The prevalence and characteristics of pruritus in patients with heart failure.

BACKGROUND: Pruritus (itching) can be a distressing symptom, and previous research suggests that it is common in patients with chronic heart failure (CHF). OBJECTIVES: The primary aim was to examine the prevalence of itching in patients with CHF and to compare this first to that among patients with coronary artery disease (CAD) and second to that of a normal Swedish population. The study also explored characteristics and possible causes of pruritus in patients with CHF. METHODS: In this cross-sectional prevalence study, a questionnaire was sent to 130 patients with CHF and to 130 with CAD. A total of 85 patients with CHF (65·4%) and 82 with CAD (63·1%) participated. Data were also compared with those of a previous study examining symptoms in a normal Swedish population. RESULTS: The prevalence of itching at some point during the last 3 months was 40·0% in patients with CHF and 23·2% in patients with CAD (P = 0·019). This difference was not significant after adjusting for sex, age and medication. Patients with CHF described their pruritus as more disturbing than patients with CAD. In addition, 13·6% of patients with CHF and 3·8% of persons in the normal population experienced itching every week without any rash (P = 0·001). CONCLUSIONS: Pruritus is common and sometimes disturbing in patients with CHF and warrants clinical attention. Medication should be considered as a cause of itching and may explain differences in the prevalence between patients with CHF and those with CAD. However, other causes of itching in patients with CHF should be explored in prospective studies.

Post-operative 3-dimensional contrast-enhanced ultrasound (CEUS) versus Tc99m-DTPA in the detection of post-surgical perfusion defects in kidney transplants - preliminary findings.

PURPOSE: 2800 renal transplants are carried out annually in the UK and it is standard practice to perform a Tc-DTPA renogram examination after surgery to check perfusion. This provides some functional information but suffers from low spatial resolution, is lengthy, immobile and costly and uses ionizing radiation. We surmised that contrast-enhanced ultrasound (CEUS) would provide an accurate alternative with increased speed, resolution (temporal and spatial), cost efficiency and safety. MATERIALS AND METHODS: 97 renal transplant patients underwent both Tc-DTPA and CEUS after surgery to assess the perfusion of the graft. Tc-DTPA was performed in the nuclear medicine department with at least 10 minutes of continuous screening and a standard dose of 150 mBq Tc-DTPA. CEUS consisted of I. V. 2.4 ml Sonovue contrast agent, 60 seconds continuous capture and a 3 D acquisition of the organ. 3 D CEUS was assessed using QLab analysis software. RESULTS: Tc-DTPA detected 9 perfusion defects of varying size. CEUS detected all these defects plus 14 further defects (0.2 - 17 % of total renal volume) not detected on DTPA. These results demonstrate a statistically significant divergence (p < 0.0001). Retrospective clinical correlation showed ligated polar arteries in 8 of these 14 cases. CONCLUSION: CEUS will detect perfusion defects seen with Tc-DTPA and due to increased spatial and temporal resolution and multiple scanning angles, will detect further perfusion defects not seen on Tc-DTPA. 3 D CEUS is useful in the quantification of perfusion defects. CEUS is an accurate examination for detecting renal transplant perfusion defects and will detect significantly more defects than DTPA.

Coping and self-image in patients with symptoms attributed to indoor environment.

This study investigated self-image and coping ability in a group of patients with symptoms from indoor environment. A follow-up questionnaire was sent to 239 patients previously referred with nonspecific building-related symptoms at University Hospital in Umeå, Sweden. One hundred seventy-four women and 14 men answered and the patient group rated their self-image as more spontaneous, more positive, and less negative than a control group. The patient group rated higher on the cognitive scale in the Coping Resources Inventory (CRI) than the control group. The female patients had an increased risk of not being able to work associated with a low score on negative self-image. The authors conclude that certain personality traits may be potential risk factors that increase the probability of encountering and experiencing stressful work situations. The resulting stress may increase workers' susceptibility to indoor environment exposure.

A new technique for assessing renal transplant perfusion preoperatively using contrast-enhanced ultrasound (CEUS) and three-dimensional ultrasound (3DUS)--a porcine model pilot study.

