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Faksova K, Walsh D, Jiang Y, Griffin J, Phillips A, Gentile A, Kwong JC, Macartney K, Naus M, Grange Z, Escolano S, Sepulveda G, Shetty A, Pillsbury A, Sullivan C, Naveed Z, Janjua NZ, Giglio N, Perälä J, Nasreen S, Gidding H, Hovi P, Vo T, Cui F, Deng L, Cullen L, Artama M, Lu H, Clothier HJ, Batty K, Paynter J, Petousis-Harris H, Buttery J, Black S, Hviid A. COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals. Vaccine 2024; 42:2200-2211. [PMID: 38350768 DOI: 10.1016/j.vaccine.2024.01.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The Global COVID Vaccine Safety (GCoVS) Project, established in 2021 under the multinational Global Vaccine Data Network™ (GVDN®), facilitates comprehensive assessment of vaccine safety. This study aimed to evaluate the risk of adverse events of special interest (AESI) following COVID-19 vaccination from 10 sites across eight countries. METHODS Using a common protocol, this observational cohort study compared observed with expected rates of 13 selected AESI across neurological, haematological, and cardiac outcomes. Expected rates were obtained by participating sites using pre-COVID-19 vaccination healthcare data stratified by age and sex. Observed rates were reported from the same healthcare datasets since COVID-19 vaccination program rollout. AESI occurring up to 42 days following vaccination with mRNA (BNT162b2 and mRNA-1273) and adenovirus-vector (ChAdOx1) vaccines were included in the primary analysis. Risks were assessed using observed versus expected (OE) ratios with 95 % confidence intervals. Prioritised potential safety signals were those with lower bound of the 95 % confidence interval (LBCI) greater than 1.5. RESULTS Participants included 99,068,901 vaccinated individuals. In total, 183,559,462 doses of BNT162b2, 36,178,442 doses of mRNA-1273, and 23,093,399 doses of ChAdOx1 were administered across participating sites in the study period. Risk periods following homologous vaccination schedules contributed 23,168,335 person-years of follow-up. OE ratios with LBCI > 1.5 were observed for Guillain-Barré syndrome (2.49, 95 % CI: 2.15, 2.87) and cerebral venous sinus thrombosis (3.23, 95 % CI: 2.51, 4.09) following the first dose of ChAdOx1 vaccine. Acute disseminated encephalomyelitis showed an OE ratio of 3.78 (95 % CI: 1.52, 7.78) following the first dose of mRNA-1273 vaccine. The OE ratios for myocarditis and pericarditis following BNT162b2, mRNA-1273, and ChAdOx1 were significantly increased with LBCIs > 1.5. CONCLUSION This multi-country analysis confirmed pre-established safety signals for myocarditis, pericarditis, Guillain-Barré syndrome, and cerebral venous sinus thrombosis. Other potential safety signals that require further investigation were identified.
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Affiliation(s)
- K Faksova
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
| | - D Walsh
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - Y Jiang
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - J Griffin
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - A Phillips
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - A Gentile
- Department of Epidemiology, Ricardo Gutierrez Children Hospital, Buenos Aires University, Argentina
| | - J C Kwong
- ICES, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - K Macartney
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia; The University of Sydney, Australia
| | - M Naus
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Z Grange
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - S Escolano
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France
| | - G Sepulveda
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - A Shetty
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - A Pillsbury
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - C Sullivan
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - Z Naveed
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - N Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - N Giglio
- Department of Epidemiology, Ricardo Gutierrez Children Hospital, Buenos Aires University, Argentina
| | - J Perälä
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - S Nasreen
- ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - H Gidding
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia; The University of Sydney, Australia
| | - P Hovi
- Department of Public Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - T Vo
- Faculty of Social Sciences, Tampere University, Finland
| | - F Cui
- School of Public Health, Peking University, China
| | - L Deng
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - L Cullen
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - M Artama
- Faculty of Social Sciences, Tampere University, Finland
| | - H Lu
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - H J Clothier
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - K Batty
- Auckland UniServices Limited at University of Auckland, New Zealand
| | - J Paynter
