The economic impact of multiple sclerosis to the patients and their families in Norway.

BACKGROUND: Multiple sclerosis (MS) imposes high economic costs on society, but the patients and their families have to bear some of these costs. OBJECTIVE: We aimed to estimate the magnitude of these economic costs in Norway. METHOD: We collected data through a postal questionnaire survey targeting 922 MS patients in Hordaland County, western Norway, in 2013-2014; 546 agreed to participate and were included. The questionnaire included clinical and demographic characteristics, volume and cost of MS-related resource use, work participation, income, government financial support, and disability status. RESULTS: The mean annual total economic costs for the patients and their families were €11,603. Indirect costs accounted for 66% and were lower for women than for men. The direct costs were nearly identical for men and women. The costs increased up to Expanded Disability Status Scale score 6 except for steps between 3 and 4 where it remained nearly constant. The costs reduced from EDSS 6 to 8, and increased from 8 to 9. Lifetime costs ranged from €24,897 to €70,021 for patients with late disease onset and slow progression, and between €441,934 and €574,860 for patients with early onset and rapid progression. CONCLUSION: The economic costs of MS impose a heavy burden on the patients and their families. Supplementing the information on the cost of MS to society, our finding should be included as background information in decisions on reimbursing and allocating public resources for the well-being of MS patients and their families.

[A user evaluation of software programs in family practice]. / En brukerundersøkelse av dataprogrammer i legepraksis.

Software for electronic patient journals was evaluated. A questionnaire was sent to a total of 551 general practitioners working on contract, salaried general practitioners and specialist practitioners. Among the 345 respondents, 63% used electronic journals. Three programs dominated. Legeservice (n = 94) was exclusively used by salaried general practitioners, Profdoc (n = 88) and Infodoc (n = 34) were preferred by general practitioners working on contract and by specialists. In the latter group only 40% used electronic journals. In general, the users of Profdoc and Infodoc were satisfied with the central functions of the software and the service provided by the suppliers. The users of Legeservice were significantly less satisfied. In conclusion, some of the existing software for patient journals in Norway can safely be recommended.

[Scleroderma with an unusual complication]. / Sklerodermi med en uvanlig komplikasjon.

A 30 year-old woman who had had progressive systemic sclerosis for seven years was admitted to our hospital with a history of one week of increasing abdominal girth and one month's history of increasing peripheral oedema, especially in the lower limbs, and a weight loss of 10 kilograms in the course of five months. On admission she had oedema of the lower limbs, lower back and abdomen, and had ascites but no signs of peritonitis. An abdominal X-ray examination revealed distended bowels with elevated air fluid levels and pneumoperitoneum. The combination of the clinical and radiological findings, as well as the history, strongly suggested a diagnosis of pneumocystosis cystoides intestinalis as a complication to progressive systemic sclerosis. The symptoms improved on treatment and no signs of recurrence were found at follow-up after four years. We discuss the underlying pathology and management of this condition.

[Occupational environment and health among hospital physicians]. / Arbeidsmiljø og helseforhold blant sykehusleger.

66% of the hospital doctors at the Central Hospital, Akershus and Ullevål Hospital responded to a questionnaire concerning different aspects of a doctor's work situation and health. The investigation revealed a large work load and lack of consulting rooms and equipment. Violence, threats, abusive language, risk of infection, high temperatures, cytostatic drugs, narcosic gases, irradiation are all risk factors during daily work for a large percentage of the doctors. Even so, they seem to be fairly satisfied with the organization of the work, and nearly all of them enjoy their work.

24,25-dihydroxy vitamin D3 treatment inhibits parathyroid-stimulated adenylate cyclase in iliac crest biopsies from uremic patients.

