Browsing by Subject "SURGICAL-TREATMENT"

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  • Ten Broek, Richard P. G.; Krielen, Pepijn; Di Saverio, Salomone; Coccolini, Federico; Biffl, Walter L.; Ansaloni, Luca; Velmahos, George C.; Sartelli, Massimo; Fraga, Gustavo P.; Kelly, Michael D.; Moore, Frederick A.; Peitzman, Andrew B.; Leppaniemi, Ari; Moore, Ernest E.; Jeekel, Johannes; Kluger, Yoram; Sugrue, Michael; Balogh, Zsolt J.; Bendinelli, Cino; Civil, Ian; Coimbra, Raul; De Moya, Mark; Ferrada, Paula; Inaba, Kenji; Ivatury, Rao; Latifi, Rifat; Kashuk, Jeffry L.; Kirkpatrick, Andrew W.; Maier, Ron; Rizoli, Sandro; Sakakushev, Boris; Scalea, Thomas; Soreide, Kjetil; Weber, Dieter; Wani, Imtiaz; Abu-Zidan, Fikri M.; De'Angelis, Nicola; Piscioneri, Frank; Galante, Joseph M.; Catena, Fausto; van Goor, Harry (2018)
    Background: Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups. Methods: The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion. Recommendations: Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are nil per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO. Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention. Discussion: This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.
  • Kiiski, Juha; Kuokkanen, Hannu O.; Kääriäinen, Minna; Kaartinen, Ilkka S.; Pakarinen, Toni-Karri; Laitinen, Minna K. (2018)
    Background: Sacrectomy is a rare and demanding surgical procedure that results in major soft tissue defects and spinopelvic discontinuity. No consensus is available on the optimal reconstruction algorithm. Therefore, the present study evaluated the results of sacrectomy reconstruction and its impact on patients' quality of life (QOL). Methods: A retrospective chart review was conducted for 21 patients who underwent sacrectomy for a primary bone tumour. Patients were divided into groups based on the timing of reconstruction as follows: no reconstruction, immediate reconstruction or delayed reconstruction. QOL was measured using the EQ-5D instrument before and after surgery in patients treated in the intensive care unit. Results: The mean patient age was 57 (range 22-81) years. The most common reconstruction was gluteal muscle flap (n =9) and gluteal fasciocutaneous flap (n = 4). Four patients required free-tissue transfer, three latissimus dorsi flaps and one vascular fibula bone transfer. No free flap losses were noted. The need for unplanned re-operations did not differ between groups (p =0.397), and no significant differences were found for pre- and post-operative QOL or any of its dimensions. Discussion: Free flap surgery is reliable for reconstructing the largest sacrectomy defects. Even in the most complex cases, surgery can be safely staged, and final reconstruction can be carried out within 1 week of resection surgery without increasing peri-operative complications. Sacrectomy does not have an immoderate effect on the measured QOL. (C) 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
  • Launonen, Antti P.; Huttunen, Tuomas T.; Lepola, Vesa; Niemi, Seppo T.; Kannus, Pekka; Felländer-Tsai, Li; Berg, Hans E.; Laitinen, Minna K.; Mattila, Ville M. (2020)
    Purpose Distal biceps tendon rupture is a relatively rare injury usually occurring with excess external extension force applied to a flexed elbow. The aim of this study was to examine the incidence of distal biceps tendon rupture surgery in the Finnish and Swedish adult population between the years 1997 and 2016. A secondary aim was to investigate the distal biceps rupture incidence in the Swedish population in 2001 to 2016. Methods We assessed the number and rate of distal biceps tendon rupture surgery using the Finnish and Swedish Hospital Discharge Register as databases. The study included the entire Finnish and Swedish adult population aged 18 years and older between January 1, 1997 and of December 31, 2016. Results During the study period, 2,029 patients had a distal biceps tendon rupture in Finland, and the corresponding figure was 2,000 in Sweden. The rate of distal biceps tendon rupture surgery increased steeply, but equally, in both countries, in Finnish men from 1.3 per 100,000 person-years in 1997 to 9.6 in 2016, and in Swedish men from 0.2 in 1997 to 5.6 in 2016. The incidence of distal biceps tendon rupture in Sweden increased in men from 1.6 to 10.0 per 100,000 person-years from 2001 to 2016. Conclusions There was a 7-fold and a 28-fold increase in the incidence of distal biceps tendon rupture surgery in Finnish and Swedish men during 1997 to 2016. The incidence of distal biceps tendon rupture rose 6-fold in Swedish men in 2001 to 2016. Copyright (C) 2020 by the American Society for Surgery of the Hand. Published by Elsevier Inc.
