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  • T cell receptor gene therapy targeting WT1 prevents acute myeloid leukemia relapse post-transplant.

    Chapuis, Aude G; Egan, Daniel N; Bar, Merav; Schmitt, Thomas M; McAfee, Megan S; Paulson, Kelly G; Voillet, Valentin; Gottardo, Raphael; Ragnarsson, Gunnar B; Bleakley, Marie; et al. (Nature Publishing Group, 2019-07)
    Relapse after allogeneic hematopoietic cell transplantation (HCT) is the leading cause of death in patients with acute myeloid leukemia (AML) entering HCT with poor-risk features1-3. When HCT does produce prolonged relapse-free survival, it commonly reflects graft-versus-leukemia effects mediated by donor T cells reactive with antigens on leukemic cells4. As graft T cells have not been selected for leukemia specificity and frequently recognize proteins expressed by many normal host tissues, graft-versus-leukemia effects are often accompanied by morbidity and mortality from graft-versus-host disease5. Thus, AML relapse risk might be more effectively reduced with T cells expressing receptors (TCRs) that target selected AML antigens6. We therefore isolated a high-affinity Wilms' Tumor Antigen 1-specific TCR (TCRC4) from HLA-A2+ normal donor repertoires, inserted TCRC4 into Epstein-Bar virus-specific donor CD8+ T cells (TTCR-C4) to minimize graft-versus-host disease risk and enhance transferred T cell survival7,8, and infused these cells prophylactically post-HCT into 12 patients ( NCT01640301 ). Relapse-free survival was 100% at a median of 44 months following infusion, while a concurrent comparative group of 88 patients with similar risk AML had 54% relapse-free survival (P = 0.002). TTCR-C4 maintained TCRC4 expression, persisted long-term and were polyfunctional. This strategy appears promising for preventing AML recurrence in individuals at increased risk of post-HCT relapse.
  • Low aspirin use and high prevalence of pre-eclampsia risk factors among pregnant women in a multinational SLE inception cohort.

    Mendel, Arielle; Bernatsky, Sasha B; Hanly, John G; Urowitz, Murray B; Clarke, Ann Elaine; Romero-Diaz, Juanita; Gordon, Caroline; Bae, Sang-Cheol; Wallace, Daniel J; Merrill, Joan T; et al. (BMJ Publishing Group, 2019-07)
  • Anaplastic thyroid carcinoma transformation in a lateral neck node metastasis - A case report and a review of the literature

    Gunnarsdottir, Agnes B; Briem, Birgir A; Jonasson, Larus; Tryggvason, Geir; [ 1 ] Skanes Univ Sjukhus Lund, Dept Otolaryngol & Head & Neck Canc, Lund, Sweden Show more [ 2 ] Landspitali Univ Hosp, Dept Otolaryngol Head & Neck Surg, IS-108 Reykjavik, Iceland Show more [ 3 ] Landspitali Univ Hosp, Dept Surg Pathol, Reykjavik, Iceland (Taylor & Francis, 2018)
    Anaplastic thyroid carcinoma is thought to be derived from previous existing papillary or follicular thyroid carcinoma that dedifferentiates into its anaplastic counterpart. We present a case where this type of dedifferentiation occurs at a metastatic site in a regional lymph node, years after the primary papillary thyroid tumor had metastasized.
  • Endurlífgun nýbura: Klínískar leiðbeiningar

    Herbert Eiríksson; Elín Ögmundsdóttir; Þórður Þórkelsson; Landspítala (Ljósmæðrafélag Íslands, 2019-03)
    Þó svo flestir nýburar séu í góðu ástandi við fæðingu verðum við alltaf að vera undir það búin að nýfætt barn sé óvænt slappt. Því þarf í öllum tilvikum að vera til staðar tækjabúnaður til endurlífgunar og í það minnsta einn sem kann til verka á því sviði. Í flestum tilvikum þurfa börnin aðeins öndunaraðstoð, sjaldan þarf að beita hjartahnoði og enn sjaldnar að gefa lyf. Í þessari grein eru gefnar leiðbeiningar um endurlífgun nýbura sem byggjast einkum á nýjustu leiðbeiningum Evrópska endurlífgunarráðsins.
  • Meðferð á þriðja stigi fæðingar kvenna sem eru í lítilli hættu á blæðingu

