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Biomedical subjects

S Mattila

Publications and source records attributed to S Mattila.

At least 109 records · Page 6Linked to original sources
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

Combined valve replacement and myocardial revascularization. Factors influencing early and late results.

The risk factors involved in simultaneous valve replacement and coronary artery bypass grafting were evaluated in 54 consecutive patients, 42 men and 12 women, aged 22 to 73 years. The predominant valve anomalies were aortic stenosis (30 patients), aortic regurgitation (9), mitral regurgitation (10) and mitral stenosis (5). All the patients had angina. Myocardial infarction had occurred in 22 cases and was impending at the time of operation in 10. The diseased valves were replaced with mechanical prostheses, and on average 2.5 coronary arteries per patient were bypassed with vein or with internal mammary artery grafts. Four of the 54 patients died in association with surgery, and four more during follow-up (0.5-6 years). The operative mortality was 2/39 in the aortic valve group and 2/14 in the mitral valve group. The late mortality was equal in both groups. A relatively small ejection fraction and long aortic cross-clamping were the only factors which attained statistical significance as surgical risks, but mitral regurgitation due to ischaemic papillary muscle dysfunction, advanced rheumatic mitral regurgitation and tight aortic stenosis combined with coronary artery disease also seemed to be indicators of poor prognosis.

Adult↗
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

Serum selenium concentration related to myocardial infarction and fatty acid content of serum lipids.

A longitudinal case-control study of 33 patients with one or more risk factors for coronary heart disease and 64 controls showed that the serum selenium concentration (range 0.63-1.33 mumol/l (50-105 micrograms/l] was not associated with development of clinical manifestations of coronary heart disease during a follow up of five to seven years. The content of polyunsaturated fatty acids, especially eicosapentaenoic acid, in serum cholesterol esters and phospholipids was positively correlated with selenium concentration. As a low content of polyunsaturated fatty acids in serum lipids was an independent risk factor for coronary heart disease in these subjects it may be hypothesised that the high coronary risk in subjects with a very low serum selenium concentration (less than 0.57 mumol/l (less than 45 micrograms/l] might be due not to selenium deficiency but to the coexisting low concentrations of polyunsaturated fatty acids in serum.

Cholesterol Esters↗
PubMed1983

Late aneurysms after patch aortoplasty for coarctation of the aorta in adults.

Sixty-eight patch aortoplasties were performed for coarctation of the aorta (CoA) in adult patients from 1967 to 1978 in our hospital. The mortality was 1.5% and the immediate result of the surgical repair seemed good. Long-term follow-up of 2 to 14 years later revealed aneurysm formation at the repair area in 27% of the 62 patients for whom sufficient follow-up data are available. Two aneurysms had ruptured with a fatal outcome. Other repair methods used for coarctation in 106 patients were free from aneurysm complication. Thirteen patients with an aneurysm underwent reoperation without mortality. The etiology of these unexpected aneurysms is discussed.

Adolescent↗
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

Chylothorax. Clinical experience in nine cases.

Clinical experience in nine cases of chylothorax is presented. In five cases the cause was iatrogenic, in two cases idiopathic and in two cases the chylothorax was secondary to an advanced malignant disease. Iatrogenic chylothorax occurred after mediastinoscopy, thoracic sympathectomy, pneumonectomy, resection of an aneurysm of the thoracic aorta and closure of a patent ductus arteriosus. Only one of these patients needed an operative closure of the thoracic duct. In one of the two cases of a neoplastic origin the chylothorax was caused by a malignant mesothelioma and thoracic duct ligation was needed while in the other case it was due to an inoperable pancreatic carcinoma and was treated by thoracocentesis. In one of the idiopathic cases supradiaphragmatic ligation of the thoracic duct was necessary. It is concluded that in most iatrogenic or traumatic cases chylothorax can be cured by conservative therapy (diet, thoracocentesis); in other cases the operative therapy should be adjusted to the primary disease, and the ligation of the thoracic duct should be performed at a level where it is able to prevent the chylous leak without unnecessarily interfering with the collateral lymphatic circulation. Abundant and prolonged chylous leakage should be always treated operatively to prevent disastrous nutritional and immunological deficiencies.

