Computerized tomography guided percutaneous needle biopsies at Landspitali University Hospital. Indications, complications and results

Hægt er að lesa greinina í heild sinni með því að smella á hlekkinn View/OpenOBJECTIVE: Transthoracic needle aspiration biopsies (TNAB) are ideal for diagnosis of peripheral lung nodules. The purpose of the study is to investigate computerized tomography (CT) guided TNAB at Landspitali University Hospital (LUH) in regard to indications, complications, results and evaluate the diagnoses that were obtained with the biopsies. MATERIAL AND METHODS: Retrospective study where information was obtained from clinical charts at LUH. A list of TNAB done over an 18 month period in 2003 to 2004 was obtained from the Department of Medical Imaging. Indications for biopsy, pathology diagnosis, complications and treatment were studied. Further studies and final diagnosis were also studied. RESULTS: There were total of 93 patients that had TNAB. Records were available on 82 patients (46 males og 36 females). Most often the study was done because of cancer suspicion. Nodules were commonly 2-3 cm large. Most commonly there was one nodule that was peripheral. 25/82 (30%) patients developed pneumothorax after the procedure and four patients needed a chest tube. The most common diagnosis was cancer in 36/82 (44%), unspecific changes in 15/82, normal tissue in 12/82, inflammation in 9/82 and other benign causes in 10/82. The sensitivity to diagnose cancer was 61% and specificity 100%. The final diagnosis was cancer in 59/82 (72%) of the cases and benign causes in 23/82. CONCLUSIONS: The diagnostic yield of TNAB is lower in our study than in many previous studies. The rate of complications is similar. It it necessary to do followup studies in benign diagnoses because many of them have cancer when studied further.Tilgangur: Ástunga gegnum brjóstvegg með nál er heppileg þegar um er að ræða hnúða í lungum sem liggja að eða nálægt brjóstvegg. Tilgangur rannsóknarinnar var að kanna ábendingar, árangur og fylgikvilla af ástungum í tölvusneiðmyndatæki á Landspítala (LSH) og kanna lokagreiningu. Efniviður og aðferðir: Aftursæ rannsókn þar sem upplýsingar voru fengnar úr sjúkraskrám LSH. Frá myndgreiningardeild LSH var fenginn listi yfir ástungur gegnum brjóstvegg sem framkvæmdar voru á 18 mánuðum árin 2003-2004. Kannaðar voru ábendingar fyrir ástungu, niðurstaða vefjagreiningar, fylgikvillar og meðferð þeirra. Frekari rannsóknir sem gerðar voru og lokagreining voru athugaðar. Niðurstöður: Alls var um að ræða 93 sjúklinga. Upplýsingar fengust um 82 sjúklinga (46 karlar og 36 konur). Langflestir komu vegna gruns um krabbamein. Algengast var að hnúðarnir væru 2-3 cm að stærð. Oftast var um einn hnúð að ræða sem lá nálægt brjóstvegg. 25/82 (30%) sjúklingar fengu loftbrjóst eftir aðgerðina og þurftu fjórir brjóstholskera. Algengasta greining var krabbamein hjá 36/82 (44%), ósértækar breytingar 15/82, eðlilegur vefur hjá 12/82, bólga hjá 9/82 og aðrar góðkynja orsakir hjá 10/82. Næmi rannsóknarinnar gagnvart krabbameini er 61% og sértæki 100%. Lokagreining var krabbamein hjá 59/82 (72%) einstaklingum og góðkynja orsakir hjá 23/82 þeirra. Ályktanir: Árangur af þessum ástungum er lakari en í erlendum rannsóknum. Tíðni fylgikvilla er svipuð. Nauðsynlegt er að fylgja eftir góðkynja greiningum því stór hluti þeirra reynist vera krabbamein við nánari skoðun

Bronchial artery embolization as a treatment for massive hemoptysis. A case report

