Estulic--a well tolerated and effective antihypertensive drug in general practice. The results of the treatment of 28 patients with mild to moderate hypertension using guanfacin (Estulic) monotherapy and of 24 patients receiving combined antihypertensive therapy containing Estulic are reported on. The blood pressure was lowered and stabilized during the first month of therapy. No addiction or loss in effectivity was seen. There were no changes in ECG or laboratory results during the mean follow up time of 11 months. Four patients discontinued the drug because of subjective side-effects. The single daily dose, the reliable effectivity, the safety of the drug makes it an important antihypertensive drug in general practice.


Mydocalm treatment of muscular and vascular complaints accompanying climacterics. Coated Mydocalm tablet, known as striated muscle relaxant and peripheral vasodilator, has been used in climacteric women. The women suffered from muscular and vascular complaints besides the common symptoms of decreased or lacking ovarian function which could not be controlled with oestrogen substitution therapy. Mydocalm significantly moderated these complaints without causing unwanted effects and the majority of the women could be maintained in a complaint-free condition in this respect. According to the opinion of the author the drug is a valuable adjuvant to an adequate hormone therapy.


Observations with a tri-phasic oral contraceptive (Tri-Regol) in everyday clinical practice. The theoretical general principles of triphasic oral contraception are discussed in the introduction. This method, which is the closest to a physiological dosage, seems to be the most advantageous today. International data and the advantages and wide indication field of such "step-up" tablets are also discussed. The observations with the Hungarian Tri-Regol tablet are described in detail. In the course of controlling 355 cycles of 79 women pregnancy was not observed, the tablets were well tolerated by the women-except for some milder side-effects. The use of Tri-Regol needed not be discontinued due to, any unwanted effect or complication. The rate of intermenstrual bleeding was very low, and the triphasic therapy proved to be beneficial in case of manifesting cycle disorders or if the change of the contraceptive tablet became necessary because of intolerance. According to the opinion of the authors the oral contraceptive Tri-Regol is today's drug of choice due to its reliable ovulation inhibitory action, low hormone content, and favourable tolerability.


Some indications for the gynaecological use of budesonide (Apulein). Budesonide-containing Apulein ointment has been used for the treatment of 29 women suffering from vulvitis, pruritus vulvae caused by vaginal discharge, gestational inflamed hemorrhoid, hymenitis, and late postoperative suture inflammation. The ointment rapidly and completely controlled local infiltration and the accompanying subjective complaints. It did not cause local alteration, the consistency of the ointment met the requirements and it did not disturb the patients' making their toilet. According to the author's opinion the product is a potent antiphlogistic which proved to be a valuable adjuvant to target specific treatment of inflammatory processes of the external female genital organs and perianal regions.


[HELLP syndrome--a life-threatening pregnancy complication]. A serious complication to pregnancy-induced hypertension and preeclampsia is the HELLP syndrome (H - haemolysis, EL - elevated liver enzymes, LP - low platelet count). Perinatal and maternal mortality are reported to be high, 7-60% and 2-24%, respectively. A non-obstetric diagnosis is often made, such as gastrointestinal or haematologic disease. Typical symptoms are epigastric and right upper-quadrant pain and tenderness, nausea and vomiting. Recognition of the clinical and laboratory findings is important, so that early, aggressive therapy can be initiated in order to prevent maternal and perinatal death. We present data from 14 patients with the HELLP syndrome treated in our hospital. There was one intrauterine death. The other infants were discharged in good condition. Two of the patients had eclampsia.


[HELLP syndrome--4 case reports].

[HELLP syndrome--4 case reports]. HELLP-syndrome (H - haemolysis, EL - elevated liver enzymes, LP - low platelet count) is a serious complication of pregnancy. It can be considered as a variant of severe preeclampsia, where haemolysis, hepatic damage (elevated liver enzymes) and thrombocytopenia (low platelets) are all present. Four case reports of HELLP-syndrome are described. HELLP-syndrome may develop within a few hours. It can be seen pre-, intra- and postpartum. Many patients do not exhibit a clinical picture of severe preeclampsia. Patients who develop HELLP-syndrome usually complain of malaise, nausea, epigastric pain and headache. The diagnosis is confirmed when haemolysis, elevated liver enzymes and thrombocytopenia are demonstrated. Patients with HELLP-syndrome require intensive care by a team of obstetricians, anaesthesiologists and haematologists.


[Organ donation from recently deceased patients. Experiences from a donor hospital and suggestions for handling potential organ donors and their relatives]. Homologous organ transplantation using organs from patients suffering complete destruction of the brain and brain stem is a major achievement in modern medicine. The care of potential organ donors and their relatives is complex and very demanding for the medical team and nursing staff. In Norway the law sets very clear criteria (documentation of total irreversible brain and brain stem injury) for performing donation. As a rule consent from the family is asked for, although not legally required. This article deals with the problems related to the treatment of potential organ donors. We give practical guidelines for medical staff on how to prepare the patient and his/her family, with emphasis on the human and psychosocial aspects. Preservation of the donor and the organs is not discussed.


[Postrenal acute renal failure with deficient or minimal dilatation of the renal pelvis]. This article presents the clinical and radiological findings in three patients with acute obstructive renal failure. In a setting of typical clinical symptoms of acute postrenal obstruction, the lack of or only minimal ultrasonographic dilatation of the pelvicalyceal system should not lead to the conclusion that there is no obstruction until supplementary invasive procedures have demonstrated open urinary tracts. Minimal pelvic dilatation in acute obstructive renal failure is typically associated with malignant diseases encasing the distal parts of the ureters, retroperitoneal fibrosis, urinary calculi and urinary infections. Various pathophysiologic mechanisms are discussed.


[Treatment of stomach ulcer with bismuth subnitrate, oxytetracycline and metronidazole]. 60 patients with recurrent duodenal ulcers were treated with bismuth subnitrate, oxytetracycline and metronidazole. Helicobacter pylori status was assessed before and after treatment by means of the 14C-urea breath test. All patients were helicobacter positive before treatment. Four weeks after cessation of therapy H pylori had been eradicated in 57 out of 60 patients (95%). The ulcer healing rate was 100% after six weeks. 43% of the patients complained of moderate to severe side effects, mainly nausea and diarrhoea, but no patients discontinued the treatment prematurely. The study indicates that nearly all patients with recurrent duodenal ulcer are infected with H pylori, and that the present triple treatment regimen is very effective both in eradicating H pylori and in healing the ulcer.


[Congenital short Achilles tendon. A survey of habitual toe-walking in children]. Congenital short tendo calcaneus is seen in children as partial or complete walking on the toes, and may represent a major disturbance for normal motor development and coordination. This clinical finding may indicate a more serious, underlying disease (cerebral paresis, childhood psychosis or a neuromuscular disorder). If the patient, apart from walking on the toes exhibits normal clinical findings, the diagnosis of congenital short tendo calcaneus may be justified. The disease may be inherited. The diagnosis should be made by an orthopaedist, and the treatment is either conservative with aggressive physical therapy, or surgery. The prognosis is good after early diagnosis and special treatment. A review of the literature, with emphasis on diagnosis and treatment, is presented, together with a brief review of five patients operated by the authors.


[Quality assurance in clinical trials. Problems related to patient information]. In connection with a phase-III study of cholesterol lowering agents, a questionnaire survey was carried out on information to patients' during clinical trials. The survey included 124 patients and nine team members with different professional backgrounds. The results show that, in spite of the fact that the patients had received information in accordance with the guidelines, only 47% of them had perceived that conventional treatment would be offered to those who dropped out of the study. A test of the extent of the patients' understanding about the drugs they were taking showed that only 39% knew how the drug acted and the reasons for the chosen dosing schedule. 23% of the patients would like to have received more information, but 9% of these had problems in formulating questions to the health personnel. Anxiety was a problem for 16% of patients, especially in the early phase of the clinical study. Only half of the team-members were aware of this. 45% of the patients felt that they would disappoint the team if they expressed a wish to drop out of the study. Most of the team-members would have tried to motivate the patients to continue to participate in the trial. Based on the results of the survey, we suggest some main elements of standard procedures for providing information to patients in connection with clinical trials.


[Quality assurance in laboratory medicine--reality and challenge]. So far, quality assurance in laboratory medicine in Norway has concentrated mainly on results. As yet, however, much still remains to be done, particularly in the fields of pathology, radiology and nuclear medicine. Insufficient emphasis has been paid to quality assurance of the requests made for tests and interpretation of the results. Important for this part of quality assurance are teaching and education, cooperation between the laboratory physician and the clinician, more active participation of the laboratory physician in the solving of clinical problems and a change from menu-oriented to problem-oriented requests.


[Bone density measurements in prevention of femoral neck fractures]. With a view to preventing hip fractures, bone mineral density measurements have been suggested as a means of selecting individuals at risk. We suggest two focuses in a preventive strategy: selection and information. The overlap in mineral density distributions among women who experience hip fractures and those who do not leads to a high number of inconclusive measurements as regards placing individuals into two such groups. The measurements should therefore be used primarily to inform individuals about their risk. In order to evaluate this technology, prospective studies on bone mineral density measurements prior to oestrogen hormone replacement therapy are highly desirable.


[Alcohol consumption among convicted drivers]. 150 males imprisoned for drunken driving were assessed by means of a questionnaire and medical examination. The objectives were to study alcohol consumption and frequency of alcohol-related problems. Half of the assessed persons were less than 30 years of age. 62% had a blood alcohol concentration > 1.50%. 36% had previously been convicted for drunken driving. Average alcohol consumption was 58 gram per day. 40% of the convicted persons reported a consumption of more than 40 gram alcohol per day. Corrected for under-reporting the consumption was even higher. The CAGE questionnaire was positive in 54%, indicating an alcohol-related problem. GGT (gamma-glutamyltransferase) was elevated in 23% and CDT (carbohydrate deficient transferrin) in 35%. This study indicates that 50-60% of convicted drunken drivers were excessive drinkers or/and had alcohol-related problems. Imprisonment and fines seem to have a limited impact on occurrence of drunken driving. Other strategies are discussed.


