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Brix MAK, Järvinen J, Bode MK, Nevalainen M, Nikki M, Niinimäki J, Lammentausta E. Financial impact of incorporating deep learning reconstruction into magnetic resonance imaging routine. Eur J Radiol 2024; 175:111434. [PMID: 38520806 DOI: 10.1016/j.ejrad.2024.111434] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Artificial intelligence and deep learning solutions are increasingly utilized in healthcare and radiology. The number of studies addressing their enhancement of productivity and monetary impact is, however, still limited. Our hospital has faced a need to enhance MRI scanner throughput, and we investigate the utility of new commercial deep learning reconstruction (DLR) algorithm for this purpose. In this work, a multidisciplinary team evaluated the impact of the widespread deployment of a new commercial deep learning reconstruction (DLR) algorithm for our magnetic resonance imaging scanner fleet. METHODS Our analysis centers on the DLR algorithm's effects on patient throughput and investment costs, contrasting these with alternative strategies for capacity expansion-namely, acquiring additional MRI scanners and increasing device utilization on weekends. We provide a framework for assessing the financial implications of new technologies in a trial phase, aiding in informed decision-making for healthcare investments. RESULTS We demonstrate substantial reductions in total operating costs compared to other capacity-enhancing methods. Specifically, the cost of adopting the deep learning technology for our entire scanner fleet is only 11 % compared to procuring an additional scanner and 20 % compared to the weekend utilization costs of existing devices. CONCLUSIONS Procuring DLR for our existing five-scanner fleet allows us to sustain our current MRI service levels without the need for an additional scanner, thereby achieving considerable cost savings. These reductions highlight the efficiency and economic viability of DLR in optimizing MRI service delivery.
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Affiliation(s)
- Mikael A K Brix
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, Oulu FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland.
| | - Jyri Järvinen
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, Oulu FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
| | - Michaela K Bode
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, Oulu FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
| | - Mika Nevalainen
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, Oulu FI-90220, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
| | - Marko Nikki
- Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
| | - Jaakko Niinimäki
- Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, Oulu FI-90220, Finland
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Leppävuori M, Lammentausta E, Peuna A, Bode MK, Jokelainen J, Ojala J, Nieminen MT. Characterizing Vocal Tract Dimensions in the Vocal Modes Using Magnetic Resonance Imaging. J Voice 2021; 35:804.e27-804.e42. [DOI: 10.1016/j.jvoice.2020.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/25/2022]
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Lahti AM, Huhtakangas J, Juvela S, Bode MK, Tetri S. Increased mortality after post-stroke epilepsy following primary intracerebral hemorrhage. Epilepsy Res 2021; 172:106586. [PMID: 33744678 DOI: 10.1016/j.eplepsyres.2021.106586] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/13/2020] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to determine whether post-stroke epilepsy (PSE) predicts mortality, and to describe the most prominent causes of death (COD) in a long-term follow-up after primary intracerebral hemorrhage (ICH). METHODS We followed 3-month survivors of a population-based cohort of primary ICH patients in Northern Ostrobothnia, Finland, for a median of 8.8 years. Mortality and CODs were compared between those who developed PSE and those who did not. PSE was defined according to the ILAE guidelines. CODs were extracted from death certificates (Statistics Finland). RESULTS Of 961 patients, 611 survived for 3 months. 409 (66.9%) had died by the end of the follow-up. Pneumonia was the only COD that was significantly more common among the patients with PSE (56% vs. 37% of deaths). In the multivariable models, PSE (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.06-1.87), age (HR 1.07, 95% CI 1.06-1.08), male sex (HR 1.35, 95% CI 1.09-1.67), dependency at 3 months (HR 1.52, 95% CI 1.24-1.88), non-subcortical ICH location (subcortical location HR 0.78, 95% CI 0.61-0.99), diabetes (HR 1.43, 95% CI 1.07-1.90) and cancer (HR 1.45, 95% CI 1.06-1.98) predicted death in the long-term follow-up. CONCLUSION PSE independently predicted higher late morality of ICH in our cohort. Pneumonia-related deaths were more common among the patients with PSE.
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Affiliation(s)
- Anna-Maija Lahti
- Department of Neurology, Oulu University Hospital, Box 25, 90029 OYS, Finland.
| | - Juha Huhtakangas
- Department of Neurology, Oulu University Hospital, Box 25, 90029 OYS, Finland.
| | - Seppo Juvela
- Department of Clinical Neurosciences, University of Helsinki, Haartmaninkatu 4, PO Box 22, 00014, Finland.
| | - Michaela K Bode
- Department of Diagnostic Radiology, Oulu University Hospital, Box 25, 90029 OYS, Finland.
| | - Sami Tetri
- Department of Neurosurgery, Oulu University Hospital, Box 25, 90029 OYS, Finland.
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Qian C, Huhtakangas J, Juvela S, Bode MK, Tatlisumak T, Savolainen M, Numminen H, Ollikainen J, Luostarinen L, Kupila L, Tetri S. Early vs. late enoxaparin for the prevention of venous thromboembolism in patients with ICH: A double blind placebo controlled multicenter study. Clin Neurol Neurosurg 2021; 202:106534. [PMID: 33578226 DOI: 10.1016/j.clineuro.2021.106534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 11/30/2022]
Abstract
BACKROUND Venous thromboembolism (VTE) after primary intracerebral hemorrhage (ICH) worsens patient prognosis. Administering low-molecular weight heparins (LMWH) to prevent VTE early (24 h) may increase the risk of hematoma enlargement, whereas administering late (72 h) after onset may decrease its effect on VTE prevention. The authors investigated when it is safe and effective to start LMWH in ICH patients. METHODS In the setting of double blinded, placebo controlled randomization, patients >18 years of age with paretic lower extremity, and admitted to the emergency room within 12 h of the onset of ICH, were randomized into two groups. Patients in the enoxaparin group received 20 mg twice a day 24 h (early) after the onset of ICH and in the placebo group 72 h (late) after onset respectively. Both groups immediately received intermittent pneumatic compression stockings at the ER. Patients were prospectively and routinely screened for VTE and hemorrhagic complications 1 day after entering the study and again before discharge. RESULTS 139 patients were included for randomization in this study. Only 3 patients developed VTE, 2 in the early enoxaparin group and one in the late enoxaparin group. No patients developed PE. Thromboembolic events (p = 0.901), risk of hematoma enlargement (p = 0.927) and overall outcome (P = 0.904) did not differ significantly between the groups. CONCLUSION Administering 40 mg/d LMWH for prevention of VTE to a spontaneous ICH patient is safe regardless of whether it is started 24 h (early) or 72 h (late) after the hemorrhage. Risk of hemorrhage enlargement is not associated with early LMWH treatment. Administering LMWH late did not increase VTEs.
