Biomedical subjects

S Asko-Seljavaara

Publications and source records attributed to S Asko-Seljavaara.

At least 19 recordsLinked to original sources

PubMed2001

Activation of coagulation and fibrinolysis during reconstructive microsurgery in patients with cancer.

Cancer patients are subjected to increased systemic risk of thrombotic events and may therefore be at higher risk of even local thrombosis compromising the outcome of reconstructive microsurgery. Coagulation and fibrinolysis activities were studied serially during and after reconstructive microsurgery in seven patients with oropharyngeal cancer or sarcoma in the extremities. A preoperative hypercoagulable state was found in four patients (elevated fibrinogen, TAT, F1+2, or D-dimer); two of these patients also had a local thrombotic event. In all patients, the plasma markers generally varied perioperatively: fibrinogen decreased, whereas TAT and subsequently D-dimer increased at the end of the operation. However, tPA and PAI-1 remained unaltered, except in the patients with thrombosis in whom PAI-1 activity increased progressively during the operation. F1+2 was also clearly elevated in these two patients at the time of thrombosis. Preoperative assessment of hypercoagulability for this group of patients could be helpful in targeting meticulous antithrombotic protection.

Adult↗

PubMed2001

Sebaceous carcinoma of the eyelid associated with retinoblastoma.

OBJECTIVE: To analyze the association between retinoblastoma (Rb) and sebaceous carcinoma (SC) of the eyelid to improve surveillance of survivors of RB: DESIGN: Case report and systematic literature review. METHODS: Ten patients who had SC develop after Rb were identified by systematic literature review, and a child who died with lymph node, lung, and liver metastases 7 years after irradiation for Rb is described. The data were analyzed by univariate statistics, including cumulative frequency distribution plots and Kaplan-Meier analysis. RESULTS: Of 11 children with SC of the eyelid who all had hereditary RB, 9 (82%; 95% confidence interval, 48-98) received a median of 46 Gy (range, 21-89) of radiotherapy at a median age of 16 months (range, 0.5-15 years) and had SC develop within the field of radiation. Their median age at diagnosis of SC was 14 years (range, 8-30 years), median diagnostic delay 12 months (range, 6 months-3 years), and median interval from irradiation 11 years (range, 5-26 years); 7 of them (78%; 95% confidence interval, 40-97) were diagnosed between 5 and 15 years after radiotherapy. SC also developed at the age of 32 and 54 years in two nonirradiated Rb patients. Five patients had regional lymph node metastases after a median time of 12 months (range, 1 month-24 years). The 5-year cumulative probability of survival was 87%. CONCLUSIONS: SC of the eyelid may occur in patients with hereditary Rb regardless of primary treatment, especially within the field 5 to 15 years after radiotherapy.

Adenocarcinoma, Sebaceous↗

PubMed2001

Blood flow in a pedal bypass combined with a free muscle flap.

OBJECTIVE: to assess the haemodynamic effect of a free muscle flap on the midterm success of a pedal bypass. DESIGN: prospective consecutive study. MATERIALS: a pedal bypass (autogenous vein graft) combined with a free muscle flap was performed in 13 patients with critical leg ischaemia. The feeding artery of the flap was anastomosed end-to-side to the bypass. METHODS: blood flow was measured in the bypass before and after transplanting the flap. Doppler was used postoperatively to assess the patency. RESULTS: the bypass and flap pedicle were patent in 11 cases six months postoperatively. Two grafts were thrombosed and the legs amputated. In the successful group the median (range) blood flow in the bypass was 50 (10-100) ml/min. It increased (p<0.05) after transplantation to 64 (20-113) ml/min, being 44 (14-97) ml/min distributed to the foot. Blood flow through the flap was 20 (6-37) ml/min. The two failing grafts had a flow of 30 and 51 ml/min before and 48 and 52 ml/min after transplantation, respectively. Blood flow through the flap was 47 ml/min and 36 ml/min, respectively. In the failure group the free flap received most of the blood supply through the bypass. CONCLUSIONS: a free muscle flap connected to an infrapopliteal bypass increases the distal outflow bed and thus decreases the outflow resistance and increases graft flow.