[Pain and pain relief in neonates and infants]. We review the development of the anatomical and physiological basis for nociception. We point out the ability of babies, even those who are born very prematurely, to feel pain. Procedures which would be painful to older children and adults are also painful to newborns and infants. A sick infant in intensive care may be particularly sensitive to the destabilizing effects of pain, and analgesics will very often be indicated in such infants. We discuss various types of analgesia suitable for infants, and doses of commonly used analgesics.


[Head injuries with delayed intracranial hemorrhage]. Nine cases of delayed intracranial haematomas were found among 300 patients with head injuries during a two-year period. Six of the nine patients developed delayed traumatic intracerebral haematoma, two epidural haematoma and one subdural haematoma. Delayed intracerebral haematoma was diagnosed from 12 hours to six days after the trauma. The primary CT showed brain contusion in the majority of the patients. The outcome was poor. One patient died and two were severely disabled. The clinical course was more rapid in the two patients with epidural haematoma than in the others. Marked elevation of intracranial pressure was monitored in both cases prior to the second CT examination. In spite of successful evacuation of the haematoma, one patient died and the other developed physical and mental retardation. In one patient a subdural haematoma was diagnosed three months after the trauma. The patient did well postoperatively.


[Exchange practice visits--a new and good way of training. A method for quality assurance in general medicine]. The Norwegian Association of General Practitioners has adopted a method for postgraduate education in general practice called exchange practice visit. This article presents the method, which is a simplified version of the procedure described in the booklet, What sort of doctor, from The Royal College of General Practitioners in England. We have tested this way of education, and describe our experiences of it. We conclude that an exchange practice visit is an important supplement to the training of general practitioners, and provides a good tool for quality assurance in medicine.


[Aspects of quality assurance and research in general practice]. Research is a prerequisition for setting standards in the field of quality assurance. It is emphasized that scientific work that is intended to have an impact on general practice has to be carried out in general practice. Quality assurance plays a decisive role in recognizing and applying the results of relevant research. The author discusses the significance of typical topics concerning the presentation and prevalence of diseases in general practice. Issues related to quality assurance of scientific studies performed by general practitioners are considered. Intra- and interobserver variation as a problem towards achieving reliable results is described and discussed. The author emphasises the importance of The research council in general practice, as a help in achieving quality assurance.


[Quality assurance in a department of pathology and anatomy]. The author describes a quality assurance programme in a department of anatomic pathology. An internal quality assurance committee consisting of four consultants, two chief technicians and a chief secretary meets monthly to decide what measures should be carried out each month. The main activities have been to review random cases of surgical pathology, frozen sections, diagnostic revisions, turn-around times and single event reports. Problems of diagnosis are discussed at a medical staff meeting before they are put before the committee. The programme has been well received in the department.


[Should ultrasound examination be performed earlier in pregnancy?]. In 1991 33 perinatal deaths occurred at Rogaland hospital. Seven of the babies showed severely retarded growth (< 3 percentile) compared with the delivery date indicated by ultrasound. Five babies showed moderately retarded growth (from 3-10 percentile) and the remaining babies were not definitely growth retarded. For the three groups the delivery date indicated by ultrasound was on average 18, eight and five days later than the date estimated according to the rule of Naegele. A delivery date estimated by ultrasound at 18-19 weeks may cause serious misjudgements in cases of early retardation of growth. Earlier ultrasound examination is recommended for a more reliable estimated date of delivery. The author discusses ultrasound examination which differentiates estimation of delivery date and screening for malformation.


[Curettage in Troms and Finnmark 1980-89. Was it necessary?]. 11,201 dilatations and curettages were performed at four hospitals in the counties of Troms and Finnmark (Northern Norway) during the years 1980-89. The overall rate was 100 per 10,000 women/year. The age distribution and the indications for dilatation and curettage are shown and discussed. Large variations were found during the period, and between the four hospitals. These variations are probably due to differences in the physicians' style of practice. It is concluded that the operation rate is too high, especially in younger women. A further approach to investigations of variations in operation rates is discussed.


[Cooperation between regional and central hospitals--how to achieve the best results?]. The authors reviews a recent governmental analysis of cooperation between third-line university clinics and local and central hospitals. The hospitals are owned by the government (mainly by the counties), and the various Acts and regulation permit the central authorities to make decisions on all aspects of highly specialized medicine. The analysis concludes that a limited number of problems should be solved by decision of the central government, but only those where national concerns are involved. The counties within a health region should cooperate within a Regional Health Policy Board, to create plans for flow of patients through the health care system, specified for each field of medicine. When such plans have been approved by the Regional Health Policy Board, each county should be willing to accept them. In the event of local disagreement, the central government should decide.


[Disseminated fungal infections in neonates--risk factors, treatment and course]. During 10 1/2 months in 1990/91 eight premature babies and one mature baby with an intra-abdominal disease had disseminated Candida albicans infections. The incidence in premature newborns was 9% (8/92 patients). Risk factors such as respirator therapy, the use of broad spectrum antibiotics, supplemental parenteral nutrition and central intravascular catheters were frequently seen. Four patients survived the fungal infection. These included three of five babies treated with amphotericin B 0.5 mg/kg/day. Two patients who received fluconazole 3 mg/kg/day died after three days. In one patient the diagnosis was obtained post-mortem, and one patient with possible fungemia survived without therapy. The treatment of these patients depends on optimal fungal cultures and good co-operation between paediatricians and microbiologists.


[Extirpation of benign renal cysts with laparoscopic technique]. Laparoscopic surgery is rapidly increasing its field of application. We describe the uncomplicated use of peritoneoscopic techniques to remove a benign renal cyst. No previous report of this mini-invasive, patient-friendly and cost-effective method has been found in the literature. It should be considered in the rare cases where surgery is indicated as treatment for this benign condition.


[Quality assurance of cooperation/distribution of work between primary health care and other health services. Using care for diabetics as a basis]. Chronic illnesses account for an increasing share of the work load of the health services, implying that health personnel have to face a number of different complex problems. Many of these concern co-operation between the various professionals and levels of the health services, and distribution of the load of work. How well this co-operation works will have a decisive effect on the quality of the treatment. These problems are discussed using care of diabetes patients as an example. It is important to achieve medical consensus at different levels. The authors suggest ways of establishing co-operation within the medical profession, specifically defining responsibility, ensuring good and frequent communication with patients, and promoting patient participation. The article also describes concrete solutions and includes a check list for quality assessment.


[High quality medical records--high quality medicine]. The medical record is both an indicator of the quality of care, and a means of improving this quality. In addition to being a source of information and a means of communication in the care of patients, the medical record is also becoming a document of increasing legal importance. The content and design of medical records, and how they are kept, should comply with legal requirements. The patients' right to read their own records is well established in Norway. Incomplete records and lack of information will always be held against the doctor in the case of complaints or lawsuits. The medical record provides a good basis for evaluation of care, and a systematic evaluation of medical records, e.g. in groups, is an effective form of medical audit. While the authorities are making an effort to achieve better standardization of medical records, every medical practitioner should do his best to let the everyday use of medical records become an important part of his personal quality assurance.


[Quality assurance of medical education--a prerequisite for good medical practice]. Assured quality of medical education is a prerequisite for high quality medicine. Quality assurance of medical education implies a well-planned assessment of the structure, process and outcome of education based on defined standards and objectives, and draws heavily on a thorough knowledge of how people learn. Learning in medicine shares common features at all levels, from undergraduate to continuing education. Three core elements are the context of learning, availability of information, and opportunities for elaboration (educational counselling, mentorship, interaction with peers) as a basis for linking practice and theory. A quality assurance programme must examine all these factors and suggest remedies when appropriate. The upgrading of educational research in medicine, and valuing and recognition of teaching within the profession, are important factors in promoting continuous improvement of the quality of medical education.


[Violent behavior of patients--is it predictable?]. In previous research on prediction of violent behaviour in patients some of the most important limitations have been lack of precision in defining violent behaviour, unsystematic registration of violence, and the fact that the prediction has been made valid for contexts other than that in which the original assessment was made. Of the neurobiological factors associated with violence, scientists have recently focused upon the serotonergic system in the central nervous system as being important. The authors review the literature on individual predictors of violent behaviour. Strong predictors seem to be previous violent behaviour, a high degree of hostility, suspiciousness and grandiosity, and current alcohol or drug abuse. The article includes suggestions for future research, and concludes with a presentation of guidelines for clinical assessment of risk of violence, with emphasis on recent events and observed behaviour.


[Assessment of habitually violent persons with psychiatric symptoms]. Persons with habitual violent behaviour are categorized according to their motivation, psychiatric illness and/or personality disorder. Assessments of the different types of violence are essential for placement and safe handling of potentially violent persons in acute threatening situations, and for planning treatment.


[Social network, alcohol drinking habits and injuries caused by violence among women and men in the county of Akershus. Results from anonymous questionnaires among persons aged 40-42 years. 1990-91]. All residents aged 40-42 in Akershus county were invited to screening for cardiovascular risk factors in 1990-91 as part of a prevention programme. Of the 13,607 attendants, 8,960 answered an anonymous questionnaire about social network, drinking habits, and injuries due to violence. Compared with data from the Central Bureau of Statistics, our material included a high percentage of persons with a higher education, a high percentage of married persons, and a low percentage of persons living alone. Results in respect of social network and drinking habits roughly agreed with those of other studies. Of the males, 15.7% had been injured at least once as a result of violence, most often assault and robbery. Of the females, the corresponding percentage was 18.1. Here the dominating forms of violence were maltreatment, threats and sexual assault. Females were more often exposed than males to repeated violence and more often suffered persisting problems as a result of maltreatment. Compared with other studies, we found a high prevalence of injuries from violence among females, suggesting underreporting of experiences of violence by females in studies based on personal interview or the hospitals' injury register.


