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Two brothers, born in 1944 and 1950, had been brought up in separate homes since 1951. In 1978 they were both afflicted with Behçet's syndrome. This condition is uncommon in Scandinavia, and there are no other known reports of familial cases from the Scandinavian countries. The etiology of the disease is obscure and controversial. In our two cases a hereditary disposition seems more probable than an infectious origin.
A 41-year-old Vietnamese refugee was found to have tuberculoid leprosy. Dapsone treatment cleared her skin lesion, but did not remove the paraesthesia in the right ulnar nerve. Immunological investigations revealed a strongly positive lepromin test and a significant change in the ratio of T-y and T-mu lymphocytes in peripheral blood. The incidence of leprosy in Vietnamese refugees in Scandinavia is discussed.
There are a small group of colonic carcinomas of known etiology and large group of unknown etiology. In the latter group epidemiology, metabolic epidemiology, and animal experiments suggest a correlation between the fat content of the diet and the incidence of colonic carcinoma. Burkitt's postulate of a protective value of high fibre intake receives backing from 3 epidemiological studies from Israel, Scandinavia, and San Francisco.
Reactive arthritis is arthritis in which, although the nature of the responsible infection is known or suspected upon serological grounds, attempts at recovering the pathogen from the synovial fluid have failed. One of the main pathogenetic problems is the multiplicity of etiologic agents. Some are exogenous and may be related to the articular tropism of certain microorganisms, to immunologic depression due to an antecedent or coincident infection, and to successive reinfections by the same pathogen or by others which may promote an exacerbation of the disease. Others are endogenous and attention should be given to the local or systemic presence of an antigen as well as, in some instances, to the persistence of residual forms of infecting agents, which are more readily demonstrated with current bacteriological and serological methods. Although reactive arthritis is to be distinguished from septic arthritis, it can no longer be clearly differentiated from the classical post-infectious rheumatism. Once it has been produced, the antigenic stimulation is responsible for an immunologic response which tends to check systemic extension but may also produce tissue damage in the host. Some patients have circulating immune complexes which may bind to the joint, thereby damaging it. In other patients, particularly those who are HLA B27 positive, host-pathogen cross-reactions are demonstrated. Actually, the most frequent pathogenetic sequence seems to be a combination of two or more of these mechanisms, as there are reasons to believe that presence of the pathogen in situ is not required for the persistence of the inflammatory process. Reactive arthritis was first reported in adults following either sexually transmitted urethritis due to chlamydiae, mycoplasma or gonococci, or hepatitis B or an intestinal infection due to Yersinia, Campylobacter, Shigella, Klebsiella or Salmonella. Later, it was described in pediatric patients, particularly in Scandinavia where, for genetic reasons, the HLA B27 group is prevailing. Reactive arthritis seems less frequent in caucasian ethnic groups and above all in Latin Americans among whom HLA B27 carriers are more uncommon; however, it must be pointed out that they have not been as extensively studied and that other etiologic factors may still remain to be discovered. The course and etiology of the different forms of arthritis share certain characteristics which have been determined through a better knowledge of these conditions: onset occurs one or several weeks after a respiratory, urinary or, most often in children, digestive infection. This episode is unremarkable or latent and often overlooked.(ABSTRACT TRUNCATED AT 400 WORDS)
Anaerobic bacteria constitute a substantial component of the normal vaginal flora and of the outer cervical canal. Consequently, one would expect infections emanating from the vaginal flora to be caused to a substantial degree by anaerobic bacteria. The anaerobes may contribute in colpitis, but their role is difficult to prove in this situation, since sampling only yields normal flora components. One clue that anaerobes may contribute to colpitis is the circumstance that the flora under those conditions differ from the normal situations. Another is the circumstance that metronidazole, which only inhibits anaerobes, does reduce symptoms e.g. of colpitis in the presence of the microaerophilic Gardnerella vaginalis, which is resistant to metronidazole (but sensitive to the metabolite hydroxymetronidazole). In the US, pelvic inflammatory disease (PID) is to a substantial degree apparently caused by anaerobic bacteria. Our experience in Scandinavia indicates that anaerobes are of neglible importance in this condition, since we rarely isolate anaerobes in spite of adequate sampling, transport and processing of specimens. We mostly find anaerobes in post-operative PID when the vaginal wall has been passed, or as a complication of pregnancy (puerperal fever, early rupture of membranes, abortion), and in connection with intrauterine devices. The role of anaerobes in bartholinitis is established. PID may be associated with appendicitis or colonic diverticulosis. Anaerobes are regularly isolated from abscesses developing in the pelvic organs. This also applies to tuboovarial and vulvovaginal abscesses. The most important anaerobic bacteria in infections of the female genital organs are Bacteroides fragilis and other species of the fragilis group, B. melaninogenicus and related species, other Bacteroides, peptococci and peptostreptococci. Clostridium perfringens rarely cause infections of female genital organs, although such conditions have a dramatic course.
