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S Leinonen

Publications and source records attributed to S Leinonen.

At least 19 recordsLinked to original sources
PubMed2003

Extracranial internal carotid and vertebral artery dissections: angiographic spectrum, course and prognosis.

We reviewed the clinical and radiological findings of 93 consecutive patients with 111 extracranial internal carotid (ICAD) and vertebral artery (VAD) dissections and one concomitant intracranial VAD; 83% of the patients had unilateral and 17% multiple vessel dissections. The diagnosis was made by intra-arterial digital subtraction angiography in 92 patients and MR angiography in one. Follow-up angiography was performed in 77 cases (83%): of 49 initially stenotic arteries, 40 became completely or almost completely normal, while three showed slight improvement. Of 30 initially occluded arteries, nine had completely or partly recanalised. Of 12 pseudoaneurysms eight were unchanged at follow-up. The proximal vertebral artery was involved as often as the C1-C2 level. Recurrences were rare: a new dissection in another vessel was found in three patients. Kinking or coiling was found in 23% of the dissected internal carotid arteries.

Adolescent↗
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

Treatment of renal cysts with single-session percutaneous drainage and ethanol sclerotherapy: long-term outcome.

OBJECTIVES: To evaluate the safety, efficacy, and long-term outcome of single-session ethanol sclerotherapy for non-neoplastic renal cysts. METHODS: In a prospective study, 32 patients with a simple renal cyst were treated with ultrasound-guided percutaneous aspiration, and no more than 100 mL sterile 99% ethanol was injected into the cyst. The procedure was performed under local anesthesia, and the patients were hospitalized overnight. The serum concentrations of alcohol immediately after the sclerotherapy and 1 hour later and the corresponding urine concentrations were measured. The mean follow-up period was 55 months (range 12 to 156). Control checkups were scheduled at 1, 3, 6, 9, and 12 months after the sclerotherapy. During the control visits, the patients underwent ultrasound measurement of the size of the cyst. The history concerning renal pain especially was evaluated by the urologist. The patients were asked if they did or did not have pain. The severity of pain was not evaluated. RESULTS: Sclerotherapy with ethanol was performed successfully in all 32 patients with a simple renal cyst. The cyst disappeared completely in 7 patients (22%). The mean size of all cysts decreased from 7.8 cm (range 3 to 16) to 1.7 cm (range 0 to 9; P <0.0001). Before the sclerotherapy, 24 patients had symptoms due to the cyst, and 18 of these (75%) were asymptomatic after the ethanol sclerotherapy. In 2 patients the pain decreased, 2 patients were without change, and in 2 patients the pain increased. There was no correlation between the size of the cyst and the intensity of pain. No major complications occurred. The serum concentration of alcohol varied from 0 to 0.30 g/L and that in urine from 0.04 to 0.27 g/L. CONCLUSIONS: Percutaneous aspiration and sclerotherapy with ethanol for simple renal cysts is simple, fast, safe, effective, and inexpensive. The results are comparable to those reported earlier. The treatment is without major complications. We propose sclerotherapy with 99% ethanol as the primary treatment of simple renal cyst. The treatment can be done in an outpatient clinic.

Adolescent↗
PubMed2001

Developmental pathways of children with and without familial risk for dyslexia during the first years of life.

Comparisons of the developmental pathways of the first 5 years of life for children with (N = 107) and without (N = 93) familial risk for dyslexia observed in the Jyväskylä Longitudinal study of Dyslexia are reviewed. The earliest differences between groups were found at the ages of a few days and at 6 months in brain event-related potential responses to speech sounds and in head-turn responses (at 6 months), conditioned to reflect categorical perception of speech stimuli. The development of vocalization and motor behavior, based on parental report of the time of reaching significant milestones, or the growth of vocabulary (using the MacArthur Communicative Development Inventories) failed to reveal differences before age 2. Similarly, no group differences were found in cognitive and language development assessed by the Bayley Scales of Infant Development and the Reynell Developmental Language Scales before age 2.5. The earliest language measure that showed lower scores among the at-risk group was maximum sentence length at age 2. Early gross motor development had higher correlation to later language skills among the at-risk group rather than the control children. The most consistent predictor of differential development between groups was the onset of talking. Children who were identified as late talkers at age 2 were still delayed at the age 3.5 in most features of language-related skills-but only if they belonged to the group at familial risk for dyslexia. Several phonological and naming measures known to correlate with reading from preschool age differentiated the groups consistently from age 3.5. Our findings imply that a marked proportion of children at familial risk for dyslexia follow atypical neurodevelopmental paths. The signs listed previously comprise a pool of candidates for early predictors and precursors of dyslexia, which await validation.

