Now showing items 1-20 of 6528

    • 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.
    • Sex differences in the spatial distribution of bone in relation to incident hip fracture: Findings from the AGES-Reykjavik study.

      Marques, Elisa A; Carballido-Gamio, Julio; Gudnason, Vilmundur; Sigurdsson, Gunnar; Sigurdsson, Sigurdur; Aspelund, Thor; Siggeirsdottir, Kristin; Launer, Lenore; Eiriksdottir, Gudny; Lang, Thomas; Harris, Tamara B; 1 National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA. Electronic address: emarques@ismai.pt. 2 Department of Radiology, School of Medicine, University of Colorado Denver, Denver, CO, USA. 3 Icelandic Heart Association Research Institute, Kópavogur, Iceland; University of Iceland, Reykjavik, Iceland. 4 Icelandic Heart Association Research Institute, Kópavogur, Iceland; University of Iceland, Reykjavik, Iceland; Landspitalinn University Hospital, Reykjavik, Iceland. 5 Icelandic Heart Association Research Institute, Kópavogur, Iceland. 6 Icelandic Heart Association Research Institute, Kópavogur, Iceland; Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland. 7 National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA. 8 Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA. (Elsevier Science, 2018-09-01)
      In this case-cohort study, we used data-driven computational anatomy approaches to assess within and between sex spatial differences in proximal femoral bone characteristics in relation to incident hip fracture. One hundred male and 234 female incident hip fracture cases, and 1047 randomly selected noncase subcohort participants (562 female) were chosen from the population-based AGES-Reykjavik study (mean age of 77 years). The baseline -i.e. before hip fracture- hip quantitative computed tomography scans of these subjects were analyzed using voxel-based morphometry, tensor-based morphometry, and surface-based statistical parametric mapping to assess the spatial distribution of volumetric bone mineral density (vBMD), internal structure, and cortical bone properties (thickness, vBMD and trabecular vBMD adjacent to the endosteal surface) of the proximal femur, respectively, in relation to incident hip fracture. Results showed that in both men and women: 1) the superior aspect of the femoral neck and the trochanteric region (except for cortical bone thickness) were consistently identified as being associated with incident hip fracture, and 2) differences in bone properties between noncases and incident hip fracture cases followed similar trends, were located at compatible regions, and manifested heterogeneity in the spatial distribution of their magnitude with focal regions showing larger differences. With respect to sex differences, most of the regions with a significant interaction between fracture group and sex showed: 1) differences of greater magnitude in men between noncases and incident hip fracture cases with different spatial distributions for all bone properties with the exception of cortical bone thickness, and 2) that while most of these regions showed better bone quality in male cases than in female cases, female cases showed higher vBMD in the principal compressive group and higher endotrabecular vBMD at several regions including the anterior, posterior, and lateral aspects of the proximal femur. These findings indicate the value of these image analysis techniques by providing unique information about the specific patterns of bone deterioration associated with incident hip fracture and their sex differences, highlighting the importance of looking to men and women separately in the assessment of hip fracture risk.
    • Interactions between drugs and geriatric syndromes in nursing home and home care: results from Shelter and IBenC projects.

