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Biomedical subjects

P T Harjola

Publications and source records attributed to P T Harjola.

At least 19 recordsLinked to original sources
PubMed1999

Angiographic 20-year follow-up of 61 consecutive patients with internal thoracic artery grafts.

OBJECTIVE: To assess the behavior of internal thoracic artery (ITA) grafts versus venous grafts in repeated angiograms up to 20 years. SUMMARY BACKGROUND DATA: Use of ITA grafts to bypass left anterior descending artery stenosis has been shown to be associated with improved survival in patients undergoing coronary artery bypass grafting. METHODS: Sixty-one consecutive patients who received one or two ITA grafts and who underwent surgery from Oct. 5, 1971, to Dec. 18, 1973, in Helsinki University Central Hospital, Finland, were included in this prospective follow-up series. Fifty-six of the patients (92%) also received at least one venous graft. The number of distal anastomoses was 157, of which 47.7% (75) were performed with ITA grafts. The median age of the patients was 47.7 years (range 30.0 to 63.1), and 85% (52) were men. RESULTS: After 20 years of follow-up, 18/20 (90%) of the survivors underwent angiography; the patency rate was 88.9% for ITA grafts and 47.8% for venous grafts. Cumulative graft patency at 20 years, using all the information obtained from repeated angiographic examinations and autopsies, was also calculated to eliminate selection bias. The cumulative 20-year patency rate was 81% for ITA-left anterior descending artery anastomoses, 53.8% for venous graft-right coronary artery anastomoses, and 48.5% for venous graft-left circumflex artery anastomoses. In paired comparisons between anastomoses, the patency time of the ITA-left anterior descending artery anastomoses was on average 2.8 years longer than the venous graft-left circumflex artery patency time and 2.6 years longer than the venous graft-right coronary artery. CONCLUSIONS: Internal thoracic artery grafts, especially in left anterior descending artery anastomoses, should be considered as a primary solution in coronary artery bypass grafting surgery in patients with >10 years of life expectancy; if venous grafting is preferred, further evidence is needed.

Adult↗
PubMed1996

Trends in vascular surgery--an evaluation of operative activity in Finland 1976-1992.

To evaluate trends in vascular surgical activity in Finland, data were gathered from cross-sectional questionnaire surveys during three separate years. The material consisted of 1,658 (1976) and 4,887 (1992) procedures in Finland, and 1,039 (1988) and 1,212 (1992) in the Tampere region. In 1976 there was an annual mean of 350 vascular reconstructions per one million inhabitants, 660 in 1992, and 967 if also endovascular revascularisations were included. Sympathectomy was virtually vanished by 1992, thromboembolectomies clearly decreasing, carotid, aortic aneurysm and femorodistal surgery increasing and endovascular surgery emerging as a new major force, comprising of one third of all vascular activity. Vascular surgical activity appears to be strongly increasing, but the treatment pattern has markedly changed towards well-targeted endovascular and vascular interventions with a decreasing number of emergency operations and ill defined procedures like sympathectomies.

Cross-Sectional Studies↗
PubMed1989

Femoral-tibial bypass for limb salvage.

From 1967 to 1982, 305 femoral tibial bypasses were performed. Of these 180 (59%) were performed on limb salvage indication. A reversed autogenous saphenous vein was used in 134 instances, among 46 vein substitutes there were 15 vein allografts, 13 human umbilical cord vein grafts, 12 PTFE grafts and six dacron grafts. Hospital mortality was six patients. An additional 37 patients died during the follow-up period. The patency rates for saphenous vein bypass grafts were 62.5%, 48%, and 25% at one, five, and ten years, respectively, and 33% and 25% at one and five years, respectively, for the vascular substitutes. The mean +/- SD follow-up time was 62.27 +/- 5.7 months. During the early postoperative period 23 legs (12.7%) had to be amputated. During the follow-up period an additional 14 legs (7.8%) were lost giving a limb salvage rate of 79.5%.

Adult↗
PubMed1986

Treatment of Takayasu's arteritis: an analysis of 29 operated patients.

Over a 25-year period 29 patients underwent 49 vascular procedures due to arterial insufficiency or vascular complications caused by Takayasu's arteritis. In bypass operations 36 grafts were inserted. The 5-year patency rates were 53% when grafts were used for patients with the active disease stage and 88% during the inactive disease stage (p = 0.059). The material of the graft, or postoperative warfarin or platelet-inhibitor drug treatment administered for at least 3 postoperative months had less bearing on graft patency. Ten out of the 11 graft occlusions occurred within the first 2 postoperative years. In operations due to lesions of the brachiocephalic arteries (20 patients), bypass procedures appeared to be superior to thromboendarterectomies; 67% (20/30) of the grafts and 17% (1/6) of the thromboendarterectomies remained patent. Five hypertensive patients underwent surgery because of renal artery stenosis. Hypertension was cured in one patient and in another the antihypertensive regimens could be reduced. There were 2 operative deaths, one due to myocardial infarction after aortic valve replacement and the other due to cerebral hemorrhage, probably because of excessive blood flow resulting from the insertion of an aorto-bicarotid bifurcation bypass graft. Four of the 7 late deaths occurring nine months to 15.7 years postoperatively were considered to be related to Takayasu's arteritis.

