145 results on '"Mäkisalo, Heikki"'
Search Results
102. Hepatic and splanchnic oxygenation during liver transplantation
- Author
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Tallgren, Minna, primary, Mäkisalo, Heikki, additional, Höckerstedt, Krister, additional, and Lindgren, Leena, additional
- Published
- 1999
- Full Text
- View/download PDF
103. Hepatosplanchnic and Peripheral Tissue Oxygenation During Treatment of Hemorrhagic Shock: The Effects of Pentoxifylline Administration
- Author
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Nordin, Arno, primary, Mildh, Leena, additional, Mäkisalo, Heikki, additional, Härkönen, Matti, additional, and Höckerstedt, Krister, additional
- Published
- 1998
- Full Text
- View/download PDF
104. Circulating xanthine oxidase and neutrophil activation during human liver transplantation
- Author
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Pesonen*, Eero J., primary, Linder*, Nina, additional, Raivio*, Kari O., additional, Sarnesto*, Annikki, additional, Lapatto*, Risto, additional, Höckerstedt‡, Krister, additional, Mäkisalo‡, Heikki, additional, and Andersson*,§,∥, Sture, additional
- Published
- 1998
- Full Text
- View/download PDF
105. HEPATOTOXICITY AND ABSORPTION OF EXTRAHEPATIC ACETALDEHYDE IN RATS
- Author
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MATYSIAK-BUDNIK, TAMARA, primary, JOKELAINEN, KALLE, additional, KÄRKKÄINEN, PÄIVI, additional, MÄKISALO, HEIKKI, additional, OHISALO, JORMA, additional, and SALASPURO, MIKKO, additional
- Published
- 1996
- Full Text
- View/download PDF
106. Dopamine infusion during resuscitation of experimental hemorrhagic shock
- Author
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Nordin, Arno, primary, Mäkisalo, Heikki, additional, and Höckerstedt, Krister, additional
- Published
- 1994
- Full Text
- View/download PDF
107. Peripheral and liver tissue oxygen tensions in hemorrhagic shock
- Author
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SOINI, HANNU O., primary, TAKALA, JUKKA, additional, NORDIN, ARNO J., additional, MÄKISALO, HEIKKI J., additional, and HÖCKERSTEDT, KRISTER A. V., additional
- Published
- 1992
- Full Text
- View/download PDF
108. Endoscopic treatment of anastomotic biliary complications after liver transplantation using removable, covered, self-expandable metallic stents.
- Author
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Haapamäki, Carola, Udd, Marianne, Halttunen, Jorma, Lindström, Outi, Mäkisalo, Heikki, and Kylänpää, Leena
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LIVER transplantation ,PANCREATITIS ,BILIARY tract ,THERAPEUTICS ,INFLAMMATION - Abstract
Objective. Anastomotic bile duct complications after liver transplantation (LT) have been treated endoscopically by dilation and plastic tube stenting, with the stent therapy having moved toward using covered, self-expandable metallic stents (cSEMS) in recent years. The aim of this study was to analyze therapy outcome of post-LT anastomotic complications using cSEMS. Material and methods. Seventeen post-LT patients had 29 cSEMS (Allium stent, n == 23; Wallstent®, n == 4; Micro-Tech, n == 2) placed during endoscopic retrograde cholangiopancreatography (ERCP). The fully covered stents (Allium, Micro-Tech) were placed entirely inside the common bile duct. Data were collected and analyzed in a retrospective manner. Results. These 17 patients had 19 stent treatment periods. Resolution was eventually established in all patients. There were four (14%) stent migrations. Pancreatitis was seen after one ERCP procedure, whereas five cases of cholangitis were seen. Conclusion. Treatment of post-LT anastomotic complications with cSEMS seems to be both safe and efficient. Further assessment regarding indications, stent types and stenting time is needed. [ABSTRACT FROM AUTHOR]
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- 2012
- Full Text
- View/download PDF
109. ACUTE EFFECT OF ALCOHOL ON ANDROGENS IN PREMENOPAUSAL WOMEN.
- Author
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Sarkola, Taisto, Fukunaga, Tatsushige, Mäkisalo, Heikki, and Peter Eriksson, C. J.
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ALCOHOL research ,ALCOHOL drinking ,ANDROGENS ,TESTOSTERONE ,ANDROSTENEDIONE ,HYPERANDROGENISM ,PERIMENOPAUSE - Abstract
The aim of the present study was to investigate the effect of alcohol on androgen levels among premenopausal women. Eighty-seven women in the mid-cycle phase of the menstrual cycle, 47 of whom used oral contraceptives (OC+), were included in the study. The range for reported alcohol consumption was 0–4 drinks/day. The total testosterone levels were significantly higher after alcohol intake (0.5 g/kg) than after placebo at 45 min and 90 min from the start of drinking among both OC– and OC+ subjects. This effect was also seen in the free testosterone fraction. The effect on testosterone was more prominent among OC+ subjects. Androstenedione levels were significantly lowered and the testosterone:androstenedione ratio significantly elevated by alcohol among both OC– and OC+ subjects. No effect of alcohol on dehydroepiandrosterone or dihydrotestosterone levels was observed. A positive correlation was observed between the change in testosterone levels and the change in androstenedione levels during placebo conditions. The correlation was significantly reduced during alcohol conditions among OC+ subjects, indicating an increased androstenedione to testosterone conversion. No significant dose (0.34, 0.68 and 1.02 g/kg) or time (45, 90 and 150 min) effects on total testosterone were observed in a substudy involving 10 OC+ subjects. The present results suggest that the testosterone effect is related to the zero-order mechanism of ethanol oxidation. The observed testosterone and androstenedione effects are suggested to be the result of an increased androstenedione to testosterone conversion in the liver caused by the alcohol-mediated elevation in the [NADH]:[NAD+] ratio. The present findings may be relevant in the development of hyperandrogenism and loss of female sexual characteristics associated with heavy alcohol consumption. [ABSTRACT FROM PUBLISHER]
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- 2000
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110. Acute Effect of Alcohol on Estradiol, Estrone, Progesterone, Prolactin, Cortisol, and Luteinizing Hormone in Premenopausal Women.
