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Sandviknes_ Kenneth

VIEWS: 246 PAGES: 114

									Book of Abstracts


  Student theses

       Class 97


         2003




 The University of Bergen
   Faculty of Medicine
Preface

The Student Thesis

A full 6 (or 6 ½) years medical curriculum at The University of Bergen includes the thesis
work. At the end of the 5th year, 4 weeks are exclusively reserved for this purpose. Apart
from this period, the thesis work must be done parallel to the full-time study. The thesis must
be completed and accepted within the last but one semester.

The students must start to prepare their research work early. They are encouraged to develop
ideas for their own research from the very start, and in addition they can choose subjects from
a catalogue on the intranet. At the end of the 3rd year, they must have decided a subject and
made contact with a supervisor. They must hand in a project review which has to be
approved by the Committee of Theses (appointed by The Faculty of Medicine).
Most students do their research work within the university area, but they may also do this
outside the Bergen area. Some students even go to distant locations like Africa and South-
America and do their fieldwork there in their elective period. A condition is nevertheless that
one of our faculty academic must take responsibility as a local mentor in addition to any
supervisor at their chosen study site.

The aim of the project work is for the students to achieve competence in all aspects of medical
research conduct, including ethical and legal considerations, literature search strategies,
definition and hypothesis formulation, choice of methods, data collection and analysis, and
interpretation and dissemination of results.

The objectives of the student thesis are training in critical thinking, scientific methods and
search for information, and the research subjects must be relevant for medical theory or
practice in a wide sense. The student thesis may, thus, build on scientific literature, existing
(patient) data, or own original observations within the area of medicine.
One of the aims is to further written communication skills. It is therefore recommended that
the format, extent and level of the thesis must comply with the requirements of a scientific
journal paper in the field of their chosen subject or method. Each thesis may have one, two or
at most three student authors.

This Book of Abstracts presents the English summaries of all the student theses of class 97.
These demonstrate the wide aspects of subjects, and the academic ability of our students. For
most of the students this is their first publication, and it hopefully will encourage further
research activity, including those choosing a clinical career.

Every year, five theses from students at the beginning of the 6th year are selected to be
presented to fellow students and staff. There is a reward of NOK 2000 for each thesis
presented.



Head of Committee
Are Næss
Professor
Cancer mammae 1990 – et årsmateriale

Abelseth, Bente Kristin
Haugland, Birte Toft


Supervisors: Jan Erik Varhaug, professor/seksjonsoverlege og Turid Aas, overlege
Insitutt for kirurgiske fag, UiB/Endokrinkirurgisk seksjon, Haukeland Universitetssykehus



Background: In 1996 four Norwegian counties, including Hordaland County, started a
program with breast cancer screening mammography for all women aged 50-69 years. In this
analysis we look at a group of patients from 1990. We have done this partly because it has its
own interest to describe the situation at that time, and partly to obtain a material to be
compared with a similar one from year 2000. In that way we will see how the breast cancer
picture may have changed after screening mammography was introduced.
Methods: We analyzed the surgical medical files of those women who were admitted to the
Endocrine Surgical Department at Haukeland University hospital in the period from 01.01.90
till 31.12.90, under the diagnosis breast cancer. We have excluded those women who did not
have a newly diagnosed breast cancer at that time. All together, 82 patients were included in
our material.
Results: We have analyzed how breast cancer was discovered, which diagnostic methods
were used, and which treatment was given. We have also looked at the histopathology of the
tumor, the complications the women suffered, and the follow up. One of the interesting
discoveries we made was that 20 % of the tumors were found in women who did not have any
symptom of breast cancer disease, and that 4,9 % had in situ carcinoma.
Discussion: We have analyzed a relatively small number of patients, and it is difficult to draw
any firm conclusions. The majority of tumors (80 %) were clinically detectable at the time of
diagnosis. Twenty one % of the cancers were TNM-stage 3 or 4. The question is whether the
screening program that was introduced five years after our material, have improved this
picture. We will be able to tell when the results from year 2000 are analyzed. Numbers from
the first screening round in Hordaland county, show that a larger number of women were
diagnosed with cancer in stage 1 (81 % vs. 60 % for comparable age groups.) The most
important factor for improving survival from breast cancer, is to diagnose the tumor at an
earlier stage.
Kardiovaskulær sykdom hos pasienter med diabetes. Årsaker, forebygging og
behandling.

Aksdal, Hilde


Supervisor: Sylvi Aanderud, professor/overlege
Seksjon for endokrinologi, Institutt for indremedisin, UiB



2 –3 % of the population of Norway have diabetes mellitus (DM). Type 2 DM outnumbers
type 1 four times. Numerous of patients don’t even know they have the disease. Worldwide
there are probably 100 million people with DM, and the number is likely to reach 215
millions in 2010.

The reasons for this enormous increase in incidens are more elderly people and an unhealthy
lifestyle where consume of calories is larger than consumption.
Coronary heart disease (CHD) is the most important cause of death in this group of patients..
Men and women with DM have respectively 2-3 and 3-6 times higher risk of CHD. The
background for this phenomenon is familiar modifiable risk factors like dyslipidemia, insulin
resistens syndrome (IRS), hypertension, smoking and hyperglycemia.
It is important to consider the possibility of good primary and secondary intervention. Factors
like diet, physical activity and smoking should be attacked first. The doctors must believe that
intervention of lifestyle is important, and follow up.
If this type of prevention and treatment doesn’t give desirable effect, one should consider the
need of medical treatment.

Treatment of dyslipidemia can be either indirect or direct. The former is by improved control
over hyperglycemia, the latter by lipid reducing agents. Statins are no prescribed more often.
There is still a potential for higher start doses. Better follow up could uncover the need for
even higher doses. There are several strategies for treatment, according to type of
dyslipidemia.
In the treatment of hypertension traditional antihypertensiva like beta blockers or tiazids can
be used. ACE inhibitors are recommended, though, since these probably have other
cardiovascular protective qualities in addition.

So far, we have no studies proving significant reduction in CVD by treatment of
hyperglycemia. Through Metformin treatment, and the favourable effect on adipositas, one
might expect a reduced risk of CVD.
The new glitazons, the so called “insulin sensitizers” are participating in long-term studies
with cardiovascular endpoints.
Prevention and treatment should include much more than controlling B-glucose. Patients with
DM need a highly comprehensive treatment.
Early intrahospital defibrillation

Alnes, Eirik Buanes


Supervisor: Ivar Austlid, universitetslektor/overlege
Medisinsk ferdighetssenter, UiB/Akuttmedisinsk seksjon, Haukeland Universitetssykehus



Introduction: According to international guidelines, intrahospital patients experiencing cardiac arrest
should be defibrillated within 3 minutes. At Haukeland University Hospital in Bergen, Norway, the
time from cardiac arrest to defibrillation varied from 0 - 16 minutes, with a median time of 5 minutes.
If time to defibrillation is reduced to 3 minutes, survival from cardiac arrest is likely to double.
General wards at Haukeland University Hospital are equipped with manual defibrillators that require
rhythm recognition skills. In Las Vegas, USA, simple semiautomatic defibrillators have been
distributed in casinos. This has reduced the time from cardiac arrest to defibrillation from 10.7 to 4.4
minutes and increased the survival to hospital discharge from 29% to 53%. In this study we aim to
determine whether intrahospital distribution of semiautomatic defibrillators will reduce the time from
cardiac arrest to defibrillation in general wards.

Method: Two general wards at Haukeland University Hospital were compared. We placed a modern
semiautomatic defibrillator in one of the wards, and a modern manual defibrillator in the other ward.
Doctors and nurses in each ward received only written information describing how to resuscitate and
defibrillate a patient with cardiac arrest. One week after the information was handed out we performed
a series of tests by placing a resuscitation manikin in a patient bed, triggering the alarm and allowing
ward employees to resuscitate the manikin. Tests were performed at both wards in parallel and
repeated 6 months after the initial information was handed out. A total of 41 tests were completed.

Results: In our material the median time from alarm to delivery of the first shock was 2 minutes 39
seconds, a significant improvement when compared to the median time of 5 minutes prior to the
intervention. The semiautomatic defibrillator delivered the first shock within 3 minutes in 80% of the
cases whereas the manual defibrillator delivered the first shock within 3 minutes in 50% of the cases.
(p<0.05; Mann-Whitney U-test) If we combine the results of both defibrillators to examine the effect
of the training programme, we find that 1 week after handing out the written information ward
employees manage to defibrillate the manikin within 3 minutes in 70% of the cases. The same holds
true 6 months later; the first shock is delivered within three minutes in 70% of the cases.

Conclusion: It is possible to reduce the time to defibrillation in patients experiencing cardiac arrest in
general wards by placing simple, semiautomatic defibrillators within the wards. A training programme
consisting of written information on resuscitation, followed by testing of resuscitation skills within the
ward, allows skills to be maintained better than traditional training programmes. Traditional training
programmes employ most of the resources into the course itself, whereas we have utilized nearly all
our resources in the practical testing of resuscitation skills within the ward. With our programme we
have spent only half the amount of instruction-resources compared to the standard Norwegian
defibrillation-course recommended by the Norwegian Resuscitation Council. In addition, ward
personnel did not need time off for training purposes.
Hjerterate- og hudlednings responser til bilder av kjente og ukjente ansikt og
objekt hos barn med autisme

Heartrate- and skin conductance responses to pictures of familiar and
unfamiliar faces and objects in autistic children

Avdovic, Damir
Aunan, Torbjørn


Supervisor: Kjell Morten Stormark, forsker, dr. psychol.
Regionsenter for barn og unges psykiske helse, UiB



Background. The purpose of our study has been to measure facial recognition with the
physiological parameters heart rate and skin conductance rate, in children with autism. The
goal has been to see if the former reported difficulties in facial recognition are caused by
general cognitive and/or perceptual deficits.

Methods and material. 10 children with autism (mean age 6,2 years), 9 children with Down
syndrome (mean age 6,8 years), and 10 normally developed children (mean age 5,3 years)
were presented to pictures of familiar and unfamiliar faces and objects. Heart rate (HR) and
skin conductance responses (SCR) were recorded during the presentation of the pictures.

Results. The children without any developmental delay showed marked deceleration in HR to
pictures of faces compared to objects, and larger deceleration to unfamiliar versus familiar
faces. The also showed a larger increase in SCR to familiar faces compared to unfamiliar
faces. The autistic children showed no difference in HR or SCR to familiar and unfamiliar
faces, but showed a larger increase in SCR to known objects compared to unknown objects.
The children with Down syndrome did not differ in responses to faces and objects, familiar or
unfamiliar.

Interpretation. The fact that autistic children differ in their autonomic responses to familiar
and unfamiliar objects, makes it unlikely that failure to respond to faces is caused by
decreased cognitive abilities or a more generalized perceptual disturbance. It is more likely
reflecting specific problems with relating to social and emotional stimuli, like the human face.
ALS – Har riluzol effekt?

Axe, Birgit Grini
Hasselø, Cecilie


Supervisor: Johan A. Aarlie, professor dr.med./avd.overlege
Institutt for klinisk medisin, UiB/Nevrologisk avdeling, Haukeland Universitetssykehus



ALS is a fatal disease that affects both upper and lower motor neurones. It has often a rapid
progression, and in almost all cases it leads to death within a few years. The disease is
familial in 10% of the cases, and the rest are sporadic. The pathogenesis seems to be
multifactorial and may include glutamate mediated excitotoxity, free radical effects and
genetic function disturbances. A wide range of drugs have been tested in order to slow the
progression of the disease, including calcium channel blockers and immunosuppressiva. The
only effective drug so far is riluzol, a glutamat-inhibitor. In addition, important treatment
includes multidisciplinary teams helping the patients to deal with the different problems that
occur as a consequence of the pareses; dysphagia, respiratory insufficiency, dysarthria and
spasms.

This survey includes 40 patients with the diagnosis ALS (amyotrophic lateral sclerosis). 20 of
these patients were diagnosed in the period 1980-1985, and the other 20 were diagnosed in the
period 1995-2000. The patients in the last group have all been treated with riluzol, and none
in the first group. We have observed the time elapsed from symptoms appear until death (or
tracheostomia) of the patients. We found that those patients treated with riluzol have an
estimated survival time 8 months longer than those who did not receive riluxol. The survey
also includes a study of the effect of riluzol on the different types on onset of ALS, and in
addition the possible effect of early riluzol treatment.
Contusio Bulbi

Bakken, Marit S.
Farstad, Hilde


Supervisor: Gunnar Høvding, professor/overlege
Institutt for klinisk medisin, UiB/Øyeavdelingen, Haukeland Universitetssykehus



Background: Blunt bulb contusions occur frequently, especially among young people, and
are often followed by complications. Out aim was to reveal possible changes related to bulb
contusions over time, especially regarding to causal relations and extent of severity. All this
to be able to recommend eye wear protection in risk situations.

Material and methods: Case records of all patient admitted to Øyeavdleingen, Haukeland
sykshus with the diagnosis contusio bulbi in the years 1965-99 were examined. The material
contains 245 case records, 136 from the first period and 109 from the second. Ten different
parametres were compared.

Results: The amount of women with the diagnosis contusio bulbi was doubled over the
period of 30 years, but the increase was not statistically significant. This probably due to the
fact that even in the last 5 year period women represented ony 11 % of the patients with bulb
contusions. The decreased amount of children and young adults (<20 years) was highly
significant (p<0,002), there was also an increased amount of injuries amoung people between
21 and 30 years (p<0,05), and people aged 71 or older (p<0,01). The average age at the time
of injury increased by 7,6 years between the two periods in question. Eye injuries in the
months of April and May were statistically more frequent in the sixties than in the nineties
(p<0,05), while eye injuries in November and December were more frequent (p<0,01) in the
last period. The enhanced share of eye injuries caused by different sports activities was
highly significant (p<0,002), as was the decline in injuries caused by child’s play (p<0,002).
There were no statistically significant changes in the other mail groups (work, home/leisure
time, traffic, violence, illness).
Neither regarding numbers and types of findings at the time of hospitalization, nor numbers
and types of later complications there were significant changes. Seventyeight patients
(32,8%) had one or more complications. Changes in visual findins (at the time of
hospitalixation and later control examinations) were not statistically significant between the
periods 1965-69 and 1995-99, but there was a highly significant decrease in the amount of
control examinations (p<0,002).
Heriditær spastisk paraparese

Bjørdal, Stine
Åstrøm, Grethe


Supervisor: Laurence Bindoff, professor
Seksjon for nevrologi, Institutt for klinisk medisin, UiB



Objective: To study the prevalence and type of HSP among patients in Hordaland.

Design: Retrospective study.

Method: We traced all patients with HSP by searching 140 journals identified by IDC 9- and
10 hospital codes. We studied the journals by using a questionnaire. The data was then
plotted into Microsoft access and analysed.

Results/conclusion: of the 140 patients, 20 had been given the diagnosis HSP previously.
That gave the prevalence of 20/440000. Due to clinical variability and possibility that some
patients may be misdiagnosed, we included all patients that could possibly have HSP. In this
case the prevalence rose to 36/440000. The distribution between pure HSP and complicated
form of HSP was 50:50 in our study.

The results were comparable to other studies of HSP in Europe.
Preklinisk undervisning ved UiB for kull 97 – tilbakeblikk 1,5 år etter.

En studentevaluering med fokus på anatomi.

Bjørnstad, Carl Christian L.


Supervisor: Torvid Kiserud, professor
Seksjon for obstetrikk og gynekologi, Institutt for klinisk medisin, UiB



        In order to evaluate the preclinical teaching, anatomy in particular, a questionnaire was
distributed to the student class of -97 one and a half years after they had entered their clinical
studies. Out of a total of 143 students, 57 (40%) answered the questionnaire. This low
number of responses implies that the results should be interpreted with caution.

        16% of the students felt that they did not acquire the knowledge required to perform as
a clinican, while 83% felt they got this knowledge. The most requested types of education
was to incorporate more clinical examples in the lectures, emphasizing general principles
instead of details at lectures and teaching in small-sized groups using senior students.
Although four out of five students attended over 75% of the lectures, this form of learning
was the least popular. Arguments for not attending included poor quality of lectures,
preferring self-studying and other private reasons. One of three students felt that the results
they achieved at the anatomy exam did not reflect their knowledge of the subject. On the
other hand, one of ten students felt that they performed better on the exam than they had
expected.

       The qualities of a doctor that the students felt were most important were that the doctor
had a thorough knowledge of the basics, good communication and social skills. Every third
student felt that some students having failed the exam could have become adequate doctors.
However, half of the students did not know, or had no opinion, whether students failed in the
exam. Is this linked to the fact that only 12% thought empathy was important atribute of a
good doctor? Does that indicate that the curriculum has left little space for anything else than
the body as a biomechanical unit?

       Although the education provides ample room for improvement, most students felt they
had a sufficient background in anatomy to fully appreciate the clinical education.
Reduced cardiovascular reactivity to stress during acclimatization to high
altitude (4200 m)

Bjørntvedt, Trude
Lygre, Kristin B.
Skåre, Christiane


Supervisor: Morten Rostrup, overlege dr.med.
Akuttmedisinsk avdeling, Medisinsk divisjon, Ullevål universitetssykehus



In the present study we assessed the changes in cardiovascular reactivity during the early
phase of acclimatization to high altitude. It has previously been demonstrated indices of
reduced sympathetic activity and reduced cardiovascular reactivity during such
acclimatization in a laboratory study. The current study looks at similar indices in a field
context. In the present study 8 subjects were gradually exposed to hypobaric hypoxia by
stepwise ascent to 4200 m over 3 days. Heart rate (HR), blood pressure and oxygen
saturation were measured at rest, during a cold pressor test (CPT) and after 5 minutes
recovery. Data are given by mean ± SEM. At 4200 there was a significantly decreased
cardiovascular response to CPT compared to sea level. The systolic (SBP) and diastolic blood
pressure (DBP) responses decreased significantly with increasing altitude (Δ SBP 14 ± 2 % at
sea level vs. 4 ± 2 % at 4200 m and Δ DBP 30 ± 7 % at sea level vs. 7 ± 4 % at 4200 m, P ≤
0.05). There were significant increases in resting SBP, DBP and HR during the ascent (111 ±
4 mmHg at sea level vs. 123 ± 5 mmHg at 4200 m, 62 ± 2 mmHg at sea level vs. 80 ± 5
mmHg at 4200 m and 57 ± 3 beats/min at sea level vs. 72 ± 4 beats/min at 4200 m,
respectively, P ≤ 0.05). Oxygen saturation decreased with increasing altitude (98 ± 0.3 vs. 85
± 1.2 %, P ≤ 0.001). There was a partial recovery of oxygen saturation from the first to the
last day at 4200 m (88 ± 0.9 %, P ≤ 0.04).

We conclude that there is a reduction in cardiovascular reactivity during stepwise
acclimatization to high altitude.
MARK-Medisinerstudentenes Alternative RøykfriKampanje

En beskrivelse og foreløpig evaluering

Bjaanæs, Snorre


Supervisor: Per Bakke, professor
Institutt for Indremedisin, UiB



MARK is the alternative antismoking campaign of the medical students at the University
of Bergen. After being challenged by the pulmonary Department at Haukeland University
Hospital 10 medical students created an anti smoking project aimed at pupils in the
secondary schools. In 2001 the project was tried out on a pilot class of students. Two
secondary school classes are invited each time to half a day of intervention at the
Haukeland University Hospital.

6 medical students are teaching. The pupils rotate between 5 posts. The topics on the various
posts are pathology, coronary heart disease, chronic obstructive lung disease, positive and
negative arguments for smoking, and finally pregnancy.
A search on PubMed has not shown similar anti smoking campaigns. The anti smoking
projects have emphasized teaching of the pupils, but incorporating the pupils into the
hospitals for the anti smoking campaign has not been done before.

Nine hundred pupils from the 9th and 10th class level have now completed the intervention.
An evaluation based on 373 questioners completed immediately after the intervention is
positive. Only 6% of the pupils think that the intervention has no effect. Of the 373 pupils
there were 17% smokers. There were more girls than boys smoking, but smoking boys
reported higher cigarette consumption than smoking girls.
About 85% of the girls wanted to stop smoking while the corresponding figure among the
boys is 37%. All together 78% of the pupils think that this intervention will prevent somebody
in their class from taking up smoking, 37% think that the day will cause some of the smokers
in class to stop.

The pathology post is the most popular (40%), while 45% state that none of the posts were
inefficient.

Based on this immediate evaluation we have chosen to continue the project while waiting for
the 12 months evaluation regarding the effect of this intervention on smoking rates in
secondary school.
Vitamin A i helse og sykdom

Borge, Dorthe Marie


Supervisor: Bjarne Bjorvatn, professor
Senter for internasjonal helse, UiB



The term vitamin A is used for retinoids having the same biological activity as retinol.
Vitamin A is essential to health and is generally acquired by humans with a healthy diet. It
has been known for a long time that vitamin A is required to maintain a normal vision and
that vitamin A deficiency can lead to blindness. In addition, Vitamin A is necessary for the
life, growth and development of higher animal species through its effect on differentiation and
proliferation of a lot of different types of cells.

Vitamin A deficiency is a major contributor to childhood mortality and is also a contributing
factor to maternal deaths. Every year, several million children in developing countries die
before they reach schoolage, many during the first year of life. Seven out of ten of these
deaths are due to acute respiratory infections (mostly pneumonia), diarrhoea, measles,
malaria or malnutrition - or more commonly, some combination of these conditions. These
children are also at high risk of vitamin A deficiency, a factor known to contribute to most of
these causes of disease and death.

The World Health Organization estimates that 250 million preschool children worldwide are
vitamin A deficient. Out of these, about 3 million develop eye symptoms, between 250,000
and 500,000 are becoming blind.

Vitamin A deficiency can be corrected by a number of strategies, including a) improving diet
by better use of available vegetables, b) food fortification, c) agricultural efforts and
d) supplementation.

Provision of high doses vitamin A supplementation every 4-6 months not only protects
against blindness, but also has a significant impact on the general health of preschool
children, reducing the mortality and morbidity to a large degree. Although traditionally,
most studies related to vitamin A have been carried out in children, recent research indicates
that among both mothers and children with vitamin A deficiency morbidity and mortality can
be reduced significantly by vitamin A supplementation.
Det kliniske bilde ved arvelig ALS

Brattrud, Anja Otrebska


Supervisor: Johan A. Aarli, professor dr.med./avd.overlege
Institutt for klinisk medisin, UiB/Nevrologisk avdeling, Haukeland Universitetssykehus



Background: Amyotrophic lateral sclerosis is a progressive, fatal disease which affects
motor neurons in cerebral cortex, brain stem and spinal cord. The clinical features are paresis,
muscle wasting, fasciculations, spastisity and hyperreflexia. The disease has an annual
incidens of 2/100 000 and 5-10% of the cases are hereditary. The object of this study was to
study the clinical eatures in patients with hereditary ALS at Department of Neurology,
Haukeland University Hospital.

Material/methods: Journals of patients with two or more cases of ALS in the family were
reviewed retrospectively and the data were then compared to data from other larger studys.
From 6 patientjournals from 4 different families, we found a total of 23 cases in the 4
families.

Results: The average age of onset in patients with ALS in our hospital was 53.7 years. 75%
had symptoms from their extremities at presentation and 25% had bulbar symptoms. The
clinical features showed great familial heterogeneity. Our patients had an average duration of
illness of 3.1 years and a survival time of 2.0 years. The patients with bulbar symptoms at
presentation had the most sinister prognosis. The sex ration was 1.2:1 (M/F 12:10). The
inheritance pattern was autosomal domonant with high/complete penetrance.

