Hepatitis E in Norway: seroprevalence in humans and swine.

In Norway, no published data on seroprevalence of hepatitis E virus (HEV) in humans and swine exists. Serum samples from blood donors, veterinarians, swine farm workers and swine were analysed by ELISA to estimate the seroprevalence of HEV in Norway and to investigate the association between direct contact with swine and HEV seroprevalence in humans. The seroprevalence of HEV IgG antibodies was 30% (24/79) in farm workers, 13% (21/163) in veterinarians, 14% (162/1200) in blood donors and 90% (137/153) in swine. Our results show a high seroprevalence of HEV in humans and swine in Norway. HEV seroprevalence in farm workers and blood donors increased with age, and veterinarians working with swine were twice as likely to be HEV seropositive compared to other veterinarians. High HEV seroprevalence in farm workers and veterinarians working with swine support previous reports suggesting swine as a reservoir for HEV infections in humans in Europe.

[Quality of rapid tests for determination of infectious mononucleosis]. / Kvalitet av hurtigtester til påvisning av infeksiøs mononukleose.

BACKGROUND: The Norwegian centre for quality assurance in primary health care, NOKLUS, was established in 1992 to ensure the quality of laboratory analyses performed in primary health care. This article evaluates results from the surveys of infectious mononucleosis. MATERIAL AND METHODS: From 1996 to 2000, five serum panels were sent to participating practices in order to control test-kits designed for serological rapid diagnosis of infectious mononucleosis. 648 practices participated in this external quality assessment in 2000. Target values were determined using the Paul Bunell Davidsohn test. The results obtained for each type of test and variables that might have affected the results were evaluated. RESULTS: Outdated kits or kits close to the date of expiration showed poorer results than the other test-kits. The quality of the results depended mainly on the type of test-kit used and the training level of the persons performing the analyses. INTERPRETATION: The best performing tests in these surveys were Clearview IM (Unipath Limited) and Contrast Mono (Genzyme diagnostics). These two tests are among the three most frequently used tests, out of a total of thirteen, in our surveys.

[Acetazolamide--are there reasons for its revival in antiepileptic treatment?]. / Acetazolamid--verdt en renessanse i epilepsibehandlingen?

BACKGROUND: Since 1950 the carbonic anhydrase inhibitor acetazolamide has been used as an antiepileptic drug. Because of its tolerance developing properties, acetazolamide has probably been bypassed by the new antiepileptic drugs on the market. However, when taken for 14 day periods with one week's stop in between, acetazolamide is still of value in the treatment of epilepsy. MATERIAL AND METHODS: The paper discusses acetazolamide and its present use in antiepileptic treatment in the light of existing internal control and quality assurance requirements in the medical services. RESULTS: Irrespective og type of seizure, about 90% of patients have an initial reliable effect from acetazolamide, though it is uncertain how long the effect will last after repeated periods of use. As an additional drug, acetazolamide may be particularly well suited for women with menses-related seizures. INTERPRETATION: Acetazolamide may be the drug of choice when drug interaction is a problem, when rapid onset of effect is wanted, or when an additional drug is needed for a short period of time only.

[Chronic low back pain in 40-year olds in 12 Norwegian counties]. / Kroniske korsryggssmerter hos 40-åringer i 12 norske fylker.

In this study, a questionnaire and a short interview were used to estimate the prevalence of chronic low back pain alone and low back pain together with other musculo-skeletal pains among 40-year-old women and men in 12 Norwegian counties (a total of 67,338 persons). On average 2.4% of men and 1.7% of women had only chronic low back pain, while 5.7% of men and 9.2% of women in addition had other pains as well. Persons with low back pain only were approximately equally distributed across the counties. Greater variations across the counties and between the sexes were found in persons with additional pain. The duration of the pain did not vary significantly between the sexes or across the counties, but the duration was on average two years longer in cases of multi-cause pain. Reduced capacity for work because of pain was approximately equally distributed between the sexes and the groups. More women than men were unable to do their daily work. About one third in both groups (more men than women) had been absent from work because of pain during the last year. More women than men in both groups received national insurance benefits. Persons with only low back pains were approximately equally represented across all levels of education and regardless of marital status, while people with multi-cause pain were overrepresented among those with low levels of education and among the divorced.

["Silent" areas of the brain--a challenge in family practice]. / "Stumme" områder i hjernen--en utfordring i allmennpraksis.

Based on two medical histories found among complaints dealt with by the Norwegian Board of Health the author points out the main symptoms of frontal or temporal lobe failure. Following a history of three weeks one of the patients died as a result of an overlooked cerebral abscess. During the history three different doctors had made wrong diagnostic suggestions, mainly because of the coincidence of an influenza epidemic in the neighbourhood. The other patient died from a cerebral tumour. In his history epilepsy was the main symptom for many months. This diagnosis was overlooked because the doctor suggested that the patient had a high alcohol consumption.

