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Brandt E, Harjama L, Elomaa O, Saarela J, Donner K, Lappalainen K, Kivirikko S, Ranki A, Kere J, Kettunen K, Hannula-Jouppi K. A novel SERPINA12 variant and first European patients with diffuse palmoplantar keratoderma. J Eur Acad Dermatol Venereol 2024; 38:413-418. [PMID: 37684051 DOI: 10.1111/jdv.19498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Hereditary palmoplantar keratodermas (hPPKs) comprise a heterogeneous group of skin disorders characterized by persistent palmoplantar hyperkeratosis. Loss-of-function variants in a serine peptidase inhibitor, SERPINA12, have recently been implicated in autosomal recessive diffuse hPPK. The disorder appears to share similarities with another hPPK associated with protease overactivity, namely Nagashima-type PPK (NPPK) caused by biallelic variants in SERPINB7. OBJECTIVES The aim of this study was to enhance the understanding of the clinical and genetic characteristics of serine protease-related hPPKs caused by variants in SERPINA12 and SERPINB7. METHODS Whole-exome sequencing (WES) was performed for hPPK patients. Haplotype analysis was completed for the patients with identified recessive SERPINA12 variants and their available family members. In addition, the current literature of SERPINA12- and SERPINB7-related hPPKs was summarized. RESULTS The phenotype of SERPINA12-related hPPK was confirmed by reporting three new SERPINA12 patients, the first of European origin. A novel SERPINA12 c.1100G>A p.(Gly367Glu) missense variant was identified confirming that the variant spectrum of SERPINA12 include both truncating and missense variants. The previously reported SERPINA12 c.631C>T p.(Arg211*) was indicated enriched in the Finnish population due to a plausible founder effect. In addition, SERPINA12 hPPK patients were shown to share a similar phenotype to patients with recessive variants in SERPINB7. The shared phenotype included diffuse transgradient PPK since birth or early childhood and frequent palmoplantar hyperhidrosis, aquagenic whitening and additional hyperkeratotic lesions in non-palmoplantar areas. SERPINA12 and SERPINB7 hPPK patients cannot be distinguished without genetic analysis. CONCLUSIONS Recessive variants in SERPINA12 and SERPINB7 leading to protease overactivity and hPPK produce a similar phenotype, indistinguishable without genetic analysis. SERPINA12 variants should be assessed also in non-Asian patients with diffuse transgradient PPK. Understanding the role of serine protease inhibitors will provide insights into the complex proteolytic network in epidermal homeostasis.
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Affiliation(s)
- E Brandt
- Department of Dermatology and Allergology, ERN-Skin Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - L Harjama
- Department of Dermatology and Allergology, ERN-Skin Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - O Elomaa
- Folkhälsan Research Center, Helsinki, Finland and Research Programs Unit, Stem Cells and Metabolism Research Program, University of Helsinki, Helsinki, Finland
| | - J Saarela
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
- The Centre for Molecular Medicine Norway (NCMM), University of Oslo, Oslo, Norway
| | - K Donner
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - K Lappalainen
- Department of Dermatology and Allergology, ERN-Skin Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - S Kivirikko
- Department of Clinical Genetics and Department of Medical and Clinical Genetics, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - A Ranki
- Department of Dermatology and Allergology, ERN-Skin Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - J Kere
- Folkhälsan Research Center, Helsinki, Finland and Research Programs Unit, Stem Cells and Metabolism Research Program, University of Helsinki, Helsinki, Finland
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - K Kettunen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
- HUS Diagnostic Center, Division of Genetics and Clinical Pharmacology, Laboratory of Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - K Hannula-Jouppi
- Department of Dermatology and Allergology, ERN-Skin Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland and Research Programs Unit, Stem Cells and Metabolism Research Program, University of Helsinki, Helsinki, Finland
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Virtanen P, Tomppo L, Georgiopoulos G, Brandstack N, Peltola E, Kokkonen T, Lappalainen K, Korvenoja A, Strbian D. Recanalization status and temporal evolution of early ischemic changes following stroke thrombectomy. Eur Stroke J 2023:23969873231214207. [PMID: 37991143 DOI: 10.1177/23969873231214207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Present-day computer tomography (CT) scanners have excellent spatial resolution and signal-to-noise ratio and are instrumental detecting early ischemic changes (EIC) in brain. We assessed the temporal changes of EIC based on the recanalization status after thrombectomy. PATIENTS AND METHODS The cohort comprises consecutive patients with acute ischemic stroke in anterior circulation treated with thrombectomy in tertiary referral hospital. All baseline and follow-up scans were screened for any ischemic changes and further classified using Alberta Stroke Program Early CT Score (ASPECTS). Generalized linear mixed models were used to analyze the impact of recanalization status using modified Thrombolysis in Cerebral Infarction (mTICI) on temporal evolution of ischemic changes. RESULTS We included 614 patients with ICA, M1, or M2 occlusions. Median ASPECTS score was 9 (IQR 7-10) at baseline and 7 (5-8) at approximately 24 h. mTICI 3 was achieved in 207 (33.8%), 2B 241 (39.3%), 2A in 77 (12.6%), and 0-1 in 88 (14.3%) patients. Compared to patients with mTICI 3, those with mTICI 0-1 and 2A had less favorable temporal changes of ASPECTS (p < 0.001). Effect of recanalization was noted in the cortical regions of ICA/M1 patients, but not in their deep structures or patients with M2 occlusions. All ischemic changes detected at baseline were also present at all follow-up images, regardless of the recanalization status. CONCLUSIONS Temporal evolution of the ischemic changes and ASPECTS are related to the success of the recanalization therapy in cortical regions of ICA/M1 patients, but not in their deep brain structures or M2 patients. In none of the patients did EIC revert in any brain region after successful recanalization.
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Affiliation(s)
- Pekka Virtanen
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Liisa Tomppo
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Nina Brandstack
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Erno Peltola
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tatu Kokkonen
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kimmo Lappalainen
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Antti Korvenoja
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Nguyen TN, Qureshi MM, Strambo D, Strbian D, Räty S, Herweh C, Abdalkader M, Olive-Gadea M, Ribo M, Psychogios M, Fischer U, Nguyen A, Kuramatsu JB, Haupenthal D, Köhrmann M, Deuschl C, Kühne Escola J, Yaghi S, Shu L, Puetz V, Kaiser DPO, Kaesmacher J, Mujanovic A, Marterstock DC, Engelhorn T, Klein P, Haussen DC, Mohammaden MH, Abdelhamid H, Souza Viana L, Cunha B, Fragata I, Romoli M, Diana F, Virtanen P, Lappalainen K, Clark J, Matsoukas S, Fifi JT, Sheth SA, Salazar-Marioni S, Marto JP, Ramos JN, Miszczuk M, Riegler C, Jadhav AP, Desai SM, Maus V, Kaeder M, Siddiqui AH, Monteiro A, Masoud HE, Suryadevara N, Mokin M, Thanki S, Siegler JE, Khalife J, Linfante I, Dabus G, Asdaghi N, Saini V, Nolte CH, Siebert E, Meinel TR, Finitsis S, Möhlenbruch MA, Ringleb PA, Berberich A, Nogueira RG, Hanning U, Meyer L, Michel P, Nagel S. Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study. Stroke 2023. [PMID: 37222709 DOI: 10.1161/strokeaha.123.042674] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND The optimal management of patients with isolated posterior cerebral artery occlusion is uncertain. We compared clinical outcomes for endovascular therapy (EVT) versus medical management (MM) in patients with isolated posterior cerebral artery occlusion. METHODS This multinational case-control study conducted at 27 sites in Europe and North America included consecutive patients with isolated posterior cerebral artery occlusion presenting within 24 hours of time last well from January 2015 to August 2022. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The coprimary outcomes were the 90-day modified Rankin Scale ordinal shift and ≥2-point decrease in the National Institutes of Health Stroke Scale. RESULTS Of 1023 patients, 589 (57.6%) were male with median (interquartile range) age of 74 (64-82) years. The median (interquartile range) National Institutes of Health Stroke Scale was 6 (3-10). The occlusion segments were P1 (41.2%), P2 (49.2%), and P3 (7.1%). Overall, intravenous thrombolysis was administered in 43% and EVT in 37%. There was no difference between the EVT and MM groups in the 90-day modified Rankin Scale shift (aOR, 1.13 [95% CI, 0.85-1.50]; P=0.41). There were higher odds of a decrease in the National Institutes of Health Stroke Scale by ≥2 points with EVT (aOR, 1.84 [95% CI, 1.35-2.52]; P=0.0001). Compared with MM, EVT was associated with a higher likelihood of excellent outcome (aOR, 1.50 [95% CI, 1.07-2.09]; P=0.018), complete vision recovery, and similar rates of functional independence (modified Rankin Scale score, 0-2), despite a higher rate of SICH and mortality (symptomatic intracranial hemorrhage, 6.2% versus 1.7%; P=0.0001; mortality, 10.1% versus 5.0%; P=0.002). CONCLUSIONS In patients with isolated posterior cerebral artery occlusion, EVT was associated with similar odds of disability by ordinal modified Rankin Scale, higher odds of early National Institutes of Health stroke scale improvement, and complete vision recovery compared with MM. There was a higher likelihood of excellent outcome in the EVT group despite a higher rate of symptomatic intracranial hemorrhage and mortality. Continued enrollment into ongoing distal vessel occlusion randomized trials is warranted.
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Affiliation(s)
- Thanh N Nguyen
- Neurology, Boston Medical Center, MA. (T.N.N., J.C.)
- Radiology, Boston Medical Center, MA. (T.N.N., M.M.Q., M.A., P.K.)
| | - Muhammad M Qureshi
- Radiology, Boston Medical Center, MA. (T.N.N., M.M.Q., M.A., P.K.)
- Radiation Oncology, Boston Medical Center, MA. (M.M.Q.)
| | - Davide Strambo
- Neurology Service, Lausanne University Hospital, University of Lausanne, Switzerland (D. Strambo, P.M.)
| | - Daniel Strbian
- Neurology, Helsinki University Hospital, Finland. (D. Strbian, S.R.)
| | - Silja Räty
- Neurology, Helsinki University Hospital, Finland. (D. Strbian, S.R.)
| | - Christian Herweh
- Neuroradiology, Heidelberg University Hospital, Germany. (C.H., M. Moehlenbruch)
| | | | - Marta Olive-Gadea
- Neurology, Hospital Universitario Vall d'Hebron, Barcelona, Spain. (M.O.-G., M. Ribo)
| | - Marc Ribo
- Neurology, Hospital Universitario Vall d'Hebron, Barcelona, Spain. (M.O.-G., M. Ribo)
| | - Marios Psychogios
- Neurology Service, Lausanne University Hospital, University of Lausanne, Switzerland (D. Strambo, P.M.)
| | - Urs Fischer
- Neurology, Basel University Hospital, University of Basel, Switzerland. (U.F.)
