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Biomedical subjects

H Sairanen

Publications and source records attributed to H Sairanen.

16 recordsLinked to original sources
PubMed1995

Regional generation of free oxygen radicals during cardiopulmonary bypass in children.

Studies on free radical generation during cardiopulmonary bypass have focused mainly on the heart and the lungs. However, low pumping pressure, nonpulsatile perfusion, and hypothermia affect the entire circulation, resulting in decreased splanchnic blood flow, increased intestinal permeability, and endotoxemia. To evaluate regional phenomena, we studied 16 children undergoing cardiopulmonary bypass. Free radical production, granulocyte activation, and hypoxanthine metabolism were assessed separately in the circulations drained by the inferior and superior venae cavae, as well as in the oxygenator. Three minutes after the onset of cardiopulmonary bypass, significant gradients between the inferior vena cava and the arterial line of the oxygenator existed in malondialdehyde (+0.60 +/- 0.12 mumol/L, lactoferrin (+18.21 +/- 7.65 micrograms/L), myeloperoxidase (+53.75 +/- 16.50 micrograms/L), hypoxanthine (-0.62 +/- 0.15 mumol/L), and urate (+8.87 +/- 4.03 mumol/L). These gradients decreased in parallel with decreasing body temperature. Except for a transient gradient in malondialdehyde at 3 minutes after the onset of cardiopulmonary bypass (+0.23 +/- 0.08 mumol/L), no changes were detected between the superior vena cava and the arterial line. In the oxygenator, granulocyte activation was observed only after aortic declamping. We conclude that during cardiopulmonary bypass, significant free radical generation, granulocyte activation, hypoxanthine elimination, and urate production take place in the region drained by the inferior vena cava. In the oxygenator, granulocyte activation occurs only after aortic declamping.

Body Temperature↗
PubMed1992

Bronchoscopy during the first month of life.

During the 6-year period from 1984 to 1989, 196 bronchoscopies were performed on 132 neonates. The indications were grouped into four categories: (1) difficulties in artificial ventilation or failure to wean the baby from the ventilator (52); (2) other respiratory difficulties (52); (3) audible stridor (16); and (4) routine preoperative or postoperative examination of esophageal atresia patients (12). The most common finding was laryngomalacia or tracheomalacia (31). Other findings were: obstructing tracheal or bronchial granulation or stricture (23), obstructing mucous plug (22), grave tracheobronchitis (11), tracheoesophageal H-fistula (5), laryngeal perforation (3), congenital laryngeal stenosis (2), and complete laryngotracheoesophageal cleft (1). Four patients had miscellaneous pathology. The findings were normal in 30 patients. A therapeutic procedure was included in 99 of the 196 bronchoscopies. Seven serious complications occurred during the operative bronchoscopies, two of them requiring immediate pulmonary surgery. All complications were successfully managed. In contrast, no complications occurred in the 97 purely diagnostic bronchoscopies. In experienced hands, bronchoscopy of the newborn is a safe and useful examination. Complications occur when therapeutic procedures are included. Therefore, operative bronchoscopy should only be performed in conditions in which immediate thoracotomy and pulmonary surgery can be performed.

Bronchial Diseases↗
PubMed1992

Dimensions of the heart and great vessels in normal children. A postmortem study of cardiac ventricles, valves and great vessels.

Knowledge of normal heart dimensions is often needed in the planning of cardiac surgery in children. Attempts to define 'normal' have so far given varied and somewhat controversial results. The purpose of this study was to determine normal values for all heart measurements of clinical importance in children. Special interest was focused on the relationship between the diameters of the right and the left pulmonary artery (RPA abd LPA) and the descending thoracic aorta (DTA), defined as RPA/DTA+LPA/DTA, which is widely used in evaluating the feasibility of certain pediatric cardiac operations. The normal curve of this ratio during growth has not previously been presented in the literature. The observed data provide reliable normal values for the diameters of the great vessels and valves and the ventricular volumes of the heart.

