Jyrki Mäkelä - Academia.edu (original) (raw)
Papers by Jyrki Mäkelä
PubMed, Mar 30, 1999
Background: Optimal treatment of acute cholecystitis in high-risk patients with acute cholecystit... more Background: Optimal treatment of acute cholecystitis in high-risk patients with acute cholecystitis continues to be a difficult therapeutic problem. With the development of more advanced radiological imaging techniques, percutaneous cholecystostomy (PCS) has been presented as an effective treatment alternative in critically ill patients. This paper reports our experiences of percutaneous cholecystostomy in the treatment of acute cholecystitis in a well defined high-risk patient group. Methods: The data concerning 69 high-risk patients with acute cholecystitis treated by percutaneous cholecystostomy in Oulu University Hospital and Kokkola Central Hospital were analyzed. Results: Ultrasound showed gallbladder stones in 71% (49/69) of the patients and 29% of them presented with acalculous cholecystitis. After PCS, pain diminished in 94% (61/65), fever in 90% (35/39), CRP values in 87% (53/61) and leucocyte count in 84% (46/55) of the patients. Before PCS, the CRP value was 132+/-106 mg/l and after PCS 79+/-73 mg/l (P = 0.001) and corresponding leucocyte counts were 14.7+/-5.0 and 9.3+/-3.2 (P = 0.001), respectively. The antegrade cholecystocholangiography was performed in 29 patients after PCS, and common bile duct stones were detected in 8 patients; these stones were treated by endoscopic papillotomy. Complications after PCS occurred in 17 patients (26%), but only two patients required emergency laparotomy. Mortality was 19% (13/69). Acute cholecystitis alone was the cause of death in only three patients. Mostly, fatal outcome was caused by the serious underlying diseases. Conclusion: According to our results, PCS should be the method of choice in high-risk patients with acute cholecystitis.
BMC surgery, 2015
The purpose of this study was to evaluate the clinical course and possible benefit of a percutane... more The purpose of this study was to evaluate the clinical course and possible benefit of a percutaneous cholecystostomy in patients with acute cholecystitis. Retrospective study of 104 patients with severe cholecystitis or cholecystitis not responding to antibiotic therapy treated with percutaneous drainage of the gall bladder (PC) during the period 2007 - 2013. Primary outcome was relief of cholecystitis, complications following the procedure and need for later cholecystectomy. There were 57 men and 47 women with a median age of 73,5 years (range 22 - 96). 43% of the patients were ASA III or IV and 91% had cholecystitis Grade 2 or 3. About 60% of the patients had severe comorbidity (cardiovascular disease or active cancer). Drain insertion was successful in all but one patient and complications were mild, apart from two patients that needed percutaneous drainage of intraabdominal fluid collection due to bile leakage. The drain was left in place for 1 - 75 days (median 6,5). When evalu...
