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Biomedical subjects

H Paajanen

Publications and source records attributed to H Paajanen.

At least 19 recordsLinked to original sources
PubMed2002

Novel serum inflammatory markers in acute appendicitis.

BACKGROUND: Cytokines and leukocyte adhesion molecules are activated and found in increased concentrations in bacterial infection. The purpose of this study was to investigate whether some of these new serum markers could be feasible as a single on-admission test to predict acute appendicitis (AA). METHODS: In an open prospective study the diagnostic potentials of two cytokine measurements (interleukin-6 and interleukin-8), soluble leukocyte adhesion molecule (CD44), C-reactive protein (CRP) and white blood cell (WBC) count were compared in 80 consecutive patients who had undergone surgery for suspected AA. The diagnostic performance of each parameter was tested by using receiver operating characteristic (ROC) curves. RESULTS: Phlegmonous AA was found in 34%, gangrenous AA in 40% and perforated AA in 5% of the patients. The proportion of negative explorations was 21%. Preoperative serum concentrations of IL-6 and CRP were elevated only in gangrenous and perforated AA. The concentrations of IL-8 and CD44 remained unchanged in AA. The sensitivity (84%), specificity (79%) and diagnostic accuracy (82%) of IL-6 were higher than the values for CRP, WBC, IL-8 and CD44 in predicting AA. CONCLUSION: ROC analysis confirmed that IL-6 showed the best trend in the diagnosis of AA. However, the diagnosis of AA was not greatly improved by any of the new serum markers as single on-admission tests.

Acute Disease↗
PubMed2001

The demands of screening mammography on surgical inpatient services of breast cancer.

A nationwide mammographic screening of women ages 50 to 59 years commenced in Finland in January 1987. We studied the demands of screening on surgical inpatient services by comparing the treatment strategy, volume of breast biopsies, and hospital stay before and after implementation of mass screening of women age 50 to 59. Approximately 20 patients per 100,000 inhabitants were referred annually from mass screening for surgical biopsies, in half of which cancer was detected. In 1985 through 1986 (before screening) we operated on 134 patients suspected of having breast cancer. After the first (in 1990) and the second (in 1995) round of mammographic screening we operated on 161 patients in 2 years suspected of having breast cancer. Concurrently 25 of 92 cancers (27%) were found only because of the screening. Before the screening period clinical symptoms and palpable tumors were cause for referral to surgery in 84 per cent of the cases and abnormal mammography in only 16 per cent. During screening these ratios were 34 and 61 per cent, respectively. The number of T(is)-1 cancers (<2 cm) increased from 44 per cent before screening to 70 per cent during screening. In contrast the number of T2 cancers (2-4 cm) decreased from 40 to 20 per cent. The mammographic screening did not increase the hospital stay of patients. We conclude that the mammographic screening program of all women age 50 to 59 years increased the number of surgical biopsies in our hospital by only 30 per cent. Breast cancer was found at an earlier stage during screening. More than one-fourth of breast cancers are currently found through the mass screening program in Finland.

Biopsy↗
PubMed2001

Lichtenstein inguinal herniorraphy under local infiltration anaesthesia as rapid outpatient procedure.

BACKGROUND: In Scandinavian countries the use of local anaesthesia combined with fast patient's discharge is still uncommon in inguinal herniorraphy. AIMS: To report the feasibility, safety, costs and long-term outcome in terms of pain and recurrence after 101 open inguinal herniorraphies operated under local anesthesia as rapid outpatient procedure. METHODS: All patients were selected and operated using Lichtenstein polypropylene mesh herniorraphy by the same senior surgeon and one nurse. The incidence of pain and recurrences were asked by questionnaire after the mean follow-up of 2 years. RESULTS: The rate of clinically important wound hematomas (n = 3) and infections (n = 1) were low as well as the number of recurrences (n = 1). Although 23% of the patients felt later some pain sensations in the inguinal region, only 2 patients needed occasionally pain-relieving drugs. Over 90 per cent of the patients were very satisfied with the operation. CONCLUSION: Lichtenstein inguinal hernioplasty under local infiltration anaesthesia is rapid, well-tolerated, simple and inexpensive operation, which gives excellent results.

