Colon cancer in Iceland 1955-2004. Study on epidemiology, histopathology and gender difference

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenOBJECTIVE: Colon cancer is the third most common cancer in Iceland. The aim of this study was to analyze the epidemiology and histopathology of colon cancer in Iceland, resection rate and the difference between men and women. MATERIAL AND METHODS: Pathology and autopsy reports for all patients diagnosed with colon cancer between 1955 and 2004 where reviewed. All the histopathology material was re-evaluated. Demographical information and pathological findings were registered. Age-standardized incidence was calculated for both men and women. Gender difference was evaluated. Time trend was evaluated by linear regression. RESULTS: After re-evaluation 2293 cases remained (1148 males and 1145 females). The incidence increased for men from 7.5, to 22.2/105 and for women from 8.6 to 15.1/105. Most tumors were located in the sigmoid colon (35%). Surgical rate increased from 50% to 85%. Adenocarcinomas where 84% and mucinous adenocarcinoma 7%. Altogether 7% of cases were TNM-stage I, 32% were stage II, 24% stage III, 21% in stage IV and stage was unknown in 16% of cases. Slight gender difference was observed regarding grade, vessel invasion, depth of invasion and anatomic subsite. CONCLUSION: Incidence of colon cancer increased considerably, mainly for men. Surgical rate and pathology of colon cancer is similar to that reported elsewhere except that there are somewhat fewer cases in TNM-stage I. Little gender difference was observed in the pathological parameters analysed.Inngangur: Krabbamein í ristli er þriðja algengasta krabbamein á Íslandi. Þessi rannsókn gerir grein fyrir faralds- og meinafræði ristilkrabbameins á Íslandi, skurðtíðni og kynjamun. Efniviður og aðferðir: Vefjasvör og krufningaskýrslur þeirra sem greindust með ristilkrabbamein á árunum 1955-2004 voru yfirfarin. Vefjasýni sjúklinga voru endurskoðuð og meinafræðilegir og lýðfræðilegir þættir skráðir. Aldursstaðlað nýgengi var reiknað fyrir bæði kyn. Meinafræðilegir þættir voru athugaðir með tilliti til kyns. Breyting yfir tíma var skoðuð með línulegri aðhvarfsgreiningu og kynjamunur með kí-kvaðratsprófi. Niðurstöður: Eftir endurmat urðu eftir 2293 ristilkrabbamein (karlar 1148, konur 1145). Nýgengi jókst hjá körlum úr 7,5 í 22,2/105 og hjá konum úr 8,6 í 15,1/105. Flest æxlin voru í bugaristli (35%). Skurðtíðni jókst úr 50% í 85%. Kirtilkrabbamein voru 84% æxla en slímkirtilkrabbamein 7%. Alls voru 7% sjúklinga á TNM-stigi I, 32% á stigi II, 24% á stigi III, 21% á stigi IV en stig var óþekkt hjá 16%. Lítilsháttar kynjamunur var á gráðu, æðaíferð, íferðardýpt og staðsetningu. Ályktun: Nýgengi ristilkrabbameins jókst verulega á tímabilinu, aðallega hjá körlum. Skurðtíðni og meinafræðileg birtingarmynd er svipuð því sem lýst hefur verið erlendis fyrir utan heldur færri tilfelli á TNM-stigi I. Lítill munur er á kynjum með tilliti til einstakra meinafræðiþátta

The many faces of Actinomycosis. Results from a retrospective study in Iceland, 1984-2007

