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Biomedical subjects

M Lempinen

Publications and source records attributed to M Lempinen.

At least 37 records · Page 2Linked to original sources
PubMed1988

Near-total gastrectomy for gastric cancer.

Fifty-nine consecutive patients (95 percent) with gastric cancer of the distal portion of the stomach were operated on with 95 percent subtotal gastrectomy between 1975 and 1980. The operations were for cure in all cases. Twenty-five patients were alive after 5 years, for a crude 5 year survival rate of 42 percent. The operative mortality rate was 5 percent (three patients). Twenty-four patients (41 percent) had complications, which consisted of postoperative respiratory infection in 11 patients (19 percent), postoperative ileus in 4 patients (7 percent), and subphrenic abscess in 2 patients (3.4 percent). In addition, there was one wound dehiscence and one liver rupture (with fatal outcome), one deep venous thrombosis, one urinary infection, and one wound infection. Only one patient (1.7 percent) had an anastomotic leak at the gastrojejunostomy site. Seven relaparotomies (12 percent) had to be performed for complications. We have concluded that, in patients with distal gastric cancer, 95 percent subtotal gastrectomy can result in a 5 year survival rate that is comparable to that reported in the literature for total gastrectomy, and it has the advantage of a very low rate of anastomotic leakage between the minute gastric remnant and the jejunum. Therefore, 95 percent subtotal gastrectomy is recommended over total gastrectomy in the treatment of distal gastric cancer.

Adenocarcinoma↗
PubMed1987

Analysis of 58 patients surviving more than ten years after operative treatment of gastric cancer.

We evaluated 58 patients who were still alive more than ten years after operative treatment of gastric cancer. We reexamined their histologic specimens and compared them with those of matched paired controls of the same sex and age who had died of gastric cancer. Forty-two patients consented to a follow-up study. The age of the patients did not affect survival. For patients with gastric cancer, those with distal cancer or an ulcer simulating cancer had had a better prognosis. Forty percent of the patients had had an early gastric cancer. Only two patients had had lymph node metastases in regional lymph nodes, and macroscopic tumor growth through the serosa had been recorded in only four cases. In 23 cases, a distal resection had proved successful. No significant correlation between intestinal or diffuse types of cancer and prognosis was observed. One recurrence after ten years was found; in one case, there was a new cancer in the gastric remnant. In addition, biopsy specimens from two patients showed grave dysplasia. We suggest that throughout their lives annual follow-up examinations be performed in patients who have undergone radical operations for gastric cancer.

Adult↗
PubMed1987

Total and near-total gastrectomy for gastric cancer in patients over 70 years of age.

A total or near-total gastrectomy was performed in 52 patients over 70 years of age in our hospital from 1975 through 1982. The hospital mortality rate was 9.6 percent. The operation was palliative in nine patients. In these patients, the operation was performed because of an obstructing cancer. At last follow-up, 11 patients had survived more than 5 years and 6 patients were alive and free of disease more than 3 years after the operation. Total and near-total gastrectomies seem to be justified in elderly patients in good overall physical condition.

Age Factors↗
PubMed1987

Aprotinin and Na2CaEDTA in experimental hemorrhagic pancreatitis in pigs.

We have analyzed the effects of aprotinin and Na2CaEDTA on phospholipase A2 activity and on the outcome of experimental pancreatitis in pigs. Hemorrhagic pancreatitis was induced in 29 piglets by infusing Na-taurocholate and trypsin into the pancreatic duct with simultaneous intravenous injection of secretin. Twelve animals serving as controls had no specific treatment. Nine animals were treated with aprotinin and eight pigs with Na2CaEDTA. Ten of the control animals died within 24 h of the induction of pancreatitis, and two of them lived for a week. In the aprotinin group three piglets died within 24 h and two died during the next day; four animals lived for a week. In the Na2CaEDTA group five animals died within 24 h and one the next day; two animals lived for a week. In all the animals serum phospholipase A2 activity increased significantly (p less than 0.01), there being no differences between the groups. In those animals that lived for a week the phospholipase A2 activities decreased on the 2nd day. This decrease was seen in both treated groups. Aprotinin prolonged the survival time of the animals. This prolongation was statistically significant (p less than 0.05, chi-square test, logrank test). Na2CaEDTA did not improve the prognosis of the animals. Neither of the drugs given influenced the serum phospholipase A2 activities during the first hours of the disease.