PURPOSE: This pilot study aims to assess the viability of using contrast-enhanced ultrasound (CEUS) in renal grafts while they are on hypothermic perfusion machines prior to transplantation. We assessed the vascularity and renal perfusion of machine-perfused porcine kidneys (Maastricht category II) using CEUS. MATERIALS AND METHODS: Five kidneys were placed on hypothermic machine perfusion for up to 24 hours after retrieval. The kidneys were then scanned with a low MI contrast-specific preset and a bolus of 0.5 ml of Sonovue contrast agent was administered. Contrast-specific ultrasound images of the kidney were acquired in 2D and 3D. RESULTS: The five kidneys demonstrated variable flow rates on the perfusion machine (10 - 37 ml/min at 30 mmHg). The CEUS technique demonstrated good perfusion and flow patterns, similar to those seen in vivo, in four kidneys. One kidney had patent arteries up to the interlobar region but no contrast filling in the cortex or medulla. Small perfusion defects were seen in two of the perfused kidneys. CONCLUSION: CEUS appears to be a viable technique for assessing global perfusion and small defects within kidneys prior to transplantation. The flow patterns seen in vitro appear to correspond to those seen in vivo. Further work is required to evaluate the relevance of the flow dynamics measured.

Scoring of hand eczema: good agreement between patients and dermatological staff.

BACKGROUND: Assessment of hand eczema in a clinical study has been achieved using a scoring system which documents extent of eczema on different areas of the hand. OBJECTIVES: To investigate whether the same scoring system could be used by patients to communicate current status of hand eczema. METHODS: In a study of 62 patients (36 women and 26 men, age range 19-75 years), the patient's own assessment was compared with the assessment by a dermatologist and a dermatological nurse. Standardized information was given to the patient and the form was filled in independently by the patient, the nurse and the dermatologist, during the patient's visit to the clinic. Individual area scores were summed to a total score. RESULTS: The overall agreement was good, with an interclass correlation (ICC) of 0·61 between patient and dermatologist for the total score. The ICC between nurse and dermatologist was 0·78. Differences between observers were more pronounced for the more severe cases - those with higher numerical scores as assessed by the dermatologist. There was a tendency for women and for patients over the median age of 44 years to set a lower point score than the dermatologist. The concordance of observations from individual anatomical areas was higher for fingertips and nails and lower for the palm and dorsum of the hand. CONCLUSIONS: Patients are able to report the extent of hand eczema with good accuracy. Self-assessment protocols for hand eczema may well have a place in the monitoring of hand eczema extent over time.

Methotrexate vs. ciclosporin in psoriasis: effectiveness, quality of life and safety. A randomized controlled trial.

BACKGROUND: When this study was initiated, no previous studies comparing methotrexate and ciclosporin for moderate to severe plaque psoriasis had been performed. OBJECTIVES: To compare the effectiveness, quality of life and side-effects of methotrexate and ciclosporin treatments in a context reflecting normal clinical practice. METHODS: Eighty-four patients with moderate to severe plaque psoriasis were randomized to treatment with methotrexate or ciclosporin for 12 weeks. The primary outcome was the Psoriasis Area and Severity Index (PASI). The secondary outcome was quality of life, measured by the Dermatology Life Quality Index (DLQI) and the 36-item Short Form Health Survey (SF-36). A visual analogue scale (VAS) was used for patients' assessment. RESULTS: Sixty-eight patients started treatment and were included in the analysis. Dropout before initiation of treatment was higher in the ciclosporin group. Mean PASI change from baseline at 12 weeks was 58% in the methotrexate group and 72% in the ciclosporin group, showing ciclosporin to be more effective than methotrexate. Improvement of the VAS score was higher in the ciclosporin group. The methotrexate group showed a greater improvement in the subscale Physical Functioning of the SF-36. No significant difference between the groups was found for DLQI. CONCLUSIONS: Treatment with methotrexate or ciclosporin for chronic plaque psoriasis brings satisfactory disease control, improved quality of life and tolerable side-effects. A statistically significant difference in effectiveness between treatment groups was recorded, showing ciclosporin to be more effective than methotrexate in a short-term perspective.

Medical and social prognoses of non-specific building-related symptoms (Sick Building Syndrome): a follow-up study of patients previously referred to hospital.