Conclusion: Hereditary ALS has a somewhat lower age of onset compared to sporadic ALS.
The symptoms at presentation are similar to those of sporadic ALS, while the survival time is
shorter. Our data on hereditary ALS were similar to findings in other studys, exept from the
age of onset, which was higher than the age found in greater studies.
Kva kan legen gjera for å oppnå tillit og reell kommunikasjon i lege-pasient-
forholdet?

What can the doctor do to gain trust and real communication in the patient-
doctor-relationship?

Braut, Grethe Regine


Supervisor: Ole Frithjof Norheim, professor
Seksjon for allmennmedisin, Institutt for samfunnsmedisinske fag, UiB



The first part of this paper gives a review of a selection of articles published in TNLF 1996/1-
2001/17 on the subject of patient-doctor-relationship. It shows what Norwegian physisians
and others have written in regard to my leading question. To find relevant articles I used a
number of keywords to search on the website of TNLF. I excluded articles on special
diagnostic groups and patient groups.

There has been a shift in general practise towards the humanistic, patient-centered methods of
both ideologic and resultoriented reasons.

Part two provides a presentation and evaluation of two major theoretical and practical
methods of patient-doctor-communication. Both patientcentered method and narrative method
states the importance of equality in the therapeutic meeting, and gives the patient opportunity
to address issues of subjective importance.
De verbo anatomico

Brekke, Ragnvald Ljones


Supervisor: Torvid Kiserud, professor
Seksjon for obstetrikk og gynekologi, Institutt for klinisk medisin, UiB



The basis of this assignment is to create a didactic tool for medical students in the study of
anatomy. Today's students have less education in Latin and nomenclature than what they used
to have in earlier times. This combined with the fact that anatomy still uses a classical
nomenclature, makes it probably even more difficult to learn all the “foreign” words, which
one meets in this subject.

In an attempt to make it a little easier to acquire all these new words, I've developed a
“pseudoetymological” dictionary to the booklet VISCERA, which is used as guidance during
dissection.

In addition I've made a small survey of the historical development of the medical
nomenclature. I chose to do so attempting to explain why anatomy has ended up with a very
conservative and classical use of language. I also hope that this can contribute to placing the
assignment in a bigger medical linguistic context, and by that help to bring a greater
understanding of the language we use in the medical surroundings in general.
Endring i forekomst og dødelighet for ustabilt koronar syndrom i perioden
1973-2001 ved Haukeland Universitetssykehus

The change in incidence and mortality of unstable coronary syndrome in the
period 1973-2001 at Haukeland University Hospital

Butt, Noreen


Supervisor: Jan Erik Nordrehaug, professor/avd.overlege
Institutt for indremedisin, UiB/Hjerteavdelingen, Haukeland Universitetssykehus



Background: The epidemiology of cardiovascular disease has changed. The number of
patients with myocardial infarction has decreased while the number of unstable angina
patients has been increasing. The tendency has gone towards less large Q-wave infarctions
and an increase in smaller non-Q-wave myodardial infarctions. The total number of patients
with cardiovascular disease is increasing, while the overall mortality has been decreasing.
This feature can be due to the improvement in the medi al treatment. The improved treatment
strategies can explain the fall in number of myocardial infarctions and the fall in mortality.
That is the reason why we have presented the treatment strategies for unstable coronary
syndrome based on large trials.

Material and methods: All patients admitted to Haukeland University Hospital in 1973-
1998 with unstable angina and myocardial infarction were registered. In addition patients
with unstable angina in 1999-2001 were also inclulded. A total of 6684 patients were
included in the study, 3551 with myocardial infarction and 3133 with unstable angina. We
studied the median number of days in hospital, 30 days mortality and survival up to five years
for both study groups.

Results: We observed a decrease in 30 day fatality rate in both groups. There was a fall in
mortality from 44% (1973) to 22% (1997), a difference of 22% in the myocardial infarction
group. There was an improvement in the five-year survival follow up of the myocardial
infarction group in certain time periods. On the other hand the improvement in prognosis for
the unstable angina patients was more even in the whole period. The number of patients with
myocardial infarction and the number of myocardial infarctions in the hospital has been
almost constant in the period from 1973 to 1997, while the number of unstable angina patients
in the period 1973-2001 has been increasing.

Interpretation: The reasons behind the improvement in prognosis are not clear yet.
Probably it can be related to the change in lifestyle. In addition the improvement is also due
to improved modern treatment of unstable coronary syndrome. The time of improvement in
mortality corresponds to the implementation of new medical treatment strategy. It is
important to develop treatment strategy. It is important to development treatment strategies
for unstable coronary syndrome. We therefore discuss important strategies for the treatment
of unstable coronary syndrome.
Kirurgisk behandling av lungekreft ved Haukeland Sykehus 1989 – 2000

Båtevik, Roy


Supervisors: Ketil Grong, professor og Lodve Stangeland, 1.amanuensis
Institutt for kirurgiske fag, UiB



Background: Every year approximately 1840 patients are diagnosed with primary lung
carcinoma in Norway. Some of these patients with localized non-small cell lung carcinoma
are candidates for surgical resection of the tumor. The aim of this study was to evaluate
postoperative survival with relation to tumor classification.

Material and methods: A total of 255 patients with non-small cell lung carcinoma
underwent resection and pathological staging at Haukeland Hospital in the period from
30.01.1988 to 07.06.2000. 186 of these were included in this study, because tissue of their
rumors has been investigated at STAMI in Oslo for an accurate histological diagnosis. For
these patients the records have been investigated and information plotted in an Access
database. Survival rates were calculated with the Kaplan-Meier method on the basis of
overall accumulated deaths.

Results: Postoperative mortality was 1,9% and 6,9% for lobectomi and pneumonectomy,
respectively. Survival of the patients depends on tumor staging after the operation. Kaplan
Meier diagrams show a five year survival rate of 46%, 21,7% and 18,7% for histological stage
I, II and III, respectively.

Conclusions: The results from this group of patients from Haukeland Hospital accordance
with five-year survivalrate found in similar patient studies from other institutions.
Foramen ovale changes in growth-restricted fetuses

Chedid, Ghantous


Supervisor: Torvid Kiserud, professor
Seksjon for obstetrikk og gynekologi, Institutt for klinisk medisin, UiB



Objective In animal experiments hypoxemia induces an increased shunting through the
fetal foramen ovale (FO). Based on the hypothesis that the FO is expended to permit
more flow, we determined the size of the FO in growth-restricted human fetuses.

Methods Thirty-one women with singleton pregnancies complicated with growth-
restriction (<5 percentile) were examined at gestational weeks 24-39. The diameter
between the FO valve and the atrial septum was determined during maximum excursion
in a horizontal transection of the fetal heart. Correspondingly, the transverse diameter of
the right atrium (RA) was noted. Pulsatility Index (PI) was detrmined in the umbilical
artery and absent or reversed diastolic flow (ARED) was noted. The measurements were
compared to reference population using z-score.

Results Compared to normally grown fetuses, the growth-restricted had a smaller
diameter of the FO (p=0.002), particularly when expressed as a relative size by the ratio
FO/RA(P<0.0001). This effect was seen mainly ?32 weeks of gestation (p=0.003 and
p<0.0001, respectively), and was not significant later in pregnancy.There was a strong
negative relationship between relative size of the FO (FO/RA) and increased degrees of
placental compromise expressed by the umbilical artery waveform ( overall p<0.0001).

Conclusions FO in growth-restricted fetuses is smaller than in normally grown,
particularly in fetuses with placental hemodynamic compromise before 32 weeks of
gestation. The smaller FO support the assumption that a progressive detrioration affects
the left ventricle more than right, and in keeping with compensatory mechanisms such as
increased reversed flow through the isthmus aortae.
Virkningsmekanismer bak Misteltein og Phytohaemagglutinin lektiner i tidlig
stimulering av immunforsvaret

Christiansen, Tove Camilla


Supervisor: Ian F. Pryme, professor
Seksjon for biokjemi og molekylærbiologi, Institutt for biomedisin,



The background of lectin research at the Department of Biochemistry and Molecular Biology,
IBMB, was investigated. A series of experiments were then undertaken to investigate further
the immunostimulatory effect of lectins on macrophages and lymphocytes isolated from mice
spleens. Mistletoe extracts have been used in cancer treatment for more than 80 years, and
the results have been varying. Lectins are proteins with a mono- og disaccharide attached.
They are resistant to degradation in the gut, and thus may be given orally. There are several
types of lectins, the best known are Mistletoe lectins, Phytohaemagglutinin (PHA) lectin, and
Concanavalin-A (Con-A) lectin.

Mistletoe lectins (ML) are divided into several subgroups, ML-1, ML-2, and ML-3. We have
used ML-1 in our laboratory because this is the subtype most used in cancer research.
Experiments have shown that it is vital that ML-1 is given orally for it to bind to cells in
Peyers patches in the gut mucosa and thereby induce growth of the small intestine and cause
stimulation of the immune cells through second messengers.

Polyamines have been shown to be involved in mechanisms involving cell proliferation. One
of the earliest reactions in this process is the induction of the enzyme ornithine decarboxylase
(ODC), which is the first enzyme in the biosynthesis of polyamines. All known tumour
promoters induce ODC. A selective inhibitor of ODC activity, α-difluoromethylornithine
(DFMO), has not been effective in vivo in spite of great expectations, this may partly be
because tumour cells are not dependent on endogenous polyamine synthesis since polyamines
can be supplied continously from the body pool. Lectins cause hyperplasia of the gut
epithelium and this draws an increased amount of polyamines away from the body pool and
into the small intestine epithelium. The hypothesis is that this leaves less polyamines
available for a growing tumour. Polyamine content and tumour size in animals fed a
Lactalbumin diet (LA) with 7,5 mg/g ML-1 added, and injected with murine non-Hodgkins
lymphoma cells to form solid tumours, is reduced significantly. Apart from the direct effect
on the growth of the small intestine, ML-1 has long been known to be profoundly
immunostimulatory. Other lectins such as PHA and Con-A stimulate lymphocytes in vitro.

Several trials have shown that lectins, particularly ML-1, have potent immunostimulatory
effects in vivo. Modulation of the immune system affects the utilisation of nutrients by tissues
through a cytokine response. In this study, macrophages and lymphocytes from spleen from
mice injected with murine non-Hodgkin cells and fed PHA in the diet were compared with
mice fed control diets and injected with the same cells. Results showed that spleens from
mice fed on PHA were considerably smaller than controls. Lymphocytes from the spleen in
the group fed on PHA could not be stimulated in vitro. This was in contrast to lymphocytes
from the LA group. The results were not statistically significant. The tendency shown may
be due to a higher degree of lymphocyte stimulation in vivo in the group fed on PHA. The
lymphocytes have migrated to the tumour and are no longer residing in the spleen.
Macrophages collected from the peritoneal cavity by lavage showed a slightly higher
liberation of the cytokine TNF-α, but results were not statistically significant.

Possible errors in the trial are little control regarding the amount of PHA ingested by each
animal and remaining erythrocytes in the macrophage supernatant after wash causes the latter
because hemolysis influences absorption studies, or optical density (OD). PHA is a much less
potent immunostimulatory agent than Mistletoe. Forther experiments with a controlled oral
administration of lectins, with emphasis on ML-1, are necessary to further clarify the effects
of orally fed lectins on the immune system.
Mors alder og svangerskap: Fødselsutfall

Dale, Kjetil Samuel
Danielsen, Tor Jørgen
Endresen, Stian


Supervisors: Lorentz Irgens, professor og Rolf Skjærven, professor
Seksjon for epidemiologi og medisinsk statistikk, Institutt for samfunnsmedisinske fag, UiB



Objective: In our study we have tried to find out whether extreme maternal age is a
disadvantage for the child, and whether this tendency has changed over the last thirty years.
By the expression “extreme age”, we mean mothers being teenagers (<20 years old) or elderly
women (≥ 35 years old).

Material and method: The material is drawn from the Medical Birth Registry of Norway,
and includes every primiparous women in Norway during the period 1967-1998 (a total of
738.688 births). Multiple pregnancies and pregnancies of women with related partners are
excluded from the material. We have compared primiparous teenagers to all primiparous
women being twenty years or older. Also, we have compared primiparous elderly women to
all primiparous women younger than thirty-five years old. The material has been divided into
two periods, 1967-82 and 1983-98, to see whether time has had an effect on the variables we
have examined. The variables we examined were: short period of gestation (<253 days),
congenital malformations, perinatal mortality (stillborn or dead ≤ 6 days), high birthweight (>
4500 g), low birthweight (< 2500g) and very low birthweight (< 1500g).

Results: For the period 1983-98, elderly women had an increased chance for unfortunate
outcome for the following variables: low virthweight (< 2500 g) OR=1,20 (95% CI 1,14 –
1,26), very low birthweight (< 1500 g) OR=2,12 (95% CI 1,90-2,37), short period of gestation
(< 253 d) OR = 1,65 (95% CI 1,53-1,76), congenital malformations OR=1,24 (95% CI 1,14-
1,35, and perinatal mortality OR=1,29 (95% CI 1,17-1,42).
For the period 1983-98, young women had an increased chance for unfortunate outcome for
the following variables: perinatal mortality OR=1,24 (95% CI 1,17-1,42), short period of
gestation (< 253 d) OR = 1,28 (95% CI 1,22-1,35), low birthweight (< 2500 g) OR=1,74
(95% CI 1,63 – 1,80), very low birthweight (< 1500 g) OR=1,19 (95% CI 1,08-1,30).
We found a significant interaction of time (p<0,001) for short period of gestation and for
congenital malformations. There was an increase in unfortunate pregnancy outcomes from
the first period to the second period for all variables examined exept for perinatal mortality.

Conclusion: Extreme low maternal age is unfavourable for the child. This effect decreases
closer to the twenties. It is very unfavourable for the child if the mother waits until she is 35
years or older. For the variables we looked into, there was much more unfavourable for the
child having a primipara mother aged 35 or older than a teenaged mother.
A Survey on Child Nutrition in Bhaktapur, Nepal: Complementary Diet and
Time of Weaning

Eide, Hanne
Havstad, Hege


Supervisor: Dr. Tor Strand
Senter for internasjonal helse, UiB



Existing guidelines on child nutrition recommends exclusive breastfeeding for the first 6
months of infant life. We wanted to investigate child nutrition with the main focus on
complementary diet and weaning times. Furthermore, to assess whether a connection between
complementary food, time of weaning and stunting/wasting existed.

Methods: A questionnaire on child and family food habits was made and administered to the
caretakers of children in Bhaktapur, Nepal. Five hundred and ninety children between the age
of 6 and 35 months were subsequently included in the study.

Results: Twenty-four percent of the enrolled children were wasted and twenty-seven were
stunted. Forty-three percent of the children were given solid food before the age of 4 months.
This early introduction of complementary food was associated with a 1.49 (95% CI: 1.01,
2.23) fold increased odds of becoming stunted.

Conclusion: Our findings indicate that the children are introduced to solid food too early
compared to what is recommended and that this poor feeding practice impairs growth.
Kronisk/postviralt utmattelsessyndrom etter mononukleose.
1. Litteraturstudie   2. Et klinisk materiale fra Haukeland Universitetssykehus


Ekanger, Christian
Halland, Frode


Supervisor: Harald Nyland, professor/overlege
Institutt for klinisk medisin, UiB/Nevrologisk avdeling, Haukeland Universitetssykehus



Epstein-Barr is a member of the herpesvirus family and one of the most common human
viruses. As many as 95 % of adults between 35 and 40 years of age have been infected. The
classic clinical presentation of the virus is mononucleosis with fever, sore throat, and swollen
lymph glands. The diagnosis is made from the clinical findings, but usually laboratory tests
are needed for confirmation. EBV-infection has complications falling in to different
categories. The neurologic complications include viral meningitis, encephalitis and
neuromuscular complications. Sometimes involvement of the nervous system is the only
manifestation of infection. The introduction of cerebrospinal fluid polymerase chain reaction
for Epstein-Barr virus DNA has improved diagnosis, and has enabled cerebrospinal fluid
monitoring of therapy. Generally, the prognosis of nervous involvement is good, but also
recently it has been reported fatal cases. Antiviral treatment has not yet been confirmed
effective.
Chronic fatigue syndrome, myalgic encephalomyelitis (CFS/ME) is a clinical syndrome
defined as having new and incessent exhaustion, energyloss, physical and mental fatigue that
substantially reduces activity level. The syndrome can be observed after a number of viral
infections and is reported to occur in 10 % of patients with mononucleosis. We are presenting
data obtained from clinical examination of 56 patients referred to Department of Neurology,
Haukeland University Hospital, suspected of having this disease. In this report we have
described the clinical features through a questionnaire in addition to the results from
neurological examinations including electroencephalography and serologic studies of Epstein-
Barr virus.
Røyking i svangerskapet

Engebretsen, Ingunn Marie Stadskleiv


Supervisor: Kjell Haug, professor
Seksjon for sosialmedisin, Institutt for samfunnsmedisinske fag, UiB



In developed countries nearly every fourth woman smoke, but just seven do that in developing
countries. Nearly every second man smokes in both developing and developed countries. In
USA people have been quitting smoking the last years, but in developing countries they
gradually smoke more. In Norway about thirty per cent of men and women smoke, and every
fifth pregnant woman smokes. The rate of women starting to smoke has been decreasing the
last thirty years. At the same time there have also been national anti-smoking campaigns.
Women with low education, young age, multipara, who smoke a lot and maybe are single are
the women smoking most in pregnancy. First of all children of smoking mothers are on
average 200 g lighter than children of non-smoking mothers. Some studies show that the
more mothers smoke the lower birth weight the children get. Unpublished data from the
Norwegian Birth Registry from 1999 show that it is the first five cigarettes, which give the
biggest fall in birth weight. It is most harmful to smoke in the second and third trimester
when birth weight is considered. Just reducing the amounts of cigarettes do not give a weight
benefit. Smoking mothers run a greater risk for having Small for Gestitional Age infants.
Passive smoking can affect the birth weight, but that is not a big problem in Norway.
Smoking is one important factor, which increses the risk for having a child who dies from
Sudden Infant Death Syndrome; more than ten cigarettes a day increase the risk three times.
Increased upper respiratory tract infection rate of children with smoking parents is one
explanation. Foetal mortality in pregnancy and still birth is increased with smoking mothers.
Cleft lip/palate (SL/P) is more frequent when there is smoking in pregnancy. Renal
Glomeruli reduction both in size and number, hypospadias and chryptorchidism can also have
smoking as one of their causes. Asthma and reduced lung function is associated with
maternal smoking. Many kinds of cancers are more frequent among children of smoking
mothers, especially testis cancers are more frequent among children of smoking mothers,
especially testis cancer is increased among men in Copenhagen where women smoke more
than anywhere else in Europe. Smoking just before pregnancy also increases the risk for
some cancers. Breastfeeding is also reduced among smoking mothers. This can be due to the
cigarettes effect on the hormone balance and that the quality of milk changes. Even though
smoking among pregnant women has been reduced the last years, it is important that we do
not forget this is a big and preventable health problem for the mother and child.
Drug treatment of Alzheimer`s disease- background and possibilities

Fauske, Hildegunn Knapstad


Supervisor: Johan A. Aarli, professor/avd.overlege
Institutt for klinisk medisin, UiB/Nevrologisk avdeling, Haukeland Universitetssykehus



Background: Alzheimer`s disease is a disease that so far has no effective treatment. People in
general are frightened by the thought of getting this degenerative disease. Since the
pathological background for the disease is not completely understood, the research is also on a
basical level.

Material and methods: The following is a literature-based review on current treatment
perspectives.

Results and interpretation: The cholinergic hypotesis has been the background for drug
treatment of Alzheimer`s disease since the 1970s until now. Recent study shows that persons
with mild cognitive impairment have an upregulated cholinergic system. The authors
postulate that mild cognitive impairment is the prestage to Alzheimer`s disease, and that
Alzheimer`s disease is manifest when the compensation mechanisms seen in mild cognitive
impairment are vanished.
Gir økt mosjon bedret adferd hos personer med barneautisme?

Does an increase in exercise improve the behavior in persons with autism?

Flem, Bernt-Olaf Lian
Jørgensen, Robert
Sundal, Kim Erik


Supervisor: Einar Heiervang, overlege dr.med.
Regionsenter for barne- og ungdomspsykiatri, UiB



Design:
The study is based on registration of behavior and exercise in a period of two months


Subjects:
Two persons with childautism who both have behavior problems


Main outcome measures:
We have measured behavior problems using a individually adjusted scheme, and measured
the amount of exercise registered as daily walking.


Results:
Person 1 showed improvement in one behavior parameter and person 2 showed improvement
in two combinations of behavior parameters.


Conclusion:
An increase in exercise is assosiated with improved behavior for the persons in the
experiment. No negativ development in behavior was registrated in the second month of the
experiment.
Risk factors of dyskinesias and hallucinations in Parkinson’s disease?

Fredriksen, Kristin Jørstad
Aanensen, Karoline


Supervisor: Ole-Bjørn Tysnes, overlege prof.dr.med.
Nevrologisk avdeling, Haukeland Universitetssykehus



Objectives: The aim of the present work was to study the occurrence of the levodopa-
assosciated symptoms dyskinesias and hallucinations in a Norwegian Parkinson population.

Materials and methods: Files of patients that had been hospitalised for Parkinson’s disease
at Haukeland University Hospital, Norway, during the period 1990 to 1995 were carefully
reviewed for demographic data, clinical data and treatment regimens.

Results: Fiftynine per cent of the patients developed dyskinesias at some time of the
observation. The 5 and 10 years risk of having developed dyskinesias was 25% and 54%.
Young age at onset and high initial levodopa dose were independent risk factors. The risk of
dyskinesias was similar in patients on levodopa alone and in patients on levodopa plus
dopamine agonists or deprenyl. The risk of developing hallucinations was 20% in 10 years.

Conclusion: Levodopa-induced symptoms are frequent in Parkinson’s disease, but less
frequent in this Norwegian cohort than generally reported. Careful use of levodopa may
reduce the risk of dyskinesias.
Cholerapreventive work in Mozambique

Furnes, Geirmund
Strøm, Jan Harald


Supervisor: Nina Langeland, professor/overlege
Institutt for indremedisin, UiB/Medisinsk avdeling, Haukeland Universitetssykehus



Objective: To assesshow the volunteers in Cruz Vermelha de Mocambique (CVM)
experienced their working situation and performed preventive work during the cholera
epidemic in 1997-1998. To compare the findings in Maputo Province to Maputo City.

Design: Data were collected through interviews using both a structured questionnaire and
unstructured conversation in groups.

Setting: Maputo Province and Maputo City, December 1999-January 2000.
Subjects: Volunteers in CVM

Main outcome measures:
Sociodemographical differences
Door-to-door campaign
Implementation
Follow-up and leadership

Results: Twenty-five and thirty-five volunteers were interviewed in Maputo Province and
Maputo City, respectivelly (the values from the city are written in parenthesis). Mean age:
35.7 years, standard deviation (SD) = 11.1 (24.7 years, SD = 4.7). Experience as a volunteer:
8.5 years, SD = 3.6 (6.9 years, SD = 4.0). Distribution of gender: 80% women (69%
women). Public education: 5.4 years, SD = 2.4 (8.5 years, SD = 1.7). In both areas 52%
reported having the door-to-door campaign as the main activity. In both areas 67% said they
were able to change the families’ behaviour “much” concerning water-treatment and oral
rehydration therapy (ORT). Fifty-six percent (74%) felt they were appreciated by CVM. The
degree of follow-up seemed to be less in the province.

