Skjelstad D.V.,Buskerud Hospital |
Malt U.F.,University of Oslo |
Holte A.,Norwegian Institute of Public Health |
Holte A.,University of Oslo
Journal of Affective Disorders | Year: 2010
Background: Systematic studies addressing symptoms, signs and temporal aspects of initial bipolar prodrome are reviewed to identify potential clinical targets for early intervention. Methods: The databases PsycINFO, PubMed, EMBASE and British Nursing Index were searched for original studies. Results: Eight studies were identified. Irritability and aggressiveness, sleep disturbances, depression and mania symptoms/signs, hyperactivity, anxiety, and mood swings are clusters representing common symptoms and signs of the distal prodrome of bipolar disorder (BD). As time to full BD onset decreases, symptoms of mania and depression seem to increase gradually in strength and prevalence. The specificity of prodromal symptoms and signs appears to be low. Not every person who develops BD experiences a prolonged initial prodrome to the full illness. Current data on the mean duration of the prodrome are contradictory, ranging from 1.8 to 7.3 years. No qualitative studies were found. Limitations: Because of the scarcity of data, studies that did not explicitly investigate bipolar prodrome were included when thematically relevant. The selected studies are methodologically diverse and the validity of some findings is questionable. Findings must be interpreted cautiously. Conclusions: The initial prodrome of BD is characterized by dysregulation of mood and energy. Because of the apparently low specificity of prodromal symptoms and signs of BD, it is currently neither possible nor advisable to predict the development of BD based solely on early phenomenology. More well-designed in-depth studies, including qualitative ones, are needed to characterize the initial bipolar prodrome. © 2009 Elsevier B.V. All rights reserved.
Gunnarsson R.,University of Oslo |
Molberg O.,University of Oslo |
Gilboe I.-M.,University of Oslo |
Gran J.T.,University of Oslo |
And 12 more authors.
Annals of the Rheumatic Diseases | Year: 2011
Objectives Mixed connective tissue disease (MCTD) is an immune-mediated, systemic disorder of unknown aetiology. As the epidemiology of the disease is largely unknown, the authors performed a nationwide crosssectional retrospective study to assess the prevalence and incidence of MCTD in Norway. Methods Every adult patient (≥18 years) with MCTD seen at one of the departments of rheumatology was reviewed for inclusion. Only patients who satisfied the following four criteria were included: clinical diagnosis of MCTD verified by a rheumatologist; positive serum anti-ribonucleoprotein antibody test; fulfilment of at least one of three of following criteria sets: the modified Sharp's criteria, the criteria of Alarcón-Segovia and Villareal and those of Kasukawa; and exclusion of other connective tissue diseases. Results The four inclusion criteria were fulfilled by 147 adult Caucasian patients. The female to male ratio was 3.3 and the mean age at diagnosis of adult-onset MCTD was 37.9 years (95% CI 35.3 to 40.4 years). At the end of 2008, the point prevalence of living adult MCTD patients in Norway was 3.8 (95% CI 3.2 to 4.4) per 100 000 adults. The incidence of adult-onset MCTD in Norway during the period from 1996 to 2005 was 2.1 (95% CI 1.7 to 2.5) per million per year. Conclusions MCTD has a female predominance and the incidence and prevalence of MCTD is low, and lower than reported figures for polymyositis, dermatomyositis, systemic sclerosis and systemic lupus erythematosus. The prevalence estimates were similar across the three criteria sets of MCTD.
Stray-Pedersen A.,University of Oslo |
Omland S.,University of Oslo |
Nedregaard B.,University of Oslo |
Klevberg S.,Buskerud Hospital |
Rognum T.O.,University of Oslo
Forensic Science, Medicine, and Pathology | Year: 2011
An 11-month-old girl presented to hospital with a massive subdural haematoma and bilateral retinal haemorrhages following an allegedly minor fall. There were no external signs of bruising and no prior bleeding tendency was reported. Although initial analyses were normal, repeated testing of the coagulation-fibrinolysis system led to a diagnosis of mild von Willebrand disease (vWD) Type 1. It was concluded that minor head trauma as described by the parents, in the presence of such a coagulation disorder, could explain the findings. Police charges against the parents, initially accused of child abuse, were withdrawn. Retinal haemorrhages in infants with vWD have not been previously reported. This case highlights the importance of considering vWD as a possible contributory factor in cases of infant head injury. © 2010 Springer Science+Business Media, LLC.
Gunnarsson R.,University of Oslo |
Aalokken T.M.,University of Oslo |
Molberg O.,University of Oslo |
Lund M.B.,University of Oslo |
And 14 more authors.
