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Biomedical subjects

M Talja

Publications and source records attributed to M Talja.

At least 55 records · Page 3Linked to original sources
PubMed1995

Biocompatibility of various indwelling double-J stents.

The biocompatibility of 8 double-J stent brands was evaluated both in vivo, by scanning electron microscopy and histological analysis of pig ureters intubated for 6 weeks, and in vitro, by cell culture methods. In vivo findings showed that superficial epithelial destruction was milder in the ureters intubated with hydrogel-coated stents than in those intubated with other stents. Inflammatory reactive changes were milder in the ureters intubated with silicone stents than in those intubated with other stents, while encrustation was more severe on silicone and Grey stents than the others. In vitro, the 3 stent brands made of "modified polyurethane" were found to be cytotoxic while the others were not. Overall, silicone and hydrogel-coated stents seemed to be more biocompatible than the others, and hydrogel-coated stents to be more suitable than silicone stents for long-term ureteral stenting, being less prone to encrustation. Although they are of an experimental nature, these findings may be of relevance to clinical practice.

Animals↗
PubMed1995

Biochemical parameters as prognostic factors in prostatic adenocarcinoma.

The serum levels of creatinine (CR), alkaline phosphatase (ALP), acid phosphatase (ACP) and tartrate inhibitable acid phosphatase (TIAP) were related to Gleason score, TM-category, disease progression and survival in 325 prostatic adenocarcinoma patients followed up for over 12 years. Elevated serum levels of CR, ALP, ACP and TIAP were related to invasive and metastatic disease as well as with a high Gleason score. Elevated serum levels of CR, ALP, ACP and TIAP, all significantly predicted prognosis in a univariate analysis. In the M0 tumours, ACP and TIAP and TIAP had prognostic value, as they did in the T1-2M0 tumours respectively. Cox's multivariate analysis showed that serum creatinine level at diagnosis had independent prognostic value additional to the TM-classification, Gleason score and patient age. In the M0 tumours, ALP had independent prognostic significance additional to the T-category, Gleason score and patient age. In the T1-2M0 tumours, TIAP had independent prognostic value supplementary to the Gleason score, T-category and patient age, whereas in the T1M0 tumours, the gleason score was an independent prognostic parameter. The results indicate that these simple laboratory tests give important prognostic information in prostatic adenocarcinoma.

Acid Phosphatase↗
PubMed1995

Biodegradable self-reinforced polyglycolic acid spiral stent in prevention of postoperative urinary retention after visual laser ablation of the prostate-laser prostatectomy.

PURPOSE: The efficacy and safety of a new biodegradable (self-reinforced polyglycolic acid) spiral stent in securing free voiding despite edema after visual laser ablation of the prostate were studied. MATERIALS AND METHODS: A biodegradable spiral stent was inserted into the prostatic urethra in 22 patients immediately after visual laser ablation of the prostate. Uroflowmetry, measurement of residual urine volume, urine culture, cystoscopy and assessment of symptomatic improvement were done before, and 1, 3 and 6 months after visual laser ablation of the prostate. RESULTS: All 22 patients voided freely on day 1 or 2 after visual laser ablation of the prostate. However, 4 patients later had urinary retention due to a short spiral or too rapid spiral degradation. Half of the patients experienced a transient decrease in flow with some obstructive symptoms at 3 weeks that lasted 1 to 2 weeks. At 4 weeks all spirals were degraded and 3 patients had a positive urine culture. The maximum flow rate increased and the residual urine volume decreased significantly concomitantly with significant symptomatic improvement. CONCLUSIONS: The self-reinforced polyglycolic acid spiral stent can effectively and safely prevent postoperative urinary retention after visual laser ablation of the prostate.

Aged↗
PubMed1994

Histological grade, perineural infiltration, tumour-infiltrating lymphocytes and apoptosis as determinants of long-term prognosis in prostatic adenocarcinoma.

A series of 325 prostatic adenocarcinomas with a long-term clinical follow-up were subjected to light microscopic analysis of histological prognostic factors, including three grading systems (Gleason score, WHO grade, nuclear grade), perineural infiltration of the tumour (PNI), tumour infiltrating lymphocytes (TIL) and the presence of apoptotic cells (APO). All three histological classifications correlated significantly with the prognosis, but in multivariate analysis, the Gleason score was superior to the WHO grading or nuclear grading in predicting patient survival. PNI was significantly related to poor differentiation of the tumour, its progression and ominous disease outcome, particularly in T1-2MO tumours. The density of TIL was independent of the tumour differentiation, and absent or weak TIL were signs of a high risk of tumour progression and of a fatal disease. Apoptotic cells were commonly detected in poorly differentiated tumours and apoptosis was related to disease progression and low survival probability. The results suggest that the Gleason score, PNI and the density of TIL should be included in routine pathology reports, to be used by clinicians while making therapeutic decisions in prostatic cancer.

