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Biomedical subjects

L Halme

Publications and source records attributed to L Halme.

At least 37 records · Page 2Linked to original sources
PubMed1999

Complications of diagnostic and therapeutic ERCP.

BACKGROUND AND AIMS: In the era of magnetic resonance cholangiopancreaticography (MRCP) and laparoscopic biliary surgery, indications for endoscopic retrograde cholangiopancreaticography (ERCP) should be profoundly considered in the light of ERCP related complication rate. MATERIAL AND METHODS: To evaluate the frequency of complications associated with diagnostic and therapeutic ERCP, all endoscopic procedures from 1991 to 1996 were retrospectively reviewed. RESULTS: A total of 813 cannulations were performed on 590 patients. Endoscopic sphincterotomy (EST) was performed on 223 patients out of 230 attempted. Common bile duct stones were removed from 134 patients, an endoscopic stent was inserted in 69 patients and a benign stricture was dilated in 11 patients. After diagnostic ERCP, the complication rate was 1.8% with no mortality, after EST the complication rate was 9.1% with a mortality rate of 0.9%. Pancreatitis was the most common complication with a rate of 1.5% after diagnostic ERCP and 3.9% after EST. In three patients the pancreatitis was severe and resulted in the deaths of two of them. Other complications were haemorrhage after EST (2.6%), duodenal wall or bile duct perforation (0.7% of the cannulations and 2.2% of EST) and cholangitis (0.6% of all cannulations). All of these patients survived. CONCLUSION: Complication rates were comparable with large series from clinics specialised in endoscopic procedures.

Adult↗
PubMed1998

Peripheral arterial disease as a predictor of outcome after renal transplantation.

Our aim was to assess the prevalence of symptomatic and asymptomatic peripheral occlusive arterial disease (POAD) in 129 consecutive diabetic (n = 34) and nondiabetic (n = 95) patients undergoing renal transplantation. The association of pre-existent POAD and complaints of claudication, lower limb amputations, and graft and patient survival were evaluated during a 5-year follow up. A questionnaire on walking capacity, ankle/brachial (ABI) and toe/brachial (TBI) pressure indices as well as the pulse volume recording (PVR) at the ankle were used to assess resting haemodynamics and the presence of POAD 4 days after the transplantation. Unquestionable ischaemia was encountered in 5 (4%) patients all with a history of intermittent claudication and an ABI equal or below 0.77. While using assessment methods not affected by vessel calcification, i.e. toe pressures and PVR damping, a many-fold frequency of arterial disease was observed when compared to previous studies. TBI below 0.65 was found in 11 of diabetic (32%) and in 15 of the others (16%), and a PVR amplitude below 5 min in 28 of diabetics (82%) and in 34 of non-diabetics (36%). During the 5-year follow up, abnormal TBI and PVR values and diabetes at the time of transplantation were the greatest risk factors for proximal foot amputations. The low TBI levels also indicated a shortened patient survival. However, transplant function was not affected by the presence of abnormal haemodynamic indices at the time of transplantation.

Adolescent↗
PubMed1998

CMV infection detected in the upper gastrointestinal tract after liver transplantation.

As a pilot series on the frequency of gastroduodenal cytomegalovirus (CMV) involvement after liver transplantation, we examined forceps biopsies of 13 consecutive patients who underwent esophagogastroduodenoscopy during the first 3 months after transplantation. CMV was demonstrated in frozen sections by monoclonal antibody and immunoperoxidase staining. In parallel, peripheral blood was examined for CMV pp65 antigenemia. CMV antigens were detected in biopsies of ten patients, in ten cases in the duodenum and in four in the stomach. At the time of endoscopy, sic patients had CMV antigenemia, five of them had a simultaneous positive finding in the duodenum. Although all ten patients with the positive biopsy finding had some gastrointestinal symptoms, only one had severe enteritis. In liver transplant patients, CMV was commonly detected in leukocytes located in the mucosa of the upper gastrointestinal tract, especially in the duodenum. Further investigation is needed to determine the significance of positive CMV findings in the biopsies and their association with the development of severe gastrointestinal symptoms.

Biopsy↗
PubMed1998

Ganciclovir prophylaxis after lung and heart-lung transplantation.