British Journal of Cancer, 1999
Colorectal cancer is the second most common cancer in many Western countries. Outcome among such ... more Colorectal cancer is the second most common cancer in many Western countries. Outcome among such patients is often poor, with a mean 5-year relative survival rate of around 50% (Mäkelä et al, 1995; Sant et al, 1995). Prognosis is dependent on the stage of the disease at the moment of diagnosis. In patients with the least advanced Dukes' classes A and B tumours, 5-year cumulative survival is as good, 95% and 70% respectively, whereas it is around 30% in patients with the more advanced Dukes' class C, and in patients with the primarily metastatic Dukes' class D it is only 2% (Arveux et al, 1997). Surgery is the most efficient therapy in colorectal cancer. Despite radical surgical treatment, tumour recurrence occurs in 30-40% of cases (Mäkelä et al, 1995; Obrand and Gordon, 1997). The use of adjuvant therapies in preventing recurrence, especially in patients with Dukes' class C colon and rectal cancers, and also in some patients with Dukes' class B rectal cancer, is continuously increasing. These therapies have side-effects, and thus they should be given only to those who really benefit from them, which actually means they should be given to those patients prone to develop a recurrent tumour (Fielding et al, 1992; Swedish Rectal Cancer Trial, 1996). These recurrences cannot be reliably predicted by any means at the moment of primary operation. Thus, targeting of adjuvant therapies is nowadays based only on the primary stage of
British Journal of Surgery, 1993
A group of 27 patients with carcinoma of the gallbladder was treated by superselective intra-arte... more A group of 27 patients with carcinoma of the gallbladder was treated by superselective intra-arterial chemotherapy with mitomycin between 1981 and 1990. Results were compared with those in 22 historical controls. The overall response rate to intra-arterial chemotherapy was 48 per cent. The median survival time for responders was 34 months and for non-responders 8 months. Survival was significantly related to tumour stage in patients treated by chemotherapy (P < 0.001) and controls (P < 0.01); all patients with tumour extending beyond the serosa died within 4 years. The median survival period after intra-arterial chemotherapy was 14 months, compared with 4 months in controls. The cumulative 5-year survival rates for patients treated by chemotherapy and controls were not significantly different. Cessation of chemotherapy was required in 16 of the 27 patients: in eight because of tumour progression, in seven after toxicity to chemotherapy and in one because of patient refusal. Su...
Duodecim; lääketieteellinen aikakauskirja, 1993
International Journal of Colorectal Disease, 2010
Objective. The aim was to identify the clinical factors and tumor characteristics that predict mo... more Objective. The aim was to identify the clinical factors and tumor characteristics that predict mortality and survival in patients older than 70 years with colorectal adenocarcinoma. Material and methods. One hundred and ninety-four patients with colorectal cancer aged over 70 years were identified from a computer database and their clinical variables were analyzed by both univariate and multivariate analyses. Results. All patients underwent resective surgery, 79% radical and 21% palliative resection, and postoperative mortality was 6% being associated with the presence of postoperative complications, especially anastomotic leakage. The cumulative 5-year survival was 38%, the median survival 35 months, and the cancer-specific 5-year survival 48% and this did not differ significantly between the age groups. The recurrence rate after radical surgery was 30%, being 12, 22, 56, and 100% in Dukes classes A, B, C, and D. Kaplan-Meier estimates indicated that gender, Dukes staging, grade of tumor, number of lymph node metastasis, venous invasion, and recurrent disease were significant predictors of survival, but in the Cox regression model, only venous invasion and recurrent disease were independent prognostic factors of survival. Conclusions. Low mortality and acceptable survival can be achieved in elderly patients with colorectal cancer. Venous invasion and recurrent cancer are independent predictors of survival.
HPB Surgery, 2000
Eleven patients with a preoperative diagnosis of adenoma of the papillae of Vater were followed u... more Eleven patients with a preoperative diagnosis of adenoma of the papillae of Vater were followed up during the fifteen-year period from 1984 till 1998 in the Oulu University Hospital. Seven patients were treated primarily by transduodenal excision without any recurrences so far. One of these seven patients was found to have adenocarcinoma in a histological examination.Active surgery for adenoma of the papillae of Vater is recommended because of the precancerous nature of the lesion, and because malignancy cannot always be detected by endoscopic biopsies. Transduodenal excision could be recommend for patients at high operative risk, especially in cases with small adenomas and low-grade dysplasia, where histologically free resection margins can be achieved, but pancreaticoduodenectomy should still be performed on patients at low operative risk.
American Journal of Surgery, 1995
Purpose: To identify patients who have high risk of wound dehiscence and who might benefit from t... more Purpose: To identify patients who have high risk of wound dehiscence and who might benefit from the use of internal retention sutures.Patients and methods: Forty-eight patients with midline abdominal wound dehiscence were compared with 48 control patients standardized by sex, age, and operative indication.Results: The mean hospital stay was significantly prolonged in the dehiscence group, resulting in a higher total
Diseases of the Colon & Rectum, 2003
PURPOSE: To identify the risk factors for anastomotic leak-age after left-sided colorectal resect... more PURPOSE: To identify the risk factors for anastomotic leak-age after left-sided colorectal resections with rectal anasto-mosis. METHODS: Forty-four patients with anastomotic leakage identified from a computer-generated database were compared with 44 control patients ...
