Biomedical subjects

R K Haapiainen

Publications and source records attributed to R K Haapiainen.

At least 19 recordsLinked to original sources

PubMed2001

Prognosis after lymph node recurrence in papillary thyroid carcinoma depends on age.

Papillary thyroid carcinoma (PTC) is a malignancy that has good prognosis especially among patients up to 45 years of age; about half of the patients are female and of childbearing age. Lymph node recurrence (LNR) occurs in 10%-14% of patients but is considered to be associated with relatively good prognosis. The purpose of this study was to estimate the association between patient age at primary operation, and the behavior of the disease after LNR. Between 1967 and 1994, 495 patients underwent surgery for primary PTC at the Department of Surgery, Helsinki University Central Hospital. There were 391 (79.0%) women and 104 (21.0%) men with a mean age of 44.5 years (range, 10.8-85.4 years). Fifty-eight patients in whom LNR was the first clinical sign of persistent disease after complete clinical response to primary treatment were included in this series. At the time of primary operation, 37 (64.3%) of the 58 patients who developed LNR were younger than 45 years of age and 21 patients were older. The mean times to LNR in these groups were 42.0 months (range, 3.0-194.5 months) and 49.0 months (range, 3.6-209.0 months) respectively. Carcinoma-specific 5-year survival after LNR was 100% (95% confidence interval [CI] 88.8%-100.0%) in patients ages up to 45 years and 61.1% (40.5%-82.8%) in older patients; 10-year survival rates were 100%, and 41.3% (p < 0.0001), respectively. Relative survival at 10 years was 98.6% for patients ages up to 45 years and 42.6% for older patients (p = 0.0014). Using the Cox model it was shown that development of LNR after primary treatment has an independent highly significant negative effect on survival (p < 0.001) in patients over 45 years of age. Prognosis of PTC even after LNR on patients ages up to 45 years at the time of the primary operation is almost parallel to the normal reference population, but in patients over 45 years of age the prognosis is relatively poor.

Adolescent↗

PubMed2001

Procalcitonin, soluble interleukin-2 receptor, and soluble E-selectin in predicting the severity of acute pancreatitis.

OBJECTIVE: To investigate whether marker(s) of systemic inflammation detect, at an early stage of acute pancreatitis, patients who may ultimately develop severe disease. DESIGN: Prospective study. SETTING: University hospital emergency unit. PATIENTS: Thirty patients with mild acute pancreatitis (SEV0 group) and 27 with severe acute pancreatitis. Of the latter, 11 did not develop organ failure (SEV1 group), whereas the other 16 patients developed acute respiratory failure and 9 of them also developed renal failure (SEV2 group). INTERVENTIONS: Blood samples were collected at admission to the hospital (T0), and at 12 hrs (T12) and 24 hrs (T24 after admission. MEASUREMENTS AND MAIN RESULTS: The plasma concentrations of procalcitonin (PCT), soluble E-selectin (sE-selectin), soluble interleukin-2 receptor (sIL-2R), and the serum concentration of C-reactive protein (CRP) were monitored. PCT levels at T0 were significantly higher in the SEV1 group (median 0.4 ng/mL, range 0.2-2.3) and the SEV2 group (0.8 ng/mL, 0.2-73.5) than in the SEV0 group (0.3 ng/mL, 0.1-3, p < .05 and p < .001, respectively). At T12, PCT level in the SEV2 group was significantly higher than that in the SEV1 group (2.2 ng/mL, 0.2-86.6 vs. 0.4 ng/mL, 0.3-2.8, p = .05), as it also was at T24 (2.2 ng/mL, 0.4-73.3 vs. 0.5 ng/mL, 0.3-4, p < .01). Among SEV2 patients, PCT concentration correlated negatively with the time elapsed between admission and the diagnosis of organ failure. At T12, sIL-2R levels of the SEV1 group (1,011 U/mL, range 334-2,211) and the SEV2 group (1,495 U/ml, range 514-4,526) both differed significantly from the SEV0 group (636 U/ml, range 356-1,678, p < .05 and p < .001, respectively) as they also did at T24. Although CRP level in the SEV1 group at T12 did not differ from the SEV0 group, the difference between SEV2 (272 microg/mL, range 46-462) and SEV0 was significant (53 microg/mL, range 5-243, p < 0.01). sE-selectin levels did not differ between groups. CONCLUSIONS: At admission to hospital, concentrations of PCT, but not those of CRP, sE-selectin, or sIL-2R, are higher in patients with severe acute pancreatitis than in patients with mild pancreatitis. PCT test had sensitivity of 94% and specificity of 73% for development of organ failure. PCT may be useful to identify the patients who benefit from novel therapies aimed at modifying the course of systemic inflammation.

