Corticotroph Aggressive Pituitary Tumors and Carcinomas Frequently Harbor ATRX Mutations

CONTEXT

Aggressive pituitary tumors (APTs) are characterized by unusually rapid growth and lack of response to standard treatment. About 1% to 2% develop metastases being classified as pituitary carcinomas (PCs). For unknown reasons, the corticotroph tumors are overrepresented among APTs and PCs. Mutations in the alpha thalassemia/mental retardation syndrome X-linked (ATRX) gene, regulating chromatin remodeling and telomere maintenance, have been implicated in the development of several cancer types, including neuroendocrine tumors.

OBJECTIVE

To study ATRX protein expression and mutational status of the ATRX gene in APTs and PCs.

DESIGN

We investigated ATRX protein expression by using immunohistochemistry in 30 APTs and 18 PCs, mostly of Pit-1 and T-Pit cell lineage. In tumors lacking ATRX immunolabeling, mutational status of the ATRX gene was explored.

RESULTS

Nine of the 48 tumors (19%) demonstrated lack of ATRX immunolabelling with a higher proportion in patients with PCs (5/18; 28%) than in those with APTs (4/30;13%). Lack of ATRX was most common in the corticotroph tumors, 7/22 (32%), versus tumors of the Pit-1 lineage, 2/24 (8%). Loss-of-function ATRX mutations were found in all 9 ATRX immunonegative cases: nonsense mutations (n = 4), frameshift deletions (n = 4), and large deletions affecting 22-28 of the 36 exons (n = 3). More than 1 ATRX gene defect was identified in 2 PCs.

CONCLUSION

ATRX mutations occur in a subset of APTs and are more common in corticotroph tumors. The findings provide a rationale for performing ATRX immunohistochemistry to identify patients at risk of developing aggressive and potentially metastatic pituitary tumors.

Changes in quality of life after rehabilitation for patients with progressive neurological disorders

The aim was to study whether patients with progressive neurological disorders experienced a changed quality of life at the end of a rehabilitation period and 3-4 months after their return home. Forty-one and 37 patients respectively filled in a self-administered questionnaire Quality of Life: Status and Change (QLsc). There was a significant difference between the two occasions for responses regarding the items 'My bodily health has become', 'My well-being has become' and 'I am able to maintain a good pace and lead an active life'. The alternatives 'rather good' to 'much better' were chosen more often at the end of the rehabilitation period than after 3-4 months. There were also differences between respondents who had been to the rehabilitation centre for the first time and those who had recurrent visits, regarding the items: 'My bodily health has become', 'My well-being has become' and 'My whole life is'. The alternative neither/nor was rated fairly evenly on both response occasions. The study probably indicates that the recurrent rehabilitation periods at the centre have an effect. When the respondents respond to items with a global focus, they seem to indicate experiences of a higher QOL.

Evaluation of the QALY model for analysis of cost-effectiveness of eating training after stroke

New methods developed and insights gained in research are of increasing significance in health care and the question is which services and methods are to be implemented. If eating training after stroke is to be implemented it must be given priority in relation to other measures. Otherwise there is a risk that patients with eating difficulties after stroke will be fed by personnel or permanently receive nourishment via tube. This may lead to expensive measures or costs for the tube feeding as well as costs for the personnel needed for feeding, and patients' well-being will be reduced if they do not have the opportunity to eat as independently as possible. Economic analyses should not guide the priorities to be made, but can be one of several bases for resource allocation. The estimation of cost-effectiveness must, however, be made by means of a method which in its ethical foundation is in line with nursing and the Swedish Government Bill for guiding priorities in health care. The aim of this paper is to discuss the ethical foundation of nursing care and the ethical principles proposed by the Swedish Government Bill for guiding priorities in health care and the model of Quality Adjusted Life Years (QALYs) related to eating training after stroke. The findings showed that there was a considerable difference in the ways health and health maximization were discussed in the QALY model and in specific nursing care. There are two aspects underpinning the QALY model that are not in line with either the ethical foundations of nursing or the principles proposed by the Swedish Government Bill for guiding priorities in health care. However, a new method called Equity Adjusted Life Years (EQALYs) can be a tool for evaluation in specific nursing care. Cost per EQALY is based on a compromise between initial severity of disease and treatment effect that is very close to the distribution rule applied in specific nursing care. In conclusion it is obvious that cost per EQALY, a balance between health maximization and severity of disease and treatment effects, can be a tool for the evaluation of eating training after stroke.

A care policy and its implementation

Chief physicians, nurse managers and head nurses (n = 50) in hospital care and primary health care in Västerbotten, Sweden, were interviewed to explore their views on adopting and implementing a new care policy. The results indicated agreement among the respondents concerning the values of the care policy and its adaptability to the health-care system. More respondents in hospital care than in primary health care expressed a positive view (63%, respectively 55%), reported involvement in the implementation process (64%, respectively 35%) and planned or ongoing activities (63%, respectively 45%). Obstacles in the implementation process due to a frustrated situation and barriers between professional groups were, however, expressed by 67% of the respondents, more among the respondents in primary health care than among those in hospital care (75%, respectively 62%). Divergent views among respondents working in the same department were seen in both hospital care and primary health care. The findings indicated demands for further efforts if the implementation is to move on from its early stages, especially in primary health care.

