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					Book of Abstracts


  Student theses

       Class 99



         2005




 The University of Bergen
   Faculty of Medicine




                            1
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 99.
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




                                                                                               2
PDA-versjon av Metodebok i Akutt Indremedisin for Haukeland
Universitetssykehus
Handbook in Acute Internal Medicine forHaukeland Universityhospital

Alme, Bjørn Arild


Supervisor: Hrafnkell Thordarson, ass.avdelingsoverlege
Medisinsk avdeling, Haukeland Universitetssykehus



        This ”Handbook in Acute Internal Medicine” for PDA (personal digital assistent) is
developeted as a studyassignment by Bjørn Arild Alme in 2004. It is ment as a electronic
reference book for doctors and medicalstudents in the emergency- and hospitalward at
Haukeland Universityhospital.
        This PDA edition is based on the 4. edition 2. print of “Metodebok i Akutt
Indremedisin for Haukeland Universitetssykehus”. Dr. Hrafnkell Baldur Thordarson has been
the editor and supervisor.
    During the work with the PDA-version I first assisted with the corrections to the printed
version of the handbook. Then I continued working with this and adapting it for use on a
PDA. There has been a few changes to ease the reading and use.
    o Editing of the layout.
    o Extensive hyperlink system to ease the navigation between topics and chapters.
    o Adaptation of tables for an easier overview.
    o Development of an alfabetic index.
    o Illustrations and images in connection with the infection- and hematology- chapter to
        assist the diagnostics of skin infections and their differencial diagnosis.
    o Chapters concerning the classification of heartfailure and COPD to exend the use of
        the handbook as a reference book.

   The handbook comes as a pdb-file ment for reading on a Pocketpc or Palm. This filetype
require “Isilo for Pocketpc” or “Isilo for PalmOS” to be read properly. In this CD there a 30
days trial-version of “Isilo for Windows” for reading pdb-files on a stationary pc.
   If there are any questions concerning this fil-type or if there is a need for a demonstration I
can be contacted on telephone 92020677 and email: baalme@broadpark.no




                                                                                                3
Pappa i fødsel-en studie av hormonelle og psykologiske forhold hos menn som
blir fedre for første gang

Andersen, Gry Nyland


Supervisor: Jostein Tjugum, overlege dr.med.
Kvinneklinikken, Sentralsjukehuset Sogn og Fjordane



Objective To study blood levels in cortisol, prolactin, estradiol and testosterone in men
becoming fathers for the first time and to see if any changes can be reflected in paternal
psychological responses.
Population 23 men were included.

Methods Participants were recruited at Førde Central Hospital between October 2002 and
July 2003. The men completed a questionnaire at 17-18 weeks of pregnancy and 6-8 weeks
after birth. This included General Health Questionnaire-28, State Anxiety Inventory and
Impact of Event Scale. The men also provided blood-samples at 5 different occations; 17-18
weeks of pregnancy, 3 and 1 months before expected birth, at birth and 6-8 weeks after birth.
Cortisol, prolactin, estradiol and testosterone levels were quantified.

Results The questionnaires indicated a reduction of intrusion at 6-8 weeks after birth
compared to the results from 17-18 weeks of pregnancy. The other parametres showed no
changes after birth compared with the early results. There were no marked changes in the
hormones at any point except from a reduction in testosterone in sample 3. The response rate
varied for the bloodsamples but were constant for the questionnaires.

Conclusions The results showed no marked change, either psychological or hormonal. The
decline in intrusion following delivery may indicate that at least some of the participants
found the time during pregnancy more stressful than the time after birth.




                                                                                                4
Kurshefte - hjernedisseksjon

Andersen, Gard Kristian
Wiksnes, Eli


Supervisors: Svend Davanger, førsteamanuensis, dr.med, Anatomisk institutt, Universitetet i
Oslo
Knut Wester, professor/overlege, Institutt for kirurgiske fag, UiB/Nevrokirurgisk avdeling,
Haukeland Universitetssykehus



Dette er en revidert utgave av det hjernedisseksjonsheftet som ble utgitt første gang i 2002.
Første-utgaven ble laget av stud.med. Gard Anderssen og stud.med. Eli Wiksnes, på initiativ
fra førsteamanuensis Svend Davanger.
I denne reviderte utgaven har også professor og overlege Knut Wester ved Nevrokirurgisk
avdeling, Haukeland Universitetssykehus, bidratt med anatomisk, fysiologisk og klinisk stoff.
Fotografiene er tatt av Svend Davanger og de fleste figurene er tegnet av Marit Sæbø.

Heftet er ment som en hjelp til undervisningen i hjernens makro-anatomi. Vi håper at heftets
instruksjoner og forklaringer kan bidra til at du lærer mest mulig av undervisningen på
disseksjonssalen.
Teksten fører deg trinn for trinn gjennom hjernedisseksjonen på en kortfattet og skjematisk
måte.
Viktige strukturer er merket med uthevet skrift eller kursiv. Mange av disse strukturene har i
heftet henvisninger til Feneis Anatomiske Atlas, med sidetall og figurnummer. Dette er en
paperback pocketbok som GA og EW brukte mye i sine anatomistudier, og som fungerte som
en forenkling og tidsbesparende hjelp til eksamenslesingen.
Klinikk- og funksjons-bokser er tatt med for å gi en bedre forståelse for behovet for basal
anatomi/fysiologi, samtidig som de har klinisk nytteverdi.




                                                                                              5
Ukonvensjonell behandling av kreft

Askeland, Cecilie


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



Unconventional medicine is getting more and more visible in our society today, and peoples’
interest in it is rising. Therefore it is important that patients who want to try unconventional
practitioners are given correct and neutral information about the different therapies found on
the market, so that they can avoid regimens focusing only on profit and not on the patients’
well-being. The purpose of this article is to give a general view of what unconventional
medicine is, to explain the difference between alternative and complementary therapies and to
look at the prevalence of CAM-users in the world, including Norway. There is also a
discussion why the CAM-prevalence varies between studies and countries. Some of the most
popular and used unconventional treatments offered to cancer patients today are presented.
The literature used to write this article is scientific articles found in BIBSYS, PUBMED and
MEDLINE, together with books and websites.




                                                                                               6
Intravenøs trombolytisk behandling med rt-PA ved akutt hjerneinfarkt:
Rekanalisering versus ingen rekanalisering etter 24 timer verifisert ved
transkranial Doppler ultralydundersøkelse

Intravenous thrombolytic treatment with rt-PA in acute ischemic stroke:
Recanalization versus no recanalization within 24 hours from treatment verified by
transcranial Doppler ultrasound examination.


Askevold, Erik Tandberg


Supervisor: Lars Thomassen, overlege og Halvor Næss, overlege
Nevrologisk avdeling, Haukeland Universitetssykehus



Background and purpose
Early clinical recovery after thrombolytic treatment for acute ischemic stroke predicts a favourable
long-term outcome. Knowledge regarding the differences between patients who experience
recanalization within 24 hours from treatment, and those who do not, is still scarce. The purpose of
this study was two-fold; firstly to analyze potential differences between the two patient-groups,
secondly to assess if any variables were associated with clinical recovery during the first day after
treatment.

Subjects and methods
Unselected, consecutive patients with acute ischemic stroke, who received intravenous thrombolytic
treatment and underwent transcranial Doppler ultrasound investigation (TCD) at presentation and 24
hours post-treatment, were included in the study population. The patients were clinically evaluated
using the National Institute of Stroke Scale (NIHSS) at presentation, and after 2 and 24 hours post-
treatment.

Results
Nineteen of the 27 patients included in the study experienced recanalization within 24 hours from
treatment (16 completely, 3 partially). TCD revealed lack of recanalization in 8 patients. The patients
who recanalized had significantly lower average NIHSS score on presentation than those who did not
recanalize (12,7 versus 19,3 (P=0,01)). After 24 hours the NIHSS score was 5 and 19,5 (P<0,001)
respectively. The patients experiencing recanalization had a mean clinical improvement on the NIH
Stroke Scale of 4,6 points 2 hours after treatment (P=0,002). At 24 hours after treatment the
improvement was 7,7 points (P<0,001). Two (10,5 %) of the patients who recanalized had atrial
fibrillation as risk factor, as opposed to 4 (50 %) of the pastients who did not recanalize (P=0,044).
There was a trend towards higher serum glucose values on presentation (P=0,050), more risk factors
(P=0,052), and increasing presence of diabetes mellitus (P=0,080) and hypertension (P=0,087) in
those patients who did not experience recanalization.

Conclusions
Patients with acute ischemic stroke who recanalize after thrombolytic treatment have lower NIHSS
scores (P=0,01) and more often atrial fibrillation (P=0,044) on admittance in hospital than those who
do not recanalize. Recanalization within 24 hours from treatment is associated with a significant
decline in NIHSS score (P<0,001). There is a trend towards higher serum glucose values, more
hypertension and diabetes mellitus, and an increasing number of risk factors in patients who do not
experience recanalization within 24 hours from treatment.



                                                                                                          7
Terminal sedering - Bærumsaken; saksforløp og noen etiske betraktninger

Asprusten, Emil A.


Supervisor: Ole Frithjof Norheim, professor
Fagområdet medisinsk etikk og vitenskapsteori, Institutt for samfunnsmedisinske fag, UiB



The so called Bærum-case started with that one chief physician at Bærum
hospital accused a colleague of the treatment he gave a man suffering from cancer in July
1998. Beside the actual case, the accusation included ten other cases of euthanasia/“help in
dying”. The Health Council however criticized the accused chief physician of missing journal
keeping, but found no basis of the statement of “help in dying”. Bærum hospital was criticized
for wanting routines concerning terminal sedation. As the case later on had great media
exposure, among other things the question of disqualification an insufficient documentation of
mode of treatment, The Health Council decided to deal with the case once more. After having
received the actual documents the prosecuting authority by the Public Prosecutor chooses to
dismiss the case in December 2001 because of the state of evidence. The Health Council
finishes the case in April 2002 by giving the doctor in charge of the treatment a warning.

Background: Terminal sedation is the intention of purposely inducing and maintaining a
sedated state, but not deliberately causing death, in specific clinical circumstances
complicated by refractory symptoms. As the medication itself might hasten death, it is
asserted that this is a form of slow euthanasia.

Purpose: The intention with the first part of this work is to give an account of the course of
events in an uncommitted way. In the second part of this work I’ll deal with terminal sedation
as such – here I’ll emphasise ethical considerations, and I’ll try to discriminate between
terminal sedation and euthanasia.

Method: The work is in its entirety based on literature. As sources I’ve used Aftenposten
and Vårt Land (May 1999 till May 2002), “Medisinsk etikk – en problembasert tilnærming”
(textbook in medical ethics), “Må jeg dø I smerte?” (the accused chief physician’s remarks)
and The Health Council’s documents available on internet.

Conclusion: Under further assumptions terminal sedation is an ethical acceptable way of
treatment. On account of special conditions great demands have to be made to the decision
process, the accomplishment and the documentation of the treatment. All together it seems
appropriate that the so called Bærum-case was dismissed according to criminal law
assessment ant at the same time the doctor responsible for the treatment got a warning
from The Health Council against the background of professional assessment. The doctor
who blew the whistle on his colleague deserves recognition.




                                                                                              8
Frakturer i laterale malleol. En gjennomgang av frakturtyper, behandling og
etterbehandling, med spesiell vekt på røntgenkontroll i oppfølgingsperioden

Bekkevar, Tor
Skår, Fredrick


Supervisors: Kjell Matre, seksjonsoverlege, Ortopedisk avdeling, Haukeland Universitets-
sykehus og og Anders Mølster, professor, Institutt for kirurgiske fag, UiB



Purpose of the study: Isolated lateral malleol-fractures are relatively common. This study
was performed to evaluate the necessity of frequent roentgenograms in the follow-up of these
fractures.

Material and methods: The study was based on 110 patients that had been treated for an
isolated lateral malleolar fracture at Haukeland University Hospital. 26 of the patients were
treated closed with a plaster cast and 84 were treated operatively. There were 46 males and
64 females. Evaluation was made by use of journals and radiographs.

Results: Of the total of 110 patients there were 7 Weber A-, 67 Weber B- and 24 Weber-C
fractures. For the patients treated by closed means, the radiographic follow-up after 10-14
days resulted in operative treatment for 3 of the 26 patients. The radiographs taken after 6
weeks resulted in change of treatment for only one patient, which had to wear his plaster cast
for another 14 days.
For the patients treated by open reduction and internal fixation, the radiograph taken after 6
weeks had consequences for four of the patients but with correct interpretation, it should only
have had consequence for one of the patients. This patient had a Weber-C fracture with a
loosened syndesmotic positioning screw. He was allowed only partial weight bearing until
the syndesmotic screw was removed.

Conclusion: For patients treated non-operatively the radiographs taken postoperatively and
after 10-14 days are necessary. The radiographic follow-up after 6 weeks is not necessary.
For the operated patients with Weber-A and B fractures, without syndesmotic screw, the
radiographic follow-up after 6 weeks is not necessary. For patients with Weber-B fracture,
with syndesmotic injury, the radiographic follow-up can be delayed until 8 weeks after the
injury. In that case the roentgenograms and the removal of the screw can be done at the same
time.
For Weber-C fractures the radiographs taken after 6 weeks probably is appropriate, but we
recommend further studies.




                                                                                                9
Representasjon av rommet i hjernen. Hippocampus evne til å lagre og
behandle informasjon om ytre omgivelser.

Bekkevik, Marit Gjone


Supervisor: Boleslaw Srebro, førsteamanuensis
Seksjon for fysiologi, Institutt for biomedisin, UiB



Hippocampus is a part of the limbic system, and is important among other things for
orientation in space and navigation. In the hippocampus (mainly in the CA1 and CA3 in the
posterior hippocampus) a type of cell with place specific activity has been found. These cells,
called place cells, fire at maximum rate when the animal is in a specific part of the
environment, and is almost completely quiet elsewhere. The discovery of place cells led to
the cognitive map theory, which says that hippocampus a neuronal substrate for a cognitive
map, and the place cells is the basic units of this map.

After the discovery of place cells an extensive research on these cells’ qualities and function
started. It has among other things been shown that what controls the place cells’ firing is
external landmarks, especially distal, visual ones, and information derived from the body like
that from the vestibular organs and proprioception.

After this, other types of cells with place specific activity have also been found. Head
direction cells are a kind of cell which fires at maximum rate when the rats’ head is oriented
in a specific direction in a horizontal plane, for instance north east. They are independent of
location.

A method for studying the firing activity of single cells by implanting microelectrodes in the
rodent brain has been developed. Modern computer technology has made it possible to
construct models for neuronal networks. This allows you to study different hypotheses.

Thus far it is not been completely determined how space is processed in the brain, but there
are different models and theories in addition to the cognitive map theory already mentioned.
These are not necessarily conflicting, but a theory which can sum up these has not yet been
modelled.




                                                                                              10
Kognitiv terapi i behandling av pasienter med depresjoner. Sammenligning av
medikamentell og kognitiv behandling

Berget, Sissel M.
Brar, Ramnit K.
Dahl-Paulsen, Anne Karen (Class 00a)


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



Introduction/ background: The two main approaches in treatment of depression are
psychotherapy and drugs. Among the different types of psychotherapy, cognitive therapy is
the best documented. We have chosen to study the theory of the cognitive model and how to
use this form of therapy in clinical practice. We have also studied the effect of cognitive
therapy and drugs in treatment of depression, both separately and in combination.

Materials/ method: In studying the theory and the clinical use of cognitive therapy we used
two of Aaron T. Beck`s books, Depresjonshåndboken and some textbooks on general
psychiatry. We also performed a search in the PubMed database with selection of 23
representative studies on cognitive therapy and drugs in treatment of patients with depression.

Results/ conclusion: According to the cognitive model, our emotions and behavior are
consequences of how we interpret a specific situation and which thought that goes through
our minds. By becoming aware of these thoughts and change dysfunctional patterns of
thinking, the patient will experience a relive of symptoms and also reduce the risk of relapse
after ended treatment.

*In treatment of patients with mild to moderate depression Cognitive therapy and drugs have
the same response-rate, and there is no additional effect in combining the two.

*If drugs can not be given, cognitive therapy can be used as monotherapy to patients with
severe depression, but the response-rate is low.

*Cognitive therapy is useful when symptoms persists after adequate drug treatment, and there
is additional effect in response-rate when cognitive therapy is combined with drugs in patients
with chronic depression.

*Cognitive therapy reduce the risk of relapse in patients at high risk.

*Cognitive therapy continues to work after treatment is ended.




                                                                                             11
Funksjonelle somatiske lidelser; patofysiologiske mekanismer og behandling

Berling, Vegard


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



An illness is often neither only functional nor somatic. Most conditions are multi-factorial.
Lifestyle, life situation, gender, personal experiences, environment, working conditions and
many other factors are important medical information of the same importance as biologically
based parameters. They all work together and can create, preserve or even worsen a medical
condition.
To understand patients who struggle with medically unexplained diseases, it is important to
have a biopsychosocial understanding of the humanity and disease. One has to have a broad
understanding of disease that includes personality-, psychosocial factors and factors on group-
and social level. They work together –and make the person ill. When we realize that most
medical conditions are more or less influenced by psychosocial factors, one can therefore
question the term psychosomatic disease.

Functional somatic disease concerns disease where one takes it for granted that psychosocial
factors play an important role.

I have in this article chosen to focus on functional gastrointestinal disease (Functional
dyspepsia (FD) and irritable bowel syndrome (IBS)). About 30 percent of the population in
the western world are more or less struggling with such problems.

A good therapeutic relationship between the doctor and the patient is a must to be able to
achieve a common understanding of the patient’s condition. The patient’s experiences and
reflections around his own situation should be the basis of all further communication and
treatment. That is what lies behind the term patient-centred method.

Cognitive therapy and the cognitive model of functional somatic disease form the basis of
treatment and how to meet a patient with these problems. Coping with the problems and
thereby reducing stressors is often a way out of the problems for many of these patients.




                                                                                             12
Urinveiskomplikasjoner hos omskårne kvinner – en litteraturstudie

Bhatti, Rebecca


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



Background: 100-130 million women are circumised in the world today. It is assumed that these
women experience both immediate, long-term and obstetric complications, urinary complications
being the most frequent. The aim of this study, was to search the literature for documentation of these
assumptions.

Method: I searched the Internet, selected databases, journals, and reference lists in review articles to
find relevant articles. The articles were chosen according to relevant title, language, original studies
and whether the article was accessible through the university system without excessive costs. The
literature was used to get an impression of how well documented urinary complications are in
circumcised women.

Result: After searches in PubMed, Cochrane Library, Yahoo, Google, and home pages of WHO and
Royal College of Obstetricians and Gunaecologists and journals of obstetrics and gynecology, I found
33 relevant articles. 12 of these were original articles comprising a total of 16782 women. Urinary
retention occurred in 9%, urinary infection 14%, recurrence after treatment for urinary infection 13%,
problems with miction 15%, and urinary incontinence 6%. Only one of the studies has chosen a
random sampling technique. In this study one finds urinary retention among 3%, new infection after
urinary tract infection 9% and problems with miction 5%.

Discussion: I had to limit my search to articles available on the internet or in the university system at
a low cost. The complication numbers in the population based study are lower than in the hospital
based studies, as expected. The studies are limited to a few countries and it is uncertain how
representative they are. Most of them are done in Nigeria, Somalia and Sudan. One has to be cautious
when trying to generalize because the circumstances around circum-cision might be different in other
places. None of the studies have statistical analysis to show differences in groups. Compared to
urintract infections in women in industrialised countries, urinary tract infection does not seem to be
more frequent among circumcised women.
Under-reporting due to embarrassment has been pointed out as a possible cause of error. Low
numbers in some of the studies reduces further the reliability. Many of the studies seem more suitable
for identifying possible complications, rather than to assess the severity of the problem. The
interviews were pre-tested for validity and objectivity in only one of the studies, only. It is expected
that the most extensive type of circumcision should give more complications, but only 3 of the studies
differentiated type of circumcision and with no statistics.

Conclusion: Based on the literature, the most extensive circumcision seems to cause more frequently
complications, but this is not substantiated in appropriate statistics. Although it is assumed that
urinary tract problems occur more commonly in the circumcised women compared to background
populations, the numbers are not convincing and the hypothesis hardly tested in appropriate studies.
When considering the extent of the problem, there are remarkably few appropriately designed studies
addressing the issue. Does this reflect the economic, social and cultural bias that governs medical
research?




                                                                                                       13
Are triglycerides an independent risk factor for cardiovascular disease? What
treatment is available?

Bjørdal, Jonas


Supervisor: Rolf K. Berge, professor
Seksjon for medisinsk biokjemi, Instituttt for indremedisin, UiB



Background. Cardiovascular disease is a major cause of mortality in industrialized countries.
The suspicion of triglycerides being an independent risk factor for cardiovascular disease has
increased over the past years.

Material and methods. Searches were made in PubMed for ”Triacylglycerol + Risk factor”
and in the “Journal of the Norwegian Medical Association” for ”Triglycerider” and
”Triglyserider”. In addition I studied therapy recommendations from the Norwegian
Medicines Agency and Norwegian Electronic Handbook.

