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Biomedical subjects

J Viljanto

Publications and source records attributed to J Viljanto.

At least 19 recordsLinked to original sources
PubMed2004

Effects of post-operative pain treatment using non-steroidal anti-inflammatory analgesics, opioids or epidural blockade on systemic and local immune responses in children.

BACKGROUND: Many studies have been carried out on the effects of anaesthetic drugs and methods on the immune response, but pain and its relief also affect the immune response. We measured systemic immune responses in the blood circulation and local responses in the surgical wound when non-steroidal anti-inflammatory analgesics (NSAIDs), opioids or epidural blockade was used in the peri-operative treatment of pain. METHODS: Responses were measured in 51 children, aged from 2 to 12 years and undergoing major surgery under balanced anaesthesia. Bolus doses of diclofenac intravenously (i.v.) and rectally (NSAID group), continuous i.v. infusion of oxycodone (opioid group) or continuous epidural infusion of bupivacaine + fentanyl (epidural group) were used peri-operatively for pain relief. RESULTS: The only difference related to the analgesic method was shorter duration of post-operative leucocytosis and lower phytohaemagglutinin (PHA)-induced lymphocyte proliferative responses in peripheral blood in the opioid group than in the NSAID or epidural groups. By contrast, time-related alterations were seen overall in leucocyte and differential counts, lymphocyte and their subset counts, lymphocyte proliferative responses, and in serum cortisol, C-reactive protein, plasma interleukin-6 and group II phospholipase A2 concentrations and in the appearance of different cell types in the wound. CONCLUSIONS: Post-operative pain treatments using diclofenac (NSAID), oxycodone (opioid) and epidural blockade have basically similar effects on systemic and local immune responses with only slight, probably clinically unimportant differences in children undergoing surgery under general anaesthesia.

Analgesia, Epidural↗
PubMed2000

Local and systemic immune response to surgery under balanced anaesthesia in children.

We studied perioperative changes in the immune response and compared changes in the peripheral blood with those in the wound in 20 boys (0.5-3 years) during elective inguinal surgery under balanced anaesthesia. Blood samples were drawn before premedication, immediately, and 4 or 24 h after anaesthesia. Cells from the wound were harvested with the Cellstick device, removed from the wound 4 (n=10) or 24 h (n=10) after anaesthesia. We found decreased lymphocyte counts in the peripheral blood, increased percentages of activated T lymphocytes and B lymphocytes, and decreased percentages of total T lymphocytes, T helper cells and T cytotoxic cells. The percentages of T helper cells and B lymphocytes were lower in the wound than in blood. Mitogen-induced lymphocyte proliferative responses decreased. This study demonstrates perioperative changes in the immune response in children and, as a new finding, that immune effector cells in the blood and in the wound are in a dynamic balance.

Analysis of Variance↗
PubMed1999

Is cellulose sponge degradable or stable as implantation material? An in vivo subcutaneous study in the rat.

The long-term behaviour of cellulose sponge implants, 10 x 10 x 5 mm in size, and tissue reactions in and around them were examined in the subcutaneous tissue of the rat from 1 to 60 weeks after implantation. The cellulose sponge used was filled up with connective tissue 4 to 8 weeks after implantation. Histologically, moderate foreign body tissue reaction inside the implant, the appearance of cracks and fissures, spotty colouration, and softening of the pore walls were observed up to 16 weeks after implantation. Later, the foreign body reaction inside the sponge became milder, the spotty colouration disappeared and micropores enlarged in the viscose cellulose matrix. Histomorphometrically, the cross-sectional area of the implants and the size of the pore wall fragments decreased, and the number of pore wall fragments increased significantly. The cellulose sponge used can be regarded as a slowly degradable implantation material. However, the time needed for the total disappearance of the cellulose sponge from subcutaneous tissue is longer than the 60 weeks.

Absorbable Implants↗
PubMed1999

Neurocognitive sequelae of scaphocephaly.

