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Introduction: In Denmark, as in other countries, there is an increasing focus on evidence-based medicine (EBM) as a necessary tool for using modern sources of information, but until now EBM training has not been incorporated in our undergraduate curriculum., Material and Methods: This course is given in the ninth semester (out of 13) and the subject matter is clinical biochemistry. The course consists of seven (one-hour) lectures over three weeks. First, the EBM method is introduced, then the students split up into small groups, choose their own diagnostic problem, and carry out a structured search. The search leads to the choice of a scientific article, which is subsequently presented to and discussed by all the students. We asked about their opinion of the course by questionnaire., Results: The answers to the questionnaire confirmed that the students have improved their ability to read and assess scientific articles and to seek information, and it has stimulated them to understand concepts instead of memorising details., Discussion: Although the assessment of this course was positive, it can no doubt be improved and further developed. In our opinion the use of EBM should not be confined to one course. The medical students should be introduced to EBM at an early stage, thereby abling them to practice it throughout their training.

Seventy-nine patients admitted to Frederiksberg Hospital had peripheral intravenous catheters inserted to aid treatment. We followed the patients in order to determine the frequency of phlebitis, and to isolate mechanical and chemical parameters that increase the risk of phlebitis. The frequency of phlebitis was 27.8%. We found that 35.8% of all complications evolve when the catheter has been inserted for more than 72 hours, and that 45.5% of patients treated with antibiotics develop phlebitis. Furthermore, it seems that acetyl salicylic acid reduces the number of cases with phlebitis. Catheters inserted around the wrist have a higher frequency of phlebitis. Changing the catheters every 72 hours significantly reduces the frequency of phlebitis by 40%. The risk of developing a septic condition due to catheter-induced phlebitis seems small because we suggest that phlebitis is an inflammatory reaction to the plastic-catheter, and not infectious.

Endoscopic extraction of calculi in the common bile duct has been the treatment of choice for many years. According to international standards a stone-free common bile duct should be achieved in at least 90% of the patients and with an overall complication rate below 20%. We reviewed records of 416 patients who underwent ERC for common bile duct stones between January 1990 and January 1995. The overall success rate of achieving a common bile duct free of stones was 89.0%, and in 94.7% of the patients endoscopic treatment was definitive. The overall complication rate was 9.6% and the 30-day mortality rate was 2.2%. Our study showed that with a medical staff of four to six persons (of which two were trainees), approximately 450 ERCP-examinations per year and with a catchment area of half a million inhabitants (Funen County), it was possible to achieve acceptable results.

In a controlled randomised trial we analysed whether the use of the term "smoker's lung" (Danish: "rygerlunger") instead of chronic bronchitis when talking to patients with chronic obstructive lung disease (COLD) changed their smoking habits. Fifty-six smoking patients with COLD were allocated to either intervention (n = 25) or control groups (n = 31). In the intervention group the lung disease was designated smoker's lung in all communication with patients about their illness and in the control group traditional terminology was used. All patients were given the same medical treatment and the same encouragement to stop smoking. One week after discharge 57% had stopped smoking in the smoker's lung group vs 26% in the control group (p = 0.028), at three months 50% vs 19% (p = 0.027) and at one year 40% vs 20% (p = 0.148). Referring directly to the cause of a self-inflicted illness may be an effective way of discouraging risk behaviour, at negligible cost.

Hereditary motor and sensory neuropathy (HMSN) comprises a heterogenous group of peripheral neuropathies which are classified on the basis of symptoms, mode of inheritance and electrophysiological and neuropathological investigations. HMSN type I, or Charcot-Marie-Tooth disease (CMT) type 1, is a hypertrophic and demyelinating neuropathy with reduced nerve conduction velocity, and most often with dominant inheritance. HMSN type II (CMT type 2), the neuronal or axonal form, is dominantly inherited with normal or only moderately reduced nerve conduction velocity. HMSN type III, also called Déjérine-Sottas disease, is a hypertrophic neuropathy with markedly reduced nerve conduction velocity. HMSN type I is genetically heterogenous with at least four autosomal loci and at least two X-linked loci. The most frequent form, HMSN type Ia, is associated with a specific duplication on chromosome 17, which can be detected by DNA-analysis. The genes for HMSN type Ia, Ib and an X-linked dominant form have been identified as PMP22, MPZ and GJB1 respectively. Analysis for these molecular defects will become important in the differential diagnosis of peripheral neuropathies and will surely prove invaluable in the genetic counselling of the families.

Molecular analysis of structural chromosomal abnormalities, involving the sex chromosomes, has provided us new knowledge concerning sex determination in humans. This has raised three hypotheses of sexual differentiation, which will be discussed even though none of these can explain all abnormalities involved. Meiotic recombination which normally takes place during the male meiotic cell division, can give rise to sex reversal syndromes such as XX male and XY female, if crossing over is abnormal. Analysis of these abnormalities has made it possible to map sex determining regions on chromosome Y, and to construct a deletion map. Methods using DNA probes, are capable of identifying Y-specific sequences in persons with sex reversal. This means a more optimal counselling, possibilities of prenatal diagnosis, and opportunities for selecting patients with risk of gonad cancers, for extirpation.

This article describes a case of 46,XX male, the most frequent form of sex reversal syndromes in humans. A method of identifying Y chromosome material in these and other patients with structural chromosomal abnormalities involving chromosome Y is given. Chromosomes from a phenotypically normal male child without any congenital malformation, where prenatal diagnosis revealed the female karyotype 46,XX, were analysed using fluorescence in situ hybridisation (FISH). The analysis revealed an X chromosome, containing Y chromosome sequences on the tip of the short arm. The sequences are not normally visible in conventional cytogenetic analyses of XX males. The breakpoint on Y was determined to be in the region of Yp11.2, which is proximal for the putative sex determining gene on Y. The results are consistent with theories of abnormal crossing-over during the paternal meiotic cell division where meiotic recombination can give rise to structural abnormalities, which can then cause sex reversal syndromes. Prenatal diagnosis of structural sex chromosome abnormalities has become available using the FISH method.

On account of an increase in the frequency of amniotic fluid samples (AFS), the need for further decentralisation of sampling developed. Viborg Amt (Viborg County) was able to offer this service to all pregnant women in the county after 01.VIII.1985 who fulfil the indication for prenatal diagnosis (PD). Among 902 registered AFS divided over a period of two years before and two years after the decentralisation there was no significant deterioration of the service measured by the number of spontaneous abortions and unsuccessful AFS. The indications for prenatal diagnosis altered in such a way that the unofficial indication of anxiety rose significantly while the indication of maternal age greater than or equal to 35 years decreased. Furthermore, a positive correlation was registered between a reduction of distance from the pregnant woman to the centre of sampling and the percentage of referrals made by the local practitioner. The paper also shows that more pregnant women, referred for AFS on account of advanced age, accepted PD than was registered in an earlier research, but this pattern declined in the research period.