Browsing by Subject "Endoscopy"

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  • Leppäniemi, A.; Tolonen, M.; Tarasconi, A.; Segovia-Lohse, H.; Gamberini, E.; Kirkpatrick, A.W.; Ball, C.G.; Parry, N.; Sartelli, M.; Wolbrink, D.; Van Goor, H.; Baiocchi, G.; Ansaloni, L.; Biffl, W.; Coccolini, F.; Di Saverio, S.; Kluger, Y.; Moore, E.; Catena, F. (2019)
    Although most patients with acute pancreatitis have the mild form of the disease, about 20-30% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Infection of the pancreatic and peripancreatic necrosis occurs in about 20-40% of patients with severe acute pancreatitis, and is associated with worsening organ dysfunctions. While most patients with sterile necrosis can be managed nonoperatively, patients with infected necrosis usually require an intervention that can be percutaneous, endoscopic, or open surgical. These guidelines present evidence-based international consensus statements on the management of severe acute pancreatitis from collaboration of a panel of experts meeting during the World Congress of Emergency Surgery in June 27-30, 2018 in Bertinoro, Italy. The main topics of these guidelines fall under the following topics: Diagnosis, Antibiotic treatment, Management in the Intensive Care Unit, Surgical and operative management, and Open abdomen. © 2019 The Author(s).
  • Nykänen, Taina; Udd, Marianne; Peltola, Erno; Leppaniemi, Ari; Kylänpää, Marja-Leena (2017)
    Bleeding pancreatic pseudocysts (PPCs) are a rare but lethal complication of pancreatitis. Transcatheter arterial embolization (TAE) is the first-line treatment of acute hemorrhage, but consensus on the definitive management of bleeding PPCs is lacking. The aim of this study was to evaluate the safety and efficacy of the combination of TAE and therapeutic endoscopy in the treatment of bleeding PPCs. Patients with acute or chronic pancreatitis treated for bleeding PPCs in Helsinki University Hospital during 2004-2014 comprised the study group. Inpatients with acute necrotizing pancreatitis were excluded. Patients underwent TAE as the primary treatment to control the bleeding. Therapeutic endoscopy performed on an outpatient visit after TAE allowed the definitive treatment of PPCs. A total of 58 patients underwent TAE. Re-bleeding rate (<30 days) was 15.5 %, necessitating re-embolization on seven and surgical intervention on two patients. Overall, TAE success rate was 96.6 %. Mortality rate (<30 days) was 3.4 %. Of the 58, 47 patients were followed up for their PPCs in our unit. PPCs resolved spontaneously in 13 (27.1 %). The remaining 34 had an endoscopic treatment attempt with endoscopic draining performed on 32 and unsuccessful cannulation on two (5.9 %). Of the 32 patients with initially successful endoscopy, 7 (21.9 %) needed an additional drainage procedure (six non-surgical and one surgical). Overall success rate of non-surgical management was 91.5 %. Post-endoscopy mortality rate (<30 days) was 2.9 %. Our follow-up continued for 15 (1-75) months. By the time of data retrieval, 35 of 58 patients had died with alcohol liver disease being the most common cause of death. Five-year survival estimate was 63 %. Bleeding pancreatic pseudoaneurysms require non-surgical management. We need more data on the optimal timing of therapeutic endoscopy and on the role of empirical embolizations.
