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Browsing by Author "Pakarinen, Mikko"

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  • Etiology, Management and Outcome of Acute Pancreatitis in Children 
    Junkkari, Ella; Hukkinen, Maria; Merras-Salmio, Laura; Koivusalo, Antti; Pakarinen, Mikko (2020)
    Objective. Recent studies have reported an increasing incidence of acute pancreatitis (AP) in children. The etiology of AP in children is more diverse compared to adults. All patients treated for acute pancreatitis (AP) or acute recurrent pancreatitis (ARP) in Helsinki University Children’s hospital during 1999-2018 were reviewed. Methods. ARP was considered as two or more episodes of AP over a lifetime. Demographics, clinical findings, laboratory test results, genetic assessment, imaging findings, endoscopic and surgical treatment, duration of hospital stay, number of pancreatitis episodes, and outcome were analyzed. Results. Of a total of 34 identified patients [n=22 (64%) AP; n=12 (35%) ARP; n=17 (50%) females] none died. The most frequent etiologies were pancreaticobiliary (26%), drug-induced (21%), hereditary (18%), autoimmune (9%) and idiopathic (21%) pancreatitis. An underlying SPINK1 (n=4) and PRSS1 mutation was found in five (15%) patients. Median age at diagnosis was 9.8 (8.2-11) years. Patients with pancreaticobiliary pancreatitis were younger at presentation [4.3 (2.5-9.8) vs. 10 (8.5-12) years, p=0.025] and underwent ERCP (n=7/9 vs. 8/25, p=0.025), and surgical or endoscopic interventions (n= 8/9 vs. 8/25 p=0.006) more frequently compared to the rest of the cohort. The most common long-term complications affecting 29% of patients were chronic upper abdominal pain and diarrhea, occurring each in three patients (8.8%), respectively. Four patients received pancreatic enzyme substitution, while none developed diabetes. Conclusions. Our study highlights the diverse etiology of pediatric pancreatitis necessitating comprehensive diagnostic work-up and management options with relatively low long-term morbidity.
  • Incidence and long-term outcomes of surgically treated childhood hepatic malignancies in Finland 
    Tiusanen, Toivo; Hukkinen, Maria; Leskinen, Outi; Soini, Tea; Kanerva, Jukka; Jahnukainen, Timo; Mäkisalo, Heikki; Heikinheimo, Markku; Pakarinen, Mikko (2019)
    Aim: To analyse incidence, treatment and outcomes of paediatric liver malignancies in Finland during 1987‐2017. Methods: Medical records and national cancer registry data of 47 children with liver malignancies were reviewed. Survival was calculated with the Kaplan‐Meier method. Results: During follow‐up, liver malignancy incidence remained stable at 1.1:10^6. Altogether, 42 patients with hepatoblastoma (n = 24), hepatocellular carcinoma (n = 11) and undifferentiated embryonal sarcoma (n = 7) underwent surgery at median age 4.6 (interquartile range, 2.0‐9.6) years and were followed up for 13 (7.0‐19) years. Cumulative 5‐year survival was 86% for hepatoblastoma, 41% for hepatocellular carcinoma and 67% for undifferentiated embryonal sarcoma. Five‐year survival was decreased among hepatoblastoma patients aged ≥ 2.4 years (73% versus 100%, P = .040), with PRETreatment EXTent of disease IV (PRETEXT, 60% vs 100%,P = .004), and with recurrent disease (67% vs 88%, P = .029). Recurrent/residual disease associated with decreased 5‐year survival in hepatocellular carcinoma (0% vs83%, P = .028). Survival was similar among 19 transplanted and 23 resected patients. In total, 14 deaths occurred either for the underlying malignancy (n = 8), adverse effects of chemotherapy (n = 5) or unrelated reasons (n = 1). Conclusion: Outcomes for PRETEXT I‐III hepatoblastoma and un‐metastasized hepatocellular carcinoma were encouraging. Adverse effects of chemotherapy significantly contributed to mortality.
  • Increased prevalence of Pancreaticobiliary maljunction in Biliary malignancies 
    Hyvärinen, Ilona; Hukkinen, Maria; Kivisaari, Reetta; Parviainen, Helka; Nordin, Arno; Pakarinen, Mikko (2018)
    Aim: The incidence of pancreaticobiliary maljunction (PBM) is thought to approximate 1:100,000 within Western populations. We aimed to study the significance of PBM in biliary tract malignancies. Methods: Medical records and magnetic resonance cholangiopancreatography (MRCP) images of 252 consecutive patients treated for biliary malignancies during 2005-2016 were reviewed. Patients with other known risk factors for biliary cancers (n=27) were excluded. A common pancreaticobiliary channel measuring ≥10 mm outside the duodenal wall was defined as PBM. Main results: Of the 225 patients, a reliably interpretable preoperative MRCP was available for 73 (32%). Sex (47% vs. 57% females) and age at diagnosis (67 vs. 66 years) were similar among patients with or without an MRCP (p=ns for both). In MRCP a PBM with a median length of 20mm (range 10-23mm) was identified in four patients (5.5%, 95% confidence interval 1.6-14), while none had evident accompanying biliary tree dilatation. PBM patients were significantly more often females (100% vs. 43%, p=0.043), less likely to have intrahepatic bile duct cancer (0% vs. 65%, p=0.019) while more likely to have gallbladder cancer (75% vs. 22%, p=0.044) compared to the others. Age at diagnosis (66 vs 67 years, p=0.898), extrahepatic bile duct cancer incidence (25% vs. 13%, p=0.453) and survival status at last follow-up (50% vs. 42% alive, p=1.000) were comparable between the subgroups. Conclusion: The prevalence of PBM is substantially higher in adults with biliary malignancies than one would expect based on its incidence, reinforcing the etiologic role of PBM especially in females with gallbladder cancer.
