在瑞典宠爱养鸟与肺癌危险性的探讨

目的：调查瑞典养鸟与肺癌危险性的联系。研究设计：肺癌病例与社区对照组的病例对照研究，由两位经过特殊训练的护士进行调查。调查地区：瑞典西南地区三所医院。病例：全部为新近诊断的肺癌病例，年龄最大７５岁，居住于Ｇｏｔｈｅｎｂｕｒｇ，Ｂｏｈｕｓ及Ａｌｖｓｂｏｒｇ三个城市的２６个社区。对照组配对条件：从人口登记资料中选出同性别、年龄相近和同一居住地点的居民。养鸟情况：肺癌病例３８０人（男２５２，女１２８），对照组６９６人（男４３３，女２６３）。探讨的主要问题：探讨养鸟与否和养鸟年限与肺癌的ＯＲ值。结果：家中曾养鸟和未养鸟的调整ＯＲ值男性为０．９４（９５％ＣＩ＝０．６４～１．３９），女性为１．１０（９５％ＣＩ＝０．６４～１．９０）。未见到养鸟年限增加有肺癌危险性增加的倾向。结论：瑞典家中养鸟对男、女肺癌危险性并无影响     

Screening for intrauterine growth retardation in late pregnancy

A prospective study was performed on an unselected area-based population in order to improve the antenatal diagnosis of intrauterine growth retardation (IUGR). The clinical importance of simple clinical tests to follow fetal growth (measurements of the symphysis-fundus (SF) distance and recordings of maternal pregnancy weight gain) was investigated. Risk factors for IUGR, appearing in late pregnancy (vaginal bleeding, non-proteinuric pregnancy hypertension and pre-eclampsia) were also studied.

A pathological SF curve (frequency 3.5%) was found to be valuable, but mainly as a screening instrument rather than a diagnostic tool for IUGR. Pre-eclampsia was the only risk factor appearing in late pregnancy that could be associated with IUGR.

Previously we have recommended early pregnancy screening for the following high risk factors for IUGR: smoking, previous birth of a low birth weight infant, low pre-pregnancy weight, renal disease and addiction. When also screening for preeclampsia, 22% of the population exhibited at least one screening factor.

Retrospectively we identified all severely growth-retarded infants (birth weight for gestational age - 2 S.D.) born in 1980 (n = 27). 23 of these infants were delivered to mothers exhibiting high-risk factors for IUGR or a pathological SF curve. In this way a high-risk group for IUGR can be identified, which should be monitored more carefully during the last period of pregnancy.     

Smoking, maternal age, and fetal growth

In a prospective clinical study from an unselected area-based population, the influence on birth weight for gestational age (standardized birth weight) was studied with special respect to risk factors for intrauterine growth retardation. Smoking was the most important risk factor: 16% of the mothers smoked at least ten cigarettes per day, and the influence of smoking on standardized birth weight was highly significant (P less than .001). Maternal age in itself had no effect on standardized birth weight. However, among smokers the reduction in standardized birth weight became more pronounced with increasing maternal age (P less than .001). Longterm smoking has been reported to increase the risk of severe placental complications. This study emphasizes that elderly smokers also must be considered to be at a higher risk than younger smokers for developing fetal growth disturbances.     

Changes in cochlear blood flow during acoustic stimulation as determined by 14C-iodoantipyrine autoradiography

Local blood flow was measured in the tissues of the cochlea using the [14C]iodoantipyrine autoradiographic technique. Flow observed without acoustic stimulation was compared with that seen during exposure to wide-band noise at 85 or 105 dB SPL. Compared with the unexposed cochlea, substantial increases in blood flow were observed during exposure to 85 dB SPL noise in the spiral ganglion, VIII nerve and spiral lamina. Little or no change was noted in external wall structures. These results are consistent with changes in cochlear metabolism which have been reported previously using similar techniques, suggesting that increases in blood flow may be linked to increases in local metabolism. No changes in blood flow were measured during exposure to 105 dB SPL noise. This result is similar to those of other investigators using potentially damaging intensities of acoustic stimulation.     

A prospective controlled five-year follow-up study of primiparas with gestational hypertension

Primiparas with hypertension first recognized in pregnancy and an age- and parity-matched control group, normotensive throughout pregnancy, were monitored during 5-6 years with blood pressure recordings performed in a standardized way. At the end of the study period, 21 out of 49 women with hypertension in pregnancy had developed hypertension requiring therapy or borderline hypertension, compared with 2 women in the control group who had developed borderline hypertension. Therapy was required in 7 of the women. Factors associated with increased risk of developing hypertension were gestational week at diagnosis of gestational hypertension, 1st diastolic blood pressure during follow-up, family history, smoking, and age.     

