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Biomedical subjects

J Isolauri

Publications and source records attributed to J Isolauri.

49 records · Page 3Linked to original sources
PubMed1986

Gastrointestinal symptoms after colon interposition.

To assess gastrointestinal symptoms after colon interposition, 12 patients with colon interposition for malign disease and 33 for benign esophageal disease were interviewed. A 7-day diary, including time of eating and gastrointestinal symptoms experienced by patients during and between meals, was kept by every patient. The observations of the interview and diary were compared. No patient had swallowing difficulties or heartburn. All could also eat solid foods; 24% had no gastrointestinal gastrointestinal symptoms during follow-up. Regurgitation, vomiting, and dumping symptoms were common, being observed in 22, 31, and 18% of the cases. There were no differences with these symptoms between patients with anti- or isoperistaltic colon grafts. The information from interviews agrees with the information recorded in the diaries. We conclude that various degree reflux symptoms are common after colon interposition, being experienced by almost half of the patients.

Adolescent↗
PubMed1985

Surgical treatment of pancreatic pseudocysts. A review of 42 cases.

21 years' experience of operated pancreatic pseudocysts is reviewed. The number of patients was 42, with mean age of 50 +/- 5 years. Thirteen patients (31%) were alcoholic. In 6/42 cases (14%) pancreatic carcinoma was considered the reason for pseudocyst formation. In 30 patients an internal and in 11 an external drainage was created. Operative mortality occurred in 3 patients (7%). External drainage was effected in patients with complicated pseudocyst. The complication rate in this group was 6/11 (55%) and in the internal drainage group 7/30 (23%). Internal drainage is a safe and effective procedure in patients with a mature pseudocyst wall. External drainage should be used in patients critically ill or with an immature pseudocyst wall.

Adult↗
PubMed1983

Proximal osteotomy of the tibia in the treatment of osteoarthritis of the knee.

A total of 50 patients with osteoarthritis of the knee joint treated by proximal osteotomy of the tibia were followed up 1-5 years after operation. Fusion occurred within an average of 24 weeks. The subjective result of the treatment was good or fair in 44/50 patients. The results were the same 1-2 years and 4-5 years postoperatively. Half the patients showed some significant general disease, most usually hypertension or cardiac disease. Although the patients' subjective condition was significantly better after than before operation, the treatment did not improve or maintain their working capacity. Preoperatively 29 patients worked, while this number was reduced to 12 at the time of follow-up, and two of the latter patients had been trained for new occupation.

Adult↗
PubMed1980

Intertrochanteric osteotomy without displacement fixed with an AO blade plate in the treatment of osteoarthritis of the hip.

The results in 90 patients with osteoarthritis of the hip, treated by intertrochanteric osteotomy fixed with an AO blade plate, were analyzed 1-5 years after operation. The operation was performed without displacement of osteotomy, the aim being to produce bony union in the original position using the AO compression technique. With one exception, all osteotomies fused, but dislocation exceeding 0.5 cm resulted in four cases. The operation brought about relief from night pain in 88% of the patients and relief from weight-bearing pain in 41%. Abduction and adduction were the only movements that improved. The results were the same 1-2 and 4-5 years after the operation. Complications were rare, and the use of the compression method enabled the patients to get on by themselves the day after operation. This method is particularly well suited for young patients.

Adult↗
PubMed1978

Basal osteotomy of the first metatarsal bone in hallux valgus: experiences with the use of AO plate.

In young patients with hallux valgus, osteotomy with excision of the exostosis is frequently indicated. The basal, laterally based wedge osteotomy, is relatively seldom used. However this operation may produce a considerable reduction of the metatarsus primus varus. We modified the method by adding a small AO plate to ensure stabilization. The series consisted of 36 patients, in whom 52 feet were operated on. Pain was the most frequent indication for seeking treatment. A followup was performed an average of 1.5 years postoperatively. The subjective results were good in 41 cases, fair in nine, and poor in one. Objectively the results were good in 42 cases and fair in nine. The mean period of work was seven weeks. The metatarsus varus angle was reduced from 14.8 degrees to 9.3 degrees and the hallux valgus angle from 33.2 degrees to 17.7 degrees. The distance between the first and second metatarsal bones was reduced from 13. 7 mm to 10.2 mm. A good functional and cosmetic result was achieved in most of the cases.

Adult↗
PubMedDate not supplied

Reoperation following failed fundoplication.

Fifty patients reoperated for failed Nissen fundoplication are presented; 29 patients (group 2) were operated between 1983 and 1988 while 21 patients (group 1) were operated before 1983. In group 1, the "slipped Nissen" had been the most frequent cause of reoperation (48%). In group 2, the most frequent causes for the unsuccessful operation were: (1) partial or total disruption of the fundic wrap (62%), (2) slipping of the fundoplication, giving rise to the telescope phenomenon (21%), and (3) creation of a fundoplication which was too low (10%). Refundoplication was performed in cases where the dissection of the previously formed fundic wrap was possible (42/50 = 84%). In group 1, three patients were treated by resection of the cardia, one by an Angelchik prosthesis and one by a distal gastric resection with Roux-en-Y diversion. In group 2, fundectomy was performed in one patient; in another, an Angelchik device was inserted, and in a third patient, fundoplication and proximal gastric vagotomy were performed. The results were excellent or good in 66% of patients in group 1 and in 76% of group 2. Operative mortality was 2% and morbidity, 4%. In conclusion, repeat fundoplication is recommended when reestablishment of the fundic region anatomy is possible during dissection. The operation can usually be performed through an abdominal route. Meticulous preoperative evaluation of the patients including 24-hour pH measurement and manometry is necessary. Good results of refundoplication should be expected in 66%-76% of patients with recurrent disease.