    Ásta Dan Ingibergsdóttir; Landspítala (Ljósmæðrafélag Íslands, 2018-07)
  • Þunglyndi og Parkinsonsveiki

    Marianne E. Klinke; Arna Hlín Ástþórsdóttir; Rakel Gunnlaugsdóttir; Jónína H. Hafliðadóttir; 1) Taugalækningadeild B2, Landspítala-háskólasjúkrahúsi og hjúkrunarfræðideild, háskóla Íslands 2) Sjúkradeild HSU, Vestmannaeyjum 3)4) Taugalækningadeild B2, Landspítala-háskólasjúkrahúsi (Félag íslenskra hjúkrunarfræðinga, 2018)
    Núverandi hjúkrunarmeðferð fyrir einstaklinga með parkinsonsveiki (PV) miðar að því auka lífsgæði þeirra. Það felur í sér að greina og meðhöndla einkenni sem skipta máli fyrir hvern og einn einstakling. Líta má á hjúkrunarfræðinginn sem nokkurs konar leiðsögumann sem styrkir einstaklinginn í því að bregðast við sjúkdóms tengdum erfiðleikum á viðeigandi hátt. Þunglyndi er algengt vandamál sem skerðir lífsgæði hjá fólki með PV. Markmiðið með þessari fræðslugrein er að bæta þekkingu hjúkrunar - fræðinga og annarra heilbrigðisstarfsmanna á þunglyndi parkinsonssjúklinga ásamt því að kynna nýjan fræðslubækling um efnið.
  • „Með hreinum höndum“ - Handhreinsun á Landspítala

    Ásdís Elfarsdóttir Jelle; Heiða Björk Gunnlaugsdóttir; Þórdís Hulda Tómasdóttir; 1 Deildarstjóri sýkingavarnadeildar Landspítala. 2 hjúkrunarfræðingur á sýkingavarnadeild Landspítala. 3 hjúkrunarfræðingur á sýkingavarnadeild Landspítala. (Félag íslenskra hjúkrunarfræðinga, 2018)
  • „Það er fróðlegt og krefjandi að vinna í teymi“- Þverfræðilegt nám á heilbrigðisvísindasviði Háskóla Íslands: þriggja ára þróunarverkefni

    Sóley S. Bender; Andri St. Björnsson; Anna Bryndís Blöndal; Guðlaug Kristjánsdóttir; Inga B. Árnadóttir; Ólöf Guðný Geirsdóttir; Þorvarður Jón Löve; Ólöf Ásta Ólafsdóttir (Félag íslenskra hjúkrunarfræðinga, 2018)
  • Læknisfræði framtíðar – Mun gervigreind og vélmenni leysa lækna af hólmi?

    Magnús Haraldsson (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-12)
  • Towards an Individualized Nutrition Treatment: Role of the Gastrointestinal Microbiome in the Interplay Between Diet and Obesity.