Adenocarcinoma↗
PubMed1994

Progression and survival in prostatic adenocarcinoma: a comparison of clinical stage, Gleason grade, S-phase fraction and DNA ploidy.

Clinical data were reviewed in 325 patients with prostatic adenocarcinoma followed up for a mean of 13 years. Paraffin-embedded tumour biopsy specimens from the primary tumours were available for flow cytometry (FCM) in 273 cases. Intra-tumour heterogeneity in DNA index (DI) was found in 4% of the tumours (54 cases were analysed). S-phase fraction (SPF) and DNA ploidy were significantly interrelated. Aneuploidy and high SPF were significantly related to both a high T category and high Gleason score. The progression in T1-2M0 tumours was related to Gleason score (P = 0.009), DNA ploidy (P = 0.006) and SPF (P = 0.007), while the Gleason score (P = 0.0013), DNA ploidy (P = 0.002) and SPF (P < 0.001) had prognostic value in univariate survival analysis. In the entire cohort, the T category (P < 0.001), M category (P < 0.001), Gleason score (P < 0.001), DNA ploidy (P < 0.001) and SPF (P < 0.001) were significant prognostic factors. In Cox's analysis, the M category (P < 0.001), Gleason score (P < 0.001), T category (P = 0.003), age (P = 0.001) and SPF (P = 0.087) were independently related to prognosis. In the T1-2M0 tumours, Gleason score (P < 0.001), T category (P = 0.022) and SPF (P = 0.058) were independent predictors. A novel classification system in which the DNA ploidy or SPF and the Gleason score were combined was found to be of significant prognostic value in all M0 tumours (P < 0.001). The results suggest that FCM can be used as an adjunct to conventional histological assessments for determination of the correct prognostic category in prostatic adenocarcinoma.

Adenocarcinoma↗
PubMed1993

A bioresorbable urethral stent. An experimental study.

The aim of the present study was to examine the suitability of biodegradable polymers as materials for a urethral stent. A new urethral stent made of biodegradable self-reinforced poly-L-lactide (SR-PLLA) was implanted in 16 male rabbits after urethrotomy. Seven stents of stainless steel served as controls. The dimensions of the two types of stents were identical: length 15 mm, diameter 8.2 mm. The mechanical construction was a helical spiral. The SR-PLLA spiral was sustained with three microspirals, and the whole device was coated with DL-lactide to achieve an active initial tissue reaction and better tissue penetration. The SR-PLLA stent showed more favourable implantation properties than the steel one. Within 6 months all PLLA stents had implanted, and the tissue reaction around the stent material was minimal. The helical spiral of stainless steel induced a remarkable inflammatory reaction due to poor implantation properties. We suggest that biodegradable SR-PLLA is a promising material for a urethral stent to prevent re-stenosis of urethral strictures.

Absorption↗
PubMed1993

Randomized controlled study of chemoprophylaxis in transurethral prostatectomy.

We studied 599 evaluable patients with benign prostatic hypertrophy at 7 urological units. Before transurethral prostatectomy the patients were randomized into 3 groups: group 1--197 patients given single-dose ceftriaxone (2 gm.), group 2--203 patients given 160/800 mg. trimethoprimsulfamethoxazole and group 3--199 controls given no antimicrobial prophylaxis. Patients with a preoperative indwelling catheter, positive urine culture, signs of active infection or preoperative antibiotic treatment were excluded. Postoperative infectious complications were demonstrated in 15 of 197 (7.6%), 25 of 203 (12.3%) and 43 of 199 (21.6%) patients in the study groups, respectively. The difference in infectious complications between groups 1 and 3 was statistically highly significant (p < 0.01) and between groups 2 and 3 it was significant (p < 0.05). Single-dose antibiotic prophylaxis proved to be useful in the prevention of serious infectious complications after transurethral prostatectomy.

Aged↗
PubMed1993

Toxicity and immediate allergenicity of latex gloves.

Surgical latex gloves and a natural rubber latex (NRL) catheter were evaluated for biocompatibility by cell culture methods and Type I allergic reactions in operating room personnel using latex gloves. The prevalence of relevant immediate allergy to NRL was 5.2% when using eluates made from different latex gloves as allergens and the skin-prick test methodology. The reliability of a questionnaire in detecting the sensitized persons was limited. Weak positive skin test reactions to surgical latex glove eluates were found to be unreliable as compared with challenging with the corresponding glove. Latex gloves exhibited more toxicity in cell culture than non latex gloves, but, inversely, the toxic catheter gave weak positive skin-prick test reaction in only one sensitized person, confirming that the allergenicity and toxicity of natural rubber products do not refer to the same properties of the products. Catheters exhibiting toxicity in cell culture have earlier been found to cause significant clinical symptoms in operated patients, but in the case of surgical gloves this relationship is not clear. One glove brand with a low content of known sensitizing rubber chemicals caused clear toxicity in cell culture but was well tolerated by the hospital personnel.