Aged↗

PubMed2001

Evaluation of blood flow in free microvascular flaps.

Free flap surgery is routine today, yet little is known of its pathophysiology. In this study, the authors evaluated the hemodynamics in different types of free microvascular flaps, by measuring intraoperative transit-time flow. Eighty-six free transplants--21 free TRAM flaps for breast reconstruction, 18 radial forearm flaps for head and neck reconstructions, and 47 muscle flaps for head and neck, trunk and lower extremity reconstructions--were studied. Donor artery flow was highest in the radial artery (mean: 57.5 +/- 50 (SD) ml/min) but dropped (p < 0.001) to one tenth (6.1 +/- 2 ml/min) after anastomosis. The flow was lowest (4.9 +/- 3 ml/min) in the recipient artery of the TRAM flap but, after anastomosis, increased significantly (13.7 +/- 5 ml/min) to the level of the flow in the donor artery. The donor-artery flow in muscle flaps had a mean of 15.9 +/- 11 ml/min, and it significantly increased after anastomosing (23.9 +/- 12 ml/min). Weight-related intake of blood was highest in the radial forearm flap (18.5 +/- 6 ml/ min/100g) and lowest in the TRAM flap (2.5 +/- 1 ml/min/100g). The study showed that blood flow through a free microvascular flap does not depend on recipient artery flow. Even low-flow arteries can be used as recipients, because the flow increases according to free-flap requirements. The blood flow through a free microvascular flap depends on the specific tissue components of the flap.

Adolescent↗

PubMed2001

Free flap reconstructions in the management of oral and pharyngeal cancer.

Fifty patients who had undergone microvascular free flap reconstruction of the oral cavity or pharynx for malignancy between 1989 and 1995 were retrospectively analysed to find factors predicting postoperative complications and outcomes. The mean follow-up time was 2.6 years. More than half (26/50) of the patients had a stage IV malignancy and 10 patients had a recurrent tumour. The overall flap success rate, with 2 flap losses, was 96%. Postoperative medical complications occurred in 29/50 (58%) cases. The recipient site of 10/50 (20%) flaps required re-exploration. Mortality was 2%, with 1 death occurring within 30 days. The mean survival rate after the microvascular operation was 1.6 years, and the 3- and 5-year survival rates were 42% and 23%, respectively. Patients with an oropharyngeal tumour seemed to have the best prognosis and those with a hypopharyngeal tumour the poorest. Men had a threefold greater risk of dying within < 1 year postoperatively compared with women. Tumour stage was the strongest attribute influencing survival. The risk of death after the microvascular procedure increased 2.8-fold when the stage advanced from II to III or from II to IV. None of the tested variables alone could predict complications.

Adolescent↗

PubMed2001

Intraoperative evaluation of blood flow in the internal mammary or thoracodorsal artery as a recipient vessel for a free TRAM flap.

Although the free microvascular transverse rectus abdominis musculocutaneous (TRAM) flap is in routine use for breast reconstruction, little is known of its hemodynamics. The purpose of this study was to determine whether any differences exist when the free TRAM flap is anastomosed to the thoracodorsal or internal mammary vessels. The study comprised 25 patients receiving a free TRAM flap for breast reconstruction. The thoracodorsal vessels were used as recipients in 21 patients and the internal mammary vessels were used in 4 patients. Blood flow rate was measured directly in the donor and recipient arteries, and after anastomosis by a transit-time ultrasonic flowmeter (CardioMed). Two- and 3-mm probes were used. The blood flow rate in the donor artery (deep inferior epigastric) before flap dissection was 11 +/- 6 ml per minute (mean +/- standard deviation). The rate was significantly (p < 0.05) lower (5 +/- 3 ml per minute) in the recipient thoracodorsal artery than in the donor, but after transplantation it increased to 14 +/- 5 ml per minute (p < 0.05), attaining the same value as the donor artery. The blood flow rate in the intact internal mammary artery was significantly higher (25 +/- 10 ml per minute) than in the donor and thoracodorsal arteries, but after anastomosis it dropped to the same value (12 +/- 3 ml per minute; p < 0.05) as the donor artery. The intake of blood in TRAM flaps supplied by the intemal mammary artery seems to be no greater than that in free flaps anastomosed to thoracodorsal vessels, although the flow in the internal mammary artery was much higher. The authors concluded that the blood supply in a free TRAM flap is independent of the flow in the recipient artery and that thoracodorsal vessels, although often in a scarred bed and radiated, are as suitable for anastomosing a free TRAM flap as are internal mammary vessels.