- Neurology, Bern University Hospital, University of Bern, Switzerland (T.R.M., U.F.)
| | - Anh Nguyen
- Radiology, Basel University Hospital, University of Basel, Switzerland. (A.N, M.P.)
| | - Joji B Kuramatsu
- Neurology, University of Erlangen-Nuremberg, Germany. (J.B.K., D.H.)
| | - David Haupenthal
- Neurology, University of Erlangen-Nuremberg, Germany. (J.B.K., D.H.)
| | - Martin Köhrmann
- Neurology, Universitätsklinikum Essen, Germany. (M. Köhrmann, J.K.E.)
| | | | | | - Shadi Yaghi
- Neurology, Rhode Island Hospital, Brown University Medical School, Providence, RI (S.Y., L.S.)
| | - Liqi Shu
- Neurology, Rhode Island Hospital, Brown University Medical School, Providence, RI (S.Y., L.S.)
| | - Volker Puetz
- Radiology, Helsinki University Hospital, Finland. (P.V., K.L.)
- Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany. (V.P.)
| | - Daniel P O Kaiser
- Neuroradiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany. (D.P.O.K.)
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Switzerland (J. Kaesmacher, A. Mujanovic)
| | - Adnan Mujanovic
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Switzerland (J. Kaesmacher, A. Mujanovic)
| | | | - Tobias Engelhorn
- Neuroradiology, University of Erlangen-Nuremberg, Germany. (D.C.M., T.E.)
| | - Piers Klein
- Radiology, Boston Medical Center, MA. (T.N.N., M.M.Q., M.A., P.K.)
| | - Diogo C Haussen
- Neurology, Grady Memorial Hospital, Atlanta, GA (D.C.H., M.H.M., H.A., L.S.V.)
| | | | - Hend Abdelhamid
- Neurology, Grady Memorial Hospital, Atlanta, GA (D.C.H., M.H.M., H.A., L.S.V.)
| | - Lorena Souza Viana
- Neurology, Grady Memorial Hospital, Atlanta, GA (D.C.H., M.H.M., H.A., L.S.V.)
| | - Bruno Cunha
- Neuroradiology, Centro Hospitalar Universitario de Lisboa Central, Portugal (B.C., I.F.)
| | - Isabel Fragata
- Neuroradiology, Centro Hospitalar Universitario de Lisboa Central, Portugal (B.C., I.F.)
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy (M. Romoli)
| | - Francesco Diana
- Interventional Neuroradiology, Hospital Universitario Vall d'Hebron, Barcelona, Spain. (F.D.)
| | - Pekka Virtanen
- Radiology, Helsinki University Hospital, University of Helsinki, Finland (P.V., K.L.)
| | - Kimmo Lappalainen
- Radiology, Helsinki University Hospital, Finland. (P.V., K.L.)
- Radiology, Helsinki University Hospital, University of Helsinki, Finland (P.V., K.L.)
| | - Judith Clark
- Neurology, Boston Medical Center, MA. (T.N.N., J.C.)
| | - Stavros Matsoukas
- Neurosurgery, Mount Sinai Health System, New York City, NY (S.M., J.T.F.)
| | - Johanna T Fifi
- Neurosurgery, Mount Sinai Health System, New York City, NY (S.M., J.T.F.)
| | - Sunil A Sheth
- Neurology, McGovern Medical School at UTHealth, TX (S.A.S., S.S.-M.)
| | | | - João Pedro Marto
- Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal. (J.P.M.)
| | - João Nuno Ramos
- Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal. (J.N.R.)
| | - Milena Miszczuk
- Neuroradiology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Germany. (M. Miszczuk, E.S.)
| | - Christoph Riegler
- Neurology, Experimental Neurology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Germany. (C.R., C.H.N.)
| | - Ashutosh P Jadhav
- Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J., S.M.D.)
| | - Shashvat M Desai
- Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J., S.M.D.)
| | - Volker Maus
- Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Germany (V.M., M. Kaeder)
| | - Maximilian Kaeder
- Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Germany (V.M., M. Kaeder)
| | | | - Andre Monteiro
- Neurosurgery, University of Buffalo, NY (A.H.S., A. Monteiro)
| | - Hesham E Masoud
- Neurology, New York Upstate Medical University, Syracuse, NY (H.E.M.)
| | | | - Maxim Mokin
- Neurosurgery, University of South Florida, Tampa (M. Mokin, S.T.)
| | - Shail Thanki
- Neurosurgery, University of South Florida, Tampa (M. Mokin, S.T.)
| | - James E Siegler
- Cooper Neurological Institute, Camden, NJ (J.E.S., J. Khalife)
| | - Jane Khalife
- Cooper Neurological Institute, Camden, NJ (J.E.S., J. Khalife)
| | | | | | - Negar Asdaghi
- Neurology, University of Miami Miller School of Medicine, FL (N.A., V.S.)
| | - Vasu Saini
- Neurology, University of Miami Miller School of Medicine, FL (N.A., V.S.)
| | - Christian H Nolte
- Neurology, Experimental Neurology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Germany. (C.R., C.H.N.)
| | - Eberhard Siebert
- Neuroradiology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Germany. (M. Miszczuk, E.S.)
| | - Thomas R Meinel
- Neurology, Bern University Hospital, University of Bern, Switzerland (T.R.M., U.F.)
| | | | - Markus A Möhlenbruch
- Neuroradiology, Heidelberg University Hospital, Germany. (C.H., M. Moehlenbruch)
| | - Peter A Ringleb
- Neurology, Heidelberg University Hospital, Germany. (P.A.R., S.N.)
| | | | - Raul G Nogueira
- Neurology, University of Pittsburgh Medical Center, PA (R.G.N., N.S.)
| | - Uta Hanning
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., L.M.)
| | - Lukas Meyer
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., L.M.)
| | - Patrik Michel
- Radiology, Basel University Hospital, University of Basel, Switzerland. (A.N, M.P.)
| | - Simon Nagel
- Neurology, Heidelberg University Hospital, Germany. (P.A.R., S.N.)
- Neurology, University of Pittsburgh Medical Center, PA (R.G.N., N.S.)
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Jauhiainen S, Ilmonen H, Vuola P, Rasinkangas H, Pulkkinen HH, Keränen S, Kiema M, Liikkanen JJ, Laham Karam N, Laidinen S, Beter M, Aavik E, Lappalainen K, Lohi J, Aronniemi J, Örd T, Kaikkonen MU, Salminen P, Tukiainen E, Ylä-Herttuala S, Laakkonen JP. ErbB signalling is a potential therapeutic target for vascular lesions with fibrous component. eLife 2023; 12:82543. [PMID: 37199488 DOI: 10.7554/elife.82543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/17/2023] [Indexed: 05/19/2023] Open
Abstract
Background: Sporadic venous malformation (VM) and angiomatosis of soft tissue (AST) are benign, congenital vascular anomalies affecting venous vasculature. Depending on the size and location of the lesion, symptoms vary from motility disturbances to pain and disfigurement. Due to high recurrence of the lesions more effective therapies are needed. Methods: As targeting stromal cells has been an emerging concept in anti-angiogenic therapies, here, by using VM/AST patient samples, RNA-sequencing, cell culture techniques and a xenograft mouse model, we investigated the crosstalk of endothelial cells (EC) and fibroblasts and its effect on vascular lesion growth. Results: We report, for the first time, expression and secretion of transforming growth factor A (TGFA) in ECs or intervascular stromal cells in AST and VM lesions. TGFA induced secretion of VEGF-A paracrinally, and regulated EC proliferation. Oncogenic PIK3CA variant in p.H1047R, a common somatic mutation found in these lesions, increased TGFA expression, enrichment of hallmark hypoxia, and in a mouse xenograft model, lesion size and vascularization. Treatment with afatinib, a pan-ErbB tyrosine-kinase inhibitor, decreased vascularization and lesion size in mouse xenograft model with ECs expressing oncogenic PIK3CA p.H1047R variant and fibroblasts. Conclusions: Based on the data, we suggest that targeting of both intervascular stromal cells and ECs is a potential treatment strategy for vascular lesions having a fibrous component. Funding: Academy of Finland, Ella and Georg Ehnrooth foundation, the ERC grants, Sigrid Jusélius Foundation, Finnish Foundation for Cardiovascular Research, Jane and Aatos Erkko Foundation, and Department of Musculosceletal and Plastic Surgery, Helsinki University Hospital.
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Affiliation(s)
- Suvi Jauhiainen
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Henna Ilmonen
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Pia Vuola
- Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Heta Rasinkangas
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Heidi H Pulkkinen
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Sara Keränen
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Miika Kiema
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jade J Liikkanen
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Nihay Laham Karam
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Svetlana Laidinen
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mustafa Beter
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Einari Aavik
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kimmo Lappalainen
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lohi
- Department of Pathology, Helsinki University Hospital, Helsinki, Finland
| | - Johanna Aronniemi
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Tiit Örd
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Minna U Kaikkonen
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Päivi Salminen
- Department of Pediatric Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Erkki Tukiainen
- Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Seppo Ylä-Herttuala
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Johanna P Laakkonen
- AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
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5
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Helin T, Tirri T, Korkala H, Lappalainen K, Joutsi-Korhonen L. Laboratory Assessment of Unfractionated Heparin (UFH) with Activated Clotting Time (ACT) and Anti-Xa Activity during Peripheral Arterial Angiographic Procedure. Diagnostics (Basel) 2023; 13:diagnostics13081489. [PMID: 37189590 DOI: 10.3390/diagnostics13081489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Activated clotting time (ACT) is used in cardiac surgery for monitoring unfractionated heparin (UFH). In endovascular radiology, ACT use is less established. We aimed to test the validity of ACT in UFH monitoring in endovascular radiology. We recruited 15 patients undergoing endovascular radiologic procedure. ACT was measured with ICT Hemochron® device as point-of-care (1) before standard UFH bolus, (2) immediately after the bolus, and in some cases (3) 1 h into the procedure or a combination thereof (altogether 32 measurements). A total of two different cuvettes, ACT-LR and ACT+ were tested. A reference method of chromogenic anti-Xa was used. Blood count, APTT, thrombin time and antithrombin activity were also measured. UFH levels (anti-Xa) varied between 0.3-2.1 IU/mL (median 0.8) and correlated with ACT-LR moderately (R2 = 0.73). The corresponding ACT-LR values were 146-337 s (median 214). ACT-LR and ACT+ measurements correlated only modestly with one another at this lower UFH level, with ACT-LR being more sensitive. Thrombin time and APTT were unmeasurably high after the UFH dose, rendering them of limited use in this indication. We adopted an ACT target of >200-250 s in endovascular radiology based on this study. While ACT correlation with anti-Xa is suboptimal, the readily available point-of-care nature increases its suitability.
