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Biomedical subjects

I Louhimo

Publications and source records attributed to I Louhimo.

At least 55 records · Page 3Linked to original sources
PubMed1983

Colon interposition or gastric tube? Follow-up study of colon-esophagus and gastric tube-esophagus patients.

Between 1963 and 1980, 34 elective esophageal reconstructions were performed on 29 esophageal atresia patients. Five patients needed two reconstructions. Among 20 colon replacement procedures there were 2 early deaths and three transplants failed. In 14 gastric tube reconstructions there was no mortality, but two tubes failed. The mean follow-up age of the 15 colon esophagus patients was 11.8 yrs, while for the 12 gastric tube patients it was 5.6 yrs. One death occurred during the follow-up period in each group. Late complications occurred in 7/15 of the colon and 3/12 of the gastric tube groups. Most of the serious complications occurred within 3 yr after surgery. The previously reported malabsorption following colon interposition seemed to be transient. At follow-up all but 3 patients with no significant other anomalies were within two standard deviations of the mean of height and weight. All were satisfied with their new esophagus. Nine out of 14 of the colon and 7/11 of the gastric tube groups were without symptoms, the others having only minor complaints. It is concluded that both colon replacement and gastric tube are satisfactory methods for esophageal reconstruction, and the long-term function seems equally good. However, the gastric tube procedure is easier to perform, has less mortality and fewer complications than colon replacement.

Body Height↗
PubMed1983

30-year follow-up of the original Sulamaa (end-to-side) operation for oesophageal atresia.

Between 1949 and 1955 end-to-side anastomosis was performed on 26 patients with oesophageal atresia at Helsinki Children's Hospital. During the same period, 28 patients with oesophageal atresia were operated by the end-to-end method. The re-fistula rate and rate of anastomotic leaks did not differ significantly. After 30 years, four patients operated with the end-to-side method were alive and were re-examined. All four are well and lead a normal life. Three have no symptoms and one patient has minor swallowing symptoms. In oesophagograms two patients had grossly pathological peristalsis and two had slightly disturbed oesophageal motility. For comparison five patients operated with the end-to-end technique in 1951-1956 were also re-examined. One was symptom-free, the other four had minor symptoms on swallowing, but all were satisfied with their oesophagus. Two oesophagograms showed slight dysfunction, two were moderately pathologic and one was grossly pathologic. The oesophagograms correlated poorly with the subjective symptoms. The long-term prognosis of both end-to-side and end-to-end operated patients with oesophageal atresia seems equally good, all the re-examined patients leading a normal life.

Adult↗
PubMed1982

Bilateral Wilms' tumor and secondary malignancies.

A series of six patients with bilateral Wilms' tumor (nephroblastoma) is presented. Multimodal therapy yielded a survival rate of 83% at 2 yr of follow-up. However, at the end of a later follow-up period only two patients (33%) were alive. of the 4 patients who died. Only 1 died of Wilms' tumor. One died of complications of aggressive chemotherapy and two patients died after 12 and 16 yr following treatment of secondary malignant tumors arising in the irradiated region. Patients with bilateral tumor should be followed at regular intervals for the duration of life for the occurrence of secondary malignant tumors.

Child, Preschool↗
PubMed1982

Open lung biopsy in children with diffuse pulmonary lesions.

During the period 1973-81, open lung biopsy was performed in 33 consecutive children, aged 1 month to 13 years, to exclude or diagnose Pneumocystis carinii pneumonia and to differentiate other interstitial pulmonary lesions. Twenty-one of the patients were undergoing immunosuppressive treatment because of their malignant disease. The clinical diagnosis was correct only in 55% of the patients, but open lung biopsy and histological examination gave the final answer in every patient. Pneumocystis carinii was the causative organism in 67% of the immunosuppressed patients. Nine patients had postoperative complications, 5 of which were mild in nature and resolved spontaneously. Three patients had to be reoperated on for postoperative sequelae. There was one death possibly caused by surgical intervention--tension pneumothorax 10 days after surgery. It is concluded that open lung biopsy is the most reliable method in the diagnosis of diffuse interstitial pneumonitis in children. The need of anaesthesia is no contra-indication and the benefits of the biopsy far outweight the risks of its complications.

Adolescent↗
PubMed1982

Gastroschisis: neonatal features and somatic development.

Thirty-nine newborns were treated for gastroschisis at the Children's Hospital, Helsinki University Central Hospital from 1964 to 1980. Sixteen infants died during the first hospital admission. Of the 23 survivors, 11 were two years or older, and these 11 children were subjected to a follow-up examination. The incidence of the lesion increased markedly during the period of observation. Dysmaturity (birth weight at or below the 10th percentile of normal intrauterine growth) accompanied gastroschisis in 17 cases, and a low birth weight (below 2,500 g) in 23 cases. The mortality of gastroschisis was clearly and constantly decreasing, being 54% for the first decade, 23% for the last 5 years, and 41% for the total series. The age of the mothers at parturition, 20.9 years, was significantly (p less than 0.001) lower than the Finnish average. The extensive clinical and laboratory analysis of the 11 oldest children with completed reconstruction of the abdominal wall indicated good physical condition and, specifically, normal absorptive function of the intestine.