OBJECTIVE: Early cranioplasty for scaphocephaly has become routine in most countries. In addition to normalizing the shape of the skull, it has been found to decrease intracranial hypertension. Whether corrective surgery benefits the child's cognitive outcome has been poorly documented. DESIGN: Eighteen children whose sagittal suture showed premature fusion at birth or soon thereafter were operated on at age 1 week to 7 months. All patients healed without complications and were followed-up at regular intervals. At the age of 7.8 to 16.3 years they were examined to clarify their neurocognitive development and to compare the results with their age- and gender-matched healthy controls. RESULTS: Originally scaphocephalic children, although operated on, had mild deficiencies in auditory short-term memory and language development when examined with the general comprehension, similarities, and digit span subscales of the Wechsler Intelligence Scale for Children-Revised. In all other respects their developmental outcome was equal to that of the controls. CONCLUSIONS: Despite relative early correction of the skull shape, originally scaphocephalic children's neurocognitive performances do not reach the same level in all of the neurocognitive domains as their matched controls at school age. Early operation (</=1 month) may decrease this developmental delay. This implies that impairment of brain function has already taken place in utero. For the same reason an early operation seems to be justified not only for correction of the skull shape, but also to allow unrestricted development for the brain. Postponement of the operation would not serve either of these aims.

Adolescent↗
PubMed1998

Matrix metalloproteinase 9 level predicts optimal collagen deposition during early wound repair in humans.

BACKGROUND: This study examined two matrix metalloproteinases (MMPs) and their association with deposition of collagen during wound repair. METHODS: In 15 hernia wounds, wound fluid was collected using two Cellstick devices, which were implanted adjacent to two expanded polytetrafluoroethylene (ePTFE) tubes. MMP-2 and MMP-9 levels were analysed 24 and 48 h after operation using specific enzyme-linked immunosorbent assays, and collagen deposition in the ePTFE tubes was measured 10 days after operation as hydroxyproline. RESULTS: The levels of both MMPs in wound fluid were increased compared with those of control serum, although MMP-9 decreased (P < 0.01) in the wounds 24-48 h after operation. The MMP-9 level at 24 h correlated inversely and specifically to deposited collagen measured as hydroxyproline (rs = -0.80, P < 0.01). CONCLUSION: These results indicate that the level of MMP-9 in the early inflammatory phase can predict the amount of collagen deposited later in the wound healing process.

Adult↗
PubMed1998

Connective tissue formation in subcutaneous cellulose sponge implants in the rat. The effect of the size and cellulose content of the implant.

Granulation tissue formation was studied in viscose cellulose sponges with different cellulose contents and sizes after subcutaneous implantation in rats. Samples were removed and studied histologically and histomorphometrically 1-16 weeks after implantation. The implants with lower cellulose content and smaller size were invaded by more cells and filled with connective tissue more rapidly than those with the higher content and larger size. In larger sponge implants the beneficial effect of the lower cellulose content was more conspicuous.

Animals↗
PubMed1998

Biocompatibility of cellulose sponge with bone.

The purpose of this study was to investigate the biocompatibility of viscose cellulose sponge (VCS) with bone. Twenty-five Sprague-Dawley rats were used for the study. After curettage of the bone marrow from both femoral cavities, VCS (15 x 1 x 1 mm) was implanted into one femur, leaving the contralateral side empty as a control. The rats were killed 1-6 weeks after curettage, and bone formation inside the sponge was assessed by light-microscopic examination and histomorphometric assessment. Whereas normal bone formation in rat femoral cavity took place in 2 weeks after curettage, 4 weeks were needed for bone formation in the cellulose sponge. VCS is a compatible matrix for osseous tissue ingrowth and it may be useful as a scaffold for bone tissue engineering in experiments and possibly also in clinical practice.

Animals↗
PubMed1997

Treatment results of osteogenic sarcoma. An evaluation of 36 patients treated during 30-year period in south-western Finland.

