Carbon dioxide insufflation for more comfortable endoscopic retrograde cholangiopancreatography: a randomized, controlled, double-blind trial.

BACKGROUND AND STUDY AIMS: The effect on abdominal pain of using carbon dioxide (CO2) for insufflation during endoscopic retrograde cholangiopancreatography (ERCP) has not been investigated. The present study aimed to compare CO2 insufflation with standard air insufflation with respect to the pain experienced during and after ERCP. In addition, we investigated the effect of CO2 insufflation on the partial pressure of CO2 (Pco2). PATIENTS AND METHODS: A total of 118 consecutive patients who were undergoing ERCP were randomized to CO2 insufflation or to air insufflation during the procedure. Both the endoscopists and the patients were blinded with regard to the gas used. Patients rated the intensity of pain experienced on a 100-mm visual analogue scale (VAS) during ERCP and at 1 hour, 3 hours, 6 hours, and 24 hours after the procedure. Transdermal Pco2 was measured continuously in all patients during the procedure. RESULTS: Altogether, 116 patients were eligible for analysis, 58 in each treatment group, and 91 patients responded to the questionnaire (78 %). The mean severity of postprocedure pain was significantly reduced in the CO2 group compared with the air group at 1 hour (5 mm vs. 19 mm on the VAS, P < 0.001), at 3 hours (7 mm vs. 21 mm, P < 0.001), at 6 hours (10 mm vs. 22 mm, P = 0.006), and at 24 hours (4 mm vs. 20 mm, P < 0.001) after the procedure. Radiographs taken 5 minutes after the procedure showed that abdominal distension was more pronounced in patients in the air insufflation group. There were no differences in Pco2values between the two treatment groups. CONCLUSIONS: Carbon dioxide insufflation during ERCP significantly reduces postprocedural abdominal pain. No side effects were observed. Carbon dioxide should be the standard gas used for insufflation in ERCP.

A controlled vocabulary for nursing and allied health in Norway.

Nursing and allied health libraries at educational institutions in Norway have generally indexed their book collections with uncontrolled terms. With the reorganization of higher education in 1994, the majority of these libraries joined BIBSYS, which is a joint library system for higher education and research in Norway. This has led to chaos when searching the joint catalogue for literature on nursing and related fields. A term such as 'behaviour problems' may have up to five synonyms. In an attempt to improve the quality of searching the health literature, BIBSYS appointed a working group in the Spring of 1999 to find a suitable controlled vocabulary for this subject area, and to see how this vocabulary could be integrated into BIBSYS. The group presented its recommendations in October 1999. The report has been well received by the BIBSYS Board and by user groups. There are no Norwegian vocabularies that are suitable for use in nursing and allied health, therefore it will be necessary to translate and combine existing thesauri. The group has looked at the Nordic Multilingual Thesaurus on Health Promotion, the Swedish Spriline Thesaurus, MeSH (Medical Subject Headings) and CINAHL Subject Heading List. Other relevant thesauri are AMED/CATS Thesaurus, Bioethics Thesaurus (Bioethicsline) and the RCN thesaurus. The group recommends the development of a Norwegian thesaurus based on a translation of parts of MeSH and CINAHL Subject Heading List.

[Diagnostic imaging of annular pancreas]. / Bildediagnostikk ved annulaer pancreas.

BACKGROUND: Annular pancreas is a rare congenital anomaly. A ring of pancreatic tissue encircles the second part of the duodenum and results in varying degrees of obstruction. When the first symptoms occur in adults, they are non-specific and may consist in epigastric pain, fullness after meals, indigestion and nausea. Concomitant lesions such as ulcer or pancreatitis may obscure the diagnosis. MATERIAL AND METHODS: A case report documents that radiologic examination with barium meal disclosed the duodenal stenosis. RESULTS: A properly performed CT examination revealed the ring of pancreatic tissue which encircled the duodenum. Endoscopic retrograde pancreatography may show a duct with a characteristic circular pattern around the duodenum. MR and endoscopic ultrasonography are supplementary examinations in equivocal cases. INTERPRETATION: A CT examination is a good non-invasive primary examination when annular pancreas is suspected.

Measles antibodies and herd immunity in 20- and 40-year-old Norwegians.

