Browsing by Subject "surgery"

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  • Carcao, Manuel; Altisent, Carmen; Castaman, Giancarlo; Fukutake, Katsuyuki; Kerlin, Bryce A.; Kessler, Craig; Lassila, Riitta; Nugent, Diane; Oldenburg, Johannes; Garly, May-Lill; Rosholm, Anders; Inbal, Aida (2018)
    Recombinant factor XIII-A(2) (rFXIII-A(2)) was developed for prophylaxis and treatment of bleeds in patients with congenital FXIII A-subunit deficiency.mentor (TM) 2 (NCT00978380), a multinational, open-label, single-arm, multiple-dosing extension to the pivotal mentor (TM) 1 trial, assessed long-term safety and efficacy of rFXIII-A(2) prophylaxis in eligible patients (patients with severe [<0.05 IU/mL] congenital FXIII subunit A deficiency) aged >= 6 years. Patients received 35IU/kgrFXIII-A(2) (exactdosing) every 28 +/- 2 days for >= 52 weeks. Primary endpoint was safety (adverse events including immunogenicity); secondary endpoints were rate of bleeds requiring FXIII treatment, haemostatic response after one 35 IU/kg rFXIII-A(2) dose for breakthrough bleeds and withdrawals due to lack of rFXIII-A(2) efficacy. Steady-state pharmacokinetic variables were also summarized. Elective surgery was permitted during the treatment period. Sixty patients were exposed to rFXIII-A(2); their median age was 26.0 years (range: 7.0-77.0). rFXIII-A(2) was well tolerated without any safety concerns. No non-neutralizing or neutralizing antibodies (inhibitors) against FXIII were detected. Mean annualized bleeding rate (ABR) was 0.043/patient-year. Mean spontaneous ABR was 0.011/patient-year. No patients withdrew due to lack of efficacy. Geometric mean FXIII trough levelwas 0.17 IU/mL. Geometric terminal half-life was 13.7 days. rFXIII-A(2) prophylaxis provided sufficient haemostatic coverage for 12 minor surgeries without the need for additional FXIII therapy; eight procedures were performed within 7 days of the patient's last scheduled rFXIII-A(2) dose, and four were performed 10 to 21 days after the last dose.
  • Kullberg, Pontus (Helsingfors universitet, 2017)
    Befolkningen i Västvärlden åldras och människor lever allt längre. I Finland är över 90 åringar den snabbast växande befolkningsgruppen och mängden 90 år fyllda uppskattas tredubblas fram till år 2040. Ändå finns det relativt lite kirurgisk forskning om denna viktiga patientgrupp. Morbiditeten och mortaliteten vid operativa ingrepp ökar med ålder, men samtidigt har det visats att även över 100 åringar klarar av operativa ingrepp relativt bra. Målet med denna studie är att undersöka resultaten och effektiviteten av hudtransplantationsoperationer på patienter som fyllt 90 år. Data samlades retrospektivt in från samtliga hudtransplantationsoperationer gjorda på ≥90 åringar under åren 2010-2013 på HUS plastikkirurgiska enhet i Tölö sjukhus. Utgående från resultaten är hudtransplantation en effektiv och relativt trygg metod att rekonstruera vävnadsdefekter på ≥90 åringar. Hudtransplantationen lyckades i 89% av ingreppen. Dödligheten under post-operativ vård var 4,8%, vid 30 dygn 7,14% och vid ett år 33,3%, vilket är litet mindre än i tidigare studier där post-operativa dödligheten på 90 åringar har undersökts. Operationen är dock inte riskfri och ett års dödlighet är högre hos de som genomgått hudtransplantation än i samma åldersgrupp i genomsnitt.
