Recurrent pericarditis.

Pericarditis is an important differential diagnosis in patients with chest pain. The two most common causes in the developed world are idiopathic pericarditis and inflammation following cardiac surgery or myocardial infarction. Recurrence of pericarditis affects up to 30 % of patients, half of whom experience multiple episodes, and approximately 10 % develop steroid-dependent and colchicine-refractory pericarditis.

Treatment of motor symptoms in Parkinson's disease.

In recent years, the development of new therapies and improvements in our understanding of older therapies have led to changes in the management of Parkinson's disease. However, current Norwegian and international therapy recommendations present a range of different options as being equally viable. In this clinical review, we propose an updated algorithm for the medical treatment of motor symptoms in Parkinson's disease, based on evidence-based recommendations and our own personal experience and opinions.

Downgrading of referrals to breast cancer patient pathway.

Background: The purpose of the study was to investigate whether the downgrading of external referrals to breast cancer patient pathways was clinically justifiable and led to a more correct prioritisation of patients who are referred to the specialist health service.

Material And Method: The study included 214 external referrals to breast cancer patient pathways at the Breast Screening Centre, Oslo University Hospital, which were downgraded in 2020 since they did not meet the national criteria. The information obtained from electronic patient records included age, district of Oslo, name of referring doctor, outcome after investigation and treatment, as well as recommended timeframe for initiating the investigation.

Vascular parkinsonism.

Parkinsonism can have many causes, among them cerebrovascular disease. Vascular parkinsonism can be caused by infarction or haemorrhage in the nigrostriatal pathway, resulting in hemiparkinsonism, or by widespread small vessel disease in the white matter, leading to the gradual development of bilateral symptoms in the lower extremities. Compared to patients with Parkinson's disease, individuals with vascular parkinsonism have earlier onset of gait disturbance, are more likely to have urinary incontinence and cognitive impairment, and have poorer treatment response and prognosis; however, they are less likely to have tremor.

[Lateral ankle ligament injuries].

Lateral ankle ligament injuries occur in connection with inversion traumas and are one of the most common injuries, both in the general population and among athletes. A lateral ankle ligament injury weakens the stabilising structures in the ankle and disposes the ankle joint to prolonged instability. Acute lateral ankle ligament injuries with no suspicion of fracture can be treated and followed up conservatively in the primary health service.

Measuring broad-spectrum antibiotic use in hospitals with established versus new indicators.

Background: The target of a 30 % reduction in the use of broad-spectrum antibiotics in hospitals from 2012 to 2020 was not achieved, measured using the standard indicator of defined daily doses (DDD) per 100 bed days. We wished to investigate the reliability of the standard indicator and of selected alternative indicators for antibiotic use, and to determine the actual reduction in use.

Material And Method: We included ten DDD-based indicators with adjustment for combinations of activity marker, admission category (inpatient vs.

A pregnant woman in her thirties with abdominal pain, seizures and haemorrhagic shock.

A pregnant woman at term was admitted to the emergency department with abdominal pain, generalised seizures and haemorrhagic shock. An outpatient check-up five days earlier showed good general condition, normal blood pressure and normal fetal heartbeat.

[Poor uptake of service provision at a drug-related emergency department – a qualitative study].

Background: The patient pathway for follow-up after a drug overdose, which is an important part of Norway's national overdose strategy, started up on 1 January 2022. Four years earlier, a collaboration was initiated between the ambulance service and the drug-related emergency department at Oslo University Hospital with the same aim as this patient pathway: to provide emergency follow-up in the specialist health service after a drug overdose. Uptake of the follow-up provision was minimal, and the purpose of this study was to investigate the reasons behind this.

Spinal artery infarction.

Spinal cord infarctions are rare, and the symptoms vary depending on location and size. One patient presented with severe neck pain and paresis of the left arm. Compression of a cervical nerve root was initially suspected, but the progression of symptoms and MRI findings gradually suggested a different aetiology.

[A child with periorbital swelling].

Background: A young boy presented with acute ethmoiditis and recurrent periorbital swelling. The periorbital swelling was confirmed to be caused by a rare condition.

Case Presentation: Debut symptoms were acute rhinitis, unilateral periorbital swelling, fatigue, and swelling in the temple region, probably caused by an insect bite.

[Chronic graft-versus-host disease].

Chronic graft-versus-host disease is a late complication of allogeneic stem cell transplantation and leads to chronic inflammation and fibrosis in various organs due to dysregulation of donor immune cells. The disease can occur in all organs, but is most frequently seen in the skin, eyes, oral cavity, gastrointestinal tract, genitalia, lungs, muscles, fascia and joints. Chronic graft-versus-host disease is associated with considerable morbidity and mortality, and treatment requires close collaboration between different parts of the specialist health services.