      Onder, Graziano; Giovannini, Silvia; Sganga, Federica; Manes-Gravina, Ester; Topinkova, Eva; Finne-Soveri, Harriet; Garms-Homolová, Vjenka; Declercq, Anja; van der Roest, Henriëtte G; Jónsson, Pálmi V; van Hout, Hein; Bernabei, Roberto; [ 1 ] Univ Cattolica Sacro Cuore, Dept Gerontol Neurosci & Orthoped, Ctr Med Invecchiamento, Largo F Vito 1, I-00168 Rome, Italy Show more [ 2 ] Charles Univ Prague, Dept Geriatr & Gerontol, Fac Med 1, Prague, Czech Republic Show more [ 3 ] Univ South Bohemia, Fac Hlth & Social Sci, Ceske Budejovice, Czech Republic Show more [ 4 ] Natl Inst Hlth & Welf, Helsinki, Finland [ 5 ] HTW Berlin Univ Appl Sci, Dept Econ & Law, Berlin, Germany Show more [ 6 ] Katholieke Univ Leuven, LUCAS, Leuven, Belgium Show more [ 7 ] Katholieke Univ Leuven, Ctr Sociol Res, Leuven, Belgium Show more [ 8 ] Vrije Univ Amsterdam Med Ctr, Amsterdam Publ Hlth Inst, Dept Gen Practice & Elderly Care Med, Amsterdam, Netherlands Show more [ 9 ] Univ Iceland, Dept Geriatr, Fac Med, Landspitali Univ Hosp, Reykjavik, Iceland (Springer, 2018-09-01)
      Drugs may interact with geriatric syndromes by playing a role in the continuation, recurrence or worsening of these conditions. Aim of this study is to assess the prevalence of interactions between drugs and three common geriatric syndromes (delirium, falls and urinary incontinence) among older adults in nursing home and home care in Europe. We performed a cross-sectional multicenter study among 4023 nursing home residents participating in the Services and Health for Elderly in Long-TERm care (Shelter) project and 1469 home care patients participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Exposure to interactions between drugs and geriatric syndromes was assessed by 2015 Beers criteria. 790/4023 (19.6%) residents in the Shelter Project and 179/1469 (12.2%) home care patients in the IBenC Project presented with one or more drug interactions with geriatric syndromes. In the Shelter project, 288/373 (77.2%) residents experiencing a fall, 429/659 (65.1%) presenting with delirium and 180/2765 (6.5%) with urinary incontinence were on one or more interacting drugs. In the IBenC project, 78/172 (45.3%) participants experiencing a fall, 80/182 (44.0%) presenting with delirium and 36/504 (7.1%) with urinary incontinence were on one or more interacting drugs. Drug-geriatric syndromes interactions are common in long-term care patients. Future studies and interventions aimed at improving pharmacological prescription in the long-term care setting should assess not only drug-drug and drug-disease interactions, but also interactions involving geriatric syndromes.
    • 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.
    • MAP1B mutations cause intellectual disability and extensive white matter deficit.

      Walters, G Bragi; Gustafsson, Omar; Sveinbjornsson, Gardar; Eiriksdottir, Valgerdur K; Agustsdottir, Arna B; Jonsdottir, Gudrun A; Steinberg, Stacy; Gunnarsson, Arni F; Magnusson, Magnus I; Unnsteinsdottir, Unnur; Lee, Amy L; Jonasdottir, Adalbjorg; Sigurdsson, Asgeir; Jonasdottir, Aslaug; Skuladottir, Astros; Jonsson, Lina; Nawaz, Muhammad S; Sulem, Patrick; Frigge, Mike; Ingason, Andres; Love, Askell; Norddhal, Gudmundur L; Zervas, Mark; Gudbjartsson, Daniel F; Ulfarsson, Magnus O; Saemundsen, Evald; Stefansson, Hreinn; Stefansson, Kari; 1 deCODE genetics/Amgen, Reykjavik, 101, Iceland. 2 Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland. 3 Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 405 30, Sweden. 4 Department of Radiology, Landspitali University Hospital, Fossvogur, Reykjavik, 108, Iceland. 5 School of Engineering and Natural Sciences, University of Iceland, Reykjavik, 101, Iceland. 6 Faculty of Electrical and Computer Engineering, University of Iceland, Reykjavik, 101, Iceland. 7 The State Diagnostic and Counselling Centre, Kopavogur, 200, Iceland. 8 deCODE genetics/Amgen, Reykjavik, 101, Iceland. hreinn@decode.is. 9 deCODE genetics/Amgen, Reykjavik, 101, Iceland. kstefans@decode.is. 10 Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland. kstefans@decode.is. (Nature Publishing Group, 2018-08-27)
      Discovery of coding variants in genes that confer risk of neurodevelopmental disorders is an important step towards understanding the pathophysiology of these disorders. Whole-genome sequencing of 31,463 Icelanders uncovers a frameshift variant (E712KfsTer10) in microtubule-associated protein 1B (MAP1B) that associates with ID/low IQ in a large pedigree (genome-wide corrected P = 0.022). Additional stop-gain variants in MAP1B (E1032Ter and R1664Ter) validate the association with ID and IQ. Carriers have 24% less white matter (WM) volume (β = -2.1SD, P = 5.1 × 10
    • Genetic association analysis identifies variants associated with disease progression in primary sclerosing cholangitis.

