Biomedical subjects

P Luukkonen

Publications and source records attributed to P Luukkonen.

18 recordsLinked to original sources

PubMed1992

Abdominal rectopexy with sigmoidectomy vs. rectopexy alone for rectal prolapse: a prospective, randomized study.

A prospective, randomized study comparing abdominal rectopexy and sigmoid resection (Group I; n = 15) with polyglycolic acid mesh rectopexy without sigmoidectomy (Group II; n = 15) for complete rectal prolapse was carried out. One patient in Group I died of myocardial infarction, one patient in Group II had a small bowel obstruction and two patients in Group I an asymptomatic stricture of the anastomosis. Otherwise a safe and efficient control of the prolapse was achieved in both groups. Eleven (73%) patients in Group I and 12 (80%) patients in Group II were more or less incontinent before surgery. After correction of prolapse incontinence improved in eight and ten patients in Groups I and II, but became slightly worse in one patient in Group II. A similar rise in anal pressures was measured in both groups after surgery. Constipation disappeared in three and seven patients in Groups I and II six months after surgery, but five additional patients in Group II became severely constipated and colectomy had to be performed in one of them. Surgery caused no significant change in colonic transit times even though increased transit times were measured in each group six months postoperatively. Sigmoid resection in conjunction with rectopexy does not seem to increase operative morbidity but tends to diminish postoperative constipation possibly by causing less outlet obstruction.

Adult↗

PubMed1992

Laparoscopic cholecystectomy for symptomatic gallstone disease. Experience of the first 200 cases.

Laparoscopic cholecystectomy was carried out in 200 patients between January 1991 and September 1992 at the Second Department of Surgery, Helsinki University Central Hospital. Mortality was nil. The overall major complication rate was 4% (n = 8). The incidence of common bile duct lesions was 0.5% (n = 1). In seven (3.5%) patients the procedure had to be converted into open cholecystectomy. Repeat surgery was needed in two patients. The average hospital stay was 3.0 +/- 1.5 days and the average sick leave 14 +/- 4 days. Obese and high-risk patients tolerated the procedure well without significant increase in complication rate or hospital stay. Laparoscopic cholecystectomy may be regarded as the treatment of choice for symptomatic gallstone disease.

Adolescent↗

PubMed1991

Comparison of restorative proctocolectomy with and without covering ileostomy in ulcerative colitis.

The experience of restorative proctocolectomy for ulcerative colitis is reported in 16 consecutive patients with no covering ileostomy (group 2) in comparison with 15 patients with a covering stoma (group 1); in each group a J pouch was constructed. All patients had pre- and postoperative clinical and manometric evaluations of the functional result up to 12 months. There were no deaths or permanent failures. The number of early complications was four in each group. Re-ileostomy was needed in one patient of group 1, and an ileostomy was constructed in three patients of group 2. At 1 year after operation the functional results did not differ between groups 1 and 2 in terms of daily frequency of defaecation (mean 5.6 and 5.4 in 24 h respectively), or in terms of anal basal or maximal squeeze pressures. There was a significant (P less than 0.01) saving in total hospital stay (median 11 days) and in operating theatre time (mean 41 min) in patients with no covering ileostomy. It is concluded that a covering ileostomy may be unnecessary in restorative proctocolectomy, at least in suitable cases with no technical difficulty at the time of operation.

Adolescent↗

PubMed1991

Sphincter-saving surgery for rectal carcinoma. Comparison of two five-year periods from 1980 to 1989.

The early results of treatment for rectal adenocarcinoma in 290 patients were compared in two five-year periods, from 1980 to 1989, considering sphincter preservation. Altogether, 223 patients (77%) had radical surgery and the primary tumour was excised in 267 cases (92%). Operative mortality was 2.8% (8 patients), 3.2% in the first and 2.3% in the second five-year period. Sphincter-saving surgery was undertaken in 68 of 157 patients (43%) and in 90 of 133 patients (68%) within the two periods. This failed in one (1.5%) and five (5.6%) patients (P greater than 0.05), respectively. Anastomotic leak rates were 1.4, 18 and 38% after anterior resections for tumours of the upper, middle and lower thirds of the rectum. Both mortality (1.4 vs 3.8%) and the total number of complications (23 vs 39%) were less after anterior resection than after abdominoperineal excision of the rectum. In conclusion, increased use of low anterior resection for rectal carcinoma has not led to higher mortality or overall morbidity, but the high leak rate after very low anastomoses remains to be solved.

