Social phobia is a neglected disorder, which can cause very debilitating consequences in patients' lives. The patients tend to isolate and suffer from comorbid disorders such as depression, other anxiety disorders, and drug and alcohol abuse. Traditional treatment methods such as medication and psychotherapy do not help everyone. A prospective, uncontrolled follow-up study with 169 social phobic patients was performed by uni- or bilateral endoscopic sympathetic block of the upper thoracic ganglia. The method is reversible by taking the compression block away, if needed. The selected patients had conservative treatment resistant social phobia according to DSM IV. Structured interview, Davidson's modified brief social phobia scale, and Liebowitz Quality of life questionnaire were used both pre- and postoperatively to assess the value of the treatment. All aspects of social phobia, both somatic and psychological, were highly significantly improved. Reflex sweating as the only remarkable side effect was less than in most series for other indications with sympathetic ablative surgery elsewhere. Endoscopic sympathetic block is recommended as the treatment of choice in severe, conservative therapy resistant social phobia.
OBJECTIVE:To investigate the effect of free sialic acid on collagen gene expression in fibroblasts.DESIGN:Cell culture study.SETTING:University hospital, Finland. CELL LINES: Human granulation tissue fibroblasts, human hypertrophic scar fibroblasts and human keloid fibroblasts.INTERVENTIONS:Treatment of cell cultures with 3 microM, 30 microM and 300 microM N-acetyl-neuraminic acid.MAIN OUTCOME MEASURES:The measurement of steady state level of mRNA for type I and type III collagen.RESULTS:Fibroblast lines react dissimilarly under the influence of sialic acid. Granulation tissue fibroblasts showed decrease in the gene expression of type I and III collagen, while keloid fibroblasts contrastingly showed an increase. Hypertrophic scar derived fibroblasts showed no change.CONCLUSIONS:Sialic acids may decrease collagen gene expression in granulation tissue and that disturbed wound healing in diabetics and smokers may in part be due to direct effect of sialic acids on fibroblasts. Sialic acids may in part induce keloid formation.
Diabetes mellitus (DM) is a complex metabolic disease associated with increased accumulation of extracellular matrix by endothelial cells and contributing to vascular complications of long-standing diabetes. On the other hand, DM is also associated with decreased accumulation of extracellular matrix in granulation tissue, which is suggested to be a consequence of impaired angiogenesis. The role of hyperglycemia in these situations is not fully understood. We examined the effects of high glucose concentrations on the gene expression and secretion of various collagens in cultured EAhy 926 endothelial cells. EAhy 926 endothelial cells expressed alpha 1(I) collagen mRNA at a low level and small amount of the corresponding peptide was secreted from the cells; mRNA was not affected but peptide secretion was increased by elevated glucose concentration. mRNAs for type III and VI collagens were not detected in the endothelial cells Furthermore, high glucose concentration in long term had no morphological effects on cultured endothelial cells but increased the expression of type IV collagen, which could rather be beneficial for angiogenesis in a healing wound. Our results suggest that high glucose concentration per se may contribute to increased accumulation of extracellular matrix in blood vessels but probably is not responsible for decreased angiogenesis and granulation tissue formation in diabetic patients.
The purpose of the present study was to compare the procalcitonin (PCT), neopterin, interleukin-8 (IL-8), interleukin-10 (IL-10) and interleukin-12 (IL-12) levels with those of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in cancer patients with (56) and without infection (36) and to evaluate their ability to differentiate infections from neoplastic fever (n=10). The infection group had statistically higher levels of CRP (91 vs. 19 mg/l, p < 0.001), PCT (0.28 vs. 0.12 ng/ml, p < 0.001), neopterin (12.8 pg/mL vs. 4.0 pg/mL, p < 0.001), IL-8 (27.7 vs. 16.9 pg/ ml, p = 0.032), IL-10 (3.8 pg/mL vs. 1.8 pg/mL, p = 0.005 ) and ratios of neopterin to IL-12 (1.74 vs. 0.11, p < 0.001), and IL-10 to IL-12 (0.4 vs. 0.05, p < 0.001) than the non-infection group. After a subdivision of the study population into patients with local or advanced disease, the differences between the study groups remained statistically significant for CRP and neopterin both in local (p < 0.05 and p < 0.001) and advanced diasease (p < 0.01 and p < 0.001) and in advanced disease for PCT (p < 0.001), IL-10 (p < 0.05), IL-12 (p < 0.05), neopterin to IL-12 ratio (p < 0.01) and IL-10 to IL-12 ratio (p < 0.01). The ESR levels did not differ between the study group (50 vs. 42 p = 0.16), while the IL-12 values were lower in the infection group (10.6 pg/mL vs. 71.6 pg/mL, p = 0.007). The tumor load did not influence any of the studied infection markers within the study groups. For identifying bacteremia by area under the operating characteristics curves (AUC), the highest values were obtained for PCT (0.92) and neopterin (0.90), and slightly lower values were recorded for the ratios neopterin to IL-12 (0.79) and IL-10 to IL-12 (0.75). None of the markers or ratios were good for differentiating non-bacteremic infections from neoplastic fever, the AUC values rangin from 0.27 for ESR to 0.61 for IL-10 to IL-12 ratio. The simultaneous use of the ratio of neopterin to IL-12 with its high sensitivity (82%) and that of IL-10 to IL-12 with its high specificity (90%) should be further studied.
