Progressive albuminuria and glomerulosclerosis in a rat model of chronic renal allograft rejection.

A significant proportion of renal allografts fail within several months or years after transplantation, primarily because of chronic rejection. The etiology and pathophysiology of this condition remain unclear. We studied the renal function, morphology, and immunohistology, in parallel, among F344-to-Lewis allografts (n = 23) and isografts (n = 13) over the course of 24 weeks. Only an initial 10-day course of CsA (5 mg/kg/day) was given to both groups to prevent acute rejection. Hypertension did not develop, although awake systolic blood pressure was significantly higher in allografts at the end of the study. Significant differences in urine albumin excretion (UalbV) between isografts and allografts were evident as early as 4 weeks after engraftment but rose dramatically by 20 weeks (3.3 +/- 0.7 vs. 21.2 +/- 3.7 mg/day, respectively, P < .001). This pattern continued until the conclusion of the study (5.0 +/- 1.1 vs. 53.5 +/- 7.6 mg/day, P < .001). Serum creatinine values were only significantly elevated in allografts at 16 weeks, which temporally corresponded to the dramatic increase in UalbV. However, renal blood flow and glomerular filtration rate, measured by paraaminohippurate and inulin clearances, respectively, were significantly lower in allografted organs, at 24 weeks. The frequency of glomerulosclerosis lesions was significantly increased in allografted kidneys at 24 weeks and correlated with UalbV values. Glomerular localization of mononuclear leukocyte subsets were equivalent between allografts and isografts; however, the numbers of interstitial macrophages, CD8+, and pan-T-cells were all significantly greater in allografts at 24 weeks. The infiltration of significantly greater numbers of macrophages and lymphocytes into the tubulointerstitium of the allograft group suggests a mononuclear leukocyte effector cell mediation of the progressive glomerular abnormalities in this model of chronic renal allograft rejection in the rat.


The use of DiI-marked hepatocytes to demonstrate orthotopic, intrahepatic engraftment following hepatocellular transplantation.

A novel method is described for marking primary hepatocytes with the fluorescent dye DiI prior to hepatocellular transplantation and identifying these cells within the hepatic parenchyma of recipient animals by fluorescence microscopy and flow cytometry. Optimal conditions are described for marking cells with DiI in suspension or in monolayer cultures prior to transplantation. DiI is shown to be nontoxic to hepatocytes and not to be exchanged between adjacent cells in vitro. Histological analysis of transplanted tissues shows DiI staining of engrafted hepatocytes and phagocytotic cells (Kupffer cells). This analysis shows that hepatocytes engraft within the hepatic parenchyma and exhibit a histological appearance indistinguishable from normal by conventional hematoxylin and eosin staining. Many previous reports of hepatocellular transplantation have been limited by their inability to unequivocally identify transplanted cells within the liver. These data illustrate the importance of having specific markers for transplanted cells that engraft in an orthotopic location and assume a normal morphological appearance.


Effect of cyclosporine A at therapeutic and toxic doses on the superluteinized ovaries in BALB/c mice.

Administration of cyclosporine (CyA) at therapeutic (10 to 50 mg/kg per day) and at toxic doses (100 mg/kg per day) to gonadotropin-treated immature BALB/c mice led to detection of this drug in the blood and in the ovary at levels that were dose- and time-dependent, the maximum level reached in the blood was 23.8 micrograms/mL, and in the ovary was 0.164 micrograms/mg ovarian weight. Although these were toxic levels, there was no adverse effect on the survival rate as it ranged from 90% to 100%, nor did it induce body weight reduction. In addition, it did not cause any significant structural alterations in the ovarian tissues. The histology of the graafian follicles and the corpora lutea were the same as in the control. On the other hand, the numbers of the corpora lutea were decreased in the ovaries of the CyA-treated mice. This was parallel to the reported decrease in plasma progesterone level to values less than that of the control. These results indicate that the use of gonadotropin primed mice decreased the degree of CyA-induced toxicity.


Cardiopulmonary transplantation service establishment in the 1990s: Australia--a developing country?

1. A National Transplantation Service has been established at the Alfred Hospital performing more than 50 transplants per year. 2. Increased access to transplantation technology has facilitated an improvement in national population servicing from 2.7 to 6.2 transplants per million population per year. National funding of A$4.062 million per year has been secured. 3. Basic research into organ preservation has facilitated transcontinental organ procurement. 4. An active lung transplantation program has been established synchronous with the cardiac transplant service activities. 5. MCS program establishment has paralleled clinical transplantation activities. 6. Budget management and cost containment has been achieved through rationalisation of management protocols.


Donor factors and liver transplantation.

There are thus many factors that may affect the suitability of a donor liver for transplantation, and a reliable, objective method of determining whether or not a liver is likely to function adequately after transplantation is urgently required. At the present time, however, the decision to use a particular donor liver remains a matter of clinical judgement. This decision will inevitably be influence both by the general availability of donor organs and by the urgency of recipient need at the time the liver becomes available, but should nevertheless be based primarily on an appreciation of the donor factors described above.


Neuroendocrine actions of endothelins.

Endothelins are produced in neuronal, pituitary and peripheral endocrine cells, and act through specific endothelin receptors (predominantly the ETA subtype) that are widely distributed in the neuroendocrine system. Endothelin receptors share a common signal transduction pathway with other Ca(2+)-mobilizing receptors, and endothelins induce IP3 and diacylglycerol production, and elevation of [Ca2+]i in many cell types, with kinetics similar to the cognate agonists. As reviewed here by Stanko Stojilković and Kevin Catt, the physiological consequences of endothelin-mediated cell signalling are relevant to the control of several neuroendocrine and endocrine activities including neuropeptide release, pituitary hormone secretion, gonadal and placental function, fluid and electrolyte homeostasis and glycogenolysis.


Recent advances in the electrophysiological characterization of 5-HT3 receptors.

5-HT3 receptors are ligand-gated, cation-selective ion channels, mediating membrane depolarization and neuronal excitation. Established and potential therapeutic applications of selective 5-HT3 receptor antagonists, coupled with the localization of this receptor subtype within discrete areas of the CNS, have resulted in an intensification of research in this area. In this review, Jeremy Lambert and colleagues summarize recent developments in the electrophysiological characterization of 5-HT3 receptors, and comment upon the unresolved issue of 5-HT3 receptor heterogeneity.


New insights into activation of the steroid hormone receptor superfamily.

For many years the prevailing view of how steroid hormone receptors exert their effects on gene transcription has been that these intracellular receptor proteins, upon association with their specific cognate ligands, undergo a transformation to a state where they are capable of interacting with chromatin and regulating the transcription of specific genes. It has become implicit dogma in the field of biochemical endocrinology that receptor activation is absolutely dependent upon this ligand-binding event. However, recent studies described here by Bert O'Malley and colleagues have shown that certain members of the steroid hormone receptor superfamily can be activated in a totally ligand-independent manner by a cell membrane receptor agonist, the neurotransmitter dopamine.


Designing therapeutically effective 5-lipoxygenase inhibitors.

Metabolism of arachidonic acid by the enzyme 5-lipoxygenase leads to the formation of a group of biologically active lipids known as leukotrienes. Peptidoleukotrienes are powerful bronchoconstrictor agents while leukotriene B4 is a potent chemotactic agent for a variety of leukocytes. In view of these properties, leukotrienes have been proposed as important mediators in allergic and inflammatory disorders, and inhibitors of 5-lipoxygenase, by blocking leukotriene synthesis, have therapeutic potential in a range of diseases including arthritis and asthma. This review by Rodger McMillan and Ed Walker summarizes the biology of leukotrienes and the current knowledge of the mechanism of 5-lipoxygenase, providing a framework for consideration of the discovery, development and clinical status of drugs in the three major classes of 5-lipoxygenase inhibitors: 'redox' inhibitors, iron ligand inhibitors and 'non-redox' inhibitors.


Spastic colitis and irritable bowel syndrome: which expression is prevalent? (A review of 120 cases).

Spastic Colitis (SC) of the fifties has been deleted and included in the Irritable Bowel Syndrome, as inflammation is not present, and the disturbed intestinal motility may involve the small and large intestine. With the advent of colonoscopy, we could investigate this generalized common term. Between 1983 and 1988 we have studied 120 documented cases of SC by colonoscopy with multiple biopsies. In every patient, we relied on consecutive procedures to confirm the diagnosis. They included: Stool examination, barium enema, small bowels series, colonoscopy with multiple biopsies. Serological diagnosis of Amebiasis has been applied to 41 patients only. With a normal small bowels, barium enema revealed a severe spasm of the whole colon, or a segmental spasm in one part of the colon. In 53 cases (44%,) we have noted virtual absence of haustra in the tubular descending colon. Colonoscopy in all cases has revealed an active contraction with some congestion of the mucosa or hyperemia. Different degrees of inflammatory reaction shown on multiple biopsies make the diagnosis of SC in these cases more relevant. In the Afro-Asiatic countries where amebiasis is endemic, SC is to be considered, as colonoscopy is proving the prevalence of congested or inflammatory process in the colonic mucosa, even when stool examination is repeatedly negative for amebiasis.


Heller's cardiomyotomy after failed pneumatic dilatation for achalasia cardia--operative pitfalls.

A female aged 46, with achalasia cardia had no relief of dysphagia after pneumatic dilatation done twice. At surgery the muscle fibres were found disrupted, with submucosal adhesions and friable mucosa. Heller's cardiomyotomy could not be done. Repair similar to Mickulicz pyloroplasty was done.


Typhoid and paratyphoid fever: a retrospective study.

