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Biomedical subjects

K Ala-Kulju

Publications and source records attributed to K Ala-Kulju.

At least 19 recordsLinked to original sources
PubMed1990

Long-term results of direct aortoplasty for repair of aortic coarctation in adults.

The long-term results of 14 adult patients who underwent a direct aortoplasty for aortic coarctation were reviewed. The mean age of the patients at operation was 31.5 years. Three of the patients died; 1 died perioperatively, and 2 died later of cardiovascular disease. The survivors were followed for 15.8 years. None of the patients had complications at the site of coarctation repair. This contrasts with our earlier findings on patch graft aortoplasties, which showed a high incidence of postoperative aneurysm at the repair site. The etiology of these aneurysms is discussed with reference to the information provided by the present study.

Adolescent↗
PubMed1990

Morphological and histopathological aspects of aneurysms after patch aortoplasty for coarctation.

Repair of coarctation of the aorta by synthetic patch grafting has been complicated by late aneurysm formation. These aneurysms differ macroscopically from atherosclerotic thoracic aortic dilatations. Specimens for microscopic examination were taken from 14 of 20 patients undergoing aneurysm resection. Histological analysis of the specimens showed medionecrosis in 13 patients of the specimens showed medionecrosis in 13 patients (93%), foreign body reaction in 11 patients (78%), and intimal thickening in 3 patients (21%). The three layers of the aortic wall could be identified in the aneurysms. On the basis of these results, we discuss the etiologic factors and pathogenetic mechanisms involved in the development of these aneurysms.

Adult↗
PubMed1990

Diagnosis and treatment of subclavian artery aneurysms.

The diagnostic features and operative results in 13 patients with subclavian artery aneurysms were analysed. Symptoms related to subclavian artery aneurysms were present in seven patients, whereas six patients were asymptomatic and the aneurysm was discovered incidentally on chest X-ray. Angiography was the most valuable diagnostic examination and was also necessary in planning the operation. A correct preoperative diagnosis was made in five of six patients with computed tomography. Resection of the aneurysm was performed in nine and aneurysmal exclusion in the latest four patients. Direct reconstruction was used in nine and in four cases an extra-anatomic carotico-subclavian bypass was performed. Postoperative complications arose in two symptomatic and in four asymptomatic patients (46%: two strokes, two wound infections demanding extirpation of the prosthesis in one patient, two pareses of the recurrent nerve and one postoperative haemorrhage). Operative mortality was one patient. Follow-up data was available for all patients for periods of 6 months to 14 years. The vascular graft was patent in all patients. The authors conclude that subclavian artery aneurysm must be included in the differential diagnosis of all obscure upper mediastinal masses as seen on the chest X-ray and examined with CT and angiography. Exclusion of the aneurysm with extra-anatomical reconstruction is technically easier and gives the same postoperative long-term results as resection of the aneurysm and direct reconstruction. A relatively high complication rate after operation on asymptomatic subclavian aneurysms indicates a need for re-evaluation of operative indications in asymptomatic patients.

Aneurysm↗
PubMed1990

Use of omental pedicle for treatment of Buerger's disease affecting the upper extremities. A modified technique.

We present a report of a 58-year-old male patient who suffered from Buerger's disease of the upper extremities verified by microscopy and angiography. Despite medical treatment and repeated thoracic sympathectomy he developed gangrene at the tip of his right thumb and index finger. Pedicled omentum was prepared through midline laparatomy, placed through subcostal incision to the subcutaneous space of the forearm and affected fingers. Rest pain disappeared by the fifth day after surgery. The omental pedicle was ligated six weeks post-operatively and the extremity mobilized. The thumb healed well. The index finger required amputation because of continuing infection. Five years postoperatively the patient has a good functioning hand in which the transferred omentum has retained its viability.

Angiography↗
PubMed1989

Aneurysms after patch graft aortoplasty for coarctation of the aorta: long-term results of surgical management.

Twenty-two (32.8%) of 67 patients who had patch graft aortoplasty for aortic coarctation underwent reoperation because of aneurysm formation opposite or at the site of the patch. The mean age at primary repair was 25.3 years (standard deviation, 9.5 years). Reoperation took place 12.3 years (standard deviation, 3.7 years) later. In 19 patients, the aneurysm was resected and the aorta reconstructed with a tubular prosthesis. In 3 patients, the aneurysm was given external support. There were no hospital deaths. Recurrent nerve paralysis (36%) and bleeding necessitating repeat thoracotomy (32%) were the most common complications. Mean follow-up was 4.6 years. No aneurysms developed at the site of reoperation. Two patients died of causes not related to reoperation. Reconstruction with a tubular prosthesis gives good long-term results in patients with aneurysm formation after patch grafting for coarctation. External support offers technical advantages in select patients. Close follow-up of patients who have coarctation repair with a patch graft is essential.

