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L Kivisaari

Publications and source records attributed to L Kivisaari.

At least 55 records · Page 3Linked to original sources
PubMed1997

High-resolution CT in long-term follow-up after lung transplantation.

OBJECTIVE: Our aim was to evaluate the development of changes on high-resolution CT (HRCT) associated with chronic pulmonary rejection. MATERIALS AND METHODS: Repeated HRCT examinations were performed 140 times on 13 consecutive lung transplant recipients during a mean observation period of 26 months. The postoperative time interval to the first detection of each chronic change on CT was calculated and compared with the onset of chronic rejection. Bronchiolitis obliterans syndrome (BOS) or the histologic diagnosis of obliterative bronchiolitis was assessed by the published criteria of the International Society for Heart and Lung Transplantation. RESULTS: BOS developed in eight patients, on an average, within 11.6 (+/-5.0) months. Histologic diagnosis was available from five patients. On HRCT, among the first identifiable chronic changes were volume contraction, decreased peripheral vascular and bronchial markings, and thickening of septal lines, all of which appeared between 7 (+/-5.0) and 11 (+/-6.8) months postoperatively. The mean interval for appearance of bronchodilatation was 12.5 (+/-8.7) months. Hyperlucency and mosaic phenomenon were identified, on an average, 16 (+/-6.3) and 21 (+/-7.3) months after transplantation. CONCLUSION: On radiologic monitoring of lung recipients with HRCT, in addition to bronchodilatation. a special attention should be paid to the early chronic changes, including diminution of peripheral bronchovascular markings, thickening of septal lines, and volume reduction, which usually precede the establishment of the diagnosis of chronic rejection, whereas hyperlucency and mosaic phenomenon usually appear during more advanced BOS.

Bronchiolitis Obliterans↗
PubMed1997

Altered fractionation of hemithorax irradiation for pleural mesothelioma and failure patterns after treatment.

Malignant pleural mesothelioma is a rare malignancy with a bleak prognosis. The role of radiotherapy has not yet been clarified. Our aim was to study the effect of altered fractionation on mesothelioma. We have treated 57 patients, 41 males and 16 females, with hemithorax irradiation with six different fractionation schedules. All the patients have been included in a combined modality program consisting of surgery followed by chemotherapy and finally by hemithorax irradiation. The radiotherapy schedules used were: I. Conventional fractionation of 20 Gy in 10 fractions over 12 days. II. Split-course radiotherapy 55 Gy in 25 fractions of 2.2 Gy over 7 weeks (a two weeks rest halfways) followed by a boost dose of 15 Gy over 8 days to the major tumour area. III. Hyperfractionation of 70 Gy over 7 weeks, 1.25 Gy BID with a 6-h interval and a 10-day rest halfways. IV. Combined hyperfractionation and hypofractionation, 35 Gy hyperfractionation in 28 fractions (1.25 Gy BID with a 6-h interval) over three weeks followed by 36 Gy hypofractionation 9 fractions of 4 Gy given every other day over 3 weeks to the major tumour areas only. V. Hypofractionation of 38.5 Gy over 15 days (9 x 3.5 Gy). VI. Combined conventional radiotherapy and hypofractionation with 20 Gy given conventionally in 10 fractions followed by 10 fractions of 3 Gy over two weeks, overall time 4 weeks. The 2-year survival rate of all patients was 21% and the 5-year survival rate 9%. Two patients are still alive more than 6 and 9 years after radiotherapy. Progression occurred after surgery in four patients, during and after chemotherapy in 22 patients and after completed radiotherapy in 29 patients. The pattern of progression was similar in each treatment group.

Adult↗
PubMed1997

Acute rejection diagnosed with computed tomography in a porcine experimental lung transplantation model.

The role of computed tomography (CT) in the diagnosis of acute rejection was studied in an experimental lung transplantation model, with 15 left lung allotransplantations and six autotransplantations performed on piglets weighing 16-24 kg. There were 31 episodes of acute rejection. In the allotransplantation group the development of acute rejection was monitored 115 times with CT, transbronchial biopsy (TBB) and bronchoalveolar lavage (BAL). The stages of acute rejection were 1) ill-defined centrilobular micronodules or minimal patchy ground-glass opacities. 2) dense, small-nodular infiltration or extensive ground-glass opacities, and bronchial wall thickening. 3) lung volume loss and dense, patchy ground-glass opacities and 4) consolidation of the lung. In the autotransplantation group monitoring was done 42 times. After allotransplantation, TBB and BAL suggested rejection 60 times and infection 23 times. CT had 86.7% sensitivity and 85.6% specificity. During the first month these figures were, respectively, 71.4% and 84.2%. Rising histologic grade was associated with increasing stage of acute rejection on CT, which thus proved to be a sensitive and specific method for diagnosing acute rejection of lung transplant.

