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Biomedical subjects

I Louhimo

Publications and source records attributed to I Louhimo.

At least 37 records · Page 2Linked to original sources
PubMed1988

Duodenal atresia: late follow-up.

In this study, 41 randomly chosen patients aged 15 to 35 years (mean 22 years) were carefully examined. As primary operations there were 13 membrane excisions, five duodenoduodenostomies, 22 duodenojejunostomies, and one gastrojejunostomy. Twenty-eight patients were symptom-free, ten admitted some discomfort, three had major pains, including one with a history of duodenal ulcer. Reoperation for adhesion ileus had been performed in six patients, in the early postoperative phase in one instance. At late follow-up barium meals (N = 41) showed completely normal findings in two cases only, hiatal hernia in two, gastritis in three, duodenogastric reflux in 12, slight dilation of the duodenum with good emptying and no reflux in 16, a huge duodenal sac in nine, diminished peristalsis in eight, delayed emptying in five, slight luminal narrowing in three, duodenal diverticuli in nine, bezoars in two, and a polyp in the duodenum of one patient. Ultrasound (N = 35) revealed a gallbladder septum in one patient and a dilated common bile duct in another; in one subject the gallbladder was not visualized satisfactorily. Isotope biligraphy (N = 15) showed biliary reflux to the stomach in 12 cases. Endoscopy (N = 20) findings were: esophagitis (1), hiatal hernia (2), gastric mucosa in the lower esophagus (2), biliary reflux (9), gastritis (7), gastric polyps (2), dilated duodenum of variable degree (19), diminished peristalsis (4), marked retention (2), abnormal papilla (3), diverticuli (4), and a persistent membrane (1). Histology showed superficial gastritis in three patients. E coli was cultured from the duodenal juice in five patients and Candida found in two.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Extralobar sequestration of the lung in children.

Sixteen patients with extralobar sequestration of the lung are reported on. The age at time of diagnosis varied from 21 days to 12 years (mean 3.6 years). Most of the patients presented with respiratory symptoms, such as dyspnoea, pneumonia, coughing attacks, cyanosis and asthmatic symptoms, but diagnosis was made incidentally in 4. Diagnosis was established by chest X-ray in every case. Preoperative angiography and bronchography was carried out in six cases. All 16 patients underwent thoracotomy for removal of the sequestration. Rudimentary bronchial remnants were found in 6 cases. Extralobar sequestration was associated with 12 additional malformations in 10 of the 16 patients. The clinical picture varies considerably and many of the "typical" features, such as systemic arterial blood supply, left lower lobe localization and diaphragmatic defect, are often absent. Diagnosis and treatment are easy.

Bronchopulmonary Sequestration↗
PubMed1987

Cardiopulmonary bypass in tracheal surgery in infants and small children.

Five resections of the distal trachea with cardiopulmonary bypass were carried out in four children aged 6 weeks to 24 months. Only technical aspects are discussed, and the operative method is described in detail. The use of cardiopulmonary bypass and heparinization of the patients did not cause any problems. Cardiopulmonary bypass allows an easy and unhurried procedure. Although other authors do not regard cardiopulmonary bypass as necessary in similar circumstances, we believe that it is the safest way of providing optimal operative conditions and results in surgery of distal tracheal stenoses.

Cardiopulmonary Bypass↗
PubMed1987

Primary mediastinal tumors in children.

From 1950-1986, a total of 159 children (age 1 day-16 years) were treated for primary mediastinal tumors at our hospital. There were 77 malignant and 82 benign tumors. Tracheal compression causing respiratory distress was a significant symptom in 45.3% (24/53) of the children under 2 years of age. The diagnosis was based on the chest X-ray and the findings at surgery. Malignant lymphoma was usually diagnosed by cervical lymph node biopsy (23/39) but the treatment protocol was non-surgical. Non-lymphatic malignant tumors were completely or partially excised in 59.0% (23/39) of the cases. There was no early or late mortality in patients with benign tumors. At follow-up (0.5-24 years; mean 6.0 years), 62.3% (48/77) of the patients with malignant tumors were alive and symptom free. About half of the mediastinal tumors in children are malignant. Mediastinal tumors in small children can cause severe respiratory symptoms demanding urgent treatment. The treatment of choice is surgery (except in lymphomas) and the results are good even in malignant tumors.

Adolescent↗
PubMed1987

Livaditis myotomy in long-gap esophageal atresia.

During 1973 to 1983, Livaditis myotomy was performed on 12 esophageal atresia patients in whom anastomosis otherwise would have been impossible. Ten patients had the usual malformation with a distal fistula, while two had an isolated atresia. Four patients belonged to Waterston's risk group A, 4 to group B, and 4 to group C. In 11 cases anastomosis was permitted by myotomy. In one patient anastomosis was impossible even after myotomy. This baby weighed 1,380 g and she also had trisomy 18 with severe cardiac and renal anomalies leading to death. One patient had a refistula and died of pneumonia, she also had a severe congenital cardiac malformation. There were no anastomotic leakages to free pleural cavity nor complications related to the myotomy. The ten survivors were followed up for a mean period of 5.4 years (range 1.6 to 11.3 years). The subjective results at last follow-up according to the criteria of Desjardins were excellent in eight and good in two patients. Esophagograms showed no strictures, but two patients had a myotomy pouch.