Child↗
PubMed2000

Cost-effectiveness of Percutaneous Transluminal Angioplasty (PTA) Versus Vascular Surgery in Limb-threatening Ischaemia.

The purpose of this study was to analyze the cost and cost-effectiveness of femoropopliteal PTA compared to femoropopliteal bypass surgery in chronic critical ischaemia of the lower limb. A total of 772 patients were treated either by femoropopliteal PTA or vascular reconstruction in two of the three largest vascular centers in Finland 1991-1992. A subset of 124 cases with chronic critical leg ischaemia, which according to a retrospective independent analysis by a vascular surgeon and a radiologist could have been treated with either modality, were included in the study. Eighty-six of those were treated with PTA and 38 with surgery. The patients were followed up for to three years after treatment. Clinical outcomes were measured as change in the ABI (ankle-brachial pressure index) and avoidance of reoperation and amputation. The hospital costs covering all events from preoperative examinations to the three-year follow-up visit were identified by using hospital discharge register and accounting data. Cost-effectiveness was calculated as cost per reoperation-free year and year of leg saved. Surgery cases were found to have a more severe disease as indicated by lower distal pressures and longer occlusions and they also showed a slightly better clinical outcome, although the differences were not statistically significant. PTA costs were half of those of vascular surgery. The cost-effectiveness rates were significantly better for the PTA patients. PTA is a feasible and cost-effective procedure in chronic critical ischaemia of the lower limb and should be the treatment of choice in the subset of patients where both procedures are possible.

Journal Article↗
PubMed1999

Modulation of murine phenobarbital-inducible CYP2A5, CYP2B10 and CYP1A enzymes by inhibitors of protein kinases and phosphatases.

Phenobarbital causes a multitude of effects in hepatocytes, including increased cell proliferation, inhibition of apoptosis and upregulation of xenobiotic and endobiotic metabolizing enzymes. In this study, the involvement of several protein kinase and phosphatase pathways on constitutive and phenobarbital-induced activities of CYP2A5, CYP2B10 and CYP1A1/2 in primary mouse hepatocytes was determined using well-defined chemical modulators of intracellular protein phosphorylation and desphosphorylation events. A 48-h treatment of the hepatocytes with 2-aminopurine, a nonspecific serine/threonine kinase inhibitor, elicited dose-dependent increases in both basal and phenobarbital-induced CYP2A5 catalytic activity (assayed as coumarin 7-hydroxylation), the maximal induction being 60-fold greater than the control value upon cotreatment with 1.5 mM phenobarbital and 10 mM 2-aminopurine. In contrast, phenobarbital induction of CYP2B10 (pentoxyresorufin O-deethylase) and CYP1A1/2 (ethoxyresorufin O-deethylase) activities were blocked by 2-aminopurine. Increases in CYP2A5 activity were also observed after exposure of the hepatocytes to other protein kinase inhibitors affecting the cell cycle, i.e. roscovitine, K-252a and rapamycin. Inhibitors of protein kinases A and C, as well as tyrosine kinases, did not appreciably affect CYP2A5 activity levels. The serine/threonine phosphatase inhibitors tautomycin, calyculin A and okadaic acid all reduced both basal and phenobarbital-induced CYP2A5, CYP2B10 and CYP1A1/2 activities. These results further strengthen the concept that hepatic CYP2A5 is regulated in a unique way compared with CYP2B10 and CYP1A.

Animals↗
PubMed1998

Intracranial arterial dissection.

We review the angiographic and CT findings, precipitating factors and clinical features in nine patients with ten intracranial arterial dissections. The internal carotid artery was involved in five cases, the vertebral artery in four and the posterior inferior cerebellar artery in one. Angiography revealed irregular stenosis in four cases, irregular stenosis and a pseudoaneurysm in two, irregular stenosis and irregular dilatation in one, arterial occlusion in two and a pseudoaneurysm in one. CT demonstrated an infarct in four cases, a dense middle cerebral artery in two and subarachnoid haemorrhage in one. A possible precipitating factor was identified in five cases. Six patients recovered well, while three had persisting neurological deficits.

