Elevated serum levels of S-100B reflect the extent of brain injury in alcohol intoxicated patients after mild head trauma.

Elevated systemic levels of S-100B are proposed as a potential indicator of brain damage in identifying high-risk patients after mild head trauma (MHT). Although incidence of alcohol intoxication is high in these patients, the influence of alcohol intoxication on S-100B levels is unclear. Therefore, the aim of our study was to investigate serum concentrations of S-100B in intoxicated (group 1) and sober (group 2) patients after MHT in comparison with those of mild (group 3) or severely intoxicated (group 4) individuals without trauma. S-100B was significantly increased in MHT patients exhibiting posttraumatic lesions in initial cranial computed tomography scan. Alcohol intoxication did not elevate S-100B levels in group 3 or 4 subjects. Our data indicate for the first time that alcohol intoxication does not influence the diagnostic value of S-100B measurements in patients after MHT.

[Alcohol--forensic aspects]. / Alkohol--forensische Aspekte.

Alcohol (resp. ethanol) in forensic medicine includes mainly the following areas and fields of problems: analysis (in particular blood- and breath alcohol), ability to drive resp. DUI/DWI, impairment of responsibility, alcohol use, abuse and dependence, intoxication, alcohol as direct and indirect cause of death and organ damage. A short overview presents these problem areas of alcohol use and misuse as well as results of alcohol research ("ethanology") which may be relevant for clinical use.

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.

Carbohydrate-deficient transferrin is not affected by serum separators.

We studied the possible effects on serum carbohydrate-deficient transferrin (CDT) determination by a CDTect (Pharmacia) method of serum isolation in four different types of blood-collection tubes, namely: (1) glass tubes (glass Vacutainer tubes with no additive); (2) S-Monovette Neutral tubes (plastic tubes with no additive); (3) S-Monovette Serum tubes (plastic tubes with kaolin-coated plastic granulate coagulation accelerator); and (4) S-Monovette Serum/Gel tubes (plastic tubes with kaolin-coated plastic granulate and a polymerized acrylamide resin). Using Passing and Bablok regression analysis, we did not observe significant differences in CDT concentrations determined in 58 serum samples using any of these four blood-collection systems.

Nonoxidative ethanol and methanol changes in the heart and brain tissue of alcohol abusers.

Fatty acid ethylesters (FAEE) are synthesized from ethanol and fatty acids in the heart and brain. Similarly fatty acid methylesters (FAME) are synthesized from methanol and fatty acids. Whereas methanol reportedly indicates recent or chronic consumption of alcoholic beverages, an elevated serum methanol concentration (SMC) indicates mainly chronic alcohol intake. We compared levels of FAEE and FAME in cardiac and brain tissues with the blood ethanol concentration(BEC) and SMC in 18 alcohol abusers and 29 control subjects without history of alcohol abuse(control) to clarify the relationships between BEC and FAEE levels and that between SMC and FAME levels. We also assessed the possibilities of discriminating the alcohol abusers from the control group and of detecting FAEE and FAME accumulations in cardiac and brain tissues. Levels of FAEE and FAME were determined by gas chromatography (GC) in autopsied cardiac and brain tissues. Heart FAEE (HFAEE) levels correlated with BEC (r = 0.61) and it was possible to distinguish between alcohol abusers and controls using discriminant analysis. HFAEE levels in the alcohol abusing group were elevated even with low BEC. Therefore, HFAEE levels indicate ethanol accumulation in cardiac tissues of alcohol abusers. Brain FAEE (BFAEE) and heart and brain FAME (HFAME and BFAME) levels did not correlated closely with BEC and SMC, respectively. However, there are some possible means of discriminating between the two groups in terms of BEC and BFAEE, and SMC and FAME respectively, using discriminant analysis. Employing this analysis, the rate of misclassification was 17-25.5%. The mean levels of HFAEE, BFAEE, HFAME and BFAME were higher in the alcohol abusing group than in the control group, even when their BEC and SMC were quite low.

