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Biomedical subjects

E Alhava

Publications and source records attributed to E Alhava.

At least 91 records · Page 5Linked to original sources
PubMed1996

Acute abdominal pain in adults.

The purpose of this prospective study was to elucidate the characteristics of adult patients with acute abdomen admitted to a Finnish university hospital. A total of 639 patients entered the study. The most common cause of acute abdomen was non-specific abdominal pain (NSAP) (33.0%) followed by acute appendicitis (23.3%) and acute biliary disease (8.8%). The male:female ratio was 47:53 in the whole study population, but there were differences in the age and sex distributions when studied by diagnosis. NSAP was mainly presented in young women, but also in patients over 75 years of age. Acute appendicitis was most frequently found in young men, and biliary disease was most common in elderly women. A male predominance was noted in cases of alcoholic pancreatitis and gastritis, renal stones and peptic ulcer. Young women and elderly patients were slightly over-represented in the study population when compared with the whole population residing within the study area. 43% of the patients were operated on, and surgery was most common in patients aged 55-64 years and 15-24 years. Altogether 15% of the patients were discharged without hospitalisation. Twelve patients (1.9%) died of various causes, the most common of which was malignancy (four patients). In conclusion, a considerably large proportion (one third) of cases with acute abdomen remained without any specific explanation. Further, age and gender seem to be important factors when the most probable cause of acute abdomen is to be considered. Operative treatment is necessary in almost half of cases, and mortality for acute abdomen is low.

Abdomen, Acute↗
PubMed1996

The outcome of elderly patients after operation for acute abdomen.

A retrospective analysis of 224 patients was carried out to evaluate the outcome of elderly patients after operation for acute abdominal pain. The mean (+/- SD) age of the patients was 74.6 (+/- 6.4) years (range 65-96) and the male/female ratio was 104/120. The most common causes for an emergency operation were acute biliary disease (26%), acute appendicitis (18%), gastrointestinal cancer (11%) and incarcerated hernia (10%). Twenty-nine patients (13%) died during the one-month postoperative period. The most common causes of death were gastrointestinal cancer (24%), ischaemic heart disease (14%) and complicated peptic ulcer disease (14%). Ninety-two (41%) patients had non-lethal postoperative complications, the commonest of which were wound infection or dehiscence (28%), urinary tract infection (17%), and paralytic ileus (8%). Ten patients were reoperated on for postoperative complications. The mean hospitalization time was 12.5 days (range 1-99). The results in the analysis of the long-term outcome (mean follow-up time 21 months) revealed that 17% of the primarily survived patients had died. Living patients were satisfied with the treatment and only a few patients were institutionalised after surgery. We conclude that both the short-term and long-term outcome of elderly patients after an emergency abdominal operation is good in benign diseases, and active surgery is justified.

Abdomen, Acute↗
PubMed1995

Prediction of fracture risk using axial bone mineral density in a perimenopausal population: a prospective study.

Several prospective studies have shown that the bone mineral density (BMD) measured in the appendicular or axial skeleton has an inverse relationship with the risk of subsequent fractures. However, most of these studies have concentrated on relatively old age groups, and the usefulness of measuring BMD at the time of menopause has not been established. In the present study, BMD was measured at the lumbar spine and femoral neck by dual X-ray absorptiometry (DXA) in a random stratified population sample of 3222 perimenopausal women (mean age 53.4 years, range 47-59 years). These women were followed for fractures over a period of 2 years. The fractures reported by a postal inquiry were verified from medical records. Fractures sustained in motor vehicle accidents were excluded from the analyses. During a mean follow-up of 2.4 years, 183 fractures occurred in 168 women. Wrist (n = 47), ankle (n = 31), and rib (n = 28) were the most common sites of a fracture. Women in the lowest quartile of spinal BMD had a 2.9 times greater risk of fracture than those in the highest quartile. The respective risk increased 2.2 times from the lowest to the highest quartile of femoral BMD, respectively. The relative risk for suffering from any fracture per one SD decrease in BMD was 1.50 (95% CI; 1.27-1.76) for the spine and 1.41 (1.21-1.64) for the femoral neck. The present study demonstrates that bone mass is important in the pathogenesis of fractures even in perimenopausal women. We conclude that the axial BMD measurement at the time of menopause can be of use in predicting subsequent fracture risk.

