Showing papers in "Danish Medical Bulletin in 1999"

The Danish National Hospital Register. A valuable source of data for modern health sciences.

Abstract: The Danish National Hospital Register (LPR) has collected nationwide data on all somatic hospital admissions since 1977, and since 1995 data on outpatients and emergency patients have been included as well. Numerous research projects have been undertaken in the national Danish context as well as in collaboration with international teams, and the LPR is truly a valuable source of data for health sciences, especially in epidemiology, health services research and clinical research. Nearly complete registration of somatic hospital events in Denmark is combined with ideal conditions for longterm follow-up due to the existence of a national system of unique person identification in a population of relative demographic stability. Examples of studies are provided for illustration within three main areas: I: Using LPR for surveillance of the occurrence of diseases and of surgical procedures, II: Using the Register as a sampling frame for longitudinal population based and clinical research, and III: Using the Register as a data source for monitoring outcomes. Data available from the Register as well as studies of the validity of the data are mentioned, and it is described how researchers may get access to the Register. The Danish National Hospital Register is well suited to contribute to international comparative studies with relevance for evidence-based medicine.

Intraluminal pH of the human gastrointestinal tract.

Abstract: After a short introduction (chapter 1) methods of measuring gastrointestinal pH are described in chapter 2. The methods are divided into intubation techniques and tubeless methods, and the advantages and disadvantages are discussed. Measurements with pH-sensitive, radiotransmitting capsules are highlighted, and methodological problems with these capsules are described. Chapter 3 concerns the gastrointestinal pH profile of healthy subjects. The intraluminal pH is rapidly changed from highly acid in the stomach to about pH 6 in the duodenum. The pH gradually increases in the small intestine from pH 6 to about pH 7.4 in the terminal ileum. The pH drops to 5.7 in the caecum, but again gradually increases, reaching pH 6.7 in the rectum. The physiological background of these pH values is discussed. Chapter 4 describes the effect of gastrointestinal pH on bacterial flora, absorption of vitamins and electrolytes, and on the activity of digestive enzymes. The pH-profile in children is described in chapter 5. The profile is identical with that of adults, and it is therefore concluded that the release of a drug from pH-dependent, controlled-release preparations is also probably identical with that of adults. Chapter 6 describes the correlation between certain diseases and the gastrointestinal pH. A resection of the colon and the creation of an ileostomy do not affect the pH of the remaining gut. An ileocaecal resection shortens the small intestinal transit time, increases pH of the proximal colon, but does not change the pH-profile of the small intestine. Chronic pancreatitis and cystic fibrosis seem to decrease pH of the proximal small intestine. Very low colonic pH values have been observed in severe active ulcerative colitis and in Crohn's disease, but the background and clinical implication of this phenomenon are not clear. Chapter 7 describes the modulating effect of diet and drugs on gastrointestinal pH. Diet primarily has an effect on the colonic pH, whereas drugs might affect both small intestinal and colonic pH. The different effects are described. Finally, chapter 8 summarizes the present knowledge about gastrointestinal pH, and future investigations are proposed.

The Danish registers of causes of death.

Abstract: In 1875 registration of causes of death in Denmark was established by the National Board of Health, and annual statistics of death have since been published. Until 1970 the national statistics were based upon punched cards with data collected from the death certificates. Since then the register has been fully computerized and includes individual based data of all deaths occurring among all residents in Denmark dying in Denmark. Furthermore, a microfilm of all death certificates from 1943 and onward is kept in the National Board of Health. The Danish Institute for Clinical Epidemiology (DICE) has established a computerized register of individual records of deaths in Denmark from 1943 and onwards. No other country covers computerized individual based data of death registration for such a long period, now 54 years. This paper describes the history of the registers, the data sources and access to data, and the research based upon the registers, presenting some examples of research activities.

The Danish in vitro fertilisation (IVF) register.