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Affiliation(s)
- Tuukka Helin
- Department of Clinical Chemistry, HUS Diagnostic Center, Helsinki University Hospital, P.O. Box 720, 00029 Helsinki, Finland
- Department of Clinical Chemistry, University of Helsinki, 00014 Helsinki, Finland
| | - Tomi Tirri
- Department of Clinical Chemistry, HUS Diagnostic Center, Helsinki University Hospital, P.O. Box 720, 00029 Helsinki, Finland
- Department of Clinical Chemistry, University of Helsinki, 00014 Helsinki, Finland
| | - Heidi Korkala
- Department of Radiology, HUS Diagnostic Center, Helsinki University Hospital, P.O. Box 320, 00029 Helsinki, Finland
| | - Kimmo Lappalainen
- Department of Radiology, HUS Diagnostic Center, Helsinki University Hospital, P.O. Box 320, 00029 Helsinki, Finland
| | - Lotta Joutsi-Korhonen
- Department of Clinical Chemistry, HUS Diagnostic Center, Helsinki University Hospital, P.O. Box 720, 00029 Helsinki, Finland
- Department of Clinical Chemistry, University of Helsinki, 00014 Helsinki, Finland
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Kluger N, Jeskanen L, Cajanus S, Lappalainen K. Primary cutaneous follicle center lymphoma within a tattoo. Ann Dermatol Venereol 2022; 149:281-283. [PMID: 35644693 DOI: 10.1016/j.annder.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/07/2021] [Accepted: 03/14/2022] [Indexed: 12/30/2022]
Affiliation(s)
- N Kluger
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Consultation "tatouages", service de dermatologie, hôpital Bichat, Claude-Bernard, AP-HP, Paris, France.
| | - L Jeskanen
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S Cajanus
- Ylioppilaiden Terveydenhoitosäätiö YTHS (Foundation for Student Health), Helsinki, Finland
| | - K Lappalainen
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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7
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Virtanen P, Tomppo L, Martinez-Majander N, Kokkonen T, Sillanpää M, Lappalainen K, Strbian D. Thrombectomy in acute ischemic stroke in the extended time window: Real-life experience in a high-volume center. J Stroke Cerebrovasc Dis 2022; 31:106603. [PMID: 35749938 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/23/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Selected patients with acute ischemic stroke (AIS) caused by proximal middle cerebral artery (MCA) or internal carotid artery occlusion benefit from endovascular thrombectomy (EVT) in extended time window (6-24 h from last seen well) based on two landmark randomized controlled trials (RCTs) DAWN and DEFUSE-3. We evaluated patients' outcome in the real-life with the focus on adherence to protocol of the two RCTs. MATERIALS AND METHODS We included consecutive patients with AIS (excluding basilar artery occlusions) referred to EVT in our stroke center in the extended time window between January 2018 and December 2019 and compared the outcome of patients who fulfilled criteria of the RCTs with those who did not. RESULTS Of the total of 100 patients, 23 complied with RCT's criteria and 18 presented with minor non-adherence (lower NIHSS score or longer treatment delay), whereas 22 patients had large baseline ischemia (>1/3 MCA), 28 presented with M2 and more distal occlusions, and 9 patients did not undergo perfusion imaging prior to EVT. Good 3-month outcome (modified Rankin Scale 0-2) was observed in 54% of those who either met the RCT criteria or presented with lower NIHSS score or longer treatment delay, but only in 30% of M2 occlusions, and in none of the patients with large baseline ischemia. CONCLUSIONS Our findings highlight the impact of mostly large baseline ischemia but also vessel status when selecting patients for EVT in the extended time window and emphasize the need for further data in these patient subgroups.
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Affiliation(s)
- Pekka Virtanen
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Finland
| | - Liisa Tomppo
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Finland.
| | | | - Tatu Kokkonen
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Finland
| | - Mikko Sillanpää
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Finland
| | - Kimmo Lappalainen
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Finland
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Finland
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8
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Nordanstig A, Curtze S, Gensicke H, Zinkstok SM, Erdur H, Karlsson C, Karlsson JE, Martinez-Majander N, Sibolt G, Lyrer P, Traenka C, Baharoglu MI, Scheitz JF, Bricout N, Hénon H, Leys D, Eskandari A, Michel P, Hametner C, Ringleb PA, Arnold M, Fischer U, Sarikaya H, Seiffge DJ, Pezzini A, Zini A, Padjen V, Jovanovic DR, Luft A, Wegener S, Kellert L, Feil K, Kägi G, Rentzos A, Lappalainen K, Leker RR, Cohen JE, Gomori J, Brehm A, Liman J, Psychogios M, Kastrup A, Papanagiotou P, Gralla J, Magoni M, Majoie CBLM, Bohner G, Vukasinovic I, Cvetic V, Weber J, Kulcsar Z, Bendszus M, Möhlenbruch M, Ntaios G, Kapsalaki E, Jood K, Nolte CH, Nederkoorn PJJ, Engelter S, Strbian D, Tatlisumak T. EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients (EVA-TRISP) registry: basis and methodology of a pan-European prospective ischaemic stroke revascularisation treatment registry. BMJ Open 2021; 11:e042211. [PMID: 34373287 PMCID: PMC8354282 DOI: 10.1136/bmjopen-2020-042211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The Thrombolysis in Ischemic Stroke Patients (TRISP) collaboration was a concerted effort initiated in 2010 with the purpose to address relevant research questions about the effectiveness and safety of intravenous thrombolysis (IVT). The collaboration also aims to prospectively collect data on patients undergoing endovascular treatment (EVT) and hence the name of the collaboration was changed from TRISP to EVA-TRISP. The methodology of the former TRISP registry for patients treated with IVT has already been published. This paper focuses on describing the EVT part of the registry. PARTICIPANTS All centres committed to collecting predefined variables on consecutive patients prospectively. We aim for accuracy and completeness of the data and to adapt local databases to investigate novel research questions. Herein, we introduce the methodology of a recently constructed academic investigator-initiated open collaboration EVT registry built as an extension of an existing IVT registry in patients with acute ischaemic stroke (AIS). FINDINGS TO DATE Currently, the EVA-TRISP network includes 20 stroke centres with considerable expertise in EVT and maintenance of high-quality hospital-based registries. Following several successful randomised controlled trials (RCTs), many important clinical questions remain unanswered in the (EVT) field and some of them will unlikely be investigated in future RCTs. Prospective registries with high-quality data on EVT-treated patients may help answering some of these unanswered issues, especially on safety and efficacy of EVT in specific patient subgroups. FUTURE PLANS This collaborative effort aims at addressing clinically important questions on safety and efficacy of EVT in conditions not covered by RCTs. The TRISP registry generated substantial novel data supporting stroke physicians in their daily decision making considering IVT candidate patients. While providing observational data on EVT in daily clinical practice, our future findings may likewise be hypothesis generating for future research as well as for quality improvement (on EVT). The collaboration welcomes participation of further centres willing to fulfill the commitment and the outlined requirements.
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Affiliation(s)
- Annika Nordanstig
- Department of Clinical Neurosciences Sahlgrenska Academy at University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sami Curtze
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Sanne M Zinkstok
- Department of Neurology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Hebun Erdur
- Department of Neurology and Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Camilla Karlsson
- Department of Clinical Neurosciences Sahlgrenska Academy at University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden
| | - Jan-Erik Karlsson
- Department of Clinical Neurosciences Sahlgrenska Academy at University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Gerli Sibolt
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Christopher Traenka
- Department of Neurology and Stroke Center, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Merih I Baharoglu
- Department of Neurology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Jan F Scheitz
- Department of Neurology and Center for Stroke Research, Charite Universitatsmedizin Berlin Klinik fur Neurologie mit Experimenteller Neurologie, Berlin, Germany
| | | | - Hilde Hénon
- Department of Neurology, University of Lille, Lille, France
| | - Didier Leys
- Department of Neurology, University of Lille, Lille, France
| | - Ashraf Eskandari
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Patrik Michel
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Christian Hametner
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Marcel Arnold
- Department of Neurology, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hakan Sarikaya
- Department of Neurology, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David J Seiffge
- Department of Neurology, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Andrea Zini
- Department of Neurology and Stroke Center, Maggiore Hospital, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Visnja Padjen
- Neurology Clinic, Clinical Centre of Serbia, Belgrade, Clinical Center of Serbia, Beograd, Serbia
| | - Dejana R Jovanovic
- Neurology Clinic, Clinical Centre of Serbia, Belgrade, Clinical Center of Serbia, Beograd, Serbia,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andreas Luft
- Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Susanne Wegener
- Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Lars Kellert
- Department of Neurology, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Katharina Feil
- Neurology and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Georg Kägi
- Department of Neurology, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Alexandros Rentzos
- Department of Radiology, Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden,Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kimmo Lappalainen
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Ronen R Leker
- Department of Neurology, Hebrew University Hadassah Medical School, Yerushalayim, Israel
| | - Jose E Cohen
- Department of Neurosurgery, Hebrew University Hadassah Medical School, Yerushalayim, Israel
| | - John Gomori
- Department of Radiology, Hebrew University Hadassah Medical School, Yerushalayim, Israel
| | - Alex Brehm
- Department of Neurology, Georg-August-Universitat Gottingen Universitatsmedizin, Gottingen, Germany
| | - Jan Liman
- Department of Neurology, Georg-August-Universitat Gottingen Universitatsmedizin, Gottingen, Germany
| | - Marios Psychogios
- Department of Neuroradiology, Georg-August-Universitat Gottingen Universitatsmedizin, Gottingen, Germany,Neuroradiology and Stroke Center Basel, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Andreas Kastrup
- Department of Neurology, University Hospitals Bremen-Mitte and Bremen-Ost, Bremen, Germany
| | - Panagiotis Papanagiotou
- Clinic for Diagnostic and Interventional Neuroradiology, University Hospitals Bremen-Mitte and Bremen-Ost, University of Bremen, Bremen, Germany,Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mauro Magoni
- USD Stroke Unit and Vascular Neurology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Charles B L M Majoie
- Department of Neuroradiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Georg Bohner
- Institute of Neuroradiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Ivan Vukasinovic
- Clinic of Neurosurgery, Clinical Center of Serbia, Beograd, Serbia
| | - Vladimir Cvetic
- Faculty of Medicine, University of Belgrade, Beograd, Serbia,Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - Johannes Weber
- Department of Radiology and Nuclear Medicine, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Martin Bendszus
- Department of Neuroradiology, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Markus Möhlenbruch
- Department of Neuroradiology, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Volos, Thessaly, Greece
| | - Eftychia Kapsalaki
- Department of Radiology, University Hospital of Larissa, School of Medicine, University of Thessaly, Volos, Thessaly, Greece
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden,Department for Clinical Neuroscience and Rehabilitation, Sahlgrenska Academy, Goteborg, Sweden
| | - Christian H Nolte
- Department of Neurology and Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Paul J J Nederkoorn
- Department of Neurology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Stefan Engelter
- Department of Neurology and Stroke Center, University of Basel, Basel, Switzerland,Deptartment of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athen, Greece
| | - Daniel Strbian
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Clinical Neurosciences, Sahlgrenska University Hospital, Goteborg, Sweden,Department of Neurology, University of Helsinki, Helsinki, Finland
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9
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Schwartz C, Hafez A, Lönnrot K, Rezai Jahromi B, Lappalainen K, Lehecka M, Siironen J, Niemelä M. Microsurgical removal of a misplaced intraspinal venous stent in a patient with inferior vena cava atresia. J Neurosurg Spine 2020; 32:763-767. [PMID: 31952036 DOI: 10.3171/2019.11.spine191220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/20/2019] [Indexed: 11/06/2022]
Abstract
Inferior vena cava atresia (IVCA) is a rare vascular condition that may be treated by venous stenting. The authors report on the microsurgical removal of an intraspinally misplaced stent causing nerve root compression and neurological deficits.A 42-year-old patient with IVCA and painful cutaneous collaterals had been scheduled for treatment by stenting of the iliocaval confluence and associated venous collaterals. Initial stenting of the right iliac vein was successful; however, during recanalization of the left paravertebral plexus, the stent entered the spinal canal via extraspinal-to-intraspinal venous collaterals. Because of the use of monoplanar angiography, the stent misplacement was not seen during the procedure. Postinterventionally, the patient experienced a foot elevation weakness (grade 1/5) as well as pain and hypesthesia corresponding to the L5 dermatome. Ultrasonography ruled out a lumbosacral plexus hematoma. CT angiography showed that a stent had entered the spinal canal through the left S1 neuroforamen causing nerve root compression. The intraspinal portion of the stent was removed piecemeal via a left-sided hemilaminectomy. Venous bleeding due to the patient's anticoagulation therapy, the stent's sharp mesh wire architecture, and the proximity to nerve roots complicated the surgery. Postoperatively, the foot elevation improved to grade 4/5.
