A Group-Based Training Programme for General Practitioners: A Norwegian Experience

Westin S, stensen A I, Lvslett K, Prytz J, Telje J, TelstadW and Lie A. A group-based training programme for general practitioners:a Norwegian experience. Family Practice 1988; 5: 244–252. There are approximately 3000 general practitioners in Norway,serving a population of slightly above four million people.A three year postgraduate education scheme for general practitionershas been in effect since 1973, to be replaced by a five yearvocational training programme from January 1985, making generalpractice a fully recognized specialty from that date. The educationalrequirements consist of one year of hospital training, fouryears of training in general practice, and a total of 400 hoursof course education, mainly in clinical subjects. The core elementof the training is attendance at a group-based structured educationalprogramme of two years' duration. This article describes theconcepts and content of this decentralized group-based education,as well as some of the conflicting considerations which eventuallyled to this new Norwegian model of general practice training.The first evaluation studies indicate that the educational programmehas met a long standing need among general practitioners.     

Estrogen receptor β– an independent prognostic marker in estrogen receptor α and progesterone receptor‐positive breast cancer?

Both subtypes of estrogen receptor (ER), ERα and ERβ, are normally present in the mammary gland. The role of ERα as a prognostic marker in breast cancer is well established due to the beneficial effect of providing tamoxifen as adjuvant therapy. The role of ERβ, however, is less clear. To gain insight into the importance of ERβ in breast cancer, 145 primary breast cancers were examined by immunohistochemistry for ERβ, and the expression level was compared with ERα and progesterone receptor (PR) status. Especially, we wanted to examine the significance of ERβ in the contrasting ERα+/PR+ and ERα?/PR? subgroups. In the ERα+/PR+ subgroup (dual positive), the survival difference between patients with low, medium and high ER β level was statistically significant (p = 0.004), with more than 70% of patients with medium and high ERβ levels surviving 100 months, compared with less than 30% in the group with low ERβ level. Further, for ERα+/PR+ patients there was a reduced risk of fatal outcome by multivariate analysis with increasing ERβ levels (p(trend) < 0.01 [univariate analysis]; p(trend) = 0.05 [multivariate analysis]). The risk was 31% and 27% for medium and high ERβ levels, respectively, compared with low ERβ level, adjusting for standard prognostic factors such as tumor diameter, nuclear tumor grade (quantified by mean nuclear area), lymph node status, and patient age at operation. For patients with ERα?/PR? tumors (dual negative), however, there was no association between ERβ levels and patient outcome. Our findings indicate that ERβ expression provides independent prognostic information for breast cancers with ERα/PR‐positive status, a feature typical among screen‐detected breast cancers. The role of ERβ needs to be further evaluated especially in this group of breast cancers.     

Randomized response estimates for the purchase of smuggled liquor in Norway

The randomized response technique is applied on a voluntary basis for estimating the purchase of smuggled liquor in Norway. Of a total sample of 2330 respondents, aged 15 and over, about one half chose the protective option of the RR-technique. The other half responded directly to the supposed sensitive questions. The estimates from the two groups were weighted together to give population estimates for the percentage of buyers, and the quantities bought, of smuggled liquor. The resulting estimates were found to be considerably higher than estimates from a contemporary survey based on direct response only.     

In vitro study of the giant tubule collagen formation in bovine dentin by [3H]- proline incorporation

Abstract – Unerupted permanent bovine incisors studied by routine autoradiography using radioactive proline incorporation revealed collagen formation within the giant tubules situated in the incisal dentin. A high [³H]-proline labeling was seen within the pulpal vascularized portion of the giant tubules, as well as in association with groups of cells immediately incisal to the blood vessel loops. The incisal portion of the giant tubules showed no or insignificant [³H] -proline labeling.     

Glycolate Causes the Acidosis in Ethylene Glycol Poisoning and is Effectively Removed by Hemodialysis

Abstract Six male patients with severe ethylene glycol poisoning were studied with respect to the origin of the metabolic acidosis. The plasma concentrations of ethylene glycol were 4–41 mmol/l and treatment included alkali, ethanol and hemodialysis. Plasma analysis by isotachophoresis and whole blood lactate determinations showed that glycolate (17.0–29.3 mmol/l), lactate (1.4–6.2 mmol/l) and β-hydroxybutyrate (≤1.8 mmol/l) were present in elevated concentrations contributing to the acidosis. Oxalate (≤0.33 mmol/l), glyoxylate (<0.2 mmol/l) and formate (<0.4 mmol/l) concentrations were negligible and did not contribute to any significant degree to the acidosis. The elevated plasma glycolate concentration was highly correlated to the anion gap (r=0.923) and the glycolate made up for 96.1% (n=6, range 84.7–108.8) of the increased anion gap. We conclude that glycolate accumulation is the main reason for the metabolic acidosis in ethylene glycol poisoning. The mean dialysator (1.6 m²) clearances of glycolate at a blood flow of 200 ml/min in two patients were 137 ml/min (n=9, SD±8, range 125–149) and 144 ml/min (n=11, SD±8, range 133–158). By applying first order kinetics during hemodialysis a volume of distribution of glycolate of 0.55 l/kg was found, assuming that the dialysator clearance equals the total body clearance of glycolate. Thus glycolate, the probable main metabolite of ethylene glycol, is efficiently removed by hemodialysis.     

