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PubMed1987

Effects of strategy changes in the treatment of femoral neck fractures during a 17-year period.

From 1966 to 1982 new concepts in the treatment of fresh femoral neck fractures were introduced at a university hospital in Sweden. These included immediate postoperative weight-bearing, a program with rehabilitation at home in collaboration with primary care, and an alteration of the treatment policy from primary hemiarthroplasty to a flanged nail and finally to hook pins. The total annual number of hospital days was reduced by about one-third during this period in spite of the fact that the annual number of femoral neck fractures doubled. Thus, the mean hospitalization time decreased from 44 to 16 days. The proportion of patients admitted from their own homes decreased from 80% to 52% during the 17-year period, and for these, the return rate home at discharge from the hospital increased from 44% to 75%. According to several reports from Scandinavia, the number of hip fractures will double in the next two decades. Ways of further reducing the hospitalization time, new techniques, and, if possible, methods of preventing hip fractures must be sought.

Femoral Neck Fractures↗
PubMed1987

Membranous lipodystrophy. Light and electron microscopic study of a biopsy case.

Membranous lipodystrophy is a peculiar systemic disease almost exclusively found in Japan and Scandinavia and characterized by formation of numerous membranous structures in the adipose tissue of bone marrow and soft tissue. Light and electron microscopic study of a biopsy case of the disease was presented. The membranous structures consisted of membrane and inner space on both light and electron microscopic study. The membrane consisted of two kinds of layers, dense and amorphous. The dense layer was positive for lipid stainings. The amorphous layer did not show any definite lipid constituents and was supposed to consist of an amorphous substance derived from abnormal fat metabolism of diseased fat cells, degenerative cytoplasms of the diseased cells, and/or stromal cells. It probably also had some stromal substance alteration due to membranolipodystrophic change. Accumulation of the amorphous layer in the interstitium leads to degeneration and disappearance of adjacent fat cells. This process may play a role in further advance of membranous structures.

Adipose Tissue↗
PubMed1986

Binge stroke. A case report.

Cerebral infarction developed in a 33-year-old normotensive coloured male after an alcoholic binge. This sequence of events has been described in Scandinavia and may occur in southern Africa more often than is realized.

Adult↗
PubMed1986

[Proposal for radio-oncologic needs planning].

The demand planning for radio-oncologic treatment considers the population density and structure of the region served by the hospital, the geographic conditions of this region, the medical prescriptions of the hospital institution, the incidence of cancer, the part of radiotherapy in the treatment of the tumor, hospital-specific factors and, finally, the minimum requirements for technical equipment and staff of a radiotherapeutic functional unit. The most important factors are certainly the incidence of cancer and the number of tumor patients actually receiving a radiotherapy. For the Federal Republic of Germany, an incidence of annually 300 to 320 new cancers per 100,000 inhabitants is determined, based on the mortality statistics of the Federal Republic of Germany, England, Wales and Norway as well as the cancer incidence statistics of Hamburg, Baden-Württemberg, Saarland and the very reliable registers of Scandinavia and the German Democratic Republic. The part of radiotherapy is probably between 32 and 35% of primary treatments, repeated treatments must be added. With respect to technical equipment and staff, some minimum requirements have to be fulfilled by a radiotherapeutic functional unit if its work shall be satisfactory in the medical and economical domain. A concentration of radiotherapeutic resources is recommended. The number of beds required for a radio-oncologic hospital applying modern techniques and combined methods is 40 to 45% of the number of patients irradiated per day. A three-category system for radio-oncologic treatment is presented. Future planning, however, should only be based on two categories.

Germany, West↗
PubMed1986

[The physician, The French judiciary and transsexuals in 1986. II. Three basic questions: treatment, legal change of sex and possible recourse to the legislator].

