North Estonia Medical Center

Tallinn, Estonia

North Estonia Medical Center

Tallinn, Estonia
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Lamy A.,Hamilton Health Sciences | Devereaux P.J.,Hamilton Health Sciences | Prabhakaran D.,Center for Chronic Disease Control | Taggart D.P.,University of Oxford | And 21 more authors.
New England Journal of Medicine | Year: 2012

BACKGROUND:The relative benefits and risks of performing coronary-artery bypass grafting (CABG) with a beating-heart technique (off-pump CABG), as compared with cardiopulmonary bypass (on-pump CABG), are not clearly established. METHODS:At 79 centers in 19 countries, we randomly assigned 4752 patients in whom CABG was planned to undergo the procedure off-pump or on-pump. The first coprimary outcome was a composite of death, nonfatal stroke, nonfatal myocardial infarction, or new renal failure requiring dialysis at 30 days after randomization. RESULTS:There was no significant difference in the rate of the primary composite outcome between off-pump and on-pump CABG (9.8% vs. 10.3%; hazard ratio for the off-pump group, 0.95; 95% confidence interval [CI], 0.79 to 1.14; P = 0.59) or in any of its individual components. The use of off-pump CABG, as compared with on-pump CABG, significantly reduced the rates of blood-product transfusion (50.7% vs. 63.3%; relative risk, 0.80; 95% CI, 0.75 to 0.85; P<0.001), reoperation for perioperative bleeding (1.4% vs. 2.4%; relative risk, 0.61; 95% CI, 0.40 to 0.93; P = 0.02), acute kidney injury (28.0% vs. 32.1%; relative risk, 0.87; 95% CI, 0.80 to 0.96; P = 0.01), and respiratory complications (5.9% vs. 7.5%; relative risk, 0.79; 95% CI, 0.63 to 0.98; P = 0.03) but increased the rate of early repeat revascularizations (0.7% vs. 0.2%; hazard ratio, 4.01; 95% CI, 1.34 to 12.0; P = 0.01). CONCLUSIONS:There was no significant difference between off-pump and on-pump CABG with respect to the 30-day rate of death, myocardial infarction, stroke, or renal failure requiring dialysis. The use of off-pump CABG resulted in reduced rates of transfusion, reoperation for perioperative bleeding, respiratory complications, and acute kidney injury but also resulted in an increased risk of early revascularization. (Funded by the Canadian Institutes of Health Research; CORONARY number, NCT00463294.). Copyright © 2012 Massachusetts Medical Society.

Lamy A.,Hamilton Health Sciences | Devereaux P.J.,Hamilton Health Sciences | Prabhakaran D.,Center for Chronic Disease Control | Taggart D.P.,University of Oxford | And 21 more authors.
New England Journal of Medicine | Year: 2013

BACKGROUND: Previously, we reported that there was no significant difference at 30 days in the rate of a primary composite outcome of death, myocardial infarction, stroke, or new renal failure requiring dialysis between patients who underwent coronary-artery bypass grafting (CABG) performed with a beating-heart technique (off-pump) and those who underwent CABG performed with cardiopulmonary bypass (on-pump). We now report results on quality of life and cognitive function and on clinical outcomes at 1 year. METHODS: We enrolled 4752 patients with coronary artery disease who were scheduled to undergo CABG and randomly assigned them to undergo the procedure off-pump or on-pump. Patients were enrolled at 79 centers in 19 countries. We assessed quality of life and cognitive function at discharge, at 30 days, and at 1 year and clinical outcomes at 1 year. RESULTS: At 1 year, there was no significant difference in the rate of the primary composite outcome between off-pump and on-pump CABG (12.1% and 13.3%, respectively; hazard ratio with off-pump CABG, 0.91; 95% confidence interval [CI], 0.77 to 1.07; P=0.24). The rate of the primary outcome was also similar in the two groups in the period between 31 days and 1 year (hazard ratio, 0.79; 95% CI, 0.55 to 1.13; P=0.19). The rate of repeat coronary revascularization at 1 year was 1.4% in the off-pump group and 0.8% in the on-pump group (hazard ratio, 1.66; 95% CI, 0.95 to 2.89; P=0.07). There were no significant differences between the two groups at 1 year in measures of quality of life or neurocognitive function. CONCLUSIONS: At 1 year after CABG, there was no significant difference between off-pump and on-pump CABG with respect to the primary composite outcome, the rate of repeat coronary revascularization, quality of life, or neurocognitive function. (Funded by the Canadian Institutes of Health Research; CORONARY number, NCT00463294). Copyright © 2013 Massachusetts Medical Society.