Adult↗
PubMed1998

Non-prosthetic surgery in the treatment of erectile dysfunction. A retrospective study of 45 impotent patients in the University of Oulu.

The purpose of this retrospective study was to assess the outcomes of the patients with total erectile impotence who have undergone non-prosthetic surgery in our hospital and to make a decision concerning the continuation of this treatment modality. The study series consisted of 45 operated patients, 21 of whom had undergone venous leakage surgery and 24 revascularization of the penis. The follow-up time was at least 12 months. The outcome of venous surgery after 6 months was initially good in 16 patients (76%) but declined in such a way that 12 months after the operation it was good only in 6/21 patients (29%). Despite this, 11/21 patients were capable of intercourse after a prostaglandin E1 injection 1 year from the operation. Altogether 17/21 patients (81%) benefited from venous surgery after 12 months. The outcome of arterial surgery was good in 11/24 patients (46%) 12 months after the operation. A moderate outcome was obtained in another 8/24 patients (33%), who were capable of intercourse after a prostaglandin E1 injection. Minor complications occurred in 20% of the venous surgery patients; 25% of the patients with arterial surgery had complications and half of these were severe, resulting in glans hypervascularization. Our findings indicate that non-prosthetic surgery continues to have an established position in the treatment of severe impotence when all conservative treatment modalities have been used.

Adult↗
PubMed1998

Duplex ultrasound in the subclavian steal syndrome.

PURPOSE: The effect of subclavian steal on the contralateral vertebral flow and its possible effect on carotid flow were studied and the US results were compared to the angiographic findings. MATERIAL AND METHODS: The study consisted of the records of 74 patients with a duplex Doppler finding of subclavian steal syndrome. Of these, 48 patients had had both angiography and US of the neck arteries and were selected for comparison. For a comparison of the US flow values, a control series of 48 was selected from our carotid archive and consisted of patients without subclavian steal who had also been examined with both US and angiography. RESULTS: Of the 48 patients, 44 had a subclavian steal syndrome at angiography, 31 on the left side and 13 on the right. Of the 44, 21 patients had subclavian occlusion, and 23 stenosis. In 84% of the subclavian occlusions, US showed a complete systodiastolic steal and in 16% a partial systolic steal, while the corresponding findings for subclavian stenoses were 17% and 83%. Of the 48 cases, 4 were not real subclavian steals: 2 had vertebral occlusion (1 with a 90% subclavian diameter stenosis) on the side of retrograde flow at US and a steal through the vertebral and collateral arteries to the spinal arteries; and 2 had a 70% diameter stenosis of the subclavian artery and to-and-fro flow in the vertebral artery at angiography. In the 21 cases of complete steals, the subclavian diameter stenosis was 97 +/- 8% at angiography, and in the 23 partial steals, it was 85 +/- 10%. There was a significant increase in contralateral vertebral and common carotid flow in the cases with retrograde vertebral flow compared to the vertebral and common carotid flow of the control subjects. The retrograde flow values, the ipsilateral vertebral lumen diameter, and the flow values in the common carotid arteries were higher in complete steals and subclavian occlusions than in partial steals. CONCLUSION: A complete vertebral steal at US correlated well with subclavian occlusion and a partial steal suggested stenosis of the subclavian artery. There were also flow changes in the contralateral vertebral artery and the common carotid arteries that compensated for the steal. Retrograde vertebral flow at US was sometimes associated with vertebral occlusion in subclavian stenosis without a true subclavian steal.

Adult↗
PubMed1997

Superselective intra-arterial chemotherapy with mitomycin C in hepatic metastases from colorectal cancer.