The introduction of a measles vaccination programme in Norway in 1969 using one dose of vaccine, and since 1983 two doses, was followed by a substantial decrease in the incidence of the disease. Since 1992, the annual incidence has been less than 20 cases. Small clusters and outbreaks have occasionally been observed among military personnel and unvaccinated children. This paper describes a seroepidemiological investigation of the level of immunity among 1,188 military conscripts, aged 18-28 years (mean 20.7) compared with 695 healthy 40-year-olds. The conscripts had been offered measles vaccine in infancy, in some cases also at 12-13 years of age, but they had also been exposed to wild measles virus, since the virus continued to circulate many years after the vaccination had started. The measles immunity in this group is considered to indicate the immunity level among the first 5 cohorts offered measles vaccine in Norway. The 40-year-olds had grown up in a community with no measles vaccination. Their level of immunity gives an indication of the level finally obtained when there are no vaccinations, and thus of the level that would induce herd immunity against measles in the Norwegian population. The aims of the vaccination programme must be to obtain a corresponding immunity. The results of the investigation show that the percentages with measles antibodies in the respective groups were 92.3 and 98.1. The observation of measles outbreaks among young Norwegian conscripts, as well as reports from several countries on outbreaks in university and college settings with levels of seropositivity of even more than 95%, indicate that the seropositivity in the 20-year-old group may be too low to afford protection, especially when this group is living under close conditions. Consideration should be given to the need for an intensification of the existing vaccination programme to ensure that the protection level needed for herd immunity is reached.

Fifty-Hertz magnetic field exposures of premature infants in a neonatal intensive care unit.

In this study the magnetic flux density in and around incubators of a neonatal intensive care unit was registered and mapped. The mean 50-Hz magnetic flux densities in an incubator were typically in the range of 0.2-1 microT, with maximum values around 1.5 microT. For 1 incubator, harmonics contributed to the field substantially. The field levels varied depending on the type of equipment, the positioning of the electronics and the position of the 240-volt main plugs. The positioning of the infant in the incubator and the precise mattress position in the incubator affected the magnetic flux density to a great extent, as did the positioning of the electronic monitoring and treatment equipment. The flux density values found were fairly low as compared to magnetic field levels present at some work places where high electric currents are used. In intensive care units, however, the duration of exposure can be very long, especially for premature infants. The fields can also be compared with the magnetic field levels of residences and are then approximately 100 times higher. Further studies are necessary -it seems important to record magnetic fields and attempt to reduce the levels. Such a reduction can be achieved by reducing the field from the incubators but also by changing the electronic equipment around the incubators or increasing the distance to the incubator. Further research should of course also study any mechanism by which magnetic fields can affect cells and organisms. Compared to the risks many of these infants are exposed to, it is difficult to say whether the magnetic field levels measured can represent a significant additional risk factor. However, this is an area where one should adopt a prudent avoidance strategy, particulary considering how easily these fields can be reduced, mainly through redesign of the various equipment.

[Global transmission of Salmonella--increased risk in Norway. Interdisciplinary measures are necessary to maintain Norway's favourable situation]. / Global spredning av Salmonella--økt smittepress i Norge. Tverrfaglig innsats nødvendig for å opprettholde Norges gunstige situasjon.

Over the last 20 years, Salmonella infections in humans have increased considerably in the industrialized world, including Norway. The situation has been characterized as a serious problem, with considerable economic, political and public health implications. In contrast to the situation in most other countries, a large majority of the Norwegian patients have contracted the infection abroad. The endemic level of salmonellosis in Norway is low, and the prevalence of Salmonella in Norwegian food products is negligible. Appropriate intersectorial actions are required to maintain Norway's favourable status. Such actions include: preventing import of infected food, feed, and live animals; ensuring good hygienic practices at all stages of production, processing, and preparation of food; maintaining the present good health status of meat producing animals; providing consumers with drinking water of adequate hygienic quality; and intensifying national and international collaboration to prevent and control salmonellosis.

Radiology of the ileal J-pouch-anal anastomosis (IPAA).

Forty-four consecutive patients operated on with ileal J-pouch-anal anastomosis (IPAA) and diverting ileostomy were examined with barium contrast medium of the pouch before closure of the ileostomy. CT was performed in 4 of the patients. The anatomy of the ileal reservoir as well as complications were assessed. As normal postoperative anatomy we found a "blind loop" at the upper part of the reservoir in 29 patients and a contrast lucency at the anastomosis between the anal channel and the pouch in 5 patients. Complications were revealed at barium contrast medium examinations in 13 patients, including stenoses at the anastomosis between the pouch and the anal channel in 8 patients and fistulas in 5 patients. CT was especially valuable in the exact diagnosis and location of a pelvic abscess in 3 patients, none of which was shown at pouchography.

