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Biomedical subjects

J Pukander

Publications and source records attributed to J Pukander.

At least 37 records · Page 2Linked to original sources
PubMed1997

Microvascular free flaps in head and neck cancer surgery in Finland 1986-1995.

Microvascular free tissue transfer has in many cases replaced classic flap techniques and is now an established workhorse for head and neck reconstructions. In this retrospective study the over 300 patients, who had microvascular free flap reconstructions in head and neck cancer surgery in Finland during a 10-year period (1986-1995) were reviewed. The operations were performed in the University Hospitals by plastic surgeons, ENT specialists or maxillofacial surgeons. The cases consisted of defects resulting from resection of oral cavity tumors (63%), mid- or upper-face and skullbase tumors (20%) and hypopharyngo-esophageal tumors (17%). The series includes a wide range of flap types and analyses flap outcome and complications. A total of 313 cases was reconstructed by 317 flaps (forearm flaps 47%, latissimus dorsi flaps 19%, free jejunum or colon transfers 15%, free iliaca crest flaps 8% and other flaps 11%). Thrombosis of one of the vessels and haematoma were the most frequent causes of failure in microvascular free tissue transfer. A total flap necrosis occurred in 27 (8.5%) and a partial necrosis in 12 (4%) patients. The most reliable flap in terms of survival was the radial forearm flap. The ever-improving success of microvascular free tissue transfer has made it a useful procedure for head and neck reconstructions. There is also a growing need for microvascular team surgery in the field of head and neck cancer therapy.

Female↗
PubMed1996

Penetration of azithromycin into middle ear effusions in acute and secretory otitis media in children.

In an open-label study, the concentrations of azithromycin in middle ear effusions and plasma were determined in 29 children between 1 and 8 years of age with a diagnosis of either secretory otitis media of at least 1 month's duration or acute otitis media. Azithromycin (10 mg/kg) was administered as a single dose 12, 24 or 48 h before the insertion of tympanostomy tubes to 17 children with secretory otitis media and once daily for 5 days (10 mg/kg on day 1, 5 mg/kg on days 2-5) to 12 children with acute otitis media. In the 16 evaluable patients with secretory otitis media, azithromycin penetrated middle ear effusions, with group mean concentrations approximately two orders of magnitude greater than the concurrent plasma concentrations 12, 24 and 48 h after administration. Similar plasma:effusion ratios were found 24 and 48 h after starting once-daily therapy in 10 evaluable patients with acute otitis media.

Acute Disease↗
PubMed1995

End-tidal oxygen concentration and pulse oximetry for monitoring oxygenation during intratracheal jet ventilation.

OBJECTIVE: In this study, we evaluated the usefulness of end-tidal oxygen monitoring during intratracheal jet ventilation (ITJV) for endolaryngeal laser surgery. METHODS: A total of 20 consecutive patients of both genders scheduled for endolaryngeal procedures under general anesthesia were studied. Inspiratory oxygen concentration and respiratory rate were varied, with patients serving as their own controls. Readings of pulse oximetry, airway oxygen, and carbon dioxide concentrations were recorded, and arterial blood samples for blood gas analysis were taken. RESULTS: At jet cycle rates of 20 cycles/min, end-tidal oxygen (ETO2) concentration indicated alveolar hypoxia 30 to 60 sec before hypoxemia was detected by pulse oximetry. Jet mixing of inspiratory and expiratory gas caused a larger difference between end-tidal and arterial gas concentrations than normally seen with conventional ventilation. Correlations between ETO2 concentrations, oxygen saturations, and arterial oxygen levels depended on respiratory rate and inspiratory oxygen concentration; correlations were stronger at low than at high inspiratory oxygen concentrations and stronger at low than at high respiratory rates. CONCLUSIONS: ETO2 concentration should be maintained well over 21% during ITJV to prevent alveolar and arterial hypoxia. Monitoring of respiratory oxygen concentrations at jet cycle rates of 20 cycles/min and less verifies safe oxygen levels during laser surgery, and confirms adequate alveolar oxygenation.

Adult↗
PubMed1992

Primary mandibular reconstruction after ablative cancer surgery.

