Carbamazepine induced right bundle branch block in a Greenlandic patient.

A 53 year old Greenlandic male was admitted twice over a period of 4 years with a new complete right bundle branch block after ingestion of 10 g and 4 g of carbamazepine respectively. In both instances, reversion of intraventricular conduction to normal occurred within 72 hours, coinciding with clearance of carbamazepine from the blood stream. We recommend routine follow up by ECG of patients over the age of 50 treated with carbamazepine.

Doubling of the tuberculosis incidence in Greenland over an 8-year period (1990-1997).

OBJECTIVE: To determine the trends in conventional and molecular epidemiology of tuberculosis (TB) in Greenland over an 8-year period. DESIGN: A nation-wide, retrospective, population-based study of all cases of TB reported to the National Health Division of Greenland from 1 January 1990 to 31 December 1997. An analysis of microbiology data including RFLP results. RESULTS: The annual incidence increased from 85/100,000 in 1990 to 172/100,000 in 1997; 335 (72%) of the cases were culture-positive. On average 58% of culture-positive cases were smear-positive, with an increase from 40% in 1990 to 69% in 1997. There was a significant increase in childhood TB from four cases in 1990 to 26 in 1997. RFLP analysis shows that 15% of the patients were infected with unique strains and 85% were infected with strains belonging to one of 20 clusters. There were four major clusters, comprising respectively 52, 34, 26 and 14 patients. CONCLUSION: There was a dramatic increase in TB cases in Greenland from 1990 to 1997. The increase is due to micro-epidemics in small isolated settlements, and affects primarily young adults and children. RFLP analysis confirms this observation and indicates confined, local transmission. In this context RFLP is not useful as the only parameter for monitoring recent transmission.

[Female genital tuberculosis]. / Kvindelig genital tuberkulose.

Immigration from African countries has led to an increasing incidence of tuberculosis in Denmark. The immigrants from the third world have a relative high proportion of extrapulmonary tuberculosis, and we report a case of female genital tuberculosis in a woman from Somalia. Problems in diagnosing female genital tuberculosis are illustrated and discussed. Treatment and subsequent fertility are discussed.

[Tuberculosis in Greenland 1994. A minor outbreak of new cases of tuberculosis in the village of Kullorsuaq]. / Tuberkulose i Grønland 1994. Et mindre udbrud af nye tuberkulosetilfaelde i bygden Kullorsuaq.

An outbreak of pulmonary tuberculosis was detected in 1994 in a small village, Kullorsuaq, located 300 kilometres north of Upernavik in the north-western part of Greenland. The inhabitants of Kullorsuaq mainly live off subsistence, hunting, seal-hunting and fishing. Too many people were living in bad housing and with a general lack of sanitation facilities. There had been a few serious cases of pulmonary tuberculosis in 1993, and when three new cases of tuberculosis in school children were diagnosed in April 1994, the authorities arranged for all 292 inhabitants of Kullorsuaq to be examined by chest X-ray. We defined tuberculosis as an infiltration seen on X-ray when tuberculosis was discovered in the near environment together with a strongly positive mantoux test. We found 20 cases of tuberculosis, two were smear positive by microscopy, both confirmed by culture, and a further five cases were diagnosed only by culture. By DNA-fingerprint-analysis we found all culture positive cases to be exactly alike. Two cases of lung cancer were also diagnosed.

[Tuberculosis in low prevalence countries. Back to the future?]. / Tuberkulose i lavpraevalenslande. Tilbage til fremtiden?

The incidence of tuberculosis has declined in all European countries in this century but in several countries the decline has come to a stop. Microscopy a.m. Ziehl-Neelsen and culture are still the mainstays in the diagnosis of tuberculosis but new DNA-technics such as PCR and RFLP are increasingly used. The tuberculin test is hitherto the only practically feasible test for identification of subjects infected with M. tuberculosis. BCG is the most used vaccine in the world but the protective mechanisms are not fully understood and the efficacy controversial. Immunotherapy with M. vaccae may be used as an adjuvant to chemotherapy. Few cases of tuberculosis are observed in AIDS-patients in Denmark. Modern standard treatment of tuberculosis comprises a six-month regimen with isoniazid, rifampicin, pyrazinamide and possibly ethambutol. Multidrug resistance in tuberculosis is rare in Western Europe. Chemoprophylaxis with isoniazid is debatable. Patients with smear-positive sputum may be infectious whereas patients with extrapulmonary tuberculosis normally pose no risk.

[Tuberculosis in Funen]. / Tuberkulosen på Fyn.

In the beginning of this century 20 percent of all deaths in the county of Funen, Denmark, was caused by tuberculosis. The sanatorium of Nakkebølle was opened in 1908. Dr. Otto Helms (1866-1942), who was a great personality with hobbies such as ornithology and writing textbooks for school children, became the first medical director from 1908 to 1940 of this famous sanatorium. His life and especially his fight against tuberculosis at the sanatorium is described. In general, today tuberculosis in Denmark is a minor problem. However, the incidence of tuberculosis in immigrants, especially from Somalia, has caused some difficulties. In the future the challenge of this field consist of AIDS and tuberculosis, and multiresistent tuberculosis. Tuberculosis hopefully may cause only limited problems if professionals are aware of early diagnosis and careful treatment of the populations at risk.

[Male genital tuberculosis]. / Mandlig genital tuberkulose.

