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Biomedical subjects

A Rantala

Publications and source records attributed to A Rantala.

At least 37 records · Page 2Linked to original sources
PubMed1996

Dispersion of the QT interval and autonomic modulation of heart rate in hypertensive men with and without left ventricular hypertrophy.

Left ventricular hypertrophy is an independent risk factor for sudden cardiac death in hypertension, but the mechanisms of electrical instability associated with hypertrophy are not well known. We studied dispersion of the QT interval, an index of inhomogeneity of repolarization, and heart rate variability, a measure of cardiac autonomic modulation, in a randomly selected population of 162 men with systemic hypertension and made comparisons between the patients with echocardiographic evidence of left ventricular hypertrophy (left ventricular mass index > or = 131 g/m2, n = 44) and those without hypertrophy (left ventricular mass index < 131 g/m2, n = 118). The heart rate-corrected QT dispersion (67 +/- 37 versus 53 +/- 21 milliseconds, P < .05) and QT apex dispersion (55 +/- 22 versus 44 +/- 16 milliseconds, P < .01) were significantly longer in the patients with left ventricular hypertrophy than in those without hypertrophy. Thirteen of the 44 patients (30%) with hypertrophy versus 7 of the 118 patients (6%) without hypertrophy had an abnormally long QT apex dispersion ( > 70 milliseconds) (P < .001). The time and frequency domain measures of heart rate variability did not differ significantly between the patient groups with and without left ventricular hypertrophy. The measures of heart rate variability were not related to QT dispersion or left ventricular mass index but had a negative correlation with blood pressure values (eg, r = -.30 between the low-frequency component of heart rate variability and systolic pressure, P < .001). Age, body mass index, antihypertensive medication, and the other demographic variables were similar between the groups, but the patients with left ventricular hypertrophy had higher systolic (P < .01) and diastolic (P < .01) pressures compared with the patients without hypertrophy. Left ventricular hypertrophy in hypertensive men is associated with inhomogeneity of the early phase of ventricular repolarization, favoring susceptibility to reentrant ventricular tachyarrhythmias. Abnormalities in cardiac autonomic function, which may trigger a spontaneous onset of arrhythmias, are related to elevated blood pressure but not specifically to left ventricular hypertrophy.

Adult↗
PubMed1996

Enhanced IgE response to Candida albicans in postoperative invasive candidiasis.

BACKGROUND: Invasive candidiasis is a life-threatening complication problem in post-operative and immunocompromized patients, e.g. those treated by intensive care. Candida is frequently cultured from the mucous membranes of hospital patients and fungal cultures offer little diagnostic help. Other diagnostic methods, such as blood cultures, serology and diagnostic imaging techniques produce results too late and, if positive, low sensitivity. OBJECTIVE: To study the value of Candida-specific antibodies, especially those of IgE class, in diagnosing invasive Candida infection. METHODS: The immunoglobulins IgE, IgG and IgM responses to antigens of Candida albicans in the sera of 14 patients with culture, biopsy and/or autopsy proven postoperative invasive candidiasis and of 11 colonized and 19 non-colonized operated patients were studied by mannan radioallergosorbent test (RAST), mannan enzyme-linked immunosorbent assay (ELISA) and immunoblotting. RESULTS: Detection of IgE antibodies to C. albicans polysaccharide (mannan) and protein antigens proved specific and sensitive in diagnostics of invasive candidiasis after major abdominal surgery. IgE rose early in the course of the infection and the method made a clear distinction between invasive infection and mucous colonization. Immunoblotting for protein antibodies was most sensitive while nitrocellulose-RAST for mannan antibodies was most specific. The combined use of immunoblotting and RAST increased the sensitivity and the specificity. Determinations of anti-Candida IgG and IgM antibodies had low sensitivity and specificity. CONCLUSION: Critically ill patients with invasive candidiasis develop IgE antibodies to Candida antigens probably because of disturbed TH1/TH2 responses. Determination of specific IgE antibodies can be used as a diagnostic aid in the early stage of invasive Candida infection.

Adult↗
PubMed1996

Laparoscopic removal of the acutely inflamed gall bladder.