[Supplementary hay reduces fur chewing in rabbits]. We tested the hypothesis that loose grass hay as a supplement to a pelleted diet reduces fur chewing in rabbits. Weanling rabbits (n = 315) were given one of three diets ad libitum: a control, pelleted diet, the pelleted diet containing 20% (wt/wt) hay meal or the pelleted diet plus loose hay. Fur chewing was assessed indirectly by blind scoring of the extent of alopecia in live rabbits and the amount of gastric hair after slaughter. Rabbits given either loose hay or the diet pellets containing hay displayed significantly less alopecia on the back and sides than control rabbits did. Loose hay, but not the pellets containing hay, completely prevented the development of alopecia on the forehead. The provision of loose hay as supplement to the control diet pellets significantly reduced the amount of gastric hair, whereas inclusion of hay meal into the pellets had no effect. It is concluded that supplemental loose hay prevents rabbits from pulling off fur from the forehead of cage mates. This effect of hay might be related to satisfaction of a craving for nibbling.


[Diarrhea in cats].

[Diarrhea in cats]. Diarrhoea is regarded as the characteristic symptom of intestinal disturbances. However, cats with intestinal disturbances can also show other symptoms such as vomiting, increased or decreased appetite and loss of weight. Cats with diarrhoea are usually only referred to the clinic if they have a chronic problem. Acute diarrhoea reacts well to symptomatic treatment, but chronic diarrhoea requires a specific diagnosis for a directed therapy and prognosis. It is essential to examine faeces and blood when evaluating a cat with diarrhoea. In contrast to the situation for dogs, there are no good specific digestion and absorption tests available for cats to evaluate pancreatic and intestinal function. Exocrine pancreatic insufficiency rarely occurs in cats. A preliminary diagnosis of small intestine disorders can be made on the basis of the faeces staining positive for fat, an oral fat absorption test and the response to therapy. The definitive diagnosis must usually await the results of histological examination of intestinal biopsy samples. Cats with acute diarrhoea often recover spontaneously, and symptomatic treatment is only necessary for severe cases. A specific diagnosis is needed for cats with chronic diarrhoea, to enable directed treatment. Corticosteroids are used in the treatment of chronic enteritis because of their immunosuppressive and anti-inflammatory actions. Antibiotics are only indicated for specific bacterial infections (such as Salmonella and Campylobacter), bloody diarrhoea, or rampant bacterial growth. Specially formulated diets play a major role in the treatment of both acute and chronic diarrhoea.


[Professional practice and health status of veterinarians]. By carrying out an inquiry by mail to 925 veterinarians in the Southern Netherlands, there was looked after a relationship between the professional practice of the veterinarian and his health status. The inquiry was completed and returned by 453 veterinarians. The questions about the health status dealt with complaints about: the respiratory tract, the stand and motion apparatus and the hearing. Based on over 75% of the work package the veterinarians were divided into: veterinarians in the large animal practice, veterinarians in the small animal practice and veterinarians with an other job. The results are compared with the results of a comparable inquiry by pig farmers. Veterinarians, who do smoke, have twice as much respiratory complaints than no smoking veterinarians. Veterinarians in the large animal practice have more respiratory complaints, more complaints about elbows and wrists and more deafness. Veterinarians in the small animal practice have more complaints about allergies, and more complaints about the back and the knees and feet.


[Acute mortality in pigs caused by Streptococcus suis type 1]. In early 1991 many young pigs died without clinical signs on a farm in the Province of Utrecht. This article describes the isolation of Streptococcus suis type 1 after postmortem examination of the piglets.


[Taxus baccata poisoning in lambs and meat inspection]. Yew (Taxus baccata) poisoning in lambs: meat control twenty-two poisoned lambs were slaughtered at a special slaughterhouse. Yew intoxication was diagnosed on the basis of the anamnesis and the presence of yew needles in the rumen. Data from the literature concerning the toxicity of yew and some (traditional) uses of yew are reported. The symptoms and post-mortem findings in animals and humans are discussed, together with the poorly effective treatment of yew poisoning and preventative measures. The outcome of the meat inspection is explained on the basis of current and new regulations (Regulations and Guidelines Governing the Inspection of Meat 91/497/EEG). A reliable and recognized method for the detection of taxins is required.


Effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin or 2,2',4,4',5,5'-hexachlorobiphenyl on vitamin K-dependent blood coagulation in female germfree WAG/Rij-rats. Newborn infants are susceptible to bleeding disorders caused by a vitamin K deficiency, so called 'haemorrhagic disease of the newborn' (HDN). These bleedings often occur in infants after medication of the mother with antiepileptics, such as phenobarbital or phenytoin. It has been suggested that an increase in the late type of HDN in exclusively breast-fed infants might be related to the presence of cytochrome P450-inducing polychlorinated biphenyls (PCBs), dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) in human milk. In order to study this possible mechanistic relationship 5-week-old, germfree, female WAG/Rij-rats were exposed to a single oral dose of either 1 microgram 2,3,7,8-tetrachlorodibenzo-p-dioxin/kg body weight (TCDD) or 30 mg 2,2',4,4',5,5'-hexachlorobiphenyl/kg body weight (HxCB), representing cytochrome P-450 1A (3-methylcholanthrene type) and 2B (phenobarbital type) inducers. During the experiment blood coagulation time from each rat was measured. Also, hepatic 7-ethoxy-(EROD) and 7-pentoxyresorufin O-dealkylating (PROD) activities and total cytochrome P450 content were measured. Blood coagulation time (Thrombotest) in the HxCB-treated rats was significantly prolonged and positively correlated to PROD activity and total P450 content. No clear effect of TCDD on coagulation time could be observed under these experimental conditions. These results suggest involvement of P450 2B isoenzymes in vitamin K metabolism.


Acute renal and hepatic toxicity of 2-haloanilines in Fischer 344 rats. Aniline and its halogenated derivatives are widely used as chemical intermediates. The purpose of this study was to determine the hepatotoxic and nephrotoxic potential of the 2-haloanilines. Male Fischer 344 rats (n > or = 4) were injected (i.p.) with 1.0 or 1.25 mmol/kg of: aniline (A), 2-fluoroaniline (2-FA), 2-chloroaniline (2-ClA), 2-bromoaniline (2-BrA), 2-iodoaniline (2-IA) or vehicle (0.9% saline, 2.5 ml/kg). All compounds were injected as hydrochloride salts. Renal and hepatic function was monitored 24 h after treatment. All of the 2-haloanilines induced oliguria, diminished kidney weight, tubular casts and decreased renal cortical slice accumulation of organic anions. Blood urea nitrogen (BUN) levels were increased (P < 0.05) by treatment with 1.0 or 1.25 mmol/kg of 2-FA, 2-ClA or 2-BrA. Hepatic alterations were also observed and characterized by elevated plasma ALT/GPT activity and altered morphology in the centrilobular region. The nephrotoxic and hepatotoxic potentials were similar among the 2-haloanilines but aniline was less toxic than its 2-halo derivatives. These results demonstrated that halogen substitution at the 2-position of aniline increased hepatic and renal toxicity. However, the severity of toxicity was not influenced by the nature of the halogen substituent.


Interaction of cadmium with atrial natriuretic peptide receptors: implications for toxicity. Atrial natriuretic peptide (ANP) is a diuretic and vascular smooth muscle relaxant which plays a pivotal role in cardiovascular regulation. Since cadmium (Cd) produces cardiovascular toxicity and alters ANP levels in atria and hypothalamus, its effect on ANP receptors were studied in rats and in PC12 cells exposed to Cd. Male rats were injected with CdCl2 (0.01, 0.1, 0.5 or 1.0 mg/kg, i.p.) twice a day for 7 days and then maintained for a period of 30 days. On experimental day 37 ANP receptor binding in the adrenal cortex, aorta and kidney cortex was studied by saturation isotherm analysis. In Cd-treated animals a non-dose related decrease in receptor affinity and density was observed in the kidney and aorta with the aortic ANP receptors being the most sensitive. Cellular regulation of the receptor was studied in PC12 cells, a cell line that expresses functional ANP receptors. Incubation of PC12 cells with Cd reduced both the affinity of the receptor for ANP and decreased the number of binding sites on the cell plasma membrane. The ratio of ligand-receptor complex internalized in the cell to ligand bound to the plasma membrane was significantly decreased following Cd pretreatment (500 microM). A significant decrease in the internalization rate of [125I]ANP was observed in cells incubated concurrently with Cd and ligand. In photoaffinity labelling studies with [125I]ANP, binding of ANP to B and C receptors subtypes was decreased following treatment of either intact cells or plasma membranes with Cd. It was concluded that Cd produces significant alterations in the ANP receptor, both in in vitro and in vivo models and it is proposed these effects play a role in the cardiovascular toxicity of this heavy metal.


Effect of cigarette smoking on salivary epidermal growth factor (EGF) and EGF receptor in human buccal mucosa. The mouth acts as a primary target for cigarette smoke which is associated with several oral diseases and cancer. The present study investigated the effect of cigarette smoking on salivary EGF and the buccal EGF receptor. Samples of whole saliva and buccal biopsy were obtained from 15 healthy volunteers (10 smokers and 5 non-smokers). The smokers smoked 20 or more cigarettes/day for more than 5 years. Salivary cotinine (a major metabolite of nicotine) was determined by radioimmunoassay (RIA). The salivary cotinine level was consistent with the self-reported smoking status (smokers, 106-530 ng/ml saliva; non-smokers, < 2 ng/ml saliva). As compared to the non-smokers, the salivary EGF concentration (determined by RIA) was 32% lower in those smokers whose salivary cotinine level was 250 ng/ml or higher (non-smokers, 2.21 +/- 0.16; smokers, 1.57 +/- 0.09 ng/ml saliva; mean +/- S.E.M., P < 0.01). There was no significant difference in 125I-labeled EGF binding to the buccal receptor between the two groups. However, EGF stimulated the autophosphorylation of a 170-kDa protein band in the sample of non-smokers, but not in the smokers. The immunoblot analysis using anti-EGF receptor antibody indicated that the smoking-related deficiency in EGF receptor autophosphorylation was due to the functional alteration of the receptor proteins. In conclusion, cigarette smoking reduces the salivary EGF level and impairs the function of buccal EGF receptor, which may be associated with the pathology of smoking-related oral disease.


