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Biomedical subjects

L Heikkinen

Publications and source records attributed to L Heikkinen.

At least 19 recordsLinked to original sources
PubMed2000

A comparison of remifentanil and alfentanil for use with propofol in patients undergoing minimally invasive coronary artery bypass surgery.

UNLABELLED: Most patients undergoing minimally invasive direct coronary artery bypass surgery can be awakened and tracheally extubated in the operating room. We have compared two techniques of total IV anesthesia in this patient population: 30 patients (aged 44 to 74 yr; 24 male) premedicated with temazepam were randomly assigned to receive either remifentanil-propofol or alfentanil-propofol. Anesthesia was induced with remifentanil 2 microg/kg or with alfentanil 40 microg/kg, with propofol, and maintained with remifentanil at 0.25 or 0.5 microg x kg(-1) x min(-1) or alfentanil at 0.5 or 1 microg x kg(-1) x min(-1). The stable maintenance infusion rate of propofol was adjusted for age. Times to awakening and tracheal extubation were recorded. Postoperatively, IV morphine provided by patient-controlled analgesia was used for 48 h. Times to awakening and tracheal extubation (mean +/- SD) were shorter (P < 0. 01) in patients receiving remifentanil, and interpatient variations in times to awakening and tracheal extubation smaller (awakening 25 +/- 7 vs 74 +/- 32 min, and extubation 27 +/- 7 vs 77 +/- 32 min). Analysis of variance revealed that postoperative consumption of morphine was dependent on both the intraoperative opioid and the time elapsed after surgery (P < 0.05): patient-controlled analgesia morphine use during the first 3 h after awakening was more in patients receiving remifentanil (P < 0.01). IMPLICATIONS: Recovery of patients undergoing Minimally Invasive Direct Coronary Artery Bypass Surgery is significantly shorter and more predictable after total IV anesthesia with remifentanil-propofol than with alfentanil-propofol, which may be important if the goal is that patients will be awakened and tracheally extubated in the operating room.

Aged↗
PubMed1999

Validity of self-reports of fractures in perimenopausal women.

The validity of self-report of fractures in postal inquiry among perimenopausal women was evaluated. Self-reports of fractures in the 1989 baseline postal inquiry data of the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) were compared with information in patient records. The study population consisted of 373 women who reported fractures sustained during the last 10 years and 200 randomly selected women who did not report fractures from a population base of 2,007 women aged 47-56 years. Self-report as a screening test for fracture was evaluated in the total sample of 2,007 women by estimating the number of false negative reports in all the women who did not report a fracture with the information on these 200 women. Of the self-reports of fractures, 84% proved to be true fractures, 12% soft tissue injuries, and the rest either self-diagnoses or misnomers. Self-report of wrist fracture was more accurate (95%). The sensitivity of self-report to detect fracture was 78% for all fractures and 95% for wrist fracture, while the respective specificities were 96 and 99%. Self-report is a relatively accurate way to obtain information about past major fractures in perimenopausal women. However, it is rather insensitive in the detection of minor fractures, if the reporting period is several years.

Female↗
PubMed1999

Infrarenal endoluminal bifurcated stent graft infected with Listeria monocytogenes.

Prosthetic graft infection as a result of Listeria monocytogenes is an extremely rare event that recently occurred in a 77-year-old man who underwent endoluminal stent grafting for infrarenal abdominal aortic aneurysm. The infected aortic endoluminal prosthesis was removed by means of en bloc resection of the aneurysm and contained endograft with in situ aortoiliac reconstruction. At the 10-month follow-up examination, the patient was well and had no signs of infection.

Aged↗
PubMed1997

Surgical treatment of acute myocardial ischaemia related to coronary angioplasty with special reference to use of perfusion balloon catheter and long-term outcome.

