http://www.hirsla.lsh.is/lsh Hirsla captures, stores, indexes, preserves, and distributes digital research material. Search the Channel search http://www.hirsla.lsh.is/lsh/simple-search http://hdl.handle.net/2336/208470 Titill: Obesity and the metabolic syndrome: role of different dietary macronutrient distribution patterns and specific nutritional components on weight loss and maintenance.<br/><br/>Höfundar: Abete, Itziar; Astrup, Arne; Martínez, J Alfredo; Thorsdottir, Inga; Zulet, Maria A<br/><br/>Útdráttur: Weight loss and subsequent body weight maintenance are difficult for obese individuals despite the wide variety of dietary regimens and approaches. A substantial body of scientific evidence has shown that by simply varying the macronutrient distribution and composition of dietary factors, weight losses of varying amounts, longer-term body weight maintenance periods, better appetite regulation, and changes in features of the metabolic syndrome can be achieved. At present, renewed efforts are underway to increase the protein content of weight-loss diets, simultaneously restrict fat consumption to no more than 30%, favor polyunsaturated fat, have carbohydrates account for between 40 and 50% of total energy intake, and promote the consumption of low-glycemic foods. The present article reviews the scientific evidence for the effects of several dietary manipulations and sustainable strategies for weight loss and body weight stability as well as for treating specific features of the metabolic syndrome. Mon, 29 Mar 2010 22:58:59 GMT http://hdl.handle.net/2336/200749 Titill: Incidental Detection of Renal Cell Carcinoma is an Independent Prognostic Marker: Results of a Long-Term, Whole Population Study.<br/><br/>Höfundar: Palsdottir, Helga Bjork; Hardarson, Sverrir; Petursdottir, Vigdis; Jonsson, Armann; Jonsson, Eirikur; Sigurdsson, Martin Ingi; Einarsson, Gudmundur Vikar; Gudbjartsson, Tomas<br/><br/>Útdráttur: The true effect of incidental detection on the survival of patients with renal cell carcinoma has been debated. We used centralized databases in Iceland to study prognostic factors of survival, focusing on the effect of incidental detection.; This retrospective study included all living patients diagnosed with renal cell carcinoma in Iceland from 1971 to 2005. Hospital charts and histology were reviewed. Incidentally diagnosed renal cell carcinomas were compared to symptomatic tumors and prognostic factors were evaluated using Cox multivariate analysis.; Of the 910 patients 254 (27.9%) were diagnosed incidentally, most often by abdominal ultrasound (29.5%) or computerized tomography (28.3%). The incidental detection rate increased from 11.1% in 1971 through 1975 to 39.2% in 2001 through 2005 (p <0.001). During the same period the incidence increased significantly in males but in females only during the last 5 study years. Mortality remained unchanged for each gender. Incidentally detected tumors were an average of 2.6 cm smaller and diagnosed at lower stage and lower grade than symptomatic tumors. Age and histology were similar in each group. TNM stage was by far the strongest independent prognostic factor of survival but age, calendar year of diagnosis and ESR were also significant. After correcting for confounders patients with symptomatic renal cell carcinoma had worse survival than those diagnosed incidentally.; With increased incidence and unchanged mortality the survival of patients with renal cell carcinoma has improved. This is mainly related to a steep increase in incidental detection. Incidental detection affects survival favorably and to a greater extent than can be explained by lower stage compared to the survival of patients diagnosed with symptoms. Thu, 29 Dec 2011 22:58:59 GMT http://hdl.handle.net/2336/188429 Titill: The anti-microbial peptide LL-37 modulates immune responses in the palatine tonsils where it is exclusively expressed by neutrophils and a subset of dendritic cells.