Two simultaneously occurring hypopharyngo-oesophageal diverticula.

We report a case of two simultaneously occurring hypopharyngeal-oesophageal diverticula, one apparently originating above, the other below the cricopharyngeal muscle. The radiological and clinical findings of this rare condition are presented.

Descriptive epidemiology of infections due to thermotolerant Campylobacter spp. in Norway, 1979-1988.

This report reviews the first ten years of Campylobacter surveillance in Norway. During 1979-1988, a total of 3,545 isolates of thermotolerant Campylobacter spp. were reported. The isolation rate increased from 1.8 per 100,000 persons per year in 1979 to 13.1 in 1988. The highest isolation rate for both sexes occurred during the first five years of life (31.0 per 100,000). A smaller second peak was detected in the age group 15-24 years (11.1 per 100,000). The male-to-female ratio was 1.52:1 for infants less than five years of age, compared with a ratio of 1.35:1 for all ages combined. Thirty-eight percent of the infections had most probably been acquired abroad. The isolation rate in urban areas (12.4 per 100,000) was over twice that observed in rural agricultural municipalities (5.5 per 100,000). However, this difference was largely due to a higher proportion of imported cases in urban areas, only small variations in isolation rate were observed when imported cases were excluded. The seasonal distribution of Campylobacter isolates showed a peak during the warm months of the year. Travel activity during summer holidays did not account for this trend, since the summer peak became even more pronounced when imported cases were excluded. A north-south gradient in the seasonality was observed; when domestic cases were considered, the summer peak became more accentuated with increasing latitude reaching a maximum in subarctic areas. This might be explained by corresponding variations in occurrence of campylobacters in surface water sources.

Clinical features of sporadic Yersinia enterocolitica infections in Norway.

During October 1988 through January 1990, a study of sporadic Yersinia enterocolitica infections was done in the Oslo region to assess the clinical impact and risk factors for this disease. Sixty-seven case-patients (mean age, 23.4 years) and 132 population-based age- and sex-matched controls were enrolled. Among patients who were well when interviewed, illness lasted a mean of 20 days, but 10% of the others remained symptomatic a year later. Bloody diarrhea occurred only in persons less than 18 years old (P = .002); joint pain was more common in adults (P = .001). Prolonged carriage was found in 47% of patients after resolution of symptoms. Patients were less likely to shed the organism after antimicrobial treatment (relative risk, 0.3; P = .003). Case-patients were more likely than controls to have antecedent enteric illness (odds ratio, 8.2; P less than .001). Y. enterocolitica infection in Norway is notable for its severity and chronicity. Postsymptomatic shedding, which occurs commonly, may be reduced by antimicrobial treatment.

CT appearances of normal and obstructed submandibular duct.

CT scans of 40 patients without pathology in the floor of the mouth or the submandibular glands were reviewed. Intraglandular ducts were visualized in 27 and extraglandular ducts in 3 patients. The CT appearances of dilated submandibular ducts are described in 4 patients with proven causes of obstruction. Widening of the narrow gutter between the mylohyoid and hyoglossus muscles in one scan level is a prominent feature. An intra- or extraglandular duct diameter of 3 mm or more indicates possible obstruction, and the CT images should be scrutinized to reveal the cause.

[Tularemia in Norway. A clinical and epidemiological review]. / Tularemi i Norge. En klinisk og epidemiologisk oversikt.

Altogether 105 cases of tularemia were reported to the nationwide notification system for infectious diseases (MSIS) in Norway during the period 1975-90. The zoonosis appears every year in Northern Norway. The first epidemic outbreak was reported from Central Norway in 1984-85. During the nineteen eighties the disease has reappeared in Southern Norway. We review the clinical features and epidemiological patterns of tularemia in Norway. Preliminary investigations indicate that the future drug of choice for treatment of tularemia is one of the gyrase-inhibitors.

Clinical features of sporadic Campylobacter infections in Norway.