326 patients presenting with acute abdominal pain to a hospital in Tampere were compared with others in England and Norway, and with a large series of 6097 cases collected under the auspices of the World Organization of Gastro-Enterology. The distribution of disease in these 326 Finnish patients bore remarkable similarities to the distribution in other countries. When subjected to a computer-aided diagnostic analysis, comparing Finnish patients with UK and world-wide data, as regards appendicitis, cholecystitis and nonspecific pain, the computer performed roughly as well as the clinicians diagnosing the same cases. It is concluded that these diseases therefore have a common presentation in Finland with that elsewhere. As regards small bowel obstruction however, the computer diagnosed only 22% of cases correctly, (compared with the accuracy of clinical diagnosis 73%). This leads us to conclude that this disease presents unusually in Scandinavia, and possible reasons are discussed.
Twenty-three laboratories from 13 countries in continental Europe, Scandinavia, the British Isles, and North America participated in a polychlorinated biphenyl (PCB) Check Sample Program conducted under the auspices of the International Council for Exploration of the Sea (ICES). PCBs were determined in unspiked and spiked (1.00 mg Aroclor 1254/kg oil) herring (Clupea harengus harengus) oil by the participants, each of which used his or her own cleanup and quantitation techniques; a common Aroclor 1254 mixture was used as a standard and a common quantitation technique was used for comparative purposes. Results for the unspiked oil ranged from 0.48 to 3.416 mg PCB/kg oil, while spiked oil results ranged from 0.70 to 3.891 mg/kg. Calculated spike recoveries ranged from 22 to 136%. Serious deficiencies were found in most steps in the procedures. No evidence was found to support the use of a common PCB standard or a common method of calculation using packed column chromatography. The chromatographic stationary phase used appeared to affect the PCB levels obtained. Florisil cleanup adsorbent yielded higher mean results for both unspiked and spiked oils than did alumina. Large coefficients of variation were found (25-50%), the principal source of which was systematic error (interlaboratory).
Foetal alcohol syndrome (FAS) is the combination of growth retardation, neurological impairment and abnormal facies shown by some infants born to alcoholic women. It seems likely that FAS only indicates a small proportion of the total damage inflicted on the foetus by maternal drinking. Levels of alcohol consumption below the equivalent of 30 ml per day of absolute alcohol probably do not have a significant effect on the foetus. But there is an increased incidence of either growth retardation or behavioural and congenital abnormalities amongst the infants of women who drink heavily in pregnancy but who are not alcoholic. Such children are sometimes described as showing foetal alcohol effects and such effects are probably commoner than complete FAS. The way in which alcohol damages the foetus is unknown. Genetic and nutritional factors in mother or child may determine the response to alcohol. Smoking appears to potentiate the effects of alcohol on the foetus. Drugs may also alter the foetal response to alcohol. The prevalence of children damaged by maternal drinking is impossible to estimate. Foetal alcohol effects overlap with many other congenital and developmental abnormalities. FAS is more common than 1 in 2500 births in Liverpool and may even approach the incidence of 1 or 2 cases per 1000 births seen in U.S.A. and Scandinavia.
With 2 436 deaths in 1979, ovarian cancer is relatively infrequent in France comprising but 5 per cent of female mortality from malignant disease. However, the rate of increase in mortality is considerable, 70 per cent between 1955 and 1979 or 2,9 per cent per year, greater than that for female bladder and breast cancer. The estimated morbidity and mortality rates (age-adjusted to the world standard population) were 7,5 and 5,4 per 100,000 per annum respectively for 1979, figures in the mid range of international data. This is situated below the rates observed in Scandinavia and North America which occupied the first ranks. The high proportion of metastatic dissemination (55%) at the time of diagnosis and the variety of morphological types (80% being epithelial cancers) emerges from clinical data relating to a series of 2,937 ovarian cancers diagnosed by the "Enquête Permanente Cancer". The 5-year survival rate was 13 per cent with only 50 per cent being alive at the end of the first year. To improve these poor results it is necessary to identify new risk factors in a future French epidemiological study using case control and prospective approaches.
