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Biomedical subjects

I Kellokumpu

Publications and source records attributed to I Kellokumpu.

36 records · Page 2Linked to original sources
PubMed1996

Gasless laparoscopic cholecystectomy: comparison of postoperative recovery with conventional technique.

We have compared, in a randomized study in 26 patients, immediate and late postoperative recovery after elective laparoscopic cholecystectomy using the gasless, mechanical abdominal wall lift method with conventional carbon dioxide pneumoperitoneum. After the gasless method, tracheal extubation was performed significantly earlier than after the conventional method (P < 0.01). End-tidal carbon dioxide concentrations were significantly higher after pneumoperitoneum for 30 min after operation (P < 0.01). In the conventional group, deviation in Maddox-Wing recordings from preoperative values remained at a significantly higher level during the 3-h recovery room period (P < 0.01). There was a positive correlation between the total amount of carbon dioxide used and duration of drowsiness (r = 0.61, P < 0.001) and the Maddox-Wing deviation (r = 0.62, P < 0.001). Postoperative nausea and vomiting, and right shoulder pain occurred less often after the gasless method (P < 0.05). Late recovery criteria (ability to drink, void and walk) in patients in the gasless group were fulfilled approximately 7 h earlier than in those in the pneumoperitoneum group (P < 0.01). Gasless laparoscopic cholecystectomy resulted in more uneventful and faster immediate and late postoperative recovery than conventional carbon dioxide pneumoperitoneum.

Adult↗
PubMed1995

Frequency of hereditary nonpolyposis colorectal cancer. A prospective multicenter study in Finland.

PURPOSE: Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal dominant cancer syndrome characterized by early onset of colorectal carcinomas (CRC). Recently, two HNPCC genes have been mapped and cloned, one in the short arm of chromosome 2 and another in the short arm of chromosome 3. There has been a major controversy about the frequency of HNPCC. The few estimates available have been based on series selected by age or series representing local area. The purpose of the present study was to design a nonselected, prospective, multicenter study, taking into account the family background and other risk factors of CRC. METHODS: The proportion of HNPCC of all (N = 406) CRC cases was evaluated in a prospective multicenter study. Family history and other risk factors were investigated over a 12-month period for all new CRC patients in ten hospitals. These cases constituted 23 percent of all CRCs diagnosed in Finland during the study period. RESULTS: Three (0.7 percent) cases of verified and seven (1.7 percent) cases of suspected HNPCC were identified, following the evaluation of all families with features indicative of susceptibility to cancer. The proportion of identifiable risk factors of CRC was 5.8-7.5 percent (HNPCC, 0.7-2.4 percent; previous CRC, 3.4 percent; ulcerative colitis, 1.0 percent; familial adenomatous polyposis coli, 0.7 percent). CONCLUSION. This prospective multicenter study revealed that the frequency of hereditary colorectal cancer is lower than in some previous studies, when diagnosis is based on extensive pedigree analysis. This result with recent findings of common ancestral founding mutation in Finnish HNPCC families indicates that there may be geographic differences in the occurrence of HNPCC. However, this does not change the fact that identification of HNPCC--perhaps one of the most common inherited diseases identified in humans--has become a question of vital importance now when diagnosis of the syndrome and large-scale screening of gene carriers using specific tests are on the horizon.

Adult↗
PubMed1995

Conventional pneumoperitoneum compared with abdominal wall lift for laparoscopic cholecystectomy.

We have compared, in a randomized study, conventional carbon dioxide pneumoperitoneum with abdominal wall lift in 25 patients undergoing laparoscopic cholecystectomy. Intra-abdominal pressure (IAP) (11 (SD 2) mm Hg vs 2.7 (9) mm Hg) (P < 0.01) and total amount of carbon dioxide used (40 (23) litre vs 9 (7) litre) (P < 0.001) were significantly less with abdominal wall lift. Pulmonary compliance was significantly greater (P < 0.01) in the abdominal wall lift group throughout operation. During the first 15 min of insufflation, arterial pressures were lower with abdominal wall lift (P < 0.05). In the conventional pneumoperitoneum group, femoral vein pressure increased (P < 0.01) and remained elevated for 3 h in the recovery room. Postoperative drowsiness was of significantly longer duration in the conventional pneumoperitoneum group than in the abdominal wall lift group (98 (46) min vs 13 (34) min) (P < 0.01). Postoperative nausea and vomiting and right shoulder pain occurred more often in patients with conventional pneumoperitoneum (P < 0.05). We conclude that the benefits of abdominal wall lift may be attributed to avoiding excessive carbon dioxide and high IAP.