Balance board training: prevention of traumatic injuries of the lower extremities in female soccer players? A prospective randomized intervention study

This prospective randomized intervention investigated whether training on a balance board could reduce the amount of traumatic injuries of the lower extremities in female soccer players. A total of 221 female soccer players from 13 different teams playing in the second and third Swedish divisions volunteered to participate in the study. Seven teams (n = 121) were randomized to an intervention group and six teams (n = 100) to a control group and were followed during one outdoor season (April-October). Before and after the season muscle flexibility and balance/postural sway of the lower extremities were measured in the players. There were no significant differences in age, height, weight, muscle flexibility and balance/postural sway of the lower extremities between the intervention and the control group. During the season the players in the intervention group performed a special training program consisting of 10-15 min of balance board training in addition to their standard soccer practice and games. After a 37% drop-out the intervention group consisted of 62 players and the control group of 78 players. The results showed no significant differences between the groups with respect either to the number, incidence, or type of traumatic injuries of the lower extremities. The incidence rate of "major" injuries was higher in the intervention group than in the control group. Four of five anterior cruciate ligament injuries occurred in the intervention group, which means that we could not prevent severe knee injuries in female soccer players with balance board training. However, among the players who had been injured during the 3-month period prior to this investigation there were significantly more players from the control group than from the intervention group who sustained new injuries during the study period.

Assessment of functional knee bracing: an in vivo three-dimensional kinematic analysis of the anterior cruciate deficient knee

OBJECTIVE

To describe three-dimensional tibial and femoral movements in vivo and examine the effect of a brace on knee kinematics during moderate to intense activity.

DESIGN

Skeletal kinematics of anterior cruciate ligament deficient knees was measured with and without braces during moderate to intense activity.

BACKGROUND

Invasive markers implanted into the tibia and femur are the most accurate means to directly measure skeletal motion and may provide a more sensitive measure of the differences between brace conditions.

METHODS

Steinmann traction pins were implanted into the femur and tibia of four subjects having a partial or complete anterior cruciate ligament rupture. Non-braced and braced conditions were randomly assigned and subjects jumped for maximal horizontal distance to sufficiently stress the anterior cruciate ligament.

RESULTS

Intra-subject peak vertical force and posterior shear force were generally consistent between conditions. Intra-subject kinematics was repeatable but linear displacements between brace conditions were small. Differences in angular and linear skeletal motion were observed across subjects. Bracing the anterior cruciate ligament deficient knee resulted in only minor kinematic changes in tibiofemoral joint motion.

CONCLUSION

In this study, no consistent reductions in anterior tibial translations were observed as a function of the knee brace tested. Relevance. Investigations have reported that knee braces fail when high loads are encountered or when load is applied in an unpredictable manner. Questions remain regarding tibiofemoral joint motion, in particular linear displacements. The pin technique is a means for direct skeletal measurement and may provide a more sensitive measure of the differences between brace conditions.

Emission of ozone and organic volatiles from a selection of laser printers and photocopiers

To estimate the impact of office equipment on the quality of indoor air, the emission of ozone and organic volatiles was measured from one photocopier and four laser printers, three of which operated according to traditional corona discharge technology. The laser printers equipped with traditional technology emitted significant amounts of ozone and formaldehyde. Lesser amounts of other volatile aldehydes were emitted during printing. The photocopier emitted mainly ozone. In a well-ventilated office environment, the amounts encountered here for individual volatiles were within recommended maximum exposure limits for a reasonable density of printers. Because it is not known whether the concentration of irritating volatiles, such as formaldehyde, should be kept lower in an ozone rich environment or not, and because emissions in the immediate vicinity of the printers exceeded recommendations, the authors recommend that laser printers equipped with the traditional corona rods not be placed beside or immediately at the working site of office personnel. This way, ozone concentrations can be kept below recommended maximum exposure limits, provided that the ventilation rate is adequate. Further, it seems that if a reliable quantitative comparison of total organic volatiles prior to and during printing is to be made, the inertness of the sorbent toward ozone should be confirmed.

Body burden of aluminum in relation to central nervous system function among metal inert-gas welders

OBJECTIVES

The relationship between elevated internal aluminum loads and central nervous system function was studied among aluminum welders, and the threshold level for adverse effect was defined.

METHODS

For 65 aluminum welders and 25 current mild steel welders body burden was estimated, and the aluminum concentrations in serum (S-Al) and urine (U-Al) were analyzed with graphite furnace atomic absorption spectrometry with Zeeman background correction. Referents and low-exposure and high-exposure groups were defined according to an aggregated measure of aluminum body burden, the group median S-Al levels being 0.08, 0.14, and 0.46 micromol/l, respectively, and the corresponding values for U-Al being 0.4, 1.8, and 7.1 micromol/l. Central nervous system functions were assessed with a neuropsychological test battery, symptom and mood questionnaires, a visual and quantitative analysis of electroencephalography (EEG), and P3 event-related potentials with pitch and duration paradigms.

RESULTS

Subjective symptoms showed exposure-related increases in fatigue, mild depression, and memory and concentration problems. Neuropsychological testing revealed a circumscribed effect of aluminum, mainly in tasks demanding complex attention and the processing of information in the working memory system and in the analysis and recall of abstract visual patterns. The visual EEG analysis revealed pathological findings only for aluminum welders. Mild, diffuse abnormalities were found in 17% of the low-exposure group and 27% of the high-exposure group, and mild to moderate epileptiform abnormalities at a frequency of 7% and 17%, respectively.

