Chronic eosinophilic pneumonia in Iceland: clinical features, epidemiology and review

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenOBJECTIVE: The objective of the study was to describe the incidence and clinical features of chronic eosinophilic pneumonia (CEP) in Iceland and review recent literature. MATERIAL AND METHODS: Retrospective study where information was obtained from clinical charts from 1990-2004. Records, imaging studies and histopathology were evaluated. RESULTS: During the study period 10 individuals were diagnosed with CEP, 7 males and 3 females. Mean age was 58 years. None of the patients was a current smoker. The incidence of CEP during the study period was 0.23 per 100,000/year but increased to 0.54 per 100,000/year during the last 5 years of the study period. Clinical symptoms were malaise, cough, dyspnea, sweating and weight loss. Sedimentation rate was 72 mm/h and C-reactive protein (CRP) 125 mg/L. Eight of the ten patients had increase in blood eosinophils. On chest auscultation crackles were heard in seven patients and wheezing in three. Forced vital capacity (FVC) was 75% of predicted value and forced expiratory volume in one second (FEV1) was 73% of predicted. Mean PO2 was 68 mmHg. All the patients had classic diffuse bilateral opacities on chest radiograph that most commonly were peripheral. All patients were treated with corticosteroids and responded well. The average initial dose of Prednisolone was 42.5 mg per day. Seven of the patients relapsed but they all responded well to repeated treatment. CONCLUSIONS: Chronic eosinophilic pneumonia is a rare disorder but it has specific radiologic and histologic features. It is important to think of the disease in patients with diffuse infiltrates that are resistant to antibiotics. CEP responds well to corticosteroids but there is a high relapse rate, which also responds to treatment.Inngangur: Tilgangur rannsóknarinnar var að kanna nýgengi langvinnrar eósínófíl lungnabólgu á Íslandi, lýsa klínískum einkennum og veita yfirlit yfir sjúkdóminn. Efniviður og aðferðir: Aftursæ rannsókn þar sem upplýsingar voru fengnar úr sjúkraskrám árin 1990-2004. Sjúkraskrár voru yfirfarnar, kannaðar voru myndgreiningarrannsóknir og vefjafræðilegar greiningar endurskoðaðar. Niðurstöður: Á tímabilinu greindust 10 manns, sjö karlar og þrjár konur. Meðalaldur var 58 ár. Enginn sjúklinganna reykti. Nýgengi sjúkdómsins á öllu tímabilinu var 0,23 á 100.000/ári en jókst síðustu fimm árin í 0,54 á 100.000/ári. Einkenni voru slappleiki, þreyta, hósti, mæði, og megrun. Sökk var 72 mm/klst og C-reactive protein (CRP) 125 mg/L. Átta af 10 voru með aukningu eósínófíla í blóði. Við lungnahlustun heyrðist brak hjá sjö en önghljóð hjá þremur. Forced vital capacity (FVC) var 75% af áætluðu gildi og forced expiratory volume in one second (FEV1) var 73% af áætluðu gildi. Meðalhlutþrýstingur súrefnis (pO2) var 68 mmHg. Sjúklingarnir höfðu allir dæmigerðar dreifðar íferðir beggja vegna sem voru yfirleitt útlægar. Allir fengu sterameðferð og svöruðu meðferðinni fljótt og vel. Meðaltalsskammtur af prednisólon í upphafi meðferðar var 42,5 mg. Hjá sjö kom sjúkdómurinn aftur en allir svöruðu endurtekinni sterameðferð. Ályktanir: Langvinn eósínófíl lungnabólga er sjaldgæfur sjúkdómur en þó með einkennandi myndrænt og vefjafræðilegt útlit. Mikilvægt er að hafa hann í huga hjá sjúklingum með dreifðar íferðir sem svara ekki hefðbundinni sýklalyfjameðferð. Sjúkdómurinn svarar vel meðferð með barksterum sem getur þó þurft að endurtaka

