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PubMed2000

[Hormone replacement therapy after breast cancer].

The use of hormone replacement therapy after breast cancer is controversial. The published epidemiological studies shown no association between HRT and recurrence of breast cancer. However, the interpretation of these results is very difficult because of numerous biases in this context of observational studies. Prospective randomised trials that examine the effects of HRT in women with a history of breast cancer are currently underway in United States and in Scandinavia. The markov approach is interesting for determining the global risk-benefit balance of HRT and for visualising the effects of different risk levels on breast cancer and to compare different therapeutic strategies. Hot flushes and functional symptoms represent the essential unresolved problem of these women. The results of all these will provide valuable data to define efficient and non-deleterious approaches to improve the well being of the women after breast cancer.

Breast Neoplasms↗
PubMed2000

[Aftercare of newborn infants in a patient hotel].

INTRODUCTION: Postnatal care of the healthy term newborn and the mother has, in modern times, taken place in the hospital setting. As a result of tightened hospital budgets as well as maternal preferences the duration of hospital stay has successively been shortened. Most women in Scandinavia today leave the hospital within four days after delivery. Postnatal care in a hotel like setting has emerged as an alternative to the well-baby nursery unless medical conditions makes this option inappropriate. MATERIAL AND METHODS: To evaluate the safety of postnatal care a study was undertaken to investigate whether correct criteria were being used for referral of the newborn to the hotel. We also wanted to document the duration of stay, unexpected medical complications, and weight development of the infants. Data from 865 infants were used for analysis. RESULTS: Ten (1.1%) newborns had to be readmitted to the hospital due to medical complications. 488 (56%) of the mothers went home within 96 hours, and only 23 (2.6%) stayed more than 120 hours. The weight of the infants reached a nadir on the fourth day post partum (-5.2% of birth weight). INTERPRETATION: The patient hotel is a medically safe alternative to the traditional well-baby nursery, provided that appropriate criteria for referral are used.

Aftercare↗
PubMed2000

MS genetics: recent Scandinavian efforts.

As a potential founder population of MS, the Scandinavian ethnic group is of special interest in MS genetics. Project in these countries have recently led to several reports, including associations with HLA class I, CTLA-4 and suggestive linkage to several chromosomal candidate loci. The analysis of isolated populations within Scandinavia may also prove to be rewarding.

Founder Effect↗
PubMed2000

Ecological antibiotic policy.

Development of resistance to antibiotics is a major problem worldwide. The normal oropharyngeal flora, the intestinal flora and the skin flora play important roles in this development. Within a few days after the onset of antibiotic therapy, resistant Escherichia coli, Haemophilus influenzae and Staphylococcus epidermidis can be detected in the normal flora of volunteers or patients. Horizontal spread of the resistance genes to other species, e.g. SALMONELLA: spp., Staphylococcus aureus and Streptococcus pneumoniae, occurs by conjugation or transformation. An ecologically sound antibiotic policy favours the use of antibiotics with little or no impact on the normal flora. Prodrug antibiotics which are not active against the bacteria in the mouth and the intestine (before absorption) and which are not excreted to a significant degree via the intestine, saliva or skin are therefore preferred. Prodrugs such as pivampicillin, bacampicillin, pivmecillinam and cefuroxime axetil are favourable from an ecological point of view. Experience from Scandinavia supports this, since resistance to mecillinam after 20 years of use is low (about 5%) and stable.

Journal Article↗
PubMed2000

[Treatment of localized prostatic cancer--different alternatives. Patients with localized prostatic cancer must actively participate in the choice of therapy].

The treatment options currently available for patients with clinically localized prostate cancer are radical prostatectomy, irradiation and deferred symptom-guided treatment. Today we do not have any controlled data indicating that any of these treatments is better than the other. Management policies that have evolved are, at best, based on structured comparisons of data from uncontrolled treatment series. In such comparisons the differences between the various treatment options with respect to disease-specific survival up to 10 to 15 years after diagnosis are modest. These comparisons are based on patient series diagnosed 15 to 20 years ago, i.e. before prostate specific antigen (PSA) was available as a marker for prostate cancer. The utilization of PSA has dramatically changed the conditions for diagnosing prostate cancer, in that with PSA we find more men with prostate cancer with smaller tumors at diagnosis. Today we find many tumors because of an elevated PSA followed by systematic biopsies in men without palpable prostatic lesions. Thus it is difficult to translate long-term outcome data from older patient series to the current situation in which tumors are found under changed clinical conditions. Consequently, a patient can only be informed about the different treatment options and their side effects. In the treatment decision process he has to balance a possible benefit in survival against side effects, according to his own preferences. We need randomized studies comparing the different treatment options. Such research is under way in Scandinavia, but due to the long course of the disease we will probably have to wait many years before we can answer the questions which sparked these studies.