CONCLUSIONS

Both objective neurophysiological and neuropsychological measures and subjective symptomatology indicated mild but unequivocal findings dose-dependently associated with increased aluminum body burden. The study indicates that the body burden threshold for adverse effect approximates an U-Al value of 4-6 micromol/l and an S-Al value of 0.25-0.35 micromol/l among aluminum welders.

Potency test of inactivated Newcastle disease vaccines by monoclonal antibody blocking ELISA

The potency of 27 different inactivated Newcastle disease (ND) vaccines was determined by immunization and challenge tests. Three- and four-week-old SPF chickens were immunized with 1/50 dose of vaccines. The chickens were bled and challenged three weeks later. The protected/challenged ratio was determined. Serum samples were tested by the haemagglutination inhibition (HI) test and by a monoclonal antibody (MAB) blocking enzyme-linked immunosorbent assay (B-ELISA). Ninety-four percent of the vaccinated chickens (353 birds) with a B-ELISA value above 60% were protected. A strong positive correlation (0.934) was found between 'actual protection' (protection against challenge) and 'estimated protection' (protection calculated from the B-ELISA results). Based upon the results obtained, this B-ELISA seems to be suitable for replacing the challenge test in the potency control of inactivated ND vaccines in the future.

Intra-articular absorption and distribution of ketoprofen after topical plaster application and oral intake in 100 patients undergoing knee arthroscopy

OBJECTIVE

The primary objective of this study was to assess the kinetics of ketoprofen in synovial fluid and intra-articular tissues in relation to plasma. The secondary objective was to study whether intra-articular tissues act as reservoirs.

METHODS

The ketoprofen concentration was analysed in plasma, synovial fluid and intra-articular tissues after single application of a 30 mg plaster (n = 40), multiple applications for 5 days (n = 30) or oral intake of 50 mg (n = 30) in patients undergoing knee arthroscopy.

RESULTS

Median CMax values after topical application were 12.8 ng/ml in synovial fluid, 56.7 ng/g in synovial tissue, 349.3 ng/g in meniscus and 568.9 ng/g in cartilage.

CONCLUSION

Topical applications of ketoprofen allow the attainment of high intra-articular tissue concentrations.

A comparison of 50, 100 and 200 mg of intra-articular pethidine during knee joint surgery, a controlled study with evidence for local demethylation to norpethidine

Pethidine (meperidine) is a compound with both local anaesthetic and opioid agonist properties. We have in a recent study demonstrated that pethidine could be an interesting alternative to prilocaine in arthroscopy with local anaesthetic technique. Therefore, we investigated, in a controlled randomized double-blind study, the effect of three doses of pethidine compared with a standard local anaesthetic, in patients subjected to arthroscopic knee joint surgery. Ten patients in each group received 50 mg (P50), 100 mg (P100), 200 mg (P200) of pethidine or prilocaine (5 mg/ml) + adrenaline (4 mg/ml) (PC), injected intra-articularly (i.a.) before surgery. We measured pain intensity and discomfort during arthroscopy and pain intensity at rest and at movement, nausea and tiredness for 3 days post-operatively at regular intervals using the VAS-technique. We also measured the concentration of pethidine and its demethylated metabolite, norpethidine, in plasma by collecting blood samples at 20, 40, 60, 80, 140 and 200 min following injection, and in synovial fluid which was collected through the arthroscope at the start and the end of the surgery. It was found that significantly more patients in the P50 group (n = 6) needed general anaesthesia due to intense pain than those in the P100 group (n = 1), P200 group (n = 0) or the PC group (n = 1). The PC group required significantly more analgesics and had a significantly higher calculated total sum of pain scores at movement post-operatively, than the other three groups. The P200 group more often reported tiredness post-operatively than the other three groups. We conclude that 100 or 200 mg pethidine i.a. produces satisfactory anaesthesia for surgery. There was a rapid transfer of pethidine from synovial fluid to plasma, resulting in plasma levels earlier reported to produce centrally mediated effects, such as analgesia and tiredness. We found much higher concentrations of norpethidine in the synovial fluid than in plasma, suggesting a local demethylation in the knee joint tissues. This site of drug oxidation has not earlier been demonstrated neither in vitro nor in vivo. The results suggest that pethidine given i.a. in the dose range of 50 to 200 mg results in analgesia due to both peripheral and central mechanisms. The significant systemic uptake of pethidine can cause unwanted side-effects.

Effect of antibiotic growth promoters and anticoccidials on growth of Clostridium perfringens in the caeca and on performance of broiler chickens

The effects of the growth promoters avoparcin and avilamycin and the ionophore anticoccidials maduramicin, narasin and monensin on the growth of Clostridium perfringens (Cp) in the caeca and on performance of broiler chickens were tested in 2 experiments. The supplements were fed as single feed additives or in some combinations. No clinical signs or lesions caused by coccidia were observed in any of the studies. All supplements had an antibacterial effect on Cp and improved growth rate significantly. Carcass yield of birds fed growth promoters avilamycin or avoparcin was significantly higher compared with birds fed anticoccidials. These data indicate that, what concerns bird performance, during good hygienic conditions supplementation with antibiotic growth promoters may not be necessary when the diet is supplemented with an anticoccidial with antibacterial effects.

