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Biomedical subjects

A Kivioja

Publications and source records attributed to A Kivioja.

30 records · Page 2Linked to original sources
PubMed1994

Emergency CT in blunt abdominal trauma of multiple injury patients.

Multiple injury patients with blunt abdominal trauma (n = 110) were examined by abdominal CT. An i.v., but not peroral, contrast medium was used, thereby eliminating the delay caused by administering peroral contrast medium and any subsequent delay in making the diagnoses and beginning operative treatment. Eighteen patients underwent emergency laparotomy after the initial CT examination. The preoperative CT findings were compared to the laparotomy findings. CT revealed all but one of the severe parenchymal organ lesions requiring surgery. The one liver laceration that went undetected had caused hemoperitoneum, which was diagnosed by CT. The bowel and mesenteric lesions presented as intra-abdominal blood, and the hemoperitoneum was discovered in every patient with these lesions. Fourteen patients also initially had positive abdominal CT findings; 10 of them underwent an additional abdominal CT within 3 days, but the repeat studies did not reveal any lesions in need of surgery. Omission of the oral contrast medium did not jeopardize making the essential diagnoses, but it did save time.

Abdominal Injuries↗
PubMed1993

Cytogenetic study of 249 consecutive patients examined for a bone tumor.

Chromosome analysis was performed on 304 samples of 249 consecutive patients examined for a possible bone tumor. The series consisted of 86 nonneoplastic disorders, 108 benign and 78 malignant primary bone tumors, and 32 other bone malignancies. In the group of nonneoplastic disorders, one sample from an infectious lesion demonstrated a clonal chromosome aberration, i.e., additional material in the short arm of chromosome 1. Simple clonal aberrations were noted in six of 75 successfully cultured benign tumors, e.g., a chondromyxoid fibroma with an insertion type translocation from 2p21p25 to 5q13 and 2p deletion and a nonossifying fibroma with del(4)(p14). Complex clonal aberrations were evident in 21 of 54 successfully cultured malignant primary bone tumors and eight of 21 secondary bone malignancies. The complexity of clonal aberrations correlated with the grade of malignancy as the osteosarcomas and chondrosarcomas of high-grade demonstrated chaotic abnormalities. Six Ewing's sarcomas demonstrated the t(11;22)(q24;q12); in one this was the sole abnormality, and in five additional changes were evident: der(1;16)(q10;p10) in one. Homogeneously staining elongated areas interpreted as HSR were observed in three patients, all of whom had a highly malignant tumor. The most frequent nonclonal abnormality was telomeric association, which was observed mainly in giant cell tumors.

Aneuploidy↗
PubMed1993

Chromosome study of 249 patients examined for a bone tumor.

The authors have performed cytogenetic studies of bone tumors since 1987, and this article, based on previous work, summarizes their experiences in this field. Altogether 304 samples from 249 consecutive patients examined for a possible bone tumor at the Helsinki University Central Hospital, between October 1987 and April 1992, have been analyzed. The series consisted of 86 nonneoplastic disorders, 108 benign and 78 malignant primary bone tumors, and 32 other bone malignancies. In the group of nonneoplastic disorders, one sample from an infectious lesion demonstrated a simple clonal chromosome aberration. Simple clonal aberrations were seen in six of 75 successfully cultured benign tumors. Complex clonal aberrations occurred in 21 of 54 successfully cultured malignant primary bone tumors and in eight of 21 secondary bone malignancies. The complexity of clonal aberrations correlated with the grade of malignancy as the osteosarcomas and chondrosarcomas of high grade demonstrated chaotic abnormalities. The chaotic nature of the aberrations implicates the evolution of several different clones and thus advanced malignant transformation. Six of eight successfully cultured Ewing's sarcomas demonstrated the diagnostic t(11;22)(q24;q12); this translocation was also seen in one primitive neuroectodermal tumor. Cytogenetic study provides increasing knowledge of the biology of bone tumors and is a valuable adjunct in their evaluation.

Bone Neoplasms↗
PubMed1992

Platelet activation during acute phase after multiple trauma.

The acute phase after multiple trauma is associated with both thrombotic phenomena and a bleeding diathesis. To evaluate the activation of platelets, beta-thromboglobulin (BTG) in plasma and serum and thromboxane B2 (TxB2) in serum were measured in 14 patients with multiple trauma. BTG in plasma was significantly increased on days 1, 2 and 10 to 14 after the trauma. The highest median value 90 micrograms/l was measured on day 1. BTG in serum was significantly reduced 1 to 7 days after the trauma (median levels 4450-9100 micrograms/l). TxB2 was significantly reduced (median levels 18-97 ng/l) on days 1 to 14. The increased plasma levels of BTG is due to the posttraumatic activation of platelets in vivo. The reduced levels of serum BTG and TxB2 reflect the deficient functional capacity of circulating platelets to respond to extreme stress. Therefore, platelet count alone may correlate poorly with the haemostatic potential and may underestimate the need of platelet transfusions.