The authors, having taken a general view of French jurisprudence and law and having compared western and European law about transsexualism, now attempt to reply to three essential questions that specialist doctors and the judiciary should direct themselves to on this subject; As far as medical and surgical treatment is concerned this can only be decided on after a very careful diagnosis of transsexualism authenticated by thorough observation over a period of months that may even extend to 2 or 3 years. The patient should have access to a team of several disciplines, including a psychiatrist, an endocrinologist and a surgeon. This seems to be the minimum size of the team to decide what the hormonal treatment should be and, later, what the surgical treatment may be. The economic repercussions of the whole of the treatment for a transsexual are not negligible and are important to be taken into account. This includes the prevention of legal action against the doctors if the treatment fails or if the transsexual later is disillusioned or regrets what has been done. As far as the law is concerned the chronology of the legal decisions for a legal change of sex a opposed to an anatomical change of sex, achieved by hormone treatment and surgery, is far from being solved. The Conseil National de l'Ordre des Médecins are insisting that a legal change of sex should precede surgical intervention whereas the lawyers, following the lead given by those in Scandinavia and in other European countries, say that tests of medical and surgical procedures to change the person should be undertaken before the law changes the gender of the person. Finally, there is the problem that has been raised by an attempt to replace the legal position that has already been tried. This plan, both medical and legal, has hardly been supported by the majority of French authors who have been consulted. They tend to take up the position of the Académie Nationale de Médecine which was frightened that changing the law would give too much importance socially to transsexualism. This phenomenon is still fairly limited in France but would become more widespread if a new liberal law was passed. Although the authors cannot give positive answers to the main questions raised by this difficult problem they think that these problems should not be avoided, although they are so complex, by doctors and jurists who have to take serious decisions when handling authentic transsexuals.

Female↗
PubMed1985

Prostatic cancer: some epidemiological features.

Prostatic cancer is a frequent tumour in old men. The disease is very common in North America, particularly among Blacks, and in Scandinavia, while it is currently rare in Asian countries. Both morbidity and mortality rates have increased in most areas in recent years, the rate of increase being greatest in populations where the risk has hitherto been low. "Latent" (microscopic) prostatic cancer is much commoner than overt clinical prostatic cancer and, in contrast to the latter, the prevalence is similar in a wide spectrum of countries and ethnic groups. Detection of these latent tumours is dependent on medical care variables. The relationships between tumor development, latency and progression are not understood. It may be useful to consider "latent" prostatic cancer as a separate entity in future classifications and epidemiological research. Hormonal, sexual, dietary, chemical and genetic factors have been implicated in the aetiology although the mechanisms by which they act and the relationships between these factors are not known. As a high fat diet has been found to increase risk in case-control studies, a plausible sequence of events would be a fat-induced change of hormone profile with increased uptake by the prostate of male sex hormones leading to carcinoma--as in the rat. The evidence is however by no means entirely consistent and should be explored further in studies of the US Black and White populations, populations with age-standardized incidence rates in the order of 100 and 50 per 100,000 per annum respectively. If it be accepted that the factors leading to latent carcinoma of prostate are evenly distributed throughout the world, then studies directed at uncovering the agents responsible for progression from latent to clinically invasive state could be rewarding. Such studies would need to be large, prospective in nature and would require a high frequency of autopsy of cohort members to ascertain whether the prostate was cancer free or not. Prevention is not feasible on the basis of current knowledge and further inquiry regarding the aetiopathogenesis of prostatic cancer is needed before preventive approaches can be envisaged.

Adenocarcinoma↗
PubMed1985

Clinical implications of recent developments in gastric cancer pathology and epidemiology.