Twenty of 569 consecutive patients (3.5%) undergoing percutaneous transluminal coronary angioplasty required emergency coronary artery bypass grafting for acute closure of the dilated vessel. In seven patients an intracoronary autoperfusion balloon catheter was inserted to ensure antegrade blood flow across the injured zone of the coronary artery. The time needed for completion of the bypass grafts ranged from 100 to 399 minutes (mean 180 minutes). An average of 1.9 coronary artery bypasses was inserted. In total, 11 of the 20 patients (55%) developed new Q waves and had elevated CK-MB levels. However, the myocardial infarction rate was only 14% in those with a perfusion balloon catheter as against 77% in those without one. The insertion of a ball-out catheter permitted greater utilization of the internal mammary artery as a bypass graft. Angiographic follow-up was conducted after a mean of 28 months (19 patients). The patency rate of the bypass grafts placed in the emergency setting was relatively good (91%). Thallium tomography revealed a scar of variable size in all 17 patients studied and a reversible exercise perfusion defect requiring coronary reangioplasty in three patients. In conclusion, the insertion of a perfusion balloon catheter after abrupt coronary occlusion during coronary angioplasty solved the problems of acute myocardial ischemia and markedly lowered the definite myocardial infarction rate. This technique ensures favourable haemodynamic conditions for emergency myocardial revascularization.

Angioplasty, Balloon, Coronary↗
PubMed1997

Heart transplantation in Finland 1985-1995.

BACKGROUND AND AIMS: Since improved immunosuppression in the 1980's, heart transplantation is a well established procedure to treat patients with end-stage heart failure. The first heart transplantation in Finland was performed in 1985. Since then the activity has gradually increased to a level of about 25 annual transplants. The aim of this report is to sum up the clinical experience during the first 11 years. MATERIALS AND METHODS: From February 1985 till the end of 1995, 190 heart transplantations were performed in our institution. There were 176 males and 14 females ranging from 15 to 62 (mean 42.2) years of age. End-stage preoperative cardiac disease was dilating cardiomyopathy in 108 cases, coronary artery disease in 65 cases, valvular disease in 12 cases and congenital heart disease in five cases. RESULTS: The 30-day hospital mortality was 29 out of 190 (15.2%). The actuarial survival was 77% at one year, 75% at two years and 73% at 10 years. The most common causes of death were rejection (11 cases), graft failure (11 cases), abdominal complications (six cases) and cytomegalovirus (CMV) infection (four cases). A total of 87 rejection episodes occurred in 53 patients consisting 28 per cent of patients. 44 rejections occurred within three months post transplantation. Significant infections were noted in 198 instances in 97 patients. These were of bacterial origin in 92, viral in 48, fungal in 12 and protozoal in 10 cases, and 36 such infections which responded to antibiotics favourably but in which the microbe remained unidentified. 138 infections (i.e. 80%) occurred within 6 months post transplantation. In viral infections cytomegalovirus (CMV) predominated (29 out of 48). The CMV infection was significantly milder in patients who were seropositive preoperatively than in preoperatively seronegative patients with seropositive donors. CMV infection was associated with increased risk of post-transplant coronary artery disease. Three years after transplantation some restoration of sympathetic nervous response was observed at orthostatic test in heart rate and blood pressure. CONCLUSIONS: It can be concluded that 1) if a patient survives the three immediate postoperative months, his prognosis is good for the forthcoming years, 2) clinically significant rejections occur in less than one third of the patients, 3) cytomegalovirus is the most harmful agent post transplantation and a risk factor for post-transplant coronary artery disease and that 4) some restoration of sympathetic nervous control of the heart occurs within three years after transplantation.

Adult↗
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↗
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↗
PubMed1985

Clinically significant neurological disorders following open heart surgery.

In 1982, 364 consecutive adult patients with congenital and acquired heart disease were operated on using cardiopulmonary bypass (CPB). This population was analysed to determine the frequency of neurological complications and possible risk factors. One hundred fifty-four patients were studied prospectively (group I) and the results of 151 patients were reviewed retrospectively (group II). The overall surgical mortality was 4.5%. A neurological event was not the primary cause of death in any patients. Twenty-one patients (5.8%) had clinically significant neurological disturbances postoperatively, of these 85.7% were central and 14.3% peripheral nerve pareses. Patients with neurological complications (21) and the patients who did not survive the operation (16) were compared with a control group (59 cases) with no neurological defects operated on during the same year. Age of the patient, duration of CPB and low CPB pressure were not associated with neurological complications. Previous neurological events seem to have an influence on the postoperative neurological status although this could not be proved statistically. Except for 2 cases the neurological disturbances were transient with complete recovery or improved symptoms at the time of discharge.

