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Background and purpose — The use of trabecular metal cups in primary total hip arthroplasty (THA) is increasing, despite the survival of Continuum cups being slightly inferior compared with other uncemented cups in registries. This difference is mainly explained by a higher rate of dislocation revisions. Cup malpositioning is a risk factor for dislocation and, being made of a highly porous material, Continuum cups might be more difficult to position. We evaluated whether Continuum cups had worse cup positioning compared with other uncemented cups. Patients and methods — Based on power calculation, 150 Continuum cups from 1 center were propensity score matched with 150 other uncemented cups from 4 centers. All patients had an uncemented stem, femoral head size of 32 mm or 36 mm, and BMI between 19 and 35. All operations were done for primary osteoarthrosis through a posterior approach. Patients were matched using age, sex, and BMI. Cup positioning was measured from anteroposterior pelvic radiograph using the Martell Hip Analysis Suite software. Results — There was no clinically relevant difference in mean inclination angle between the study group and the control group (43° [95% CI 41–44] and 43° [CI 42–45], respectively). The study group had a larger mean anteversion angle compared with the control group, 19° (CI 18–20) and 17° (CI 15–18) respectively. Interpretation — Continuum cups had a greater anteversion compared with the other uncemented cups. However, the median anteversion was acceptable in both groups and this difference does not explain the larger dislocation rate in the Continuum cups observed in earlier studies.

Background and Aims: Reduction mammoplasty alleviates macromastia symptoms and improves quality of life. We investigated a large series of consecutive reduction mammoplasties to assess various risk factors for both minor and major complications after the procedure., Materials and Methods: A retrospective analysis of 453 consecutive reduction mammoplasties was performed between 2007 and 2010 at an academic tertiary referral center to evaluate risk factors and complications., Results: The incidence of minor and major complications was 40.5% and 8.8%, respectively. Patients with minor complications had both a significantly higher mean body mass index (30.2 vs 28.0) and sternal notch to nipple distance (33.9 vs 32.4 cm) than patients who recovered without complications (p < 0.001 for both comparisons), as well as more visits to the outpatient clinic (p < 0.001). In the multivariate analysis, body mass index was found to be the only significant risk factor for minor complications (p < 0.001). Furthermore, patients with body mass index higher than 27 had a 2.6-fold greater risk of minor complications (p < 0.001). An increase of one unit in body mass index increased the probability of minor complications by 14.1% (p < 0.001). 22 (4.9%) patients developed a hematoma requiring evacuation in the operating room. The mean body mass index of patients who developed a hematoma was 26.4, a value lower than that of patients without this complication (mean 29.0; p = 0.003). This finding was significant also in the multivariate analysis (p = 0.002)., Conclusion: A higher body mass index was strongly associated with an increased risk of minor complications after reduction mammoplasty. It is important to inform obese patients about the increased risk of complications and to encourage them to lose weight before surgery.

Background: Endovenous ablation techniques and ultrasound-guided foam sclerotherapy (UGFS) have largely replaced open surgery for treatment of great saphenous varicose veins. This was a randomized trial to compare the effect of surgery, endovenous laser ablation (EVLA) (with phlebectomies) and UGFS on quality of life and the occlusion rate of the great saphenous vein (GSV) 12 months after surgery., Methods: Patients with symptomatic, uncomplicated varicose veins (CEAP class C2-C4) were examined at baseline, 1 month and 1 year. Before discharge and at 1 week, patients reported a pain score on a visual analogue scale. Preoperative and 1-year assessments included duplex ultrasound imaging and the Aberdeen Varicose Vein Severity Score (AVVSS)., Results: The study included 214 patients: 65 had surgery, 73 had EVLA and 76 had UGFS. At 1 year, the GSV was occluded or absent in 59 (97 per cent) of 61 patients after surgery, 71 (97 per cent) of 73 after EVLA and 37 (51 per cent) of 72 after UGFS (P < 0·001). The AVVSS improved significantly in comparison with preoperative values in all groups, with no significant differences between them. Perioperative pain was significantly reduced and sick leave shorter after UGFS (mean 1 day) than after EVLA (8 days) and surgery (12 days)., Conclusion: In comparison with open surgery and EVLA, UGFS resulted in equivalent improvement in quality of life but significantly higher residual GSV reflux at 12-month follow-up., (© 2016 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.)

