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Biomedical subjects

A Harjula

Publications and source records attributed to A Harjula.

At least 55 records · Page 3Linked to original sources
PubMed1987

Distant graft procurement for combined heart and lung transplantation using pulmonary artery flush and simple topical hypothermia for graft preservation.

Although combined heart and lung transplantation has great potential for improving survival and rehabilitation in selected patients with pulmonary vascular disease, the lack of suitable donor organs has restricted the number of operations performed. We report a heart and lung transplantation operation for Eisenmenger's syndrome in which distant donor graft procurement was used with a simple system for preservation.

Adult↗
PubMed1987

Ultrasound in the evaluation of the knee and patellar regions.

Studies were carried out in 25 patients (mean age, 34.2 years) with knee or patellar problems, using a real-time scanner. The contralateral leg, which was asymptomatic, was used as a control. Identification of the patellar bone and the area of insertion of the infrapatellar tendon was not difficult. The area of insertion was less echogenic than other parts of the tendon. Patchy, partial, or total ruptures could be identified using ultrasound. Sonolucent structures in cases of Baker's cyst were easily identified. The study revealed three partial suprapatellar tendon ruptures, three partial infrapatellar tendon ruptures, six old injuries of the infrapatellar tendon with fibrosis and scar tissue, one case of prepatellar bursitis, one parapatellar (cartilaginous) loose body, two intraarticular loose bodies (bony), and four cases of Baker's cyst, of which one was found to be ruptured. The differences in echogenicity of the tendons and surrounding soft tissues were more conspicuous using interposed Kiteko than with direct skin contact.

Adult↗
PubMed1987

Proper donor selection for heart-lung transplantation. The Stanford experience.

Clinical cardiopulmonary transplantation is currently limited by the availability of suitable heart-lung donors. Distant graft procurement, with pretreatment, of the donor by intravenous prostaglandin E1 and cooling of the graft with pulmonary artery perfusion, is now clinically established and should increase the number of available donors. Between March 1981 and September 1986, 40 heart-lung transplantations were performed. The characteristics of the donor pool were analyzed. Gram stain of the donor tracheal aspirate revealed gram-positive bacteria in 80% and gram-negative organisms in 35%. Yeast was present on stain in 25% of the patients. Donor arterial oxygen tension was less than 100 torr inspired oxygen concentration 40%) repeatedly in one patient; this recipient died of lung failure at operation. Severe deterioration of allograft lung function was seen in 11 (27.5%) recipients. The causes of deterioration were substantial postoperative bleeding in six patients, sepsis in two, and acute rejection, poor lung function, and allograft heart failure in one patient each. HLA-A locus mismatch, poor donor alveolar-capillary gas exchange, tracheal colonization with heavy polymorphonuclear cells, and heavy bacteria and fungus resulted in increased operative mortality. Donor pretreatment with prostaglandin E1 was associated with improved survival. Recipient selection, emphasizing adequate liver function and absence of previous thoracic operation, careful surgical technique with minimal bleeding, and brief perfusion time were factors associated with improved survival. Early morbidity and mortality were principally related to recipient risk factors, and the strict criteria observed for selection of heart-lung donors were valid. The importance of appropriate recipient selection is underscored.

Adolescent↗
PubMed1987

Coronary endothelium and cardioplegic solutions.

Using surface and transmission electron microscopy in eight isolated sheep hearts it was noted that cold crystalloid cardioplegic solution produced coronary endothelial damage which could be prevented if homologous blood or albumin was added into the preservation fluid. Similar endothelial damage was observed in the endothelium of aorto-coronary saphenous vein bypasses and in the endothelium of the proximal aorta after infusion with cold crystalloid cardioplegic fluid. No endothelial changes were seen after infusion of the grafts with cold blood. There was no correlation between the preservation of the high energy phosphates of the myocardium and the endothelial changes of the coronary arteries.