Cytomegalovirus (CMV) infection causes both acute and chronic allograft damage. The aim of this study was to analyze the utility of ganciclovir in preventing CMV infection in pulmonary allografts. Thirty five consecutive lung (LTX) and heart-lung (HLTX) transplant patients were studied from 1990 to 1996. CMV prophylaxis was started in January 1995. Recipients with CMV-positive serology received ganciclovir on postoperative days (POD) 7-28. Acyclovir was given on POD 29-90. Recipients with CMV-negative serology received ganciclovir on POD 7-90 if the serology of the donor was positive. CMV was demonstrated by rapid cell vial culture and/or detecting CMV-specific antigens in bronchoalveolar lavage (BAL) samples. The time point of the first BAL fluid specimen exhibiting CMV was estimated using the Life Table method. BAL samples of all the recipients without ganciclovir treatment became positive for CMV, whereas two of the 11 patients with ganciclovir administration remained negative. Ganciclovir significantly (P < 0.05) delayed but did not absolutely prevent CMV infection after LTX and HLTX.

Adolescent↗
PubMed1998

Peritoneal dialysis access: a comparison of peritoneoscopic and surgical insertion techniques.

Prospectively collected data were analysed comparing 108 consecutive peritoneoscopically (n = 65) and surgically (n = 43) placed peritoneal dialysis catheters during a three-year period. Catheter-linked mechanical complications occurred more often in the peritoneoscopical group, and pericatheteral leakage ended in catheter loss in 13.8%. Overall probability of catheter survival in the peritoneoscopic group at 12, 24 and 36 months was 73%, 56% and 24%, and in the surgical group 87%, 87% and 66%, respectively (p < 0.05). Rates of infectious complications, peritonitis and exit site infections were similar.

Case-Control Studies↗
PubMed1997

Is obesity still a risk factor in renal transplantation?

At our center, since 1982, a body mass index (BMI) of less than 30 has been a prerequisite for placing a patient on the waiting list for renal transplantation. This decision was made because obese transplant recipients seemed to have a less than favorable post-transplant outcome. The aim of this study was to evaluate whether this requirement is still justified. Forty-six patients with a BMI above 30 underwent primary cadaveric renal transplantation between 1972 and 1993. For each of these obese patients, five consecutive non-obese (BMI 20-25) control patients were selected. Patient and graft survival, causes of graft loss, and acute rejection rate were evaluated for the two patient groups before and after the year 1982. Within the first 30 post-transplant days, one patient (2%) and 11 grafts (24%) were lost in the group of obese patients whereas seven patients (3%) and 36 grafts (16%) were lost in the control group. Among the obese patients, renal circulatory complications were a major cause of graft loss. In the period 1973-1981, the 1-year patient survival rate was 65% among obese patients versus 75% among controls from 1982 to 1993, this was 90% versus 93%. From 1973 to 1981, the 1-year graft survival rate was 25% among obese patients versus 53% among controls (P < 0.05); from 1982 to 1993, it was 68% versus 84% (P = NS). Multivariate analysis showed that the immunosuppressive regimen, age of the patient, BMI, and cold ischemia time of the graft had a significant influence on graft survival. The acute rejection rate within the first 30 days was 28% among obese patients and 35% among controls (P = NS). We conclude that a BMI below or equal to 30 is still justified as a prerequisite for placement on the waiting list for renal transplantation, for despite an overall improvement, the outcome of renal transplantation in obese patients remains worse than that in non-obese patients.

Adolescent↗
PubMed1997

Endoscopically inserted stent as treatment for pancreatic ascites. A case report.

After 3 weeks of unsuccessful conservative treatment, a pancreatic fistula with peritoneal fluid collection was managed with the endoscopic insertion of a stent from the duodenum into the pancreatic duct beyond the origin of the fistula. The patient who presented contraindications at surgery, made a remarkable recovery. At stent-retrieval, however, a stricture formation was seen in the main pancreatic duct.

Adult↗
PubMed1997

Urinary excretion of iohexol as a marker of disease activity in patients with inflammatory bowel disease.

BACKGROUND: Increased intestinal permeability of water-soluble contrast medium during an intestinal follow-through is found in patients with active Crohn's disease in the small bowel. METHODS: Urinary excretion of the water-soluble X-ray contrast medium iohexol was measured after oral administration in patients with inflammatory bowel disease and in healthy controls. The patients were grouped on the basis of disease activity and location and extent of intestinal involvement. RESULTS: Urinary excretion of iohexol was significantly higher in patients with active disease than in patients with quiescent disease or in healthy controls (P = 0.005), and it correlated positively with activity indices and with the extent of the disease. CONCLUSION: The intestinal permeability of iohexol is significantly increased in patients with active inflammatory bowel disease in the small bowel and in the colon, whereas the permeability of patients with inactive disease is similar to that in healthy controls. We suggest that urinary excretion of iohexol can be used as a marker of disease activity in patients with inflammatory bowel disease.

Administration, Oral↗
PubMed1997

Primary gastrointestinal non-Hodgkin's lymphoma. A population based study in central Finland in 1975-1993.

