Biomedical subjects

P Summanen

Publications and source records attributed to P Summanen.

80 records · Page 5Linked to original sources

PubMed1988

Neovascular glaucoma following vitrectomy for diabetic eye disease.

Between September 1979 and December 1985, 124 eyes of 105 patients underwent vitrectomy for diabetic eye disease. Until May 1987 (mean follow-up of 3.2 +/- 0.3 years) neovascular glaucoma (NVG) occurred in 21 eyes (17%); in 18 of them within the first post-operative year. Post-operative total retinal detachment (P = 0.0003) and pre- and/or per-operative aphakia (P = 0.0047) proved to be significant independent risk factors for post-operative NVG (odds ratio 9.9 and 4.6, respectively). The rate of NVG decreased from 22% in the second half of the study period (NS). This decrease may be related to smaller proportion of aphakic vitrectomies in the latter half (50% vs 18%, P less than 0.0004). Lack of previous panretinal photocoagulation did not increase the risk of NVG significantly. Of the 84 non-vitrectomized fellow-eyes NVG occurred in 17. In 4 of the 21 eyes the intraocular pressure (IOP) was satisfactorily controlled by antiglaucomatous medication after retinal panphotocoagulation, direct photocoagulation of the iris new vessels and/or cyclocryocoagulation. Four eyes remained hypertonic, but were comfortable with symptomatic medication, 12 eyes became hypotonic. One eye was enucleated. Useful vision was preserved in 3 eyes, light perception (LP) in 2 eyes, the remaining 16 lost LP. In 13 of the 16 eyes vision was lost within the first post-operative year.

Adolescent↗

PubMed1987

Effect of tranexamic acid on postvitrectomy haemorrhage in diabetic patients.

Thirty one diabetic patients were prospectively randomized for treatment with or without tranexamic acid during vitrectomy for proliferative diabetic retinopathy. No significant difference in the occurrence of postoperative haemorrhage in the treated and untreated group was observed (37%/28% during the 1st postoperative week, and 25%/40% during the 2nd-4th postoperative weeks, respectively). The final visual result was similar in both groups.

Adolescent↗

PubMed1987

Cortisone, heparin and argon laser in the treatment of corneal neovascularization.

Chemical burns and contact lenses can induce corneal neovascularization. The pathogenic mechanisms of angiogenesis are not well understood. A heparin-cortisone combination has been shown to inhibit traumatic angiogenesis and argon laser photocoagulation has been useful in the treatment of corneal graft neovascularization. We describe three patients treated for corneal neovascularization with these methods. Tear fluid plasmin levels were also monitored. The corneal neovascularization was caused by contact lens use in two patients, and by a severe chemical burn in one patient. Subconjunctival cortisone injections proved to be efficient in the treatment of the contact lens induced corneal neovascularization. Corneal argon laser photocoagulation seemed to have an additional effect. The role of topical heparin remained unclear. The tear fluid plasmin levels were not significantly elevated.

Adolescent↗

PubMed1987

Concomitant problems to the anaesthesia of diabetic vitrectomy patients.

Problems related to general anaesthesia of 109 consecutive vitrectomies performed on diabetic patients were retrospectively reviewed. On the morning of surgery a normal or a slightly reduced dose of the patient's regular insulin was administered subcutaneously. The amount of intravenous infusion, mostly 5% glucose, was calculated according to the pre-operative urine volume. After surgery, hypoglycaemic (less than 3 mmol/l) values were seen in less than 11% of the patients, and high glucose in less than 30%; 20% had a mild ketoacidosis post-operatively. Difficulties in tracheal incubation was encountered in 10%. Three patients complained of chest pain after surgery, and in one of them a myocardial infarction was diagnosed. Forty-one per cent of the patients complained of nausea or vomited in the afternoon after surgery, and 21% had difficulties in urination the night after surgery. Two of four patients with peritoneal dialysis complained of stomach pain post-operatively. There was no significant association between recurrent vitreous haemorrhage and blood glucose concentration or arterial blood pressure in the early post-operative period.

Anesthesia, General↗

PubMed1987

Characteristics and survival of diabetic patients undergoing vitreous surgery.

Characteristics, and the occurrence of other diseases, and complications related to diabetes mellitus of 91 consecutive diabetic patients who underwent vitreous surgery in 1979-1985 were examined. The mean age of the patients was 40 years (median 37, range 19-74), and the mean duration of diabetes 23 years (range 5-44). All, but one, had insulin therapy. Abnormalities in the cardiovascular and/or renal function were found in 89 of the 91 patients (98%). Signs of cardiovascular disease were observed in 58 patients (64%): 42% had elevated blood pressure (greater than or equal to 150/100 mmHg), 46% were on antihypertensive therapy, 14% had a history or signs of ischaemic heart disease, 12% had been digitalized, 7% had a history of cerebral ischaemia, and 8% had had surgery for gangrene of the lower limb. Signs of nephropathy were recorded in 64 patients (70%); 6 of them were on dialysis therapy, and two had received a kidney transplant. Symptoms possibly related to autonomic neuropathy e.g. postural hypotension, urinary tract symptoms, and gastric discomfort were found in 27%. Nine patients (10%) had some kind of thyroid disease, and two of them signs of multiple autoimmune endocrinopathy. The percentage surviving decreased from 96% at one year to 80% after 5 years of follow-up.

