Major cardiac rupture following surgical treatment for deep sternal wound infection.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.We report a case of an 80-year old male patient who sustained a major rupture of the right ventricle after surgical revision of an infected sternotomy wound following coronary artery bypass surgery. The rupture of the right ventricle occurred despite an early wound debridement and the use of negative pressure wound therapy on the sternum that did not provide sufficient stability to the sternum after the sternal wires were removed. The rupture resulted in a major bleeding but by establishing emergent cardiopulmonary bypass, the patient was saved

Case of the monthSudden chest pain and changed voice after the use of an electronic cigarette

Tæplega tvítugur, áður hraustur, fyrrverandi reykingamaður leitaði á bráðamóttöku Landspítala vegna skyndilegra brjóstverkja. Tveimur klukkustundum áður hafði hann notað rafsígarettu sem olli kröftugu hóstakasti. Verkurinn versnaði við djúpa innöndun en hann fann einnig fyrir verkjum við hreyfingu og kyngingu, auk þess sem rödd varð rámari. Við skoðun var hann ekki bráðveikur né meðtekinn af verkjum að sjá og með eðlileg lífsmörk. Brak fannst við þreifingu efst á bringu og við háls. Lungna- og hjartahlustun var eðlileg. Tekin var röntgenmynd af lungum sem sýnd er á mynd 1. Hver er greiningin? Þarf frekari rannsóknir og í hverju er meðferð fólgin?Peer reviewe

Incidental detection by computed tomography is an independent prognostic factor for survival in patients operated for nonsmall cell lung carcinoma.

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnWe studied the rate of incidental detection of lung carcinomas and its effect on long-term survival in a nationwide cohort of patients operated for nonsmall cell lung cancer (NSCLC). All patients operated for NSCLC in Iceland during 1991-2010 were included. Demographic and clinicopathological features were compared in patients diagnosed incidentally using chest radiography or computed tomography (CT), and in those with symptomatic presentation. Multivariate analysis was used to evaluate prognostic factors. Out of 508 patients, 174 (34%) were diagnosed incidentally; in 26% of cases by chest radiography and in 8% by CT. The CT-detected tumours were significantly smaller than symptomatic tumours, diagnosed at earlier TNM (tumour, node and metastasis) stages and more often of adenocarcinoma histology. 5-year cancer-specific survival for symptomatic versus incidentally diagnosed patients detected by chest radiography and CT was 41%, 57% and 68%, respectively (p=0.003). After adjusting for stage, the hazard ratio (HR) for NSCLC mortality was significantly lower for incidental diagnosis by CT (HR 0.55, 95% CI 0.31‒0.98; p=0.04) compared to incidental diagnosis by chest radiography (HR 0.95, 95% CI 0.70‒1.27; p=0.71) or symptomatic diagnosis (HR 1.0). One-third of surgically treated NSCLCs were detected incidentally, with an increasing rate of incidental CT diagnosis. NSCLC patients diagnosed incidentally by CT appear to have better survival than those diagnosed incidentally by chest radiography, and particularly those who present with symptoms

The impact of tumour size on the probability of synchronous metastasis and survival in renal cell carcinoma patients: a population-based study.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.The observed low metastatic potential and favorable survival of small incidentally detected renal cell carcinomas (RCCs) have been a part of the rationale for recommending partial nephrectomy as a first treatment option and active surveillance in selected patients. We examined the relationship between tumor size and the odds of synchronous metastases (SMs) (primary outcome) and disease specific survival (secondary outcome) in a nationwide RCC registry.Retrospective study of the 794 RCC patients diagnosed in Iceland between 1971 and 2005. Histological material and TNM staging were reviewed centrally. The presence of SM and survival were recorded. Cubic spline analysis was used to assess relationship between tumor size and probability of SM. Univariate and multivariate statistics were used to estimate prognostic factors for SM and survival.The probability of SM increased in a non-linear fashion with increasing tumor size (11, 25, 35, and 50%) for patients with tumors of ≤4, 4.1-7.0, 7.1-10.0, and >10 cm, respectively. On multivariate analysis, tumor size was an independent prognostic factor for disease-specific survival (HR = 1.05, 95% CI 1.02-1.09, p < 0.001), but not for SM.Tumor size affected the probability of disease-specific mortality but not SM, after correcting for TNM staging in multivariate analysis. This confirms the prognostic ability of the 2010 TNM staging system for renal cell cancer in the Icelandic population.Landspitali University Hospital Scientific Foundation Memorial Foundation of Bergthora Magnusdottir and Jakob J. Bjarnaso