Antineoplastic Agents↗
PubMed2000

Ecological antibiotic policy.

Development of resistance to antibiotics is a major problem worldwide. The normal oropharyngeal flora, the intestinal flora and the skin flora play important roles in this development. Within a few days after the onset of antibiotic therapy, resistant Escherichia coli, Haemophilus influenzae and Staphylococcus epidermidis can be detected in the normal flora of volunteers or patients. Horizontal spread of the resistance genes to other species, e.g. Salmonella spp., Staphylococcus aureus and Streptococcus pneumoniae, occurs by conjugation or transformation. An ecologically sound antibiotic policy favours the use of antibiotics with little or no impact on the normal flora. Prodrug antibiotics which are not active against the bacteria in the mouth and the intestine (before absorption) and which are not excreted to a significant degree via the intestine, saliva or skin are therefore preferred. Prodrugs such as pivampicillin, bacampicillin, pivmecillinam and cefuroxime axetil are favourable from an ecological point of view. Experience from Scandinavia supports this, since resistance to mecillinam after 20 years of use is low (about 5%) and stable.

Animals↗
PubMed2000

Postpartum Clostridium sordellii infection associated with fatal toxic shock syndrome.

Clostridium bacteria are anaerobic Gram positive spore-form-ing bacilli, known to cause distinct clinical syndromes such as botulism, tetanus, pseudomembranous colitis and myonecrosis. The natural habitats of Clostridium species are soil, water and the gastrointestinal tract of animals and humans. In 5-10% of all women, Clostridium species are also found to be normal inhabitants in the microbial flora of the female genital tract. In case of a non-sexually transmitted genital tract infection, Clostridium species are isolated in 4-20%, and clostridium welchii seems to be the most common isolate. Clostridium sordellii is rarely encountered in clinical specimens (1% of Clostridium species), but it has been described as a human pathogen with fatal potential. Two toxins, a lethal and a hemorrhagic (that antigenically and pathophysiologically appear similar to Clostridium difficile toxins B and A, respectively) are responsible for this potential. Reviewing the obstetric literature, only six cases of postpartum endometritis caused by C. sordellii, are described - all being fatal. In addition, one lethal case of spontaneous endometritis resulting from C. sordellii is reported. The clinical aspects of these cases include: - sudden onset with influenza-like symptoms in previously healthy women - progressive refractory hypotension - local and spreading tissue edema - absence of fever Laboratory findings include: - marked leukocytosis - elevated hematocrit. This paper reports the seventh fatal postpartum C. sorlellii associated toxic shock syndrome - the first recognized in Scandinavia.

Adult↗
PubMed2000

Autosomal dominant cone-rod dystrophy due to a missense mutation (R838C) in the guanylate cyclase 2D gene (GUCY2D) with preserved rod function in one branch of the family.

We present the clinical and molecular genetic features of a large multi-generation Norwegian family with dominant cone-rod dystrophy. Ophthalmological evaluation including electroretinography showed cone dysfunction in younger patients, with rod dysfunction becoming apparent at more advanced stages of the disease. In one branch of the family, cone degeneration remained the only manifestation despite advancing age. Linkage analysis mapped the disease gene in this family to 17p12-p13, a chromosome region previously linked to cone-rod dystrophy in a Swedish family (CORD5). A maximum LOD score of 3.25 (straight theta = 0.00) for marker D17S1844 was obtained. Mutation analysis of the guanylate cyclase 2D gene (GUCY2D, MIM 600179, previously called RETGC1), located at 17p12-p13, showed a missense mutation (R838C) in exon 13, that co-segregated with the eye disease in the family. Our suspicion of the possibility of an interrelationship between the Swedish CORD5 family and the present family, both originating from Northern Scandinavia, initiated the linkage analysis in the Norwegian family. The R838C missense mutation was not, however, detected in the Swedish patients, strongly suggesting no relationship between these two families. The long-term ophthalmological evaluation in this large four-generation family, combined with the identification of the disease-causing mutation, provide critical information for refining the classification, prognosis, and genetic counselling of patients with cone-rod dystrophies.