OBJECTIVES: The aim of this study was to describe and analyse the medical and social prognoses of patients with non-specific building-related symptoms. METHODS: A follow-up questionnaire focusing on current medical and social status, care, treatment, other actions taken and personality traits was sent to 239 patients with non-specific building-related symptoms assessed during the period between 1986 and 1998 at University Hospital in Umeå, Sweden. The response rate was 79%. RESULTS: Fatigue, irritation of the eyes, and facial erythema were the most common weekly symptoms reported at follow-up. As females constituted 92% of the respondents, statistical analyses were restricted to women. The level and severity of symptoms decreased over time, although nearly half of the patients claimed that symptoms were more or less unchanged after 7 years or more, despite actions taken. Twenty-five percent of the patients were on the sick-list, and 20% drew disability pension due to persistent symptoms at follow-up. The risk of having no work capabilities at follow-up was significantly increased if the time from onset to first visit at the hospital clinic was more than 1 year. This risk was also significantly higher if the patient at the first visit had five or more symptoms. All risk assessments were adjusted for length of follow-up. Symptoms were often aggravated by different situations in everyday life. CONCLUSIONS: Long-lasting symptoms aggravated by environmental factors exist within this group of patients. The results support that early and comprehensive measures for rehabilitation are essential for the patients.

Multivariate evaluation of VOCs in buildings where people with non-specific building-related symptoms perceive health problems and in buildings where they do not.

UNLABELLED: Volatile organic compounds (VOCs) were sampled in buildings where people with non-specific building-related symptoms perceive health problems and in buildings where they do not. In total, nine persons and 34 buildings were included in the study. The obtained VOC data was evaluated using multivariate methods, to investigate possible systematic differences in air quality of 'problem' and 'non-problem' buildings. All individual compounds were included as variables in a multivariate partial least squares (PLS) data analysis. 'Problem' and 'non-problem' buildings separated into two distinct groups, showing that air samples of the two groups of building were chemically different. PRACTICAL IMPLICATIONS: The study showed that there was an identifiable systematic difference in the collected VOC data between buildings causing and not causing problems for people with non-specific building-related symptoms (also called sick building syndrome, SBS). This is an important indication that even such volatile organic compounds that can be sampled by commonly used adsorbents are of importance for the presence of such symptoms. By coordination of procedures for sampling and analysis of VOCs in buildings between laboratories, to get large datasets and more general models, the method can become a useful diagnostic measure in evaluating indoor air and to identify chemical compounds and sources that contribute to SBS problems.

Remembering childhood atopic dermatitis as an adult: factors that influence recollection.

BACKGROUND: Atopic dermatitis (AD) is common in the population, and studies have shown that the disease is on the increase. Studies based on hospital records reflect selected populations and may miss less severe cases of AD, and the use of self-reported questionnaires has the drawback of recall bias. OBJECTIVES: To investigate some possible factors influencing recall bias when questionnaires are used to establish the prevalence of childhood eczema in an adult population. METHODS: A questionnaire regarding past and present eczema was sent to 557 cases (with signs suggesting the diagnosis AD) and 554 matched controls (subjects lacking signs of AD) born during 1960-1969 and identified in school health medical records. Cases and controls were aged 31-42 years at the time of the study and 70.5% returned the questionnaire. RESULTS: Of 403 cases, 29% did not report childhood eczema in the questionnaire. There was a difference between those who did recall their childhood AD (remembering group, RG), and those who did not (forgetful group, FG) in who had documented the diagnostic signs in the school health records. In the RG the signs were reported by both parents and school health personnel in 51% of cases, and in the FG this was true of only 16%. The RG had a higher prevalence of eczema after 15 years of age and of hand eczema. The RG also reported more visits to physicians after the age of 15 years and more time taken as sick leave due to eczema. CONCLUSIONS: Several factors influence how well people remember their AD in childhood. These factors include disease activity in adult life, disease severity, and who noticed the eczema in childhood.

Changes in health over time in patients with symptoms allegedly caused by their dental restorative materials.