<br/><br/>Höfundar: Sigurdardottir, Sigrun L; Thorleifsdottir, Ragna H; Guzman, Andrew M; Gudmundsson, Gudmundur H; Valdimarsson, Helgi; Johnston, Andrew<br/><br/>Útdráttur: Antimicrobial peptides are essential elements of epithelial defense against invading micro-organisms. The palatine tonsils are positioned at the entry of the airway and the gut and as such are ideally situated to act as immune sentinels in the pharynx protecting against microbial invasion. Tonsils express a number of antimicrobial peptides including hCAP18/LL-37. Here we clearly define the expression of hCAP18/LL-37 in the tonsils showing unequivocally that hCAP18/LL-37 is mainly expressed by infiltrating neutrophils and follicular CD11c+CD13+HLA-DR+ dendritic cells, rarely by macrophages, and never by the epithelium itself. To explore possible functions for follicle-derived LL-37, we stimulated tonsil mononuclear cells with LL-37 in vitro and observed the secretion of the proinflammatory cytokines CCL5 and CXCL9, expression of IFN-γ and MX-1 and down-regulation of chemokine receptors CCR4 and CCR6 which are involved in tissue-selective T cell trafficking. Taken together, these data illustrate new potential immunoregulatory functions for hCAP18/LL-37 in the tonsils. Thu, 06 Oct 2011 22:58:59 GMT http://hdl.handle.net/2336/183789 Titill: B12-vítamín - hvernig á að gefa það og hversu oft?<br/><br/>Höfundar: Elín I. Jacobsen; Einar S. Björnsson Wed, 28 Sep 2011 22:58:59 GMT http://hdl.handle.net/2336/183749 Titill: Helsinki-yfirlýsingin<br/><br/>Höfundar: Jón Snædal Wed, 28 Sep 2011 22:58:59 GMT http://hdl.handle.net/2336/182013 Titill: Kirtilkrabbamein í botnlanga á Íslandi 1990-2009 - lýðgrunduð rannsókn<br/><br/>Höfundar: Halla Viðarsdóttir; Jón Gunnlaugur Jónasson,; Páll Helgi Möller<br/><br/>Útdráttur: Adenocarcinoma of the appendix is less than 0.5% of all gastrointestinal cancers. The aim of this study was to analyse the incidence, symptoms, pathology and treatment of appendiceal adenocarcinoma in a well defined cohort as well as the prognosis of the patients.; This is a retrospective study on all patients diagnosed with adenocarcinoma of the appendix in Iceland from 1990-2009. Information on epidemiological factors, survival and treatment was collected. All histological material was reviewed. Overall survival was estimated with median follow up of 15 months (range, 0-158).; A total of 22 patients were diagnosed with appendiceal adenocarinoma in the study period (median age 63 yrs, range: 30-88, 50% males). Age-standardized incidence was 0.4/100,000/year. The most common symptom was abdominal pain (n=10). Eight patients had clinical signs of appendicitis. Most patients were diagnosed at operation or at pathological examination but one patient was diagnosed at autopsy. Five patients had an appendectomy and 11 a right hemicolectomy. One patient was not operated on and in three patients only a biopsy was taken. Twelve patients had chemotherapy and seven of them for metastatic disease. Eight patients had adenocarcinoma, seven mucinous adenocarcinoma, three signet ring adenocarcinoma, one mixed goblet cell carcinoid and mucinous adenocarcinoma,one mixed adenocarcinoma and signet ring adenocarcinoma and two a mucinous tumour of unknown malignant potential. In eight cases the tumor originated in adenoma. Most of the patients had a stage IV disease (n=13), three stage III, three stage II and three stage I. Operative mortality was 4.8% (n=1). Disease specific five year survival was 54% but overall five year survival was 44% respectively.; Adenocarcinoma of the appendix is a rare disease. No patients were diagnosed pre-operatively. Over half of the