Robert Bjerknes

Nordic consensus on treatment of undescended testes

Aim: To reach consensus among specialists from the Nordic countries on the present state‐of‐the‐art in treatment of undescended testicles.

Cryptorchidism: classification, prevalence and long-term consequences

Undescended testis is a common finding in boys, and the majority of cases have no discernible aetiology. There are unexplained geographical differences and temporal trends in its prevalence. Cryptorchidism, especially bilateral, is associated with impaired spermatogenesis and endocrine function and increases the risk of testicular cancer. There is an urgent need to identify factors that adversely affect testicular development and optimize treatment.

Microbial colonization of large wounds

This study determines the nature of microbial wound colonization in 28 patients with large burns admitted to the Burn Centre, Haukeland University Hospital, Bergen. Altogether, 748 swabs were taken in 141 sampling procedures. A total of 414 microbial isolates were detected and their resistance patterns to a variety of systemic antimicrobial agents determined. The most frequent isolates were coagulase-negative staphylococci (21.5 per cent) and Staphylococcus aureus (14 per cent), followed by Enterococcus species (11.3 per cent), Pseudomonas aeruginosa (10.9 per cent) and Candida species (9.7 per cent). Forty-one per cent of the enterococci and 36 per cent of the coagulase-negative staphylococci were resistant to the aminoglycosides routinely given in conjunction with surgery in our ward. Only four of the 89 strains of coagulase-negative staphylococci were insensitive to methicillin, and no Staph. aureus were methicillin resistant. The time-related changes of burn wound colonization showed that on admission and during the first week, staphylococci and alpha-haemolytic streptococci were dominant. During the next weeks, these bacteria were gradually superceded by enterococci, gram-negative opportunists (mainly Pseud. aeruginosa, Acinetobacter calcoaceticus and Escherichia coli) and Candida species. The nature of microbial wound colonization and how the flora changes with time should be taken into consideration by those treating thermally injured patients.

Overweight and obesity in Norwegian children: prevalence and socio-demographic risk factors

Aim:  The aim of this study was to estimate the prevalence of childhood overweight and obesity and to identify socio‐demographic risk factors in Norwegian children.

Exome sequencing reveals FAM20c mutations associated with fibroblast growth factor 23–related hypophosphatemia, dental anomalies, and ectopic calcification

Fibroblast growth factor 23 (FGF23) plays a crucial role in renal phosphate regulation, exemplified by the causal role of PHEX and DMP1 mutations in X‐linked hypophosphatemic rickets and autosomal recessive rickets type 1, respectively. Using whole exome sequencing we identified compound heterozygous mutations in family with sequence similarity 20, member C (FAM20C) in two siblings referred for hypophosphatemia and severe dental demineralization disease. FAM20C mutations were not found in other undiagnosed probands of a national Norwegian population of familial hypophosphatemia. Our results demonstrate that mutations in FAM20C provide a putative new mechanism in human subjects leading to dysregulated FGF23 levels, hypophosphatemia, hyperphosphaturia, dental anomalies, intracerebral calcifications and osteosclerosis of the long bones in the absence of rickets.

Concentrations of cytokines in plasma of patients with large burns: their relation to time after injury, burn size, inflammatory variables, infection, and outcome

OBJECTIVE To monitor longitudinally the concentrations of cytokines in the plasma of patients with severe burns. DESIGN Prospective open study. SETTING Burns unit, university hospital, Norway. SUBJECTS 27 patients (5 women and 22 men, mean age 37 (range 13-82) years). INTERVENTIONS Measurement of plasma concentrations of interleukin-1beta(IL-1beta), interleukin-1 receptor antagonist (IL-1ra), interferon-7(IFN-gamma) and tumour necrosis factor-alpha (TNF-alpha) were measured by enzyme linked immunosorbent assays (ELISA). MAIN OUTCOME MEASURES Changes in concentrations, and correlation with morbidity and mortality. RESULTS The concentration of IL-1beta and IL-1ra were increased in all patients and highest at the time of admission. Initially there was little or no circulating IFN-gamma, but this increased from day 5-10 in all patients. Only 8/15 patients had transient increases in circulating TNF-alpha. Concentrations of IL-1ra correlated with total burn surface area (TBSA) and area of third degree burn, as well as with plasma concentrations of C - reactive protein (CRP). Concentrations of IL-1beta and IL-1ra were higher in patients who developed infective complications than in those who did not (interleukin-8 (IL-8) has previously been shown to follow this pattern as well). Patients who survived had significantly higher IL-1beta concentrations than those who died (13(1) compared with 3 (1) pg/ml, p = 0.005) CONCLUSION There are significant time-dependent changes in plasma concentrations of IL-1beta, IL-1ra, IFN-gamma and TNF-alpha after serious burns. IL-1ra concentrations may be influenced by size of the burn and the acute phase response; IL-1beta, IL-1ra and IL-8 may have a role in the hosts response to infection; and IL-1beta may influence outcome.

