Biomedical subjects

P Aarnio

Publications and source records attributed to P Aarnio.

At least 19 recordsLinked to original sources

PubMed2005

Comparison between flutter valve drainage bag and underwater seal device for pleural drainage after lung surgery.

AIM OF THE STUDY: The purpose of the present study was to compare the use of a conventional underwater seal device with suction and a flutter valve drainage bag for pleural drainage after lung surgery. PATIENTS AND METHODS: Altogether 59 patients undergoing elective lung surgery except pneumonectomy between February 2001 and April 2002 were prospectively randomized to receive postoperative pleural drainage by 28F chest tube(s) attached to underwater seal device placed on negative pressure of 15 cm of water or flutter valve drainage bag. Following withdrawal of four patients from the study, 55 patients were evaluated (31 patients in the underwater seal device group and 24 patients in the flutter valve drainage bag group). RESULTS: In the conventional underwater seal device group the mean drainage time was 2.6 (SD +/- 2.0) days and in the flutter valve drainage bag group the mean drainage time was 3.3 days (SD +/- 4.0); difference -0.8, 95% confidence interval (CI) -2.4 to 0.9. The mean length of hospitalization in the surgical ward was 3.6 (SD +/- 2.7) and 4.1 (SD +/- 4.4) days respectively (difference -0.5, 95% CI -2.5 to 1.4). CONCLUSIONS: The results of this study suggest that flutter valve drainage system is a safe and feasible alternative in managing postoperative air leaks and haemorrhage after lung surgery other than pneumonectomy if air leaks are not extremely massive.

Drainage↗

PubMed2004

Glove perforations in open and laparoscopic abdominal surgery: the feasibility of double gloving.

BACKGROUND AND AIMS: According to the traditional view, the glove protects the patient from the bacterial growth of the surgeons' hands and doing so prevents infections. Today, with growing incidences of HIV and Hepatitis B and C, surgical gloves are also important as protection for the surgeon. We compared the safety of double indicator gloves to standard single surgical gloves by investigating how often surgical gloves are punctured in laparoscopic and open gastrointestinal surgery. STUDY: As study material we gathered all gloves that had been used in gastrointestinal surgery in Satakunta Central Hospital during two months. 814 gloves from 274 operations were tested by using standardized water filling test method. RESULTS: In open surgery 67 gloves out of 694 had been punctured (9.6 percent). Puncture occurred in 22.5 percent of operations (53 out of 236). During open surgery 24 holes out of 35 were undetected with single gloves (69 percent). With double indicator gloves, only 3 out of 31 holes were unnoticed (10 percent). Long duration of operation increased the risk of puncture. In laparoscopic operations 4 gloves out of 120 had been perforated (3.3 percent). CONCLUSION: Double surgical gloves give markedly better protection in surgery. This is important especially in high risk operations.

Chi-Square Distribution↗

PubMed2004

Glove perforation in orthopaedic and trauma surgery. A comparison between single, double indicator gloving and double gloving with two regular gloves.

The spread of viral diseases such as HIV has highlighted the importance of protecting medical personnel against contamination from blood. We have assessed the frequency of the perforation of surgical gloves during orthopaedic and trauma surgery and compared the efficiency of single and double gloving. We examined all the gloves used by surgeons for a period of two months. There were 1769 gloves from 349 operations. Perforations occurred in 18.5% of conventional and 5.8% of arthroscopic procedures. The risk of contamination from blood was 13 times higher when using single compared with double gloves. Surprisingly, the combination of two regular gloves was much less efficient than double indicator gloves when comparing the rate of perforation of the inner glove when the outer had been damaged (24% vs 4.9%; p = 0.02). We recommend double gloving in orthopaedic surgery in general and also in long arthroscopic procedures.

Arthroscopy↗

PubMed2002

Endovascular treatment of aortic aneurysms in Finland: the first four years' experience.