Ambulatory Surgical Procedures↗
PubMed2001

Lichtenstein inguinal herniorraphy under local infiltration anaesthesia as rapid outpatient procedure.

BACKGROUND: In Scandinavian countries the use of local anaesthesia combined with fast patient's discharge is still uncommon in inguinal herniorraphy. AIMS: To report the feasibility, safety, costs and long-term outcome in terms of pain and recurrence after 101 open inguinal herniorraphies operated under local anaesthesia as rapid outpatient procedure. METHODS: All patients were selected and operated using Lichtenstein polypropylene mesh herniorraphy by the same senior surgeon and one nurse. The incidence of pain and recurrences were asked by questionnaire after the mean follow-up of 2 years. RESULTS: The rate of clinically important wound hematomas (n = 3) and infections (n = 1) were low as well as the number of recurrences (n = 1). Although 23 % of the patients felt later some pain sensations in the inguinal region, only 2 patients needed occasionally pain-relieving drugs. Over 90 per cent of the patients were very satisfied with the operation. CONCLUSION: Lichtenstein inguinal hernioplasty under local infiltration anaesthesia is rapid, well-tolerated, simple and inexpensive operation, which gives excellent results.

Adolescent↗
PubMed1999

Sensitivity of transabdominal ultrasonography in detection of intraperitoneal fluid in humans.

The sensitivity and specificity of ultrasonography in detection of free intraperitoneal fluid is over 90 %. The lowest detectable volume of free fluid in humans is unknown. The distribution of intraperitoneal fluid was studied in 86 patients by transabdominal US in group A (n = 21, 10 ml of fluid), in group B (n = 15, 50 ml of fluid) and group C (n = 50, splenic trauma). Ultrasound detected fluid in 15 of 21 patients in group A, and in all patients in groups B and C. In group A 10 ml of fluid was found in 71 % of cases behind the bladder, and in only 5-14 % of cases in the upper abdomen. In group B 50 ml of fluid was found in all patients in the lower pelvis, but in only 20 % in Morison's pouch and in 7 % around the spleen. In group C 200-4500 ml of fluid was detected by US in 72 % of patients in the perisplenic space, in 60 % in Morison's pouch and in 42 % in the retrovesical space. Small volumes of free intraperitoneal fluid (10-50 ml) can be detected with current US scanners, but only near the site of injury. These results support the role of US as a primary imaging modality in abdominal trauma.

Abdominal Injuries↗
PubMed1999

Proliferation potential of human lumbar disc after herniation.

To investigate the regenerative potential of human disc tissue, the disc samples were obtained during surgery from 24 adult patients with first lumbar prolapses and from 14 patients with recurrent lumbar prolapses. Preoperative magnetic resonance imaging (MRI) confirmed prolapse and disc degeneration in all cases. The proliferation activity of the sampled connective tissue cells was studied with the immunohistochemical expression of Ki-67(MIB-1) antigen. The antigen was positive in 6 of 24 (25%) specimens from first prolapse and in none of the 14 specimens from the recurrent prolapse. The amount of proliferative cells did not correlate to the degree of disc degeneration in MRI. Our results indicate that connective tissue cells in adult degenerative disc may show proliferation activity after the first herniation and thus regenerative potential. The enhanced matrix proliferation may not be a significant reason for recurrent prolapses because none of the recurrent disc specimen showed proliferation activity.

Adult↗
PubMed1998

Hyperamylasemia after cardiopulmonary bypass: pancreatic cellular injury or impaired renal excretion of amylase?

BACKGROUND: Postoperative hyperamylasemia and even acute pancreatitis are associated with coronary artery bypass grafting (CABG). The mechanism of hyperamylasemia and pancreatic acinar cell damage was studied in 20 patients undergoing CABG. METHODS: Serial blood and urine samples at eight time points before, during, and 24 hours after the CABG were collected. Salivary and pancreatic isoamylases, the fractional clearance of isoamylases (i.e., relative to creatinine clearance), pancreatic phospholipase A2 (a specific serum marker of pancreatic acinar cell injury), and cystatin C (a sensitive marker of glomerular filtration rate) were measured. RESULTS: Mild serum hyperamylasemia (300 to 1000 units/L) was found in 11 of 20 (55%) and severe (> 1000 units/L) in 6 of 20 (30%) patients with no signs of clinical acute pancreatitis. Hyperamylasemia occurred from 6 to 24 hours after the CABG and was mainly caused by pancreatic isoamylase. Serum pancreatic phospholipase A2 concentration remained unchanged, which excludes acinar cell damage. Although renal glomerular filtration was normal during CABG as measured by serum cystatin C and creatinine clearance, the fractional clearance of isoamylases decreased. CONCLUSIONS: The decreased rate of excretion into urine, rather than pancreatic cellular damage, is the major source of hyperamylasemia after CABG.