Afferent connections to the abducent nucleus in the cat.

The afferent connections to the abducent nucleus in the cat were studied by means of retrograde transport of WGA-HRP after implantations of the tracer in crystalline form. Retrogradely labelled cells were found bilaterally in the medial and descending vestibular nuclei, mainly in their ventral and medial portions, in the rostral part of the ipsilateral gigantocellular reticular nucleus, in the medial part of the contralateral caudal pontine reticular nucleus and bilaterally in the oculomotor nucleus, mainly in its dorsolateral division. Some labelled cells were also found bilaterally in the mesencephalic reticular formation, the periaqueductal grey and the nucleus of the trapezoid body.

Neisseria meningitidis group B capsular polysaccharide. Bacterial content and release in relation to categories of infection and filtrability of released endotoxin.

A total of 41 Neissera meningitidis isolates were analyzed for capsular polysaccharide (CP) and lipopolysaccharide (LPS) release and filtrability. Twenty-two of these isolates were serogroup B from blood or cerebrospinal fluid of patients, five were group B isolates from healthy throat carriers, and 14 were nongroupable (acapsular) meningococcal isolates from healthy carriers. Filtration of liquid whole-cell cultures through cellulose acetate-nitrate filters resulted in distinctly lower LPS filtrate activity for acapsular than for capsular meningococci (p less than 0.001). On the other hand, when polysulfone membrane filtration was performed, filtrates from acapsular and capsular meningococci contained LPS in similar amounts. These results indicate that LPS-containing particles released from acapsular isolates are larger or more aggregated than corresponding CP- and LPS-containing particles released from capsular isolates. The LPS released from acapsular isolates apparently are more efficiently retained by adsorption to cellulose acetate-nitrate. From the capsular isolates comparatively more CP than LPS appeared to be released, as related to cell-bound amounts. The total amounts of CP and released, filtrable LPS through cellulose acetate-nitrate filters were both relatively low and had similar values for capsular carrier meningococci and systemic isolates from mild meningococcal disease. The amount of CP released and passing this type of membrane was significantly higher for systemic isolates from severe septicemia than from mild meningococcal disease (p = 0.03).

Prevalence of cytomegalovirus antibodies in Norwegian kidney-transplant recipients and their living donors. A comparative study of two different methods.

376 sera from Norwegian kidney-transplant recipients and their living, related donors, were tested for the presence of cytomegalovirus antibodies (CMV-ab) by the complement fixation test (CF), and for IgG CMV-ab by the enzyme-linked immuno-sorbent assay (ELISA). Whenever the results of the two methods differed, the sera were also tested by the indirect fluorescence antibody test (FAT). 325 of 376 sera showed corresponding results, giving a concordance of 86 per cent between CF and ELISA, ELISA being the more sensitive of the two, with a sensitivity in the same range as FAT, and high specificity with only 0.3 per cent false positive results. The prevalence of CMV-ab in Norwegian kidney-transplant recipients and their living, related donors, differed very little. The overall CMV-ab seropositivity was 76 per cent. The prevalence increased from 50 per cent at the age of 20 years, to 80 per cent at 30 years and 90 to 100 per cent from 60 years of age.

The diagnostic significance of specific serum IgA detection in cytomegalovirus infections.

The prevalence of virus-specific serum antibodies of IgA class against cytomegalovirus (CMV) was determined in 228 healthy blood donors and in 112 patients suspected of CMV infection. All patients had a titer of 40 or higher in the complement fixation test. Specific CMV-IgA was found in 81 per cent of CMV-IgM positive patient sera and in 20 per cent of sera from patients strongly suspected of CMV infection, but with negative CMV-IgM. Less than 2 per cent of healthy blood donors had CMV specific serum IgA.

The reticulocerebellar projection in the cat as studied with retrograde transport of horseradish peroxidase.

Injections of horseradish peroxidase into the various parts of the cerebellar cortex and the cerebellar nuclei in the cat result in labelled cells within the reticular formation proper. All the reticular nuclei (with the exception of the reticular formation of the mesencephalon) send fibres to the cerebellum. The highest number of labelled neurons after cerebellar injections is found in the caudal reticular formation, especially within nucleus reticularis ventralis, nucleus reticularis lateralis and nucleus reticularis gigantocellularis. Another region for an accumulation of labelled cells is the rostral part of nucleus reticularis pontis caudalis. Except for the paraflocculus, all cerebellar cortical areas and all cerebellar nuclei receive afferents from one or more of the nuclei within the reticular formation proper, but the largest number of labelled neurons is observed in cases with injections including the intermediate-lateral part of lobulus simplex and the adjacent areas of the anterior lobe and crus I. the projection is bilateral with an ipsilateral preponderance (the cerebellar nuclei appear to receive a higher number of fibres from the contralateral side). Cells of all sizes are labelled, but labelled giant cells are found only after large cortical injections.