BACKGROUND: Mitomycin C has been found clinically useful in the treatment of colorectal cancer when administered via the hepatic artery. In a prospective therapeutic trial, we studied the effect of superselective intra-arterial chemotherapy with mitomycin C in patients with hepatic metastases from colorectal cancer. METHODS: Forty-six patients with hepatic metastases from colorectal cancer received intra-arterial chemotherapy with mitomycin C (SIAC) between 1981 and 1991. The results of a 5-year follow-up were compared with 46 control patients standardized by sex, age, and tumor distribution. RESULTS: The overall response rate to intra-arterial chemotherapy was 20%. The median survival time for responders was 26 months and that for nonresponders 12 months (P < 0.003). The median survival period after intra-arterial chemotherapy was 15 months, compared with 9 months in controls (P < 0.004). The cumulative 5-year survival rate was 6% for patients treated by SIAC and 5% for controls. Cessation of chemotherapy was necessary in 39 of the 46 patients: in 28 because of tumor progression, in 9 because of toxicity, in 1 because of catheterization difficulties, and in 1 because of patient refusal. CONCLUSIONS: Superselective intra-arterial mitomycin C therapy had a poor effect on hepatic metastases from colorectal cancer because of the low response and long-term survival rates.

Adult↗
PubMed1997

Insulin-like growth factors and their binding proteins in the venous effluents of ovary and adrenal gland in severely hyperandrogenic women.

Insulin and insulin-like growth factors (IGF) are thought to play an important role in the pathogenesis of excessive androgen production. To explore this question further we measured the concentrations of IGF-I and -II and their binding proteins (IGFBP-1 and-3) in adrenal and ovarian vein samples of severely hyperandrogenic women (serum testosterone > 5 nmol/l) collected as part of their diagnostic work-up. The concentration of IGF-II was slightly but not significantly higher in the ovarian vein than in the adrenal and peripheral veins. The concentrations of IGF-I and IGFBP were identical in both the adrenal and ovarian veins and did not differ from those in the peripheral circulation. The concentration of IGFBP-1 was negatively correlated (r = -0.60, P > 0.05) with insulin and IGFBP-3 showed a strong positive correlation with IGF-1 (r = 0.90, P > 0.01). These results indicate that neither the ovary nor the adrenal gland contributes significantly to the circulating pool of IGF or their binding proteins in severely hyperandrogenic subjects. Hyperinsulinaemia is associated with low circulating IGFBP-1 concentrations and IGFBP-3 seems to be an excellent indicator of the peripheral IGF-I concentration. The concentrations of IGF-I suggested decreased somatotrophic activity in these obese, hyperinsulinaemic subjects.

Adrenal Glands↗
PubMed1997

Preoperative embolization in the management of neck paragangliomas.

Surgery of neck paragangliomas carries inherent risks of excessive blood loss and cranial nerve injury. Preoperative embolization has been used to lessen the morbidity of surgery. We sought to characterize our experience with preoperative embolization by evaluating safety, efficacy, and surgical data. During a period of 22 years (1974 to 1996), 19 consecutive patients with 27 histopathologically confirmed neck paragangliomas were surgically treated at the Oulu University Hospital. All patients underwent preoperative arteriography and 17 patients had cervical ultrasonography (US). Eleven patients with 15 tumors were operated on without embolization and nine patients with 12 tumors were preoperatively embolized with 150- to 250-microm polyvinyl alcohol (PVA) particles. The mean blood loss during surgery in the nonembolized group was 1374 mL (range, 100 to 4500 mL) and the mean operation time was 4 hours and 48 minutes (range, 1.5 to 9 hours). In the embolized group the mean blood loss was significantly less (588 mL; range, 100 to 1800 mL; P = 0.04) and the mean operation time shorter (3 hours 24 minutes; range, 2 to 5 hours; P = 0.05). No embolic complications were recorded after the embolization. We conclude that preoperative embolization of neck paragangliomas 3 cm or greater in diameter with PVA particles is safe. Embolization to minimize operative bleeding facilitates surgery, shortens the operation time, and lessens the surgical risks.

Adolescent↗
PubMed1997

Transarterial embolization of a direct carotid cavernous fistula with Guglielmi detachable coils.

Four patients underwent transarterial embolization of a carotid-cavernous fistula with Guglielmi detachable coils; in three cases as the initial form of treatment and in one case after treatment via transarterial balloon embolization failed. The fistulas were 2 to 3 mm in diameter on pretreatment angiograms. Complete obliteration was achieved in two patients; in the other two, minimal residual flow remained immediately after embolization but disappeared by follow-up angiography. One to four coils were used to occlude the fistulas. The internal carotid artery remained patent in all patients, and there were no complications.