patients presented with stage IV disease.; Tilgangur: Kirtilkrabbamein í botnlanga er innan við 0,5% krabbameina í meltingarvegi. Tilgangur rannsóknarinnar var að skoða nýgengi, einkenni,meinafræði, meðferð og horfur sjúklinga hér á landi.Efniviður og aðferðir: Rannsóknin var afturskyggn og náði til allra sjúklinga sem greindust með kirtilkrabbamein í botnlanga á Íslandi 1990-2009. Skoðaðirvoru faraldsfræðilegir þættir, meðferð og lifun. Öll vefjasýni voru skoðuð og meinafræði endurmetin. Meðaleftirfylgni lifandi greindra var 15 mánuðir (bil:0-158).Niðurstöður: Alls greindust 22 sjúklingar með kirtilkrabbamein í botnlanga (miðaldur 63 ár, bil: 30-88, 50% karlar). Aldursstaðlað nýgengi var 0,4/100.000á ári. Algengasta einkennið var kviðverkur (n=10) en átta sjúklingar höfðu klínísk einkenni botnlangabólgu. Flestir sjúklingar greindust í aðgerð eða viðvefjagreiningu en einn við krufningu. Fimm sjúklingar fóru í botnlangatöku og 11 í brottnám á hægri hluta ristils. Einn sjúklingur fór ekki í skurðaðgerðog hjá þremur var eingöngu tekið vefjasýni. Tólf sjúklingar fengu krabbameinslyfjameðferð, þar af sjö við dreifðum sjúkdómi. Átta sjúklingar höfðukirtilkrabbamein, sjö slímkrabbamein, þrír sigðfrumukrabbamein, einn blandað krabbalíkisæxli af slímfrumugerð og slímkrabbameini, einn kirtilkrabbameinmeð sigðfrumukrabbameini og tveir höfðu slímæxli af óvissri illkynja hegðan. Í átta tilvikum var æxlið upprunnið í kirtilsepaæxli. Flestir höfðu sjúkdóm á stigiIV (n=13), 3 á stigi III, 3 á stigi II og 3 á stigi I. Skurðdauði var 4,8% (n=1). Sjúkdómssértæk fimm ára lifun var 54% en heildar fimm ára lifun 44%.Ályktun: Kirtilkrabbamein í botnlanga eru sjaldgæf. Allir sjúklingar greindust fyrir tilviljun. Rúmlega helmingur sjúklinga var með dreifðan sjúkdóm viðgreiningu. Wed, 28 Sep 2011 22:58:59 GMT http://hdl.handle.net/2336/146830 Titill: Frestun læknisþjónustu meðal Íslendinga: Umfang og skýringar<br/><br/>Höfundar: Rúnar Vilhjálmsson<br/><br/>Útdráttur: Equal access to health care is a central goal in socialized health systems like the one in Iceland. Previous research in Iceland indicates considerable individual and group differences in access to health care. The study maps the distribution of postponement and cancellation of physician care among Icelandic adults and considers a number of potential explanations.; The data come from a national postal health survey of Icelandic adults, age 18-75, who were randomly drawn from the National Register. 1532 individuals responded to the survey yielding a 60% response rate.; 22% of the respondents had postponed or cancelled a physician visit they thought they needed in the past 6 months. The study found considerable variations in postponement rates. Postponement was positively related to younger age, full employment, financial difficulties, high out-of-pocket health care costs, inflexible daily schedules (fixed roles), dissatisfaction with last physician visit, and the number of chronic medical conditions experienced.; Postponement or cancellation of medical care is fairly common among Icelandic adults, although considerable individual and group differences in postponement are observed. The results raise concerns, as equal access to care is a central goal of the Icelandic health care system. It is incumbent upon health authorities to pursue effective ways to equalize access to medical care and prevent postponement and cancellation of needed services.; Tilgangur: Jafnt aðgengi að heilbrigðisþjónustu er meginmarkmið í félagslegum heilbrigðiskerfum eins og því íslenska. Fyrri innlendar rannsóknir benda tilþess að talsverður munur sé á aðgengi einstaklinga og hópa að heilbrigðisþjónustunni. Markmið rannsóknarinnar var að kortleggja frestun læknisþjónustu íólíkum samfélagshópum fullorðinna Íslendinga og meta vægi einstakra áhrifaþátta.Efniviður og aðferðir: Rannsóknin byggði á landskönnuninni Heilbrigði og aðstæður Íslendinga I. Spurningalistar voru póstsendir til þjóðskrárúrtaksÍslendinga á aldrinum 18-75 ára. 1532 manns svöruðu könnuninni og heimtur voru 60%.Niðurstöður: Alls höfðu 22% fullorðinna Íslendinga frestað eða fellt niður læknisþjónustu á sex mánaða tímabili. Frestunarhlutföll voru misjöfn eftir hópum.