- School of Population Health, University of Auckland, New Zealand
| | - H Petousis-Harris
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; School of Population Health, University of Auckland, New Zealand
| | - J Buttery
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Murdoch Children's Research Institute, Parkville, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
| | - S Black
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; School of Population Health, University of Auckland, New Zealand
| | - A Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Biancari F, Paone R, Venermo M, D'Andrea V, Perälä J. Diagnostic Accuracy of Computed Tomography in Patients with Suspected Abdominal Aortic Aneurysm Rupture. Eur J Vasc Endovasc Surg 2013; 45:227-30. [DOI: 10.1016/j.ejvs.2012.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
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Viertiö S, Tuulio-Henriksson A, Perälä J, Saarni SI, Koskinen S, Sihvonen M, Lönnqvist J, Suvisaari J. Activities of daily living, social functioning and their determinants in persons with psychotic disorder. Eur Psychiatry 2011; 27:409-15. [PMID: 21377336 DOI: 10.1016/j.eurpsy.2010.12.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 12/13/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The determinants of everyday functioning in persons with psychotic disorder have not been widely studied in community dwelling samples. Our aim was to investigate limitations in everyday functioning among subjects with psychotic disorders in a population-based study. METHOD Everyday functioning was assessed in a nationally representative sample of 7112 persons aged 30+ using interviewer observations and self-reports, while verbal fluency and memory were also measured. Diagnostic assessment of DSM-IV psychotic disorders was based on SCID interview and case-note data. Lifetime-ever diagnoses of psychotic disorder were classified into schizophrenia (n=61), other non-affective psychotic disorders (ONAP) (n=79) and affective psychoses (n=45). RESULT Non-affective psychotic disorder was significantly associated with limitations in everyday functioning, as well as with deficits in verbal fluency and memory. Negative symptoms, depression, age, gender, verbal memory deficits, and reduced visual acuity were predictors of limitations in everyday functioning even after controlling for sociodemographic factors and chronic medical conditions, and difficulties in social functioning were also related to expressive speech problems. CONCLUSION Persons with schizophrenia and ONAP have significantly more problems in everyday functioning than the general population. One significant predictor of problems was reduced visual acuity, which at least in some situations could be easily corrected.
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Affiliation(s)
- S Viertiö
- National Institute for Health and Welfare Department of Mental Health and Substance Abuse Services, PO Box 30, 00271 Helsinki, Finland.
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Castaneda AE, Suvisaari J, Marttunen M, Perälä J, Saarni SI, Aalto-Setälä T, Lönnqvist J, Tuulio-Henriksson A. Cognitive functioning in a population-based sample of young adults with anxiety disorders. Eur Psychiatry 2010; 26:346-53. [PMID: 20627469 DOI: 10.1016/j.eurpsy.2009.11.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 10/12/2009] [Accepted: 11/17/2009] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Cognitive functioning in anxiety disorders has received little investigation, particularly among young adults and in non-clinical samples. The present study examined cognitive functioning in a population-based sample of young adults with anxiety disorders in comparison to healthy peers. METHODS A population-based sample of 21-35-year-olds with a lifetime history of anxiety disorders (n=75) and a random sample of healthy controls (n=71) derived from the same population were compared in terms of performance in neuropsychological tests measuring verbal and visual short-term memory, verbal long-term memory, attention, psychomotor processing speed, and executive functioning. RESULTS In general, young adults with anxiety disorders did not have major cognitive impairments when compared to healthy peers. When participants with anxiety disorder in remission were excluded, persons with current anxiety disorder scored lower in visual working memory tests. Current psychotropic medication use and low current psychosocial functioning associated with deficits in executive functioning, psychomotor processing speed, and visual short-term memory. CONCLUSION Lifetime history of anxiety disorders is not associated with cognitive impairment among young adults in the general population. However, among persons with anxiety disorders, current psychotropic medication use and low psychosocial functioning, indicating more severe symptoms, may associate with cognitive impairments.
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Affiliation(s)
- A E Castaneda
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland.