      Alberts, Rudi; de Vries, Elisabeth M G; Goode, Elizabeth C; Jiang, Xiaojun; Sampaziotis, Fotis; Rombouts, Krista; Böttcher, Katrin; Folseraas, Trine; Weismüller, Tobias J; Mason, Andrew L; Wang, Weiwei; Alexander, Graeme; Alvaro, Domenico; Bergquist, Annika; Björkström, Niklas K; Beuers, Ulrich; Björnsson, Einar; Boberg, Kirsten Muri; Bowlus, Christopher L; Bragazzi, Maria C; Carbone, Marco; Chazouillères, Olivier; Cheung, Angela; Dalekos, Georgios; Eaton, John; Eksteen, Bertus; Ellinghaus, David; Färkkilä, Martti; Festen, Eleonora A M; Floreani, Annarosa; Franceschet, Irene; Gotthardt, Daniel Nils; Hirschfield, Gideon M; Hoek, Bart van; Holm, Kristian; Hohenester, Simon; Hov, Johannes Roksund; Imhann, Floris; Invernizzi, Pietro; Juran, Brian D; Lenzen, Henrike; Lieb, Wolfgang; Liu, Jimmy Z; Marschall, Hanns-Ulrich; Marzioni, Marco; Melum, Espen; Milkiewicz, Piotr; Müller, Tobias; Pares, Albert; Rupp, Christian; Rust, Christian; Sandford, Richard N; Schramm, Christoph; Schreiber, Stefan; Schrumpf, Erik; Silverberg, Mark S; Srivastava, Brijesh; Sterneck, Martina; Teufel, Andreas; Vallier, Ludovic; Verheij, Joanne; Vila, Arnau Vich; Vries, Boudewijn de; Zachou, Kalliopi; Chapman, Roger W; Manns, Michael P; Pinzani, Massimo; Rushbrook, Simon M; Lazaridis, Konstantinos N; Franke, Andre; Anderson, Carl A; Karlsen, Tom H; Ponsioen, Cyriel Y; Weersma, Rinse K; 1 Department of Gastroenterology and Hepatology, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands. 2 Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. 3 Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK. 4 Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK. 5 Norwegian PSC Research Center, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 6 Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 7 Department of Surgery, Wellcome Trust-Medical Research Council Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK. 8 Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK. 9 Institute for Liver and Digestive Health, University College London, Royal Free Hospital, London, UK. 10 Department of Gastroenterology Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. 11 Integrated Research and Treatment Center-Transplantation (IFB-tx) Hannover Medical School, Hannover, Germany. 12 Division of Gastroenterology and Hepatology, University of Alberta, Edmonton, Alberta, Canada. 13 Department of Medicine, Division of Hepatology, University of Cambridge, Cambridge, UK. 14 Department of Clinical Medicine, Division of Gastroenterology, Sapienza University of Rome, Rome, Italy. 15 Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. 16 Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 17 Department of Internal Medicine, Division of Gastroenterology and Hepatology, Landspitali University Hospital, Reykjavik, Iceland. 18 K G Jebsen Inflammation Research Centre and Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 19 Division of Gastroenterology and Hepatology, University of California Davis, Davis, California, USA. 20 Sapienza University of Rome, Medico-Surgical Sciences and Biotechnologies, Rome, Italy. 21 Department of Medicine and Surgery, Program for Autoimmune Liver Diseases, International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy. 22 Department of Hepatology, AP-HP, Hôpital Saint Antoine, Paris, France. 23 General Internal Medicine, University Health Network, Toronto General Hospital, Toronto, Canada. 24 Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece. 25 Division of Gastroenterology and Hepatology, Mayo Clinic Minnesota, Rochester, Minnesota, USA. 26 Department of Medicine, Snyder Institute of Chronic Diseases, University of Calgary, Calgary, Canada. 27 Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany. 28 Department of Medicine, Division of Gastroenterology, Helsinki University Hospital, Helsinki, Finland. 29 Department of Surgical Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy. 30 Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy. 31 Department of Medicine, University Hospital of Heidelberg, Heidelberg, Germany. 32 Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham, UK. 33 Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands. 34 Department of Medicine II, Liver Center Munich, University of Munich, Munich, Germany. 35 Popgen Biobank, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany. 36 Institute for Epidemiology, Christian-Albrechts University, Kiel, Germany. 37 Wellcome Trust Genome Campus, Wellcome Trust Sanger Institute, Cambridge, UK. 38 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden. 39 Department of Gastroenterology, Università Politecnica delle Marche, Ospedali Riuniti University Hospital, Ancona, Italy. 40 Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland. 41 Department of Internal Medicine Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. 42 Liver Unit Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain. 43 Department of Internal Medicine IV, University Hospital of Heidelberg, Heidelberg, Germany. 44 Department of Medicine I, Krankenhaus Barmherzige Brüder, Munich, Germany. 45 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 46 Department for General Internal Medicine, Christian-Albrechts-University, Kiel, Germany. 47 Section of Gastroenterology, Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 48 Inflammatory Bowel Disease (IBD) Group Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital Toronto, Ontario, Canada. 49 Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 50 1st Department of Medicine, University of Mainz, Mainz, Germany. 51 Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands. 52 Department of Internal Medicine, University of Thessaly, Larissa, Greece. 53 Department of Hepatology, John Radcliffe University Hospitals NHS Trust, Cambridge, UK. (BMJ Publishing Group, 2018-01-01)
      Primary sclerosing cholangitis (PSC) is a genetically complex, inflammatory bile duct disease of largely unknown aetiology often leading to liver transplantation or death. Little is known about the genetic contribution to the severity and progression of PSC. The aim of this study is to identify genetic variants associated with PSC disease progression and development of complications. We collected standardised PSC subphenotypes in a large cohort of 3402 patients with PSC. After quality control, we combined 130 422 single nucleotide polymorphisms of all patients-obtained using the Illumina immunochip-with their disease subphenotypes. Using logistic regression and Cox proportional hazards models, we identified genetic variants associated with binary and time-to-event PSC subphenotypes. We identified genetic variant rs853974 to be associated with liver transplant-free survival (p=6.07×10 We present a large international PSC cohort, and report genetic loci associated with PSC disease progression. For liver transplant-free survival, we identified a genome-wide significant signal and demonstrated expression of the candidate gene
    • Systems analysis of metabolism in platelet concentrates during storage in platelet additive solution.

