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PubMed1990

Epidemiology of antibiotic resistant Neisseria gonorrhoeae in industrialized and developing countries.

The in vitro susceptibility of Neisseria gonorrhoeae to antimicrobial drugs has been studied currently for around fifty years, and it has been convincingly demonstrated that the results of the in vitro determinations can be used as a guideline for choice of an efficient standard treatment regimen as well as for the choice of therapeutic agent in individual cases. During these past 50 years, the susceptibility of gonococci to antimicrobial drugs has undergone dramatic changes. The genetic background is chromosomal mutations as well as the acquisition of R plasmids. The selective pressure has been exerted both by use (and misuse) of antibiotics in treatment of patients and by factors in the micro-environment of the gonococcus. Review of the current spectrum of antimicrobial susceptibility patterns of N. gonorrhoeae in industrialized and developing countries and a comparison with the changing epidemiology of gonorrhoea, rises the question as to what extent antimicrobial resistance and the choice of treatment regimen influence the spread of gonorrhoea (and other sexually transmitted diseases). In the developed countries, in spite of the access to an optimal antibiotic treatment, the prevalence of gonorrhoea increased significantly in the beginning of the 1970s and remained at a high level until around 1985. Then--within the following subsequent few years--the gonorrhoea rate fell dramatically e.g. in Scandinavia. This fall coincides with the establishment of comprehensive educational programmes for the promotion of changes in sexual lifestyle. It is therefore tempting to conclude that the impact of increasing antimicrobial resistance on the changing epidemiology of gonorrhoea is minor.

Developing Countries↗
PubMed1990

Serological, bacteriological and clinical observations on an outbreak of canine infectious tracheobronchitis in Norway.

During the autumn of 1988 an outbreak of canine infectious tracheobronchitis, which seemed to be more infectious than usual, occurred throughout Scandinavia. Paired serum samples and bacterial swabs were collected from 52 dogs with clinical signs of infectious tracheobronchitis in three districts of Norway. The results revealed a fourfold or greater rise in the titre of antibodies against canine parainfluenza virus in 79 per cent of the cases, strongly suggesting that the virus was of aetiological importance in the outbreak. Bordetella bronchiseptica was not isolated from the diseased dogs, and they showed no rise in the titres of antibodies against influenza virus, reovirus or adenovirus.

Adenoviridae↗
PubMed1990

Systemic lupus erythematosus.

Descriptive epidemiologic studies of SLE have been conducted worldwide; the most extensive data are available for Scandinavia, especially Sweden, and the United States. In the United States, blacks have threefold higher incidence, prevalence, and mortality rates compared with whites; the reasons for this excess, however, remain unknown. Analytic and genetic epidemiologic studies suggest a multifactorial etiology of SLE; results support a polygenic mode of inheritance including important roles for an autosomal dominant "autoimmune" gene and female sex hormones. Although a viral etiology remains attractive, there is little evidence to support such a hypothesis. Rather, other environmental factors including chemical exposures may be important as "triggers" of disease. Finally, observational epidemiologic studies demonstrate an increasingly favorable prognosis for patients with SLE, allowing a better understanding of long-term morbidity and impact on overall health status. Future epidemiologic studies should focus on identifying noninfectious environmental etiologic factors and improving the quality of life for all patients with SLE.

Humans↗
PubMed1990

Resistance situation of oral antibiotics in the Scandinavian countries with special reference to the fluoro-quinolones.

In general, the Scandinavian countries have a rather conservative attitude towards new antimicrobial agents. Our antibiotic policies are based upon many years of clinical and laboratory experiences. It is generally believed, although not always satisfactorily proven, that our relatively restrictive attitude to the use of new as well as of older antimicrobial drugs by one mechanism or another, is a matter of some importance when explaining the relatively low antibiotic resistance profile (ARP) existing in most places in Scandinavia. When a new group of drugs, such as the quinolones, is going to be introduced in the therapeutic armamentarium, the existing ARPs of the microbes actually involved have to be taken into consideration.

4-Quinolones↗
PubMed1990

[The use of free maternal preventive services among immigrant pregnant women in Denmark during 1983-1987].

