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Biomedical subjects

E Alhava

Publications and source records attributed to E Alhava.

At least 163 records · Page 9Linked to original sources
PubMed1991

Diagnostic accuracy of ultrasound, computed tomography, and endoscopic retrograde cholangiopancreatography in the detection of obstructive jaundice.

The purpose of this prospective study was to investigate the diagnostic accuracy of ultrasound (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) in the distinction between extrahepatic and intrahepatic causes of jaundice. The limit for the inclusion to the study was defined as a serum bilirubin concentration greater than or equal to 40 mumol/l. Altogether 187 jaundiced patients were studied. The sensitivities of US, CT, and ERCP were 63%, 77%, and 87%, respectively. The differences between all these methods were statistically significant. The specificities and positive predictive values were high, reaching 96-99%, but the negative predictive values were low, ranging between 38% and 60%. Choledochal stone disease constituted the main etiology of false-negative studies in all investigations. Imaging procedures have a prominent role in the diagnostic study of the jaundiced patient, but it is obvious that their diagnostic accuracy may vary between institutions because of the variance in local experience and expertise, and because of the differences in diseases causing jaundice.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1991

Hormone receptors as prognostic factors in female breast cancer.

The oestrogen (ER) and progesterone receptor (PR) status in a series of 281 women with breast cancer (followed up for a mean of 8.5 years) was correlated with eight histological variables, seven nuclear morphometric factors and two mitotic indices. Sex steroid receptor status was not significantly related to tumour size, axillary lymph node status or tumour recurrence. Sex steroid receptors were related to histological grade (P less than 0.0001), nuclear grade (P less than 0.0001), tumour necrosis (P = 0.0003), tumour circumscription (P = 0.0027), inflammatory cell reaction (P = 0.007), intraductal growth pattern (P = 0.0378), and tubule formation (P = 0.0432). Receptor status was also significantly related to nuclear morphometric variables (P less than 0.001) and mitotic indexes (P less than 0.001). In univariate analysis, ER (P = 0.2) and PR (P = 0.1) negatively predicted the recurrence free survival. Cancer related survival was predicted by ER (P = 0.0068) and PR (P = 0.0027). In small (diameter less than or equal to 2 mm) axillary lymph node negative tumours, ER (P = 0.09) and PR (P = 0.1) had some value in predicting the survival. The survival advantage of steroid receptor positive tumours was not due to adjuvant hormone therapy. Sex steroid receptors had independent predictive value in multivariate survival analysis and also in small (diameter less than or equal to 20 mm) tumours. The results indicate that sex steroid receptor negativity is related to several malignant histological features in breast cancer and hormone receptors have prognostic value. Their prognostic influence seems to be mediated through the different proliferation rates in receptor positive and negative breast carcinomas.

Breast Neoplasms↗
PubMed1991

Nuclear morphometry and mitotic indexes as prognostic factors in breast cancer.

The primary tumors of 106 female patients with breast cancer (with a mean follow-up of 17 years) were analysed for prognostic factors, with special emphasis on improved prognostic prediction of the small axillary lymph node-negative tumours. In addition to classic prognostic variables (histological type, nuclear grade, tumor size, node involvement), six morphometrically determined nuclear variables (mean nuclear area, SD of nuclear area, mean area of the 10 largest nuclei, maximum nuclear diameter, shortest nuclear diameter, mean nuclear perimeter, and SD of nuclear perimeter) and two mitotic indexes (mitotic activity index (MAI) and volume corrected mitotic index (M/V-index] were measured and related to the patient survival data. Mitotic indexes (p less than 0.001) as well as nuclear morphometric features (p less than 0.001) accurately predicted axillary lymph node involvement at operation. The axillary metastases that developed during the follow-up were also significantly related to mitotic indexes (p less than 0.001). The same indexes also predicted the recurrence free survival (p less than 0.001). The best predictors of cancer related survival were axillary node status and the mitotic indexes at the time of diagnosis (p less than 0.001). The potential of the M/V index in predicting the patient survival was equal to that of the axillary lymph node status. Of the two mitotic indexes, the M/V index was superior to the MAI in survival analysis. The results had us to advocate the inclusion of the newly introduced M/V index in the prognostic factors used in predicting the biological behaviour of breast cancer.

Aged↗
PubMed1991

Hypermetabolism after coronary artery bypass.

