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Biomedical subjects

R Luosto

Publications and source records attributed to R Luosto.

At least 37 records · Page 2Linked to original sources
PubMed1987

Correlation of NYHA classification, bicycle ergometry and right heart haemodynamics after total correction of tetralogy of Fallot in adults.

Thirty-two patients who had undergone correction of Fallot's tetralogy in adult life were examined on average 6.3 years postoperatively, at mean age 25.8 years. Palliative shunt operation had been performed in childhood in 28 cases. The clinical condition was good in 25 patients (78%). 13 of whom had mean gradient between right ventricle and pulmonary artery 16.0 +/- 4.2 mmHg and systolic right ventricular pressure 39.0 +/- 10.0 mmHg, while 12 had right ventricular pressure 62.6 +/- 16.3 mmHg. In these groups the maximum exercise capacity was, respectively, 136.7 +/- 36.1 and 106.1 +/- 30.8 W/min. Three other patients were in satisfactory, and four in poor clinical condition, with right ventricular systolic pressure, respectively, 74.3 +/- 10.9 and 91.5 +/- 60.0 mmHg. The gradient from right ventricle to pulmonary artery averaged 58.5 +/- 10.4 mmHg in the latter group but, despite the obstructed pulmonary outflow tract, the exercise capacity (116.7 +/- 28.9 W/min) was similar to that in the groups with better clinical results. It is concluded that in most patients with palliative surgery in childhood, tetralogy of Fallot can be successfully corrected in adult life. The causes of right ventricular impairment do not significantly reduce the exercise capacity.

Adult↗
PubMed1986

Histological pattern and changes in extracellular matrix in aortic dissections.

Samples from 34 patients were studied both histologically and immunocytochemically by the indirect biotin-avidin peroxidase technique to analyse the distribution of the extracellular matrix components (type IV collagen, fibronectin, types I and III collagens) in dissection of the aorta. Most showed defects in type IV collagen around medial smooth muscle cells. Defects in smooth muscle cell basement membrane were found throughout the media in cystic medial degeneration and in medionecrosis, whereas in atherosclerosis such unlabelled areas were found only above advanced atherosclerotic plaques. In aortitis other defects in the smooth muscle cell basement membrane were found in areas of inflammatory infiltrates. In all of these conditions similar defects in fibronectin expression were also found. No defects in the expression of interstitial collagens type I and III were seen in the dissecting aortas. Moreover, cystic medial degeneration, medionecrosis, and atherosclerosis were characterised by intense staining of these interstitial matrix components. In the pathogenesis of the aortic dissection local changes in the basement membranes of the medial layer may be important.

Aortic Dissection↗
PubMed1986

Surgical treatment of aortic dissection in 60 patients.

During the years 1964-82 a total of 60 patients underwent surgery for aortic dissection. Forty of them were males, with a mean age of 48.8 years (22 to 69) and 20 were females, with a mean age of 49.0 years (31 to 65). Forty-five patients were operated in an acute stage of aortic dissection and 15 patients in a chronic stage of this disease. The mortality rate of patients operated on for acute dissections was 51.1% and of patients with a chronic dissection 13.3%, the over-all hospital mortality rate being 41.7%. Cardiac and haemorrhagic complications were the commonest cause of death. Among the 35 operative survivors, there were seven late deaths (11.7%); 4 patients died of cardiovascular causes. The mean follow-up time was 6.1 years (2.7 to 13.4). Twenty-six long-term survivors were re-examined in the hospital.

Actuarial Analysis↗
PubMed1986

Mediastinal neurogenic tumours. Early and late results of surgical treatment.