Sixty-eight proved cases of typhoid and paratyphoid fever were reviewed in a retrospective study covering 5 years (1986-1990). Patients within the age range of 10 to 39 years constituted 82.3 per cent of cases and there was equal incidence in both sexes. The mean duration of illness before presentation was 9.67 days. The major clinical features were fever (97%), abdominal tenderness (-9.4%), headache and abdominal pain (70.58%) each). Intestinal perforation was the commonest complication (27.9%) with a male preponderance (M:F-3:1). Perforation occurred after the first week of illness in 73.7 per cent of cases. Fourteen out of the nineteen patients who perforated were not on therapy at the time of perforation and they constituted 80 per cent of those cases of mortality in which perforation played a role. Surgical management of perforation gave better results than conservative management (mortality rates of 16.7% and 40% respectively). Salmonella was sensitive to Chloramphenicol in all the cases where the organism was grown. There were 10 recorded deaths (14.9%) of whom 60 per cent (i. e. 6 patients) presented after two weeks of illness.


The surgical pathology of colorectal carcinomas in Nigerians.

This paper presents a 10-year experience on the examination of surgical specimens of colorectal carcinomas in Nigerians. Colorectal carcinomas were found to constitute about 80% of all cases of large bowel malignancy. The Male: Female ratio was 2.28:2. Most of the cases (65.9%) were 50 years or younger and the peak incidence was in the 41-50 year age group. The site distribution in order of frequency was recto-sigmoid area (57.3%), descending colon (23.2%), caecum (12.2%) ascending colon and transverse colon 3.7% each. Seventy-three percent of the tumours were well differentiated adenocarcinomas while 15.9% were poorly differentiated. Mucinous carcinoma and signet ring carcinoma were found in 7.3% and 3.7% respectively. There was colonic metastasis in 54.9% of cases and 20.8% had distant metastases at initial surgery. Associated lesions were villous adenoma, 24.4%, Tubular adenoma-17.1%, amoebiasis 6.1% and schistosomiasis, 3.7%. The above observations together with those of previous authors suggests a difference in the biology of colorectal carcinomas in the tropics. The association with chronic granulomatous diseases, in particular, may be indicative of an entirely different oncogenic mechanism in their development in the tropics.


Malignant carcinoid tumor of the gallbladder: a case report and review of literature.

Carcinoid of the gallbladder and bile ducts is a rare tumor. Till date 20 cases have been reported. Here we report one more case and review all 21 cases collectively. The tumor affects elderly patients of either sex equally. Surgical obstructive jaundice (SOJ), followed by abdominal symptoms were the commonest presenting complaints. None of the patients presented with carcinoid syndrome. Bile duct carcinoids presented significantly earlier than gallbladder carcinoids because of strategic location causing SOJ. Gallstones were present only in 3 cases. Fifty per cent of these tumors were malignant, with liver followed by bone as the commonest site of metastasis. Surgery has been the mainstay of the treatment of these lesions. Old age, jaundice and metastasis at presentation and location of carcinoid in bile duct were found to be bad prognostic factors. In the absence of these features overall survival after surgical procedures like radical cholecystectomy was encouraging enough to undertake the surgical challenge.


Peroperative cholangiogram--routine or selective results of a prospective study.

Peroperative cholangiography (POC) performed as a routine during cholecystectomy for cholelithiasis was evaluated in 102 patients. POC was normal 93 patients. Nine patients had abnormal POCs: 5 were true positive--CBD stones (4) and sphincteric fibrosis (1): 4 were false positive--air bubbles (2) and sphincteric spasm (2). Preoperative indication of CBD stones were present in 12 patients-5 of these had abnormal POC (4 true positive and 1 false positive). CBD exploration was avoided in 7 patients with normal POC. Ninety patients did not have any preoperative indication of CBD stones-4 of these had abnormal POC (1 true positive and 3 false positive). None of the patients with a normal POC had any clinical evidence of residual stones on follow up for one year. POC did not help in any case to delineate biliary ductal anatomy. Routine POC during cholecystectomy should be abandoned and should be performed selectively in patients suspected to have CBD stones only to avoid a negative CBD exploration.


[Effect of ethanol and ethylene glycol on the circadian rhythm of adenylic nucleotide levels in muscles].

The 24-hour's changes in ATP content in the gastrocnemiuses of intact rast are not significant. Both the ADP and AMP content is subjected to 24-hour's variations. It reaches its maximum within the time period from 12 to 15 o'clock p.m. for ADP and at 18 o'clock p.m. for AMP. Intragastric administration of ethanol and ethylene glycol to rats in a dose of 1/3 LD50 once per 24-hour period at 9 a. m. during a 7-days-long period dramatically changes the 24-hour's rhythm of adenylic nucleotide content in the rat gastrocnemius. It has been found that ethanol increases the average 24-hour's content of ATP, but decreases that of ADP. It increases the range of their 24-hour period variations and changes the acrophase. Ethylene glycol decreases the average 24-hour content of the both ATP and ADP, but it increases that of AMP. It changes their acrophases and increases the ranges of 24-hour-period variations of ATP.


Evaluation of antacid gel preparations available commercially in the Indian market.

A scoring system based on the neutralising capacity, cost efficiency and time of buffering of twenty four commercially available antacid gels was analysed. A gel scoring eight out of the ten points was considered as the best antacid. The study provides a practical guide in choosing a quick neutralizing and low cost antacid gel.


[Respiratory and detoxication activity of two fractions of hepatocytes isolated by a non-enzymatic method].

Slow centrifugation of isotonic sucrose medium containing the suspension of hepatocytes, obtained after disaggregation of liver, which has been preliminarily perfused by EDTA solution, results in the formation of two fractions of cells of different colour. Fraction 1 contains intact and metabolically active hepatocytes. Cells of fraction 2 have a damaged membrane, but they are capable of realizing biotransformation of xenobiotics in the presence of exogenous NADPH as well as maintaining efficiency of oxidative phosphorylation of mitochondria under the transfer to the medium simulating cytoplasm.


[Biochemical criteria for assessment of the population status of the northern birch mouse in technologic pollution].

Energy metabolism and microsomal oxidation in the liver of meadow mice caught near a source of technogenic pollution (0.5 km from the enterprise) were studied for 2 years for their peculiarities. Intensification of oxidative processes of succinic acid in the liver mitochondria and a tendency to a decrease of glycolysis in the liver homogenates were observed. Under conditions of technogenic pollution in liver of animals the level of lipid peroxidation and rate of aniline metabolism increase. Activation of the processes of aminopyrine metabolism took place in the meadow mice liver only for one season. The next year the rate of aminopyrine metabolism in the animals liver was lower. This is explained by the system inhibition under the effect of technogenic factors. Therefore, the investigation of biochemical indices is used to indicate the unfavourable effect of technogenic factors in the natural populations of small rodents.


[Effect of sodium nitrite poisoning on the activity of enzymes of anti-oxidant protection and peroxidation processes in mouse erythrocytes].

The intoxication of white mice with sodium nitrite results in the decrease of red cell superoxide dismutase (SOD) and catalase activity. The glutathione peroxidase activity is the same as in the control group. The level of red cell lipid peroxidation in the group of mice that receive sodium nitrite is higher as compared to the control group. After the intoxication the total activity of glucose-6-phosphate dehydrogenase and dehydrogenase of 6-phosphogluconate as well as the activity of glutathione reductase are higher than in the control group. The level of SH-groups and reduced glutathione is higher in the group of mice that receive sodium nitrite in comparison with the control group.


[Antivitamin activity of oxythiamine disulfide nicotinate].

The B1-antivitamin activity of oxythiamine disulphide nicotinate has been determined in experiments on albino mice and it is shown that in the liver this derivative exerts the equal action while in the blood and heart--a more profound and prolonged inhibitory action on the transketolase activity in comparison with oxythiamine disulphide. Like the initial compound oxythiamine disulphide nicotinate does not penetrate through hemato-encephalic barrier and does not inhibit the brain transketolase.


[Comparative analysis of the spatial organization of myoglobins. I. Hydrophobicity profiles].

Hydrophobicity profiles of myoglobins in the animal species far remote in the evolutionary series are considerably similar. A complete coincidence as to the arrangement of hydrophobic zones along the polypeptide chain in myoglobins of the compared species (from a man to mollusc) is revealed at the beginning of alpha-helix of B-segment and in the area corresponding to a cluster which embodies a heme- bound water molecule, distal histidine E7 being directed to this cluster. The mollusc myoglobin with two absent (as compared to myoglobins of other species) hydrophobic sites differs in the profile of hydrophobicity most of all. It is supposed that hydrophobic nuclei forming the heme circumference create a globule "skeleton" thus pre-setting general spatial structure of the myoglobin molecule, which is very significant for its functional activity.


[Mathematical modelling of charge properties of protein molecules].

A procedure of theoretical determination of the dependence of protein molecule charge on the medium pH has been developed. The suggested procedure allows calculating the protein pI value, the molecule charge at the definite pH value, as well as the corresponding values for the protein molecule. Calculations for insulin, apo A-I and apo A-II molecules have been carried out. Calculated pI values are equal to 5.25, 5.64 and 4.86, respectively. A comparison of the theoretical curves and experimental data allows obtaining information of the molecule structure. Carboxyl groups with abnormally high pK values are discovered, that, probably, indicates to the direct interaction of two COOH-groups. A supposition is made on the most probable arrangement of the functional fragments in apo A-I and apo A-II molecules.


[Anti-oxidant system of blood plasma].

Recent data available in literature and the author's data about the state of the antioxidant protection of the blood plasma have been generalized. The role of superoxide dismutase as the basic compound of the antioxidant system is discussed. The character of individual macromolecules (transferrin, ceruloplasmin, albumin) which have shown nonenzymatic specific antioxidant properties is presented. Possible mechanisms of biological activity of some antioxidants have been examined.


[Role of the K4 and K5 plasmin heavy chain kringles in the fibrin clot structure destruction].

A comparative analysis of the rates of polymeric fibrin structure destruction by plasmin (Pm) and its proteolytic derivatives such as Val354-plasmin (c-Pm), Val442-plasmin (m-Pm) and Lys530-plasmin (mu-Pm) has been undertaken. It was shown, that Pm, c-Pm, m-Pm and mu-Pm at equal proteolytic activity, have dissolved fibrin clots with relative rates 40.3:38.0:4.6:1.0 correspondingly. The Pm, m-Pm and mu-Pm relative rates were changed by epsilon-aminocaproic acid to 4.6:1.5:1.0 correspondingly. In this case fibrin clot destruction time was increased for Pm and m-Pm and was not changed for mu-Pm. The rates of fibrinogen hydrolysis were nearly equal for these forms of enzyme. It was suggested, that the specific interactions between plasmin K4 and K5 kringles and solid phase fibrin substrate determine the polymer fibrin structure destruction rate.


