• Drep í fingrum í kjölfar ísetningar slagæðaleggja - sjúkratilfelli

      Atli Steinar Valgarðsson; Sigurbergur Kárason; Elín Laxdal; Kristín Huld Haraldsdóttir; 1 Skurðlækningadeild, 2 svæfinga- og gjörgæsludeild Landspítala, 3 læknadeild Háskóla Íslands. (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-12)
      Inngangur: Notkun slagæðaleggja er algeng hjá gjörgæslusjúklingum vegna þarfar fyrir rauntímaupplýsingar um blóðþrýsting og vökva­ástand sem notaðar eru til að stýra meðferð ásamt því að vera notaðir til blóðsýnatöku. Alvarlegir fylgikvillar eru afar sjaldgæfir, en varanlegur blóðþurrðarskaði kemur fyrir hjá færri en 0,1% sjúklinga. Tilfelli: Hér er sagt frá sjúklingi í sýklasóttarlosti á gjörgæsludeild sem gekkst undir aðgerð vegna rofs á skeifugörn. Á annarri viku komu fram einkenni blóðþurrðar í öllum fingrum vinstri handar. Sjúklingurinn var fjölveikur, hafði þurft háa skammta af æðavirkum lyfjum og þurfti endurtekið að skipta um slagæðaleggi í mismunandi slagæðum, meðal annars í sveifarslagæð og ölnarslagæð vinstri handar. Beitt var blóðþynnandi meðferð sem sjúklingurinn þoldi ekki vegna blæðinga frá meltingarvegi og því dregið úr henni. Átta vikum síðar hafði afmarkast drep í öllum fingrum vinstri handar og í kjölfarið var framkvæmd aðgerð þar sem hluti af fingrum II-V voru fjarlægðir en ekki þurfti að gera aðgerð á þumli. Orsök drepsins er talin vera margþætt, meðal annars undirliggjandi ástands sjúklings, blóðsegi eða blóðþurrð í kjölfar ísetningar slagæðaleggja. Ályktun: Hér er lýst vel þekktum en mjög sjaldgæfum fylgikvilla slagæðaleggsísetningar og lögð fram tillaga að meðferðarferli sjúklinga með einkenni um blóðþurrðardrep í fingrum.
    • Risafituæxli á kvið - sjúkratilfelli

      Bryndís Ester Ólafsdóttir; Halla Fróðadóttir; Rebekka Guðrún Rúnarsdóttir; Elsa Björk Valsdóttir; 1) 2) Skurðsviði Landspítala 3) meinafræðideild Landspítala 4) Skurðsviði Landspítala‚ læknadeild Háskóla Íslands (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-11)
      Fituæxli eru algeng góðkynja mjúkvefjaæxli, oftast lítil, hægvaxandi og einkennalaus. Hér er lýst tilfelli 52 ára konu í mikilli yfirþyngd sem leitaði læknis vegna stækkandi æxlis ofan við lífbein sem var á stærð við fótbolta. Æxlið hafði farið vaxandi síðustu 8 mánuði. Uppvinnsla gaf vísbendingu að um fituæxli væri að ræða. Sjúklingurinn undirgekkst aðgerð þar sem æxlið var fjarlægt. Vefjagreiningin sýndi fituæxli án illkynja vaxtar. Fituæxli eru fjarlægð þegar stærð þeirra er farin að valda einkennum eða útiloka þarf illkynja mein. Risafituæxli eru skilgreind sem fituæxli yfir 10 cm í þvermál eða sem vega meira en 1000 grömm.
    • Truflun á starfsemi heiladinguls vegna ópíóíða - Sjúkratilfelli

      Ásta Ísfold Jónasardóttir; Jakob Jóhannsson; Már Kristjánsson; Rafn Benediktsson; Ásta Ísfold Jónasdóttir 1, Jakob Jóhannsson 2, Már Kristjánsson 3, Rafn Benediktsson 1,4 - 1 Innkirtladeild, 2krabbameinslækningadeild 3smitsjúkdómadeild Landspítala, 4 læknadeild Háskóla Ísland (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.
    • Beriberi áratug eftir magahjáveituaðgerð – sjúkratilfelli

