Thoracic myelitis as a possible cause of myocardial infarction.

During the course of an inflammatory process in the thoracic part of the spinal cord, a previously healthy male suffered two myocardial infarctions in separate coronary territories. A coronary angiogram revealed only minor wall changes in one coronary artery. We hypothesize that the myocardial infarctions may have been caused by vasospastic reactions secondary to his spinal cord pathology, and present the case report and a review of the literature.

[Coronary angiography in a county hospital]. / Koronarangiografi ved et sentralsykehus.

BACKGROUND: At a county hospital in northern Norway, coronary angiographies have been performed for more than 25 years. We wanted to compare our complication rates with results from larger hospitals. MATERIAL AND METHODS: Data concerning indication for angiography, findings and complications were collected retrospectively from the files of 837 patients who underwent coronary angiography at our hospital during the last ten years. The number of procedures per year has varied from 30 to 125. RESULTS: 50% of the patients had three-vessel and/or left main coronary artery stenosis. Less than 10% of the patients had no significant coronary stenosis or valvular disease at angiography. The total complication rate was 4.8%. Nine patients (1.1%) had myocardial infarction or stroke with sequelae; three patients died (0.4%). INTERPRETATION: Our complication rates are higher than those from other larger hospitals in Norway and internationally, but they have decreased over time. The high percentage of serious coronary pathology among our patients may have contributed significantly to the complication rate. In addition, the annual number of exams may have been too low to give sufficient operator training. The results require a continuing evaluation of our practice.

[Coronary angiography in a county hospital]. / Koronarangiografi ved et sentralsykehus.

BACKGROUND: At a county hospital in northern Norway, coronary angiographies have been performed for more than 25 years. We wanted to compare our complication rates with results from larger hospitals. MATERIAL AND METHODS: Data concerning indication for angiography, findings and complications were collected retrospectively from the files of 837 patients who underwent coronary angiography at our hospital during the last ten years. The number of procedures per year has varied from 30 to 125. RESULTS: 50% of the patients had three-vessel and/or left main coronary artery stenosis. Less than 10% of the patients had no significant coronary stenosis or valvular disease at angiography. The total complication rate was 4.8%. Nine patients (1.1%) had myocardial infarction or stroke with sequelae; three patients died (0.4%). INTERPRETATION: Our complication rates are higher than those from other larger hospitals in Norway and internationally, but they have decreased over time. The high percentage of serious coronary pathology among our patients may have contributed significantly to the complication rate. In addition, the annual number of exams may have been too low to give sufficient operator training. The results require a continuing evaluation of our practice.

Limb-threatening ischemia due to ergotamine: case report with angiographic evidence.

A 29-year-old woman presented with severe leg pain that had lasted for several weeks. During that period, she had taken painkillers in order to achieve sleep. In the week before she was admitted to hospital, she had noticed numbness and a cold feeling below her knees. There were no arterial pulsations below her groin, the skin of her legs being cold and pale. She had a history of chronic daily headache and had ingested Cafergot compound corresponding to ergotamine 2 to 3 mg daily for the previous 2 or 3 months. Angiography demonstrated severe narrowing of both superficial femoral arteries for a distance of about 5 to 6 cm and a subtotal stenosis of the right popliteal artery. After discontinuation of ergotamine, the patient's symptoms gradually disappeared within a few days. Angiography was repeated 2 days after the first examination and demonstrated regression of the spasms in the femoral arteries and reestablished flow in the distal vessels. Ergotamine tartrate can induce life-threatening ischemia of an extremity. Discontinuation of ergotamine is usually sufficient to reverse the ischemia, however, intravenous infusion of sodium nitroprusside may occasionally be necessary to avoid limb amputation.

[Congenital luxation of the hip. A selective screening of newborn infants at a central hospital]. / Medfødt hofteleddsluksasjon. En selektiv screening av nyfødte ved et sentralsykehus.

