Association of polymorphism of methylene-tetrahydro-folate-reductase with urinary albumin excretion rate in type 1 diabetes mellitus but not with preeclampsia, retinopathy, and preterm delivery.

AIM: The genetic setting is a potential risk factor for dysfunction of vascular endothelial cells. The prevalence of polymorphism in the methylene-tetrahydro-folate-reductase (MTHFR) gene (677C-->T) was evaluated in diabetic pregnancy complicated by preeclampsia, nephropathy, retinopathy, and preterm delivery. The role of hyperhomocysteinemia in microangiopathy in diabetes mellitus has been debated and is mainly seen with reduced activity of the MTHFR gene. A polymorphism in the gene for MTHFR is identified causing this phenomenon. DESIGN: Two hundred and sixty-eight pregnant women with type 1 diabetes mellitus were recruited. Two hundred and thirty-three women were successfully analyzed for MTHFR gene polymorphism 677C-->T and compared to the incidence of the polymorphism in the background population (n=1084). The pregnancy data charts were reviewed retrospectively. RESULTS: The frequency of the MTHFR polymorphism in the background population was 29% and the heterozygozity 42%. The women with type 1 diabetes mellitus had a higher frequency of the MTHFR polymorphism with 52% heterozygotes and 9% homozygotes than had the background population (heterozygotes, background vs. type 1 diabetes mellitus: chi(2)=14, df=1, p<0.0002). The odds ratio for heterozygozity of the MTHFR polymorphism was 1.8 (95% Cl: 1.3-2.4) in women with type 1 diabetes mellitus. Women with either micro- or macroalbuminuria had a higher frequency of MTHFR polymorphism with 61% heterozygotes and 3% homozygotes than had the background population (heterozygotes: chi(2)=8.9, df=1, p<0.01). The odds ratio for heterozygozity of the MTHFR polymorphism was 2.3 (95% CI: 1.4-4) in women with type 1 diabetes mellitus. CONCLUSION: An association was demonstrated between the MTHFR polymorphism and type 1 diabetes mellitus as well as increasing albumin excretion rate in pregnant women.

A Nordic survey of patient doses in diagnostic radiology.

The aim of this study was to test the applicability of the guidance levels for patient doses cooperatively set by the radiation protection authorities in the five Nordic countries. The kerma-area product (KAP) for five conventional radiological examination types was obtained from several hospitals in each of the Nordic countries. The number of radiographic images and fluoroscopy time were also registered, and the mean values for each examination type and hospital were established based on a representative number of patients (40-100 kg). The results indicate that the situation is very similar in the five Nordic countries, even though some differences were identified. Most of the hospitals demonstrated lower doses than the proposed guidance levels for chest, probably explained by use of faster film/screen combinations during the past decade. An increased use of fluoroscopy for positioning was observed for radiographic examinations of lumbar spine and urography. Large variations in patient doses were found for barium enema depending on the use of fluorospot or 100-mm camera vs full-format film, the range in fluoroscopy times, dose rate, and field size. The guidance levels for lumbar spine (10 Gy x cm2), pelvis (4 Gy x cm2), urography (20 Gy x cm2), and barium enema (50 Gy x cm2) seem to reflect the present quality of X-ray equipment and examination techniques in the Nordic countries. The guidance levels for chest (1 Gy x cm2) should be lowered to 0.6 Gy x cm2.

Pregnancies complicated by diabetic proliferative retinopathy.

BACKGROUND: To examine retinal and pregnancy outcome in insulin-dependent diabetic women with proliferative retinopathy and assess the effect of albuminuria on morbidity. METHODS: The records of 26 women with known proliferative retinopathy before pregnancy were studied retrospectively in the prepregnancy period, during pregnancy, and after delivery. Perinatal and maternal morbidity was studied using ophthalmic, obstetric and pediatric records. RESULTS: Seven pregnancies were delivered preterm (27%). Serious neonatal morbidity occurred in five pregnancies (19%). Perinatal survival was 88%. Laser treatment was given prior to pregnancy to 54%, during pregnancy to 27% and after delivery to 31% of the women. Laser treatment during pregnancy was more common in those with no prior photocoagulation and in White class F/R. Low birthweight was more frequently associated with nephropathy and proliferative retinopathy compared to retinopathy alone (p<0.05). Recent hemorrhage, maculopathy or glaucoma was found in 14 (54%) of the women. Blindness developed unilaterally in two women. CONCLUSIONS: Perinatal morbidity was associated with nephropathy rather than retinopathy. The incidence of hemorrhage, maculopathy or glaucoma was similar in White classes R and F/R.

