- Email: [email protected]
ALCOHOL, HDL CHOLESTEROL, AND LIVER MICROSOMAL INDUCTION
47
reported to the PHLS Communicable Disease Surveillance Centre, London. Hepatitis B carriers are a potential hazard to surgeons, anaesthetists, and theatre staff. For this
reason, 5 years ago, one of 100 E. ) investigated patients who attended the plastic (F. surgery centre in Bradford for surgical removal of tattoos as inpatients or outpatients. 25 needed a general anaesthetic. Of the 100 patients examined 81 were female. Their average age was 21 - 4 years (range 13-58). 99 were White and 1 was Asian. In 77, from whom further information was obtained, the average age at tattooing was 15 years (range 10-35) and 56 (73%) were under 16 at the time. Some had been tattooed more than once. 54% of the tattooings had been done by friends, 28% were self-inflicted, and 18% were done by professional tattooists. 84% of the tattoos were on the arms or hands. Specimens of blood from all patients were tested for HBsAg and anti-HBs. HBsAg was sought by ’Hepatest’ (Wellcome) and counterimmunoelectrophoresis and also by the ’Auscell’ test (Abbott) in 80 cases; anti-HBs was tested for by counterimmunoelectrophoresis and passive haemagglutination inhibition. More sensitive methods are available today. All specimens were negative for HBsAg. In only 1 patient, whose tattoos had been done by a
us
E.
professional tattooist, was anti-HBs found. Since most of these people who asked for tattoos to be removed had been tattooed as schoolchildren by friends or by themselves, it is not surprising to find that the risk of transmission of hepatitis B is not great, although this sample is not big enough to show a small increase compared with the population as a whole. However, the danger cannot be discounted, and it would seem wise to take care to avoid contamination with blood from patients with professional tattoos and to take preventive action in the event of a "needleprick" accident. We thank Mr T. L.
investigate the patients virological tests.
Barclay and Mr D. J. Crocket for permission to under their care and Dr M. H. Hambling for the F. E. EDGAR W. M. EDGAR
St Luke’s Hospitals, Bradford BD5 0NA
SIR,-In 1975 I did a survey of self tattooing among 84 glue sniffers in Lanarkshire consecutively referred to me by police, social agencies, parents and assessment centre staff. Tattoos were found in 19 (23%) of the sniffers, and all had been self-inflicted by means of a needle or pin used to prick particles of indian ink into the dermis. In every case tattooing had been carried out as a condition of gang membership, which was of vital importance to the people concerned. The age range at which each individual had been tattooed was 10-15 years. The figure of 4% quoted in your article might well indicate that peer group influences are of more importance to glue sniffers than to schoolchildren in general. Woodside Health Centre, Glasgow G20 7LR
induction and HDL-C.Much work has now been done on HDL and LDL in relation to induction. To the discussion we would like to add some findings from older and new investigations. Induction is characterised by proliferation of the liver
endoplasmic reticulum, with increases in hepatic phospholipids, protein, and cytochrome P-450,2 and its extent can be assessed by P-450, a marker enzyme of the endoplasmic reticulum and a sensitive measure of the activity of the microsomal enzyme system.22 Antipyrine clearance is a measure of microsomal activity in vivo. Both alcohol intake3and treatment with enzyme-inducing drugs6-S are associated with increased plasma HDL levels, and increases in HDL-C and in apoprotein are related to antipyrine clearance and P-450 (figure).1,4-6 The decrease in a raised HDL-C after alcohol withdrawal parallels the prolongation of the alcohol-induced shortening of the antipyrine half-life.These data indicate a connection between plasma HDL levels and the magnitude