Adult↗

PubMed2000

Natural coral as bone-defect-filling material.

Natural coral (NC) has been studied experimentally and clinically as a bone substitute, but its resorption rate and possible replacement by bone still need to be defined in humans. In this study bicortical bone was harvested from the iliac crest of 10 patients. The defect was filled with a NC block, and changes were monitored by X-rays and quantitative CT scans for a mean of 2.1 years. A biopsy was taken at 1 year. The purpose of the study was to investigate the resorption rate and pattern of NC (Porites) implants and the replacement, if any, of the implant by new bone. The blocks underwent centripetal resorption, but all the blocks still could be detected by X-rays and CT scans at the end of the follow-up period. The density of the remaining block did not change. Seven of the 10 implants were smaller than 50% of their original size at the end of the study. Bone ingrowth could be observed only in two of seven biopsies. One implant had to be removed after 1.7 years due to infection. The study shows that resorption of natural coral proceeds centripetally and apparently more rapidly when accompanied by tissue ingrowth. None of the blocks resorbed completely, and the defect at the iliac crest had not been restored by the end of the study.

Adolescent↗

PubMed2000

Immunohistochemical evaluation of failed vessel anastomoses in clinical microsurgery.

Failed vessel anastomoses collected from 12 patients during elective free flap surgery, and from one patient after failed mid-hand replantation were subjected to immunohistochemical analysis. The anastomotic failure was due to an obvious thrombosis, poor flow, an excessively sharp pulse or some other reason causing a non-functioning anastomosis. A total of 17 samples were obtained, 13 of them arterial, three between the artery and vein graft, and one venous. The majority of samples were resected during primary surgery and four of them at reoperation. Variables of coagulation and fibrinolysis were analysed repeatedly during the operation in 7/13 patients. Total occlusion was seen in 6/17 samples and a non-occlusive thrombus in 4/17; two of these were due to suture error. Immunohistochemistry showed that, overall, the endothelial cells (PECAM-l, CD 31) were absent and that the staining pattern for platelets (CD 42b and CD 31) and fibrin (fibrin II, T2G1) correlated. In the absence of a thrombus, however, adherent platelets were positive only for CD 42b, not for PECAM-1. Vessel inflammation was a prominent feature at reoperations. Analysis of coagulation and fibrinolytic markers (thrombin-antithrombin III complex, prothrombin fragment 1 + 2 and D-dimer) confirmed the occurrence of thrombosis in three patients undergoing breast reconstruction with clinically obvious thrombosis during primary surgery or at reoperation. Moreover, the patients with active cancer (2/7) were clearly hypercoagulable compared with the other patients. In short, the primary anastomotic failure was associated with loss of endothelial cells, and with co-localised platelet recruitment and fibrin formation at these sites. At reoperation, inflammation was a prominent feature at the vessel site of thrombi.

Adult↗

PubMed2000

Asymmetry of gait after free flap reconstruction of severe tibial fractures with extensive soft-tissue damage.

Gait patterns of the preferred speed were investigated on 17 patients recovering (9 months-14 years) after reconstruction of severe tibial fractures. A novel data-acquisition system was used to record the plantar pressures as well as electromyographic (EMG) activities during walking. The results indicated incomplete recovery of symmetrical gait patterns. In particular, the duration of the stance phase was shorter on the operated side (mean (SD) 701 (90) ms compared with 765 (128) ms, p < 0.001). The peak pressure points under the foot were different on bilateral comparison, the operated side being regularly higher under the lateral forefoot area. This may imply attempts to reduce the loading of the ankle joint during stance. The pressure distribution models reflected these asymmetrical patterns more specifically than the EMG activities of the lower leg muscles examined.

