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Biomedical subjects

S Mattila

Publications and source records attributed to S Mattila.

At least 19 recordsLinked to original sources
PubMed1992

Long-term blood flow potentials in sequential internal mammary artery grafts. Exercise thallium scan for myocardial perfusion study.

In two groups of patients, coronary artery bypass surgery for angina pectoris included internal mammary artery (IMA) sequential grafts (group I) or single grafts (group II). At postoperative angiography all grafts were patent. In addition, the patients received on average 1.8 vein grafts into other coronary arteries. The mean interval to postoperative follow-up was 9.5 years in group I and 9.7 years in group II. The preoperative incidence of acute myocardial infarction was 44% and 45% in groups I and II. Exercise thallium scan at follow-up showed IMA graft-related ischemia in 33% of the patients with sequential graft and in 64% of those with single graft (ns). Our results indicated that sequential IMA grafts functioned at least as well as single grafts and maintained adequate myocardial supply even 10 years postoperatively. Internal mammary arteries are superior graft material and can be recommended both as single and as sequential graft in coronary artery bypass surgery.

Aged↗
PubMed1992

Peripheral excimer laser-assisted angioplasty. Preliminary clinical experience.

A non-thermal Xenon-Chloride excimer laser was used for peripheral arterial recanalization in eight patients with obliterating atherosclerosis of the superficial femoral artery. All patients had a total occlusion with severe claudication or pain at rest. There were three complications, which all led to thrombosis of the irradiated artery. In one, the puncture site in the artery had to be closed operatively. All vessels were followed up radiographically three months after the procedure. In seven patients the vessel was patent. Several investigators have warranted caution in using thermal lasers (continuous wave Nd:YAG or argon) for angioplasty. The non-thermal excimer laser is a viable alternative--although not without problems. Initial experiences with the new device are described.

Aged↗
PubMed1991

Cytomegalovirus myocarditis in transplanted heart verified by endomyocardial biopsy.

Cytomegalovirus infections are common disorders after heart transplantations. Manifestation of the virus without a clinical disease is still more prevalent. Differentiation of clinical infections from cytomegalovirus activations without major pathogenetic importance issues a challenge in the follow-up of patients with cardiac transplants. The case describes a 56-year-old female patient with a multiple organ lethal infection and myocarditis due to cytomegalovirus diagnosed during life with endomyocardial biopsy.

Biopsy↗
PubMed1990

Recurrence and malignant transformation of endotracheal chondroma.

An endotracheal chondroma with recurrent course and malignant transformation is described. The first chondroma recurrence appeared 5 years after the primary operation, with no histopathological signs of malignancy. A second recurrence after a further 6 years showed obvious histological evidence of malignant chondrosarcoma. A third recurrence after 1 more year metastasized to various organs and led to the patient's death 14 years from the date of primary diagnosis.

Brain Neoplasms↗
PubMed1990

Surgery after heart transplantation.

Of 17 patients who underwent heart transplantation in 1985-1988, three were later operated for reasons unrelated to the transplant. Two of them had acute cholecystitis and one haemothorax, due to rupture of the internal mammary artery during endomyocardial biopsy. Cholecystectomy was performed in the first two cases and thoracotomy in the third, with uneventful recovery in all cases. Early diagnosis and adequate surgical treatment are necessary in these cases. Consideration of the immunosuppressive medication is important during and after operation.

Adolescent↗
PubMed1990

Bronchoplastic procedures in the treatment of endobronchial carcinoid tumors.

Pulmonary carcinoid tumor was surgically treated in 33 patients during a 22-year period. The tumor was polypoid and endobronchial in 19 (58%) of the patients. Conventional operation was required in 12 (63%) of the 19, viz. pneumonectomy (1), bilobectomy (1), lobectomy (9) or lingulectomy (1). In one of these 12 patients, metastasis to a salivary gland was found 15 years postoperatively, and to the mediastinum after 16 years. The other seven patients (5 female, 2 male) were treated with bronchoplasty, or with lobectomy and bronchial resection including bronchoplasty, to avoid more extensive pulmonary resection. All seven were recalled for follow-up examination 5 months to 10 years postoperatively. No recurrence or metastasis of the tumor was found, and spirometry and radiospirometry showed that the saved pulmonary tissue was functional.

