12.01.2023: 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. This article reviews the management of lipoprotein(a) in clinical practice. Lipoprotein(a), abbreviated as Lp(a) and often referred to as lipoprotein little a, was first identified in 1963 by the...

24.10.2022: Melanoma is a relatively common diagnosis, both in the primary and specialist health service. Ongoing research and new evidence base means that the recommendations for investigation and treatment are continually changing. This can lead to uncertainty among doctors who do not treat this patient group regularly. In this clinical review we give a summary of the latest recommendations, primarily aimed at general practitioners, dermatologists and doctors in local hospitals. Melanoma is one of the most common forms of cancer in Norway, and its incidence has been rising sharply since the 1960s. After...

05.08.2021: Anterior shoulder dislocation can occur in connection with a traumatic event or as a result of an anatomical predisposition. A traumatic dislocation can damage stabilising structures, which can predispose an individual to recurrent dislocations. People under the age of 30 and those who participate in contact sports are particularly susceptible, and can consequently incur further damage to the stabilising structures. Patients in these categories should be considered for surgical treatment at an early stage. The shoulder joint is the body's most mobile joint and is therefore particularly prone...

02.06.2021: Spinal cord stimulation with weak electric current is a neuromodulatory treatment suitable for subgroups of patients with chronic neuropathic pain and certain other pain conditions. Neuropathic pain can reduce quality of life, and the effectiveness of pharmacological treatment is often limited. Studies of spinal cord stimulation have shown significant pain relief and improved functioning at group level, and recent years have seen the development of new stimulation methods which are currently under evaluation. Pain relief upon electrical stimulation of the spinal cord, first described in a case...

07.04.2021: Many medicines prescribed for older patients have an unintended anticholinergic effect in addition to the primary intended effect. This may lead to adverse reactions such as dizziness and memory loss, particularly in older people. Before prescribing new medicines, it is therefore important to assess the total anticholinergic burden by means of specific screening tools, such as AGS Beers Criteria® and the STOPP/START criteria. If the anticholinergic burden is high, drugs should be replaced or discontinued. Medicines with anticholinergic properties are regularly prescribed for older and often...

11.01.2021: Thrombocytopaenia is defined as a platelet count of < 150 · 109/L and occurs frequently in the critically ill. The condition arises as a result of the reduced production or increased destruction or consumption of platelets. Thrombocytopaenia in critically ill patients is often the result of multiple pathophysiological mechanisms, and these must be identified if the prognosis is to be determined and appropriate treatment provided. Thrombocytopaenia occurs frequently in the critically ill, and often has several underlying causes. This article provides an overview of thrombocytopaenia in...

03.09.2020: Thyroid nodules are common. As a result of increased use of diagnostic imaging, more nodules are detected as incidental findings. The great majority of them are benign and need no treatment. Systematic ultrasonography performed by a skilled doctor, possibly combined with cytology sampling, will to a large extent determine which nodules require follow-up. Thyroid nodules are common. As a result of increased use of diagnostic imaging, more nodules are detected as incidental findings. The great majority of them are benign and need no treatment. Systematic ultrasonography performed by a skilled...

23.06.2020: Excision of skin lesions takes place regularly in general practice. The procedure is simple, but correct execution depends on a knowledge of skin anatomy and basic surgical principles. This article presents indications for excision of skin lesions and a recommended method based on clinical experience and relevant literature. The method can be used on both pigmented and non-pigmented lesions. Seborrheic keratoses are not discussed (1). The contents of the article apply to the primary health service. Indication Skin lesions are excised with a view to obtaining a histological diagnosis. Pigmented...

17.06.2020: As the pandemic has been unfolding, reports have emerged of a relatively high incidence of coagulopathy and thromboembolic events in connection with COVID-19 infections. Raised awareness surrounding this issue, and appropriate antithrombotic prophylaxis and treatment, are therefore important for this group of patients. The COVID-19 pandemic has dominated the medical debate in recent months, and has impacted all aspects of society (1). SARS-CoV-2 is a virus of the Corona group which primarily attacks the respiratory epithelium and can result in acute respiratory distress syndrome. In extreme...

