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Biomedical subjects

R Huttunen

Publications and source records attributed to R Huttunen.

At least 37 records · Page 2Linked to original sources
PubMed1977

Traumatic splenic rupture.

71 patients with traumatic splenic rupture are reported. Most had severe associated injuries. In 44 patients the mechanism of trauma was blunt, in 10 penetrating, and in 17 iatrogenic, occurring most commonly (11/17) during operations for peptic ulcer. Splenectomy gave use to thrombocytosis which reached its peak about 2 weeks and returned to normal within one month after operation. Postoperative complications occurred in 24 of the 60 surviving patients (40%) of which most, 17 patients (30%) were infectious in origin. One patient developed deep venous thrombosis. Mortality was 16%. Associated injuries were the main cause of death in most patients (9/11), the ruptured spleen being responsible for only 2 deaths. None of the 17 patients with injury to the spleen alone died, whether associated with fractures of the left lower ribs or not. Primary unconsciousness, shock on admission, and multiple injuries, especially renal and hepatic, increased the mortality rate markedly. The necessity of drainage, the possibility of increased susceptibility of splenectomized patients to infection and thromboembolic complications and their prevention are briefly discussed.

Accidents↗
PubMed1977

Management of injuries of the large intestine.

Blunt trauma accounted for 1/3 of the 32 patients operated upon for injuries of the large intestine and penetrating wounds for 2/3. Most of the blunt injuries (9/10) were caused by traffic accidents, and more than half of the penetrating ones (12/22) were stab wounds. The transverse colon was most commonly affected, followed by the ascending, descending and sigmoid colon, rectum and mesentery. Perforation of the small intestine was the most frequent associated intra-abdominal injury, occurring in 11 patients (34%). Most patients (22/32) underwent simple suture, 6 patients suture with proximal colostomy, 3 primary resection and one exteriorization, combined in all cases with broad-spectrum antibiotic coverage and drainage of the abdominal cavity. Injuries to the right and transverse colon were managed mainly with simple suture, and those to the left colon and rectum with suture and proximal colostomy. 50% of the patients had complications, most frequently wound infection and intra-abdominal abscess. The patients with simple suture had fewer complications than the others. In the absence of complicating factors injuries to the colon are best managed with simple suture, whereas in the presence of complicating factors and in injuries of the rectum, suture or resection with proximal colostomy, especially in cases of severe tissue destruction, remains the treatment of choice.

Accidents↗
PubMed1976

Spontaneous rupture of liver tumours.

Five geriatric patients with spontaneous rupture of the liver caused by hepatic malignancies were operated upon without mortality. Liver resection seems to be the treatment of choice, but in selected cases with unresectable tumours ligation of the hepatic artery alone is preferable to an attempt to control haemorrhage by packing and suture.

Aged↗
PubMed1976

Prolonged recovery after extended right hepatic lobectomy in a patient with severe blunt liver injury and laceration of the vena cava. A report of case with special references to autotransfusion and complications of biliary decompression.

A patient with severe blunt liver injury and laceration of the vena cava who underwent a successful extended right hepatic lobectomy is reported. The use of autotransfusion unit saved the patient from exsanguination. His postoperative course was complicated by renal and hepatic failure, bile leakage, and persistent jaundice due to cholangitis. Prolonged choledochal drainage via T-tube obviously acted as a source of infection. The use of autotransfusion, choledochal drainage and the proper timing of its removal, the treatment of vena cava lesions and jaundice due to cholangitis in patients with severe liver trauma are discussed.

Acute Kidney Injury↗
PubMed1976

Hiatal hernia repair.

128 patients operated on for hiatal hernia are reported. The follow-up study consisted of 102 patients, 16 with paraoesophageal and 86 with axial hiatal hernia. The mean follow-up time was 4 1/2 years, range 1-11 years. In our experience cineradiographic studies bring abnormalities to light more readily because this kind of study is repeatable compared with conventional techniques based on fluoroscopy. Four different methods of operation were used in this study. The recurrence rate was as follows: Nissen fundoplication 13%, both anterior 180 degrees fundoplication and Lortat-Jacobs procedure 38%, and Nissen fundoplication combined to vagotomy and pyloroplasty 54%. Postoperative complications occurred in 9%. There was no hospital mortality. The authors prefer the abdominal to the transthoracic approach because many patients had other intra-abdominal, surgically easily correctable condition. If the transthoracic operation is indicated, as in a very obese patient or in a patient with a secondary short oesophagus, intra-abdominal disease must have been excluded preoperatively. In the treatment of axial hiatal hernia the best operative method has not yet been agreed upon, but in our hands the Nissen fundoplication yielded the best results.