      Linda Ó. Árnadóttir; Svanur Sigurbjörnsson; Tómas Guðbjartsson; læknadeild Háskóla Íslands‚ skurðsviði Landspítala, slysa- og bráðadeild Landspítala (Læknafélag Íslands, Læknafélag Reykjavíkur, 2016-11-03)
    • Tilfelli mánaðarins – aðskotahlutur í auga

      Elín Björk Tryggvadóttir; Gunnar Már Zoega; Óskar Jónsson; Augndeild Landspítala, Sjónlag (Læknafélag Íslands, Læknafélag Reykjavíkur, 2016-10-06)
    • Endurtekin krampaköst hjá ungri konu – sjúkratilfelli

      Guðrún Mist Gunnarsdóttir; Arna Guðmundsdóttir; Per Hellman; Peter Stålberg; 1 Landspítala, 2 háskólasjúkrahúsinu í Uppsölum, Svíþjóð (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
    • Rof á efri bogagöngum – sjúkratilfelli

      Bryndís Baldvinsdóttir; Martina Vigdís Nardini; Ingvar Hákon Ólafsson; Ólafur Guðmundsson; Sigurður Stefánsson; Höfundar eru öll læknar. 1 Skurðlækningasviði, 2 heila- og taugaskurðdeild, 3 háls-, nef- og eyrnadeild Landspítala. (Læknafélag Íslands, Læknafélag Reykjavi­kur, 2016-04)
    • Sjúklingatilfelli frá Tannlæknadeild Háskóla Íslands – Partagerð

      Kristín Telma Halldórsdóttir; Ellen Flosadóttir; Tannlæknadeild Háskóla Íslands (Tannlæknafélag Íslands, 2016)
    • Miðaldra prófessor með verk í vísifingri

      Tómas Guðbjartsson; Engilbert Sigurðsson; Magnús Karl Magnússon; Læknadeild Háskóli Íslands (Læknafélag Íslands, Læknafélag Reykjavi­kur, 2015-12)
    • Kona á níræðisaldri með mæði og surg við öndun

      Sigríður María Kristinsdóttir; Elín Maríusdóttir; Jón Gunnlaugur Jónasson; Einar Steingrímsson; Tómas Guðbjartsson; 1 Læknadeild Háskóla Íslands, 2 hjarta- og lungnaskurðdeild, 3 meinafræðideild Landspítala, 4 Læknisfræðilegri myndgreiningu. (Læknafélag Íslands, Læknafélag Reykjavi­kur, 2015-10)
    • Útbrot og kláði eftir Asíuferð – sjúkratilfelli

      Guðmundur Dagur Ólafsson; Emil L. Sigurðsson; Bryndís Sigurðardóttir; Læknadeild Háskóla Íslands, Heilsugæslustöðinni Sólvangi, Hafnarfirði, Heimilislæknisfræði Háskóla Íslands, Smitsjúkdómadeild Landspítala (Læknafélag Íslands, Læknafélag Reykjavi­kur, 2015-09)
    • Sjaldgæft tilfelli af vöðvabandvefsæxli með bólgufrumuíferð í hægri kinnkjálka

      Hannes Halldórsson,; Ari Jón Arason,; Margrét Sigurðardóttir; Paolo Gargiulo,; Magnús Karl Magnússon,; Þórarinn Guðjónsson; Hannes Petersen; Líffærafræði læknadeildar Háskóla Íslands, rannsóknarstofu í stofnfrumufræðum við Lífvísindasetur Háskóla Íslands, blóðmeinafræðideild Landspítala, lyfja- og eiturefnafræðideild Háskóla Íslands, meinafræðideild Landspítala, heilbrigðisog taugaverkfræðisetur Háskólans í Reykjavík, háls-, nef- og eyrnadeild Landspítala (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.
    • Brátt blóðþurrðarslag hjá unglingsstúlku - sjúkratilfelli

