Search PubMed⌕ Search

Biomedical subjects

H Rantala

Publications and source records attributed to H Rantala.

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

Risk factors of infantile spasms compared with other seizures in children under 2 years of age.

To analyze the magnitude of the risk factors for infantile spasms, we evaluated the records of 80 children with infantile spasms, 474 children with other types of epilepsy, 2,196 children with febrile seizures, and 262 children with CNS infections. There was a family history of seizures in 13.8% of children with infaNtile spasms, 28.5% of children with other forms of epilepsy, 25.5% of children with febrile seizures, and 5.3% of children with CNS infections. Children with a family history of seizures were 2.82 times more likely to have infantile spasms, 7.05 time more likely to have other epilepsy, and 6.08 time more likely to have febrile seizures than controls (children with CNS infections). However, a family history of seizures increased the risk for infantile spasms only in the cryptogenic group. Children with infantile spasms were significantly more likely to have cerebral palsy, microcephaly, hydrocephaly, CNS malformations, neonatal hypoxia, or neonatal seizures than children with other types of epilepsy, febrile seizures, or CNS infections. There was a modest genetic predisposition to seizures in children with infantile spasms. However, our data suggest a much stronger association with underlying neurologic abnormalities, mainly neonatal seizures, neonatal hypoxia, and CNS malformations.

Age Factors↗
PubMed1995

Risk factors of respiratory failure in children with Guillain-Barré syndrome.

Recently it was found that plasmapheresis and intravenous immunoglobulins are effective in treating patients with Guillain-Barré syndrome (GBS). However, these treatments are expensive and not without possible adverse effects. Because signs and symptoms predictive for respiratory failure in GBS would be helpful in targeting the treatment, risk factors for respiratory failure were evaluated in 120 children with GBS. Twenty children required assisted ventilation. None of the children without any of the following risk factors had respiratory failure. If the symptoms of GBS began within 8 days after a preceding infection, the odds ratio (OR) for respiratory failure was 4.9 [95% confidence intervals (CI): 1.3-18.5]. Cranial nerve involvement was more common in children who required assisted ventilation (15/20 versus 32/100, OR: 6.4, 95% CI: 2.1-19.1). A cerebrospinal protein level > 800 mg/L during the first week had an OR for assisted ventilation of 3.1 (95% CI of OR: 1.04-9.0). In the logistic multivariate model, all of these risk factors were associated with the need for assisted ventilation. On the basis of our findings, preventive treatment with either plasmapheresis or intravenous immunoglobulins could be directed to those children with any of the risk factors; for those patients without the risk factors, clinical monitoring would be satisfactory.

Child↗
PubMed1995

Effect of acetaminophen and of low intermittent doses of diazepam on prevention of recurrences of febrile seizures.

Acetaminophen and low doses of diazepam were evaluated for the prevention of recurrences of febrile seizures in a placebo-controlled, double-blind trial. Children after their first febrile seizure were assigned to receive either one dose of rectally administered diazepam, and then, after 6 hours, oral doses of 0.2 mg/kg three times a day for the first 2 days if the fever stayed greater than 38.5 degrees C, or a placebo similarly during forthcoming febrile episodes. In addition, each febrile episode was randomly assigned to be treated with acetaminophen or the placebo. Thus four groups were examined for 2 years: patients receiving two kinds of placebo, patients receiving diazepam and a placebo, patients receiving acetaminophen and a placebo, and patients receiving both diazepam and acetaminophen. Of a total of 180 patients (102 boys), 161 were followed for the 2-year period and 157 were seen at the last outpatient examination: 80 in the diazepam group and 77 in the placebo group. The final analysis of the efficacy of the drugs was made on the basis of the data from 153 patients who had had at least one febrile episode during follow-up. There were 641 fever events during this period, and 38 children (21.1%) had 55 recurrences of febrile seizures. Acetaminophen had no effect on the recurrence rate. Seizures recurred at least once in 21 patients (28.4%) receiving diazepam and 17 (21.5%) receiving a placebo (p = 0.4138, log-rank test). The combination of antipyretic agents with anticonvulsant medication did not reduce the recurrence of febrile seizures. Our results show that low doses of acetaminophen or diazepam or both are ineffective for preventing febrile seizures.

Acetaminophen↗
PubMed1995

Factors triggering the first febrile seizure.

The symptomatology of infections as well as immunological and virological findings were analysed using a logistic model in a survey of 58 children experiencing their first febrile seizures. These were then compared with findings in 116 age- and sex-matched controls with infections but no seizures. There were no statistically significant differences in the aetiology of infections between patients and controls. High temperature was the only variable to explain the occurrence of febrile seizures in the logistic model after adjusting for duration of symptoms (partial correlation coefficient in logistic model, r = 0.31). The duration of symptoms before hospitalization was shorter in patients than in controls (mean 1.0 and 3.6 days). With a longer duration of symptoms, the likelihood of seizures diminished (r = -0.34). Patients in the seizure group had a significantly higher temperature at home than controls before hospitalization (39.4 versus 38.8 degrees C). Our findings of higher temperatures in children with febrile seizures supports its importance as the most important triggering factor in febrile convulsions.

