Search PubMed⌕ Search

Biomedical subjects

J Koivukangas

Publications and source records attributed to J Koivukangas.

30 records · Page 2Linked to original sources

Completely computer-focused ultrasound imaging. First clinical imaging results.

Completely computer-focused ultrasound imaging has been achieved using the UHB (ultrasound holographic B) method. This is a synthetic aperture method that combines ultrasonic holography and the conventional B-scan method. A wide-angle ultrasound burst (4 MHz) is transmitted into the object and the reflected echoes are measured as a function of the propagation time, but both the amplitude and phase angle are recorded, giving multiple one-dimensional holograms in a cross-sectional plane. This UHB data is rearranged to obtain one-dimensional wave fields, which represent the wave fronts reflected from each depth. The image is then reconstructed by propagating these wave fields backward to their original positions on the image using Fourier transform, a spectrum shift theorem, and inverse Fourier transform. The whole UHB image is obtained by calculating the intensity lines from these wave fields and by scanning these lines one by on the cathode ray tube (CRT) monitor. Following extensive laboratory testing with single and multielement transducers, special 32- and 64-element linear array transducers were fabricated, as was computer software capable of producing a UHB image in 40 seconds. Tissue imaging tests followed by clinical imaging of 30 patients showed that images obtained with this prototype compared favorably with those obtained by state-of-the-art conventional ultrasound scanners. The potential advantages of the new method are enhanced lateral resolution and the incorporation of phase information in tissue characterization. This would be important in diagnostic and intraoperative, especially neurosurgical, imaging.

Brain↗

Role of quality of life in therapeutic strategies in brain tumors.

The results of the surgical management of brain tumors have improved considerably with the development of new technology. One of the current problems is the evaluation of results of surgical treatment of infiltrative brain tumors, for example, the low-grade astrocytoma. This paper centers on the evaluation of changes in quality of life based on in-depth qualitative, together with some quantitative, data on quality of life of 4 representative cases of cerebral astrocytoma. Results of clinical evaluation (Karnofsky scale, Glasgow Outcome Score) and semi-structured theme interview showed improvement of quality of life during the first post-treatment year in all cases. This was particularly noted in social aspects of quality of life, including the effect of reduced symptoms on social interaction. The patients' own evaluation of the quality of their lives was not influenced only by the illness and treatment, but also by general life circumstances, such as social relations and work. The study further provides some basic data that can be used to develop questionnaires for evaluation of results of the treatment of these patients.

Brain Neoplasms↗

Thoracic spine CT, diagnostic efficacy.

In 67 patients the diagnostic efficacy of thoracic spine CT was assessed. Diagnoses suspected clinically or by other examination methods could be confirmed by CT in 81% and excluded in 18% of cases. In one per cent (one case) the diagnosis, myelopathia vascularis, could not be seen by CT nor by myelography. In 49 cases the results of thoracic spine CT and myelography were compared with each other. CT gave additional information to myelography in 27% (13/49), but not in 73% (36/49). In 27% (18/67) of the whole material CT was able to replace myelography. It seems that CT is useless if myelography is normal, but CT may be useful in tumors, infections and medullary diseases. In traumas CT may replace myelography.

Female↗

Management of patients with pain.

Out of an early study of 74 patients treated for pain at our facilities, 14 were selected for dorsal column stimulation (DCS). Compared to a control group on medications, the DCS patients benefited in terms of reduced amounts of pain relievers needed. One patient showed transient loss of somatosensory evoked potentials in association with the use of a high frequency stimulator at the cervical level, as possible evidence of the potential dangers to neural tissue related to the use of bioelectrical devices. However, despite the development of pain centers, new neurosurgical methods including bioelectrical equipment should be devised for treatment of pain patients who are referred from these multidisciplinary centers for neurosurgical treatment.

Adult↗

Preliminary experiences with CO2-laser and ultrasonic aspirator in brain surgery.

The basic problems and potential of CO2-laser and ultrasound aspirator in brain surgery are presented on the basis of experience with the Sharplan 733A CO2-laser and the Sonotec ultrasound aspirator. Complete removal of meningiomas and gliotic scar and partial removal of malignant astrocytomas by CO2-laser and ultrasound aspirator was performed. There were no complications related to the surgical procedure. The main advantage of the CO2-laser was precise cutting of neural tissue and rapid evaporation for debulkment of tumor. The ultrasound aspirator was especially useful for rapid internal debulkment by fragmentation and aspiration of soft tumors. On the basis of these experiences the surgical theater should be equipped with these and other instruments in such a way that they can be readily and interchangeably used in any neurosurgical procedure.

Adolescent↗

Treatment of low-grade cerebral astrocytoma: new methods and evaluation of results.

Seventeen patients with low-grade cerebral gliomas, fourteen of them low-grade astrocytomas, were operated using CT/ultrasound-guided operative technique. The mean age of the patients was 34 years, and the mean follow-up time 13 months. The patients usually presented with symptoms of headache and/or epilepsy. Craniotomy was performed, and all lesions could be visualized as hyperechogenic masses using intraoperative ultrasound imaging. This paper describes the preliminary results of treatment with conventional resection methods, and discusses methods which could be readily adapted to the CT/ultrasound-based imaging system: CO2 and Nd-YAG laser, ultrasound aspirator, intense focused ultrasound lesioning and immunotherapy with monoclonal antibodies. Finally the evaluation of treatment results with quality of life studies is suggested, especially for longitudinal follow-up of patients treated with alternative therapeutic methods. The role of quality of life studies is particularly important in assuring the longest and most useful survival of patients with small low-grade cerebral tumors.