The olivocerebellar projections to the flocculus and paraflocculus in the cat, compared to those in the rabbit. A study using horseradish peroxidase as a tracer.

The projections from the inferior olive to the flocculus and paraflocculus in the cat have been mapped by means of the method of retrograde axonal transport of horseradish peroxidase. The findings show that the afferents to the flocculus are derived from the dorsal cap, ventrolateral outgrowth, the principal olive (the caudal parts of the ventral and dorsal lamella) and from the rostral part of the medial accessory olive. The fibres to the paraflocculus come from the caudal part of the principal and from the rostral part of the medial accessory olive. Details in the projections are seen from Figs. 1 and 2. Concerning some points the findings are at variance with those made in the rabbit by Hoddevik and Brodal, and suggest that there are species differences hitherto not known.

The pontine projection onto longitudinal zones of the paramedian lobule in the cat.

The distribution of labeled cells in the pontine nuclei was studied following microinjections of horseradish peroxidase into three longitudinal zones in the paramedian lobule in the cat. Labeled cells were only found when the staining of the cerebellar cortex included the granular layer. The labeled cells were present contralateral to the injection site in the cases with the smallest injections, in the others there was a bilateral distribution with a contralateral preponderance. The labeled cells lie concentrated in three groups medially, ventrally, and laterally to the peduncle. No indication of a different projection from these three groups to the three longitudinal paramedian zones was found, although in the same material a zonal projection exists for the climbing fibers from various parts of the inferior olive to the same cerebellar lobule (Brodal and Walberg, 1977).

The pontocerebellar projection of the uvula in the cat.

The occurrence of retrogradely labeled cells in the pontine nuclei was mapped following injections of 0.3-0.4 microliter of a horseradish peroxidase suspension (50% weight/volume) into the uvula (lob. IX of Larsell) in the cat. The uvula was found to receive afferents from three pontine cell collections. One of these is situated in the paramedian pontine nucleus close to the midline. It forms a fairly distinctly outlined longitudinal column of cells and is present at all levels of the pons except most rostrally and caudally. Another group, in the dorsolateral and lateral pontine nuclei, extends as a somewhat shorter cell column in the longitudinal direction. The third region consists of cells within the rostral part of the peduncular nucleus in its dorsomedial region. The pontine projection to the uvula is bilateral, with some preponderance of crossed connections. The projection to the uvula is organized according to the pattern determined previously for pontine projections to other parts of the cerebellum. A single lobule or part of its receives afferents from more than one cell group in the pons. The projecting cells are most often arranged in longitudinal columns. Correlations with data on the termination of afferents to the pons permit some conclusions regarding the sources of information reaching the uvula via the pons. Main sources seem to be the superior and inferior colliculi, the intracerebellar nuclei and the sensorimotor cortices.

Cerebellar afferent projections from the perihypoglossal nuclei: an experimental study with the method of retrograde axonal transport of horseradish peroxidase.

Details of cerebellar afferent projections from the perihypoglossal nuclei were studied in the cat by means of retrograde axonal transport of horseradish peroxidase (HRP). Labeled cells were observed bilaterally (with a preponderance ipsilaterally) in nuclei intercalatus and praepositus hypoglossi following injections in various folia of the entire vermis, paraflocculus, flocculus, fastigial nucleus, and the nucleus interpositus anterior and posterior. Relatively high densities of labeled cells were found in nucleus intercalatus following injections in the anterior part of the vermis, whereas labeled cells in nucleus praepositus hypoglossi were found more frequently following injections in the posterior part of the vermis. Labeled cells in the nucleus of Roller were found only following injections in the anterior lobe vermis, posterior vermal lobules VI and VII, in the flocculus and in the nucleus interpositus anterior. No labeled cells could be detected in the three subdivisions of the perihypoglossal nuclei following HRP injections in crus I, crus II, paramedian lobule, and lateral cerebellar nucleus. The distribution of the HRP positive cells indicated the presence of a topographically organized projection from certain regions of the perihypoglossal nuclei to different parts of the cerebellum. The afferent and efferent connections of the perihypoglossal nuclei in relation to a functional role in eye and head movements are discussed.

The pontine projection to the flocculonodular lobe and the paraflocculus studied by means of retrograde axonal transport of horseradish peroxidase in the rabbit.

