirium the plasma cAMP level was significantly lower as compared with pretreatment level.

Beer potomania: an unusual cause of symptomatic hyponatremia.

A 43-year-old woman presented to the emergency department with acute agitation, confusion, and tonic seizures. She had a history of drug abuse, most notably beer, which constituted her major dietary intake. The patient's seizures were at first thought to be factitious in association with an acute psychosis; however, her serum sodium concentration was 110 mEq/L and urine sodium was 14 mEq/L. The patient responded to IV hypertonic saline and subsequently recovered completely. Beer potomania, the most likely etiology for this patient's hyponatremia, is a rare disorder in which dietary sodium and protein insufficiency lead to dilutional hyponatremia.

[Changes in the aggregative properties of the erythrocytes in chronic alcoholism]. / Dinamika izmenenii agregatsionnykh svoistv éritrotsitov krovi pri khronicheskom alkogolizme.

On the basis of examination of 50 alcoholics the authors have established that alcoholism is associated with impairments of the aggregational properties of blood erythrocytes expressed in a persistent and marked increase of aggregation and the appearance of enlarged massive aggregates. The severity of aggregation disturbances depends not only on the presence of the abstinence syndrome but is also closely related to the stage of alcoholism, becoming more gross in the progressive course with signs of encephalopathy, and directly correlates with severity of psychotic symptoms.

[Clinical pharmacokinetics of mebikar. Computation of individual dosage regimens]. / Klinicheskaia farmakokinetika mebikara. Raschet individual'nykh rezhimov dozirovaniia.

The authors review the principles of calculating the optimal dosage regimens of mebicar used in the treatment of borderline psychopathological abnormalities in alcoholics. Mebicar administered to patients according to the calculated dosage regimens ensures the positive clinical effect. This is supported by the clinicopsychopathological and electrophysiological data.

Dexamethasone suppression test in recently detoxified alcoholics: clinical implications.

An overnight dexamethasone suppression test (DST) was performed on 66 nondepressed primary alcoholics, a mean of 20.79 +/- 11.5 days after last alcohol intake. The Beck Depression Inventory (BDI) was given concurrently. Only 6% of the subjects were nonsuppressors. There was no correlation between cortisol levels at 17 and 24 hours postdexamethasone and the age of the subjects or duration of abstinence. There was a low level correlation between cortisol values at 24 hours and the BDI scores. Review of published data indicates that the DST may be abnormal in alcoholics in the first 2 weeks of abstinence, probably a result of abnormal liver function and withdrawal phenomena. DST response of alcoholics resembles that of normal controls after more than 2 weeks of abstinence. Alcoholics with clinical features of depression and an abnormal DST after 2 weeks of abstinence may be candidates for antidepressant therapy or electroconvulsive therapy.