PubMed Health⌕ Search

Biomedical subjects

Ville Remes

Publications and source records attributed to Ville Remes.

28 records · Page 2Linked to original sources
PubMed2003

Total knee arthroplasty in patients with diastrophic dysplasia.

BACKGROUND: Diastrophic dysplasia results in severe disproportionate short stature, generalized joint deformities, and early osteoarthritis. The knee joint often has an abnormal valgus position and is unstable, and degeneration of all joint compartments occurs, even during growth. The purpose of our study was to evaluate the clinical and radiographic results of total knee arthroplasty in a series of patients with diastrophic dysplasia. METHODS: Between February 1992 and March 2000, twenty-one primary total knee arthroplasties were performed on fourteen consecutive patients with severe osteoarthritis due to diastrophic dysplasia. The patients were followed prospectively with clinical examinations, determination of the Hungerford knee scores, and radiographs. Preoperatively, ten knees had chronic dislocation of the patella. The mean duration of follow-up was 3.4 years. RESULTS: The mean Hungerford knee pain and total scores improved from 5.8 points and 46 points preoperatively to 50 points and 83 points, respectively, at the final follow-up examination (p < 0.001 for both comparisons). Two knees required a distal femoral corrective osteotomy because of metaphyseal angulation. None of the total knee arthroplasties had to be revised during the follow-up period. Six complications were recorded. CONCLUSIONS: Total knee arthroplasty substantially improved the function of patients with diastrophic dysplasia. Additional peripatellar procedures were commonly needed, and complications were frequent.

Arthroplasty, Replacement, Knee↗
PubMed2003

Harrington and Cotrel-Dubousset instrumentation in adolescent idiopathic scoliosis. Long-term functional and radiographic outcomes.

BACKGROUND: Previous studies have shown that the long-term clinical outcome does not correlate with the radiographic outcome in patients treated with Harrington instrumentation for adolescent idiopathic scoliosis. Cotrel-Dubousset instrumentation has been reported to provide better correction radiographically, but it is unclear whether it provides better long-term clinical or functional outcomes. We are not aware of any long-term studies comparing Harrington and Cotrel-Dubousset instrumentation. METHODS: Seventy-eight patients in whom adolescent idiopathic scoliosis was treated with Harrington instrumentation and fifty-seven in whom it was treated with Cotrel-Dubousset instrumentation participated in this study. The mean duration of follow-up was 20.8 years for the Harrington instrumentation group and 13.0 years for the Cotrel-Dubousset instrumentation group. The mean age at the time of follow-up was thirty-six years and twenty-eight years, respectively. Radiographs were made preoperatively and at the two-year and final follow-up examinations. The Scoliosis Research Society questionnaire was completed, a physical examination was performed, and spinal mobility and non-dynamometric trunk strength were measured at the final follow-up visit. RESULTS: The mean preoperative Cobb angle of the thoracic curves was 53 degrees in the Harrington instrumentation group and 55 degrees in the Cotrel-Dubousset instrumentation group. The mean numbers of vertebrae included in the instrumentation were 10.7 and 9.9, respectively. At the two-year follow-up evaluation, the mean postoperative Cobb angles were 38 degrees and 25 degrees, respectively (p < 0.0001). At the final follow-up evaluation, the mean angles were 45 degrees and 32 degrees (p < 0.0001). No significant difference in thoracic kyphosis or lumbar lordosis was observed between the study groups at the final follow-up evaluation. The average score on the Scoliosis Research Society questionnaire was 97 points in both groups. Measurements of non-dynamometric trunk strength corresponded with age and sex-adjusted reference values, on the average, but patients with Cotrel-Dubousset instrumentation performed significantly better in the squatting test (p = 0.010). Abnormal lumbar extension and trunk side-bending were significantly more common in the Harrington instrumentation group (p = 0.050 and p = 0.0061, respectively). Complications were recorded for nine (12%) of the patients treated with Harrington instrumentation and fifteen (26%) of those treated with Cotrel-Dubousset instrumentation (p = 0.027). CONCLUSIONS: Cotrel-Dubousset instrumentation yielded better long-term functional and radiographic outcomes in patients with adolescent idiopathic scoliosis than did Harrington instrumentation. However, complications were more common in the Cotrel-Dubousset instrumentation group.

Adolescent↗
PubMed2002

Comparison of long-term functional and radiologic outcomes after Harrington instrumentation and spondylodesis in adolescent idiopathic scoliosis: a review of 78 patients.

