Welcome to Hirsla, Landspítali University Hospital research archive

Hirsla is an open access repository, designed as a place to store, index, preserve and redistribute in digital format scholarly work of Landspitali employees. (A/H1N1)

  • Comparing osteonecrosis clinical phenotype, timing, and risk factors in children and young adults treated for acute lymphoblastic leukemia.

    Mogensen, Signe Sloth; Harila-Saari, Arja; Mäkitie, Outi; Myrberg, Ida Hed; Niinimäki, Riitta; Vestli, Anne; Hafsteinsdottir, Solveig; Griškevicius, Laimonas; Saks, Kadri; Hallböök, Helene; Retpen, Jens; Helt, Louise Rold; Toft, Nina; Schmiegelow, Kjeld; Frandsen, Thomas Leth; 1 Department of Pediatrics and Adolescent Medicine, the Juliane Marie Center, University Hospital Rigshospitalet, Copenhagen, Denmark. 2 Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. 3 Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden. 4 Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden. 5 Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland. 6 PEDEGO Research Unit, University of Oulu, Oulu, Finland. 7 Department of Pediatric Oncology and Hematology, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway. 8 Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland. 9 Department of Hematology, Oncology, and Transfusion Medicine Center, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania. 10 Faculty of Medicine, Vilnius University, Vilnius, Lithuania. 11 Department of Hematology Oncology, Tallinn Children´s Hospital, Tallinn, Estonia. 12 Department of Medical Sciences, Uppsala University, Uppsala, Sweden. 13 Department of Orthopedic Surgery, University Hospital Herlev Gentofte, Copenhagen, Denmark. 14 Department of Hematology, University Hospital Rigshospitalet, Copenhagen, Denmark. 15 Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark. (Wiley, 2018-10-01)
    Treatment-related osteonecrosis (ON) is a serious complication of treatment of acute lymphoblastic leukemia (ALL). This study included 1,489 patients with ALL, aged 1-45 years, treated according to the Nordic Society of Paediatric Haematology and Oncology ALL2008 protocol, using alternate-week dexamethasone during delayed intensification, with prospective registration of symptomatic ON. We aimed at comparing risk factors, timing, and clinical characteristics of ON in children and young adults. ON was diagnosed in 67 patients, yielding a 5-year cumulative incidence of 6.3%, but 28% in female adolescents. Median age at ALL diagnosis was 12.1 years and 14.9 years for females and males, respectively. At ON diagnosis, 59 patients had bone pain (91%) and 30 (46%) had multiple-joint involvement. The median interval between ALL and ON diagnosis was significantly shorter in children aged 1.0-9.9 years (0.7 years [range: 0.2-2.1]) compared with adolescents (1.8 years [range: 0.3-3.7, P < 0.001]) and adults (2.1 years [range: 0.4-5.3, P = 0.001]). Female sex was a risk factor in adolescent patients (hazard ratio [HR] = 2.1, 95% confidence interval [CI]: 1.1-4.2) but not in children aged 1.1-9.9 years (HR = 2.4, 95% CI: 0.9-6.2, P = 0.08) or adults aged 19-45 years (HR = 1.1, 95% CI: 0.3-4.0). Age above 10 years at ALL diagnosis (odds ratio [OR] = 3.7, P = 0.026) and multiple joints affected at ON diagnosis (OR = 3.4, P = 0.027) were risk factors for developing severe ON. We provide a detailed phenotype of patients with ALL with symptomatic ON, including description of risk factors and timing of ON across age groups. This awareness is essential in exploring measures to prevent development of ON.
  • Following the genetic clues towards treatment of hand OA.

    Jonsson, Helgi; Landspitali University Hospital, University of Iceland, Reykjavik, Iceland. helgi@hi.is. (Nature Pub. Group, 2018-09-01)
  • Accidental injuries among older adults: An incidence study.

