The influence of the luteal and follicular phases on major pharmacokinetic parameters of blood and breath alcohol kinetics in women

Drink tests involving 14 women were carried out to determine the effects of the menstrual cycle phases on the pharmacokinetics of ethanol. One experiment was carried out in the follicular phase of the cycle and another in the luteal phase, with the estradiol, progesterone, and testosterone levels being determined in both cases. The target concentration was a final blood alcohol concentration (BAC) of approximately 0.08g%. After drinking was completed, concurrent BAC and breath alcohol concentration (BrAC) measurements were carried out at intervals of 10-20min. The ethanol elimination rate was determined by calculating a linear function in the part of the slope that was clearly linear. In addition, the c(0) and Widmark factors r were calculated. In 10 of the volunteers, who had a normal increase in progesterone in the luteal phase, the average hourly elimination rate ss(60) in the follicular phase amounted to 0.0194+/-0.0020g%/h (BAC) and 0.0975+/-0.0068mg/L/h (BrAC), and in the luteal phase to 0.0193+/-0.0031g%/h (BAC) and 0.1026+/-0.0101mg/L/h (BrAC). There was no significant difference. Other pharmacokinetic parameters (c(0) concentrations, Widmark factors r, distribution volumes, maximal BAC, mean absorption rate, time until the peak concentrations were reached) also revealed no significant differences between the blood and breath alcohol levels of the luteal and follicular phases. In addition, no significant correlations were observed between the absolute progesterone level and the respective elimination rates ss(60).

[Perioperative fatal bleeding: link between acetabular anchoring of a cementless implant]

This case report concerns a 75-year-old patient who suffered haemorrhagic shock and mors in tabula during implantation of a total hip arthroplasty. The cause was established as an injury of the external iliac vein, probably as a result of the predrilling of holes for the anchoring screws and pegs. The surgical method and topographic anatomy of the operating area are presented. Such vascular injuries are a rare but life-threatening complication of this procedure; the literature quotes a frequency of about 0.3%. So far, no fulminate venous bleeding process has been reported. Complications in such operations cannot always be avoided. However, detailed knowledge of the acetabular geometry can provide more safety for the surgeon when carrying out the secondary anchoring of a press-fit implant.

Ethanol elimination rates in men and women in consideration of the calculated liver weight

The purpose of the study was to examine gender differences on the pharmacokinetics of ethanol. Sixty-eight healthy men and 64 healthy women with normal body mass indexes received between 0.79 and 0.95 g ethanol/kg body weight in the form of their choice after they had eaten a "typical" breakfast. The aimed concentration for both genders was a blood alcohol concentration C(0) of 0.104 g/dl. Blood samples in the elimination phase were taken in 10- to 20-min intervals beginning after completion of absorption. The maximum blood ethanol concentration was 0.0819+/-0.0184 g/dl for women and 0.0841+/-0.0155 g/dl for men. The hourly ethanol elimination rate, calculated over a linear function, in blood of 0.0179+/-0.0030 g/dl/h in women was significantly higher than the 0.0159+/-0.0029 g/dl/h for men (P<.0001). In relation to the liver weight, the hourly elimination rates were 5.008+/-0.678 g/kg liver/h for women and 4.854+/-0.659 g/kg liver/h for men, and were not statistically significant. The different liver masses as calculated in relation to the distribution volume account for the differing ethanol elimination rates between men and women.

[Cerebral hemorrhage after the consumption of amphetamine]

Cerebral hemorrhages are rare complications that occur after the consumption of amphetamine; the mortality rate is estimated at 50 %. It is assumed that cerebral hemorrhages are caused by amphetamine-induced hypertensive crises coinciding with pre-existing vascular alterations (congenital vascular malformations, vasculitis). In the present case report, a 40-year-old man, who is said to have regularly consumed hashish, heroin and speed, died of a massive cerebral hemorrhage located in the region of the basal ganglia shortly after the intravenous administration of amphetamine and heroin. In the course of the post-mortem investigation, neither vascular malformations nor vasculitis could be detected in the brain. Even if the evidence for the existence of such alterations was missing, this does not exclude their presence for certain. Other potential amphetamine-induced vascular alterations are discussed.

