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Lindholm J, Taipale C, Ylinen P, Tuuminen R. Perioperative subconjunctival triamcinolone acetonide injection for prevention of inflammation and macular oedema after cataract surgery. Acta Ophthalmol 2020; 98:36-42. [PMID: 31210019 DOI: 10.1111/aos.14175] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 12/02/2018] [Accepted: 05/28/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the efficacy, safety and tolerability of a single perioperative subconjunctival injection of triamcinolone acetonide (TA) with steroid drops for the prevention of macular oedema and ocular inflammation after cataract surgery. METHODS This prospective non-randomized controlled clinical trial analysed 101 eyes of 101 patients having an elective cataract surgery at Kymenlaakso Central Hospital, Kotka, Finland. Fifty eyes received conventional postoperative care with dexamethasone 1 mg/ml eye drops (DEX), and 51 eyes received a perioperative 20 mg subconjunctival injection of TA. None of the eyes received postoperative topical antibiotic prophylaxis. The main outcome measures were aqueous flare, central retinal thickness (CRT), corrected distance visual acuity (CDVA) and intraocular pressure (IOP) measured at 7, 28 and 90 days after surgery. RESULTS Central retinal thickness (CRT) increased in DEX but not in TA-treated eyes at 7 days (+1.2 ± 20.1 μm and -9.2 ± 24.8 μm, p = 0.031), at 28 days (+23.8 ± 62.6 μm and -3.3 ± 27.7 μm, p = 0.008) and at 90 days (+8.5 ± 24.4 μm and -5.5 ± 33.4 μm, p = 0.026). Aqueous flare increased from baseline in both groups but remained higher in DEX eyes at 90 days (+3.3 ± 9.9 photons/ms and -0.2 ± 6.6 photons/ms, p = 0.021). Corrected distance visual acuity (CDVA) and IOP changes were similar, and ocular tolerance was good in both groups. No serious adverse events were observed. CONCLUSIONS Perioperative subconjunctival TA was effective in preventing ocular inflammation and macular oedema after cataract surgery. Subconjunctival TA combined with intracameral cefuroxime provides a noteworthy option for dropless postoperative care in modern cataract surgery.
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Affiliation(s)
- Juha‐Matti Lindholm
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Claudia Taipale
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Petteri Ylinen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Kymenlaakso Central Hospital Unit of Ophthalmology Kotka Finland
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Ylinen P, Taipale C, Lindholm JM, Laine I, Holmström E, Tuuminen R. Postoperative management in cataract surgery: nepafenac and preservative-free diclofenac compared. Acta Ophthalmol 2018; 96:853-859. [PMID: 30284393 DOI: 10.1111/aos.13843] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 02/19/2018] [Accepted: 05/14/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Current cataract surgery guidelines recommend routine use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing pseudophakic cystoid macular oedema (PCME). Here, we compare the clinical efficacy and tolerability of two potent NSAIDs, nepafenac and preservative-free diclofenac following cataract surgery. METHODS Randomized, double-blind, prospective single-centre study. Ninety-six eyes of 95 patients undergoing routine cataract surgery were randomized 1:1 either to nepafenac (Nevanac, 1 mg/ml) or diclofenac (Dicloabak, 1 mg/ml) for 3 weeks. Seventy-three patients accounting for 73 eyes completed the entire follow-up. Aqueous flare and central retinal thickness (CRT) analysis were conducted preoperatively and at control visits 28 days and 3 months after surgery. A structured home questionnaire and interview were used to record any adverse effects of the topical medications, subjective visual recovery and the dispenser's ease of use. RESULTS No differences were observed between the groups for aqueous flare, CRT, speed of recovery or visual acuity gain. Seven patients (16%) on nepafenac and 20 patients (48%) on preservative-free diclofenac reported symptoms related to topical use of NSAID medications (p = 0.001). CONCLUSION No differences in clinical efficacy were found between potent NSAIDs, while tolerability might be an issue.
