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Biomedical subjects

E Harju

Publications and source records attributed to E Harju.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Rabbit care unit for intravenous feeding and metabolic studies.

A simple rabbit care unit for peripheral intravenous feeding and metabolic studies was developed. The unit consists of six aluminum boxes with a common cover. Inverted T-shaped mobile supports hanging from the upper horizontal part of a frame hold the infusion lines. The side walls of the box prevent the rabbit from turning around, but other movements are possible. After initial training with 21 surgically treated animals, there was only one early anesthetic death among the subsequent 21 rabbits (4.8%). There was one late death (4.8%), and one animal was slightly, and two animals clearly, deteriorated. The ear vein cannula had to be changed in one-third of the animals not more than 3 days from the outset. Problems associated with the infusion systems or urinary bladder catheterization were minor. The results showed that it is practical to infuse rabbits via a peripheral intravenous route in a semi-restraining metabolic unit. The cases of late death and deterioration can be explained in part by the stress of experimental conditions with starvation and surgery, rather than by the effect of the metabolic unit alone. With previous experience in treating rabbits, we find the period required to learn this technique is short.

Animal Husbandry↗
PubMedDate not supplied

Empty iron stores as a significant risk factor in abdominal surgery.

The mortality and morbidity in abdominal surgery were investigated in two groups of patients, one with empty (N = 228) and the other with normal (N = 220) iron stores before operation. The estimation of body iron stores by measurements of serum ferritin concentration assumes that the only reason for a low ferritin value is an empty iron store. The results showed that the period of hospital treatment was shorter and the number of complications, especially infections, fewer, in patients with normal as compared to empty iron stores before the operation (p less than 0.001). These differences were especially striking in patients subjected to gastric or large bowel surgery. The results were not explained by differences in sex, age, serum albumin, or clinical anemia. The complications were not predictable from preoperative serum albumin, alkaline phosphatase, or alanine amino transferase levels. Among patients with postoperative complications those with preoperative empty iron stores also had a lower preoperative blood hemoglobin concentration (127 +/- 10 g/liter) than those with normal preoperative iron stores (136 +/- 9 g/liter). Thus it is speculated that the mechanisms behind postoperative complications due to preoperative empty iron stores might be a decrease in tissue oxygenation, resulting in an increased fatigue while working, decreased contractile capacity of the respiratory muscles, and a decrease in immune function. Thus a measurement of serum ferritin concentration and correction of empty iron stores is recommended before abdominal surgery.

Aged↗
PubMedDate not supplied

Effect of atropine on insulin secretion in healthy subjects.

The effect of an anti-cholinergic drug (atropine) on insulin secretion was studied in a double-blind manner by the glucagon C-peptide secretion test in five healthy subjects and controlled with saline only (placebo) in four subjects. Blood C-peptide increased only by 157% in the group given atropine and by 252% in the group given placebo. The blood glucose concentration increased by 25% and 32%, respectively. Thus, it is concluded that the cholinergic system, probably through the vagus nerve, has an insulin secretion stimulating effect. The results also suggest that denervation of the vagus nerve, e.g. in gastric surgery, may partly explain post-prandial hyperglycaemia particularly found in dumping.

Adult↗
PubMedDate not supplied

Vitamin D and calcitonin treatment in patients with femoral neck fracture: a prospective controlled clinical study.

The effects on general and bone metabolism of femoral neck fracture patients of 0.25 micrograms alpha-calcoid given orally twice daily (n = 9) and 25 micrograms calcitonin given subcutaneously 30 times (n = 10) in 10 weeks were studied against a control (n = 11). Bone histology and histomorphometry showed non-age related osteoporosis in 30% and osteomalacia in 22% of the patients studied. Impaired serum vitamin D status was found in 47-88% of patients, secondary hyperparathyroidism and increased serum parathyroid hormone in 59% and decreased serum calcitonin levels in 69%. On histology, normal findings and non-age related osteoporosis on histology were associated with low serum levels of 25-hydroxyvitamin D3, 1,25- and 24,25-dihydroxyvitamin D3. Very high serum levels of 1,25-dihydroxyvitamin D3 and low levels of 25-hydroxyvitamin D3 occurred in fracture patients with osteomalacia. Calcitonin improved calcium balance, reduced osteoporosis and increased the serum 1,25- and 24,25-dihydroxyvitamin D3 levels but had no effect on osteomalacia. Vitamin D reduced osteomalacia, slightly increased the serum 1,25-dihydroxyvitamin D3 concentration and decreased serum levels of parathyroid hormone. Both treatments gave a similar slight decrease in serum calcitonin concentrations. A mechanism of action for the treatments is suggested.