Adolescent↗
PubMed1991

Surgery for ventricular septal defect.

Of 255 patients undergoing closure of ventricular septal defect (VSD), 48% were younger than 2 years, 59% had associated cardiac and 26% non-cardiac abnormality, 13% had multiple, and only 29% isolated VSD. VSD was closed via the left ventricular apex in seven cases, without increased morbidity or mortality. The three early and six late deaths occurred in patients with complicated defects. Pulmonary vascular occlusive disease caused four deaths (1 early, 3 late). At follow-up (mean c. 3, range 1-11 years), 79% of the patients were well, 10% had cardiac symptoms and 7.5% had symptoms from associated noncardiac anomalies. Reoperation for significant residual VSD was required in 12 cases (4 single and 8 multiple VSD). Complete, pacemaker-requiring A-V block was found in four patients (none with simple VSD closure). It is concluded that 1) concomitant cardiac and non-cardiac lesions are common in VSD, 2) mortality is closely related to such lesions and to pulmonary vascular occlusive disease, 3) the latter is a rare, but real cause of death, 4) left ventricular approach need not increase mortality or morbidity, 5) significant residual VSD is rare after single, but common in multiple VSD, and 6) risk of complete A-V block after simple VSD closure is very low.

Adolescent↗
PubMed1989

Iatrogenic, unexpected and other vascular rings in children.

Between May 1955 and July 1987, 33 children with a vascular ring compression syndrome were treated at this institution. There were 4 iatrogenic, 2 unexpectedly found and 27 symptomatic congenital vascular rings. Accurate diagnosis is based on a water soluble iodine contrast dye oesophagogram, bronchoscopy and angiography which are complementary examinations. All symptomatic congenital vascular rings were treated successfully without mortality, but the mortality was 50% if the lesion was iatrogenic in origin or unexpectedly found during palliative or corrective cardiac surgery.

Aorta, Thoracic↗
PubMed1987

Primary mediastinal tumors in children.

From 1950-1986, a total of 159 children (age 1 day-16 years) were treated for primary mediastinal tumors at our hospital. There were 77 malignant and 82 benign tumors. Tracheal compression causing respiratory distress was a significant symptom in 45.3% (24/53) of the children under 2 years of age. The diagnosis was based on the chest X-ray and the findings at surgery. Malignant lymphoma was usually diagnosed by cervical lymph node biopsy (23/39) but the treatment protocol was non-surgical. Non-lymphatic malignant tumors were completely or partially excised in 59.0% (23/39) of the cases. There was no early or late mortality in patients with benign tumors. At follow-up (0.5-24 years; mean 6.0 years), 62.3% (48/77) of the patients with malignant tumors were alive and symptom free. About half of the mediastinal tumors in children are malignant. Mediastinal tumors in small children can cause severe respiratory symptoms demanding urgent treatment. The treatment of choice is surgery (except in lymphomas) and the results are good even in malignant tumors.

Adolescent↗
PubMed1986

Pulmonary vein diameter in normal children.

A total of 24 normal children's hearts with their great vessels were examined at autopsy and the diameters of the pulmonary veins measured. The values so obtained were plotted against patient height, body-surface area, weight, and age and were subjected to multi-variate regression analysis. Height gave the best correlation with pulmonary venous diameter. For practical purposes, the normal diameter of each pulmonary vein (in millimeters) = 0.07 X height (in centimeters).

Adolescent↗
PubMed1985

Post mortem measurement of ventricular volumes of the heart. An analysis of errors and presentation of a new method.