BACKGROUND:Despite increasing safety of blood supplies, and blood conservation strategies, the need for blood transfusion is increasing. Due to storage characteristics, blood is not always available when it is needed.AIMS:Review the necessity for an oxygen carrying blood substitute. Review the history of the compounds that may become blood substitutes, and briefly describe those in clinical trials.MATERIAL AND METHODS:Review of literature in the area of blood substitutes.RESULTS AND CONCLUSIONS:There is a need for oxygen carrying blood substitutes. Despite disappointments in recent clinical trials leading to withdraw of some compounds, there are several promising products nearing clinical approval.
BACKGROUND AND AIMS:There are no universally accepted guidelines for blood transfusion in primary, unilateral Total Knee Replacement Arthroplasty (TKA). Transfusion is associated with post-operative infection, fluid overload and prolonged duration of hospitalisation. Due to this morbidity and reports of "inappropriate" transfusion practice, an audit of the local practice was organised, with the aim of assessing compliance to existing evidence.METHODS:A 1-year retrospective survey of blood transfusion practice was conducted for all consecutive elective, primary, unilateral TKA operations.RESULTS:169 operations were performed; 96% for osteoarthritis; mean patient age was 69 years; 66% were females; 34% of the patients were transfused, 60% intra-operatively. There was no threshold of pre-operative Hb predictive of a transfusion and no significant difference in the pre-operative Hb between transfused and non-transfused groups. Only 26% of the cross-matched blood was eventually transfused. Intra-operative blood loss was negligible and only 10% of transfused patients had shown cardiovascular instability. The post-operative Hb drop was maximal at around day-4.CONCLUSIONS:The lack of guidelines has led to inconsistent local transfusion practice, often with no scientific evidence to support it. In the absence of a randomised controlled trial addressing the issue, certain transfusion guidelines are suggested, based on existing indirect scientific evidence.
BACKGROUND AND AIMS:Hydroxyapatite (HA) has been considered as a carrier material for bone morphogenetic proteins (BMP). The aim of this study was to evaluate the capacity of a composite implant of HA and native bovine BMP to heal a 2 cm segmental defect in the canine ulna.MATERIALS AND METHODS:A composite HA+BMP implant was compared with plain HA implants and cortical autografts. The fixation was accomplished with an intramedullary Kirschner wire. The bone union was evaluated by X-rays taken at operation and after 3, 6, 9, 12, 16, 25, 35 weeks and by histology and mechanical torsion tests.RESULTS:HA implants were not able to produce complete bone union even with BMP. There was some bridging between the implant and the bone in the defects treated with either plain HA or HA+BMP implant, the bridging being slightly more pronounced with HA+BMP. The autografts showed a significantly better capacity to heal the defect. The HA implant did not resorb markedly during the study. There was no significant difference in mechanical strength between the HA and HA+BMP groups.CONCLUSIONS:HA was not an adequate bone substitute material in this study model, and BMP was not able to enhance sufficiently the poor capacity of HA to heal canine ulnar defects.
BACKGROUND AND AIMS Colon cancer is one of the most common malignancies in Finland. The purpose of the current study was to analyse the results of surgical treatment of right-sided colon cancers operated in the 1980s at Turku University Central Hospital. In addition, we compared the results to those reported from earlier decades. MATERIAL AND METHODS One hundred and fifty-three patients with primary proximal colon cancer were operated in 1981-1990. The results were analysed retrospectively from patient records. RESULTS The crude five-year survival rate of the patients was 48%. The most crucial factor affecting survival was the stage of spreading of the tumour. Obstructive tumours had a poorer prognosis than non-obstructive ones. CONCLUSIONS The results of surgical treatment of proximal colon cancer were satisfactory at Turku University Central Hospital and slightly better compared to earlier reports.