Adolescent↗
PubMed1990

Benign mesenchymal tumours of the lung including sclerosing haemangiomas.

Clinical aspects of twelve patients with benign mesenchymal lung tumours including four so-called sclerosing haemangiomas were studied. The age of the patients varied from 17 to 62 years (mean 40 years). Seven patients were female and five were male. The benign tumour was enucleated in five cases and excised by segmentectomy in one case. Three tumours were removed by lobectomy, and one by bilobectomy including bronchial resection and bronchoplasty. Two tumours (an endobronchial leiomyoma and fibroma) were removed by bronchial resection. Two patients who had previous hysterectomy for uterine leiomyomas had intraparenchymal pulmonary leiomyomas with histologically benign appearance. Although these tumours might represent metastases from uterine tumours, the follow-up of 5 and 8 years did not reveal clinically malignant features. None of the patients in this series showed tumour recurrences. Our results confirm earlier observations suggesting that the so-called sclerosing haemangioma is actually an epithelial, not a mesenchymal tumour.

Adult↗
PubMed1990

A malignant Leydig cell tumour associated with testicular trauma and prostatic carcinoma.

A case of metastatic Leydig cell carcinoma without sex hormone overproduction is reported. The patient had had a prior testicular contusion trauma on the same side after which the testicle had been swollen and firm. The possible aetiological role of extreme trauma is discussed. Radical orchidectomy is recommended for large tumours because of the difficulty in predicting malignant potential, and routine follow-up with retroperitoneal ultrasound scanning for 10 years in all cases.

Aged↗
PubMed1990

Single lung allotransplantation in pigs. A morphologic study of tissue preservation with modified Euro-Collins and fluorocarbon solutions.

In the present study the functional and morphologic effects of two pulmoplegic solutions are evaluated. Single left-lung allotransplantation with ligation of the right pulmonary artery was performed in 15 piglets (13-20 kg). The lungs were preserved after donor prostaglandin E-1 treatment with single pulmonary artery flush with either modified Euro-Collins solution (mECS) (9 pigs) or oxygenated fluorocarbon emulsion (FC-43) (6 pigs) and transplanted after 6-hr storage in cold Physiosol solution. Tidal volumes of 15 ml/kg x fr (18) with 40% inspired oxygen were used for ventilation during reperfusion. Function of the transplanted lung was monitored for 4 hr postoperatively by determining pa CO2 and pa O2 levels from arterial samples and by noninvasive monitoring of end-tidal CO2 values and arterial oxygen saturations. Sequential morphologic changes in pulmonary artery flow surface and lung tissue were studied after 6-hr storage and 4-hr reperfusion, using light, scanning, and transmission electron microscopy (LM, SEM, TEM). There was no mortality. After transplantation the mECS group experienced significant hypoxia and hypercarbia and had low end-tidal CO2 values as signs of defective oxygenation and gas exchange, whereas the FC-43 group was normoxic and normoventilated without disturbed elimination of carbon dioxide. After storage and reperfusion, LM showed signs of increased vascular permeability and reperfusion damage--more evident in the mECS group compared with the FC-43 group--while the lymphoid cell population was more intensely activated in the latter group. Electron microscopy after storage showed good overall preservation of structures in both groups. After reperfusion preservation of pulmonary artery flow surface and lung tissue was estimated to be moderate in the mECS group, whereas it was good-to-moderate in the FC-43 group by SEM (NS). TEM of lung tissue, however, showed significantly better-preserved alveolar epithelial lining in the FC-43 group compared with the mECS group. In conclusion, oxygenated fluorocarbon (FC-43) pulmoplegia gave better functional and morphologic preservation of lung grafts compared with modified Euro-Collins solution.

Animals↗
PubMed1989

Angiographic findings in patients exhibiting ischemia after oral dipyridamole.

We have assessed the angiographic features of a group of 37 patients given oral dipyridamole and 37 patients given matching placebo. Both groups represented severe coronary arterial disease and were studied prior to bypass surgery. Six patients (16%) had angina and 13 patients (35%) had electrocardiographic changes after dipyridamole. All the patients in the control group were nonresponders. In the group given dipyridamole the patients responding with angina had significantly more compromised collaterals than the patients without chest pain (P = 0.021). The same applied to the patients with electrocardiographic changes versus those with no electrocardiographic changes (P = 0.034). No differences between responders and nonresponders could be found in terms of the severity of coronary arterial disease, severity of anginal symptoms, exercise tolerance, antianginal medication, number of past myocardial infarctions, and left ventricular ejection fraction. In conclusion, the data strongly suggest that ischaemic responses to dipyridamole originate from myocardial steal accentuated by compromised flow in collateral vessels.

