Browsing by Subject "Recurrence"

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  • PERSARC Study Group; Acem, Ibtissam; Verhoef, Cornelis; Rueten-Budde, Anja J.; Grünhagen, Dirk; van Houdt, Winan; van de Sande, Michiel A. J.; Aston, Will; Bonenkamp, Han; Desar, Ingrid; Ferguson, Peter C.; Fiocco, Marta; Gelderblom, H.; van Ginkel, Robert; Van der Graaf, Winette; Griffin, Anthony; Haas, Rick; van der Hage, Jos A.; Hayes, Andrew; Jeys, Lee M; Keller, Johnny; Laitinen, Minna K.; Leithner, Andreas; Maretty-Kongstad, Katja; Ozaki, Toshifumi; Pollock, Rob; van Praag, Veroniek M.; Smith, Myles; Smolle, Maria; Styring, Emelie; Szkandera, Joanna; Tanaka, Kazuhiro; Tunn, Per-Ulf; Willegger, Madeleine; Windhager, Reinhard; Wunder, Jay S.; Zaikova, Olga (2020)
    Purpose: No studies extensively compared the young adults (YA, 18-39 years), middle-aged (40-69 years), and elderly (≥70 years) population with primary high-grade extremity soft tissue sarcoma (eSTS). This study aimed to determine whether the known effect of age on overall survival (OS) and disease progression can be explained by differences in tumour characteristics and treatment protocol among the YA, middle-aged and elderly population in patients with primary high-grade eSTS treated with curative intent. Methods: In this retrospective multicentre study, inclusion criteria were patients with primary high-grade eSTS of 18 years and older, surgically treated with curative intent between 2000 and 2016. Cox proportional hazard models and a multistate model were used to determine the association of age on OS and disease progression. Results: A total of 6260 patients were included in this study. YA presented more often after 'whoops'-surgery or for reresection due to residual disease, and with more deep-seated tumours. Elderly patients presented more often with grade III and larger (≥10 cm) tumours. After adjustment for the imbalance in tumour and treatment characteristics the hazard ratio for OS of the middle-aged population is 1.47 (95% confidence interval [CI]: 1.23-1.76) and 3.13 (95% CI: 2.59-3.78) in the elderly population, compared with YA. Discussion: The effect of age on OS could only partially be explained by the imbalance in the tumour characteristics and treatment variables. The threefold higher risk of elderly could, at least partially, be explained by a higher other-cause mortality. The results might also be explained by a different tumour behaviour or suboptimal treatment in elderly compared with the younger population. Keywords: Adolescents and young adults; Elderly; Extremities; Metastasis; Middle-aged; Recurrence; Soft tissue sarcoma; Survival.
  • Alhede, Christina; Lauridsen, Trine K.; Johannessen, Arne; Dixen, Ulrik; Jensen, Jan S.; Raatikainen, Pekka; Hindricks, Gerhard; Walfridsson, Haakan; Kongstad, Ole; Pehrson, Steen; Englund, Anders; Hartikainen, Juha; Hansen, Peter S.; Nielsen, Jens C.; Jons, Christian (2017)
    Background: Supraventricular ectopic complexes (SVEC) originating in the pulmonary veins are known triggers of atrial fibrillation (AF) which led to the development of pulmonary vein isolation for AF. However, the long-term prevalence of SVEC after catheter ablation (CA) as compared to antiarrhythmic medication (AAD) is unknown. Our aims were to compare the prevalence of SVEC after AAD and CA and to estimate the association between baseline SVEC burden and AF burden during 24 months of follow-up. Methods: Patients with paroxysmal AF (N = 260) enrolled in the MANTRA PAF trial were treated with AAD (N = 132) or CA (N = 128). At baseline and 3, 6, 12, 18 and 24 months follow-up patients underwent 7-day Holter monitoring to assess SVEC and AF burden. We compared SVEC burden between treatments with Wilcoxon sum rank test. Results: Patients treated with AAD had significantly lower daily SVEC burden during follow-up as compared to CA (AAD: 19 [6-58] versus CA: 39 [14-125], p = 0.003). SVEC burden increased post-procedurally followed by a decrease after CA whereas after AAD SVEC burden decreased and stabilized after 3 months of follow-up. Patients with low SVEC burden had low AF burden after both treatments albeit this was more pronounced after CA at 24 months of follow-up. Conclusion: AAD was superior to CA in suppressing SVEC burden after treatment of paroxysmal AF. After CA SVEC burden increased immediately post-procedural followed by a decrease whereas after AAD an early decrease was observed. Lower SVEC burden was highly associated with lower AF burden during follow-up especially after CA. (C) 2017 Elsevier B.V. All rights reserved.
