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Biomedical subjects

O Suomalainen

Publications and source records attributed to O Suomalainen.

35 records · Page 2Linked to original sources
PubMed1992

Does the anesthetic method influence the postoperative breathing pattern and gas exchange in hip surgery? A comparison between general and spinal anesthesia.

We studied the effects of elective hip surgery, performed under either spinal (SA, n = 10) or general anesthesia (GA, n = 10), on breathing pattern and gas exchange. Measurements were made with respiratory inductive plethysmograph and indirect calorimetry in two positions before and after surgery. The method of anesthesia had no effect on the severity of postoperative hypoxemia. Reduced arterial oxygenation (PaO2; P less than 0.001, SA from 12.5 +/- 2.37 kPa to 10.5 +/- 1.38 kPa, GA from 12.5 +/- 2.95 kPa to 10.5 +/- 1.75 kPa) despite increased alveolar ventilation (P less than 0.01; from 2.30 +/- 0.37 l/min to 2.39 +/- 0.43 l/min in SA, 2.27 +/- 0.56 l/min to 2.57 +/- 0.35 l/min in GA) and reduced arterial carbon dioxide partial pressure (PaCO2; SA from 5.20 +/- 0.22 kPa to 4.95 +/- 0.33 kPa, P less than 0.01, GA from 5.07 +/- 0.36 kPa to 4.72 +/- 0.41 kPa, P less than 0.05) indicated maldistribution of ventilation and perfusion. Changes in breathing pattern and gas exchange and differences between the groups were minimal. Minute ventilation, tidal volume and mean inspiratory flow remained unchanged in both groups. The contribution of rib cage to tidal volume increased postoperatively in the supine position (P less than 0.001; SA from 32.6% +/- 10.3 to 46.3% +/- 7.5, GA from 36.5 +/- 16.4 to 48.5% +/- 15.4). CO2 production, oxygen consumption and energy expenditure remained unchanged. The postoperative changes in breathing pattern are related to the operation, not to the type of anesthesia and do not explain the alterations in gas exchange.

Adult↗
PubMed1991

Thromboprophylaxis in patients with hip fractures: a prospective, randomized, comparative study between Org 10172 and dextran 70.

A prospective, randomized, assessor-blind trial has been undertaken to compare the thromboprophylactic effect and safety of the heparinoid Org 10172 (a mixture of low molecular-weight sulfated glycosaminoglycuronides) and dextran 70 in patients operated on for hip fracture. Prestudy biostatistical calculations led to the need for 260 patients. Three hundred eight patients were randomized and 19 were excluded after randomization, the majority because of postponed surgery. Analyses were made on the 289 patients on an intention-to-treat basis, as well as on the 247 patients given correct prophylaxis. Diagnosis of deep vein thrombosis was based on bilateral ascending phlebography on postoperative days 10 through 12. The frequency of deep vein thrombosis on an intention-to-treat basis was 10% in the Org 10172 group and 30% in the dextran 70 group and, on the basis of correct prophylaxis, 12% and 31%, respectively, both differences being significant (p less than 0.001). Two-month mortality rates were equal in the groups. Three fatal pulmonary emboli were seen in the dextran group. Significantly more patients in the dextran group received postoperative transfusions; no other differences in various hemorrhagic parameters were seen. Thus it can be concluded that Org 10172 has a significantly better thromboprophylactic effect than does dextran in patients with hip fractures without significant side effects.

Aged↗
PubMed1990

The use of fibrinogen uptake test in screening for deep vein thrombosis in patients with hip fracture.

255 hip fracture patients were studied by 125I-fibrinogen uptake test and bilateral phlebography. We found the sensitivity of fibrinogen scanning to be 44% for the non-operated limb and 50% for the calves. The predictive value of a negative result was found to be 92% and 93% respectively. We conclude that the use of fibrinogen uptake test as single diagnosticum is not valid and can only be recommended in combination with phlebography when studying patient where the frequency of DVT is expected to be low.

Fibrinogen↗
PubMed1985

Long term results of late reconstruction for anterior or anteromedial instability of the knee.

