Meilahti Hospital Research Articles

Operating unit time use is associated with anaesthesia type in below-knee surgery in adults.

Peripheral nerve blocks could reduce the operating unit and theatre time spent on high-risk patients who are particularly vulnerable to complications of general anaesthesia or have medications that prevent application of central neuraxial blocks. Medical record data of 617 and 254 elderly adults undergoing below-knee surgery in Jorvi and Meilahti hospitals (Helsinki University Hospital) between January 2010 and December 2012 were used to investigate the influence of anaesthetic technique on operating theatre times and on operating unit times using flexible parametric survival models. We report operating theatre and unit exit ratios (i.e. hazard ratios but using ratios of exit rates) for different types of anaesthesia. Adjusted analyses: In Jorvi Hospital, anaesthesia type was associated with large initial differentials in operating theatre times. The theatre exit ratios remained lower for general anaesthesia and central neuraxial blocks compared to peripheral nerve blocks until 30 min. In Meilahti Hospital, anaesthesia type did not influence theatre time, but was the best predictor of operating unit times. Compared to peripheral nerve blocks, the exit ratio remained lower for general anaesthesia until five operating unit hours in both hospitals and for central neuraxial blocks until 1 h in Meilahti Hospital and until 3 h in Jorvi Hospital. Holding area was used more in Jorvi Hospital compared to Meilahti Hospital. Peripheral nerve block anaesthesia reduces time spent in the operating unit and can reduce time spent in the operating theatre if induced in holding area outside of theatre.

Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications.

BackgroundThe purpose of the study was to identify risk factors for conversion of laparoscopic cholecystectomy and risk factors for postoperative complications in acute calculous cholecystitis. The most common complications arising from cholecystectomy were also to be identified.MethodsA total of 499 consecutive patients, who had undergone emergent cholecystectomy with diagnosis of cholecystitis in Meilahti Hospital in 2013–2014, were identified from the hospital database. Of the identified patients, 400 had acute calculous cholecystitis of which 27 patients with surgery initiated as open cholecystectomy were excluded, resulting in 373 patients for the final analysis. The Clavien-Dindo classification of surgical complications was used.ResultsLaparoscopic cholecystectomy was initiated in 373 patients of which 84 (22.5%) were converted to open surgery. Multivariate logistic regression identified C-reactive protein (CRP) over 150 mg/l, age over 65 years, diabetes, gangrene of the gallbladder and an abscess as risk factors for conversion. Complications were experienced by 67 (18.0%) patients. Multivariate logistic regression identified age over 65 years, male gender, impaired renal function and conversion as risk factors for complications.ConclusionsAdvanced cholecystitis with high CRP, gangrene or an abscess increase the risk of conversion. The risk of postoperative complications is higher after conversion. Early identification and treatment of acute calculous cholecystitis might reduce the number of patients with advanced cholecystitis and thus improve outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13017-016-0111-4) contains supplementary material, which is available to authorized users.

Do-Not-Resuscitate (DNR) Orders in Patients with Intracerebral Hemorrhage

Do-not-resuscitate orders may be associated with poor outcome in patients with intracerebral hemorrhage because of less active management. We sought to characterize the practice of issuing do-not-resuscitate orders in intracerebral hemorrhage. We also aimed to identify possible differences in care according to do-not-resuscitate status. We conducted a retrospective study of all consecutive intracerebral hemorrhage patients admitted to the Meilahti Hospital of the Helsinki University Central Hospital between January 2005 and March 2010. Data obtained from medical records allowed comparison of characteristics of patients and care of do-not-resuscitate and non-do-not-resuscitate patients as well as patients with early (within 24 h) and late (>24 h) do-not-resuscitate decisions. Logistic regression was used to identify factors independently associated with do-not-resuscitate decisions. Of our 1013 patients, a do-not-resuscitate order was issued in 368 (35%), of which 262 (73%) occurred within 24 h from admission. Advanced age (odds ratio 1·06 per year; 95% confidence interval 1·04-1·08), more severe stroke (1·09 per National Institutes of Health Stroke Scale point; 1·06-1·13), and deterioration soon after admission (5·12, 3·33-7·87) had the strongest associations with do-not-resuscitate decisions. Patients with do-not-resuscitate orders received recommended care including stroke unit care (43% vs. 64%; P < 0·001) and prophylaxis for deep venous thrombosis (45% vs. 54%; P = 0·027) less often than non-do-not-resuscitate patients. This was especially the case when the do-not-resuscitate order was issued early. In addition to confirming the role of known intracerebral hemorrhage prognostic factors in do-not-resuscitate decision-making, our results demonstrate that do-not-resuscitate orders led to less active care of intracerebral hemorrhage patients.