The occurrence and distribution of labeled cells in the pontine nuclei were mapped following injections of small amounts of horseradish peroxidase (0.05-0.5 microliter, 50% suspension) in the flocculus, nodulus and the dorsal and ventral paraflocculus in adult albino rabbits. While no labeled cells were found in the pontine nuclei following injections in the nodulus, some were present following injections in the flocculus and a great number following injections in the paraflocculus. The projections onto the flocculus and paraflocculus are precisely organized. Following injections in the paraflocculus labeled neurons are arranged in four columns (E and G in the paramedian pontine nucleus, F in the peduncular and H in the dorsolateral nucleus). Following injections in the ventral paraflocculus labeled cells are present only in parts of column E and F, while columns G and H and parts of E and F project onto the dorsal paraflocculus. Following injections in the flocculus labeled cells occur in the rostral part of column E only. A comparison between the sites of termination of pontine afferents and the areas giving origin to floccular and parafloccular fibers shows that only few fibers mediating visual impulses end in these pontine areas, while they receive numerous fibers from gyrus cinguli and areas 18 and 19 of the cerebral cortex.

The cerebellar projection from the raphe nuclei in the cat as studied with the method of retrograde transport of horseradish peroxidase.

Following injections of horseradish peroxidase (HRP) in the cerebellar cortex and nuclei of the cat, the distribution of labeled cells in the raphe nuclei was mapped. The findings confirm those made previously in studies of retrograde cell degeneration following cerebellar ablations (Brodal et al., 1960a), and in addition reveal new details in the projection of the raphe nuclei onto the cerebellar cortex and nuclei. All the raphe nuclei except nucleus linearis intermedius and nucleus linearis rostralis project onto the cerebellar cortex. The nuclei raphe obscurus and pontis contribute the greatest number of afferents to the cerebellum. With the exception of lobule VI which probably is the recipient of a weak projection, all parts of the cerebellar cortex receive afferents from the raphe nuclei. The heaviest projection is to the vermis of lobules VIIA and X, and to crus II. The afferents to the cerebellar nuclei are few in number (Tables 2-6). The observations indicate that each raphe neuron probably projects to more than one terminal site in the cerebellum. The findings are discussed with reference to other efferent and afferent studies of the raphe nuclei. All these studies indicate that the raphe nuclei have widespread efferent and afferent connections, making them capable to participate in a variety of regulatory functions.

The olivocerebellar projection studied with the method of retrograde axonal transport of horseradish peroxidase. V. The projections to the flocculonodular lobe and the paraflocculus in the rabbit.

HRP was injected in the flocculonodular lobe and the paraflocculus in the rabbit to determine the areas of the inferior olive which project onto these cerebellar regions. Following injections in the flocculus labeled cells occurred in the dorsal cap and the rostralmost tip of the medial accessory olive. Following injections in the nodulus labeled cells were likewise found in the dorsal cap, but in addition in the rostralmost part of the dorsomedial cell column and the adjoining part of the medial accessory olive. Injections in the dorsal paraflocculus gave rise to labeling in the rostrolateral part of the medial accessory olive, while injections in the ventral paraflocculus resulted in labeling in the principal olive, mainly in the lateral part of the ventral lamella. Injections in the lateral third of the dentate nucleus gave rise to labeling mainly in the dorsal lamella of the principal olive. The results are discussed with reference to those obtained by previous authors. There are both similarities and discrepancies. It appears from what is known of afferents from areas mediating visual impulses to the inferior olive that the olivary areas projecting onto the flocculonodular lobe, and possibly the dorsal paraflocculus, may mediate visual impulses to these lobules.

The pontine projection to the cerebellar vermal visual area studied by means of the retrograde axonal transport of horseradish peroxidase.

Following injections of horseradish peroxidase (HRP) in cerbellar vermal lobules VI, VIIA and B, VIIA and B in the cat, the distribution of labeled cells in the pontine nuclei was mapped in drawings of serial transverse and horizontal sections. The labeled pontine cells are distributed in 4 largely longitudinal columns, situated in the dorsolateral, peduncular, lateral and paramedian pontine nucleus (referred to as columns A, B, C and D, respectively). The majority of afferents to the vermal, visual areas come from colums A and B. To some extent cells projecting to the various sublobules have their preferential location within each column (Fig. 5). The majority of the fibers end in lobule VII. Available data from the literature show that only columns A, D and rostral part of B may be involved in the transmission of visual impulses to the vermal area, since these columns receive afferents from the superior colliculus, the lateral geniculate body and the visual cortex, respectively. The route via the superior colliculus-dorsolateral nucleus appears to be quantitatively the most important. As judged from data on fiber connections, impulses from various sources (inferior colliculus, cerebellar nuclei and "non-visual" parts of the cerebral cortex) are transmitted to certain parts of the 4 columns. The functional importance of this convergence and some general features in the organization of the pons are discussed.