       Document 0044
 DOCN  M9620044
 TI    Beta-carbolines in chronic alcoholics undergoing elective tumor
       resection.
 DT    9602
 AU    Spies CD; Rommelspacher H; Schnapper C; Muller C; Marks C; Berger G;
       Conrad C; Blum S; Specht M; Hannemann L; et al; Department of
       Anesthesiology, Benjamin Franklin Medical Center,; Berlin, Germany.
 SO    Alcohol Clin Exp Res. 1995 Aug;19(4):969-76. Unique Identifier :
       AIDSLINE MED/96026615
 AB    The prevalence of chronic alcoholism in patients with carcinomas of the
       upper digestive tract exceeds 60%. The patient's history and laboratory
       markers, preoperatively, are often not sensitive or specific enough to
       detect alcohol-dependent patients, preoperatively, who are at risk of
       developing alcohol withdrawal syndrome (AWS) during their postoperative
       intensive care unit (ICU) stay. Previously, it was found that plasma
       norharman was elevated in chronic alcoholics, suggesting marker
       characteristics for chronic ethanol misuse and possibly alcohol
       dependence. We investigated whether beta-carbolines (i.e., harman and
       norharman) were different between chronic alcoholics and nonalcoholics
       with carcinoma, and how the levels change in alcohol-dependent patients
       during their hospital stay. Ninety-seven patients with oral, pharyngeal,
       laryngeal, or esophageal carcinomas were evaluated regarding their
       drinking habits. Sixty patients were transferred to the ICU following
       tumor resection. Chronic alcoholics met the DSM-III-R and ICD-10
       criteria for alcohol dependence or chronic alcohol abuse/harmful use.
       The daily ethanol intake in chronic alcoholics was > or = 60 g. Blood
       samples were collected on admission to the hospital, preoperatively, on
       admission to the ICU and on days 2, 4, and 7 in the ICU. Harman and
       norharman were determined by HPLC. Elevated norharman was found in
       chronic alcoholics on admission to the hospital, whereas harman did not
       differ between groups. On admission, the area under the receiver
       operating characteristics curve was significantly larger for
       carbohydrate-deficient transferrin and preoperatively for norharman. The
       preoperative norharman levels were significantly correlated with the
       period of mechanical ventilation and the length of ICU stay.
       Postoperatively, norharman decreased in all patients, except a group of
       11 alcohol-dependent patients who developed AWS during their ICU stay.
       The finding that elevated norharman levels were found in chronic
       alcoholics on admission to the hospital and preoperatively supports the
       view of a specific marker for alcoholism. Preoperative norharman was
       superior to carbohydrate-deficient transferrin and was associated with a
       prolonged ICU stay and a prolonged period of mechanical ventilation.
       Further studies are required to determine whether norharman aids in the
       preoperative diagnosis of chronic alcohol misuse with respect to the
       prevention of postoperative complications.
 DE    Adult  Aged  Aged, 80 and over  Alcoholism/BLOOD/*DIAGNOSIS  Biological
       Markers/BLOOD  Carbolines/*BLOOD  Critical Care  Esophageal
       Neoplasms/BLOOD/*SURGERY  Harmine/ANALOGS & DERIVATIVES/BLOOD  Human
       Male  Middle Age  Otorhinolaryngologic Neoplasms/BLOOD/*SURGERY
       Postoperative Complications/BLOOD/*PREVENTION & CONTROL  Risk Factors
       Support, Non-U.S. Gov't  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