In recent years discussions about the development of psychiatric care internationally and in Scandinavia have been focused on principles of opening and sectorizing, sometimes at the cost of existing differentiated and effective psychiatric in-patient care-programs. During the last 6 years a process of strengthening and opening psychiatric care was started on the Swedish island of Gotland (55 000 inhabitants), based on an existing mental hospital, utilizing the existing personnel, maintaining existing effective structures of institutional care and developing new ones in out-patient care. The intention was to combine principles of subspecialized psychiatric in-patient are treatment with ideas of sectorization, accessibility and openness. Our results seem to show that it is well possible to reach positive results, optimizing and opening up an existing institution, using a basic psychodynamic, synoptic and eclectic ideology, offering differentiated treatment programs and without the immediate use of sectorizing principles. Sectorization and accessibility without qualified treatment programs of in-patient care may not be a sufficient solution to all the problems we find in psychiatric organisations. On the other hand, our achieved positive results have probably the naturally sectorized character of the island of Gotland as a presupposition. Principles of sectorization and differentiation seem in psychiatry not to be contrary but complementary. However, it seems to be legitimate, possible and effective to start a process of psychiatric evolution transforming an existing old-fashioned mental hospital.
Benign lymphocytic infiltrations may often occur in the skin of nipple and areola: 55 cases have been described in literature especially in Scandinavia and in Germany, sometimes in correlation with tick bites or erythema chronicum migrans, but until now no cases have been reported in France. In a retrospective study of 30 cutaneous lymphocytomas, we found 8 cases localized on the breast-3 children and 5 older patients-, associated with a erythema chronicum migrans in 3 patients and following a tick bite in another patient. The course of the disease is always benign and the healing can be accelerated by penicillin therapy. The pathogenesis still remains unclear but some data argue for an infectious mechanism: frequency of tick bites (20 p. 10), geographical occurrence in the spreading area of common ticks in Europe, affinity of ticks for the breast in all mammals, carriage of viruses by some tick species, efficiency of penicillin in tick-transmitted viral infectious and in benign skin lymphocytomas, positive inoculations in volunteers, general course of an infectious disease (seasonal variations, frequency of satellite lymph-node swelling, spontaneous healing).
This paper explores the relationships among culture, character, and suicide. It draws on the author's research in Scandinavia and his studies of suicide among United States urban blacks and college students. The differences in motivation and significance of suicide in Sweden and Denmark are illustrated. The United States is an amalgam of subcultures which must be studied separately to identify the psychosocial determinants of behavior. The varying rates and motivations of suicide in different cultures and subcultures, the differences between men and women, between young and old, differences in ways of coping with love and loss, life and death make clear that suicide is part of a culture's possibilities. The varying psychodynamic ways in which the suicidal individual in differing cultures and subcultures conceives of, uses and absorbs death also has much to tell us about how we live.
In the Scandinavian countries, laws require reporting of the traditional venereal diseases, i.e., gonorrhea, syphilis, lymphogranuloma venereum (LGV), and ulcus molle, or chancroid. Incidence figures for these diseases, therefore, are fairly reliable. In the Scandinavian countries, LGV and chancroid are rare diseases, and the syphilis incidence has remained low. These three diseases are typically male afflictions. Gonorrhea outnumbers the other diseases mentioned and at present has a nearly 1:1 male: female ratio. In Scandinavia, as in other parts of the world after World War II, gonorrhea has shown great epidemiological fluctuations. A heavy increase in its incidence was evident in Sweden and Denmark during the 1960s. During the 1970s, however, the incidence in Sweden dropped significantly, with the 1980 figures corresponding to those seen in 1960. Sweden now has the lowest incidence of gonorrhea among the Scandinavian countries. During the past three years, the incidence of infections with penicillinase-producing gonococci (PPNG) has increased. Most of the strains isolated have originated from the Far East. As documented in several recent investigations, genital chlamydial infections are at least as common as gonorrhea in the Scandinavian countries. Acute salpingitis has been shown to be a common complication of such infections. Among the other sexually transmitted diseases (STD), Trichomonas infections are still common. The prevalence of genital warts and of Herpes Simplex Virus (type 2) infections is increasing and within the next few years these probably can be expected to become an even greater problem than are the traditional venereal diseases, because no specific treatment is yet available.
A case of congenital erythropoietic porphyria (CEP) in a Swedish boy is described. It is the second case of this extremely rare disease encountered in Scandinavia. Like the first Scandinavian case--a Norwegian boy--this patient showed a porphyrin excretion pattern like that of porphyria cutanea tarda (PCT) which was regarded as pointing to a hepatic type of porphyria. In the Norwegian boy this was regarded as atypical, but our study of the literature revealed two older cases with features pointing to a similar pattern and disclosed that analysis of the porphyrin pattern with modern methods, such as thin-layer chromatography, has not been performed in the great majority of the cases of CEP, because such methods were not available at the time these cases were published. Therefore, it is necessary to study more cases of CEP with modern analytical methods in order to get an adequate picture of the porphyrin pattern typical of this disease.
