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Biomedical subjects

A Sivula

Publications and source records attributed to A Sivula.

At least 19 recordsLinked to original sources
PubMed2003

Comparison of cyclooxygenase 2 expression in adenocarcinomas of the gastric cardia and distal oesophagus.

BACKGROUND: Adenocarcinomas of the gastric cardia and distal oesophagus are at present often considered as one clinical entity because of their comparable increasing incidence, prognosis, and optimal treatment options. However, it is still a matter of debate whether these malignancies have the same pathogenesis and genotype. AIMS: The aim of this study was to analyse expression of cyclooxygenase 2 (COX-2) in cardia carcinomas, and correlate this expression with clinicopathological parameters and survival. The results were compared with the prognostic value of COX-2 found for Barrett carcinomas. METHODS: Tumour sections of 134 consecutive patients undergoing potentially curative surgery for an adenocarcinoma of the gastric cardia and substantially invading the distal oesophagus were immunohistochemically stained using a COX-2 monoclonal antibody. Specimens were blindly scored based on intensity and extent of COX-2 immunopositivity. RESULTS: COX-2 expression was negative to weak in 59% ("COX-2 low") and moderate to strong in 41% ("COX-2 high") of tumours. This was significantly lower than in Barrett carcinomas (p<0.0001). COX-2 expression was not correlated with any clinicopathological parameter. A correlation between elevated COX-2 expression and reduced survival, as described for Barrett carcinomas, was not identified for cardiac carcinomas. CONCLUSIONS: There is a difference in COX-2 expression with respect to intensity and prognostic significance between adenocarcinomas of the gastric cardia and distal oesophagus. This suggests a different pathogenesis and different genetic constitution of these two cancers. Based on these findings, the role of selective COX-2 inhibitors in the treatment of adenocarcinomas of the gastric cardia is less promising than in Barrett carcinomas.

Adenocarcinoma↗
PubMed2000

Natural course of adrenal incidentalomas: seven-year follow-up study.

Most adrenal incidentalomas are nonfunctioning cortical adenomas that do not require surgery. Operative treatment is indicated if the incidentaloma has malignant features as seen during the radiologic workup, is hormonally active, or grows during follow-up. A conservative attitude is justified in asymptomatic patients if we know that the natural course of these tumors is not disadvantageous. We followed a group of patients treated by observation to determine the natural course of adrenal incidentalomas. Altogether 30 incidentalomas in 27 patients were detected in the Helsinki University Central Hospital from June 1981 through December 1992 and were re-examined during 1997. The patients were evaluated clinically, and hormonal testing was done by performing a 1-mg overnight dexamethasone suppression test; the next day we measured the 24-hour urinary excretion of vanillylmandelic acid, metanephrines and normetanephrines, and serum potassium. Magnetic resonance imaging (MRI) was used to determine the size of the tumor. If the patient had died during the follow-up period, the causes of death from the death certificates and autopsy reports were reviewed. The mean follow-up was 7 years. Nine patients had died, with none of deaths related to the incidentaloma. Sixteen patients were evaluated clinically and by the basic hormonal tests and MRI; none showed any signs of hormonal activity or features of malignancy. Two patients did not want to be reexamined but stated that they were asymptomatic. This follow-up study supports the conclusion that conservative therapy is justified because the growth tendency of adrenal incidentalomas is slow and they seem to remain hormonally inactive.

Adrenal Gland Neoplasms↗
PubMed1999

The value of ultrasound-guided fine-needle aspiration biopsy (FNAB) and frozen section examination (FS) in the diagnosis of thyroid cancer.

