[Evaluation of a thyroid nodule].

Thyroid nodules are common and their incidence has increased due to various factors. Systematic approach to the work-up of thyroid nodules is necessary to decrease overdiagnosis as well as over treatment. Applying the trifecta of history, physicial examination and high-resolution ultrasound (HRUS) as well as fine needle aspiration biopsy (FNAB) with added TSH measurement is important in the work-up. HRUS is a central part in the diagnostic approach, being able to risk classify nodules and selecting nodules for FNAB. Systematic analysis of aspirates is necessary to simplify communication between cytologists and clinicians. 1Department of Otolaryngology - Head and Neck Surgery, Landspitali, Fossvogi, 2Department of Medicine, University of Iceland. Key words: thyroid nodule, thyroid cancer, ultrasound, cytology Correspondence: Geir Tryggvason, geirt@lsh.is.

[Acute epiglottitis in Iceland from 1983-2005]. / Bráo barkaloksbólga á Islandi 1983-2005.

OBJECTIVE: To describe the changes in the epidemiology of acute epiglottitis in Iceland from 1983-2005. METHODS: All patients with discharge diagnosis of epiglottitis during the study years were identified and diagnosis confirmed by chart review. Main outcome measures were age, gender, month/year of diagnosis, microbiology, airway management, ICU admissions, choice of antibiotics, length of hospital stay and major complications/mortality. RESULTS: Fifty-seven patients were identified (annual incidence 0.93/100.000). The mean age was 33.3 years (1-82). Childhood epiglottitis disappeared after introduction of Haemophilus influenzae type b (Hib) vaccination in 1989 but adult disease showed non-significant increase. In the pre-vaccination era Hib was the most common organism cultured but it has not been diagnosed in Iceland since 1991 and Streptococci are now the leading cause of epiglottitis. The mean hospital stay was 5.05 nights with 51% of patients admitted to ICU. All children under 10 years and a total 30% of patients received airway intervention. Ninety percent of adults were observed without airway intervention. Major complications were rare and mortality was 0% in our series. CONCLUSION: There have been major changes in the epidemiology of epiglottitis in Iceland during the study period. Previously a childhood disease, epiglottitis has disappeared in children and is now almost exclusively found in adults. This can be attributed to widespread Hib vaccination, eliminating the major causative agent in children. The treatment of this life-threatening disease remains a challenge. Our series suggest that it is safe to observe patients with mild/moderate symptoms without airway intervention.

Acute epiglottitis in Iceland 1983-2005.

OBJECTIVE: To describe the changes in the epidemiology of epiglottitis in Iceland from 1983 to 2005. METHODS: All patients with the discharge diagnosis of epiglottitis during the study years were identified and diagnosis confirmed by chart review. Main outcome measures were age, gender, month/year of diagnosis, microbiology, airway management, ICU admissions, choice of antibiotics, length of hospital stay and major complications/mortality. RESULTS: Fifty-seven patients were identified (annual incidence 0.93/100.000). The mean age was 33.3 years (1-82). Childhood epiglottitis disappeared after introduction of Haemophilus influenzae type b (Hib) vaccination in 1989 but adult disease showed non-significant increase. In the pre-vaccination era Hib was the most common organism cultured but it has not been diagnosed in Iceland since 1991 and Streptococci are now the leading cause of epiglottitis. The mean hospital stay was 5.05 nights with 51% of patients admitted to ICU. All children under 10 years and a total 30% of patients received airway intervention. Ninety percent of adults were observed without airway intervention. Major complications were rare and mortality was 0% in our series. CONCLUSION: There have been major changes in the epidemiology of epiglottitis in Iceland during the study period. Previously a childhood disease, epiglottitis has disappeared in children and is now almost exclusively found in adults. This can be attributed to widespread Hib vaccination, eliminating the major causative agent in children. The treatment of this life-threatening disease remains a challenge. Our series suggest that it is safe to observe patients with mild/moderate symptoms without airway intervention.

[Lingual thyroid--case report: a woman with a tumor at the base of the tongue]. / Tungurótarskjaldkirtill (lingual thyroid) -- sjúkratilfelli: kona meeth fyrirfereth í tungurót.

We report a case of lingual thyroid. A woman presented with a few years history of mild dysphagia, cough and uncomfortable breathing when going to sleep at night. Laryngostroboscopy showed a mass lesion at the base of the tongue. A CT scan and thyroid scanning revealed a bilobar mass of thyroid tissue, compatible with a lingual thyroid. No thyroid gland was found at its usual location. The woman was euthyroid and since her symptoms were mild she was treated with thyroxin and observation. Lingual thyroid is a rare phenomenon caused by abnormal migration of thyroid cells during the first weeks of fetal life. Females are affected more often than males and although this condition is often asymptomatic, symptoms can occur, most often during puberty, pregnancy and menopause. On examination a mass is noted at the base of the tongue and the diagnosis is then confirmed with CT/MRI and thyroid scanning. Treatment can vary from observation to thyroxin medication, radioactive iodine and complicated surgical intervention, depending on the symptoms and the overall health of the patient.

[Public comprehension of medical terminology.].

The quality of doctor-patient communication is critical for the practice of medicine. Studies show that effective communication results in patient satisfaction and improved compliance. To better understand one aspect of this complex phenomenon we estimated the ability of people to comprehend 11 commonly used medical terms. We used multiple choice questions in a telephone survey of 1167 Icelanders aged 16-75 years. Results (% of participants with correct answers): Gastroesophageal reflux (72), emphysema (25), steroids (40), one tablet twice a day (79), side effects (67), bronchitis (68), white blood cells (56), erythrocyte sedimentation rate (33), diabetes mellitus (72), antibiotics (87), chronic obstructive pulmonary disease (42). Variables associated with better comprehension were: Female gender (better in 7/10 questions), university degree (10/10) and high income (9/10). Decision tree analysis showed that education had the most impact. The youngest participants (age 16-24) had the worst outcome in seven out of 10 questions. The results define certain medical terms that require more careful explanation than others. They also indicate that those of young age, low socioeconomic status and less educated require more help in understanding medical terms. Interestingly, 21% of participants failed to understand a very simple medication order, emphasizing the importance of explaining these in detail. The data may also have implications for informed consent. A larger study exploring the public comprehension of multiple medical terms should be considered.