Acute kidney injury and outcome following aortic valve replacement for aortic stenosis.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.Most studies on acute kidney injury (AKI) following open-heart surgery have focused on short-term outcome following coronary artery bypass grafting. We reviewed the incidence, risk factors and outcome, including long-term survival, of AKI after aortic valve replacement (AVR) in a population-based cohort.A retrospective review of 365 patients who underwent AVR for aortic stenosis during 2002-2011 was made. AKI was defined according to the RIFLE criteria. All patients requiring dialysis were followed up in a centralized registry. Risk factors for AKI were analysed with univariable and multivariable analysis, and survival was graphically presented with the Kaplan-Meier method.The rate of AKI was 82/365 (22.5%); 40, 28 and 14 patients belonging to the Risk, Injury and Failure groups, respectively. Preoperatively, 37 (45.1%) AKI patients had reduced kidney function. Transfusion of red blood cells, obesity and prolonged cardiopulmonary bypass time were independent risk factors for AKI. Acute postoperative dialysis was required in 15 patients (4.1%), and 1 patient developed dialysis-dependent end-stage renal disease. Major postoperative complications were more common in the AKI group (65 vs 22%, P < 0.001). The 30-day mortality rate in the AKI group was 18%, as opposed to 2% in the non-AKI group (P < 0.001), with a 5-year survival rate of 66 vs 87%, respectively (P < 0.001). In multivariable analysis AKI was an independent predictor of operative mortality [odds ratio = 5.89, 95% confidence interval (CI) = 1.99-18.91] but not of long-term survival (hazard ratio = 1.44, 95% CI = 0.86-2.42).More than 1 in 5 patients (22.5%) who underwent AVR developed AKI postoperatively. AKI was associated with higher morbidity and was an independent predictor of operative mortality. However, AKI was not a determinant of long-term survival.Landspitali University Research Fund, University of Iceland Research Fund, Helga Gudmundsdottir and Sigurlidi Kristjansson Memorial Fund

Erratum: The impact of tumour size on the probability of synchronous metastasis and survival in renal cell carcinoma patients: a population-based study.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access

Penetrating stab injuries in Iceland: a whole-nation study on incidence and outcome in patients hospitalized for penetrating stab injuries

Publisher's version (útgefin grein)Background: Studies on penetrating injuries in Europe are scarce and often represent data from single institutions. The aim of this study was to describe the incidence and demographic features of patients hospitalized for stab injury in a whole nation. Materials and methods: This was a retrospective nationwide population-based study on all consecutive adult patients who were hospitalized in Iceland following knife and machete-related injuries, 2000-2015. Age-standardized incidence was calculated and Injury Severity Score (ISS) was used to assess severity of injury. Results: Altogether, 73 patients (mean age 32.6 years, 90.4% males) were admitted during the 16-year study period, giving an age-standardized incidence of 1.54/100,000 inhabitants. The incidence did not vary significantly during the study period (P = 0.826). Most cases were assaults (95.9%) occurring at home or in public streets, and involved the chest (n = 32), abdomen (n = 26), upper limbs (n = 26), head/neck/face (n = 21), lower limbs (n = 10), and the back (n = 6). Median ISS was 9, with 14 patients (19.2%) having severe injuries (defined as ISS > 15). The median length of hospital stay was 2 days (range 0-53). Forty-seven patients (64.4%) underwent surgery and 26 of them (35.6%) required admission to an intensive care unit (ICU), all with ISS scores above 15. Three patients did not survive for 30 days (4.1%); all of them had severe injuries (ISS 17, 25, and 75). Conclusion: Stab injuries that require hospital admission are rare in Iceland, and their incidence has remained relatively stable. One in every five patients sustained severe injuries, two-thirds of whom were treated with surgical interventions, and roughly one-third required ICU care. Although some patients were severely injured with high injury scores, their 30-day mortality was still low in comparison to other studies.Funding for this study was received from Landspitali University Hospital Research Fund and was used for work hours spent on data collection, analysis and interpretation of data and writing of the manuscript.Peer Reviewe