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Affiliation(s)
- Christoph Schwartz
- 1Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Finland
- 2Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Austria; and
| | - Ahmad Hafez
- 1Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Finland
| | - Kimmo Lönnrot
- 1Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Finland
| | - Behnam Rezai Jahromi
- 1Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Finland
| | - Kimmo Lappalainen
- 3Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Finland
| | - Martin Lehecka
- 1Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Finland
| | - Jari Siironen
- 1Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Finland
| | - Mika Niemelä
- 1Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Finland
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10
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Kluger N, Keinonen A, Jeskanen L, Lappalainen K. Borréliose de Lyme mimant une chrondrite de l’oreille. Ann Dermatol Venereol 2019; 146:596-599. [DOI: 10.1016/j.annder.2019.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/19/2019] [Accepted: 03/07/2019] [Indexed: 10/26/2022]
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11
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Kortesniemi M, Siiskonen T, Kelaranta A, Lappalainen K. Actual and Potential Radiation Exposures in Digital Radiology: Analysis of Cumulative Data, Implications to Worker Classification and Occupational Exposure Monitoring. Radiat Prot Dosimetry 2017; 174:141-146. [PMID: 27103644 DOI: 10.1093/rpd/ncw099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/16/2016] [Indexed: 06/05/2023]
Abstract
Radiation worker categorization and exposure monitoring are principal functions of occupational radiation safety. The aim of this study was to use the actual occupational exposure data in a large university hospital to estimate the frequency and magnitude of potential exposures in radiology. The additional aim was to propose a revised categorization and exposure monitoring practice based on the potential exposures. The cumulative probability distribution was calculated from the normalized integral of the probability density function fitted to the exposure data. Conformity of the probabilistic model was checked against 16 years of national monitoring data. The estimated probabilities to exceed annual effective dose limits of 1 mSv, 6 mSv and 20 mSv were 1:1000, 1:20 000 and 1:200 000, respectively. Thus, it is very unlikely that the class A categorization limit of 6 mSv could be exceeded, even in interventional procedures, with modern equipment and appropriate working methods. Therefore, all workers in diagnostic and interventional radiology could be systematically categorized into class B. Furthermore, current personal monitoring practice could be replaced by use of active personal dosemeters that offer more effective and flexible means to optimize working methods.
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Affiliation(s)
- Mika Kortesniemi
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, PO Box 340, Helsinki FI-00029 HUS, Finland
- Department of Physics, University of Helsinki, PO Box 64, Helsinki FI-00014, Finland
| | - Teemu Siiskonen
- STUK - Radiation and Nuclear Safety Authority of Finland, PO Box 14, Helsinki FI-00881, Finland
| | - Anna Kelaranta
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, PO Box 340, Helsinki FI-00029 HUS, Finland
- Department of Physics, University of Helsinki, PO Box 64, Helsinki FI-00014, Finland
| | - Kimmo Lappalainen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, PO Box 340, Helsinki FI-00029 HUS, Finland
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12
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Aronniemi J, Lohi J, Salminen P, Vuola P, Lappalainen K, Pitkäranta A, Pekkola J. Angiomatosis of soft tissue as an important differential diagnosis for intramuscular venous malformations. Phlebology 2016; 32:474-481. [PMID: 27688038 DOI: 10.1177/0268355516671463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background We aimed to improve management of extremity low-flow vascular malformations by analyzing the histology and imaging of venous malformations (VMs) not responsive to sclerotherapy. Method We reviewed patient records of 102 consecutive patients treated with sclerotherapy for extremity VM in our institution to identify patients who had undergone surgery due to insufficient response. We semi-quantitatively analysed the tissue specimens and compared histological findings to those in preoperative imaging. Result The number of patients operated on was 19 (18.6%); 15 of them had lower-extremity intramuscular lesions. The histological pattern of 13 of these 15 lesions corresponded to angiomatosis of soft tissue (AST). All other lesions treated surgically were VMs. The histology of AST was distinctive but magnetic resonance imaging findings often overlapped with those of VM. Conclusion AST is easily mixed with intramuscular VM. The differentiation of these two entities has therapeutic importance. We emphasize the role of histology in the differential diagnostics of intramuscular slow-flow vascular malformations.
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Affiliation(s)
- Johanna Aronniemi
- 1 University of Helsinki, Helsinki, Finland.,2 Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lohi
- 1 University of Helsinki, Helsinki, Finland.,3 Department of Pathology, HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Salminen
- 1 University of Helsinki, Helsinki, Finland.,4 Department of Pediatric Surgery, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Pia Vuola
- 1 University of Helsinki, Helsinki, Finland.,5 Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Lappalainen
- 1 University of Helsinki, Helsinki, Finland.,2 Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Anne Pitkäranta
- 1 University of Helsinki, Helsinki, Finland.,6 Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, Institute of Clinical Medicine, Helsinki, Finland
| | - Johanna Pekkola
- 1 University of Helsinki, Helsinki, Finland.,2 Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
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13
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Salonen O, Kivisaari L, Standertskjöld-Nordenstam CG, Oksanen K, Lappalainen K. Chest Radiography and Computed Tomography in the Evaluation of Mediastinal Adenopathy in Lymphoma. Acta Radiol 2016. [DOI: 10.1177/028418518702800619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Thoracic computed tomography (CT) in 232 patients with either primary staging of new or suggested relapsing lymphoma was compared with conventional chest radiography and both were correlated with clinical staging. Particular attention was given to the possibility of reducing routine thoracic CT, which is the current method used in this hospital in all patients with suggested lymphoma. Mediastinal lymphoma was detected by CT in 95 per cent of patients with clinically active mediastinal lymphoma, and by conventional chest radiography in 56 per cent. CT was found to be less reliable in evaluation of the hilar region than in that of other mediastinal areas. No areas of particular difficulty were found with chest radiography. CT also provided additional information concerning extra-mediastinal lymph adenopathy and involvement of the thoracic wall and pericardium. Routine thoracic CT examination was considered justifiable in all patients with suggested lymphoma.
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14
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Aronniemi J, Castrén E, Lappalainen K, Vuola P, Salminen P, Pitkäranta A, Pekkola J. Sclerotherapy complications of peripheral venous malformations. Phlebology 2016; 31:712-722. [PMID: 26494223 DOI: 10.1177/0268355515613740] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Sclerotherapy is often the primary treatment for peripheral venous malformations. It is mostly sufficient alone, but can be combined with other endovascular techniques. Despite its mini-invasiveness, it is not without potentially severe complications. Here, we systematically report sclerotherapy complications in trunk and extremity venous malformations. Methods We retrospectively assessed the complications of 127 consecutive patients who had received sclerotherapy for peripheral venous malformation in our tertiary care unit (January 2007-August 2013). We applied the Clavien-Dindo classification to grade the severity of complications. We mostly used detergent sclerosants (85.7%), and less often ethanol (5.7%) or bleomycin (4.2%). In 4.2% of the procedures, we combined glue, coils, endovascular laser or particles to sclerotherapy. Results The overall complication rate per procedure was 12.5%. Most complications (83.3%) were local and managed conservatively. We encountered four severe complications, all related to blood coagulopathy. Subcutaneous lesion location and use of ethanol significantly increased the risk of local complications. Conclusion Sclerotherapy alone or combined with other endovascular techniques is a safe method for local venous malformations with moderate risk for conservatively manageable complications. Blood coagulopathy constitutes a risk for, otherwise rare, severe complications.
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Affiliation(s)
- Johanna Aronniemi
- 1 Department of Radiology, University of Helsinki, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Eeva Castrén
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Kimmo Lappalainen
- 1 Department of Radiology, University of Helsinki, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Pia Vuola
- 3 Department of Plastic Surgery, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Päivi Salminen
- 4 Department of Pediatric Surgery, University of Helsinki, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Anne Pitkäranta
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Johanna Pekkola
- 1 Department of Radiology, University of Helsinki, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
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15
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Mahmoud O, Vikatmaa P, Aho P, Halmesmäki K, Albäck A, Rahkola-Soisalo P, Lappalainen K, Venermo M. Efficacy of endovascular treatment for pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord 2016; 4:355-70. [DOI: 10.1016/j.jvsv.2016.01.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/10/2016] [Indexed: 11/30/2022]
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16
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Mattila KA, Kervinen K, Kalajoki-Helmiö T, Lappalainen K, Vuola P, Lohi J, Rintala RJ, Pitkäranta A, Salminen P. An interdisciplinary specialist team leads to improved diagnostics and treatment for paediatric patients with vascular anomalies. Acta Paediatr 2015; 104:1109-16. [PMID: 26096329 DOI: 10.1111/apa.13076] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/12/2015] [Accepted: 06/08/2015] [Indexed: 11/28/2022]
Abstract
AIM Patients with vascular anomalies are often misdiagnosed, leading to delayed or improper treatment. The aim of this study was to evaluate the impact of an interdisciplinary team on the diagnosis and treatment of paediatric patients with vascular anomalies. METHODS We reviewed the paediatric patients evaluated by our interdisciplinary team between 2002 and 2012, analysing the referral diagnosis, final diagnosis, patient age, sex, clinical history, laboratory tests, imaging studies and treatments. RESULTS Of the 480 patients who were evaluated, 435 (90.6%) had a vascular anomaly: 30.7% of all patients had a tumour and 55.2% had a malformation. Haemangiomas comprised 93.2% of all tumours, while malformations included capillary (9.8%), lymphatic (30.1%), venous (36.8%), arteriovenous (3.8%) and combined slow-flow (7.9%) malformations. Tumours were initially diagnosed correctly in 89.2% of the patients, but only 38.0% of the malformations were diagnosed correctly. Improper treatment was given to 1.4%, due to incorrect diagnoses. CONCLUSION This study showed that haemangiomas were likely to be diagnosed correctly, but other tumours and vascular malformations were likely to be misdiagnosed. Misdiagnosis seldom led to improper treatment, but probably led to delayed treatment in many cases. The interdisciplinary approach led to improved diagnostics and treatment.