Allergens↗
PubMed1993

Prostakath in urinary outflow obstruction.

Prostatic stents are a new method in the treatment of urinary outflow obstruction caused by benign prostatic hyperplasia. In this study the usefulness of the PROSTAKATH urospiral was evaluated in a multicenter study for treatment of urinary outflow obstruction. There were 87 males with problems related to urination. Sixty-eight patients had total retention. The mean functioning time of the spiral was nine (1-35) months. The outflow obstruction was cleared in 69 (81%) patients. During follow-up, 33 spirals (39%) were removed; 15 of them within a few days after insertion. Altogether, transurethral resection of the prostate (TURP) was done on 22 patients, and transurethral incision of the prostate (TUIP) on four patients. Chronic urinary tract infection reduced significantly (P < 0.05) the functional time of the spiral; no other factors had influence on this variable. The spiral is a good alternative for treating urinary retention in patients waiting for prostatic surgery. The spiral may also be useful in the treatment of urinary obstruction caused by prostatic cancer. Recurrent vesical neck contracture can be prevented with the spiral. Entirely bedridden and demented patients do not benefit from this form of treatment.

Aged↗
PubMed1993

Contact Nd:YAG laser and regional renal hypothermia in partial nephrectomy.

Contact Nd:YAG laser resection using the sapphire tip is nowadays a well-known method of partial nephrectomy. Our material consists of six patients (seven resections). The indication for the operation was a renal carcinoma in five patients (six resections) and renal changes of von Hippel-Lindau syndrome in one patient. Occlusion of the renal artery insured a good intraoperative haemostasis. This improved the cutting properties of the laser and made it more accurate. Low energy levels could be used. Thus the destruction of the renal parenchyma will be reduced. The mean follow-up time was 15.3 months. No local recurrences or distant metastases have been detected. In our hands the Nd:YAG contact laser combined with renal hypothermia is superior to traditional methods of partial nephrectomy.

Carcinoma, Renal Cell↗
PubMed1993

Zinc compounds in urethral catheters. A possible source of toxicity?

The cytotoxicity of latex urinary catheters has been earlier documented. During the manufacturing process tens of chemicals are added to the natural rubber base. Several of the accelerators and other chemicals used have carcinogenic and acute toxic effects. Some of the accelerators are zinc compounds. In the present study, the cytotoxicity and zinc concentration of 68 latex catheter extracts were analysed. The siliconized latex catheters were the most toxic, and a correlation was seen between the IC50 values and the zinc concentration. The good manufacturing practice (GMP) has to some extent resolved the cytotoxicity problem of latex urinary catheters. There is, however, still a need to reformulate the manufacturing process and to find new catheter materials to meet the new EN standards concerning the biological safety of urinary catheters.

Biocompatible Materials↗
PubMed1993

Clean intermittent self-catheterization after urethrotomy for recurrent urethral strictures.

Although endoscopic optical urethrotomy is the primary treatment for urethral stricture, it is associated with a high recurrence rate, and the essential problem is how to stop the scar from shrinking after cutting. In a controlled study the effect of treatment of recurrent urethral stricture by internal urethrotomy followed by clean intermittent self-catheterization (CIC) for 6 or 12 months was compared in 25 and 24 patients, respectively. Patients learnt easily how to perform CIC: only one patient was not able to do it at home. All patients were evaluated by uroflowmetry before and immediately after urethrotomy, and 3, 6, 9 and 12 months later. Recurrence was defined as the need for further treatment. There was no difference in the recurrence rate between the two groups, but the maximum flow rate was significantly lower at 12 months in the patients who had ceased catheterization at six months. Complications included in two patients asymptomatic bacteriuria and in 10 patients symptomatic urinary infection. CIC is a very satisfactory method of managing patients with recurrent stricture, it is easy to learn, it prevents a decrease in the maximum flow rate and can thus be applied to most patients instead of regular bouginage. On the basis of the present study we could not determine any optimal time for the duration of CIC after urethrotomy, or whether it has any effect on the natural course of the disease.

Bacteriuria↗
PubMed1992

Morphological effects of photodynamic therapy on rabbit bladder using Photofrin II and Photosan intravesically and intravenously.