Early and late results of surgery for neurogenic mediastinal tumour were evaluated in 66 cases with a mean follow-up of 12 years. The series comprised 48 neurilemmomas, 8 neurofibromas, 7 ganglioneuromas, and neurinoma, neurofibrosarcoma and ganglioneuroblastoma each in one case. There were two early deaths (3%), one due to peroperative bleeding from the left subclavian artery and the other to acute myocardial infarction. Operative complications arose in 12 cases (18%), the most common being wound infection (3 cases). There were 17 late deaths (26.6%). In the neurilemmoma group, 3 of the 13 late deaths were related to the tumour or its treatment, and both deaths in the neurofibroma group were related to malignant transformation. Recurrence of tumour appeared in 3 of the 48 patients with neurilemmoma and also in the single patient with neurinoma as tumour classification. One neurilemmoma was a dumb-bell tumour, and operation in this case resulted in paraplegia. Malignant transformation appeared in 2 of the 8 neurofibromas 5 and 13 years postoperatively. Because of the risks of malignant degeneration and of recurrence, patients operated on for neurogenic mediastinal tumour should be carefully followed up for many years.

Adolescent↗
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

Late results of the surgical treatment for aortic dissections.

The results of 32 patients who had undergone surgery for aortic dissections were analyzed. Twenty-six patients were examined in hospital during the follow-up study while one patient refused the examination and 5 others had succumbed. The average follow-up was 42.6 months. Late functional status was generally good. Resuspension of the aortic annulus for incompetent aortic valves in type I and II dissections resulted in grave aortic regurgitation and death in one case, and in mild valvular incompetence in another case, while 5 patients had competent valves after resuspension. Computed tomography (CT) and angiographic studies frequently revealed residual changes such as double lumen of the aorta. Five subsequent aortic aneurysms were discovered, 4 of them having been reoperated after the study was completed. Periodical follow-up and screening of the aorta of operative survivors is recommended.

Adult↗
PubMed1984

Total correction of tetralogy of Fallot in adults.

A series of 42 patients who underwent total correction of tetralogy of Fallot as adults is presented. Previous palliative operation had been performed in 33 cases: Blalock-Taussig shunt in 28 (bilateral in 6), Brock operation in four and Potts' anastomosis in one case. Severe cyanosis (average hemoglobin 203 g/l), thrombotic complications and hypoxic spells were the most pertinent of the clinical manifestations necessitating the total repair. Blalock-Taussig shunt had closed spontaneously before the intracardiac operation in 14 cases (3 bilateral) and in 11 it was ligated. In six cases the shunt was left untreated, being hemodynamically insignificant at operation. Three of the 42 patients died in association with the intracardiac operation. A-V block developed in two patients and required permanent pacemaker. During follow-up periods of up to 13 years, a residual ventricular septal defect was found in seven patients. Two of the defects were surgically closed. Five were not corrected, as the patients were doing well and the pulmonary/systemic flow ratio was less than 1.5 at repeat catheterization. Two-thirds of the patients were in NYHA class I at re-examination, and the others were in class II. The subjective functional improvement was greater than could have been expected from results of exercise tolerance tests.

Adolescent↗
PubMed1984

Local anaesthesia in carotid surgery. A prospective study of 111 endarterectomies in 100 patients.

A prospective study was carried out on 100 patients consecutively undergoing carotid endarterectomy in local anaesthesia, in order to evaluate the usefulness of clinical signs in awake patients for monitoring of cerebral function and to determine the need for internal shunt in carotid surgery. The indications for operations were transient ischemic attacks in 67 patients and major or minor stroke in 24 (16 with persistent neurologic deficit). In nine asymptomatic patients the endarterectomy was prophylactic, following detection of bruit and angiographic stenosis. Bilateral stenosis was present in 47 patients, including 13 with total occlusion of the contralateral vessel, and 60 patients had significant vertebral artery stenosis. The carotid artery was first tentatively occluded and, if this was well tolerated for 5 min, endarterectomy was done without an internal shunt. Neurologic deficit signs during the trial occlusion necessitated such shunt in 16 patients with pressure in the internal carotid stump ranging from 0 to 40 (mean 22.4) mmHg. On the other hand, 11 additional patients with stump pressure less than 35 mmHg tolerated the trial occlusion well, underwent carotid endarterectomy without internal shunt and had no deficit symptoms during or after operation. One patient died postoperatively. Hemiparesis appeared in two more patients, but resolved completely in one and gave only minor sequelae in the other. These complications were related to the preoperative condition (stroke) and the postoperative residual pressure gradient. It is concluded that trial occlusion of the carotid artery and observation of the awake patient provide reliable information on the need for an internal shunt during carotid endarterectomy.

