Search PubMed⌕ Search

Biomedical subjects

J Ovaska

Publications and source records attributed to J Ovaska.

46 records · Page 3Linked to original sources
PubMed1988

Improvements in the treatment and prognosis of colorectal carcinoma.

In a survey of the surgical results in 709 patients with colorectal carcinoma (CRC) treated between 1976 and 1985 a favourable shift of stage distribution was observed. The tumour was localized (Dukes' classification A or B) in 61 per cent of patients, as compared with 47 per cent in the previous 10-year period. This change was, in part, due to different interpretation of stage definitions. Clear improvements of the results were, however, also noted. Radical surgery was possible in 76 per cent of patients and the primary tumour was removed in 93 per cent. Surgical mortality was 4.4 per cent and complication rate 15 per cent, significantly less than earlier (6.5 and 38 per cent, respectively). Increasing numbers of sphincter-saving operations were performed in rectal cancers (47 per cent as compared with 24 per cent in the previous 10-year period). The overall 5-year survival rate improved from 40.5 to 52.5 per cent. Premalignant conditions were identified in 12.6 per cent of patients: previous CRC 4.8 per cent, cancer family syndrome 4.1 per cent, ulcerative colitis 1.7 per cent and familial adenomatosis 0.6 per cent. In order to sustain the favourable trend of improving survival prospects, more emphasis must be directed to the detection of early stage cancers.

Adult↗
PubMed1987

Drainage by endoscopic endoprosthesis in biliary obstruction. A report of initial experience.

Biliary drainage by endoscopic, transpapillary insertion of endoprosthesis was attempted in 38 patients with obstructive jaundice and was successful in 25. The procedure was palliative in 17 cases and preoperative in eight. Benefit was obtained by ten of the former and seven of the latter patients, while in eight the serum bilirubin did not fall despite adequate catheterization. In two intubated patients with recurrent nonterminal jaundice, the endoprostheses were repeatedly changed; the median time to clogging was 51 (8-77) days. Cholangitis developed in 15 of the total 38 patients. Antibiotic prophylaxis, though not routinely used, is recommended for all cases with biliary stasis. Unimpeded bile flow was not ensured with 7 F endoprostheses, whose patency time tended to be short. By using sizes 10-12 F the authors hope to improve bile flow, thereby diminishing obstruction, stagnation and infection and prolonging patency. In selected cases the method may offer an alternative to the percutaneous approach, and possibly also to surgical bypass.

Aged↗
PubMed1978

Does adrenergic activity suppress insulin secretion during surgery? A clinical experiment with halothane anesthesia.

Peroperative inhibition of insulin release is widely attributed to increased alpha-adrenergic activity. To test this hypothesis serum insulin and glucose concentrations were measured at short intervals in 11 patients who underwent major surgery. Five patients were anesthetized with halothane and six with general anesthesia without halothane. The results were similar in both patient groups; halothane had no effect on insulin. This suggests that suppression of insulin under operations is probably not due to activation of the alpha-adrenergic receptors of the pancreatic beta-cells. The authors propose that suppression of insulin secretion during surgery may be caused by adrenaline, which, in competing for the glucose receptors, insensitizes the pancreatic beta-cells.

Aged↗
PubMed1978

Insulin, growth hormone and catecholamines as regulators of energy metabolism in the course of surgery.