Conclusion: Most volunteers felt they did an important job and were willing to do it again.
Cholera preventive work could be recommended to be included as a daily activity for CVM.
Recruiting and follow-up of the volunteers were less focused in the province than the city.
The Management of Severe Malnutrition in a Hospital Setting in Uganda, and
Suggestions for Low Cost Improvments

Gjerpen, Jeanne
Hoel, Hedda


Supervisor: Thorkild Tylleskär, professor
Senter for internasjonal helse, UiB



Background
Severe malnoutrition in children is a potentially life threatening disorder which requires very
careful management even in hospitals in order to avoid a high case fatality rate. We wanted to
study the management of these children in a hospital setting in Kampala, Uganda, in order to
identify gaps, and suggest some low-cost improvements.

Methods
We did a survey of recent literature in the field of severe malnutrition, and looked at the
recent recommendations for management.
We studied the management of severe malnutrition in Mulago Hospital, Uganda, through
case-studies and participatory observation during a 6 week period June-July 2002. Also, we
did a study using questionnaires, to get an overview over the patients anthropometrics and
socio-economic setting.
On the background the above, we suggested some low-cost improvements, that could possibly
reduce the morbidity and mortality of these children.

Findings
Our suggestions for low-cost improvements were as followed: An increased use and
understanding of the already existing guidelines for management; more accurate recording of
the child's condition and treatment; more efficient prevention of initial hypoglycaemia and
hypothermia; increased surveillance of feeding, and increasing infection control. Our
impression was that these measures could possibly reduce the mortality and morbidity of
severely malnourished children.
Ekstrauterin graviditet etter sterilisering

Gjerstad, Hedvig


Supervisor: Roar Sandvei, professor
Seksjon for obstetrikk og gynekologi, Institutt for klinisk medisin, UiB



Background
The aim of this study was to estimate the frequency of women suffering an ectopic pregnancy
following tubal sterilization.We also intended to see the results in relation to the methods used
during the sterilization procedures.
Material and methods.
We conducted a retrospective cohort study of a hospital material of 1535 patients with the
discharge diagnosis of ectopic pregnancy. The patients were admitted to Haukeland
University Hospital during the years 1985- 2001. We reviewed the medical records of all
these women, to see how many who had been previously sterilized. The surgical methods, by
which the sterilization procedures had been conducted, were also recorded. In addition we
noticed if the procedure was performed post partum, post abortum or as an interval procedure.
Results
Of 1535 women with the discharge diagnosis of ectopic pregnancy, 35 had undergone
previous tubal sterilization. Ten of the 35 women had been refertilized by tubal anastomosis
before their incidence of ectopic pregnancy, and were therefore excluded from the analysis.
Thus 25 women were included in the study. We also found that 220 (15.3%) of the women
had become pregnant with an IUCD in situ, and 15.2% of the study population had suffered
repeated ectopic pregnancies.
The mean age of all the women with ectopic pregnancy was 30.1 years (16-47 years), and
those who experienced ectopic pregnancy subsequent to tubal sterilization were 36.0 years
(27-46 years). The mean interval between tubal sterilization and ectopic pregnancy was 57.8
months (5-176 months).
Interpretation
Our data suggests that that the possibility of pregnancy must be considered in women who
have undergone tubal sterilization. The risk of the pregnancy to be ectopic is greater than that
of an intrauterine pregnancy. The increased risk is supposed to last during the fertile period of
life.
Description of Clinical and Epidemiologic Aspects of Escherichia coli
O157:H7 infections in the State of Georgia, United States of America,
1993-2001.

Granå, Ronny


Supervisor: Blake, Paul A., MPH
Department of Human Resources, Atlanta, Georgia



In the years 1993-2001 there were confirmed 372 cases of E. coli O157:H7 infections in
Georgia. The number of cases of E. coli O157:H7 infections reported in Georgia rose
between 1993 and 1997, peaked in 1998 and has been stable in subseqent years. The fact that
there has been no increase in the annual number of cases since 1998 may reflect a measure
of success in controlling E. coli O157:H7 infections. 31% of cases were part of identified
outbreaks. In 1993-2001 four large outbreaks occurred in the years 1995, 1996, 1998 and
2001 affecting a total number of 62 persons.E. coli O157:H7 infecions are much more
common during the summer and early fall months. Children in the 1-4 year age group have a
remarkably higher incidence of E. coli O157:H7 infections, this age group is also much more
likely than infected persons in other age groups to develop hemolytic uremic syndrome. The
incidence of E. coli O157:H7 infections fall off through the adult years until the age 50, after
it begins to climb. During 2000-2001 the two persons known to have died were both
elderly, 76 and 81 years of age. In 1993-2001 the incidence of E. coli O157:H7 infections
was almost three fold lower in Georgias African-American population than in the white
population. There was also a concentration of reported cases in northern Georgia. Among
cases reported in 2000-2001 almost all of the cases (96%) had diarrhea, and a large majority
(74%) had bloody diarrhea. Forty-one (39%) of the cases in 2000-2001 were hospitalized, the
median duration of hospitalization was 4 days. The mean age of hospitalized cases was 23.3
years, and 17.6 years for non-hospitalized cases. The rate of hopitalized cases is substantially
higher for persons 60 or more years of age.
Newborns reaction to tape recordings of their own and other babies cries

Griffiths, Silja Torvik
Thorsen, Anna Maja Holm


Supervisor: Kjell Morten Stormark, dr. psychol
Regionsenter for barn og unges psykiske helse, UiB



Self perception in newborns
Several studies have shown that newborns are subjectively aware of themselves as unique
individuals The purpose of this study was to examine if newborns would distinguish the tape-
recordings of their own crying from that of another newborn.. The study was performed at
Kvinneklinikken, Haukeland sykehus. We filmed behavioral responses of 14 newborns when
they were listening to audio-recordings of their own or another newborns' crying. Both
audiorecordings were presented while the subjects were in two different states, once when the
children were calm, and once when they were crying. Thus, the experiment consisted of four
conditions: calm / own crying, calm / peers' crying, crying / own crying and crying / peers'
crying.
We scored the amount of time the children were crying for each of the four situations. The
time (in seconds) before the child changed from being calm to crying, and vice versa, was
also scored. The results showed that the children cried for a longer duration when they were
crying initially than when they were calm, no matter which audiorecording they heard. It also
took the newborns longer to change from crying to calm than vice versa when they were
presented with the audio-recordings. This was particularly pronounced when they were
presented with the audiorecordings of their own crying. This suggests that newborns can
differentiate between their own and peers' distress crying. One could speculate whether this
may reflect an early, innate sense of self in the newborn.
Angiogenese: effekt av trening på serumnivå av basic
Fibroblast Growth Factor (bFGF)"

Angiogenesis: Effect of exercise activity on serum levels of basic fibroblast
growth factor.

Grøvan, Fredrik


Supervisor: Øystein Bruserud, professor/overlege
Institutt for indremedisin, UiB/Medisinsk avdeling, Haukeland Universitetssykehus



Research in the field of angiogenesis started in the seventies and today it is a vast field
involving many different medical disciplines. Physiologic angiogenesis is a strictly controlled
process, and loss of control is a hallmark of pathologic angiogenesis. More than 20
endogenous substances released locally or systemically have pro- or antiangiogenic effects,
and basic fibroblast growth factor (bFGF) is one of the most important proangiogenic
substances.

During exercise training new vessels are formed locally in skeletal muscle. In our study we
investigated whether intensive physical activity in young, regularly trained male kayakers
affected serum levels of bFGF. The levels were determined before and immediately after 45
minutes of intensive physical activity. The results showed that serum levels of bFGF were
significantly decreased after exercise.
Spedbarnskolikk – en oversikt

Haugland, Christian


Supervisor: Edda Olafsdottir
Seksjon for pediatri, Institutt for klinisk medisin, UiB



This paper reviews current litterature about infantile colic, as regards to ethiology, prognosis
and documented therapies. Infantile colic is characterised by excessive crying which subsides
within 3 months. It is still not known what causes colic – whether gastrointestinal or
behavioural dysfunction is the problem, or whether there’s actually no pathology at all. In
any case, children who have had colic are not more prone to illness than other children later in
life.
Various therapies have been tried, very few of them are well documented. There is a
significant placebo effect. Dicyclomine is likely to be beneficial, but unfortunately this drug
can have serious side-effects. Elimination of cow’s milk can be beneficial for some children,
as can sucrose. Dimethicon and chiropractic therapy are widely used, but are not effective.
Other treatments have shown promising results, but the studies are too small or have too many
important methodological problems to draw conclusions from.
Prevalensen av røyking blant kroniske smertepasienter henvist til en
tverrfaglig smerteklinikk – farmakologisk betydning?

Heimen, Anja


Supervisors: Ole Jacob Broch, professor og Rae Frances Bell, seksjonsoverlege
Institutt for farmakologi, UiB og Anestesi- og intensivavdelingen, Haukeland
Universitetssykehus



Background: It is a general impression that many patients with chronic pain are smokers.
Existing studies show that smoking influences drugmetabolism. In this study we have
determined the number of smokert in a random group of chronic pain patients, and examined
how much tobacco they use, which drugs they are treated with and possible pharmacological
significanse.

Methods: This is a retrospective study. The journals of one hundred consecutive patients
evaluated at a multidiciplinary pain clinic were examined. Information regarding tobacco,
alcohol, age and gender was registered. A Medline-search was performed to collect
information from available literature regarding the interaction of tobacco with analgesic
metabolism.

Results: We found that a greater number of patients with chonic pain-problems were
tobacco-users (65%) compared to the general Norwegian population (33%). Thirty three
percent of the Norwegian female population are regular smokers compared to 67% of females
in the study group. The amount of tobacco consumed by the study group was significantly
higher compared to the general population. The Medline search revealed several studies
reporting interactions between cigarette smoking and the metabolism of different analgesics.

Conclusion: Relatively few analgesic drugs have been investigated regarding interactions
with tobacco smoking. Available literature indicates that tobacco smoking influences drug
metabolism. This study revealed that a large percent of chronic pain patients in the study
population are smokers. An important treatment goal is reduction of tobacco consumption.
Genterapi ved HIS infeksjon

Herikstad, Ragnar


Supervisor: Birgitta Åsjø, professor
Avdeling for mikrobiologi og immunologi, Gades institutt, UiB



Though much progress has been made in the treatment of the human immunodeficiency virus
(HIV) infection, and the introduction of highly active antiretroviral therapy (HAART) has
improved the prognosis and quality of life considerably, we are still without any curative
therapy. Many alternative treatment strategies are being explored; among them is the rather
new discipline of gene therapy. In this article we look in particular at results that have been
published so far from clinical trials. The different approaches can be divided into two main
categories depending on whether they aim to stop viral replication or to destroy infected cells.
So far the results from 3 phase I studies have been published, several more are still in progress
and a few phase II protocols have been approved by the National Institute of Health (NIH).
While we are still far from a cure, the last years results have led to excitement in the field.
This article reviews some of the strategies for a possible use of gene transfer for the treatment
of HIV infection.
Clinical Trials on the Treatment of Arrhythmia in ventricular Dysfunction:
Primary prevention in post-myocardial Infarction, primary and secondary
prevention in congestive Heart Failure

Herstad, Jon
Power, Øystein


Supervisor: Per Ivar Hoff, overlege
Hjerteavdelingen, Haukeland Universitetssykehus



Background

Cardiovascular disease is still the most common cause of death in developed countries. Of all
deaths due to cardiovascular causes, sudden death accounts for approximately 50%, and the
majority of such deaths are caused by acute ventricular tachyarrhythmias. Even though the

identification of common cardiovascular risk factors such as smoking, hypertension and
hyperlipidemia is straightforward, these determinants estimate the risk of underlying disease
rather than the risk of the event immediately responsible for death. This has lead clinicians
and scientists to investigate whether it is possible to determine more specific markers of the
risk of death from arrhythmia. In this paper we try to review the clinical trials that have led to
current routines of management in ventricular arrhythmia in post-MI patients and patients

with congestive heart failure. Furthermore we highlight recent trials and the ongoing
discussion concerning the use of Implantable Cardioverter Defibrillators (ICD) as an
alternative approach in treating this population of patients.

Methods

A review of the clinical trials on the treatment of arrhythmia in ventricular dysfunction:
Primary post-myocardial infarction trials, primary and secondary prevention in congestive
heart failure. We present the most established pharmacological approach in the prevention

of ventricular arrhythmia, namely amiodarone, as well as a brief historical introduction to the
use of the ICD. We compare trials promoting these substantially different approaches in
preventing ventricular arrythmia, and focus on medical implications, cost-effectiveness, risk-
stratification and quality of life.

Conclusion

ICDs seem more beneficial than drug therapy for secondary prevention of sudden cardiac
deaths and for primary prevention in certain high-risk groups. However, further research is
needed to develop accurate risk stratification tools, to determine the economic impact of ICD
therapy in different subgroups of patients, and to evaluate quality-of-life issues. And with new
trials suggesting worsening heart failure after ICD-implantation in certain subgroups, the
importance of stratification in unquestionable.
Glutamat som tilsetningsstoff og dets innvirkning på symptomer hos pasienter
med funksjonell dyspepsi

Hessen, Siw Margrethe


Supervisors: Trygve Hausken, professor dr.med./overlege og Ina Hjelland, stipendiat
Institutt for indremedisin, UiB/Gastroenterologisk seksjon, Medisinsk avdeling,
Haukeland Universitetssykehus



Background/aims: Patients with functional dyspepsia often have meal-induced dyspeptic
symptoms. They seem to react particularly strong after ingestion of Tor Klar Kjøttsuppe. We
wanted to study wether it could be the content of glutamate (MSG) in this soup that was
responsible for the intens symptoms found in these patients.

Methodology: In 10 patients with functional dyspepsia, symptoms, the area of gastric antrum
and fundus, and the diameter of the sagital fundus were recorded, as measured with 2D
ultrasound, before, at 0 min, 10 min, and 20 min after ingestion of 500 ml of bullion in 4 min.
In all subject this was recorded on two separate visits, where they, in randomized order, on
one occation were served standard Toro Klar Kjøttsuppe with glutamate, on the other soup
without glutamate. With exeption of the glutamate, the two soups were identical.

Results: Scores of all the symptome showed a tendency to be higher after ingestion of the
glutamatefree soup. The results were only significant for the symptom nausea at 20 min after
they had stopped drinking (p=0.04). We found no significant difference in the antral
ultrasound recordings, but there was a slight tendency of the antral volume, expressed by
these 2D measures, to be higher after ingestion of the standard soup. The fundus diameter
and area, however, seemed to be higher after the glutamatfree soup. The fundus diameter and
area, however, seemed to be higher after the glutamatfree soup. These differences were,
however, also not statistically significant.

Conclusion: Nothing in our study supports the hypothesis that it is glutamate in foodstuffs
that is the symptom-inducing factor in patients with functional dyspepsia. On the contrary, it
can seem as if removing the glutamate actually makes these people worse. It is possible that
glutamate in food can work by stimulating the vago-vagal reflex pathway, and consequently
lead to better relaxation of the stomach after ingestion of a meal. More research needs to be
done to establish if this is the case.
Pneumothorax – beskrivelse av et pasientmateriale

Hjelle, Kjersti


Supervisor: Sverre Sørenson
Seksjon for lungemedisin, Institutt for indremedisin, UiB



Objectives
The objective of this study was to search for more information on the subject of spontaneous
pneumothorax, an acute pulmonary disease that seems to occur spontaneously without any
reason. Why does it occur, and which patients are most likely to have it? By studying a
patient material and register 14 different parameters, I have tried to find explanations and
figure out the importance of each factor in producing disease. It was also an objective to
describe the outcome of the different treatment alternatives.

Methods
I orderes lists of patients that were admitted with an ICD-10 diagnosis code of spontaneous
pneumothorax in the years 1998 and 1999, and excluded those who were found to have an
iatrogenic pneumothorax. Manually I searched all of the 98 patient records to register my 14
parameters. I have also counted the results manually.

Results
Basically, I found that the typical patient having primary spontaneous pneumothorax is a
young, smoking man with low socio-economic status. I found no connection between
physical activity and the disease whatsoever. There is a clear-cut connection between
smoking and the degree of disease. Non-smokers did have a smaller pneumothorax than
smokers, and sadly, three fourth of this patient population were smokers. The question is
whether the high consume of cigarettes is reated to the low socio-economic status of the group
or not. More than 42% of the patients with a primary spontaneous pneumothorax had some
kind of “pulmonary set-back” in the immediate past or at present when they were admitted.
In addition to the smoking and a possible genetic predisposition, this may have been
contributing factors to the occurrence of spontaneous disease. Treatment; obviously simple
aspiration (and conservative treatment) are the alternatives having the lowest degree of
relapses and amount of days in the ward, but it is important to take into consideration that
those patients that were treated with these methods had a smaller pneumothorax in the first
place, and so we cannot assume that the good coutcome was solely because of the simple
aspiration itself.
Utredning av primære immundefekter hos barn med hovedvekt på bruk og
tolkning av laboratorieundersøkelser

Holstad, Kristin
Støfring, Ingunn


Supervisor: Einar K. Kristoffersen, førsteamanuensis/overlege
Gades institutt, UiB/Immunologisk seksjon, Avdeling for mikrobiologi og immunologi,
Haukeland Universitetssykehus



Primary immunodeficiencies (PID) in children are rare disorders. This work is based on
present written knowledge about PID. An overview on the different types of PID and a
suggestion for which laboratorytests to investigate is presented.

The immunesystem is very complex, and can be classified into four groups; cellular
immunity, humoral immunity, the complement system and the fagocytic system. This work
presents the immunodeficiencies according to this classification.

A thorough medical history, physical examination and if necessary laboratory tests constitute
the investigation. The medical history should be thorough and pinpointed, and preferably
indicate the location of the defect in the immunesystem. This makes the doctor able to order
laboratorytests according to the conclusions of the medical history. This work presents and
describes the most useful laboratorytests used in further investigation. The tests are grouped
according to which part of the immunesystem they describe.

The final objective is to be able to make a quick diagnosis and to carry out the correct
treatment. This can be done following our suggestion of how to investigate PID. In this
perspective the investigation will be cost– and timesaving and of benefit to the patients.
Kunsten å leve med atopisk eksem – og dets behandlere
Hopsnes, Solveig
Eide, Gunn-Vivian


Supervisors: Svein Helland, professor dr.med./overlege og Tore Morken, seksjonsoverlege
Institutt for indremedisin, UiB/Hudavdelingen, Haukeland Universitetssykehus


Objectives:
The objective of the survey was to find if there is correspondence between dermatology,
alternative medicine and the patients own thoughts with regards to causes, symptom
increasing factors, symptom relieving factors and different types of treatment for atopic
eczema.

Methods:
A sizeable questionnaire was answered by 27 patients; 10 alternative therapists, 9 nurses and
14 doctors, of whom 8 were dermatologists. This article is structured in chapters. An
introduction describes the methods used, amongst other topics. The following section
describes facts about symptoms and findings, etiology and various types of treatment
according to dermatologists and alternative medicine respectively. Next follow the results,
presented in diagrams and tables. The discussion is subdivided into the topics causality, outer
irritation factors, diet, climate, psychosocial relations, treatment, alternative treatment and
qualitative patient information.

Results:
Patients with atopic dermatitis form a heterogeneous group, and their responses to treatment
often show individual variation. However, the groups in the survey share views on quite a few
questions. Negative effects from soap, wool and sweat, and positive effects from moderately
warm climate, natural sunbathing and bathing in the sea are examples. Practically all the
participants agree that genetics is the single most important etiologic factor. The major
differences are that alternative therapists believe most strongly in negative effects from
various food intakes, less in the effect of outer irritation factors and in recovering effects from
local corticosteroids. The doctors in the survey have less faith in allergies as a cause for the
symptoms. They do not regard computers or coffee as important worsening factors, and have
less faith in positive effects from fatty fish and cod liver oil.

The patients, in comparison to the other groups, emphasis negative effects from negative
frames of mind. More or less all of them have seen good effects from moisturizing creams,
sunbathing and local corticosteroids. Quite a few patients have also tried different herbal
creams with a positive effect. Furthermore, the patients mention dietary restrictions and
homeopathy as the best treatments within alternative medicine.

Conclusions:
Disagreement between the groups was relatively small. More often than not, the different
groups of health workers share views. The patients will probably benefit from an open
communication between the practitioners and willingness to learn from each other and from
the patients. There is, however, much to gain from individually customised treatment and
information regarding simple practical adjustments.
Radiær keratotomi – en retrospektiv studie

Høvding, Pål
Ueland, Hans Olav


Supervisor: Gunnar Høvding, professor dr.med./overlege
Institutt for klinisk medisin, UiB/Øyeavdelingen, Haukeland Universitetssykehus



During the years 1988 – 1991 215 refractive surgery procedures were performed at the
Department of Ophtalmology, Haukeland University Hospital, using the method of
keratotomy. Fiftyeight pasients who had undergone radial keratotomy (RK) for myopia, in
some cases with an additional transverse keratotomy (KT) for astigmatism, participated in a
postoperative follow-up study between 1991-1992. This paper reports the pre- and
postoperative data in these patients, including their subjective opinion of the outcome of the
operation.

There was no statistically significant difference between the pre- and postoperativ corneal
thickness after radial keratotomy. The mean reduction of spherical equivalent was 3,0D.
Among the patients operated on both eyes there was a significant correlation between the
reduction of myopia in the right and left eye. Only the preoperative spherical ezuivalent was
found to have a significant influence on the reduction of myopia, the effect increasing with
increased preoperative myopia. While the preoperative uncorrected visual acuity in the
majority of most patients was only finger counting, 67% achieved a postoperative uncorrected
visual acuity of 0,5 or better. As much as 95% of the patients were satisfied or very satisfied
with the outcome of the operation. The degree of patient satisfaction was significantly
correlated to both reduction of myopia and to postoperative uncorrected visual acuity. Glare,
unstability of vision and complaints associated with driving in the dark were among the most
frequently reported side effects after surgery.
However, none of these problem prevented the patients from being operated on their second
eye.
Robotic Project

Høvik, Berit Helen


Supervisors: Kay E. Davies, professor og Laurence A. Bindoff, professor
Department of Human Anatomy and Genetics, University of Oxford og
Seksjon for nevrologi, Institutt for klinisk medisin, UiB



The robotic mouse is an autosomal dominant mutant that arose from a large-scale chemical
mutagenesis programme. It has a jerky, ataxic gait and develops adult-onset Purkinje cell loss
in the cerebellum in a striking region-specific pattern, as well as cataracts. Genetic and
physical mapping of the disease locus led to the identification of a missense mutation in a
highly conserved region of Af4, a putative transcription factor that has been previously
implicated in leukemogenesis. We demonstrate that Af4 is specifically expressed in Purkinje
cells and that a gain of function mutation in Af4 leads to neurodegeneration. My role in this
project was the morphometric analysis of Purkinje cell loss.
Medisinstudenters holdninger til seksualitet

Iversen, Jan Olav


Supervisor: Kåre-Steinar Tveit, universitetslektor
Hudavdelingen, Haukeland Universitetssykehus



The medical students of today are the physicians of tomorrow. Their attitudes towards
sexuality and erotica may influence their ability to talk about this subject with their patients.

The purpose of this paper was to report upon medical students attitudes towards sexuality and
erotica. A total of 587 students at the Faculty of Medicine and The Faculty of Dentistry at the
University of Bergen, answered an anonymous self administered questionnaire concerning
their own sexual experience, including questions about sexual fantasies and attitudes.

Of the respondents there were 64 students of dentistry, all attending the first year of their
education. The remainder of the respondents (523) were medical students at their two pre-
clinical years, and in the clinical part of their education.