[Comparative analysis of spatial organization of myoglobins. II. Secondary structure].

An analysis of probability of distribution curves of alpha-helical sites and bends of polypeptide chains of myoglobins in half-water mammals (beaver, nutria, muskrat, otter) carried out in comparison with those of myoglobins of the horse and Sperm whale (X-ray diffraction analysis has revealed their tertiary structure) has revealed a coincidence of the secondary structure sites end bends of the chain in the studied respiratory hemoproteins of muscles. Despite a considerable number of amino acid substitutions the profiles of alpha-helicity and B-bends of the compared proteins are practically identical. This indicates to the "resistance" of the probability curves to amino acid substitutions and to retention of the tertiary structure of myoglobins in evolutionary remote species of the animals.


[Level and correlation of metabolites of NAD(P)+-dependent dehydrogenase systems in newborn calf tissues in acute diarrhea].

Substantial disorders of redox and energetic processes are observed in the newborn calf tissues which is evidenced by changes in glucose, lactate oxalo-acetate, malate, citrate, alpha-ketoglytarate and glutamate concentrations, as well as in activity of lactate dehydrogenase and gamma-glutamyltransferase, succinate dehydrogenase and alkaline phosphatase and correlations of (NAD(p)/NAD(P)H) in blood cytoplasm and liver and kidney mitochondria.


[Effect of stress factors on carboxypeptidase H activity in areas of the rat brain].

It is established that carboxypeptidase H activity increases as affected by various stress factors in the rat brain departments. The increase of the enzyme activity because of the emotional-pain stress is of continuous character. Possible role of carboxypeptidase H in the development of the stress response is discussed.


Effects of compound RU38486 on growth and lipid biosynthesis in glucocorticoid sensitive human leukemia line CEM-C7.

Glucocorticoid sensitive human lymphoblastoid cells CEM-C7 were examined for the effects of antiglucocorticoid RU38486 on the prevention of early dexamethasone-induced changes, including reduced cell growth, cell shrinkage and fragmentation, decrease in cell plating efficiency and incorporation of acetate into cellular lipids. When RU38486 was added no later than 24 hours after the addition of dexamethasone, it prevented the inhibition of [14C]acetate incorporation into nonsaponifiable lipids, partly reversed the decrease in plating efficiency and reduced cell fragmentation. In addition, the accumulation of dolichols in the nuclei of dexamethasone-treated cells was abolished by RU38486. These results indicate that glucocorticoid-induced changes in cellular lipids are receptor dependent and may be linked to the initiation of the apoptotic cascade.


[Change in concentration of cholesterol and lipoprotein fractions of rabbit blood serum in the dynamics of hypercholesterolemia].

Three quantitatively different periods have been detected as a result of 21-week monitoring of blood serum total cholesterol at hypercholesterolemia in rabbits. The first of them (4th week) ends by a relative decrease of cholesterol concentration: the second one (4th-13th weeks) is characterized by its sharp increase; in the third period (13th-21st weeks) the sterol accumulation slows down. Concentration variations of all main lipoprotein fractions are observed in each of the above periods. Their specific features enable us to suppose that in the first period the cholesterol transport system is activated which, probably, reflects the development of adaptation mechanisms of hypocholesterolemia. The second period can be considered as a transition stage from norm to pathology and is most likely, connected with atherogenesis induction. In the third period, in spite of relative stabilization of total cholesterol level clear signs of hyperbeta and hypoalpha dyslipoproteinemias are observed.


[Localization and causes of lipid peroxidation disorders in the rat cerebral cortex in the early stages of hereditary retinal degeneration].

It is established that previously observed increased rate of the induced lipid peroxidation in brain tissue of rats with hereditary retinal degeneration as compared with normal rats is due to the change of the rate of this process in the microsome cortex brain fraction and was not observed in the mitochondrial-synaptosomal and nuclear fractions. The content of nonheme iron ions in microsome cortex brain fraction of the Campbell rats is decreased by 35% and of the Fe ion was in the reduced form as compared with the Wistar rats. The ratio of Fe2+/Fe3+ in this fraction of the Campbell rats will be 5.21; Wistar rats--0.51. The increase of the reduced form of the Fe ion may be a result of the increased rate of the glucose-6-phosphate dehydrogenase activity in cortex brain tissue of the Campbell rats. We accept change of the content and the forms of the Fe ions in the microsome cortex brain fraction as a cause of the increased rate of induced lipid peroxidation in brain of the Campbell rats. All the observed phenomena are manifested at the early stage of life and indicated that different metabolic disorders can be observed in the Campbell rats not only in the retina and eye pigment epithelium but also in the brain tissue.


[Incorporation of [3H]alpha-tocopherol into isolated nuclei and its binding by rat liver chromatin].

The investigation of inclusion of [3H]alpha-tocopherol to isolated rat liver nuclei has revealed its nonspecific character. The presence of cytosol is necessary for specific interaction of alpha-tocopherol with nuclei. After the centrifugation of preliminarily labeled chromatin the most quantity of tocopherol was bound with oligonucleosomes and pelleted chromatin. It is supposed, that the preservation of supernucleosomes level of chromatin folding was necessary for the interaction of alpha-tocopherol with chromatin.


[Role of alpha-tocopherol and retinol in the antiradical protection of the body in peptic ulcer].

Retinol and tocopherol content, the intensity of spontaneous chemiluminescence as well as concentration of malonic dialdehyde in the blood of practically healthy persons of different age groups and in patients with gastric and duodenal ulcer have been studied. Results are presented. The lower content of tocopherol was revealed in the young persons as compared with other age groups, while the level of vitamin A was not established to depend on age. The content of tocopherol is established to decrease in the blood serum under peptic ulcer. Under these conditions low level of retinol correlates with considerable growth of spontaneous chemiluminescence. Reserve interrelation of tocopherol content in the blood with the level of spontaneous chemiluminescence as well as the absence of true dependence on the concentration of malonic dialdehyde at peptic ulcer are proved. Mechanisms of participation of vitamins E and A in the inhibition of free-radical reactions are discussed, role of their deficiency in pathogenesis fo peptic ulcer is substantiated.


[Chronic inflammatory bowel disease--current status].

Chronic inflammatory bowel disease (IBD) encompasses the disease entities, ulcerative colitis (UC) and Crohn's disease (CD). An aetiologic agent has not yet been defined and the diagnosis is based, therefore, on the sum of clinical, paraclinical, radiologic, endoscopic and histopathologic features. In recent years pathogenetic studies have focused on immune mechanisms, transmissible infectious agents, the potential role of the normal intestinal flora, dietary factors, enzymatic alterations and genetic features, in addition to vascular, neuromotor, allergic and psychologic factors. The prevalence of IBD is increased in first-degree relatives of patients and there is a high rate of disease concordance among monozygotic twins. Thus abnormal genes may encode for one or several immunoregulatory factors, while bacterial wall products seem to activate colonic inflammatory cells in a non-specific way, leading to increased production of cytokines, complement-derived peptides, eicosanoids, platelet activating factor, biogenic amines, kinins, chemotactic oligopeptides, and neuropeptides. The named soluble inflammatory mediators, in addition to free oxygen radicals, are considered responsible for the secondary amplification of the inflammatory process. The corner stones in medical therapy of IBD are still corticosteroids and sulphasalazine (SAZ). The new oral salicylates, which are analogues of SAZ or "slow release" preparations of 5-aminosalicylic acid (mesalazine), have provided a therapeutic progress, because they are tolerated better than SAZ. Immunosuppressive agents, such as azathioprine and 6-mercaptopurine, reduce the requirement for corticosteroids and are effective in refractory CD, but the effect is delayed up to several months. The therapeutic action of cyclosporine A is not sustained, but often associated with side effects. Metronidazole has a beneficial effect on perineal disease.(ABSTRACT TRUNCATED AT 250 WORDS)


[Oxygen binding of myoglobins of diving animals].

When studying oxygen binding by myoglobins of diving animals it is shown that half-saturation of myoglobins obtained from the muscles of animals who can stop the external respiration for a long period of time occurs at oxygen strength of 0.62-0.67 mm Hg. Such indices of oxygenation of respiratory hemoprotein of muscles are characteristic of most mammals. Temperature being decreased from 37 to 15 degrees C, myoglobin affinity to oxygen considerably increases.


[Selective N-heterylazimine inhibition of reactions catalyzed by rat liver glutathione transferase].

Three reactions (nucleophile substitution, thiolysis and N-deoxygenation) catalyzed by rat liver glutathione transferase have been studied using several N-heterylazimine inhibitors. The inhibitors are sharply different in their effectiveness in the transferase reactions. Their efficiency depends on their structure. The mechanism which underlies the found regularities is suggested.


[Autoimmune hepatitis. Forms of manifestation, diagnosis and treatment].

A retrospective study concerning ten patients with autoimmune hepatitis (AiH), diagnosed during a 2 1/2-year period is presented. The age of the patients ranged from 25 to 82 years and nine of the patients were women. Their symptoms included jaundice, pruritus, fever, anorexia and fatigue during a few weeks to years. Seven patients had increased serum aspartate aminotransferase (ASAT) levels. The three patients with normal ASAT levels had hypoalbuminaemia, decreased level of prothrombin or high levels of serum immunoglobulin G. Moderate or high levels of smooth muscle antibody titer were detected in nine patients, while none had increased levels of anti-nuclear antibody titer. Histological features of moderate or severe chronic active hepatitis were demonstrated in nine patients. One patient presented with clinical and histological features of acute hepatitis. Prednisolone therapy was followed by biochemical improvement in all the patients. In one patient, maintenance therapy with prednisolone was combined with azathioprine.


[Immunomodulating effect of ecdysterones].

