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Laurikainen E.,University of Turku | Valpas A.,South Carelia Central Hospital | Aukee P.,Central Finland Central Hospital | Kivela A.,University of Oulu | And 3 more authors.
European Urology | Year: 2014

Background Midurethral slings have become the most preferred surgical treatment for female urinary incontinence. Objective To compare the efficacy and safety of two midurethral sling procedures with a different technique of sling insertion 5 yr after intervention. Design, setting, and participants Multicenter randomized clinical trial conducted in seven public hospitals in Finland including primary cases of stress urinary incontinence. Intervention Surgical treatment with the retropubic tension-free vaginal tape (TVT) procedure or the transobturator tension-free vaginal tape (TVT-O) procedure. Outcome measurements and statistical analysis Objective treatment success criteria were a negative stress test, a negative 24-h pad test, and no retreatment for stress incontinence. Patient satisfaction was assessed by condition-specific quality-of-life questionnaires. Results and limitations A total of 95% of the included women could be assessed according to the protocol 5 yr after surgery. The objective cure rate was 84.7% in the TVT group and 86.2% in the TVT-O group, with no statistical difference between the groups. Subjective treatment satisfaction was 94.2% in the TVT group and 91.7% in the TVT-O group, with no difference between groups. Complication rates were low, with no difference between groups. Conclusions Both objective and subjective cure rates were >80% in both groups even when women lost to follow-up were included as failures. The complication rates were low, with no difference between the groups. No late-onset adverse effects of the tape material were seen. Patient summary Female urinary stress incontinence can be treated surgically with minimally invasive midurethral sling procedures. Two main approaches of sling placement have been developed: the retropubic and the transobturatory. We compared both approaches and followed the patients for 5 yr. We found no difference in cure rate between the procedures, and patient satisfaction was high. Trial registration ClinicalTrials.gov identifier NCT00379314. © 2014 European Association of Urology.


Aro A.L.,University of Helsinki | Anttonen O.,Paijat Hame Central Hospital | Tikkanen J.T.,University of Oulu | Junttila M.J.,University of Oulu | And 4 more authors.
Circulation | Year: 2012

Background-T-wave inversion in right precordial leads V1 to V3 is a relatively common finding in a 12-lead ECG of children and adolescents and is infrequently found also in healthy adults. However, this ECG pattern can also be the first presentation of arrhythmogenic right ventricular cardiomyopathy. The prevalence and prognostic significance of T-wave inversions in the middle-aged general population are not well known. Methods and Results-We evaluated 12-lead ECGs of 10 899 Finnish middle-aged subjects (52% men, mean age 44±8.5 years) recorded between 1966 and 1972 for the presence of inverted T waves and followed the subjects for 30±11 years. Primary end points were all-cause mortality, cardiac mortality, and arrhythmic death. T-wave inversions in right precordial leads V 1 to V 3 were present in 54 (0.5%) of the subjects. In addition, 76 (0.7%) of the subjects had inverted T waves present only in leads other than V 1 to V 3. Right precordial T-wave inversions did not predict increased mortality (not significant for all end points). However, inverted T waves in leads other than V 1 to V 3 were associated with an increased risk of cardiac and arrhythmic death (P<0.001 for both). Conclusions-T-wave inversions in right precordial leads are relatively rare in the general population, and are not associated with adverse outcome. Increased mortality risk associated with inverted T waves in other leads may reflect the presence of an underlying structural heart disease. © 2012 American Heart Association, Inc.