  • Candido, Marcus Vinicius; Syrjä, Pernilla; Kilpinen, Susanne; Spillmann, Thomas (2018)
    Background: Gastric carcinoma (GC) is a rather rare pathological finding in dogs, with the exception of some breeds which seem predisposed. The etiopathogenesis is largely unknown in dogs, whereas in humans GC often develops from gastric mucosal metaplasia and dysplasia. This study investigates whether dogs of certain breeds are more often subject to gastroduodenoscopy (GDS), and diagnosed with GC, mucosal metaplasia or dysplasia. A retrospective clinical database search was performed at the Veterinary Teaching Hospital at the University of Helsinki, Finland. The following inclusion criteria were applied to estimate relative risk for metaplasia/dysplasia and GC: dogs from pure breeds with at least five individuals subject to GDS with histopathology of gastric biopsies. Results: Between 2006 and 2016, from a total of 54945 canine patients presented, 423 dogs underwent GDS. Inclusion criteria were met in 180 dogs of 20 different pure breeds. Eight dogs had GCs (mean age = 9.8 +/- 1.7 years): Belgian Tervuren (n = 4), Collie (n = 2), Golden Retriever (n = 1) and Jack Russel Terrier (n = 1). Fourteen dogs of eight breeds had gastric mucosal metaplasia or dysplasia. A log-binomial statistical model revealed that dogs in the following breeds had a significantly higher probability to undergo GDS than the others in the study population: Australian Terrier, Belgian Tervuren, Cairn Terrier, Collie and Siberian Husky. Belgian Tervuren was found at higher risk to be diagnosed with GC [RR = 19 (5.7-63.9; P <0.0001)], as well as mucosal metaplasia/dysplasia [RR (7.6; 2.95-19.58; P <0.0001)], as compared to the other breeds included. Shetland Sheepdog had an increased RR (5.83; 1.75-19.45; P = 0.0041) for metaplasia. Conclusions: The results indicate a very low incidence of GC in dogs. The Belgian Tervuren, however, appears as predisposed. The histopathologic descriptions of mucosal changes such as metaplasia and dysplasia were also rare, but were more frequent in the Belgian Tervuren. Previous reports of these changes in dogs are very scarce, but they might be presumably related to GC in dogs, as they are in humans. Future research should investigate the possible role of metaplasia and dysplasia in the development of GC in dogs, especially those of predisposed breeds.
  • Candido, Marcus V; Syrjä, Pernilla; Kilpinen, Susanne; Spillmann, Thomas (BioMed Central, 2018)
    Abstract Background Gastric carcinoma (GC) is a rather rare pathological finding in dogs, with the exception of some breeds which seem predisposed. The etiopathogenesis is largely unknown in dogs, whereas in humans GC often develops from gastric mucosal metaplasia and dysplasia. This study investigates whether dogs of certain breeds are more often subject to gastroduodenoscopy (GDS), and diagnosed with GC, mucosal metaplasia or dysplasia. A retrospective clinical database search was performed at the Veterinary Teaching Hospital at the University of Helsinki, Finland. The following inclusion criteria were applied to estimate relative risk for metaplasia/dysplasia and GC: dogs from pure breeds with at least five individuals subject to GDS with histopathology of gastric biopsies. Results Between 2006 and 2016, from a total of 54945 canine patients presented, 423 dogs underwent GDS. Inclusion criteria were met in 180 dogs of 20 different pure breeds. Eight dogs had GCs (mean age = 9.8 ± 1.7 years): Belgian Tervuren (n = 4), Collie (n = 2), Golden Retriever (n = 1) and Jack Russel Terrier (n = 1). Fourteen dogs of eight breeds had gastric mucosal metaplasia or dysplasia. A log-binomial statistical model revealed that dogs in the following breeds had a significantly higher probability to undergo GDS than the others in the study population: Australian Terrier, Belgian Tervuren, Cairn Terrier, Collie and Siberian Husky. Belgian Tervuren was found at higher risk to be diagnosed with GC [RR = 19 (5.7–63.9; P < 0.0001)], as well as mucosal metaplasia/dysplasia [RR (7.6; 2.95–19.58; P < 0.0001)], as compared to the other breeds included. Shetland Sheepdog had an increased RR (5.83; 1.75–19.45; P = 0.0041) for metaplasia. Conclusions The results indicate a very low incidence of GC in dogs. The Belgian Tervuren, however, appears as predisposed. The histopathologic descriptions of mucosal changes such as metaplasia and dysplasia were also rare, but were more frequent in the Belgian Tervuren. Previous reports of these changes in dogs are very scarce, but they might be presumably related to GC in dogs, as they are in humans. Future research should investigate the possible role of metaplasia and dysplasia in the development of GC in dogs, especially those of predisposed breeds.