Adult↗

PubMed2000

Severe acute pancreatitis: prognostic factors in 270 consecutive patients.

Acute pancreatitis (AP) is a common abdominal disorder with severity varying from mild to fatal disease. Predicting a patient's outcome remains problematic. The aim of this study was to analyze a large consecutive series of patients with severe AP and to identify prognostic factors for hospital mortality. Between 1989 and 1997, a consecutive series of 270 patients with severe AP were included in the study. All patients fulfilled the criteria of Atlanta classification for severe AP. Retrospectively and prospectively collected data included age, gender, etiology, number of previous episodes of pancreatitis, medication history, type of admission, body-mass index (BMI), respiratory failure, renal failure, need for pressor support, and abdominal surgery performed during hospitalization. The overall mortality rate was 24.4%. In univariate survival analysis advanced age, history of continuous medication, patient transferred from other hospital, high BMI, respiratory or renal failure, need for pressor support, and need for abdominal surgery were significant prognostic factors for hospital mortality. In a multivariate stepwise logistic regression analysis, the need of pressor support, renal failure requiring dialysis, advanced age, history of continuous medication and need for abdominal surgery were identified as independent prognostic factors for mortality. A logistic regression analysis of variables available on admission (the first seven above mentioned variables) showed that transferral admission, advanced age, and history of continuous medication were independent prognostic factors for mortality. In patients with severe AP, advanced age, history of continuous medication, and need for dialysis, mechanical ventilator support, and pressor support predict fatal outcome and thus should be taken into account in clinical evaluation.

Acute Disease↗

PubMed2000

Long term prognosis of medullary thyroid carcinoma in 39 patients.

BACKGROUND AND AIMS: Thyroidectomy and radical cervical lymph node dissection have been suggested as primary and secondary operations aimed at achieving biochemical cure in cases of medullary thyroid carcinoma (MTC). The purpose of this study was to find out behaviour of MTC in long-term follow-up, and to estimate possible difference in biological virulence between sporadic MTC and MTC in MEN2A. MATERIAL AND METHODS: From 1967 through 1994, 39 patients with MTC, including 9 patients with hereditary disease, were operated on at the Second Department of Surgery, Helsinki University Central Hospital. Enlarged lymph nodes were dissected selectively. The main outcome measure was carcinoma-specific survival. RESULTS: In sporadic MTC, ten-year carcinoma-specific survival was 57.9% (95% CI 39.1%-76.7%) and ten-year survival after reoperation due to lymphatic node recurrence was 51.4% (CI 18.7%-84.2%). The presence of distant metastases at diagnosis (p = 0.0001) and extrathyroidal growth of the primary tumor (p = 0.0008) were independent predictors of carcinoma-specific survival in the Cox model. The risk ratio of sporadic MTC to MTC in MEN2A was 5.40 (CI 0.67-43.2) after adjusting the survival time for the size of the primary tumor. CONCLUSION: Distant metastases and the local extrathyroidal extent of the primary tumor have a significant effect on the prognosis of MTC, lymphatic node metastases and other clinical factors being less important. The biological virulence of sporadic MTC may be clinically significantly higher than that of MTC in MEN2A.

Adult↗

PubMed1999

Anaplastic thyroid carcinoma survival.