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Castaneda AE, Marttunen M, Suvisaari J, Perälä J, Saarni SI, Aalto-Setälä T, Aro H, Lönnqvist J, Tuulio-Henriksson A. The effect of psychiatric co-morbidity on cognitive functioning in a population-based sample of depressed young adults. Psychol Med 2010; 40:29-39. [PMID: 19413917 DOI: 10.1017/s0033291709005959] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Psychiatric co-morbidity is often inadequately controlled for in studies on cognitive functioning in depression. Our recent study established no major deficits in cognition among young adults with a history of pure unipolar depression. The present study extends our previous work by examining the effects of psychiatric co-morbidity and other disorder characteristics on depression-related cognitive functioning. METHOD Performance in verbal and visual short-term memory, verbal long-term memory and learning, attention, processing speed, and executive functioning was compared between a population-based sample aged 21-35 years with a lifetime history of unipolar depressive disorders (n=126) and a random sample of healthy controls derived from the same population (n=71). Cognitive functioning was also compared between the subgroups of pure (n=69) and co-morbid (n=57) depression. RESULTS The subgroups of pure and co-morbid depression did not differ in any of the cognitive measures assessed. Only mildly compromised verbal learning was found among depressed young adults in total, but no other cognitive deficits occurred. Received treatment was associated with more impaired verbal memory and executive functioning, and younger age at first disorder onset with more impaired executive functioning. CONCLUSIONS Psychiatric co-morbidity may not aggravate cognitive functioning among depressed young adults. Regardless of co-morbidity, treatment seeking is associated with cognitive deficits, suggesting that these deficits relate to more distress.
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Affiliation(s)
- A E Castaneda
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.
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Abstract
BACKGROUND The literature suggests an association between obesity and schizophrenia but fat mass and fat-free mass, which have been shown to be more predictive of all-cause mortality than only waist circumference and obesity [body mass index (BMI) 30 kg/m2], have not been reported in psychotic disorders. We examined the detailed body composition of people with different psychotic disorders in a large population-based sample. METHOD We used a nationally representative sample of 8082 adult Finns aged 30 years with measured anthropometrics (height, weight, waist circumference, fat percentage, fat-free mass and segmental muscle mass). Psychiatric diagnoses were based on a consensus procedure utilizing the Structured Clinical Interview for DSM-IV (SCID)-interview, case-notes and comprehensive register data. RESULTS Schizophrenia (including schizo-affective disorder) was associated with obesity [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.5-3.6], abdominal obesity (waist circumference 88 cm for women, 102 cm for men) (OR 2.2, 95% CI 1.3-3.6) and with higher fat percentage (mean difference 3.8%, 95% CI 2.0-5.7%), adjusted for age and gender, than in the remaining sample. The associations between schizophrenia and low fat-free mass and decreased muscle mass on trunk and upper limbs became statistically significant after adjusting for BMI. After further adjusting for current antipsychotic medication, education, diet and smoking, schizophrenia remained associated with obesity (OR 1.9, 95% CI 1.1-3.6) and abdominal obesity (OR 3.8, 95% CI 1.5-9.4). Participants with affective psychoses did not differ from the general population. CONCLUSIONS Individuals with schizophrenia have metabolically unfavorable body composition, comprising abdominal obesity, high fat percentage and low muscle mass. This leads to increased risk of metabolic and cardiovascular diseases.
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Affiliation(s)
- S E Saarni
- National Public Health Institute, Department for Mental Health and Alcohol Research, Mannerheimintie 166, 00300 Helsinki, Finland.