Abstract: The Danish IVF Register was established in 1994 and covers all treatments with in vitro fertilisation (IVF), intracytoplasmatic sperm injection (ICSI), frozen embryo replacements (FER) and egg donations (ED). Since data are recorded with personal identification numbers, they provide the starting point for cohort studies of treated women and offspring. It is obligatory for each clinic to report each treatment cycle to the register, by means of special treatment report forms that contain clinical as well as laboratory data. The pregnancy outcome is reported on special forms no later than two months after birth. The personal identification number (CPR) allows cross-linkage of the data from the register, with several other national Danish registers, such as the National Hospital Register the Abortion Register, the Danish Register of Causes of Death, the Cytogenetic Central Register and the Cancer Register. In 1998 a total of 7131 IVF and ICSI cycles were performed in Denmark. This corresponds to around 6500 cycles per 1 million women in the reproductive age, which is among the highest number per capita in the world. The coverage of the register is believed to be very close to 100% for the treatment reports, but less for the pregnancy outcome forms, at least during the first two years after the register was established. The main importance of the register is quality control aspects of assisted reproductive techniques and research in relation to follow-up on maternal and infant health.

State of health after deployment in the Persian Gulf. The Danish Gulf War Study.

Abstract: BACKGROUND: Multiple symptoms have been reported in American Gulf War Veterans including headache, fatigue, impaired short-term memory, sleep disturbances, agitation, respiratory symptoms, muscle and joint pain, diseases of the skin, and intermittent fever. The Danish Gulf War Study was performed to clarify if a corresponding pattern existed among Danes having served in the Persian Gulf during and mainly after the conflict. MATERIAL AND METHODS: A cross-sectional study was performed during the period January 1997 to January 1998 which included 821 subjects who had been deployed in the Persian Gulf within the period August 2 1990 until December 31 1997. Of 686 (83.6%) subjects who participated in the study, 95% had been engaged in peace keeping operations after the war. A group consisting of randomly selected age- and gender matched controls, comprised 231 of 400 potential participants (57.7%). All participants underwent clinical and paraclinical examinations, and had an interview based on a previously completed questionnaire. RESULTS: Unspecific symptoms such as repeated fits of headache, fatigue, memory and concentration difficulties, sleep disturbances, agitation, dyspnea, diseases of the skin, and intermittent fever, were significantly more frequent among Danish Gulf War Veterans, p < 0.05, than among controls; no association was found with respect to muscle and joint pain. The higher symptom prevalence among Gulf War Veterans was observed for conditions which had made their first appearance during or after the Gulf War. The prevalence of symptoms which made their first appearance before August 2 1990 was similar for both groups. CONCLUSION: Except for musculo-skeletal symptoms, this study demonstrated a pattern of symptoms among Danish Gulf War Veterans consistent with the findings among American Gulf War Veterans. Considering that American Gulf War Veterans were predominantly deployed during the armament phase and the brief war phase, and that Danish Gulf War Veterans were predominantly deployed after the war in peace keeping missions, the results indicate the existence of some common risk factors independent of war action.

Risk indicators of disability pension. A 15 year follow-up study.

Abstract: OBJECTIVE To identify risk indicators for granting of disability pension (DP) during a period of 15 years DESIGN Follow-up study The initial data were obtained from a health survey in a general population 1977/78 Variables were initially collected through questionnaires and objective measurements Information about the end-point for the follow-up, granting of DP, was obtained from the Registry for Early Retirement Pension in 1992/93 Data analyses were performed by logistic regression and Cox analyses SETTING The Glostrup Population Studies, Glostrup University Hospital and The Danish Committee for the Assessment of Substandard Lives POPULATION General population of 892 persons, born in 1918, 1928, 1938, and 1948, and living in the municipality of Glostrup, Denmark Eighty-four were granted DP during the 15 years follow-up RESULTS Ninety-six variables from the initial study were analysed, age and 18 variables were found to be risk indicators for DP These were general health variables, including dyspnoea, colic, nervousness, previous hospitalizations and operations, self-reported poor general health the last year, and low general health risk-score by the doctor Objective measurements included high Body Mass Index, low peak flow and isometric endurance of the back muscles Among the occupational variables unemployment and sick leave were found to be risk indicators In addition, low physical activity in leisure time, self-reported worse physical condition than those at the same age and smoking were also identified as risk indicators CONCLUSION The main indicators for granting of DP can be covered by the heading poor physical condition and general health

