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Hannu Paajanen

Publications and source records attributed to Hannu Paajanen.

16 recordsLinked to original sources
PubMed2006

Incidence of occult inguinal and Spigelian hernias during laparoscopy of other reasons.

BACKGROUND: A true incidence of occult inguinal and Spigelian hernias in adult population is unknown. The frequency of incipient hernias was studied during laparoscopy of other abdominal diseases. METHODS: The 201 laparoscopic procedures included 104 cholecystectomies, 55 fundoplications, 36 diagnostic, and 6 miscellaneous operations. There were 133 females and 68 males with a mean age of 53 +/- 14 years. The orifices of all inguinal and Spigelian hernias were carefully recorded at the beginning of laparoscopy by using 30 degrees optic. RESULTS: The overall frequency of unexpected hernias was 43 of 201 (21%) including 36 (18%) inguinal hernias, 5 (2%) Spigelian hernias and 2 (1%) ventral hernias. The number of hernias was higher in males than in females (P = .003). The most common finding was indirect inguinal hernia in 27 (13%) subjects. Usually hernia orifices were insignificant and only 5 of 201 laparoscopic hernioplasties were undertaken without any complications. CONCLUSIONS: Occult hernia orifices are commonly found in laparoscopic operation. Usually the defects are asymptomatic and hernioplasty is not needed. Herniation of Spigelian fascia is rare (<2%) in adults during laparoscopy.

Adult↗
PubMed2006

Effect of screening mammography on the surgery of breast cancer in Finland: a population-based analysis during the years 1985-2004.

A nationwide mammographic screening of women aged 50 to 59 years commenced in Finland in January 1987. We studied the effect of screening on surgical diagnosis, treatment, and survival of breast cancer in one geographic area in Finland. We reviewed the medical records, survival data from Finnish Cancer Registry, and screening data from the Finnish Mammogrphic Working Group of 1049 women who underwent surgery for breast cancer in our hospital between the years 1985 and 2004. Altogether, 35 parameters including diagnostic procedures, operative data, and staging were recorded. The results of tumors detected by mammographic screening (n=156) and interval cancers (n=148) were compared with the tumors detected outside of screening (n=745). The incidence of breast cancer increased from 35 to 72 cases per 100,000 inhabitants, and the percentage of nonpalpable cancers increased from 12 to 33. Approximately 30 women per 100,000 inhabitants were annually referred from mass screening for surgical biopsies, in 60 per cent of which cancer was detected. Breast lump was still a first sign of cancer in 60 per cent of patients. The mammographic screening detected 20 per cent of new breast cancers. The cancers detected by screening were smaller, found at an earlier stage, and their 10-year-survival was better (90% vs 70%) than those detected by other means (P = 0.003). Overall mortality of interval cancers was worse (27%) than screening cancers (6%, P < 0.0001). Mammographic screening detects up to 20 per cent of new breast cancers in a well-defined population area. The prognosis of screening cancers is better than the cancers found outside of screening.

Breast Neoplasms↗
PubMed2006

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Journal Article↗
PubMed2005

Localization of sentinel nodes in breast cancer: novel method and device to help pen marking of active nodes during gamma camera imaging.

Gamma camera imaging with Tc-99m marking is a widely used method to locate sentinel lymph nodes (SNs) in breast cancer patients. Prior to SN biopsy, the anterior and lateral location of the SN is marked on the patient's skin using an ink pen. The pen marks guide the surgeon during an operation. However, in many cases the marking is difficult due to limited space under the detectors of a gamma camera. The aim of this study was to improve the pen marking method. Eleven female patients were imaged 3-4 h after injection of Tc-99m labelled Nanocol. Injection was performed to parenchyma surrounding the breast tumour. To facilitate pen marking, two polycarbonate (PC) plates with 40 x 32 holes (spacing=10 mm) were engineered for anterior and lateral side imaging and then installed on the bed of a dual-head gamma camera. Two drops of Tc-99m were placed into the top corners of both the PC plates, in order to trace the corresponding x-y coordinates first from the acquired images and then from the plates. After imaging, the x-y coordinates of the SN(s) were determined from the anterior and lateral side images. Subsequently, the location of each SN was marked with an ink pen on the skin through the small holes in the PC plates. According to the surgeon's evaluation, the distance between the marks and the true location of the SNs was 4.5+/-6.9 mm. Measurements with a custom made phantom revealed that the accuracy of the novel method was significantly (P=0.06) higher as compared with the traditional method (2.7+/-3.0 mm versus 9.2+/-3.0 mm). In addition, we were not able to mark the weakest activity (0.02 MBq) with the traditional method. Taken together, the marking process was considerably easier with the novel method, it had better accuracy and sensitivity than the traditional method and the device is simple enough to be adapted for most gamma cameras.