Ecdysterone, its 20-desoxy-derivative alpha-ecdysone, their 2-desoxy-derivatives ecdysterone 2, 3, 22-triacetate and preparation BTI-4 have been studied for their effect on [3H]-thymidine incorporation in different populations of animal and human lymphocytes. It is shown the ecdysteron and its analogs in concentrations of 10(-12)-10(-5) M take considerable stimulating effect on DNA biosynthesis in animal lymphocytes activated by polyclonal mitogens. The concentration of ecdysterone being increased to 10(-4) m one can observe complete inhibition of activating effect of polyclonal mitogens. Effect of the studied ecdysteroids did not considerably depend on their structure. In case of splenocytes the stimulating effect of ecdysterone on DNA biosynthesis is less expressed than in the case of activated thymocytes. Ecdysterone was established to have considerable inhibiting effect on DNA biosynthesis in the culture of activated Con A cells of lymphocytes in the peripheral blood of healthy donors.


[Patients' knowledge about their own medication--does verbal information help? A blind, randomized study].

Patient's knowledge about their own medicine is often insufficient, and this is possibly a contributory factor for noncompliance. We interviewed 65 patients (median age 61 years) from an out-patient clinic with free access and 86 patients (median age 68 years) from a hospital outpatient clinic. In both groups, knowledge about the dosage and the adverse effects of the drugs was poor. Old age and polypharmacy were associated with poor knowledge; there were no differences as regards knowledge between the two out-patient clinics. The 86 patients from the hospitals out-patient clinic were randomised to either 30 minutes of extended verbal information or to the standard information of the department. At the subsequent visit eight weeks later, a repeated interview indicated, that the informed group had generally improved knowledge about their own medication, while this was not the case in the control group. A statistically significant difference between the groups was, however, only found for medication knowledge about side effects. It is concluded that out-patients knowledge about their own medication is often poor, but can be improved by verbal information.


[Monosymptomatic pneumoperitoneum is not an indication for surgery].

Pneumoperitoneum results from a perforation of the gastrointestinal tract in the majority of instances and the necessity for surgery is involved. In some cases with monosymptomatic pneumoperitoneum, surgery is unnecessary. A case of a man aged 64 with great amount of free intraperitoneal air is presented. The patient was clinically unaffected and had neither fever nor signs of peritoneal affection. The intraperitoneal air decreased slowly and disappeared after about 60 days. A self-sealing perforation of a duodenal ulcer was the cause of pneumoperitoneum. The most common causes of non-surgical pneumoperitoneum (PP) are discussed. Monosymptomatic PP is not an indication for emergency surgery. If the patient has no signs of peritoneal reactions conservative treatment can be considered.


[Kinetic characteristics of Ca2+-phospholipid-dependent protein kinase from the rat liver in the early stages after x-ray irradiation].

The changes of kinetic characteristics (apparent Km and Vmax) of the Ca2+ phospholipid-dependent protein kinase (protein kinase C) from the rat liver for substrates ATP and histone Hl 2 and 24 hours after total X-ray irradiation have been established. The obtained results evidence for the important role of these changes in early radiosensitivity of protein kinase C.


[Spontaneous esophageal rupture during the 3rd trimester].

A 30-year-old woman, 35 weeks pregnant, developed spontaneous rupture of the oesophagus following severe vomiting, probably caused by treatment with Ritodrin (Utopar). The symptoms, diagnosis and treatment of spontaneous oesophageal rupture are discussed.


[Should I also eat fish oils? A critical assessment of the use of fish oils in the prevention of ischemic heart disease].

The effect of a daily dietary supplement of 6 g fish oil (3.4 g eicosapentaenoic and docosahexaenoic acid) on body weight, blood pressure, bleeding time and blood lipids was assessed in an open trial. The fish oil was taken for four weeks by nine 30-55 year-old individuals. An age- and sex-matched control group took equivalent amounts of safflower oil, which has an overall fatty acid composition similar to the tested fish oil. The fish oil supplement caused significant changes in body weight (median: +0.9 kg), systolic blood pressure (-10 mmHg), diastolic blood pressure (-5 mmHg), and high density lipoprotein (HDL) cholesterol concentration (+0.21 mmol/l), whereas serum triglycerides decreased insignificantly (-0.25 mmol/l). Low density lipoprotein (LDL) concentration were not affected. We observed no changes in the control group. In the discussion, it is underlined that fish oil supplementation may affect some risk markers of ischemic heart disease favourably. However, other important risk markers, including LDL cholesterol, are unaffected or unfavourably affected by fish oils. A more uni-directional reduction in risk can be attained by a change in dietary habits, which should be preferable to a fish oil supplement in the general population. Individuals who show critically low HDL/total cholesterol ratios, who are hypertriglyceridemic, or are mildly hypertensive may, however, benefit from a fish oil supplement of the amount tested here.


[Use of pneumatic anti-shock equipment (MAST = military anti-shock trousers) in prehospital emergency treatment. A review].

Employment of pneumatic anti-shock (MAST) equipment is a therapeutic possibility in some countries for hypovolaemic and shocked patients. This treatment may be associated with particularly serious side effects and no documentation is available to prove that MAST is beneficial for the patients. The only meticulous clinically controlled investigation concludes that MAST is without effect in city regions with well-trained paramedical or medical staff and employment of MAST can thus not be recommended. The effect of MAST outside urban regions is unknown and should be assessed by means of a clinically controlled investigation.


[Dynamic continuous vectorcardiography].

Continuous dynamic vectorcardiography is an ideal method for monitoring patients with myocardial ischemia. The monitoring is a non-invasive and real time registration and simultaneously safe and reproducible. The method has proved valuable for describing the evolution in different ischemic heart diseases. The method measures the electric myocardial activity in three orthogonal leads and a computer calculates the different vectorcardiographic parameters for the ST- and QRS-complexes. Vectorcardiographic registration is feasible for computer analysis, because it can summarize all information in a few parameters. Using continuous registration, the different parameters can show dynamic evolution and, in this way, describe the variability during acute myocardial infarction and unstable angina pectoris. The method also made it possible to evaluate anti-ischemic treatment in patients, as for example thrombolytic therapy.


[Sick-leave during pregnancy--focusing on textile workers].

In order to illustrate the conditions involved in sick-leave during pregnancy, 593 consecutive parturient women received a questionnaire on the day after delivery. 48% of the pregnant women were certified as sick and 16% were admitted to hospital during pregnancy. The most common reasons for sick-leave were threatening abortion (19%), haemorrhage (18%) and threatening premature delivery (15%). The duration of sick-leave averaged 15 weeks as compared with 7.3 weeks in Denmark as a whole. In the subgroup of textile workers, 71% considered that the work was physically stressing and 70% were certified sick. Compared with all of the other occupationally active women, textile workers were more frequently certified sick, considered that their work was more physically stressing and had more frequently required sick-leave but were more rarely admitted to hospital. Similarly, textile workers had a greater risk for sick-leave on account of threatening abortion, pelvic loosening or pain in the locomotor system.


[Experiences with microcomputer based registration of esophago-gastro-duodenoscopy].

The development of and the experience with a microcomputer based register of endoscopy is described. The paper work was reduced from nine forms to one. The register provides the information necessary for budgeting the resources for staff and new equipment. The system provides the opportunity for analysing existing and new principles for treatment and provides information about the pattern of diagnoses, thereby supporting the running of clinical controlled studies. During the first 29 months, data from 6,014 endoscopies were collected. The categories of patients and the distribution of diagnoses is presented.


[Cholesteatoma behind an intact ear drum--an overlooked disease?].

On the background of increasing international interest for early diagnosis, pathogenesis and treatment of cholesteatoma in children, a sub-group is described and termed primary cholesteatoma, congenital cholesteatoma in the middle ear or cholesteatoma in the middle ear behind an intact ear-drum. This review is based on a retrospective review of cholesteatoma in children submitted to operation in Hjørring Hospital during a period of five years from 1986 to 1991. All of the children were under the age of 16 years. Out of 22 cholesteatoma treated operatively in children, the authors found six cases (27%) of congenital cholesteatoma. The symptomless congenital cholesteatoma in the middle ear is recognized clinically by otoscopy where it appears as a white shadow, most frequently in the anterior upper quadrant, behind an intact ear-drum. Early diagnosis is important and may be established by general practitioners, paediatricians and otologists at routine otoscopy.


[Extraintestinal manifestations of Salmonella infections illustrated by 2 cases of mycotic aortic aneurysm].

Following an increased number of cases of Salmonella bacteraemia during recent years, an increased number of extra-intestinal manifestations were observed. Early diagnosis and rapid institution of treatment (both surgical and antibiotic) is decisive for the prognosis. Peroperative antibiotic treatment should cover possible Salmonella infection.


[Conservative treatment of brain abscess complicating neonatal Escherichia coli meningitis].

The case of a newborn infant who developed meningitis caused by E. coli is presented. During i.v. treatment with ampicillin and gentamycin in recommended doses and according to susceptibility patterns, the patient developed cerebral abscesses detected on CT. After changing to third generation cephalosporin, the patient improved clinically and the CT-changes regressed and disappeared. Because of their superior bactericidal effect, we recommend a third generation cephalosporin as a first choice in the treatment of neonatal E. coli meningitis.


[Treatment of isolated systolic hypertension in the elderly by general practitioners].

By means of a questionnaire investigation, 150 general practitioners selected at random were asked about how they defined isolated systolic hypertension in elderly individuals, whether they employed medicinal treatment of this patients group and what their reasons for this were. The mean values for the highest systolic blood pressure which were considered to be normal were 175, 185 and 200 mmHg for the age groups 60-69 years, 70-79 years and > or = 80 years. Only approximately one fourth of Danish general practitioners consider medicinal treatment of isolated systolic hypertension and only at a much higher systolic blood pressure level than shown by a corresponding investigation among American doctors where 89% employ treatment for isolated systolic hypertension. On the basis of the present strategy in Denmark and the recent results from the first prospective placebo-controlled investigation of the treatment of isolated systolic hypertension, the future therapeutic strategy is discussed.


