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PubMed1978

[Management of a systematic follow-up clinic (author's transl)].

The essential differences between the common, irregular medical check-up, as practiced in the follow-up clinics in England and Scandinavia, and the type practiced in the systematic follow-up clinic in the "Marburg experiment" are presented with examples. The necessity of the latter for clinical knowledge, for the attending surgeon, for special patients, and last but not least, for clinical research, is stressed. Based on examples from the Marburg systematic follow-up clinic for duodenal ulcer studies, its practicability is discussed.

Duodenal Ulcer↗
PubMed1987

[Acute sinusitis in adults].

An average of 1.4% of the more than 30,000 participants in a treatment study were diagnosed as having acute sinusitis. 62% of all cases of sinusitis arose in patients aged between 15 and 44 years. Treatment with antibiotics is indicated in purulent sinusitis whilst non-purulent sinusitis is treated either with local or systemic antiphlogistic agents. The secondary bacterial infection is usually caused by Haemophilus influenzae, Streptococcus pneumoniae and anaerobic bacteria. In Scandinavia these probably account for 90% of the purulent sinusitis cases whilst Branhamella catarrhalis is responsible for the remaining 10%. Penicillin V is the agent of choice in acute sinusitis. Cefaclor is preferable in combatting H. influenzae. In a double blind study comparing doxycycline to cefaclor in the management of acute sinusitis (108 patients with cefaclor, 105 patients with doxycycline, no difference emerged between the two groups in the subjective assessment of the treatment results. Objective evaluation recorded excellent results for 88% and 83% of the patients in the cefaclor and doxycycline groups, respectively. Side-effects were noted by 7% of the cefaclor and by 13% of the doxycycline patients. The difference between the incidence of side-effects was not statistically significant. Taking into account the treatment results, the side-effects and ecological aspects, cefaclor is second only to penicillin as the agent of choice in suspected or confirmed purulent sinusitis (e. g. in presence of penicillin allergies or failure of the infection to respond to penicillin V).

Acute Disease↗
PubMedDate not supplied

West Germany: still an underdeveloped country in the diagnosis and early treatment of primary hyperparathyroidism?

Early diagnosis of asymptomatic patients with primary hyperparathyroidism (primary HPT) has been achieved in Scandinavia, the United States of America, and the United Kingdom during the last 20 years. Comparable results have been reported from some medical centers from West Germany; however, clinical manifestations were pronounced and patient symptoms were high in our population with primary HPT (N = 128) operated on at the University of Düsseldorf from April, 1986 to July, 1989. Only 19 patients (14.8%) were asymptomatic while the others suffered from nephrolithiasis (39%), osteopathy (32%), gastrointestinal disturbances (28.9%), and depression (11.7%). In 46 (35.9%) of our patients, the duration of these clinical symptoms exceeded 10 years, in 27 patients (21%) 15 years, and in 12 patients (9.3%) even 25 years. We, therefore, conclude that primary HPT is still a grossly underdiagnosed illness in parts of West Germany, presently, with patients suffering from severe clinical symptoms for more than 1-2 decades before definitive treatment.

Adult↗
PubMed1996

Initial treatment of preterm infants--continuous positive airway pressure or ventilation?

The question of which strategy is the best in the initial treatment of preterm infants has been on debate for years. Especially in Scandinavia, but also in other parts of the world, there is a strong tradition of early treatment with nasal continuous positive airway pressure (CPAP), while other European and North American centres prefer early intubation and mechanical ventilation. This article gives a brief overview of the history of CPAP, and the current treatment strategies as well as outcomes from a tertiary care Danish neonatal centre are presented. These data suggest that early nasal CPAP may be as good as initial mechanical ventilation with regard to mortality rates and adverse cerebral outcome and perhaps better in preventing chronic lung disease. The results must, however, be interpreted with caution, as the populations in different centres may be incomparable, even when adjustment for severity of illness is performed. A clinical randomized trial comparing initial intubation and mechanical ventilation with initial nasal CPAP using current techniques is therefore not only warranted but is indeed an absolute necessity to answer the question of which treatment is the best.

Humans↗
PubMed1995

An international perspective on the prevalence of the Wernicke-Korsakoff syndrome.

