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J Santavirta

Publications and source records attributed to J Santavirta.

9 recordsLinked to original sources
PubMed2004

Glove perforations in open and laparoscopic abdominal surgery: the feasibility of double gloving.

BACKGROUND AND AIMS: According to the traditional view, the glove protects the patient from the bacterial growth of the surgeons' hands and doing so prevents infections. Today, with growing incidences of HIV and Hepatitis B and C, surgical gloves are also important as protection for the surgeon. We compared the safety of double indicator gloves to standard single surgical gloves by investigating how often surgical gloves are punctured in laparoscopic and open gastrointestinal surgery. STUDY: As study material we gathered all gloves that had been used in gastrointestinal surgery in Satakunta Central Hospital during two months. 814 gloves from 274 operations were tested by using standardized water filling test method. RESULTS: In open surgery 67 gloves out of 694 had been punctured (9.6 percent). Puncture occurred in 22.5 percent of operations (53 out of 236). During open surgery 24 holes out of 35 were undetected with single gloves (69 percent). With double indicator gloves, only 3 out of 31 holes were unnoticed (10 percent). Long duration of operation increased the risk of puncture. In laparoscopic operations 4 gloves out of 120 had been perforated (3.3 percent). CONCLUSION: Double surgical gloves give markedly better protection in surgery. This is important especially in high risk operations.

Chi-Square Distribution↗
PubMed2002

Screening sigmoidoscopy in persons aged 60 years.

OBJECTIVE: To reduce mortality associated with colorectal cancer, an increased interest has focused in recent years on screening of colorectal cancer. No studies of colorectal cancer screening in Finland has been reported. A pilot study of screening sigmoidoscopy was started in 1994 and the results are presented in this paper.SUBJECTS AND METHODS: Between March 1994 and May 2000 all 1224 persons aged 60 years from four communities (population 15 400) were invited to screening sigmoidoscopy; 896 (73%) took part in this study. The screening procedure was flexible sigmoidoscopy to 60 centimetres. All the patients who had adenomas or cancers, were invited to have a double contrast barium enema (DCBE) or colonoscopy to investigate the proximal colon. To study the experience of persons undergoing screening sigmoidoscopy, a questionnaire was sent to 81 consecutive persons after the examination. Sixty persons (74%) returned the filled-in questionnaire.RESULTS: Hyperplastic polyps were found in 136 people (15.2% of the whole material). Hyperplastic polyps were more common in males than females (19.3% and 11.4%, respectively, P=0.0015). People with hyperplastic polyps had the same rate of neoplasia as people without. Neoplastic lesions were found in 65 people. Adenomas were found in 62 patients (6.9%). Twenty-five people (2.8%) had at least one advanced adenoma (>10 mm or villous component). The rate of advanced adenomas in males was 4.9% and in females 0.9% (P=0.0006). Three patients (0.3%) were found to have colorectal cancer. Of 43 diabetic patients, 7 (16.3%) had adenomas whereas 6.5% of the non-diabetic persons had adenomas (P=0.03). The proximal colon was investigated in 34 patients by DCBE and/or colonoscopy and the rate of proximal adenomas in patients with neoplastic findings in screening sigmoidoscopy was 5/34 (14.7%). Concerning the experience of screening sigmoidoscopy, 56 persons (93%) found bowel preparation easy and 4 unpleasant, 55 (92%) experienced either no or mild discomfort during the endoscopy whereas 5 found the examination painful; 59 people (98%) said that they would participate again in screening sigmoidoscopy.CONCLUSIONS: In this study of screening sigmoidosopy, the first published in Finland, adenoma rate was 6.9%, advanced adenoma rate was 2.8% and cancer rate was 0.3%. Males had more hyperplastic polyps and advanced adenomas than females. Diabetic people had more adenomas than non-diabetics. Experiences of the people screened were positive and nearly all said that they would participate again in screening sigmoidoscopy.

Journal Article↗
PubMed1991

Lactulose hydrogen and [14C]xylose breath tests in patients with ileoanal anastomosis.

To study the intestinal bacterial flora and mouth to pouch transit time after ileoanal anastomosis, lactulose hydrogen and [14C]xylose breath tests were performed on 19 patients with ileoanal anastomosis and J-pouch and 8 patients with conventional ileostomy. Evaluated by the [14C]xylose breath test, patients with ileoanal anastomosis and ileal pouch showed no difference in the bacterial flora of the proximal small bowel when compared with ileostomy patients. The lactulose hydrogen breath test showed a significant rise in breath hydrogen, indicating bacterial overgrowth, in 68% of patients with ileoanal anastomosis but in none with conventional ileostomy (p less than 0.01). It was concluded that this peak in breath hydrogen was produced by the bacteria in the pouch. Thus the lactulose hydrogen breath test can be used to measure mouth to pouch transit time in 2/3 of patients with ileoanal anastomosis. Mouth to pouch transit time was 63 +/- 9 min and it correlated inversely with stool frequency (p less than 0.05).

