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Biomedical subjects

L Nuutinen

Publications and source records attributed to L Nuutinen.

43 records · Page 3Linked to original sources
PubMed1977

Traumatic splenic rupture.

71 patients with traumatic splenic rupture are reported. Most had severe associated injuries. In 44 patients the mechanism of trauma was blunt, in 10 penetrating, and in 17 iatrogenic, occurring most commonly (11/17) during operations for peptic ulcer. Splenectomy gave use to thrombocytosis which reached its peak about 2 weeks and returned to normal within one month after operation. Postoperative complications occurred in 24 of the 60 surviving patients (40%) of which most, 17 patients (30%) were infectious in origin. One patient developed deep venous thrombosis. Mortality was 16%. Associated injuries were the main cause of death in most patients (9/11), the ruptured spleen being responsible for only 2 deaths. None of the 17 patients with injury to the spleen alone died, whether associated with fractures of the left lower ribs or not. Primary unconsciousness, shock on admission, and multiple injuries, especially renal and hepatic, increased the mortality rate markedly. The necessity of drainage, the possibility of increased susceptibility of splenectomized patients to infection and thromboembolic complications and their prevention are briefly discussed.

Accidents↗
PubMed1977

Management of injuries of the large intestine.

Blunt trauma accounted for 1/3 of the 32 patients operated upon for injuries of the large intestine and penetrating wounds for 2/3. Most of the blunt injuries (9/10) were caused by traffic accidents, and more than half of the penetrating ones (12/22) were stab wounds. The transverse colon was most commonly affected, followed by the ascending, descending and sigmoid colon, rectum and mesentery. Perforation of the small intestine was the most frequent associated intra-abdominal injury, occurring in 11 patients (34%). Most patients (22/32) underwent simple suture, 6 patients suture with proximal colostomy, 3 primary resection and one exteriorization, combined in all cases with broad-spectrum antibiotic coverage and drainage of the abdominal cavity. Injuries to the right and transverse colon were managed mainly with simple suture, and those to the left colon and rectum with suture and proximal colostomy. 50% of the patients had complications, most frequently wound infection and intra-abdominal abscess. The patients with simple suture had fewer complications than the others. In the absence of complicating factors injuries to the colon are best managed with simple suture, whereas in the presence of complicating factors and in injuries of the rectum, suture or resection with proximal colostomy, especially in cases of severe tissue destruction, remains the treatment of choice.

Accidents↗
PubMed1976

Cardiopulmonary bypass time and renal function.

Patients undergoing open-heart surgery were divided into two groups according to cardiopulmonary bypass time: in Group I the bypass time was less than 60 minutes (25 patients) and in Group II more than 60 minutes (25 patients). Renal function parameters were investigated preoperatively, during the operation and for two days-postoperatively. The urine volume and excretion of sodium and potassium increased significantly in both groups during the bypass period compared to the values of the pre-bypass period. Significant differences (p less than 0.001) were seen during the bypass period in free water clearance: -0,8 +/- 0.6 ml/min in Group I and -0.2 +/- 0.2 ml/min in Group II, and in creatinine clearance: 114 +/- 42 ml/min in Group I and 60 +/- 12 ml/min in Group II. The inter-group differences in free water and creatinine clearances were significant (p less than 0.001) from the bypass period to the second day period. In Group II, urine osmolality was significantly lower in serum osmolality significantly higher from the bypass period to the third day period compared to the values of Group I. The excretion of sodium and potassium was higher in Group I during bypass and postoperatively and this was reflected in the serum values of sodium and potassium. According to our results, signs of functional renal impairment were seen in the group with the longer perfusion. In this group, however, the patients were older and had a higher preoperative serum creatinine mean value than the patients with the shorter perfusion. The mechanism of functional renal impairment is discussed.

Adolescent↗
PubMed1976

The effect of prophylactic use of furosemide on renal function during open heart surgery.

Forty-five patients who underwent open heart surgery were divided into a short-perfusion group (SPG, 21 patients) with a perfusion time shorter than 60 minutes and a long-perfusion group (LPG, 24 patients) with a perfusion time longer than 60 minutes. Nine patients in the SPG and 13 in the LPG received furosemide prophylactically prior to the perfusion. The furosemide dose was 20-60 mg. During the perfusion and postoperatively all patients were given furosemide when necessary, i.e. when the volume for diuresis per hour declined below 40 ml/h. The patients who received prophylactic furosemide in the LPG subsequently had clearly less need for furosemide (3.9 mg/h) than the control subjects (7.9 mg/h/3 day). The patients with furosemide prophylaxis in the LPG had significantly ( less than 0.05) higher creatinine clearance and lower serum creatinine values during the postoperative night period and on the 3rd day. In perfusions lasting less than 60 minutes the patients with furosemide prophylaxis had significantly higher urine flow (p less than 0.001), sodium excretion (p less than 0.001) and potassium excretio-n (p less than 0.01) during bypass surgery and postoperatively compared with that of controls. According to our findings, the prophylactic use of furosemide had a beneficial effect on glomerular filtration rate (endogenous creatinine clearance) and postoperative serum creatinine level in LPG. In perfusion shorter than 60 minutes furosemide prophylaxis may be harmful owing to the increased excretion of water, sodium and potassium.

Acute Kidney Injury↗
PubMed1975

Blood sugar levels during routine fluid therapy of surgical patients.

The study was carried out to investigate the variations in blood sugar values during routine fluid therapy in surgical patients, when the rate of infusion often is very haphazardly adjusted. Surgical patients with normal sugar and fluid balance were divided into two groups. The glucose group (34 patients) was given 5% glucose solution as infusion fluid and the control group (the saline group, 26 patients) received 0.9% physiological saline solution. The preoperative mean value of blood sugar in the glucose group was 4.9 mmol/1 and in the saline group 4.6 mmol/1. Half an hour after the beginning of the operation the blood sugar in the glucose group rose to 7.2 mmol/1 (p smaller than 0.001) and in the saline group to 5.3 mmol/1 (p smaller than 0.01). At the end of the operation the blood sugar values in both groups had further increased significantly from the half-hour levels, in the glucose group to 7.8 mmol/1 and in the saline group to 6.1 mmol/1 (p smaller than 0.01). The difference between the groups, at each test after the initial test, was highly significant throughout (p smaller than 0.001). The result indicates to carefulness in using glucose solutions even during operations lasting 1-2 hours.

Adolescent↗