Heavy drinking in hospital patients

The study examines the prevalence of high consumption of alcohol among the patients of a large university hospital, and the ability of physicians to detect heavy drinking. According to self-report, the results of CAGE questionnaire or the physicians' opinion, 25% of the male and 11% of the female patients were heavy drinkers. The physicians identified 43% and 26% of the men and women who screened positively either according to CAGE or self-report. On the other hand, 17% of the men and 14% of the women who were identified by the physicians as heavy drinkers had a negative screening result. Heavy drinking was most often connected with psychiatric disorders, but it was present in all specialities. A wide range of diagnoses were found among abusers. It is concluded that all patients in all clinics should be asked about their drinking habits instead of relying solely on the physician's instinct or on the patient's self-report or CAGE. More individual interviews should be done to make possible early intervention in heavy drinking.     

Serum 25-Hydroxyvitamin D Levels in Finnish Children Aged 2 to 17 Years

ABSTRACT. Serum levels of 25-hydroxyvitamin D (25-OHD) in summer and winter were studied in 564 children aged 2–17 years living in the northern, central or southern parts of Finland. The mean levels of 25-OHD were significantly lower in winter (13.3 ± 10.8 ng/ml) than in summer (27.2 ± 10.3 ng/ml) in all age groups ( p < 0.001). The mean 25-OHD levels in the northern part of the country did not differ significantly from the others. In both seasons the levels of 25-OHD were lower in the 11–17 year age group than in younger children. In that age group 22.4 % of the children had serum levels of 25-OHD below 5 ng/ml (the limit of risk for rickets), compared to 16.8 % of children 6–10 years old and 7.5 % of children 2–5 years old, but none of the children showed any laboratory evidence of rickets.     

Peripheral venous concentrations of oestrogens in postmenopausal women with ovarian cancer

Summary. Serum concentrations of oestrone, oestradiol and oestriol were measured in 23 postmenopausal women, 12 with ovarian cancer and 11 with genital prolapse. Oestrone (387.6 pmol/1) and oestradiol (72.7 pmol/1) levels were higher in the cancer group than those in the control group (159.8 and 27.5 pmol/1 respectively), while oestriol levels did not differ (434.5–270.8 pmol/1). The results indicate abnormal ovarian function in postmenopausal patients with ovarian cancer.     

THE EFFECT OF ETHANOL OR HEPATOTOXIN EXPOSURE ON RAT TRANSFERRIN DESIALYLATION

Serum carbohydrate-deficient transferrin (CDT) is being increasinglyused as a biological indicator for excessive alcohol consumption.However, the mechanisms behind the changes in the carbohydratemoiety of transferrin are unclear, although they have been suggestedto be mediated by acetaldehyde or liver damage. To study this,an animal model involving alterations in serum isotransferrinconcentrations would be needed. The present work examined thechanges in the carbohydrate moiety of transferrin in rats afterdifferent degrees of ethanol exposure, the effects of chronicallyelevated acetaldehyde levels, and also the changes producedwith liver toxins (galactosamine and carbon tetrachloride).Ethanol was administered both in the drinking fluid and by intubation,reaching a dose of 11 g/kg/day over 7 weeks, or 16 g/kg/dayover 4 weeks. Serum samples from rats maintained on high ethanolfor 10 weeks by intragastric infusion were also analysed. Somerats simultaneously had cyanamide administered to elevate acetaldehydelevels. However, neither ethanol nor acetaldehyde had any effecton transferrin. Intraperitoneal galactosamine, but not carbontetrachloride, induced transferrin desialylation. Thus, in therat, neither chronic ethanol consumption nor elevated acetaldehydeinduces changes in transferrin microheterogeneity.     

