OBJECTIVE To analyze renal glomerular and tubular function and their association in patients oper... more OBJECTIVE To analyze renal glomerular and tubular function and their association in patients operated for posterior urethral valves (PUV) and to prognosticate the risk for end-stage kidney disease (ESKD) METHODS: Sixty-three previously treated patients were evaluated for renal function during 1987-1991. The patients' age at evaluation was 11 years (range 2-24). Glomerular function was assessed by measuring glomerular filtration rate (GFR) and urine albumin excretion. Tubular function was determined by measuring urine concentration capacity and excretion of electrolytes (Na, K, Cl, Ca, P, Mg) and β-2-microglobulin. Additionally, the prevalence of hypertension and serum parathyroid hormone (PTH) and aldosterone values were registered. Tubular function was compared with GFR and the risk of developing ESKD before November 2018. RESULTS Twenty of the study patients (32%) had decreased GFR. In addition, 19% had proteinuria and 56% were hypertensive. Those without proteinuria or hypertension had better GFR values (p<0.01 for both). There was a significant correlation between GFR and all the tubular function (p<0.05) variables (except excretion of chloride) measured. Compared to the patients with favorable renal outcome, the patients (n=10) who later developed ESKD had significantly (p<0.01) lower GFR and reduced urinary excretion of all measured electrolytes except calcium. Consistently, urine β-2 microglobulin and serum PTH and aldosterone values were significantly higher in the patients who developed ESKD (p≤0.01). CONCLUSION Both glomerular and tubular function decline was common and several parameters were likely to predict ESKD in PUV patients.
We evaluated the incidence and clinical implications of urinomas in boys with posterior urethral ... more We evaluated the incidence and clinical implications of urinomas in boys with posterior urethral valves. Our secondary aim was to evaluate the treatment modalities of urinomas. We retrospectively reviewed the hospital data of 200 patients with posterior urethral valves treated between 1953 and 2003. Documentation was sufficient in 196 cases to evaluate the presence of urinomas. A group of 69 patients with posterior urethral valves without urinoma served as controls. Of 196 patients 17 (9%) had urinoma. However, the incidence of urinoma increased to 15% after ultrasonography came into standard clinical use. Nine patients had perirenal urine collection, 6 had urinary ascites and 2 had urinothorax. At presentation median serum creatinine values were similar in patients with urinoma (145 mumol/l, range 54 to 431) and controls (126 mumol/l, 19 to 593, p = 0.547). Creatinine decreased similarly in patients with and without urinoma after the obstruction was relieved. Vesicoureteral reflux was detected in 69% of the patients with urinoma and in 76% of the controls. Median split function on the side of the urinoma was 51% (range 38% to 70%) on (99m)technetium diethylenetetramine pentaacetic acid scintigraphy. During childhood end-stage renal failure developed in 4 of the 16 patients (25%) with urinoma and in 16 of the 69 controls (23%). The true incidence of urinomas is probably close to 15% in patients with posterior urethral valves. Renal function is similar in patients with posterior urethral valves with and without urinoma. In asymptomatic cases urinomas apparently do not require any specific treatment.
To evaluate sexual function and fertility in adult patients treated for posterior urethral valves... more To evaluate sexual function and fertility in adult patients treated for posterior urethral valves (PUV) in childhood and to compare these patients with the normal population. To examine if patient characteristics such as chronic renal failure (CRF), history of cryptorchidism and bladder neck incision in childhood have an impact on sexual function. Information on sexual function was assessed using questions from the International Index of Erectile Function (IIEF). In addition, the patients were asked if they had had children or been treated for CRF. Out of 108 adult patients with PUV, 67 (62%) returned the questionnaires. Sexual function in these patients was compared with 201 controls and paternity rates were compared with a national database. The mean (sd) age of the patients and controls was 38 (9) and 38 (7) years, respectively. Six percent of the patients and 9% of the controls reported problems in achieving erection during sexual stimulation and 9% of the patients and 10% of the controls reported problems with the hardness of erection (P = nonsignificant). Ejaculation was absent in 1/61 sexually active patients (2%). The only significant risk factor in patients for erectile dysfunction (ED) was increasing age. Thirty-three (49%) of all 67 patients and four (57%) of the seven patients with kidney transplantation had had children. The paternity rates were similar to those in corresponding age groups of the general Finnish population. Eight patients (12%) had attempted to have children without success. Men treated for PUV have a similar prevalence of ED and similar paternity rates to men without PUV. Erectile function and paternity rates can be satisfactory in spite of CRF.