      Jóhannsson, Freyr; Guðmundsson, Steinn; Paglia, Giuseppe; Guðmundsson, Sveinn; Palsson, Bernhard; Sigurjónsson, Ólafur E; Rolfsson, Óttar; [ 1 ] Univ Iceland, Ctr Syst Biol, Sturlugata 8, Reykjavik, Iceland Show more [ 2 ] Univ Iceland, Med Dept, Sturlugata 8, Reykjavik, Iceland Show more [ 3 ] European Acad Bolzano Bozen, Ctr Biomed, Via Galvani 31, Bolzano, Italy Show more [ 4 ] Landspitali Univ Hosp, Blood Bank, Snorrabraut 60, Reykjavik, Iceland Show more [ 5 ] Reykjavik Univ, Sch Sci & Engn, Menntavegur 1, Reykjavik, Iceland (Portland Press, 2018-07-17)
      Platelets (PLTs) deteriorate over time when stored within blood banks through a biological process known as PLT storage lesion (PSL). Here, we describe the refinement of the biochemical model of PLT metabolism, iAT-PLT-636, and its application to describe and investigate changes in metabolism during PLT storage. Changes in extracellular acetate and citrate were measured in buffy coat and apheresis PLT units over 10 days of storage in the PLT additive solution T-Sol. Metabolic network analysis of these data was performed alongside our prior metabolomics data to describe the metabolism of fresh (days 1-3), intermediate (days 4-6), and expired (days 7-10) PLTs. Changes in metabolism were studied by comparing metabolic model flux predictions of iAT-PLT-636 between stages and between collection methods. Extracellular acetate and glucose contribute most to central carbon metabolism in PLTs. The anticoagulant citrate is metabolized in apheresis-stored PLTs and is converted into aconitate and, to a lesser degree, malate. The consumption of nutrients changes during storage and reflects altered PLT activation profiles following their collection. Irrespective of the collection method, a slowdown in oxidative phosphorylation takes place, consistent with mitochondrial dysfunction during PSL. Finally, the main contributors to intracellular ammonium and NADPH are highlighted. Future optimization of flux through these pathways provides opportunities to address intracellular pH changes and reactive oxygen species, which are both of importance to PSL. The metabolic models provide descriptions of PLT metabolism at steady state and represent a platform for future PLT metabolic research.
    • 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.
    • Garnaflækja á bugaristli á Landspítala 2000-2013