    Adalsteinsdottir, Solveig A; Magnusdottir, Ola K; Halldorsson, Thorhallur I; Birgisdottir, Bryndis E; 1 Unit for Nutrition Research, Faculty of Food Science and Nutrition, Landspitali University Hospital, University of Iceland, Eiriksgata 29, 101, Reykjavik, Iceland. 2 Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, DK-2300, Copenhagen, Denmark. 3 Unit for Nutrition Research, Faculty of Food Science and Nutrition, Landspitali University Hospital, University of Iceland, Eiriksgata 29, 101, Reykjavik, Iceland. beb@hi.is. (Springer, 2018-12-01)
    Dietary treatments for obesity have relatively low long-term success. Recent studies have identified the gastrointestinal microbiome as a factor of high relevance. The current knowledge on the interplay between diet, obesity, and the gastrointestinal microbiome and the potential for individualized dietary treatment will be discussed. Studies indicate that each individual digests and metabolizes identical food substances differently depending on their gastrointestinal microbiome composition. Factors related to this crosstalk may improve our understanding of weight homeostasis and treatment of obesity. Long-time dietary intake is the key in the composition of the gastrointestinal microbiome which seems to be an important factor for energy balance, resulting in emerging opportunities for increasingly varied obesity treatment. Compliance to dietary treatment is critical for long-term success as enduring changes in gastrointestinal microbiome seem to slow over time. More research is urgently needed to investigate this missing link in our understanding of obesity.
  • Lækningar í Íslendingasögum

    Óttar Guðmundsson; Formaður Félags áhugamanna um sögu læknisfræðinnar (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-11)
  • Framhaldsmenntun lækna á Íslandi

    Tómas Þór Ágústsson; Landspítala (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-10)
  • Af læknanámi

    Kristján Erlendsson; Kennslustjóri læknadeildar HÍ (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-10)
  • Giant gastric lipoma successfully removed by endoscopic submucosal dissection: case report and systematic review.

    Ingason, Arnar B; Theodors, Asgeir; Agustsson, Arnar S; Arnarson, Adalsteinn; 1 a Department of Medicine , University of Iceland , Reykjavik , Iceland. 2 b Department of Gastroenterology , Landspitali University Hospital , Reykjavik , Iceland. 3 c Department of General Surgery , Landspitali University Hospital , Reykjavik , Iceland. (Taylor & Francis, 2018-08-01)
    Gastric lipomas are rare adipose tumors that constitute less than 1% of gastric tumors. While lipomas generally do not need removal unless symptomatic, endoscopic resection has been proposed as safe for gastric lipomas smaller than 2 cm. Yet, there is no consensus on the optimal treatment method for larger lipomas. We report a case of a giant 7-cm gastric lipoma successfully removed by endoscopic submucosal dissection (ESD) and systematically review the literature for gastric lipomas removed by ESD. Systematic review was conducted by searching PubMed and Scopus databases, up to 15 February 2018, using combinations of relevant terms. We report a 55-year-old male with known gastroesophageal reflux disease and asthma, who sought medical attention due to chronic heartburn and asthma exacerbations. These symptoms were attributed to a large 7 cm × 3 cm gastric lipoma that caused gastric outlet obstruction. The lipoma was safely removed by ESD, allowing quick recovery and alleviation of symptoms. In our review, we identified 20 gastric lipomas treated with ESD, with 15 (75%) being 2 cm or larger. The average size of the lipomas was 4 cm (range: 1.2-9 cm). All lipomas were limited to the submucosa, with 80% of the tumors located in the antrum. Three lipomas were removed by submucosal tunneling. All tumors were successfully removed en bloc and no major complications were reported. Our findings support the conclusion that ESD may be a safe alternative to conventional surgery for removal of large symptomatic gastric lipomas.
  • Editor's Choice - The Impact of Centralisation and Endovascular Aneurysm Repair on Treatment of Ruptured Abdominal Aortic Aneurysms Based on International Registries.