Results. Several studies have showed that triglycerides are an independent risk factor for
cardiovascular disease. Triglyceride level diagnosis and management is therefore important in
CVD prevention. It is important to not only look at isolated risk factors, but to estimate the
total risk of the patient. Change of behavioral risk factors should be the first attempt. If this
doesn’t modify the patients risk profile, pharmacological treatment may be necessary.
Available pharmacological treatment is fibrates, n-3-fatty acids, nicotinic acid and statins.




                                                                                              14
Sammenheng mellom skademekanisme og skader hos pasienter som har vært
utsatt for høyenergitraume

Braut, Runar


Supervisor: Kari Schrøder Hansen, overlege dr.med. og Asgaut Viste, professor
Kirurgisk avdeling, Haukeland Universitetssykehus og Institutt for kirurgiske fag, UiB



Background: This study was done to find out more about injuries after motorcycle accidents
and to see if different types of accidents causes different injuries.

Material and methods: Data was collected retrospectively by reviewing journals after
motorcycle accidents at the Emergency Department and the Department of Pathology, section
for forensic medicine at Haukeland University Hospital, Bergen, Norway.

Results: Bone fractures, haemorrhages and contusions to the extremities, thorax and the head
were the most common injuries. Head injuries were more common to the collision victims
than to those who drove off the road. Injuries to the head, thorax and abdomen were more
common among the dead than among survivors. Injuries to the extremities were more
common to the survivors. Almost all (94 %) fatal cases had injuries to more than one region,
while this was true for 57 % of the survivors.
Rib/sternal fractures were a strong predictor for internal thoracic and abdominal injuries. Face
injuries were a strong predictor for traumatic brain injury.

Interpretation: Injuries to the head, thorax and abdomen should be looked for and excluded
early in every motorcycle accident victim. Rib fractures and facial injuries should be
especially noted since they are strong predictors for more serious injuries.




                                                                                             15
Lungekreftpasienter og bruk av alternativ behandling

Breivold, Jørgen
Skoge, Kjetil Rune


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



Between January, 2003 and May, 2004, 180 patients with lung cancer from Haukeland
University hospital in Bergen, Norway, and University hospital, Linköping, Sweden were
asked if they were willing to fill out a questionnaire about use of alternative/complementary
treatment. Among 121 patients who accepted to participate in the study, 6 % had used
alternative treatment and 16 % were planning to do so. More Norwegian than Swedish
patients told that they were planning to use complementary medicine. There were no
differences between the two nations among those who had used complementary medicine.
Patients who believed that their doctor had given them greater chances of survival did not
use complementary medicine as often as those who believed they had less chances of survival.
Those who had prior experience with complementary medicine were more frequent users of
complementary medicine for their lung cancer. Those who have had the diagnosis of lung
cancer for more than 9 months were less often users of complementary medicine than those
who recently had received the diagnose.
The most common reason given for using or planning to use complementary medicine was
that the patients were willing to try everything to get well again. One of the most important
reasons that patients had not tried complementary medicine was that they did not know very
much about it. 81% of the patients meant that complementary medicine should be offered in
Norwegian hospitals. Of those who had felt need to discuss complementary treatment with
their physician, less than 50% took the initiative for doing so.




                                                                                          16
Cancer mammae 2001 – eit årsmateriale

Brekke, Jorunn
Størkson, Elisabeth


Supervisor: Jan Erik Varhaug, professor/seksjonsoverlege
Institutt for kirurgiske fag, UiB/Endokrinkirurgisk seksjon, Haukeland Universitetssykehus



Background: During 2000, there were 22185 new cases of cancer reported in Norway (1), of
which 48% were women. Among women, breast cancer constitutes the largest group, and this
diagnosis was given to 2503 women in 2000 (1). Each year this number increase by 50 (2).
We have had a closer look into patient materials from Haukeland Universitets Sjukehus in
2001 where the patients have had surgical treatment because of cancer mammae.
A similar study exists with patient material from 1990 and 2000, and public mammography
screenings in Hordaland were started in 1990. We therefore have the opportunity to compare
results before and after mammography screenings were started.

Method: We have read through the surgical journals for women who during 2001 had
surgical treatment for breast cancer at the Endocrine Surgical Ward, Haukeland Universitets
Sjukehus. There were a total of 235 patients who met our inclusion criteria.

We analyzed how cancer was discovered, the diagnosis methods used, localization and size of
tumor, type of surgical treatment used, treatment, complications, histology and TNM grade.

Result/ Discussion: One interesting result is that of all the women who were found to have
cancer in the mammography screenings, 60% did not have clinically palpable tumor.




                                                                                             17
Hypofyseadenomer – forekomset og resultater av behandling i Helseregion
Vest

Brendefur, Linn Merete
Brekkå, Lena (class 00)
Vassboth, Gunnhild


Supervisor: Eystein Husebye, professor dr.med.
Institutt for indremedisin, UiB



Background: The prevalence of pituitary adenomas in the health region of Western Norway
(Counties ”Hordaland, Rogaland, Sogn og Fjordane”) is not known. Systematic evaluation of
the results of treatment have likewise not been performed.

Objective: To investigate the epidemiology of pituitary adenomas and results of treatment of
non-functioning pituitary adenomas (0-adenomas).

Material and methods: A retrospective study of case records of patients with pituitary
adenomas diagnosed between 1992 and 2003, and treated at Haukeland University Hospital.

Results: Altogether, 158 patients were diagnosed with pituitary adenoma between 1992 and
2003. Thirty-seven (twenty-one men) with growth-hormone-producing adenoma (mean age
46,9 years), 21 (6 men) with ACTH-producing adenoma (mean age 41,5 years), 3 (1 man)
with TSH-producing adenoma (mean age 59,0 years) and 97 (56 men) with 0-adenoma (mean
age 57,3 years). The incidence of the different pituitary adenomas showed no obvious
increase from 1992 to 2003. A higher prevalence of 0-adenomas was diagnosed in Sogn og
Fjordane compared to Hordaland and especially Rogaland. For instance, there were twice as
many ACTH-producing adenomas in Sogn og Fjordane compared to Rogaland. Forty-eight
(twenty-eight men) were diagnosed with 0-adenoma in Hordaland (mean age 56,8 years).
Forty-two had macroadenoma, and 6 had microadenoma. Visual symptoms and incidentally
discovery (incidentaloma) were the most frequent reasons for diagnosis. Twenty-eight of the
forty-eight patients were operated on. At diagnosis, 29/48 (60%) had visual symptoms or
signs, and 24/29 of these underwent operative treatment. Postoperatively, 15/24 (63%)
revealed improvement of visual function. Twenty-two of the patients had pituitary failure and
fifteen of these underwent surgery. Postoperatively 3 had their pituitary function normalized.
Eight of twenty-eight patients who underwent surgery showed new tumour growth, and 7/8
were reoperated or received radiation treatment. Of the 20 initially observed patients, 15
remained stable. The 5 patients with increased growth of their tumor were operated on.

Conclusions: Compared to other studies, we found a lower incidence of 0-adenomas. Visual
symptoms were the most frequent symptom leading to the diagnosis. Of the initially observed
0-adenomas, the majority showed no evidence of growth. These patients can be followed
until criteria for surgery are fulfilled.




                                                                                           18
IVIgG behandling ved nevromuskulære sykdommer

Breyholtz, Nina


Supervisor: Christian Vedeler, professor, overlege
Seksjon for nevrologi, Institutt for klinisk medisin, UiB/Nevrologisk avdeling, Haukeland US.



Intravenous immunoglobulin (IVIg) is an immunomodulating agent that has multiple
activities. IVIg modulates the expression and function of Fc receptors, contains anti-idiotypic
antibodies, suppresses inflammatory mediators such as cytokines, metallo-proteinases and
chemokines and interferes with activation of complement products.
IVIg also has an effect on the activation differentiation and effector functions of T-cells and
B-cells. This includes up regulation and down regulation of antibody production,
neutralization of pathogenic autoantibodies and T-cell superantigens, interferans with the
selection of B-cell repertoires and control of cell growth.

IVIg is primarily used replacement therapy in patients with hypogammaglobulinemia. In the
early 80s it was shown to be effective in the treatment of patients with autoimmune
thrombocytopenic purpura. IFIg has since been used to treat a number of neurologic
inflammatory disorders, including Guillain-Barré syndrome, chronic inflammatory
demyelinating polyneuropathy, myasthenia gravis and inflammatory myopathies. In the
specific diseases IVIg different mechanisms interact to give the end-effect. IVIg has in such
neurological diseases been compared with plasma exchange as a treatment for acute clinical
conditions. It has, however, also a place in more chronic conditions, where it has been
compared with corticosteroids and cytotoxic drugs.

IVIg is a safe preparation with no long term side effects. Adverse reactions are few and occur
in 5-10 % of the patients. IVIg is safe with regards to the transmission of known viruses and
infections.




                                                                                            19
Biologiske legemidler ved revmatoid artritt

Brodin, Eli


Supervisor: Johan G. Brun, overlege, førsteamanuensis
Revmatologisk avdeling, Medisinsk avdeling, HUS/Institutt for indremedisin, UiB



RA is a chronic inflammatory disease of unknown origin which attacks synovial joints. It
results in pain, disability and reduced quality of life for the patient. The options for treatment
are divers, but so far none of the alternatives have had the ability to stop progression of the
disease. Over the last decades there has been a growing understanding of the immunological
process, and this has resulted in the development of therapies which target specific molecules
in this process. This article reviews these biological drugs. It shows how the immunology of
RA has been elucidated, and highlights the importance of cytokines in particular.
Different studies and animal-models have shown that TNF and IL-1 are the most important
proinflammatory cytokines in the rheumatoid joint, and how inhibition of these cytokines
have profound effect on the symptoms of the disease.
When this article is written, four biological drugs are approved for treatment of RA. Several
studies have been carried out to evaluate the safety and efficacy of these therapies, and the
results have generally been convincing; rapid and lasting effects on many criterias of disease,
including progression of joint- destruction.
The drugs are generally well tolerated, but there is an increased risk of infection. Reactivation
of tuberculosis has been reported as a particularly serious side- effect.
The new therapies have improved the life of many patients who suffer from RA. Remission is
still a rare event, but for many the quality of life is significantly improved and they function
better in everyday life.
By blocking cytokines one does not affect the cause of RA, and scientist will continue to
search for this. Still, the biological drugs are a small revolution in the field of rheumatology.




                                                                                                20
Sammenligning av holdninger til genetisk testing mellom menn og kvinner:
En spørreundersøkelse blant barn til pasienter med diagnostisert
aldersdemens (Alzheimers sykdom)

Bølum, Camilla
Dyrbekk, Anne Pernille H


Supervisor: Harald Nygaard, professor emeritus dr.med.
Seksjon for geriatri, Institutt for samfunnsmedisinske fag, UiB



In Norway there are about 60000 people with dementia, the majority is more than 65 years
old. Alzheimer’s disease (AS) constitutes 55-60% of all dementias. The disease is divided in
to AS with early and late onset (before and after age 65). AS is characterized by changes in
the cerebral tissue, with neurofibrillary tangles, amyloid plaques and loss of neurons. The
characteristic clinical symptoms are impaired memory, language and orientation, apraxia and
emotional changes like isolateion, anxiety, depression and intensification of the personality.
The available treatment today can only delay the progress of, but not cure, the disease.

The disease is assumed to have a multifactorial cause. High age, heredity, female gender,
hypertention and depression are belived to be riskfactors. Dominantly inherited dementia
(presehilin1 and 2) is extremely rare, and have early onset. In the case of late onset AS there
is found higher incidence of the apolipproteinvariant APOE e4 compared to the general
population. This may lead to future genetic testing. The purpose of our investigation was to
survey the attitudes of first-degree relatives against genetic testing, especially differences in
gender. 154 children of patients with AS returned a questionnaire. The questionnaire
contained demographic questions, questions regarding selfperceived treath and concerns
about developing AS, and attitudes against testing in several hypothetical scenarios. The
group was in general positive to testing, and men more than women. The survey showed that
women are more concerned about getting the disease and they report a bigger burden having a
parent with AS, than men.




                                                                                              21
Substitusjonsbehandling ved binyrebarksvikt

Carlsen, Espen Aabol


Supervisor: Kristian Løvås, postdoc, ass.lege
Institutt for indremedisin, UiB/Medisinsk avdeling, Haukeland Universitetssykehus



Patients with chronic adrenal failure are dependent on lifelong replacement therapy. The
current treatment is not optimal, as many patients experience reduced subjective health and
quality of life. The aim of this paper is to give an overview of adrenal failure and the current
treatment, and to point to new knowledge which can contribute to improvement of the
treatment.
 The adrenal cortex produces the steroid hormones cortisol, aldosterone and adrenal
androgens, but the current replacement therapy in adrenal failure substitutes only cortisol and
aldosterone. Adrenal failure is divided into two groups, primary and secondary. Primary
adrenal failure is due to dysfunction in the adrenal cortex and the dominant cause is
autoimmune destruction. Secondary adrenal failure is due to failure in the pitituary secretion
of ACTH, witch stimulates the adrenal secretion of cortisol, the dominant cause being
iatrogenic as a side effect to treatment with glucocorticoids. The prevalence of adrenal failure
in Western-Norway is estimated to 140 per million in a recent study. The same study
concludes with an increasing incidence of adrenal failure. The symptoms of adrenal failure
are often diffuse and of gradual onset, and as a consequence it commonly takes time before
the diagnosis is made. The most important symptoms include fatigue, weight loss and
hyperpigmentation of skin and mucous membranes. The diagnosis can be made by measuring
morning concentration of cortisol in serum and of ACTH in plasma. The diagnosis is
confirmed by stimulation tests with synthetic ACTH.
 The common treatment in Norway is 20-37,5 mg cortisone-acetate daily divided into two or
three doses. Patients with primary adrenal failure in addition needs 0,05-2mg fludrocortisone
as mineralcorticoid replacement. Patients who are overdosed with glukocorticoids are at risk
of weight gain, hypertension, arteriosclerosis and other side effects. Patients who are
undertreated get symptoms of glukocoricoid deficiency and are at risk of life threatening
Addison crisis. Currently, the monitoring of substitution treatment is demanding, and better
methods are required. Measurement of salivary cortisol and use of standardised diagnostic
questionnaires to identify symptoms and effect of treatment may contibute to a more
individually adapted and more physiological treatment. Cortisol is secreted with a diurnal
variation witch the current treatment ignores. Modern pharmalogical methods should be able
to provide glukocorticoid formulations witch mimic the natural pattern of secretion better than
the current formulations. More studies are required to determine whether this will improve the
patients` quality of life.




                                                                                             22
Crohns sykdom og kirurgisk behandling

Corwin, Christian


Supervisor: Arne Skarstein, overlege/professor
Kirurgisk avdeling, Haukeland Universitetssykehus/Inst. for kirurgiske fag, UiB



Crohn’s disease is a chronic disease that often requires surgical treatment. The indications for
surgery are inadequate response to pharmaceutical treatment and a few certain acute
conditions such as ileus and bowel perforation.
In this retrospective study, we have examined the history of 155 patients who underwent
surgery due to Crohn’s disease at Haukeland University Hospital during a ten-year period
from 1991-2000. The aim was primarily to examine their age at diagnosis and surgery,
indication for surgery, type of surgery, and the number of surgery undergone during a certain
period. The mean age at the time of diagnosis was 27 years. The largest age-group at
diagnosis was ranging from 20 to 29 years. This group accounted for 41,4% of new cases. The
location of disease at the first operation during this period was the distal ileum-coecum
43,9%, other/more parts of small bowel 9,7%, colon 24,5%, small bowel and colon 16,8% and
perianal location 5,2%. Resection was the type of surgery in 85,2% of the patients.
The main indication for surgery involved pain for 77,9% of the patients with disease in the
distal ileum, and for 34,2% of the patients with disease primarily in the colon. 47,7% of the
patients who had undergone surgery in the colon only, had diarrhea as a main indication for
surgery, whereas 20,6% of the patients with disease primarily in the distal ileum had diarrhea
a as main indication for surgery.
Strictureplasty is a method that was hardly used in this study. However, publications are
indicating that this is a method likely to be popular in the future.
Out of the proportion of patients it was possible to follow over a 5- and 10-yearperiode after
the first resection, 33,6% were operated on again after 5 years. 69,4% underwent further
surgery within 10 years after their first resection. The mean length of resected small bowel
was 36,8 cm. This is consistent with today’s policy of only resecting macroscopically affected
small bowel, in order to preserve as much of the the small bowel as possible.




                                                                                             23
Lavdose cytostatica som spesielt påvirker blodkar i tumores
Low Doses of Cytotoxic Drugs That Especially Interrupt With Angiogenisis.

Dahl, Erling


Supervisors: Olav Mella, avd.overlege/professor og Olav Dahl, overlege/professor
Onkologisk avdeling, Haukeland Universitetssykehus/Institutt for indremedisin, UiB



Tumour cells use the same mechanisms for dividing as normal cells. Most conventional
cytotoxic drugs attack processes involved in mitosis, and therefore they have a small
therapeutic window. The last 25 years one has become aware of the fact that tumours
stimulate proliferation of new vessels (angiogenesis) to provide sufficient nutrition.
Interaction with this process may lead to adhanced supression of tumour growth and give a
therapeutic benefit. The adverse effects attacking the formation of new vessels by drugs are
moderate due to the fact that normal tissue have a well established net of vessels which are
not interrupted and that the treatment to a small degree interacts with the cell cycle. One also
avoids the problem of tumours developing acquired resistance.

The metronomic scheduling of cytotoxic drugs in the treatment of solid tumours is based on
the administration of repeated low doses for a longer period of time, instead of high doses
with rest intervals (conventional). The therapy diminishes the adverse effects without
diminishing the antitumour effects. Metronomic scheduling has been intensively studied
during recent years and has proven to have an antiangiogenetic effect. We have studied the
effect of two cytotoxic drugs (cyclophosphamide and vinblastine) given by a metronomic
schedule combined with local hyperthermia. Hyperthermia is known to destroy tumour
vessels and may lower perfusion in the heated area. To our knowledge there has not been
reported similar studies exploiting the effects of hyperthermia combined with metronomic
scheduled cytotoxic drugs. In our studies we have used a aggressive glioma tumour
transplanted subcutaneosly on the dorsum of the right back leg of rats. We have done toxicity
studies followed by tumour response studies. Local hyperthermia was achieved by placing the
back leg of an anesthesised rat in a precisely regulated waterbath at 44,2°C, which gives an
intratumoural temperature of 42,5 - 43.0 °C. We have done two parallell studies with
vinblastine and cyclophosphamide, respectively, alone and combined with hyperthermia. We
have proven that metronomic scheduling of cyclophosphamide and hyperthermia individually
have antitumour effects, and that the combination of either vinblastine nor cyclophosphamide
in combination with hyperthermia potensates the antitumour effects. Especially the latter
combination has yielded promising results with strong inhibition of tumour growth. Several
rats even developed complete regress of tumour.




                                                                                               24
Hvordan lære avansert hjerte-lungeredning?

Dale, Jon Espen
Engum, Are Stokkenes


Supervisor: Ivar Austlid, universitetslektor
Medisinsk ferdighetssenter, Det medisinske fakultet, UiB



Background: At Haukeland University Hospital, Norway, students receive a course in
advanced cardiac life support (ACLS) during their 3rd year of medical school. Previous
studies have indicated that 12 months after the course, 3/4 of the students are considered
incompetent. We have studied the effect of simple repetition courses on retention of ACLS
skills.

Methods: Two groups of students were compared 13 months after attending an identical
ACLS course. One group (control) received no follow-up during the period. The other group
(case) underwent one test and was offered two simple training sessions (in total 4,5 hours of
lecturing pr. student). All the students were then tested in teams of three on an advanced
resuscitation simulator. Specific ACLS procedures were evaluated by standardized methods to
give comparable results.

Results: The first rhythm presented in the test was ventricular fibrillation. 66% of the students
in the case group defibrillated the patient within 60 seconds, compared to 15% in the control
group. Mean time interval from arrival to first defibrillation shock in the control group was 99
seconds, and 50 seconds in the case group. Evaluation of basic CPR quality revealed that 23%
of the control group students were found to be competent, compared to 83% of the case group
students.

Conclusion: Medical students following the current educational program at Haukeland
University Hospital do not achieve adequate ACLS-skills. In this study we show that by using
fairly inexpensive, but focused lectures one can dramatically improve the students skills.




                                                                                              25
Diagnostikk og kirurgi ved hjerteklaffelidelser

Eilerås, Sigbjørn


Supervisor: Lodve Stangeland, førsteamanuensis/overlege
Institutt for kirurgiske fag, UiB/Medisinsk avdeling, Haukeland Universitetssykehus



Several diseases and syndromes, both general, in the heart and in the hearts valve-apparatus,
predispose for heart valve pathology, which requires surgical intervention. Before valve-
surgery the patient must be thoroughly examined and several considerations concerning risk
by going through surgery, as opposed to not going through the procedure, must be done.

The purpose with this assignment is to get an overview of managing of heart valve patients,
the considerations concerning risk by surgery opposed to conservative treatment and selecting
patients for surgery. In addition the assignment will give an overview of the different surgical
procedures that is being done and, shortly, how they are performed and followed up. Finally,
the assignment shall give an overview over how the different heart valve prostheses is
functioning and how one selects the type of prosthesis in the different patients. To get the
whole picture, the normal anatomy and function of the heart valves and an overview of
different diseases causing valve-pathology is mentioned in the assignment as well.

