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Biomedical subjects

T K Larmi

Publications and source records attributed to T K Larmi.

At least 73 records · Page 4Linked to original sources
PubMed1976

Four years' experience of valve replacement with the Björk-Shiley tilting-disc prosthesis.

105 valve replacements with the Björk-Shiley tilting-disc prosthesis have been performed in 99 patients with an overall mortality of 12%. The hospital mortality for 73 single aortic valve replacements was 10%, for 24 single mitral valve replacements 13%, and for 5 double valve operations 20%. One late death (1%) occurred in a case with single aortic valve replacement. The follow-up period of the first patients with aortic valve replacement is 4 1/2 years, and that of those with mitral valve replacement over 2 1/2 years. The most common late complication in patients with mitral valve replacement was a paravalvular leak (19%), whereas in patients with aortic valve replacement slight haemolytic anaemia (4%) and late thromboembolism (3%) occurred most frequently. 84 of the 87 survivors showed manifest clinical improvement in their preoperative status and increased exercise tolerance.

Adolescent↗
PubMed1976

Closed mitral valvulotomy.

During an average follow-up period of five years (from 1966 to 1975) 60 patients, 43 females and 17 males, were subjected to closed mitral valvulotomy at the Oulu University Central Hospital. Two patients died when still in hospital, and one died later at home. 25 % of whole series, and 41 % of the patients with atrial fibrillastion presented with a history of preoperative systemic embolism. Intraoperative embolism occurre in one patient, and late embolism in two patients. All these patients survived. Excellent or good results were recorded for 66 % of the living patients. Significant mitral calcification and/or preoperative regurgitation affected adversely both mortality and functional results. Closed mitral valvulotomy still offers excellent palliation with a minor risk for a significant number of carefully selected patients with mitral stenosis.

Adult↗
PubMed1976

Surgical treatment of arterial embolism. Fifteen years experience.

A series of 102 surgical operations for arterial emboli in 85 patients during a fifteen-year period is presented. Seventeen patients were operated upon before the institution of the Fogarty balloon embolectomy catheter. 82 embolectomies using the Fogarty embolectomy catheter were carried out in 68 patients with a mortality of 32%. The amputation rate in the surviving patients was 39%. The most common cause of death was severe underlying heart disease, while the most important reason for amputation after an unsuccessful embolectomy was concomitant occlusive atherosclerosis, and to a lesser degree, a delay in the performance of the embolectomy.

Adult↗
PubMed1976

Spigelian hernia.

Six consecutive patients with Spigelian hernia treated operatively over a period of ten years are reported. There were no complications, no deaths, and no recurrence in this series. Recognition of this rather rare lesion may be difficult, but it is important because of its quite high predisposition to incarceration and strangulation. The main pathological and clinical features are discussed, and the literature briefly reviewed.

Adult↗
PubMed1976

Surgical considerations in tracheal resection for tracheal stenosis.

Five patients were succesfully operated upon for tracheal stricture following prolonged assisted ventilation with a cuffed tracheal tube. The operative exposures and techniques to be recommended with relation to site and extent of tracheal stenosis are discussed. Most tracheal resections can be carried out through a low cervical incision. Lesions of the lower part of the trachea (5 cm or less from the carina) are best approached through a right posterolateral thoracotomy incision. A stenosed tracheal segment of 4 cm or less can be resected easily by both routes without undue tension on the anastomotic line. The use of interrupted Prolene sutures is proposed for the tracheal anastomosis, because it produces much less tissue reaction than chromic catgut.

Adolescent↗
PubMed1976

Aneurysm of the sinus of Valsalva. Clinical considerations and surgical treatment of five patients.

Five patients underwent operative repair of an aneurysm of the sinus of Valsalva. Four of the aneurysms were considered as congenital and one as mycotic. There were four males and one female. One patient with VSD and characteristics of Marfan's syndrome die on the first postoperative day of a recurrence of fistulae. The follow-up time is over one year for all but one of the surviving patients. There are no late deaths, and all patients are doing well. Aneurysms and fistulae of the sinus of Valsalva, which are perhaps not as rare as was previously thought, present a challenging surgical problem. Ruptured aneurysms and fistulae, even if asymptomatic, should be treated operatively, preferably by a transaortic approach.

Adolescent↗
PubMed1975

Pulmonary diffusion-circulation interrelationships two to seven years after pneumonectomy.

Ventilatory function, pulmonary diffusion capacity and right heart catheterization were studied in eight patients 2-7 years after pneumonectomy. The operation had been carried out for bronchial carcinoma. Dependence of pulmonary diffusion capacity on pulmonary perfusion rather than on ventilatory changes was characteristic of the elderly patients in the late post-pneumonectomy state. When decreased pulmonary perfusion, produced by cardiac disease or increased pulmonary vascular resistance, severely affects the pulmonary diffusion capacity, a careful assessment of the cardiac state is very important in the pre-operative evaluation of operability. In the absence of coexisting diseases, the cardiopulmonary state of long-term survivors usually remains good.

Adult↗
PubMed1975

Aortic valve replacement with the Björk-Shiley tilting disc valve prosthesis. Clinical experiences in 50 cases.

Single aortic valve replacement with the Björk-Shiley tilting disc valve prosthesis has been performed in 50 patients since April 1971. None of the total of six deaths (12.0%) was attributable to malfunction of the prosthesis or to embolic complications. Follow-up examination showed insignificant or moderate prosthetic regurgitation in two patients and moderate paravalvular leakage in one patient. A slight intravascular haemolysis was found in two cases, one of them without marked regurgitation, and a slight reversible cerebral thrombo-embolism in two. Clinical improvement was observed in 43 of the 44 survivors during the 6 to 12 months of follow-up. Objective evidence of improvement was verified by cardiac catheterization following the replacement of aortic valve with the Björk-Shiley tilting disc prosthesis.