  • Cantu, Paolo; Tenca, Andrea; Parzanese, Ilaria; Penagini, Roberto (2016)
    There is growing interest in using covered self-expandable metal stents for the treatment of benign biliary conditions, and the presence of anastomotic biliary strictures and leaks after liver transplantation provide a valuable opportunity for testing them. The performance of the stents is encouraging, and the technical success rate is high. They provide larger diameter dilation and are easily removed, and can potentially limit costs by reducing the number of procedures needed to treat anastomotic biliary strictures. However, drawbacks such as sub-optimal tolerability and migration may affect both patient management and costs. New stent designs are currently being evaluated. Randomized controlled trials and cost-effectiveness analyses comparing covered metal stents with multiple plastic stent endotherapy are warranted in order to define the role of the former as first-line or rescue treatment. (C) 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
  • Jokelainen, Jarno; Belozerskikh, Anna; Mustonen, Harri; Udd, Marianne; Kylänpää, Leena; Lindström, Outi; Mazanikov, Maxim; Pöyhiä, R. (2020)
    Background Endoscopic retrograde cholangiopancreatography (ERCP) requires moderate to deep sedation, usually with propofol. Adverse effects of propofol sedation are relatively common, such as respiratory and cardiovascular depression. This study was conducted to determine if doxapram, a respiratory stimulant, could be used to reduce the incidence of respiratory depression. Methods This is a single-center, prospective randomized double-blind study performed in the endoscopy unit of Helsinki University Central Hospital. 56 patients were randomized in a 1:1 ratio to either receive doxapram as an initial 1 mg/kg bolus and an infusion of 1 mg/kg/h (group DOX) or placebo (group P) during propofol sedation for ERCP. Main outcome measures were apneic episodes and hypoxemia (SpO(2) <90%). Mann-Whitney test for continuous variables and Fisher's exact test for discrete variables were used and mixed effects modeling to take into account repeated measurements on the same subject and comparing both changes within a group as a function of time and between the groups. Results There were no statistically significant differences in apneic episodes (p = 0.18) or hypoxemia (p = 0.53) between the groups. There was a statistically significant rise in etCO(2) levels in both groups, but the rise was smaller in group P. There was a statistically significant rise in Bispectral Index (p = 0.002) but not modified Observer's Assessment of Agitation/Sedation (p = 0.21) in group P. There were no statistically significant differences in any other measured parameters. Conclusions Doxapram was not effective in reducing respiratory depression caused by deep propofol sedation during ERCP. Further studies are warranted using different sedation protocols and dosing regimens.
  • Silvola, Juha Tapio (2020)
    Objectives: Analyze reasons for unilateral conductive hearing loss (CHL) with unknown etiology in children. Introduction: Unilateral conductive hearing loss (HL) without known etiology can be undiagnosed despite of hearing screening programs. It can be difficult to find the reason for HL and to make a treatment plan. Middle ear endoscopy gives hard-evidence diagnosis and basis for an individual treatment plan. Methods and material: Prospective clinical follow-up study for a cohort of generally healthy elementary school age children with unilateral conductive HL with unknown etiology. The study population was 192 children, of which 46 had a HL of at least 25 dB with more than 10 dB conductive component. Mean age was 8.7 years. Preoperative tests included otomicroscopy, bone- and air-conduction audiogram, tympanometry, stapes reflex tests, Rinne and Weber test and Otoacoustic emissions. The children underwent endoscopy of the middle ear with an individual treatment plan and long-term follow-up. The aim was to explore etiology and to give a treatment plan for hearing loss. Follow-up included air- and bone conduction hearing tests annually or every other year. Mean follow-up was 5.2 years. Results: A clear etiological finding was found in 36 (78%) ears, stapes anomaly (23) as the most common (64%) finding. Other findings were two cholesteatomas, 2 status after trauma, 5 middle ear anomalies, 5 incus fixations and one incus erosion. Air conduction hearing improved spontaneously during follow-up in 81% (17/21, 2 dropouts) of the stapes anomaly ears (mean 11,3 dB, range 4-32 dB), and none of these ears showed hearing deterioration. In the incus fixation group, one ear showed hearing deterioration. There were no major complications for exploration, and 5 minor postoperative infections. Conclusions: The most common reason for pediatric unilateral conductive hearing loss was stapes anomaly/ fixation. The HL does not deteriorate. Hearing loss in stapes anomalies shows a tendency for spontaneous recovery. Stapes surgery can be postponed or avoided.