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Affiliation(s)
- C Qian
- Department of Neurosurgery, Oulu University Hospital, Oulu, Finland
| | - J Huhtakangas
- Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - S Juvela
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - M K Bode
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - T Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - M Savolainen
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland; Department of Neurology, South Karelian Central Hospital, Lappeenranta, Finland
| | - H Numminen
- Department of Neurology, Tampere University Hospital, Finland
| | - J Ollikainen
- Department of Neurology, Tampere University Hospital, Finland
| | - L Luostarinen
- Department of Neurology, Päijät-Häme Central Hospital, Finland
| | - L Kupila
- Department of Neurology, Päijät-Häme Central Hospital, Finland
| | - S Tetri
- Department of Neurosurgery, Oulu University Hospital, Oulu, Finland.
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Hautala TJ, Perelygina L, Vuorinen T, Hautala NM, Hägg PM, Bode MK, Rusanen HT, Renko MH, Glumoff V, Schwab N, Schneider-Hohendorf T, Murk JL, Sullivan KE, Seppänen MRJ. Nitazoxanide May Modify the Course of Progressive Multifocal Leukoencephalopathy. J Clin Immunol 2017; 38:4-6. [PMID: 29159786 PMCID: PMC7086546 DOI: 10.1007/s10875-017-0463-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Timo J Hautala
- Department of Internal Medicine, Oulu University Hospital, P.O. Box 20, FIN-90029 OYS, Oulu, Finland.
| | - Ludmila Perelygina
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tytti Vuorinen
- Department of Virology, University of Turku, Turku, Finland
- Department of Clinical Virology, Turku University Hospital, Turku, Finland
| | - Nina M Hautala
- Department of Ophthalmology, Medical Research Center and PEDEGO Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Päivi M Hägg
- Department of Dermatology, Medical Research Center and PEDEGO Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Michaela K Bode
- Department of Diagnostic Radiology, PEDEGO Research Unit and Oulu University Hospital, Oulu, Finland
| | - Harri T Rusanen
- Department of Neurology, PEDEGO Research Unit and Oulu University Hospital, Oulu, Finland
| | - Marjo H Renko
- Department of Pediatrics, PEDEGO Research Unit and Oulu University Hospital, Oulu, Finland
| | - Virpi Glumoff
- Research Unit of Biomedicine, University of Oulu, Oulu, Finland
| | - Nicholas Schwab
- Department of Neurology, University of Münster, Münster, Germany
| | | | - Jean-Luc Murk
- Department of Medical Microbiology and Infection control, University Medical Center Utrecht, Utrecht, The Netherlands
- Laboratory of Medical Microbiology and Immunology, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands
| | - Kathleen E Sullivan
- Division of Allergy Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mikko R J Seppänen
- Immunodeficiency Unit, Inflammation Center and Center for Rare Diseases, Children's Hospital, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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Lahti AM, Saloheimo P, Huhtakangas J, Salminen H, Juvela S, Bode MK, Hillbom M, Tetri S. Poststroke epilepsy in long-term survivors of primary intracerebral hemorrhage. Neurology 2017; 88:2169-2175. [PMID: 28476758 DOI: 10.1212/wnl.0000000000004009] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/20/2017] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To identify the incidence and predisposing factors for development of poststroke epilepsy (PSE) after primary intracerebral hemorrhage (PICH) during a long-term follow-up. METHODS We performed a retrospective study of patients who had had their first-ever PICH between January 1993 and January 2008 in Northern Ostrobothnia, Finland, and who survived for at least 3 months. These patients were followed up for PSE. The associations between PSE occurrence and sex, age, Glasgow Coma Scale (GCS) score on admission, hematoma location and volume, early seizures, and other possible risk factors for PSE were assessed using the Cox proportional hazards regression model. RESULTS Of the 615 PICH patients who survived for longer than 3 months, 83 (13.5%) developed PSE. The risk of new-onset PSE was highest during the first year after PICH with cumulative incidence of 6.8%. In univariable analysis, the risk factors for PSE were early seizures, subcortical hematoma location, larger hematoma volume, hematoma evacuation, and a lower GCS score on admission, whereas patients with infratentorial hematoma location or hypertension were less likely to develop PSE (all variables p < 0.05). In multivariable analysis, we found subcortical location (hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.35-3.81, p < 0.01) and early seizures (HR 3.63, 95% CI 1.99-6.64, p < 0.01) to be independent risk factors, but patients with hypertension had a lower risk of PSE (HR 0.54, 0.35-0.84, p < 0.01). CONCLUSIONS Subcortical hematoma location and early seizures increased the risk of PSE after PICH in long-term survivors, while hypertension seemed to reduce the risk.
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Affiliation(s)
- Anna-Maija Lahti
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland.
| | - Pertti Saloheimo
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Juha Huhtakangas
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Henrik Salminen
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Seppo Juvela
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Michaela K Bode
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Matti Hillbom
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Sami Tetri
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland.
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Abstract
Neurosarcoidosis is a diagnostic challenge, especially if systemic symptoms are absent. We present a 49-year-old woman with isolated neurosarcoidosis. The main symptom was loss of vision in the left eye. Brain MR imaging showed 6 high-signal white matter lesions frontotemporally on proton density and T2-weighted turbo spin-echo images. Coronal fat-saturated turbo FLAIR images of the orbits showed a swollen left optic nerve with increased signal intensity, which finding has not been previously published in sarcoid optic neuropathy. A control MR examination showed meningeal enhancement of the left optic nerve and leptomeningeal enhancing lesions around the brain stem. Spinal MR revealed leptomeningeal enhancement throughout the spinal cord and asymptomatic enhancing cauda equina lesions, mimicking subarachnoid tumour seeding, and an enhancing nerve root mass at Th12/L1. Biopsy of the latter lesion revealed non-caseating granulomas consistent with sarcoidosis.