Adolescent↗
PubMed1986

Traumatic rupture of the right hemidiaphragm.

Sixteen cases of traumatic disruption of the right hemidiaphragm are presented. Six tears were treated in the acute post-trauma phase and ten were detected from late manifestations. The causal trauma was penetrating in 11 cases and blunt in five. Rupture of the right hemidiaphragm not uncommonly occurs without serious associated injuries. Bowel often herniates through such tears, unhindered by the liver, though the liver is the most commonly herniating organ. No recurrence of hernia was found after standard repair techniques (mean follow-up 5.2 years). Three of the 16 patients died, one from associated injury, one from strangulation of herniated bowel and one from postoperative myocardial infarction. To demonstrate diaphragmatic tearing and subsequent organ herniation, serial chest radiographs and computed tomography are useful, and exploratory laporotomy should be done without delay after penetrating injury to the trunk. The treatment of diaphragmatic tear is surgical, with better results from early than from late repair.

Adult↗
PubMed1986

Hospital cost development in coronary bypass surgery.

The rapid expansion of open-heart surgery together with steadily rising costs of health services has elicited criticism against uncontrollably expanded costs of coronary bypass surgery. However, critical analyses of the cost structures and the attempts for cost containment can only rarely be found in medical literature. This study emphasizes self-evident surgical principles which have led to surprisingly high cost reductions. Further savings can be obtained by constant financial education of the surgical staff, in spite of some controversial experiences gained elsewhere. The conditions needed are more accurate, up-to-date hospital bookkeeping and closer contacts between the hospital administration and the medical staff.

Coronary Artery Bypass↗
PubMed1986

Surgical treatment of occlusion of the infrarenal abdominal aorta. Experience with 55 patients.

A series of 55 patients with occlusion of the infrarenal abdominal aorta operated on in the 15-year period 1966-1980 is presented. The type of operation was an extra-anatomic reconstruction in four cases and some type of anatomic repair in 51 cases. The operative mortality was 5.4%. The cause of death was myocardial infarction in two out of three cases. After a follow-up period of 90.4 months on average 25 patients were alive and were reached to a follow-up examination. Nineteen out of these 25 patients (76%) were symptom-free and six patients (24%) complained of mild to moderate symptoms related to obstructive arteriosclerotic lesions of the lower extremities. During the follow-up 27 patients expired. The most common causes of late deaths were myocardial infarction (13 out of 27 patients) and CVA (5 out of 27 patients).

Adult↗
PubMed1985

A sustained effect of coronary bypass surgery in stable angina pectoris.

One hundred patients with angina pectoris were randomly allocated for medical therapy and bypass surgery in groups of 50 patients each. The effect of the respective therapies was assessed by annual exercise testing for up to five years. The surgical group was also studied by postoperative coronary angiograms at three weeks, one year and five years after the operation. The medical group was subjected to repeated coronary angiography five years after randomization. All of the variables depicting exercise tolerance were significantly improved in the surgical group but remained largely at the initial level in the medical group. A subgroup analysis of the surgical series revealed that the sustained improvement was largely confined to the completely revascularized subset of patients. The slowly increasing use of beta blocking compounds in the surgical group also contributed to the favourable results for bypass surgery.

Angina Pectoris↗
PubMed1985

Coronary bypass surgery in stable angina pectoris. A randomized study of the effects on morbidity, mortality and employment.

The effects of coronary bypass surgery on morbidity, mortality and employment were assessed in a randomized prospective 5-year study. Exercise tolerance showed an immediate, striking improvement, which was maintained throughout the follow-up period. Corresponding patients treated with medical therapy showed no change. More than 40 percent of patients in the surgical group were free from symptoms over the five years. The annual mortality of the surgical patients was 0.8 percent as compared with 4.0 percent in the medical patients (p less than 0.05). The annual mortality of the intensively treated medical patients with multivessel disease was not significantly higher than the 3.1 percent for a group of patients with single-vessel disease followed concomitantly. The rate of work at 5 years after bypass surgery was 47 percent as compared with only 18 percent in the randomized medically treated group (p less than 0.01). It is concluded that coronary bypass surgery reduces morbidity and mortality and improves employment.

Angina Pectoris↗
PubMed1985

Epicardial lipoma.

A case of epicardial lipoma is presented. Coexisting coronary artery disease partly masked the symptoms by pointing to myocardial failure caused by compression from the tumor. An unexpectedly good result was achieved by combining excision of the lipoma with the planned coronary bypass procedure.

Heart Neoplasms↗
PubMed1985

Direct hospital costs in coronary bypass surgery.

The direct hospital costs of 100 coronary artery bypass grafting operations are calculated. The basis of the calculations is the detailed, function-based, market-priced analysis of the files, including the hospital deaths, complication and reoperations of this patient group. The price of a CABG operation proved to lie somewhere between FIM 30,000 and 50,000, the mean value being FIM 46,800. The variation range is wide: FIM 18,200-FIM 249,500 (SD +/- FIM 26,000). It must be emphasized, however, that all preoperative hospital costs including coronary angiography costs and also postoperative follow-up hospital costs fall beyond this study.

