[Liver transplantation in Norway through 25 years]. / Levertransplantasjon i Norge gjennom 25 år.

BACKGROUND: In Norway, liver transplantation has been the treatment of choice for irreversible acute and chronic liver failure for 25 years. The aim of this article is to present a summary of the results obtained. MATERIAL AND METHODS: All liver transplants performed in Norway in the period 25.02.84-31.12.08 have been reviewed retrospectively with respect to patient and donor epidemiology, survival and recurrence. RESULTS: 651 transplants have been performed in this period. The annual number of transplants increased gradually up to the year 2000 (31), and more steeply afterwards - to 79 in 2008. Also the number of organ donations has increased and reached 98 (20 pr. million inh.) in 2008. 5-year patient survival was 53 % in the period 1984-1994. In the period 2001-2008, 1-year survival was 90 % and 5-year survival was 83 %. INTERPRETATION: The gradual improvement of results should be interpreted in light of improvements within transplant surgery, medicine and anaesthesiology and the increased local experience due to the increasing number of transplants performed. The transplant centre at Rikshospitalet has developed into being among the largest of its kind within the Nordic Countries and the results compare well with the best international data.

[The incidence and mortality of ARDS in Icelandic intensive care units 1988-1997]. / Brátt andnau[eth]arheilkenni (ards) á gjörgaesludeildum á Islandi 1988-1997.

OBJECTIVE: A retrospective analysis of the epidemiology and intensive care treatment of ARDS in Iceland during the 10 year period, 1988-1997 with observation of trends within the period. MATERIAL AND METHODS: All ICU admissions in Iceland 1988-1997 were reviewed according to the American-European consensus conference criteria on ARDS to select patients with the diagnosis of ARDS i.e. bilateral pulmonary infiltrates, PaO(2)/FiO(2) <200 and excluding patients with signs of heart failure or a pulmonary capillary wedge pressure (PCWP) >18 mmHg. Data were collected on age, gender, length of stay, ventilator treatment and ventilatory modes, causes of ARDS and mortality. RESULTS: A total of 220 patients with severe respiratory failure were found and 155 of them were diagnosed as having ARDS or an annual incidence of 15.5 cases/year or 5.9 cases/100.000/year. If reference population >15 years of age is used for calculation the incidence is 7.8 cases/100.000/year. Hospital mortality was 40%, mean length of ICU stay was 21 days, mean hospital length of stay 39 days. The incidence of ARDS increased during the period with a tendency to lower mortality rates. Mortality was significantly lower when pressure controlled ventilation was used, compared to volume controlled ventilation. CONCLUSION: The incidence of ARDS in a well defined population of Iceland is lower than recent studies in USA and Europe have shown or 5.9 cases/100.00/year but is increasing. The mortality is 40% and shows a slight downward trend, which may be due to the use of lung protective ventilation.

[Should patients with severe sepsis be treated with activated protein C?]. / Bør sepsispasienter behandles med aktivert protein C?

BACKGROUND: Xigris (recombinant human activated protein C) has recently been introduced as a treatment for severe sepsis following a large multicentre trial (the PROWESS trial). MATERIAL AND METHODS: Critical review of the original paper, follow-up studies and commentaries, and subgroup analyses from the US Food and Drug Administration. RESULTS: Changes in trial design after the start of the trial as well as inconsistent results in two phases of the trial make interpretation difficult. The overall trial results indicate a small benefit from treatment with activated protein C. However, subgroup analysis reveals that several groups of patients appeared to have little benefit. The drug may have severe and potentially lethal side effects in some patients. INTERPRETATION: Although activated protein C may have beneficial effects in some patients with severe sepsis, the effect on different subgroups of patients remains to be clarified. We conclude that there is at present insufficient documentation for a recommendation of activated protein C in patients with severe sepsis.