Adenocarcinoma↗

PubMed1990

Adult Hirschsprung's disease. Clinical features and functional outcome after surgery.

To assess the clinical features and long-term functional outcome after surgery, eight patients operated on for adult Hirschsprung's disease during the 20-year period, 1968-1988, were re-examined. There were six men and two women with a mean age of 40 +/- 3 years at the time of survey. The mean age of the patients at the time of diagnosis was 23.8 years (range, 16 to 41 years). Results were compared with eight consecutive patients operated on for Hirschsprung's disease during the neonatal period. The Duhamel operation was performed initially on seven patients in the adult group and on all patients in the neonatal group. Anterior resection was performed on one adult patient initially but this was converted subsequently to Soave's pull-through operation. None of the patients had constipation after definitive surgery. The mean defecation frequency was two in both groups. Three patients in the adult group and two patients in the neonatal group were completely continent, others had occasional soiling. The mean anal sphincter pressures were lower in the neonatal group than in the adult group and in each group lower than in normal controls. Adult Hirschsprung's disease must always be suspected in the context of chronic constipation. Functional results after surgery in adult patients are similar to those achieved in children.

Adult↗

PubMed1990

Decreased risk of gastric stump carcinoma after partial gastrectomy supplemented with bile diversion.

The exact incidence of gastric stump cancer is not known. The reported incidence figures vary greatly, even in studies using similar methods. The aim of this study was to re-evaluate the risk of gastric stump cancer after gastric surgery for peptic ulcer in the Finnish population. A total of 285 patients (252 men and 33 women) operated on for benign peptic ulcer between 1948 and 1954 were followed-up till the end of 1984 (mean for men = 19.4 years, for women = 22.9 years). At the end of 1984 58 patients (20%) were still alive with no verified gastric cancer. One patient developed gastric cancer within five years after the operation and was excluded from the series. Nine patients (3%) were lost to follow-up. Six patients (four men and two women) of the total 285 had developed gastric cancer 6, 7, 8, 21, 25 and 27 years after operation. The risk of getting gastric cancer in a control population (no operation) of equal size and age during a similar follow-up period was 6.71 cases for men and 0.86 cases for women (total = 7.57). The observed number (6 patients) does not differ significantly (P greater than 0.5) from the expected number (7.57). According to this study the risk of gastric cancer is not significantly increased by partial gastrectomy for benign peptic ulcer.

Adult↗

PubMed1990

Decreased risk of gastric stump carcinoma after partial gastrectomy supplemented with bile diversion.

The exact incidence of gastric stump cancer is not known. The reported incidence varies greatly, even in studies using similar methods. The aim of this study was to re-evaluate the risk of gastric stump cancer after gastric surgery for peptic ulcer in the Finnish population. A total of 285 patients (252 men and 33 women) operated on for benign peptic ulcer between 1948 and 1954 were followed-up till the end of 1984 (mean follow-up for men = 19.4 years, for women = 22.9 years). At the end of 1984, 58 patients (20%) were still alive without verified gastric cancer. One patient developed gastric cancer within five years after the operation and was excluded from the series. Nine patients (3%) were lost to follow-up. Six patients (four men and two women) of the total 285 developed gastric cancer 6, 7, 8, 21, 25 and 27 years after the operation. The risk of contracting gastric cancer in a control population (no operation) of equal size and age during a similar follow-up period was 6.71 cases for men and 0.86 cases for women (total = 7.57). The observed number (6 patients) does not differ significantly (P less than 0.5) from the expected number (7.57). This study shows that the risk of gastric cancer does not significantly increase after partial gastrectomy for benign peptic ulcer.

Female↗

PubMed1990

Anal spinchter reconstruction. Surgical results and functional outcome.

Direct repair of anal sphincter injuries was undertaken in seven patients, three men and four women. Obstetrical tears were the cause of injury in all the female patients; surgical trauma, road traffic accident, and sexual assault caused the injuries to the men. Temporary covering colostomies were fashioned for six patients either before, or at the time of, the repair. There were no major complications associated either with the repairs or with the colostomy closures. The degree of incontinence was reduced in all patients, but only two became completely continent after the operation. The change in anal sphincter pressures was not significant. Postanal repair was subsequently undertaken for one woman, but all the other patients were satisfied with their repairs. We conclude that direct sphincter repair should be the treatment of choice for patients with major injury to the anal sphinchter.

Adult↗

PubMed1989

Surgical repair of vulvar anus in adults.