Abdominal Muscles↗
PubMed1995

Effect of intraperitoneal bupivacaine on pain after laparoscopic cholecystectomy.

The effect of intraperitoneal bupivacaine on postoperative pain was studied in 60 ASA 1-2 patients undergoing elective laparoscopic cholecystectomy. The patients were randomly selected (20 patients in each group) to receive in double-blind fashion 100 mo of either plain 0.15% bupivacaine (150 mg.100 ml-1) or the same solution with adrenaline (1.5 micrograms ml-1), or the same volume of saline into the right subdiaphragmatic space at the end of surgery. The patients were kept in the Trendelenburg's position for 20 min after the instillation. Venous blood samples for the determination of bupivacaine plasma concentrations were drawn up to 180 min. Plasma bupivacaine concentrations peaked at 30 min (highest individual value 2.6 micrograms ml-1) after instillation. Bupivacaine concentrations were significantly lower in the bupivacaine-adrenaline group. During the follow-up no difference between the groups occurred as to the time to first demand of analgesia, severity of postoperative pain, amount of consumed analgesics during 7 days, and length of hospitalization. In all groups, 30-45% of the patients complained of right shoulder pain. After the first 24 hours, pain at rest and during moving was reported as mild and was managed with oral ketoprofen. It is concluded that postsurgical intraperitoneal instillation of 150 mg bupivacaine in 100 ml of saline had no effect on pain after laparoscopic cholecystectomy.

Abdominal Pain↗
PubMed1994

The true extent of ulcerative colitis? A radiological, endoscopic and histological study.

Twenty-six radiological, endoscopic and histological examinations of the large bowel were performed in 25 patients with ulcerative colitis. Extensive colitis was observed in 42% of the radiological, in 38% of the endoscopic, and in 27% of the histological examinations. Agreement as to the extent of the colitis between all three examination methods was reached in 53% of the cases. The endoscopic extent of colitis varied between left-sided and extensive in 41% of the patients during a 7-year median follow-up. The frequent change in the extent of ulcerative colitis and the considerable disagreement between radiography, colonoscopy and histology in evaluating the extent of colitis justify the question, "Does a true, unambiguous extent of colitis really exist?" It is more likely that the extent of colitis is just a function of time and the examination method used.

Adolescent↗
PubMed1991

Dysplasia and carcinoma in longstanding ulcerative colitis: an endoscopic and histological surveillance programme.

From 1976 to 1989 a total of 66 patients with longstanding ulcerative colitis were entered in a colonoscopic surveillance programme in order to detect dysplasia. Thirty patients had extensive or total ulcerative colitis and 36 left sided colitis. The median duration of the disease at the end of the follow up was 15.0 years. Altogether 182 colonoscopies (2.8 per patient), each involving approximately 20 biopsies from different sites of the colon, were performed. In the total or extensive colitis group, five patients had low grade and one patient had high grade dysplasia. In the left sided colitis group, three patients had low grade dysplasia. In three patients low grade dysplasia was detected in a macroscopic lesion or mass of colonic mucosa. Sixty per cent of the dysplasia specimens were from the right colon. The incidence of dysplasia was higher in patients with extensive colitis and increased with the duration of the disease. None of the patients have so far developed colorectal carcinoma. Our results indicate that a colonoscopic surveillance programme is a safe alternative to prophylactic colectomy in longstanding ulcerative colitis.

Adolescent↗
PubMed1991

Multiple adenomas and synchronous hyperplastic polyps as predictors of metachronous colorectal adenomas.