- Author
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Sarkola, Taisto, Mäkisalo, Heikki, Fukunaga, Tatsushige, and Eriksson, C. J. Peter
- Abstract
Background: Heavy alcohol consumption is associated with menstrual irregularities, including anovulation, luteal-phase dysfunction, recurrent amenorrhea, and early menopause. In addition, moderate to heavy alcohol intake has been found to increase the risk of spontaneous abortions and breast cancer. These adverse effects could at least in part originate from alcohol-mediated changes in hormone levels. Method: The acute effect of alcohol on the hormone balance in women using oral contraceptives (OC+) and also in nonusers (OC-), was evaluated in 30 OC- and 31 OC+ subjects, representing the whole period of the menstrual cycle. It was also evaluated in 40 OC- and 47 OC+ subjects during the midcycle phase and in 10 OC+ subjects with unknown cycle phase. Result: We found that among subjects who used oral contraceptives, estradiol levels increased and progesterone levels decreased after intake of alcohol (0.5 g/kg). No dose effect (0.34-1.02 g/kg) on progesterone was observed in a substudy on 10 OC+ subjects. With regard to estrone levels, no effect was observed, although a significant increase was found in the estradiol-to-estrone ratio. Among subjects not using oral contraceptives, progesterone levels decreased after intake of alcohol (0.5 g/kg). No effect was found in estradiol, estrone, or the estradiol-to-estrone ratio during midcycle in this study group. A transient elevating effect of alcohol (0.5 g/kg) on prolactin levels was observed in both study groups. We found that alcohol (0.5 g/kg) had no significant effect on luteinizing hormone (LH) levels among subjects not using oral contraceptives, and observed a decline among subjects using oral contraceptives at midcycle. Conclusions: We suggest that the estradiol and progesterone effects are related to decreased steroid catabolism, resulting from the alcohol-mediated increase in the hepatic NADH-to-NAD ratio. The transient effect on prolactin levels may reflect acute changes in opioid and dopamine levels in the hypothalamus. The present findings regarding female sex steroids may be of relevance in the association between moderate to heavy alcohol consumption and the development of breast cancer. [ABSTRACT FROM AUTHOR]
- Published
- 1999
- Full Text
- View/download PDF
111. FINE-NEEDLE ASPIRATION BIOPSY IN THE MONITORING OF LIVER ALLOGRAFTS.
- Author
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Lautenschlager, Irmeli, Höckerstedt, Krister, Taskinen, Eero, Korsbäck, Charles, Mäkisalo, Heikki, and Häyry, Pekka
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- 1988
- Full Text
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112. ASSOCIATION OF GRAFT NEUTROPHIL SEQUESTRATION WITH DELAYED GRAFT FUNCTION IN CLINICAL RENAL TRANSPLANTATION
- Author
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Turunen, Arto J., Lindgren, Leena, Salmela, Kaija T., Kyllönen, Lauri E., Mäkisalo, Heikki, Siitonen, Sanna M., and Pesonen, Eero J.
- Abstract
The authors studied the impact of neutrophil activation, detected in experimental models, on reperfusion injury in clinical renal transplantation.
- Published
- 2004
- Full Text
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113. FINENEEDLE ASPIRATION BIOPSY IN THE MONITORING OF LIVER ALLOGRAFTS
- Author
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Lautenschlager, Irmeli, Höckerstedt, Krister, Taskinen, Eero, Korsbäck, Charles, Mäkisalo, Heikki, and Häyry, Pekka
- Abstract
We have used allogeneic pig liver transplants to investigate the structure of inflammation in acute liver allograft rejection. An inflammatory episode of acute cellular rejection was observed in 9/10 allografts in non-immunosuppressed recipients, when monitored with simultaneous fine-needle aspiration biopsies (FNAB) and core needle biopsies (NB). The intensity of inflammation in FNAB was quantitated using the corrected increment method and correlated with NB findings. In FNAB, all inflammatory episodes were detected on the 4th day after transplantation with lymphoid blast and lymphocyte infiltration, later accompanied by monocytes and macrophages. Maximal intensity of inflammation was recorded in FNAB on day 14. In NB, histology demonstrated distinct inflammation in the portal area on day 4. The predominantly lymphocytic infiltration, also containing varying numbers of plasma cells, eosinophils, neutrophils and macrophages, reached its maximum 7–14 days after transplantation. With the indirect immunoperoxidase technique, lymphoid cell subpopulation analysis of FNAB demonstrated an increase of both T4 and T8 cells during rejection. The T4/ T8 ratio was first low, and increased at the beginning of the episode, on day 4, but decreased again on days 7 and 14. The number of B cells in the graft was also elevated during rejection. The cellular changes in the corresponding blood specimens followed approximately the same lines, although the changes were less prominent. NB immunohistology, using immunoperoxidase and frozen sections, correlated well with FNAB results, and demonstrated a T4 predominance in the portal area on day 4 but a T8 predominance on days 7 and 14. In addition to lymphoid cells, macrophages/granulocytes were also frequent in the portal area and scattered in the parenchyma on days 7 and 14. An additional inflammatory cell component in liver allograft rejection, detectable only in the NB, was eosinophils in the portal area, recorded in maximum on day 14. Taken together, the inflammatory changes in the FNAB and NB were similar, and time-related changes of cellular infiltrate in FNAB and NB correlated closely.
