PubMed Health⌕ Search

Biomedical subjects

K von Smitten

Publications and source records attributed to K von Smitten.

18 recordsLinked to original sources
PubMed1992

The impact of adjuvant radiotherapy and cytotoxic chemotherapy on the outcome of immediate breast reconstruction by tissue expansion after mastectomy for breast cancer.

In an attempt to evaluate the impact of radiation therapy and cytotoxic chemotherapy on the outcome of immediate breast reconstruction by tissue expansion after mastectomy a prospective study on 32 patients was performed. The radiation therapy significantly worsened the surgical outcome, because the irradiated patients more often had pectoral muscle stiffness making the expansion more painful and the reconstructed breast too small, hard and with insufficient ptosis to obtain a natural breast mould. These results indicate that this technique should be avoided in patients likely to receive postoperative adjuvant cytotoxic chemotherapy and radiation therapy, thus reducing the indication to a small group of patients undergoing mastectomy for widespread ductal carcinoma in situ.

Adult↗
PubMed1990

Wire-guided biopsies of nonpalpable breast lesions.

The purpose of this study was to review the results of mammographic wire-guided biopsies of nonpalpable breast lesions and the features of the lesions in the preoperative examinations. Sixty women, mean age 50.2 years (range 31 to 74), underwent a wire-guided biopsy of the lesion. Twenty-nine patients had preoperative fine needle aspiration of the lesion. The radiographic diagnosis was correct in 33 patients (55%); 25 had breast cancer and 8 patients had a benign lesion. In 9 of the 14 patients with clustered microcalcifications in mammography and in 13 of the 15 patients with a mass noted in mammography, the cytological examination was correct. Nonpalpable mammographic masses with regular borders and normal fine needle aspiration examination do not require biopsy. In malignant mammographic appearances associated with a normal fine needle aspiration examination, biopsy of the lesion should always be done.

Adult↗
PubMed1989

Long term outcome after resection of the first rib for thoracic outlet syndrome.

A total of 112 first ribs in 103 patients were resected over 11 years for thoracic outlet syndrome. Seventy-seven patients (84 operations) were followed up for 2.5 years or more to assess the long term results of this procedure and the factors affecting them. One month after surgery 52 per cent of limbs were asymptomatic and 77 per cent were at least improved. A follow-up examination was performed, on average 6.1 years after the operation, by two independent examiners. This evaluation showed a permanent success rate of 37 per cent among 84 limbs examined. These long term results compare unfavourably with previously published data. The reason for the poor final outcome seemed to be difficulty in selecting patients for the operation. This was not aided by any of the preoperative tests. Patients in this study were evaluated by independent examiners, and only a total absence of preceding symptoms was accepted as the criterion for success. We emphasize the importance of unbiased evaluation and long term follow-up.

Adult↗
PubMed1989

The incidence of Crohn's disease in the Helsinki metropolitan area during 1975-1985.

The hospital incidence of Crohn's disease in the Helsinki metropolitan area during 1975-1985 was studied retrospectively. The resident population in this urban, well-defined district was 790,000 in the year 1985. During this period 193 new patients suffering from Crohn's disease were diagnosed. The annual incidence increased three times from 1/100,000 to 3/100,000, while the annual mean incidence was 2,3/100,000. The age-specific incidence was highest in the age-groups 15-24 with no sex difference. After the initial rapid increase the incidence of Crohn's disease in the Helsinki metropolitan area has stabilized on the level 3/100,000. These figures are similar to those reported from other Scandinavian and Western countries.

Adolescent↗
PubMed1988

Replantation service in Helsinki University Central Hospital 1980-1985.

