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Biomedical subjects

J Ovaska

Publications and source records attributed to J Ovaska.

At least 37 records · Page 2Linked to original sources
PubMed1995

Laparoscopic Nissen fundoplication. Initial experience.

Fifty-two patients underwent laparoscopic Nissen fundoplication. Oesophagogastroscopy, ambulatory 24-hour pH-recording and oesophageal manometry were evaluated both preoperatively and at follow-up. Forty-seven operations were completed laparoscopically, five were converted to laparotomy. There was no mortality, but minor postoperative complications occurred in four patients. The mean hospital stay after a laparoscopic operation was three days and sick leave 14 days. After three months, 94% of the patients were free of reflux symptoms, oesophagogastroscopy showed normal findings in 95% of the patients and oesophageal 24-hour pH-values were normal in 95% of the patients. Dysphagia (28%) and gas bloating (17%) were the most frequent postoperative complaints. A total of 94% of the subjects were satisfied with the result. Our initial experience of laparoscopic Nissen fundoplication shows that the operation is safe and efficient in the treatment of gastro-oesophageal reflux disease.

Adult↗
PubMed1994

Association between medically induced achlorhydria of the stomach and a severe postoperative infection? A report of two cases.

Two cases are reported, where severe postoperative septic infection developed after gastric resection without surgical technical complication. Both patients had had long preoperative therapy with omeprazole and no perioperative antibiotic prophylaxis was given in either of the cases. The other of the cases was fatal. The need for an effective perioperative prophylaxis in gastric surgery together with drugs creating gastric achlorhydria is discussed.

Achlorhydria↗
PubMed1994

Barrett's esophagus after cardiomyotomy for esophageal achalasia.

Heller's myotomy for esophageal achalasia was performed on 64 patients in the 24 yr up to 1988. After follow-up averaging 13 yr, 46 patients were reexamined with endoscopy, biopsy, and manometry. Barrett's metaplasia of the distal esophagus was found in four patients 6, 13, 20, and 23 yr after the myotomy. These four also underwent ambulatory 24-h pH monitoring. They had the lowest distal esophageal sphincter pressures (1-5 mm Hg), and all four had symptoms of gastroesophageal reflux and pathologic pH values (< 4 in the distal esophagus for 32-62% of the total recording time). Because of heightened risk for the development of Barrett's metaplasia following cardiomyotomy for esophageal achalasia, with increased liability to carcinoma of the esophagus, regular endoscopic surveillance of these patients is advisable.

Adolescent↗
PubMed1993

What happens to the Valtrac anastomosis of the colon? A follow-up study.

Late results after colonic anastomoses performed with the biofragmentable anastomosis ring (BAR; Valtrac; Davis & Geck, Wayne, NJ) were evaluated in 30 patients who had undergone a left-sided colonic or rectosigmoid anastomosis a mean of 24.5 (range, 12-38) months earlier. Patients were asked about their late postoperative recovery and their bowel habits. A barium enema was performed, and then a flexible endoscopy was done, during which the anastomotic area was evaluated both in macroscopic terms and histologically. One of the patients had died, and three refused to participate in the investigation. Of the remaining 26 patients, one had been reoperated on 22 months after the primary sigmoid resection. The reason for reoperation was an anastomotic stricture. One of the patients was admitted to the hospital during the study and was operated on for reasons not related to the anastomosis. Twenty-four patients underwent the study scheme. All had recovered uneventfully. Sixteen anastomoses could not be identified radiologically and seven not even during endoscopy. Histologically, there was mild-to-moderate fibrosis and scarring in 17 anastomoses, and, in the seven that could not be identified, only normal colonic mucosa was found. The late results of BAR anastomoses are satisfying, and the rate of complications is acceptable.

Adult↗
PubMed1992

Colonic anastomosis using the biofragmentable anastomotic ring and manual suture: a prospective, randomized study.

