Acute pancreatitis in Buskerud County, Norway. Incidence and etiology.

BACKGROUND: Data on the incidence of acute pancreatitis in Norway are sparse. Danish studies have shown incidence rates increasing to about 35/100,000 (26-65% alcohol-induced), higher than found in American and British studies. METHODS: We have prospectively registered all cases of acute pancreatitis during 1 year in the county of Buskerud, with a population of 224,000. RESULTS: The incidence of acute pancreatitis was 41.5 per 100,000. The median age of the patients was 63 years (range, 21-96 years). The main etiologic factors were gallstone disease (51%) and alcohol abuse (15%), whereas 10% of the cases were classified as idiopathic. Pseudocysts or abscesses developed in 8.8%. The mortality was 6.5%. CONCLUSION: The incidence of acute pancreatitis in this population is comparable to what has been found elsewhere in Scandinavia, but the relative frequency of alcoholic pancreatitis is substantially less.

Mesalazine suppositories versus hydrocortisone foam in patients with distal ulcerative colitis. A comparison of the efficacy and practicality of two topical treatment regimens.

BACKGROUND: Topical treatment is effective in patients with distal ulcerative colitis. This trial compares the efficacy, safety, and practicality of 4 weeks' treatment with 500 mg mesalazine suppositories with those of 178 mg hydrocortisone foam, both given twice daily. METHODS: Seventy-nine patients with distal ulcerative colitis were stratified on the basis of the extent of the disease (proctitis and proctosigmoiditis) and randomized to one of the treatment groups. A disease activity index (DAI) based on symptoms and endoscopic findings was calculated. The patients evaluated the practicality of the treatment regimens, patients compliance was measured, and histologic findings recorded. RESULTS: Of all the patients 22% and 38% were complete responders after 2 and 4 weeks, respectively. Median DAIs in the mesalazine and hydrocortisone groups before and after 2 and 4 weeks' treatment were 14, 6, and 4, and 13, 8, and 6, respectively. The difference between the treatment groups was statistically significant (p = 0.02) due to a better effect of mesalazine in patients with proctitis. Patients' evaluation of practicality and patient compliance were statistically significantly better in the mesalazine group. CONCLUSIONS: Both treatment regimens are effective; mesalazine suppositories seem to be the preferred alternative.

Changes in diagnostic imaging routines of the stomach and the large bowel during the period between 1975 and 1992.

In a retrospective study on diagnostic imaging of the stomach and large bowel, we evaluated the examination routines in six Norwegian hospitals for the period between 1975 and 1992. For both organ systems, a shift in routines from radiological examination toward endoscopy was observed. For the stomach there was a significant correlation between an increase in the use of endoscopy and a decrease in the use of X-ray examinations. Additionally, the total number of stomach examinations had declined. For the large bowel, the total number of endoscopic and radiological examinations had increased for all hospitals studied. While not as prominent as for the stomach, an obvious shift from X-ray examinations toward endoscopy was observed. These results should be considered when planning new imaging departments and hospitals in Norway.

[Results of respiratory treatment in a medical intensive care department]. / Resultater av respiratorbehandling i en medisinsk intensivavdeling.

During a three-year period 77 patients (43 men and 34 women, aged 21-82 years, mean age 62.0 years) were treated with mechanical ventilation in a medical intensive care unit. Three patients were treated twice. The most common diagnoses (in decreasing order of frequency) were acute exacerbation of chronic obstructive pulmonary disease, acute myocardial infarction, cerebrovascular trauma and chronic ischemic cardiac disease. The mean duration of ventilation was 6.4 days. 41 patients (51.3%) survived--80% of whom could be discharged to their home. Patients with chronic pulmonary disease showed the highest survival rate, those with cerebrovascular disease the lowest, with the cardiac patients in-between. It is calculated that it cost NOK 207,000 to treat each patient who survived.

Gastrointestinal disturbances in marathon runners.

To determine the prevalence of various gastrointestinal disturbances related to long-distance running and its effect on weight, diet and everyday digestive problems, we gave a questionnaire to 279 leisure-time marathon runners, comprising 10% of the participants in a local marathon race. Their answers disclosed a prevalence of dietary changes, weight reduction and altered bowel habits (mainly looser stools and/or more frequent defaecation) of 37, 38 and 48% respectively. A quarter reported earlier long lasting gastrointestinal problems, which improved in 41% of the runners after they started regular training. Thirty-four percent experienced gastrointestinal disturbances during or after running, 20% to such an extent that it seriously affected their performance.

[Retrograde ileography. Contrast imaging of the terminal ileum by colonoscopy]. / Retrograd ileografi. Kontrastfremstilling av terminale ileum ved koloskopi.

The distal ileum, the segment most frequently affected by small intestinal disease, may be difficult to visualize by conventional x-ray techniques. In recent years various methods have been described for retrograde ileography during or after colonoscopy. However, these methods require special equipment and may be difficult to perform in practice. We have therefore tried out a somewhat modified technique. Patients with suspected distal ileal disease are examined on a fluoroscopy table at the x-ray department. When necessary, biopsies are taken during the introduction of the scope. With the tip of the colonoscope in the terminal ileum (or coecum) a catheter is introduced through the biopsy channel into the distal ileum. Water-soluble contrast (Mixobar) is then instilled under fluoroscopic control and films are taken in the supine, oblique and prone positions. Owing to gas already present in the ileum a double contrast effect is obtained. The ileography is completed in 5-10 minutes and entails no additional discomfort for the patient. The technique is easy to learn and requires no special equipment. It does not obviate the need for conventional small bowel enema, but may be a valuable supplement to this examination when distal ileal pathology is suspected.

[Biliary duct obstruction presenting with laboratory levels indicating liver cell damage]. / Gallegangsokklusjon med laboratorieutfall som ved levercelleskade.

Some patients with extrahepatic biliary occlusion present high levels of serum aminotransferases indicating parenchymatous liver disease. The levels, usually in the range of 400-500 U/l, may sometimes exceed 1,000 U/l. Most of these patients have stones in the bile ducts, but the causes may occasionally be pancreatic tumours and pancreatitis. Typically the maximum enzyme levels are reached within 1-2 days, followed by a rapid fall--whether the gallstones have passed or not. The alkaline phophatase levels are initially normal or slightly elevated, usually increasing slowly to about twice the upper reference level. The pathogenesis of this rapid elevation of the aminotransferases has yet not been fully elucidated. However, the main mechanisms are probably increased permeability of the hepatocyte membrane caused by elevated pressure in the bile ducts, combined with a direct toxic effect of retinated bile acids. Increased enzyme synthesis may also be a contributory factor. Further knowledge of this not unusual enzyme pattern in acute (and sometimes also chronic) biliary obstruction will help to establish a correct diagnosis at an early stage of the disease, and thus avoid a need for invasive, potentially dangerous investigations.

Gastrointestinal bleeding in marathon runners.

Gastrointestinal bleeding has been proposed to be a contributing factor in the development of 'runner's anaemia'. To study the incidence of gastrointestinal bleeding, 2-3 prerace and 2-3 postrace faecal samples from 63 marathon runners were tested for the presence of blood. Five of the participants had faecal blood before but not after the race. A reasonable explanation for the bleeding was found for four. Eight runners (13%) had positive tests for faecal blood after the competition. Clinical investigation disclosed no gastrointestinal disease. Postrace haematuria was discovered in another 13% of the runners. None of the runners observed overt gastrointestinal bleeding or haematuria, nor did anyone develop anaemia. Gastrointestinal disturbances related to running were reported by 54%. It is concluded that gastrointestinal complaints and gastrointestinal bleeding are prevalent among marathon runners.