  • Bryk, Saara Susanna; Färkkilä, Anniina; Butzow, Ralf; Leminen, Arto; Johanna, Tapper; Heikinheimo, Markku; Unkila-Kallio, Leila; Riska, Annika (2016)
    Objective. Adult-type ovarian granulosa cell tumors (AGCTs) have an unpredictable tendency to relapse. In a carefully validated patient cohort, we evaluated the prognostic factors related to AGCT recurrence. Methods. We identified all patients diagnosed with AGCT during 1956-2014 in Helsinki University Hospital, with a minimum follow-up of one year (n = 240). After a histological review supplemented with FOXL2 (402C G) mutation status analysis, we analyzed the clinical data for association with relapse. Results. The final cohort included 164 (68%) molecularly defined AGCTs (MD-AGCTs). The majority of the women were postmenopausal (63%), and 92% of tumors were stage I. The median follow-up time was 15.5 years. Fifty-two (32%) patients developed tumor recurrence, of whom 55% had successive recurrences. Multiple-site recurrences were common, and nearly half of the recurrences were asymptomatic. The median time to the first relapse was 7.4 years, and 75% of relapses occurred within ten years after primary diagnosis. The median disease-free survival was 11.3 years. Premenopausal status at initial diagnosis, FIGO stage Ic versus la, and tumor rupture associated with relapse. However, tumor rupture was the only independent predictive factor. Of the relapsed patients, 48% died of AGO' in a median time of 153 years. Conclusion. Tumor rupture is the strongest predictive factor for recurrence, and these patients might benefit from a more aggressive initial treatment approach. AGCT requires active follow up for 10 to 15 years after primary diagnosis, since recurrences may develop late, asymptomatically and in multiple anatomical locations. (C) 2016 Elsevier Inc. All rights reserved.
  • Oksi, Jarmo; Anttila, Veli-Jukka; Mattila, Eero (2020)
    • C. difficile -infektion tärkeimmät hoitovaihtoehdot ovat vankomysiini ja fidaksomisiini. Metronidatsolia tulee nykysuositusten mukaan käyttää vain nuorehkojen potilaiden lievien tai kohtalaisen lievien infek¬tioiden hoidossa. • Suurin riski infektion uusimiseen on iäkkäillä ja/tai immunosuprimoiduilla potilailla. Heillä voidaan käyttää standardihoidon rinnalla uusimisriskiä vähentämään betslotoksumabi-infuusiota (monoklonaalinen toksiini B:n vasta-aine). • Ulosteensiirto on tehokkain hoitokeino. Sitä suositellaan harkittavaksi jo kolmannen perättäisen infektion yhteydessä.