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Lepäntalo M, Laurila K, Roth WD, Rossi P, Lavonen J, Mäkinen K, Manninen H, Romsi P, Perälä J, Bergqvist D. PTFE Bypass or Thrupass for Superficial Femoral Artery Occlusion? A Randomised Controlled Trial. J Vasc Surg 2009. [DOI: 10.1016/j.jvs.2009.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Lepäntalo M, Laurila K, Roth WD, Rossi P, Lavonen J, Mäkinen K, Manninen H, Romsi P, Perälä J, Bergqvist D. PTFE bypass or thrupass for superficial femoral artery occlusion? A randomised controlled trial. Eur J Vasc Endovasc Surg 2009; 37:578-84. [PMID: 19231250 DOI: 10.1016/j.ejvs.2009.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 01/12/2009] [Indexed: 11/16/2022]
Abstract
UNLABELLED Early results of a thrupass endograft in the treatment of femoral lesions are promising. Less morbidity and better cost-effectiveness are suggested to be achieved in the treatment of chronic lower limb ischaemia with endovascular treatment compared to surgical treatment. PATIENTS AND METHODS This randomised multicentre trial aimed to enroll a group of 60+60 patients for the treatment of 5-25-cm occlusions of superficial femoral artery (SFA) to be followed up for 3 years. Patients were treated either with endoluminal PTFE thrupass (WL Gore & Ass) or with surgical polytetrafluoroethylene (PTFE) bypass to proximal popliteal artery. Primary patency at 3 years was scheduled to be the primary end-point and secondary patency, functional success, costs and quality of life the secondary end-points. RESULTS A sample of 100 consecutive SFA occlusions in one of the centres revealed that only 4% of the lesions were amenable for the study. The trial was prematurely terminated due to the results of an interim analysis at the time when 44 patients were recruited: the 1-year primary patency (excluding technical failures) was 48% for thrupass and 95% for bypass (p=0.02). The patency difference in favour of surgical bypass over endovascular thrupass was also sustained after completion of 1-year follow-up, the primary patencies being 46% and 84% at 1 year with grossly equilinear life-table curves thereafter (p=0.18), respectively. The corresponding secondary patencies were 63% and 100% (p=0.05) when excluding technical failures and 58% and 100% (p=0.02) according to intention-to-treat analysis. Secondary outcomes were thus not analysed. CONCLUSION Treatment of SFA occlusions (TASC IIB and C or Imelda Ia and II) should be done by PTFE bypass rather than by PTFE thrupass, as thrupass is connected with worse early outcome. These results represent only a small category of femoral disease.
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Affiliation(s)
- M Lepäntalo
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
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Suvisaari J, Aalto-Setälä T, Tuulio-Henriksson A, Härkänen T, Saarni SI, Perälä J, Schreck M, Castaneda A, Hintikka J, Kestilä L, Lähteenmäki S, Latvala A, Koskinen S, Marttunen M, Aro H, Lönnqvist J. Mental disorders in young adulthood. Psychol Med 2009; 39:287-299. [PMID: 18507875 DOI: 10.1017/s0033291708003632] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The effect of mental disorders may be particularly detrimental in early adulthood, and information on mental disorders and their correlates in this age group is important. METHOD A questionnaire focusing on mental health was sent to a nationally representative two-stage cluster sample of 1863 Finns aged 19 to 34 years. Based on a mental health screen, all screen-positives and a random sample of screen-negatives were asked to participate in a mental health assessment, consisting of the Structured Clinical Interview for DSM-IV (SCID-I) interview and neuropsychological assessment. We also obtained case-notes from all lifetime mental health treatments. This paper presents prevalences, sociodemographic associations and treatment contacts for current and lifetime mental disorders. RESULTS Forty percent of these young Finnish adults had at least one lifetime DSM-IV Axis I disorder, and 15% had a current disorder. The most common lifetime disorders were depressive disorders (17.7%) followed by substance abuse or dependence (14.2%) and anxiety disorders (12.6%). Of persons with any lifetime Axis I disorder, 59.2% had more than one disorder. Lower education and unemployment were strongly associated with current and lifetime disorders, particularly involving substance use. Although 58.3% of persons with a current Axis I disorder had received treatment at some point, only 24.2% had current treatment contact. However, 77.1% of persons with a current Axis I disorder who felt in need of treatment for mental health problems had current treatment contact. CONCLUSIONS Mental disorders in young adulthood are common and often co-morbid, and they may be particularly harmful for education and employment in this age group.
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Affiliation(s)
- J Suvisaari
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.
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Biancari F, Romsi P, Perälä J, Koivukangas V, Cresti R, Juvonen T. Staged endovascular stent-grafting and surgical treatment of a secondary aortoduodenal fistula. Eur J Vasc Endovasc Surg 2005; 31:42-3. [PMID: 16269256 DOI: 10.1016/j.ejvs.2005.09.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 09/26/2005] [Indexed: 01/07/2023]
Abstract
Secondary aortoenteric fistula is a dramatic, rather infrequent late complication occurring mostly after abdominal aortic surgery. Currently, graft excision and in situ bypass is considered the treatment of choice, but it is associated with significant mortality and morbidity. Herein, we describe the case of a secondary aortoduodenal fistula treated by staged endovascular stent-grafting and surgical closure of the fistula. Forty days after stent-grafting, Tc-99m-HMPAO labelled leukocyte scanning failed to identify leukocyte infiltration of the graft and there were no clinical signs of infection. At 8-month follow up, the patient was asymptomatic.