Adult↗

PubMed2000

Prevalence and characteristics of pressure ulcers. A one-day patient population in a Finnish city.

This article discusses the prevalence and characteristics of pressure ulcers in a one-day patient population in a Finnish city. The data was collected using two questionnaires. Data analysis was based on percentage distributions; statistical significances were tested with the Chi-square test. The measurement identified 186 patients with a total of 300 pressure ulcers. The majority (90%) of these patients were hospitalized and 10% were in outpatient care. The main causes for the development of pressure ulcers were inadequate turning and positioning and the patient's primary illness. Most of the ulcers were grade II. Only a few patients had ulcers that exposed bone. The preventive effort should extend from the nursing unit level, through the organizational level, to the level of society as a whole. It should consist of the identification of people at high risk for pressure ulcers and the provisions of quality care for these people.

Adolescent↗

PubMed2000

Prevention of pressure ulcers in acute and long-term care facilities in Finland: results of a survey.

The purpose of this study was to identify those healthcare organizations that have a high incidence of pressure ulcers, and to determine what their staffs do to prevent pressure ulcer formation. The sample was formed from 11 hospitals in one large city on a certain day in Finland in 1998. The researchers sent questionnaires to 154 hospital units and achieved a 94% response rate. Psychiatric; gynecologic; obstetric; and eye, ear, nose, and throat units were not included. The data were collected using two questionnaires: The first gathered data about the organization and the second about the patients. Fifty-seven percent of the units surveyed reported having patients with pressure ulcers. Of these units, 45% were acute and 55% were long-term care. Thirty-nine percent of all units had a pressure ulcer team. Units with pressure ulcer patients had a staffing level of 0.6 registered nurses and practical nurses per bed, compared with 0.7 registered nurses and practical nurses per bed for those units without pressure ulcer patients. The average length of stay on the unit was less for those without pressure ulcers compared to those with ulcers (P < 0.001) and only 18% of the units without pressure ulcers had a pressure ulcer team. According to the results, those units with pressure ulcer patients identified the need for more preventive measures more frequently than the units without ulcer patients. In conclusion, pressure ulcers seem to predominate in long-term care settings, and the educational level of healthcare staffing seems to impact the occurrence of pressure ulcers. Common preventive measures are used by the staff in both acute and long-term care settings.

Finland↗

PubMed1999

Postoperative changes in blood flow in free muscle flaps: a prospective study.

We used color Doppler ultrasound (US) to study postoperative changes in blood flow in 10 non-innervated free latissimus dorsi (LD) muscle flaps transplanted onto lower extremities. The peak, mean, and minimum velocities, resistance index, and diameter of the pedicle, and the recipient and control arteries were recorded preoperatively and on the 2nd, 5th, and 10th days after surgery. In the pedicle of the transplant, the peak and mean velocities increased but not significantly during the follow-up. The minimum velocity value in the thoraco-dorsal artery was (mean+/-SD) 4+/-5 cm/sec preoperatively, and was in the leg 19+/-9 cm/sec (P < 0.05) on the 5th and 17+/-10 cm/sec (P < 0.05) on the 10th postoperative day. The preoperative value of the resistance index decreased from 0.92+/-0.12 to 0.79+/-0.08 on the 10th postoperative day (P < 0.05). In the recipient artery, the peak (117+/-37) and mean (35+/-16 cm/sec) velocities increased significantly on the 5th postoperative day compared to the preoperative value (79+/-22 and 14+/-6 cm/sec, respectively). The minimum velocity increased but not significantly. The resistance index was preoperatively 1.23+/-0.09 and 0.88+/-0.16 (P < 0.05) on the 10th postoperative day. This prospective clinical study demonstrates that blood flow in the pedicle and in the recipient artery of a free muscle flap increases after surgery. This phenomenon may be due to loss of vascular tone and decreased resistance after denervation. Increased blood flow helps to keep the microanastomosis open and also promotes wound healing.