Acute-Phase Reaction↗
PubMed1992

Treatment of solitary plasmacytoma of the femur. A case report.

In radical tumour surgery the inevitable bone loss is considerable. If in addition the local tissues at the tumour site have been damaged by radiation therapy, massive endoprosthesis or even amputation should be considered. In cases with large bone loss, a vascularized fibular graft is one possibility to bridge the resected region. A case of a young man with a solitary plasmacytoma of the upper femoral diaphysis is presented. The lesion was reoperated 3 years after the primary diagnosis with resection of the non-ossified tumour site and reconstruction with a vascularized fibular graft.

Adult↗
PubMed1991

Delayed diagnosis of extremity injuries in patients with multiple injuries.

A total of 340 patients treated in the Intensive Care Unit of the Department of Orthopedics and Traumatology at Helsinki University Central Hospital were analyzed in this study. They had in all 1,071 fractures and luxations of the pelvis and extremities, of which the trauma surgeons and radiologists on duty initially missed 45 injuries, i.e., 4.2%. Taking into account the eventual late symptoms, the most severe delayed diagnoses were of injuries located around the hip and knee joints. The patients with delayed diagnoses were, on the average, the most severely ill: their needs for primary blood transfusions and assisted respiration resembled the needs of patients who later died of their trauma or its complications. The most common causes of the delay in diagnosis were: radiographs not done in 60% of patients, and no notation of visible injury in radiographs in 31%. Inferior quality of radiographs, unnoticed radiologists' reports, a fracture visible at the outermost corner of a radiograph, a fracture hidden by other fractures, or excessive obesity of the patient may also contribute to a delay. The study presents measures for improving diagnostic strategies, but it would appear that delayed diagnoses cannot be totally eradicated.

Extremities↗
PubMed1991

Survival after massive transfusions exceeding four blood volumes in patients with blunt injuries.

The authors' experience with 29 patients with blunt injuries who sustained massive transfusions exceeding four blood volumes in the initial posttraumatic 12 hours was reviewed. The overall mortality was 62 per cent. Only one patient survived when the amount of transfusions exceeded 50 units. The most common bleeding sites were abdominal and pelvic. Half of the dead succumbed within the first 24 hours. Of those who died, seven died from brain injury, six from multiple organ failure (MOF), and five from uncontrollable bleeding. Initial shock was observed in 55 per cent of patients. The high mortality of patients with massive transfusions and MOF related to the duration of shock strongly promote the importance of initial volume resuscitation.

Adolescent↗
PubMed1989

Factors affecting the prognosis of multiply injured patients: an analysis of 1169 consecutive cases.

When analysing 1169 multiply injured patients treated in the intensive care unit between 1966 and 1984 we noticed a dramatic fall in mortality from a level of about 14.6 per cent to 4.8 per cent since 1981. The patient populations and accident patterns were surprisingly identical, though since 1981 the severity of thoracic injuries has increased and the brain injuries decreased. The fall in mortality was great for all causes of death but most significant for patients with severe thoracic, brain and cervical spine injuries. The trend is to treat more and more fractures operatively and immediately after the injury. There has been a better diagnosis of all injuries according to autopsy findings. An attitude of prophylactic treatment on a respirator which leads to better oxygenation, together with a well-organized, co-ordinated injury care system with systematized diagnostic, laboratory and therapeutic procedures, are among the most important factors in the lowering of the mortality.

Critical Care↗
PubMed1989

Cervical spinal cord injury: the correlations of initial clinical features and blood gas analyses with early prognosis.

The predictive values of some early post-traumatic clinical symptoms and signs and laboratory tests on the problems, complications and prognosis of the initial treatment of tetraplegic patients were studied. The study was carried out by scrutinizing the files of 54 patients with a cervical spinal cord injury (40 of them complete and 14 incomplete). Most of the patients (n = 43) needed ventilatory support, the duration of which depended on the level and completeness of the spinal cord injury. Bradycardia, hypotonia and tachypnoea at admission occurred most frequently in those patients who later developed complications or died. In addition, the frequency of complications correlated with a patient's age, previous diseases and with the height and degree of the spinal cord injury. Tachypnoea on admission forecast the later development of respiratory complications. All 8 patients who died, 5 of them from pneumonia and 3 from pulmonary embolism, had their spinal cord injury at the level C4 to C5 and they were significantly older than those who survived.

Adult↗
PubMed1985

Periappendicular abscess as a cause of ureteral obstruction.

Ureteral obstruction due to appendicitis is a rarity. A twenty-five year old man with no previous abdominal symptoms showed right-sided hydronephrosis and hydroureter on intravenous urography. At operation the cause for this was found to be a ureteral kink due to adhesions caused by a healed periappendicular abscess.

Abscess↗
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↗