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Biomedical subjects

M Tarkka

Publications and source records attributed to M Tarkka.

At least 55 records · Page 3Linked to original sources
PubMed1991

Left ventricular function in dogs 1 year after coarctectomy.

Juxtaductal aortic coarctation was surgically created in beagle puppies at the age of 2 months and resected at the age of 10 months, after the development of good collateral circulation. Control dogs undergoing sham operations on each occasion were studied in the same environment. Cardiac catheterization was performed 1 year after the coarctectomy to evaluate the recovery of the heart. Cardiac output, heart rate, end-diastolic pressure, and Vmax were similar in both groups of seven dogs, but the systolic pressure gradient (SPG) over the operated area during isoproterenol infusion was significantly higher in the coarctectomized group, with a mean of 8.9 +/- 6.3 (SD) vs. 0.1 +/- 0.3 mmHg (p less than 0.05). The preejection period [PEP, 58 +/- 8 vs. 47 +/- 5 ms (p less than 0.01)], electromechanical delay [EMD, 18 +/- 3 vs. 13 +/- 3 ms (p less than 0.05)], and isometric contraction time [ICT, 39 +/- 7 vs. 32 +/- 4 ms (p less than 0.05)], were all significantly longer in the coarctation group after isoproterenol infusion. The results demonstrate that, even though cardiac output increased adequately during loading and mechanical pumping efficiency was preserved, excitation-contraction coupling was still prolonged. Thus, an anatomical successful coarctectomy, even at the age of 10 months, does not fully restore left ventricular function in dogs after chronic experimental coarctation.

Animals↗
PubMed1990

Open lung biopsy of patients with rheumatoid arthritis.

In order to shed light on the histological changes occurring in the lungs of patients with rheumatoid arthritis (RA), we scrutinized an open lung biopsy file of 199 patients and selected the patients with RA. The histopathological patterns observed were: pulmonary rheumatoid nodules (4 cases, including one with rheumatoid pneumoconiosis); usual interstitial pneumonia (UIP) (2 cases); desquamative interstitial pneumonia (2 cases); bronchiolitis obliterans with patchy organizing pneumonia (2 cases); follicular bronchiolitis (1 case); organizing pneumonia always associated with bronchiolitis (3 cases); granulomatous reaction (3 cases); obliterating vasculitis (3 cases); granulomatous vasculitis (1 case); lymphoid hyperplasia (2 cases); and localized pulmonary fibrosis (1 case). The clinical data and laboratory findings for the histopathological groups overlapped and did not properly predict the anatomical picture. Both patients with UIP died of lung disease. Otherwise the prognosis in the series was good.

Arthritis, Rheumatoid↗
PubMed1990

Resectable leiomyosarcoma of inferior vena cava presenting as carcinoma of the pancreas. Case report.

A 61-year-old woman was thought to have a cancer of the head of pancreas on ultrasonography, computed tomography, and endoscopic retrograde cholangiopancreatography (ERCP). At laparotomy, however, the pancreas was normal, and the tumour originated in the inferior vena cava. Histological examination showed a moderately differentiated leiomyosarcoma. The outcome was uneventful after caval resection and reconstruction with a polytetrafluoroethylene (Goretex) patch.

Diagnosis, Differential↗
PubMed1989

Surgery of thoracoabdominal aneurysms.

Seventeen patients with thoracoabdominal aneurysms, including 5 ruptured aneurysms, were operated upon using a left diaphragm-splitting thoracoabdominal incision and the retroperitoneal route. A temporary shunt was used in 13 patients, femorofemoral perfusion in 1 and cold perfusion cooling of the kidneys in 3 patients. The step-by-step reattachment technique into ready-made limbs or holes in the Dacron graft ensured that visceral and renal ischaemic times remained within acceptable limits. The mean renal and proximal clamping times were 44 and 77 min, respectively. One patient with a ruptured aneurysm (6%) died of diffuse bleeding. The others recovered without paraplegic, renal or other severe complications. During the follow-up period, mean 44 months and range 10-116 months, 3 patients died of lung cancer and 2 of coronary disease giving a late mortality of 29%. The remaining 11 patients are alive and well. The cumulative 2- and 5-year survival is 87% and 62% respectively. The patency rate of the grafts was 100% and that of the 30 individually revascularised arteries 80%. We recommend elective surgery for thoracoabdominal aneurysms using a temporary shunt or cold perfusion cooling of the kidneys as a protective measure against perioperative ischaemia.

Adult↗
PubMed1988

Bronchial stenosis after aspiration of an iron tablet.