BACKGROUND AND AIMS: In this study the results of endovascular treatment of aortic aneurysms in Finland are presented and compared to the results of the Eurostar registry. MATERIAL AND METHODS: A total of 229 patients with aortic aneurysm were treated in five different Finnish centres during 1996-2000. The data of these patients were collected prospectively by surgeon or interventional radiologist involved. During the same period of time 2464 patients were registered in the Eurostar registry. RESULTS: The procedure was performed successfully in 97% of patients in Finland, and the 30-day mortality was 0,9%. A graft limb thrombosis was detected in 9% of the patients in Finland. A permanent primary endoleak at the first 30-day control was seen in 23 patients (10%). During the follow-up 17 secondary endoleaks (7%) were detected. A secondary intervention was necessary in 26% of the patients. Three patients (1.3%) had late rupture of the abdominal aortic aneurysm. CONCLUSIONS: According to the Finnish short-time results, endovascular treatment of aortic aneurysms is safe and associated with relatively low morbidity and mortality. The mid-term results are more disappointing with relatively many graft thromboses and endoleaks, and a frequent need of secondary interventions.

Adult↗

PubMed2001

How often does glove perforation occur in surgery? Comparison between single gloves and a double-gloving system.

BACKGROUND: In surgery, intact gloves protect the surgeon from bloodborne pathogens and the surgical wound from microorganisms on the skin of the surgeon. However, glove perforation is very common, and puncture rates as high as 61% are published in the literature. One objective of this study was to compare puncture rates between a unique double-gloving puncture indication system and single-use gloves, and another was to determine the extent to which glove perforations remain undetected during surgery. METHODS: The study material comprised all gloves used in surgical operations at our hospital for a period of 2 months. The analysis was made by the glove type in a prospective and randomized manner. Gloves were tested immediately after the surgical procedure using the approved standardized water-leak method for 2 minutes to detect any holes. The gloves used in this study were either a double-gloving puncture indication system or the standard glove used at our hospital. RESULTS: In 885 operations altogether, 2,462 gloves were tested; 1,020 single gloves, 1,148 double-glove systems, and 294 combination gloves were studied. The overall perforation rate was 192 out of 2,462 gloves (7.80%), and 162 out of 885 operations (18.3%). The detection of perforation during surgery was 28 out of 76 (36.84%) with single gloves, 77 out of 89 with the double-gloving system (86.52%), and 9 out of 27 with combination gloves (33.33%; P <0.001). The inner glove of the double-gloving system was punctured in 6 out of 88 outer glove perforations (6.82%). CONCLUSIONS: In view of the critical importance of safety at work by having a sterile barrier between surgeon and patient, it is very important to use a double-gloving puncture indication system, at least in operations where there is a high risk of glove perforation.

Color↗

PubMed2001

Glove perforation rate in vascular surgery--a comparison between single and double gloving.

BACKGROUND: In surgery intact gloves act as a sterile barrier between surgeon and patient. The impermeable gloves protect the surgeon from bloodborne pathogens such as HIV, hepatitis B, and hepatitis C. On the other hand, the surgical wound is protected from micro-organisms from the skin of the surgeon. One objective of this study was to compare puncture rates between the double gloving color indication system and single-use gloves and the other to determine the extent to which glove perforations remain undetected during the course of vascular surgical operations. PATIENTS AND METHODS: The study material comprised all gloves used in vascular surgical operations at Satakunta Central Hospital for a period of two months. The analysis was made by the glove type in a prospective and randomised manner. Gloves were tested immediately after the surgical procedure using the approved standardized water-leak method. With this method the glove is filled with water using a special filling tube, and the water-filled glove is then checked for two minutes to detect any holes. The gloves used in this study were either double gloves with indicator, or the standard glove used at our hospital. RESULTS: In 73 operations altogether 200 gloves were tested, half of them were double gloves and half were single gloves. The perforation occurred in the double gloves 3 times and with single gloves 12 times. The overall perforation rate was 15 out of 200 gloves (7.5%). The detection of perforation during surgery was 60%. Most frequently the perforation was located in the second finger of the left hand, 9 out of 15 perforations. CONCLUSION: In view of the critical importance of safety at work both transmitting the pathogens from the skin of the surgeon to the wound and transmitting the bloodborne pathogens from the patient to the surgeon, it is very important to use double gloving at least in operations where there is a high risk of glove perforation.