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenA 47 year old male was admitted to the pulmonary medicine department in Landspítali University Hospital following a three day episode of massive hemoptysis but prior to admission he had been suffering from a dry cough for several weeks. Neither bronchoscopy nor a CT scan revealed the cause of bleeding and he was treated for bronchitis. Subsequently the bleeding stopped and he was discharged on Friday for a follow-up bronchoscopy to be performed three days later but only for that study to reveal continued bleeding and he was therefore readmitted. Two days later a selective bronchial arteriography was performed, showing vascular hyperemia and a bleeding site which was treated accordingly with endovascular embolization. Hemoptysis has not recurred on follow-up.Ágrip 47 ára karlmaður var lagður inn á lungnadeild Landspítala Fossvogi í kjölfar umtalsverðs blóð­hósta sem verið hafði til staðar í þrjá daga en hafði áður verið með þurran hósta í nokkrar vikur. Berkjuspeglun sýndi ekki fram á orsök blæð­ingar né tölvusneiðmynd og var hann því í fyrstu meðhöndlaður á grunni berkjubólgu. Við þetta stöðvaðist blæðingin og var hann útskrifaður á föstudegi og ráðgerð endurkoma þremur dög­um síðar í endurtekna berkjuspeglun. Í þeirri berkjuspeglun sást aftur blæðing og var hann því lagður inn á ný. Í framhaldinu var gerð sértæk æðamyndataka sem sýndi fram á æðabreytingar og blæðingarstað sem var lokað með æðainngripi og mun þetta vera í fyrsta skipti sem slík meðferð er reynd hér á landi við slíku tilfelli

The use of endobronchial stents in Iceland

Hægt er að lesa greinina í heild sinni með því að smella á hlekkinn View/OpenDiseases that cause progressive obstruction of the larger airways are commonly encountered in pulmonary medicine. Even slight narrowing of the larger airways can cause intense symptoms and sometimes be life-threatening. In recent years progress has been made in endobronchial intervention procedures. A range of technologies has been developed to obtain and maintain patency of the bronchial lumen in disease. This article briefly describes the current use of these methods in Iceland and in some detail the use of stents in airways. The placement of a bronchial stent is a fairly simple procedure that can, if properly indicated, significantly relief symptoms.Sjúkdómar sem valda viðvarandi þrengingu á berkjum eru algengt viðfangsefni lungnalækna. Jafnvel minniháttar þrengsli í barka eða berkjum geta valdið verulegum einkennum og stundum lífsháska. Á undanförnum árum hefur orðið nokkur þróun í aðgerðum á berkjum gegnum berkjuspeglun. Ýmis tækni er nú notuð til að opna og varðveita hol berkju. Þessi grein lýsir stuttlega stöðu þessara mála á Íslandi og nokkru nánar útfærslu á einni þessara aðferða. Ísetning á stoðneti í berkju er tiltölulega einföld aðgerð sem getur við rétta ábendingu veitt verulega bót einkenna

