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Biomedical subjects

R Pokela

Publications and source records attributed to R Pokela.

At least 37 records · Page 2Linked to original sources
PubMed1992

Mediastinal window: a cause of simultaneous bilateral spontaneous pneumothorax.

A case of bilateral spontaneous pneumothorax with critical collapse of both lungs in a previously healthy 19-year-old woman is described. A congenital defect of mediastinal septum was suspected on the basis of roentgenographic findings and confirmed by right-sided thoracotomy. This mediastinal window between the pleural spaces allowed air leaking from a ruptured right lung apical bulla to collapse not only the right lung but also the left. Apical TA stapler resection and right-sided parietal pleurectomy was performed to prevent recurrence.

Adult↗
PubMed1989

Surgery of thoracoabdominal aneurysms.

Seventeen patients with thoracoabdominal aneurysms, including 5 ruptured aneurysms, were operated upon using a left diaphragm-splitting thoracoabdominal incision and the retroperitoneal route. A temporary shunt was used in 13 patients, femorofemoral perfusion in 1 and cold perfusion cooling of the kidneys in 3 patients. The step-by-step reattachment technique into ready-made limbs or holes in the Dacron graft ensured that visceral and renal ischaemic times remained within acceptable limits. The mean renal and proximal clamping times were 44 and 77 min, respectively. One patient with a ruptured aneurysm (6%) died of diffuse bleeding. The others recovered without paraplegic, renal or other severe complications. During the follow-up period, mean 44 months and range 10-116 months, 3 patients died of lung cancer and 2 of coronary disease giving a late mortality of 29%. The remaining 11 patients are alive and well. The cumulative 2- and 5-year survival is 87% and 62% respectively. The patency rate of the grafts was 100% and that of the 30 individually revascularised arteries 80%. We recommend elective surgery for thoracoabdominal aneurysms using a temporary shunt or cold perfusion cooling of the kidneys as a protective measure against perioperative ischaemia.

Adult↗
PubMed1988

Survival after surgical treatment of lung cancer.

All 205 patients operated on for primary pulmonary cancer at Oulu University Hospital in 1975-1977 were followed up for 10 years to evaluate the prognostic influence of factors such as lymph-node invasion, size of tumour and histologic type. Preoperative mediastinoscopy was performed on 186 patients (91.2%), and revealed no mediastinal metastases in 182. Nevertheless N 2 (mediastinal) lymph nodes were found in 36 cases at operation and N 1 (perihilar or ipsilateral) nodes in 42. Despite lobectomy or pneumonectomy, all 32 patients (17.2%) with false-negative mediastinoscopy died within a year (mean 7.2 months) of operation. Pneumonectomy was performed in 67 cases (29 right, 38 left), lobectomy or bilobectomy in 125 and exploratory thoracotomy in the remainder. Most of the tumours were epidermoid carcinoma (53.7%). Adenocarcinoma was present in 20%, and large-cell carcinoma and oat-cell carcinoma each in 11.7%. Survival rates were significantly higher in patients without vs. those with lymph-node metastases and in epidermoid or adenocarcinoma vs. small-cell carcinoma.

Adult↗
PubMed1987

Aryl hydrocarbon hydroxylase in lymphocytes and lung tissue from lung cancer patients and controls.

The inducibility of aryl hydrocarbon hydroxylase (AHH) activity in peripheral mitogen-treated lymphocytes, and of AHH and other monoxygenase activities in lung samples, was studied in 41 patients--34 with pulmonary carcinoma, 4 with a benign lung tumour and 3 with chronic obstructive pulmonary disease. Lymphocyte AHH induction alone was studied in 43 non-smoking and 37 smoking surgical patients. Absolute induced and non-induced AHH activities were at about the same level in the lymphocytes from the lung cancer patients as in those from the non-smoking controls, whereas the activities in smoking controls were about 100% higher. The mean inducibility ratios were very similar in all groups, ranging from 4.4 in the benign tumour patients to 5.4 in both control groups. Thymidine incorporation was on average about 40% lower in the lymphocytes from the lung cancer patients. AHH activity was detectable in all the peripheral lung samples, both normal or tumorous tissue, and its inter-individual variation was more than 67-fold. ECDE activity was also detectable in all the samples studied and its correlation with AHH activity was statistically significant (r = 0.888), suggesting that the same enzyme metabolizes both substrates. ERDE was detectable only in the samples with the highest AHH and ECDE activities. There was no correlation between basal or induced lymphocyte AHH activities and lung tissue AHH activity, but there were statistically significant correlations between lung AHH activity and the inducibility ratio with (r = 0.618) or without correction by thymidine incorporation (r = 0.442). These correlations suggest that there are common regulatory factors for AHH inducibility in different tissues. No significant difference in any drug metabolism parameter measured was observed between the lung cancer patients and the controls.

Animals↗
PubMed1987

Delayed left ventricular rupture after mitral valve replacement.