Defects can arise in all four of the cardiac valves and cause stenosis, regurgitation or a
combination of these. These conditions can cause serious symptoms and life-threatening
heart- pathology and surgical intervention may be necessary. The patients is diagnosed and
carefully examined by clinical examination, ECG, chest x-ray, echocardiography and heart-
catheterisation, and a risk-analysis concerning the patients quality of life and life-expectancy
with surgery and without surgery is done. If there is an indication for surgery, valve-
preserving procedures is preferred if possible. If there is serious valve-pathology, a heart
valve replacement is performed where one implants a biological or mechanical valve
prosthesis in the position of the original valve. The type of valve prosthesis one implants is
dependent on the clinical history, the clinical examination and the patients age among other
things. Patients with mechanical valve prostheses need lifelong anti-coagulative therapy and
every patient which has undergone valve surgery is predisposed to endocarditis. Therefore it
is important with regular controls of the patient and antibiotic prophylaxis when increased risk
of sepsis, like for instance tooth-extraction.




                                                                                             26
Allergiske reaksjoner under anestesi

Ekiz, Nil
Døskeland, Benedikte (class 00)


Supervisor: Anne Berit Guttormsen, overlege
Seksjon for intensivmedisin, Haukeland Universitetssykehus



Background: Several studies report that it is difficult to diagnose anaphylaxis during
anaesthesia. Due to this some patients do not get adequate treatment caused by wrong
diagnosis. This report comprises a literature study and a retrospective collection of data from
145 patients describing how anaesthesiologists reported and performed follow-up on patients
with a suspected allergic reaction during anaesthesia in 1999 and 2002.

Patients and Methods: In the literature study we discuss incidence, terminology, anaesthesia
drugs, diagnosis, treatment and Norwegian conditions compared to the status in Denmark,
France and Australia. In the retrospective study we report data on patients reported to a
national network during the years 1999 and 2002. Anaesthesiologists were encouraged to
collect acute bloodsamples and to describe the reaction, the drugs used and treatment in order
to achieve a correct diagnosis.

Results: Age was 39 years (2-87 years) and 103 of the patients, 71,0 %, were female. In only
50% of the patients there were clinical data on treatment procedure, and 65,4 % and 70,8 % of
the patients were treated with adrenalin in 1999 and 2002 respectively. The mean time
between the reaction and blood sampling was 102 minutes (0-805 minutes) and 52 out of 145
patients had a three point tryptase profile. Mean sTryptase increased according to severity.
One patient had specific IgE towards latex and 35 patients were sensitized towards
suxamethonium. According to population density most of the patients were reported from
Oslo, Trøndelag and Hordaland.

Conclusion: To diagnose anaphylaxis during anaesthesia is difficult, and our data indicates
that more than 25% of the patients are not treated with adrenaline. There is a potential for
improvement concerning reporting and treatment of these patients.




                                                                                               27
Sensorineuralt høretap etter kraniotomi

Elvestad, Kjersti
Nærdal, Taran Buran (class 00)


Supervisor: Knut Wester, professor dr.med.
Institutt for kirurgiske fag, UiB/Nevrokirurgisk avdeling, Haukeland Universitetssykehus



One serious complication of surgery in processus mastoideus is sensorineural hearing loss.
The otologic drill has been implicated as a possible cause. Several clinical studies have been
done on this subject. Some of these studies have shown signs of temporary or permanent
hearing loss in the contralateral ear after this procedure.

This particular study includes 12 neurosurgical patients operated for arachnoidal cysts. Its
purpose has been to try to discover whether hearing loss also occurs after this procedure as
well. To achieve this, preoperative and postoperative air conduction hearing tests combined
with a questionnaire on subjective complaints of hearing loss were performed in all cases.
Patients with a postoperative hearing loss were subsequently tested three months after
surgery. During surgery the time use of drill and cranoitome was recorded.

Postoperative hearing loss was defined as a loss of 15 dB or more in one or several
frequencies. This was found in 6 patients. The results revealed a possible connection
between the use of cranoitome and hearing loss. The timing of the postoperative audiometry
also proved to be important in detecting a possible hearing loss. We conclude that hearing
loss after cranial surgery is possible, but that these changes are most often transient.
However, patients with pathology of the inner ear may be predisposed to develop a permanent
loss.




                                                                                             28
Ungdom, bruk av rusmidler, psykisk helse og sosial integrasjon

Eriksen, Bjørn M. S.
Hoel, Sindre


Supervisor: Eivind Meland, professor
Seksjon for allmennmedisin, Institutt for samfunnsmedisinske fag, UiB



Aim: Alcohol use and intoxication are highly prevalent among adolescents and may be an
important element of the socialisation process in teenage years. Significant short- and
longterm health consequences seem evident. The aim of this study was to investigate the
relationship between alcohol consumption and several aspects of psychological health and
social integration in adolescents.

Methods: The study is based on data from a 1997 cross-sectional survey of 828 Norwegian
tertiary school students in Førde (91% of all students). Three hundred and eighty (46%) were
female. The majority of students were aged 20 or younger, with 64% aged 15-17. Four
groups were defined according to frequency of alcohol consumption and frequency of
intoxication. Emotional health and social integration in the four groups are reported as means
and the differences with the reference groups (with 95% confidence limits) were estimated.
Control for confounding and interaction was performed.

Results: The study reveals that alcohol use and intoxication are established elements of
midteenage behaviour for both sexes. We found that emotional and psychosomatic problems
increased with increasing alcohol consumption. J-shaped curves were revealed concerning
anxiety and psychosomatic complaints, though differences between light consumers and
abstainers were insignificant. Alcohol is not only associated with improving friendship
quantity but also with an improved quality of friendships, especially in early adolescence.
Moderate and heavy consumers report greater problems with relations with school and with
their parents.

Conclusions: Though adolescents with moderate and heavy alcohol consumption are more
sociable with friends, abstainers and light drinkers appear emotionally healthier. They
succeed to a greater extent in a wide variety of social arenas, particularly in comparison with
heavy consumers.

Key Words: Adolescent, Health Behaviour, Lifestyle, Socialisation, Emotions




                                                                                              29
Personlighet og personlighetsforstyrrelse

Eriksen, Marte Kvello


Supervisor: Hugo Jørgensen, professor
Seksjon for psykiatri, Institutt for klinisk medisin, UiB



Personality disorders (PD) is a condition which affects about 10 to 15 % of the Norwegian
population. There is a great need for knowledge about the diagnosis and possible treatment. In
this essay the concept of personality, personality disorders and the co-existence of mood
disorders is described. Personality is illustrated by the four dimensions intensity, the need for
control, vulnerability and realityconceptualisation. Different personality traits and different
score within the personality dimensions make us vulnerable for the development of symptom
disorders and PD. Comorbidity between depression and PD is high. There are many models
for understanding PD. Earlier on the psychoanalytic tradition dominated, with it’s emphasis
on traumatic childhood experiences and theire importance on the development of pathological
personality traits. Today the cognitive approach is growing stronger. The main thesis is that
emotions and conduct are secondary to cognitive processes which can be made conscious and
therefore available for treatment. The following types of PD are presented: Paranoid, schizoid,
schizotypal, dyssocial, emotionally unstable, histrionic, narsisisstic, avoidant, dependent and
obsessive-compulsive PD. They are described and further characterized by cluster,
prevalence, hereditability, course and comorbidity. Finally six clinical examples from SK2,
post for personality and mood disorders at Sandviken University Hospital in Bergen are
presented, all women between 20 and 50 years of age and emotionally unstable, illustrating
three things: Most patients with emotionally unstable PD are women, the condition has a
tendency to burn out later in life and pasients with this type of PD come most frequently in
contact with the health care system.




                                                                                              30
ALS og frontotemporal demens

Fauske, Siri Jorunn


Supervisor: Ole-Bjørn Tysnes, professor dr.med./overlege
Seksjon for nevrologi, Institutt for klinisk medisin, UiB/Nevrologisk avdeling, Haukeland US.



ALS is the most common adult-onset motor neuron disease. An association between ALS and
dementia has been recognized since the early part of the twentieth century, and is now well
established (1). Descriptive terms have been applied to describe the cognitive changes that
have been observed in ALS patients, ranging from schizophrenia to dementia. Resent studies
suggest that the co morbid condition of ALS and specially frontotemporal dementia could be
higher then first assumed.
The Medline database was searched for articles regarding ALS patients and their cognitive
function.

In this article we look into to new studies from USA regarding this topic and also the
histological changes specific for ALS/FTD. We emphasise the importance of an early
recognition of dementia so that one can intervene at an early stage and thereby helping
patients and their families to an easier every-day situation. The patient’s cognitive function
should be tested at the time of diagnosis but also as the disease progress. It’s also important
to interview the families as the disease progress because they might be the ones first noticing
changes in the patient’s cognitive function.




                                                                                              31
Overlevelse blant multitraumatiserte pasienter i Hordaland fylke, årene 2000
og 2001

Felecian, Sidney Ch.
Hagalid, Åsne (class 00)
Tilseth, Rune H.


Supervisor: Kari Schrøder Hansen, overlege, dr.med.
Kirurgisk avdeling, Haukeland Universitetssykehus



Background: In Norway, accidents are the most common cause of death among the
population under 40 years of age. Haukeland University Hospital is the regional hospital in
the western part of Norway. The most severe injured patients in Hordaland county is
admitted to this hospital. The aim of this study is to give an overview amongst the population
with emphasis on survival, age, sex and prehospital versus hospital mortality.

Matrial and Methods: The study is partly prospective partly retrospective and include
multitraumatised patients admitted to Haukeland University Hospital in 2000 and 2001. All
patients with Injury Severity Score >9 where included. We used the Abbreviated Injury Scale
(AIS) and Injury Severity Score (ISS), to measure the severity of the injuries.

Results: Men are younger and more severe injured than women. The most severe injured
died prehospitally, and they were also younger. There is a 90 % probability of survival if the
patient is admitted alive to Haukeland University Hospital. Men has a higher incidence than
women in all age groups. Overall men had a five times greater risk of getting mulitraumatised
compared to women.

Interpretation: Our results may indicate an improvement in the survival rate after better
organisation of the trauma treatment. There are few comparable studies on this topic
conducted at Haukeland University Hospital. However the survival rate is comparabel with
studies done in Denmark, and the Danish studies conclude that their survival rate is
satisfactory.




                                                                                            32
Effekten av bronkodilaterende midler på høydeindusert reduksjon av det
maksimale oksygenopptaket hos friske, mannlige idrettsutøvere ved 2000 moh.

Fiskvik, Idun Hege
Fjerdumsmoen, Stine


Supervisor: Jostein Hallén, professor
Norges Idrettshøgskole



Exercised-induced asthma (EIA) is defined as a reduction in forced expiratory volume within
first second (FEV1) of more than 10%, from test-start to end of test.
Asthmatics inhale β2-agonists before physical activity to prevent EIA (28). The common use
of these medicaments among healthy top athletes has been made subject of a debate the last
couple of years.

We designed a test to investigate any improved endurance performance with use of formoterol
during activity 2000 metres above sea level, where there is less oxygen in the air.
Former studies indicate a linear reduction in the maximum oxygen uptake from sea level to
low/moderate altitudes. Athletes have a higher altitude-induced reduction than non-athletes.
A study by Wehrlin (13) indicated a 10% altitude-induced reduction in the maximum oxygen
uptake at 2000 metres above sea level in well-trained athletes.
We wanted to investigate the effect of formoterol on this altitude-induced reduction in
maximum oxygen uptake.

Nine, healthy, well-trained male athletes with VO2 max>60 ml/min/kg where included in the
study. Their maximum oxygen uptake where measured by running on a treadmill inside
hypobaric chamber, with air pressure compared to lowland environment and altitude 2000
metres above sea level. At altitude 2000 metres above sea level the oxygen uptake was
measured after inhalation of both placebo and formoterol. The study is a cross-over study
with a randomised double blind placebo-controlled design.
In our study we found an altitude-induced reduction in maximal oxygen uptake of 11,5% after
inhalation of placebo and 13,3% after inhalation of formoterol. This verifies the reduction
from other similar studies. Formoterol did not significantly reduce the altitude-induced
reduction of maximal oxygen uptake in our study. We also investigated if formoterol had any
improvement in other factors.

We could not find any significant improvement in maximum heart rate, lactate, oxygen
saturation or time to exhaustion.
Formoterol did not improve the endurance performance in well trained, male, non-asthmatic
athletes at physical activity in high altitude.
The results from the lungfunctiontests showed a significant improved lungfunction, measured
in FEV1 and MEF 50, but that did not improve the endurance performance.
It is possible to design a study with the same approach and more athletes invalidate an
improvement of formoterol in healthy athletes, and remove the medicament from WADA’s
dopinglist.




                                                                                         33
Fertilitet etter intensivbehandling

Flaatten, Kamilla Hoel


Supervisors: Jone Trovik, kst. seksjonsoverlege Kvinneklinikken, Haukeland
Universitetssykehus og
Hans Flaatten, seksjonsoverlege/professor, Kirurgisk serviceklinikk, Haukeland
Universitetssykehus/Inst. for kirurgiske fag, UiB



Outcome after intensive care can be evaluated in several ways, the most usual being survival
and quality of life (QOL). However, other endpoints may also be of interest. We waned to
investigate another measure of outcome in the female Intensive Care Unit (ICU) population
using reproduction rate (child birth) as an indicator.

Materials and methods: Female ICU patients in their reproductive age (16 go 42) admitted
to the general ICU at Haukeland University Hospital of Bergen from 1994-1999 were
investigated. Patients were followed after hospital discharge, and for those surviving more
than 18 months all childbirth before and after ICU stay was registered. For this purpose data
from the Norwegian Birth Registery was used.
An age matched sample with regard to normal birth frequency was created from the
Norwegian female population using available data about birth rates in Norway published by
Statistics Norway. The expected birth rate could then be compared with our female ICU
group before and after the ICU stays.

Results: During these six years 144 patients met the inclusion criteria. 109 patients survived
at least 18 months. Of these 105 were followed up (non-Norwegians survivors were lost for
follow up). The total observation time in the 105 patients was 1772 years, 1336 years before
and 436 years after the ICU stay. In the normal Norwegian female control group the number
of births was 128 and 10 respectively. The difference and the 95% CI (ICU females vs.
normal population females) was 16% before (-6 to 37%) and -46% after (-18 to -73%) the
ICU stay.

Discussion: We have found a significant reduction in female reproduction in long-term
survivors after intensive care. Reasons for this remains unknown at present, but could be
related to medical condition after ICU, a voluntary constraint or both.




                                                                                            34
Proteintilskudd – Nødvendig for muskelhypertrofi?

Fossum, Sjur Letnes


Supervisor: Alex. R. Wisnes, universitetslektor
Seksjon for fysioterapivitenskap, Institutt for samfunnsvitenskapelige fag, UiB



Background: It is questionable whether one needs protein supplements in addition to the
naturally occurring protein in the diet, to increase muscle mass in relation to training.

Material and method: Literature study. Clinical trials and reviews have been found in the
database MedLine. Literature in nutrition and physical activity from NIH.

Results: Clinical trials show that exercise increase the need of protein. The amount of protein,
the composition of protein and timing of intake according to exercise are of importance for an
anabolic response in muscle.

Conclusion: Strength training can increase the need of protein up to 1,5-1,8g/kg
bodyweight/day. Normally this will be covered by the diet. No clear indications that
supplement of protein has a positive effect on muscle hypertrophy. Intake of protein
containing high amounts of essential amino acids preceding, during and after exercise is of
importance for muscular hypertrophy.




                                                                                              35
Kognitiv terapi ved depresjon i allmennpraksis

Frøiland, Siv
Larsen, Marianne


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



Background: The population prevalence of depression is 3-5%. Most of these patients
should be diagnosed and treated by general practitioners (G.P.). It is useful to grade
depression into mild, moderate and major, according to symptoms and functional disability.
The severity of depression determines choice of treatment. Medical treatment is first choice
when treating major depression, whild anti-depressive drugs and psycho-therapy (cognitive
therapy) have no significant difference in treatment effect on mild and moderate depressions.
Choice of therapy will then depend on patients and doctor’s wishes, clinical factors like
contraindications of medication, lack of effect or low compliance. 30-40% has no satisfactory
outcome of drugs when depressed. Diagnostic- and treatment problems include co-morbidity
and under/over diagnosis.

Cognitive therapy (CT) is founded on the idea that thoughts matters for depression aetiology
and maintenance. Feelings, thoughts and actions are connected and influence earch other. CT
seeks to reduce or remove depressive symptoms. Traditionally few G.P’s have practiced CT
and mot G.P’s, unless great interest for CT, lack proper training. High patient turnover on
daily basis and also feelings of lack of time can keep G.P’s from CT usage. Today several CT
courses is available for general practitioners around the country. In order to adjust cognitive
therapy for general practice, it is advised to keep one day solely for depression treatment.
Minimum 6 treatments pr person which lasts 30 minutes, every second week is recommended.

Method: Searched and found literature on BIBSYS and medline.

Results/conclusions: Five studies from Great Britain and one Norwegian have evaluated the
short-time psychological intervention effect on mild and moderate depressions as an
alternative to drugs in General Practice. Problem solving therapy and graded exposure was
consistently to medication. Problem solving alone was as effective as combined psycho-
therapy and drugs. General Practitioners who are interested learn cognitive techniques
quickly. Frequency and length of consultation does not have to be substantially increased.
Patients seemed to be satisfied with problem solving treatment.




                                                                                            36
Gjenoppliving på Haukeland Universitetssykehus – forekomst og overlevelse

Gardum, Ingvild


Supervisor: Ivar Austlid, universitetslektor, Medisinsk ferdighetssenter, Det medisinske
fakultet, UiB og
Corinna Maintz, ass.lege, Anestesi- og intensivavdelingen, Haukeland Universitetssykehus



The aim of this study was to assess the survival rate from cardiopulmonary resuscitation at
Haukeland University Hospital (HUS) in order to be able to compare with other hospitals and
to evaluate the efficiency of the organization, training and procedures related to resuscitation
at HUS. In 1999 a new resuscitation form was created at HUS based on the Utstein Guidelines
(2,3). 151 resuscitation forms from 2000 and 2001 were registered, of which 125 cardiac
arrests in 118 patients were included. The incidence of resuscitation at HUS was 5,3 %.
Overall survival was 23 %. The initial rhythm was ventricular fibrillation (VF) or pulseless
ventricular tachycardia (VT) in 50 Patients (42%) of whom 18 (36%) survived to discharge.
Outside of the intensive care unit (ICU), cardiac care unit (CCU) and emergency room (ER),
22 of 70 patients (31,4%) had an initial rhythm of VF/VT. 10 patients (45,5%) survived to
discharge. Factors increasing chance of survival coincided with the findings of other studies
in being initial rhythm of VF/VT, early defibrillation and monitoring.




                                                                                             37
Tvangslidelse – diagnostikk og behandlingsformer med tanke på
allmennpraksis

Gloppe, Ronja Aurora


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



The anxiety disorder, OCD (Obsessive- compulsive- disorder) has been the focus of a
vast amount of research in the past two decades. This project describes the
characteristics of OCD, ways to diagnose the patients, and how to give them adequate
treatment as a general practitioner. OCD can be diagnostically challenging to
identify and diagnose because of the many spectrum disorders, comorbidities and differential
diagnoses sharing much of the same symptomatology connected with this disease. It is
therefore important to have a certain amount of knowledge when it comes to differentiating
them, since in some of the cases it can have clinical implications. There is a general consensus
concerning treatment of these patients, and that is the combination of SSRIs and cognitive-
behavioral therapy (CBT). It is important not to have expectations of total remissions when
treating these patients, but know that a reduction of symptoms can contribute enormously in
their experienced quality of life. These patients are also usually in need of a long term
treatment approach. This is challenging from a therapeutical perspective.
In Norway the major problem seems to be the lack of sufficient patient material in general
practice, so as to achieve and maintain an adequate level of competence and experience.




                                                                                             38
Nevrologisk rehabilitering ved Haukeland Universitetssykehus

Neurorehabilitation at Haukeland University Hospital

Grønseth, Heidi


Supervisor: Nils Erik Gilhus, professor dr.med.
Seksjon for nevrologi, Institutt for klinisk medisin, UiB



Background: Neurorehabilitation is a main priority for Department of Neurology,
Haukeland University Hospital. This paper examines which patient groups were selected for
such treatment and discusses possible selection criteria.

Methods and materials: Information about 250 consecutive in-patients hospitalized at the
neurological department with the diagnosis simple or complex rehabilitation (ICD-10) was
recorded retrospectively from the patient journals.

Results: The group consisted of 119 women and 131 men with a mean age 55 years. For 126
patients, it was their first stay at the department. Only 5 of the 250 patients were living in an
institution at hospital admission. 236 patients had a primary disease in the central or
peripheral nervous system (including muscle disease). 99 patients had cerebrovaskular
disease, 38 patients spinal cord injury, whereas 36 patients had previous poliomyelitis. Only
23 patients had progressive disorder, such as multiple sclerosis or Parkinsons disease.

Conclusion: Neurorehabilitation is a multidisciplinary and specialised treatment. Even in our
university department with a broad neurorehabilitation interest and motivation there is a
selection of some patient groups. Patients with progressive disorders do not seem to have the
highest priority, and it is obvious that large groups do not get what they require regarding
treatment.