      Hörður Már Kolbeinsson; Birta Dögg Ingudóttir Andrésdóttir; Pétur H. Hannesson; Elsa Björk Valsdóttir; Páll Helgi Möller; Hörður Már Kolbeinsson, Skurðlækningadeild Landspítala - Birta Dögg Ingudóttir Andrésdóttir, Skurðlækningadeild Landspítala - Pétur H. Hannesson, röntgendeild Landspítala‚ læknadeild Háskóla Íslands - Elsa Björk Valsdóttir, Skurðlækningadeild Landspítala‚ læknadeild Háskóla Íslands Páll Helgi Möller læknir‚ Skurðlækningadeild Landspítala‚ læknadeild Háskóla Íslands
      Inngangur Garnaflækja á bugaristli er sjaldgæf orsök garnastíflu í flestum vestrænum löndum. Kjörmeðferð er ristilspeglun og síðar skurðaðgerð. Tilgangur rannsóknarinnar var að kanna meðferð og horfur garnaflækju á bugaristli á Landspítala. Efniviður og aðferðir Framkvæmd var afturskyggn rannsókn á einstaklingum sem greindust með garnaflækju á bugaristli á Landspítala á árunum 2000-2013. Farið var yfir sjúkraskrár og skráð kyn, aldur, legutími, meðferð, fylgikvillar meðferðar, vefjagreining og tíðni endurkomu. Niðurstöður Heildarfjöldi sjúklinga var 49; 29 karlar og 20 konur (1,5:1). Meðalaldur var 74 ár (bil: 25-93). Einn sjúklingur fór beint í bráða aðgerð vegna gruns um lífhimnubólgu, aðrir (n=48) voru meðhöndlaðir með ristilspeglun (n=45), skuggaefnisinnhellingu um endaþarm og endaþarmsröri (n=2) eða einungis endaþarmsröri (n=1). Þrír enduðu í bráðaaðgerð sökum misheppnaðrar ristilspeglunar en 8 sjúklingar fóru í skipulagða aðgerð í legunni. Þrjátíu og sex útskrifuðust eftir íhaldssama meðferð með ristilspeglun (n=35), innhellingu (n=1) eða endaþarmsröri (n=1). Tveir sjúklingar lögðust inn síðar til valaðgerðar á ristli. Tuttugu og tveir (61%) fengu endurkomu sjúkdóms. Miðgildi tíma að endurkomu var 101 dagur (bil: 1-803). Líkur á að fá ekki endurkomu eftir þrjá mánuði, 6 mánuði og 24 mánuði voru 66%, 55% og 22%. Heildardánartíðni (innan 30 daga) var 10,2%. Dánartíðni eftir bráðaaðgerðir var 25% (1/4) en 16,6% eftir skipulagðar aðgerðir (3/18). Ályktanir Meirihluti sjúklinga sem ekki fer í aðgerð í fyrstu innlögn fær endurkomu sjúkdóms. Heildardánartíðni vegna garnaflækju á bugaristli á Landspítala er lág en dánartíðni eftir skurðaðgerðir er há.
    • Ráðstefna LÍ og WMA - lífsiðfræðin í brennidepli á Íslandi

      Svanur Sigurbjörnsson (Læknafélag Íslands, 2018-09)
    • Nýliðun lækna

      Reynir Arngrímsson (Læknafélag Íslands, 2018-09)
    • Vísindastörf íslenskra lækna - framþróun fræðanna

      Þórður Harðarson; Guðmundur Þorgeirsson; Fyrrum prófessorar í lyflæknisfræði við Háskóla Íslands og Landspítala (Læknafélag Íslands, 2018-07)
    • Defining Clinical-Posturographic and Intra-Posturographic Discordances: What Do These Two Concepts Mean?