Grouping the respondents revealed several significant differences among the respondents.
Male students tended to be more erotophilic than the female respondents. Their attitudes
towards an unconventional sexual life-style, were more positive then for the female
respondents. Female respondents tended to be more positive towards homosexuality then the
male respondents. Students who had debuted sexually, were more erotophilic then the not-
debuted students. This was found both for the group of students seen as one, and when the
respondents were grouped according to their sex (difference between males debuted and not-
debuted, and between females debuted-not debuted). We also found that non-religious
students tended to be more erotophilic, more positive towards an unconventional sexual life-
style, and more positive towards homosexuality than religious students.

There were no differences among students of dentistry and medical students.

Several significant differences indicate great challenges in changing the attitudes towards
sexuality, among the physicians of tomorrow. It is necessary to conduct further research on
how students and physicians attitudes influence their ability to talk about sexually related
subjects.
Skjebnezapping – medisinsk grunnopplæring, legestudenters dannelse og den
etiske fordring

Johansson, Kjell Arne
Ohldieck, Christian
Aase, Margrethe


Supervisor: Edvin Schei, førsteamanuensis
Seksjon for allmennmedisin, Institutt for samfunnsmedisinske fag, UiB



As medical students,we go through a process which profoundly alters our emotional lives, our
identity and our understanding of reality. However, the development of personal insight,
behavior and empathy in a professional context is to a large extent left to ourselves and is only
occasionally the subject of discussion or explicitly expressed in terms of goals or ideals. The
fact that current medical practice is rarely scrutinized, makes it all too easy for us to
uncritically adjust to the current medical culture as expressed by the physicians` behaviour
and actions. Brief and isolated confrontations with the suffering and vulnerability of patients
unavoidably evoke emotional reactions in us and raises difficult questions for us. These
reactions are seldom commented on or indeed dealt with as part of our formal education.
        In this article our own experiences of bedside teaching at the hospital will be described
and illustrated with the help of key features of the ethical teachings of the Danish philosopher
Knud Ejlert Løgstrup. His appreciation of man as fundamentally relational challenges the
modern belief that people are separate, autonomous individuals. His philosophy also
represents an alternative to the objectifying perspective of man that we become familiarised
with through our medical training.
Adjuvant treatment for breast cancer during 1983-91

Johnsen, Svein Joar A.


Supervisor: Gun Anker
Onkologisk avdeling, Haukeland Universitetssykehus



Background
Adjuvant hormonal therapy and chemotherapy were recommended for selected groups of
patients with breast cancer since 1981. New directives for adjuvant treatment of breast cancer
were given in 1988. The new recommendations suggested Tamoxifen as adjuvant hormonal
therapy to patients with hormone receptor positive or hormone receptor status unknown
tumors in primary breast cancer stadium 2. Additional treatment with an adjuvant CMF-
regime for a period of 3-6 months was also described in the proposal. We intended to survey
which adjuvant treatment was given prior to and after the new directions. We therefore
recorded nodal status, hormonal treatment, chemotherapy and radiotherapy given.

Methods
The Cancer Registry of Norway made a selection of patients from given criteria for the
periods 1983-87 and 1989-91. The study included women with: 1) diagnosed primary breast
cancer in stadium 2 and 2) premenopausal condition aged 40-55. The diagnostic criteria of
breast cancer stadium 2 are node positive (pN+) tumour ≤5,0cm. The total number of patients
contenting the diagnostic criteria were 115 and 73 of them were treated during 1983-87 and
42 during 1989-91.

Results
Total number of 65 (89%) patients received adjuvant treatment during
1983-87 and 40 (95%) patients from 1989-91. 30 (41%) patients received adjuvant hormonal
therapy during 1983-87 and 31 (74%) patients received hormonal therapy during 1989-91 .
After distribution of new directives in 1988 20 (48%) patients received adjuvant Tamoxifen
and 4 (10%) patients received during the period 1989-91.

Interpretations and conclusion
Our conclusion is that patients during both periods are treated according to the
recommendations given. We find a significant increase in adjuvant hormonal therapy given
after the distribution of new directives in 1988.
Røykevaner blant medisinerstudentene i Bergen 2002

Jonassen, Trygve
Valaker, Trine


Supervisor: Per Bakke, professor dr.med.
Seksjon for lungemedisin, Institutt for indremedisin, UiB



Background:
Little is known regarding Norwegian medical students' smoking habits. It's been well
documented that smoking cessation is the measure with greatest potential in reducing disease.
Doctors who smoke are not as involved as their non-smoking colleagues when it comes to
promoting smoking cessation among their patients. Daily cigarette smoking among
Norwegian doctors is now about 6%. By examining the smoking habits of today's students,
we might make some predictions on the smoking habits of future doctors.

Method:
The study was done by handing out questionnaires at plenum lectures to all medical students
at the University of Bergen during the spring term -02. The students who were not present,
were reached by mail.

Results:
The compliance was 97%(866/894). Eight questionnaires were excluded from the study. The
total included thus numbered 858. The study revealed that 53,1% of the students had never
smoked, 14,1% were ex-smokers, 28,1% were occasional smokers and 4,7% reported that
they smoke regularly. No differences were found regarding age, gender or how long the
students had attended medical school.

Interpretation:
The high percentage of occasional smokers, indicates that the prevalence of smoking among
Norwegian doctors will rise. The fact that one third of the students either smokes regularly or
occasionally, can be taken as a sign of lacking attitudes among today's medical students
towards the health hazards of tobacco use.
En sammenlignende tversnittsstudie av postoperative sårinfeksjoner i et vestlig
sykehus versus et sykehus i den tredje verden

Jørgensen,Andreas Vik
Andenæs, Amund Meidell (class 98)


Supervisor: Kjell Andenæs, dr.med.



        In 1999 we made a protocol in co-operation with our supervisor, PhD Kjell Andenæs.
The protocol was sent to two hospitals, one in Ngaoundere in Cameroon, and one in Istanbul.
The purpose was to perform a comparative cross-sectional surveillance study regarding
postoperative wound infections (PWI)`s in a western hospital versus an African hospital. The
study and definition of PWI was mainly based on a scoring system for PWI as described in
the thesis “Plastic surgery and postoperative wound infection” (16).

With no clinical experience and with only a brief introduction to the subject by our
supervisor, who also gave us relevant articles, most of the clinical evaluation was done by the
hospital staff. We therefore were very dependent on the co-operation with the local doctors.
Leukocyttmigrasjon og filterstudiet; et aktuelt og enkelt “In Vitro” studie av
kjemotakse hos den polymorfonukleære leukocytt

Kilhus, Kristin Stenhaug


Supervisor: Alfred Halstensen, professor
Institutt for indremedisin, UiB



Locomotion is generally agreed to be important for the accumulation of leukocytes at sites of
inflammation and infection. A variety of methods have been devised for the study of details
surrounding chemotaxis and leukocyte migration. Throughout history many different
methods have been presented, many of these have subsequently been replaced by newer and
allegedly better alternatives. In 1962 Boyden introduced the membrane filter method. Today,
the membrane filter study, with its more recent modifications, has become the technique of
choice for studies of leukocyte migration in vitro. The filter membrane study utilizes
commercially available and disposable chambers gathered in multichamber apparatus, this
makes the method easy to learn and rapid to perform allowing multiple samples to be
handeled at the same time. Factors mentioned above have most probably resulted in the great
popularity and attention granted the filter study today.
This assay presents basic methodological principles of the practiticability of the filter
membrane study and at the same time focuses on the technical challenges and miscalculations
often seen when carrying out the method.

In a busy working day it often happens that blood samples are stored for some time before the
laboratory assistant has time to handle and analyse them. In this connection we have
examined the effect of storage on leukocyte migration. An other aspect of interest is the
comparison between leukocyte migration in heparine kept cells with migration in EDTA kept
cells. Heparine kept leukocytes have earlier been the alternative of choice when carrying out
the filter membrane study. If it was to be proven that EDTA kept leukocytes migrate
satisfactorily, these cells could be employed customarly in such studies, making it easier to
procure material when already taken for other purposes. Results obtained through the
laboratory work are presented and discussed. Finally, practical and theoretical experience
achieved through working with this paper is evaluated.
Ebola- og Marburgvirus – et litteraturstudium med fokus på Kikwitepidemien
i Kongo 1995

Kjelby, Eirik


Supervisor: Nina Langeland, professor dr.med.
Institutt for indremedisin, UiB



Ebola- og Marburgvirus cause disease which is classified as viral haemorrhagic fevers.
Disease caused by Marburg virus first erupted in a research facility in Germany in 1967. The
virus source was probably monkeys imported from Africa for research purposes. The Ebola
virus first came to human attention during the epidemics in Zaire and Sudan in 1976. The
symptoms consisted of astenia, vomitting, abdominal pain, myalgias, arthralgias, headache,
fever and haemorrhagic manifestations. Some of the patients developed a characteristic
maculopapulous rash. After these first outbreaks there have been numerable minor outbreaks
and a few larger epidemics of Ebola. The Marburg virus has been a rarer cause of disease, but
did cause a larger epidemic in the Democratic Republic of Congo (DRC) in 1999. So far four
subtypes of the Ebola virus have been discovered of which three are African in origin and one
comes from the Philippines. Nobody knows where the viruses originally come from.
Infected primates also get sick. Primates are therefore not thought of as the host species. The
virus spreads from patient to patient via body fluids and can also infect by direct skin contact
with deceased. The mortality of sich patients varies from 25-90%. Death usually takes place
6-9 days after the first symptoms occur. The patients die in shock with multiorgan failure.
Post-mortem examination has shown focal necrosis in multiple organs including lymphoid
tissue. The diagnosis is attained from ELISA detection of IgM antibodies, virus culture or
PCR-amplification. Today there does not exist any effective treatment. Hospital care
concentrates on preventing spread of the infection. The Ebola epidemic in Kikwit, a city in
DRC, in 1995 is described in more detail in the last part of this review. This leads to a great
interest for the disease in the international press. The review focuses on the positive and
negative consequences of this media interest. In addition a couple of papers which deal with
recording of symptoms, epidemiological studies and a treatment experiment with full blood
transfusions are described. Finally some conclusions are drawn concerning the situation
today – what is being done and what should be done?
Oppfølging av pasienter med små uopererte Ventrikkel Septum Defekter

Follow-up of patients with small unoperated Ventricular Septal Defects
Kjærvik, Cato
Marskar, Bernt Johan

Supervisor: Gunnar Norgård, professor dr.med.
Institutt for klinisk medisin, UiB


Background: The aim of this study was to assess the physical performance, general health,
incidence of endocarditis and the knowledge and use of prophylactic antibiotics to prevent
endocarditis in a group of children and adolescents with an isolated ventricular septal defect
(VSD) too small to warrant operation. We also conducted a search in available litterature to
evaluate the current guidelines and indications for closure of this type of congenital heart
defect.

Material and methods: A group of 33 patients diagnosed as having an isolated, small
(<35%) ventricular septal defect, received a questionnaire addressing the issue of general
health, physical performance and endocarditis. All patients were evaluated by heart
catheterization and had a VSD considered too small to warrant operation. 17 patients
completed and returned the questionnaire. We compared our results with other studies
addressing these issues.

Results: All patients in our study are enjoying good health and are reported to have a normal
physical performance. 76% reported knowledge of routine endocarditis prophylaxis, but only
46% had actually used it at some time. 12% used it regularly. There were no incidences of
bacterial endocarditis amongst our candidates.

Discussion: Our study was designed to collect subjective information from patients on
general health and physical performance. Other investigations addressing the same issues, but
using an objective approach have found a subnormal physical performance and a higher
percentage of complications than in our study. The knowledge and use of prophylactic
antibiotics to prevent endocarditis is similar to other studies. No patients had suffered
bacterial endocarditis. This may be due to the small number of patients included in our study
and the low mean age in our study population. Considering our findings and other available
studies it looks like patients with a small, isolated ventricular septal defect are in good health
compared to their peers. The incidence of heart related complications is similar to the
incidence of complications related to open heart surgery. The surgical techniques of open
heart surgery have improved since its introduction and new non-invasive techniques are being
evaluated.

Conclusion: All patients in our study are enjoying good health and are reported to have a
normal physical performance. The knowledge and use of endocarditis prophylaxis is not
acceptable. The consequences of suffering bacterial endocarditis are severe. Prophylaxis is
cheap, safe and effective in preventing bacterial endocarditis. More emphasis must be placed
on communicating this knowledge to patients. Given that patients with a small, isolated
ventricular septal defect are thoroughly investigated and diagnosed, we find that the
guidelines for surgical closure of an isolated, small ventricular septal defect are adequate.
Personlighet og prestasjoner hos en norsk sydpolekspedisjon

Personality and performance among a Norwegian South Pole expedition

Kristoffersen, Stian


Veileder: Holger Ursin, professor dr.med.
Institutt for fysiologisk psykologi, UiB



Background: The right personal qualifications are assumed to be an important determinant
for succeeding under extreme conditions as a South Pole expedition. To predict and measure
personal qualifications is important in the selection of candidates for such tasks.

Material and methods: This study follows a Norwegian South Pole expedition with four
participants. The group stayed in Antarctica for 14 months from December 1999 to March
2001. Two of the participants crossed Antarctica from 21 December 2000 to 4 March 2001.

The group was tested before, under and after the expedition.

Prior to departure all four participants answered the questionnaire Selection of Antarctic
Personnel, SOAP. SOAP is developed as part of an international research project for selecting
personnel, and is tested for 300 seekers and participants in expeditions by British Antarctic
Survey. The answers from the four were compared to this background material.

To follow the participants’ performance we used several methods. As a measure of stress
level, cortisol in saliva was taken monthly. During the Antarctic crossing the skiers answered
“Antarctic Questionnaire”. As soon as possible after arrival Norway we did an individual
debriefing using a structured interview based on Antarctic Questionnaire. The purpose of this
interview was to get an impression of the performance of the group and each of the
participants.

Results and interpretation: The SOAP-questionnaire unveils a significant difference of
personality between the two main participants of the expedition. Debriefing tells that to the
extent there were conflicts within the group, these two were the ones involved. This study
suggests that SOAP could be useful in selecting personnel for tasks like this.
Høy alder og kirurgi?
En oppfølgingsstudie av pasienter eldre enn 85 år operert ved Haukeland
sykehus kirurgiske avdeling

Kvelvane, Christer
Lindblad, Martin


Supervisors: Åke Andrén-Sandberg, professor og Odd Søreide, professor
Institutt for kirurgiske fag, UiB



Background: The surgeons often have to consider whether the patient should be operated or
not. Normally, surgeons use generelly accepted indications or common criteria to decide
whether surgery is indicated or not. But when concidering indications for surgery on very old
patients, other criteria might be added. Such considerations must be based on factors known
to predict outcome, for instance mental status and home situation. How does age affect the
potential benefits from surgery?

Methods: In a retrospective cohort study based on patient journals at the Department of
surgery Haukeland University Hospital, 62 elderly patients above 85 years of age, undergoing
surgery during year 2000, were followed up with telehpone-interview two years
postoperative. Data elements recorded were age, sex, diagnosis on admission, past medical
history, mental status, Karnofski Index, postoperative stay and home situation. We devided
the population into groups for survivors and dead, and compared the two groups, related to
potential prognostic factors.

Results: After a follow up of two years, 37 of the subjects were dead and 25 had survived.
We found that in the group of those patient who died; there were more acute operations, they
had more often deteriorated mental status, their past medical history were more serious and
they often came directly from an other institution. Based on the diagnosis at admission, it was
one particular diagnosis that was more frequent in the group of the dead, that was arterial
insufficiency.

Conclusions: Patients surviving two years have maintained their quality of life. Therefore
age per se should not be a single factor in determining treatment strategy. Factors found to
influence outcome negatively were; impaired mental status, low Karnofski-index, serious past
medical history and admission directly from an institution. Patients admitted for arterial
insufficiency carry a special risk, but this can probably be explained on the basis on the
mentioned factors.
Mot utryddelse av polioviruset –
strategier, utfordringer og gjenstående problemer

Kvideland, Katrin
Lysberg, Ane


Supervisor: Maja Sommerfelt Grønvold, professor
Avdeling for mikrobiologi og immunologi, Gades institutt, UiB



For centuries poliovirus has been sweeping the world, destroying the lives of millions by
causing disease, paralysis and even death of the ones touched. In its wake there are still more
millions affected by the dreaded disease of poliomyelitis; the families, the friends and
relatives of the victims. Knowing that by far the greatest group of victims are young children,
only adds to the disaster.

The World’s Health Organisation launched a brave new program I 1988, namely the resolve
to eradicate poliomyelitis and its etiologic agent, poliovirus, from the face og the earth by
2001. The time estimate has since been changed to 2005. By May 2003 the number of
countries where poliovirus is endemic had decreased from 127 in 1988, to seven.
To reach this ambitious goal, the WHO has worked out elaborate strategiew. The simple
premise is to vaccinate as many as possible of the young children under five years of age in
all endemic countries, and in this way immunise entire generations. The vaccine of choice is
the OPV, oral polio vaccine, consisting of attenuated virus and developed by Dr. Albert Sabin
in 1961.
The Eradication Program also includes provisions for surveillance of polio occurrence,
strategies for ending the vaccinationactivities and the safe containment of the virus in a world
free of polio.

In this paper we examine the strategies for a successful vaccination operation, and the
challenges met by the WHO during this work, such as warfare and frequent cross-border
population movement. We also look at the preparations for ending the vaccination program,
and lastly we discuss the calculated risk of keeping this hazardous virus confined to
laboratories once eradication is complete.
Er det kroppen min?

Ei empirisk kartlegging av kroppsbilete hos gutar og jenter.

Laupsa, Lena
Nævdal, Randi


Supervisor: Kjell Morten Stormark, førsteamanuensis II
Regionsenter for barn og unges psykiske helse, UiB



Background: Previous reports suggest that there are major differences between hos males
and females view their own body. The purpose of this study was to empirically investigate
how males and females estimate their body size.

Material and Mathods: Twenty-three male and twenty-eight female, healthy young adults
were presented with a series of pictures of themselves, another person and an object, which
were manipulated in width, so that the motifs appeared either narrower or wider than real size.
The subjects were asked to adjust the width of the motifs to what they recognized as the
original size.

Results: No total differences between males and females in their estimation of the pictures
were found. The females significantly underestimated the picture of the other person, and
also tended to underestimate the pictures of themselves compared to the males.

Conclusion: These findings support the idea that there are gender differences in estimation of
body size.
Sammenhengen mellom plasmakonsentrasjon av Vaskulær Endotelial
Vekstfaktor (VEGF) og IGFBP-3 proteaseaktivitet hos brystkreftpasienter

Lehmann, Sjur


Supervisor: Svein Inge Helle, overlege dr. philos.
Onkologisk avdeling, Haukeland universitetssykehus



Angiogenesis is one of the key elements in the process of tumour growth and metastasis.
Previous studies have shown elevated levels of the important angiogenetic growth factor
Vascular Endothelial Growth Factor (VEGF) in cancer patients. There is also an increase in
the activity of spesific proteases for Insulinlike Growth Factor - Binding Protein - 3 (IGFBP-3
protease).

As VEGF increases capillary permeability and IGFBP-3 protease is abundant in extracellular
fluid, we hypothetised a positive correlation between plasma levels of these parameters in
breast cancer patients. EDTA-plasma from 54 breast cancer patients with known protease
activities was sampled and VEGF-levels determined by ELISA. Statistical analysis of the
results indicated a positive, though not significant, correlation (p=0.228). Mean VEGF
concentrations for samples in the high protease activity range were compared to samples in
the low activity range, yielding no significant difference.

Conclusion: No significant correlation could be demonstrated between IGBP-3 protease
acticity and VEGF concentration in these samples.
Tuberkulose ved Haukeland sykehus i 1989 og 1999

Lied, Anbjørn Elgvin


Supervisor: Odd Mørkve, førsteamanuensis, overlege, dr. med.
Senter for internasjonal helse, UiB



Setting: Treatment for tuberculosis at Haukeland University Hospital, Bergen, Norway

Objectives: To investigate resistance, cure rate, symptoms and adverse effects associated
with tuberculosis and treatment for tuberculosis in a Norwegian city.

Design: A retrospective analysis of 28 patients with tuberculosis in 1989 and 1999.

Results: Resistance: Isoniazid (18%), streptomycin (21%). We did not find resistance for
rifampicin, ethambutol or multidrug resistance. The cure rate was 79%, 7% died, and 14%
defaulted. Most frequent symptoms where cough with or without sputum and unspecific
symptoms. Haemoptysis occurred rarely. 11% did not have any symptoms. 33% experienced
serious adverse effects. These resulted in suspension of one drug in half of the cases. Most
frequent where: Skin rash with itching, gastrointestinal disturbances and fever.

Conclusion: In this study there is a higher occurrence of resistance than in comparable
countries. The cure rate is below WHO target, this is mainly caused by a high proportion of
immigrants. The symptoms have changed compared to the traditional, with a very low
occurrence of haemoptysis. Serious adverse effects where common, but did not result in
discontinuation of therapy.
Effekt av “dobbel glutamat” hos pasienter med funksjonell dyspepsi

Lilleøren, Unn Hege


Supervisor: Trygve Hausken, professor dr.med./overlege
Institutt for indremedisin, UiB/Gastroenterologisk seksjon, Medisinsk avdeling, HUS



Background/Aims: Patients with functional dyspepsia often have meal-induced dyspeptic
symptoms. They seem to react particularly strong after ingestion of clear meat soup rich on
glutamate (Toro Klar Kjøttsuppe). A former study examined the possibility that it could be
the content of glutamate (MSG) in the soup that was responsible for the intense symptoms
found in these patients after ingestion of the soup. The results did not support this hypothesis.
On the contrary it seemed that removing the glutamate from the soup made the symptoms
worse. We wanted to examine whether a increase in the glutamate-content of the soup would
further improve the symptoms in these patients.

Method: In 10 patients with functional dyspepsia, symptoms (pain, nausea, epigastric
fullness, epigastric discomfort and satiation) was recorded by a visual analoge scale (VAS)
before, at 0 min, 10 min and 20 min after ingestion of 500 ml clear meat soup in 4 min. The
area of gastric antrum and sagittal fundus, and the frontal diameter of the fundus was
recorded, as measured with 2D ultrasound, before, at 0 min, 10 min and 20 min after ingestion
of 500 ml clear meat soup in 4 min. In all subjects this was recorded on two separate
occasions, where they, in randomised order, on one occasion were served clear meat soup
with single dose of glutamate, on the other clear meat soup with double dose of glutamate.
Except of the glutamate-content, the two soups were identical.

Results: Total scores of the symptoms showed a tendency to be lower at 10 min and 20 min
after ingestion of the suop with double dose of glutamate. The differences were not statistical
significant at neither 10 nor 20 minutes. At 0 min after ingestion of soup the total scores of
symptoms were virtually identical for the two soups. Differences in ultrasound recordings
were only significant for frontal diameter of the fundus at 0 min after ingestion of soup
(p=0,04). There were a slight tendency, though, of the antral areal, fundusareal and the
fundusdiameter to be higher after ingestion of soup with double dose of glutamate, but these
differences were, however, not statistically significant.