Administration, Oral↗
PubMed1989

Primary cardiac tumours--operative treatment of 20 patients.

This report describes a series of 20 patients operated on for a primary cardiac tumour. The majority of the tumours (16) were benign myxomas; 12 of them were located in the left atrium, two in the right atrium and two were biatrial. Two lipomas were found; one was epicardial and the other was located in the left atrium. The only intraventricular tumour was a malignant left ventricular myosarcoma. The propensity of intracardiac tumours to embolize was distinctive. Nine of the 16 myxomas presented with peripheral embolization, and in two patients surgery was complicated by fatal perioperative cerebral embolization of myxomatous tissue. Furthermore, in one patient embolization of a left atrial lipoma necessitated amputation of her left arm before cardiac surgery. Late postoperative recurrences were found in two patients with atrial myxomas. In one of them, reoperation showed that the tumour had grown at that site in the interatrial septum where the original pedicle had been excised. One patient developed severe mitral valve regurgitation and underwent replacement with a prosthetic valve at reoperation. Otherwise our late follow-up study showed that the results of surgery were usually excellent even though mild echocardiographic abnormalities were not uncommon. Our experience emphasizes the embolic potential of intracardiac myxomas and suggests, furthermore, that to avoid recurrences excisions with wide margins should be preferred. Echocardiography is an optimal method for the follow-up of these patients.

Echocardiography↗
PubMed1989

Intracellular-type solution flush for preservation of myocardium and coronary and pulmonary artery flow surface.

Modified Euro-Collins solution (ECS), which has been successfully used in kidney, liver and lung transplantation, was tested concerning myocardial and endothelial preservation in nine piglets. In six (group I), 1-hour cardiac arrest was induced with cold modified ECS, and in three (group II) heart-lung transplantation was performed, using modified ECS for graft preservation. In group I myocardial energy preservation was determined with biochemical assays for adenosine triphosphate, creatine phosphate, lactate and creatine 5, 15, 30 and 60 minutes after aortic clamping, and preservation of endothelium in the aorta and coronary arteries was studied with scanning electron microscopy. In group II electron microscopy was performed on endothelial samples from the ascending aorta and coronary and pulmonary arteries of the heart-lung block after excision, after 2 hours of ischemia, and after 1-2 hours of reperfusion. High-energy phosphates decreased progressively during the ECS cardioplegia in group I, and circulatory support was required during the post-transplantation reperfusion period in group II. The endothelial lining in all specimens was remarkably well preserved, however. Modified ECS flush thus was ideal for vascular endothelium but, because of its poor energy-preserving capacity, unsuitable for cardioplegia.

Animals↗
PubMed1989

Single-lung allotransplantation in pigs following donor pretreatment with intravenous prostaglandin E-1. Morphologic changes after preservation and reperfusion.

Single left lung allotransplantation with ligation of the right pulmonary artery was performed on 11 pigs after donor pretreatment with prostaglandin E-1 and pulmonary artery flush with modified Euro-Collins solution. Sequential morphologic changes in pulmonary artery flow surface and lung structure were studied after 6-hour storage and after 4-hour reperfusion, using light microscopy and scanning and transmission electron microscopy. Morphologic observations were compared with functional changes. After 6-hour preservation slight degenerative changes were found in the pulmonary artery flow surface and changes in lung tissue suggestive of increased vascular permeability and edema. During 4-hour reperfusion the changes progressed. Preservation was in general moderate. Lung tissue showed vascular congestion and slight inflammation. Localized areas of reperfusion damage could adjoin near-normal looking alveoli. Oxygenation and gas exchange, though low in the beginning of reperfusion, tended to improve during the reperfusion period. The method was concluded to afford good morphologic preservation of the graft after 6-hour storage, and moderately good morphologic and functional preservation after 4-hour reperfusion.

Animals↗