  • Russo, Fabrizio; De Salvatore, Sergio; Ambrosio, Luca; Vadalà, Gianluca; Fontana, Luca; Papalia, Rocco; Rantanen, Jorma; Iavicoli, Sergio; Denaro, Vincenzo (2021)
    Low back pain (LBP) is currently the leading cause of disability worldwide and the mostcommon reason for workers’ compensation (WC) claims. Studies have demonstrated that receivingWC is associated with a negative prognosis following treatment for a vast range of health conditions.However, the impact of WC on outcomes after spine surgery is still controversial. The aim of thismeta-analysis was to systematically review the literature and analyze the impact of compensationstatus on outcomes after lumbar spine surgery. A systematic search was performed on Medline,Scopus, CINAHL, EMBASE and CENTRAL databases. The review included studies of patientsundergoing lumbar spine surgery in which compensation status was reported. Methodologicalquality was assessed through ROBINS-I and quality of evidence was estimated using the GRADErating. A total of 26 studies with a total of 2668 patients were included in the analysis. WC patientshad higher post-operative pain and disability, as well as lower satisfaction after surgery whencompared to those without WC. Furthermore, WC patients demonstrated to have a delayed return towork. According to our results, compensation status is associated with poor outcomes after lumbarspine surgery. Contextualizing post-operative outcomes in clinical and work-related domains helpsunderstand the multifactorial nature of the phenomenon.
  • Dillmann, Johannes; Hafez, Ahmad; Niemelä, Mika; Braun, Veit (2019)
    BACKGROUND: An integrated multimodality approach can be effective in treatment of high-grade dural arteriovenous fistulas. Nevertheless, this requires a high level of efficient cooperation between different departments, underlying a degree of bias in the decisional process. In comparison, hybrid capability, integrating these modalities in one hand, may allow aggregating multimodality treatment strategies by pooling their individual benefits, leading to a more holistic view of the consequences of each modality. METHODS: We retrospectively reviewed 18 cases of dural arteriovenous fistulas subjected to a hybrid treatment approach at the Diakonieklinikum Jung-Stilling, Siegen, Germany, between March 2008 and January 2017. Nine cases were excluded. We selected 4 cases that highlight different aspects of hybrid capability for illustrative purposes. RESULTS: Hybrid capability allows treatment of a dural arteriovenous fistula based on the individual clinical situation of the patient and features of the lesion, free of interdepartmental bias. The surgeon maintains a level of flexibility that enables him or her to move from a minimally invasive endovascular approach to a maximally invasive surgical access according to the specific situation. Hybrid capability can lead to a highly efficient treatment regimen with palliation of symptoms and complete obliteration of the fistula, improving performance in these complex pathologies. CONCLUSIONS: Hybrid capability has great potential in the treatment of complex neurovascular lesions. It remains to be seen if a single surgeon with hybrid capability can supersede the current multidepartmental practice and achieve better outcomes.