Drinking habits and detection of heavy drinking among middle-aged women

Little is known about alcohol consumption and the efficiency of alcohol questionnaires among women. In the present study 40-year-old (n= 90) and 45-year-old (n= 75) women participating in a health screening gave a self-report about their alcohol consumption and filled out the Malmö modified Michigan Alcoholism Screening Test (Mm-MAST) and the CAGE questionnaires. Teetotallers comprised 11% of the 40-year-old group and 8% of the 45-year-old women. CAGE, but not Mm-MAST -worked with the traditional cut-off point of two recommended for men. When the criterion for heavy drinking was a self-reported consumption ≥140g of absolute alcohol per week or a positive (≥ 2) finding in the CAGE or ≥4 ‘yes’ answers in the Mm-MAST, 20% of the 40-year-old and 17% of the 45-year-old group (together 19%) proved positive. Neither of the two questionnaires nor self-report atone worked perfectly for identifying eke heavy drinker group (n = 3l) screened. Using the three above criteria; of the heavy drinkers 52% were detected by self-report, 55% by CAGE, and 45% by Mm-MAST. CAGE in combination with self-report detected 90% and this combination, being short and simple, can be recommended for clinical practice.     

The efficiency of a questionnaire in detecting heavy drinkers

The suitability of the nine-question Malmö modified Michigan Alcoholism Screening Test (Mm-MAST) was tested on 133 40-year-old men and 140 45-year-old men attending a voluntary population health screening in a typically week-end-drinking society. With a cut-off level of two yes' answers 29% of the middle-aged male population has been reported to give a positive result in this questionnaire. In our study alcoholics were excluded. The amount and type of alcohol consumed per week was asked. The subjects were divided into three groups: (1) social drinkers (0 or 1 yes' answer), (2) suspect abusers (two “yes” answers), and (3) abusers (three or more yes' answers or drinking at least 280 g absolute alcohol per week). Group 2 reported drinking more than group I, but according to biological markers they belonged better to group 1 than group 3. With the originally recommended cut-off level of two yes'answers 50.8% of 40-year-old men and 36.5% of 45-year-old men in our study proved positive. With the three yes’answer criterion the corresponding percentages were 28.5 and 24.0. Forty- and 45-year-old men in group 2 gave many positive answers in the question concerning week-end drinking and avoidance of alcohol for a time, as did 40-year-old men in the question concerning bad conscience after drinking. Beer and spirits were the most popular beverage combination and week-end drinking was the commonest drinking habit. The number of positive answers correlated well with the announced amount of alcohol. In Mm-MAST typical week–end drinking is linked with many positive answers although the weekly amount of alcohol remains low. In many cases the questionnaire was the only way to diagnose alcohol abuse. It should be kept in mind that the specificity of questionnaires is not equal in different cultures. Concerning the Mm-MAST questionnaire we recommend three yes’answers as a cut-off level in week-end-drinking societies.     

Tumour-associated antigen CA 125 in patients with ovarian cancer

Summary. The serum levels of antigen CA 125 expressed by epithelial ovarian carcinoma were measured in 27 postmenopausal women with ovarian tumours and in 16 controls. Increased serum levels of CA 125 were found in nine (75%) out of 12 patients with ovarian cancer; in three with stage I disease levels were not elevated. No significant difference was found in the concentration of CA 125 detected in peripheral or ovarian venous blood. Decreased antigen levels were found 6–30 weeks after radical operation and cytostatic chemotherapy in the ovarian cancer group. The results indicate the value of measuring CA 125 as a tumour marker in the follow-up of ovarian cancer.     

Rapid progression of small cell carcinoma in a renal transplant recipient

Immunosuppression is thought to be responsible for the increased incidence of tumor development after organ transplantation. Natural history of these tumors may be more aggressive than would be expected for a similar tumor in a patient without transplant. We describe the fulminant course of small cell carcinoma, likely of prostatic origin, in a kidney transplant patient. Small cell carcinoma (SCC) and especially SCC of the prostate is an aggressive and rare type of tumor. Due to its rarity, only case reports have been published. To our knowledge, this is the first case of SCC, likely of prostatic origin, in an organ transplant recipient (OTR). The case illustrates the aggressiveness of the disease as reflected by its fulminant progression, which may have been further accentuated by the immunosuppression.