Koski J.M.,Mikkeli Central Hospital |
Hammer H.B.,Diakonhjemmet Hospital
Rheumatology (United Kingdom) | Year: 2012
US allows us to detect joint alterations and to perform procedures such as aspiration of fluid as well as therapeutic injections; it helps in placing the needle correctly, greatly improving the outcome. Tissue biopsies (of, for example, synovium, muscle or salivary glands) can be performed with US guidance, and this method may be of significant importance in diagnostic examinations. Other imaging methods may be fused with US, and thus detailed maps are available to navigate in soft tissues. The new era in rheumatology will include US as an important part of its armament. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.
Peltola H.,University of Helsinki |
Paakkonen M.,University of Turku |
Paakkonen M.,Mikkeli Central Hospital |
Kallio P.,University of Helsinki |
Kallio M.J.T.,University of Helsinki
Pediatric Infectious Disease Journal | Year: 2010
Background: Considerable uncertainty exists on the optimal duration of antimicrobials for acute hematogenous osteomyelitis (AHOM) in children. Often they are administered for 1 to 2 months, the first 1 to 2 weeks intravenously, and decompressive surgery is usually added. No prospective, randomized, sufficiently powered comparative trial has been available. Methods: Children aged 3 months to 15 years with culture-positive AHOM were randomly assigned to receive clindamycin or a first-generation cephalosporin for 20 or 30 days, including an intravenous phase for the first 2 to 4 days. Surgery was kept at minimum. Illness was monitored with preset criteria. Antimicrobial was discontinued once most signs had subsided and serum C-reactive protein decreased ≤20 mg/L. The primary end point was full recovery without need for further antimicrobial therapy because of an osteoarticular indication during the 12 months after the primary therapy. Results: Of the 131 cases, 18% also involved the adjacent joint. Staphylococcus aureus caused 89% of cases, and all strains were methicillin susceptible. The median duration of treatment was 20 days for 67 children, and 30 days for 64 children. Most children underwent only the diagnostic percutaneous aspiration or drilling, and 24% had no surgery. Except for 1 mild sequela in both treatment groups, all patients recovered entirely. Conclusions: Most cases of childhood AHOM can be treated for 20 days, including a short period intravenously, with large doses of a well-absorbed antimicrobial such as clindamycin or a first-generation cephalosporin, provided the clinical response is good and C-reactive protein normalizes within 7 to 10 days. Extensive surgery is rarely needed. © 2010 Lippincott Williams & Wilkins.
Salminen P.,University of Turku |
Paajanen H.,Mikkeli Central Hospital |
Paajanen H.,University of Eastern Finland |
Rautio T.,University of Oulu |
And 15 more authors.
JAMA - Journal of the American Medical Association | Year: 2015
IMPORTANCE: An increasing amount of evidence supports the use of antibiotics instead of surgery for treating patients with uncomplicated acute appendicitis. OBJECTIVE: To compare antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis confirmed by computed tomography (CT). DESIGN, SETTING, AND PARTICIPANTS: The Appendicitis Acuta (APPAC) multicenter, open-label, noninferiority randomized clinical trial was conducted from November 2009 until June 2012 in Finland. The trial enrolled 530 patients aged 18 to 60 years with uncomplicated acute appendicitis confirmed by a CT scan. Patients were randomly assigned to early appendectomy or antibiotic treatment with a 1-year follow-up period. INTERVENTIONS: Patients randomized to antibiotic therapy received intravenous ertapenem (1 g/d) for 3 days followed by 7 days of oral levofloxacin (500mg once daily) and metronidazole (500mg 3 times per day). Patients randomized to the surgical treatment group were assigned to undergo standard open appendectomy. MAIN OUTCOMES AND MEASURES: The primary end point for the surgical interventionwas the successful completion of an appendectomy. The primary end point for antibiotic-treated patients was discharge from the hospital without the need for surgery and no recurrent appendicitis during a 1-year follow-up period. RESULTS: Therewere 273 patients in the surgical group and 257 in the antibiotic group.Of 273 patients in the surgical group, all but 1 underwent successful appendectomy, resulting in a success rate of 99.6%(95%CI, 98.0%to 100.0%). In the antibiotic group, 70patients (27.3%; 