Epidemiology of perforated peptic ulcer:Age-and gender-adjusted analysis of incidence and mortality

AIM:To investigate the epidemiological trends in inci-dence and mortality of perforated peptic ulcer(PPU)in a well-defined Norwegian population. METHODS:A retrospective,population-based,single-center,consecutive cohort study of all patients diag-nosed with benign perforated peptic ulcer.Included were both gastric and duodenal ulcer patients admitted to Stavanger University Hospital between January 2001 and December 2010.Ulcers with a malignant neoplasia diagnosis,verified by histology after biopsy or resection,were excluded.Patients were identified from the hospitals administrative electronic database using pertinent ICD-9 and ICD-10 codes(K25.1,K25.2,K25.5, K25.6,K26.1,K26.2,K26.5,K26.6).Additional searches using appropriate codes for relevant laparoscopic and open surgical procedures(e.g.,JDA 60,JDA 61,JDH 70 and JDH 71)were performed to enable a complete identification of all patients.Patient demographics,presentation patterns and clinical data were retrieved from hospital records and surgical notes.Crude and adjusted incidence and mortality rates were estimated by using national population demographics data. RESULTS:In the study period,a total of 172 patients with PPU were identified.The adjusted incidence rate for the overall 10-year period was 6.5 per 100 000 per year(95%CI:5.6-7.6)and the adjusted mortality rate for the overall 10-year period was 1.1 per 100 000 per year(95%CI:0.7-1.6).A non-significant decline in ad-justed incidence rate from 9.7 to 5.6 occurred during the decade.The standardized mortality ratio for the whole study period was 5.7(95%CI:3.9-8.2),while the total 30-d mortality was 16.3%.No difference in in-cidence or mortality was found between genders.However,for patients≥60 years,the incidence increased over 10-fold,and mortality more than 50-fold,compared to younger ages.The admission rates outside office hours were high with almost two out of three(63%) admissions seen at evening/night time shifts and/or during weekends.The observed seasonal variations in admissions were not statisti     

Plate fixation of tibial fractures in the rabbit: Correlation of bone strength with duration of fixation

Bone healing after metal plate fixation of rabbit tibial osteotomies was studied in order to gain information as to the optimum time for plate removal. The fracture had regained almost normal biomechanical properties after 6 weeks. Significantly greater strength and stiffness of the healing tibiae were obtained at 12 weeks when the plate was removed after 4, 6 or 9 weeks and no further fixation was subsequently applied, compared to those plated for 12 weeks. The results indicate that a metal plate should be removed as soon as the fracture has regained normal biomechanical properties; i.e. before the stress-protecting effect has secondarily weakened the bone.

The findings suggest that metal plates should be removed at an earlier stage of the healing period than is usual in clinical practice.     

Low doses of methylphenidate (Ritalin) may alter the delay-of-reinforcement gradient

The present study investigated effects of methylphenidate on spatio-temporal distributions of responses generated by a fixed interval 60-s schedule of reinforcement. A response panel with 20 different response locations (holes) made it possible to distinguish effects of the drug on the procedurally-correct response (correct according to the contingencies) and effects on other topographically similar responses acting as functionally-adequate responses. Detailed flow charts show how the dynamics of responding changed with dose and segment of the fixed interval. The number of holes visited was increased after low and medium doses, but decreased after high doses. The spatial differences between responses in the initial and the final parts of the fixed interval gradually disappeared after 6 mg/kg or higher doses as the functionally-adequate responses moved to earlier segments of the fixed interval. Few results could, however, be described as response rate dependent. Distributions of responses around the correct hole illustrated differences between procedurally-correct and functionally-adequate classes. The number of holes included in the latter class changed by dose in an inverted U-shaped fashion. Perseverations and stereotyped responding increased with increasing dose. Most of the effects may be described as motor stimulatory. One way of explaining the stimulatory effect is in terms of a lengthened delay-of-reinforcement gradient. The rate-dependent effect of methylphenidate on the procedurally-correct class after some doses may have been due to the combined effects of a lengthened delay gradient increasing the response rates early in the interval and interference from perseverations having their most detrimental effects on the high rates late in the interval. Offprint request to: T. Sagvolden     

Effects of diethylstilbestrol and estramustine phosphate (estracyt) on natural killer cell activity and tumor susceptibility in male mice

The effects of estramustine phosphate (EMP) and diethylstilbestrol (DES) on natural killer (NK) cell activity, tumor growth, and artificial metastases were investigated in male C57BL/6 mice. Kinetic analysis and studies at the single-cell level indicated that EMP did not influence the number of NK cells but interfered with their lytic activity thereby reducing the actual killer capacity. NK cells from EMP-exposed animals responded normally to the interferon inducer Poly I:C which restored NK activity to control levels. Spleen cells from DES-treated animals had lytic activity comparable to that of control animals. However, more detailed analysis showed that DES reduced the number of lymphocytes able to recognize target cells, while the individual NK cell had an increased lytic activity and recycling capacity. Moreover, NK cells from DES-treated animals were refractory to poly-I:C stimulation, suggesting that they were prestimulated in vivo. The pertubations of the NK cell system induced by both EMP and DES were reversible and normalization of NK activity was reached within a week. The incidence of tumor takes after subcutaneous inoculation of the syngeneic Lewis lung carcinoma was increased in EMP as well as DES-treated animals. Artificial lung metastasis produced by intravenous injection of the same tumor was increased in EMP but not in DES-exposed animals.     