The incidence and mortality of ARDS in Icelandic intensive care units 1988-1997

Neðst á síðunni er hægt er að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenOBJECTIVE: A retrospective analysis of the epidemiology and intensive care treatment of ARDS in Iceland during the 10 year period, 1988-1997 with observation of trends within the period. MATERIAL AND METHODS: All ICU admissions in Iceland 1988-1997 were reviewed according to the American-European consensus conference criteria on ARDS to select patients with the diagnosis of ARDS i.e. bilateral pulmonary infiltrates, PaO(2)/FiO(2) 18 mmHg. Data were collected on age, gender, length of stay, ventilator treatment and ventilatory modes, causes of ARDS and mortality. RESULTS: A total of 220 patients with severe respiratory failure were found and 155 of them were diagnosed as having ARDS or an annual incidence of 15.5 cases/year or 5.9 cases/100.000/year. If reference population >15 years of age is used for calculation the incidence is 7.8 cases/100.000/year. Hospital mortality was 40%, mean length of ICU stay was 21 days, mean hospital length of stay 39 days. The incidence of ARDS increased during the period with a tendency to lower mortality rates. Mortality was significantly lower when pressure controlled ventilation was used, compared to volume controlled ventilation. CONCLUSION: The incidence of ARDS in a well defined population of Iceland is lower than recent studies in USA and Europe have shown or 5.9 cases/100.00/year but is increasing. The mortality is 40% and shows a slight downward trend, which may be due to the use of lung protective ventilation.Tilgangur: Að kanna nýgengi, orsakir, dánarhlutfall og öndunarvélarmeðferð sjúklinga með brátt and­nauðarheilkenni (BAH) á gjörgæsludeildum á Íslandi á 10 ára tímabili. Efniviður og aðferðir: Farið var yfir allar inn­lagn­ir á gjörgæsludeildir á Íslandi 1988-1997 og sjúk­lingar með alvarlega öndunarbilun skoðaðir sérstaklega. Safnað var upplýsingum um aldurs- og kynjadreifingu, orsakir, legutíma, gjör­gæslumeðferð og af­drif þeirra sjúklinga sem féllu undir alþjóðlega skilgreiningu á BAH, það er bráður sjúkdómur með dreifðar íferðir í báðum lungum án merkja um hjartabilun og PaO2/FiO2 hlutfall <200. Borin voru saman árabilin 1988-1992 og 1993-1997. Niðurstöður: Alls reyndust 220 sjúklingar vera með alvarlega öndunarbilun. Af þeim reynd­ust 155 sjúklingar falla undir alþjóðlegu skil­grein­inguna á BAH, 82 konur og 73 karlar, og var meðalaldur 52,3 ár. Nýgengi var 15,5 tilfelli á ári, eða 5,9 tilfelli/100.000 íbúa/ár. Ef miðað er við mannfjölda eldri en 15 ára var nýgengi 7,8 tilfelli 100.000/ár. Alls létust 62 sjúklingar, eða 40%. Meðallegutími á gjörgæsludeild var 21 dagur en legutími á sjúkrahúsi 39 dagar. Meðaltími frá áfalli að staðfestum BAH var 3,2 dagar. Til­fell­um á hverja 100.000 íbúa fjölgaði seinni hluta tímabilsins, úr 4,8 tilfellum/100.000 íbúa/ár 1988-1992 í 6,9 tilfelli/100.000 íbúa/ár 1993-1997. Dánar­hlutfall lækkaði úr 46,9% í 40,2% en ekki töl­fræði­lega marktækt. Ef notuð var þrýstingsstýrð öndunarvélarmeðferð var dánarhlutfall 38,7% en var 45,7% ef rúmmálstýrð meðferð var notuð. Ályktun: Tilfellum af BAH virðist fara fjölgandi á gjörgæsludeildum á Íslandi. Um er að ræða fremur ungt fólk og dánarhlutfall er hátt en hefur lækkað svipað og í nágrannalöndunum og bendir flest til þess að framfarir í gjörgæslumeðferð svo sem lungnaverndandi öndunarvélameðferð séu að skila árangri

Modelling and Simulation of Asynchronous Real-Time Systems using Timed Rebeca

In this paper we propose an extension of the Rebeca language that can be used to model distributed and asynchronous systems with timing constraints. We provide the formal semantics of the language using Structural Operational Semantics, and show its expressiveness by means of examples. We developed a tool for automated translation from timed Rebeca to the Erlang language, which provides a first implementation of timed Rebeca. We can use the tool to set the parameters of timed Rebeca models, which represent the environment and component variables, and use McErlang to run multiple simulations for different settings. Timed Rebeca restricts the modeller to a pure asynchronous actor-based paradigm, where the structure of the model represents the service oriented architecture, while the computational model matches the network infrastructure. Simulation is shown to be an effective analysis support, specially where model checking faces almost immediate state explosion in an asynchronous setting.Comment: In Proceedings FOCLASA 2011, arXiv:1107.584

