Laeknabladid最新文献

Appendicitis is one of the most common causes of acute abdominal pain worldwide. About 6-7% of individuals develop appendicitis during their lifetime, with the highest incidence in young people aged 10 to 19 years of age. The incidence of appendicitis varies between geographical regions and both diet and socioeconomic status are thought to play a role in this difference. Mortality rates are higher in less developed countries. Appendicitis is believed to occur due to obstruction of the lumen of the appendix. Complications such as perforation and abscess formation can occur, so prompt diagnosis is important. A detailed history and physical examination are key components of diagnosis, but blood tests and imaging studies also provide important information. Various scoring systems have been developed to aid in the diagnosis of appendicitis. Surgery is the primary treatment for appendicitis but treatment with antibiotics is also an option.

Involuntary movements are an uncommon manifestation of transient ischemic attacks (TIAs) and are often associated with carotid occlusion or stenosis. These symptoms are frequently position-dependent, typically occurring when the patient stands or becomes hypotensive, and can be misdiagnosed as focal motor seizures. Patients presenting with this phenomenon may be at a high risk of recurrent stroke due to underlying carotid disease. We present the case of a 79-year-old woman who exhibited hyperkinetic movements on her left side. Her symptoms appeared upon transitioning from sitting to standing and were exacerbated following more aggressive antihypertensive treatment. Diagnostic imaging revealed a near-occlusion of her right carotid artery and multiple ischemic lesions in the right cerebral hemisphere. She was admitted for carotid endarterectomy, after which she became symptom-free.

Amyotrophic lateral sclerosis (ALS) is a severe and progressive neurodegenerative disorder. We describe four cases of familial ALS based on SOD1 mutations who received intrathecal treatment with the antisense oligonucleotide tofersen at Landspítali University Hospital Iceland. Since initiation of treatment, there has not been any significant deterioration, and three patients have shown signs of cinical improvement. The cerebrospinal fluid concentration of neurofilament light chain (Nf-L), a biomarker of neuronal axonal damage, has decreased to the reference range of healthy individuals. No serious side effects have been observed.

Immunotherapy, particularly immune checkpoint inhibitors, has significantly impacted cancer treatment by enhancing the immune system's ability to identify and attack cancer cells. However, this treatment introduces unique immune-related adverse events (irAEs), which require careful management due to their potential to affect multiple organ systems. IrAEs can manifest during or after treatment, affecting organs such as the gastrointestinal tract, endocrine glands, lungs, and liver, with symptoms ranging from mild to life threatening. While irAEs are distinct from those seen in traditional cancer treatments, their early recognition and appropriate management are crucial. Steroid therapy and other immunosuppressive treatments are often necessary to mitigate these effects. Guidelines from organizations like ESMO and ASCO recommend a structured approach for evaluating and managing irAEs, including staging the severity, ruling out other diagnoses, and adjusting treatment protocols accordingly. Medical doctors need to stay vigilant, as the indications for immune checkpoint inhibitors continue to expand. The potential for delayed onset of irAEs months after treatment cessation increases the importance of maintaining irAEs on the differential diagnosis list for an extended period, even after patients have stopped immune checkpoint inhibitor therapy.

Background: Frontotemporal dementia (FTD) is a group of neurodegenerative disorders, with three distinctive phenotypes each presenting with different symptoms. The pathology of FTD is characterized by degeneration of the frontal and temporal lobes of the brain. The aim of this project was to investigate the prevalence and incidence of FTD in Iceland over the last few decades and gather information about demographics, clinical symptoms and diagnostic methods as well as to compare the three phenotypes with respect to clinical symptoms. Patients with FTD typically receive their diagnosis at Landspitali memory clinic in Reykjavik.

Methods: The study population consisted of individuals who had been diagnosed with frontotemporal dementia from the beginning of electronic medical records at Landspítali until 2022. Medical records were used for data collection and descriptive and analytical statistical methods were used for data processing and analyses.

Results: The frequency of FTD in Landspitali memory clinic population from the years 2008-2022 was found to be 1,7%. Over the entire period, a total of 97 individuals received the diagnosis, 50 men and 47 women. The prevalence was 45.3/100,000 inhabitants and the average incidence was 11.67/100,000/year. Mean age at onset of symptoms was 67 years. The behavioral variant of FTD was the most common phenotype, and the most common clinical feature of all three phenotypes was memory impairment.

Discussion: The prevalence of frontotemporal dementia in Iceland is lower than has been reported in some previous studies, incidence comparison is difficult due to difference in age distribution in different studies. Prevalence in the memory clinic population was low, reflecting the rarity of FTD. The average age at diagnosis was higher in Iceland than described in foreign studies and the frequency of memory impairment as an initial symptom was higher compared to foreign studies. Diagnostic methods have developed in recent years and the diagnostic process is more precise than in the earlier years of the study period.

Venovenous extracorporeal membrane oxygenation (VV-ECMO) therapy can be indicated as a last resort treatment in severe respiratory failure. It is a complex and resource demanding treatment that can pose challenges, particularly during a pandemic such as COVID-19. We report two cases of previously healthy, middle-aged men who suffered severe respiratory failure following COVID-19 pneumonia. Both patients required VV-ECMO therapy at a low-volume, geographically isolated center in Iceland, a country of 400,000 inhabitants. They recovered well after the VV-ECMO treatment and returned to full-time work approximately one year later.

Introduction: Worldwide, the number of older people will increase in the coming decades. With high-er age the likelihood of being diagnosed with a life-threatening illness increases, often leading to suffering and decreased quality of life. Earlier introduction to palliative care (PC) can help patients to better cope with their illness and improve quality of life. Knowledge of PC among the general public can affect attitudes towards accepting PC service.

Material and methods: The Social Science Institute of University of Iceland performed a survey using online panel consisting of individuals 18 years and older. Random sample of 1963 individuals from Registers Iceland received the Palliative Care Knowledge Scale (PaCKS) with 7 right and 6 wrong statements and 8 questions on attitudes to end-of-life issues. Results Response rate was 41%. 730 (37%) answered the PaCKS, mean score of right answers was 6.37. A total of 95% had heard of PC, mostly from media or through a friend/relative who had received PC. A total of 70% thought PC was all about end-of life, 9 % had heard about advanced care planning. Half of the responders had never thought about writing down their wishes regarding end-of-life care, 32% thought about it but had not done anything about it. Over half would like to receive care at home in the last months of life, 70% would like to die at home. Around 80% were followers of euthanasia.

Conclusion: Knowledge of PC among the general public in Iceland is lacking. It is important to promote knowledge of PC. Many had never thought of end-of-life care but are pro legalizing euthanasia.