Biomedical subjects
Publications and source records attributed to S Hunskaar.
A case of orf is presented in a patient with chronic lymphocytic leukaemia treated with chlorambucil and prednisone. Diagnosis was confirmed by electron microscopy and histopathology. Human orf is normally a self-limiting and benign condition but in this case the lesion grew to a size of 60 X 60 X 28 mm. When it was excised, local recurrence was treated with topical idoxuridine.
Orphenadrine, a muscle relaxant with antinociceptive effects, was shown to increase and prolong the antinociceptive effects of paracetamol in mice. Both in the increasing temperature hot plate test and in the formalin test, a combination of the two drugs showed a significantly improved effect compared to either of the drugs alone. The time course of the effects was tested in the increasing temperature hot plate test. The group treated with the drug combination showed a prolonged effect compared to both single drug treated groups, the effect lasting longer than 120 min. for the combination and about 80 min. for the single drugs. Orphenadrine and paracetamol increased antinociception even when orphenadrine was injected 90 min. after paracetamol, which by that time did not exert antinociceptive effects by itself. Thus the combination of orphenadrine and paracetamol enhances the antinociceptive effect of either drug in mice.
Intrathecally administered substance P (SP) or capsaicin in mice elicited a pain-related behavioral response consisting of vigorous biting, licking and scratching of the caudal part of the body. Pretreatment of the animals with intraperitoneally injected acetylsalicylic acid (300 and 400 mg/kg), paracetamol (300 and 400 mg/kg) and morphine (2.5 and 5 mg/kg) reduced the responses in a dose-dependent manner. The analgesia is probably mediated by inhibition of a postsynaptic SP sensitive mechanism. Thus these results demonstrate central antinociceptive effects of acetylsalicylic acid and paracetamol.
The antinociceptive effect of orphenadrine citrate, a muscle relaxant, was investigated in mice. Four different pain tests were selected to involve different noxious stimuli. Clear antinociceptive effects were found in the formalin test. The increasing temperature hot-plate test showed a biphasic dose-response relationship with slight hyperalgesia after low doses and hypoalgesia after higher doses. No significant effects of orphenadrine (0-25 mg/kg) were found in the tail flick and constant temperature hot-plate tests. The data suggest that orphenadrine may reduce, enhance or leave unaffected different types of nociceptive transmission. Orphenadrine may also possess analgesic properties in conditions not involving muscle spasm.
A modification of the formalin test appropriate for testing of mice is described. Formalin 1 or 5% was injected into the dorsal surface of a hindpaw, and the time the animal spent licking the paw was recorded. On the basis of the response pattern, two distinct periods of intensive licking activity were identified; an early (0-5 min after injection) and a late response (20-30 min after injection). The following analgesics were investigated (dose range): acetylsalicylic acid (100-400 mg/kg), paracetamol (100-400 mg/kg) and morphine (0.6-10 mg/kg). Acetylsalicylic acid (200-400 mg/kg early response, 300-400 mg/kg late response), paracetamol (200-400 mg/kg early response, 300-400 mg/kg late response) and morphine (2.5-10 mg/kg) inhibited the responses in a dose-dependent manner. The results indicate that the test is useful for evaluating mild analgesics. It may have advantages over some of the tests that are commonly used for testing analgesics.
The experiences of eighty-five final-year medical students in twenty practical procedures identified as relevant to medical emergencies were registered. Notable differences between exposures to some of these procedures within and outside teaching situations were found. Instruction must be seen as inadequate prior to first performance in real-life situations. Experiences in cardiopulmonary resuscitation were acceptable, however, while exposures to procedures with special equipment, e.g. lumbar puncture or bladder catheterization, were variable. It is concluded that opportunities may be increased by expanding already existing scheduled activities and by spending more time on planning and organization. Examples or activities in order to increase students' experiences in practical procedures during medical school are given and discussed. The problem of assessment of practical competence is pointed out as is also the need for a clear definition of the teaching objectives.
The experiences of seventy-six final-year medical students with chemical faecal occult blood tests (FOBT) and rectal examination were assessed using a simple questionnaire. About one third of the students had no experience at all. Among the students familiar with the tests one third had received their experience exclusively outside the teaching environment. The findings may partly explain why physicians seem to often omit rectal examinations and FOBT even when indicated in the diagnostic process.
Scarlatiniform rash and urticaria were observed twice in the same patient following codeine intake. This rare drug-induced eruption may lead to mis-diagnosis in patients taking mild analgesics containing codeine. The side effects of codeine, hypersensitivity mechanisms, and the use of analgesic combination products are discussed.
The effect is evaluated of a checklist exploring acquisition of practical skills by medical students during the first clinical course in internal medicine. A group of forty-five students using the checklist was compared with two reference groups doing their clerkship before and after the study group. The amount of exposure to practical procedures increased by about 30%. At the same time exposure to some simpler procedures was reduced, while there was an increase in exposures to more complicated procedures. The conclusion is that a checklist has potential value for increasing exposure to practical procedures, if given with advice about the procedures to be preferred and by demand for mastery of particular skills.
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This study was designed to provide some insight into the manner and degree of students' acquisition of practical skills. One hundred and fifty-two of a total of 166 students in a medical clerkship during the first clinical year answered a questionnaire. The questionnaire contained fifty-eight different laboratory tests and technical procedures. The study revealed deficiencies in the teaching programme. On the average the students had been exposed to 19.4 procedures during their 13-week clerkship. We found no differences according to sex or age. Fourteen skills were considered mandatory. The mean result was 62% for these procedures. Urine analysis and participating in evening rounds gained best scores, while test for blood in faeces and discussing insulin dosage had the lowest scores, 14% and 10% respectively. In order to increase the amount of exposure to practical skills, some improvements in the teaching programme are suggested.
Orphenadrine citrate, a monomethylated derivative of diphenhydramine, has been used as a muscle relaxant and as an analgesic both alone or as a constituent of combination products. Data on the efficacy of orphenadrine alone and in combination with paracetamol for painful conditions are evaluated in the present review. From the available animal data it is concluded that the antinociceptive effect of orphenadrine has been clearly demonstrated but data have also clearly indicated that it has muscle relaxant properties. Human placebo-controlled studies have shown some support for the view that orphenadrine on its own acts as a mild analgesic in painful conditions associated with muscle spasm. Although only a small number of well-controlled studies have been completed with the combination product of orphenadrine/paracetamol, each supports the view that the combination has superior efficacy over paracetamol alone. There is no doubt that the combination product is more efficacious than placebo.
In the 1960s general practitioners were a dying race in Norway. Today general practice is a highly approved specialty among doctors as well as patients. Better education is one of the revitalizing factors. General practice is currently taught as a mandatory subject at all four universities in Norway. The practice apprenticeship is the essential element in our undergraduate curricula. In their fifth year, the students spend three to eight weeks in a structured training program supervised by general practice faculty. Approximately 500 general practitioners take part in this decentralized training network. In 1985 general practice was recognized as a specialty in Norway. The obligatory requirements in the five-year educational program are: -courses, 400 hours -hospital training, one year -general practice training, four years -group-based training program, two years The last element is based on a decentralized concept where a group of two to 10 trainees meet for three hours every two weeks during a two-year period. The group is headed by an appointed and qualified trainer. Besides being in accordance with the geography and demography of Norway, this model gives substance to the slogan "general practice can only be learnt in general practice."