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Biomedical subjects

M Tarkka

Publications and source records attributed to M Tarkka.

At least 37 records · Page 2Linked to original sources
PubMed1997

Postoperative hyperamylasaemia in cardiac surgery.

The mechanism of postoperative hyperamylasaemia was studied in 48 patients undergoing coronary artery bypass grafting (CABG). Mild hyperamylasaemia developed in 87% of the patients, and in 10% the serum amylase activity was > 1000 U/l. Serial measurements of serum salivary (S-) and pancreatic (P-) isoamylases indicated that hyperamylasaemia was highest 24 hours after CABG and consisted mainly of P-amylase component. Serum creatinine, creatinine clearance and urinary albumin concentration remained normal after CABG, excluding severe renal damage. The fractional clearance (i.e. relative to creatinine clearance) of P-amylase decreased more than of S-amylase (from 3.6 to 0.9% vs 1.3 to 0.8%). Decreased rate of excretion into urine, rather than pancreatic cellular damage, is the main source of hyperamylasaemia after CABG.

Aged↗
PubMed1996

Prostacyclin and thromboxane A2 synthesis are increased in acute lower limb ischaemia.

Prostacyclin (PGI2) and thromboxane A2 (TXA2) play an important role in the pathophysiology of various cardiovascular diseases. The balance between PGI2 and TXA2 regulates the interaction between platelets and the vessel wall in vivo. In this study we measured PGI2 and TXA2 synthesis by analysing their urinary index metabolites 2,3-dinor-6-keto-PGF1 alpha and 11-dehydro-TXB2, respectively, in acute (10 patients) and chronic (10 patients) lower limb ischaemia. Both PGI2 and TXA2 synthesis were increased about two-fold in patients with acute lower limb ischaemia compared to chronic lower limb ischaemia. However, the PGI2/TXA2 ratio was more or less the same in acute and chronic lower limb ischaemia. In patients with acute lower limb ischaemia caused by thrombotic occlusion, PGI2 and TXA2 formation were about two times higher than in patients with acute lower limb ischaemia caused by embolic occlusion. Elevation of PGI2 and TXA2 synthesis in acute lower limb ischaemia may reflect increased platelet-vascular wall interactions without changing the PGI2/TXA2 ratio.

6-Ketoprostaglandin F1 alpha↗
PubMed1996

Effect of antioxidants on postoperative hyperamylasemia in coronary bypass surgery.

Antioxidants may reduce pancreatic cellular injury after coronary artery bypass grafting (CABG) Twenty patients (Group A) received vitamin E (600 mg/ day) for 28 days and vitamin C (2 g/day) and allopurinol (600 mg/day) 2 days before and 1 day after CABG. Seventeen patients (Group C) received all drugs for 3 days, and 25 (Group B) and 19 (Group D) patients served as corresponding controls. The pre- and postoperative pancreatic isoamylase (P-amylase), creatinine, and antioxidant concentrations were measured. Serum hyperamylasemia was highest on the first postoperative day and occurred in 73% of the patients. After surgery serum P-amylase increased in all study groups and urine P-amylase decreased. Postoperative serum hyperamylasemia, whether primarily renal or pancreatic, cannot be decreased by pretreatment with allopurinol, vitamin C, and vitamin E.

Aged↗
PubMed1996

Intimal thickening and fragmentation of the internal elastic lamina in the mesenteric arteries.

To evaluate the intimal thickness and continuity of the internal elastic lamina (IEL) in the mesenteric arteries, proximal segments of the coeliac artery (CA), superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) were studied light microscopically in 123 consecutive postmortem examinations. The mean age of the subjects was 62 years. Arterial segments were fixed in formalin, embedded in paraffin blocks, sectioned, and stained with Masson's trichrome. Fifty-one per cent of the samples examined showed at least minimal intimal thickening. The occurrence of significant luminal narrowing increased with age. We found a positive correlation between defects in the IEL and thickness of the intima in the mesenteric arteries, which is in harmony with previous observations showing marked fragmentation of the IEL in atherogenesis.

Arteriosclerosis↗
PubMed1995

Pretreatment with antioxidants and allopurinol diminishes cardiac onset events in coronary artery bypass grafting.

Oxygen-derived free radicals constitute one part of the etiologic factors for cardiac onset harmful events. Allopurinol is able to reduce the generation of free radicals. Vitamins E and C scavenge radicals after their formation. Eighty-one patients with coronary artery disease were randomized into four study groups: Group 1 (n = 20) patients had stable disease and received oral vitamin E for 4 weeks, and vitamin C and allopurinol 2 days before and 1 day after coronary artery bypass grafting. Group 2 (n = 25) consisted of their controls. Group 3 patients (n = 17) had more unstable disease and received the same medications as group 1, except that vitamin E was given only 2 days before the operation. Group 4 (n = 19) was their controls. Groups 1 and 3 had fewer ischemic electrocardiographic events and required less dopamine perioperatively than corresponding control groups 2 and 4. Group 3 had fewer perioperative infarctions and less creatine kinase-MB release than the respective controls (group 4). Plasma levels of vitamins E and C, urate, and total free radical trapping ability were considered to support the theory about the role of free radicals in reperfusion injury. Especially the unstable patients, but also patients with stable coronary artery disease requiring coronary artery bypass grafting benefit from perioperative allopurinol and vitamin E and C treatment.