Adult↗
PubMed1975

Yersinia enterocolitica arthritis.

Human infections with Yersinia were first recognized and reported in upper New York State almost 40 years ago. Recently, there have been increasing numbers of reports from Scandinavia of episodes of polyarthritis associated with Yersinia infections. A 6-month-old girl from upstate New York had a fever of 40 C for two weeks and green watery diarrhea, and irritability was noted when she was handled. An evanescent rash was most apparent at times of temperature elevations. Her mother and father had had diarrhea during the month preceding the child's illness. Stool cultures were grown in an effort to identify Yersinia enterocolitica if it was present, and the organism was found. A rise in serum agglutination titer against polyvalent Y. enterocolitica was demonstrated from zero to 1:256 dilutions. Y. enterocolitica is probably a cause of arthritis, mesenteric adenitis, and erythema nodosum in the United States.

Antibodies, Bacterial↗
PubMed2000

Healthcare buildings as supportive environments.

Why should hospital buildings be regarded as special buildings in society? Why do the big hospitals look like permanent building sites? How does the staff experience their environment and how often do they have thoughts about their working places? How do health care buildings function as supportive environments for care? This paper will seek to analyse these questions from the viewpoint of historical architectural development of the hospital and the issue of the local environment, namely the hospital ward, which occupies the largest part in surface area of all hospitals and effectively constitutes the primary 'living' area for staff and patients and the place in which the staff conduct their major tasks. Much of that discussed and observed with regard to the hospital ward, is also valid and may be applied to other hospital units. Finally, the question on the criteria and requirements involved in planning large hospitals as applied in the RIT 2000 international programme recently conducted in Scandinavia are addressed and the article concludes by highlighting the principles of design theory the applications of which would serve to unify the various requirements with which to draw up good designs for healthcare buildings.

Architecture↗
PubMed2000

[Orbital tumors].

BACKGROUND: Orbital tumours are relatively uncommon, and few series of patients with such tumours have been reported from Scandinavia. Here we present the experience of a Norwegian referral centre. MATERIAL AND METHODS: We have retrospectively evaluated the records of 278 patients with orbital tumours hospitalized at the Department of Ophthalmology, Haukeland University Hospital from 1961 to 1999. RESULTS: In 177 patients, a benign tumour was present, while 96 patients suffered from malignant disease. In five cases, the malignant potential of the tumour could not be assessed. A total of 71 different histological entities were observed. Surgical treatment performed at our department was in 22 patients exenteration, in 87 lateral orbitotomy, in 47 anterior orbitotomy and in 41 biopsy through an anterior approach. INTERPRETATION: This series illustrates the wide panorama of space-occupying lesions that may be present in the orbit. Since the lesions are rare and management in many cases complex, the treatment should be centralized to an eye department with a defined interest in orbital disease.

Adolescent↗
PubMed2000

The effect of birdsfoot trefoil (Lotus corniculatus) and white clover (Trifolium repens) in mixed pasture swards on incoming and established nematode infections in young lambs.

Lotus corniculatus L., a leguminous plant containing condensed tannins, is now being evaluated in Sweden as a component of mixed pastures. This is because of its high nutritive value, palatability, modest requirement for water, calcium and phosphorous and particularly because it has the ability to survive harsh weather conditions that typify northern Scandinavia. This trial was undertaken to assess the possible parasitological benefits of using L. corniculatus when fed as a minor component in a mixed pasture sward to young sheep. This was compared with similar sheep that were fed pasture with a comparable legume content consisting of Trifolium repens L. Separate groups of lambs, maintained in pens and provided with fresh pasture cuts containing either L. corniculatus or T. repens each day, were trickle-dosed with infective larvae of mixed parasite species. For each pasture type, groups of 6 lambs had either established worm burdens only, received incoming infections only, or had the combination of both adult and incoming infections. Worm burdens were monitored by serial faecal egg counts and at the termination of the study, all animals were slaughtered for worm recovery, identification and enumeration. The results showed that there were no differential effects between L. corniculatus and T. repens on the different stages of development for a range of nematode parasite species recovered from these lambs. Several reasons may account for this: such as the low level of condensed tannins in the L. corniculatus variety tested, the minor proportion of this plant in the diet and/or the variety of L. corniculatus used in this trial which do not provide any benefits to controlling parasites of sheep.