  • Siiki, Antti; Arkkila, Perttu; Karjula, Heikki; Kylänpää, Leena (2018)
    Endoskooppisia menetelmiä käytetään yhä enemmän kuvantamisen tukena epäselvien haimamuutosten selvittelyssä. Ensisijainen keino solu- tai kudosnäytteen saamiseksi haimamuutoksesta on neulanäytteen ottaminen kaikuendoskopiaohjauksessa. Haimatiehyen tähystystä voidaan käyttää valikoiduissa tapauksissa haimatieahtauman tai -laajentuman selvityksissä. Useimpien haimamuutosten hoitolinja voidaan päättää tietokonetomografian ja magneettikuvan perusteella. Endoskooppisia menetelmiä pitää käyttää valikoiden ja moniammatillisen harkinnan jälkeen.
  • Hukkinen, Maria; Pakarinen, Mikko Petteri; Merras-Salmio, Laura; Koivusalo, Antti; Rintala, Risto; Kolho, Kaija-Leena (2016)
    Background: Fecal calprotectin (FC) correlates with endoscopic recurrence of Crohn's disease (CD) in adults but has not been studied among children postoperatively. We aimed to analyze whether FC relates with postoperative CD recurrence in children. Methods: Altogether 51 postoperative endoscopies and FC measurements from 22 patients having undergone surgery for CD at age Results: Ileocecal resection (n = 15), small bowel resection (n = 6), or left hemicolectomy (n = 1) was performed at median age of 15.1 (interquartile range 14.4-17.6) years. Following surgery, FC decreased significantly (659 vs. 103 mu g/g, p = 0.001). During median follow-up of 5.7 (4.2-7.7) years, either endoscopic or histological recurrence occurred in 17 patients (77%). FC > 139 mu g/g at time of endoscopy or FC increase of 79 mu g/g compared to first postoperative value was suggestive of endoscopic recurrence (Rutgeerts score i2-i4), while FC > 101 mu g/g or increase of 21 mu g/g indicated histological recurrence. Best accuracy for prediction of recurrence was obtained by combining FC at endoscopy and the postoperative increase of FC. The corresponding AUROC values were 0.74 (95% 0.58-0.89) for endoscopic recurrence whereas 0.81 (95% CI 0.67-0.95) for histological recurrence. Conclusion: FC is a useful surrogate marker of postoperative recurrence also in pediatric CD patients. (C) 2016 Elsevier Inc. All rights reserved.
  • Cândido, Marcus Vinicius; Syrjä, Pernillä; Hanifeh, Mohsen; Lepajõe, Jaan; Salla, Kati; Kilpinen, Susanne; Noble, Peter-John Mäntylä; Spillmann, Thomas (2021)
    Gastric carcinoma (GC) is uncommon in dogs, except in predisposed breeds such as Belgian Shepherd dogs (BSD) of the Tervuren and Groenendael varieties. When GC is diagnosed in dogs it is often late in the disease, resulting in a poorer prognosis. The aim of this prospective clinical study was to investigate possible associations of gastric mucosal pathologies with clinical signs, laboratory test results and GC in BSD. An online survey gathered epidemiological data to generate potential risk factors for vomiting as the predominant gastric clinical sign, and supported patient recruitment for endoscopy. Canine Chronic Enteropathy Clinical Activity Index (CCECAI) score and signs of gastroesophageal reflux (GER) were used to allocate BSD older than five years to either Group A, with signs of gastric disease, or Group B, without signs. Findings in the clinical history, laboratory tests and gastric histopathology of endoscopic biopsies were statistically analysed in search of associations.