Telemedicine consultations in Iceland

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenOBJECTIVE: A Telemedicine project was initiated to evaluate the usefulness of medical teleconsultations in Iceland and to gain experience for further planning of Telemedicine in the country. MATERIAL AND METHODS: The consultations were based on videoconference and store and forward method. Electronic stethoscope, spirometry, otoendoscope and digital pictures were used along with conventional videoconsultations. Doctors in six specialties in Landspitali University Hospital and one in private practice and Primary Care Physicians from five Health Care Centers in Iceland participated in the project. RESULTS: The results show that the Telemedicine consultations is practical and can be very useful. The doctors were content with the use of Telemedicine and the patients were pleased with the technique and the consults in general. All patients for example said that the consultation was just as or even better as if the specialist was in the room in person. The use of Telemedicine was helpful in almost all of the cases. Attention must be paid to organization of the consultations, payment, technical details and knowledge. CONCLUSION: Telemedicine have a role for Icelandic healthcare and may prove to be very useful. There are a number of factors who need preparation before the implementation of a Telemedicine service.Tilgangur: Að meta hvernig nota megi fjarlækningar við samráð (consultation) lækna á Íslandi og safna reynslu fyrir framtíðarskipulagningu fjarlækninga í heilbrigðisþjónustu hér á landi. Efniviður og aðferðir: Samráð voru tvíþætt, annars vegar með fjarfundabúnaði (videoconference) og hins vegar með rafrænum sendingum (store and forward) þar sem notuð voru gögn úr rafrænni hlustpípu, öndunarmæli (spírómetría) og stafrænni myndavél. Auk þess var notuð eyrnaholsjá (otoendóskóp) á fjarfundum. Sérgreinalæknar sex sérgreina, það er í barnalækningum, háls-, nef- og eyrnalækningum, hjartalækningum, húðlækningum, lungnalækningum og skurðlækningum, voru ráðgefandi fyrir heimilislækna á fimm heilsugæslustöðvum víðsvegar um landið. Læknarnir störfuðu á Landspítala, einkarekinni læknamóttöku og heilsugæslustöðvunum á Seyðisfirði, Egilsstöðum, Kópaskeri, Patreksfirði og í Reykjavík. Niðurstöður: Niðurstöður sýna að fjarlækningaþjónusta eins og veitt var í verkefninu gegnir hlutverki sínu ágætlega og getur verið mjög gagnleg. Almenn ánægja var meðal sjúklinga og lækna með fjarlækningarnar. Til dæmis töldu allir sjúklingar sem tóku þátt í fjarlækningum með fjarfundabúnaði að læknisviðtalið gagnaðist svipað og jafnvel betur en ef sérgreinalæknirinn hefði verið til staðar í eigin persónu. Fram kom að til að ná fram hámarks gagnsemi fjarlækninga þarf skipulag samráða að vera gott, greiða þarf fyrir þessa vinnu og einnig þarf tækni og tækniþekking að vera til staðar. Ályktun: Fjarlækningar eiga erindi inn í íslenskt heilbrigðiskerfi og geta verið til mikils gagns. Að mörgum þáttum þarf að huga varðandi uppbyggingu og skipulagningu fjarlækningaþjónustu

Generation of Quality Hit Matter for Successful Drug Discovery Projects.

A drug discovery project needs a number of components for its success [...]