                                                                                               39
ADHD og Tourette – en presentasjon av hyperkinetisk lidelse (ADHD), Gilles
de la Tourette syndrom og komorbiditet mellom disse sykdommene

Gubberud, Espen Tyse


Supervisor: Ole Bernt Fasmer, førsteamanuensis
Seksjon for psykiatri, Institutt for klinisk medisin, UiB



Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common psychiatric
conditions among children, often being a chronic disease lasting into adulthood. Inattention,
hyperactivity and impulsiveness are all present in childhood. But it seems this changes later in
life, making the diagnosis hard in adulthood. ADHD often presents itself together with other
psychiatric disorders and drug abuse. Stimulants, antihypertensives and antidepressants often
play a fundamental role in the treatment across the lifespan.

Tourette`s syndrome (TS) is easy recognizable because of the tics. In TS they are both vocal
and motor in their expression. Often they follow a wax-and-wane pattern, making assessment
of treatment difficult. Also, there are no ideal anti-tic drugs. Neuroleptics and antihyper-
tensives are most commonly used. Symptoms peak in the teens, but may last for life.
ADHD and TS are often co-occurring. Research shows that at least 50% of probands with TS
have ADHD as well. Having both diseases increases the risk for further comorbid disorder,
drug abuse and social dysfunction. Recent data support a biological basis for both disorders,
and an increasing number of genes seem to be in common for them both.




                                                                                             40
Kan fastlegen vera inhabil?

Hagen, Harald Ravn
Vassbø, Børge


Supervisor: Steinar Hunskår, professor dr.med.
Seksjon for allmennmedisin, Institutt for samfunnsmedisinske fag, UiB



Background. We wanted to find out to what extent Norwegian "fastlegar"
have patients who they are disqualified from treating, what services they offer these, and what
attitudes a representative choice of the "fastlegane" have towards situations where one is
asked to offer services to such patients.

Material and methods. We sent a questionnaire to 622 randomly chosen "fastlegar". It
registered sex, age, list-size, county-size
and health region for every "fastlegepraksis". Given set alternatives the "fastlegen" registered
who were on the list and what services one had offered the last two years. The doctor then
was to form an opinion on eight hypothetical situations where the patient was not on his list,
whether he clearly, probably or hardly would offer the services. Data were registered and
processed in univariate and bivariate analysis.

Results. About one quarter of the doctors had their spouses and own children below 18 years
on their list. As many had the secretary or colleague from the same office on their list, while
more than 50 % had a colleague from the same county on their list. From 18 to 31 % of the
doctors confirmed that they have prescribed a "blå resept" to on of the mentioned patients.
The doctors showed great variation in the view on their own disqualification in the eight
hypothetical situations.

Interpretation. The research shows that the "fastlegane" in large extent will encounter
problems of disqualification. At the same time many express that they feel a strict
interpretation of the law being opposed to what should be a pragmatic practice in
"allmennpraksis". For instance in small counties there will be situations where one will have
to find most unpractical ways of solution to fully obey the law. Most important one should be
conscious of ones own practice and aware of both the disqualifying problems and other
challenges by having family, close friends and co-workers on your "fastlegeliste".




                                                                                              41
Seponering av langvarig behandling med antipsykotika hos demente
sykehjemsbeboere. Effekt på atferdssymptomer?

Heimdal, Ragnhild
Wøien, Solveig Lund (class 00)
Øiestad, Anne Hjelle


Supervisor: Harald Nygaard, professor dr.med. og Sabine Ruths, førsteamanuensis
Seksjon for geriatri, Institutt for samfunnsmedisinske fag, UiB



Background
70- 80% of the residents in Norwegian nursing homes are demented. Behavioral and psychological
symptoms of dementia (BPSD) are frequent and a common cause of admittance to nursing homes.
Prescribing antipsychotics is a common way of handling behavioral symptoms. Although the effect is
poorly documented, this practice is frequent. Antipsychotics have numerous undesirable side effects,
i.e. extrapyramidal symptoms and tardive dyskinesia. Behavioral symptoms in demented patients are
often trancient, and it is thus important to reduce drug doses and attempt withdrawal of medication.

Our work is based on the study “ Withdrawal of longterm use of neuroleptics in demented nursing
home patients. A randomized, placebo controlled study” at the Department of Geriatrics. Similar
studies have never been performed in Norway. The main object of this study was to examine whether
withdrawal of longterm treatment with antipsychotics led to altered expression of BPSD.

Materials and methods
30 patients from nine nursing homes in Bergen participated in the study. The study has a randomized,
placebo controlled, double blind design. 15 patients in the intervention group received placebo, while
15 patients in the control group continued their antipsychotic medication. Behavioral symptoms were
registered by using the measuring scale NPI-Q (Neuropsychiatric Inventory Questionnaire). Nursing
staff were interviewed three times during the six- week study period.

Results
During the four- week withdrawal period there were no substantial changes in the expression of
BPSD in the intervention group. In the control group the expression of BPSD remained mainly
unchanged. Only one out of 15 patients in the intervention group went back to antipsychotics during
the study.

Conclusion
Withdrawal of antipsychotics in demented nursing home patients will only to a small extent lead to
changes in behavioral symptoms. More studies are needed where results can be transferred to
Norwegian conditions, and also studies which assess longterm effect of withdrawal. The use of
antipsychotics may lead to adverse side effects. In addition, the effect on behavioral symptoms is
uncertain in longterm treatment of patients with dementia. Psychological, social and somatic factors
may provoke, reinforce and/ or maintain the behavioral symptoms of the demented patient. Treatment
of BPSD should be based on non- pharmacological interventions to a greater extent.




                                                                                                      42
MEUSTA - forebyggende HIV/AIDS-forbyggende prosjekt i Tanga, Tanzania.
Var det vellykket?

Henriksen, Gro


Supervisor: Astrid Blystad, forsker
Senter for internasjonal helse, UiB



This article is based on observations made during three weeks of field work as a participatory
observer at an internal evaluation of the MEUSTA programme in the Tanga region, Tanzania,
July 2002. Internal and external evaluation reports were also examined.

The HIV/AIDS prevention programme MEUSTA (1995-2003) was founded by The
Norwegian Nurses Association (NNA) in 1995. Its main objective was to contribute to the
work of reducing the incidence of HIV infection among children and youngsters in Tanga
Region, Tanzania. The work was mainly channeled into educational establishments and
school teacher guidance.

The purpose of this article is to evaluate whether it is possible to make conclusions about the
efficacy or success of the MEUSTA programme, as there are no direct measures of HIV
prevalence or incidence in this region, either before or after the start-up of the extensive
MEUSTA programme. The article also discusses how the MEUSTA programme coordinators
evaluate their results.




                                                                                             43
Alkoholavhengighet. Biokjemiske, psykososiale og genetiske faktorer.

Hovlid, Bjørnar
Hovlid, Øystein
Ringen, Dag Sigmund


Supervisor: Brit Haver, professor
Seksjon for psykiatri, Institutt for klinisk medisin, UiB



The development of alcohol dependence is a complex phenomena, both in an individual and
population based perspective. This paper deals with three different aspects of the subject:
biochemical, psychosocial and genetic factors associated with the risk of developing alcohol
dependence.

The biochemical basis of alcohol dependence is at present explained as neurobiological
alterations in receptors and transmitters of the CNS, of which GABA, glutamate, serotonin
and dopamine are important. These neurotransmitters are modulated by complex mechanisms
induced by alcohol. In general the GABA and dopamine systems are excitated/potentiated,
while glutamate and serotonin are inhibited. This may explain the clinical signs of alcohol
intoxication and withdrawal. Alcohol influences cognitive processes and induces feelings of
reward, which can be eludicated by the same transmitter and receptor systems.

Age at alcohol debut is probably the most important factor among the psychosocial risk
factors related to the development of alcohol dependence. This risk is probably ten times
greater among those who have an early versus those with a late debut. High alcohol
consumption and a higher drinking frequency is probably the underlying factor promoting the
elevated risk for alcohol dependence. Also, positive alcohol expectancy and lack of discipline
and care in the family can result in high alcohol consumption and higher drinking frequency
via an earlier alcohol debut.

The heritability of alcohol dependence is probably about 50-60%. Using the results of twin
and family studies combined with adoption studies it is possible to distinguish between
inheritance and environment. Differences in concordance between MZ and DZ twins are of
special interest. There are conflicting results when it comes to gender differences. The genes
that encode for ALDH, ADH and DRD2 are important. Differences in frequency of the
different genetic forms/mutations between populations can tell us something about the
liability of developing alcohol dependence.




                                                                                            44
Er det riktig å bruke dyre AIDS-medisiner på fattige afrikanere?

Hovlid, Elisabeth Kirkengen


Supervisor: Bernt Lindtjørn, professor dr.med.
Senter for internasjonal helse, UiB



HIV (Human Immunodeficiency Virus) is the leading cause of death among adults who die
from infectious diseases today. There is no vaccine or curative treatment, but medications that
can curb the epidemic exists. The question raised in this paper is which position medications
have in the fight against HIV/AIDS in sub-Saharan Africa.

This paper is a literature study. I have searched in the PubMed database and the reference lists
to collect a wide source material. In addition I have been given access to information from an
ongoing cohort study in Ethiopia. The survival of 354 patients that was followed before ART
was accessible and after ART was accessible is examined. The results are presented in
Appendix 1.

The paper looks at which elements that contributes to the fact that the epidemic is spreading
faster in sub-Saharan Africa than in the rest of the world. To gain appreciation to this it is
necessary to look at both economical and cultural factors. I also debate medical aspects of
treatment. In the beginning of the epidemic and until today there has been a change in the way
of thinking, about which actions that should have priority. Early in the debate, prevention was
thought to be the most important strategy in the fight against HIV. As the cost of the
medications has been reduced, medical treatment has become more interesting. The “3 by 5”-
initiativ that has been launched by UN is an example of this. It is possible that prevention
these days is being neglected. We might wonder whether this is a setback or an advance.

Economical, political and medical approaches can give different answers to the question
raised. My evaluation is that it is right to treat HIV/AIDS in sub-Saharan Africa, but it is
important that it is not done at the expense of prevention of HIV/AIDS.




                                                                                               45
Radon i boliger og risiko for lungekreft

Hubred, Tonje H
Rinde, Marianne M.
Skogseth, Kristina


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



This is a literature study of 22 articles about lung cancer and residential radon. 16 of these are
case-control studies. The project includes studies from 1990-2001, and most of them are from
North America and Europe.
We started out with 76 articles, but because we did not find them relevant, we excluded 48.
The reasons for this exclusion were that they had too few cases, were not studies performed
by the article writers themselves or did not deal with our subject.
The studies took smoking into account and radon dosimetries were usually performed using
an α-track detector. It is difficult to make a correct estimation of radon concentrations many
years ago.
It is hard to draw any conclusions because of several uncertainties in each study. Most studies
suggest that radon can influence development of lung cancer, and none of them find reasons
to rule out such a relation.

Keywords: radon radiation, lung cancer, smoking, α-track detector .




                                                                                               46
Sosial fobi – årsaker og behandling

Instanes, Johanne Telnes
Songstad, Margrethe Elisabeth


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



Individuals suffering from Social Phobia have an extreme fear of being focused by others in
social situations. The fear often leads to avoidance of social interactions. Some people endure
social situations with intense anxiety. This leads to isolation and reduced quality of life.
The pathogenesis of Social Phobia is not known, but several theories have been presented.
Clark and Wells presented in 1995 a cognitive model of Social Phobia. This model explains
how the Phobia can be maintained. According to this theory, individuals suffering from Social
Phobia develop automatic negative thoughts about their behaviour in social situations.
About one out of ten people suffer from Social Phobia during their lifetime. Sadly, few
sufferers seek professional help. Even doctors are not always aware of the symptoms.
Satisfactory treatment is available. Among these are different kinds of psychological
treatment such as exposure, cognitive-behavioural therapy and social skills training.
Pharmacotherapy is also effective. Selective serotonin reuptake inhibitors are the medicines
most in use in the treatment of Social Phobia.




                                                                                            47
En innføring i Tradisjonell Kinesisk Medisin, og perspektiver på dens nytte
som helse/sykdomsmodell. En oversikt over akupunktur, akupunktur evidens,
og akupunktur i Norge

Jansen, Kristian


Supervisor: Terje Alræk, akupunktør PhD/forsker
Nasjonalt forskningssenter innen komplementær og alternativ medisin, Det medisinske
fakultet, Universitetet i Tromsø



This project’s first part is an analysis of the logical properties of the main concepts of
Traditional Chinese Medicine (TCM) theory, and a description of TCM treatment and its
principles, with a special focus on acupuncture in its many forms, also outside of TCM
tradition. The second part summarizes clinical research on acupuncture, the contemporary
extent of use of acupuncture in Norway, and mentions recent developments in the
standardization-process of acupuncture education in Norway, and the health-cooperation
between the governments of Norway and China. The third and last part cast perspectives on
TCM as a theoretical model for disease and health, departing from the central question: TCM
is so different…what can we learn from it?




                                                                                         48
Laser Scanning Cytometri og bildeanalyser

Jellestad, Stig


Supervisor: Roland Jonsson, professor
Broegelmanns lærestol i immunologi, Gades institutt, UiB


     Programmed cell death of peripheral blood B cells determined by laser scanning
          cytometry in Sjogren's syndrome with a special emphasis on BAFF.
             (Journal of Clinical Immunology, Vol. 24, No. 6, November 2004)
Functionally impaired B cells play an important role in the pathogenesis of Sjögren's syndrome (SS). The aim of
the study was to investigate the apoptosis susceptibility of peripheral blood B cells from patients with SS and the
impact of B cell activating factor (BAFF) on the apoptosis capability of these cells in correlation with IgG
production. Peripheral blood B cells were isolated and stained for apoptosis markers (Bax, Bcl-2) and members
of the TNF-R superfamily, CD95 and CD40. The apoptosis frequency of cells bearing these markers were
assessed. Also, the apoptosis capability of cultured B-lymphocytes was investigated in medium alone, with anti-
CD95 or with soluble BAFF. Quantitative ELISA was performed to detect plasma levels of sBAFF.
Furthermore, the level of circulating B-cell cytokines was measured. BAFF levels were compared between
patients with normal and elevated IgG levels. In SS, Bcl-2 positive B cell counts were significantly higher then
in controls, also in this population the apoptosis frequency was reduced. Apoptosis within Bax+ and CD40+ B
cells were significantly decreased in patients. BAFF induced a significant antiapoptotic effect in SS; also this
effect was clearly evident in B cells from SS with hypergammaglobulinaemia. Plasma BAFF levels were
significantly higher in SS, mostly in patients with hypergammaglobulinaemia. Plasma B-cell cytokines were
raised in SS. In Sjögren's syndrome B cells, a general antiapoptotic tendency might lead to prolonged B-cell
survival driven at least partly by elevated levels of BAFF and supposedly by B-cell cytokines. Also, the
exaggerated BAFF stimulation might lead to excessive immunoglobulin production. The B-cell apoptosis
defects, the increased BAFF levels-correlating with hypergammaglobulinaemia-together with the raised B-cell
cytokine levels indicates the disturbed B-cell biology in the disease.

         Programmed Cell Death in Rheumatoid Arthritis Peripheral Blood T-Cell
               Subpopulations Determined by Laser Scanning Cytometry
                           (Lab Invest 2003, 83:1839–1848).
Because peripheral blood mononuclear cells play an important role in the perpetuation of the autoimmune
process in rheumatoid arthritis (RA) and because the maintenance of these cells might be caused by the
dysregulation of apoptosis, we investigated the apoptosis susceptibility of peripheral blood mononuclear cells
from patients with RA. Freshly separated peripheral blood lymphocytes were stained for apoptosis markers
(CD95, Bax, Bcl-2, TNF receptor) and for an activation marker(CD45-RO), and the apoptosis frequency of cells
bearing these markers were assessed by the terminal-deoxynucleotidyl transferase-mediated dUTP digoxigenin
nick end labeling method and nuclear condensation analysis with laser scanning cytometry. Also, the ability of
CD4+ and CD8+ T-cell populations to undergo apoptosis was investigated with 24-hour culture in medium alone
or with different apoptosis inducers (anti-CD3, anti-CD95, anti-TNF receptor). Laser scanning cytometry
analysis was used to enumerate the phenotype and apoptosis ratios of both freshly isolated and cultured
lymphocytes. Quantitative ELISA was performed to detect plasma levels of TNF- and soluble Fas ligand.
Furthermore, we studied the relationship between marked apoptotic defects in patients with RA and the severity
of clinical disease. CD4+ T-cell counts in patients with RA were elevated compared with controls. A decreased
rate of anti-CD95–mediated apoptosis was found within the CD4+ and CD8+ lymphocytic subpopulations. In
patients with RA, decreased Bax expression and decreased apoptosis rate within the Bax-positive cells were
found, whereas Bcl-2 expression was elevated. The CD45-RO expression was higher, whereas the apoptosis
within CD45-RO+ cells were decreased in RA. Evaluation of plasma soluble Fas ligand revealed significantly
decreased levels in patients compared with controls. The reduced susceptibility to CD95-mediated apoptosis may
contribute to the expansion of an activated CD4+ lymphocyte subpopulation and thus to the maintenance of
peripheral autoreactive T-cell clones in RA. We also revealed a relationship between in vitro demonstrated
lymphocyte apoptosis defects and clinical disease activity.


                                                                                                                49
Veileder i fysikalsk medisin for medisinerstudenter

Jørgensen, Kåre


Supervisor: Jan Sture Skouen, seksjonsoverlege, førsteamanuensis dr.med. og
Eirik Vikane, ass.lege
Avdeling for fysikalsk medisin og rehabilitering, Haukeland Universitetssykehus



Physical medicine consists of diagnosis and treatment of musclo-skeletal problems.

During consultation with a patient some symptoms and signs will give suspicion of serious
pathology. These are usually called “red flags”. Psycho-social factors that can indicate long-
term and persistent pain in the musclo-skeletal-system, are usually termed “yellow flags”.

The lesser skilled professional will have an advantage in taking the history and perform an
examination in the same manner with all patients. Thus, developing skills in what is
perceived as “normal finds”, and will quickly be able to react on atypical finds and “red flags”
where these are found in patients.

With localized problems in the extremities and soft-tissue, specific testing will help to decide
which structure that is affected. In principal one differentiates between lesions in active
structures (different parts of the neuro-muscular unit), and lesions in passive structures that
can be capsular (arthrosis, arthritis) and/or non-capsular (bursitis, ligament-lesions, meniscus
injuries, loose body in joints, etc.).

In low-back pain problems, one normally divide these into three descriptive diagnosis
categories as a basis for further action (unspecific low-back pain, root-affection, severe
underlying pathology). In this compendium I have chosen to also include a fourth category
(other groups of low-back pain).
With cervical-pain I have chosen to differentiate between muscular cervical-pain, mechanical
cervical-pain, cervicobracialgia, torticollis, and serious underlying pathology.

Treatment of patients with musclo-skeletal disorder can consist of any of the following;
exercise, physiotherapy, manual therapy, chiropractics, medication, Tens, acupuncture,
information and cognitive therapy.

Persistent musclo-skeletal disorders may be an indication of multi-professional treatment.
The treatment is as mentioned above, but is recognized by a close understanding regarding the
patient’s problem between the different professionals. The different professionals will work
closely together on a daily basis, cooperate closely with the patient, and give the patient the
same information. This will contribute to increased safety for the patient and increased trust
in the treatment.




                                                                                              50
Pediatrisk samhällsförvad for medisinerstudenter

Karlsson, Daniel Bo


Supervisor: Aud. K.H. Berstad, overlege dr.med.
Barneklinikken, Haukeland Universitetssykehus



Paediatric community-acquired pneumonia is one of the major contributors to death amongst
children under five years, especially in low-income countries. The annual incidence is 30-40
cases per 1 000 children. The diagnosis is often based upon symptoms and clinical features.
The child’s age is guiding for the aetiology. Viral pneumonias are most common in children
younger than two years and decreases with age. Streptococcus pneumoniæ is the most
common bacterial pathogen. In primary care settings, Mycoplasma pneumoniæ and
Chlamydia pneumoniæ are important pathogens in children older than five years. The
treatment is usually empiric against age-specific bacterial pathogen. Infants and very ill
children might require hospitalization.




                                                                                           51
Prevention of HIV/AIDS in Ethiopia

Klungsøyr, Hilde


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



Aim of the study
The aim of the study was first to describe the current HIV prevention efforts in Ethiopia,
second to describe whether these preventive efforts have reached a remote area in the
Southwest of Ethiopia; Jinka, and third to describe HIV awareness in Jinka.

Methods
My two sources in order to gain knowledge of the HIV prevention status in Ethiopia, were
secondary data review and key-informant interviews. HIV awareness in Jinka, was assessed
by a total of eight focus groups interviews in Jinka in December 2003. Each group, consisting
of five-eight persons, was homogenous with respect to age (under/over 18 years) and sex.

Results
HIV prevention in Ethiopia is divided between two main national bodies: the Ministry of
Health and HIV/AIDS Prevention and Control Office. The former is in charge of the medical
aspects of HIV prevention while the latter is mainly a coordinating organ, which coordinates,
subsidises and supervises all actions of HIV prevention in Ethiopia. Both bodies have offices
at national, regional and local levels. In addition to this, quarterly meetings are arranged by
the National Aids Council to put HIV on the agenda.
HIV awareness in Jinka was surprisingly good. Very little misconceptions were found. Also it
seemed like most wanted to make an effort to protect themselves, and that HIV prevention
guidelines were followed.

