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O Lindfors

Publications and source records attributed to O Lindfors.

At least 19 recordsLinked to original sources
PubMed2005

A case study in comparing therapies involving informative drop-out, non-ignorable non-compliance and repeated measurements.

Virtually no comparisons of different psychotherapies with long follow-up times have been carried out until now. The Helsinki Psychotherapy Study is a randomized clinical trial, where patients were monitored for 12 months after the onset of study treatments, of which each lasted approximately 6 months. The patients' psychiatric status was measured at five pre-determined time points during the follow-up period. In general, the analyses of trials are complicated in cases where compliance with the given treatment is incomplete or the drop-out from the follow-up is non-ignorable. In the present study, the quality of the treatment deviated from the protocol for some patients and some patients took auxiliary treatments which had similar effects to the study treatment during the study treatment or follow-up period. This might have resulted in standard intention-to-treat analyses providing excessively conservative or liberal conclusions. Non-compliance may have been non-ignorable in some cases, so subject-specific latent factors may have influenced the outcome both directly and indirectly via compliance behaviour. The most and least healthy patients are the most likely to dropout from the follow-up a priori, so the missing data process is informative. The missing data can partly be augmented with surrogate information collected during interviews with patients who dropped out. A Bayesian hierarchical as-treated model, which uses random-effects-based selection models to account for non-ignorable missing data and non-compliance, was compared with different mixed effects models.

Adult↗
PubMed1999

Distal pulse palpation: is it reliable?

The aim of this study was to evaluate the reliability of distal pulse palpation. The dorsalis pedis and the tibialis posterior arteries of 25 patients with suspected lower limb arterial disease were independently palpated by three vascular surgeons and three medical students in the outpatient clinic and by two vascular nurses and one physician in the vascular laboratory. The palpation findings were compared to the ankle/brachial index (ABI). Palpable and unpalpable pulses were best separated with ABI 0.76 as the cutoff point. The degree of misdiagnosis was unacceptably high, with an underdiagnosis of more than 30%. The agreement was highest (kappa 0. 68, good) among the vascular laboratory personnel in the peaceful vascular laboratory and lowest (kappa 0.38, fair) among the vascular surgeons in the busy outpatient clinic. The poor agreement and the high proportion of misdiagnosis obtained in the outpatient clinic argue against the use of pulse palpation as a single diagnostic method. Palpable pulses with low ABIs clearly state the need for more objective measurements whenever ischemia is suspected. Yet, by carefully palpating both pedal arteries under good, nonhurried conditions the reproducibility and accuracy of pulse palpation can be tolerable.

Adult↗
PubMed1996

Aortofemoral surgery and sexual function.

OBJECTIVES: To determine the incidence and pathophysiology of erectile dysfunction (ED) in patients with aortoiliac occlusive disease (AIOD) and the effects of aortofemoral surgery, including endarterectomy (E) and reconstruction (R), on erectile function (EF). DESIGN: Evaluation of EF before and 3 months after surgery. METHODS: 31 out of 40 male patients scheduled for aortofemoral surgery were given multiple choice questionnaires and penile dynamic Colour Doppler Ultrasonography. RESULTS: Of the 31 who agreed to enter the study five (16%) were found to be potent and 26 (84%) to suffer from ED. This was purely arteriogenic in 8% of the cases, purely venogenic in 23%, combined arteriogenic and venogenic in 53%, and neurogenic in 16%. Twenty patients returned for postoperative evaluation of EF, nine who had undergone E and 11 who had undergone R. Improvement of EF, in terms of increased penile arterial inflow, occurred in seven patients, six who had undergone E and one who had undergone R. EF remained unchanged in nine patients, three who had undergone E and six who had undergone R. Deterioration of EF occurred in four patients, all who had undergone R, and was attributable to decreased arterial inflow in two cases and to neurogenic surgical injury in the other two. CONCLUSIONS: The majority of patients with AIOD suffers from ED. Reduced penile arterial inflow and cavernovenous leakage are equally important in the pathophysiology of ED in patients with AIOD, suggesting that atherosclerosis may also compromise the penile veno-occlusive mechanism. Endarterectomy seems more likely than reconstruction to improve or maintain EF.

Aorta, Abdominal↗
PubMed1994

Ability to work after arterial surgery for chronic incapacitating ischaemia of the lower limb in middle-aged patients.