Adolescent↗

PubMed1999

Free microvascular tram flaps: report of 185 breast reconstructions.

The free TRAM flap is the most elegant technique currently available for breast reconstruction. We describe here the surgical technique, the complications, the possible effects of the prognosis of the breast cancer, and the learning curve of the surgical team. From December 1990 to the end of 1995 we reconstructed 185 breasts (10 bilateral) in 175 patients with free TRAM flaps; 27 were immediate reconstructions. We harvested the flap based on the inferior epigastric pedicle on the opposite side to the affected breast. To dissect the rectus muscle we used a muscle-sparing technique. The flap was designed and de-epithelialised while still on the abdomen, and was anastomosed to the thoracodorsal or circumflex scapular vessels with loupes only. In the immediate reconstructions we removed the breast tissue through a periareolar incision; we dissected the group I axillary lymph nodes and exposed the recipient vessels through a separate incision. The areolar complex was autotransplanted as a free skin graft. Only two flaps were lost. Eight patients were reoperated on for thrombosis of the vessels. The complication rate was nearly 50% among the first 50 patients. However, as surgical experience grew, the figure was reduced, eventually being down to 20%-25%. Of the patients who had delayed reconstructions only two died during the follow-up period of 48 months. One patient had a local recurrence above the TRAM skin. During the last eight years the free TRAM flap has been our main method of breast reconstruction. Free flaps today are reliable and the reconstruction does not seem to worsen the prognosis of breast cancer.

Adult↗

PubMed1999

Free flap reconstructions of 100 tibial fractures.

OBJECTIVE: Reconstructive microsurgery has been part of the treatment for severe tibial fractures for over 20 years. METHODS: In this study, we have analyzed 100 patients with 104 microvascular reconstructions to the lower leg in a 15-year period (1980-1994). Sixty-three of the reconstructions were made during the past 5 years (1990-1994), which means that microvascular reconstruction is increasing as a treatment of severe tibial fractures. RESULTS: Free flap transfer is a safe procedure: the failure rate among the patients studied was 2%, and the amputation rate was 5%. CONCLUSION: In the past 5 years, the flap survival rate and the microvascular free flap operation methods were the same as they were in the 1980s, but the methods for enhancing the fracture union or reconstructing the bone defect has changed.

Adolescent↗

PubMed1999

Prognostic value of tumour vascularity in primary melanoma.

To investigate the prognostic value of tumour vascularity we studied 84 patients with primary melanomas ranging in tumour thickness (Breslow) from 0.37 to 7 mm and in depth of tumour infiltration (Clark) from II to V. Vascularization was assessed by immunohistochemistry with a CD-31 antibody recognizing endothelial cells. The CD-31-positive vessels were counted and the degree of vascularization was correlated with the survival of the patients. In addition, the relationship between blood vessel density and some histopathological data is discussed. In our study, the multivariate Cox model showed that the only independent variable in disease-free survival was tumour thickness (Breslow classification) and the only one in overall survival was depth of tumour infiltration (Clark classification). In disease-free survival, tumour thickness (Breslow classification) was a clear prognostic factor (P = 0.004) after 4 years' follow-up, as were depth of tumour infiltration (Clark classification) (P = 0.04) and ulceration (P = 0.04). In overall survival, tumour vascularity was the strongest prognostic factor at 4 years, high vascularity being associated with a good prognosis (P = 0.06). Clark classification was also a prognostic factor (P = 0.02) in overall survival. We conclude that high vascularization is associated with a better prognosis but is not an independent prognostic indicator.

Adult↗

PubMed1999

Comparison of genetic changes in primary sarcomas and their pulmonary metastases.