Adult↗
PubMed1983

Management of arteriosclerotic aneurysms of the innominate and subclavian arteries.

Two patients with innominate artery aneurysm and four with subclavian artery aneurysm are presented. Resection of the aneurysm and reconstruction of the vascular continuity were performed in all cases. No patient died in association with surgery. The complications included paralysis of the recurrent laryngeal nerve in one patient and postoperative infection of the vascular prosthesis, necessitating removal of the graft, in another. Because of the absence of surgical mortality and the acceptable complication rate, surgical resection of these aneurysms is recommended.

Adult↗
PubMed1983

Flail chest--pathophysiology, treatment and prognosis.

Multiple injury is often associated with an unstable serial rib fracture and a pulmonary contusion under the contact area which both lead to respiratory insufficiency. This has to be treated at an ICU by respirator with IMV and PEEP from the beginning. With this method the time of respirator treatment has been lowered to nearly one half and tracheostomy is seldom needed. Also, the required oxygen concentration is less (35%) which decreases the risk of toxic pulmonary injury. The prognosis is poorer with head injury or other concomitant injury, especially severe trauma causing bleeding in parenchymatous organs of the abdomen.

Flail Chest↗
PubMed1983

An anomalous retrocaval right iliac artery in a patient with an aortic aneurysm. A case report.

A case of anomalous retrocaval right common iliac artery in a patient with an abdominal aortic aneurysm is presented. In addition to being retrocaval the artery also made a wide loop deep in behind the fibres of the psoas muscle, becoming visible again in the minor pelvis. The incidence of venous and arterial anomalies is briefly discussed, and a summary review of the literature presented.

Aged↗
PubMed1982

Fatty-acid composition of serum lipids predicts myocardial infarction.

During a follow-up of five to seven years 33 out of 1222 middle-aged men initially free of coronary heart disease sustained fatal or non-fatal myocardial infarction or died suddenly. The fatty-acid composition of serum triglycerides, phospholipids, and cholesterol esters had been measured at the start of the surveillance in these men and in a control group of 64 men matched for age, serum cholesterol and triglyceride concentrations, blood pressure, obesity, smoking, and one-hour glucose tolerance. Palmitic and stearic acids of phospholipids were significantly higher and linoleic and most polyunsaturated fatty acids, including arachidonic acid and eicosapentaenoic acid, of phospholipids were lower in the subjects who sustained coronary events compared with the controls. Linoleic acid tended to correlate negatively with blood pressure while other polyunsaturated fatty acids, especially eicosapentaenoic acid, exhibited a negative correlation with blood pressure and relative body weight in the controls but not in the subjects who sustained coronary events. These findings suggest that the fatty-acid pattern of serum phospholipids is an independent risk factor for coronary heart disease.

Adult↗
PubMed1982

Treatment and prognosis of thymoma: a review of 25 cases.

Experience of 25 patients with thymoma is reported. Based on the presence or absence of gross invasion 17 tumors were regarded as benign, 8 as malignant. All patients were operated on. Twenty-two had a complete excision, 2 a palliative excision, and 1 a biopsy only. Five patients received post-operative radiotherapy and 2 patients were given cytotoxic chemotherapy. None of the 17 patients with a benign thymoma had a recurrence or death due to thymoma during the follow-up. The five- and ten-year survival rates for malignant thymoma were 50% and 17%, respectively. Excision is the treatment of choice for all thymomas, since the prognosis for benign tumor is excellent and the malignancy can only by determined at exploration. Post-operative radiotherapy seems to be indicated in malignant thymoma. Myasthenia gravis and histologic features of thymoma have some value in predicting prognosis.

Follow-Up Studies↗
PubMed1982

Severe bronchiolitis probably caused by varicella-zoster virus.