Blood-Borne Pathogens↗

PubMed2001

Insulin secretion and glucose kinetics during exercise with and without pharmacological alpha(1)- and alpha(2)-receptor blockade.

The mechanism behind exercise-induced decreases in plasma insulin concentrations was examined in eight healthy young men. In addition, the influence of specific alpha(1)- and alpha(2)-adrenoceptor blockade on glucose kinetics during exercise was studied. To test the hypothesis that exercise-induced decreases in insulin secretion are mediated via alpha(2)-adrenoceptors, all subjects exercised for 60 min on separate occasions under four conditions: with and without alpha(1)-receptor blockade (1 mg prazosin) and with and without or alpha(2)-receptor blockade (15 mg yohimbine). Glucose kinetics were measured using [3-(3)H]glucose. During exercise with alpha(2)-receptor blockade, the insulin concentration initially increased (first 20 min) then decreased, whereas it continually decreased in the corresponding control experiment. The C-peptide concentration did not change during exercise with alpha(2)-receptor blockade but decreased in the control experiment. During exercise with alpha(1)-receptor blockade and corresponding control experiments, insulin and C-peptide levels always decreased. With alpha(1)-receptor blockade, the glucose concentration increased (first 30 min) and then decreased, whereas it slightly decreased in all other experiments. In addition, with alpha(1)-receptor blockade, the glucose rate of appearance (Ra) increased rapidly (because of higher catecholamine concentrations in alpha(1)-receptor blockade versus control) and the glucose rate of disappearance (Rd) was higher compared with control. During exercise with alpha(2)-receptor blockade, the Ra and Rd were always lower compared with control. Therefore, we conclude that exercise-induced decreases in insulin secretion are mediated via alpha(2)-adrenoceptors and that blockade of alpha(1)- and alpha(2)-adrenoceptors during exercise elicits opposite responses in glucose Ra and Rd.

Adrenergic alpha-1 Receptor Antagonists↗

PubMed2001

Flutter valve drainage bag is a useful device for the pleural drainage.

BACKGROUND AND AIMS: The purpose of the present study was to compare the use of the flutter valve pleural drainage bag and the conventional underwater seal system for the pleural drainage in the treatment of pneumothorax and pleural effusion. PATIENTS AND METHODS: Altogether fifty patients who needed the pleural drainage at our hospital between February and October 1999 were randomized to this prospective study either into the flutter valve pleural drainage group or into the conventional underwater seal pleural drainage group, 25 patients in each. RESULTS: In the conventional underwater seal system group, the mean drainage time was 4.1 (SD +/- 4.0) days and in the flutter valve drainage bag group 4.8 (SD +/- 4.9) days (difference -0.7, 95% confidence interval (CI) -3.3 to 1.8). The mean length of hospitalization was 16.3 (SD +/- 20.9) days and 18.7 (SD +/- 27.0) respectively (difference -2.4, 95% CI -16.1 to 11.3). CONCLUSIONS: The results of this study suggest that flutter valve drainage bag is a safe and feasible system in the most cases when pleural drainage is needed in the treatment of pneumothorax and pleural effusion.

Aged↗

PubMed2000

Vascular Clips in Anastomoses of Femoropopliteal Arterial Reconstruction.

The vascular anastomoses are usually made with sutures. Some mainly experimental studies have been published about a new method of doing the vascular anastomoses with metal clips. We studied the suitability of vascular closure staple (VCS) clip applier system for making the anastomoses in femoropopliteal and femorotibial arterial reconstruction. During an 11-month period, VCS clips were used in 17 out of 27 patients who were operated due to severe claudication or incipient gangrena of the foot. Altogether 26 anastomoses were made with VCS clips using either great saphenous vein or PTFE graft. The making of anastomosis was easy and reliable. No postoperative bleeding was noticed. All anastomoses were patent 4-6 weeks postoperatively studied by palpation and measured by ankle brachial pressure index (mean 0.96). In Duplex Doppler examination all studied patients had well patent anastomoses on an average 11 months after the operation. With VCS clip applier system, it is possible to do anastomoses in arteriosclerotic arteries like in femoropopliteal reconstructions. This method helps making reliable anastomoses more easily.

