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Background: The value of early chest computed tomography (CT) was evaluated among severe community-acquired pneumonia (SCAP) patients.Methods: The study population consisted of 65 of 457 SCAP patients with concomitant chest CT and radiograph performed within 48 h of ICU admission. Each image pair was re-evaluated by two radiologists. The type of pneumonia, the presence of pleural fluid and atelectasis were assessed. Therapeutic and diagnostic procedures induced by CT results were analysed together with clinical, microbiological and outcome data.Results: Alveolar pneumonia was observed in 72.3% of patients by radiograph and in 75.4% of patients by CT. Pleural fluid was detected via chest radiograph and CT in 17 (26.2%) and 41 cases (63.1%), (P < 0.001) and atelectasis in 10 (15.4%) and 22 cases (33.8%), (P = 0.002), respectively. In 34 patients (52.3%), the CT revealed 38 new findings (58.5%) not shown in plain chest radiograph. Out of these 34 patients, therapeutic interventions or procedures were performed in 26 (76.5%). The number of infected lobes correlated negatively with the lowest PaO2 /FiO2 ratio (ρ = -0.326, P = 0.008) for chest CT scans.Conclusion: Compared with chest radiograph, chest CT generated new findings in nearly 60% of SCAP patients, leading to new procedures or changes in medical treatment in nearly 75% of those patients. Chest CT better describes the pulmonary involvement and severity of oxygenation disorder compared to a plain chest radiograph. [ABSTRACT FROM AUTHOR]

Background: Previous studies have reported chest radiographic findings of consolidation and ground-glass opacity in patients with swine-origin influenza A (H1N1). However, most of these studies include both hospitalized and outpatients. Purpose: To evaluate initial chest radiographic and CT findings of hospitalized swine flu patients, adults and children, confirmed with a real-time reverse transcriptase polymerase chain reaction (PCR) assay for H1N1 virus. Material and Methods: All PCR-verified swine flu patients admitted to the Department of Emergency Medicine (October 1 to December 15, 2009) at Oulu University Hospital, in Northern Finland, who underwent frontal chest radiography within 24 hours of presentation and who were hospitalized, were included. The radiographs and CT scans were assessed for the presence of pneumonia and characterized by pattern and distribution. The patients' medical records were analyzed for demographics, underlying medical conditions, the admission to the intensive care unit (ICU), initiation of mechanical ventilation or non-invasive ventilation support (NIV) and death. Results: Of 159 H1N1 influenza patients, 135 (85%) underwent chest radiographs at admission; 113 adults and 22 children. Findings of pulmonary infiltrates were detected in 62% (70/113) of adults and 64% (14/22) of children, being bilateral in 67% of adults and 64% of the children. The anatomic location of infiltrates was more often peripheral in adults; 42/70 (60%) vs. 4/14 (29%), P = 0.041, and diffuse among children; 9/14 (64%) vs. 26/70 (37%), P = 0.078. When the ICU and NIV patients were compared to less severe cases, on their chest radiographs four or five lobes were more often affected (65%, 11/17 vs. 34% 23/67, P = 0.029 ). The predominant radiographic findings were consolidation (93% of all patients, 91% of adults and 100% of children) and ground-glass opacity (74% of all, 77% of adults and 57% of children). Pulmonary emboli were detected by CT in 2/9 (22%) patients. Conclusion: The pandemic 2009 swine influenza causes common and widely distributed infiltrates on chest radiographs among hospitalized patients, which are not peculiar to usual respiratory viral infections, and these findings can not be differentiated from usual bacterial pneumonia. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the detection and the size of focal patellar cartilage lesions in T2 mapping as compared to standard clinical magnetic resonance imaging (MRI) at 1.5T. Material and Methods: Fifty-five consecutive clinical patients referred to knee MRI were imaged both with a standard knee MRI protocol (proton-density-weighted sagittal and axial series, T2-weighted sagittal and coronal series, and T1-weighted coronal series) and with an axial multislice multi-echo spin-echo measurement to determine the T2 relaxation time of the patellar cartilage. MR images and T2 maps of patellar cartilage were evaluated for focal lesions. The lesions were evaluated for lesion width (mm), lesion depth (1/3, 2/3, or 3/3 of cartilage thickness), and T2 value (20-40 ms, 40-60 ms, or 60-80 ms) based on visual evaluation. Results: Altogether, 36 focal patellar cartilage lesions were detected from 20 human subjects (11 male, nine female, mean age 40±15 years). Twenty-eight lesions were detected both on MRI and T2 maps, while eight lesions were only visible on T2 maps. Cartilage lesions were significantly wider (P = 0.001) and thicker (P<0.001) on T2 maps as compared to standard knee MRI. Most lesions 27 had moderately (T2 40-60 ms) increased T2 values, while two lesions had slightly (T2 20-40 ms) and seven lesions remarkably (T2 60-80 ms) increased T2 relaxation times. Conclusion: T2 mapping of articular cartilage is feasible in the clinical setting and may reveal early cartilage lesions not visible with standard clinical MRI. [ABSTRACT FROM AUTHOR]