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Affiliation(s)
- Petteri Ylinen
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Department of Ophthalmology; Helsinki University Hospital; Helsinki Finland
| | - Claudia Taipale
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Department of Ophthalmology; Helsinki University Hospital; Helsinki Finland
| | - Juha-Matti Lindholm
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Department of Ophthalmology; Helsinki University Hospital; Helsinki Finland
| | - Ilkka Laine
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Department of Automation and Electrical Engineering; Aalto University; Helsinki Finland
| | - Emil Holmström
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Transplantation Laboratory; University of Helsinki; Helsinki Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Unit of Ophthalmology; Kymenlaakso Central Hospital; Kotka Finland
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Lindholm JM, Laine I, Hippala H, Ylinen P, Tuuminen R. Improving eye care services with a lean approach. Acta Ophthalmol 2018; 96:724-728. [PMID: 29461675 DOI: 10.1111/aos.13703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 03/19/2017] [Accepted: 12/14/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Effective provision of eye care services in government-financed hospitals is essential to balance the discrepancy between growing demand and limited resources. We aimed to improve efficiency of the treatment protocol for Nd:YAG laser posterior capsulotomy. Predetermined quality targets were a patient-oriented and patient-safe approach and the development of a clinical care process with purposeful use of competences. METHODS We utilized a lean process improvement methodology to develop a streamlined Nd:YAG laser posterior capsulotomy treatment protocol. A total of 206 patient visits were evaluated, where the lean-oriented treatment protocol was utilized in 158 of the visits and the conventional (CONV) protocol was followed in 48 of the visits. RESULTS All baseline variables were comparable between the study groups. Compared to the CONV protocol, implementation of new operational principles shortened the total reception time per patient from 55:36 ± 30:23; 12-136 min to 44:40 ± 4:49; 37-54 min (mean ± SD; range, p = 0.040). The per hour number of patients and eyes treated in the operation room improved from 4.7 ± 1.6; 2.6-8.4 patients and 5.5 ± 2.0; 3.5-11.3 eyes to 16.3 ± 2.3; 14.3-19.4 patients (p < 0.001) and 18.0 ± 1.6; 16.8-20.4 eyes (p < 0.001). The time spent by the operating physician reduced from 8:19 ± 3:06; 3:57-14:30 min to 3:01 ± 1:00; 1:34-6:38 min in unilateral procedure (p < 0.001) and from 8:45 ± 3:55; 5:52-14:10 min to 4:40 ± 2:03; 2:38-10:14 min in bilateral procedure (p < 0.006). Furthermore, the overall patient satisfaction grade improved from 17.3 ± 1.04; 15-18 points to 17.8 ± 0.61; 15-18 points (p = 0.001). CONCLUSIONS The lean approach improved the treatment protocol for Nd:YAG laser posterior capsulotomy with substantial reductions in lead times without compromising patient satisfaction.
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Affiliation(s)
- Juha-Matti Lindholm
- Unit of Ophthalmology; Kymenlaakso Central Hospital; Kotka Finland
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
| | - Ilkka Laine
- Unit of Ophthalmology; Kymenlaakso Central Hospital; Kotka Finland
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Department of Automation and Electrical Engineering; Aalto University; Helsinki Finland
| | - Heli Hippala
- Unit of Ophthalmology; Kymenlaakso Central Hospital; Kotka Finland
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
| | - Petteri Ylinen
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Department of Ophthalmology; Helsinki University Hospital; Helsinki Finland
| | - Raimo Tuuminen
- Unit of Ophthalmology; Kymenlaakso Central Hospital; Kotka Finland
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Patient Insurance Centre; Helsinki Finland
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Ylinen P, Holmström E, Laine I, Lindholm JM, Tuuminen R. Anti-inflammatory medication following cataract surgery: a randomized trial between preservative-free dexamethasone, diclofenac and their combination. Acta Ophthalmol 2018; 96:486-493. [PMID: 29369527 DOI: 10.1111/aos.13670] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 07/24/2017] [Accepted: 11/14/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the anti-inflammatory efficacy and tolerance between preservative-free dexamethasone (DEX) and diclofenac (DICL) eye drops, and their combination following cataract surgery. METHODS A randomized, double-blind, prospective single-centre study with 189 eyes of 180 patients undergoing routine cataract surgery. Laser flare meter measurement and spectral-domain optical coherence tomography imaging were conducted before surgery and at the 28-day postoperative visit. Clinical characteristics, surgical parameters and assessment of postoperative symptoms were recorded. RESULTS Preoperative flare was 9.0 ± 0.6 pu/ms and central retinal thickness (CRT) 269.6 ± 1.9 μm (mean ± SEM). On day 28, flare was 22.1 ± 2.9 pu/ms for DEX, 17.4 ± 2.5 pu/ms for DICL and 13.0 ± 1.6 pu/ms (p < 0.05) for their combination. Central retinal thickness (CRT) increase was 31.5 ± 8.8 μm for DEX, 6.0 ± 0.8 μm (p = 0.001) for DICL, and 3.5 ± 0.5 μm (p < 0.001) for their combination. The incidence of ocular symptoms related to the eye drops was 11% for DEX, 37% for DICL and 34% for their combination (p < 0.001). Clinically significant pseudophakic cystoid macular oedema (PCME) was observed in seven eyes which were all treated with DEX (p < 0.001). CONCLUSION Diclofenac (DICL), as well as the combination of DEX and DICL, were superior to DEX monotherapy in minimizing CRT change and the incidence of PCME. Combination medication showed no added value compared to DICL monotherapy in uneventful cataract surgery.