Acute Disease↗
PubMed1997

Incorrect estimation of severity of acute pancreatitis by contrast-enhanced computed tomography.

BACKGROUND AND AIMS: In acute pancreatitis, contrast-enhanced CT is widely accepted to give reliable information in the early assessment of severity. This study critically evaluates the clinical data, outcome, and CE-CT findings in patients with incorrect radiological estimation of the severity of the condition. MATERIAL AND METHODS: All patients suspected of having severe pancreatitis underwent contrast-enhanced CT. Clinical data and CE-CT findings of 341 patients were re-examined. RESULTS AND CONCLUSIONS: In 28 patients (8.2%) the radiological diagnosis was inconsistent with the clinical findings. The most common reason--in 20 of the 28 patients (71.4%)--for failure to estimate the severity of pancreatitis was partial necrosis of the gland. In severe cases the partial necrosis was overlooked in nine patients (32.1%). In mild cases clinical significance of partial necrosis--overestimated as representative for the whole gland and technical failure both explained the incorrect interpretation in six (21.4%) patients; and in five patients (17.9%) intermediate patchy enhancement was incorrectly regarded as low. The misleading estimation remained inexplicable in only two (7.1%) patients. These results emphasize adequate assessment of CE-CT and inclusion of all areas of the pancreas in the estimation of enhancement.

Acute Disease↗
PubMed1996

Early localization of necrosis by contrast-enhanced computed tomography can predict outcome in severe acute pancreatitis.

A total of 161 primary contrast-enhanced computed tomography (CT) scans of patients with acute necrotizing pancreatitis taken between 1982 and 1994 were analysed retrospectively. The aim was to assess the prognostic significance of the extent and anatomical site of pancreatic tissue necrosis in the first contrast-enhanced CT scan. The scans were obtained a mean of 2.9 days after the onset of symptoms. The pancreatic head was affected in 107 patients, the body in 119 and the tail in 138. Pancreatic tissue necrosis, when divided into four groups according to anatomical site, correlated with overall clinical outcome. The anatomical site of necrosis was clearly better than its crude extent in predicting the risk of complications. For patients with necrosis in the head of the pancreas, the outcome was as severe as when the entire pancreas was affected. In contrast, for patients with necrosis only in the distal part of the pancreas, the outcome was favourable with few complications. The exact site of pancreatic tissue necrosis should be known when early contrast-enhanced CT is used in prognostic scoring.

Acute Disease↗
PubMed1996

Serum trypsinogen-2 in the prediction of outcome in acute necrotizing pancreatitis.

BACKGROUND: The accuracy of serum trypsinogen-2 in predicting the severity of acute necrotizing pancreatitis (ANP) was prospectively evaluated in 52 consecutive patients. METHODS: A new sensitive immunofluorometric assay was used for serum trypsinogen-2, RESULTS: Mean values during the first 24 h were 42.1 micrograms/l in control patients, 1435 micrograms/l in uncomplicated cases, and 4090 micrograms/l in complicated or fatal cases. There was a significant difference in serum trypsinogen-2 values between patients with uncomplicated and complicated disease (p = 0.002) already on admission. When a cutoff level of 1000 micrograms/l was used, patients with uncomplicated ANP were differentiated from patients with complicated ANP with a sensitivity of 91% and with a specificity of 71%. CONCLUSIONS: The immunofluorometric assay of serum trypsinogen-2 is a sensitive and specific method for prediction of the severity of the disease in necrotizing pancreatitis.

Adult↗
PubMed1996

Value of high-resolution computed tomography in routine evaluation of lung transplantation recipients during development of bronchiolitis obliterans syndrome.

BACKGROUND: Chronic rejection is a major long-term complication after lung transplantation. The purpose of our study was to evaluate the role of repeated high-resolution computed tomographic examinations in monitoring the development of bronchiolitis obliterans syndrome after lung transplantation. METHODS: A total of 126 high-resolution computed tomographic examination in 13 lung transplant recipients was analyzed. During a mean follow-up period of 23 months, bronchiolitis obliterans syndrome developed in eight of the patients. A scoring system from 0 to 10 based on the number of chronic changes on high-resolution computed tomography was developed, and the score of each patient was compared with decline in the forced expiratory volume in 1 second and maximal forced expiratory flow rate of 50% of the forced vital capacity. RESULTS: The score of chronic changes, measured at 1 year after transplantation, correlated inversely with the values of forced expiratory volume in 1 second and maximal forced expiratory flow rate at 50% of the forced vital capacity (p < 0.05). Stage I bronchiolitis obliterans syndrome was associated with scores of 4 to 6 (mean 5.0), stage 2 with scores of 6 to 9 (mean 7.0), and stage 3 with scores of 6 to 9 (mean 7.7). The sensitivity of high-resolution computed tomography was 93% and its specificity was 92% when five chronic changes were used as a cutoff level. CONCLUSIONS: The progress of chronic changes on high-resolution computed tomography occurs concurrently with the development of bronchiolitis obliterans syndrome. High-resolution computed tomography may provide additional morphologic information for noninvasive evaluation of chronic lung rejection.