Albumins↗
PubMed1987

Early endocarditis following open-heart surgery--importance of surgical treatment.

Nine cases of proven early form of endocarditis occurred after open-heart surgery. Eight of these occurred after valve surgery with an incidence 0.7% while one complicated correction of Fallot's tetralogy. Sternal wound infection preceeded endocarditis in two cases and respiratory tract infection in one case. In these three patients, the infection was caused by the same bacteria as the subsequent postoperative endocarditis. In only one patient were there no signs of infection during the immediate postoperative course. A new cardiac murmur suggesting prosthetic malfunction was a clear indication for early reoperation in five patients; four of them survived. In one patient with a paravalvular leakage the decision to operate was delayed with fatal outcome. Generally, in patients without signs of prosthetic valve malfunction or other prosthetic complication the indication and timing of surgery is problematic. In our series the antibiotic therapy was continued over two months in three patients. Two of them died while the third patient was operated on successfully.

Adult↗
PubMed1986

Prolonged survival with a thrombotically occluded tricuspid valve prosthesis.

A 49-year-old man who had undergone tricuspid valve replacement with a Björk-Shiley prosthesis in November 1974 was reoperated on in January 1985 due to prosthesis malfunction. The operation revealed a totally occluded prosthetic valve and a paravalvular defect which had served as the channel for atrioventricular blood flow. In retrospect, all evidence indicated that the valve had stuck as early as six months after the primary operation, when the patient had first noticed the loss of audible valve clicks and the reappearance of effort intolerance. Due to the gradual progression of the patient's symptoms and misinterpretation of the significance of absent valve clicks, the correct diagnosis was not made until a follow-up study 10 years after the first operation when contrast echocardiography showed the absence of both disc movements and transvalvular contrast flow. Our experience indicates that thrombosis of a tricuspid valve prosthesis may present highly insidiously and that the loss of audible valve clicks should be relied on as a sign of prosthesis malfunction.

Adult↗
PubMed1986

Failure of mechanical valves in Ebstein's malformation.

Five patients with Ebstein's malformation were operated on with closure of the atrial septal defect and implantation of a mechanical prosthesis at the right atrioventricular junction. The 4 patients who survived showed an excellent early recovery. Three of the patients noticed the disappearance of the valve clicks 6 months after the operation. At re-examination using echophonocardiography, peripheral dye dilution curves and catheterization, these valves were found to be stuck in the open position in 2 patients and in the closed position in 1 patient. The last patient had a paravalvar channel supplying blood into the right ventricle. One patient who had a St. Jude prosthesis was doing excellently 4 years postoperatively and the valve was functioning well. Two years after the operation, the other patient with a St. Jude valve again noticed valve clicks after over 1 year of silence. Examination revealed the prosthesis to be functioning normally. The totally occluded Björk-Shiley prosthesis (10 years postoperatively) was excised at re-operation and replaced by an Ionescu-Shiley bioprosthesis. The patient with a jammed Björk-Shiley prosthesis (10 years postoperatively) declined a re-operation and is doing well, albeit under close observation.

Adult↗
PubMed1986

Intrathoracic surgery for retained endocardial electrodes.

Intrathoracic surgery for retained endocardial electrodes was performed in 12 patients; the indication for electrode removal was Staphylococcus aureus or epidermidis infection in 11 patients and malfunction in one patient. Two operations had to be performed on emergency basis. One was carried out because of myocardial rupture and cardiac tamponade after a tightly fixed electrode lead had been pulled out. The other patient was operated on because of ventricular arrhythmia arising from a malfunctioning lead which had slipped back completely after transsection into the right ventricle. Ten patients underwent elective surgery; cardiopulmonary bypass was needed in 6 of these. In one case a mitral prosthesis was replaced because of infection. Radical treatment is recommended for pacemaker infections and the removal of electrodes should be considered even if intrathoracic surgery is required.