Absorptiometry, Photon↗
PubMed1995

Breathing pattern and gas exchange in emergency and elective abdominal surgical patients.

OBJECTIVE: To evaluate the effects of intra-abdominal surgical emergency on breathing pattern and gas exchange and compare it with the changes induced by elective abdominal surgery. DESIGN: Prospective clinical study. SETTING: Abdominal surgical departments in a university hospital. PATIENTS: Patients operated for intra-abdominal emergency (n = 10, EAS), elective upper abdominal (n = 19, UAS). MEASUREMENTS AND RESULTS: Breathing pattern and gas exchange were measured with a respiratory inductive plethysmograph and a gas exchange monitor. EAS patients had pre-operatively a classical rapid shallow breathing pattern and increased ventilatory demand due to increased energy expenditure. The operation improved the breathing to normal pattern (frequency, 26 +/- 5/min and 17 +/- 3/min, p < 0.01; tidal volume, 439 +/- 128 ml and 541 +/- 165 ml, NS., before and after surgery, respectively). Sighing was absent before and after EAS and strictly reduced after elective surgery (p < 0.01 for UAS). The operation restricted the abdominal-diaphragmatic breathing movement which was reflected as increased contribution of the rib cage to VT (%RC: from 37% +/- 15 to 57% +/- 15 for UAS p < 0.001; from 47% +/- 16 to 61% +/- 14 for EAS NS.). After EAS and UAS hypoxemia was common (p < 0.001) with frequent radiological pathology. We conclude that intra-abdominal surgical emergencies increase the ventilatory demand and challenge the respiratory system to marked adaptive changes both pre- and post-operatively.

Abdomen↗
PubMed1995

The effect of gynecological risk factors on lumbar and femoral bone mineral density in peri- and postmenopausal women.

The relationship between gynecological history and bone mineral density (BMD) of the lumbar spine and femoral neck was studied in 3126 perimenopausal women. The study population was a random, stratified sample of participants, selected from the Kuopio Osteoporosis Study, which consisted primarily of all 14,220 women aged 47-56 years in Kuopio Province in 1989. After exclusion of 1521 women reporting past or present hormonal replacement therapy (HRT), 1605 women formed the final study population. Present HRT users had significantly higher lumbar BMD but not femoral BMD, than non-hormone users. Postmenopausal status, late menarche, and bilateral oophorectomy were risk factors for low BMD. Protective factors against low BMD were increased body weight, increased number of pregnancies, as well as hysterectomy without bilateral oophorectomy. The majority (43.8%) of these operations had been performed due to the presence of leiomyomas. No significant correlation was found between nulliparity, breast-feeding or amenorrhea before the age of 30 and BMD. In the multiple regression analysis, gynecological variables could account for only 18.4-26.8% of the variance in BMD, while time since last periods, age, age at menarche, weight and hysterectomy were the most significant variables. We conclude that reproductive history gives rise to some special risk groups, to whom BMD measurements and osteoporosis prevention efforts should be directed. However, it is impossible to predict BMD by gynecological characteristics.

Bone Density↗
PubMed1995

Fractures and low axial bone density in perimenopausal women.

The relationship between past fractures and current bone density (BMD) was analyzed in a population sample of 3222 women aged 48-58. BMD was determined with dual X-ray absorptiometry (DXA) at the spine and femoral neck. 702 women reported fractures. Wrist and ankle were the most common fracture sites. Fracture history increased the risk [OR (95% CI)] of low spinal BMD (of more than 1 SD below the study population mean) by 1.75 (1.41; 2.18). The sensitivity and specificity of fracture history to detect a low spinal BMD were 31 and 80%, respectively. One SD decreases of spinal and femoral BMD equalled to respective overall fracture risks (adjusted ORs) of 1.36 (1.24; 1.50) and 1.38 (1.25; 1.51). Both BMDs related more strongly to wrist fracture [1.73 (1.47; 2.05)/1.69 (1.43; 1.99)] than to all nonwrist fractures combined [1.24 (1.11; 1.37)/1.27 (1.14; 1.42)]. Ankle and rib fractures related only to spinal [1.21 (1.00; 1.46)/1.45 (1.12; 1.87)] but tibia and foot bone fractures only to femoral [2.04 (1.37; 3.04)/2.20 (1.42; 3.41)] BMD. Spinal BMD related more strongly to fractures due to falls on same level than to fractures due to all other trauma combined. Fracture history poorly screens out low perimenopausal BMD. The results suggest that pre- and perimenopausal fractures relate to low axial bone density and that the magnitude of this relation depends on the sites of fracture and densitometry as well as on the type of trauma.

