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Biomedical subjects

E Saarela

Publications and source records attributed to E Saarela.

At least 19 recordsLinked to original sources
PubMed2006

Characterisation of patients treated at the Red Cross field hospital in Kashmir during the first three weeks of operation.

OBJECTIVE: To evaluate the characteristics of patients treated at a field hospital in the first month after a major earthquake. METHODS: Age, sex, diagnosis, and operations performed on patients admitted to the field hospital of the International Committee of the Red Cross in Pakistani Kashmir between 21 October and 10 November 2005 were recorded and the data analysed. RESULTS: During the three week period of this study, 316 patients were treated at the hospital; 246 were women and children (77.9%). Two thirds were hospitalised, over 90% because of the need for surgery or surgical consultation. Altogether 345 operations were performed on 157 patients. The majority of patients had infected wounds with or without fractures. CONCLUSIONS: Most patients need medical evaluation in consequence of earthquake-related trauma even weeks after the catastrophe, especially in areas difficult of access.

Adolescent↗
PubMed1994

Contribution of non-neurologic disturbances in acute physiology to the prediction of intensive care outcome after head injury or non-traumatic intracranial haemorrhage.

OBJECTIVE: To study the additional contribution of non-neurologic disturbances in acute physiology and chronic health to the prediction of intensive care outcome in patients with head injury or non-traumatic intracranial haemorrhage. DESIGN: A nationwide study in Finland with prospectively collected data on all adult patients admitted to intensive care after head trauma or non-traumatic intracranial haemorrhage during a 14-month period. Two-thirds of the patients were randomly selected to derive predictive models, and the remaining one third constituted the validation sample. SETTING: A total of 25 medical and surgical ICUs in Finland (13 in tertiary referral centers). PATIENTS: 901 consecutive adult patients with head injury or non-traumatic intracranial haemorrhage. MEASUREMENTS AND RESULTS: Variables of the APACHE II including Glasgow Coma Score were collected at the time of ICU admission. Two predictive models were created to explain hospital mortality. The addition of variables describing acute physiology to a predictive model consisting of Glasgow Coma Score, age, diagnosis of head injury and the type of ICU admission did not increase its performance in discriminating between survivors and nonsurvivors, but the calibration accuracy of the predictive model especially at the high ranges of risk was improved. CONCLUSIONS: The non-neurologic disturbances in acute physiology have prognostic significance in the prediction of intensive care outcome in patients with head injury or non-traumatic intracerebral haemorrhage. The created predictive model may supplement clinical judgement of this patient group.

APACHE↗
PubMed1994

Prediction of outcome from intensive care after gastroenterologic emergency.

Prognostic factors determining the outcome from intensive care were studied in 952 patients admitted to 25 Finnish ICUs after gastroenterologic emergency. Logistic regression analysis was used to create predictive models based on the APACHE II-system. The models were constructed by using data from a random two-thirds of the study population and validated in the remaining independent one-third together with the original APACHE II-index. The Acute Physiology Score, age, and a pre-existing liver disease were the three most important determinants of outcome. The inclusion of the TISS score describing the intensity of treatment into a model did not enhance the accuracy of the prediction. Our models were better calibrated than the original APACHE II-equation when tested by the goodness-of-fit -statistics. These statistical models may help the clinicians to predict the outcome for an individual patient by providing them information about the relative impacts of predictive factors or about the probability of death. These probabilities should be interpreted cautiously, taking into account the limitations of statistical methods. This is especially important when assessing the highrisk patients. Their number in our study was too low for accurate outcome prediction.

APACHE↗
PubMed1991

Current practice regarding invasive monitoring in intensive care units in Finland. A nationwide study of the uses of arterial, pulmonary artery and central venous catheters and their effect on outcome. The Finnish Intensive Care Study Group.

As part of a nationwide evaluation of intensive care, we examined patient- and hospital-related factors which could influence the patterns of utilization of arterial cannulae and central venous and pulmonary artery catheters. We also studied the possible impact of these interventions on the short-term outcome among 14,951 consecutive ICU admissions to 25 intensive care units (75% of all ICU beds) in Finland. There was considerable variation between individual units in the use of these devices even if the differences in severity of illness were taken into account. Arterial cannulation was used in 71.2%, PA catheterization in 10.6% and CVP monitoring in 49.3% of cases in teaching ICUs, excluding cardiac surgery, and in 38.5%, 2.6% and 33.1% of cases in non-teaching ICUs respectively. The factors predicting the use of invasive monitoring included extensive surgery causing a risk of cardiovascular instability, needs for mechanical ventilation, infusion of vasoactive drugs and complicated fluid therapy. Cardiovascular problems among non-operative patients increased the odds for PA catheterization but reduced them for arterial and CV cannulation. No clear-cut benefit could be found in the form of hospital mortality reduction from invasive haemodynamic monitoring, used as described in this study.