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Affiliation(s)
- M K Bode
- Department of Radiology, Keski-Pohjanmaa Central Hospital, Kokkola, Finland
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Bode MK, Lindholm P, Kiviniemi V, Moilanen I, Ebeling H, Veijola J, Miettunen J, Hurtig T, Nordström T, Starck T, Remes J, Tervonen O, Nikkinen J. DTI abnormalities in adults with past history of attention deficit hyperactivity disorder: a tract-based spatial statistics study. Acta Radiol 2015; 56:990-6. [PMID: 25182805 DOI: 10.1177/0284185114545147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 06/28/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diffusion tensor imaging (DTI) is a magnetic resonance imaging (MRI) technique enabling visualization and measurement of white matter tracts. Attention deficit hyperactivity disorder (ADHD) has been studied with DTI earlier with variable results, yet there is little research on remitted ADHD. PURPOSE To compare the brain white matter between ADHD drug naïve subjects whose ADHD symptoms have mostly subsided and healthy controls. MATERIAL AND METHODS Tract-based spatial statistics (TBSS) was used to compare 30 subjects with adolescent ADHD with control subjects at the age of 22-23 years. The study population was derived from a population-based Northern Finland Birth Cohort 1986. Fractional anisotropy (FA), mean diffusivity (MD), and measures of diffusion direction (λ1-3) were calculated. Permutation testing was used to test for differences in mean values of FA, MD, and λ1-3 between the groups. The results were corrected for multiple comparisons across the whole white matter skeleton. RESULTS The ADHD group showed increased FA related to decreased radial diffusivity in the left forceps minor (P < 0.05). In the vicinity along the same tract, axial diffusion was significantly decreased without any significant effect on FA. No between-group difference in MD was observed. Regressor analysis revealed no gender-, IQ- or GAF-related changes. After removal of left handed subjects the statistical significance was only barely lost. CONCLUSION In a setting with remitted ADHD, the results may represent a compensatory mechanism in the left forceps minor.
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Affiliation(s)
- Michaela K Bode
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Päivi Lindholm
- Department of Child Psychiatry, University of Oulu, Oulu, Finland
- Clinic of Child Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Vesa Kiviniemi
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Irma Moilanen
- Department of Child Psychiatry, University of Oulu, Oulu, Finland
- Clinic of Child Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Hanna Ebeling
- Department of Child Psychiatry, University of Oulu, Oulu, Finland
- Clinic of Child Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Juha Veijola
- Department of Psychiatry, University of Oulu, Oulu, Finland
- Clinic of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Jouko Miettunen
- Department of Psychiatry, University of Oulu, Oulu, Finland
- Clinic of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Tuula Hurtig
- Clinic of Child Psychiatry, Oulu University Hospital, Oulu, Finland
- Department of Health Sciences, University of Oulu, Oulu, Finland
| | - Tanja Nordström
- Department of Health Sciences, University of Oulu, Oulu, Finland
| | - Tuomo Starck
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Jukka Remes
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Osmo Tervonen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Juha Nikkinen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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Löppönen P, Qian C, Tetri S, Juvela S, Huhtakangas J, Bode MK, Hillbom M. Predictive value of C-reactive protein for the outcome after primary intracerebral hemorrhage. J Neurosurg 2014; 121:1374-9. [PMID: 25170663 DOI: 10.3171/2014.7.jns132678] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Primary intracerebral hemorrhage (ICH) carries high morbidity and mortality rates. Several factors have been suggested as predicting the outcome. The value of C-reactive protein (CRP) levels in predicting a poor outcome is unclear, and findings have been contradictory. In their population-based cohort, the authors tested whether, independent of confounding factors, elevated CRP levels on admission (< 24 hours after ictus) are associated with an unfavorable outcome. METHODS The authors identified all patients who suffered primary ICH between 1993 and 2008 among the population of Northern Ostrobothnia, Finland, and from the laboratory records they extracted the CRP values at admission. Independent predictors of an unfavorable outcome (moderate disability or worse according to the Glasgow Outcome Scale at 3 months) were tested by unconditional logistic regression in a model including all the well-established confounding factors and CRP on admission. RESULTS Of 961 patients, 807 (84%) had CRP values available within 24 hours of admission, and multivariable analysis showed elevated CRP at that point to be associated with an unfavorable outcome (OR 1.41 per 10 mg/L [95% CI 1.09-1.81], p < 0.01), together with diabetes mellitus (OR 1.99 [95% CI 1.09-3.64], p < 0.05), age (1.06 per year [95% CI 1.04-1.08], p < 0.001), low Glasgow Coma Scale score (0.75 per unit [95% CI 0.67-0.84], p < 0.001), hematoma size (1.05 per ml [95% CI 1.03-1.07], p < 0.001), and the presence of an intraventricular hemorrhage (2.70 [95% CI 1.66-4.38], p < 0.001). Subcortical location predicted a favorable outcome (0.33 [95% CI 0.20-0.54], p < 0.001). CONCLUSIONS Elevated CRP on admission is an independent predictor of an unfavorable outcome and is only slightly associated with the clinical and radiological severity of the bleeding.
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Löppönen P, Tetri S, Juvela S, Huhtakangas J, Saloheimo P, Bode MK, Hillbom M. Association between warfarin combined with serotonin-modulating antidepressants and increased case fatality in primary intracerebral hemorrhage: a population-based study. J Neurosurg 2014; 120:1358-63. [DOI: 10.3171/2013.12.jns131898] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Object
Patients receiving oral anticoagulants run a higher risk of cerebral hemorrhage with a poor outcome. Serotonin-modulating antidepressants (selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors [SNRIs]) are frequently used in combination with warfarin, but it is unclear whether this combination of drugs influences outcome after primary intracerebral hemorrhage (PICH). The authors investigated case fatality in PICH among patients from a defined population who were receiving warfarin alone, with aspirin, or with serotonin-modulating antidepressants.
Methods
Nine hundred eighty-two subjects with PICH were derived from the population of Northern Ostrobothnia, Finland, for the years 1993–2008, and those with warfarin-associated PICH were eligible for analysis. Their hospital records were reviewed, and medication data were obtained from the national register of prescribed medicines. Kaplan-Meier survival curves were drawn to illustrate cumulative case fatality, and a Cox proportional-hazards analysis was performed to demonstrate predictors of death.