As part of an investigation of immigrants' living conditions in Denmark, we have investigated how pregnant immigrant women utilize the possibility of free examinations during pregnancy. The study is based on data on all deliveries in Denmark in the years 1983-1987, retrieved from the Danish Medical Birth Registry concerning parturient women with permanent address in Denmark and who were born in either one of the Scandinavian countries, Yugoslavia, Turkey, Pakistan, Marocco, Iran of Vietnam. The women born outside Scandinavia gave birth to about 6,500 infants during the study period; roughly half of these were borne by Turkish women. The largest percentage of young parturients were found among women from Turkey and Yugoslavia. Pakistani and Maroccan mothers had higher parity. These two groups were especially concentrated in the municipality of Copenhagen, where half of the parturient women lived. A few lived in the remainder of the country while a total of 85% lived in the metropolitan area. Four out of ten pregnant Turkish or Pakistani women had been examined by a midwife less than the five times recommended. Among those living in the metropolitan area. Danish women have an average total of almost 11 examinations compared to 8.2-8.9 among immigrants. The conclusion of the study is that the immigrant women have less contact with the free antenatal care system during their pregnancies than the Scandinavian women and that the differences are greatest when examinations by the midwife were concerned. Further discussion on antenatal care in Denmark, is required.

Adult↗
PubMed1990

Disability medicine.

Rehabilitation/disability medicine has become big business in the USA, Europe and Scandinavia but has yet to establish firm footing as a specialty in the UK. Under the reforms of the Government's White Paper, however, time in hospital becomes money. The need for early re-integration and maintenance of patients in the community may well provide the cue for disability medicine to emerge as a specialty in its own right. But what is the nature of this specialty and who should do it?

Humans↗
PubMed1990

Guided tissue regeneration: an overview.

In recent years a new technique in periodontal surgery, known as guided tissue regeneration, has been developed in Scandinavia and the USA. After raising a flap and debriding the root surface, an inert membrane is placed between the flap and the underlying tissues. This allows the periodontal ligament to regain some of the connective tissue attachment lost during the disease process, something which has been unobtainable until now. The purpose of this paper is to review the area of periodontal reattachment and to introduce the new technique of guided tissue regeneration.

Connective Tissue↗
PubMed1975

Ecological observation of the 137Cs-contamination in beef of animals from the southern-Bavarian area.

Certain climatic and edaphic conformations in the Bavarian sub-alpine mountains and in the Alps favor above all the development of a land utilization system and farm structures similar to those in the northern part of Scandinavia. In 1963/64, the years of the highest environmental contamination up to the present, we established in 600 beef samples from the round or shoulder of male and female cattle (mainly Highland cattle) close connections between the 137Cs-contamination of green crop and the long lastnig yearly precipitation quantities, as well as certain relations between the 137Cs-contamination of meat and differences in the feeding and keeping of the animals. During summer-seasons (April-October), beef of cattle from pastures with heavy rainfall (Alps) was contaiminated by 137Cs up to 15 times more than that of confined animals. Hereby the rate of 137Cs-contamination in the meat of grazing cattle was nearly proportional to the quantities of precipitation. When confined cattle were fed on pastures in autumn after harvesting for 2 to 3 weeks, a quick increase of 137Cs-contamination of the meat was caused within this time up to values which in this district were otherwise only observed in grazing cattle. The lower 137Cs-content in meat of cattle housed during the summer season is due to the more varied fodder, which is at that time less contaminated than green crop. During the winter season (November to March), the highest contaminations in the meat of confined (Bohemian Forest) or grazing cattle (Alps) was measured when the animals in these districts were almost exclusively fed with fodder from the own farmground or with leafy silage. The highest contamination was almost regularly noticed in January, February and March, as generally during these months the highly contaminated first cut hay is fed. Here the meat was often even more contaminated than that of grazing cattle. After the quick decrease of 137Cs in fallout noticed in the years 1964 and 1965, in 1965/66 a dependance in the 137Cs-contamination of beef on the methods of keeping and feeding could still be observed in only the extreme cases (Alps, Bavarian- and Bohemian Forest); though in general, meat of animals from districts with heavy rainfall was slightly more contaminated than meat of animals from regions with less precipitation.

Animals↗
PubMed1990

[Pustular arthro-osteitis. Pustulosis palmaris et plantaris with arthritis of the sternoclavicular joint].

A 26-year-old female patient presented with pustulosis palmaris et plantaris simultaneously with arthritis of the sternoclavicular joint. This association is described as an entity and is called pustulotic arthroosteitis in the Japanese literature, as well as in publications from Scandinavia. To our knowledge, this is the first observation in the Federal Republic of Germany.

Adult↗
PubMed1990

Infantile tibia vara.