BACKGROUND AND AIMS: Although only a small minority of thyroid nodules are malignant, a large proportion of operations are performed to exclude malignancy. The purpose of this study was to evaluate the role of preoperative ultrasound-guided fine-needle aspiration biopsy (FNAB) and intraoperative frozen section examination (FS) in the management of thyroid cancer. MATERIAL AND METHODS: A retrospective study of 664 consecutive patients operated on for thyroid cancer from 1966 through 1994 at the Meilahti Hospital was performed. FNAB was taken with manual guidance in the sixties and seventies and with ultrasound guidance in the eighties and nineties. FS was performed in 335 cases. Malignancy was not known preoperatively in 210 cases. RESULTS: Ultrasound-guided FNAB was more accurate than manually guided FNAB (75 out of 143 or 52.4% vs. 112 out of 276 or 40.6%) in detecting malignancy in spite of the fact that the tumors were smaller (23 +/- 15 mm vs. 30 +/- 22 mm, p = 0.011). A true positive FS diagnosis was given in 250 out of 335 (74.6%) of patients. However, in follicular carcinoma, the amount of true positive FS diagnoses was only 12 out of 27 (44.4%). CONCLUSIONS: Ultrasound guidance has improved the sensitivity of FNAB. Follicular neoplasia is a problem for both FNAB and FS.

Adult↗
PubMed1999

Laparoscopic adrenalectomy for primary aldosteronism: clinical experience in 12 patients.

Laparoscopic adrenalectomy has become a viable option for removal of small adrenal neoplasms. We present our initial experience of this operation for primary aldosteronism. In this prospective study, 12 consecutive patients with primary aldosteronism were operated on laparoscopically by one surgeon. Operative time, blood loss, postoperative pain, complications, hospital stay, convalescence time, and outcome were analyzed. Five right-sided and seven left-sided adrenalectomies were performed in six female and six male patients with a mean age of 51 years. The mean operative time was 126 minutes. All procedures were successfully carried out laparoscopically. No major complications occurred. All patients turned normokalemic and the medication for hypertension could be stopped or diminished in all cases. The mean hospital stay was 3.4 days, and the mean sick leave was 13 days. Laparoscopic adrenalectomy seems to be a safe and effective treatment for primary aldosteronism and should be considered the operation of choice.

Adrenal Cortex Neoplasms↗
PubMed1998

Adrenalectomy for primary aldosteronism: long-term follow-up study in 29 patients.

Primary aldosteronism consists of a mixture of subgroups. The operative treatment is successful only in cases of aldosterone-producing neoplasia (and in rare cases of primary unilateral hyperplasia); all other cases should be treated medically. The aim of this study was to determine if aldosterone-producing neoplasia had been successfully differentiated from the other subgroups and the outcome of operative treatment. Altogether 29 patients with primary aldosteronism were operated on between January 1, 1979 and December 31, 1993. Patient charts were reviewed retrospectively. The follow-up data were collected from the patients' charts, and all patients were contacted to obtain recent blood pressure and serum potassium values. The patients were asked about symptoms related to hyperaldosteronism. If any suspicion of recidive aldosteronism was present, patients were carefully reexamined by hormonal tests and computed tomography (CT). A total of 27 patients had unilateral adenoma, 1 patient had hyperplasia, and 1 patient had an aldosterone-producing cortical carcinoma. There was no operative mortality or morbidity. The serum potassium level had normalized in all patients. Mean follow-up time was 76 months. One patient died during the follow-up from cholangiocarcinoma; 11 patients (41%) were cured by the operation, 10 patients (37%) have a mild but medicated hypertension, and in the remaining 22% the hypertension persisted but was well controlled by the medication. Of the 29 patients, 28 were correctly diagnosed as having an aldosterone-producing neoplasm. Basic hormonal studies and CT can be used effectively to differentiate aldosterone-producing neoplasia from hyperplasia in most cases.

Adrenal Cortex Neoplasms↗
PubMed1996

Long-term health risk of primary hyperparathyroidism: the effect of surgery.

