Biomedical subjects

J Kinnunen

Publications and source records attributed to J Kinnunen.

At least 19 recordsLinked to original sources

PubMed2000

Natural coral as bone-defect-filling material.

Natural coral (NC) has been studied experimentally and clinically as a bone substitute, but its resorption rate and possible replacement by bone still need to be defined in humans. In this study bicortical bone was harvested from the iliac crest of 10 patients. The defect was filled with a NC block, and changes were monitored by X-rays and quantitative CT scans for a mean of 2.1 years. A biopsy was taken at 1 year. The purpose of the study was to investigate the resorption rate and pattern of NC (Porites) implants and the replacement, if any, of the implant by new bone. The blocks underwent centripetal resorption, but all the blocks still could be detected by X-rays and CT scans at the end of the follow-up period. The density of the remaining block did not change. Seven of the 10 implants were smaller than 50% of their original size at the end of the study. Bone ingrowth could be observed only in two of seven biopsies. One implant had to be removed after 1.7 years due to infection. The study shows that resorption of natural coral proceeds centripetally and apparently more rapidly when accompanied by tissue ingrowth. None of the blocks resorbed completely, and the defect at the iliac crest had not been restored by the end of the study.

Adolescent↗

PubMed2000

Prioritization attitudes among doctors and nurses examined by a scenario method.

OBJECTIVES: To investigate doctors' and nurses' attitudes toward 14 potential prioritization criteria. METHODS: This study was performed by using the random paired scenario method. The respondents received a questionnaire with 12 pairs of scenarios, imaginary patient cases, each of which contained two to three different prioritization criteria (e.g., child, old patient, poor patient). Respondents were asked which one of each scenario pair they would choose if only one patient could be treated. The scenarios were randomly put into 30 different questionnaire sets. There was a random selection of 241 doctors and 151 nurses in Finland, with response rates of 60.3% and 50.3%, respectively. RESULTS: Doctors prioritized young patients, severe disease, expensive treatments and posteriorized (negatively prioritized) demented or institutionalized patients, and patients having a self-caused disease. Children were strongly prioritized, even over serious diseases. Expensive treatments appeared to be favored by doctors, and this result cannot be explained by severity of disease. Nurses' attitudes were similar to those of doctors. CONCLUSIONS: Children were strongly prioritized. Elderly persons were posteriorized if they had dementia or were living in institutions. Patients having a self-caused disease are posteriorized, more often by nurses than by doctors.

Adult↗

PubMed2000

Chondrosarcoma in a family with multiple hereditary exostoses.

Multiple hereditary exostoses is an autosomal dominant skeletal disorder in which there are numerous cartilage-capped excrescences in areas of actively growing bone. The condition is genetically heterogeneous, and at least three genes, ext1, ext2 and ext3 are involved. The reported risk for malignant transformation to chondrosarcoma has been from 0.6% to 2.8%. We have reviewed six generations of a family with 114 living adult members, 46 of them with multiple exostoses. Four have had operations for chondrosarcoma, giving the risk for malignant transformation as 8.3% in this family. Clinical and radiological examination revealed two additional patients with a suspicion of malignancy, but in whom the histological findings were benign. Reported elsewhere in detail, genetic linkage analysis mapped the causative gene to chromosome 11 and molecular studies revealed a guanine-to-thymine transversion in the ext2 gene. Patients with multiple hereditary exostoses carry a relatively high risk of malignant transformation. They should be informed of this possibility and regularly reviewed.

Adolescent↗

PubMed1999

Electron spin resonance (ESR) probe for interventional MRI instrument localization.

This article presents a miniaturized electron spin resonance (ESR) probe for deducing the position of a surgical instrument on an MR image. The ESR probe constructed was small enough to fit inside a 14-G biopsy needle sheath, and position information of the sheath could be acquired using a simple gradient sequence. The position accuracy was estimated from needle trajectories as inferred from the needle artifact, the actual physical trajectory, and measured coordinates. The probe was able to track the tip of a biopsy needle quickly (10 samples/sec) and precisely with accuracy better than +/-2 mm. J. Magn. Reson. Imaging 1999;10:216-219.