Seventy-six patients underwent laparoscopic cholecystectomy for acute cholecystitis between June 1991 and April 1995 at our clinic and were retrospectively reviewed. Seventy per cent of the operations could be completed laparoscopically with uneventful recovery. In 15 cases the procedure was converted into an open one. Three patients had to be reoperated, one of them died in myocardial infarction three weeks after the reoperation. The mean operative time was 95 minutes (range 45-180). The average postoperative hospitalisation was 3.1 days. The laparoscopic method is suitable for removal of the acutely inflamed gall bladder. The procedure is more difficult and time-consuming than in elective cases, and conversion are more frequent.

Acute Disease↗
PubMed1996

Major haemorrhage associated with a pseudocyst in chronic pancreatitis: a gastro-surgical challenge.

During the fifteen years between 1979 and 1994, ten patients with alcohol-associated chronic pancreatitis were treated for acute haemorrhage from pancreatic pseudocyst. Five of the cases took place in the last two years of the period. All patients were men with a median age of 39.5 years and with a mean of six years of alcohol misuse. Seven patients presented with massive gastrointestinal bleeding, two with intraperitoneal and one with retroperitoneal bleeding. In six patients the pseudocyst had perforated into the stomach or duodenum. Pancreatic resection resulted in permanent haemostasis in those patients it was attempted to perform, whereas ligation of the bleeding site failed in three out of four patients. One angiographic embolisation resulted in a good primary result but after 77 days the patient was operated on for recurrent bleeding. There was no hospital mortality, but altogether five patients were reoperated on for recurrent haemorrhage and six patients had other postoperative complications. Haemorrhage from pancreatic pseudocyst must be suspected in patients with anamnestic alcohol misuse and major gastrointestinal bleeding. Aggressive diagnostic evaluation, experience in pancreatic surgery, and operative strategies consisting of either resection or extracystic ligation are mandatory in the treatment of this acute condition.

Adult↗
PubMed1995

Palliative laser treatment of rectal cancer.

BACKGROUND: Endoscopic neodymium-yttrium aluminum garnet laser treatment is a therapeutic modality for gastrointestinal neoplasms. METHODS: Patients given palliative therapy with laser for invasive rectal cancer during 1989-93 at the Dept. of Surgery, University of Turku, were analyzed. RESULTS: All 20 patients (median age, 81.5 years) were unsuitable for radical surgery owing to the poor clinical condition and/or advanced disease. In 14 (70%) patients laparotomy and diversion was avoided with laser treatment; 6 patients underwent laparotomy, 2 for pelvic infiltration and large-bowel obstruction, 2 for rectovaginal fistula formation, and 1 for severe pain. One patient underwent abdominoperineal resection for bleeding after laser treatment. Postoperative complications developed in three (15%) patients--two episodes of bleeding and one of sepsis; none of these complications was fatal. CONCLUSIONS: Local palliative laser treatment of rectal carcinoma is efficient in patients who are unsuitable for radical surgery. Operative diversion can be avoided without deaths and with minimal morbidity.

Aged↗
PubMed1995

Laparoscopic Nissen fundoplication. Initial experience.

Fifty-two patients underwent laparoscopic Nissen fundoplication. Oesophagogastroscopy, ambulatory 24-hour pH-recording and oesophageal manometry were evaluated both preoperatively and at follow-up. Forty-seven operations were completed laparoscopically, five were converted to laparotomy. There was no mortality, but minor postoperative complications occurred in four patients. The mean hospital stay after a laparoscopic operation was three days and sick leave 14 days. After three months, 94% of the patients were free of reflux symptoms, oesophagogastroscopy showed normal findings in 95% of the patients and oesophageal 24-hour pH-values were normal in 95% of the patients. Dysphagia (28%) and gas bloating (17%) were the most frequent postoperative complaints. A total of 94% of the subjects were satisfied with the result. Our initial experience of laparoscopic Nissen fundoplication shows that the operation is safe and efficient in the treatment of gastro-oesophageal reflux disease.

Adult↗
PubMed1994

Circadian rhythms of frequency domain measures of heart rate variability in healthy subjects and patients with coronary artery disease. Effects of arousal and upright posture.