  • Grabala, Pawel; Helenius, Ilkka; Shah, Suken A.; Larson, A. Noelle; Buchowski, Jacob M.; Latalski, Michal; Grabala, Michal; Guszczyn, Tomasz (2020)
    OBJECTIVE: A retrospective multicenter comparative study was carried out to evaluate whether pregnancy leads to the loss of deformity correction (LOC) in female patients surgically treated for idiopathic scoliosis. METHODS: A total of 128 female patients who underwent segmental spinal instrumentation and fusion for adolescent idiopathic scoliosis (AIS) between 1999 and 2014 were reviewed. Of these patients, 62 became pregnant (surgery-pregnancy group [SPG]), whereas 66 did not (surgery-nonpregnancy [SNP] group). Radiographic parameters were analyzed before surgery, after surgery, before pregnancy, up to 1 year after delivery, and at final follow-up (FFU). Health-related quality of life was analyzed using the Scoliosis Research Society outcome questionnaire (SRS-22r). RESULTS: The mean age at the time of surgery was 16 years in both groups. The mean preoperative major curves were 65 degrees (standard deviation [SD], 12 degrees) versus 67 degrees (SD, 11 degrees), 18 degrees (SD, 9 degrees) versus 17 degrees (SD, 9 degrees) immediately after surgery, and 20 degrees (SD, 8 degrees) versus 20 degrees (SD, 8 degrees) at FFU in the SPG and SNP groups, respectively (P > 0.10 for all comparisons). The mean loss of correction was 3.5 degrees (SD, 3 degrees) in the SPG and 4.5 (SD, 3 degrees) for SNP groups, respectively (P = 0.379). The mean preoperative thoracic kyphosis (T5-T12) was 26.5 degrees (SD, 11.9 degrees) for SPG and 24.7 degrees (SD, 14.5 degrees) for SNP, after surgery 19.2 degrees (SD, 9.5 degrees) for SPG, 18.8 (SD, 8.9 degrees) for SNP and at FFU, 20.3 degrees (SD, 9 degrees) for SPG and 21.3 degrees (SD, 8.5 degrees) for SNP. CONCLUSIONS: Women who have undergone pedicle screw instrumentation and fusion who have had >= 1 pregnancies do not have curve progression or deterioration in the longer-term outcomes compared with patients who have not become pregnant.
  • Niinistö, K.E.; Ruohoniemi, M.O.; Freccero, F.; Raekallio, M.R. (2018)
    Enteropathy associated with sand accumulation in the large colon of horses has been reported worldwide. Intestinal sand accumulations are commonly treated medically, but randomised controlled clinical trials on horses are scarce. This prospective study evaluated the efficacy of an enterally administered combination of psyllium and magnesium sulphate (MgSO4) for the removal of large colonic sand accumulations in horses without clinical signs of acute colic. The two groups comprised 20 untreated control horses and 20 horses treated with 1g/kg bodyweight (bwt) of psyllium and 1g/kg bwt of MgSO4 administered by nasogastric intubation once daily for 4 days. Both groups had no access to soil during the study period. The amounts of accumulated sand were evaluated radiographically before and after treatment. Significantly more treated horses cleared their sand accumulations than horses in the control group. This clearance was determined by observing the estimated quantity by area of sand remaining in the large colon (P
  • Laitinen, M. K.; Parry, M. C.; Le Nail, L-R; Wigley, C. H.; Stevenson, J. D.; Jeys, L. M. (2019)
    Aims The purpose of this study was to investigate the potential for achieving local and systemic control after local recurrence of a chondrosarcoma of bone. Patients and Methods A total of 126 patients with local recurrence (LR) of chondrosarcoma (CS) of the pelvis or a limb bone were identified from a prospectively maintained database, between 1990 and 2015 at the Royal Orthopaedic Hospital, Birmingham, United Kingdom. There were 44 female patients (35%) and 82 male patients (65%) with a mean age at the time of LR of 56 years (13 to 96). The 126 patients represented 24.3% of the total number of patients with a primary CS (519) who had been treated during this period. Clinical data collected at the time of primary tumour and LR included the site (appendicular, extremity, or pelvis); primary and LR tumour size (in centimetres); type of operation at the time of primary or LR (limb-salvage or amputation); surgical margin achieved at resection of the primary tumour and the LR; grade of the primary tumour and the LR; gender; age; and oncological outcomes, including local recurrence-free survival and disease-specific survival. A minimum two years' follow-up and complete histopathology records were available for all patients included in the study. Results For patients without metastases prior to or at the time of local recurrence, the disease-specific survival after local recurrence was 62.5% and 45.5% at one and five years, respectively, After univariable analysis, significant factors predicting disease-specific survival were grade (p <0.001) and surgical margin (p = 0.044). After multivariable analysis, grade, increasing age at the time of diagnosis of local recurrence, and a greater time interval from primary surgery to local recurrence were significant factors for disease-specific survival. A secondary local recurrence was seen in 26% of patients. Wide margins were a good predictor of local recurrence-free survival for subsequent recurrences after univariable analysis when compared with intralesional margins (p = 0.002) but marginal margins did not reach statistical significance when compared with intralesional margins (p = 0.084). Conclusion In cases of local recurrence of a chondrosarcoma of bone, we have shown that if the tumour is non-metastatic at re-staging, an increase in disease-specific survival and in local recurrence-free survival is achievable, but only by resection of the local recurrence with a wide margin.