Further studies on the hematopoietic damage produced by a single dose of T-2 toxin in mice. Previous studies revealed that a single dose of T-2 toxin produces a strong inhibition of the 59Fe incorporation into circulating erythrocytes in mice. In the present work it is shown that equivalent doses of T-2 toxin (0.30 mg/kg and above) can produce a relative depletion of granulocyte-macrophage colony-forming cells (CFU-GM) in the bone marrow of treated mice. In additional experiments, both the 59Fe uptake into erythrocytes and the bone marrow CFU-GM were measured as a function of dose and time after a single administration of T-2 toxin. It was found that the initial inhibitory effects are reverted between 24 h and 72 h and that in some cases there is even a significant increase over the normal values, indicating that there may be a compensatory activation of the hematopoietic system. The results presented here suggest that extremely small doses of T-2 toxin can produce a significant degree of bone marrow cytotoxicity and therefore even low level dietary contamination may be of concern.


The role of metabolism in carbon tetrachloride-mediated immunosuppression. In vitro studies. In vitro studies were performed to determine the role of metabolic bioactivation in mediating immunosuppression by CCl4. Direct addition of CCl4 to naive spleen cell cultures sensitized with either sheep erythrocytes, DNP-Ficoll or lipopolysaccharide (LPS) resulted in a marked inhibition of the antibody forming cell (AFC) response to all three of the selected antigens at 3.0 mM concentration in culture. However, this inhibition was primarily due to the direct cytotoxic effects of CCl4 on spleen cells following 3-5 days of culture in the presence of the chemical as evidenced by a decrease in cell number and viability and by the absence of selective effects on T-cell dependent humoral responses which is contradictory to the effects observed in vivo. Co-incubation of splenocytes for 1 h with primary hepatocytes, but not with subcellular metabolic activation systems, such as S9 or microsomes, enhanced the immunotoxic effects of CCl4 in vitro. Interestingly, a 3-h co-incubation of spleen cells with metabolically active hepatocytes in primary culture resulted in an even greater potentiation of the immunotoxic effects of CCl4 as determined by the T-cell dependent IgM AFC response. Conversely, under identical conditions, CCl4 did not suppress humoral responses to the polyclonal B-cell activator LPS which is in agreement with the effects produced by in vivo exposure to CCl4. It is important to emphasize that for the metabolic activation studies (i.e. co-incubation with either S9, microsomes or hepatocytes), spleen cells were washed free of CCl4 immediately following the co-incubation period. Control splenocyte cultures (i.e. no metabolic activation system) incubated in the presence of CCl4 alone at 3.0 mM over a 3-h time-period, had no effect on spleen cell function, number or viability. In agreement with our previous findings which indicate that pretreatment of mice with inducers and inhibitors of the mixed function oxygenase system prior to CCl4 administration modulated the immunotoxic effects of CCl4 in vivo, these results lead us to conclude that immunotoxicity by CCl4 requires metabolic activation.


Reduced Leydig cell volume and function in adult rats exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin without a significant effect on spermatogenesis. Exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is known to alter testicular function. However, its effect on the efficiency of spermatogenesis or on Leydig cell volume has not been determined in adult rats. In two replicas, adult male rats received a single intraperitoneal injection of TCDD at a rate of 0, 12.5, 25.0, or 50.0 micrograms/kg body weight. Rats were sacrificed 4 weeks after treatment. The cytosolic Ah receptor in the testis was estimated at 10.3 +/- 1.2 fmol/mg protein in these adult rats. The presence of the Ah receptor at this concentration in the testis reveals that the testis is a possible target organ for TCDD-induced responses. Left testes were homogenized and testicular spermatids were counted by phase contrast cytometry to determine daily sperm production. Right testes were vascularly perfused with glutaraldehyde, embedded in Epon 812, sectioned at 0.5 micron, stained with toluidine blue and evaluated by stereology for germ cells or Leydig cells. Body weight was reduced (P < 0.01) in a dose-dependent fashion. Testicular weight and daily sperm production per testis were not significantly reduced by TCDD. Androgen receptor concentrations in the testis and prostate were not affected. Weights of two androgen-sensitive organs (seminal vesicles and epididymis) were reduced (P < 0.01) in a dose-dependent fashion and serum concentrations of testosterone were reduced in a dose-dependent fashion in Replica 2. Due to low numbers of animals in Replica 1, the reduced Leydig cell volume was not significant after TCDD treatment; however, in Replica 2 there was a dose-dependent reduction (P < 0.01) in volume per testis of Leydig cell cytoplasm, nuclei, or total Leydig cell volume. Production of testosterone was sufficient to maintain spermatogenesis quantitatively; however, TCDD caused a dose-dependent reduction in Leydig cell function and Leydig cell volume per testis. This study showed for the first time that TCDD-induced androgen deficiency of male rats may be explained by the loss of total volume of Leydig cell cytoplasm. This study also further illustrates the reserve capacity of Leydig cell function to maintain spermatogenesis when the volume of these cells is significantly reduced.


Assessment of exposure to parenteral and oral aluminum with and without citrate using a desferrioxamine test in rats. The primary purpose of this study was to determine the relative usefulness of various measures to monitor body aluminum burden in weanling rats fed various amounts of aluminum (0.39 mumol Al/g diet for 29 days, approximately 40 mumol Al/g diet with or without citrate for 29 days and approximately 100 mumol Al/g diet with citrate for 12 or 29 days) or injected intraperitoneally with graded doses of aluminum (0.01, 4.6, 11.8, 23.5 or 94 mumol Al). Twenty-four hours prior to sacrifice, all rats were injected intraperitoneally with either desferrioxamine (75 mg DFO) or buffer. All seven indices of aluminum exposure monitored (i.e. tibia, liver, kidney and serum aluminum concentrations; changes in serum aluminum concentrations in response to DFO; urinary aluminum excretion with and without DFO treatment) were highly (P < 0.001) correlated to parenteral aluminum exposure. Five of these measures (i.e. tibia, liver and serum aluminum concentrations and urinary aluminum excretion with and without DFO treatment) were also highly (P < 0.001) correlated to oral aluminum loads. Changes induced by DFO were very small. Moreover, the 'DFO stimulated' serum and urine aluminum concentrations were not more correlated to the body load of aluminum, as indicated by tibia aluminum concentrations, than baseline values. Comparisons of aluminum exposure in tibias and sera of rats exposed to parenteral and oral aluminum indicated that only 0.01-0.04% of dietary aluminum was absorbed. Ingestion of citrate had small but significant effects on aluminum retention.


Interaction of monocrotophos and its novel thion analogues with microsomal cytochrome P-450: in vivo and in vitro studies in rat. The binding of monocrotophos (MCP) and its two thion analogues (coded as RPR-II and RPR-V) to rat hepatic microsomal cytochrome P-450 (HMC) were investigated in vitro by difference spectroscopy. These three organophosphorus insecticides were found to bind stoichiometrically to HMC with very high affinity (Ks 34-50 microM). RPR-V showed the highest binding affinity followed by RPR-II and MCP. Association of these compounds with HMC occurred within 2 min of addition in the cuvette and therefore, appeared to be tight binding ligands of cytochrome P-450. In vivo studies at equitoxic doses of the three compounds 24 h after oral treatment in rats revealed that they all caused reduction in MC content in liver, lung, kidney and brain, as against induction in cardiac and splenic cytochrome P-450. These in vivo results suggest organ specificity in modulating the microsomal cytochrome P-450 (MC) content of hepatic and extra-hepatic tissues by the three compounds. Apparently, their binding affinity with HMC is strongly correlated with their LD50 value and has a substantial co-relationship with the cytochrome P-450 level in the liver.


Localization and health effects of lanthanum chloride instilled intratracheally into rats. Lanthanum (La) is one of the rare earths used in diverse high technology fields for which sufficient data for assessing its health effects have been lacking. The biological effects and metabolic behaviors of La were studied by instilling lanthanum chloride intratracheally into male Wistar rats. The distribution of La among tissues revealed that the metal remains mostly in the lung with a biological half-time of 244 days. The subcellular localization by transmission electron microscopy with an X-ray microanalyzer indicated that La localizes in macrophages as high electron-dense granular inclusions in lysosomes and on the cell surface and basement membranes of type I pneumocytes among lung cells. The pulmonary health effects were examined by biological indices of the bronchoalveolar lavage fluid (BALF) and lung tissue. The acute toxicity estimated by lactate dehydrogenase activity in BALF was comparable to those of yttrium and copper that had been determined under the same protocol. Microscopic examination of the lung indicated a characteristic increase in the number of eosinophils.


Poly(ADP-ribose)polymerase-activity of chicken embryo cells exposed to nucleotoxic agents. Poly(ADP-ribose)polymerase (PARP)-activity was assessed in vitro from the incorporation of the adenosine-diphosphate-ribose moiety of 14C-NAD+ in the acid-insoluble cell fraction. When compared to mammalian (rat) cells, chicken embryo cells exhibit an almost three- to fourfold higher constitutive PARP-activity and an about two- to threefold lower chromatin compactness as evidenced by viscometry of alkaline cell lysates and nucleoid sedimentation. X-irradiation, bleomycin and H2O2 activated PARP. Hyperthermia (43 degrees C), doxorubicin, ethidium bromide and novobiocin resulted in an inhibition of the enzyme activity. Even at the highest doses used, UV-light, monofunctionally alkylating agents and the bisbenzimide Hoechst 33258 remained without significant effects. It is suggested that, with respect to DNA-and/or chromatin-interactive agents, the chicken embryo PARP-test may be complementary to the results of morphological and biochemical studies.


Reptilian thymus gland: an ultrastructural overview. Like in higher vertebrates, the thymus gland of reptiles consists of lymphoid cells within epithelial framework and characteristic myoid cells. Mammalian-like Hassall's corpuscles are absent. Secretory cells, secretory and degenerative cysts as well as phagocytic cells, and plasma cells can be observed. Interdigitating cells and some characteristic features of thymic innervation and vascular system are also described in the reptilian thymus gland.