Anaplastic thyroid carcinoma is a rare, highly malignant tumor of elderly people. The purpose of this retrospective study was to characterize the patient population and to detect a potential subgroup with better prognosis or any intervention that would be useful. From 1967 through 1994 a total of 33 anaplastic thyroid carcinomas were operated on at the Second Department of Surgery, Helsinki University Central Hospital. There were 26 females and 7 males with mean age of 66.0 years (range 36-89 years). At the time of diagnosis 16 of 33 patients had distant metastases, and 32 of 33 of the tumors had invaded the thyroid capsule. Disease-specific survival was 9.7% (95% confidence interval from 2.0% to 25.9%) at 1 year using the product limit survival analysis. In the stepwise Cox proportional hazards regression model, local resectability (p = 0.0002), presence of distant metastases at diagnosis (p = 0.0014), radiotherapy (p = 0.014), and radioiodine ablation (p = 0.039) were independent prognostic factors. We concluded that even though statistically significant, independent, prognostic factors can be found the survival of the patients with the best prognostic characteristics is still poor. Only one patient, who had an anaplastic carcinoma focus within an encapsulated follicular thyroid carcinoma, survived in this series. At present there seems to be no surgical treatment that would be efficient for treating symptomatic anaplastic thyroid carcinoma.

Adult↗

PubMed1999

Indications for early mandatory laparotomy in abdominal stab wounds.

BACKGROUND: Patients with an abdominal stab wound presenting with shock, peritonitis or evisceration are usually subjected to early laparotomy, although very few studies have been done to validate the criteria. METHODS: In a retrospective study of 209 consecutive patients with stab wounds of the anterior abdomen, flank or lower chest, 23 clinical and radiological criteria were evaluated for their accuracy in predicting the presence of significant abdominal organ injury. RESULTS: Overall, 89 patients (43 per cent) had a significant abdominal injury. The criteria with the highest positive predictive values for significant injury were: signs of continuing haemorrhage in initially normotensive patients (86 per cent), shock on admission (83 per cent) and generalized peritonitis (81 per cent). No positive direct or indirect signs of peritoneal penetration including omental evisceration, extraluminal air on plain radiography, or free peritoneal fluid on abdominal ultrasonography were independent predictors of significant injury. CONCLUSION: Signs of major internal haemorrhage or generalized peritonitis are reliable criteria by themselves for early laparotomy. Peritoneal penetration is a poor indicator of significant organ injury and warrants direct organ-specific evaluation, such as computed tomography or laparoscopy, to identify patients who can safely be treated without operation.

Abdominal Injuries↗

PubMed1999

Risk factors of delayed diagnosis of pancreatic trauma.

OBJECTIVE: To identify risk factors associated with delayed diagnosis of pancreatic injuries. DESIGN: Retrospective study. SETTING: University hospital, Finland. PATIENTS: 31 patients treated for pancreatic injuries from January 1986 to April 1998. INTERVENTIONS: Clinical, laboratory, and radiological assessment. Initial management operative (n = 22) and non-operative (n = 9). MAIN OUTCOME MEASURES: Timely or delayed (>12 hours after injury) recognition of pancreatic trauma. RESULTS: Blunt trauma (7/17 timely and 12/14 delayed diagnosis, p = 0.03), intoxication on admission (4/10 compared with 5/5 patients studied, p < 0.05), low New Injury Severity Score (median, interquartile 34, 11.5-41 compared with 14.5, 10-25, p = 0.02), low Abdominal Trauma Index (38, 20-54 compared with 16.5 15-24, p = 0.01), absence of associated abdominal organ injuries (1/17 compared with 8/14, p = 0.004), and initial nonoperative management (2/17 compared with 7/14, p = 0.04) were significant risk factors of delayed diagnosis of pancreatic trauma. The main reasons for the delay in diagnosis were missed pancreatic injury at initial operation (n = 4, 2 penetrating), failure to exclude blunt pancreatic injury before non-operative management (n = 4), delay in presentation (n = 3), underestimation of the severity of pancreatic injury on initial computed tomogram (n = 2), and missed diagnosis of blunt duodenal rupture with mild pancreatic injury (n = 1). CONCLUSIONS: In patients with blunt abdominal trauma and altered consciousness with few clinical signs, and no or mild associated abdominal injuries, we recommend additional diagnostic studies to exclude pancreatic rupture before starting non-operative management. Exposure and evaluation of the pancreas during laparotomy for trauma is essential.