Primary hyperparathyroidism is a common disease but 90% of sufferers remain undetected. In elderly women its prevalence is about 1%. The disease can cause severe hypercalcaemia and lead to life-threatening symptoms. However, the majority of cases represent milder forms of hyperparathyroidism with minimal symptoms or no symptoms at all, and slight hypercalcaemia which does not progress during follow-up. Surgery is the only effective treatment of primary hyperparathyroidism and most of the symptoms respond favourably to surgery. Nevertheless, the role of surgery has been controversial in the treatment of mini-symptomatic patients. Recently it has become evident that primary hyperparathyroidism is associated with increased mortality due mainly to cardiovascular diseases, and it has been shown that surgical treatment is able to diminish or even eliminate this risk of premature death. The extra mortality is connected also to the mild and nonprogressive forms of the disease, and it seems to have a strong correlation with the duration of the disease. This aspect favours active treatment at an early stage of the disease. Conservative treatment can be considered only in old patients with mild and stable clinical course. Primary hyperparathyroidism is an important risk factor causing morbidity and mortality.

Female↗
PubMed1993

Gastrointestinal non-Hodgkin's lymphoma. A population-based clinicopathological study of 111 adult cases with a follow-up of 10-15 years.

All cases of gastrointestinal (GI) non-Hodgkin's lymphoma diagnosed in Finland between 1972 and 1977 were histologically reexamined and immunostained in order to study the value of histological classification. One hundred and eleven cases were found. The crude annual incidence was 0.51/10(5) and the age-adjusted (world standard population) incidence 0.23/10(5). The male-to-female ratio of age-adjusted incidence rates was 2.7. The most common histological type was large B-cell lymphoma comprising 61% of all classifiable cases. Low-grade mucosa-associated lymphoid tissue (MALT) lymphoma comprised 12%, centrocytic lymphoma 9%, peripheral T-cell lymphoma 9%, Burkitt's lymphoma 7% and large-cell anaplastic lymphoma 3% of the total. In the jejunum, almost one half of the cases were T-cell lymphomas and there were no lymphomas with definite MALT features. Gastric lymphomas had higher survival rates than intestinal lymphomas, B-cell lymphomas slightly higher survival rates than T-cell lymphomas, and low-grade MALT lymphomas higher survival rates than other B-cell lymphomas. The other types of lymphomas differed only slightly from each other in prognosis. The histological grade according to the Working Formulation correlated with survival rates, but a great majority of cases were classified as intermediate grade. Classification of GI lymphomas into the types mentioned above appears to correlate with several clinical and pathological parameters.

Adult↗
PubMed1993

[Endocrine surgery today].

Endocrine surgery is an important branch of modern surgery, and includes surgery of the thyroid and parathyroid as well as operative treatment of endocrine tumours in the adrenals, pancreas and the alimentary tract. Close cooperation between endocrine surgeons, medical endocrinologists, pathologists and radiologists is a prerequisite. The development of endocrine surgery has a long tradition in the Scandinavian countries, characterised by cooperation both in surgical training and research.

Adrenal Glands↗
PubMed1991

Primary small intestinal non-Hodgkin's lymphoma in Finland 1972-1977. Clinical presentation and results of treatment.

During the period of 1972-1977, 29 patients were treated for primary non-Hodgkin's small intestinal lymphoma (PSIL) in different hospitals in Finland. Most frequently the disease occurred in patients in middle age and there was a male predominance. Clinical symptoms were non-specific. An abdominal mass was felt in 31% of the patients. Radiological findings were mostly non-specific, and often a stricture was revealed. All patients underwent surgery, ten patients curative resection, 15 patients palliative resection and 4 patients exploration and biopsy only. Sixty per cent of the patients who underwent curative resection survived five years compared with ten per cent who underwent palliative resection. The stage of the disease was an important prognostic factor. The five-year survival was 60% for patients with stage I disease, while all the patients with stage IV disease died during the first two years.

Adult↗
PubMed1990

Primary gastric non-Hodgkin's lymphoma in Finland, 1972-1977. Clinical presentation and results of treatment.