Sipponen A.,Paijat Hame Central Hospital | Laitinen K.,University of Helsinki
APMIS | Year: 2011

Rosins (resins) are natural products of the coniferous trees. Purified rosin from the trunk of Norway spruce (Picea abies) is antibacterial against the gram-positive bacteria, but not against the gram-negative bacteria in agar plate diffusion test. In this study, we examined the antimicrobial properties of the coniferous rosin against bacteria and yeasts using the European Pharmacopoeia (EP) challenge test. The microbes tested were Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli, Pseudomonas aeruginosa, Bacillus subtilis, and Candida albicans. To prepare challenge media, purified rosin was mixed with a biologically inert salve in varying concentrations. The microbes were inoculated (5×10 5 microbes (bacteria) or 5×10 4 microbes (yeast, C.albicans)) into 10g of the rosin-containing challenge medium for 14days at maximum. Samples were taken from the media for re-cultivation of the microbes at time intervals of 1h, 24h, 4, 7, and 14days. The microbicidal efficacy of the challenge media was estimated by reduction of the number of the colony forming units (CFU) of microbes in the test samples. A reduction of more than 10 3CFU for bacteria and 10 2CFU for fungi in 7days was considered to indicate a significant microbicidal action. Pure rosin was antimicrobial within 24h against all microbes tested. The 0.5% rosin-salve medium (w/w) did not differ in microbicidal effects from the rosin-free salve medium (control). A raise of the rosin concentration resulted in increase of the microbicidal effect of the rosin-salve medium against all micro-organisms tested. Rosin concentration of 10% (w/w) in the medium significantly reduced the colonization of S. aureus (including MRSA) within 24h and significantly reduced the colonization of all other micro-organisms within 4days. Rosin is strongly microbicidal against a wide range of microbes, against both gram-positive and gram-negative bacteria, and against C. albicans, in the EP challenge test. The minimum concentration of rosin is 10% (w/w) to prevent the preservation of the microbes in the rosin-salve media. © 2011 The Authors. APMIS © 2011 APMIS.


Kerola A.M.,University of Helsinki | Kerola A.M.,Paijat Hame Central Hospital | Kauppi M.J.,Paijat Hame Central Hospital
Clinical Rheumatology | Year: 2014

Only limited evidence exists on the therapeutic potential of biologic agents in the treatment of myositis. We present a brief review of the literature on off-label experiences of biologic agents in myositis, with a special interest in abatacept. Rituximab has been indicated to be beneficial and well tolerated in one large randomized controlled trial and many smaller studies. Initial data on tumour necrosis factor (TNF) inhibitors are conflicting. There are only a few case reports and mechanistic studies on the treatment of myositis with other biologics, including alemtuzumab, anakinra, tocilizumab and abatacept. We report a patient with severe myositis overlap syndrome, manifesting also as rheumatoid arthritis, peripheral vasculitis and interstitial lung disease. Her myositis was refractory to many conventional and biologic therapies but was well controlled with abatacept. This suggests that abatacept might be a beneficial option for the treatment of refractory myositis and that clinical trials are needed to further investigate its efficacy. © 2014 Clinical Rheumatology.


Valimaki J.,Paijat Hame Central Hospital | Uusitalo H.,University of Tampere
Acta Ophthalmologica | Year: 2014

Purpose To detect by immunohistochemical means the changes in bleb capsules at the cellular level between functioning and non-functioning glaucoma drainage implants (GDIs). Methods Three samples each of functioning (1 Baerveldt and 2 Molteno implants) and non-functioning filtration blebs (1 Molteno and 2 Ahmed implants) were studied. A non-functioning bleb was defined as an intra-ocular pressure (IOP) >21 mmHg or a <20% reduction in IOP from baseline on three consecutive follow-up visits with maximal tolerated medication. The capsules were obtained between 6 and 108 months after GDI insertion for medical reasons only. Primary antibodies were used to stain fibronectin, tenascin, laminin, collagen IV and smooth muscle actin (SMA). The samples were graded on the basis of the intensity and quantity of immunohistochemical staining into four categories as follows: no staining or a mild, moderate or marked staining. Results The non-functioning blebs expressed more fibronectin, tenascin and SMA through the whole capsule wall than the functioning blebs. In the functioning blebs, tenascin was found mainly in the inner layer of the capsule. More type IV collagen and laminin were also found in the non-functioning bleb capsules than in the functioning blebs. No difference was found between the bleb capsules irrespective of whether they had been perfused with aqueous humour immediately after surgery (Ahmed) or after a delay (Molteno, Baerveldt). Conclusion Accumulation of extracellular matrix components and activated fibroblasts in the bleb capsules of non-functioning GDI indicates the presence of an active wound healing process, suggesting a possible reduction in filtration through the bleb wall. © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.