Abdominal Injuries↗

PubMed1998

Ultrasonically activated shears in thyroid surgery.

BACKGROUND: Ultrasonically activated shears (UAS) have been documented to be both safe and fast devices in laparoscopic surgery. We studied whether the use of UAS would have some advantage in thyroid surgery. METHODS: Thyroidectomies, performed by one senior endocrine surgeon between December 1996 and February 1997, were retrospectively matched, with patients operated on by the same surgeon using the conventional method. RESULTS: Six pairs of total thyroidectomies and one pair of lobectomies could be matched. Mean operating time was 100 minutes for the patients operated on with the UAS and 154 minutes for the patients operated on with the conventional method. The mean operating time with the UAS was thus on average 64.6% of the operation time with the conventional method, with a 95% confidence interval from 50.1% to 83.5% (t = 4.00, 6 df, P = 0.007). CONCLUSIONS: In this material the use of UAS reduced significantly operating time in thyroidectomies.

Blood Loss, Surgical↗

PubMed1998

Advances in the laboratory diagnostics of acute pancreatitis.

Acute pancreatitis is a rather common abdominal disorder. In most patients the disease is mild, but about 20% of cases develop a severe necrotizing form of the disease with complications. In an emergency setting, the diagnosis of acute pancreatitis remains problematic and several patients with severe disease are diagnosed only at autopsy. Measurements of amylase or lipase are the principal laboratory methods for diagnosing acute pancreatitis. However, their sensitivity and specificity are generally considered unsatisfactory. Recent advances in the knowledge of the pathogenesis of acute pancreatitis and advances in laboratory technology have revealed new diagnostic possibilities. Especially assays based on trypsin pathophysiology have brought new alternatives for diagnostics and severity grading of the disease. Additionally, development of phospholipase A2 determinations and discovery of a new pancreatic protein, pancreatitis-associated protein, are very interesting. This article summarizes the value of new methods in the laboratory diagnostics of acute pancreatitis.

Acute Disease↗

PubMed1997

Rapid measurement of urinary trypsinogen-2 as a screening test for acute pancreatitis.

BACKGROUND: Acute pancreatitis can be difficult to diagnose. We developed a rapid dipstick screening test for pancreatitis, based on the immunochromatographic measurement of urinary trypsinogen-2. METHODS: We prospectively compared the urinary trypsinogen-2 dipstick test with a quantitative urinary trypsinogen-2 assay, a urinary dipstick test for amylase, and serum and urinary amylase assays in 500 consecutive patients with acute abdominal pain at two emergency departments. Acute pancreatitis was diagnosed according to standardized criteria. RESULTS: The urinary trypsinogen-2 dipstick test was positive in 50 of the 53 patients with acute pancreatitis (sensitivity, 94 percent), including all 7 with severe pancreatitis. Two patients with urinary trypsinogen-2 concentrations below the sensitivity threshold of the test (50 ng per milliliter) and one with a very high concentration had false negative results. The test was also positive in 21 of the 447 patients without pancreatitis (specificity, 95 percent), including 7 with abdominal cancers, 3 with cholangitis, and 2 with chronic pancreatitis. The sensitivity and specificity of the dipstick test were similar to those of the quantitative urinary trypsinogen-2 assay and higher than those of the urinary amylase dipstick test. The serum amylase assay had a sensitivity of 85 percent (with a cutoff value of 300 U per liter for the upper reference limit) and a specificity of 91 percent. The sensitivity and specificity of the urinary amylase assay (cutoff value, 2000 U per liter) were 83 and 88 percent, respectively. CONCLUSIONS: In patients with acute abdominal pain seen in the emergency department, a negative dipstick test for urinary trypsinogen-2 rules out acute pancreatitis with a high degree of probability. A positive test usually identifies patients in need of further evaluation.

Acute Disease↗

PubMed1997

Incorrect estimation of severity of acute pancreatitis by contrast-enhanced computed tomography.

