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Biomedical subjects

J Hernesniemi

Publications and source records attributed to J Hernesniemi.

At least 19 recordsLinked to original sources
PubMed2006

Toll-like receptor 4 polymorphism is associated with coronary stenosis but not with the occurrence of acute or old myocardial infarctions.

OBJECTIVE: Atherosclerosis is considered to be a chronic inflammatory disease. Toll-like receptor 4 (TLR-4), a key mediator in activating inflammatory cascade, has an A-to-G functional polymorphism that changes aspartic acid to glycine at position 299. TLR-4 is activated by, for example, lipopolysaccharides. The purpose of this study was to investigate the role of a common Asp299Gly polymorphism of the TLR-4 gene in atherosclerosis. MATERIAL AND METHODS: The study comprised autopsy material from 657 men (the Helsinki Sudden Death Study; mean age 53, range 33-70 years). RESULTS: Fewer G-allele carriers had 3-vessel coronary artery disease compared with AA homozygotes (OR 0.32; 95 % CI, 0.12-0.88, p = 0.027), and they also had a lower mean value for maximal coronary stenosis (p = 0.019). TLR-4 polymorphism was not significantly associated with the occurrence of acute or old myocardial infarction (MI). CONCLUSIONS: The G allele of the TLR-4 gene, which is associated with a lower inflammation response, was associated with a lower risk of coronary stenosis but not with the occurrence of MI and hence is not a major factor in the development of coronary atherosclerosis.

Acute Disease↗
PubMed2005

Early surgery for ruptured cerebral arteriovenous malformations.

Acute surgery on cerebral arteriovenous malformations (AVMs) has seldom been reported or used. We reviewed 49 patients of ages 2 months to 78 years (mean 32.8 years), 32 male (65%) and 17 female (35%), treated acutely (within 4 days of bleed) in Helsinki Neurosurgery during 1997-2002. The following variables were assessed in regards to the outcome (Glasgow outcome score; GOS; 2-3 months after bleed): age, sex, Hunt and Hess Grade (HH), Spetzler-Martin Grade (SMG), location of AVM, size of intraparenchymal haematoma (ICH), and presence of intraventricular haemorrhage (IVH). Most of the patients were in a poor clinical condition on admission (two thirds were HH 4-5). 45 (92%) patients underwent extirpation of AVM and evacuation of ICH, within 4 days after bleed. Over 55% had good functional outcome. GOS correlated significantly with HH (p = 0.001), age (p = 0.006), and IVH (p = 0.049). On the other hand, SMG, location of AVM, and size of haematoma did not significantly predict the outcome. Microneurosurgery with preoperative embolization has made possible the excision of 90% of AVMs. It is our experience that it can be done acute and early, and it saves lives as compared to natural history of cerebral AVMs or late surgery, and accelerates rehabilitation of the patients.

Adolescent↗
PubMed2005

Lateral supraorbital approach as an alternative to the classical pterional approach.

OBJECTIVE: The standard pterional approach has been used to approach aneurysms of the anterior circulation and the basilar tip, suprasellar tumors, cavernous lesions. The senior author (JH) established a lateral supraorbital approach as an alternative to the pterional approach after continuous trial and error. We describe the techniques of this approach based on clinical experiences. METHODS: The lateral supraorbital approach is more subfrontal and anterior than the pterional approach. This approach has been regularly used by the senior author (JH) in the last decade in more than 2000 operations for mostly aneurysms of anterior circulation, but also for tumors of the anterior fossa and parasellar area as well as the sphenoid wing area. RESULTS: This approach can be used to operate on most cases, in which the classical pterional approach would be used. There are almost no craniotomy-related complications with this approach. This approach is not suitable in certain lesions which need to be exposed from a more temporal perspective. CONCLUSION: This approach is simpler, faster, safer and less invasive than the classical pterional approach.

Humans↗
PubMed2005

Subtemporal approach to basilar bifurcation aneurysms: advanced technique and clinical experience.

OBJECTIVE: The surgical treatment of basilar bifurcation aneurysms is challenging, and many of these aneurysms are currently treated by endovascular means. However, the complete closure of the aneurysm by surgical clipping still remains the best and most permanent cure for the aneurysm. The "gold standard", subtemporal approach was established and introduced by Drake and it has been adapted by the senior author Hernesniemi. We describe our present modified technique of this approach based on clinical experience. METHODS: The subtemporal approach to basilar bifurcation aneurysms has been regularly used by the senior author Hernesniemi in recent 15 years in over 200 operations in Kuopio and Helsinki, Finland. RESULTS: This approach is suitable in most basilar bifurcation aneurysms except for those high above the posterior clinoid process. To avoid temporal lobe damage, cerebrospinal fluid drainage is necessary. Benefits of subtemporal approach are short operative and retraction times, and no need for skull base resection. CONCLUSION: The subtemporal approach is simple and safe in experienced hands, and should be considered the standard method to approach most basilar bifurcation aneurysms.