Active life in old age. Combining measures of functional ability and social participation.

Abstract: This paper describes a new measure of Active Life Expectancy, called Active Life Classification (ALC) in which the criterion for successful aging is a combination of good functional ability and high social participation Objectives 1) to describe the distribution of ALC among 75-year-old men and women, 2) to investigate the association between ALC and life satisfaction and 3) to describe how ALC is determined by socio-demographic, psycho-social, and health factors Design A cross-sectional population survey Setting Eleven municipalities in the Western part of Copenhagen County in 1989 Subjects A random sample of 75-year-old people who were invited to participate in the study (participation rate: 89, n = 477) Main outcome measure ALC is a combination of two dichotomized variables: functional ability (dependent vs not dependent of help) and social participation (low vs high) Results For both men and women an active life (measured by ALC) was significantly associated with life satisfaction For men only good self-rated health was related to ALC in the multivariate analysis Among women high income, many social contacts, good self-rated health, good memory and lack of chronic diseases were associated with ALC Conclusions It is an advantage to combine functional ability and social participation in the description of quality of life in old age, as 1) a high social participation may compensate for a poor functional ability, and vice versa, 2) the combined measure is meaningful for both sexes, and 3) it gives more information than the two concepts used as separate outcome measures

Studies of gene expression and activity of hexokinase, phosphofructokinase and glycogen synthase in human skeletal muscle in states of altered insulin-stimulated glucose metabolism.

Abstract: When whole body insulin-stimulated glucose disposal rate is measured in man applying the euglycaemic, hyperinsulinaemic clamp technique it has been shown that approximately 75% of glucose is taken up by skeletal muscle. After the initial transport step, glucose is rapidly phosphorylated to glucose-6-phosphate and routed into the major pathways of either glucose storage as glycogen or the glycolytic/tricarboxylic acid pathway. Glucose uptake in skeletal muscle involves-the activity of specific glucose transporters and hexokinases, whereas, phosphofructokinase and glycogen synthase hold critical roles in glucose oxidation/glycolysis and glucose storage, respectively. Glucose transporters and glycogen synthase activities are directly and acutely stimulated by insulin whereas the activities of hexokinases and phosphofructokinase may primarily be allosterically regulated. The aim of the review is to discuss our present knowledge of the activities and gene expression of hexokinase II (HKII), phosphofructokinase (PFK) and glycogen synthase (GS) in human skeletal muscle in states of altered insulin-stimulated glucose metabolism. My own experimental studies have comprised patients with disorders characterized by insulin resistance like non-insulin-dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM) before and after therapeutic interventions, patients with microvascular angina and patients with severe insulin resistant diabetes mellitus and congenital muscle fiber type disproportion myopathy as well as athletes who are in a state of improved insulin sensitivity. By applying the glucose insulin clamp method in combination with nuclear magnetic resonance 31P spectroscopy to normoglycaemic or hyperglycaemic insulin resistant subjects impairment of insulin-stimulated glucose transport and/or phosphorylation in skeletal muscle has been shown. In states characterized by insulin resistance but normoglycaemia, the activity of HKII measured in needle revealed any genetic variability that contributes to explain the decreased muscle levels of GS mRNA or the decreased activity and activation of muscle GS in NIDDM patients and their glucose tolerant but insulin resistant relatives. Thus, the causes of impaired insulin-stimulated glycogen synthesis of skeletal muscle in normoglycaemic insulin resistant subjects are likely to be found in the insulin signalling network proximal to the GS protein. In insulin resistant diabetic patients the impact of these yet unknown abnormalities may be accentuated by the prevailing hyperglycaemia and hyperlipidaemia. Endurance training in young healthy subjects results in improved insulin-stimulated glucose disposal rates, predominantly due to an increased glycogen synthesis rate in muscle, which is paralleled by an increased total GS activity, increased GS mRNA levels and enhanced insulin-stimulated activation of GS. These changes are probably due to local contraction-dependent mechanisms. Likewise, one-legged exercise training has been reported to increase the basal concentration of muscle GS mRNA in NIDDM patients to a level similar to that seen in control subjects although insulin-stimulated glucose disposal rates remain reduced in NIDDM patients. In the insulin resistant states examined so far, basal and insulin-stimulated glucose oxidation rate at the whole body level and PFK activity in muscle are normal. In parallel, no changes have been found in skeletal muscle levels of PFK mRNA and immunoreactive protein in NIDDM or IDDM patients. In endurance trained subjects insulin-stimulated whole body glucose oxidation rate is often increased. However, depending on the intensity and frequency, physical exercise may induce an increased, a decreased or an unaltered level of muscle PFK activity. In athletes the muscle PFK mRNA is similar to what is found in sedentary subjects whereas the immunoreactive PFK protein concentration is decreased.