A new method to determine ventricular volumes of the heart post mortem was developed. Atrioventricular valves are carefully closed with continuous monofilament sutures, and the ventricles are filled with liquid paraffin through the base of the aorta and pulmonary trunk using a standard filling pressure. The effect of various post mortem factors on the volumes of cardiac ventricles was studied using this method. Many factors, such as rigor mortis, time of measurement, mechanical handling of the heart and filling pressure used in the measurement have an effect on the ventricular volume. The volume of ventricles after formalin fixation is only about half of that of fresh hearts handled in the same way. The contraction caused by rigor mortis keeps the volume low and can be relaxed only by manipulation of the heart. The results of measurements are comparable only if the hearts have been manipulated in the same way, have been preserved for the same length of time and under the same conditions, and the volume has been measured using the same filling pressure.

Animals↗
PubMed1984

Elective surgery of abdominal aortic aneurysms. Experience with 174 patients.

Clinical experience with 174 patients (150 M, 24 F) with abdominal aortic aneurysm operated on during the 15-year-period 1966-80 is presented. The age range was 45-79 (average 62) years. The reconstruction was by means of a dacron Y-prosthesis after resection of the aneurysm, aortoiliac in 136 cases, aortofemoral in 31 cases, aortoaortal (tube prosthesis) in 5 cases. Wrapping was performed in two cases. Simultaneous arterial reconstruction of the lower extremities was done on 32 occasions, reconstruction of the renal arteries on 15 occasions, and mesenteric artery on one. The operative mortality was 8% and late mortality 22% (average follow-up of 4 years). Later arterial reconstruction of the lower extremity was necessary in 22 cases, carotid endarterectomy in 4 cases and lumbar sympathectomy in 5 cases. In the follow-up questionnaire (after 4 years on average) 56 patients reported claudication, 46 patients had angina, 36 high blood pressure and 28 symptoms referable to a cerebrovascular disorder.

Aged↗
PubMed1983

Neonatal operative treatment of club foot. A preliminary report.

A total of 67 patients with 94 resistant club feet were treated operatively as soon after birth as all other postnatal problems could be excluded, the mean age of the patients being 12 days. No treatment was attempted before operation. The results, after a follow-up period of a minimum of two years (mean 4.4 years) are comparable with the best published results. This method of treatment has many advantages but cannot be recommended for general use without reservations.

Age Factors↗
PubMed1983

Surgical treatment of nondissecting aneurysms of the descending thoracic aorta.

Between 1966 and 1981, 58 patients underwent operation for nondissecting aneurysm of the descending thoracic aorta at the University Central Hospital in Helsinki. The cause of the aneurysm was atherosclerotic in 38 cases. Nine aneurysms were post-traumatic and 11 had developed after correction of aortic coarctation with a Dacron patch. Rupture of the aneurysm with hypotension and haemothorax were present on admission in three patients (5.2%). Six operations were performed without use of shunt or bypass. In the other patients the circulation to the spinal cord and viscera was protected during the aortic resection and reconstruction. Left atrial-to-femoral artery bypass was used in 43 patients, femoral vein-to-femoral artery bypass in five, heparinized TDMAC shunt in three patients and total perfusion in one case. Transient paraparesis and irreversible paraplegia each occurred in one case in which some form of circulatory protection had been used. In the latter patient there was aneurysm rupture and hypotension on admission to hospital, and resection (greater than 10 cm) was done with TDMAC shunt. The patient died postoperatively of pulmonary complications. The total operative mortality was 12.1%. The mortality in the follow-up period (range 1-14 years, mean 5 years) was 13.8%. The conclusion from the study was that, when adequate technique of aneurysm resection is combined with shunt or bypass, an acceptable operative mortality and low incidence of paraplegia are obtainable.

Adult↗
PubMed1980

Renal angiomyolipoma as cause of massive retroperitoneal haemorrhage.

A previously healthy woman was admitted to the hospital because of sudden pain in the right flank. Massive retroperitoneal haemorrhage was found to be the cause, produced by spontaneous rupture of an angiomyolipoma in the right kidney. Both the tumour and the kidney were removed. Owing to the rare occurrence of angiomyolipoma, preoperative diagnosis is seldom arrived at. If the presence of the tumour could be suspected and its benign character confirmed, the kidney itself or its intact part could often be saved.

Adult↗