Adolescent↗
PubMed1975

Emergency aortic valve replacement in active endocarditis with the Björk-Shiley tilting disc valve prosthesis.

Because of severe and intractable heart failure in three patients with infective endocarditis, an emergency replacement of the aortic valve with a Björk-Shiley prosthesis was carried out. Heart failure, which is the most common cause of death in infective endocarditis, was in these cases due to acute aortic regurgitation caused by perforation and other damage of the aortic valve. One patient died in the early postoperative period because of myocardial damage and respiratory insufficiency. The other two survived and are in relatively good condition after follow-up periods of 2 years and 6 months, respectively. The emergency replacement of incompetent valves may be a lifesaving procedure during the course of active endocarditis.

Acute Disease↗
PubMed1975

Stercoraceous and idiopathic perforations of the colon.

Fourteen patients have been encountered with stercoraceous or idiopathic perforations of the colon. Seven patients had a stercoraceous perforation; four had an idiopathic perforation; and three patients remained without exact classification. All the patients were admitted to hospital because of sudden abdominal pain. All except one patient, who was in an agonal condition, were operated on with a diagnosis of peritonitis. The preoperative clinical, radiologic and laboratory examinations were not specific, and in only one instance, the provisional diagnosis was correct. The main differnece between idiopathic and stercoraceous perforations was the macroscopic and histologic appearance of the perforation. In a perforated stercoraceous ulcer, the perforation was a round or an ovoid hole with necrotic and inflammatory edges, while in the idiopathic form, the perforation was a tear with a normal appearance of the colonic wall. The treatment consisted of a closure of the perforation and a proximally situated stoma, or exteriorization. Four patients of the seven with stercoraceous perforations survived. In idiopathic perforations, the prognosis was poor. All patients died during the first 24 hours after the operation. This possibly is an indication of some basic difference in the pathophysiology of these two diseases.

Adult↗
PubMed1975

A critical analysis of the cystic duct remnant.

The cystic duct remnant can be an etiologic factor for distress after cholecystectomy, justifying reoperation and excision of the stump. In connection with cholecystectomy, it is not justified to leave any cystic duct stump unless there is a special reason for it. Stones in the cystic duct remnant, overlooked or newly formed, scar tissues and cystic duct syndrome of whatever cause--inflammation and stasis of the bile, a poorly healing stump end and neuroma--can also be factors producing the discomfort. Unresorbable suture material which provokes foreign body granulomas should be avoided in operations upon the biliary tract since, together with even a normal nerve under pressure, it may cause biliary distress. For the same reason, special attention should be devoted to careful trimming of the cystic nerve in cholecystectomy, and ligation or cautery of nerve tissues should be avoided. The cystic duct remnant is more often visualized in peroperative cholangiography than in an intravenous examination but even then not unfailingly. The cholangiographic finding alone does not justify surgical intervention, since in a number of patients troubles deriving from elsewhere in the biliary tract or from adjacent organs persist and not all cystic stumps apparently produce discomfort.

Adolescent↗
PubMed1975

Severe liver injury. Surgical treatment of eight consecutive cases.

A series of eight consecutive patients with severe liver injury is presented. Surgical treatment consisted of liver resection in four patients, one hepatic artery ligation and suture and drainage in three patients. Six patients survived. There were about three complications per patient, infection, and bile leakage being the most common. Of three patients who required hemodialysis for renal failure, only one survived. It is strongly recommended that an autotransfusion device should be ready to hand when a patient with severe liver injury is to be operated. In a case of massive bleeding from a lesion of the vena cava or major hepatic vein, autotransfusion could save the patient's life.

Abdominal Injuries↗
PubMed1975

Evaluation of the ligation of the hepatic artery and regional arterial chemotherapy in the treatment of primary and secondary cancer of the liver.

Ligation of the hepatic artery was carried out in 23 patients with primary and secondary cancer of the liver. The survival time correlated well with the amount of tumor tissue in the liver. Ligation of the hepatic artery prolonged the survival time of the operated patients when compared with the untreated group, and, in addition, yielded good palliation. In appropriate cases, the most promising result in the treatment of hepatic malignancies was achieved by liver resection two to four months after the initial ligation of the hepatic artery, whereas from our experiences the final value of regional arterial chemotherapy is still unsettled. Very promising results were achieved by ligation in the treatment of liver metastases from lymphosarcoma of the stomach, which responded especially well to this kind of therapy.

Adolescent↗
PubMed1975

Spontaneous rupture of the liver and the spleen: report of a successfully treated case with immunopathologic reaction.

A patient with a spontaneous rupture of the liver, followed by a spontaneous rupture of the spleen and gastrointestinal bleeding, is reported. The patient was operated for both ruptures and survived. We could not find any corresponding reports in the literature. Histological findings both in the liver and in the spleen were suggestive of an acute immunologic reaction and the symptoms of the patient resembled those of an autoimmune disease. Attention is drawn to the possibility that the ruptures of the liver and the spleen might have represented an allergic reaction reminiscent of the general type of Schwartzman reaction. This also could explain the other systemic manifestations of the disease. In the present patient steroid therapy eliminated all symptoms, and this possibility should be kept in mind when treating obscure ruptures of the liver and the spleen.

Autoimmune Diseases↗
PubMed1974

Necrotizing colitis.

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Acid-Base Equilibrium↗