Six patients subjected to major surgery (esophageal resection, group I) and eight patients undergoing moderate surgery (exploratory laparotomy, group II) were investigated in order to study the effects of surgery and glucose infusion on the blood glucose, plasma FFA, serum insulin and growth hormone concentrations as well as on the urinary excretion of adrenaline, noradrenaline and nitrogen. In the patients undergoing esophageal resection, blood samples were taken at short intervals during five 24-hour periods, covering a time span from the second preoperative to the tenth postoperative day. In the case of exploratory laparotomy four such periods up to fifth postoperative day were similarly investigated. For adrenaline, noradrenaline and nitrogen, urine was collected in two 12-hour samples for each 24-hour period in order to roughly estimate the "day" and "night" excretions. The results and conclusions can be summarized as follows: A rapid rise in blood glucose and plasma FFA concentrations occurred after the beginning surgery. The zeniths of the curves were recorded about 4--6 hours after the skin incision in both patient groups, despite the different duration of the operations. This suggests that the regulatory mechanism is spontaneously active for a certain time after being initially triggered. Insulin secretion was usually suppressed 4--5 hours after the beginning of surgery. A marked increase of insulin secretion occurred after this time, the rise of IRI being associated with a fall of BG and FFA. Maximum insulin secretion was recorded during the night after surgery. Because excretion of noradrenaline was maximal during this time in group I, noradrenaline activity is perhaps a less likely explanation of the suppression of insulin. The response of growth hormone secretion to surgery and anesthesia was not uniform. Trauma apparently causes no constant rise, whereas a rather regular elevation of serum GH levels follows the fall in BG and plasma FFA concentrations, In group I there was a decrease of insulin and GH secretion and the number of insulin and GH "peaks" in the postoperative period, possibly reflecting a weakening of central stimuli after major surgery. The same was not always noted in group II, in which the mean secretion of insulin was postoperatively somewhat elevated compared to the preoperative values. Urine analyses revealed no day--night rhythmicity in catecholamine excretion except possibly on the day of operation, when the "day" samples contained absolutely and proportionately more adrenaline than the "night" samples.

Aged↗
PubMedDate not supplied

Small bowel anastomosis with the biofragmentable anastomosis ring and manual suture: a prospective, randomized study.

A total of 170 patients undergoing upper gastrointestinal surgery requiring a jejuno-jejunal enteroanastomosis were randomized into two groups according to the method to be employed at the enteroanastomosis. The most common procedures were partial gastrectomy for benign disease (84 patients), partial or total gastrectomy for malignant disease (35 patients), and bilioenteral bypass (31 patients, 25 for malignant disease). The enteroanastomosis was created by manual suture (3-0 Dexon, two layers) in 89 patients and with the Biofragmentable Anastomosis Ring (Valtrac-BAR) in 81 patients. Both end-to-side (101 patients) and side-to-side (69 patients) reconstructions were done. No ruptures or obstructions of the jejuno-jejunal anastomosis occurred. The postoperative recovery of the gastrointestinal tract was similar in the two groups in duration of nasogastric drainage, intravenous fluid therapy, and intestinal paralysis. Nor was there any difference between the groups in the duration of the postoperative hospital stay. Ten patients, 7 in suture-group and 3 in BAR-group, died postoperatively of causes unrelated to the enteroanastomosis. Thus the mortality rate was 7.9% in the suture group and 3.7% in the BAR group. The biofragmentable ring offers a safe alternative to manual sutures for small bowel anastomoses.

Anastomosis, Surgical↗
PubMedDate not supplied

Esophagocardiomyotomy for achalasia. Long-term clinical and endoscopic evaluation of transabdominal vs. transthoracic approach.

Modified Heller's myotomy for achalasia of the esophagus was performed via a left thoracotomy in 34 cases (group A) and via an upper midline abdominal incision in 30 (group B). There were no perioperative deaths. Complications arose in ten cases. After follow-up averaging 13 years (range 3-24 years) 4% of the group A patients reported dysphagia for solids, but none for liquids, and in group B the corresponding figures were 52% and 26%. Reflux symptoms were present in 30% of the group A and 60% of the group B cases, and the respective incidence of microscopic esophagitis was 30% and 43%. There were three esophageal strictures, all in group B, and three cases of Barrett's epithelium, all in group A. Because of the high incidence of esophagitis and its complications following esophagomyotomy for achalasia, yearly endoscopy with biopsy and brush cytology is recommended. When myotomy is performed, an antireflux operation should be added.

Adolescent↗
PubMedDate not supplied

Polyarteritis nodosa of the descending colon. Case report.

A 28-year-old man presented with fulminant, haemorrhagic, left-sided colitis, that was thought to be Crohn's disease both clinically and macroscopically. Histopathological examination, however, showed polyarteritis nodosa. The patient had no other signs of this disease, which should be added to the differential diagnoses of colitis.

Adult↗