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Biomedical subjects

T K Larmi

Publications and source records attributed to T K Larmi.

At least 55 records · Page 3Linked to original sources
PubMed1977

Intraoperative determination of the aortic valve area (Gorlin) by flowmetry.

The aortic area (Torlin) for diseased stenotic aortic valves was calculated in 10 patients using two different methods; data obtained in preoperative cardiac catheterization and by intraoperative flowmetric and aortic and left ventricular pressure-recording measurements, and their mutual correlation was tested. The correlation between the aortic valve areas obtained by these methods was very good (r = 0.992), confirming the valve and reliability of the intraoperative flowmetric and pressure recording measurements in clinical work.

Aortic Valve↗
PubMed1977

Plasma renin activity, renal artery blood flow and cortical tissue oxygen tensionin haemorrhagic hypotension.

The changes occurring in plasma renin activity (PRA), tissue oxygen tension of the renal cortex and the change in renal total blood flow were studied during haemorrhagic hypotension in six dogs. The flow was measured with an electromagnetic flowmeter, the plasma renin activity was determined by radioimmunoassay and tissue oxygen tension with IBC oxygen electrodes. Haemorrhagic hypotension led to a significan increase in PRA. The fall in renal total blood flow and cortical tissue oxygen tension were significant after all three epizodes of bleeding (each of 10 ml/kg. Metabolic acidosis increased after every bleed. The correlation between PRA, renal blood flow and cortical tissue oxygen tension is evaluated in the discussion.

Acidosis, Renal Tubular↗
PubMed1977

Indomethacin and canine lower esophageal sphincter pressure.

A total of 20 experiments were carried out on 10 dogs to investigate the effect of indomethacin, administered rectally, on the canine lower esophageal sphincter pressure (LESP). Indomethacin increases LESP. Its effect begins 60 minutes after rectal administration and lasts for about 120 minutes. It reaches its highest level 90 minutes after administration. Indomethacin has no effect on the canine fundal or esophageal pressure.

Animals↗
PubMed1977

Immediate surgical treatment of major renal trauma.

Of the 77 cases of renal trauma treated at Oulu University Central Hospital during the years 1965--1975, 60 injuries were minor and 17 severe. 73 of these injuries were closed and 4 penetrating. The rate of operative treatment in severe renal injuries was 88% minor renal injuries being treated conservatively. Primary exploration was done in 18 of the 77 cases and in all patients with penetrating injuries. Only 7 of the 73 patients with blunt trauma and one of the 4 patients with penetrating injury required nephrectomy, including one patient with renal carcinoma. 6 of the 77 patients died, most as a result of severe associated injuries, giving a mortality of 8%. None of the surviving patients treated for renal trauma suffered from major complications. In 13 of the 18 patients operated upon, renal injury was the main indication for operation. Operation was performed in 5 of the 18 patients after immediate radiological evaluation. The advantages of immediate surgical management in severe renal injuries are early and final treatment, short hospital stay, and low incidence of complications. Qualifications for emergency surgery are access to renal angiography and familiarity with reparative renal procedures.

Accidents↗
PubMed1977

Subcutaneous rupture of the urinary bladder.

Fourteen patients operated upon for subcutaneous bladder perforation are reported. The majority of the patients (11/14) had intraperitoneal rupture of the bladder and multiple associated injuries (10/14), most often pelvic fractures (9/14). In 12 patients the injury was caused by a road traffic accident. 2 patients with extraperitoneal rupture presented with a typical history of a blow or kick in the lower abdomen following a drinking session. In doubtful cases cystography was the diagnostic method of choice. The principles of treatment we recommend are well known: urinary drainage with a catheter in all cases, and in intraperitoneal ruptures, prompt surgery.

Accidents↗
PubMed1977

Traumatic splenic rupture.

71 patients with traumatic splenic rupture are reported. Most had severe associated injuries. In 44 patients the mechanism of trauma was blunt, in 10 penetrating, and in 17 iatrogenic, occurring most commonly (11/17) during operations for peptic ulcer. Splenectomy gave use to thrombocytosis which reached its peak about 2 weeks and returned to normal within one month after operation. Postoperative complications occurred in 24 of the 60 surviving patients (40%) of which most, 17 patients (30%) were infectious in origin. One patient developed deep venous thrombosis. Mortality was 16%. Associated injuries were the main cause of death in most patients (9/11), the ruptured spleen being responsible for only 2 deaths. None of the 17 patients with injury to the spleen alone died, whether associated with fractures of the left lower ribs or not. Primary unconsciousness, shock on admission, and multiple injuries, especially renal and hepatic, increased the mortality rate markedly. The necessity of drainage, the possibility of increased susceptibility of splenectomized patients to infection and thromboembolic complications and their prevention are briefly discussed.

Accidents↗
PubMed1976

Spontaneous rupture of liver tumours.

Five geriatric patients with spontaneous rupture of the liver caused by hepatic malignancies were operated upon without mortality. Liver resection seems to be the treatment of choice, but in selected cases with unresectable tumours ligation of the hepatic artery alone is preferable to an attempt to control haemorrhage by packing and suture.