95%CI, 22.0%to 33.2%) underwent appendectomy within 1 year of initial presentation for appendicitis. Of the 256 patients available for follow-up in the antibiotic group, 186 (72.7%; 95%CI, 66.8%to 78.0%)did not require surgery. The intention-to-treat analysis yielded a difference in treatment efficacy between groups of -27.0%(95%CI, -31.6%to ∞) (P =.89). Given the prespecified noninferiority margin of 24%, wewere unable to demonstrate noninferiority of antibiotic treatment relative to surgery. Of the 70patients randomized to antibiotic treatmentwho subsequently underwent appendectomy, 58 (82.9%; 95%CI, 72.0% to 90.8%) had uncomplicated appendicitis,7(10.0%;95%CI,4.1% to 19.5%) had complicated acute appendicitis, and 5 (7.1%; 95%CI, 2.4% to 15.9%) did not have appendicitis but received appendectomy for suspected recurrence. Therewere no intra-abdominal abscesses or other major complications associated with delayed appendectomy in patients randomized to antibiotic treatment. CONCLUSIONS AND RELEVANCE: Among patients with CT-proven, uncomplicated appendicitis, antibiotic treatment did not meet the prespecified criterion for noninferiority compared with appendectomy. Most patients randomized to antibiotic treatment for uncomplicated appendicitis did not require appendectomy during the 1-year follow-up period, and those who required appendectomy did not experience significant complications. Copyright © 2015 American Medical Association. All rights reserved.
Long-term outcome of patients with frequently recurrent non-muscle-invasive bladder carcinoma treated with one perioperative plus four weekly instillations of mitomycin C followed by monthly Bacillus Calmette-Guérin (BCG) or alternating BCG and interferon-α2b instillations: Prospective randomised finnbladder-4 study
Jarvinen R.,University of Helsinki |
Marttila T.,Seinajoki Central Hospital |
Kaasinen E.,Hyvinkaa Hospital |
Rintala E.,University of Helsinki |
And 9 more authors.
European Urology | Year: 2015
Background Recurrent TaT1 non-muscle-invasive bladder cancer (NMIBC) patients should be treated with immediate instillation of chemotherapy after transurethral resection of bladder tumour followed by instillation therapy. Objective To present long-term results of a study exploring the effect of initial mitomycin C (MMC) instillations followed by two types of immunotherapy for patients with frequently recurring NMIBC. Design, setting, and participants Between 1992 and 1996, 236 patients with frequently recurring TaT1 grade 1-2 NMIBC were enrolled in the prospective randomised multicentre FinnBladder-4 study. Intervention One perioperative plus four weekly instillations of MMC followed by monthly bacillus Calmette-Guérin (BCG) or alternating BCG and interferon (IFN)-α2b instillations for up to 1 yr. Outcome measurements and statistical analysis Primary end points were time to first recurrence and time to progression. Secondary end points were disease-specific mortality and overall survival. The principal statistical methods were the proportional subdistribution hazards model and Cox proportional hazards model plus cumulative incidence and Kaplan-Meier analyses. Results and limitations The median follow-up was 10.3 yr (maximum: 19.8 yr) in the MMC-BCG group and 8.6 yr (maximum: 19.8 yr) in the MMC-BCG/IFN group. The probability of recurrence was significantly lower in the MMC-BCG group than in the MMC-BCG/IFN group (43% vs 78% at 10 yr and 45% vs 80% at 15 yr, respectively; hazard ratio: 2.86; 95% confidence interval, 1.98-4.13; p < 0.001). There were no significant differences in the probability of progression, disease-free mortality, or overall survival. Conclusions Perioperative plus four weekly MMC instillations followed by monthly BCG, instead of alternating BCG and IFN-α2b instillations, significantly reduce long-term recurrence. Patient summary We demonstrated in non-muscle-invasive bladder cancer patients with exceptionally frequent recurrences that the risk of long-term recurrence was reduced from 78-80% to 43-45% if one perioperative plus four weekly mitomycin C instillations were followed by monthly bacillus Calmette-Guérin (BCG) instillations for 1 yr instead of alternating instillations of BCG and interferon-α2b. Trial registration The registration was not considered necessary at this stage of the follow-up because the study was initiated as early as in 1992 and the last randomisation took place in 1996, before the current requirements concerning study registrations were implemented. © 2015 European Association of Urology.