During the period 1965-1977, a total of 339 patients with polycystic renal disease received at least 1 renal transplant at one of 10 transplant centres in Scandinavia. Patient survival at one year was 67%. The one year graft survival of 319 cadaveric grafts was 40%. The average age of the patient was 56.7 years. Patients who were 60 years or older (93 patients) had a significantly poorer patient and graft survival at one year (50% and 29.5% respectively). Patients receiving kidneys with O incompatibilities did significantly better than other donor-recipient combinations. Previous blood transfusions were associated with better graft prognosis, though the difference was only significant for 2 years. The incidence of posttransplant urinary tract infection (present in 47% of all the patients) was twice as common in patients with a history of pretransplant urinary tract infection (seen in 41% of all the patients). There was no association between posttransplant septicaemia and either pre- or post-transplant urinary tract infection. Only 10.5% of the patients were nephrectomized at the time of transplantation, half of these had urinary tract infection. Twenty-four per cent of the patients were nephrectomized in the posttransplant period, half of these because of infection. There was no difference in the graft survival data of the patients with or without pretransplant urinary tract infection. These findings justify a restrictive practice with regard to pretransplant nephrectomy in patients with polycystic renal disease.
Phlebology originated in Paris and Tübingen where Jean Sicard and Paul Linser accidentally discovered the possibility of the sclerotherapy of varicose veins. The second element in the treatment of lymphovenous insufficiency is ambulatory compression described as far back as the 18th century. It is only recently that reasons for its efficiency have been understood, with the study of fibrinolysis (which is counter-thrombotic), in England. The third step was the medical treatment of arterial affections, developed notably by Henri Reboul in Paris, with the aid of intra-arterial injections. In this way non-surgical disorders entered into the realm of phlebology. In 1947 Raymond Tournay, Jean Sicard, Jean Marmasse founded the French Phlebological Association (Société Française de Phlébologie) which went rapidly from strength to strength. Ten years later its counterpart was founded in Benelux (Van der Molen, Van der Stricht, Zoller) and in the Federal Republic of Germany (E. Krieg, F. Jäger, M. Ratschow, P. Matis, U. Ellerbroek, F. Olsen). Today there are phlebological associations throughout Europe, or at least phlebological sections of dermatological associations (Austria, Italy, Scandinavia). Switzerland, too, is very active in the phlebological field (Bolliger, Kappert, Leu). New evaluation devices (such as Sonar-Doppler, plethysmography etc.) improve diagnosis, made even more objective by the use of radiology. There are still too few phlebological teaching centres, and many of the existing ones have a surgical and clinical emphasis, and neglect polyclinical work. Besides the existing Phlebological Associations on other continents (Canada, Australia, South America) the Collège de Pathologie Vasculaire found by Cl. Olivier in Paris is very active. It offers most comprehensive theoretical and practical teaching. Other phelobological centres at Hamburg (Ellerbroek, Stegmann), Tübingen (Schneider, Fischer), Essen (Klüken), Zurich (Bolliger, Brunner), Vienna (Santler), Terwolde, Holland (Van der Molen), Bad Nauheim (Dembowski, Hach), Strasburg (Stemmer), Lille (Huriez, Merlen), Rouen (Ouvry, Davy), Louvain (Haven, De Greef), London (Hobbs), are engaged in spreading knowledge of phlebology, whose social significance is very important, since it deals with very widespread illnesses. A whole series of reviews and papers specialising in peripheral vascular disorders are published in all the main languages the world over.
Based on an inquiry it was found that aspiration biopsy and cytology of the prostate in West-Germany is practiced less than in Scandinavia. This in spite of the fact that the fine needle biopsy can be done with the same accuracy as punch biopsy of the prostate, but with more advantages. Beside of that the cytological grading proofed to be very important for the biological activity of the carcinoma of the prostate. The technique of fine needle biopsy of the prostate is not easy and must be practiced very well.
Over a period of 18 months Campylobacter jejuni was isolated from the faeces of 19 (5.8%) of 329 travellers with diarrhoea, among 2488 patients attending the Outpatient Department of Tropical Diseases at Aurora Hospital. Incidences of Salmonella, Shigella and C. jejuni in diarrhoeal patients were very similar. C. jejuni caused initial symptoms of diarrhoeal disease indistinguishable from travellers' diarrhoea from other causes. Double bacterial or bacterial-parasitic infections were shown in 22 patients. During the same period at Aurora Hospital a total of 48 patients were found to have imported C. jejuni from 21 countries outside Scandinavia. Of these 83% had been on tourist trips.