BACKGROUND: Altered neural regulation of the cardiovascular system may be an important factor for various manifestations of ischemic heart disease. This research was designed to compare the circadian rhythm of cardiac neural regulation and autonomic responses to arousal and upright posture between patients with uncomplicated coronary artery disease (CAD) and age-matched subjects with no evidence of heart disease. METHODS AND RESULTS: Twenty-four-hour heart rate variability (HRV) in the frequency domain was analyzed in 20 male patients (mean age, 52 +/- 7 years) with angiographic evidence of CAD without prior myocardial infarction and in 20 healthy men (mean age, 51 +/- 8 years) with no clinical, echocardiographic, or exercise ECG evidence of heart disease. None of the 24-hour average frequency-domain components of HRV differed significantly between the two groups. Healthy subjects had a significant circadian rhythm of normalized units of high-frequency (HF) power of HRV with higher values during sleep. Normalized units of low-frequency (LF) power and the LF/HF ratio also showed a significant circadian rhythm in healthy subjects, with higher values during the daytime. No significant circadian rhythms in any of the normalized spectral components of HRV were observed in patients with CAD, and the night-day difference in LF/HF ratio was smaller in the patients with CAD than in the healthy subjects (0.5 +/- 1.4 versus 1.8 +/- 0.7, P < .001). Awakening when in the supine position resulted in a significant increase in the LF/HF ratio (P < .01) in the healthy subjects, but no significant changes in HRV were observed after awakening in patients with CAD. Assumption of upright position resulted in a comparable decrease in the components of HRV between the groups. CONCLUSIONS: The circadian rhythm of cardiac neural regulation is altered in patients with uncomplicated CAD. Reduced autonomic responses to sleep-wake rhythm suggest that the modulation of cardiac autonomic function by stimuli from the central nervous system is impaired in CAD.

Arousal↗
PubMed1994

Association between medically induced achlorhydria of the stomach and a severe postoperative infection? A report of two cases.

Two cases are reported, where severe postoperative septic infection developed after gastric resection without surgical technical complication. Both patients had had long preoperative therapy with omeprazole and no perioperative antibiotic prophylaxis was given in either of the cases. The other of the cases was fatal. The need for an effective perioperative prophylaxis in gastric surgery together with drugs creating gastric achlorhydria is discussed.

Achlorhydria↗
PubMed1993

Determination of serum arabinitol levels by mass spectrometry in patients with postoperative candidiasis.

A combined gas chromatography-mass spectrometry (GC-MS) technique was used for serial determination of serum arabinitol levels in patients with postoperative candidiasis. Forty subjects were investigated, 18 patients with candidiasis, 7 patients with superficial Candida colonization and 15 postoperative control patients. The arabinitol levels were highly elevated, slightly elevated and normal in 13, 1 and 4 patients respectively with candidiasis; in 2, 2 and 3 colonized patients and in 1, 1 and 13 control patients (p < 0.001, chi 2, between all the groups). The sensitivity of a single arabinitol determination for detection of postoperative candidiasis was 27.6 % and the specificity 89.2 %. Use of multiple samples improved sensitivity up to 72.2% per patient (123 samples) with a specificity of 86.4 %. Highly elevated arabinitol concentrations were detected in only one patient before the onset of therapy. Determination of arabinitol levels by GC-MS is a specific test for diagnosing candidiasis, but multiple samples are required for adequate sensitivity, and the initiation of therapy must still be on an empirical basis.

Candidiasis↗
PubMed1993

Early Candida isolations in febrile patients after abdominal surgery.

The significance of finding Candida sp. in febrile patients after abdominal surgery was studied in a prospective study on 107 patients. The patients were divided into 3 groups, based on the isolation and time of sampling of Candida sp. and on any other microbiological documentation of the infection. Eight patients were found Candida-positive either by blood cultures or by cultures of urine, abdominal pus, tracheal aspirate or wound exudate within the first postoperative week and had significantly greater mortality than patients with other infections or later Candida sp.-isolation (50% vs 10%, p < 0.05). Isolation of Candida was associated with prolonged antibiotic therapy, extended central vein catheterization, parenteral nutrition and operations on the small bowel, ascending colon or pancreas, but not with the underlying illness. The results support the view that isolation of Candida sp. within the first week after surgery does not represent harmless colonization but is rather associated with serious morbidity.

Abdomen↗
PubMed1993

Postoperative candidiasis.