Conclusion
In spite of Jinka’s remote localisation, my focus group study showed remarkable results on
the level of HIV awareness in Jinka, as a result of the multi-sectoral HIV prevention efforts
having reached Jinka. The rural areas in South Omo Zone, though, are not likely to have a
high level of HIV awareness, and actions need to be taken by HAPCO and/or Ministry of
Health. Despite increasing levels of HIV awareness in rural areas, HIV infection still occur
because knowledge does not always lead to change of behaviour. The future depends on the
choices of the individual.




                                                                                                52
Nevrologiske manifestasjoner ved sarkoidose

Kråkenes, Ellen Bettina Casanova


Supervisor: Christian Vedeler, overlege/professor
Nevrologisk avdeling, HUS/Seksjon for nevrologi, Institutt for klinisk medisin, UiB



Sarcoidosis is a chronic multisystem granulomatous disease of unknown etiology, which
affects the nervous system in about 5 % of patients. Neurosarcoidosis has a highly variable
clinical picture. Usual manifestations are cranial neuropathies (especially the optic nerve and
the facial nerve), myelopathy, the basal meninges, and parenchymatous lesions of the central
nervous system. In this study the records of 14 patients admitted to Department of neurology,
Haukeland University Hospital were reviewed. Among these patients the most common
manifestations were: central nervous system disease (71,4 %), polyneuropathy (42,9 %), and
cranial neuropathy (21,4 %). 13 of the patients were treated, mostly with corticosteroids.
Eight of the patients improved after treatment, while the rest of the patients either had a stable
or progressive disease. It is difficult to make any certain conclusions from this study because
a definite diagnosis requires a positive biopsy from the nervous system, and this was only
obtained from one patient. The rest of the patients had probable or possible diagnoses. It’s
important to make the correct diagnosis because neurosarcoidosis can be treated, mainly with
corticosteroids.




                                                                                                53
Mor-barn samspill: Stabilitet av kontingent og ikke-kontingent mødreatferd

Langseth, Hanne
Stenehjem, Margrethe


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



The purpose of this study was to examine whether mothers’ and infants’ sensitivity to social
contingency are related to maternal soothing during inoculation of their 3 months old infants.
Braarud and Stormark reported in their article “Maternal regulation of infant distress” (re-
submitted) a difference in soothing behaviour among the mothers. They divided the mothers
into two groups: “preparatory mothers” and “contingent mothers”. “Preparatory mothers”
evidenced more soothing before than after the injection and the “contingent mothers”
evidenced more soothing after than before the injection. We used data from the “double-
video study” of Stormark and Braarud to examine whether the behavioural pattern in Braarud
and Stormarks “inoculation study” is a pattern that is stable in other situations as well. We
used mothers’ fundamental frequency (FO) and the infants gaze at mother during the different
sequences as parameters. Infants’ sensitivity to social contingency was significantly
positively correlated to mothers’ degree of contingent soothing during inoculation. But, not
consistent with the results for the children, the mothers’ sensitivity to social contingency was
significantly negatively correlated to their degree of contingent soothing during inoculation.

These results suggest that there is a relation between mothers’ and infants’ reactions during
inoculation and their sensitivity to social contingency.




                                                                                                54
Mitochondria dysfunction in human diseased

Lekobe, Baleufi Calstro


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



The objectives of this assignment are to discuss the functions and structure of mitochondria
and its DNA. The interrelation between mitochondrial DNA and the nuclear genome will also
be discussed briefly. The rest of the assignment will focus on a detailed review of some
human diseases that are caused by mitochondrial DNA dysfunction, paying particular
attention to their clinical manifestations. Mitochondrion’s main function is the production of
energy through biological oxidations, electron transport and oxidative phosphorylation.
Mitochondrial diseases are caused by defects in nuclear genome, mitochondrial DNA or both.
Patients normally present with neurological and muscle symptoms: difficulty in walking,
muscle crumps, fatigue, breathlessness on exertion, diplopia, ptosis, muscle weakness, muscle
wasting, reduced reflexes, encephalopathy, and epilepsy. Loss of hearing, cardiomyopathy
and diabetes mellitus are also common conditions.




                                                                                           55
Biologiske mekanismer bak levodopa induserte motorkomplikasjoner ved
Parkinsons sykdom

Lie, Heidi


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



Levodopa represented a revolution in the treatment of Parkinsons disease when introduced in
the 1960s. It has a very good effect on rigidity, tremor and akinesia. Levodopa is still, more
than 40 years after, the best treatment that can be offered against the symptoms in Parkinsons
disease. But there are side effects. 40% of patients with Parkinsons disease will get motor
complications 4-6 years after initiating levodopa therapy, 90% of the patients using levodopa,
experiences fluctuations and dyskinesias during the course of the disease. The motor
complications often constitute major disabilities for the patients, and may be that reduce their
quality of life.

The pathological mechanisms of levodopa induced motor complications are not yet fully
understood. This article is a presentation of the mechanisms of levodopa induced motor
complications described in literature. The Pub Med database was searched for “Parkinsons,
levodopa, fluctuations, dyskinesias, and pathological mechanisms”. We have among others
considered genpolymorphism with DRD2 TaqIA, when to initiate levodopa therapy,
dopaminreceptor subtypes, continuous versus pulsatile dopamine receptor stimulation, and
familiar versus sporadic Parkinsons disease.
When a better understanding of the mechanisms behind motor complications is achieved, it
becomes possible to adjust the treatment to the patients in ways that lower the risk of
developing dyskinesias and fluctuations.




                                                                                              56
Keisarsnitt - ein snarveg ut?

Lillegraven, Gro


Supervisor: Per E Børdahl, klinikkoverlege, førsteamanuensis dr.med.
Kvinneklinikken, Haukeland Universitetssykehus



Caesarean section rates are rising, particularly in recent years. Caesarean section confers an
increase in maternal mortality and morbidity as well as having financial implications.
Caesarean section is today only performed when risks are justified by the assumed benefit for
the fetus. Benefits often unquantefied and sometimes based on scanty evidence. These are
related to the causes or indications for caesarean section. Research performed for different
indications has shown variety in their conclusions. The evidence for optimal way of giving
birth for several different indications remains somewhat unsolved. This needs to be resolved
for the obstetricians to be able to perform their duty as the pregnant woman`s advisor.
Today’s situation makes selective influence from different research results possible and
therefore different clinical practice at different hospitals. Cultural changes such as the
womens expectations for birthgiving also is an influential factor. An increasing number of
women asks for caesarean section with no medical indication. The population of birthgiving
women has in recent years changed in several ways. In addition the increasing number of
lawsuits because of medical treatment are among possible contributing factors for the doctor
to, in spite of marginal risks for vaginal delivery, perform caesarean section.
Most developed countries has a culture that emphasises the importance of autonomy, this
makes it even harder to reject a mothers request.

During the 1970`s electronic monitoring of fetus (EMF) became more common, this had a
large impact on caesarean section rates. A variety of factors seems to contribute to the
increase in caesarean section rates. This will demand active approach to be kept on a
reasonable level. What needs to be achieved probably is research that proves benefits for
mother and child for different indications. Vaginal delivery probably needs to be encouraged
when medical indications for otherwise lacks.




                                                                                            57
Komplikasjoner ved ERCP. En retrospektiv gjennomgang av ERCP-
undersøkelser gjort ved Haukeland Universitetssykehus året 2002.

Lind-Larsen, Jens Kristian
Moe, Joakim Oliu


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



Background: Reported complications following ERCP are relatively high, varying from 10%
- 20%. Although most complications are minor, lethal outcome is also encountered. Following
the introduction of MRCP, the indication for ERCP is diminished. The purpose of this study
was to analyze the rate of complication following ERCP, and identify possible predisposing
and procedure-related factors leading to complications.

Methods: We studied a one year series consisting of 118 patients undergoing 152 ERCP-
procedures at Haukeland University Hospital in Bergen, Norway. Data has been collected
retrospectively. We differenciated between 108 therapeutic and 44 non-therapeutic
procedures. ERCP was defined as therapeutic when endoscopic papillotomi (EPT), pre-cut,
stone-extraction (SEXT), stent-implantation and other mechanical procedures where done.

Results: 15 complications (9,9%) where recorded: pancreatitis 5 (3,3%),
hemorrhage 4 (2,6%), both pancreatitits and hemorrhage 1 (0,7%), others 5
(3,3%). Most common indications where: gall stones 84 (55%), suspected bile
ducts pathology 31 (20%), gallstone associated pancreatitis 20 (13%), suspected malignancy 8
(5%), others 9 (6%). The procedures disclosed the following pathology: gall stone 47 (31%),
unspecific bileduct changes 36 (24%), suspected malignancy 13 (9%), and 8 (5%) got
profylactic papillotomy after preoperative pancreatitis. 42 (28%) procedures did not disclose
pathology; among these 13 (9%) failed in canulation; 12 (8%) of the 42 got papillotomy
without such indication. From the 84 patients with the indication gall stone, such pathology
where confirmed in 39 (46%) cases. There was a higher frequency of aborted procedures
among the procedures leading to complications.

Conclusions: The study shows a complication frequency in the same order as
other studies published the recent years. Well considered indications for ERCP are still
needed because of the relatively high risk frequency.




                                                                                           58
Bullies and bullied: Perpetrators and victims or fellow sufferers

Lobben, Stian Ellingsen
Rydning, Jan Henrik


Supervisor: Eivind Meland, professor
Seksjon for allmennmedisin, Institutt for samfunnsmedisinske fag, UiB



Objectives To explore and clarify distributions of mental health and psychosomatic
symptoms among different groups involved in bullying behaviour. And to explore differences
in social integration and self perceptions, among the different groups involved in bullying and
to compare these with peers not involved in bullying.

Design Cross sectional survey.

Setting Junior high school in Ålesund, North Western Norway.

Participants 1237 pupils aged 11-15 years, grade 6, 8 and 10.

Main outcome measures Self reported bullying behaviour, psychological and psychosomatic
symptoms, social integration and self perceptions.

Results 812 pupils (67%) reported neither being bullied nor bullying others in the current
term. 165 (14%) reported being bullied and 131 (11%) reported bullying others at least once
during current term. 112 (9%) reported both bullying others and being bullied at least once
during current term. Bullying and being bullied are both associated with depression, anxiety
and low self-confidence. Bullies are the only group reporting more psychosomatic symptoms,
they also score low on optimism. Bullied pupils tend to be dissatisfied with their own body.
Concerning social integration, bullies report more problems relating with school, parents,
teachers and are more dissatisfied with the relational class climate. Similar to the bully-
victims they score better concerning friendship quantity. The bullied pupils have more
problems in their school life (relations with school) and rate their friendship quantity, the
confidence with friends and the relational climate within the class lower than their peers not
involved in bullying. Their relation with the teachers is, however, better than any peer group.

Conclusion Bullying and victimising others are unacceptable behaviour. Perpetrators and
victims are sufferers but not fellows. They succeed in their socialisation process on different
arenas. However, bullied and bullies have many relational, emotional and self conceptual
problems in common that students, teachers and health care personnel need to discuss with
empathy and mutual respect. Such a dialogue might be essential in promoting health among
students.




                                                                                              59
Screening for ADHD blant barn i grunnskolealder – en sammenligning av to
spørreskjema

Lyngøy, Anita Sandmo


Supervisor: Einar Heiervang, forsker/overlege dr.med.
Regionsenter for barn og unges psykiske helse, UiB



Objective: ADHD is an assumingly underdiagnosed condition which untreated have a severe
impact on the daily life of the affected children and their surroundings, and it is also
associated with a higher risk for developing other serious disorders in adolescence and
adulthood. With a simple and effective screening instrument one could help many more of
these children. This study compares the Strenghts and Difficulties Questionnaire (SDQ),
hyperactivity subscale, with the ADHD subscale of the SNAP-IV rating scale.

Method: In the Bergen Child Study teachers and parents of 9430 children aged 7 to 9 years
were asked to complete a questionnaire with items on a wide range of emotional and
behavioural symptoms, general health and background. The parents of screen-positive
children and a comparative control group were asked to go through the DAWBA parent
interview, which gives a preliminary diagnosis. This study comprises 601 children, both
screen-positive and screen-negative from the BCS. Sensitivity and specificity at a chosen cut-
off and ROCs were made for the two scales.

Results: With cutoff set at the 90-percentile, sensitivity varied from 0,45 (parents SDQ) to
0,91 (teachers SNAP) and specificity varied from 0,90 (parents SNAP and teachers SDQ) to
0,91 (parents SDQ and teachers SNAP).

Conclusions: SNAP-IV is suitable for ADHD screening in low-risk populations. We
recommend cut-off at 6 for parents and 9 for teachers. The SDQ hyperactivity subscale used
alone can not be recommended used for screening.




                                                                                           60
Pilot study on inhibiting effect of marint algaeon protease

Ma, Ying


Supervisor: Knut-Jan Andersen, professor
Institutt for indremedisin, UiB



The inhibitory effect of extracts from marine algae on protease activity was investigated in
this study. Water and methanol extracts of ten different marine algae were tested for possible
inhibitory effects on trypsin and gelatinase synthesis and the proliferative and invasive
behaviour of cancer cells. Quantitative experiments were carried out to test the inhibitory
effects of different concentrations of each alga on trypsin. For most of the algae, a positive
linear correlation was found between the amount of algae extracts and the percentage of
inhibition. The zymogram technique was used to detect the inhibiting effect of the algae water
extracts on gelatinase. When the algae water solutions were incubated at 37C overnight with
normal and cancer tissue respectively, they showed surprisingly strong protease activities that
the pure algae bands overshadowed both normal tissue bands and cancer tissue bands.
However, when the gels that contained both normal and cancer tissues were incubated
overnight with algae water extracts containing buffer, inhibiting effects were shown for most
of the algae. Two of the three algae that were randomly chosen for confrontation tests showed
clear inhibition. The third alga showed more aggressive invasion of the cancer spheroid into
normal spheroid compared to the control group. Radioactive thymidine was used in DNA
synthesis test.

The results showed that all the ten algae had absolute inhibition with the inhibition percentage
ranging from 38 to 98%. The apoptosis test was also performed to compare the apoptotic
effects of three randomly chosen algae on normal and cancer cells. The results showed that
the algae caused apoptosis on both normal and cancer cells. However, there were more
apoptotic cells among the cancer cells than among the normal cells.




                                                                                             61
REM sleep and memory - an overview

Markussen, Dagfinn
Totland, Jon André


Supervisor: Chiara M. Portas, professor dr.med.
Seksjon for fysiologi, Institutt for biomedisin, UiB



The hypothesis that REM sleep is important for memory consolidation has been a subject of
active investigation since the 1950s. In this article, we review literature in this area and
discuss possible mechanisms whereby the neurophysiological processes characteristic of sleep
states may play a role in memory consolidation. We have looked at changes in sleep
parameters following learning, and the effect of REM sleep deprivation on memory
consolidation. In addition, we have reviewed the essential molecular mechanisms for memory
consolidation and how they may be modulated by sleep.

 The results presented in the literature are not conclusive. There is, however, disagreement
about the interpretation of the findings, and role for REM sleep in memory consolidation is
still being investigated.




                                                                                               62
Genital Herpes Simplex virus infeksjon – kliniske funn, diagnostikk og
behandling

Melby, Vibeke
Wesnes, Marianne


Supervisor: Arvid Nilsen, universitetslektor/overlege
Institutt for indremedisin, UiB/Hudavdelingen, Haukeland Universitetssykehus



The prevalence of genital herpes simplex virus (HSV) infection has been steadily increasing
over the past decades. HSV-2 is most frequently isolated from the clinical lesions, however,
HSV-1 has recently also been increasingly identified, particularly among younger people in
Europe and USA. Until now, virus isolation on cell culture media has been considered to be
the “gold standard” laboratory diagnostic method. During the past 10 years polymerase chain
reaction (PCR) has been developed. The two main aims of this work were to compare the
outcome of PCR with traditional cell culture in the diagnosis of genital HSV infection, and
furthermore to learn about the PCR method and also perform PCR analyses ourselves.

Material and methods: We used data and clinical specimen from the Depts. of
dermatovenerology and virology, Haukeland University Hospital. Between 1998 and 2001,
95 clinical specimen were analysed with virus isolation on cell culture and with PCR. We
used 10 of these characterised specimen for our own PCR analyses.

Results: Out of 95 specimen, HSV was detected in 49, 32 were positive for HSV with both
methods, 4 by virus isolation on cell culture alone, and additionally 17 using PCR. Forty
specimens gave negative results with both methods. This gives a sensitivity and specificity
(culture versus PCR) of 65% and 91%.

Discussion: Our material is far too low to allow firm conclusions. However, in line with
previous studies, our results indicate that the PCR method is superior to virus isolation on cell
culture in the diagnosis of genital HSV infection. We identified a number of difficulties
during processing the PCR analysis, and suggest measures to diminish these difficulties, to
improve the diagnostic accuracy of the PCR.




                                                                                               63
Røyke- og snusvaner blant medisinerstudentene i Bergen 2004

Mestad, Hilde
Olsen, Stine Feiring
Sørheim, Inga Cecilie


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



Background: There are few studies on medical students’ smoking habits in Norway. In 2002
the smoking habits among the medical students in Bergen were examined, and the result
found showed that 4,7 % smoked daily, and 28,1 % were occasional smokers. We wanted to
repeat the study and see if there had been a change in smoking habits since 2002. It was also
interesting to see if there were differences between age, gender and how long the students had
attended medical school. We also wanted to examine the students’ use of snuff. In addition,
we wished to make a base for a cohort study of the smoking habits of medical students.

Method: The study was done by handing out questionnaires to the students. The
questionnaire was the same as was used in 2002, but we added a question on snuff. We met
the students at plenum lectures, and those we did not reach there, got a questionnaire by post.
The questionnaire was identifiable. The study was done spring 2004.

Results: The compliance was 89,4 %. 800 students were investigated. The study revealed that
3,0 % smoked regularly, while 19,9 % were occasional smokers. We found no differences
regarding gender or how long the students had attended medical school. There were fewer
under the age of 25 who smoked regularly. 6,4 % used snuff daily, and 8,6 % were occasional
snuffers. The use of snuff was highest among men. The smoking prevalence was highest
among the students who also used snuff, and there were also more ex-smokers in this group.

Interpretation: As expected the smoking prevalence was lower among medical students than
among the population in general. There had been a reduction in the number of smokers
compared with the results from 2002. Anyhow, there were still a high number of occasional
smokers. The prevalence of snuff was more like the population in general compared to
smoking habits. The use of snuff had not been examined among the medical students in
Bergen earlier. To follow the further progress, the study should be repeated every second
year.




                                                                                             64
Trenger pasienter med ventrikkel septum defekt endokarditt profylakse?

Do patients with ventricular septal defect need endocarditis prophylaxis?

Midtbø, Helga B


Supervisors: Gottfried Greve, professor/overlege, Seksjon for pediatri, Institutt for klinisk
medisin, UiB/Hjerteavdelingen, Haukeland Universitetssykehus og
Asle Hirth, overlege, Hjerteavdelingen, Haukeland Universitetssykehus



Background: Patients with ventricle septal defect (VSD) are considered at higher risk of
infectious endocarditis than the population in general. According to guidelines these patients
should receive antibiotic prophylaxis before health procedures. Lately there has been
published several studies that challenges this view.

Material and methods: With background in searches performed in Medline, we discuss the
risk of endocarditis and indication of antibiotic prophylaxis in patients with VSD.

Results: Patients with perimembranous and subvalvular defects have higher risk of
endocarditis than the population in general. The proportion of patients developing
endocarditis in relation to health procedures is low. Antibiotic prophylaxis is just partial
effective.

Interpretation: The share of preventable cases of endocarditis is low, and the prophylaxis
does not give sufficient protection. Studies suggest that only patients at highest risk should
receive prophylaxis in the future.




                                                                                                 65
Atrioventrikulær nodal reentry takykardi hos barn. Se vedlegg. På vegne av

Mikkelsen, Ragnhild Beate
Vislie, Charlotte Händler


Supervisor: Gottfried Greve, professor/overlege, Seksjon for pediatri, Institutt for klinisk
medisin, UiB/Hjerteavdelingen, Haukeland Universitetssykehus



Background: Atrioventricular nodal re-entry tachycardia (AVNRT) is a supraventricular
tachycardia (SVT). In AVNRT there is an accessory pathway between the atrias and the
ventricles. The pathway lies in the normal AV-node and can cause a re-entry circuit. Although
this arrhythmia is one of the most common SVTs in adulthood, it is seldom diagnosed in the
paediatric population. In this article, we focus on AVNRT among children and adolescents.
We have looked closer on diagnostic criteria, clinical presentation, incidence, prognosis and
treatment.

Methods: The article is based on literature found in the databases PubMed and Medline.
Further more, articles are identified by examining the references.

Results: AVNRT is an arrhythmia that is relatively rare in the first years of life, but becomes
more frequent with age. Finding reliable data on incidence proved to be difficult, because
there are few studies including children. Prognostic variables are even harder to find,
especially of untreated cases. Three main treatment regiments are available: acute and
prophylactic medication and curative treatment with radiofrequency catheter ablation (RFA).