Tuuminen T.,Eastern Finland Laboratory Center Joint Authority Enterprise |
Tuuminen T.,University of Helsinki |
Viiri H.,Finnish Forest Research Institute |
Vuorinen S.,Mikkeli Central Hospital
Journal of Clinical Microbiology | Year: 2014
The first vector-borne Capnocytophaga canimorsus sepsis case is presented. An immunocompetent male who denied any contact with canines and who worked in a sawmill was bitten on his neck by a large pine weevil (Hylobius abietis L.; Coleoptera: Curculionidae). Bacteriological diagnosis was confirmed by 16S rRNA gene sequence analysis. Copyright © 2014, American Society for Microbiology. All Rights Reserved.
Tuuminen T.,University of Helsinki |
Tuuminen T.,Eastern Finland Laboratory Center Joint Authority Enterprise |
Suomala P.,Eastern Finland Laboratory Center Joint Authority Enterprise |
Vuorinen S.,Mikkeli Central hospital
BMC Infectious Diseases | Year: 2013
Background: In 1872, in British Medical Journal (BMJ) Dr. David Ferrier published that Sarcina ventriculi (Goodsir) constantly occurred in the blood of man and the lower animals. His observation was based on bleeding experiments, incubation of blood at 100oF (37.8oC) and later examination. He found " immense numbers of beautifully formed sarcinæ" In the next issue of BMJ Dr. Charlton Bastian expressed concerns that Sarcina might indeed be " really a living thing" or " might be partly organic and partly mineral in its constitutions" .Case presentation: Anaerobic gram-positive giant coccae assembled in tetrads were recovered from one anaerobic blood culture bottle of a 48-year-old female who in her early childhood was diagnosed with congenital chloride diarrhoea. This is a rare recessively inherited disease that belongs to the Finnish disease heritage. The bacteria were identified with the 16S rRNA gene sequencing.Conclusions: Here, after more than a century we present the first report that Sarcina ventriculi can indeed cause bacteremia in a susceptible person. © 2013 Tuuminen et al.; licensee BioMed Central Ltd.
Paakkonen M.,University of Helsinki |
Paakkonen M.,Mikkeli Central Hospital |
Kallio M.J.T.,University of Helsinki |
Kallio P.E.,University of Helsinki |
Peltola H.,University of Helsinki
Clinical Orthopaedics and Related Research | Year: 2010
In addition to the examination of clinical signs, several laboratory markers have been measured for diagnostics and monitoring of pediatric septic bone and joint infections. Traditionally erythrocyte sedimentation rate (ESR) and leukocyte cell count have been used, whereas C-reactive protein (CRP) has gained in popularity. We monitored 265 children at ages 3 months to 15 years with culture-positive osteoarticular infections with a predetermined series of ESR, CRP, and leukocyte count measurements. On admission, ESR exceeded 20 mm/hour in 94% and CRP exceeded 20 mg/L in 95% of the cases, the mean (± standard error of the mean) being 51 ± 2 mm/hour and 87 ± 4 mg/L, respectively. ESR normalized in 24 days and CRP in 10 days. Elevated CRP gave a slightly better sensitivity in diagnostics than ESR, but best sensitivity was gained with the combined use of ESR and CRP (98%). Elevated ESR or CRP was seen in all cases during the first 3 days. Measuring ESR and CRP on admission can help the clinician rule out an acute osteoarticular infection. CRP normalizes faster than ESR, providing a clear advantage in monitoring recovery. Level of Evidence: Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence. © 2009 The Association of Bone and Joint Surgeons®.
Saarakkala S.,University of Oulu |
Waris P.,Mikkeli Central Hospital |
Waris V.,Mikkeli Central Hospital |
Tarkiainen I.,Mikkeli Central Hospital |
And 3 more authors.