Concentration dependency of the BAC/BrAC (blood alcohol concentration/breath alcohol concentration) conversion factor during the linear elimination phase

According to the theoretical pharmacokinetical considerations put forward by Wehner et al. the BAC(ven)/BrAC conversion factor Q is not a constant value and varies depending on the pharmacokinetic phase deduced from the alcohol concentration curve. Based on these considerations we propose that Q must be inversely proportional to the BrAC during the postabsorptive linear elimination phase, expressed as the hyperbola Q=1/kappa+(CT)/BrAC. The constants kappa or 1/kappa and (CT)--where (CT) consists of different parameters which remain constant during the linear elimination phase--can be experimentally determined from the linear relationship BrAC = kappaBAC(ven)-kappa(CT). To test this hypothesis 12 human volunteers received parenteral doses of ethanol. During the elimination phase, BAC and BrAC of each volunteer were measured between 18 and 34 times in a BrAC range between 0.65 mg/l and 0.12 mg/l. The conversion factor Q was either expressed in the form of the hyperbola Q=1/kappa+(CT)/BrAC or directly calculated from the ratio BAC(ven)/BrAC and the results obtained using both methods were found to be very similar. The values of 1/kappa of the hyperbolic functions varied between 1.808 and 2.165 and those of (CT) between 0.004 and 0.127. For a BrAC of 0.25 mg/l, an average value of 2.308+/-0.080 could be calculated for the conversion factor Q(0.25). On average, the value of Q(0.40) amounted to 2.207+/-0.048 and that of Q(0.55) to 2.160+/-0.056.

[Causality of an accident in subsequent fatal pulmonary embolism a few hours after trauma]

An 87-year-old woman, who was largely immobilized in a wheelchair, suffered rib fractures and an unstable fracture of the pelvic ring in a fall. Approximately 2 1/2 hours later she developed marked clinical symptoms of pulmonary thromboembolism and died 5 hours after the accident. The question to be discussed with regard to the causality was the unusually short interval of only 2 1/2 to 5 hours between the accident and the clinical signs of embolism leading to her death. Current literature gives only rough outlines stating that thromboembolism can occur as early as the first day after the trauma. An alternative theory explaining the pulmonary thromboembolism may be the breaking off of a pre-existing thrombus due to manipulation during transport or diagnostic measures in connection with the unstable fracture of the pelvic ring.

Investigations on the reliability of determining an individual's age from the proximal femur

In the context of individual identifications the reliable determination of age is important. It has been suggested that the femur is appropriate for reliably determining age and excellent results were indeed claimed but calculated errors of estimation were often missing in the studies. In order to check the reliability and validity for forensic diagnostics, two independent investigators who were not informed of the actual age of the femur specimens evaluated x-ray views of 90 femurs according to methods described in the literature. The results of the two investigators differed by maximally 5 years in 64.4% of all cases examined; the average error of estimation amounted to 10.1-17.0 years. Only one-seventh of all cases examined could be precisely grouped into the 5-year class. Deviations of more than 15 years occurred in nearly one fourth of all cases. In particular, individuals over 50 years of age were estimated as being much younger. We must therefore conclude that the method under examination is only appropriate for rough estimations of age. A more accurate estimation within a five-year interval is only rarely possible.

Rupture of an intracranial aneurysm--unusual complication of an electric shock

Here we report about a 35-year-old electrical engineer who was found dead in his study. Postmortem examination revealed that death resulted because of subarachnoid and intraventricular hemorrhage caused by the rupture of an intracranial aneurysm. Right hand and left cheek revealed electrical marks with metallizations on skin, an electric shock was diagnosed to have preceded death. The close temporal correlation suggests that a sudden rise in blood pressure was caused by the electric current and was thus responsible for the rupture of the aneurysm.

[Animal bites caused by a song bird?]

The report describes a case of post-mortem scavenging by a songbird. A married couple had opened the cage of an astrild (finch) prior to their joint death. The body of the wife showed unusual patchy epidermal lesions on parts of the body not covered by the clothing, which were obviously caused by the songbird. According to the observations made by Roll and Rous they are attributable to "pecking and pulling". The behaviour of the bird was most probably due to lack of fluid.

