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Biomedical subjects

E Kotilainen

Publications and source records attributed to E Kotilainen.

34 records · Page 2Linked to original sources
PubMed1997

Intradiscal glycerol or bupivacaine in the treatment of low back pain.

A total of 15 patients suffering from chronic low back pain were treated with an intradiscal injection of either 1 ml of 50% glycerol or 2 ml of 0.5% bupivacaine. Most (60%) of the patients had previously undergone spinal surgery for lumbar disc herniation or spinal stenosis and 73% showed clinical signs and symptoms of segmental instability of the lumbar spine. According to self-evaluation questionnaires, immediate response to both treatments was mainly good. Of the 9 patients who received glycerol, 56% showed subjective improvement on the first day after the injection and after two weeks, 45% of the patients still felt improvement. After one month, however, the pain had reappeared in all except one (11%) patient. The corresponding numbers for the 6 with bupivacaine treated patients were 83%, 67%, and 17%. Based on the very short duration of response to the treatment, we did not find intradiscal injections with these agents to be cost-effective. In our department, this therapeutic approach is no longer employed in patients with chronic discogenic pain.

Adult↗
PubMed1997

Paraparesis caused by a bilateral cervical synovial cyst.

We describe a 64-year-old man who suffered from rapidly progressive paraparesis. At operation the cervical cord of the patient was found to be displaced anteriorly due to compression caused by an epidural synovial cyst. The cyst was located bilaterally on the dorsolateral aspect of both CVII facet joints. The rapid development of paraparesis in this patient can, thus, be explained by the enlargement of the cyst on both sides of the spinal cord. After microsurgical removal of the cystic tumor, the recovery of the patient was good. Cervical epidural cysts are extremely rare, and only anecdotal cases have been reported in the literature. Among all previously described patients the present case is unique due to the bilateral location of the cyst.

Female↗
PubMed1996

Spinal epidural abscess: an unusual cause of sciatica.

A previously healthy patient was admitted to our hospital because of low back pain and sciatica. For 4 weeks preceding the admission, he had been treated with nonsteroidal antiinflammatory analgetics and bed rest with a clinical diagnosis of lumbar disc herniation. On admission, the patient was subfebrile but developed general symptoms of septic infection by the next day. Computed tomography and magnetic resonance imaging of the lumbar spine revealed a spinal epidural abscess and spondylodiscitis at the L5-S1 level. During an emergency laminotomy, gross pus in abundance was evacuated from the epidural space; microbiological cultures from the pus and blood yielded Staphylococcus aureus. The unique clinical presentation of our patient combined with merely indolent symptoms of infection delayed the correct diagnosis. We are not aware of any similar reports of patients with lower spinal epidural abscess whose primary presentation was sciatic pain.

Abscess↗
PubMed1995

Cross-sectional areas of lumbar muscles after surgical treatment of lumbar disc herniation. A study with magnetic resonance imaging after microdiscectomy or percutaneous nucleotomy.

We assessed in this study the potential development of postoperative muscle atrophy in the operation area in 39 patients treated by either microdiscectomy or percutaneous nucleotomy for lumbar disc herniation. The cross-sectional areas of the lumbar muscles were measured on magnetic resonance images created on the day preceding the operation and 6 months postoperatively. The cross-sections of the lumbar muscles remained unchanged during the observation period in all treated patients indicating that no muscle atrophy had developed in the operation area. Since peroperative tissue trauma may correlate with subsequent muscle denervation and atrophy, this finding may be due to the tissue sparing nature of microdiscectomy and percutaneous nucleotomy, thus encouraging the use of these techniques in the treatment of lumbar disc herniation.

Adult↗
PubMed1994

Percutaneous nucleotomy in the treatment of lumbar disc herniation results after a mean follow-up of 2 years.

We have evaluated the clinical outcome of 45 consecutive patients who underwent percutaneous nucleotomy for a single-level disc herniation. Included were 28 (62%) woman and 17 (38%) men, with a mean age of 46 years. The mean postoperative follow-up time was 2 years. Intra-operatively, disc herniation was graded as a protrusion in 23 (51%) patients and as a prolapse in 22 (49%) patients. During the follow-up, sciatic pain completely recovered or markedly diminished in 38 (84%) patients and 35 (78%) patients returned to work. The occupational outcome of the patients operated on for a protrusion was inferior to that of the patients operated on for a prolapse: only 22% of the patients who underwent surgery for a protrusion reported to manage their work well, while as many as 41% of those with a prolapse managed well (p = 0.04). Pre-operatively, clinical examination revealed segmental instability of the lumbar spine in 11 (24%) patients. There was a significant association between instability and unsatisfactory long-term outcome: of the patients with pre-operative instability, 45% were postoperatively retired or on sick leave because of the back, as compared to 15% of the 34 patients without instability (p = 0.03). Furthermore, patients with instability suffered from sciatica and low back pain significantly (p = 0.02) more often than those without instability. Surgical complications were infrequent. There were no nerve root lesions and no vascular injuries. Postoperative discitis developed in 2 (4%) patients. Of all patients, only 1 (2%) has been re-operated on for a recurrent disc.