Results
Of the 176 patients eligible for analysis, 17 had been taking aspirin and 19 had been taking SSRI/SNRI together with warfarin. The 30-day case fatality rates were 50.7%, 58.8%, and 78.9%, respectively, for those taking warfarin alone, with aspirin, or with SSRI/SNRI (p = 0.033, warfarin plus SSRI/SNRI compared with warfarin alone). Warfarin combined with SSRI/SNRI was a significant independent predictor of case fatality (adjusted HR 2.10, 95% CI 1.13–3.92, p = 0.019).
Conclusions
Concurrent use of warfarin and a serotonin-modulating antidepressant, relative to warfarin alone, seemed to increase the case fatality rate for PICH. This finding should be taken into account if hematoma evacuation is planned.
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Affiliation(s)
| | | | - Seppo Juvela
- 4Department of Clinical Neurosciences, University of Helsinki, Finland
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Tikkakoski T, Ostrovska V, Ingo S, Bode MK, Timo K, Tuominen H. [Gliomatosis cerebri as cause of neuropsychiatric symptoms]. Duodecim 2014; 130:1183-1187. [PMID: 25016665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Gliomatosis cerebri (GC) is a rare cancer of the central nervous system, having already penetrated into various areas of the central nervous system upon becoming manifest. In tissue specimens the histopathologic picture of the tumor appears similar to that seen in diffuse gliomas at different stages of disease. Typical MRI findings in GC include diffuse increases in signal intensity in the brain, and indistinct gray-white matter demarcation in T2-weighted images. Surgical treatment is usually not possible. We describe a patient, in whom CG turned eventually out to be the cause of severe neuropsychiatric symptoms.
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Kaivorinne AL, Bode MK, Paavola L, Tuominen H, Kallio M, Renton AE, Traynor BJ, Moilanen V, Remes AM. Clinical Characteristics of C9ORF72-Linked Frontotemporal Lobar Degeneration. Dement Geriatr Cogn Dis Extra 2013; 3:251-62. [PMID: 24052799 PMCID: PMC3776392 DOI: 10.1159/000351859] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The most common genetic cause of frontotemporal lobar degeneration (FTLD) and amyotrophic lateral sclerosis (ALS) has been linked to a hexanucleotide repeat expansion in the C9ORF72 gene. The frequency of the C9ORF72 expansion in Finland is among the highest in the world. METHODS We assessed 73 Finnish patients with FTLD in order to examine the clinical characteristics associated with the expanded C9ORF72. Demographic and clinical features were evaluated. As a potential disease modifier, the apolipoprotein E (APOE) genotype was also assessed. Neuropathological analysis was available on 2 expansion carriers and 1 non-carrier. RESULTS The C9ORF72 expansion was present in 20 of 70 (29%) probands. Significant associations with the C9ORF72 expansion were observed for concomitant ALS and positive family history of dementia or ALS. Psychoses were detected in both carriers and non-carriers (21 vs. 10%, p = 0.25). The APOE ε4 allele did not cluster among expansion carriers. Numerous p62-positive neuronal inclusions were detected in the cerebellar cortex of the 2 expansion carriers. CONCLUSION In line with the suggested C9ORF72 core phenotype, we also detected a high frequency of neuropsychiatric symptoms; however, these symptoms seem not be specific to C9ORF72-associated FTLD. FTLD should be considered in cases of middle-age-onset psychosis.
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Affiliation(s)
- Anna-Lotta Kaivorinne
- Department of Neurology, Institute of Clinical Medicine, University of Oulu, Kuopio, Finland ; Clinical Research Center, Oulu University Hospital, Kuopio, Finland
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Huhtakangas J, Löppönen P, Tetri S, Juvela S, Saloheimo P, Bode MK, Hillbom M. Predictors for recurrent primary intracerebral hemorrhage: a retrospective population-based study. Stroke 2013; 44:585-90. [PMID: 23329207 DOI: 10.1161/strokeaha.112.671230] [Citation(s) in RCA: 30] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Underlying comorbidities, previous strokes, and medication may increase the risk for primary intracerebral hemorrhage (PICH) and its recurrence. The aim of this study was to determine the independent predictors for recurrent PICH. METHODS We identified 961 subjects with first-ever PICH from 1993 to 2008 among the population of Northern Ostrobothnia, Finland. Hospital and death records were reviewed and data on drug use were obtained from the national register of prescribed medicines. Kaplan-Meier survival curves and Cox proportional hazards models were used to demonstrate predictors for recurrence of PICH. RESULTS Total follow-up time of the 961 patients was 3481 person-years. During the follow-up time, 58 subjects had altogether 68 recurrent PICHs. The annual average incidence of first recurrence was 1.67%. Cumulative 5- and 10-year incidence rates were 9.6% and 14.2%, respectively. In univariable analysis, history of ischemic stroke, diabetes mellitus, and aspirin use were associated with a higher recurrence rate. In multivariable analysis, only previous ischemic stroke (adjusted hazard ratio, 2.22; 95% confidence interval, 1.22-4.05; P=0.009) independently predicted PICH recurrence. Diabetes mellitus tended to increase (adjusted hazard ratio, 2.38; 95% confidence interval, 0.98-5.80; P=0.056), whereas treated hypertension tended to decrease (0.45, 0.20-1.01; P=0.054) the risk for fatal recurrent PICH. CONCLUSIONS Previous ischemic stroke independent of confounding factors may increase the risk for PICH recurrence.
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Affiliation(s)
- Juha Huhtakangas
- Department of Neurology, Oulu University Hospital, Oulu, Finland.