Experiences with a compound method for estimating the time since death. II. Integration of non-temperature-based methods

The period since death was estimated at the scene in 72 consecutive cases using the temperature-based nomogram method as the primary method and supplemented by examination of criteria such as lividity, rigor mortis, mechanical and electrical excitability of skeletal muscle and chemical excitability of the iris. A case-oriented, computer-assisted selection of the non-temperature-based methods and integration of the results into a common result of the compound method was made following a special logistic. The limits of the period since death as estimated by the nomogram were improved in 49 cases by including the non-temperature-based methods and also provided results in 4 cases where the temperature method could not be used. In a further 6 cases the non-temperature-based methods confirmed the limits estimated by the temperature method but in 14 cases a useful result could not be obtained. In only one of the cases investigated was the upper limit of the period since death, as estimated by the criterion re-establishment of rigor (8 h post-mortem), in contradiction with the period determined by the police investigations (9.4 h post-mortem).

Experiences with a compound method for estimating the time since death. I. Rectal temperature nomogram for time since death

The temperature-based nomogram method for estimation of the time period since death was used at the scene of death as the primary method within a compound method in 72 consecutive cases. The situation and cooling conditions inspected and evaluated by the forensic pathologist at the scene are described as far as necessary to enable handling of the method. A comparison of the estimated period since death with the period determined by the police investigations demonstrates the reliability of the method. There were no contradictions in any of the 60 cases between the period of death estimated by this method and that determined by the police investigations. The criminal investigations were effectively supported in the earliest stages in 11 cases despite the fact that the period estimated was of considerable duration.

Invasion and distribution of methanol

After the enzyme systems responsible for methanol oxidation were blocked by ethanol, five test persons were given methanol at a dose of approximately 10 mg/kg weight, once orally and once parenterally. Taking into account the endogenous blood methanol levels detectable before the administration of methanol, C0 concentrations of 11.1-15.9 mg/kg were reached. This corresponds to a distribution volume of approximately 0.77 +/- 0.07 l/kg, which is comparable to the 0.78 +/- 0.09 l/kg obtained for ethanol. After parenterally administering methanol as a bolus, the distribution half-life was on average 8 min (range: 3.8-13.8 min). After oral administration of methanol diluted in 100 ml water on an empty stomach, invasion took place with a half-life of approximately 5 min (3.8-6.9 min). In one case, however, due to vegetative disturbances the invasion half-life was 23.1 min.

Effects of prepulses and d-amphetamine on performance and event-related potential measures on an auditory discrimination task

RATIONALE

Prepulse inhibition (PPI) of the startle reflex is a measure of sensorimotor gating, that is the processing of the startle stimulus (S2) is inhibited by the interfering processing of a closely preceding prepulse (S1). It has been demonstrated that PPI is disrupted in a variety of mental disorders and that several neurotransmitter systems, including dopamine, participate in the modulation of sensorimotor gating. Previous studies have also shown that a task-relevant S1 enhances PPI in healthy subjects but not in schizophrenic patients. These findings indicate an influence of attentional processes on sensorimotor gating and an impairment of this modulation in schizophrenia.

OBJECTIVE

Assuming a dopamine-mediated suppression of S1 processing as a mechanism of resource management and selective attention, which might be impaired in certain mental disorders, the present study investigated the effects of the indirect dopaminergic agonist d-amphetamine on prepulse-altered S2 discrimination and event related potentials (ERPs).

METHODS

Twelve healthy volunteers were tested in a double-blind, placebo-controlled experimental design. Here, S2 is the target in a difficult Go/NoGo auditory discrimination task.

RESULTS

Confirming our previous results, S2 processing is "accentuated" by a weak acoustic prepulse in healthy subjects, thus leading to a lower rate of errors of omission but also to more false alarms (i.e. a liberal response bias). This performance change correlated with a prepulse-induced increase in the amplitude of the P3 ERP towards non-targets ("prepulse-induced non-target positivity"; PINTP). In addition, the results of the present study show that under prepulse conditions amphetamine disrupts "S2 accentuation" associated with a dose-related reduction of the P2 component of the S1 response and a plasma level related reduction of PINTP.

CONCLUSIONS

These data suggest an involuntary attentional shift towards S1 processing with increasing dopamine-release similar to that observed in patients with schizophrenia or OCD. It is concluded that sensory gating alters selective attention via dopaminergic modulation.

