Biomedical subjects

P Luukkonen

Publications and source records attributed to P Luukkonen.

46 records · Page 3Linked to original sources

PubMed1988

Manometric follow-up of anal sphincter function after an ileo-anal pouch procedure.

Between January 1985 and January 1987 restorative proctocolectomy with J-pouch was undertaken in 20 patients with ulcerative colitis. In all patients anal manometry was performed preoperatively, before closure of the temporary ileostomy (mean 3.9 months after operation) and 3,6 and 12 months after the closure of the ileostomy. Preoperatively the basal resting pressure was 60.2 +/- 12 cm water and the maximum squeeze pressure 88.5 +/- 18 cm water. After the operation the respective pressures were 33.2 +/- 8 and 68 +/- 21 cm water, a decrease of 45% (p less than 0.05) and 12% (p less than 0.05), respectively. One year after the closure of the loop ileostomy the basal pressure was 46.2 +/- 9 cm water, which is still 23% lower (p less than 0.05) than preoperatively. At the same time the maximum squeeze pressure was 96.5 +/- 13 cm water, 8% higher (p greater than 0.1) than preoperatively. The continence of the patients at the end of the follow-up was either good (n = 6) or excellent (n = 9). A correlation seemed to exist between sphincter pressures and the degree of continence. It is concluded that the internal anal sphincter suffers damage during the operation and slowly recovers up to 6 months after closure of the covering ileostomy. After that its function usually does not improve and remains at a lower level than preoperatively.

Adult↗

PubMed1988

Fecal bacteriology and reservoir ileitis in patients operated on for ulcerative colitis.

To investigate the etiology of ileal reservoir inflammation, fecal bacteriology and ileal wall morphology were compared in three groups of 15 patients operated on for ulcerative colitis: 1) conventional ileostomy, 2) Kock ileostomy; and 3) pelvic ileal pouch. Total bacterial counts showed overgrowth of fecal bacteria in each group, but the anaerobic bacterial counts were significantly higher (P less than .05) in the two pouch groups than in the conventional ileostomy group. Mucosal morphology did not differ among the three groups showing either normal mucosa or mild chronic inflammatory changes in most patients. In contrast, five of the six patients with clinical pouchitis had acute inflammatory changes in histologic specimens. Fecal bacteriologic findings in these patients did not differ quantitatively or qualitatively from others. It is concluded that proctocolectomy for ulcerative colitis predisposes to ileal bacterial overgrowth, and after pouch operations especially, anaerobic overgrowth may be one factor in the development of pouch inflammation. Acute clinical pouchitis with clear histologic changes was, however, not connected with specific changes in fecal bacteriology.

Adult↗

PubMed1988

Restorative proctocolectomy for ulcerative colitis.

The results of 36 restorative proctocolectomies (with 2-loop reservoir) for ulcerative colitis (UC) performed in a three-year period were surveyed. These patients represented 69% of all those undergoing definitive surgery for UC at the same time at our department. There was no operative mortality. Both early (44.4%) and late complications (45.2%) were quite common, but they were mostly minor and only two were permanent failures (5.6%) requiring construction of conventional ileostomy. Anastomotic retraction and sinus formation (25%), as revealed by pouch x-ray, were the most frequent early complications, occurring in a lesser degree (19.4%) also after stoma closure. Pouchitis was also a common (20%) late complication, but usually resolved promptly with metronidazole treatment. The functional results in the 23 patients evaluated were satisfactory, with a mean defaecation frequency of 5.4 per 24 hour and a minor soiling frequency of 36%. None of the patients had to wear a pad. The over-all results are compatible to those from other centres and suggest that acceptable anal function follows restorative proctocolectomy in most suitable cases with UC. The role of adequate surgical experience and consideration of contraindications must, however, be emphasised, and the surgeon must be ready to handle many minor and even major complications.

Adolescent↗

PubMed1988

Mucosal alterations in pelvic ileal reservoirs. A histological and ultrastructural evaluation in an experimental model.

To study mucosal changes in ileal pouches, three different types of pelvic ileal reservoir (2-loop, 3-loop and 4-loop), interposed in place of resected rectum, were constructed in 12 piglets, 4 animals in each group (n = 12). After a 6 week interval the animals were sacrificed and the reservoirs removed and processed for light and scanning electron microscopy (SEM). Both acute and chronic inflammatory changes were present but not prominent in the pouch mucosa. With the exception of mucosal ulcers both the histological and SEM-findings greatly resembled the atrophic, flat mucosa seen in ileal coeliac disease. Macroscopic findings did not correlate with histological findings. Colonization by bacteria and bacterial overgrowth were noticed in every pouch suggesting a possible link between bacterial invasion and pouch ileitis. No correlation was found, however, between the amount of intraluminal bacteria and the severity of the pouchitis.