    Budtz-Lilly, Jacob; Björck, Martin; Venermo, Maarit; Debus, Sebastian; Behrendt, Christian-Alexander; Altreuther, Martin; Beiles, Barry; Szeberin, Zoltan; Eldrup, Nikolaj; Danielsson, Gudmundur; et al. (W.B. Saunders, 2018-08-01)
    Current management of ruptured abdominal aortic aneurysms (RAAA) varies among centres and countries, particularly in the degree of implementation of endovascular aneurysm repair (EVAR) and levels of vascular surgery centralisation. This study assesses these variations and the impact they have on outcomes. RAAA repairs from vascular surgical registries in 11 countries, 2010-2013, were investigated. Data were analysed overall, per country, per treatment modality (EVAR or open aortic repair [OAR]), centre volume (quintiles IV), and whether centres were predominantly EVAR (≥50% of RAAA performed with EVAR [EVAR(p)]) or predominantly OAR [OAR(p)]. Primary outcome was peri-operative mortality. Data are presented as either mean values or percentages with 95% CI within parentheses, and compared with chi-square tests, as well as with adjusted OR. There were 9273 patients included. Mean age was 74.7 (74.5-74.9) years, and 82.7% of patients were men (81.9-83.6). Mean AAA diameter at rupture was 7.6 cm (7.5-7.6). Of these aneurysms, 10.7% (10.0-11.4) were less than 5.5 cm. EVAR was performed in 23.1% (22.3-24.0). There were 6817 procedures performed in OAR(p) centres and 1217 performed in EVAR(p) centres. Overall peri-operative mortality was 28.8% (27.9-29.8). Peri-operative mortality for OAR was 32.1% (31.0-33.2) and for EVAR 17.9% (16.3-19.6), p < .001, and the adjusted OR was 0.38 (0.31-0.47), p < .001. The peri-operative mortality was 23.0% in EVAR(p) centres (20.6-25.4), 29.7% in OAR(p) centres (28.6-30.8), p < .001; adjusted OR = 0.60 (0.46-0.78), p < .001. Peri-operative mortality was lower in the highest volume centres (QI > 22 repairs per year), 23.3% (21.2-25.4) than in QII-V, 30.0% (28.9-31.1), p < .001. Peri-operative mortality after OAR was lower in high volume centres compared with the other centres, 25.3% (23.0-27.6) and 34.0% (32.7-35.4), respectively, p < .001. There was no significant difference in peri-operative mortality after EVAR between centres based on volume. Peri-operative mortality is lower in centres with a primary EVAR approach or with high case volume. Most repairs, however, are still performed in low volume centres and in centres with a primary OAR strategy. Reorganisation of acute vascular surgical services may improve outcomes of RAAA repair.
  • Dramatically improved survival in multiple myeloma patients in the recent decade: results from a Swedish population-based study.

    Thorsteinsdottir, Sigrun; Dickman, Paul W; Landgren, Ola; Blimark, Cecilie; Hultcrantz, Malin; Turesson, Ingemar; Björkholm, Magnus; Kristinsson, Sigurdur Y; 1 Department of Internal Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland. 2 Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 4 Myeloma Service, Division of Hematologic Oncology, Memorial Sloan-Kettering Cancer Center, NY, USA. 5 Department of Internal Medicine, Hematology Section, Sahlgrenska University Hospital, Gothenburg, Sweden. 6 Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden. 7 Department of Hematology and Coagulation Disorders, Skane University Hospital, Malmo, Sweden. 8 Department of Internal Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland sigyngvi@hi.is. (Ferrata Storti Foundation, 2018-09-01)
  • Menntun, störf og tækifæri hér og erlendis

    Júlíana Sigurveig Guðjónsdóttir; Agnar Óli Snorrason (Sjúkraliðafélag Íslands, 2018-10)
  • Adrenergic and metabolic effects of electrical weapons: review and meta-analysis of human data.