- Published
- 1988
114. Manipulation of Alcohol Drinking by Liver Transplantation.
- Author
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Eriksson, C. J. Peter, Koivisto, Tiina, Sriwatanawongsa, Voravit, Martelius, Tirni, Mäkisalo, Heikki, and Höckerstedt, Krister
- Abstract
The procedure of liver transplantation in alcoholic liver disease raises the question whether it would be possible to regulate the recipient's future drinking by the choice of donor liver. To address this question, we conducted transplantations with rat lines selected for high (AA) and low (ANA) alcohol preference. AA recipients having alcohol experience before the operation remained heavy drinkers regardless of whether the graft came from an AA or ANA donor. However, in those AA recipients who started drinking only after the operation, differences emerged, with AA grafts creating heavy drinking and ANA donor livers resulting in very low drinking. An overall increase in the acetaldehyde levels was introduced by the ANA livers, thus reflecting the original line differences. Similarly, in subsequent experiments, it was observed that when the aldehyde dehydrogenase inhibitor calcium carbimide was introduced in different amounts to the diet, alcohol drinking was reduced more in animals not used to drinking. The magnitude of this effect, especially in situations with established heavy drinking, is of relevance in future contemplations about liver transplantations between humans with dfferent aldehyde dehydrogenase genotypes. [ABSTRACT FROM AUTHOR]
- Published
- 1997
- Full Text
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115. Predictors of insufficient recanalization and portal hypertensive complications after treatment of non-cirrhotic, non-malignant portal vein thrombosis – a population-based study
- Author
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Lemma, Aurora, Åberg, Fredrik, Mäkisalo, Heikki, Pirkka Vikatmaa, Mentula, Panu, Leppäniemi, Ari, and Sallinen, Ville
- Subjects
3. Good health - Abstract
In acute portal vein thrombosis (PVT), a six-month anticoagulation treatment achieves complete recanalization in only 35%–45% of patients, but the predictors of poor treatment responses are unclear. We examined treatment outcomes in PVT and aimed to identify predictors of incomplete recanalization and portal hypertensive complications. This retrospective study comprised patients diagnosed with PVT between 2006 and 2015. Key exclusion criteria were liver cirrhosis, malignancy, and age
116. Predictors of insufficient recanalization and portal hypertensive complications after treatment of non-cirrhotic, non-malignant portal vein thrombosis – a population-based study
- Author
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Lemma, Aurora, Åberg, Fredrik, Mäkisalo, Heikki, Pirkka Vikatmaa, Mentula, Panu, Leppäniemi, Ari, and Sallinen, Ville
- Subjects
3. Good health - Abstract
In acute portal vein thrombosis (PVT), a six-month anticoagulation treatment achieves complete recanalization in only 35%–45% of patients, but the predictors of poor treatment responses are unclear. We examined treatment outcomes in PVT and aimed to identify predictors of incomplete recanalization and portal hypertensive complications. This retrospective study comprised patients diagnosed with PVT between 2006 and 2015. Key exclusion criteria were liver cirrhosis, malignancy, and age
117. Subcutaneous and liver tissue oxygen tension in hemorrhagic shock
- Author
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MÄKISALO, HEIKKI JORMA, primary, SOINI, HANNU OLAVI, additional, TAPANI LALLA, MARTTI LEO, additional, and VICTOR HÖCKERSTEDT, KRISTER ANDERS, additional
- Published
- 1988
- Full Text
- View/download PDF
118. CHRONIC ENDOTOXIN/ALCOHOL EXPOSURE: THE DEVELOPMENT OF A NEW ANIMAL MODEL.
- Author
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Lindros, Kai O., Järveläinen, Harri, Karjalainen, Ari, Mäkisalo, Heikki, and Karhunen, Pekka J.
- Published
- 1998
- Full Text
- View/download PDF
119. Infections in lung and heart transplant recipients : studies on the impact of bronchoscopy in the diagnosis of respiratory infections and detection of viral infections in blood and bronchoalveolar lavage fluid
- Author
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Lehto, Juho, University of Helsinki, Faculty of Medicine, Institute of Clinical Medicine, Department of Medicine, Division of Respiratory Diseases, Helsinki University Central Hospital, Transplantation laboratory, University of Helsinki and Helsinki University Central Hospital, Helsingin yliopisto, lääketieteellinen tiedekunta, kliininen laitos, Helsingfors universitet, medicinska fakulteten, institutionen för klinisk medicin, Mäkisalo, Heikki, Halme, Maija, and Koskinen, Petri
- Subjects
lääketiede - Abstract
Infection is a major cause of mortality and morbidity after thoracic organ transplantation. The aim of the present study was to evaluate the infectious complications after lung and heart transplantation, with a special emphasis on the usefulness of bronchoscopy and the demonstration of cytomegalovirus (CMV), human herpes virus (HHV)-6, and HHV-7. We reviewed all the consecutive bronchoscopies performed on heart transplant recipients (HTRs) from May 1988 to December 2001 (n = 44) and lung transplant recipients (LTRs) from February 1994 to November 2002 (n = 472). To compare different assays in the detection of CMV, a total of 21 thoracic organ transplant recipients were prospectively monitored by CMV pp65-antigenemia, DNAemia (PCR), and mRNAemia (NASBA) tests. The antigenemia test was the reference assay for therapeutic intervention. In addition to CMV antigenemia, 