[Is treatment of diabetes too complicated for general practitioners?]. / Er diabetesbehandling for vanskelig for allmennpraktikeren alene?

The prevalence of type 2 diabetes is increasing rapidly. In order to reduce the morbidity and mortality of type 2 diabetes, it is important to treat both hyperglycaemia and risk factors for cardiovascular disease. This means that diabetes care is becoming increasingly comprehensive and complicated. Studies in Norway show that diabetes care in general practice could be improved. The primary care system needs more resources and better organisation to be able to meet the demands for improved quality and more comprehensive care. We suggest more active use of nurses and other health care professionals, as well as changes in the remuneration system for general practitioners. Remuneration for an annual review of patients with diabetes will stimulate quality improvement work. The division of work between primary health care and hospital clinics should be clarified.

Reduced thiamine phosphate, but not thiamine diphosphate, in erythrocytes in elderly patients with congestive heart failure treated with furosemide.

OBJECTIVES: To measure the concentrations of thiamine and thiamine esters by high-pressure liquid chromatography (HPLC) in elderly patients treated with furosemide for heart failure and in a control group. DESIGN: A cross-sectional study of blood thiamine and thiamine ester concentrations. SUBJECTS: Forty-one patients admitted to hospital for heart failure and 34 elderly living at home. No vitamin supplementation was allowed. RESULTS: Compared with the healthy controls, furosemide-treated patients had significantly reduced whole blood thiamine phosphate (TP; 4.4 +/- 2.2 vs. 7.6 +/- 2.0 nmol L-1) and thiamine diphosphate (TPP; 76 +/- 21.5 vs. 91 +/- 19.8 nmol L-1) (mean +/- SD). When the thiamine concentrations were related to the haemoglobin concentrations, which were reduced in the heart failure patients, the levels of TP (nmol g-1 Hb) were 0.38 +/- 0.26 vs. 0.54 +/- 0.17 (P < 0.0001), and of TPP were 6.35 +/- 1.76 vs. 6.37 +/- 1.29 (P = 0.95). There were no differences in T and TP concentrations in plasma between the two groups. CONCLUSIONS: The elderly patients with heart failure treated with furosemide have not reduced the storage form of thiamine, TPP, but only TP. This change is most likely not an expression of a thiamine deficiency, but rather of an altered metabolism of thiamine, which is not understood at present.

[Information routines in HIV screening of pregnant women]. / Informasjonsrutiner ved HIV-testing av gravide.

HIV-antibody testing has been carried out as a routine among pregnant women in Norway since September 1987. Up to September 1991 (later information is incomplete) 339,823 women have been tested. 25 of these were positive. In this survey we interviewed by questionnaire 55 physicians and nurses who had been asked for a second blood sample from their patients. None of the physicians who had tested the 25 HIV-positive women were included. Among these 55, nine stated that the women had suffered psychological distress after the second testing, and one reported that the woman in question had chosen to have an abortion. The study demonstrates possible opportunities for improving the handling of information, both between laboratories and physicians/nurses and between physicians/nurses and the women who are asked to give a second blood sample. We also interviewed 290 physicians who had asked for a HIV-test for pregnant women but had received no false positive results (the number of respondents was 258). Among a total of 379 physicians and nurses, one third stated that they seldom or never asked explicitly if the woman wanted to be tested. 88% were in favour of routine testing and 97% reported a positive or very positive attitude among the pregnant women towards screening. Nearly one third stated that they had insufficient knowledge about the significance of a false positive test result.

[Chemical determination of blood in gastric contents]. / Kjemisk påvisning av blod i mageinnhold.

The chemical tests used to determine blood in faeces and urine have not been recommended for determining blood in gastric contents, since highly acidic samples may give false-negative reactions. Based on model studies this article states that, in most cases, ordinary chemical tests for faecal blood may also prove useful for determining blood in gastric materials.

[Immuno-filtration. A new principle of analysis exemplified by the determination of HCG]. / Immunfiltrering. Et nytt analyseprinsipp belyst ved eksemplet HCG-Bestemmelse.

PIP: A rapid quantitative test for human chorionic gonadotropin (HCG) is useful for diagnosis of extra-Uterine pregnancy. The development of monoclonal antibodies has made it possible to produce immuno-filters of very high specific sensitivity. The reported tests were performed on samples from 90 patients with varying diagnoses. The HCG levels determined in the tests were checked against radioimmunoassay tests standardized to World Health Organization 1st international standard. Urine has traditionally been the sample material for simple tests of HCG, but early tests were easily spoiled by any protein present in the urine, for example, from weak hematuria. The new immuno-filtration technique washes protein and other interfering materials away. The new technique is better suited for measuring HCG concentration in serum since the HCG concentration does not vary so much as it does in urine. The Tandem Icon HCG Hybritech test has been found to be nearly 100% specific and 100% sensitive. The extremely high sensitivity which will show a positive test many days before expected menstruation for normal pregnancy. There is a disadvantage in that perhaps 50% of all initial pregnancies are spontaneously aborted in the course of the 1st few weeks of pregnancy. False hopes can be aroused. By timing the development of the blue indicator spot with a stopwatch, changes in HCG concentration may be plotted over time for a patient for better control of the pregnancy diagnosis.^ieng