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2006
Stoma-related complications and problems in stoma care are common after gastrointestinal surgery ... more Stoma-related complications and problems in stoma care are common after gastrointestinal surgery requiring the construction of a stoma. The frequency and types of such complications and problems were evaluated in a patient cohort operated on in Oulu University Hospital. A detailed questionnaire concerning clinical problems and stoma care was mailed to 163 stoma patients operated on during the years from 1995 to 2001 in Oulu University Hospital. One hundred and nineteen patients (70 percent) answered the questions adequately. The clinical variables concerning stoma complications and the patients' symptoms, problems with stoma care and adaptation to the situation were recorded. Special attention was paid to the patients' general wellbeing and social problems. Thirty-five patients (30%) had stoma complications, most commonly parastomal hernias (18 cases). Patients with an ileostomy had more difficulties with stoma handling more often than the patients with a colostomy. Seventy-...
Journal of Surgical Oncology, 2005
There is only limited and somewhat controversial information available on hepatic artery infusion... more There is only limited and somewhat controversial information available on hepatic artery infusion of cytotoxic agents in gallbladder cancer. We report the results of 5-year follow-up of all gallbladder cancer patients treated with surgery and intra-arterial mitomycin C or mitomycin C alone in our hospital during 15 years. Thirty-five patients with gallbladder cancer were treated with superselective intra-arterial chemotherapy (SIAC) with mitomycin C during 1981-1996. Survival was measured from diagnosis, and all patients were followed up until death or the end of January 2002. Cumulative survival rates and median survival times were calculated for all patients, according to response to treatment and staging. The data are presented as 5-year survival. Median survival times after SIAC for all patients, responders, and non-responders were 48, 60+, and 8.5 months, respectively. Overall response rate was 60%. Survival was significantly better for tumors limited to the gallbladder wall, as expected. Drug toxicity occurred in half of the patients, requiring cessation of chemotherapy in 25% of the cases. The median survival of gallbladder cancer patients treated with surgery and SIAC seems to be significantly better compared to the previously reported outcome of surgical treatment alone. Drug toxicity limits the use of i.a. chemotherapy and requires careful monitoring for early side-effects.
Journal of Aerosol Science, 2000
. Biogenic aerosol formation in the boreal forest. Boreal Env. Res. 5: 281-297. ISSN 1239-6095 Ae... more . Biogenic aerosol formation in the boreal forest. Boreal Env. Res. 5: 281-297. ISSN 1239-6095 Aerosol formation and subsequent particle growth in the ambient air have been frequently observed at the boreal forest site (SMEAR II station), southern Finland. The EU funded project BIOFOR (Biogenic aerosol formation in the boreal forest) has focused on a) the determination of formation mechanisms of aerosol particles in the boreal forest site, and b) the verification of emissions of secondary organic aerosols from the boreal forest site, including the quantification of the amount of condensable vapours produced in photochemical reactions of biogenic volatile organic compounds (BVOC) leading to aerosol formation. Although the exact formation route for 3 nm particles is still unclear, the project results can be summarised as follows: (i) The most probable formation mechanism is ternary nucleation (water-sulphuric acid-ammonia) and the growth to observable sizes is mainly due to condensation of organic vapours. However, we do not have a direct proof of these phenomena, since it is impossible to determine the composition of 1 to 5-nm-size particles using the present state-of-art instrumentation; (ii) If nucleation takes place, it always occurs in cold-air advection in polar and Arctic air masses at low cloudiness, and the nucleation is closely connected to the onset of strong turbulence, convection, and entrainment in the morning-noon transition from a stable to an unstable stratified boundary layer; (iii) The emissions rates for several gaseous compounds have been verified. The model calculations showed that the amount of the condensable vapour needed for observed growth of aerosol particles is in the range 1-5 × 10 7 cm -3 . The estimations for the vapour source rate are in the range 3-8 × 10 4 cm -3 s -1 .