Adult↗
PubMed1995

Early antibiotic treatment in acute necrotising pancreatitis.

Despite improvements in surgical treatment and intensive care, mortality from severe acute pancreatitis remains high. We have carried out a randomised study of 60 consecutive patients with alcohol-induced necrotising pancreatitis to find out whether early antibiotic treatment can improve outcome. 30 patients were assigned cefuroxime (4.5 g/day intravenously) from admission. In the second group, no antibiotic treatment was given until clinical or microbiologically verified infection or after a secondary rise in C-reactive protein. The inclusion criteria were C-reactive protein concentration above 120 mg/L within 48 h of admission and low enhancement (< 30 Hounsfield units) on contrast-enhanced computed tomography. There were more infectious complications in the non-antibiotic than in the antibiotic group (mean per patient 1.8 vs 1.0, p = 0.01). The most common cause of sepsis was Staphylococcus epidermidis; positive cultures were obtained from pancreatic necrosis or the central venous line in 14 of 18 patients with suspected but blood-culture-negative sepsis. Mortality was higher in the non-antibiotic group (seven vs one in the antibiotic group; p = 0.03). Four of the eight patients who died had cultures from pancreatic necrosis positive for Staph epidermidis. We conclude that cefuroxime given early in necrotising pancreatitis is beneficial and may reduce mortality, probably by decreasing the frequency of sepsis.

Acute Disease↗
PubMed1995

Late and acute adverse reactions to iohexol in a pediatric population.

The purpose of this study was to determine the incidence of acute and late reactions after contrast-medium injection in the Finnish paediatric population. From March 1989 to November 1990, 321 children under 19 years of age were examined with a nonionic contrast medium, iohexol, for urography and CT. The follow-up time for late reactions was up to 24 h after the contrast-medium injection. The return rate for the questionnaires given to patients to record their reactions was 73.2%. Acute adverse reaction was noted in 1.9% of the patients, with the most frequent reactions being in the weight range 24-40 kg. Asthma and previous reaction to contrast medium are risk factors for acute reaction. Late reactions were found in 6.2% of the patients, most frequently in children weighing under 24 kg.

Acute Disease↗
PubMed1995

Evaluation of the clinical TNM staging system for malignant pleural mesothelioma: an assessment in 88 patients.

There is no universally-recognised method for staging malignant mesothelioma, although the use of computed tomograph (CT) scanning has improved the staging of non-invasive disease. The International Union against Cancer has recently proposed using the Tumour Node Metastases (TNM) staging system for mesothelioma, but in clinical practice it is difficult to assess tumour and nodal involvement due to the unique plate-like growth pattern of this tumour. In order to evaluate TNM staging we analysed pre-operative CT scans from 88 patients with histologically-confirmed malignant pleural mesothelioma, all from the same institution. The median age of the patients was 56 years (range 38-79). There were 70 men and 18 women, and 33 had tumours with epithelial histology. The median survival time was 10 months (range 0.2-110), from the date of histological confirmation of mesothelioma. The same radiologist analysed all the CT scans according to the TNM staging system. Actuarial survival curves were constructed by the Kaplan-Meier method. Survival curves for the different TNM categories were compared using the log-rank test. Node evaluation could not be completed in eight cases because the tumour had encompassed the hilum and mediastinum. In multivariate analysis, significant differences in prognosis correlated with the different T categories (P < 0.01), and the different TNM stages (P < 0.05), but not the N categories or the M categories. Larger studies are needed to assess the importance of TNM staging in the selection of treatment and as a prognostic factor for malignant mesothelioma.

Adult↗
PubMed1995

Dynamic high-field MR imaging in experimental porcine acute pancreatitis.