Histological re-evaluation revealed 36 osteogenic sarcoma (OS) patients for analysis in South-Western Finland treated between 1958 and 1987. In 21 cases (58%) the tumour was located in the knee region. The mean age at diagnosis was 28 years (range: 5-62 years) and the follow-up time of the patients was at least 5 years or until death. In 29 patients without metastases at the time of diagnosis, the extent of the primary tumour was T2 in 37% and T3 in 63% of the patients. There were no differences regarding the extent of the primary tumour, delay of the diagnosis, mean age of the patients, or duration of the symptoms while comparing the three decades of the study. Before the 1970s the treatment consisted of surgery with or without radiotherapy in most cases. Since the 1970s the combination of surgical treatment (amputation or wide excision) and adjuvant chemotherapy was the most common treatment modality. Since the late 1970s limb-salvage surgery has been applied in selected cases, and it seems to be justified. None of the patients treated before 1970 survived for 5 years. The 5- and 10-year survival of all 36 patients was 44.4% and 33.6%, respectively. In non-metastatic patients both the 5- and 10-year disease-free survival was 46.7%. A certain group exhibiting a good prognosis was found; the 10-year survival of the 10 patients with OS in extremities, treated with combined chemotherapy and surgery, was 70%. The median survival time was significantly longer for the patients with an intracompartmental tumour extent of T2 (112 months) compared with an extracompartmental extent of T3 (23 months), and for the patients with the primary tumour in the knee region (112 months) compared with other locations (18 months). The long-term survival of the OS patients has improved concomitantly with the multimodality of the treatment.

Adolescent↗
PubMed1996

Viscose cellulose sponge as an implantable matrix: changes in the structure increase the production of granulation tissue.

Since the 1950s a number of implantable substances have been used to study granulation tissue formation: steel mesh, polyvinylalcohol (PVA), polytetrafluoroethylene (PTFE), polyurethane, and viscose cellulose sponges (VCS). The side effects of these materials on granulation tissue formation vary considerably. An ideal material does not interfere with the normal wound-healing process and collects as many cells as possible for further analysis. Viscose cellulose sponge has been shown to be one of the most inert materials for this purpose. In this study we examined the correlation between changes in the structure of the sponge and the number of cells harvested and the synthesis of granulation tissue after subcutaneous implantation in rats. It was discovered that it is possible to control the structure of the sponge and by certain changes in this structure increase the number of invading cells and the production of granulation tissue in the sponge. There is, however, a distinct plateau after which changes in structure do not increase the number of invading cells and the production of granulation tissue in the sponge.

Animals↗
PubMed1995

[Fibrin glue].

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Blood Loss, Surgical↗
PubMed1992

[Fetal surgery].

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Animals↗
PubMed1991

Macrophages in trauma-induced myositis ossificans.

The basic cellular mechanisms of different forms of myositis ossificans are poorly known. In the current experiment the nature of the early (24-168 h) inflammatory cell reaction preceding trauma-induced myositis ossificans was studied. New bone formation was induced in the vastus intermedius region of the rabbit quadriceps muscle by means of immobilization and daily passive mobilization. Before the start of treatment, a cell harvesting device (viscose cellulose sponge in a silastic tube) was implanted in the region of interest. The opposite intermedius muscle and a standardized surgical skin wound served as the control sites. The results showed a significantly prolonged invasion of macrophages into the ossifying intermedius muscle as compared with the control intermedius muscle. It is hypothesized that microinjury and subsequent muscle necrosis cause the invasion of macrophages, and these cells respond to the conditions of the traumatized muscle under passive mobilization by releasing osteogenic growth factors.

Animals↗
PubMed1990

Effect of haematocrit on wound healing in children.

The effects of mild or moderate normovolaemic anaemia on wound healing (WH) continue to be debatable. The results of animal experiments and clinical experience are somewhat controversial. In this study, sixty-six boys, aged from 5 to 15, mean 10.1 years, were routinely operated on for a unilateral inguinal hernia, after which their WH was studied by the Cellstic device. Based on differential count of wound cells and their mutual transformed cell to cell ratios it was found that the optimum level of haematocrit (Hct) for WH was 37-39% with haemoglobin (Hb) values of 12.0-12.4 g/100 ml. Hct values under and over these limits began to retard WH significantly (p less than 0.02) without any visual signs of delay in WH. Both values are below the age adjusted means but just above the lower limits of normal. It is thus allowed, for the majority of healthy children with normal blood values, a mild decrease of Hct during the operation without any harmful effect on WH.

