Reconstruction of cranial bone defects with fiber-reinforced composite–bioactive glass implants

A cranial bone defect may result after an operative treatment of trauma, infection, vascular insult, or tumor. New biomaterials for cranial bone defect reconstructions are needed for example to mimic the biomechanical properties and structure of cranial bone. A novel glass fiber-reinforced composite implant with bioactive glass particulates (FRC–BG, fiber-reinforced composite–bioactive glass) has osteointegrative potential in a preclinical setting. The aim of the first and second study was to investigate the functionality of a FRC–BG implant in the reconstruction of cranial bone defects. During the years 2007–2014, a prospective clinical trial was conducted in two tertiary level academic institutions (Turku University Hospital and Oulu University Hospital) to evaluate the treatment outcome in 35 patients that underwent a FRC–BG cranioplasty. The treatment outcome was good both in adult and pediatric patients. A number of conventional complications related to cranioplasty were observed. In the third study, a retrospective outcome evaluation of 100 cranioplasty procedures performed in Turku University Hospital between years 2002–2012 was conducted. The experimental fourth study was conducted to test the load-bearing capacity and fracture behavior of FRC–BG implants under static loading. The interconnective bars in the implant structure markedly increased the load-bearing capacity of the implant. A loading test did not demonstrate any protrusions of glass fibers or fiber cut. The fracture type was buckling and delamination. In this study, a postoperative complication requiring a reoperation or removal of the cranioplasty material was observed in one out of five cranioplasty patients. The treatment outcomes of cranioplasty performed with different synthetic materials did not show significant difference when compared with autograft. The FRC–BG implant was demonstrated to be safe and biocompatible biomaterial for large cranial bone defect reconstructions in adult and pediatric patients.Kallon luupuutosten korjausleikkaukset kuitulujitteisella bioaktiivisella komposiitti-istutteella Kallon luupuutos voi syntyä tulehduksen, kasvaimen, vamman tai aivoverenkiertohäiriön takia tehdyn leikkauksen myötä. Uusia luunkorvikemateriaaleja kallon luupuutosten korjaamiseen tarvitaan, jotta ne vastaisivat oman luun ominaisuuksia ja rakennetta. Lasikuiduilla vahvistettu, bioaktiivista lasia sisältävä yhdistelmämateriaali (FRC–BG, fiber-reinforced composite–bioactive glass) on prekliinisissä tutkimuksissa osoittautunut ominaisuuksiltaan otolliseksi luutumiselle. Tämän tutkimuksen ensimmäisessä ja toisessa osatyössä selvitettiin FRC–BG-istutteen soveltuvuutta kallon luupuutoksen korjausmateriaaliksi. Turun yliopistollisessa keskussairaalassa ja Oulun yliopistollisessa sairaalassa toteutettiin kliininen etenevä seurantatutkimus, jossa arvioitiin vuosina 2007–2014 FRC–BG-istutteella tehtyjen kallon luupuutoksen korjausleikkausten hoitotuloksia yhteensä 35 aikuis- ja lapsipotilaalla. Sekä aikuisilla että lapsilla hoitotulokset olivat hyviä. Luupuutoksen korjausleikkaukseen liittyviä tavanomaisia lisätauteja esiintyi tälläkin materiaalilla. Kolmannessa osatyössä selvitettiin taannehtivassa tutkimusasetelmassa vuosina 2002–2012 Turun yliopistollisessa keskussairaalassa tehdyn sadan kallon luupuutoksen korjausleikkauksen hoitotuloksia. Neljännessä kokeellisessa osatyössä testattiin FRC–BG-istutteen kuormituksen kantokykyä ja murtumista staattisen kuormituksen alla. Pitkittäiset lasikuitulujitteiset vahvikkeet lisäsivät merkittävästi istutteen kuormituksen kantokykyä. Kuormituksen lisääntyessä istute lommahtaa ja laminaatit irtoavat toisistaan, mutta lasikuitujen katkeamista ei havaittu. Tutkimuksessa havaittiin, että joka viidennen kallon luupuutoksen korjausleikkauksen jälkeen ilmenee lisätauti, joka johtaa uusintaleikkaukseen tai korjausmateriaalin poistamiseen. Kallon luupuutosten korjausleikkausten hoitotulokset synteettisillä materiaaleilla ja omalla luusiirteellä eivät eronneet toisistaan. FRC–BG-istute osoittautui turvalliseksi ja kudosyhteensopivaksi biomateriaaliksi aikuis- ja lapsipotilaiden kallon luupuutosten korjausleikkauksissa.Siirretty Doriast