Adult↗

PubMed1987

Certain bacterial species and morphotypes in localized juvenile periodontitis and in matched controls.

Subgingival microflora in localized juvenile periodontitis (LJP) was examined by culture of certain bacterial species and by direct dark-field microscopy in affected and unaffected periodontal pockets of 11 patients and in their age- and sex-matched controls. Only Actinobacillus actinomycetemcomitans (A.a.) correlated to periodontal destruction and occurred most frequently at the affected LJP sites. A.a., Bacteroides intermedius and Fusobacterium nucleatum were isolated in proportions greater than 5% of the flora at the affected LJP sites, but various Actinomyces spp. at the unaffected and control sites. The proportions of straight rods, fusiforms and small spirochetes correlated to gingival bleeding tendency and were higher at the affected LJP sites than at the control sites. Certain nonpigmented Bacteroides spp. and Eikenella corrodens were never isolated when only cocci were seen at dark-field microscopy. The more complex the flora, the more frequently B. intermedius occurred. The results support a significant role for A.a. in LJP and indicate that certain bacterial species appear to prefer occurring in the complex composition of subgingival microflora.

Actinobacillus↗

PubMedDate not supplied

Retrobulbar/peribulbar block with 0.2% ropivacaine or 1% lidocaine for transscleral cyclophotocoagulation or retinal panphotocoagulation.

BACKGROUND AND OBJECTIVES: Brief analgesia is needed to complete krypton laser cyclophotocoagulation for glaucoma patients and is advantageous in argon laser panphotocoagulation for diabetic retinopathy. We studied whether 0.2% ropivacaine, known for analgesia with minimal motor block or 1% lidocaine, with rapid onset and short duration of action, both supplemented with hyaluronidase, are suitable local anesthetics for retrobulbar/peribulbar block for these procedures. METHODS: Seventy-four treatment sessions of 65 patients were included in this prospective, randomized, double-blind study. Data were collected on adequacy of analgesia, need for supplementary blocks and eye movements at 10 minutes after injecting the block and at the end of the treatment, and need for patching the eye at discharge. RESULTS: Frequency of inadequate analgesia (24% in ropivacaine group and 32% in lidocaine group), and of supplementary blocks (11% and 14%, respectively) did not differ between the groups and exceeded our clinically acceptable level. Ropivacaine produced less motor block than lidocaine at 10 minutes (P < .001) and at the end of the treatment (P = .002). However, at discharge, the eye was significantly more often patched in the ropivacaine (70%) group than in the lidocaine group (41 %) (P = .035). In the ropivacaine group, a mobile eye did not predict inadequate intraoperative analgesia, whereas in the lidocaine group it did (P = .001). CONCLUSION: According to our preliminary data, neither 0.2% ropivacaine nor 1% lidocaine reached acceptable frequencies of adequate analgesia during transscleral cyclophotocoagulation, while all retinal panphotocoagulations could be completed under the initial block.

Adult↗

PubMedDate not supplied

Visual outcome of eyes with malignant melanoma of the uvea after ruthenium plaque radiotherapy.

BACKGROUND AND OBJECTIVE: To analyze the overall visual outcome in 100 consecutive eyes with malignant uveal melanoma irradiated with ruthenium-106 plaques between 1981 and 1991. PATIENTS AND METHODS: The follow-up ranged from 4 months to 10.1 years (median 3.0 years). Scattergrams of equal follow-up periods, life-table survival analysis, and Cox's proportional hazards analysis were used to analyze visual outcome. RESULTS: VA increased for some time in 14 eyes. By 3 years, VA of at least 20/70, 20/200, counting fingers, and light perception were retained in 27%, 41%, 67% and 82% of eyes, respectively. Macular pathology cause loss of reading vision; neovascular glaucoma or enucleation caused loss of light perception. In univariate analysis, large tumor size (height > 5 mm or TNM class T3) predicted visual loss of all VA levels. For the loss of light perception, the tumor's largest basal diameter > 15 mm reached significance. In Cox's multivariate analysis tumor height > 5 mm was the only significant independent risk indicator for loss of VA levels 20/70 and 20/200. For the level CF, largest basal tumor diameter also reached significance, but location of the tumor within 1 disc diameter of the optic disc, either alone or in addition to the fovea, had the greatest risk ratio (6.3, 95% CI 4.1-9.8). For losing light perception, large TNM size (T3) was the strongest risk indicator (risk ratio 10.0; 95% CI 4.5-22.5), followed by proximity of the tumor to the optic disc (risk ratio 4.3, 95% CI 2.4-7.8). CONCLUSION: Ruthenium brachytherapy may retain vision in an eye with a malignant melanoma of the uvea for a considerable period of time. The data presented are useful in patient counseling and allow comparison to subsequent series.

Adult↗