Protein and energy intake during weaning. III. Effects on plasma amino acids

Preprandial plasma amino acid concentrations were measured at 5 and 6 months of age in 30 healthy term infants who were either breast-fed ad libitum or fed one of two different formulas (1.9 g of protein per 100 ml with a whey:casein ratio of 50:50; 2.9 g of protein per 100 ml with a whey:casein ratio of 20:80) ad libitum, plus the same supplementary food regimen. The mean plasma concentrations of total amino acids and especially total essential amino acids were higher in the formula-fed infants. Those fed formula also had plasma concentrations of methionine, isoleucine, phenylalanine, leucine, valine, threonine, aspartate, proline, lysine, tyrosine, histidine that exceeded plasma concentrations of breast-fed infants by 2 or more standard deviations. Concentrations of arginine, glutamic acid, glutamine, ornithine, serine, cystine did not differ and taurine was higher in the breast-fed infants. The data indicate that formulas in common use today during weaning (4-6 months) provide excessive protein intakes when compared to the breast-fed control infants. A lowering of protein concentration and a further manipulation of the whey:casein ratio is necessary if plasma amino acid patterns similar to those found in breast-fed infants is to be achieved with artificial feeding.     

Anaphylaxis and angioedema due to rubber allergy in children

Delayed hypersensitivity to rubber chemicals is well known but there are an increasing number of case reports on an immediate type of hypersensitivity inducing contact urticaria and anaphylaxis in adults. We now report on three atopic children who developed angioedema, which in two of them progressed to anaphylaxis after exposure to natural rubber products. All three patients showed positive skin prick tests and one had a positive RAST test to latex from the rubber tree (Hevea brasiliensis). It is clear that sensitized subjects are at risk of developing anaphylaxis when exposed to natural rubber products, e.g. during medical examination or surgery when rubber gloves are used.     

Chylothorax as a complication after delivery

A 23-year old female who developed a chylothorax as a probable complication after delivery is described and a possible mechanism is proposed. Conservative treatment was unsuccessful and the surgical management was complicated by an anatomical variation with the thoracic duct presenting as a plexiform system instead of a single duct.     

Performance-based reimbursement in health care. Consequences for physicians' cost awareness and work environment

BACKGROUND: The funding and structure of health care is currently undergoing major changes. The impact of such changes on professional behaviour and working conditions have not been widely studied in Europe. The two aims of this study were to prospectively assess the impact of performance-based reimbursement on physicians' attitudes and self-assessed professional behaviour, related to cost awareness, as well as their working conditions. METHOD: Physicians in Stockholm County Council (with a performance-based reimbursement system) and physicians in eleven Swedish councils without performance-based reimbursement were examined simultaneously in 1994. This was a cross-sectional questionnaire study. RESULT: The results show a heightened cost awareness among physicians in Stockholm but also greater discontent with working condition factors such as decision latitude, job satisfaction and personal well-being. CONCLUSION: These results suggest that in order to counteract physicians discontent as a result of altered structure and increased focus on performance-based reimbursement, the autonomy and influence of physicians over the work processes need to be considered.     

Postoperative pain relief using intermittent injections of 0.5% ropivacaine through a catheter after laparoscopic cholecystectomy

Postoperative pain has been an important limiting factor for ambulatory laparoscopic cholecystectomy. We anesthetized 40 ASA physical status I-II patients using propofol for the induction and sevoflurane in oxygen and air for the maintenance of anesthesia. At the end of the anesthesia, the patients were randomized into one of two groups: Group P (Placebo) and Group R (0.5% Ropivacaine). Twenty milliliters of normal saline or ropivacaine, respectively, were injected intraperitoneally at the end of surgery via a catheter placed in the bed of the gall bladder. Postoperatively, intermittent injections (10 mL) of the study solution were given when required for pain. Ketobemidone 1-2 mg was given IV as rescue medication. Pain was assessed using a visual analog scale at 1, 2, 3, 4, 8, 12, 16, and 20 h after surgery and once each day for 1 wk at rest (deep pain), shoulder and incision sites, and pain during coughing. Recovery was assessed by the time to transfer from Phase 1 to 2, the ability to walk, drink, and eat, and the ability to void. Plasma concentrations of ropivacaine were measured in eight patients. Time to ability to walk, defecation, driving a car, and return to normal activities were also recorded through a questionnaire sent home with the patient. During the first 4 postoperative h, patients in Group R had lower scores for deep pain and during coughing compared with Group P (P < 0.05). No differences were found in the postoperative consumption of ketobemidone. Median times to recovery at home were similar between the groups. By the seventh day, 93% of the patients had returned to normal activities of daily living. We conclude that the early postoperative pain after ambulatory laparoscopic cholecystectomy could be relieved using intermittent injections of ropivacaine 0.5% into the bed of the gall bladder. IMPLICATIONS: Early postoperative pain can be relieved by intermittent injections of ropivacaine 0.5% through a catheter placed in the bed of the gall bladder after ambulatory laparoscopic cholecystectomy.