The aims of the present study were to compare genetic aberrations in primary sarcomas and their pulmonary metastases and to explore the pathways associated with disease spreading. The primary tumor and its subsequent pulmonary metastasis of 22 patients were analyzed by comparative genomic hybridization. All samples were obtained before the initiation of chemo- or radiotherapy. The mean total number of aberrations per tumor was 7.6 (range, 0-17) in primary tumors and 7. 5 (range, 0-19) in metastases. The mean numbers of high-level amplifications per tumor were similar (0.32 in primary tumors and 0. 36 in metastases). The frequencies of the most common aberrations were relatively similar in primary tumors and metastases: the most frequent gain affected 1q (minimal common regions 1q21-q23 in 36% of primary tumors and 1q21 in 45% of metastases). The most frequent losses were detected at 9p (9p22-pter in 32% of primary tumors and 9p21-pter in 32% of metastases), 10p (10p11.2-p12 in 41% of primary tumors and 10p11.2-pter in 32% of metastases), 11q (11q23-qter in 36% of primary tumors and 32% of metastases), and 13q (13q14-q21 in 45% of primary tumors and 50% of metastases). No aberrations specific to metastases were detected. An increase in the total number of changes during progression was a predominant feature in a majority of these paired samples. Also, the number of differences in the genetic profile outnumbered common changes in a majority of the samples. However, despite the heterogeneous and numerous changes, all pairs with aberrations in both specimens had some shared alterations in both samples. Genes Chromosomes Cancer 25:323-331, 1999.

Adolescent↗

PubMed1998

Haemostatic disturbances in burned patients during early excision and skin grafting.

Bleeding is a major problem during early excision of burned skin. Therefore, 13 severely burned adult patients operated on during the first week after the trauma were studied. Blood loss was replaced with crystalloids, colloids and packed red cell concentrates (PRC). After ten infused PRCs, four fresh frozen plasma (FFP) units were given and thereafter one FFP unit with one PRC unit. Arterial blood samples were drawn before anaesthesia (SO), during operation after every four units of PRC transfusion (S1-4), 4 h postoperatively (S5) and on the first postoperative morning (S6). Prothrombin time (%) and activated partial thromboplastin time (s) were abnormal before operation (median values 67%, range 22-99% and 44 s, range 30-86 s, respectively). Prothrombin time decreased during operation and reached the critical level for normal haemostasis at S2. Thrombelastography showed decreased clot formation rate and impaired fibrin platelet interaction peri- and postoperatively. Fibrinogen and factor VIII activity were high preoperatively (median 6.1 g/l and 253%) and the critical values for normal haemostasis were not reached. Burned patients have a consumption coagulopathy which, in combination with haemodilution during operation, results in a clinically significant deficiency of coagulation factors II, VII and X, in spite of reactive elevation of coagulation factor VIII and fibrinogen.

Adult↗

PubMed1998

Problems in wearing external prosthesis after mastectomy and patient's desire for breast reconstruction.

BACKGROUND AND AIMS: To evaluate the inconvenience caused by an external prosthesis and the desire for breast reconstruction among Finnish breast cancer patients. MATERIAL AND METHODS: A questionnaire was sent to 345 mastectomized women 2-58 months after surgery between 1989 and 1993; 176 questionnaires were eliglible for review. Response rate was 63%. RESULTS: Mean age of the patients was 58 years, and 91% wore an external prosthesis. Of the patients under 65 years old, 46% wished to have reconstruction, but only one patient in the group 65 years old or older was interested in reconstructive surgery. In this study, interest in reconstructive surgery did not decrease with time. Younger patients had more difficulties and inconvenience with the prosthesis in every-day life while working, enjoying leisure time pursuits and wearing clothing. CONCLUSIONS: Breast cancer patients under 65 years have considerable problems with external prosthesis in every-day life. This is the group of patients therefore, that should be considered when evaluating the need for breast reconstruction in the community. Of new breast cancer patients in Finland, 40% per cent are between 45 and 59; about 50-70% of them will have a mastectomy. Our study suggests that breast reconstruction is needed for about half of these patients. Therefore, the annual need for breast reconstruction in Finland involves about 370 women.

Adult↗