Growth of Belgian and Norwegian children compared to the WHO growth standards: prevalence below −2 and above +2 SD and the effect of breastfeeding

Background New national growth references have been published in Belgium and Norway. The WHO recommends universal use of their 2006 Child Growth Standards based on data from breastfed children. Objective To compare the growth of Belgian and Norwegian children with the WHO standards. Participants 6985 children 0–5 years of age from Belgium and Norway. Design Proportion of children below −2 SD and above +2 SD of the WHO standards was calculated for length/height, weight, body mass index and head circumference. Average SD scores of exclusively breastfed children of non-smoking mothers were compared with national reference data and with the WHO standards. Results Generally, the number of Belgian and Norwegian children below −2 SD lines of the WHO standards was lower and above +2 SD higher than expected. The largest differences were for head circumference (0.97% Belgian and 0.18% Norwegian children below −2 SD, 6.55% Belgian and 6.40% Norwegian children above +2 SD) and the smallest for length/height (1.25% Belgian and 1.43% Norwegian children below −2 SD, 3.47% Belgian and 2.81% Norwegian children above +2 SD). The growth pattern of breastfed children of non-smoking mothers was in both countries more alike the local national growth references than the WHO standards. Conclusions There are significant deviations in the proportion of children outside normal limits (±2 SD) of the WHO standards. This was true for all children, including those who were exclusively breastfed. Hence, adoption of the WHO growth charts could have consequences for clinical decision-making. These findings advocate the use of national references in Belgium and Norway, also for breastfed children.

Growth references for Norwegian children

BACKGROUND The growth charts currently used in Norway, are based on measurements from the 1970s and 80s. New data are available from the Bergen Growth Study collected in 2003 - 6. In 2006, WHO published international charts for 0-5 year-old children. MATERIAL AND METHODS New growth charts based on data from the Bergen Growth Study and the Medical Birth Registry of Norway are presented for children aged 0-19 years. These were compared with existing references and with the WHO curves. RESULTS Norwegian children aged 0-4 years have length, height and weight measurements that are only marginally different from those in the Norwegian growth charts in current use. In older children there has been an increase in the 50-percentile for height up to 3.4 cm in boys and 2.5 cm in girls. For children older than four years, weight for height has increased, especially for the upper percentiles. The percentile lines in the new Norwegian reference are generally positioned above the WHO standard for weight at birth, and for length/height, weight and head circumference in the age group 6 months to 5 years. INTERPRETATION The secular trends in growth mirror the need for new charts. The fact that Norwegian children differ from the WHO standards may reflect population differences relating to environment or growth potential between the populations.

Overweight and obesity in Norwegian children: Secular trends in weight‐for‐height and skinfolds

Aim: The prevalence of overweight and obesity in paediatric populations has been rapidly increasing in many countries over the past decades. The aims of the present study were to provide new data on weight‐for‐height and skinfolds, and to compare these to growth references for children between 3 and 17 years, collected in the same city between 1971 and 1974.

Phagocyte C3-mediated attachment and internalization: Flow cytometric studies using a fluorescence quenching technique

SummaryThe dynamics of phagocyte C3-mediated attachment and internalization of fluorescein-isothiocyanate (FITC)-labelled zymosan particles was studied by a flow cytometric (FCM) fluorescence quenching technique, using trypan blue as quenching agent. Trypan blue effectively quenched the fluorescence of extracellular, i.e. free and phagocyte-attached, zymosan particles, but did not influence on the fluorescence of particles internalized by phagocytes. During phagocytosis, an average of 2 C3-coated zymosan particles were simultaneously attached to the phagocyte surface, and the number of attached particles could not be increased by increasing the zymosan to leukocyte ratio, the concentration of C3, the incubation time, or by inhibiting internalization by Cytochalasin B. Phagocyte C3-mediated internalization of zymosan particles was dependent on the concentration of complement, and in the presence of sufficient amounts of C3, internalization continued until saturation was reached at 11 particles per phagocyte.