Aged↗
PubMed1976

Prolonged recovery after extended right hepatic lobectomy in a patient with severe blunt liver injury and laceration of the vena cava. A report of case with special references to autotransfusion and complications of biliary decompression.

A patient with severe blunt liver injury and laceration of the vena cava who underwent a successful extended right hepatic lobectomy is reported. The use of autotransfusion unit saved the patient from exsanguination. His postoperative course was complicated by renal and hepatic failure, bile leakage, and persistent jaundice due to cholangitis. Prolonged choledochal drainage via T-tube obviously acted as a source of infection. The use of autotransfusion, choledochal drainage and the proper timing of its removal, the treatment of vena cava lesions and jaundice due to cholangitis in patients with severe liver trauma are discussed.

Acute Kidney Injury↗
PubMed1976

Hiatal hernia repair.

128 patients operated on for hiatal hernia are reported. The follow-up study consisted of 102 patients, 16 with paraoesophageal and 86 with axial hiatal hernia. The mean follow-up time was 4 1/2 years, range 1-11 years. In our experience cineradiographic studies bring abnormalities to light more readily because this kind of study is repeatable compared with conventional techniques based on fluoroscopy. Four different methods of operation were used in this study. The recurrence rate was as follows: Nissen fundoplication 13%, both anterior 180 degrees fundoplication and Lortat-Jacobs procedure 38%, and Nissen fundoplication combined to vagotomy and pyloroplasty 54%. Postoperative complications occurred in 9%. There was no hospital mortality. The authors prefer the abdominal to the transthoracic approach because many patients had other intra-abdominal, surgically easily correctable condition. If the transthoracic operation is indicated, as in a very obese patient or in a patient with a secondary short oesophagus, intra-abdominal disease must have been excluded preoperatively. In the treatment of axial hiatal hernia the best operative method has not yet been agreed upon, but in our hands the Nissen fundoplication yielded the best results.

Adult↗
PubMed1976

Selective proximal vagotomy. A preliminary report.

Eearly results of a prospective clinical trial of selective proximal vagotomy (SPV) with or without pyloroplasty are reported. The total number of patients was 41, of whom 39 had chronic duodenal ulcer, one gastric ulcer and one heamorrhage gastritis. The follow-up period in our preliminary series now averages 18 months. Recurrent duodenal ulcer appeared in two patients with proved incomplete vagotomy (5%), and two other patients suffered postoperatively from gastric retention. All the symptomatic patients underwent SPV without pyloroplasty. The promising early results warrant continuation of our trial in order to asses the role of SPV in the surgical treatment of duodenal ulcer.

Adolescent↗
PubMed1976

Retroperitoneal injuries of the duodenum caused by blunt abdominal trauma.

Five patients with blunt retroperitoneal injury of the duodenum are presented. In three of them the trauma was caused by a traffic accident, the most common mechanism of such injuries. One patient died. The high index of suspicion is still the best indication for laparotomy in retroperitoneal injuries of the duodenum, because no typical finding or reliably diagnostic test could be demonstrated even in the present study. The proper treatment in less severe injuries of the retroperitoneal duodenum is evacuation of the hematoma or simple suture of the rupture with drainage and naso-gastric suction. Internal drainage as an afferent jejunostomy is sometimes necessary in the treatment of more severe injuries. Pancreatoduodenectomy is to be reserved for only the very severe duodenal injuries, where the head of the pancreas is badly crushed.

Abdominal Injuries↗
PubMed1976

Retroperitoneal injuries of the duodenum caused by blunt abdominal trauma.

Five patients with blunt retroperitoneal injury of the duodenum are presented. In three of them the trauma was caused by a traffic accident, the most common mechanism of such injuries. One patient died. The high index of suspicion is still the best indication for laparotomy in retroperitoneal injuries of the duodenum, because no typical finding or reliably diagnostic test could be demonstrated even in the present study. The proper treatment in less severe injuries of the retroperitoneal duodenum is evacuation of the hematoma or simple suture of the rupture with drainage and naso-gastric suction. Internal drainage as an afferent jejunostomy is sometimes necessary in the treatment of more severe injuries. Pancreatoduodenectomy is to be reserved for only the very severe duodenal injuries, where the head of the pancreas is badly crushed.

Abdominal Injuries↗
PubMed1976

Postpneumonectomy empyema in pulmonary carcinoma patients. Treatment with antibiotic irrigation and closed-chest drainage.

Seven patients with postpneumonectomy empyema who had had pulmonary carcinoma were treated with intrapleural antibiotic irrigation and closed-chest drainage. Two tubes were used to irrigate and drain the cavity. Although most patients had a bronchopleural or esophagopleural fistula, the treatment was successful in every case. Three of the 7 patients died of far-advanced carcinoma 1 to 2 years postoperatively, but none died of sequela of the empyema. In 3 patients with bronchopleural fistula, empyema recurred during the first postoperative year. However, it responded well to repeated irrigation and drainage. This simple, time-saving, and easily repeatable regimen proved to be both effective and also very comfortable for the patient. It has none of the disadvantages of open thoracic drainage or mutilating thoracoplasty.

Adult↗