Nordisk medicin最新文献

The principles of gene therapeutic "antigen" and "antisense" drugs are briefly presented. The target of such drugs is the genetic material of the cell--either the DNA itself, or its messenger molecules, mRNA. By exploiting base-complementary principles, "antigen" and especially "antisense" drugs can easily be designed to target specific genes, the activity of which it is medically advantageous to inhibit. These could be virus- or oncogenes. In particular, the prospects of using peptide nucleic acids (PNA) as gene therapeutic drugs are discussed. PNA is a synthetic structural DNA mimic, which chemically is more closely related to peptides and proteins and which has so far shown very promising chemical and (molecular) biological properties in terms of its development into gene therapeutic drugs as well as diagnostic tools.

In a postal questionnaire investigation of experiences and attitudes concerning end-of-life decisions among Danish physicians, most of the respondents reported having made decisions involving the hastening of a patient's death, and considered this acceptable. Such decisions were more frequent, and were considered ethically more acceptable, when made with the patient's informed consent than without. Of the respondents, two per cent had participated in assisted suicide, and five per cent had administered a lethal injection at the patient's request, practices considered ethically acceptable by 37 per cent and 34 per cent, respectively, of the respondents. The most frequently cited reasons for opposing such practices were double effect principle, the active killing/allowed-death distinction, and the sanctity of life; and the most frequently cited justifications were respect for the patient's autonomy, the avoidance of unnecessary suffering, and the patient's right to a death with dignity.

Sciatica (a term used synonymously with lumbar radiculopathy) is usually caused by lumbar disc herniation or lumbar spinal stenosis. Mechanical compression of nerve roots is a predominant factor, and decompression the surgical goal. Emphasis should be placed on clinical identification of the nerve roots causing the complaint. Although computed tomography (CT) and magnetic resonance imaging (MRI) are the most important diagnostic tools used today, plain x-ray may be required for correct identification of the lowest mobile segment, and the functional myelography combined with CT may be required if lumbar spinal stenosis is suspected, or if the clinical findings are unclear--especially if the patient has already undergone surgery for sciatica. The proper selection for candidates for surgery seems to be a more important determinant of successful outcome than whether macro- or micro-surgery is used, or whether one or more segments are operated upon (12, 13). Clear clinical identification of the roots affected and corresponding pathological findings at imaging are the best predictors of successful surgical outcome, an additional factor of positive predictive value being psychosocial stability. Impaired fibrinolysis, occurring in smokers and in the sedentary and obese, may be a negative predictive factor (10, 11). Published findings suggest that, unlike the case with disc surgery (9), neither long duration of symptoms nor long preoperative sick leave is associated with poor outcome of surgery for spinal stenosis (14).

Recent experimental studies performed at the Dept of Orthopaedics at Gothenburg University have systematically assessed the basic pathophysiological mechanisms behind sciatica due to disc herniation. It has hereby been seen that the epidural presence of nucleus pulposus may induce structural and functional injury of the adjacent nerve roots similar in magnitude to those induced by mechanical deformation. By increasing the knowledge of the substances and mechanisms leading to this nucleus pulposus-induced nerve injury it may be assumed that sciatica to a certain extent may be treated by specific pharmacologic agents in the future, in combination with existing treatment modalities.

The appearance of various consensus reports, guidelines, Cochrane Centers, and other evidence-based medicine initiatives during the past decade has resulted in marked improvement in the rational utilisation of available knowledge of attitudes toward the issue of low back pain (LBP). Moreover, owing to the ready access to updated data bases, this knowledge has been disseminated with incredible speed. In the spring of 1995, the Danish National Board of Health in Denmark convinced a multidisciplinary team of back specialists to tailor data available in the international reports for Danish needs. The article outlines the findings of this team, the major recommendations being that providing information is preferable to treatment, that patients should be encouraged to remain active, that physical exercise should be kept up except during the acute phases, that most episodes of LBP are to be considered life events rather than automatic reasons to seek treatment, and that passive treatment should be minimised, though manipulation may be helpful in the short term.

In arctic Norway, where there is a lack of specialists in pulmonary medicine two postgraduate students, already qualified as specialists in internal medicine at Tromsø Regional Hospital, applied to continue their training at their respective local hospitals. The regional hospital in Tromsø has a long tradition of telemedicine, with network links to local hospitals in the region, and is equipped for interactive consultation and the bilateral transmission of x-rays and video recordings, and digital transmission of x-rays. Accordingly, supported by their supervisor, the two postgraduate students applied to the committee for postgraduate education in pulmonary medicine to have a year's work at their respective local hospitals, supervised via the telemedicine facilities, accepted as equivalent to a six-month module of the normal syllabus. The project was approved and executed as planned. The registrars, who were responsible for pulmonary service at their local hospitals, served four days a month at the regional hospital, and their supervisor visited the local hospitals one day each month. All internal education at the regional hospital was made available by means of a weekly interactive televised link-up, x-rays being displayed on screen as transmitted digitally; bronchoscopies were shown by video, and ad hoc tutorials arranged as needed. Evaluated by the national committee, the project was found satisfactory, and the registrars were duly qualified.

Positron emission tomography (PET) allows the in vivo recording of tracer compounds with respect to anatomical distribution, time course and absolute concentration. These features has proven of great value in drug development, especially in the phase of early clinical trials. PET can be used to assess the tissue kinetics of a new drug, or to evaluate a drugs interaction with a target system and thereby aid in decisions regarding dosing regimes.

Among adult Finns salt intake is about twice as high as the recommended levels and almost five-fold greater than the physiological requirement. Information as to salt intake in children has hitherto been sparse. Daily sodium intake among 1-5-year-olds was investigated in this study, and the foodstuffs from which it was derived were identified. In all age groups, sodium intake was at least two-fold greater than the Nordic recommendations, and among five-year-olds it exceeded the recommended intake for adults. Approximately half of the sodium intake was found to have derived from salt used in cooking. Levels of sodium derived by children from dairy, meat and grain products were also relatively high. Sodium intake in children after infancy merits greater attention than previously accorded it, as permanent eating habits and taste preferences are already formed at this age, and reasonable limits for salt intake should therefore be established during childhood.