Aged↗
PubMedDate not supplied

Treatment with antioxidant and other nutrients in combination with chemotherapy and irradiation in patients with small-cell lung cancer.

Eighteen non-randomized patients with small cell lung cancer (4 women and 14 men, mean age 60.4, SD 7.8 years) received in addition to conservation small cell lung cancer treatment antioxidant treatment with vitamins, trace elements and fatty acids. All patients were out-patients who, except for one were also treated with chemotherapy and/or irradiation at regular intervals at a university of central hospital. Five patients (28%) were in an advanced stage of the disease. At the end of the follow-up period (31.7.90) the median survival time for the whole group was 505 days. Fourteen (77%) of the patients survived for more than 12 months and six patients (33%) for more than two years. One patient (5%) survived more than five years. Eight patients (44%) were still alive with a mean survival time of 32 months at the end of the study. Ten patients succumbed earlier from progression of the disease. Antioxidant treatment, in combination with chemotherapy and irradiation, prolonged the survival time of patients with small cell lung cancer compared to most published combination treatment regimens alone. We also noticed that the patients receiving antioxidants were able to tolerate chemotherapy and radiation treatment well. Surviving patients started antioxidant treatment in general earlier than those who succumbed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Transmediastinal esophagectomy and colon interposition without thoracotomy.

In the Central Hospital of Central Finland (responsibility for 250,000 inhabitants) the technique of transmediastinal esophagectomy and colon interposition without thoracotomy was used on 19 consecutive patients in the years 1983-1988. Fourteen of the patients had a malignant and five a benign disease. The type of cancer was squamous cell cancer in 13, and adenocancer in 1 case. All five patients with a benign disease had an etiology of corrosion by various agents. Two of them had a spontaneous rupture. In three cases the perforation occurred as a complication of endoscopic dilatation. There were no peroperative but one postoperative death. Six minor complications were well under control. The survival rate of cancer patients is comparable with the results reported by other authors. All five patients with a benign disease are in excellent condition with a follow up time from 4 to 100 months (mean 44 mo).

Adult↗
PubMedDate not supplied

Is it possible to reduce the number of cerebral complications in carotid endarterectomy?

An effort was made to reduce the number of cerebral complications in carotid endarterectomy by focusing attention on the perioperative prevention of embolism and thrombosis in a prospective series of carotid endarterectomies (group I, n = 62) performed during a 24 months' period 1982-1984 in Tampere University Hospital. Controls were two other series of carotid endarterectomies (group II, n = 60, and group III, n = 60) comprising all 120 carotid endarterectomies carried out by other trained vascular surgeons in the same hospital during the years 1976-1984. During the first 30 postoperative days there were no deaths, one stroke and one TIA in group I. On the other hand there were three deaths, seven strokes and five TIAs in group II and four deaths, two strokes and three TIAs in group III. The number of cerebral complications in carotid endarterectomy was significantly less in the study group than in the control groups, and thus it was possible to reduce the perioperative complications in carotid endarterectomy possibly by pre- and postoperative drug treatment and routine intraoperative heparinization.

Adult↗
PubMedDate not supplied

The protective effect of guar gum against stress-induced gastric ulcers in the rat.