[Temporal lobe epilepsy--psychiatric aspects and surgical treatment].

The prevalences and types of psychiatric disorders connected with temporal lobe epilepsy and surgical treatment hereof are discussed. Studies comparing psychiatric morbidity among surgically treated patients and less selected groups of patients with epilepsy, respectively, are desired. Previous follow-up studies of patients undergoing temporal lobe resection point to a high prevalence of psychiatric disorders pre- and postoperatively, in terms of personality disturbances (especially aggression) and various psychotic disorders. On the basis of older studies, postoperative psychoses are believed to appear in 7-10% of surgically treated patients. New Brain Imaging and neurophysiological techniques permit a more precise focal diagnosis. Thus more selective surgical procedures have been introduced, e.g. resection of the amygdala and hippocampus. Together with an increased awareness of the importance of psycho-social factors and the absence of severe psychiatric disturbances for a good postoperative outcome this means that results of older studies may no longer apply. Studies reflecting present day conditions are needed.


[Psychosocial consequences and surgical treatment of epilepsy. A review].

Epilepsy is one the commonest neurological diseases. In 25% of the cases, particularly in patients with temporal foci, the seizures prove to be resistant to medicinal treatment. Several investigations have stressed that these patients have pronounced psychosocial problems which may be more important to the patient than the actual seizures. Taking into consideration the WHO definition of health as complete physical, mental and social well-being, patients with epilepsy have problems in all of these dimensions. The major problems are social isolation and employment. Surgical treatment of epilepsy has a pronounced effect on the seizures in 90% of the operations in the best series but it is still uncertain whether reduction in the number of seizures also implies better quality of life. The present data suggest improvement in the psychosocial conditions of the patients who functioned best preoperatively and who became seizure-free after operation. The importance of further longitudinal studies emphasizing the psychosocial aspects is stressed.


[Extent of HIV infection and AIDS among drug addicts].

The purpose of this study was to review the extent of the HIV-epidemic and to make a prognosis about the number of AIDS-cases among drug addicts in the community of Copenhagen. In the public institutions for treatment of drug addicts, 191 HIV-positive individuals were known by January 1991. In the period August 1990-November 1991, 33 newly recognized cases of seropositivity were registered among drug addicts in the area of Copenhagen, but the time of infection was unknown. By October 1991, 53 cases of AIDS among drug addicts in Denmark were recorded. Based upon the knowledge of incubation period and mortality of AIDS, it was possible to set up a mathematical model, from which the number of expected AIDS-cases could be estimated. This model showed that the number of living drug addicts with AIDS in the community of Copenhagen probably not will exceed 20 during the coming years. It was also showed, that the number of drug addicts, who were infected with HIV in the primary spread of the virus in 1985-1986, was probably lower than 250. The actual prevalence and incidence of HIV-infection among drug addicts is uncertain, and there is a need for better surveillance of the epidemic.


[Blood pressure check-up--routine blood pressure measurements in a patient with arteriovenous shunt and under dialysis].

A case of untreated hypertension in a patient, where blood pressure could be measured in the right arm only is presented. At autopsy, the brachio-cephalic artery was found to be occluded explaining why blood pressure values were low. Significant left ventricular hypertrophy indicating high central blood pressure was found. Sudden death followed a spontaneous intracerebral bleeding. The value of conventional blood pressure measurement in patients with arteriovenous shunt because of chronic dialysis is discussed.


[Functional hypoglycemia. Fancy or fact?].

Idiopathic reactive or functional hypoglycemia is not a recognised disease entity. It is defined solely on the basis of a history of hypoglycemic symptoms in everyday life, which can be relieved by food intake. However, the general opinion is that functional hypoglycemia exists, but it is not a frequent condition. The coincidence of a low blood glucose nadir and hypoglycemic symptoms in the hypoglycemic phase of the oral glucose tolerance test is not diagnostic of functional hypoglycemia. Endocrine dysfunction has never been demonstrated. The logical approach to the problem is to study blood glucose values during everyday life and at the onset of symptoms. This has been done in two controlled studies using reliable monitoring techniques. Low blood glucose concentrations during attacks could only be demonstrated in one of the studies and only in some of the subjects. Furthermore, the pattern of recorded symptoms was independent of the measured levels. Thus, these patients are probably not hypoglycemic in the true sense of the word. In a recent controlled but unblinded study, a higher blood glucose threshold for the onset of hypoglycemic symptoms was demonstrated in a group of patients with functional hypoglycemia. This, combined with a highly refined diet poor in fibre and starch, could provide symptomatic oscillations of blood glucose levels. However, much more research is needed in this field, before any conclusions are drawn.


[Should all women be ordered gynecological examination a few days after delivery?].

The results of a national survey, including all maternity units in Denmark, showed that 43 of 57 units (almost 75%) advocated routine pelvic examination a few days after delivery. Three out of 60 units did not answer the enquete corresponding to a 95% reply rate. Following the same procedure as the main part of delivery units in Denmark, all women confined in Sønderborg Hospital were offered routine pelvic examination four days after birth, however six days after caesarean section. A retrospective survey of the records for all women hospitalised for delivery in Sønderborg Hospital during 16.5.1990-16.11.1990 showed that 550 out of 715 women (77.0%) had been submitted to routine pelvic examination. Twenty one of these (3.8%) were treated according to one of the following abnormalities: atony of the uterus (14), superficial inflammation in caesarean scar of episiotomy (4) or endometritis (3). Based on a critical review of the cases, its concluded that all the treated complications were either insignificant, were treated unnecessarily or should have been diagnosed from the symptoms. As an alternative it is proposed, that routine pelvic examination a few days after birth should be restricted to selected women at risk. Other puerperal women should be observed closely and, depending on relevant symptoms, a pelvic examination should be made. In all cases and according to regulatives of the Danish Health Authorities (Sundhedsstyrelsen) all puerperal women should be offered a final examination by their practitioner eight weeks after birth.


[CO2 laser treatment of proximal pharyngo-esophageal diverticula (Zenker's diverticula)].

The pharyngo-esophageal diverticulum (Zenker's diverticulum) has traditionally been treated operatively by an external approach. Since the 1950's the endoscopic technique has been performed increasingly as a good alternative. Since 1989, we have treated Zenker's diverticulum endoscopically as a standard procedure, and hereby we present our results here. We use the Benjamin-Hollinger diverticuloscope, through which the septum between the diverticulum and esophagus is divided by a CO2-laser. Nine patients have been treated, five men and four women. Mean age 77 years (range 59-93). Diverticulum size varied between 1x2 cm and 6x6.5 cm. No major complications occurred. One patient had recurrence of symptoms after three months and was reoperated with the same technique. The mean observation period is 12 months (range 4-28). We find the endoscopic CO2-laser technique safe, and for the elderly age group suffering from Zenker's diverticulum, less traumatic than the external approach.


[Preventive hepatitis B vaccination of hospital staff].

In March 1990, a vaccination campaign against hepatitis B was organized in a municipal hospital in Copenhagen (Bispebjerg Hospital). The hospital staff (830 subjects) at risk of infection with hepatitis B were offered vaccination with Engerix B. The vaccination was given as Engerix B (recombinant DNA vaccine) in muscle deltoid after 0, 1 and 6 months. Antibody level was measured after one month. A total of 362 (44%) received vaccination against hepatitis B and 86% of these completed the vaccination schedule and received at least three vaccinations. 95% of the vaccinated subjects were protected after three vaccinations (HBsAg more than 10 IU/l). The recombinant DNA vaccine does not differ from the plasma-derived vaccine concerning immunogenicity and adverse reactions. There was a low compliance with the vaccination campaign, especially among doctors (35%) and laboratory technicians (35%), despite central organization.


[Use of narcotics by school children in Greenland. A nation-wide study of habits of school children concerning narcotics].

An attempt was made to describe the extent to which school pupils employ the intoxicants: tobacco, alcohol, hash and sniffing. The prophylactic committee, PAARISA, issues informative campaigns about intoxicants, the effects of which are assessed by means of investigations such as this. An anonymous questionnaire was employed. This was sent to 18 towns and seven villages distributed over all of Greenland. The questionnaire contained questions about social background, smoking habits, alcohol habits, sniffing and smoking of marihuana. The questionnaire was completed by the pupils in the schools under confidential conditions and was then returned to the author. The investigation was carried out during the period from 15.10. 1990- 15.11. 1990. All of the towns and the largest villages in all Greenland participated. The investigation was established on the initiative of the author in cooperation with PAARISA. A total of 1,934 school pupils aged from 12 to 19 years replied to the questionnaire. The percentage of replies was 88 of these questioned. Out of 1,557 pupils who spoke Greenlandic, 774 were boys and 783 girls. Out of 377 pupils who spoke Danish, 208 were boys and 169 girls. 26% of the Danish-speaking boys and 45% of the Greenlandic-speaking boys smoke, while 39% of the Danish-speaking girls and 61% of the Greenlandic-speaking girls smoke. Three quarters of the oldest age group smoke. Girls smoke more frequently than boys. 71% smoke more than three cigarettes daily. 87% of the Danish-speaking and 63% of the Greenlandic-speaking pupils had tried drinking alcohol.(ABSTRACT TRUNCATED AT 250 WORDS)


[Written patient information. Analysis of Danish biomedical research programs].

All patients involved in biomedical research must, according to the Helsinki II declaration, receive complete verbal and written information about the project. Valid consent must be based on adequate information. This study analyses all of the 225 written patient information sheets submitted for approval to the regional research ethical committee covering the three southernmost counties in Jutland (Denmark) during the years 1989 and 1990. Linguistic analysis shows that the information is written in a difficult style with a median readability index of 48.2. It is generally recommended that information directed to the general public should have a readability index below 40 (approximately the level of the popular press). Analysis of information content shows that several important pieces of information are often missing: for instance, information about the name of the leader of the research and about the fact that the relationship with the institution will not be adversely affected by a refusal to participate in the research programme.