Artifacts↗

PubMed1999

Prolonged low-back pain in young athletes: a prospective case series study of findings and prognosis.

We investigated the prognosis of low-back pain and the association of clinical symptoms and anatomic findings among young athletes. Consecutive patients, aged between 12 and 18 years, who had low-back pain that had interfered with their training for at least 4 weeks were included in the case series. All the patients participated in a standardized interview and clinical examination, and plain radiographs and magnetic resonance images were also obtained. Most patients also participated in technetium bone scan examination. In 15 out of 19 subjects there were anatomic abnormalities that corresponded with the location and type of clinical symptoms. Twelve subjects had changes in the disk-vertebral end plate complex and eight had a positive bone scan indicative of posterior vertebral arch stress reaction. Six out of eight boys and two out of 11 girls had stress reaction (P = 0.043). Restriction of painful activities was recommended to all subjects, restriction of activities and the use of a dynamic low-back brace for the first 3 months was recommended to patients with posterior vertebral arch stress reaction. The self-reported intensity of low-back pain (scale 0-100) among all the patients was 69 +/- 16 (mean +/- SD) at baseline and 18 +/- 21 at the 1-year follow-up (P < 0.0001). In conclusion, the reasons for prolonged back pain among young athletes are usually established by imaging studies. A knowledge of anatomic abnormalities may help in tailoring training programmes and avoiding the progression of changes during growth. Simple restriction of painful activities usually leads to good recovery.

Adolescent↗

PubMed1999

Attitudes to health care prioritisation methods and criteria among nurses, doctors, politicians and the general public.

The aim of this postal questionnaire study was to measure attitudes to health care prioritisation criteria among the Finnish general public (n = 1156), politicians (n = 1096), doctors (n = 803) and nurses (n = 667), altogether 3722 subjects. The questionnaire consisted of questions on background data, a list of seven alternative prioritisation methods and a list of 11 possible criteria for health care prioritisation. The most acceptable prioritisation methods were increased treatment fees and restricting expensive treatments and examinations. Only a few supported administrative prioritisation decisions. One third of the general public indicated that they did not accept any limitations in health care, whereas only 5% of doctors agreed with them. More doctors accepted prioritisation methods than respondents in other groups. Patient is a child, patient is an elderly person, severity of the disease and prognosis of the disease were the most accepted prioritisation criteria. Politicians and the general public also accepted self-induced nature of disease and patient's wealth as prioritisation crieteria. Logistic regression analysis of the general public respondents demonstrated that male gender, higher education and higher personal income were associated with acceptance of most prioritisation criteria. Similarly, older age of the respondent was associated with acceptance of self-induced nature of disease and patient's wealth as prioritisation criteria.

Adult↗

PubMed1999

Genome scan for predisposing loci for distal interphalangeal joint osteoarthritis: evidence for a locus on 2q.

The genetic contribution to common forms of osteoarthritis (OA) is well established but poorly understood. We performed a genome scan, using 302 markers for loci predisposing to distal interphalangeal joint (DIP) OA. To minimize genetic heterogeneity in our study sample, we identified siblings with a severe, radiologically defined phenotype from the nationwide registers of Finland. In the initial genome scan, linkage analysis in 27 sibships gave a pairwise LOD score (Z) >1.00 with nine of the screening markers. In the second stage, additional markers and family members were genotyped in these chromosomal regions. On 2q12-q13, IL1R1 resulted in Z=2.34 at recombination fraction (theta) 0, allowing a dominant mode of inheritance. Association analysis of markers D2S2264, IL1R1, D2S373, and D2S1789 jointly provided some evidence for a shared haplotype among the affected individuals (P value of.012). Also, multipoint nonparametric linkage analysis yielded a P value of.0001 near the locus IL1R1 and P=.0007 approximately 20 cM telomeric near marker D2S1399, which, in two-point analysis, gave Z=1.48 (straight theta=. 02). This chromosomal region on 2q harbors the interleukin 1 gene cluster and, thus, represents a good candidate region for inflammatory and autoimmune disorders. Three additional chromosomal regions-4q26-q27, 7p15-p21, and Xcen-also provided some evidence for linkage, and further analyses would be justified to clarify their potential involvement in the genetic predisposition to DIP OA.