International surgery
Optimal treatment of acute cholecystitis in high-risk patients with acute cholecystitis continues... more Optimal treatment of acute cholecystitis in high-risk patients with acute cholecystitis continues to be a difficult therapeutic problem. With the development of more advanced radiological imaging techniques, percutaneous cholecystostomy (PCS) has been presented as an effective treatment alternative in critically ill patients. This paper reports our experiences of percutaneous cholecystostomy in the treatment of acute cholecystitis in a well defined high-risk patient group. The data concerning 69 high-risk patients with acute cholecystitis treated by percutaneous cholecystostomy in Oulu University Hospital and Kokkola Central Hospital were analyzed. Ultrasound showed gallbladder stones in 71% (49/69) of the patients and 29% of them presented with acalculous cholecystitis. After PCS, pain diminished in 94% (61/65), fever in 90% (35/39), CRP values in 87% (53/61) and leucocyte count in 84% (46/55) of the patients. Before PCS, the CRP value was 132+/-106 mg/l and after PCS 79+/-73 mg/l (P = 0.001) and corresponding leucocyte counts were 14.7+/-5.0 and 9.3+/-3.2 (P = 0.001), respectively. The antegrade cholecystocholangiography was performed in 29 patients after PCS, and common bile duct stones were detected in 8 patients; these stones were treated by endoscopic papillotomy. Complications after PCS occurred in 17 patients (26%), but only two patients required emergency laparotomy. Mortality was 19% (13/69). Acute cholecystitis alone was the cause of death in only three patients. Mostly, fatal outcome was caused by the serious underlying diseases. According to our results, PCS should be the method of choice in high-risk patients with acute cholecystitis.
PubMed, Mar 30, 1999
Background: Optimal treatment of acute cholecystitis in high-risk patients with acute cholecystit... more Background: Optimal treatment of acute cholecystitis in high-risk patients with acute cholecystitis continues to be a difficult therapeutic problem. With the development of more advanced radiological imaging techniques, percutaneous cholecystostomy (PCS) has been presented as an effective treatment alternative in critically ill patients. This paper reports our experiences of percutaneous cholecystostomy in the treatment of acute cholecystitis in a well defined high-risk patient group. Methods: The data concerning 69 high-risk patients with acute cholecystitis treated by percutaneous cholecystostomy in Oulu University Hospital and Kokkola Central Hospital were analyzed. Results: Ultrasound showed gallbladder stones in 71% (49/69) of the patients and 29% of them presented with acalculous cholecystitis. After PCS, pain diminished in 94% (61/65), fever in 90% (35/39), CRP values in 87% (53/61) and leucocyte count in 84% (46/55) of the patients. Before PCS, the CRP value was 132+/-106 mg/l and after PCS 79+/-73 mg/l (P = 0.001) and corresponding leucocyte counts were 14.7+/-5.0 and 9.3+/-3.2 (P = 0.001), respectively. The antegrade cholecystocholangiography was performed in 29 patients after PCS, and common bile duct stones were detected in 8 patients; these stones were treated by endoscopic papillotomy. Complications after PCS occurred in 17 patients (26%), but only two patients required emergency laparotomy. Mortality was 19% (13/69). Acute cholecystitis alone was the cause of death in only three patients. Mostly, fatal outcome was caused by the serious underlying diseases. Conclusion: According to our results, PCS should be the method of choice in high-risk patients with acute cholecystitis.