  • Peuraharju, Elin (Helsingin yliopisto, 2019)
    Kronisk skleroserande sialadenit (KSS) anses vara en manifestation av IgG4-associerad sjukdom (IgG4-AS). Kohorter i tidigare publikationer är små och omfattar sällan västerländsk befolkning. KSS kliniska beteende samt behovet av uppföljning i denna patientpopulation bör studeras. Studiens mål var att utreda ifall KSS alltid är en manifestation av IgG4-AS eller förknippas med andra autoimmuna sjukdomar, samt att utreda vilka ytterligare undersökningar denna patientpopulation kräver. Materialet bestod av patienter som mellan åren 2000 - 2017 inom HUCS sjukvårdsdistrikt fått diagnosen KSS efter submandibulektomi (n=51). Vi omvärderade patienternas histologiska vävnadsprover och utförde immunohistokemisk färgning för IgG4. IgG4 positiva vävnadsprover (≥70 IgG4-positiva plasmaceller/ high power field (HPF)) färgades för IgG och CD31. Diagnosen IgG4-AS tillskrevs ifall ‘Boston consensus statement’- kriterierna för IgG4-AS uppfylldes. Vi granskade patientjournaler och skickade en uppföljningsblankett angående symptom av IgG4-AS eller autoimmuna sjukdomar. Trettiofyra vävnadsprover uppfyllde kriterierna för KSS, 17 vävnadsprover tillskrevs diagnosen icke-skleroserande kronisk sialadenit (KS). I 19 fall associerades en spottkörtelsten till organskadan. Tolv vävnadsprover var IgG4-positiva, varav två uppfyllde kriterierna för IgG4-AS. Båda fallen tillhörde KS-gruppen och hade manifestationer av IgG4-AS i andra organ. Histopatologiska drag hos KSS och KS sammanföll delvis. I finländsk befolkning verkar KSS inte tillhöra IgG4-AS. Däremot kan KS vara associerat med IgG4-AS. Att histologiskt urskilja KSS från KS är utmanande. Således bör IgG4-färgning utföras när lymfoplasmacytära infiltrat påträffas i KS och KSS.
  • Le Dran, Henry-François (Paris, 1742)
  • Tommiska, Pihla; Lönnrot, Kimmo; Raj, Rahul; Luostarinen, Teemu; Kivisaari, Riku (Helsingin yliopisto, 2019)
    Background A number of randomized controlled trials have shown the benefit of drain placement in the operative treatment of chronic subdural hematoma (CSDH); however, few reports have described real-life results after adoption of drain placement into clinical practice. We report the results following a change in practice at Helsinki University Hospital from no drain to subdural drain (SD) placement after burr hole craniostomy for CSDH. Methods We conducted a retrospective observational study of consecutive patients undergoing burr hole craniostomy for CSDH. We compared outcomes between a 6- month period when SD placement was arbitrary (July-December 2015) and a period when SD placement for 48 hours was routine (July-December 2017). Our primary outcome of interest was recurrence of CSDH necessitating reoperation within 6 months. Patient outcomes, infections, and other complications were assessed as well. Results A total of 161 patients were included, comprising 71 (44%) in the drain group and 90 (56%) in the non-drain group. There were no significant differences in age, comorbidities, history of trauma, or use of antithrombotic agents between the 2 groups (P>0.05 for all). Recurrence within 6 months occurred in 18% of patients in the non-drain group, compared with 6% in the drain group (odds ratio, 0.28; 95% confidence interval, 0.09-0.87; P=0.028). There were no differences in neurologic outcomes (P=0.72), mortality (P=0.55), infection rate (P=0.96), or other complications (P=0.20). Conclusions The change in practice from no drain to use of an SD after burr hole craniostomy for CSDH effectively reduced the 6-month recurrence rate with no effect on patient outcomes, infections, or other complications.
