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Background: Pharmacogenetic testing is used to uncover genetic causes for variations in drug response. Documentation of the method's usefulness in a clinical setting is scarce. The aim of the study was to systematically categorize the experience from routine CYP2D6 genotyping in a diagnostic laboratory., Material and Methods: All samples submitted to our laboratory for CYP2D6 genotyping in the period 29.06.98-28.12.09 were examined retrospectively. The samples were classified into three indication groups based on clinical information given in the request form. All samples, and a control group consisting of 100 healthy blood donors, were tested for the four most prevalent non-functional CYP2D6 alleles in the European population, and for ultrarapid metabolizer-associated duplications of the gene., Results: 325 samples were included. The proportion of ultrarapid metabolizers was significantly higher in the patient group (4.0 %, p = 0.045) than in the control group (0 %), with the highest proportion among those patients that used a known CYP2D6 substrate. The percentage of poor metabolizers was not significantly higher in the patient group (8.3 %) than in the control group (6.0 %) (p = 0.528)., Interpretation: The CYP2D6 analysis could rarely explain the patients' side effects or lack of drug response, even though the study group was selected because of clinical problems due to drugs they were using. Two explanations may be that the indication(s) for genetic testing is not clearly defined and that the CYP2D6 genotype is only one of many factors that determine individual drug response.

Background: There is little information available on long-term follow up of patients treated with primary angioplasty for acute myocardial infarction., Material and Methods: 100 consecutive patients with acute ST-elevation myocardial infarction and symptoms of less than six hours' duration were treated with primary angioplasty. Clinical examination was performed in 97 patients and exercise stress test in 74 patients 11-37 months (mean 20 months) later. Patients were observed for survival up to 48 months., Results: 24 patients had been rehospitalized, 16 because of chest pain. 77 patients were treated with beta blocker, 83 with statins, and 95 with antithrombotic medication. 84 patients were in NYHA (New York's Heart Association's classification's) class I at follow-up examination. Three patients died. 11 patients had a serious event, reinfarction (n = 3) or need for revascularization (n = 8) during the first 13 months. Total cumulative mortality rates after one and three years were 3% (95% CI 1-8) and 11% (95% CI 6-19)., Interpretation: The good initial results in primary angioplasty are maintained in long-term follow-up. This is in accordance with reports from centres abroad.

Background: Percutaneous angioplasty is an alternative to thrombolysis to reestablish coronary blood flow in patients with transmural myocardial infarction. At present, this treatment option is not widely accepted in Norway., Material and Methods: From 1996 to 1998, one hundred consecutive patients were treated with angioplasty for acute transmural infarction. The angiography showed one-vessel disease in 55%, two-vessel in 25%, and multivessel in 20%. The infarct related artery was the LAD in 44%, the CX in 14%, the RCA in 41%, and bypass graft in one. 92% had TIMI 0 or 1 flow. Stent was placed in 73%, GPIIb/IIIa was used in 11% and temporary pacemaker placed in 5%., Results: Successful angioplasty was performed in 95%, 3% was not done, and 2% failed. Peripheral stenoses were treated in 15% and stenoses in other arteries in 10%. Complications and events within 24 hours related to the angioplasty were seen in 9%., Conclusion: Primary angioplasty for acute myocardial infarction can be done with high primary success, good short-term results and few complications.

Background: This article reviews causative factors for asthma and allergy during childhood and describes current trends in prevalence and hospitalisation for childhood asthma., Materials and Methods: A review of the prevalence of childhood asthma in Norway over the last 50 years together with recent trends in hospitalisation for childhood asthma, is given. Possible causative factors for childhood asthma are reviewed, and recent theories for the current increase in prevalence are discussed., Results and Interpretation: During the last 50 years, a steady increase in the prevalence of childhood asthma has been documented through published studies from 1948 and onwards. From 1980 and until 1990, an increase in hospital admissions due to acute asthma was observed; later, admissions have leveled off, particularly as regards readmissions. Smoking during pregnancy and childhood decreases lung function. Allergic sensitisation is related to asthma development and may occur already during pregnancy. Increased allergic sensitisation may occur due to reduced load of infections. However, respiratory virus infections, and especially RS virus and rhinovirus infections, are closely related to asthma development and symptoms during childhood. A reduction in readmissions for asthma may be related to increased use of antiinflammatory therapy for asthma.