  • Cândido, Marcus V; Syrjä, Pernillä; Hanifeh, Mohsen; Lepajõe, Jaan; Salla, Kati; Kilpinen, Susanne; Noble, Peter-John M; Spillmann, Thomas (BioMed Central, 2021)
    Abstract Background Gastric carcinoma (GC) is uncommon in dogs, except in predisposed breeds such as Belgian Shepherd dogs (BSD) of the Tervuren and Groenendael varieties. When GC is diagnosed in dogs it is often late in the disease, resulting in a poorer prognosis. The aim of this prospective clinical study was to investigate possible associations of gastric mucosal pathologies with clinical signs, laboratory test results and GC in BSD. An online survey gathered epidemiological data to generate potential risk factors for vomiting as the predominant gastric clinical sign, and supported patient recruitment for endoscopy. Canine Chronic Enteropathy Clinical Activity Index (CCECAI) score and signs of gastroesophageal reflux (GER) were used to allocate BSD older than five years to either Group A, with signs of gastric disease, or Group B, without signs. Findings in the clinical history, laboratory tests and gastric histopathology of endoscopic biopsies were statistically analysed in search of associations. Results The online survey included 232 responses. Logistic regression analysis recognized an association of vomiting with gagging, poor appetite and change in attitude. Recruitment for endoscopy included 16 BSD in Group A (mean age 9.1 ± 1.8 years, mean CCECAI = 3.1 ± 2.2 and signs of GER); and 11 in Group B (mean age 9.8 ± 1.4 years, CCECAI = 0, no signs of GER). Seven (25.9%) of the 27 BSD (Group A 4/16, Group B 3/11) had leukopenia. Serum C-reactive protein tended to be increased with more advanced GC (P = 0.063). Frequency of GC, mucosal atrophy, mucous metaplasia, or glandular dysplasia did not differ between groups. GC was frequently diagnosed (6/27), even without clinical signs (2/11). The odds ratio for vomiting (OR = 9.9; P = 0.016) was increased only when glandular dysplasia was present. GC was associated with mucous metaplasia (P = 0.024) and glandular dysplasia (P = 0.006), but not with mucosal atrophy (P = 1). Conclusions GC can develop as an occult disease, associated with metaplasia and dysplasia of the gastric mucosa. Suggestive clinical signs, notably vomiting, should warrant timely endoscopy in BSD. Extensive endoscopic screening of asymptomatic dogs remains, however, unrealistic. Therefore, biomarkers of mucosal pathology preceding clinical illness are needed to support an indication for endoscopy and enable early diagnosis of GC.
  • Seppala, Toni T.; Ahadova, Aysel; Dominguez-Valentin, Mev; Macrae, Finlay; Evans, D. Gareth; Therkildsen, Christina; Sampson, Julian; Scott, Rodney; Burn, John; Möslein, Gabriela; Bernstein, Inge; Holinski-Feder, Elke; Pylvänäinen, Kirsi; Renkonen-Sinisalo, Laura; Lepistö, Anna; Lautrup, Charlotte Kvist; Lindblom, Annika; Plazzer, John-Paul; Winship, Ingrid; Tjandra, Douglas; Katz, Lior H.; Aretz, Stefan; Hueneburg, Robert; Holzapfel, Stefanie; Heinimann, Karl; Della Valle, Adriana; Neffa, Florencia; Gluck, Nathan; Cappel, Wouter H. de Vos Tot Nederveen; Vasen, Hans; Morak, Monika; Steinke-Lange, Verena; Engel, Christoph; Rahner, Nils; Schmiegel, Wolff; Vangala, Deepak; Thomas, Huw; Green, Kate; Lalloo, Fiona; Crosbie, Emma J.; Hill, James; Capella, Gabriel; Pineda, Marta; Navarro, Matilde; Blanco, Ignacio; ten Broeke, Sanne; Nielsen, Maartje; Ljungmann, Ken; Nakken, Sigve; Lindor, Noralane; Frayling, Ian; Hovig, Eivind; Sunde, Lone; Kloor, Matthias; Mecklin, Jukka-Pekka; Kalager, Mette; Moller, Pal (2019)
    BackgroundRecent epidemiological evidence shows that colorectal cancer (CRC) continues to occur in carriers of pathogenic mismatch repair (path_MMR) variants despite frequent colonoscopy surveillance in expert centres. This observation conflicts with the paradigm that removal of all visible polyps should prevent the vast majority of CRC in path_MMR carriers, provided the screening interval is sufficiently short and colonoscopic practice is optimal.MethodsTo inform the debate, we examined, in the Prospective Lynch Syndrome Database (PLSD), whether the time since last colonoscopy was associated with the pathological stage at which CRC was diagnosed during prospective surveillance. Path_MMR carriers were recruited for prospective surveillance by colonoscopy. Only variants scored by the InSiGHT Variant Interpretation Committee as class 4 and 5 (clinically actionable) were included. CRCs detected at the first planned colonoscopy, or within one year of this, were excluded as prevalent cancers.ResultsStage at diagnosis and interval between last prospective surveillance colonoscopy and diagnosis were