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Seppo Laitinen

Publications and source records attributed to Seppo Laitinen.

6 recordsLinked to original sources
PubMed2005

Prognostic factors of perforated sigmoid diverticulitis in the elderly.

BACKGROUND: The Finnish population is aging fast and the prevalence of perforated sigmoid diverticulitis is simultaneously increasing in northern Finland. The fact that an increasing number of elderly patients, with their age-specific problems, are subjected to emergency surgery for acute diverticulitis underlines the importance of risk stratification. METHODS: One hundred and seventy-two patients admitted to Oulu University Hospital because of diverticular perforation from 1983 to 2002 were identified from the computer database. The clinical variables were evaluated as prognostic indicators of postoperative complications, mortality and time of hospitalization. RESULTS: The resection rate was 91%; 64 primary anastomoses, 93 Hartmann's procedures and two covering colostomies were performed. The overall complication rate was 33%. In patients under 70 years, a stepwise logistic regression analysis showed that the Mannheim Peritonitis Index (MPI) score and American Society of Anesthesiologists (ASA) score were independent prognostic factors. None of factors predicted morbidity in patients over 70 years. Overall mortality rate was 8%, without any significant difference between the procedures. Of the clinical variables, MPI score, ASA score, Hinchey classes and malnutrition correlated with mortality. All patients who died presented with ASA scores of III-IV, and 12 out of 14 patients had an MPI score of II. In a stepwise logistic regression analysis, only the MPI score seemed to be an independent predictor of mortality. CONCLUSIONS: Mortality is related to age but age alone is not an independent predictor of mortality. The MPI score is useful in predicting the risk of death in patients with perforated diverticulitis.

Adult↗
PubMed2003

Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis.

PURPOSE: To identify the risk factors for anastomotic leakage after left-sided colorectal resections with rectal anastomosis. METHODS: Forty-four patients with anastomotic leakage identified from a computer-generated database were compared with 44 control patients standardized for gender, age, and operative indication. RESULTS: The mean hospital stay was significantly prolonged in the leakage group, which resulted in a higher total cost of hospital treatment. The preoperative variables significantly associated with anastomotic leakage included malnutrition, weight loss, hypoalbuminemia, cardiovascular disease, two or more underlying diseases, and use of alcohol. The surgery-related factors that turned out to be significant were The American Society of Anesthesiologists physical status, operation time greater than two hours, multiple blood transfusions, intraoperative contamination of the operative field, and a short distance of the anastomosis to the anal verge. Obesity, body mass index, diabetes, smoking, serum hemoglobin, serum creatinine, serum bilirubin, bowel preparation, mode of antibiotic prophylaxis, type of anastomosis, technique of stapling, size of stapler used, and use of drain were nonsignificant variables. Malnutrition, weight loss, use of alcohol, intraoperative contamination, long operation time, and multiple blood transfusions remained significant in logistic regression model. Eighty-six percent of the patients with three or more risk factors of anastomotic leakage belonged to the leakage group. CONCLUSIONS: Patients with multiple risk factors have higher risk for anastomotic leakage. When patients have three or more risk factors, the creation of a protective stoma should be considered in cases with a low rectal anastomosis, and all these patients should be carefully monitored postoperatively for signs of possible leak.

Aged↗
PubMed2002

Prevalence of perforated sigmoid diverticulitis is increasing.

