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Biomedical subjects

L Kivisaari

Publications and source records attributed to L Kivisaari.

At least 91 records · Page 5Linked to original sources
PubMed1991

Correlations between findings at computed tomography (CT) and at thoracoscopy/thoracotomy/autopsy in pleural mesothelioma.

Thirty five computed tomography (CT) scans of the thorax and upper abdomen of thirty three patients with malignant pleural mesothelioma were correlated with the findings at thoracotomy (28 patients), thoracoscopy (2 patients) or autopsy (5 patients). Pleural thickening with contrast medium enhancement was detected on the CT scans of all patients. This finding was a valuable diagnostic tool, especially in cases of large amounts of pleural effusion and/or only thin layers of tumour barely or not at all visible on plain film chest X-rays. Difficulties in defining the exact extent of the diseases for clinical staging and/or evaluation of treatment response arose at the following sites: diaphragmatic pleura, chest wall, pericardium, mediastinum and mediastinal lymph nodes. Extension into the lung was difficult to identify following chemo- and/or radiotherapy. Our results show that CT is essential in the clinical management of mesothelioma. We recommend that CT scans of the chest and upper abdomen, using contrast medium enhancement, should be required in routine practice and in particular in clinical trials involving pleural mesothelioma.

Adult↗
PubMed1991

Radiographic chest assessment of lung injury following hemithorax irradiation for pleural mesothelioma.

To characterize the nature, extent and time-course of radiation-induced lung injury, and to evaluate the usefulness of serial chest radiographs in this assessment, we studied 253 chest radiographs of 46 patients with pleural mesothelioma given hemithorax irradiation according to one of four different regimens: I 20 Gy; II 55 Gy; III hyperfractionation 70 Gy; IV hyperfractionation 35 Gy followed by local hypofractionation 36 Gy. Lung injury on the chest radiograph was graded from 0 (none) to V (maximal) based on the degree of loss of aerated lung tissue. Grade I changes were present 1-2 mths after radiotherapy in regimens II-IV. Grade V injury had developed in all but 3 out of 4 patients of the 20 Gy group by 6-12 months after irradiation. The extent and time-course of radiation-induced lung injury could be defined by serial chest radiographs alone. However, the documentation of tumour status and/or infections needed additional imaging or laboratory investigation, especially when grade IV-V lung injury was present. For research protocols evaluating radiation-induced lung injury serial chest X-rays are recommended at the following time-points: before treatment and 2, 6 and 12 mths after treatment, with additional computerized tomographic (CT) scans as required for differential diagnosis.

Female↗
PubMed1990

Different imaging methods in the assessment of radiation-induced lung injury following hemithorax irradiation for pleural mesothelioma.

We have characterized the radiation-induced lung injury on serial chest X-rays, CTs and ultralow field MRs and evaluated the clinical value and cost/benefit ratio of the different imaging methods in 30 patients receiving high-dose hemithorax irradiation for pleural mesothelioma. Lung injury was severe in all patients, but non-specific and essentially as described in text-books. CT provided no clinically relevant, cost effective diagnostic advantage over conventional X-rays in the detection of early or late radiation-induced lung injury, but it was necessary for the evaluation of the disease status of mesothelioma. The possible advantage of MR over CT could not be evaluated and needs further studies. Optimal time-points for imaging CTs or MRs to detect early radiation-induced lung injury following high dose hemithorax irradiation were during the latter part of treatment or very shortly after the end of irradiation. Late injury or irreversible fibrosis developed rapidly after 6 months and was clearly documented by chest X-rays. We recommend serial chest X-rays at 1-2, 6 and 12 months following radiotherapy as a cost-effective method for the detection of radiation-induced lung injury with additional CTs to document the stage of mesothelioma, when needed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Deranged vitamin D metabolism but normal bone mineral density in Finnish noncirrhotic male alcoholics.