[Effect of low alcohol concentrations on visual attention in street traffic]. / Wirkung niedriger Alkoholkonzentrationen auf das Blickverhalten im Strassenverkehr.

There is currently public discussion as to whether the legal limit of blood alcohol concentration of drivers might be reduced from 0.8% to 0.5%. To acquire information concerning this problem, we measured temporal parameters of saccades and analysed the overall eye-movement behaviour with various blood ethanol concentrations. Eye movements were registered with an IR eye tracker and analysed while the subjects followed a randomly moving stimulus on a CRT screen and during presentation of a realistic traffic scene of 4 min duration on a TV screen. Alcohol has a significant effect on latency, velocity and accuracy of saccades, even at low concentrations between 0.4% and 0.6%. Because of the altered "gaze activity", the inflow of visual information is reduced in a state of inebriation. Our results are a further argument for reducing the legal limit of blood alcohol concentration to 0.5%.

[Isopropanol and acetone level in serum after preoperative surface disinfection with antiseptics containing isopropanol]. / Isopropanol- und Acetonspiegel im Serum nach präoperativer Flächendesinfektion mit isopropanolhaltigen Antiseptika.

After preoperative skin disinfection in pediatric surgery, serum levels of isopropanol up to 12.2 mg/l (MW 5.0 mg/l +/- 3.37, n = 26) were found. They result from a rapid and prolonged but uncharacteristic percutaneous resorption of the isopropanol-containing disinfectant. In about 50% of the cases, serum levels of acetone showed an increase up to 82 mg/l already before skin disinfection, presumably caused by preoperative starvation. After skin disinfection, raised acetone levels were found in 19 of 26 cases. As increased isopropanol and acetone levels are discussed as alcoholism markers, a falsification of congener analysis after skin disinfection, e.g. in cases of adult victims of accidents, has to be taken into consideration. Endogenous serum levels of methanol (0.87 mg/l +/- 0.49), ethanol (0.32 mg/l +/- 0.09), acetaldehyde (0.31 mg/l +/- 0.10) and others remained unaffected. Some uncharacteristic elevations of propanol-1 levels are caused by contaminated rubber caps.

[Change in congener analysis caused by percutaneous absorption of propanol-containing antiseptics]. / Veränderung von Begleitstoffanalysen durch percutane Resorption propanolhaltiger Antiseptika.

According to the forensic literature, an alteration of blood alcohol concentration through alcohol disinfection before venepuncture is unlikely, however, percutaneous resorption of alcohol containing antiseptics is well documented. There are no investigations available, elucidating to what extent this is also correct for congener alcohols, particularly propanol-1/-2, which have serum levels in range of mg/l. In experiments with surgical hand and local skin disinfection, carried out with and without oral alcohol, relevant levels of propanol-1/-2 between 0.2 and 2 mg/l were measured. We conclude, that the routine clinical use of antiseptics is able to alterate and to falsify congener levels and can lead to incorrect interpretation of congener analysis.

[Statistical approach to forensic conversion values for alcoholics]. / Statistiche Annäherung an forensische Rückrechnungswerte für Alkoholiker.

With collaboration of the study groups from Tübingen, Munich and Kiel and consideration of the results of Bonnichsen et al 1968, alcohol elimination curves of 98 alcoholics were subjected to a joint evaluation for determination of the beta 60 values. The average elimination rate was 0.21 g/kg/h (s = 0.05 g/kg/h). By analogy to average beta 60 values and back-conversion factors of nonalcoholics, the limit values for alcoholics were estimated as being between 0.12 g/kg/h (minimum value) and 0.29 g/kg/h (maximum value).

[Methanol metabolism in chronic alcoholism]. / Methanolstoffwechsel bei chronischem Alkoholismus.

Serum methanol concentrations (SMC) exceeding 10 mg/l are highly suggestive of long-term alcohol intoxication and can be considered as marker for chronic alcohol abuse. Endogenously formed or consumed methanol is almost exclusively metabolized by alcohol dehydrogenase. As long as blood alcohol concentrations exceed 0.2-0.5 g/l methanol cannot be metabolized and accumulates. In a prospective study on 78 patients admitted for alcohol detoxification, elevated SMC up to 78 mg/l were found, with a mean SMC of 29.4 mg/l. No correlation was demonstrated between SMC and severity of the alcohol withdrawal syndrome. Further clinical, forensic and biochemical aspects of methanol metabolism are discussed.