22 LTRs were monitored for HHV-6 and HHV-7 antigenemia. The diagnostic yield of the clinically indicated bronchoscopies was 41 % in the HTRs and 61 % in the LTRs. The utility of the bronchoscopy was highest from one to six months after transplantation. In contrast, the findings from the surveillance bronchoscopies performed on LTRs led to a change in the previous treatment in only 6 % of the cases. Pneumocystis carinii and CMV were the most commonly detected pathogens. Furthermore, 15 (65 %) of the P. carinii infections in the LTRs were detected during chemoprophylaxis. None of the complications of the bronchoscopies were fatal. Antigenemia, DNAemia, and mRNAemia were present in 98 %, 72 %, and 43 % of the CMV infections, respectively. The optimal DNAemia cut-off levels (sensitivity/specificity) were 400 (75.9/92.7 %), 850 (91.3/91.3 %), and 1250 (100/91.5 %) copies/ml for the antigenemia of 2, 5, and 10 pp65-positive leukocytes/50 000 leukocytes, respectively. The sensitivities of the NASBA were 25.9, 43.5, and 56.3 % in detecting the same cut-off levels. CMV DNAemia was detected in 93 % and mRNAemia in 61 % of the CMV antigenemias requiring antiviral therapy. HHV-6, HHV-7, and CMV antigenemia was detected in 20 (91 %), 11 (50 %), and 12 (55 %) of the 22 LTRs (median 16, 31, and 165 days), respectively. HHV-6 appeared in 15 (79 %), HHV-7 in seven (37 %), and CMV in one (7 %) of these patients during ganciclovir or valganciclovir prophylaxis. One case of pneumonitis and another of encephalitis were associated with HHV-6. In conclusion, bronchoscopy is a safe and useful diagnostic tool in LTRs and HTRs with a suspected respiratory infection, but the role of surveillance bronchoscopy in LTRs remains controversial. The PCR assay acts comparably with the antigenemia test in guiding the pre-emptive therapy against CMV when threshold levels of over 5 pp65-antigen positive leukocytes are used. In contrast, the low sensitivity of NASBA limits its usefulness. HHV-6 and HHV-7 activation is common after lung transplantation despite ganciclovir or valganciclovir prophylaxis, but clinical manifestations are infrequently linked to them. Keuhkon- ja sydämensiirtopotilailla infektiot ovat yleisiä ja ne aiheuttavat merkittävää kuolleisuutta. Infektioiden aiheuttajakirjo on laaja, joten hyvät menetelmät infektioiden diagnostiikassa ovat välttämättömiä. Tässä väitöskirjatutkimuksessa selvitettiin bronkoskopian käyttökelpoisuutta keuhkon- ja sydämensiirtopotilaiden infektiodiagnostiikassa, verrattiin sytomegalovirus(CMV)-infektioiden osoittamiseen käytettäviä menetelmiä näissä potilasryhmissä sekä tutkittiin ihmisen herpesvirusten 6 ja 7 (HHV-6 ja HHV-7) esiintymistä ja merkitystä keuhkonsiirtopotilailla. Tutkimme sydämensiirtopotilaille tehtyjen 44:n ja keuhkonsiirtopotilaille tehtyjen 472:n bronkoskopian tulokset. Seurasimme 21:tä keuhkon- tai sydämensiirron saanutta potilasta veren CMV-antigenemia-, DNAemia- (PCR) ja mRNAemia(NASBA)testein. CMV-infektioiden hoito perustui antigenemiatestiin, johon kahden muun testin tuloksia verrattiin. CMV antigenemiatestin lisäksi 22:ta keuhkonsiirtopotilasta seurattiin HHV-6:n ja HHV-7:n suhteen valkosolujen antigeenitestien avulla. Infektioepäilyn yhteydessä tehtyjen bronkoskopioiden näytteistä saatiin diagnoosi sydämensiirtopotilailla 41 %:ssa ja keuhkonsiirtopotilailla 61 %:ssa tapauksista. Bronkoskopia osoittautui hyödyllisimmäksi ajanjaksona yhdestä kuuteen kuukautta elinsiirrosta. Sen sijaan oireettomille keuhkonsiirtopotilaille tehtyjen ns. seuranta-bronkoskopioiden löydökset vaikuttivat potilaan hoitoon vain 6 %:ssa tapauksista. Yleisimmät bronkoskopianäytteissä todetut mikrobit olivat CMV ja Pneumocystis carinii, joka aiheutti infektioita keuhkonsiirtopotilailla yllättäen myös estolääkityksen aikana. Bronkoskopiaan liittyi vain harvoin merkittäviä komplikaatioita. Lääkehoitoa vaatineista CMV antigenemioista DNAemia-testi oli positiivinen 93 %:ssa ja mRNAemia-testi 61 %:ssa tapauksista. Antigenemia- ja DNAemia-testien tulokset korreloivat aineistossamme hyvin. Antigenemiatasoja 2, 5 ja 10 pp65-positiivista leukosyyttiä/50 000 leukosyyttiä vastaavat parhaan herkkyyden ja tarkkuuden summan tuottavat DNAemia (herkkyys/tarkkuus)-tasot olivat 400 (75.9 % / 92.7 %), 850 (91.3 % / 91.3 %) ja 1250 (100 % / 91.5 %) kopiota/ml. Näitä antigenemiatasoja vastaavat mRNAemia-testin herkkyydet olivat 25.9 %, 43.5 % ja 56.3 %. Keuhkonsiirtopotilaista 91 %:lla todettiin HHV-6 antigenemia ja 50 %:lla HHV-7 antigenemia. Molemmat virukset aktivoituivat yleensä n. kuukauden kuluessa keuhkonsiirron jälkeen. Yhdellä potilaalla HHV-6 viruksen aktivaatio assosioitui radiologisiin keuhkomuutoksiin ja toisella neurologisiin löydöksiin, mutta muutoin HHV-6 ja HHV-7 antigenemiaan ei voitu liittää selkeitä oireita. Gansikloviiri tai valgansikloviiri estolääkityksen aikana 15 potilaalla (79 %) todettiin HHV-6, seitsemällä (37 %) HHV-7 ja yhdellä (7 %) CMV antigenemia. Tämän tutkimuksen perusteella bronkoskopia on turvallinen ja käyttökelpoinen menetelmä keuhkon- ja sydämensiirtopotilaiden infektioiden diagnostiikassa. Sen sijaan oireettomille keuhkonsiirtopotilaille tehtävien seuranta-bronkoskopioiden hyödyllisyys on kyseenalainen. CMV DNAemia-testi (PCR) vaikuttaa toimivan yhtä hyvin verrattuna CMV antigenemiatestiin, kun hoidon aloittamisen kynnysarvoina on käytetty yli 5 pp65-antigeenipositiiivista leukosyyttiä. Sitä vastoin NASBA-testin matala sensitiivisyys rajoittaa sen käyttöä. HHV-6 ja HHV-7 antigenemia on yleistä keuhkonsiirron jälkeen huolimatta CMV infektioita vastaan suunnatusta estolääkityksestä. Näiden virusten aktivaatioon liittyy kuitenkin harvoin selkeitä oireita tai löydöksiä.