  • Athanasiou, Antonios; Veroniki, Areti Angeliki; Efthimiou, Orestis; Kalliala, Ilkka; Naci, Huseyin; Bowden, Sarah; Paraskevaidi, Maria; Martin-Hirsch, Pierre; Bennett, Philip; Paraskevaidis, Evangelos; Salanti, Georgia; Kyrgiou, Maria (2019)
    Introduction Local treatments for cervical intraepithelial neoplasia (CIN) and microinvasive disease remove or ablate a cone-shaped part of the uterine cervix containing the abnormal cells. A trend toward less radical techniques has raised concerns that this may adversely impact the rates of precancerous and cancerous recurrence. However, there has been no strong evidence to support such claims. We hereby describe a protocol of a systematic review and network meta-analysis that will update the evidence and compare all relevant treatments in terms of efficacy and complications. Methods and analysis Literature searches in electronic databases (CENTRAL, MEDLINE, EMBASE) or trial registries will identify published and unpublished randomised controlled trials (RCTs) and cohort studies comparing the efficacy and complications among different excisional and ablative techniques. The excisional techniques include cold knife, laser or Fischer cone, large loop or needle excision of the transformation zone and the ablative radical point diathermy, cryotherapy, cold coagulation or laser ablation. The primary outcome will be residual/recurrent disease defined as abnormal histology or cytology of any grade, while secondary outcomes will include treatment failure rates defined as high-grade histology or cytology, histologically confirmed CIN1+ or histologically confirmed CIN2+, human papillomavirus positivity rates, involved margins rates, bleeding and cervical stenosis rates. We will assess the risk of bias in RCTs and observational studies using tools developed by the Cochrane Collaboration. Two authors will independently assess study eligibility, abstract the data and assess the risk of bias. Random-effects meta-analyses and network meta-analyses will be conducted using the OR for dichotomous outcomes and the mean difference for continuous outcomes. The quality of the evidence for the primary outcome will be assessed using the CINeMA (Confidence In Network Meta-Analysis) tool. Ethics and dissemination Ethical approval is not required. We will disseminate findings to clinicians, policy-makers, patients and the public. PROSPERO registration number CRD42018115508.
  • Ekroos, Heikki; Mazur, Witold (2017)
  • Lehtovirta, Suvituuli (Helsingfors universitet, 2015)
    Gynekologiset laskeumat ovat yleisiä ongelmia naisilla. Vaikka niitä pystytään nykyisin hoitamaan operatiivisesti, ne saattavat uusiutua eli residivoida. Tutkimuksen tavoitteena oli selvittää, kuinka suuri residiiviprosentti on Jorvin sairaalassa ja mitkä ovat tärkeimmät residivointiin vaikuttavat potilaan taustatekijät. Tavoitteena oli myös selvittää toimenpidetyypin, leikkaavan lääkärin kokemuksen ja anestesiamuodon vaikutusta residivointiin. Tutkimus tehtiin keräämällä kahden vuoden ajalta laskeumaleikkausaineisto leikkaustietojärjestelmä Operasta ja analysoimalla sitä. 192:n potilaan tutkimuksessa residiiviprosentiksi 3-5 vuoden seuranta-ajalla tuli 11 %. 22:n residiivipotilaan esitiedoista ei löytynyt yhtään merkittävää residiiville altistavaa tekijää. Residiivipotilailta oli poistettu kohtu useammin kuin muilta laskeumapotilailta, mutta tämän todettiin olevan tiastollisesti merkityksetön residiivin kannalta. Toimenpiteistä eturafian todettiin olevan useimmiten uusiva, mikä vastaa aiemmissa tutkimuksissa saatuja tuloksia. Leikkaavan lääkärin kokemuksella ei todettu olevan merkitystä residivointiin. Sen sijaan huomattiin, että paikallispuudutus – vastoin aiempaa käsitystä – johtaa harvemmin residivointiin kuin muu anestesiamuoto. Tätä tietoa voidaan jatkossa hyödyntää pohdittaessa paikallispuudutuksessa tehtävien leikkausten siirtämistä polikliinisiksi.
