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Biomedical subjects

S Laitinen

Publications and source records attributed to S Laitinen.

At least 73 records · Page 4Linked to original sources
PubMed1986

Detection of recurrent rectal carcinoma with computed tomography.

In patients with abdominoperineal resection CT is the only effective radiologic method for demonstrating the recurrence of rectal carcinomas. Our series consists of 20 patients examined with CT (38 examinations) because of suspected recurrent rectal carcinoma. Three patients had no recurrence. 13 recurrences were definitely diagnosed. In 2 cases the possibility of an abscess was considered. One recurrent tumour was misdiagnosed as postoperative fibrosis and one as a uterine fibroid.

Aged↗
PubMed1985

Sucralfate and alginate/antacid in reflux esophagitis.

The efficacy of sucralfate and of an alginate/antacid compound was compared in a randomized, double-blind 6-week trial in patients with symptomatic, endoscopically confirmed macroscopic reflux esophagitis. Of the 68 patients who completed the study, 36 received sucralfate and 32 alginate/antacid. Significant symptomatic improvement occurred in both treatment groups: almost 70% of the patients became symptom-free or improved. Esophagitis healed completely in 53% of the patients receiving sucralfate and in 34% of the alginate/antacid patients, as measured with endoscopic criteria (p greater than 0.05). Our results indicate that sucralfate seems to be at least as effective as alginate/antacid in relieving symptoms and in healing macroscopic lesions. As a safe, locally active mucosal protecting agent, sucralfate is a promising new drug for the treatment of reflux esophagitis and deserves further trials over longer periods.

Adult↗
PubMed1985

Impact of new imaging techniques on survival in cancer of the head of the pancreas and the periampullary region.

The impact of new imaging techniques on diagnostic delay and on survival in carcinoma of the head of the pancreas and the periampullary region was investigated. The study comprised 67 patients treated before (1968-1975) and 82 treated after (1979-1981) the introduction of new imaging techniques at Oulu University Central Hospital. The symptomatology, diagnostic delay and survival rates were identical in both groups, but the number of patients per year increased significantly during the latter period. The study indicated that the new imaging techniques, despite their increased diagnostic yield, did not influence diagnostic delay or survival in pancreatic and periampullary carcinoma.

Aged↗
PubMed1984

Sensitivity of single and double contrast barium enema in the detection of colorectal carcinoma.

The preoperative barium enema of the 188 colorectal carcinoma patients operated at the Oulu University Central Hospital (Finland) during 1977-1982 were examined retrospectively. Altogether 112 single contrast studies and 87 double contrast studies had been made on these patients. The single contrast barium enemas had resulted in a correct diagnosis of colorectal carcinoma in 93 cases (sensitivity 83%). The correct diagnosis in the double contrast studies numbered 71 (sensitivity 82%). Most of the overlooked carcinomas were located in the caecum, in the sigmoid or the rectum. Most of the errors made in the single contrast studies were due to detection errors and poor evacuation. The most common failures in double contrast enemas were detection errors and nonvisualisation of the sigmoid. The authors recommend use of the double contrast technique and suggest that the two methods of barium enema be used to complement each other. A false negative diagnosis delayed the operation of the colorectal carcinoma patients by 2.2 months (median).

Adult↗
PubMed1984

Finnish registry for familial adenomatosis coli.

Collecting of patients diagnosed to have familial adenomatous polyposis coli (FPC) in Finland and a centralized systematic screening of their family members were undertaken by the Depts. of Surgery of the five Finnish university hospitals. In all, 160 FPC patients belonging to 50 families could be identified, and they had 178 descendants at 50% risk. The frequency of FPC was 5.63 X 10(-5) (1:18,000), which may represent an underestimate. It gives rise, however, to four new FPC patients in Finland every year. The distribution of the origin of the FPC families was even over central Finland, but small aggregates, probably branches of the same families, were found. Of the 50 families, 28 (56%) had at least 2 affected members, whereas 22 had only 1. The gene penetrance was estimated to be 80-89% at minimum. Children of solitary FPC patients must be considered to have the same risk of inheriting the gene as do those of established familial patients. The necessity of a permanent national centralized organization for the screening and management of FPC is emphasized.

Adolescent↗
PubMed1984

Pancreatic and periampullary carcinoma.