Clinical Course of Postoperative Atrial Fibrillation After Cardiac Surgery and Long-term Outcome

Funding Information: The study was supported by the Swedish Heart-Lung Foundation (grant 20180560 to AJ), the Swedish state (ALFGBG-725131 to AJ) under the agreement between the Swedish government and the county councils concerning economic support of research and education of doctors (ALF agreement), Region Västra Götaland (grant VGFOUREG-847811 to AJ and grant VGFOUREG-648981 to AT), and Wilhelm and Martina Lundgrens Foundation (grant 2019-3110 to AT). The authors had full freedom of investigation and full control of the design of the study, analysis of data, and production of the written report. Dr Jeppsson discloses a financial relationship with Boehringer-Ingelheim, XVIVO, Portola, Baxter, and LFB; Dr Taha with Bayer; Dr Bergfeldt with Bayer, Boehringer Ingelheim, and Sanofi. Funding Information: The study was supported by the Swedish Heart-Lung Foundation (grant 20180560 to AJ), the Swedish state (ALFGBG-725131 to AJ) under the agreement between the Swedish government and the county councils concerning economic support of research and education of doctors (ALF agreement), Region Västra Götaland (grant VGFOUREG-847811 to AJ and grant VGFOUREG-648981 to AT), and Wilhelm and Martina Lundgrens Foundation (grant 2019-3110 to AT). The authors had full freedom of investigation and full control of the design of the study, analysis of data, and production of the written report. Publisher Copyright: © 2022 The Society of Thoracic SurgeonsBackground: New-onset postoperative atrial fibrillation (POAF) after cardiac surgery is associated with worse short- and long-term outcomes. Although the clinical presentation of POAF varies substantially, almost all studies model it with a dichotomous yes or no variable. We explored potential associations between the clinical course of POAF and long-term outcome. Methods: This retrospective, observational, single-center study included 6435 coronary artery bypass grafting and/or valve patients between 2010 and 2018. POAF patients were grouped into spontaneous/pharmacologic conversion to sinus rhythm, sinus rhythm after electrical cardioversion, and sustained AF at discharge. Multivariable Cox regression models adjusted for age, sex, type of surgery, comorbidities, and early-initiated oral anticoagulation were used to study associations between the clinical course of POAF and long-term risk for mortality, ischemic stroke, thromboembolic events, heart failure hospitalization, and major bleeding. Median follow-up time was 3.8 years (range, 0-8.3). Results: POAF occurred in 2172 patients (33.8%), 94.9% of whom converted to sinus rhythm before discharge. Of these, 73.6% converted spontaneously or with pharmacologic treatment and 26.4% after electrical cardioversion. Both sustained AF and electrical cardioversion were independently associated with an increased long-term risk for heart failure (adjusted hazard ratio for sustained AF at discharge, 2.55 [95% confidence interval, 1.65-3.93; P < .001]; adjusted hazard ratio for electrical cardioversion, 1.28 [95% confidence interval, 1.00-1.65; P = .049]) but not with increased long-term risk for death, thromboembolic complications, or bleeding. Conclusions: A more complicated POAF course is associated with increased long-term risk for heart failure hospitalization but not for all-cause mortality or thromboembolic complications.Peer reviewe