Organising Pneumonia - a review and results from Icelandic studies

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenOrganising pneumonia (OP) is a relatively rare interstitial lung disease. It s definition is based on a characteristic histological pattern in the presence of certain clinical and radiological features. Organising pneumonia represents also what has been called Bronchiolitis Obliterans Organising Pneumonia (BOOP). Recently it has been recommended to call OP cryptogenic organising pneumonia (COP) when no definite cause or characteristic clinical context is found and secondary organising pneumonia (SOP) when causes can be identified such as infection or it occurs in a characteristic clinical context such as connective tissue disorder. The most common clinical symptoms are dyspnea, cough, fever and general malaise. It is common that symptoms have been present for some weeks before the diagnosis is made. Patients commonly have lowered PO2 and a mildly restrictive spirometry. Radiographic features are most often patchy bilateral airspace opacities but an interstitial pattern or focal opacities can also be seen. Most of patients respond well to steroids but relapses are quite common. The aim of this paper is to present an overview of the disease and the main results from studies on OP in Iceland. The mean annual incidence for OP in Iceland was 1.97/100,000 inhabitants. Annual incidence for COP was 1.10/100,000 and 0.87/100,000 for SOP. This is higher than in most other studies. In Iceland patients with OP had a higher standardized mortality ratio than the general population despite good clinical responses. No clinical symptoms could separate between SOP and COP.Trefjavefslungnabólga er sjúkdómur í lungum, skilgreindur með klínískum einkennum, myndgreiningarrannsóknum og vefjameinafræðilegum breytingum í sameiningu. Klínísk einkenni eru hósti, mæði, hækkaður líkamshiti og almennur slappleiki. Algengt er að einkennin hafi verið til staðar í nokkrar vikur áður en greining fæst. Myndgreiningarrannsóknir geta sýnt fjölbreytt mynstur, til dæmis dreifðar millivefsíferðir, afmarkaðar lungnablöðruíferðir eða staka hnúða. Yfirleitt svarar sjúkdómurinn vel meðferð með barksterum en tekur sig upp hjá um fimmtungi sjúklinga

Closed needle pleural biopsy in Iceland 1990-1999

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: Closed pleural biopsy is done to determine causes of pleural effusion after fluid analysis has been nondiagnostic. The aim of the study was to evaluate results of closed pleural biopsy in Iceland. Material and methods: All pathology reports of closed pleural biopsy from 1990-1999 at the Department of Pathology were reviewed. Hospital records for these patients were screened. Results: There were 130 samples from 120 individuals. There were 74 males and 46 females. Deceased are 75/120. The most common diagnosis was pleuritis or fibrosis in 85/120, cancer in 15 and three had tuberculosis but 17/120 had other results. The sensitivity of a closed pleural biopsy for diagnosing cancer was 27%. Adding cytology increased the sensitivity to 56%. Of those that had pleuritis on initial biopsy the cause was found to be cancer in 33/85, pneumonia in 11, trauma in 5 and in 8 there were other causes. In 25/85 no etiology could be found. By doing further studies it was demonstrated that the cause for the fluid was malignancy in 55/120. Of those most had lung cancer or 24/55, and the second most common cause was breast cancer in 7. Despite further studies no cause was found in 32/85. Conclusions: Closed pleural biopsy has fairly low sensitivity for diagnosis of cancer but it can be increased by adding cytologic evaluation. It is necessary to do further investigations and follow-up in patients that have inflammation in pleural biopsy.Inngangur: Lokuð fleiðrusýnataka er gerð til að finna orsök fyrir vökvasöfnun í fleiðruholi sem ekki hefur fundist skýring á með vökvarannsókn eingöngu. Tilgangur rannsóknarinnar var að kanna niðurstöður lokaðrar fleiðrusýnatöku með nál á Íslandi. Efniviður og aðferðir: Hjá Rannsóknastofu Háskólans í meinafræði voru athuguð vefjarannsóknasvör allra fleiðrusýna frá 1990-1999. Sjúkraskýrslur voru kannaðar. Niðurstöður: Um var að ræða 130 sýni frá 120 einstaklingum, 74 körlum og 46 konum. Látnir eru 75/120. Algengasta greiningin var fleiðrubólga eða bandvefsaukning hjá 85/120, krabbamein hjá 15 og þrír voru með berkla en hjá 17/120 voru aðrar niðurstöður. Næmi fleiðrusýnis var um það bil 27% við greiningu á illkynja vexti. Ef frumurannsókn var einnig gerð á vökvanum jókst næmið í 56%. Af þeim sem greindust með fleiðrubólgu var orsökin illkynja vöxtur hjá 33/85, lungnabólga hjá 11, fimm vegna áverka og hjá átta voru aðrar orsakir, en hjá 25/85 fannst engin skýring. Með frekari rannsóknum var hægt að sýna fram á að orsökin fyrir vökvanum var krabbamein hjá 55/120. Af þeim voru langflestir með lungnakrabbamein, eða 24/55, því næst kom brjóstakrabbamein með sjö tilfelli. Þrátt fyrir frekari rannsóknir fannst engin skýring á vökvasöfnuninni hjá 32. Ályktanir: Lokuð fleiðrusýnataka með nál hefur fremur lágt næmi í greiningu illkynja æxla en auka má næmið með því að gera frumurannsókn á vökvanum. Þörf er frekari rannsókna og eftirlits hjá þeim sem hafa bólgu í fleiðrusýni