BACKGROUND AND AIMS: In acute pancreatitis, contrast-enhanced CT is widely accepted to give reliable information in the early assessment of severity. This study critically evaluates the clinical data, outcome, and CE-CT findings in patients with incorrect radiological estimation of the severity of the condition. MATERIAL AND METHODS: All patients suspected of having severe pancreatitis underwent contrast-enhanced CT. Clinical data and CE-CT findings of 341 patients were re-examined. RESULTS AND CONCLUSIONS: In 28 patients (8.2%) the radiological diagnosis was inconsistent with the clinical findings. The most common reason--in 20 of the 28 patients (71.4%)--for failure to estimate the severity of pancreatitis was partial necrosis of the gland. In severe cases the partial necrosis was overlooked in nine patients (32.1%). In mild cases clinical significance of partial necrosis--overestimated as representative for the whole gland and technical failure both explained the incorrect interpretation in six (21.4%) patients; and in five patients (17.9%) intermediate patchy enhancement was incorrectly regarded as low. The misleading estimation remained inexplicable in only two (7.1%) patients. These results emphasize adequate assessment of CE-CT and inclusion of all areas of the pancreas in the estimation of enhancement.

Acute Disease↗

PubMed1996

Selective nonoperative management of abdominal stab wounds: prospective, randomized study.

In a prospective, randomized trial the safety and cost-effectiveness of selective nonoperative management was compared to mandatory laparotomy in patients with abdominal stab wounds not requiring immediate laparotomy for hemodynamic instability, generalized peritonitis, or evisceration of abdominal contents. Fifty-one patients were randomly assigned to mandatory laparotomy or expectant nonoperative management and compared for early (<90 days) mortality and morbidity, length of hospital stay, and hospital costs. There was no early mortality. The morbidity rate was 19% following mandatory laparotomy and 8% after observation (p = 0.26). Four patients (17%) managed nonoperatively required delayed laparotomy. The hospital stay was shorter in the observation group (median 2 days versus 5 days;p = 0.002). About $2800 (US) was saved for every patient who underwent successful nonoperative management. It is concluded that selective nonoperative management of abdominal stab wounds, although resulting in delayed laparotomy in some patients, is safe and the preferred strategy for minimizing the days in hospital with concomitant savings in hospital costs. Mandatory laparotomy detects some unexpected organ injuries earlier and more accurately but results in a high nontherapeutic laparotomy rate and surgical management of minor injuries that in many cases could be managed nonoperatively.

Abdominal Injuries↗

PubMed1994

Pancreatic trauma with proximal duct injury.

UNLABELLED: A retrospective study of patients with traumatic injuries to the head of the pancreas involving the main pancreatic duct but not the duodenum identified five cases comprising 0.5% of all abdominal, and 21% of pancreatic injuries managed operatively. Four of the injuries resulted from penetrating, and one from blunt trauma. Two patients treated with pancreaticoduodenal resection died of septic complications caused by the pancreatic procedures. Three patients undergoing duodenum-preserving pancreatic resection survived without developing diabetes during five months follow-up. CONCLUSIONS: Pancreatic trauma with proximal duct injury can in some cases be managed with distal subtotal pancreatectomy. If the resection would include more than 80% of the gland, a duodenum preserving resection of the head of the pancreas with distal Roux-en-Y pancreaticojejunostomy is a viable option providing the duodenum with its vasculature, the common bile duct, and the ampulla of Vater are uninjured. Unstable patients with severe associated injuries can be managed with external drainage alone.

Adult↗

PubMed1994

Civilian low velocity gunshot wounds of the liver.