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Affiliation(s)
- Petteri Ylinen
- Department of Ophthalmology; Helsinki University Hospital; Helsinki Finland
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
| | - Emil Holmström
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Transplantation Laboratory; University of Helsinki; Helsinki Finland
| | - Ilkka Laine
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Department of Automation and Electrical Engineering; Aalto University; Helsinki Finland
| | - Juha-Matti Lindholm
- Department of Ophthalmology; Helsinki University Hospital; Helsinki Finland
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Kymenlaakso Central Hospital; Unit of Ophthalmology; Kotka Finland
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Ylinen P, Tulamo RM, Kellomäki M, Türmälä P, Rokkanen P, Palmgren T. Lumbar intervertebral disc replacement using bioabsorbable self-reinforced poly-L-lactide full-threaded screws, or cylindrical implants of polylactide polymers, bioactive glass and Polyactive™. Vet Comp Orthop Traumatol 2018. [DOI: 10.1055/s-0038-1632777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryIntervertebral disc surgery leads to changes in the segmental anatomy and mobility, and subsequently to degenerative changes in the lumbar spine. Artificial intervertebral disc implants sufficient to replace the human lumbar intervertebral disc have been developed and the requirements for these defined. This is to our knowledge the first study on bioabsorbable intervertebral disc replacement implants. SR-PLLA screws, previously used in orthopaedic internal fixations, and cylindrical implants, specifially developed for this experimental preliminary study, were used to replace lumbar intervertebral discs of growing pigs. After a 15-week follow-up period, the radiological and histological changes in the intervertebral spaces were analyzed. The cylindrical implants were able to prevent narrowing of discectomied spaces, and tissue regeneration in the intervertebral space was induced and occured simultaneously with degradation of the implant.
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Laine I, Lindholm JM, Ylinen P, Tuuminen R. Intravitreal bevacizumab injections versus dexamethasone implant for treatment-naïve retinal vein occlusion related macular edema. Clin Ophthalmol 2017; 11:2107-2112. [PMID: 29225460 PMCID: PMC5708292 DOI: 10.2147/opth.s144688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/27/2023] Open
Abstract
Purpose To compare the short-term effects of three monthly intravitreal bevacizumab (IVB) injections to single dexamethasone (DEX) implantation in treatment-naïve patients with cystoid macular edema (CME) secondary to branch (BRVO) and central retinal vein occlusion (CRVO). Design A retrospective single-center study. Subjects A total of 135 eyes of 135 patients with BRVO (n=83) and CRVO (n=52). Methods Changes in clinical parameters were recorded before treatment and at the first and third month after commencement of IVB (n=121) and DEX (n=14). Main outcome measures Central retinal thickness (CRT), intraocular pressure (IOP), and best-corrected visual acuity (BCVA). Results The baseline parameters were comparable between IVB and DEX groups. After the first month, CRT decreased by 131.3±42.9 μm in IVB and by 266.9±48.3 μm in DEX (mean ± SEM; p=0.047). IOP change was –0.29±0.39 mmHg in IVB and +3.70±2.34 mmHg in DEX (p=0.005). IOP elevation to ≥25 mmHg and ≥5 mmHg from the baseline was observed in two of the DEX- and in none of the IVB-treated eyes (p=0.010). After the third month, no differences regarding CRT and IOP were observed between the treatment modalities. Moreover, BCVA gain was comparable between IVB (0.37±0.05 logarithm of minimum angle of resolution [logMAR] units) and DEX (0.33±0.30 logMAR units) groups. Conclusion DEX was associated with faster resolution of CME, but had greater probability for short-term IOP elevation when compared to IVB. After the third month, treatments were comparably effective. Anatomical outcomes and adverse drug reactions of IVB versus DEX should be considered case specifically in patients having CME secondary to BRVO/CRVO.
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Affiliation(s)
- Ilkka Laine
- Helsinki Retina Research Group, University of Helsinki, Helsinki.,Unit of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland.,Department of Automation and Electrical Engineering, Aalto University, Helsinki, Finland
| | - Juha-Matti Lindholm
- Helsinki Retina Research Group, University of Helsinki, Helsinki.,Unit of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
| | - Petteri Ylinen
- Helsinki Retina Research Group, University of Helsinki, Helsinki.,Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki.,Unit of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland.,The Insurance Centre, Patient Insurance Centre, Helsinki, Finland
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Ylinen P, Laine I, Lindholm JM, Tuuminen R. Poor glycemic control as a risk factor for pseudophakic cystoid macular edema in patients with diabetes. J Cataract Refract Surg 2017; 43:1376-1382. [DOI: 10.1016/j.jcrs.2017.07.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/26/2017] [Indexed: 02/06/2023]
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Koskinen E, Paavolainen P, Ylinen P, Eskelinen A, Harilainen A, Sandelin J, Tallroth K, Remes V. Mid-Term Results for Three Contemporary Total Knee Replacement Designs — A Comparative Study of 104 Patients with Primary Osteoarthritis. Scand J Surg 2010; 99:250-5. [DOI: 10.1177/145749691009900414] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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
Aims: The purpose of this study was to compare retrospectively the mid-term clinical and radiological results of three contemporary knee designs in cohorts operated on in the same hospital during the same time period. Materials and Methods: We evaluated mid-term clinical and radiographic outcome of three contemporary total knee designs (the AGC V2, the Duracon and the Nexgen) in 104 consecutive patients (129 knees) operate on for primary knee osteoarthritis at our hospital. The mean indexed age at the time of the operation was 69.2 years (range, 49.3 to 81.1 years). The mean follow-up time was 6.0 years (range, 0.2 to 7.9). All patients were followed for at least three years or until the first revision. In the survival analyses, the end point was defined as, revision for any reason. Results: The Kaplan-Meier survival analysis showed a 98% (95% CI 94–100) survival rate for the NexGen, a 98% (95% CI 93–100) for the AGC and a 90% (95% CI 81–99) for the Duracon design at six years. Both the mean KSS for pain, KSS for function and the mean clinical knee score improved significantly in all three groups. There was no difference between the three designs in mid-term survivorship. Conclusions: Most of the revisions could be directly linked to perioperative surgical errors. In conclusion, the most recently introduced knee replacements of the present study (Duracon and Nexgen) did not show any clinically significant benefit over the older design (AGC) in the mid-term.
