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Biomedical subjects

H Alaranta

Publications and source records attributed to H Alaranta.

At least 91 records · Page 5Linked to original sources
PubMed1989

Connective tissue changes of the multifidus muscle in patients with lumbar disc herniation. An immunohistologic study of collagen types I and III and fibronectin.

The connective tissue components, Types I and III collagen fibronectin, were immunohistologically analyzed using their specific antibodies for localization and semiquantitative estimation in 24 patients (11 women and 13 men, all under 55 years of age) operated on for herniated lumbar intervertebral disc. Nine cadavers without known back problems (2 women, 7 men) served as controls. In controls, Type I collagen was present in the endo- and perimysial structures of the muscle, more conspiciously in the former. Type III collagen, together with fibronectin, were more abundant in the perimysium than in the endomysium. Thickening of these structures was not evident in the controls. In most patients Types I and III collagen and fibronectin distribution was similar to that of the controls. However, fibrotic changes of both and endo- and perimysial structures involved all Types I and III collagen and fibronectin in ten cases. In two patients an increase in Type I collagen staining intensity in the endomysium was recorded and thickening of the endomysial structures was observed in six patients. There were correlations with the severity of the connective tissue structural changes to atrophy of the muscle and furthermore to disability of the patient in the 1-year postoperative check-up. These findings suggest that if marked fibrosis of the muscle occurs, it can be a factor impairing recovery from the disease during the long-term postoperative course.

Adult↗
PubMed1989

Primary survival and prosthetic fitting of lower limb amputees.

During the period 1984-1985 amputation of the lower limb at a level potentially requiring a prosthesis was performed on 577 patients in 16 operative units. The mean age was 75.7 years for females and 68.1 for males. The most common site of the amputation was above the knee (49.9%). The majority of amputations (93.8%) were performed for vascular diseases and diabetes. Survival figures showed that 25.5% of amputees died within 2 months of amputation, 60.7% were alive after one year and 43.2% after two years. Out of a total of 577 patients, 26.9% were fitted with a prosthesis. Out of below-knee and above-knee amputees surviving over 2 months, 61.5% and 27.2% respectively were fitted with a prosthesis. There were markedly fewer prosthetic fittings in the over-60 age group. Diabetic patients of both sexes were fitted with a prosthesis more often than arterio-sclerotic patients. Among tumour patients 82.4% received a prosthesis. In the study area more emphasis must be put on the concept of preserving the knee joint and preoperative assessment of vascular patients for selection of amputation level. Every effort must be made to avoid delay in the postoperative mobilization and rehabilitation. Prosthetic fitting of amputees could be improved by better liaison between surgical unit and specialized rehabilitation unit and by closer team approach of amputee care.

Aged↗
PubMed1988

Lower limb amputations in southern Finland 1984-1985.

To assess the current epidemiological situation concerning lower limb amputations in southern Finland the data on all amputations made in the catchment area of the Helsinki University Central Hospital were analysed for the period 1984-85. During the two-year period, 880 amputations of lower limbs were performed on 705 patients. The amputation rate was 32.5 per 100,000 inhabitants in 1984 and 28.1 in 1985. Patients requiring amputation were arteriosclerotics in 43.1 per cent. and diabetics in 40.7 per cent. Diabetics underwent amputation 3 years younger on average than the arteriosclerotics. The most common site of unilateral amputations was above-knee (42.0 per cent) followed by below-knee (27.7 per cent) and toe amputations (22.2 per cent). The level of amputation tended to become more proximal with increasing age of the patients. The overall mortality figure during three postoperative months was 27.0 per cent. Amputation incidence increased sharply with increasing age. On the base of predictions, the overall age structure of the Finnish population will shift upward causing an increase in the proportion of elderly age groups. A 50% increase in amputation rate is expected in Finland within the next 20-30 years.

Adult↗
PubMed1988

Compliance and subjective relief by corset treatment in chronic low back pain.