Adult↗
PubMed1986

Auscultatory characteristics of normally functioning Lillehei-Kaster, Björk-Shiley, and St Jude heart valve prostheses.

Auscultatory and echocardiographic and phonocardiographic studies were performed on 26 patients who had a total of 11 Lillehei-Kaster, 16 Björk-Shiley, and 18 St Jude heart valve prostheses functioning normally in the aortic or mitral positions or both. With all types and positions of prostheses a distinct closing sound was always detected. It was frequently heard in two parts which, according to echocardiographic and phonocardiographic studies, resulted from the onset and completion of the valve closure. An opening sound could be heard from all Björk-Shiley and St Jude valves but from only four of the 11 Lillehei-Kaster valves. The opening sounds due to mitral prostheses consisted of two to three closely spaced clicks detected as a faint early diastolic crackle on auscultation. Echocardiography with phonocardiography indicated that they were related to the onset and termination of the disc opening excursion. In the aortic position the valves always produced early to mid-systolic murmurs, and a soft early diastolic murmur was also heard in seven of 23 patients. A mid-diastolic rumble was heard in 12 of 22 patients with mitral prostheses. Normally functioning tilting disc valve prostheses produce characteristic auscultatory findings, and familiarity with these findings will be useful in clinical evaluation of patients with these prostheses.

Adult↗
PubMed1986

Comparative analysis of tilting disc and ball valve prosthesis in aortic position.

In a retrospective analysis, comparison was made between the Cutter-Smeloff ball valve (n = 63) and the Lillehei-Kaster tilting disc valve (n = 256) in the aortic position. No significant intergroup difference was found as regards rate of thromboembolism (0.6/100 patient years for both valve types), endocarditis (0.2 for Cutter-Smeloff and 0.5 for Lillehei-Kaster/100 patient years) and paraprosthetic leak (0.9 and 0.5, respectively/100 patient years). The actuarial curve of cumulative survival was similar for both valves until 6 years postoperatively. Thereafter the outcome was less favourable for the patients with Cutter-Smeloff valve (actuarial survival 79 +/- 5% than for those with Lillehei-Kaster valve (91.2 +/- 2%). The reason for this, statistically significant, difference may be associated with the difference in valve profiles.

Actuarial Analysis↗
PubMed1986

Long-term follow-up of Björk-Shiley mitral valve replacement. 10 years' experience.

Retrospective analysis was made of 176 patients who received a Björk-Shiley mitral valve replacement in the period 1973 through 1982. Actuarial cumulative curves showed the 10-year and 5-year survival rates to be 79 +/- 3.4%. The functional status at follow-up was better than preoperatively in 77.1% of the patients. The hospital mortality was 9.1% and the late mortality was 3.6/100 patient years. Early complications included disc entrapment against the ventricular wall in three cases, wedging of chorda between disc and valve rim in two and posterior perforation of the left ventricle in three patients. There was no structural valve damage. Calculated per 100 patient years, the incidence of thromboembolism was 2.5, endocarditis 1.4 and prosthetic leak 1.8. One thrombosed valve was successfully replaced by a new prosthesis 11 years after the initial implantation. Jamming of the disc by tissue over-growth necessitated a new valve implantation in one case. The incidence of early valve-related complications was high, but the long-term results were comparable with those from other mechanical valves. One early complication--disc entrapment against the ventricular wall--may be avoided by use of a sufficiently small valve if the ventricle is small and thickened.

Actuarial Analysis↗
PubMed1986

Mediastinal neurogenic tumours. Early and late results of surgical treatment.