Abnormalities, Multiple↗
PubMed1987

Oesophageal anastomosis without bougienage in isolated atresia--do the segments really grow while waiting?

Four cases of isolated oesophageal atresia, in which a successful oesophageal anastomosis was achieved without bouginage, are reported. The anastomoses were performed at ages from one month to three and a half months. No certain growth of the segments could be observed. However, in the cases, where the operation was performed after a longer waiting period, the lower segment was surprisingly thick walled, which made the anastomosis possible. A single Livaditis myotomy was required in three cases and a double myotomy in one. All patients needed Nissen's fundoplication because of gastro-oesophageal reflux, which caused stricturation of the anastomosis and oesophagitis. After the follow-up period of 1.3 to 2.5 years, two patients had an excellent result, one patient a fair result and one patient had died of his severe cardiac anomaly associated with Down's syndrome.

Anastomosis, Surgical↗
PubMed1986

Vater association and anorectal malformations.

In a twenty-year series of 208 patients with anorectal malformations there were 39 infants with three or more Vater association anomalies. The neonatal mortality of Vater association patients was 28%; beyond the neonatal period only two patients died. Most early deaths were associated with the combination of cardiac anomalies and oesophageal atresia. The incidence of prematurity (30%) and lethal anomalies (15%) was high. High and complex anorectal anomalies were frequent (85%) and some kind of urogenital malformation was present in 95% of the patients. Despite the grave early prognosis and multiple hospitalisations and surgical procedures required in the management of these patients, the long-term outlook and quality of life does not differ significantly from other patients with corresponding anorectal anomalies.

Abnormalities, Multiple↗
PubMed1986

Pulmonary vein diameter in normal children.

A total of 24 normal children's hearts with their great vessels were examined at autopsy and the diameters of the pulmonary veins measured. The values so obtained were plotted against patient height, body-surface area, weight, and age and were subjected to multi-variate regression analysis. Height gave the best correlation with pulmonary venous diameter. For practical purposes, the normal diameter of each pulmonary vein (in millimeters) = 0.07 X height (in centimeters).

Adolescent↗
PubMed1986

C-reactive protein compared with white blood cell count and erythrocyte sedimentation rate in the diagnosis of acute appendicitis in children.

Acute abdominal symptoms in 162 children were investigated with rapidly quantified C-reactive protein (CRP), white blood cell (WBC) count and erythrocyte sedimentation rate (ESR) as laboratory parameters. When the symptoms had been present for at least 12 hours, the CRP level was greater than 10 mg/l in 72% of cases with histologic evidence of appendicitis, while leukocytosis (WBC greater than 15 000/mm3) and raised ESR (greater than 20 mm/l h) were found in 58% and 51%, respectively. If appendicitis had progressed to gangrenous stage, however, CRP alone was capable of identifying 83% of cases, while 76% had leukocytosis and 60% elevated ESR. When perforation had occurred there was greatly increased CRP and invariably leukocytosis, but elevated ESR in only 60%. With the combination CRP and WBC count (using rise in one or both), 88% of all appendicitis cases could be identified, and at least 96% of those with gangrene or perforation. The predictive value of combined positive CRP and WBC tests was not less than 93%.

Acute Disease↗
PubMed1985

The treatment of low retrosternal tracheal stenosis in the neonate and small children.

In the years 1979 to 1983, 8 infants or small children under 2 years of age were treated for severe low retrosternal (carinal) tracheal stenosis. The etiology was iatrogenic (postintubation) in 7 cases and congenital in one. Low tracheal stenosis was seen in 0.4% of all intubated (1607 patients) neonates during the same time period. In 6 cases of acute obstruction, diagnostic bronchoscopy was used to relieve the stenosis by forcefully dilating the trachea. One patient died and all had severe complications, but 3 children are living and doing well without further treatment. Only short granular retrosternal stenoses appeared to be suitable for violent dilatation, which is indicated if the patient is otherwise facing death due to suffocation. All other operative facilities must be at hand. Resection of low retrosternal trachea under cardiopulmonary bypass was performed in 4 patients - 2 of them had had earlier unsuccessful dilatations. One patient, aged 1.5 months, died. In this case the obstruction extended into both bronchi. Another patient was re-resected with success. The follow-up time of the 3 living patients with resection is already 2.4, 4.5 and 4.7 years respectively. The patients are living a normal life and the anastomoses are growing normally.

Bronchoscopy↗
PubMed1985

Duhamel-Sulamaa operation for Hirschsprung's disease--early and late results in forty-eight patients.