- Published
- 2007
120. Polyarteritis nodosa with abdominal bleeding: imaging with PET/CT and angiography on the same day.
- Author
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Taimen K, Koskivirta I, Pirilä L, Mäkisalo H, Seppänen M, and Allonen T
- Published
- 2024
- Full Text
- View/download PDF
121. Liver trauma in a young woman.
- Author
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Saarinen T and Mäkisalo H
- Subjects
- Animals, Blood Transfusion, Female, Fluid Therapy, Horses, Humans, Resuscitation methods, Young Adult, Accidental Falls, Conservative Treatment, Liver injuries
- Abstract
A young woman fell off a horse, leaving her right flank contused by a hoof. This resulted in a severe liver trauma that seemed to require surgical treatment. After fluid resuscitation and five units of red blood cells the patient's status, however, stabilized upon entering the operating room. The operation was avoided, but intensive care follow-up was continued for six days. The patient made a complete recovery. Conservative treatment of liver trauma is successful in 90% of mild and almost 70% in severe traumas.
- Published
- 2017
122. Post-transplant Merkel Cell Carcinoma.
- Author
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Koljonen V, Sahi H, Böhling T, and Mäkisalo H
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- Carcinoma, Merkel Cell epidemiology, Carcinoma, Merkel Cell therapy, Host-Parasite Interactions, Humans, Polyomavirus immunology, Polyomavirus pathogenicity, Risk Assessment, Risk Factors, Skin Neoplasms epidemiology, Skin Neoplasms therapy, Skin Neoplasms virology, Treatment Outcome, Carcinoma, Merkel Cell immunology, Carcinoma, Merkel Cell virology, Immunocompromised Host, Immunosuppressive Agents adverse effects, Organ Transplantation adverse effects, Skin Neoplasms immunology
- Abstract
Malignant tumours are the foremost complications of immunosuppressive treatment. They are a major challenge for organ transplant recipients and their treating physicians. This paper reviews the aetiology and current treatment of an unusual neuroendocrine skin cancer, Merkel cell carcinoma (MCC), caused by a Merkel cell polyomavirus infection. MCC occurs more frequently than expected in immunosuppressed subjects, especially in organ transplant recipients. The current literature comprises reports of 79 organ transplant recipients with MCC. The risk of MCC in organ transplant recipients is increased up to 66-182-fold compared with the general population. In addition to the increased risk of developing MCC, immunosuppressed individuals have poorer MCC-specific survival. The aim of this review article is to familiarize organ transplant doctors with this unique and clinically challenging skin cancer, and to provide recent data on the diagnosis and current treatment recommendations for an immunosuppressed population.
- Published
- 2016
- Full Text
- View/download PDF
123. [Prophylactic platelet transfusions].
- Author
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Ilmakunnas M, Remes K, Hiippala S, Mäkisalo H, and Åberg F
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- Finland, Hemorrhage etiology, Humans, Platelet Aggregation Inhibitors adverse effects, Thrombocytopenia complications, Thrombocytopenia therapy, Hemorrhage prevention & control, Platelet Transfusion statistics & numerical data, Surgical Procedures, Operative
- Abstract
The consumption of platelet products in Finland is exceptionally high. For the most part, platelets are transfused pre-operatively to thrombocytopenic patients in order to prevent hemorrhage. Most of the minor procedures could, however, be conducted even if the patients'platelet levels would be lower than usual. In cardiac surgery, platelets are used because of the hemorrhagic diathesis associated with platelet inhibitors. Platelet inhibitors will, however, also bind to transfused platelets, whereby instead of prophylactic platelet transfusions it would be more sensible to leave the thorax open and not carry out ineffective platelet transfusions until the effect of the inhibitors has run out. We outline the prophylactic use of platelets based on recent international clinical practice guidelines.
- Published
- 2016
124. What to do when I find a focal lesion in the liver?
- Author
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Mäkisalo H and Lantto E
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- Biopsy, Diagnosis, Differential, Humans, Liver Neoplasms pathology, Magnetic Resonance Imaging, Neoplasm Metastasis, Liver Neoplasms diagnosis
- Abstract
A focal lesion in a healthy liver of a person not having cancer is almost always benign. Diagnosis is often achieved on the basis of anamnesis and imaging findings. A histologic specimen is required in the case of suspected malignant tumor or hepatocellular adenoma. Magnetic resonance imaging is the primary investigation for an unresolved focal lesion of a cancer patient, and the histologic specimen will, when necessary, be taken only after this. Early detection of metastases of colorectal cancer in particular is important, since metastases that have spread to the liver or lungs may be operable. A focal lesion in a cirrhotic liver is either a regenerative nodule or hepatocellular carcinoma.
- Published
- 2016
125. [Dangerous animals].
- Author
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Koljonen V, Söderlund T, Mäkisalo H, and Gissler M
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- Accidents, Traffic, Animals, Finland epidemiology, Hospitalization statistics & numerical data, Humans, Wounds and Injuries epidemiology, Horses, Wounds and Injuries etiology
- Abstract
Contacts between humans and animals inevitably involve encounters possibly resulting in the human being injured. During the period of 2000 to 2014 almost 90 people died in this kind of conflict in Finland. Of these deaths, one third were associated with horses. In addition, over the same period 85 people died in traffic accidents in which an animal was hit by a car. Accidents requiring hospitalization occurred for approx. 8 000 people.
- Published
- 2016
126. [Chronic liver disease and thrombosis risk].
