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Jyrki Mäkelä

Publications and source records attributed to Jyrki Mäkelä.

8 recordsLinked to original sources
PubMed2006

Budding invasive margin and prognosis in colorectal cancer--no direct association with beta-catenin expression.

Cancer cell budding at the invasive margin has been associated with poor prognosis in rectal cancer. beta-Catenin is an adhesion protein involved in the nuclear Wnt/beta-catenin pathway, and mesenchymal transition of colorectal cancer cells. Hence, we investigated the relationship between cancer cell budding at the invasive margin, beta-catenin expression, and 5-year-survival in colorectal cancer. Four hundred and sixty six colorectal cancer specimens were analysed for budding margin, and 108 specimens from the same set for beta-catenin by immunohistochemistry. A budding margin was present in 24.0% of the cases and predicted a poor 5-year-survival (15.4%, P < 0.00001). Nuclear beta-catenin expression increased from the central area towards the invasive margin (P < 0.001), but did not predict budding. Budding margin is an independent factor associated with poor prognosis in colorectal cancer, and could be utilised in diagnostic pathology. Nuclear beta-catenin was often found at the invasive margin, but is unlikely to be the sole cause of budding.

Colorectal Neoplasms↗
PubMed2006

Does gastric banding for morbid obesity reduce or increase gastroesophageal reflux?

BACKGROUND: Conflicting results regarding the influence of laparoscopic adjustable gastric banding (LAGB) on gastroesophageal reflux disease (GERD) have been published. METHODS: A prospective follow-up study was conducted in 31 patients (male/female 5/26, mean age 44 +/- 11 SD years) with 24-hour pH and manometry recordings, symptom assessment, and upper GI endoscopy. RESULTS: Total number of reflux episodes decreased from a mean value of 44.6 +/- 23.7 SD preoperatively to 22.9 +/- 17.1 postoperatively (P=0.0006), after a median follow-up time of 19 months (range 7-32 months). Total reflux time decreased from 9.5% +/- 6.2% to 3.5% +/- 3.7%, P=0.0009, and DeMeester score decreased from 38.5 +/- 24.9 to 18.6 +/- 20.4, P=0.03. Symptomatic patients decreased from 48.4% preoperatively to 16.1% postoperatively (P=0.01), medication for GERD decreased from 35.5% to 12.9% (P=0.05), and the diagnosis of GERD on 24-hour pH recordings decreased from 77.4% to 37.5% (P=0.01). There were no pouch enlargements seen on upper GI endoscopy. Esophageal motility was unchanged, but 36% of the patients had incomplete relaxation of the lower esophageal sphincter following the operation (P<0.0001). Mean BMI decreased from 46.0 +/- 5.46 to 38.4 +/- 6.45 (P<0.0001), excess weight from 60.0 kg +/- 18.58 kg, 44.9% +/- 6.56% to 38.4 kg +/- 20.27 kg, 28.4% +/- 10.97% (P<0.0001). No association between the postoperative diagnosis of GERD and the amount of weight loss could be found. CONCLUSIONS: The correctly placed gastric band is an effective anti-reflux barrier in the short term. Long-term results have to be awaited.

Adult↗
PubMed2005

Inflammation and prognosis in colorectal cancer.

AIM OF THE STUDY: Previous work has indicated that quantification of inflammatory cell reaction is of prognostic value in colorectal cancer. We evaluated the prognostic significance of inflammatory cell reaction patterns in colorectal cancer and developed a grading method which could be used in the routine assessment of tumours. METHODS: The intensity of overall inflammatory cell reaction, numbers of neutrophilic and eosinophilic granulocytes, lymphoid cells and macrophages in both the central region and the invasive margin were estimated in 386 colorectal cancer patients. Prognostic significance was analysed by uni- and multivariate analysis. RESULTS: Our method for classification of inflammatory reaction was reliable. High-grade inflammation at the invasive margin in Dukes' stage A and B cancers (pT1-2N0 and pT3N0, respectively) was associated with better 5-year-survival (87.6%) than low-grade inflammation (47.0%). CONCLUSIONS: Inflammatory cell response at the invasive border is a relevant prognostic indicator and could be easily incorporated into the routine evaluation of histopathological specimens.

Adolescent↗
PubMed2002

Prevalence of perforated sigmoid diverticulitis is increasing.