Restoring of the oral functions is one of the most complicated procedures in head and neck cancer surgery. For the moment "primary reconstruction" using functionally stabile reconstruction plates in recontouring and stabilizing of the remaining mandibular stumps after tumour extirpation is becoming increasingly popular. The aim of the present study was to evaluate treatment results and complications of primary reconstruction after major tumour surgery.

Adolescent↗
PubMed1992

Pharyngo-oesophageal reconstruction with free jejunal transplants. New design of the upper anastomosis to improve monitoring of viability of transfer.

Since 1987, 13 free microsurgical jejunal transplants for large pharyngo-oesophageal tumors have been done in 12 patients at Tampere University Hospital. The conventional technique was used for the end to end upper anastomosis in seven patients, and our new end to side anastomotic technique in six. Five patients were alive at the time of writing, the mean survival being 22 months (range 1-48). Five patients developed orocutaneous fistulas, three of which healed spontaneously. In the remaining two the fistulas were caused by rapid recurrence of the tumour. There was no significant difference in ability to feed orally or swallow among the patients operated upon by the end to end or the end to side anastomotic technique. Our results show that the free microvascular jejunal transfer is a safe procedure for repair of the hypopharynx. Our new end to side hypopharyngojejunal anastomosis makes it possible to monitor the transplanted bowel reliably by direct vision.

Aged↗
PubMed1991

Azithromycin concentrations in sinus fluid and mucosa after oral administration.

The concentrations of azithromycin in sinus fluid and mucosal tissue were determined in a total of 23 patients with acute or chronic sinusitis. Five patients with acute sinusitis and four with chronic sinusitis were administered a five-day course of oral azithromycin (500 mg on day 1, 250 mg on days 2-5, all as single doses), and the remaining 14 patients, all with chronic sinusitis, received single oral doses of azithromycin (500 mg). With the five-day regimen, the mean levels of azithromycin in sinus fluid were markedly higher in patients with acute sinusitis (1.34 micrograms/ml) than in patients with chronic sinusitis (0.25 micrograms/ml) 24 h after the first dose. The levels of azithromycin in the sinus fluid increased from the first to the last dose in both patient groups; the mean levels of azithromycin 24 h after the last dose were 2.33 micrograms/ml in acute sinusitis patients and 0.38 micrograms/ml in chronic sinusitis patients. In chronic sufferers, the mean levels of azithromycin in the sinus fluid following a single oral dose were 0.25, 0.41, 0.57 and 0.22 micrograms/ml at 24, 48, 72 and 96 h, respectively, after administration. In these patients the mean sinus drug concentrations were much greater in the mucosal tissue (1.23 micrograms/g) than in the sinus fluid (0.41 micrograms/ml) 48 h after administration of the single dose. There were no treatment-related changes in laboratory function tests, and side effects were described as mild to moderate (five patients complained of nausea, abdominal pain or headache).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1991

The comparative efficacy and safety of clarithromycin and amoxycillin in the treatment of outpatients with acute maxillary sinusitis.

The efficacy and safety of clarithromycin and amoxycillin in the treatment of acute maxillary sinusitis were compared in a single-blind, multicentre outpatient study. Fifty patients were randomly assigned to receive either clarithromycin 500 mg 12-hourly or amoxycillin 500 mg 8-hourly orally. Clinical signs and symptoms, sinus culture and blood and urine laboratory profiles were assessed prior to treatment, at four to six days during treatment, and within 48 h of the end of therapy (usually 9-11 days). Patients from whom beta-lactamase producing strains were isolated were excluded from the study. Both antibiotics achieved a clinical success rate of 91% within 48 h post-treatment; radiological resolution or improvement was observed in 91% of patients treated with clarithromycin and 89% of patients who received amoxycillin. Bacteriological cure was achieved in 88% and 91% of evaluable patients for clarithromycin and amoxycillin, respectively. Adverse events were reported for 16% of patients in the clarithromycin group compared to 26% in the amoxycillin group. Gastrointestinal disturbance was the most commonly occurring adverse event in both groups. The results of this study suggest that clarithromycin is as effective and well tolerated as amoxycillin in the treatment of acute maxillary sinusitis.

