[Diagnosis of Clostridium difficile infection in pseudomembranous colitis]. / Diagnostik af Clostridium difficile-infektion ved pseudomembranøs colitis.

C. difficile is known as the main cause of pseudomembranous colitis, however, some individuals may be asymptomatically colonized. In this paper two patients with diarrhoea had three respectively five negative stool cultures. Endoscopically, one patient had severe colitis consistent with both pseudomembranous colitis and inflammatory bowel disease. In the other case the endoscopic findings were typical for pseudomembranous colitis. In both cases there were positive cultures for C. difficile from biopsies from colon-plaques. We find that culture of biopsy of a colon-plaque may contribute to the detection of C. difficile infection in patients with negative stool cultures.

Death and injury caused by land mines in Burma.

One hundred and eighty-eight Burmese refugees in Thailand were interviewed. One hundred and five of those interviewed had knowledge of a total of 313 persons who had been exposed to land mine explosions. Twenty-three of the interviewed were land mine survivors. They were all male, aged between eight and 68 years, and all except one had been injured between 1986 and 1997. Fifteen of the 23 were civilians, eight were guerilla soldiers who were injured either in battle or while deploying or disarming land mines. Those who had stepped on land mines were all crus or femur amputated and had several scars on the lower limbs, abdomen and some also on the forearms. Those who had handled a land mine had lost either fingers or hands and one also lost both eyes. This study shows that the frequency of land mine accidents in Burma has been underestimated and that the mortality is high. The study also supports the general impression that many victims are civilians.

[Endoscopic diagnosis of enterobiasis]. / Endoskopisk diagnosticering af børneorm.

This article describes two cases of worm-infestation with symptomatology, diagnosis and treatment. The cases are discussed in respect to the other cases in the literature emphasizing symptomatology and diagnosis by endoscopy.

Human rights violations in Burma/Myanmar. A two year follow-up examination.

INTRODUCTION: The aim was to describe recent exposure to human rights violations among refugees from Burma/Myanmar. The study includes the Mon people, an ethnic group whose human rights situation hitherto has not been documented thoroughly. Moreover, the aim was to compare the refugees that fled recently with refugees who fled two to three years ago, with respect to exposure to human rights violations in order to evaluate whether the situation of Burmese ethnic minority groups has changed during the last few years. METHODOLOGY: Systematic interviews and clinical examinations of 129 Burmese refugees, including Mons, who had fled Burma within 12 months were carried out in December 1999. A score was used to quantify the exposure. RESULTS: The interviewees reported forced labour (88%), porter service (77%), forced relocation from their villages (54%), looting (88%), and/or loss of at least one relative (46%) through killing, disappearances or landmine accidents. Twenty per cent reported that they themselves or family members had been tortured. Rape of women was reported by 46%. CONCLUSION: All groups examined reported exposure to massive violations of human rights. The Mons had been exposed to the same extent as the others. There was no sign of improvement of the human rights situation during the past two years. Apart from a few cases of arbitrary arrests and landmine operations, the Burmese army was held responsible for all the reported violations of human rights. A cease-fire agreement with the Burmese army seems to influence the risk of an ethnic group of being forcibly relocated, but not the overall exposure to human rights violations.

Comparative Slow-Blasting in Rice Grown Under Upland and Flooded Blast Nursery Culture.

Evaluation of rice for resistance to rice blast disease caused by Pyricularia grisea usually is conducted in upland (nonflooded) disease nurseries, although all commercial U.S. rice is produced under flood irrigation. Upland rice is more susceptible to leaf blast than is flooded rice, and the magnitude of this differential susceptibility can vary among cultivars. This 2-year study was undertaken to determine (i) the relationship between rates of disease development (slow-blasting) in upland and flooded rice and (ii) the value to a rice breeding program of establishing a flooded blast nursery, a facility far more difficult to manage than an upland nursery. Among 200 rice lines compared for leaf blast susceptibility under upland and flooded cultures, only 7 were rated as slightly more resistant under upland culture and 136 rated more resistant under flooded culture. Disease ratings under upland and flooded cultures were highly correlated (R = 0.819). Among 14 preselected cultivars over 2 years, disease development curves under upland and flooded cultures were highly correlated (R = 0.990). The cultivars with intermediate susceptibility under upland culture appeared to benefit most from flooded culture. Upland culture provided more opportunities to assess slow-blasting than did flooded culture, since many lines that produced susceptible-type lesions in upland culture failed to do so under flooded culture. It was concluded that adequate information on comparative leaf blast resistance among rice lines was attainable from upland blast nurseries and that routine evaluation of rice breeding lines for blast resistance in flooded nurseries was not necessary.