To assess risk factors and clinical impact of campylobacteriosis in Norway, a case-control study of sporadic cases of infection with thermotolerant Campylobacter spp. was conducted. This report describes: (1) the frequency and duration of signs and symptoms, antimicrobial treatment, hospitalization, and faecal carriage among the study patients; (2) diarrhoeal illness and campylobacter carriage among their household members; and (3) antimicrobial susceptibility pattern among bacterial isolates. A total of 135 patients with bacteriologically confirmed campylobacter infection were enrolled in the study. Of these, 58 (43%) were domestically acquired while 77 (57%) were acquired abroad. If the study enrollees are representative of the cases reported to the national surveillance system, the reported infections led to an estimated annual average of at least 8590 days of illness, 78 admissions to hospital, 329 days of hospital stay, 2236 days lost at work or at school, 1000 physician consultations, and 96 antimicrobial prescriptions among the 4.2 million Norwegians. Convalescent carriage of campylobacter was detected in 16% of the patients who submitted follow-up stool specimens; the organism was carried for a mean of 37.6 days (median 31, range 15-69) after the onset of illness. Antimicrobial treatment appeared to have reduced the likelihood of carriage once symptoms had resolved. Diarrhoeal illness was more commonly reported in members of case households than control households (OR = 5.44, p < 0.0001). Cases were more likely than controls to report antecedent recurrent diarrhoea (OR = 6.00, p = 0.034). Two cases of neonatal infection, probably acquired from the mother at the time of delivery, were detected.(ABSTRACT TRUNCATED AT 250 WORDS)

The epidemiology of meningococcal disease in Norway 1975-91.

The epidemiology of meningococcal disease (MCd) in Norway is described on the basis of official notification figures for 1975-91. Morbidity is presented by serogroup of the isolated Neisseria meningitidis strain, time of onset of the disease in addition to the place of living, age and sex of the patient. A long-term group B epidemic with high incidence and case fatality rates in the age groups below 5 years and between 13 and 19-20 years is the main characteristics of the situation.

[Help for Africa in the campaign against AIDS]. / Håp for Afrika i kampen mot AIDS-epidemien [news]

PIP: A national survey in Zimbabwe in 1990 indicated that 16.5% of 1104 pregnant women and 40.6% of 723 patients with venereal diseases were HIV positive. The Ministry of Health estimated that 7% of the population was HIV positive. According to Arne Kristian Myhre, who worked as a district medical officer in Mutzi district from 1988 to 1991, the AIDS epidemic is a formidable challenge for the health service, but people are receptive to education reinforced by home-based care for patients and intensive involvement of health personnel, administrators, and local leaders. Sexually transmitted diseases (STDs) in Mutzi district decreases from 7939/100,000 people in 1988 to 7380/100,000 in 1989 and 6240/100,000 in 1990 as a result of campaigns against STDs initially launched in 1988 in connection with the World AIDS Day. Press reports of misery, helplessness, and destruction are not entirely true. The media could help by pointing out that many African countries need external expertise and financial help in order to intensify health education and to care for the sick.^ieng

Chlamydia pneumoniae infections in Norway 1981-87 earlier diagnosed as ornithosis.

Ornithosis has been a notifiable disease in Norway since 1957. During an outbreak of respiratory disease in 1981-82, described as ornithosis, contact with birds was stated in only 50% of the cases, suggesting that the infection was spread by interhuman transmission. A similar outbreak occurred in the western part of Norway in 1987. Serum specimens from altogether 260 patients, collected during the outbreaks in 1981-82 and in 1987, were investigated for antibodies against Chlamydia pneumoniae (strain TWAR). Evidence of recent infection with C. pneumoniae was found in 67.7% of the cases. The results indicate that the increased incidence of ornithosis in 1981-82 and in 1987 was due mainly to C. pneumoniae infections.

[Diseases caused by Streptococcus pyogenes in Norway, 1975-1989. A microbiologic and epidemiologic survey]. / Sykdom forårsaket av Streptococcus pyogenes i Norge 1975-89. En mikrobiologisk og epidemiologisk oversikt.

The article briefly surveys the epidemiology of Streptococcus pyogenes caused disease in Norway during the last 15 years based on notification data, with emphasis on the nation-wide outbreak in 1987-88 caused by mucoid M-1 organisms. During the season S. pyogenes infections was 60% higher than expected. The number of bacteraemia cases, many with fulminant septicaemia, showed an almost threefold increase compared with earlier years. Unusual clinical manifestations such as necrotising fasciitis, pneumonia with empyema, primary peritonitis and meningitis also occurred. We briefly review the known virulence factors of S. pyogenes in an attempt to improve our understanding of the shift in clinical manifestations and occurrence of the disease.