Identical but different: haemophilia B in monozygotic twins with inhibitor in one brother and subsequent successful immune tolerance induction

HaemophiliaVolume 18, Issue 4 p. e349-e351 Letters to the Editors Identical but different: haemophilia B in monozygotic twins with inhibitor in one brother and subsequent successful immune tolerance induction S. Ranta, S. Ranta Children′s Hospital, and Helsinki University Central Hospital, Helsinki, FinlandSearch for more papers by this authorB. Verbruggen, B. Verbruggen Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsSearch for more papers by this authorA. Wikström, A. Wikström Children′s Hospital, and Helsinki University Central Hospital, Helsinki, FinlandSearch for more papers by this authorA. Mäkipernaa, Corresponding Author A. Mäkipernaa Unit of Coagulation Disorders, Division of Haematology, Department of Medicine, Helsinki University Central Hospital, Finland Correspondence: Anne Mäkipernaa, MD, PhD, Meilahti Hospital, PO Box 340, 00029 HUS, Helsinki, Finland. Tel.:+358 50 427 9367; fax: +358 9 471 74707; e-mail: [email protected]Search for more papers by this author S. Ranta, S. Ranta Children′s Hospital, and Helsinki University Central Hospital, Helsinki, FinlandSearch for more papers by this authorB. Verbruggen, B. Verbruggen Radboud University Nijmegen Medical Centre, Nijmegen, The NetherlandsSearch for more papers by this authorA. Wikström, A. Wikström Children′s Hospital, and Helsinki University Central Hospital, Helsinki, FinlandSearch for more papers by this authorA. Mäkipernaa, Corresponding Author A. Mäkipernaa Unit of Coagulation Disorders, Division of Haematology, Department of Medicine, Helsinki University Central Hospital, Finland Correspondence: Anne Mäkipernaa, MD, PhD, Meilahti Hospital, PO Box 340, 00029 HUS, Helsinki, Finland. Tel.:+358 50 427 9367; fax: +358 9 471 74707; e-mail: [email protected]Search for more papers by this author First published: 28 May 2012 https://doi.org/10.1111/j.1365-2516.2012.02865.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume18, Issue4July 2012Pages e349-e351 RelatedInformation

‘Intense inner agitation’: an overlooked side effect of droperidol

Acta Anaesthesiologica ScandinavicaVolume 56, Issue 2 p. 261-262 LETTER TO THE EDITOR ‘Intense inner agitation’: an overlooked side effect of droperidol D. A. Cozanitis, D. A. CozanitisSearch for more papers by this authorP. H. Rosenberg, P. H. RosenbergSearch for more papers by this author D. A. Cozanitis, D. A. CozanitisSearch for more papers by this authorP. H. Rosenberg, P. H. RosenbergSearch for more papers by this author First published: 12 December 2011 https://doi.org/10.1111/j.1399-6576.2011.02582.xCitations: 1 Address: Dimitri A. Cozanitis Department of Anaesthesiology & Intensive Care Medicine Helsinki University Meilahti Hospital 00029 HUS Helsinki Finland e-mail: dacozanitis@gmail.com Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume56, Issue2Febuary 2012Pages 261-262 RelatedInformation