of liver microsomal induction in people exposed to inducing agents. Moreover, increases in apolipoprotein I, HDL-C, and the HDLC/total cholesterol ratio are comparable with increases in hepatic 8 phospholipids and protein associated with induction. Hepatic histological changes influence liver microsomal activity, and should hence be taken into account when evaluating lipoproteins in relation to induction.5 The significance of the association between lipoproteins and induction is also emphasised by observations showing that serum low-density-lipoprotein cholesterol (LDL-C) and the LDL-C/HDL-C ratio, strong predictors of coronary heart disease, are negatively proportional to the magnitude of liver microsomal enzyme induction.9 Clinical Research Unit, University Medical Centre, SF-90220 Oulu 22, Finland
P. V. LUOMA E. A. SOTANIEMI R. O. PELKONEN
JOYCE M. WATSON
SIR,-In the past 12 months I have had more referrals for removal of amateur and ugly tattoos than in the preceding 8 years together. The number of professional tattoos presented for removal has remained constant and small. Removal is time-consuming and, for the best possible cosmetic result, the method used must be tailormade for each tattoo, depending upon site and size. Health education should therefore be directed towards discouraging teenagers from this practice, since most believe that tattoos can be removed without permanent blemish. The presence of tattoos does jeopardise the chances of employment, and several youngsters have failed entry to the Armed Services because of their tattoos. Cumberland Infirmary, Carlisle CA2 7HY
Plasma HDL-C, apolipoprotein I (A-1) and hepatic P-450 in 18 subjects with normal liver histology, with (A) or without (N) recent alcohol intake.
W. D. PATERSON
ALCOHOL, HDL CHOLESTEROL, AND LIVER MICROSOMAL INDUCTION
SIR,-Dr Thornton and colleagues suggest (Oct 8, p 819) that alcohol increases plasma high-density-lipoprotein cholesterol (HDL-C) levels through hepatic microsomal enzyme induction. This possibility has been a focus of interest from the late 1970s, particularly so since our description of an association between
1. Luoma
PV, Sotaniemi EA, Pelkonen RO, Myllylä VV. Plasma high density lipoprotein cholesterol and hepatic cytochrome P-450 concentrations in epileptics undergoing anticonvulsant treatment. Scand J Clin Lab Invest 1980 40: 163-67. 2. Estabrook RW, Lindenlaub E, eds The induction of drug metabolism. Stuttgart and New York: FK Schattauer Verlag, 1979. 3. Johansson BG, Medhus A. Increase in plasma &agr;-lipoproteins in chronic alcoholics after acute abuse. Acta Med Scand 1974; 195: 273-79. 4. Luoma PV, Sotaniemi EA, Pelkonen RO, Ehnholm C. High density lipoproteins and hepatic microsomal enzyme induction in alcohol consumers. Res Commun Chem Pathol Pharmacol 1982; 37: 91-5 5. Luoma PV, Sotaniemi EA, Pelkonen RO, Arranto A, Ehnholm C. Plasma high density lipoproteins and hepatic microsomal enzyme induction. Relation to histological changes in the liver. Eur JClin Pharmacol 1982; 23: 275-82. 6. Luoma PV, Sotaniemi EA, Pelkonen RO, Ehnholm C. High plasma HDL cholesterol and apoprotein A-I and A-II concentrations and hepatic microsomal enzyme activity in epileptics with alcohol abuse. Acta Pharmacol Toxicol 1981; 49 (suppl 1): 52 Abstr. 7. Cushman P, Barboriak JJ, Liao A, Hoffman NE. Association between plasma high density lipoprotein cholesterol and antipyrine metabolism in alcoholics. Life Set 1982; 30: 1721-4. 8. Luoma PV, Savolainen MJ, Sotaniemi EA, Pelkonen RO, Arranto A, Ehnholm C Plasma high density lipoproteins and liver lipids and proteins in man. Relation to hepatic histology and microsomal enzyme induction. Acta Med Scand 1983; 214: 103-9. 9. Luoma PV, Sotaniemi EA, Pelkonen RO. Inverse relationship of serum LDL cholesterol and the LDL/HDL cholesterol ratio to liver microsomal enzyme induction in man. Res Commun Chem Pathol Pharmacol 1983; 42: 173-6.