Gastrointestinal lymphomas have been uncommon, but the frequency of their predisposing conditions is increasing. The objective of the present study is to determine the frequency of gastrointestinal lymphomas in the area of central Finland as well as the influence of clinical features and therapeutical approaches on the survival of these patients. All samples of gastrointestinal non-Hodgkin's lymphomas diagnosed of patients living in the province of central Finland in 1975-1993 were re-examined. In central Finland the mean annual frequency of new gastrointestinal lymphomas was 10/1000000 in 1975-1984 and 16.0/1000000 in 1985-1993. The total incidence of gastrointestinal lymphomas in Finland adjusted for age to the world standard population was 12.5/1000000 in 1992. Two patients with peripheric T-cell lymphoma had a coeliac disease. Other predisposing conditions were not found. The stage of distribution of the lymphoma (p < 0.01) and radicality of the surgery (p < 0.01) were the most influencing factors on the survival of these patients. In conclusion the early distinction of gastrointestinal lymphomas is vital because of an increasing frequency of predisposing factors and a better prognosis due to new combination therapies.

Adolescent↗
PubMed1996

Randomized comparison of the neuroendocrine response to laparoscopic cholecystectomy using either conventional or abdominal wall lift techniques.

Increase in plasma renin activity and noradrenaline concentration occur in response to carbon dioxide insufflation during laparoscopic cholecystectomy. In a randomized study the conventional carbon dioxide pneumoperitoneum was compared with the abdominal wall lift method for laparoscopic cholecystectomy, with special reference to neuroendocrine changes and renal function. The total mean(s.d.) volume of carbon dioxide insufflated was 42(23) litres with the conventional method and 9(7) litres with abdominal wall lift (P < 0.001). Mean(s.d.) intra-abdominal pressure after 15 min of insufflation was 11(2) and 3(9) mmHg respectively (P < 0.01). In the conventional group mean(s.d.) plasma renin activity increased slightly from 5.5(2.1) to 6.1(2.0) ng ml-1 during the first 55 min of laparoscopic cholecystectomy. In the abdominal wall lift group plasma renin activity decreased from 5.3(2.7) to 3.8(0.9) ng ml (P < 0.01 between the groups). Plasma antidiuretic hormone concentration increased similarly in both groups. Diuresis was significantly less with conventional pneumoperitoneum during the first 35 min of the operation compared with the abdominal wall lift method (P < 0.001). There were significant increases in plasma noradrenaline concentration in both groups (P < 0.001), but the increase was slightly higher in the conventional group during the first 15 min of insufflation. The abdominal wall lift method with minimal carbon dioxide insufflation was associated with smaller neuroendocrine responses and better preservation of renal function compared with conventional carbon dioxide pneumoperitoneum.

Adult↗
PubMed1996

Transfusion-related acute lung injury (TRALI) after fresh frozen plasma in a patient with coagulopathy.

BACKGROUND: Transfusion-related acute long injury (TRALI) is due to specific antigen-antibody reaction involving the donor's leucocyte or granulocyte antibodies towards the recipient's antigens. Aggregation in small pulmonary vessels occurs, leading to derangement of permeability. CASE HISTORY: TRALI after transfusion of four units of fresh frozen plasma (FFP) for factor V deficiency prior to elective cholecystectomy is presented. Within a few minutes after the third unit of FFP a florid pulmonary oedema developed. Hypotension and hypoxia with SpO2 83-87% at FiO2 1.0 followed. Prompt monitoring of central haemodynamics revealed a normal cardiac index without pulmonary hypertension. The operation was then conducted as planned. The bilateral pulmonary oedema resolved after 72 hours with ventilatory support. The patient recovered without complications. When tested postoperatively, the second unit of FFP contained granulocyte antibodies and the third unit contained HLA antibodies. The crossmatch of the patient's granulocytes and lymphocytes towards the two donors of the two units of FFP was positive. CONCLUSION: When TRALI is suspected the donor blood has to be tested against the recipient. Ventilatory support of the patient is continued until adequate oxygenation is reached.

Acute Disease↗
PubMed1996

Number of activated T-helper cells and NK cells in peripheral blood is decreased in severe Crohn's disease.

Monoclonal antibodies and flow cytometry were used to analyse the proportions of T-cell subsets and NK cells in blood of patients (n = 45) with Crohn's disease. In patients with severe activity disease decreased numbers of activated (CD25+CD4+) T-helper cells and NK (CD16+CD56+) cells were found, while in patients with low activity disease the numbers of activated T-helper cells were increased and the numbers of NK cells were similar to those in normal controls. Thus, 8% of T cells were CD25+CD4+ and 16% of mononuclear cells were CD16+CD56+ in patients with severe disease. In patients with quiescent disease, 11% of T cells were CD25+CD4+ and 26% of mononuclear cells were CD16+CD56+. The results suggest that disease activity may be reflected in the proportions of blood circulating mononuclear cells, perhaps because of accumulation of CD25+CD4+ T-helper cells and NK cells in the affected tissue during exacerbation of the disease.