Journal Article↗

PubMed2000

Healing of bronchial allografts in pigs.

Our purpose was to investigate the healing of bronchial grafts in a porcine experimental model. Via left thoracotomy, a 2.5 cm long bronchial stump was anastomosed back to the same animal (autograft) or to another pig (allograft). Autotransplanted bronchi (six pigs) healed very well without infection. Allotransplantation without immunosuppression (eight pigs) was followed in all cases by rejection with formation of major bronchopleural fistula. After allotransplantation with triple-drug immunosuppressive medication (seven pigs), three pigs showed infection-free healing, but the anastomoses were slightly stenosed at the time of sacrifice (mean 30 d), while four had bronchopleural fistula. The study thus showed the healing ability of totally avascular bronchial graft in pigs to be very good when it is autotransplanted, but poor when allotransplanted without immunosuppressive treatment.

Animals↗

PubMed2000

Percutaneous dilational tracheostomy or conventional surgical tracheostomy?

OBJECTIVE: Percutaneous dilational tracheostomy (PDT) is increasingly used in intensive care units (ICU), and it has a low incidence of complications. The aim of this study was to compare the costs, complications, and time consumption of PDT with that of conventional surgical tracheostomy (ST) when both procedures were performed in the ICU. DESIGN: The study was a prospective, randomized trial. SETTING: The procedures were performed routinely in the ICU of Satakunta Central Hospital. PATIENTS: During a 23-month period from December 1995 to November 1997, 30 patients underwent PDT and 26 patients had ST. In one patient, PDT was converted to ST. All patients were receiving ventilation in the ICU, and all tracheostomies were performed at the patient's bedside in the ICU. The Portex percutaneous tracheostomy kit was used for all PDTs. RESULTS: The mean time to perform PDT was 11 mins (SD, 6; range, 2-40), and the mean time to perform ST was 14 mins (SD, 6; range, 3-39). In the PDT group, five patients had moderate bleeding during the procedure. In three patients, the bleeding was resolved with compression; in one patient, it was resolved with ligation of the vessel; and in one patient, it was resolved with electrocoagulation. Bleeding did not cause any complications afterward. In the PDT group, one patient had minimal oozing from the wound edge on the first postoperative day and it was resolved spontaneously. In the ST group, there were no intraprocedural complications. One patient had bleeding from the wound on first postoperative day. The sutures were removed, and the bleeding vessel was ligated. The mean cost (in U. S. dollars) of PDT was $161 (SD, 10.4; range, $159-$219), and the mean cost of ST was $357 (SD, $74; range, $239-$599). The cost of PDT was significantly lower than the cost of ST (p < .001). CONCLUSION: We found that PDT is a cost-effective procedure in critically ill ICU patients. Although we performed ST at the bedside in the ICU to avoid the risks associated with moving critically ill patients to the operating room, we found PDT to be a simple and safe procedure.

Adult↗

PubMed2000

User satisfaction with teleconsultations for surgery.

We carried out a prospective study of realtime videoconferencing in surgical consultations. Videoconferencing equipment at the Satakunta Central Hospital, Pori, was connected by ISDN at 384 kbit/s to two health centres in the cities of Kankaanpää and Huittinen (55 and 60 km from Pori, respectively). A document camera was used to transmit images of radiographs and paper documents. Fifty patients who needed a surgical consultation were examined by a doctor in the health centres, and the surgeon interviewed and observed the physical examination by videoconference. The consultation time ranged from 12 to 23 min (mean 15 min). Technically the equipment functioned reliably and the quality of the video-picture was good. According to the consulting surgeon, the decision made in the videoconference was reliable in 48 cases (96%). According to the doctors in the health centres, the consultation was useful in 49 cases (98%) and was considered satisfactory in one. The doctors thought that the teleconsultation was as reliable as an outpatient appointment in 49 cases (98%). The educational benefit of the consultation was excellent or good in 38 cases (76%). The overall satisfaction of patients was very good or good in 45 cases (96%). All patients, except one, avoided travelling to a face-to-face appointment because they received a definite treatment decision during the teleconsultation.