28.04.2020: Odontogenic infections are infections that originate in the teeth and/or their supporting tissues. Such infections are common, and a large proportion of infections of the head and neck region are of odontogenic origin. Most odontogenic infections cause mild signs and symptoms, but they can also develop into serious conditions. This article provides an overview of the most common pathogenic microbes in the oral cavity, the most frequently occurring odontogenic infections, and the treatment and potential complications of the latter. The article is based on a non-systematic search in PubMed, plus...

23.04.2020: Frail elderly patients with multimorbidity are at high risk of serious illness and death in cases of corona virus infection. Unlike 'normal deaths' in nursing homes with time to prepare, the condition can change rapidly and cause organ failure. In this article we describe palliative non-invasive and invasive interventions for frail elderly patients in nursing homes who are dying due to COVID-19. COVID-19 (SARS-CoV-2) is communicable and may cause infections in all age groups of the population, but frail, elderly and multimorbid patients are vulnerable and at high risk of serious illness and...

30.01.2020: Patients in intensive care have increased nutritional needs but are often incapable of eating independently. When should intravenous parenteral nutrition be started, and what is the optimal dose? Here we review the recently updated European guidelines on nutritional support in intensive care patients. During critical illness, the body is in a hypercatabolic state in which muscle mass and energy stores are depleted and nutrients are used at a high rate (1). This catabolic state manifests clinically as weight loss, sarcopenia and undernutrition. This has been shown to prolong stays in intensive...

29.01.2020: More than 10 % of schoolchildren suffer from lower urinary tract dysfunction, often leading to contact with the healthcare system. The problem is socially limiting as well as mentally and physically demanding for children and their parents, and it is important to offer treatment. This article describes a structured approach that can form the basis for correct diagnosis and treatment. Symptoms from the lower urinary tract are commonly referred to as LUTS (lower urinary tract symptoms) based on the terminology of the International Children's Continence Society (ICCS) (1). The terminology has...

02.08.2019: Multiple sclerosis can give rise to signs and symptoms from the entire nervous system, including visual impairments. Visual impairments often go unreported because they are not obvious to patients, which means that doctors must ask about them specifically. Regular monitoring of vision is important, however, to provide personalised rehabilitation and assistive technologies, and thereby improve patients' functioning and quality of life. Multiple sclerosis (MS) is a neurological disorder characterised by inflammation, demyelination and neurodegeneration of the central nervous system (1). The...

13.06.2019: The soreness that commonly follows unaccustomed and strenuous exercise is unlikely to be due to inflammation of the muscles. However, the rarer and more serious exercise-induced rhabdomyolysis appears to have a different pathogenesis, with clinical signs including tissue inflammation and muscle cell death, as well as elevated creatine kinase and myoglobinuria. Soreness and rhabdomyolysis can both be caused by the same type of muscular activity. Muscle soreness is a very common skeletal muscle phenomenon with distinctive characteristics (1, 2; see Table 1). It occurs after unaccustomed, and...

27.05.2019: Persistent symptoms of dizziness may be due to inappropriate compensatory strategies following an episode of acute dizziness. Common symptoms are dizziness in an upright position that is aggravated by visual stimuli and passive movement. In the World Health Organization's new disease classification, ICD-11, the condition has been named persistent postural-perceptual dizziness. It is important to recognise this condition in order to avoid unnecessary investigation and to initiate the correct treatment. Persistent symptoms of dizziness may be due to inappropriate compensatory strategies...

03.04.2019: Diagnosing different types of headache correctly can be challenging, but is the most important prerequisite for optimal treatment. Controlled use of acute medications and prophylaxis is recommended. Headache disorders are among the most common causes of disability, according to the findings of the Global Burden of Disease project (1). These disorders have a substantial impact on the affected persons and their relatives, as well as on society in general. Simple diagnostic tools and therapeutic measures can make a big difference. The aim of this article is to provide practical advice on the...