      Perrin, Philippe; Mallinson, Art; Van Nechel, Christian; Peultier-Celli, Laetitia; Petersen, Hannes; Magnusson, Mans; Kingma, Herman; Maire, Raphaël; 1 ] Univ Lorraine, Fac Med, Res Unit, EA 3450,DevAH Dev Adaptat & Handicap, Nancy, France [ 2 ] UFR STAP, Nancy, France Show more [ 3 ] Univ Hosp Nancy, Dept Pediat Otolaryngol, Nancy, France Show more [ 4 ] Univ British Columbia, Vancouver Gen Hosp, Div Otolaryngol, Unit Neurootol, Vancouver, BC, Canada Show more [ 5 ] Erasme Univ Hosp, Unit Neuroophthalmol, Brussels, Belgium Show more [ 6 ] Landspitali Univ Hosp, Dept Otorhinolaryngol, Reykjavik, Iceland Show more [ 7 ] Univ Hosp Lund, Clin Sci, Dept Otorhinolaryngol Head & Neck Surg, Lund, Sweden Show more [ 8 ] Maastricht Univ, Med Ctr, Dept Otorhinolaryngol Head & Neck Surg, Maastricht, Netherlands Show more [ 9 ] Tomsk Res State Univ, Fac Phys, Tomsk, Russia Show more [ 10 ] Lausanne Univ Hosp, Clin Otolaryngol Head & Neck Surg, Neurotol Unit, Lausanne, Switzerland (AVES, 2018-04-01)
      The European Society for Clinical Evaluation of Balance Disorders - ESCEBD - Executive Committee meets yearly to identify and address clinical equilibrium problems that are not yet well understood. This particular discussion addressed "discordances" (defined as "lack of agreement") in clinical assessment. Sometimes there is disagreement between a clinical assessment and measured abnormality (ies); sometimes the results within the assessment do not agree. This is sometimes thought of as "malingering" or an attempt to exaggerate what is wrong, but this is not always the case. The Committee discussed the clinical significance of unexpected findings in a patient's assessment. For example intraposturographic discordances sometimes exhibit findings (eg performance on more difficult trials may sometimes be better than on simpler trials). This can be suggestive of malingering, but in some situations can be a legitimate finding. The extreme malingerer and the genuine patient are at opposite ends of a spectrum but there are many variations along this spectrum and clinicians need to be cautious, as a posturography assessment may or may not be diagnostically helpful. Sometimes there is poor correlation between symptom severity and test results. Interpretation of posturography performance can at times be difficult and a patient's results must be correlated with clinical findings without stereotyping the patient. It is only in this situation that assessment in a diagnostic setting can be carried out in an accurate and unbiased manner.
    • 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.
    • Burðarmálsdauði á Íslandi 1988-2017

