Meðganga og geislun

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenAlþjóðageislavarnaráðið (International Commission on Radiological Protection, ICRP) hefur nýlega gefið út samantekt og leiðbeiningar sem varða læknisfræðilega röntgengeislun og þungun (1). Útkoma leiðbeininganna er tilefni þessarar upprifjunar og samantektar um efnið í samræmi við ríkjandi viðhorf. Ætla má, að læknar og annað heilbrigðisstarfsfólk séu almennt vel upplýst um líffræðilegar áhættur tengdar jónandi geislun, en með síaukinni fræðslu til almennings um heilsutengd efni, í skólum og fjölmiðlum, er hætt við að upp geti komið misskilningur, mistúlkun og ótti vegna myndgreiningarrannsókna og hugsanlegra afleiðinga þeirra. Niðurstöður Alþjóðageislavarnaráðsins eru, að fræðsla til almennings, og einkum kvenna er málið snertir, um stöðu og áhættur sé brýn. Þá er lokaniðurstaða sú, að sennilega hafi áhættur vegna „óhóflegra“ geislaskammta verið ofmetnar í fyrri leiðbeiningum og vinnureglum. Því mælir stofnunin nú með verulegri hækkun þeirra geislaskammta sem miða beri við vegna hugsanlegra ákvarðana um fóstureyðingu Það er réttur barnshafandi konu, hvort heldur hún þarf myndgreiningu með röntgengeislum eða verður fyrir jónandi geislun í starfi, að fá upplýsingar um magn og umfang geislunarinnar, svo og um eðli mögulegra geislunaráhrifa, sem fóstur geti orðið fyrir

Frequency of serious complications following laparoscopic cholecystectomy

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenIn the the last decade laparoscopic cholecystectomy has emerged as the prefered method in the treatment of gallbladder stones. It has proved to be safe and has a relatively low rate of complications. However, major bile duct injuries occur more frequently during laparoscopic cholecystectomy when compared to the open procedure. The aim of this study was to examine the types and frequency of complications occurring during the initial period of laparoscopic cholecystectomy (1991-1998) at Landspitali University Hospital with a special emphasis on major bile duct injuries. Materials and methods: A retrospective analysis was performed on patients charts and operative notes of those who underwent laparoscopic cholecystectomy during the years 1991-1998. Results: 1008 consecutive patients were included in the study of which 727 (72%) were females. Bile leak from the cystic duct or the gallbladder bed was the most common complication and occurred in 23 patients (2.3%). Twenty patients (2%) had an intra-abdominal bleeding postoperatively. Seventeen (1.5%) of the patients had retained stones. Four patients (0.4%) developed a haematoma in the gallbladder bed. Two patients (0.2%) had a lesion of a bile duct and three patients (3%) died in the postperative phase. One hundred and six (10.5%) laparoscopic cholecystectomies were converted to an open procedure with the number of conversions highest in the second year (23%) of the procedure but thereafter the conversion rate was between 5 and 10%. Of the operations which required conversion from a laparoscopic procedure to an open one 74 (70%) were operations done urgently or as an emergency. Conclusion: Laparoscopic cholecystectomy at Landspitali University Hospital is a safe procedure with a low incidence of complications including major biliary injury. These findings are in accordance with results from other similar studies.Tilgangur: Fyrsta gallkögunin á Íslandi var framkvæmd árið 1991. Hún er nú með algengari aðgerðum. Þekktur alvarlegur fylgikvilli aðgerðarinnar er áverki á gallpípu. Tilgangur þessarar rannsóknar var að kanna tegundir og tíðni fylgikvilla gallkögunar frá 1991-1998 á Landspítalanum með sérstakri áherslu á gallgangaáverka. Efniviður og aðferðir: Um er að ræða afturvirka rann­­sókn á öllum sjúklingum sem fóru í gallkögun á árunum 1991-1998. Farið var yfir sjúkraskrár allra sjúklinganna en þeir voru fundnir með ICD greiningum og aðgerðarnúmerum. Skráð voru aldur og kyn, hvort um bráðaaðgerð eða valaðgerð var að ræða og hvort snúið var yfir í opna aðgerð. Fylgikvillar, þar á meðal áverki á gallpípu eftir aðgerð, voru skráðir, svo og tíðni enduraðgerða. Niðurstöður: 1008 sjúklingar komu til aðgerðar fyrstu átta árin. Af þeim voru 727 (72%) konur. Algengasti fylgikvilli reyndist vera gallleki. Tuttugu og þrír sjúklingar (2,3%) fengu gallleka frá gallpíplu eða gallblöðrubeð í kjölfar aðgerðarinnar. Tuttugu sjúk­lingar (2%) fengu blæðingu í kviðarhol eftir aðgerð. Steinar urðu eftir í gallpípu hjá 17 sjúklingum (1,5%). Fjórir sjúklingar (0,4%) fengu blóðkökk (hematoma) í gallblöðrubeð. Tveir sjúklingar (0,2%) fengu skaða á gallpípu og þrír sjúklingar (0,3%) létust í kjölfar aðgerðarinnar. Hundrað og sex (10,5%) gallkögunum var snúið í opna aðgerð en fjöldi þeirra var mjög mismunandi milli ára, mest 29 (23%) annað árið, en eftir það á bilinu 5-10%. Sjötíu og fjórar (70%) þeirra aðgerða sem snúið var í opna aðgerð voru bráðaaðgerðir. Ályktun: Tíðni alvarlegra fylgikvilla eftir gallblöðru­aðgerðir með kviðsjá á Landspítala er lág og sambæri­leg við niðurstöður rannsókna erlendis frá