  • Ahonen-Siirtola, Mirella; Nevala, Terhi; Vironen, Jaana; Kössi, Jyrki; Pinta, Tarja; Niemeläinen, Susanna; Keränen, Ulla; Ward, Jaana; Vento, Pälvi; Karvonen, Jukka; Ohtonen, Pasi; Mäkelä, Jyrki; Rautio, Tero (2020)
    Purpose Laparoscopic incisional ventral hernia repair (LIVHR) is often followed by seroma formation, bulging and failure to restore abdominal wall function. These outcomes are risk factors for hernia recurrence, chronic pain and poor quality of life (QoL). We aimed to evaluate whether LIVHR combined with defect closure (hybrid) follows as a diminished seroma formation and thereby has a lower rate of hernia recurrence and chronic pain compared to standard LIVHR. Methods This study is a multicentre randomised controlled clinical trial. From November 2012 to May 2015, 193 patients undergoing LIVHR for primary incisional hernia with fascial defect size from 2 to 7 cm were recruited in 11 Finnish hospitals. Patients were randomised to either a laparoscopic (LG) or a hybrid (HG) repair group. The main outcome measure was hernia recurrence, evaluated clinically and radiologically at a 1-year follow-up visit. At the same time, chronic pain scores and QoL were also measured. Results At the 1-year-control visit, we found no difference in hernia recurrence between the study groups. Altogether, 11 recurrent hernias were found in ultrasound examination, producing a recurrence rate of 6.4%. Of these recurrences, 6 (6.7%) were in the LG group and 5 (6.1%) were in the HG group (p > 0.90). The visual analogue scores for pain were low in both groups; the mean visual analogue scale (VAS) was 1.5 in LG and 1.4 in HG (p = 0.50). QoL improved significantly comparing preoperative status to 1 year after operation in both groups since the bodily pain score increased by 7.8 points (p <0.001) and physical functioning by 4.3 points (p = 0.014). Conclusion Long-term follow-up is needed to demonstrate the potential advantage of a hybrid operation with fascial defect closure. Both techniques had low hernia recurrence rates 1 year after operation. LIVHR reduces chronic pain and physical impairment and improves QoL. Trial Registry: Clinical trial number NCT02542085.
  • Kanerva, Jukka; Aro, Hannu; Janes, Rita (2019)
  • Waris, Pekka; Huusko, Tiina; Niskanen, Leo (2020)
    Osteoporoosihoitojen kohdentamisessa on keskeistä murtumien sekundaaripreventio heti ensimmäisen pienienergiaisen murtuman jälkeen. Jos tämä laiminlyödään, uusi murtuma olisi korvattava ­potilasvahinkona.
  • Mäkelä, Mika; Malmberg, Pekka; Pelkonen, Anna (2018)
    • Alle 3-vuotiaan lapsen astma todetaan yleensä kliinisin perustein. Leikki-ikäisillä lapsilla käytetään ¬oskillometriaa ja kouluikäisillä spirometriaa keuhkojen toiminnan poikkeavuuden osoittamiseksi. • Toiminnalliset hengityshäiriöt ovat isommilla lapsilla erotusdiagnostinen haaste. • Inhaloitava kortisoni on hoidon perusta, ja suurimmalla osalla lapsista se riittää anti-inflammatoriseksi hoidoksi. • Oleellista on huolehtia lääkitykseen sitoutumisesta, oikeasta inhalaatiotekniikasta ja opastaa omahoitoon. • Lapsen astma on yleensä lievä ja ennuste hyvä.
  • FinCV Investigators (2018)
    Background: Electrical cardioversion (CV) is essential in rhythm management of atrial fibrillation (AF). However, optimal timing of CV remains unknown. Hypothesis: Timing of CV in AF is associated with risk of adverse events. Methods: We analyzed the effect of AF episode duration on safety and efficacy of electrical CV in a multicenter, multicohort study exploring 4356 CVs in 2530 patients on oral anticoagulation. The composite adverse outcome included unsuccessful CV, acute arrhythmic complications, thromboembolic events, mortality, and AF recurrence within 30-day follow-up. Results: Study groups were stratified according to duration of index AF episode ( 30d), consisting of 1767, 516, 632, and 1441 CVs, respectively. CVs were unsuccessful in 8.5% (30d), respectively (P <0.01). Occurrence of thromboembolic events (0.1%), mortality (0.1%), and asystole >5 seconds (0.7%) within 30-day follow-up was infrequent and comparable in the study groups. AF recurrence within 30 days after initially successful CVs was 29.8% (30d), respectively (P <0.01). Composite adverse outcome occurred in 1669 (38.4%) CVs, and index AF episode >48 hours was an independent predictor for the composite endpoint (OR: 1.49, 95% CI: 1.28-1.74, P <0.01) in multivariate analysis. Conclusions: Optimal timing of CV for AF showed a J-shaped curve, with fewest adverse outcomes in patients with CV performed 24 to 48 hours after onset of AF. In patients with rhythm-control strategy, delaying CV >48 hours is associated with increased risk for adverse outcomes.