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Affiliation(s)
- F Biancari
- Department of Surgery, Oulu University Hospital, P.O. Box 21, 90229 Oulu, Finland.
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Abstract
Magnetic resonance imaging (MRI) has emerged as a potential guidance tool for a variety of procedures. Diagnostic and therapeutic procedures using either open surgical or percutaneous access are performed. They span from simple lesion targeting and biopsy to complex applications requiring multiple tasks performed simultaneously or in rapid succession. These tasks include instrument guidance and therapy monitoring as well as procedural follow-up. The interventional use of MRI (IMRI) is increasing steadily. This article reviews the prerequisites, systems, and clinical interventional procedures of IMRI.
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Aho PS, Pimenoff G, Salenius JP, Leinonen S, Ylönen K, Manninen H, Jaakkola P, Perälä J, Edgren J, Keto P, Roth WD, Salo J, Sipponen J, Aarnio P, Jalonen T, Lepäntalo M. Endovascular treatment of aortic aneurysms in Finland: the first four years' experience. Scand J Surg 2003; 91:155-9. [PMID: 12164515 DOI: 10.1177/145749690209100204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS In this study the results of endovascular treatment of aortic aneurysms in Finland are presented and compared to the results of the Eurostar registry. MATERIAL AND METHODS A total of 229 patients with aortic aneurysm were treated in five different Finnish centres during 1996-2000. The data of these patients were collected prospectively by surgeon or interventional radiologist involved. During the same period of time 2464 patients were registered in the Eurostar registry. RESULTS The procedure was performed successfully in 97% of patients in Finland, and the 30-day mortality was 0,9%. A graft limb thrombosis was detected in 9% of the patients in Finland. A permanent primary endoleak at the first 30-day control was seen in 23 patients (10%). During the follow-up 17 secondary endoleaks (7%) were detected. A secondary intervention was necessary in 26% of the patients. Three patients (1.3%) had late rupture of the abdominal aortic aneurysm. CONCLUSIONS According to the Finnish short-time results, endovascular treatment of aortic aneurysms is safe and associated with relatively low morbidity and mortality. The mid-term results are more disappointing with relatively many graft thromboses and endoleaks, and a frequent need of secondary interventions.
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Affiliation(s)
- P S Aho
- Department of Vascular Surgery, Helsinki University Central Hospital, Finland.
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Rautio T, Perälä J, Biancari F, Wiik H, Ohtonen P, Haukipuro K, Juvonen T. Accuracy of hand-held Doppler in planning the operation for primary varicose veins. Eur J Vasc Endovasc Surg 2002; 24:450-5. [PMID: 12435347 DOI: 10.1053/ejvs.2002.1734] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate whether hand-held Doppler (HHD) examination is an adequate screening test in planning surgical treatment for primary varicose vein. DESIGN Prospective study. MATERIALS One hundred and eleven consecutive patients (142 legs) with primary, uncomplicated varicose veins. METHODS Legs were examined clinically, with HHD and duplex ultrasonography on the same day at the outpatient clinic. The plan for the subsequent treatment was recorded separately after each examination. RESULTS At the sapheno-femoral junction and at the sapheno-popliteal junction, the sensitivity was 56 and 23%, the specificity 97 and 96%, the positive predictive values was 98 and 43%, the negative predictive value was 44 and 91%, and the Kappa coefficient was 38 and 24%, respectively. Clinical examination failed to correctly plan the treatment in 21 (26%) of 80 proposed operations. In 13 limbs (9.1%) the HHD-based treatment plan was modified on the basis of duplex ultrasound findings. In seven cases, patients would have undergone only stab avulsion procedure, whereas stripping of a saphenous vein was indicated on the basis of duplex ultrasound findings. In two other cases, HHD findings would have led to resect the wrong saphenous vein. In six cases, the treatment was wrongly planned because of assessment problems during HHD examination at the popliteal fossa. CONCLUSIONS The accuracy of HHD in the preoperative evaluation of primary, uncomplicated varicose veins is unsatisfactory. These results suggest that duplex ultrasonography should be considered as the preoperative diagnostic method of choice.
