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Biomedical subjects

A Tapaninaho

Publications and source records attributed to A Tapaninaho.

13 recordsLinked to original sources
PubMed1993

Shunt-dependent hydrocephalus after subarachnoid haemorrhage and aneurysm surgery: timing of surgery is not a risk factor.

Early hydrocephalus is a risk factor of shunt-dependent late hydrocephalus (SDHC). In the CT era 1980-1990 we had 835 consecutive patients operated on because of aneurysm and subarachnoid haemorrhage (SAH); 294 had an early hydrocephalus and 67 finally required a shunt. There were 14 patients with normal early CT and SDHC, in all 81 patients needed a shunt (10%). Patients with shunt did worse, they were older (53 vs 49) than the non-shunted group and there was a female preponderance. Pre-operative Grade correlated significantly with the need for a shunt operation; no one in Grade I developed SDHC, incidence in Grades III and IV was high (18% and 10%, respectively). Location was important; in vertebrobasilar area 28% and in anterior communicating area 14% but in middle cerebral area only 4% of the patients had SDHC. The amount of cisternal bleeding correlated significantly with SDHC; in 155 patients with non detectable or minimal cisternal blood only one developed SDHC, with severe cisternal bleeding the incidence was 16%. Ventricular bleeding increased the risk of SDHC, but intracerebral haematoma did not. Timing of surgery had no correlation with the risk of SDHC. Postoperative complications, haematomas and infections increased the risk of late SDHC. Delayed ischaemia correlated with the risk, but so did the treatment with nimodipine. Severe bleeding was the common predictor for the risk of SDHC. Location of the bleeding and postoperative problems are the other major causes. Outcome is, however, not so gloomy; 54% of patients with SDHC are independent one year later.

Adult↗
PubMed1993

One-year outcome in early aneurysm surgery: a 14 years experience.

In a consecutive series of 1150 patients with cerebral aneurysms diagnosed in our department by angiography or autopsy between the years 1977-1990, 1007 patients underwent definitive operative treatment of their aneurysms mainly by early surgery. More than half (55%) were operated on during the first three days after subarachnoid haemorrhage (SAH), and more than three quarters (77%) during the first week. The surgical mortality at 30 days was 9%; at one-year follow-up 13% had died. The total management mortality was 22%. The 618 patients presenting in Hunt and Hess Grades I-II had a 4% mortality, and 90% had an independent life at follow-up; 270 Grade III patients had a 19% mortality and 68% were independent. There were 99 patients operated on in Grades IV-V with a 46% mortality and 30% were independent. Age of the patient and size of the aneurysm were strongly related to outcome; however, many of the giant aneurysms were operated on as an emergency because of large intracerebral haematomas. Best results were obtained in the anterior communicating artery (ACA) area; the lowest rate of useful recoveries was in the vertebro-basilar artery (VBA) area (71%). Early surgery did not prevent delayed ischaemic deficits. During the first 72 hours patients in Grades I-III can be operated on safely with good results. The results in Grades IV-V are poor, and we suggest that only cases with large haematomas or considerable hydrocephalus or those improving should be operated on in the first days after SAH, with limited hopes of functional recovery.

Adolescent↗
PubMed1993

Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome.

Impairment and disability after back surgery is a common diagnostic and therapeutic problem. For the most part the reasons are unclear. Of 178 patients who had undergone laminectomies 2-5 years earlier, 14 patients with good recovery and 21 patients with poor recovery but no evidence of restenosis on computed tomography were selected by the Oswestry index. According to radiologic, neurophysiologic, and muscle biopsy evidence most patients (13 of 15 studied) suffering from the severe postoperative failed back syndrome had dorsal ramus lesions in one or more segments covered by the scar and local paraspinal muscle atrophy at the corresponding segments. Disturbed back muscle innervation and loss of muscular support leads to the disability and increased biomechanical strain and might be one important cause to the failed back syndrome. It may be possible to develop operating techniques that save back muscle innervation better than the usual ones.