Tentative injuries to exposed skin in a homicide case

A 28-year-old man stabbed both his wife and his 3-year-old son to death, before unsuccessfully attempting to commit suicide. The incident occurred against a background of marital conflict. The child's body exhibited six tentative wounds to the skin in the area of the heart, with no corresponding defects in the overlying clothing, a pattern normally seen only in suicide. Their presence can be explained by the fact that this can be considered an extended suicide, the father's motivation for the killing being comparable to that for true suicide. However, wounds of this nature can be produced in such cases only if the victim is severely limited in his ability to defend himself, here due to the superior physical strength of the father.

The form of the supraorbital margin as a criterion in identification of sex from the skull: investigations based on modern human skulls

Sexual dimorphism in the shape of the supraorbital margin was reported by Broca and various subsequent authors, but no consistently applied, precise definition has been established. In this study of modern human skulls, the value of our definition of the sex-related difference in this area in the identification of sex from the skull was investigated. It was found that this feature can be assessed reliably, is strongly related to sex, and is independent of the side. The accuracy of identification of sex using this method alone was found to be about 70%.

Curvilinear increase in methanol concentration after inhibition of oxidation by ethanol: significance for the investigation of endogenous methanol concentration and formation

Endogenous methanol production was assessed over a period of 5 h in subjects given an infusion of ethanol to inhibit methanol oxidation in the liver after a period of fasting and abstinence from alcohol. Ethanol was administered to each of five subjects at rates of 0.35 g/kg per hour and 0.70 g/kg per hour. The rise in methanol concentration was biphasic regardless of the rate of ethanol administration, with a steeper gradient in the first 10-30 min. This may be due to the existence of a deep compartment from which methanol can be displaced by ethanol. This could take the form of loose binding of methanol to the hepatic oxidation enzymes as an enzyme-substrate complex, or a shift of the oxidation-reduction equilibrium between methanol and formaldehyde. The biphasic nature of the increase, with an initial steeper rise, means that the values obtained in the first 30 min should be excluded from the calculations when the rate of endogenous methanol production is determined by linear regression analysis. Endogenous methanol concentrations to be taken into account after ethanol administration are on average 0.4-0.6 mg/kg higher than those detectable in the absence of ethanol due to the additional method displaced from the deep compartment.

The kinetics of methanol elimination in alcoholics and the influence of ethanol

Methanol concentrations were studied during the end phase of ethanol elimination and for about five hours afterwards in 12 alcoholics admitted with alcohol intoxication for acute care. The rate of ethanol elimination (beta 60) ranged from 0.114 g/kg/h to 0.270 g/kg/h (mean 0.178 +/- 0.045 g/kg/h). The methanol concentration was found to remain almost steady as long as ethanol levels were relatively high, and changed only to an extent that could be explained by the combined opposing influences of methanol excretion and endogenous synthesis. There was no significant relationship between the rate of ethanol elimination and the methanol level. The methanol concentration began to decrease when the ethanol concentration had fallen to under 0.2 g/kg. When the ethanol concentration had fallen to base levels, methanol was eliminated at a rate characterized by an elimination constant (kel) of 0.212-0.481 h-1, and a half life of 1.44-3.27 h. There was a positive correlation between the rate of ethanol elimination and the rate of methanol elimination (r = 0.642; p < 0.05).

Methanol elimination in non-alcoholics: inter- and intraindividual variation

Five male subjects aged between 25 and 40 years were given methanol at a dose of 10 mg/kg, once orally and once intravenously, while the enzyme systems responsible for methanol oxidation were blocked by ethanol. The study assessed the duration of inhibition of methanol oxidation in relation to the blood ethanol concentration, and the elimination of methanol not influenced by ethanol. Methanol elimination was found to begin at a blood ethanol concentration of 0.04-0.13 g/kg. Elimination constants of 0.406-0.267 h-1 with corresponding half-lives of 1.71-2.60 h were established for methanol not influenced by ethanol. When data from a previous study using an identical protocol for parenteral administration were included, making the total number of subjects nine, the mean elimination constant was found to be 0.298 +/- 0.470 h-1 and the mean half-life 2.37 +/- 0.357 h, distribution being normal. No evidence of any differences in methanol elimination kinetics between alcoholics and non-alcoholics or of a significant influence of the route of administration was found. The extent of intraindividual variation in methanol elimination as indicated by the difference in each subject between the values established, expressed as a percentage of the corresponding mean values, was found to be 3-25%, which is comparable to the magnitude of intraindividual variation in the rate of ethanol elimination.