Attitude of Health Personnel↗

PubMed2000

Abdominal disorders arising from 71 Meckel's diverticulum.

BACKGROUND AND AIMS: The study was done to investigate the frequency of Meckel's diverticulum, and its manifestations as the cause of abdominal disorders. MATERIAL AND METHODS: The material consisted of 71 patients with Meckel's diverticulum treated in our hospital during the years 1988-1998. From the material the age and sex were analyzed as well the outcome of patients. The histological findings of diverticulectomies were evaluated. RESULTS: In a retrospective analysis 46 males (65.5%) and 25 females (34.5%) were found. At the same eleven-year study period Meckel's diverticulum was found during 55 out of 3758 appendicectomies (1.5%). The age of patients ranged from 11 months to 87 years (mean 30.4 years). Preoperatively the diagnosis was made in three cases: two patients with TC-99m scanning and one patient with intestinal passage radiography. 46 Meckel's diverticles were asymptomatic, but 25 (34.5%) cases were symptomatic. Nine patients had ulcer in the diverticulum, which was perforated in five cases. Eight patients had intestinal occlusion, five patients had Meckel's diverticulitis, two patients had invagination, and in one case a sharp piece of plastic material had perforated the Meckel's diverticulum. CONCLUSION: Meckel's diverticulum should be searched in the laparotomy due to acute abdomen. It can be the cause of serious abdominal complications.

Abdominal Pain↗

PubMed2000

A new method for surgical consultations with videoconference.

BACKGROUND: The aim of our prospective study was to examine the technical ability and the medical suitability of a realtime teleconferencing system in surgical consultations. METHOD: A personal computer-based-videoconferencing system was used over an architecture of the IP (Internet Protocol) over ATM (Asynchronous Transfer Mode) area network connecting Satakunta Central Hospital, Pori with a health center in the community of Noormarkku (15 km apart from Pori). A document camera was used for transfering the radiographs and paper documents. The material consisted of 50 patients who needed surgical consultation. The patients were examined by a physician in the health center of Noormarkku, and the surgeon interviewed and observed the physical examination with the aid of teleconference. RESULTS: Technically the videoconferencing system functioned reliably, and the visual quality of the videopicture was good after more powerful personal computers (Pentium II with a 266 MHz prosessor and 64 Megabits RAM-memory) were changed for the videoconferencing system. All patients, except one, saved the travelling to the face-to-face appointment because they got a definite decision of the treatment already at the videoconsultation. According to the opinion of the consulting surgeon, the decision which was made in the teleconference was good or very good, except in one case very poor. The physicians of the health centers were satisfied both with the decisions of the treatment of their patients and with the educational effect of a consultation where two physicians are present at the same time. All patients thought that it was good to be in consultation with two doctors. CONCLUSION: Surgical videoconsultations are a reliable method and a real alternative to sending a patient to a distant place for consultation.

Female↗

PubMed1999

A prospective study of teleconferencing for orthopaedic consultations.

We carried out a prospective study of teleconsulting in orthopaedics. A commercial videoconferencing system was connected by three ISDN lines between the Satakunta Central Hospital in Pori and the Orton Orthopaedic Hospital in Helsinki, 240 km away. A document camera was used to transfer radiographic images and paper documents. Twenty-nine patients who needed an orthopaedic consultation were studied over three months. They were examined by a surgeon in Pori with the aid of teleconferencing and again later in a traditional, face-to-face appointment in Helsinki. Patients and doctors completed questionnaires after the consultations. Technically, the videoconferencing system functioned reliably and the quality of the video was judged to be good. Twenty patients (69%) would not have needed to travel for a face-to-face appointment, because the teleconsultation afforded a definite treatment decision. The orthopaedic surgeons considered all the treatment decisions arising from the teleconsultation good, except in one case which was considered satisfactory. The quality of the radiographic images transferred with the document camera was good or very good in 17 cases and satisfactory in three cases. None of the patients had experienced videoconferencing before; 87% of them thought that teleconsultation was a good or very good method and the rest felt that it was satisfactory. All patients wanted to participate in teleconsultations again and most would have recommended it to other patients.