Renal osteodystrophy with increased bone resorption is a major clinical problem in patients with chronic renal failure. Previous reports have shown that treatment with 24,25-dihydroxy vitamin D3 (24,25(OH)2D3) may result in decreased bone resorption. The present study addresses basic mechanisms for the action of 24,25(OH)2D3 in bone of patients with elevated serum parathyroid hormone (PTH) levels due to chronic renal disease. Twenty-four patients 56 +/- 17 years old (mean +/- SE) with chronic kidney disease in the predialytic state (serum creatinine > 150 mumol/l) and elevated serum midregion PTH > 1.2 micrograms/l were randomly assigned to oral treatment with either 1,25-dihydroxy vitamin D3 (1,25(OH)2D3) (0.25-0.50 microgram/day), 24,25(OH)2D3 (daily dose of 15 micrograms), or a combination of the two vitamin D3 analogs. The control group received calcium carbonate (maximal dosage of 1 g x 3). Selected variables in serum and urine as well as hormone sensitive adenylate cyclase (AC) in iliac crest biopsies were assessed before treatment and during follow-up after two and six months. Serum levels of 1,25(OH)2D3 and 24,25(OH)2D3 were significantly (P < 0.05) increased after two and six months in the respective treatment groups. Net bone PTH-enhanced AC (PTH-AC) fell abruptly (P < 0.01) after two months of treatment and was nearly abolished (P < 0.01) after six months with 24,25(OH)2D3 given alone or in combination with 1,25(OH)2D3. An inverse relationship (r = -0.57, P < 0.05, n = 48) between net PTH-AC in bone and serum levels of 24,25(OH)2D3 was demonstrated. In all groups, serum total calcium (s-Ca) was maintained within normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Quality of life after kidney transplantation. A 10-22 years follow-up.

Out of 69 patients who were kidney transplanted from 1963 to 1978, 33 patients were alive with a functioning graft in 1988. Of these, 94% completed a questionnaire for the assessment of the quality of life. The total life situation was considered very good by 16%, good by 48%, medium by 29% and difficult by 6%. Nine patients (eight males) had a total of 16 children after the transplantation. There were 72% who were working full-time and the family income was acceptable for most of the patients. No patients had major psychological problems. Our conclusion is that this group of transplanted patients almost all reported a good quality of life and were almost fully rehabilitated in the second and third decade after their transplantation.

A low oncogenic variant of Friend murine leukemia virus with strong immunosuppressive properties.

Friend leukemia complex (FLC) is known to induce immunosuppression but the use of FLC in studies of immune cells function is disadvantageous since the immunosuppression always is accompanied by an acute erythroleukemia. To obtain immunosuppressive variants of FLC with reduced leukemogenic potential, we isolated T-helper cells from FLC infected mice, and passed lysates of the cells to recipient uninfected mice. A group of these mice developed a condition distinct from the disease induced by FLC. A viral stock prepared from these mice, designated Fd-MIV for friend derived murine immunodeficiency virus, induced a profound suppression of the primary antibody response without acute transformation in adult NMRI mice. Terminally a wasting disease with weight loss, atrophy of the thymus and lymph nodes and renal disease was observed in some mice. Analysis of viral DNA and RNA from infected NIH 3T3 cells showed that Fd-MIV contained at least two viral components, a 8.4 kb friend murine leukemia virus (F-MuLV) and a 7.4 kb mink cell focus (MCF)/xenotropic virus related genome. The 7.4 kb genome was not detected in Fd-MIV infected, immunocompromised mice indicating that the 8.4 kb genome might be responsible for the disease.

Alterations in serum and urine parameters reflecting bone turnover in uremic patients during treatment with 1,25-dihydroxyvitamin D3 and 24,25-dihydroxyvitamin D3.