Power and Temperature Guided Radiofrequency Catheter Ablation of the Right Atrium in Pigs

The aim of the present study was twofold: to assess the safety of ablating the atrial free wall using RF current; and to assess the effect of a single dose of intravenous beparin foUowed by aspirin once daily to prevent tbrombas formation after RF ablation. Temperature and power guided catheter ablation were evaluated. Twenty pigs were randomized to power or temperature guided unipolar RF catheter ablation. Ten animals received a bolus of beparin (150 U/kg) followed by 150-mg aspirin daily. and ten served as controls. A mid-sternal tboracotomy was performed 5–7 days later. the ability of a lesion to resist an increased transmural atrial pressure was examined by inflating a cuff around the palmonal artery. Transmurai lesions were found in all animals. Rigbt atrial pressure was increased from 5 to 30 mmHg witb no sign of perforation. In 11 of 20 (55%) animals, 1–3 lesions were foand in the lungs (diameter 4–18 mm). the localization of these lesions corresponded to the lesions in the atria. there were no differences in the energy delivery modes witb regard to the number of animals witb lung lesions. Lesions witb thrombus formation were found in four animals in the heparin/aspirin group and in nine animals in the control group. The incidence of thrombi was significantly smaller in the treatment group. there were no differences between temperature and power guided catheter ablation witb regard to the size of the atrial lesions or to the incidence of tbrombus formation. Transmural lesions induced in the rigbt atrium by RF energy are resistant to increases in transmural pressure. However, lung tissue overlying the ablated target may be injured by the RF energy delivered. The combination of a single dose intravenous beparin followed by aspirin daily may reduce the incidence of tbrombus formation.     

The prevalence, location, and size of enamel pearls on human molars

abstract — Of 8,854 extracted molars in Norwegians, 201 teeth contained a total of 219 macroscopically detectable enamel pearls. The uncertainty in tooth determination had a limited effect upon the prevalence figures. Maxillary molars showed a higher prevalence than mandibular molars. The highest prevalence, 4.6%, was found on maxillary third molars. With few exceptions, the pearls were located in the bifurcation area or in the furrow between incompletely separated roots. The mean pearl diameter was 0.96 mm, and the mean distance to the cemento-enamel junction 2.8 mm. The relationship between enamel pearls and cervical enamel projections is discussed. It is suggested that simple enamel pearls and cervical enamel projections are of a similar nature and origin. The enamel of composite enamel pearls is probably initiated in a different way.     

Identification of cellulose fibers in oral biopsies

Abstract – Oral biopsies comprising five periapical cysts, three cases of exuberant granulation tissue in extraction sockets and one case of a mandibular radiopaque structure, all displaying material consistent with cellulose fibers on routine histologic examination, were subjected to histochemical, polarization, fluorescence and scanning electron microscopical, energy dispersive X-ray and chemical investigations. Routine screening of periapical lesions with polarization microscopy and identification of possible cellulose fibers with Calcofluor White is advocated. Further, attention is drawn to endodontic paper point material as an etiologic factor in postendo-dontic periapical inflammatory processes.     

Circumferential continuity of perikymata in human dental enamel investigated by scanning electron microscopy

Abstract – Theoretically the perikymata may represent one of two possible configurations: closed circles or continuous spirals. In the present study one randomly selected perikyma groove in one randomly selected tooth (the mandibular first premolar of a 12-yr-old girl) was tracked around the circumference of the crown in the scanning electron microscope. It was found that the perikymata geometrically represented closed circles. The possibility of methodologic error was excluded.     

A scanning electron microscope study of the three-dimensional extent of Retzius lines in human dental enamel

A method involving carefully planned sectioning and grinding of human maxillary first premolars, allowing enamel structure to be studied with the SEM in more than one plane at the same time, was employed to demonstrate the extent of Retzius lines within the confines of the three-dimensional enamel cap. It was found that the Retzius lines behaved as could be predicted by the theory stating that the striae represent one-dimensional cuts of two-dimensional, curved growth planes. Retzius lines in adjoining planes were continuous across the edge where the two planes met. In a supernumerary tooth, the surface of its hypoplaslic tooth tip was continuous with distinct Retzius lines. The present observations provide for the first time direct morphologic verification of the supposed nature of Retzius lines, with reference to extent and continuity in three-dimensional space.