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Affiliation(s)
- E. Koskinen
- Orton Orthopaedic Hospital and Research Institute, Invalid Foundation, Helsinki, Finland
| | - P. Paavolainen
- Orton Orthopaedic Hospital and Research Institute, Invalid Foundation, Helsinki, Finland
| | - P. Ylinen
- Orton Orthopaedic Hospital and Research Institute, Invalid Foundation, Helsinki, Finland
| | - A. Eskelinen
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - A. Harilainen
- Orton Orthopaedic Hospital and Research Institute, Invalid Foundation, Helsinki, Finland
| | - J. Sandelin
- Orton Orthopaedic Hospital and Research Institute, Invalid Foundation, Helsinki, Finland
| | - K. Tallroth
- Orton Orthopaedic Hospital and Research Institute, Invalid Foundation, Helsinki, Finland
| | - V. Remes
- Department of Orthopedics, Peijas Hospital, Helsinki University Central Hospital, Vantaa, Finland
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Ylinen P, Raekallio M, Taurio R, Vihtonen K, Vainionpää S, Partio EK, Törmälä P, Rokkanen P. Coralline hydroxyapatite reinforced with polylactide fibres in lumbar interbody implantation. J Mater Sci Mater Med 2005; 16:325-331. [PMID: 15803277 DOI: 10.1007/s10856-005-0631-z] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 02/27/2004] [Accepted: 11/17/2004] [Indexed: 05/24/2023]
Abstract
Porous hydroxyapatite HA blocks reinforced with poly-l/dl-lactide fibres were used to maintain the lumbar disc space and to start to create intercorporeal fusion in 23 growing pigs. In four pigs two emptied non adjacent disc spaces were left open. After 3, 6, 12 and 16 weeks the implanted disc blocks were studied radiologically, histologically, histomorphometrically, microradiographically, and with oxytetracycline fluorescence. In plain films slight to moderate ossification of the implanted disc spaces was detected at 12 and 16 weeks. Resorption of the implants was seen radiologically from 3 weeks and fragmentation from 12 weeks onwards. In microradiographs disintegration of the coralline inner structure started at 3 weeks. Histologically, connective tissue ingrowth was seen inside the porous structure from three weeks onwards. Small amounts of new bone were visible and connective tissue inside the implant increased from a mean of 65.6% at 3 weeks to a mean of 79.4% at 16 weeks histomorphometrically. The bone ingrowth varied from 0.7 to 1.7%. A loss of height in the implanted disc spaces was seen (p < 0.05, linear regression analysis). In control pigs the emptied disc spaces lost their height similarly. The implants used were not strong enough to maintain the lumbar disc height.
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Affiliation(s)
- P Ylinen
- ORTON Orthopaedic Hospital of Invalid Foundation, Helsinki, Finland.
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Ylinen P, Suuronen R, Taurio R, Törmälä P, Rokkanen P. Use of hydroxylapatite/ polymer-composite in facial bone augmentation. An experimental study. Int J Oral Maxillofac Surg 2002; 31:405-9. [PMID: 12361074 DOI: 10.1054/ijom.2002.0252] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/18/2022]
Abstract
On purpose to achieve better and more controlled alveolar ridge augmentation, biodegradable polyglycolide (PGA) curved implants with porous, particulate hydroxylapatite (HA) were developed to be used in an experimental augmentation in sheep mandible. Prior to surgery curved PGA implants were loaded with particulate HA with help of a rather fast degrading adhesive, polyglycolide/polylactide (PGA/PLA) copolymer. This augmentation device was inserted into the ridge using a slight modification of the tunnelling technique. Macroscopically, a dehiscence with loss of HA particles was observed in 3 of the 16 augmentations. Bone ingrowth was seen in a noticeable degree in one sheep at 24 weeks. Instead, foreign body-type cells were shown at the interface of mandibular bone and hydroxylapatite deposit, as well as abundant connective tissue reaction inside HA deposits. The results of the study give rise to concern about bony integration in the presence of biodegradable polyglycolide substances in HA augmentation. The findings call in question even their use as a carrier for bone forming agents in combination with HA.
