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Biomedical subjects

V Perhoniemi

Publications and source records attributed to V Perhoniemi.

At least 19 recordsLinked to original sources
PubMed1992

Benign retroperitoneal schwannoma.

A rare case of benign retroperitoneal schwannoma in a 76-year-old man is reported. Ultrasound and computerized tomography disclosed two cystic retroperitoneal tumors sized 12 cm and 7 cm. The larger tumor was located anterior to psoas muscle and the smaller one was within the muscle. The larger tumor was excised via laparotomy. After 3.5 years follow-up the intramuscular tumor has remained unchanged and the patient has no symptoms.

Aged↗
PubMed1991

Primary arterioenteric fistula between common iliac artery and ileum with massive bleeding.

Primary iliac artery aneurysms are rare, and a fistula to the terminal ileum with bleeding is very uncommon. A case with a primary massively bleeding iliaco-ileal fistula is described. In an emergency operation the common iliac artery was ligated and the fistula to the small bowel was resected. Arterial reconstruction was done by extra-anatomical femoro-femoral suprapubic prosthesis. The immediate outcome of the operation was excellent, but the patient died four days later because of acute myocardial infarction.

Aged↗
PubMed1991

Venous gangrene of the limb. Pathophysiological and therapeutic considerations.

Venous gangrene of the limb is a rare disease. Peripheral arterial collapse has been shown to underlie the ischaemia. The two patients studied had venous gangrene and malignancy of the gastrointestinal tract with liver metastases. One patient had slowly and the other rapidly progressing gangrene despite heparin-warfarin therapy. Both patients died. Microscopy revealed occlusive thrombosis of small peripheral arteries of the leg. The authors conclude that the pathophysiology in venous gangrene may be occlusive thrombosis of small arteries. This situation is the lethal form of the entity and responds poorly to established therapy.

Aged↗
PubMed1990

Strain gauge plethysmography in the assessment of venous reflux after subfascial closure of perforating veins: a prospective study of twenty patients.

Doppler ultrasonography and strain gauge plethysmography were used prospectively to study the hemodynamic changes in 20 patients' (5 men and 15 women) legs operated on by means of subfascial closure for insufficiency of perforating veins. In 10 patients (50%) the valves of the deep veins were incompetent as verified by Doppler ultrasonography, and deep vein thrombosis had previously been diagnosed in seven patients. After subfascial ligature, strain gauge plethysmography showed no changes in arterial flow, venous capacity, or in venous emptying rate. However, both venous reflux flow and reflux volume were significantly lowered (p less than 0.01) after surgery as compared to values before operation. The clinical objective results were good in all cases. In two of four patients with fair subjective results the arterial flow was pathologically high, which probably implies the presence of microscopic arteriovenous fistulas. It is concluded that strain gauge plethysmography can quantitate the change in deep venous reflux after ligation of perforating veins.

Adult↗
PubMed1989

Peripheral atherosclerosis in familial hypercholesterolaemia.

Unlike coronary artery disease, peripheral atherosclerosis is considered to be infrequent in heterozygous familial hypercholesterolaemia. The authors studied 20 consecutive asymptomatic familial hypercholesterolaemic patients and an age- and sex-matched control group of consecutive normolipidaemic and asymptomatic patients admitted to the hospital for elective non-vascular surgery. The patients and the controls were studied non-invasively by measuring the ankle-arm systolic blood pressure ratio at rest. Peripheral atherosclerosis was common in this study population in contrast to the control group: an abnormal (less than 0.97) pressure ratio was found in 13 patients (65%) in the study group but in only one person in the control group. Eight out of 20 patients had coronary artery disease, and seven of them had an asymptomatic concomitant peripheral artery disease. Neither the classical risk factors, i.e. age, smoking, obesity, hypertension and glucose intolerance, nor serum lipid or lipoprotein status or the parameters of cholesterol metabolism correlated with peripheral atherosclerosis. It is concluded that atherosclerosis in familial hypercholesterolaemia is a multilevel disease that frequently affects also the peripheral arteries.

Adult↗
PubMed1989

[Duodenopancreatectomy as the treatment of primary duodenal cancer].

Nine patients were operated on for primary adenocarcinoma of the duodenum at the Second Surgical Department of Helsinki University, between 1966 and 1985. They were three males and six females and were aged between 37 and 76 years. The average interval between primary symptoms and diagnosis was 3.2 months. Pancreatico-duodenectomy, the classical Whipple operation, was performed on seven cases, including one with liver resection. Four of the patients who had undergone radical surgery are alive (by Mai 1988), after six postoperative years have passed, on average (57 per cent). They are without metastases. Three patients died, among them one with liver resection one month from surgery and two with recurrent carcinoma after 1.2 and 1.8 years. Healing rates for primary duodenal carcinoma might be improved by more aggressive evaluation of symptoms in the upper gastro-intestinal tract and subsequent radical surgery.

Adenocarcinoma↗
PubMed1988

Catechol-O-methyltransferase activity in human and rat small intestine.

The activities of soluble (S-COMT) and membrane-bound (MB-COMT) forms of catechol-O-methyltransferase in different regions of human and rat small intestine were determined. S-COMT was the predominant form both in the mucous membrane and in the muscle layers. The activity of S-COMT was more than twice as high in the mucous membrane as in the muscle layer. The activity of MB-COMT was almost equal in the different regions of the gut as well as in the mucous membrane and muscle layers. However, the ratio of the soluble form to the membrane-bound form was close to one in the human muscle layers of the jejunum and ileum.