Patient injuries from tonsil and adenoid surgery in Finland

Objectives The aims of this national register-based study were to examine patient injury claims related to tonsil and adenoid surgery injuries and to compare the frequency of claims between tonsillectomies and tonsillotomies in Finland. Methods We analyzed the complaints related to tonsil and adenoid surgery received by the Finnish Patient Insurance Center (PIC) between the years 2000 and 2019. One hundred seventy-two cases were included in the analysis. The annual surgery rates between the years 2000 and 2018 were acquired from the Finnish Institute for Health and Welfare. Results During the years 2000 to 2018, a total of 292,679 patients had tonsil and/or adenoid surgery nationwide. For tonsil or adenoid surgeries, the national average was 5.3 cases and 1.8 cases per 10,000, respectively, resulting in patient injury claims and compensations. A total of 33.1% of the claims regarding tonsil or adenoid surgery processed by the PIC were compensated. Most of the claims were made after a tonsillectomy (87.8%), and few were made after a tonsillotomy (1.7%). Seven deaths were recorded. Conclusion Patient injuries from tonsil and adenoid surgeries were mostly related to traditional extracapsular tonsillectomies. Most surgeries, along with most complications, involved specialists, who performed routine operations in high-volume centers. Surgeries for acute or recurrent infections resulted in more claims. Severe complications arising from tonsil and adenoid surgeries were rare. Level of Evidence 4.Peer reviewe

Identification of proprioceptive thalamocortical tracts in children : comparison of fMRI, MEG, and manual seeding of probabilistic tractography

Studying white matter connections with tractography is a promising approach to understand the development of different brain processes, such as proprioception. An emerging method is to use functional brain imaging to select the cortical seed points for tractography, which is considered to improve the functional relevance and validity of the studied connections. However, it is unknown whether different functional seeding methods affect the spatial and microstructural properties of the given white matter connection. Here, we compared functional magnetic resonance imaging, magnetoencephalography, and manual seeding of thalamocortical proprioceptive tracts for finger and ankle joints separately. We showed that all three seeding approaches resulted in robust thalamocortical tracts, even though there were significant differences in localization of the respective proprioceptive seed areas in the sensorimotor cortex, and in the microstructural properties of the obtained tracts. Our study shows that the selected functional or manual seeding approach might cause systematic biases to the studied thalamocortical tracts. This result may indicate that the obtained tracts represent different portions and features of the somatosensory system. Our findings highlight the challenges of studying proprioception in the developing brain and illustrate the need for using multimodal imaging to obtain a comprehensive view of the studied brain process.Peer reviewe

Treatment of sleep apnoea with tonsillectomy : a retrospective analysis using long-term follow-up data

Purpose This single-group, retrospective, pre-test-post-test study was performed to examine clinical outcomes in treating obstructive sleep apnoea (OSA) with tonsillectomy alone and had the longest follow-up periods to date. Methods We analysed 151 tonsillectomies in our district between the years 2004 and 2018 that had either sleep apnoea or snoring listed as a diagnosis. Twenty-one patients met our criteria and were included. Patient records were analysed for home sleep apnoea test and Epworth Sleepiness Scale (ESS) scores. Results We defined success as a > 50% reduction of the Apnoea-Hypopnea Index (AHI) and a total AHI of < 20 post-surgery. The averages before surgery were an AHI of 22.3 and an ESS of 7.22. The success rate was 47.6% after tonsillectomy as the sole treatment for obstructive sleep apnoea in our adult population. Eleven patients were non-responders. The average ESS score reduction was 0.69 and did not reach statistical significance. With follow-up times ranging from 1.8 to 171 months, this study had the longest follow-up period compared to other existing studies. No patient with a follow-up longer than one year was a responder. Conclusion Our results support that tonsillectomy is an effective treatment for obstructive sleep apnoea in adults with tonsillar hypertrophy. With less severe OSA than those reported on previously, our patients also had less severe daytime sleepiness before surgery, and daytime sleepiness score reductions did not reach statistical significance. In the future, long-term results should be further analysed.Peer reviewe

Patient injuries from tonsil and adenoid surgery in Finland

Objectives: The aims of this national register-based study were to examine patient injury claims related to tonsil and adenoid surgery injuries and to compare the frequency of claims between tonsillectomies and tonsillotomies in Finland. Methods: We analyzed the complaints related to tonsil and adenoid surgery received by the Finnish Patient Insurance Center (PIC) between the years 2000 and 2019. One hundred seventy-two cases were included in the analysis. The annual surgery rates between the years 2000 and 2018 were acquired from the Finnish Institute for Health and Welfare. Results: During the years 2000 to 2018, a total of 292,679 patients had tonsil and/or adenoid surgery nationwide. For tonsil or adenoid surgeries, the national average was 5.3 cases and 1.8 cases per 10,000, respectively, resulting in patient injury claims and compensations. A total of 33.1% of the claims regarding tonsil or adenoid surgery processed by the PIC were compensated. Most of the claims were made after a tonsillectomy (87.8%), and few were made after a tonsillotomy (1.7%). Seven deaths were recorded. Conclusion: Patient injuries from tonsil and adenoid surgeries were mostly related to traditional extracapsular tonsillectomies. Most surgeries, along with most complications, involved specialists, who performed routine operations in high-volume centers. Surgeries for acute or recurrent infections resulted in more claims. Severe complications arising from tonsil and adenoid surgeries were rare. Level of Evidence: 4.</p

