Diagnosis of the cause of malfunction of indwelling catheters for insulin injections by the use of digital fluoroscopy.

BACKGROUND: Subcutaneous indwelling catheters are used for reducing pain when injecting insulin and other drugs. OBJECTIVE: To use digital fluoroscopy for the diagnosis of catheter malfunction. MATERIAL AND METHODS: Seven children (aged 5-11 years) with diabetes mellitus were studied. They used indwelling catheters (Insuflon) for insulin injections. Contrast medium was injected into the problem catheter. RESULTS: The subcutaneous position of the catheter was correct in all cases, but we found two cases of delayed absorption caused by lipohypertrophy and one case of leakage. CONCLUSIONS: Digital fluoroscopy is a useful method for determining potential problems with indwelling catheters.

Occupational retirement in women due to age. Health aspects.

The impact of occupational age-retirement on physical and mental health was investigated in 116 female municipal employees (age 62-64 years old) in Malmö. Interviews and physical examinations were made about six months prior to and five months after retirement. The women were asked about present state of subjective health, earlier and present diseases, various symptoms, medication, calls to physicians, smoking habits, physical activity and sleeping habits. The majority (n = 109.94%) felt healthy before retirement. At least one definable disease was noted in 41 (35%). A proportion of them had a low level of subjective health which, however, improved after retirement. The disease most commonly found was hypertension. After retirement the subjective health improved in 22% and got worse in 9%. Blood pressure diminished and particularly musculo-skeletal and psychiatric symptoms were less common. Calls to physicians diminished. Intake of drugs, smoking and sleeping habits and physical activity changed little. In general, occupational retirement due to age was associated with mostly positive influences on health.

Relationship between general health, social factors and oral health in women at the age of retirement.

Relationships between some medical, psychological, social factors and oral health were analyzed within a comprehensive study of women around the age of retirement. The study was performed in Malmö in 1985-1986 and included 165 women retiring from work between 851201 and 870131. Women in qualified professional positions and with high prosperity indices had an average significantly more remaining teeth and were less often edentulous than the others. The same applied to unmarried women compared to divorcees and widows. There were significant correlations between full blood glucose and serum urate concentrations and number of teeth, DFT and DFS. The mean number of prescribed drugs was negatively related to the number of remaining teeth and high drug consumption was positively related to oral dryness. Women complaining of strain, overwork, restlessness and difficulty in relaxing reported more often problems with oral dryness. Oral dryness was also related to high blood values of calcium, urate and triglycerides, while the serum levels of cholesterol were low. There were no differences between smokers and non-smokers concerning any of the studied tooth-related variables, oral dryness, hypertension or bodyweight. The results indicate a close relationship between general health, social factors and oral health.

Ulcer disease among geriatric inpatients with positive faecal occult blood test and/or iron deficiency anaemia. A prospective study.

The purpose of this study was to investigate the prevalence and type of lesions in the upper gastrointestinal tract and to identify characteristics associated with ulcer disease among geriatric inpatients with positive faecal occult blood test and/or iron deficiency anaemia. Two thousand five hundred and four patients aged 60-98 (mean, 82) years admitted to a geriatric clinic for rehabilitation were screened by faecal occult blood test, for B-haemoglobin, and, in a case of anaemia, analyses of serum levels of mean corpuscular volume, mean corpuscular haemoglobin concentration, iron, and total iron-binding capacity. One hundred and seventy patients were included in the study. A high prevalence of ulcer disease (22%) was found. Significantly higher proportions of non-steroidal anti-inflammatory drugs and steroid users and of patients with rheumatoid arthritis and osteoarthrosis were found among ulcer patients than among patients without ulcerative upper gastrointestinal lesions. The clinical picture of ulcer disease differed from the classic presentation: abdominal pain occurred in only 7 of 38 patients (18%), whereas appetite and weight loss and nausea/vomiting were common. It is important to be aware of the high prevalence and the clinical picture of ulcer disease among geriatric inpatients with iron deficiency anaemia and/or occult gastrointestinal bleeding.

Carotid artery blood flow velocity related to transient ischemic attack and stroke in a population study of 69-year-old men.

A population-based sample of 478 men aged 69 years living in Malmö, Sweden, underwent Doppler ultrasonic examination of their carotid arteries; cerebrovascular symptoms and signs were recorded independently. Among 471 men with complete examinations, 117 (25%) showed significant abnormalities in carotid blood flow velocity (moderate stenoses [30-60% diameter reduction] in 20%, severe stenosis [greater than or equal to 60% reduction] or occlusion in 5%). The latter seemingly formed a group separate from the main distribution curve. Stroke was reported in 28 men (6%), during the year before examination in nine (2%). Carotid transient ischemic attack (TIA) was clinically confirmed in one man during this year, while unconfirmed symptoms were reported in 63 (13%). There was a relation between ipsilateral hemispheric stroke/TIA and severe carotid disease (p less than 0.001). Four of seven men with total occlusion had a stroke or a clinically confirmed TIA. Nevertheless, the majority of carotid stenoses (including severe stenoses) were asymptomatic. Cerebrovascular symptoms were not significantly more frequent among the men having moderate stenosis than among those having healthy arteries.

Age retirement in women. I. General presentation.