Posterior left ventricular rupture (LVR) is a serious complication following mitral valve replacement (MVR), especially if occurring postoperatively with the chest already closed or the patient in the intensive care unit. Only one of the patients with this delayed type of LVR reported earlier has been treated successfully. Our experience consists of 4 such complications among 161 MVR patients, the incidence being 2.5%. Two of these patients survived. Mechanical factors seem to constitute the most important etiologic causes for this complication. Immediate reoperation must be performed, and extracorporeal circulation is generally mandatory for successful repair. The reconstruction of the ruptured posterior left ventricular wall in both surviving patients was performed from the epicardial surface of the heart using pledget sutures. The auricle of the left atrium was used to cover the site of the tear when bleeding was not stopped with pledget sutures. It usually seems possible to avoid this complication if all mechanical etiologic factors are taken into consideration. After successful correction, a pseudoaneurysm may arise and, for that reason, a cardiac echo sonography follow-up is recommended.

Cardiac Surgical Procedures↗
PubMed1987

Infection prophylaxis in pulmonary surgery: a randomized prospective study.

A prospective randomized study to evaluate the efficacy of antibiotic prophylaxis against postoperative infections was carried out on 120 patients undergoing pulmonary operations. The patients were randomized into two groups of 60 patients each. One group received doxycycline (deoxytetracycline) prophylaxis for five days, and the other received cefuroxime (a second-generation cephalosporin) for one day. The groups were comparable with regard to age, sex, common risk factors, diagnosis, and operative procedures. A reduction in the infection rate was noted in the cefuroxime group (10/60) compared with the doxycycline group (19/60), but the difference was not statistically significant (p = 0.055). In major infections (empyema and pneumonia) there was no difference between the groups (4/60 in the cefuroxime group and 5/60 in the doxycycline group), but a significant (p less than 0.05) reduction was noted in minor infections (6/56 and 14/55, respectively) such as lower respiratory tract infections and prolonged fever. There were no wound infections in the two study groups. There were significantly (p less than 0.05) fewer postoperative fever reactions (axillary temperature greater than 37.5 degrees C) in the cefuroxime group (30/60) compared with the doxycycline group (44/60). Both antibiotics were effective in preventing wound infections, but cefuroxime may also be beneficial in preventing minor respiratory infections. The bactericidal effect of cefuroxime may explain this finding.

Cefuroxime↗
PubMed1985

Repair of ruptured oesophagus. A case report.

Oesophageal perforation or rupture is a serious condition. Delayed diagnosis is associated with high mortality rate. A method of repair is described, used to cover a lower oesophageal tear with high gastric fundoplication in three cases with delayed diagnosis (greater than 12 h), two of which survived.

Aged↗
PubMed1984

One turn more: threshold superiority of 3-turn versus 2-turn screw-in myocardial electrodes.

Epicardial electrodes are an alternative for patients in whom the transvenous approach presents technical difficulties. We have had clinical experience with two types of myocardial sutureless electrodes inserted in the anterior left ventricular wall: the 3-turn screw-in electrode (Medtronic 6917) was used in 209 patients from 1974 to 1977 and the 2-turn screw-in lead (Medtronic 6917 A) was used in 61 patients from 1978 to 1981. The initial threshold was equal and acceptable with both types of electrodes. During a follow-up period (up to 48 months), critical elevation of the pacing threshold resulting in exit block was found in 12% (25) of the patients with the 3-turn screw-in electrode and in 20% (12) of the patients with the 2-turn electrode (p less than 0.05). Elevation of the pacing threshold developed fairly early, usually within 6 months, with the 2-turn screw-in electrode, but much later, within 2-4 years, with the 3-turn electrode. During a longer follow-up time of up to 96 months the frequency of exit block increased up to 16% with the 3-turn electrode. Our results indicate that late critical elevation of the pacing threshold is surprisingly frequent with screw-in electrodes inserted into the left ventricular myocardium, and it is especially common with the 2-turn screw-in electrode.

Adolescent↗
PubMed1984

Surgery of thoracoabdominal aortic aneurysms.

Arteriosclerotic aneurysm of the thoracoabdominal aorta, involving one or more visceral branches, was successfully operated on in eight patients. Two of the aneurysms had ruptured. The left diaphragm-splitting thoracoabdominal incision through the 8th intercostal space, using a retroperitoneal route, gave unrestricted exposure. A temporary aortofemoral shunt effectively protected abdominal organs and spinal cord from perioperative ischemic damage. The step-by-step reattachment technique into ready-made side limbs in the woven Dacron graft ensured that visceral and renal ischemic times remained within acceptable limits. Perfusion cooling of the abdominal organs was done in one patient in whom shunt could not be used. A standby autotransfusion device was life-saving in another case. All the patients recovered without major complications. Moderate elevation was found as regards serum creatinine levels in seven patients and liver enzymes in four patients, but the values normalized within a month. No paraplegic complications occurred, although all bleeding intercostal and lumbar arteries were ligated intra-aneurysmatically in seven of the eight patients. Seven patients are well 20 to 60 months postoperatively, with patent and well functioning grafts. One patient died of lung cancer after 7 months. Four of the 18 revascularized arteries in three patients were shown by control angiography to be occluded, but without serious sequelae. Our experience suggests that most thoracoabdominal aortic aneurysms are suitable for surgical correction, with acceptable risk. Elective surgery is therefore recommended.