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Affiliation(s)
- Katariina A. Mattila
- Department of Paediatric Surgery; Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Kaisa Kervinen
- Department of Paediatric Surgery; Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Teija Kalajoki-Helmiö
- Department of Radiology; HUS Medical Imaging Centre; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Kimmo Lappalainen
- Department of Radiology; HUS Medical Imaging Centre; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Pia Vuola
- Department of Plastic Surgery; Helsinki University Hospital and University of Helsinki; Helsinki Finland
| | - Jouko Lohi
- Department of Pathology; HUSLAB; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Risto J. Rintala
- Department of Paediatric Surgery; Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Anne Pitkäranta
- Department of Otorhinolaryngology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
- The College of Medicine; Qatar University; Doha Qatar
| | - Päivi Salminen
- Department of Paediatric Surgery; Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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17
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Castrén E, Aronniemi J, Klockars T, Pekkola J, Lappalainen K, Vuola P, Salminen P, Pitkäranta A. Complications of sclerotherapy for 75 head and neck venous malformations. Eur Arch Otorhinolaryngol 2015; 273:1027-36. [DOI: 10.1007/s00405-015-3577-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/23/2015] [Indexed: 12/13/2022]
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18
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Tikkanen I, Lappalainen K. [Renal denervation in the treatment of hypertension]. Duodecim 2013; 129:825-832. [PMID: 23720950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Therapy resistant hypertension is common in hypertensive patients. The kidneys play an important role in the sympathetic nervous system overactivity associated with hypertension. Percutaneous transluminal ablation of renal nerves is a novel treatment strategy for resistant hypertension decreasing both renal and systemic sympathetic activity. Renal denervation resulted in significant blood pressure reduction within 6 months in a multicentre, prospective, randomized trial. The treatment has proved safe and blood pressure reduction appears sustained up to 2 years. It also improves glycemic control. Further studies are needed to evaluate the mortality and morbidity impact of this promising therapy of resistant hypertension.
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Affiliation(s)
- Ilkka Tikkanen
- Helsinki Hypertension Centre of Excellence, Biomedicum Helsinki
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19
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Strbian D, Mustanoja S, Pekkola J, Putaala J, Haapaniemi E, Paananen T, Kaste M, Lappalainen K, Tatlisumak T. Intravenous alteplase versus rescue endovascular procedure in patients with proximal middle cerebral artery occlusion. Int J Stroke 2012; 10:188-93. [PMID: 23013407 DOI: 10.1111/j.1747-4949.2012.00918.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 05/13/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To compare outcome of ischaemic stroke patients undergoing rescue endovascular procedure for proximal middle cerebral artery occlusion with matched patients without endovascular procedure after unsuccessful intravenous thrombolysis. METHODS Endovascularly treated patients with middle cerebral artery occlusion (n = 41) were matched by propensity score with similar patients treated by intravenous thrombolysis and having a considerable post-thrombolysis neurological deficit (n = 82). We compared their three-month outcome (modified Rankin Scale) and frequency of symptomatic intracerebral haemorrhage. For the endovascular group, we report onset-to-puncture time, onset-to-recanalization time, and recanalization rates. RESULTS In age, gender, time from onset, admission National Institutes of Health Stroke Scale, systolic and diastolic blood pressure, blood glucose, history of hypertension, diabetes mellitus, hyperlipidaemia, atrial fibrillation, and congestive heart failure, and in aetiology, the groups were similar. Endovascular group patients had a recanalization rate of 90%, and more often reached three-month modified Rankin Scale 0-2 (36.6% vs. 18.3%, P = 0.03). Mortality was equally common (19.5%) in both groups, and frequency of symptomatic intracerebral haemorrhage was 9.8% vs. 14.6% (P = 0.45). The endovascular group's median onset-to-puncture time was four-hours and six-minutes and onset-to-recanalization time was five-hours and 12 min. The latter time was more than one-hour longer in patients treated under general anaesthesia compared with patients treated under conscious sedation (median four-hours 50 min vs. five-hours 58 min; P < 0.01). CONCLUSIONS Rescue endovascular approach increases likelihood of recanalization and may improve functional outcome in acute ischaemic stroke patients with proximal middle cerebral artery occlusion who did not respond to intravenous thrombolysis.
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Affiliation(s)
- Daniel Strbian
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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20
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Pekkola J, Lappalainen K, Vuola P, Klockars T, Salminen P, Pitkäranta A. Head and neck arteriovenous malformations: results of ethanol sclerotherapy. AJNR Am J Neuroradiol 2012; 34:198-204. [PMID: 22766677 DOI: 10.3174/ajnr.a3180] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Peripheral AVM is a locally aggressive disease with a high tendency to recur; its treatment is complex, especially in the anatomically delicate head and neck area. Here, we report results of ethanol sclerotherapy for head and neck AVM and discuss its potential use for peripheral AVM. MATERIALS AND METHODS We retrospectively assessed degree of AVM eradication, complications, and clinical or imaging signs of recurrence for 19 patients treated with ethanol sclerotherapy for head and neck AVM (1 intraosseous, 18 soft-tissue AVMs). RESULTS Of the 19 patients, 11 had complete eradication of arteriovenous shunting at DSA, with 1 recurrence (mean follow-up 15 months), and for 7 patients, treatment is ongoing. During 59 treatment sessions, 12 patients experienced 14 complications, 1 leading to permanent functional damage. CONCLUSIONS Ethanol sclerotherapy has potential for complete eradication of head and neck AVM with low recurrence within the first year after completion of treatment. Complete eradication may require several treatment sessions during which complications should be minimized with careful techniques.
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Affiliation(s)
- J Pekkola
- Department of Radiology, University of Helsinki and HUS Radiology, Helsinki, Finland.
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21
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Scheperjans F, Pekkola J, Mustanoja S, Putaala J, Tiainen M, Ollila L, Paananen T, Lappalainen K. IV Thrombolysis-Bridging and Endovascular Treatment for Occlusive Internal Carotid Artery Dissection with Tandem Occlusion. Case Rep Neurol 2012; 4:13-9. [PMID: 22379480 PMCID: PMC3290017 DOI: 10.1159/000335990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Compared to other etiologies of ischemic stroke, occlusive internal carotid artery dissection responds worse to intravenous (IV) thrombolysis. Intracranial tandem occlusion is a predictor of poor outcome. A direct endovascular approach has been proposed as a safe and probably superior alternative to IV thrombolysis. However, it may lead to considerable treatment delays. We used rapidly initiated IV thrombolysis-bridging and subsequent endovascular treatment in two patients with severe hemispheric ischemia due to occlusive internal carotid artery dissection with tandem occlusion and achieved good outcomes. Minimizing recanalization times likely improves patient outcome and IV thrombolysis-bridging may be a reasonable strategy to achieve this. The positive initial results obtained with endovascular approaches and IV thrombolysis-bridging in this patient group deserve further scientific exploration.
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Affiliation(s)
- Filip Scheperjans
- Department of Neurology, Helsinki University Central Hospital, and Department of Neurological Sciences, University of Helsinki and HUS Radiology, Medical Imaging Center, Helsinki, Finland
- *Filip Scheperjans, MD, PhD, Helsinki University Central Hospital, Department of Neurology, Haartmaninkatu 4, FI-00290 Helsinki (Finland), Tel. +358 94 711, E-Mail
| | - Johanna Pekkola
- Department of Radiology, University of Helsinki and HUS Radiology, Medical Imaging Center, Helsinki, Finland
| | - Satu Mustanoja
- Department of Neurology, Helsinki University Central Hospital, and Department of Neurological Sciences, University of Helsinki and HUS Radiology, Medical Imaging Center, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, and Department of Neurological Sciences, University of Helsinki and HUS Radiology, Medical Imaging Center, Helsinki, Finland
| | - Marjaana Tiainen
- Department of Neurology, Helsinki University Central Hospital, and Department of Neurological Sciences, University of Helsinki and HUS Radiology, Medical Imaging Center, Helsinki, Finland
| | - Leena Ollila
- Department of Neurology, Helsinki University Central Hospital, and Department of Neurological Sciences, University of Helsinki and HUS Radiology, Medical Imaging Center, Helsinki, Finland
| | - Tapio Paananen
- Department of Radiology, University of Helsinki and HUS Radiology, Medical Imaging Center, Helsinki, Finland
| | - Kimmo Lappalainen
- Department of Radiology, University of Helsinki and HUS Radiology, Medical Imaging Center, Helsinki, Finland
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22
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Saarela MS, Tiitola M, Lappalainen K, Vikatmaa P, Pinomäki A, Alberty A, Lassila R. Pseudoaneurysm in association with a knee endoprothesis operation in an inhibitor-positive haemophilia A patient - treatment with local thrombin. Haemophilia 2010; 16:686-8. [PMID: 20201962 DOI: 10.1111/j.1365-2516.2010.02205.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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23
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Ikonen TS, Pätilä T, Virtanen K, Lommi J, Lappalainen K, Kankuri E, Krogerus L, Harjula A. Ligation of Ameroid-Stenosed Coronary Artery Leads to Reproducible Myocardial Infarction—A Pilot Study in a Porcine Model. J Surg Res 2007; 142:195-201. [PMID: 17612566 DOI: 10.1016/j.jss.2007.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Revised: 01/16/2007] [Accepted: 01/23/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Myocardial gene and cellular therapies have revived the use of porcine ischemic heart models. Commonly applied ameroid-obstruction produces inconsistent coronary stenoses and myocardial lesions, whereas abrupt coronary occlusion causes arrhythmias and sudden death. To produce a constant myocardial lesion after adaptation to ischemia, we surgically modified the ameroid-model by ligation. As a pilot study for further cell therapy research, the spontaneous myocardial response is described. MATERIALS AND METHODS Simultaneously with ameroid application, a loose loop of nonabsorbable thread was placed around the left circumflex artery (LCx) on 11 domestic piglets. Three weeks later, the loop was tightened. Coronary arteriograms with Rentrop collateral grading from 0 to 3, and 99mTc-single photon emission computerized tomography studies were performed 1 to 5 wk after ligation. At autopsy, the hearts were analyzed macroscopically, histologically, and with von Willebrandt factor-staining. RESULTS LCx-banding was well-tolerated in nine animals, of which angiographic occlusion was gained in eight. Postmortem analysis revealed a 5 to 10 cm(2) transmural or subendocardial lateral myocardial infarction in all except one heart. One week after occlusion, LCx showed well-developed collateral filling (Rentrop-grade 2.7 +/- 0.4), which remained unchanged at 5 wk. On single photon emission computerized tomography-scans, lateral wall perfusion increased spontaneously between 1 and 5 wk (P = 0.02), and von Willebrandt factor revealed clusters of neovascularization at the borders of infarct areas. CONCLUSIONS This new modification of ameroid model standardizes myocardial lesion, which might reduce animal number in preclinical studies, thus having ethical aspect. The remarked potential for spontaneous recovery in ischemic porcine myocardium should be considered in preclinical therapeutic studies.
