Microbial translocation and inflammatory response in patients with acute peritonitis

BACKGROUND: In peritonitis, increased production of cytokines and changes in the splanchnic cellular immune system may cause translocation of bacteria and endotoxins. The aims of this study were to assess the frequency of translocation and relate translocation to the immune response in patients with acute peritonitis. METHODS: Patients with local (LP, n=20) or general peritonitis (GP, n=15) were compared with controls (C, n=12). Blood was obtained preoperatively for cultures, and analyses of endotoxin and cytokines (tumour necrosis factor-alpha, interleukins 6 and 10). Mesenteric lymph nodes (MLNs) were excised for culturing and immunohistochemistry using antibodies CD4, CD8 and CD68. RESULTS: Positive blood and MLN cultures were not obtained in controls. DNA typing proved bacterial translocation in one patient with local and one patient with general peritonitis. Thus translocation was proven to occur in 6% of patients with peritonitis. Endotoxaemia was predominantly found in the GP group. Cytokines increased during peritonitis and more so in patients with GP than in those with LP. More CD8 and CD68 cells were found in MLNs from LP patients than in C patients and more CD4 and CD8 cells in LP patients than in GP patients. There was no significant difference in this regard between the GP and C groups. CONCLUSIONS: Bacterial translocation occurs during acute peritonitis but seems to be fairly infrequent. Peritonitis causes significant inflammatory cellular reactions.     

Intervention strategies directed at exposure to organic solvents at worksites: A case study

Exposure to organic solvents is a serious occupational health problem. Research has mainly been focused on the harmful medical effects of the substances. Models for practical safety work are lacking. The purpose of this review is to summarize and scrutinize experience gained by implementing methods for early detection of symptoms caused by exposure to solvents in the health services and practical safety work in the wood processing industry. Five interdependent phases have been developed during a 10-year period within the framework of a multidisciplinary collaboration: i) community diagnosis, ii) a treatment program, iii) an occupational environment program, iv) education and v) a demonstration plant. The results illustrate the need for regional epidemiological surveillance and increased collaboration between the health services and other sectors of the community.     

Chronic open-angle glaucoma and advanced visual field defects in a defined population.

In a case-finding study in a municipality in central Sweden, 128 cases of chronic open-angle glaucoma with visual field defects (VFD) were found. The prevalence amounted to 1.4% in those greater than or equal to 45 years of age. Sixty-three percent had capsular glaucoma. Advanced visual field defects (AVFD), i.e. a restriction of the visual field to a diameter of less than or equal to 20 degrees, were seen in 49 patients. Four patients had AVFD in both eyes. Patients with AVFD were older, had had the disease longer, had higher mean initial intraocular pressure (IOP), and had more extensive VFD at the time of diagnosis. When age and duration were taken into consideration, the risk of developing AVFD was 14 times greater in those with VFD stage III at the time of diagnosis, i.e. a Bjerrum scotoma with nasal breakthrough or more widespread VFD. An IOP of greater than or equal to 35 mmHg signified that the risk of having VFD stage III at the time of diagnosis, when age and type of glaucoma were taken into consideration, was 8.6 times greater than if the IOP was less than 35 mmHg.     

Is positron emission tomography using 18F-fluorodeoxyglucose and 11C-acetate valuable in diagnosing indeterminate pancreatic masses?

BACKGROUND: It can be impossible to differentiate a mass forming chronic pancreatitis from adenocarcinoma of the pancreas using standard anatomical imaging. Positron emission tomography using 2-[18F] fluoro-2deoxy-D-glucose (18FDG-PET) and 1-[11C]-acetate (11C-acetate-PET) are methods taking advantage of the metabolic differences between benign and malignant tissues. AIMS: To determine the diagnostic accuracy of 18FDG-PET and 11C-acetate-PET in indeterminate pancreatic masses. METHODS: Twenty patients with an indeterminate mass of the head of the pancreas were prospectively studied. All patients underwent 18FDG-PET and eighteen of them 11C-acetate-PET. Scans were evaluated qualitatively and quantitatively; the later by using regional standardised uptake value (SUV). Final diagnosis was established using histopathologic evaluation of resected specimen or biopsy. RESULTS: Adenocarcinoma was diagnosed in twelve patients and chronic pancreatitis in eight. Qualitative evaluation of 18FDG-PET imaging revealed three false negative and one false-positive results. The sensitivity, specificity, and diagnostic accuracy were 75 %, 88 %, and 80 %, respectively. The cut-off SUV to differentiate malignant from benign disease was 3,5 demonstrating a sensitivity of 91.7 % and a specificity of 75 %. CONCLUSION: 18FDG-PET imaging could not confirm or exclude malignancy in indeterminate masses of the head of the pancreas with high sensitivity and diagnostic accuracy. 11C-acetate-PET provided no additional diagnostic benefits.     