Annals of the Rheumatic Diseases | Year: 2012
Background: Mixed connective tissue disease (MCTD) is an immune-mediated, systemic disorder of unknown cause. Objective: To assess the prevalence, pattern and severity of interstitial lung disease (ILD) in a crosssectional study of the nationwide, Norwegian MCTD cohort. Methods: 126 patients with MCTD were systematically examined for ILD by high-resolution CT (HRCT), pulmonary function tests (PFT), 6 min walk test (6MWT) and by the New York Heart Association (NYHA) functional classification of dyspnoea. The extent and type of HRCT lung abnormalities were scored according to the CT criteria of ILD recommended by the Fleischner Society. Results: All 126 patients were Caucasian, 75% women. At the time of the cross-sectional ILD study, the patients had a mean disease duration of 9.0 years. 52% of the patients had abnormal HRCT findings, most commonly reticular patterns consistent with lung fibrosis (35%). Lung fibrosis was quantified as minor in 7%, moderate in 9% and severe in 19% of the patients. Fibrosis was uniformly concentrated in the lower parts of the lungs and was not associated with smoking. Patients with severe lung fibrosis had lower PFT values, shorter 6MWT and a higher mean NYHA functional class. After a mean 4.2 years' follow-up, overall mortality was 7.9%. Mortality in patients with normal HRCT was 3.3%, as compared with 20.8% in patients with severe lung fibrosis (p<0.01). Conclusions: Severe lung fibrosis is common in MCTD, has an impact on pulmonary function and overall physical capacity and is associated with increased mortality.
Groven S.,University of Oslo |
Groven S.,Buskerud Hospital |
Eken T.,University of Oslo |
Skaga N.O.,University of Oslo |
And 3 more authors.
Journal of Trauma - Injury, Infection and Critical Care | Year: 2011
Background: Few studies have evaluated intrainstitutional improvement of trauma care. We hypothesized that the formalization of a dedicated multidisciplinary trauma service in a major Scandinavian trauma center in 2005 would result in improved outcome. Methods: Institutional trauma registry data for 7,243 consecutive patients from the years 2002-2008 were retrospectively evaluated using variable life-adjusted display (VLAD) as one of several performance indicators. VLAD is a refinement of the cumulative sum method that adjusts death and survival by each patient's risk status (probability of survival) and provides a graphical display of performance over time. Probability of survival was calculated according to Trauma and Injury Severity Score (TRISS) methodology with National Trauma Data Bank 2005 coefficients. Results: VLAD demonstrated a sharp increase in cumulative survival starting at the beginning of 2005 and continuing linearly throughout the study period, amounting to 68 additional saved lives. The increase was mainly caused by improved survival among the critically injured (injury severity score 25-75). A cutoff point t0 for analysis of differences between time periods was set at January 1, 2005, coinciding with the formalization of a dedicated trauma service. Mortality in the whole trauma population showed a 33% decrease after t0. W-statistics confirmed the increased survival to be significant. There were no significant changes in age, gender, or injury mechanism. Injury severity score decreased, but differences in case mix were adjusted for in the survival prediction model. Conclusion: We have shown that the start of the long-lasting performance improvement coincided with formalization of a dedicated trauma service, providing increased multidisciplinary focus on all aspects of trauma care. Copyright © 2011 by Lippincott Williams &Wilkins.
Figved W.,University of Oslo |
Figved W.,Baerum Hospital |
Dahl J.,University of Oslo |
Snorrason F.,University of Oslo |
And 5 more authors.
Osteoarthritis and Cartilage | Year: 2012
Objective: Cartilage wear is a feature of osteoarthritis and rheumatoid arthritis. Precise measurements of wear have been difficult. Cartilage wear caused by an artificial articulating joint surface is a well-known feature of hemiarthroplasties. The aim of this study was to demonstrate that radiostereometric analysis (RSA) may be used for three-dimensional measurements of cartilage wear in hemiarthroplasties of the hip. Method: We performed a phantom model study to assess the feasibility of a subsequent clinical trial. We showed that the motion of the prosthetic head relative to the pelvis was not influenced by the orientation of the prosthetic head. Twenty-two patients were randomised to treatment with a cemented or an uncemented hemiarthroplasty for an acute femoral neck fracture. Migration of the prosthetic head into the acetabulum was measured using RSA. Results: A mean migration of the prosthetic head into the acetabulum of 0.62mm was found at 3months [95% confidence interval (CI): 0.27-0.97] and a further migration of-0.07mm at 12months (95% CI:-0.16-0.32). There were no differences between the groups in prosthetic migration or functional outcome. Between threeand 12months, there was no detectable cartilage wear during the first postoperative year. Conclusion: Whether the migration during the first 3months represents a period of bedding in due to a harder opposite surface remains to be shown. RSA may be used for measurement of cartilage wear in hemiarthroplasties of the hip. This study demonstrates a highly precise method for measurements of cartilage wear. © 2011 Osteoarthritis Research Society International.
Strom E.H.,University of Oslo |
Sund S.,Forde Central Hospital |
Reier-Nilsen M.,Buskerud Hospital |
Dorje C.,University of Oslo |
Leren T.P.,University of Oslo
Ultrastructural Pathology | Year: 2011
Familial lecithin:cholesterol acyltransferase (LCAT) deficiency is a rare metabolic disease with lipid deposition in several organs. The authors report a man with hypertension and proteinuria. Renal biopsy revealed glomerular changes, including peculiar thrombus-like deposits, consistent with LCAT deficiency. He was found to be compound heterozygous for two mutations of the LCAT gene. He received a kidney graft from his father. The authors also describe LCAT deficiency-related lesions in the explanted native kidneys and in biopsies at 2 days, 6 weeks, and 1 year after transplantation. The morphology of this disease is characteristic, and the diagnosis should be suspected from the ultrastructural findings. © 2011 Informa Healthcare USA, Inc.