STUDY DESIGN: A retrospective follow-up study of adolescent idiopathic scoliosis after Harrington instrumentation and spondylodesis was conducted. OBJECTIVE: To correlate radiographic parameters with the Scoliosis Research Society questionnaire in terms of patient outcome, clinical findings, spine mobility, and trunk strength measurements. SUMMARY OF BACKGROUND DATA: Previous studies have shown that long-term radiologic correction can be achieved with Harrington instrumentation. It seems, however, that radiologic correction does not correlate with patient outcome. There are no previous studies on long-term results of functional outcome, including spine mobility and trunk strength measurements, after operative treatment of adolescent idiopathic scoliosis, as compared with findings in the normal population. METHODS: Of 98 consecutive patients who underwent surgery with Harrington distraction rod and posterior spondylodesis in 1979, 78 (80%) (11 males; mean age, 36 years) participated in the study. The average follow-up period was 20.8 years (range, 19.1-22.4 years). Radiographs were obtained before surgery, at the 2-year follow-up assessment, and at the 20-year follow-up assessment. Additionally, physical examination was performed, and the Scoliosis Research Society questionnaire was completed. Spine mobility and nondynamometric trunk strength measurements were obtained at the 20-year follow-up assessment. RESULTS: The mean Cobb angle of the instrumented thoracic curve was 53 degrees +/- 10 degrees before surgery, and 38 degrees +/- 11 degrees at the 2-year follow-up assessment. At the 20-year follow-up assessment, the mean angle was 45 degrees +/- 12 degrees. Degenerative changes in the noninstrumented lumbar spine (sclerosis of facets, endplate sclerosis, osteophyte formation) were noted in 17 patients (22%). Ten patients (13%) reported having low back pain often or very often at rest according to the Scoliosis Research Society questionnaire. No correlation was found between the Cobb angle of the thoracic or lumbar curves at follow-up assessment and the Scoliosis Research Society total score or back pain indexes. Neither was any association found between the Scoliosis Research Society total score and the spondylodesis fusion level. However, the magnitude of the thoracic curve at follow-up assessment showed a significant inverse correlation with the scores for Scoliosis Research Society questions about cosmetic aspects. The nondynamometric trunk strength measurements corresponded with the reference values, on the average, but did not show any correlation with the magnitude of the thoracic or lumbar curves or with the Scoliosis Research Society total score or back pain indexes. Spine mobility, especially trunk side bending, was diminished in 59% of the patients, and did not correlate with the Scoliosis Research Society total score or individual indexes. CONCLUSIONS: In patients with adolescent idiopathic scoliosis who undergo surgery with Harrington instrumentation, the overall long-term clinical outcome does not correlate with the radiologic outcome. However, a significant inverse correlation was found between the magnitude of the primary thoracic curve at follow-up assessment and the scores for questions on cosmetic matters in the Scoliosis Research Society questionnaire. Spine mobility is diminished as a result of spondylodesis, but the patients perform, on the average, as well as the normal population in nondynamometric trunk strength measurements.

Adolescent↗
PubMed2002

Lung function in diastrophic dysplasia.

Diastrophic dysplasia (DD) is a rare skeletal dysplasia characterized by short-limbed short stature, contractures and early degeneration of joints, and spinal deformities such as scoliosis. Mortality is increased in the neonatal period, in part due to tracheo- and bronchomalacia. Additionally, spinal deformities are very rigid, decreasing mobility of the chest cage. The aim of our study was to evaluate lung volumes and airway flow dynamics in patients with DD. A total of 31 patients (12 males, 19 females) underwent a detailed clinical examination measurements of standing height PA-radiography of the spine, flow-volume spirometry, and body plethysmography. The patients were assigned to two groups: children and adolescents (0-18 years, n = 18) and adults (over 18 years, n = 13). The mean spirometric parameters were mostly within the predicted value range, although the variation was wide. At least one abnormally low spirometry parameter was found in 6 (33%) of the children and adolescents and in 7 (54%) of the adults. Mean forced vital capacity (FVC) was 104% (range 48-163%) of predicted values in the children and adolescents and 95% (58-140%) of the adults. Peak expiratory flow (PEF) values were abnormal in 4 (22%) of the children and adolescents and in 5 (39%) adults. The mean plethysmographic parameters were all within the predicted value range. At least one abnormal plethysmographic value was found in 6 (33%) of the children and adolescents and in 4 (31%) of the adults. Airway resistance (Raw) was significantly higher in the adults than in the children and adolescents (P = 0.016), and was abnormally high in 3 (23%) of the adults. The angle of thoracic or thoracolumbar scoliosis correlated with the percentages of the predicted values of FVC (r(s) = - 0.66), forced expired volume in 1 sec (FEV(1)) (r(s) = - 0.56), and total lung capacity (TLC) (r(s) = - 0.67). Age correlated with the FEV(1)/FVC ratio (r(s) = - 0.41), with the maximal expired flow at 50% FEV (MEF(50)) values (r(s) = - 0.55), with the residual volume (RV) values (r(s) = - 0.47), and with the RV/TLC ratio (r(s) = - 0.43). Variable bronchial obstruction was found in 1 (6%) child and in 2 (17%) adults. Although the patients with DD had, on average, normal lung volumes, large individual variation occurred. Airway resistance was increased in adults. The angle of scoliosis correlated inversely with lung volume parameters.

