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Biomedical subjects

I Louhimo

Publications and source records attributed to I Louhimo.

At least 19 recordsLinked to original sources
PubMed1992

Long-term endoscopic and flow cytometric follow-up of colon interposition.

During 1963 to 1978 colon interposition was performed on 20 children. Early and late mortality accounted for 3 patients and two transplants failed. Of the 15 long-term survivors, subjective results were obtained from 12 patients 12 to 26 years after the reconstruction. Three patients had an excellent subjective result and 9 had a good result. Nine patients underwent esophagogastroduodenoscopy 12 to 26 years after the reconstruction. The endoscopic findings included: marked tortuosity or dilatation (6), pooling of bile or yellow bezoar (3), macroscopic colitis (3), and polyps in the distal anastomosis (2). Only two patients had a straight colon tube without mucosal changes or marked retention. Specimens for histology were obtained in each endoscopy. Colitis was found in 3 patients, 1 patient had gastric metaplasia in the transplant, 1 patient had dysplasia of colonic mucosa and an inflammatory colonic polyp, and in 4 patients histology showed normal colonic mucosa. Flow cytometric samples were obtained from 8 patients. Two showed an aneuploid cell population; the other 6 had normal diploid findings. Because of frequent endoscopic and histological changes, regular endoscopic follow-up of these patients is warranted.

Adolescent↗
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↗
PubMed1990

The rectourogenital connection in anorectal malformations is an ectopic anal canal.

Histological investigation of the rectal blind pouch and rectourogenital or rectoperineal connection was performed in 10 patients with high or intermediate anorectal malformations. Nine of the patients underwent postoperative manometric evaluation. In nine of the 10 patients, transitional epithelium typical of the normal anal canal could be found in the distal rectum or rectal end of the fistulous connection. The zone of transitional epithelium was aganglionic and showed abnormally strong acetylcholinesterase reaction. A positive rectoanal inhibitory reflex was found manometrically in all cases in which the distal rectal pouch was utilized in the reconstruction of the anal canal. The slow pressure wave activity of the reconstructed anal canal was characteristic of a normal anal canal. The manometric evidence strongly suggests that there is a functional internal sphincter in high and intermediate anorectal malformations. The present study shows that in anorectal malformations the distal rectal pouch with the fistulous connection is actually an ectopic anal canal.

Anal Canal↗
PubMed1990

Cervical Barrett's esophagus: a common complication of gastric tube reconstruction.

Upper gastrointestinal endoscopy was performed on 14 of our 18 long-term (more than 2 years) gastric tube esophagus survivors, with special attention paid to cervical gastric metaplasia. Barrett's esophagus was found in 10 patients. In eight cases, this could also be histologically verified. Three patients had esophagitis, but no verified gastric metaplasia. Isotope reflux studies were performed on six patients, all having both endoscopically and histologically shown pathology in the cervical esophagus. Reflux was provoked by putting patients in different positions. Only one patient showed gastrotubal reflux, and only in the prone Trendelenburg position. We conclude that Barrett's esophagus is a common complication of gastric tube patients, and is probably due to acid secreted by the tube itself. Life-long endoscopic follow-up of these patients is warranted.

Barrett Esophagus↗
PubMed1989

Neuronal intestinal dysplasia.

A series of 21 patients with NID is presented. A histologic and histochemical picture of NID was seen in an heterogenous group of patients. NID was associated with bowel obstruction and/or perforation in six neonates and infants. One neonate died. During follow-up the bowel histology gradually normalized in four of the five patients. NID was found incidentally in four patients with anorectal malformations and two with Hirschsprung's disease. Three patients with Hirschsprung's disease and associated NID had chronic proctitis; one patient with an anorectal anomaly had chronic obstipation and megacolon and one proctitis. Two children with multiple endocrine neoplasia 2b syndrome and chronic obstipation had typical NID in their rectum biopsies, as did a 50-year-old woman with CIIP. The clinical heterogeneity of patients with NID suggests that NID may not be a distinct clinical entity but rather a reaction of the neuronal network of the bowel wall and could be caused either by congenital or secondary factors.

