Case: A 46-year-old female presented to her general practitioner with abdominal pain, lethargy, dyspnea and pedal edema. Computed tomography (CT) revealed features of heart and liver failure with pleural fluid and ascites and the liver having a cirrhotic appearance. A gastroenterologist confirmed the diagnosis of cirrhosis, but the etiology was unknown. Pericardial calcifications and elevated jugular venous pressure on examination gave rise to a suspicion of constrictive pericarditis as the cause of the liver cirrhosis. Cardiac catheterization confirmed pericardial constriction, and the patient underwent a total pericardiectomy. Discussion: It is easy to miss a diagnosis of constrictive pericarditis because it must be specifically sought after in the echocardiogram, and pericardial calcifications are only present in a minority of cases.
Introduction: Most studies comparing Off-pump and On-pump coronary artery bypass grafting (CABG) have primarily focused on short-term outcomes. The aim of this study was therefore to evaluate and compare long-term complications and survival between these surgical approaches. Material and methods: This retrospective study included 2337 patients who underwent primary isolated CABG in Iceland between 2001-2021; 397 (17,0%) performed Off-Pump and 1940 (83,0%) On-Pump. The complications stroke, myocardial infarction (MI), percutaneous coronary intervention (PCI), repeat CABG and death; combined as major adverse cardiovascular and cerebrovascular events (MACCE), were compared between the groups after 1:1 propensity score matching (377 pairs). Long-term survival and MACCE-free survival were estimated using the Kaplan-Meier method and multivariable Cox regression. Results: Before matching, patients in the On-Pump group had more extensive coronary artery disease and were more often operated on acutely. At 10-year follow-up, the cumulative incidence of PCI (14.0% in the Off-Pump group vs. 10.2% in the On-Pump group, p=0.110), MI (9.0% vs. 8.0%, p=0.784), stroke (4.6% vs. 6.8%, p=0.090) and repeat CABG (0.9% vs. 0.0%, p=0.090) were comparable between groups in the matched cohort. MACCE-free survival (71.0% in the Off-Pump group vs. 71.4% in the On-Pump group, p=0.74) and overall survival (78.5% vs. 73.2%, p=0.095) at 10 years was also comparable between groups. Furthermore, multivariate analysis showed similar overall survival for both surgical techniques (HR: 0.81; 95%-CI: 0.60-1.09; p=0,156). Conclusions: The long-term outcomes following CABG in Iceland are favorable for both Off-pump and On-pump procedures, both in terms of survival and long-term complications.
This case describes a serious but rare adverse effect of the antiepileptic drug valproicacid (valproate-induced encephalopathy) in a 65-year-old man. The patient was started on valproic acid on questionable grounds due to a suspected single seizure. He remained on the medication for 10 years before progressively worsening Parkinsonian symptoms were attributed to side effects of the drug. The medication was subsequently tapered off. Then, it was as if a veil had been lifted from thepatient. All suspicion of Parkinson’s disease disappeared. This case highlights the importance of a correct epilepsy diagnosis before initiating treatment, as well as maintaining a high level of awareness of adverse effects in patients receiving antiepileptic drugs.
Introduction: In the past decade, the use of antidepressants in Iceland has increased rapidly. Given their widespread use, it is important to assess potential effects of SSRI/SNRI exposure during pregnancy on the newborn. The aim of this study was to examine the prevalence of SSRI/SNRI use at the time of delivery, the frequency of neonatal support or resuscitation, monitoring or admissions to the neonatal intensive care unit (NICU), and which clinical signs may possibly be linked to SSRI/SNRI exposure during pregnancy. Methods: This was a retrospective comparative study, including all infants born at Landspítali in 2023 (n=3200). Infants born before 35 weeks of gestation were excluded. The study group consisted of infants whose mothers were on SSRI/SNRI treatment upon delivery, while the control group included all other infants in the study population. Additionally, infants admitted to the NICU were examined in more detail. Results: Out of 3069 infants, 336 (10.9%) were exposed to SSRI/SNRI treatment during pregnancy. The need for neonatal support was significantly higher in the SSRI/SNRI group (29.2%) compared with controls (14.6%). Similarly, NICU admission or monitoring was more common (19.4% vs. 13%). Other significant differences included higher rates of respiratory distress, lower Apgar scores at 1 and 5 minutes, and more frequent sepsis work-ups in the SSRI/SNRI group. Conclusions: Infants exposed to maternal SSRI/SNRI treatment are more likely to require postnatal support, including oxygen therapy and respiratory assistance, as well as NICU care. Furthermore, these infants have lower Apgar scores at birth, and increased rate of sepsis work-up.