Effects of cyclosporin A on mouse thymus: immunochemical and ultrastructural studies. The in vivo effect of cyclosporin A (CsA) on the murine thymus was investigated by studying the ultrastructural cellular alterations, which are described for the first time, and the immunohistochemical modifications of thymocytes and thymic reticulo-epithelial cells (TREC). A marked reduction of the thymus size became apparent after 6 days of CsA treatment (10 mg/kg/day). Light microscopy studies using polyclonal antibodies (Ab) or monoclonal Ab specific to lymphoid sub-populations (anti-CD4, anti-CD5, anti-CD8), and specific to epithelial cells (anti-keratin: AKs, K8), to cortical TREC (TR4) and to subcapsular/medullary TREC (TR5, 3H9) showed that the number of CD4- 8+ or CD4+ 8- medullary thymocytes dramatically decreased and that the cortical TREC are affected, after 10 days of CsA treatment. These observations were confirmed by electron microscopy studies demonstrated that the medullary lymphoid population disappeared almost entirely. TREC, principally cortical type, presented signs of cellular lysis. A few cortical thymocytes showed some damage. At day 8 the medullary thymic tissue was disorganized, but no change was noted in the subcapsular area right up to the final day (day 10) of CsA treatment. These results suggest that CsA has a harmful effect on cortical TREC, which affects the development of immature thymocytes.


Interdigitating cells in the rat thymus during cyclosporin A treatment: ultrastructural observations. Major Histocompatibility Complex (MHC) class II-positive cells are almost completely absent in the rat thymic medulla after cyclosporin A (CsA) exposure. This phenomenon has been related to alterations in the medullary interdigitating cells (IDCs), representing either down-modulation of RT1 class II antigen on persistent IDCs, or actual disappearance of IDCs. To resolve this issue, we performed an ultrastructural study of the rat thymic medulla during CsA treatment (15 mg/kg body weight/day CsA subcutaneously for 7 to 14 days). At day 7 after exposure, only very few IDCs could be identified. They showed an abnormal ultrastructural morphology as judged by inconspicuous membrane interdigitations and lack of Birbeck granules. At day 14, the number of IDCs was larger. At this time, the IDCs had a normal ultrastructure, except for the almost complete absence of Birbeck granules. We conclude that CsA causes an initial depletion of IDCs from the thymic medulla. The ultrastructural morphology of the few IDCs present suggests an immature character. New IDC immigrants appear in the medullary area already during CsA treatment, indicating early recovery.


[Hydrophobic interactions of serine proteases with low molecular weight compounds: partial effector displacement from the activated enzyme by the substrate]. 1,2,3-tris-tri-beta-phenylethylaminopropane (a compound which can simultaneously interact with S1- and S2'-enzyme sites and has complicated grouping in the region analogous to "leaving group" of a substrate) has been studied for the effect on chymotriptic hydrolysis. Anomalously high inhibitory effect of some cumbersome organic compounds is explained on the base of the obtained data.


[Postradiation changes in Ca2+-ATPase and Mg2+-ATPase in thymocyte plasma membranes]. The rats were irradiated in the doses 1, 5, 4, 7 and 10 Gr and on the 1, 8, 15, 22 and 30 day after the irradiation activity of Ca(2+)-ATPase and Mg(2+)-ATPase and peroxidation lipids in the thymocytes was determined. It was found that postradiation changes in activity of Mg(2+)-ATPase were characterized by a higher sensitivity to the processes of lipids peroxidation as compared to Ca(2+)-ATPase.


[Thermoregulatory uncoupling of oxidation and phosphorylation in the chick brain in embryogenesis]. The cooling of hen incubated eggs to 28 degrees C brings to disconnection of oxidative phosphorylation in brain on the 12th day of development. The addition of DNP (5 x 10(-5) M) takes off the cooling effect.


[Effect of brain cytosol proteins of embryonal and adult animals on RNA-polymerase activity of isolated brain nuclei]. Cytosol and its fractions obtained by the precipitation with ammonium sulphate and ion-exchange chromatography have been studied for their effect on the RNA-polymerase activity of isolated nuclei. We observed the discrepancies in the action of total cytosol of embryonal, newborn or adult animals on the label's incorporation in RNA. It was found that some fractions increased DNA-polymerase activity of isolated nuclei in cattle embryonal cytosol. The same fractions obtained from adult cytosol did not act in such a way. It was found that most fractions obtained from cytosol of adult brain inhibited the RNA-polymerase activity of brain nuclei.


[Influence of delta-sleep-inducing peptide on the activity of proteolytic enzymes in the rat brain under hypokinesia]. Single administration of the delta-sleep-inducing peptide (DSIP) in a dose of 12 micrograms/100 g to intact animals makes the activity of neutral proteinases and cathepsin D higher in the rat brain and blood serum. Hypokinesia of different duration changes activity of neutral and acidic proteinases and induces accessibility of cathepsin D to the cytosol as a result of damage in lysosomal membrane. Injection DSIP induces a decrease A/B of cathepsin D to the control level under 1-h hypokinesia condition and normalizes the neutral proteolytic activity under 6-h hypokinesia condition.


[Pyruvate decarboxylase inactivation by interaction with substrate and molecular oxygen]. Pyruvate may promote the yeast pyruvate decarboxylase inactivation when affected by molecular oxygen. In the presence of pyruvate and O2 inactivation of enzyme increases with the initial substrate concentration increasing. pH-dependence of pyruvate decarboxylase inactivation under joint action of substrate and O2 has maximum in the region 6.9-7.5. It is suggested that the influence of pyruvate and molecular oxygen is connected with the coenzyme-substrate complex oxidation in an active site of yeast pyruvate decarboxylase on the steps preceding the release of free acetaldehyde.


[Effect of compounds having hypotensive activity on microviscosity of phospholipids membranes]. Vincapane, apressin, raunatin, reserpine and prazosin have been studied for their effect on the state of microviscosity of phospholipid bilayers from lecithin and cardiolipine. The method of fluorescent probing using pyrene and asymmetrical polymethine dye 4501 u have been used for this study. Character of changes of phospholipid bilayers microviscosity as affected by these compounds depends on their concentration in the solution. Vincapan lowers microviscosity of membranes from lecithin in the interval of the concentrations given. Advantages of fluorescent probing by means of asymmetric polymethine dye in comparison with pyrene were shown.


[Effect of a single and fractionated gamma-irradiation on lipid content in rat blood and tissues]. Contents of lipids, character of blood plasma chemiluminescence and separate classes of lipoproteins as well as the content of the lipids of tissues under single and fractionated gamma-irradiation of rats in a dose of 3 Gr. The development of hyperlipidemia and hypercholesterolemia for four weeks after irradiation which are more expressed under a single irradiation, a decrease of total content of cholesterol and triglycerides in the heart and liver tissues to the end of the experiment 24 hour after irradiation are registered in the both groups of animals.


[Isolation of lectin from horse chestnut (Aesculus hippocastanum L.) seeds and study of its interaction with carbohydrates and glycoproteins]. The lectin from horse chestnut seeds was obtained by affinity chromatography on a sorbent prepared from the egg white, 95 mg of lectin per 1 kg of fresh seeds being obtained. Molecular weight was determined by gel-filtration on tojopearl HW-55 and it composed 132 kDa. SDS-polyacrylamide gel electrophoresis revealed the presence of one component with molecular weight of 33 kDa. One band has been revealed by means of disc-electrophoresis in acidic (pH 4.5) and alkaline system (pH 8.9). Sugar was not detected in the lectin. Amino acid composition of the lectin has been determined. The lectin agglutinated horse erythrocytes in minimal concentration of 9.5 ngml, to the less extent rabbit (4.9 mkg/ml), rat (62 mkg/ml), human (73 mkg/ml), but did not agglutinate erythrocytes of a sheep and cow. Purified lectin did not interact with monosaccharides, but interacted with O-glycans.


[Electrolyte composition of cow and calf tissues in health and in acute digestive disturbances]. Sodium, potassium, calcium, magnesium, manganese, zinc and chloride contents in the blood plasma of calves at parturition have been established to correspond to their levels in blood of cows during their calving period. Iron and inorganic phosphorus contents in calves blood plasma appeared to increase and copper content to be lower in this period as compared to postnatal period. By the third day of postnatal ontogenesis sodium concentration in calves blood decreased, copper level increased and the rest indices of water-salts metabolism in calves and adult animals were alike. Digestion disturbances in the calves were accompanied by changes in levels and magnitude of Na+/K+ ratio, magnesium, iron, copper, manganese and zinc contents in blood, liver and kidneys as well as Ca++/Pi ratio in mitochondria and cytosol of liver and jejunum mucose layer cells in comparison with clinically healthy animals.


[Antioxidant properties of oxy- and metmyoglobin]. Lipid peroxide formation is inhibited by met- and oxymyoglobin. Oxymyoglobin as higher antioxidant activity than metmyoglobin. Oxymyoglobin has higher antioxidants activity in concentration of 800 ng/ml than metmyoglobin by 38.6%.


[Accidental falls in nursing homes. A study of the extent and circumstances of accidental falls in nursing homes]. Accidental falls in 54 nursing homes with 2228 elderly residents aged 65 years and over were registered during a period of seven months. During the seven months, 512 of the elderly residents fell on a total of 934 occasions. Forty-two fractures of the neck of the femur occurred. The risk of falls for elderly residents of nursing homes is very high, but the majority of falls do not result in permanent damage. In this investigation, no differences could be demonstrated between staff groups or circumstances concerning falls with and without resultant damage. All falls should be regarded as warnings and result in detailed investigation of the circumstances of the fall in view of prophylactic measures. Accidental falls are caused by a complex interaction between a series of health, therapy, furnishing and attitudes. Various circumstances are emphasized in this investigation which are connected with an increased risk of falling, e.g. vertigo, problems of balance, certain aids and activities in connection with toileting.


[Change in the structural state of fractionated liver chromatin in E vitamin deficiency]. Structural modification of transcriptionally active and repressed rat liver chromatin fractions at antioxidant insufficiency caused by E-avitaminosis, was shown. This modification consisted in the compactization of the first fraction structure and in the relaxation of the second one. Besides, compactization of the active fraction structure was accompanied with the increase of fluidity of the lipid bilayer. On the whole antioxidant insufficiency caused more expressed structural changes in the active chromatin fraction, this correlated with the intensity of lipid peroxidation reactions in the fractions.


