Tidsskr Nor Laegeforen
· 2026 Jun · PMID 42237796
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Epistaxis, or nosebleed, is a common condition both in and outside hospital settings. Most episodes resolve spontaneously or can be managed with simple measures, but more advanced treatment may be required in some cases....Epistaxis, or nosebleed, is a common condition both in and outside hospital settings. Most episodes resolve spontaneously or can be managed with simple measures, but more advanced treatment may be required in some cases. This article provides a clinical overview of the management of acute epistaxis, with particular emphasis on measures that can be undertaken by healthcare personnel in primary care and in pre-hospital settings.
Tidsskr Nor Laegeforen
· 2026 Jun · PMID 42237795
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BACKGROUND: Ketamine can cause severe toxicity to both the upper and lower urinary tracts. Chronic use has been linked to ulcerative cystitis, ureteric strictures and hydronephrosis, leading to renal failure. CASE PRESEN...BACKGROUND: Ketamine can cause severe toxicity to both the upper and lower urinary tracts. Chronic use has been linked to ulcerative cystitis, ureteric strictures and hydronephrosis, leading to renal failure. CASE PRESENTATION: A previously healthy woman in her thirties was admitted to hospital with severe suprapubic pain, dysuria, haematuria and urinary frequency. Imaging showed bladder wall oedema, bilateral hydronephrosis and hydroureter without obstruction. Cystoscopy revealed extensive ulcerations, granulation tissue and a markedly reduced bladder capacity (< 150 mL). Histology demonstrated denuded urothelium with necrosis and inflammation. The patient required prolonged hospitalisation for multimodal pain management and urinary diversion. After discharge, she received repeated intradetrusor botulinum toxin injections. Two years later, she disclosed heavy ketamine use prior to symptom onset and suffered recurrent acute renal failure during continued use. INTERPRETATION: This case illustrates ketamine-induced ulcerative cystitis and renal failure. Awareness of ketamine's urological toxicity is essential in the context of increasing recreational and therapeutic use of the drug.
Tidsskr Nor Laegeforen
· 2026 Jun · PMID 42237792
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BACKGROUND: Questions concerning paternity have been of major interest over the centuries. Issues such as legitimacy, fidelity, inheritance and child maintenance have been central. Maternity was unequivocal, but paternit...BACKGROUND: Questions concerning paternity have been of major interest over the centuries. Issues such as legitimacy, fidelity, inheritance and child maintenance have been central. Maternity was unequivocal, but paternity could be uncertain. A key issue in paternity cases was whether the mother's account of sexual intercourse was consistent with the timing of the birth. This required an understanding of the possible duration of pregnancy. We examined how law and forensic medicine assessed the significance of pregnancy duration in establishing paternity throughout the 20th century. MATERIAL AND METHOD: The study is based on a review of paternity case judgments by the Norwegian Supreme Court in the 20th century with regard to pregnancy duration in the context of historical obstetric literature. RESULTS AND INTERPRETATION: Well into the 20th century, knowledge of pregnancy duration was primarily of interest in forensic medicine. Paternity could be ruled out but not established. In 1914, the Norwegian Forensic Medicine Commission defined pregnancy duration as 240-320 days, and this became the standard in Norwegian law for much of the 20th century. The courts made an overall assessment in which pregnancy duration and the mother's credibility, conduct and sexual morality were taken into account. Around 1990, DNA typing replaced blood group testing and discretionary assessments, and paternity disputes largely disappeared from the courts.