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)INTRODUCTION: Actinomycosis is a rare infection caused by Actinomyces spp. which are part of the oral, intestinal and vaginal bacterial flora. It can invade tissue through mucosal disruption and form abscesses which tend to be difficult to treat and diagnose. This population-based study explores the epidemiology and manifestations of actinomycosis in Iceland. METHODOLOGY: All diagnosed cases of actinomycosis in Iceland 1984-2007 were identified by a computerised search using ICD and SNOMED codes. Clinical information was collected by chart review. The subjects were included in the study if they fulfilled two out of five diagnostic criteria. RESULTS: 41 women and 25 men (mean age 45 years) met the diagnostic criteria. The incidence rate during the first half of the period was 0.86/year/100.000 and 1.17 during the second half.The cervicofacial region (42%) was most commonly affected, then the pelvis (32%), lacrimal duct (14%), abdomen (11%) and thorax (2%). Diagnostic delay was common. The longest delay from first symptoms to diagnosis was 8-9 years (median 5 months) and it was significantly shorter among patients with abdominal or pelvic infections compared to infections of the lacrimal duct (p=0.012). No significant difference was noted in diagnostic delay between other groups and no patients died from the infection. CONCLUSION: This is the first population-based study of actinomycosis. The incidence rate increases with age and the time passing from first symptoms to diagnosis tends to be long.Inngangur: Geislagerlabólga (actinomycosis) er fátíð sýking sem orsakast af Actinomyces spp. sem lifa gistilífi í örveruflóru munnhols, meltingarvegar og æxlunarfæra kvenna. Sýklarnir geta við rof á slímhúð komist í dýpri vefi og valdið ígerðum sem torvelt er að greina og meðhöndla. Markmiðið var að kanna faraldsfræði og birtingarmynd sýkingarinnar á Íslandi. Efniviður og aðferðir: Gerð var afturvirk rannsókn á geislagerlabólgu greindri 1984-2007 á Íslandi. Leitað var eftir ICD-greiningarkóðum og vefjasýnum með viðeigandi SNOMED-númerum. Klínískar upplýsingar fengust úr sjúkraskrám. Greiningarskilmerki í fimm liðum voru sett fram og þurftu sjúklingar að uppfylla tvö þeirra. Niðurstöður: Greiningarskilmerki uppfylltu 41 kona og 25 karlar, meðalaldur 45 ár. Nýgengi fyrri helming tímabilsins var 0,86/ár/100.000 en 1,17 á þeim seinni. Algengasti sýkingarstaður var höfuð og andlit (42%), grindarhol (32%), táragöng (14%), kviðarhol (11%) og brjósthol (2%). Greiningartöf var algeng, lengst liðu 8-9 ár frá fyrstu einkenn-um að greiningu (miðgildi 5 mánuðir) og var hún styttri hjá sjúklingum með sýkingu í grindar- eða kviðarholi en sýkingu í táragöngum (p=0,012). Enginn munur var á greiningartöf milli annarra hópa og enginn lést vegna sýkingarinnar. Ályktun: Þetta er fyrsta lýðgrundaða rannsóknin á geislagerlabólgu. Nýgengi eykst með hækkandi aldri og tími frá fyrstu einkennum að greiningu er oft langur

Transferring avalanches between paths

Estimates of exceedance probabilities of runout lengths of avalanches for a specific path can rarely be based on measured avalanches in that slope alone, if they are to become statistically reliable. Thus one has, directly or indirectly, to include information of known runout lengths in other paths, i.e. to transfer runout lengths between paths. An attempt is made to classify such transfer methods, including both topographical methods that only make use of information on the shape of the path, such as methods based on runout ratios and a/ß-models, as well as physical methods which also make use of physical models, simulating the avalanche as it runs down the path. By introducing a specific standard slope all avalanches in a given dataset can be transferred to that slope. The length of the transferred avalanche in the standard slope then becomes a slope-independent measure of its length. Using an Icelandic dataset of 196 avalanches we demonstrate how estimates of exceedance probabilities of run out lengths may vary with the choice of transfer method and how the order of the slope-independent lengths of the avalanches in the dataset will vary. The implication for avalanche risk assessment is briefly discussed

Prevalence, diagnosis and treatment of depression and anxiety in patients in cardiac rehabilitation