Administration, Oral↗
PubMed1995

Misclassification in a questionnaire survey of varicose veins.

The objective of this study was to assess the determinants and the effect of misclassification in a questionnaire survey of varicose veins. A random sample of 166 individuals aged 50 years in a larger prevalence study (n = 6874) was examined by a surgeon to validate the self-reporting of varicose veins. Varicose veins were assessed by a mailed questionnaire completed by the study subjects themselves and validated in a clinical examination by a surgeon. The sensitivity, specificity, positive and negative predictive values, kappa coefficient, and Chamberlain indices of the self-assessed diagnosis in reference to the diagnosis by surgeon were estimated overall and in categories of determinants. The overall sensitivity and specificity estimates were 0.92 and 0.93, respectively. The specificity appeared to be poorer among subjects who reported positive family history of varicose veins (0.83) than among those with negative family history (0.98). With respect to some other determinants of varicose veins such as gender, height and weight, occupational status and position at work, there was at best weak but nevertheless inconclusive evidence on possible differential misclassification. Sensitivity appeared to be relatively good for epidemiologic purposes but one could have hoped for better specificity. The correction for misclassification resulted in estimated prevalence of 19% (uncorrected 24%) in men and 43% (uncorrected 45%) in women. A questionnaire survey of varicose veins showed a relatively good validity. The effect of misclassification in the total 5-year-old study population was small in women but moderately large in men. Familial predisposition to varicosis was associated with a lower accuracy of self-assessed diagnosis.

Adult↗
PubMed1995

Atherosclerosis of the inferior epigastric and internal mammary arteries.

Atherosclerosis of the inferior epigastric artery (IEA) and the internal mammary artery (IMA) was evaluated in 21 patients with coronary heart disease. Both arteries were used simultaneously in coronary artery bypass grafting. Histologic samples were obtained from the proximal and distal segments of IEA and from the distal segment of IMA. Morphologic findings in regard to atherosclerosis were classified semiquantitatively as normal (0), or luminal narrowing <25% (1), 25-50% (2) or >50% (3), or as overt atherosclerosis and calcification (4). Atherosclerosis was absent or minimal (1) in distal samples from both arteries. Only one IMA showed moderate (2) luminal atherosclerotic obstruction. Two samples from proximal IEA showed moderate (2) or severe (4) atherosclerotic changes which limited their use as free grafts. These finding suggest that atherosclerosis is minimal and comparable in distal IEA and IMA in their natural environments even in patients with coronary heart disease. The long-term effect of aortic pressure on free IEA graft is still unclear.

Adult↗
PubMed1995

Deep hypothermia and circulatory arrest in the surgical management of renal cell carcinoma with vena caval involvement.

Six patients operated on for renal cell carcinoma with vena caval involvement were prospectively studied. The mean age of the four men and two women was 58 (range 51-77) years. In four of them the tumour was excised during cardiopulmonary bypass and deep hypothermic circulatory arrest. The operation was radical in three of these patients and palliative in one. There were no major complications or deaths during hospitalisation averaging 9 (7-17) days. The mean follow-up was 9 (4-14) months, during which two patients had died of metastatic disease. The surgical approach with cardiopulmonary bypass and deep hypothermic circulatory arrest is well tolerated and can be used to facilitate complete tumour thrombectomy, with low operative risk. Need for caval tumour thrombectomy was found in 5% of all patients with renal cell carcinoma during the study period.

Aged↗
PubMed1995

Outcome of surgical treatment in acute upper limb ischaemia.

During a 26 years' period, 547 thromboembolectomies were undertaken for acute limb ischaemia. The portion of upper limb ischaemia was 17.7% (97/547). The annual incidence of surgically treated acute upper limb ischaemia was 1.3 cases/100,000/year during the last 15 years of study period. There were 91 patients, 45 males and 46 females, ranging from 17 to 92 years with a median age of 73 years. Pulselessness (96), coldness (94), pain (85), paraesthesia (45) and dysfunction (45) of the affected limb were the main symptoms. The right upper limb was more often affected (59/38, P < 0.05). An embolus originating from the heart was the reason for the ischaemia in 71 cases, while in 11 cases the occlusion was caused by a local thrombosis. In 15 cases the origin of the embolus remained unsolved. In five cases an additional arterial reconstruction was needed to restore the circulation. Reembolectomy of the same limb was needed in five cases, and additionally in two patients, a third embolectomy was unavoidable. A secondary humeral amputation was necessary for one patient. Eleven patients (11.3%) died within 30 days and of these nine did so from recurrent embolism. The mortality was not related to the duration of the ischaemia, but rather to patients' general condition. During a mean follow-up time of 50 weeks a good functional result was achieved in 78 cases (80.4%). The clinical results in ischaemia caused by embolism are markedly better than those of local thrombosis (P < 0.001).

