Evaluation of a thyroid nodule

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files.Hnútar í skjaldkirtli eru algengt vandamál og nýgengi þeirra hefur aukist mikið. Kerfisbundin nálgun við uppvinnslu er nauðsynleg til að greining fáist fljótt en ekki síður til að koma í veg fyrir ofgreiningu og ofmeðhöndlun sjúklinga. Það er mikilvægt að nota hina svokölluðu þrígreiningu, sögu/skoðun, ómun og fínnálarástungu ásamt skjaldvakamælingu (TSH). Ómun af skjaldkirtli er lykilþáttur í uppvinnslu, þar er mikilvægt að áhættuflokka hnúta, það er eftir líkum á krabbameini, og það er einnig mikilvægt við val á hnútum til að stinga, ef þeir eru fleiri en einn. Ómun er einnig hjálpleg við ástungu, sérstaklega í hnútum sem ekki eru þreifanlegir eða eru að hluta vökvafylltir. Kerfisbundið mat á frumusýnunum, flokkuðum eftir til dæmis Bethesda, er nauðsynlegt til að einfalda samskipti meinafræðinga og klínískra lækna. Thyroid nodules are common and their incidence has increased due to various factors. Systematic approach to the work-up of thyroid nodules is necessary to decrease overdiagnosis as well as over treatment. Applying the trifecta of history, physicial examination and high-resolution ultrasound (HRUS) as well as fine needle aspiration biopsy (FNAB) with added TSH measurement is important in the work-up. HRUS is a central part in the diagnostic approach, being able to risk classify nodules and selecting nodules for FNAB. Systematic analysis of aspirates is necessary to simplify communication between cytologists and clinicians

Public comprehension of medical terminology

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenThe quality of doctor-patient communication is critical for the practice of medicine. Studies show that effective communication results in patient satisfaction and improved compliance. To better understand one aspect of this complex phenomenon we estimated the ability of people to comprehend 11 commonly used medical terms. We used multiple choice questions in a telephone survey of 1167 Icelanders aged 16-75 years. Results (% of participants with correct answers): Gastroesophageal reflux (72), emphysema (25), steroids (40), one tablet twice a day (79), side effects (67), bronchitis (68), white blood cells (56), erythrocyte sedimentation rate (33), diabetes mellitus (72), antibiotics (87), chronic obstructive pulmonary disease (42). Variables associated with better comprehension were: Female gender (better in 7/10 questions), university degree (10/10) and high income (9/10). Decision tree analysis showed that education had the most impact. The youngest participants (age 16-24) had the worst outcome in seven out of 10 questions. The results define certain medical terms that require more careful explanation than others. They also indicate that those of young age, low socioeconomic status and less educated require more help in understanding medical terms. Interestingly, 21% of participants failed to understand a very simple medication order, emphasizing the importance of explaining these in detail. The data may also have implications for informed consent. A larger study exploring the public comprehension of multiple medical terms should be considered.Samskipti lækna og sjúklinga eru afar mikilvæg. Rannsóknir sýna að fræðsla bætir líðan sjúklinga. Einnig er talið að mörg kærumál á hendur heilbrigðisstarfsmönnum byggist á misskilningi. Útskýringar þurfa að vera vandaðar og skilningur góður til að unnt sé að efla fræðslu og forðast misskilning. Til þess að byrja að kanna þetta flókna samspil rannsökuðum við skilning almennings á 11 orðum úr læknisfræði. Við notuðum símakönnun og lögðum fjölvalsspurningar fyrir 1167 Íslendinga á aldrinum 16-75 ára. Niðurstöður (% þátttakenda með rétt svar): Bakflæði (72), lungnaþemba (25), sterar (40), ein tafla tvisvar á dag (79), aukaverkanir (67), berkjubólga (68), hvít blóðkorn (56), sökk (33), sykursýki (87), langvinn lungnateppa (42). Þættir sem bættu árangur í könnuninni voru: Kyn (konur betri í sjö af tíu spurningum), háskólamenntun (10/10), háar tekjur (9/10). Fjölbreytugreining sýndi að menntun vó þyngst af þessum þáttum. Yngstu þátttakendurnir (16-24 ára) stóðu sig verst í sjö spurningum af tíu. Nýta má niðurstöðurnar til þess að útskýra sérstaklega vel þau orð sem illa skiljast og verja meiri tíma til fræðslu ungs fólks, tekjulágra og lítt skólagenginna. Huga þarf sérstaklega vel að lyfjafyrirmælum þar sem 21% fólks skilur ekki einföldustu fyrirmæli af þessu tagi. Niðurstöðurnar geta einnig nýst til þess að bæta upplýst samþykki. Gera þarf viðameiri rannsókn á því hvernig fólki gengur að skilja algeng orð úr læknisfræði

Utilization and outcomes of tracheostomies in the intensive care unit in Iceland in 2007–2020 : A descriptive study