A replantation service is a routine part of medical services. The best results are obtained when the work is centralized. In Finland five university hospitals have a replantation service. In the Helsinki University Central Hospital, 94 severed parts of the upper limb were replanted/revascularized in 1980-85. The amputation injury requiring replantation was most often a thumb avulsed by the driving axle of a tractor. The patients came from all over the country, and the short time span between the initial injury and admission to hospital--2.4 hours an average in 1985--shows that transport of these patients is not a problem in Finland. The mean duration of surgery was 6.9 hours. Most of the operations took place in the late afternoon, evening or at night. 16% of the cases needed immediate reoperation because of vascular problems. Later, over 40% of the cases underwent secondary procedures. Most of the patients returned to their former employment. In long-term follow-up, however, nine out of ten patients reported that the replanted organ was intolerant to cold. Therefore, with the exception of the thumb, single finger replantation should not be a routine procedure in a cold climate such as that encountered in Finland. A replantation service requires a minimum of four surgeons qualified in plastic surgery or hand surgery. The operating theatre will be in use through the night. Nurses, physiotherapists and occupational therapists must be specially trained. The surgeon must be prepared to perform multiple reconstructive procedures, both immediately and later on.

Adult↗
PubMed1988

Abdominal rectopexy and sigmoid resection (Frykman-Goldberg operation) for rectal prolapse.

Transabdominal posterior rectopexy with resection of the redundant left colon (Frykman-Goldberg operation) was performed on 48 selected patients with complete rectal prolapse. Uterine suspension was also performed on most of the women. The 30-day mortality rate was 2.1%. Prolapse recurred in 4 (9%) of the 45 patients followed up for 1-10 (mean 4.3) years. There were no complications attributable to bowel resection or anastomosis. Adequate data on both preoperative and postoperative anal function and bowel habit were available in 41 cases. All but two of the 32 patients with associated incontinence experienced improved anal control after the operation (9 regained normal continence). Bowel habit improved in 23 patients (56%), especially in those with chronic constipation. No patient reported increased problems of bowel management. The operation does not involve the risks associated with implantation of foreign material and can be especially beneficial for constipated patients with rectal prolapse who are fit for major abdominal surgery.

Adult↗
PubMed1987

The rabbit ear pedicle flap. A new model for evaluating factors affecting the circulation in flaps.

Laser Doppler flowmetry and transcutaneous oximetry were compared regarding their speed and accuracy in detecting occlusion of the artery of an experimental rabbit ear pedicle flap. The laser Doppler flowmeter showed a significant decrease in flow and the transcutaneous oximeter showed a significant decrease in oxygen tension within one minute after occlusion of the artery. A significant increase in flow was observed within one minute, and a significant increase in oxygen tension readings was observed one minute after the artery was opened. A steady state after opening the artery was reached sooner for the laser Doppler flowmeter readings. This study suggests that laser Doppler flowmetry and transcutaneous oximetry are equally fast and accurate in detecting changes in blood flow to a pedicle graft. These methods also have equally good reproducibility. Repeated clampings within a 30 min period did not affect the measured parameters.

Animals↗
PubMed1986

Histochemical examination of energy metabolism in aortic vein grafts in rats.

The duration of the presumed metabolic depression of syngeneic vena cava to aorta transplants was determined in rats and the site and type of energy metabolism in the vein grafts assessed. The aerobic metabolic activity was measured from the histochemical reactivity of the enzymes, succinate dehydrogenase and cytochrome oxidase, and the anaerobic activity by staining with lactate dehydrogenase. The activity of the hexose-monophosphate shunt was assessed by the histochemical demonstration of glucose-6-phosphate dehydrogenase. Sixteen hours after grafting a pronounced metabolic depression was noted. Recovery occurred 24 hours after transplantation. The most intense staining was from lactate dehydrogenase in the vein grafts and in the non-transplanted veins. At the end of the observation period of four months the grafts were definitely more strongly stained than the non-transplanted veins, with most of the activity in the thickened intima. This layer had a metabolic profile resembling that of the media of the adjacent aorta.

Animals↗
PubMed1986

Long-term results of sigmoidostomy in patients with anorectal malignancy.

The long-term results with permanent end-sigmoidostomy were studied in 54 patients after abdominoperineal excision of the rectum for anorectal malignancy. The patients were re-examined 1-8 years postoperatively, when the function and late complications of the end-sigmoidostomy and the need for reconstructive procedures were assessed. An attempt was also made to evaluate the patients' quality of life. Only one patient reported severe impairment of social life due to the enterostomy. The main surgical problem was paracolostomy hernia (48% of the series), but revisonal surgery because of hernia was necessary in only two cases. Stomal stenosis (5.6%) in no case required reoperation. Peristomal eczema (5%) was always manageable with local treatment. The results indicated that the quality of life with end-sigmoidostomy is reasonably good, and this should be kept in mind when deciding on type of operation for low rectal malignancy.