    Kunz, S N; Calkins, H G; Adamec, J; Kroll, M W; [ 1 ] Landspitali Univ Hosp, Dept Forens Pathol, IS-101 Reykjavik, Iceland Show more [ 2 ] Johns Hopkins Med Inst, Baltimore, MD 21205 USA Show more [ 3 ] Ludwig Maximilians Univ Munchen, Inst Forens Med, Munich, Germany Show more [ 4 ] Univ Minnesota, Dept Biomed Engn, Minneapolis, MN USA Show more [ 5 ] Calif Polytech Inst, San Luis Obispo, CA USA (Springer, 2018-09-01)
    Electronic control with the CEW (conducted electrical weapon) has gained widespread acceptance as the preferred force option due to its significant injury reduction. However, a CEW application does stress the human body. In the case of the CEW, the human body response is similar to the challenge of physical exercise combined with emotional stress over a very short time interval. There has been concern whether the tension of the skeletal-muscle system together with the emotional stress of being exposed to the effects of a CEW, can lead to severe metabolic dysfunction. A systematic and careful search of the MedLine database was performed to find publications describing pathophysiological effects of CEWs. Additional publications were collected through a manual search of reference lists in retrieved articles. After preliminary exclusions, we carefully reviewed the remaining publications and found 24 papers reporting prospective human clinical research data on adrenergic, ventilation, or metabolic effects. Where there were multiple studies on the same endpoints, we performed meta-analyses. A CEW exposure provides a clinically insignificant increase in heart rate (7.5 BPM) and a drop in both systolic and diastolic blood pressure. Alpha-amylase goes down but cortisol levels increase-both epinephrine and norepinephrine levels are increased by levels similar to mild exercise. A CEW exposure increases ventilation but does not appear to interfere with gas exchange. Lactate is increased slightly while the pH is decreased slightly with changes equivalent to mild exercise. The lactate and pH changes appear quickly and do not appear to be affected by increasing the exposure duration from 5 to 30 s. Thorough review and meta-analyses show that electrical weapon exposures have mixed and mild adrenergic effects. Ventilation is increased and there are metabolic changes similar to mild exercise.
  • Frá bræðralagi til fagmennsku. Siðferðileg viðmið íslenskra lækna í hundrað ár. Vilhjálmur Árnason

    Vilhjálmur Árnason; Prófessor í heimspeki við Háskóla Íslands (Læknafélag Íslands, 2018-09)
    Læknar hafa frá öndverðu haft siðferðileg viðmið í starfi sínu. Elsta og þekktasta dæmið er eiðurinn sem kenndur er við gríska lækninn Hippókrates (460-370 f. Kr.). Segja má að hinn siðferðilegi kjarni eiðsins sé fólginn í þessu ákvæði: „Ég heiti því að beita læknisaðgerðum til líknar sjúkum, eftir því sem ég hef vit á og getu til, en aldrei í því skyni að valda miska eða tjóni.“1 Hér er velferð sjúklingsins í fyrirrúmi og enn er vísað til kröfunnar primum non nocere, umfram allt valdið ekki miska, sem meginsiðareglu læknislistarinnar. Samkvæmt nútímalegri greiningu á siðareglum eru slík ákvæði um að gæta hagsmuni sjúklinga hluti af frumskyldum lækna.2,3 Aðrir meginflokkar siðareglna eru félagslegar skyldur við almenning og samfélag, hæfniskyldur að viðhalda þekkingu og færni og skyldur gagnvart starfssystkinum (stundum nefndar bróðurlegar skyldur).
  • Ormur í auga og endurteknar bólgur á útlimum - Sjúkratilfelli

    Davíð Þór Bragason; María Soffía Gottfreðsdóttir; Birgir Jóhannsson; Magnús Gottfreðsson; 1) 2) Augndeild Landspítala 3) 4) Smitsjúkdómadeild Landspítala (Læknafélag Íslands, 2018-09)
    Lýst er tveimur tilfellum af lóasýki hjá konum búsettum hér á landi, 35 ára konu sem fæddist í Afríku og 31 árs konu sem hafði ferðast um Afríku. Þær leituðu til læknis vegna óþæginda frá auga. Við skoðun sást í báðum tilfellum ormur, um 3 cm á lengd og 0,5 mm á breidd, sem hreyfðist undir slímhúð augans. Báðar konurnar höfðu einnig einkenni frá útlimum: endurteknar lotubundnar bólgur og kláða, og vöðvaverki. Greiningin var í báðum tilfellum lóasýki með Calabar-bólgum á útlimum og meðferð með albendazóli og díetýlcarbamazíni leiddi til lækningar. Aukinnar árvekni er þörf gagnvart sýkingum sem hafa verið sjaldgæfar í okkar heimshluta hingað til.

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