Adolescent↗
PubMed1983

Ultrastructural characteristics of cells in human wound collected by Cellstic device.

The differentiating human wound cells and intercellular matrix was studied by electron microscopy. The cells were collected with a special wound drain containing a piece of cellulose sponge. Although fibroblastic cells could be detected as early as 20 hr after operation, the main cell population consisted of inflammatory cells. The fibroblastic cells were classified into three types according to the stage of ultrastructural differentiation. Some cells of different types were in close contact by membrane apposition to each other and to the sponge material. However, no specialized junctions were seen. Organized collagen fibers were not seen during the observation period despite the well developed organelles for protein synthesis in the fibroblastic cells. The close contacts of normal cells with the sponge pore walls indicated good compatibility with human tissue and safe use for clinical experiments in routine operations.

Adolescent↗
PubMed1983

Signs of capillary formation in the early phase of wound healing in children.

Small silicone rubber tubes containing a standard size viscose cellulose sponge (Cellstic) were implanted in wounds of 23 children at the end of routine surgery. The Cellstics were drawn out of the wounds 1-4 days after implantation. Single cells and cell aggregates, called cell aggregation centers (CAC), were washed out of the Cellstic sponges by the retrograde injection technique, centrifuged, studied histologically and histochemically for cytochrome oxidase activity. Small leukocytic CACs and solitary cells, also including some macrophages and a few endothelial cells, were observed on the first postoperative day. On the second postoperative day and thereafter 2-4 endothelial cells were attached to each other surrounding a lumen. These capillary segment-looking formations (CSF) resembled capillary segments and they were seen both inside and outside the (now larger) CACs. Outside the CACs solitary endothelial cells occasionally exhibited ring-like formations. High cytochrome oxidase activity was observed especially in many CSFs but the solitary and the ring-shaped endothelial cells, in- and outside the CACs, also showed intense oxidative metabolism.

Capillaries↗
PubMed1983

Effect of intrauterine thymectomy on granulation tissue formation. An experimental study.

Intrauterine thymectomy was successfully performed on 9 guinea pig foetuses at the gestational age of 36-48 days. This resulted in a significant suppression of the phytohemagglutinin (PHA) response of the whole blood lymphocytes at the age of 3 mth. The in utero-thymectomized guinea pigs and their littermate non-thymectomized controls were operated on by making 4 symmetrical dorsal skin incisions and by subcutaneously implanting 8 standardized pieces of viscose cellulose sponge. On the 1st, 3rd, 5th and 10th days the tensile strength of the wounds was determined and the implants were analysed histologically and enzymehistochemically. At the time of incipient fibroplasia on the 5th post-operative day, the tensile strength of the wounds, the number of fibroblasts and the activities of aminopeptidase and succinate dehydrogenase were clearly less in the guinea pigs which had been thymectomized in utero. These findings indicate that adequate thymic function was necessary for normal fibroblast proliferation, since intrauterine thymectomy led to a temporary delay in the beginning of the fibroblastic phase in wound healing.

Animals↗
PubMed1982

Anastomotic leakage in oesophageal atresia. Diagnostic and therapeutic considerations.

Oesophageal anastomotic leakage complicates 5-38% of operations performed for congenital atresia, and continues with prematurity and concomitant anomalies to be a cause of a fatal outcome. After a short review of the diagnostic and therapeutic possibilities of this complication the authors present their own series of 37 consecutive oesophageal atresia and/or oesophagotracheal fistula. Seven of these had anastomotic leakage within 2 to 8 days after operation. Three of them had been primarily operated on through a retropleural approach. The remaining four had had a transpleural approach and were all treated with an immediate rethoracotomy and resuture of the disruption with good primary results. A few cases reported earlier and the authors' present experience support the view that rethoracotomy and resuture of the disruption in transpleurally operated patients provides a method which allows early debridement of the pleural cavity and pulmonary reexpansion, accelerates secondary anastomotic healing and shortens the period needed for pleural drainage and intravenous nutrition.

Esophageal Atresia↗