Surgical treatment of hamstring injuries and disorders – the clinical spectrum from chronic tendinopathy to complete rupture

Hamstring muscle injuries and tendon disorders are common, especially in sports. They can be severe and difficult to treat, often resulting in impaired athletic performance and long rehabilitation times. Previous studies considering treatment of these problems are scarce. The current study was designed to investigate the effect of surgery on different types of hamstring muscle injuries and on proximal hamstring tendinopathy. In addition, we wanted to study the typical histopathological findings relating to proximal hamstring tendinopathy. In the study of complete (all three muscles torn) proximal hamstring avulsions (41 patients), our results showed that early operative treatment gives significantly better results than late surgery, and is therefore recommended. Despite this, considerable improvement of symptoms could also be achieved in chronic cases. In the study of partial (one or two muscles torn) proximal hamstring tears (47 patients), we observed that these injuries can cause significant functional deficit and impaired performance in athletes. The main finding was that after surgical repair most of the patients were able to return to their pre-injury level of sports. In the study of distal hamstring tears (18 patients), the results showed that surgical treatment had a good effect in the majority of these cases. In proximal hamstring tendinopathy, the main problem is pain which limits sports. In this study (90 patients), we found that after unsuccessful conservative treatment, surgery was a good treatment option resulting in full return to sports in most cases. In tendinopathic hamstring tendons, the morphological changes of tendinosis were largely identical to those previously described in other common (e.g. Achilles and patellar) tendinopathies. In chronic proximal hamstring avulsions, and also in reoperations, a large defect between distally retracted tendons and the ischial tuberosity may occasionally prevent anatomic reinsertion. We have described a reconstruction method using fascia lata autograft augmentation to be used in these most challenging repairs. This technique was utilized in the treatment of five patients, with encouraging results.

It all comes back to you

Soitinnus: big band.

Recovery of carboxylic acids from aqueous streams by extraction and back extraction

Separation of carboxylic acids from aqueous streams is an important part of their manufacturing process. The aqueous solutions are usually dilute containing less than 10 % acids. Separation by distillation is difficult as the boiling points of acids are only marginally higher than that of water. Because of this distillation is not only difficult but also expensive due to the evaporation of large amounts of water. Carboxylic acids have traditionally been precipitated as calcium salts. The yields of these processes are usually relatively low and the chemical costs high. Especially the decomposition of calcium salts with sulfuric acid produces large amounts of calcium sulfate sludge. Solvent extraction has been studied as an alternative method for recovery of carboxylic acids. Solvent extraction is based on mixing of two immiscible liquids and the transfer of the wanted components form one liquid to another due to equilibrium difference. In the case of carboxylic acids, the acids are transferred from aqueous phase to organic solvent due to physical and chemical interactions. The acids and the extractant form complexes which are soluble in the organic phase. The extraction efficiency is affected by many factors, for instance initial acid concentration, type and concentration of the extractant, pH, temperature and extraction time. In this paper, the effects of initial acid concentration, type of extractant and temperature on extraction efficiency were studied. As carboxylic acids are usually the products of the processes, they are wanted to be recovered. Hence the acids have to be removed from the organic phase after the extraction. The removal of acids from the organic phase also regenerates the extractant which can be then recycled in the process. The regeneration of the extractant was studied by back-extracting i.e. stripping the acids form the organic solution into diluent sodium hydroxide solution. In the solvent regeneration, the regenerability of different extractants and the effect of initial acid concentration and temperature were studied.

Epidemiology, management and outcome of facial injuries

Dental injuries are common and the incidence of maxillofacial injuries has increased over the recent decades in Finland. Accidental injuries are the global leading cause of death among children over the age of one year and among adults under the age of 40 globally. Significant resources and costs are needed for the treatment of these patients. The prevention is the most economical way to reduce trauma rates and costs. For the prevention it is crucial to know the prevalences, incidences and risk factors related to injuries. To improve the quality of treatment, it is essential to explore the causes, trauma mechanisms and management of trauma. The above mentioned was the aim of this thesis. With a large epidemiological cohort study (5737 participants) it was possible to estimate lifetime prevalence of and risk factors for dental trauma in general population (Study I). The prevalence of dental fractures was 43% and the prevalence of dental luxations and avulsions was 14%. Male gender, a history of previous non-dental injuries, mental distress, overweight and high alcohol consumption were positively associated with the occurrence of dental injuries Study II was conducted to explore the differences in type and multiplicity of mandibular fractures in three different countries (Canada, Finland and Kuwait). This retrospective study showed that the differences in mandibular fracture multiplicity and location are based on different etiologies and demographic patterns. This data can be exploited for planning of measures to prevent traumatic facial fractures. The etiology, management and outcome of 63 pediatric skull base fracture (Study III) and 20 pediatric frontobasal fracture patients (Study IV) were explored. These retrospective studies showed that, both skull base fracture and frontobasa fracture are rare injuries in childhood and although intracranial injuries and morbidity are frequent, permanent neurological or neuropsychological deficits are infrequent. A systematic algorithm (Study V) for computer tomography (CT) image review was aimed at clinicians and radiologists to improve the assessment of patients with complex upper midface and cranial base trauma. The cohort study was cross sectional and data was collected in the Turku and Oulu University Hospitals. A novel image-reviewing algorithm was created to enhance the specificity of CT for the diagnosis of frontobasal fractures. The study showed that an image-viewing algorithm standardizes the frontobasal trauma detection procedure and leads to better control and assessment. The purpose of the retrospective subcranial craniotomy study (VI) was to review the types of frontobasal fractures and their management, complications and outcome when the fracture is approached subcranially. The subcranial approach appears to be successful and have a reasonably low complication rate. It may be recommended as the technique of choice in multiple and the most complicated frontal base fractures where the endoscopic endonasal approach is not feasible.