Acute Disease↗
PubMed1995

The incidence of postoperative deep vein thrombosis in vascular procedures. FINNVASC Study Group.

This survey aimed to estimate the rate of deep venous thrombosis (DVT) in an unselected population treated for peripheral vascular diseases. The study comprised 7533 patients on the nationwide Finnish vascular registry (FINNVASC) during two-years study period. Thirty-four (0.45%) patients were reported to have a postoperative thrombosis. Thirty-two (94%) of these had undergone vascular procedures involving the infrarenal aorta or arteries in the lower extremities. There was no difference in the occurrence of determinants (diabetes, hypertension etc.) when the group with postoperative DVT was compared to the rest of the patients on the registry. The procedures involving the lower extremity seem to carry a higher risk of postoperative DVT. In this type of surgery special attention should be focused on DVT prophylaxis.

Adolescent↗
PubMed1995

Local intra-arterial thrombolysis in limb-threatening ischaemia.

The purpose of this study was to determine the angiographic and clinical success rate and the immediate limb salvage and mortality rate after intra-arterial thrombolysis in limb-threatening ischaemia. A retrospective study of 66 patients treated with intra-arterial thrombolysis for 71 episodes of limb-threatening ischaemia was carried out. Immediate angiographic recanalisation rate, pre- and post-treatment ankle-brachial index (ABI) and clinical stage were established. Major amputations and deaths were recorded. The immediate primary angiographic recanalisation was complete in 25 cases and partial in 20 cases. Combined complete plus partial recanalisation rate was thus 63.4% (45/71). The overall mean ABI after treatment was significantly higher than before treatment (0.35 versus 0.68), excluding patients undergoing amputation. Clinical improvement was achieved in 59.2% of cases for one month after treatment. The amputation rate was 18.3% during the first month and 29.6% during the median follow-up of 16 weeks. The mortality rates were 6.1% and 33.3% respectively. Despite a high mortality the complications of thrombolysis were few emphasizing the relative safety of this method in treating limb threatening ischaemia. Furthermore, thrombolysis may identify the underlying pathology, which can be corrected by additional surgery or interventional procedure.

Adult↗
PubMed1994

Inferior epigastric artery as a conduit for myocardial revascularization.

In 18 patients the inferior epigastric artery (IEA) was used for myocardial revascularization along with the left internal mammary artery and saphenous vein (4.5 grafts/patient). Preoperative duplex scan assessment of IEA correctly predicted its distal diameter. At operation the mean internal diameter was 1.6 (1.5-2.0) mm distally and 2.1 (2.0-2.5) mm proximally. The mean in situ flow after intraluminal injection of papaverine was 115 (36-210) ml/min in IEA and 136 (56-210) ml/min in internal mammary artery. There was no perioperative death or myocardial infarction. Morbidity associated with IEA harvesting was minor: ultrasonography showed diastasis and slower contraction of the rectus muscle at the harvesting site than contralaterally in one case. The preoperative duplex scan was useful for evaluating IEA size. All the patients were clinically improved. The patency rate at selective IEA angiography 3 months post-operatively was 72% (13/18). This poor early patency of IEA in our small series raises doubts concerning the vessel's suitability for myocardial revascularization.

Abdominal Muscles↗
PubMed1994

Acute intestinal ischaemia. A review of 214 cases.

The records of 214 patients with acute intestinal ischaemia treated between 1972-1990 were studied retrospectively. The median age of the patients was 74.9 years. A prior history of cardiovascular disease was present in 86% of the patients. Overall mortality of 30 days after the diagnosis was 82%. One hundred seventy-one patients (80%) were operated on. Fifty-one per cent of operations remained exploratory laparotomies. The best results, with a mortality of 51% in 30 days, were achieved in patients who were treated aggressively with bowel resection. Any of the revascularizations (7%) did not turn out to be successful. All the 43 patients (20%) remaining on conservative treatment died. Survivors were usually younger and had less extensive bowel infarction. Thus, the extent and duration of the bowel necrosis were important prognostic factors. To improve the prognosis clinical awareness of the problem and attempts toward early diagnosis should be raised.

Aged↗
PubMed1993

Rheumatoid arthritis as a cause of cardiac compression. Favourable long-term outcome of pericardiectomy.