Forty-one patients who had had surgical repair for anterior or anteromedial instability of the knee were examined on average 3.7 years after the operation. Of these patients, 17 had been injured in sports activities, 11 in work accidents, 5 in traffic accidents and 8 during other activities. Twenty-six patients underwent intra-articular reconstruction of the anterior cruciate ligament where the Jones procedure was used, 7 with the HeyGroves procedure, and 2 by the Eriksson procedure. The remaining 6 patients were treated by transfer of the gracilis, semitendinosus tendon or fascia lata. During the operation, the medial collateral ligament was reefed in 4 knees and Mauck's reconstruction was performed on 4 knees. Medial meniscectomy was carried out in 9 patients. The results were evaluated using subjective, functional and objective criteria. The objective criteria included both clinical examination and stress radiography using a specially designed apparatus. Laxity of the medial collateral ligament and anterior drawer sign were recorded on radiographs, using the uninjured knee for comparison. The operation was estimated to have been successful subjectively (excellent or good) in 25 patients, functionally successful in 20 and objectively successful in 23 patients. In the personal opinion of 33 patients the knee improved. Meniscectomy and long follow-up time were found to cause a decrease in successful results. More arthritic changes appeared if meniscectomy had been performed. The patients returned to work within an average period of 3.7 months. In 7 cases the result was classified as functionally poor, and the knee required a subsequent operation.

Accidents↗
PubMed1985

The 125I-labelled fibrinogen uptake test in elective hip surgery.

The value of the 125I-labelled fibrinogen uptake test as a screening method for deep vein thrombosis was estimated in 49 patients (97 extremities) undergoing elective hip operations. The legs were monitored preoperatively, on the 1st, 2nd and 4th postoperative days. Contrast venography, as a reference method, was performed on the 5th postoperative day. The sensitivity was 73%, specificity 85%, positive predictive value 63%, negative predictive value 86% and correlation coefficient 55%. 78% of fibrinogen uptakes appeared within the first 24 hours, and 6% on the 4th postoperative day. Only 1 of 3 patients with a positive fibrinogen uptake test in the femoral region had roentgenologic evidence of deep vein thrombosis. According to these results the isotope-labelled fibrinogen uptake test can also be utilized as a screening method in elective hip surgery.

Fibrinogen↗
PubMed1985

Secondary repair of digital flexor tendons in outpatient clinic.

A total of 32 digits, including 3 thumbs, were reconstructed in an outpatient clinic. The patients were allowed to go home 3-4 hours after the operation. The patients had injury to the flexor tendon in no man's land without other complications except for an injury to the digital nerve in 6 cases. The tendon was reconstructed secondarily using a free graft. The minimum follow-up time was 6 months. The results were classified in three ways. With all methods the results, which were deemed satisfactory in 79% and poor in 21%, reached the average standard for this type of repair. Increasing age of the patients, injury to the pulley, preoperative adhesions, digital nerve injury, and time elapsed from injury to surgery impaired the results. This study indicates that tendon surgery of the hand with short postoperative care can also be conducted with satisfactory results in an outpatient clinic.

Adult↗
PubMed1985

Surgical treatment for nonunion of the carpal scaphoid.

Between 1978 and 1982, 23 male patients were operated on for delayed union or nonunion of scaphoid fractures. The average age of these patients at follow-up examination was 32.5 years. Twenty patients were treated by bone grafting using the Matti-Russe technique; in 2 patients the proximal fragment was excised for avascular necrosis, and in one patient a Swanson prosthesis was used. Bony union occurred in 18 patients treated with the Matti-Russe technique. The patients' subjective evaluations agreed with radiological results. Ten of the patients had no pain; 8 had pain only during strenuous activity, and 2 patients with subsequent nonunion had pains with moderate activity. Bony union with minor dislocation did not influence the results. Results according to radiological and clinical findings were judged to be excellent in 2 patients and good in 13 patients. According to the patients' own subjective evaluation, 7 assessed the results as excellent and 11 as good. At the follow-up examination 4 patients had normal gripping power, 9 had greater than 75% normal, 6 had greater than 50% and less than 75% normal, and 1 had less than 50% normal gripping power. In the 2 patients who underwent excision of the proximal pole of the scaphoid the result was good in one and poor in the other. For the patient whose scaphoid was replaced with an implant the result was good. Nineteen of the 23 patients returned to their previous work within 6 months of the operation.