In the Western world previous studies have shown that the majority of cases of the Wernicke-Korsakoff syndrome (WKS), which is caused by thiamine deficiency, occur in alcoholics. However, in France, a country with one of the highest per capita consumptions of alcohol, the prevalence of the WKS was found to be only 0.4% in a small retrospective autopsy study. This figure is compared with data sent to the authors by a number of neuropathologists from the U.S.A., Europe, Scandinavia and Australia. There was no obvious correlation between the prevalence rates of the WKS, which were highest in Australia (2.8%-previously published), and per capita consumption of alcohol. Other issues such as diet, National programs for supplementation of foods with thiamine, and drinking habits are considered. The pathological diagnosis of the WKS can often be made on macroscopic examination of the brain after fixation in formalin. The mammillary bodies are smaller than normal in most cases of chronic WKS. However in this study it was found that the most common causes of small mammillary bodies were Alzheimer's disease and atrophy due to transneuronal degeneration secondary to lesions in the hippocampus.

Alcohol Amnestic Disorder↗
PubMed1994

Methicillin-resistant Staphylococcus aureus in Europe.

In order to obtain pan-European data on methicillin-resistant Staphylococcus aureus (MRSA), 43 laboratories from ten European countries each screened 200 consecutive Staphylococcus aureus isolates for methicillin resistance. Only one isolate per patient was permitted. All participants used a uniform oxacillin-supplemented screening plate. MRSA isolates were sent to Munich for reconfirmation and further susceptibility testing. Phage typing of the MRSA strains was performed in Denmark. Of the 7,333 Staphylococcus aureus strains screened, 936 (12.8%) were methicillin resistant. The proportion of MRSA in the various European countries ranged from < 1% in Scandinavia to > 30% in Spain, France and Italy. Rates of resistance to the non-glycopeptide antibiotics were lowest for rifampin and highest for ciprofloxacin. Sixty percent of the methicillin-resistant strains originated from patients in surgical and medical departments, with wounds being the most common isolation source. MRSA was found more frequently in intensive care patients. Only 13% of the strains were non-typable, and 76% of the isolates belonged to phage group III. For each area phage typing detected one or a few dominating (epidemic) types, but 46% of the strains did not belong to these types; the MRSA population is thus a mixture of epidemic and non-epidemic strains. MRSA seems to be a growing problem, especially in southern Europe, where incidence and rates of antibiotic resistance are alarmingly high.

Anti-Bacterial Agents↗
PubMed1986

[Radiation exposure and risk of radon in the room air of Swiss houses].

The radioactive noble gas radon, a member of the natural decay chains of uranium and thorium, enters the indoor environment in regionally highly diverging amounts. Subsoil of dwellings, building materials and drinking water are the main sources. In Switzerland and in many other countries, exposure of the lung tissue to the short lived radon decay products is the most important component of the radiation dose of the general public. Annual doses in areas with crystalline rock of high uranium content may reach the limits set up for occupational exposure. However, a clear link between cumulative exposure to radon daughters and elevation of the lung cancer incidence exists only for underground miners. The majority of human epidemiological studies point to a linear dose effect relationship. The indoor radon levels are determined by geology, building materials and techniques, climate and behaviour of the occupants. Experiences from Scandinavia and the Northern parts of America clearly indicate the possibility of cost-efficient remedial measures to reduce indoor radon levels.

Air Pollution, Radioactive↗
PubMed1987

Ophthalmomyiasis interna posterior.

Ophthalmomyiasis interna posterior (OIP) means infection of the posterior part of the eye with the larvae of flies. Few cases have been reported in which the larvae have been removed from the eye and the visual acuity preserved. We report four cases of OIP with living larva in the vitreous cavity. The larvae produced severe uveitis and were removed alive with vitrectomy and a procedure for removing foreign bodies. They were identified as first-stage reindeer warble fly larvae (Oedemagena tarandi). We also observed dead larva in the vitreous cavity of a patient who suffered severe uveitis in 1943, and this eye survived with normal visual acuity. Another patient had a blind eye enucleated and the remnants of a larva were found inside the eye. All patients live in Scandinavia.