EMU and the Icelandic labour market

In this paper we look at the costs and benefits for Iceland from joining the EMU from a labour-market perspective. We conclude that none of Mundell's three criteria for an optimal currency area are at present fulfilled for Iceland and the initial Euro zone. Shocks to the Icelandic economy are found to be asymmetric with those experienced in other countries, nominal wages rigid, and migration limited. The painful adjustment of the Faeroese economy to macroeconomic shocks in the early 1990s suggests that the disadvantages of not having a separate currency can be substantial if nominal wages are rigid. Substantial variation in labour market participation and frequent adjustments of the exchange rate seem to have held unemployment in check in Iceland, at least until around 1988.

Prehospital cardiac life support in the Reykjavík area 1999-2002

Hægt er að lesa af greinina í heild sinni með því að smella á hlekkinn í Additional LinksOBJECTIVES: A physician manned ambulance has provided advanced resuscitation service in the Reykjavík area for over 20 years. Out of hospital resuscitation since 1982 has been done with average response time of 4.6-4.9 minutes, the survival rate to hospital admission has been 31-40% and survival to hospital discharge 16-17%. In the years preceding this study, several changes were done in the service; the service area was enlarged, dispatch was centralized to one emergency number, the training of EMT s and physicians was improved and a two-tier rendezvous system was adopted. Cell phone coverage reached over 90% of the population. The study was done in 1999-2002 with the objective to: 1. measure the results of attempted prehospital resuscitations for cardiac diseases in the area, 2. to monitor the effect of bystander response, 3. to estimate the effect of changes in the service prior to the study period. MATERIALS AND METHODS: A ambulance staffed with EMTs and one with a physician were dispatched to all possible cases of cardiac arrest. Resuscitation was attempted using the AHA guidelines for resuscitation. Prospective data was collected following the Utstein template recorded by the physician on call. RESULTS: A total of 319 resuscitative attempts were made during the years 1999-2002, excluding hanging, SIDS, drowning, suicide, trauma, internal bleeding and other diseases, a total of 232 arrests were considered of cardiac origin giving an incidence of 33/100,000/year. The average response time was 6,1 min. Of 232 cardiac resuscitation attempts 140 patients (60%) were in VF/VT, 53 (23%) in asystole and 39 (17%) in other rhythms. Ninety-six (41%) of all patients survived being admitted to hospital ward and 44 (19%) survived to discharge with 39 being alive at 12 months. Of patients in VF/VT, 79 (56%) survived to hospital admission and 39 (28%) to hospital discharge. Resuscitation