Adult↗
PubMed1984

Primary retroperitoneal tumours in adults.

48 patients underwent operation for a primary retroperitoneal tumour during the years 1962 to 1983. Palpable abdominal mass and abdominal pain were the most common presenting symptoms. Computerized tomography complemented by cavography, aortography and intravenous pyelography were the most effective radiological investigations available. 35 (73%) of the 48 tumours were malignant but only 8/35 (17%) of them had local metastases. 11 (23%) of the 48 tumours were radically excised, 20/48 (42%) had partial excision and 17/48 (35%) an incisional biopsy. 4 (11%) of the 35 malignant tumours were excised radically, 16/35 (46%) were partially excised and 15/35 (43%) had an incisional biopsy. Resection of adjacent organs was performed in 8 patients (17%). Overall operative mortality was 15% and morbidity 23%. All mortality in patients with malignant tumours occurred after incisional biopsy. Prognosis of benign tumours was excellent. The 5-year cumulative survival for malignant tumours was 28 +/- 9%. 7 patients were alive 5 years after operation but only 2 of them without evidence of recurrent disease. In conclusion, long-term results obtained by surgery of malignant tumours were less satisfactory. Hence, randomized trials with adjuvant radiation and chemotherapy are necessary. Local recurrences should be diagnosed early and resected aggressively.

Adolescent↗
PubMed1983

Somatosensory evoked responses as a diagnostic aid in thoracic outlet syndrome. A postoperative study.

In the present study we have recorded evoked responses in the supraclavicular fossa (Erb's point) following stimulation of the median and ulnar nerves separately on both sides, in patients with thoracic outlet syndrome. Nine out of the 13 patients showed abnormal findings in the preoperative recordings when compared to the recordings of the 20 healthy controls. The first postoperative recordings were performed two months after operation and 3 out of 9 patients with the abnormal preoperative recordings showed normalized results and in addition 2 patients, about one to two years after the operation in the second postoperative recordings. It is suggested that the Erb's point recordings may be of value not only in the diagnosis of thoracic outlet syndrome but also that these recordings are possibly suitable for postoperative follow-up of this disorder.

Adolescent↗
PubMed1982

Somatosensory evoked responses as a diagnostic aid in thoracic outlet syndrome. A preoperative study.

Responses evoked in the supraclavicular fossa (Erb's point) were recorded after stimulation of the median and ulnar nerves separately in both arms. The recordings were made in 20 healthy controls and 13 patients with unilateral thoracic outlet syndrome. In 12 of the 13 patients subsequent surgery clearly confirmed the diagnosis. Nine of the 13 patients showed abnormalities in the preoperative recordings at Erb's point. In all of these nine patients the relative amplitude difference on the affected side was outside the normal range. In two patients there was also abnormally low conduction velocity. The differences of amplitudes in the Erb's point responses between patients and controls were statistically significant. The suggestion is made that Erb's point responses evoked by stimulation of the median and ulnar nerves may be of diagnostic value in thoracic outlet syndrome and that the method is suitable as a supplement to conventional electroneurography in routine clinical practice.

Adolescent↗
PubMed1981

Lack of effect of ischemia and dipyridamole on prostacyclin production in arteriosclerosis obliterans.

Six patients with advanced arteriosclerosis obliterans in the lower extremities were subjected to an exercise test on a tread mill with and without dipyridamole treatment. Prostacyclin (PGI2) release was measured by the concentration of its stable metabolite, 6-keto-prostaglandin F1 alpha in plasma. All the patients suffered from ischemic pain during both tests, but no changes were seen in plasma 6-keto-PGF1 alpha. Dipyridamole did not affect the physical performance. Our results suggest that atherosclerotic vessels do not increase PGI2 production in response to ischemia and that a single dose of dipyridamole does not change PGI2 production.

6-Ketoprostaglandin F1 alpha↗
PubMed1980

Ultrastructure of terminal respiratory epithelium and prognosis in chronic interstitial pneumonia.

Following acute damage, proliferation of granular pneumocytes with subsequent transformation into membranous cells is the basic pattern of repair of the alveolar epithelium. Regarding chronic interstitial pneumonias little is known about the ultrastructural changes of terminal respiratory epithelium and their clinical significance. We studied open lung biopsies from 10 patients showing clinical and light microscopic changes consistent with chronic idiopathic interstitial pneumonia (UIP). We studied the ultrastructure and correlated it with the clinical course of the patients. Only alveolar type epithelium was seen in two cases with a short duration of disease and good response to therapy. Bronchiolar-type epithelium was present in the terminal respiratory units of all other patients with longer duration of disease and less favourable prognosis. Four patients died: all of them showed signs of mucus secretion and keratinization in the terminal respiratory epithelium. Thus in chronic interstitial pneumonia the presence of the alveolar type of epithelium seems to indicate reversibility and that of the bronchiolar type irreversibility of the lesions, while mucous and keratinizing metaplasias apparently occur at a late stage of the disease.

Adult↗