Bacterial Infections↗
PubMed1994

Medical student abuse: an international phenomenon.

OBJECTIVE: To evaluate the prevalence of physical and psychological mistreatment of medical students at two medical schools in Finland. STUDY DESIGN AND SETTING: To enable comparison between Finnish and American students, we used the American Medical Association's Office of Education Research questionnaire. RESULTS: Three of every four students surveyed reported experiencing some kind of mistreatment during their medical education. Students most commonly reported sexual mistreatment, usually as slurs and sexual discrimination, from classmates, preclinical teachers, clinical teachers, clinicians, nurses, and patients. Other forms of verbal abuse, psychological mistreatment, and physical threats were also reported. CONCLUSIONS: All forms of mistreatment were reported occurring less frequently than in the United States; still, the level of such behavior was high. The results suggest the need for more international awareness and debate regarding the habits and behavior of teaching staff in medical schools.

Female↗
PubMed1994

Epidemiology of Guillain-Barré syndrome in children: relationship of oral polio vaccine administration to occurrence.

Because a cluster of cases of Guillain-Barré syndrome followed a mass vaccination program using oral polio vaccine, a retrospective epidemiologic survey was carried out in southern California to examine the relationship between oral polio vaccine and Guillain-Barré syndrome. We also examined the yearly pattern of Guillain-Barré syndrome and compared rates of illness in different ethnic populations. The mean annual incidence of Guillain-Barré syndrome was 0.60 (95% confidence intervals 0.48 to 0.73) per 100,000 children under 15 years of age. There was no difference in incidence between boys and girls or between ethnic populations. The incidence was significantly higher in 2-year-old children than in any other age group (p < 0.05). The onset of Guillain-Barré syndrome was preceded by an infection in 71 (76%) of 93 children. In five children (5%) a vaccination was given within 8 weeks before illness onset. Only two children received the oral polio vaccine; the duration from vaccine administration to the onset of Guillain-Barré syndrome was 41 and 52 days, whereas the mean incubation time associated with infectious illnesses was 10.3 days. Strong evidence against a causal relationship between oral polio vaccine administration and Guillain-Barré syndrome is provided by the failure to find a correlation between the usual age of immunization with oral polio vaccine and the incidence of Guillain-Barré syndrome by age and the failure to find any children with onset of Guillain-Barré syndrome within 1 month of immunization with oral polio vaccine.

Adolescent↗
PubMed1994

Risk factors for recurrences of febrile convulsions.

Risk factors for predicting recurrences of febrile seizures were studied in an unselected series of 169 children after their first febrile seizure. Follow-up data covering 2.1-6.8 (mean 3.8) years from the first febrile seizure were available from 167 of them (98.8%) including 72 girls. Altogether 35/167 (21.0%, 95% confidence intervals (CI) 14.6% to 29.1%) had further febrile seizures, and multivariate logistic regression analysis showed the number of febrile episodes (p = 0.011) and the occurrence of such seizures among first degree relatives (p = 0.015, relative risk 3.75, CI 1.22 to 11.5) to be significant risk factors for recurrences. Our findings indicate that more emphasis should be placed on preventing febrile episodes rather than concentrating only on preventing seizures with antiepileptic therapy.

Child↗
PubMed1992

Fumarase deficiency: two siblings with enlarged cerebral ventricles and polyhydramnios in utero.

A family having two boys with progressive encephalomyopathy and fumaric aciduria due to fumarase deficiency is described. Both patients initially presented with polyhydramnios and enlarged cerebral ventricles in utero, with subsequent cerebral atrophy, severe developmental delay, infantile spasms, and hypsarythmia on electroencephalogram. Fumarase activity in blood mononuclear cells and in the mitochondrial and cytosolic fractions of cultured skin fibroblasts was less than 0.5% of the control mean or undetectable. The older boy died at the age of 5 years and 4 months and the younger one is now 2 years and 10 months. The unrelated parents are symptomless and the other three children in the family are clinically healthy. Fumarase activities in the blood mononuclear cells of the father, mother, sister, and two brothers were 59%, 52%, 52%, 120%, and 44% of the control mean, respectively. The results strongly support autosomal recessive inheritance of fumarase deficiency and suggest its consideration in children with congenital hydrocephalus, progressive brain atrophy, and infantile spasms.

Cells, Cultured↗
PubMed1991

Outcome after childhood encephalitis.

The prognosis for 73 children treated for encephalitis between 1973 and 1983 was evaluated. 70 children participated in a follow-up examination 2.4 to 12.9 years after the acute phase of the disease. The 61 school-aged children had lower performance and full-scale IQs than their randomly selected, age- and sex-matched controls. Visual acuity was more often reduced, and they more often had focal slowing on EEG and electronystagmogram abnormalities. Clinically, these differences were not significant. Encephalitis with a poor prognosis occurred seldom, the incidence being 3.5 cases per one million children at risk annually. These results show that the prognosis for childhood encephalitis is much better than anticipated on the basis of experience mainly with herpes simplex virus encephalitis.