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Affiliation(s)
- P Ylinen
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Finland.
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Alho A, Lepistö J, Ylinen P, Paavilainen T. Cemented Lubinus and Furlog total hip endoprosthesis: a 12-year follow-up study of 175 hips comparing the cementing technique. Arch Orthop Trauma Surg 2000; 120:276-80. [PMID: 10853895 DOI: 10.1007/s004020050464] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 02/09/2023]
Abstract
We analyzed 175 total hip replacements with cemented Lubinus and Furlong arthroplasties in 164 patients with a median age of 65 (32-80) years and followed them for 12 years to evaluate and compare the efficacy of total hip prosthesis designs. Survival analysis was combined with an analysis of radiological findings and a study of functional outcome of the patients. The 12-year survival of Furlong arthroplasty in patients of 60 years of age and older was O.85 (95% CI 1.00-0.52). The survival of Lubinus arthroplasty in patients younger than 60 years of age was 0.70 (0.91-0.48), while the survival in older patients was 0.75 (0.89-0.61). The 12-year survival of well-cemented Lubinus prosthesis was 0.91 (1.00-0.79), indicating the importance of the cementing technique. The survival of the cups was marginally better than that of the stems. In the 12-year follow-up study, the clinical state and function varied from hips ready for revision to hips where a continuously long survival could be predicted. Harris hip score did not differentiate between patients who had intact and loose components. We conclude that cemented arthroplasty affords a notable alternative with satisfactory long-term survival and function. The better survival of cemented cup than the stem may be utilized as a basis for "reverse" hybrid arthroplasty. Adequate long-term follow-up of all arthroplasties as a quality maintenance and to prevent difficult revisions is a major challenge.
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Affiliation(s)
- A Alho
- ORTON Orthopaedic Hospital, Invalid Foundation, Helsinki, Finland.
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Pekkarinen J, Alho A, Lepistö J, Ylikoski M, Ylinen P, Paavilainen T. Impaction bone grafting in revision hip surgery. A high incidence of complications. J Bone Joint Surg Br 2000; 82:103-7. [PMID: 10697324 DOI: 10.1302/0301-620x.82b1.9802] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have reviewed retrospectively 68 revisions of the femoral component in arthroplasties of the hip in 65 patients, using impaction bone grafting, at a median of three years (1 month to 6 years). We employed the cemented Exeter X-Change technique in 36 patients and the uncemented Bi-Metric allografting method in 32. The 37 bone defects were grade 3 or grade 4 on the Endo-Klinik classification. The Mayo hip score improved from a mean of 32 (SD +/- 18) to 62 (SD +/- 15). Most (25) of the 34 complications occurred in grade-3 and grade-4 defects; nine were intraoperative diaphyseal fractures and eight fractures of the greater trochanter. All the fractures united. The risk of intraoperative fracture was prevented by supporting the bone with wires in 16 hips, with reinforcement mesh in 18 and by a plate in six. Early migration of the stem of more than 10 mm during the first year indicated rotational instability; it occurred in three cases. In difficult revision cases with large defects of the femoral bone, bone-impaction techniques carry a high risk of complications.
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Affiliation(s)
- J Pekkarinen
- ORTON Orthopaedic Hospital, The Invalid Foundation, Helsinki, Finland
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Abstract
We have reviewed retrospectively 68 revisions of the femoral component in arthroplasties of the hip in 65 patients, using impaction bone grafting, at a median of three years (1 month to 6 years). We employed the cemented Exeter X-Change technique in 36 patients and the uncemented Bi-Metric allografting method in 32. The 37 bone defects were grade 3 or grade 4 on the Endo-Klinik classification. The Mayo hip score improved from a mean of 32 (sd ± 18) to 62 (sd ± 15). Most (25) of the 34 complications occurred in grade-3 and grade-4 defects; nine were intraoperative diaphyseal fractures and eight fractures of the greater trochanter. All the fractures united. The risk of intraoperative fracture was prevented by supporting the bone with wires in 16 hips, with reinforcement mesh in 18 and by a plate in six. Early migration of the stem of more than 10 mm during the first year indicated rotational instability; it occurred in three cases. In difficult revision cases with large defects of the femoral bone, bone-impaction techniques carry a high risk of complications.
