[Cardiac transplantation and donation in Icelandic patients - indications and outcome].

INTRODUCTION: Information on the number, indications and outcome of cardiac transplantations in Icelandic patients is scarce, as is information on the number of hearts donated from Iceland for cardiac transplantation. MATERIAL AND METHODS: A retrospective study on patients receiving heart transplantation from the first procedure in 1988 until March 2019. Clinical information was gathered from Landspitali Transplantation Clinic, patient charts, and information on donated hearts from the Icelandic Donation Registry. Age-standardized incidence of the procedure was calculated, and overall survival (Kaplan-Meier) estimated. Mean follow-up was 10.3 years. RESULTS: Altogether 24 patients (19 males, median age 38 years, range: 4-65 years) underwent cardiac transplantation; that included one re-transplantation, three simultaneous heart- and lung transplants and two heart- and kidney transplants. The transplantations were performed in Gothenburg (n=20), London (n=3) and Copenhagen (n=2). Most common indications were dilated cardiomyopathy (n=10), congenital heart disease (n=4), and viral myocarditis (n=3). Five patients were bridged left ventricular-assist device preoperatively. Overall survival at 1 and 5 years was 91% and 86%, respectively; median survival being 24 years. The incidence of cardiac transplantation was 2.7 heart-TX pmp/year but increased to 4.6 heart-TX pmp/year after 2008 (p=0.01). During the same period 42 hearts were donated from Iceland for transplantation abroad, the first in 2002 and increasing from 0.8 to 3.0 hearts/year during the first and second half of the study-period, respectively. CONCLUSION: Survival of Icelandic cardiac transplant recipients is good and comparable to larger transplant centers overseas. Number of hearts donated from Iceland have increased and currently Iceland donates twice as many hearts at it receives.

[Bilateral pneumothoraces in a pregnant woman following acupuncture - a case report].

A woman in her thirties, 15 weeks pregnant, underwent acupuncture therapy because of pregnancy-related nausea and vomiting. Several hours later she experienced shortness of breath and therefore came to the emergency room. Physical examination revealed tachypnea and reduced breath sounds bilaterally but normal oxygen saturation and blood pressure. Chest X-ray showed bilateral subtotal pneumo-thoraces. Chest tubes were inserted into both pleural cavities and the patient recovered successfully and was discharged in good health 3 days after admission. This case report emphasizes the risks of acupuncture to the chest cavity that in this case resulted in bi---- l-ateral pneumothoraces, a condition that can become life threatening in this case to both mother and fetus.

[Finger necrosis following arterial cannulation - a case report].

Arterial cannulation is a common procedure in critically ill patients, as it facilitates continuous monitoring of blood pressure, titration of inotropes, vasopressors and fluids and is also used for blood sampling. Serious complications from arterial lines are very rare, permanent ischemic damage occurs in less than 0,1% of patients. We report the case of a 60-year-old woman in septic shock caused by a perforated duodenal ulcer which was treated with emergent laparoscopic repair. She required high doses of vasopressors and received several arterial lines, including lines in both the ulnar and the radial arteries of the left arm. After two weeks in the intensive care unit she developed ischemia in all fingers of her left hand. She received anticoagulative therapy which was complicated by serious gastrointestinal bleeding and the therapy had to be discontinued. Eight weeks later she had demarcated necrosis in all fingers of her left hand and underwent partial amputation of fingers II-V, the thumb recovered without surgery. The cause of the necrosis was believed to be arterial embolism or ischemia secondary to arte- rial cannulations in combination with her underlying critical septic condition.