The effects of acute pancreatitis on MR imaging signal intensities (SIs) were determined in an experimental study at 1.0 T. Oedematous pancreatitis was induced in 9 piglets and haemorrhagic pancreatitis in 11 piglets. Each animal served as its own control for MR imaging before and after induction of pancreatitis. T1-weighted spin echo (450/15 ms) and dynamic turbo FLASH (flip angle 8 degrees) sequences were used without contrast medium in testing the stability of the SI measurements. There was no significant difference in the SI-versus-time curves of the pancreas in piglets with oedematous and haemorrhagic pancreatitis. However, the difference in mean SIs between healthy and diseased piglets was significant. Thus, although non-contrast MR may be useful in the diagnosis of acute pancreatitis, it does not distinguish between oedematous and haemorrhagic pancreatitis.

Acute Disease↗
PubMed1995

Acute and late adverse reactions to low-osmolal contrast media.

A prospective study of acute and late reactions to low-osmolal contrast media was conducted in 4,875 patients. The contrast medium was injected intravenously in 4,417 patients and intraarterially in 458 for CT, urography or angiography. In the i.v. group only nonionic contrast media, iohexol or iopamidol, were used and in the intraarterial group both ionic and nonionic contrast media, ioxaglate and iohexol, were used. The patients completed 2-phase questionnaires, the rate of reply being 88%. In the i.v. group the incidence of acute reactions was 1.2% and that of late reactions was 4.7%. In the intraarterial group the incidence of acute reactions was 7.4% and the incidence of late reactions was 4.8%. Women and patients from under 40 to 60 years of age were the most susceptible to late reactions. The risk factors for late reactions are allergy, medicine allergy, previous adverse reaction to contrast medium and other diseases including diabetes mellitus, heart-, liver- and kidney diseases.

Acute Disease↗
PubMed1993

Bronchoalveolar lavage fluid findings following radiotherapy for non-small cell lung cancer.

PURPOSE: To evaluate the diagnostic potential of bronchoalveolar lavage fluid analysis in radiation-induced lung injury. METHODS AND MATERIALS: Thirty patients with inoperable non-small cell lung cancer received either high-dose hyperfractionated radiotherapy or radiotherapy and interferon, a potential radiosensitizer, or radiotherapy and N-acetylcysteine, a potential radioprotector. Bronchoalveolar lavages were performed before and immediately after radiotherapy, and thereafter 6-8 weeks and 3 months after radiotherapy. Total and differential cell counts were measured from the bronchoalveolar lavage fluid samples. Urea measured in serum and in bronchoalveolar lavage fluid was used to calculate epithelial lining fluid. The concentrations of protein and phosphatidylcholine, the major surfactant phospholipid, in epithelial lining fluid were measured. The extent of radiation-induced lung injury was assessed from computed tomographies performed before radiotherapy, and 6-8 weeks and 3 months after radiotherapy. RESULTS: More patients in the interferon-arm developed radiation pneumonitis than did patients in the other groups, but no significant differences in alveolar fluid indices were noted between the groups. When all the patients were studied together, radiation was shown to have induced a significant relative increase of lymphocytes in bronchoalveolar lavage fluid 6-8 weeks and 3 months after the end of radiotherapy. The concentration of phosphatidylcholine in epithelial lining fluid decreased significantly 6-8 weeks and 3 months after treatment. The increase in protein concentration in epithelial lining fluid reached a statistically significant level 6-8 weeks after radiotherapy. CONCLUSION: Analysis of bronchoalveolar lavage fluid predicts the degree of radiation pneumonitis; however, radiology remains to be "the gold standard."

Acetylcysteine↗
PubMed1993

Contact fibre Nd:YAG laser for partial nephrectomy: experimental study in pigs.

Thirty-two partial nephrectomies were performed without renal cooling on 13 pigs with a contact fibre Nd:YAG laser (10 W) or a steel scalpel with or without a vascular pedicle clamp. Nine pigs had a 2-week follow-up with an abdominal ultrasound 1 week postoperatively. The time for haemostasis was 6.9 +/- 5.2 min (mean +/- SD) with the laser and 9.1 +/- 5.8 min with the steel scalpel when the clamp was used (P = 0.028). There was no significant difference in the total operating time (13.2 +/- 4.5 min with the laser vs 12.6 +/- 4.6 min with the steel scalpel, P = 0.203). Intraoperative blood loss was similar in the two groups when the clamp was used. Clamping the renal pedicle decreased the blood loss by 61% in the laser group and 31% in the steel scalpel group. The number of ligatures used was significantly lower in the laser group (3.7 +/- 2.6) compared with the steel scalpel group (6.6 +/- 3.4) (P = 0.013). Five urinomas developed on the laser side and four on the steel scalpel side. These results indicate that the contact fibre Nd:YAG laser method can be used in partial nephrectomy, but it offers no definitive advantage over the conventional technique.

Aluminum↗