  • Karjalainen, Liisa; Tikkanen, Minna; Rantanen, Kirsi; Laivuori, Hannele; Gissler, Mika; Ijäs, Petra (2019)
    BackgroundPregnancy-associated stroke is a rare but life-threatening event, with an estimated incidence of 30/100000 deliveries. Data on the risk of stroke recurrence and the risk of other adverse pregnancy outcomes are essential for adequate counselling and surveillance in subsequent pregnancies. The aim of this systematic review is to describe the implications of a pregnancy-associated stroke for the future health of these women.MethodsWe searched Ovid Medline, PubMed, Cochrane Library and CINAHL for articles published in 1980-2018. Articles including women with pregnancy-associated stroke and information on at least one of the following outcomes were included: 1) recurrence of stroke during subsequent pregnancy, 2) number and course of subsequent pregnancies and their outcomes and 3) subsequent cardiovascular health.ResultsTwelve articles were included in the review, with six providing information on subsequent pregnancies, four on subsequent maternal health and two on both. The included articles varied greatly in terms of study design, length of follow up and reported outcomes. We found 252 women with pregnancy-associated stroke for whom the outcomes of interest were reported: 135 women with information on subsequent pregnancies and 123 women with information on future health. In total, 55 pregnancies after stroke were found. In the majority of studies, the incidence of pregnancy complications was comparable to that of the general population. The risk of stroke recurrence during pregnancy was 2%. Data on subsequent health of these women were limited, and the quality of the data varied between the studies.ConclusionsData on subsequent pregnancies and health of women with a history of pregnancy-associated stroke are limited. Further research on this topic is essential for adequate counselling and secondary prevention.
  • Karjalainen, Liisa; Tikkanen, Minna; Rantanen, Kirsi; Laivuori, Hannele; Gissler, Mika; Ijäs, Petra (BioMed Central, 2019)
    Abstract Background Pregnancy-associated stroke is a rare but life-threatening event, with an estimated incidence of 30/100000 deliveries. Data on the risk of stroke recurrence and the risk of other adverse pregnancy outcomes are essential for adequate counselling and surveillance in subsequent pregnancies. The aim of this systematic review is to describe the implications of a pregnancy-associated stroke for the future health of these women. Methods We searched Ovid Medline, PubMed, Cochrane Library and CINAHL for articles published in 1980–2018. Articles including women with pregnancy-associated stroke and information on at least one of the following outcomes were included: 1) recurrence of stroke during subsequent pregnancy, 2) number and course of subsequent pregnancies and their outcomes and 3) subsequent cardiovascular health. Results Twelve articles were included in the review, with six providing information on subsequent pregnancies, four on subsequent maternal health and two on both. The included articles varied greatly in terms of study design, length of follow up and reported outcomes. We found 252 women with pregnancy-associated stroke for whom the outcomes of interest were reported: 135 women with information on subsequent pregnancies and 123 women with information on future health. In total, 55 pregnancies after stroke were found. In the majority of studies, the incidence of pregnancy complications was comparable to that of the general population. The risk of stroke recurrence during pregnancy was 2%. Data on subsequent health of these women were limited, and the quality of the data varied between the studies. Conclusions Data on subsequent pregnancies and health of women with a history of pregnancy-associated stroke are limited. Further research on this topic is essential for adequate counselling and secondary prevention.
  • Oksi, Jarmo; Aalto, A.; Saila, P.; Partanen, T.; Anttila, Veli-Jukka A; Mattila, E. (2019)
    Reports on real-world experience on efficacy of bezlotoxumab (BEZ) has been lacking thus far. We retrospectively studied the efficacy and safety of BEZ in preventing the recurrence of Clostridium difficile infection (CDI) in five university hospitals in Finland. Seventy-three percent of our 46 patients remained free of recurrence in the following 3 months and the performance remained as 71% effective also among immunocompromised patients. In severe CDI, BEZ prevented recurrence in 63% of cases. From our study patients, 78% had three or more known risk factors for recurrence of CDI. Eight of our patients were waiting for fecal microbiota transplantation but after stopping the antibiotics that were continued to prevent recurrence of CDI and after receiving BEZ, all remained free of recurrence and did not need the procedure. Success with BEZ as an adjunctive treatment in preventing recurrence of CDI in high-risk patients may be rated as high. Among a subgroup of our patients, those already evaluated to be in need of fecal microbiota transplantation, BEZ seems to be an alternative option.
