Nammas W.,Satakunta Central Hospital |
Airaksinen J.K.E.,University of Turku |
Paana T.,Satakunta Central Hospital |
Karjalainen P.P.,Satakunta Central Hospital
Heart Rhythm | Year: 2016
Afferent renal sympathetic nerve signaling regulates central sympathetic outflow. In this regard, renal sympathetic denervation has emerged as a novel interventional strategy for treatment of patients with resistant hypertension. Despite the disappointing results of the Simplicity HTN-3 randomized controlled trial, promoters of renal denervation argue that the negative results were due to ineffective denervation technique and poor patient selection. Yet, long-term “pathologic” increase of efferent sympathetic nerve activity is observed in many chronic disease states characterized by sympathetic overactivity, such as arrhythmia, heart failure, insulin resistance, and chronic kidney disease. In this review, we highlight the contemporary evidence on the safety/efficacy of renal denervation in the treatment of patients with atrial fibrillation. © 2016 Heart Rhythm Society
Karjalainen P.P.,Satakunta Central Hospital |
Nammas W.,Satakunta Central Hospital
Journal of Cardiology | Year: 2016
Chronic total occlusion (CTO) is a challenging subset of coronary artery disease that is commonly encountered in real-world practice; it is associated with worse long-term prognosis. Observational studies suggest that percutaneous coronary intervention (PCI) for CTO is associated with reduction in myocardial ischemia and improvement in quality of life and left ventricular function. Some observational studies suggested that CTO-PCI is associated with improvement of the 'hard' clinical endpoints; others did not. Nearly all these studies compared the clinical outcome of successful versus failed PCI, rather than comparing the outcome of a whole CTO-PCI cohort versus a 'true' control group. Interestingly, in observational studies that compared the outcome of CTO-PCI versus optimal medical treatment, long-term mortality was comparable between the two strategies. In patients with multi-vessel disease and CTO, complete revascularization is more often achieved by coronary artery bypass grafting than by PCI; the SYNTAX score of these patients often favors surgical revascularization according to the current guidelines. The current guidelines reflect the divergence of opinion on the usefulness/benefit of CTO-PCI, mainly due to the lack of randomized trials. Evidence is awaited from three ongoing randomized controlled trials comparing PCI versus optimal medical treatment in the setting of CTO. © 2016 Japanese College of Cardiology.
Joutsa J.,University of Turku |
Joutsa J.,Satakunta Central Hospital |
Gardberg M.,University of Turku |
Roytta M.,University of Turku |
Kaasinen V.,University of Turku
Parkinsonism and Related Disorders | Year: 2014
Movement disorder specialists can achieve a high level of accuracy when clinically diagnosing parkinsonism syndromes. However, data about the diagnostic accuracy among general neurologists is limited. Objectives: This study investigated the recent diagnostic accuracy of parkinsonism syndromes by general neurologists. Methods: A retrospective examination of 1362 post-mortem cases diagnosed in the years 2000-2012 by neuropathologists was performed. Out of these cases, we identified 111 patients who received a clinical parkinsonism diagnosis during life and 122 patients who received a neuropathological diagnosis of a parkinsonism syndrome post-mortem including 11 incidental cases. Results: Fifty-eight (75.3%) of the 77 patients who had received clinical Parkinson's disease (PD) diagnoses were confirmed after the neuropathological examination. The sensitivity of the clinical diagnosis for idiopathic Parkinson's disease (PD) was 89.2% and the specificity was 57.8%. The corresponding numbers for progressive supranuclear palsy (PSP) were 52.9% and 100%, and for multiple system atrophy (MSA) were 64.3% and 99.0%, respectively. Conclusions: Parkinson's disease is heavily overdiagnosed by general neurologists, whereas parkinsonism plus syndromes are underdiagnosed. Despite improvements in the diagnostic methods during recent decades and the development of diagnostic clinical criteria for parkinsonian syndromes, the diagnostic accuracy of Parkinson's disease remains relatively low, and 1/4 of diagnoses are incorrect. © 2014 Elsevier Ltd.
