Biomedical subjects
Jukka Perälä
Publications and source records attributed to Jukka Perälä.
Intra-arterial chemotherapy with mitomycin C in gallbladder cancer: a follow-up study.
BACKGROUND AND OBJECTIVES: There is only limited and somewhat controversial information available on hepatic artery infusion of cytotoxic agents in gallbladder cancer. We report the results of 5-year follow-up of all gallbladder cancer patients treated with surgery and intra-arterial mitomycin C or mitomycin C alone in our hospital during 15 years. METHODS: Thirty-five patients with gallbladder cancer were treated with superselective intra-arterial chemotherapy (SIAC) with mitomycin C during 1981-1996. Survival was measured from diagnosis, and all patients were followed up until death or the end of January 2002. Cumulative survival rates and median survival times were calculated for all patients, according to response to treatment and staging. The data are presented as 5-year survival. RESULTS: Median survival times after SIAC for all patients, responders, and non-responders were 48, 60+, and 8.5 months, respectively. Overall response rate was 60%. Survival was significantly better for tumors limited to the gallbladder wall, as expected. Drug toxicity occurred in half of the patients, requiring cessation of chemotherapy in 25% of the cases. CONCLUSIONS: The median survival of gallbladder cancer patients treated with surgery and SIAC seems to be significantly better compared to the previously reported outcome of surgical treatment alone. Drug toxicity limits the use of i.a. chemotherapy and requires careful monitoring for early side-effects.
Radiofrequency endovenous obliteration versus stripping of the long saphenous vein in the management of primary varicose veins: 3-year outcome of a randomized study.
We evaluated the 3-year outcome of a series of patients with primary varicose veins who were randomized to radiofrequency endovenous obliteration vs. stripping of the long saphenous vein (LSV). Twenty-eight patients were included in the study: 15 were randomized to the radiofrequency endovenous obliteration procedure and 13 to LSV stripping. At 3-year follow-up, five patients (33.3%) of the endovenous group had recurrent or residual varices and in three of them a reflux in the thigh veins was detected. None of the primarily occluded LSV segments was recanalized. In the stripping group, three patients (23.1%, p = 0.68) showed varicosities at clinical and duplex examinations. In one patient, a patent duplicate LSV trunk was detected. In the remaining two patients, no reflux in the thigh region was detected. According to the present results, radiofrequency endovenous obliteration of the LSV is associated with somewhat poorer short-term results compared with the stripping operation.
Interventional and intraoperative MRI at low field scanner--a review.
Magnetic resonance imaging (MRI) is a cutting edge imaging modality in detecting diseases and pathologic tissue. The superior soft tissue contrast in MRI allows better definition of the pathology. MRI is increasingly used for guiding, monitoring and controlling percutaneous procedures and surgery. The rapid development of interventional techniques in radiology has led to integration of imaging with computers, new therapy devices and operating room like conditions. This has projected as faster and more accurate imaging and hence more demanding procedures have been applied to the repertoire of the interventional radiologist. In combining features of various other imaging modalities and adding some more into them, interventional MRI (IMRI) has potential to take further the interventional radiology techniques, minimally invasive therapies and surgery. The term "Interventional MRI" consists in short all those procedures, which are performed under MRI guidance. These procedures can be either percutaneous or open surgical of nature. One of the limiting factors in implementing MRI as guidance modality for interventional procedures has been the fact, that most widely used magnet design, a cylindrical magnet, is not ideal for guiding procedures as it does not allow direct access to the patient. Open, low field scanners usually operating around 0.2 T, offer this feature. Clumsy hardware, bad patient access, slow image update frequency and strong magnetic fields have been other limiting factors for interventional MRI. However, the advantages of MRI as an imaging modality have been so obvious that considerable development has taken place in the 20-year history of MRI. The image quality has become better, ever faster software, new innovative sequences, better MRI hardware and increased computing power have accelerated imaging speed and image quality to a totally new level. Perhaps the most important feature in the recent development has been the introduction of open configuration low field MRI devices in the early 1990s; this enabled direct patient access and utilization of the MRI as an interventional device. This article reviews the current status of interventional and intraoperative MRI with special emphasis in low field surrounding.
Arterial embolization and prophylactic catheterization for the treatment for severe obstetric hemorrhage*.