Recent developments in the epidemiology of gastric cancer have direct clinical implications: It is important to classify patients as belonging to communities with high or low gastric cancer risk. Most native white Americans are at low risk. American Indians, blacks, and Hispanics, as well as immigrants from Russia, Scandinavia, Japan, and some Latin American countries, are at high risk. In high-risk populations the predominant histologic type of gastric carcinoma is "intestinal" or "expansive" which tends to form discrete masses, predominates in males and older people, and has a relative better prognosis. In low-risk populations the tumors tend to be "diffuse" or "infiltrative," are frequent in females and younger people, and tend to have a worse prognosis. The intestinal type of gastric cancer is probably related to diet, characterized by low fat and animal protein intake, high ingestion of grains and tubercular roots, high salt intake, and low intake of fresh fruits and fresh vegetables. Some foods such as fava beans and Japanese fish are suspected of yielding gastric carcinogens after nitrosation. Populations at high risk in which the intestinal type predominates have a high prevalence of atrophic gastritis and intestinal metaplasia. Some of these precursor lesions reach the precancerous stage of dysplasia. The management of these lesions needs further clinical research. Some gastrectomy techniques facilitate the reflux of bile acids into the stomach where they may react with nitrite to produce mutagens and possibly carcinogens. The risk of "stump-carcinoma" increases with time after gastrectomy. Billroth II operations should be replaced with techniques that minimize duodenal reflux.

Animals↗
PubMedDate not supplied

Imported canine visceral leishmaniasis in Denmark.

The first case of imported visceral leishmaniasis in the dog in Denmark, and probably in Scandinavia, is described. The dog, a 5-year-old female wire-haired bird dog, became ill about 21 months after it had returned from a year's stay in Spain (Malaga). The clinical signs were fever, lameness, enlargement of the popliteal lymph nodes and weight loss. A tentative clinical diagnosis of leukaemia was discarded after the microscopic recognition of Leishmania organisms in a biopsy from a popliteal lymph node (Fig. 1). The diagnosis was confirmed by the demonstration of the kinetoplast in the organisms by electron microscopy (Fig. 3 a-b). The organisms measured about 2 micron in diameter indicating that the species in question was Leishmania donovani infantum, which is indigenous to Spain and other Mediterranian countries. The dog was killed, and Leishmania were found in sections of mesenteric and popliteal lymph nodes, spleen, liver, lung and kidneys. The most interesting histologic features were interstitial nephritis, dominated by numerous plasma cells and membranous glomerulonephritis (Fig. 2). It is suggested that the glomerulonephritis is immune complex-mediated as it is in human visceral leishmaniasis. The risk of bringing dogs in and out of the Mediterranean region is stressed, and veterinarians are advised to have leishmaniasis in mind when they are confronted with dogs taken ill with non-specific symptoms after a stay in that part of the world, even if as much as two years have elapsed between the return and the onset of clinical signs.

Animals↗
PubMed1974

Fine-needle aspiration biospy of the thyroid.

Fine-needle thyroid aspiration biopsy has a 20-year history in Scandinavia but has seen little use in North America owing to concern about the dissemination of malignant disease and the more limited use of aspiration cytology in general. We have reviewed our experience with this method in 103 cases, and on the basis of our work and the accumulated evidence of others, believe that the procedure is of considerable practical value with little or no risk to the patients under study.

Acute Disease↗
PubMed1973

The use of lithium carbonate in the treatment of mood disorders.

The use of lithium ions in the treatment of manic states is discussed. Lithium is possibly the only specific drug treatment presently available for the major psychoses and has met with enthusiasm in England, Scandinavia, Australia and, more recently, in Canada and the United States.A number of the published papers on the subject are not sufficiently comprehensive to provide guidance for even its empiric use; some lack the necessary controls and design to permit comparisons with other studies.Some clinicians with wide experience of lithium therapy do not maintain laboratory control of patients by ordering serum lithium determinations but rely entirely on clinical judgement in establishing drug schedules. This is not advised if one has little experience with lithium therapy because of the possible side effects and toxicity.

Abnormalities, Drug-Induced↗
PubMed1969

Recent developments in the laboratory diagnosis of gonococcal infections.

