Icelandic regulations for prescription medicines need to improve

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Ope

Kawasaki disease in Iceland 1996-2005, epidemiology and complications

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open Allur texti - Full textOBJECTIVE: To analyze the epidemiology of Kawasaki disease in Icelandic children and its complications. METHODS: A retrospective analysis of all cases of Kawasaki disease and atypical Kawasaki disease in children in Iceland from 1996-2005. Chart records were reviewed and children diagnosed at Landspítali - University Hospital invited for a Follow up study with emphasis on heart complications. RESULTS: Thirty children were diagnosed with Kawasaki disease, annual incidence was 10.7/100.000 children <5 years of age. The boy:girl ratio was 2.3:1. All 30 children were treated with IVIG, without any major adverse events related to the treatment. The median time from the initial symptoms to treatment was six days (range 3-31 days). There was no mortality. Two children developed coronary aneurysms and three coronary ectasia. Follow up echocardiography was preformed in 23 of the children four to twelve years after Kawasaki disease. Two of the children still had coronary ectasia, and six (26%) had mitral regurgitation. CONCLUSIONS: The incidence of Kawasaki disease in Iceland was comparable to an earlier Icelandic study and reported incidence in the Nordic countries. Coronary involvement during the acute phase was mild, and all coronary aneurysm regressed. Serious cardiac complications were not seen. Children with Kawasaki disease in Iceland have favorable prognosis. Interestingly, mild mitral regurgitation and coronary ectasia were common at mid-term follow up.Tilgangur: Markmið rannsóknarinnar var að athuga faraldsfræði og fylgi­kvilla Kawasaki-sjúkdóms hjá börnum á Íslandi. Efniviður/aðferðir: Afturskyggn rannsókn, frá ársbyrjun 1996 til ársloka 2005. Leitað var að börnum með Kawasaki-sjúkdóm eða óhefðbundinn Kawasaki-sjúkdóm. Þeim börnum sem greindust á Landspítala var boðin þátttaka í framhaldsrannsókn með áherslu á langtímaaukaverkanir á hjarta. Niðurstöður: Alls greindust 30 börn með Kawasaki-sjúkdóm á tímabilinu. Nýgengi var 10,7/100.000 hjá börnum <5 ára á ári og kynjahlutfall 2,3:1 (drengir:stúlkur). Öll börnin fengu meðferð með mótefnum í æð án alvarlegra fylgikvilla. Miðfjöldi daga frá upphafi veikinda til mótefnagjafar voru 6 dagar (spönn 3-31dagur). Í bráðafasa fengu tveir (6,7%) kransæðagúla og víkkun mældist á kransæðum þriggja barna (10%). Enginn sjúklingur lést. Við endurkomu, fjórum til 12 árum eftir veikindin, voru tveir enn með kransæðavíkkun og 6 með míturlokuleka (26%). Ályktanir: Nýgengi og kynjahlutfall var sambærilegt við fyrri íslenska rannsókn og rannsóknir frá Norðurlöndunum. Fá börn greindust með kransæðabreytingar í bráðafasanum, þær breytingar sem greindust gengu til baka í öllum tilvikum nema tveimur og engir alvarlegir fylgikvillar urðu af þeirra völdum. Horfur barna sem greinast með Kawasaki-sjúkdóm á Íslandi eru góðar, en athygli vekur hátt algengi míturlokuleka