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenOBJECTIVE: The aim of this study was to estimate the prevalence of depression and anxiety among patients in cardiac rehabilitation at Reykjalundur Rehabilitation Center and to study the impact of a 4-5 weeks inpatient cardiac rehabilitation program on these symptoms. Secondly we wished to compare the concordance of our clinical diagnosis with the results of a standardized psychometric scale, Hospital Anxiety and Depression scale, HAD. MATERIALS AND METHODS: Of 224 patients in one year, 200 (89.3%) were included in the study, 151 men and 49 women. The patients were first evaluated by a doctor and a nurse separately at the arrival and a clinical evaluation was made jointly. Shortly after arrival and before departure a HAD questionnaire was to be answered. All new psychiatric treatment was recorded. RESULTS: Prevalence of depression as measured by HAD was reduced from 9.5% to 3.1% and anxiety from 11.6% to 2.5%. The sensitivity of clinical diagnosis of depression as compared to the results of HAD was 73.7% and specificity 87.3%. For anxiety the sensitivity was 86.4% and specificity was 79.2%. The predictive value of a positive clinical diagnosis of depressions was 37.8% and anxiety 33.9%, but predictive value of a negative clinical diagnosis was 96.9% and anxiety 97.9% respectively. CONCLUSION: The prevalence of depression and anxiety is similar or somewhat lower than in other studies on patients with cardiac diseases. The agreement of clinical diagnosis and HAD questionnaire was acceptable and the questionnaire will not be used routinely. A comprehensive cardiac rehabilitation program seems to reduce substancially symptoms of depression and anxiety among patients in cardiac rehabilitation at Reykjalundur.Tilgangur: Markmið rannsóknarinnar var að kanna algengi þunglyndis og kvíða hjá þeim sem komu til hjartaendurhæfingar á Reykjalundi og samsvörun klínískrar greiningar og niðurstöðu viðurkennds þunglyndis- og kvíðakvarða, Hospital Anxiety and Depression Scale (HAD). Einnig að meta áhrif hjartaendurhæfingar á Reykjalundi á einkenni þunglyndis og kvíða. Efniviður og aðferð: Allir sem innrituðust í hjartaendurhæfingu á Reykjalundi frá 1. apríl 2005 til 31. mars 2006 voru beðnir að taka þátt. Læknir og hjúkrunarfræðingur mátu hvort í sínu lagi við innritun sjúklings hvort viðkomandi væri þunglyndur eða kvíðinn og skráðu síðan sameiginlegt klínískt mat. Í fyrstu viku endurhæfingartímans var HAD spurningalistinn lagður fyrir og aftur við brottför. Skráð var öll ný geðmeðferð á dvalartímanum. Niðurstöður: Af 224 sjúklingum sem komu á árinu tóku 200 (89,3%) þátt í rannsókninni, 151 karl og 49 konur. Samkvæmt HAD var algengi þunglyndis 9,5% við komu en 3,1% við brottför og algengi kvíða var 11,6% við komu en aðeins 2,5% við brottför. Næmi klínískrar greiningar þunglyndis borið saman við niðurstöður HAD reyndist 73,7% en sértækni 87,3%. Næmi greiningar kvíða reyndist 86,4% en sértækni 79,2%. Forspárgildi jákvæðar klínískrar greiningar þunglyndis var 37,8% og kvíða 33,9% en forspárgildi neikvæðar klínískrar greiningar þunglyndis 96,9% og kvíða 97,9%. Ályktun: Algengi þunglyndis og kvíða er svipað eða nokkru lægra en í öðrum rannsóknum meðal hjartasjúklinga. Næmi og sértækni klínískra greininga miðað við HAD kvarða er ásættanlegt og ekki virðist því ástæða til að taka upp reglubundna skimun. Hjartaendurhæfing með þjálfun og fjölbreyttum stuðningi ásamt sérhæfðri geðmeðferð, dregur verulega úr einkennum þunglyndis og kvíða

Hepatitis C: a clinical-histopathological study

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenOBJECTIVE: Hepatitis C is a common cause of chronic hepatitis and cirrhosis in Western countries. In recent years a large group of individuals have been diagnosed with the disease in Iceland. The aim of this study was to investigate histological parameters of patients with hepatitis C and to correlate histological findings with clinical findings. MATERIALS AND METHODS: In this retrospective study, all patients diagnosed with hepatitis C in Iceland that had a liver biopsy in the years 1991-2001 were included. Data on age, route of infection, duration of infection and co-infection was obtained from medical records. Liver biopsy specimens were evaluated and inflammatory activity graded and the degree of fibrosis staged. RESULTS: In all 97 patients (58 males, 39 females) were included in the study. The mean age was 35.6 years (range 11-64). Risk factors were intravenous drug abuse in 70 (72.6%), blood transfusion in 12 (12.4%) and eight had no known risk factors. Estimated duration of infection was 8.85 years (range 1-31). Average inflammatory grade was 2.84 (range 0-8) and average fibrosis stage was 0.95 (range 0-6). The majority (72.6%) of patients had minimal or no inflammation and 85.5% had minimal or no fibrosis. Only four patients had cirrhosis. Significant correlation was observed between the age at infection and the degree of fibrosis. No correlation was detected between the duration of infection or route of infection and histopathological parameters. CONCLUSION: Patients with hepatitis C that underwent a liver biopsy in 1991-2000 had mild histopathological changes in the liver. This is most likely due to short duration of infection and young age of the patients in this study.Tilgangur: Lifrarbólga C er ein algengasta orsök langvinnrar lifrarbólgu og skorpulifrar á Vesturlöndum. Á undanförnum árum hefur stór hópur Íslendinga greinst með sjúkdóminn. Þessi rannsókn miðaði að því að kanna bólguvirkni og bandvefsmyndun í vefjasýnum sjúklinga með lifrarbólgu C og athuga tengsl við klíníska þætti. Efniviður og aðferðir: Rannsóknin var aftursæ og náði til allra sjúklinga með lifrarbólgu C sem fóru í lifrarsýnistöku á tímabilinu 1991-2000. Upplýsinga var aflað um aldur, smitleið, smittíma, lifrarpróf, samhliða sýkingar og fleira. Vefjasýni voru endurskoðuð og metin var bólga og bandvefsmyndun. Einnig var könnuð fylgni klínískra þátta við niðurstöður úr vefjasýnum. Niðurstöður: Alls 97 sjúklingar (58 karlar og 39 konur) uppfylltu skilmerki rannsóknarinnar og var meðalaldur 35,6 ár (bil 11-64). Sprautufíklar voru 77 (79,4%), blóðþegar 12 (12,4%) og hjá átta (8,2%) var smitleið óþekkt. Áætlaður smittími var 8,85 ár (bil 1-31). Meðaltal bólgudrepsstuðuls var 2,84 (bil 0-8) og bandvefsstuðuls 0,95 (bil 0-6). Alls voru 70 (72,6%) sjúklingar með enga/mjög væga bólgu og 83 (85,5%) með enga/mjög væga bandvefsmyndun. Einungis fjórir höfðu skorpulifur. Fylgni var á milli áætlaðs aldurs við smit og bandvefsmyndunar. Ekki var fylgni á milli smittíma eða smitleiðar og vefjameinafræðilegra þátta. Ályktun: Sjúklingar með lifrarbólgu C sem fóru í lifrarsýnistöku árin 1991-2000 höfðu væga bólgu og bandvefsmyndun í lifur. Líklegasta skýringin er tiltölulega stuttur smittími og lágur aldur