On the pathophysiology of late onset non-insulin dependent diabetes mellitus. Current controversies and new insights.

Abstract: The development of late onset non-insulin dependent diabetes mellitus (NIDDM) is due to a complicated interplay between genes and environment on one side, and the interaction between metabolic defects in various tissues including the pancreatic beta cell (decreased insulin secretion), skeletal muscle (insulin resistance), liver (increased gluconeogenesis), adipose tissue (increased lipolysis) and possibly gut incretin hormones (defective glucagon like peptide 1 (GLP1) secretion) on the other side. Evidence for a genetic component includes the finding of a variety of metabolic defects in various tissues in non-diabetic subjects with a genetic predisposition to NIDDM, higher concordance rates for abnormal glucose tolerance including NIDDM in monozygotic compared with dizygotic twins, and the more recent demonstration of different NIDDM susceptibility genes at the sites of Insulin Receptor Substrate 1 (IRS1), the beta-3 adrenergic receptor, and the sulfonylurea receptor. However, the latter susceptibility genes only explain a minor proportion of NIDDM in the general population, and the quantitative extent to which genetic versus non-genetic factors contribute to NIDDM is presently unsolved. Environmental components include both an early intrauterine component associated with low birth weight, and later postnatal components including low physical activity, high fat diet, and the subsequent development of obesity and elevated plasma and tissue free fatty acid levels. Our finding of lower birth weights in monozygotic twins compared with their non-diabetic genetically identical co-twins excludes the possibility that the association between NIDDM and low birth weight as demonstrated in several studies may solely be explained by a coincidence between a certain gene causing both a low birth weight and an increased risk of NIDDM. Young first degree relatives of patients with NIDDM are characterized by hyperinsulinaemia and peripheral insulin resistance, which in turn may be explained by a decreased insulin activation of the enzyme glycogen synthase in skeletal muscle. Therefore, a defective skeletal muscle glycogen synthase activation may represent an early phenotypic expression of a genetic defect contributing to an increased risk of later development of NIDDM. However, elderly insulin resistant non-diabetic co-twins (64 years old) of twins with overt NIDDM does not--in contrast to their NIDDM co-twins--have a significantly decreased insulin activation of glycogen synthase in skeletal muscle. This demonstrates that the defective muscle glycogen synthase insulin activation has an apparent non-genetic component, and that this key defect of metabolism can be escaped or postponed even in non-diabetic subjects with a presumably 100% genetic predisposition to NIDDM. The insulin activation of glycogen synthase in skeletal muscle is compensated or apparently normalised in NIDDM patients when studied during their ambient fasting hyperglycaemia and a subsequent isoglycaemic (hyperglycaemic) physiologic insulin infusion. This indicates that the prevailing hyperglycaemia in NIDDM subjects compensates for the defective insulin activation of glycogen synthase present in those subjects when studied during eulycaemia. Our data and those of others also indicates that hyperglycaemia in NIDDM compensates for the defects in insulin secretion, the disproportionately elevated hepatic glucose production, and to some extent for the increased lipid oxidation and the decreased glucose oxidation present in NIDDM patients. Accordingly, NIDDM subjects exhibit all of those defects of metabolism when studied during "experimental decompensation" when the ambient hyperglycaemia is normalized by a prior and later withdrawn intravenous insulin infusion. However, shortly after the withdrawal of the intravenous insulin infusion, the plasma glucose concentration increased spontaneously in the NIDDM patients. (ABSTRACT TRUNCATED)