Conclusion: Our results supports the hypothesis that glutamate may improve the intensity of
symptoms, gastric accomodation and visceral hypersensitivity in patients with functional
dyspepsia. However, the results were not statistically significant. More research need to be
done to establish if this is the case.
Antibodies against Enterotoxigenic Escherichia coli and Vibrio cholerae in
Young Children in Bhaktapur, Nepal

Lindemark, Frode


Supervisors: Harleen M.S. Grewal, førsteamanuensis og Tor A. Strand, stipendiat
Avdeling for mikrobiologi og immunologi, Gades institutt og Senter for internasjonal helse



Introduction: Diarrheal diseases are estimated to account for up to a quarter of childhood
deaths in developing countries. Community-based studies have identified enterotoxigenic
Escherichia coli (ETEC) as the most frequent cause of diarrhea among children under five.
ETEC and Vibrio cholerae produce immunologically cross-reacting toxins [LT and cholera
toxin (CT), respectively] that play a key role in their pathogenicity. Protection against these
infections is probably mediated by antibacterial antibodies at the mucosal surface in the gut
and by secretory IgA antitoxin antibodies. In order to be efficacious, vaccines against enteric
infections should induce a specific secretory IgA (SIgA) as well as an adequate systemic
immune response. Serum anti-toxin antibodies (against ETEC LT and CT), though a marker
of prior exposure, may not reflect protection.

Objectives: 1) Describe natural immunity to ETEC infections; and 2) describe age specific
antibody levels at baseline in a group of Nepali children that participated in a vaccine trial.

Design: We determined age specific vibriocidal and anti-toxin antibody levels at baseline in
94 Nepali children 32 - 59 months of age who took part in a trial examining whether zinc
modulates the immune responses to a cholera B subunit toxoid whole cell vaccine
(Dukoral®).

Results: In the analyses of 66 and 69 sera, there were no associations between age and the
levels of anti-CTB IgG or IgA, respectively, at baseline. Furthermore, there were also no
associations between age and vibriocidal antibody levels (n=94).
Prionsykdommer

Lund, Stein Arve


Supervisor: Maja A. Sommerfelt Grønvold, professor
Avdeling for mikrobiologi og immunologi, Gades institutt, UiB



Prion diseases are a group of rare yet fatal neurological diseased affecting both animals and
man. The most widely known members of this group are Creutzfeldt-Jakob disease (CJD)
and Kuru in man, Scrapie in sheep and Bovine Spongiform Encephalopathy (BSE/”Mad Cow
Disease”) in cattle. Disease arises when a naturally occurring hos protein, the prion, acquires
an altered secondary structure that is resistant to natural breakdown and accumulates in the
cell. These diseases can be inherited or occur sporadically. Transmission can be iatrogenic
between patients through the use of surgical instruments, the use of human derived growth
factor and cornea and dura mater grafts.

In the mid 1980’s a severe epidemic of BSE developed amongst cattle in the United
Kingdom. It is most likely that the animals became infected through consumption of
industrial feed derived from slaughter waste. BSE is now considered to be the most probable
cause of a new prion disease in humans called variant CJD (vCJD) acquired through the
ingestion of contaminated beef. Due to the long incubation period it is not yet clear how
many people are affected.
Diagnosing prion diseases is difficult. Brain biopsy is not generelly recommended. At
present the only definitive diagnosis can be made at autopsy.
Sampling of interstitial fluid in mice by subcutaneous and intermuscular
wicks
Markhus, Carl Erik


Supervisor: Helge Wiig, professor dr.med.
Seksjon for fysiologi, Institutt for biomedisin, UiB



Colloid osmotic pressure (Л) is one of the factors determining transcapillary fluid flux. By
use of a wick method, first described by Aukland and Fadnes (1) and later modified for use in
muscles by Wiig (2), we were able to isolate interstitial fluid from mouse subcutis and
skeletal muscle. Three-stranded, dry nylon wicks were inserted post mortem to avoid local
inflammation and thus, eliminating protein extravasation and wick fluid contamination. Wick
fluid Лi (in mmHg) averaged 18.7 ± 2.2 (means ± SD) in plasma and 9.1 ± 2.1 and 12.5 ±
1.7 in subcutis and muscle, respectively. The corresponding albumin and globulin
concentrations (in mg/ml) were 31.5 ± 2.8 and 11.0 ± 1.6 in plasma, 20.3 ± 3.0 and 2.9 ± 0.5
in subcutis and 21.3 ± 1.1 and 3.2 ± 0.6 in muscle. HPLC analysis of plasma and wick fluid,
al showed similar patterns, with peaks at 7.7 ml and 11.4 ml, representing the globulin
fraction, and a peak at 12.8 ml, representing the albumin area. Only a minor peak in the
myoglobin area was observed, indicating an almost insignificant leakage of intracellular
proteins to wick fluid, both from subcutis and muscle. Plasma protein extravasation,
evaluated by leakage of 125I-human serum albumin, showed that contamination of wick fluid
by plasma proteins was negligible. Induction of net capillary filtration by injection of saline,
led to average Л of 14.5 ± 1,4m 6.8 ± 0.8 and 7.7 ± 1.0 mmHg in plasma, subcutis and
muscle, respectively. We conclude that the wick technique easily can be adapted for use in
mice, and may represent a reliable method to isolate interstitial fluid and to study
transcapillary fluid flux in this species.
Regulering av angiogenese i aggressive maligne melanomer


Mathew, Seema


Supervisor : Lars A. Akslen, professor
Avdeling for Patologi, Gades institutt, UiB



A malignant melanoma is a melanocyte-derived tumor that originates primarily from nevi.
This is among the cancer forms that are increasing in the western world. Ultraviolet radiation,
sunburns in childhood, fair skin type, familial occurrence and multiple moles are important
risk factors. Since the response to radiation treatment is low, the first choice of treatment is
surgical excision. The prognosis, being related to Breslow's tumor thickness, decreases with
thickness > 3,5mm.

Tumor cells need sufficient nutrients and oxygen for growth and metastasis. This is due to a
balanced interplay between pro- and antiangiogenic factors. bFGF, VEGF, IL-8 are among
factors that act synergistically. bFGF induces neovascularisation by both autocrine and
paracrine mechanisms. The aim of the project was to look into the importance of bFGF in
angiogenesis and tumor progress.

A total of 202 human tissue samples from aggressive malignant melanomas and lymph nodes
were analyzed by immunohistochemistry and TMA technique to identify bFGF. bFGF and its
association with different parameters (mean vessel density, prognosis, etc.) was determined
by the SPSS statistic program.

78% of the tumor associated endothelium showed positive staining for bFGF, whereas few of
the tumor cells (29%) were FGF+. As expected, bFGF expression was correlated to mean
vessel density. In addition, we found significantly increased lymph vessel density and survival
with FGF positive endothelium. The latter finding is probably attributed to FGF's role as a
differensiation factor in endothelial cells.

The conclusion must be that FGF is a factor vital to the stimulation and upholding of adequate
vascularisation, but it is not the most decisive factor for tumor growth and metastasis.
Individual factors can modulate the effects of others, and more studies are needed. The
challenge lies in finding effective antiangiogenic therapies.
DiGeorges syndrom
Seks pasienter – en kasusserie fra Senter for Medisinsk Genetikk

Melhus, Janne Dahle


Supervisor: Jaran Apold, professor
Senter for medisinsk genetikk, UiB



DiGeorge´s syndrome has been recognized since 1965, and the most extensive part of the
research related to the syndrome has been focused on the most common malformations; the
cardiac features, cleft palate, thymus- and parathyroid gland-hypoplasia and the characteristic
facial features. The patients are found to have a deletion of the long arm of chromosome 22, a
defect which arises a spontaneous mutation in 80-90% of the cases, and it is inherited in an
autosomal dominant pattern. The deletion occurs in 1 of 3000-4000 individuals.

This paper reviews the medical records of six patients who have been referred to the Center of
Medical Genetics at Haukeland University hospital in Bergen, Norway. The cases
demonstrate the great need for multidisciplinary care, which is highly developed in Norway,
but they also reveal that the majority of the patients have already reached puberty before they
are diagnosed. This fact suggests that there is a lack of knowledge about the syndrome among
the primary care centers and in the pedagogic- psychological service for schoolchildren. The
reviewed cases also show that we still know too little about the language- and learning
disabilities and psychiatric problems these patients face, and the hope is that these areas will
receive greater attention in the future.
Er det skadelig for hørselen å spille i brassband?

Moen, Henrik Sundt


Supervisor: Ola Lind, overlege dr.med.
Høresentralen, Haukeland universitetssykehus



Sound pressure measurements were performed in five different brass bands, and a
questionnaire regarding the experience of the sound pressure among 164 brass band musicians
was also performed. On the background of audiometry measurements performed in similar
studies in symphonic orchestras, and by comparing sound pressure measurements performed
in brass bands, the goal was to find out if playing in brass band is a hazard to hearing, and
also if the sound pressure is in conflict with official regulations (Forskrift om støy på
arbeidsplassen). The results show that the sound pressure in most cases exceed the limits set
by official regulations. At the same time, playing in brass band does not seem to be a hazard
to hearing. Nevertheless, the questionnaire shows that there is a widespread opinion that there
is a too high sound pressure in brass band, and that there is a concern for the future
consequence on hearing from the high sound pressure level.
The epidemiology of tuberculosis

Mokgwathi, Gaorutwe


Supervisor: Aksel Schreiner, professor
Institutt for indremedisin, UiB



Tuberculosis kills 2 million people each year. The global epidemic is growing and becoming
more threatening. The breakdown in health services, the spread of HIV/AIDS and the
emergence of multi-drug resistant TB are contributing to the worsening impact of the disease.

In Africa in the last decade, HIV is the single most important factor that determines the
increased incidence of TB. The objectives of TB control programmes are to reduce mortality,
morbidity and disease transmission, while avoiding the development of multi-drug resistant
TB. The WHO recommended treatment strategy for detection and cure of TB is the “Directly
Observed Therapy Strategy” (DOTS). The epidemiological surveillance methods are the
tuberculin test, the chest X-ray, and the bacterial examination of sputum by microscopy and
culture. The administrative and environmental control measures are aimed at reducing M.
tuberculosis tranmission. As an example, a brief analysis of the TB programme in
Mahalaphye district is described.
Døgnvariasjoner har ikke stor innvirkning på serumverdier av løselige (s) L-
selectin, s-intercellulær adhesjonsmolekyl-1 (sICAM-1) og trombopoietin
(TPO) hos friske voksne.

Circadian variations do not have a major impact on serum levels of soluble (s)
l-selectin(CD63l), s-intercellular adhesion molecule 1 (sICAM-1/CD54) and
trombopoietin in healthy individuals.

Mosevoll, Knut Anders


Supervisor: Øystein Bruserud, professor
Institutt for indremedisin, UiB



Several studies have been done to reweal how leukocytes migrate, and which mediators that
modulate migration. Several soluble adhesion molecules and cytokines are important
mediators, and can be detected in human serum. Some of these mediators show altered serum
levels in hematopoietic malignancies, autoimmune diseases or serious infections. In the
present study we examined whether serum levels of soluble (s) L-selectin and soluble
intercellular adhesion molecule-1 (sICAM-1), that both are expressed by immunocompetent
and hematopoietic cells, and the hematopoietic growth factor Thrombopoietin (Tpo) show
circadian variations in healthy adults. The results reweal that venous serum levels of all three
mediators showed only minimal variations when measured regularly during a 24 hour period.
In contrast, previous studies have demonstrated that these levels are markedly altered for
example during serious bacterial infections. Taken together my results demonstrate that serum
sampling at standardized times is not necessary in future studies of the possible clinical use of
these serum levels.
Resistance to anti-tuberculosis drugs in Mycobacterium tuberculosis with
emphasis on drug resistant strains isolated in Botswana
Motswakadikgwe, Thusego


Supervisor: Bjarne Bjorvatn, professor
Senter for internasjonal helse, UiB


1995-1996 SURVEY:
Background: Botswana, southern Africa, were the tuberculosis (TB) case rate increased by
120% from 1989 to 1996 in spite of a decade of implementation of the directly observed
therapy, short course (DOTS) strategy.
Objective: To determine the prevalence of and risk factors for drug-resistant TB in an
epidemic setting.
Design: Systematic national random survey of newly diagnosed pulmonary TB and all
patients requiring retreatment during 1995-1996. Interviews were conducted, human
immunodeficiency virus (HIV) testing was offered, and drug susceptibility testing was
performed on isoniazid, rifampicin, streptomycin and ethambutol.
Results: Resistance to at least one drug was identified in 16 (3.7%) new cases (95%
Confidence Interval (CI) = 2.2-5.8) and 18 (14.9%) retreatment cases (95% CI=9.3-22.1).
One (0.2%) new case (95% CI=0.01-1.5) and seven (5.8%) retreatment cases (95% CI=2.6-
11.1) had resistance to at least isoniazid and rifampicin (multidrug-resistant TB). Retreatment
cases with MDR-TB were significantly more likely to have worked in the mines in South
Africa than were cases with fully susceptible isolates. Of 240 patients tested for HIV, 117
(48.8%) were positive; the prevalence was similar among new and retreatment cases, and was
not a risk factor for drug resistance in either group.
Conclusion: During the HIV and TB co-epidemics in sub-Saharan Africa, widely
implemented DOTS may help to control drug-resistant TB. However, the TB case rate can be
expected to continue to climb in spite of the implementation of the DOTS strategy.

1999 SURVEY.
Background: Botswana, where HIV prevalence was 38% among adults and the TB rate was
584/100,000 in 2000. A 1995-6 survey demonstrated low levels of anti-TB drug resistance.
Objective: Because TB drug resistance may increase rapidly in HIV-infected populations, a
second survey was undertaken in 1999 to determine any increase in anti-TB drug resistance.
Design: Sputum specimens positive for acid-fast bacilli from patients without prior TB
treatment (new patients), and all sputum specimens from all patients reporting prior TB
treatment (retreatment patients) were collected nationwide. Specimens were cultured for
Mycobacterium tuberculosis and tested for resdistance to isoniazid, rifampicin, ethambutol,
and streptomycin.
Results: January to May 1999, 783 patients were consecutively enrolled from all districts.
Of these, 483 (61.7%) were male, median age was 33 years, and 82% were new patients.
Drug resistance occurred in 6.3% of new patients (95% CI=4.6-8.6) and 22.8% of retreatment
patients (95% CI=16.5-30.1). Resistance to at least isoniazid and rifampicin (=MDR-TB) was
found in 0.5% of new (95% CI=0.1-1.3) and 9.0% of retreatment patients (95% CI=5.1-14.5).
Concusion: Despite the high HIV prevalence, antituberculosis drug resistance remains
relatively low in Botswana, probably as a result of a well-functioning TB programme.
Periodic surveys will be essential to adequately determine any significant trend.
Hypoglykemi hos diabetikere – med fokus på hypoglykemi-assosiert autonom
svikt og “unawareness”

Mulelid, Runar


Supervisor: Hrafnkell Thordarson, seksjonsoverlege
Endokrinologisk seksjon, Medisinsk avdeling, Haraldsplass Diakonale Sykehus



Hypoglycemia is the main limiting factor in the treatment of diabetes mellitus type 1.
Hypoglycemia normally causes a neuroendocrine reaction including increased production of
glucagon and adrenalin. However, repeated hypoglycemic episodes reduce this response in
many diabetic patients. This is called hypoglycemia-associated autonom failure and leads
both to defective glucose counterregulation and disappearance of normal hypoglycemic
symptoms (unawareness). The patients will therefore reach neuroglycopenia directly with
reduced cognitive function and reduced consciousness. This makes it difficult for the patient
to help himself. Hypoglycemia-associated autonomic failure and unawareness therefore
increase the risk of severe hypoglycemia.

Even though hypoglycemia happens much more seldom in patients with diabetes mellitus
type 2 than in those with diabetes mellitus type 1, experiments have shown that patients with
advanced type 2 disease can develop hypoglycemia-associated autonomic failure in the same
way as patients with diabetes mellitus type 1.

Several experiments have shown that unawareness can be reversed if the patient avoids
hypoglycemia over a period of 2-3 weeks. This way the patient can regain symptoms of
hypoglycemia at higher glucose levels than what is necessary for cognitive dysfunction.
Experiments also show that the adrenalin component of the counterregulation – at least partly
– can be increased if hypoglycemia is avoided.

However, in practice it is very difficult to both manage good metabolic control and avoid
hypoglycemic episodes at the same time. Many therapists will doubt if this is possible with
the technology and treatment of today. The challenge is to make treatment procedures which
ensure good metabolic control, but which at the same time reduce the frequency of
hypoglycemic episodes.
Skadeforekomst i norsk judo med særlig vekt på kneskader

Injuries in Norwegian judo, with emphasis on knee injurie.

Myrebø, Esther A.


Supervisor: Sverre Mæhlum, dr.med.
Pfizer Norge AS



The intention of this survey was to get an overview of the injuries occurring in Norgegian
judo, particularly looking at knee injuries, as there seemed to be an increase in serious knee
injuries among competitors at a high level. There has never been a similar survey in Norway.
A special questionnaire was made.
The sample is small and cannot be considered, representative, since the total population (judo
players aged 14 and more registered with the Norwegian Judo Federation) is unknown for the
period as the federations register was lost just before the questionnaires were sent out.
No conclusions can therefore be drawn.

Totally 114 persons was included in the survey two years after the beginning of the study, 77
men and 37 women. 107 of these were still active in judo, seven had quit because of injuries,
3 by injuries caused in judo (we have no information as to what kind of injuries caused this).
The injury rate was 52%. This is very high compared with other studies, and is probably an
expression of a biased sample.
We did not find any difference in the frequency of injuries between the sexes. The highest
rate of injury was among senior competitors at a high level with many years of experience in
judo. The rate among beginners was considerably lower at 21%. Most injuries were to
shoulder, elbow, knee and ankle. This is in concordance with other studies.
This survey, while not conclusive, can be used as a reference for new studies. These should
be based on a greater population based on e.g. registers from the federation and new revised
questionnaires sent to each individual.
Supraventrikulære tachykardier som følge av ekstra ledningsbaner mellom
atriene og ventriklene

Nakling, Christian


Supervisors: Ole Jørgen Ohm, professor/overlege og Jian Chen, post doktor
Institutt for indremedisin, UiB og Hjerteavdelingen, Haukeland universitetssykehus



Background
Supraventricular tachycardias (SVT) caused by extra conduction pathways between the atria
and the ventricles are relatively common disorders, and some have quite annoying symptoms.
The aim of this study was to review the options of treatment for SVT and evaluate
symptomatology and the results and complications of radiofrequency ablation (RFA).

Material and methods
To find the success- and complication rate of RFA, the results of all patients with SVT treated
by RFA at Haukeland sykehus from 01.01.01.-30.09.01 were investigated. Three different
types of SVT (atrioventricular nodal reentry tachycardia = AVNRT, Wolff Parkinson White
Syndrome = WPW-syndrome and concealed accessory pathway =concealed AP) were
studied. 56 patients had AVNRT (38 women and 18 men), 18 had WPW-syndrome (6 women
and 12 men) and 14 had concealed AP (6 women and 8 men). The patients had an age range
of 7-78 years (mean 42.2 years).
In addition 20 patients hospitalized due to RFA treatment were interviewed with focus on
symptoms and complaints during daily activities. A quality-of-life form was filled out by
every patient. These forms were made especially for this study.

Results
The RFA treatment was successful in 55 of 56 patients (98,2 %) with AVNRT, 15 of 16
patients (83,3%) with WPW-syndrome and 14 of 14 patients (100 %) with concealed AP.
Generally there were few complications. In the patient group with AVNRT, two developed
transient pericarditis and one developed an temporary AV-block. One of the patients with
concealed AP developed transient pericarditis after the RFA treatment.
The quality-of-life study reflected that most of the patients had some annoying symptoms, but
only a few were markedly affected in their daily activities. This affection was influenced by
the duration and frequency of the SVT attacks, and by precipitating factors of the attacks.

Conclusion
SVT caused by extra conduction pathways between the atria and the ventricles is treated
effectively by RFA. There is a high rate of success and a low complication rate. The patients
are permanently healed, avoid side effects of antiarrhythmic drugs and often achieve higher
quality of life. This makes RFA a treatment of first choice to patients with these types of heart
rhythm disorders.
Depresjon og koronarsykdom

Nesheim, kjersti


Supervisor: Ottar Nygård, overlege/post doktor
Hjerteavdelingen, Haukeland universitetssykehus/Institutt for indremedisin, UiB



Background: Coronary heart disease and depression are both significant health problems.
Data suggest a connection between the two diseases.

Purpose: To critically evaluate data that suggest a connection between disorders, discuss
possible mechanisms that may underlay the association, and assess if this should influence the
treatment of choice of the diseases.

Method: A literature study using the literature database PubMed. The most important search
items are ”mental depression”, ”myocardial infarction”, and ”coronary artery disease”.

Conclusion: Data from prospective studies do not suggest that depression leads to
development of coronary heart disease and myocardial infarction. There is however good
documentation that depression is associated with a 30-40 % increased risk of reinfarction and
death after acute myocardial infarction. The elevated risk can be caused by increased activity
in the sympathetic nerve system, increased peripheral serotonine level and altered platelet
activity. The effect on the long-term prognosis can also be caused by an unfavorable health
behavior among depressed patients. There are still no data from large-scale randomized
studies that may clarify whether medical antidepressant treatment can improve prognosis
among depressed patients with coronary heart disease. A recent study however shows that
sertraline may be safely administered and improves depressive symptoms among patients with
acute myocardial infarction. The treatment was also associated with a clear, but non-
significant reduction in overall cardiovascular events during follow-up.
Trengs det nye retningslinjer for håndtering av pasienter med lette
hodeskader ?

Nummedal, Bjørnar


Supervisor: Haldor Slettebø
Nevrokirurgisk avdeling, Haukeland universitetssykehus



Mild head injury is a common cause of admission to Norwegian hospitals. The objective of
the management of patients with mild head injury is early detection and treatment of
intracranial hematomas, which is a rare but potentially fatal complication. The article focuses
on today’s management of mild head injury patients in hospitals, and to determine whether it
is suitable to introduce new management guidelines. The article shows that there is
considerable management variation between hospitals. About half of Norwegian hospitals
admit by routine all mild head injury patients. It is advocated that CT scan could be used more
efficient in the management. New management guidelines are suggested based on literature,
that include use of Head Injury Severity Scale (HISS), more extensive use of CT scan and
early discharge of patients with minimal risk of complications. The introduction of the
suggested guidelines would be cost saving without reducing the quality of the management
of patients with mild head injury.
Folat og svangerskap

Nystad, May Britt
Petersen, Therese


Supervisors: Anne Kjersti Daltveit, førsteamanuensis og Stein Emil Vollset, professor
Seksjon for forebyggende medisin og Seksjon for medisinsk statistikk, Institutt for
samfunnsmedisinske fag, UiB


Introduction:
The National Council on Nutrition and Physical Activity, Oslo, recommended in 1998 that Norwegian
women planning pregnancy should take folate-subtitutes before conception and in the three first
months of pregnancy to reduce the risk of neural tube defects. Their report recommended information
campaigns towards fertile women and health workers as information providers.
We wanted to find out whether the use of folate related to pregnancy has increased after this
recommendation, and in which way health personnel help increasing knowledge.

Material and methods:
Part I - Using data from the Medical Birth Registry of Norway, with information about 176 929
womens pregnancies during the period 1999-2001, we have looked for the association between
folate/multivitamin use and variables like socio-economic, geography and smoking.
Part II - We have done an interview with 24 public health nurses within Bergen community about their
knowledge, attitudes and practice when it comes to information about folate to fertile women

Results:
Part I - Women`s use of folate and multivitamins before and during pregnancy has increased in the
period 1999-2001. The folate use before pregnancy increased from 4.1 % to 8.9 % in this periode.
Largest increase in folate use was during pregnancy from 15.3 % to 28.2 %. Those who use most
folate are women above 30 years of age, married or cohabitants, women working fulltime, women
giving birth for their first time and women living within the health region east*. Smoking is negatively
assosiated with folate use.
Part II - Public health nurses within Bergen municipality that information about folate and pregnancy
is important, but they do not regard it as their task to inform fertile women about it. They state that
reason for this is that they do not see the target group in the right period of time. Their knowledge
about folate is good, but nearly half of them did not know that folatesupplements is important also
before conception.

