Hiroyuki Imamichi

Long-term outcome in 306 males with alcoholism

Abstract The subjects of this study were 306 male alcoholics who lived in Osaka, Japan, and who were initially diagnosed with alcoholism at a psychiatric institution between 1972 and 1983. Follow‐up studies were done on three occasions: 1 March 1985 (Time 1), 1 November 1988 (Time 2) and 1 March 1992 (Time 3). We followed up 232 (75.8%) of the 306 male alcoholics. By the end of the study period 110 (35.9%) of the subjects were deceased. Regarding cross‐sectional sobriety status, from Time 1 to Time 3 the complete abstinence rate changed from 16.0 to 18.6%, excessive drinking rate was from 13.1 to 9.8%, and controlled drinking rate was from 6.9 to 9.8%. The longitudinal sobriety status of 122 living patients during the 5 years before the close of this study were: rate of stable abstinence, 28.7%; unstable abstinence, 21.3%; controlled drinking, 12.3%; and relapse 37.7%. Such variables as being without public assistance at the time of the initial diagnosis of alcoholism and attending a self‐help group soon after the initial treatment were associated with stable abstinence. Age (20–39 years) and receiving outpatient treatment at the time of the initial treatment also emerged as predictors of survival. However, those variables, except attending a self‐help group soon after the initial treatment, might merely indicate severity of alcoholism. For improving treatment results, it may be most important to provide a treatment environment within the residential area so that alcoholics may receive treatment at an early stage of alcoholism and attend a self‐help group.

Individual difference in urinary excretion of salsolinol in alcoholic patients

Urinary excretion of salsolinol (6,7-dihydroxy-1-methyl-1,2,3,4-tetrahydroisoquinoline) in 30 male alcoholic patients during the withdrawal period was determined. They were divided into two groups, i.e., Group A with 14 subjects had a high level of urinary salsolinol (51.9 +/- 40.8 ng/mg creatinine) on admission to a hospital, and Group B with 16 subjects showed a low level of the substance (3.9 +/- 1.9 ng/mg creatinine). Following a sustained drinking bout, urinary salsolinol in Group A declined to a normal level within a few days. We found that the subjects in Group A showed a greater excretion of urinary dopamine and norepinephrine than those in Group B. There were no differences between the two groups in levels of blood ethanol, serum GOT, GPT and gamma-GTP.

Cause‐specific mortality risk among male alcoholics residing in the Osaka metropolitan area

Abstract We evaluated the mortality risk among 306 male alcoholics living in Osaka, Japan, at the time of initial diagnosis between 1972 and 1983, with regard to the cause of death, length of time from diagnosis, and participation in an alcohol abstinence self‐help group. By the closing date on 1 March 1992, 110 of the 306 alcoholics had died, yielding an observed‐to‐expected (O/E) ratio of 4.5 [95% confidence interval (CI) = 3.7–5.4]. The alcoholics had significantly elevated mortality risks from all malignant neoplasms (O/E = 2.1, 95%CI = 1.2–3.3), esophageal cancer (O/E = 8.4, 95%CI = 1.7–24.5), diseases of the circulatory system (O/E = 4.4, 95%CI = 3.0–6.2), liver cirrhosis (O/E = 15.9, 95%CI = 10.2–23.6), diseases of the genitourinary system (O/E = 6.3, 95%CI = 1.3–18.5), and external death (O/E = 10.3, 95%CI = 6.3–15.8). The mortality risk from all causes still remained significantly high beyond the tenth year following initial diagnosis (O/E = 2.6, 95%CI = 1.0–6.2). The mortality risks from liver cirrhosis and external death (such as suicide) were highest within the first year following diagnosis, and were still high beyond the tenth year. A significantly high mortality risk from diseases of the circulatory system was observed between the first and ninth years, and the mortality risk from all malignant neoplasms was significantly elevated beyond 10 years following diagnosis. Alcoholics who did not join a self‐help group soon after the initial institutional treatment had different cause‐specific and time‐specific mortality risks from those who did join a self‐help group. These findings show the importance of long‐term clinical follow‐up of male alcoholics, taking into consideration the cause‐specific mortality.

Cholesterol Hydroperoxides in Erythrocyte Membranes of Alcoholic Patients

Evidence for the presence of 5α-hydroperoxycholest-6-en-3β-ol (cholesterol 5α-hydroperoxide, Ch 5α-OOH) and 7α- and 7β-hydroperoxycholest-5-en-3β-ols (cholesterol 7-hydroperoxides: Ch 7α-OOH and Ch 7β-OOH, respectively) in human erythrocyte membrane was found. Blood samples were collected from alcoholic patients and healthy volunteers (controls), and their cholesterol hydroperoxides were analyzed by high-performance liquid chromatography postcolumn chemiluminescence and roughly identified by liquid chromatography-mass spectrometry. Ch 7α-OOH and Ch 7β-OOH were present in each sample, being significantly higher in alcoholic samples than in control samples. Ch 5α-OOH was present in some alcoholic samples, but not in the control ones. The accumulation of cholesterol hydroperoxides suggests enhanced lipid peroxidation by active oxygen species and/or a reduced elimination system for lipid peroxide in alcoholic patients.

Abnormality of very long-chain fatty acids of erythrocyte membrane in alcoholic patients

Profiles of very long-chain fatty acids were studied in the erythrocyte membrane of five alcoholic patients. We identified three fatty acids as cis-16-pentacosenoic acid (C25:1), cis-17-hexacosenoic acid (C26:1), and hexacosenoic acid (C26:1), and hexacosanoic acid (C26:0) by gas chromatography-mass spectrometry. The ratios of C26:1/C22:0, C26:0/C22:0, C24:1/C22:0, and C24:0/C22:0 were increased. These findings suggest that active oxygen species or free radicals generated by chronic alcohol consumption in alcohol patients interrupt the peroxisomal beta-oxidation of fatty acids, because very long-chain fatty acids are mainly metabolized by the peroxisomal beta-oxidation system. This is the first study showing accumulation of very long-chain fatty acids in the erythrocyte membrane of alcoholic patients.

Induction Factors Related to the Severity of the Alcohol Withdrawal Syndrome

M. Victor et al. (1953, 1973) evidenced the time of onset of each withdrawal symptom, and divided the alcohol syndrome into minor and major withdrawal syndromes based on their detailed clinical observations. Subsequently, a good many of the studies on induction factors of the acute withdrawal syndrome have been published; viz., alcohol consumption and drinking period (M. Victor and R.D. Adams, 1953; H. Isbell et al. 1955; K.C. Powell, 1979), drinking pattern (J.H. Mendelson and N.K. Mello, 1970), food intake (J.H. Mendelson, 1970), gastrointestinal symptoms (N.K. Mello, 1972), etc.