[Changes in glucose metabolism in gestational diabetes mellitus during and after pregnancy]. / Forandringer i glukosestofskiftet ved gestationel diabetes mellitus under og efter graviditet.

Twenty-nine pregnant women with gestational diabetes mellitus (GDM) diagnosed before the 34th gestational week had three intravenous glucose tolerance tests (IVGTT) performed during pregnancy and a follow-up with OGTT post partum. The women with a normal OGTT post partum had a significant decrease in fasting serum glucose from the 33rd to the 38th week in pregnancy (4.8-->4.0 mmol/l, p < 0.05). However, the women with a diabetic/borderline OGTT showed no decrease in fasting serum glucose during the same period (5.1-->5.0 mmol/l). The K-value (the diminution rate of blood glucose) of the IVGTT in week 38 was significantly lower in women with puerperal diabetic/borderline OGTT compared with women with a normal post partum OGTT (1.05 +/- 0.07 vs. 1.32 +/- 0.08 -10(2) x mmol/l x min-1, respectively, p < 0.05). Diabetic or borderline diabetic OGTT in the first week post partum was significantly associated with a decrease in the K-value from week 33 to 38 (p < 0.05). Early diagnosis of GDM was found to be associated with a pathological OGTT post partum (p < 0.05). Five of 22 women (23%) with previous GDM had a diabetic and one (5%) a borderline OGTT at follow-up four to thirteen months post partum. High fasting serum glucose levels during the last trimester in GDM can identify the women at risk of diabetic/borderline OGTT post partum.

Use of microbiological diagnostics and antibiotics in Danish general practice.

This article analyzes the use of antibiotics in Danish general practice. We observed considerable variation in the prescription of antibiotics among general practitioners (GPs). Internationally, Denmark has a low consumption of antibiotics. The use of antibiotics was closely associated with GPs' use of drugs, other than antibiotics, and to some extent with use of microbiological diagnostic tests. These findings provide evidence for the assumption that the consumption of antibiotics can be decreased further, which stresses the need for a restrictive policy concerning antibiotics.

Variation in antibiotic prescribing costs in Danish general practice: an epidemiological pharmaco-economic analysis.

Based on 49,621 prescriptions during a period of 6 months we analysed factors relevant to the use of antibiotics among 137 general practitioners based on the reimbursement by the Danish Health Service. The background population constituted 167,105 adults and 42,392 children. The Danish Health Service refunds either 50 or 75% of the costs of antibiotics. The mean reimbursement per prescription was 96.45 DKK ranging between 56.10 DKK and 141.95 DKK. The total prescribed amount of antibiotics per GP measured in defined daily dose (DDD), the reimbursement per prescription for all other drugs than antibiotics, the proportion of patients above the age of 65 years and the number of cultures per 1,000 patients were positively associated with the reimbursement per prescription of antibiotics. The four variables explained 29% of the variation. The number of cultures and consultations per general practitioner were positively associated with the total reimbursement for antibiotics per general practitioner, while the number of throat swabs per general practitioner was negatively associated. The prescribed amount of DDD per prescription and the reimbursement per DDD of antibiotics contributed almost equally to the variation in reimbursement for each prescription. The study thus shows that the doctors prescribing the highest amounts of antibiotics measured as DDD also choose the most expensive drugs and that this choice of expensive drugs seems to be a general trend independent of the ATC group.

[Papillary transitional cell carcinoma of the bladder after 1 year use of a double-J ureteral catheter]. / Transitiocellulaer papillaer blaeretumor efter et år med dobbelt J-kateter.