[Documentation of violence against civilians in a civil war. Examples from Kashmir]. / Dokumentation af overgreb mod civile i en borgerkrig. Eksempler fra Kashmir.

Physicians for Human Rights/Denmark visited Kashmir three times in 1993 and 1994. In Indian-held Kashmir we examined victims of torture and gunshots and we assessed similar evidence collected by local lawyers and doctors. In refugee camps for Indian Kashmiries we examined ten children, who were reported to have been tortured at the age of 5-14 years, and ten other children who allegedly had been ill-treated. Furthermore, 17 adults, who reported that they had been tortured, were examined. In nearly all cases there were physical findings in accordance with the histories of torture. In many cases, including those of the children, the findings were highly remarkable by their shape and localization. We interpret them as evidence of intentionally inflicted injuries. In the refugee camps we carried out a prevalence study of exposure to organized violence. Approximately 95% of all families had been exposed to violence; 35% reported that their children had been ill-treated. The physical findings indicate that intentional traumatization of civilians including children in Indian-held Kashmir takes place; the results of the prevalence study suggest that exposure to violence is widespread.

Results of medical examination of refugees from Burma.

OBJECTIVES: To describe exposure to human rights violations among refugees from rural Burma; to compare exposure experienced by an ethnic Burmese minority group, the Shans, with that of the rest of the study population; and to compare exposure of those who had fled Burma recently with that of refugees who had arrived in Thailand earlier. DESIGN: Cross-sectional interview and clinical examination. SETTING: Refugee settlements and refugee camps in Northern Thailand near the border to Burma in November 1997. SUBJECTS: 92 persons (group A) were examined according to the program. Fourty-six were Shans; 34 had migrated within the past five months. A further 96 person (group B), more randomly selected, were interviewed according to an abbreviated interview program; of these, 38 had fled recently. MAIN OUTCOME MEASURES: A score was used to quantify the exposure. Testimonies of exposure to physical violence were validated, assessing the consistency between the reported exposure, reported ensuing symptoms and the result of the clinical examination. RESULTS: Both groups reported massive exposure to the following human rights violations: forced labour (group A: 66%, group B: 35%), porter service (65%, 44%), forced relocation (51%, 51%), killing of family members (36%, 29%). In group A, there were twelve cases of self-reported torture. Moreover, there were reports of rape, disappearances and land mine accidents. In all cases of exposure to physical violence the testimonies were appraised to be valid. CONCLUSION: The violations of human rights in Burma were massive. The Shans were exposed as heavily as the others. Those who had arrived recently were as heavily exposed as the other groups. Apart from the land mine problem, the Burmese army was held responsible for all the reported and documented human rights violations.

Evidence of physical torture in a series of children.

In a refugee camp for Kashmiris it was stated that children had been exposed to torture and ill-treatment; consequently, we decided to appraise the validity of such statements. Ten boys allegedly exposed to torture and 10 children who were said to have been ill-treated were interviewed and examined. The veracity of the individual statements about exposure was appraised through an assessment of the consistency between the history and the clinical findings. In all cases of alleged torture, the history was in agreement with clinical findings ascribed to torture. Torture methods included cuts with bayonets and burns with items easily available in any setting. In five of the 10 cases of torture, the scars were highly indicative of intentionally inflicted injuries, by their shapes, their presence in clusters and their localization in regions not normally exposed to traumatization. Nine of the 10 children allegedly exposed to ill-treatment had scars in accordance with their histories. In all cases, Indian security forces were said to have been responsible for the inflicted violence. The histories and the clinical findings were in accordance with results of examinations of adult victims of organized violence from the same region. On the basis of the physical evidence, in each case in agreement with the history, it is concluded that torture of children has occurred in Kashmir. Series of children with physical evidence of torture have not previously been described in the medical literature.

Assessment of evidence of human rights violations in Kashmir.

From a region with ethnic and political contrasts, recent human rights violations are documented through medical examinations of a small sample of victims and through information given by local medical doctors and lawyers. Within the individual case stories of torture, there was consistency between the history and the clinical and paraclinical data. Furthermore, the sum of the evidence fitted into a general pattern of torture and killing of civilians committed by the Indian Security Force. Cases of rarely documented mutilating torture are presented. Examples of difficulties in the assessment of complicated cases where a complete history could not be obtained are given, together with examples of difficulties and inaccuracies arising from the use of interpreters, who were possibly biased.

General health assessment in refugees claiming to have been tortured.

