Meningococcal infections in a district hospital. Some clinical observations and therapeutic experiences during an epidemic in North Norway.

From 1974 to 1980, 70 patients with meningococcal disease were treated in the Harstad district hospital. Six patients died (8.6%). The prognostic score system of Niklasson gave an average of 2.31 for unfavourable factors which is high as compared to other studies. The percentage of high risk patients (score higher than three) was 24.3. Fifty-four patients were treated with benzylpenicillin as the sole antibacterial agent. The standard duration of therapy was five days, which is shorter than commonly recommended. Meningococci of serogroup B were most often isolated; nearly all of them sulphonamide resistant.

[Lyme borreliosis]. / Lyme-borreliose.

In Norway, physicians and patients alike are becoming increasingly aware of Lyme borreliosis. This fact has created a need for information on different aspects of this disease. This paper reviews the historical background for Lyme borreliosis and the epidemiological situation in Norway, based on data collected by the national system for notification of infectious diseases (MSIS) in 1993. The role of the tick vector and the overall clinical picture is presented briefly. The authors discuss indications for and possibilities of different microbiological diagnostic methods, and finally list the recommendations for treatment and prophylaxis.

Malignant histiocytosis and adult coeliac disease.

A 54-year-old female with a 3 year history of coeliac disease suddenly deteriorated. Clinical investigation and bone marrow aspirate were consistent with malignant histiocytosis. The patient died and the following postmortem examination confirmed the diagnosis. The significance of the concomitant occurrence of coeliac disease and malignant histiocytosis is discussed.

[Tricuspid valve endocarditis with pulmonary embolism]. / Trikuspidalendokarditt med lungeembolier.

We describe two patients suffering from bacterial endocarditis with tricuspid valve envolvement. Both had pulmonary embolism, revealed by scintigraphic lung perfusion examination. The diagnosis was made by transthoracic echocardiography in one patient and transoesophageal echocardiography in the other. Both received therapy with antibiotics and heparin given intravenously. In one patient the vegetation disappeared. We discuss the epidemiology, diagnosis and treatment of the condition, with special focus on the possible role of heparin.

Severity of meningococcal disease: assessment by factors and scores and implications for patient management.

Results from our own and other published series of cases of meningococcal disease were used to study prognostic factors and to compose scores for assessment of severity of disease on admission to the hospital. The difference in risk for fatality was designated the factor fatality difference (FFD); the FFD was determined by subtracting the percent fatality for factor-negative patients from the percent fatality for factor-positive patients. FFD was useful for selection of good indicators of severity of disease. Blood pH of less than 7.35 was the best single factor; low platelet count came next, followed by low blood pressure, cyanosis, ecchymosis, and low blood leukocyte count. New scores were constructed based on multiple regression analyses. Several older and new scores seemed to be comparable. By combining age-adjusted systolic blood pressure (less than 100 mm Hg), cyanosis, ecchymosis, diarrhea before or at admission, cold extremities, absence of nuchal or back rigidity, and rectal temperature of greater than or equal to 40 degrees C, a simple bedside percentage score, the MenOPP bedside clinical score (MOC), was devised. Cross-evaluations on test materials generally confirmed the choice of score. The simplicity of this score made it more clinically suitable than laboratory or mixed laboratory and bedside scores.

Neisseria meningitidis infections in Northern Norway: an epidemic in 1974-1975 due mainly to group B organisms.

A severe epidemic of disease due to Neisseria meningitidis has been occurring in northern Norway since 1974. Based on bacteriological and clinical examination of cases during the 18 months between January 1, 1974 and June 30, 1975, an overall attack rate of 26.3 cases per 100,000 population per year has been calculated. The attack rates were highest in 1975 (total, 37.4 cases per 100,000 population; Troms County, 54.5) and in children younger than four years (total, 173.6; Troms County, 328.9). The epidemic shows a total case-fatality ratio of 14.1%. The highest case fatality ratio was recorded for patients older than 20 years (25.0%). Among the youngest children, cases were distinctly more frequent in males than females; in older children and adults, male patients had a clearly higher case-fatility ratio than female patients. Of the three serogroups of N. meningitidis, group B caused more cases of infection that groups A and C together. In addition, the causative meningococcal strains were almost uniformly resistant to high concentrations of sulfonamide. Both of these traits appear to have developed in northern Norway at or shortly before the time when the epidemic began.

Multiple myeloma in central Norway 1981-1982: a randomized clinical trial of 5-drug combination therapy versus standard therapy.

67 previously untreated patients with multiple myeloma were entered on a randomized clinical trial to determine whether the use of combination chemotherapy including vincristine, carmustine, alkylating agents, and prednisone was more effective than conventional therapy with melphalan and prednisone. The treatment groups did not show significant differences with respect to major prognostic factors. With the 2-drug combination therapy and 5-drug combination therapy, 67 and 74% of the patients achieved remission, respectively. Moreover, no significant difference was found between the two treatment schedules in terms of median survival (30+ months). The survival curves for stage III patients treated with the two regimens did not differ significantly. After 12 months, patients who had achieved remission were randomized to have treatment discontinued or to have maintenance treatment. 7 of 15 patients on maintenance therapy relapsed, whereas 9 of 14 patients who had their therapy discontinued relapsed, and the survival of the two groups was similar.

Multiple myeloma in central and northern Norway 1981-1982: a follow-up study of a randomized clinical trial of 5-drug combination therapy versus standard therapy.

In a randomized study of 92 previously untreated patients with multiple myeloma, the intention was to document the possible beneficial effect of combination chemotherapy including vincristine, carmustine, alkylating agents and prednisone, as compared to conventional therapy with melphalan and prednisone. Major prognostic factors did not differ significantly between the treatment groups. With the 2-drug therapy and 5-drug combination therapy, 48 and 54% of the patients achieved remission, respectively. Median survival for patients treated with the 2-drug regimen and 5-drug regimen was 29 and 33.5 months, respectively. No significant difference was found between the survival curves for stage III patients treated with the two regimens. After 12 months, patients who had achieved remission were randomized to have treatment discontinued or to have maintenance treatment. The numbers of relapses, remission duration and survival of the two groups were similar.