reported to the PHLS Communicable Disease Surveillance Centre, London. Hepatitis B carriers are a potential hazard to surgeons, anaesthetists, and theatre staff. For this
reason, 5 years ago, one of 100 E. ) investigated patients who attended the plastic (F. surgery centre in Bradford for surgical removal of tattoos as inpatients or outpatients. 25 needed a general anaesthetic. Of the 100 patients examined 81 were female. Their average age was 21 - 4 years (range 13-58). 99 were White and 1 was Asian. In 77, from whom further information was obtained, the average age at tattooing was 15 years (range 10-35) and 56 (73%) were under 16 at the time. Some had been tattooed more than once. 54% of the tattooings had been done by friends, 28% were self-inflicted, and 18% were done by professional tattooists. 84% of the tattoos were on the arms or hands. Specimens of blood from all patients were tested for HBsAg and anti-HBs. HBsAg was sought by ’Hepatest’ (Wellcome) and counterimmunoelectrophoresis and also by the ’Auscell’ test (Abbott) in 80 cases; anti-HBs was tested for by counterimmunoelectrophoresis and passive haemagglutination inhibition. More sensitive methods are available today. All specimens were negative for HBsAg. In only 1 patient, whose tattoos had been done by a
us
E.
professional tattooist, was anti-HBs found. Since most of these people who asked for tattoos to be removed had been tattooed as schoolchildren by friends or by themselves, it is not surprising to find that the risk of transmission of hepatitis B is not great, although this sample is not big enough to show a small increase compared with the population as a whole. However, the danger cannot be discounted, and it would seem wise to take care to avoid contamination with blood from patients with professional tattoos and to take preventive action in the event of a "needleprick" accident. We thank Mr T. L.
investigate the patients virological tests.
Barclay and Mr D. J. Crocket for permission to under their care and Dr M. H. Hambling for the F. E. EDGAR W. M. EDGAR
St Luke’s Hospitals, Bradford BD5 0NA
SIR,-In 1975 I did a survey of self tattooing among 84 glue sniffers in Lanarkshire consecutively referred to me by police, social agencies, parents and assessment centre staff. Tattoos were found in 19 (23%) of the sniffers, and all had been self-inflicted by means of a needle or pin used to prick particles of indian ink into the dermis. In every case tattooing had been carried out as a condition of gang membership, which was of vital importance to the people concerned. The age range at which each individual had been tattooed was 10-15 years. The figure of 4% quoted in your article might well indicate that peer group influences are of more importance to glue sniffers than to schoolchildren in general. Woodside Health Centre, Glasgow G20 7LR
induction and HDL-C.Much work has now been done on HDL and LDL in relation to induction. To the discussion we would like to add some findings from older and new investigations. Induction is characterised by proliferation of the liver
endoplasmic reticulum, with increases in hepatic phospholipids, protein, and cytochrome P-450,2 and its extent can be assessed by P-450, a marker enzyme of the endoplasmic reticulum and a sensitive measure of the activity of the microsomal enzyme system.22 Antipyrine clearance is a measure of microsomal activity in vivo. Both alcohol intake3and treatment with enzyme-inducing drugs6-S are associated with increased plasma HDL levels, and increases in HDL-C and in apoprotein are related to antipyrine clearance and P-450 (figure).1,4-6 The decrease in a raised HDL-C after alcohol withdrawal parallels the prolongation of the alcohol-induced shortening of the antipyrine half-life.These data indicate a connection between plasma HDL levels and the magnitude of liver microsomal induction in people