This datasheet on selenium poisoning covers Identity, Hosts/Species Affected, Diagnosis.
Cystic fibrosis (CF), the most common life-threatening autosomal recessive disorder in Causcasian populations, is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene on chromosome 7, which encodes a protein that functions as a chloride channel in the apical membrane of epithelial cells. The clinical manifestations comprise recurrent and chronic bronchopulmonary infections, pancreatic insufficiency, and hidrotic salt depletion. Such complications as diabetes, cirrhosis, and respiratory insufficiency develop, resulting in death in the absence of lung transplantation. Treatment is aggressive and comprehensive from the time of diagnosis. Early and intensive treatment of bacterial colonisation and lung infection is correlated with improved prognosis, and monthly follow-up at a CF Centre is mandatory. Mean survival among CF patients at the Danish CF Centre i Copenhagen is more than 40 years. Clinical trials of gene therapy are under way, but results to date have been disappointing.
Suppressor genes is the collective term for genes that regulate growth control. Inactivation of both copies may promote malignant transformation, though usually only in the presence of other mutations. The distinction between suppressor genes and other genes of importance to the development of malignancy is not clear cut. Suppressor genes may be activated genetically or somatically. In the latter case, mutations may occur before, during or after malignant transformation, and will determine the cancer phenotype and thus its clinical manifestations.
During the last 10-15 years allergic reaction to Natural rubber latex (NLR) has become an increasing occupational problem among health-care workers. The allergy is caused by allergenic proteins in the NRL. The diagnosis is achieved through a relevant history, skin prick tests with aquous NRL glove extracts and blood tests. History and prick tests are most important. The most frequent cross-reaction is to banana. Careful instruction on prevention is a must.
Cystic fibrosis (CF), the most common life-threatening autosomal recessive disorder in Causcasian populations, is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene on chromosome 7, which encodes a protein that functions as a chloride channel in the apical membrane of epithelial cells. The clinical manifestations comprise recurrent and chronic bronchopulmonary infections, pancreatic insufficiency, and hidrotic salt depletion. Such complications as diabetes, cirrhosis, and respiratory insufficiency develop, resulting in death in the absence of lung transplantation. Treatment is aggressive and comprehensive from the time of diagnosis. Early and intensive treatment of bacterial colonisation and lung infection is correlated with improved prognosis, and monthly follow-up at a CF Centre is mandatory. Mean survival among CF patients at the Danish CF Centre i Copenhagen is more than 40 years. Clinical trials of gene therapy are under way, but results to date have been disappointing.
Positron emission tomography (PET scanning) is a useful tool in staging of malignant melanoma. A radiolabelled glucoseanalogue can demonstrate changes in metabolism and thus identify malignancy in macroscopic unchanged structures. It is a non-invasive, fast method to identify especially visceral, still symptomless metastases. The patient can often be spared from mutilating surgery.
A recent analysis of epidemiological data from the Nordic Cancer Registries revealed that the prognosis of several groups of cancer patients in Denmark is inferior to that of the other countries. These differences have evolved during the last 20-30 years. The prognosis of cancer patients in the Nordic countries is reasonably good compared to other European countries and to the black community in the United States while the white community in the US has a better prognosis with regard to most of the cancer diseases. It is speculated that these differences reflect differences in resources allocated to cancer treatment.
After allergic disorders, nocturnal enuresis is the most common chronic childhood condition. Recent research has yielded abundant new knowledge about the condition, especially about its aetiology and pathophysiology, and the psychological consequences. A hereditary background has been substantiated by the identification in genetic linkage studies of areas in chromosomes 12 and 13 that are manifestly associated with bedwetting, though genotype expression in the phenotype appears to be complex and heterogeneous. Pathophysiologically, findings in current intensive research suggest three interactive factors to be involved: (i) relative nocturnal polyuria, due to insufficient antidiuretic hormone release during sleep in pre-teenagers, and due to renal tubular dysfunction in adolescents and adults; (ii) reduced nocturnal bladder capacity, especially in the 33 per cent of cases which do not respond to desmopressin treatment; and (iii) the patient's inability to waken in response to signals from a full bladder. Recent findings have also confirmed previous reports that with very few exceptions bedwetting is not caused by psychological factors. On the contrary, the condition causes psychological problems manifested in reduced self-esteem, shame and guilt, though self-esteem is restored by successful treatment. Active treatment should be started as soon as the child is ready to receive it, the main options being an enuresis alarm, desmopressin, or a combination of the two. If reduced bladder capacity is suspected, treatment with a detrusor relaxant should be included.
