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Biomedical subjects

T Juvonen

Publications and source records attributed to T Juvonen.

At least 73 records · Page 4Linked to original sources
PubMed1997

Elevated circulating levels of inflammatory cytokines in patients with abdominal aortic aneurysm.

The basic feature in the pathogenesis of abdominal aortic aneurysm (AAA) is the degradation of extracellular matrix components. This process is induced partly by cytokines secreted from inflammatory and mesenchymal cells. Circulating levels of inflammatory cytokines were studied in AAA patients and compared with subjects suffering from atherosclerotic disease only. Furthermore, the predictive value of cytokine concentrations was evaluated for aneurysm expansion rate. Circulating levels of interleukin 1 beta (IL-1 beta), interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and interferon-gamma (IFN-gamma) were measured in 50 AAA patients (40 men, 10 women), 42 patients with coronary heart disease (CHD) (23 men, 19 women), and 38 controls whose angiogram was normal (17 men, 21 women). No differences in cytokine concentrations were found between the CHD patients and the controls. AAA disease was found to be associated with significantly higher IL-1 beta and IL-6 concentrations in both male patients (median concentrations of 19.40 pmol/L and 6.45 pmol/L, respectively) and female patients (19.26 pmol/L and 7.99 pmol/L) than in either the CHD patients or the controls (P < .005). TNF-alpha levels were slightly higher in the AAA patients (1.64 pmol/L in the males and 1.59 pmol/L in the females) than in the other groups (P < .05). IFN-gamma levels were elevated significantly in the female AAA patients (3.75 pmol/L) compared with levels found in the other female (P < .05) or male (P < .01) patient groups. The measured cytokine concentrations were not related to the size of the aneurysm or the maximal thickness of the thrombus within the aneurysm. IFN-gamma concentration showed a significant positive correlation to the aneurysm expansion (R = .37, P < .02) and negative correlation to the concentration of aminoterminal propeptide of type III procollagen during 6-month follow up (R = -.42, P < .005). The results show that circulating levels of inflammatory cytokines are elevated in patients with AAA disease, suggesting that the production of these cytokines is increased in these patients compared with CHD patients and controls. Elevated INF-gamma concentrations seem to predict an increased rate of expansion in AAA.

Aortic Aneurysm, Abdominal↗
PubMed1997

Surgical and long-term outcome of graft replacement of aneurysms of the descending thoracic aorta. Analysis of 28 consecutive cases.

A consecutive series of 28 patients operated on at the Oulu University Hospital during the years 1974-1994 for aneurysms of the descending thoracic aorta is presented. Twenty-five cases were elective and three were operated on as emergencies. Their mean age was 58 years. During the aortic cross-clamp, circulatory support of the lower body, was used in 27 cases as follows: a direct aorto-femoral shunt without a pump (12/28), left-heart bypass (11/28) or femoro-femoral perfusion (4/28). Hospital mortality was 14% (4/28). One patient with a ruptured aneurysm died of renal failure, but there were no other renal complications. None had paraplegia postoperatively. Three had symptoms of paraparesis, but only one of them had a slight permanent discomfort while walking. The mean follow-up time was 100 months, range 2-242 months. Late actuarial survival including hospital mortality, was 65% at 5 years and 41% at 10 years, reflecting the generalized aortic disease with a high risk of very late rupture (4) and other manifestations of atherosclerosis with myocardial infarction (6) or cerebral atherosclerosis (1), the remaining late deaths being unrelated. The efficacy of lower body circulatory support in avoiding peroperative renal and spinal cord ischaemic complications is demonstrated.

Adult↗
PubMed1997

The rupture type determines the outcome for ruptured abdominal aortic aneurysm patients.

BACKGROUND: The treatment of patients with ruptured abdominal aortic aneurysm (RAAA) poses a significant surgical challenge. To achieve improvement in survival, factors influencing case fatality must be identified and modified. The aim of the present survey was to determine the contribution of preoperative, perioperative and postoperative events in predicting the mortality among AAA patients undergoing an emergency operation. MATERIAL AND METHODS: Fifty-one consecutive patients with ruptured infrarenal abdominal aortic aneurysm and twenty-six patients with 'expanding symptomatic aneurysms' (EAAA) were reviewed retrospectively to determine the relative contributions of preoperative, perioperative and postoperative factors on mortality. RESULTS AND CONCLUSIONS: The 30-day mortality was 47% in the RAAA group and 12% in the EAAA group. The rupture type was the main predictor of the outcome for the RAAA patients, the mortalities being 88% and 29% among patients with free (n = 16) and contained (n = 35) ruptures, respectively. In conclusion, the best way of avoiding poor results in cases of emergency aneurysm repair is to aim at elective operations. After the rupture, the clinical course is mainly determined by the rupture type, which is unfortunately beyond the surgeon's control. Surgical expertise and the avoidance of technical error can significantly affect the survival.