[Total uterine rupture of a cesarean section scar during attempted vaginal delivery under epidural analgesia].

A case of complete uterine rupture and abruptio placentae during an attempt of vaginal delivery under epidural analgesia in a woman with previous caesarean section is described and discussed. When using epidural analgesia for such a patient during vaginal delivery it is imperative that newly developed pain should be ascribed to the uterine scar and the diagnosis of threatening uterine rupture be made immediately.


[Meningitis caused by Capnocytophaga carnimorsus with development of erythema nodosum].

A case of meningitis in a 42-year-old previously healthy man caused by the gram-negative rod Capnocytophaga carnimorsus is presented. The patient had erythema nodosum. Bacteremia was possibly induced during dental treatment.


[Leptospirosis. A disease with non-specific initial symptoms].

A case of leptospirosis in a young fish-farm worker is described. Early penicillin therapy was initiated solely on the clinical suspicion of the disease. The importance of recognition of the disease is emphasized together with early institution of penicillin therapy and effective eradication of vermin.


[Heart rate disorders in potassium and magnesium deficiency].

Potassium and magnesium deficiencies are common in patients with heart disease. These are often coexistent and pathophysiologically related. Potassium deficiency cannot be treated without correction of concomitant magnesium deficiency. Correlations between serum levels and body stores are very poor for both ions. Therefore diagnosis and treatment of these conditions based on serum levels alone are erroneous. There is some evidence that it is primarily the intracellular depletion of these ions which is arrhythmogenic. Magnesium infusion has been proved effective in treatment of torsade de pointes ventricular tachycardia and arrhythmias induced by digoxin-intoxication, and is recommended in these conditions. Whether it is effective in other forms of arrhythmia is not yet elucidated.


[Parasitic diseases in patients with impaired immune response. Clinical picture and diagnosis].

Patients with impaired immune system are frequently infected with various parasitic diseases. The clinical picture is characterized by unusual manifestations and frequently severe recurrences of infections which are not normally serious. Some almost parasitic microorganisms produce symptoms exclusively in patients with impaired immune system. Parasitic infections have become increasingly common with the increasing number of patients who live for prolonged periods with impaired immune systems, often as a result of infection with HIV. Among the numerous parasitic infections which are observed in man, there are a few which occur particularly frequently in patients with impaired immune systems. This is a brief review of the clinical pictures and diagnostic options in parasitic disease in individuals with impaired immune system with particular emphasis on infections caused by: Pneumocystis carinii, Toxoplasma gondii, Cryptosporidium ssp., Microspora, Entamoeba histolytica, Leishmania ssp., and Strongyloides stercoralis. In patients with impaired immunity, parasitic infections frequently cause nonspecific symptoms and, on account of the impaired immunity, antibodies to the parasite are not always produced. The diagnosis of these infections is, therefore, based on morphological demonstration of the microorganism concerned, culture, specific antigen or DNA defections.


[Is it possible to change long-term benzodiazepine consumption by counseling in general practice?].

Twelve general practitioners in a community offered 576 long-term consumers of benzodiazepines interviews in order to discuss possible reduction in medication. A total of 175 accepted the offer. Consumption of benzodiazepines was registered in the local pharmacy before and after the intervention. The total average reduction occurred in 20% and a definite reduction in consumption of sedatives by 30-49 years in 60%. The consumption of benzodiazepines by patients aged over 70 year remained the same as before the intervention.


[Characteristics of a group of long-term consumers of benzodiazepines who were offered interview with their general practitioner].

In connection with a project aimed at reducing the consumption of benzodiazepines in the Municipality of Odder, an attempt was made to select the patients who would be motivated for accepting offers of interviews with the general practitioner to discuss possible reduction of the consumption of benzodiazepines. It did not prove possible to select the group of patients who would be motivated for this type of encounter in advance. A positive effect of the offer of interviews to discuss possible reduction in the use of benzodiazepines was observed. More than half of the patients had either discontinued or had reduced the consumption of benzodiazepines.


[Adolescents' wishes to have children].

During the period 1984-1986, an investigation concerning sexual behaviour, contraceptive methods and pregnancies was performed among Danes aged 16-20 years in Denmark. A random sample consisting of 286 women (respondent rate = 75.3) and 336 men (respondent rate = 79.6) was interviewed by the Institute of Social Research. During the same time interval, 140 women admitted for legal termination of pregnancy in the County of Funen (respondent rate = 73.6) replied to a corresponding questionnaire. Some results have been published previously (4-6). This paper present results concerning the number of children the adolescents wish to have in the future and the age at which they want to become parents. A remarkable correspondence in the replies was found. The majority, including the women admitted for termination of pregnancy, the non-pregnant women and the young men, want to have two to three children. The majority, however, would prefer to have children when they themselves were between 20 and 30 years of age. In all, 62.9% (n = 171) of the non-pregnant women and 54.5% (n = 181) of the men would choose or advise application for legal termination, in the case of pregnancy. The women admitted for termination of pregnancy were asked to give priority to ten preformulated attitudes and their importance for the choice made when applying for abortion. A total of 70.5% (n = 93) replied that the formulation "It is too early for me to have a child" was of great importance for their choice, while the financial situation, housing problems and the possibility of being a single mother had lower priorities.


[Duplication in a medical department of tests previously performed in a primary sector].

The aim of this study was to evaluate whether an insufficient flow of information from the primary to the secondary sector was the cause of unnecessary duplications of investigations. From practitioners of 202 patients admitted to a medical department information about paraclinical examinations during the previous year was obtained. In all 111 general practitioners participated. An average of 3.0 blood analyses and 0.9 other investigations were carried out on each patient. 44% of the patients were not investigated at all. An average of 1.9 blood analyses and 0.2 other investigations on each patient were repeated. 22% of the repetitions in both cases were due to insufficient communication between the practitioner and the hospital. These figures seem low and insufficient communication between the primary and the secondary sector appears to be a minor problem.


[Insect allergy and sudden unexpected death].

A case of sudden unexpected death after an insect sting in a middle aged man known to be allergic to insect stings is presented. In connection with an allergic shock, many years before death occurred, he had been offered allergological investigation. If the directives in the consensus report on insect sting allergy, recently published by the Danish Association for Allergology had been followed, similar deaths and expensive visits to casualty departments could probably be reduced.


[Congenital tuberculosis. 2 case reports].

Two cases of congenital tuberculosis are presented and the literature is reviewed. One child survived without sequelae while the other survived but was severely handicapped. The importance of early diagnosis and treatment of this rare but serious manifestation of tuberculosis is emphasized.


[Check-ups of colorectal neoplasms--current practice].

In order to investigate the practice for control of patients with colorectal adenomata and cancer, a questionnaire investigation was carried out in 1990-1991 among 53 Danish surgical departments. The investigation revealed great differences in the control programmes offered to these patients as regards the methods, the intensity and duration. In addition, differences were present in the control pattern for adenomata in specialist departments as compared with the remaining departments where there was a tendency to very frequent but, on the other hand, brief control. On the basis of these results, it is considered necessary that a reference programme should be prepared on this subject.


[The pacemaker syndrome].

The pacemaker syndrome is a complex of symptoms consisting of heart failure, near fainting, sensations of pulsation in the neck or abdomen or cough which develop or are aggravated after cardiac pacing. Objectively, a fall in systolic blood pressure is observed in the majority of cases and also canon waves in the neck veins, signs of heart failure, retrograde arterial activation and possibly canon-a-awaves in the central venous pressure. The syndrome occurs in approximately 15% of the patients with ventricular pacing. The condition is most probably caused by lack of atrioventricular synchrony with resultant distension of the atria which results in a reflex mediated decrease or defective increase in the total peripheral resistance and, thus, a fall in systolic blood pressure. Treatment consists of establishing normal atrioventricular synchrony either by implantation of an atrial or AV-sequential pacemaker or by re-programming so that the patient has, primarily, his own rhythm. Ensuring normal atrioventricular synchrony has also other advantages as several investigations have shown that 60-80% of the patients prefer this form of pacing rather than ventricular pacing. The working capacity improves and the patients feel subjectively better and the risk for development of chronic atrial fibrillation and heart failure decreases.


[Surgical treatment of temporomandibular joint ankylosis].

Surgical treatment of temporo-mandibular joint (TMJ) ankylosis may be a particularly difficult procedure due to unfavourable anatomic configurations and the proximity of vital structures. Postoperatively, it is followed by an often long and painful period of physiotherapy. The results of treatment of eight patients with TMJ ankylosis are reported. Different methods were used according to age of the patient and the extent of the ankylotic changes. The importance of early treatment is emphasized. This results in less extensive surgery and reduces secondary growth anomalies of the jaws.


[Effect of 0-(beta-hydroxyethyl)-rutoside (Venoruton) on symptomatic venous insufficiency in the lower limbs].

Forty-three patients recruited from general practice with symptom-producing chronic venous insufficiency in the lower limbs participated in a randomized double-blind clinical trial with Venoruton (300 mg x 3) or a placebo for 28 days. Twenty-eight patients were treated with Venoruton and 19 with a placebo. None of the patients received other forms of treatment for chronic venous insufficiency. No differences were observed between the two groups as regards changes in symptoms (swelling, pain, heaviness, restlessness, itching and cramps) the subjective assessment of the discomfort in the extremities or the circumference of the limbs. Venoruton does not appear to have any effect on chronic venous insufficiency in the lower limbs.


[Failure of the pacemaker in electric cardioversion of atrial fibrillation].

A 72-year-old man with an AAI-rate-responsive pacemaker (Siemens-Elema Sensolog III; unipolar pacing electrode) was admitted for cardioversion of atrial fibrillation. Electrical defibrillation was followed by severe nodal bradycardia and pacemaker malfunction characterized by loss of atrial capture. The pacemaker failure was due to an acute rise in the stimulation threshold, possibly secondary to current-induced tissue damage at the electrode-endomyocardial interface. It is recommended that a pacemaker is reprogrammed to maximum pulse voltage amplitude prior to elective DC-cardioversion and that serial measurements of the myocardial stimulation threshold are performed after defibrillation. Other factors essential for the management of the pacemaker patient who requires electrical defibrillation are outlined.