A 37-year old man with a five-year history of nephrolithiasis was catheterized with a double-J ureteral stent (Angiomed) in the left ureter before extra corporeal shock wave lithotripsy. After eight lithotripsy treatments over the course of one year, the double-J stent was removed. Papillary tumor was discovered around the left ureter ostium. Histology showed papillary transitional cell carcinoma grade 2 without invasive growth. No neoplasm has previously been observed after using double pigtail stents for longtime-stenting. One should keep this case in mind, when controlling ureteral stents that are left in place for longer periods.

Selenium in human mammary carcinogenesis: a case-referent study.

In a case-referent study on the possible role of selenium in human mammary carcinogenesis, serum selenium was found to be 79 +/- 12 micrograms/l in 66 cases and 81 +/- 12 micrograms/l in 93 referents. An internal trend in serum selenium was observed among cases (TNM stage I 81 +/- 11 micrograms/l and TNM stage II 76 +/- 13 micrograms selenium/l), indicating disease-mediated changes. The evaluation of selenium as a risk indicator in human breast cancer was therefore restricted to TNM stage I patients (n = 36). Multiple logistic regression analyses including variables associated with selenium levels revealed no association between selenium levels and breast cancer risk.

CaF2 in enamel biopsies 6 weeks and 18 months after fluoride treatment.

Fluoride concentrations were studied in enamel biopsies from maxillary central incisors 6 weeks and 18 months after fluoride treatment. In the short-term study biopsies were obtained prior to and after treatment with acidic sodium or ammonium fluoride. The findings showed that large amounts of fluoride were deposited in enamel from NH4F treatment (mean concentration 84,723 ppm), indicating substantial CaF2 formation. NaF treatment resulted in mean fluoride concentrations of 7,818 ppm. In the 18-month study, biopsies from 58 placebo-treated teeth were analyzed for total fluoride (mean 1,733 ppm). Twenty-five additional biopsies from placebo-treated and 58 from NH4F-treated teeth were analyzed for KOH-soluble (CaF2) and KOH-nonsoluble (apatitic) fluoride. The mean values for total fluoride were 1,669 and 2,085 ppm in the placebo-treated and in the NH4F-treated groups, respectively. The corresponding mean values for KOH-nonsoluble fluoride were 1,467 and 1,731 ppm and for KOH-soluble fluoride 202 and 354 ppm, respectively. The increase in enamel fluoride after fluoride treatment was only marginally significant. Biopsies from the ammonium fluoride treated group were significantly more likely to have high (30 vs. 8%) and moderate (28 vs. 16%) CaF2 levels and less likely to have low levels than biopsies of placebo-treated teeth (chi-square = 8.0 with 2 d.f.; p = 0.018). It is concluded that very substantial amounts of CaF2 are present in enamel 6 weeks after treatment, and small amounts may persist in the surface enamel for as long as 18 months.

Age-dependent change in myocardial cardiac glycoside receptor (Na,K-pump) concentration in children.

Myocardial Na,K-ATPase concentration was quantified in 18 0-8-year-old human subjects by vanadate-facilitated 3H-ouabain binding to intact samples of the left ventricle of the heart obtained at autopsy. Within the first 6 months of life, the Na,K-ATPase concentration showed a rapid decrease. The mean value in the age range from birth to 6 months was 1.6 times the mean value obtained in the age range 6 months to 8 years. The mean values +/- SEM were 1,076 +/- 57 (n = 10) and 671 +/- 28 (n = 8) (p less than 0.001) pmol/g wet weight, respectively. The highest value [1,433 +/- 56 pmol/g wet weight (n = 5)] was found in a 3-month-old child and the lowest value [545 +/- 22 pmol/g wet weight (n = 5)] in an 8-year-old. Evaluation of 3H-ouabain-binding kinetics showed no age-dependent variations. The total amount of Na,K-ATPase found in the heart was approximately 30 and 80 nmol within the first 3 years of life and at 8 years, respectively. The age-dependent change in myocardial Na,K-ATPase concentration can be ascribed to variation in the ratio between the amount of Na,K-ATPase and muscle mass during development. Since myocardial Na,K-ATPase is the receptor for cardiac glycosides, the present results may in part explain the clinical observation that cardiac glycoside sensitivity and toxicity change in young age.