During the 10-year period from 1972 to 1981, 179 patients were treated for pancreatic and periampullary carcinoma (40 resections, 91 bypasses, 39 laparotomies and 9 non-operated) in Oulu University Central Hospital. Mortality after resections was 10% and complication rate 33%. In 1977-1981, mortality after resections decreased from 30 to 3% (p less than 0.05) but resectability or survival did not improve. Median survival following resection for pancreatic and periampullary carcinoma was 8 and 34 months (p less than 0.001). The 5-year cumulative survival rate for resected periampullary carcinomas was 42 +/- 16%. We conclude that 5-year survival after resection for periampullary carcinoma is significantly better than after resection for pancreatic carcinoma. The effect of modern imaging techniques on resectability and survival is negligible. Age as such is not a limiting factor for resection. We recommended a prophylactic duodenal bypass is conjunction of biliary diversion for unresectable carcinoma. The acceptable mortality after resection encourages us to continue an aggressive policy in surgical treatment. However, attention should be drawn to a more careful patient selection and proper preparation.

Adenocarcinoma↗
PubMed1984

Perforation of the gallbladder. A retrospective comparative study of cases from 1946-1956 and 1969-1980.

The records of patients treated for perforation of the gallbladder in 1946-1956 or 1969-1980 (n = 41 and 70) were reviewed to elucidate if changed strategy in acute cholecystitis, i.e. delayed vs. early surgery, had had any effect on the prognosis. The overall mortality declined significantly between the two periods, from 20 to 7%. The mortality was lowest (6%) after cholecystectomy, as compared with cholecystostomy (29%) and conservative treatment (67%). The frequency of chronic biliary fistula, calculated on all gallbladder perforations, decreased significantly (46 vs. 27%), but the frequency of acute free perforation was similar in both periods (27 and 34%). Treatment policy in acute cholecystitis is discussed. The study indicated that early surgery (Cholecystectomy with peroperative cholangiography and, if required, choledochotomy) is the treatment of choice, giving the best results also in patients with perforation of the gallbladder.

Acute Disease↗
PubMed1984

Primary retroperitoneal tumours in adults.

48 patients underwent operation for a primary retroperitoneal tumour during the years 1962 to 1983. Palpable abdominal mass and abdominal pain were the most common presenting symptoms. Computerized tomography complemented by cavography, aortography and intravenous pyelography were the most effective radiological investigations available. 35 (73%) of the 48 tumours were malignant but only 8/35 (17%) of them had local metastases. 11 (23%) of the 48 tumours were radically excised, 20/48 (42%) had partial excision and 17/48 (35%) an incisional biopsy. 4 (11%) of the 35 malignant tumours were excised radically, 16/35 (46%) were partially excised and 15/35 (43%) had an incisional biopsy. Resection of adjacent organs was performed in 8 patients (17%). Overall operative mortality was 15% and morbidity 23%. All mortality in patients with malignant tumours occurred after incisional biopsy. Prognosis of benign tumours was excellent. The 5-year cumulative survival for malignant tumours was 28 +/- 9%. 7 patients were alive 5 years after operation but only 2 of them without evidence of recurrent disease. In conclusion, long-term results obtained by surgery of malignant tumours were less satisfactory. Hence, randomized trials with adjuvant radiation and chemotherapy are necessary. Local recurrences should be diagnosed early and resected aggressively.

Adolescent↗
PubMed1984

Tinidazole prophylaxis in elective colorectal surgery.

Bowel wall concentrations of tinidazole in two patient groups undergoing elective colorectal surgery were determined 8 h (22 patients) and 12 h (26 patients) after a single 500-mg intravenous infusion. In addition, the efficacy of 1-day tinidazole prophylaxis with 8- and 12-h dosage intervals in the prevention of postoperative infection complications was evaluated. The mean bowel wall tinidazole concentrations 8 and 12 h after infusion were 5.1 +/- 2.5 micrograms/g and 4.3 +/- 1.8 micrograms/g, respectively, which are considerably higher than the minimal inhibitory concentration for Bacteroides fragilis strains. Three patients out of 48 (6.3%) developed a wound infection: 1 from the 8-h dosage interval group (4.5%) and 2 from the 12-h interval group (7.7%). Wound cultures revealed only aerobic growth. The results confirm that an adequate bowel wall concentration remains for more than 12 h after a single 500-mg intravenous infusion of tinidazole. One-day tinidazole prophylaxis is an effective means of preventing postoperative infections after colorectal surgery.

Adult↗
PubMed1982

Effect of surgery on liver function in patients with liver cancer.

The effect of hepatic resection, hepatic artery ligation (HAL), and artery ligation combined with regional infusion of 5-fluorouracil (HAL + 5-FU) on liver function was investigated by liver tests including antipyrine in 20 patients with liver cancer. One month after resection the conventional liver tests except serum albumin were normalized, but the rate of antipyrine elimination was still significantly reduced. This suggests that the oral antipyrine test may be a sensitive reflector of the reserve capacity of the liver. Palliative procedures (HAL +/- 5-FU) had a transient effect on conventional liver tests and a negligible effect on functional liver capacity as determined by the antipyrine test or serum albumin concentration. On the basis of our results it remains unknown whether antipyrine determination provides any additional advantage over serum albumin as a measure of functional liver capacity in localized liver diseases, such as liver tumours.