Fetal echocardiography in Iceland 2003-2007; indications and outcomes

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)OBJECTIVE: The aim of the study was to evaluate the indications and outcomes of fetal echo (FE) and determine which indication has the highest detection rate for congenital heart disease (CHD). METHODS: The referral indications and results of FE performed in Iceland during 2003-2007 were reviewed. Information regarding gestational age at diagnosis, nuchal translucency, pregnancy outcome, autopsy results and postnatal diagnosis were obtained from medical records. RESULTS: During the five year period 1187 FE were performed. Structural heart defect was diagnosed in 73 fetuses. The most common referral indication was family history of CHD (631;53.2%) which led to diagnosis of 18 heart defects prenatally (2.9%). The second most common referral indication was increased nuchal translucency (159) and abnormal cardiac findings were present in 16 cases (10.1%). A total of 30 women were referred for FE because of abnormal four chamber view (AFCV) which resulted in the diagnosis of 22 (73.3%) major heart defects, either incompatible with life or requiring immediate intervention after birth. Other indications led mostly to the diagnoses of minor defects. CONCLUSIONS: AFCV is the most important predictor for diagnosis of structural heart defects. 2,5% were referred for FE due to AFCV which led to diagnosis of 30% of all heart defects, all of which were major. Key words: fetal echocardiography, indications, congenital heart disease.Inngangur: Í þessari rannsókn voru skoðaðar ábendingar og útkoma fósturhjartaómskoðana og hvaða ábendingum fylgja mestar líkur á hjartagalla. Efniviður og aðferðir: Farið var yfir ábendingar og útkomu fósturhjartaómana sem gerðar voru á árunum 2003-2007 og hjartagallar sem greindust skráðir. Meðgöngulengd við greiningu, hnakkaþykkt fósturs við 12 vikur, afdrif þungunar, niðurstöður krufninga og greining barns eftir fæðingu fengust úr sjúkraskýrslum. Niðurstöður: Alls voru framkvæmdar 1187 fósturhjartaómskoðanir og greindist hjartagalli í 73 fóstrum. Algengasta ábendingin var fjölskyldu-saga um hjartagalla (631/1187;53,2%) sem leiddi til greiningar 18 hjartagalla í fósturlífi (18/631;2,9%). Næstalgengasta ábendingin var aukin hnakkaþykkt (159/1187;13,4%) og voru 16 hjartagallar greindir (16/159;10,1%). Þrjátíu konur (30/1187;2,5%) fóru í fósturhjartaómun vegna óeðlilegrar fjögurra hólfa sýnar sem leiddi til greiningar 22 (22/30;73,3%) hjartagalla sem kröfðust inngrips á nýburaskeiði eða höfðu slæmar horfur. Aðrar ábendingar leiddu til greiningar á minniháttar hjartagöllum. Ályktanir: Óeðlileg fjögurra hólfa sýn er mikilvægasti forspárþátturinn fyrir greiningu hjartagalla í fósturlífi. Sú ábending var aðeins 2,5% af heildarfjölda fósturhjartaómana á tímabilinu en leiddi til greiningar 30% allra hjartagalla og voru allir meiriháttar

Cardiac arrest in a teenager - a case report

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenCardiac arrest is rarely seen in children and teenagers. We present a 12-year old girl with cardiac arrest following myocardial infarction, that required prolonged cardiac massage and extracorporeal-membranous-oxygenation (ECMO). At coronary angiography the left main coronary artery (LMCA) was stented for a suspected coronary dissection. The contraction of the heart improved and the ECMO-treatment was discontinued a week later. The patient was discharged home, but six months later a coronary artery bypass surgery was performed for in-stent restenosis. Further work-up with computed tomography (CT) showed that the LMCA originated from the right aortic sinus instead of the the left one. This case demonstrates how life threatening myocardial infarction can be caused by coronary artery anomalies.Hjartastopp er sjaldgæft hjá börnum og unglingum. Lýst er 12 ára stúlku sem fór í hjartastopp eftir brátt hjartadrep þar sem beita varð langvarandi hjartahnoði og hjarta- og lungnavél til að bjarga lífi hennar. Við kransæðaþræðingu vaknaði grunur um flysjun í vinstri kransæðarstofni og var því komið fyrir kransæðastoðneti. Samdráttur hjartans lagaðist og var hjarta- og lungnavélin aftengd viku síðar. Hún útskrifaðist heim en hálfu ári síðar sást endurþrenging í stoðnetinu og var því gerð kransæðahjáveituaðgerð. Á tölvusneiðmyndum sást að um meðfæddan galla var að ræða þar sem vinstri kransæðarstofn átti upptök frá hægri ósæðarbolla í stað þess vinstra. Tilfellið sýnir að kransæðamissmíð getur valdið lífshættulegu hjartadrepi

Icelandic regulations for prescription medicines need to improve

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Ope

Diagnosis of critical congenital heart defects in Iceland 2000-2014

Critical congenital heart defects (CCHDs) are preferably diagnosed prenatally or soon after birth. Late diagnosis has been related to poorer prognosis. The aim of this study is to assess when CCHDs are diagnosed in Iceland and whether late diagnosis is a problem. All live born children in Iceland and foetuses diagnosed with CCHDs during the years 2000-2014 were included. CCHD was defined as a defect requiring intervention or causing death in the first year of life, or leading to abortion. The total number of pre- and postnatal diagnosis of CCHDs was 188. Prenatal diagnosis was made in 69 of 188 (36.7%). Of 69 diagnosed prenatally 33 were terminated due to CCHD. Of the 155 live born children with CCHD, 36 (23.2%) had a prenatal diagnosis and 100 (64.5%) were diagnosed shortly after birth, before discharge from birth facility. 19 children (12.3%) were diagnosed late, that is after discharge from birth facility. Coarctation of the aorta was the most common CCHD diagnosed late (6/19). Prenatal screening and newborn examination give good results in diagnosis of CCHDs in Iceland. Late diagnosis are relatively few, but both the number of prenatally diagnosed CCHDs and CCHDs diagnosed shortly after birth can be further improved