Structure of Delay in Carotid Surgery – An Observational Study

Objectives and design: Undelayed investigation and surgical treatment of symptomatic carotid artery stenosis are recommended as per guidelines on stroke prevention. We evaluated patient referral pathways and delays from symptom to surgery in Helsinki University Central Hospital (HUCH) region. Materials and Methods: One hundred consecutive symptomatic patients scheduled for carotid endarterectomy (CEA) between August 2007 and September 2008 were identified and the delay between ischaemic index symptom and CEA was analysed. Results: The median time from the index symptom to surgery was 47 days (range: 3–688 days). The longest delay was surgery related with a median of 25 days (range: 2–202 days) from the consultation of the vascular surgeon to the operation. Only 11% of the patients were operated within the recommended 2 weeks’ time. It was more likely that CEA was performed within 2 weeks if an emergent consultation to Meilahti Hospital neurologist on call did take place (odds ratio (OR) 12.6, 95% confidence interval (CI) 1.5–104, p = 0.019). Conclusion: Delays from symptom to surgery were generally too long and the in-hospital door-to-knife time (DKT) was long mostly due to waiting for the operation theatre. The investigation of all stroke, amaurosis fugax and transient ischaemic attack patients should be performed on an emergency basis and most optimally centralised to hospitals were carotid surgery is performed.

Structure of Delay in Carotid Surgery – An Observational Study

Objectives and design Undelayed investigation and surgical treatment of symptomatic carotid artery stenosis are recommended as per guidelines on stroke prevention. We evaluated patient referral pathways and delays from symptom to surgery in Helsinki University Central Hospital (HUCH) region. Materials and methods One hundred consecutive symptomatic patients scheduled for carotid endarterectomy (CEA) between August 2007 and September 2008 were identified and the delay between ischaemic index symptom and CEA was analysed. Results The median time from the index symptom to surgery was 47 days (range: 3–688 days). The longest delay was surgery related with a median of 25 days (range: 2–202 days) from the consultation of the vascular surgeon to the operation. Only 11% of the patients were operated within the recommended 2 weeks’ time. It was more likely that CEA was performed within 2 weeks if an emergent consultation to Meilahti Hospital neurologist on call did take place (odds ratio (OR) 12.6, 95% confidence interval (CI) 1.5–104, p = 0.019). Conclusion Delays from symptom to surgery were generally too long and the in-hospital door-to-knife time (DKT) was long mostly due to waiting for the operation theatre. The investigation of all stroke, amaurosis fugax and transient ischaemic attack patients should be performed on an emergency basis and most optimally centralised to hospitals were carotid surgery is performed.

OBSTRUCTIVE SLEEP APNEA SYNDROME: CLINICAL PICTURE AND DIAGNOSIS

Acta Neurologica ScandinavicaVolume 65, Issue S90 p. 314-315 OBSTRUCTIVE SLEEP APNEA SYNDROME: CLINICAL PICTURE AND DIAGNOSIS M. Partinen, M. Partinen Department of Neurology, (M.P. and T.E.), Meilahti Hospital, University of Helsinki and Department of Physiology, (J.A.), University of Turku, Finland.Search for more papers by this authorT. Erkinjuntti, T. Erkinjuntti Department of Neurology, (M.P. and T.E.), Meilahti Hospital, University of Helsinki and Department of Physiology, (J.A.), University of Turku, Finland.Search for more papers by this authorJ. Alihanka, J. Alihanka Department of Neurology, (M.P. and T.E.), Meilahti Hospital, University of Helsinki and Department of Physiology, (J.A.), University of Turku, Finland.Search for more papers by this author M. Partinen, M. Partinen Department of Neurology, (M.P. and T.E.), Meilahti Hospital, University of Helsinki and Department of Physiology, (J.A.), University of Turku, Finland.Search for more papers by this authorT. Erkinjuntti, T. Erkinjuntti Department of Neurology, (M.P. and T.E.), Meilahti Hospital, University of Helsinki and Department of Physiology, (J.A.), University of Turku, Finland.Search for more papers by this authorJ. Alihanka, J. Alihanka Department of Neurology, (M.P. and T.E.), Meilahti Hospital, University of Helsinki and Department of Physiology, (J.A.), University of Turku, Finland.Search for more papers by this author First published: March 1982 https://doi.org/10.1111/j.1600-0404.1982.tb03505.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume65, IssueS90March 1982Pages 314-315 RelatedInformation