- Author
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Aberg F, Lassila R, Ilmakunnas M, Jokelainen K, Numminen K, and Mäkisalo H
- Subjects
- Algorithms, Blood Coagulation Disorders complications, Blood Coagulation Disorders drug therapy, Chronic Disease, Humans, Prognosis, Risk Factors, Anticoagulants therapeutic use, Liver Cirrhosis complications, Portal Vein, Portasystemic Shunt, Transjugular Intrahepatic, Venous Thrombosis etiology, Venous Thrombosis therapy
- Abstract
The coagulopathy of chronic liver disease involves elevated risks for thrombosis in the portal vein and extra-splanchic sites. Hypercoagulability may moreover accelerate liver fibrosis progression. Cirrhosis-related portal vein thrombosis is associated with decompensation events and inferior prognosis; anticoagulation therapy achieves complete recanalization in -40% of recent thromboses and prevents thrombosis progression in chronic cases. Standard thrombosis prophylaxis seems appropriate for hospitalized cirrhotic patients. This review provides practical guidance to tailoring anticoagulation therapy in cirrhosis according to individual bleeding risk. We also propose an algorithm for using anticoagulation and transjugular intrahepatic portosystemic shunts in the treatment of cirrhotic portal vein thrombosis.
- Published
- 2015
127. [Parenteral nutrition--temporary and permanent treatment].
- Author
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Bäcklund M and Mäkisalo H
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- Aged, Energy Intake, Humans, Nutrition Disorders diet therapy, Parenteral Nutrition methods
- Abstract
Enteral nutrition of an elderly patient having ended up in hospital or intensive care and suffering from malnutrition should be started as soon as it is technically possible. If less than 60% of the estimated energy need is fulfilled during the first week of treatment, parenteral nutrition should also be initiated. Multi-chamber bags are the most effective means to provide energy and nutrients via the central vein. To reduce the risk of liver damage, parenteral nutrition is upon prolongation recommended to be administered periodically. Weight monitoring is important in order to observe the effect of the treatment and the possible accumulation of fluid load.
- Published
- 2014
128. [Cytology is in pivotal role at screening and surveillance of PSC].
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Boyd S, Arola J, Mäkisalo H, and Färkkilä M
- Subjects
- Bile Duct Neoplasms pathology, Bile Duct Neoplasms prevention & control, Bile Ducts, Intrahepatic, Cholangiocarcinoma pathology, Cholangiocarcinoma prevention & control, Cholangiopancreatography, Endoscopic Retrograde, Cholangitis, Sclerosing epidemiology, Cholangitis, Sclerosing pathology, Cholangitis, Sclerosing therapy, Finland epidemiology, Flow Cytometry, Humans, Liver Transplantation, Population Surveillance, Cholangitis, Sclerosing diagnosis, Cytological Techniques methods
- Abstract
Primary sclerosing cholangitis (PSC) is an autoimmune disease leading to biliary strictures and inflammation. The lifetime risk for cholangiocarcinoma (CCA) among PSC patients is 7-13%, and biliary dysplasia is thought to be a precursor lesion for CCA. The diagnosis of PSC is based on endoscopic retrogradic cholangiography (ERC). During ERC brush cytology samples are routinely taken in our unit to detect possible biliary dysplasia. With repeated cytological dysplasia, liver transplantation is considered. Aneuploidy in DNA flow cytometry may support the suspicion of dysplasia. PSC is the most common indication for liver transplantation in Finland, and half of transplantations are prophylactic.
- Published
- 2014
129. [Cutaneous leukocytoclastic vasculitis in a patient with an adenocarcinoma of the colon].
- Author
-
Nikkilä K, Mäkisalo H, and Virolainen S
- Subjects
- Adenocarcinoma drug therapy, Adenocarcinoma surgery, Adrenal Cortex Hormones therapeutic use, Biomarkers, Tumor analysis, Colonic Neoplasms surgery, Contrast Media, Hematuria complications, Humans, Liver Neoplasms secondary, Liver Neoplasms surgery, Neoadjuvant Therapy, Tomography, X-Ray Computed, Vasculitis, Leukocytoclastic, Cutaneous drug therapy, Whole Body Imaging, Adenocarcinoma complications, Colonic Neoplasms complications, Vasculitis, Leukocytoclastic, Cutaneous complications
- Abstract
Association of cutaneous leukocytoclastic vasculitis with colon carcinoma has occasionally been reported. We report a case of acute cutaneous leucocytoclastic vasculitis that developed over two weeks after liver resection due to metastatic rectal adenocarcinoma. The primary tumor had earlier been resected and treated with neoadjuvant chemotherapy. No actual infection was found and the medication was not changed recently except for the prophylaxis cephalosporin for five days at the time of liver resection. The patient received corticosteroid therapy and had remission of vasculitis at one month control but still ongoing haematuria. Eight months after liver resection colonoscopy, contrast enhanced whole-body computed tomography, tumour markers and urine red cell count showed no significant findings.
- Published
- 2013
130. [Fire in the operating room].
- Author
-
Koljonen V and Mäkisalo H
- Subjects
- Gases, Hazardous Substances, Hot Temperature, Humans, Risk Factors, Fires, Operating Rooms
- Abstract
This article reviews the recent literature on operating room fires. Most of the reported cases have occurred from a spark from an ignition source in an oxygen-enriched atmosphere. Fire requires the presence of three components which all are ample in the operating room: heat, flammable materials or flammable gases.
- Published
- 2013
131. [Kidney transplantation from a living donor: criteria for donor and recipient].
- Author
-
Mäkelä S, Honkanen E, Isoniemi H, Jalanko H, Koskinen P, Kyllönen L, Lempinen M, Mäkisalo H, Tertti R, Salmela K, and Saha H
- Subjects
- Brain Death, Cost-Benefit Analysis, Finland, Humans, Kidney Transplantation economics, Prognosis, Quality of Life, Renal Dialysis economics, Tissue and Organ Procurement organization & administration, Waiting Lists, Kidney Transplantation statistics & numerical data, Living Donors
- Abstract
The annual number of kidney transplantations in Finland is 150 to 200. Successful kidney transplantation improves the patient's quality of life and prognosis and is cost-effective as compared with dialytic therapy. Only a few per cent of transplantations are made from a living donor. Waiting times for kidney transplantations have become longer in the last few years. Whereas attempts should be made to better identify potential brain-dead organ donors in order to increase kidney transplantations, transplantations from living donors could also reduce the disproportion between the availability and the need of organs.