An unusual, severe pneumonia probably caused by varicella-zoster virus is reported in a 19-year-old previously healthy man. The diagnosis was based on high titer of varicella-zoster antibodies in serum, and demonstration of varicella-zoster antigen from lung biopsy specimen. The uncommon feature in the pathophysiological course of the disease was the selective hypercarbia that responded well to bronchodilator therapy with theophylline. Furthermore, the patient had no skin manifestations during his illness.

Adult↗
PubMed1982

HDL cholesterol and beta-adrenoceptor blocking agents in a 5 year multifactorial primary prevention trial.

1 Serum HDL cholesterol measured at the end of a 5 year multifactorial primary prevention trial, aimed to reduce risk factor levels and incidence of ischaemic heart disease, revealed quite low values in drug-treated subjects. 2 Analysis of subgroups treated with beta-adrenoceptor blocking agents (mainly pindolol) alone or in different combinations with diuretics showed inconsistent effects of beta-adrenoceptors blockers on serum HDL cholesterol. HDL cholesterol levels in patients treated with pindolol with or without a diuretic were not different from those of the risk-free control group. 3 Subjects on combined beta-adrenoceptor blocker-hypolipidaemic treatments had lower HDL-cholesterol than those on hypolipidaemic agents alone. 4 Withdrawal of pindolol at the end of the trial caused a small but significant increase in serum HDL cholesterol in a small subgroup of mildly hypertensive patients. Thus, pindolol appears to have slightly reduced serum HDL cholesterol but the relevance of this small decrease on the incidence of ischaemic heart disease is questionable.

Adrenergic beta-Antagonists↗
PubMed1982

Valve replacement for bacterial endocarditis.

During the 10-year period 1970-79, 88 patients underwent valve replacement for complications of bacterial endocarditis. The mean age of the patients was 42 (15-60) years. There were 64 men and 22 women. Thirty-three patients had a history of rheumatic fever. In 11 cases the murmur was heard already in childhood. In 44 cases (50%) no heart disease was diagnosed before the onset of symptoms of bacterial endocarditis. Strepto- and staphylococci were the most common organisms found in culture. In 12 cases a dental and in 12 a respiratory tract infection preceded the endocarditis. In 51 cases, however, the origin of the infection remained unestablished. Intractable heart failure and embolizations were most common indications for operation. Only 9 patients underwent operation in the acute phase. Aortic valve replacement (AVR) was performed in 58 cases, mitral valve replacement (MVR) in 19, both AVR and MVR in 6, AVR and aneurysm of sinus Valsalva repair in 3 cases, AVR and repair of VSD in one and AVR combined with myocardial revascularization and replacement of the ascending aorta for aneurysm in one case. The early mortality was 9 patients (10%) and late mortality 9 patients. During follow-up times of up to 10 years, 7 patients experienced embolic complications. They recovered uneventfully. One valve prosthesis was replaced because of thrombosis and another due to paraprosthetic leak. Two patients had a late recurrent bacterial endocarditis 5 and 8 years postoperatively. They were treated conservatively and recovered. It was concluded that after valve replacement for bacterial endocarditis, the risk of recurrent infection is relatively low and that results approaching those for elective valve replacement can be achieved.

Adolescent↗
PubMed1982

Surgical intervention in cases of Ebstein's anomaly. Abnormal origin and structure of the tricuspid valve.

During the ten-year period 1972-81 four patients, two men and two women, with Ebstein's disease underwent operation at our institution. Their average age was 34. Central cyanosis at rest, clubbing and polycythaemia were the most common clinical features of the patients. Enlarged heart, a small pulmonary arterial arch and transluminal lung fields were seen in chest X-ray. Operative findings were a grossly enlarged right atrium and ventricle, the latter having a segment that was typically atrialized and thin-walled but was contracting synchronously with the true right ventricle, and a wide variation in the leaflets of the tricuspid valve and their origins. The atrial septal defect was small in all cases. Artificial heart valves (1 Cutter-Smeloff, 2 Björk-Shiley, 1 St. Jude) were used in the tricuspid reconstruction in addition to closure of the ASDs. One of the patients died postoperatively, the other three are doing well.

Adult↗