Biomedical subjects
Publications and source records attributed to K Stavem.
Benign fibrous mesothelioma of the pleura is rare. The tumour may present in several ways, as shown in our two patients, one with an elevated diaphragm and the other with slowly growing intrathoracic tumour. The tumour may reach a considerable size, is localized, is normally benign, and is curable by surgical resection.
Atrial fibrillation in pregnancy is rare and, when encountered, appears mainly as a secondary phenomenon to congenital or valvular heart disease. Increased risk of thromboembolism or detrimental influence on the foetus makes rapid treatment essential. Conventional treatment with digitalis glycosides, verapamil and beta-blockers is safe, as shown in a 32 year-old pregnant woman without known heart disease. Synchronized direct current countershock also appears to be safe in cases resistant to drug therapy.
The diagnosis of diaphragmatic rupture is most commonly made during surgical exploration following penetrating injuries, or in the presence of obvious herniation of viscera through the diaphragm. In the absence of acute herniation a diaphragmatic rupture frequently remains unrecognized and may cause herniation of intra-abdominal contents into the thorax after latency periods of up to several decades. Therefore diaphragmatic rupture is an important differential diagnosis in subjects with unclear abdominal conditions or unexplained pleural effusion in the presence of a history of previous thoracoabdominal trauma. A case is presented which highlights pitfalls and clinical findings.
Medical expert systems is a term for computer programs which represent and structure medical knowledge, and which can supplement or replace man in decisionmaking. Several research groups in Denmark, Finland, Norway and Sweden are developing such systems. Many of the projects emphasize educational aspects and also serve to qualify the participants in the project. The medical expert systems are applied to clinical chemistry, neurophysiological testing or intensive care. Within this field of medical expert systems there is much duplication of activities and too little practical application. Usually the systems are developed to be used as functional prototypes and are often not good enough or not intended to be used in daily hospital routines. There should be good prospects in this field in the near future.
Medical expert systems have been developed for more than 20 years, in particular in the United States. Most existing systems are prototypes, and only a few commercial systems are available. The prototypes are generally limited in scope or functions (and have not been transferred to other users). However, in the near future we can expect useful applications to appear in special areas of medicine. In Norway we probably do not have the resources required to develop large commercial medical expert systems. If we want to develop medical expert systems, we should concentrate on limited areas. We must prepare the ground for future use of such systems in Norway. An important first step is to give health personnel basic education in the use of computers.
Health care is chosen as one of the major target sectors under a national industrial policy program for information technology. The program offers direct support to industrial information technology projects. The part of the program related to health care is executed partly by the Ministry of Health and Social Affairs, partly through a new program under the Royal Norwegian Council for Scientific and Industrial Research. This program is called IT in health care and runs 1989-92. During this five-year period the health care program has a total budget of approximately NOK 85 million for research and development. The funds are used for projects with a distinct industrial objective, and emphasis is placed on cooperation between health care services, research and industry.
Patient-administrative systems are becoming increasingly accepted in general practice. The market is now more mature than before. Many physicians are now purchasing computer systems for general practice the second time. Due to national characteristics of the health services the market for these systems is not truly international. In Norway this market is dominated by two makes: Infodoc and Profdoc. In future more physicians will use systems for general practice, and more functions will be added, although the usefulness of these may be a matter for discussion. Furthermore, the importance of telecommunications is expected to increase, and similarly, integration with other services. This development would be furthered by central government action for the purpose of harmonizing and standardizing data, systems and possibly user-interface.
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Nephropathia epidemica (NE) antigen was detected by IFAT (indirect fluorescent antibody technique) in the lungs of 14 of 97 bank voles (Clethrionomys glareolus) collected in three endemic areas. The distribution of antigen positive voles within an endemic location was scattered. Antibodies to Korean hemorrhagic fever (KHF) virus antigens were detected by IFAT in 12 of 14 NE antigen positive bank voles and in 15 of 83 that were antigen negative. NE antigen positive voles exhibited higher antibody titres. Antibodies to KHF were demonstrated in sera from C. rutilus and C. rufocanus collected more than 200 km north of the distribution area for C. glareolus. It appears likely that these vole species can serve as virus vectors for NE cases occurring north of the bank vole area. NE antibodies cross-reacting with KHF virus seem to diminish with time after infection in some NE patients, while for others such cross-reacting antibodies were detected up to 12 years after the disease. Antibodies to KHF were detected in eight of 106 healthy forestry workers with no clinical history of NE. No serological cross-reactions were detected between NE/KHF antigens and representative Bunyaviridae present in Norway. NE/KHF-like viruses appear widespread in Norway, both within and outside of the distribution area of the bank vole.
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