[Stress fractures].

The authors present stress fracture (fatigue fracture). Theories about the cause, the underlying mechanism, etiology, pathology, localisation, diagnoses and treatment are discussed, and two case histories are mentioned. Suitable precautions are recommended for runners. The authors would like to emphasize the importance of further investigations including technetium scintigraphic, in cases where stress fracture is suspected.


[Malaria and pregnancy].

In regions where malaria is endemism, the disease is a recognised cause of complications of pregnancy such as spontaneous abortion, premature delivery, intrauterine growth retardation and foetal death. Malaria is seldom seen in pregnant women in Denmark but, during the past two years, the authors have treated four patients in the University Hospital in Copenhagen. These pregnancies were all successful but two of the mothers required emergency Caesarean section on account of threatening intrauterine asphyxia. The patients came relatively late for treatment which may be because not only the patients but also their practitioners were unaware that malaria can occur several years after exposure. Three out of the four patients had employed malaria prophylaxis. As resistance to malarial prophylactics in current use is increasing steadily, chemoprophylaxis should be supplemented by mechanical protection against malaria and insect repellents. As a rule, malaria is treated with chloroquine. In cases of Falciparum malaria in whom chloroquine resistance is suspected, treatment with mefloquine may be employed although this should only be employed in cases of dire necessity in pregnant patients during the first trimester. Severe cases should be treated with infusion of quinine. During pregnancy, benign malaria may run a violent course and pregnant women with malaria should be monitored in maternity departments and should be treated in cooperation with specialists in tropical medicine.


[Sensory deprivation].

A review of sensory deprivation is presented. The history of the concept and the terminological problems are reviewed. The symptoms are subdivided into: perceptual, cognitive and affective and the physiological disturbances are reviewed. Various etiological theories are discussed. These include biological, psychodynamic and social psychological theories. Experimental variables related to the subject, the investigator and the design of the research are presented. A review of the clinical and practical implications of sensory deprivation is given. It is emphasized that sensory deprivation might contribute to development of symptomatology in numerous situations. Finally, the potential therapeutic effects of controlled sensory deprivation are discussed.


[3-layer anastomoses after resection of colorectal cancer. A prospective study of 1015 anastomoses].

This study included patients who underwent elective curative resection of adenocarcinoma of the large bowel with primary suture of the anastomosis. The overall incidence of clinical anastomotic leakage was 5%. The incidence of anastomotic leakage was significantly higher in men than in women after low anterior resection. The three-layer anastomosis has no advantage in large bowel surgery when compared with data from other sutured anastomoses reported in the literature.


[Consumption of psilocybin-containing hallucinogenic mushrooms by young people].

The aim of this questionnaire survey was to investigate the extent of hallucinogenic mushroom consumption among students from a high school in the county of Aarhus, Denmark and among students at the University of Aarhus and students from the Danish school of journalism in Aarhus, Denmark. 3% of the high school students had used psilocybine-containing mushrooms as a hallucinogen. Only 1% had experience with LSD. Of the students at the University of Aarhus, and students from the Danish school of journalism in Aarhus, 333 persons (83%) returned the anonymous questionnaire. 9% had experience with hallucinogenic psilocybine containing mushrooms while only 2% had LSD experience. The use of hallucinogenic mushrooms was surprisingly high. This suggest that mushrooms are the most commonly used hallucinogenic substance in Denmark and that the use has exceeded that of LSD. Compared to non-users mushrooms users had significant more friends with mushroom experience. Furthermore, the study shows that the intention to use mushroom is commoner in persons who have friends with HPS experience. We find that the use of mushroom takes place in minor groups known to each other. Compared to non-users, mushroom-users are significant more experienced with marijuana and other substances. Unfortunately, our data do not permit us to show whether mushroom users are more inclined to try other drugs or whether persons with a high drug experience use mushrooms as well. Further investigation on the subject is recommended.


[Serum creatine kinase isoenzyme MB and myoglobin in patients with acute myocardial infarction and coronary reperfusion].

Thrombolytic therapy in patients with acute myocardial infarction (AMI) changes the time-concentration curve of serum creatine kinase isoenzyme MB (CK-MB) and serum myoglobin. In this study, 60 AMI patients received thrombolytic therapy and acute coronary arteriography, or conservative treatment. Group one (n = 32) demonstrated a patent infarct-related artery after intravenous thrombolytic therapy; group two (n = 17) had an initially occluded coronary artery which became patent during catheterisation; group three (n = 11) did not receive thrombolytic therapy. Frequent serum CK-MB and myoglobin measurements showed that patients with acute coronary reperfusion had a rapid increase, an earlier peak value and less total release of both CK-MB and myoglobin to blood compared to AMI patients treated conservatively. The changes in serum myoglobin compared to CK-MB demonstrated an even more rapid, more uniform, and relatively greater increase. Measurements of serum myoglobin may be a useful non-invasive method for evaluation of thrombolytic therapy in AMI patients.


[Intravagal paragangliomas].

Two patients with vascular tumors adjacent to the carotid branch of the vagus nerve are presented. Contrary to expectations, the tumours proved to be intravagal paragangliomata. Both were treated surgically.


[Atrial flutter with paroxysmal 1:1 atrioventricular conduction].

Three patients with "lone" paroxysmal atrial flutter complicated by paroxysms of 1:1 AV conduction are presented. One patient (42 years of age) had been misdiagnosed as an neurotic for 18 years. The mechanism, diagnosis and treatment of the condition are outlined. The most characteristic symptoms are dizzy spells and fainting. The recommended diagnostic procedures include long term ECG recording by telemetry or Holter, exercise-ECG and oesophageal-ECG.


["Case manager" in district psychiatry. A review of the concept].

During the past 20 years, the "case manager" has become a central expression in district psychiatry in USA. The case manager is a person who has the main responsibility for coordination and to a varying extent granting of the district psychiatric contributions to persons with prolonged psychoses. This function was introduced because the previous system with many administrative and physically separate offers appeared to be uncoordinated, mutually competitive and ineffective. The case manager acts as a supplementary "ego" for the patient on his own terms and has an active supportive function. Whereas, coordination was previously the central task, it became considered to an increasing extent more suitable that a multidisciplinary team of case managers supply the district psychiatric therapy themselves. Investigations reveal that the results are just as good or even better than those of the previous combination of hospitalization and outpatient treatment and that the patients are more satisfied. Many hospitalizations can be avoided but the employment of resources is probably not reduced on account of expenses for the case manager function and housing. The number of patients per case manager varies between four and 50, depending on the therapeutic needs of the patient group and, in particular, the tasks which the case manager must perform (all over the treatment or coordination of treatment administered by others). On account of the close contact by the case manager and his supportive activity, there are reasons for particular attention to ethical problems concerning personal choice and exchange of information. Utilization of the American experience with case managers is recommended simultaneously with avoidance of administrative practical splitting of district psychiatry which would make the total therapy ineffective.


[Pelvic inflammation after induced abortion].

A total of 949 women referred for legal termination of pregnancy in the first trimester participated in an investigation to assess the risk of pelvic inflammation in connection with the intervention in women with and without previous pelvic inflammation in connection with previous pregnancies, the gestational age and the clinical experience of the surgeon. Women who had not borne children developed pelvic inflammation more frequently after legal termination of pregnancy (p < 0.01) than women who had previously borne children. Women with previous pelvic inflammation developed renewed pelvic inflammation, if they had not previously borne children (p < 0.01) or if they had previously undergone legal termination of pregnancy (p < 0.05). Women without previous pelvic inflammation developed pelvic inflammation significantly more frequently, if they had not previously been pregnant (p < 0.05). The occurrence of pelvic inflammation was independent of the gestational age and the clinical experience of the surgeon.


[Registration under the diagnosis of traumatic hip luxation in the national registry].

A national study of patients treated on account of traumatic dislocation of the hip in Denmark in 1989 and 1990 revealed that 755 cases had been registered under this diagnosis in the National Patient Register. A review of case reports from 71 departments with 755 registered identity numbers in the National Patient Register demonstrated that 121 patients had been treated for traumatic dislocation of the hip during the same period, and that seven of these had not been registered via the National Patient Register. The remaining 605 patients (80%) had either sustained dislocation of a hip prosthesis or had congenital dislocation of the hip. It is concluded that the Danish National Register, in its present form is of no value whatsoever in registration of traumatic dislocation of the hip nor congenital dislocation of the hip or dislocation of a total hip prosthesis.


[Exercise echocardiography. A new valuable method for demonstration or exclusion of myocardial ischemia].

The aim of our study was to assess the diagnostic value of exercise echocardiography compared with exercise ECG and coronary arteriography. Exercise echocardiography was performed in 60 consecutive patients referred for coronary arteriography because of suspected coronary artery disease. Echocardiography was carried out in combination with bicycle exercise ECG and was performed 1) at rest before exercise with the patient supine, 2) at peak exercise on the bicycle and 3) immediately after exercise in supine position. Conventional standard views were recorded by means of an image computer. For the regional wall motion analysis, images were displayed simultaneously from the rest, peak and post exercise situations in a quadscreen format. Ischemia was diagnosed when wall motion deteriorated from rest to peak or post exercise in at least one out of a total of 16 left ventricular segments. Analysis was made without knowledge of patient data or results of exercise ECG or coronary arteriography. No patient was excluded because of reduced echocardiographic image quality during exercise or other technical reason. Coronary arteriography was performed in all patients and used as reference. The sensitivity of exercise echocardiography was 91% and the specificity 100%. The predictive value of a positive test was 100% and the predictive value of a negative test 78%. For exercise ECG the corresponding values were 58%, 100%, 100% and 39% respectively. We conclude that exercise echocardiography seems to be useful for the diagnosis and exclusion of ischemic heart disease. This and other studies indicate that the method is more sensitive than exercise ECG.


[Amphetamine abuse in Denmark].

