Psychiatric prognostic factors in patients with alcohol-related end-stage liver disease before liver transplantation.

UNLABELLED: Discussion of selection criteria for liver transplantation in alcoholics has been controversial. The concern that there might be a return to alcohol misuse after transplantation which would cause non-compliance with post-transplantation management is not supported by recent reports. Six months of abstinence have been required generally as exclusion criterion, no other psychiatric prognostic factors have been evaluated up to now. METHODS: In 39 consecutive patients with alcohol-related end-stage liver disease who were referred to the Surgical University Clinic of Vienna for transplantation the psychiatric prognostic factors abstinence for at least six months, motivation (defined as combination of insight into the necessity of abstinence and readiness for alcohol dependence treatment) and compliance (which was stated to be positive if the psychiatric counselling dates were kept by the patients) were evaluated regarding survival for at least one year. RESULTS: Abstinence of at least six months failed to prove to be a positive influence on survival. In contrast, motivation and compliance proved to be good psychiatric prognosis parameters.

Depression and relapses in treated chronic alcoholics.

In a sample of 99 male alcoholics at an alcoholics' rehabilitation clinic we recorded drinking/abstinence behavior and depression up to 1 year after discharge. Seventy-eight patients completed the inpatient therapy, and of these, 39 respondents were recorded up to the final follow-up point. Generally, the initial, markedly elevated depression scores had declined significantly by the end of the inpatient treatment. In the abstainers, the depression scores continued to fall after release and remained low throughout the entire observation period. In patients who resumed alcohol use, relapses were accompanied by immediate, sharp increases in the scores, but declined upon a return to abstinence.

Hormonal derangements in patients with severe alcohol intoxication.

Controversial results of fluid and electrolyte derangements in patients with moderate alcohol intoxication have been described. However, no information is available about severe alcohol intoxication. We investigated differences of hormonal disorders between alcohol-habituated and alcohol-naive subjects with severe ethanol intoxication. The hormonal derangements and recommendations on therapy of these patients are discussed. Thirty-three patients [10 alcohol-naive (group A) and 23 alcohol-habituated (group B) subjects] with severe alcohol intoxication (blood ethanol > 200 mg/dl) were selected for the study. Electrolytes and osmolarity of serum and urine, blood ethanol, vasopressin, renin, and aldosterone were determined on admission 2, 4, and 6 hr later. Fluid balance was calculated for each hour. All patients received isotonic saline solution according to urine production. Group A: On admission, serum osmolarity was increased (308 mOsmol/kg). Concomitantly, vasopressin level was elevated on admission (9.12 pg/ml). Increased serum osmolarity was correlated with elevated vasopressin levels (r = 0.8211; p < 0.005). Serum electrolytes, renin, and aldosterone values were within normal ranges. Group B: On admission, vasopressin level was significantly decreased (0.9 pg/ml), despite an elevated serum osmolarity (309 mOsmol/kg). Serum osmolarity remained high despite a sufficient fluid substitution. In addition, vasopressin level remained suppressed over the observation period. Aldosterone level was significantly increased on admission (319 ng/ml). Accordingly, serum sodium was increased from 142 to 148 mM/liter, and serum potassium was decreased from 3.9 to 3.4 mM/liter. Response to hyperosmolarity due to severe alcohol intoxication is different in alcohol-naive and alcohol-habituated subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevalence of alcohol drinking in Alpine skiing]. / Erhebung der Prävalenz des Alkoholgebrauchs beim alpinen Skisport.

UNLABELLED: Previous investigations showed direct correlation between the degree of alcoholization and the severity of injuries after ski accidents. The aim of our study was to investigate the prevalence of alcohol use on slopes and on ski tours. RESULTS: The examination of breath in 414 probands proved 30% alcohol positive ski tourists. A significantly higher frequency of alcohol positive skiers was found on tours, if an open mountain hut was located on the tour, but the mean degree of alcoholization was significantly higher on slopes.

[Amphetamine doping in leisure-time mountain climbing at a medium altitude in the Alps]. / Amphetamindoping beim Freizeitbergsteigen in mittlerer Höhenlage in den Alpen.

Although doping in leisure sports may potentially be of relevance for medical emergency situations, it has attracted much less attention than doping in elite athletes. The aim of our study was to evaluate the prevalence of amphetamine consumption in medium altitude mountaineering. Urine samples were taken from 253 males after a successful ascent. Analysis for amphetamines proved positive for 7.1% of mountaineers climbing above 3300 m. On peaks between 2500 to 3300 meters above sea level, 2.7% of the mountaineers we examined had amphetamines residues in their urine. Below 2500 meters, no positive sample was detected. For tourists living outside of the Alpine range, we noticed a significantly higher proportion of positive analyses. We conclude that attempts to induce a higher performance level by pharmacological means are not overly uncommon in leisure mountaineering. Such a behaviour may be of medical relevance in emergency situations.