Tidsskr Nor Laegeforen
· 2026 Jun · PMID 42237791
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BACKGROUND AND AIM: The aim of this study was to examine trends in the prevalence of cerebral palsy according to birth characteristics among Norwegian children born between 2002 and 2018, as well as associations between...BACKGROUND AND AIM: The aim of this study was to examine trends in the prevalence of cerebral palsy according to birth characteristics among Norwegian children born between 2002 and 2018, as well as associations between birth characteristics, subtypes of cerebral palsy and gross motor function. MATERIAL AND METHOD: Data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy were linked with the Medical Birth Registry of Norway. The prevalence of cerebral palsy per 1000 live births was calculated for the categories gestational age at birth, birth weight and small for gestational age. Trends were analysed using logistic regression, and distributions by subtype and level of gross motor function were analysed using descriptive statistics. RESULTS: Among 1,006,537 live-born children, 1897 were diagnosed with cerebral palsy. Most children with cerebral palsy were born at term with a normal birthweight. The prevalence of cerebral palsy was higher among children born preterm, with a low birth weight or small for gestational age. The prevalence among term-born children decreased from 1.30 per 1000 live births in 2002 to 0.90 in 2018 (-3.4 % per year, odds ratio (OR) 0.966; 95 % confidence interval (CI) 0.954 to 0.978), while the prevalence among preterm children remained stable. Most children had spastic hemiplegia or diplegia and mild gross motor impairment across birth characteristics. INTERPRETATION: The prevalence of cerebral palsy in children born at term has decreased, but they still constitute the majority. Across birth characteristics, children predominantly had less severe subtypes and mild gross motor impairments.
Tidsskr Nor Laegeforen
· 2026 May · PMID 42118933
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Publisher ↗
BACKGROUND: Post-transfusion purpura is a rare complication characterised by paradoxical destruction of autologous platelets 5-10 days after transfusion of cellular blood products. CASE PRESENTATION: A middle-aged multip...BACKGROUND: Post-transfusion purpura is a rare complication characterised by paradoxical destruction of autologous platelets 5-10 days after transfusion of cellular blood products. CASE PRESENTATION: A middle-aged multiparous woman presented with mucocutaneous bleeding and severe thrombocytopenia seven days after aorta graft surgery and platelet transfusion. Initial treatment with steroids and intravenous immunoglobulin was ineffective. Platelet antibody testing showed anti-HPA-1a at a very high level of > 600 IU/mL, weak anti-HPA-3a and platelet auto-reactivity. Weakly reactive anti-HLA class I antibodies were also observed. The patient's platelet type was HPA-1bb/HPA-3bb. A diagnosis of post-transfusion purpura was therefore made. Additional treatment with plasma exchange was initiated, resulting in rapidly rising platelet counts, resolution of bleeding symptoms and decreasing antibody levels. Sustained normal platelet counts were achieved on day 50 after the initiating event. INTERPRETATION: This case represents a classic presentation of post-transfusion purpura, with high levels of anti-HPA-1a and severe thrombocytopenia with bleeding one week after transfusion, successfully treated with a combination of plasma exchange and intravenous immunoglobulin. Direct platelet antibody testing was positive during the thrombocytopenic phase and became negative following normalisation of the platelet count. This correlation between autoreactivity and thrombocytopenia supports the hypothesis of a secondary autoreactive process trigged by an HPA-incompatible transfusion.
Pettersson SL, Hansen M, Iversen A
… +1 more, Tollånes MC
Tidsskr Nor Laegeforen
· 2026 May · PMID 42118932
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Publisher ↗
BACKGROUND AND AIM: Under section 3-1 of the Norwegian Mental Health Care Act, chief public health officers (CPHOs) have the authority to make decisions regarding compulsory medical examinations for individuals with susp...BACKGROUND AND AIM: Under section 3-1 of the Norwegian Mental Health Care Act, chief public health officers (CPHOs) have the authority to make decisions regarding compulsory medical examinations for individuals with suspected severe mental illness requiring treatment. This is an intrusive intervention, and procedures and practice are strictly regulated by law and regulations. Our aim was to survey the practices, organisation and administrative aspects of decisions on compulsory medical examinations by local authorities in Norway. MATERIAL AND METHOD: In autumn 2024, a digital survey was distributed to all 357 local authorities in Norway, with CPHOs as the intended recipients. RESULTS: We received responses from 173 CPHOs, 115 of whom were aware of the number of decisions made by their local authority under section 3-1. Ninety-seven reported that the decisions were stored in the local authority's case management system, as required by law. Nearly all provided written justification for the decisions and signed them with their own name. Eighty-one indicated who had raised concerns in the decision and communicated the decision to the patient whenever possible. INTERPRETATION: There was a lack of comprehensive data on the extent of decisions under section 3-1 in local authorities, and practices varied considerably. This lack of oversight makes quality assurance and improvement efforts challenging.