Þeir sem voru ungir að árum í fullri vinnu, áttu við fjárhagserfiðleika að etja, höfðu há heimilisútgjöld vegna heilbrigðisþjónustu, áttu erfitt með að komast frádaglegum verkefnum, voru óánægðir með síðustu læknisheimsókn, eða glímdu við langvinna sjúkdóma og kvilla, frestuðu oftar en aðrir ferð til læknis.Ályktun: Nokkuð algengt er að Íslendingar fresti eða felli niður læknisþjónustu sem þeir telja þörf fyrir. Jafnframt er verulegur munur á tíðni frestunarmilli fólks og hópa. Niðurstöðurnar eru umhugsunarefni í ljósi þess meginmarkmiðs heilbrigðiskerfisins að allir landsmenn hafi jafnan aðgang aðheilbrigðisþjónustu. Mikilvægt er að heilbrigðisyfirvöld leiti leiða til að jafna aðgengi einstaklinga og hópa að læknisþjónustu og vinni gegn frestun eðaniðurfellingu hennar. Wed, 28 Sep 2011 22:58:59 GMT http://hdl.handle.net/2336/146829 Titill: Lokuskipti vegna ósæðarlokuþrengsla á Íslandi 2002-2006: Ábendingar og snemmkomnir fylgikvillar<br/><br/>Höfundar: Inga Lára Ingvarsdóttir,; Sindri Aron Viktorsson; Kári Hreinsson; Martin Ingi Sigurðsson; Sólveig Helgadóttir; Þórarinn Arnórsson; Ragnar Danielsen; Tómas Guðbjartsson<br/><br/>Útdráttur: Information on surgical outcome of aortic valve replacement (AVR) has not been available in Iceland. We therefore studied the indications, short-term complications and operative mortality in Icelandic patients that underwent AVR with aortic stenosis.; This was a retrospective study including all patients that underwent AVR for aortic stenosis at Landspitali between 2002 and 2006, a total of 156 patients (average age 71.7 years, 64.7% males). Short term complications and operative mortality (≤ 30 days) were registered and risk factors analysed with multivariate analysis.; The most common symptoms before AVR were dyspnea (86.9%) and angina pectoris (52.6%). Preop. max aortic valve pressure gradient was on average 74 mmHg, the left ventricular ejection fraction 57.2% and EuroSCORE (st) 6.9%. The average operating time was 282 min and concomitant CABG was performed in 55% of the patients and mitral valve surgery in nine. A bioprothesis was implanted in 127 of the patients (81.4%), of which 102 were stentless valves, and a mechanical valve in 29 (18.6%) cases. The mean prosthesis size was 25.6 mm (range 21-29). Atrial fibrillation (78.0%) and acute renal injury (36.0%) were the most common complications and 20 patients (13.0%) developed multiple-organ failure. Twenty-six patients (17.0%) needed reoperation due to bleeding. Median hospital stay was 13 days and operative mortality was 6.4%.; The rate of short term complications following AVR was relatively high, including reoperations for bleeding and atrial fibrillation. Operative mortality is twice that of CABG, which is in line with other studies.; Inngangur: Ósæðarlokuskipti eru önnur algengasta hjartaaðgerðin á Íslandi og er oftast gerð vegna ósæðarlokuþrengsla. Tilgangurinn var að kannaábendingar, snemmkomna fylgikvilla og skurðdauða eftir þessar aðgerðir hér á landi.Efniviður og aðferðir: Afturskyggn rannsókn á sjúklingum sem gengust undir ósæðarlokuskipti vegna ósæðarlokuþrengsla á Landspítala 2002-2006,samtals 156 einstaklingum. Skráðir voru fylgikvillar aðgerðanna og ein- og fjölþáttagreiningu beitt til að skilgreina áhættuþætti fylgikvilla og skurðdauðainnan 30 daga.Niðurstöður: Meðalaldur var 71,7 ár (bil 41-88) og voru karlar 64,7% hópsins. Algengustu einkenni sjúklinga fyrir aðgerð