Catheterization, Central Venous↗
PubMed1991

Acute physiology and chronic health evaluation (APACHE II) and Glasgow coma scores as predictors of outcome from intensive care after cardiac arrest.

OBJECTIVES: a) To examine the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Glasgow Coma Scores as predictors of the outcome of patients following resuscitation from cardiac arrest; b) to study the impact of the components of APACHE II on the prediction. DESIGN: A nationwide study in Finland with prospectively collected data on all patients admitted to intensive care after cardiac arrest during a 14-month period. Two thirds of the cardiac arrest patients included in the study were randomly selected to derive predictive models, and the remaining one third constituted the validation sample. SETTING: A total of 25 medical and surgical ICUs in Finland (13 in tertiary referral centers). PATIENTS: Six-hundred nineteen consecutive cardiac arrest patients. Fifteen patients less than 16 yrs were excluded. MAIN OUTCOME MEASURES: Variables included in the APACHE II or Glasgow Coma Scores were collected at the time of ICU admission and then three times after admission, at 24-hr intervals. ICU- and hospital-mortality rates and a 6-month mortality rate after ICU admission were studied. RESULTS: Of 604 study patients, 370 (61.3%) patients died in the hospital. The most accurate prediction of hospital outcome was based on data collected after the first day of ICU care, not on the admission values. Twenty-one (21.9%) of 96 patients with a low APACHE II score (less than or equal to 9) died compared with 66 (84.6%) of 78 patients with a high APACHE II score (greater than or equal to 25) (p less than .001). Of 160 patients with a normal Glasgow Coma Score (14 to 15), 45 (28.1%) died, whereas there were 114 (81.4%) nonsurvivors among 140 patients with a low Glasgow Coma Score of 3 (p less than .001). The performance of predictive models, including age, the Chronic Health Evaluation, and either the Acute Physiology Score (Acute Physiology Score model) or the Glasgow Coma Score (Glasgow Coma Score model) were compared with the prediction according to the APACHE II in the validation sample. When using 80% probability of death as a decision rule, the Acute Physiology Score model determined 35 of 153 patients to have high risk of death, 29 of whom died (the positive predictive value being 82.9%). The Glasgow Coma Score model predicted 34 patients to die, 26 of whom died (positive predictive value 76.5%), and the APACHE II score predicted seven deaths, five of whom actually died (positive predictive value 71.4%). CONCLUSIONS: The APACHE II scoring system cannot be recommended as a prognostic tool to support clinical judgement in cardiac arrest patients, but by modifying it, a more accurate prediction of poor outcome could be achieved. The Glasgow Coma Score explained to a great extent the predictive power of the APACHE II.

Adult↗
PubMed1981

Increased prostacyclin and thromboxane production in man during cardiopulmonary bypass.

To study the effect of the cardiopulmonary bypass (CPB) on the productions of antiaggregatory prostacyclin (PGI2) and proaggregatory thromboxane A2 (TxA2), we collected serial plasma samples from seven patients before, during, and after CPB and assayed them for 6-keto-PGF 1 alpha and thromboxane B2, the main metabolites of PGI2 and TxA2, respectively. The PGI2 production rose significantly (p less than 0.05) following cannulation of the large vessels and remained elevated during the CPB. After discontinuation of CPB, the PGI2 decreased progressively. The TxB2 production also rose during CPB, but later than the increase in PGI2. There was a significant correlation between 6-keto-PGF 1 alpha and TxB2 levels (r = 0.429, p less than 0.001, n = 77). Thus the deficient PGI2 production, or an imbalance between PGI2 and TxA2, does not seem to be responsible for the platelet loss during CPB. By contrast, the human body appears to be protected from platelet aggregation by a surge in endogenous PGI2 during CPB.

6-Ketoprostaglandin F1 alpha↗
PubMed1981

Autotransfusion; a review.

