[Familial Mediterranean fever with pseudodominant inheritance]. / Familiaer middelhavsfeber med pseudodominant arvegang.

Familial Mediterranean fever (FMF) is an autosomal, recessively inherited disease, mainly affecting patients from the Mediterranean basin. Owing to the recessive transmission, the disease in most of the affected families only occurs in the members of one generation. However, high consanguinity rates in populations with carrier frequencies as much as 1:5 may account for the occurrence of FMF in two or more successive generations, so-called pseudodominant inheritance. We report a case of pseudodominant inheritance in a Turkish family living in Denmark.

[Microbiological examination of patients hospitalized in Aarhus municipal hospital]. / Mikrobiologisk udredning af patienter indlagt på Arhus Kommunehospital.

The purpose of this retrospective study was to evaluate 1) the nature, extent and relevance of the microbiological examination performed before institution of antibiotic treatment, 2) the relevance of the instituted treatment in the light of the microbiological findings or clinical diagnosis of infection. A minimum of requirements concerning microbiological examination was put forward for each clinical diagnosis of infection. Among patients with the diagnosis of sepsis, cystitis or pneumonia, 33%, 80% and 6.5%, respectively, fulfilled the minimum requirements, no attempt at microbiological examination was performed in 4.8%, 10%, and 32%, respectively. There is a need for education in relevant use of clinical microbiology e.g. samples related to focus of infection, and more consistency in the use of microbiological results.

[Should recurrent Cytomegalovirus infections in patients with liver transplantation be treated?]. / Skal recidiverende cytomegalovirus-infektioner hos levertransplanterede patienter behandles?

Cytomegalovirus (CMV) is the single most important viral pathogen in organ transplantation. Treatment strategy for CMV infection and disease is not well established in transplantation. We report a case of primary CMV infection and two relapses in a woman with a liver transplant in whom spontaneous clearing of the second CMV relapse was seen. A 23 year-old CMV-seronegative woman received a liver transplant with a CMV-negative organ. Six weeks after transplantation she had her primary CMV infection proved by seroconversion and virus isolation. She had no clinical symptoms. Treatment with ganciclovir for five weeks resulted in declining CMV-antigen positive cells from 300/200.000 PMNs to CMV-antigen negativity. Only a slight antibody response was seen. At week 13 the first relapse occurred evidenced by antigenaemia. Ganciclovir was reinstituted for six weeks resulting in reduced antigenaemia. At week 22 liver biopsy was performed due to slightly elevated ALAT. The biopsy showed evidence of focal CMV hepatitis and blood analysis showed 120 CMV-antigen positive cells/200.000 PMNs. In spite of this, ganciclovir was not reinstituted, but the immunosuppressive treatment was reduced to a minimum to stimulate the patient's immune response to CMV. During the following months the patient gradually developed IgG antibody, cleared the antigen and levels of liver enzymes returned to normal. We suggest that ganciclovir treatment, may be omitted in cases of relapse with minimal clinical symptoms, slight antigenaemia and a beginning antibody response and that, the immunosuppressive treatment should be reduced instead. Such an approach requires careful clinical monitoring of the patient.

[Utilization of antibiotics at the Arhus Municipal Hospital. A prevalence study]. / Antibiotikaforbruget på Arhus Kommunehospital. En praevalensundersøgelse.

The hospital charts of 689 patients in Aarhus Municipal Hospital were surveyed on a single day in the autumn of 1994. Antibiotics were administered to 22% of the patients. In the intensive care unit, 69% of the patients received antibiotics, while 24% of the surgical patients and 17% of medical patients received antibiotics. Twenty-seven percent of 203 prescriptions were given as prophylaxis, mainly to surgical patients. Sixty-four percent were prescribed as monotherapy. Penicillins constituted 41% of the total usage of antibiotics. Antibiotics were administered orally in 55%, intravenously in 37%, topically in 5% and rectally in 3%. The prescription was noted in the medical chart for 96%, the indication in 74% and the planned duration of treatment in only 58% of the cases. Information concerning previous allergic reactions to penicillin was noted for 7% of the patients. It is concluded that the usage of antibiotics and the microbiological findings in the departments should be evaluated regularly, and the antibiotic regime and the practice of prescription adjusted accordingly.

[Schistosomiasis at Marselisborg hospital 1981-1990]. / Schistosomiasis på Marselisborg Hospital fra 1981 til 1990.

Schistosomiasis cases diagnosed and treated at Marselisborg Hospital, Denmark from 1.1.1981 to 31.12.1990 were reviewed. In all cases the infection was acquired in Africa. Among 41 patients 15 were Danes and 26 were immigrants, and a total of 57 episodes of schistosomiasis was recorded. Schistosoma mansoni was found in 27 patients, Schistosoma haematobium in 11 patients and in three cases the diagnosis was based on serology. Forty-eight percent of patients with S. mansoni had symptoms, compared to 82% of the patients with S. haematobium. The immigrants more often had symptoms than the Danes, possibly due to the occurrence of other infections. The treatment was in all cases praziquantel. Residual infection was observed in 24%. We recommend that subjects from endemic areas who may have been exposed to infection should be tested for schistosomiasis by examination of urine, stool, or snips of the rectal mucosa. Re-examination after treatment is recommended especially in cases of S. mansoni infection due to risk of residual infection.

Glutathione peroxidase activity in patients with rheumatoid arthritis and in normal subjects: effects of long-term selenium supplementation.

The effects of dietary supplementation with selenium were studied in 6 patients with severe, active rheumatoid arthritis (RA) and in 6 healthy control subjects. Initial concentrations of Se in red blood cells and in serum, and the activity of the Se-dependent enzyme glutathione peroxidase (GSH-Px) in red blood cells, serum, and granulocytes were significantly lower in RA patients compared with controls. During Se supplementation, however, the differences in Se levels and in GSH-Px activity between the 2 groups disappeared, except that, in RA patients, GSH-Px activity in granulocytes increased but remained significantly lower than in controls.