Journal of Small Business and Enterprise Development, 2018
Purpose The purpose of this paper is to analyse how different strategic goals of (micro-, small- ... more Purpose The purpose of this paper is to analyse how different strategic goals of (micro-, small- and medium-sized firms=SMEs) relate to the business model innovation (BMI) paths that SMEs take when improving their business. Design/methodology/approach The authors conducted 11 in-depth case studies involving SMEs innovating their business models (BMs). Findings The authors found evidence that strategic goals of SMEs (start new business, growth and profitability) lead them to alternative innovation path in terms of BM components affected. Growth seekers start from the right-hand side of a BM Canvas, while profitability seekers start from the back end, the left side of a Canvas; and new businesses adopt a cyclical approach considering BM components in turn, while at the same time redesigning and testing the BM. The findings of this study also indicate that all three paths gradually lead to improvement in several BM components. Research limitations/implications Findings indicate that a ...
In this paper we discuss productivity paradox and the origin of business value of ICT investments... more In this paper we discuss productivity paradox and the origin of business value of ICT investments, especially as we see that the present approaches in building ICT-based value networks of companies raises new productivity problems. The findings indicate that the organizations can reap the benefits of ICT-investments in terms of productivity only by managing the long term process change both at operational and management levels to match the organizational capacity and competitive position. This is achieved not by building information systems only, but by balancing automational, informational and transformational effects in the business context. We analyze three alternative approaches for information systems development against this backdrop: software engineering, business process redesign and reversed quality life cycle (RQLC by Nurminen & Forsman, 1994). There is growing evidence in favor of RQLC in designing and implementing intraorganizational systems, so we apply its ideas in the...
OBJECTIVE To analyze renal glomerular and tubular function and their association in patients oper... more OBJECTIVE To analyze renal glomerular and tubular function and their association in patients operated for posterior urethral valves (PUV) and to prognosticate the risk for end-stage kidney disease (ESKD) METHODS: Sixty-three previously treated patients were evaluated for renal function during 1987-1991. The patients' age at evaluation was 11 years (range 2-24). Glomerular function was assessed by measuring glomerular filtration rate (GFR) and urine albumin excretion. Tubular function was determined by measuring urine concentration capacity and excretion of electrolytes (Na, K, Cl, Ca, P, Mg) and β-2-microglobulin. Additionally, the prevalence of hypertension and serum parathyroid hormone (PTH) and aldosterone values were registered. Tubular function was compared with GFR and the risk of developing ESKD before November 2018. RESULTS Twenty of the study patients (32%) had decreased GFR. In addition, 19% had proteinuria and 56% were hypertensive. Those without proteinuria or hypertension had better GFR values (p<0.01 for both). There was a significant correlation between GFR and all the tubular function (p<0.05) variables (except excretion of chloride) measured. Compared to the patients with favorable renal outcome, the patients (n=10) who later developed ESKD had significantly (p<0.01) lower GFR and reduced urinary excretion of all measured electrolytes except calcium. Consistently, urine β-2 microglobulin and serum PTH and aldosterone values were significantly higher in the patients who developed ESKD (p≤0.01). CONCLUSION Both glomerular and tubular function decline was common and several parameters were likely to predict ESKD in PUV patients.