Adult↗
PubMed1989

One-stage vascular surgery for abdominal aortic aneurysm infected by salmonella.

A case is presented of abdominal aortic aneurysm infected with salmonella enteritidis, maintaining septicaemia. Immediate surgery became necessary because of imminent rupture of the aneurysm. The infected thrombus within the aneurysmal sac was debrided, with irrigation of antibiotic solution, and in situ aorto-iliac reconstruction was carried out. A prolonged course of ciprofloxacine and a short course of vancomycin were administered. Recovery was uneventful. The infection parameters are normal 6 months postoperatively and CT-scan shows no signs of periprosthetic infection. The relevant literature concerning the surgical procedures for mycotic aneurysms is reviewed.

Aneurysm, Infected↗
PubMed1989

Primary tumours of the sternum.

In 1966-1986, two men and four women (mean age 47.5 years) underwent surgery for primary sternal tumour. Three of the tumours were benign (two condromata, one osteochondroma) and three were malignant (two chrondrosarcomata, one reticulum cell sarcoma). Inflammatory or degenerative lesions impeded differential diagnosis in three additional cases (without tumour). The tumours were treated with radical resection of the affected part of the sternum, including the relevant attached structures. Marlex-mesh reconstruction of the defect was necessary in four cases. There was no operative mortality. One Marlex graft became infected. At follow-up (average 11.1 years, range 9.0-14.7 years), five patients were alive without recurrence of tumour and the sixth had died of unrelated cause.

Adult↗
PubMed1989

Femoral-tibial bypass for limb salvage.

From 1967 to 1982, 305 femoral tibial bypasses were performed. Of these 180 (59%) were performed on limb salvage indication. A reversed autogenous saphenous vein was used in 134 instances, among 46 vein substitutes there were 15 vein allografts, 13 human umbilical cord vein grafts, 12 PTFE grafts and six dacron grafts. Hospital mortality was six patients. An additional 37 patients died during the follow-up period. The patency rates for saphenous vein bypass grafts were 62.5%, 48%, and 25% at one, five, and ten years, respectively, and 33% and 25% at one and five years, respectively, for the vascular substitutes. The mean +/- SD follow-up time was 62.27 +/- 5.7 months. During the early postoperative period 23 legs (12.7%) had to be amputated. During the follow-up period an additional 14 legs (7.8%) were lost giving a limb salvage rate of 79.5%.

Adult↗
PubMed1988

Primary tumours of the ribs.

Thirty-four primary rib tumours (24 benign, 10 malignant) were surgically treated in 1966-1985. The mean age was higher and the tumour diameter was greater in the patients with malignant, than in those with benign neoplasm. The benign tumours were excised without operative death. At follow-up after a mean of 12.3 years there was no recurrence of benign growth, but in two cases with initial diagnosis of chondroma a regrowth at the same site proved to be chondrosarcoma. Among the cases of malignant tumour there was one operative death from pulmonary embolism, after radical resection of sarcoma. None of the four patients with chondrosarcoma had recurrence 6-13 years after surgery. There was no long-term survival among the patients with other forms of sarcoma or malignant tumour of the reticuloendothelial system.

Chondroma↗
PubMed1987

Smooth muscle tumours of the oesophagus.

Twelve patients with oesophageal smooth muscle tumour were operated on between 1955 and 1984 in the Department of Thoracic and Cardiovascular Surgery of Helsinki University Central Hospital. Eleven tumours were leiomyomata, the twelfth was a leiomyosarcoma. Dysphagia (83%) and chest or epigastric pains (67%) were the most common symptoms presented. All patients underwent transthoracic removal of the tumour. Complications of the surgery included two cases of postoperative oesophageal fistula; in both instances the lumen of the oesophagus had been entered during the extirpation of the tumour. The surgery was effective in eliminating the most prominent symptom, i.e. dysphagia. However, follow-up examinations 11.1 +/- 6.8 (SD) years later revealed reflux symptoms and endoscopically and histologically verified oesophagitis in seven of the nine (78%) surviving patients. Additionally, two of them had developed Barrett's oesophagus, 10 and 19 years, respectively, after the primary surgery. These two patients underwent subsequent transabdominal antireflux procedures (Nissen fundoplication). We conclude that long-term follow-up of patients who have been treated for benign oesophageal tumour is indicated.

Adult↗
PubMed1987

Fibre-endoscopic dilatation of peptic oesophageal strictures.

