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The authors aimed to investigate the clinical characteristics, accuracy of diagnostic tests, and long-term outcomes after interventions in patients diagnosed with primary aldosteronism (PA) in Iceland throughout 5 years. A retrospective chart review was performed for all patients diagnosed with PA during the years 2007-2011 at Landspitali Hospital in Iceland, a referral center for the whole country. Workup after detection included salt loading test, positional test, computed tomography, and adrenal vein sampling. Patients with unilateral disease were offered treatment with adrenalectomy. A total of 33 patients were diagnosed with PA during the study period: 17 patients with bilateral disease and 16 with unilateral disease. Results from salt loading test were positive in 90% of patients. In patients with adenoma, 36% were responsive on their positional test and computed tomography scan showed a nodule in 73%. All patients with unilateral disease had a lateralization index ≥3. After surgery, patients had lower systolic blood pressure (P<.001) and number of hypertensive medications (P<.01). [ABSTRACT FROM AUTHOR]

Introduction: Gallstone disease in pregnant patients and their management in Iceland has not been studied. Management of these patients changed after the introduction of laparoscopic cholecystectomy. The aim of this study was to investigate the incidence, symptoms, diagnostic methods and management of gallstone disease during pregnancy at the National University Hospital of Iceland during the years 1990-2010., Material and Methods: This was a retrospective study and included all pregnant women admitted with gallstone diseases to the National University Hospital of Iceland which is the only tertiary hospital in Iceland. Information regarding age, symptoms and diagnostic methods for all women with gallstone disease along with BMI, ASA scores, pathology results and pregnancy related outcomes for women who underwent cholecystectomy were gathered., Results: During the twenty year time period 77 women were admitted with gallstone disease in 139 admissions which makes incidence 0,1% amongst pregnant women. Diagnoses incuded biliary colic (n=59), common bile duct stones (n=10), acute cholecystitis (n=7) and gallstone pancreatitis (n=1). The most common symptom was RUQ pain (n=63). Two preterm births were a direct consequence of gallstone disease. Fifteen women underwent cholecystectomy during pregnancy and 17 during the six week period after birth. Mean BMI was 31,1 and median ASA score was 1. Pathology reports showed chronic inflammation (n=24) and acute inflammation (n=5), one case included gallstones without inflammation Adverse outcomes of surgeries were two cases of gallstones left in the common bile duct. No stillbirths or preterm births resulted from cholecystectomies during pregnancy., Conclusion: Gallstone disease during pregnancy is rare and readmissions are frequent. Pregnancy related complications are rare. Laparoscopic cholecystectomy is safe during pregnancy. Key words: gallstones, pregnancy, laparoscopic cholecystectomy. Correspondence: Pall Helgi Moller pallm@landspitali.is.

Objective: To evaluate the long-term outcome of elective splenectomy, with emphasis on the incidence of complications, vaccine immunization and patient´s knowledge about asplenia., Material and Methods: Medical reports of all patients, who underwent elective splenectomy during the time period of 1993-2004, were reviewed. Questionnaire was sent to 96% (44/46) patients alive., Results: The average age was 50 (8-83) years. Thirty-five patients were male and 32 were female. Eighty percent responded to the questionnaire. Most of the patients (31) had idiopathic thrombocytopenic purpura (ITP). Complete response was obtained in 60% (18/30) and partial response in 23% (7/30). Five patients had spherocytosis and all of them had complete response. None of the three patients with autoimmune hemolytic anemia had any response to the splenectomy. Patients were vaccinated against pneumococci in 92% of the cases. In 44% of the cases revaccination was done. Only 41% of those who answered experienced that they had got a good education about the consequences of asplenia. Sixteen percent of the patients (10/64) had major postoperative complications. One patient with metastatic cancer and thrombocytopenia died within 30 days of surgery. Five patients had long-term complications. Two had pneumococcal sepsis, one of them was unvaccinated and the other had not been revaccinated., Conclusion: Splenectomy has a good long-term outcome for spherocytosis and ITP patients. The incidence of complications is high. It is possible that better guidelines and better patient´s education can lower the complication rate and improve the outcome.

Objective: Non-specific abdominal pain (NSAP) is the most common diagnosis of patients presenting to emergency departments (ED) with abdominal pain. The aim of this retrospective study was to investigate how many NSAP patients were re-admitted within 1 year to the ED with abdominal pain., Material and Methods: Included were all patients discharged with NSAP from adult EDs of Landspítali University Hospital (gynecology and pediatric EDs excluded), from January 1, 2005 to December 31, 2005. Hospital records for patients re-admitted within 12 months with abdominal pain were reviewed. Symptoms, pain location, blood tests and imaging results were registered, also the subsequent discharge diagnosis at re-admission., Results: Out of 62.116 patients attending the EDs in 2005, 1411 (2.3%) were diagnosed with NSAP. During 12 months, 112 of these 1411 patients (7.9%) were re-admitted to the ED with abdominal pain, most of them ≥2 times. Out of 112 patients, 27 (24.1%) were discharged with a more specific diagnosis; cholelithiasis (29.6%), appendicitis (18.5%) and gastrointestinal cancer (7.4%) being the most common diagnosis. The other 85 (76%) patients were diagnosed with NSAP again. Surgery was performed in 17 of the 27 (63%) cases and 8 received specific treatment, most often antibiotics., Conclusion: Almost 8% of discharged NSAP patients were re-admitted within a year for abdominal pain. At re-admission, one of four patients received a more specific diagnosis, most often cholelithiasis or appendicitis. Our results suggest that the diagnosis of patients with NSAP, at the first visit to the ED, could be improved.