Early arthroscopic treatment of primary traumatic anterior shoulder dislocation. A follow-up study

This study evaluates the results of early arthroscopic Bankart repair in patients with primary traumatic anterior dislocation of the shoulder. The patients' age range was 17-34 years. Arthroscopic Bankart repair was performed within 12 days after the dislocation. First follow-up was at 18 months. According to Rowe's score, 11 patients (73%) were excellent, 3 (20%) were good and 1 (7%) was poor. The median external rotation deficit was 4 degrees in the adducted position. At a second follow-up at 34 months, two patients had redislocated. Both of these patients had severe generalized joint laxity. Another patient reported frequent subluxations. We conclude that in young patients with primary anterior traumatic shoulder dislocation, early arthroscopic Bankart repair implies a low recurrence rate and restores shoulder function to normal. Generalized joint laxity could indicate an increased risk for recurrent dislocation.

The view of caring among patients and personnel

All patients in hospital care and primary health care in the country of Västerbotten, Sweden (n = 5158) were asked to express their level of satisfaction with the quality of care. The study was carried out on one specific day. All personnel on duty that day (n = 2824) were also included and asked to give their interpretations of their patients' experiences. A questionnaire containing positive and negative statements concerning both the relationship and the task aspects of care was used. The results showed that the youngest and oldest patients expressed the highest degree of satisfaction, while young and middle-aged patients expressed a more restrained view. The least satisfactory aspects concerned the opportunities to express criticism and the possibilities of receiving information about access to help outside the health care organization. The personnel's responses agreed with those of the patients, but fewer personnel thought that their patients were satisfied than was in fact the case.

Self-reported quality of life for patients with progressive neurological diseases

Progressive neurological diseases influence the life situation of patients either totally or partially. Such patients' own ratings of their life situation and well-being were made using a health-related quality of life HRQoL instrument called Quality of Life: status and change (QLsc). In general the interviewees rated their life domains in terms of positive response alternatives and no subgroups were found, e.g. with the same diagnoses, periods of sickness or age. The results suggest that the interviewees' experience of quality of life (QoL) is subjective and individual. The interviewees who had been to the rehabilitation centre several times rated their quality of life, in terms of positive response alternatives for the items covering overall experiences of bodily health, well-being and their whole life as well as for items in the social domain, to a greater extent than those who were visiting it for the first time.

Factors affecting donor-site morbidity after anterior cruciate ligament reconstruction using bone-patellar tendon-bone autografts

The objective of this study was to assess knee function after anterior cruciate ligament reconstruction focusing on residual donor-site problems. Ninety consecutive patients with chronic unilateral anterior cruciate ligament rupture were operated on by the same surgeon using patellar tendon autografts, the all-inside arthroscopic technique, and interference screw fixation. At the follow-up examination 24 (range 22-32) months after the index operation, the median total anterior-posterior KT-1000 side-to-side difference was 2.5 (-7 to 11) mm. The median Lysholm score was 86 (range 37-100) points and the median Tegner activity level was 6 (range 1-9). Using the IKDC evaluation system, 62 of 90 (69%) were classified as normal or nearly normal. The median one-leg-hop quotient was 93 (range 0-167)% of the uninjured leg. Of 90 patients, 44 (49%) had minor or no discomfort when asked to walk on their knees (kneewalkers) and 46 of 90 (51%) patients had severe problems or found it impossible to perform the test (non-kneewalkers). The 'kneewalkers' had a median loss of anterior knee sensitivity of 10 (range 0-120) cm2. The corresponding value for the 'non-kneewalkers' was 25 (range 0-200) cm2 (P = 0.0001). Palpatory donor-site tenderness was registered in 19 of 44 (43%) of the 'kneewalkers' and 37 of 46 (80%) of the 'non-kneewalkers' (P < 0.001). Full hyperextension was not regained by 9 of 44 (20%) of the 'kneewalkers' and 19 of 46 (41%) of the 'non-kneewalkers' (P < 0.05). Additional surgery during the follow-up period was required by 6 of 44 (14%) of the 'kneewalkers' and 19 of 46 (41%) of the 'non-kneewalkers' (P < 0.01). Magnetic resonance imaging focusing on the donor site was performed on 31 randomly selected patients and revealed no difference between the 'kneewalkers' and the 'non-kneewalkers' in terms of patellar tendon width, thickness, length, and residual donor-site gap size. The kneewalking test was found to be a functional and reliable test for detecting donor-site morbidity. It appears that donor-site morbidity was related to problems requiring additional surgery during the follow-up period, such as extension deficit and pain near the metal implant on the tibial side, as well as the loss of anterior knee sensitivity. It appears to be important to attempt to preserve the sensitivity in the operated area during surgery and to regain full hyperextension in the postoperative period to minimize donor-site morbidity.

Effect of antibiotic growth promoters and anticoccidials on growth of Clostridium perfringens in the caeca and on performance of broiler chickens

The effects of the growth promoters avoparcin and avilamycin and the ionophore anticoccidials maduramicin, narasin and monensin on the growth of Clostridium perfringens (Cp) in the caeca and on performance of broiler chickens were tested in 2 experiments. The supplements were fed as single feed additives or in some combinations. No clinical signs or lesions caused by coccidia were observed in any of the studies. All supplements had an antibacterial effect on Cp and improved growth rate significantly. Carcass yield of birds fed growth promoters avilamycin or avoparcin was significantly higher compared with birds fed anticoccidials. These data indicate that, what concerns bird performance, during good hygienic conditions supplementation with antibiotic growth promoters may not be necessary when the diet is supplemented with an anticoccidial with antibacterial effects.