One hundred and fifty consecutive patients undergoing colonic surgery were randomized into two groups: 71 underwent hand-suture with a two-layer anastomosis of resorbable suture material (3/0 Dexon) and 79 were fitted with the biofragmentable anastomotic ring (Valtrac-BAR). Five patients, two treated using the BAR and three by suturing, developed anastomotic leakage which required a Hartmann-type reoperation. This was successful in four; one patient in the suture group died after reoperation. One patient who underwent suture had an early anastomotic stricture with fatal sequelae. Three other patients (one in the BAR group and two in the suture group) died after operation from other causes. Thus the mortality rate was 6 per cent in the suture group and 1 per cent in the BAR group. During follow-up, one patient in each group underwent reoperation for anastomotic stricture. Recovery of the gastrointestinal tract was similar in the two groups regarding duration of nasogastric drainage, intravenous fluid therapy and ileus. There was no difference between the groups in duration of hospital stay. The BAR seems to be a safe and reliable alternative to conventional suture anastomosis in colonic surgery.

Aged↗
PubMed1992

When is routine operative cholangiography necessary? An evaluation of 200 consecutive patients operated on for gallbladder stones.

Operative cholangiography (OC) was performed during open standard cholecystectomy in 195 of 200 consecutive patients. The cholangiography was considered suspicious for choledochal stones in 28 patients (14%). Both choledochotomy and choledochoscopy were carried out. Stones in the biliary tree were found in 17 patients and in 11 cases choledochotomy was negative. Cholecystectomy was performed on an emergency basis in 46 patients, 15 of them underwent choledochotomy and in 11 (24%) bile duct stones were found. In 154 electively operated patients six (4%) had choledochal stones. Based on preoperative history choledochal stones were suspected in 30 electively operated patients but only eight had stones in the biliary tree at the time of operation. The percentage of false positive cholangiograms was 6% in the whole material, and unsuspected choledochal stones were diagnosed in 5% respectively. It is recommended that operative cholangiography should be performed routinely in patients subjected to emergency cholecystectomy. In elective operations selective use is acceptable.

Adolescent↗
PubMed1992

Laparoscopic cholecystectomy. Experience of the first 150 patients.

Between April 1991 and May 1992, 150 patients were treated by laparoscopic cholecystectomy. Eleven patients (7.3%) required conversion to open laparotomy and five (3.3%) patients were operated on for postoperative complications. There were two (1.3%) patients with a hepatic duct lesion, one of which was treated with a T-tube alone but the other required a bilioenteral reconstruction. The average operation time was 72 minutes (range 30-240 minutes). The mean hospital stay of all patients was 2.1 days (range 1-28 days) and the mean time to return to work was 11.5 days (range 6-60 days).

Adolescent↗
PubMed1992

Cholecystoenteral anastomosis with the biofragmentable ring and manual suture--a prospective, randomized study.

20 patients treated by cholecystojejunostomy for obstructive icterus were randomized to be treated either with a biofragmentable intraluminal ring (Valtrac) (10 patients) or suture of the cholecystointestinal anastomosis (10 patients). Postoperatively one patient in each group died of advanced malignancy. There were no surgical complications in either group. The relief of icterus, recovery of the gastrointestinal tract and the mean hospital stay were similar in both groups. The biofragmentable anastomosis ring (BAR) is a safe method for cholecystoenteral anastomoses.

Adult↗
PubMed1991

Comparison of endoscopic Nd:YAG laser therapy and oesophageal tube in palliation of oesophagogastric malignancy.

The clinical results of 96 patients with upper gastrointestinal malignancy have been evaluated retrospectively. Sixty-nine patients with a mean age of 72 years (35 men and 34 women) were treated with endoscopic laser therapy, and 27 patients with a mean age of 67 years (16 men and 11 women) with insertion of an oesophageal tube. After laser therapy the bulk of the tumour was reduced in 87%, and in 55% clear signs of relieved dysphagia were seen. The insertion of an oesophageal tube was successful in 89%. In the laser group no fatal complications occurred, and the overall complication risk was 8.7%. The 1-year survival in all laser patients was 12%, and in patients with impassable tumour stenosis the survival was 6%. The mortality related to the insertion of an oesophageal tube was 11%, and complications occurred in 48% of the patients. The 1-year survival of the tube group was nil. It is concluded that endoscopic laser therapy and insertion of oesophageal tube are both effective methods in palliation of oesophagogastric malignancy, but the mortality and risk for complications were markedly lower after laser therapy.

Adenocarcinoma↗
PubMed1990

Laser-induced hyperthermia in the treatment of liver tumors.