Adult↗
PubMed1992

Saccular aneurysms of the distal anterior cerebral artery and its branches.

We report a series of 84 consecutive patients (41 women) with 92 distal anterior cerebral artery aneurysms (DACAA). All aneurysms were saccular. Four different locations of DACAAs were found: proximal, 5 aneurysms; frontobasal, 8; genu corporis callosi, 72; and distal, 7. Sixty-five patients presented with subarachnoid hemorrhage (SAH), the rest were incidental findings in patients with multiple aneurysms. Forty-five patients had single DACAAs. Multiple aneurysms (a total of 117) were found in 39 patients (46.4%), and DACAAs were responsible for SAH in 20 patients. Of the 65 patients with SAH, 54 underwent mainly early direct surgery, and 46 (85%) of these had good outcomes 1 year after surgery. Three patients remained severely disabled, and five patients (9%) died. All of the poor surgical results were obtained in patients with severe preoperative deficits. Exact measurements of DACAA sizes and necks were smaller than those of cerebral aneurysms in other locations. Aside from localization, microsurgery of these aneurysms presented no special difficulties, as compared with surgery of aneurysms in other locations.

Adult↗
PubMed1990

Impaired utilization of exogenous amino acids after surgery for subarachnoid haemorrhage.

We studied the metabolic response to acute aneurysm surgery and its modification by parenteral nutrition. Forty-eight patients receiving perioperative corticosteroid treatment were randomly assigned to receive glucose alone (7.2 kcal/day, D5W + C), glucose and a conventional amino acid solution (7.2 kcal/day and 0.15 gN/day, CAA + C) or glucose and branched chain amino acid enriched solution (7.2 kcal/day and 0.14 gN/day, BCAA + C). Twenty patients without corticosteroid treatment received either glucose alone (7.2 kcal/day, D5W) or glucose and a conventional amino acid solution (7.2 kcal/day and 0.14 gN/day, CAA). Poor nitrogen utilization was indicated by strongly negative nitrogen balance in all groups and a failure of the infused amino acids to improve nitrogen balance. (Day 0; D5W + C: -9.3 +/- 3.6 g/day and CAA + C: -8.2 +/- 9.7 g/day vs CAA: -2.6 +/- 4.9 g/day, p less than 0.05, Day 1; D5W + C: -14.9 +/- 9 g/day vs CAA: -7.7 +/- 6.5 g/day, p less than 0.05, MANOVA). We conclude that subarachnoid haemorrhage and its surgical treatment induce a catabolic response and impaired utilization of exogenous nitrogen, further amplified by perioperative corticosteroids, which is in sharp contrast to the response to surgery not involving the central nervous system.

Adrenal Cortex Hormones↗
PubMed1988

Emergency treatment of cerebral aneurysms with large haematomas.

Of 469 patients with subarachnoid haemorrhage (SAH) from ruptured intracranial aneurysms, 31 had large intracerebral haematomas and were treated as emergency cases at the University Central Hospital, Kuopio, Finland during 1979-1985. The haematomas were evacuated and the aneurysms clipped immediately after diagnosis with CT and angiography. The mean diameter of the haematomas was 48 mm. Of the 31 patients 15 died. Mortality was lower for patients with aneurysms of the middle cerebral artery and for those with a better clinical grade (Gr. IV) at the time of the operation (41%); all patients with dilated pupils in grade V died. Five patients returned to work, and 10 are living a useful and independent life at home. Because early CT is increasingly used as the first diagnostic tool in vascular catastrophies, the pressure for early emergency treatment of aneurysmal intracerebral haematoma is increasing. The almost 100% mortality with conservative treatment should be compared to the 41% mortality with selection of the surgical candidates.

Adult↗
PubMed1986

Early clinical signs and prognosis in children with brain injuries.