[Comparative characterization of the lipoprotein spectrum and status of free radical processes in the blood of rabbits exposed to external gamma-irradiation and cholesterol administration]. Characteristic of lipoprotein spectrum and state of free-radical processes in the animals under action of ionizing radiation and cholesterin diet are comparatively studied. The content of lipids in the blood serum increases on the 5th day after irradiation and then decreases on the 15th and 30th days. Cholesterin diet increases the content of cholesterin under practically unchanged content of triglycerides in the blood serum in all the terms of investigations. Total decrease of the intensity of induced chemiluminescence of the blood serum and erythrocytes after irradiation is shown. Peroral introduction of cholesterin evokes differently directed changes in the light sum of chemiluminescence--a decrease in erythrocytes and increase in the blood serum.


[Effect of chelators of bivalent metal ions on the reaction of myometrium actomoysin superprecipitation]. Kinetic regularities of the reaction of superprecipitation of myometrium actomyosin, as well as the effect of different concentrations of EGTA, EDTA and diphosphonic acids on this process have been studied. Results obtained are of interest from the viewpoint of possible practical use of diphosphonates as factors modifying interaction of the contractile proteins of the uterus smooth muscles under the pathology of contractile response.


[Changes in the structure and reactions of lipid peroxidation of liver chromatin as affected by 0,0-dimethyl-0,2,2-dichlorovinylphosphate]. Intoxication of rats by 0,0-dimethyl-0-2,2-dichlorovinylphosphate (DDVPh) leads to marked biochemical changes of transcriptionally active (TACh) and repressed (RCh) liver chromatin fractions. These changes are connected with structural relaxation of the fractions, which is manifested by the increase of intensity of protein self-fluorescence. Free radical nature of these changes was supposed, which was proved by the modification of LPO reactions in the both chromatin fractions under the influence of the pesticide concerned.


[Accidental falls in nursing homes. A study on the role of drugs in accidental falls in nursing homes]. The drug consumptions of 2228 residents in nursing homes aged 65 years and over were investigated and related to accidental falls during a period of seven months. 95% of the residents received treatment with one or more drugs and 33% with six or more drugs. The risk of accidental falls was significantly increased in persons receiving hypnotics, psychomarmaca and anti-Parkinson medicine. Individuals receiving diuretics, particularly thiazides, were less at risk for accidental falls. This investigation revealed an increased risk of falls particularly when residents were receiving treatment with a short-term hypnotic (Triazolam). It is recommended that this finding should be investigated further.


[Physical causes of accidental falls among the elderly in their own homes]. Accidental falls in elderly persons involve considerable illness and great hospital costs. During the period 1971-1986, the incidence has risen from 14 to 19 per 1000 annually. Four hundred and seventy-three individuals aged 60 years or more who had fallen in their own homes and who sought help in Odense Hospital after the accident were interviewed consecutively. The replies to these interviews described the circumstances involved in the fall together with the health and social conditions. Women constituted 78% of the material with preponderance of people living alone as compared with the background population. Just under half of the patients had had a previous fall. Fractures were sustained in 40% of the cases. In 51% of the cases, a definite or probable external circumstance was the cause of the fall. In 150 out of 237 accidental falls, caused by external circumstances, the accident was considered to have been preventable by means of eg more accessible lighting, non-slip carpeting, removal of doorsteps, more suitable arrangement of furniture and better supportive measures beside stairs. The risk of falling is found to increase markedly in persons aged 75 years or more. Prophylactic measures are recommended before patients reach this age by means of information to elderly persons and to persons involved in home care about situations involving risks.


[Effect of hyperglycemia and hyperthermia on liver mitochondrial respiration and blood glucose content of rats during postnatal ontogenesis]. Correlation between glucose level in blood and liver mitochondrial energetics of 1, 10, 20-days rats under hyperglycemia and high environmental temperature (38 degrees C) has been studied. Glucose feeding led to a significant increase of glucose content in blood, this increase being less at hyperthermia. Glucose feeding strengthened the oxidation of such intermediates as succinate (Krebs cycle), pyruvate and malate (hydrocarbonates) and caprylate (lipid). High environmental temperature with hyperglycemia suppresses the liver mitochondria breathing, hydrocarbon and lipid intermediates being used; the suppression is less in the presence of succinate. It is found that liver mitochondria of growing rats at different experimental conditions oxidize different intermediates with various rates. These data can be explained in the light of ontogenetic evolution of the energetic apparatus. It is supposed that exogenic glucose is the factor which activates growing processes of animals and to certain extent diminishes the negative influence of hyperthermia on the organism.


[Humoral factors of transplantation immunity in carp]. The levels of isohemagglutinins, isohemolysins, heterohemagglutinins and lysozyme in blood serum of one and half year old carps have been fixed after scales transplantation. Since three weeks after grafting isohemagglutinins and isohemolysins were revealed in recipient fishes with the prevalence of 25% and 95% respectively. Intact carps from the same group were lack of these antibodies. Recipient and intact fishes did not differ reliably by heterohemagglutinins and lysozyme level in the blood serum. There was no correlation between destroyed allografts share and hemolysins titre of serum, so the double role of humoral antibodies in grafting immunity in carps can be assumed.


[Transfusion-associated graft-vs-host disease]. Transfusion-associated graft-versus-host disease (TA-GVHD) is a serious, often fatal complication to the transfusion of blood components. TA-GVHD is caused primarily by donor T lymphocytes reacting towards recipient MHC antigens. The diagnosis TA-GVHD should be considered when patients, within a month of receiving blood transfusion, develop sudden, unexpected high fever and erythematous rash, possibly accompanied by gastrointestinal symptoms and/or pancytopenia. Congenital (cellular) immune defect, intrauterine transfusion, bone marrow transplantation, Hodgkin's disease, and directed transfusions (especially from first degree relatives) all carry high risk of developing TA-GVHD. Since mortality exceeds 90% irrespective of any treatment, prevention is essential. Pretransfusion gamma-irradiation of blood components with a 25 Gy dose effectively prevents TA-GVHD, and it is therefore recommended that all blood components be irradiated prior to transfusion to patients belonging to defined groups-at-risk.


[Can the carpal tunnel syndrome be work-related?]. The carpal tunnel syndrome is the most commonly reported nerve entrapment syndrome. While a number of medical risk factors are wellknown, accounting for approximately 25% af the cases, the significance of repetitive occupational hand strain has been disputed during several decades. Recently, a number of controlled epidemiological studies concerning this issue have emerged. A critical review arrives at the conclusion that jobs requiring highly repetitive and forceful sustained hand activity are associated with an increased risk for the carpal tunnel syndrome. The risk is, in particular, high when both risk factors are involved concomitantly. Exposure to hand-arm vibration also increases the risk, but it is undecided whether vibration per se or the associated ergonomic strain is the causal factor. It is argued that the evidence is sufficient to justify worker compensation and action should be taken to prevent this work-related disorder.


[Kleine-Levin syndrome].

[Kleine-Levin syndrome]. The Kleine-Levin syndrome is a rare and probably underdiagnosed syndrome. It is characterized by periodic attacks of the triad: hypersomnia, vegative disturbances such as hyperphagia and hypersexuality, psychopathological changes in the level of consciousness and control of emotions. Boys and young men in the age group 10-20 years are most commonly affected. Spontaneous remission with a tendency to remission is observed and the disease "burns out" after a prolonged period of years. The etiology and pathogenesis are unknown. Theories have been propounded suggesting dysfunction of the hypothalamus. No pathognomonic findings have been observed in the early phase of sleep during the daylight hours. Central stimulating drugs have been reported to have some effect on the hypersomnia. The diagnosis is based on the clinical picture. Frequently, a long period can elapse before the diagnosis is established and some cases are never diagnosed. The literature is reviewed and is illustrated by two case reports.


[Transfusion-associated graft-vs-host disease in a patient with Hodgkin's disease]. Transfusion-associated graft-versus-host disease (TA-GVHD) is a serious complication of blood transfusion which is caused by immunocompetent donor lymphocytes reacting against recipient antigens. We report a case of TA-GVHD in a male patient with Hodgkin's disease who had received several units of non-irradiated blood components. TA-GVHD was diagnosed by histological examination of affected skin and demonstration of engrafted lymphocytes of female phenotype by in situ hybridization using a Y-chromosome specific probe. The need to irradiate blood components given to patients in defined risk-groups is stressed.


[Juvenile renovascular hypertension of unusual origin]. The case history of a girl aged 10 years with renovascular hypertension is presented. The symptoms were atypical. The diagnosis was made on basis of positive captopril renography. Angiography showed delayed filling of the right main renal artery by a long collateral vessel. The right renal artery was found to be occluded proximally by intimal hyperplasia. Renal angioplasty was performed and resulted in normalized blood pressure and normalized right kidney function.


[Temporal arteritis without histological changes]. A patient with severe giant cell arteritis with involvement of both eyes is presented. The symptoms were partly reversible by treatment with high doses of prednison. Three months previously (having symptoms of polymyalgia rheumatica) she had started treatment with a low dosage of prednison. Biopsies of both temporal arteries showed no signs of giant cell arteritis at that time, and the results of eye examinations were normal. The importance of follow-up on patients with symptoms of polymyalgia rheumatica, even if biopsies of the temporal arteries show no histological changes, is emphasised.


[Treatment of injuries in the county of Ringkøbing. 1. Incidence of injuries during a period of 4 weeks]. During a period of four weeks (17 September-14 October 1990) all treatments of injured persons in the five hospitals in the County of Ringkøbing were registered. In addition, the refund accounts for all additional services connected with injuries submitted by the 166 general practitioners to the Danish National Health Insurance were also registered. A total incidence rate (calculated on an annual basis) of injuries requiring treatment was found to be 229/1000 og the population per annum. As compared with a similar investigation carried out in 1969, increases in incidence rates of 2.1 for admissions, 3.8 for outpatient hospital treatments and 4.4 for treatment of injuries in general practice were found. An increase in the number of minor injuries is thus concerned, probably partly conditioned by an altered threshold for seeking treatment and partly a slighter increase in the number of more serious injuries. In addition, a significant difference in the frequency of injuries requiring treatment with more numerous treatments was found in the regions of Lemvig and Ringkøbing as compared with the remainder of the county. It is recommended that registration from casualty departments with collection of data for analysis of accidents be undertaken with the object of elucidating the background for the increase in the injuries and the differences between the individual regions in the county.