Mattila E.,University of Helsinki |
Uusitalo-Seppala R.,Satakunta Central Hospital |
Wuorela M.,Turku City Hospital |
Lehtola L.,Maria Hospital |
And 9 more authors.
Gastroenterology | Year: 2012
Background & Aims: Treatment of recurrent Clostridium difficile infection (CDI) with antibiotics leads to recurrences in up to 50% of patients. We investigated the efficacy of fecal transplantation in treatment of recurrent CDI. Methods: We reviewed records from 70 patients with recurrent CDI who had undergone fecal transplantation. Fecal transplantation was performed at colonoscopy by infusing fresh donor feces into cecum. Before transplantation, the patients had whole-bowel lavage with polyethylene glycol solution. Clinical failure was defined as persistent or recurrent symptoms and signs, and a need for new therapy. Results: During the first 12 weeks after fecal transplantation, symptoms resolved in all patients who did not have strain 027 C difficile infections. Of 36 patients with 027 C difficile infection, 32 (89%) had a favorable response; all 4 nonresponders had a pre-existing serious condition, caused by a long-lasting diarrheal disease or comorbidity and subsequently died of colitis. During the first year after transplantation, 4 patients with an initial favorable response had a relapse after receiving antibiotics for unrelated causes; 2 were treated successfully with another fecal transplantation and 2 with antibiotics for CDI. Ten patients died of unrelated illnesses within 1 year after transplantation. No immediate complications of fecal transplantation were observed. Conclusions: Fecal transplantation through colonoscopy seems to be an effective treatment for recurrent CDI and also for recurrent CDI caused by the virulent C difficile 027 strain. © 2012 AGA Institute.
Hynninen J.,University of Turku |
Lavonius M.,University of Turku |
Oksa S.,Satakunta Central Hospital |
Grenman S.,University of Turku |
And 2 more authors.
Gynecologic Oncology | Year: 2013
Objective: Most cases of epithelial ovarian cancer (EOC) are diagnosed in an advanced stage. When the disease has spread intra-abdominally, complete surgical tumor debulking is the single most important prognostic factor. Neoadjuvant chemotherapy (NACT) before surgery can cause fibrosis and adhesions in the peritoneal cavity and may interfere with the perioperative evaluation of tumor spread. In this prospective study, we evaluated whether perioperative visual assessment of tumor dissemination is similar in patients undergoing primary and interval surgery for EOC. Methods: Systematic visual evaluation of tumor spread was performed at the start of primary surgery/diagnostic laparoscopy (n = 39) or interval surgery (n = 16). Peritoneal cavity was divided into 22 anatomical regions. The carefully documented results of the visual assessment were compared with the histopathological analysis of 220 biopsies from primary and 92 biopsies from interval surgery. Results: In primary surgery, perioperative visual estimation of tumor spread showed 98% sensitivity, 76% specificity and 95% accuracy compared to histopathology. The corresponding figures after NACT were 86%, 76% and 84%, respectively. The difference in sensitivity and accuracy in primary and interval operations was statistically significant (p < 0.001). Conclusions: In advanced EOC, microscopically carcinomatous areas have a benign visual appearance more often after NACT than at primary surgery. NACT may interfere with the perioperative visual evaluation of tumor spread and thus lead to incomplete resection of tumor in potentially resectable areas. © 2012 Elsevier Inc. All rights reserved.