General health assessment of refugees claiming to have been previously exposed to torture takes place in a psychological atmosphere affected by the difficult situation of the refugee. Thirty-one refugees, mainly from the Middle East and Africa, were assessed as regards their physical and mental health. Assessment took place with the help of professional interpreters and was, during each interview, performed by two medical doctors using double-blind techniques. Based on a number of highly significant (P < 0.001) correlation coefficients and Kappa values, observers agreed frequently on gradients of symptom intensity and less frequently on absolute symptom levels. However, agreement was almost complete when assessing the presence of intense symptoms and the absolute absence of a symptom. Symptom patterns were demonstrated to be consistent, clinically interpretable and, furthermore, closely associated (P < 0.0001) with self-reported global (general) health. Reliability was moderate with respect to clinical observation during interview.

Gastrin and somatostatin in Helicobacter pylori infected antral mucosa.

Helicobacter pylori infection is associated with increased meal stimulated gastrin secretion, but the reason for this is unknown. Sequence specific radioimmunoassays were used to measure the concentration of alpha-amidated gastrin, the total progastrin product, and somatostatin in biopsy specimens of human antral mucosa. The antral concentrations of alpha-amidated gastrin and of total progastrin products were significantly higher in H pylori infected patients than in those not infected by this organism. In contrast, the antral somatostatin concentration was significantly decreased in infected patients. Progastrin processing, determined by gel chromatography, seemed unaffected by H pylori infection. The results suggest that the finding of increased gastrin secretion from the antral G cells in H pylori infected patients may be a result of reduced inhibition of G-cell secretion by somatostatin.

Medical appraisal of allegations of torture and the involvement of doctors in torture.

Today, torture is used in more than 90 countries. In most of these countries, the authorities try to conceal the use of torture. Therefore torture methods which do not leave marks are more often selected. Consequently, appraisal of statements of torture is mostly based on interviews with ex-prisoners. The statement of torture is compared with the description of symptoms in the period following imprisonment and with the result of the clinical examination, which is often normal. In the evaluation of the validity of a statement reservations often have to be made for minor disagreements between the single elements of the examination, for example because of impaired concentration during the examination and loss of consciousness during the torture. Furthermore, the statement may be incomplete because of psychological inhibitions and imperfect interpretation. Assessment of allegations of medical involvement in torture is also based on information given by the ex-detainee. The presumed doctor's examination technique and the treatment carried out and prescribed by him, are compared with the context in which he acted. Only very rarely do torture victims have marks from e.g. injections or suturing which can be related to medical treatment in torture centres. The critical evaluation of data collected during in-depth interviews with torture victims is the core of documentation of torture and medical involvement in torture. The national medical associations share the responsibility of ensuring that their country's doctors comply with the ethical rules and do not in any way participate in or omit to report torture.

Effects on aflatoxin M1 residues in milk by addition of hydrated sodium calcium aluminosilicate to aflatoxin-contaminated diets of dairy cows.

Hydrated sodium calcium aluminosilicate (HSCAS), an anticaking agent for agricultural feeds, was added to aflatoxin (AF)-contaminated diets of 3 lactating dairy cows and evaluated for its potential to reduce aflatoxin M1 (AFM1) residues in milk. During phase I, cows were fed alternating diets that consisted of 200 micrograms of AF/kg of feed for 7 days, 0.5% HSCAS plus 200 micrograms of AF/kg of feed for 7 days, and feed with the HSCAS removed for a final 7 days. The AFM1 milk concentrations from the intervals with HSCAS added to diets were compared with those times when HSCAS was absent. The presence of 0.5% HSCAS in feed containing 200 micrograms of AF/kg reduced AFM1 secretion into the milk by an average of 0.44 micrograms/L (from pretreatment of 1.85 micrograms/L to 1.41 micrograms/L with HSCAS, a 24% reduction). Following a 10-day period of noncontaminated feed consumption and no AFM1 residues in the milk, phase II of the study was begun. The same experimental design as phase I was used, but the dosages of HSCAS and AF were changed to 1.0% and 100 micrograms/kg of feed, respectively. The addition of 1.0% HSCAS in feed containing 100 micrograms of AF/kg decreased AFM1 content in the milk by an average of 0.40 micrograms/L (from a pretreatment of 0.91 micrograms/L to 0.51 micrograms/L when HSCAS was present, a 44% reduction). These findings suggest that HSCAS, a high-affinity sorbent compound for AF in vitro, is capable of reducing the secretion of AFM1 into milk.

Effects of a hydrated sodium calcium aluminosilicate on growing turkey poults during aflatoxicosis.