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Affiliation(s)
- J. Pekkarinen
- ORTON Orthopaedic Hospital, The Invalid Foundation, Tenholaptie 10, POB 29, FIN-00281 Helsinki, Finland
| | - A. Alho
- ORTON Orthopaedic Hospital, The Invalid Foundation, Tenholaptie 10, POB 29, FIN-00281 Helsinki, Finland
| | - J. Lepistö
- ORTON Orthopaedic Hospital, The Invalid Foundation, Tenholaptie 10, POB 29, FIN-00281 Helsinki, Finland
| | - M. Ylikoski
- ORTON Orthopaedic Hospital, The Invalid Foundation, Tenholaptie 10, POB 29, FIN-00281 Helsinki, Finland
| | - P. Ylinen
- ORTON Orthopaedic Hospital, The Invalid Foundation, Tenholaptie 10, POB 29, FIN-00281 Helsinki, Finland
| | - T. Paavilainen
- ORTON Orthopaedic Hospital, The Invalid Foundation, Tenholaptie 10, POB 29, FIN-00281 Helsinki, Finland
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14
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Saikko V, Nevalainen J, Revitzer H, Ylinen P. Metal release from total hip articulations in vitro: substantial from CoCr/CoCr, negligible from CoCr/PE and alumina/PE. Acta Orthop Scand 1998; 69:449-54. [PMID: 9855223 DOI: 10.3109/17453679808997777] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We used a hip joint simulator to compare the metal release from CoCr/CoCr, CoCr/PE, and alumina/PE total hip articulations. The metal release was quantified by analyzing the Co, Cr, and Ni contents of the bovine serum lubricant used with atomic absorption spectroscopy. CoCr/CoCr articulations released substantial amounts of metal, whereas CoCr/PE was equal to the control, alumina/PE, in that metal release was negligible. The metal release was in accordance with the known clinical wear rates of CoCr/CoCr articulations. The largest dimensional changes occurred in polyethylene cups, the penetrations of CoCr heads to the polyethylene cups being twice that of the alumina head, which is consistent with clinical experience. The research on the wear behavior of different materials, aiming to find a prosthesis with negligible wear, needs to be continued. Due to the substantial metal release, the CoCr/CoCr articulation is hardly the final solution of the wear problem in total hip arthroplasty.
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Affiliation(s)
- V Saikko
- Helsinki University of Technology, Department of Mechanical Engineering, Finland.
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15
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Affiliation(s)
- P Ylinen
- ORTON Orthopaedic Hospital, Invalid Foundation, Helsinki, finland
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16
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Langenskiöld A, Hakkinen S, Ylinen P. Incorporation of cancellous bone into a diaphyseal defect of the radius in growing rabbits: tube-shaped versus homogeneous grafts. J Pediatr Orthop 1996; 16:237-42. [PMID: 8742292 DOI: 10.1097/00004694-199603000-00020] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of the investigation was to find out whether healing of a defect in a tubular bone is different when a transplant of crushed spongy bone is tube shaped or homogeneous. In rabbits aged 6-8 weeks a defect in the radius was completely filled with bone in 34 rabbits. In 91 animals a piece of steel wire, catgut, or gelatin sponge was implanted, provoking a tube shape of the crushed bone. The animals were killed 8-90 days after the operation. In transverse sections of the transplants, the amount of spongy bone, compact bone, and marrow cavity each was estimated by means of a grid of squares in the microscope. The remodeling of the transplants was considerably faster in the series with tube-shaped grafts than in the series in which the whole defect was filled with bone. The material was reexamined by histomorphometry. The results confirmed the findings achieved with a grid.
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Affiliation(s)
- A Langenskiöld
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Finland
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17
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Kivi P, Ylinen P. [Epicondylitis and tenosynovitis or peritendinitis as an occupational disease]. Duodecim 1995; 111:1703-7. [PMID: 9273293] [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: 02/05/2023]
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18
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Abstract
Radiographic signs of loosening were assessed, and their sequential appearance recorded, in a retrospective analysis of 20 loosened, threaded acetabular cups. There was radiographic evidence of loosening in 19 (95%) cups. In decreasing order of frequency, the radiographic manifestations included bone resorption between the threads in 19 (95%) cups, increased bone density above the cup in 15 (75%), continuous lucency around the cup in 14 (70%), axial migration in 9 (45%), and rotation in 6 (30%). The order of appearance of these radiographic manifestations was the same as the order of frequency of occurrence of the alterations. In the one patient with no radiographically detectable signs of loosening, the cup did not move freely but was easily detached during surgery. Early radiographic diagnosis of loosening requires accurate positioning of the patient in order for the radiographs to reveal bone resorption between the threads of the cup.
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Affiliation(s)
- K Tallroth
- Department of Radiology, Orthopaedic Hospital, Helsinki, Finland
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19
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Harilainen A, Sandelin J, Ylinen P, Vahvanen V. Revision of the PCA unicompartmental knee. 52 arthrosis knees followed for 2-5 years. Acta Orthop Scand 1993; 64:428-30. [PMID: 8213120 DOI: 10.3109/17453679308993659] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We evaluated 52 unicompartmental PCA arthroplasties for primary (46) or secondary (6) arthrosis after 3 (2-5) years. Cementless fixation was used in 35 femoral and in 28 tibial components. There were indications for revision in 11 cases. Conversion to a total knee had been performed in 4 cases, and 1 tibial as well as 1 femoral component had been exchanged, mainly because of polyethylene wear with increasing deformity. 2 femoral components were loose and 1 had fractured.