Organising pneumonia in connection with Amiodarone treatment. Case reports and review

Hægt er að lesa greinina í heild sinni með því að smella á hlekkinn View/OpenOBJECTIVE: The objective of the study was to describe case reports of organising pneumonia in Iceland induced by the drug amiodarone. MATERIAL AND METHODS: Retrospective study where information was obtained from clinical charts from 1984-2003. Medical records, imaging studies and histopathology were re-evaluated. RESULTS: Described are three case reports of organising pneumonia associated with amiodarone use in two males and one female. Diagnostic methods and treatment are described and current literature is discussed. CONCLUSIONS: It is important for physicians to be aware of lung changes that amiodarone can cause and the importance of monitoring these patients.Tilgangur: Tilgangur rannsóknarinnar var að lýsa sjúkratilfellum trefjavefslungnabólgu sem tengdust notkun lyfsins amíódarón á Íslandi. Efniviður og aðferðir: Aftursæ rannsókn þar sem upplýsingar voru fengnar úr sjúkraskrám árin 1984-2003. Sjúkraskrár voru yfirfarnar og kannaðar myndgreiningarniðurstöður, vefjafræðilegar niðurstöður og meðferð sjúklinga. Niðurstöður: Lýst er þremur tilfellum trefjavefs-lungnabólgu hjá tveimur körlum og einni konu og greiningu og meðferð þeirra. Gefið er yfirlit yfir stöðu þekkingar. Ályktanir: Nauðsynlegt er fyrir lækna að vera meðvitaðir um að amíódarón getur valdið lungnabreytingum og að mikilvægt er að fylgjast vel með sjúklingum sem taka lyfið

Gatekeeping and referrals from GPs to cardiologists: patients' opinions and registration of information flow