A cartographic study of hospital utilization in the county of Uppsala

In this study the question whether increased resources in community based primary care lead to decreased utilization of in-patient care has been analysed. Two alternative types of analysis were compared: a municipality-based analysis and a cartographic analysis based on non-administrative reference areas. The study material consisted of person-based data from Uppsala County in Sweden. The cartographic analyses revealed important characteristics of the utilization pattern, which would not have been possible to ascertain using traditional methods such as analyses based on administrative areas. Thus, the cartographic analysis gave some support to the hypothesis that increased resources to primary care will reduce the utilization of in-patient care.     

Interest and Responsibility of ADA in Dental Licensure

The ADA is the voice of dentistry and the recognized authority on dentistry in the eyes of the profession and the public. Our history of action and the consensus of the dental community confirm the ADA's interest and responsibility for licensure. Our living documents speak to our position of trust with society and our obligation for self-regulation. ADA has consistently supported the important role of the states and their boards of dentistry in the administrative implementation of that responsibility. Through its policies, committees, and task forces, and most importantly, its role as a facilitator, the ADA has provided its expertise, resources, and support to move the licensure process forward. Great progress has been made through collaboration and contributions from all stakeholders in the process. The ADA believes it is vital to keep the lines of communication open to allow continued collaboration. The ADA also believes it has a responsibility to do all it can to see that this occurs.     

Policy content and context for health promotion in Swedish schools. An analysis of municipal school plans

In international literature policy documents are consideredas major strategic tools for health promotion in schools. InSweden, since 1991, local municipalities are obliged to producea politically approved school plan for compulsory schools, grades1–9, i.e. policy instruments which should indicate theaims and objectives, the moral and political values of the municipality.The aim of this study was to describe the content of schoolplans, focusing on health and environment in 1994 in 62 municipalitiesin four counties in Sweden, using content analysis. The studywas implemented as a total investigation of the 62 municipalitiesbased on the principles of purposeful sampling procedures inorder to provide selections of informative cases for in-depthstudies. The content analysis was conducted in four steps. Twelvethemes were identified in the school plans, representing differentissues on health and environment in the first step. Secondly,quotations illustrate and provide a broader meaning of themes.Third, similarities and differences between the counties andmunicipalities are summarized. Finally, the strategic componentsof the HELPSAM model (The HEaLth Promotion Strategy AnalysisModel) are presented in relation to the 12 themes. As policydocuments the school plans seem to be valid instruments to promotethe intentions of the municipality concerning health promotion.A supportive environment for health relates to the physicaland social aspects of our surroundings, and these aspects areprominent as themes of the school plans. The major part of themunicipalities has focused on environmental issues, well inadvance of the desired development of a local Agenda 21. Thefinding points out a rapid diffusion of environmental questionsin the Swedish society, at least in the counties of concern.     

Posthypotensive generation of superoxide free radicals--possible role in the pathogenesis of the intestinal mucosal damage

Graded small intestinal ischemia was induced in cats by partial occlusion of the superior mesenteric artery. Specimens from the small intestine were studied at the end of the hypotensive period, 10 min and 60 min posthypotensively . Specimens obtained late during hypotension revealed characteristic mucosal damage in all cases. However, the intestinal mucosal damage was more pronounced in the specimens taken posthypotensively . This aggravation was prevented if the cats were given superoxide dismutase (SOD) during the hypotensive period. Further, the intestinal tissue concentration of total glutathione was reduced posthypotensively . It is suggested that the posthypotensive aggravation of the intestinal mucosal damage is caused by generation of cytotoxic oxygen free radicals. Data favouring the suggestion that the glutathione-glutathione peroxidase system is an important generator of free radicals in intestinal ischemia is presented.