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Affiliation(s)
- T Rautio
- Department of Surgery, Oulu University Hospital, Finland
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Rautio T, Perälä J, Wiik H, Haukipuro K, Juvonen T. Phlebology 2002; 16:149-153. [DOI: 10.1007/s005230200014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rautio T, Perälä J, Wiik H, Haukipuro K, Juvonen T. Influence of Preoperative Duplex Ultrasonography on the Operative Procedure for Primary Varicose Vein Surgery. Phlebology 2001. [DOI: 10.1177/026835550101600405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate the impact of duplex ultrasonography on the treatment plan of patients with uncomplicated primary varicose veins. Methods: Forty-nine consecutive patients (62 legs) with primary uncomplicated varicose veins were examined clinically and with hand-held Doppler (HHD) and duplex ultrasonography in an outpatient clinic on the same day. The plans for subsequent treatment were recorded separately after the two ultrasound examinations. Results: The accuracy of the HHD examination was 0.71 in the saphenofemoral junction (SFJ) and long saphenous vein (LSV trunk). In fifty-six limbs (90%) duplex scanning did not affect the surgical treatment of the patients. Conclusions: Most operations on primary varicose veins can be performed on the basis of clinical and HHD examinations by an experienced surgeon. Duplex ultrasonography can be used selectively in the patients with suspected saphenopopliteal junction (SPJ) reflux or equivocal HHD findings.
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Affiliation(s)
- T. Rautio
- Department of Surgery, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - J. Perälä
- Department of Radiology, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - H. Wiik
- Department of Surgery, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - K. Haukipuro
- Department of Surgery, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - T. Juvonen
- Department of Surgery, University of Oulu and Oulu University Hospital, Oulu, Finland
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Juvonen T, Biancari F, Ylönen K, Perälä J, Rimpiläinen J, Lepojärvi M. Combined surgical and endovascular treatment of pseudoaneurysms of the visceral arteries and of the left iliac arteries after thoracoabdominal aortic surgery. Eur J Vasc Endovasc Surg 2001; 22:275-7. [PMID: 11506523 DOI: 10.1053/ejvs.2001.1433] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- T Juvonen
- Department of Cardio-thoracic and Vascular Surgery, Oulu University Hospital, 90221-Oulu, Finland
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Paananen I, Hellström P, Leinonen S, Merikanto J, Perälä J, Päivänsalo M, Lukkarinen O. Treatment of renal cysts with single-session percutaneous drainage and ethanol sclerotherapy: long-term outcome. Urology 2001; 57:30-3. [PMID: 11164138 DOI: 10.1016/s0090-4295(00)00889-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the safety, efficacy, and long-term outcome of single-session ethanol sclerotherapy for non-neoplastic renal cysts. METHODS In a prospective study, 32 patients with a simple renal cyst were treated with ultrasound-guided percutaneous aspiration, and no more than 100 mL sterile 99% ethanol was injected into the cyst. The procedure was performed under local anesthesia, and the patients were hospitalized overnight. The serum concentrations of alcohol immediately after the sclerotherapy and 1 hour later and the corresponding urine concentrations were measured. The mean follow-up period was 55 months (range 12 to 156). Control checkups were scheduled at 1, 3, 6, 9, and 12 months after the sclerotherapy. During the control visits, the patients underwent ultrasound measurement of the size of the cyst. The history concerning renal pain especially was evaluated by the urologist. The patients were asked if they did or did not have pain. The severity of pain was not evaluated. RESULTS Sclerotherapy with ethanol was performed successfully in all 32 patients with a simple renal cyst. The cyst disappeared completely in 7 patients (22%). The mean size of all cysts decreased from 7.8 cm (range 3 to 16) to 1.7 cm (range 0 to 9; P <0.0001). Before the sclerotherapy, 24 patients had symptoms due to the cyst, and 18 of these (75%) were asymptomatic after the ethanol sclerotherapy. In 2 patients the pain decreased, 2 patients were without change, and in 2 patients the pain increased. There was no correlation between the size of the cyst and the intensity of pain. No major complications occurred. The serum concentration of alcohol varied from 0 to 0.30 g/L and that in urine from 0.04 to 0.27 g/L. CONCLUSIONS Percutaneous aspiration and sclerotherapy with ethanol for simple renal cysts is simple, fast, safe, effective, and inexpensive. The results are comparable to those reported earlier. The treatment is without major complications. We propose sclerotherapy with 99% ethanol as the primary treatment of simple renal cyst. The treatment can be done in an outpatient clinic.