Determinants of long-term neuropsychological symptoms. The Danish Gulf War Study.

Abstract: INTRODUCTION Compared with controls, up to six years after their return, Danish Gulf War Veterans have a significantly higher prevalence of self-reported neuropsychological symptoms. Independent associations are found for concentration or memory problems, repeated fits of headache, balance disturbances or fits of dizziness, abnormal fatigue not caused by physical activity, and problems sleeping all night. We investigated whether psychosocial, physical, chemical or biological exposures were associated with these symptoms. METHODOLOGY This study is a prevalence study using retrospective data on exposure. Some 686 subjects who had been deployed in the Persian Gulf within the period August 2 1990 until December 31 1997 were included; the control group comprised 257 subjects matched according to age, gender and profession. All participants underwent clinical and paraclinical examinations, and were interviewed by a physician based on a completed questionnaire. RESULTS A clustering of three to five of the above symptoms were found in 21.4% of Gulf War Veterans vs. 6.2% in controls, p < 0.001. Psychosocial and physico-chemical factors were strongly associated with neuropsychological symptoms, and a significant interaction of the two was found, p < 0.001. CONCLUSION Although the results of this study are based on self-report the factors identified seem plausible. It may be impossible even in peace-keeping missions to avoid hostile events. However, the results also suggest that psychosocial work conditions known to be important in civilian life, and also environmental factors, should be improved to minimize the risk of long-term neuropsychological symptoms.

The Danish Prevention Register. A comprehensive health and socio-economic, individual based register.

Abstract: The Danish Prevention Register has been created recently as a very comprehensive national individual based register, based on register linkage. The Prevention Register currently comprises eight registers, which have been linked together using the unique personal identification number. The register contains data from 1977 and onwards. From an international research perspective this register offers unique opportunities to the researchers. The eight registers can be divided into three groups: health-related registers, registers on living conditions and a Register of Population Statistics. The health-related registers are: Register of Causes of Death, National Patient Register (in-patients and out-patients) and Register of Health Insurance Statistics (primary health care, GPs). Within the next few years the register will be expanded with The Medical Birth Register. The Abortion Register and The Malformation Register. The registers on living conditions are: Longitudinal Register of Social and Employment Statistics, Employment Classification Module, Educational Classification Module and Register of Population and Housing Censuses. The Register allows for cross-sectional and follow-up studies and is used for administrative purposes as well as research purposes. An overview of the register is presented in the article. Earlier articles in the Danish Register series in DMB explain details of the registers.

Risk factors for gastrointestinal symptoms. The Danish Gulf War Study.