Conclusion:
Our data shows that the recommendations from the National Council on Nutrition and Physical
Activity has reached fertile women, some groups more than others. This can be used in the planning of
new information campaigns to reach those with less knowledge.
The knowledge has also reached the public health nurses, but they do not give knowledge to fertile
women. They have insufficient knowledge about when folate supplements should be taken, this can
explain why they do not regard themselves as natural intermediary of this knowledge.
We regard the public health nurses as an important provider of information about folate through the
school health service and health station work if they are informed that folate is important to take also
before pregnancy.
Even though the knowledge and use of folate for health personnel and fertile women has increased in
the periode 1999-2001, the usage is still too low to expect a significant decline in the number of neural
tube defects.
Kontroll med egen helse før og etter utryddelse av Helicobacter pylori ved
ulcussykdom

Nytrøen, Gunhild


Supervisor: Ingvard Wilhelmsen, professor, dr.med/overlege
Institutt for indremedisin, UiB


Background:
The role of psychological factors in peptic ulcer disease is still open to discussion.

Aim:
To examine health locus of control in patients before and after eradication of Helicobacter
pylori.
Our hypothesis is that their sense of control regarding own health will increase if they are
cured of their ulcer disease.

Methods:
74 H.pylori-positive patients with relapsing duodenal ulcers and 78 control subjects without
dyspepsia where included in a prospective, controlled trial. The patients were compared to
normal controls two years before and ten years after eradication of H.pylori. Patients and
controls answered 18 questions in a questionnaire called Health Locus of Control Scale
(HLCS). HLCS records whether individuals believe that their health is controlled by internal,
external or chance factors.

Results:
At the time of inclusion there was no significant difference in patients and controls regarding
health beliefs. At the 10 year follow-up external and chance beliefs were not significantly
different, but the patients had significantly less internal control than the controls.

Conclusions:
These results are inconsistent with our hypothesis. It turned out that the patients attained a
feeling of having less internal control after their peptic ulcer had been cured. This was found
by comparing them to themselves 10 years ago, and in comparing them to the normal controls
now. Perhaps the healthy controls have an unrealistic belief that one can control one’s health.
While the patients who have gone through a long period of illness, followed by a period of
good health, have learned that life is uncertain. Through this the patients become more aware
of the fact that humans have little influence over our health.
Medikamentell behandling i svangerskapet

Nøkling, Cathrine H


Supervisor: Anders Lund, professor
Seksjon for psykiatri, Institutt for klinisk medisin, UiB



Objective: This paper discusses medical treatment of depression during pregnancy. The
arguments for treating a depression with medicaton versus the possibility of adverse effects
with prenatal antidepressant exposure on perinatal outcome are discussed. To assist
physicians in optimizing treatment plans for childbearing women with depression, a guideline
for medical treatment is presented. A decision-making plan to structure the information given
to the women in the context of a risk-benefit discussion is also presented.

Method: A search on the words “depression”, “pregnancy” and “antidepressant” was done
on medline from 1993-2003. The articles that were used are all published in well recognized
journals.

Results: Neither tricyclic antidepressant (TCA) nor selective serotonin reuptake inhibitors
(SSRI) is associated with major birth defects. Two studies suggest an increased risk of low
birthweight, premature birth and a decrease in Apgarscore when exposed to SSRI during third
trimester. Untreated depression is also known to increase the risk of low birthweight and
early delivery.

Conclusion: Women with moderat to severe depression should receive somatic
antidepressive treatment since the adverse effects of a non-treated fulminant depression is
considered most serious. To ensure good compliance, it is essential that the patient receive
information regarding the disease, its possible treatment options and outcome. The physician
must identify the womans perception of risk and “significant others” who might influence the
decision-making process.
Sjelelig næring i oppveksten – om behovet for myter og eventyr

The Spiritual Nourishment of Children and Young People - about the need for
myths and fairy tales.

Ohldieck, Annabel


Supervisor: Jon Geir Høyersten, overlege
Sandviken sykehus



The aim of this study is to elucidate the function of myths and fairy tales in children's and
young people's search for meaning and identity. It is written in the light of the current cultural
environment's significance for the way in which the individual perceives him/herself and the
world.

Background material for this study is gleaned from the work of a number of prominent
psychologists and psychiatrists. They maintain that a range of psychological illnesses are the
result of the lack of myths in today's society, which could otherwise provide ways of
understanding the world.

Harvard psychologist, Jerome Bruner states, “ When the prevailing myths are no longer
adjusted to the changes in man's condition, frustrations will arise; firstly in the form of a
mythoclast, and then in the lonely search for an inner identity.”

Developments in recent history have promoted science and rational thinking, perhaps at the
expense of the forms of understanding that myths represent. This development contrasts
considerably with earlier times and cultures, when great importance was attached to the
mythical. Myths acted as models of explanation for a number of central conditions relating to
man's view of life; from ethical and moral guidelines to deep religious questions, such as The
Creation.

Myths and fairy tales incorporated society's values; individuals discovered their identities
with the help of myths. Psychoanalyst C.G. Jung wrote, “For the sake of reason, `mytholising'
is a sterile speculation, but for the mind it is a health-bringing activity; it gives existence a
lustre that one would prefer not to be without”

Progress in the name of reason, can have supplanted other means of reaching understanding.
This, in turn, can have negatively affected our spiritual life, making it more vulnerable. Rollo
May writes about this, “A healthy society provides its citizens with relief from neurotic
feelings of guilt and exaggerated worries, through its myths.”

Suicide statistics among young people today highlight an alarming development. Drug misuse
continues to increase. Families are breaking up and traditions are in decline. Scientific and
technological developments cause changes in society at an accelerating speed. All these
conditions place great demands on man's ability to create an inner structure and meaning.
May writes, “Those who want to maintain their reason, will necessarily look for order and
coherence in the stream of impressions, feelings and ideas that enter their consciousness,
either from the inside or the outside. Each one of us is forced to take standpoints that in earlier
times were decided by the family, tradition, the church or the state. There is a need to create
myths that make our experiences meaningful.”

In “the lonely search for an inner identity” and the search for meaningful coherence, today's
children and young people have little support from myths. “As long as the world and society
are without myths that express beliefs and ethical ideals, depression and suicide will flourish.”
(May)

The hypotheses:

       1.     The absence of myths makes it difficult for children and young people to
       develop their identities.
       2.     The images that myths create open doors into parts of a person's life, that direct
       speech would have difficulty in describing. This means that myths are of particular
       importance to children and young people.

In this work, I have used the term “identity” as it is used in ego-psychology, in particular E.
Erikson's Development Theory. The approach is in the form of interpretation and I have relied
upon Gadamer's hermeneutic. The method is therefore phenomenalistic - hermeneutic

It is my wish that this study will stimulate to raising the awareness of the healing properties of
myths in work with children and young people.
Anvendelse av MRI i studiet av eksperimentell og klinisk tumorfysiologi med
vekt på angiogenese

Oppegaard, Oddvar


Supervisor: Arvid Lundervold, førsteamanuensis
Seksjon for nevrovitenskap, Fysiologisk institutt, UiB



There exist a great number of different MR-techniques, and every year seems to bring forth a
new method of application or a new pulssequence, which opens up new imaging possibilities.
The potensial is great, and it is hard to keep up with the rapid development.

This report gives a review of some of the traditional MRI-techniques and applications, as well
as a peek at the cutting edge of experimental use.
It is focused on the possibilities within cancer research, and especially the study of
angiogenesis. MR can be used to investigate multiple parametres and aspects of tumor
physiology and biology, for instance tumor vasculature (incl. perfusion and permeability) and
metabolism. Some of these parametres have been shown to correlate closely to tumor type
and grading, as well as risk of metastasis and mortality. This provides a basis for more
precise diagnostic and prognostic evaluation, optimization of treatment and for better
monitoring of therapeutic response.
Volvulus coli sigmoidei – belyst ut fra et klinisk materiale

Pedersen, Sigrun Ringdal


Supervisor: Arne Skarstein, professor dr.med.
Kirurgisk avdeling, Haukeland universitetssykehus



Background: Volvulus is a term used to describe a loop of bowel twisted on its mesentery. The
segment of bowel most frequently affected is the sigmoid colon. The patients are often elderly who
suffer from concurrent illnesses. Many have neurological or psychiatrical diagnoses, and a
considerable number of patients have a history of chronic constipation. How to treat this group of
patients most adequately has been a matter of dispute for years. The attitude towards offering
operation has been relatively liberal when dealing with young and otherwise healthy patients. The aim
is to avoid multiple recurrences during the many years left to live. When faced with elderly patients,
the approach has been somewhat different. Many are impaired in consequence of ageing and
comorbidity, and surgery may represent a great hazard. On the other hand, mortality has turned out to
increase with multiple recurrences, and the frequencies of recurrences are clearly less when the most
appropriate operative treatment has been performed. Whether decompression using a rectal tube
should be the only treatment, or whether operation should be considered, either acutely or electively, is
therefore a matter of judgement in each individual case.
By seeking information from patient’s medical records at the Department of Surgery, Haukeland
University Hospital, we hoped to establish an answer to whether surgery in some cases has been
postponed too long, or whether a more conservative approach generelly seems appropriate.

Material and Method: All medical records of patients with the diagnosis volvulus discharged from
the Department of Surgery, Haukeland University Hospital, during the period of 1990-99, were
reviewed. There were 51 patients with sigmoid volvulus, and this constituted 65% of all cases of
volvulus.

Results: Based on each patient’s first case record during this decade, the average age of those with
sigmoid volvulus was 66.78% of these patients suffered from neurological or psychiatrical illnesses
and/or chronic constipation. 42 patients had their first admission with volvulus, while 9 patients had
been admitted and treated for sigmoid volvulus on earlier occations. In most cases, the diagnosis was
confirmed by plain abdominal x-rays. In the remainder, barium enema was used, or the diagnosis was
established during operation. 34 patients were conservatively treated, 12 patients went through
surgery, in 3 cases barium enema proved to be sufficient treatment, and 2 patients were merely
observed. The operative procedures chosen were sigmoid resection and primary anastomosis or
Hartmann’s procedure. Postoperative complications in terms of pneumonia, ileus and atonic colon
occurred in 36% of these cases. 24 patients (47%) escaped new admissions during this decade.
Among the rest, there were 50 new admissions, and 38 were results of recurrences. Most recurrences
occurred among those conservatively treated. 14 new operations were performed, som electively and
others acutely. Two of the operations were performed laparoscopically. At the end of this decade, 24
of the 51 patients had died, and three of these deaths were directly associated with admissions for
sigmoid volvulus.
Conclusion: A ow recurrence rate following operation supports the view that radical treatment is the
best solution among patients without contraindications. Among old and frail patients, the approach
should be more cautious. Based on the results from our study, the risk of postoperative complications
is relatively high (36%). Since a considerable number of patients never experience recurrence, we
consider it best still to follow the policy of choosing a conservative approach to treatment among those
at particular risk, where postoperative complications could be disastrous.
Legen som moralsk aktør – et medisinsk-etisk essay basert på tre kasuistikker

Reiakvam, Kyrre K


Supervisor: Stein Husebø, overlege
Bergen Røde Kors sykehjem



In this essay a medical student presents an analysis of three medical cases, focusing on the
ethical problems and questions attached to them and on the doctor’s role as a moral agent.
The study is partly a literature study, in that the analysis depends on thoughts from a broad
selection of relevant texts concerning medical ethics (see the literature list for details). The
selection consists of thorough and basic standard works in the field of medical ethics or bio-
ethics, and shorter books and articles dealing with narrower parts of the field, especially texts
that treat difficult questions that doctors need to ask and answer in their encounters with
seriously ill and dying people.
An extra emphasis is put on central bio-ethical concepts like the principle of beneficence,
paternalism, patient autonomy, informed consent, and futility, and these key words (among
others) have been used in the PubMed search for relevant literature.A presentation of the most
important concepts is found in the first part of the essay. The study also has a practical side:
The reflections on bio-ethics concern situations that the author has taken part in as an
observer. During the fall of 2001, the student followed the doctors at Bergen Røde Kors
Sykehjem in their work with five seriously ill patients and their closest family. In this field
work he observed conversations between doctors and patients, doctors and patient’s close
family members and between doctors, nurses and nursers’ assistants. He also made
interviews of his own of patients and their family members. Two of these cases are presented
in this essay, in addition to one case that is taken from one of the student’s internship periods
during the fourth year of medical school. The use of informed consent was initially the
central point of investigation; but as the study evolved, more and more emphasis was put on
the idea of the doctor as a moral agent, as presented in a book by David Lamb. In the
conclusion it is pointed out that the significance of the doctor’s role as a moral agent seemed
greater than initially believed, and it is stressed that this, as much as it is often an irrefutable
fact, doesn’t have to represent a danger for the patient’s integrity and well being – as long as
the doctor is aware of and concerned about that part of her role.
Atherosclerose og koronar hjartesjukdom

Reikvam, Håkon


Supervisor: Karel Kier-Jan Kuiper, overlege
Hjerteavdelingen, Haukeland universitetssykehus



Cardiovascular disease is the most common reason to morbidity and mortality in Norway.
The last year of research has brought attention to oxidative modification of LDL-particles,
and the importance of the antioxidantsystem of the body in protection against atherosclerosis
and coronary heart disease. The bodys antioxidantsystem exists of both antioxidant
enzymsystem and antioxidantsystem dependent on dietary supplementation. By the last one
vitamin E, vitamin C, carotenoides og flavonoides are of highly interest. Reduction in the
level of circulating cholesterol and LDL, both by drugs and by diet, is well documented in
reduction the atherogenesis and the probability of cardiovascular incidents. Today treatment
of coronarydisease includes both drugs and invasive methods. Despite the last year of
research, our knowledge is still incomplete about optimal profylaxis and treatment or
coronarydisease, particularly about the optimal combination of different components. Still
our few good advices to the patients are a variable diet, regular physical activity and avoid
tobacco smoke.
Bilateral brystkreft

Bilateral Breast Cancer

Reitan, Bernt Christian


Supervisor: Bjørn O. Mæhle, førsteamanuensis og Lars A. Akslen, professor
Avdeling for patologi, Gades institutt, UiB



Background: There is uncertainty as to whether women with bilateral breast cancer carry a
prognosis worse than women with unilateral disease, and how common the development of
bilateral disease is. The purpose of this study was to examine the frequency and prognosis of
patients with bilateral breast cancer.

Methods: 3881 patients were treated for breast cancer between 1970 -1995 and were followed
to the end of 2000 for development of bilateral breast cancer. Information on time and cause
of death was available from The Norwegian Central Bureau of Statistics to desember 1999.
Information on age at operation, tumour size, lymph node status, date and type of operation
and treatment before the operation was present in most patients.

Results: 107 women (2.8 %) developed bilateral breast cancer. 20 patients (0.5 %) had
synchronous bilateral cancer defined as presentation of the second tumour 6 months or less
after the first one. Bilateral disease gave statistical significant worse prognosis than unilateral
disease from time of the second tumour. There was no difference in prognosis between the
two groups of patients from time of first tumour. Metachronous and synchronous bilateral
patients had similar prognosis. Cox regression analyses with time-dependent covariate gave
2.68 times higher risk of dying from bilateral than unilateral breast cancer.

Conclusions: 2,8 % of the women developed bilateral breast cancer. Women with bilateral
disease had a disease outcome similar to those with unilateral disease from the time of the
first tumour. After development of the second tumour bilateral patients had poorer prognosis
than unilateral patients. Bilateral patients with metachronous and synchronous disease had
similar prognosis. Patients with bilateral disease had 2.68 times higher risk of dying of the
disease than those with unilateral breast cancer.
Diagnostiske metoder ved akutt appendicitt

Rieser, Heidi


Supervisor: Asgaut Viste, professor dr.med.
Institutt for kirurgiske fag, UiB



Background: 20% of appendectomies reveal a normal appendix. It is therefore of interest to
analyse the different methods applied in diagnosing acute appendicitis; clinical examination
along with deDombal score, blood leucocyte-level (lpk), C-reactive protein-level (CRP),
abdominal ultrasound examination and urine tests.

Patients and methods: We performed a retrospective study of 100 patients admitted to
Haukeland sykehus, Bergen, during 2000 and 2001. All patients were operated due to
suspected acute appendicitis. Based on diagnosis, the material was divided into two groups;
acute appendicitis – group A, normal appendix – group B. Clinical findings and lab tests
were recorded for both groups, with special emphasis on analysing the relationship between
inflammatory markers (CRP, lpk) and diagnosis. In addition, a ROC-analysis was performed
to evaluate inflammatory markers’ limit values to decide highest sensitivity and specificity
values.

Results: The study showed that there was a significant difference between the groups
considering the factors CRP, lpk, and deDombal-score. Urine tests and temperature had no
significant values in this study. Group A had mean deDombal-score at 3, group B at 2. Most
frequent symptoms in group A were defence and indirect pain sensation. Pain migration gave
highest odds ratio (9,6).
Mean CRP value was 64 in group A, and 22 in group B. In patients with CRP above 8 mg/dl
sensitivity and specificity was 80% and 56% respectively, PPV=91% and NPV=35%. 17
patients in group A had CRP less or equal to 8 mg/dl. No patients in group B had CRP > 100
mg/dl. Lpk mean value was 15 in group A and 10 in group B. Lpk > 11 x 109 cells/l gave a
sensitivity value of 80 %, specificity of 69%, PPV=93% and NPV=39%. 16 patients in group
A had lpk < 10 x 109 cells/l. In group A five patients had both lpk and CRP within reference
values, and 55 patients had both markers increased. In group B six patients had both CRP and
lpk within normal area, while 2 patients had both increased. The ROC-curve showed that the
cut-off values for CRP and lpk with the highest sensitivity and specificity were CRP > 12
mg/dl and lpk > 11 x 109 cells/l. The sensitivity was 76% and 80% respectively. The
specificity was 69% for both markers, which gives a rate of 31% false positives.

Interpretation: A significant difference was found between the two groups respecting
deDombal-score, lpk and CRP values. The highest sensitivity and specificity was found for
lpk > 11 x 109 cells/l and CRP > 8 mg/dl. Both had low sensitivity and high false positives,
and must therefore be characterized as poor diagnostic tests. In conclusion, lab tests can only
be used to support the clinical diagnosis of acute appendicitis.
Livsstilsintervensjon ved diabetes mellitus type 2

Rotlid, Cecilie


Supervisor: Sylvi Aanderud, professor dr.med./overlege
Institutt for indremedisin/Endokrinologisk seksjon, Medisinsk avdeling, Haukeland
universitetssykehus



The aim of this essay is to study the relation between lifestyle and the development of
diabetes mellitus type 2 and to find out if it is shown that lifestyle intervention has a
preventive effect on the development of type 2 diabetes.
The illness has today become a regular medical condition and the prevalence has increased
considerably all over the workld during the last ten years. Regarding the increasing incidence
and the consequenses of the disease, both for the patient and the society, it’s important to
make serious efforts to stop this development.
There is clear relationship between the increasing indicence and the modern, western lifestyle
with less physical activity and an unhealthy diet. It’s done several clinical trials to examine if
lifestyle intervention has a preventive effect on type 2 diabetes in persons at high risk. These
studies all conclude that increased physical activity and a healthier diet reduce the incidence
of type 2 diabetes.
The challenge is how to get people to make those changes in lifestyle. It is suggested that the
authorities should focus on this epidemic disease and establish information campaignes and
try to reverse this serious development.
Non-Motor problems in patients with Parkinson’s disease

Sandviknes, Kenneth


Supervisor: Jan Petter Larsen, professor
Seksjon for nevrologi, Institutt for klinisk medisin, UiB



Parkinson`s disease (PD) is a chronic, progressive, neurodegenerativ disease which
mainly affects older people. In Norway around 7000 people is suffering from the disease. The
cause is still unknown and there is no cure. The main focus has traditionally been in
evaluation and treating the motor problems and there is now a fairly good symptomatic
treatment. However, PD may also cause non-motor problems, which may have profound
implications on the quality of life. Among these, depression and sleeping problems are
recently found to be the two most important factors for reducing quality of life in patients
with PD. During the past years greater emphasis has been placed on the total impact of the
disease on the patientes` lives, thereby letting the non-motor problems be focused.
This review article tries to highlight the non-motor problems of PD, which affect a
substantial portion of the patients. According to recent studies, 88 % of the patients have at
least one non-motor problem, many are experiencing a lot more. The disease may cause
problems in a variety of areas such as psyche, cognition and sleep, bowels, bladder and skin.
Neuropsychiatric problems are most frequent, but many suffer a mild degree of autonome
dysfunction. More complex problems can be seen, including fatigue, sexual problems and
pain. It`s important to recognize these problems and the patient`s quality of life; in this way an
optimal treatment can be given.
The article is partly based upon publicated research form The Central Hospital of
Rogaland, Norway, and partly upon articles found through systematic search in medical
databases.
Metoder for svangerskapsavbrudd i Norge med hovedvekt på medisinske
metoder

Schou, Synne


Supervisor: Magnar Ulstein, professor dr.med.
Seksjon for obstetrikk og gynekologi, Institutt for klinisk medisin, UiB



Background: Induced abortion is a controversial issue which is often debated. The medical
termination of pregnancy in the first trimester became an option in Norway in 1998 and is a
relatively new offer to women who want to terminate their pregnancy. The objectives of this
paper is to present the Norwegian statistics of abortion, summarize the legislation of abortion
and review the methods available for termination of pregnancy with especially focus on the
medical method. Other medical conditions for which the medicaments can be used and
availability in other countries, will also be mentioned.

Method: Literature: The paper is mainly based on articles found in databases such as
PubMed, Medline and Cochrane, informasionpapers on abortion, the annual reports from
Statistisk sentralbyrå and textbooks in gynecology, pharmacology and endocrinology.

Key words: Abort, Medical Abortion, Induced Abortion, Mifepristone.

Results: Todays statute of abortion has been in force from 1979 and gives the woman right to
terminate her pregnancy before the end of week 12. After this date, the woman has to apply
to a committee to get her abortion approved. After the 22. week of pregnancy the embryo is
defined to be capable of living and induced abortion is no longer allowed.
The number of abortions was predicted to increase after the introduction of the medical
method, but the number has remained between 13000 and 15000 annually. However, the
share of abortion performed medically has been increasing and represented in 2002 49 percent
of of induced abortions performed before the end of week 9.

In Norway, a women can choose between the surgical and medical method before the end of
the 9. week of her pregnancy. In the 10.-12. week, only surgical abortion is offered, and in
the 2. trimester, medication is used. The surgical method consists of cervical dilatation and
vacuum aspiration. In medical termination of pregnancy, two drugs are used; the
antiprogestin Mifepristone, which causes sloughing of the uterine lining and etachment of the
products of conception, and the prostaglandin analogue Misoprostol, which stimulates uterine
contractions. 200 mg of Mifepristone is given orally by day 1 and 800 microgram of
Misoprostol is administered vaginally after 48 hours. Some women start bleeding after the
intake of Mifepristone and a few experience complete expulsion before the administration of
the prostaglandin. In about 50% of women, abortion occur within 4 hours after the
prostaglandin has been given, and 4 out of 5 are finished after 24 hours. For women with a
pregnancy of less than 63 days duration, the success rate of the Mifepristone-Misoprostol
procedure ranges from 92 to 96% and several clinical trials show that the medical and surgical
method are now equal options as regards risk of failure and acceptability to the women.
Mifepriston is also used as cervix-softener before surgical abortion in the 1. trimester and as
pretreatment before abortion with prostaglandin analouges in the 2. trimester. There have also
been promising results regarding the use as a contraceptive and in the treatment of
spontaneous abortion, leiomyoma and certain cancers.