Lehto J.,University of Turku |
Gunn J.,University of Turku |
Karjalainen P.,Satakunta Central Hospital |
Airaksinen J.,University of Turku |
Kiviniemi T.,University of Turku
Journal of Thoracic and Cardiovascular Surgery | Year: 2015
Objectives Postpericardiotomy syndrome is a well-known complication after cardiac surgery. Nevertheless, little is known about the incidence and predictors of postpericardiotomy syndrome requiring medical attention or hospitalization in a contemporary set of patients undergoing isolated coronary bypass. Methods This retrospective analysis included 688 patients from 2008 to 2010. The median follow-up time was 5.3 [4.5-6.0] years. Results The incidence of postpericardiotomy syndrome was 61 of 688 patients (8.9%), and the median time to diagnosis was 21 [11-52] days, but only 13 patients (22%) required pleural drainage and 3 patients (4.9%) required pericardiocentesis. Patients with postpericardiotomy syndrome more often had 1 or more red blood cell units transfused (61% vs 43%, P = .008) after surgery and less often had diabetes (12% vs 31% P = .002) or metformin medication (3.3% vs 20%, P = .001) compared with those without postpericardiotomy syndrome. In multivariable Cox regression model, renal insufficiency and 1 or more red blood cell units transfused remained as independent predictors of postpericardiotomy syndrome and diabetes remained as a protective factor. Incidence of recurrences was high (38%), and increasing body mass index was the only predictor of relapse. Conclusions The incidence of symptomatic postpericardiotomy syndrome leading to medical care contact was markedly lower compared with that reported in older clinical studies. Postpericardiotomy syndrome was associated with the use of red blood cell units and was less common in patients with medically treated diabetes. © 2015 The American Association for Thoracic Surgery.
Airaksinen K.E.J.,University of Turku |
Gronberg T.,University of Turku |
Nuotio I.,University of Turku |
Nikkinen M.,Kuopio University Hospital |
And 3 more authors.
Journal of the American College of Cardiology | Year: 2013
Objectives This study sought to explore the incidence and risk factors of thromboembolic complications after cardioversion of acute atrial fibrillation. Background Anticoagulation therapy is currently recommended after cardioversion of acute atrial fibrillation in patients with risk factors for stroke, but the implementation of these new consensus-based guidelines has been slow. Methods A total of 7,660 cardioversions were performed in 3,143 consecutive patients with atrial fibrillation lasting <48 h in 3 hospitals. For this analysis, embolic complications were evaluated during the 30 days after 5,116 successful cardioversions in 2,481 patients with neither oral anticoagulation nor peri-procedural heparin therapy. Results There were 38 (0.7%; 95% confidence interval [CI]: 0.5% to 1.0%) definite thromboembolic events (31 strokes) within 30 days (median 2 days, mean 4.6 days) after cardioversion. In addition, 4 patients suffered transient ischemic attack after cardioversion. Age (odds ratio [OR]: 1.05; 95% CI: 1.02 to 1.08), female sex (OR: 2.1; 95% CI: 1.1 to 4.0), heart failure (OR: 2.9; 95% CI: 1.1 to 7.2), and diabetes (OR: 2.3; 95% CI: 1.1 to 4.9) were the independent predictors of definite embolic events. Classification tree analysis showed that the highest risk of thromboembolism (9.8%) was observed among patients with heart failure and diabetes, whereas patients with no heart failure and age <60 years had the lowest risk of thromboembolism (0.2%). Conclusions The incidence of post-cardioversion thromboembolic complications is high in certain subgroups of patients when no anticoagulation is used after cardioversion of acute atrial fibrillation. (Safety of Cardioversion of Acute Atrial Fibrillation [FinCV]; NCT01380574). © 2013 by the American College of Cardiology Foundation.
Karjalainen P.P.,Satakunta Central Hospital |
Nammas W.,Satakunta Central Hospital
International Journal of Cardiology | Year: 2012
Optical coherence tomography is an exciting light-based imaging modality with a much higher axial resolution as compared with intravascular ultrasound. The diagnostic value of optical coherence tomography resides in its ability to provide information on the stent interaction with the vessel wall at the level of individual struts. Chief clinical implications include evaluating strut neointimal coverage and strut malapposition following coronary stenting. This Editorial covers the basics of optical coherence tomography, its established and potential clinical implications, probable caveats and downsides, in addition to a future perspective, all in view of the late-breaking peer-reviewed literature. © 2012 Elsevier Ireland Ltd.