available for 209 patients with 218 CRCs, including 162 path_MLH1, 45 path_MSH2, 10 path_MSH6 and 1 path_PMS2 carriers. The numbers of cancers detected within 3.5years since last colonoscopy were 36, 93, 56 and 33, respectively. Among these, 16.7, 19.4, 9.9 and 15.1% were stage III-IV, respectively (p=0.34). The cancers detected more than 2.5years after the last colonoscopy were not more advanced than those diagnosed earlier (p=0.14).ConclusionsThe CRC stage and interval since last colonoscopy were not correlated, which is in conflict with the accelerated adenoma-carcinoma paradigm. We have previously reported that more frequent colonoscopy is not associated with lower incidence of CRC in path_MMR carriers as was expected. In contrast, point estimates showed a higher incidence with shorter intervals between examinations, a situation that may parallel to over-diagnosis in breast cancer screening. Our findings raise the possibility that some CRCs in path_MMR carriers may spontaneously disappear: the host immune response may not only remove CRC precursor lesions in path_MMR carriers, but may remove infiltrating cancers as well. If confirmed, our suggested interpretation will have a bearing on surveillance policy for path_MMR carriers.
  • Seppälä, Toni T; Ahadova, Aysel; Dominguez-Valentin, Mev; Macrae, Finlay; Evans, D. G; Therkildsen, Christina; Sampson, Julian; Scott, Rodney; Burn, John; Möslein, Gabriela; Bernstein, Inge; Holinski-Feder, Elke; Pylvänäinen, Kirsi; Renkonen-Sinisalo, Laura; Lepistö, Anna; Lautrup, Charlotte K; Lindblom, Annika; Plazzer, John-Paul; Winship, Ingrid; Tjandra, Douglas; Katz, Lior H; Aretz, Stefan; Hüneburg, Robert; Holzapfel, Stefanie; Heinimann, Karl; Valle, Adriana D; Neffa, Florencia; Gluck, Nathan; de Vos tot Nederveen Cappel, Wouter H; Vasen, Hans; Morak, Monika; Steinke-Lange, Verena; Engel, Christoph; Rahner, Nils; Schmiegel, Wolff; Vangala, Deepak; Thomas, Huw; Green, Kate; Lalloo, Fiona; Crosbie, Emma J; Hill, James; Capella, Gabriel; Pineda, Marta; Navarro, Matilde; Blanco, Ignacio; ten Broeke, Sanne; Nielsen, Maartje; Ljungmann, Ken; Nakken, Sigve; Lindor, Noralane; Frayling, Ian; Hovig, Eivind; Sunde, Lone; Kloor, Matthias; Mecklin, Jukka-Pekka; Kalager, Mette; Møller, Pål (BioMed Central, 2019)
    Abstract Background Recent epidemiological evidence shows that colorectal cancer (CRC) continues to occur in carriers of pathogenic mismatch repair (path_MMR) variants despite frequent colonoscopy surveillance in expert centres. This observation conflicts with the paradigm that removal of all visible polyps should prevent the vast majority of CRC in path_MMR carriers, provided the screening interval is sufficiently short and colonoscopic practice is optimal. Methods To inform the debate, we examined, in the Prospective Lynch Syndrome Database (PLSD), whether the time since last colonoscopy was associated with the pathological stage at which CRC was diagnosed during prospective surveillance. Path_MMR carriers were recruited for prospective surveillance by colonoscopy. Only variants scored by the InSiGHT Variant Interpretation Committee as class 4 and 5 (clinically actionable) were included. CRCs detected at the first planned colonoscopy, or within one year of this, were excluded as prevalent cancers. Results Stage at diagnosis and interval between last prospective surveillance colonoscopy and diagnosis were available for 209 patients with 218 CRCs, including 162 path_MLH1, 45 path_MSH2, 10 path_MSH6 and 1 path_PMS2 carriers. The numbers of cancers detected within < 1.5, 1.5–2.5, 2.5–3.5 and at > 3.5 years since last colonoscopy were 36, 93, 56 and 33, respectively. Among these, 16.7, 19.4, 9.9 and 15.1% were stage III–IV, respectively (p = 0.34). The cancers detected more than 2.5 years after the last colonoscopy were not more advanced than those diagnosed earlier (p = 0.14). Conclusions The CRC stage and interval since last colonoscopy were not correlated, which is in conflict with the accelerated adenoma-carcinoma paradigm. We have previously reported that more frequent colonoscopy is not associated with lower incidence of CRC in path_MMR carriers as was expected. In contrast, point estimates showed a higher incidence with shorter intervals between examinations, a situation that may parallel to over-diagnosis in breast cancer screening. Our findings raise the possibility that some CRCs in path_MMR carriers may spontaneously disappear: the host immune response may not only remove CRC precursor lesions in path_MMR carriers, but may remove infiltrating cancers as well. If confirmed, our suggested interpretation will have a bearing on surveillance policy for path_MMR carriers.