Background and Aims: Complex nontraumatic foot lesions often lead to major lower-limb amputation in diabetic patients. We aimed to evaluate outcome of free flap transfer in such cases., Materials and Methods: A total of 11 consecutive diabetic patients, hospitalized between 2007 and 2012 at a university central hospital for a free flap transfer, were followed until September 2013. Amputation-free survival, patient survival, and complete wound healing were defined as primary endpoints. Healing time of tissue lesions was analyzed. All pre- and postoperative data were retrospectively collected from hospital charts., Results: Complete tissue healing at 6 and 12 months after free flap transfer were 55% (6/11) and 82% (9/11), respectively. The median time to complete tissue healing was 123 days (range, 45-207 days). Overall limb salvage, survival, and amputation-free survival rates at 12 months were 90%, 91%, and 82%, respectively. The clinically important endpoint, namely, amputation-free survival with completely healed wounds, was attained in 9 of 11 patients at 1 year., Conclusion: Free tissue transfer enables successful wound healing and limb salvage rather than amputation in selected diabetic patients with difficult-to-heal wounds. Complete healing of tissue lesions is slow even after successful surgery. Preoperative assessment of the condition of patients is the key to success., (© The Finnish Surgical Society 2014.)

Aims: To assess the impact of superficial venous surgery (SVS) on health-related quality of life (HRQoL) and to explore the cost-utility of venous surgery., Material and Methods: 143 patients (110 female and 33 male) enrolled for SVS between 2003 and 2005 in Helsinki University Central Hospital filled in the 15D survey before and six months after operation. Direct hospital costs were obtained from a patient administration database and were examined from the perspective of secondary care provider., Results: After SVS, the HRQoL score improved in 71% of the patients, and the mean score increased from 0.919 (on a 0-1 scale) preoperatively to 0.933 postoperatively at 6 months (p < 0.001). Patients with a clinically important result from SVS (> or = 0.03 increase in the HRQoL score) had significantly worse HRQoL at baseline. At 6 months postoperatively, the mean (SD) hospital costs were 1637 euros (693) and the mean quality-adjusted life year (QALY) gain 0.504 (1.674), respectively. Thus, the mean cost per QALY gained during a 6-month period was 3248 euros for SVS., Conclusions: Superficial venous surgery improves HRQoL, and is a cost-effective treatment of symptomatic superficial venous insufficiency.

Objective: To review the published papers reporting on the use of infrainguinal angioplasty in the treatment of critical limb ischaemia (CLI)., Methods: A MEDLINE (1966-2005) and Cochrane library search for articles relating to the use of infrainguinal angioplasty in the treatment of CLI., Results: Recent papers reporting on the results of infrainguinal angioplasty as treatment for CLI patients show excellent limb salvage rates regardless of the patency rates. The Cochrane Database of systematic reviews has accepted two prospective randomised trials comparing bypass operations and angioplasty among CLI patients. Pooling both trials showed no overall significant difference in amputation rates between the surgery and PTA groups. A multicentre, randomised controlled trial, the BASIL (Bypass versus Angioplasty in Severe Ischaemia of the Leg) trial showed that in the medium term (after six months), the outcomes after angioplasty or surgery among CLI patients did not differ significantly with respect to amputation-free survival, all-cause mortality and quality of life., Conclusions: Infrainguinal PTA is feasible in CLI patients. Data from the BASIL trial show the similar ability of bypass surgery and balloon angioplasty in preserving both life and limb in short term. These results are, however, not applicable for the majority of CLI patients as only 15% (70/456) of the patients with severe limb ischaemia were considered candidates for the trial.