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Affiliation(s)
- I Paananen
- Urological Unit, Surgical Clinic, Oulu University Hospital, Oulu, Finland
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Kiviniemi H, Mäkelä JT, Autio R, Tikkakoski T, Leinonen S, Siniluoto T, Perälä J, Päivänsalo M, Merikanto J. Percutaneous cholecystostomy in acute cholecystitis in high-risk patients: an analysis of 69 patients. Int Surg 1998; 83:299-302. [PMID: 10096746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Optimal treatment of acute cholecystitis in high-risk patients with acute cholecystitis continues to be a difficult therapeutic problem. With the development of more advanced radiological imaging techniques, percutaneous cholecystostomy (PCS) has been presented as an effective treatment alternative in critically ill patients. This paper reports our experiences of percutaneous cholecystostomy in the treatment of acute cholecystitis in a well defined high-risk patient group. METHODS The data concerning 69 high-risk patients with acute cholecystitis treated by percutaneous cholecystostomy in Oulu University Hospital and Kokkola Central Hospital were analyzed. RESULTS Ultrasound showed gallbladder stones in 71% (49/69) of the patients and 29% of them presented with acalculous cholecystitis. After PCS, pain diminished in 94% (61/65), fever in 90% (35/39), CRP values in 87% (53/61) and leucocyte count in 84% (46/55) of the patients. Before PCS, the CRP value was 132+/-106 mg/l and after PCS 79+/-73 mg/l (P = 0.001) and corresponding leucocyte counts were 14.7+/-5.0 and 9.3+/-3.2 (P = 0.001), respectively. The antegrade cholecystocholangiography was performed in 29 patients after PCS, and common bile duct stones were detected in 8 patients; these stones were treated by endoscopic papillotomy. Complications after PCS occurred in 17 patients (26%), but only two patients required emergency laparotomy. Mortality was 19% (13/69). Acute cholecystitis alone was the cause of death in only three patients. Mostly, fatal outcome was caused by the serious underlying diseases. CONCLUSION According to our results, PCS should be the method of choice in high-risk patients with acute cholecystitis.
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Affiliation(s)
- H Kiviniemi
- Department of Surgery, Oulu University Hospital, Finland
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Spalding H, Perälä J, Martikainen H, Tekay A, Jouppila P. Assessing tubal patency with transvaginal salpingosonography after the reversal of tubal ligation for female sterilization. Hum Reprod 1998; 13:2819-22. [PMID: 9804238 DOI: 10.1093/humrep/13.10.2819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objective of this study was to assess tubal patency using transvaginal salpingosonography (TSSG) among women treated by tubal ligation after sterilization and to compare these results with those obtained using X-ray hysterosalpingography (HSG). Twenty-one healthy women were recruited. Air was used as a contrast medium in TSSG and Omnipaque as a water-soluble contrast medium in the HSG examination. All women underwent at least one TSSG. If the woman did not become pregnant during the follow-up or had a miscarriage or tubal pregnancy, she was re-examined with a second TSSG and the results were compared with those of HSG undertaken during the same menstrual cycle. Because of the high pregnancy rate the final number of patients was reduced to 10. The observed agreement between the two TSSGs was 70%, which was low compared with our earlier results. The kappa coefficient was only 0.41. The sensitivity of TSSG for the detection of tubal occlusion was 54%. This can be explained by the fact that the mean time interval between the two TSSGs was long (5.5 months) and results were not therefore comparable or repeatable. We can conclude that the women with patent tubes became pregnant after the first TSSG while the women taking part in the second TSSG had impaired tubal function. There were more occluded tubes observed in the second TSSG than in the first. An analysis comparing the second TSSG with HSG produced better results. The observed agreement was 84%, kappa coefficient 0.67, demonstrating a good reproducibility of TSSG; the sensitivity of TSSG for the detection of tubal occlusion was 83%, specificity 85%, positive predictive value 91% and negative predictive value 75%. Thus, TSSG should be regarded as a reliable, rapid, safe and inexpensive method for testing tubal patency after reversal of tubal ligation for sterilization. It also allows simultaneous scanning of the uterine corpus, endometrium and ovaries and may have a clearing action on occluded tubes. TSSG can thus replace X-ray HSG in the primary evaluation of tubal status, even in this special group of patients.