INTRODUCTION: The population of Finland is aging fast, and dietary fiber consumption has decreased during the past few decades; the prevalence of sigmoid diverticular perforation can therefore be anticipated to increase. This study presents our experience concerning the outcome of 133 patients admitted to a university hospital for diverticular perforation during a 15-year period. METHODS: One hundred thirty-three patients admitted into our hospital for sigmoid diverticular perforation during the 15-year period from 1986 to 2000 were identified using a computer database. Clinical data were reviewed from the database and the patients' records. RESULTS: The annual prevalence of perforated sigmoid diverticulitis is increasing. It was 2.4 per 100,000 in the year 1986 and 3.8 per 100,000 in the year 2000. The resection rate was 90 percent; after resection, 45 primary anastomoses, 75 Hartmann's colostomies, and 1 covering colostomy were performed. The overall complication rate was 32 percent, without any significant difference between the procedures. Of the clinical variables, the Mannheim Peritonitis Index scores (P = 0.0088) and the number of previous hospital treatments (P = 0.035) correlated with postoperative complications. Overall mortality was 9 percent, without any significant difference between the procedures. Of the clinical variables, the Mannheim Peritonitis Index scores correlated with mortality. Of the 12 patients who died, 11 had Mannheim Peritonitis Index scores of 21 or more (P = 0.0001). Forty-five percent of the colostomies have been closed. CONCLUSIONS: The prevalence of perforated sigmoid diverticulitis is increasing in northern Finland. Mannheim Peritonitis Index score can be used in predicting the outcome of patients admitted for perforated sigmoid diverticulitis.

Adult↗
PubMedDate not supplied

Impact of laparoscopic adjustable gastric banding for morbid obesity on disease-specific and health-related quality of life.

BACKGROUND: Health-related quality of life (HRQoL) in Finnish morbidly obese individuals was compared with that of Finnish age norms and prospectively with the HRQoL and the disease-specific quality of life (QoL) at 12 months, and cross-sectionally at 28 months, following laparoscopic adjustable gastric banding, mainly with the Swedish band. METHODS: The Moorehead-Ardelt questionnaire was used for disease-specific QoL assessments in 95 patients preoperatively, in 52 patients prospectively followed-up to 12 months, and cross-sectionally in 52 patients operated at a median of 28 months earlier. A generic 15-dimensional questionnaire was used for HRQoL-measurements in 75 patients preoperatively, and 34 patients have been followed-up to 12 months. HRQoL outcomes were compared cross-sectionally with the 52 patients operated at a median of 28 months earlier. RESULTS: Disease-specific QoL scores were significantly improved on all domains of the Moorehead-Ardelt questionnaire 12 months after surgical treatment, an improvement maintained at a median of 28 months follow-up. Significant improvements in generic HRQoL scores were seen on the dimensions mobility, respiratory function, sleep, the performance of usual acts, vitality and sexuality 12 months after surgery. Significant worsening was seen on the eating dimension. Of these dimensions, mobility and sleeping were not significantly improved at a median of 28 months follow-up, and scores on the eating dimension were not significantly worse compared with values obtained in the preoperative group. HRQoL single index score was significantly improved 12 months after surgery. This improvement did not correlate with the extent of weight loss. CONCLUSION: Disease-specific QoL was significantly improved at 12 months follow-up, an improvement that seems to have been maintained at a median of 28 months following operation. HRQol was significantly improved 12 months after the operation. There may be a decline in the improvements after that.

Comorbidity↗
PubMedDate not supplied

Prognostic factors after surgery in patients younger than 50 years old with colorectal adenocarcinoma.

BACKGROUND/AIMS: The factors predicting recurrence and survival were evaluated using a computer-generated database to identify the independent predictors of survival of colorectal cancer in patients under 50 years of age. METHODOLOGY: One hundred and two patients under the age of 50 years with colorectal cancer who had been admitted into our hospital during the 20-year period of 1980-1999 were identified from a computer database. The factors possibly predicting recurrence were compared by bivariate analysis and the predictors of long-term survival by both univariate and multivariate analysis. RESULTS: A family history of colorectal cancer was present in 14% of all patients and in 15% of the patients aged under 40 years. Overall 5-year survival after radical resection was 59% and median survival 47 months. The recurrence rate after radical resection was 40%, being 13%, 35%, 55% and 80% in Dukes classes A, B, C and D, respectively. The risk of recurrence was most closely related to lymphatic invasion, vascular invasion and Dukes stage. Kaplan-Meier estimates showed that Dukes stage, grade of tumor, venous invasion, lymphatic invasion, perineural invasion and radicality of resection were the best predictors of survival, but in multivariate analysis only the radicality of operation, venous invasion and tumor grade retained their significance. CONCLUSIONS: Young age is not a poor prognostic marker in colorectal cancer. In addition to radical operation, venous invasion and tumor grade are good predictors of survival in patients under the age of 50 years.

Adenocarcinoma↗