Basilar Artery↗
PubMed2001

Evidence for excess long-term mortality after treated subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: The purpose of this study was to examine the long-term mortality rate of patients with aneurysmal subarachnoid hemorrhage (SAH) compared with that of the general population. METHODS: Aneurysmal SAH patients who were treated for ruptured aneurysm from 1977 through 1998 in a tertiary referral center (n=1537) were followed up for a median of 7.5 years. Dates and causes of death were determined. Standardized mortality ratios (observed/expected deaths) according to age, sex, and Glasgow Outcome Scale at 12 months after surgery were calculated. RESULTS: The mortality rate among patients with good recovery at 12 months was twice that of the general population. The excess mortality appeared to be most evident in younger age groups. Cerebrovascular and cardiovascular diseases were the principal causes of premature death. The result was similar among patients without preexisting cardiovascular diseases at the time of SAH. CONCLUSIONS: Aneurysmal SAH patients have an excess mortality rate even after successful treatment of ruptured aneurysms. Therefore, aneurysmal SAH should be viewed more as one aspect of a chronic general vascular disease, and more attention should be given to treatment of risk factors and long-term follow-up of these patients.

Adolescent↗
PubMed2000

Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms. A prospective randomized study.

BACKGROUND AND PURPOSE: This prospective study was conducted to compare the outcomes of surgical clipping and endovascular treatment in acute (<72 hours) aneurysmal subarachnoid hemorrhage (SAH). METHODS: One hundred nine consecutive patients were randomly assigned to either surgical (n=57) or endovascular (n=52) treatment. Clinical and neuropsychological outcome was assessed at 3 and 12 months after treatment; MRI of the brain was performed at 12 months. Follow-up angiography was scheduled after clipping and 3 and 12 months after endovascular treatment. RESULTS: One year postoperatively, 43/41 (surgical/endovascular) patients had good or moderate recovery, 5/4 had severe disability or were in a vegetative state, and 9/7 had died (NS) according to intention to treat. Patients with good clinical recovery did not differ in their neuropsychological test scores. Symptomatic vasospasm (OR 2.47; 95% CI 1.45 to 4.19; P<0.001), poorer Hunt and Hess grade (OR 2.50; 95% CI 1.31 to 4.75; P=0.005), need for permanent shunt (OR 8.90; 95% CI 1.80 to 44.15; P=0.008), and larger size of the aneurysm (OR 1. 22; 95% CI 1.02 to 1.45; P=0.032) independently predicted worsened clinical outcome regardless of the treatment modality. In MRI, superficial brain retraction deficits (P<0.001) and ischemic lesions in the territory of the ruptured aneurysm (P=0.025) were more frequent in the surgical group. Kaplan-Meier analysis (mean+/-SD follow-up 39+/-18 months) revealed equal survival in both treatment groups. No late rebleedings have occurred. CONCLUSIONS: One-year clinical and neuropsychological outcomes seem comparable after early surgical and endovascular treatment of ruptured intracranial aneurysms. The long-term efficacy of endovascular treatment in preventing rebleeding remains open.

Aneurysm, Ruptured↗
PubMed1999

Ruptured intracranial aneurysms: acute endovascular treatment with electrolytically detachable coils--a prospective randomized study.

PURPOSE: To compare the use of electrolytically detachable coils versus surgical ligation for the management of acutely ruptured intracranial aneurysm. MATERIALS AND METHODS: A prospective randomized study included 109 patients with acute (< 72 hours) subarachnoid hemorrhage caused by a ruptured aneurysm (Hunt and Hess grade I-II [n = 67], grade III [n = 26], or grade IV-V [n = 16]). All patients were suitable candidates for both endovascular and surgical treatment and were randomly assigned to undergo coil embolization (n = 52) or surgical ligation (n = 57). RESULTS: Significantly better primary angiographic results were achieved after surgery in patients with anterior cerebral artery aneurysm (n = 55, P = .005) and after endovascular treatment in those with posterior circulation aneurysm (n = 11, P = .045). No significant differences were seen in middle cerebral artery (n = 19) or internal carotid artery (n = 24) aneurysms. Early rebleeding occurred in one patient after incomplete coil embolization. The technique-related mortality rate was 4% in the surgical group and 2% in the endovascular group. Clinical outcome (Glasgow Outcome Scale score) at 3 months was not significantly different between treatment groups in terms of intended treatment modality. No late rebleedings had occurred at the time of this writing. CONCLUSION: In selected patients with a recently ruptured intracranial aneurysm, favorable results were achieved by using endovascular treatment. Subsequent acute or late open surgery was sometimes required. The clinical outcome at 3 months was comparable in the endovascular and surgical treatment groups.

Acute Disease↗
PubMed1999

Familial subarachnoid hemorrhage. Outcome study.