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Affiliation(s)
- A Harilainen
- Orthopedic Hospital, Invalid Foundation, Helsinki, Finland
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20
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Abstract
We surgically treated 16 patients with Bertolotti's syndrome (chronic, persistent low back pain and radiographically diagnosed transitional lumbar vertebra). Eight had posterolateral fusion and another eight resection of the transitional articulation. Thirteen patients had in addition to the chronic low back pain, suffered from repeated episodes or chronic sciatica. In six cases with resection treatment, local injections were administered at the transitional articulation before deciding for resection of the transitional joint; each patient reported transient relief of pain, while this preoperative test did not correlate with successful outcome of treatment. Six patients had to be treated with second operations. Ten of the 16 operatively treated patients showed improvement of the low back pain, and this result was similar in the group treated with fusion and in that treated with resection. Seven had no low back pain at follow-up, and the improvement according to the Oswestry pain scale was similar in the two groups, and statistically significant. Eleven patients still had persisting episodes of sciatica (versus 13 preoperatively). The average disability according to the Oswestry total disability scale was 30%, corresponding with moderate outcome, and both operatively treated groups did equally well. At follow-up the first disc above the fused segments was found to be degenerated in seven out of eight cases, and in the group treated with resection the first disc above the transitional vertebra was degenerated in five cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Santavirta
- Orthopedic Hospital, Invalid Foundation, Helsinki, Finland
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21
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Abstract
We reviewed 15 patients with Charcot-Marie-Tooth disease who were treated with foot or ankle fusions. Altogether, 26 feet were treated with fusions and the average follow-up time was 14 years. In half of the patients the principal symptom leading to fusion operation was instability of the ankle. In four patients, in two of them bilaterally, soft tissue corrections were performed before the fusion. In 21 cases, a subtalar triple arthrodesis was performed and each time correction to neutral position was the aim. In six feet, the triple arthrodesis was complemented by soft tissue plasties, e.g., plantar release, Achilles elongation, or transposition of tibial or peroneal tendons in order to achieve proper balance. Other primary fusions were a Grice-type fusion in one case, pantalar arthrodesis in one case, talocrural fusion in one case, and interphalangeal fusions in both feet in one patient with extreme claw foot. In four cases the triple arthrodesis failed to fuse (three nonunions and one delayed union), and new fusions were successful in three of them. The one pantalar fusion in the series was done for a 58-year-old man with late onset of the disease who had a very severe cavovarus deformity at the time of the operation, and this fusion failed to unite. In 17 of 26 feet, other operations than the primary fusion were performed, and five feet were operated on three or four times. In four feet the result was judged as excellent, in 15 good, in four fair, and in three poor.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Santavirta
- Orthopedic Hospital, Invalid Foundation, Helsinki, Finland
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22
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Partio EK, Merikanto J, Heikkilä JT, Ylinen P, Mäkelä EA, Vainio J, Törmälä P, Rokkanen P. Totally absorbable screws in fixation of subtalar extra articular arthrodesis in children with spastic neuromuscular disease: preliminary report of a randomized prospective study of fourteen arthrodeses fixed with absorbable or metallic screws. J Pediatr Orthop 1992; 12:646-50. [PMID: 1517428] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Seven patients with spastic neuromuscular disease and severe hindfoot valgus deformity were treated by subtalar arthrodesis. Arthrodesis was performed in both feet at the same operation and fixed on one side with a self-reinforced poly-L-lactide (SR-PLLA) screw, and with a standard AO screw on the other side. The functional status state was improved, and radiographic union of the arthrodesis occurred in all feet. The radiograph showed better solid fusion in five feet treated with PLLA screws, similar fusion in both sides in one patient, and one slower fusion in the side treated initially with a PLLA screw. Totally absorbable SR-PLLA screws appear to be firm enough for fixation of subtalar extraarticular arthrodesis in children.
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Affiliation(s)
- E K Partio
- Department of Surgery and Orthopaedics, Children's Hospital, Helsinki University Central Hospital, Finland
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23
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Ylinen P, Raekallio M, Toivonen T, Vihtonen K, Vainionpää S. Preliminary study of porous hydroxylapatite particle containment with a curved biodegradable implant in the sheep mandible. J Oral Maxillofac Surg 1991; 49:1191-7. [PMID: 1682431 DOI: 10.1016/0278-2391(91)90415-i] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [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: 12/28/2022]
Abstract
A conventional augmentation method without a splint was compared with the use of a biodegradable polyglycolide (PGA) splint as a container of hydroxylapatite (HA) particles. With the PGA splint there was a 35% rate of dehiscence of the incision, leading to loss of HA particles. Based on microradiographic measurements, the HA was retained better on the side augmented by the conventional technique. Toward the end of 24 weeks, however, a decrease of augmentation and in the quantity of HA was seen with both methods. According to the histologic studies, there was evidence of HA phagocytosis by osteoclast-type cells. In the histomorphometric studies after 24 weeks of follow-up, new bone ingrowth was 12% without and 10% with the PGA splint. Although the planimetric studies showed the PGA splint to be a good container, the material still requires further development.