- Published
- 2013
132. [Extracorporeal blood purification for poisonings].
- Author
-
Haapio M, Koivusalo A, and Mäkisalo H
- Subjects
- Finland epidemiology, Hemodiafiltration, Humans, Poisoning epidemiology, Hemoperfusion, Poisoning therapy, Renal Dialysis
- Abstract
Most poisonings that have resulted in hospitalization in Finland are alcohol, drug or mixed poisonings of adults. If the quantity of the drug or the poison is high or organ injury is anticipated, the patients may require extracorporeal blood purification in order to eliminate the substance or its metabolic products from the circulation. Hemodialysis or hemodiafiltration are used as the treatment, if the substance having caused the poisoning is water-soluble, binds to proteins only to a small extent, and has a low molecular weight and small distribution of volume. Fat-soluble substances are eliminated by using hemoperfusion, those having bound to proteins by using albumin dialysis.
- Published
- 2012
133. [Liver disease and hemostasis--evaluation of bleeding risk].
- Author
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Aberg F, Lassila R, Koivusalo AM, Numminen K, Nuutinen H, and Mäkisalo H
- Subjects
- Blood Coagulation Tests, Humans, Liver Diseases complications, Risk Assessment, Risk Factors, Hemorrhage diagnosis, Hemorrhage etiology, Hemorrhage prevention & control, Hemostasis, Liver Diseases physiopathology
- Abstract
In severe liver disease, simultaneous abnormalities in procoagulant and anticoagulant pathways seem to maintain the hemostatic balance, provided that the platelet level is sufficient. Common coagulation screening tests such as INR fail to measure the concomitant anticoagulant deficiencies and fibrinolytic abnormalities, and do not predict bleeding in patients with compensated liver disease undergoing invasive procedures. Thus, specific INR cut-off levels and prophylactic use of fresh-frozen plasma are discouraged. Volume expansion, hemodynamic disruption, endothelial dysfunction, and infections increase the bleeding risk. Individualized bleeding risk assessment mandates evaluation of the patient's clinical condition and a comprehensive assessment of the hemostatic system.
- Published
- 2012
134. [Wilson's disease].
- Author
-
Moilanen V and Mäkisalo H
- Subjects
- Copper metabolism, Hepatolenticular Degeneration therapy, Humans, Liver metabolism, Hepatolenticular Degeneration diagnosis
- Abstract
Wilson's disease is a disorder of the liver's copper metabolism. Accumulation of copper causes liver and central nervous system damage. Wilson's disease should always be suspected, when a liver disease is detected in a child or an adolescent. The disease may also manifest itself as severe neurological or neuropsychiatric disorders. The diagnosis is often delayed despite the fact that the accumulation of copper in the body can be shown by various means. Early started medication will stop the accumulation of copper into the body. If the treatment is delayed or ineffective, liver transplantation is required.
- Published
- 2010
135. Best cases from the AFIP: biliary papillomatosis.
- Author
-
Antila KM, Mäkisalo H, Arola J, and Numminen K
- Subjects
- Humans, Male, Middle Aged, Bile Duct Neoplasms diagnostic imaging, Papilloma diagnostic imaging, Tomography, X-Ray Computed methods
- Published
- 2008
- Full Text
- View/download PDF
136. [Not Available].
- Author
-
Mäkisalo H
- Published
- 2006
137. Spontaneous rupture of a hepatic cystadenoma and cystadenocarcinoma: report of two cases.
- Author
-
Lempinen M, Halme L, Numminen K, Arola J, Nordin A, and Mäkisalo H
- Subjects
- Adult, Cystadenocarcinoma surgery, Cystadenoma surgery, Female, Humans, Liver Neoplasms surgery, Middle Aged, Rupture, Spontaneous, Tomography, X-Ray Computed, Cystadenocarcinoma pathology, Cystadenoma pathology, Liver Neoplasms pathology
- Abstract
Hepatobiliary cystadenomas and cystadenocarcinomas are rare tumors. Differentiating between these tumors and benign hepatic cysts may be difficult. Because of their rarity, diagnosis is often delayed and may result in inaccurate treatment, resulting in unnecessary morbidity and mortality. The purpose of this report is to draw attention to these entities and their complications. We report on two cases with spontaneous rupture of hepatobiliary cystadenoma and cystadenocarcinoma cysts, initially treated as simple hepatic cysts by aspiration, or by aspiration combined with sclerotherapy. The spontaneous rupture of the cysts appeared years after the initial treatment of the cysts, leading in one case to a prolonged stay in an intensive care unit. In both cases, a formal liver resection was carried out and microscopic investigations revealed a mucinous cystadenocarcinoma and cystadenoma. In conclusion, although hepatobiliary cystadenomas and cystadenocarcinomas are rare findings, they should not be forgotten in the diagnostic workshop when examining patients with hepatic cysts. If hepatobiliary cystadenomas and cystadenocarcinomas cannot be excluded following radiological imaging, surgery is recommended.
- Published
- 2005
- Full Text
- View/download PDF
138. [Bile duct injuries during laparoscopic surgery--diagnosis and treatment].