Avoiding pitfalls in tibial bone plug fixation in anterior cruciate ligament reconstruction

Performing arthroscopic anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone autograft normally includes placing sutures in the femoral bone plug to be able to pull the graft through the joint, and in the tibial bone plug to be able to apply tension to the graft as you insert the distal interference screw. We have used one No. 5 Ethibond suture (Ethicon, Somerville, NJ) for the femoral bone plug, and normally place two similar sutures into the tibial bone plug. This is to reduce the risk of loosing tension if one of the sutures is cut while inserting the tibial fixation screw. This article suggests a solution to the problems that will arise in cases of accidentally cutting both of the sutures in the tibial bone plug.

Local anesthesia for arthroscopic surgery of the ankle using pethidine or prilocaine

Investigation of the intraoperative and postoperative pain-reducing effect of pethidine (meperidine) as compared with local anesthetics given into the ankle joint was performed, in a comparative and double-blind fashion, in 20 patients subjected to arthroscopy of the ankle, diagnostic and surgical procedures. These patients were randomly assigned to one of two groups. Group A consisted of 10 patients receiving prilocaine 5% with adrenaline and the patients of group B received pethidine 5% with adrenaline intraarticularly. During arthroscopy, the patients reported on pain and discomfort using visual analog scales. Ratings did not differ between the two groups, but six patients would not have chosen the local anesthetic technique again. Postoperatively, all patients rated their pain and discomfort at rest and at movement (1, 2, 3, 5, 6, 8, and 24 hours and at three times during 2 following days). No differences were found between the two groups, except for pain at rest through the whole observation period when significant lower values for pethidine. There were no differences in use of analgesics between the two groups. The current study indicates that pethidine is a potential alternative to prilocaine in arthroscopy of the ankle.

Ankle arthroscopy under local and general anaesthesia for diagnostic evaluation and treatment

Improvements in techniques and instrumentation are extending the diagnostic and therapeutic indications for ankle arthroscopy. We aimed to study the diagnostic and therapeutic benefits and complication rate from 112 consecutive ankle arthroscopies performed between 1991 and 1994 under local and general anaesthesia. One-hundred and twelve outpatient ankle arthroscopies were performed in 72 male and 37 female patients, 16-64 years old. The patients were comparable in terms of gender and age in the arthroscopies done under local (n = 69) and the arthroscopies done under general anaesthesia (n = 43). The indications for surgery were pain in 75%, instability in 15%, limited function in 7% and swelling in 4%, and these criteria were similar in both groups. Antero-medial and anterolateral portals were used in all cases. No tourniquet was used and an external distractor was used in one case only. In 64 cases (57%) surgery was performed and included synovectomy, removal of loose bodies, shaving drilling of osteochondritic or other cartilage lesions, resection of impinging osteophytes, fibrosis and meniscoid lesions. In 95 ankles (85%) a definite diagnosis was established. Comparable diagnostic and therapeutic potentials were found between local and general anaesthesia. The complication rate was low. One patient who was operated on under general anaesthesia sustained a deep infection, and three suffered minor superficial nerve injuries. In conclusion, ankle arthroscopy may be performed under local or general anaesthesia with similar diagnostic value and with a low complication rate.

Patients' narratives concerning good and bad caring

Narratives from patients (n = 80) and patients' relatives (n = 12) were collected to illuminate experiences of good and bad caring episodes and to obtain descriptions of good caring. Narratives describing good caring included such task aspects as swift and correct assessment and access to information. Aspects less frequently mentioned were, for example, being given time, receiving pain relief and good food. Relationship aspects mentioned; having an interest shown in the care, being taken seriously and being cared about. There are parallels regarding relationship aspects between the narratives concerning good and bad caring episodes; for example what was praised in the good caring narratives was criticized in those describing bad caring. Such parallels were being/not being trusted, being/not being believed and being/not being respected. The narrations concerning bad caring were more specific and more vivid than those about good caring. The authors' interpretation was that the bad episodes were unexpected and very painful and therefore remained imprinted in the patients' memories. The descriptions of good caring included relationship aspects in only 34 cases, task aspects in only five cases and a combination of both in 50 cases. The ultimate purpose of the study was to obtain a basis for the development of a policy for good caring founded on patients' experiences. It is desirable that further studies be undertaken within various clinical specialties which would also take into consideration medical, social and cultural perspectives.

What neurological patients regard as quality of life

The aim of this study was to investigate how patients with progressive neurological disorders describe what they perceive as quality of life. The patients (n = 169) were interviewed while staying at a neurological rehabilitation centre by way of an open question, what 'quality of life' represented to them. Patients' statements were classified and a comparison was made with Kajandi's three levels of factors constituting quality of life. The categories that came forth were 'living in a sense of affinity', 'being independent', 'living on one's own terms' and 'feeling that life is meaningful'. The statements constituting the basis of the categories were impressive and illustrated wisdom. The results underline the uniqueness of each patient's situation, and how important it is that nursing and treatment are adjusted to the needs of the individual.

Nivalenol in Swedish cereals--occurrence, production and toxicity towards chickens

Nivalenol has been analysed in Swedish cereals between 1987 and 1990 and it was found in oats (35% of all samples), barley (13%) and wheat (4%), with a high yearly variation. The highest concentration was 4700 micrograms/kg. Nivalenol-producing strains of Fusarium poae were isolated from contaminated samples. Feeding nivalenol to chicks produced no toxic effects at concentrations below 5 mg/kg and only small effects at 6 and 12 mg/kg.

