RSS 1.0Case of the month (Sjúkratilfelli mánaðarins) Articles in Icelandic
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Truflun á starfsemi heiladinguls vegna ópíóíða - Sjúkratilfelli(Læknafélag Íslands, 2018-07)Sjötíu og sjö ára kona með flöguþekjukrabbamein í endaþarmsopi var lögð inn vegna slappleika, niðurgangs og ógleði, en hún hafði einnig glímt við bakverki vegna samfallsbrots. Vegna verkjanna var hún meðhöndluð með sterkum ópíóíðum en hrakaði klínískt í kjölfarið með lækkandi blóðþrýstingi, versnandi öndunarstarfsemi og brenglun á blóðsöltum. Gildi kortisóls, TSH og LH mældust lækkuð og prólaktíns vægt hækkað, en nýrnahettuörvunarpróf (Synacthen-próf) og segulómskoðun af heila reyndust eðlileg. Vaknaði þá grunur um að ópíóíðameðferð hefði valdið truflun á starfsemi heiladinguls. Var því hafin sykursterauppbót með hýdrókortisóni með góðum klínískum árangri. Hér er tilfellinu lýst og greint frá alvarlegri en minna þekktri aukaverkun ópíóíða.
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Sjúklingatilfelli frá Tannlæknadeild Háskóla Íslands – Partagerð(Tannlæknafélag Íslands, 2016)
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Beriberi áratug eftir magahjáveituaðgerð – sjúkratilfelli(Læknafélag Íslands, Læknafélag Reykjavíkur, 2016-11-03)
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Tilfelli mánaðarins – aðskotahlutur í auga(Læknafélag Íslands, Læknafélag Reykjavíkur, 2016-10-06)
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Endurtekin krampaköst hjá ungri konu – sjúkratilfelli(Læknafélag Íslands, Læknafélag Reykjavikur, 2016-07-05)A previously healthy 18 year old female has repeated admissions over a six week period to the emergency department because of seizures. She has no previous history of epilepsy and denies any drug use. Imaging and electroencephalogram do not indicate epilepsy. Blood sugar levels are low on two occasions, 1.3 mmol / L and 1.7mmól / L (4.0 - 6.0 mmol / L). After further investigations the suspicion of an insulin-producing tumor arises. Extensive research and imaging is conducted to look for tumor growth without any findings. Subsequently she was sent abroad for further evaluation with a 11C-5HTP-PET scan, selective angiography with celiacography and an intra-arterial calcium stimulation test. She was diagnosed with nesidioblastosis. Here we will discuss the presentation and work-up of the medical case and review this rare causative disease
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Rof á efri bogagöngum – sjúkratilfelli(Læknafélag Íslands, Læknafélag Reykjavikur, 2016-04)
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Miðaldra prófessor með verk í vísifingri(Læknafélag Íslands, Læknafélag Reykjavikur, 2015-12)
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Kona á níræðisaldri með mæði og surg við öndun(Læknafélag Íslands, Læknafélag Reykjavikur, 2015-10)
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Útbrot og kláði eftir Asíuferð – sjúkratilfelli(Læknafélag Íslands, Læknafélag Reykjavikur, 2015-09)
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Brátt blóðþurrðarslag hjá unglingsstúlku - sjúkratilfelli(Læknafélag Íslands, Læknafélag Reykjavikur, 2015)During soccer practice a fifteen year old girl experienced a sudden onset of pain in the left side of her neck and collapsed. Upon arrival at the emergency room she had right hemiparesis and expressive aphasia. On CT angiography a left carotid arterial dissection was suspected. Symptoms improved during the first threedays but worsened again on the fourth and a CT scan showed an ischemic area in the brain. Conventional angiography showed decreased perfusion in the left middle cerebral artery but no evidence of dissection or thrombus. The most likely diagnosis was thought to be reverse cerebral vasoconstriction syndrome and the girl was treated with calcium channel inhibitors. Here we report the case and review the literature.
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Sjaldgæft tilfelli af vöðvabandvefsæxli með bólgufrumuíferð í hægri kinnkjálka(Læknafélag Íslands, Læknafélag Reykjavikur, 2015-01)28 year old male with inflammatory myofibroblastic tumor in the right maxilla undergoes multiple surgeries for the removal of recurrent tumors over a period of 4 years and is without symptoms of recurrences today. Cells cultured from the tumor show stem cell properties that could contribute to the recurrent tumor growth. It is important to do a close follow up on patients with these traits and further recurrences cannot be excluded even though surgical edges are free of tumor growth.