Objective: To review the published papers reporting on the use of infrapopliteal bypass in elderly patients (aged 70 years or more) in the treatment of critical limb ischaemia., Methods: A MEDLINE (1966-2006) search for articles relating to the topic. Eight single centre studies were identified and in addition one population based study from Finland., Results: Perioperative mortality rate after infrapopliteal bypass surgery among elderly patients ranged from 2% to 12%. Patency and limb salvage rates were comparable to those reported in literature for younger patients. Data on survival rates were inconsistent. Several authors propose an active reconstruction policy in the elderly provided that a successful bypass procedure is likely to save the leg and improve the quality of life of these patients by maintaining ambulatory function and independent living at least for a year., Conclusions: Despite a relatively short life expectancy, after successful revascularisation, the majority of elderly patients can be expected to spend their remaining years ambulatory and at home. The decision whether to reconstruct or amputate is always patient bound, taking into consideration different risk factors. Age alone should, however, seldom be a reason to decline infrapopliteal bypass.

Background and Aims: The aim of the study was to assess the changes in diabetes-related lower extremity amputations and to compare it with the development of amputations for critical leg ischaemia in patients without diabetes., Material and Methods: Clinical records of 1094 patients undergoing major lower limb amputations for vascular disease in the town of Helsinki during 13 years from 1990 to 2002 were analyzed retrospectively. Data concerning patient factors, diagnosis, existence of diabetes and amputation level were recorded. The study period was divided into three parts (1990-1994, 1995-1998 and 1999-2002) and results were compared between diabetic and nondiabetic vascular amputees during these time periods., Results: From 1990 through 2002, 561 of patients undergoing major lower limb amputation had diabetes mellitus. The overall incidence of major amputations of diabetics reduced from the first time period to the last period by 23%. At the same time, the incidence of amputations in non-diabetic patient group decreased 40%. If the incidence rate for amputations is expressed per million individuals with diabetes, 33% decrease was observed during the study period., Conclusions: The decrease in major amputation rates among diabetic as well as non-diabetic patients can be attributed to the increased interest in amputation prevention, with a contribution by vascular surgeons being made in both groups.

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.

Objectives: To assess the current incidence of major lower limb amputations in Southern Finland and epidemiological trends during the last 17 years., Materials and Methods: In a retrospective survey for the year 2000 patient data was gathered from hospital records in the eight surgical hospitals in the area studied. Follow-up was 1 year. Amputation data for years 1984-1995 was gathered from reports done before at the same area and amputation figures for years 1990-2001 also from the National Research and Development Centre for Welfare and Health., Results: In year 2000, the incidence of major amputations was 154/million inhabitants. The reason for major amputation was chronic critical lower limb ischaemia in 71.8% and acute ischaemia in 16.5% of the cases. The below-knee (BK)/above-knee (AK) ratio was 0.76. After 1 year only 48% of the patients were alive. From 1984 to 2000 amputation incidence showed a decrease of 41%. The decline in age-adjusted amputation incidence from 1990 to 2000 was 30% and by 2001 as much as 40%. There was a significant inverse correlation both between incidence of infrainguinal bypass and amputation (r=-0.682, p=0.021) and between infrapopliteal bypass and amputation (r=-0.682, p=0.021)., Conclusions: There was a reduction in the number of amputations in Southern Finland during the past 17 years. This occurred synchronously with the increase in vascular reconstructions. Our data suggests that vascular surgery saves patients from BK-amputations and therefore relative amount of AK-amputations inevitably rises.

Objective: To examine the association between the incidences of infrapopliteal bypass for critical limb ischaemia (CLI) and major amputation in Finns aged >or=70 years., Methods: Patients undergoing infrapopliteal bypass or major amputation for CLI during 1997 were retrospectively analysed. The incidence of major amputation in a group of hospitals performing infrapopliteal bypass "actively" was compared to that in a group performing such surgery "passively"., Results: The incidence of major amputations in the active (978 bypasses per million inhabitants) and passive (57 per million) groups was 1976 and 3177 per million, respectively (p = 0.016). There was a significant (p = 0.012) inverse relationship between the incidence of the two procedures in patients aged >or=80, but not <80 years., Conclusions: These results suggest that infrapopliteal bypass is effective in reducing the requirement for major amputation in patients aged >or=80 years.