      Ragnhildur Hauksdóttir; Þórður Þórkelsson; Gestur Pálsson; Ragnheiður I Bjarnadóttir; Ragnhildur Hauksdóttir 1,4, Þórður Þórkelsson 1,2,3, Gestur Pálsson 1,2,3, Ragnheiður I. Bjarnadóttir 1,2,4 -1 Landspítali, 2 læknadeild Háskóla Íslands, 3 Barnaspítala Hringsins, 4 kvennadeild Landspítala. (Læknafélag Íslands, 2018-07)
      Inngangur Með burðarmálsdauða er átt við fæðingu andvana barns eða dauða þess á fyrstu 7 dögunum eftir fæðingu. Tíðni burðarmálsdauða á Íslandi hefur verið ein sú allra lægsta í heiminum undanfarin ár. Markmið rannsóknarinnar var að kanna hvernig tíðni og orsakir burðarmálsdauða hafa breyst á síðastliðnum 30 árum, einkum til að meta hvort hugsanlega sé hægt að lækka tíðnina enn frekar. Efniviður og aðferðir Gerð var afturskyggn rannsókn og var rannsóknartímabilið 1988-2017. Upplýsingar um þau börn sem dóu á burðarmálsskeiði voru fengnar úr Fæðingaskrá og þau flokkuð samkvæmt NBPDC-flokkunarkerfi, sem byggist á að skilgreina þá flokka burðarmálsdauða sem hugsanlega væri hægt að fyrirbyggja. Breyting á burðarmálsdauða var reiknuð út sem árleg prósentubreyting með Poisson-aðhvarfsgreiningu. Niðurstöður Tíðni burðarmálsdauða lækkaði að meðaltali um 3,3% (p<0,001) á ári á tímabilinu miðað við ≥28+0 vikna meðgöngu. Börnum sem létust vegna meðfæddra galla fækkaði um 4,8% (p=0,001) á ári. Andvana fæðingum vaxtarskertra einbura eftir ≥28+0 vikna meðgöngu fækkaði um 3,1% (p=0,029) á ári. Andvana fæðingum einbura eftir ≥28+0 vikna meðgöngu sem voru ekki vaxtarskertir fækkaði ekki marktækt. Ályktun Tíðni burðarmálsdauða hefur lækkað umtalsvert síðastliðin 30 ár. Dauðsföllum vegna meðfæddra galla fækkaði mikið vegna framfara í fósturgreiningu. Andvana fæðingum vaxtarskertra barna hefur fækkað og hefur árvökul mæðravernd skipt þar miklu máli. Erfiðast hefur reynst að fækka andvana fæddum einburum án áhættuþátta eins og vaxtarskerðingar. Mikilvægt að fræða konur um þýðingu minnkaðra hreyfinga fósturs á meðgöngu, hlusta á þær og rannsaka þegar ástæða þykir til.
    • Árangur kransæðahjáveituaðgerða hjá konum á Íslandi

      Helga Rún Garðarsdóttir; Linda Ósk Árnadóttir; Jónas A. Aðalsteinsson; Hera Jóhannesdóttir; Sólveig Helgadóttir; Þórdís Jóna Hrafnkelsdóttir; Arnar Geirsson; Tómas Guðbjartsson; Helga Rún Garðarsdóttir1 kandídat Linda Ósk Árnadóttir1 deildarlæknir Jónas A. Aðalsteinsson1 deildarlæknir Hera Jóhannesdóttir1 deildarlæknir Sólveig Helgadóttir4 læknir Þórdís Jóna Hrafnkelsdóttir2,3 læknir Arnar Geirsson5 læknir Tómas Guðbjartsson1,3 læknir 1Hjarta- og lungnaskurðdeild, 2hjartadeild Landspítala, 3 læknadeild Háskóla Íslands, 4svæfinga- og gjörgæsludeild Akademíska sjúkrahússins í Uppsölum, Svíþjóð, 5hjartaskurðdeild Yale New Haven spítala, Bandaríkjunum. (Læknafélag Íslands, 2018-07)
      Inngangur Markmið þessarar rannsóknar var að bera saman árangur kransæðahjáveituaðgerða hjá konum og körlum á Íslandi með áherslu á snemm- og síðkomna fylgikvilla, 30 daga dánartíðni og langtímalifun. Efniviður og aðferðir Afturskyggn rannsókn á öllum sjúklingum sem gengust undir kransæðahjáveituaðgerð á Íslandi á árunum 2001-2013. Upplýsingar fengust úr sjúkraskrám og Dánarmeinaskrá Embættis landlæknis. Fylgikvillum var skipt í snemm- og síðkomna fylgikvilla og heildarlifun reiknuð með aðferð Kaplan-Meier. Fjölþátta aðhvarfsgreining var notuð til að meta forspárþætti dauða innan 30 daga og Cox aðhvarfsgreining til að meta forspárþætti verri langtímalifunar. Meðaleftirfylgd var 6,8 ár. Niðurstöður Af 1755 sjúklingum voru 318 konur (18%). Meðalaldur þeirra var fjórum árum hærri en karla (69 ár á móti 65 árum, p<0,001), þær höfðu oftar sögu um háþrýsting (72% á móti 64%, p=0,009) og EuroSCOREst þeirra var hærra (6,1 á móti 4,3, p<0,001). Hlutfall annarra áhættuþátta eins og sykursýki var hins vegar sambærilegt, líkt og útbreiðsla kransæðasjúkdóms. Alls létust 12 konur (4%) og 30 karlar (2%) innan 30 daga frá aðgerð en munurinn var ekki marktækur (p=0,08). Tíðni snemmkominna fylgikvilla, bæði minniháttar (53% á móti 48% p=0,07) og alvarlegra (13% á móti 11%, p=0,2), var sambærileg. Fimm árum frá aðgerð var lifun kvenna 87% borin saman við 90% hjá körlum (p=0,09). Þá var tíðni síðkominna fylgikvilla sambærileg hjá konum og körlum 5 árum frá aðgerð (21% á móti 19%, p=0,3). Kvenkyn reyndist hvorki sjálfstæður forspárþáttur 30 daga dánartíðni (OR 0,99; 95%-ÖB: 0,97-1,01) né verri lifunar (HR 1,08; 95%-ÖB: 0,82-1,42). Ályktun Mun færri konur en karlar gangast undir kransæðahjáveituaðgerð á Íslandi og eru þær fjórum árum eldri þegar kemur að aðgerð. Árangur kransæðahjáveitu er góður hjá konum líkt og körlum, en 5 árum eftir aðgerð eru 87% kvenna á lífi.
    • Tólf gjörgæslurúm á Landspítala – dugar það til?

