Vitamin D insufficiency in Greenlanders on a westernized fare: ethnic differences in calcitropic hormones between Greenlanders and Danes.

We studied the influence of age, gender, latitude, season, diet and ethnicity on plasma 25-hydroxyvitamin D 25 OHD, PTH, 1,25-dihydroxyvitamin D, vitamin D-binding protein, bone-specific alkaline phosphatase, and osteocalcin levels in 46 Greenlanders living in Nuuk (64 degrees N) on a traditional fare (group A), 45 Greenlanders living in Nuuk on a westernized fare (group B), 54 Greenlanders (group C), and 43 Danes (Group D) living in Denmark (55 degrees N) on a westernized fare. Blood specimens were drawn both summer and winter. Vitamin D insufficiency (plasma 25 OHD <40 nmol/l) was common in all four study groups during summer (23-74%) and winter (42-81%). Compared to groups A and D, vitamin D insufficiency was significantly more frequent in groups B and C. In all groups, summer levels of 25 OHD were above winter levels. Multiple regression analysis revealed a significant effect of ethnicity. Compared to Danes, Greenlanders had higher 1,25-dihydroxyvitamin D levels, but lower 25 OHD and PTH levels despite relatively low plasma calcium concentrations. In addition to ethnicity, 25(OH)D levels were influenced by age, season (summer > winter), and diet (a traditional Inuit diet>westernized diet). Ethnic differences exist between Greenlanders and Danes. Our results suggest that Greenlanders may have an inherent lower "set-point" for calcium-regulated PTH release or an enhanced renal 1,25(OH)(2)D production. In addition to ethnicity, age, season, and diet were important determinants of vitamin D status. Changes from a traditional to a westernized fare are associated with a reduced vitamin D status in Greenlanders. Vitamin D supplementation should be considered.

Twenty-four-hour blood pressure among Greenlanders and Danes: relationship to diet and lifestyle.

BACKGROUND: Greenlanders have a lower rate of cardiovascular mortality and morbidity than Danes, possibly due to lower blood pressure. However, 24-h blood pressure has never been measured in Greenlanders. The aim of this study was to compare the 24-h blood pressure of Greenlanders and Danes, and to analyse the influence of Arctic food and lifestyle on blood pressure. METHODS: Four groups of healthy subjects were recruited for the study. Group I: Danes in Denmark consuming European food; group II: Greenlanders in Denmark consuming European food; group III: Greenlanders in Greenland consuming mainly European food; and group IV: Greenlanders in Greenland consuming mainly traditional Greenlandic food. All subjects underwent a physical examination, laboratory screening of blood and urine samples, and completed a questionnaire on diet, physical activity, smoking status, intake of alcohol, liquorices, vitamins and minerals. Twenty-four-hour blood pressure was measured. RESULTS: It was found that 24-h diastolic blood pressure was lower in Greenlanders than in Danes for the whole 24-h period and during both day and night-time, whereas systolic blood pressure was the same (mean 24-h blood pressure with 95% CI: Danes 123/75 mmHg (120/73-127/77), Greenlanders 122/ 69 (119/68-124/70)). Among Greenlanders, blood pressure increased with age and male gender, and systolic blood pressure increased with body mass index (BMI). No association with diet was found. The difference between the two populations persisted after controlling for age, gender, BMI, outdoor temperature, and lifestyle factors. CONCLUSION: Greenlanders have a lower 24-h diastolic blood pressure than Danes, and it is suggested that genetic factors are mainly responsible for the lower blood pressure level among Greenlanders.

[Factors determining the development of wound infection after appendectomy]. / Faktorer bestemmende for udviklingen af sårinfektion efter appendektomi.

In order to illustrate which factors are of significance for the development of wound infection after appendectomy, an extensive prospective material of 2,097 patients submitted to appendectomy was analysed. Regression analyses demonstrated that age alone, employment of preoperative antibiotics (cefoxitin) and patient delay (time from onset of symptoms till admission) were of significance. The present authors conclude, on the basis of this material, that all patients over 25 years of age should be given preoperative antibiotic prophylaxis which covers aerobic and also anaerobic microorganisms. If a gangrenous or perforated appendix is found, antibiotics should be administered intraoperatively if prophylactic treatment has not been administered. In cases of perforation, antibiotics should be administered postoperatively for 72 hours.

Antibiotic prophylaxis in acute nonperforated appendicitis. The Danish Multicenter Study Group III.

In a prospective, block-randomized, multicenter study, the safety and efficacy of cefoxitin in preoperative prophylaxis were studied. 1735 patients undergoing appendectomy were evaluable, and half of these patients received 2 g of cefoxitin before undergoing operation. The patients were divided into three groups: patients with a normal appendix, patients with an acutely inflamed appendix, and patients with a gangrenous appendix. The study showed for each group a significant reduction of the incidence of wound infection in patients receiving prophylaxis. However, intra-abdominal abscess formation was not influenced by preoperative antibiotic prophylaxis. Consequently, routine preoperative prophylaxis is recommended before appendectomy.