Osteoarthritis and Cartilage | Year: 2012
Objective: To investigate the diagnostic performance of non-invasive knee ultrasonography (US) to detect degenerative changes of articular cartilage using arthroscopic grading as the gold standard. Design: Forty adult patients referred to a knee arthroscopy because of knee pain were randomly selected for the study. Before the arthroscopy, knee US was performed and cartilage surfaces at medial and lateral femoral condyles as well as at intercondylar notch area (sulcus) were semi-quantitatively graded from US. Ultrasonographic grading was compared with the arthroscopic Noyes' grading for cartilage degeneration. Results: Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic odds ratio for detecting arthroscopic cartilage changes in US varied between 52 and 83%, 50-100%, 88-100%, 24-46%, and 5.0-13.0, respectively, depending on the site. Correlation of severity of cartilage changes (grades) between US and arthroscopy varied from insignificant to significant depending on the site: at the sulcus area the correlation was highest (. r s=. 0.593, . P<. 0.001), at the medial condyle also significant (. r s=. 0.465, . P=. 0.003), and at the lateral condyle non-significant (. r s=. 0.262, . P=. 0.103). The sum of cartilage grades in all three sites of the femoral cartilage between US and arthroscopy had the highest correlation (. r s=. 0.655, . P<. 0.001). Conclusions: Positive finding in US is a strong indicator of arthroscopic degenerative changes of cartilage, but negative finding does not rule out degenerative changes. Non-invasive knee US is a promising technique for screening of degenerative changes of articular cartilage, e.g., during osteoarthritis. © 2012 Osteoarthritis Research Society International.
Pakarinen M.,Kuopio University Hospital |
Vanhanen S.,Mikkeli Central Hospital |
Sinikallio S.,University of Eastern Finland |
Aalto T.,Kyyhkyla Rehabilitation Center |
And 3 more authors.
Spine Journal | Year: 2014
Background context In lumbar spinal stenosis (LSS), conservative treatment is usually the first choice of treatment. If conservative treatment fails, surgery is indicated. Psychological factors such as depression and anxiety are known to affect the outcome of surgery. Previous studies on depression and surgery outcome using long follow-up times are scarce.Purpose The purpose of this study was to investigate the effect of depressive symptoms on the surgical outcome during a 5-year follow-up among patients with LSS.Study design A prospective observational study.Patient sample Patient sample included 102 LSS patients who needed surgical treatment.Outcome measures The outcome of surgery was evaluated with the Oswestry Disability Index (ODI), visual analog scale pain assessment, and self-reported walking capacity.Methods The patients completed a set of questionnaires preoperatively and 3 and 6 months, as well as 1, 2, and 5 years after the surgery. Depressive symptoms were assessed with the Beck Depression Inventory. The depressive burden was estimated by summing all individual Beck Depression Inventory scores. Statistical analyses included cross-sectional group comparisons and linear regression analyses. No conflicts of interest.Results On 5-year follow-up, a high depressive burden associated with a poorer outcome of surgery when assessed with the ODI. In linear regression analysis, a high depressive burden associated with higher ODI score.Conclusions Even slightly elevated long-term depressive symptoms in LSS patients are associated with an increased risk of a poorer functional ability after decompressive surgery. © 2014 Elsevier Ltd. All rights reserved.
Kuikka L.,Kuopio University Hospital |
Hermunen H.,Mikkeli Central Hospital |
Paajanen H.,Kuopio University Hospital
Scandinavian Journal of Medicine and Science in Sports | Year: 2015
Athletic pubalgia (sportsman's hernia) is often repaired by surgery. The presence of pubic bone marrow edema (BME) in magnetic resonance imaging (MRI) may effect on the outcome of surgery. Surgical treatment of 30 patients with athletic pubalgia was performed by placement of totally extraperitoneal endoscopic mesh behind the painful groin area. The presence of pre-operative BME was graded from 0 to 3 using MRI and correlated to post-operative pain scores and recovery to sports activity 2 years after operation. The operated athletes participated in our previous prospective randomized study. The athletes with (n=21) or without (n=9) pubic BME had similar patients' characteristics and pain scores before surgery. Periostic and intraosseous edema at symphysis pubis was related to increase of post-operative pain scores only at 3 months after surgery (P=0.03) but not to long-term recovery. Two years after surgery, three athletes in the BME group and three in the normal MRI group needed occasionally pain medication for chronic groin pain, and 87% were playing at the same level as before surgery. This study indicates that the presence of pubic BME had no remarkable long-term effect on recovery from endoscopic surgical treatment of athletic pubalgia. © 2013 John Wiley & Sons A/S.