                                                                                               66
Effekter av fysisk aktivitet på serum nivåer av angiogenese regulatorer

Møinicken, Christina
Østerhus, Karin


Supervisor: Øystein Bruserud, professor dr.med./overlege
Institutt for indremedisin, UiB/Hematologisk seksjon, Medisinsk avdeling, Haukeland
Universitetssykehus



Angiogenesis, the growth of new blood vessels, is an important natural process occurring in
the body, both in health and disease. The normal, healthy body maintains a perfect balance of
angiogenesis modulators.
We investigated the effects of physical activity on the serum levels of the pro-angiogenic
mediators leptin and bFGF. Peripheral blood samples were collected immediately before and
after a 4 hours mountain walk in 20 elderly individuals.
Serum was separated within 2 hours after blood sampling, and the samples were stored frozen
at -70°C until analysis. The serum levels of leptin and bFGF were determined by ELISA
analysis. We also performed peripheral blood cell counts.
The preexercise levels of leptin were significantly higher for the women, than for the men.
The leptin levels were not altered in the elderly individuals after this moderate exercise,
whereas they showed significantly decreased levels of bFGF.
Physical activity also had an effect on peripheral blood counts, the elderly individuals showed
increased neutrophils and decreased monocytes.




                                                                                             67
Kvinneperspektivet i kampen mot HIV/AIDS

Natvik, Marianne


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



With this essay I wish to show the impact HIV and AIDS have on women, and by doing so, I
want to address how important it is to focus on women’s position in society and her rights,
whild fighting against HIV/AIDS.

In many countries women’s rights and position are very limited and a dependent on her
husband and marriage. As a consequence she has few opportunities when her husband is
violent or unfaithful. It she has a positive HIV test, it might change her life dramatically.
Many husbands reject the wife if she tells him that she decides to leave him, she leaves her
whole life behind, and has to start anew, with sparse resources and few possibilities of
managing on her own.

For some vomen this may lead to prostitution and further exposure to HIV and other sexually
transmitted diseases. Violence against women is a major problem and contributes even
further. The lack of a possibility for women to deny unwanted sex or to demand safe sex, are
important contributors to the spread of the HIV epidemic.

The increased workload that HIV gives the women is enormous. The culture defines the
women’s duties. She has to take care of sick family members and younger siblings. This may
limit her possibilities to education, work and farming. Without education her chances of
getting knowledge on HIV, its transmission and how to protect herself becomes poor.

A main goal in the work against HIV and AIDS has to be to strengthen women’s position.
Her rights to house, land and children should be secured, in case the husband dies, leaves her
or she gets thrown out of her home.




                                                                                                68
Antihypertensivas effekt på plasma noradrenalin (”sympatikus”)

Nepstad, Ronny
Caldwell, Anders (class 00)


Supervisor: Ole Terland, lege
Øyrane legekontor



Antihypertensive treatment triggers compensatory mechanisms to maintain the blood
pressure. Elevated plasma norepinephrine (sympaticus) is of particular importance.
Sympathetic overactivity is associated with eg. Cardiovascular disease and diabetes mellitus
of type II. There are many different kinds of antihypertensives, and the outcome of
sympathetic activity is various. The Pubmed and medline databases were searched for articles
using the terms hypertension, antihypertensive drugs and plasma norepinphrine (pNA). The
groups of drugs were compared to each other with focus on pNA, heart rate and peripheral
vascular resistance. A gradual decrease of blood pressure will cause a minor reflectoric
adrenergical enhancement. Use of antihypertensive drugs with minimal direct catecholamine
releasing effects may be of beneficial value. Combination of several drugs may be convenient
in regard of achieving optimal antihypertensive effects and minimal sympathetic activation.




                                                                                         69
Bruk av myokardscintigrafi ved Hjerteavdelingen, Haukeland
Universitetssykehus

Nerland, Eldfrid


Supervisor: Eva Gerdts, postdoc
Institutt for indremedisin, UiB



Objective: Assessment of clinical use and consequences for patient management of
myocardial nuclear perfusion imaging (MIBI).

Methods: Retrospective collection of data from hospital records on referral, patients’
symptoms and cardiovascular risk, test results and their implications on further management
in patients referred for MIBI at Haukeland University Hospital in 2003.

Results: Of 379 patients, 45 % were referred from cardiologists in general practice. Only 60
% of the patients had referral diagnoses that were within guideline recommendations for
MIBI, and this did not differ between patients referred from cardiologists outside or within
our department. In 94 patients additional coronary angiography was performed. Using
diagnosis of > 50 % coronary artery stenosis by angiography as diagnostic gold standard,
MIBI had 0.63 sensitivity, 0.47 specificity, negative predictive value 0.86 and positive
predictive value 0.19 to diagnose or exclude significant coronary artery disease.

Conclusions: Our study shows that 40 % of patients referred for MIBI at Haukeland
University Hospital in 2003 did not have a recommended referral diagnosis. As all patients
were accepted, this reduced pre-test probability of coronary artery disease within the study
population, which together with methodological limitations reduced diagnostic accuracy by
MIBI to an unacceptable low level in our hands.




                                                                                               70
T-celle reseptor Vβ gen polymorfisme hos pasienter med Sjøgrens Syndrom

Ngo, Son Stian


Supervisor: Torbjørn Hansen, førsteamanuensis
Avdeling for Mikrobiologi og Immunologi, Gades Institutt, UiB.



We did a research on TCRVβ-gene polymorphism in 30 patients with Sjøgren’s syndrome
and 30 controlls. Three TCRVβ-genes were used to search for restriction fragment length
polymorphism with the help of polymerase chain reaction and restriction enzymes.
We did not find any relation between Sjøgren’s syndrome and the three TCRVβ-gene
polymorphisms that we studied




                                                                                          71
Repeterbarhet ved Metakolin-provokasjon hos barn og ungdom med astma
bronkiale”

Njå, Håvard


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



Introduction: Bronchial asthma is a heterogeneous disease characterised by chronic
inflammation of the small airways and episodes of wheeze. A consequence of
bronchial mucosal inflammation is hypersensitivity or increased reactivity of the small
airways. Bronchial hyperreactivity (BHR) can be measured or quantified by a
metacholine challenge test called PD20.

Aim: To examine the repeatability of a standardised PD20-test in children and
adolescents with verified asthma.

Study design: Open study of children and adolescents with bronchial asthma and
positive PD20-test.

Results: 10 patients (4 girls and 6 boys) with mean age 9.5 years (range 8-16), were
examined twice within 3 weeks. All patients performed technical acceptable tests.
There was no significant difference in basic lung parameters on day 1 compared to
day 2. The repeatability of the PD20 test was within1½ increase of primary cut off
dose of metacholine.

Conclusion: This study support that the repeatability of the PD20-test which is used
in advanced diagnostics of children and adolescents with chronic lung disease at the
Department of Paediatrics at Haukeland University Hospital, is comparable to other
national as well as international Laboratories. The variability was, however, higher
than clinical experienced, and probably a result of the small number and
heterogeneous group of patients examined. Further study is needed to confirm this
anticipation.




                                                                                          72
Legestudenters ferdigheter i avansert hjerte-lungeredning

Nordli, Hege
Aarsetøy, Reidun


Supervisor: Ivar Austlid, universitetslektor
Medisinsk ferdighetssenter, Det medisinske fakultet, UiB



Context: Medical students at the University of Bergen attend a course in advance
cardiopulmonary resuscitation (CPR) during the third year of study. Previous research has
shown that these skills can be difficult to acquire, and that retention of CPR skills often are
poor. The aim of this study was to survey practical skills in advanced CPR among medical
students that had taken the course.

Material and methods: Two classes of students were tested and compared. One class had
attended course 1 month ago, while the other class had taken the course 15 months ago. 45
students from “1 month class” and 51 students from “15 month class” were randomly
assigned to participate in this study. They worked in groups of 3 persons. Each group was
tested by means of an advanced resuscitation-manikin. Each CPR procedure was evaluated in
a standardized way that made it possible to compare skills.

Results: Only 29% of the “1 month class” and 23% of the “15 month class” were able to
perform satisfactory cardiopulmonary resuscitation according to the accepted quidelines.
Those who had taken the course in advanced CPR just 4 weeks ago achieved better results
than the students that had attended the course during the previous year. But still, the overall
performance by the “1 month group” was not as good as could be expected.

Conclusions: This study has shown that knowledge and skills decay over time, and that
regular training is necessary to maintain practical skills. It is not very likely that the students
forget skills in just one month, so different ways to improve the course is discussed.




                                                                                                  73
Modified sham feeding improves stomach function and postprandial
symptoms in functional dyspepsia

Nordstrøm, Lars Michael
Haukelid, Alf-Olav (class 00)


Supervisors: Trygve Hausken, professor og Johan A. Lunding, stipendiat
Seksjon for gastroenterologi, Institutt for indremedisin, UiB



Functional dyspepsia (FD) is associated with low vagal tone, postprandial symptoms and
disturbed gastric function.

Aims and methods: The aim of this study was to investigate the effect of sham-feeding on
antral motility, symptoms and gastric emptying in FD-patients. Ten healthy volunteers (HV)
and ten FD-patients (median 23 years) were included. Each person underwent, in randomized
order, two separate drinking-tests; with, and without sham-feeding. The drink, 500 ml clear
meat soup (12 kcal, 37oC), was ingested during 4 minutes. Sham-feeding was started after
finishing drinking and performed by chewing of a sugar containing chewing gum,
continuously spitting out all saliva. In the postprandial period (10 min), antral motility index
(MI, contraction amplitude x frequency) was estimated by ultrasound, and perception
(fullness/nausea and pain) were continuously recorded. After 10 minutes, the intragastric
volume was estimated using 3D ultrasound.

Results: FD-patients had lower MI than HV at baseline (mean MI 0-4 min: 0.8 ± 0.3 vs. 1.8
± 0.4/min. ANOVA 0-10 min, F = 5.0, p = 0.04). All FD-patients showed an increase in MI
after sham-feeding (4-8 min: 0.8 ± 0.6 vs. 1.7 ± 0.2/min, p = 0.004). In HV, sham-feeding
did not alter MI. Sham-feeding increased the intragastric volume in FD-patients (232 ± 25 vs.
290 ± 25 ml, p = 0.02), suggesting an improvement in gastric accommodation. This effect
was not seen in HV. In FD-patients with symptoms, sensory score were reduced due to sham-
feeding after 6 min and for the rest of the period (76.5 ± 40.0 vs. 58.8 ± 37.7, p = 0.03, n = 4).

Conclusion: Sham-feeding as a natural vagal stimulator increases the antral motility,
improves gastric accommodation and reduces postprandial symptoms in FD-patients. These
results suggest that FD-patients might benefit from additional tasting and chewing in relation
to a meal.




                                                                                               74
Bruk av øretemperaturmåling på et sykehus. Er det godt nok?

Nordås, Turid
Leiren, Silje (class 00)


Supervisor: Kari Schrøder Hansen, overlege dr.med.
Kirurgisk avdeling, Haukeland Universitetssykehus



The rectal mercury thermometer has been replaced with digital rectal thermometers and ear
thermometers. The ear thermometers measure the body temperature non- invasive, and it
takes about 5 seconds. There are two principle means of infrared thermometry: tympanic
thermometry and ear canal thermometry. Several reports indicate that tympanic measurements
are influenced by external factors. There are few studies that have examined the accuracy of
ear canal thermometers. The purpose of this study is to examine the liability of infrared ear
thermometers compared with the digital rectal thermometer.

We carried out the measurements using two different ear thermometers: OTOTEMP
LighTouch LTX AND ivac CORPORATION core-check, and compared the measurements
with the rectal temperature. We measured the temperature of persons older than 18 years at 4
different wards at Haukeland universitetssykehus (n =230). All the measurements were
blinded for the correct temperature. Student t-test was used to compare the average.

The tympanic measurements show an average of –0.53 from the rectal temperature. The ear
canal thermometers show an average of –0.23 from the rectal temperature. The measurements
are statistic significant (p<0.001, 95% CI: 0.1323 to 0.3634). By using the tympanic
thermometer, the sensitivity to find fever was 13.6 % and negative predictive value was 89.1
%. Ear canal thermometry had 50 % sensitivity for finding fever and a negative predictive
value of 94.8 %. The measurements carried out by nurses showed a greater deviation than the
measurements made by medical students.
There are many advantages by using ear thermometers, but the accuracy and ability to detect
patients with fever is not good enough to be recommended for detecting fever. Calibrating the
tympanic thermometer + 0.5 degrees Celsius, shows a considerable less deviation from rectal
temperature. If fever is suspected, a rectal thermometer is recommended.




                                                                                           75
Et barn for lite – mor og fars sorg etter tapet av et barn

Olsen, Charlotte Meyer


Supervisors: Anders Lund, professor/overlege
Seksjon for psykiatri, Institutt for klinisk medisin, UiB og
Elin Hordvik, psykolog, Senter for krisepsykologi



To lose a child is a most distressing experience. Mothers and fathers often seem to react
different when facing such a tragedy. I will focus on how these gender differences are
expressed in cooping strategies, grief reactions and finally how they effect on the marriage.

Research has offered remarkably little attention to this subject. The literature that exists shows
obvious gender differences in grief. Woman use an emotional cooping style, where as men
show an instrumental style. Woman tend to use a wider range of cooping strategies and they
also use such strategies to a higher degree then men do.

There are also differences in grief reactions. Mothers´ grief seems to be more intense. They
experience more anger, pain, irritability and guilt then fathers do. Women cry frequently,
while men tend to hide their emotions. Mothers have more symptoms of anxiety and
depression, but if the fathers increased alcohol consummation is considered, their grief seems
to be equally strong.

The differences in grief represent a challenge for the relationship. Her grief reactions makes
him worried, while she´s angry due to his lack of emotional sharing. Failure in
communication, lack of tolerance and intimacy can create difficulties.




                                                                                                 76
Narkolepsi - en gjennomgang av et pasientmateriale med beskrivelse av
kliniske karakteristika for pasientgruppen

Narcolepsy – a presentation of a patient material with description of clinical
characteristics of this group of patients

Pettersen, Siri K.


Supervisor: Nils Erik Gilhus, professor dr.med.
Seksjon for nevrologi, Institutt for klinisk medisin, UiB



Background: Narcolepsy is a disorder of sleep, characterized by sleep attacks, cataplexy,
sleep paralysis and hypnagogic hallucinations. Prevalence is 0.05%. It is assumed to be a
result of REM-sleep abnormalities, possibly because of low levels of the neuropeptide
hypocretin-1.

Material and methods: This is a study of the medical journals of 44 patients with narcolepsy
admitted to the Department of Neurology, Haukeland University Hospital, Norway and
diagnosed as having narcolepsy.

Results: 16 of the patients were men and 28 were women. 12 of the patients were
unemployed because of their disease. All patients had typical excessive daytime sleepiness,
25 had described cataplectic attacks, 17 had experienced hypnagogic hallucinations and 15
had described sleep attacks. Common additional complaints were difficulties with
concentration (12) and impaired memory (10). Methylphenidate had been used by all the
patients, with a dose variation from sporadic use to 60 mg per day and the effect reported as
good or very good by the majority. Other medication taken for excessive daytime sleepiness
was dextroamphetamin (10) (dose 5-40 mg) and modafinil (2). In two patients the stimulant
drug was withdrawn because of excess consumption. 16 of the 25 patients with cataplexy used
antidepressants as treatment with good or very good effect reported by the majority.

Conclusions: Narcolepsy is a lifelong disease with serious impact on the patients’ quality of
life, including their ability to work; we find a much higher rate of unemployment among the
patients with narcolepsy than in the general population. Compared to other studies we find a
fewer descriptions of hypnagogic hallucinations and sleep paralysis. Doctors need more
knowledge about narcolepsy so that a correct diagnose can be assigned earlier. An optimal
treatment should be prescribed; the doses needed may vary individually. A good follow-up of
patients is necessary to monitor response, potential side effects of treatment and the
possibility of drug dependence. More research is needed to find new therapeutic possibilities.




                                                                                            77
Diettbehandling av barn med AD/HD

Pileberg, Kjersti Beate
Tesaker, Mette


Supervisor: Karl Ludvig Reichelt, forsker dr.med. (emeritus)
Pediatrisk forskningsinstitutt, Det medisinske fakultet, Universitetet i Oslo



The intention of this thesis is to put focus on the possibility of nutritional treatment of
patients, most frequently children, with Attention Deficit Hyperactivity Disorder (ADHD).
Since Benjamin Feingold, in 1973, was the first to maintain that a diet free from preservatives
and salicylates could normalize hyperactive behaviour, there has been extensive research on
the topic. We have reviewed a sample of double blind placebo controlled crossover studies
done in Norway and abroad, comparing how behaviour in children with ADHD has fluctuated
in accordance with diet. Hyperactive children were put on Few-food- and Placebo- diet,
respectively, and behavior was ranked using standard gradingscales. Finally we have
summoned relevant advantages and drawbacks on putting a child on a restrictive diet versus
treatment with medication .




                                                                                            78
Fosterdiagnostikk – muligheter og konsekvenser, med spesielt henblikk på
selektiv abort

Prenatal testing – possibilities and consequences, with a special view to fetal
selection.

Sandvik, Miriam Kristine


Supervisor: Ole Frithjof Norheim, professor
Fagområdet medisinsk etikk og vitenskapsteori, Institutt for samfunnsmedisinske fag, UiB



Background: The rapid development of biotechnology opens to a lot of new possibilities,
and forces the question of where to draw the line – or should there even be a line? Prenatal
testing is one of the subjects of debate, and in this paper I concentrate on fetal selection and
the ethical approaches to this subject. My object was to get acquainted with the discussion
and some of the existing arguments, and on this basis make my own evaluation of the ethical
questions raised.

Methods: This paper is based on a literary review of a selection of ethical studies on prenatal
testing. First, I define and explain a few central conceptions, then refer some statistics and
extracts from Norwegian legislation. The first main part presents my study of existing ethical
arguments pro and con today’s practice, with sources like Norwegian legislation, Norwegian
and foreign doctors and experts on genetics, and examples from other countries’ policy and
practice. In the next part I describe some important ethical theories, and I sum up with a
discussion and a personal conclusion.

Results/conclusion: Strong and different arguments characterize this debate – some
conservative, that emphasize the absolute worth of human beings, some liberal and pointing
out the health benefits from abortion of fetuses with serious illnesses and injuries. In Norway,
the fear of developing a society that sorts out certain groups is still evident in the discussion
and legislation. Nevertheless, the debate on fetal selection shows that our attitude is
changing. We are, of course, affected by the fact that the technological development puts us
in the position of constantly having to make new choices.

Personally, I base my opinion on the principal of an absolute worth of human beings. This
means that a fetus has a right to life independent of age or possible diseases or injuries, and I
can not accept selection of fetuses on such grounds.




                                                                                                79
Kvinner med juvenil myoklonisk epilepsi. Behandling med antiepileptika og
utkomme av svangerskap. Litteraturstudie med blikk på tall fra Haukeland
Universitetssykehus.

Skarstein, Ingerid


Supervisor: Bernt Engelsen, overlege/professor
Nevrologisk avdeling, Haukeland Universitetssykehus/Seksjon for nevrologi, Institutt for
klinisk medisin, UiB



It is well known that use of anti epileptic drugs (AED) during pregnancy leads to increased
congenital malformation rate in the offspring. Women diagnosed with juvenile myoclonic
epilepsy (JME) are often treated with sodium-valproate. This is still the International League
Against Epilepsies (ILAE) first choice in treatment of primary generalized epilepsy. Other
AED used, are karbamazepine, phenemal and some other new antiepileptic formulas. The
reviewers seem to agree that treatment with sodium-valproat is associated with a higher rate
of congenital malformations in the offspring. (1) This is also the result in our material. We
have reviewed the medical journals of twenty women diagnosed with JME which have given
birth. We have registered use of AED, serum concentration of AED, serum-homocystein
(hct), serum-folic acid and erythrocyte-folic acid in three trimesters where the numbers are
available. Among 53 pregnancies, there are born two children with malformations, which can
represent a small increase compared to the normal population. There is one child with neural
tube defect (NTD) combined with hydrocephalus, and one child with polydactyly. There was
also one child with the chromosomal abnormality trisomy 21. All of the women had folic acid
levels in the reference area during the pregnancy. Some of the women had homocystein levels
lower than recommended, as expected.




                                                                                           80
Etiske aspekter ved en HIV/AIDS vaksine

Skeid, Eli Ringstad


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



On a world basis 70 million people have been infected with the HIV virus. This is a major
problem in the developing countries where the HIV/AIDS prevalence can reach 40%.
Vaccination is an important part of the work to stop the AIDS epidemic, especially in those
countries where the antiretroviral medicines are not available to the majority of the population
because they are too expensive. However it has turned out to be more complicated to make a
protective HIV/AIDS vaccine than expected because such a vaccine must be based on a new
concept.