Coronary Artery Bypass↗
PubMed1985

Isolated renal artery and combined aortic and renal artery reconstruction for renovascular hypertension. Late results of surgical treatment.

Fifty consecutive patients with renal artery occlusive disease underwent surgery for renovascular hypertension. The etiology was arteriosclerosis; only three patients had fibromuscular hyperplasia. Isolated renal artery stenosis was operated on in 22 patients while 28 patients underwent combined renal and aortoiliac/femoral procedures. Four of the patients required re-operation because of unsuccessful primary results. There was no operative mortality. Renin was determined in 29 patients and postoperative angiography was carried out in 22 cases. The patency rate of the aorto-renal grafts was 94%; 2 aneurysmal vein graft dilatations occurred. Preoperative renin assays were positive in 90% of the patients with isolated renal artery stenosis but in only 45% of those having renal and aortoiliac/femoral arteriosclerosis. Postoperatively, the renin values had returned to normal limits in 95% of the patients. Long-term (2-11 years) successful treatment of hypertension was achieved in 79% of the cases with isolated stenosis and in 59% of the cases with aorto-iliac/femoral arteriosclerosis. The patients having a preoperative ipsilateral/contralateral renin ratio greater than or equal to 1.5 showed a success rate of 69%. Normal levels of renin were found in 85% of the successful cases.

Adult↗
PubMed1984

Polydioxanone in cardiovascular surgery.

Polydioxanone (PDS) suture material was used in vascular anastomoses in patients submitted to femoropopliteal bypass (10 patients), aortoiliac endarterectomy (5 patients), and aortocoronary bypass (5 patients). Clips of this material and conventional metallic clips were compared in vitro for holding-in-place properties, and PDS clips were used in ligation of branches of the autologous vein grafts in femoropopliteal bypass (10 patients) and aortocoronary bypass (10 patients). There were no complications related to the PDS material either intraoperatively or during the follow-up from 3 to 6 months. The PDS clips did not slip when burst-tested in vitro. The material is suitable and advantageous in cardiovascular operations where autologous tissue is handled.

Adult↗
PubMed1984

Sequential internal mammary artery (IMA) grafts in coronary artery bypass surgery.

Since 1972, double or triple left IMA bypasses have been made on 61 consecutive patients with a total of 123 distal anastomoses to the LAD or to the LD branches of the LAD. There were 54 additional vein grafts with 102 distal anastomoses. The number of single IMA grafts in the same period of time was 400. Hospital mortality was 2 patients (3.3%), with a late mortality of 7 patients (11.3%), 2 of them being heart-related, one of hypernephroma, one suicide, and of unknown cause in the remaining 3 patients. Five patients refused postoperative angiography. There were 50 patients with one or more postoperative angiograms available for the analysis after a mean follow-up time of 35.1 (0.5 to 128) months. The late patency of the left IMA anastomoses was 97% (98/101) and 82.4% (84/102) of the vein anastomoses. There were 2 anastomotic left IMA occlusions to the LD at 2 weeks and 10 months, respectively, and to LAD at 13 months. No left IMA graft had become completely occluded. According to the trend analysis, there was a 97.5% patency at 5 years, and 95.7% at 10 years with left IMA grafts compared to 78.4 and 67.9, respectively, with vein grafts. Ten left IMA grafts were dilated, 2 narrowed and 36 unchanged at the late angiography. Sequential left IMA graft, in appropriate cases seems to result in the most superior patency rate of all types of grafts.

Adult↗
PubMed1983

Progression of coronary artery disease in randomized medical and surgical patients over a 5-year angiographic follow-up.

Progression of coronary artery disease (CAD) was assessed prospectively in a randomized series of 36 medically treated and 42 surgically treated patients with angina pectoris. The medical patients were reexamined after 5 years and the surgical patients 3 weeks, 1 year and 5 years after operation. Sixty-seven percent of the medical patients and 69% of the surgical patients had progression. The frequency of new lesions in initially normal segments after 5 years in the medical group was 6.7%, versus 4.1% in ungrafted normal segments in the surgical group (p = 0.05 less than 0.010). The frequency of progression in abnormal arteries was 24.1% in the medical group, versus 22.6% in the ungrafted arteries of the surgical group (p = 0.90 less than 0.95). The rate of progression of obstructed segments proximal to the graft over 5 years was 43%, versus 27% of the corresponding segments in the medical group (p less than 0.01). Progression took place in 11.6% of normal segments proximal to the graft, versus 2% of the corresponding segments in the medical group (p less than 0.05); 69% of progression occurring in segments proximal to the graft had reached total occlusion, versus 38% of the corresponding segments in the medical group (p less than 0.01). Progression developed in 3.9% of segments distal to the graft, versus 3.1% of the corresponding segments in the medical group. Progression takes place at identical rates in medically treated patients and in ungrafted arteries and segments distal to the graft in surgical patients. Proximal to the graft the rates differ and total occlusions appear as early as 3 weeks after operation.

Coronary Angiography↗