Abstract: INTRODUCTION Compared with controls, up to six years after their return, Danish Gulf War Veterans have a significantly higher prevalence of self-reported gastrointestinal symptoms characterized by constant or occasional recurrent diarrhoea and frequent rumbling of the stomach within the preceding 12 months. The aim of this study was to clarify whether these symptoms could be attributed to physical, chemical or biological exposures. METHODOLOGY Some 686 subjects who had been deployed in the Persian Gulf within the period August 2 1990 until December 31 1997 were included in a prevalence study using retrospective data on exposure; the control group comprised 257 subjects matched according to age, gender and profession. All participants underwent clinical and paraclinical examinations, and were interviewed by a physician based on a previously completed questionnaire. RESULTS Among Gulf War Veterans the prevalence of gastrointestinal symptoms was 9.1% vs 1.7% among controls, p < 0.001. Of 24 physical, chemical or biological exposures, 15 were significantly, p < 0.05, associated with the outcome in bivariate analyses. After multivariate adjustment, two exposure variables were significantly associated with the outcome: Burning of waste or manure and exposure to insecticides against cockroaches; tooth brushing using water contaminated with chemicals or pesticides, and bathing in or drinking contaminated water, were nearly significant, p < 0.10. A group of 74 subjects had 3-4 of these exposures, and a prevalence of 18.9%; 164 subjects had 2 exposures and a prevalence of 12.8%, 270 subjects with one symptom had a prevalence of 7.4%, and 153 subjects without any of these exposures had a prevalence of 2.0%, a prevalence comparable to that of controls. The associations were not explained by differences in psychiatric symptoms, age or gender. CONCLUSION Our results suggest that, 1) a large proportion of long-term gastrointestinal problems among Gulf War Veterans can be attributed to specific exposures, 2) it should be possible to avoid a large proportion of long-term gastrointestinal symptoms in future similar missions by committed interventive measures.

Guidelines for good scientific practice.

Abstract: The Danish Committee on Scientific Dishonesty (DCSD) has existed for five years. As a preventive measure two sets of guidelines for the presentation of experimental reports and data documentation have been issued. Experiences from 24 cases of suspected scientific dishonesty have proven a need for further guidelines covering a wider range of scientific practice. Three key areas susceptible to conflicts between researchers and often resulting in subsequent accusations of scientific misconduct have been localized. Guidelines have, therefore, been prepared for these three areas: 1) Agreements at the start of cooperative research projects. 2) Rights and duties in storing and using research data. 3) Authorship. It is hoped that they will be helpful in prevention of conflicts and deviations from good scientific practice, and that they will be useful in the education of young researchers. The Danish Committee on Scientific Dishonesty. The Ministry of Research and Information Technology, Copenhagen.

Results from screening for gestational diabetes mellitus in a Danish county.

Abstract: OBJECTIVE To examine the complications in gestational diabetes mellitus with special reference to the significance of the threshold for the oral glucose tolerance test (OGTT, plasma glucose > or = 7.8 mmol/l (equivalent to blood glucose 6.9 mmol/l) (WHO criteria) or blood glucose > 6.7 mmol/l (local criteria) after 2 h 75 g oral glucose load). DESIGN Prospective descriptive study. SETTING From April 1, 1995 to April 1, 1997 a screening for gestational diabetes mellitus (GDM) according to the recommendations from the Danish board of health was performed in Ribe county. SUBJECTS Pregnant women in Ribe county (n = 6158). MAIN OUTCOME MEASURES Complications during pregnancy and the outcome. RESULTS Two hundred and twenty (3.6%) women had GDM by the local selection criteria and 2.8% according to the WHO criteria. The study revealed a significantly increased frequency of malformations (7.3% vs. 1.2%, p < 0.0001) and preeclampsia (15.5% vs. 1%, p < 0.0001) in the group with GDM independent of selection criteria (obesity vs. family history and glucosuria). The frequency of preeclampsia appeared higher in the group with obesity (p = 0.040). Malformations appeared with identical frequency in the groups with OGGT threshold higher than blood glucose 6.9 mmol/l (plasma glucose 7.8 mmol/l) (WHO criteria) and with blood glucose between 6.7 and 6.9 mmol/l, whereas preeclampsia did not occur with higher frequency in the latter group. CONCLUSION Complications appear frequently in women with an abnormal OGGT, and obesity predisposes to preeclampsia. The use of the WHO criteria for screening for GDM would miss a number of women with complications.