BMC surgery, 2015
The purpose of this study was to evaluate the clinical course and possible benefit of a percutane... more The purpose of this study was to evaluate the clinical course and possible benefit of a percutaneous cholecystostomy in patients with acute cholecystitis. Retrospective study of 104 patients with severe cholecystitis or cholecystitis not responding to antibiotic therapy treated with percutaneous drainage of the gall bladder (PC) during the period 2007 - 2013. Primary outcome was relief of cholecystitis, complications following the procedure and need for later cholecystectomy. There were 57 men and 47 women with a median age of 73,5 years (range 22 - 96). 43% of the patients were ASA III or IV and 91% had cholecystitis Grade 2 or 3. About 60% of the patients had severe comorbidity (cardiovascular disease or active cancer). Drain insertion was successful in all but one patient and complications were mild, apart from two patients that needed percutaneous drainage of intraabdominal fluid collection due to bile leakage. The drain was left in place for 1 - 75 days (median 6,5). When evalu...
British Journal of Cancer, 1999
Colorectal cancer is the second most common cancer in many Western countries. Outcome among such ... more Colorectal cancer is the second most common cancer in many Western countries. Outcome among such patients is often poor, with a mean 5-year relative survival rate of around 50% (Mäkelä et al, 1995; Sant et al, 1995). Prognosis is dependent on the stage of the disease at the moment of diagnosis. In patients with the least advanced Dukes' classes A and B tumours, 5-year cumulative survival is as good, 95% and 70% respectively, whereas it is around 30% in patients with the more advanced Dukes' class C, and in patients with the primarily metastatic Dukes' class D it is only 2% (Arveux et al, 1997). Surgery is the most efficient therapy in colorectal cancer. Despite radical surgical treatment, tumour recurrence occurs in 30-40% of cases (Mäkelä et al, 1995; Obrand and Gordon, 1997). The use of adjuvant therapies in preventing recurrence, especially in patients with Dukes' class C colon and rectal cancers, and also in some patients with Dukes' class B rectal cancer, is continuously increasing. These therapies have side-effects, and thus they should be given only to those who really benefit from them, which actually means they should be given to those patients prone to develop a recurrent tumour (Fielding et al, 1992; Swedish Rectal Cancer Trial, 1996). These recurrences cannot be reliably predicted by any means at the moment of primary operation. Thus, targeting of adjuvant therapies is nowadays based only on the primary stage of
British Journal of Surgery, 1993
A group of 27 patients with carcinoma of the gallbladder was treated by superselective intra-arte... more A group of 27 patients with carcinoma of the gallbladder was treated by superselective intra-arterial chemotherapy with mitomycin between 1981 and 1990. Results were compared with those in 22 historical controls. The overall response rate to intra-arterial chemotherapy was 48 per cent. The median survival time for responders was 34 months and for non-responders 8 months. Survival was significantly related to tumour stage in patients treated by chemotherapy (P < 0.001) and controls (P < 0.01); all patients with tumour extending beyond the serosa died within 4 years. The median survival period after intra-arterial chemotherapy was 14 months, compared with 4 months in controls. The cumulative 5-year survival rates for patients treated by chemotherapy and controls were not significantly different. Cessation of chemotherapy was required in 16 of the 27 patients: in eight because of tumour progression, in seven after toxicity to chemotherapy and in one because of patient refusal. Su...
Duodecim; lääketieteellinen aikakauskirja, 1993
International Journal of Colorectal Disease, 2010
Objective. The aim was to identify the clinical factors and tumor characteristics that predict mo... more Objective. The aim was to identify the clinical factors and tumor characteristics that predict mortality and survival in patients older than 70 years with colorectal adenocarcinoma. Material and methods. One hundred and ninety-four patients with colorectal cancer aged over 70 years were identified from a computer database and their clinical variables were analyzed by both univariate and multivariate analyses. Results. All patients underwent resective surgery, 79% radical and 21% palliative resection, and postoperative mortality was 6% being associated with the presence of postoperative complications, especially anastomotic leakage. The cumulative 5-year survival was 38%, the median survival 35 months, and the cancer-specific 5-year survival 48% and this did not differ significantly between the age groups. The recurrence rate after radical surgery was 30%, being 12, 22, 56, and 100% in Dukes classes A, B, C, and D. Kaplan-Meier estimates indicated that gender, Dukes staging, grade of tumor, number of lymph node metastasis, venous invasion, and recurrent disease were significant predictors of survival, but in the Cox regression model, only venous invasion and recurrent disease were independent prognostic factors of survival. Conclusions. Low mortality and acceptable survival can be achieved in elderly patients with colorectal cancer. Venous invasion and recurrent cancer are independent predictors of survival.
