Kristinn Sigvaldason

Acute respiratory distress syndrome: nationwide changes in incidence, treatment and mortality over 23 years.

The aim of this study was to assess population‐based changes in incidence, treatment, and in short‐ and long‐term survival of patients with acute respiratory distress syndrome (ARDS) over 23 years.

Induced hypothermia in comatose survivors of asphyxia: a case series of 14 consecutive cases

Background: Induced hypothermia is widely used for comatose survivors of cardiac arrest. Other causes of hypoxic brain injury carry a poor prognosis when treated using traditional methods. At our hospital, hypothermia has also been used for the management of all comatose survivors of asphyxiation. The aim of the present study was to report the results of the management of these patients.

Epidemiology of spinal fractures and associated spinal cord injuries in Iceland

Study designA retrospective epidemiological study.SettingLandspítali University Hospital, Iceland.ObjectivesAssessment of epidemiological data and risk factors for traumatic spinal fractures (SFs) and associated spinal cord injury (SCI).MethodsA retrospective review of hospital admissions due to traumatic SFs during a 5-year period, with analysis of epidemiological parameters and occurrence of concomitant SCI. Patients with asymptomatic SFs and non-traumatic SCI were excluded.ResultsA total of 487 patients were diagnosed with a SF or 310 PMI (per million inhabitants), 42 of them (9%, 27 PMI) with an associated SCI. The mean age was 56 years, males were 57%. Falls were the leading cause of both SFs (49%) and SCIs (43%). Low falls (<1 m) caused SFs more often in elderly women (67%, mean age 77 years) and more than 96% were without SCI. Road traffic accidents (RTA) caused 31% of SFs and 26% of SCIs. Seat belts were not used in 20% of car accidents, but information was missing in 27%. Sports/leisure-related accidents caused SFs in 12% of cases, whereof horseback riding accidents were the most common (36%).ConclusionsSFs led to SCI in 9% of patients. Several risk factors were common for SFs and SCIs but two major differences were seen: SFs without SCI were most common in older women due to low falls, while the risk of a concomitant SCI increased in young patients, in males, in falls from high levels and when driving without using seat belts. Preventive efforts should therefore be directed towards these risk factors.

Fjórföld hækkun á blóðfitum í bráðu ástandi ketónasýringar - sjúkratilfelli

Severe hypertriglyceridemia is a known, but uncommon complication of diabetic ketoacidosis. We discuss the case of a 23-year-old, previously healthy, woman who initially presented to the emergency department with abdominal pain. Grossly lipemic serum due to extremely high triglyceride (38.6 mmol/L) and cholesterol (23.2 mmol/L) levels were observed with a high blood glucose (23 mmol/L) and a low pH of 7.06 on a venous blood gas. She was treated successfully with fluids and insulin and had no sequale of pancreatitis or cerebral edema. Her triglycerides and cholesterol was normalized in three days and she was discharged home on insulin therapy after five days. Further history revealed a recent change in diet with no meat, fish or poultry consumption in the last 12 months and concomitantly an increase in carbohydrate intake which might have contributed to her extremely high serum lipid levels. This case demonstrates that clinicians should be mindful of the different presentations of diabetic ketoacidosis. Key words: diabetic ketoacidosis, hypertriglyceridemia, hyperlipidemia, vegan diet, carbohydrate diet. Correspondence: Hrafnkell Stefansson, hrafnkell.stefans@gmail.com.

Mænuskaði af völdum slysa á Íslandi á árunum 1975-2014

INTRODUCTION Traumatic spinal cord injury (TSCI) is serious and often has long-term consequences. Since no cure has been found the emphasis has been on preventive measures. The incidence of TSCI varies between countries and the epidemiology has been changing. The aim of this study was to gather epidemiological data on patients with TSCI in Iceland and search for risk factors. MATERIAL AND METHODS Hospital records of everyone diagnosed with TSCI in 1975-2014 admitted to Landspitali University Hospital were reviewed and information gathered on incidence, age, gender and causes of injury. The American Spinal Injury Association Impairment Scale (AIS) was used to assess the extent of TSCI. RESULTS A total of 233 patients were diagnosed with TSCI during the study period or 26 per million annually on average. Males were 73% and the mean age was 39 years. Traffic accidents were the most common cause of TSCI. The majority were car rollovers in rural areas. Around 50% did not use a seatbelt. The second most common cause of TSCI were falls. The most common sport/leisure accidents were those related to horseback-riding and winter sports. A third of patients had a complete SCI. At discharge 9% had gained full recovery. CONCLUSIONS Safe roads and good traffic culture are essential factors in the prevention of serious traffic accidents. Strict safety regulations in the work place and an investigation of causes of falls amongst the elderly could decrease SCIs due to falls. Further preventive measures and protective equipment could possibly be of use in sport- or leisure-related activities. Key words: Traumatic spinal cord injury, incidence, age, gender, causes, extent. Correspondence: Pall E. Ingvarsson, palling@landspitali.is.