After the methodology had been studied and pilot studies conducted, nine groups of rats (10 rats per group) were fed solutions of different compositions via orogastric tube during induction of stress ulcers by resistant and a cold ambient temperature. The first group was a control group and received no feeding. Group 2 rats received distilled water, group 3 rats guar gum in distilled water, group 4 rats wheat flour (placebo) in distilled water, group 5 rats a 10% solution of glucose in distilled water, group 6 rats guar gum in the 10% glucose solution, group 7 rats wheat flour in the 10% glucose solution, group 8 rats a 30% glucose solution and group 9 rats cimetidine, intraperitoneally. Cimetidine provided the best protection against stress-induced ulcers. Guar gum in distilled water was almost as effective as cimetidine. Slightly fewer rats (30%) exhibited ulcers in the guar gum group than in the cimetidine group (40%). However, the ulcers in the guar gum group were larger than those in the cimetidine groups. The percentage of rats with ulcers and the percentage of the largest category of ulcers decreased as the energy content of the solutions changed from 10% to 30% glucose and from the control percentages. The protective effect of guar gum in distilled water was reduced when it was infused in a 10% glucose solution. In the latter solution, the effect of guar gum was similar to that in the rats given wheat flour (placebo) in a 10% glucose solution.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMedDate not supplied

Diagnosing mammary cancer among an unselected Finnish population. Proposal for practical improvements.

A total of 309 new mammary cancer patients were found in three successive years among 250,000 unselected Finns showing an annual rate of 1.08 cancers per 1000 women over 20 years of age. The main preoperative examinations were palpation and mammography. Palpation alone was performed preoperatively in 158 (51 percent) patients, palpation and mammography in 120 (38 percent), and the tumor was nonpalpable and found only in mammography in 31 (10 percent) patients. Fine-needle biopsy with palpation was performed in 191 (62 percent) patients and it confirmed definite malignancy in 89 cases, that is in 47 percent of the biopsied patients and in 29 percent of all patients. Mammography was most valuable in small tumors and fine-needle biopsy in large ones. The number of mammographies performed in the whole population per each new cancer case was 50; it seems unreasonable to increase the number of mammographies performed. It seems that the best way to improve the present preoperative evafuation of mammary cancer patients would be to perform a fine-needle biopsy under stereotactic guidance in every patient, and especially in those with a small tumor.

Animals↗
PubMedDate not supplied

Clinical and metabolic effects and wound healing metabolism in controlled total parenteral nutrition with high vs. low nitrogen content for seven days after abdominoperineal rectum resection for carcinoma.

The clinical, metabolic and anthropometric effects and wound healing metabolism of two regimens of total parenteral nutrition with different amount of nitrogen low, 0.1 g, and high, 0.3 g/body weight kg/day were examined in this prospective double-blind study in two groups of ten patients subjected to abdominoperineal rectum resection for carcinoma for seven postoperative days. The results showed that the high nitrogen infusion associated with metabolic stress indicated by high excretion of urea, high level of serum urea and by a higher frequency of complications. Five patients of the high and one of the low nitrogen group showed complications (p less than 0.05). Further, the metabolic load, complications and high nitrogen infusion associated with higher body temperature, degree of fatigue, levels of C-reactive proteins, leukocytosis and lower of hand pressure force than found in those with low nitrogen infusion. The patient with low or high nitrogen infusion had similar parameters in wound healing metabolism of incision and stoma. The patients with complications showed a reduced stomal hydroxyproline concentration on the third postoperative day (p less than 0.05) and an increase of stomal and wound hydroxyproline and DNA on the seventh postoperative day (p less than 0.05). It is concluded that nitrogen amount of 0.1 g body weight kg/day is a better and a good alternative as compared to 0.3 g in total parenteral nutrition after major abdominal surgery for carcinoma.

Carcinoma↗
PubMedDate not supplied

Metabolic problems after gastric surgery.

The findings on dumping syndrome (DS) are not consistent considering its relations with age, sex, weight/height, smoking habits, race, dose of oral glucose, the time elapsed since surgery, the function of exocrine pancreas nor the duration of ulcer symptoms. The patients after total gastrectomy (TG) may present relative postprandial lack of insulin. As a sign of long-term hyperglycemia elevated HbA1 has been measured in DS patients. Oral galactose test may reveal new features of DS. Abnormalities in splanchnic blood circulation as well as release of intestinal hormones are involved with DS. Dietary habits including fibers, pectin and guar gum, play a central role in the prevention and treatment of DS. In unresponsive cases several operative methods have been applied with success. Alkaline reflux gastritis is most often seen after B II and I reconstructions and after pyloroplasty. Chronic diarrhea follows mostly after truncal vagotomy. Ten to 50% of patients after gastrectomy (GE) waste 10 to 20% of their body weight because of decreased food, energy, vitamin and mineral intake caused by eating-related symptoms. Vitamin and mineral supplements, a small snack 20 min before the major meal, digestive enzymes, treatment of colonization with antibiotics and protein foods may help. About 50% of GE patients show iron deficiency anemia. Easily dissolved iron between meals with ascorbic acid give the most effective response. Deficiency of vitamin B12 or of folate may develop as megaloblastic anemia. B12 supplement and antibiotics are effective in bacterial overgrowth, but surgical correction is necessary in troublesome blind loop. Folic acid deficiency is corrected by oral folic acid.(ABSTRACT TRUNCATED AT 250 WORDS)