HPB Surgery, 2000
Eleven patients with a preoperative diagnosis of adenoma of the papillae of Vater were followed u... more Eleven patients with a preoperative diagnosis of adenoma of the papillae of Vater were followed up during the fifteen-year period from 1984 till 1998 in the Oulu University Hospital. Seven patients were treated primarily by transduodenal excision without any recurrences so far. One of these seven patients was found to have adenocarcinoma in a histological examination.Active surgery for adenoma of the papillae of Vater is recommended because of the precancerous nature of the lesion, and because malignancy cannot always be detected by endoscopic biopsies. Transduodenal excision could be recommend for patients at high operative risk, especially in cases with small adenomas and low-grade dysplasia, where histologically free resection margins can be achieved, but pancreaticoduodenectomy should still be performed on patients at low operative risk.
American Journal of Surgery, 1995
Purpose: To identify patients who have high risk of wound dehiscence and who might benefit from t... more Purpose: To identify patients who have high risk of wound dehiscence and who might benefit from the use of internal retention sutures.Patients and methods: Forty-eight patients with midline abdominal wound dehiscence were compared with 48 control patients standardized by sex, age, and operative indication.Results: The mean hospital stay was significantly prolonged in the dehiscence group, resulting in a higher total
Diseases of the Colon & Rectum, 2003
PURPOSE: To identify the risk factors for anastomotic leak-age after left-sided colorectal resect... more PURPOSE: To identify the risk factors for anastomotic leak-age after left-sided colorectal resections with rectal anasto-mosis. METHODS: Forty-four patients with anastomotic leakage identified from a computer-generated database were compared with 44 control patients ...
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2006
Stoma-related complications and problems in stoma care are common after gastrointestinal surgery ... more Stoma-related complications and problems in stoma care are common after gastrointestinal surgery requiring the construction of a stoma. The frequency and types of such complications and problems were evaluated in a patient cohort operated on in Oulu University Hospital. A detailed questionnaire concerning clinical problems and stoma care was mailed to 163 stoma patients operated on during the years from 1995 to 2001 in Oulu University Hospital. One hundred and nineteen patients (70 percent) answered the questions adequately. The clinical variables concerning stoma complications and the patients' symptoms, problems with stoma care and adaptation to the situation were recorded. Special attention was paid to the patients' general wellbeing and social problems. Thirty-five patients (30%) had stoma complications, most commonly parastomal hernias (18 cases). Patients with an ileostomy had more difficulties with stoma handling more often than the patients with a colostomy. Seventy-...
Journal of Surgical Oncology, 2005
There is only limited and somewhat controversial information available on hepatic artery infusion... more There is only limited and somewhat controversial information available on hepatic artery infusion of cytotoxic agents in gallbladder cancer. We report the results of 5-year follow-up of all gallbladder cancer patients treated with surgery and intra-arterial mitomycin C or mitomycin C alone in our hospital during 15 years. Thirty-five patients with gallbladder cancer were treated with superselective intra-arterial chemotherapy (SIAC) with mitomycin C during 1981-1996. Survival was measured from diagnosis, and all patients were followed up until death or the end of January 2002. Cumulative survival rates and median survival times were calculated for all patients, according to response to treatment and staging. The data are presented as 5-year survival. Median survival times after SIAC for all patients, responders, and non-responders were 48, 60+, and 8.5 months, respectively. Overall response rate was 60%. Survival was significantly better for tumors limited to the gallbladder wall, as expected. Drug toxicity occurred in half of the patients, requiring cessation of chemotherapy in 25% of the cases. The median survival of gallbladder cancer patients treated with surgery and SIAC seems to be significantly better compared to the previously reported outcome of surgical treatment alone. Drug toxicity limits the use of i.a. chemotherapy and requires careful monitoring for early side-effects.
