Pathologic fracture of the distal femur in osteitis fibrosa cystica simulating metastatic disease

A 32-year-old woman sustained a minor sliding accident with moderate to severe pain about the left distal thigh and hip and the right shoulder. Radiographs showed marked osteopenia, multiple osteolytic bone lesions, and a pathologic fracture of the left distal femur. Surgical intervention was conducted for the pathologic fracture, and the pathological findings confirmed the diagnosis of primary hyperparathyroidism with osteitis fibrosa cystica. We report this rare case here because it may be mistaken for neoplastic metastatic disease on radiographs and bone scan. The pathologic fracture usually heals and the bone mineral density improves significantly within 6 months after parathyroidectomy.     

Risk for invasive and borderline epithelial ovarian neoplasias following use of hormonal contraceptives: the Norwegian-Swedish Women's Lifestyle and Health Cohort Study

The risk of ovarian epithelial neoplasia following use of hormonal contraceptives (HC) was examined in data from the Norwegian-Swedish Women's Lifestyle and Health cohort including 103551 women aged 30-49 years in 1991-92. Follow-up through 2000 produced 214 incident cases of histologically confirmed epithelial ovarian neoplasias (135 invasive and 79 borderline cases). Using the Cox proportional hazard models, ever having used HC was associated with a decreased relative risk of epithelial ovarian cancer of 0.6 (95% CI 0.5-0.8). The effect of duration of HC use was convincing (P for trend <0.0001), and more important than age at start of use or time since first or last use. There was no significant difference between the effects of combined oral contraceptives and progestins-only contraceptives on risk (P=0.98). Similarly, there was no significant difference between the effects of ever use of HC on invasive and borderline ovarian neoplasia (P=0.37). In this cohort, use of HC seems to reduce the risk of epithelial ovarian neoplasia markedly and persistently in relation to the duration of use.     

Help-seeking for mental health problems among young physicians: is it the most ill that seeks help?

Abstract Objectives The aims of this study were to assess the prevalence of self-reported mental health problems and help-seeking among young physicians, and identify predictors of seeking help. Methods A prospective cohort sample of Norwegian medical students (N=631) were assessed in their final semester (T1), and in the first (T2) and fourth (T3) postgraduate year. The average observation period was 3.6 years. Results The prevalence of mental health problems that needed treatment over the preceding year was observed to have increased from 11% at T2 to 17% at T3. There was no increase in help-seeking. Longitudinally, 34% reported that they needed treatment on one or several occasions. Adjusted predictors of help-seeking were perceived level of mental health problems and a reality weakness personality trait. Conclusion Those who sought help had higher levels of emotional distress than those who did not. However, higher reality weakness scores predicted lower help-seeking and, therefore, may be a risk factor for avoiding necessary care.     

Artificial Tears Inhibit the Development of Experimental Immune-mediated Blepharoconjunctivitis

Purpose To investigate whether treatment with artificial tears inhibits the development of experimental immune-mediated blepharoconjunctivitis (EC).Methods Brown Norway rats were immunized with ovalbumin (OVA) or ragweed (RW) emulsified in complete Freunds adjuvant. Fourteen days after immunization, the rats were challenged with the same antigen (Ag) in eye drops. Treated rats were administered artificial tears by eye drops immediately after, 15min after, or 30min after the Ag challenge. Treatment doses of 2, 4, or 8 drops per eye were evaluated. Twenty-four hours after the Ag challenge, the rats were killed and their eyes were harvested for histological studies.Results Treatment with artificial tears immediately after and 15min after challenge with partially insoluble RW Ag suppressed infiltration of inflammatory cells into the conjunctiva. Inhibition was not observed at any time following challenge with OVA Ag, which is a soluble protein. The treatment dose of artificial tears administered did not affect the extent of inhibition of EC following challenge with either Ag.Conclusions Treatment with artificial tears by eye drops inhibited the development of EC induced by the partially insoluble RW Ag when administered within 15min of the Ag challenge. Jpn J Ophthalmol 2004;48:530–534 © Japanese Ophthalmological Society 2004     

Prevalence of nosocomial infections and use of antibiotics in long-term care facilities in Norway, 2002 and 2003