The aim of this questionnaire-based 12-month follow-up study of 113 patients was to elucidate patient compliance and subjective help achieved with a first, elastic or semirigid corset in chronic, idiopathic low back pain. Subjective help obtained from the corset was reported as excellent or good in 37% of the returned questionnaires. A total of 60% reported having worn the corset even during the preceding month. Low semirigid and elastic models were found to be better by the males and high semirigid ones by the females (p less than 0.001). Age, height, weight, body mass index, retirement or physical strenuousness of work showed no statistically significant correlation with the subjective relief gained from the corset. It is important that sufficient time be allocated to fitting the corset and that adequate information be provided about wearing the brace and about suitable trunk exercises.

Adult↗
PubMed1988

Upper limb amputations in southern Finland 1984-85.

There is a specific requirement for amputee statistics to facilitate the planning of prosthetic rehabilitation of amputee patients. The aim of this study was to analyse the epidemiological situation concerning upper limb amputations in southern Finland. The data on all limb amputations made in the catchment area of the Helsinki University Central Hospital were collected for the period 1984-85. During the two-year period upper limb amputations had been performed on 52 patients. A total of six major amputations had been performed on 52 patients. A total of six major amputations had been performed at a level potentially requiring a prosthesis, and 46 patients had undergone amputation distal to the carpal joint. The overall upper limb amputation rate was 2.2 and rate of major amputations 0.3 per 100,000 inhabitants per year. The ratio of men to women was 7.7 for all amputations and 10.5 for finger amputations. Of the 52 amputees, 62 per cent were in the 20-59 age group. The mean age of all amputees was 42.7 years. The typical upper limb amputee was a man of active working age. Trauma, mainly occupational accident, was the most common cause, accounting for 61 per cent of all upper limb amputations. The annual incidence of major amputations in the whole of Finland is as low as 20-30 cases. It would seem reasonable to concentrate prosthetic fitting of upper limb amputations at two or three prosthetic factories and rehabilitation centres.

Adult↗
PubMed1988

Neck and shoulder pain and disability. Evaluation by repetitive gripping test.

A repetitive gripping test for the evaluation of neck and shoulder pain and disability was standardized and validated in a population study. Repeatability of the endurance of gripping was acceptable (correlation coefficient 0.74). Out of 49 women without neck and shoulder pain during the preceding seven days, 18% showed low endurance (endurance time less than 7 min); out of 19 women with disabling pain during the preceding seven days, 58% showed low endurance; and of 10 women with disabling pain at the time of examination, 80% showed low endurance. Low endurance was related to disability especially in some critical functions of the arms as e.g. working with the hands overhead. Endurance was not affected by age. In men, low endurance did not correlate with neck and shoulder pain. The test provides a tool for the evaluation of patients, but the applicability of the test to men needs further research.

Adult↗
PubMed1987

Factors predicting the result of surgery for lumbar intervertebral disc herniation.

The prospective study was undertaken to find out preoperative or perioperative factors predicting the results of the first surgery for lumbar disc herniation. The results were evaluated 1 and 6 months postoperatively using, in addition to the patient evaluation, indices for pain, activities of daily living (ADL), and working capacity. The best result was achieved if the patient was operated on before 2 months' duration of disabling sciatica. The operative finding graded as protrusion predicted poor result. The social and psychological factors influenced the outcome more than the findings in the preoperative physical examination or the grade of operative finding. It is recommended to add indices for pain and ADL and a psychological test to the preoperative examinations of patients with lumbar disc herniation.

Absenteeism↗
PubMed1987

Increased activity of serum gamma-glutamyltransferase in myotonic dystrophy.

The activity of serum gamma-glutamyltransferase (gamma-GT) and its determinants were studied in 17 patients with myotonic dystrophy. The gamma-GT activity was elevated in 11 patients and its mean value was five-fold higher than in healthy controls. The increase in gamma-GT could not be explained by factors generally known to result in a misleading elevation of gamma-GT. Most patients with elevated gamma-GT also had one or more other pathological laboratory tests related to hepatic function but none had a clinically significant liver disease. Serum gamma-GT activity was not related to the disability caused by dystrophy or to the level of serum creatine kinase suggesting that the elevation of serum gamma-GT is not an indication of a general cell membrane dysfunction. It is concluded that the increase in serum gamma-GT activity in patients with myotonic dystrophy is due to a real but mild liver involvement, which should be taken into account in the examination of these patients who often complain of gastrointestinal symptoms.