  • Immonen, Isa Anna Maria; Karikoski, Ninja; Mykkänen, Anna; Niemelä, Tytti; Junnila, Jouni; Tulamo, Riitta-Mari (2017)
    Background: Surgical treatment of colic is expensive and complications may occur. Information on the prognosis and the use of the horse after surgery for colic is important for surgeons and owners. Current literature on return to athletic function after celiotomy is limited. The present study reviewed surgical cases of the Veterinary Teaching Hospital, Helsinki, Finland for 2006-2012. The aim was to follow the population of horses of different breeds for surgical findings, postsurgical complications, long-term recovery and prognosis. The findings and their influence on survival, return to previous or intended use and performance were assessed. Results: Most of the operated horses (82.6%; 195/236) recovered from anesthesia and 74.9% (146/195) were discharged. The total follow-up time was 8 years and 10 months and the median survival time 79.2 months. Age of the horse, location of the abdominal lesion (small vs. large intestine), incidence of postoperative colic, surgical site infection, incisional hernia or convalescence time after surgery, did not significantly affect the probability of performing in the previous or intended discipline after the surgery. A majority of the discharged horses (83.7%) was able to perform in the previous or intended discipline and 78.5% regained their former or higher level of performance. Operated horses had 0.18 colic episodes per horse-year during the long-term follow-up. The incidence of colic was 20.0% within the first year after surgery. Horses operated for large intestinal colic were 3.3-fold more prone to suffer postoperative colic than horses operated for small intestinal colic. The majority of the owners (96.3%) were satisfied with the veterinary care and nearly all (98.5%) evaluated the recovery after the colic surgery to be satisfactory or above. Conclusions: If the horse survives to discharge, prognosis for long-term survival and return to previous level of sporting activity and performance was good after colic surgery in a population of horses of different breeds. None of the factors studied were found to decrease the probability of performing in the same or intended discipline after surgery. The majority of horses were able to return to their previous activity and perform satisfactorily for several years after surgery.
  • Kask, Gilber; Nieminen, Jyrki; Van Iterson, Vincent; Naboistsikov, Mihhail; Pakarinen, Toni-Karri; Laitinen, Minna K. (2020)
    Background and purpose - The pelvis is the 3rd most common site of skeletal metastases. In some cases, periacetabular lesions require palliative surgical management. We investigated functional outcome, complications, and implant and patient survival after a modified Harrington's procedure. Patients and methods - This retrospective cohort study included 89 cases of surgically treated periacetabular metastases. All patients were treated with the modified Harrington's procedure including a restoration ring. Lesions were classified according to Harrington. Functional outcome was assessed by Harris Hip Score (HHS) and Oxford Hip Score (OHS). Postoperative complications, and implant and patient survival are reported. Results - The overall postoperative functional outcome was good to fair (OHS 37 and HHS 76). Sex, age, survival > 6 and 12 months, and diagnosis of the primary tumor affected functional outcome. Overall implant survival was 96% (95% Cl 88-100) at 1 year, 2 years, and 5 years; only 1 acetabular implant required revision. Median patient survival was 8 months (0-125). 10/89 patients had postoperative complications: 6 major complications, leading to revision surgery, and 4 minor complications. Interpretation - Our modified Harrington's procedure with a restoration ring to achieve stable fixation, constrained acetabular cup to prevent dislocation, and antegrade iliac screws to prevent cranial protrusion is a reliable reconstruction for periacetabular metastases and results in a good functional outcome in patients with prolonged survival. A standardized procedure and low complication rate encourage the use of this method for all Harrington class defects.