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)INTRODUCTION: Formal referrals to medical specialists have not been required in Iceland since 1984. In 2006, however, referrals were required for patients to receive reimbursement for cardiologists fees. We studied patients' experiences and opinions on the referral process and explored the potential for quality improvement related to the increase in written communication between referring GPs and cardiologists. MATERIAL AND METHODS: Based on the electronic medical record system, referrals from GPs at Efstaleiti Health Care Center in Reykjavík to cardiologists between 1 June 2006 and 1 April 2007 were analyzed. A total of 344 patients were referred in this period. 245 agreed to participate in a questionnaire study about their opinions on the referral system and 209 (85%) completed the questionnaire. Relevant data on previous contacts with the health care center and received consultants reports from the years 2005-7 were extracted from the record system. RESULTS: Participating patients had a mean age of 72 years, male/female ratio 1:1. Ninety percent (95% C.I. 86-94) regarded the new referral system as more expensive and troublesome, but 89% (95% C.I. 85-94) wanted their cardiologist to send a formal report to the referring GP. The number of reports from cardiologists to the health centre's GPs increased from 43 in 2005 to 326 in 2007. CONCLUSION: Implementation of a referral system led to some dissatisfaction among the patients. On the other hand, it led to a major increase in the information exchange between GPs and cardiologists, in clear accordance with patients' wishes. It would be of interest to study the impact of the increased information flow influenced on the health care delivered.Inngangur: Árið 2006 varð greiðsluþátttaka sjúkratrygginga háð tilvísun heimilislækna til hjartalækna. Tilgangur þessarar rannsóknar var að kanna viðhorf sjúklinga til þessa tilvísanakerfis og hvort breytingin hafi leitt til aukinna samskipta í formi tilvísana og læknabréfa. Efniviður og aðferðir: Árið 2007 var gerð rannsókn á tilvísunum frá heimilislæknum Heilsugæslunnar Efstaleiti, Reykjavík, til sérfræðinga í hjartasjúkdómum. Skoðað var samskiptaform alls 344 einstaklinga sem fengu tilvísun til hjartalækna á tímabilinu 1. júní 2006 til 1. apríl 2007. Þar af samþykktu 245 að taka þátt í viðhorfskönnun um aðdraganda tilvísunar, viðhorf til þessa fyrirkomulags, kostnaðar og fyrirhafnar. Svör bárust frá 209 (85%). Úr sjúkraskrá stöðvarinnar voru jafnframt fengnar upplýsingar um fjölda samskipta hjartasjúklinga við heilsugæslustöðina og fjöldi læknabréfa á tímabilinu 2005 til 2007. Niðurstöður: Meðalaldur sjúklinga var 72 ár og kynjahlutfall jafnt. Níutíu prósent (95% öryggisbil 85,7-93,9) töldu að tilvísanir leiddu til meiri fyrirhafnar og eða auka kostnað. Áttatíu og níu prósent (95% öryggisbil 85,1- 93,5) töldu að hjartalæknir ætti að senda heimilislækni læknabréf. Heildarfjöldi læknabréfa frá hjartalæknum á stofu til heimilislæknanna jókst úr 43 árið 2005 í 326 yfir allt árið 2007. Ályktanir: Niðurstöður benda til þess að tilkoma tilvísanakerfis hafi vakið óánægju meðal sjúklinga. Tilvísanakerfi leiðir hins vegar til faglegs ávinnings með gagnkvæmri miðlun þekkingar fagaðila um sjúklinga sína sem er í samræmi við óskir þeirra sjálfra og líklegt til að auka gæði þjónustunnar

Own-race and other-race face recognition problems without visual expertise problems in dyslexic readers

Post-print (lokagerð höfundar)Both intact and deficient neural processing of faces has been found in dyslexic readers. Similarly, behavioral studies have shown both normal and abnormal face processing in developmental dyslexia. We tested whether dyslexic adults are impaired in tests of own-race and other-race face recognition. As both face and word recognition rely considerably on visual expertise, we wished to investigate whether face recognition problems of dyslexic readers might stem from difficulties with experience-driven expert visual processing. We utilized the finding that people tend to be worse at discriminating other-race faces compared to own-race faces, the so-called other-race effect, thought to reflect greater experience with own-race faces. If visual expertise is compromised in dyslexic readers, so that their visual system is not effectively shaped by experience, then they might show a diminished other-race effect. Matched dyslexic and typical readers completed two tests of own- and other-race face recognition. The results show that dyslexic readers have problems with recognizing faces, and these difficulties are not fully accounted for by general problems with attention or memory. However, recognition is compromised for both own- and other-race faces, and the strength of the other-race effect does not differ between dyslexic and typical readers. There was individual variability in both groups, and an exploratory analysis revealed that while dyslexic readers with no university education showed deficits in face recognition, the dyslexic participants with higher education did not. We conclude that dyslexic readers as a group have face recognition problems. These are potentially modulated by educational level but compromised visual expertise cannot demonstrably account for the face recognition problems associated with dyslexia. We discuss the implications of these findings for theoretical accounts of dyslexia and for theories of word and face recognition.This work was supported by The Icelandic Research Fund (Grant No. 174013-051) and the University of Iceland Research Fund.Accepted peer-reviewed manuscrip