Cardiac arrest in a teenager - a case report

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenCardiac arrest is rarely seen in children and teenagers. We present a 12-year old girl with cardiac arrest following myocardial infarction, that required prolonged cardiac massage and extracorporeal-membranous-oxygenation (ECMO). At coronary angiography the left main coronary artery (LMCA) was stented for a suspected coronary dissection. The contraction of the heart improved and the ECMO-treatment was discontinued a week later. The patient was discharged home, but six months later a coronary artery bypass surgery was performed for in-stent restenosis. Further work-up with computed tomography (CT) showed that the LMCA originated from the right aortic sinus instead of the the left one. This case demonstrates how life threatening myocardial infarction can be caused by coronary artery anomalies.Hjartastopp er sjaldgæft hjá börnum og unglingum. Lýst er 12 ára stúlku sem fór í hjartastopp eftir brátt hjartadrep þar sem beita varð langvarandi hjartahnoði og hjarta- og lungnavél til að bjarga lífi hennar. Við kransæðaþræðingu vaknaði grunur um flysjun í vinstri kransæðarstofni og var því komið fyrir kransæðastoðneti. Samdráttur hjartans lagaðist og var hjarta- og lungnavélin aftengd viku síðar. Hún útskrifaðist heim en hálfu ári síðar sást endurþrenging í stoðnetinu og var því gerð kransæðahjáveituaðgerð. Á tölvusneiðmyndum sást að um meðfæddan galla var að ræða þar sem vinstri kransæðarstofn átti upptök frá hægri ósæðarbolla í stað þess vinstra. Tilfellið sýnir að kransæðamissmíð getur valdið lífshættulegu hjartadrepi

Coronary flow reserve in the newborn lamb: An intracoronary Doppler guide wire study

Recent studies indicate a severely reduced coronary flow reserve (CFR) in neonates with congenital heart disease. The significance of these studies remains debatable, as the ability of the anatomically normal neonatal heart to increase coronary flow is currently unknown. This study was designed to establish normal values for CFR in newborns after administration of adenosine [pharmacologic CFR (pCFR)] and as induced by acute hypoxemia (reactive CFR). Thirteen mechanically ventilated newborn lambs were studied. Coronary flow velocities were measured in the proximal left anterior descending coronary artery before and after adenosine injection (140 and 280 mug/kg i.v.) using an intracoronary 0.014-in Doppler flow-wire. Measurements were made at normal oxygen saturation (Sao(2)) and during progressive hypoxemia induced by lowering the fraction of inspired oxygen. CFR was defined as the ratio of hyperemic to basal average peak flow velocity. In a hemodynamically stable situation with normal Sao(2,) pCFR was 3.0 +/- 0.5. pCFR decreased with increasing hypoxemia. Regression analysis showed a linear relation between Sao(2) and pCFR (R = 0.86, p < 0.0001). Reactive CFR obtained at severe hypoxemia (Sao(2) <30%) was 4.2 +/- 0.8, and no significant further increase in coronary flow velocity occurred by administration of adenosine. Newborn lambs have a similar capacity to increase coronary flow in response to both pharmacologic and reactive stimuli as older subjects. Administration of adenosine does not reveal the full capacity of the newborn coronary circulation to increase flow, however, as the flow increase caused by severe hypoxemia is significantly more pronounced

Paediatric and adult congenital cardiology education and training in Europe

Publisher Copyright: © The Author(s), 2022. Published by Cambridge University Press.Background: Limited data exist on training of European paediatric and adult congenital cardiologists. Methods: A structured and approved questionnaire was circulated to national delegates of Association for European Paediatric and Congenital Cardiology in 33 European countries. Results: Delegates from 30 countries (91%) responded. Paediatric cardiology was not recognised as a distinct speciality by the respective ministry of Health in seven countries (23%). Twenty countries (67%) have formally accredited paediatric cardiology training programmes, seven (23%) have substantial informal (not accredited or certified) training, and three (10%) have very limited or no programme. Twenty-two countries have a curriculum. Twelve countries have a national training director. There was one paediatric cardiology centre per 2.66 million population (range 0.87-9.64 million), one cardiac surgical centre per 4.73 million population (range 1.63-10.72 million), and one training centre per 4.29 million population (range 1.63-10.72 million population). The median number of paediatric cardiology fellows per training programme was 4 (range 1-17), and duration of training was 3 years (range 2-5 years). An exit examination in paediatric cardiology was conducted in 16 countries (53%) and certification provided by 20 countries (67%). Paediatric cardiologist number is affected by gross domestic product (R2 = 0.41). Conclusion: Training varies markedly across European countries. Although formal fellowship programmes exist in many countries, several countries have informal training or no training. Only a minority of countries provide both exit examination and certification. Harmonisation of training and standardisation of exit examination and certification could reduce variation in training thereby promoting high-quality care by European congenital cardiologists.Peer reviewe