Biomedical subjects

Tuomo Visuri

Publications and source records attributed to Tuomo Visuri.

9 recordsLinked to original sources

PubMed2006

Malignant tumors at the site of total hip prosthesis. Analytic review of 46 cases.

During the years 1974 to 2003, a total of 46 cases of malignant tumors at the site of total hip arthroplasty, 41 sarcomas, 4 lymphomas, and 1 epidermoid carcinoma, have been reported in the Western literature. Soft tissue sarcomas occurred in 31 and bone sarcomas in 10 cases. Malignant fibrous histiocytoma was the most common in 20 (65%) of all soft tissue sarcomas. The patients with malignant tumors had been operated on more often for secondary osteoarthritis and had more local complications than those in ordinary total hip arthroplasty series. Primary osteoarthritis was the indication in 63% and secondary osteoarthritis in 37% of the 38 reported cases. Tumor developed after 8 (17%) revisions. Deep infection complicated 4 (9%) of the cases. Four cases (9%) were preceded by a precondition for cancer, 2 postradiation necroses of the femoral head, 1 chronic sinus, and 1 Mafucci syndrome. Mean age of the patients at the time of first implantation was 59 years (range, 24-79 years). The mean latent period was 6 years (range, 0.5-20 years) from the first operation. Longer latency period did not correlate positively with the cancer risk. Sarcomas were highly aggressive. Of the 31 reported patients, 24 (77%) died within 1 year after the diagnosis. The number of reported sarcoma cases is low considering the total population behind the cases. In addition, one observed local sarcoma from Nordic cohorts was less than expected. Chronic, particle-induced inflammation around the prosthesis does not seem to increase the risk for carcinogenesis.

Adult↗

PubMed2005

Long-term vertebral changes attributable to postoperative lumbar discitis: a retrospective study of six cases.

UNLABELLED: A clinical, plain radiographic, and magnetic resonance imaging retrospective followup study was done on six patients with postoperative septic L4-L5 lumbar spondylodiscitis to identify the characteristic long-term radiographic findings predicting the clinical outcome. The mean followup was 12 years (range, 9-13 years). Three patients had moderate low-back pain and two were handicapped. One patient had slight peroneal weakness. Flexibility of the lumbar spine was restricted to some extent in all patients. Laminectomy for spinal stenosis (L4-L5) had been done in one patient and reoperation because of recurring disc herniation was done in two patients. Partial or total bone marrow depletion and corresponding enhancement of fat signals in relation to adjacent vertebral bodies, narrowing of the intervertebral disc space, and irregularity or cavitations affecting one or both end plates were long-term findings of magnetic resonance imaging. Plain radiographs and magnetic resonance imaging scans revealed a complete bony fusion in one patient and partial fusion in one patient. In two patients, residual disc protrusion or herniation in relation to the surgically treated disc was evident; three affecting L3-L4 and two affecting L5-S1 disc levels. Septic postoperative lumbar discitis severely hampers clinical recovery after disc operations and results in long-term changes as seen on magnetic resonance imaging scans. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗

PubMed2005

Narrowing of lumbar spinal canal predicts chronic low back pain more accurately than intervertebral disc degeneration: a magnetic resonance imaging study in young Finnish male conscripts.

The objective of this magnetic resonance imaging study was to evaluate the role of degenerative changes, developmental spinal stenosis, and compression of spinal nerve roots in chronic low back (CLBP) and radicular pain in Finnish conscripts. The degree of degeneration, protrusion, and herniation of the intervertebral discs and stenosis of the nerve root canals was evaluated, and the midsagittal diameter and cross-sectional area of the lumbar vertebrae canal were measured in 108 conscripts with CLBP and 90 asymptomatic controls. The midsagittal diameters at L1-L4 levels were significantly smaller in the patients with CLBP than in the controls. Moreover, degeneration of the L4/5 disc and protrusion or herniation of the L5/S1 disc and stenosis of the nerve root canals at level L5/S1 were more frequent among the CLBP patients. Multifactorial analysis of the magnetic resonance imaging findings provided a total explanatory rate of only 33%. Narrowing of the vertebral canal in the anteroposterior direction was more likely to produce CLBP and radiating pain than intervertebral disc degeneration or narrowing of the intervertebral nerve root canals.