BACKGROUND AND AIMS:There is rather limited recent information on major amputations in Finland. Our objective was to describe the incidence of major lower limb amputations in a defined central hospital, the demographic characteristics of the amputees, diagnosis and situations leading to amputation, level of amputations and survival of the amputees after one year.MATERIAL AND METHODS:A retrospective study was undertaken on 156 patients with 169 lower limb major amputations from 1997 to 2000 at the Seinäjoki Central Hospital and Ahtäri District Hospital.RESULTS:The annual incidence of major amputations reduced from 29.5 to 15.2/100000 inhabitants. The mean age of the patients was 78.5 years but highest 80.1 in the year 2000. The reason for major amputation was chronic critical leg ischaemia with or without diabetes mellitus in 79.1% and acute ischaemia in 13.9%. The average below-knee (BK)/above-knee (AK) amputation ratio was 0.80 during the years 1997-1999 and the ratio was lowest 0.67 in year 2000. At the same year 2000 the amount of patients, whose condition was too poor for reconstructive surgery, was significantly higher than in 1997-1999.CONCLUSIONS:We suggest that BK/AK amputation ratio is decreasing in the future as the amputees tend more often to be institutionalized and immobile, and reconstruction is not an alternative and BK amputation is impossible or useless.
Background and aims Aneurysms of the splenic artery (SAA) are the most common type of aneurysms found in the splanchnic arterial bed (1) and are second in frequency only to aortic and iliac artery aneurysms among intra-abdominal aneurysms (2). Historically rupture occurs in 6-9.2% of asymptomatic cases and in pregnant women rupture occurs in 95% of afflicted women further emphasizing the importance of early diagnosis (3-5). Possible treatments are surgical resection or trans-catheteral arterial embolization. Material and methods The relationship of SAA to pregnancy, pancreatitis and the outcome after surgical resection or arterial embolization was studied. Fifteen patients were diagnosed with SAA between January, 1992 and December 1999. The patients were classified by their clinical characteristics, etiology, size, and location of the aneurysm, relationship to pregnancy in women, clinical outcome of ruptured aneurysms and treatment. Results Fifteen patients, male to female ratio of 1.1:1 (eight men, seven women), with splenic artery aneurysm were treated. Patients were mostly in their sixty's and the mean age was 49.07. Chronic pancreatitis and pseudocysts were found in four cases (26.7%). Acute pancreatitis, portal hypertension, splenomegaly, and bronchitis were comorbidities found each in one case (6.7%). Eight cases (53.3%) were without associated disease Conclusions SAA has historically shown predominance in women, but in this study, men showed predominance and no relation to pregnancy could be found. In cases were the aneurysms ruptured and treatment was initiated, one of four patients died. One patient refused treatment and subsequently died. As most of the aneurysms measure over 2 cm at the time of detection, operative resection was recommended in all cases. In the high-risk patients, arterial embolization using coiling can be effective early in treatment, but arterial embolization in SAA secondary to pancreatitis was shown only to be palliative and needed to be complimented with surgical intervention. Arterial embolization is the method of choice in high-risk patients.
Background and Aims: The Marshall-Marchetti-Krantz procedure (MMK) is a vesico-urethral suspension, for the correction of urethral hypermobility in women with stress urinary incontinence. This study aims to describe the long-term outcome of the procedure.Material and Methods: 40 women with stress incontinence underwent the MMK. All operations were performed by one surgeon. Analysis of patients' notes yielded the early continence rate and perioperative morbidity. Long-term outcome was measured by means of a postal questionnaire with telephone contact to ensure maximum uptake.Results: The immediate continence rate was 82 %. Continence rates at up to 22 years follow-up (mean 8.5 years) is 61 %. All failures occurred within 2 years of the operation.Conclusion: Patients still continent two years after the MMK will maintain continence in the long-term.
BACKGROUND AND AIMS:Radiological imaging alone is not reliable enough in staging of pancreatic cancer. Not only because of poor sensitivity but also because there is a tendency to overstage tumours. The aim of the study was to compare the efficiency of spiral computed tomography (CT), transabdominal ultrasound (US), laparoscopy (LAP) and laparoscopic ultrasound (LUS) in staging of pancreatic tumours.MATERIAL AND METHODS:In this prospective study 27 patients underwent pancreatic tumour staging with CT, US, LAP and LUS. The reference standard was operative evaluation or in case of disseminated disease laparoscopic assessment.RESULTS AND CONCLUSIONS:Although LAP was hindered by adhesions in 11% of the patients the benefit of LAP staging was evident in detecting peritoneal carcinomatosis. The assessment of the local tumour expansion of a pancreatic carcinoma was difficult for all staging modalities. LUS did not change the decision whether to proceed with laparotomy once. In our experience routine use of laparoscopic staging does not benefit patients with pancreatic tumour but in selected cases it may prevent unnecessary laparotomy.