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Huhtakangas J, Tetri S, Juvela S, Saloheimo P, Bode MK, Karttunen V, Käräjämäki A, Hillbom M. Improved survival of patients with warfarin-associated intracerebral haemorrhage: a retrospective longitudinal population-based study. Int J Stroke 2012; 10:876-81. [PMID: 23231388 DOI: 10.1111/j.1747-4949.2012.00926.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Warfarin-associated intracerebral haemorrhage carries poor outcome due to rapid haemorrhage growth. Reversal of warfarin anticoagulation with prothrombin complex concentrate has been implemented as an acute treatment option for these subjects. AIM We investigated whether survival of subjects with warfarin-associated intracerebral haemorrhage had improved after implementation of reversal of warfarin anticoagulation with prothrombin complex concentrate. METHODS We identified all subjects with warfarin-associated intracerebral haemorrhage during 1993-2008 among the population of Northern Ostrobothnia, Finland. From 2004 onwards, prothrombin complex concentrate was used in Oulu University Hospital, the only hospital treating intracerebral haemorrhage subjects in the region, to counteract the effect of warfarin in subjects with warfarin-associated intracerebral haemorrhage. We compared the outcomes of subjects admitted during 1993-2003 and 2004-2008 and those treated and not treated with prothrombin complex concentrate. We also explored the predictors for one-year survival of the warfarin-associated intracerebral haemorrhage subjects. RESULTS We identified altogether 181 subjects who had intracerebral haemorrhage while on warfarin. One-year survival was significantly (P = 0·031) higher for the 60 subjects admitted during 2004-2008 (43·3%) than for the 121 admitted before 2004 (30·6%). In multivariable analysis, prothrombin complex concentrate treatment reduced one-year case fatality (hazard ratio 0·52, 95% confidence interval 0·29-0·93). Thromboembolic complications did not occur more frequently among those treated with prothrombin complex concentrate. CONCLUSION The survival of warfarin-associated intracerebral haemorrhage subjects among the population of Northern Ostrobothnia has improved likely because of introduction of prothrombin complex concentrate.
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Affiliation(s)
- Juha Huhtakangas
- Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - Sami Tetri
- Department of Neurosurgery, Oulu University Hospital, Oulu, Finland
| | - Seppo Juvela
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Pertti Saloheimo
- Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - Michaela K Bode
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Vesa Karttunen
- Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - Anni Käräjämäki
- Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - Matti Hillbom
- Department of Neurology, Oulu University Hospital, Oulu, Finland
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Bode MK, Mattila ML, Kiviniemi V, Rahko J, Moilanen I, Ebeling H, Tervonen O, Nikkinen J. White matter in autism spectrum disorders - evidence of impaired fiber formation. Acta Radiol 2011; 52:1169-74. [PMID: 22101385 DOI: 10.1258/ar.2011.110197] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diffusion tensor imaging (DTI) enables measurements and visualization of the microstructure of neural fiber tracts. The existing literature on autism spectrum disorders (ASDs) and DTI is heterogenous both regarding methodology and results. PURPOSE To compare brain white matter of high-functioning individuals with ASDs and controls. MATERIAL AND METHODS Tract-based spatial statistics (TBSS), a voxel-based approach to DTI, was used to compare 27 subjects with ASDs (mean age 14.7 years, range 11.4-17.6 years, 20 boys, 7 girls) and 26 control subjects (mean age 14.5 years, range 11.7-17.3 years, 17 boys, 9 girls). Mean fractional anisotropy (FA) image (skeleton) was created and each subject's aligned FA data were then projected onto this skeleton. Voxelwise cross-subject statistics on the skeletonized FA data, mean diffusivity (MD), and measures of diffusion direction were calculated. Importantly, the data were corrected across the whole image instead of using ROI-based methods. RESULTS The ASD group showed significantly greater FA (P < 0.05, corrected) in the area containing clusters of optic radiation and the right inferior fronto-occipital fasciculus (iFOF). In the same area, λ(3) (representing transverse diffusion) was significantly reduced in the ASD group. No age-related changes were found. CONCLUSION The results suggest that the reduced transverse diffusion within the iFOF is related to abnormal information flow between the insular salience processing areas and occipital visual areas.
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Affiliation(s)
| | | | | | - Jukka Rahko
- Clinic of Child Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Irma Moilanen
- Clinic of Child Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Hanna Ebeling
- Clinic of Child Psychiatry, Oulu University Hospital, Oulu, Finland
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Affiliation(s)
- Juha Huhtakangas
- From the Departments of Neurology (J.H., P.S., M.H.), Neurosurgery (S.T.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital, Oulu, Finland; and Clinical Neurosciences (S.J.), University of Helsinki, Helsinki, Finland
| | - Sami Tetri
- From the Departments of Neurology (J.H., P.S., M.H.), Neurosurgery (S.T.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital, Oulu, Finland; and Clinical Neurosciences (S.J.), University of Helsinki, Helsinki, Finland
| | - Seppo Juvela
- From the Departments of Neurology (J.H., P.S., M.H.), Neurosurgery (S.T.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital, Oulu, Finland; and Clinical Neurosciences (S.J.), University of Helsinki, Helsinki, Finland
| | - Pertti Saloheimo
- From the Departments of Neurology (J.H., P.S., M.H.), Neurosurgery (S.T.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital, Oulu, Finland; and Clinical Neurosciences (S.J.), University of Helsinki, Helsinki, Finland
| | - Michaela K. Bode
- From the Departments of Neurology (J.H., P.S., M.H.), Neurosurgery (S.T.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital, Oulu, Finland; and Clinical Neurosciences (S.J.), University of Helsinki, Helsinki, Finland
| | - Matti Hillbom
- From the Departments of Neurology (J.H., P.S., M.H.), Neurosurgery (S.T.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital, Oulu, Finland; and Clinical Neurosciences (S.J.), University of Helsinki, Helsinki, Finland
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Abstract
BACKGROUND Diagnosis of mucinous carcinoma can be difficult due to its benign appearance on mammograms and ultrasonographic (US) images. In the light of the rather scarce literature, core needle biopsy (CNB) has proved useful in diagnosing mucinous lesions. PURPOSE To assess mammographic, US, and CNB findings of mucinous breast tumors and to correlate them with final histology obtained in therapeutic surgery. MATERIAL AND METHODS From 2000-2006, 25 mucinous carcinomas detected with CNB were surgically removed. The mammography, US, and CNB results were analyzed and correlated with final histology. RESULTS Ninety-six percent of the mucinous carcinomas (24/25) were visible with US. All except two of the 24 tumors were solid masses. All the mixed-type lesions (group 2) were hypoechoic and had irregular or lobulated margins and heterogeous internal echotexture. The US features were more variable among the 14 pure mucinous carcinomas (group 1) and the six US visible mucinous carcinomas with cancerous cells outside the tumor (group 3). Fifty-seven percent of group 1 and 50% of group 3 tumors had clearly lobulated or irregular margins. Fifty-seven percent of group 1 and 67% of group 3 cancers were hypoechoic. A vast majority of these tumors had heterogenous echotexture. Seventy-one percent (17/24) of the lesions visible with US had posterior acoustic enhancement. Eighty percent (20/25) of the mucinous carcinomas were classified as BI-RADS 4 lesions in US. All the lesions with images available were visible on mammograms, where most of the tumors were seen as a high-density circumscribed lesion and classified as BI-RADS 4 lesions, while none were classified as BI-RADS 1, 2 or 5. The sensitivity and positive predictive value of CNB regarding mucinous carcinoma was 100%. CONCLUSION CNB was found to be a highly reliable diagnostic tool for diagnosing mucinous carcinoma in this selected material. US findings of pure mucinous carcinoma were variable, however, all reached BI-RADS 4 category. The presence of posterior acoustic enhancement beneath a solid breast lesion should raise suspicion of mucinous carcinoma. Most of the tumors appeared as BI-RADS 4 lesions in US and in mammography thus making both a useful tool for raising a suspicion of malignancy in mucinous cancers.