  • Long-term single center outcomes after proctocolectomy with ileoanal anastomosis for paediatric ulcerative colitis 
    Nyholm, Iiris; Hukkinen, Maria; Koivusalo, Antti; Merras-Salmio, Laura; Kolho, Kaija-Leena; Rintala, Risto; Pakarinen, Mikko (2019)
    Tutkimuksen tarkoitus. Lapsuudesta asti haavaista koliittia (UC) sairastaneista lapsista neljännes tarvitsee proktokolektomian elinaikanaan. Tutkimuksen tarkoitus oli selvittää proktokolektomian ja ileoanaalianastomoosin (IAA) pitkäaikaistuloksia lapsena leikatuilla UC-potilailla. Aineisto ja menetelmät. Tutkimukseen otettiin mukaan haavaista tai määrittämätöntä koliittia sairastavat potilaat, joille oltiin tehty proktokolektomia ja IAA HUS:n Lastenklinikalla vuosina 1985-2016. Tiedot sairaushistoriasta, diagnostiikasta, leikkauksista, kirurgisista komplikaatioista, postoperatiivisesta Crohnin taudista ja leikkauksen epäonnistumisesta eli pysyvästä ileostoomasta kerättiin retrospektiivisesti. Leikkauksen epäonnistumisen riskitekijät analysoitiin Coxin regressiomallilla. Tulokset. 87 potilaasta 85:llä (98%) preoperatiivinen diagnoosi oli UC ja kahdella (2%) määrittämätön koliitti. 57 (66%) leikattiin kaksivaiheisesti ja 30 (34%) kolmivaiheisesti. Keskimääräisen 7,8 (kvartiiliväli 4,1-14,5) vuoden seuranta-aikana yhdeksällä (10%) potilaalla diagnoosi tarkentui Crohnin taudiksi. Postoperatiivisista komplikaatioista saumalekaasit (n=8, 9%) ja striktuurat (n=10, 11%) olivat yhtä yleisiä Crohn- ja UC-potilailla, kun taas fisteleitä (78% vs. 9%, p<0,001) ja abskesseja (56% vs 14%, p=0,009) oli enemmän Crohnin tautia sairastavilla lapsilla. Kahdeksalla (9%) oli pysyvä ileostooma viimeisellä seurantakäynnillä. Muiden potilaiden keskimääräinen ulostamisfrekvessi oli 5 (4-7) päivisin ja 0,5 (0-1) öisin. Crohnin tauti (hasardisuhde, HR=23,3, p=0,005), postoperatiiviset fistelit (HR=20,9, p=0,007) ja abskessit (HR=16,3, p=0,013) sekä kolmivaiheinen leikkaus (p=0,018) lisäsivät pysyvän ileostooman riskiä. Johtopäätökset. Proktokolektomian jälkeisen IAA-leikkauksen funktionaaliset ja kirurgiset pitkäaikaistulokset ovat hyviä lapsuuden haavaisessa koliitissa. Postoperatiiviset fistelit ja abskessit sekä tarve kolmivaiheiselle leikkaukselle ovat yhteydessä Crohnin tautiin ja kohottavat riskiä päätyä pysyvälle ileostoomalle. Alkuperäinen artikkeli julkaistiin Journal of Crohn’s and Colitis -lehdessä 3.10.2018. (220 sanaa)
  • Pneumonia after Repair of Esophageal Atresia–Incidence and Main Risk Factors 
    Nurminen, Paula; Koivusalo, Antti; Hukkinen, Maria; Pakarinen, Mikko (2019)
    Introduction: Esophageal atresia (EA) is associated with significant respiratory mortality. We aimed to assess incidence and predictive factors of EA associated pneumonia during the first 5 years of life. Materials and Methods: Institutional ethical consent was obtained. Hospital records of patients with EA from 2002 to 2017 were reviewed. Episodes of pneumonia that were diagnosed in university or regional hospitals were included. For instance, acute respiratory infections other than pneumonia, anastomotic complications, aortopexy, fundoplication and EA anastomosis dilatations were tested as potential risk factors. Results: 104 patients were included. 35 (34%) patients had 94 episodes of pneumonia corresponding to median 2 (IQR 1–4) and 609 episodes per thousand patient years. Majority of pneumonias occurred before the age of 3 years. The cause of pneumonia could be identified as respiratory syncytial virus in 15 (16%) and aspiration in 7 (7.4%) episodes. In univariate analysis, pneumonia was predicted by occurrence and number of nonpneumonia respiratory infections, anastomotic reoperations, fundoplication, and number of EA anastomosis dilatations. In multivariate logistic regression analysis, significant risk factors for pneumonia were occurrence of nonpneumonia respiratory infections and number of anastomotic dilatations. Conclusion: Episodes of pneumonia occurred in one-third of patients. The incidence of pneumonia was highest during the first 3 years. Patients with nonpneumonia respiratory infections and high number of dilatations were at the greatest risk.

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