Background: Monogenic inherited disorders are caused by a mutation in one single gene. Each of these disorders is very rare, but as there are many thousand different monogenic disorders, they represent a significant health problem. Most monogenic disorders are severe and have no cure. Gene therapy will therefore often be the only possible treatment., Material and Methods: Characterisation of the gene is necessary for the development of gene therapy, and at the present time only a limited number of the genes in relation to the total number of the severe monogenic disorders is known., Results: Clinical trials for some of the monogenic disorders, such as cystic fibrosis, have been going on for many years., Interpretation: In spite of the tremendous effort, it is so far not documented that patients have been cured of a monogenic disorder by gene therapy.

Background: This article presents a review of the relationship between physical training and airways diseases: the relationship between physical activity and the development of airways diseases, and the effect of physical training in rehabilitation after airways diseases., Material and Methods: The article is a systematic review of exercise-induced asthma (EIA), the effect of physical training upon bronchial hyperresponsiveness and the development of asthma; how chronic lung diseases affect the ability to participate in physical activity; and the use of physical training in rehabilitation after airways diseases., Results and Interpretation: Physical training may provoke EIA in asthmatic patients. Furthermore, heavy regular training over long periods of time may contribute to the development of asthma. Mastering EIA is an important goal in the management of asthma, especially in children and adolescents, in order to foster normal physical and mental development. Physical training improves fitness and the mastering of asthma, but not of bronchial hyperresponsiveness and asthma activity. In other airways disorders like cystic fibrosis or chronic obstructive lung disease, a reduced lung function may limit the ability to participate in physical activity. Training is an important tool in the rehabilitation of patients with pulmonary disorders as it improves physical fitness and quality of life.

Ileal pouch-anal anastomosis is an alternative to ileostomy for patients with ulcerative colitis. Results of a questionnaire survey answered by 155 patients organised in a support group are presented. Consequences of the operation were mainly faecal incontinence, experienced by half of the group in the daytime, and frequent defaecations (5-7 per day, 1-2 per night). One half of the patients used medication every day to decrease the number of defaecations. 64% had changed their diet, while social and physical activities were reduced for 43% of the patients. Changes in lifestyle after the operation lead to increased expenses for 70% of the group. Women were more often incontinent than men and experienced it as a serious problem, and more women than men had changed their dietary habits. The quality of sleep was inferior to that of the preoperative period for 47% of the patients. 50% felt restricted in daily life activities due to frequent defaecations. These patients are living with a concealed disability. In spite of this, their assessments of self-esteem, health and quality of life were mainly positive.

Since the spa resort Vikersund Kurbad was reorganised in 1992 as a retraining unit, improvements have taken place. There is now one fulltime rheumatologist, two part-time general practitioners, 14 physiotherapists, one social worker and nurses in a new unit with a hot pool and an occupational therapy department. In this article, assessment data continuously recorded since 1981 are used to find out how the changes have affected patient intake and patient improvement. It was found that the patients now admitted are more disabled, but the number of patients who thrive and improve has increased. However, the intake of rheumatic patients has simultaneously decreased. It is suggested that measures are taken to enable more rheumatics to use the institution.

In female mammals one of the two X chromosomes is inactivated in early embryonic life. Females are therefore mosaics for two cell types, cells with the maternal X as the active X chromosome, and cells with the paternal X as the active X chromosome. The process of X inactivation is random and permanent for each cell. A skewed X chromosome inactivation pattern may be defined as a pattern where the ratio between the two cell types is 80:20 or more. Skewed X inactivation may have several causes. Since X inactivation is a stochastic event, a skewed pattern may be the result of a chance occurrence. It may also be the result of genetic factors, or be the result of a selection leading to a growth advantage for one of the two cell types. A selection mechanism may be the reason for the increase in the frequency of skewed X inactivation found in normal elderly females. An important consequence of skewed X inactivation is the manifestation of X-linked disease in female carriers.