Amylases↗
PubMed1987

Fecal bile acids related to small-bowel length before and after ileal exclusion.

We studied the relationship among the small-bowel length, the fecal excretion of bile acids and neutral steroids, and cholesterol synthesis in 16 patients with familial hypercholesterolemia before and 1 month after the ileal bypass operation. The mean small-bowel length measured during the operation was 6.3 +/- 0.3 (SEM) m before and 4.3 +/- 0.2 m after the bypass of the distal third of the small bowel. The preoperative fecal bile acid excretion was negatively correlated (r = 0.63, p less than 0.01) with the small-bowel length, whereas this correlation was insignificant for fecal neutral steroid excretion and cholesterol synthesis. Postoperative amounts of fecal bile acids and neutral steroids and cholesterol synthesis were negatively correlated with the length of the small bowel remaining in function (r = -0.52, -0.51, and -0.62, respectively). Our study suggests that fecal bile acid excretion and, hence, bile acid synthesis are related to the small-bowel length even under physiologic conditions.

Adult↗
PubMed1987

Treatment of rectal prolapse. A clinical study of 50 consecutive patients.

The results of surgical treatment of rectal prolapse in 50 consecutive adult patients were evaluated. The mean age of the patients was 51.8 +/- 15.9 years. 8 of the patients were males. 13 of the patients had recurrent prolapse after operations performed earlier elsewhere. There were 4 types of operations: Delorme's mucosal sleeve resection (n = 21), perineal rectosigmoidectomy (n = 7), low anterior resection (n = 12) and abdominal rectopexy (n = 10). There was no operative mortality. The main postoperative complications were perforation or stricture of the rectum in the Delorme group and ileus and anastomotic complications in the low anterior resection group. The frequency of postoperative complications was clearly highest in the low anterior resection group (67%). Follow-up examination was performed 5.2 +/- 3.9 years postoperatively. The recurrence rate of prolapse was highest after perineal operations. Fecal incontinence was almost always associated with recurrence of prolapse and its incidence increased with reoperation. In conclusion, abdominal rectopexy was superior to other forms of operation in the treatment of rectal prolapse. Successfull correction of rectal prolapse does not necessarily rule out the need for later surgery for faecal incontinence.

Adult↗
PubMed1986

Total gastrectomy with esophagojejunostomy. Analysis of 100 consecutive patients.

One hundred consecutive patients treated for gastric cancer by total gastrectomy from 1977 to 1982 at the second department of surgery of the Helsinki University Central Hospital were analyzed. The mean age of the patients was 61.5 years. Gastroscopy proved to be diagnostically superior to roentgenographic examination, particularly in cases of proximally located cancer. The mean length of postoperative hospital stay was 19.7 days, and the hospital mortality was 8 percent. Respiratory complications accounted for nearly half of the complications, and postoperative intraabdominal complications were recorded in 15 patients. Reoperation was performed on eight patients during the initial hospital stay due to complications. The results suggest that total gastrectomy is a safe procedure with an acceptable mortality rate, and it can be recommended both as a curative and a palliative operation in patients with gastric cancer.

Adult↗
PubMed1986

Diagnosis of acute pancreatitis.

The diagnosis of acute pancreatitis is still mainly based on the clinical signs and symptoms of the patients. Systemic organ failure, peritonitis and/or shock indicate severe disease, but to obtain optimal results of treatment the diagnosis of individual patients at high risk should be done before the development of systemic manifestations. A number of laboratory tests are valuable in the follow-up of the patients, but immediate onset of intensive therapy cannot be based on these tests. At present, contrast enhanced CT seems to be the most accurate method for the early detection of hemorrhagic/necrotizing forms of acute pancreatitis.

Acute Disease↗
PubMed1986

The effect of peritoneal exudate on peritoneal morphology in experimental acute pancreatitis. A histologic and scanning electron microscopic study.