Control of Salmonella enteritidis in Sweden

The Swedish control of Salmonella, with special reference to Salmonella enteritidis, in poultry is described. The control is directed at all serotypes of Salmonella and imported grandparent chickens are controlled, which is considered to be the main reason why Sweden so far is not found to be involved in the worldwide spread of different phagetypes of S. enteritidis. However, this spread has initiated a more stringent control of Salmonella in layers as earlier existed in broilers. Since 1990, 90% of the layer flocks are voluntarily tested for Salmonella before slaughter by bacteriological examination of pooled faecal samples. If S. enteritidis is isolated the flock is destroyed. This test, and in addition two similar tests during the production are mandatory as of January 1st, 1994. The voluntary Salmonella control programme has also been extended to all of the layer parents and hatcheries since 1991. Only heat-treated feed is given to all layer chickens during the rearing period and its use is becoming gradually more common also during the production period. Since 1987, four layer flocks have been found to be infected by S. enteritidis phagetype 4 and one flock with phagetype 6. During 1970-1984, 90% of all flocks of broilers were voluntarily tested bacteriologically for Salmonella before slaughter, and since 1984 such a control is mandatory to all flocks. As a result of this and other controls, S. enteritidis has not been isolated from broilers since 1972. Based on a governmental regulation from 1961, introduced as a result of a large Salmonella epidemic in 1953, Sweden runs an active, official control of Salmonella (Wierup et al., 1992).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of feeding nivalenol-contaminated diets to male broiler chickens

In two feeding trials the effect of nivalenol (NIV) on male broiler chickens was studied. A commercial starter diet was provided for ad libitum consumption throughout the whole experiment. The NIV was added to the feed when the birds were 7 d old. Growth and feed consumption were thereafter registered every 5th d during 20 d. In the first trial birds were offered feed containing 0, .5, 2.5, or 5 ppm NIV. The only variable that significantly differed from the control was the concentration of uric acid in plasma, which was increased by 94 and 66%, respectively, in treatment groups 2.5 and 5 ppm. In the second trial, NIV-concentrations of 0, 3, 6, and 12 ppm were used. The weight gain for the 20-d period was decreased by 11% with 6 and 12 ppm. During this period these birds showed a decrease of about 6% in feed consumption and feed conversion efficiency. Gizzard erosions were found in 33% of the birds fed 12 ppm NIV and in 8% of those fed 3 or 6 ppm. No such erosions were found in the control birds. Relatively, the liver weights in the 12 ppm group were reduced more than total body weights. No effects on relative organ weights were found when bursa, spleen, and gizzard were compared to control. In the blood, no change compared to control was found in hematocrit or in the plasma concentration of glucose, calcium, cholesterol, triglycerides, and uric acid, or in the plasma activity of aspartate amino transferase, alanine amino transferase, or gamma glutamyl transpeptidase.

Distribution of cisplatin in perilymph and cerebrospinal fluid after intravenous administration in the guinea pig

The concentration of free cisplatin was followed in plasma, scala tympani perilymph and cerebrospinal fluid (CSF) after an intravenous injection (12.5 mg/kg) in guinea pigs. Liquid chromatography with postcolumn derivatization was used for quantitative determination of the drug. The distribution of cisplatin to CSF was fast; at 10 min after drug administration the concentration was 7 micrograms/ml and the CSF:plasma ratio was 0.37. Cisplatin seems to distribute more slowly to the perilymphatic compartment. The highest concentration measured was 4 micrograms/ml at 20 min after the injection, and the perilymph:plasma ratio was 0.40 at that time. The concentration-time curves generated for cisplatin in perilymph and CSF were similar. No accumulation in the perilymphatic compartment or CSF was observed.

Detection of specific antibodies directed against a consistently expressed surface antigen of Mycoplasma gallisepticum using a monoclonal blocking enzyme-linked immunosorbent assay

Sera from 14 groups of chickens inoculated with different laboratory and field strains of Mycoplasma gallisepticum (MG) were used to compare the diagnostic potential of the hemagglutination-inhibition (HI) test and a recently developed monoclonal blocking enzyme-linked immunosorbent assay (ELISA). HI was performed with strain A5969, commonly used as hemagglutinating antigen, and it could detect 62.7% of the inoculated chickens as positive. Of all sera, 83% proved to be positive when examined with the blocking ELISA. The difference between the sensitivities of the two methods was due to group-specific insensitivity of the HI test. None of the sera from groups inoculated with strains K 1501, K 1503, K 503, or K 703 and only half of the sera from groups inoculated with K 1453 or 236C could inhibit the activity of the A5969 hemagglutinating antigen, indicating antigenic differences between these challenge strains and the diagnostic strain. ELISA detected MG-specific antibodies in every group of sera, although inoculation with variant strains K 503 or K 703 resulted in lower level of antibody production than inoculation with other strains. The monoclonal blocking ELISA can be useful in the serological diagnosis of MG infections, because it is based on a consistently expressed, specific region of MG.