We measured the changes in energy expenditure in the early postoperative phase after coronary artery bypass operations and the ventilatory response to the increased demand for respiratory gas exchange. Breathing pattern and gas exchange were measured noninvasively by respiratory inductive plethysmography and indirect calorimetry with a canopy. Eighteen patients were studied after weaning from mechanical ventilation. Energy expenditure increased by 18.3%, which is comparable to the response to major injury. Carbon dioxide production increased from 162 +/- 20 to 195 +/- 36 ml/min in the supine position (p less than 0.001), and similar changes were observed in the half-sitting position. Arterial carbon dioxide tension increased marginally (37.5 +/- 2.96 mm Hg preoperatively versus 39.7 +/- 4.87 mm Hg postoperatively; p less than 0.05), while oxygen tension decreased from 89.9 +/- 17.3 mm Hg to 62.9 +/- 13.4 mm Hg (p less than 0.001). Minute ventilation increased by 34% in the supine position (p less than 0.01) and by 28% in the half-sitting position (p less than 0.05), while tidal volume remained unchanged. We conclude that coronary artery bypass operations induce hypermetabolism and substantially increase ventilation and risk of arterial hypoxemia during the phase of compromised cardiovascular reserves.

Calorimetry, Indirect↗
PubMed1990

[Osteoporosis].

Explore the source record for details and available documents.

Calcitonin↗
PubMed1990

The effect of prophylactic use of famotidine, ranitidine, and sodium citrate in upper abdominal surgery.

The effects of famotidine (40 mg), ranitidine (300 mg) and sodium citrate (30 ml) on the gastric pH and volume were tested in 114 patients undergoing upper abdominal surgery. Gastric content was aspirated through a multiorifice tube immediately after intubation, at the end of operation and after a recovery room period of one hour. All three drug regimens significantly increased the mean gastric pH value compared with the control group. Famotidine and ranitidine reduced the volume of gastric content in comparison with sodium citrate and the control group. However, the difference was significant only in the recovery room sample.

Abdomen↗
PubMed1990

The necessity and safety of calcium and vitamin D in the elderly.

The necessity and safety of an oral calcium (Ca) and vitamin D regimen was evaluated in a population of 66 independently living and 73 institutionalized elderly women over an 11-week winter period. The members of both groups were randomly assigned into trial and control groups. Serum Ca, creatinine, and calcidiol levels were measured before and after the trial. The regimen consisted of 1.558 g of Ca and 45 micrograms (equal to 1,800 IU) of vitamin D administered daily in addition to the normal diet. The controls received no treatment. A majority of the elderly subjects living independently had ensured their Ca, and a quarter of them also their vitamin D intake on their own initiative. The mean serum calcidiol concentration before the trial was 24.1 nmol/L in the institutionalized and 38.5 nmol/L in the elderly subjects living independently (P less than .001). After the trial, serum calcidiol was 10.4 nmol/L in the institutionalized control subjects and had decreased (P less than .001) in both control groups, but increased (P less than .001) in both treatment groups. The safety indicators, serum Ca, creatinine, and calcidiol, did not indicate any group or individual side effect.

Aged↗
PubMed1990

Volume-corrected mitotic index in human pancreatic cancer. Relation to histologic grade, clinical stage, and prognosis.

A retrospective study was performed on 59 pancreatic cancer patients diagnosed during 1970-1988. The mean follow-up time of all individual patients was 6.9 months (range, 0-37 months). Histologic grade, clinical stage (UICC), and volume-corrected mitotic index (M/V index) were correlated to the survival of patients. Histologic grade (p = 0.167) and clinical stage (p = 0.066) were not related to overall survival with statistical significance. The M/V index was significantly associated with overall survival (p = 0.004). M/V index (p = 0.004), clinical stage (p = 0.029), and histologic grade (p = 0.126) predicted survival at 1 year after diagnosis. M/V index divided grade-II tumors into two prognostically different groups (p = 0.050). Seven of 59 patients who survived more than 12 months had an M/V index less than 2, and patients who survived less than 6 months had significantly higher M/V index values (chi-square = 528.3, p less than 0.001). The metastasizing potential of pancreatic cancer and lymph node involvement was also associated with the M/V index. Histologic grade and M/V index were positively correlated (chi-square = 38.6, p less than 0.001, r = 0.702). On the basis of our results, it seems that the M/V index is better than histologic grade or clinical stage in predicting survival of pancreatic cancer patients. This result suggests the potential use of the M/V index in selecting patients for different modes of therapy.

Adenocarcinoma↗
PubMed1990

Ultrasonography and computed tomography in diffuse liver disease with cholestasis.