Tuberculous meningitis

Ten patients with confirmed tuberculous meningitis were seen at Meilahti Hospital, University of Helsinki, in 1966--1977. Six of the patients had a positive CSF culture for M. tuberculosis, and a positive CSF smear for acid-fast bacilli was found in one case. On admission, seven patients had an altered state of consciousness, five complained of headache, and nuchal rigidity was noted in two. Five patients recovered completely, three had persistent late sequelae, and two of the patients died. The most important fact influencing the prognosis was an early institution of adequate antituberculous chemotherapy.

A prospective study of acute poisonings in Finnish hospital patients.

1. We have carried out a prospective study of all adult patients presenting with acute poisoning during one month to the Helsinki University Central Hospital (Meilahti Hospital). 2. Two hundred and twenty-six cases of acute poisoning (113 males and 113 females) presented to the emergency department. Most cases in both men (66%) and women (67%) involved alcohol. As to drugs, psychotropic agents predominated in both men and women. The frequency of patient presentation peaked between 7 p.m. and 9 p.m. and was lowest between 8 a.m. and 10 a.m. In most cases, the delay from ingestion of the poison to presentation was longer than 4 h. 3. The clinical status of the patients on arrival was generally good; more than half (55%) of them were fully awake. Serious symptoms (e.g. unconsciousness, insufficient respiration necessitating intubation, aspiration, convulsions or hypotension) occurred in 15% of the presentations. There were no fatalities. 4. One hundred and thirty-five patients (60%) received at least one 50-g dose of activated charcoal. However, charcoal was given in 86% of the cases of drug poisoning. Gastric lavage was performed in 112 cases (50%), and 106 cases (47%) involved both gastric lavage and administration of charcoal. Twenty-one patients received antidotes (flumazenil, calcium gluconate or naloxone) and three patients were hemodialysed. 5. Of the 226 cases, 142 (63%) were managed solely in the emergency department. Of the 84 cases admitted to the hospital, eight had to be managed in the intensive care unit. Almost all patients (94%) were discharged within 24 h. 6. In this survey on 226 consecutive cases of acute poisoning, about two-thirds of the cases involved alcohol, while the most common drugs taken were psychotropic agents. The poisoning was mild in the great majority of the cases. Activated charcoal was generally administered in all but trivial cases of drug poisoning.

Increased resistance among Staphylococcus epidermidis isolates in a large teaching hospital over a 12-year period.

The prevalence of drug resistance among clinically significant blood isolates of Staphylococcus epidermidis (n = 464) and consumption of antibiotics at a tertiary care teaching hospital (Meilahti Hospital, Helsinki) were analysed for the period 1983-1994. Resistance to methicillin increased from 28 to 77%. Simultaneously, usage of third-generation cephalosporins increased nearly sevenfold (from 8.6 kg/ to 56.4 kg/year). A significant correlation was found between percentages of methicillin resistance and usage of penicillinase-stable beta-lactam agents, including cloxacillin, imipenem, and first-, second-, and third-generation cephalosporins (r = 0.737, p < 0.0062). The increase in ciprofloxacin resistance occurred soon after the introduction of ciprofloxacin. Moreover, there was a remarkable increase in resistance to fusidic acid (from 10 to 40%) and rifampin (from 0 to 23%) despite the low usage of these agents. Overall, the rate of multiply resistant isolates roughly tripled (from 20 to 71%) and, by 1994, the frequency of isolates susceptible to vancomycin only was as high as 11%, which remarkably limits options for therapy.