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Affiliation(s)
- MK Bode
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - T Rissanen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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Karttunen V, Bode MK. [Microhemorrhages in the brain. A magnetic resonance imaging finding with emerging significance]. Duodecim 2010; 126:1810-1818. [PMID: 20824970] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Microhemorrhages in the brain refer to minor chronic hemorrhages that are revealed by specific magnetic imaging techniques. Whereas microhemorrhages in the brain are a common finding in patients with a disorder of the cerebral circulation, they are surprisingly often found also in elderly persons who are considered healthy. Microhemorrhages can be regarded as a biomarker of cerebral microangiopathy. They may also offer additional diagnostic information, provide clues for the prognosis of brain diseases, and influence clinical decisions. The patient's medical history, the location, number and distribution of imaging findings have a central role in the assessment of clinical significance.
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Abstract
BACKGROUND The diagnosis of phyllodes tumors of the breast is challenging due to many similarities with common fibroadenomas. PURPOSE To determine the diagnostic accuracy of core needle biopsy in diagnosing phyllodes tumors and to analyze the ultrasonographic (US) features of phyllodes tumors and fibroadenomas. MATERIAL AND METHODS From 1999 to 2003, 1010 breast lesions underwent imaging-guided core needle biopsy. Of these, 57 fibroadenomas and 12 phyllodes tumors were removed surgically. The US and needle biopsy results of a total of 64 lesions (52 fibroadenomas and 12 phyllodes tumors) were further analyzed, compared, and correlated with surgical histological results. RESULTS The median sonographic sizes of the phyllodes tumors and the fibroadenomas were 3.2 cm and 1.6 cm, respectively. At US, 58% of the phyllodes tumors (7/12) were classified as equivocal or suspicious of malignancy and 42% (5/12) as probably benign, while 54% of the fibroadenomas (28/52) were classified as probably benign and 46% (24/52) as equivocal. The sensitivity, specificity, and positive and negative predictive values of core needle biopsy histology regarding tumor phyllodes were 83%, 92%, 71%, and 96%, respectively. CONCLUSION Imaging-guided core needle biopsy was accurate in differentiating between fibroadenomas and phyllodes tumors. US classification was unreliable due to considerable overlap in the findings. Combined use of US feature analysis and needle biopsy may help to avoid the misinterpretation of phyllodes as fibroadenoma.
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Affiliation(s)
- M K Bode
- Departments of Diagnostic Radiology and Pathology, Oulu University Hospital, FIN-90029 OYS, Oulu, Finland.
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Abstract
Diffusion magnetic resonance imaging (MRI) is a method for quantifying the microscopic random motion of water molecules in tissues. Diffusion imaging provides indirect structural information of a kind not available on basic MRI sequences of many pathological conditions. Lately, especially brain tumors have been under active investigation, with numerous papers already published, and their number continues to increase. This review summarizes the heterogeneous and complex research data on diffusion imaging of brain tumors.
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Affiliation(s)
- M K Bode
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
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Bode MK, Nieminen MT. Is diffusion tensor imaging at 3T useful in assessing tumor extension in brain tumors? Acta Radiol 2006; 47:230. [PMID: 16613301 DOI: 10.1080/02841850500518243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bode MK, Karttunen A, Karttunen V, Jartti P. [Radiological findings of brain, connected to alcohol overuse]. Duodecim 2006; 122:315-23. [PMID: 16619889] [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] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Bode MK, Perälä J, Kariniemi J, Venhola M, Kunelius P, Hellström P. [Not Available]. Duodecim 2006; 122:2044-8. [PMID: 17115686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Abstract
BACKGROUND AND OBJECTIVES There is only limited and somewhat controversial information available on hepatic artery infusion of cytotoxic agents in gallbladder cancer. We report the results of 5-year follow-up of all gallbladder cancer patients treated with surgery and intra-arterial mitomycin C or mitomycin C alone in our hospital during 15 years. METHODS Thirty-five patients with gallbladder cancer were treated with superselective intra-arterial chemotherapy (SIAC) with mitomycin C during 1981-1996. Survival was measured from diagnosis, and all patients were followed up until death or the end of January 2002. Cumulative survival rates and median survival times were calculated for all patients, according to response to treatment and staging. The data are presented as 5-year survival. RESULTS Median survival times after SIAC for all patients, responders, and non-responders were 48, 60+, and 8.5 months, respectively. Overall response rate was 60%. Survival was significantly better for tumors limited to the gallbladder wall, as expected. Drug toxicity occurred in half of the patients, requiring cessation of chemotherapy in 25% of the cases. CONCLUSIONS The median survival of gallbladder cancer patients treated with surgery and SIAC seems to be significantly better compared to the previously reported outcome of surgical treatment alone. Drug toxicity limits the use of i.a. chemotherapy and requires careful monitoring for early side-effects.
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Affiliation(s)
- Michaela K Bode
- Department of Radiology, Oulu University Hospital, Oulu, Finland.
