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ABC om Handläggning av psykiska besvär.
Lakartidningen Pub Date : 2025-03-25
Christian Nordenstam, Johan Bengtsson, Kristoffer Domargård, Katrin Hagskog Engel
{"title":"ABC om Handläggning av psykiska besvär.","authors":"Christian Nordenstam, Johan Bengtsson, Kristoffer Domargård, Katrin Hagskog Engel","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Pan-neurofascin autoimmune nodopathy - an emerging and treatable differential diagnosis to Guillain-Barré syndrome].
Lakartidningen Pub Date : 2025-03-24
Ivan Kmezic, Anders Eriksson, Eva Sundman, Rayomand Press
{"title":"[Pan-neurofascin autoimmune nodopathy - an emerging and treatable differential diagnosis to Guillain-Barré syndrome].","authors":"Ivan Kmezic, Anders Eriksson, Eva Sundman, Rayomand Press","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Autoimmune nodopathy (AN) is an emerging diagnostic category with antibodies targeting the peripheral node of Ranvier. Clinically, AN overlaps with Guillain-Barré syndrome (GBS) and acute-onset CIDP. However, the immunopathology of AN is different, hence AN is considered as a separate entity. Antibodies targeting all neurofascin isoforms are associated with a phenotype and immunopathology described as pan-neurofascin (panNF) AN. Here, we describe a clinical and serological work-up of two patients with anti-panNF IgG4 AN, as well as treatment response. Due to the high morbidity of panNF and its treatable nature, we suggest early antibody testing in severe cases of GBS, especially when a prolonged need for invasive ventilation occurs. Specialized intensive care rehabilitation promotes autonomy and recovery, and should be considered as an alternative to traditional ICU care.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Non-seminomatous testicular cancer presenting with hyperthyroidism].
Lakartidningen Pub Date : 2025-03-24
Djordje Grujovic, Åke Sjöholm
{"title":"[Non-seminomatous testicular cancer presenting with hyperthyroidism].","authors":"Djordje Grujovic, Åke Sjöholm","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Thyrotoxicosis caused by human chorionic gonadotropin (hCG) is a rare form of hyperthyroidism, often associated with conditions involving very high levels of hCG and sometimes seen in women with gestational hyperthyroidism. Here we present a case of a 53-year-old man with metastatic non-seminomatous testicular cancer (NSGCT) and concomitant thyrotoxicosis related to extremely high hCG levels. The patient sought care with symptoms such as fatigue, weight loss, nausea, and a distended abdomen. Laboratory work-ups showed thyrotoxicosis with suppressed TSH and elevated levels of free T4 and T3. At the same time, a grossly elevated hCG level of over 100,000 IU/L was detected. Further diagnostics confirmed NSGCT with extensive liver, lung, and lymph node metastases. The patient was treated with chemotherapy, which resulted in rapid reduction of hCG levels and remission of thyrotoxicosis. Thyrotoxicosis induced by hCG should be considered in patients with germ cell tumors and very high hCG levels. Effective treatment of the underlying malignancy can lead to normalization of the thyroid function.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Increasing prescription of drug treatment for sleep disorders in children calls for reflection].
Lakartidningen Pub Date : 2025-03-21
Kjersti Kvernebo Sunnergren
{"title":"[Increasing prescription of drug treatment for sleep disorders in children calls for reflection].","authors":"Kjersti Kvernebo Sunnergren","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Sleep disorders are common in children. The Swedish Medical Products Agency recommends careful evaluation of children with sleep disorders with focus on underlying disease and lifestyle factors. The treatment of choice is implementation of sleep hygiene advice. Medical treatment is rarely necessary. The endogenous melatonin level is affected by lifestyle factors such as exposure to darkness and blue light at nighttime. Addressing lifestyle factors is necessary to secure an effective treatment. Within child and adolescent psychiatry, there is a trend of increasing prescription of drug treatment for various diagnoses, including sleep disorders. Caregivers may express a desire to find an easy solution to a complex problem, but extensive prescription of melatonin should be avoided. Melatonin has physiological effects exceeding regulation of sleep. The potential long-term effects of melatonin treatment are not known. Children are vulnerable and should be treated with extra caution.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[The use of melatonin continues to increase - rational prescribing and follow-up is important].
Lakartidningen Pub Date : 2025-03-21
Elin Dahlén, Emelie Bergman Perland, Elin Maria Bergsten, Veronica Arthurson, Elin Kimland
{"title":"[The use of melatonin continues to increase - rational prescribing and follow-up is important].","authors":"Elin Dahlén, Emelie Bergman Perland, Elin Maria Bergsten, Veronica Arthurson, Elin Kimland","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The prescribing of melatonin continues to increase and occurs partially off-label. The largest increase is among children aged 6-17 years. During the COVID pandemic, the over-the-counter sales of melatonin increased despite jet lag in adults being the only approved indication. The Swedish Medical Products Agency notes an increased interest in melatonin and signals of unwarranted sale of melatonin as a dietary supplement. There is a risk that melatonin medications are used too casually. In addition, knowledge of the long-term effects of melatonin use is scarce. The increasing use of melatonin needs to be highlighted and monitored to ensure rational use.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Penetrerande intrakraniella skador – en utmaning även här.