Allogeneic stem cell transplantation in adults 2015-21.

Background: Allogeneic stem cell transplantation is the only curative treatment for several malignant and non-malignant haematological diseases, and is associated with a risk of serious complications. In recent years, several changes have been introduced with the aim of reducing treatment-related complications. This retrospective study reviews quality indicators for patients who underwent transplantation in the period 2015-21.

Individual supported work placements (ReISE) for improving sustained return to work in unemployed people with persistent pain: study protocol for a cohort randomised controlled trial with embedded economic and process evaluations.

Background: Around one-third of workdays lost in Norway are due to musculoskeletal conditions, with persistent (chronic) pain being the most frequent cause of sick leave and work disability. Increasing work participation for people with persistent pain improves their health, quality of life, and well-being and reduces poverty; however, it is not clear how to best help unemployed people who have persistent pain to return to work. The aim of this study is to examine if a matched work placement intervention featuring case manager support and work-focused healthcare improves return to work rates and quality of life for unemployed people in Norway with persistent pain who want to work.

Associations between health problems and athlete burnout: a cohort study in 210 adolescent elite athletes.

Objectives: We studied associations between the burden of health problems and athlete burnout in a population of athletes from Norwegian Sport Academy High Schools.

Methods: This is a mixed prospective/retrospective cohort study. We included 210 athletes, 135 boys and 75 girls, from endurance, technical and team sports.

[Sickle cell disease – clinical manifestations and diagnostics].

Sickle cell disease is a group of diseases presenting with a set of characteristic acute and chronic manifestations. Sickle cell disease has traditionally been uncommon in the Northern European population; however, due to demographic changes, it is increasingly also something that Norwegian clinicians should be cognisant of. In this clinical review article we wish to present a brief introduction to sickle cell disease, with an emphasis on its aetiology, pathophysiology, clinical manifestation and how the diagnosis is established based on laboratory testing.

[Glioblastoma in adults].

Glioblastoma is the most common form of primary brain cancer in adults, and the disease has a serious prognosis. Although great progress has been made in molecular characteristics, no major breakthroughs in treatment have been achieved for many years. In this article we present a clinical review of current diagnostics and treatment, as well as the challenges and opportunities inherent in developing improved and more personalised treatment.

Temporal lobe epilepsy.

The temporal lobes are the part of the brain most likely to give rise to epileptic seizures. Seizures originating in the temporal lobes vary greatly in character; some may be so unusual that they are not even recognised as epileptic. For patients who have been diagnosed with hippocampal sclerosis and whose seizures cannot be controlled with drugs, epilepsy surgery may be a good treatment option.

[Extracorporeal membrane oxygenation for acute respiratory distress syndrome in patients with COVID-19].

Background: COVID-19 can lead to acute respiratory distress syndrome (ARDS). In some patients for whom conventional mechanical ventilation is insufficient, venovenous (VV) extracorporeal membrane oxygenation (ECMO) can be life-saving.

Material And Method: Retrospective analysis of data from patients with ARDS triggered by COVID-19 who received ECMO therapy between March 2020 and February 2022.

High levels of lipoprotein(a) - assessment and treatment.

Approximately 5 % of the population have highly elevated levels of lipoprotein(a) (Lp(a)), which is a genetically determined risk factor for cardiovascular disease. Measuring lipoprotein(a) can improve cardiovascular risk stratification and have consequences for preventive measures. Treatment is targeted at reducing modifiable cardiovascular risk factors, but Lp(a)-lowering drugs are being trialled.

A man in his twenties with weakness and numbness in his legs.

Neuropathy can have many causes, some less well known than others. In this article, we present the case of a young man with progressive neurological deficit over several months. The cause was found to be an increasing social problem.

[Factor Xa inhibitors in the prevention and treatment of venous thromboembolism in cancer patients].

Venous thromboembolism is a common complication of cancer. The prevalence varies according to cancer type and increases proportionally with the stage of cancer. In the past 15-20 years, low molecular weight heparin has been recommended as the first-line treatment.

Gentamicin serum concentration measurement in children.

Background: Gentamicin is often used to treat serious paediatric infections. It has been standard practice in Norway to measure the serum concentration of gentamicin immediately prior to the second or third dose (pre-dose [trough] concentration) to assess the risk of toxicity. The clinical significance of such measurements in children has not previously been evaluated in Norway.

Drug-induced aseptic meningitis.

Drug-induced aseptic meningitis is a rare but serious condition that should be suspected in patients with meningitis who test negative for a microbiological agent. The medical history is presented here of a woman with recurrent urinary tract infections where meningitis symptoms arose after repeated exposure to a frequently prescribed drug.