Akuutti ruoansulatuskanavan alaosan verenvuoto

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Vanhuksen ohutsuolitukos

VINKISTÄ VIHI

Active Cerebrospinal Fluid Exchange System for Treatment of Pyogenic Ventriculitis

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Lymph node metastases and elevated postoperative calcitonin : Predictors of poor survival in medullary thyroid carcinoma

Background Total thyroidectomy is the treatment of choice for medullary thyroid carcinoma (MTC), but the extent of neck dissection is controversial. Lymph node metastases, distant metastases, and old age are known predictors of poor survival. Patients Patients treated for primary MTC at Helsinki University Hospital from 1990 to 2009 were included (n = 54). Their clinical characteristics, treatment, and outcome were analysed retrospectively, these patients were followed until death or their last follow-up date. Results At last follow-up (3.4-23 years), of 54 MTC patients, 19 (35%) were disease-free, 17 (32%) were alive with disease, and 12 (22%) had died of MTC; six patients died of unrelated causes (11%). All disease-free patients were node negative and had normal postoperative calcitonin level. Of 19 disease-free patients, only four (21%) had undergone lymph node dissection. All patients who died of MTC were Stage IV at diagnosis and died with distant metastases. Disease-specific five-and 10-year survival was 84% and 76.2%. Advanced T-stage (p = 0.004), lymph node metastases (p <0.001), distant metastases (p <0.001), stage (p <0.001), and elevated postoperative calcitonin (p <0.001) significantly associated with survival. Conclusions Lymph node metastasis and elevated postoperative calcitonin are important prognostic factors. Patients with lymph node metastasis and/or elevated postoperative calcitonin with present treatments cannot become disease-free, but most of them can live a long life with metastasis.Peer reviewe

Comparison of high versus low frequency cerebral physiology for cerebrovascular reactivity assessment in traumatic brain injury: a multi-center pilot study

Current accepted cerebrovascular reactivity indices suffer from the need of high frequency data capture and export for post-acquisition processing. The role for minute-by-minute data in cerebrovascular reactivity monitoring remains uncertain. The goal was to explore the statistical time-series relationships between intra-cranial pressure (ICP), mean arterial pressure (MAP) and pressure reactivity index (PRx) using both 10-s and minute data update frequency in TBI. Prospective data from 31 patients from 3 centers with moderate/severe TBI and high-frequency archived physiology were reviewed. Both 10-s by 10-s and minute-by-minute mean values were derived for ICP and MAP for each patient. Similarly, PRx was derived using 30 consecutive 10-s data points, updated every minute. While long-PRx (L-PRx) was derived via similar methodology using minute-by-minute data, with L-PRx derived using various window lengths (5, 10, 20, 30, 40, and 60 min; denoted L-PRx_5, etc.). Time-series autoregressive integrative moving average (ARIMA) and vector autoregressive integrative moving average (VARIMA) models were created to analyze the relationship of these parameters over time. ARIMA modelling, Granger causality testing and VARIMA impulse response function (IRF) plotting demonstrated that similar information is carried in minute mean ICP and MAP data, compared to 10-s mean slow-wave ICP and MAP data. Shorter window L-PRx variants, such as L-PRx_5, appear to have a similar ARIMA structure, have a linear association with PRx and display moderate-to-strong correlations (r ~ 0.700, p Peer reviewe

Henkilökohtaisten avustajien motiiveista hakeutua alalle ja suhteista työnantajiinsa

Pro gradu -tutkielmassani tarkastelen henkilökohtaisten avustajien motiiveja hakeutua alalle ja henkilökohtaisten avustajien kokemuksia avustajan ja avustettavan välisistä suhteista. Tutkimus liittyy yhteiskunnalliseen asiayhteyteen. Tämä tutkimus on kvalitatiivinen, teoriasidonnainen tutkimus. Tutkimusaineisto koostuu kolmentoista henkilökohtaisen avustajan kyselylomakkeen vastauksista. Lisäksi olen täydentänyt aineistoa haastattelemalla neljää kyselylomakevastauksen palauttanutta henkilökohtaista avustajaa. Tutkimukseen sisältyy asiantuntijahaastattelu. Tutkimuksen aineiston analysointi on tehty sisällönanalyysin pohjalta. Tutkimukseni teoreettisena viitekehyksenä käytän Arja Jokisen (2016) suhdeteoriaa tarkastellen henkilökohtaisten avustajien ja heidän vaikeavammaisten työnantajiensa välisiä suhteita yhteiskunnallisena, institutionaalisena, ammatillisena auttamissuhteena sekä vuorovaikutuksessa rakentuvana suhteena. Tutkimustulokset osoittivat, että henkilökohtaisiksi avustajiksi hakeudutaan auttamisen halusta, lisäansioiden saamiseksi ja työkokemuksen vahvistamiseksi. Lisäksi avustajat hakeutuvat henkilökohtaisiksi avustajiksi saadakseen toimintaa ja tekemistä omaan elämäänsä. Avustajilla on usein omakohtaista kokemusta läheisen sairaudesta, vammautumisesta tai menettämisestä ennen avustajan työhön ryhtymistä. Aineiston mukaan avustajien työmarkkina-asema näyttäytyy heikkona, avustajien työ on usein osa-aikaista, sivutoimista ja palkkaus on matalatasoista. Henkilökohtaisten avustajien kokemusten mukaan vuorovaikutuksessa rakentuvat suhteet näyttäytyvät selkeästi tutkimustuloksissa, eikä henkilökohtaisten avustajien heikko työmarkkina-asema heijastu avustajien ja heidän vaikeavammaisten työnantajiensa suhteen laatuun. Tuloksissa on nähtävissä henkilökohtaisten avustajien ja avustettavien välisiin suhteisiin liittyvän työsuhteen lisäksi avustajien ja avustettavien välisiä vastavuoroisia suhteita. Avustajien sosiaali- ja terveysalan koulutus osoittautuu vähäiseksi. Avustajat toivovat koulutusta avustajan työhön, vaikka ammatillista koulutusvaatimusta alalle ei ole. Tulosten mukaan avustajilla on monipuolista aikaisempaa työkokemusta, jota he hyödyntävät avustajan työssään