OBJECTIVE: To report our experience in the management of hepatic gunshot wounds. DESIGN: Retrospective study of medical records. SETTING: University department of surgery, Finland. SUBJECTS: 38 patients admitted with hepatic gunshot wounds confirmed at operation. INTERVENTIONS: Laparotomy in all cases. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: Of the 35 low velocity bullet wounds of the liver, 23 (66%) were severe, but 34 (97%) could be managed with simple operative techniques. Two of the three shotgun injuries were at point-blank range, and one required lobectomy. Four patients (11%) died, and in all cases haemorrhage from associated cardiovascular injuries was a major contributing factor. Postoperative morbidity after bullet wounds was 57%, including two local hepatic complications. CONCLUSIONS: Simple operative repairs are sufficient and safe in most patients with low velocity bullet wounds of the liver. Associated injuries are the main cause of postoperative mortality and morbidity. Point-blank shotgun injuries involving the liver are not necessarily fatal.

Adolescent↗

PubMed1994

Penetrating liver laceration with complete transection of hilar structures presenting with minimal clinical signs.

A 42-year old man with a penetrating laceration of the right liver lobe with complete transection of the right hepatic artery, right portal vein and left hepatic duct presented with minimal clinical signs and haemorrhage. Selective coeliac angiography and computer tomography (CT) revealed the vascular injuries. Forty-three hours after hospital admission the patient underwent right hepatectomy and bilioenteric anastomosis of the transected left bile duct to a Roux-en-Y segment of upper jejunum without stenting. Abscess formation and thrombosis of the inferior caval vein complicated recovery, but the patient was discharged from the hospital six weeks after this major hepatic injury, which usually presents with an exsanguinating massive haemorrhage.

Adult↗

PubMed1992

Acute surgical treatment of bleeding peptic ulcer. A retrospective analysis of 193 patients.

A retrospective analysis of 193 consecutive patients over an 11 year period operated on for continued bleeding from gastric or duodenal ulcer is presented. All patients were operated on within the first 48 hours after hospitalization. Preoperative endoscopic examination was performed in 108 patients and it was diagnostic in 79% of the cases. A sole duodenal ulcer was responsible for bleeding in 59 patients (31%) and in 50 patients (26%) the bleeding ulcer was located in the lesser curvature of the stomach. Other gastric ulcerations were scattered irregularly in different parts of the stomach. Gastric resection and Billroth II reconstruction were the most common procedures performed. Vagotomy, either truncal or gastric, was added to the resection in 31 (16%) cases. Primary mortality rate within 45 days from the operation was 15%. The survivors were on the average ten years younger (mean 58 years) than those who died. Forty one (21%) of the patients were operated on as emergency cases. These patients survived significantly better than those operated on after an observation period. It is concluded, that aggressive surgical treatment immediately after fluid resuscitation was associated with a reduction in mortality and morbidity rates in patients with bleeding peptic ulcer.

Adult↗

PubMed1991

Role of magnetic resonance imaging in blunt renal parenchymal trauma.

The accuracy of magnetic resonance imaging (MRI) in the evaluation of blunt renal parenchymal trauma was compared with that of contrast-enhanced computed tomography (CT) and ultrasonography (US) in a prospective study of 12 patients. CT was superior to other methods in identifying and characterising the renal parenchymal lesion, and both CT and US exceeded low field MRI in recognising a perirenal fluid collection. The role of high field MRI in the evaluation of blunt renal trauma requires further study.

Hematoma↗

PubMed1990

Prostate tumour markers and differentiation grade in prostatic cancer.

Serum acid phosphatase activity, prostate specific phosphatase and prostate specific antigen were measured in 100 patients with prostatic cancer. The patients were divided according to the differentiation grade into 3 groups: G1 (well), G2 (moderately) and G3 (poorly differentiated) carcinoma. Bone metastases were identified by scintigraphy. Among the 76 M0 patients the mean levels of all 3 markers were slightly higher in patients with moderately differentiated prostatic carcinoma. Among the 24 M1 patients the primary tumour was either G2 (18 patients) or G3 (6 patients); none had G1 lesions. Significantly higher serum ACP and PAP levels were found in patients with G2 tumours than in those with G3 lesions. It was concluded that the histological differentiation grade of prostatic carcinoma did affect serum levels of prostatic tumour markers; the tendency towards higher levels in the G2 group was noticeable in both non-metastatic and metastatic cases despite the limited number of patients in the latter category. In clinical practice this information may be an important additional tool in staging prostatic cancer.

Acid Phosphatase↗