Absorptiometry, Photon↗
PubMed1995

The inhibition of CYP enzymes in mouse and human liver by pilocarpine.

1. Pilocarpine is a cholinomimetic natural alkaloid. Its interactions with testosterone hydroxylations, coumarin 7-hydroxylase (COH), dimethylnitrosamine N-demethylase (DMNA), pentoxyresorufin O-dealkylase (PROD) and 7-ethoxyresorufin O-deethylase (EROD), which are indicative of the activities of cytochrome P4502A5 (CYP2A5) or 6, 2E1, 2B, 1A, were examined in mouse and human liver microsomes. 2. In mouse liver microsomes the IC50 values of pilocarpine were 6 microM for COH and testosterone 15 alpha-hydroxylase (T15 alpha OH) activities, 4 microM for PROD, approximately 100 microM for DMNA and testosterone 6 beta-hydroxylase (T6 beta OH) activities and > 1 mM for EROD activity. 3. In human liver microsomes, the IC50 value for COH was 6 microM and for DMNA 10 microM; T15 alpha OH and PROD activities were not detectable but T6 beta OH and testosterone 16 beta/2 beta-hydroxylase activities were moderately inhibited (IC50 70 microM). 4. These results suggest that pilocarpine has (i) a high affinity towards phenobarbitone-inducible CYP2A4/5 and CYP2B activities in mouse liver, (ii) a high affinity towards CYP2A6 in human liver microsomes and (iii) a moderate affinity towards CYP3A enzyme(s) in both microsomal preparations. 5. The low IC50 concentrations in vitro indicate potential metabolic interactions between pilocarpine and several P450 enzymes.

Aged↗
PubMed1995

Competitive inhibition of coumarin 7-hydroxylation by pilocarpine and its interaction with mouse CYP 2A5 and human CYP 2A6.

1. We have shown earlier that pilocarpine strongly inhibits mouse and human liver coumarin 7-hydroxylase activity of CYP 2A and pentoxyresorufin O-deethylase activity of CYP 2B in vitro. Since pilocarpine, like coumarin, contains a lactone structure we have studied in more detail its inhibitory potency on mouse and human liver coumarin 7-hydroxylation. 2. Pilocarpine was a competitive inhibitor of coumarin 7-hydroxylase in vitro both in mouse and human liver microsomes although it was not a substrate for CYP 2A5. Ki values were similar, 0.52 +/- 0.22 microM in mice and 1.21 +/- 0.51 microM in human liver microsomes. 3. Pilocarpine induced a type II difference spectrum in mouse, human and recombinant CYP 2A5 yeast cell microsomes, with Ka values of 3.7 +/- 1.6, 1.6 +/- 1.1 and 1.5 +/- 0.1 microM, respectively. 4. Increase in pH of the incubation medium from pH 6 to 7.5 increased the potency of inhibition of coumarin 7-hydroxylation by pilocarpine. 5. Superimposition of pilocarpine and coumarin in such a way that their carbonyls, ring oxygens and the H-7' of coumarin and N-3 of pilocarpine overlap yielded a common molecular volume of 82%. 6. The results indicate that pilocarpine is a competitive inhibitor and has a high affinity for mouse CYP 2A5 and human CYP 2A6. In addition the immunotype nitrogen of pilocarpine is coordinated towards the haem iron in these P450s.

Animals↗
PubMed1995

Risks of perimenopausal fractures--a prospective population-based study.