exposed to inducing agents. Moreover, increases in apolipoprotein I, HDL-C, and the HDLC/total cholesterol ratio are comparable with increases in hepatic 8 phospholipids and protein associated with induction. Hepatic histological changes influence liver microsomal activity, and should hence be taken into account when evaluating lipoproteins in relation to induction.5 The significance of the association between lipoproteins and induction is also emphasised by observations showing that serum low-density-lipoprotein cholesterol (LDL-C) and the LDL-C/HDL-C ratio, strong predictors of coronary heart disease, are negatively proportional to the magnitude of liver microsomal enzyme induction.9 Clinical Research Unit, University Medical Centre, SF-90220 Oulu 22, Finland
P. V. LUOMA E. A. SOTANIEMI R. O. PELKONEN
JOYCE M. WATSON
SIR,-In the past 12 months I have had more referrals for removal of amateur and ugly tattoos than in the preceding 8 years together. The number of professional tattoos presented for removal has remained constant and small. Removal is time-consuming and, for the best possible cosmetic result, the method used must be tailormade for each tattoo, depending upon site and size. Health education should therefore be directed towards discouraging teenagers from this practice, since most believe that tattoos can be removed without permanent blemish. The presence of tattoos does jeopardise the chances of employment, and several youngsters have failed entry to the Armed Services because of their tattoos. Cumberland Infirmary, Carlisle CA2 7HY
Plasma HDL-C, apolipoprotein I (A-1) and hepatic P-450 in 18 subjects with normal liver histology, with (A) or without (N) recent alcohol intake.
W. D. PATERSON
ALCOHOL, HDL CHOLESTEROL, AND LIVER MICROSOMAL INDUCTION
SIR,-Dr Thornton and colleagues suggest (Oct 8, p 819) that alcohol increases plasma high-density-lipoprotein cholesterol (HDL-C) levels through hepatic microsomal enzyme induction. This possibility has been a focus of interest from the late 1970s, particularly so since our description of an association between
1. Luoma
PV, Sotaniemi EA, Pelkonen RO, Myllylä VV. Plasma high density lipoprotein cholesterol and hepatic cytochrome P-450 concentrations in epileptics undergoing anticonvulsant treatment. Scand J Clin Lab Invest 1980 40: 163-67. 2. Estabrook RW, Lindenlaub E, eds The induction of drug metabolism. Stuttgart and New York: FK Schattauer Verlag, 1979. 3. Johansson BG, Medhus A. Increase in plasma &agr;-lipoproteins in chronic alcoholics after acute abuse. Acta Med Scand 1974; 195: 273-79. 4. Luoma PV, Sotaniemi EA, Pelkonen RO, Ehnholm C. High density lipoproteins and hepatic microsomal enzyme induction in alcohol consumers. Res Commun Chem Pathol Pharmacol 1982; 37: 91-5 5. Luoma PV, Sotaniemi EA, Pelkonen RO, Arranto A, Ehnholm C. Plasma high density lipoproteins and hepatic microsomal enzyme induction. Relation to histological changes in the liver. Eur JClin Pharmacol 1982; 23: 275-82. 6. Luoma PV, Sotaniemi EA, Pelkonen RO, Ehnholm C. High plasma HDL cholesterol and apoprotein A-I and A-II concentrations and hepatic microsomal enzyme activity in epileptics with alcohol abuse. Acta Pharmacol Toxicol 1981; 49 (suppl 1): 52 Abstr. 7. Cushman P, Barboriak JJ, Liao A, Hoffman NE. Association between plasma high density lipoprotein cholesterol and antipyrine metabolism in alcoholics. Life Set 1982; 30: 1721-4. 8. Luoma PV, Savolainen MJ, Sotaniemi EA, Pelkonen RO, Arranto A, Ehnholm C Plasma high density lipoproteins and liver lipids and proteins in man. Relation to hepatic histology and microsomal enzyme induction. Acta Med Scand 1983; 214: 103-9. 9. Luoma PV, Sotaniemi EA, Pelkonen RO. Inverse relationship of serum LDL cholesterol and the LDL/HDL cholesterol ratio to liver microsomal enzyme induction in man. Res Commun Chem Pathol Pharmacol 1983; 42: 173-6.