Adult↗
PubMed1987

Leisure time physical activities and the results of surgery of lumbar disc herniation.

The aim of this study was to elucidate the consequences of leisure time physical activities on the one-year results of surgery of lumbar intervertebral disc herniation. Pre- and postoperative leisure time physical activities and severity of occupation handicap were analyzed from 212 patients. Only to a certain degree the findings support the claim that a high preoperative level of physical activities during leisure time is linked with good postoperative results.

Adolescent↗
PubMed1986

Rehabilitation after surgery for lumbar disc herniation: results of a randomized clinical trial.

The aim of this prospective study was to examine the one-year postoperative results in patients operated on for lumbar disc herniation randomized in two groups: one with comprehensive rehabilitation and the other taken care of by normal care facilities. A total of 212 patients without any previous spinal operations comprised the final study group. The physiatrist, the surgeon, the social worker, and the psychologist performed the handicap evaluation according to the occupation handicap scales of the WHO. The handicap was evaluated for two phases: before the onset of acute sciatica leading to operation and one year after operation. No significant differences in handicap distribution between the intervention and normal care groups were seen. The postoperative handicap correlated highly significantly with preoperative handicap for both groups. More than half (57%) of all the patients returned to work within two months of the operation. The amount of sick leaves did not differ significantly between the intervention and normal care groups. A total of 15 persons (7%) retired during the postoperative year.

Absenteeism↗
PubMed1986

The multifidus muscle in patients with lumbar disc herniation. A histochemical and morphometric analysis of intraoperative biopsies.

Structural changes in the multifidus muscle were analyzed in 41 patients operated on for herniated intervertebral disc. Twelve cadavers served as controls. The two main findings follow: Both in the patients and in the controls the Type 2 muscle fibers were markedly and selectively smaller than the Type 1 fibers, which were of normal size for striated muscles, and the internal structure of Type 1 fibers showed so-called core-targetoid and/or moth-eaten change. Group atrophy or fiber-type grouping (indicators of denervation and reinnervation) were observed only in a few patients. The selective small size of the Type 2 fibers may indicate atrophy due to relative inactivity of the multifidus muscle both in the patients and in the controls, ie, it does not need to be related to the herniated disc. Definite proof for denervation of the multifidus muscle was not observed, but neither the possibility be excluded. The cause of the core-targetoid and/or moth-eaten changes cannot yet be determined with certainty, because these changes are not specific for any single entity but may be due, for example, to denervation, ischemia, or altered use of the muscles because of pain. In any case, because the changes were significantly more common in the patients than in the controls, they signal for a pathologic condition, the character of which remains to be elucidated.

Adult↗
PubMed1986

The concept of consequences of disease in patients with low back pain.

This paper is based on 212 patients operated on 1 year earlier for lumbar disc herniation. We should have liked to find severity scales for impairment in the ICIDH. The severity scale for disability was not practical for use with low back pain patients. Assignment to the different scale categories of occupation handicap was relatively easy. As a theoretical model of the process of an individual's illness we found it helpful to use that proposed by Purola. The ICIDH concepts seem like a bridge between the medical (internal system) and social connexions (external system) of illness.

Activities of Daily Living↗
PubMed1986

Handicap 1 year following surgery for lumbar disc herniation: special reference to social and vocational factors.

The aim of this cross-sectional study was to clarify social and vocational factors defining occupation handicap in 212 patients operated 1 year earlier for lumbar disc herniation. It seemed that many social and vocational factors had a significant correlation with low back pain problems. Although it is not always relevant to offer social and vocational factors as the cause of back complaint, these may be regarded as associated factors where the link could exist through coping with life situation.

Adolescent↗