Acute Disease↗
PubMed1990

Radical surgery for lingual cancer.

The survival rates of 58 patients treated for squamous carcinoma of the tongue between 1972 and 1985 were evaluated. The overall 5-year survival rate was 41.6%; for stage I it was 61.8%; stage II 59.5%; and stage III, 27.7%. No patient survived for more than 2 years when their tumour was stage IV on presentation. A composite pull-through resection with radical neck dissection gave a 5-year survival rate of 50.7%, which was significantly (P less than 0.01) higher than the 13.8% achieved by other treatments, mainly local tumour excision combined with radiation therapy. The same trend in favour of radical surgery was also seen stage by stage. In 45% of the patients regional neck metastases (palpable in 35% and occult in 10%) were present and predicted a poor prognosis. Among T1-T2 cases the 5-year survival of 58.5% in the N0 group was significantly (P less than 0.01) higher than the 15.1% among those with nodal involvement. The location of the primary tumour did not affect the survival rates.

Adult↗
PubMed1990

Hypopharyngeal reconstruction with free microvascular jejunal transfer after total laryngopharyngectomy.

One-stage laryngopharyngeal free microvascular jejunal transfer after total laryngopharyngectomy was performed in 8 patients with advanced laryngopharyngeal cancer. The study showed that this was a relatively safe and time-saving method for hypopharyngeal reconstruction after radical cancer surgery. It improved the quality of life of the patients, allowing normal alimentation, though in some cases only temporarily due to the highly malignant nature of the disease.

Aged↗
PubMed1988

Long-term safety of budesonide nasal aerosol: a 5.5-year follow-up study.

The effects of prolonged treatment with intranasally applied budesonide was studied in twenty-four patients with perennial allergic or non-allergic rhinitis. Patients on continuous treatment were followed up for 5.5 years. At entry and follow-up visits, rhinoscopic findings, nasal symptom scores, blood chemistry, haematology, urine analysis and determination of plasma cortisol levels, before and after stimulation with ACTH (Synacthen, Ciba-Geigy AG, Basel, Switzerland), were registered. Biopsies of the nasal mucosa were taken before entry into the study, after 1 year of treatment, and after varying time intervals ranging from 2.5 to 5.5 years during the treatment. The biopsy specimens were examined blindly by an independent pathologist. The analyses revealed no histopathological changes in the nasal mucosa. All nasal symptom parameters assessed by the patients were significantly reduced from the baseline during the entire follow-up period. No clinically significant changes in the haematological and blood chemistry parameters were observed. Plasma cortisol analyses before and after challenge with ACTH revealed no influence on the hypothalamic pituitary adrenal (HPA) axis. The present study suggests that intranasal budesonide in the dose of 200-400 micrograms/day is also a safe treatment for prolonged treatment of perennial rhinitis.

Adolescent↗
PubMed1987

Double-blind comparison of nedocromil sodium (1% nasal spray) and placebo in rhinitis caused by birch pollen.

A double-blind parallel group study was undertaken during May and June 1985 to compare the effect of nedocromil sodium (1% nasal spray) and placebo, taken twice daily, in relieving the symptoms of rhinitis caused by birch pollen. Two centres were involved. The 54 patients studied had a history of rhinitis in 2 previous birch pollen seasons and positive skin tests to birch pollen. Patients were treated for 4 weeks, but to compare the effects of the 2 treatments the peak pollen periods were used. For dairy card symptoms, results in the 2 centres differed: in Tampere, there were trends in favour of nedocromil sodium with respect to itching (P = 0.04, sneezing (P = 0.06) and total symptoms (P = 0.09); in Oulu no significant differences were seen. Nasal peak expiratory flow rates were slightly better in the nedocromil sodium group. In respect of antihistamine usage, results in the 2 centres were similar and significantly more were used in the placebo group (P less than 0.01). At the end of the trial, both the patients' and the investigators' opinions of treatment effect favoured nedocromil sodium. There were no serious side effects. The results suggest that nedocromil sodium 1% nasal spray, when given twice daily, is effective in the treatment of seasonal allergic rhinitis.