Adult↗
PubMed1984

Elective surgery of abdominal aortic aneurysms. Experience with 174 patients.

Clinical experience with 174 patients (150 M, 24 F) with abdominal aortic aneurysm operated on during the 15-year-period 1966-80 is presented. The age range was 45-79 (average 62) years. The reconstruction was by means of a dacron Y-prosthesis after resection of the aneurysm, aortoiliac in 136 cases, aortofemoral in 31 cases, aortoaortal (tube prosthesis) in 5 cases. Wrapping was performed in two cases. Simultaneous arterial reconstruction of the lower extremities was done on 32 occasions, reconstruction of the renal arteries on 15 occasions, and mesenteric artery on one. The operative mortality was 8% and late mortality 22% (average follow-up of 4 years). Later arterial reconstruction of the lower extremity was necessary in 22 cases, carotid endarterectomy in 4 cases and lumbar sympathectomy in 5 cases. In the follow-up questionnaire (after 4 years on average) 56 patients reported claudication, 46 patients had angina, 36 high blood pressure and 28 symptoms referable to a cerebrovascular disorder.

Aged↗
PubMed1983

Surgical treatment of nondissecting aneurysms of the descending thoracic aorta.

Between 1966 and 1981, 58 patients underwent operation for nondissecting aneurysm of the descending thoracic aorta at the University Central Hospital in Helsinki. The cause of the aneurysm was atherosclerotic in 38 cases. Nine aneurysms were post-traumatic and 11 had developed after correction of aortic coarctation with a Dacron patch. Rupture of the aneurysm with hypotension and haemothorax were present on admission in three patients (5.2%). Six operations were performed without use of shunt or bypass. In the other patients the circulation to the spinal cord and viscera was protected during the aortic resection and reconstruction. Left atrial-to-femoral artery bypass was used in 43 patients, femoral vein-to-femoral artery bypass in five, heparinized TDMAC shunt in three patients and total perfusion in one case. Transient paraparesis and irreversible paraplegia each occurred in one case in which some form of circulatory protection had been used. In the latter patient there was aneurysm rupture and hypotension on admission to hospital, and resection (greater than 10 cm) was done with TDMAC shunt. The patient died postoperatively of pulmonary complications. The total operative mortality was 12.1%. The mortality in the follow-up period (range 1-14 years, mean 5 years) was 13.8%. The conclusion from the study was that, when adequate technique of aneurysm resection is combined with shunt or bypass, an acceptable operative mortality and low incidence of paraplegia are obtainable.

Adult↗
PubMed1983

Fistula between abdominal aortic aneurysm and left renal vein.

A 77-year-old man with spontaneous rupture of an abdominal aortic aneurysm into the left renal vein, in the presence of an anomalous retroaortic left renal vein is described. The patient was operated and recovered without complications. In the previous literature seven similar cases were found.

Aged↗
PubMed1982

Surgical treatment of acute superior vena caval syndrome. A report of two cases.

The syndrome caused by the acute obstruction of the superior vena cava with central nervous system symptoms as well as with symptoms related to the oedema of the upper respiratory tract is often very severe and fatal to the patient. Conservative treatment is usually of no help, and consequently the palliative reconstruction of the superior vena cava may be indicated. Two cases of acute superior vena caval syndrome with reconstruction of the superior vena cava are presented. In the first case, when a malignant mediastinal tumour (Hodgkin's) was removed, a segment of the superior vena cava and the anonymous vein had to be removed. Following this operation acute superior vena caval syndrome developed and another operation was performed in which the superior vena cava was reconstructed with a Dacron prosthesis. Radiological examination of the superior vena cava 28 months postoperatively showed the prosthesis patent and the patient was free from symptoms. 51 months after the operation the patient was still asymptomatic. In the second case the obstruction of the superior vena cava was caused by anaplastic carcinoma of the upper lobe of the right lung. The acutely obstructed superior vena cava was reconstructed with a Dacron prosthesis. 9 months postoperatively the superior vena caval syndrome recurred and two months later the patient died of lung cancer. In both cases good palliation of the obstruction of the superior vena cava was obtained.