Mifepristone is now available in 27 countries. There are both political, ethical and/or
economic reasons why some countries are not willing to make the drug available and other
combinations have therefore been tried with successful results; Methotrexat-Misoprostol and
repeated doses of misoprostol.

Conclusion: The medical method for termination of pregnancy is a satisfactory alternative to
surgery as regards the rate of success and side effects. The method is now often
recommended because the woman then avoid complications to anesthesia and surgery. There
have also been promising results for use at 10 – 13 weeks gestation, but further clinica trials
are required to confirm the findings. The controversy around Mifepristone as an abortifacient
agent has delayed further clinical investigation, but over the last few years, more cliical trials
have been performed which shows potential use in other medical conditions. The
introduction of medical abortion has not increased the number of abortions as some people
feared. In many countries, Mifepristone is not available and other medical procedures for
termination of pregnancy have also showed to be successful.
Kombinert testmetode for måling av anstrengelsesutløst bronkial obstruksjon
og maksimalt oksygenopptak. En metodevalidering.

Shehzad, Kasher


Supervisor: Britt T. Skadberg, seksjonsoverlege, dr.med.
Barneklinikken, Haukeland universitetssykehus



Introduction: Exercise induced asthma (EIA) is a common manifestation of asthma and
occurs in 70-80% of untreated asthmatic patients. EIA may influence daily life activities in
children and teenagers, and an accurate diagnosis of EIA is necessary for optimal treatment.
Furthermore, pulmonary as well as cardiac disease may influence on oxygen uptake. The aim
of the present study was to assess and compare the ability of a new developed and modified
test protocol, “Modified EIA”, to measure bronchial hyperreactivity and oxygen uptake with
two separate tests, “Standard EIA” and “Modified Bruce”.

Methods: An open, randomized study of nine asthmatic children and 14 healthy teenagers
was performed. The results of “Modified EIA” and “Standard EIA” and “Modified Bruce”
and Modified EIA”, were compared for the astmatics and healthy teenagers, respectively.
Basic lung function was measured before running and 1,3,6,10 and 15 min after the run.
Oxygen uptake, heart rate and ventilation were continuously recorded. Bronchial
hyperreactivity was estimated by the percentage decrease in forced expiratory volume first
second, FEV1, and working capacity by maximum oxygen uptake perminute and kilo body
weight.

Results: There were no significant differences of any key parameters of lung function or
ergometry (forced vital capacity, FVC, forced expiratory volume first second, FEV1 or
midxpiratory flow, FEF50, maximum fall in FEV1 maximum oxygen uptake, max VO2, heart
rate or respiratory rate) in either group or test combination.

Conclusion: Comparable test results suggest that the ”Modified EIA” protocol has the ability
to replace the two traditional tests saving both the patients for exhaustion and unnecessary
workload on the technicians in our laboratory.
Epidemiologi av muskel- og skjelettplager i Hordaland

Sirnes, Eivind
Sødal, Erlend


Supervisor: Grethe S. Tell, professor og Eha Nurk, stipendiat
Seksjon for epidemiologi og medisinsk statistikk, Institutt for samfunnsmedisinske fag, UiB



Background: Musculoskelatel complaints are widespread and a major public health problem
in western countries. Prevention and treatment are challenging because etiologic factors are
not fully understood. The objective was to estimate the prevalence of and identify possible
risk factors for musculoskeletal complaints.

Material and methods: A cross sectional study including 11,566 men and 13,660 women
aged 40-49 and 70-74 years who completed a questionnaire in The Hordaland Health Study
’97-’99 (HUSK).

Results: Musculoskeletal pain and/or stiffness lasting at least three months during the past
year was reported by 4,461 men (39%) and 6,713 women (49%). The prevalence increased
with age among women. Musculoskeletal complaints were associated with low educational
attainment and smoking among both men and women 40-49 years old, and with high body
mass index (BMI) and low physical activity among women. Among the oldest, complaints
were associated with low educational attainment among men and with smoking, high BMI
and low physical activity among women. A dose-response relationship between smoking and
musculoskeletal complaints was found, with a stronger effect among women than men.

Interpretation: Musculoskeletal complaints were common, with a higher prevalence among
women than men. The results indicate that musculoskeletal complaints may be prevented or
reduced by quitting smoking.
Substitusjonsbehandling og livskvalitet

Soltvedt, Åshild


Supervisor: Fred Holsten, professor dr.med.
Seksjon for psykiatri, Institutt for klinisk medisin, UiB



Background:
Since the Norwegian Governments in the late nineties decided to legalize use of the
synthetical opioid Methadone in treatment of heroine addicts, there has been a continuous
debate discussing the effect of this treatment. Based on this I decided to study the history of
methadone, the background for the public Norwegian methadone programme, and different
methods used to evaluate the effect of this treatment.

Methode:
Litterature study: Central search words: Methadone, addiction tretment, quality of life, dual
diagnosis,

Results:
When the Norwegian Governments in 1997 decided to legalize the use of Methadone in
treatment of heroine addicts, it was, in an international context, nothing new about that.
But according to traditional Norwegian drug policy, it was quite revolutionary.
A programme was formed with straight rules for admission, treatment and exclusion. It
was underlined that the primary goal was rehabilitation, with less focus on habilitation.
Several studies show increased prevalence of psychiatric problems among drug addicts
compared with the rest of the population. Only a few studies have tried to investigate the
reason for this, and these conclude with that there is no simple causal connections.
A common way of measuring efficiency of treatment is to study in which scale the patients
choose to remain in treatment. This is not a satisfying measurement of the methadone
maintenance treatment. Aspects as patient satisfaction, the use of other drugs and level of
rehabilitation has to be included in evaluation of this kind of treatment.
Substance abuse is a very complicated problem, where many different factors have an impact
on the treatment result. The process of rehabilitation continues over many years.
This together with the high level of mortality and suffering of this population make it even
more difficult to investigate the efficiency of treatment. A common feature of the articles
and reports that discuss this is that quality of life, self experienced as well as objectively
measured should be a part of this measurement.
The fact that also opiate users who are not able to follow the strict rules of the methadone
programme report a increased quality of life, has lead to a new debate about whether
habilitation should be an indication for the treatment.
Øsofagusperforasjoner ved Haukeland Universitetssykehus

Esophageal perforations at Haukeland University Hospital

Stein, Arne W.


Supervisor: Asgaut Viste, professor dr.med.
Institutt for kirurgiske fag, UiB



Background: Perforation of the esophagus is a rare, but severe condition that is associated
with high mortality in most studies. The literature is inconsistent on many questions like
prognosis, most important prognostic factors and optimal treatment.

Method/Material: In ten years from 1988 to 1998 there was 16 patients treated for
perforation of the esophagus at Haukeland University Hospital. The journals were reviewed
with focus on etiology, localization, clinical presentation, time to diagnosis and treatment, and
treatment received. Length of hospitalization, stay in intensive care unit and complications
were analyzed.

Results: Of 16 patients there were 14 men and 2 women with median age 65,5 years (25-90).
Perforations were due to endoscopic procedures in 7, abdominal operation in 2 and
spontaneous in 7. Most (69%) were located in the distal esophagus with the rest equally
distributed between proximal esophagus and abdomen. Eleven patients had underlying
esophageal disease: stricture in 5 and esophagitis in 6. Five perforations were diagnosed late
(>24 h): 2 spontaneous and 3 iatrogenic. Patients with spontaneous perforations typical
presented with chest pain and dyspnea. Patients with iatrogenic perforations had a more
heterogenic presentation with fever as the most common finding. X-ray of the esophagus with
water soluble contrast established the correct diagnosis in most cases, and had a 69 %
sensitivity. 5 patients received conservative treatment, 8 had primary closure, 2 had resection
and one was treated with a self - expanding stent. There were no deaths in our material. Total
hospital stay was 4 to 131 days, median 43. Nine patients needed a stay in an intensive care
unit, median 25 days (2-83). 12 patients had one or more complications, 6 had a sequela. One
had a reinforced closure of the perforation after the first broke down, four others had some
kind of reoperation because of complications. Factors that influenced morbidity were
etiology, localisation, age and treatment received..

Conclusions: Perforation during operation with fundoplicatio was clearly the most serious
etiology. The fact that late diagnosis was a more common finding among the iatrogenic
perforations warrants a high degree of suspicion for perforation of the esophagus in these
patients. In support of the view that conservative treatment is appropriate in carefully selected
patients we find that patients who received such treatment had significantly lower morbidity
then patients that were operated. The absence of any mortality is remarkable and support the
assumption made in some other newer studies that the mortality for this condition is getting
lower in parallel with improved treatment options regarding antibiotics and parenteral
nutruition.
Patientnära analysering av CK-MB, Troponin I och Myoglobin I diagnostiken
av akut hjärtinfarkt. En evaluering.

Point of care testing for CK-MB, Troponin I and Myoglobin in the diagnosis
of acute myocardial infarction. An evaluation.

Stjärne, Johan


Supervisor: Rune J. Ulvik, professor
Institutt for klinisk biokjemi, UiB



Background:
Coronary heart disease is the leading course of illness and death in the Western World. There
is a need of a more sensitive diagnosis of AMI, correct risk stratification of patients and fewer
false negative diagnoses.
The importance of biochemical markers in diagnosis of coronary heart disease has increased
due to new effective markers and more precise methods of analysis. The need to detect
myocardial damage under development has increased due to new therapeutic strategies. A fast
and correct placement of patients into the right level of care also has economic implication.
There has been developed bedside instruments for fast analysis of biochemical markers. We
wanted to try such an instrument in the emergency department at Haukeland Hospital. The
intention was to compare rapid analysis of myoglobin, CK-MB and TnI with the routine
analysis of CK-MB and TnI, in the diagnosis of AMI.
The study also had some minor goals (see page 13-14). One of these was to examine the
increase of patients with possible AMI diagnosis, at first analyse, after introduction of a new
TnI AMI cut off. Another minor goal was to evaluate the importance of myoglobin analysis in
the emergency department.

Matherials and method:
The study was done between 20/3 and 11/4 -00. 56 patients were included. In 46 of the
patients (the main group) markers were analyzed due to primary AMI suspicion. The rest of
the patients (the side group) had no primary AMI suspicion, but still markers were analysed.
For rapid analysis of heart markers we borrowed Dade Behrings Stratus CS. The ordinary
diagnosis was running parallel. After the collection of data from Stratus CS and LKB we
noted the final diagnosis of the patients.

Results:
Correlation curve for CK-MB (n=44): y = 1.0071 x + 0.2029. R2 = 0.9779.
Correlation curve for TnI (n=46): y = 1.2712 x + 0.0531. R2 = 0.9862.
(y = Stratus CS, x = LKB)
In the main group 22% of the patients got the final diagnosis AMI. 40 of 41 patients though
either currently or previosly had some heart disease. The sensitivity for final AMI diagnosis in
the first analyses was 44% for Stratus CS and 56% for LKB. With some modifications we got
the sensitivity 50% and 63% respectively, see page 33-34. The specificity was 97% in both
methods.
Stratus CS was more sensitive for registrations of low TnI values, and in Stratus CS there was
more or less an abnormal TnI in all patients with final AMI diagnosis.
Stratus CS probably shortens TAT from about 2-3 hours to about 30 minutes. Stratus CS
analysis was simple, but a correct use depends on incorporation of new routines in the
emergency department and in the lab.
Introduction of a new AMI cut off increased the number of patients with possible AMI
diagnosis, at first analyse, from 6 to 12 patients.
Myoglobin analysis alone revealed no major extra information, but 75% of the patients who
tested positive in all tree markers got the final diagnosis AMI. Only 20% of the patients who
tested positive in two markers got the final diagnosis AMI.

Conclusion:
The data from Stratus CS and LKB showed a good correlation.
About one fifth of the patients with primary AMI suspicion got the final diagnosis AMI. Most
of the patients though had some current or previous heart disease. The sensitivity for the final
AMI diagnosis, at the time for the first analysis, was generally low but a little higher in LKB.
The specificity was high and equal in both methods.
Stratus CS is more sensitive for low TnI concentrations. In risk stratification and due to a new
AMI cut off this can be of importance.
Stratus CS shortens TAT and is easy to use.
A new AMI cut off will increase the number of patients with the final diagnosis AMI.
The importance of myoglobin analysis in the emergency department probably has to be
evaluated in larger studies. But parallel analysis of many markers seems to be useful.
BNP and heart failure - current issues

Storebråten, Gøril


Supervisor: Kjell Breivik, overlege
Hjerteavdelingen, Haukeland universitetssykehus



Congestive heart failure is a common with high morbidity and mortality. It is characterised by
chronic overactivation of sodium- and water retaining neurohormons and vasoconstrictor
hormones. Over time this maladaptive response leads to fibrosis and hypertrophy of the heart
and further progression of the dysfunction of ventricular function. Humans have several
endogenous systems that are countering these effects. One mechanism is the endogenous
vasodilator system that includes natriuretic peptides, nitric oxide and prostaglandin. These
systems have natriuretic, diuretic, and antimitogenic effects and counteract the
vasocontriction. In heart failure these natriuretic and vasodilator effects are overwhelmed by
the influenses that lead to vasoconstriction, salt and water retention and abnormal cellular
growth.

The natriuretic peptides include the hormones ANP, BNP, CNP and Urodilatin. The actions of
ANP and BNP are similar and tend to oppose those of Ang2.

BNP is a hormone mainly produced in the heart ventricles in response to increasing wall-
tension and the plasma concentration is raised in heart failure. The discovery of BNP it has
created excitement because of the multiple possibilities it may posses in different aspects of
heart failure. The excitement was increased when a rapid point-of-care test for BNP was
developed and approved.

In this paper will some important aspects of BNP and congestive heart failure be discussed;
Many studies suggest that a measurement of BNP can be helpful in ruling out a diagnosis of
heart failure in patients with symptoms like fluid retention, exercise intolerance or dyspnea.

BNP might also be useful in assessing outcomes in patients with established heart failure and
it may have prognostic value for risk stratification in patients with acute coronary syndromes.

There is also some promising research on how BNP can be used to fine tune the treatment of
heart failure. Circulating plasma BNP concentration can be raised artificially for treatment
purposes. This can be done in different situations; As an infusion or with orally active drugs
that inhibit parts of the elimination of BNP. These drugs may play a part in the future
treatment of heart failure.
Multippel sklerose og spinalvæske forandringer

Sundal, Christina


Supervisor: Christian Vedeler, professor
Seksjon for nevrologi, Institutt for klinisk medisin, UiB



MS is a chronic, immune mediated, inflammatory disease, affecting the Central Nervous
System,CNS, in persons with a genetic predisposition. The diagnosis is in principal an
exclusion diagnosis, thus other causes of multiple lesions in the CNS have to be ruled out.
There are no simple laboratory tests, symptom scores, or investigations giving the diagnosis.
The clinical picture consists of the examiner pointing out symptoms and motor or sensory
deficits correlating to a results of other investigations. The disease usually has a chronic and
progressive course, and will eventually lead to more or less distinct loss of function. The
etiology of the disease is still not clear, but it is presumed to include genetic predisposition,
different agents, and auto-immune mechanisms affecting the CNS. There is no curative
treatment for the disease. This retrospective study is based on medical journals from 34
patients with relapsing, remitting MS, RRMS. All the patients were diagnosed according to
the Poser criteria, and have in addition had a genotyping of IL-10 and Fc-receptor 3b, FcR 3b.
The aim of the study was to investigate an eventual correlation between the number of cells,
bands found in CSF, and IgG-index, in relation to MS prognosis and IL-10 and FcR 3b gene
polymorphisms. The material showed a significant correlation between oligoclonal bands
(OCB) in CSF and the amount of cells in CSF. It also revealed a tendency for CSF IgG to be
higher in the patiens with a higher number of cells, in addition to more than 5 OCB. The
analysis of the results also showed that few OCB coupled with a low cell number in the CSF,
correlated to a favourable prognosis. The measured amounts of CSF IgG was found to be
higher in the IL-10 592 genotype AA, compared to genotype AC and CC ,thus correlating to a
worse prognosis. No significant correlations to the FcR 3b were found. The conclusion of the
study is that CSF findings can be prognostic valuable for MS and that anti-inflammatory
therapi is of great importence.
Kroppsbilde hos ungdom

Svendsrud, Ingvild


Supervisor: Anders Bærheim, professor
Seksjon for allmennmedisin, Institutt for samfunnsmedisinske fag, UiB



Eating disorders is a substantial health problem among adolescents in the western countries
today. Heavy focusing on loosing weight and a perfect body image in our culture, are thought
to have impact on the prevalence of eating disorders. Knowledge about the body image
among normal adolescents in the same cultural settings may be useful.

Aim: To evaluate normal adolescents’ ideas about their body, body image, ideal body and
link between body image and self-confidence.

Material and methods: The students in two classes at Tank’s secondary high school in
Bergen. They were asked to answer a free text questionnaire, focusing on their thoughts
about the body image. 39 pupils completed the questionnaire, 19 girls and 20 boys. The
material was analysed using Georgi’s method for qualitative analysis as modified by
Malterud.

Results: The boys and the girls opinions were clearly different. Some of the boys were
satisfied with their body, and paid little interest in body and appearance. Many girls descibed
that their self-confidence depended on their body image. The girls wanted to have bigger
breast and less belly, butt and thighs. The boys wanted more and bigger muscles, and focused
on function.

Discussion: Our results may be useful for school physicians, school nurses and teachers
when discussing body image with adolescents.
Does introduction of roluzole and PEG affect time to diagnosis and survival in
ALS?

Svindland, Jostein


Supervisor: Ole-Bjørn Tysnes, professor dr.med.
Seksjon for nevrologi, Institutt for klinisk medisin, UiB



Objectives: To study the effect of introduction of new treatments in ALS on survival and
diagnostic delay.

Methods: Riluzole was introduced as treatment option in ALS in Norway in 1995 and PEG
has during the last decade been used in cases with bulbar symptoms. All patients diagnosed
as ALS in Haukeland University Hospital were registered for the periods 1985 to 1989 and
1995 to 1999. Files were reviwed for time of symptom onset, diagnosis and treatment.
Norwegian National Statistics were reviewed for time of death.

Results: 37 ALS cases were diagnosed during the first period, 41 during the last. Clinical
characteristics were similar. There was no difference in survival between the two periods.
Patients treated with riluzole had similar survival as other comparable cases. Similarly,
bulbar cased treated with PEG during the last period had similar survival as bulbar ALS
patients not receiving PEG during the first period. Median time from onset to diagnosis was
12 months in both periods.

Conclusions: This historical review failed to show any effects on new treatment options on
survival or diagnostic delay in ALS.
Eventuelle fordeler med den nye typen antipsykotika. Hvor mye brukes de i
klinikken?

Svingen, Gard F.


Supervisor: Hugo A. Jørgensen, professor dr.med.
Seksjon for psykiatri, Institutt for klinisk medisin, UiB



The use of traditional antipsychotics in the treatment of long-time schizophrenia has been
conflicted by severe, and potentially fatal, side effects. Even though their effect on positive
symptoms has been acceptable, they have shown to lack proper effect on the negative
symptoms due to schizophrenia. In addition, a great number of patients have not shown
significant clinical response, even though receiving appropriate doses of traditional
antipsychotics.
Recently, novel antipsychotics with different pharmacokinetic and –dynamic properties, have
entered the market. The producers of novel antipsychotics have claimed the new drugs far
more acceptable in terms of side effects and effect on negative symptoms. By studying
mainly review articles, using PubMed and Medline, we have come to the conclusion that
novel antipsychotics do have a more acceptable side effect profile, especially when it comes
to extrapyramidal symptoms and tardive dyskinesia. They also tend to treat megative
symptoms and improve patients’ cognitive functions better than traditional drugs. In addition,
some of the new drugs have shown a particular effect in treatment-resistant schizophrenics.
Yet, the new antipsychotics have shown to be able to induce significant weight gain and
diabetes, and in the case of Clozapine, leukopehia or agranulocytosis.
In addition, we made a study on the use of novel antipsychotics in a Norwegian psychiatric
hospital. The conclusion is that Norway may lag behind the USA in the switching to second-
generation antipsychotics, but more studies are needed to say this for sure.
Brain Function and Neural Networking Modeling

Sæthre, Kristian R.


Supervisor: Arvid Lundervold, førsteamanuensis, dr.med.
Seksjon for fysiologi, Institutt for biomedisin, UiB



The last 15 years there has been a significant increase in the number of neuroscientist who
uses computer models to simulate brain function. A new scientific field has emerged called
Computational Neuroscience. The computational power of today's computers together with
advances in our knowledge of the brain has laid the basis of which a new and groundbreaking
exploration of the brain is possible. Realistic biology-based modeling of the nervous system
based on computer simulations, gives the opportunity to test experimental results and simulate
experiments that are impossible to do directly on nerve tissue. Such computer simulations will
ask for new biological experiments to test new hypotheses that emerge. Precise and detailed
understanding of the brain function on a neural level will probably be essential to future
understanding of diseases like Schizophrenia, Alzheimer, Multiple Sclerosis, Parkinson, and
other diseases related to the nervous system.

This report gives a review of some of the fundamental principles that modern modeling of
neurons and neural networks are based on. The report will demonstrate some of the methods
used in neural modeling when seeking new insight about how the brain works. A few of the
most used computer programs will be described briefly. Example of neural modeling in
dementia research and research on Parkinson's disease will also be presented.
Acupuncture Treatment in the Prevention of Uncomplicated Recurrent Lower
Urinary Tract Infection in Adult Women

Sødal, Liv Inger F
Fagerheim, Siri U. (Hovland, class 98)


Supervisor: Anders Bærheim, professor
Seksjon for allmennmedisin, Institutt for samfunnsmedisinske fag, UiB



Background: In a previous study, acupuncture treatment reduced the reinfection rate in
cystitis-prone women. We wanted to re-evaluate this effect.

Mathods: Ninety-four cystitis-prone women were randomised to acupuncture treatment or no
treatment. Main effect parameter was occurrences of cystitis during 6 months observation
time. Residual urine was measured using ultrasound.

Results: The incidence rate (episodes/person-month) of acute, bacterial cystitis in the
acupuncture group was 0.049 versus 0.108 in the non-treated group, incidence rate ratio
= 0.45 (95% C.I. = 0.23-0.86). Women receiving acupuncture had mean residual urine of
35.4 ml at inclusion compared to 18.2 ml 6 months after treatment, p ≤ 0.01. There was no
change in the untreated group.

Conclusions: Acupuncture reduced the infection rate among cystitis-prone adult females,
corresponding to a reduction in their residual urine.
The Incidence of Crohn’s Disease in Hordaland county 1999 and 2000: A
retrospective case-control study, and a literature review.

Thorsen, Elin C O


Supervisor: Kåre Vetvik, førsteamanuensis
Institutt for indremedisin, UiB



The first part of this paper is a review of the literature concerning some aspects of Crohn’s
disease. The second part is a retrospective case-control study. The aim of this study was to
assess the incidence of Crohn’s disease in Hordaland during 1999-2000. We also studied life-
style and disease parameters and compared them with the literature. To include patients the
questionnaires were sent to hospitals and specialists. All of them accepted to participate in
the study. A total of 44 patients were included. This resulted in an incidence of 5.04/100 000
per year. The highest age-specific incidence rate was between 20-29 years of age, calculated
to 10.8. The F7M-ration was 1:1.26. There were more of the participants with only a
secondary school diploma than in the general population giving an OR of 1.7. Nine per cent
of the patients had a first-degree relative who also suffered from CD.

