Browsing by Subject "outcome"
Now showing items 1-6 of 6
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(2017)BACKGROUND: Population-based long-term data on pediatric patients with cerebral arteriovenous malformations (AVMs) are limited. OBJECTIVE: To clarify the characteristics and long-term outcome of pediatric patients with AVM. METHODS: A retrospective analysis was performed on 805 consecutive brain AVM patients admitted to a single center between 1942 and 2014. The patients were defined as children if they were under 18 yr at admission. Children were compared to an adult cohort. Changing patterns of presentation were also analyzed by decades of admission. RESULTS: The patients comprised 127 children with a mean age of 12 yr. The mean follow-up time was 21 yr (range 0-62). Children presented more often with intracerebral hemorrhage (ICH) but less often with epilepsy than adults. Basal ganglia, cerebellar, and posterior paracallosal AVMs were more common in pediatric than in adult patients. Frontal and temporal AVMs, in contrast, were more common in adult than in pediatric patients. As the number of incidentally and epilepsy-diagnosed AVMs increased, ICH rates dropped in both cohorts. In total, 22 (82%) pediatric and 108 (39%) adult deaths were assessed as AVM related. After multivariate analysis, small AVM size and surgical treatment correlated with a favorable long-term outcome. CONCLUSION: Hemorrhagic presentation was more common in children than in adults. This was also reflected as lower prevalence of epileptic presentation in the pediatric cohort. Lobar and cortical AVM locations were less frequent, whereas deep and cerebellar AVMs were more common in children. Hemorrhagic presentation correlated negatively with incidentally and epilepsy-diagnosed AVMs. In children, AVM was a major cause of death, but in adults, other factors contributed more commonly to mortality.
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Effect of decompressive craniectomy on outcome after traumatic brain injury : A single center review (2015)The role of decompressive craniectomy as a cure in traumatic brain injuries has been widely been discussed. Therefore our aim was to assess the independent effect of decompressive craniectomy the outcome and mortality of the patient. We conducted an open-cohort retrospective study on adult blunt TBI patients. Patients were divided into three groups; conservative treatment, acute craniotomy and mass lesion evacuation (craniotomy) and decompressive craniectomy. Outcome was assessed using Glasgow Outcome Scale and overall mortality six months after the operation. The adjusted multivariate analysis did not show an independent association between decompressive craniectomy and mortality. Decompressive craniectomy prooved to be an independent risk factor for poor neurological outcome with an OR of 3.06. In conclusion, operating TBI patients with decompressive craniectomy was found to be a life-saving intervention for patients who in other cases were destined to die. For stronger evidence this subject needs more research of a prospective type.
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(2017)Sairaalansisäisten ensihoitoryhmien (Medical Emergency Team, MET) vaikutuksia sairaalansisäisten sydänpysähdysten ilmaantuvuuteen ja ennusteeseen on tutkittu runsaasti. Tutkittua tietoa itse MET-ryhmien kohtaamien potilaiden ennusteesta on vähemmän ja tutkimusten raportointimenetelmät vaihtelevat. Tavoitteenamme oli tehdä systemaattinen katsaus MET-potilaiden hoidonrajauksista, siirroista teho-osastolle sekä lyhyt- ja pitkäaikaisesta ennusteesta. Sähköinen kirjallisuushaku (tammikuu 1990 – maaliskuu 2016) toteutettiin PubMed- ja Cochrane-tietokannoista. Noudatimme PRISMA-protokollaa. Kirjallisuushausta tutkimukseen sisällytettyjen artikkeleiden kirjallisuusviitteet tarkistettiin mahdollisen lisäkirjallisuuden löytämiseksi. Ennalta määrättyä MET-raportoinnin laatupisteytystä (asteikolla 0-17) käytettiin tutkimusten metodien arvioimiseen. Katsaukseen sisällytettiin 29 tutkimusta, jotka olivat dokumentoineet tietoa yhteensä 157 383 MET-hälytyksestä. Tutkimusten laatu arvioitiin vaatimattomaksi; laatupisteytyksen keskiluku oli 8 (vaihteluväli 2 – 11). Tulosten perusteella keskimäärin 8.1 % MET-hälytyksistä johtaa hoidonrajaukseen (vaihteluväli 2.1 – 25 %) ja 23 % (8.2 – 56 %) potilaan siirtämiseen teho-osastolle. Tehohoitoon siirretyistä potilaista keskimäärin 29 % (6.9 – 35 %) menehtyy tehohoitohoitojakson aikana. MET-ryhmien arvioimien potilaiden sairaalakuolleisuus