Testing of a protective vaccine trial in a population raises a long list of ethical questions. The
most important guidelines for medical ethics are established in the Helsinki declaration by the
World Medical Association. A crucial part of the ethics of research is the requirement that
each participant give his or her informed consent to participation. There are many challenges
linked to this, for instance how to inform the participants so they understand what the testing
means. They have to understand the meaning of placebo, the effect of a control group and
that the vaccine is not 100% effective and that practice of safe sex is crucial. A requirement is
also that the participants in the trial should be given counselling on how to protect themselves
from being infected even if this implies that the vaccine will not be as efficiently tested and
that more people will have to be tested. A controversial issue is the standard of care that
should be given to those infected in a trial. So far there is no agreement on whether the
participants in the trial that get infected should get the best available standard of care or if
they should get the best available local standard of care. Treatment of those who get infected
represent a considerable cost for the sponsors of the trial, and if the standard is too high this
can stop the testing of candidate vaccines. However some researchers fear that if we put the
level of ethics below the maximum, the ethics might be lowered even more. An other ethical
requirement the Helsinki declaration raises is that the whole population in the country where
the trial has been preformed should benefit from the trial. It will therefore be a
recommendation that the whole population in the country where a trial has been going on
should get the vaccine for free it is shown to be effective. Furthermore there has to be a
workplan for how a vaccine program can be financed so that everyone in the countries with a
high HIV prevalence will receive the vaccine. Different solutions to this problem have been
raised.

Even if it seems very difficult to maintain the ethical guidelines during an HIV vaccine trial, it
is important to remember that no action versus action is also an ethical choice. I believe that
we can come a long way in the battle against AIDS through information practice on safe sex,
free condoms, HIV testing and clean needles. However, to stop the epidemic it is necessary
with an effective vaccine. It is therefore crucial to have agreement on the guidelines for HIV
vaccine trials as soon as possible.




                                                                                               81
Fordelar og ulemper ved overgangen frå 1,5 Tesla til 3,0 Tesla
magnesundersøkingar (MRI)

Skrede, Bjarte Ingvar


Supervisor: John Ludvig Larsen, professor dr.med.
Radiologisk seksjon, Haukeland Universitetssykehus



Background and purpose: Haukeland University Hospital is about to start using a new and
expensive 3 Tesla magnetic tomograph. Up to recently, Haukeland has been using MRI-
machines with 1.5 T maximum static magnetic field strength. An increase in magnetic field
strength from 1.5 T to 3.0 T is expected to give several advantages but also disadvantages and
challenges. The purpose of this paper is to evaluate important aspects in the transition to 3 T
MRI.

Materials and methods: The project work is based on systematic search and study of
relevant papers.

Results: A twofold increase in static magnetic field strength gives, in theory, a doubled
signal-to-noise ratio. By keeping SNR constant, the scan-time may be reduced (up to approx.
75%) by a doubling of the magnetic field strength. In practice, though, it seems difficult to
obtain the calculated enhancement in SNR because of an increased amount of challenging
artefacts and altered field homogenity and line width (peak separation). More precise and
faster information, achieved by enhanced SNR, open up for a new and increased use of
functional MRI, diffusion analysis, cardial MRI, spectroscopy and angiography. By using 3 T
instead of 1.5 T MRI, there will be more acoustic noise, and increased temperature of the
examined body tissue is observed.

Conclusions: 3 Tesla MRI gives the potential for better and faster visualization of anatomy,
pathology and pathophysiology than what is offered by 1.5 Tesla. Further knowledge and
experience is required to utilize that potential. Increased acoustic noise and heating is
supposed to originate as possible side effects. Despite the fact that a 3 T magnetic
tomography is considerably more expensive than a 1.5 T tomography, this investment may be
justified because of the new potentials it offers.




                                                                                             82
Neuronal signal transduction in schizophrenia and drug-membrane
interactions: A broadened perspective

Skrede, Silje


Supervisor: Holm Holmsen, professor
Seksjon for biokjemi og molekylærbiologi, Institutt for biomedisin, UiB



Selv om schizofreni rammer 1% av befolkningen og medfører sterkt redusert livskvalitet for
et stort antall pasienter, vet vi lite om patogenesen bak tilstanden. Det finnes heller ingen
tilfredsstillende behandlingsmetoder. Etter at de første antipsykotika, som alle virket via
antagonisme av dopaminerge reseptorer, ble tatt i bruk for 50 år siden, har den mest utbredte
forklaringsmodellen vært overaktivitet i hjernens dopaminerge neurotransmittersystem. Siden
er et utall enkeltstående patologiske funn kommet til. Svært mange angår neurotransmitternes
antall eller funksjon, og en rekke ulike neurotransmittersystemer er trukket inn. Det er gjort
få forsøk på å skissere helhetlige konsepter.

Etter ca. 1970 har det vokst frem en ”alternativ” hypotese, den såkalte membranhypotesen.
Denne fokuserer på den neuronale cellemembran, der en finner alle neurotransmittor-
reseptorer. I løpet av de siste årene er man blitt mer klar over at membranen ikke bare opptrer
som en passiv barriere, men deltar aktivt i signaltransduksjon og derfor spiller en avgjørende
rolle i intercellulær kommunikasjon. Membranens sammensetning er nøye regulert, og
aktiviteten til en rekke membranrelaterte enzymer og proteiner påvirkes av de fysikokjemiske
forholdene i membranen. Derfor tenker man seg at en forstyrrelse av membranens
sammensetning kan gi nedsatt neuronal funksjonsnivå, og at dette kan bidra til det patologiske
bilde man ser ved schizofreni. Flere konkrete biokjemiske mekanismer er foreslått, og en del
studier er gjennomført uten at overbevisende funn er lagt frem. Det relativt svake
eksperimentelle grunnlag er trolig blant årsakene til at membranhypotesen er blitt møtt med
liten interesse.

Det viser seg at antipsykotiske medikamenter har evne til å interagere med membranen uten å
gå veien om en reseptor. I studier med modellmembraner og levende celler er det påvist at
medikamentene ikke bare går direkte inn i membranen, men at de også kan påvirke
membranrelaterte enzymer. Oppgaven presenterer det teoretiske og eksperimentelle materiale
som utgjør ”membranteorien”. Deretter fremlegges en del resultater basert på forfatterens
egne forsøk med modellmembraner og blodplater. Det er for tidlig å si om disse resultatene
vil få konsekvenser for membranhypotesen eller for forståelsen av antipsykotiske
medikamenters virkningsmekanismer, men de burde likevel kunne bidra til å øke interessen
omkring ”alternativ” tenkning i et underprioritert forskningsfelt.




                                                                                            83
Kronisk/postviralt Utmattelsessyndrom G93,3

Chronic Fatigue Syndrome (CFS)

Skrettingland, Dagny Bekkeheien


Supervisor: Harald Nyland, professor
Seksjon for nevrologi, Institutt for klinisk medisin, UiB



Chronic Fatigue Syndrome (CFS) describe a relative common and well-defined medical
disorder that causes significant ill health and disability in sufferers. The aetiology (cause) and
pathogenesis (disease mechanisms) are unclear although research is increasingly providing
important clues both to factors that predispose, precipitate and perpetuate the condition. The
impact of the disease even in its milder forms can be extensive, people who are severely
affected and/or with longstanding disease are profoundly compromised, and improvement of
their care is a challenge. An early diagnosis is key to improving outcomes. Symptoms are
diverse, but increased activity frequently worsens fatigue, malaise, and other symptoms with
characteristically delayed impact on function.

All patients need appropriate clinical evaluation and follow-up, a flexible management plan.
Therapeutic strategies include graded exercise/activity programmes, cognitive therapy and
pacing. The overall aim of management must be to optimise all aspects of care that contribute
to natural recovery process.
Education and support can empower patients to act as partners in care. Much support is also
provided by the voluntary sector.




                                                                                               84
Kryobiologi. Nedfrysing og oppbevaring av levende celler og vev

Solberg, Sigrid


Supervisor: Ole Didrik Lærum, professor dr.med.
Avdeling for patologi, Gades institutt, UiB



Freeze preservation and prolonged storage of living cells and tissue fragments have gained
increasing interest in medicine during the recent years. Basically, there are two main
methods: Programmed freezing, where a gradual decrease of temperature, usually 1oC per
minute is used, and vitrification where a rapid freezing transforms cells and liquid to a solid
state. In both cases chemical substances and macromolecules are added to reduce the risk for
deleterious crystal formation in water.

At present, such techniques are mainly used in reproductive medicine, with storage of human
embryos after in vitro fertilization. In addition, there is an increasing use of cells for other
therapeutic purposes, from hemopoietic stem cells to tissue fragments from skin and joint
cartilage. Large biobanks of living, frozen cells are now being established in several
countries for diagnostic, therapeutic and research purposes.




                                                                                              85
Effekt av lysbehandling og melatonin ved skiftarbeid på Snorre-plattformen

Stangenes, Kristine


Supervisor: Bjørn Bjorvatn, professor dr.med.
Seksjon for allmennmedisin, Institutt for samfunnsmedisinske fag, UiB



Introduction:
Melatonin and bright light treatment have effects on problems related to the circadian rhythm
after night work. Most studies have been done under simulated night work in laboratories, and
not during real work.
Studies that have been done on night shift workers in the North Sea show faster adaptation to
night work compared to earlier studies on night workers on shore (Bjorvatn et al.1999,
Bjorvatn et al.1998). The social rhythm on the platform has been thought to contribute to
make it easier to adapt. The fact that the workers are not exposed to light on their way home
has also been thought to contribute

Methods:
In this study at the Snorre platform we wanted to see if melatonin or light could have effect
compared with placebo. We also wanted to compare the effect of light to the effect of
melatonin.
17 workers who worked swing shift and had severe problems related to shift work completed
the study. Swing shift is the first week on night shift, and the second week on day shift. The
17 workers were included from a earlier study that included 109 shift workers. The subjects
were evaluated on three consecutive working schedules of 14 days in a randomized crossover
design: placebo capsules, melatonin capsules and bright light treatment.
Subjective ratings of sleepiness were obtained using the Karolinska Sleepiness Scale, KSS
and a shortened version of the Accumulated Time with Sleepiness, ATS.
Objective ratings of sleepiness were obtained using a reaction time test, and objective sleep/
wake activity was recorded with an Actiwatch portable recorder.
Before leaving the platform after a working period they completed Hospital Anxiety and
Depression rating scale, HADS.

Results:
I have chosen to present and discuss the subjective data. Melatonin gave significant longer
sleep time compared to placebo and bright light. Melatonin also gave a modest reduction in
sleepiness, compared to placebo and bright light. This reduction in sleepiness was present
during the day shift, not during the night shift.
Light had few effects except a modest but significant reduction in sleep onset latency,
compared to melatonin and placebo, during the night shift period.
The bright light treatment had a negative effect in the day shift period. The reason was
probably that the time for the bright light treatment not was correct.
To summarize, the differences between placebo, light and melatonin were small. We had
expected to find more positive effects.




                                                                                              86
Indikasjoner for keisarsnitt ved Kvinneklinikken, Haukeland
Universitetssykehus 2003

Stensvåg, Dordi
Hjelle, Åse (class 01)


Supervisor: Per E Børdahl, klinikkoverlege, førsteamanuensis dr.med.
Kvinneklinikken, Haukeland Universitetssykehus



Objective
The purpose of the present study is to investigate the indications for caesarean delivery at
Kvinneklinikken, Haukeland Universitetssjukehus in 2003, related to maternal age, weight and parity,
type of anaesthesia and presurgery planning, gestational age and degree of cervical dilatation.

Study design
This is a retrospective study, based on a review of medical records.. The inclusions criteria were
delivery by caesarean section of a living single infant. The medical records were investigated and
planned preregistration forms were filled out by Gro Lillegraven and Dordi Stensvåg (5th and 6th
study year). The form was approved by Medical chief, senior consultant Per E. Børdahl, MD, PhD.
The data were thereafter filled in an Excel Calculation Form by Åse Hjelle (4th study year).

Results
In 431 cases (79%), there was one indication for CS, in 91 (17%) two, and in 23 (4%), three
indications. In the group with only one indication mother’s demand and two or more previous
caesarean sections were the dominant reasons for an elective caesarean (together 57%). In the
emergency cases fetal distress and inertia dominated (53%). In the total group eight indications
accounted for 78,0%; fetal distress (21,7%), maternal demand, secondary inertia, preeclampsia, two or
more previous caesarean sections , placental abruption, breech presentation according to protocol and
chorioamnionitis. Of the total number of deliveries 36,5% were planned as elective surgery, but 5,5%
of these were carried out as emergency operations. Totally 69,0% of the caesareans were performed as
emergency operations.

Conclusions
Within Norway today there are considerable differences in the rates of caesarean sections (6). The
total distribution at Kvinneklinikken Haukeland Universitetssjukehus was in 2003 very similar to the
distribution found in the national study by Kolås et al. (12). The distribution of indications in relation
to degree of emergency was as to be expected. Obesity was in our study not an individual risk factor
for operative delivery under a given indication.
It is important to have strategies to lower the rate of unnecessary caesarean sections. Several studies
show that these methods exist, and it is therefore utterly important that personnel working within the
obstetric field knows how to use them, and does so.
Both within Norway and the international community it is important with a consensus regarding
indications for caesarean sections. It is utterly important that these indications are funded in scientific
proven gain of health for either mother and/or child. Several studies show that at present this is not the
case.




                                                                                                        87
Kompartmentsyndrom i underarm; en retrospektiv studie av pasienter operert
ved Haukeland Universitetssykehus i perioden 2000-2003

Storesund, Anders


Supervisor: Leiv M. Hove, professor dr.med./overlege og Yngvar Krukhaug, kst. overlege
Institutt for kirurgiske fag, UiB/Ortopedisk Klinikk, Haukeland Universitetssykehus



Background; Compartment syndrome in the forearm is a rare and potentially limb
threatening disease. Much is known about its etiology, pathophysiology, symptomatology and
methods of treatment. Less is known about its sequelae. The aim of this retrospective study
has been to illustrate the incidence and different types of sequelae, and see if they were
correlated to any particular cause. We also wanted to define the patients at risk of developing
the syndrome, and which surgical techniques that gave the best subjective cosmetic results.

Materials and methods; In the time period 2000 – 2003 17 patients were treated by
fasciotomy due to the developing compartment syndrome. 11 of these were reexamined, the
median follow up time was 33 months. We examined the muscle strength, the range of
movement and nerve function in both forearms. Any subjective forms of sequelae were
recorded, as well as the patients’ satisfaction with the function and appearance of their
affected forearm. They all answered the DASH-questionnaire.

Results; The muscle strength was significantly reduced in the affected forearm. The range of
movements was decreased in all directions compared to the unaffected forearm. Four patients
showed signs of nerve damage, and seven complained about subjective sequelae. The median
DASH score was 18 (1 – 31). The patients treated with vesselloop-technique were more
satisfied with the cosmetic results than those treated with skin graft.

Interpretation; We found a high number of different sequelae among the patients in this
study. The interpretation of the DASH-questionnaire suggests that they interfere with daily
functioning. There was no obvious correlation between the number, types or severity of
sequelae and time before fasciotomy, nor did we find any correlation to other conditions. We
therefore assume that the sequelae are a result of both the initial trauma and its complications,
and ischemic damage to the forearm.




                                                                                               88
Trimodal behandling med hypertermi, stråle- og kjemoterapi ved primært
inoperabel endetarmskreft og lokalt tilbakefall av endetarmskreft - effekter og
bivirkninger

Storlid, Eline Lundekvam


Supervisor : Baard-Christian Schem, førsteamanuensis
Seksjon for onkologi, Institutt for indremedisin, Haukeland Universitetssykehus



The background for this paper is a pilot study performed at the Department of Oncology at
Haukeland Universitetssykehus from 2000 to 2002 under the leadership of professor Olav
Mella. The study treated 16 patients with the diagnosis primary inoperable rectal carcinoma
and local recurrence of rectal carcinoma with a combination of radiation therapy,
chemotherapy and hyperthermia aimed at the pelvic tumor.

The background material for this paper consists of patient journals, various imaging
diagnostics and patient data registered during the pilot study in addition to relevant literature
about cancer in general and specifically about rectal carcinoma. The method applied has been
a systematic review, presentation and discussion of these data.

The most important results were the verification of a better local tumor control than expected
for this group of patients, that the trimodality treatment was relatively toxic, especially
regarding the acute diarrhea during treatment, and also that a phase-II-study, if any, will
probably give similar good results with a lower treatment intensity , both regarding radiation
and chemotherapy doses.




                                                                                               89
Cryopreservation of human glioma spheroids, maintains essential phenotypic
traits

Sundlisæter, Eirik


Supervisor: Rolf Bjerkvig, professor
Seksjon for anatomi og cellebiologi, Institutt for biomedisin, UiB



Object. Establishing frozen stocks of human glioma spheroids would ease planning and
carrying out experiments related to these tumours’ biology, as in vitro growth gradually
changes the pheno- and genotype of the tumour cells. However, it is crucial that
cryopreservation itself does not alter behaviour of the tumour.
The aim of this study was to assess whether cryopreservation of human glioma spheroids
preserves essential phenotypic traits.

Methods. The spheroids were frozen to -40 °C, stored for 2 weeks at -196 °C, thawed quickly
and cultured for one week. Viability assessment using a two-colour fluorescence assay for
animal cell viability demonstrated that cryopreservation was well tolerated. We also assessed
the invasiveness in vitro with a collagen invasion assay. No significant differences in invasive
properties were seen. Evaluation of in vivo tumour growth and invasion were carried out by
implanting cryopreserved and control spheroids into the brain of nude rats. High-resolution
MRI was used for observation. Cryopreserved spheroids were as tumourigenic as the control
tumour spheroids. Further, immunhistochemical analyses performed on paraffin sections from
these brains showed no significant changes regarding vessel density and/or proliferation of
human glioma cells in the rat brain. The relative expression of genes involved in angiogenesis
and metastasis were demonstrated using a micro-array system.

Conclusions. Cryopreservation is well tolerated by tumour spheroids from human gliomas.
They remain viable in a high degree, and proliferative, invasive and angiogenic properties are
not altered. Consequently, human glioma spheroids maintain essential phenotypic traits after
cryopreservation. This will enable extensive studies on human gliomas. E.g. can experiments
be carried out at different dates, earlier experiments be repeated, and tumours from several
patients can be compared to eliminate inter-individual variation.

Key Words: Gliomas, spheroids, cryopreservation, viability, invasiveness, implantation,
immunhistochemistry.




                                                                                             90
Survey of traumatic brain injury deaths in the Nordic countries 1987-2002

Sundstrøm, Terje


Supervisor: Knut G. Wester, professor dr.med.
Nevrokirurgisk avdeling, Haukeland Universitetssykehus/Institutt for kirurgiske fag, UiB



Background. Severe traumatic brain injury is a major cause of death among young adults in
the Nordic countries. In connection with a common Nordic initiative regarding future
management of severely head-injured patients, it was of interest to disclose the magnitude and
the most recent development of the problem.

Material and methods. We have conducted a survey of the epidemiological aspects of
traumatic brain injury deaths in Denmark, Finland, Norway and Sweden for the period 1987-
2002. This is discussed in the context of statistical data on traffic accidents, accidental falls
and suicides.

Results. There were considerably more deaths from traumatic brain injury in Finland, with an
average annual death rate of 20.9 / 100.000 (1082 / year), about twice those of the other
countries. The corresponding figures were 12.6 / 100.000 (677 / year) for Denmark, 10.4 /
100.000 (470 / year) for Norway and 9.9 / 100.000 (892 / year) for Sweden. The death rate
was about three times higher for males, compared with females. For each country there has
more or less been a decline in head injury deaths.

Interpretation. A modest reduction in traffic casualties in Finland, together with a high
proportion if violent suicides and relatively many accidental falls, may explain the high
number of traumatic brain injury deaths versus the other Nordic countries.




                                                                                                91
Variabilitet av motorisk aktivitet hos pasienter med schizofreni

Thoppil, Suma


Supervisor: Ole Bernt Fasmer, førsteamanuensis
Seksjon for psykiatri, Institutt for klinisk medisin, UiB



Schizophrenia is a clinical syndrome with extensive psychopathology with involves thought,
perception, emotion, movement and behaviour. Genetical factors, gestational and birth
complications, Rhesus incompatibility, influenza epidemics, starvation, winter births and
substance abuse are some known risk factors.

Different neurobiological disturbances cause a wide variety of positive and negative
symptoms in schizophrenia.
CT and MRI studies have shown a smaller brain volume, more CSF and enlarged ventricles in
these patients. They also have abnormalities in several neurotransmitter systems which could
explain positive and negative psychotic symptoms.

Motor dysfunction is associated with schizophrenia and longitudinal studies indicate that it
precedes the onset of clinical symptoms. Schizophrenic patients often have a history of
delayed motor development and movement abnormalities during the two first years when
compared to their healthy siblings and patients with affective disorders. Many patients have a
quantitative change in their activity levels. This is most commonly manifested as reduction in
energy, initiative and spontaneity. In acute stages patients may become excited and show
increased activity but usually only in the early phases of the illness.

Project description
In this project we have studied patterns of motor activity, measured by actigraphs, in
schizophrenic patients and compared with controls. We chose to include only patients who
are in a stable phase of their illness. All of them were medicated with different neuroleptics.

Background: Alterations in locomotor-activity levels and disturbances in rest-activity
rhythms are cardinal signs of several psychiatric disorders. Actiwatches are mechanical
activity monitors worn like a wrist watch and they record activity throughout the day.
Quantifications of overall levels of activity during the day or night can detect hyperactivity,
agitation or psychomotor retardation.

Hypothesis: Schizophrenic patients have altered locomotor-activity levels when compared
with controls.