Adult↗
PubMed1996

Membrane-bound carbonic anhydrase IV is expressed in the luminal plasma membrane of the human gallbladder epithelium.

Alkaline hepatic bile is acidified in the gallbladder to prevent calcium precipitation and gallstone formation. Because membrane-bound carbonic anhydrase (CA) isoenzyme IV participates with cytoplasmic CA II in the acidification of urine in the kidney, we studied its expression in different regions of the human biliary tract using immunohistochemical techniques. The enzyme was expressed in the apical plasma membrane of the gallbladder epithelial cells and in the endothelium of the subepithelial capillaries. In the liver, some epithelial cells of the large bile ducts showed positive staining. Its presence in the gallbladder epithelium could be confirmed by Western blotting, which showed a single 35-kd polypeptide band, corresponding in molecular weight to the intact enzyme. The majority of the enzyme was phased to Triton X-114 detergent phase. A small amount of 35-kd polypeptide was also seen in the water phase. Smaller proteolytic fragments of the enzyme were not seen, suggesting that the tissue sample was well preserved. The results show that CA IV is expressed in abundance in the human gallbladder epithelium, where it may participate together with cytoplasmic CA II and ion transporters in acidification of the gallbladder bile via bicarbonate reabsorption.

Blotting, Western↗
PubMed1996

Cerebral haemorrhage after carotid endarterectomy.

Cerebral stroke is a serious complication related to carotid endarterectomy (CEA), being most frequently caused by thromboembolic events and less frequently on account of cerebral haemorrhage. The present series comprised five out of 857 (0.6%) patients who had undergone CEA at Oulu University Hospital between the years 1974 and 1993 and suffered a postoperative stroke four to 13 days after surgery due to intracerebral haemorrhage (IH). Preoperatively, all these patients were neurologically intact, with transient ischaemic attacked (TIA) as the main indication for CEA. All five patients had a history of arterial hypertension treated adequately preoperatively, and one patient had high blood pressure levels after surgery. Critical ipsilateral stenosis of the internal carotid artery (> 90%) was detected in the preoperative angiogram in all five cases. The primary outcome after CEA was uneventful in every case, without any signs of neurological deficiency. The symptoms, comprising severe headache, convulsions and/or hemiparesis occurred suddenly four to 13 days (mean seven days) after CEA. The diagnosis of IH was based on computed tomography (CT) findings. All five patients were treated conservatively. Three of them died. We conclude that even normotensive, neurologically intact patients without demonstrable cerebral infarction or postoperative hypertension may suffer cerebral haemorrhage after the relief of high-grade carotid stenosis. The role of possible insufficiency of the autoregulatory mechanisms of the cerebral vasculature on account of long-standing critical stenosis of the internal carotid artery and subsequent uncontrolled hyperperfusion following CEA are discussed.

Aged↗
PubMed1996

Outcome of elective infrarenal abdominal aortic aneurysm repair--an analysis of 174 consecutive patients.

The aim of the study was to assess the surgical outcome of elective infrarenal abdominal aortic aneurysm (AAA) repair and the clinical and surgical factors that may predict this outcome. The series comprises 174 consecutive patients who underwent elective surgery for infrarenal AAA. Factors found to be predictive of early hospital death (4.5%) were aneurysm size (> 5 cm), ischaemic heart disease, chronic obstructive pulmonary disease (COPD), preoperatively elevated C-reactive protein (CRP) and a history of aneurysm-related pain preoperatively. The outcome was also very poor if the bacterial culture from the aneurysm sac was positive. On the whole, the abdominal aortic aneurysm operation effectively controls the disease and can be safely employed electively.

Adult↗
PubMed1995

Immunohistochemical demonstration of the carbonic anhydrase isoenzymes I and II in pancreatic tumours.