Next to headache recurrent gastro-intestinal complaints constitute the most common reason for medical consultation among daycare and school children. The use of more sophisticated examination methods has shown that in up to 50 per cent of cases the cause of the gastric complaints is a treatable disease or a functional anomaly of the gastro-intestinal tract. The commonest conditions are lactose intolerance, gluten sensitivity, gastro-oesophageal reflux, and gastritis. In some cases stomach pain is triggered by psychosomatic mechanisms. Depending upon the child's age, aetiological indications can sometimes be derived from history taking. In many cases the investigations can be made in the out-patient clinic. The cornerstones of treatment are various kinds of dietary elimination regimens, prokinetic agents, and antibiotics. Recently, the investigation of neuroendocrinological and neurophysiological processes related to psychosomatic causes of gastric complaints has once again become common.
Positron emission tomography has developed very much since the start in the late 1970s, especially with the development of new labelling procedures for PET-tracers. With the development of whole body imaging and the discovery that 18F-FDG allows a high sensitivity for the detection of soft tissue tumors, the clinical use has increased remarkably. The cost-effectiveness of this modality, when properly used, has been demonstrated and 18F-FDG-PET should be considered as an early alternative in patient evaluation.
We have investigated 13 patients with incidentaloma using PET with 11C-metomidate. The patients included six adrenocortical adenomas, one adrenal cancer, two pheochromocytomas, one myelolipoma, one benign cyst and two metastases. A very high tracer uptake was observed in all tumors originating from the adrenal cortex, allowing excellent visualisation, whereas all other processes were negative. PET with 11C-metomidate is a very promising method for the characterisation of incidentalomas and is suggested to be included very early in the evaluation of these patients.
The appearance of various consensus reports, guidelines, Cochrane Centers, and other evidence-based medicine initiatives during the past decade has resulted in marked improvement in the rational utilisation of available knowledge of attitudes toward the issue of low back pain (LBP). Moreover, owing to the ready access to updated data bases, this knowledge has been disseminated with incredible speed. In the spring of 1995, the Danish National Board of Health in Denmark convinced a multidisciplinary team of back specialists to tailor data available in the international reports for Danish needs. The article outlines the findings of this team, the major recommendations being that providing information is preferable to treatment, that patients should be encouraged to remain active, that physical exercise should be kept up except during the acute phases, that most episodes of LBP are to be considered life events rather than automatic reasons to seek treatment, and that passive treatment should be minimised, though manipulation may be helpful in the short term.
With the radionuclide tracers available today, 50-90 per cent of neuroendocrine tumours of the gastro-intestinal tract can be visualised with PET (positron-emission tomography). PET also enables the effect of tumour treatment to be monitored in terms of biochemical and functional variables, which is not possible with other radiological techniques. Owing to the very good tumour resolution possible with PET, it serves as a complement to other routine methods such as computed tomography and ultrasonography, and can be used to screen the chest and abdomen for small primary tumours that can not be detected with other methods. In several pre-operative trials PET has been shown to demonstrate more changes in the pancreas and liver than was possible with other methods. In the near future it will be possible to demonstrate the presence of and quantify growth factor receptors, hormones, enzymes, DNA synthesis, mRNA synthesis and protein synthesis. Access to these tumour biological data will be of crucial importance to the individualisation of treatment.
Physicians responding to emergency calls on board airliners in intercontinental traffic may not be aware of certain legal complications which may arise. For instance, the medical practitioner may hold a license valid in one country, the air carrier may be registered in another, and the patient may be a third state national. Legislation varies between nations, as do courts decisions. Physicians may not be aware of the laws and regulations which apply or of the subtle differences between terms and interpretations used in formal language. This article contains a scenario description from a commercial air liner in intercontinental transit carrying a patient unknown to the physician who responds to a call for medical assistance. The main considerations to be made, the more likely diagnoses and various strategies for immediate interventions are reviewed. Likewise, appraisal and use of medical equipment on board are discussed, as are issues concerning responsibility and liability when equipment is used in supposedly "trained hands". Main themes in the current international medico-legal debate are considered with emphasis on the "Good Samaritan Principle", the responsibility of commercial air carriers, and telemedicine with insurance against law suits. The article concludes with some practical advice to the travelling medical community.
A successful model of liaison between the primary and secondary (hospital) levels of health care entails improved co-operation between hospital doctors and general practitioners (GPs). Since its introduction in Denmark in 1991, this approach has been adopted in Sweden and, to a lesser extent, in Norway. Important principles of the model include: 1) both at the primary and secondary level, responsibility for cooperation rests with the physicians themselves; 2) all physicians at both levels are involved; 3) liaison is maintained by selected GPs serving as liaison officers acting in concert under the guidance of a coordinator; 4) liaison officers are responsible for cultivating personal contacts and good relations at hospitals, and promoting interest in and commitment to the system. Evaluation of the model requires both quantitative and qualitative studies. Although few evaluations have been completed, and no definite conclusions can be drawn, the preliminary results of current evaluations in progress in Sweden and Norway are promising, as are the reported experiences of those who use the system. A Nordic ad hoc group has been actively engaged in promoting the quality of primary-secondary health care liaison since 1997.