OBJECTIVES: In Sweden, many patients with symptoms allegedly caused by their dental materials have exchanged their restorations, but the effects of the exchange have been insufficiently investigated. Therefore, the aim of the study was to describe the change in health over time for these patients and the hypothesis was that the patients could be divided based on their symptoms and that the ability to recover differs between these groups. Furthermore, we also examined if other factors such as replacement of dental restorative materials and follow-up time had any impact on the perceived health status. METHODS: A questionnaire was sent to 614 patients who had been referred to the School of Dentistry, Umeå, Sweden, with symptoms allegedly caused by dental restorative materials. The response rate was 55%. RESULTS: The risk of having any further complaints was higher for patients with complex symptoms (P = 0.03) and these patients had exchanged their restorations to a significantly larger extent than the others (P = 0.03). The remaining complaints was more frequent among men (P = 0.02). Exchange of dental restorative materials had no significant impact on the ability to recover completely. However, the patients who had exchanged their restorations completely perceived a significantly larger alleviation of their symptoms than the others (P < 0.01), although the frequency of most of the symptoms had increased. CONCLUSIONS: Patients with complex symptoms had a more unfavorable long-term prognosis concerning persistent complaints than those with localized symptoms only. Furthermore, the results indicate that the patients might experience health improvements after removal of their dental restorative materials. The reason for this improvement, however, is unclear. Further analyses regarding other possible explanations than the 'odontological/medical' are needed.

Effects of three months of low molecular weight heparin (dalteparin) treatment after bypass surgery for lower limb ischemia--a randomised placebo-controlled double blind multicentre trial.

OBJECTIVES: To test the hypothesis that long-term postoperative dalteparin (Fragmin), Pharmacia Corp) treatment improves primary patency of peripheral arterial bypass grafts (PABG) in lower limb ischemia patients on acetylsalicylic acid (ASA) treatment. DESIGN: Prospective randomised double blind multicenter study. MATERIALS AND METHODS: Using a computer algorithm 284 patients with lower limb ischemia, most with pre-operative ischemic ulceration or partial gangrene, from 12 hospitals were randomised, after PABG, to 5000 IU dalteparin or placebo injections once daily for 3 months. All patients received 75 mg of ASA daily for 12 months. Graft patency was assessed at 1, 3 and 12 months. RESULTS: At 1 year, 42 patients had died or were lost to follow-up. Compliance with the injection schedule was 80%. Primary patency rate, in the dalteparin versus the control group, respectively, was 83 versus 80% (n.s.) at 3 months and 59% for both groups at 12 months. Major complication rates and cardiovascular morbidity were not different between the two groups. CONCLUSIONS: In patients on ASA treatment, long-term postoperative dalteparin treatment did not improve patency after peripheral artery bypass grafting. Therefore, low molecular weight heparin treatment cannot be recommended for routine use after bypass surgery for critical lower limb ischemia.

Coping and self-image in patients with visual display terminal-related skin symptoms and perceived hypersensitivity to electricity.

OBJECTIVES: The aim of the present study was to measure coping resources and self-image in patients with visual display terminal (VDT)-related skin symptoms and hypersensitivity to electricity (HE). METHODS: From 1980 to 1998, 350 patients with electrical sensitivity were registered. The patients were subdivided into two groups: patients with skin symptoms evoked by VDTs, television screens, and fluorescent-light tubes and patients with so-called hypersensitivity to electricity with multiple symptoms evoked by exposure to different electrical environments. A questionnaire was sent to all patients and contained the coping resources inventory (CRI) and the structural analysis of social behaviour (SASB) in order for us to measure coping resources and self-image, respectively. The CRI and SASB scores were compared with those of control groups. Two hundred and fifty respondents (73%) returned the questionnaire, 200 (78.5% women) in the VDT group and 50 (62% women) in the HE group. RESULTS: The patient group rated high on the CRI spiritual/philosophical scale and high on the SASB spontaneous, positive and negative clusters but low on the controlled cluster. The female patients scored high on the CRI emotional scale. The VDT group rated lower than the controls on the SASB controlled cluster and higher on both the positive and negative cluster. The HE group scored higher than the control group on the SASB spontaneous and positive clusters. The women in the HE group scored higher on the CRI cognitive and CRI total scale than the VDT group and control group and higher on the CRI emotional scale than the controls. The women in the HE group rated higher than both the women in the VDT and control groups on the SASB spontaneous and positive clusters. CONCLUSIONS: The deviant self-image found in these patients, especially the female HE patients, support the view that VDT and HE symptoms can be stress related. In the clinic, a trustful alliance should be established with the patient in order for a more realistic view to be achieved of the capacity.

