[Hyperferritinemia - investigation, diagnosis and treatment].

Ferritin is one of the most requested blood tests in both primary and inpatient care, and high values occur frequently. One of the greatest challenges in the investigation of hyperferritinemia is to determine if there is a presence of iron overload. Patient history (chronic liver disease, excessive alcohol consumption, hereditary factors), clinical features (metabolic syndrome, acute or chronic inflammation, infection, malignancy) and biochemical tests (ferritin, transferrin saturation, hemoglobin, liver enzymes, CRP/SR, phosphatidyl ethanol, lipid profile, glucose) facilitate the determination of the cause of hyperferritinemia.

[New Swedish national guidelines - management of Percuteaneous Endoscopic Gastrostomy (PEG) and other enteral feeding tubes].

Numerous patients stand to gain significant health benefits from enteral nutrition support facilitated by percutaneous feeding tubes. Consequently it is crucial for endoscopists, general practitioners, surgeons and neurologists to be well-versed with indications, contraindications and potential complications of PEG and other enteral feeding tubes. In this context we present a concise overview of the new national guidelines by the Swedish Society of Gastroenterology regarding the management of PEG and other enteral feeding tubes.

[SPOR covers 100 percent of publicly run surgical care].

The Swedish Perioperative Register (SPOR) - a national quality register - supports automatic data transfer from local medical records to its central database, without the need for further manual input. Covering 100 percent of surgical operations across all publicly run hospitals in Sweden, SPOR data show regional inequality regarding patients' waiting time from the decision to operate until the start of surgery. SPOR data can inform several areas of improvement for perioperative care, such as management of postoperative pain and nausea, increased use of the Checklist for Safe Surgery, and improved logistics.

[Saksenaea caused invasive infection in an immunocompetent patient after trauma].

This text discusses a rare case of soft tissue infection caused by the fungus Saksenaea in a young, immunocompetent woman following an all-terrain vehicle accident abroad. Despite initial treatment, her wound worsened, necessitating multiple surgical revisions and aggressive antifungal therapy with liposomal Amphotericin B. The interdisciplinary collaboration among orthopedic surgeons, infectious disease specialists, and plastic surgeons played a vital role in her successful treatment.

[Four perspectives on Graves' orbitopathy - from the point of view of the patient, general practitioner, endocrinologist, and ophthalmologist].

Graves' orbitopathy is a common complication of Graves' disease. The mild form dominates, whereas moderate to severe and sight threatening forms are rarer. They require quick, adequate care, involving cooperation between county hospitals and the regional hospital, and adequate diagnostics and choice of treatments of treatments.

[Significant medical improvements with CPUP - a combined follow-up program and national quality registry for cerebral palsy].

CPUP is a combined follow-up program and national quality registry for cerebral palsy (CP). Since its inception in southern Sweden in 1994, CPUP has expanded geographically to cover all of Sweden, and similar programs are used in several northern European countries. Over 95% of all children with CP in Sweden, and a growing proportion of adults, are followed according to CPUP.

[Treatment of intracerebral hemorrhage - An overview].

Intracerebral hemorrhage (ICH) carries the highest mortality and morbidity of all stroke types. Although small vessel disease accounts for the majority of ICH, there is a broad spectrum of other etiologies. Modern imaging techniques are a cornerstone of the work-up process.

[Long-term follow up after childhood cancer - during childhood and adult life].

In Sweden, approximately 350 children and teenagers up to 18 years of age are diagnosed with cancer each year. The survival rate is high, above 80%, but the majority of those who survive will experience at least one late complication. The risk of late complications after treatment are mainly related to cumulative dose exposure of specific chemotherapeutic agents as well as radiation doses to certain organs at risk.

[Methods for fertility preservation].

Methods for cryopreservation of sperms, eggs, embryos and gonadal tissue have been developed and are available at many centers that have programs for fertility preservation. In Sweden, such programs are established at university hospitals and fertility preservation is offered within the publicly financed healthcare to patients when medically indicated. The largest patient groups undergoing procedures for fertility preservation include those with a cancer diagnosis, but also individuals with benign diseases, gender dysphoria and genetic conditions facing infertility risk may be offered fertility preservation.

[Janusmed Renal Function, an appreciated CDSS to support prescription of drugs and appropriate dosing in patients with renal impairment].

Janusmed Renal Function is a clinical decision support system (CDSS) that provides evidence-based dosage recommendations for adult patients with renal impairment. Dosage recommendations are presented for each drug/active substance in relation to four stages of chronic kidney disease (CKD). In addition, substances that are nephrotoxic are labelled with a warning.

[Lung complications in adults due to premature birth: an increasint patient population that needs to be followed up].

Infants born prematurely are susceptible for respiratory disease later in life. In particular, children born before 32 gestational weeks, treated with oxygen or respiratory support and diagnosed with bronchopulmonary dysplasia (BPD) have the highest risk.  Airways obstruction is the major lung function impairment, and it can be aggravated in adult life when age-related loss of lung function takes place.

[Medical doctor specialists - an overview of the research on formal and informal continued professional development].

An overview of the research literature about physicians' continuing development was conducted and shows that formal learning activities often target individuals and their development, and focus on increasing knowledge and influencing attitudes. Research studies showing changes in practice are less common. Regulated continuous medical education may lead to instrumental approaches to learning.

[On micropenis, diagnosis and differential diagnoses].

The term inconspicuous penis in children covers both micropenis with a penile length less than 2.5 SD for age and other conditions with a normal length of corpora, but when the penis looks smaller due to other diagnoses. Micropenis in a newborn is a serious condition that needs immediate attention by a paediatric endocrinologist.

[The utility of whole genome sequencing in rare disease diagnostics].

If a disease affects fewer than 1 in 2 000, the European Union defines it as a rare disease. Globally, about 300 million people live with a rare disease, and in Sweden about 400 000. There are approximately 7 000 different rare diseases.

[Acute necrotizing esophagitis - a rare condition that may lead to life-threatening perforation of the esophagus].

Perforated acute necrotizing esophagitis is a condition with several proposed etiological factors, hypothesized to be caused by weakened mucosal defence mechanisms and hemodynamic insult, leading to subsequent ischemia. We present a patient with acute necrotizing esophagitis, where underlying cardiovascular comorbidity and patient delay serve as potential contributing causal factors to the perforation. To prevent subsequent circulo-respiratory collapse and multi-organ failure, emergency esophagectomy was required, given that control of persistent leakage and mediastinitis was unlikely if managed conservatively.

[Retinal hemorrhages in abusive head trauma].

Brain injuries due to abusive head trauma (AHT) in infants are not rare and they are probably under-diagnosed. Retinal hemorrhages (RH) constitute a cardinal symptom of AHT and AHT is the most common cause of RH in infants next to childbirth. Retinoschisis with or without retinal folds is highly suggestive of AHT and never seen secondary to childbirth.