Adolescent↗

PubMed2004

Primary cartilage lesions and outcome among subjects with patellofemoral pain syndrome.

We investigated the association between cartilage lesion and future symptoms in two groups of subjects with patellofemoral pain syndrome (PFPS). Group A consisted of 31 men (mean age 20.9 years, range 19-32) and group B of 28 consecutive patients (12 men and 16 women; mean age 27.8 years, range 15-50) operated on for PFPS. The mean follow-up time was 3.4 (range 1-7) years in group A and 4.9 (range 1-6) years in group B. At follow-up the subjects in group A with severe cartilage lesion (n = 10) reported more knee symptoms as measured by their Kujala score (mean 75.1, SE 3.6 vs. 88.5, SE 2.4) than those with minor cartilage lesion (n = 21) (age and follow-up time-adjusted P < 0.01). In group B the subjects with severe cartilage lesion tended to report more knee symptoms according to their Kujala score (mean 71.0, SE 7.0 vs. 86.1, SE 5.9; age, sex and follow-up time-adjusted P = 0.15) and VAS score (mean 51.8, SE 11.8 vs. 12.7, SE 10.4; adjusted P = 0.04) than the subjects without cartilage lesion. Our study shows that among the patients with PFPS, the subjects with severe cartilage lesion of the patella or femoral trochlea reported more subjective symptoms and functional limitations at follow-up than those without or with small cartilage lesion of the patella or femoral trochlea.

Adolescent↗

PubMed2003

Fatigue stress fractures of the sacrum: diagnosis with MR imaging.

The aim of this study was to describe the MRI findings and clinical observations in a fatigue stress fracture of the sacrum. In this retrospective study, 380 conscripts (53 women, 327 men; age range 18-29 years, mean age 20.7 years) who suffered from stress-related hip pain were studied with MRI of the pelvis. The findings of MRI were evaluated with regard to stress fracture of the sacrum. Thirty-one (8%) patients had MRI changes in signal intensity of the cranial part of the sacrum, extending to the first and second sacral foramina. The MRI changes in signal intensity were intermediate on T1-weighted images, and high on short tau inversion recovery or T2-weighted fat-suppressed images. A linear signal void fracture line was also seen. Multiple stress injuries to the pelvic bones were also seen in 7 of 31 (23%) patients. Five patients (16%) had bilateral sacral stress fracture. Fatigue sacral stress fractures appeared more commonly in women than in men ( p<0.001). During recovery time 20 of the 31 patients underwent control MRI, and fatty marrow conversion was seen in 8 (40%) cases as high signal intensity on T1-weighted images, which disappeared 5-6 months after the onset of symptoms. Fatigue sacral stress fractures are associated with stress-related hip pain. These fractures were more common in women than in men. Other stress injuries of the pelvis may be seen simultaneously with sacral stress fractures. Signal intensity of the sacrum was normal after 5-6 months.

Adolescent↗

PubMed2003

Decreased cancer risk in patients who have been operated on with total hip and knee arthroplasty for primary osteoarthrosis: a meta-analysis of 6 Nordic cohorts with 73,000 patients.

3 Nordic cohorts of total hip (THA) and total knee arthroplasty (TKA) in patients operated on for primary osteoarthrosis during 1967-1995 were partly adapted and combined for meta-analysis. THA was performed in 49,000 patients and TKA in 24,000 totaling 497,000 person years. The mean and maximum follow-up times were 6.8 and 30 years, respectively. Standardized incidence ratios (SIRs) with 95% confidence intervals (95% CI) were calculated for the observed and expected number of cancers. The expected numbers were based on national incidence rates. The overall SIRs as well as the site-specific ones were similar in the THA and TKA patients. The observed number of cancers at all sites was 7,639 and the expected one was 8,202 (SIR 0.93, 95% CI 0.91-0.95). The SIRs for lung cancer (0.69, 0.64-0.75) and laryngeal cancer (0.64, 0.44-0.92) were reduced. The incidence was also low for cancers of the stomach (SIR 0.76, 0.67-0.84), colon (SIR 0.86, 0.79-0.93) and rectum (SIR 0.89, 0.80-0.98). Among TKA patients, the only increases in SIRs were seen in cancers of the endometrium (SIR 1.36, 1.05-1.74), prostate (SIR 1.19, 1.02-1.38) and, among both THA and TKA patients, in skin melanoma (combined SIR 1.21, 1.03-1.41).