[Treatment of injuries in the county of Ringkøbing. 2. Function of the closed casualty department]. The closed casualty department function in the County of Ringkøbing was investigated during a period of four weeks. It was demonstrated that this functioned according to plan as the distribution general practice/casualty department was 3.4:1 and 70% of the patients in the casualty department were referred via general practice. The result of this was that the majority of minor injuries (removal of foreign bodies and treatment of wounds) were treated in general practice. In the casualty departments, there were fewer minor injuries and injuries which did not require specific treatment than are the case in open casualty departments. However, a definite diurnal variation was observed in the function of the closed casualty department as patients showed a greater tendency to seek treatment in the casualty department after working hours than during working hours and the general practitioners referred twice as many patients after working hours for continued treatment in the casualty departments. It is concluded that the closed casualty department system in the County of Ringkøbing functions well but that problems may be anticipated with the function if the duty-rosters for the general practitioners are altered so that the distances between general practitioners on duty increase and these have an increased work-load.


[Treatment of injuries in the county of Ringkøbing. 3. Attitude and behavior of the population and general practitioners in relation to treatment of injuries]. This investigation describes the attitudes and behaviour of the population and the general practitioners in the County of Ringkøbing concerning treatment of injuries and the closed casualty department. The investigation consists of three parts. 1. In order to describe the general practitioners in the County of Ringkøbing as those who treat injuries, a questionnaire was sent to these and 88.0% replied. In general, the general practitioners had relatively great experience of work in casualty departments from their hospital appointments. Only eight (5.6%) had experience for less than six months. Practically all (93.2%) had assistance during the day but, during on-call periods, only 16.4% had assistance from doctors. Only 2.1% had access to radiographic examination in their practices. The general practitioners stated that they were able to complete treatment in 82.5% (95-50) of the patients without referral to hospital. Lack of facilities and expertise were the commonest reasons for referral to hospital. 70% considered treatment of injuries as interesting or very interesting. Only 1.4% found it boring. 2. In order to describe self referral to hospital in cases of slight injury by the population of the County of Ringkøbing a questionnaire was sent to 600 of the population aged over 17 years chosen at random. 71.6% replied. 70% stated that they would contact their general practitioner or doctor-on-call in cases of wounds and suspected fracture. The individuals who would contact the casualty department, particularly in the case of wounds, were persons who lived close to the casualty department and who did not have any advantage in contacting their own general practitioner where distance was concerned.(ABSTRACT TRUNCATED AT 250 WORDS)


[Treatment of injuries in the county of Ringkøbing. 4. Referral and transport of severe traffic accident traumas]. In Denmark, all cases of severe injuries are referred to the nearest hospital regardless of the size of the hospital and the county boundaries. In order to investigate whether this type of referral functions according to plan, the authors investigated referral of all traffic accidents in the County of Ringkøbing during the period 1 January 1983 to 31 December 1990. It was demonstrated that in only one out of 310 traffic accidents with fatal outcome, referral did not function according to plan and that the patient had been transported to a hospital which was not the nearest. It is thus concluded that referral now functions according to plan in its present form. In addition, the authors investigated whether there was any basis for establishing prehospital treatment of injuries in the country. It was found, however, that during a period of eight years (analysed on the basis of post mortem data) a maximum of 20 relevant patients would be involved annually and in whom the mortality might be reduced was concerned. Simultaneously, the average distance for transport to the nearest hospital was found to be only 12.9 km. There is thus no basis for employing massive resources for advanced prehospital service in the County of Ringkøbing. With an ambulance service staffed by doctors from the anaesthetic and intensive care units of the central hospitals it is possible to provide prehospital treatment in 70% of all severe traffic injuries in the County of Ringkøbing.


[Genital Chlamydia trachomatis infection in abortion seekers. Strategy of examination and treatment in order to reduce the sequelae of the infection]. Among women applying for termination of pregnancy, 5-17% are infected with Chlamydia trachomatis. The prevalence is higher among women under 20 years of age (12-30%), in nulliparae and when Neisseria gonorrhoeae are found simultaneously. If women applying for termination of pregnancy with Chlamydia infection are not treated, 10-60% will develop pelvic infection after abortion. Salpingitis caused by Chlamydia runs a milder clinical course than salpingitis caused by gonococci or other etiology but salpingitis due to Chlamydia is regarded as one of the most important causes of tubal infertility and extrauterine pregnancy. The symptoms may be discharge and dysuria or objective findings such as cervicitis and pathological findings in wet smears of the cervical secretion. The majority of women applying for termination of pregnancy with Chlamydia infection have no symptoms. Only few investigations have analysed Chlamydia infection in connection with sexual behaviour and association between Chlamydia infection and the number of sexual partners has been demonstrated. Direct immune fluorescent microscopic examination or enzyme immune examination of material from the cervix and urethra may be employed in women applying for termination of pregnancy on account of the rapid results. Tetracyclines and erythromycin may be employed for treatment of demonstrated Chlamydia infection. Completion of treatment prior to abortion is probably not necessary. The sexual partners should be treated.


[Presence of genital Chlamydia trachomatis in abortion seekers--correlates with young age and nulliparity but not with previous genital infection]. Out of 432 women applying for termination of pregnancy, 7.9% (34/428) had cervical Chlamydia trachomatis and 0.7% (3/431) genital Neisseria gonorrhoeae. The prevalence of Chlamydia was 19.2% among the women applying for termination who were under 20 years and 12.8% among those aged 21-25 years. The finding of Chlamydia among nulliparae was 14.5%. Only 2.8% of the women with Chlamydia had previously had pelvic infections. Women with Chlamydia did not have significantly greater frequency of previous venereal diseases. It is concluded that women under the age of 25 years and nulliparae who apply for termination of pregnancy should be examined for Chlamydia and should be treated in connection with the intervention. Previous pelvic infections are observed significantly more rarely in women with Chlamydia applying for termination and thus do not constitute an indication for examination for Chlamydia. It is not yet elucidated whether women with previous venereal diseases should be examined for Chlamydia. On account of the low prevalence, there are no indications for performing routine smears in women applying for termination of pregnancy for gonococci but, on the other hand it appears relevant to examine women with Chlamydia for gonococci as double infections are frequently present.


[Preventive antibiotics in induced first-trimester abortion]. The frequency of infection following induced first-trimester abortion is 3-5%. Duration of hospitalization is often five days, and the total costs per abortion were 5,400 Dkr (approximately pounds 500) in Denmark in 1979. Sequelae of postabortal infection are similar to and occur with the same frequency as sequelae to "spontaneous" pelvic inflammatory disease. Thus, secondary infertility was found in 10% of women with postabortal infection, spontaneous abortion in 22%, dyspareunia in 20%, and chronic pelvic pain in 14%. The risk of ectopic pregnancy is probably also increased. Surgical scrub cannot sterilize the endocervix and, as a consequence, abortion is performed in a contaminated field. The presence of pathogenic bacteria, i.e. Chlamydia trachomatis, therefore increases the risk of postoperative infection. The organism is found in approximately 7% of those applying for abortion and the risk of sustaining infection is 20%. Other risk factors are previous pelvic inflammatory disease, vaginal infection, first pregnancy and young age. Prophylactic antibiotics halve the incidence of infection, but by applying prophylaxis to risk groups only, the amount of prescriptions can be reduced. Prophylaxis need only be administered peroperatively, and tetracyclines, metronidazol, and penicillin/pivampicillin have been found to be effective. Women applying for abortion should be examined for C. trachomatis and positive cases treated no later than at the time of the abortion.


[Thrombocyte aggregation and serum thromboxane B2 in patients with unstable angina pectoris treated with diltiazem or verapamil]. Patients with unstable angina pectoris have increased thrombocyte aggregation and disturbances in serum prostaglandin balance. As a pilot project, we conducted a single-blind investigation of 24 patients with unstable angina pectoris treated with dilthiazem (n = 12, 240-360 mg) or verapamil (n = 12, 240-360 mg) for ten days. At the commencement of the investigation, both patient groups had hyperaggregating thrombocytes and increased serum-thromboxan-B2 (TXB2) as compared to healthy individuals (p < 0.01). In the patient group treated with dilthiazem, the aggregation threshold rose (p < 0.01), and the serum TXB2 values fell to approximately normal (p < 0.05). In the patient group treated with verapamil, no significant changes were observed in the measurements registered. The difference between the two groups remained significant during the entire therapeutic period (p < 0.01). Thus, dilthiazem appears to counteract thrombocyte aggregation in patients with unstable angina pectoris.


[Unconsciousness after ingestion of nail varnish]. Two males in their twenties lost consciousness after ingestion of 50 ml gamma-butyrolactone. Bradycardia was observed and treated during the first hours and they recovered after a few hours.


[Reversible pulmonary hypertension in a woman with connective tissue disease]. The present case report describes a woman with known MCTD, who developed acute pulmonary hypertension. She was treated with methylprednisolone and had fully recovered after five days.


[Use of psychopharmaceuticals in municipal nursing homes. A nationwide survey]. In 32 nursing homes selected at random in the 16 counties in Denmark, the use of psychotropic medication was studied in all residents aged over 65 years (1454 persons) by interview of nursing staff and review of treatment records regarding drug group, dose, duration of treatment and target symptoms. Psychotropic prescriptions were recorded in 56% of the elderly. The frequency of residents receiving daily treatment with neuroleptics was 20% and for anxiolytics, hypnotics and antidepressants 13%, 33% and 11%, respectively. The duration of treatment was two to three years. The indications were mostly unspecified behavioural disturbances. The use reflects the high psychiatric morbidity in nursing home residents, especially regarding dementia. From what is known of therapeutic efficacy and side-effects, it is concluded that the prescription rate is too high, duration of treatment much longer than necessary and that drugs inappropriate for elderly are often used.