Acute Disease↗
PubMed1980

Surgical treatment of coarctation of the aorta with minimal collateral circulation.

Twenty-four aortic coarctation patients with minimal collaterals were operated on. Left-side bypass was used in 18 cases, internal shunt in 4, while a jump graft ws inserted in 2 cases. These methods were applied when the distal aortic pressure fell below 50 mmHg systolic during test clamping. The coarctation was corrected with isthmusplasty in 12 cases, resection and end-to-end anastomosis in 5 cases, resection with prosthetic replacement in 5 cases and jump graft in 2 cases. The operative mortality was 2 patients (8.3%). One patient died of complications of a post-perfusion bleeding tendency; the other, who had concomitant aortic insufficiency, died of cerebral infarction and pneumonia. At follow-up examination, the blood pressure difference between the upper and lower extremities had disappeared in all cases. The blood pressure was still over 150 mmHg systolic in 9 patients, 8 of whom received anti-hypertensive medication. One patient died during the follow-up period, while waiting for an operation for aortic insufficiency.

Adolescent↗
PubMed1980

Extrathoracic approach for reconstruction of subclavian and vertebral arteries.

One hundred extrathoracic arterial reconstructions were performed on 98 patients with occlusions or stenoses of the subclavian or vertebral arteries: 52 bypasses, 18 transpositions of the subclavian artery to the common carotid artery, 13 endarterectomies and 17 operations involving two or more simultaneous reconstructions. The operative mortality was 1% (one patient). In 2 patients hemiplegia occurred as a complication of carotid-subclavian bypass operation. Six patients had a nerve injury as an operative complication: 1 lesion of the brachial plexus, 3 lesions of the recurrent nerve, and two lesions of the phrenic nerve (one patient also had Horner's syndrome). Immediate thrombosis of the operated arteries developed in 7 patients, 2 of whom were re-operated on. During the follow-up period (mean 4.5 years), six additional operations were performed because of failure of the first operation: the bypass graft was thrombosed in 5 of these cases and in one case a venous bypass graft with insufficient flow was replaced by a prosthesis. One patient underwent reconstruction of the contralateral side because of residual symptoms. In addition, 1 carotid endarterectomy, 2 thoracic sympathectomies, 4 coronary artery reconstructions and 8 lower limb arterial reconstructions were performed during the follow-up period. There were 17 late deaths, 9 of which were due to coronary artery disease. Of the 80 survivors 79% were satisfied with the operative result. The bypass was considered patent in 68%.

Adolescent↗
PubMed1980

Traumatic rupture of the thoracic aorta.

During the years 1961-78, 17 patients with traumatic rupture of the aorta underwent surgery at the Department of Thoracic and Cardiovascular Surgery, University Central Hospital, Helsinki. Nine of the cases were acute ruptures and 8 were chronic aneurysms. All cases were confirmed by pre-operative aortography. Rupture was located in each case in the proximal descending thoracic aorta just distal to the left subclavian artery. Surgical repair was made by using a left-side bypass in all cases but one, in which the operation time was so short that no organ protection was needed. The absence of paraplegias and kidney lesions demonstrated the adequacy of organ protection. Two of the three operative deaths were probably related to the systemic heparinization during left-side bypass which, by causing exacerbation of the cerebral bleeding, could have led to death. The possibility that these two deaths could have been avoided by using the new heparin-bonded, non-thrombogenic shunts, which obviate the need for generalized heparinization, is discussed. Operation is also recommended in chronic cases and should be performed as soon as an aneurysm has been diagnosed.

Adolescent↗
PubMed1980

Lumbar sympathectomy in the treatment of severe lower limb ischaemia in old people.

One hundred and twenty lumbar sympathectomies were performed in 110 old people (over 65 years of age) as the treatment for severe lower limb ischaemia. Only one quarter of the patients benefited from the operation. In nearly half the cases the limb was ultimately amputated. The operative mortality was 7%, with pneumonia the most common cause of death. Age and mild diabetes mellitus had no effect on the result of treatment. Diabetics on insulin, however, derived no benefit from the operation. the degree of severity of the ischaemia, and the location of the arterial occlusion affected the result of treatment.

Age Factors↗