Changes in peritoneal morphology were examined histologically and by scanning electron microscopy during porcine acute hemorrhagic (n = 8) and edematous (n = 9) pancreatitis and after intraperitoneal installation of hemorrhagic pancreatitis-associated peritoneal exudate in healthy piglets (n = 3). In all experimental groups peritoneal inflammatory changes with mesothelial damage were evident already 1 h after the induction of the disease, and increased with time. Hemorrhagic pancreatitis caused desquamation of mesothelial cells and denudation of the basal membrane. Intraperitoneal installation of hemorrhagic pancreatitis-associated peritoneal exudate in healthy piglets caused similar changes, whereas the changes in edematous pancreatitis were much less extensive. Peritoneal exudate accumulating in the peritoneal cavity during hemorrhagic pancreatitis caused early chemical peritonitis characterized by severe inflammation of the peritoneum with destruction of the mesothelial cell layer, leading to denudation of the underlying connective tissue. The significance of these changes in the pathophysiology of acute fulminant pancreatitis remains to be further studied.

Acute Disease↗
PubMed1986

Hypovolemic shock and contrast-enhanced computed tomography of the pancreas.

The effect of profound hemorrhagic hypovolemia on cardiac output and pancreatic blood flow was studied in pigs with the thermodilution method and microsphere technique. Approximately 30-40% of the circulating blood volume was withdrawn slowly during 5 h. Cardiac output and pancreatic blood flow decreased by 35% and 32%, respectively. The animals underwent contrast-enhanced computed tomography (CT) before hypovolemia and at 5 h after its onset. The changes in systemic and local blood flow were related to the contrast enhancement of the pancreas. In spite of profound hypovolemia and a significant decrease in pancreatic blood flow (p less than 0.005), the contrast enhancement remained normal. The results of the present study indicate that pancreatic hypoperfusion caused by hypovolemia does not affect the contrast enhancement of the pancreas in CT.

Animals↗
PubMed1986

Microangiography of the pancreas in experimental oedemic and haemorrhagic pancreatitis.

UNLABELLED: Microangiography of the pancreas was performed in five normal piglets and in 10 piglets with oedemic and haemorrhagic pancreatitis in order to evaluate the role of microcirculatory changes in experimental pancreatitis. Acute haemorrhagic pancreatitis was induced by intraductal infusion of trypsin-taurocholate and oedematous pancreatitis correspondingly by infusion of autologous diluted bile. Both types of pancreatitis were confirmed by histological examination. Microangiography of the control animals revealed well-filled arteries, arterioles and capillaries, which formed a dense capillary network. In the areas of histologically documented haemorrhagic pancreatitis, unfilled capillary nets were observed as empty areas in the microangiography. Other areas of focal extravasation of the contrast material could be seen. Arteries and arterioles were well filled. In oedematous pancreatitis, the microangiography was unchanged compared with the control. CONCLUSION: Acute experimental haemorrhagic pancreatitis is associated with severe disturbances in the capillary circulation of the pancreas, whereas in oedematous pancreatitis the microangiography of the pancreas is normal.

Angiography↗
PubMed1986

Effects of dextran 70 versus crystalloids in the microcirculation of porcine hemorrhagic pancreatitis.

The cause of hemodynamic changes occurring during acute pancreatitis remains obscure. Using a pig model of acute hemorrhagic pancreatitis and the reference sample method with 113Tin and 46 Scandium labelled microspheres, blood flow to organs was determined before and five hours after the induction of pancreatitis. Blood pressure, pulse rate and cardiac output were measured hourly. There were two treatment groups. The first group received dextran 70 (5.7 milliliters per kilogram per hour) and saline solution (7.5 milliliters per kilogram per hour) in sufficient amounts to maintain cardiac output at the initial (prepancreatic) level. The second group received saline solution (26 milliliters per kilogram per hour) only and during the experiment the cardiac output was allowed to decrease to approximately one-half of the initial level. In the dextran 70 group, blood flow in various organs stayed at the initial level or was slightly increased. However, in the saline solution group there was a marked and significant decrease in the blood flow in all organs except the antral mucosa, gallbladder and adrenal glands. The changes in the pancreatic fraction of the cardiac output during the experiment were similar to those of other organs in respective treatment groups. In conclusion, adequate infusion of dextran maintains cardiac output and organ microcirculation at the initial level during the early phase of acute hemorrhagic pancreatitis. It is suggested that the hemodynamic changes which develop during acute pancreatitis are mainly secondary to the ensuing hypovolemia and not direct consequences of the pancreatic inflammatory process.