Ultrasonography (US) and computed tomography (CT) were performed on respectively 67 and 42 (altogether 72) patients, for the assessment of intrahepatic cholestasis. The diagnostic ability to differentiate between malignant (17 patients) and benign (55 patients) liver disease was analyzed. Coarse echogenicity of the liver led to inconclusive results in differentiating between cirrhosis (2 out of 29 patients) and malignant infiltration (4 out of 15 patients) by US. Other benign liver diseases in 23 patients, including acute hepatitis, chronic active hepatitis, fatty liver, and liver congestion, were correctly interpreted as benign. CT correctly disclosed malignant liver disease in all cases. A false positive diagnosis of malignancy was encountered in 4 (out of 17) patients with decompensated hepatic cirrhosis because of non-homogeneous expansive areas on CT in 3 cases. The true cause was in 2 patients non-uniform fatty infiltration, and in one patient with acute hepatitis A, small hypodense lesions. Among cholestatic patients, decompensated cirrhosis and malignant liver infiltration could not always be differentiated on US or CT.

Adolescent↗
PubMed1989

Relationship between DNA ploidy and survival in patients with primary breast cancer.

The DNA ploidy of breast cancer tissue from paraffin blocks was measured by flow cytometry in 117 patients whose disease had been detected and treated with surgery between 1974 and 1976. Patients with aneuploid tumours had positive axillary nodes and distant metastases more often than those with diploid tumours. Aneuploid tumours were more common in postmenopausal than premenopausal women. The S-phase fraction (SPF) was significantly higher in aneuploid than in diploid tumours and positive axillary lymph nodes were found in 26 per cent of the patients who had a tumour with a SPF below the median (4.8 per cent) and in 48 per cent of those with tumours with SPF values above the median. At the primary clinical investigation 2 per cent of the patients with diploid tumours and 6 per cent of those with aneuploid tumours had distant metastases. During the follow-up, the proportion of patients with distant metastases increased to 42 and 72 per cent, respectively. With a follow-up of 11.5 years, the DNA aneuploidy of the tumour showed a significant association with decreased survival. Thirty-three per cent of patients with diploid and 65 per cent of patients with aneuploid tumours had died from breast cancer during the follow-up (P less than 0.001). All patients with hypertetraploid or multiploid tumours died from breast cancer. High SPF values were associated more closely with distant metastases or death during the follow-up than low SPF values. Our results suggest that DNA ploidy measured by flow cytometry from paraffin embedded tissue blocks of human breast cancer can be used to predict the aggressiveness of the tumour and the survival of the patients.

Aged↗
PubMed1989

Lymphoma of the breast.

Three cases of malignant lymphoma of the breast are described, seen over a 14 year period in the district of Kuopio University Central Hospital. The neoplasms were either of high or intermediate grade of malignancy: one immunoblastic, one Burkitt-type, and one centroblastic-centrocytic malignant lymphoma. The patient with centroblastic-centrocytic malignant lymphoma had advanced disease with pulmonary and adenoidal involvement and died 15 months after the detection of the breast tumor. The two other neoplasms were confined to the breast with no evidence of further dissemination. The patient with immunoblastic malignant lymphoma developed intestinal lymphoma 3 years later which was treated with surgery and cytostatic therapy. The patient has since been in remission for a period of 10.5 years. The patient with Burkitt-type malignant lymphoma was subjected to surgical resection which was followed by cytostatic treatment. The patient has remained in good health during the 20-month follow-up. The correct diagnosis is especially important in breast lymphoma because without it the appropriate treatment cannot be applied.

Adult↗
PubMed1988

Is lactose malabsorption a risk factor in fractures of the elderly?

The prevalence of lactose malabsorption (LM) was determined by lactose tolerance tests in 18 women with spinal fragility fractures and 28 women with hip fractures and compared with 35 female controls of the same ethnic background. The association of LM with bone density in the spine, bone mineral density in the distal radius and histomorphometric values of iliac crest biopsies was also evaluated. The prevalence of LM did not differ between the fracture groups and the control subjects. Patients with LM did not differ from those with normal lactose tolerance with regard to bone densitometry or histomorphometric findings in iliac crest biopsies. These results suggest that in Finland LM is not a risk factor for osteopenic fractures in the elderly.

Adult↗
PubMed1987

Immunization of chickens via the bursa of Fabricius isolated from the rest of the gut-associated lymphoid tissue using four surgical techniques.