The introduction and increasing usage of nucleic acid based methods in clinical microbiology over the last years have contributed to better and earlier diagnosis of infectious diseases as well as more accurate monitoring of treatment. Various nucleic acid amplification methods such as the polymerase chain reaction and the ligase chain reaction are widely used in Norwegian clinical microbiological laboratories to detect fastidious or non-cultured infectious agents. The amplification methods combine an extremely high sensitivity with acceptable specificity. About 200,000 nucleic acid based examinations are now performed in clinical microbiological laboratories in Norway each year.

Clinical experience and molecular genetics have demonstrated several exceptions to Mendelian inheritance in man. Genomic imprinting is a mechanism that regulates expression or repression of genes according to their parental origin. The phenotypic expression of imprinted genes is therefore dependent on whether the gene was inherited from the father or the mother. More than 20 imprinted genes in man are recognized, and these genes tend to occur in clusters in the genome. The best characterized imprinted regions are the 15q11-13 region which involves Prader-Willi's syndrome and Angelman's syndrome and the 11p15 region involving Beckwith-Wiedemann's syndrome. The mechanism for disease expression in these two regions is discussed.

Simpson-Golabi-Behmel's syndrome is characterized by pre- and postnatal overgrowth, coarse face, visceromegali, congenital anomalies such as heart defects, diaphragmatic hernia and gastrointestinal malformations. Etiology is X-linked inheritance, the causative gene (GPC3) has recently been discovered. Female carriers may have mild symptoms. We report on an eight year old boy with characteristic anomalies and moderately retarded psychomotor development. Differentiating Simpson-Golabi-Behmel's syndrome and other overgrowth syndromes, such as Beckwith-Wiedemann's and Sotos' syndrome can be difficult. Clinical overlap and differences between these three conditions are discussed. The diagnosis of Simpson-Golabi-Behmel's syndrome is important because of increased risk for cardiac arrhytmias and for development of embryonal tumors such as neuroblastoma and Wilms' tumor in early childhood.

The Finnmark Health Survey of 1987-88 showed that there was no significant difference in the prevalence of coronary heart disease between a Sámi population and a Norwegian population. Among men 40-59 years of age, a prevalence of myocardial infarction or angina pectoris or both, of 5.5%, was found both in Norwegians and in the predominantly Sámi population of Inner Finnmark. Among women, a prevalence of 3.1% and 3.3% was found among Norwegians and Sámis, respectively. The difference in results between males and females was less among Sámis than Norwegians, despite Sámi women having a lower risk factor level than Norwegian women. A clinical follow-up study done in 1992-93 showed no significant differences in serum lipid concentrations between the Sámi and the Norwegian population. Sámis had a lower familial occurrence of coronary heart disease than Norwegians. Waist to hip ratio was higher among Sámis than Norwegians.

During the period 1994-95, 22 patients were examined with CT during arterial portography for evaluation of hepatic tumours. The majority, 20 patients, had metastases from colon cancer. All patients were candidates for liver resection. In the series of patients described here, this process detected additional lesions in four more of the patients than found with any other imaging techniques. This supports that CT during arterial portography is the most sensitive method for detecting small malignant hepatic tumours, and for localizing them in relation to liver segments and major vascular structures. Optimal results are obtained in the absence of diffuse parenchymal disease and portal hypertension. Non-tumourous perfusion defects limit the accuracy of this technique, but such defects have characteristic locations and appearance. In difficult cases the technique should be correlated with ultrasonography and MR.

The traditional types of health care institutions, the spas and convalescence homes, were reorganised in Norway in 1992 to become retraining units group I and group II. The new regulations demanded that the institutions should upgrade and strengthen their treatment facilities. The physician in charge of group I institutions has to have rheumatological or physical medical qualifications, and the institution itself has to have sufficient nursing and other medical staff to be able to treat patients in need of a higher level of therapy than required by patients at group II institutions. A survey of the institutions concludes that most of them now conform with the new regulations.

The Ministry of Health and Social Affairs has started a research program introducing information technology into the float of information between central and local authorities. The prospect is to make a better platform for statistics and planning. This article describes the process of designing a computer program designed to meet the needs of the local authorities. The result is a program that integrates sending and receiving of data with preparation of the local annual report. An evaluation revealed that the need of such computer tools and support is greatest in the small municipalities.