was more successful in cases of witnessed arrest and if CPR was attempted by bystanders. CONCLUSION: Despite various changes in the EMS system, the results of resuscitative attempts are similar to previous studies in the area but an increased proportion of survivors is left with neurological damage. In 54% of the cases COR was performed by bystanders. Response time needs to be shortened and CPR training increased.Inngangur: Neyðarbíll hefur sinnt endurlífgunarþjónustu á höfuðborgarsvæðinu síðan 1982. Hefur útkallstími við endurlífganir verið 4,6-4,9 mínútur, lifun að innlögn á sjúkrahús 31-40% og lifun að útskrift frá sjúkrahúsi 16-17%. Í upphafi árs 1996 var fyrirkomulagi breytt þegar þjónustusvæði var stækkað og sama ár var einnig tekið upp stefnumótakerfi, auk þess sem neyðarlínan tók til starfa. Farsímanotkun þjóðarinnar náði yfir 90% í lok rannsóknartímabilsins sem hefur auðveldað tilkynningar um hjartastopp og á tímabilinu var þjálfun neyðarbílslækna og sjúkraflutningamanna aukin. Rannsóknin var gerð á árunum 1999-2002. Tilgangur hennar var að meta: 1) árangur endurlífgunartilrauna utan sjúkrahúsa vegna hjartasjúkdóma á höfuðborgarsvæðinu, 2) áhrif viðbragða og endurlífgunartilrauna nærstaddra á afdrif sjúklinga, 3) hugsanleg áhrif skipulagsbreytinga á þjónustunni. Efniviður og aðferðir: Í öllum tilvikum skyndilegs meðvitundarleysis fer sjúkrabíll og neyðarbílslæknir á vettvang. Endurlífgunartilraunir voru framkvæmdar samkvæmt stöðlum AHA (american heart association) og skýrslur um allar endurlífgunartilraunir fylltar út jafnharðan af neyðarbílslæknum samkvæmt Utsteinstaðli. Niðurstöður: Alls var reynt að endurlífga í 319 tilvikum. Í 87 tilvikum var um að ræða hengingu, drukknun, lyfjaeitrun, innri blæðingu, vöggudauða, áverka eða aðrar ástæður, en í 232 tilvikum var hjartastopp vegna hjartasjúkdóma og miðast uppgjörið við þann hóp. Tíðni hjartaendurlífgunartilrauna var 33 á hverja 100.000 íbúa á ári. Meðalaldur var 68 ár og 77% voru karlar. Meðalútkallstími var 6,1 mínútur. Af 232 hjartasjúkdómaendurlífgunum voru 140 einstaklingar (60%) í sleglatifi eða sleglahraðtakti án blóðflæðis (VF/VT), 53 (23%) í rafleysu og 39 (17%) í öðrum takti. Af öllum sjúklingum þar sem endurlífgun var reynd komust 96 (41%) lifandi inn á legudeild og 44 útskrifuðust (19%). Eftir 12 mánuði voru 39 á lífi. Sé litið sérstaklega á þá sem voru í VF/VT komust 79 (56%) lifandi inn á deild og 39 (28%) útskrifuðust. Þegar vitni var að upphafi hjartastopps var skyndihjálp beitt í 54% tilvika. Ályktanir: Þrátt fyrir lengingu á útkallstíma hefur árangur endurlífgunartilrauna ekki breyst en fjöldi þeirra sem lifa af með heilaskaða hefur aukist. Aðgerðir til þess að stytta útkallstíma og auka fjölda þeirra sem framkvæma hjartahnoð eru nauðsynlegar

Nordic research and development cooperation to strengthen nuclear reactor safety after the Fukushima accident