Adult↗
PubMed1985

Collagens, laminin, fibronectin, and cytoskeletal composition of cells in syngeneic aortal vein grafts in the rat.

The supradiaphragmatic vena cava of the rat was transplanted to the abdominal aorta in syngeneic recipients. The cells and the connective tissue matrix of these grafts were studied 3 days to 12 weeks after transplantation by immunofluorescence staining of the cytoskeletal proteins desmin, vimentin, and myosin. The matrix proteins, collagen Types I and III, laminin, fibronectin, and fibrin(ogen) were similarly demonstrated. Blood coagulation Factor VIII was used as a marker for endothelial cells. Inflammatory cells invaded the graft during Week 1, but later on the grafts were crowded with cells containing vimentin. Intimal thickenings developed already after 1 week. Smooth muscle cells containing desmin proliferated in these thickenings. After transplantation collagen Type I increased in the graft, but collagen Type III rather decreased. During the phase of intense proliferation of smooth muscle cells the media contained a rich matrix of diffusely distributed laminin. The laminin of older grafts was confined mostly to the subintimal zone and to the intimal plaques.

Animals↗
PubMed1985

The effect of perfusion on post-operative viability in the replanted rabbit ear: measured by laser Doppler flowmetry and skin temperature.

The effect of perfusion by heparinized Ringer solution on post-operative microcirculation in rabbit ear replants was studied. One ear in each of five rabbits was replanted after perfusion with heparinized Ringer solution and these were compared with five replantations of rabbit ears without perfusion. The ears were studied post-operatively for 2 1/2 days by skin temperature monitoring and Laser Doppler Flowmetry (LDF). During the first day after replantation the perfused ears had better capillary flow, whereafter no significant differences were noted. LDF was more sensitive to changes in capillary blood flow, and this seems to make the reproducibility of LDF poor. It is, however, a suitable method for continued observation of post-operative viability.

Animals↗
PubMedDate not supplied

Congruence of adrenergic and cholinergic intrinsic innervation of human and rat atria.

Right atrial biopsies from rat and human hearts were studied using combined methods for the demonstration of glyoxylic acid-induced fluorescence (GIF) of catecholamines and acetylcholinesterase (AChE) reactions in the same specimens. In specimens from the rat heart, the GIF and AChE reactions were performed either simultaneously or consecutively. In biopsies of the human right atrium, obtained at right atria cannulation during open-heart surgery, the reactions were performed consecutively. It was found that in both rat and human atria the adrenergic nerves and AChE reactive nerves, which are probably cholinergic, run partly separately and partly together. In the rat atrial specimens, close relations between adrenergic nerves and clusters of AChE reactive cells were observed. In addition, clusters of fluorescent cells were observed in the vicinity of AChE reactive nerve bundles. This indicates that there may be several possible means of peripheral interaction between the intrinsic adrenergic and cholinergic systems of the rat heart.

Acetylcholinesterase↗
PubMedDate not supplied

Assessment of metabolic activity in aortic vein grafts in rats by histochemical examination of hydrolases.

The metabolic pattern of aortic vein grafts in rats was studied by estimating histochemically the activity of the hydrolytic enzymes alfa-esterase, aminopeptidase, adenosine triphosphatase, acid phosphatase and alkaline phosphatase. The enzyme activity was lowest in the 16 hour and 1 day old grafts, and recovery was noted at three days. Five days after transplantation the enzyme activities were higher than in the non-transplanted veins. The rapid increase in enzymatic activity found in histochemical studies on wound healing was not seen in these vein grafts. At four weeks some grafts showed intimal thickening the activity of which did not exceed that of the other layers of the graft wall. At the end of the observation period of sixteen weeks most of the grafts showed intimal thickening, and this layer stained intensely especially for ATPase. The staining pattern of most of the grafts at sixteen weeks resembled that of the aortic media.

Acid Phosphatase↗