Empirical treatment of bacteraemic urinary tract infection. Evaluation of a decision support system.

Abstract: INTRODUCTION In a Danish county with a low prevalence of antibiotic resistance to most antibiotics, we have constructed and evaluated a decision support system (DSS) for guidance of empirical antibiotic therapy in patients with bacteraemia originating from the urinary tract. METHODOLOGY The DSS was based upon a causal probabilistic network, and a decision theoretic approach was used to balance the costs of antibiotic therapy against the therapeutic benefit. The costs included direct cost of purchasing antibiotics, side effects, and the risk of development of antibiotic resistance. The therapeutic benefit was defined as the increase in life-expectancy caused by antibiotic therapy. Life-years were chosen as the common currency unit. Four hundred and ninety-one bacteraemias seen during 1992-1994 were used to construct the DSS (derivation set), and 426 bacteraemias during 1995-1996 were used for evaluation (validation set). The cases were identified in a regional register of bacteraemias. The study was non-interventional. RESULTS The DSS suggested antibiotics which would provide coverage in 377 of the 426 episodes (88.5%) compared to 259 episodes (60.8%) for which empirical therapy actually provided coverage (p < 0.01, McNemar-test). The regimens suggested by the DSS included mecillinam as monotherapy in 240 episodes (56.3%), gentamicin as monotherapy in 81 (19.0%), and a combination of gentamicin and ampicillin in 80 (18.8%). CONCLUSION A decision theoretic approach shows promise of improving empirical antibiotic treatment, and may be a measure to support an antibiotic policy.

Waist circumference and body mass index as predictors of elevated alanine transaminase in Danes aged 30 to 50 years.

Abstract: Introduction We examined whether waist circumference and waist-to-hip circumference ratio were a better predictor for elevated alanine transaminase level than body mass index. Methodology In a cross-sectional survey we examined body mass index, waist circumference, waist-to-hip ratio, alcohol consumption, and alanine transaminase level in a random sample of 903 men and women aged 30 to 50 years from The Ebeltoft Health Promotion Project in Denmark. Results Body mass index, waist circumference and waist-to-hip ratio explained an approximate 12% variation in alanine transaminase in men and 4% in women, whereas waist-to-hip circumference ratio explained a 2% variation in women. The risk of elevated alanine transaminase level in men, calculated as odds ratio, with a body mass index (kg/m2) above 30, or a waist circumference above 102 cm, or a waist-to-hip circumference ratio above 0.9 was 9.3 (95% confidence interval [CI], 3.6-24.1), 5.6 (95% CI, 2.5-12.5) and 2.7 (95% CI, 1.3-5.3) respectively, but there was no elevated risk among women. Conclusions Waist circumference and body mass index were both predictors in men. Waist-to-hip ratio was also a predictor in men, but not as strong a predictor as waist circumference and body mass index. No association was found in women. This difference is probably explained by differences in the accumulation of intra-abdominal adipose tissue among men and women with the same degree of obesity.

Gastroscopic treatment of gastric band penetrating the gastric wall.

Abstract: Gastric wall penetration of a gastric band after operation for morbid obesity is a well known late complication The treatment is usually reoperation In this case report we show that a band penetrating the gastric wall can be successfully treated by gastroscopic operation This technique is more simple than reoperation, especially in case of morbid obesity at the time of the complication

Cardiovascular effects of oesophageal dilation under general anaesthesia.