Dumping Syndrome↗
PubMedDate not supplied

Late results of surgical and nonoperative treatment of carotid stenosis. Eighty-four patients documented by angiography in 1974-1976.

The long-term results of carotid endarterectomy are controversial. Here we report the late results of 44 surgically and 40 non-surgically treated patients with carotid stenosis documented by angiography in 1974-1976. The groups were similar with respect to sex-distribution, age, length of follow-up time (median 123.0 and 130.0 months in the surgical and non-surgical groups, respectively) and the occurrence of risk factors. Hypertension was more frequent (p less than 0.05) in the surgical group, as was medical treatment, mostly anticoagulants (p less than 0.06). The angiographic findings were also more severe in this group (p less than 0.001). During the follow-up period the occurrence of cerebrovascular complications (death, stroke and/or TIA) was more frequent in the nonoperated than in the operated group; however, survival of the patients was similar, as the cardiovascular deaths were an equalizing factor. The quality of life in patients alive examined for clinical and neurologic status and by neuropsychological tests and interview was similar, except that the operated patients were more satisfied. The progression of atherosclerosis in the carotid artery assessed by Duplex scanning was more frequent in the nonoperated group. Differences in medical treatment did not explain the results. Thus it is concluded that the late results were better in the operated patients with carotid stenosis than in the nonoperated ones.

Carotid Artery Diseases↗
PubMedDate not supplied

Early cerebral complications in carotid endarterectomy: risk factors.

Three hundred and thirty one carotid endarterectomies were performed on 279 patients during a period of twenty years from 1965 to 1984. The indication for surgery was transient ischemic attack in 67.4%, stroke in 22.7% and asymptomatic carotid stenosis in 10.0% of the operations. The overall major cerebral complication rate attending the operation was 9.6%. During the last four years' period from 1981 to 1984 the procedure morbidity was 3.6% and there was no mortality. Postoperative complications comprised 31 ipsilateral strokes and one contralateral stroke; the complications occurred during the first 24 hours in 28 cases and on the fourth or fifth day in four cases. Of these patients 11 succumbed to internal carotid thrombosis, one to cerebral infarction without thrombosis and one to intracerebral hemorrhage. The associated factors for major complications were analyzed retrospectively in the light of 32 parameters. Patients of advanced age, patients with type II diabetes mellitus, elevated serum triglycerides, high-grade stenosis or occlusion of the contralateral carotid artery, negative smoking history and those undergoing a second operation proved to be at high risk of early postoperative cerebral complications. These complications can be reduced by intraoperative use of heparin, preoperative ASA treatment and a short clamping time. Also peroperative use of shunt is obviously of benefit.

Age Factors↗
PubMedDate not supplied

Malignancies in the families of patients with gastric polyps.

The present series consists of 155 patients with gastric polyps who attended the Central University Hospital of Tampere/between 1972 and 1983/but who did not develop gastric malignancies during the follow-up. 93 patients with non-ulcer dyspepsia served as controls. Both the experimental and control patients were interviewed with the help of a schedule as to the occurrence of malignancies among their family. The family was defined as parents, grand parents, brothers, sisters and children. There was a total of 961 members in the families of the study patients and 755 in the families of controls. In the families of the men with gastric polyps, the frequency of intestinal malignancies as a percentage of all malignancies was higher than in the controls, 10.3 and 2.9 percent, respectively (p less than 0.01). The frequency of gastric malignancies in the families of the women with gastric polyps was higher than in the controls and in men, 6.2, 3.1 and 2.4 percent, respectively (p less than 0.05, and p less than 0.025). The frequencies of all malignancies were similar in the study and control families. Thus there seems to be some family -related accumulation of intestinal malignancies in men and of gastric malignancies in women with gastric polyps.