To study the role of the chicken bursa of Fabricius separately from the rest of the gut-associated lymphoid tissue (GALT), four operating methods were developed; these techniques are described in detail. Bursal function and immunological state of the operated chickens were assessed by applying colloidal carbon, Brucella abortus organism, and sheep red blood cells (SRBC) into the isolated bursa and then measuring the humoral immune responses. Closing the bursal duct, after administering antigens through it, was shown to be a reliable and reproducible method for immunizing chickens strictly via the bursal system. In this method, morphology and endocytosis of carbon in the isolated bursae were normal. Furthermore, the anti-Brucella titers did not significantly differ from those in the unoperated per anum immunized control chickens, whereas the response to SRBC was significantly lower (P less than .001) in the operated chickens compared with controls. Separation of the bursa from the rest of the GALT showed that the chicken bursa of Fabricius functions as a peripheral lymphoid organ; specific antibodies are formed against antigens introduced into the bursal lumen. The operating method also has confirmed that Brucella is a bursa-dependent antigen, but that SRBC need cooperation of the GALT to evolve a good humoral immune response.

Animals↗
PubMed1987

Bone density, histomorphometry and biochemistry in patients with fractures of the hip or spine.

Bone density in the lumbar spine and distal radius, histomorphometric values of iliac crest biopsies and biochemical parameters, including vitamin D metabolites, were determined in 30 women with recent hip fractures and in 19 women with spinal fragility fractures. In both groups, as compared with age- and sex-matched controls, bone density in the spine and peripheral skeleton was reduced. In the peripheral skeleton the degree of osteopenia in the two groups was equal, but loss of trabecular bone in the spine was disproportionate and more extensive in the group with spinal fragility fractures. In the patients with hip fractures the percentage of trabecular bone occupied by osteoid in the iliac crest biopsies was increased in 11 of the 25 patients. Osteomalacia was further suggested by the lower mean levels of serum calcium and phosphate and lower mean urinary excretion of calcium in this group. In the patients with spinal fractures histomorphometry showed that the osteoid and trabecular resorption surfaces were increased and the relative thickness of the osteoid seams was decreased, indicating increased bone turnover. This evidence was further reinforced by the increased mean serum concentration of 1,25(OH)2D and increased urinary excretion of calcium. The results support the view that these two groups of patients suffer from different forms of osteoporosis.

Adult↗
PubMed1986

The value of scintigraphy and computed tomography for the differential diagnosis of primary hyperaldosteronism.

Adrenocortical adenoma is the most common cause of primary hyperaldosteronism. Most tumours are small, less than 2 cm in diameter and, therefore, their localization may be difficult. We have compared two different methods, adrenal scintigraphy (AS) and computed tomography (CT) in the differential diagnosis of 12 patients with primary hyperaldosteronism. AS was performed using either [131I]cholesterol or 6-iodomethyl-19-norcholesterol during dexamethasone suppression. Of the patients, five showed a normal CT and symmetrical uptake of the isotope as AS. They were considered representative of bilateral hyperplasia. All showed good therapeutic response to spironolactone. Seven patients had an adrenocortical adenoma verified at operation. The CT finding indicated a tumour in five patients. This was correct in four, but in one patient the adenoma was found in the contralateral adrenal gland. In two patients with an adenoma, CT was considered normal. AS correctly indicated the tumour in all seven patients. The uptake was unilateral in six, and bilateral but clearly asymmetrical in one patient. The results indicate that AS is superior to CT in the pre-operative localization of aldosteroma. Although CT remains the primary method for the investigation of these patients, AS should be applied always when CT does not unequivocally indicate the presence and localization of an adrenal tumour.

Adenoma↗
PubMed1985

Bone density in women with spinal and hip fractures.

Bone density in the lumbar spine and distal radius of 98 postmenopausal women was measured by quantitative computed tomography and in the distal radius by gamma ray attenuation. Nineteen had spinal fragility fractures, 30 had recent hip fractures while 49 were healthy control subjects. The trabecular bone density in spines of the control subjects showed a linear correlation with age corresponding to an annual decrease of 1 per cent and total decrease of 44 per cent between 46 and 86 years of age. Both patient groups had bone density reduction at the spine and peripheral measuring sites as compared with controls. In the distal radius, the reduction in bone density was of the same magnitude in both patients groups but in the spine, the reduction in patients with spinal fracture was more extensive than that in patients with hip fracture. Trabecular bone density in the distal radius and spine correlated in control and hip fracture patients, but not in spinal fracture patients. The results support the opinion that two forms of osteoporosis exist. One is characterised by excessive trabecular bone loss in the axial skeleton leading to spinal fractures; the second is due to equal extents of axial and peripheral osteopenia, found in connection with hip fractures.

Adult↗