Within the framework of a longitudinal population study of age retirement in women, the short-term consequences of retirement were studied in 116 municipally employed women in the city of Malmö (230,000 inhabitants) in southern Sweden half a year before and half a year after retirement. The women represented about 40 different occupations, mostly within the sectors of health care, social services and administration. The study comprised four main parts, namely health and discomfort, social psychology, dietary habits and body composition, and oral health. The present paper concerns a general presentation of the study including sampling procedures and analyses of non-response. The response rate was a little more than 70%. Only a few significant differences were observed between non-responders and responders, such as more working hours per week, and more frequently a negative attitude towards retirement in the non-responders after retirement. This longitudinal prospective study of the same cohort of women has so far shown that the general design, sampling procedure and general methods of data collection appear adequate and feasible. In general, the study population was representative of women about to retire from municipal employment in Sweden. Results from the different studies will be presented elsewhere. To illustrate not only the short-term effects of retirement we intend to reexamine the same women about 2 years after the retirement.

Age retirement in women. II. Dietary habits and body composition.

Within the framework of a longitudinal study of municipally employed women in Malmö, Sweden, before and after retirement, comprising health, social, psychological, nutritional and odontological aspects, the dietary habits and body composition were evaluated. 116 women aged 62, 63 and 64 were included. A detailed dietary interview was performed by a nutritionist, anthropometric measurements were made, and body compartments were calculated after retirement with a new electrical impedance method. Average dietary intakes were relatively high, but variation was marked. Intake of energy and almost all nutrients showed a clear decreasing tendency from before to after retirement, despite an increase in body weight and waist measurement, indicating decreasing physical activity after retirement in these women. There was also an increasing consumption of pastry, potato chips and similar food items. One third of the women was below the recommended dietary allowances (RDA) regarding calcium and almost all women below the RDA regarding vitamin D. There are reasons to believe that the event of retirement in women might imply some dietary hazards.

Ultrasonographic screening for gallstone disease in middle-aged women. Detection rate, symptoms, and biochemical features.

Five hundred and forty-seven middle-aged women, selected at random from the population of Malmö, Sweden, were invited to a screening survey for gallstone disease; 424 participated (77.5%). Forty-one had previously been operated on for gallbladder disease. The prevalence of gallstone disease, on the basis of a positive finding at ultrasonography and cholecystography, was 11%. The predictive value of a positive finding at ultrasonography was 86%. Six out of 10 women with gallstone were classified as asymptomatic. Body weight, blood pressure, liver enzymes, fasting blood glucose, and blood lipids, including apolipoprotein-A, did not differ significantly in women with and without gallstone disease. At least 9 out of 10 gallstones appeared to be cholesterol stones. Approximately half were of a size that would make them accessible for dissolution therapy.

Acute gastrointestinal haemorrhage. Experience with early panendoscopy and tranexamic acid in a rural hospital.

One hundred and fifty-nine consecutive patients admitted to a small rural hospital because of acute gastrointestinal haemorrhage were studied. Patients with haematemesis and/or melaena were treated with antacids and tranexamic acid from the very beginning and were examined by means of early panendoscopy. All patients were closely observed on a general medical ward by a staff especially trained to deal with acute gastrointestinal bleeding. Eight patients required acute surgery. The overall mortality rate was 4.4%. It is concluded that acute gastrointestinal haemorrhage can be successfully handled with modern diagnosis and treatment even in a small hospital.

Diagnosis and treatment of acute gastrointestinal haemorrhage in a small district hospital.

Ninety-eight consecutive patients admitted to a small district hospital because of acute gastrointestinal haemorrhage have been studied. Patients with haematemesis and/or melaena were treated with antacids and tranexamic acid from the very beginning and were examined with early panendscopy. All patients were closely observed in an ordinary medical ward by a staff especially trained to handle acute gastrointestinal bleeding. Seven patients required acute surgery. The overall mortality was 4.1%. It is concluded that acute gastrointestinal haemorrhage can be successfully handled with modern diagnosis and treatment in a small hospital.

Increasing caesarean section rate.

At the University Hospital in Uppsala 719 Caesarean Sectons (C.S.) were performed 1966-1970. The total number of deliveries was 16 708. The C.S. rate increased from 2.0% to 7.8%. This trent was mainly due to an increasing frequency of C.S. performed for cephalopelvic disproportion fetal distress "bad obstetrical history" and failed induction of labour with intravenous oxytocin drip. No maternal deaths occurred. The perinatal mortality was 5.0%. In infants with a birth weight of 1 500 g or less the perinatal mortality was 57% and in infants with a birth weight of more than 2 500 g and a gestational age of 37 weeks or more it was 0.9%. In 207 elective C.S. on healthy mothers at term no perinatal deaths were noted.

Hypothyroidism with subacute pseudomyotonia--an early form of Hoffmann's syndrome? Report of a case.

A 25-year-old man was admitted to the hospital because of painful muscle cramps and action myospams of subacute onset and 6 weeks' duration. No myotonia could be demonstrated objectively and his deep tendon reflexes showed no prolongation of the relaxation phase. Serum creatinine was raised but creatinine clearance was normal. Serum levels of aldose, CPK, ASAT and ALAT were increased but ordinary light microscopy revealed no histological signs of muscle disease in a quadriceps biopsy. ECG showed a prolonged PQ interval and flat T waves in the left precordial leads. Laboratory tests of thyroid function revealed intensive hypothyroidism, and high titers of circulating thyroid antibodies were demonstrated. During 2 1/2 months of thyroid therapy, the muscle symptoms gradually disappeared completely and the patient could return to work. By that time the serum enzymes and the ECG had normalized. Despite the lack of objective signs of myotonia, we consider that the very dominant subjective muscle symptoms, severe enough to prevent the patient from performing his ordinary manual work and completely reversible on thyroid therapy, justify the designation of hypothyroid myopathy. The question is raised whether the case represents an early form of Hoffmann's syndrome.