Autologous blood transfusion is a procedure in which blood is removed from a donor (patient) and returned to his circulation at some later time. Autologous blood transfusion can be performed in four different ways: 1. elective preoperative blood collection, storage and retransfusion during surgery; 2. immediate preoperative phlebotomy with simultaneous artificial hemodilution and later reinfusion of phlebotomized blood; 3. pre- or postoperative salvage and retransfusion of blood shed via wound drains as an emergency method; 4. intraoperative blood salvage and retransfusion. All these four types of autotransfusion offer a potentially superior method of blood transfusion which eliminates many of the problems and complications associated with the banking and administration of homologous donor blood. However, autotransfusion has it's own inherent problems and hazards which have limited its acceptance. A review to literature on autotransfusion is given, with the emphasis on intraoperative blood salvage and retransfusion mode. Some of our experiences with intraoperative autotransfusion is also presented here.

Blood Coagulation Disorders↗
PubMed1979

Are changes in serum immunoglobulin and complement levels following open heart surgery influenced by oxygenator type or postoperative parenteral nutrition?

The serum IgG and IgA concentrations significantly decreased through the seventh day and the serum IgM and complement (C3 and C4) concentrations through the second day after elective open heart surgery for heart valve disease in a series of 16 patients. A significant increase over the preoperative concentration was seen, however, in the serum IgA, IgM, C3 and C4 on day 14 postoperatively. The serum IgG and IgM concentrations declined significantly only in patients perfused by a bubble oxygenator, although the two small series of patients perfused by bubble and membrane oxygenator did not differ significantly from each other. Parenteral nutrition had no effect on postoperative changes in serum immunoglobulin and complement concentrations.

Adolescent↗
PubMed1978

Intraoperative changes in coronary resistance during aortic valve replacement.

Coronary vascular resistance was investigated in 10 patients undergoing aortic valve replacement using continuous constant-pressure coronary perfusion at 32 degrees C. After coronary flow was initiated, resistance was low but increased steadily until it reached a certain resting level. The plateau was attained faster after a short period of anoxia than after a longer period. The initial postischemic resistance was dependent on the duration preceding anoxia, being of the same magnitude after short and moderate periods of anoxia but significantly higher after a long period. This resistance difference between the groups lasted for the whole perfusion. The total coronary resistance and flow reached a plateau in 30 minutes, while resistance increased threefold but flow decreased to half of the initial postanoxia flow. Our results indicate the importance of initiating coronary perfusion soon after aortic cross-clamping to avoid increase in the initial vascular resistance and subsequent inadequate myocardial flow.

Adult↗
PubMed1978

Myocardial reactive hyperemia caused by initial myocardial anoxia during aortic valve replacement.

Reactive hyperemic response of individual coronary arteries and of the whole heart to anoxia during coronary cannulation was investigated in 10 patients undergoing aortic valve replacement. Reactive hyperemic response in man is identical to that reported in experimental investigations. The duration of hyperemic response was dependent on the length of the preceding period of anoxia; the longer the period of anoxia, the more prolonged was the hyperemic response. No significant collateral circulation between the coronary arteries could be demonstrated during prolonged anoxia of an individual coronary artery. Blood flow debt was almost always overpaid, but the repayment percentage decreased with the lengthening of the anoxic period, being 460 percent after a short period of anoxia (less than or equal to 2 minutes), 230 percent after an anoxic period of moderate length (3 to 5 minutes), and only 160 percent after a long period of anoxia (greater than or equal to 7 minutes). The total mean repayment of blood flow debt of the whole heart was 195 percent.

Adult↗
PubMed1978

Effect of initial myocardial anoxia on coronary flow during aortic valve replacement.

Flow to the right and left coronary arteries was recorded continuously during aortic valve replacement using continous constant-pressure coronary perfusion at 32 degrees C in 13 patients. The initially high coronary flow decreased gradually until a certain level, the so-called resting flow level, was reached and stabilized there as long as perfusion temperature remained unchanged. At 32 degrees C, resting flow was about 50% of the peak hyperaemic flow. The length of preceding anoxia had a significant effect on the duration of reactive hyperaemic response. After a short anoxic period, resting flow level was reached in about 3 min, after moderate period in 15 min and after long anoxia in 35 min, respectively.