Arteriovenous Fistula↗
PubMed1997

Is varicocele treatment useful?

The effect of the treatment of varicocele on symptoms and fertility was followed up in 66 patients for an average of 27 months (range 6-84 months). The patients had been treated either surgically (n = 45) or with embolization (n = 21). The mean duration of the inpatient periods and sick leaves were significantly shorter among the patients treated with embolization than among the surgical patients (2.4 vs 3.3 days and 4.8 vs 21.3 days, respectively). Scrotal problems disappeared either completely or almost completely in 73% of the patients treated for symptoms (n = 40). The number of spermatozoa increased significantly (from 6.7 mill/ml to 27.4 mill/ml) in the patients with infertility after the treatment of varicocele. Pregnancy started in 31% of the couples with infertility problems. A spontaneous abortion occurred in two cases, and six couples (23%) had a child of their own. It could be concluded that the treatment of varicocele is useful regardless of whether it is given for symptoms or infertility. It is also indicated for the patients with infertility problems who have a low number of spermatozoa and disturbed spermatozoan motility in sperm analysis.

Adult↗
PubMed1996

Adrenal steroidogenesis is related to insulin in hyperandrogenic women.

OBJECTIVE: To evaluate ovarian and adrenal steroid secretion in women with severe hyperandrogenism. DESIGN: A prospective study. SETTING: The Gynecological Endocrine Research Unit of the University Central Hospital, Oulu, Finland. PATIENTS: Thirteen obese, hirsute women with severe hyperandrogenism. INTERVENTIONS: Adrenocorticotropin hormone stimulation and dexamethasone suppression tests and selective catheterizations of the left ovarian and adrenal veins were performed. MAIN OUTCOME MEASURES: The concentrations of insulin, P, 17-hydroxyprogesterone (17-OHP), androstenedione (A), T, DHEA, DHEAS, and cortisol were measured. RESULTS: The secretory gradients of T and its precursors, P, 17-OHP, A, and DHEA in the selective catheterizations showed the adrenal to be the main source of excessive steroid production in these patients. The concentrations of P (r = 0.82), 17-OHP (r = 0.89), A (r = 0.84), T (r = 0.86), and cortisol (r = 0.87) in the adrenal vein showed a strong correlation with insulin measured from the same samples. CONCLUSIONS: Excessive androgens were secreted mainly by the adrenals in these obese hyperinsulinemic women. Correlation analyses suggested that insulin stimulates adrenal androgen and cortisol secretion, which may constitute an important component of the pathogenetic mechanisms of hyperandrogenism and the polycystic ovary syndrome.

Adolescent↗
PubMed1996

Quantification of carotid artery stenosis with various Doppler velocity parameters.

PURPOSE: To assess the Doppler indices best suited for detecting a stenosis of the internal carotid artery. MATERIAL AND METHOD: 358 patients (234 men, 124 women, mean age 59 years, range 25-83 years) were examined via duplex carotid sonography (US) and arteriography. Flow indices and B-mode real-time results of stenoses were compared with arteriographic findings. RESULTS: The accuracy of US in differentiating a 50% or more severe ICA stenosis was 93% and the correlation coefficient between angiographic and US stenosis was 0.94. Peak systolic velocity of the internal carotid artery (vpICA) and its ratio to the systolic (vpICA/vpCCA) and diastolic velocity of the common carotid artery were most accurate at 70% stenosis. The vpICA/vpCCA ratio was even slightly more accurate in cases of less severe stenosis. B-mode real-time measurement of diameter stenosis was most accurate at the < 30% level. There was large variation in the flow values of the ICA, mostly due to the variability of flow in the common carotid artery. The vpCCA was low in wide and higher in medium-sized or narrow common carotid arteries. Contralateral ICA stenosis also affected the flow and thus on the vpICA/vpCCA ratio and the differentiation between significant and non-significant stenosis. CONCLUSIONS: At duplex US, B-mode real-time measurement is suitable for screening small carotid plaques and flow indices, especially vpICA and vpICA/vpCCA in severe stenoses.

Adult↗