Akuutin haimatulehduksen etiologia

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Lessons learned from COVID-19 pandemic in undergraduate surgical education

In this editorial, we review our experience on distance teaching and based on our experiences suggest modifications to undergraduate surgical education.Peer reviewe

Miten haen tutkimusapurahaa?

English summar

Pitääkö suomalaisten haimoista olla huolissaan?

Haiman sairaudet tunnetaan puutteellisesti

Surgical and oncological outcomes of D1 versus D2 gastrectomy among elderly patients treated for gastric cancer

Introduction: Gastrectomy with D2 lymphadenectomy is considered standard treatment in gastric cancer (GC). Among Western patients, morbidity and mortality seem to increase in D2 relative to D1 lymphadenectomy. As elderly patients with co-morbidities are more prone to possible complications, it is unclear whether they benefit from D2 lymphadenectomy. This study aims to compare the short- and long-term results of D1 and D2 lymphadenectomy in elderly patients undergoing gastrectomy for GC. Methods: All elderly (> 75 years) patients undergoing gastrectomy with curative intent for GC during 2000-2015 were included and grouped according to the level of lymph node dissection into the D1 or D2 group. Short-term surgical outcome included the Comprehensive Complication Index (CCI) and 30-day mortality. Long-term outcomes comprised overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). Cox regression was used in multivariable analyses. Results: In total, 99 elderly patients were included in the study (51 in D1 group, 48 in D2 group). The median follow-up was 32.5 months. Patients in the D1 group were older and had a higher American Society of Anesthesiologist (ASA) score. Both groups had similar burden of postoperative complications (CCI 20.9 versus 22.6, p = 0.26, respectively) and 90-day mortality (2% for both groups). The OS, DSS, and DFS were similar between groups. Multivariable analysis adjusted for potential confounders detected no difference in the survival between the D1 and D2 groups. Conclusions: Gastrectomy with D2 lymphadenectomy can be performed with low postoperative morbidity and mortality suggesting its use also in the elderly. Long-term outcomes seem similar but need further studies.Peer reviewe

Nekroptoosi syöpätaudeissa - pahantekijä vai pelastaja?

Vertaisarvioitu.Ohjelmoitunut apoptoosi, joka ei aiheuta tulehdusvastetta ja kontrolloimaton nekroosi, joka aiheuttaa tulehdusreaktion vapauttamalla solun sisältöä soluvälitilaan, ovat hyvin tunnettuja solukuolemamuotoja. Ohjelmoitunut nekroptoosi on tulehdusreaktion aiheuttava solukuolema, jonka aktivoitumis- ja signaalireitit muistuttavat apoptoosia. Nekroptoosilla on monitahoinen osuus syövän synnyssä, kasvussa ja estossa. Nekroptoosin muokkaama mikroympäristö voi edistää tai hidastaa syövän kasvua. Nekroptoosi pystyy aktivoimaan immuunijärjestelmän tunnistamaan ja tuhoamaan pahanlaatuisesti käyttäytyviä soluja. Toisaalta nekroptoosin aiheuttama tulehdusvaste voi suosia angiogeneesiä, syöpäsolujen jakautumista ja etäpesäkkeiden lähettämistä. On kehitetty syöpälääkkeitä, joilla voidaan tuhota syöpäsoluja ohittamalla apoptoosiresistenssi nekroptoosin välityksellä. Ymmärtämällä paremmin nekroptoosin osuus myös tulehduksellisten tautien patogeneesissä voitaisiin nekroptoosiin vaikuttamalla mahdollisesti estää tulehdukseen liittyvää syövän kehittymistä.Peer reviewe

Akuutin haimatulehduksen diagnostiikka ja hoito

VertaisarvioituAkuutin haimatulehduksen yleisin aiheuttaja Suomessa liiallinen alkoholin käyttö. Vaikea tautimuoto on tärkeää tunnistaa nopeasti. Ensimmäisen vuorokauden maltillinen nesteytys Ringerin liuoksella ja elintoimintojen monitorointi parantavat ennustetta. Vatsaontelon painetta lasketaan konservatiivisen hoidon menetelmin. Myös varhainen enteraalinen ravitsemus on tärkeä. Pienellä osalla potilaista voidaan joutua kajoavaan hoitoon, ja siinä mini-invasiiviset menetelmät ovat ensisijaisia. Taudin uusiutumista estävät sappikivitaudin hoito ja alkoholin käytön lopettaminen.Peer reviewe

Repeated Negative Urine Trypsinogen-2 Dipstick Test Rules Out Diagnosis of Post-ERCP Pancreatitis

Background: A dipstick test for urine trypsinogen-2 has been used in the diagnosis of acute pancreatitis, but there are only a few studies exploring the effectiveness of this test for early diagnose of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Goals: The authors explore if the rapid point-of-care urine trypsinogen-2 dipstick test can replace assay of amylase in diagnosing PEP. Study: For this prospective study, from Helsinki University Hospital 400 ERCP patients were enrolled in whom the authors analyzed plasma amylase or pancreas-specific amylase, bilirubin, and urine trypsinogen-2, and urine trypsinogen-2 with dipstick before, 4 and 24 hours after ERCP. Results: PEP developed in 15 (3.8%) patients. Urine trypsinogen-2 concentrations were significantly higher in PEP than in non-PEP patients 24 hours after ERCP (P=0.001, Mann-Whitney U test) but not 4 hours after ERCP (P=0.094). When combined with abdominal pain symptoms at 4 hours the dipstick test had a sensitivity of 60%, a specificity of 99%, a positive predictive value of 64%, and a negative predictive value 98%. At 24 hours, sensitivity was 100%, specificity 98%, positive predictive value 71%, and negative predictive value 100%. Conclusions: A positive dipstick seems to identify PEP cases and a negative test excludes PEP with high accuracy.Peer reviewe

Inflammation and immunosuppression in severe acute pancreatitis

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