Adolescent↗

PubMed1999

Bioabsorbable self-reinforced poly-L-lactide, metallic, and silicone stents in the management of experimental tracheal stenosis.

The aim of the present study was to compare, in rabbits, the biocompatibility and suitability of a bioabsorbable spiral stent made of self-reinforced poly-L-lactide (SR-PLLA) in the management of experimental tracheal stenosis with stents made of metal and silicone. Tracheobronchial stenosis, and its management, is still problematic because stenoses are not always amenable to surgical resection and reconstruction, especially concerning anastomotic problems and stenosis after lung transplantation. Stenosis can be handled with stenting, although the ideal stent has yet to be developed; all the stents available have their disadvantages. Because stenting of the airways can be only temporary, stents made of bioabsorbable materials, theoretically, offer benefits. Tracheal stenosis was created in rabbits by the extramucosal resection of cartilaginous arches of the cervical trachea. After a few weeks, the animals were operated on again, and those stenoses that had developed were dilated with a balloon. Stents then were implanted in the area of stenosis to keep the dilated trachea open. All the animals in the group with silicone stents had to be killed because of respiratory difficulties: their stents had a tendency to occlude because of internal encrustation, and they developed a hyperplastic polyp at the ends of the stents. The SR-PLLA and metallic stents were tolerated well, and after follow-up ended the animals were put to death. This experimental study showed that silicone stents had a tendency to occlude and that stents made of metal and of SR-PLLA were well tolerated and can be used in the management of airway stenosis.

Absorption↗

PubMed1999

Use of the Heimlich valve for treating pneumothorax.

BACKGROUND AND AIMS: The aim of this retrospective study was to compare the use of a small caliber tube connected to Heimlich flutter valve with a conventional thoracic drainage system in the treatment of pneumothorax. MATERIALS AND METHODS: Patients with simple pneumothorax during the years 1991-1995 in Satakunta Central Hospital were included in this study. Nineteen patients were treated with the Heimlich flutter valve and 57 patients were treated with the standard drainage tube connected to an underwater seal device. The data were collected from hospital records focusing on the duration of chest drainage, the number of chest roentgenograms and the length of hospital stay. RESULTS: In the Heimlich valve group the mean drainage time was 2,2+/-0.9 days and in the standard thoracic drainage group 3.4+/-3.8 days (p <0.05) respectively. The mean length of hospitalization in the Heimlich valve group was 3.3+/-2.2 days and in the standard thoracic drainage group 5+/-4.9 days (p < 0.01). The number of chest roentgenograms in the Heimlich valve group was 3+/-1.1 and in the standard thoracic drainage group 4.6+/-2.7 (p < 0.001). CONCLUSION: We believe that the treatment with a small caliber tube and Heimlich valve is a safe and effective procedure. It also reduces the duration of chest drainage and the length of hospital stay.

Adult↗

PubMed1999

Using IP-videoconferencing systems in a surgery consulting.

In this paper we describe how to use IP-videoconferencing systems in medical surgery consulting. We started to think about how we could use special doctor's services without patients having to travel a long way. The answer to this question is that the information goes from one place to another, not the patient. First we had a pilot project, where we used the 3xISDN transmission rate and now we are using ATM. We have here in Satakunta a local area network between our Satakunta Central Hospital and the Health Care Center in Noormarkku and Kankaanpää, so we have very good environment to do this kind of research. Our network is quite fast, we can use the 10 Mbps bitrate and in this network there are no other activities in this moment, so there are not any interferences. There is a surgery specialist in the hospital and a doctor in the health care center with a patient. The specialist looks at the monitor, where there is a videopicture of the patient from the health care center. Then the specialist makes the treatment plan for the patient.

Adolescent↗