Adult↗
PubMed1994

Magnetic resonance image changes and clinical outcome after microdiscectomy or nucleotomy for ruptured disc.

Preoperative and postoperative magnetic resonance imaging (MRI) of the lumbar spine was performed on 41 patients treated either microsurgically or with percutaneous nucleotomy for lumbar disc herniation. On the first postoperative day, MRI revealed an edematous mass effect at the level of surgery in 25 (61%) patients. The mass effect caused compression of the anterior dural sac mimicking preoperative disc herniation. After the follow-up of 6 months, the mass effect had disappeared in all patients, and the MRI finding in the operated disc space was that of a prolapse in six (15%) patients and that of a protrusion in 16 (39%) patients. Postoperative scarring was detected in 23 (56%) patients. The amount of the epidural scar tissue was significantly (p = 0.0002) associated with the extent of the early postoperative hemorrhagic changes detected in these patients with MRI. No association was observed between these MRI findings (mass effect, disc herniation, epidural scarring) and the clinical outcome of the patients.

Adult↗
PubMed1994

Postoperative hematomas after successful lumbar microdiscectomy or percutaneous nucleotomy: a magnetic resonance imaging study.

We evaluated the incidence of postoperative extradural hematomas by means of magnetic resonance imaging (MRI) technique in 44 patients who underwent successful surgery for a virgin lumbar disc herniation. Of these patients, 28 were treated with microdiscectomy and 16 with percutaneous nucleotomy. Postoperative hematoma proved to be a universal MRI finding in the microsurgically treated patients: hematomas were found in all patients in the microdiscectomy group. In 12 (43%) patients the hematoma extended into the dural sack. The incidence of hematomas was significantly (p = 0.001) lower in the patients treated with percutaneous nucleotomy: hematomas were detected in only 10 (63%) of the 16 patients in the nucleotomy group. The hematomas in these patients were also smaller in size and none of them connected with the dural sac. Correlation between the hematomas and clinical findings showed that the presence of a hematoma had no obvious effect on the immediate postoperative recovery of a patient.

Adult↗
PubMed1994

Differential expression of myc, max and RB1 genes in human gliomas and glioma cell lines.

Deregulated expression of myc proto-oncogenes is implicated in several human neoplasias. We analysed the expression of c-myc, N-myc, L-myc, max and RB1 mRNAs in a panel of human gliomas and glioma cell lines and compared the findings with normal neural cells. The max and RB1 genes were included in the study because their protein products can interact with the Myc proteins, being thus putative modulators of Myc activity. Several gliomas contained c/L-myc mRNAs at levels higher than those in fetal brain, L-myc predominantly in grade II/III and c-myc in grade III gliomas. High-level N-myc expression was detected. In one small-cell glioblastoma and lower levels in five other gliomas. In contrast, glioma cell lines totally lacked N/L-myc expression. The in situ hybridisations revealed mutually exclusive topographic distribution of myc and glial fibrillary acidic protein (GFAP) mRNAs, and a lack of correlation between myc expression and proliferative activity, max and RB1 mRNAs were detected in most tumours and cell lines. The glioma cells displayed interesting alternative splicing patterns of max mRNAs encoding Max proteins which either suppress (Max) or augment (delta Max) the transforming activity of Myc. We conclude that (1) glioma cells in vivo may coexpress several myc genes, thus resembling fetal neural cells; but (2) cultured glioma cells expression only c-myc; (3) myc, max and RB1 are regulated independently in glioma cells; and (4) alternative processing of max mRNA in some glioma cells results in delta Max encoding mRNAs not seen in normal fetal brain.

Adult↗
PubMed1994

Microinvasive lumbar disc surgery. A study on patients treated with microdiscectomy or percutaneous nucleotomy for disc herniation.

During the last two decades, new microinvasive techniques have been introduced into the treatment of lumbar disc herniation. The potential benefits of microinvasive disc surgery are the reduced surgical trauma to the tissue, increased safety due to good visualization of the operation field under the microscope and, consequently, reduced postoperative morbidity and shorter hospitalization in comparison to conventional surgery. In this study, we evaluated the use of microdiscectomy and percutaneous nucleotomy in the treatment of patients with lumbar disc herniation. Of the 237 patients who underwent microdiscectomy for virgin single-level lumbar disc herniation, 92% informed that their sciatic pain had completely recovered or markedly diminished during a median postoperative follow-up of 2 years and 79% of these patients had returned to work. The outcome of the patients operated on for a disc protrusion was to some extent less satisfactory than the outcome of the patients operated on for a prolapse or a sequestrum. Further, of the 45 patients who underwent percutaneous nucleotomy, the sciatic pain had completely recovered or markedly diminished in 38 (84%) patients during a mean postoperative follow-up of 2 years and 78% of them had returned to work. Also in these patients, a protrusion-type of disc herniation was associated with an inferior outcome. After a mean postoperative follow-up of 3 years, the patients treated with microdiscectomy underwent repeated clinical examination. Segmental instability of the lumbar spine was observed in 22% of 190 patients studied. Lumbar instability correlated significantly (P < 0.0001) with an unsatisfactory long-term outcome in these patients. Clinical instability was preoperatively detected in 24% of the 45 patients treated with percutaneous nucleotomy. Also in these patients, instability predicted significantly (P < 0.05) an inferior outcome. On the first postoperative day, there was an extradural hematoma in 86% of the 44 patients studied with MRI. The incidence of hematomas was associated with the surgical method used: all 28 patients treated with microdiscectomy but only 10 (63%) of the 16 patients treated with percutaneous nucleotomy had a hematoma (P = 0.001). In addition, 25 (61%) of the 41 patients studied had an edematous epidural mass effect mimicking preoperative disc herniation. During follow-up for 6 months, the mass effect resolved completely in 10 of these patients but in 15 patients, MRI subsequently revealed either a disc prolapse or a protrusion. In addition, a protrusion was detected in 7 patients with no postoperative mass effect. There was, however, no association between these MRI findings and the clinical outcome of the patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1993