The author reviews the more important studies on the laboratory diagnosis of gonococcal infections published since 1964. The most significant new developments are the use (a) of fluorescent antibody techniques and (b) of selective media for the identification and isolation of Neisseria (N.) gonorrhoeae. The sensitivity and specificity of culture methods and of the direct "delayed" fluorescent antibody technique (FAT), both at their best, are very similar, but the FAT allows for more rapid reporting. The results of the direct "undelayed" FAT can be given even more rapidly, but, especially with specimens from women, it is less sensitive than culture or the direct "delayed" FAT. The use of a selective medium facilitates the recognition and identification of N. gonorrhoeae, but the advantage of a selective medium over a non-selective medium depends very much on the skill of the technical personnel involved. One disadvantage is the existence of gonococcal strains that are very sensitive to the antibiotics used hitherto for the suppression of Gram-positive contaminants. Ideally, selective medium should be used in combination with the direct "delayed" FAT after growth on non-selective medium. Other new achievements are a complete, chemically defined, protein-free liquid medium for the culture of fastidious Neisseriae; a commercially available chemically defined enrichment supplement; and a new specimen-transport kit using Stuart's medium.The author also reviews recent reports which suggest that the in vitro sensitivity of N. gonorrhoeae to penicillin and other antibiotics used for treating gonorrhoea is generally decreasing; however, some reports of increasing sensitivity have lately come from Scandinavia.

Bacteriological Techniques↗
PubMedDate not supplied

[Maternal mortality in the gynaecological and obstetrical clinic of the University Hospital in Rennes. A retrospective study over 10 years, from 1969 to 1979 (author's transl)].

Maternal mortality in the C.H.U. of Rennes from the 1st January 1969 to the 1st January 1979 consisted of 8 deaths in 24.911 deliveries and 1.381 Caesarean sections, which gives a mortality of 32 per 100.000 deliveries. There was 1 death due to hyperemesis gravidarum, 1 due to toxaemia of pregnancy, 3 due to haemorrhage, 1 due to puerperal sepsis, 1 due to cerebral haemorrhage and lastly 1 due to cancer of the pancreas. 2 women died during Caesarean section, which works out at 1 death per 690 Caesareans. Of these 8 deaths, 4 were possibly avoidable, and 3 of their children survived. In spite of continual progress since the end of the second world war, maternal mortality should decrease still further and tend down to the figures for Scandinavia or England (10 deaths for 100.000 deliveries).

Cesarean Section↗
PubMed1977

Angiosarcoma in post-mastectomy lymphoedema. A report of one case of Stewart-Treves syndrome.

A 67 year old woman developed lymphoedema in the ipsilateral arm about 1/2 year after radical mastectomy for carcinoma of the breast with no metastases. 11 years later she developed an angiosarcoma in the same upper arm and this spread rapidly to the forearm and chest wall. She had considerable bleeding from the lesions and had to be given repeated blood transfusions. Radiotherapy was without effect and she died of pulmonary emboli 3 months after the diagnosis of angiosarcoma was made. No sign of distant metastases, 0ut a small carcinoma was found in the right breast. On going through the literature, the author has found 206 cases of Stewart-Treves Syndrome (development of angiosarcoma in post-mastectomy lymphoedema), 7 of which were from Scandinavia.

Aged↗
PubMed1977

Histiocytic ulcerative colitis in a boxer. A case report.

A case of canine histiocytic ulcerative colitis, a disease of boxers, is here described. It appears that this disease has not been previously reported in Scandinavia. The diagnosis was established at necropsy of a 5-month-old boxer, which had shown bloody diarrhoea since the age of four weeks. Treatment with antibiotics had only given a temporary remission of the condition. Macroscopical findings included thickening of the wall of the descending colon and rectum, multiple ulcers in the rectocolonic mucosa and marked enlargement of the colonic lymph nodes. Microscopically the lesions were characterized by large accumulations of PAS-positive histiocytes, mixed with cells of the plasma cell type, in the mucosa and submucosa of the rectum and descending colon and in the colonic lymph nodes. The importance of using proctocolonoscopy and colon biopsy for the clinical diagnosis of this condition is stressed.

Animals↗
PubMedDate not supplied

Isolation from birds of influenza viruses with human neuraminidase.