In vivo study of slow-release fluoride resin and enamel uptake.

The purpose of this study was to investigate in vivo enamel fluoride uptake of a slow-release boron trifluoride BIS-GMA resin material. Study subjects were orthodontic patients with at least one pair of permanent bicuspid teeth indicated for extraction. The material was applied to the buccal surface of the test tooth 1 month prior to extraction; the contralateral tooth served as the control tooth. Following extraction, the resin was removed by soaking in acetone for 36 h and polishing with a sodium bicarbonate slurry. Prior scanning electron microscopic studies have shown that this cleaning procedure effectively removes all residual resin. Enamel fluoride analyses were completed for 12 pairs of teeth from 9 subjects. The mean differences in enamel fluoride concentrations between the treated and control teeth were significantly different from zero at the 0.01 level. At each successive depth, the absolute mean amount of fluoride uptake by the test teeth was fairly constant; however, the proportional mean amount or percent increase in fluoride concentration resulting from treatment became greater in the deeper enamel layers. The data suggest that this material has the potential to provide an effective means of introducing substantial amounts of permanently bound fluoride into surface enamel, even into the deeper layers.

[Prescription habits. Illustrated by a random sample]. / Receptvaner. Belyst ved en stikprøve.

With the object of illustrating prescribing habits and errors in prescriptions, a randomized sample of 1,000 prescriptions was employed from the prescriptions from a single day. The main result of the investigation is that, in general, a great proportion of errors occur as 61.7% of the prescriptions were incorrect. Errors concerning limiting of issue and indications of reasons for use are particularly noticeable. Only 48% of the drugs prescribed for which limitation of issue is compulsory and 32.4% of all preparations do not show the indication for use. The alterations in the circular on dispensing issued by the Danish Board of Health with the object of prompting doctors to write multiple prescriptions and always to give the indication for employment of the preparation concerned are thus far from fulfilled. Employment of telephonic prescriptions is still extensively employed as nearly 50% of all prescriptions are given by telephone and the intention of the circular that telephone prescriptions should only be employed in special circumstances is thus far from fulfilled. The present authors find the the doctors' duty to provide the indications for use should be emphasized on account of control of prescriptions in the pharmacies and ensuring correct medication for the patients concerned. Similarly is should be deliberated whether the requirement of endorsing prescriptions for reissue of B preparations should be maintained and measures for limitation of the use of telephonic prescriptions should be limited with due respect to the advantages and disadvantages of these.

[Errors in prescriptions and control of prescriptions]. / Receptfejl og receptkontrol.

In Denmark, there is a tradition for strict control and safety measures in connection with prescribing and dispensing medicine in order to avoid undesirable or incorrect intake of medicine. The basis for this is the circular on dispensing from the Danish Board of Health which provides guidelines for composition of prescriptions by doctors and the control function by pharmacists. The object of this investigation is to describe the material of incorrect prescriptions which pharmacists are required to collect in connection with control of prescriptions. The investigation is based on material collected during a period of one month in the County of Arhus. The commonest type of erroneous prescription is incorrect statement of the strength of the preparation. This was found in 44.3% of the collected prescriptions. Another common problem is absence of the endorsement "for a child" and absence of the age of the child in prescriptions for these. In the material of incorrect prescriptions, statistically significantly more prescriptions were written by hospital doctors and secretaries. In contrast to ordinary prescriptions, telephone prescriptions are characterized a low frequency of errors as telephone prescriptions only constituted 8.2% of the erroneous material as compared with 47.8% in the conventional investigation. The authors consider that in a future revision of the circular on dispensing the requirement concerning repeated dispensing should be made more lenient and the indications and declarations of age should be more strict. Similarly, reduction in the synonymous preparations and the number of strengths should be reduced in order to facilitate clarity for the prescribing doctor.(ABSTRACT TRUNCATED AT 250 WORDS)

Cadmium exposure in Denmark. Based on analyses of liver and kidney tissues.