The role of coagulation, fibrinogenolysis and fibrinolysis in the development of fluid and clotted cadaver plasma.

Parameters for coagulation, fibrinogenolysis and fibrinolysis were measured in order to understand the formation of fluid or clotted cadaver plasma. All values found were distinctly elevated without significant differences between fluid and clotted material. The electrophoretic banding pattern of the fibrinogen and fibrin material also proved extensive coagulation and fibrinolysis in all cases. In vitro experiments in which similar electrophoretic banding patterns were obtained suggested that the development of fluid cadaver plasma depends on the activation of fibrinolysis prior to complete coagulation, and is enhanced by persistence of circulation as well as a physiological pH (7.4). In correspondence to post mortal time only an increase in elastase values was found.

[Fatal hemorrhage from an isolated scalp injury]. / Tödliche Verblutung aus isolierter Kopfschwartenverletzung.

By means of 3 casuistics it is illustrated, that fatal bleeding from a single scalp injury can occur under special preconditions. Beside signs of massive loss of blood at the place of discovery and on the corpse, particularly chronic and acute alcohol intoxication with presumably impaired coagulation and prospective anemic history play a dominant role in these courses.

Changes in trabecular bone, hematopoiesis and bone marrow vessels in aplastic anemia, primary osteoporosis, and old age: a comparative histomorphometric study.

Retrospective histologic analyses of bone biopsies and of post mortem samples from normal persons of different age groups, and of bone biopsies of age- and sex-matched groups of patients with primary osteoporosis and aplastic anemia show characteristic age dependent as well as pathologic changes including atrophy of osseous trabeculae and of hematopoiesis, and changes in the sinusoidal and arterial capillary compartments. These results indicate the possible role of a microvascular defect in the pathogenesis of osteoporosis and aplastic anemia.

Effects of ethyl alcohol on the electrooculogram and color vision.

Color vision tests and electrooculography (EOG) were performed in 6 male and 2 female healthy young trichromatic volunteers between 60 and 130 min after finishing consumption of ethyl alcohol leading to blood levels of approximately 0.07% to 0.16%. The average number of errors in the desaturated Panel D-15 arrangement test rose from 0.86 to 2.0; the average error score in the Farnsworth-Munsell 100-Hue test rose from 26 to 79. The axis of errors in both tests was clearly tritanopic and tetartanopic, pointing to a specific effect of ethyl alcohol on the function of blue-sensitive cones and/or their interaction with longer wavelength-sensitive cones. Ethyl alcohol decreased the size of the light-peak, apparently in a dose-dependent fashion, in each of the 16 eyes by values between 3% and 79%. The effect of alcohol on the EOG light peak was stronger between 30 and 95 min (23% decrease in average) than between 95 and 130 min (14% decrease) after the finish of alcohol administration.

[Perceptual disorders of the peripheral visual field caused by alcohol. Studies with the automatic Octopus perimeter]. / Wahrnehmungsstörungen im peripheren Gesichtsfeld unter Alkoholeinfluss. Untersuchungen mit dem automatischen Perimeter Octopus.

The present paper reports on examinations of temporal visual field perimetry with the Octopus computer-controlled automatic perimeter (Program 51). Nine subjects were tested under normal conditions and after consumption of alcohol. The Octopus represents a static examination method employing the grid perimetry principle. Under the influence of alcohol 7 subjects with blood alcohol concentrations of over 1 0/00 had visual fields which were concentrically restricted to various degrees, with relative scotomata centrally to the concentric restriction. In paired comparisons, reductions in sensitivity to light were found which were statistically highly significant. Previous investigations, conducted exclusively with kinetic perimeters, were unable to demonstrate the subjectively perceived concentric restriction of the visual field ("tunnel vision") following consumption of alcohol.