Adult↗
PubMed1982

Experiences with the EEA stapling instrument for anastomoses of the upper gastrointestinal tract.

Technique, early experiences and results with the EEA stapling instrument for the reconstruction of intestinal continuity after gastric and esophageal resection in 52 patients are reported. 12 patients with gastric cancer and 4 patients with cardiac cancer underwent total gastrectomy with esophagojejunostomy, 25 patients with gastric cancer underwent subtotal gastrectomy with gastrojejunostomy, 8 patients with esophageal cancer had esophageal resection with esophagogastrostomy and 3 patients with non-resectable gastric or cardiac cancer had palliative by-passing esophagojejunostomy, all performed by means of the EEA stapler. Three anastomotic leakages were detected radiologically, two after esophagojejunostomy and one after gastrojejunostomy. These leaks did not lead to clinical signs or symptoms and healed with parenteral nutrition in three weeks. One patient died of myocardial infarction on the 8th postoperative day, but at autopsy the anastomosis was intact. At follow-up endoscopy three mild anastomotic strictures have been found, but no treatment have been required. In two patients the stricture resolved spontaneously in a few months. According to our experience, esophagojejunal, gastrojejunal and esophagogastric anastomosis performed with the EEA stapling instrument seems to be at least as reliable as a hand sutured anastomosis, obviously even more reliable. The EEA stapler is also time saving, especially after adequate experience with the use of the instrument has been achieved. The difficulties and hazards associated with the use of the stapler are discussed.

Adult↗
PubMed1982

Comparison of metronidazole with clindamycin-gentamycin combination in the prevention of infectious complications after elective colonic surgery.

The efficacy of metronidazole, active only against anaerobes, and clindamycin-gentamycin combination, covering both anaerobes and aerobes, in the prevention of infectious complications after elective colonic surgery was compared in a prospective randomized trial over a three-year period. A total of 130 patients were accepted for the trial, 67 receiving metronidazole intrarectally and 63 receiving clindamycin-gentamycin combination. The prophylactic treatment was started on the evening before the operation and continued for 24 hours. One patient out of 67 receiving metronidazole (1.5%) and two patients out of 63 receiving clindamycin-gentamycin (3.2%) developed a wound infection. An intra-abdominal infection occurred in two patients in both groups (3% and 3.2%, respectively). There was no statistically significant difference in postoperative infections between the groups. The authors conclude that metronidazole is as effective as the clindamycin-gentamycin combination and should be preferred to broad-spectrum antibiotics because of its fewer side effects and lower potential of developing resistant bacterial strains.

Adolescent↗
PubMed1980

Experiences with the EEA stapling instrument for colorectal anastomosis.

Early experiences and results with the EEA stapling instrument for colorectal anastomosis are reported. 39 patients underwent anterior resection or left hemicolectomy with end-to-end anastomosis performed by means of the EEA stapler. Two patients had a clinically recognizable anastomotic leakage, both of which healed spontaneously. One patient died from pulmonary embolism, but at autopsy the anastomosis was intact. No significant problems in the control of anorectal function developed. On follow-up sigmoidoscopic examinations two patients showed a distinct narrowing of the anastomotic site, but both of these stenoses were spontaneously dilated by six months. It seems that an anastomosis performed with the EEA stapler is at least as reliable as a hand sutured one and apparently more so. With this instrument an anastomosis can be achieved at a lower level than would be feasible with conventional hand suture techniques. In addition, it is much more easily and rapidly performed, especially in patients with a narrow pelvis or other anatomical difficulties.

Adult↗
PubMed1978

Anaesthesia induction and lower oesophageal sphincter pressure.

The effects of some drugs generally used in premedication for and induction of anaesthesia on the lower oesophageal sphincter (LOS) pressure were investigated in 30 dogs, using the modern oesophageal manometric technique. In thiopental-induced anaesthesia, a distinct pressure gradient was noted between the LOS and gastric pressure. Atropine eliminated this pressure gradient almost completely. Metoclopramide increased the LOS pressure significantly, and subsequent atropine administration was unable to bring it down. Metoclopramide administered after atropine was unable to elevate the LOS pressure reduced by atropine. Succinylcholine had no observable lasting effect on the LOS pressure. The present findings seem to indicate that of the drugs generally used in premedication for and induction of anaesthesia, atropine significantly reduces the LOS competence, thereby creating favourable conditions for gastro-oesophageal reflux (GOR) and consequent postoperative pulmonary complications. Use of metoclopramide in premedication for or induction of anaesthesia to eliminate the depressant effect of atropine on the LOS pressure appears to be indicated.

Anesthesia, General↗