Funding Information: The work undertaken in this study was supported by a contribution from the Landspitali University Hospital Research Fund. Publisher Copyright: © 2022 Acta Anaesthesiologica Scandinavica Foundation.Background: Tracheostomies are commonly utilized in ICU patients due to prolonged mechanical ventilation, upper airway obstruction, or surgery in the face/neck region. However, practices regarding the timing of placement and utilization vary. This study provides a nationwide overview of tracheostomy utilization and outcomes in the ICU over a 14-year period. Methods: A retrospective study including all patients that received a tracheostomy during their ICU stay in Iceland between 2007 and 2020. Data were retrieved from hospital records on admission cause, comorbidities, indication for tracheostomy insertion, duration of mechanical ventilation before and after tracheostomy placement, extubation attempts, complications, length of ICU and hospital stay and survival. Descriptive statistics were provided, and survival analysis was performed using Cox regression. Results: A total of 336 patients (median age 64 years, 33% females) received a tracheostomy during the study period. The most common indication for tracheostomy insertion was respiratory failure, followed by neurological disorders. The median duration of mechanical ventilation prior to tracheostomy insertion was 9 days and at least one extubation had been attempted in 35% of the cases. Percutaneous tracheostomies were 32%. The overall rate of complications was 25% and the most common short-term complication was bleeding (5%). In-hospital mortality was 33%. The one- and five-year survival rate was 60% and 44%, respectively. Conclusions: We describe a whole-nation practice of tracheostomies. A notable finding is the relatively low rate of extubation attempts prior to tracheostomy insertion. Future work should focus on standardization of assessing the need for tracheostomy and the role of extubation attempts prior to tracheostomy placement.Peer reviewe

Public comprehension of medical terminology

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenThe quality of doctor-patient communication is critical for the practice of medicine. Studies show that effective communication results in patient satisfaction and improved compliance. To better understand one aspect of this complex phenomenon we estimated the ability of people to comprehend 11 commonly used medical terms. We used multiple choice questions in a telephone survey of 1167 Icelanders aged 16-75 years. Results (% of participants with correct answers): Gastroesophageal reflux (72), emphysema (25), steroids (40), one tablet twice a day (79), side effects (67), bronchitis (68), white blood cells (56), erythrocyte sedimentation rate (33), diabetes mellitus (72), antibiotics (87), chronic obstructive pulmonary disease (42). Variables associated with better comprehension were: Female gender (better in 7/10 questions), university degree (10/10) and high income (9/10). Decision tree analysis showed that education had the most impact. The youngest participants (age 16-24) had the worst outcome in seven out of 10 questions. The results define certain medical terms that require more careful explanation than others. They also indicate that those of young age, low socioeconomic status and less educated require more help in understanding medical terms. Interestingly, 21% of participants failed to understand a very simple medication order, emphasizing the importance of explaining these in detail. The data may also have implications for informed consent. A larger study exploring the public comprehension of multiple medical terms should be considered.Samskipti lækna og sjúklinga eru afar mikilvæg. Rannsóknir sýna að fræðsla bætir líðan sjúklinga. Einnig er talið að mörg kærumál á hendur heilbrigðisstarfsmönnum byggist á misskilningi. Útskýringar þurfa að vera vandaðar og skilningur góður til að unnt sé að efla fræðslu og forðast misskilning. Til þess að byrja að kanna þetta flókna samspil rannsökuðum við skilning almennings á 11 orðum úr læknisfræði. Við notuðum símakönnun og lögðum fjölvalsspurningar fyrir 1167 Íslendinga á aldrinum 16-75 ára. Niðurstöður (% þátttakenda með rétt svar): Bakflæði (72), lungnaþemba (25), sterar (40), ein tafla tvisvar á dag (79), aukaverkanir (67), berkjubólga (68), hvít blóðkorn (56), sökk (33), sykursýki (87), langvinn lungnateppa (42). Þættir sem bættu árangur í könnuninni voru: Kyn (konur betri í sjö af tíu spurningum), háskólamenntun (10/10), háar tekjur (9/10). Fjölbreytugreining sýndi að menntun vó þyngst af þessum þáttum. Yngstu þátttakendurnir (16-24 ára) stóðu sig verst í sjö spurningum af tíu. Nýta má niðurstöðurnar til þess að útskýra sérstaklega vel þau orð sem illa skiljast og verja meiri tíma til fræðslu ungs fólks, tekjulágra og lítt skólagenginna. Huga þarf sérstaklega vel að lyfjafyrirmælum þar sem 21% fólks skilur ekki einföldustu fyrirmæli af þessu tagi. Niðurstöðurnar geta einnig nýst til þess að bæta upplýst samþykki. Gera þarf viðameiri rannsókn á því hvernig fólki gengur að skilja algeng orð úr læknisfræði

Anaplastic thyroid carcinoma transformation in a lateral neck node metastasis - A case report and a review of the literature