BACKGROUND AND PURPOSE: The aim of our study was to compare outcome and its determinants in familial subarachnoid hemorrhage and in sporadic subarachnoid hemorrhage in a large and well-documented patient population. METHODS: Patients with aneurysmal subarachnoid hemorrhage (SAH) treated at the Department of Neurosurgery, Kuopio University Hospital, from 1977 to 1995 were included. Patients with polycystic kidney disease were excluded. The Glasgow Outcome Scale (GOS) score at 12 months was studied. RESULTS: There were 120 patients (97 first-, 15 second-, and 8 third-degree family connections) in 96 different families with familial SAH and 1237 patients with sporadic SAH. Age, gender, and admission grade on the Hunt and Hess scale did not differ between these 2 groups. In both groups >80% of patients were in relatively good condition at admission. The outcome was good (GOS score of 1 to 2) in 87 patients (73%) with familial SAH and in 874 patients (71%) with sporadic SAH. Analysis of 20 variables, including presence of coexisting diseases, aneurysm site and size, amount of blood shown on CT scan, intraventricular bleeding, preoperative intracerebral hematoma and hydrocephalus, as well as postoperative bleeding and vasospasm, revealed no significant differences between study groups. The degree of family connection (first-, second-, and third-degree) did not have any statistically important effect on outcome in the familial group in the Finnish study population. In multivariate analysis the knowledge of familial SAH was not an independent prognostic factor. CONCLUSIONS: Admission status, postoperative course, and outcome were similar in the familial and sporadic SAH groups in this Finnish population, in contrast to previous results. Familial SAH may not be a significant risk factor for poor outcome.

Adult↗
PubMed1998

A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary.

OBJECTIVE: After 40 years of experience with anterior cervical operations, whether to fuse is still controversial. This study seeks to answer this question. METHODS: In this prospective randomized study, we operated on 91 patients with single-level cervical root compression using three different methods: 1) discectomy without fusion, 2) fusion with autologous bone graft, and 3) fusion with autologous bone graft plus plating. RESULTS: After 4 years of follow-up, the radiological results indicated that complete bony union was achieved in almost all cases. A slight kyphosis developed in 62.5% of the patients who had undergone discectomy, 40% of the patients who had undergone fusion, and 44% of the patients who had undergone fusion plus plating (not significant). The clinical outcomes were good for 76% of the patients who had undergone discectomy, 82% who had undergone fusion, and 73% who had undergone fusion plus plating. The outcomes were poor in 0, 4, and 4%, respectively (not significant). CONCLUSION: According to this study, satisfactory results can be achieved by performing simple discectomy to treat single-level cervical root compressive disease.

Adult↗
PubMed1998

Risk of harboring an unruptured intracranial aneurysm.

BACKGROUND AND PURPOSE: The purpose of the present study was to calculate the prevalence and relative risk of unruptured incidental intracranial aneurysms (IAs) among families with IA case(s) compared with the general population in one geographically defined area in East Finland and to identify the risk group that could benefit most from screening for IAs. We compared these results with our earlier study results of familial IA (FIA) cases, with two or more known IA cases in the same family. METHODS: The study groups were collected from the catchment area of the University Hospital of Kuopio in East Finland. The inclusion criteria were age 30 to 70 years and unruptured incidental IAs > or =3 mm. Patients with previous subarachnoid hemorrhage or in whom a ruptured IA was found to be the cause of death were excluded from all study groups. During routine forensic autopsies the circle of Willis was studied for IAs to estimate the number of IAs in the general population. In the families with one known IA case and in FIA families, MR angiography was used as a preliminary screening method for IAs, followed by intra-arterial angiography to verify suspected IAs. Study populations were age and sex adjusted for the statistical calculations. RESULTS: The relative risk for IAs among first-degree relatives in FIA families was 4.2 (95% confidence interval, 2.2 to 8.0) and among first-degree relatives in families with only one affected family member was 1.8 (95% confidence interval, 0.7 to 4.8) compared with the general population in East Finland. CONCLUSIONS: First-degree relatives in FIA families constitute a high-risk group for incidental IAs, and this group would benefit from screening studies for IAs. Screening for IAs in families with only one affected member or in the general population is not recommended.

Adult↗
PubMed1998

Regional cerebral blood flow in aneurysmal subarachnoid hemorrhage: single photon emission tomography evaluation of endovascular versus surgical treatment.

Since February 1995, 59 patients with recent aneurysmal SAH have been randomised in our study program, either for surgical aneurysm clipping or for endovascular treatment with Guglielmi detachable coils, to compare the safety and long-term efficacy of these methods. Patients with expansive haematomas or those in a moribund state were excluded, as well as those with aneurysms unsuitable for treatment with both methods. We used single photon emission tomography (SPET) to compare regional cerebral blood flow (rCBF) in surgically and in endovascularly-treated patients. In a sub-study presented in this paper, we analysed the data of patients in Grade I-III (Hunt & Hess) with anterior circulation aneurysms (n = 21). When changes between the pre- and post-treatment rCBF were compared, the surgically treated group showed a tendency towards improved rCBF (change in different vascular territories varied from +4% to +12%) while the endovascularly-treated group showed no consistent change (changes varied from -3% to +6%). There was, however, no significant statistical difference between the changes in the groups. Our results are preliminary, but they suggest that endovascular treatment of anterior circulation aneurysms may not have any advantage over surgical treatment in respect to disturbances in the rCBF.

Cerebrovascular Circulation↗