Previously we demonstrated that bone resorption in uremic patients appears to be related to increased serum parathyroid hormone (PTH) and to osseous PTH-stimulated adenylate cyclase (AC), the latter being inversely correlated to serum 24,25-dihydroxyvitamin D3 [24,25(OH)2D3]. In this study, we continue to examine the possible modulatory role of vitamin D3 analogs on the progression of the uremic condition. Four groups of predialytic uremic patients received oral administrations of CaCO3 (control), 1,25-dihydroxy-vitamin D3 [1,25(OH)2D3] (0.25-0.50 microgram/day), 24,25(OH)2D3 (15 micrograms/day) or a combination of the two vitamin D3 analogs for 6 months. In the treatment groups receiving single or combined therapy, respectively, the low pretrial serum levels of 1,25(OH)2D3 were raised (p < 0.05) within upper normal range, while the serum levels of 24,25(OH)2D3 were increased (p < 0.05) to twice the average physiological level. Neither regimens alone resulted in significant changes in serum levels of calcium of PTH. 1,25(OH)2D3 moderately hampered bone formation by reducing serum alkaline phosphatase (ALP) by some 15%. 24,25(OH)2D3 significantly decreased (p < 0.01) bone PTH-AC up to 98% after 2 and 6 months. However, no correlation was found between serum 24,25(OH)2D3 and the bone turnover parameters serum ALP, serum osteocalcin and urine hydroxyproline/creatinine ratio. These parameters were all positively correlated (p < 0.05) to serum PTH, indicating an on-going bone turnover. These biochemical events strongly indicate that 24,25(OH)2D3 may retard the PTH-dependent progression in bone demineralization occurring in uremic patients. This effect is apparently not reduced by concomitant 1,25(OH)2D3 administration.

[Exposure to blood among hospital physicians]. / Blodeksposisjon blant sykehusleger.

We used a questionnaire to study the working situation of physicians in two large Norwegian hospitals. During the last six months 40% of the doctors reported one or more episodes of exposure to blood when transfer of infectious agents such as hepatitis B-virus or HIV would have been possible. The fact that so many doctors had been exposed to blood conflicts with the low number reported to the hospital department of the occupational health service. Surprisingly, 40% of the physicians who reported exposure were physicians not taking part in surgical procedures. All hospitals should establish follow-up procedures for employees exposed to blood or other possible infectious agents, and physicians should be urged to follow these routines.

Prevention of hemodialysis associated hypoxemia by use of low-concentration bicarbonate dialysate.

Hypoxemia during acetate dialysis is caused by hypoventilation due to bicarbonate loss across the dialyzer and its regeneration from acetate by a CO2 consuming process. Loss of bicarbonate is prevented by using a bicarbonate containing dialysate, but hypoxemia is still found by many authors. In the current study, ten patients were dialyzed twice against acetate dialysate, high concentration bicarbonate (36 mmol/L), and low concentration bicarbonate (29 mmol/L) dialysates. A significant decrease in PO2 was found during both acetate and high concentration bicarbonate dialysis. Hypoxemia was prevented by low concentration bicarbonate dialysate. A possible explanation for the hypoxemia in high concentration bicarbonate dialysis may be hypoventilation induced by alkalosis. It was concluded that low concentration bicarbonate dialysate prevents hypoxemia during hemodialysis.

Long term morbidity and mortality after kidney transplantation.

A cohort of 69 patients received a kidney transplant in the period 1963-1977. The mean observation time was 9.5 years. Accumulated follow-up time was 661.4 patients year. The mean (SE) 10-year survival was 55(5.9)%. Univariate analysis showed that female patients had poorer survival than male. Patients with a cadaveric donor had lower survival than those with a living donor. Also survival with different HLA-A,B match differed significantly. A multivariate analysis pinpointed nature of donor, cadaveric vs. living, as the sole independent predictor of mortality. Patients receiving a cadaveric kidney were on double (2.2) relative risk of mortality as compared to patients with a living donor. The major causes of death were infections during rejection treatment, and cardiovascular disease. Patients had low rates of morbidity. Our results showed satisfactory outcome of kidney transplantation.

Removal of chelated aluminium during haemodialysis using polysulphone high-flux dialysers.