Infantile tibia vara is a developmental condition producing progressive varus deformity of the knee in young children. It appears to have a worse prognosis in the predominantly nonwhite population seen with this condition in the United States than previous studies from Scandinavia would suggest. Early roentgenographic diagnosis is critical, since toddlers can have infantile tibia vara at an early stage instead of physiologic genu varum. Aggressive bracing is appropriate treatment until age three years. Correction to valgus alignment with upper tibial osteotomy predictably can produce complete resolution of the condition if performed by age four years. After that age, the procedure becomes less effective. Prognosis for Langenskiold Grade IV disease is guarded at best, regardless of age, because the physis behaves as if effective growth arrest has already occurred. Young patients with Grade IV or greater lesions should have corrective osteotomy combined with a physeal procedure to attempt restoration of growth in the medial physis. Early effective treatment can prevent permanent intraarticular incongruity.

Age Factors↗
PubMed1990

Smokeless tobacco: a product for the new generation of tobacco users. Dipping and chewing in the Northwest Territories, Canada, and its global relevance.

The use of smokeless tobacco appears to be a socially acceptable behavior among certain ethnic and cultural groups in developing and developed countries. Some native groups in the Northwest Territories have traditionally used smokeless tobacco. With the visits of the merchant supply ships to the Northwest Territories in the early 1950's, a wider commercial variety of smokeless tobacco began to be used. Of great concern is the generation of Canadian children and adolescents who start this habit and become addicted to smokeless tobacco during their primary and secondary school years. Smokeless tobacco is reemerging as a popular form of tobacco among children and adolescents in Canada, the United States (including Alaska), Scandinavia and Britain. Chemical analysis of samples of smokeless tobacco from six countries has revealed that moist snuff obtained in 1985, from Gjoa Haven, Northwest Territories (imported from the United States) had the highest levels of cancer causing tobacco-specific nitrosamines (TSNA) of 228,400 and 240,100 parts per billion. If these levels were found in any other consumer product today, it would be banned from the marketplace. Because of their known carcinogenicity, the United States Department of Agriculture and Federal Food and Drug Administration have set up strict tolerance levels for human exposure to these chemicals and they prohibit the sale of beer, bacon or baby bottle nipples that contain levels greater than 10 parts per billion. TSNA concentrations in snuff exceed the levels of nitrosamines in other consumer products by over one hundredfold. During snuff dipping or chewing tobacco, the nitrosation process continues within the mouth.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Refsum's disease. Epidemiologic, clinical and biological correlation. 6 cases].

Nine patients with symptoms and signs of Refsum's disease are reported. In 6 a systemic accumulation of phytanic acid was demonstrated, together with low phytanic acid oxidase activity in skin fibroblasts in 5 of them. In 3, no disorder of phytanic acid metabolism was demonstrated. In 3, the diagnosis was made during the pre-clinical period. The disease seems more frequent in Northern France, which agrees with the hypothesis of a genetic mutation which would have taken place in Scandinavia some centuries ago and was subsequently spread by the Vikings. The effects of a dietary treatment on serum phytanic acid levels and clinical disorders are reported. The general condition of the patients improved remarkably but only partially. The diet is unpalatable and in some patients the level of serum phytanic acid increased, due to the mobilization of body fat. Patients with very high levels of phytanic acid might be initially treated by plasmapheresis. For the same reason, the diet should supply enough calories to keep body weight unchanged, and body weight loss whatever its cause should be avoided.

Adolescent↗
PubMed1989

[Isovaleric acidemia].

The three first cases of isovaleric acidemia diagnosed in Scandinavia are described. The disorder is characterized by periodic vomiting, lethargy and coma accompanied by ketoacidosis and a "sweaty feet" odour. These attacks are often triggered of by upper respiratory tract infections or by ingestion of large amounts of protein. Often there are feeding difficulties because these children have aversion to protein-containing foods. Isovaleric acidemia can be subdivided into two types: an acute neonatal form and a chronic intermittent form. The basic defect is deficient activity of isovaleryl-CoA dehydrogenase, resulting in increased urinary excretion of mainly isovaleryl-glycine and 3-hydroxy-isovaleric acid. The defective gene is assigned to the long arm of chromosome 15, and at least five different mutations among 15 patients have been demonstrated. Therapy is symptomatic with correction of the metabolic acidosis and protein restriction and long term treatment with oral glycine and possibly carnitine.

Acidosis↗
PubMed1989

[Fiber bronchoscopy and bronchoalveolar lavage in patients with asthma. A description of the method].