The Sulamaa modification of the Duhamel procedure and the early and late results of the first 48 patients are reported. A specially devised clamp is used in the colorectal side-to-side anastomosis with no intra-abdominal or intrapelvic anastomoses being required. There were no mortality and no anastomotic leaks among the patients. A postoperative septum between rectum and the pull-through segment developed in 35% of the patients. Soiling and, in some cases, constipation, were the main symptoms of septum formation. These problems ceased after reclamping of the septum. At the last follow-up, 2 to 15 years after surgery, 37 patients had normal bowel habits, 4 had occasional soiling and 7, six of whom are mentally retarded, daily soiling. None of the children had constipation. The Duhamel-Sulamaa operation gives satisfactory long-term results in the treatment of Hirschsprung's disease. Septic anastomotic complications appear to be avoidable with this technique, but the significant frequency of postoperative septum formation requires close early follow up of the operated patients.

Child↗
PubMed1985

The management of primary acetabular dysplasia. Its association with habitual side-lying.

Fifty-one infants with limited abduction of the hip and acetabular dysplasia were, between 1969 and 1975, treated with abduction-adduction exercises, administered by the parents; no abduction devices were used. In 1983 a follow-up examination was carried out on 41 of these patients. Although at birth these children had characteristics similar to patients with congenital dislocation of the hip, none of their hips dislocated. At birth acetabular measurements showed that half the children had severe dysplasia and the other half slight dysplasia; the difference between the affected and the healthy hips was significant. At follow-up the gait was normal in all the patients. Movements at the hips were symmetrical and within normal limits in all but one patient. The acetabular angle, the centre-edge angle, the shaft-neck angle, the hip ratio, and the size of the femoral head were the same on the previously affected side as on the normal side. Nineteen of the children followed up had preferred lying on one side and dysplasia of the upper hip had developed. The significance of the sleeping position on the development of acetabular dysplasia is discussed.

Acetabulum↗
PubMed1984

Late diagnosis in congenital dislocation of the hip.

In 1966-1975, congenital dislocation of the hip was diagnosed after the neonatal period in 115 children in Uusimaa county in southern Finland; the incidence was 0.76 per thousand liveborns. No decreasing tendency could be seen during the time of the investigation. In most children, the diagnosis was made during the first medical examination at the child welfare clinic at the average age of 3 months. The number of children diagnosed at walking age seemed to be decreasing. The numbers of boys and bilateral affections were smaller in this group than among cases diagnosed during the neonatal period. Dislocation was suspected in 23 per cent of the children even before the diagnosis was made. The reasons for the delay are given and discussed. In 1981, 66 per cent of the children were symptomless and no radiographic signs could be seen. Sixteen per cent of the children had minor residual signs with no need for follow-up, and in 18 per cent the outcome was still unclear.

Birth Weight↗
PubMed1983

Esophageal atresia: primary results of 500 consecutively treated patients.

During 1947-1978, 500 patients with esophageal atresia and/or tracheoesophageal fistula were treated at the Children's Hospital, University of Helsinki. The proportion of different types of anomaly followed the usual distribution, the commonest being the type with distal fistula (88.2%). For analysis, the patients were divided into five phases, each consisting of 100 consecutively treated patients. The hospital mortality decreased from 81% in the first phase to 15% in the last phase. No patients were excluded, not even those cases with lethal associated anomalies. Many more severe cases were treated in the last two phases than in the first three. Patients with distal fistula were examined separately as were the patients without a fistula and those with only a tracheoesophageal fistula. With time, early diagnosis and early referral for treatment became a rule. This led to the policy that nearly all patients in the last phase had an early operation without staging. Gastrostomy was not considered necessary when early anastomosis was possible. In the last phase, only the transpleural approach was used and single-layer end-to-end anastomosis was favored. As a whole, the type of approach or anastomosis did not have significant effect on the results, except that the Sulamaa-type end-to-side anastomosis had the highest frequency for refistula. With time there was only a slight decrease in the incidence of anastomotic leak, but significant improvement in its management. Refistula as an early complication was seen only once in the last phase. As all anastomoses were routinely dilated, severe strictures were uncommon; there were only six in the series. The factor that probably improved the prognosis the most was better pulmonary care. The improved prognosis was also due to earlier referral, modern anesthesia, and intensive care. Postoperative pulmonary complications dropped from 92% in the first phase to 40% in the last. They were the most common single cause of death in the early series but caused no deaths among the last 100 patients with no associated anomalies. Low birth weight was an important prognostic factor early in the series but in the last phase the survival rate of under-2500-gm infants with no associated anomalies was 88%. The presence of severe associated anomalies remains the most important single cause of death of an esophageal atresia patient today. Some patients (eg, trisomy 18) are beyond the possibilities of surgical treatment. To improve the prognosis of the others, efforts in the treatment of their associated (especially cardiovascular) anomalies must be made. In the treatment of esophageal atresia itself, improvement may still be achieved in the number of patients using their own esophagus without replacement procedures. Finally, a new prognostic classification of esophageal atresia patients is suggested, excluding pneumonia as an index factor in the Waterston classification.

Dilatation↗