Adolescent↗

Application of ultrasound imaging to stereotactic brain tumor surgery.

This report describes the first application of intraoperative ultrasound to the stereotactic removal of subcortical brain tumors, here specifically applied to the Kelly system for stereotactic computer-controlled laser resection. The feasibility of ultrasound control of such procedures was demonstrated in the two cases of resection of cerebral astrocytoma presented in this paper. The chief benefits of ultrasound imaging seem to be the supplementary data it gives on the tumor itself, and the possibility of real-time imaging to follow the effects of tumor removal at successive stages of the procedure.

Adult↗

Three-dimensional ultrasound imaging of brain for neurosurgery.

The ultrasound study group at the Departments of Neurosurgery and Electrical Engineering, University of Oulu, has worked since 1980 on the development of ultrasound holographic B (UHB) imaging for clinical use. It has produced images of human brain based on synthetic focusing of data obtained by wide-angle nonfocused transducers. At the same time, clinical ultrasound B-imaging has been applied to brain and spinal cord surgery. On the basis of laboratory and clinical investigations, some of the possibilities of three dimensional ultrasound imaging in neurosurgery are presented. Particularly the role of supplementary three-dimensional ultrasound imaging data in computer-controlled brain surgery is stressed.

Animals↗

The treatment of Moyamoya disease by superficial temporal-middle cerebral artery (STA-MCA) anastomosis.

STA-MCA anastomosis was performed in a total of eight patients ranging in age from five to 42 years for treatment of symptomatic Moyamoya disease. All of the patients presented with symptoms of cerebral ischemia. In most cases bilateral procedures were performed at separate operations. No patients have experienced increased neurological deficits as a result of surgery, while the ischemic symptoms have been relieved completely in most cases. The surgical procedure is especially demanding in the treatment of Moyamoya disease, but remains one of the few solutions to the treatment of this disease.

Adolescent↗

Surgery of vertebrobasilar aneurysms and nimodipine.

Five patients among 60 consecutive patients suffering from recent subarachnoid hemorrhage were operated for ruptured vertebrobasilar aneurysm. Topical nimodipine treatment was given during the operation after clipping and continued systemically for three weeks. One out of the five patients developed symptoms which could be ascribed to delayed arterial vasospasm. Nimodipine may be advantageous in preventing ischemic complications when used prophylactically. Further investigation is needed to elucidate its efficacy in cases of vertebrobasilar aneurysms and conventional timing of surgery.

Adult↗

Low-field MR imaging of meningiomas including dynamic contrast enhancement study: evaluation of surgical and histopathologic characteristics.

BACKGROUND AND PURPOSE: Risks associated with surgery of meningiomas, especially those located in the skull base, are influenced by tumor consistency and vascularity. The purpose of this study was to find out if vascularity, consistency, and histologic characteristics of meningioma can be predicted preoperatively by using low-field MR imaging, including dynamic imaging of contrast enhancement. MATERIALS AND METHODS: Twenty-one patients (mean age, 56; range, 34-73 years; 16 women, 5 men) with meningioma requiring first surgery were imaged by a 0.23T scanner. Time to maximum enhancement, maximum enhancement, and maximum intensity increase were noted from the enhancement curve of dynamic imaging. Relative intensity of tumor in fluid-attenuated inversion recovery (FLAIR) and T2-weighted images was calculated. The neurosurgeon evaluated surgical bleeding and hardness of tumor on a visual analog scale. Histopathologic analysis included subtype, World Health Organization grade, mitotic activity, grades of progesterone receptor expression and collagen content, proliferation activity by Ki-67 (MIB-1), and microvessel density by CD34. Correlations were studied with Kendall tau statistics. RESULTS: The most powerful association was found between time to maximum enhancement and microvessel density (tau = -0.60, P < .001). Surgical bleeding (tau = 0.49, P = .002), blood loss during surgery (tau = 0.49, P = .002), progesterone receptor expression (tau = 0.59, P < .001), and collagen content (tau = -0.54, P < .001) were statistically best correlated with the relative intensity of meningioma on FLAIR images. Tissue hardness correlated best with relative intensity on T2-weighted images (tau = 0.40, P = .012). CONCLUSION: Assessment of microvessel density, collagen content, and progesterone receptor expression of meningioma may be clinically feasible by using low-field MR imaging.

Adult↗

Computed tomography after lumbar disc surgery.

Computed tomography (CT) findings following lumbar disc surgery were analyzed in a series of 53 patients one week after surgery and in another series of 43 patients 6 months to 20 years (average 4.3 years) after surgery. In addition to changes caused by the surgical exposition (laminotomy or laminectomy, gas bubbles) a mass lesion was found on the posterior aspect of the disc in all cases. Hypodensity of the disc interspace as well as vacuolization were found in several cases. These changes were less in the patients examined late after surgery but the CT findings were never completely normal. Findings characteristic of recurrent prolapse included disc-like attenuation values within the mass and non-enhancement with contrast medium. Hypodensity of the disc interspace is associated with discitis but as a non-specific finding it is insufficient in itself for diagnosis of discitis.

Adolescent↗