BACKGROUND: Various studies during the 1980s indicated that ultrasound examination of the hips in newborns might be a good supplement to clinical examination in early diagnosis of congenital dislocation of the hip (CDH). MATERIAL AND METHODS: From 1993, a selective screening group of newborn infants with a positive Ortolani's/Barlow's test and/or anamnestic risk factors for CDH received an ultrasound examination using a modified Graf's method. Indications, results, treatment and clinical course were recorded consecutively over three years. Information about late diagnosed CDH (later than at four weeks of age) was recalled retrospectively with at least two years follow-up. RESULTS: Of 3,690 newborns, 623 infants had increased risk of CDH. 621 of these were examined with ultrasound. Only half of the children with a positive Ortolani's/Barlow's test were found to have CDH in need of treatment on the ultrasound examination. 37 infants were treated with Frejka's abduction device. In this group, five children needed additional treatment with abduction splint due to CDH diagnosed on X-ray examination at five months of age. In addition one child with early diagnosed CDH was not treated until it was five months of age. INTERPRETATION: Totally, we treated 38 children in the selective screening group. This is proportionally fewer infants than in other Norwegian studies. Nevertheless, none of the children in the selective screening group had late diagnosed CDH. We found that ultrasound examination of the hips is a useful supplement to clinical examination in early diagnosis of CDH.

[Moyamoya disease. A rare case of stroke in children?]. / Sykdommen moyamoya. En sjelden årsak til hjerneslag hos barn?

Moyamoya disease is a rare cerebrovascular disease with a wide variety of clinical outcomes. The main signs of the disease are progressive occlusion of the main intracerebral arteries and development of a special network of collateral vessels, Symptomatology can be intermittent, with light neurologic symptoms, or the disease can progress step-wise, with eventual physical and mental deterioration. Several operative methods have been evolved to improve cerebral bloodflow in this disease. We describe three children with Moyamoya disease. Two of them were the first patients offered operation for their disease in Norway. The article describes diagnostic measures, possible pathogenic mechanisms, and treatment.

[The pulmodiaphragmal ligament. An often misinterpreted normal variant]. / Ligamentum pulmodiaphragmale. En ofte feiltolket normalvariant.

In some cases the pulmonary ligament extends caudally to the diaphragm, where it blends with the parietal pleura. This anatomical variant is named the pulmodiafragmal ligament. In chest X-ray it gives rise to spikes and unsharp areas in the central part of the diaphragm in the lateral view. The article describes the pulmodiafragmal ligament and its significance by the interpretation of chest X-ray in normal and pathologic states.

A group-based training programme for general practitioners: a Norwegian experience.

There are approximately 3000 general practitioners in Norway, serving a population of slightly above four million people. A three year postgraduate education scheme for general practitioners has been in effect since 1973, to be replaced by a five year vocational training programme from January 1985, making general practice a fully recognized specialty from that date. The educational requirements consist of one year of hospital training, four years of training in general practice, and a total of 400 hours of course education, mainly in clinical subjects. The core element of the training is attendance at a group-based structured educational programme of two years' duration. This article describes the concepts and content of this decentralized group-based education, as well as some of the conflicting considerations which eventually led to this new Norwegian model of general practice training. The first evaluation studies indicate that the educational programme has met a long standing need among general practitioners.

In vivo and in vitro phototoxicity of different parts of Heracleum laciniatum.

Experimental phytophotodermatitis was produced using homogenates from different parts of Heracleum laciniatum and long-wave ultraviolet light. The homogenates of leaves and flowers produced strong phototoxic reactions, fruit slightly less. Stems were either non-phototoxic or only slightly phototoxic. The roots of young plants did not evoke photosensitivity reactions, whereas the roots of older plants were strongly phototoxic; even roots collected from the frozen ground in December elicited strong reactions. Abdominal and midback skin were more photosensitive than skin of the lateral aspects of the underarms and legs.

Phototoxicity of Heracleum laciniatum. Case reports and experimental studies.

Phytophotodermatitis from Heracleum laciniatum is described in 2 typical cases. Experimental phytophotodermatitis was produced using homogenates from leaves of the plant and long-wave ultraviolet light. The homogenates of leaves produced strong phototoxic reactions. The minimal phototoxic erythema dose was determined to be lowest for abdominal and midback skin. The action spectrum for Heracleum laciniatum homogenates applied topically was found to be in the range 315-375 nm with peak sensitivity at 330-335 nm.