Adolescent↗
PubMedDate not supplied

Esophagocardiomyotomy for achalasia. Long-term clinical and endoscopic evaluation of transabdominal vs. transthoracic approach.

Modified Heller's myotomy for achalasia of the esophagus was performed via a left thoracotomy in 34 cases (group A) and via an upper midline abdominal incision in 30 (group B). There were no perioperative deaths. Complications arose in ten cases. After follow-up averaging 13 years (range 3-24 years) 4% of the group A patients reported dysphagia for solids, but none for liquids, and in group B the corresponding figures were 52% and 26%. Reflux symptoms were present in 30% of the group A and 60% of the group B cases, and the respective incidence of microscopic esophagitis was 30% and 43%. There were three esophageal strictures, all in group B, and three cases of Barrett's epithelium, all in group A. Because of the high incidence of esophagitis and its complications following esophagomyotomy for achalasia, yearly endoscopy with biopsy and brush cytology is recommended. When myotomy is performed, an antireflux operation should be added.

Adolescent↗
PubMedDate not supplied

Lye ingestion and carcinoma of the esophagus.

Fifteen cases of carcinoma of the esophagus associated with a history of lye ingestion are presented. They compromised 3% of the total patients treated for esophageal carcinoma in 1964-1986. The mean age of the ten women and five men was 57 years and the average time from corrosion injury to diagnosis of carcinoma was 58 years in the men and 47 years in the women. Most of the patients had accidentally swallowed liquid lye at 2-3 years of age. All 15 tumors were squamous cell carcinoma, and 11 were located at the level of the tracheal bifurcation. Esophageal resection was possible in ten cases. The survival rate in the total series was 40% at 1 year and 13% at 5 years. Because of the high carcinoma risk, patients with corrosion injury to the esophagus should be kept under surveillance that includes regularly repeated esophagoscopy, cytologic study of washings and biopsy at least when the time from the injury exceeds 20 years.

Accidents, Home↗
PubMedDate not supplied

Pancreatic remnant abscess after resection for acute necrotising pancreatitis.

Pancreatic resection for acute necrotising pancreatitis was followed by abscess of the remnant in 14 out of 83 cases. Not even extensive pancreatic resection could prevent pancreatic remnant infection. The 14 cases of abscess are reviewed. Seven were fatal. Enterocutaneous fistula, commonly accompanied by sepsis and major bleeding, was identified in five patients, four of whom died.

Abscess↗
PubMedDate not supplied

Decreased galactose absorption in dumping after colon interposition.

Intestinal absorption was examined using an oral galactose test in colon interposition patients with dumping (no. 4) and without symptoms (no. 5). Normal subjects (no. 5), and patients after total gastrectomy (no. 7) and gastric resection (no. 4) served as controls. Galactose is absorbed in the same way as glucose, but does not stimulate insulin secretion. Colon interposition patients presented abnormally rapid postprandial transit and absorption for 20 minutes after the meal. After this rapid phase, colon interposition patients with dumping demonstrated a strong decrease in absorption rate, whereas the asymptomatic patients presented a normal rate during the whole follow-up period. The elimination of galactose from the blood was studied in eight patients after intravenous infusion of galactose; the disappearance was linear during 10 to 30 min after injection and did not explain the differences in blood galactose levels in the oral galactose test. We suggest a reactive reflux back to the intra-abdominal colon graft loop in the avagotonic intestinal tract as the mechanism for the differences in absorption. The most likely reason for this is the rapid initial phase transit through the coloantral anastomosis and pyloroplasty. To normalize postprandial transit and absorption as much as possible after colon interposition, a short intra-abdominal colon graft loop anastomosed to the posterior proximal stomach is suggested.

Colon↗
PubMedDate not supplied

Ranson signs and necrosis of the pancreas in acute necrotising pancreatitis.

The value of Ranson signs as an indicator of the extent of pancreatic parenchymal necrosis in acute pancreatitis was investigated in 84 patients. Ranson signs could be compared with histologic extent of pancreatic necrosis in 69 cases. The overall mortality rate was 38/84 (45%). The mortality risk increased with the number of positive Ranson signs (correlation coefficient 0.96). The mean total of Ranson signs showed linear increase with extent of parenchymal necrosis up to 75% (from 2.9 signs at no necrosis to 5.4 signs at 75% necrosis, but only 4.7 signs at 76-100%). A similar relationship was found between extent of necrosis and mortality rate. Although the number of positive Ranson signs correlated with the extent of necrosis in resected pancreas (coefficient 0.96), the signs did not adequately predict necrosis in total pancreas. Ranson criteria can be accepted as prognostic signs even when acute necrotizing pancreatitis is treated with resection. The Ranson factors also correlate with necrosis, but do not alone reliably establish its extent in individual cases.

Acute Disease↗