[Adenocarcinoma of the appendix in Iceland 1990-2009. A population based study].

Adenocarcinoma of the appendix is less than 0.5% of all gastrointestinal cancers. The aim of this study was to analyse the incidence, symptoms, pathology and treatment of appendiceal adenocarcinoma in a well defined cohort as well as the prognosis of the patients.This is a retrospective study on all patients diagnosed with adenocarcinoma of the appendix in Iceland from 1990-2009. Information on epidemiological factors, survival and treatment was collected. All histological material was reviewed. Overall survival was estimated with median follow up of 15 months (range, 0-158).A total of 22 patients were diagnosed with appendiceal adenocarinoma in the study period (median age 63 yrs, range: 30-88, 50% males). Age-standardized incidence was 0.4/100,000/year. The most common symptom was abdominal pain (n=10). Eight patients had clinical signs of appendicitis. Most patients were diagnosed at operation or at pathological examination but one patient was diagnosed at autopsy. Five patients had an appendectomy and 11 a right hemicolectomy. One patient was not operated on and in three patients only a biopsy was taken. Twelve patients had chemotherapy and seven of them for metastatic disease. Eight patients had adenocarcinoma, seven mucinous adenocarcinoma, three signet ring adenocarcinoma, one mixed goblet cell carcinoid and mucinous adenocarcinoma,one mixed adenocarcinoma and signet ring adenocarcinoma and two a mucinous tumour of unknown malignant potential. In eight cases the tumor originated in adenoma. Most of the patients had a stage IV disease (n=13), three stage III, three stage II and three stage I. Operative mortality was 4.8% (n=1). Disease specific five year survival was 54% but overall five year survival was 44% respectively.Adenocarcinoma of the appendix is a rare disease. No patients were diagnosed pre-operatively. Over half of the patients presented with stage IV disease.Tilgangur: Kirtilkrabbamein í botnlanga er innan við 0,5% krabbameina í meltingarvegi. Tilgangur rannsóknarinnar var að skoða nýgengi, einkenni, meinafræði, meðferð og horfur sjúklinga hér á landi. Efniviður og aðferðir: Rannsóknin var afturskyggn og náði til allra sjúklinga sem greindust með kirtilkrabbamein í botnlanga á Íslandi 1990-2009. Skoðaðir voru faraldsfræðilegir þættir, meðferð og lifun. Öll vefjasýni voru skoðuð og meinafræði endurmetin. Meðaleftirfylgni lifandi greindra var 15 mánuðir (bil: 0-158). Niðurstöður: Alls greindust 22 sjúklingar með kirtilkrabbamein í botnlanga (miðaldur 63 ár, bil: 30-88, 50% karlar). Aldursstaðlað nýgengi var 0,4/100.000 á ári. Algengasta einkennið var kviðverkur (n=10) en átta sjúklingar höfðu klínísk einkenni botnlangabólgu. Flestir sjúklingar greindust í aðgerð eða við vefjagreiningu en einn við krufningu. Fimm sjúklingar fóru í botnlangatöku og 11 í brottnám á hægri hluta ristils. Einn sjúklingur fór ekki í skurðaðgerð og hjá þremur var eingöngu tekið vefjasýni. Tólf sjúklingar fengu krabbameinslyfjameðferð, þar af sjö við dreifðum sjúkdómi. Átta sjúklingar höfðu kirtilkrabbamein, sjö slímkrabbamein, þrír sigðfrumukrabbamein, einn blandað krabbalíkisæxli af slímfrumugerð og slímkrabbameini, einn kirtilkrabbamein með sigðfrumukrabbameini og tveir höfðu slímæxli af óvissri illkynja hegðan. Í átta tilvikum var æxlið upprunnið í kirtilsepaæxli. Flestir höfðu sjúkdóm á stigi IV (n=13), 3 á stigi III, 3 á stigi II og 3 á stigi I. Skurðdauði var 4,8% (n=1). Sjúkdómssértæk fimm ára lifun var 54% en heildar fimm ára lifun 44%. Ályktun: Kirtilkrabbamein í botnlanga eru sjaldgæf. Allir sjúklingar greindust fyrir tilviljun. Rúmlega helmingur sjúklinga var með dreifðan sjúkdóm við greiningu

