Alcoholism in elderly persons: a study of the psychiatric and psychosocial features of 216 inpatients

The medical records of 216 elderly persons, admitted to the hospital for treatment of alcoholism, were reviewed. Concern of family and friends was the most common factor motivating patients for admission. Patients with late-onset alcoholism reported an association between a life event and problem drinking more frequently than did the early-onset alcoholics. The most common associated psychiatric disorders were tobacco dependence (67%), organic brain syndrome (25%), atypical or mixed organic brain syndrome (19%), and affective disorder (12%). Fourteen percent of patients also had a drug abuse or dependence problem, all using legally prescribed drugs. Psychiatric diagnoses and results of psychologic testing did not differ between early-onset and late-onset alcoholism groups. In a 60-patient cohort studied for correlation of outcome of treatment for alcoholism with major psychiatric diagnoses, no associations were found.     

Differential targeting and function of alpha2A and alpha2C adrenergic receptor subtypes in cultured sympathetic neurons

Previous research suggested that alpha2A and alpha2C adrenergic receptor (AR) subtypes have overlapping but unique physiological roles in neuronal signaling; however, the basis for these dissimilarities is not completely known. To better understand the observed functional differences between these autoreceptors, we investigated targeting and signaling of endogenously expressed alpha2A and alpha2CARs in cultured sympathetic ganglion neurons (SGN). At Days 1 and 4, alpha2A and alpha2CARs could be readily detected in SGN from wild-type mice. By Day 8, alpha2A ARs were targeted to cell body, as well as axonal and dendritic sites, whereas alpha2C ARs were primarily localized to an intracellular vesicular pool within the cell body and proximal dendritic projections. Expression of synaptic vesicle marker protein SV2 did not differ at Day 8 nor co-localize with either subtype. By Day 16, however, alpha2C ARs had relocated to somatodendritic and axonal sites and, unlike alpha2A ARs, co-localized with SV2 at synaptic contact sites. Consistent with a functional role for alpha2 ARs, we also observed that dexmedetomidine stimulation of cultured SGN more efficiently inhibited depolarization-induced calcium entry into older, compared to younger, cultures. These results provide direct evidence of distinct developmental patterns of endogenous alpha2A and alpha2C AR targeting and function in a native cell system and that maturation of SGN in culture leads to alterations in neuronal properties required for proper targeting. More importantly, the co-localization at Day 16 of alpha2C ARs at sites of synaptic contact may partially explain the differential modulation of neurotransmitter release and responsiveness to action potential frequency observed between alpha2A and alpha2C ARs in SGN.     

Reversal of p53 epigenetic silencing in multiple myeloma permits apoptosis by a p53 activator

Inactivation of the p53 pathway is a common feature of neoplasia. Dysregulation of the p53 pathway has been shown to involve mutations of p53, increased expression of the p53 inhibitor HDM-2, or epigenetic silencing of the p53 promoter. In multiple myeloma, a neoplasia of terminally differentiated B cells, p53 mutations and deletions are relatively rare and occur in late stage disease. Here, we show that the p53 promoter is hypermethylated in several multiple myeloma cell lines in comparison to normal plasma cells. Two cell lines containing mutant p53, Lp-1 and OPM-2, show a methylation pattern that suggests that they contain one methylated and one unmethylated mutant allele. Two other cell lines, KMS-11 and OPM-2, show hypermethylation of p53 with a lack of expression. In all cell lines tested, treatment with a demethylating agents results in higher expression of p53. Furthermore, following increased expression of p53, treatment of the myeloma cell lines with a p53 activating peptide induces apoptosis. Therefore, combinatorial treatment with demethylating agents followed by delivery of a p53 activating peptide may be an effective therapeutic strategy against multiple myeloma.     

Fatal rectus sheath hematoma

Rectus sheath hematoma is an uncommon, often misdiagnosed, and usually self-limited condition. In a recent review of autopsy cases at the Mayo Clinic, Rochester, Minn, we found two patients in whom hemorrhages into the rectus sheaths were considered the immediate cause of death and one in whom the hemorrhage was considered a contributing cause of death. Rectus sheath hematoma should be included in the differential diagnosis of an abdominal mass of sudden onset, especially in patients who have been given anticoagulants. The condition may be fatal if the volume of the hemorrhage is large and if treatment is delayed.     

Validation of the revised Self-Administered Alcohol Screening Test (SAAST-R)

This study examined the sensitivity and specificity of the revised Self-Administered Alcohol Screening Test (SAAST-R)1 among adult outpatients evaluated at community addictions and psychiatry and psychology clinics. A total of 417 adults (mean +/- SD age of 41.4 +/- 15.0 years, 52% female, 91% Caucasian) completed the 36-item SAAST-R prior to their evaluation. Based on the clinician's documentation of the patient's alcohol use, two criterion groups were established: one composed of subjects classified as having no alcohol problems (n = 214), and one with alcohol problems (n = 203). The SAAST-R was found to have high internal consistency reliability (Cronbach's alpha = 0.96), sensitivity (90%), and specificity (82%) for differentiating outpatients with and without alcohol problems, respectively, using a cut point of >or=4 to indicate risk for alcohol-related problems. The SAAST-R was found to have good sensitivity and specificity among both males and females.