Anal Canal↗
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↗
PubMed1989

Failure of the Nissen fundoplication to control gastroesophageal reflux in esophageal atresia patients.

During the 5-year period from 1981 to 1985, Nissen fundoplication was performed on 13 esophageal atresia patients. One patient with Down's syndrome died because of cardiac malformation 2 weeks after the operation and is excluded from the analysis. Nine of the remaining 12 patients had the usual malformation with distal fistula, while three had isolated atresia. In eight patients there was a long gap between the segments, and in five Livaditis myotomy was necessary. The median age of the patients at the fundoplication was 1.3 years (range, 4.5 months to 10.6 years). The main clinical manifestations were anastomotic stricture (six patients), respiratory complications (three patients), vomiting and difficulties in feeding (two patients), and esophagitis only (one patient). Altogether nine patients had preoperative distal esophagitis. Mean follow-up time was 4.1 years (range, 2.0 to 6.4 years). All patients primarily benefited from the operation. Routine control endoscopy 3 to 8 months after the operation showed a competent fundoplication in all patients. However, in five patients the reflux later recurred, and endoscopy revealed a partially disrupted fundal wrap and esophagitis. Four patients underwent refundoplication and one is waiting for it as of this writing. Four patients had Barrett's esophagus at the last endoscopic control. There was one late death due to cardiac failure. In conclusion, although the short-term results of Nissen fundoplication in esophageal atresia patients are good, the risk for late recurrence is high. Regular long-term follow-up is therefore necessary.

Adolescent↗
PubMed1988

Pancreatitis after open heart surgery in children.

Between January 1981 and March 1986, we found 54 children with abnormal serum amylase values or clinical pancreatitis after open heart surgery. Of these 33, had increased serum amylase values only, and 19 had increased serum amylase values in conjunction with clinical pancreatitis. Two patients had haemorrhagic pancreatitis identified at autopsy. The mortality was 42.9% (9/21) in patients with pancreatitis compared to 9.1% (3/33) with amylasaemia only. Pancreatitis is a serious complication after complex open heart surgery in children. The aetiology is probably of vascular origin, and routine serum amylase screening is recommended.

Adolescent↗
PubMed1988

Duodenal atresia: late follow-up.

In this study, 41 randomly chosen patients aged 15 to 35 years (mean 22 years) were carefully examined. As primary operations there were 13 membrane excisions, five duodenoduodenostomies, 22 duodenojejunostomies, and one gastrojejunostomy. Twenty-eight patients were symptom-free, ten admitted some discomfort, three had major pains, including one with a history of duodenal ulcer. Reoperation for adhesion ileus had been performed in six patients, in the early postoperative phase in one instance. At late follow-up barium meals (N = 41) showed completely normal findings in two cases only, hiatal hernia in two, gastritis in three, duodenogastric reflux in 12, slight dilation of the duodenum with good emptying and no reflux in 16, a huge duodenal sac in nine, diminished peristalsis in eight, delayed emptying in five, slight luminal narrowing in three, duodenal diverticuli in nine, bezoars in two, and a polyp in the duodenum of one patient. Ultrasound (N = 35) revealed a gallbladder septum in one patient and a dilated common bile duct in another; in one subject the gallbladder was not visualized satisfactorily. Isotope biligraphy (N = 15) showed biliary reflux to the stomach in 12 cases. Endoscopy (N = 20) findings were: esophagitis (1), hiatal hernia (2), gastric mucosa in the lower esophagus (2), biliary reflux (9), gastritis (7), gastric polyps (2), dilated duodenum of variable degree (19), diminished peristalsis (4), marked retention (2), abnormal papilla (3), diverticuli (4), and a persistent membrane (1). Histology showed superficial gastritis in three patients. E coli was cultured from the duodenal juice in five patients and Candida found in two.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Extralobar sequestration of the lung in children.