To study the effect of prolonged ethanol consumption on calcium metabolism and on the prevalence of osteoporosis we examined 38 Finnish noncirrhotic male alcoholics (30-55 years of age) with dietary interviews and biochemical measurements and by measuring the bone mineral content of the forearm using single photon absorptiometry (SPA) and the bone mineral density of the spine, humerus and proximal femur using nonquantified computer tomography (CT) and dual-energy x-ray absorptiometry (DEXA). In comparison two groups of healthy controls were studied. The mean daily dietary intake of calcium was 1.3 g in the patients and 1.2 g in the controls. The dietary intake of vitamin D was equal in the study groups, too. The serum levels of calcium, phosphate and parathyroid hormone did not show any difference between the patients and controls but in the alcoholics the urinary excretion of calcium was reduced by 42% (p less than 0.0001) as compared to the controls. The serum levels of 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D3, and 24,25-dihydroxyvitamin D3 were reduced in the alcoholics by 40% (p less than 0.0001), 23% (p less than 0.01), and 48% (p less than 0.0001), respectively, as compared to the controls. The alcoholic men had normal levels of serum testosterone and they did not have hypercortisolism. The bone mineral content of the dominant forearm measured by SPA was similar in the study groups as were the bone mineral densities (BMD) of the lumbar and humeral areas measured by CT. The BMD at the lumbar, femoral neck, Ward's triangle and trochanter sites measured by DEXA did not differ, either.(ABSTRACT TRUNCATED AT 250 WORDS)

24,25-Dihydroxyvitamin D 3↗
PubMed1990

Changes in surfactant in bronchoalveolar lavage fluid after hemithorax irradiation in patients with mesothelioma.

Experimental studies have shown that the surfactant system of the lung is affected shortly after irradiation. It is unclear, however, whether surfactant plays a role in the pathogenesis of radiation pneumonitis. In the present study surfactant components (saturated phosphatidylcholine, surfactant protein A, phosphatidylglycerol, and phosphatidylinositol) and other phospholipids of bronchoalveolar lavage fluid (BAL) were studied in four patients with pleural mesothelioma before and during hemithorax irradiation (70 Gy) as well as zero, 1, 2, 3, and 4 months following irradiation. The concentrations of these same components and of soluble proteins were also estimated in the epithelial lining fluid (ELF) using urea as a marker of dilution. After radiotherapy, the concentrations of the surfactant components in ELF decreased to 12 to 55% of the control values before radiation, whereas the concentration of sphingomyelin in ELF increased ninefold. There were small changes in the other phospholipids. The concentration of soluble protein in ELF increased sevenfold. The minimum surface activity of crude BAL increased from 12 +/- 4 to 32 +/- 6 mN/m, and that of the sediment fraction of BAL increased from 7 +/- 4 to 22 +/- 6 mN/m, p less than 0.001. The protein-rich supernatant fraction of BAL from irradiated lung had a inhibitory effect on normal surfactant. There were significant correlations between the increasing severity of the radiologic changes on the one hand and, on the other, the saturated phosphatidylcholine/sphingomyelin ratio (p less than 0.001), the concentrations of soluble protein (p less than 0.001), and the concentrations of the surfactant components (p less than 0.02-0.001) in ELF.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Percutaneous nephrostomy in the management of urinary leakages and fistulas.

Treatment with percutaneous nephrostomy (PN) without co-existing stents was attempted in 18 patients with urinary fistulas and leakages. Seven patients were cured by PN alone. Two of these developed a ureteral stricture at the site of the lesion: one showed no impairment of urinary flow on the follow-up, the other needed continuous urological surveillance. In the remaining 6 cases PN provided temporary relief of the associated urinary stasis. Percutaneous nephrostomy could not be applied in 5 cases because of the lack of renal pelvic dilatation. Only catheter related complications occurred. Because of its easy and little traumatic technique, simple PN could be used as the primary therapeutic approach in such lesions.

Adult↗
PubMed1990

Percutaneous evacuation of abdominal abscesses and fluid collections--aspiration or catheter drainage?

Ninety-three abdominal abscesses and fluid collections (pseudocysts, hematomas and bilomas) in 79 patients were treated under radiological guidance, for a total of 111 procedures (23 needle aspirations (NA) of 17 foci and 88 catheter drainages (CD) of 84 foci). In eight foci both methods were used. Catheter drainage was curative in 65% of abscesses and in 56% of pseudocysts and improved the patients' condition before surgery in another 11% or 10%, respectively. The aim of CD could not be achieved in 24% of the abscesses and in 34% of the pseudocysts. Needle aspiration showed little effect being curative in only 6% and partially beneficial in 24% as all the foci were considered. Complications occurred in 8% of CD:s and in 0% of NA:s. We suggest that radiologically guided CD of abscesses and fluid collections should be the primary therapeutic approach in all cases where this can be performed safely. The therapeutic effect of NA was poor.

Abdomen↗
PubMed1989

Pseudocysts in chronic pancreatitis. Surgical results in 102 consecutive patients.