Early and late results of surgery for neurogenic mediastinal tumour were evaluated in 66 cases with a mean follow-up of 12 years. The series comprised 48 neurilemmomas, 8 neurofibromas, 7 ganglioneuromas, and neurinoma, neurofibrosarcoma and ganglioneuroblastoma each in one case. There were two early deaths (3%), one due to peroperative bleeding from the left subclavian artery and the other to acute myocardial infarction. Operative complications arose in 12 cases (18%), the most common being wound infection (3 cases). There were 17 late deaths (26.6%). In the neurilemmoma group, 3 of the 13 late deaths were related to the tumour or its treatment, and both deaths in the neurofibroma group were related to malignant transformation. Recurrence of tumour appeared in 3 of the 48 patients with neurilemmoma and also in the single patient with neurinoma as tumour classification. One neurilemmoma was a dumb-bell tumour, and operation in this case resulted in paraplegia. Malignant transformation appeared in 2 of the 8 neurofibromas 5 and 13 years postoperatively. Because of the risks of malignant degeneration and of recurrence, patients operated on for neurogenic mediastinal tumour should be carefully followed up for many years.

Adolescent↗
PubMed1986

Plasma cell granuloma of lung and pleura.

A report is presented of seven patients with plasma cell granuloma of the lung or pleura. Two were operated on in 1970, three in 1971, one in 1973 and one in 1984. None of the patients had smoked cigarettes. Five had a history of infection. Most of the patients were young, healthy and working. The surgical treatment was lobectomy in four cases, bilobectomy in one case and resection of tumour in two cases. The histology of the tumours was re-evaluated, and was similar in all cases. They were composed mainly of plasma cells, lymphocytes and granulocytes, and small foci of calcification were also seen. No recurrence of tumour was found in observation up to 13 years postoperatively. One patient died of pancreatic carcinoma after 6 years. The others are doing well.

Adolescent↗
PubMed1986

Residual carcinoma in bronchial resection line.

Microscopic residual tumour growth was found postoperatively in the bronchial resection lines in 44 out of a total of 1069 patients who underwent resection for pulmonary carcinoma. Bronchopleural fistula developed in six of these patients (13.6%). The incidence of bronchopleural fistula in the material overall was 4.2% (45 patients). Residual carcinoma therefore seemed to impair healing of the bronchial stump (p less than 0.01). Routine intraoperative frozen sections of the bronchial resection line can be recommended in order to reveal the residual carcinoma and thus lower the incidence of bronchopleural fistula. The five-year survival rate of these patients with microscopic residual carcinoma in their bronchial resection lines was similar to that in patients with the same TNM staging who had undergone resection for pulmonary carcinoma. Residual carcinoma in the bronchial resection line therefore did not worsen prognoses. The survival rate in our patients was better than survival rates reported for other series. Most of our patients had received postoperative radiotherapy. Previous reports relate to patients treated only surgically. Postoperative radiotherapy may therefore improve the prognosis in patients with residual tumour growth in their bronchial resection lines.

Adenocarcinoma↗
PubMed1986

Carcinoembryonic antigen (CEA) and gastrointestinal cancer associated antigen CA 19-9 in bronchioloalveolar carcinomas and pulmonary adenocarcinomas.

The concentrations of carcinoembryonic antigen (CEA) and the gastrointestinal cancer associated antigen CA 19-9 were studied by radioimmunoassay in serum samples from patients with malignant and benign pulmonary tumours. Elevated levels of either markers were found in 14% of patients with malignant tumours and in none of the cases with benign lesions. Following removal of the tumour, a decline in high CA 19-9 levels was found. The advanced tumours produced the highest serum CA 19-9 concentrations but elevated values were also found in small bronchioloalveolar carcinomas and pulmonary adenocarcinomas. Immunohistochemical staining for CEA and CA 19-9 was performed on routine histopathological specimens. About half of the cases of bronchioloalveolar carcinomas and pulmonary adenocarcinomas were CA 19-9 positive and about 90% were CEA positive. No correlation between intensity of tissue expression and serum levels of CA 19-9 could be demonstrated. However, the bronchioloalveolar carcinomas and pulmonary adenocarcinomas which produced high serum levels of CA 19-9 also stained positively.

Adenocarcinoma↗