Epidemiology of Crohn’s disease
Epidemiological studies are important to get a better understanding of the very complex
aetiology of Crohn’s disease (CD). The incidence of CD has increased over the past decades.
There was a rapid increase in the incidence of CD during 1965-1980. This increase seems to
level off in most of the western countries at the moment (1). In a study from Copenhagen the
incidence of CD was increasing during the period from 1970-78 with a mean value of 2.7105
inhabitants (2). Crohn’s disease is more common in females than among males. The M/F sex
ratio in Western countries was 0.9 (3). In a Swedish study the male-female ratio was found to
be 1:1.12 (4). Smokers have a twofold risk of developing CD compared to non-smokers (4,5).
Nasale vaksiner; Neseslimhinnens egnethet som administrasjonssted for
antigener i vaksinesammenheng.

Toft, Ingrid


Supervisor: Roland Jonsson, professor
Broegelmanns forskningslaboratorium, Gades institutt, UiB



Background, goal and results:
The majority of human pathogens gain entrance to the body via the mucosal surface, which,
both because of its area and the fact that it harbours 80% of the body's immunocompetent
cells, is considered the main barrier betweenthe body interior and the surroundings. There is
an independent mucosal immune system which operates separately from the systemic immune
system. This mucosal immune system is best stimulated by antigens administered directly at
mucosal surfaces and not that well by parenteral vaccination. To be able to exploit the
potential of the mucosa associated immune system, much effort is invested in trying
to develop vaccines which could be administered mucosally. In this overview, the reasons
why the nose could be a suitable site for vaccine administration are discussed. The discussion
is based on current knowledge in mucosal immunology and the anatomy and function of the
nasal lymphoid tissue. There is already many promising results in this field. Nasal vaccines
could be designed towards several pathogens. But we still do not have all the understanding
needed when it comes to the regulation and interconnections in the mucosal immune system.
Time will show if nasal administration of antigens becomes a preferred way of vaccination.

Method:
Material for this overview was found by searching on Pub Med for "Vaccines, nasal"
MRI of patients operated for transposition of the great arteries with Senning
technique

Tveiten, Hallgeir


Supervisor: Terje H. Larsen, overlege/professor
Radiologisk avdeling, Haukeland universitetssykehus/Seksjon for anatomi og cellebiologi,
Institut for biomedisin, UiB



Background: Transposition of the great arteries (TGA) is a serious congenital heart lesion
who requires early surgery. Former, the method of atrial switch was performed. Blood from
the lungs was diverted to the right ventricle (HV) and the blood from systemic circulation was
diverted to the left ventricle (VV). HV then becomes the systemic ventricle and is exposed to
greater workload than in normal hearts. In this study we wanted to evaluate atrial switch
operated patients with MRI, especially the function of HV, and evaluate MRI as a method for
this.

Material and method: 12 patients and 8 healthy were studied. A 1, 5 Tesla Siemens Vision
MT MRI was used.

In the study we used two different methods, velocity mapping technique of the ascending
aorta and pulmonal artery and CINE technique of the ventricles. In the vessels peak velocity,
mean velocity and blood flow were registered. In the ventricles stroke volume (SV), end-
diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF) and myocardial
mass of VV were measured.

Results: One of the patients was excluded because the quality of the images was not good
enough. In two patients only flow quantification in the vessels were performed for the same
reason.

In the pulmonal artery we found higher velocity compared to ascending aorta in the patient
group. The opposite results were found in the control group. We found no significant
differences in blood flow, SV or EF when comparing the groups. On the other hand we found
a difference between SV of the ventricles, measured with CINE technique, and blood flow of
the vessels, measured with velocity mapping technique. As expected, the mass of VV
myocardium was greater in the controls compared to the patients. We also observed that the
normally delayed contraction of the HV compared to VV was preserved in the patients.

Conclusion: Since we found difference between the blood flow measured in the vessels and
the ventricles, should probably one method be used if patients are followed up. Eventually can
the methods be used as supplements to each other. All the patients felt healthy before the
study, so the small differences between the patient and control group were as expected. The
greater muscular mass in VV of the controls was also expected.
Female Genital Mutilation

Tysnes, Karin N


Supervisors: Gunnar Kvåle, professor, Institutt for Internasjonal Helse, UiB
og Rachel Manongi, Department of Community Health, KCMC, Tanzania



Female genital mutilation has been practiced worldwide, and affects today almost 137 million
women. Every year further 2 million are at risk. The practice includes different forms of
modification of the female external genitalia for non-medical reasons. There are several
justifications that vary between different regions and tribes. They include, among others:
reduction of womenæs sexual desire to ensure virginity, chasity and fidelity, removal of “the
male elements” and a poisonous clitoris, provide a greater stimulation for the husband during
sex, etc. There are many serious complications related to FGM, including haemorrhage,
shock, damage to nearby structures (urethra, bladder, vagina, anus), infections and prolonged
labour. Today FGM is considered a serious violation of women’s human rights, and should
therefore not be justified in the name of culture or tradition. As an attempt to eliminate the
practice, there has been med legislation against FGM in both African and European countries.
Further have medicalization of the practice been a controversial issue, where WHO has stated
a consistent condemnation.
         This report gives a review of FGM and all of its aspects and problems, based on other
articles and reviews. We have also presented a study on attitudes towards FGM in health
professionals in Moshi, Tanzania. 3 months were spent in KCMC, mainly in Labour Ward.
22 auestionnaires about FGM were given to doctors, nurses and medical students. Many
cases of FGM were seen and discussed with the doctors in the Labour Ward.
         The questionnaires showed mainly similar attitudes towards FGM, and no significant
differences betseen ages and sex were found. The majority considered FGM to be a violation
of universal human and women’s rights, and that it should be prohibited. There were some
disagreements about how to eliminate the practice. Less than 50% wanted specific
legislation, but over 90% were against medicalization of FGM. Reasons for this were no
medical indication and that it would lead to its promotion. Most believed in health education
about complications and bad effects of FGM. About ¼ suggested alternatives for the practice,
e.g. traditional dances. Almost none would ever perform FGM themselves. The majority had
seen patients undergone FGM, type 2 were rapported to be the most common. They reported
to see complications, e.g. perineal tears during delivery, prolonged labour, haemorrhage,
infections and sexual problems. Only a small fraction believed in positive aspects of FGM,
and they mentioned the value and respect of tradition.
         The health personnel at KCMC have a great deal of knowledge about the issue FGM.
It is also obvious that they have thought about the problems related to it. They want to end
the practice and have specific ideas of how to do it. However you can find that some are
critical towards “Europeans” who judge African customs like this. It seems clear that
cooperation between cultures and the spreading of knowledge about the practice of FGM is
the best and most effective way to eliminate it.
HIV vaksine / Immunbasert terapi

Ukkelberg, Oddvin


Supervisor: Anne Margaritha Dyrhol Riise, post doktor
Institutt for indremedisin, UiB



This review describes HIV-1 vaccines in the battle against AIDS. I have tried to focus on the
present status for design and testing of vaccines, not only used in a prophylactic manner, but
also used in at therapeutic manner. My impression is undoubtedly that the ongoing research
to find an effective vaccine is enormous. The first phase I clinical trial took place in USA in
1987. Since then more than 30 candidate vaccines have been tested in more than 60 phase I
and II clinical trials, but no effective vaccine has been found. Very few vaccine candidates
reach phase III clinical trials, partly because of the complex interaction between the HIV-1
virus and the immune system, and partly because of the expenses involved when performing
large vaccine trials. Also ethical issues make the trials complicated. So far it is only
AIDSVAX that has been in phase III clinical trials for a long time. Tat-Vaccine has just
recently started in phase III clinical trials. A decision not to proceed with ALVAC 1452 in a
phase III trial was just made due to methodological problems, whereas ALVAC 1521 is
planned to enter phase III trial in a short time. In the case of AIDSVAX the problem has been
to overcome virus variability, a classical problem in HIV-1 vaccine design. However, the use
of new adjuvants, delivery methods and combinational vaccine regimens bring hope for an
effective prophylactic HIV-1 vaccine in the future. Despite that no break through has been
reached, the use of therapeutic vaccine in . Despite that no break through has been reached,
the use of therapeutic vaccines to boost the immune system is promising in many trials. As
our understanding of the HIV-1 specific immunity increases, therapeutic vaccines most likely
will become an opportunity for many HIV-1 infected people, also with the aim to totally
eradicate the virus in them.
Prenatal diagnostikk og selektiv abort –
ein litteraturbasert gjennomgang av argument i lys av ein etisk modell

Vattøy, Gyril


Supervisor: Guri Rørtveit, stipendiat
Seksjon for allmennmedisin, Institutt for samfunnsmedisinske fag, UiB



Ethical models have been developed to support diffcult decisions in medicine. Developments
in genetic technology and sampling methods result in great changes in prenatal diagnostics.
One ethical model is selected in this thesis to assess arguments used in the debate on selective
abortion as a consequense of prenatal diagnosis.

Relevant litterature on the practice of prenatal diagnosis and selective abortion in Norway is
reviewed. The ethical model used is called a ”principle-based model”. It is based on the
following four basic principles: The principle of beneficence, the principle of non-
maleficence, the principle of respect for autonomy, and the principle of justice. These
principles are presented in more detail, and thereafter applied on some arguments used in the
debate on selective abortion.

Application of this ethical theory highlights important themes of each argument. The issues
may be controversial, but the model contributes to an unprejudiced discussion and gives a
good foundation for choice of action. The principle-based model can be applied on most
ethical problems in medicine. The four principles are easy to remember, and they also allow
more extensive ethical analysis.
Parent Management Training og Multisystemisk Terapi. Behandlingsmetoder
for barn og unge med alvorlige atferdsvansker

Wergeland, Gro Janne Henningsen


Supervisor: Einar Heiervang, førsteamanuensis
Seksjon for psykiatri, Institutt for klinisk medisin, UiB



Conduct disorder is one of the most frequent reasons for referral to child and adolescent
treatment services in Norway. This work is a litterature study of three different therapeutic
models used in treatment of children with conduct disorder; Patterson's and Webster-Stratton's
Parent Management Training models, and Multisystemic Therapy.

Children presenting with a high level of aggression, hostility and rule-breaking at young ages
run a noticeably risk of developing antisocial behavior. Longitudinal studies have shown that
this is the best predictor for commitment of criminal acts and other problems in adult life.
Early onset and severe symptomathology are associated with poor prognosis. Studies have
shown that prevention is possible. There have been significant advances in treatment.

In 1997 the Norwegian Research Council arranged a conference on children with conduct
disorder. Based on topics discussed at this conference, an expert comittee recommended that a
systematic study aimed at evaluating the effects of PMT and MST should be conducted in
Norway. In 1999, two studies were started, with a three year follow-up period. This period
will end in 2002. A third study started in 2001, and will end in 2004.

Parent Management Training refers to procedures in which parents are trained to alter their
child's behavior in the home. Two separate PMT approaches have been developed by Gerald
Patterson and by Carolyn Webster-Stratton. Multisystemic Therapy focuses on systems in
which behavior is embedded and on altering these systems in concrete ways that can influence
behavior.

PMT and MST have been evaluated in randomised, controlled outcome trials, and show good
effect on reducing antisocial behavior compared to control groups. Similar studies are
currently conducted in Norway.
Interleukin 10 genpolymorfismer og respons på interferon behandling hos
pasienter med multippel sklerose

Wergeland, Stig


Supervisor: Kjell-Morten Myhr, overlege dr.med.
Nasjonalt Kompetansesenter for Multippel Sklerose, Nevrologisk avdeling, Haukeland
Universitetssykehus


Introduction
The cytokine interleukin 10 (IL-10) has been shown to elicit an antiinflammatory response in
the pathogenesis of multiple sclerosis (MS). Polymorphisms in the promoter region of the IL-
10 gene have been shown to influence its expression. Three polymorphisms are of
significance, -1082 (G/A), -819 (T/C) and -592 (A/C), making up several haplotype
combinations, associated with either high, medium or low IL-10 expression. These
polymorphisms have been shown to influence the desease activity and –course of some
autoimmune and infectious diseases, as hepatitis C. In hepatitic C, they have also been shown
to influence initial treatment response to IFN-α.

Aim
To study wether polymorphisms in the IL-10 gene influences interferon (IFN) treatment
response in MS.

Materials and methods
63 patients (43 women and 20 men), with a mean duration of MS of 8,3 years were included
in the study. DNA was extracted from patient blood samples, and analyzed for IL-10
polymorphisms by polymerase chain reaction (PCR) and gene sequencing. All patients were
evaluated with concern to disability (Expanded Disability Status Scale, EDSS), and disease
activity on magnetic resonance imaging. Disability and disease activity were evaluated
against IL-10 expression haplotypes.

Results
Patients with low IL-10 expression haplotypes had significantly fewer (0,77 ± +0,36) new
contrast-enhancing MRI lesions compared to other patients (2,45 ± 0,57) (p=0,05). However,
overall comparison of the three groups showed no significant differences (p=0,12). With
regards to occurrence of new T2W lesions, no significant differences were detected (p=0,49).
There were no significant difference in change in EDSS-score between high, medium or low
IL-10 expression haplotypes (p=0,73). Occurrence of new relapses were the same in the three
groups (p=0,61). 5/12 patients with high, 9/30 patients with medium and 9/19 patients with
low IL-10 expression sufferred one or more relapses during a 6 month period after treatment
initiation.

Conclusion
In this small sample of MS patients, polymorphisms in the promoter region of the IL-10 gene
may seem to influence clinical IFN treatment response in MS measured by T1W contrast
enhancing lesions. Further prospective studies seem necessary to establish the exact influence
of IL-10 gene polymorphisms on interferon treatment response in MS.
Carriage rate of group B streptococci in pregnant women and colonization of
their babies.
A study at Kilimanjaro Christian Medical Centre (KCMC), Tanzania and
literature review

Wilhelmsen, Marianne


Supervisors: Nina Langeland, professor dr.med., Institutt for indremedisin, UiB
Noel E. Sam, dr., Department of microbiology, KCMC, Tanzania og
Claus Klingenberg, dr., Barneavdelingen, Universitetssykehuset Nord-Norge



Background: Group B Streptococci (GBS) seems to be more common as a cause of neonatal
infections in many industrialized countries compared to developing countries. In a previous
three month survey at the neonatal ward, Kilimanjaro Christian Medical Centre (KCMC) from
December 1998 to march 1999 there were no cases of GBS septicaemia among 247
admissions. Among ten cases with significant bacterial growth from blood cultures, S. aureus
was the most common bacteria isolate. Of 66 positive cultures from blood, skin and ulcer
base, there were no cases of GBS. The following study was performed to determine the
colonization rate of GBS in delivering women at KCMC.

Methods/results: Vaginal swabs were collected from 153 women admitted at labour ward,
KCMC, from December 1999 through January 2000. Ear swabs from 89 of their newborn
children were also collected (including to twin pairs). GBS was isolated from ten of the
women. This equals a colonization rate of 6.5%. GBS was also isolated from two of the
children.

Conclusions: The GBS colonization rate of 6.5% probably represent an underestimated value
because of sub-optimal routines for sample collection and laboratory techniques. 6.5% is
lower than the mean estimated from other studies in Sub-Saharan countries.

The GBS colonization rate in developing countries seems to vary within the same range as in
industrialized countries. According to these observations, low colonization rate is not a
plausible explanation for the low incidence of neonatal GBS infection in developing
countries. Other possible explanations are genetic differences in susceptibility to develop
disease, differences in GBS strains and their virulence, different levels of antibodies to GBS
disease. The great uncertainty in estimating the incidence also makes it difficult to compare
the results from different studies.
En deskriptiv studie av PTSD hos voksne som har opplevd krig I Bosnia og
Hercegovina

Zvizdic, Asja


Supervisor: Kjell Morten Stormark, forsker dr.psychol.
Regionsenter for barn og unges psykiske helse, UiB



PTSD (post traumatic stress disorder) develops after a traumatic and life threatening event.
Diagnosis includes 3 categories of symptoms:
   1. Intrusive with reliving of a trauma
   2. Avoiding of stimuli associated with the trauma and emotional numbness
   3. Persistent hyperarousal that was not there before

Bosnia and Hercegovina went through extraordinary war condition where neighbours became
enemies and fought each other. This makes it interesting to look at PTSD victims in Bosnia.
I wanted to see what patient population with diagnosis PTSD participate in the treatment and
if PTSD has the connection with stressors and premorbidity relationships.
Summer 2002, 23 patients took part in a group therapy at the psychiatric hospital in Sarajevo.
I went through these patients’ charts. Charts are filled after a standard procedure using
different variables. All information in the charts is self reported by the patients themselves.
The results are showing that most of the patients were middle aged men. 2 have previously
had a psychiatric disorder, 4 had a close family member suffering from a psychiatric disorder
and 2 had unadjusted premorbid personality before the war. Everyone has experienced life
threatening traumas and intense and constant fear. There were otherwise no known other risk
factors.
Many are still suffering but refusing to seek help. It is very stigmatising to seek psychiatric
help. Today it is being accentuated on informing people about this disorder and
destigmatising it.
Cognitive therapy in general practice

Åkre, Jørgen


Supervisor: Tone Tangen Haug, professor
Seksjon for psykiatri, Institutt for klinisk medisin, UiB



Purpose of the study: In this literature study the main goal has been to describe application
of cognitive therapy in general practice. At first an overview regarding general aspects of
cognitive therapy is given. The importance of intersubjectivity and therapeutic relation is
emphasized. Further on, different approaches of cognitive therapy in general practice are
presented. Cognitive therapy or elements of this in different relevant conditions such as stress,
somatic disease, somatization, hypochondriasis, depression, social phobia, panic disorder and
specific phobias, is discussed. One of the main issues has been to describe cognitive therapy,
and it`s feasibility for general practitioners.

Method: Literature study.

Results: Several studies describe the use of cognitive therapy and/or elements of this in
general practice, even though there are few randomized controlled studies. Coping with stress
and somatic disease are areas where cognitive techniques seem to be useful. Likewise, there is
evidence for prevention of disability in patients with chronic spinal pain provided cognitive
interventions. Cognitive-behavioural treatment in groups can be effective for patients with
somatoform conditions. An understanding of patients` cognitive content seems to be of
special importance regarding hypochondriasis, where this again can be the startpoint for
cognitive restructuring. Cognitive treatment and problemsolving techniques are effective in
mild to moderate depression, and have been proved to be equally effective as medication.
Some studies show a reduction in relapse rate of depression given this therapy, and another
aspect is increased compliance. Cognitive therapy in panic disorder with agoraphobia had a
more robust and persistent outcome than medication with antidepressants alone. Treatment of
social phobia with exposure therapy in general practice has shown to be feasible and effective.

Conclusion: Cognitive therapy is applicable for a range of conditions seen in general practice.
An increased use of cognitive therapy or elements of this by general practitioners, would be
desirable. The most important aspect regarding feasibility in general practice, is probably a
strong interest in cognitive techniques and therapeutic relation by the doctor.
Mors alder og svangerskap: Mors helse, komplikasjoner og
forløsningsmetode

Aanderaa, Elisabeth
Danielsen, Gabrielle
Dale, Kjetil Samuel


Supervisors: Lorentz M. Irgens, professor dr.med. og Rolv Skjærven, professor dr.philos
Medisinsk fødselsregister, Institutt for samfunnsmedisinske fag, UiB



Objective: In our study we have tried to find out whether extreme maternal age is a
disadvantage for the child, and whether this tendency has changed over the last thirty years.
By the expression “extreme age”, we mean mothers being teenagers (<20 years old) or elderly
women (≥35 years old).

Material and method: The material is drawn from the Medical Birth Registry of Norway,
and includes every primiparous women in Norway during the period 1976-1998 (a total of
738688 births). Multiple pregnancies and pregnancies of women with related partners are
excluded from the material. We have compared primiparous teenagers to all primiparous
women being twenty years or older. Also, we have compared primiparous elderly women to
all primiparous women younger than thirty-five years old. The material has been divided into
two periods, 1967-82 and 1983-98, to see whether time has had an effect on the variables we
have examined. The variables we examined, were: apgarscore, caesarian section,
preeclampsia, breech presentation and delivery with forceps or vacuum.

Results: For the period 1983-98, elderly women had an increased chance for unfortunate
outcome for the following variables: apgarscore OR=1,37 (95% CI 1,20-1,56), diabetes OR
2,14 (95% CI 1,84-2,50), caesarean operations OR=3,26 (95% CI 3,14-3,38), preeclampsia
OR=1,26 (95% CI 1,17-1,35), breech presentation OR=1,45 (95% CI 1,35-1,56), forceps and
vacuum OR=1,59 (95% CI 1,52-1,66). We found a significant interaction of time (p<0,001)
for caesarean operations, preeclampsia, breech presentation and the use of forceps and
vacuum. There was an increase in unfortunate outcomes of pregnancies from the first period
to the second, for all variables examined.
For the period 1983-98, younger women had an decreased chance for unfortunate outcome for
the following variables; forceps and vacuum OR=0,57 (95% CI 0,55-0,59), diabetes OR=0,54
(95% CI 0,45-0,64), caesarean operations OR=0,65 (95% CI 0,62-0,67) and breech
presentation OR=0,68 (95% CI 0,64-0,72).

Conclusion: Extreme low maternal age is unfavourable for the child. This effect decreases
closer to the twenties. From the variables we have looked into, there was no obvious
unfavourable influence of the health of the mothers during their pregnancies or deliveries. On
the other hand, if a woman waits until she is thirtyfive years old or older before she gets her
first child, it is unfavourable both for the child and for the mother during her pregnancy and
delivery.
Pparγ-aktivering og dens effekt på celleproliferasjon i MCF-7 celler i kultur

Aase, Jenny Hild


Supervisor: Gunnar Mellgren, førsteamanuensis dr.med.
Hormonlaboratoriet, Institutt for indremedisin, UiB



The peroxisome proliferator-activated receptor γ is a transcription factor shown to play a
crucial role in the control of cellular growth and differentiation. Especially, the recently
emerged concept of ligand-dependent PPARγ-mediated inhibition of cancer cell proliferation,
is of clinical interest to cancer therapy. Tetradecylthioacetic acid (TTA) is a sulphur-
substituted saturated fatty acid analog and a known ligand for PAARγ. It has also been shown
to inhibit cell proliferation in gliomacells from rat. Rosglitazone (BRL) is a thiazolidinedione
(anti-diabetic drug) and known to be a PPARγ-agonist. In this study, we wanted to investigate
if TTA inhibits cell growth via PAARγ dependent pathways. We used cancercells from breast
tumors (MCF-7), as they have shown to be the most sensitive in inhibition of growth with
another syntetic PPAR-ligand, Troglitazone. Transfection experiments confirmed that TTA
stimulates PPARγ. We then introduced the PPARγ-stimulating cofactor TIF-2 in another
transfection experiment. The transfected cells were treated with different consentrations of
TTA and BRL, and the results showed that the cofactor TIF-2 enhances PPARγ-mediated
transcription both in the presence of TTA, and the spesific ligand BRL. Finally, we performed
a growth experiment where 3H-thymidin was incorporated in the DNA of MCF-7 cells, and
used as a measure of proliferation. Cells treated with TTA showed inhibited proliferation in a
dose-dependent manner. Cells treated with BRL did not show any significant growth
inhibition. Thus, in conlution, our results indicate that TTA inhibits proliferation of MCF-7
cells in culture, but the effect is not mediated via PPARγ.

								
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