Adolescent↗
PubMed2002

Surgical procedure skills of graduating medical students: effects of sex, working, and research experience.

BACKGROUND: Surgical procedures constitute an important part of every physician's daily practice. However, few studies have investigated the surgical skills of graduating medical students and, especially, factors that might be related to their degree of surgical competence. The present study sought to gather information on the basic surgical skills of graduating medical students and to establish whether factors influencing the students' competence could be identified and used to improve the teaching of basic surgical skills at medical schools. METHODS: A questionnaire was sent to all final-year medical students in Finland in 1997. It was returned by 404 (participation rate 80.2%) students. The questionnaire included questions on the theoretical knowledge and successful performance of 10 basic surgical procedures: abdominal paracentesis, application of Sengstake-Blakemoore tube, rubber-band ligation of hemorrhoids, reposition and casting of Colles' fracture, knee arthrocentesis, application of tibial traction, evacuation of subcutaneous abscess, male bladder catheterization, suprapubic catheterization, and nevus excision. RESULTS: Over 90% of the final-year medical students knew the theory of performing reposition and casting of Colles' fracture, knee arthrocentesis, urinary tract catheterization, and nevus excision, but only 32% (124/393) knew the theory of applying the Sengstake-Blakemoore tube. Nevus excision had been successfully performed by over 90% of the students. Of the emergency or duty procedures, application of the Sengstake-Blakemoore tube and abdominal paracentesis had been successfully performed by 1% (4/393) and 8% (32/393) of the students, respectively, whereas Colles' fracture reposition and suprapubic catheterization had been successfully performed by 46% of the students (182/393 and 179/393, respectively). The age-adjusted odds ratios for performing Colles' fracture reposition (OR 1.59; 95% CI 1.01 to 2.50), application of tibial traction (2.00; 1.03 to 3.89), evacuation of subcutaneous abscess (2.13; 1.25 to 3.62), and suprapubic catheterization (2.23; 1.21 to 4.09) were significantly higher among males than females. Students with working experience had higher odds ratios for performing suprapubic catheterization (OR 6.75; 95% CI 1.99 to 22.84), nevus excision (5.69; 2.49 to 13.0), reposition and casting of Colles' fracture (1.72; 1.01 to 2.94), knee arthrocentesis (4.78; 2.67 to 8.53), and evacuation of subcutaneous abscess (12.9; 6.12 to 27.1) than students without such experience. Students who had done extracurricular research had significantly lower odds ratios for performing evacuation of subcutaneous abscess (0.58; 0.34 to 0.99) than students without such experience. When the five medical faculties in Finland were compared, the highest odds ratios for performing procedures were at the university in which a student logbook was systematically used. CONCLUSIONS: Final-year medical students have fairly good theoretical knowledge of basic surgical procedures, but the successful performance rates of these procedures range from 1 to 90%. Males have performed surgical procedures significantly more often than females. Working experience clearly enhanced the surgical skills of medical students. However, research experience may impair the learning of these procedures. The systematic use of logbooks seems to be useful.

Adult↗
PubMed2002

Effect of continuing or finishing high-level sports on airway inflammation, bronchial hyperresponsiveness, and asthma: a 5-year prospective follow-up study of 42 highly trained swimmers.