OBJECTIVE: To assess the efficacy of arterial surgery in restoring ability to walk and working capacity. DESIGN: Retrospective follow up study. SETTING: Fourth Department of Surgery, Helsinki University Central Hospital. SUBJECTS: 67 middle-aged patients (mean age 53 years) with chronic incapacitating ischaemia of the lower limb. INTERVENTIONS: Arterial reconstruction. MAIN OUTCOME MEASURES: Clinical outcome, vascular laboratory assessments, mortality, morbidity, return to work, and retirement. RESULTS: According to objective vascular laboratory criteria a primary positive effect was achieved in 63/67 (94%). Fourty-eight of the 65 surviving patients (74%) were free of symptoms on treadmill testing three months after the operation. Working capacity was restored in 41/50 of the patients not yet retired (82%). Three years postoperatively 77% of the surviving patients still fared objectively better than before operation. The 10-year survival rate was 67%. Fourteen of the 22 patients who died did so of cardiovascular diseases (64%). Advanced distal ischaemia (indicated by a preoperative ankle-brachial index of 0.5 or less) was associated with increased risk of death. Altogether 251 working years were achieved of the 435 that could have potentially been gained. The most common reason for retirement during follow up was progression of peripheral arterial disease in the lower limbs in 13/41 patients (32%). At the end of the study there were nine patients still working with potentially 73 working years left. CONCLUSION: These results indicate that arterial surgery can restore working capacity in middle aged patients with threatening or temporary invalidity. Long term outcome, especially mortality, is mostly affected by other signs of cardiovascular disease, whereas working capacity is dependent on a wider variety of factors.

Adult↗
PubMed1992

Cardiac arrhythmias and myocardial ischemia after thoracotomy for lung cancer.

The records of 598 patients undergoing a thoracic surgical procedure for lung cancer from 1975 through 1989 were reviewed for occurrence of cardiac arrhythmias and myocardial ischemic events. Atrial tachycardias occurred in 16% (94/598); atrial fibrillation was preponderant (87%), followed by supraventricular tachycardia and atrial flutter. Patients with recurrent episodes of dysrhythmias had a significantly higher mortality rate than those without episodes or with a single episode only (17% versus 2.4%; p less than 0.01). Transient ischemic electrocardiographic changes were documented in 23 patients (3.8%) and myocardial infarction in 7 (1.2%). An abnormal preoperative exercise test result and intraoperative hypotension were strongly associated with both dysrhythmia and ischemia (p less than 0.01). Pneumonectomy, ischemic changes on the electrocardiogram, and cardiac enlargement were also associated with arrhythmias (p less than 0.01). A weaker association (p less than 0.05) was found between postoperative arrhythmias and old myocardial infarction (greater than 6 months), arterial hypertension, and heart failure. Pulmonary function had no predictive value in this respect. A history of angina or old myocardial infarction was predictive of transient postoperative myocardial ischemia but not myocardial infarction. Despite improved anesthetic and monitoring techniques and more frequent use of the intensive care unit postoperatively in the last decade, the incidence of arrhythmias after thoracotomy has not decreased. More effective prevention is needed, particularly for patients with defined preoperative and perioperative risk factors.

Aged↗
PubMed1990

How many projections are really needed in angiographic assessment of the femoral bifurcation?

The purpose of this study was to analyze how many angiographic projections are needed in the diagnosis of hemodynamically significant stenoses of the femoral bifurcation. A total of 134 femoral bifurcations were examined with triplanar angiography in 67 patients (45 men and 22 women). The patients, ranging in age from 42 to 81 years (mean 63), suffered from incapacitating symptoms of peripheral arterial disease. The contralateral posterior oblique projection proved to be the most valuable in the assessment of hemodynamically significant arterial stenoses of the femoral bifurcation. An AP projection added information on stenoses of the inlets of the deep femoral artery in 9% of cases and on stenoses of the inlets of the superficial femoral artery in 6% of cases. An arteriographic examination should be started with a contralateral posterior oblique projection and this view will suffice in most cases.

Adult↗
PubMed1990

[Vascular surgery in Finland].

The number of vascular operations performed in Finland correspond to those in Europe as a whole but is less than in the other Nordic countries. Unlike the practice in the other Nordic countries vascular surgery in Finland is included in other heart and thorax surgery, which means that it receives fewer resources.

Cardiac Surgical Procedures↗
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↗
PubMed1987

Personality factors as predictors of compliance with and the outcome of supervised self-care program for patients with intermittent claudication.

Personality factors related to the outcome of supervised self-care treatment program were studied in 56 patients with intermittent claudication. Psychological methods used were: structured interviews, the Rorschach Test, the Thematic Apperception Test, Beck's Depression Inventory, the Beth Israel Hospital Inventory of alexithymic behavior and Sauri's Creativity Inventory of psychic flexibility and adaptability. The patients who had no apparent signs of psychic disorders and were also capable of coping with disease-related psychic problems showed the best recovery. Alexithymic patients with a low level of psychic adaptability were likely to find the supportive relationship rewarding, but optimal recovery was not achieved. The results indicated that paranoid tendencies may be obstacles to a satisfying doctor-patient relationship and should be controlled.

Adult↗
PubMed1987

Personality factors in intermittent claudication related to the outcome of self-care program.

The relationship between personality factors in intermittent claudication and the patient's compliance with the therapeutic regimen was studied. Fifty-three patients with intermittent claudication were clinically examined, interviewed and tested with the Wechsler Intelligence Test, the Rorschach Test and the Ceasarec-Marke Inventory. The patients were given self-care program with four recommendations. After half a year, the clinical examinations and interviews were repeated. The results showed that the compliance with self-care program was relatively poor. Hostility, aggressiveness and affect-lability were obstacles to compliance. Obsessive-compulsive and dependent patients as well as those with strong guilt feelings followed the regimen best.