  • Vanhanen, Hanni (Helsingin yliopisto, 2021)
    Akuutti yläruuansulatuskanavan verenvuoto on yleinen päivystyspotilaan tulosyy. Suurin osa näistä vuodoista on itsestään rajoittuvia eikä vaadi hoitoa tai sairaalaseurantaa, mutta toisaalta pieni osa vuodoista on potentiaalisesti henkeä uhkaavia. Tämän vuoksi potilaiden riskin arvioimiseksi on kehitetty erilaisia pisteytysjärjestelmiä helpottamaan kliinikoiden päätöksentekoa. Suomessa ei tiettävästi ole rutiinikäytössä mitään tiettyä pisteytysjärjestelmää. Tässä tutkielmassa tutkittiin erityisesti modifioidun Glasgow-Blatchford scoren (mGBS) toimivuutta suomalaisessa potilasaineistossa. Aineistona analysoitiin retrospektiivisesti aikaväliltä 10/2016 - 9/2017 ne Meilahden sairaalan päivystyspotilaat, joiden tulosyy oli yläruuansulatuskanavan verenvuoto tai sen epäily. Tutkittavia potilaita oli lopulta 409, joille kaikille laskettiin mGBS sekä clinical Rockall score (cRS). Tämän jälkeen tutkittiin, miten hyvin nämä pisteytysjärjestelmät kykenivät ennustamaan tutkimuspotilaiden tarvetta lääketieteelliselle interventiolle tai kuolleisuutta 30 vrk:n kuluessa. Interventioiksi määriteltiin seuraavat toimenpiteet: endoskooppinen toimenpide, verensiirto, leikkaus ja angioembolisaatio. Modifioitu GBS osoittautui varsin sensitiiviseksi menetelmäksi intervention tarpeen tai kuolleisuuden ennustamisessa. Raja-arvolla mGBS > 0 scoren sensitiivisyys oli 98,5% ja sensitiivisyys 34,2%, raja-arvolla mGBS >1 sensitiivisyys oli 96,2% ja spesifisyys 59,1%. Vastaavasti raja-arvolla cRS > 0 tämän pisteytyksen sensitiivisyys oli 93,5% ja spesifisyys 33,6%. Molemmille pisteytyksille laskettiin ROC-käyrät, ja myös tässä mGBS osoittautui cRS:a paremmaksi menetelmäksi: AUROC 0,911 (0,880-0,941) vs. 0,767 (0,720-0,815). Johtopäätöksenä mGBS vaikuttaisi tunnistavan luotettavasti matalan riskin potilaat, ja mikäli pisteytys otetaan tulevaisuudessa käyttöön, voidaan sitä hyödyntää näiden potilaiden identifioimiseksi päivystyksissä. Tällä tavoin voitaisiin potentiaalisesti kasvattaa avohoidossa hoidettavien potilaiden määrää ja tätä kautta vähentää sairaalahoidosta ja päivystyksellisistä toimenpiteistä aiheutuvia kustannuksia. (222 sanaa)
  • Siiki, Antti; Kylänpää, Leena (2020)
    • Sappi- ja haimasairauksissa vaativiakin hoitotoimenpiteitä pystytään nykyisin tekemään ¬hyvin siedetysti ja turvallisesti tähystyksessä. • Endoskooppinen retrogradinen kolangiopankreatografia (ERCP) on ensisijainen menetelmä sappitietukoksen ja tiehytkivien hoidossa. • Lähettävän yksikön kirjaamat lähetetiedot ovat olennaisen tärkeitä. • ERCP:hen liittyvät komplikaatiot jäävät useimmiten lieväasteisiksi. Niiden riski noin 5 %. • Toimenpiteen jälkeinen vatsakipu tai verenvuoto vaatii erikoissairaanhoidon arvion.