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadAnaplastic 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

Rock garden at the entrance to the South British Insurance Company building, 155-161 Queen Street, Melbourne, 1961, architects Bates, Smart and McCutcheon [4] [picture] /

Condition: Good.; Title devised by cataloguer based on inscription on reverse.; Part of Wolfgang Sievers photographic archive.; Sievers number: 3116O; Also available in an electronic version via the Internet at: http://nla.gov.au/nla.pic-vn3971295; Also available as a negative PIC WS 3116O LOC Cold store PIC Siev B&WN-F

Gastrointestinal stromal tumors in Iceland, 1990-2003: the icelandic GIST study, a population-based incidence and pathologic risk stratification study

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldGastrointestinal stromal tumor (GIST) is a newly defined clinical and pathologic entity. This study examines the whole population-based incidence of GIST as well as pathologic risk stratification schemes. All patients diagnosed in Iceland with a gastrointestinal mesenchymal tumor over the years 1990-2003 were evaluated with an immunohistochemical panel including staining for c-kit. The age-adjusted incidence of GIST was calculated. Size, mitotic rate per 50 HPF and various other pathologic parameters were evaluated. Each tumor was categorized into 1 of 4 recently defined NIH risk stratification categories. Fifty-seven of the mesenchymal gastrointestinal tumors were positive for c-kit and therefore categorized as GIST. The annual incidence for the study period is 1.1 per 100,000. The median age of patients was 65.8 years and median tumor size was 4.6 cm. Only 2 of 35 gastric tumors fall into the NIH high-risk category while half of the nongastric tumors (11 of 22) fall into this high-risk category. Eight of the 57 tumors (14%) metastasized, 7 of which were nongastric. The positive predictive value for malignant behavior of the high-risk category is 46%. The negative predictive value of low- and very-low-risk NIH category is 100%. Pathologic predictors of malignant behavior are tumor size, mitotic rate, mucosal disruption, necrosis and high cellularity. Nongastric GISTs are clearly at much higher risk of a malignant behavior than gastric GISTs. This population-based GIST study estimates the incidence of GISTs at 1.1 per 100,000 and furthermore supports the NIH consensus categories for the prediction of malignant behavior of GISTs

Salivary gland tumours in Iceland 1986-2015: a nationwide epidemiological analysis over a 30-year time period.

To access publisher's full text version of this article click on the hyperlink belowSalivary gland tumours (SGT) are a vast and heterogenous group of neoplasms. There is a relative lack of comprehensive nationwide epidemiological studies on the subject. The aim of this nationwide analysis was to gain insight into epidemiological traits, such as site, incidence and histological subtypes of SGT in general. Patients diagnosed with a primary SGT between 1986 and 2015 were identified from The Icelandic Cancer Registry and registries from all pathology departments in Iceland. Information on age, sex, tumour location and histology was retrieved from pathology reports. A total of 687 patients were diagnosed with a SGT, 609 (89%) were benign and 78 (11%) malignant. 9% of parotid gland tumours, 22% of submandibular gland tumours and 26% of minor SGT were malignant. The most common malignant tumours were mucoepidermoid carcinoma, acinic cell carcinoma and adenoid cystic carcinoma. The incidence of benign SGT was 4.9 per 100 000 among men and 7.0 per 100 000 among women. The incidence of malignant tumours was 0.59 per 100 000 for men and 0.79 per 100 000 for women. The proportion of malignant SGT is lower than most often reported. Only 10% of parotid gland tumours, 20% of submandibular gland tumours and 25% of minor salivary gland tumours are malignant. Keywords: Salivary gland; epidemiology; histology; oncology; tumour

Gastrointestinal Stromal Tumour (GIST). Case report

Neðst á síðunni er að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenIn 1987 a 73 year old man was diagnosed with a malignant sarcoma of the anus. It was originally regarded as a leiomyosarcoma. Fourteen years later the original diagnoses of the specimen was reviewed and the diagnosis was changed to GIST (gastrointestinal stromal tumour). This diagnosis was confirmed with appropriate immunohistochemical staining on the tumour tissue. This is the first case of GIST in the anus diagnosed in Iceland.Í þessu sjúkratilfelli er um að ræða sjötíu og þriggja ára karlmann sem greindist með illkynja sarkmein í daus (anus) og talið var af sléttvöðvatoga (leiomyosarcoma). Við endurskoðun á sýnum sjúklings í apríl árið 2004 vaknaði sá grunur að um væri að ræða strómaæxli í meltingarvegi (GastroIntestinal Stromal Tumour, GIST). Þessi greining var í framhaldi staðfest með viðeigandi mótefnalitunum á æxlisvefnum. Þetta er fyrsta tilfelli GIST í daus hér á landi

Epithelioid angiomyolipoma of the liver: case report and review of the literature

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldHepatic angiomyolipoma is a rare tumor. Here we describe a case and review the literature