Amylases↗
PubMed1998

The distribution of collagen types I, III, and IV in normal and malignant colorectal mucosa.

OBJECTIVE: To compare the distribution of interstitial collagens (type I and III) and basement membrane collagen (type IV) in cancerous and normal colon. DESIGN: Retrospective study. SETTING: University hospital, Finland. SUBJECTS: 13 patients with colorectal cancer of different stages and grades. MAIN OUTCOME MEASURES: Indirect immunofluorescence labelling for type I, III, and IV collagens of fresh frozen tissue samples, both normal and cancerous, cut into serial sections 6 microm thick. RESULTS: In normal mucosa, the epithelial basement membrane showed an intense immunoreaction for type IV collagen. Type I and III collagens were localised to the interstitial stroma underlying it. The membrane in cancer samples was characterised by discontinuities and thinning as estimated by immunolabelling for type IV collagen. Furthermore, immediately adjacent to the membrane type I and III collagen positivity was fragmented. The cancerous stroma showed a strong positive immunosignal for type I and III collagens. CONCLUSION: Both the epithelial basement membrane and the collagenous matrix immediately beneath it are degraded in malignant tissue. This may suggest the simultaneous activation of several degradative enzymes (as type I and III collagens are at least in part degraded by different enzymes from type IV collagen) or alterations in the expression of collagen subtypes in normal compared with malignant tissue.

Collagen↗
PubMed1997

Age-dependent correlation of low-back pain and lumbar disc regeneration.

The prevalence of lumbar disc degeneration in subjects suffering from low-back pain (n = 207; age range 10-49 years) and in age-matched asymptomatic controls (n = 216) was investigated by magnetic resonance imaging. The percentage of subjects with degenerated discs increased with age; starting from the age of 15 years, this increase was more rapid in subjects with low-back pain. Concurrently, the number of degenerated discs was higher in the pain group than in controls. Lumbar disc degeneration manifests earlier and in a greater percentage of subjects with low-back pain than in asymptomatic controls.

Adolescent↗
PubMed1997

Postoperative hyperamylasaemia in cardiac surgery.

The mechanism of postoperative hyperamylasaemia was studied in 48 patients undergoing coronary artery bypass grafting (CABG). Mild hyperamylasaemia developed in 87% of the patients, and in 10% the serum amylase activity was > 1000 U/l. Serial measurements of serum salivary (S-) and pancreatic (P-) isoamylases indicated that hyperamylasaemia was highest 24 hours after CABG and consisted mainly of P-amylase component. Serum creatinine, creatinine clearance and urinary albumin concentration remained normal after CABG, excluding severe renal damage. The fractional clearance (i.e. relative to creatinine clearance) of P-amylase decreased more than of S-amylase (from 3.6 to 0.9% vs 1.3 to 0.8%). Decreased rate of excretion into urine, rather than pancreatic cellular damage, is the main source of hyperamylasaemia after CABG.

Aged↗
PubMed1997

Are serum inflammatory markers age dependent in acute appendicitis?

BACKGROUND: Preoperative measurement of body inflammatory agents reduces unnecessary appendectomies by up to 30 percent. A decline in the formation of blood leukocytes and C-reactive protein with aging may hinder the correct diagnosis of appendicitis. STUDY DESIGN: White cell count and C-reactive protein were determined before appendectomy in 600 patients aged 0 to 5 years, 6 to 19 years, 20 to 39 years, 40 to 59 years, 60 to 79 years, and older than 80 years. Their records were analyzed. The sensitivity, specificity, diagnostic accuracy, and receiver-operating characteristic curves for C-reactive protein and white cell count to predict appendicitis were calculated separately for each age group. RESULTS: The rates of negative explorations and perforations were highest at both extremes of age. In uncomplicated appendicitis, the diagnostic potential of white cell count was better than C-reactive protein in all age groups except infants. The C-reactive protein was elevated similarly throughout human life, but only in those with perforated appendicitis. The receiver-operating characteristic curves confirmed that the performance of white cell count was better than C-reactive protein in the correct diagnosis in every age group except infants and octogenarians. CONCLUSIONS: The leukocyte response declines in 0- to 5-year-old children with appendicitis, but the C-reactive protein response is well preserved in all other age groups.

