Biomedical subjects

A Luoma

Publications and source records attributed to A Luoma.

6 recordsLinked to original sources

PubMed1991

Thoracic outlet syndrome. Thoracic surgery perspective.

We have attempted throughout this review to identify the issues surrounding thoracic outlet syndrome as well as to highlight their origins. It should be clear that many aspects of TOS remain controversial from the definition of the entity through pathogenesis, diagnosis, and treatment. The conflicts surrounding TOS are underlined most poignantly in the many letters to the editor of the New England Journal of Medicine in response to Urschel's 1972 publication. It is incumbent upon those of us who treat patients with TOS to dispel the ignorance surrounding this syndrome with astute, accurate, and reproducible observations. We must clearly define TOS as a clinical entity such that we may analyze the characteristics of the patients we treat. We must continue to search for innovative and specific diagnostic criteria. We must quantitatively and reproducibly measure subjective end points of pain severity and quality of life. The use of these methods will provide yardsticks for therapeutic success and act as determinants for the natural history of TOS. The objectives of treatment will remain the alleviation of symptoms and the restoration of function. We have applied these principles to the formulation of a protocol in which we record, in a prospective manner, both routine and innovative clinical parameters. With quantification of subjective end points, we may be able to correlate clinical presentation with outcome. We also may be able to define with some accuracy this entity we call thoracic outlet syndrome.

Cervical Rib Syndrome↗

PubMed1989

Pathologic findings in total esophagectomy specimens after intracavitary and external-beam radiotherapy.

Pathologic findings in 21 esophagectomy specimens from patients having preoperative combined intracavitary radiotherapy (ICR) and external-beam radiotherapy (EBR) are described. Eleven patients received 1500 cGY ICR and 4000 cGy EBR (Group 1) and ten patients received 1500 cGy plus 2000 to 3000 cGy EBR (Group 2). Effectiveness of radiotherapy was expressed as the ratio between depth of radiation effect and depth of tumor invasion. Depth was expressed as one of four levels: Level I, not deeper than the muscularis mucosa; Level 2, involving but not deeper than submucosa; Level 3, involving but not deeper than muscularis propria; and Level 4, involving periesophageal soft tissue. The depth of radiation damage to tumor cells was comparable between the two groups. However, residual tumor was present in the periesophageal tissue in only one of 11 patients after high-dose EBR compared to of ten patients with lower dose EBR (P less than 0.01, chi-square test). A ratio of one between radiation effect and depth of tumor invasion was present in six patients receiving high-dose EBR and one patient receiving lower dose EBR (P less than 0.05). The authors conclude that ICR combined with EBR affords good local tumor control in the majority of patients. Higher doses of EBR give a better radiation effect in deeper layers of the esophageal wall. The ratio between depth of radiation effect and tumor invasion provides a simple and objective approach to the pathologic analysis of esophagectomy specimens.

Adenocarcinoma↗

PubMed1989

Cecal diverticulitis.

Cecal diverticulitis is an uncommon entity. Its operative treatment represents 0.2% of procedures performed for an acute abdomen. The clinical presentation is often indistinguishable from acute appendicitis. At operation, it may be confused with cecal carcinoma. The surgeon must be aware of this condition and be prepared to choose the most appropriate treatment. Local excision has been advocated as the treatment of choice. The authors review 18 cases seen over a 10-year period. In no case was the correct diagnosis made preoperatively. Intraoperatively, a correct diagnosis was made in 12 of the 18. Carcinoma was the next most frequent intraoperative diagnosis (four cases). Twelve of the 18 patients were treated by standard or limited right hemicolectomy. One patient died early in the series of sepsis caused by a perforated diverticulum and one patient had a life-threatening complication. Right hemicolectomy appears to be a safe and effective treatment option for cecal diverticulitis.

Acute Disease↗

PubMed1985

Lymph node metastases from well-differentiated thyroid cancer. A clinical review.

The records of 77 patients with well-differentiated thyroid cancer and proved lymph node metastases have been reviewed. The control of regional metastases was satisfactory in those with only a few nodes involved when limited dissections were utilized initially. In those patients with more extensive nodal involvement, the ultimate rate of failure to control disease in the neck was unacceptably high among those who initially underwent conservative localized neck dissection. Although regional control will not influence mortality, a more aggressive modified neck dissection is recommended for patients presenting with significant nodal involvement.

Adenocarcinoma↗

PubMed1979

Morphological and biochemical changes in striated muscle after experimental tourniquet ischaemia.

Histological and biochemical changes were studied in the striated muscle following total tourniquet ischaemia between one and four h, the reflow time being 30 min and 24 h. Electronmicroscopy was applied to study the fine structure of the muscle after 24 h reflow. In light microscopy ischaemic changes were not seen even when the tourniquet time was extended to four h. When a four-h ischaemia was followed by a 24-h recovery period, the electron microscopy showed a variety of minor mitochondrial changes such as condensed and slightly dilatated mitochondria. The SDH activities did not vary significantly between the experimental and control samples even after a four-h ischaemia followed by 30 min or 24h reflow. The differences between the experimental and control samples were, however, highly significant in the LDH values in the groups where ischaemia had lasted for three and four h. The results indicate that tourniquet ischaemia for two to three h does not significantly affect the striated muscle of a rabbit and the alterations even after a four-h ischaemia seem to be partly reversible.

Animals↗

PubMed1978

Ultrastructural changes in striated muscle after experimental tourniquet ischaemia and short reflow.

The effect of experimental tourniquet ischaemia on the fine structure of a rabbit's hind limb striated muscle was studied. The tourniquet time varied from 1 to 4 h. Samples were obtained from the tibialis anterior muscle 30 min after releasing the tourniquet, the contralateral limb serving as the control. As the first sign of ischaemia, dilatation of the sarcoplasmic reticulum was observed after a tourniquet blockade of 1 h. After 4 h ischaemia myofibrillar components showed advanced degeneration. Ultrastructural alterations were distinct in the mitochondrial morphology. After 2 h, the mitochondria showed moderate but clear condensation. After 3 h many mitochondria showed high amplitude swelling and structural disorganization. Total blockade of the limb circulation up to 4 h effects the energy-producing organelles in the first place, especially sarcoplasmic reticulum, T tubules and mitochondria prior to the alterations in myofilaments. Ischaemia extended up to 3 h induces sublethal damage to the muscle cells.

Animals↗