Since problem-based learning is becoming more popular in medical education, the interest in the effects of and theoretical foundations for, such educational strategies is increasing. This article reviews research on the effects of problem-based learning, and relevant research on the development of knowledge and learning. In conclusion it is shown that the learning effects are contingent on how problem-based learning is implemented in the curriculum.

During the two first years of the war in Bosnia (1992-93) refugees came both to Norway and to other European countries. Bosnian "war refugees" are released prisoners from Serbian concentration camps, and their close families. Most of the former prisoners and their families had experienced extreme traumas, qualifying them for help from expert psychotherapists. No such help was available. The aim of the present project was to find out whether useful psychosocial preventive work can be done within the primary health services. Our intervention, which was carried out during a six month period in 1993-94, included two semi-structured interviews with each refugee family in the centre, and follow-up contacts with persons who indicated major psychological problems. All the refugees reported that they experienced deep sorrow, and the majority had difficulty in sleeping and concentrating. A pessimistic view of their future was common. Most of the refugees were positive towards participating in the interviews. Several of them have reported that the interviews were of direct help. In the majority of cases we have experienced that the ordinary health contacts later have been meaningful.

A 72 year old man with coronary heart disease underwent cardioangiographic examination using monomeric non-ionic contrast medium. During and after the examination he gradually developed nearly total cortical blindness. His vision slowly returned after two days, but was not fully restored. Computer tomography (CT) of the brain five hours after the examination showed bilateral contrast medium retention in the visual cortex area, which became normal the day after. The gradual development of nearly total blindness combined with bilateral transient CT-alterations in the visual cortex area suggest a complication induced by the contrast medium.

Elite athletics, particularly endurance sports, are characterised by a high prevalence of bronchial hyperresponsiveness (BHR) and exercise-induced asthma (EIA). Findings in several studies suggest short-term high intensity physical activity to cause a transient increase in BHR. Recent studies in Oslo have shown that regular physical endurance training over several years, particularly when combined with such climatic factors as low air temperatures, may result in an increased risk of BHR and EIA among elite athletes--e.g., cross-country skiers. Inhalation beta 2-agonists and steroids have been used by many athletes in endurance sports, particularly skiers. Athletes with symptoms of BHR or EIA should be examined with lung function tests and exercise testing, and the effect of antiasthmatic drugs should be ascertained. Inhaled beta 2-agonists have no beneficial effect upon physical performance in nonasthmatic athletes, and may have a slight limiting effect upon physical endurance.

Acute asthma is a manifestation of chronic inflammation of airways, and may be due to inadequate control. Assessment of acute asthma is based upon respiratory rate and pattern, thoracic respiratory recessions, auscultatory rales and rhonchi, skin colour (cyanosis/pallor) and heart rate. Acute asthma in children is best treated with inhaled nebulised drugs, especially beta 2-agonists and adrenaline. Acute severe asthma should be treated with systemic steroids (by injection or orally), and it is important that this treatment is not started too late. Symptomatic treatment with intravenous theophyllamine may also be relevant. Anaphylactic shock occurs most often after injection of drugs or after bites by a wasp or a bee. Food allergy may be the cause in some patients. Speed is necessary in the treatment of anaphylactic shock, and intramuscular injection of adrenaline is the treatment of choice. Systemic steroids or antihistaminics may be used to stabilize the state of the patient.

Perinatal and infant death are important indicators of community health. We examined the rate of stillbirth and death before the age of two years among 36,700 children with Norwegian and 2,750 children with Pakistani background. There was no difference in the rate of stillbirth and death during the second year of life, but a 2.5-3 times higher death rate during the first year of life among the Pakistani children, compared with the Norwegian children. When deaths due to single gene disorders and congenital malformations were excluded, the death rate during the first year of life was similar in the two groups. The Pakistani children had an 18 times higher death rate from autosomal recessive disorders and a ten times higher death rate from malformations of the central nervous system. The difference in death rate between the two groups was probably due to the high rate of consanguinity among the Pakistani parents.

During four winter months 1989-90, two children died suddenly from asthma, and one suffered a life threatening attack. A 20 months old boy with moderately severe asthma, just recovered from an adenovirus infection, was symptom free at a routine consultation less than 12 hours before death. He died suddenly after a spell of coughing. A six year old girl with severe but well controlled asthma received unknown quantities of inhaled nebulized salbutamol during a three day exacerbation. She died at home due to respiratory arrest. A 16 year old boy who attended the clinic sporadically had a severe uncontrolled attack of asthma. He inhaled at least 400 doses of salbutamol via a metered dose inhaler during the two days prior to a sudden respiratory arrest. He was successfully resuscitated. This paper addresses possible mechanisms underlying different types of severe attacks of asthma.