Background: Prophylactic placement of a mesh has been suggested to prevent parastomal hernia, but evidence to support this approach is scarce., Objective: The aim of this study was to evaluate whether laparoscopic placement of a prophylactic, dual-component, intraperitoneal onlay mesh around a colostomy is safe and prevents parastomal hernia formation after laparoscopic abdominoperineal resection., Design: This is a prospective, multicenter, randomized controlled clinical trial., Settings: This study was conducted at 2 university and 3 central Finnish hospitals., Patients: From 2010 to 2013, 83 patients undergoing laparoscopic abdominoperineal resection for rectal cancer were recruited. After withdrawals and exclusions, the outcome of 70 patients, 35 patients in each study group, could be examined., Interventions: In the intervention group, an end colostomy was created with placement of a intraperitoneal, dual-component onlay mesh and compared with a group with a traditional stoma., Main Outcome Measures: The main outcome measures were the incidence of clinically and radiologically detected parastomal hernias and their extent 12 months after surgery. Stoma-related morbidity and the need for surgical repair of parastomal hernia were secondary outcome measures., Results: Parastomal hernia was observed by clinical inspection in 5 intervention patients (14.3%) and in 12 control patients (32.3%; p = 0.049). Surgical repair of parastomal hernia was performed in 1 control patient (3.2%) and in none of the patients in the intervention group. CT detected parastomal hernia in 18 intervention patients (51.4%) and in 17 control patients (53.1%; p = 1.00). The extent of hernias was similar according to European Hernia Society classification (p = 0.41). Colostomy-related morbidity (32.3% vs 14.3%; p = 0.140) did not differ between the study groups., Limitations: The study was limited by its small size and short follow-up time., Conclusions: Prophylactic laparoscopic placement of intraperitoneal onlay mesh does not significantly reduce the overall risk of radiologically detected parastomal hernia after laparoscopic abdominoperineal resection. However, prophylactic mesh repair was associated with significantly lower risk of clinically detected parastomal hernia.

Background: In Finland, the pandemic A(H1N1)v-influenza was experienced in late 2009., Material and Methods: A(H1N1)v-patients hospitalized in Oulu University Hospital were evaluated., Results: Altogether, 159 A(H1N1)v-patients, including 37 children, were hospitalized. Their median age was 35. Eighteen (11 %) patients required admission to ICU; three of them died. As many as 62% of the patients suffered from radiologically confirmed pneumonia. The incidences of hospitalization, ICU care and death were 40,5, 4,6 and 0,8 per 100000, respectively., Conclusions: Despite the low mortality rate, a rather high number of patients required hospitalization. Findings in chest radiography were common and prominent.

Most patients, up to 75-80 percent, with anatomical diverticulosis will remain uncomplicated with a few symptoms. They might benefit of increasing their fruit and vegetable fibre intake and active movement. Advancing age of the Finnish population and decreasing daily consumption of dietary fibre led at the end of 1990' to increasing incidence of diverticle perforations. The annual mortality associated with diverticle perforation is as high as that following hip fracture. It has earlier been recommended that the patients aged under 50 years should be operated after recovery from one acute diverticulitis. However, at present younger patients seem not to be at an increased risk of complications. Elective operation after acute diverticulitis should be made on a case-by-case basis and operations should be restricted to the most symptomatic patients.