Animals↗
PubMed1986

Results of 32 major hepatic resections for primary and secondary malignancies of the liver.

Thirty-two consecutive liver resections performed during the years 1972-1984 for liver malignancies have been analysed. Among indications for resection were primary liver malignancy and liver secondaries equally often in 16 patients, mostly originating from colorectal cancer (12 patients). Ultrasound (US) was the most reliable diagnostic method being fully confident in 11 patients studied. Computed tomography (CT) missed one lesion out of 13 (confidence rate 92%), whereas angiography and liver scintiscan missed two and three lesions respectively with a confidence rate of 84 and 79. Most of the patients (94%) experienced an anatomical liver resection including 12 extended right lobectomies (ERL), eight right lobectomies (RL), five left lobectomies (LL), and five left lateral segmentectomies (LLS). The hospital mortality (16%) was almost exclusively connected to the ERL procedure with a 33% mortality rate. The crude 3-year survival rate of the series was 28%. Among the patients undergoing liver resection for colorectal cancer secondaries the corresponding figure was 41%. More than half of the patients surviving surgery have died of the same malignancy mostly developing in the remaining liver.

Adolescent↗
PubMed1986

Factors influencing 5-year survival in gastric malignancies after total gastrectomy.

One hundred consecutive patients were analysed who had been treated with total gastrectomy in the Second Department of Surgery, Helsinki University Central Hospital, for malignancies of the stomach from 1977 to 1982. Hospital mortality was 8%. The 5-year survival rate in this selected group of patients was 43% and 34% for patients with gastric cancer. Patients with metastases died within 42 months, more than half of them within one year. However, palliative total gastrectomy is recommended in proximally located obstructing tumours. Radical operations on patients with tumour growth to adjacent tissue and organs had no effect on the 5-year survival rates compared to those on patients with metastases. Surgical removal of the primary tumour is recommended in these cases as well. Patients without lymph node metastases had a survival rate of 67% but the prognosis was even better in cases with intact serosa (96%).

Adult↗
PubMed1986

Fatal pancreatitis. A study of 64 consecutive cases.

An analysis is presented of 64 fatal cases of acute pancreatitis in the decade 1972-1981. In the same period altogether 2842 episodes of acute or relapsing pancreatitis were treated. The male/female ratio in the fatal cases was 49/15, with mean age 46.9/61.4 years. The mortality rate was 22% among patients with acute hemorrhagic pancreatitis and 2.3% among all patients. Of the patients who died, 23% had fewer than 3 Ranson signs, suggesting mild pancreatitis. The etiology of the disease was alcohol in 48% of the fatal cases, biliary disease in 16% and postoperative state in 17%. The study indicated two groups with high mortality rate--young men with a first attack of alcohol-induced pancreatitis and elderly patients with pancreatitis of biliary origin. Systemic complications arose in all patients, the most common being respiratory dysfunction (51%), anuria/uremia (33%) and intra-abdominal complications (31%). The most important causes of death were anuria (27%), respiratory dysfunction (22%) and gastric bleeding (13%).

Acute Disease↗
PubMed1986

Microangiography of the pancreas in experimental hemorrhagic pancreatitis.

In experimental hemorrhagic pancreatitis induced with sodium-taurocholate-trypsin, contrast enhancement of the pancreas in computed tomography (CT) has been shown to be decreased in spite of normal pancreatic blood flow. The contrast enhancement in CT depends on blood flow to the organ, capillary permeability and the amount of extracellular fluid in the organ. For further evaluation of the role of microcirculatory changes in our model of hemorrhagic pancreatitis, microangiography was performed in five normal piglets and in ten piglets with acute hemorrhagic pancreatitis. In this experimental model histological studies showed focal necroses, hemorrhages and leucocyte accumulation. In the affected areas microangiography revealed unfilled capillaries and extravasation of contrast medium. Arteries and arterioles were well filled, as in the normal control animals. These severe disturbances in the capillary circulation of the pancreas may explain the decreased contrast enhancement of the pancreas in CT during acute hemorrhagic pancreatitis.

Acute Disease↗