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Affiliation(s)
- P Ylinen
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Finland
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24
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Abstract
In three patients a mechanically well-fixed Mathys Ceros 80 (Ha) hydroxyapatite-coated acetabular component was revised 2, 5 and 13 months after total hip replacement due to component malposition. In each case there was a thin cellular connective tissue membrane between hydroxyapatite and bone, the main cell type being fibroblast with only occasional giant cells. Immunohistological analysis revealed some MHC locus II antigen positive cells that were identified as monocytes. No interleukin-2 receptor positive cells were found. Under clinical cyclic loading conditions there does not seem to be chemical fixation or bony ingrowth into the hydroxyapatite coated prosthesis component. In human lymphocyte cultures, hydroxyapatite (Interpore 200, particle diameters 15-40 microns) did not cause an increase in lymphocyte DNA synthesis as assessed by the 3H-thymidine incorporation method on culture days 1, 3 and 5. As analysed with lymphocyte activation markers, the hydroxyapatite-dependent expression of MHC locus II antigen was modest and differed significantly (P less than 0.05) from that in culture medium only on day 3. Hydroxyapatite induced only a slight interleukin-2 receptor expression that did not differ from culture medium on days 1, 3 and 5. CD4 and CD8 positive lymphocytes as well as monocytes were not seen attached to hydroxyapatite particles during the culture days. Our findings suggest that hydroxyapatite is an immunologically inert implant material.
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Affiliation(s)
- S Santavirta
- Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland
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25
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Ylinen P, Kinnunen J, Laasonen EM, Lamminen A, Vainionpää S, Raekallio M, Rokkanen P, Törmälä P. Lumbar spine interbody fusion with reinforced hydroxyapatite implants. Arch Orthop Trauma Surg 1991; 110:250-6. [PMID: 1657085 DOI: 10.1007/bf00572882] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [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: 12/28/2022]
Abstract
Porous coralline and synthetic hydroxyapatite blocks reinforced with either self-reinforced polyactide or polyglycolide were implanted into 15 lumbar intervertebral disc spaces in five minipigs in order to determine whether they could provide an osteoconductive bridge for interbody fusion. Histological examination and radiological analysis with plain films, computed tomography and magnetic resonance imaging were carried out. The osteoconductive properties were promising; creeping bone formation could be observed, although no complete fusion had been achieved at 24 weeks.
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Affiliation(s)
- P Ylinen
- Department of Orthopedics and Traumatology, Töölö Hospital, University Central Hospital, Helsinki, Finland
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26
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Ylinen P, Kinnunen J, Höckerstedt K. Superior mesenteric artery syndrome. A follow-up study of 16 operated patients. J Clin Gastroenterol 1989; 11:386-91. [PMID: 2760427] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
A series of 18 patients underwent surgery for upper abdominal symptoms and signs of superior mesenteric artery syndrome (SMAS). The diagnosis was made by simultaneous arteriography and barium meal. Findings at operation confirmed SMAS in every patient, and a duodenojejunostomy was performed. Duodenal and jejunal wall biopsy from 13 patients revealed normal myenteric and submucous plexuses. A follow-up study of 16 patients was performed after 7 years. At follow-up, the weight loss seen preoperatively had been corrected. However, symptoms were essentially similar to those found at the original examination. Only the frequency of the most distressing symptom, vomiting, was significantly decreased (p less than 0.05). The most striking features in the production of the "pincher mechanism" of the duodenum were found to be a short aortomesenteric distance together with sagittal parallelism between aorta and superior mesenteric artery. In conclusion, we recommend a conservative attitude in the treatment of SMAS. Surgical treatment with duodenojejunostomy may be indicated only if vomiting is a predominant symptom and proper conservative treatment has failed.
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Affiliation(s)
- P Ylinen
- Fourth Department of Surgery, Helsinki University Central Hospital, Finland
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27
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Abstract
A 10-year series of 75 acetabular fractures has been reviewed. Traffic accidents (61%) and falls from heights (20%) were the most common etiologic factors. In 80% of the patients multiple injuries were recorded. Seventeen patients were treated operatively. Forty-three patients were examined clinically and radiologically at an average of 7 years after the accident. The outcome of posterior wall fractures was usually good. Most of the fair and poor results occurred in the group of transverse fractures, in which conservative treatment did not accurately align the fracture dislocation. Operative treatment is suggested in both-column fractures and severely dislocated transverse fractures.
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Affiliation(s)
- P Ylinen
- Division of Orthopaedic Surgery and Traumatology, Surgical Hospital, University Central Hospital, Helsinki, Finland
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28
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