Actinomycosis in a 70 year old woman with a forgotten intrauterine contraceptive device

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenActinomycosis is an infectious disease that has been known since the late nineteenth century. In the pre-antibiotic era it was thought to be rather common but with increased use of antimicrobial agents its incidence has decreased significantly. The causative agent, most commonly Actinomyces israelii, is part of the commensal bacterial flora. It can infect any tissue, respects no tissue boundaries and can spread throughout the body. The clinical presentation of this illness can be similar to malignant disease and definite diagnosis is sometimes not apparent until after surgery and histologic examination. We report the case of a 71 year old woman who suffered from actinomycosis of the uterus and ovaries due to a forgotten intrauterine contraceptive device that had been in place for over four decades. The disease presentation was consistent with malignant disease and tumor markers, CA 125, CA 19-9 and CEA, measured in blood were elevated. She was treated successfully with total hysterectomy and bilateral salphingo-oophorectomy, as well as penicillin for six months.Geislagerlabólga (actinomycosis) er sjúkdómur sem þekktur hefur verið síðan um lok nítjándu aldar. Fyrir tíma sýklalyfja var hann fremur algengur, en með tilkomu sýklalyfja hefur verulega dregið úr algengi sjúkdómsins. Sýkillinn er oftast Actinomyces israelii og finnst víða í líkamanum sem hluti af eðlilegri bakteríuflóru. Hann getur lagst á alla vefi, virðir ekki hefðbundin vefjamörk og getur dreifst víða. Birtingarmynd sýkingarinnar getur verið áþekk krabbameini og oft liggur endanleg greining ekki fyrir fyrr en eftir skurðaðgerð og vefjarannsókn. Hér er lýst sjúkratilfelli þar sem 71 árs gömul kona fékk geislagerlabólgu í leg og eggjastokka út frá lykkju sem hafði verið til staðar í rúmlega fjóra áratugi og gleymst. Birtingarmynd sjúkdómsins var áþekk því að um krabbamein væri að ræða og voru æxlisvísarnir CA 125, CA19-9 og CEA hækkaðir. Konan var læknuð með brottnámi á legi og eggjastokkum ásamt penicillíngjöf í sex mánuði

Learning from Many: Partner Exposure and Team Familiarity in Fluid Teams

In services where teams come together for short collaborations, managers are often advised to strive for high team familiarity so as to improve coordination and consequently, performance. However, inducing high team familiarity by keeping team membership intact can limit workers’ opportunities to acquire useful knowledge and alternative practices from exposure to a broader set of partners. We introduce an empirical measure for prior partner exposure and estimate its impact (along with that of team familiarity) on operational performance using data from the London Ambulance Service. Our analysis focuses on ambulance transports involving new paramedic recruits, where exogenous changes in team membership enable identification of the performance effect. Specifically, we investigate the impact of prior partner exposure on time spent during patient pickup at the scene and patient handover at the hospital. We find that the effect varies with the process characteristics. For the patient pickup process, which is less standardized, greater partner exposure directly improves performance. For the more standardized patient handover process, this beneficial effect is triggered beyond a threshold of sufficient individual experience. In addition, we find some evidence that this beneficial performance impact of prior partner exposure is amplified during periods of high workload, particularly for the patient handover process. Finally, a counterfactual analysis based on our estimates shows that a team formation strategy emphasizing partner exposure outperforms one that emphasizes team familiarity by about 9.2% in our empirical context