Tavanomaisen irtaimen esineen sale and lease back -järjestely. Tarkastelussa erityisesti vuokralleottajan sivullissuoja.

Tutkielman aiheena on tavanomaisen irtaimen esineen sale and lease back -järjestely. Järjestelyyn kuuluu nimensä mukaisesti luovutus ja takaisinvuokraus. Kokonaisjärjestelyn avulla rahoittaja ja luotonsaaja pyrkivät luomaan luotonmaksun vakuudeksi omistusoikeuteen perustuvan esinevakuuden. Järjestelyn tavoitteena on, että luotonsaajan asemassa oleva myyjä pystyisi käyttämään samaa esinettä samanaikaisesti sekä va-kuusobjektina että elinkeinotoimintansa tuotantovälineenä. Juuri siitä syystä, että luo-tonsaaja tarvitsee esinettä koko ajan elinkeinotoiminnassaan, ei panttausta voida käyttää. Tutkielma on oikeusdogmaattinen ja sen pyrkimyksenä on antaa selkeä kokonaiskäsitys irtaimen esineen sale and lease back -järjestelystä ja sen käytettävyydestä vakuusjärjestelynä. Oikeusdogmaattiselle tutkimukselle tyypillisesti tutkielmassa tarkastellaan olemassa olevaa tietomateriaalia. Keskeisimmät tutkielmassa käytetyt kirjallisuuslähteet ovat Jarno Teporan useat sale and lease back -järjestelyyn keskittyvät artikkelit, Jarmo Tuomiston omistusvakuuksia koskeva kirjallisuus sekä Erkki Havansin esineoikeudellinen perusteos Esinevakuudet. Virallislähteistä selvästi merkittävimmät ovat vuonna 1997 voimaantullut maakaari ja sen esityöt. Tutkimuksessa keskitytään erityisesti vuokralleottajan sivullissuojaan. Näin ollen tärkeimmäksi tutkimuskysymykseksi jäsentyy se, voiko sale and lease back -järjestelyssä ostajan roolissa oleva sijoittaja tai rahoittaja saavuttaa järjestelyn avulla kollisiotilanteiden varalta turvaavan vakuusaseman. Tutkimuksen kannalta keskeinen omistusvakuus-järjestely on vakuusluovutus, jollaiseksi vakuustarkoituksessa tehty sale and lease back -järjestely melko vakiintuneesti tulkitaan. Tutkimuksessa tarkastellaan mahdollisuutta hyväksyä sale and lease back -järjestely rahoittajalle dynaamista kollisiosuojaa tarjoavaksi vakuusjärjestelyksi ilman julkivarmistusta. Toisaalta selvitetään julkivarmistuksen toteuttamisen mahdollisuutta ilman hallinnansiirtoa muun muassa maakaaren 14:4.1:n 1 kohdan mukaisen kirjaamisen avulla. Nykylainsäädännön puitteissa järjestelyn hyväksyminen itsenäiseksi omistusvakuudeksi näyttää olevan epätodennäköistä ja ilman julkivarmistusta dynaaminen sivullissuoja jää saavuttamatta, vaikka järjestely on sitova inter partes. Tutkimuksen loppupäätelmissä pohditaan, voisiko sale and lease back -järjestelyyn liittyviä ongelmia ratkaista muuttamalla voimassa olevaa lainsäädäntöä tai antamalla täysin uutta lainsäädäntöä. Asiaa pohditaan myös oikeusvertailun keinoin selvittäen muiden Pohjoismaiden sekä Saksan oikeusjärjestelmien kantaa järjestelyyn.