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Affiliation(s)
- Tuija S Ikonen
- Department of Vascular Surgery, University of Helsinki, Meilahti Hospital, Helsinki, Finland
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24
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Pätilä T, Ikonen T, Rutanen J, Ahonen A, Lommi J, Lappalainen K, Krogerus L, Ihlberg L, Partanen TA, Lähteenoja L, Virtanen K, Alitalo K, Ylä-Herttuala S, Harjula A. Vascular Endothelial Growth Factor C–induced Collateral Formation in a Model of Myocardial Ischemia. J Heart Lung Transplant 2006; 25:206-13. [PMID: 16446222 DOI: 10.1016/j.healun.2005.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Revised: 08/07/2005] [Accepted: 08/07/2005] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Besides being a known lymphangiogenic activator, vascular endothelial growth factor (VEGF)-C may express angiogenic potential by proteolytic cleavage and activation of endothelial cells. We assessed myocardial collateral formation and functional changes after adenovirus-mediated VEGF-C gene transfer in an ischemic porcine model. METHODS Fifteen Landrace piglets underwent Ameroid-induced gradual occlusion of the left circumflex artery (LCx) and consequent progressive myocardial ischemia. Three weeks after Ameroid placement, the animals underwent gated 99mTc SPECT during rest and stress, in vivo angiography and 18FDG PET. Pigs were randomized to intramyocardial injections of adenoviruses encoding vascular endothelial growth factor (VEGF-C; n = 7) or control beta-galactosidase (LacZ; n = 5). Four weeks later, the examinations were repeated and histology was analyzed. RESULTS Angiography showed significant progression of LCx stenosis in both groups during the treatment period. Left ventricular wall thickening (LVWT) at the LCx area in gated 99mTc SPECT remained unchanged in the VEGF-C group, indicating that VEGF-C prevented progression of myocardial ischemia, whereas LVWT deteriorated in the LacZ group (p = 0.042). Semi-quantitative assessment of 18FDG PET suggests more reduction in ischemia in the adVEGF-C group than in controls (p = 0.052). Angiography showed significant clustering of collaterals in the adVEGF-C gene transfer area compared that in LacZ (p = 0.004). von Willebrand factor staining revealed a significantly (p = 0.03) greater number of microvessels in the adVEGF-C-treated myocardium. CONCLUSIONS This appears to be the first large-animal study in which, during progressive ischemia, functional and metabolic benefits of intramyocardial VEGF-C gene transfer were apparent. VEGF-C-induced collateral formation occurred at the site of gene transfer. The angiogenic potency of VEGF-C deserves further study as a therapeutic option.
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Affiliation(s)
- Tommi Pätilä
- Department of Cardiothoracic Surgery, University of Helsinki, Meilahti Hospital, Helsinki, Finland.
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25
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Mäntylä T, Sirola H, Kansanen E, Korjamo T, Lankinen H, Lappalainen K, Välimaa AL, Harvima I, Närvänen A. Effect of temporin A modifications on its cytotoxicity and antimicrobial activity. APMIS 2005; 113:497-505. [PMID: 16086819 DOI: 10.1111/j.1600-0463.2005.apm_107.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Temporin A (TA), a short alpha-helical antimicrobial peptide isolated from the skin of the frog Rana temporaria, is effective against a broad spectrum of Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium strains. TA interacts directly with the cell membrane of the microorganism and it has been reported to be non-toxic to erythrocytes at concentrations that are antimicrobial. Less is known about the effects on the viability and growth of nucleated eukaryotic cells. In this study we have tested antibacterial and growth-inhibitory properties of TA, its dimeric analogue (TAd), and all-L (TAL L512) and all-D (TAD L512) enantiomeric derivatives of modified TA towards S. aureus and cultured human keratinocytes, respectively. All molecules were antibacterial at concentrations from 1.5 microM to 10 microM. In keratinocyte cultures, TAD L512, as well as TAd, showed cytotoxicity. The original TA and TAL L512 did not affect the viability of the cells at their bacteriolytic concentrations. The growth of keratinocytes in low- and high-calcium media was only slightly inhibited by temporins at concentrations which were antibacterial to S. aureus. This suggests that original TA and its modification, TAL L512, are promising molecules against multiresistant bacterial infections.
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Affiliation(s)
- T Mäntylä
- Department of Chemistry, University of Kupio, Kuopio, Finland
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26
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Vuorisalo S, Railo M, Lappalainen K, Aho P, Lepäntalo M. Low-energy Blunt Abdominal Aortic Trauma in an Underweighted Man. Eur J Vasc Endovasc Surg 2005; 29:595-6. [PMID: 15878535 DOI: 10.1016/j.ejvs.2005.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2004] [Accepted: 02/10/2005] [Indexed: 11/22/2022]
Affiliation(s)
- S Vuorisalo
- Department of Vascular Surgery and Radiology, Helsinki University Central Hospital, FIN-00029 Helsinki, Finland.
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27
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Eskelinen E, Albäck A, Roth WD, Lappalainen K, Keto P, Railo M, Eskelinen A, Lepäntalo M. Infra-inguinal percutaneous transluminal angioplasty for limb salvage: a retrospective analysis in a single center. Acta Radiol 2005; 46:155-62. [PMID: 15902890 DOI: 10.1080/02841850510022705] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To review the feasibility of infra-inguinal angioplasty in the management of critical limb ischemia (CLI). MATERIAL AND METHODS Data on 221 patients with 230 critically ischemic limbs, treated with consecutive percutaneous transluminal angioplasty (PTA) at Helsinki University Central Hospital between January 2000 and December 2002 were collected and analyzed retrospectively. Patency, limb salvage, and survival rates were calculated on an intention-to-treat basis. Comparisons were done with univariate (Kaplan-Meier) and multivariate analysis (Cox regression). RESULTS Overall primary patency, secondary patency, limb salvage, and survival rates were 47%, 59%, 92%, and 76%, respectively, at 12 months. In the multivariate analysis, low toe pressure (< or =30 mmHg) was a significant risk factor for poor patency. Uremia with hemodialysis, low toe pressure (< or =30 mmHg), and hemodynamic failure of the endovascular procedure were found to increase significantly the risk of amputation. Uremia with hemodialysis, coronary artery disease, tissue loss as indication for PTA (Fontaine stage IV), and age over 70 years were all found to increase significantly the risk of death. CONCLUSION Infra-inguinal PTA is feasible in patients with CLI and resulted in good limb salvage.
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Affiliation(s)
- E Eskelinen
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
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28
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Pätilä T, Ikonen T, Rutanen J, Ahonen A, Lommi J, Lappalainen K, Ihlberg L, Partanen T, Virtanen K, Alitalo K, Ylä-Herttuala S, Harjula A. VEGF-C induces collateral formation in ischaemic porcine heart model. J Heart Lung Transplant 2004. [DOI: 10.1016/j.healun.2003.11.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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29
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Polamo M, Lappalainen K, Hämäläinen M. Crystal structure of 2,6-di[(2-ethyl)phenylamino]pyridine, C21H23N3. Z KRIST-NEW CRYST ST 2002. [DOI: 10.1524/ncrs.2002.217.jg.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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30
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Polamo M, Lappalainen K, Hämäläinen M. Crystal structure of 2,6-di[(2-ethyl)phenylamino]pyridine, C21H23N3. Z KRIST-NEW CRYST ST 2002. [DOI: 10.1524/ncrs.2002.217.1.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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31
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Martikainen T, Pitkälä K, Lappalainen K, Tikkanen I. [Treatment of renovascular hypertension with balloon dilatation and stenting]. Duodecim 2002; 115:1213-9. [PMID: 11877840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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32
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Lindsberg PJ, Roine RO, Lappalainen K, Paananen T, Lamminen A, Kaste M. [Thrombolytic therapy of basilar artery occlusion]. Duodecim 2002; 114:889-97. [PMID: 11524808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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33
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Heikkinen S, Aitio H, Permi P, Folmer R, Lappalainen K, Kilpeläinen I. J-multiplied HSQC (MJ-HSQC): a new method for measuring 3J(HNHalpha) couplings in 15N-labeled proteins. J Magn Reson 1999; 137:243-246. [PMID: 10053154 DOI: 10.1006/jmre.1998.1661] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A new method for the measurement of homonuclear 3J(HNHalpha) coupling constants in 15N-labeled small proteins is described. The method is based on a modified sensitivity enhanced HSQC experiment, where the 3J(HNHalpha) couplings are multiplied in the f1-dimension. The J-multiplication of homonuclear 3J(HNHalpha) couplings is based on simultaneous incrementation of 15N chemical shift and homonuclear coupling evolution periods. The time increment for the homonuclear coupling evolution period is chosen to be a suitable multiple (2N x t1) of the corresponding increment for 15N-shift evolution. This results in the splitting of the HSQC correlation in the f1-dimension by 2N x 3J(HNHalpha). Because the pulse sequence has good sensitivity and water suppression properties, it is particularly useful for natural abundance samples.