Adolescent↗
PubMed1991

Cross-national comparisons of the occurrence of Alzheimer's and vascular dementias.

The relative occurrence of Alzheimer's and vascular dementias is examined in various countries using data of four types: incidence, prevalence, clinic and neuropathological studies. There is clear evidence that Alzheimer's dementia is more common than vascular dementia in Great Britain and North America and, to a lesser extent, in Scandinavia. The evidence from other countries with predominantly Caucasian populations is more limited, but also supports a predominance of Alzheimer's dementia. By contrast, the evidence from Japan generally shows that vascular dementia is more common. The more limited evidence available from China also supports a preponderance of vascular dementia. There is a need for studies directly comparing the occurrence of Alzheimer's dementia in Caucasian and Oriental populations.

Aged↗
PubMed1995

Personality and the inheritance of smoking behavior: a genetic perspective.

In contrast to the extensive research effort to understand the genetic contribution to alcoholism risk, there has been little research directed at understanding genetic influences on smoking behavior. Data from large twin studies in Scandinavia and Australia are consistent with a major genetic influence on the probability that an individual will become a smoker ("initiation") and will persist in the smoking habit once smoking has started ("persistence"). We use data from the 1988/1989 follow-up survey of the Australian NH&MRC twin panel to determine to what degree personality measures (Tridimensional Personality Questionnaire, Eysenck Personality Questionnaire--Revised) and attitudinal and sociodemographic variables (social and political conservatism, education, religious involvement) might account for genetic or environmental influences on smoking. While we find significant phenotypic associations between these variables and smoking, these are too modest to account for much of the genetic variance. Possible mechanisms by which this genetic variance may arise are discussed.

Adolescent↗
PubMed1981

Aspartylglycosaminuria in an Italian family: clinical and biochemical characteristics.

Two members of a consanguineous Italian family are described with symptoms of aspartylglycosaminuria. Both patients exhibit mental retardation, some facial dysmorphism and discrete radiological abnormalities affecting the skull and vertebrae. Peripheral blood smears revealed multi-vacuolated lymphocytes. Enzyme studies in leukocytes showed an absence of aspartylglucosaminidase activity. Urine analysis demonstrated abnormal oligosacchariduria. Angiokeratoma corporis diffusum was observed in one patient. The disease is seen as not being limited to Scandinavia or to patients of Scandinavian descent.

Acetylglucosamine↗
PubMed1990

Nonpharmacologic means of preventing asthma.

Cessation of smoking in the home is one of the most important nonpharmacologic actions to be recommended. There is a highly significant increase in wheezing, coughing, and respiratory infections in children with smoking mothers, and this increase is directly proportional to the number of cigarettes smoked. Cord blood IgE levels are increased in babies whose mothers smoke during pregnancy. Other agents, such as sulpur dioxide and chemical pollutants from industrial processes may play a role in the development or exacerbation, of asthma symptoms and should be avoided. One of the most interesting areas in food allergy is whether breast feeding causes sensitization or induces tolerance in infants to foods ingested by the mother. There is an increase in asthma in second-generation immigrant populations who are exposed, from birth, to the Western style of living which increases their exposure to house dust mite. Several studies have shown that month of birth is important in the development of specific allergies, for example, in the incidence of birch pollen allergy in Scandinavia. The presence of a pet in the home at birth is associated with a greater incidence of allergy to that animal. Our study in asthmatic children has shown a strong association (p less than 0.001) between the presence of allergens in the air in their homes (sampled retrospectively in the month of birth) with a positive skin test to those allergens.(ABSTRACT TRUNCATED AT 250 WORDS)

Air Pollutants↗
PubMed1985

Dietary fibre consumption and its association with large bowel cancer in man.

The hypothesis that lack of fibre in the diet is responsible for a variety of large bowel problems, including cancer, has stimulated much discussion and research over the past 15 years. However, the epidemiological examination of this hypothesis has been hampered by the absence of data on the fibre content of most of the world's foods. In studies in Britain and Scandinavia where consumption of the chemical fraction of dietary fibre, the non-starch polysaccharides, has been determined using accurate methods, significant negative association between colon cancer occurrence and NSP consumption have been shown. Fibre may therefore be protective to populations otherwise assumed to be at risk from a westernised type of diet. At present, methodological problems preclude the use of case-control studies in confirming or refuting these associations.