Adult↗
PubMed1991

Mucosal morphology and faecal bacteriology after ileoanal anastomosis.

Mucosal morphology and faecal bacteriology were studied in 30 patients with ileoanal anastomosis and J-pouch and 10 patients with conventional ileostomy. Patients with ileoanal anastomosis had more acute and chronic inflammatory changes on histological examination than patients with conventional ileostomy. Patients with ileoanal anastomosis had a greater number of anaerobes and total bacteria and a greater ratio of anaerobes to aerobes in faecal samples than patients with conventional ileostomy. Patients with a history of clinical pouchitis had more acute inflammation than those without. In patients with ileoanal anastomosis there was a significant correlation between acute inflammation and number of aerobes and between chronic inflammation and number of anaerobes and total bacterial counts. These observations suggest that bacterial overgrowth in the pouch may be a possible pathogenic factor in inflammatory changes in the mucosa.

Adult↗
PubMed1991

Water and electrolyte balance after ileoanal anastomosis.

Water and electrolyte balance was studied in 30 patients with ileoanal anastomosis and J pouch, 10 patients with conventional ileostomy, and nine nonoperated patients with quiescent ulcerative colitis. Serum electrolyte concentrations, daily urinary volume, and daily losses of sodium, potassium, and chloride were measured in all patients. Daily fecal weight and daily losses of sodium and potassium were analyzed in patients with ileoanal anastomosis or conventional ileostomy. Serum chloride in patients with ileoanal anastomosis was significantly lower (P less than 0.05) than in those with conventional ileostomy or in nonoperated patients. Daily urinary loss of sodium in nonoperated patients was significantly higher than in patients with ileoanal anastomosis (P less than 0.01) or conventional ileostomy (P less than 0.05). Daily urinary loss of chloride in patients with ileoanal anastomosis was significantly lower (P less than 0.05) than in nonoperated patients. Daily fecal loss of potassium in patients with ileoanal anastomosis was significantly higher (P less than 0.05) than in those with conventional ileostomy. Daily urinary volume and fecal weight did not differ significantly in patients with ileoanal anastomosis or conventional ileostomy. The present study indicates that changes in water and sodium balance after ileoanal anastomosis are similar to those after conventional ileostomy but chloride balance is more altered after ileoanal anastomosis.

Adult↗
PubMed1990

Ileoanal anastomosis without covering ileostomy.

Ileoanal anastomosis is usually performed with covering ileostomy. This is primarily done because of fear of pelvic sepsis. Temporary ileostomy may, however, be a source of significant complications. The first 21 patients in the authors clinic were operated upon using covering loop ileostomy in ileoanal operations. These patients had no anastomotic or pouch complications, but there were complications, especially with the closure of the ileostomy. Therefore, a trial of one-stage operations in ileoanal anastomosis was started. Ileoanal anastomosis without ileostomy was performed on 25 consecutive patients. All the patients were operated upon for ulcerative colitis. There was one patient with pelvic abscess who needed diverting ileostomy. Thus, the early failure rate in patients operated upon without ileostomy was 4 percent. There were many other complications among these patients, but no other relaparotomy was needed. The complication rate was not different in patients operated upon without ileostomy compared with the authors first 21 patients operated upon with ileostomy (60 and 52 percent, respectively). Patients with one-stage operation needed a significantly shorter mean hospital stay than patients with two-stage operation (13.6 days and 25.3 days, respectively; P less than 0.001). The use of corticosteroids appears not to be a contraindication for one-stage operation, because there were significantly more patients using corticosteroids in the one-stage group compared with the two-stage group (92 and 62 percent, respectively; P less than 0.05).

Adult↗
PubMed1990

Absorption of bile acids after ileoanal anastomosis.

Absorption of bile acids was investigated using 75Se-homotaurocholate (SeHCAT) in 27 patients with ileoanal anastomosis and J-pouch, 7 patients with conventional ileostomy and 9 non-operated patients with ulcerative colitis. Retention of SeHCAT at seven days was higher in non-operated patients than in patients with ileoanal anastomosis (P less than 0.001) or conventional ileostomy (P less 0.01). There was no difference in retention of SeHCAT between patients with ileoanal anastomosis or conventional ileostomy. Malabsorption of bile acids was not associated with changes in blood chemistry or faecal fat excretion. Patients with ileoanal anastomosis and low retention of SeHCAT had more severe villous atrophy of the pouch mucosa than those with high retention (P less than 0.05). In conclusion, both patients with ileoanal anastomosis and conventional ileostomy have impaired absorption of bile acids when compared with non-operated patients with ulcerative colitis. In patients with ileoanal anastomosis, impairment of bile acid absorption is related to villous atrophy of the pouch mucosa.

Adult↗