Diagnosing occupational diseases. Examples from shellfish industry

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenIt is very important to report suspected occupational diseases in Iceland to the Administration of Occupational Safety and Health, so they can be diagnosed, investigated in details and improvements made. This article describes the illness of clam workers at Thornórshöfn, a small village in the northern part of Iceland. It lead to a detailed investigation and the diagnosis of clamworkers hypersensitivity pneumonitis. Many specialists participated in the study that lead to improvement in the factory that has benefitted the workers.Mikilvægt er að tilkynna um atvinnusjúkdóma til Vinnueftirlits ríkisins því þá er hægt að greina þá, rannsaka ítarlega og gera tillögur til úrbóta. Hér er lýst veikindum starfsmanna í kúskelvinnslu á Þórshöfn sem leiddu til mjög yfirgripsmikillar rannsóknar og til greiningar kúfisksóttar sem er tegund ofsanæmislungnabólgu. Margir aðilar tóku þátt rannsókninni sem leiddi til endurbóta á verksmiðjunni sem hafa komið starfsfólki til góða

Impact of dust deposition on the albedo of Vatnajökull ice cap, Iceland

Deposition of small amounts of airborne dust on glaciers causes positive radiative forcing and enhanced melting due to the reduction of surface albedo. To study the effects of dust deposition on the mass balance of Brúarjökull, an outlet glacier of the largest ice cap in Iceland, Vatnajökull, a study of dust deposition events in the year 2012 was carried out. The dust-mobilisation module FLEXDUST was used to calculate spatio-temporally resolved dust emissions from Iceland and the dispersion model FLEXPART was used to simulate atmospheric dust dispersion and deposition. We used albedo measurements at two automatic weather stations on Brúarjökull to evaluate the dust impacts. Both stations are situated in the accumulation area of the glacier, but the lower station is close to the equilibrium line. For this site ( ∼  1210 m a.s.l.), the dispersion model produced 10 major dust deposition events and a total annual deposition of 20.5 g m−2. At the station located higher on the glacier ( ∼  1525 m a.s.l.), the model produced nine dust events, with one single event causing  ∼  5 g m−2 of dust deposition and a total deposition of  ∼  10 g m−2 yr−1. The main dust source was found to be the Dyngjusandur floodplain north of Vatnajökull; northerly winds prevailed 80 % of the time at the lower station when dust events occurred. In all of the simulated dust events, a corresponding albedo drop was observed at the weather stations. The influence of the dust on the albedo was estimated using the regional climate model HIRHAM5 to simulate the albedo of a clean glacier surface without dust. By comparing the measured albedo to the modelled albedo, we determine the influence of dust events on the snow albedo and the surface energy balance. We estimate that the dust deposition caused an additional 1.1 m w.e. (water equivalent) of snowmelt (or 42 % of the 2.8 m w.e. total melt) compared to a hypothetical clean glacier surface at the lower station, and 0.6 m w.e. more melt (or 38 % of the 1.6 m w.e. melt in total) at the station located further upglacier. Our findings show that dust has a strong influence on the mass balance of glaciers in Iceland.The study described in this manuscript was supported by NordForsk as part of the two Nordic Centres of Excellence Cryosphere-Atmosphere Interactions in a Changing Arctic climate (CRAICC), and eScience Tools for Investigating Climate Change (eSTICC). Part of this work was supported by the Centre of Excellence in Atmospheric Science funded by the Finnish Academy of Sciences Excellence (project no. 272041), by the Finnish Academy of Sciences project A4 (contract 254195). Data from in situ mass balance surveys and on glacier automatic weather stations are from joint projects of the National Power Company and the Glaciology group of the Institute of Earth Science, University of Iceland. C. Groot Zwaaftink was also funded by the Swiss National Science Foundation SNF (155294), and Louise Steffensen-Schmidt, Finnur Palsson and Sverrir Gudmunds-son by the Icelandic Research Fund (project SAMAR) and the National Power Company of Iceland. Olafur Arnalds was in part funded by Icelandic Research Fund (grant no. 152248-051)Peer Reviewe

Elevation Change, Mass Balance, Dynamics, and Surging of Langjökull, Iceland from 1997 to 2007