Juhani Junttila M.,University of Miami | Juhani Junttila M.,University of Oulu | Sager S.J.,University of Miami | Tikkanen J.T.,University of Oulu | And 3 more authors.
European Heart Journal | Year: 2012

The variations in the electrocardiographic patterns of J-point elevations, and the complex of J-points and J-waves in early repolarization (ER), in conjunction with disparities in associated sudden cardiac death (SCD) risk, have lead to a recognition of the need to carefully classify the spectrum of these observations. Many questions about the pathogenesis of J-wave patterns, and the associated magnitudes of risk, remain unanswered, especially in regard to the risk implications in certain high-prevalence subpopulations such as athletes, children, and adolescents. Interest in these electrocardiography (ECG) patterns has grown dramatically in recent years, in large part because of the frequency with which these patterns are observed on routine ECGs. In this review, we discuss the current knowledge on the prevalence of different J-point/J-wave patterns and estimates of the magnitude of mortality and SCD risk associated with J-point elevations and J-waves, in what has become known as ER patterns. © 2012 The Author.


Valimaki J.,Paijat Hame Central Hospital
Eye (Basingstoke) | Year: 2015

Purpose This pilot study, the first of its type, was conducted to determine the clinical outcome of a sequential glaucoma drainage implant (GDI) inserted in piggyback manner, that is into the bleb of a primary GDI.MethodsThis was a retrospective chart study with a minimum 1-year follow-up involving 16 eyes of 14 uncontrolled glaucoma patients who had previously undergone sequential GDI performed using a technique to convert a one-plate into a two-plate implant system. Surgical success was defined as intraocular pressure (IOP) <21 mm Hg with at least a 30% reduction in IOP from baseline on two consecutive follow-up visits, IOP >5 mm Hg on two consecutive follow-up visits, and neither reoperation of glaucoma nor loss of light perception vision.ResultsThe mean ±SD baseline IOP was 29.2±5.2 mm Hg, and the mean postoperative IOP was 17.3±3.4 mm Hg, with a mean pressure drop of 39.4±10.4% (P<0.001). Life-table analysis showed an 88% success rate after 12 months of follow-up. The mean preoperative best corrected visual acuity (BCVA) was 0.2±0.2 logMAR (Snellen equivalent 6/9.5), compared with 0.3±0.3 logMAR postoperatively (Snellen equivalent 6/12; P=0.497). Postoperative complications included a flat anterior chamber and choroidal detachment (one eye), uveitis and cataract (one eye), diplopia (one eye), and worsening of pre-existing pseudophakic bullous keratopathy (one eye).ConclusionsIn glaucoma eyes with useful vision the piggyback GDI seems to provide a significant IOP lowering with minimal complications in patients in whom an initial GDI had failed to control the IOP. © 2015 Macmillan Publishers Limited All rights reserved.


Valimaki J.O.,Paijat Hame Central Hospital
European Journal of Ophthalmology | Year: 2014