We evaluated the incidence and clinical implications of urinomas in boys with posterior urethral ... more We evaluated the incidence and clinical implications of urinomas in boys with posterior urethral valves. Our secondary aim was to evaluate the treatment modalities of urinomas. We retrospectively reviewed the hospital data of 200 patients with posterior urethral valves treated between 1953 and 2003. Documentation was sufficient in 196 cases to evaluate the presence of urinomas. A group of 69 patients with posterior urethral valves without urinoma served as controls. Of 196 patients 17 (9%) had urinoma. However, the incidence of urinoma increased to 15% after ultrasonography came into standard clinical use. Nine patients had perirenal urine collection, 6 had urinary ascites and 2 had urinothorax. At presentation median serum creatinine values were similar in patients with urinoma (145 mumol/l, range 54 to 431) and controls (126 mumol/l, 19 to 593, p = 0.547). Creatinine decreased similarly in patients with and without urinoma after the obstruction was relieved. Vesicoureteral reflux was detected in 69% of the patients with urinoma and in 76% of the controls. Median split function on the side of the urinoma was 51% (range 38% to 70%) on (99m)technetium diethylenetetramine pentaacetic acid scintigraphy. During childhood end-stage renal failure developed in 4 of the 16 patients (25%) with urinoma and in 16 of the 69 controls (23%). The true incidence of urinomas is probably close to 15% in patients with posterior urethral valves. Renal function is similar in patients with posterior urethral valves with and without urinoma. In asymptomatic cases urinomas apparently do not require any specific treatment.
To evaluate sexual function and fertility in adult patients treated for posterior urethral valves... more To evaluate sexual function and fertility in adult patients treated for posterior urethral valves (PUV) in childhood and to compare these patients with the normal population. To examine if patient characteristics such as chronic renal failure (CRF), history of cryptorchidism and bladder neck incision in childhood have an impact on sexual function. Information on sexual function was assessed using questions from the International Index of Erectile Function (IIEF). In addition, the patients were asked if they had had children or been treated for CRF. Out of 108 adult patients with PUV, 67 (62%) returned the questionnaires. Sexual function in these patients was compared with 201 controls and paternity rates were compared with a national database. The mean (sd) age of the patients and controls was 38 (9) and 38 (7) years, respectively. Six percent of the patients and 9% of the controls reported problems in achieving erection during sexual stimulation and 9% of the patients and 10% of the controls reported problems with the hardness of erection (P = nonsignificant). Ejaculation was absent in 1/61 sexually active patients (2%). The only significant risk factor in patients for erectile dysfunction (ED) was increasing age. Thirty-three (49%) of all 67 patients and four (57%) of the seven patients with kidney transplantation had had children. The paternity rates were similar to those in corresponding age groups of the general Finnish population. Eight patients (12%) had attempted to have children without success. Men treated for PUV have a similar prevalence of ED and similar paternity rates to men without PUV. Erectile function and paternity rates can be satisfactory in spite of CRF.
Journal of Small Business and Enterprise Development, 2018
Purpose The purpose of this paper is to analyse how different strategic goals of (micro-, small- ... more Purpose The purpose of this paper is to analyse how different strategic goals of (micro-, small- and medium-sized firms=SMEs) relate to the business model innovation (BMI) paths that SMEs take when improving their business. Design/methodology/approach The authors conducted 11 in-depth case studies involving SMEs innovating their business models (BMs). Findings The authors found evidence that strategic goals of SMEs (start new business, growth and profitability) lead them to alternative innovation path in terms of BM components affected. Growth seekers start from the right-hand side of a BM Canvas, while profitability seekers start from the back end, the left side of a Canvas; and new businesses adopt a cyclical approach considering BM components in turn, while at the same time redesigning and testing the BM. The findings of this study also indicate that all three paths gradually lead to improvement in several BM components. Research limitations/implications Findings indicate that a ...
In this paper we discuss productivity paradox and the origin of business value of ICT investments... more In this paper we discuss productivity paradox and the origin of business value of ICT investments, especially as we see that the present approaches in building ICT-based value networks of companies raises new productivity problems. The findings indicate that the organizations can reap the benefits of ICT-investments in terms of productivity only by managing the long term process change both at operational and management levels to match the organizational capacity and competitive position. This is achieved not by building information systems only, but by balancing automational, informational and transformational effects in the business context. We analyze three alternative approaches for information systems development against this backdrop: software engineering, business process redesign and reversed quality life cycle (RQLC by Nurminen & Forsman, 1994). There is growing evidence in favor of RQLC in designing and implementing intraorganizational systems, so we apply its ideas in the...
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