The development of metachronous adenomas was evaluated in 56 patients, 34 men and 22 women, with a history of 139 removed adenomas and non-neoplastic polyps, in order to determine whether the presence of concomitant adenomas and hyperplastic polyps at the initial examination could predict a higher risk of new adenomas. Sixteen of the 56 patients developed 21 metachronous adenomas and 1 rectal carcinoma after a median follow-up of 2.8 years. Among the 16 patients developing metachronous adenomas there were significantly more men (P less than 0.01), patients with multiple adenomas (P less than 0.05) or patients with adenomas and synchronous hyperplastic polyps at the initial examination (P = 0.043) than among the 40 patients without new adenomas. The combination of multiple adenomas with synchronous hyperplastic polyps at the initial examination predicted best the risk of developing new adenomas (P = 0.005). The results of the study suggest that patients with multiple adenomas and synchronous hyperplastic polyps at the initial examination may comprise a new higher risk group for developing metachronous colorectal adenomas.

Adenoma↗
PubMed1990

Double-contrast barium examination and endoscopy in the detection of small polyps of the large intestine.

The purpose of this study was to compare double-contrast barium examination (DCBE) and endoscopy in detection of small colonic polyps. In 57 patients DCBE revealed 106 polyps in the large intestine. On total colonoscopy, 62 polyps could be verified. The size of the polyps excised ranged from 2 to 15 mm. Compared with DCBE, colonoscopy verified 48 true positive, 44 false positive and 14 false negative polyps. In revealing a polyp less than 5 mm, DCBE had a sensitivity of 72%, whereas in detection of larger polyps the sensitivity was 81%. Histological verification was available in 52 of the 62 removed polyps. A tubular adenoma was found in 12 of the 29 diminutive polyps verified with histology. DCBE and colonoscopy could not differentiate between adenomas and hyperplastic polyps. Since a polyp less than 5 mm may represent an adenoma, a precancerous lesion, its removal is indicated during colonoscopy after DCBE has detected it.

Adenoma↗
PubMed1987

Identification of glycoproteins expressing tumour-associated PNA-binding sites in colorectal carcinomas by SDS-GEL electrophoresis and PNA-labelling.

Many tumour-specific antigens in gastrointestinal cancers have carbohydrate immuno-determinants. These epitopes can be identified by lectins and monoclonal antibodies. By using fluorescein-isothiocyanate (FITC)-conjugated peanut agglutinin (PNA) and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) we have investigated glycoproteins carrying altered carbohydrate epitopes in normal and carcinomatous human colorectal mucosa. In normal mucosa PNA stained goblet cell glycoconjugates in the supranuclear (Golgi) distribution. After neuraminidase pretreatment PNA stained actual mucin goblet itself at all levels of the crypts. Colorectal carcinomas displayed a strong and direct binding of PNA to apical cell membranes of carcinomatous cells and intraluminal secretions. Analysis of the glycoproteins by SDS-PAGE and PNA-labelling revealed four carcinoma-associated glycoproteins (26kD, 32kD, 35kD and 50kD). In addition, four glycoproteins (29kD, 30kD, 33kD and 36kD) common to normal and carcinomatous colorectal mucosa could be identified. All of these glycoproteins differed in their molecular weight from those in red cell controls which bind PNA only after desialylation. The study shows that the expression of PNA-binding sites in colorectal carcinomas signifies a cancer-associated carbohydrate alteration. Four carcinoma-associated glycoprotein antigens could be detected by this lectin. The antigens we have identified might be useful in the isolation and purification of more selective reagents for the serologic detection of colorectal cancer.

Antigens, Neoplasm↗
PubMed1987

Colorectal adenomas: morphologic features and the risk of developing metachronous adenomas and carcinomas in the colorectum.