Abdominal Muscles↗
PubMed1981

Perforated appendix and antibiotics.

60 consecutive children operated for perforated appendicitis were treated randomly with either penicillin and streptomycin or with clindamycin and gentamycin. Suppurative complications occurred somewhat more often and were definitely more severe in the former group. The number of hospital days spent in the treatment of these complications were three times as great in the former than in the latter group. Bacteroides fragilis could be isolated in most of the severe infections treated without clindamycin. Two out of 28 patients treated with clindamycin presented with severe diarrhoea.

Anti-Bacterial Agents↗
PubMed1981

Primary cardiac tumours in infancy and childhood. A review and six case reports.

Primary cardiac tumours are rarities in infants and children. We have had 6 patients, aged 17 days to 10 years, with primary cardiac tumours: 1 had a fibroma, 1 had a myxoma, 2 had an haemangioma and 2 had a rhabdomyoma. Correct diagnosis was missed pre-operatively in 3 cases and finally established at autopsy. Three of the patients underwent cardiac operation-one of them unsuccessfully. At surgery the main difficulties were with tumour infiltration and the multifocal nature of some tumours. We conclude that the echo- and angiocardiography are essential tools in the diagnosis of primary cardiac tumours. Large tumours or conduction tissue infiltration means an extremely poor prognosis. Multifocal cardiac tumours can be successfully removed, even in newborn babies, and the outcome for the patients is also affected by other important factors, e.g. tuberous sclerosis in rhabdomyomas.

Child↗
PubMed1980

Immunologic consequences of neonatal splenectomy.

The hazard of overwhelming postsplenectomy infection has been suggested to be greatest in children operated upon before 1 yr of age. In this work immune functions of 3 children, splenectomized within 2 days after birth were studied. The opsonic activity of the sera of all patients towards pneumococcus was decreased. The other immunologic findings were normal. These observations support the concept that all splenectomized patients should receive pneumococcal polysaccharide vaccine and in case of any infection adequate antibiotic therapy must be started very soon after the first symptoms.

Humans↗
PubMed1980

Neonatal surgery.

The scope and the problems of neonatal surgery are illustrated by reviewing a series of 1831 patients operated on over 15 years in one surgical unit. The patients were listed according the surgical subspeciality to which they belong (Tables 1--9). The results show that operative mortality is negligible in the good risk neonates (tumours, urology, orthopaedic and general surgery) but remains significant in the groups of serious malformations with high incidence of prematurity and associated anomalies. The present hospital mortality for patients with anorectal anomalies is about 5%, for spina bifida cystica about 10% and has even in oesophageal and duodenal atresia patients dropped to 15%. For other bowel atresias it is still 25% for gastroschisis and omphalocoele around 35% and for diaphragmatic hernia 50%. Cardiac surgery, including perfusion operations, has become an integral part of neonatal surgery, its present mortality being around 35%.

Congenital Abnormalities↗
PubMed1979

Diagnosis of Hirschsprung's disease.

A prospective study of the accuracy of various diagnostic methods used in the detection of Hirschsprung's disease (syn. congenital intestinal aganglionosis, CIA) in 60 consecutive infants and children was done during the period 1972--76. Every patient underwent a barium enema, a rectal mucosal biopsy, which was prepared for both the demonstration of ganglia and for the assessment of acetylcholinesterase activity (ACE), and anal manometry was performed. In evaluating the clinical history, special emphasis was placed on signs of neonatal ileus. In the group of 10 patients with a definite diagnosis of CIA the results were almost uniform. In the 'non-CIA' group the search for ganglia in biopsy material proved non-confirmatory in nearly half of the cases studied due to the fact that specimens were taken too superficially. The findings pertaining to ACE, barium enema and the results of manometry were at variance or inconclusive of a final diagnosis in 10, 16 and 22% of the performed studies, respectively. The value given to neonatal history proved to be of the same order, i.e., 20% proved to be falsely positive.

Acetylcholinesterase↗
PubMed1978

Emergency surgery of the neonates.

A review of 1,666 neonatal surgical operations is given. According to the presenting symptoms the cases are divided into five major groups: skin defects and obvious malformations, tumours, acute abdominal conditions, respiratory emergencies, and cardiac conditions. The number of cases in each group are presented in tables and the surgical mortality of the most important conditions are similarly presented. Prematurity and associated malformations are pointed out as the most important factors causing death in neonatal surgery. While it is difficult to influence their existence, it is always possible to improve the diagnostic readiness and surgical skills.

Abdomen, Acute↗
PubMed1977

Subdural effusion: results after treatment with subdural-pleural shunts.

In an unselected material of 22 consecutive patients subdural effusion, which did not respond to repeated taps, was treated with subdural-pleural shunt operation using nonvalve silicone catheters. After a mean follow-up time of 3 years 4 months, 17 patients (77%) were mentally and 15 patients (69%) neurologically normal. The results are certainly not worse than results achieved with craniotomies and membranectomies. A shunt operation is more simple and less hazardous than membranectomy and we agree with the opinion that the latter is an obsolete procedure in the treatment of persistent subdural effusions.

Cerebrospinal Fluid Shunts↗