Animals↗
PubMedDate not supplied

Influence of the diet made by its family ancestors in the hereditary component of an individual: study in six generations of rats.

BACKGROUND: The prevalence of the deficiency of enzyme Lactase/phlorizin hydrolase (LPH) varies widely between different countries, with a low of 1-3% in Scandinavia and close to 100% in most of South-East Asia. Various carbohydrates are capable of enhancing LPH mRNA levels in the small intestine, and that transcriptional control plays a major role in the carbohydrate-induced alterations of LPH mRNA expression. MATERIAL AND METHODS: A generation of rats was randomized and assigned to two groups; those that were fed a high-carbohydrate diet and, those that were fed standard rodent meal. The sixth generation of these animals was fed standard rodent meal. Transfection experiments using Caco-2 cells were performed using sperm samples of the sixth generation of rats. RESULTS: This study suggests that the feeding with a high-carbohydrate diet during five generations of rats increases the capacity of production of enzyme LPH, LPH mRNA levels and the transcription rate of the LPH gene in the sixth generation of these animals, and this fact happens independently of the diet that this generation of rats had. Transfection experiments show that this influence has had to take place necessarily within the hereditary component which the last generation of rats received from its family ancestors. CONCLUSION: The feeding received by the ancestors of a generation of rats could influence within hereditary component received by them.

Animals↗
PubMed2001

Prevalence of multiple sclerosis in Västerbotten County in northern Sweden.

OBJECTIVE: To estimate the prevalence and clinical characteristics of multiple sclerosis (MS) in Västerbotten County in northern Sweden. METHODS: Individuals with MS were identified from several sources. A follow-up interview and/or examination was performed in 94% of cases still living in the area during 1997-99. Onset adjusted prevalence and a definition of onset symptoms were applied. RESULTS: A total of 313 cases were identified, resulting in an onset adjusted crude prevalence of MS for January 1990 of 125/105 (95% confidence interval (CI): 112-140). Female predominance was evident (163/105 (95% CI: 142-187) vs 86/105 (95% CI: 71-104)). Diagnostic coding registers were the most important source for identification of cases. CONCLUSIONS: The crude prevalence of MS in Västerbotten was higher than previous reports from other major areas in Scandinavia. The adjusted prevalence was significantly higher when compared with a previous study from Göteborg, south-western Sweden. The methodology used in this study gives a high degree of case ascertainment and increases the comparability of multiple sclerosis epidemiological studies.

Adolescent↗
PubMed2001

Tobacco use and oral cancer: a global perspective.

For both genders, cancer of the mouth and pharynx ranks sixth overall in the world; it is also the third most common site among males in developing countries. In industrialized countries, men are affected two to three times as often as women, largely due to higher use of alcohol and tobacco. Ethnicity strongly influences prevalence due to social and cultural practices, as well as socioeconomic differences. In population terms, survival rates around the world show little improvement. In terms of etiology, the effects of tobacco use, heavy alcohol consumption, and poor diet together explain over 90 percent of cases of head and neck cancer. All forms of tobacco represent risk factors for oral cancer, but on present evidence, snuff habits as they exist in Scandinavia and probably in the United States carry lower risks of serious health hazards, including oral cancer. Alcohol synergizes with tobacco as a risk factor for all upper aerodigestive tract SCC: this is super-multiplicative for the mouth, additive for the larynx, and between additive and multiplicative for the esophagus. The increase in oral cancer in the Western world has been related to rising alcohol use.

Alcohol Drinking↗
PubMed2000

Prevalence and inheritance of hip osteoarthritis in Iceland.