Background and Aims: There is rather limited recent information on major amputations in Finland. Our objective was to describe the incidence of major lower limb amputations in a defined central hospital, the demographic characteristics of the amputees, diagnosis and situations leading to amputation, level of amputations and survival of the amputees after one year., Material and Methods: A retrospective study was undertaken on 156 patients with 169 lower limb major amputations from 1997 to 2000 at the Seinäjoki Central Hospital and Ahtäri District Hospital., Results: The annual incidence of major amputations reduced from 29.5 to 15.2/100000 inhabitants. The mean age of the patients was 78.5 years but highest 80.1 in the year 2000. The reason for major amputation was chronic critical leg ischaemia with or without diabetes mellitus in 79.1% and acute ischaemia in 13.9%. The average below-knee (BK)/above-knee (AK) amputation ratio was 0.80 during the years 1997-1999 and the ratio was lowest 0.67 in year 2000. At the same year 2000 the amount of patients, whose condition was too poor for reconstructive surgery, was significantly higher than in 1997-1999., Conclusions: We suggest that BK/AK amputation ratio is decreasing in the future as the amputees tend more often to be institutionalized and immobile, and reconstruction is not an alternative and BK amputation is impossible or useless.

Amphoterin, a major form of HMG (high mobility group) 1 proteins, is highly expressed in immature and malignant cells. A role in cell motility is suggested by the ability of amphoterin to promote neurite extension through RAGE (receptor of advanced glycation end products), an immunoglobulin superfamily member that communicates with the GTPases Cdc42 and Rac. We show here that cell contact with the laminin matrix induces accumulation of both amphoterin mRNA and protein close to the plasma membrane, which is accompanied by extracellular export of amphoterin. A role for amphoterin in extracellular matrix-dependent cell regulation is further suggested by the finding that specific decrease of amphoterin mRNA and protein, using antisense oligonucleotides transfected into cells, inhibits cell migration to laminin in a transfilter assay whereas the oligonucleotides in the culture medium have no effect. Moreover, affinity-purified anti-amphoterin antibodies inhibit cell migration to laminin, supporting an extracellular role for the endogenous amphoterin in cell motility. The finding that amphoterin expression is more pronounced in cells with a motile phenotype as compared to cells of dense cultures, is consistent with the results of the cell migration assays. Our results strongly suggest that amphoterin is a key player in the migration of immature and transformed cells.

A controlled, randomized, double-blind, parallel-group study compared the effects of ViviScal (a new food supplement incorporating special marine extracts and a silica compound) with those of a fish extract in the treatment of young males with hereditary androgenic alopecia. The pretreatment histological diagnosis was alopecia with a mild to moderate perifollicular inflammation zone. The study consisted of 20 subjects who received two tablets of ViviScal once daily and 20 who received two tablets of fish extract once daily for 6 months. The mean patient age and mean duration and severity of baldness compared well between the two groups. Most patients had been treated with long-term topical 2% minoxidil for 1 year or more prior to the study. At baseline and after 6 months' treatment, a biopsy was taken for histological examination. A non-vellus hair count was performed at baseline and after 2, 4 and 6 months. In the fish extract treatment group three patients withdrew from the study before the fourth month due to lack of therapeutic effect. After 6 months' treatment, patients receiving ViviScal showed a mean increase in non-vellus hair of 38% compared with a 2% increase in the fish extract treatment group (P < 0.0001). In the ViviScal group, 19 (95%) subjects showed both clinical and histological cure, whereas none treated with fish extract showed any clinical or histological difference after 6 months' treatment (P < 0.0001). In both groups, a minimal decrease in the erythemal index was observed. In conclusion, ViviScal appears to be the first highly active treatment for androgenic alopecia in young males.

The effects of a 12-week oral treatment with tiapamil (200 mg t.i.d.) were compared to those of placebo treatment in a group of 20 men with coronary heart disease. There was a slight reduction of anginal symptoms (p less than 0.05) and a tendency to less nitroglycerin consumption (p less than 0.07). There were no statistically significant differences between the treatments in blood pressure, exercise tolerance during repeated exercise tests, ECG conduction intervals, or routine laboratory tests. No adverse side-effects were encountered. It seems that tiapamil may be beneficial in preventing angina pectoris, but a higher oral dose must be used.