Neointimal coverage and vasodilator response to titanium-nitride-oxide- coated bioactive stents and everolimus-eluting stents in patients with acute coronary syndrome: Insights from the BASE-ACS trial
Karjalainen P.,Satakunta Central Hospital
International Journal of Cardiovascular Imaging | Year: 2013
Incomplete stent endothelialization is associated with late and very late stent thrombosis. In a post hoc analysis of the BASE-ACS trial, we sought to assess neointimal coverage and coronary flow reserve (CFR) 9 months after implantation of titanium-nitride-oxide-coated bioactive stents (BAS) versus everolimus-eluting stents (EES) in patients with acute coronary syndrome (ACS). In the BASE-ACS trial, 827 patients with ACS were randomized to receive either BAS or EES. In the current study, we examined neointimal growth and strut coverage by optical coherence tomography and CFR by trans-thoracic echocardiography in 28 consecutive non-diabetic patients with the culprit lesion in the left anterior descending coronary artery. The primary endpoints were binary stent strut coverage and CFR at 9-month follow-up. A total of 13 patients were included in the BAS group (2,033 struts); 15 in the EES group (2,898 struts). Binary stent strut coverage was higher and malapposed struts lower with BAS versus EES (99.4 vs 89.2, and 0.2 vs 4.6 %, respectively, p < 0.001 for both). Neointimal hyperplasia thickness was greater with BAS versus EES (274.2 vs 100.1 μm, respectively, p < 0.001). CFR was lower with EES versus BAS (2.2 ± 0.8 vs 3.0 ± 0.5, respectively, p = 0.001). Abnormal CFR (<2.5) were detected in 10 patients in the EES group versus one in the BAS group (p = 0.002). The current study demonstrated that in patients with ACS, BAS resulted in improved neointimal stent strut coverage and better coronary vasodilator function as compared with EES at 9-month follow-up. © 2013 Springer Science+Business Media Dordrecht.
Kokki M.,Kuopio University Hospital |
Sjovall S.,Satakunta Central Hospital |
Keinanen M.,Kuopio University Hospital |
Kokki H.,Kuopio University Hospital
International Journal of Obstetric Anesthesia | Year: 2013
Background Postdural puncture headache is common in parturients following lumbar puncture. If headache is severe and persistent, an epidural blood patch is recommended. In this paper we reviewed the efficacy of epidural blood patches over a 13-year period at two hospitals in Finland with a particular emphasis on its timing. Methods The hospitals' databases were searched to identify parturients who underwent an epidural blood patch from March 1998 to June 2011. Parturients' records were reviewed to establish the characteristics and associated symptoms of headache and the effectiveness of the epidural blood patch. Results A total of 129 parturients received 151 epidural blood patches. These followed spinal (n = 49), epidural (n = 47) or combined spinal-epidural blocks (n = 33). The success rate of the first procedure was 89%, with permanent relief in 76%. The first procedure provided permanent relief of postdural puncture headache for 86% of 78 patients having the procedure after 48 h, compared to 65% of 37 patients when it was performed between 24 and 48 h, and 50% of 14 patients with the procedure within the first 24 h after dural puncture (P = 0.003). A second procedure was performed for 22 parturients due to incomplete relief (n = 5) or recurrent symptoms (n = 17); all had complete resolution of symptoms. Conclusions Epidural blood patch performed later than 48 h following lumbar puncture or accidental dural puncture is effective in parturients with postdural puncture symptoms. The recurrence rate of symptoms after an initially successful epidural blood patch is high, and therefore patients should be provided with counselling and contact information. © 2013 Elsevier Ltd. All rights reserved.