The outcome of 76 brain-injured children treated at the Department of Neurosurgery, Kuopio University Central Hospital, Kuopio, Finland, during 1980-83 was analyzed to determine the prognostic value of early clinical signs and investigations. Five (8%) of the children died. The coma level (Glasgow Coma Score, GCS) was below 9 in 24 children, four (17%) of whom died. Three of these deaths occurred very early, during or soon after the computerized tomography (CT) study and in these cases aggressive treatment was withheld. There were actually no deaths in children with GCS of 6-8 and one death due to severe intra-abdominal injury in 52 children with GCS of 9-14. Seventeen (22%) of the children had multiple injuries. Fourteen children had significant intracranial hematoma or depressed skull fracture requiring surgical treatment, and all of these children did well. The intraventricular pressure was measured in 11 children with GCS of 3-5, all under controlled respiration. Six children had increased intracranial pressure (ICP), above 20 mmHg. In one child the pressure could not be managed, and she died. CT gave very important prognostic information. All children who died of early uncontrollable ICP already had marked hemorrhagic lesions in the basal cisterns, hypodense areas in the brain stem or brain stem compression. Early and repeated CT to show the complications and aggressive intensive care with intracranial pressure recording in children with GCS of 3-5 can keep the mortality associated with severe brain injury below 20% with an acceptable level of survival.

Adolescent↗
PubMed1985

Deep vein thrombosis after aneurysm surgery.

In a prospective study of 100 consecutive patients who underwent operations for intracranial aneurysms, the incidence of deep vein thrombosis (DVT) was 14%. The diagnosis was based on contrast venography, which was carried out in any patient who showed clinical symptoms and signs of DVT. In the presence of DVT the patient was placed on bed rest and intravenous plus peroral anticoagulation was begun. No complications thought to be related to anticoagulation were observed. A programme of postoperative prophylaxis is suggested for a selected group of aneurysm patients with a high risk for thromboembolic disease.

Adolescent↗
PubMed1985

Late epilepsy after aneurysm operations.

The risk of late epilepsy was analyzed in a consecutive series of 177 patients operated on for supratentorial aneurysms. Late seizures occurred in 25 patients (14%); the seizures were recurrent in 21 patients (12%). Most seizures were partial, secondary generalized, or generalized tonic-clonic (72%). The mean latency between the operation and seizures was 8.4 months (range, 1 to 24 months), and in only 2 patients was the interval more than 12 months. The most important risk factors were preoperative and postoperative complications. Only 2.5% of the 81 Grade I patients developed epilepsy, compared to 33% of the 42 Grade III-IV patients. Other risk factors were location of the aneurysm in the middle cerebral artery, the presence of a large intracerebral hematoma, postoperative spasm with late ischemic infarction, and shunt-dependent hydrocephalus. The timing of operation or intraventricular intracranial pressure monitoring did not change the risk of late epilepsy. The fact that only 2 patients had early epilepsy may have been due to routine treatment with prophylactic anticonvulsants. The value of prophylaxis in late epilepsy is unproven, but prophylactic treatment could be useful in patients with a high risk of epileptic seizures.

Adult↗
PubMed1984

Early aneurysm operation and outcome in two remote Scandinavian populations.

The Kuopio University Clinic is the neurosurgical referral center for a population of 930,000 inhabitants in central Finland while the Lund University Clinic is the neurosurgical referral center for a population of 1.46 million inhabitants in southern Sweden. The incidence of aneurysmal subarachnoid hemorrhage (SAH) is approximately 19/100,000/year in central Finland and approximately five/100,000/year in southern Sweden. During the calendar year 1982, 69 patients with a ruptured supratentorial aneurysm were admitted in Lund, and 71 such patients were admitted in Kuopio. Thirty-nine patients in neurological Grades I to III (according to Hunt and Hess) underwent early aneurysm operation in Lund, and 46 such patients were operated on within a week after SAH in Kuopio. In the combined series of 85 Grade I to III patients with aneurysm operation within a week after rupture, 78% made a good recovery; the morbidity rate was 14%, and the mortality rate was 8%.

Adult↗