Endogenous methanol: variability in concentration and rate of production. Evidence of a deep compartment?

The endogenous methanol concentration was determined in 72 men aged between 18 and 35 years in the morning after a 12-h period of fasting and abstinence from alcohol. The distribution curve was found to be skewed to the right, the concentrations ranging from '0' (below the detection threshold) to 3.4 mg/kg. The median was 0.1 mg/kg and the mean 0.35 mg/kg. Significant differences were found between three groups defined according to the duration of prior abstinence from alcohol (8 h, 30 h, and 5 days). The highest values were seen after the shortest period of abstinence and the lowest values after the longest period of abstinence. The course followed by the methanol concentration in the presence of blocking of methanol oxidation by orally or parenterally administered ethanol was observed over at least 10 h on two separate occasions in a further 8 subjects aged between 24 and 35 years. At blood ethanol concentrations of more than 0.20 g/kg, the rate of production of methanol, calculated by regression, ranged from 0.09-0.37 mg/kg/h (r = 0.970-0.554, S(y.x) = 0.227-0.565 mg/kg). The rise in methanol concentration at the start of ethanol administration was significantly more rapid than the subsequent rise. It is hypothesised that there may be a so-called deep compartment for methanol that would explain the dependence of the endogenous methanol level on the duration of the preceding period of abstinence from ethanol, and the occurrence of an initial phase of faster rise in methanol concentration associated with the administration of ethanol.

[Traffic accidents in alcoholic intoxication]

A study of group comprising all road accidents caused by drivers of private cars who were under the influence of alcohol (BAC > = 0.3 g/kg; X = 1.56 +/- 0.62 g/kg) that occurred in a defined area over the span of one calendar year (n = 625) was compared with a randomly selected control group of 718 road accidents in which the drivers had not been under the influence of alcohol. The drivers in the study group were marginally younger than the ones in the control group. However, there was no evidence of an alcohol related increase in the risk of an accident associated with younger age. The sex ratio in the study group corresponded to that, generally found amongst people driving under the influence of alcohol. In the study group there was no evidence of a restricted manner and extent of car use, based on the distances between the sites of the accidents and the offenders' homes. However, the proportion of accidents occurring out of towns was greater in the study group. Alcohol associated accidents occurred more frequently in the evenings and at night, which reflects habitual drinking patterns. Therefore these accidents occurred mainly in darkness and twilight. Surprisingly, unfavorable weather conditions such as rain or ice did not lead to an increase in accidents due to alcohol. In fact, in the study group, proportionally fewer accidents occurred on icy roads. Both injury to persons and damage to property were more severe in the study group. While no relationship between accident severity and blood alcohol concentration could be proven within the study group, the risk of death or severe injury was 3 to 4 times greater in this group than in the control group.

[Changes in the spectrum of alcohol-induced traffic accidents in relation to blood alcohol level]

A retrospective study was undertaken to determine whether the degree of alcohol intoxication has an effect on the driving performance with regards to both the quantity and quality. A total of 625 accidents caused by drivers who were under the influence of alcohol were reviewed. They were divided into three groups according to the blood alcohol concentration (BAC):0.30 - 1.09 g/kg, 1.10 - 1.99 g/kg and > 2.00 g/kg. In order to exclude the influence of factors unrelated to alcohol, the groups were matched for age, sex, location of accident and the light and road conditions. This resulted in a total of 85 accidents in each group. The accidents were classified with reference to the "Register of causes of accidents" used in road accident statistics. The three groups differed significantly in their causes of accidents (p < 0.025), although those due to speeding dominated in each group. In the group with low BAC, the next most common accidents were the ones caused by failure to give way. In the group with medium BAC, rear-end collisions and accidents occurring during low speed manoeuvres were the second most common. In the group with highest BAC, the next most common causes of accidents were the leaving of the correct traffic lane unassociated with speeding.