Animals↗
PubMed1987

Effect of spinal versus epidural anaesthesia with 0.5% bupivacaine on lower limb blood flow.

Changes in the haemodynamics of the lower extremities, big toe temperature, blood pressure and heart rate were studied in 20 patients undergoing spinal or epidural anaesthesia for transurethral surgery. Calf blood flow was determined by strain gauge plethysmography (SGP) and Doppler ultrasound. Bupivacaine 0.5% was injected at the L3-L4 interspace, the dose being 3-4 ml (mean 3.6) in the spinal and 17-20 ml (mean 18.6) in the epidural group. The number of sensory blocked segments 30 min after anaesthesia was 12.7 +/- 0.7 (mean +/- s.e.mean) and 14.4 +/- 0.7, respectively. Only minor decreases in blood pressure were noted following the blocks. Heart rate remained virtually unchanged. The increase in skin temperature was more pronounced (P less than 0.01) following epidural (mean 8 degrees C) than spinal anaesthesia (mean 4 degrees C). In addition, the arterial blood flow was significantly higher (P less than 0.05) following epidural than spinal block (means 3.5 and 2.2 ml/100 ml/min, respectively). The venous capacity and maximum venous outflow remained practically unchanged in both groups. Obviously, epidural anaesthesia with bupivacaine causes a more intensive sympathetic block than does spinal anaesthesia. As probably no venous pooling occurred, when examined by SGP and Doppler ultrasound, neither of the blocks is likely to contribute to the initiation of deep vein thrombosis.

Aged↗
PubMed1986

An alternative method for calculating changes in arterial calf blood flow at rest. An initial study.

In 20 patients we studied the changes in calf arterial blood flow (AF) following spinal and epidural blocks, using venous occlusion strain gauge plethysmography (SGP). AF was calculated both in the conventional way by drawing a tangent to the initial upslope of the curve, and by a new method which measures the time to the point when 50% of venous capacity is reached (tVC50). The statistical differences within and between the spinal and epidural groups for AF and tVC50 were determined. In measuring the post-block changes in AF as compared with the control values, a statistically significant correlation (rs = -0.85, p less than 0.01) was observed between the two methods. We conclude that the new variable, tVC50, seems to be potentially useful in calculating changes in arterial blood flow at rest, and could be used, for example, in connection with surgical and pharmacological interventions, especially when the initial upslope of the SGP curve is equivocal.

Adult↗
PubMed1986

Hemodynamics of the legs and clinical symptoms following regional blocks for transurethral surgery.

In a prospective clinical study we compared the hemodynamics and clinical symptoms following regional blocks and general anesthesia. 115 patients undergoing transurethral resection of the prostate were randomized to spinal (n = 62) and epidural (n = 53) blocks. An additional 10 patients received general anesthesia. Calf arterial flow, determined by strain gauge plethysmography (SGP), was similar pre- and postoperatively in the regional block groups but decreased in the general anesthesia group (p less than 0.05) on the 5th postoperative day compared to the preoperative day. On the 2nd and 5th postoperative days, venous capacity was lower (p less than 0.05) after general anesthesia compared to regional blocks. Antiembolism stockings offered no hemodynamic or clinical advantages. During the hospital stay (screening by Doppler and SGP) and 3 months of follow-up, no deep vein thrombosis or pulmonary embolism was diagnosed. 3 months after the operation, unspecific pain and/or weakness in the legs were reported by 12 patients in the spinal group, while the epidural group remained asymptomatic (p less than 0.01). We conclude that the predictive value of negative Doppler and SGP findings is good and that spinal and epidural blocks are hemodynamically advantageous as compared to general anesthesia.

Anesthesia, Epidural↗
PubMed1986

Venous haemodynamics in the legs after ligation of the inferior vena cava.

Doppler ultrasound and strain gauge plethysmography (SGP) were used to study venous insufficiency in 22 patients after ligation of the inferior vena cava (LIVC), 13 control patients with unilateral postthrombotic syndrome (PS) and 20 normal controls. Isotope venography was performed in eight patients. SGP showed low venous capacity in LIVC legs without deep vein thrombosis (DVT), indicating restrictive syndrome. There was no venous obstruction in any of the groups studied. In the LIVC limbs with DVT and in the PS limbs, venous reflux differed significantly from that of normal controls. The popliteal venous reflux examined by Doppler ultrasound was sporadic in LIVC limbs without DVT, occurring in 71% of LIVC limbs with DVT and in 77% of limbs with PS. Isotope venography in eight LIVC patients showed abundant collateral circulation. We conclude that DVT causes venous reflux. LIVC causes a restrictive syndrome without venous obstruction, and alone it did not cause venous reflux. Clinically it indicates that symptoms after uncomplicated LIVC are mild and that late postoperative morbidity is principally arising from DVT and not from LIVC alone.

Adolescent↗
PubMed1986

Caval ligation versus clipping to counteract pulmonary embolism.

In 1967-1983 31 patients underwent surgical interruption of the inferior vena cava (IIVC) with ligation, and in 1984-1985 five patients were treated by IIVC with clipping (Adams-de Weese clip). The early adverse effects in the legs and complications were studied, and all five IIVC patients with clipping underwent isotope phlebography. The most serious early complication was sudden death on the 9th postoperative day after ligation. In one half of the affected legs moderate or severe oedema was found after the ligation. After clipping early adverse effects in the legs were minimal, and isotope phlebography showed an open inferior vena cava in all cases; only in one patient were collateral veins found past the inferior cava. It is concluded that when IIVC is indicated clipping is the optimal surgical method. IIVC with ligation is indicated only in septic embolism.

Adult↗