[Audit--a method for quality assessment in health care]. If the intentions of genuine assessment of quality and ensuring quality are to be realised in the Danish health service, it is essential that the methods employed are known and accessible. This review presents audit which is a concrete method of assessing quality. In an audit, concrete clinical cases are assessed in order to evaluate the quality of the services rendered by the health service in this instance. Assessment of quality is performed on the basis of criteria and standards for the services rendered. The conclusions end in assessment of whether the services was satisfactory or not. In connection with the unsatisfactory services, the reasons leading to this conclusion are specified. The object of an audit is to assess, ensure and raise the quality of the professional standard. By means of assessing concrete case histories the object is to identify problems of quality which could be influenced by adjustment or alteration of the practice with the object of improving the quality of the diagnosis, treatment and care. Assessment of quality in an audit should thus be carried out as a link in ensuring quality. This implies that the reasons for possible defects in quality should be elucidated. Reports should be given to the health staff involved and measures to improve quality should be worked out and instituted. After a suitable interval, the quality of the service concerned should be assessed again. International experience with audit is extensive. In a series of countries, audit is an integral part of systematic assessment of quality.(ABSTRACT TRUNCATED AT 250 WORDS)


[The post-thrombotic syndrome. A review]. The post-thrombotic syndrome which is caused by deep venous thrombosis and characterized by pain, oedema, pigmentation, eczema, lipodermatosis, varices and ulceration, is due to deficient function of the venous valves and/or obstruction of the deep veins with venous hypertension. The diagnosis may be established by investigation of the investigation of the muscular-venous pump by pletysmography or dynamic phlebography and invasive measurement of the venous pressure is not employed to any great extent. The results of valvuloplasty have, by and large, been negative. The main form of treatment is, therefore, conservative compressive bandaging which can reduce the symptoms, facilitate healing of venous ulcers and prevent recurrence of ulcers. It is emphasized, however, that this treatment must be continued consequently during the remainder of the patient's life, regardless of other treatment.


[The post-thrombotic syndrome. Description and comparison of diagnostic methods: clinical examination, venous return time, phlebography and ultrasonography]. Thirty-one patients with deep vein thrombosis (DVT) confirmed by phlebography 5-11 years previously were examined for the post-thrombotic syndrome (PTS). Where all of the patients were concerned, the examination included crossing-off of their symptoms of PTS on a special chart and clinical examination carried out by four doctors independently of one another, for 29 patients also determination of the venous return time by strain gauge pletysmography and for 29 patients also secondary phlebography (SF) and B-method ultrasonic scanning (UL). The degree of severity of PTS was determined by means of a scoring value which was calculated on the bases of four observers assessment of the clinical symptoms and findings. Significant differences were found for the clinical scores for legs with and without previous DVT, which shows that the method is of value despite a not inconsiderable interobserver variation. In the form employed here, pletysmography was found unsuitable for quantitating of PTS. In 60% of the patients, agreement was present between the clinical assessment, SF and UL. The necessity of agreement both as regards the diagnostic clinical criteria and as a measure for the degree of severity of PTS is emphasized. UL is recommended as a screening investigation for changes after DVT. Phlebography is only considered to be indicated in cases where detailed knowledge of the anatomical conditions is desired e.g. prior to venous surgery.


[Left-side colonic ileus treated with peroperative lavage and primary anastomosis]. Eight patients aged 56-85 years were operated on as emergencies because of left sided mechanical colonic obstruction. The whole colon was mobilized, a Foley-catheter introduced into coecum preferably through the appendicular stump or alternatively a terminal ileotomy and a scavenger tube was introduced into the left colon proximal to the obstruction. By antegrade lavage with isotonic sodium chloride assisted manually colon was emptied, the pathological process resected and a primary anastomosis performed. No cases of anastomotic leakage or infectious complications occurred. One patient had to be operated on again because of a small wound dehiscence. The mean hospital stay was 13 days. The advantages of the treatment are that the patient is managed at the emergency operation, the frequency of complications is low and hospital stay short. It is therefore a good alternative to procedures involving temporary colostomy.


[Effect of 1-year long-term treatment with sucralfate on symptomatic recurrence of duodenal ulcer]. One hundred and two patients, who obtained relief from their duodenal ulcer symptoms with sucralfate (Antepsin R) in a dosage of 2 g b.i.d. for four weeks, were randomized to maintenance therapy with sucralfate 2 g at bedtime or a placebo for one year or until possible recurrence of symptoms. Ninety-four patients completed the study, 46 on sucralfate and 48 on the placebo. Eighteen of the sucralfate-treated patients (39%) experienced relapse of symptoms, as did 36 (75%) of the placebo treated patients. This difference was significant (p = 0.0008). In the sucralfate group most of the symptoms recurred within three months after randomisation, whereas the relapse rate seemed constant in the placebo group. It is concluded that 2 g sucralfate at bedtime is effective in preventing recurrence of duodenal ulcer symptoms.


[Evaluation of trainee assistant education]. All of the trainee assistant appointments in general practice in Denmark were assessed by means of a questionnaire investigation during a period of two years. Particular attention was paid to the quality of training and whether there were particular characteristics in the practice which provide the best training. The material consists of 360 questionnaires sent to trainee assistants in general practice one month before conclusion of the appointment. The percentage of replies was 89. The average number of years after graduation was 6.5, which is considerably higher than aimed at in future plans. The investigation reveals that the educational quality and training by the tutor did not appear to be influenced by the number of postgraduate years although there was no doubt that younger trainees required more training and supervision. The quality of training is best in one-man practices and this is followed closely by small partnerships. The investigation reveals that training by the tutor is of decisive significance. It is therefore recommended that trainees in general practice should be more closely associated with one of the practitioners responsible for training. Three fourths of the trainees found that trainee assistant appointment was better than hospital appointments in general. The investigation indicates that following should be standard in every practice: 1) own consultation room, 2) typed records, 3) an introductory leaflet and that training should be arranged with: 1) introduction, 2) half-way assessments, 3) daily conferences about individual patients and 4) weekly conferences about particular subjects related to the practice.


[Overlooked posterior shoulder dislocation]. Posterior dislocation of the shoulder is frequently overlooked. Early diagnosis is a prerequisite for successful treatment. Supplementary axillary or apical oblique projections should be included in the routine radiograms to confirm the diagnosis.


[The hairdresser's syndrome, observatio pro]. Six hairdressers with minor brain damage are presented. The etiology is discussed and the need for a study of the possible injurious factors in hairdressing-salons is stressed.


[The synonymous preparation Andion vs. the original preparation becotide in the treatment of steroid-dependent bronchial asthma. A comparative double-blind cross-over trial]. Two different beclomethasone dipropionate inhalation aerosols (Andion and Becotide) were compared in a double-blind, cross-over study in patients with stable, steroid-dependent asthma. Fifty-two patients were included in the study, and 44 completed the two 6-week periods of treatment. The difference in therapeutic efficacy on FEV1 between Andion and Becotide was -0.018 1, and likewise no differences in therapeutic efficacy on FVC and peak expiratory flow were found. There were no significant differences between the two treatment periods regarding peak expiratory flow rates, symptoms, frequency of adverse effects, and amount of salbutamol and beclomethasone dipropionate employed. In conclusion, no significant differences could be demonstrated between Andion and Becotide with regard to pulmonary function, symptoms, and frequency of adverse effects in the treatment of patients with steroid-dependent bronchial asthma.


[Oophorectomy per occasionem and ovarian cancer]. The mortality from ovarian cancer is responsible for 450-500 cancer deaths annually in Denmark. This high mortality rate has remained unchanged for decades. No effective screening method is available. Oophorectomy per occasionem may reduce the incidence of ovarian cancer. The literature suggests a reduction in the incidence of ovarian cancer of 5.7% which corresponds to approximately 30 women annually in Denmark when OPO is performed at the age of forty or later. OPO also avoids reoperation due to the Residual Ovarian Syndrome, which is detected in approximately 2% of women after pelvic surgery.


[Cardiovascular changes in arterial hypertension]. In untreated essential hypertension cardiovascular structural changes will develop after some time. In arteries and arterioles, thickening and reduced compliance of the vascular wall is noted and in the left ventricle, myocardial hypertrophy. Both types of changes will enhance the risk of ischemia and of developing cardiac complications, i.e. coronary heart disease, myocardial infarction and heart failure. Methods for measurement of vascular and cardiac hypertrophy are reviewed and the value of echo-cardiographic evaluation of the hypertensive patient is stressed.


[Regression of hypertensive cardiovascular changes during treatment with antihypertensive ddrugs]. Antihypertensive medical treatment may induce regression of hypertensive structural cardiovascular changes after a period of time: Hypertrophy of the left ventricle and of the smooth muscle layer in the resistance vessels. In this paper, we refer to significant human studies, published during the last decade, concerning the degree of regression of these presumably secondary structural changes, resulting from antihypertensive treatment. It has been shown that most antihypertensive regimens in common use, calcium antagonists, ACE inhibitors and most beta blockers, but not diuretics and nonspecific vasodilators, are, when effective in lowering blood pressure, also capable of inducing a probably complete regression of the cardiac hypertrophy. However, complete regression of the vascular changes has not been shown.


[Intrauterine hematoma in threatened abortion]. In order to demonstrate the consequences of intrauterine haematoma demonstrated by ultrasound in hospitalised patients with imminent abortion, the course of pregnancy and delivery in patients with demonstrated intrauterine haematoma and patients in whom intrauterine haematoma could not be demonstrated were compared retrospectively. Intrauterine haematoma was demonstrated in 29% of patients with immiment abortion in The Department of Gynaecology and Obstetrics in Herlev Hospital. Patients with intrauterine haematoma were hospitalised more frequently and for more prolonged periods for imminent abortion and for imminent premature delivery. On the other hand, no differences were found in the frequencies of abortion, the birth weights, gestational age on delivery, number of preterm deliveries, frequencies of Caesarean section and adherent placenta between the two groups. Therapeutic bias may have been the cause of the increased number of days of hospitalisation in patients with intrauterine haematoma demonstrated by ultrasound.