BACKGROUND: Mild eosinophilic airway inflammation and bronchial hyperresponsiveness-ie, mild asthma-have been shown to affect a high proportion of endurance athletes. The persistence of airway inflammation, bronchial hyperresponsiveness, and asthma in this population is not known, however, inasmuch as follow-up studies of athletes' asthma have not been performed. OBJECTIVE: The purpose of this study was to investigate effect of finishing high-level sports on airway inflammation, bronchial hyperresponsiveness, and asthma. METHODS: Forty-two elite competitive swimmers, most of them from the Finnish national team (37/42; 88%), were followed for 5 years in a prospective manner. All of the swimmers completed questionnaires and underwent resting spirometry, histamine challenge testing, and skin prick tests at baseline and at follow-up. Twenty-nine swimmers (69%) also gave induced sputum samples on both occasions. Sixteen (38%) of the swimmers had continued their competitive careers during follow-up (active swimmers), but 26 (62%) had stopped competing more than 3 months before the follow-up examination (past swimmers). RESULTS: Bronchial responsiveness was increased in 7 (44%) of the 16 active swimmers at baseline and in 8 (50%) of the 16 active swimmers at follow-up; it was increased in 8 (31%) of the 26 past swimmers at baseline and in 3 (12%) of the 26 past swimmers at follow-up (McNemar test, P =.025). The difference in the change in bronchial hyperresponsiveness between the study groups was significant (likelihood ratio test, P =.023). Current asthma (defined as bronchial hyperresponsiveness and exercise-induced bronchial symptoms monthly) was observed in 5 (31%) of the active swimmers at baseline and in 7 (44%) of the active swimmers at follow-up; of the past swimmers, it occurred in 6 (23%) at baseline and in 1 (4%) at follow-up (McNemar test, P =.025). The difference in the change in current asthma between the study groups was significant (likelihood ratio test, P =.0040). The sputum differential cell counts of eosinophils and lymphocytes increased significantly during the follow-up period in the active swimmers (Wilcoxon signed rank sum test; P =.033 and P =.0029, respectively); in the past swimmers, the sputum differential cell counts of eosinophils tended to decrease during the follow-up period (P =.17), whereas the differential cell counts of lymphocytes did not change significantly. The changes in the sputum differential cell counts of eosinophils between the study groups differed significantly (Mann-Whitney U test, P =.019). CONCLUSION: In swimmers who had stopped high-level training, bronchial hyperresponsiveness and asthma attenuated or even disappeared. Mild eosinophilic airway inflammation was aggravated among highly trained swimmers who remained active during the 5-year follow-up. Our results suggest that athletes' asthma is partly reversible and that it may develop during and subside after an active sports career.

Adult↗
PubMedDate not supplied

Early degeneration of the knee in diastrophic dysplasia: an MRI study.

Magnetic resonance imaging (MRI) findings of 23 patients (13 females, 10 males; 45 knees) with diastrophic dysplasia were examined. The age of the patients ranged from 5 to 40 years (mean 20.5 years). T1- and T2-weighted MR images were obtained. MRI revealed degenerative changes in the articular cartilage of the knees from age 6 years. The subchondral bone of the distal femur was often fragmented, and cartilaginous intrusions from the growth plate into the metaphysis were noted. Menisci developed abnormally. In 43 (96%) of the knees studied, the anterior cruciate ligament was either thinned or rudimentary, or could not be detected. The posterior cruciate ligament was affected in 40 (89%) knees but was at least rudimentary in all patients. In contrast, the patellar tendon was thick and short and the patella was in an inferior position The patella showed bony fragmentation in 32 (71%) knees. The pathologic changes in all joint compartments increased with age, reflecting early degeneration of the knee in this disease.

Adolescent↗
PubMedDate not supplied

Walking ability in patients with diastrophic dysplasia: a clinical, electroneurophysiological, treadmill, and MRI analysis.

Patients with diastrophic dysplasia have walking difficulties of obscure etiology; some are even wheelchair-bound. To explore the problem, physical examination, treadmill, magnetic resonance imaging (MRI), and electroneurophysiologic studies were performed on 87 patients (56 females, 31 males) with an average age of 31 (range 3-56) years. Mobility of the spine, hips, knees, and feet was diminished. Some of the patients were obese (mean body mass index 27.0 kg/m). In the treadmill study, patients were able to walk an average of 638 m (range 0-1,618 m). On MRI, five patients showed compression of neural structures; one of them also had clinical symptoms. Somatosensory evoked potentials and electroneuromyography revealed evidence of compression of neural structure in three (3%) and two (3%) patients, respectively. The walking difficulties seem to have a multifactorial etiology: flexion contractures of the knees, early and rapid osteoarthrosis, equinus or equinovarus foot deformities, and obesity, but only rarely spinal stenosis.

Adolescent↗
PubMedDate not supplied

Magnetic resonance imaging analysis of hip joint development in patients with diastrophic dysplasia.

The authors used magnetic resonance imaging to evaluate the hip joint in patients with diastrophic dysplasia. T1- and T2-weighted images were obtained from 35 patients (25 female patients, 10 male patients) of different ages (1-39 years). The status of the joint and paraarticular soft tissues was evaluated. Hip joint congruity was good, although the joint was usually deformed. The thickness of the joint cartilage was diminished and signs of early osteoarthritis, including bone cysts and local edema, were common. The ligamentum teres was visible in only 24% of patients, suggesting abnormality of the ligamentous structures. Epiphyses were flattened or absent in all young patients. Of the 17 visible epiphyses, 7 showed avascular necrosis, indicated as a decrease in signal intensity in both T1- and T2-weighted images. It seems that proximal femoral epiphysis fails to bear normal weight pressure.

Adolescent↗