Class separation of buildings with high and low prevalence of SBS by principal component analysis.

In this study, we were able to separate buildings with high and low prevalence of sick building syndrome (SBS) using principal component analysis. The prevalence of SBS was defined by the presence of at least one typical skin, mucosal and general (headache and fatigue) symptom. Data from the Swedish Office Illness Study describing the presence and level of chemical compounds in outdoor, supply, and room air, respectively, were evaluated together with information about the buildings in six models. When all data were included the most complex model was able to separate 71% of the high prevalence buildings from the low prevalence buildings. The most important variable that separates the high prevalence buildings from the low prevalence buildings was a more frequent occurrence or a higher concentration of compounds with shorter retention time in the high prevalence buildings. Elevated relative humidity in supply and room air and higher levels of total volatile organic compounds in outdoor and supply air were more common in high prevalence buildings. Ten building variables also contributed to the separation of the two classes of low and high prevalence buildings.

Self-reported hand eczema: symptom-based reports do not increase the validity of diagnosis.

BACKGROUND: Hand eczema is a common skin disease that affects about 10% of the general population of working age in Sweden. The resulting long sick-leave periods and need for changes of work and re-training put an economic burden on society, and there is an interest in developing cost-effective epidemiological surveillance instruments such as a screening questionnaire. OBJECTIVES: In a search for a simple screening questionnaire for hand eczema we compared the validity of a question about the presence of hand eczema with hand eczema diagnosis based on self-reported signs. METHODS: Consecutive patients (n = 95) referred for hand eczema and people in an ongoing epidemiological survey (n = 113) participated in the study. Before seeing an experienced dermatologist they had to: (1) answer a short questionnaire about current signs and symptoms from the hands; and (2) state whether they had hand eczema on the day of examination. The minimum criteria for hand eczema diagnosed by the dermatologist ('gold standard') were erythema and papules or vesicles, or erythema and scaling and fissures/lichenification. RESULTS: Of the 208 persons examined 93 fulfilled the criteria for hand eczema according to the 'gold standard'. Hand eczema diagnosis based on clinical signs reported in the questionnaire by the participants gave a sensitivity of 0.62 and a specificity of 0.87 in comparison with the dermatologists' diagnoses. Regarding the question about current hand eczema, agreement was good between the participants' and the dermatologists' judgements, giving a sensitivity of 0.87 and a specificity of 0.79. Comparing clinical signs reported by the participants and the findings by the dermatologists, the best agreement was for fissures, with a kappa-value of 0.65 (95% CI 0.55-0.75), and the poorest was for papules with 0.47 (95% CI 0.32-0.62). CONCLUSIONS: It was difficult for the individual to identify skin signs compatible with the clinical diagnosis of hand eczema. Asking 'Do you have hand eczema?' had high sensitivity and specificity compared to the suggested gold standard for hand eczema. However, the validity of a screening questionnaire depends on the type of population investigated.

Anaerobic desulfurization of ground rubber with the thermophilic archaeon Pyrococcus furiosus--a new method for rubber recycling.

The anaerobic sulfur-reducing archaeon Pyrococcus furiosus was investigated regarding its capacity to desulfurize rubber material. The microorganism's sensitivity towards common rubber elastomers and additives was tested and several were shown to be toxic to P. furiosus. The microorganism was shown to utilize sulfur in vulcanized natural rubber and an increase in cell density was obtained when cultivated in the presence of spent tire rubber. Ethanol-leached cryo-ground tire rubber treated with P. furiosus for 10 days was vulcanized together with virgin rubber material (15% w/w) and the mechanical properties of the resulting material were determined. The increase in the stress at break value and the decrease in swell ratio and stress relaxation rate obtained for material containing microbially treated rubber (compared to untreated material) show the positive effects of microbial desulfurization on rubber.

Prevalence of pigmented naevi in a Swedish population living close to the Arctic Circle.