The location of carbonic anhydrase (CA) isoenzymes I, II and VI in normal and neoplastic pancreatic tissue was studied using polyclonal antisera and the immunoperoxidase technique. Samples were obtained from patients with well-differentiated (n = 4), moderately differentiated (n = 1) and poorly differentiated (n = 4) ductal adenocarcinomas, cystadenocarcinoma (n = 2), adenosquamous carcinoma (n = 1), acinar adenocarcinoma (n = 1), gastrinoma (n = 3), insulinoma (n = 3) and glucagonoma (n = 1). The control specimens were from a patient with traumatic laceration of the pancreas. The normal and malignant endocrine tissue showed intense positive staining for CA I localized in the cells expressing glucagon. In the exocrine pancreatic tissue, CA II was detected in the normal and neoplastic ductal epithelium. No specific staining was detected with anti-CA VI serum in either normal or malignant tissue.

Carbonic Anhydrases↗
PubMed1995

Anomalies at the thoracic outlet are frequent in the general population.

BACKGROUND: Abnormal anatomy at the thoracic outlet is frequent in patients operated on for thoracic outlet syndrome (TOS). The present study was designed to find out the rate of thoracic outlet anomalies in the general population. METHODS: Fifty cadavers representing a general population were subjected to a total of 98 meticulously performed cervical dissections to ascertain the frequency of congenital anomalies in the thoracocervicoaxillary region. RESULTS: During the 98 cervical dissections, 62 instances of abnormal anatomy of the thoracic outlet were found, and fully normal anatomy was found in 36 cases. Of the total 69 abnormalies, 66 could be classified according to Roos: 37 were type 3 abnormalities, 15 were type 5, 9 were type 11, and there was 1 each of type 4, type 6, type 7, type 9, and type 10 abnormalities. The remaining 3 abnormalities did not fit into Roos' classification. Only 10% (5/50) of the cadavers had a bilaterally normal anatomy. CONCLUSIONS: The results demonstrate that abnormal structures, such as congenital bands in the thoracic outlet, are more common in the general population than had previously been described. We suggest that fibrous bands confer a predisposition for TOS following a certain degree of stress or injury.

Adolescent↗
PubMed1995

Factors influencing wound dehiscence after midline laparotomy.

PURPOSE: To identify patients who have high risk of wound dehiscence and who might benefit from the use of internal retention sutures. PATIENTS AND METHODS: Forty-eight patients with midline abdominal wound dehiscence were compared with 48 control patients standardized by sex, age, and operative indication. RESULTS: The mean hospital stay was significantly prolonged in the dehiscence group, resulting in a higher total cost of hospital treatment. The variables that were significantly associated with wound dehiscence included hypoalbuminemia, anemia, malnutrition, chronic lung disease, and emergency procedure. The additional postoperative factors that were found to be significant were vomiting, prolonged intestinal paralysis, repeated urinary retention, and increased coughing. Obesity, chronic heart disease, diabetes, alcoholism, preoperative intestinal obstruction, jaundice, systemic and local infection, use of steroids, type of incision, operating time, and type of wound closure were nonsignificant variables. The number of wound dehiscences increased significantly (P = 0.0001) when the number of risk factors increased from zero to five. CONCLUSION: We recommend using internal retention sutures for patients who have three or more risk factors.

Aged↗
PubMed1995

Increased turnover of collagen in abdominal aortic aneurysms, demonstrated by measuring the concentration of the aminoterminal propeptide of type III procollagen in peripheral and aortal blood samples.

PURPOSE: The pathogenesis of abdominal aortic aneurysm (AAA) involves many factors; elastin degradation is believed to lead to initial dilation, whereas changes in the collagen structure predispose the aneurysm to rupture. The major collagens in the aortic wall are types I and III. We set out here to determine whether changes in serum propeptide of type III procollagen (PIIINP), a biologically relevant marker of type III collagen turnover, could be associated with the characteristics of AAA. METHODS: The aminoterminal PIIINP and the carboxyterminal propeptide of type I collagen were measured by radioimmunoassay in 87 patients with AAA and 90 control subjects with aortodistal arteriosclerosis. The samples were taken from the peripheral blood and from the abdominal aorta at the levels of the diaphragm and the common iliac artery. RESULTS: Mean PIIINP concentrations were higher in patients with AAA than in control subjects (3.47 micrograms/L vs 2.73 micrograms/L, p < 0.0001), correlating positively with aneurysm diameter in the former (r = 0.27, p = 0.04) and with the maximum thickness of the intraluminal thrombus (r = 0.39, p = 0.003). The gradient in PIIINP between the upper and lower end of the abdominal aorta was significant in the AAA group (-0.30 microgram/L, range -0.20 to -0.50 vs -0.10 micrograms/L, range -0.20 to 0.30, p = 0.002). CONCLUSIONS: These studies indicate that the turnover of type III collagen is increased in patients with AAA.