Adult↗
PubMed1987

Late results and prognosis after carotid artery surgery.

Carotid reconstruction was performed on 75 patients (84 operations) mainly because of transient ischemic attacks (TIA) and/or amaurosis fugax (67%) or TIA with incomplete recovery (20%). The operative mortality was 2.4%. The incidence of permanent postoperative neurologic deficit was 6.0%. The postoperative observation time was 1 year to 13 years 5 months (mean 66 months). At follow-up 87% of the survivors were symptom-free. Three new strokes, one of them not related to the operated side, occurred follow-up, and 26 more patients died. The relative cumulative 5-year survival was 87.3%. Of the total 28 deaths, 16 were due to myocardial infarction. Mortality was significantly heightened and cumulative 5-year survival reduced when preoperative ECG had indicated coronary heart disease. The high incidence of deaths from myocardial disease during long-term follow-up was directly related to preoperative presence of coronary heart disease.

Adult↗
PubMed1986

Peripheral arterial disease--natural outcome.

Three hundred and twelve patients with peripheral arterial disease were followed up for 8 3/4 years or more (maximum 11 3/4 years) to assess the natural history of the disease and factors determining its outcome. Of the 312 patients, 188 (69%) died during the follow-up, 68% of the deaths having cardiovascular causes. The 10-year relative cumulative survival rate was 0.61 for males and 0.48 for females. The role of smoking as a risk factor could not be analysed without bias. In addition to known risk factors diabetes mellitus, cerebrovascular disease and coronary heart disease, the degree of peripheral arterial disease itself also proved to be a risk factor among men. The expected life lost for men with intermittent claudication was 20%, but 44.3% for men with advanced lower limb ischaemia (p less than 0.01). This difference could not be explained by the well-known association of advanced ischaemia and diabetes mellitus. The present results therefore suggest that the state of advanced ischaemia indicates larger involvement of the whole of the arterial tree and predicts fatal cardiovascular events among these patients.

Aged↗
PubMed1983

The effect of withdrawal of beta-adrenergic blockade on intermittent claudication.

Twenty-eight patients with intermittent claudication were studied before and one month after withdrawal of treatment with beta-adrenergic blocking drugs for hypertension, coronary heart disease or both. Heart rate, blood pressure, ankle/arm systolic blood pressure ratio and ankle pulse volume recording (PVR) at rest and after treadmill exercise were recorded, as well as walking distance, time of recovery from subjective symptoms, restitution time of pressure ratio and PVR. A control group of 14 patients, whose beta-adrenergic blocking drugs were not withdrawn, was also included. The result can be summarized as showing that withdrawal of beta-blockade was not demonstrably advantageous in patients with intermittent claudication. Significant improvement was observed only during the first month of the trial, a change which was independent of withdrawal of beta-blockade. The relief of subjective symptoms after exercise occurred significantly faster after withdrawal of nonselective beta-blockade. Otherwise, there was no difference between nonselective and cardioselective beta-adrenergic blocking drugs.

Adrenergic beta-Antagonists↗
PubMed1983

The ankle/arm systolic blood pressure ratio as a screening test for arterial insufficiency in the lower limb.

Doppler-derived ankle/arm systolic blood pressure ratios were measured in 424 patients with ischaemic arterial disease of the lower limbs and in 52 controls. 90 of the patients were diabetic. The value of this simple test in screening for arterial insufficiency was evaluated retrospectively. The results were reproducible the coefficient of variation being about 10%. In most patients a test performed at rest was sufficient to detect arterial insufficiency. However, in some milder cases a stress test was needed to distinguish them from subjects without arterial insufficiency. In some patients with advanced diabetes mellitus false high pressure readings were recorded as a result of vessel wall stiffness. However, only one patient with mild diabetes had a false normal pressure ratio. In patients with distal gangrene diabetes mellitus caused erroneously high pressure ratios.

Adult↗
PubMed1982

A false aneurysm of the deep femoral artery.

A case of deep femoral artery false aneurysm as a late complication to a blunt trauma is reported. The diagnosis was confirmed by angiography. The patient was operated on and she was symptom-free at follow-up 15 months later.

Adolescent↗
PubMed1982

Predictive value of preoperative segmental blood pressure measurements in below-knee amputations.

Segmental blood pressure criteria for below-knee amputations were assessed retrospectively. 40 patients underwent 44 below-knee amputations for advanced lower limb ischaemia. Preoperative systolic blood pressure measurements using a Doppler device as a distal sensor were performed on 31 limbs to be amputated. Healing occurred in all limbs with calf systolic pressures of 68 mmHg or more and distal thigh systolic pressures of 100 mmHg or more. With calf pressures below 35 mmHg and distal thigh pressures of 60 mmHg or less, all amputations failed. Diabetes did not affect the pressure criteria except for one obvious case with mediasclerosis. It appeared that pressure data could be used to improve the preoperative assessment of the amputation level.

Aged↗