  • Rihkanen, Heikki; Takala, Annika (2016)
    Lähtö­kohdat Useilla eri­koi­sa­loilla se­kä sai­rauksien lääkkeel­linen hoi­to et­tä toimen­pi­teiden taa­juudet vaihte­levat tervey­den­huollon yksi­köissä. Tä­mä ei välttä­mättä ku­vaa sai­rauksien epä­ta­saista jakau­tu­mista, vaan epäyh­te­näisiä ­hoi­to­pe­rus­teita. Täs­sä tutki­muk­sessa selvi­tettiin kor­va-, ne­nä- ja kurkku­tautien eri­koi­salan taval­listen toimen­pi­teiden mää­rien muu­toksia 2000-lu­vulla ja ver­tailtiin sairaan­hoi­to­piirien suorit­teita väes­töön suhteu­tet­tuna. Sa­malla ar­vioitiin Ter­veyden ja hyvin­voinnin lai­toksen hoitoil­moi­tus­re­kis­terin (Hilmo) luotet­ta­vuutta toimen­pi­de­jak­sojen kuvaa­jana. Mene­telmät Hilmo-re­kis­te­ristä ke­rättiin sairaan­hoi­to­pii­reittäin ai­kuisia kos­kevat tie­dot nielu­ri­sojen pois­ton, ne­nän väli­seinän oi­kaisun ja ne­nän sivuon­te­loiden tähys­tys­leik­kauksen suori­te­mää­ristä vuo­silta 2002–12. Näi­tä luku­määriä ­ver­rattiin sairaa­loiden anes­tesia- ja leikkaus­toi­minnan vertai­sar­vioin­ti­tie­to­kannan (BM-OR) se­kä Hel­singin ja Uu­denmaan sairaan­hoi­to­piirin (HUS) leikkaus­salien toimin­na­noh­jaus­jär­jes­telmän (OPERA) tie­toihin. Tu­lokset Ai­kuisten nielu­ri­sa­leik­kaukset ovat vähen­tyneet 2000-lu­vulla va­jaat 20 % ja ne­nän väli­seinän oikai­su­leik­kaukset run­saat 30 %. Sivuon­te­loiden tähys­tys­ki­rurgian koko­nais­määrä on säi­lynyt en­nallaan. Leikkaus­hoidon toden­nä­köisyys vaih­teli sairaan­hoi­to­pii­reittäin. Konser­va­tii­vi­simman ja aktii­vi­simman sairaan­hoi­to­piirin vä­linen ero oli aikuis­po­tilaan nielu­ri­sa­leik­kauk­sessa yli kaksin­ker­tainen, sivuon­te­loiden tähys­tys­ki­rur­giassa nelin­ker­tainen ja ne­nän väli­seinän oikai­su­leik­kauk­sessa yli kymmen­ker­tainen. Hil­mo- ja BM-OR-tie­to­kan­tojen vä­linen korre­laatio vuo­sina 2010–12 oli erittäin hy­vä. Pää­telmät Aikui­sille suori­tetut ne­nän väli­seinän oi­kaisu, nielu­ri­sa­leikkaus ja sivuon­te­loiden tähys­tys­ki­rurgia edus­tavat toimen­pi­teitä, joi­ta teh­dään kai­kissa eri­kois­sai­raan­hoidon yksi­köissä. Kun­kin toimen­piteen yleisyys vaih­teli sairaan­hoi­to­pii­ristä toi­seen ja väes­töön suhteu­tettu ero saat­toi ol­la monin­ker­tainen. Toden­nä­köi­sesti hoi­toon oh­jaus, mieli­piteet ja re­surssit määrit­te­levät leikkau­sai­heita ole­tettua enemmän.