Abstract: Myocardial ischaemia and cardiac arrhythmias may occur during oesophageal dilation under conscious sedation, but no prospective data exist regarding dilation under general anaesthesia. We have studied the haemodynamic and electrocardiographic changes during routine oesophageal balloon dilation under general anaesthesia. Ten consecutive patients with benign oesophageal strictures were evaluated. Arterial oxygen saturation was measured by continuous pulse oximetry, ECG was recorded continuously with a Holter tape recorder, and blood pressure was measured non-invasively every five minutes during the procedure. Four patients developed significant hypotension at the time of balloon inflation with two patients requiring medical intervention to re-establish sufficient cardiovascular function. Tachycardia and ST-deviation occurred in four and three patients, respectively, during the general anaesthesia, but was not associated with the actual time of oesophageal distension. Thus, all cases of myocardial ischaemia were related to the time of extubation. No lasting complications were seen, and all patients could be discharged a maximum of 24 hours after the procedure. Pneumatic dilation of the oesophagus under general anaesthesia may be associated with significant hypotension, but the pathogenetic mechanisms involved are not clear. In this pilot study, the observed hypotension was not related to concurrent myocardial ischaemia.

Gastric mucosal interleukin-8 and IL-8 antibody concentrations related to prevailing Helicobacter pylori infections. A Danish-Albanian study.

Abstract: OBJECTIVES Helicobacter pylori (H. pylori) appears to initiate an inflammatory cascade. Thus, phagocytes are accumulated in the gastric mucosa, in inflammatory conditions. Further, a potent chemotactic mediator, interleukin 8 (IL-8) is synthesized at such sites. The recently described IL-8 autoantibodies may, however, counteract the pro-inflammatory actions of IL-8. The aim was to study the correlation between H. pylori infection and IL-8, together with IL-8 autoantibodies in two different populations from a developed and a developing country. METHODS Two different endoscopically characterized populations (65 Danes and 89 Albanians) were examined. IL-8 and IL-8 autoantibodies were detected by ELISA techniques, and H. pylori was identified by histological examinations. RESULTS Significantly more Albanian controls and dyspeptic patients (80 out of 89 persons) were H. pylori positive as compared to 24 of 65 Danes (p 0.05). Further, H. pylori positive patients from both countries had significantly higher levels of IL-8 as compared to H. pylori negative patients (p < 0.001). However, significantly higher levels of IL-8 autoantibodies were found in the Albanian sub-population (median 138 O.D. units versus 52 O.D. units among Danes) (p < 0.001). CONCLUSIONS In H. pylori related disorders, a high mucosal IL-8 production has been found. However, this investigation further demonstrates higher levels of IL-8 autoantibodies among dyspeptic patients from a developing country, which might possibly counteract the pro-inflammatory actions of IL-8 by binding the molecule. The physiological significance of an altered immune response as described here needs to be elucidated in future studies.

Risk factors in wound infections after laparotomy in obstetrics and gynaecology.

Abstract: BACKGROUND The objectives of the study are to obtain risk factors for and rates in postoperative wound infections in order to develop an infection surveillance program. METHODS A retrospective, case-controlled three-year study of wound infections in Caesarean sections and gynaecological laparotomies with 15 predictive variables. For each patient and variable, the likelihood ratio of having infection was calculated. The prior odds of infection were iteratively combined by a set of predictive variables to establish the posterior probability of being infected. A patient was classified as pathological if the posterior probability was above 0.5 and as normal if the posterior probability was below 0.5. The squared risk of misclassification was used as indicator of the goodness of classification. RESULTS Ruptured membranes prior to Caesarean section classified 88% of the patients correctly. For gynaecological laparotomies body mass index classified 76% of the patients correctly. The remaining predictive variables added little to improve the classification. CONCLUSIONS Infection surveillance programs may reduce wound infection rates and have been recommended because they offer increased service quality, safer guidance for the implemantation of preventive measures, and better patient information. We have demonstrated that the number of predictive variables necessary in registering Caesarean sections can be limited to one or two, and in gynaecological laparotomies to one to three.