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Affiliation(s)
- S Heikkinen
- Institute of Biotechnology, University of Helsinki, FIN-00014, Finland
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Abu-Surrah AS, Lappalainen K, Klinga M, Leskelä M, Hodali HA, Rieger B. A dichloropalladium(II) complex with a mixed-donor bidentate ligand: dichloro[2-(diphenylphosphino)-1-(methylthio)ethane-P,S]palladium(II). Acta Crystallogr C 1999. [DOI: 10.1107/s0108270198012773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Saarinen L, Hakkola M, Pekari K, Lappalainen K, Aitio A. Exposure of gasoline road-tanker drivers to methyl tert-butyl ether and methyl tert-amyl ether. Int Arch Occup Environ Health 1998; 71:143-7. [PMID: 9553791 DOI: 10.1007/s004200050262] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Organic oxygenates, namely, methyl tert-butyl ether (MTBE) and methyl tert-amyl ether (MTAE), are added to gasoline to reduce carbon monoxide in exhausts and to enhance the octane number. The aim of this study was to investigate road-tanker drivers' exposure to oxygenate vapors during road-tanker loading and unloading as well as to evaluate the measurements of these ethers and their metabolites in the urine as a means of assessing the uptake of the ethers. A total of 11 drivers in different parts of Finland were trained to monitor their exposure with personal samplers, to report their working conditions, and to collect their whole-day urine samples. Charcoal tubes of the air samples were analyzed for MTBE, MTAE, benzene, toluene, and aliphatic hydrocarbons. For biological monitoring purposes the two main oxygenates, tertiary ethers MTBE and MTAE, as well as their main metabolites, tertiary alcohols tert-butanol (TBA) and tert-amyl alcohol (TAA), were determined in urine specimens. On average the drivers were exposed to vapors for short periods (21 +/- 14 min) three times during a work shift. The mean concentrations of MTBE and MTAE (mean +/- SD) were 8.1 +/- 8.4 and 0.3 +/- 0.4 mg/m3. The total MTBE uptake during the shift was calculated to be an average of 106 +/- 65 mumol. The mean concentrations of MTBE, TBA, MTAE and TAA detected in the first urine after the work shift were 113 +/- 76, 461 +/- 337, 16 +/- 21, and 40 +/- 38 nmol/l, and those found the next morning, 16 h later, were 18 +/- 12, 322 +/- 213, 9 +/- 10, and 20 +/- 27 nmol/l. The good relationship (r = 0.84) found between MTBE exposure and postshift excretion suggests that urinary MTBE can be used for biological monitoring of exposure, but at the present low level of exposure the corresponding metabolite TBA is not equally reliable. The determination of MTAE and its metabolite TAA in urine is sensitive enough to detect the low degree of exposure to MTAE, but in this study the data were too scarce to allow calculation of the correlations due to very low levels of MTAE exposure.
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Affiliation(s)
- L Saarinen
- Finnish Institute of Occupational Health, Helsinki, Finland
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36
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Abstract
Mantle cell lymphoma (MCL) is a subtype of B-cell non-Hodgkin's lymphoma recently recognised as a distinct disease entity. Little is known about the prognostic factors and optimal treatment of MCL. The aim of this study was to analyse retrospectively the clinical features and effect of treatment in 94 MCL patients diagnosed and treated in one centre between 1980 and 1996, and to find out different factors influencing the treatment results and prognosis. The median age of the patients was 66 years, and 77% were over 60 years old. Of the patients, 76% had advanced disease, the performance status (PS) was WHO 0-1 in 86%, and B symptoms were present in 35% of the cases. Bone marrow infiltration was found in 61% and overt leukaemia in 12% of the patients. Of the patients, 47% achieved complete remission with first- or second-line therapy. The median duration of remission, time to treatment failure (TTF), and survival were 28, 18, and 41 months, respectively. In multivariate analyses, age, stage and leukaemic disease were significantly associated with TTF, and age, stage, leukaemic disease and lactate dehydrogenase (LDH) with survival. Long-term prognosis is poor in MCL. None of the conventional chemotherapies seems curative. A prospective randomised trial should be made to evaluate the benefit of anthracycline-containing regimens in MCL.
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Affiliation(s)
- R Oinonen
- Department of Medicine, Oncology Hospital, Helsinki, Finland
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37
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Ristamäki R, Joensuu H, Lappalainen K, Teerenhovi L, Jalkanen S. Elevated serum CD44 level is associated with unfavorable outcome in non-Hodgkin's lymphoma. Blood 1997; 90:4039-45. [PMID: 9354673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
CD44 molecule is a cell surface glycoprotein involved in many cell-cell and cell-matrix interactions. Circulating serum CD44 (s-CD44) levels have been found to change in parallel with response to therapy, but little is known about the predictive or prognostic significance of s-CD44. In the present study, we measured s-CD44 levels in sera taken before treatment from 194 patients with non-Hodgkin's lymphoma using a chemiluminescence-enzyme immunoassay method. All except 1 patient were regularly followed-up after therapy at least for 60 months (range, 33 to 143 months). The median pretreatment s-CD44 level was 440 ng/mL (range, 13 to 1,220 ng/mL). Only 32% of the 92 patients with an International Prognostic Index (IPI) score of 0 or 1 had an s-CD44 concentration higher than the median as compared with 67% of the patients with an IPI score >/=2 (P < .0001). Patients with lower than the median s-CD44 achieved more often a complete remission to therapy (P = .0002) and had better survival (P = .007) than those with higher s-CD44 levels. However, in a multivariate analysis, only the IPI score had independent prognostic value (P < .001). The findings were similar if only the patients with diffuse large-cell lymphoma (n = 51) were included in the analysis, but among patients with low-grade lymphoma, the median s-CD44 level was not significantly associated with the IPI or survival. In conclusion, a high s-CD44 level at diagnosis is associated with a high IPI score, poor response to treatment, and unfavorable outcome in non-Hodgkin's lymphoma.
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Affiliation(s)
- R Ristamäki
- Department of Oncology, Turku University Central Hospital, National Public Health Institute, MediCity Research Laboratory, Turku University, Turku, Finland
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38
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Lappalainen K, Miettinen R, Kellokoski J, Jääskeläinen I, Syrjänen S. Intracellular distribution of oligonucleotides delivered by cationic liposomes: light and electron microscopic study. J Histochem Cytochem 1997; 45:265-74. [PMID: 9016315 DOI: 10.1177/002215549704500211] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Synthesized oligonucleotides are used in anti-sense and anti-gene technology to control gene expression. Because cells do not easily take up oligonucleotides, cationic liposomes have been employed to facilitate their transport into cells. Although cationic liposomes have been used in this way for several years, the precise mechanisms of the delivery of oligonucleotides into cells are not known. Because no earlier reports have been published on the liposomal delivery of oligonucleotides at the ultrastructural level, we performed a study, using electron microscopy, on the cellular uptake and intracellular distribution of liposomal digoxigenin-labeled oligodeoxynucleotides (ODNs) at several concentrations (0.1, 0.2, an 1.0 microM) in CaSki cells. Two cationic lipids (10 microM) were compared for transport efficiency: polycationic 2,3-dioleoyloxy-N-[2(sperminecarboxamido)ethyl]-N,N-dimethyl -1-propanaminium trifluoroacetate (DOSPA) and monocationic dimethyl-dioctadecylammonium bromide (DDAB). Both liposomes contained dioleoyl-phosphatidylethanolamine (DOPE) as a helper lipid. Endocytosis was found to be the main pathway of cellular uptake of liposomal ODNs. After release from intracellular vesicles, ODNs were carried into the perinuclear area. The nuclear membrane was found to be a barrier against the penetration of ODNs delivered by liposomes into the nucleus. Release from vesicles and transport into the nuclear area was faster when the oligo-DDAB/DOPE complex had a positive net charge (0.1 and 0.2 microM ODN concentrations), and only under this condition were some ODNs found in nucleoplasm. Although DOSPA/DOPE could also efficiently deliver ODNs into the cytosol, no ODNs were found in nucleoplasm. These findings suggest that both the type of liposome and the charge of the oligo-liposome complex are important for determination of the intracellular distribution of ODNs.
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Affiliation(s)
- K Lappalainen
- MediCity Research Laboratory, University of Turku, Finland
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39
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Ollikainen H, Lappalainen K, Jääskeläinen I, Syrjänen S, Pulkki K. Liposomal targeting of bcl-2 antisense oligonucleotides with enhanced stability into human myeloma cell lines. Leuk Lymphoma 1996; 24:165-74. [PMID: 9049973 DOI: 10.3109/10428199609045725] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cationic liposomes improve the delivery of antisense oligonucleotides (ODNs) into cells. However, there is marked variability in the cellular uptake of ODNs into different cell lines. We used liposomes containing dimethyloctadecylammonium bromide (DDAB) and dioleoylphosphatidylethanolamine (DOPE) to increase the delivery of phosphodiester ODNs into four different myeloma cell lines. The delivery by cationic liposomes increased the delivery of bcl-2 antisense ODNs by a factor of 9 to 45 as compared to plain ODNs. The stability of ODNs was increased with liposomes both in the culture medium and within the cells. Intact liposomal ODNs were detected inside the cells up to 24 hours with gel electrophoresis and phosphor imager analysis. Antisense ODNs had no effect on bcl-2 mRNA levels. Also the proliferation of myeloma cells remained unchanged during the 3-day incubation period. Our study shows that liposomal antisense ODNs targeting bcl-2 of human myeloma cells result in increased stability of ODNs with minimal toxicity. However, further modifications are needed to gain biological effects of antisense ODNs on human myeloma cells.
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Affiliation(s)
- H Ollikainen
- MediCity Research Laboratory, University of Turku, Finland
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40
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Lappalainen K, Pirilä L, Jääskeläinen I, Syrjänen K, Syrjänen S. Effects of liposomal antisense oligonucleotides on mRNA and protein levels of the HPV 16 E7 oncogene. Anticancer Res 1996; 16:2485-92. [PMID: 8917339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite the known association of human papillomavirus (HPV) infection with cervical cancer there is no specific antiviral treatment for HPV infection. Antisense oligode-oxynucleotides (AS-ODNs) may offer an effective way to treat HPV infections as the stability and delivery have been improved using modified ODNs or carrier systems. In this study we investigated the effects of liposomal AS-ODNs (0.1, 1 and 5 microM) on HPV 16 E7 mRNA and protein levels in CaSki cells. We used cationic liposomes (10 microM) containing dimethyldioctadecylammonium bromide (DDAB) or 2,3-dioleyloxy-N-[2(sperminecar-boxamido)ethyl]-N, N-dimethyl-1-propanaminium trifluoroacetate (DOSPA). Both these liposomes had dioleoylphosphatidyl-ethanolamine (DOPE) as a helper lipid. The target of the AS-ODNs was E7 protein because it is the one of the two oncoproteins of HPV 16. Only liposomal AS-ODNs which were targeted to the initiation codon of E7, had an effect on E7 mRNA expression; two shorter transcripts were detected, suggesting that RNase H degradation was activated. Liposomal random ODN or liposomal ODN targeted downstream from the initiation site of E7 did not affect the mRNA pattern. However, no change was found in the E7 protein levels detected by immunoprecipitation. Further studies showed that AS-ODNs inhibited the translation of E7 mRNA in a rabbit reticulocyte lysate assay. This data, together with the changes in mRNA levels, proved that the AS-ODNs reached the target mRNA. One possible explanation for the unchanged protein level of E7 in CaSki cells might be that immunoprecipitation is not sensitive enough to detect minor changes in protein levels. However, further progress is still needed in the field of carrier systems and modifications of AS-ODNs before non-sequence specific effects can be avoided.