A comprehensive study of photon interaction features has been made for some alloys containing Pd and Ag content to evaluate its possible use as alternative gamma radiations shielding material. The mass attenuation coefficient (μ/ρ) of the present alloys was measured at various photon energies between 81 keV – 1333 keV utilizing HPGe detector. The measured μ/ρ values were compared to those of theoretical and computational (MCNPX code) results. The results exhibited that the μ/ρ values of the studied alloys are in same line with results of WinXCOM software and MCNPX code results at all energies. Moreover, Pd75/Ag25 alloy sample has the maximum radiation protection efficiency (about 53% at 81 keV) and lowest half value layer, which shows that Pd75/Ag25 has superior gamma radiation shielding performance among the compared other alloys. Keywords: Alloys, shielding material, MCNPX, photon, HPGe detecto

Acute pancreatitis. Prospective study of incidence, aetiology, severity, and mortality in Iceland

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: To evaluate the aetiology, severity and mortality of patients with acute pancreatitis at Landspítali - University Hospital (LSH) and to estimate the incidence in Iceland. Material and methods: A prospective study of all patients diagnosed with acute pancreatitis LSH during the one-year period October 1998 - September 1999 inclusive. The main outcome measures were APACHE II, Ranson, and Imrie scores, and C-reactive protein (CRP) concentrations. The Balthazar - Ranson criteria were used for scoring of computed tomograms (CT). Results: Twenty seven of the 50 patients were male. The median age of the whole series was 60 years (range 19-85). The estimated incidence was 32/100000 for the first attack of acute pancreatitis. The causes were; gallstones 42%, alcohol 32%, miscellaneous 24%, and idiopathic 2%. Thirty three percentage of the patients had APACHE II scores 9, 38% had Ranson scores of 3, 50% had Imrie scores of 3, and 34% had CRP concentrations >210 mg/L during the first 4 days or >120 mg/L during the first week. Seven patients had severe pancreatitis. Two patients in the whole group died, and both had clinically severe pancreatitis. Conclusions: Incidence and aetiology of acute pancreatitis in Iceland is in concordance to that described in other studies. Prospective assessment makes it possible to evaluate the aetiological factors more accurately. Measurement of the CRP concentration is an attractive and simple alternative to the severity scoring systems currently in use

Isolation, characterization and biotechnological potentials of Thraustochytrids from Icelandic waters

The following study reports on the first thraustochytrid isolates identified from Iceland. They were collected from three different locations off the northern coast of the country (Location A, Skagaströnd; Location B, Hveravík; and Location C, Eyjafjörður). Using 18S rDNA sequence analysis, isolates from Locations A and B were identified within the Thraustochytrium kinnei species while other isolates within the Sicyoidochytrium minutum species when compared to other known strains. Cells isolated from Locations A ( 2.10±0.70 g/L) and B ( 1.54±0.17 g/L) produced more biomass than the ones isolated from Location C ( 0.43±0.02 g/L). This study offers the first-time examination of the utility of byproducts from fisheries as a nitrogen source in media formulation for thraustochytrids. Experiments showed that isolates produced more biomass (per unit of substrate) when cultured on nitrogen of marine ( 2.55±0.74 g/L) as compared to of commercial origin ( 1.06±0.57 g/L). Glycerol ( 2.43±0.56 g/L) was a better carbon source than glucose ( 1.84±0.57 g/L) in growth studies. Fatty acid (FA) profiles showed that the isolates from Location C (S. minutum) had low ratios of monounsaturated ( 4.21±2.96% ) and omega-6 ( 0.68±0.59% ) FAs. However, the isolates also had high ratios of docosahexaenoic acid (DHA; 35.65±1.73% ) and total omega-3 FAs ( 40.39±2.39% ), indicating that they could serve as a source of marine oils for human consumption and in aquaculture feeds. The T. kinnei isolates from Location A could be used in biodiesel production due to their high ratios of monounsaturated ( 18.38±6.27% ) long chain ( 57.43±8.27% ) FAs.The research reported here was partly funded by the AVS R&D Fund of the Ministry of Fisheries and Agriculture in Iceland, grant number AVS: R 047-10.Peer Reviewe