  • Ramo, Lasse; Taimela, Simo; Lepola, Vesa; Malmivaara, Antti; Lähdeoja, Tuomas; Paavola, Mika (2017)
    Introduction Humeral shaft fractures represent 1%-3% of all fractures and 20% of humeral fractures in adults. The treatment of these fractures is mainly conservative and operative treatment is usually reserved for specific circumstances. To date, no randomised controlled trial (RCT) has compared operative treatment of humeral shaft fractures with conservative treatment. Methods and analysis We will conduct an RCT to compare the effectiveness and cost-effectiveness of surgical and conservative treatment of humeral shaft fractures. After providing informed consent, 80 patients from 18 years of age with humeral shaft fracture will be randomly assigned to open reduction and internal fixation with locking plate or conservative treatment with functional bracing. We will follow the patients for 10 years and compare the results at different time points. The primary outcome will be Disabilities of Arm, Shoulder and Hand (DASH) at 12 months. The secondary outcomes will include Numerical Rating Scale for pain at rest and in activities, Constant Score and quality of life instrument 15D. Patients not willing to participate in the RCT will be asked to participate in a prospective cohort follow-up study, 'the declined cohort'. This cohort will be followed up at the same time points as the randomised patients to assess the potential effect of participation bias on RCT results and to enhance the external validity of the RCT. In one of the recruiting centres, all cooperative patients with humeral shaft fractures not eligible for randomisation will be asked to participate in a 'non-eligible cohort' study. We will use blinded data interpretation of the randomised cohort to avoid biased interpretation of outcomes. Our null hypothesis is that there is no clinically relevant difference in the primary outcome measure between the two treatment groups. We will consider a difference of a minimum of 10 points in DASH clinically relevant. Ethics and dissemination The institutional review board of the Helsinki and Uusimaa Hospital District has approved the protocol. We will disseminate the findings of this study through peer-reviewed publications and conference presentations.
  • Oksanen, Hanna Mari; Jalanko, Tuomas; Helenius, Ilkka J. (2021)
    Background and Aims: Posterolateral hemivertebrectomy with monosegmental instrumentation at an early age is an established method to correct congenital scoliosis but is associated with a relatively high risk of instrumentation failure and health-related quality of life outcomes are not available. We aimed to investigate the effects hemivertebrectomy with postoperative hip spica cast on complications and health-related quality of life in small children with congenital scoliosis. Materials and Methods: A follow-up study of 30 children (at mean age = 3.4 years, range = 1.0-8.5 years) undergoing posterolateral hemivertebrectomy and short pedicle instrumentation. Children were immobilized postoperative with hip spica cast for 6 weeks and immobilization for 4 months using a rigid thoracolumbosacral orthosis. The Caregivers filled out Scoliosis Research Society 24 outcome questionnaire preoperatively, at 6 months, and at final follow-up visit on behalf of their child. Standing radiographs were obtained preoperatively, postoperatively in the cast, and standing at final follow-up. Results: Mean major curve was 41 degrees (range = 26 degrees-87 degrees) preoperatively and was corrected to 14 degrees (4.0 degrees-35 degrees) at final follow-up. Eight (27%) children had postoperative complications, including three (10%) deep surgical site infections. The Scoliosis Research Society 24 back domain showed an improvement from a mean of 3.8 preoperatively to 4.4 at final follow-up (p < 0.001). Function from back condition domain showed a significant deterioration from 4.2 preoperatively to 3.7 at 6 months (p = 0.020) but improved back to baseline at final follow-up (4.2, p = 0.0022 6 months vs final follow-up). Conclusion: Hemivertebrectomy with short instrumentation resulted into 64% correction of scoliosis and improved health-related quality of life in back pain and function domains.