There were 42900 institution-beds in long-term care facilities for elderly persons in Norway in 2000. This is twice as many as in 1984. Of those living in an elderly people's care institution 77% were above 80 years. To determine the magnitude and distribution of nosocomial infections in such institutions, the Norwegian Institute of Public Health initiated a surveillance system. The system is based on two annual one-day prevalence surveys recording the four most common nosocomial infections: urinary tract infections, lower respiratory tract infections, surgical-site infections and skin infections, as well as antibiotic use. All long-term care facilities were invited to participate in the four surveys in 2002 and 2003. The total prevalence of the four recorded nosocomial infections varied between 6.6 and 7.3% in the four surveys. Nosocomial infections occurred most frequently in the urinary tract (50%), followed by infections of the skin (25%), of the lower respiratory tract (19%) and of surgical sites (5%). The prevalence of nosocomial infections was highest in rehabilitation and short-term wards, whereas the lowest prevalence was found in special units for persons with dementia. In all the surveys the prevalence of the four recorded nosocomial infections was higher than the prevalence of patients receiving antibiotics. The frequency of nosocomial infections in such facilities highlights the need for nosocomial infection surveillance in this population and a need to implement infection control measures, such as infection control programmes including surveillance of nosocomial infections.     

Social transfers and the health status of mothers in Norway and Canada

The unconditional health status of lone mothers is worse than that of married mothers in Canada but not in Norway. Even controlling for demographic characteristics and health behaviours in Canada, the health status of lone mothers is worse. Only after we control for income does the differential in health status between married and lone mothers in Canada disappear. An important difference between the countries is that lone mothers are much less likely to be poor in Norway because they receive more generous social transfers. A simulation which involves 'giving Canadian mothers Norwegian transfers,' illustrates the possibility of significant gains in socioeconomic status and health of poor mothers in Canada.     

Women's death in Scandinavia — what makes Denmark different?

OBJECTIVE: To compare the mortality for women in Sweden, Norway and Denmark in order to search for clues for the low life expectancy of Danish women. METHODS: Prospective age-period-cohort study covering 40 years for all Swedish, Norwegian and Danish women aged 40-84 during the period 1960-2000, and born 1900-1950. OUTCOME MEASURES: Relative risks and 95% confidence intervals for deaths. RESULTS: The high risk of dying among Danish women was associated with being born between the two World Wars, and that a similar pattern was not found for women in Norway and Sweden. A tendency of a cohort effect was observed for Swedish women born around 1940. CONCLUSIONS: The currently low life expectancy of Danish women compared with that of women in Norway and Sweden is partly a transitional phenomenon caused by excessive death rates for women born between the two World Wars. Data on smoking prevalence by birth cohort and age indicate that a high percentage of Danish women in these cohorts were smokers throughout their adult life.     

Atopy in Norwegian and Russian adults: a population-based study from the common border area

Background: Several studies have concluded that atopy is more common in Western than in Eastern Europe. We aimed to study whether a similar difference exists between Norwegian and Russian adults living in geographically adjacent areas. Methods: A cross‐sectional population‐based study was performed in Sør‐ Varanger municipality (Norway) and in the cities of Nikel and Zapolyarny (Russia). The Russian cities are heavily polluted by sulfur dioxide from local nickel industry. In addition to questionnaire information, results on IgE sensitization (S‐Phadiatop, Pharmacia & Upjohn, Uppsala, Sweden) were obtained from 3134 Norwegian and 709 Russian participants. Results: A positive Phadiatop was found in 20.7% of the Norwegians (men 21.9%, women 19.7%) and in 27.5% of the Russians (men 35.7%, women 23.0%); the sex‐ and age‐adjusted relative risk of testing positive in Russia being 1.49 (95% CI 1.23–1.81). The Norwegian participants reported more atopic dermatitis and hay fever, although this difference was statistically significant only for atopic dermatitis in women. Conclusion: IgE sensitization was more common in Russia than in Norway, unlike findings from other east–west European studies. The Russians did not, however, report more atopic diseases. This discrepancy might reflect different awareness of allergies in the two countries and demonstrates the need for objective markers of atopy when comparing prevalence in different populations.     

Brown tumor of the thyroid cartilage: CT findings

Brown tumor of the larynx is extremely rare. We describe a patient with long-standing primary hyperparathyroidism and severe skeletal involvement associated with brown tumors of the axial and appendicular skeleton and of the thyroid cartilage. Ossification of the laryngeal skeleton may explain the presence of this process in this unusual location.