Histamine-containing nerve fibers innervate human cerebellum.

Histamine is found in nerve cell bodies of the tuberomammillary nucleus in mammalian brain. This nucleus is prominent in human brain. Samples of human cerebelli obtained from neurosurgical operations were examined for the presence of histamine-containing nerve fibers. In all samples, a moderately dense network of histamine-immunoreactive fibers was seen in the molecular layer. These fibers ran parallel to the Purkinje cell layer after traversing it perpendicularly. Numerous fibers were also seen in the granular cell layer. The results suggest that the human cerebellar cortex receives a direct input from histamine-synthesizing hypothalamic neurons, as no other histamine-containing neurons have been found in human brain.

Aged↗
PubMed1993

Clinical instability of the lumbar spine after microdiscectomy.

A total of 190 patients treated microsurgically for a virgin single level lumbar disc herniation were examined physically after a mean follow-up period of 3 years (range 21-68 months). Included were 99 (52%) men and 91 (48%) women with a mean age of 42 years. During the observation period, sciatica had completely recovered or markedly diminished in 172 (90%) patients, and 142 (75%) patients had returned to work. However, as many as 29% of the patients occasionally suffered from low back pain. Clinical examination revealed various signs and symptoms of segmental instability of the lumbar spine in 22% of the surgical patients. There was a significant association between postoperative instability and unsatisfactory long-term outcome: of the 42 patients with instability, 62% suffered from low back pain and 45% were on sick leave or retired because of the back, while the corresponding numbers for those patients without instability were 20% and 8%, respectively (p < 0.0001). Moreover, the mean value of the Oswestry index in instability patients was as high as 34% (SD 12), indicating moderate disability, whereas a significantly (p = 0.0001) lower Oswestry Index 16% (SD 13), indicating minimal disability, was detected in patients without instability.

Activities of Daily Living↗
PubMed1993

Microsurgical treatment of lumbar disc herniation: follow-up of 237 patients.

We have reviewed retrospectively the results of 237 consecutive patients who underwent microsurgical discectomy for a virgin lumbar disc herniation. Included were 128 (54%) mean and 109 (46%) women, with the mean age of 42 years. Intra-operatively, protrusion was found in 60 (25%) patients, prolapse in 127 (54%) patients and sequestration in 50 (21%) patients. The median post-operative follow-up time was 2 years. During the observation period, sciatic pain had completely recovered or markedly diminished in 218 (92%) patients, and 187 (79%) patients had returned to work. The mean duration of preoperative sciatica was 3.8 months in those patients who finally returned to work. In contrast, it was as long as 6.3 months in those patients who lost their working capacity as a consequence of low back pain. The patients operated on for a prolapse or a sequestrum recovered better than those who underwent surgery for a protrusion. Of the patients operated on for a protrusion, 68% returned to work, while 76% of those operated on for a sequestrum and 85% of those operated on for a prolapse returned to work during the follow-up. Difference was seen also in the occupational outcome: only 37% of the patients operated on for a protrusion reported to manage their work well, while 47% of those with a prolapse and 58% of those with a sequestrum managed well. Surgical complications were infrequent in this study. Dural tear appeared in 10 (4%) patients and post-operative discitis in 4 (1.7%) patients. Of all patients, 9 (4%) required re-operation for a true recurrent disc.

Activities of Daily Living↗
PubMed1990

A histamine-containing neuronal system in human brain.

A well-organized network of varicose fibers was revealed throughout the frontal and temporal cortex of adult humans with specific antisera against histamine. The densest network of fibers was seen in lamina I, where varicose fibers were seen to run in parallel to the overlying pia mater. Electron microscopic immunohistochemistry revealed histamine-immunostaining in granules in a small number of nerve fibers and varicosities. Hypothalamic samples obtained from autopsy brains of adult humans revealed numerous histamine-immunoreactive nerve cell bodies in the posterior basal hypothalamus in and around the tuberomammillary nucleus. The results suggest that a histaminergic neuronal system reminiscent of that described in rodents is present in human brain.

Cerebral Cortex↗