Journal of Aerosol Science, 2000
. Biogenic aerosol formation in the boreal forest. Boreal Env. Res. 5: 281-297. ISSN 1239-6095 Ae... more . Biogenic aerosol formation in the boreal forest. Boreal Env. Res. 5: 281-297. ISSN 1239-6095 Aerosol formation and subsequent particle growth in the ambient air have been frequently observed at the boreal forest site (SMEAR II station), southern Finland. The EU funded project BIOFOR (Biogenic aerosol formation in the boreal forest) has focused on a) the determination of formation mechanisms of aerosol particles in the boreal forest site, and b) the verification of emissions of secondary organic aerosols from the boreal forest site, including the quantification of the amount of condensable vapours produced in photochemical reactions of biogenic volatile organic compounds (BVOC) leading to aerosol formation. Although the exact formation route for 3 nm particles is still unclear, the project results can be summarised as follows: (i) The most probable formation mechanism is ternary nucleation (water-sulphuric acid-ammonia) and the growth to observable sizes is mainly due to condensation of organic vapours. However, we do not have a direct proof of these phenomena, since it is impossible to determine the composition of 1 to 5-nm-size particles using the present state-of-art instrumentation; (ii) If nucleation takes place, it always occurs in cold-air advection in polar and Arctic air masses at low cloudiness, and the nucleation is closely connected to the onset of strong turbulence, convection, and entrainment in the morning-noon transition from a stable to an unstable stratified boundary layer; (iii) The emissions rates for several gaseous compounds have been verified. The model calculations showed that the amount of the condensable vapour needed for observed growth of aerosol particles is in the range 1-5 × 10 7 cm -3 . The estimations for the vapour source rate are in the range 3-8 × 10 4 cm -3 s -1 .
International surgery
Optimal treatment of acute cholecystitis in high-risk patients with acute cholecystitis continues... more Optimal treatment of acute cholecystitis in high-risk patients with acute cholecystitis continues to be a difficult therapeutic problem. With the development of more advanced radiological imaging techniques, percutaneous cholecystostomy (PCS) has been presented as an effective treatment alternative in critically ill patients. This paper reports our experiences of percutaneous cholecystostomy in the treatment of acute cholecystitis in a well defined high-risk patient group. The data concerning 69 high-risk patients with acute cholecystitis treated by percutaneous cholecystostomy in Oulu University Hospital and Kokkola Central Hospital were analyzed. Ultrasound showed gallbladder stones in 71% (49/69) of the patients and 29% of them presented with acalculous cholecystitis. After PCS, pain diminished in 94% (61/65), fever in 90% (35/39), CRP values in 87% (53/61) and leucocyte count in 84% (46/55) of the patients. Before PCS, the CRP value was 132+/-106 mg/l and after PCS 79+/-73 mg/l (P = 0.001) and corresponding leucocyte counts were 14.7+/-5.0 and 9.3+/-3.2 (P = 0.001), respectively. The antegrade cholecystocholangiography was performed in 29 patients after PCS, and common bile duct stones were detected in 8 patients; these stones were treated by endoscopic papillotomy. Complications after PCS occurred in 17 patients (26%), but only two patients required emergency laparotomy. Mortality was 19% (13/69). Acute cholecystitis alone was the cause of death in only three patients. Mostly, fatal outcome was caused by the serious underlying diseases. According to our results, PCS should be the method of choice in high-risk patients with acute cholecystitis.