- Author
-
Halme L, Nordin A, Tervahartiala P, and Mäkisalo H
- Subjects
- Bile Duct Diseases diagnosis, Female, Finland, Follow-Up Studies, Humans, Intraoperative Complications etiology, Laparoscopy methods, Laparotomy methods, Male, Reoperation, Treatment Outcome, Bile Duct Diseases surgery, Bile Ducts injuries, Intraoperative Complications diagnosis, Intraoperative Complications surgery, Laparoscopy adverse effects
- Published
- 2005
139. Liver transplantation for primary sclerosing cholangitis; predictors and consequences of hepatobiliary malignancy.
- Author
-
Brandsaeter B, Isoniemi H, Broomé U, Olausson M, Bäckman L, Hansen B, Schrumpf E, Oksanen A, Ericzon BG, Höckerstedt K, Mäkisalo H, Kirkegaard P, Friman S, and Bjøro K
- Subjects
- Adult, Carcinoma, Hepatocellular complications, Cholangiocarcinoma complications, Cholangitis, Sclerosing mortality, Colorectal Neoplasms complications, Contraindications, Female, Gallbladder Neoplasms complications, Humans, Male, Middle Aged, Prognosis, Survival Rate, Biliary Tract Neoplasms complications, Cholangitis, Sclerosing complications, Cholangitis, Sclerosing surgery, Liver Neoplasms complications, Liver Transplantation
- Abstract
Background/aims: Hepatobiliary malignancies are frequently seen in primary sclerosing cholangitis (PSC) and they complicate the evaluation of patients and timing of liver transplantation., Methods: Data from all Nordic PSC patients listed for liver transplantation during 1990-2001 were recorded prospectively. Predictors of hepatobiliary malignancy and patient survival rates have been analysed., Results: Hepatobiliary malignancy was found in 52/255 (20%) patients accepted to the waiting list. Recent diagnosis of PSC, no ursodeoxycholic acid (UDCA) treatment, clinical suspicion and previous colorectal-cancer were predictors of malignancy. Among 89 patients with a strong suspicion of malignancy prior to acceptance, 35 (39%) had confirmed malignancy. A clinical suspicion had been raised in 35/52 (67%) patients with malignancy. Malignancy was found in 31/223 patients who received a liver allograft. The 1-, 3- and 5-year patient survival rates following transplantation for patients with PSC and cholangiocarcinoma were 65, 35 and 35%, respectively., Conclusions: Hepatobiliary malignancy is suspected in 1/3 of the PSC patients and found in 1/5. Although cholangiocarcinoma is regarded as a contraindication to liver transplantation (LTX), PSC patients with cholangiocarcinoma had a 35% 5-year survival following transplantation.
- Published
- 2004
- Full Text
- View/download PDF
140. [Care of organ transplant patients in the centralized outpatient care unit].
- Author
-
Mäkisalo H, Kastarinen H, and Saarelma O
- Subjects
- Female, Finland, Graft Rejection prevention & control, Humans, Male, Monitoring, Physiologic methods, Organ Transplantation adverse effects, Quality of Health Care, Ambulatory Care methods, Continuity of Patient Care, Health Services Needs and Demand, Organ Transplantation methods, Patient Care Team organization & administration
- Published
- 2004
141. [Which organs will be transplanted in the future?].
- Author
-
Jalanko H and Mäkisalo H
- Subjects
- Adult, Animals, Child, Child, Preschool, European Union, Female, Finland, Forecasting, Humans, International Cooperation, Male, Policy Making, Swine, Transplantation, Autologous, Transplantation, Homologous, Organ Transplantation standards, Organ Transplantation trends, Tissue and Organ Procurement standards, Tissue and Organ Procurement trends
- Published
- 2004
142. Liver transplantation for primary sclerosing cholangitis in the Nordic countries: outcome after acceptance to the waiting list.
- Author
-
Brandsaeter B, Broomé U, Isoniemi H, Friman S, Hansen B, Schrumpf E, Oksanen A, Ericzon BG, Höckerstedt K, Mäkisalo H, Olsson R, Olausson M, Kirkegaard P, and Bjøro K
- Subjects
- Adolescent, Adult, Aged, Child, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Risk Factors, Scandinavian and Nordic Countries epidemiology, Survival Analysis, Treatment Outcome, Cholangitis, Sclerosing mortality, Cholangitis, Sclerosing surgery, Liver Transplantation mortality, Waiting Lists
- Abstract
Primary sclerosing cholangitis (PSC) is a common indication for liver transplantation, but evaluation of patients and timing of liver transplantation remain as major problems. Data from PSC and control patients listed for liver transplantation from 1990 through 2000 in the Nordic countries were recorded prospectively. Outcomes from the waiting list and after transplantation have been recorded for both groups. For PSC patients, regression analyses have been performed to analyze predictors of outcome. A total of 255 PSC and 610 control patients were accepted on the liver transplantation waiting list from 1990 to 2000. In the PSC group, 223 patients (87%) received a first liver allograft, and 32 patients (13%) died without transplantation. The corresponding figures for the control group were 89% and 10%. For PSC patients, the 5- and 10-year survival from the time of acceptance was 68% and 58%, respectively. A higher Model for End-Stage Liver Disease score and a shorter duration of PSC predicted death on the waiting list for PSC patients. PSC is a frequent indication for liver transplantation. In our material, serum bilirubin or Model for End-Stage Liver Disease score and PSC duration are predictors of outcome including survival of the waiting list.
- Published
- 2003
- Full Text
- View/download PDF
143. [Listening at Tosca on the balcony. The secret of heavenly sound--a randomized, cross-sectional study].
- Author
-
Nieminen O, Mäkisalo H, and Vaara M
- Subjects
- Cross-Sectional Studies, Humans, Equipment and Supplies microbiology, Music, Occupations, Pseudomonas isolation & purification
- Published
- 2003
144. [Radiology in the diagnostics of liver diseases].
- Author
-
Numminen K, Mäkisalo H, and Tervahartiala P
- Subjects
- Clinical Competence, Diagnosis, Differential, Humans, Interdisciplinary Communication, Liver Diseases diagnostic imaging, Magnetic Resonance Imaging methods, Sensitivity and Specificity, Tomography, X-Ray Computed methods, Ultrasonography, Liver Diseases diagnosis
- Published
- 2003
145. [Treatment of short bowel patients has to be centralized].
- Author
-
Pakarinen M, Rintala R, and Mäkisalo H
- Subjects
- Clinical Competence, Delivery of Health Care standards, Humans, Patient Care Team, Treatment Outcome, Centralized Hospital Services, Delivery of Health Care organization & administration, Short Bowel Syndrome therapy
- Published
- 2003
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