In order to clarify the significance of rheumatoid arthritis (RA) as a cause of cardiac compression, we scrutinized pericardiectomy files of 47 patients over a ten-year period at two university hospitals in Finland. Five patients with RA were found. All the patients with RA were men with seropositive disease and subcutaneous rheumatoid nodules. Two of the patients had pulmonary fibrosis, one had cutaneous vasculitis and three had had rheumatoid pleurisy. There was a mean delay of 10 months from the first cardiac symptom to the diagnosis of cardiac compression, the most common misdiagnosis being primarily a liver disease. On the basis of clinical and operative data, four out of the five patients had constrictive pericarditis and one had an effusive-constrictive form of the disease. The histopathological findings in all cases were consistent with chronic fibrosing pericarditis. A follow-up of seven to seventeen years of four patients has not revealed any signs of recurrent pericardial disease. Our results demonstrate that RA is an important aetiological factor for cardiac compression. The long-term outcome of this manifestation seems to be good after pericardiectomy.

Adult↗
PubMed1993

Comparison of cardioprotection with crystalloid and blood cardioplegia in CABG patients.

One hundred patients scheduled for elective coronary artery bypass grafting (CABG) were randomly allocated to two groups for myocardial preservation:blood cardioplegia (BCP) or crystalloid cardioplegia (CCP). The study protocol comprised recording of the following parameters: mode of resumption of cardiac rhythm, CK-MB analysis, ECG recording, cardiac output measurement, cross-clamping and perfusion times, and clinical outcome. The study period covered the time from commencement of anesthesia to the first postoperative morning. Spontaneous resumption of sinus rhythm was recorded only in the BCP group (22/51 v 0/49, P < 0.001). CK-MB values were similar in both groups, but 1 hour postoperatively the BCP group had lower values (58.8 +/- 26.7 v 74.5 +/- 31.5 U/L, P = 0.0098 by t test). Fifteen patients in the BCP group did not receive any electric countershock; this subgroup had very low CK-MB values. There were four intraoperative myocardial infarctions in the BCP group and two in the CCP group (BCP: 3/51 v CCP: 3/49, P = 0.68). The results suggest better cardioprotection with blood cardioplegia in this subgroup of patients. Spontaneous resumption of normal cardiac rhythm seems to indicate good myocardial preservation, as reflected in markedly lower CK-MB values in this subgroup.

Blood↗
PubMed1993

Varicose veins in a Finnish population aged 40-60.

STUDY OBJECTIVE: To assess the prevalence and the extent of treatment of varicose veins in a Finnish population. DESIGN: A prevalence study in a defined cohort was performed by using a mailed questionnaire. The method's validity was tested in a random sample of 166 individuals who were studied clinically. SUBJECTS: In 1989 a questionnaire was mailed to every resident born in 1929, 1939, and 1949 who was living in Tampere, the second largest town in Finland. The eligible population comprised 3284 men and 3590 women. MEASUREMENTS AND MAIN RESULTS: The response rate was 75% in men and 86% in women. Both the sensitivity and specificity of the self assessed diagnosis were 0.92. The life time prevalence of varicose veins was 18% for men and 32% for women, with an increasing prevalence in relation to age. Twenty five per cent of the men and 41% of the women who reported varicose veins had received treatment. CONCLUSIONS: Self reporting of varicose veins by mailed questionnaire was a relatively valid method. The prevalence of varicose veins was high in the population studied, and the disease is more common in women than men. Moreover, the prevalence increased with age. The results are comparable with other western populations. Preventive methods are needed because treatment alone seems to be inadequate in the control of varicose veins.

Adult↗
PubMed1992

Reversibility of hypertensive vascular changes after coarctation repair in dogs.

A silk ligature was tied around the aorta at the site of the ligamentum arteriosum in beagle puppies aged 8 wk, and the aortic coarctation was corrected 8 mo later, when the aortic peak-to-peak systolic pressure gradient was 6.0 (SD 0.7) kPa. Similar thoracotomy was performed as a sham operation on the control animals on both occasions. One y after the coarctation repair, there was practically no systolic pressure gradient across the aortoplasty site at rest [0.5 (1.0) kPa]. Histologic examination 12 mo after the correction operation showed the medial and intimal layers of the aortic arch in the aortoplasty group (n = 8) were significantly thicker than those in the control group (n = 7) [media 1.86 (0.06) versus 1.78 (0.08) mm and intima 53.2 (13.3) versus 38.3 (10.9) microns, respectively, p less than 0.05 for both]. The thicknesses of both intima and media of the left anterior descending and circumflexing coronary arteries and descending aorta distal to the aortoplasty site were similar in both groups. The increased vascular wall thickness may cause reduced compliance of the vascular bed above the coarctation site and hypertension after correction of the coarctation. Our results support the finding that patients with repaired aortic coarctation have an increased risk of permanent vascular changes.

Animals↗