Adolescent↗
PubMed1984

Screening for postoperative pulmonary embolism on the basis of clinical symptomatology, routine electrocardiography and plain chest radiography.

The incidence of pulmonary embolism (PE) and the usefulness of various screening methods for its detection were studied in 108 patients undergoing elective hip surgery. Twenty patients had PE as shown by perfusion-ventilation lung scintigraphy. Six of them had symptoms of embolism. Clinical symptoms of PE, highly suggestive electrocardiographic (ECG) signs and signs in chest radiographs showed high specificity but low sensitivity with regard to PE. If the non-specific ECG signs and the symptoms and signs of deep vein thrombosis in the calves had also been taken into account, it would have been possible to identify 95% of the patients with PE. The use of all these screening tests revealed a suspicion of PE in two thirds of the patients. The simplest way to screen for postoperative PE seems to be to use a combination of the symptoms and signs of both PE and deep vein thrombosis, and to identify any tachycardia. This method gave a sensitivity of 85%.

Electrocardiography↗
PubMed1983

Postoperative thromboembolism and risk factors in elective hip surgery.

The incidence of pulmonary embolism determined by perfusion - ventilation lung scintigraphy was 19% in 108 consecutive patients undergoing elective hip operations. Twelve patients had clinical symptoms. The sensitivity of clinical symptoms was 30 and the specificity 93%. Warfarin was used as prophylactic anticoagulant. The incidence of deep vein thrombosis examined by contrast venography was 43%. Only one patient developed femoral vein thrombosis propagating from the calf region. From the clinical risk factors, overweight had a statistically significant relationship to thromboembolism (p = 0.005). Age over 60 years was positively associated but the difference was not significant. When operation time exceeded 150 min the risk increased significantly (p less than 0.01). A large volume of blood loss at operation showed an increased but statistically insignificant trend towards thromboembolism. There were no fatal emboli. Although prophylactic warfarin treatment is not able to prevent the development of thromboembolism, it probably reduces the incidence of fatal pulmonary emboli. Of clinical and operative risk factors overweight and increasing operation time seem to have the strongest relationship to thromboembolism.

Adult↗
PubMed1983

Computed tomography of spinal and pelvic fractures.

The value of computed tomography (CT) compared with conventional x-ray was assessed in 29 spinal and 9 pelvic fractures. In the so called bursting fractures of spinal vertebrae the position of bone fragments in the neural canal was shown better by CT. The neural canal was remarkably narrowed on several occasions without the patient having any clinical symptoms of root or medullary compression. In 2 patients a fracture of laminae was discernible only on CT. Vertical fractures of vertebral bodies were also difficult to distinguish on the conventional plain x-ray. CT was helpful for planning of the anterolateral decompression operation of L2 in one patient. In cases of pelvic trauma sacro iliac joint diastasis was readily shown by CT. CT was clearly better able to determine whether the fracture extended across the sacro iliac joint. Also in fractures of the iliac wings CT readily showed the internal and external surfaces which were difficult to evaluate on plain radiographic examination. In spinal and pelvic fractures CT can give useful additional information which can influence the treatment of the trauma patient.

Fractures, Bone↗
PubMed1983

Evaluation of two enzyme preparations--Trypure and Varidase in traumatic ulcers.

38 patients with traumatic ulcers containing pus and debris were treated for two weeks with either Trypure or Varidase in a random fashion. Efficacy and side effects were studied using a blind observer technique. The effect on pus, debris, pain, granulation and epithelialization of the ulcers was studied. Laboratory data and bacterial cultures were also evaluated. The results of treatment with the two enzyme preparations showed Varidase to be statistically significantly (p less than 0.05) better as an adjuvant in removing pus and debris from the ulcers. Varidase-treated ulcers were cleansed quicker than Trypure-treated ulcers. Thirteen patients treated with Trypure complained of side effects compared with two patients treated with Varidase. With Varidase it appears that pus and debris are more easily removed, and that at the same time the agent is well tolerated.

Adult↗