  • Marbacher, Serge; Niemelä, Mika; Hernesniemi, Juha; Frösen, Juhana (2019)
    Although endovascular therapy has been proven safe and has become in many centers the primary method of treatment for intracranial aneurysms, the long-term durability of endovascular embolization remains a concern; at least for some aneurysms despite initial good result. While healing after clipping relies on mechanical occlusion, restoration after endovascular occlusion mainly requires the induction of a biological response. Healing after embolization depends on the growth of new tissue over the thrombus formed by the embolization material, or alternatively, on the organization of thrombus into fibrous tissue. This review highlights the fundamental importance of aneurysm wall biology on the healing process and long-term occlusion after intracranial aneurysm (IA) treatment. It seems likely that the effect of luminal thrombus on the IA wall, as well as the IA wall condition at the time of thrombosis, determine if thrombus organizes into scar tissue (neointima formation by infiltration of cells originating from the IA wall) or if the wall undergoes continuous remodeling, which is primarily destructive (loss of mural cells). In the latter, intraluminal thrombus organization fails and the impaired healing increases the chance of recurrence. Mechanisms underlying IA reopening, the influence of intraluminal thrombosis on the IA wall, and clinical implications of the IA wall condition are discussed in detail, along with how knowledge of IA wall biology can offer new solutions for IA treatment and affect the patient selection for and follow-up after endovascular treatment.
  • Mattson, Johanna; Auvinen, Päivi; Bärlund, Maarit; Jukkola-Vuorinen, Arja (2016)
  • Udd, Marianne; Saarnio, Juha (2019)
    Vuotopotilaalle aloitetaan protonipumpun estäjälääkitys, ja gastroskopia pyritään tekemään 24 tunnissa sairaalaan tulosta. Maltillinen verensiirtostrategia, jossa hemoglobiinin tavoitepitoisuus on 70 g/l, parantaa potilaan ennustetta verrattuna liberaalimpaan strategiaan Endoskooppisessa hoidossa adrenaliiniruiskutukseen on liitettävä toinen menetelmä: liimaus, vuodon termaalinen koagulaatio tai klipsaus. Jos vuoto uusii, gastroskopia ja vuodon tyrehdytys endoskooppisesti toistetaan. Jos vuoto yhä jatkuu, potilas ohjataan angioembolisaatioon tai päivystysleikkaukseen.
  • Aaltonen, Gisele; Carpelan-Holmström, Monika; Keränen, Ilona; Lepistö, Anna (2018)
    To compare recurrence frequency and location between different types of bowel resections in Crohn's disease patients. This was a retrospective study of consecutive patients undergoing bowel resection for Crohn's disease between 2006 and 2016. Type of primary operation was recorded and grouped as ileocolic resection, small bowel resection, segmental colon resection with colocolic anastomosis or colorectal anastomosis, colectomy with ileorectal anastomosis, or end stoma operation. Binary logistic regression was used to compare surgical recurrence frequency between groups. We also investigated how Crohn's disease location at reoperations was related to the primary bowel resection type. Altogether, 218 patients with a median follow-up of 4.7 years were included in our study. Reoperation was performed in 42 (19.3%) patients. The risk of reoperation using the ileocolic resection group as reference was the following: small bowel resection (odds ratio (OR) 2.95, 95% confidence interval (CI) 1.01-8.66; P = 0.049), segmental colon resection with colocolic or colorectal anastomosis (OR 6.20, 95% CI 2.04-18.87; P = 0.001), colectomy with ileorectal anastomosis (OR 26.57, 95% CI 2.59-273.01; P = 0.006), and end stoma operation (OR 4.62, 95% CI 1.90-11.26; P = 0.001). In case of surgical recurrence, the reoperation type and location correlated with the primary bowel resection type. Reoperation frequency in Crohn's disease is lower after ileocolic resection than after other types of bowel resections. Surgical recurrence in Crohn's disease tends to maintain the disease location of the primary operation. One third of Crohn's patients undergoing an end stoma operation will still need new bowel resections due to recurrence.