Baburin A.,National Institute for Health Development | Aareleid T.,National Institute for Health Development | Padrik P.,University of Tartu | Valvere V.,North Estonia Medical Center | And 2 more authors.
Acta Oncologica | Year: 2014

Background. Survival from breast cancer (BC) in Estonia has been consistently among the lowest in Europe. The aim of this study was to examine most recent trends in BC survival in Estonia by age and stage. The trends in overall BC incidence and mortality are also shown in the paper. Material and methods. Estonian Cancer Registry data on all cases of BC, diagnosed in women in Estonia during 1995-2007 (n = 7424) and followed up for vital status through 2009, were used to estimate relative survival ratios (RSR). Period hybrid approach was used to obtain the most recent estimates (2005-2009). Stage was classified as localized, local/regional spread or distant. Results. BC incidence continued to rise throughout the study period, but mortality has been in steady decline since 2000. The distribution of patients shifted towards older age and earlier stage at diagnosis. Overall age-standardized five-year RSR increased from 63% in 1995-1999 to 74% in 2005-2009. Younger age groups experienced a more rapid improvement compared to women over 60. Significant survival increase was observed for both localized and locally/regionally spread BC with five-year RSRs reaching 96% and 70% in 2005-2009, respectively; the latest five-year RSR for distant BC was 11%. Survival for T4 tumors was poor and large age difference was seen for locally/regionally spread BC. Conclusions. Considerable improvement in BC survival was observed over the study period. Women under 60 benefited most from both earlier diagnosis and treatment advances of locally/regionally spread cancers. However, the survival gap with more developed countries persists. Further increase in survival, but also decline in BC mortality in Estonia could be achieved by facilitating early diagnosis in all age groups, but particularly among women over 60. Investigations should continue to clarify the underlying mechanisms of the stage-specific survival deficit in Estonia. © 2014 Informa Healthcare.

Oha K.,North Estonia Medical Center | Oha K.,University of Tartu | Animagi L.,Tartu Health Care College | Paasuke M.,University of Tartu | And 2 more authors.
BMC Musculoskeletal Disorders | Year: 2014

Background: Occupational use of computers has increased rapidly over recent decades, and has been linked with various musculoskeletal disorders, which are now the most commonly diagnosed occupational diseases in Estonia. The aim of this study was to assess the prevalence of musculoskeletal pain (MSP) by anatomical region during the past 12 months and to investigate its association with personal characteristics and work-related risk factors among Estonian office workers using computers. Methods. In a cross-sectional survey, the questionnaires were sent to the 415 computer users. Data were collected by self-administered questionnaire from 202 computer users at two universities in Estonia. The questionnaire asked about MSP at different anatomical sites, and potential individual and work related risk factors. Associations with risk factors were assessed by logistic regression. Results: Most respondents (77%) reported MSP in at least one anatomical region during the past 12 months. Most prevalent was pain in the neck (51%), followed by low back pain (42%), wrist/hand pain (35%) and shoulder pain (30%). Older age, right-handedness, not currently smoking, emotional exhaustion, belief that musculoskeletal problems are commonly caused by work, and low job security were the statistically significant risk factors for MSP in different anatomical sites. Conclusions: A high prevalence of MSP in the neck, low back, wrist/arm and shoulder was observed among Estonian computer users. Psychosocial risk factors were broadly consistent with those reported from elsewhere. While computer users should be aware of ergonomic techniques that can make their work easier and more comfortable, presenting computer use as a serious health hazard may modify health beliefs in a way that is unhelpful. © 2014 Oha et al.; licensee BioMed Central Ltd.