[Study on the significance of mercury accumulation in the brain from dental amalgam fillings through direct mouth-nose-brain transport]

The transport of mercury (Hg) from the oro-nasal to the cranial cavity via a direct route was investigated. In 55 deceased persons, Hg concentrations were measured in the olfactory bulb and the trigeminal ganglion, and the number of dental amalgam fillings was assessed. For the purpose of comparison, Hg concentrations were also determined in the occipital lobe cortex, the pituitary gland and the kidney cortex. Quantitative Hg analysis was performed by cold vapor atomic absorption spectroscopy after acid digestion using high pressure microwave treatment. In the olfactory bulb (geom. mean 17.4 micrograms/kg w. w.), the Hg concentration was significantly higher than in the occipital lobe cortex (geom. mean 9.2 micrograms/kg w. w.) (p < 0.0001). No significant difference was found between the Hg concentration in the trigeminal ganglion (geom. mean 12 micrograms/kg w. w.) and the occipital lobe cortex (alpha = 0.005; p = 0.0342). Regression analysis did not reveal a statistically significant correlation between the number of dental amalgam fillings and the Hg content in the olfactory bulb and the trigeminal ganglion, respectively (alpha = 0.01). Therefore, these results do not support the hypothesis of a significant flow o Hg from dental amalgam fillings to the cranial cavity by a direct oro-nasal route. In contrast, a statistically significant correlation exists between the number of dental amalgam fillings and the Hg concentration in the kidney cortex (r2 = 0.317; p < 0.0001), and, to a lesser extent, the Hg concentration in the occipital lobe cortex (r2 = 0.17; p = 0.0016). The highest Hg concentrations (geom. mean 93.1 micrograms/kg w. w.) were detected in the kidney cortex, followed by the pituitary gland (geom. mean 30.0 micrograms/kg w. w.). In this study, Hg concentration in the pituitary gland did not correlate with the number of dental amalgam fillings.

Spleen findings in drowning

A retrospective study of spleen findings in 42 victims of drowning and a comparison group of 42 cases of asphyxiation due to other causes (hanging, ligature strangulation and manual strangulation), that were matched for sex, age, body weight and build, was performed. Significantly smaller spleen weights (P < 0.05), spleen weight:body weight ratios (P < 0.01) and spleen weight:liver weight ratios (P < 0.01) were found in the victims of drowning. The difference in weight was approximately 18%. A significant negative correlation between spleen weight and blood alcohol concentration was found in the study group (r = -0.44; P < 0.01), but not in the control group. The possibility that the findings are due to a stress reaction caused by hypoxia in the presence of cooling and an influence of alcohol on reflex mechanisms is discussed.

[Rate of ethanol clearance after oral and parenteral ethanol administration]

A crossover investigation of the ethanol concentration decline after oral and parenteral administration of ethanol respectively was performed with direct intra- and interindividual comparison. No significant differences in relation to the kind of administration were noted. An influence of the circadian rhythm on the rate of decline could be excluded. The low beta 60 values derived (average: 0.111 g/kg/h) can be explained by the long period over which the probands were denied food.

[Fatal complications of a colon contrast enema due to erroneous insertion of the infusion catheter in the vagina]

A 68-year-old woman was to have a barium enema of the colon to discover the cause of recurrent cramp-like symptoms in the lower abdomen. At the beginning of the examination the responsible radiologist saw, during a fluoroscopic check, that the contrast medium had not advanced beyond the region of the infusion catheter tip. Believing this to be due to blockage in the catheter he increased the infusion pressure. Suddenly the patient went into treatment-resistant shock and died. The autopsy revealed that the infusion catheter had by mistake been placed into the vagina. This had caused a tear in the vagina with resulting subperitoneal contrast-medium infiltration. Embolization of contrast medium to the lung was demonstrated both histologically and radiologically. The cause of death was the combined effect of the embolism and peritoneally induced vagal shock.