Adult↗
PubMed2005

Laparoscopy in chronic abdominal pain: a prospective nonrandomized long-term follow-up study.

GOAL: Our aim was to assess the long-term efficacy of diagnostic laparoscopy and adhesiolysis on the treatment of intractable chronic abdominal pain. STUDY: This was a prospective nonrandomized study of 72 patients (60 women and 12 men). One surgeon performed a total of 79 diagnostic laparoscopies including 61 adhesiolysis. The patients' demographic data, operative findings, and long-term postoperative course were carefully recorded. A quality-of-life questionnaire was mailed after the mean follow-up of 3.7 years to find out the late course of any chronic abdominal symptoms after the surgery. RESULTS: Intra-abdominal adhesions were found in 61 patients (85%) in the laparoscopy, gynecologic disorders in 4, chronic appendicitis in 1, and no abnormality in 6 patients. The abdominal wall pain was a likely reason for pain in 12 patients (17%). The complication rate was minimal, including only four bleedings (one major), one perforation of urinary bladder, and three wound infections. At 1-month control, 38% of the patients were completely free of pain. In the long-term follow-up, chronic abdominal pain was totally healed in 33%, diminished in 46%, and unchanged in 21% of the patients. A total of 65 patients (90%) reported that the surgery had been beneficial for their intractable pain. CONCLUSIONS: By careful selection, for patients with chronic abdominal pain, laparoscopy alleviates the symptoms in more than 70% of the patients, and it should be considered if other diagnostics tests are negative. A placebo-controlled study is needed, in which the patients are randomized into laparoscopy and conservatively treated groups with a quality-of-life measurement.

Abdominal Pain↗
PubMed2004

The influence of training level and surgical experience on survival in colorectal cancer.

BACKGROUND AND AIMS: The effect of surgical training level, experience, and operation volume on complications and survival in colorectal cancer during a 10-year period in a medium-volume university hospital was retrospectively studied. PATIENTS AND METHODS: Four hundred and fifty-six patients were resected for primary colorectal adenocarcinoma during the 10-year period of 1981-1990, and of these, 387 patients underwent resection with curative intent. The surgeons were divided into three groups according to training level and volume: group 1, surgeons in training and other surgeons operating annually on only 1-4 patients; group 2, surgeons specializing in gastrointestinal surgery (average annual volume 4-13 operations); group 3, specialists in gastrointestinal surgery (average annual volume 3-8 operations). Postoperative morbidity and mortality rates, as well as long-term survival rates, were analysed, and comparisons were made between the patients in the three groups. RESULTS: There were no statistically significant differences between the three groups in postoperative morbidity or mortality. Cancer-specific 5-year survival rate of all patients was 57%, and that of those resected in the aforementioned three groups was 51%, 63%, and 55%, respectively, P=0.087. The 5-year survival rates for colon cancer were 59% (total), 52%, 69%, and 58%, respectively, P=0.067, and for rectal cancer were 51% (total), 42%, 53%, and 52%, respectively, P=0.585. CONCLUSION: There were no significant differences in the rates of postoperative mortality, morbidity, and long-term overall survival between the volume groups. However, in patients with colon cancer, there was a trend for better survival for those operated on by the surgeons specializing in gastrointestinal surgery, and in rectal cancer patients, a tendency of fewer local recurrences in those operated on by the specialist surgeons.

Aged↗
PubMed2004

Totally extraperitoneal endoscopic (TEP) treatment of sportsman's hernia.

Sportsman's hernia is a term used to describe a weakness or disruption of is a term used to describe the musculotendinous part of the posterior inguinal wall, which causes persistent groin pain in athletes. A video-assisted placement of extraperitoneal synthetic mesh to support the damaged area may heal this injury. Forty-one male athletes at an elite level (mean age 27 +/- 7.1 years) with chronic groin pain, which was resistant to conservative therapy, were referred to surgery by sports clinics or club doctors. The majority of the patients were soccer (58%) or ice hockey players (27%) at a professional level. A 10 x 15 cm polypropylene mesh was placed into the preperitoneal space using a totally extraperitoneal video-assisted technique. The severity of pain, and the time to return to sports, were determined after 1 month and after the mean follow-up of 4 years. On operation, no macroscopic abnormality was found in 24 patients (58%), obvious musculotendinous tear was present in 10 patients, and muscle asymmetry was present in 7 patients. All except 2 patients (95%) returned to their sport activities after 1 month of convalescence. No immediate or long-term complications were associated with the operation. The placement of a retropubic mesh was safe and a mini-invasive method to repair sportsman's hernia and chronic groin pain of athletes.