Stenosis of the right intermediate bronchus was found in a 60-year-old woman four months after aspiration of an iron tablet. Right middle and lower lobe lobectomies were performed. By light microscopy, small amounts of foreign, iron-positive material surrounded by giant cells, large collections of hemosiderin containing macrophages, and severe fibrosis with only minimal inflammation were observed in the bronchial wall. Early diagnosis and management are stressed in order to avoid the stenosing process which is also possible after aspiration of some tablets.

Bronchitis↗
PubMed1988

Survival after surgical treatment of lung cancer.

All 205 patients operated on for primary pulmonary cancer at Oulu University Hospital in 1975-1977 were followed up for 10 years to evaluate the prognostic influence of factors such as lymph-node invasion, size of tumour and histologic type. Preoperative mediastinoscopy was performed on 186 patients (91.2%), and revealed no mediastinal metastases in 182. Nevertheless N 2 (mediastinal) lymph nodes were found in 36 cases at operation and N 1 (perihilar or ipsilateral) nodes in 42. Despite lobectomy or pneumonectomy, all 32 patients (17.2%) with false-negative mediastinoscopy died within a year (mean 7.2 months) of operation. Pneumonectomy was performed in 67 cases (29 right, 38 left), lobectomy or bilobectomy in 125 and exploratory thoracotomy in the remainder. Most of the tumours were epidermoid carcinoma (53.7%). Adenocarcinoma was present in 20%, and large-cell carcinoma and oat-cell carcinoma each in 11.7%. Survival rates were significantly higher in patients without vs. those with lymph-node metastases and in epidermoid or adenocarcinoma vs. small-cell carcinoma.

Adult↗
PubMed1988

Spontaneous dissection of the internal carotid artery.

Spontaneous dissection of the internal carotid artery is not well known in Scandinavia. Several hundred cases have been reported world-wide, but none from Finland. We presume the annual incidence in Finland to be at least 20-30 cases, nearly all of which remain undiagnosed. Our experience of 12 cases indicates that the typical patient is a middle-aged man who after strenuous physical exertion suffers a transient ischemic attack or progressing stroke. Manifestations may include ipsilateral incomplete Horner's syndrome and facial or cervical pain. The diagnosis is based on angiography and verified from repeat angiograms. The most typical finding is an extracranial stenosis or occlusion of the internal carotid artery. Irregular expansion, double lumen and aneurysmal dilation are also fairly common. The stenotic area usually recanalizes in a few months. Nonsurgical management is recommended. Prompt diagnosis and adequate heparinization with simultaneous start of oral anticoagulation seem to give the best final result.

Adult↗
PubMed1987

Delayed left ventricular rupture after mitral valve replacement.

Posterior left ventricular rupture (LVR) is a serious complication following mitral valve replacement (MVR), especially if occurring postoperatively with the chest already closed or the patient in the intensive care unit. Only one of the patients with this delayed type of LVR reported earlier has been treated successfully. Our experience consists of 4 such complications among 161 MVR patients, the incidence being 2.5%. Two of these patients survived. Mechanical factors seem to constitute the most important etiologic causes for this complication. Immediate reoperation must be performed, and extracorporeal circulation is generally mandatory for successful repair. The reconstruction of the ruptured posterior left ventricular wall in both surviving patients was performed from the epicardial surface of the heart using pledget sutures. The auricle of the left atrium was used to cover the site of the tear when bleeding was not stopped with pledget sutures. It usually seems possible to avoid this complication if all mechanical etiologic factors are taken into consideration. After successful correction, a pseudoaneurysm may arise and, for that reason, a cardiac echo sonography follow-up is recommended.

Cardiac Surgical Procedures↗
PubMed1987

Infection prophylaxis in pulmonary surgery: a randomized prospective study.

A prospective randomized study to evaluate the efficacy of antibiotic prophylaxis against postoperative infections was carried out on 120 patients undergoing pulmonary operations. The patients were randomized into two groups of 60 patients each. One group received doxycycline (deoxytetracycline) prophylaxis for five days, and the other received cefuroxime (a second-generation cephalosporin) for one day. The groups were comparable with regard to age, sex, common risk factors, diagnosis, and operative procedures. A reduction in the infection rate was noted in the cefuroxime group (10/60) compared with the doxycycline group (19/60), but the difference was not statistically significant (p = 0.055). In major infections (empyema and pneumonia) there was no difference between the groups (4/60 in the cefuroxime group and 5/60 in the doxycycline group), but a significant (p less than 0.05) reduction was noted in minor infections (6/56 and 14/55, respectively) such as lower respiratory tract infections and prolonged fever. There were no wound infections in the two study groups. There were significantly (p less than 0.05) fewer postoperative fever reactions (axillary temperature greater than 37.5 degrees C) in the cefuroxime group (30/60) compared with the doxycycline group (44/60). Both antibiotics were effective in preventing wound infections, but cefuroxime may also be beneficial in preventing minor respiratory infections. The bactericidal effect of cefuroxime may explain this finding.