Adolescent↗
PubMed1985

Neurological events in cardiac surgery.

Fifty consecutive coronary artery bypass grafting (Group I) and 50 single valve replacement (Group II) procedures were compared with 50 coronary artery bypass grafting with valve replacement (Group III) procedures and 50 multi-valve procedures (Group IV) to determine the frequency of neurological complications after cardiopulmonary bypass (CPB). The possible risks and aetiological implications were studied. The overall surgical mortality rate was 7.5%, being 0%, 4%, 6% and 20%, respectively for the different groups. The neurological event was not the primary cause of death in any of the patients. After CPB, neurological manifestations occurred in 4% of the patients in Gr. I, in 6% in Gr. II, in 4% in Gr. III, and in 8% in Gr. IV. Three patients had peripheral nerve paresis. The age of the patients and the duration of the CPB operation were not factors in the risk of neurological complications. Previous neurological events seemed to increase the frequency of postoperative neurological disorders, whereas combined procedures were no more dangerous in this respect.

Adolescent↗
PubMed1985

Acute renal failure related to open-heart surgery.

Open-heart surgery was performed on 1686 adult patients between 1980 and 1984. The patients were operated on using cardiopulmonary bypass procedures (CPB). Fifteen patients developed acute renal failure (ARF) after CPB, i.e. the incidence of ARF was 0.9%. All these patients were treated by peritoneal dialysis or haemodialysis. Pre-operative possible risk factors in the ARF group were compared to those in a control group of 30 patients (15 consecutive coronary artery bypass grafting and 15 consecutive valve repair procedures) experiencing no complications. Age, New York Heart Association (NYHA) classification, ejection fraction, cardiac volume and left ventricular end-diastolic pressure were not risk factors for the development of renal failure. The incidence of thrombocytopenia after CPB was statistically significantly different between the control and ARF groups. The mortality from ARF was 66.6%. The causes of death were peri-operative myocardial infarction, infection and gastrointestinal bleeding. CPB time, perioperative events and postoperative infection were the main factors contributing to ARF. Renal failure was twice as common in valve procedures as in coronary artery revascularization procedures. Impairment of renal function proved reversible only in those patients who survived. After restoration of renal function the prognosis was good.

Acute Kidney Injury↗
PubMed1984

Polydioxanone in cardiovascular surgery.

Polydioxanone (PDS) suture material was used in vascular anastomoses in patients submitted to femoropopliteal bypass (10 patients), aortoiliac endarterectomy (5 patients), and aortocoronary bypass (5 patients). Clips of this material and conventional metallic clips were compared in vitro for holding-in-place properties, and PDS clips were used in ligation of branches of the autologous vein grafts in femoropopliteal bypass (10 patients) and aortocoronary bypass (10 patients). There were no complications related to the PDS material either intraoperatively or during the follow-up from 3 to 6 months. The PDS clips did not slip when burst-tested in vitro. The material is suitable and advantageous in cardiovascular operations where autologous tissue is handled.

Adult↗
PubMed1984

Unexpected urethral strictures after short-term catheterization in open-heart surgery.

Urethral stricture was found in 59 of 478 male patients who had undergone open-heart surgery between June 79 and December 81. In 40/59 cases the stricture showed a string-of-pearls configuration or long narrowing of the penile urethra on the urethrogram. Burning pain and dysuria were the main symptoms, and the urinary stream started to weaken immediately after the removal of the siliconized latex catheter which had been routinely inserted at the time of the heart operation and usually kept indwelling for 3 days. The stricture epidemic stopped after change of the latex catheters to silicone-ones. The different catheters were investigated for cell toxicity. Eluates of catheters were added at different concentrations to cultures of various cell lines. The cell proliferation was measured by thymidine incorporation. The results were uniform and showed marked toxicity of the latex catheters against all investigated cell lines.

Cardiac Surgical Procedures↗