INTRODUCTION: The population of Finland is aging fast, and dietary fiber consumption has decreased during the past few decades; the prevalence of sigmoid diverticular perforation can therefore be anticipated to increase. This study presents our experience concerning the outcome of 133 patients admitted to a university hospital for diverticular perforation during a 15-year period. METHODS: One hundred thirty-three patients admitted into our hospital for sigmoid diverticular perforation during the 15-year period from 1986 to 2000 were identified using a computer database. Clinical data were reviewed from the database and the patients' records. RESULTS: The annual prevalence of perforated sigmoid diverticulitis is increasing. It was 2.4 per 100,000 in the year 1986 and 3.8 per 100,000 in the year 2000. The resection rate was 90 percent; after resection, 45 primary anastomoses, 75 Hartmann's colostomies, and 1 covering colostomy were performed. The overall complication rate was 32 percent, without any significant difference between the procedures. Of the clinical variables, the Mannheim Peritonitis Index scores (P = 0.0088) and the number of previous hospital treatments (P = 0.035) correlated with postoperative complications. Overall mortality was 9 percent, without any significant difference between the procedures. Of the clinical variables, the Mannheim Peritonitis Index scores correlated with mortality. Of the 12 patients who died, 11 had Mannheim Peritonitis Index scores of 21 or more (P = 0.0001). Forty-five percent of the colostomies have been closed. CONCLUSIONS: The prevalence of perforated sigmoid diverticulitis is increasing in northern Finland. Mannheim Peritonitis Index score can be used in predicting the outcome of patients admitted for perforated sigmoid diverticulitis.

Adult↗
PubMedDate not supplied

Prognostic factors after surgery in patients younger than 50 years old with colorectal adenocarcinoma.

BACKGROUND/AIMS: The factors predicting recurrence and survival were evaluated using a computer-generated database to identify the independent predictors of survival of colorectal cancer in patients under 50 years of age. METHODOLOGY: One hundred and two patients under the age of 50 years with colorectal cancer who had been admitted into our hospital during the 20-year period of 1980-1999 were identified from a computer database. The factors possibly predicting recurrence were compared by bivariate analysis and the predictors of long-term survival by both univariate and multivariate analysis. RESULTS: A family history of colorectal cancer was present in 14% of all patients and in 15% of the patients aged under 40 years. Overall 5-year survival after radical resection was 59% and median survival 47 months. The recurrence rate after radical resection was 40%, being 13%, 35%, 55% and 80% in Dukes classes A, B, C and D, respectively. The risk of recurrence was most closely related to lymphatic invasion, vascular invasion and Dukes stage. Kaplan-Meier estimates showed that Dukes stage, grade of tumor, venous invasion, lymphatic invasion, perineural invasion and radicality of resection were the best predictors of survival, but in multivariate analysis only the radicality of operation, venous invasion and tumor grade retained their significance. CONCLUSIONS: Young age is not a poor prognostic marker in colorectal cancer. In addition to radical operation, venous invasion and tumor grade are good predictors of survival in patients under the age of 50 years.

Adenocarcinoma↗
PubMedDate not supplied

Acute cholecystitis in the elderly.

BACKGROUND/AIMS: The population of Finland is ageing fast, and acute cholecystitis is common among elderly people. Because the treatment options have changed greatly since the late 1980's, we wanted to find out whether the active treatment policy nowadays used in our hospital has some effects on operability, morbidity, mortality and the duration of the in-patient period. The numerous serious illnesses of elderly people that cause considerable morbidity and mortality underlines the importance of risk stratification, and clinical variables were therefore also tested for their ability to predict the probability of morbidity and mortality. METHODOLOGY: Two hundred and eighteen patients aged over 75 years, 92 patients during the 5-year period 1988-1992 (Period I) and 126 patients during the 5-year period 1998-2002 (Period II) had been admitted into our hospital for acute cholecystitis, and they were identified from a computer database. During these two periods, different treatment strategies were used. The clinical data were reviewed from the database and the patient records. RESULTS: The active use of ERCP and percutaneous cholecystostomy during Period II decreased the number of all operations and emergency operations. Only six of the 43 patients who underwent early cholecystostomy were later scheduled for cholecystectomy. Postoperative morbidity did not differ between the two periods, and stepwise logistic regression analysis showed obesity to be an independent predictor of morbidity. Overall mortality was 8% during period I and 6% during period II, and of the clinical variables, underlying lung disease, malnutrition, pericholecystic fluid collection in ultrasound and perforation of the gallbladder were independent predictors of mortality in stepwise logistic regression analysis. Neither the primary in-patient period nor the total in-patient period were significantly shorter during Period II. CONCLUSIONS: Active treatment of acute cholecystitis in the elderly may decrease the need for emergency surgery. Malnutrition and perforation of the gallbladder are the most important predictors of mortality in this patient group.

Aged↗