The prevalence of common naevi and dysplastic naevi was investigated in a Swedish population with a low incidence of melanoma. A total of 201 subjects aged 30-50 years living in northern Sweden participated. The median number of common naevi per individual was 15, and 11% had dysplastic naevi. Higher numbers of common naevi were found in individuals with dysplastic naevi (median 68) and in those who had spent their childhood in southern Sweden (median 44). The prevalence of common naevi and dysplastic naevi was significantly lower than reported from a previously studied population in southern Sweden, with a melanoma incidence 4 times higher than in the north. The strong variability in naevus phenotype, and in melanoma incidence, between different regions of Sweden seems to be due to different levels of sun exposure rather than to differences in constitutional factors.

Biotechnological possibilities for waste tyre-rubber treatment.

Every year large amounts of spent rubber material, mainly from rubber tyres, are discarded. Of the annual total global production of rubber material, which amounts to 16-17 million tonnes, approximately 65% is used for the production of tyres. About 250 millions spent car tyres are generated yearly in USA only. This huge amount of waste rubber material is an environmental problem of great concern. Various ways to remediate the problem have been proposed. Among these are road fillings and combustion in kilns. Spent tyres, however, comprise valuable material that could be recycled if a proper technique can be developed. One way of recycling old tyres is to blend ground spent rubber with virgin material followed by vulcanization. The main obstacle to this recycling is bad adhesion between the crumb and matrix of virgin rubber material due to little formation of interfacial sulphur crosslinks. Micro-organisms able to break sulphur-sulphur and sulphur-carbon bonds can be used to devulcanize waste rubber in order to make polymer chains on the surface more flexible and facilitate increased binding upon vulcanization. Several species belonging to both Bacteria and Archaea have this ability. Mainly sulphur oxidizing species, such as different species of the genus Thiobacillus and thermoacidophiles of the order of Sulfolobales, have been studied in this context. The present paper will give a background to the problem and an overview of the biotechnological possibilities for solutions of waste rubber as an environmental problem, focusing on microbial desulphurization.

Facial skin symptoms in office workers. A five-year follow-up study.

This longitudinal study is a part of the interdisciplinary project. The Office Illness Project in Northern Sweden, which was initiated with a questionnaire study in late 1988. Among 3233 visual display terminal (VDT) workers, an initial case-referent group of 163 individuals was selected. The data acquisition included two questionnaires, assessments at the workplaces, interviews with personnel staff of the organizations concerned, and a clinical examination of the respondents. Subjects participating in the case-referent study 1988 filled out a questionnaire in the beginning of 1994. The primary objective of this study is to discuss changes in and causes of facial skin symptoms among VDT workers in the long term. The results show that (1) facial skin symptoms among VDT workers seem to be of a transitory nature for most of those with isolated skin symptoms, whereas the prognosis for those with a more complex symptom picture is more negative, (2) assumptions that measures taken in the work environment-including those involving the VDT and other electric devices-would have a positive effect on symptoms were not supported, and (3) the strongest external risk indicators for lasting skin symptoms seem to be found in the psychosocial work environment. Therefore, one important issue for the understanding of facial skin symptoms is organizational climate and personnel policies. The results also imply that individual factors, both constitutional and psychological, must be considered.

The psychosocial work environment and skin symptoms among visual display terminal workers: a case referent study.

BACKGROUND: This study is a part of the interdisciplinary project The Office Illness Project in Northern Sweden, which was initiated with a questionnaire study in late 1988. Previously published results from the project have shown that facial skin symptoms reported among visual display terminal (VDT) workers are associated with a number of exogenous factors. This part of the project investigated the relation between the psychosocial work environment and facial skin complaints. METHODS: From an initial questionnaire study among 4943 office workers, 163 VDT workers were selected for a case referent study of facial skin symptoms. The data comprise a self-administered questionnaire filled out by 149 subjects and interviews with representatives of the organizations concerned. RESULTS: Psychosocial conditions, especially lack of social support from co-workers, were associated with an increased risk of reporting skin symptoms. Stratification by sex showed that the associations between some psychosocial factors and health differed between men and women. The results indicate that there might be an interaction between psychosocial factors and electric fields in the workplace which increases the risk of reporting skin symptoms. CONCLUSIONS: This study supports the idea that the aetiological basis of facial skin symptoms among VDT-workers includes physical as well as psychosocial factors, and that the interaction between such factors might be significant in the understanding of skin complaints among VDT workers.