Seven patients with malignant liver tumors were treated with Nd:YAG laser induced hyperthermia. The laserthermia was performed during laparotomy using Nd:YAG laser with contact sapphire probes with power settings of 6 W. The contact tip was placed into the middle of the tumor and the temperature in 1.5-2.0 cm from the middle of the tumor was raised and held between 41C and 45C for ten minutes. One fatal complication appeared caused by an air embolism. In the postoperative fine needle biopsies on third and fifth postoperative day the sytologic finding in the tumor was necrosis. However, in 30% of the samples there was also a suspicion of cancer cells. In the computer tomography four weeks after the treatment there were also signs of necrosis. It seems that selective destruction of malignant liver tumors is possible with contact Nd:YAG laser induced hyperthermia.

Adult↗
PubMed1990

Follow-up of patients operated on for colorectal carcinoma.

In order to evaluate the effectiveness of follow-up in detecting potentially curable recurrences after radical surgery for colorectal cancer, we compared the results in 368 patients undergoing regular follow-up with those in 139 patients outside the follow-up program. The cancer-related 5-year survival rate was 72% in the follow-up group and 62% in the non-follow-up group (difference not significant). Cancer recurrences were more common in the follow-up group than in the group that was not followed (32% versus 21%; p less than 0.02). Curative reoperations were performed in 21% and 7%, respectively (p less than 0.01) of patients with recurrent cancer in these two groups. The cancer-related 5-year survival rate after curative reoperations was 47%. Despite these differences, only the initial Dukes' classification had an independent influence on the survival rate. It is concluded that regular follow-up detects more recurrent cancers, enabling radical reoperations significantly more often than when there is no follow-up. The outcome after curative reoperations is encouraging. These aspects favor regular follow-up of patients with colorectal carcinoma after curative operations.

Adult↗
PubMed1990

Distribution of Chlorophyll-Protein Complexes during Chilling in the Light Compared with Heat-Induced Modifications.

The effects of chilling in the light (4 days at 5 degrees C and 100-200 micromoles of photons per square meter per second) on the distribution of chlorophyll (Chl) protein complexes between appressed and nonappressed thylakoid regions of pumpkin (Cucurbita pepo L.) chloroplasts were studied and compared with the changes occurring during in vitro heat treatment (5 minutes at 40 degrees C) of isolated thylakoids. Both treatments induced an increase (18 and 65%, respectively) in the relative amount of the antenna Chl a protein complexes (CP47 + CP43) of photosystem II (PSII) in stroma lamellae vesicles. Freeze-fracture replicas of light-chilled material revealed an increase in the particle density on the exoplasmic fracture face of unstacked membrane regions. These two treatments differed markedly, however, in respect to comigration of the light-harvesting Chl a/b protein complex (LHCII) of PSII. The LHCII/PSII ratio in stroma lamellae vesicles remained fairly constant during chilling in the light, whereas it dropped during the heat treatment. Moreover, it was a minor light-harvesting Chl a/b protein complex of PSII, CP29, that increased most in stroma lamellae vesicles during light-chilling. Changes in the organization of LHCII during chilling were suggested by a shift to particles of smaller sizes on the protoplasmic fracture face of stacked membrane regions and a decrease in the amount of trans-Delta(3)-hexadecenoic acid in the phosphatidyldiacylglycerol fraction.

Journal Article↗
PubMed1990

Roux-en-Y reconstruction for severe postoperative duodenogastric reflux disease.

Thirty-two patients underwent Roux-en-Y diversion because of symptomatic postoperative duodenogastric reflux. Operative mortality was nil, but eight patients had transiently delayed gastric emptying postoperatively. At follow-up 45 months (range 9-89 months) after the Roux-en-Y operation 28 (88%) patients were in good clinical state; four patients were classified as poor. The main cause for a poor clinical outcome was a stomal ulcer in three patients. Atrophic gastritis was seen in the operative specimens of 22 patients. Severity of gastritis evaluated by gastroscopic biopsies at follow-up was less marked in 16 patients as compared to the histology of the samples from the original operation (P less than 0.001). Intestinal metaplasia had regressed in nine cases and proceeded in three cases (NS). Severe postoperative duodenogastric reflux can be treated by the Roux-en-Y reconstruction with good subjective relief of symptoms and beneficial histologic changes in the gastric stump mucosa.

Adult↗
PubMed1989

Adenocarcinoma arising in Barrett's esophagus.