Adult↗
PubMed1976

Selective proximal vagotomy. A preliminary report.

Eearly results of a prospective clinical trial of selective proximal vagotomy (SPV) with or without pyloroplasty are reported. The total number of patients was 41, of whom 39 had chronic duodenal ulcer, one gastric ulcer and one heamorrhage gastritis. The follow-up period in our preliminary series now averages 18 months. Recurrent duodenal ulcer appeared in two patients with proved incomplete vagotomy (5%), and two other patients suffered postoperatively from gastric retention. All the symptomatic patients underwent SPV without pyloroplasty. The promising early results warrant continuation of our trial in order to asses the role of SPV in the surgical treatment of duodenal ulcer.

Adolescent↗
PubMed1976

Retroperitoneal injuries of the duodenum caused by blunt abdominal trauma.

Five patients with blunt retroperitoneal injury of the duodenum are presented. In three of them the trauma was caused by a traffic accident, the most common mechanism of such injuries. One patient died. The high index of suspicion is still the best indication for laparotomy in retroperitoneal injuries of the duodenum, because no typical finding or reliably diagnostic test could be demonstrated even in the present study. The proper treatment in less severe injuries of the retroperitoneal duodenum is evacuation of the hematoma or simple suture of the rupture with drainage and naso-gastric suction. Internal drainage as an afferent jejunostomy is sometimes necessary in the treatment of more severe injuries. Pancreatoduodenectomy is to be reserved for only the very severe duodenal injuries, where the head of the pancreas is badly crushed.

Abdominal Injuries↗
PubMed1976

The effect of chronic intragastric alcohol ingestion on the pancreatic secretion of the rat.

The effect of chronic intragastric ethanol ingestion on the pancreatic secretion of rats was studied. The rats received 1 ml of 20% alcohol per 0.1 kg of body weight with gastric intubation five times weekly, and the total duration of ingestion was 10-12 weeks. Pancreatic juice was collected by cannulating the pancreatic duct under ether anesthesia; basal secretion was collected during 15 minutes, after which a further 15-minute secretion was stimulated with pancreozymin. The volume and the content of proteins, proteolytic enzymes, and trypsin inhibitors were studied. The secretion of proteins decreased significantly, while the amount of active proteolytic enzymes was increased in the pancreatic secretion of the alcohol rats. No active trypsin could be noted in either group. The amount of trypsin inhibitors decreased in the pancreatic juice of the alcohol rats compared with that of the control rats, but the decrease was relative to the decrease in the secretion of total proteins. No significant differences could be noted in the volume of the secreted pancreatic juice between the alcohol rats and the control rats. Pancreozymin increased the secretion to about twofold values, and the response to panreozymin was similar in the two groups.

Animals↗
PubMed1976

Retroperitoneal injuries of the duodenum caused by blunt abdominal trauma.

Five patients with blunt retroperitoneal injury of the duodenum are presented. In three of them the trauma was caused by a traffic accident, the most common mechanism of such injuries. One patient died. The high index of suspicion is still the best indication for laparotomy in retroperitoneal injuries of the duodenum, because no typical finding or reliably diagnostic test could be demonstrated even in the present study. The proper treatment in less severe injuries of the retroperitoneal duodenum is evacuation of the hematoma or simple suture of the rupture with drainage and naso-gastric suction. Internal drainage as an afferent jejunostomy is sometimes necessary in the treatment of more severe injuries. Pancreatoduodenectomy is to be reserved for only the very severe duodenal injuries, where the head of the pancreas is badly crushed.

Abdominal Injuries↗
PubMed1975

The trypsinogen and chymotrypsinogen contents of the pancreas during acute experimental pancreatitis of the rat.

The trypsinogen and chymotrypsinogen contents of the pancreas were examined during acute experimental pacreatitiis of the rat. The proenzymes were activated with enterokinase and the amounts of active proteases were estimated with BAPNA (N-alfa-benzoyl-DL-arginin-4-nitroanilid hydrochlorid, Fluka AG) and SUPHEPA (succinyl-L-phenylalanine-p-nitroanilide, Schwarz/Mann, Division of Becton) as the substrates. The activation of chymotrypsinogen was more rapid than the activation of trypsinogen; maximal activation occurred in 3 hours. Under similar circumstances the activation of trypsinogen required 17 hours. Both trypsinogen and chymotrypsinogen content decreased significantly during the inflammation. In 8 hours the decline of trypsinogen content was 28.4 percent and that of chymotrypsinogen content 44.9 percent from the proenzyme content of the normal resting rat pancreas. This indicates that proenzymes and/or active proteases are liberated during the course of pancreatitis. No correlation was found between the trypsinogen and the chymotrypsinogen content of the normal pancreas, but during pancreatitis the proenzyme contents correlated clearly. The correlation during inflammation possibly reflects the amount of the viable pancreatic tissue and the rate of synthesis.