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Pihlajamaa K, Bode MK, Puumalainen T, Lehtimäki A, Marjelund S, Tikkakoski T. Pneumothorax and the value of chest radiography after ultrasound-guided thoracocentesis. Acta Radiol 2004; 45:828-32. [PMID: 15690612 DOI: 10.1080/02841850410008270] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 10/25/2022]
Abstract
PURPOSE To determine the incidence, the operator's experience, and other variables that may influence the development of pneumothorax or re-expansion edema after ultrasound (US)-guided thoracocentesis. MATERIAL AND METHODS The medical records of 264 procedures in 212 patients who had undergone US-guided thoracocentesis in our radiology department or intensive care unit during the period 1996-2001 were retrospectively reviewed. RESULTS Post-thoracocentesis pneumothorax occurred in 11 cases, the incidence being 4.2% (11/264). None of the pneumothoraces occurred in the 10 mechanically ventilated patients. All but one patient with pneumothorax were asymptomatic or had only minor symptoms. Chest tube drainage was needed in one patient with a large pneumothorax. No re-expansion edema was recorded, although 1500 ml or more pleural fluid was aspirated in 29 patients. The operator's experience had no effect on the complication rate. Needle size was the only significant variable that contributed to the pneumothorax rate. CONCLUSION US-guided thoracocentesis can be done equally as safely by residents as by senior radiologists. The safety and feasibility of the method are evident among mechanically ventilated intensive care patients. Our results do not support the routine use of post-thoracocentesis chest radiography.
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Affiliation(s)
- K Pihlajamaa
- Department of Radiology, Oulu University, Oulu, Finland.
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Bode MK, Isokangas JM, Tikkakoski T, Tuisku S, Vähämäki L, Kumpulainen T, Siniluoto T. [Spinal epidural arterio-venous fistula, a rare course of paraparesis]. Duodecim 2004; 120:1091-6. [PMID: 15232851] [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] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Bode MK, Tikkakoski T, Tuisku S, Jartti P, Karttunen A, Heiskari M, Hernesniemi J. [Transdural herniation of the spinal cord due to dural tear]. Duodecim 2003; 119:61-6. [PMID: 12607474] [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] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Michaela K Bode
- Keski-Pohjanmaan keskussairaala, röntgenosasto Mariankatu 16-20 67200 Kokkola
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Tikkakoski T, Bode MK, Siponen P, Siniluoto T. [Imaging techniques in the diagnostics of pulsating tinnitus]. Duodecim 2003; 119:103-12. [PMID: 12607425] [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] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Tapani Tikkakoski
- Keski-Pohjanmaan sairaanhoitopiiri Röntgenosasto Mariankatu 16-20 67200 Kokkola.
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Pihlajamaa K, Bode MK, Puumalainen T, Tikkakoski T. [Pneumothorax and chest x-ray after ultrasonography-guided pleural puncture]. Duodecim 2003; 118:2313-5. [PMID: 12523108] [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] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- Kai Pihlajamaa
- Keski-Pohjanmaan sairaanhoitopiiri, röntgenosasto Mariankatu 16-20 67200 Kokkola.
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Bode MK, Tikkakoski T, Johansson J, Johansson K, Kariniemi J, Apaja-Sarkkinen M, Tuominen H. [Diagnostics and therapy of cervical lymphoma]. Duodecim 2003; 119:131-4. [PMID: 12607428] [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] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- Michaela K Bode
- Keski-Pohjanmaan keskussairaalan röntgenosasto 67200 Kokkola.
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Tikkakoski T, Nieminen P, Bode MK, Stenfors LE. [Clinical significance and imaging diagnostics of enlarged vestibular aqueduct]. Duodecim 2002; 118:625-8. [PMID: 12233007] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Tapani Tikkakoski
- Department of Otolaryngology, University Hospital, P.O. Box 34, N-9038 Tromsö, Norway.
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Bode MK, Tikkakoski T, Tuisku S, Rönty H, Ilkko E. [Dysphagia, cough and headache caused by Arnold-Chiari type I malformation]. Duodecim 2002; 117:1651-4. [PMID: 12182104] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- M K Bode
- Keski-Pohjanmaan keskussairaalan röntgenosasto Mariankatu 16-20, 67200 Kokkola.
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Bode MK, Tikkakoski T, Johansson J, Johansson K, Kariniemi J, Apaja-Sarkkinen M, Tuominen H. Lymphoma of the cervix. Imaging and transcatheter arterial embolization. Acta Radiol 2002. [PMID: 12225489 DOI: 10.1034/j.1600-0455.2002.430417.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A case of uterine cervix lymphoma with selective embolization after angiography is described. Chemotherapy and radiotherapy were carried out and surgery was avoided.
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Affiliation(s)
- M K Bode
- Department of Radiology, Keski-Pohjanmaa Central Hospital, Kokkola, Finland
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Bode MK, Tikkakoski T, Johansson J, Johansson K, Kariniemi J, Apaja-Sarkkinen M, Tuominen H. Lymphoma of the cervix. Imaging and transcatheter arterial embolization. Acta Radiol 2002; 43:431-2. [PMID: 12225489 DOI: 10.1080/j.1600-0455.2002.430417.x] [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: 04/19/2023]
Abstract
A case of uterine cervix lymphoma with selective embolization after angiography is described. Chemotherapy and radiotherapy were carried out and surgery was avoided.
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Affiliation(s)
- M K Bode
- Department of Radiology, Keski-Pohjanmaa Central Hospital, Kokkola, Finland
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Abstract
OBJECTIVE the extent of the processing of type III procollagen to type III collagen was determined in nine human abdominal aortic aneurysms (AAA), and compared with ten samples of aortoiliac occlusive disease (AOD). METHODS the aminoterminal propeptide (PIIINP) and telopeptide (IIINTP) of type III procollagen and collagen, respectively, were immunologically measured in the soluble and insoluble fractions of the extracellular matrix. The assay for PIIINP in the insoluble matrix was further validated. RESULTS the insoluble matrices of AAAs contained at least 12 times more incompletely processed type III pN-collagen than AOD specimens (0.74% and 0.061%, respectively). Also, the soluble extracts of AAAs tended to contain more non-processed type III pN-collagen than free, properly cleaved aminoterminal propeptide. CONCLUSIONS the larger amount of type III pN-collagen suggests an alteration in the metabolism of type III collagen in AAAs. This may partially explain the decreased tensile strength of the aortic tissue.