  • Settembre, N.; Bouziane, Z.; Bartoli, M. A.; Nabokov, V.; Venermo, M.; Feugier, P.; Malikov, S. (2017)
    Objective: Popliteal artery entrapment syndrome (PAES) is an uncommon anatomical anomaly, frequently described in adults. The most common symptom is claudication. Acute limb ischaemia (ALI) in children is rare, but it may evolve and lead to limb loss or lifelong complications. Clinical and surgical experience of PAES in children is reported. Data from the literature are analysed in order to assess the severity of this disease and to identify the factors characterising the diagnosis and the outcome of treatment in paediatric patients. Methods: Four children (aged 7-16 years) were referred with ALI due to PAES. Among the 439 articles reporting cases of PAES, 55 patients under 18 years of age were the focus. The PAES cases were classified according to the Love and Whelan classification modified by Rich. Results: Data from 79 children (106 limbs, 27 bilateral PAES) were collected and analysed. Type I PAES was present in 41 (39%), Type II in 23 (22%), Type III in 24 (23%), Type IV in 12 (11%), and Type V in two (2%) limbs. A functional PAES was present in one patient bilaterally. In two cases, the type of PAES was not reported. Claudication occurred in 68 cases (64%), and ALI in 19 (18%). In 60 cases (57%), revascularisation with or without myotomy was required; myotomy alone was performed in 41 cases (39%). Conclusions: Symptomatic PAES in children should be considered a severe condition requiring urgent investigation in order to avoid any delays in the treatment. Early diagnosis and treatment are essential to prevent serious complications. The long-term outcomes of surgical treatment with the correction of the anatomical anomaly and vascular reconstruction are satisfactory with a low complication rate. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
  • Bersano, Anna; Guey, Stephanie; Bedini, Gloria; Nava, Sara; Herve, Dominique; Vajkoczy, Peter; Tatlisumak, Turgut; Saarela, Marika; van der Zwan, Albert; Klijn, Catharina J. M.; Braun, Kees P. J.; Kronenburg, Annick; Acerbi, Francesco; Brown, Martin M.; Calviere, Lionel; Cordonnier, Charlotte; Henon, Hilde; Thines, Laurent; Khan, Nadia; Czabanka, M.; Kraemer, Markus; Simister, Robert; Prontera, Paolo; Tournier-Lasserve, E.; Parati, Eugenio; European Moyamoya Dis Initiative (2016)
    Background: The pathogenesis of moyamoya disease (MMD) is still unknown. The detection of inflammatory molecules such as cytokines, chemokines and growth factors in MMD patients' biological fluids supports the hypothesis that an abnormal angiogenesis is implicated in MMD pathogenesis. However, it is unclear whether these anomalies are the consequences of the disease or rather causal factors as well as these mechanisms remain insufficient to explain the pathophysiology of MMD. The presence of a family history in about 9-15% of Asian patients, the highly variable incidence rate between different ethnic and sex groups and the age of onset support the role of genetic factors in MMD pathogenesis. However, although some genetic loci have been associated with MMD, few of them have been replicated in independent series. Recently, RNF213 gene was shown to be strongly associated with MMD occurrence with a founder effect in East Asian patients. However, the mechanisms leading from RNF213 mutations to MMD clinical features are still unknown. Summary: The research on pathogenic mechanism of MMD is in its infancy. MMD is probably a complex and heterogeneous disorder, including different phenotypes and genotypes, in which more than a single factor is implicated. Key Message: Since the diagnosis of MMD is rapidly increasing worldwide, the development of more efficient stratifying risk systems, including both clinical but also biological drivers became imperative to improve our ability of predict prognosis and to develop mechanism-tailored interventions. (C) 2016 S. Karger AG, Basel
  • Hallikainen, Joona; Keränen, Sara; Savolainen, Jarno; Närhi, Matti; Suominen, Anna Liisa; Ylöstalo, Pekka; Kellokoski, Jari; Pyysalo, Mikko; Pussinen, Pirkko; Rauramaa, Tuomas; Frösen, Juhana (2021)
    Degeneration of intracranial aneurysm wall is under active research and recent studies indicate an increased risk of rupture of intracranial aneurysm among patients with periodontal diseases. In addition, oral bacterial DNA has been identified from wall samples of ruptured and unruptured aneurysms. These novel findings led us to evaluate if oral diseases could predispose to pathological changes seen on intracranial aneurysm walls eventually leading to subarachnoid hemorrhage. The aim of this review is to consider mechanisms on the relationship between periodontitis and aneurysm rupture, focusing on recent evidence.