Imaging of congenital esophageal cysts in adults : Bondestam S, Salo JA, Salonen OLM, Lamminen AE. (Department of Diagnostic Radiology, Meilahti Hospital, SF-00290 Helsinki, Finland) Gastroinest Radiol 1990; 15:279–281

Imaging of congenital esophageal cysts in adults : Bondestam S, Salo JA, Salonen OLM, Lamminen AE. (Department of Diagnostic Radiology, Meilahti Hospital, SF-00290 Helsinki, Finland) Gastroinest Radiol 1990; 15:279–281

Evaluation of psychiatric emergency consultations in the care of self-poisoned patients by primary physicians in a general hospital

Today most self-poisonings are treated in the outpatient department of general hospitals. Self-poisoned patients may arouse mixed feelings among primary physicians. We can also assume that this may have an effect on the assessment of treatment. This research illustrates the opinions of the referring primary physicians concerning emergency psychiatric consultations for attempted suicides treated at Meilahti Hospital. The results were collected during a 1-month period and were compared with all other emergency psychiatric consultations. The majority (87%) of primary physicians were satisfied with the consultations and considered psychiatric consultations for attempted suicides necessary. These results support the efforts to arrange psychiatric consultation for every suicide attempt.

Occurrence of cerebral seizures provoked by alcohol abuse.

Alcohol intoxication was detected in the immediate history of 277 (49%) of the 560 consecutive seizure patients brought to the emergency room of Meilahti hospital in Helsinki during the course of a year, most of these patients being young men of working age. The alcohol-provoked seizures occurred mainly on Sunday and Monday, following the weekly pattern of alcohol consumption in Finland, and preceded delirium tremens in 21 patients (4%). Even short periods of intoxication (1-2 days) provoked seizures. The data indicate that among patients with a previous history of recurrent alcohol-withdrawal seizures, new treatable diseases of the CNS, especially acute brain injuries, are frequently encountered. Therefore, all seizure problems, not neglecting those of alcoholics, should be carefully examined.

Interhospital Differences in the Treatment of Acute Leukaemia in Adults

During 5 years 203 adults with acute leukaemia were treated with a combination of daunorubicin, cytararabine and prednisone in the trials of the Finnish Leukaemia Group (FLG). The participating hospitals were classified according to size into 3 groups: 75 patients were treated in Meilahti Hospital (University Central Hospital, Helsinki), 87 patients—over 5 patients per year in each of the hospitals of the KOTT‐group (university hospitals in Kuopio, Oulu, Tampere and Turku), and 41 patients—1 to 3 patients per year in each of the 6 hospitals of the other hospital group. The remission rate in other hospitals (21%) was significantly (P &lt; 0.002) inferior to to those in Meilahti Hospital (54%) and in the KOTT‐group (51%). Evaluation of the survival data showed no difference between Meilahti Hospital and KOTT‐group, but the survival in other hospitals was significantly poorer, differing from that of Meilahti (P = 0.01) and from that of KOTT‐group (P = 0.02). The durations of remissions did not differ from each other. The distribution of patients by the type of leukaemia was similar in all groups and the interhospital differences were not related to the type of leukaemia. The remission rates in other hospitals were in all age groups smaller than in the two other groups.The experience and skill gained by the doctors and the other hospital staff in treating more patients with acute leukaemia were regarded to be the main determinant of the better results achieved in the university hospitals. The slight differences in the age distribution of patients and in the facilities for supportive treatment were regarded to be of only minor importance.