Animals↗

PubMed1987

Pelvic ileal reservoirs: experimental assessment of reservoir capacity in three reservoir designs.

In order to examine the possible effect of different pouch shape to the capacity of ileal reservoirs three different types of pelvic ileal reservoir (2-, 3- and 4-loop) were compared in piglets, with four animals in each group. The intraoperative volume of all of these reservoirs was 55 ml, measured with saline. A larger (110 ml) 2-loop reservoir was used in a control group of four animals. The animals were kept alive for 6 weeks after which time the capacity and emptying of the reservoirs were studied. The resulting volume increases (ml/kg) were 15.4, 9.2, 8.9 and 8.1 in J-, S-, large-J- and W-shaped reservoirs, respectively. The emptying of the reservoirs was incomplete in all designs. No statistical difference (P greater than 0.5) was found between groups for either of these parameters. If resistance to outflow from the pouch can be avoided, the capacity of the reservoir seems to depend more on its initial size at the time of construction than on the pouch design.

Anastomosis, Surgical↗

PubMed1986

Surgical treatment of anal incontinence--a preliminary report.

Six patients with anal incontinence were treated operatively at two Finnish proctological centres: 3 patients with post-anal repair, 2 with direct sphincter repair and 1 with a gracilis sling operation. In short term, improvement of continence was demonstrated in all cases both clinically and by manometric measurements; 5 out of the 6 patients are acceptably continent after surgery. The present techniques of surgical treatment of incontinence can offer gratifying results. Anal manometry is a valuable means in the evaluation of these patients before and after the operation.

Adult↗

PubMed1977

WAIS performances in antisocial personality (disorder).

In the present study, the WAIS performances of subjects with antisocial personality disorder were compared with the performances of controls, who had other personality disorders and had usually only occasional criminality. It appeared that in all subtests the age-scaled scores of the controls were higher than those of the subjects. Statistically significant differences emerged in subtests Information, Comprehension and Arithmetic of the Verbal Scale, and in the picture Completion subtest of the Performance Scale, as well as in the Verbal, Performance and Total IQ. In the light of these results, one fundamental feature in antisocial personality could be the lack of general interest and intellectual curiosity, which is probably associated with a poor ability to "feel" (inadequacy of feelings of pleasure) in those predisposed to antisocial personality.

Adult↗

PubMedDate not supplied

Early experience with biofragmentable anastomosis ring in colon surgery.

A biofragmentable anastomosis ring (Valtrac-BAR) was used to construct anastomoses in 20 (group I) consecutive patients (11 women and nine men; mean (SD) age 54.5 (13 years) undergoing elective colonic resection. The results were compared with those of 20 consecutive patients who underwent elective colonic resection in this department during the same period (group II) who had their anastomoses hand-sutured or stapled. There was one death in hospital in each group (5%). There were four anastomotic complications requiring reoperation, leakage (n = 3), and stricture (n = 1) in group I (20%) compared with none in group II. Three patients in each group developed postoperative ileus; these were all initially treated conservatively. In most cases with a ring anastomosis the clinical course was uneventful. We conclude that the biofragmentable ring can be used for different types of colon anastomoses, but so far it has not shown any special advantage over more commonly used anastomotic techniques, and more experience is needed before its routine use can be recommended.

Anastomosis, Surgical↗

PubMedDate not supplied

Colo-anal sleeve resection for rectal hemangioma. Case report.

Colo-anal sleeve resection was performed for rectal hemangioma extending from the upper end of the anal canal to the rectosigmoid in two adults and a child. The indication for surgery was recurrent rectal bleeding. Anastomotic stricture formed in one patient, but was easily dilated. After observation for 2-12 months, all patients were completely continent, with normal 24-hour stool frequency. Colo-anal sleeve resection is advocated as the treatment of choice for large rectal hemangioma.

Adult↗

PubMedDate not supplied

A case report of biliary cystadenoma and cystadenocarcinoma.

Three cases of intrahepatic biliary cystadenoma with mesenchymal stroma and one case of biliary cystadenocarcinoma are presented. Their immunohistochemical features and the surgical treatment are discussed together with a brief review of the literature. The benign cystadenomas stained positive for cytokeratin and CA 19-9 in the epithelium of the cyst wall. Mesenchymal stromal cells were strongly positive for a-SMA and moderately positive for desmin. The epithelium of the cystadenocarcinoma, however, was positive only for cytokeratin and the stroma only for a-SMA. Our findings indicate that biliary cystadenomas seem to be of primitive hepatobiliary origin. Furthermore, the malignant variant cystadenocarcinoma may loose its immunoreactivity for CA 19-9 and desmin.

Adenoma, Bile Duct↗