Africa↗
PubMed1989

Androgen influence on exocrine pancreatic cancer.

Since the discovery of the first gastrointestinal hormones it has been intriguing to think that these defined chemical messengers may also influence the growth of tumors. Today, treatment with sex-hormones is well documented--and used in clinical practice--in prostatic (1,2), breast (3), endometrial, and ovarian carcinoma (4). Hormonal therapy (progesterone) has also been tried with some success in renal carcinoma (5,6). Nevertheless, cancers of the gastrointestinal tract--colorectal, liver, stomach, and pancreatic, carcinoma, which constitute 25 percent of all malignancies in Scandinavia--are only treated by other means, mainly surgery, although there is substantial evidence today that these tumors can also be influenced by hormones.

Androgens↗
PubMed1995

The relationship between the tuberculin test and the Kveim test in sarcoidosis in Ireland.

The aim of this study was to correlate tuberculin reactivity with the Kveim test in sarcoidosis. Case records 1983-91 inclusive, of those patients with positive Kveim tests and recorded tuberculin tests in an acute regional general hospital serving south-west Ireland (counties Cork and Kerry) were reviewed. Of 39 patients with positive Kveim tests 28 (72%) were tuberculin negative to a test dose of 10 tuberculin units or more. The group was slightly though significantly younger (p < 0.05) in age than the corresponding group (n = 11; 28%) with positive tuberculin tests. The incidence of tuberculin reactivity in the presence of Kveim reaction is higher than that expected for sarcoidosis. Corresponding studies in Britain and Scandinavia show a considerably lower tuberculin positive rate, which may be due to a lower prevalence of tuberculosis in these countries. However the younger age of the tuberculin negative group in our study may reflect a continuing decline in tuberculosis prevalence in south-west Ireland.

Adult↗
PubMed1991

Picture archiving and communication systems and related developments in Sweden.

Large PACS (Picture Archiving and Communication Systems) installations do not yet exist in Sweden, but some hospitals have had experience with limited PACS activities. At present there are four mini PACS installations in radiology departments and about 12 teleradiology systems in use in Sweden. A couple of small Swedish enterprises work in the market segment of digital imaging including PACS and teleradiology, although the radiology market is dominated by the large international companies. Interest in PACS and teleradiology in Sweden has increased during the last few years, along with advancements in technology and international experience. However, radiology is organized very differently in the United States, Japan, Southern Europe, and Scandinavia. Because of this, PACS will be introduced in different ways, and experience with PACS gained in one health care system may differ from that gained from other health care systems. This article reviews the status of PACS and related developments in Sweden.

Humans↗
PubMed1997

[Palliative medicine].

Palliative medicine has its origin in the modern hospice movement. It is based upon an integrated-care concept for seriously ill and dying patients. The first consideration of this particular form of treatment is not to prolong life, but to reach the best possible quality of a patient's remaining lifetime. Therefore, palliative medicine consists of: (1) excellent pain treatment and symptom control; (2) an integrated approach towards the psychic, social, and spiritual needs of the patient, relatives, and attending staff during the periods of illness, dying, and, after the patient's death; (3) competence in dealing with vital matters of communication and ethics; and (4) acceptance of death as a normal process. Palliative medicine clearly rejects euthanasia. Practical implementation of the idea of hospice services can be realised anywhere when taking care of seriously ill and dying patients, whether at home, in a nursing home, or in hospital. Experience shows that quite a few patients cannot be treated successfully without additional services, such as home-care services, day-care centres, in patient hospices, and palliative-care units. Up to now, severely ill tumour patients have benefited most from these services. In palliative care units an interdisciplinary team of doctors and nursing staff assisted by physiotherapists and members of psycho-social professions is taking care of and treating patients. Additional support is given by voluntary services and the integration of the patient's relatives in the caring process. Palliative medicine is the overall term for this special kind of treatment and care. In Great Britain, Canada, and Scandinavia considerable progress has been achieved in this field, including recognition as an independent clinical discipline and the establishment of lectureships in palliative medicine.

Humans↗