Acute upper gastrointestinal bleeding: a population-based, five-year follow-up study.

OBJECTIVE: Data on long-term rebleeding risk and mortality in acute upper gastrointestinal bleeding (AUGIB) patients are scarce and comparison to controls are lacking. Aimsof the study were to assess long-term prognosis of AUGIB patients and compare to controls. METHODS: A population-based retrospective case-control study conducted at the National University Hospital of Iceland and included all patients who underwent endoscopy in 2010-2011. AUGIB was defined as haematemesis or coffee ground vomiting leading to hospitalization or occurring in a hospitalized patient. Controls underwent endoscopy in 2010-2011, matched for sex/age. Rebleeding was defined as AUGIB >14 days up to five years after index bleeding. RESULTS: Overall, 303 patients had AUGIB, mean age 67 (±18), controls66 years (±19), females, 51 and 46%, respectively. The five-year rebleeding rate for AUGIB patients was 13% (95%CI 9-17%), higher than the rate of bleeding events in controls, 3% (95%CI 1-5%; log-rank <0.001), hazard ratio (HR) 6.0 (95%CI 2.4-15) when correcting for comorbidities, NSAID's, PPI's and antithrombotics. The mortality of AUGIB patients at end of follow-up was higher when compared to controls, 39% (95%CI 49-33%) vs. 26% (95%CI 30-21%), log-rank <0.001, comorbidity-adjusted HR 1.4 (1.1-1.9). A subanalysis of non-variceal AUGIB yielded similar results in regard to rebleeding and mortality rates. CONCLUSIONS: AUGIB patients were at 6-fold risk of rebleeding compared to bleeding events in controls at five years of follow-up. Five-year mortality was higher in AUGIB patients when compared to controls even when correcting for age and comorbidities, suggesting that an episode of AUGIB indicates serious frailty.

[Incidence of Bicycle injuries presenting to the Emergency Department in Reykjavik 2005-2010].

INTRODUCTION: Bicycling has become increasingly popular in Iceland. Official registration of bicycle accidents is based on police reports. As minor accidents are often not reported to the police, these accidents may be underreported in police records. The aim of this study was to examine the epidemiology of bicycle related accidents in patients seeking medical assistance at the Emergency Department (ED) at Landspitali-University Hospital, Reykjavik (LUH), Iceland. MATERIALS AND METHODS: This retrospective cohort study was conducted at the ED at LUH, Iceland from January 2005 to December 2010. All medical files were reviewed and sex, age, year and month of accident/injury, helmet wearing, ICD-10 diagnosis, severity of injury according to the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) recorded. The rate of hospital admission was examined with length of stay, Intensive Care Unit admission, use of medical imaging and operative treatment. RESULTS: A total of 3472 patients presented to the ED with bicycle related accidents , 68.3% men and 31.7% female. The average age of patients was 22,6 years (1-95 years). Most are injured during recreational activities (72.4%) and in residence areas (45,7%). Most injuries occurred during May-September (71.4%). Data on counterparty was missing in 74.9% of cases. The cause of accident was in 44.0% a low fall or jump. The upper extremity was injured in 47.1% cases. A majority of the patients (65.6%) had a mild injury (ISS≤3points) and 29.3% had a moderate injury (4-8 points). No fatalities were found during the study period. Use of helmets was only recorded in 14.2% of cases. In total 124 patients were admitted during the period where the mean time of admission was 5 days. CONCLUSION: The incidence of bicycle injuries increased during the study period but appears to have increased less than the number of bicyclists. Injuries are more frequent among males and the majority are of a young age. The accidents usually occur during the spring and summer. Most injuries are minor but 3.6% required admission. Department of Emergency Medicine, The National University Hospital of Iceland1, Icelandic Transportation Safety Board2, Faculty of Medicine, University of Iceland3 KEY WORDS: bicycle accident, emergency department, helmet, injury. Correspondence: Hjalti Mar Bjornsson, hjaltimb@landspitali.is.

Incidental detection of renal cell carcinoma is an independent prognostic marker: results of a long-term, whole population study.

PURPOSE: The true effect of incidental detection on the survival of patients with renal cell carcinoma has been debated. We used centralized databases in Iceland to study prognostic factors of survival, focusing on the effect of incidental detection. MATERIALS AND METHODS: This retrospective study included all living patients diagnosed with renal cell carcinoma in Iceland from 1971 to 2005. Hospital charts and histology were reviewed. Incidentally diagnosed renal cell carcinomas were compared to symptomatic tumors and prognostic factors were evaluated using Cox multivariate analysis. RESULTS: Of the 910 patients 254 (27.9%) were diagnosed incidentally, most often by abdominal ultrasound (29.5%) or computerized tomography (28.3%). The incidental detection rate increased from 11.1% in 1971 through 1975 to 39.2% in 2001 through 2005 (p <0.001). During the same period the incidence increased significantly in males but in females only during the last 5 study years. Mortality remained unchanged for each gender. Incidentally detected tumors were an average of 2.6 cm smaller and diagnosed at lower stage and lower grade than symptomatic tumors. Age and histology were similar in each group. TNM stage was by far the strongest independent prognostic factor of survival but age, calendar year of diagnosis and ESR were also significant. After correcting for confounders patients with symptomatic renal cell carcinoma had worse survival than those diagnosed incidentally. CONCLUSIONS: With increased incidence and unchanged mortality the survival of patients with renal cell carcinoma has improved. This is mainly related to a steep increase in incidental detection. Incidental detection affects survival favorably and to a greater extent than can be explained by lower stage compared to the survival of patients diagnosed with symptoms.

[Renal cell carcinoma diagnosed at autopsy in Iceland 1971-2005]. / Nýrnafrumukrabbamein greind vid krufningu á Islandi 1971-2005: Samanburdur vid aexli greind í sjúklingum á lífi.

INTRODUCTION: The incidence of renal cell carcinoma (RCC) is rising in Iceland. This has been attributed to increased diagnostic activity, such as abdominal imaging of unrelated diseases, rather than changes in the behavior of the disease. The aim of this study was to compare RCCs diagnosed in living patients and at autopsy, but also to investigate the relationship between the incidence of RCC and autopsy findings. MATERIAL AND METHODS: RCC found incidentally in individuals at autopsy was compared to patients diagnosed alive over three decades in Iceland (1971-2005). Stage at diagnosis and tumor histology was reviewed. RESULTS: 110 tumors were diagnosed at autopsy with a rate of 7.1/1000 autopsies. When compared to patients diagnosed alive (n = 913) the mean age at diagnosis was higher in the autopsy group (74.4 vs. 65 yrs.) while male to female ratio and laterality was similar. Tumors found at autopsy were smaller (3.7 vs. 7.3 cm), at lower stage (88% at stage I+II vs. 42%) and at lower tumor grade (85% at grade I+II vs. 56%). A difference, although smaller, is present when the autopsy detected cases are compared to only incidentally detected RCCs in living patients. Furthermore the autopsy detected tumors were more frequently of papillary cell type (21% vs. 8%). After correcting for declining autospy rate (>50%), a slight trend for a reduced rate of autopsy dectected RCC cases was seen during the last 10 years of the period but the difference was not significant. CONCLUSION: RCCs diagnosed at autopsy are at a lower stage and tumor grade than in patients diagnosed alive. The autopsy-rate is declining in Iceland with fewer RCCs found per autopsy. After correcting for the decline in autopsy rate, the rate of RCC detected at autopsy is relatively unchanged. The increase in incidence of RCC is therefore not explained by findings at autopsy.