tutkimusaineistossa oli keskimäärin 26 % (12 – 60 %). Vain kaksi tutkimusta raportoi MET-potilaiden puolen vuoden elossa olosta. MET-potilaiden toimintakyvystä sairaalasta kotiutumisen jälkeen ei löytynyt tietoa. Keskimäärin joka neljäs MET-hälytys johtaa siirtoon teho-osastolle; toisaalta melkein joka kymmenennellä hälytyksellä potilaalle asetetaan uusi hoidonrajaus. MET-potilaiden sairaalakuolleisuus on korkea, tietoa heidän pitkäaikaisennusteestaan on vähän ja toimintakyvystä tietoa ei ole ollenkaan. Tutkielma on mukailtu alkuperäisestä englanninkielisestä julkaisusta (53). Syventävän tutkielman tekijä toteutti kirjallisuushaun, tiedon keräämisen, taulukot ja osallistui artikkelin kirjoitusprosessiin. (207 sanaa)
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(2017)Background: Some oral health factors have been associated with a higher risk for head and neck cancers (HNCs) and most clearly the existing evidence refers to an association between periodontitis and HNC. Aims: To examine oral health in a subset of HNC patients, namely patients with oropharyngeal cancer (OPC) or oral cavity cancer (OCC), and to compare these two tumor sites in this regard. Subjects and Methods: A retrospective study consisting of a series of OPC and OCC patients diagnosed between 2005-2008 at the Helsinki University Hospital, Helsinki, Finland. Study subjects were randomly selected from hospital registries. Oral health at diagnosis was assessed by reviewing the corresponding panoramic radiographs. We used modified Total Dental Index (Mattila et al. 1989) to assess oral health as a whole. Results: In univariate analysis the difference in modified Total Dental Index (mean 3,49 ±0,20 for OPC vs. 2,85 ±0,22 for OCC) was statistically significant, but after adjusting for age, gender, smoking, and heavy alcohol consumption statistical significance was lost. When individual dental variables were considered, the only statistically significant difference in univariate analysis was found concerning residual roots (mean 0,60 ±0,21 for OPC vs. 0,19 ±0,15 for OCC). Conclusions: The present findings demonstrate a fairly poor oral health status among oral and oropharyngeal cancer patients. The observed prevalence of caries and periodontitis seems to be even more common than among the Finnish general population. Whether or not there are differences in oral health risk factors between OPC and OCC patients cannot be reliably established in this study. Further studies with larger sample sizes are needed to confirm our findings either way.
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(2010)Ischemic stroke in young adults with patent foramen ovale (PFO) and/or atrial septal aneurysm is underinvestigated. Methods: We investigated 86 such patients (age 16-49 years) with long-term follow-up. Results: Most patients recovered well, one died and 15 retired prematurely due to the index stroke. Seven patients underwent PFO closure. Few stroke recurrences occurred (4%) either on aspirin or warfarin during the 6.5 years of follow-up. Conclusions: Our data suggest good outcome, low morbidity, and low recurrence. Finding the best secondary prevention measures requires randomized trials.
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(2017)Befolkningen i Västvärlden åldras och människor lever allt längre. I Finland är över 90 åringar den snabbast växande befolkningsgruppen och mängden 90 år fyllda uppskattas tredubblas fram till år 2040. Ändå finns det relativt lite kirurgisk forskning om denna viktiga patientgrupp. Morbiditeten och mortaliteten vid operativa ingrepp ökar med ålder, men samtidigt har det visats att även över 100 åringar klarar av operativa ingrepp relativt bra. Målet med denna studie är att undersöka resultaten och effektiviteten av hudtransplantationsoperationer på patienter som fyllt 90 år. Data samlades retrospektivt in från samtliga hudtransplantationsoperationer gjorda på ≥90 åringar under åren 2010-2013 på HUS plastikkirurgiska enhet i Tölö sjukhus. Utgående från resultaten är hudtransplantation en effektiv och relativt trygg metod att rekonstruera vävnadsdefekter på ≥90 åringar. Hudtransplantationen lyckades i 89% av ingreppen. Dödligheten under post-operativ vård var 4,8%, vid 30 dygn 7,14% och vid ett år 33,3%, vilket är litet mindre än i tidigare studier där post-operativa dödligheten på 90 åringar har undersökts. Operationen är dock inte riskfri och ett års dödlighet är högre hos de som genomgått hudtransplantation än i samma åldersgrupp i genomsnitt.
Now showing items 1-6 of 6