Adolescent↗
PubMed1978

Blood pressure changes during and after anaesthesia in treated and untreated hypertensive patients.

The blood pressure responses of 34 unselected hypertensive patients with and without preoperative antihypertensive therapy during thiopentone-N2O-O2-relaxant-analgesic anesthesia and the immediate postoperative period were studied. The blood pressure fluctuations, expressed as differences between the highest and lowest levels of both systolic and diastolic pressure during anaesthesia were significantly (p less than 0.01) greater in untreated hypertensive patients than in treated ones. A significant decline (p less than 0.01) of the mean blood pressure values from the initial level was seen in both treated and untreated patients during the first 24 postoperative hours. Urinary output was greater (p less than 0.05) in treated than in untreated hypertensive patients during a postoperative follow-up of 4 hours. The results show that hypertensive patients treated with antihypertensive drugs until the day of operation endure the anesthesia and the operation better than untreated patients.

Adult↗
PubMed1977

Myocardial protection by continuous coronary perfusion during aortic valve replacement.

The coronary perfusion system used at Oulu University Central Hospital is described and the importance of physiological coronary perfusion stressed. Our method of protecting the myocardium from ischemic injury during aortic valve replacement included the following: phasic constant-pressure coronary perfusion, maintenance of coronary perfusion pressure larger than or equal to 80 mmHg, maintenance of the heart in a beating, empty, oxygenated state, and the use of the largest possible coronary canula. Under these circumstances, autoregulation of the coronary vascular bed was maintained. When small coronary cannulae were used a significant pressure drop occured across the tubing system, especially at high flow rates. Flow measurements recorded by an on-line electromagnetic flowmeter proved reliable.

Adolescent↗
PubMed1977

Circulatory responses to laryngoscopy and endotracheal intubation in patients with and without cardiovascular disease. Effect of prophylactic practolol.

The effect of small intravenous doses of practolol (0.2 mg/kg body weight) on the circulatory response to laryngoscopy and endotracheal intubation, when administered with atropine (0.01 mg/kg b.w.) prior to anaesthesia was studied in 39 patients with and without cardiovascular disease. Practolol diminished significantly the rise of mean arterial pressure and pulse rate affected by laryngoscopy and endotracheal intubation when performed under thiopentone-succinylcholine anaesthesia. Arrhythmias were also less frequent through the statistical significance could not be ascertained in this small series. The small practolol dose used had no adverse circulatory effects. It is suggested that the administration of a small prophylactic dose of practolol is useful in preventing the excessive cardiovascular response due to laryngoscopy and endotracheal intubation.

Adult↗
PubMed1977

The effect of dipyridamole on the thrombocyte count and bleeding tendency in open-heart surgery.

The effect of dipyridamole (Persantine) on the thrombocyte count and bleeding tendency in connection with open-heart surgery and perfusion was studied in 22 patients. A control series of 21 patients undergoing open-heart surgery was available. The treatment group received dipyridamole, 0.5 mg. per kilogram of body weight, in the beginning of cardiopulmonary bypass into the heart-lung machine and thereafter 10 mg. intravenously three times daily for 2 days. From the third day dipyridamole was administered by mouth, 75 mg. three times a day, until the patient was discharged from hospital. We found that dipyridamole had the effect of maintaining the thrombocyte count during cardiopulmonary bypass and the first and second postoperative days. Thereafter no significant difference was seen between the dipyridamole and control groups. The use of dipyridamole did not increase the postoperative hemorrhagic tendency. There were no significant differences in per- and postoperative blood loss and in bleeding and activated partial thromboplastin times between the groups.

Adolescent↗
PubMed1976

Prolonged recovery after extended right hepatic lobectomy in a patient with severe blunt liver injury and laceration of the vena cava. A report of case with special references to autotransfusion and complications of biliary decompression.

A patient with severe blunt liver injury and laceration of the vena cava who underwent a successful extended right hepatic lobectomy is reported. The use of autotransfusion unit saved the patient from exsanguination. His postoperative course was complicated by renal and hepatic failure, bile leakage, and persistent jaundice due to cholangitis. Prolonged choledochal drainage via T-tube obviously acted as a source of infection. The use of autotransfusion, choledochal drainage and the proper timing of its removal, the treatment of vena cava lesions and jaundice due to cholangitis in patients with severe liver trauma are discussed.

Acute Kidney Injury↗