Acute Disease↗
PubMed1975

The proteinases and proteinase inhibitors in the peritoneal exudate during acute experimental pancreatitis in the rat.

The proteolytic activities and trypsin inhibitors of the peritoneal exudate produced by experimental acute pancreatitis in the rat were studied by fractionation with gel filtration on Sephadex G-200 and estimation of the hydrolysis of casein and synthetic substrates. The peritoneal exudate produced by injecting formalin solution into the peritoneal cavity was used as a control. The peritoneal exudate during pancreatitis revealed distinct proteolytic and ATEE hydrolysing activities and it also hydrolysed BAPNA to a lesser extent. These activities were absent from the control exudates, or only traces of them could be demonstrated with the methods used. The trypsin inhibiting capacity (TIC) in the pancreatic exudate was about half that in the control exudate. In gel filtration on Sephadex G-200 the BAPNA hydrolysing proteolytic activity was eluted with the macroprotein fraction, suggesting that the enzyme was bound to the macroproteins. TIC differed clearly in the control exudate and the pancreatitis exudate. In both of them TIC was eluted in two peaks after the macroproteins, but in the pancreatitis group the first peak was very weak, if demonstrable at all, while in the control exudate the two peaks were clearly separated and the TIC was more pronounced. These findings suggest that pancreatic enzymes are released during pancreatitis into the peritoneal cavity, where they combine with proteinase binding factors in the exudate.

Acute Disease↗
PubMed1975

Stercoraceous and idiopathic perforations of the colon.

Fourteen patients have been encountered with stercoraceous or idiopathic perforations of the colon. Seven patients had a stercoraceous perforation; four had an idiopathic perforation; and three patients remained without exact classification. All the patients were admitted to hospital because of sudden abdominal pain. All except one patient, who was in an agonal condition, were operated on with a diagnosis of peritonitis. The preoperative clinical, radiologic and laboratory examinations were not specific, and in only one instance, the provisional diagnosis was correct. The main differnece between idiopathic and stercoraceous perforations was the macroscopic and histologic appearance of the perforation. In a perforated stercoraceous ulcer, the perforation was a round or an ovoid hole with necrotic and inflammatory edges, while in the idiopathic form, the perforation was a tear with a normal appearance of the colonic wall. The treatment consisted of a closure of the perforation and a proximally situated stoma, or exteriorization. Four patients of the seven with stercoraceous perforations survived. In idiopathic perforations, the prognosis was poor. All patients died during the first 24 hours after the operation. This possibly is an indication of some basic difference in the pathophysiology of these two diseases.

Adult↗
PubMed1975

The proteolytic proenzymes in the peritoneal exudate during acute experimental pancreatitis of the rat.

Precursors of proteolytic enzymes were demonstrated in the peritoneal inflammatory exudate during acute experimental pancreatitis of the rat. This was done by separating the proteinase inhibitors and proenzymes by gel filtration on Sephadex G-200. After elution the proenzymes could be demonstrated by activating them with enterokinase or with trypsin. The proenzymes were eluted after the main protein bulk and proteinase inhibitors. Enzyme precursors were absent from the exudate of formalin-induced peritonitis, which suggests that the proenzymes present in the exudate of pancreatitis are of pancreatic origin. The demonstration of proenzymes in perripheral blood during pancreatitis was tested with the several modifications of the same methods, but the results were not convincing, probably owing to the insensitivity of the methods used.

Acute Disease↗
PubMed1975

Severe liver injury. Surgical treatment of eight consecutive cases.

A series of eight consecutive patients with severe liver injury is presented. Surgical treatment consisted of liver resection in four patients, one hepatic artery ligation and suture and drainage in three patients. Six patients survived. There were about three complications per patient, infection, and bile leakage being the most common. Of three patients who required hemodialysis for renal failure, only one survived. It is strongly recommended that an autotransfusion device should be ready to hand when a patient with severe liver injury is to be operated. In a case of massive bleeding from a lesion of the vena cava or major hepatic vein, autotransfusion could save the patient's life.

Abdominal Injuries↗