Continuous passive motion in rehabilitation after anterior cruciate ligament reconstruction

In a prospective, randomized study, 34 patients (25 male, 9 female; mean age 27 +/- 8 years) with unilateral anterior cruciate ligament ruptures and arthroscopic reconstruction with patellar tendon grafts were allocated at random to either early active motion only (AM; n = 17) or active motion in combination with continuous passive motion (CPM; n = 17). Range of motion was measured with a goniometer and joint swelling with a tape measure, preoperatively and at 6 weeks postoperatively. Neither associated injuries nor the age of the patients differed in the two groups. There was no difference in the range of motion between the two groups at 6 weeks' follow-up. Joint swelling was more pronounced in the AM group both preoperatively and at 6 weeks' follow-up. In this investigation the range of motion was not improved by CPM. The difference in joint swelling between the two groups may be explained by a persistent preoperative variation in joint effusion due to an imbalanced distribution of acute and chronic cases.

Patellar tendon or Leeds-Keio graft in the surgical treatment of anterior cruciate ligament ruptures. Intermediate results

In a prospective randomized study, 60 patients with unilateral chronic anterior cruciate ligament (ACL) rupture were allocated to surgical reconstruction using an autogenous patellar tendon graft (PT) or a synthetic Leeds-Keio graft (LK). Fifty-five patients (26 PT, 29 LK), 32 men, 23 women, fulfilled the criteria to be further tested. The mean time from surgery to follow up was 28 months. Laxity was tested by pivot shift and an instrumented anterior laxity test. Subjective knee function was classified using the Lysholm score, Tegner activity score, and IKDC grading. Muscle performance was analyzed in 49 patients (23 PT, 26 LK. There was no difference between the two groups in anthropometry, activity levels (before trauma; present; desired activity), time from trauma to surgery, or time from surgery to follow-up evaluation. Neither the concentric and eccentric knee extensor peak torque ratio nor the knee extensor endurance and the one-leg hop test differed between the two groups. However, both the pivotshift and the anterior laxity were significantly greater for the LK group. On the other hand, significantly more patients in the PT group had an extensor lag. Although the results are only intermediate, the Leeds-Keio ligament does not fulfill the requirements for a satisfactory result in ACL reconstructive surgery with regard to knee-joint stability.

Knee function after anterior cruciate ligament ruptures treated conservatively

Thirty-nine patients with ruptures of the anterior cruciate ligament (ACL) were treated conservatively and were subsequently examined at an average of 5.7 years after injury, the uninjured leg acting as a control. The Tegner activity score was significantly lower than the desired activity level. No patients were free of symptoms and only two could take part in sport which involved pivoting. The isokinetic knee extensor and flexor torques, as well as the one-leg-hop and instrumented knee joint laxity tests, were significantly impaired at follow-up. Functional impairment was not related to tests of knee joint laxity. Few patients were pleased with their subjective knee function after an ACL rupture despite thorough initial rehabilitation.

Nurse-patient interaction after training in integrity promoting care at a long-term ward: analysis of video-recorded morning care sessions

Morning care is a complex and problematic task for the demented patient, who has problems in understanding and coping with the situation. A training programme of integrity promoting care was given to the staff of a long-term ward and improvements of care were implemented during a 3 month intervention period. To evaluate possible effects, different parameters were used and compared with the data of a control ward. This report describes how caregivers behaved towards demented patients during morning care, before and after the training, and how patients' behaviour changed. The results are based on behaviour samples from 10 patients and 10 caregivers during 99 video-recorded morning care sessions, "double blindly" analysed. The number of coding schemes was 483, each consisting of 93 questions. The most prominent differences observed after the intervention were the increased number of opportunities to take part in decisions and activities given to the patients by the caregivers, more co-operation from patients, and finally an increase in verbal contact initiated both by patients and caregivers. It seems reasonable to suggest that when the environment was made more adequate and the demented patients could cope with it, they could use latent abilities that were not manifest in a less adequate environment.

Five-year results of anterior cruciate ligament reconstruction with the Stryker Dacron high-strength ligament

Forty-two consecutive patients (27 male and 15 female, with a mean age of 26 years) suffering from unilateral chronic anterior cruciate ligament insufficiency underwent surgical reconstruction with a Dacron high-strength ligament (Stryker). In 32 patients the synthetic ligament was used as a reinforcement in an iliotibial band intra-articular procedure and in 10 patients as an intra-articular prosthesis without biological reinforcement. There were 24 concomitant injuries such as meniscal tears, status post-meniscectomy or medial collateral ligament insufficiency at the time of reconstruction. The initial injury occurred during soccer in 23 patients and other pivoting sports in 16 patients. Two and 5 years after reconstruction, the patients underwent clinical examination, including the instrumented knee laxity test (OSI), and performed subjective evaluation. The anterior tibial translation was 6.3 +/- 2.6 mm greater than in the healthy knee, the mean Lysholm score was 78 points, and the Tegner activity score was lower than its pre-injury level. Radiography revealed that 31 of 37 ligaments had ruptured and another 2 ligaments showed more than 5 mm side-to-side increased laxity. The Stryker Dacron high-strength ligament ruptured in more than 80% of the cases and patients could not return to their pre-injury physical performance activities.

The effect of topical application of vasodilating agents on cochlear electrophysiology

The aim of this investigation was to study whether increased blood flow has beneficial effects on the ear or whether it is damaging to the auditory function, expressed as the auditory gross neural response. Four vasodilating agents were examined after topical application with respect to their influence on cochlear blood flow (CBF), blood pressure, and auditory function in the normal guinea pig. CBF was recorded with laser-Doppler. The drugs used were sodium nitroprusside, hydralazine, nicotinic acid and histamine. Sodium nitroprusside and hydralazine increased CBF and induced concentration dependent loss of auditory function. Neither nicotinic acid nor histamine had any effect on CBF. Nicotinic acid had varying effects: in some cases a negative influence on threshold shifts was seen, and in others a positive one. In most cases histamine caused improvement of the auditory function. The data indicate that topical administration of drugs to the inner ear is effective to influence both CBF and auditory function.