Improved Bronchoscopy by new image guided Approach

Navigation in bronchoscopy has developed into a feasible approach for lung diagnostics since introduced in 1998. The concept combines computer generated models from patient CT data with position and orientation tracking of the bronchoscope tip and/or other tools. Trials using navigational bronchoscopy have demonstrated increased diagnostics success rates. Despite higher diagnostic success rates and two decades of development in navigation for bronchoscopy, the use of the technology is still not common in lung diagnostics. The pulmonologist is trained surveying and assessing CT and steering via video display from a flexible scope during bronchoscopy. Expanding the conventional work with additional display through techniques such as navigational bronchoscopy can be expensive to integrate in smaller hospitals and complicated for pulmonologists without proper training. Also, existing VB approaches only offers endoluminal view, an airway segmentation as a “road map” to lesions in lungs, and in best circumstances additional models of segmented lesions and vessels. New solutions specifically for bronchoscopy visualization application was developed in this project. This thesis presents a development and evaluation of a new visualization approach for planning and guidance in bronchoscopy; Anchored to Centerline Curved Surface (ACCuSurf), consisting of more complete view for navigated bronchoscopy in tube-like structures. The technique may also be combined with other methods such as VB, PET and ultrasound images, by adding these data sources to the display. At the same time as providing overview of the lungs and tools, the ACCuSurf can be zoomed in and show more anatomical details than the conventional endoluminal view. First, a comparison of different approaches to airway segmentation was carried out to establish a route to target. Secondly, the ACCuSurf was developed by slicing the segmented airways in half, creating a 3D volume representing surrounding anatomy along the path to target. Finally, the ACCuSurf method was assessed by pulmonologists using it as a planning tool before performing bronchoscopy on a phantom with a mixed data set from a patient and the phantom. The conventional 2D (axial, sagittal, coronal) visualisation was comparison reference. The study is an effort to ease and simplify visualisation for navigation in bronchoscopy

Notetaking in Minecraft and the Educational Use of Video Games: An Experimental Study

Dataspill-basert læring er ingen ny idé. Likevel er forskning rundt det uklar. Denne studien forsøker å forstå feltet bedre, og bidra til det. Det ble gjort ved å sammenligne resultater på en kunnskapstest, utført av elever ved norske videregående skoler. De ble delt i tre grupper, hver med sin studieteknikk å lære innholdet fra en tekst med. En av disse brukte Minecraft Education, intervensjon gruppen. De to andre var kontrollgrupper. De ble også spurt om holdninger til oppgaven. Ingen signifikante funn mellom studieteknikk og testresultater ble funnet, men flere signifikante forhold ble funnet mellom holdninger. Foruten om en sterk korrelasjon mellom motivasjon og testresultater, antyder disse forholdene at studieteknikk kan ha indirekte påvirket testresultater. Dette presenterer spennende muligheter for fremtidig forskning.By no means is digital game-based learning a recent idea, yet empirical evidence surrounding it is hazy. This paper aims to attain clarity and understanding of the topic and contribute to the literature. This contribution came in the form of an experiment comparing Norwegian high school students’ knowledge test scores, after studying a text on memory using three different techniques. One of these required the use of Minecraft Education, the intervention. The remaining two being controls. Self-reports regarding task attitudes were collected. No significant effect was found between the use of Minecraft Education and test scores, but significant effects were found for task attitudes. Besides motivation being a strong predictor of test score, these effects imply that study technique could have indirectly influenced scores as well, providing interesting possibilities for future research

Monoterpene substituted thiazolidin-4-ones as novel TDP1 inhibitors: Synthesis, biological evaluation and docking.

Tyrosyl-DNA phosphodiesterase 1(TDP1) is a promising target for a new therapy in oncological disease as an adjunct to topoisomerase 1 (TOP1) drugs. In this paper, novel thiazolidin-4-one derivatives with a benzyl and monoterpene substituents were synthesized. Compounds with a monoterpene fragment attached via a phenyloxy linker were active against TDP1 with IC50 values in the 1 ÷ 3 µM range, while direct attachment of monoterpene moiety to the thiazolidin-4-one fragment had no activity. Molecular modelling predicted two plausible binding modes of the active compounds both effectively blocking access to the catalytic site of TDP. At non-toxic concentrations the active ligands potentiated the efficacy of the TOP1 poison topotecan in human cervical cancer HeLa cells, but not in non-cancerous HEK293A cells