Effects of adding .5% of a hydrated sodium calcium aluminosilicate (HSCAS) to diets containing 1 or .5 mg aflatoxin (AF)/kg were determined in male turkey poults from 1 day to 3 wk of age. Body weight gains were significantly reduced by 51 and 19% in turkey poults fed 1 and .5 mg AF/kg, respectively; efficiency of feed utilization was not affected. There were no deaths in poults fed .5 mg AF/kg; however, the mortality rate was 88% in poults fed 1 mg AF/kg. The addition of .5% dietary HSCAS resulted in a 68% decrease in mortality to 28% for the 3-wk experimental period. Treatment-related changes in relative organ weights, hematological values, serum biochemical values, and enzyme activities were observed. The HSCAS in the absence of AF did not alter any of the parameters measured. The HSCAS diminished the adverse effects of AF on body weight gains, most relative organ weights, hematological values, serum biochemical values, and enzyme activities associated with .5 mg AF/kg, but not 1 mg AF/kg. These findings indicate that HSCAS may diminish many of the adverse effects of AF in an AF-sensitive species, the turkey.

Torture in a democratic country, 1989. Medical aspects.

After a period of unrest in Caracas, Venezuela, in February/March 1989, Amnesty International (AI) received information about torture applied by security forces to people thought to have participated in or organised riots and lootings. In May 1989 a delegation from AI went to Caracas to collect and appraise testimonies of human rights abuses. The delegation consisted of two staff members from the AI International Secretariat, one lawyer and one physician. The primary task of the latter was to assess the validity of the testimonies about torture. A full report (1) including a legal analysis has been published by AI. This paper describes some of the medical aspects of the mission.

[Hospital employees' knowledge about HIV disease. A study from 2 provincial hospitals]. / Hospitalsansattes viden om HIV-sygdommen. En undersøgelse fra to provinssygehuse.

The knowledge of and attitudes to HIV infection were investigated by means of questionnaires during the period 1.10.1988 to 30.4.1989 in two small Danish Hospitals. Two hundred and thirty two nurses, 147 nursing aids, 44 doctors, 25 laboratory workers and 22 midwives took part in the investigation. The overall response was 99% of the staff contacted. The questionnaires were anonymous and were completed immediately and without use of any sources of information. Poor knowledge was revealed concerning symptoms, sources of infection, precautions to avoid infection, high-risk groups and patients duty to provide information. In fact, none of the groups exceeded 66% correct answers on these subjects. A total of 70% of the whole group had been in contact with patients, whom they suspected to be HIV-positive. Every third individual had felt insecure regarding HIV at work. Incidents at work had caused 18 employees to be tested for HIV. Only about half had been instructed about HIV. A total of 73% expressed needs for further instruction about the disease. The investigation shows difference between the staff opinion of possible claims on the patients about tests and to the policy of the Danish Department of Health concerning voluntary testing.

Acyclovir in the prevention of duodenal ulcer recurrence.

This study tests the hypothesis that reactivation of a latent herpes simplex virus infection may be a cause of recurrent duodenal ulceration. Patients with recently healed duodenal ulcer were entered into a double blind, randomised study of maintenance treatment with the antiviral drug acyclovir (400 mg bid) versus placebo, to determine if suppression of herpes virus infection would influence the natural history of the ulcer disease. One hundred and fifteen patients entered the trial and 76 patients completed it according to the protocol. Endoscopy was performed when ulcer symptoms recurred and at the end of the 25 week trial period. In the acyclovir group the cumulated relapse rate was 63% compared with 56% in the placebo group (NS). This result suggests that reactivation of herpes simplex virus is not a cause of recurrent duodenal ulcer.

[Cervical dilatation with Lamicel in gravida I women applying for termination of pregnancy]. / Cervikal dilatation med Lamicel til abortsøgende gravida I.

Thirty primigravidae referred for termination of pregnancy in the first trimester participated in a prospective randomised investigation. The object of this investigation was to determine the extent of cervical dilatation obtainable employing a new osmotic cervical dilator, Lamicel. In fifteen patients, a 3 mm Lamicel rod was introduced four hours prior to abortion by suction and fifteen patients functioned as the control group. In the treated group, dilatation of the cervix was commenced with a cervical diameter of 7 mm compared with 3 mm in the control group (p less than 0.01). Four patients stated that they experienced transient pain on introduction of Lamicel. No differences in the nature and frequencies of complications were observed between the groups. Employment of Lamicel provides gentle and effective dilatation of the cervical canal and the method is thus considered as suitable for termination of pregnancy.