  • Tjahjadi, Mardjono; Jahromi, Behnam Rezai; Serrone, Joseph; Nurminen, Ville; Choque-Velasquez, Joham; Kivisaari, Riku; Lehto, Hanna; Niemelä, Mika; Hernesniemi, Juha (2017)
    INTRODUCTION: Complex skull base approaches are frequently used to treat intracranial vertebral artery (VA) and proximal posterior inferior cerebellar artery (PICA) aneurysms. These complex procedures are associated with higher risk of neurovascular injury. Hence, a less-invasive surgical approach is needed to improve the efficacy and safety of treatment. METHODS: A retrospective analysis was conducted on clinical and radiologic data from surgeries in which simple lateral suboccipital and "lateral-enough" approaches were used to clip VA aneurysms in the Department of Neurosurgery at Helsinki University Central Hospital from 2000 to 2009. RESULTS: Fifty-two VA or PICA aneurysms were treated using the simple lateral suboccipital approach. Sixteen patients (31%) presented with an unruptured aneurysm, 21 patients (40%) with World Federation of Neurosurgical Societies (WFNS) grade 1-3, and 15 patients (29%) with World Federation of Neurosurgical Societies grade 4-5. The aneurysms were saccular in 48 cases (92%), dissecting in 3 cases (6%), and fusiform in 1 case (2%). The most common aneurysm location was the VA-PICA junction (81%). The mean final modified Rankin Scale score was 2, and in unruptured cases, all patients had favorable clinical outcomes. The main causes of unfavorable outcome were poor preoperative clinical grade (P = 0.002), preoperative intraventricular hemorrhage (P = 0.008), postoperative hydrocephalus (P = 0.003), brain infarction (P = 0.005), and postoperative pneumonia (P <0.001). CONCLUSIONS: We describe a 10-year experience using a simple lateral suboccipital approach and its modification by the senior author (J.H.) to treat VA and proximal PICA aneurysms. Unfavorable outcome was related to the poor preoperative clinical grade, preoperative intraventricular hemorrhage, and postoperative pneumonia.
  • Ratasvuori, Maire; Sillanpaa, Niko; Wedin, Rikard; Trovik, Clement; Hansen, Bjarne H.; Laitinen, Minna (2016)
    Background and purpose - Surgery for metastases of renal cell carcinoma has increased in the last decade. It carries a risk of massive blood loss, as tumors are hypervascular and the surgery is often extensive. Preoperative embolization is believed to facilitate surgery. We evaluated the effect of preoperative embolization and resection margin on intraoperative blood loss, operation time, and survival in non-spinal skeletal metastases of renal cell carcinoma. Patients and methods - This retrospective study involved 144 patients, 56 of which were treated preoperatively with embolization. The primary outcome was intraoperative blood loss. We also identified factors affecting operating time and survival. Results - We did not find statistically significant effects on intraoperative blood loss of preoperative embolization of skeletal non-spinal metastases. Pelvic localization and large tumor size increased intraoperative blood loss. Marginal resection compared to intralesional resection, nephrectomy, level of hemoglobin, and solitary metastases were associated with better survival. Interpretation - Tumor size, but not embolization, was an independent factor for intraoperative blood loss. Marginal resection rather than intralesional resection should be the gold standard treatment for skeletal metastases in non-spinal renal cell carcinoma, especially in the case of a solitary lesion, as this improved the overall survival.
  • Hallikainen, Joona; Pyysalo, Mikko; Keränen, Sara; Kellokoski, Jari; Koivisto, Timo; Suominen, Anna Liisa; Pussinen, Pirkko; Pessi, Tanja; Frosen, Juhana (2021)
    Background and purpose Periodontal infections are associated with the formation and rupture of intracranial aneurysms (IAs). This study investigated the role of two key periodontal pathogens, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Methods Immunoglobulin A (IgA) and IgG antibodies against P. gingivalis and A. actinomycetemcomitans were measured with enzyme immune assay from the serum of 227 IA patients, of whom 64 also underwent clinical oral examination. As a control group, 1096 participants in a cross-sectional health survey, Health 2000, underwent serological studies and oral examination. Logistic regression was used for multivariate analysis. Immunohistochemistry was performed to demonstrate bacteria-derived epitopes in the IA wall. Results Widespread gingivitis and severe periodontitis were more common in IA patients than in controls (2x and 1.5x, respectively). IgA antibodies against P. gingivalis and A. actinomycetemcomitans were 1.5x and 3-3.4x higher, respectively, in both unruptured and ruptured IA patients compared to controls (p