CHANGES IN SKIN TEMPERATURE OF THE NEONATE AT BIRTH

Acta PaediatricaVolume 61, Issue 2 p. 159-164 CHANGES IN SKIN TEMPERATURE OF THE NEONATE AT BIRTH A cine-thermographic study E. TÄHTI, E. TÄHTI Radiodiagnostic Department of Meilahti Hospital, the Midwifery Institute, Helsinki, Finland and the Wenner-Gren Cardiovascular Research Laboratory, Norrtull's Hospital, Stockholm, SwedenSearch for more papers by this authorJ. LIND, Corresponding Author J. LIND Radiodiagnostic Department of Meilahti Hospital, the Midwifery Institute, Helsinki, Finland and the Wenner-Gren Cardiovascular Research Laboratory, Norrtull's Hospital, Stockholm, SwedenDept. of Paediatrics, Karolinska Sjukhuset, 104 01, Stockholm, 60, SwedenSearch for more papers by this authorK. ÖSTERLUND, K. ÖSTERLUND Radiodiagnostic Department of Meilahti Hospital, the Midwifery Institute, Helsinki, Finland and the Wenner-Gren Cardiovascular Research Laboratory, Norrtull's Hospital, Stockholm, SwedenSearch for more papers by this authorEVA RYLANDER, EVA RYLANDER Radiodiagnostic Department of Meilahti Hospital, the Midwifery Institute, Helsinki, Finland and the Wenner-Gren Cardiovascular Research Laboratory, Norrtull's Hospital, Stockholm, SwedenSearch for more papers by this author E. TÄHTI, E. TÄHTI Radiodiagnostic Department of Meilahti Hospital, the Midwifery Institute, Helsinki, Finland and the Wenner-Gren Cardiovascular Research Laboratory, Norrtull's Hospital, Stockholm, SwedenSearch for more papers by this authorJ. LIND, Corresponding Author J. LIND Radiodiagnostic Department of Meilahti Hospital, the Midwifery Institute, Helsinki, Finland and the Wenner-Gren Cardiovascular Research Laboratory, Norrtull's Hospital, Stockholm, SwedenDept. of Paediatrics, Karolinska Sjukhuset, 104 01, Stockholm, 60, SwedenSearch for more papers by this authorK. ÖSTERLUND, K. ÖSTERLUND Radiodiagnostic Department of Meilahti Hospital, the Midwifery Institute, Helsinki, Finland and the Wenner-Gren Cardiovascular Research Laboratory, Norrtull's Hospital, Stockholm, SwedenSearch for more papers by this authorEVA RYLANDER, EVA RYLANDER Radiodiagnostic Department of Meilahti Hospital, the Midwifery Institute, Helsinki, Finland and the Wenner-Gren Cardiovascular Research Laboratory, Norrtull's Hospital, Stockholm, SwedenSearch for more papers by this author First published: March 1972 https://doi.org/10.1111/j.1651-2227.1972.tb15920.xCitations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume61, Issue2March 1972Pages 159-164 RelatedInformation

DIRECT GAS CHROMATOGRAPHIC ANALYSIS OF STEROID SULPHATES AND GLUCOSIDURONATES WITHOUT DERIVATIVE FORMATION

Journal Article DIRECT GAS CHROMATOGRAPHIC ANALYSIS OF STEROID SULPHATES AND GLUCOSIDURONATES WITHOUT DERIVATIVE FORMATION Get access P Ilmari Jaakonmäki P Ilmari Jaakonmäki Institute for Lipid Research, Baylor University College of Medicine, Houston, Texas, U.S.A. Present address: HYKS, Meilahti Hospital Laboratory, Helsinki, Finland Search for other works by this author on: Oxford Academic Google Scholar Acta Endocrinologica (Norway), Volume 56, Issue 1_Supplement, Dec 1967, Page S118, https://doi.org/10.1530/acta.0.056S118 Published: 01 December 1967

Semiselective renal arteriography.

From the Roentgen Diagnostic Department of Meilahti Hospital, University of Helsinki, Helsinki, Finland