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Affiliation(s)
- M K Bode
- Department of Clinical Chemistry, FIN-90014, University of Oulu, Finland
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Bode MK, Soini Y, Melkko J, Satta J, Risteli L, Risteli J. Increased amount of type III pN-collagen in human abdominal aortic aneurysms: evidence for impaired type III collagen fibrillogenesis. J Vasc Surg 2000; 32:1201-7. [PMID: 11107093 DOI: 10.1067/mva.2000.109743] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [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: 11/22/2022]
Abstract
PURPOSE This study aimed to characterize the distribution of structural domains of type I and III collagens in the wall of abdominal aortic aneurysms (AAAs), by the use of undilated atherosclerotic aortas (aortoiliac occlusive disease [AOD]) and healthy abdominal aortas as controls. METHODS Immunohistochemical staining was applied with antibodies for the aminoterminal propeptides of type I (PINP) and type III (PIIINP) procollagens, which represent newly synthesized type I and III pN-collagens. In addition, an antibody against the aminoterminal telopeptide of type III collagen (IIINTP) was used as a means of detecting maturely cross-linked type III collagen fibrils. RESULTS The newly synthesized type III procollagen detected by means of PIIINP staining was concentrated in the media in aneurysmal aortas, whereas type I pN-collagen was localized in the intima in both AAAs and AODs. The healthy aortas showed no immunoreactivity for either PIIINP or PINP. The cross-linked type III collagen, detected by means of IIINTP staining, stained transmurally in all study groups, but appeared more abundant in the media in AAAs. CONCLUSION Our results strongly suggest that the metabolism of type III collagen is enhanced in AAAs. Intensive type III pN-collagen staining was present mainly in the media layer in AAAs, suggesting a role of type III collagen in aneurysm formation, whereas type I pN-collagen was present in the intima in both AAAs and AODs, suggesting that type I collagen synthesis is a fibroproliferative response related to the atherosclerotic process. The increased type III pN-collagen in AAAs may result in impaired fibril formation and, thus, in decreased tensile strength of aneurysmal tissue.
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Affiliation(s)
- M K Bode
- Departments of Clinical Chemistry, University of Oulu, Finland
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Abstract
BACKGROUND Collagens are major proteins in the extracellular matrix, providing tissues with tensile strength. They are also important for cell adhesion and the invasion of malignant tumours. METHODS Thirty-nine samples of human colon (24 diverticulosis, 6 malignant tumours, 9 controls) were collected during elective surgery. Immunoassays for different domains of type I and III collagens and procollagens were used in soluble tissue extracts and trypsin digests of tissue samples. RESULTS The contents of cross-linked type I and III collagen telopeptides and total collagen were similar in diverticulosis and healthy tissue, whereas in malignant tissue maturely cross-linked type III collagen was scarce. Furthermore, some of the cross-linked type I telopeptide antigens were exceptionally small in size, indicating that the cross-linking of type I collagen in collagen fibres is impaired in cancer. The rate of type I collagen synthesis was clearly increased in malignancy, but not significantly in diverticulosis. However, type III collagen synthesis was increased in diverticulosis, but not in malignancy. CONCLUSIONS In colon malignancy, the collagen cross-linking process was aberrant and the synthesis of type I collagen increased. In diverticulosis, the synthesis of type III collagen was increased, suggesting only moderately increased metabolic activity.
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Affiliation(s)
- M K Bode
- Dept. of Clinical Chemistry, University of Oulu, Finland
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Abstract
Malignant tumours often induce a fibroproliferative response in the adjacent stroma, characterized by increased expression of type I and type III procollagens. In normal tissues, fibrillar collagens normally undergo extensive intermolecular cross-linking that provides tensile strength to the tissue. Here we set out to characterize collagen cross-linking in human ovarian carcinoma tissue in vivo. Biochemical and immunochemical methods were used for cross-linked telopeptides of type I and III collagens in samples of benign and malignant serous tumours. The locations and staining patterns of these proteins were visualized immunohistochemically. The contents of both total collagen and the cross-linked type I and type III collagens in the malignant samples were only about 20% of those in the benign tumours. The cross-linked telopeptide antigens derived from the collagens were smaller and more heterogeneous in size in the malignant than in the benign tumours, indicating a defective cross-linking process scarcely leading to the formation of mature cross-links in the collagen fibres in malignancy. Immunostaining revealed disorganized type I and type III collagen bundles in carcinomas. These findings suggest that the collagen cross-linking process is aberrant in malignant tumours, possibly resulting in increased susceptibility of tumour collagens for the proteolysis often associated with tumour invasion.
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Affiliation(s)
- S Kauppila
- Department of Clinical Chemistry, University of Oulu, Finland
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Bode MK, Mosorin M, Satta J, Risteli L, Juvonen T, Risteli J. Complete processing of type III collagen in atherosclerotic plaques. Arterioscler Thromb Vasc Biol 1999; 19:1506-11. [PMID: 10364082 DOI: 10.1161/01.atv.19.6.1506] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [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: 12/22/2022]
Abstract
The extent of processing of type III collagen is assessed, and the proportions of type I and III collagens are estimated in atherosclerotic plaques obtained from the carotid artery, common femoral artery, and aorta. The fraction of type III collagen that had retained its amino-terminal propeptide (pN-collagen) was 42% in the soluble extract but only 0.0081% in the insoluble residue. Taken together, only 0.011% of the type III collagen in whole plaques was in the form of type III pN-collagen. Together with the small amounts of the free propeptides of type I procollagen, this finding indicates a low rate of collagen turnover. The amounts of solubilized telopeptides of type I and III collagens were measured, after heat denaturation and trypsin digestion of the collagenous helix, by specific immunoassays for the corresponding trypsin-generated antigens. The mean proportion of type III collagen was 61% (95% confidence interval, 58% to 65%) in the carotid and femoral artery plaques and 56% (95% confidence interval, 44% to 68%) in the aortic specimens. The completely processed and cross-linked type III collagen seems to be the major collagen type in atherosclerotic plaques.
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Affiliation(s)
- M K Bode
- Department of Clinical Chemistry, University of Oulu, Oulu, Finland
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