[Information to patients following surgery for cancer]

Patients who are operated upon for cancer tumour are anxious about the postoperative information and the result of the surgical procedure. This investigation was undertaken to study the routines for postoperative information in a department of surgical oncology. Thirty two patients operated for abdominal cancer ("cancer patients") and 36 patients operated for inguinal hernia or gallstone disease ("hernia patients") answered a questionnaire with 16 questions. Sixty nine percent replied. The need for postoperative information about the result of the operation was higher for the cancer patients than for the hernia patients. The cancer patients were given more attention by the doctors postoperatively and were given more opportunities to ask about the operation than the hernia patients. However, there was lack of privacy in the information situation and both groups were informed on the ward in presence of other patients.

Experience of a 10-year use of competitive exclusion treatment as part of the Salmonella control programme in Sweden

In Sweden, competitive exclusion (CE) treatment has been used since 1981 as a part of the national control programme for Salmonella. According to the programme all broiler flocks are tested for Salmonella before slaughter thus providing an evaluation of CE treatment. The CE culture used is mainly for the two consecutive flocks raised in a unit after a Salmonella-infected flock has been identified. During the period 1981-1990 Ce culture has been given to 179 flocks, involving 3.82 million chickens. Only one of the treated flocks was found to be Salmonella-positive. A special study during a period when Salmonella was spread by contaminated feed demonstrated that CE treatment was effective in controlling Salmonella under field conditions. A likely contributory factor is that the hatcheries in Sweden can be claimed to be Salmonella-free. In addition, the control programme and related action, have led to a very low incidence of Salmonella in broiler chickens. A nationwide study carried out in 1990 demonstrated that less than 1% of broiler chickens was contaminated with Salmonella after slaughter.

Clinical evaluation of restoration margins by an endoscopic microscope

A method is presented for high magnification, clinical examination and recording of the marginal fit of dental restorations. An endoscopic microscope used in conjunction with video recording facilities affords acceptable colour records of restorative procedures for monitoring purposes. The suggestion is made that the concept of 'fit' in the clinical context has not been adequately addressed. The technique described has other clinical and research implications.

Orofacial functions in patients with congenital and acquired maxillary defects: a fluoroscopic study

By means of videofluoroscopic recordings, chewing, swallowing and speech were monitored in nine patients with congenital and acquired maxillary defects. All of them were rehabilitated with a maxillary obturator prosthesis. The defective region was seldom used for chewing. No leakage between the obturator and surrounding tissue was observed, either for solids or for liquids. All of the prosthetic reconstructions were surprisingly stable during function. In the phonetic analysis, speech production was judged to be restored almost to normal. Videofluoroscopy may be valuable as a complement to other functional diagnostic procedures, and for the evaluation and improvement of rehabilitation with an obturator prosthesis.

Shoulder function in patients with unoperated anterior shoulder instability

A functional analysis, including Rowe score and measurements of isokinetic peak torque and range of motion of the shoulder, and a subjective assessment were performed in 26 consecutive patients (23 males and 3 females) with unoperated anterior shoulder instability. Patients experienced the initial dislocation at an average age of 23 +/- 8 years and 58% occurred during sports activity. No patient had gone through any controlled rehabilitation program. In this study, an average of 7 years (range, 1 to 28) had passed since the initial dislocation. Fifty-nine percent of the patients complained of markedly reduced ability to perform in sports because of instability, impaired strength, decreased range of motion, and pain induced by activity. The majority (65%) of the patients reported instability only during physical activity. The average Rowe score was 68 +/- 14 on a scale of 100. In comparison with the healthy side, the injured shoulder had a significantly lower isokinetic peak torque during abduction and internal rotation, as well as a reduced range of motion in extension, abduction, and external rotation, but not in flexion. The severity of impairment (Rowe score, deficit in range of motion, and peak torque) was not related to the number of dislocations sustained or to the duration of instability.

Soccer injuries among elite female players

Injuries occurring in two female elite soccer teams were recorded during 1 year. Of 41 players, 33 (80%) sustained 78 injuries. The incidence of injury during games was 24/1000 hours, while the incidence during training was 7/1000 hours. The majority (88%) of injuries were localized to the lower extremities, with equal occurrence in the left and right legs. Forty-nine percent of the injuries occurred in the knee or ankle. Most of the injuries were minor (49%), while 36% were moderate and 15% were major. Of the major injuries (N = 12), 10 were due to trauma and 7 (58%) were knee ligament or meniscal tears. Overuse injuries constituted 28% of all injuries and occurred mainly during preseason training and at the beginning and end of the competitive season. Traumatic injuries (72%) occurred mainly during games with a predominance at the beginning of the competitive season. Almost 80% of the traumatic injuries occurred during physical contact with an opponent. Extrinsic factors such as weather, playing surface, temperature, or the position of the player within the team did not influence the injury rate. We conclude that female elite soccer players sustain a high incidence of injury. Few injuries were major, but 17% of the players sustained a major knee injury during the year.