Preoperative symptoms, diagnoses, and postoperative outcomes in 102 consecutive patients with pancreatic pseudocysts were analyzed. Upper epigastric pain, loss of weight, obstructive jaundice, and sudden arterial bleeding from the pseudocyst were the most common preoperative symptoms. Ultrasonography, computed tomography, and endoscopic retrograde cholangiopancreatography were the most useful diagnostic tools in the evaluation of the presence, size, location, and possible pancreatic ductal communications of the pseudocyst. In a single thick-walled pseudocyst, the best long-term results were achieved by internal drainage. Pancreatic resection is justified if the patient already has diabetes or multiple pseudocysts or if the pseudocyst is not amenable to internal drainage. The most fatal preoperative complication was a sudden arterial bleeding from a pseudocyst. In treating this complication, hemostasis with transcystic arterial ligation and external drainage of the pseudocyst gave the best results.

Adult↗
PubMed1989

Microangiography and dynamic computed tomography in experimental chronic pancreatitis in the pig.

Chronic pancreatitis was induced in 22 piglets by dividing all pancreatic attachments to the duodenum. Ten piglets served as controls. The animals were subjected to dynamic computed tomography (CT) two, four or six weeks after operation. Microangiography was also performed on the pancreas two, four or six weeks after operation, following dynamic computed tomography. Microangiography revealed significant changes in the vasculature in advanced chronic pancreatitis. The arteries and arterioles were fewer than normal, their walls were thickened and their diameters exhibited variation. The capillary network was loose and the capillaries were not as well filled as in healthy animals. Contrast enhancement of the pancreas was, however, similar in all experimental animals to that in the healthy controls. It was concluded that the morphological changes seen in chronic pancreatitis histologically and on microangiography could not adversely affect contrast-enhanced CT because there were no changes in the function of the capillary network. On the basis of these results, dynamic CT should give no more information than CT with intravenous contrast medium in chronic pancreatitis.

Angiography↗
PubMed1989

Thyroid gland: US screening in middle-aged women with no previous thyroid disease.

To determine the prevalence of thyroid nodules in the healthy population, ultrasonography (US) of the thyroid gland was performed in 101 women aged 49-58 years in an urban area in southern Finland where goiter is not considered endemic. Subjects with any previous thyroid disease were excluded. Thyroid nodules or abnormalities of the echo structure were found in 36 (35.6%) subjects. Seventeen (47.2%) subjects had solitary nodules, 14 (38.9%) had multiple nodules, and five (13.9%) had diffuse abnormalities. Subjects with abnormal findings at US were further examined with fine-needle aspiration biopsy. Clinical examination and blood tests were performed for evaluation of levels of thyroxine, thyroid-stimulating hormone, and thyroid antibodies. One patient had a leukemic thyroid nodule, but no primary thyroid malignancies were found. In most cases, cytologic findings were benign and nonspecific, with a variable amount of degenerative changes. Three atoxic multinodular goiters and two cases of Hashimoto thyroiditis were detected. The results are in accordance with autopsy studies indicating that focal nodular changes of the thyroid gland are common in middle-aged women.

Biopsy, Needle↗
PubMed1989

Magnetic resonance imaging in detecting acute oedematous and haemorrhagic pancreatitis: an experimental study in pigs.

The present study was undertaken to evaluate the role of magnetic resonance imaging (MRI) in the diagnosis of pancreatic inflammation. It was focused on the use of ultra-low- and low-field MRI imagers because of the good results achieved with them in detecting intracranial oedema and haemorrhage. In addition, there are 16 ultra-low-field MRI imagers in clinical use in the world. Nineteen piglets were examined by computed tomography (CT) and then by two MRI prototype imagers operating at 0.02 and 0.17 T. The level of the pancreas was selected on CT. Oedematous pancreatitis was induced in 9 animals by intraductal injection of autologous bile and haemorrhagic form in 7 animals by intraductal injection of 15% Na-taurocholate-trypsin with simultaneous intravenous secretin injection. After 6 or 24 h the animals were re-examined by both CT and MRI. The results show that haemorrhagic-necrotizing pancreatitis can well be differentiated from oedematous pancreatitis by CT. On MRI using an ultra-low or low magnetic field the pancreas was difficult to identify and the different forms of pancreatitis could not be differentiated. Thus, at present CT with or without contrast enhancement is superior to ultra-low-field MRI in detecting and estimating the severity of acute pancreatitis. Further progress in the MRI techniques probably improves the results in the future.

Acute Disease↗
PubMed1989

Endocrine abnormalities in patients with adrenal tumours incidentally discovered on computed tomography.