Fiber bronchoscopy under local anaesthesia is an examination procedure frequently employed in the remainder of Scandinavia, Europe and USA. It requires only few resources and the costs are considerably less than fiber bronchoscopy under general anaesthesia. Bronchoalveolar lavage (BAL) in connection with fiber bronchoscopy is rapidly undertaken but analysis of the material obtained requires considerable time. A method of induction of local anaesthesia, performance of BAL and preparation of the washings obtained is described. Fiber bronchoscopy and BAL are considered to be safe examination procedures in patients with mild asthma in a stable phase. The examination is only associated with slight discomfort for the patients, who will frequently accept repeated investigations, and complications are rare. BAL is a valuable examination procedure in research and the results have increased the knowledge of mechanisms in a series of interstitial pulmonary diseases. Future investigations of the humoral and cellular components in BAL fluid in asthmatic patients will contribute to increase knowledge of the pathological mechanisms in asthmatic disease.

Adult↗
PubMed1989

The first international conference on the Palliative Care of the Elderly: an overview.

The effort to examine and improve palliative care for the elderly is actively joined. In Europe, Scandinavia, and North America, at least, issues are slowly being examined in clinical research. The response to the conference was enthusiastic, and new information emerged, for example: British Columbia's "Levels of Intervention" guidelines, Dr Doyle's description of new developments in Geriatric and Palliative Care training and service in the United Kingdom, Dr Triau et al's (Psychogeriatric Nursing Home, Leuven, Belgium) normalization model of care for dementia, and Dr Rory Fisher's argument that instead of using negative DNR orders in palliative care we should instead take a positive approach of specifying what palliative care can provide. Palliative care is not "no treatment;" increasingly we are able to be concrete and specific in our ability to prescribe a range of measures to ensure that our dying elderly die in comfort and without medical, legal, or social intrusion.

Aged↗
PubMedDate not supplied

Perianal abscess and sinuses caused by granuloma inguinale. Case report.

An atypical case of the venereal disease granuloma inguinale, which is very rare in Scandinavia, is reported. The patient presented with recurrent perianal abscess and sinuses, and the diagnosis was not made until histologic examination of an extirpated subcutaneous nodule showed cells containing the pathognomonic Donovan bodies.

Abscess↗
PubMed1989

[Class I and II cavities for amalgam restorations].

In a Danish cross-sectional survey of replacements of fillings it was reported that a major reason for replacement of Class II amalgam restorations was bulk fractures (22). This initiated an examination of a sample of 168 Class II cavity preparations made by dentists from Denmark and other Scandinavian countries. The results showed that the Danish cavities were deepest occlusally and buccally, had the most converging proximal walls, and the broadest bucco-lingual outline occlusally. On the basis of the literature, it is not possible to evaluate the clinical significance of these differences and there is no distinct explanation why bulk fractures cause replacement of amalgam fillings more frequently in Denmark than in the rest of Scandinavia. Only a longitudinal clinical examination of the fillings may show whether the observed differences in the cavity preparations results in an increased frequency of isthmus fractures and are of importance for the longevity of the fillings.

Dental Amalgam↗
PubMed1989

[Few aspects with regard to diagnosis and treatment of oral candidiasis].

The present article discusses the rationale for daily use of the combination of amphotericin B (4 lozenges) intraorally and chlorhexidine denture disinfection (15 min) extraorally vs separate use of polyene antimycotics or chlorhexidine in the treatment of infectious denture stomatitis, frequently considered as the most common form of oral candidiasis. The amphotericin B/chlorhexidine combination has been standard treatment of infectious denture stomatitis in Scandinavia for more than 15 years. It was found to be the best among several regimens tested in 100 patients after a series of subjective and objective parameters had been used to record treatment efficacy in controlled clinical and microbiological studies. The fact that there was a significant (5% level) higher reduction of yeasts cultured from the palatal mucosa with this drug regimen than with the other modalities tested, including chlorhexidine lozenges/chlorhexidine denture disinfection, suggested that no drug interaction of clinical importance took place in vivo with this combination. Therefore, care should be taken when extrapolating findings on drug interaction in vitro (12) to the in vivo situation, and guidelines for treatment of oral candidiasis should preferably be based on controlled clinical and microbiological trials with patients. In order to prevent relapse of oral candidiasis after treatment, local and general predisposing factors should be eliminated, in particular reestablishment of plaque on the fitting side of the denture should be prevented.

Candidiasis, Oral↗