Glaciers and ice caps around the world are changing quickly, with surge-type behaviour superimposed upon climatic forcing. Here, we study Iceland’s second largest ice cap, Langjökull, which has both surge- and non-surge-type outlets. By differencing elevation change with surface mass balance, we estimate the contribution of ice dynamics to elevation change. We use DEMs, in situ stake measurements, regional reanalyses, and a mass balance model to calculate the vertical ice velocity. Thus, we not only compare the geodetic, modelled, and glaciological mass balances, but also map spatial variations in glacier dynamics. Maps of emergence and submergence velocity successfully highlight the 1998 surge and subsequent quiescence of one of Langjökull’s outlets by visualizing both source and sink areas. In addition to observing the extent of traditional surge behaviour (i.e., mass transfer from the accumulation area to the ablation area followed by recharge of the source area), we see peripheral areas where the surge impinged upon an adjacent ridge and subsequently retreated. While mass balances are largely in good agreement, discrepancies between modelled and geodetic mass balance may be explained by inaccurate estimates of precipitation, saturated adiabatic lapse rate, or degree day factors. Nevertheless, the study was ultimately able to investigate dynamic surge behaviour in the absence of in situ measurements during the surge.In situ mass balance survey is a joint effort of the Glaciology Group, Institute of Earth Sciences, University of Iceland and the National Power Company (Landsvirkjun). We thank Philippe Crochet and Tómas Jóhannesson from the Icelandic Meteorological Office for providing the gridded climate data and for useful discussions about the climatology of Langjökull. The 2007 lidar data were collected by the UK Natural Environment Research Council Airborne Research and Survey Facility (Grant IPY 07-08). Additional funding was provided by the United States National Science Foundation (Grant No. DGE-1038596), St Catharine’s, St John’s and Trinity Colleges and the University of Cambridge B.B. Roberts and Scandinavian Studies Funds. We thank Cameron Rye for initial help coding the mass balance model.This is the author accepted manuscript. The final version is available from Cambridge University Press via https://doi.org/10.1017/jog.2016.5

Elevation change, mass balance, dynamics and surging of Langjökull, Iceland from 1997 to 2007

ABSTRACTGlaciers and ice caps around the world are changing quickly, with surge-type behaviour superimposed upon climatic forcing. Here, we study Iceland's second largest ice cap, Langjökull, which has both surge- and non-surge-type outlets. By differencing elevation change with surface mass balance, we estimate the contribution of ice dynamics to elevation change. We use DEMs, in situ stake measurements, regional reanalyses and a mass-balance model to calculate the vertical ice velocity. Thus, we not only compare the geodetic, modelled and glaciological mass balances, but also map spatial variations in glacier dynamics. Maps of emergence and submergence velocity successfully highlight the 1998 surge and subsequent quiescence of one of Langjökull's outlets by visualizing both source and sink areas. In addition to observing the extent of traditional surge behaviour (i.e. mass transfer from the accumulation area to the ablation area followed by recharge of the source area), we see peripheral areas where the surge impinged upon an adjacent ridge and subsequently retreated. While mass balances are largely in good agreement, discrepancies between modelled and geodetic mass balance may be explained by inaccurate estimates of precipitation, saturated adiabatic lapse rate or degree-day factors. Nevertheless, the study was ultimately able to investigate dynamic surge behaviour in the absence of in situ measurements during the surge.In situ mass balance survey is a joint effort of the Glaciology Group, Institute of Earth Sciences, University of Iceland and the National Power Company (Landsvirkjun). We thank Philippe Crochet and Tómas Jóhannesson from the Icelandic Meteorological Office for providing the gridded climate data and for useful discussions about the climatology of Langjökull. The 2007 lidar data were collected by the UK Natural Environment Research Council Airborne Research and Survey Facility (Grant IPY 07-08). Additional funding was provided by the United States National Science Foundation (Grant No. DGE-1038596), St Catharine’s, St John’s and Trinity Colleges and the University of Cambridge B.B. Roberts and Scandinavian Studies Funds. We thank Cameron Rye for initial help coding the mass balance model.This is the author accepted manuscript. The final version is available from Cambridge University Press via https://doi.org/10.1017/jog.2016.5