[Whipple's resection in cancer of Vater's ampulla and the pancreatic head]. / Whipple's resektion ved ampulla Vateri og caput pancreatis cancer.

A review is presented of 62 Whipple's resections between 1962 and 1984 for adenocarcinoma of the choledocho-duodenal junction (CDJ) and pancreatic head (PH). The operation was radical in 17 patients with CDJ (94%) and in 34 patients with PH cancer (77%). The cumulative 5-year survival rates were 22% and 9%, respectively. The overall perioperative mortality was 23%, but was lowered to 11% during the last five years. Histology, size of tumour and age also influenced survival. Sixteen of the 32 radically operated patients who survived more than three months had a period without pain. Whipple's resection is still the only hope for cure in otherwise fit patients with CDJ or PH cancer, estimated to be radically resectable by pre- and peroperative investigations. The operation should be centralized in a few departments.

The predictive value of the third day temperature in the decision whether to continue or terminate antibiotic treatment in perforated appendicitis.

The third day temperature is frequently used in the decision whether to continue or terminate antibiotic treatment following appendicectomy in perforated appendicitis. To assess the value of the third day temperature in predicting intraperitoneal infectious complications we studied 235 consecutive patients treated with a 3-day course of cefoxitin after surgery for perforated appendicitis. The results demonstrated that regardless of the level of elevated temperature chosen, the predictive value ranged between 16 and 33%. In consequence, elevated third day temperature per se does not provide any rational basis for continuing antibiotic treatment in order to prevent intraperitoneal infectious complications following appendectomy in perforated appendicitis.

Three days cefoxitin in perforated appendicitis.

This study was undertaken to assess the efficacy and safety of a 3-day course of treatment with Mefoxitin (cefoxitin sodium, MSD) in patients with perforated or ruptured appendicitis. A series of 235 patients undergoing surgery for perforated or ruptured appendicitis were treated with cefoxitin for 3 days. Twenty-four patients (10%) developed wound infection and 28 (12%) developed an intra-abdominal abscess postoperatively. No side effects were observed during the study. Compared with the results of our previous series, where a 5-day course of cefoxitin was used, the incidence of wound infection was similar. However the incidence of intra-abdominal abscesses in the present series was significantly higher (p less than 0.01). The results seem to indicate that a 3-day course of cefoxitin is as effective as a 5-day course in controlling the incidence of wound infection following surgery for perforated or ruptured appendicitis, whereas the 3-day course seems to be inferior to a 5-day course in controlling the incidence of intra-abdominal abscesses.

Parathyroid carcinoma; a cause of recurrent primary hyperparathyroidism a few years after removal of a parathyroid adenoma.

This is a case report of recurrent hyperparathyroidism due to parathyroid carcinoma. Primarily a neck exploration revealed an adenoma of the inferior right parathyroid body but at cervical re-exploration 4 years later due to recurrence a parathyroid carcinoma at the opposite side was found. The importance of recognizing the malignancy at operation is emphasized and the author's opinion for the necessity of localizing studies in cases of reoperations at the neck for over-functioning parathyroid glands is expressed.

Intraoperative pressure measurements of the choledochoduodenal junction, common bile duct, cysticocholedochal junction and gallbladder in humans.

With the use of the perfused system for manometry, the resting pressure profile in the biliary tract system was investigated during operation in 15 patients with gallstones. Resting intraluminal pressure of the gallbladder was lower than the pressure in the common bile duct. At the level of the choledochoduodenal junction, a sphincter with phasic activity was demonstrated. A second high pressure zone was observed at the cysticocholedochal junction without phasic activity.

Serum radioactivity of 14C-triolein and 3H-oleic acid ingested in a test meal:a rapid test of pancreatic exocrine insufficiency.

A double-tracer technique to estimate lipid digestion was investigated. 3H-labelled oleic acid and 14C-labelled triolein were ingested in a test meal. The serum radioactivity of 3H after ingestion of labelled oleic acid depends on absorption and metabolism of free fatty acids, while serum radioactivity of 14C from triolein, in addition to the former, depends on triglycerol digestion. This study shows that the ratio between 3H and 14C 2h after the test meal gives a good qualitative and quantitative estimation of lipid digestion: the 3H/14C ratio in patients with maldigestion is significantly higher than for normals (P less than 0.01), the predictive value of the 3H/14C ratio in the diagnosis of maldigestion is high, that of a positive result being 1.0 and that of a negative 0.93, and quantitatively the 3H/14C ratio shows a highly significant correlation with faecal fat (P less than 0.001). The test is very easy to perform, lasts for only 2 h, and is without discomfort to the patient or nursing and laboratory staff. It gives information like or superior to that of faecal fat measurement.

Fine needle aspiration biopsy of the pancreas.

Fine needle aspiration biopsy from the pancreas was carried out peroperatively in 60 patients. A suspicion of malignancy due to a palpaple mass in the pancreas was raised in 45 cases and confirmed by cytology in 27 cases. Of the remaining 18 cases in which malignancy was suspected, the majority were caused by penetrating gastroduodenal ulcers or pancreatitis. There was only one false negative cytological report among the 37 patients with available histological control. There were no complications due to the aspiration biopsy.