The morphologic features of 307 colorectal adenomas among 159 patients are reviewed. Most adenomas (66.4%) were located in the sigmoid colon and the rectum, and the percentage decreased proximally to the right colon. The 307 adenomas comprised 244 (79.5%) tubular, 41 (13.3%) tubulovillous, and 22 (7.2%) villous adenomas. The epithelial dysplasia was graded as mild in 260 (84.7%) adenomas, moderate in 33 (10.7%), and severe in 14 (4.6%). The percentage of severe dysplasia was greater in villous adenomas than in tubular adenomas (p less than 0.05) and correlated with the increasing size (greater than 5 mm) of the adenomas (p less than 0.01). The risk of metachronous adenomas could be evaluated among 56 patients, 34 men and 22 women with a history of removed adenoma(s). Fourteen of 56 patients (25%) with 6:1 male to female ratio developed 18 new adenomas, after an average of 34.3 months (range, from 12 to 88 months). Eleven of the 14 patients had multiple adenomas at the initial examination. In addition, a carcinoma of the rectum was found in one male patient. Of the 48 patients, 17 men and 31 women, operated on for colorectal cancer 16 patients (34%) with 1.3:1 male to female ratio had 40 new adenomas after an average of 51.8 months (range, 12 to 252 months) after the surgical excision of their carcinomas. One patient had a recurrent carcinoma at the site of the anastomosis 22 months after anterior resection of his carcinoma. Our data suggest that a history of colorectal carcinoma, multiple adenomas, and male sex predict a higher risk of having future colorectal tumours.

Adenoma↗
PubMed1986

Lectin-binding sites in normal, hyperplastic, adenomatous and carcinomatous human colorectal mucosa.

The carbohydrate structures of cellular glycoconjugates in normal, hyperplastic, adenomatous and carcinomatous human colorectal mucosa were analysed with six fluorescein isothiocyanate-conjugated lectins. In normal, hyperplastic and adenomatous colorectal mucosa showing mild or moderate dysplasia Concanavalin A (Con A), Lens culinaris (LCA), and wheat germ (WGA) agglutinins stained goblet cell glycoconjugates (actual mucin goblet itself) while peanut (PNA), Vicia villosa (VVA), and Griffonia simplicifolia-II (GSA-II) agglutinins showed a supranuclear staining of goblet cell glycoconjugates. After neuraminidase treatment of tissue sections PNA and VVA stained mucin goblets of mature cells in normal mucosa, while less differentiated cells in the lower crypt displayed a supranuclear staining with VVA. The mucin goblets in adenomatous mucosa with mild or moderate dysplasia did not stain with PNA and VVA, neither before nor after neuraminidase treatment. Areas of in situ cancer in adenomas and carcinomas displayed a strong and direct binding of Con A, LCA, WGA and PNA in an apical linear distribution, while the binding of VVA and GSA-II was heterogeneous. We conclude that there are alterations in the carbohydrate structures of cellular glycoconjugates, which can be related to goblet cell differentiation in normal colorectal mucosa and to the degree of dysplasia in adenomas. Heterogeneous and incompletely glycosylated glycoconjugates appear to be synthesized by the majority of colorectal carcinomas.

Adenoma↗
PubMed1985

Malignant transformation in human colorectal mucosa as monitored by distribution of laminin, a basement membrane glycoprotein.

The distribution of laminin, a basement membrane glycoprotein, was studied by indirect immunofluorescence technique using rabbit anti-laminin serum in fifty-seven samples of normal, hyperplastic, adenomatous and carcinomatous colorectal tissue. As judged by the expression of laminin normal, hyperplastic and adenomatous colorectal mucosa were characterized by a continuous, linear basement membrane. A thick band-like basement membrane was seen under the surface epithelium and at the mouths of the crypts in normal and hyperplastic mucosa. The adenomatous epithelium was uniformly characterized by a thin, linear basement membrane. In contrast, marked alterations were constantly observed in colorectal carcinomas and their metastases, which showed a discontinuous, linear or patchy basement membrane. Our study suggests that the expression of laminin is related to cellular differentiation, and the thickness of the laminin-positive basement membrane parallels with the epithelial maturation of normal and hyperplastic colorectal mucosa and with the failure of the epithelial differentiation in adenomas. In colorectal carcinomas and their metastases the distribution of laminin is constantly altered and the severity of the alterations correlates with the histological grade of these tumours.

Adenocarcinoma↗
PubMed1983

Intravenous indomethacin in the treatment of ureteric colic. A clinical multicentre study with pethidine and metamizol as the control preparations.

The analgesic effects of intravenously administered indomethacin, pethidine and metamizol were compared in a series of 169 patients with ureteric colic. Complete pain relief was obtained in 59% in the indomethacin group, in 52% in the pethidine group and in 44% in the metamizol group. The observed side effects were not serious. On the basis of the study results indomethacin can be recommended as an alternative drug in the treatment of ureteric colic.

Adolescent↗