      Anna Stefánsdóttir; Áskell Löve; Sóley Guðrún Þráinsdóttir; Pétur Lúðvígsson; Háskóli Íslands, Röntgendeild Landspítala , Taugadeild Landspítala, Barnaspítala Hringsins (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.
    • Próteinútfellingar í lungnablöðrum meðhöndlaðar með lungnaskoli

      Ragnheiður M. Jóhannesdóttir; Steinn Jónsson; Felix Valsson; Hrönn Harðardóttir; Ólöf R. Ámundadóttir; Eyþór Björnsson; Sigfús Nikulásson; Tómas Guðbjartsson; Landspítali Hringbraut, Læknadeild Háskóli Íslands (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.
    • Kalkkirtlablaðra í miðmæti – sjúkratilfelli

      Anna Höskuldsdóttir,; Höskuldur Kristvinsson,; Hallgrímur Guðjónsson,; Arnar Geirsson,; Tómas Guðbjartsson; Landspítali, hjarta- og lungnaskurðdeild, Landspítali, almennri skurðlækningadeild, landspítali, meltingarlækningadeild (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.
    • Emetophobia: sjúklegur ótti við uppköst og ógleði

      Kolfinna Snæbjarnardóttir; Engilbert Sigurðsson; Læknadeild Háskóla Íslands, geðsvið Landspítala (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.
    • Risaæxli í hóstarkirtli – sjúkratilfelli

      Elín Maríusdóttir; Karl Erlingur Oddason; Sigfús Nikulásson; Tómas Guðbjartsson; Hjarta- og lungnaskurðdeild, meinafræðideild Landspítala, Læknadeild Háskóla Íslands (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.
    • Osteochondral autoplasty of the extensive post-traumatic defect of the proximal tibia

      Malyshev EE,; Thormodsson HS,; Korolyov SB,; Pavlov DV,; Kuvshinov SG,; Department of Traumatology, Orthopedics and Field Surgery, Nizhny Novgorod State Medical Academy, Minin and Pozharsky Square, 10/1, Nizhny Novgorod, 603005, Russian Federation, Nizhny Novgorod Research Institute of Traumatology and Orthopedics, Ministry of Health of the Russian Federation, Verkhne-Volzhskaya naberezhnaya St., 18, Nizhny Novgorod, 603155, Russian Federation, Landspitali - The National University Hospital of Iceland, Norourmyri, 101, Reykjavik, Iceland (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.
    • Tilfelli mánaðarins. Kona á fertugsaldri með kyngingarörðugleika og brjóstverki

      Helena Árnadóttir; Hallgrímur Guðjónsson; Margrét Sigurðardóttir; Sigurður Blöndal; Tómas Guðbjartsson; Landspítali Hringbraut (Læknafélag Íslands, Læknafélag Reykjavíkur, 2013-11)
    • Sjúkratilfelli: Öndunarfæraeinkenni hjá sundmanni.

      Gunnar Guðmundsson; Læknadeild Háskóla Íslands. (Læknafélag Íslands, Læknafélag Reykjavíkur, 2013-02)
      A young competitive swimmer consulted a physician because of respiratory symptoms. He was found to have a normal spirometry. Bronchial asthma was diagnosed based on bronchial challenge test and appropriate treatment started. An overview is given on the rules of the National Sports Association on the treatment of asthma, which asthma medications are banned and how to apply for an exemption. Diagnostic studies for asthma are reviewed. In addition to spirometry before and after bronchodilatation, bronchial challenge tests and exercise tests are used. An overview of pathophysiology of swimmer's asthma is given and how it is connected to chloride that is used as a disinfectant. The incidence of asthma among competitive swimmers is reviewed.