  • Mäkitie, Antti A.; Keski-Säntti, Harri; Markkanen-Leppänen, Mari; Bäck, Leif; Koivunen, Petri; Ekberg, Tomas; Sandström, Karl; Laurell, Göran; von Beckerath, Mathias; Nilsson, Johan S.; Wahlberg, Peter; Greiff, Lennart; Spaak, Lena Norberg; Kjaergaard, Thomas; Godballe, Christian; Rikardsen, Oddveig; Channir, Hani Ibrahim; Rubek, Niclas; von Buchwald, Christian (2018)
    Background: The five Nordic countries with a population of 27 M people form a rather homogenous region in terms of health care. The management of head and neck cancer is centralized to the 21 university hospitals in these countries. Our aim was to gain an overview of the volume and role of transoral robotic surgery (TORS) and to evaluate the need to centralize it in this area as the field is rapidly developing. Materials and Methods: A structured questionnaire was sent to all 10 Departments of Otorhinolaryngology-Head and Neck Surgery in the Nordic countries having an active programme for TORS in December 2017. Results: The total cumulative number of performed robotic surgeries at these 10 Nordic centers was 528 and varied between 5 and 240 per center. The median annual number of robotic surgeries was 38 (range, 5-60). The observed number of annually operated cases remained fairly low ( Conclusions: The present results showing a limited volume of performed surgeries call for considerations to further centralize TORS in the Nordic countries.
  • Lund, Lars; Nisén, Harry; Järvinen, Petrus; Fovaeus, Magnus; Gudmundsson, Eirikur; Kromann-Andersen, Bjarne; Ljungberg, Börje; Nilsen, Frode; Sundqvist, Pernilla; Clark, Peter E.; Beisland, Christian (2018)
    Purpose: To examine the variation in venous thromboembolism prophylactic treatment (VTEP) among renal cancer patients undergoing surgery. Materials and methods: An Internet-based questionnaire on renal tumor management before and after surgery was mailed to all Nordic departments of urology. The questions focused on the use of VTEP and were subdivided into different surgical modalities. Results: Questionnaires were mailed to 91 institutions (response rate 53%). None of the centers used VTEP before surgery, unless the patient had a vena caval tumor thrombus. Overall, the VTEP utilized during hospitalization for patients undergoing renal surgery included early mobilization (45%), compression stockings (52%) and low-molecular-weight heparin (89%). In patients undergoing open radical Nx, 80% of institutions used VTEP during their hospitalization (23% compression stockings and 94% low-molecular-weight heparin). After leaving the hospital, the proportion and type of VTEP received varied considerably across institutions. The most common interval, used in 60% of the institutions, was for a period of 4 weeks. The restriction to the Nordic countries was a limitation and, therefore, may not reflect the practice patterns elsewhere. It is a survey study and, therefore, cannot measure the behaviors of those institutions that did not participate. Conclusion: We found variation in the type and duration of VTEP use for each type of local intervention for renal cancer. These widely disparate variations in care strongly argue for the establishment of national and international guidelines regarding VTEP in renal surgery.
  • Gräsbeck, Helene; Ekroos, Heikki; Halonen, Kimmo; Vasankari, Tuula (2020)
    Objective: Tobacco smoking is a well-established risk factor for postoperative complications. Research on preoperative smoking cessation in primary health care is scarce. Design: This was a retrospective cohort study. Setting: The Stop Smoking before Surgery Project (SSSP) started in Porvoo, Finland, in May of 2016, involving both primary health care and specialized health care. The goals of the project were smoking awareness and preoperative smoking cessation. Subjects: Our study involved 1482 surgical patients operated at Porvoo Hospital between May and December of 2016. Main outcome measures: We studied the recording of smoking status in all patients, and ICD-10 diagnosis of nicotine dependency and the initiation of preoperative smoking cessation in current smokers. Variables were studied from electronic patient records, comparing primary health care referrals and surgical outpatient clinic records. Results: Smoking status was visible in 14.2% of primary health care referrals, and in 18.4% of outpatient clinic records. Corresponding rates for current smokers (n = 275) were 0.0 and 8.7% for ICD-10 diagnosis of nicotine dependence, and 2.2 and 15.3% for initiation of preoperative smoking cessation. The differences between primary health care referrals and outpatient clinic records were statistically significant for all three variables (p