Laeknabladid最新文献

Hereditary cystatin C amyloid angiopathy (HCCAA) is a dominantly inherited disease caused by a mutation (L68Q) in the cystatin C gene, CST3. Mutant cystatin C protein accumulates as amyloid in arterioles in the brain leading to repeated brain hemorrhages and death of young carriers. Recently a possible treatment option was reported for HCCAA carriers involving an oral treatment with N-acetyl-cysteine in order to increase glutathione which was found to dissolve aggregates of mutant cystatin C. An earlier study described how the life span of carriers of the L68Q mutation shortened in the latter half of the 19th century. During the same decades a drastic change occured in the diet in Iceland. In the beginning of the century the diet was simple and low in carbohydrates, which mostly came from milk products. Import of grains and sugar was limited, but increased greatly according to import records. Due to lack of salt, food was preserved in acid whey, but gradually salt replaced whey as means of preserving food. This study aims to explore if changes in the diet of Icelanders during the same decades could possibly affect the amount of glutathione in people.

Background: Public use of fireworks is widespread in Iceland, and unfortunately associated with injuries. No prior comprehensive research has been done on firework accidents in Iceland. The goal of this study was to gather information about the extent, cause, and impact of firework accidents in the Reykjavik capital area.

Methods: Text search was conducted in medical records to find visits to the Emergency Department (ED) resulting from fireworks accidents over the period December 2010 to January 2022. Medical records were reviewed for details of events and injury.

Results: Over the period 248 patients came to the ED after a firework related injury, 73% male. The age range was from 9 months to 79 years of age. Children were 114, 12 were younger than 6 years. There where overall 54 secondary accidents. In total 96 (39%) accidents were traced to a faulty firework. Rockets caused the most accidents 56 (23%), cakes 43 (17%) and handheld candles 32 (13%). Type of firework was not reported in 62 (25%) cases. 157 sustained a burn injury, of which 104 where on hands. Eye injury was found on 67 patients and 97 individuals had open wounds. 22 where admitted to the hospital for a total of 91 days. Nobody died but at least 13 sustained permanent physical impairment due to fireworks.

Conclusions: Over the past decade, 21 patients on average presented to the ED annually with firework injury. 73% of those injured by fireworks are male. Children make up one half of the injured and one child 5 years of age or younger sustains a firework injury every year on average. Preventive measures against firework accidents should be expanded and more restrictive regulations on their use should be considered.

Here we will briefly review the main influential factors and milestones in the history of stroke care in Iceland. Over the last few decades the treatment of ischemic stroke has revolutionized in many ways and so has the general mindset of those providing it. This review article is partly based upon interviews with Icelandic doctors that partook in the development. Looking back at this history it is clear that, in many ways, the medical care in Iceland was at the forefront in implementing those emerging new treatments in stroke care. This is mainly on account of ambitious and hard working individuals that were not easily dissuaded but firmly believed in the possibility of better outcomes for their stroke patients.

Introduction: Information on the number, indications and outcome of cardiac transplantations in Icelandic patients is scarce, as is information on the number of hearts donated from Iceland for cardiac transplantation.

Material and methods: A retrospective study on patients receiving heart transplantation from the first procedure in 1988 until March 2019. Clinical information was gathered from Landspitali Transplantation Clinic, patient charts, and information on donated hearts from the Icelandic Donation Registry. Age-standardized incidence of the procedure was calculated, and overall survival (Kaplan-Meier) estimated. Mean follow-up was 10.3 years.

Results: Altogether 24 patients (19 males, median age 38 years, range: 4-65 years) underwent cardiac transplantation; that included one re-transplantation, three simultaneous heart- and lung transplants and two heart- and kidney transplants. The transplantations were performed in Gothenburg (n=20), London (n=3) and Copenhagen (n=2). Most common indications were dilated cardiomyopathy (n=10), congenital heart disease (n=4), and viral myocarditis (n=3). Five patients were bridged left ventricular-assist device preoperatively. Overall survival at 1 and 5 years was 91% and 86%, respectively; median survival being 24 years. The incidence of cardiac transplantation was 2.7 heart-TX pmp/year but increased to 4.6 heart-TX pmp/year after 2008 (p=0.01). During the same period 42 hearts were donated from Iceland for transplantation abroad, the first in 2002 and increasing from 0.8 to 3.0 hearts/year during the first and second half of the study-period, respectively.

Conclusion: Survival of Icelandic cardiac transplant recipients is good and comparable to larger transplant centers overseas. Number of hearts donated from Iceland have increased and currently Iceland donates twice as many hearts at it receives.

Background: Transient Global Amnesia (TGA) is a benign syndrome characterized by sudden anterograde memory loss, that resolves spontaneously within 24 hours. TGA appears without other focal neurological symptoms. The aim of this study was to study TGA in the greater Reykjavik-area.

Methods: We retrospectively analysed the medical history of patients with a diagnosis of TGA (ICD-10 G45.4) at the University Hospital in Iceland in 2010-2021. Medical records were reviewed, and information about year and age at diagnosis, sex, symptoms, precipitating events, imaging results and risk factors were collected. Statistical processing was performed with Excel and Rstudio.

Results: Overall, 348 attacks of TGA were identified with a mean frequency of 29 attacks/year, where 9.9% had an earlier history of TGA. The mean age was 64.1, with 50% of subjects between 58-70 years old. The sex distribution was equal (49.9% female). Possible precipitating events were found in 53.7% of cases, with physical activity being the most common one (24.4%), followed by sudden temperature change and emotional stress. In 96% of patients a computerized tomography was performed (no sign of acute changes were found), and magnetic resonance imaging (MRI) in 36.2% of cases. MRI showed restricted diffusion in the hippocampal area in 10.3% of cases.

Discussion: TGA is not a rare but a benign syndrome. Our findings regarding age, sex distribution and precipitating events were in accordance with other studies. TGA is thought to result from a temporary hippocampal dysfunction supported by the clinical presentation and MRI findings. The cause of TGA is however still unknown.