Cranioplasty After Severe Traumatic Brain Injury: Effects of Trauma and Patient Recovery on Cranioplasty Outcome

Background: In patients with severe traumatic brain injury (sTBI) treated with decompressive craniectomy (DC), factors affecting the success of later cranioplasty are poorly known.Objective: We sought to investigate if injury- and treatment-related factors, and state of recovery could predict the risk of major complications in cranioplasty requiring implant removal, and how these complications affect the outcome.Methods: A retrospective cohort of 40 patients with DC following sTBI and subsequent cranioplasty was studied. Non-injury-related factors were compared with a reference population of 115 patients with DC due to other conditions.Results: Outcome assessed 1 day before cranioplasty did not predict major complications leading to implant removal. Successful cranioplasty was associated with better outcome, whereas a major complication attenuates patient recovery: in patients with favorable outcome assessed 1 year after cranioplasty, major complication rate was 7%, while in patients with unfavorable outcome the rate was 42% (p = 0.003). Of patients with traumatic subarachnoid hemorrhage (tSAH) on admission imaging 30% developed a major complication, while none of patients without tSAH had a major complication (p = 0.014). Other imaging findings, age, admission Glasgow Coma Scale, extracranial injuries, length of stay at intensive care unit, cranioplasty materials, and timing of cranioplasty were not associated with major complications.Conclusion: A successful cranioplasty after sTBI and DC predicts favorable outcome 1 year after cranioplasty, while stage of recovery before cranioplasty does not predict cranioplasty success or failure. tSAH on admission imaging is a major risk factor for a major complication leading to implant removal

Nielurisaleikkaus elämänlaatua parantamaan

Nielurisaleikkauksen yleisimmät aiheet ovat toistuva tai pitkäaikainen nielurisatulehdus, nielurisojen liikakasvu ja nielupaise.Leikkauksessa nielurisat poistetaan yleensä kokonaan, mutta säästävämmän osapoiston osuus on kasvanut etenkin lasten nielurisavaivojen hoidossa.Toipumisvaiheelle tyypillisiä ongelmia ovat kipu, jälkiverenvuoto ja nestehukka.</p

Treatment of sleep apnoea with tonsillectomy: a retrospective analysis using long-term follow-up data

Purpose: This single-group, retrospective, pre-test-post-test study was performed to examine clinical outcomes in treating obstructive sleep apnoea (OSA) with tonsillectomy alone and had the longest follow-up periods to date.Methods: We analysed 151 tonsillectomies in our district between the years 2004 and 2018 that had either sleep apnoea or snoring listed as a diagnosis. Twenty-one patients met our criteria and were included. Patient records were analysed for home sleep apnoea test and Epworth Sleepiness Scale (ESS) scores.Results: We defined success as a > 50% reduction of the Apnoea-Hypopnea Index (AHI) and a total AHI of Conclusion: Our results support that tonsillectomy is an effective treatment for obstructive sleep apnoea in adults with tonsillar hypertrophy. With less severe OSA than those reported on previously, our patients also had less severe daytime sleepiness before surgery, and daytime sleepiness score reductions did not reach statistical significance. In the future, long-term results should be further analysed.</p

Tutkijan tukipalvelut tehokkaaseen käyttöön

Korva-, nenä- ja kurkkutautien ja foniatrian väitöstutkijat ja vastikään väitelleet lääketieteen tohtorit kokevat hyötyvänsä erityisesti biostatistikon, kielentarkastajan, tutkimushoitajan ja informaatikon palveluista. Niistä pitäisi tiedottaa nykyistä paremmin.</p

Tutkijan tukipalvelut tehokkaaseen käyttöön

Korva-, nenä- ja kurkkutautien ja foniatrian väitöstutkijat ja vastikään väitelleet lääketieteen tohtorit kokevat hyötyvänsä erityisesti biostatistikon, kielentarkastajan, tutkimushoitajan ja informaatikon palveluista. Niistä pitäisi tiedottaa nykyistä paremmin