OBJECTIVE: To examine the associations between potential risk factors and fractures in perimenopausal women. SUBJECTS: A total of 3,140 women (mean age 53.4 +/- 2.8 (s.d.) years) were followed-up for 2.4 years after axial bone densitometry (lumbar spine and femoral neck) with regard to the occurrence of fractures. RESULTS: In all, 5.6% of the women sustained a fracture. There were 169 low energy fractures (falling on a level surface) in 157 women after the exclusion of 18 fractures caused by a high energy trauma. The wrist was the most frequent site of fracture (n = 46). Lumbar bone mineral density was 5.8% lower and femoral bone mineral density 4.6% lower among fracture cases compared with non-fracture cases (p < 0.0001). History of a fracture during 1980-1989 elevated the risk of all fractures 2.83-fold (95% confidence interval (CI) 1.95-4.10) and the risk of a first wrist fracture 2.25-fold (95% CI 1.10-4.62). The amount of weekly alcohol intake was higher among fracture cases than among non-fracture cases yielding an age-adjusted odds ratio (OR) of 1.45 (95% CI 1.05-2.02). Past or present use of hormone replacement therapy was protective against fractures (age-adjusted OR 0.70, 95% CI 0.50-0.96). If bilateral oophorectomy had been carried out under the age of 45 years, the risk of fracture was 3.64-fold (95% CI 1.01-13.04) compared with women operated upon after the age of 45 years. Age at menarche, parity, lactation and smoking history did not differ between the fracture and non-fracture groups. CONCLUSIONS: A former history of fractures, low baseline bone mineral density (BMD) and use of alcohol are predisposing factors associated with perimenopausal fractures, while hormone replacement therapy is protective in this respect.

Alcohol Drinking↗
PubMed1995

Tumour-associated trypsin inhibitor (TATI) in patients with colorectal cancer: a comparison with CEA, CA 50 and CA 242.

A prospective study of 62 patients with colorectal cancer was carried out to evaluate the value of tumour-associated trypsin inhibitor (TATI) in the diagnosis and staging of this disease. The reference group consisted of 97 patients with benign gastrointestinal disease. Increased serum TATI levels were detected in 46 patients with colorectal cancer (sensitivity 74%), and the highest mean values were measured in the patients with stage II cancer. The frequency of elevated values was not affected by the stage of the disease, however. There were altogether 64 false positives (specificity 34%). In comparison to CEA and CA 242, TATI showed higher sensitivity at low (< 40%) specificity levels, but it was less sensitive at high (70-95%) specificity levels. The performance of the CA 50 test was poorest both at high and low specificity levels. The various combinations of TATI and other markers (two tests positive) did not offer any further advantage as compared to CEA alone. A marginally significant positive correlation (p = 0.07) was found between serum TATI and CEA values in colorectal cancer patients. The results suggest that TATI is a very sensitive marker in colorectal cancer, but its utility is limited because of its low specificity in symptomatic patients. Concomitant measurement of TATI and other markers does not seem to give any further benefit, and nor does TATI seem to have any significant value in staging of the disease. Our results also indicate that CEA is probably the best current test in colorectal cancer.

Adult↗
PubMed1995

Ultrasound attenuation of the calcaneus in normal subjects and in patients with wrist fracture.

We determined broadband ultrasound attenuation (BUA) of the calcaneus, and bone mineral density (BMD) of the spine, proximal femur and radius in 137 healthy subjects (79 women and 58 men) and in 56 women with Colles' fracture. The repeated measurements on 9 healthy subjects indicated a short-term reproducibility (coefficient of variation) of 4 percent for BUA. There was a small (7 percent) but significant difference in BUA between normal men and women. The age-dependence in normal subjects was weak. When all the study subjects were pooled, modest correlations between BUA of the calcaneus and BMD at all measured skeletal sites were found (rs values 0.3-0.4). However, it was not possible to make an accurate prediction of the axial BMD, using BUA. BUA values were 13 percent lower in the wrist fracture patients than in the age-matched normals. In general, BUA could discriminate the fracture patients from normals as effectively as BMD. As suggested by the physical theory of ultrasound attenuation, our results support the idea that BUA reflects not only the bone density but also other factors related to the structural properties of bone.

Absorptiometry, Photon↗