Vanky E.,Norwegian University of Science and Technology |
Vanky E.,Institute for Laboratory Medicine |
Stridsklev S.,Norwegian University of Science and Technology |
Stridsklev S.,Institute for Laboratory Medicine |
And 17 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2010
Context: Metformin is widely prescribed to pregnant women with polycystic ovary syndrome (PCOS) in an attempt to reduce pregnancy complications. Metformin is not approved for this indication, and evidence for this practice is lacking. Objectives:Our objective was to test the hypothesis that metformin, from first trimester to delivery, reduces pregnancy complications in women with PCOS. Design and Setting: We conducted a randomized, placebo-controlled, double-blind, multicenter study at 11 secondary care centers. Participants: The participants were 257 women with PCOS, in the first trimester of pregnancy, aged 18-42 yr. Intervention: We randomly assigned 274 singleton pregnancies (in 257 women) to receive metformin or placebo, from first trimester to delivery. Main Outcome Measures: The prevalence of preeclampsia, gestational diabetes mellitus, preterm delivery, and a composite of these three outcomes is reported. Results: Preeclampsia prevalence was 7.4% in the metformin group and 3.7% in the placebo group (3.7%; 95% CI, -1.7-9.2) (P = 0.18). Preterm delivery prevalence was 3.7% in the metformin group and 8.2% in the placebo group (-4.4%; 95%, CI, -10.1-1.2) (P = 0.12). Gestational diabetes mellitus prevalence was 17.6% in the metformin group and 16.9% in the placebo group (0.8%;95% CI, -8.6 -10.2) (P = 0.87). The composite primary endpoint prevalence was 25.9 and 24.4%, respectively (1.5%; 95% CI, -8.9-11.3) (P = 0.78). Women in the metformin group gained less weight during pregnancy compared with those in the placebo group. There was no difference in fetal birth weight between the groups. Conclusions: Metformin treatment from first trimester to delivery did not reduce pregnancy complications in PCOS. Copyright © 2010 by The Endocrine Society.
Sorensen P.S.,Copenhagen University |
Lycke J.,Sahlgrenska University Hospital |
Eralinna J.-P.,Suomen Terveystalo Clinical Research |
Edland A.,Buskerud Hospital |
And 9 more authors.
The Lancet Neurology | Year: 2011
Treatment of relapsing-remitting multiple sclerosis with interferon beta is only partly effective. We aimed to establish whether add-on of simvastatin, a statin with anti-inflammatory properties, improves this efficacy. Methods: We enrolled treatment-naive patients with relapsing-remitting multiple sclerosis in a multicentre, placebo-controlled, double-blind, randomised, parallel-group trial of simvastatin (80 mg daily) as add-on treatment to intramuscular interferon beta-1a (30 μg weekly). After starting treatment with interferon beta, patients were randomly assigned (in computer-generated blocks of four patients) to simvastatin 80 mg per day or placebo for 1-3 years. Patients and treating and evaluating physicians were masked to treatment allocation. The primary outcome measure was annual rate of documented relapses; analysis was by intention to treat. This trial is registered at ClinicalTrials.gov, NCT00492765. Findings: We randomly assigned 307 patients to interferon beta plus simvastatin (n=151) or plus placebo (n=156). Annual rate of documented relapses was 0·19 (95% CI 0·13 to 0·28) in the simvastatin group and 0·14 (95% CI 0·09 to 0·23) in the placebo group (absolute difference 0·059, 95% CI -0·21 to 0·09; p=0·35). Time to first documented relapse (20th percentile) was 18·1 months in patients on simvastatin and 21·5 months in those on placebo (hazard ratio 1·21, 95% CI 0·74 to 1·99; p=0·51). Mean number of new or enlarging T2 lesions was 2·96 in the simvastatin group and 2·52 in the placebo group (ratio of new lesions, 1·17, 95% CI 8·89 to 1·55; p=0·25). Eight (6%) patients on simvastatin and 17 (13%) on placebo had no disease activity (odds ratio 0·42, 95% CI 0·17 to 1·00; p=0·05). No unexpected adverse events were seen. Generally, adverse events were mild and there were no group differences in infections or musculoskeletal disorders, including myalgia (five [3%] patients on simvastatin and nine [6%] on placebo). Rhabdomyolysis and myoglobinuria were not reported and there were no differences in serum creatine phosphokinase. Interpretation: We found no beneficial effect of simvastatin as add-on therapy to interferon beta-1a. Although unlikely, we can not exclude that combination of other statins with other disease-modifying drugs still could be beneficial. Funding: Biogen Idec. © 2011 Elsevier Ltd.