Adult↗
PubMed2003

Long-term pain and recurrence after repair of ventral incisional hernias by open mesh: clinical and MRI study.

BACKGROUND AND AIMS: Polypropylene mesh repair of large incisional ventral hernias has become increasingly popular. Long-term effects of the mesh on pain and abdominal muscles are not known. PATIENTS/METHODS: Retromuscular pre-peritoneal polypropylene mesh was placed by open technique in 84 consecutive patients with large ventral hernias (mean defect size 130 cm(2)). We re-examined the patients after a mean follow-up time of 3 years to find out the frequency of recurrence and chronic pain. We measured the thickness of abdominal muscles of eight patients preoperatively, and postoperatively after 1 year, using magnetic resonance imaging (MRI). RESULTS: Recurrent hernias had appeared in four patients (5%) at follow-up. Nine patients (13%) needed occasional pain-relieving drugs, but only three (4%) suffered persistent, severe, pain from the mesh. Some limitation during leisure-time physical activities was found in 10% of patients. Only ten patients (12%) were re-operated on because of wound complications or recurrence. MRI study indicated that abdominal muscles were postoperatively well preserved. Although wound infections (6%) and seroma (9%) were frequent complications, there was no need for meshes to be removed in the follow-up. CONCLUSION: Open ventral herniorrhaphy with mesh is safe, effective and inexpensive. Small, recurrent hernias were infrequent and easy to re-operated on. Severe pain from the mesh was not common. Postoperative MRI study indicated no obvious damage of abdominal muscles after mesh placement.

Abdominal Muscles↗
PubMed2002

Do absorbable mesh sutures cause less chronic pain than nonabsorbable sutures after Lichtenstein inguinal herniorraphy?

Chronic inguinal pain occurs in 20-30% of patients after hernia surgery. A prospective randomized study of 162 patients was undertaken to determine whether absorbable sutures cause less pain than continuous polypropylene fixation of the mesh in the Lichtenstein operation. All patients were operated on under local anesthesia by the same senior surgeon. One-half of the meshes were fixed with continuous 2-0 Dexon II sutures and one-half with continuous 2-0 Prolene sutures. The incidence of pain and recurrence was investigated after a mean follow-up of 2 years. Patient characteristics and operative outcome were similar in the two groups and statistically nonsignificant in both. The rate of significant wound hematomas (n = 3), infections (n = 1), and recurrences (n = 2) were low and not related to the type of sutures. In both study groups 24-26% of the patients felt some pain in follow-up, but over 90% were very satisfied with the operation. The absorbable suture material does not appear to cause less neuropathic pain after Lichtenstein operation than nonabsorbable sutures.

Female↗
PubMed2002

Prognostic value of various staging and grading systems in proximal colon cancer.

OBJECTIVE: To compare the ability of various methods of staging and grading to predict survival in proximal colon cancer. DESIGN: Retrospective study. SETTING: University hospital, Finland. SUBJECTS: 153 patients with primary proximal colon cancer. MAIN OUTCOME MEASURES: Staging by four classification systems, grading by two grading systems, and survival analysis based on Kaplan-Meier survival curves. RESULTS: In all staging systems the survival curves of different stages differed significantly from each other. The modified Dukes' classification was still the best predictor of survival. Grade of tumours had no significant effect on long term survival, but short term survival was affected adversely by the presence of anaplastic tissue. Tumours with no mucin had a worse prognosis than those that produced mucin. All staging methods were superior to either of the histological grading systems tested as prognosticators. Tumour depth correlated with the operator's clinical impression of radicality of operation, and also predicted survival. CONCLUSION: The clinicopathological modified Dukes' staging system was the most powerful prognosticator in proximal colonic cancer and its use in clinical practice should continue. Even a small amount of anaplastic tissue (> or = 5%) had an adverse effect on short term survival.

Adult↗