Attempts at virus isolation from cloacal swabs resulted in the recovery of 10 strains of hemagglutinating viruses from a total of 349 ducks, mainly shelducks (Tadorna tadorna) captured in the north of France. Four of these isolates were identified as influenza strains corresponding to the following antigenic composition: Hav6-N2, Hav6-Nav4 and Hav1-N2 (2 strains). Shelduck is known to be a partially migratory species, wintering in western Europe, some of them migrating northward to Scandinavia during the summer. The captures were made between November 1976 and February 1977: one of the birds was caught four times and was found to be negative for virus in November, positive in December (isolation of a strain Hav6-Nav4), negative again in January and February. Blood taken in February did not show the presence of HI antibodies to the homologous virus.

Animals↗
PubMed1982

Muroid virus nephropathies and muroid viruses of the Hantaan virus group.

Hemorrhagic fever with renal syndrome (HFRS) came dramatically to the attention of Western medicine in 1951 with the "new" disease becoming a major source of morbidity and mortality in American troops in Korea. Known there as epidemic hemorrhagic fever (EHF) or Korean hemorrhagic fever (KHF), it became apparent that it was the same disease as the endemic (epidemic) hemorrhagic nephroso-nephritis of the Soviet Far East and Songo fever of the Japanese Army in Manchuria. The conjecture that the milder epidemic (endemic) nephropathy of Scandinavia and European Russia was the same or a related disease has now been substantiated with the demonstration of close serological relationship of the Bunyamwera-like virus causing KHF (Hantaan virus) to that of HFRS in Finland, Sweden, European Russia, Greece and Yugoslavia. In the past decade the disease has been recognized as a serious problem in 19 provinces of China and in Japan, where the virus is the Hantaan virus. The severe EHF (or KHF) has its silent reservoir in the wild mouse Apodemus agrarius or in laboratory rats while the less virulent European disease resides in the voles Clethrionomys sp. A mild nonhemorrhagic form of the East Asian nephropathy is carried to man by infected urban rats, Rattus rattus or Rattus norvegicus, in Japan and Korea. All forms are carried to man as a respiratory infection "when a mouse (or rat or vole) coughs". Antibodies to the Hantaan virus have been found in man in India, Iran, Central Africa, Alaska, Bolivia and in wild rodents and urban rats in the USA where human cases of muroid virus nephropathy have not been recognized. Antibody patterns to Hantaan virus and to Scandinavian nephropathia epidemica virus antigens found in human and rodent sera in America and in Sweden, Yugoslavia, and European Russia suggest the possibility of yet a third (or more) virus serotype(s), and also the possible presence of the East Asian type of virus in Europe.

Animals↗
PubMed1984

The risk/benefit ratio of depot neuroleptics: a Scandinavian perspective.

The three developmental phases in the acceptance and use of depot neuroleptics are described. The practical advantages of these drugs are considered, as well as the extrapyramidal side effects that may result from oral or depot administration. Local (injection site) and other side effects of depot neuroleptics are discussed. Typical plasma drug concentration curves and receptor responses of depot neuroleptics are illustrated. Alternative use of oral drugs and strategies to increase the effectiveness of depot forms are presented. The depot neuroleptics used in Scandinavia today are discussed, and predictions are made regarding their use in the future.

Administration, Oral↗
PubMed1984

Haemorrhagic fever virus with renal syndrome in small rodents in Czechoslovakia.

The antigen of haemorrhagic fever with renal syndrome (HFRS) was detected in the lungs of the following free-living small rodents trapped in different localities in Eastern Slovakia: Clethrionomys glareolus (2 positive samples of 7), Apodemus flavicollis (1 sample of 24) and Apodemus agrarius (7 positive samples of 66). The virus was first identified by indirect fluorescent antibody (FA) staining using human convalescent serum from a case of epidemic nephropathy (NE) of Scandinavia. The lung suspensions selected according to positive immunofluorescence were inoculated by intramuscular (i.m.) route into suckling rats; the antigen prepared from the lungs of these rats by sucrose-acetone extraction reacted with the prototype human serum in complement-fixation (CF) reaction. The results of the latter assay were in good agreement with those of the indirect FA staining.

Animals↗