Biomedical subjects

I Toivio

Publications and source records attributed to I Toivio.

13 recordsLinked to original sources

PubMed1995

Can we achieve better results by operating on smaller abdominal aortic aneurysms?

A small (i.e. less than 5 cm) abdominal aortic aneurysm (AAA) is a problem which faces a vascular surgeon with increasing frequency. CT- and ultrasound examinations that are performed for other suspected diseases often reveal an asymptomatic small AAA. It has been common practice to observe small AAAs until they reach 5-6 cm in diameter. In 1987 the practice of operating on small AAAs as they were diagnosed was introduced. The change towards more aggressive operative strategy was made in order to decrease the number of ruptured AAAs as well as mortality and morbidity rates. This paper compares the results of the more aggressive operative therapy conducted during the period 1987-1991 with the preceding 5 years (1981-1986). A total of 119 patients were seen during this ten year period. 43 had ruptured aneurysms and 76 were elective reconstructions. The patients tended to be older and had more associated diseases in the later period of the study. The mean size of resected AAAs was smaller in the later period but the ratio between ruptured and elective AAAs remained the same throughout. Total 30-day mortality decreased from 6.9% to 4.2%. There was no mortality among patients with electively repaired small AAA. In conclusion, small AAAs can be operated on with a low mortality and morbidity. In this study, however, the change in operative strategy towards a more aggressive direction did not decrease the ratio between ruptured and elective operations. It appeared, that those AAAs with the highest risk of rupture could not be detected by operating on asymptomatic, small aneurysms.

Aged↗

PubMed1991

Chronic prosthetic vascular graft infection visualized with technetium-99m-hexamethylpropyleneamine oxime-labeled leukocytes.

Technetium-99m-HMPAO labeled leukocytes demonstrated chronic femoro-femoral prosthetic vascular graft infection several times during an 18-mo period in a 77-yr-old man. The intensity and distribution of the uptake in the graft were fluctuating in different imaging occasions possibly indicating the strength and location of the infection. Gallium-67-citrate imaging showed negative results twice. The reason for negative 67Ga results remained obscure. The infected graft was removed and the patient did well 5 mo postoperatively.

Aged↗

PubMed1989

The visualization of femoral vessels in delayed bone scans--a sign of arteriosclerosis? A comparison of 99mTc-MDP and 99mTc-DPD.

The activity of femoral vessels in delayed bone scans was evaluated visually in 237 consecutive patients and quantified in 40 female patients. In visual analysis the patients were randomly divided into three groups and in quantitative analysis into four groups of equal size. Two different MDP preparations and one DPD preparation were used as bone-seeking agents. With aging, the activity in femoral vessels increased with all agents in visual analysis, significantly with MDPs (P less than 0.001) between patients less than or equal to 60 years and greater than 60 years. In female patients with all agents a significant increase in femoral activity was found (P less than 0.001 with MDPs, P less than 0.05 with DPD). In patients greater than 60 years, the femoral uptake was significantly higher with MDP when compared with the DPD uptake (P less than 0.01 with MDP1, P less than 0.05 with MDP2). Between the MDPs no significant differences were found. In quantitative analysis the femoral vessel to soft tissue ratio was significantly higher in patients greater than 70 years when compared with patients less than or equal to 50 years with MDP. No difference was found with DPD. Histological examination of excised arteries of ten patients with intense femoral uptake of MDP showed arteriosclerosis and calcification in all cases. The findings suggest that the femoral visualization in delayed bone scans is probably related to arteriosclerosis and is not a non specific finding. There may be age-related differences in the distribution of MDP and DPD.

Age Factors↗

PubMed1989

99mTc-leukocyte scintigraphy in prosthetic vascular graft infections.

The aim of this study was to determine the diagnostic value of scintigraphy with 99mTc-HMPAO-labelled leukocytes for the detection of prosthetic vascular graft infection. 51 scans were recorded in 19 patients with suspected vascular graft infection and 8 control patients. Three-phase scanning was used at 0.5, 3-6 and 18-24 h. 13 vascular graft infections (10 early, 3 late) were found. 12 of these healed with antibiotics and only one patient with late infection had to be reoperated. None of them died during the follow-up period. The sensitivity was 100% and the specificity 96%. 99mTc-leukocyte scintigraphy seems a useful tool to detect vascular graft infection and to differentiate it from infections elsewhere. The results suggest that the incidence of vascular graft infection may be greater, and the mortality rate lower, than supposed before.

Aged↗

PubMed1988

Recurrent varicose veins--is there a role for varicography?

Recurrent varicose veins are a common problem. Ascending phlebography has been used to identify possible incompetent perforating veins. The method is accurate in the leg, but much less so in the thigh. In this study, thirteen patients with recurrent varicose veins were examined with varicography, i.e. direct injection of contrast medium into a dilated varicosity. The method is especially valuable in the thigh. In this study 12 of 13 of the patients with recurrent varicose veins had incompetent perforating veins in the thigh, which would have been missed with a more simple procedure.

Adult↗

PubMed1986

Fatal epithelioid haemangioendothelioma presenting in the lung and liver.

Three patients with epithelioid haemangioendothelioma (EHE) are described. Two patients presented with pulmonary infiltrates and one with a hepatic tumour. All had a metastatic disease ending fatally, and all were autopsied. The diagnosis was confirmed either by immunohistological or ultrastructural analysis. All three tumours were cytokeratin-negative and vimentin-positive, while only two contained cells reacting with the antibody of factor VIII-related antigen. Electron microscopy of the third tumour revealed features indicating endothelial differentiation. A short literature review is also presented demonstrating that the outlook of EHE is worse than previously thought.

Adolescent↗

PubMed1985