During the period 1972-1977, 66 patients were treated for primary gastric non-Hodgkin's lymphoma in various hospitals in Finland. Most frequently, the disease occurred in middle-aged or old patients and had a male predominance. Clinical symptoms were non-specific. An abdominal mass was felt in 21% of the patients. Roentgenologic findings were mostly non-specific but suggested a malignant tumour. A definitive diagnosis was difficult to confirm by endoscopic examination. Forty-four patients had surgical resection, 30 patients curative resection, and 14 palliative resection, and 16 patients had only explorative laparotomy. Eighty-five per cent of the patients who had curative resection survived 5 years, compared with 15% of those who underwent palliative resection. Curative resection gave the best survival of 5 years. The stage of the disease was a very important prognostic factor: the 5-year survival was 85% for patients with stage-I disease but only 3% for those with stage-IV disease.

Adult↗
PubMed1987

Natural history of treated primary hyperparathyroidism.

A follow-up study of patients operated on for primary hyperparathyroidism revealed that recurrent hypercalcemia is uncommon in patients with solitary adenoma, but common in patients with multiglandular disease. The result of parathyroidectomy on the different symptoms of primary hyperparathyroidism is good. On the other hand, even after successful surgery, patients with primary hyperparathyroidism have poorer health than controls, and they also have a higher mortality rate. Most of the deaths in the primary hyperparathyroidism group are caused by cardiovascular disease. The effect of the preoperative serum calcium level on the later state of health is evident.

Adult↗
PubMed1987

Familial and sporadic medullary thyroid carcinoma: clinical and immunohistological findings.

We have studied the clinical and thyroid immunohistological features of 19 patients with sporadic medullary thyroid carcinoma and 16 patients with the hereditary syndrome multiple endocrine neoplasia 2a (MEN 2a). Both groups were identified by family screening using serum calcitonin determinations before and after pentagastrin stimulation. Pheochromocytoma and hyperparathyroidism were associated both with multiple endocrine neoplasia 2a and some cases of sporadic medullary thyroid carcinoma. Hereditary medullary thyroid carcinoma was invariably associated with C-cell hyperplasia, but C-cell hyperplasia was also associated with some sporadic tumours. All tumours were positive for calcitonin and carcinoembryonic antigen (by immunohistological staining) (CEA) and most tumours stained for somatostatin. C-cell hyperplasia also stained for calcitonin, CEA and somatostatin. We conclude that sporadic and familial medullary thyroid carcinoma cannot always be discriminated by clinical or immunohistological methods. Family screening is essential in the diagnosis of hereditary medullary thyroid carcinoma.

Adult↗
PubMed1986

Long-term results of continent ileostomy.

The long-term results of 76 Kock continent ileostomy operations were evaluated at an average 9 years postoperatively. The early complication rate was 36%: 11 (14%) patients underwent reoperation including one (1.3%) pouch removal, and one patient died. Late complications occurred in 54 (73%) patients. These included two (2.7%) pouch-related deaths, 30 (41%) cases of nipple-valve sliding, 22 (30%) clinically observed cases of pouchitis, 12 (16%) patients with stomal strictures, and intestinal obstruction (7), ventral hernia (4), nipple-valve fistula (7), intra-abdominal abscess (4) and foreign body in the reservoir (7). Revisional surgery was required in 49 (66%) patients. Despite this high cumulative complication rate a good functional result was ultimately attained in 62 (83%) patients. Only four reservoirs were removed, and only three patients had to wear an appliance. Increasing experience with the method resulted in a marked decrease of both early and late complications. The high degree of patient satisfaction supports continuation of Kock ileostomy constructions even though prolonged follow-up and frequent reoperations may be required.

Adolescent↗
PubMed1985

Observations on 334 patients operated on for primary hyperparathyroidism.