The purpose of this study was to: (I) assess the prevalence of hip osteoarthritis (OA) in Iceland and compare it with that in Southern Scandinavia, (II) determine the incidence of total hip replacement (THR) for primary OA in Iceland, (III) compare two different methods for defining radiographic hip OA, (IV) assess in a population-wide study in Iceland the genetic contribution t hip OA leading to THR, and (V) perform a genome-wide scan of a large Icelandic family to identify a chromosomal susceptibility locus for hip OA leading to THR. many Icelandic patients with hip OA have been well aware that this disease "goes in the family". by examining a large proportion of all Icelandic colon radiographs taken 1990-1996 the prevalence of radiographic hip OA in Iceland was found to be at least five-fold higher compared to Swedish and Danish studies that have used the same methods. A comparison of two methods for estimating hip OA from colon radiographs showed that a simple quantitative method of measuring joint space was more reliable than a qualitative method. The age-standardized incidence of THR for primary hip OA in Iceland between 1982 and 1996 was estimated and found to be about 50 percent higher than for Sweden. The higher Icelandic prevalence of hip OA may explain most of this difference. To investigate the contribution of heritability to hip OA leading to THR, information from two population-wide database in Iceland was combined: A national registry of THR between 1972 and 1996, and a genealogy database of all Icelandic genealogy records for the last 11 centuries made available by deCode Genetics. The genetic contribution to THR for OA was assessed by (a) identifying familial clusters of THR for OA, (b) applying the minimum founder test (MFT) to estimate the minimum number of ancestors to account for all patients with THR for OA, compared to the average number of founders for control lists, (c) calculating an average pairwise kinship coefficient (KC) for the patient and control lists, (d) estimating the relative risk (RR) for relatives of patients with THR for OA. A large number of familial clusters of patients with THR for OA were identified. MFT showed that OA patients descended from fewer founders than the control groups. The average pairwise KC among patients with OA was greater than in the population. RR for siblings of THR for OA patients was 3.05 (2.52, 3.10). Icelandic patients with THR for OA are thus significantly more related to each other than are matched controls. These findings support a significant genetic contribution to a common form of OA and encourages the search for genes conferring an increased susceptibility to OA. New techniques now make it possible to search the whole human genome for chromosomal susceptibility loci associating with OA. A genome wide scan was done to identify susceptibility loci for hip OA leading to THR, using DNA from a large Icelandic family with a very high prevalence of primary hip OA. A genome locus with a lod score of 2.58 was identified on chromosome 16p. A similar locus has been reported on from England. This is the first instance where what may be the same susceptibility locus for OA is independently described in two different populations with hip OA. We have identified other families with hip OA which link to the studied family and are continuing an expanded genome-wide scan. Continued studies of the kind outlined here will clarify the complex genetic background of OA and identify genetic variation associated with the disease. In addition to improving our understanding of the pathogenesis of OA and identifying new molecular targets for treatment, this will allow a better insight into the interactions between genetic background and environmental factors that initiate and drive OA.

Adult↗
PubMed2000

[Surveillance of hospital infections in Poland--current condition and prospects].

This paper outlines the current achievements in the control of hospital acquired infections in modern countries as well as in Poland in recent years. Studies related to the incidence of hospital-acquired infections have been conduced in western Europe, Scandinavia, the United States, and many other countries around the world. Because of these already completed studies, we are able to develop epidemiologic analysis specifically centered upon the incidence and increased costs involved with hospital-acquired infections. In Poland this type of surveillance was unable to be attained until long after its institution. However, over the past few years, the Polish Society of Hospital-Acquired Infection, has worked to bring recognition of the seriousness of this problem to a representative group of Polish hospitals. One of the most important conclusions reached was lack of departmental control which, using standards previously agreed upon by modern countries, could provide the necessary surveillance over hospital-acquired infections. Currently, surveillance is carried out by treating physicians without the help of specially-trained infection control nurses, epidemiologists and medical microbiologists. The basic challenge for the Polish health service is that of the development and realization of a professional infection control team. This professional team would work develop guidelines for the protection of patients and hospital personnel from hospital-acquired infections.