BACKGROUND: To evaluate indications, efficacy, and complications associated with arterial embolization and prophylactic balloon catheterization in the management of obstetric hemorrhage at a university hospital. METHODS: Twenty-two women underwent arterial embolization between February 2001 and November 2003 for the treatment for primary postpartum hemorrhage resulting from abnormal placentation (n=11), uterine atony (n=7), paravaginal laceration (n=3), and disseminated intravascular coagulopathy (n=1). Blood loss was between 3.2 and 15 l. In seven patients, abnormal placentation was diagnosed prenatally and in these patients balloon catheterization was performed prophylactically before elective cesarean section. RESULTS: Of the seven patients, who underwent prophylactic catheterization, embolization was successful in five resulting in adequate hemostasis. Hysterectomy was performed in three, in two patients for uncontrolled hemorrhage and in one patient for placental invasion to bladder. There were no complications associated with prophylactic catheterization and embolization. The other 15 patients were treated in an emergency setting. In eight patients, embolization was performed as a primary surgery, and it was successful in six. In the other seven patients, hysterectomy was performed as an emergency surgery, but bleeding continued. Of these, in six patients, hemostasis was achieved with embolization. Complications associated with emergency embolization were observed in three patients. These were thrombosis of left popliteal artery, vaginal necrosis, and paresthesia of the right leg. CONCLUSIONS: Arterial embolization is of significant value in treating obstetric hemorrhage. Prophylactic insertion of balloon catheters before cesarean section seems to be a safe and effective method in controlling anticipated bleeding. In patients with persistent bleeding following cesarean section and hysterectomy, embolization could be a primary procedure before re-surgery.
[Catheter ablation of massive pulmonary embolism and local enzymatic thrombolysis].
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Accuracy of computer-aided measurements in endovascular stent-graft planning: an experimental study with two phantoms.
RATIONALE AND OBJECTIVES: The aim of this study was to evaluate the accuracy of the new measurement software, created for aortic stent-graft planning. The software finds semiautomatically the centerline of the vessel from computer tomographic angiography data and calculates semiautomatically diameters and lengths. MATERIALS AND METHODS: Two phantoms were constructed, scanned by CT and measured with the measurement software. Results were compared with the known dimensions of the phantoms and mean fractional errors were calculated. Linear regression analysis was also made between measured and known diameters. RESULTS: The mean fractional error (+/- SD) for all diameter measurements combined was 0.017 +/- 0.011. In the linear regression analysis, was 1.000. For length measurements, the mean fractional error (+/- SD) was 0.009 +/- 0.0006. CONCLUSIONS: The software enables accurate measurements perpendicular or parallel to the semiautomatically created centerline path.
Endovenous obliteration versus conventional stripping operation in the treatment of primary varicose veins: a randomized controlled trial with comparison of the costs.
OBJECTIVE: The aim of this randomized study was to compare a new method of endovenous saphenous vein obliteration (Closure System, VNUS Medical Technologies, Inc, Sunnyvale, Calif) with the conventional stripping operation in terms of short-term recovery and costs. METHODS: Twenty-eight selected patients for operative treatment of primary greater saphenous vein tributary varicose veins were randomly assigned to endovenous obliteration (n = 15) or stripping operation (n = 13). Postoperative pain was daily assessed during the 1st week and on the 14th postoperative day. The length of sick leave was determined. The RAND-36 health survey was used to assess the patient health-related quality of life. The patient conditions were controlled 7 to 8 weeks after surgery, and patients underwent examination with duplex ultrasonography. The comparison of costs included both direct medical costs and costs resulting from lost of productivity of the patients. Costs that were similar in the study groups were not considered in the analysis. RESULTS: All operations were successful, and the complication rates were similar in the two groups. Postoperative average pain was significantly less severe in the endovenous obliteration group as compared with the stripping group (at rest: 0.7, standard deviation [SD] 0.5, versus 1.7, SD 1.3, P =.017; on standing: 1.3, SD 0.7, versus 2.6, SD 1.9, P =.026; on walking: 1.8, SD 0.8, versus 3.0, SD 1.8, P =.036; with t test). The sick leaves were significantly shorter in the endovenous obliteration group (6.5 days, SD 3.3 days, versus 15.6 days, SD 6.0 days; 95% CI, 5.4 to 12.9; P <.001, with t test). Physical function was also restored faster in the endovenous obliteration group. The estimated annual investment costs of the closure operation were US $3360. The other direct medical costs of the Closure operation were about $850, and those of the conventional treatment were $360. With inclusion of the value of the lost working days, the Closure treatment was cost-saving for society, and when 40% of the patients are retired (or 60% of the productivity loss was included), the Closure procedure became cost-saving at a level of 43 operations per year. CONCLUSION: Endovenous obliteration may offer advantages over the conventional stripping operation in terms of reduced postoperative pain, shorter sick leaves, and faster return to normal activities, and it appears to be cost-saving for society, especially among employed patients. Because the procedure is also associated with shorter convalescence, this new method may potentially replace conventional varicose vein surgery.