During winter 1991, 60% of medical and nursing administrators in Telemark county made an extensive evaluation of their own jobs. Head of Department physicians spent 60% of their working time on medical tasks, 10% on budgets and accounting, and 30% on care of the staff. Direct work in connection with patients took 48% of time. 19% of the working time was spent on secretarial functions which could preferably be delegated to others. Head of Department doctors have too little education in budgeting and accounting. Head of Section doctors spent 77% of their working time on medical tasks. This is a group of contented and productive physicians. Head of Department nurses spent 74% of their time on administrative tasks and 11% on work directly connected to patients. 25% of the time was spent on individual care of colleagues in addition to professional instruction, and the group would like to have even more time for this task. Head of Ward nurses spent 38% of their working time on patients and 58% on tasks connected to the staff. 26% of their time is mere secretarial work. Individual care of colleagues required 21% of their time, and they would like to have even more time for this purpose. All groups of administrators would like to receive more feedback from the top management of their hospital.

A double blind, crossover study was used to test the effect of transdermal oestrogen therapy (Estraderm) in 22 women with climacteric complaints. The number and intensity of hot flushes were both reduced by approximately 80% (p less than 0.0025). Some improvement was also seen as regards general wellbeing, disturbed sleep and tiredness. We noted a significant increase in serum oestradiol to premenopausal follicular phase levels, and a decrease in FSH values. Systolic blood pressure was lowered during active treatment (p less than 0.025), a smaller reduction of diastolic pressure was not significant. Body weight remained unchanged. Some patients reported tender breasts, and some reported slight irritation of the skin. Neither condition necessitated withdrawal of treatment. It is concluded that Estraderm is effective and suitable for treatment of climacteric complaints.

Geilomo hospital for children with asthma and allergy is situated 800 m above sea level in a non-polluted area in the central part of Norway. 31 children who were admitted to this hospital from different parts of Norway (mostly from the main cities) were studied for six weeks. They underwent physical training and daily measurements were taken of lung function and the effect of bronchodilators. The bronchial responsiveness of the children improved significantly from week 1 to week 6, as measured by reduction in lung function after sub-maximal running on a treadmill. There was significant improvement in daily symptom score, and in degree of obstruction as shown by physical examination. The children's improvement was probably the result of a stay in a mountainous area with very little air pollution or allergens, combined with regular planned physical activity, and regular medication and surveillance.

This article briefly discusses laser theory and medical use of different types of laser, laserphysics and laser properties. The indications for lasertherapy as claimed from laser-producers, are numerous. However, we recommend that the effect of treatment with low level laser therapy has to be more documented before general use in a dental practice.

From 1980 through 1986 hospitalization of children because of obstructive airways disease has increased in the ten Norwegian counties studied. Most of the increase related to acute bronchiolitis and bronchitis among children under five years of age. The hospitalization rate is greater in urban than in rural areas, and greatest in Oslo, the capital of Norway. From 1980 through 1988, the national sale of inhaled beta 2-agonists has increased two-fold, and of local steroids for inhalation ten-fold. Mortality from obstructive airways disease has decreased from 1960 through 1987, mostly in children below five years of age. Mortality from bronchial asthma in children below 15 years has remained unchanged.

Brain tumour was diagnosed by computer tomography or magnetic resonance imaging in 100 children aged 0 to 19 years. They consecutively underwent primary surgical treatment during the years 1984 to 1988. Non-neoplastic lesions and operations for residual tumours are not included. 54 tumours were localized supratentorially. 72% of these were benign or low grade malignancies. 46 tumours had an infratentorial localisation. 59% of these were high grade malignancies. Children tolerate major-neurosurgical procedures better than adults and restitution is usually favourable. 42 children with high grade malignancies underwent postoperative radiotherapy. Per- and postoperative mortality in this series was 1%. 80 children are alive. 62 of these are in excellent condition after a median observation time of 40 months.