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Articles by P Puolakkainen
Total Records ( 2 ) for P Puolakkainen
  P Mentula , P Hienonen , E Kemppainen , P Puolakkainen and A. Leppaniemi

Hypothesis  In patients with severe acute pancreatitis and abdominal compartment syndrome, establishment of the indications and optimal time for surgical decompression may avoid exacerbation of multiple-organ dysfunction syndrome.

Design  Retrospective study.

Setting  Tertiary care university teaching hospital.

Patients  Twenty-six consecutive patients with severe acute pancreatitis and abdominal compartment syndrome treated by surgical decompression between January 1, 2002, and December 31, 2007.

Intervention  Surgical decompression of the abdomen.

Main Outcome Measures  Morbidity, mortality, and organ dysfunction before and after surgical decompression.

Results  At the time of surgical decompression, the median sequential organ failure assessment score among patients was 12 (interquartile range, 10-15), and the median intra-abdominal pressure was 31.5 (interquartile range, 27-35) mm Hg. After surgical decompression, renal or respiratory function was improved in 14 patients (54%). The overall hospital mortality was 46%, but mortality was 18% among 17 patients in whom surgical decompression was performed within the first 4 days after disease onset.

Conclusions  Patients with severe acute pancreatitis and abdominal compartment syndrome managed by surgical decompression had severe multiple-organ dysfunction syndrome and high mortality. Surgical decompression may improve renal or respiratory function. Early surgical decompression is associated with reduced mortality in patients with severe acute pancreatitis, early multiple-organ dysfunction syndrome, and abdominal compartment syndrome.

  S. A Arnold , L. B Rivera , A. F Miller , J. G Carbon , S. P Dineen , Y Xie , D. H Castrillon , E. H Sage , P Puolakkainen , A. D Bradshaw and R. A. Brekken
  Shanna A. Arnold, Lee B. Rivera, Andrew F. Miller, Juliet G. Carbon, Sean P. Dineen, Yang Xie, Diego H. Castrillon, E. Helene Sage, Pauli Puolakkainen, Amy D. Bradshaw, and Rolf A. Brekken

Utilizing subcutaneous tumor models, we previously validated SPARC (secreted protein acidic and rich in cysteine) as a key component of the stromal response, where it regulated tumor size, angiogenesis and extracellular matrix deposition. In the present study, we demonstrate that pancreatic tumors grown orthotopically in Sparc-null (Sparc–/–) mice are more metastatic than tumors grown in wild-type (Sparc+/+) littermates. Tumors grown in Sparc–/– mice display reduced deposition of fibrillar collagens I and III, basement membrane collagen IV and the collagen-associated proteoglycan decorin. In addition, microvessel density and pericyte recruitment are reduced in tumors grown in the absence of host SPARC. However, tumors from Sparc–/– mice display increased permeability and perfusion, and a subsequent decrease in hypoxia. Finally, we found that tumors grown in the absence of host SPARC exhibit an increase in alternatively activated macrophages. These results suggest that increased tumor burden in the absence of host SPARC is a consequence of reduced collagen deposition, a disrupted vascular basement membrane, enhanced vascular function and an immune-tolerant, pro-metastatic microenvironment.

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