Methods: The patients in this study are in-patients or out-patients at different psychiatric
institutions in Bergen. The controls were patients from general practice, without serious
somatic and psychiatric illness, medical students and employees at the nursing home.
Age: 18 – 50 years.
Inclusion criteria: Fulfilled diagnostic criteria for schizophrenia according to DSM-IV.




                                                                                                  92
Exclusion criteria: 1) Severe mental retardation 2) Patients who does not speak Norwegian
well enough to give adequate answers without a translator 3) Substance abuse 4) Serious
somatic illness.
Diagnosis: SCID-interview and DSM-IV diagnostic criteria were used.
Actigraph recording: Motor activity was recorded using wrist-worn adtigraphs for periods of
2 weeks. Average activity, one minute epochs, were calculated. The total activity was
divided into one hour intervals to study the variations in activity. Both standard deviation and
root mean square successive differences were calculated.
Statistics: SPSS version 11.0 was used in the calculations. The groups were compared using
t-tests. Significant differences were defined as p<0.05.

Results and conclusion:
Schizophrenic patients have a lower motor activity when compared to controls. This includes
both total activity for a whole day and activity during night. Variations in motor activity per
hour, calculated by standard deviation and root mean square successive differences were not
significantly different between the patients and controls.




                                                                                             93
Trampolineskader i Bergen

Thorsen, Kenneth


Supervisor: Christina Brudvik, førsteamanuensis
Institutt for kirurgiske fag, UiB



We wanted to register and describe trampoline injuries in Bergen in order to relevant
preventive advice, based on our findings.

Materiale and Method: We did a prospective injury registration through questionnaires that
patients answered at the time of injury and supplemented data acquired from patients journals
by retrospective analysis. The data was aquired at Bergen emergency department during the
year 2001 and 2002.

Results: 188 injuries were registered over this period of two years, the number of injuries
increased from 83 in 2001 to 105 the following year. Median age was 10, ranging from 2 to
52 years old, and 91 % were younger than 15. 55 % were girls.
Injuries to an extremity predominated; 49,5 % in the lower extremity and 43,6% in the upper
extremity. We registered 100 fractures, 67 in the upper extremity and 32 in the lower
extremity. The most serious of these were six supracondylar fractures to the humerus, one of
these affected the radial artery in a 9 year old girl. Further we counted 19 radius and ulna
fractures, 8 tibial bone fractures and 14 ankle fractures. 26 fractures needed reduction
treatment and 10 of these were admitted for orthopaedic surgery.
 Fractures (n=40) and strains/sprains (n=39) were equally frequent among those older than 10.
Among those aged 10 and younger, fractures (n=59) predominated over sprains/strains
(n=32). The number of fractures were the same in boys and girls. We found an inverse
relationship between age and severity of injury (AIS). The youngest age group- below 10,
constituted two thirds of those with serious injuries (AIS 3). Reduction treatment of fractures
was needed in 16 females and 10 males. 7 of the females and 3 of the males were admitted to
hospital.
47 sustained an injury falling off the trampoline, 127 got injured on the trampolinemat and 14
from climbing on or off, or colliding with the trampoline. The mechanism of injury was often
a fall (n=59), loss of balance at the time of landing on the mat (n=55), fall due to a push from
another person (n=39) and combined injury mechanisms in the remaining (n=35).
Conclusion: Contrary to other large studies of trampoline injuries, we found no spinal injuries
in our registration. We found a relatively high percentage of serious fracture injuries (16%),
especially among children aged 10 and younger. There is no doubt that trampolines are
devices that need to be used with carefulness and according to special recommendations.




                                                                                             94
Bioreduktive Cytostatica

Tjessem, Marius


Supervisor: Olav Dahl, professor
Seksjon for onkologi, Institutt for indremedisin, UiB



Tumor hypoxia has for a long time been a therapeutic problem: The cells located in the
hypoxic areas are the most resistant towards radiation and cytostatica. Tumor hypoxia is per
definition a result of insufficient oxygenation in the tumor tissue that can result from many
factors: Inadequate angiogenesis, diffusion distance too long or anemia. Traditional treatment
has aimed at enhancing the oxygenation in tumor by increasing the oxygenation of the blood.
Lately, several new chemical compounds have been developed in order to take advantage of
the hypoxia. These compounds are called bioreductive drugs and are given to patients in the
form of a prodrug. When such prodrugs enter the hypoxic areas in tumors, they will be
activated due to low oxygen tension in the tissue by a reduction reaction. This approach has
the advantage that low oxygen tension seldom exists in other areas than the tumor, and the
fact that the active substance therefore will have little or no effect on the surrounding normal
tissue.

Chemical compounds based on this principle include tirapazamine, mitomycin C,
nitroimidazole, misonidazole and etanidazole. The chemical compound that today has the
greatest potential according to the present literature study, is tirapazamine. This compound is
currently involved in clinical studies where it is combined with other treatment modalities like
radiation, cytostatica and hypertermi.




                                                                                             95
Hjerneforandringer ved dysleksi
- Litteraturstudie og utprøving av metodar for segmentering av hjernesubstans
basert på strukturell MRI

Tryti, Jan Ove


Supervisor: Einar Heiervang, dr.med.
Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB),
Department of Clinical Neurology, John Radcliffe Hospital, Oxford University



Dyslexia is defined as specific reading disorder and might be the most common neurological
condition affecting children. Dyslexia persists into adulthood, boys seem most affected and
there is a strong genetic component. The condition is most likely caused by a lacking ability
for phonological decoding in reading. Functional and structural neurobiological methods have
shown temporoparietal cortex deviations in children with dyslexia.

The basis for this paper is a material of structural MR-images obtained from children with
dyslexia and normal controls, used for testing two methods of voxel-based morphometric
analysis (VBM) at the Oxford Centre for Functional Magnetic Imaging of the Brain (FMRIB).
VBM is used for detecting structural differences in brain matter, in our case grey matter,
between groups of individuals. FMRIB´s own method, FMRIB`s Software Library (FSL), is
an automated computer program equipped for extracting brain tissue from MR-images and
segmenting the brain tissue into grey and white matter and cerebrospinal fluid (CSF). The
other method, Statistical Parametric Mapping (SPM), is developed at the Wellcome
Department of Cognitive Neurology in London. The main difference between these two
methods is that SPM utilizes standardized templates correcting differences in size and shape
of MR-images, which is called normalization. The main argument against such spatial
normalization is that genuine structural differences between groups studied may remain
undiscovered because they disappear in the normalization step. Further on in the analyses it is
important that the segmentation correctly identifies grey and white matter, which requires
good contrast between the different tissue types. This turned out to be a big problem when
testing FSL on the dyslexia-material because much of the grey matter was wrongly classified
as white matter. FSL might give the most truthful result since it does not use standardized
templates for normalization. This was just what turned out to be the problem in segmentation
because of great misclassification.




                                                                                            96
Internettbefolkningens bruk av helsetilbud på Internett

Tveiten, Øystein Vesterli
Vavik, Vegard


Supervisors: Tone Smith-Sivertsen, førsteamanuensis og
Atle Klovning, førsteamanuensis
Seklsjon for allmennmedisin, Institutt for samfunnsmedisinske fag, UiB



Objective:
To examine to which degree users of health information on the Internet choose to use Internet
resources instead of seeing a doctor, and why.

Design and setting:
An Internet questionnaire was made available for users of the health web pages mozon.no,
lommelegen.no and aftenposten.no through fall 2003 and spring 2004.

Participants:
A total of 409 people responded (61% women and 39% men) with age 15-78 years, average
age 31 years. Male participants were somewhat older (average 34 years) than women (average
29 years). About half had more education than «videregående skole» (high school). 3 out of 4
considered their own health to be good or very good. Most used Internet from home or at
work.

Results:
The respondents found most trust in information from a doctor. In a comparison between
different sources of health information, «my doctor» was ranked most trustworthy and
«Internet» ranked least trustworthy.

Anyhow, 37 % (44 % of the women, 26 % of the men) stated that they had used the Internet
as a source of information instead of seeing a doctor. These respondents also agreed that the
Internet was either reliable or very reliable as a source of health information.

93 % of the respondents that had used Internet instead of seeing a doctor agreed that an
important reason for this was that Internet gave quicker answers to their health questions.

Use of health information on the Internet can also cause a doctor’s consultation; 25 % (31 %
of the women, 17 % of the men) stated that they had seen their doctor after having found
information on the Internet.

Conclusion:
One of three potential patients had used the Internet instead of seeing their doctor. The most
important reason seems to be that Internet gave quicker answers to their questions.




                                                                                              97
Voluntary HIV counseling and testing in Kgatleng District, Botswana.

Ugelvik, Kristina Stølen


Supervisor: Knut Fylkesnes, professor
Senter for internasjonal helse, UiB



Objectives: Examine some of the factors that contribute to the low HIV related VCT
readiness in Kgatleng District, Botswana.

Methods: I spent my elective period in Botswana from January- March 2001. I was
cooperating with health care personnel in Kgatleng District. This was a part of a health
agreement between the University of Bergen and the Republic of Botswana. During 26.201-
7.03.01, 28 health care workers in Kgatleng District responded to a questionnaire concerning
VCT and worries of own risk of being infected by HIV. Own observations, information from
briefings and discussion with health care workers in Kgatleng District and other literature
were also used.

Results: Improvements can be made both concerning HIV counseling service and HIV testing
facilities in Kgatleng District according to health personnel working there. They believed that
VCT has a preventative effect and that people should be more encouraged to use the VCT
services. They stated that the stigma attached to HIV and fear of social rejection were
important reasons for low VCT acceptance, together with lack of any medical treatment to
offer the HIV positive. Some also mentioned that people might distrust health care workers
confidentiality. Health personnel in Kgatleng District worried a lot about getting HIV infected
themselves, and only 32% of the nurses and FEW knew their own HIV status. About 93% of
them felt that the risk of contracting HIV at the workplace was high or very high.

Conclusion: The health care workers believed in the preventative effect of VCT. However the
majority responded not to know their own HIV status, despite the feeling of being at very high
risk of contracting HIV at the workplace. There is a clear need for educational efforts trying
to: 1.reduce unnecessary worries for being HIV infected at the workplace 2.improve the
acceptability of HIV related VCT.




                                                                                            98
Metabotrope glutamatreceptorer og plastisitet i spinale nociceptive systemer

Valle, Nils Kristian


Supervisors: Lars Jørgen Rygh, postdoc dr.med. og Arne Tjølsen, professor
Seksjon for fysiologi, Institutt for biomedisin, UiB



A noncomprehensive review of current concepts of nociception, and the pathways from
physiological pain to chronic pain, focusing on mechanisms controlled or influenced by
metobotropic glutamate receptors in the spinal cord. The anatomical underpinnings of
nociceptive processing is briefly described, as are various theories on the encoding of this
information. Lasting and dynamic changes of synaptic efficiency is regarded as the basis of
transformation of the nociceptive sensory ability into a state of chronic pain, and thus the
biomolecular foundation of synaptic plasticity is to some extent described. Synaptic
efficiency is regulated by intracellular signalling pathways pre- and postsynaptically.
Metabotropic glutamate receptors are key participants in regulating these processes, both in
inflammatory and neuropathic pain states, and as such constitute a potential target for
pharmacological intervention.




                                                                                               99
Chorioamnionitis: Persistent cognitive impairment in low birth weight
children

Versland, Lene Brose


Supervisor: Kristian Sommerfelt, førsteamanuensis dr.med.
Seksjon for pediatri, Institutt for klinisk medisin, UiB



Objective: To examine whether chorioamnionitis (CA) is associated with long
term cognitive impairment in low birth weight (LBW) children without major
handicaps such as cerebral palsy.

Design/study groups: A population based long-term follow-up study at 11 years of age of
130 LBW children with birth weight less than 2000 g, without major handicaps. Fifteen
children with maternal signs of clinical CA were compared with the other 115 LBW children.

Main outcome measures: Psychometric intelligence, assessed using four subscales from the
Norwegian version of Wechsler Intelligence Scale for Children – Revised.

Results: Mean performance IQ for the LBW children with maternal signs of CA
(90, SD 15) was significantly lower compared to the other LBW children (98, SD 16) at 11
years of age (difference of mean 9, 95% CI of diff. 0.2 to 17,
p=0.04).

Conclusion: Maternal chorioamnionitis, known to be associated with an increased frequency
of cerebral palsy, may have lasting negative consequences for the fetal brain development,
resulting in long term cognitive impairments, even when major handicaps such as cerebral
palsy is absent.




                                                                                       100
cAMP dependent protein kinase and its role in human disease

Viste, Kristin


Supervisors: Anne Christensen, dr.med. og Stein Ove Døskeland, professor dr.med.
Seksjon for anatomi og cellebiologi, Institutt for Biomedisin, UiB



The cAMP dependent protein kinase (PKA) is one of the phylogenetically oldest and best
characterised protein kinases. It has two main subtypes, type I and II, both ubiquitously
expressed. PKA is an important regulator of a wide range of cellular processes, such as
metabolism apoptosis, neuronal signalling and cell differentiation. It was long believed that
change in the balance between the subtypes would alter important functions in the organism,
as it was quite early noticed that cancer cells expressed different levels of the two subtypes as
compared to normal cells. When knockout mice for the regulatory and catalytic subunits of
PKA were studied, it was quite surprising that the changes in phenotypes were over all mild.
In 2000 the first hereditary disease associated with one of the genes of PKA was discovered,
named the Carney Complex, which is a multiple endocrine neoplasia syndrome. This is not all
surprising as PKA is an important mediator of several peptide hormones. As the kinase is
important for regulation of immune function, a hunt for diseases of the immune system was
also launched, and rewarded with the discovery that the defect regulation of Systemic Lupus
Erythematosus T-cells is associated with changes in the regulation of the cAMP dependent
protein kinase pathway.




                                                                                             101
Noen emner til faget biokjemi II

Welde, Carl Martin


Supervisor: Eirik Søfteland, førsteamanuensis
Seksjon for biokjemi og molekylærbiologi, Institutt for biomedisin, UiB



For many years professor Flatmark`s collection of notes were used as prescribed biochemical
texts for medical students of the University of Bergen. A new modern textbook has now been
chosen, Will`s Biochemical basis of medicine. In order to keep traditional elements in the
syllabus, a small collection of supplements has been made. This text is a short introduction to
biological membranes, haemoglobin, plasma proteins and fat metabolism. It is the authors
project work as a part of his medical degree.




                                                                                            102
Prognostiske faktorer ved ductalt adenocarcinom i pankreas.

Zahl, Gro Flesjå


Supervisor: Anders Molven, professor dr.scient.
Seksjon for patologi, Gades institutt, UiB



Pancreatic cancer is the 13th most frequent type of cancer in Norway, yet it is the 5th most
common cause of cancer-related death. Hence, its mortality is high. In Norway about 600
patients are diagnosed with pancreatic ductal adenocarcinoma each year, the majority being
above the age of 60. Five-year survival rate for these patients is less than 5 %, and about half
of them die within six months after the time of diagnosis. So far, the only curative possibility
is radical removal of the tumor, but this is an option in less than 20 % of the cases.
In this project work, I have studied the prognostic factors related to pancreatic ductal
adenocarcinoma. A prognostic factor is defined as a measurement that gives information
about the prognosis of a patient with a certain disease. A prognostic factor must be significant,
individual and of clinical importance.

Several prognostic factors related to pancreatic ductal adenocarcinoma have been identified.
The two most important clinically are tumor’s TNM-staging at the time of diagnosis and the
absence of tumor tissue after surgical resection. Prognostic factors that describe the tumor
itself, such as its histological grade (differentiation), aneuploidy and mutations, are still of
little clinical importance. Hopefully, the knowledge we obtain regarding prognostic factors
can be used not only to evaluate the patient’s life prospects, but also as a tool to improve the
patient’s prognosis




                                                                                              103
Gatebarn og barneheimsbarn i Sør-Amerika – ein studie av to barneheimar i
Cochabamba, Bolivia

Øpstad, Åsmund


Supervisor: Gunnar Kvåle, professor
Senter for internasjonal helse, UiB



Background: Bolivia is a country where six of ten live in extreme poverty. There is a large
number of children who are not being cared for, and many children live and work on the
street. One way to tackle this problem is to place these children in orphanages or day nursery.
The Salvation Army in Bolivia runs two orphanages in Cochabamba. There are different
causes why the children come to the orphanages. The question if it is possible tohelp the
children in another way without institutionalise them is an important issue to be discussed.

Material and methods: I did a study of literature relating to lack of care and separation
reactions in children, and a study of the journals of the 84 children in the two orphanages
Oscar Ahlm and Catalina Booth. In the period from November 2000 to February 2001 I
worked as a volunteer at Oscar Ahlm. I interviewed some of the children and the employees,
did a questionnaire study among the children, and observed their behaviour and prosperity by
participating in the daily activities.

Results: 19 out of 84 children had parents living together. The children come from poor
families. Their parents have low-income occupations. 50% of the boys used to live in homes
of 1-2 small rooms, the same number the the girls were 21%. 72% of the boys had poor
clothes, for the girls 37%. 13% of the children come from families with bad relations. The
reason why the children are institutionalised is that they are mismanaged at home because of
poor socio-economic circumstances. A few have been maltreated physically or psychical.
The boys at Oscar Ahlm tell in interviews and in the questionnaire that they were generally
satisfied in the orphanage, but that they miss their parents.

Conclusion: The children were generally satisfied living in the orphanages, and they
experience a more stable adolescence by going to school and having covered their material
needs. One should aim at getting the children grouped in smaller units of 10-15 children with
1-2 adults more or less living with them permanently. In this way the children can get more
continuity in their adolescence.




                                                                                           104
Acupuncture and Dry Eye Syndrome. A pilot study.

Aamaas, Jon


Supervisor: Gunnar Høvding, professor
Seksjon for oftalmologi, Institutt for klinisk medisin, UiB

In collaboration with Five Branches Institute, Santa Cruz, California



Aim: To examine if acupuncture, needled on acupoints according to Traditional Chinese
Medicine, can help people suffering from Dry Eye Disease, diagnosed according to western
medicine, to objectively increase their tear production and/or reduce their subjective
symptoms.
To clarify what Dry Eye Syndrome of Keratoconjunctivitis Sicca is. To review the treatment
methods to date, and discusses the value of these methods. To give an overview of
acupuncture, its history, proposed functional mechanism and clinical application.

Methods: A prospective, randomized, double-blind study was conducted at the Five
Branches Institute, SC, California. Approximately 100 people, (1) who answered in a way
that suggested dry eye syndrome, were called in for a (2) screening examination, where a
bilateral Schirmer test without anaesthesia (Schirmer I) was done. Subjects with an unilateral
score below 15 mm were accepted as potentials. The final patient material consisted of 37
people, 36 females and one male. The age span was between 16 and 80 years, with a mean
age of 58. The patients were randomly assigned to an acupuncture treatment group (Group 1 :
n=18) or a control group (Group 2 : n=17). The acupuncture treatment group was needled on
UB1, GB1, GB20, GB37, TB23 bilaterally, while the placebo group was needled on non-
active points plus points not associated with treatment of dry eye disease. The acupuncture
treatments were given in three sessions with a time span of one week between each. To test
for efficacy or non-efficacy of the treatments, tear production was measured using the
Schirmer I test and the Red Thread Phenol Test before and after each treatment, and at one
week after the last treatment. The patients were asked for symptom improvement one week
and one month after the last acupuncture treatment. The patients were asked for symptom
improvement one week and one month after the last acupuncture treatment. Comparison
between the results obtained by the Schirmer I test and the phenol thread test before the first
acupuncture and one week after the last acupuncture in each test group were made by the
Wilcoxons signed ranks test. The Mann-Whitney test was used to examine the possible
difference between the two test groups before the first acupuncture as well as one week after
the final acupuncture session. The Fisher exact test was employed to compare the subjective
effect of acupuncture obtained in the two study groups. The level of statistical significance
used was <0,05.

Results: When comparing the effect of treatment oriented acupuncture with the original
values, a statistical significant improvement was found. (Phenol p=0,0059, Schirmer
p=0,0277). When comparing the treatment oriented acupuncture with the placebo
acupuncture, no significant improvement was found.
Compared with the results recorded before the first acupuncture session, a statistical
significant increase of the phenol red thread test was found in group 1 one week after the last


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acupuncture (P=0,0059). In group 2 the difference between the results found before the first
acupuncture and at the final examination did not quite reach statistical significance
(p=0,0734). The final Schirmer I measurements in both group 1 and group 2 were
significantly increased compared to the results recorded before the first acupuncture
(p=0,0277 and p=0,0109, respectively). When the tear fluid measurements obtained shortly
before and after each acupuncture session were compared, none of the differences recorded in
group 1 were statistical significant. In group 2, a statistical significant decrease were noted
after the second and third session (p=0,0046 and p=0,0109, respectively).

Conclusion: When comparing the effect of treatment oriented acupuncture with the original
values, a statistical significant improvement was found. (Åhenol p=0,0059, Schirmer
p=0277). When comparing the effects of treatment oriented acupuncture and sham
acupuncture a difference was noted in favour of treatment oriented acupuncture, but the
difference was not statistically significant. It is therefore not possible to conclude that
acupuncture is a useful treatment for Dry Eye Syndrome, either as monotherapy or as
adjuvant therapy, beyond the placebo effect. The significant improvement compared with the
original values should be noted. Two former symptom improvement. A larger population
study is therefore needed.




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