Three adult women with previously unoperated vulvar anus underwent surgical treatment for faecal incontinence which developed in adulthood. The obvious cause of incontinence in these patients was the weakening of pelvic floor musculature by aging and pregnancy. Two of the patients had several associated anomalies. The anus was transposed to the normal perineal position through the well-developed external sphincter found posterior to the vulvar anus. Faecal continence improved markedly in all patients.

Adult↗

PubMed1988

Manometric follow-up of anal sphincter function after an ileo-anal pouch procedure.

Between January 1985 and January 1987 restorative proctocolectomy with J-pouch was undertaken in 20 patients with ulcerative colitis. In all patients anal manometry was performed preoperatively, before closure of the temporary ileostomy (mean 3.9 months after operation) and 3,6 and 12 months after the closure of the ileostomy. Preoperatively the basal resting pressure was 60.2 +/- 12 cm water and the maximum squeeze pressure 88.5 +/- 18 cm water. After the operation the respective pressures were 33.2 +/- 8 and 68 +/- 21 cm water, a decrease of 45% (p less than 0.05) and 12% (p less than 0.05), respectively. One year after the closure of the loop ileostomy the basal pressure was 46.2 +/- 9 cm water, which is still 23% lower (p less than 0.05) than preoperatively. At the same time the maximum squeeze pressure was 96.5 +/- 13 cm water, 8% higher (p greater than 0.1) than preoperatively. The continence of the patients at the end of the follow-up was either good (n = 6) or excellent (n = 9). A correlation seemed to exist between sphincter pressures and the degree of continence. It is concluded that the internal anal sphincter suffers damage during the operation and slowly recovers up to 6 months after closure of the covering ileostomy. After that its function usually does not improve and remains at a lower level than preoperatively.

Adult↗

PubMed1988

Fecal bacteriology and reservoir ileitis in patients operated on for ulcerative colitis.

To investigate the etiology of ileal reservoir inflammation, fecal bacteriology and ileal wall morphology were compared in three groups of 15 patients operated on for ulcerative colitis: 1) conventional ileostomy, 2) Kock ileostomy; and 3) pelvic ileal pouch. Total bacterial counts showed overgrowth of fecal bacteria in each group, but the anaerobic bacterial counts were significantly higher (P less than .05) in the two pouch groups than in the conventional ileostomy group. Mucosal morphology did not differ among the three groups showing either normal mucosa or mild chronic inflammatory changes in most patients. In contrast, five of the six patients with clinical pouchitis had acute inflammatory changes in histologic specimens. Fecal bacteriologic findings in these patients did not differ quantitatively or qualitatively from others. It is concluded that proctocolectomy for ulcerative colitis predisposes to ileal bacterial overgrowth, and after pouch operations especially, anaerobic overgrowth may be one factor in the development of pouch inflammation. Acute clinical pouchitis with clear histologic changes was, however, not connected with specific changes in fecal bacteriology.

Adult↗

PubMed1988

Restorative proctocolectomy for ulcerative colitis.

The results of 36 restorative proctocolectomies (with 2-loop reservoir) for ulcerative colitis (UC) performed in a three-year period were surveyed. These patients represented 69% of all those undergoing definitive surgery for UC at the same time at our department. There was no operative mortality. Both early (44.4%) and late complications (45.2%) were quite common, but they were mostly minor and only two were permanent failures (5.6%) requiring construction of conventional ileostomy. Anastomotic retraction and sinus formation (25%), as revealed by pouch x-ray, were the most frequent early complications, occurring in a lesser degree (19.4%) also after stoma closure. Pouchitis was also a common (20%) late complication, but usually resolved promptly with metronidazole treatment. The functional results in the 23 patients evaluated were satisfactory, with a mean defaecation frequency of 5.4 per 24 hour and a minor soiling frequency of 36%. None of the patients had to wear a pad. The over-all results are compatible to those from other centres and suggest that acceptable anal function follows restorative proctocolectomy in most suitable cases with UC. The role of adequate surgical experience and consideration of contraindications must, however, be emphasised, and the surgeon must be ready to handle many minor and even major complications.

Adolescent↗

PubMed1988

Mucosal alterations in pelvic ileal reservoirs. A histological and ultrastructural evaluation in an experimental model.