Lakartidningen Pub Date : 2025-03-13
Alba Corell, Niklas Marklund
{"title":"Penetrerande intrakraniella skador – en utmaning även här.","authors":"Alba Corell, Niklas Marklund","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Neurosurgical management of combat-related penetrating traumatic brain injury - lessons from 10 years of war in Ukraine].
Lakartidningen Pub Date : 2025-03-13
Andrii Sirko, Alex B Valadka, Ghazal Yadav, Rocco A Armonda, Mattias K Sköld
{"title":"[Neurosurgical management of combat-related penetrating traumatic brain injury - lessons from 10 years of war in Ukraine].","authors":"Andrii Sirko, Alex B Valadka, Ghazal Yadav, Rocco A Armonda, Mattias K Sköld","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Unlike in previous recent conflicts, the casualties in the Ukrainian war are close to advanced medical facilities. We review lessons learned by the neurosurgical service at Mechnikov Dnipropetrovsk Regional Clinical Hospital (MDRCH). Aggressive and early combined treatment of injuries to the brain, the skull and the skull base reduces complications and improves outcomes. Use of the operating microscope optimizes careful handling of tissue. Pericranial flaps that retain vascularized pedicles are extensively used. Initial CT scanning and catheter-based angiography is liberally used if injury to the cerebral vasculature is seen or suspected. Traumatic pseudoaneurysms and arteriovenous fistulae are immediately treated, followed by open craniotomy for hematoma evacuation and calvarial reconstruction. With early and aggressive surgery and postoperative critical care, even the most severely injured patients can expect good recoveries. Premature decisions to withhold or withdraw care should be avoided.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[»Left bundle branch area pacing«].
Lakartidningen Pub Date : 2025-03-12
Alice David, Amar Taha, Andreas Martinsson
{"title":"[»Left bundle branch area pacing«].","authors":"Alice David, Amar Taha, Andreas Martinsson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Pacing-induced cardiomyopathy (PIC) is a condition that leads to increased morbidity and mortality. Unfortunately, it is not uncommon after implantation of a pacemaker with a right ventricular lead. Right ventricular pacing creates a delayed electrical activation, leading to dyssynchronous contraction, and it is a known risk factor for PIC. Left bundle branch area pacing (LBBAP) is a form of pacing that delivers a physiological activation of the left ventricle. The lead is implanted deep in the septum and captures the left bundle branch of the conduction system. This allows for a synchronous electrical activation of the ventricles. LBBAP has shorter ventricular activation time and less dyssynchronous contraction compared to right ventricular pacing. Recently, studies have shown that the long-term electrical parameters are comparable to right ventricular leads. Randomized trials are underway to compare LBBAP with right ventricular pacing and biventricular pacing.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Adherence to the national guidelines regarding referral of patients with knee osteoarthritis to orthopedic consultation].
Lakartidningen Pub Date : 2025-03-11
Daniel Broman, Lisa Andersson, Susanne Beischer, David Sundemo, Olof Thoreson, Maziar Mohaddes
{"title":"[Adherence to the national guidelines regarding referral of patients with knee osteoarthritis to orthopedic consultation].","authors":"Daniel Broman, Lisa Andersson, Susanne Beischer, David Sundemo, Olof Thoreson, Maziar Mohaddes","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The aim of the study was to investigate: 1) the proportion of referrals from primary care to orthopedic consultations that included the information requested by the national guidelines for patients with knee osteoarthritis, and 2) the proportion of referrals that specified whether patients had completed first-line treatment. A total of 140 referrals were examined. None of the referrals adhered fully to the national guidelines, and none included information on whether the patient had completed first-line treatment. This suggests that the referral process for this patient group needs to be reviewed and improved. We propose three possible changes regarding the referral process, including an enhanced role for physical therapists and the patients themselves and a digital referral platform enabling easier communication between different professions.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Are we hopefully on the way to eradicating HPV-related cancer?]
Lakartidningen Pub Date : 2025-03-10
Arne Wikström
{"title":"[Are we hopefully on the way to eradicating HPV-related cancer?]","authors":"Arne Wikström","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>An interesting article in this issue of Läkartidningen argues for the benefit of a broad HPV vaccination with catch-up vaccination also for men, and sheds more light on HPV-related cancer in men. There has been an increase of HPV-related anal and oropharyngeal cancer in recent years, but no screening methods for these cancers have been implemented. A gender neutral catch-up vaccination would help to decrease the burden of oncogenic HPV in society, and would also be beneficial for females. Swedish authorities have now come to the conclusion that catch-up vaccination of men would be cost-effective, a decision that we strongly support.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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