To determine endocrine activity of adrenal tumours incidentally discovered on C.T., we examined 20 consecutive patients. They underwent thorough hormonal assessment and scintigraphic scanning with radioactive cholesterol under dexamethasone suppression (19 patients). Biochemical findings compatible with cortisol hypersecretion were detected in 5 patients. One patient had reduced reserves of cortisol secretion and one had hyporeninemic hypoaldosteronism. The scintigraphy showed no uptake in 10, unilateral uptake in 4, and bilateral uptake in 5 patients. In 3 patients the finding was unilateral on CT. but bilateral on scintigraphy. Signs of autonomous cortisol production were more common among patients who had uptake on scintigraphy. At the operation of 8 patients only benign lesions were found. During the follow-up (9 to 49 months) of the 12 unoperated patients, the tumour disappeared in one and remained unchanged in the others. No changes occurred in the biochemical findings except in one patient whose cortisol response to 1 mg of dexamethasone became abnormal. Since slight hypercortisolism or a bilateral disease often exists behind an incidentally discovered adrenal tumour, we emphasize the importance of careful assessment of cortisol metabolism and a scintigraphic scanning under dexamethasone suppression in the examination of these patients.

17-Ketosteroids↗
PubMed1989

Experimental chronic pancreatitis in the pig.

Chronic pancreatitis was induced in 22 piglets by dividing all pancreatic attachments to the duodenum; five sham-operated piglets served as controls. Two piglets died of postoperative complications. The animals were autopsied 2, 4, or 6 weeks postoperatively. All operated animals developed chronic pancreatitis. Concomitant with the development of interstitial fibrosis, an increasing progressive atrophy of the exocrine parenchyma occurred, with preservation of the islets of Langerhans. This atrophy and fibrosis were considerable already after 2 weeks. In one piglet only there was some acute inflammation and fat necrosis, whereas all showed at least moderate chronic inflammation, which did not change with time. The growth of the piglets stopped, and all had diarrhoea, which was thought to reflect exocrine insufficiency. Two animals (9%) developed a large pancreatic pseudocyst, and all animals had wide pancreatic ducts. The endocrine function was undisturbed. Intravenous glucose tolerance tests showed that the animals did not become diabetic. This model is appropriate for the study of experimental pancreatitis.

Animals↗
PubMed1989

The possibility of using celiac trunk branches as coronary artery bypass grafts.

The internal mammary artery has proved to be superior to the saphenous vein for coronary artery bypass grafting, because of its arterial nature and closer approximation in size to the coronary arteries. But the internal mammary artery cannot reach the posterior surface of the heart as a pedicled graft. Two suitable intra-abdominal grafts can reach that surface, viz. the right gastroepiploic artery and the splenic artery. In experiments on eight dogs (weight 9-13.5 kg), the gastroepiploic artery was found to be too small for coronary artery anastomosis, and therefore the splenic artery was used. The size approximation with coronary artery (diameter less than 1 mm) was good. Four dogs survived the month of the study. In two of them the anastomosis was patent, in another the splenic artery was patent despite occlusion of the anastomosis, and in the fourth dog both anastomosis and graft were thrombosed. The possibility of using visceral arterial grafts in coronary surgery is discussed.

Anastomosis, Surgical↗
PubMed1988

Dominant and recessive polycystic kidney disease in children: classification by intravenous pyelography, ultrasound, and computed tomography.

Both dominant and recessive polycystic kidney disease appear in childhood. We have analyzed findings of intravenous pyelography, ultrasound and computed tomography in genetically classified cases of dominant (13 children) and recessive polycystic kidney disease (5 children) and thus defined criteria by which sporadic cases of childhood polycystic kidney disease can be classified to dominant or recessive polycystic kidney disease.

Child↗
PubMed1988

Comparison of magnetic resonance imaging with computed tomography and intravesical ultrasound in staging bladder cancer.

Magnetic resonance imaging (MRI), computed tomography (CT), and intravesical ultrasound (US) scanning were performed on 11 patients in whom infiltrative bladder cancer was suspected at cystoscopy. Equipment with magnetic field 0.02 T was used for the MRI. Tumors larger than 2 cm could be identified in all cases by MRI. In 3 of 4 cases in which the tumor was smaller than 2 cm, it could not be properly visualized and the degree of infiltration could not be assessed. When the tumor was visualized on MRI, tumor staging by MRI was correct in 7 of 8 cases (88%). Infiltration of the deep muscle layer of the bladder wall could be detected by MRI but not by CT. Intravesical US staging was correct in 7 of 9 cases (78%). As a noninvasive method, MRI is promising for the preoperative evaluation of bladder cancer and offers the advantage of imaging the bladder in different planes.

Adult↗