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Affiliation(s)
- K Lappalainen
- MediCity Research Laboratory, Faculty of Medicine, University of Turku, Finland
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41
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Abstract
A number of reports associate human papillomavirus (HPV) with cervical cancer and cancer cell lines derived from this tumour type. Considerably fewer reports have focused on the role of HPV in carcinomas from other sites of female anogenital squamous epithelia. In this study we have tested for the presence of HPV in eight low-passage vulvar carcinoma cell lines and one extensively passaged cell line, A431. One cell line from a primary vaginal carcinoma was included. The presence of the HPV was evaluated by the polymerase chain reaction (PCR), by Southern blot analysis and by two-dimensional gel electrophoresis. General primer-mediated PCR was applied by using primers from the L1 region, E1 region and HPV 16 E7 region. Southern blot hybridisation was performed under low-stringency conditions (Tm = -35 degrees C) using a whole genomic HPV 6/16/18 probe mixture and under high stringency conditions (Tm = -18 degrees C) with the whole genomic probes of HPV 16 and 33. HPV 16 E6-E7 mRNA was assessed by ribonuclease protection assay (RPA). HPV was found in only one vulvar carcinoma cell line, UM-SCV-6. The identified type, HPV 16, was integrated in the cell genome and could be amplified with all primers used. Also E6-E7 transcripts were found in these cells. Five original tumour biopsies were available from the HPV-negative cell lines for in situ hybridisation. All these were HPV negative with both the HPV 6/16/18 screening probe mixture under low stringency and the HPV 16 probe under high stringency. The results indicate that vulvar carcinoma cell lines contain HPV less frequently than cervical carcinoma cell lines and suggest that a significant proportion of vulvar carcinomas may evolve by an HPV-independent mechanism.
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Affiliation(s)
- S Hietanen
- Department of Obstetrics and Gynecology, Turku University Central Hospital, Finland
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42
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Lappalainen K, Urtti A, Söderling E, Jääskeläinen I, Syrjänen K, Syrjänen S. Cationic liposomes improve stability and intracellular delivery of antisense oligonucleotides into CaSki cells. Biochim Biophys Acta 1994; 1196:201-8. [PMID: 7841184 DOI: 10.1016/0005-2736(94)00224-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Antisense oligonucleotides (ODNs) are promising novel therapeutic agents against viral infections and cancer. However, problems with their inefficient delivery and inadequate stability have to be solved before they can be used in therapy. To circumvent these obstacles, a wide variety of improvements, including phosphorothioate ODNs and liposomes as a carrier system, have been developed. This study was designed to compare the effects of two cationic liposomes on the intracellular delivery and stability of ODNs in CaSki cell cultures. Also the stability of 3'-end phosphorothioate ODNs were investigated. The 3'-modification neither had any effect on the delivery, nor protected the ODNs against degradation. The cellular delivery and stability of ODNs was improved with both cationic liposomes, but a cationic liposomal preparations containing dimethyldioctadecylammonium bromide and dioleoylphosphatidylethanolamine (DDAB/DOPE) was more efficient than commercially available N-(1-(2,3-dioleoyloxy)propyl)-N,N,N-trimethylammoniummethylsulf ate (DOTAP). The improved cellular delivery was largely due to the stabilization of ODNs by cationic liposomes. The improved stability in the culture medium indicates that the cationic liposomes per se protect the ODNs from enzymatic degradation. Indeed, intact ODNs were found in the cytoplasm and nucleus only when delivered by cationic liposomes.
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Affiliation(s)
- K Lappalainen
- MediCity Research Laboratory, Faculty of Medicine, University of Turku, Finland
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43
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Abstract
The present study compares different cytotoxicity and cell proliferation assays including cell morphology, mitochondrial activity, DNA synthesis, and cell viability and toxicity assays. CaSki cells were exposed to two cationic liposomal preparations containing dimethyldioctadecyl-ammonium bromide (DDAB), dioleoylphosphatidylethanolamine (DOPE) and a commercial transfection-reagent DOTAP (N[1-(2,3-dioleoyloxy)propyl]-N,N,N-trimethylammonium-methylsulfat e). The results provided by these assays were similar. However, the lactate dehydrogenase assay was more sensitive in measuring early damages of cell membranes than the Trypan blue assay. Also, cell morphology showed early toxic changes, such as cytoplasmic vacuolization and cell shrinking, and it should be included with such toxicity evaluations. DDAB:DOPE was more toxic than DOTAP. The cells treated with DOTAP at 10 microM were surviving as well as the control cells, while DOTAP at 40 uM and DDAB:DOPE at 10 microM had slight toxic effects on CaSki cells. The most toxic effects were seen in CaSki cells after treatment with DDAB:DOPE at 40 microM.
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Affiliation(s)
- K Lappalainen
- MediCity Research Laboratory, Faculty of Medicine, University of Turku, Finland
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44
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Lappalainen K, Urtti A, Jääskeläinen I, Syrjänen K, Syrjänen S. Cationic liposomes mediated delivery of antisense oligonucleotides targeted to HPV 16 E7 mRNA in CaSki cells. Antiviral Res 1994; 23:119-30. [PMID: 8147581 DOI: 10.1016/0166-3542(94)90039-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The "high risk" types 16 and 18 of human papillomavirus (HPV) are involved in the etiology of genital squamous cell carcinoma. The early genes 6 and 7 (E6-E7) of these viruses code for the major transforming proteins, capable of inducing cell transformation alone or acting synergistically with other oncogenes. Antisense oligonucleotides, recently applied to inhibit the functions of a number of cellular and viral proteins, might provide the basis for a new therapeutic strategy against HPV-induced malignancies. We studied the proliferation of CaSki cells by the MTT assay after their exposure to HPV 16 E7 mRNA antisense oligonucleotides with and without cationic liposomes (containing dimethyldioctadecylammonium bromide DDAB, and dioleylphosphatidylethanolamine, DOPE). Unmodified oligonucleotides (either 12- or 23-mers) did not have any effect on either CaSki cell proliferation or morphology when compared with the untreated cells. The cellular uptake of oligonucleotides was significantly enhanced by the cationic liposomes as assessed by confocal laser scanning microscopy (CLSM). The cationic liposomes were toxic to the cells as demonstrated by the reduced cell number and altered cell morphology. Only a slight reduction of the cell proliferation was seen when antisense 12-mer was protected from its 3'- and 5'-ends with thiolate and FITC, respectively. Both the 12- and the 23-mers with the cationic liposomes inhibited cell proliferation, the inhibitory effect being longer with the 23-mer. Overall, the MTT assay was less sensitive than light microscopy to reveal the toxic effects on CaSki cells. The results suggest that antisense oligonucleotides targeted to HPV 16 E7 mRNA can be introduced into CaSki cells with cationic liposomes.
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MESH Headings
- Base Sequence
- Cations
- Cell Division/drug effects
- Cell Line, Transformed
- Colorimetry/methods
- Drug Carriers
- Formazans
- Humans
- Liposomes/toxicity
- Microscopy, Fluorescence
- Molecular Sequence Data
- Oligonucleotides, Antisense/administration & dosage
- Oligonucleotides, Antisense/chemical synthesis
- Oligonucleotides, Antisense/pharmacokinetics
- Oligonucleotides, Antisense/pharmacology
- Oncogene Proteins, Viral/genetics
- Papillomaviridae/genetics
- Papillomavirus E7 Proteins
- RNA, Messenger/genetics
- RNA, Viral/genetics
- Tetrazolium Salts
- Tumor Cells, Cultured
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Affiliation(s)
- K Lappalainen
- Department of Pathology, University of Kuopio, Finland
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45
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Affiliation(s)
- A G Maiche
- Department of Radiotherapy and Oncology, Helsinki University Central Hospital, Finland
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46
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Salonen O, Kivisaari L, Standertskjöld-Nordenstam CG, Oksanen K, Lappalainen K. Chest radiography and computed tomography in the evaluation of mediastinal adenopathy in lymphoma. Acta Radiol 1987; 28:747-50. [PMID: 2962613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Thoracic computed tomography (CT) in 232 patients with either primary staging of new or suggested relapsing lymphoma was compared with conventional chest radiography and both were correlated with clinical staging. Particular attention was given to the possibility of reducing routine thoracic CT, which is the current method used in this hospital in all patients with suggested lymphoma. Mediastinal lymphoma was detected by CT in 95 per cent of patients with clinically active mediastinal lymphoma, and by conventional chest radiography in 56 per cent. CT was found to be less reliable in evaluation of the hilar region than in that of other mediastinal areas. No areas of particular difficulty were found with chest radiography. CT also provided additional information concerning extra-mediastinal lymph adenopathy and involvement of the thoracic wall and pericardium. Routine thoracic CT examination was considered justifiable in all patients with suggested lymphoma.
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Affiliation(s)
- O Salonen
- Department of Diagnostic Radiology, Helsinki University Central Hospital, Finland
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47
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Lakkala-Paranko T, Franssila K, Lappalainen K, Leskinen R, Knuutila S, de la Chapelle A, Bloomfield CD. Chromosome abnormalities in peripheral T-cell lymphoma. Br J Haematol 1987; 66:451-60. [PMID: 3499166 DOI: 10.1111/j.1365-2141.1987.tb01326.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We have studied neoplastic lymph nodes from six patients histologically, immunologically and cytogenetically. Histologically all the cases were classified as peripheral T-cell lymphomas. These were subclassified as T-zone lymphomas in three, large cell 'pale cell' variant in one, large cell immunoblastic in one, and small cell, mycosis fungoides in one. Two had features of angioimmunoblastic lymphadenopathy (AILD). Immunologically all cases expressed CD2 (OKT11) and CD4 (T4). All six cases had clonal chromosome abnormalities, although in four cases the majority of cells were chromosomally normal. Chromosome 3 was most often involved in abnormalities, occurring in five patients. The most common single chromosome abnormality, trisomy 3, was seen in all three cases classified as T-zone lymphoma and in no other cases. In the two cases with features of AILD only numerical abnormalities were seen, whereas in the other cases complicated structural rearrangements were present. Recurring structural abnormalities involved bands 1p12or13, 1q32, 3p25 and 14q11. Our data suggest that cytogenetic analysis may assist in diagnosis and classification of the peripheral T-cell lymphomas.
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48
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Salonen O, Kivisaari L, Standertskjöld-Nordenstam CG, Oksanen K, Lappalainen K. Chest Radiography and Computed Tomography in the Evaluation of Mediastinal Adenopathy in Lymphoma. Acta Radiol 1987. [DOI: 10.3109/02841858709177438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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