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Próteinútfellingar í lungnablöðrum meðhöndlaðar með lungnaskoli(Læknafélag Íslands, Læknafélag Reykjavikur, 2014-11)Pulmonary alveolar proteinosis (PAP) is a rare lung disease of unknown origin, where an amorphous lipoprotein material accumulates in the alveoli of the lungs. We describe a young male with a four month history of progressive dyspnea, low grade fever, hypoxemia and weight loss. Chest X-ray showed diffuse interstitial and alveolar infiltrates in both lungs. The diagnosis of PAP was confirmed with trans-bronchial lung biopsy. Because of a deteriorating clinical course a whole lung lavage was performed. Under general anesthesia, both lungs were lavaged with warm saline in two different sessions with good results. Two years later the patient is almost free of symptoms and lung function has markedly improved.
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Tilfelli mánaðarins. Kona á fertugsaldri með kyngingarörðugleika og brjóstverki(Læknafélag Íslands, Læknafélag Reykjavíkur, 2013-11)
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Kalkkirtlablaðra í miðmæti – sjúkratilfelli(Læknafélag Íslands, Læknafélag Reykjavíkur, 2014-09)The most common causes of mediastinal masses are thymomas, lymphomas and neuromas. Mediastinal cysts, such as bronchogenic cysts, which are usually benign, are less common. We report the case of a 59-year-old woman with a history of progressive dysphagia. A computed tomography scan revealed a cystic lesion in the anterior mediastinum. The cyst was surgically resected and turned out to be a benign parathyroid cyst. The patient's symptoms disappeared after surgical removal. Both the serum calcium and parathyroid hormone levels were normal before, and after surgery. Parathyroid cysts are rare lesions of the mediastinum and only around 100 cases have been reported in literature. Here we report the first case of a mediastinal parathyroid cyst in Iceland.
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Osteochondral autoplasty of the extensive post-traumatic defect of the proximal tibia(Nizhny Novgorod State Medical Academy of the Ministry of Health of the Russian Federation, 2014)Application of the original method of autoplasty of the extensive osteochondral defect of the proximal part of the tibia from the posterior femoral condyle is described. A patient was operated on for the malunion of the intraarticular fracture of the lateral condyle of the tibia with the impression of osteochondral fragments. Autoplasty of the osteochondral defect of the tibia was performed from the posterior parts of the femur condyle, using fixation by tension-locked K -wires. Osteotomy zone for obtaining a transplant may vary depending on the intensity of the cartilage covering and condyle curvature. t he authors tried to exert minimum damage to the weight-bearing zones of the posterior femur condyle obtaining a sufficient size of the graft and zone of its coverage by the cartilage. t he remote result was evaluated in a year and 10 months after the operation and revealed neither misalignment of a clinical axis of the extremity, nor knee instability, and its full extension. t he patient performed full deep squats without any additional support. On the control radiograph the knee joint surface was congruent, any signs of loosening of metal components were not observed. r emodelling of the posterior femur condyle in the form of contour smoothing in the zone of osteotomy was noted. t he autoplasty technique used showed a high efficacy, and allowed to restore completely the function of the knee joint to the degree enabling participation in the sports activities.
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Risaæxli í hóstarkirtli – sjúkratilfelli(Læknafélag Íslands, Læknafélag Reykjavíkur, 2014)Thymomas are usually benign tumors and are most often found in the anterior mediastinum. We report a rare case of a giant tumor in the right hemithorax that originated in the thymus. The tumor was 15x8 cm and histology revealed a type AB thymoma. The tumor was removed and the patient is doing well and is without symptoms two years after the operation. Key words: Thymoma, abdominal pain, giant tumor, mediastinum.
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Emetophobia: sjúklegur ótti við uppköst og ógleði(Læknafélag Íslands, Læknafélag Reykjavíkur, 2014-05)Emetophobia is an intense, irrational fear or anxiety of or pertaining to vomiting. It is classified among specific phobias in ICD-10 and DSM-IV. This disorder is often hidden because of the shame associated with it among sufferers. As a result emetophobia has been studied less than most other anxiety disorders. Not much is known about the epidemiology, treatment and outcome of this disorder. We describe a woman in her thirties who has been living with emetophobia since she experienced emesis two successive Christmas Eves as a child. Subsequently her fear of vomiting has influenced many aspects of her daily life.