Adolescent↗
PubMed1991

Occurrence, clinical manifestations, and prognosis of Guillain-Barré syndrome.

In order to obtain more information on the incidence of Guillain-Barré syndrome and recent developments in its prognosis, we analysed the severity and prognosis of Guillain-Barré syndrome in children diagnosed and treated during the years 1980-6 throughout Finland. The criteria for Guillain-Barré syndrome were fulfilled in 14 boys and 13 girls. The mean annual number of cases of Guillain-Barré syndrome was thus 3.9, giving a mean annual incidence of 0.38/100,000 of population under 15 years of age (95% confidence intervals 0.25 to 0.56/100,000). The incidence of Guillain-Barré syndrome causing permanent neurological defects in children under 15 years of age was 1.4/10 million annually (95% confidence intervals 0.035 to 7.8/10 million). Our figures appeared to be one fourth to a half of that reported earlier in children and even lower than those in adults. Although there were no deaths among our patients, mortality from Guillain-Barré syndrome seems to have remained similar for the last 20 years despite current awareness of the possibility of cardiac arrest and respiratory failure.

Adolescent↗
PubMed1990

Viral infections and recurrences of febrile convulsions.

To determine whether complicated febrile seizures occur more often in children with a proven viral infection, we performed viral examinations on 144 children with febrile convulsions, of whom 112 had simple and 32 had complicated seizures. A diagnosis of virus infection was verified in 46% of the former patients and 53% of the latter. Three adenoviruses, one parainfluenza virus type 2 and one type 3, one respiratory syncytial virus, one echovirus type 11, one herpes simplex virus type 2, and one influenza B virus were isolated from the cerebrospinal fluid. A simple febrile convulsion occurred in seven children with a positive cerebrospinal fluid viral isolation, and two had a complex febrile seizure. In a follow-up of 2 to 4 years (mean 3.3 years), 21 of the 107 children with simple seizures (19.6%) and 3 of the 32 children with complicated seizures (9.4%) had recurrent febrile seizures. The children with positive evidence for a viral infection, even with a virus isolated from the cerebrospinal fluid, had no more recurrences than those without any proven viral infection. We conclude that children with a proven viral infection have no worse prognosis than those without.

Cerebrospinal Fluid↗
PubMed1989

Poliovaccine virus in the cerebrospinal fluid after oral polio vaccination.

In February-March 1985 an oral poliovirus vaccine campaign was launched in Finland in a population vaccinated earlier with inactivated poliovaccine. During this campaign a strain of poliovirus was isolated from the cerebrospinal fluid (CSF) of a 7-year-old girl 34 days after she had received oral poliovirus vaccine. She had long-lasting headache, vomiting and fever but no paralysis. This case demonstrates that poliovaccine virus can invade the central nervous system even after a complete course of inactivated poliovirus vaccine if the inactivated vaccine has been poorly antigenic against one of the three types of virus.

Cerebrospinal Fluid↗
PubMed1989

Nocturnal release of immunoreactive growth hormone-releasing hormone and growth hormone in normal children.

To evaluate the role of growth hormone-releasing hormone (GHRH) in the physiologic release of growth hormone (GH) we studied the nocturnal secretion of immunoreactive GHRH (ir-GHRH) and its relationship to GH release and various stages of sleep in six prepubertal (three boys) and six pubertal children (two boys) with normal stature. Their ages ranged from 8.1 to 14.9 yr and their bone ages from 6.8 to 14.8 yr. Blood was withdrawn continuously between 2200-0600 h at a constant rate of 5 mL/20 min. The EEG was simultaneously registered. The ir-GHRH and GH data were analyzed by a discrete-pulse detection algorithm (Pulsar). The number of nocturnal ir-GHRH pulses varied from 0-8 (median 7) and the number of GH peaks from 2-6 (median 3). Pubertal children had significantly more (p less than 0.05) ir-GHRH pulses and the pulse amplitude was higher (p less than 0.05) than in the prepubertal children. There were no significant differences in the GH parameters between the two groups. The ir-GHRH peaks were not significantly related to any specific sleep stage. The majority of the GH pulses (71%) were associated with slow wave sleep (p less than 0.001). Two-thirds (69%) of the GHRH peaks preceded closely or coincided with GH pulses (p less than 0.02). Pubertal subjects had more isolated ir-GHRH peaks than prepubertal children (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Occurrence of childhood encephalitis: a population-based study.

The occurrence of childhood encephalitis was evaluated in a population-based study in an area with no arboviral infections. Ninety-five children were treated for encephalitis during 1973 to 1987, giving an annual incidence of 8.8/100,000 children younger than 16 years of age (95% confidence interval, 6.7 to 10.1). Based on virologic and serologic studies the most common etiologic agents were varicella (24 cases), mumps (8), herpes simplex (7) and measles (4). The etiology remained unknown in 37 children. No cases of encephalitis caused by mumps, measles or rubella were found in the population after 1982, when vaccination against these viruses was introduced.

Adolescent↗