      Sigurbergur Kárason; Landspítala Hringbraut (Læknafélag Íslands, 2018-07)
    • Lög um brottnám líffæra við andlát

      Kristinn Sigvaldason, / (Læknafélag Íslands, 2018-07)
    • Cardiac and skeletal muscle effects of electrical weapons : A review of human and animal studies.

      Kunz, Sebastian N; Calkins, Hugh; Adamec, Jiri; Kroll, Mark W; [ 1 ] Landspitali Univ Hosp, Dept Forens Pathol, V Baronstig 101, Reykjavik, Iceland Show more [ 2 ] Univ Iceland, Reykjavik, Iceland Show more [ 3 ] Johns Hopkins Med Inst, Baltimore, MD 21205 USA Show more [ 4 ] Ludwig Maximilians Univ Munchen, Inst Forens Med, Munich, Germany Show more [ 5 ] Univ Minnesota, Dept Biomed Engn, Minneapolis, MN USA Show more [ 6 ] Calif Polytech Inst, San Luis Obispo, CA USA (Humana Press, 2018-09-01)
      Conducted Electrical Weapons (CEWs) are being used as the preferred non-lethal force option for police and special forces worldwide. This new technology challenges an exposed opponent similarly to the way they would be challenged by physical exercise combined with emotional stress. While adrenergic and metabolic effects have been meta-analyzed and reviewed, there has been no systematic review of the effects of CEWs on skeletal and cardiac muscle. A systematic and careful search of the MedLine database was performed to find publications describing pathophysiological cardiac and skeletal muscle effects of CEWs. For skeletal muscle effects, we analyzed all publications providing changes in creatine kinase, myoglobin and potassium. For cardiac effects, we analyzed reported troponin changes and arrhythmias related to short dart-to-heart-distances. Conducted electrical weapons satisfy all relevant electrical safety standards and there are, to date, no proven electrocution incidents caused by CEWs. A potential cardiovascular risk has been recognized by some of the experimental animal data. The effects on the heart appear to be limited to instances when there is a short dart-to-heart-distance. The effect on the skeletal muscle system appears to be negligible. A responsible use of a CEW on a healthy adult, within the guidelines proposed by the manufacturer, does not imply a significant health risk for that healthy adult.