51 patients with dysphagia caused by peptic oesophageal stricture due to primary or secondary reflux oesophagitis were treated by fibre-endoscope and Eder-Puestow dilatations under local anaesthesia and sedation, between 1976 and 1984. There was one death (2%) attributable to the procedure (perforation) and complications arose in three (6%) patients (perforation, pneumonia). The dilatation was successful in 96% but two patients (4%) had to be operated on because of undilatable stricture. Follow-up data was available for the other 44 patients for periods of one to eight (mean 2.8) years later. The stricture was cured by dilatation and antireflux treatment (conservative or operative) in all patients and 98% of them were able to eat solid food and improve their nutritional status. During follow-up 22 patients (50%) were asymptomatic and 22 (50%) had dysphagia or/and reflux symptoms. At endoscopy oesophagitis was healed with conservative or operative treatment in 25 patients (57%). It is concluded that fibre-endoscopic dilatation of peptic oesophageal strictures with the Eder-Puestow system combined with conservative or operative antireflux treatment, is a simple and safe procedure and gives good results in almost all patients. Surgical procedures aimed at total correction of the stricture are indicated only rarely in intractable cases.

Adult↗
PubMed1986

Traumatic rupture of the right hemidiaphragm.

Sixteen cases of traumatic disruption of the right hemidiaphragm are presented. Six tears were treated in the acute post-trauma phase and ten were detected from late manifestations. The causal trauma was penetrating in 11 cases and blunt in five. Rupture of the right hemidiaphragm not uncommonly occurs without serious associated injuries. Bowel often herniates through such tears, unhindered by the liver, though the liver is the most commonly herniating organ. No recurrence of hernia was found after standard repair techniques (mean follow-up 5.2 years). Three of the 16 patients died, one from associated injury, one from strangulation of herniated bowel and one from postoperative myocardial infarction. To demonstrate diaphragmatic tearing and subsequent organ herniation, serial chest radiographs and computed tomography are useful, and exploratory laporotomy should be done without delay after penetrating injury to the trunk. The treatment of diaphragmatic tear is surgical, with better results from early than from late repair.

Adult↗
PubMed1986

Surgical treatment of occlusion of the infrarenal abdominal aorta. Experience with 55 patients.

A series of 55 patients with occlusion of the infrarenal abdominal aorta operated on in the 15-year period 1966-1980 is presented. The type of operation was an extra-anatomic reconstruction in four cases and some type of anatomic repair in 51 cases. The operative mortality was 5.4%. The cause of death was myocardial infarction in two out of three cases. After a follow-up period of 90.4 months on average 25 patients were alive and were reached to a follow-up examination. Nineteen out of these 25 patients (76%) were symptom-free and six patients (24%) complained of mild to moderate symptoms related to obstructive arteriosclerotic lesions of the lower extremities. During the follow-up 27 patients expired. The most common causes of late deaths were myocardial infarction (13 out of 27 patients) and CVA (5 out of 27 patients).

Adult↗
PubMed1985

Congenital esophagobronchial fistula in the adult.

Three adult patients with congenital esophagobronchial fistula, treated between 1967 and 1984 at the Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, are presented. Correct preoperative diagnosis is very difficult and was not made for several years in our cases. Unexplained recurrence of pulmonary infection was the common feature in the patients' histories, and repeated esophagograms were helpful in diagnosing this rare congenital abnormality, which was fatal in one of our cases. The treatment should always be surgical.

Adult↗
PubMed1985

Epicardial lipoma.

A case of epicardial lipoma is presented. Coexisting coronary artery disease partly masked the symptoms by pointing to myocardial failure caused by compression from the tumor. An unexpectedly good result was achieved by combining excision of the lipoma with the planned coronary bypass procedure.

Heart Neoplasms↗
PubMed1985

Conservative treatment of ureteric stones. Ureteric stones--surgical intervention.

The present report deals with 413 ureteric stone attacks treated in hospital and followed up to six years. If there was no need for emergency surgery, the patients were treated conservatively and followed with renograms on an out-patient basis after the initial evaluation. Stones up to 6 mm in diameter were passed during a reasonable time in 92% of the cases. In some cases an endoscopic procedure preceded the passage. Many of the larger stones were also passed. Nine of the 16 uretero lithotomies in the series were performed due to compromise in renal function during the follow-up period; these resulted in no permanent damage. Only two cases of slight renal damage occurred in the conservatively treated group of patients. There were no deaths or nephrectomies. The data suggest that modern follow-up facilities allow the safe adoption of very conservative attitudes in the treatment of ureteric stones.

Analgesics↗