To determine the cadmium exposure level in the Danish population, tissue samples of kidney and liver were collected over the period 1981 to 1987 at the Institutes of Forensic Medicine in Copenhagen, Odense and Aarhus. A total of 795 samples were collected, of which 143 were selected for analysis using, the criteria sudden violent death (accident, homicide or suicide). Cadmium concentrations in kidney cortex increased by age to a maximum of approximately 22 micrograms/g/g (w/w) in the age group 45-55 years and decreased in the older age group, while liver concentrations tended to increase throughout the entire lifespan. Cadmium concentrations in kidney cortex and liver were found significantly correlated. The findings are in good agreement with internationally published data, but lower than previously reported Danish concentration levels. The reason for this difference is discussed.

Skeletal muscle Na,K-pump concentration in children and its relationship to cardiac glycoside distribution.

Skeletal muscle Na,K-pump (cardiac glycoside receptor) concentration was quantified in 18 0- to 8-year-old human subjects by vanadate facilitated [3H]ouabain binding to intact vastus lateralis samples obtained at autopsy. No age-dependent change in [3H]ouabain binding site concentration was observed. Mean value +/- S.E.M. was 268 +/- 17 pmol/g wet wt. (n = 18), range 182 to 433 pmol/g wet wt. At the age of 1 day, 3.5 month and 8 years and 8 months, unspecific uptake and retention of [3H]ouabain was 1.6, 1.4 and 1.5% of the total uptake and retention; release of specifically bound [3H]ouabain during the washout procedure took place with T 1/2 of 97, 90 and 73 hr; and apparent affinity constants for [3H]ouabain binding (KD) was 1.3 x 10(-8), 0.9 x 10(-8) and 1.2 x 10(-8) mol/l. [3H]Ouabain binding site concentrations and kinetics were in agreement with values from adults except that in children apparent affinity constant (KD) was 1.7 times the value in adults. The observation of no age-dependent changes in human skeletal muscle Na,K-adenosine triphosphatase concentration was at variance with the observations of such changes in animals. The total number of Na,K-pumps in the pool of skeletal muscles increased from 10 to 50 times that in the heart from birth to old age. The skeletal muscle pool of Na,K-pumps seems to constitute a distribution volume of importance during digitalization in children as well as adults.(ABSTRACT TRUNCATED AT 250 WORDS)

The scaphoid fat stripe in the diagnosis of carpal trauma.

During a ten-year period scaphoid fracture was suggested in 541 wrists, but in 283 cases could not be confirmed at the initial radiographic examination. These cases were immobilized in plaster of Paris and examined clinically and radiologically 10 to 14 days later. A total of 274 additional radiographic examinations revealed 32 scaphoid fractures not initially recognized. Two fractures were at the retrospective analysis found to have been neglected. In the 249 cases where a fracture was never demonstrated, the immobilization and resulting sick leave were in retrospect considered not to have been indicated. In a retrospective analysis of case records and radiographic material including the configuration of the scaphoid fat stripe (SFS) at the initial radiographic examination the SFS was found to be useful in diagnosing scaphoid fractures. The use of the SFS in differential diagnosis would result in reduction of costs and inconvenience for patients without scaphoid fracture.

Enhanced caries inhibition by certain NaF-surfactant combinations in animal models.

The purpose of this animal investigation was to determine whether the cariostatic effect of sodium fluoride can be enhanced by combining it with certain surfactants. The surfactants, Zonyl FSC and Lodyne S-110, were selected because they had been found to accelerate the rate of deposition of firmly-bound fluoride in vitro in enamel during enamel-fluoride interaction. Sixty male hamsters and 60 female rats, 21 days old, were placed on the high-sucrose diet 2000 and inoculated with Streptococcus mutans (strain #6715). Each set of animals was divided into six groups of 10 each. The groups received either distilled water, NaF, NaF with Lodyne S-110, NaF with Zonyl FSC, Lodyne S-110, or Zonyl FSC. The animals were scored for caries at the termination of the study. The caries findings in the hamster and the rat series closely paralleled each other. Animals receiving NaF with Zonyl FSC experienced the least decay (about 90% inhibition compared with about 65% for the NaF-alone group). A statistical evaluation showed significant interaction between Zonyl FSC and NaF. No effect on caries experience was seen from administration of Lodyne S-110.