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Affiliation(s)
- H Spalding
- Department of Obstetrics and Gynecology, University Hospital of Oulu, Finland
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Martikainen H, Salmela P, Nuojua-Huttunen S, Perälä J, Leinonen S, Knip M, Ruokonen A. Insulin-like growth factors and their binding proteins in the venous effluents of ovary and adrenal gland in severely hyperandrogenic women. Hum Reprod 1997; 12:446-8. [PMID: 9130737 DOI: 10.1093/humrep/12.3.446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Insulin and insulin-like growth factors (IGF) are thought to play an important role in the pathogenesis of excessive androgen production. To explore this question further we measured the concentrations of IGF-I and -II and their binding proteins (IGFBP-1 and-3) in adrenal and ovarian vein samples of severely hyperandrogenic women (serum testosterone > 5 nmol/l) collected as part of their diagnostic work-up. The concentration of IGF-II was slightly but not significantly higher in the ovarian vein than in the adrenal and peripheral veins. The concentrations of IGF-I and IGFBP were identical in both the adrenal and ovarian veins and did not differ from those in the peripheral circulation. The concentration of IGFBP-1 was negatively correlated (r = -0.60, P > 0.05) with insulin and IGFBP-3 showed a strong positive correlation with IGF-1 (r = 0.90, P > 0.01). These results indicate that neither the ovary nor the adrenal gland contributes significantly to the circulating pool of IGF or their binding proteins in severely hyperandrogenic subjects. Hyperinsulinaemia is associated with low circulating IGFBP-1 concentrations and IGFBP-3 seems to be an excellent indicator of the peripheral IGF-I concentration. The concentrations of IGF-I suggested decreased somatotrophic activity in these obese, hyperinsulinaemic subjects.
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Affiliation(s)
- H Martikainen
- Department of Obstetrics and Gynecology, University Central Hospital of Oulu, Kajaanintie, Finland
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Martikainen H, Salmela P, Nuojua-Huttunen S, Perälä J, Leinonen S, Knip M, Ruokonen A. Adrenal steroidogenesis is related to insulin in hyperandrogenic women. Fertil Steril 1996; 66:564-70. [PMID: 8816617 DOI: 10.1016/s0015-0282(16)58568-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate ovarian and adrenal steroid secretion in women with severe hyperandrogenism. DESIGN A prospective study. SETTING The Gynecological Endocrine Research Unit of the University Central Hospital, Oulu, Finland. PATIENTS Thirteen obese, hirsute women with severe hyperandrogenism. INTERVENTIONS Adrenocorticotropin hormone stimulation and dexamethasone suppression tests and selective catheterizations of the left ovarian and adrenal veins were performed. MAIN OUTCOME MEASURES The concentrations of insulin, P, 17-hydroxyprogesterone (17-OHP), androstenedione (A), T, DHEA, DHEAS, and cortisol were measured. RESULTS The secretory gradients of T and its precursors, P, 17-OHP, A, and DHEA in the selective catheterizations showed the adrenal to be the main source of excessive steroid production in these patients. The concentrations of P (r = 0.82), 17-OHP (r = 0.89), A (r = 0.84), T (r = 0.86), and cortisol (r = 0.87) in the adrenal vein showed a strong correlation with insulin measured from the same samples. CONCLUSIONS Excessive androgens were secreted mainly by the adrenals in these obese hyperinsulinemic women. Correlation analyses suggested that insulin stimulates adrenal androgen and cortisol secretion, which may constitute an important component of the pathogenetic mechanisms of hyperandrogenism and the polycystic ovary syndrome.
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Affiliation(s)
- H Martikainen
- Department of Obstetrics and Gynecology, University Central Hospital of Oulu, Finland
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Perälä J, Lähde S, Möttönen M. Sarcoma botryoides in CT imaging. Case report. ROFO-FORTSCHR RONTG 1995; 163:532-3. [PMID: 8547625 DOI: 10.1055/s-2007-1016041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- J Perälä
- Department of Diagnostic Radiology, Oulu University Central Hospital, Finland
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