  • Etminan, Nima; Brown, Robert D.; Beseoglu, Kerim; Juvela, Seppo; Raymond, Jean; Morita, Akio; Torner, James C.; Derdeyn, Colin P.; Raabe, Andreas; Mocco, J.; Korja, Miikka; Abdulazim, Amr; Amin-Hanjani, Sepideh; Salman, Rustam Al-Shahi; Barrow, Daniel L.; Bederson, Joshua; Bonafe, Alain; Dumont, Aaron S.; Fiorella, David J.; Gruber, Andreas; Hankey, Graeme J.; Hasan, David M.; Hoh, Brian L.; Jabbour, Pascal; Kasuya, Hidetoshi; Kelly, Michael E.; Kirkpatrick, Peter J.; Knuckey, Neville; Koivisto, Timo; Krings, Timo; Lawton, Michael T.; Marotta, Thomas R.; Mayer, Stephan A.; Mee, Edward; Pereira, Vitor Mendes; Molyneux, Andrew; Morgan, Michael K.; Mori, Kentaro; Murayama, Yuichi; Nagahiro, Shinji; Nakayama, Naoki; Niemela, Mika; Ogilvy, Christopher S.; Pierot, Laurent; Rabinstein, Alejandro A.; Roos, Yvo B. W. E. M.; Rinne, Jaakko; Rosenwasser, Robert H.; Ronkainen, Antti; Schaller, Karl; Seifert, Volker; Solomon, Robert A.; Spears, Julian; Steiger, Hans-Jakob; Vergouwen, Mervyn D. I.; Wanke, Isabel; Wermer, Marieke J. H.; Wong, George K. C.; Wong, John H.; Zipfel, Gregory J.; Connolly, E. Sander; Steinmetz, Helmuth; Lanzino, Giuseppe; Pasqualin, Alberto; Ruefenacht, Daniel; Vajkoczy, Peter; McDougall, Cameron; Haenggi, Daniel; LeRoux, Peter; Rinkel, Gabriel J. E.; Macdonald, R. Loch (2015)
    Objective: We endeavored to develop an unruptured intracranial aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research. Methods: An international multidisciplinary (neurosurgery, neuroradiology, neurology, clinical epidemiology) group of 69 specialists was convened to develop and validate the UIATS model using a Delphi consensus. For internal (39 panel members involved in identification of relevant features) and external validation (30 independent external reviewers), 30 selected UIA cases were used to analyze agreement with UIATS management recommendations based on a 5-point Likert scale (5 indicating strong agreement). Interrater agreement (IRA) was assessed with standardized coefficients of dispersion (v(r)*) (v(r)* 5 0 indicating excellent agreement and v(r)* = 1 indicating poor agreement). Results: The UIATS accounts for 29 key factors in UIA management. Agreement with UIATS (mean Likert scores) was 4.2 (95% confidence interval [CI] 4.1-4.3) per reviewer for both reviewer cohorts; agreement per case was 4.3 (95% CI 4.1-4.4) for panel members and 4.5 (95% CI 4.3-4.6) for external reviewers (p = 0.017). Mean Likert scores were 4.2 (95% CI 4.1-4.3) for interventional reviewers (n = 56) and 4.1 (95% CI 3.9-4.4) for noninterventional reviewers (n = 12) (p = 0.290). Overall IRA (v(r)*) for both cohorts was 0.026 (95% CI 0.019-0.033). Conclusions: This novel UIA decision guidance study captures an excellent consensus among highly informed individuals on UIA management, irrespective of their underlying specialty. Clinicians can use the UIATS as a comprehensive mechanism for indicating how a large group of specialists might manage an individual patient with a UIA.
  • Sandelin, Henrik; Jalanko, T.; Huhtala, H.; Lassila, H.; Haapala, J.; Helkamaa, T. (2016)
    Background and Aims: Patient-rated outcome measures have become increasingly important in clinical research. They provide research and clinical tools which can be utilized in the assessment of patient recovery and treatment efficacy. The purpose of our study was to translate and validate the original version of the PRWE form into Finnish. Material and Methods: We conducted the translation of the PRWE questionnaire according to standardized guidelines. Patients (N=119) with an acute distal radius fracture were recruited, and they completed the PRWE and QuickDASH questionnaires at 2months and 4months after the wrist injury. Results: The mean answering times were 52days (standard deviation [SD] 9.8 days) and 116days (standard deviation [SD] 14.8 days), respectively. Both the internal consistency (Cronbach's alpha) of 0.976 and the intraclass correlation coefficient (ICC) of 0.992 (95% CI 0.966-0.998) showed excellent reliability for the total PRWE score. The correlation coefficients between the total score, the subscales, and for improvement over time for PRWE and QuickDASH were excellent. The responsiveness was good with an effect size of 0.83 and a standard response mean of 1.22. Conclusion: Our study shows that the Finnish version of the PRWE is reliable, valid, and responsive for the evaluation of pain and disability after distal radius fracture.