Mazya M.V.,Karolinska University Hospital | Lees K.R.,Watford General Hospital | Collas D.,University of Glasgow | Rand V.-M.,North Estonia Medical Center | And 4 more authors.
Neurology | Year: 2015

Objective: To study the safety of off-label IV thrombolysis in patients with very severe stroke (NIH Stroke Scale [NIHSS] scores >25) compared with severe stroke (NIHSS scores 15-25), where treatment is within European regulations. Methods: Data were analyzed from 57,247 patients with acute ischemic stroke receiving IV tissue plasminogen activator in 793 hospitals participating in the Safe Implementation of Thrombolysis in Stroke (SITS) International Stroke Thrombolysis Registry (2002-2013). Eight hundred sixty-eight patients (1.5%) had NIHSS scores >25 and 19,995 (34.9%) had NIHSS scores 15-25. Outcome measures were parenchymal hemorrhage, symptomatic intracerebral hemorrhage, mortality, and functional outcome. Results: Parenchymal hemorrhage occurred in 10.7% vs 11.0% (p 0.79), symptomatic intracerebral hemorrhage per SITS-MOST (SITS-Monitoring Study) in 1.4% vs 2.5% (p 0.052), death at 3 months in 50.4% vs 26.9% (p < 0.001), and functional independence at 3 months in 14.0% vs 29.0% (p < 0.001) of patients with NIHSS scores >25 and NIHSS scores 15-25, respectively. Multivariate adjustment did not change findings from univariate comparisons. Posterior circulation stroke was more common in patients with NIHSS scores >25 (36.2% vs 7.4%, p < 0.001), who were also more often obtunded or comatose on presentation (58.4% vs 7.1%, p < 0.001). Of patients with NIHSS scores >25, 26.2% were treated >3 hours from symptom onset vs 14.5% with NIHSS scores of 15-25. Conclusions: Our data show no excess risk of cerebral hemorrhage in patients with NIHSS score >25 compared to score 15-25, suggesting that the European contraindication to IV tissue plasminogen activator treatment at NIHSS levels >25 may be unwarranted. Increased mortality and lower rates of functional independence in patients with NIHSS score >25 are explained by higher stroke severity, impaired consciousness on presentation due to posterior circulation ischemia, and longer treatment delays. © 2015 American Academy of Neurology.

Soeorg H.,University of Tartu | Huik K.,University of Tartu | Parm U.,University of Tartu | Ilmoja M.-L.,Tallinn Childrens Hospital | And 3 more authors.
Pediatric Infectious Disease Journal | Year: 2013

Background: Coagulase-negative staphylococci (CoNS) are the first colonizers of gastrointestinal tract (GIT) and the commonest cause of late-onset sepsis (LOS) in preterm neonates. Intravascular catheters are considered a major source of CoNS bacteremia. However, several cases of LOS remain without an identified source. To elucidate whether GIT could be a potential source of invasive strains, we aimed to assess the molecular similarity between CoNS from blood and GIT in preterm neonates with LOS. Methods: Altogether 22 blood and 53 GIT isolates collected from 22 neonates with LOS caused by CoNS {Staphylococcus haemolyticus in 13, Staphylococcus epidermidis in 7 and Staphylococcus hominis in 2 patients) were included. Rectal swabs were collected twice weekly from birth, but only isolates obtained before LOS were analyzed. S. epidermidis isolates were typed by multilocus variable number of tandem repeats analysis and multilocus sequence typing, S. haemolyticus by pulsed-field gel electrophoresis. Results: Eighteen of 22 neonates had the same CoNS species in GIT and bloodstream; all these isolates from them (altogether 18 blood and 28 GIT isolates) underwent typing. The genotypic similarity between bloodstream and ≥1 antecedent GIT isolates was observed in 13 of 18 patients-3 of 7 with S. epidermidis and 10 of 11 with S. haemolyticus infection. The concordant GIT isolates were collected 0-7 days before the positive blood culture. Conclusions: The similarity between CoNS from GIT and bloodstream indicates that preterm neonates harbour invasive strains in GIT before LOS. Whether there is a causal relationship between GIT colonization and LOS remains to be elucidated in further studies. Copyright © 2013 by Lippincott Williams & Wilkins.