Adolescent↗
PubMed1996

High frequency of helicobacter negative gastritis in patients with Crohn's disease.

The frequency of gastric Crohn's disease has been considered low. This study was undertaken to determine the prevalence of chronic gastritis and Helicobacter pylori infection in patients with Crohn's disease. Oesophagogastroduodenoscopy was performed on 62 consecutive patients suffering from ileocolonic Crohn's disease. Biopsy specimens from the antrum and corpus were processed for both histological and bacteriological examinations. H pylori antibodies of IgG and IgA classes were measured in serum samples by enzyme immunoassay. Six patients (9.7%) were infected with H pylori, as shown by histology, and in five of them the infection was also verified by serology. Twenty one patients (32%) had chronic H pylori negative gastritis (negative by both histology and serology) and one of them also had atrophy in the antrum and corpus. Granulomas were found in four patients. The characteristic appearance of H pylori negative gastritis was focal and mostly mild inflammation resembling the inflammatory changes seen in the gut in Crohn's disease. Patients with H pylori negative chronic gastritis had a significantly more active disease in their gut than those with normal gastric mucosa (p < 0.01). It is concluded that H pylori positive gastritis is rare, while H pylori negative gastritis is relatively common in patients with Crohn's disease. H pylori negative 'Crohn's gastritis' seems to be associated with active Crohn's disease.

Adult↗
PubMed1996

Inverse correlation between Helicobacter pylori infection and inflammatory bowel disease.

AIMS: To determine the seroprevalence of Helicobacter pylori in patients with Crohn's disease or ulcerative colitis and in controls without inflammatory bowel disease (IBD). METHODS: One hundred consecutive patients with Crohn's disease, 100 consecutive patients with ulcerative colitis, and 100 age and sex matched controls were studied. Serum H pylori IgG and IgA antibody titres were measured by enzyme immunoassay. RESULTS: The seroprevalence of H pylori was 15% in patients with IBD (13% in patients with Crohn's disease and 18% in patients with ulcerative colitis), whereas the corresponding figure for the controls was 43%. When compared with controls, the seroprevalence of H pylori in patients with IBD was considerably lower in all age groups tested. There was no important difference in treatment with sulphasalazine or in any other medical therapy administered to H pylori positive and negative patients. At the time of blood sampling there was no difference in the level of education or in the employment status between the patients and the controls. CONCLUSIONS: Patients with IBD were less likely to be infected with H pylori than their age and sex matched controls. Neither medical treatment nor socioeconomic factors could explain the difference.

Adolescent↗
PubMed1995

Factors related to frequency, type, and outcome of anal fistulas in Crohn's disease.

PURPOSE: Relation of clinical factors to frequency, type, and, in particular, outcome of anal fistulas in Crohn's disease was studied. METHODS: One hundred twelve patients seen in this hospital between January 1972 and June 1993 who suffered from Crohn's disease were included in the study. Those 35 (31 percent) with anal fistulas were re-examined or interviewed and asked about their perianal symptoms and anal control. RESULTS: Rectal involvement of Crohn's disease was associated with an increased incidence of anal fistula (49 vs. 17 percent; P < 0.01), especially high ones (82 vs. 17 percent; P < 0.01). Ten of 18 patients with low fistulas underwent fistulotomy; all 10 fistulas healed, but slowly (mean healing time, 7.5 months), and 4 of them recurred. Of eight low fistulas managed by drainage alone, four healed. Finally, 11 of 18 patients with low fistulas had their fistulas heated. Fourteen of 17 patients with high fistulas were primarily treated by drainage and 3 by local surgery. Finally, only three patients had healed fistulas--two after simple drainage and one after local surgery, and seven patients had to undergo proctectomy. Only two patients with low fistulas required proctectomy. Eight patients (33 percent) of those 24 with fistulas in whom anal continence could be assessed, 5 with local surgery and 3 with drainage alone, reported minor defects in anal control. CONCLUSIONS: Fistulotomy is a justifiable option with satisfactory results for low symptomatic anal fistulas associated with Crohn's disease, although healing may be delayed and some fistulas will recur. Outcome of high fistulas is less satisfactory, and proctectomy is ultimately required in a number of patients; therefore, for high fistulas a conservative approach is primarily recommended.

Adult↗