Photodynamic therapy (PDT) has proved effective against superficial papillary bladder tumours and focal and diffuse carcinoma in situ. Effective topical administration of the sensitiser would be a welcome improvement. The morphological effects of PDT on the normal bladder were examined in 13 rabbits when 2 photosensitisers (Photofrin II and Photosan III) were applied intravesically (5 mg/kg for 1 h) and compared with intravenous administration (3 or 5 mg/kg). Four animals served as controls without a sensitiser. Intravesical red light (630 nm) from an argon dye laser was used to activate the photosensitiser, using light doses of 12 or 24 J/cm2. The animals were sacrificed either 1 or 5 to 7 days after the laser treatment. Intravenous dosage induced bladder wall oedema/haemorrhage and total necrosis of the epithelium. There was no difference between the effects of the 2 sensitisers. Intravesical application induced superficial epithelial necrosis. The control animals treated with laser light alone showed slight superficial injury to the cell layer.

Administration, Intravesical↗
PubMed1992

Can fine needle aspiration biopsy detect incidental prostatic carcinoma (T1) prior to TUR?

The purpose of this study was to find out whether randomly taken fine needle aspiration biopsy (FNA) can detect incidental prostatic carcinoma prior to transurethral resection (TUR) and what are the effects of local tumor stage and grade on detection rate. Biopsies were taken from 344 patients, who came to hospitals for elective TUR without clinical evidence of prostatic carcinoma. Histologic examination of the TUR material showed prostatic carcinoma in 49 cases (14%). Sufficient material for cytologic examination was found in 343 cases. Of the 16 cases of T1a carcinoma in histologic examination, cytology found only 1, which was a G3 carcinoma. Of 33 T1b carcinoma in histologic examination, cytology found 6 and an additional 7 were suspect findings. Out of 6 G3 tumors in histologic examination, cytology showed 4. In our hands the proportion of false-negative cytologic findings in randomly taken FNA was so large that routine use of random FNA prior to TUR or as a screening procedure cannot be recommended, but positive FNA finding can be regarded as cancer.

Aged↗
PubMed1991

Comparison of two different cell culture methods in evaluation of biocompatibility of latex urinary catheters.

International biocompatibility standards for urinary catheters have not yet been set. The used in vivo animal tests earlier have been shown to be insensitive and expensive. The present study compared the sensitivity and other properties of two in vitro cell culture methods, the reference method of the British Standards Institution (BSI) and the thymidine incorporation method (DNA synthesis inhibition test. The cell culture toxicities of thirty-seven latex catheters were measured and 84.8% of the catheters tested passed the BSI reference test while 94.6% passed the thymidine incorporation test. The overall batch-to-batch correlation was poor (p greater than 0.05), but within brands the correlation was better. This is obviously to be explained by the differences the characteristics of the tests and/or the chemical composition of the catheters. The thymidine incorporation test is easier to perform, requires less manpower, and is therefore less liable to subjective interpretations than the BSI test. The biocompatibility toxicity limits for latex urinary catheters need to be tightened. Our experience in this study indicates that the thymidine incorporation test or tests similar to it, which can be highly automated can be recommended for biocompatibility screening in large series, and BSI reference test can be used additionally in unclear cases.

Animals↗
PubMed1991

Urethral blood circulation during cardiopulmonary bypass.

The haemodynamic changes induced by extracorporeal circulation (ECC) are thought to be important in the induction of urethral strictures in open heart surgery when indwelling latex catheters are used. In the present study, 6 piglets were cannulated and connected to extracorporeal perfusion apparatus. Pump flows correlated with human ECC values with non-haemic prime were used. The mucosal and submucosal blood circulation in the urethra reduced by 66% during ECC (P less than 0.05). The brain and hepatic arterial flows increased. A significant reduction was seen in renal blood circulation. The changes in the urethral blood circulation during ECC correlated with previous findings. The reduced wash out levels of chemicals leaching from the indwelling latex catheters as a result of reduced local blood circulation are the main trigger for the induction of urethral strictures during ECC and in other shock-like circulatory disturbances in the human body.

Animals↗
PubMed1991

Fibroepithelial polyps of the ureter.

Two cases of ureteric fibroepithelial polyps are presented. Macroscopic haematuria and flank pain were seen as symptoms in both cases. Intravenous urography, retrograde ureteropyelography, computed tomography, and ureterorenoscopy with visual biopsies were used as diagnostic methods. As a result of the preoperative diagnostics, saving surgical procedures (local excision and coagulation of the base of the tumour) were used with good results. The therapy of ureteric tumours should always be founded on the preoperative histological diagnosis and should be conservative transureteric or open surgical.

Adult↗