voru mæði (86,9%) og hjartaöng(52,6%). Meðalútfallsbrot hjarta (EF) var 57,2%, hámarksþrýstingsfall (ΔP) yfir lokuna 74,1 mmHg og EuroScore (st) 6,9%. Ríflega helmingur sjúklingannagekkst samtímis undir kransæðahjáveitu og 9 undir aðgerð á míturloku. Lífrænni loku var komið fyrir í 127 aðgerðanna (81,4%), í 102 tilvikum grindarlausriloku, og gerviloku hjá 29 sjúklingum. Meðalstærð ígræddra loka var 25,6 mm (bil 21-29) og aðgerðartími var 282 mínútur. Algengustu fylgikvillar eftiraðgerð voru nýtilkomið gáttatif (78,0%) og bráður nýrnaskaði (36,0%). Enduraðgerð vegna blæðingar þurfti í 17,0% tilfella og 20 sjúklingar (13,0%) fengufjöllíffærabilun. Miðgildi legutíma var 13 dagar og 6,4% sjúklinga létust innan 30 daga frá aðgerð.Ályktun: Fylgikvillar reyndust tíðir eftir þessar aðgerðir, einkum gáttatif, nýrnaskaði og blæðingar sem krefjast enduraðgerðar. Skurðdauði er helmingi tíðarien eftir kransæðahjáveituaðgerðir, sem er í samræmi við erlendar rannsóknir. Wed, 28 Sep 2011 22:58:59 GMT http://hdl.handle.net/2336/146813 Titill: Leiðbeiningar um ritun fræðigreina<br/><br/>Höfundar: Anna Bryndís Einarsdóttir; Rúnar Helgi Vignisson; Einar Stefánsson<br/><br/>Útdráttur: Ritun fræðigreina krefst æfingar og þrautseigju. Áhugiog þekking á viðfangsefninu og aðferðafræði vísindaauðvelda ferlið. Gildi vísindalegrar fræðigreinar ræðstþó fyrst og fremst af innihaldi hennar, niðurstöðunumog hvernig þær eru túlkaðar. Um leið skiptir uppbyggingog framsetning miklu máli til þess aðefniviðurinn komist vel til skila. Það er ekki til neinfullkomin uppskrift að vísindagrein en benda má áýmis atriði sem geta hjálpað við greinaskrif. Við vonumað ábendingar okkar nýtist höfundum, ekki síst yngrihöfundum sem eru að stíga sín fyrstu skref í ritunvísindagreina.1 Heimasíða International Committeeof Medical Editors (www.icmje.org) veitir nákvæmarleiðbeiningar um ritun vísindagreina og er í stöðugriendurskoðun. Höfundar vísindalegs efnis ættu að nýtasér þessa heimasíðu.2 Mon, 29 Aug 2011 22:58:59 GMT http://hdl.handle.net/2336/146792 Titill: Beinkröm hjá barni<br/><br/>Höfundar: Harpa Kristinsdottir,; Soffía Jónasdottir,; Sigurður Björnsson; Pétur Lúðvígsson<br/><br/>Útdráttur: Vitamin D is necessary for normal bone growth. Deficiency of vitamin D can lead to rickets in children and osteomalacia in adults. It is difficult to reach the recommended daily dose of vitamin D in children without cod liver oil or other vitamin D supplementation. Several cases of rickets have been diagnosed in Iceland the past few years. Studies suggest a worldwide increase in the prevalence of the disorder. We report on a girl who was diagnosed with rickets at the age of 27 months. She received inadequate amounts of vitamin D supplementation in the form of AD drops and cod liver oil. Because of food allergy she was on a restricted diet which limited her intake of dietary vitamin D. After diagnosis, she received a high-dose vitamin D therapy (Stoss therapy) which corrected the deficiency. Key words: rickets, food allergy, vitamin D.; D-vítamín er mikilvægt fyrir eðlilegan beinvöxt og getur skortur leitt til beinkramar í börnum og beinmeyru í fullorðnum. Mikilvægasti D-vítamíngjafi áÍslandi er lýsi en erfitt er að ná ráðlögðum dagsskammti D-vítamíns án lýsis eða annars D-vítamíngjafa. Allmörg tilfelli beinkramar hafa greinst hér á landi áundanförnum árum en erlendar rannsóknir sýna að sjúkdómurinn er vaxandi vandamál um allan heim.Hér er sagt frá stúlku sem greindist með beinkröm 27 mánaða gömul. Hún var á brjósti í tæpt ár og fékk D-vítamínviðbót með AD-dropum og þorskalýsien ekki í nægilegu magni. Fæðuofnæmi gerði það að verkum að hún nærðist á einhæfu fæði sem innihélt takmarkað D-vítamín. Eftir greiningu var hafinháskammta D-vítamínmeðferð (Stoss meðferð) sem leiðrétti skortinn. Mon, 29 Aug 2011 22:58:59 GMT