The main goal of this study was to evaluate the development of adenocarcinoma in patients with Barrett's esophagus. During the period from January 1975 to December 1985, a total of 134 patients had endoscopically severe esophagitis and/or Barrett's esophagus. In these patients, 32 (24%) met the macroscopic and histologic criteria for the diagnosis of Barrett's esophagus. A check-up study of these patients was performed in 1987. Adenocarcinoma developed in three patients during the follow-up period of 166.1 patient-years. Dysplasia in the columnar epithelium was found in two of these patients six and 15 months before the diagnosis of adenocarcinoma. The third patient with adenocarcinoma was detected in endoscopic follow-up in 1987. In addition, the endoscopic examination showed unchanged Barrett's epithelium in all but three patients despite the operative and/or medical treatment 3-12 years (mean 6.7 years) earlier. We conclude that Barrett's esophagus is a potential premalignant condition and careful endoscopic surveillance for dysplasia in the columnar epithelium of the distal esophagus is mandatory in patients with Barrett's esophagus.

Adenocarcinoma↗
PubMed1989

Surgical treatment of gastric carcinoma.

To investigate changes in the results of treatment of gastric carcinoma, two 10-year periods between 1963 and 1982 with 641 and 630 patients, respectively, were compared. In the two groups, 94 percent and 92 percent of patients were operated on. The operation was considered curative in 200 and 265 patients in Groups 1 and 2, respectively. There was a shift towards more radical operations, with 215 total or subtotal gastrectomies in Group 2 compared with 76 in Group 1, when distal gastric resection was considered radical enough. Despite the increasing number of curative operations and more radical surgery in Group 2, no progress in the 5-year survival rate was noted. Distal and subtotal gastrectomies gave slightly better results than total gastrectomies, but the most important single factor contributing to the long-term survival was cancerous invasion of the serosa. It is concluded that in the past 20 years, the results of surgical treatment of gastric carcinoma have not improved, despite the more advanced diagnostic methods and more radical surgery.

Aged↗
PubMed1989

The Nature of Light-Induced Inhibition of Photosystem II in Pumpkin (Cucurbita pepo L.) Leaves Depends on Temperature.

Attached leaves of pumpkin (Cucurbita pepo L.) were treated in high or moderate light at room temperature or a 1 degrees C. The symptoms of photoinhibition appearing during light treatments at room temperature could be attributed to a decrease in the primary activity of PSII. However, when the light treatment was given at 1 degrees C, the quantum yield of photosynthetic oxygen evolution decreased much more than would be expected from the decrease in the ratio of variable to maximum fluorescence at 77 degrees K. Also, light treatment at 1 degrees C lowered the chloroplast wholechain electron transfer capacity much more than it affected PSII electron transport (H(2)O to paraphenylbenzoquinone). Light treatments at both room temperature and 1 degrees C led to an increase in B(max), which indicates an increase in the proportion of PSII(beta) centers. PSI was not affected by the light treatments, and the treatments in the dark at 1 degrees C caused only minor changes in the measured properties of the leaves. We conclude that high light always inhibits the primary activity of PSII, but at low temperature there is greater inhibition of electron transfer from primary electron accepting plastoquinone of PSII to the plastoquinone pool, which leads to a drastic decrease in the quantum yield of oxygen evolution in the chilling-sensitive pumpkin.

Journal Article↗
PubMed1989

Endoscopic Nd:YAG laser therapy in upper gastrointestinal bleeding.

Between 1983 and 1986 thirty-seven patients with upper gastrointestinal bleeding or stigmata of acute bleeding were treated at the Second Department of Surgery with endoscopic laser therapy. The non-contact method was used. The cause of bleeding was gastric ulcer in 13 cases and duodenal ulcer in 5. Two patients had anastomotic ulcer, 6 had a simple ulcer, 7 had telangiectases (Mb. Osler), 2 had Mallory Weiss tears and 2 bled after gastric biopsy. Twenty-one patients bled during endoscopy and 16 had signs of recent bleeding. During acute bleeding laser treatment was effective in 95% (1, 3). However, 41% of all patients (15/37) rebled within a week after laser therapy and in 30% (11/37) an emergency operation was necessary. The overall mortality rate was 10.8% (4/37). Endoscopic laser coagulation is successful in the initial treatment of acute upper GI-bleeding. However, there is a considerable risk of rebleeding. Acute laser therapy may change an emergency operation into an elective one, provided that the group at risk of rebleeding can be anticipated at first endoscopy.

Duodenal Ulcer↗