Adolescent↗
PubMed1997

Prospective evaluation of a treatment protocol in patients with severe acute necrotising pancreatitis.

OBJECTIVE: Audit of the protocol for surgical treatment of patients with acute severe and necrotising pancreatitis (ANP). DESIGN: Prospective open study. SETTINGS: University hospital, Finland. PATIENTS: 33 patients treated for severe (Ranson score 3 or more) and necrotising (as judged on computed tomograms (CT)) pancreatitis between 1992-1993. PROTOCOL: Indications for antibiotic treatment (n = 25 patients) were: fulminant multiorgan disease; recurrent continual parallel increase in temperature, white cell count (WCC) and C-reactive protein concentration; or the presence of bacteria on Gram stain of a percutaneous fine needle aspiration smear of necrosis. Three of the 25 responded to antibiotics. They and eight others with ANP but without these indications were treated conservatively. Twenty-two patients underwent repeated necrosectomy by laparostomy. MAIN OUTCOME MEASURES: Diagnosis of pancreatic infection, morbidity and mortality RESULTS: Of the 22 patients operated on 17 had contaminated necrosis at operation, and this had been predicted by the increasing inflammatory variable and the presence of bacteria in the Gram stain. Five patients operated on died (23%), four of the five having been operated on for fulminant multiorgan disease (80%). Recurrent sepsis developed in five patients, pancreatic fistulas in two, and there were no pseudocysts. Gastrointestinal fistulas developed in 12 patients, but not after we had changed the technique of wound packing. All 11 patients treated conservatively survived. CONCLUSION: A third of patients with ANP can be selected for safe non-operative treatment. Infected ANP can be treated by repeated necrosectomy by laparostomy with low mortality (6%). Early fulminant multiorgan disease should not be treated with laparostomy.

Adult↗
PubMed1996

Effect of antioxidants on postoperative hyperamylasemia in coronary bypass surgery.

Antioxidants may reduce pancreatic cellular injury after coronary artery bypass grafting (CABG) Twenty patients (Group A) received vitamin E (600 mg/ day) for 28 days and vitamin C (2 g/day) and allopurinol (600 mg/day) 2 days before and 1 day after CABG. Seventeen patients (Group C) received all drugs for 3 days, and 25 (Group B) and 19 (Group D) patients served as corresponding controls. The pre- and postoperative pancreatic isoamylase (P-amylase), creatinine, and antioxidant concentrations were measured. Serum hyperamylasemia was highest on the first postoperative day and occurred in 73% of the patients. After surgery serum P-amylase increased in all study groups and urine P-amylase decreased. Postoperative serum hyperamylasemia, whether primarily renal or pancreatic, cannot be decreased by pretreatment with allopurinol, vitamin C, and vitamin E.

Aged↗
PubMed1996

Early childhood appendicitis is still a difficult diagnosis.

We report on 90 pre-school children operated on for suspected acute appendicitis. The data analysis was retrospective. The outcome of exploration was negative in 54% (49/90) of cases; inflamed nonperforated appendix was removed 28% (25%/90) and a perforated appendix in 18% (16/90) of cases. In infants aged < 3 years (n = 26) the perforation rate was 60%, and in children age 4-5 years (n = 64) it was 27%. Tenderness in the iliac fossa, blood leukocytosis and urinanalysis had little diagnostic value. Preoperative signs of diffuse peritonitis and elevated values of serum C-reactive protein were found more frequently only in the children with a perforated appendix. There was no mortality and the postoperative morbidity varied between 10 and 20%. Thus, although appendectomy is currently a safe procedure in children, more specific non-invasive diagnostic acids are still needed to reduce the number of negative explorations and the rate of perforation.

Acute Disease↗