[Methanol level and methanol elimination in alcoholic patients]

A total of 54 male alcoholics aged between 26 and 57 years who had been admitted in an intoxicated state to a psychiatric hospital for acute care and subsequent detoxification were included in the study. The blood ethanol concentration (BEC) and serum methanol concentration (SMC) at the time of admission (n = 49) and the methanol elimination curve during ethanol elimination (n = 19) and after the ethanol concentration had fallen to zero (n = 4) were investigated. On admission, the BEC ranged from 0.21 g/kg to 3.26 g/kg and the SMC ranged from 5 mg/kg to 44 mg/kg. The gamma-alcoholics (n = 28) exhibited higher ethanol concentrations than the delta-alcoholics (n = 11) but no difference was found in the methanol concentrations. The methanol level was found to be related to the ethanol level in gamma-alcoholics (r = 0.671; p < 0.001), but not in d-alcoholics (r = 0.215; p > 0.05). The methanol content of the most recently consumed and generally preferred type of alcoholic beverage was found to influence the SMC in all the alcoholics. The SMC did not fall during ethanol oxidation (BEC > 0.2g/kg). After the ethanol concentration had fallen to zero, methanol elimination was found to follow first order kinetics; the elimination constants ranged from 0.592 h-1 to 0.209 h-1, corresponding to elimination half-life values of 1.2 h to 3.3 h. No differences were found between these values and those of non-alcoholic subjects.

The elimination kinetics of methanol and the influence of ethanol

Four male subjects aged between 20 and 29 years were given intravenous injections of methanol at a dosage of 10 mg per kg body weight, once without prior administration of ethanol, and once after oral ingestion of 0.3 g ethanol per kg body weight. The serum methanol concentration was monitored over the next 5 h (after methanol administration alone) and 6-7 h (after methanol administration following ethanol ingestion). The elimination of methanol administered alone was found to follow first-order kinetics with a rate constant for the elimination phase of 0.475-0.259 h-1, corresponding to an elimination half-life of 1.8-3.0 h. When ethanol was also administered methanol oxidation was found to be completely blocked until the blood ethanol concentration had fallen to 0.2 g/kg. When the ethanol concentration had dropped to zero, methanol elimination followed exactly the same course as that observed in the experiment without prior administration of ethanol (k: 0.378-0.231 h-1; t1/2: 1.5-2.7 h).

[Statistical approach to forensic conversion values for alcoholics]

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).

[Morphological and toxicological findings after intravenous injection of metallic mercury]

At the autopsy of a 25-year-old man who had died from combined morphine and cocaine intoxication, depositions of metallic mercury were incidentally found in the myocardium of the right ventricular septum and posterior wall. Deposits, toxicologically identified as mercury, were also found radiologically and histologically in the lungs. All these deposits were probably the result of intravenous injections of mercury many months previously, as is known to be done occasionally by addicts. Judging by the histological picture the greatest proportion of the mercury collected in the right ventricular cavity after injection, a smaller amount by embolization in the small pulmonary arteries. The mercury spheres which came to lie in the right ventricle then penetrated into the myocardium, moving outward and causing a chronic and partly transmural inflammatory response.

[Rate of ethanol elimination in alcoholics with special reference to variants of maximal values for legal calculation of blood alcohol concentration]

The ethanol elimination rate was measured in 15 male alcoholics who had come to the Psychiatric Clinic of the University of Tübingen as in-patients. Over the course of several hours between 3 and 5 blood samples were taken in the post-absorption phase. The hourly elimination rate, calculated by lines of regression, gave a mean value of 0.224 g/kg (s = 0.038 g/kg). This was significantly higher than the elimination rate for non-alcoholics calculated from drinking experiments found in the literature (p less than 0.001). In addition 2 blood samples were taken several hours apart from each of 39 alcoholics. Based on the results of the analysis of the second blood sample, the value of the first blood sample was calculated back using the maximum value formula employed in foro. The calculated maximum values were compared to the analysis values. In 8 cases the analysis value was higher than the calculated maximum value, exceeding it by as much as 0.74 g/kg. It should be considered whether the formula currently employed to calculate the maximum BAC is sufficiently accurate in alcoholic to exclude possible false detrimental values.