AIM: To describe symptoms and clinical findings in patients with extrapulmonary tuberculosis and to draw attention to the fact that the disease still exists in spite of the declining incidence of pulmonary tuberculosis. DESIGN: Retrospective data from hospital records and the Register of Tuberculosis in Funen, Denmark from 1976 to 1991. REGIMEN: The investigation was carried out at the Department of Urology and the Department of Internal Medicine, Pneumology Section, Odense University Hospital, Denmark. MATERIAL: Eight patients with genital tuberculosis during a period of 15 years in Funen Island. RESULTS: Genital tuberculosis in males involves especially the epididymis, and the most frequent symptom is a painful swelling of the testicles. The average age of the patients was 62 years.

Male genitourinary tuberculosis. Report of 12 cases and review of the literature.

The incidence of genitourinary tuberculosis is constant in western countries, despite dramatically falling prevalence of pulmonary tuberculosis. The kidney is especially involved in urinary tuberculosis, and genital tuberculosis mostly affects the epididymis in males and the fallopian tubes in females. Twelve cases of male genitourinary tuberculosis are presented and the literature is briefly reviewed.

[Significant extrapulmonary manifestations of sarcoidosis]. / Betydende ekstrapulmonale manifestationer af sarkoidose.

Sarcoidosis is a granulomatous multisystem disorder of unknown genesis. Although the course is most often benign and self-limiting, serious or life-threatening extrapulmonary manifestations may occur when heart, central nervous system, kidney or the haemopoietic system are involved. In these cases, corticosteroid treatment is necessary to suppress the inflammation, prevent fibrosis in vital organs, and improve the general condition.

[Diffuse fibrosing alveolitis and primary biliary cirrhosis]. / Diffus fibroserende alveolitis og primaer biliaer cirrose.

Diffuse fibrosing alveolitis (DFA) is a disease with progressive, diffuse fibrosis in the interstitial tissue of the pulmonary parenchyma. As a rule, diffuse fibrosing alveolitis is limited to the lungs alone but it may occur as a partial manifestation of a systemic disease. A case report is presented here where diffuse fibrosing alveolitis was encountered in a patient with primary biliary cirrhosis. The pulmonary symptoms dominated the clinical picture and investigation revealed the autoimmune condition.

[Oxygen treatment and cigarette smoking. A potentially fatal combination]. / Iltbehandling og cigaretrygning. En potentielt letal kombination.

The case of a 60 year old male, who died while smoking in bed during oxygen therapy, is presented. The patient suffered from chronic airway obstruction and emphysema with respiratory insufficiency and he died from carbon monoxide poisoning, after the bed linen and the oxygen cylinder were ignited. Domiciliary oxygen therapy should not be prescribed to patients, who do not give up smoking.

Circulating immune complexes, free antigen and alpha 1-antitrypsin in levels in sarcoidosis patients.

Consecutive serum samples from 26 sarcoidosis patients were examined for circulating immune complex (IC) activity. Fifteen (58%) gave IC-positive reactions in a complement consumption (CC) test and a significant difference as regards anticomplementary was observed when comparing patients in clinical stages 2 and 1 respectively (P less than 0.01) The serum alpha 1-antitrypsin levels were not correlated (r=0.36) to the results of the CC-assay. The duration of IC-occurrence was studied, by two IC-assays, over 1 1/2 to 2 years. The majority of the positive reactions were registered in patients in clinical stage 2. Isolated IC was used for immunization of rabbits. Absorbed immune sera produced a single precipitate of postalbumin mobility with seven out of 36 sarcoidosis sera. In two cases a tailing of the recipitate suggested that the antigen was in complex formation. Immunoelectrophoresis indicated identity between the antigen detected in different sarcoidosis sera. No precipitates were observed using 130 sera from other patients, and screening of 100 blood donors revealed one positive reaction. The antigen, which eluted in the first protein peak on Sephadex G-200, has not been identified serologically.

Thyrotoxicosis in a patient treated with lithium carbonate for mental disease.

In recent years a few cases of hyperthyroidism and several of hypothyroidism which developed during lithium therapy have been described. We give an account of a case of hyperthyroidism, due to painless thyroiditis in a patient on long-term lithium therapy.

Mitochondrial antibodies without antinuclear antibodies in non-hepatic diseases.

The term "pseudo-LE syndrome" was previously used to describe an SLE-like disease in which AMA, but not ANA, were found in serum. In an attempt to find patients with this syndrome, we tested 9 358 sera for AMA and ANA. AMA without ANA was found in six patients without liver disease. One of these patients had an SLE-like disease. Two of the others had diseases of the thyroid and one had rheumatoid arthritis--diseases in which AMA have previously been described. One patient had allergic vasculitis and one hypercholesterolaemia; these diseases are not known to be associated with the presence of AMA.

Lithium carbonate in the treatment of thyrotoxicosis. A controlled trial.

Of 24 patients with newly diagnosed thyrotoxicosis, 13 were randomly selected for treatment with methimazole 40 mg per day, and 11 for treatment with lithium carbonate in such doses that the serum lithium lay between 0-5 and 1-3 meq. per litre. The lithium treatment brought about a fall in serum-thyroxine iodine (T4I) of 27.0%, and in the free-thyroxine index (F.T.I.) of 38.1% after 10 days. A comparison of the two patient groups with regard to the fall in F.T.I. after 3 and 10 days showed no statistically significant difference; similarly the calculated confidence limits appeared to exclude any difference of clinical importance. 8 of the 11 patients subjected to lithium treatment had side-effects, so that the general condition, which was already affected by the hyperthyroidism, was worsened. It is concluded that lithium cannot be considered superior to thiocarbamides for the rapid control of thyrotoxicosis.