Maron E.,North Estonia Medical Center | Maron E.,University of Tartu | Maron E.,Imperial College London | Nutt D.,Imperial College London
Dialogues in Clinical Neuroscience | Year: 2015

At least one third of patients with anxiety disorders do not adequately respond to available pharmacological treatment. The reason that some patients with anxiety disorders respond well, but others not, to the same classes of medication is not yet fully understood. It is suggested that several biological factors may influence treatment mechanisms in anxiety and therefore could be identified as possible biomarkers predicting treatment response. In this review, we look at current evidence exploring different types of treatment predictors, including neuroimaging, genetic factors, and blood-related measures, which could open up novel perspectives in clinical management of patients with anxiety disorders. © 2015, AICH - Servier Research Group.

Almre I.,North Estonia Medical Center | Asser A.,North Estonia Medical Center | Laisaar T.,University of Tartu
Interactive Cardiovascular and Thoracic Surgery | Year: 2014

Anterior cervical spinal surgery can lead to various complications. We hereby present a case of two rare complications combined-pharyngo-oesophageal diverticulum and its perforation after cervical plate dislodgement. A 53-year old male patient presented with progressive dysphagia 18 years after anterior cervical spinal fusion with tricortical bone graft and custom-made plate at the C6/7 level. Oesophagography revealed a pharyngo-oesophageal diverticulum in front of the cervical plate. It was confirmed by subsequent oesophagoscopy, which also demonstrated a 3-cm longitudinal defect at the posterior wall of the diverticulum. During surgical exploration of the patient's neck, the plate was removed, the diverticulum was completely mobilized and excised, the oesophageal wall manually sutured and a cricopharyngeal myotomy performed. An oesophageal suture line failure was suspected postoperatively, but was not confirmed during reoperation. A year later, the patient has no dysphagia or any other symptoms. © 2013 The Author.

Kase M.,North Estonia Medical Center | Vardja M.,University of Tartu | Lipping A.,North Estonia Medical Center | Asser T.,University of Tartu | Jaal J.,University of Tartu
Radiotherapy and Oncology | Year: 2011

Purpose: To analyze, whether higher tumor levels of DNA repair enzymes contribute to worse treatment results of glioblastoma multiforme (GBM) patients after postoperative radiotherapy. Materials and methods: Thirty four patients with GBM received postoperative radiotherapy. Tumor sections were examined for poly-ADP ribose polymerase-1 (PARP-1) and DNA protein kinase (DNA-PK) expression. Immunohistochemical staining intensities of PARP-1 and DNA-PK were determined (score 0-3) and expression levels were correlated with patients overall survival. Results: Median survival time of the whole study group was 10.0 months (95% CI 8.1-11.9). Median survival of patients with high and low (≥median and

Nestal Zibo H.,North Estonia Medical Center
Stomatologija / issued by public institution "Odontologijos studija" ... [et al.] | Year: 2011

Enucleation of large cysts in the jaws is an invasive method that might be associated with complications. Marsupialization is a less invasive alternative method but it involves a prolonged and uncomfortable healing period. This study addresses a contemporaneous and less invasive surgical technique for treating larger mandibular cysts. MATERIALS AND METHODS. A 48-year-old woman presented with a large mandibular apical cyst involving the left parasymphysis, body, ramus and condylar neck, with involvement of the alveolar inferior nerve. The cystic lesion was enucleated using a 30° 4.0 mm endoscopic scope and endoscopic instruments through two small accesses: the ostectomy site of previously performed marsupialization and the alveolus of the involved third molar extracted of the time of the enucleation of the cyst. RESULTS. The endoscopic scope provided good visualization of the whole cystic cavity allowing the removal of any residual pathologic tissue and preservation of the integrity of the involved inferior alveolar nerve. The morbidity of the surgical procedure was extremely reduced. At a 6-month follow-up the patient did not present any symptom of inflammation and a panoramic X-ray showed good bone repair and remodelation. CONCLUSIONS. Endoscopically assisted enucleation proved to be effective method of treating a large mandibular cyst, providing total enucleation with a minimal invasive technique.

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