[Statistical evaluation of 60,000 blood alcohol values from 1964 to 1983. III. Multiple convictions]

Between the years 1964 and 1983, 59,226 blood samples with appropriate blood-alcohol concentrations (BAC greater than 0.1 g/kg) were investigated at the Institute for Forensic Medicine at the University of Tübingen. These originated from 47,416 different "culprits", of whom 38,851 (81.9%) were first offenders and 8,565 (18.1%) multiple offenders. The total number of crimes committed by the latter group reached as many as 13. There were fewer women amongst the recurring offenders, the maximum number of offences in this group was 4. The age of the multiple offenders at the time of their first brush with the law was lower than that of single culprits. Their blood-alcohol level at the first offence was similar to that of single offenders, however it increased slightly with each subsequent time. Homotropic traffic offenders were mainly only represented in the group with the lower crime rate. Most multiple offenders proved to be criminal delinquents who were frequently conspicuous not only for criminal--but also for criminal--and traffic violations. In about half the cases the time intervals between 2 offences was under 3 years.

[Cough syncope as a cause of traffic accident]

The rare tussive syncope syndrome, which can lead to a road traffic accident, occurs almost solely in the male aged 40 years and over with a pyknic to athletic physique, who suffer from obstructive respiratory tract disease and/or pulmonary emphysema. Frequently there is a correlation between the illness and alcohol and tobacco consumption. Loss of consciousness lasting only a few seconds occurs a few seconds after a coughing attack leaving behind a short loss of memory. Tussive syncope can be a solitary event, but can also occur up to thirty times a day. In foro, characteristically the link between a heavy coughing and loss of consciousness as well as the type of person make diagnosis easier. The suitability of the subject to hold a driving licence should be judged carefully and on individual criteria.

Therapeutic sleep deprivation in depressives, restricted to the two nocturnal hours between 3:00 and 5:00

1. In 33 patients with a depressive syndrome the effects of partial SD restricted to the 2 hours between 3:00 and 5:00 in the morning was compared to that of no SD (= undisturbed sleep, n = 17) and total SD (n = 16) in a balanced crossover design. 2. Partial SD had a moderate antidepressant effect which is, however, clearly inferior to that of total SD. 3. Reasons for the scarceness of the effect may be an inappropriate timing of this 2-hr SD period (which seems improbable), too short a duration of SD, or the resumption of sleep at 5 o'clock. 4. "Intermediate" SD in the form it was used here represents no therapeutic advantage as we had expected. Its moderate effects lend support to the hypothesis that sleep disturbance is a sign of (mostly insufficient) restorative or self-healing efforts of the depressive organism.

[Fatalities in drug dependent patients: suicide or accident?]

The investigation is based on the evaluation of 87 fatalities arising from drug addiction in autopsy material at the Institute for Forensic Medicine, Tübingen. When considered individually there were 76 cases of intoxication, 10 deaths due to external forces and one death due to natural internal causes as a result of drug abuse. The investigation was mainly concerned with the differentiation between suicide or accidental death in the intoxication group. Amongst the total of 76 cases we found 12 to be indisputable or probable suicides and 44 to be indisputable or probable accidents. The remaining 20 could not be classified with sufficient certainty. With the exception of the existence of a farewell letter there were no single meaningful differentiation criteria. There are indications which in themselves are not strong pointers but which, when considered together, allow a cautious interpretation. Finally the question is discussed as to how far the character changes typical in drug addiction can be explained by a latent suicidal tendency with quoad vitam fatalistic indifference.

[The sensitivity of clinico-chemical markers of alcoholism following short-term motivated alcohol abstinence]

The liver enzymes GGT, GOT and GPT, as well as MCV, of 40 alcoholics were examined. They had presented at the psychiatric department of the University for withdrawal therapy. All of them had consumed alcohol up to the time of admission. The laboratory values were obtained on admission, then at weekly intervals for a period of 5 weeks, under total alcohol abstinence. GGT (85 per cent) and MCV (95 per cent) demonstrated a high sensitivity relating to alcohol abuse. While the raised GGT values reduced gradually, the MCV values remained consistently high even after strict withholding of alcohol. The sensitivity of MCV was not impaired by the previous substitutions of vitamin B complex. At the beginning GOT and GPT were elevated in only about half the number of cases and quickly became normal. Because of the more rapid lowering of the GOT activities, compared to the GPT activities, the De Ritis quotient sank to below 1 even after only one week. To demonstrate the clinical chemical evidence of the appraisement more clearly, the MCV as well as liver enzymes, must be taken into account. In general there was a decline in the diagnostic value of the laboratory results, the longer the period of alcohol abstinence lasted. Therefore, it is recommended not to set a long term time limit for examination, to favour the motivated total abstinence periods.