Polysulphone high-flux dialysers were used for removal of chelated aluminium in desferrioxamine-treated patients on maintenance haemodialysis. When compared with charcoal haemoperfusion in series with a cuprophane dialyser, the same aluminium clearance was obtained (34% of blood flow). During 4 h of haemodialysis serum aluminium was reduced to the concentration seen before desferrioxamine infusion. We conclude that high-flux polysulphone dialysers remove chelated aluminium as efficiently as does charcoal haemoperfusion, and at a lower cost.

Effects of nimodipine on cerebral blood flow and cerebrospinal fluid pressure after cardiac arrest: correlation with neurologic outcome.

Fifty-one patients were included in a blind randomized study to evaluate whether the Ca-blocker nimodipine could influence cerebral blood flow (CBF) or cerebrospinal fluid pressure (CSFP) during the cerebral hypoperfusion period that follows resuscitation from cardiac arrest and to determine whether changes in CBF correlate with neurologic outcome. CBF measured 1 to 4 hours after arrest with the use of 133Xe intravenous was significantly greater with nimodipine than with placebo (27 +/- 3 versus 13 +/- 1 ml.100 g-1.min-1 at 3 hours), but with no significant difference at 24 hours. There was no clinical evidence of seriously increased CSFP in any patient in either group the first 48 hours. Mean arterial pressure was significantly lower (86 +/- 4 versus 101 +/- 4 mm Hg at 3 hours), and antiarrhythmic drugs were used significantly less frequently in the nimodipine group than in the placebo group. Twelve patients in each group eventually regained consciousness. There was no significant difference in neurologic status between the two groups at any point, and no positive correlation between CBF in the hypoperfusion period and neurologic outcome.

Benzodiazepine-receptor antagonist, a clinical double blind study.

In a double blind study including 18 patients in whom a benzodiazepine intoxication was suspected, the first specific benzodiazepine antagonist was compared to placebo. There was a highly significant effect on consciousness, all patients given antagonist awaked, usually within minutes. No adverse effects were observed. In 2 patients the clinical condition deteriorated 1 to 2 hrs after the antagonist was given. This might endanger intoxicated patients withdrawing from medical attention.

Heat stroke in endurance exercise.

Six athletes were examined immediately after collapsing from heat stroke during exercise, and then followed for several weeks. At the time of collapse most of the patients were sweating profusely, their rectal temperatures being more than 42 degrees C. All recovered within a few hours. The renal function was not disturbed more than expected during heavy exercise, serum levels of liver enzymes were, however, increased for several weeks. Electrolyte homeostasis was undisturbed but for a transient hypercalcemia that can not be fully explained. The marked increments in plasma levels of catecholamines, vasopressin and renin were as expected after heavy exercise. We conclude that as heat stroke presents as a continuum of clinical pictures, biochemical evidence of liver cell injury is a sensitive and important parameter for the diagnosis.

TSH unresponsiveness, a case report.

A patient with congenital primary hypothyroidism is presented. His thyroid gland had a normal uptake of radioiodine which was independent of endogenous or exogenous TSH, sympathetic B-receptor blockade or prostaglandin inhibition. Infusion of dibuturyl-cyclic AMP increased the uptake of radioiodine and stimulated release of protein bound 131I. He had no goitre even when he did not receive thyroxine, but thyroid histology showed evidence of active epithelium in the presence of adequate substitution with thyroxine. We assume that some unknown factor other than TSH stimulates part of the glandular function in this patient, without leading to adequate formation and release of thyroid hormone.

The effect of regular physical activity on the organs of ventilation.

Possible effects of regular physical activity on the respiratory organs are discussed. There is no evidence that training affects the vital capacity or the diffusing capacity in healthy individuals. However, in asthmatics it is possible that systematic training can have a favourable effect on total lung volume. Further documentation is required. Documentation is at the moment very meagre as regards the ascerted training effects on vital capacity in growing children.