Biomedical subjects
Publications and source records attributed to L Ketonen.
Four cases of a rare aneurysm of the inferior thyroid artery are presented. They appeared as a pulsating mass with a bruit in the supraclavicular fossa. They were asymptomatic, with the exception of neurological deficits in one case. All the patients had an uneventful recovery after resection of the aneurysm.
The pituitary function in 20 patients with primary empty sella syndrome has been evaluated. The only endocrine symptom was secondary amenorrhoea in four patients. In half of the patients, pituitary function tests showed minor abnormalities, the most common being impaired growth hormone response to glucagon. In addition to the empty sella, other intracranial abnormalities such as pituitary tumour and hydrocephalus were found in four patients. Although commonly a benign condition, the empty sella may occasionally be associated with clinically important endocrine dysfunction, pituitary tumours and other intracranial abnormalities.
Six patients with herpes simplex virus (HSV) encephalitis underwent diagnostic and clinical evaluation. The HSV or its antigenic material was found in three brain biopsy specimens. In the remaining three cases, the diagnosis was supported by detection of HSV antibodies in the CSF. Cell count and total protein concentration in the CSF reached a maximum level at three weeks and two months, respectively. The IgG index and HSV antibody level in the CSF often remained constant after reaching maximal values. In three patients, a transient low serum sodium level was observed. Characteristic EEG changes were present five to 11 days after the onset of symptoms. Computerized tomographic scanning revealed a temporal low-density lesion. Three patients became deeply comatose and had respiratory failure. The patient without vidarabine therapy and one of the five patients treated with vidarabine died.
The eight computed tomography (CT) scans in five patients with proven herpes simplex encephalitis (HSVE) showed a low density lesion in the deep temporal lobe. In one patient the deep frontal and occipital lobes were also involved. Contrast enhancement was present in all patients examined within 78 days of the onset of symptoms. CT is valuable in the investigation of patients suspected of having HSVE and for whom it is vital to exclude a temporal lobe tumour or abscess. A CT examination may indicate the site for a brain biopsy to confirm the diagnosis.
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During the years 1961-78, 17 patients with traumatic rupture of the aorta underwent surgery at the Department of Thoracic and Cardiovascular Surgery, University Central Hospital, Helsinki. Nine of the cases were acute ruptures and 8 were chronic aneurysms. All cases were confirmed by pre-operative aortography. Rupture was located in each case in the proximal descending thoracic aorta just distal to the left subclavian artery. Surgical repair was made by using a left-side bypass in all cases but one, in which the operation time was so short that no organ protection was needed. The absence of paraplegias and kidney lesions demonstrated the adequacy of organ protection. Two of the three operative deaths were probably related to the systemic heparinization during left-side bypass which, by causing exacerbation of the cerebral bleeding, could have led to death. The possibility that these two deaths could have been avoided by using the new heparin-bonded, non-thrombogenic shunts, which obviate the need for generalized heparinization, is discussed. Operation is also recommended in chronic cases and should be performed as soon as an aneurysm has been diagnosed.
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Eighty patients who had undergone bilateral carotid endarterectomy at the same operation were reviewed. All operative procedures were performed under general anaesthesia and during systemic heparinization and in all but six cases by using internal shunt. There were three deaths related to the operation representing 3.8% hospital mortality. Transient neurological deficits were noted in four patients (5% incidence) and permanent neurological deficits in four patients (also 5% incidence). A 100% late follow-up after an average period of 48 months revealed that 85.7% of the long-term survivors were functionally normal or improved. There were ten late deaths with heart disease accounting for 50% and stroke 30%.
Eight cases of primary empty sella diagnosed on pneumoencephalography (PEG) were examined using computed tomography (CT). The diagnosis was made correctly in every case and it was possible to differentiate an empty sella from a pituitary adenoma. Slices 5 mm thick and an overlapping technique were necessary because of the small volume of the tissues analysed. PEG does not seem to be necessary in most cases of suspected intrasellar cisternal herniation, and it is needed only in the difficult case in which the clinical picture and the CT finding are not in harmony.
Two cases of acute intestinal obstruction in adults caused by a nonrotation anomaly of the bowel are presented. Both of the patients had suffered since chilhood from chronic, recurrent but rather mild abdominal symptoms which subsided spontaneously. In both cases volvulus of the cecum caused the acute abdominal condition, necessitating emergency operation. The nonrotation anomaly was an unsuspected discovery at laparotomy. The possibility of this type of congenital anomaly should be kept in mind whenever a patient has chronic recurrent abdominal symptoms or an acute abdominal condition.
The brains of 1851 patients were examined with 160 X 160 matrix computed tomography (CT) during a period of nine months. The CT patterns of 90 supratentorial tumors (excluding sellar tumors) were reviewed. A great variety of CT patterns were found with glioblastomas, the most typical being a tumor with mixed absorption values. Astrocytomas appeared as low-density lesions. The characteristic appearance for meningiomas was a homogeneous density, with an obvious increase in density after contrast injection. Metastases appeared as low- or high-density lesions with marked edema surrounding the tumor. Some minor groups such as craniopharyngiomas, epidermoid tumors and pineal tumors were described. The lesion was detected in 94% and a correct diagnosis was made in 92% of cases.
Fourteen patients suffering from abdominal angina have been operated on with different revascularization techniques. Preoperatively all of them had classical symptoms: postprandial pain and all except two had remarkable weight loss. There were six patients with isolated coeliac axis stenosis and in eight cases there were two or three diseased vessels. Liberation and reconstruction of the coeliac axis were carried out in six cases. Aorto-hepatic by pass graft was performed in three patients. Reinsertion of SMA was done in four and reinsertion of IMA in one case. Reconstruction of SMA with a by pass graft was carried out also in one case. There was no operative mortality. One of the patients died five weeks postoperatively at home from myocardial infarction. Another patient operated on in 1965 died seven years later at the age of 78 from myocardial infarction. He had had no further symptoms of abdominal angina postoperatively. The remaining 12 patients were relieved of their symptoms after the operation. They have been followed up for a mean of 5.5 years. The good long term results of arterial reconstructions in contrast to the poor prognosis without operation, favours early operation. The importance of early diagnosis and the importance of early operative treatment are emphasized.
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Two cases of primary small bowel tumors causing an acute intussusception are presented. In one case two polyps were found and in the other case a lipoma in the wall of the jejunum. In both cases there were symptoms of recurrent bowel obstruction for several months before the acute condition. Although intussusception caused by a benign tumor of the small bowel is a rare condition it should be taken into consideration in the differential diagnosis of abdominal pain of doubtful origin.
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34 episodes of acute arterial occlusion in the upper limbs were treated surgically in 30 patients. In 32 cases the embolus was considered to have originated in the heart. In 27 cases the radial pulse was reestablished after the primary operative procedure and in 2 cases after an additional operative procedure. In 3 cases the pulse remained inpalpable and 2 amputations were needed. The earlier after the onset of the symptoms the operation was performed the better were the results. Two patients expired in the hospital during the first week after operation and there were 11 late deaths during the follow up period. The remaining 17 patients were followed for an average of 4.1 yrs. 15 of these patients have not shown any evidence of re-occlusion during the follow up period.