Genetic variation in catechol-O-methyltransferase modifies effects of clonidine treatment in chronic fatigue syndrome.

Clonidine, an α2-adrenergic receptor agonist, decreases circulating norepinephrine and epinephrine, attenuating sympathetic activity. Although catechol-O-methyltransferase (COMT) metabolizes catecholamines, main effectors of sympathetic function, COMT genetic variation effects on clonidine treatment are unknown. Chronic fatigue syndrome (CFS) is hypothesized to result in part from dysregulated sympathetic function. A candidate gene analysis of COMT rs4680 effects on clinical outcomes in the Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial (NorCAPITAL), a randomized double-blinded clonidine versus placebo trial, was conducted (N=104). Patients homozygous for rs4680 high-activity allele randomized to clonidine took 2500 fewer steps compared with placebo (Pinteraction=0.04). There were no differences between clonidine and placebo among patients with COMT low-activity alleles. Similar gene-drug interactions were observed for sleep (Pinteraction=0.003) and quality of life (Pinteraction=0.018). Detrimental effects of clonidine in the subset of CFS patients homozygous for COMT high-activity allele warrant investigation of potential clonidine-COMT interaction effects in other conditions.

[Brain stem infection caused by Listeria monocytogenes]. / Hjernestammeinfeksjon med Listeria monocytogenes.

Rhombencephalitis due to Listeria monocytogenes is a serious form of brainstem inflammation. It is difficult to diagnose on the basis of clinical and laboratory findings alone. We describe a fatal case of Listeria monocytogenes rhombencephalitis in a previously healthy female teenager. Clinical and pathogenetic aspects of this condition are discussed.

[Listeria monocytogenes--the perfect parasite?]. / Listeria monocytogenes--den perfekte parasitt?

The pathogen Listeria monocytogenes has an extraordinary intracellular life cycle, based on adaption to and exploitation of normal cellular mechanisms. Extracellular organisms induce their own phagocytosis, followed by destruction of the phagosomal membrane. Cytoplasmatic bacteria organize the intracellular protein actin into "comet tails", and thus gain motility. In contact with the plasma membrane, motile bacteria induce a pseudopodium, corresponding to an invagination of the plasma membrane of the neighbouring cell. Eventually, the pseudopodium is engulfed by the neighbouring cell, creating a double membrane vacuole. L. monocytogenes destroys the double membrane, and escapes into the cytoplasm. This article reviews the molecular biology of Listeria infection, and how research in this field has yielded increased insight into normal cellular processes. Finally, we propose that the neuroinvasive properties of L. monocytogenes is caused by actin-dependent transport within axons from the periphery to the central nervous system.

[Practical procedures in Oslo '96]. / Praktiske prosedyrer i Oslo '96.

In connection with the planning of a new problem-based curriculum, it was decided to develop a detailed plan for the learning of practical clinical procedures. The process involved faculty members from all clinical disciplines and students. For each procedure, level of proficiency, learning methods, time of learning, and control routines were defined. Specific lists like those presented here may help to assure high and even quality of procedural skills acquired during medical pre-graduate training. Furthermore, they may be necessary to achieve optimal co-ordination between pre-graduate and postgraduate training. We recommend that other medical schools initiate processes similar to the one described in this article. However, emphasis of procedural-skills learning should not lead to less attention being paid to the learning of the many complex, non-technical skills of medical practice that cannot be adequately described in operational terms.

[Oslo '96--how is it?]. / Oslo '96--hvordan går det?

A new, problem-based integrated medical curriculum was introduced in Oslo in August 1996. We asked both students and teachers how satisfied they were with the first semester; teachers were also asked what their expectations were of the new curriculum. We investigated the relationship between the students' evaluation of individual elements of the curriculum and their satisfaction with the group tutors and the semester as a whole. During the course of the first semester students (n = 127), tutors (n = 26), and lecturers (n = 28) responded to questionnaires (response rates 92-100%) by rating various elements of the curriculum on a five point scale. Overall, the semester was rated either "good" or "very good" by 79% of the students and 91% of the teachers. The students' degree of satisfaction with the semester correlated with their evaluation of subject content, subject integration, and the case histories used in problem solving. The students' degree of satisfaction with the group tutors correlated with their evaluation of the tutors' contributions to subject content and group interaction and the tutors' personal attitudes. The tutors themselves expected the new curriculum to produce better results than the old one in all respects except the students' knowledge of basic science.

[Outplacement of medical students in local hospitals]. / Utplassering av legestudenter i lokalsykehus.

The organisation and content of the training of medical students in practical and clinical skills at Norwegian universities is presented and discussed. Based on experience from Tromsø University, an increased use of local hospitals for training medical students in practical and clinical skills is planned for all universities in Norway.