Cefuroxime↗
PubMed1987

Decreased renal perfusion after correction of experimental coarctation.

Hemodynamical changes in coarctation were studied with an experimental model. Coarctation of the thoracic aorta was induced in seven puppies at the age of 8 wk. After a 7-month follow-up period a corrective operation with a venous patch was performed. Two dogs were lost a few hours after the correction operation. The remaining five dogs were followed for 12 months postoperatively. Renal perfusion was measured with a 133Xenon washout method just prior to the operation, 1 h, 6 and 12 months postoperatively. The glomerular filtration rate was measured using the 51Cr-EDTA method 1 wk before the operation, 3 wk, 2, 6, and 12 months after it. Six healthy adult dogs were used as controls for glomerular filtration rate measurements. Peripheral renin activity was measured at operation, just before the correction of aortic coarctation, 1/2, 1 h, 1, 3, 7 days, 2 and 6 months after the correction operation. Renal perfusion decreased significantly (p less than 0.05) immediately after the correction operation and rose again during the follow-up. Peripheral renin activity rose significantly (p less than 0.01) from the preoperative values and was at its greatest 1 day after the operation. Later on, peripheral renin activity values returned to normal. Coarctated dogs had significantly (p less than 0.01) lower glomerular filtration rate values than controls in each measurement except at the 2 months postoperative measurement. These results support decreased renal perfusion with resultant increased peripheral renin activity as part of the pathomechanism of the paradoxical hypertension observed after correction of coarctation.

Animals↗
PubMed1986

Renal perfusion in experimental coarctation of the aorta during antihypertensive therapy.

Renal perfusion and the effectiveness of antihypertensive therapy were evaluated in experimental coarctation. A sham operation was performed at the age of two months on one group of dogs (n = 5); coarctation of the thoracic aorta was produced at the same age in a second group (n = 7) which was not treated with antihypertensive drugs; and coarctation was similarly produced in a third group (n = 6) which was treated with antihypertensive drugs; the drug treatment was begun one month after the coarctation operation. After operation, all dogs were observed for seven months under similar circumstances. With high doses of antihypertensive agents (hydrochlorothiazide 25 mg/day, propranolol 80 mg/day, and prazosin 20 mg/day), the blood pressure decreased significantly in the coarctation with treatment group compared with the coarctation without treatment group. Renal perfusion, when measured by xenon-133 washout at the age of five months, was similar in the coarctation without drug treatment and control groups but significantly lower (23% decrease, p less than 0.01) in the coarctation with drug treatment group; renal perfusion was similar in all three groups when measured at the ages of eight and nine months. The observed temporary decrease suggests a need to evaluate renal perfusion during antihypertensive treatment in coarctation in man.

Animals↗
PubMed1986

Association of bronchiolitis with connective tissue disorders.

Among 173 consecutive open lung biopsies, nine gave a histopathological diagnosis of bronchiolitis. Seven of these patients had some connective tissue disorder (CTD), six of whom are presented in this report; two had classical and one possible rheumatoid arthritis (RA), one ankylosing spondylitis, one scleroderma, and one developed classical RA four years after biopsy. Four of the patients were smokers, most suffered from breathlessness and cough. In terms of lung function three patients had obstruction, one both restriction and obstruction and three a decreased diffusion capacity. For control purposes peripheral lung tissue was studied histologically from 24 consecutive smoking patients without CTD who underwent a lobectomy for cancer. Intraluminal plugs and mucosal lymphoplasmocytic infiltration of the bronchiolar walls were more prevalent and abundant in the CTD patients than in the controls (p less than 0.02 and p less than 0.001 respectively). Two CTD patients also showed some obliterative bronchiolitis. Corticosteroids were effective in one out of four patients treated. One patient improved and the others did not show any progression during the follow up. The results suggest that smoking alone does not explain the lesions of the small airways found in CTD patients, and that bronchiolitis may be specifically associated with the basic disorder in such cases.

Bronchitis↗
PubMed1985

Effects of mechanical ventilation and halothane on pulmonary serotonin removal in dogs.

The type of anesthesia and anesthetic drug used may significantly change the capacity of the lungs to regulate blood concentrations of serotonin. This study was performed to examine the possible effect of mechanical ventilation and 1% halothane in ventilation air on pulmonary serotonin removal using C14-serotonin in eight dogs. Mechanical ventilation significantly increased serotonin removal when compared with spontaneous ventilation during anesthesia, the removal rates being 74.4% and 48.4%, respectively. The 1% halothane concentration in ventilation air did not significantly affect the pulmonary serotonin removal. It was concluded that mechanical ventilation protects the organism against harmful cardiovascular effects of serotonin during anesthesia.

Animals↗