Over a five-year period (1985-1989) among a population of 5 million, a survey was made of the presence of amphetamine in 741 cases, in living persons where the police had asked for analyses for amphetamine(s), narcotics, heroin-like compounds, methadone etc. Cases, where the requisition was for morphine (heroin) only, were not included, on account of analytical reasons. Two hundred and fifty-nine cases were found to be positive for amphetamine, with only 18 cases in 1985 followed by approximately 60 cases per year during the remainder of the period. Most of the cases concerned men (93%). The age range was 15-58 years with a median of 26 years. In 194 of the amphetamine-positive cases where relevant information was available, 56% were cases of violation of the traffic laws, 17% were cases of violence, 3% were cases of sexual offence and 9% were cases of robbery. Nineteen of the 259 amphetamine-positive cases were analysed only for amphetamine and, in 75 cases, only amphetamine was found. In the 165 remaining cases, there were 279 positive findings of other drugs/narcotics than amphetamine with benzodiazepines, morphine, cannabis and methadone as the main groups with 86, 57, 49 and 44 findings respectively.


[Emergency services in the admission department of a central hospital].

Medical treatment during the evening and night hours has been the subject of debate at present on account of changes in the practitioner-on-call system. The emergency medical service in the catchment region for the Central Hospital in Naestved before these changes was therefore analysed. Services rendered in this region outside working hours, both by the physician-on-call and the hospital, were registered for the period 1.12.1989-31.1.1990. A total of 8,742 consultations occurred during the period, viz every tenth member of the population sought medical advice. The majority of these contacts were with the practitioner-on-call as 7,253 (83%) sought their general practitioner first and the remainder came to hospital. This corresponds to 117 consultations with the practitioner-on-call and 22 visits to the casualty department per 24 hours of emergency service. Among the patients seeking help from the casualty department, it was found that 30% could have been treated in general practice. Among the taks for the practitioner-on-call, there were 27% telephone consultations, 21% in practice and 52% home visits. No differences were observed between urban rural regions as regards the proportions of services but the number of services followed population percentages. 11% sought medical help at night and 1/3 of these patients were referred to hospital. In the present material, there appeared to be relatively great misuse of the telephone number 000 (equivalent to 999) as only 1/3 of these patients were admitted to hospital. A total of 1,263 patients were admitted to hospital and 78% (982) of these had been seen primarily by the practitioner-on-call.(ABSTRACT TRUNCATED AT 250 WORDS)


[Torsades de pointes ventricular tachycardia caused by terodiline (Mictrol)?].

We report a 84 year old man taking terodiline who had torsades de pointes ventricular tachycardia with prolongation of the QT-interval. The QT-interval became normal after withdrawal of terodiline. Worldwide, the manufacturers have received a total of 37 reports of ventricular tachyarrhythmia during the past months, 28 of which were torsades de pointes ventricular tachycardia and have decided to recall the product temporarily.


[Legionnaires' disease--a multifaceted syndrome].

Multiorgan involvement is often seen in Legionella infections. We report two cases, with classical pneumonia complicated by facial paresis and severe kidney affection demanding haemodialysis. One patient had Legionella infection concomitantly with pneumococcal pneumonia. As the diagnosis often is not verified till weeks after onset of illness, it is concluded that the treatment should be started and maintained on clinical suspicion. Isolation of another respiratory pathogen does not exclude the possibility of Legionella infection.


[Migration of suture material from the abdominal cicatrix to the urinary tract].

Migration of foreign material to the genitourinary tract, often from the gastrointestinal tract through a fistula or perforation is well known. In this case, migration of a non-absorbable suture material from the abdominal wall to the urethra is illustrated. The possible mechanism was insufficient closure technique.


[Clinical microbiological service in general practice in the municipality of Copenhagen. Experiences from the clinical microbiological department at the Hvidovre Hospital 1987-1991].

Since 1987, the clinical microbiological department in Hvidovre Hospital has served physicians in primary health care in the municipality of Copenhagen with microbiological diagnoses and instruction. This paper describes the service model and experience gained during the past four years. During the observation period, the annual number of analyses doubled. In 1990, 66,460 analyses were performed for a total of 399 physicians. The number of specimens per physician varied from 1 to 1903 with a median value of 95. Chlamydia specimens (CS) and vaginal discharge specimens (VDS) examined for yeasts, Gardnerella and Trichomonas comprised the two largest categories. In spite of the increasing number of specimens, the overall rate of positive samples remained unchanged. Physicians who sent many CS in 1990 scored a significantly lower positive rate than physicians who sent few, however, no corresponding difference was demonstrable for VDS. Thus, there is scarcely evidence to assume that microbiological specimens are taken on less strict indications than previously. The increasing number of specimens reflects rather a hitherto uncovered need for microbiological diagnosis in primary health care. Specialists scored significantly lower positive rates for CS and VDS than general practitioners, which may indicate that these specimens are often repeated unnecessarily, when a patient is referred to a specialist. With a view to decentralizing selected categories of specimens, including VDS, courses in microscopy were held, in which one fourth of the physicians of the region participated. A questionnaire survey evaluating the course showed that there is a great interest among physicians in primary health care to perform simplified microbiological diagnosis, but there is still a great need for training and education.


[Hyperthermic regional perfusion in malignant melanoma of an extremity].

Circulatory isolation of an upper or lower limb and perfusion of this with heated cytostatics is an established method of treating local recurrence and in-transit metastases from malignant melanoma. Not only recurrence-free survival but also total survival are increased compared with the results after surgical excision alone. Even when this method is employed in connection with excision of a primary tumour, there appear to be favourable effects as regards recurrence-free and total survival of patients in high risk groups (tumour thickness > 1.5 mm and/or Clark level IV-V). The actual treatment is well tolerated by the patients and complications in the form of oedema of the limb and wound infection are reversible. The frequency of amputation is low and, similarly, the mortality which is 0.6%. As the frequency of malignant melanoma is increasing and, as a great proportion of the melanomata are localized to the extremities, these patients should be offered hyperthermic regional perfusion on removal of the primary tumour and also if recurrence occurs.


[Dog bites in the sledge-dog districts of Greenland].

Serious attacks on humans by dogs occur every year in Greenland. As prophylactic measures, cutting of dogs canine teeth and chaining of sledge dogs have been compulsory for many years. The significance of cutting of canine teeth and municipal regulations concerning keeping the sledge dogs in Greenland was evaluated in a retrospective study of the death certificates and the nosocomial reports. A total of twenty-two dog bite-related fatalities from 1967 through 1989 and 23 hospitalized patients following dog attacks from 1986 through 1988 in a population of 15,000 inhabitants and 29,000 dogs was studied. In only two of the killed and four of the hospitalized persons, reports of intact canine teeth as demonstrated by the typical lesions were available. However, the severe cut-out wounds in 14 survivors and twenty fatalities with great loss of tissue indicated intact canine teeth of the dogs. Unchained dogs were most frequently involved, but at least four fatalities and one severely injured person were caused by chained dogs. 87% (39/45) of the victims were under ten years of age, so future intervention should primarily involve this group despite a declining mortality rate since the mid-seventies. Small children should be escorted by adults out-of-doors and first aid education of laymen ought to have a higher priority because half of the killed children were still alive, on arrival in hospital. Infants and toddlers should be carried in an amaat, a special rucksack well known in the Eskimo culture and still used in Eskimo Canada, or alternatively rucksacks mounted on a tubular frame of aluminium.


[Efficiency of a screening program for gestational diabetes].

From 1.1.1991-31.5.1989, we evaluated a selective screening system for detection of diabetes in pregnancy in an unselected consecutive population of 665 pregnant women. The screening procedure was carried out by the general practitioners and the midwives. The screening was based on clinical criteria for potential diabetes consisting of previous delivery of a large baby, a family history of diabetes and obesity combined with examination for glucosuria and determination of the fasting blood glucose concentration. Only 2% of the pregnant women were examined correctly and only two out of 665 women were found to have diabetes in pregnancy. The screening procedure failed when it was organised by general practitioners and midwives.


[Screening for gestational diabetes in Denmark].

A questionnaire regarding the screening procedure for gestational diabetes was sent to all maternity hospitals in Denmark in 1990. Only 15 out of 51 departments used the screening procedure as proposed by Guttorm & Pedersen. Glucosuria was a clinical risk factor in 49 of 51 departments. There was no agreement about the histories and clinical risk factors. The factors used were family history of diabetes, obesity, a previous infant weighing 9 lbs or more, a previous infant born with low gestational age, habitual abortion, previous perinatal deaths, previous preterm delivery, hydramnios, excessive fetal growth or glucosuria in the present pregnancy. No department used universal screening.


[A hypersensitive reaction after radiography of the colon].

A case of systemic allergic reaction following barium enema is described. The reaction was most probably provoked by a latex balloon on the rectal catheter.


[Malignant melanoma of the penis].

Malignant melanoma of the penis is rare, and accounts for only a small percentage of penile carcinomas. The prognosis is poor, and most patients die within three years due to distant metastases. Awareness of the possibility of malignant melanoma occurring at this uncommon site is an important factor in early diagnosis and consequent improvement of survival. The case report of a man with malignant melanoma of the penis is presented.


[Research of aging: epidemiological perspectives].

The epidemiological aging research has the descriptive task of characterizing the phenomena of aging and their consequences: illness, disability, handicap, and death--in defined population groups and comparing these groups. The other closely related task is analytical epidemiology, which searches for predictive or causal factors: traits, events or conditions of the aging phenomena. Special problems for this research are created by the facts that exposure to the causal factors often may be assumed to have taken place long time before the aging process becomes apparent, that the causal factors may act on cumulative basis over long time, that the effects may be irreversible, and that the factors may no longer play a role at advanced age. The possible role of genetic factors, acting alone or in combination with environmental factors, must be considered and elucidated by special epidemiological methods. The rapid advances in molecular biology raise expectations about epidemiological utilization providing much more precise assessment of the genetic contribution to the aging phenomena, which also will improve the outlook of identification of environmental factors, particularly when there is a gene-environment interaction. The results of these studies will contribute to prevention and treatment of the health problems related to aging.