Cross Infection↗
PubMed2001

Local recurrence of soft tissue sarcoma. A Scandinavian Sarcoma Group Project.

The aim of this project was to investigate the diagnosis, treatment and consequences of local recurrence of soft tissue sarcoma (STS). It is based on patients reported to the Karolinska Hospital Sarcoma Register and the Scandinavian Sarcoma Group Register. Demographic and treatment data, based on 1613 adult patients reported to the Scandinavian Sarcoma Group Register by sarcoma centers in Norway, Sweden and Finland are presented. They all had STS of the extremities or trunk wall, and were diagnosed between 1986 and 1995. One third of the tumors were subcutaneous and two thirds deep-seated. The median size was 7 (1-35) cm and 75% were high grade. Metastases at presentation were diagnosed in 8% of the patients. Two thirds of the patients were referred to a sarcoma center before surgery. The preoperative morphologic diagnosis was made by fine-needle aspiration cytology in 72%. Among patients with final treatment for primary tumor at a sarcoma center (n = 1331), the surgical margins were wide or better in 76% of subcutaneous lesions, and in 58% of deep-seated lesions. Adjuvant radiotherapy has not generally been considered indicated after wide or compartmental excisions in Scandinavia. Overall, 23% of patients managed by surgery had adjuvant radiotherapy. Among patients with an intralesional or marginal excision, 44% had postoperative radiotherapy. Patients treated outside of sarcoma centers were seldom referred for radiotherapy. The crude local recurrence rate was 225/1331 (17%) among the patients with final treatment for primary tumor at a sarcoma center. The local recurrence rate after local surgery for high-malignant deep-seated STS was 103/391 (26%). The rate was 25/64 (39%) after an intralesional/marginal margin without postoperative radiotherapy versus 28/119 (24%) when radiotherapy was given. Fine-needle aspiration cytology (FNAC) was used to diagnose suspected local recurrences. 95 FNAC were performed in 86 patients from Karolinska Hospital. There were 47 local recurrences, of which 44 were diagnosed correctly by FNAC; one biopsy was inconclusive, and two lesions were incorrectly assessed as benign. 39 patients proved to have benign lesions in the scar examined cytologically on 50 occasions. None of the specimens was regarded as malignant, but in 4 cases FNAC was inconclusive. The inconclusive or false cytological diagnoses had no serious clinical consequences. Among 205 patients with local recurrence identified in the SSG Register 1987-1995, 169 patients were surgically treated. An intralesional or marginal margin was achieved in 110 of these patients, 59 of whom were also given radiotherapy. 54 of the 169 patients had a second local recurrence. The second local recurrence rate was 0.50 if the first local recurrence was treated using surgery with a marginal margin alone, compared to 0.28 if treated using either surgery with a marginal margin and radiotherapy, or a wide margin (p = 0.0008). In extremity STS, the amputation rate for local recurrences was 0.22, compared to 0.09 for primary tumors. The overall 5-year MFS was 0.72 (95% CI 0.68-0.76). High histopathological malignancy grade (Relative Risk 3.0; 95% CI 1.5-6.3) and an inadequate surgical margin (2.9; 95% CI 1.8-4.6) were independent risk factors for local recurrence. High histopathological malignancy grade and large tumor size (> 7 cm) were the most important risk factors for metastasis. Local recurrence was associated with an increased risk of metastasis (4.4; 95% CI 2.9-6.8), but an inadequate surgical margin was not a risk factor for metastasis (1.1; 95% CI 0.8-1.7). In conclusion, it is unlikely that local recurrence of STS is a major source of metastases. It nevertheless represents a costly, complicated and emotionally difficult problem. More radical surgical margins would improve the local recurrence rate, but this can hardly be achieved for center-operated patients without increasing the amputation rate. Instead, local control will improve by giving radiotherapy to all patients after marginal surgery, and to selected patients with wide margins. Radiotherapy is indicated especially after a previous open biopsy or when a local recurrence might lead to an amputation. Furthermore, radiotherapy seems indicated after local recurrence, regardless of margin or grade. The most effective way of reducing costs and detriment associated with local recurrence is to increase referral to sarcoma centers before biopsy or surgery as primary surgical margins would then improve.

Adolescent↗