To study mucosal changes in ileal pouches, three different types of pelvic ileal reservoir (2-loop, 3-loop and 4-loop), interposed in place of resected rectum, were constructed in 12 piglets, 4 animals in each group (n = 12). After a 6 week interval the animals were sacrificed and the reservoirs removed and processed for light and scanning electron microscopy (SEM). Both acute and chronic inflammatory changes were present but not prominent in the pouch mucosa. With the exception of mucosal ulcers both the histological and SEM-findings greatly resembled the atrophic, flat mucosa seen in ileal coeliac disease. Macroscopic findings did not correlate with histological findings. Colonization by bacteria and bacterial overgrowth were noticed in every pouch suggesting a possible link between bacterial invasion and pouch ileitis. No correlation was found, however, between the amount of intraluminal bacteria and the severity of the pouchitis.

Animals↗

PubMed1987

Pelvic ileal reservoirs: experimental assessment of reservoir capacity in three reservoir designs.

In order to examine the possible effect of different pouch shape to the capacity of ileal reservoirs three different types of pelvic ileal reservoir (2-, 3- and 4-loop) were compared in piglets, with four animals in each group. The intraoperative volume of all of these reservoirs was 55 ml, measured with saline. A larger (110 ml) 2-loop reservoir was used in a control group of four animals. The animals were kept alive for 6 weeks after which time the capacity and emptying of the reservoirs were studied. The resulting volume increases (ml/kg) were 15.4, 9.2, 8.9 and 8.1 in J-, S-, large-J- and W-shaped reservoirs, respectively. The emptying of the reservoirs was incomplete in all designs. No statistical difference (P greater than 0.5) was found between groups for either of these parameters. If resistance to outflow from the pouch can be avoided, the capacity of the reservoir seems to depend more on its initial size at the time of construction than on the pouch design.

Anastomosis, Surgical↗

PubMed1986

Surgical treatment of anal incontinence--a preliminary report.

Six patients with anal incontinence were treated operatively at two Finnish proctological centres: 3 patients with post-anal repair, 2 with direct sphincter repair and 1 with a gracilis sling operation. In short term, improvement of continence was demonstrated in all cases both clinically and by manometric measurements; 5 out of the 6 patients are acceptably continent after surgery. The present techniques of surgical treatment of incontinence can offer gratifying results. Anal manometry is a valuable means in the evaluation of these patients before and after the operation.

Adult↗

PubMed1977

WAIS performances in antisocial personality (disorder).

In the present study, the WAIS performances of subjects with antisocial personality disorder were compared with the performances of controls, who had other personality disorders and had usually only occasional criminality. It appeared that in all subtests the age-scaled scores of the controls were higher than those of the subjects. Statistically significant differences emerged in subtests Information, Comprehension and Arithmetic of the Verbal Scale, and in the picture Completion subtest of the Performance Scale, as well as in the Verbal, Performance and Total IQ. In the light of these results, one fundamental feature in antisocial personality could be the lack of general interest and intellectual curiosity, which is probably associated with a poor ability to "feel" (inadequacy of feelings of pleasure) in those predisposed to antisocial personality.

Adult↗

PubMedDate not supplied

Early experience with biofragmentable anastomosis ring in colon surgery.

A biofragmentable anastomosis ring (Valtrac-BAR) was used to construct anastomoses in 20 (group I) consecutive patients (11 women and nine men; mean (SD) age 54.5 (13 years) undergoing elective colonic resection. The results were compared with those of 20 consecutive patients who underwent elective colonic resection in this department during the same period (group II) who had their anastomoses hand-sutured or stapled. There was one death in hospital in each group (5%). There were four anastomotic complications requiring reoperation, leakage (n = 3), and stricture (n = 1) in group I (20%) compared with none in group II. Three patients in each group developed postoperative ileus; these were all initially treated conservatively. In most cases with a ring anastomosis the clinical course was uneventful. We conclude that the biofragmentable ring can be used for different types of colon anastomoses, but so far it has not shown any special advantage over more commonly used anastomotic techniques, and more experience is needed before its routine use can be recommended.

Anastomosis, Surgical↗

PubMedDate not supplied

Colo-anal sleeve resection for rectal hemangioma. Case report.

Colo-anal sleeve resection was performed for rectal hemangioma extending from the upper end of the anal canal to the rectosigmoid in two adults and a child. The indication for surgery was recurrent rectal bleeding. Anastomotic stricture formed in one patient, but was easily dilated. After observation for 2-12 months, all patients were completely continent, with normal 24-hour stool frequency. Colo-anal sleeve resection is advocated as the treatment of choice for large rectal hemangioma.

Adult↗