Adult↗
PubMed1995

Adenocarcinoma of the gastric cardia.

One hundred and ninety-five patients operated on for adenocarcinoma of the gastric cardia during the years 1961-90 were analysed and the present data indicate that the more enthusiastic attitude adopted towards resective surgery led to a significant increase in operative explorations performed and in resectability rate, from 50% (44/88) and 35% (28/88) during the years 1961-75 to 84% (90/107) and 56% (60/107) during the years 1976-90, respectively. The difference between radical resections, 54% (15/28) and 67% (34/60), remained non-significant. The overall postoperative mortality and morbidity after resective surgery were 14% and 35% and these rates did not rise with time. The anastomotic leakage rate was 15%. Anastomotic leakage was, in fact, not only the most common postoperative complication but also the most common cause of death. Overall cumulative survivals at 1, 3 and 5 years were 47%, 11% and 5%. Comparison of the cumulative survival rates between the 15-year periods indicated that there were no differences in overall survival or in survival after resective surgery. We regard these results disappointing, because over half of the patients died in 1 year and because the long-term survival remained dismal.

Adenocarcinoma↗
PubMed1995

Polymorphisms at the apoB, apoA-I, and cholesteryl ester transfer protein gene loci in patients with gallbladder disease.

Alterations in lipoprotein levels are reported to be related to an increased risk of gallstones. Plasma lipid metabolism is regulated by a number of proteins that are polymorphic in the population. The present research was designed to investigate the association between the polymorphisms of these proteins and the presence of various gallbladder diseases. Restriction fragment length polymorphisms (RFLPs) of apolipoprotein B (XbaI, EcoRI), apolipoprotein A-I (PstI, MspI), and cholesteryl ester transfer protein (CETP) (EcoNI, TaqIA, TaqIB) genes were examined in a series of 210 cholecystectomy patients operated on for symptomatic gallbladder disease and in 92 healthy controls. The patients were categorized into four groups according to the type of gallstones and the presence or absence of cholesterolosis. The distribution of CETP TaqIB polymorphism in the patients with cholesterol gallstones differed significantly from that in the controls, with the B1B1 jects (39.7%) (P = 0.036). The patients with both cholesterol and non-cholesterol stones had lower high density lipoprotein (HDL)-cholesterol levels than the control subjects. However, the most distinct difference was found in the gallstone patients with the B2B2 genotype (P = 0.006). The frequency of the X1X1 genotype of the apolipoprotein B XbaI polymorphism was markedly higher in the patients with acalculous cholesterolosis (48.9%) or cholesterolosis with stones (58.1%) than in the gallstone patients with cholesterol stones (27.2%) or with non-cholesterol stones (34.1%) (P = 0.002). The present data suggest that CETP gene polymorphism may ba associated with cholesterol gallstone disease, probably in combination with some additional factor that reduces the plasma HDL cholesterol concentration, especially in TaqIB B2B2 genotype.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Outcome of thoracoabdominal aortic aneurysm surgery. Analysis of 27 consecutive cases.

Twenty seven patients underwent repair of a thoracoabdominal aortic aneurysm at our hospital during 1978-1993. Sixteen were elective and 11 emergencies. We used a temporary shunt and transsection of the proximal aorta between vascular clamps, so that the whole distal aorta with its branches was perfused through the shunt during suturing of the proximal anastomosis. The aortic branch arteries were revascularized by the step by step technique. Hospital mortality was 6/27 (22%) and two and five-year cumulative survival rates 74% and 52%. Late deaths were not related to aneurysm disease. Paraplegia developed in two patients. Distal aortic perfusion was used as a means of spinal cord preservation.

Actuarial Analysis↗