Female↗
PubMedDate not supplied

Mammographic and palpation findings in the irradiated spared breast.

Between 1983 and 1987, 22 women underwent breast-preserving treatment for T1 (n = 19) or T2 (n = 3) cancer. Axillary surgery was performed in 17 patients and axillary node "sampling" in one patient, while 4 patients had no axillary surgery. Radiotherapy was begun no later than six weeks after operation. The patients had the first post-treatment follow-up examination at 1 month to 41 months after irradiation. Six of the patients had more than one follow-up examination. According to the length of the follow-up period, there were two different groups of patients. Fourteen patients had the first follow-up examination at 1 month to 10 months after completion of radiation treatment. Eleven breasts (79%) had solid consistency as well as radiological edema. Six of the breasts had signs of severe edema seen during the first 6 months. At the second or third examination, if made after 10 months, the signs of edema decreased or disappeared. Eight patients examined for the first time at 12 to 41 months after radiation treatment had no radiological signs of breast edema and only 3 of the breasts were solid. The present results suggest that post-treatment mammograms are not useful during the first 6 months after irradiation and that the value of palpation is limited to at least 10 months; in selected patients these periods can be considerably longer.

Breast↗
PubMedDate not supplied

High serum lactic acid concentration after laparotomy and peritonitis in iron stores depletion. An experimental study on the rat.

Total depletion of iron stores with a moderately decreased blood hemoglobin concentration (114 x 10 vs. 155 x 12 g/l in controls, n = 28) was produced in rats (n = 28) by rearing them for six weeks on an iron free diet, in iron free cages, starting at two weeks of age. The controls were treated at the same time in same conditions, except that they were given a normal supply of dietary iron. In all rats laparotomy and peritonitis by ligation and puncture of the caecum were carried out with ether anesthesia. Postoperative mortality and blood lactic acid concentration were followed for 120 minutes after the procedure. Postoperative mortality (8 of 28, 29% vs. 1 of 28, 4%) and blood lactic acid concentration (3.3 x 0.3 to 3.6 x 0.5 vs. 1.4 x 0.1 to 1.8 x 0.2 mmol/l) were higher (p less than 0.001) in the experimental group than in the control animals. The surviving rats (2.0 x 0.1 to 2.1 x 0.2 mmol/l) had a lower (p less than 0.001) blood lactic acid concentration than those who died (5.6 x 0.5 to 6.1 x 1.1). The results suggest that total lack of iron producing a moderate decrease of blood hemoglobin concentration creates a significant risk in abdominal surgery and focus the activation of the anaerobic energy yielding process.

Animals↗
PubMedDate not supplied

Decreased galactose absorption in dumping after colon interposition.

Intestinal absorption was examined using an oral galactose test in colon interposition patients with dumping (no. 4) and without symptoms (no. 5). Normal subjects (no. 5), and patients after total gastrectomy (no. 7) and gastric resection (no. 4) served as controls. Galactose is absorbed in the same way as glucose, but does not stimulate insulin secretion. Colon interposition patients presented abnormally rapid postprandial transit and absorption for 20 minutes after the meal. After this rapid phase, colon interposition patients with dumping demonstrated a strong decrease in absorption rate, whereas the asymptomatic patients presented a normal rate during the whole follow-up period. The elimination of galactose from the blood was studied in eight patients after intravenous infusion of galactose; the disappearance was linear during 10 to 30 min after injection and did not explain the differences in blood galactose levels in the oral galactose test. We suggest a reactive reflux back to the intra-abdominal colon graft loop in the avagotonic intestinal tract as the mechanism for the differences in absorption. The most likely reason for this is the rapid initial phase transit through the coloantral anastomosis and pyloroplasty. To normalize postprandial transit and absorption as much as possible after colon interposition, a short intra-abdominal colon graft loop anastomosed to the posterior proximal stomach is suggested.

Colon↗