    Gudnadottir, Maria; Thorsteinsdottir, Thordis Katrin; Mogensen, Brynjolfur; Aspelund, Thor; Thordardottir, Edda Bjork; 1 Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland. Electronic address: maria.gudnadottir@gmail.com. 2 Research Institute in Emergency Care, Landspitali, The National University Hospital of Iceland, Iceland; Faculty of Nursing, University of Iceland, Reykjavik, Iceland. Electronic address: thordith@landspitali.is. 3 Research Institute in Emergency Care, Landspitali, The National University Hospital of Iceland, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland. Electronic address: brynmog@landspitali.is. 4 Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Icelandic Heart Association, Iceland. Electronic address: thor@hi.is. 5 Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland. Electronic address: eddat@hi.is. (Elsevier, 2018-01-01)
    To date, the majority of studies assessing accidental injuries among the elderly have focused on fall injuries, while studies of other mechanisms of injuries have been lacking. Therefore, the main objective of this study was to investigate all injury-related visits among older adults to an emergency department and risk factors for injuries. Data were collected on all registered visits of adults, ≥67 years old, living in the capital of Iceland, to the emergency department of Landspitali, the National University Hospital, in 2011 and 2012. The yearly incidence rate for injuries was 106 per 1000 adults, ≥67 years old. Of all injuries (n = 4,469), falls were the most common mechanism of injury (78 per 1000), followed by being struck or hit (12 per 1000) and being crushed, cut or pierced (8 per 1000). Other mechanisms of injury, such as acute overexertion, foreign body in natural orifice, injuries caused by thermal and chemical effect and other and unspecified mechanism were less common (8 per 1000). Fractures were the most common consequences of injuries (36 per 1000). The most frequent place of injury was in or around homes (77 per 1000), with men being more likely than women to be injured outside of the home (60 per 1000 vs. 36 per 1000). Results indicate that falls are the main cause of accidental injuries, followed by being struck and hit injuries but other causes contributed to the rest. Falls constitute a major public health problem and fall-related injuries can have a substantial impact on the lives of older adults. As life expectancy continues to increase, fall risk is expected to increase. Since falls constitute a major impact on the lives of older adults and can lead to not only declines in physical activity and functional status, but to considerable health care costs, the health care system needs to intervene.
  • Menntun, störf og tækifæri hér og erlendis

    Júlíana Sigurveig Guðjónsdóttir; Agnar Óli Snorrason (Sjúkraliðafélag Íslands, 2018-10)
  • Low rate of reoperations after acute type A aortic dissection repair from The Nordic Consortium Registry.

    Pan, Emily; Gudbjartsson, Tomas; Ahlsson, Anders; Fuglsang, Simon; Geirsson, Arnar; Hansson, Emma C; Hjortdal, Vibeke; Jeppsson, Anders; Järvelä, Kati; Mennander, Ari; Nozohoor, Shahab; Olsson, Christian; Wickbom, Anders; Zindovic, Igor; Gunn, Jarmo; 1 Heart Center, Turku University Hospital, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland. 2 Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 3 Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Orebro, Sweden; School of Health and Medicine, Orebro University, Orebro, Sweden. 4 Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Skejby, Denmark. 5 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 6 Heart Center, Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland. 7 Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden; Clinical Sciences, Lund University, Lund, Sweden. 8 Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden. 9 Heart Center, Turku University Hospital, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland. Electronic address: jarmo.gunn@tyks. (MOSBY-ELSEVIER, 2018-09-01)
    To describe the relationship between the extent of primary aortic repair and the incidence of reoperations after surgery for type A aortic dissection. A retrospective cohort of 1159 patients treated for type A aortic dissection at eight Nordic low- to medium-sized cardiothoracic centers from 2005 to 2014. Data were gathered from patient records and national registries. Patients were separately divided into 3 groups according to the distal anastomoses technique (ascending aorta [n = 791], hemiarch [n = 247], and total arch [n = 66]), and into 2 groups for proximal repair (aortic root replacement [n = 285] and supracoronary repair [n = 832]). Freedom from reoperation was estimated with cumulative incidence survival and Fine-Gray competing risk regression model was used to identify independent risk factors for reoperation. The median follow-up was 2.7 years (range, 0-10 years). Altogether 51 out of 911 patients underwent reoperation. Freedom from distal reoperation at 5 years was 96.9%, with no significant difference between the groups (P = .22). Freedom from proximal reoperation at 5 years was 97.8%, with no difference between the groups (P = .84). Neither DeBakey classification nor the extent of proximal or distal repair predicted freedom from a later reoperation. The only independent risk factor associated with a later proximal reoperation was a history of connective tissue disease. Type A aortic dissection repair in low- to medium-volume centers was associated with a low reoperation rate and satisfactory midterm survival. The extent of the primary repair had no significant influence on reoperation rate or midterm survival.

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