Aged↗

PubMed2002

Causes of death after total hip arthroplasty: a nationwide cohort study with 24,638 patients.

Based on the nationwide registration of the total hip arthroplasties (THAs) in Finland since 1980, a cohort of 24,638 patients with primary THA was gathered and followed for causes of death until December 31, 1996. The causes of death were divided into 20 main categories according to the classification of diseases ICD-10. The number of person-years was 153,410, and the mean length of follow-up of a person was 6.2 years. During the follow-up, 4,626 patients died; the expected number was 6,746. The standardized mortality ratio (SMR) was 0.69 (95% confidence interval; 0.67-0.70), without any difference between men and women. The total risk increased during the follow-up, with the highest being 0.84 (95% confidence interval, 0.81-0.87). Among the ICD categories, there were significantly low SMRs for cancers (0.54), accidents (0.74), cardiovascular diseases (0.70), and respiratory diseases (0.46). Among the diseases, there was a constant and significant decline of the SMR for dementia and Alzheimer's disease (0.50), diabetes (0.40), myocardial infarction (0.73), hypertension (0.68), other ischemic diseases (0.70), other heart diseases (0.57), and cerebrovascular diseases (0.70). The explanation for the decreased SMRs seems to be attributed to factors other than the THA per se, such as preoperative patient selection, more active lifestyle after THA, and possibly the use of anti-inflammatory drugs.

Adolescent↗

PubMed2002

Survivorship of hip prosthesis in primary arthrosis: influence of bilaterality and interoperative time in 45,000 hip prostheses from the Finnish endoprosthesis register.

We studied the influence of bilaterality and interoperative time on survivorship of the hip prosthesis. The material consisted of 45,000 (3,153 bilateral) total hip arthroplasties and 38,000 patients operated on for primary osteoarthrosis, using data from the Finnish Endoprosthesis Register between 1980 and 1999. Cox regression analysis showed that male sex, young age, uncemented prosthesis and time of surgery (first 10-year period) were significant risk factors for aseptic loosening. We found no difference between the survivorship of the first bilateral and that of unilaterals, but second bilaterals survived better than the unilaterals. Bilateral prostheses survived better when the second prosthesis was implanted during the first postoperative year. The risk of loosening of a bilateral prosthesis increased when the second prosthesis was implanted a few years later. Survivorship of bilateral prosthesesin a 1-stage bilateral operation was about the same as in those operated on within the first postoperative year. Better survivorship of the second bilateral can cause bias in per hip survivorship analyses. In bilateral cases, the second hip should be operated on as soon as possible or be considered for a 1-stage bilateral procedure.

Aged↗

PubMed2002

Patellar dislocation in army conscripts.

Between 1990 and 1996, 119 Finnish male conscripts underwent operative treatment for patellar dislocation. There were 68 conscripts (58%) with primary and 51 conscripts (42%) with recurrent patellar dislocation. Sixty-five (55%) dislocations occurred during military service, 40 (34%) occurred during sports activities, and 14 (11%) occurred during leisure time. The most common cause of injury was military training at battle exercises (n = 30). The typical injury mechanism was knee valgus rotation on fixed foot and tibia (97 conscripts, 82%). Surgical procedures performed were open in 75 conscripts (63%) and arthroscopically assisted in 44 conscripts (37%). Twenty-three (19%) redislocations occurred during follow-up (mean, 6 years; range, 3-9 years). The subjective outcome of treatment was excellent in 23 (19%), good in 42 (35%), moderate in 44 (37%), and poor in 10 (9%) conscripts. The most common residual complaint was patellofemoral pain (25 conscripts, 21%). Only 42 (35%) conscripts were able to finish their military service normally; fitness classification was decreased in 16 conscripts (13%), and 61 (52%) were temporarily exempted from military service (class E). The results of operative treatment did not differ significantly in conscripts with primary and recurrent dislocation, except for the time of first recurrence, which was significantly longer in conscripts with primary than with recurrent dislocation (27 versus 9 months). Patellar dislocation is the most common form of severe knee injury among conscripts and significantly hampers military service. Operative treatment yields only satisfactory results. Preventive measurements should be considered. A suggested algorithm for the treatment and classification of acute and recurrent patellar dislocation among military conscripts is presented.

Acute Disease↗