334 patients were operated on for PHPT during the years 1956-79. A follow-up study of the material was performed during the years 1980-82 and it included 289 patients. The material was divided into single adenoma (SA) and multiglandular disease (MGD) cases. The initial diagnosis of SA given by the primary operation was later changed in 12 patients (4%) by reoperations performed for persistent or recurrent hypercalcaemia; the follow-up study changed the diagnosis in four patients. The proportion of MGD in the follow-up material was 15.2%. Reoperations were performed in 4% in the SA group and in 29% in the MGD group. The primary results concerning the serum calcium level were good in both SA and MGD groups, but, at the follow-up study 1.6% of the patients in the SA group and 41% of the patients in the MGD group were hypercalcaemic (serum calcium over 2.65 mmol/l). The hypercalcaemia at the follow-up study was, however, slight in general (mean 2.75 +/- 0.09 mmol/l). In the whole material, permanent hypoparathyroidism occurred in 1.2%, permanent unilateral vocal cord paralysis in 0.9% and permanent bilateral vocal cord paralysis in 0.6%. Operative mortality was 0.9%. The "conservative" strategy used in the whole material gave good results in SA patients but considerably worse results in MGD patients. Accordingly, MGD patients should be operated more "radically".

Adenoma↗
PubMed1985

Long-term effect of surgical treatment on the symptoms of primary hyperparathyroidism.

Two hundred and eighty-nine patients operated on for primary hyperparathyroidism (PHPT) in the years 1956-79 have been followed up for a mean period of 5 years. The aim of the study was to investigate the symptomatology of PHPT and the disappearance of the symptoms after operative treatment. Of the presenting symptoms hypercalcaemic crisis and cystic bone changes were cured, and none of the patients with pancreatitis as presenting symptom had a recurrence. In the renal stone group, 10% of the patients had recurring stones during the follow-up period. The presenting symptom disappeared in 84% of the patients. Thirty-five% of the patients had no presenting symptom and were classified as "asymptomatic", though, on questioning, most of them had various symptoms which disappeared postoperatively. Malaise, fatigue and muscular weakness disappeared in 79% of the patients, upper abdominal pains in 66%, constipation in 63%, pains in the extremities in 51% depression in 65%. Hypertension increased by 28% during the follow-up period; only three of the 90 patients with hypertension has discontinued antihypertensive treatment postoperatively. During the follow-up study, 6% of the patients were hypercalcaemic, though the serum calcium was only slightly elevated in almost all of these patients (mean +/- SD 2.75 +/- 0.09 mmol/l) and most of them had the multiglandular form of PHPT. The renal function did not deteriorate as much as was expected on the basis of earlier reports; only two patients had a serum creatinine over 500 mumol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Long-term results of adrenal surgery in patients with Cushing's syndrome due to adrenocortical adenoma.

Fourteen of 16 patients with Cushing's syndrome due to adrenal adenoma who had undergone adrenal surgery in the period 1967-1981 participated in a follow-up study 1 to 15 (mean 4.5) years after the operation. There were 14 unilateral and two bilateral adenomas. Two patients have died: one from postoperative complications, the other by suicide 10 years after surgery. None of the patients relapsed and none showed clinical features of Cushing's syndrome. However, five patients remained obese and four hypertensive. Furthermore, in the female patients the bone mineral density was lower than in age-matched controls. The function of the pituitary-adrenal axis recovered slowly. Postoperative replacement therapy was withdrawn 3 to 28 (mean 11.8) months after surgery in all but one patient. The function of the remaining adrenal gland was completely normal in 10 patients. In two patients the plasma cortisol response to ACTH-stimulation was still blunted and associated with elevated plasma ACTH-levels. The plasma ACTH-level was low in the only patient having persistent hypocortisolism. In conclusion, the results show that most patients with Cushing's syndrome due to adrenal adenoma recover fully after surgery. In some patients, however, the suppressed pituitary and/or adrenal fail to resume normal function.

Adenoma↗