Candida species are important opportunistic pathogens in compromised hosts, such as patients recovering from major abdominal surgery. The incidence, pathogenesis, diagnosis and prognosis of postoperative candidiasis were studied in a general surgical department. Transplantation surgery was not included. The mean incidence of postoperative candidiasis in abdominal surgery was 6.2 per 1000 laparotomies. The estimated incidence was higher during the years 1987-1992 than 1981-1986. Postoperative candidiasis was most often encountered in patients undergoing surgery of the small intestine or pancreas. These patients had certain typical features: a long hospitalization before signs, central catheterization, parenteral nutrition, prolonged antibiotic therapy and reoperations; malignancy, corticosteroid or immunosuppressive therapy were uncommon. Multiple blood cultures during reoperations were not found to yield Candida; hence, hematogenous dissemination from the gut was not seen. The prognosis of postoperative candidiasis was poor: the infection mortality was 70-79% and significantly higher than in patients with postoperative bacterial septicemia. Early therapeutic measures resulted in a significantly better prognosis as compared to delayed treatment. Arabinitol was found a specific marker of candidiasis, but because sequential samples were needed for adequate sensitivity, a single arabinitol concentration determination in the beginning of the disease was not useful. Febrile patients who had Candida in any sample during the first postoperative week had a poor prognosis. The results show that patients with candidiasis have typical clinical features that facilitate suspicion. Antifungal therapy is mandatory and must be started as soon as a suspicion of candidiasis has risen, before the results of specific laboratory tests are available.

Abdomen↗
PubMed1992

Colonic anastomosis using the biofragmentable anastomotic ring and manual suture: a prospective, randomized study.

One hundred and fifty consecutive patients undergoing colonic surgery were randomized into two groups: 71 underwent hand-suture with a two-layer anastomosis of resorbable suture material (3/0 Dexon) and 79 were fitted with the biofragmentable anastomotic ring (Valtrac-BAR). Five patients, two treated using the BAR and three by suturing, developed anastomotic leakage which required a Hartmann-type reoperation. This was successful in four; one patient in the suture group died after reoperation. One patient who underwent suture had an early anastomotic stricture with fatal sequelae. Three other patients (one in the BAR group and two in the suture group) died after operation from other causes. Thus the mortality rate was 6 per cent in the suture group and 1 per cent in the BAR group. During follow-up, one patient in each group underwent reoperation for anastomotic stricture. Recovery of the gastrointestinal tract was similar in the two groups regarding duration of nasogastric drainage, intravenous fluid therapy and ileus. There was no difference between the groups in duration of hospital stay. The BAR seems to be a safe and reliable alternative to conventional suture anastomosis in colonic surgery.

Aged↗
PubMed1992

Lens opacity in patients with hypercholesterolemia and ischaemic heart disease. Electronic lens opacity measurements.

Lens opacity studies were performed using an electronic Lens Opacity Meter (Interzeag Opacity Lensmeter 701) in a population (n = 321) with ischaemic heart disease. These patients are participating in a trial targetting at the reduction of mortality and incidence of myocardial infarction using a cholesterol-lowering drug, simvastatin. A separate study to evaluate the reliability of the method showed good reproducibility. Repeated measurements after a short time-interval (2-10 days) gave statistically lower opacity values either due to a change in lens transparency or perhaps a change in pigment and cell dispersion in the aqueous caused by repeated mydriasis. Lens opacity values showed a highly significant positive correlation to age. Serum cholesterol, systolic blood pressure and smoking habits showed no significant correlations to the levels of lens opacity when adjustments for age were made.

Adult↗
PubMed1992

Multiple metabolic syndrome: aspects of genetic epidemiology and molecular genetics.

Epidemiological studies have documented the association between cardiovascular disease and high blood pressure, dyslipidaemia, impaired glucose tolerance, non-insulin-dependent diabetes mellitus (NIDDM), and central obesity. In fact, several of these abnormalities, often all of them, can be identified in the very same individuals, constituting the entity of the multiple metabolic syndrome. Furthermore, many of these abnormalities seem to run in families. These findings raise important questions about the genetic epidemiology of the disease and about the molecular genetic background of the most likely common nominator of this syndrome, namely insulin resistance. Therapeutic actions must also be carefully considered to avoid the encouragement of some abnormalities while treating others.

Apolipoproteins E↗
PubMed1992

Cholecystoenteral anastomosis with the biofragmentable ring and manual suture--a prospective, randomized study.

20 patients treated by cholecystojejunostomy for obstructive icterus were randomized to be treated either with a biofragmentable intraluminal ring (Valtrac) (10 patients) or suture of the cholecystointestinal anastomosis (10 patients). Postoperatively one patient in each group died of advanced malignancy. There were no surgical complications in either group. The relief of icterus, recovery of the gastrointestinal tract and the mean hospital stay were similar in both groups. The biofragmentable anastomosis ring (BAR) is a safe method for cholecystoenteral anastomoses.

Adult↗