Sustained Antihypertensive Effect of Captopril Combined with Diuretics and Beta-adrenergic Blocking Drugs in Patients with Resistant Hypertension

ABSTRACT Ten patients with severe hypertension and unsatisfactory blood pressure control during combined therapy with β-adrenergic blocking drugs, diuretics, and vasodilators were treated with gradually increasing doses of captopril. Vasodilators were discontinued 24 hours prior to captopril administration. Six patients had essential, two renal, and two renovascular hypertension. Mild renal impairment was observed in four patients. Captopril effectively decreased blood pressure for 3 hours in all patients after the first dose. The antihypertensive effect appeared to be triphasic and was sustained in all but one patient during 12 months of observation. Captopril doses of 25–75 mg t.i.d. were sufficient to achieve acceptable blood pressure control (RR≦160/100 mmHg) when given in the above mentioned combination. Side-effects were few and tolerable and discontinuation of captopril was not required.     

Allocation of labour to somatic and psychiatric specialist care--the effects of earmarked grants

Until 2002, counties were responsible for providing both somatic and psychiatric specialized health care services in Norway. The financing arrangement of the counties consisted of fixed local taxes, a general block grant and different types of earmarked grants from the national government. Since 1997, earmarked conditional grants related to DRG-activity have been used for somatic services, whereas earmarked unconditional grants have been used for mental health care services from approximately the same time. This paper analyse the price and revenue effects of grants on the allocation of labour, with special attention to the two types of earmarked grants: conditional and unconditional. Theoretically, labour (as an index of production output) is assumed to be allocated to somatic and psychiatric services dependent upon revenues (taxes, block grants and earmarked unconditional grants), price per labour-year (that among other things are affected by earmarked conditional grants) and the preferences of the local government (which relate to the age structure and population density of the county). We assume that a conditional grant reduces the net price of labour and thereby increases the (relative) demand, whereas an unconditional grant adds to the other revenues of the county and do not affect the relative allocation of labour. Data from a panel of 18 counties for the period 1992-2001 is analysed using OLS with fixed effects. The results show revenue effects and direct price effects as expected. However, the assumption that unconditional grants do not affect relative allocation of labours is not supported. We find a positive effect of the unconditional grant to psychiatric care on the demand for labour in this sector. We interpret this as an effect of hierarchical governance such as supervision and monitoring that were remedies that were used together with the unconditional grant.     

Development of the hip joints in unoperated children with cerebral palsy: a radiographic study of 76 patients

BACKGROUND: The aims of the present study were to assess the development of hip dysplasia in children with bilateral spastic cerebral palsy and to evaluate the factors that influence the progression. PATIENTS AND METHODS: 76 children, 42 with spastic quadriplegia and 34 with diplegia, were included in the study. Their mean age at the first radiographic examination was 3.5 (1-11) years. The patients were followed up until operative treatment (54 subjects) or until the most recent radiograph in those who did not undergo hip surgery. The mean length of follow-up was 4.8 (1-13) years. On the initial and most recent radiographs, the migration percentage (MP) was measured, which is the percentage of the femoral head lateral to the acetabular rim. RESULTS: The mean MP of the side with the largest displacement was 25% (-18-66) at the initial radiographic examination and 51% (9-100) at the last follow-up. The mean increase in MP was 7% (-2-33) per year. Linear multiple regression revealed that gait function and age were the most important variables that influenced the rate of MP progression. Children who could not walk had significantly greater MP progression per year (12%) than those who walked with or without support (2%). In the quadriplegics, the maximal yearly increase in MP was 13% under 5 years of age and 7% in older children. This difference was statistically significant, whereas no significant difference in relation to patient age was seen in the diplegics. INTERPRETATION: There is a pronounced trend towards displacement of the hips in quadriplegic CP patients who are under 5 years of age and cannot walk. Because hip dislocation may lead to severe problems, close follow-up is important in finding the appropriate time for hip surgery in order to avoid progression towards dislocation. The risk of severe hip dysplasia is considerably less in spastic diplegia.     

The neuronal regulation of fracture healing: Effects of sciatic nerve resection in rat tibia

The effect of sciatic nerve resection on tibial fracture healing was studied in rats 25 days post-trauma. To prevent differences in loading between sham-operated and nerve-resected animals the fractured limbs were cast-immobilized. On radiograms 8 of 11 fractures in the sham-operated animals showed very little callus formation in contrast to only 1 of 8 fractures in the group with nerve resection. Measured by single-photon absorptiometry, animals with sciatic nerve resection had a higher bone mineral content than the sham-operated animals. However, the mechanical strength in three-point cantilever bending was not better in the nerve-resected rats, implying a defective organization of the large callus. These results suggest neural regulation plays a role in the type of fracture healing, primary or secondary, and in the amount and quality of the callus.