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Rauðkyrningabólga í vélinda í börnum - tvö sjúkratilfelli(Læknafélag Íslands, Læknafélag Reykjavíkur, 2013)Rauðkyrningabólga í vélinda er tiltölulega nýr sjúkdómur, fyrst lýst 1978, en hefur hlotið aukna athygli síðastliðinn áratug. Í fyrstu aðallega í börnum og unglingum en síðan einnig í fullorðnum. Í yngri börnum eru vanþrif og uppköst aðaleinkenni en í eldri börnum og fullorðnum kyngingarörðugleikar, brjóstverkir og jafnvel þrengingar í vélinda. Tengsl eru sterk við ofnæmi og orsökin er oftast viðbrögð við ákveðnum fæðuflokkum. Greining rauðkyrningabólgu er fyrst og fremst byggð á vefjasýnum frá vélindaspeglun en einnig þurfa að vera til staðar einkenni sem samrýmast bólgunni og jafnframt þarf að útiloka bakflæði sem undirliggjandi orsök rauðkyrningabólgu. Bólgan þarf að vera einskorðuð við vélinda. Meðferð er að forðast ákveðnar fæðutegundir og stundum lyfjameðferð. Í þessari samantekt lýsum við ólíkum birtingarformum þessa sjúkdóms í tveimur börnum.---------------------------------------------------------------------------------------------------------------------------------------------------------------Eosiniophilic Esophagitis (EoE) is a relatively new disease which was first reported in 1978 but increasingly diagnosed in the last 15 years. Initially EoE was mainly described in children but later also recognized in adults. In infants it presents as a food refusal, failure to thrive and vomiting. In older children and adults symptoms include chest pain dysphagia, oesophageal food impaction and even strictures on endoscopy. The etiology of EoE is often food allergy. Diagnosis is made on biopsies from the oesophagus and by excluding other causes of eosophageal eosinophilia. It is treated by eliminating the offending food groups or using local corticosteroids. We describe different presentation of eosinophilic esophagitis in two children and discuss diagnosis and treatment.
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Sjúkratilfelli – Mænudrep(Læknafélag Íslands, Læknafélag Reykjavíkur, 2013)Mænudrep vegna blóðþurrðar er sjaldgæft. Vel þekkt er að sjúkdómurinn orsakist af æðakölkun í ósæð eða komi sem fylgikvilli við aðgerð á ósæð. Einkenni sjúkdómsins geta líkst öðrum algengari sjúkdómum og erfitt getur verið að greina hann. Við lýsum tilfelli með drep í mænu af óþekktum toga og ræðum einkenni og horfur. Höfundum er ekki kunnugt um að tilfelli mænudreps hafi verið lýst áður í Læknablaðinu.-------------------------------------------------------------------------------------Spinal cord infarction is a rare disease. The disorder is well known as a result of aorta atherosclerosis or complication of aorta surgery. The disorder can mimic other diseases and be difficult to diagnose. We describe a special case of patient with idiopathic spinal cord infarction. Symptoms and prognosis of the disorder will also be discussed.
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Hjartastopp hjá unglingsstúlku – sjúkratilfelli(Læknafélag Íslands, Læknafélag Reykjavíkur, 2012-12)Hjartastopp er sjaldgæft hjá börnum og unglingum. Lýst er 12 ára stúlku sem fór í hjartastopp eftir brátt hjartadrep þar sem beita varð langvarandi hjartahnoði og hjarta- og lungnavél til að bjarga lífi hennar. Við kransæðaþræðingu vaknaði grunur um flysjun í vinstri kransæðarstofni og var því komið fyrir kransæðastoðneti. Samdráttur hjartans lagaðist og var hjarta- og lungnavélin aftengd viku síðar. Hún útskrifaðist heim en hálfu ári síðar sást endurþrenging í stoðnetinu og var því gerð kransæðahjáveituaðgerð. Á tölvusneiðmyndum sást að um meðfæddan galla var að ræða þar sem vinstri kransæðarstofn átti upptök frá hægri ósæðarbolla í stað þess vinstra. Tilfellið sýnir að kransæðamissmíð getur valdið lífshættulegu hjartadrepi.