Sixteen patients with extralobar sequestration of the lung are reported on. The age at time of diagnosis varied from 21 days to 12 years (mean 3.6 years). Most of the patients presented with respiratory symptoms, such as dyspnoea, pneumonia, coughing attacks, cyanosis and asthmatic symptoms, but diagnosis was made incidentally in 4. Diagnosis was established by chest X-ray in every case. Preoperative angiography and bronchography was carried out in six cases. All 16 patients underwent thoracotomy for removal of the sequestration. Rudimentary bronchial remnants were found in 6 cases. Extralobar sequestration was associated with 12 additional malformations in 10 of the 16 patients. The clinical picture varies considerably and many of the "typical" features, such as systemic arterial blood supply, left lower lobe localization and diaphragmatic defect, are often absent. Diagnosis and treatment are easy.

Bronchopulmonary Sequestration↗
PubMed1987

Cardiopulmonary bypass in tracheal surgery in infants and small children.

Five resections of the distal trachea with cardiopulmonary bypass were carried out in four children aged 6 weeks to 24 months. Only technical aspects are discussed, and the operative method is described in detail. The use of cardiopulmonary bypass and heparinization of the patients did not cause any problems. Cardiopulmonary bypass allows an easy and unhurried procedure. Although other authors do not regard cardiopulmonary bypass as necessary in similar circumstances, we believe that it is the safest way of providing optimal operative conditions and results in surgery of distal tracheal stenoses.

Cardiopulmonary Bypass↗
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↗
PubMed1987

Livaditis myotomy in long-gap esophageal atresia.

During 1973 to 1983, Livaditis myotomy was performed on 12 esophageal atresia patients in whom anastomosis otherwise would have been impossible. Ten patients had the usual malformation with a distal fistula, while two had an isolated atresia. Four patients belonged to Waterston's risk group A, 4 to group B, and 4 to group C. In 11 cases anastomosis was permitted by myotomy. In one patient anastomosis was impossible even after myotomy. This baby weighed 1,380 g and she also had trisomy 18 with severe cardiac and renal anomalies leading to death. One patient had a refistula and died of pneumonia, she also had a severe congenital cardiac malformation. There were no anastomotic leakages to free pleural cavity nor complications related to the myotomy. The ten survivors were followed up for a mean period of 5.4 years (range 1.6 to 11.3 years). The subjective results at last follow-up according to the criteria of Desjardins were excellent in eight and good in two patients. Esophagograms showed no strictures, but two patients had a myotomy pouch.

Abnormalities, Multiple↗
PubMed1987

Oesophageal anastomosis without bougienage in isolated atresia--do the segments really grow while waiting?

Four cases of isolated oesophageal atresia, in which a successful oesophageal anastomosis was achieved without bouginage, are reported. The anastomoses were performed at ages from one month to three and a half months. No certain growth of the segments could be observed. However, in the cases, where the operation was performed after a longer waiting period, the lower segment was surprisingly thick walled, which made the anastomosis possible. A single Livaditis myotomy was required in three cases and a double myotomy in one. All patients needed Nissen's fundoplication because of gastro-oesophageal reflux, which caused stricturation of the anastomosis and oesophagitis. After the follow-up period of 1.3 to 2.5 years, two patients had an excellent result, one patient a fair result and one patient had died of his severe cardiac anomaly associated with Down's syndrome.

Anastomosis, Surgical↗
PubMed1986

Vater association and anorectal malformations.

In a twenty-year series of 208 patients with anorectal malformations there were 39 infants with three or more Vater association anomalies. The neonatal mortality of Vater association patients was 28%; beyond the neonatal period only two patients died. Most early deaths were associated with the combination of cardiac anomalies and oesophageal atresia. The incidence of prematurity (30%) and lethal anomalies (15%) was high. High and complex anorectal anomalies were frequent (85%) and some kind of urogenital malformation was present in 95% of the patients. Despite the grave early prognosis and multiple hospitalisations and surgical procedures required in the management of these patients, the long-term outlook and quality of life does not differ significantly from other patients with corresponding anorectal anomalies.

Abnormalities, Multiple↗