Administration, Intranasal↗
PubMed1986

Long-term safety and efficacy of budesonide nasal aerosol in perennial rhinitis. A 12-month multicentre study.

A long-term safety study of intranasally administered budesonide, a topical glucocorticoid, has been performed. 104 patients with perennial rhinitis, allergic or non-allergic, participated in a multicentre study in seven ENT-clinics utilising an identical protocol. A budesonide dosage of 400 micrograms/day was used as starting dose, but the patients were at liberty to reduce the daily dose to 200 micrograms. The patients were observed at intervals up to 12 months. At the entry and follow-up visits the following parameters were recorded: rhinoscopic findings, nasal symptom scores, blood chemistry, hematology, urinalysis and determination of plasma cortisol levels before and after stimulation with ACTH (Synacthen). Nasal biopsies taken from 50 of the patients at the beginning and completion of the study were examined in a blinded way by an independent pathologist. The analysis revealed no histopathological changes of the nasal mucosa. At rhinoscopy no signs of atrophy or candida were reported. Lividity of the nasal mucosa was significantly reduced during the trial, which was also the case for nasal congestion and secretion. All nasal symptom parameters assessed by the patients were significantly reduced from baseline during the follow-up period. No clinically significant changes in the hematological and blood chemistry parameters were observed. Plasma cortisol analysis before and after challenge with ACTH revealed no influence on the hypothalamic pituitary adrenal axis. No tachyphylaxis was observed; on the contrary, there was a clear tendency for reduction of the daily dose of budesonide necessary to keep the patients symptom-free.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intranasal↗
PubMed1983

Possibilities of preventing otitis media by vaccination.

The prerequisites for preventing a considerable proportion of acute otitis media (AOME) of children are theoretically good--pneumococcal types/groups present in the available 14-valent pneumococcal capsular polysaccharide vaccine are the most common bacteria in AOME, and a good serum antibody response is followed by type-specific protection from infection. However, the four most common types/groups (= 2/3 of all pneumococci in AOME) have very poor immunizing capacity in infants, and therefore the vaccine offers little protection from AOME for children under the age of 2 years. This information should help towards an improved new vaccine for AOME.

Acute Disease↗
PubMed1982

Acute otitis media among rural children in Finland.

The occurrence of acute otitis media (AOM) and factors predisposing to the disease among children were studied in a small rural community in Finland. The annual incidence of AOM was 13.5% among children under 16 years of age and 28.7% under the age of 5. The highest incidences were found during the second and third years of life, with a subsequent decrease in incidences, but with the exception of peaks at the ages of 4 and 7 years. The following factors were found to predispose a child to AOM: atopic diathesis, attending a day-care center, a lack or short duration of breast-feeding, frequent respiratory infections, and housing in the center of a community, especially in an apartment. The smoking habits and otitis history of the parents did not significantly affect the occurrence of AOM in children.

Acute Disease↗
PubMed1982

[Working conditions and complications during laryngomicroscopies under endotracheal ventilation via intubation tubes or injection ventilation].

During a period of 7 years 693 laryngomicroscopies (LAR) were performed on 490 patients. General anaesthesia was given by 21 anaesthesists: 5 applied ventilation only through a conventional intubation tube. Of the remaining 16 anaesthesists, 8 constantly prefered, 4 used occasionally jet ventilation (JET), and 4 applied both methods alternatively. No rationale was found for this choice. Laryngomicroscopies were performed by 14 ENT surgeons. One case of subcutaneous emphysema and two of pneumothorax were obtained with JET, obviously because of inexperience and neglect of precautions. Two epidermoid carcinomas in the left posterior commissure escaped the primary LAR, most probably because of poor vision due to the intubation tube, and were found during subsequent procedures with JET. In spite of the risk of complications (mostly avoidable with care and increasing experience), the main advantage of JET is the better chance of revealing of carcinoma in an earlier phase, when it is more amenable to curative therapy. Therefore, we no longer recommend ventilation through an intubation tube for laryngomicroscopies, but prefer intratracheal jet-ventilation for this purpose.

Anesthesia↗