Purpose: This pilot study, the first of its type, was conducted to determine the clinical outcome of glaucoma drainage implant (GDI) surgery supplemented with injectable crosslinked hyaluronic acid (HA) in patients with severe glaucoma. Methods: This was a retrospective chart study involving 10 eyes of 10 patients with severe glaucoma (glaucomatous visual field loss worse than -20 dB) who had previously undergone GDI surgery supplemented with crosslinked HA with a 2-year follow-up. Surgical success was defined as intraocular pressure (IOP) <21 mm Hg with a reduction of ≥40% (definition A) or ≥50% (definition B) from baseline IOP on 2 consecutive follow-up visits, IOP >5 mm Hg on 2 consecutive follow-up visits, and neither reoperation of glaucoma nor loss of light perception vision. Results: The mean ± SD baseline IOP before GDI was 38.5 ± 10.7 mm Hg, and the mean IOP at the last followup visit was 13.0 ± 5.0 mm Hg, with a mean pressure drop of 24.4 ± 10.9 mm Hg (62%; p = 0.005). According to definition A, life-table analysis showed an overall success rate of 80%, while according to definition B, the success rate was 50% after 24 months of follow-up. Complications were infrequent and not serious. No complications resulting from the reticulated HA therapy itself were observed. Conclusions: In eyes with severe glaucoma, the intraoperative application of crosslinked sodium HA gel may improve the efficacy of GDI surgery. © 2014 Wichtig Publishing.


Valimaki J.,Paijat Hame Central Hospital
Journal of Glaucoma | Year: 2012

Purpose: To evaluate the outcome of 40 consecutive patients with Molteno3 implantation in uncontrolled glaucoma with at least a 6-month follow-up. MATERIALS AND Methods: Nonrandomized, interventional, and retrospective clinical study. Failure was defined as IOP >21mm Hg or less than 20% reduction of intraocular pressure (IOP) from baseline on 2 consecutive follow-up visits, IOP ≤5 mm Hg on 2 consecutive follow-up visits, reoperation of glaucoma or loss of light perception vision. RESULTS: The mean preoperative IOP was 34.3±9.1 mm Hg, and the mean postoperative IOP at the last follow-up visit was 16.8±7.5 mm Hg with a pressure drop of 19.1±11.5 mm Hg (56%) (P=0.000; 95% CI 13.5-21.4). The Kaplan-Meier life-table analysis showed a 95% success rate after 6 months and a 71% success rate after 12 months of follow-up. Postoperative complications included cataract (6 eyes), choroidal detachment (3 eyes), flat anterior chamber (2 eyes), malignant glaucoma (2 eyes), encapsulated bleb (2 eyes), corneal decompensation (2 eyes), hyphaema (1 eye), uveitis (1 eye), retinal detachment (1 eye), suprachoroidal hemorrhage (1 eye), tube erosion (1 eye), and phthisis bulbi (1 eye). Conclusion: The Molteno3 dual-chamber implant is useful and well tolerated in controlling IOP, but it does not seem to reduce the risk of postoperative hypotony. © 2012 by Lippincott Williams & Wilkins.


Silvola J.T.,Paijat Hame Central Hospital
Otolaryngology - Head and Neck Surgery (United States) | Year: 2012

Objective. To show that mastoid cavities with continuous infections and cleaning problems can be obliterated with bioactive glass (BG) and to present results of a pilot study for 16 operations on adults. Study Design. Case series with planned data collection. Setting. Päijät-Häme Central Hospital, Finland-a single ear, nose, and throat (ENT) hospital department serving a population of 216,000. Subjects and Methods. Fourteen patients had a large open radical cavity with recurrent infections. Two ears had discharge and pain after simple mastoidectomy. A re-mastoidectomy included support of the cavity skin and obliteration with BG. The mean follow-up time was 2.2 years. Results. All ears became dry. One reoperation was needed as the fascia support to the ear canal (EC) skin was too weak, and part of the BG leaked into the EC. The ear stayed dry, and the missing BG was replaced in a reoperation. A slightly short musculoperiosteal flap supported the EC skin in 1 ear. A minor amount of BG leaked into the EC. The ear stayed dry. The aim was an ample ear canal. One ear was overfilled and required meatoplasty. Simple mastoid cavities were isolated from the middle ear and become asymptomatic. Conclusions. In this pilot study, BG works safely and with success as an obliteration material in problematic open radical cavities. Bioactive glass seems to tolerate chronic infection in the mastoid and prevent postoperative infections. © 2012 American Academy of Otolaryngology - Head and Neck Surgery Foundation.

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