The prognostic significance of tall cells in papillary thyroid carcinoma

Background The subtype of the papillary thyroid carcinoma tall cell variant (TCV) has a worse prognosis than does the conventional papillary type (PTC). The new WHO 2017 classification defines a TCV as a tumor consisting of over 30% of cells that are two or three times as tall as they are wide. However, thresholds have differed. Our aim was to study how tall cells affect the prognosis of PTC patients and to determine, for such cells, a cut-off percentage. Methods Our cohort included 65 PTC patients who underwent surgery at Helsinki University Hospital between 1973 and 1996: originally 36 otherwise-matched patient pairs, eventually comprising 34 patients with an adverse outcome and 31 who had recovered. All samples were digitally scanned and scored by two investigators based on tall cell composition. The cohort was analyzed with four tall cell (TC) thresholds: 10%, 30%, 50%, and 70% with a median follow-up of 22 years. Results In survival analysis, only the 70% threshold showed a correlation with reduced overall survival (OS), disease-specific survival (DSS), and relapse-free survival (RFS). A correlation also emerged with death from PTC. In a multivariate analysis, a 70% cut-off and age at diagnosis significantly affected DSS. Conclusion A TC composition of 10%, 30%, or 50% showed no correlation with adverse outcome, and suggests that a 70% threshold should be the choice of pathologists reporting TCV. Our results thus fail to support the new WHO classification.Undergruppen lång cell variant (TCV) till papillär sköldkörtelcancer (PTC) har en sämre prognos än den konventionella varianten. I Världshälsoorganisationens 2017 utkomna upplaga klassas TCV som en tumör som till minst 30% består av celler vars längd är två till tre gånger bredden. Andelen långa celler som behövs har dock varierat kraftigt bland studier. Vårt mål var att undersöka hur andelen långa celler påverkar prognosen för PTC patienter. Därtill ville vi bestämma ett tröskelvärde för andelen långa celler som korrelerar med en sämre prognos. Vår studie inkluderade 65 PTC patienter som blivit opererade på Helsingfors Universitetssjukhus mellan 1973 och 1996. Ursprungligtvis bestod kohorten av 36 matchade patientpar. Efter bortfall p.g.a. avsaknaden av material bestod slutgiltiga kohorten av 34 patienter med dålig prognos och 31 som återhämtat sig. Patienternas histologiska prov överfördes till digitalt format och andelen långa celler räknades av två forskare. Kohorten undersöktes därefter med fyra tröskelvärden för andelen långa celler: 10%, 30%, 50% och 70%. Mediantiden för uppföljning var 22 år. I den resulterande korrelerade endast ett 70% tröskelvärde med en sämre överlevnad. Därtill korrelerade 70% med död till följd av PTC. I en analys av multipla variabler korrelerades ett 70% tröskelvärde med ålder vid diagnos och sjukdomsspecifik överlevnad. Tröskelvärden 10%, 30% och 50% för långa celler visade ingen korrelation med en sämre prognos. Sammanfattningsvis bör ett tröskelvärde av 70% långa celler i PTC användas av patologer vid diagnostisering av TCV

Comparison of high versus low frequency cerebral physiology for cerebrovascular reactivity assessment in traumatic brain injury: a multi-center pilot study.

Current accepted cerebrovascular reactivity indices suffer from the need of high frequency data capture and export for post-acquisition processing. The role for minute-by-minute data in cerebrovascular reactivity monitoring remains uncertain. The goal was to explore the statistical time-series relationships between intra-cranial pressure (ICP), mean arterial pressure (MAP) and pressure reactivity index (PRx) using both 10-s and minute data update frequency in TBI. Prospective data from 31 patients from 3 centers with moderate/severe TBI and high-frequency archived physiology were reviewed. Both 10-s by 10-s and minute-by-minute mean values were derived for ICP and MAP for each patient. Similarly, PRx was derived using 30 consecutive 10-s data points, updated every minute. While long-PRx (L-PRx) was derived via similar methodology using minute-by-minute data, with L-PRx derived using various window lengths (5, 10, 20, 30, 40, and 60 min; denoted L-PRx_5, etc.). Time-series autoregressive integrative moving average (ARIMA) and vector autoregressive integrative moving average (VARIMA) models were created to analyze the relationship of these parameters over time. ARIMA modelling, Granger causality testing and VARIMA impulse response function (IRF) plotting demonstrated that similar information is carried in minute mean ICP and MAP data, compared to 10-s mean slow-wave ICP and MAP data. Shorter window L-PRx variants, such as L-PRx_5, appear to have a similar ARIMA structure, have a linear association with PRx and display moderate-to-strong correlations (r ~ 0.700, p < 0.0001 for each patient). Thus, these particular L-PRx variants appear closest in nature to standard PRx. ICP and MAP derived via 10-s or minute based averaging display similar statistical time-series structure and co-variance patterns. PRx and L-PRx based on shorter windows also behave similarly over time. These results imply certain L-PRx variants may carry similar information to PRx in TBI