Adult↗

PubMed1999

Joint-specific twin and familial aggregation of recalled physician diagnosed osteoarthritis.

In our three-stage questionnaire study we investigated patterns of twin and familial aggregation of osteoarthritis (OA) for commonly affected joints. The baseline questionnaire study of the Finnish Twin Cohort was performed in 1975. In 1990, 4095 twin pairs of the same gender born 1930-1957 responded to a questionnaire and reported whether they had OA diagnosed by a physician. In 1996 both twins of 266 pairs of which at least one had reported OA in 1990 responded to a detailed questionnaire on joint-specific OA, including family history of OA. In male pairs shared (non-genetic) familial effects accounted for 37% of the total variance in liability to OA and unshared environmental effects for 63%. In female pairs additive gene effects explained 44% of the variance in liability to OA, and unshared environmental effects for 36%. Familial aggregation of finger and knee OA was clearly higher than that of hip OA. Twin-pair discordance for OA was, to some extent, associated with body-mass index, occupational loading and trauma. Our results indicate that genetic effects may be modulated by sex or by environmental factors distributed differently between men and women. Based on our joint-specific data finger and knee joints are the most optimal targets for studies of genetic factors predisposing to the development of OA.

Adult↗

PubMed1999

MR imaging in suspected acute trauma of wrist bones.

OBJECTIVE: The purpose of this study was to evaluate the findings of MR imaging compared to plain radiography in acute wrist trauma. METHODS: Radiography and MR imaging (obtained at 1.5 T) of 67 patients (38 female, 29 male, aged 15-80 years) were analysed by three senior radiologists in a blinded random fashion. RESULTS: One-third (n= 13) of the 37 fractures observed on MR images were missed on the radiographs. The McNemar test indicated significant differences in diagnoses between radiography and MR. CONCLUSION: We recommend that MR imaging should be considered in the diagnosis of acute wrist trauma when: 1) There is a clear discrepancy between the clinical status and a negative radiography and when splint treatment would increase cost by causing occupational restrictions; and 2) Healing of trauma diagnosed as contusion or distension does not occur within the expected time.

Adolescent↗

PubMed1998

Intramedullary fixation of distal femoral diaphyseal osteotomies with absorbable self-reinforced poly-L-lactide and metallic intramedullary rods assessed by plain radiographs, quantitative computed tomography, and magnetic resonance imaging: an experimental study in rabbits.

Osteotomies of distal femoral diaphysis were fixed intramedullary with self-reinforced poly-L-lactide acid (SR-PLLA) rods in 19 and with metallic rods in 34 adult rabbits. The follow-up times were 8, 16, 24, and 48 weeks. Plain radiographs, computed tomography (CT), quantitative computed tomography (QCT), and magnetic resonance imaging (MRI) were used to evaluate the bone changes at two different levels of the osteotomy region. There were no significant differences in cortical bone density compared to the intact in the SR-PLLA fixed femurs at the osteotomy site. In the metallic-fixed femurs, the density values were significantly lower as compared to the contralateral femurs. There was a significant reduction of the cortical bone density values in SR-PLLA fixed femurs compared to the intact control side outside the osteotomy area at 8 (p = 0.01), at 16 (p = 0.0001), and at 24 weeks (p = 0.0003). In the metallic-fixed femurs significant reductions at 8 weeks (p = 0.02), at 16 weeks (p = 0.01), at 24 weeks (p = 0.009), and at 48 weeks (p = 0.002) were found compared with the intact control. MRI depicted well the SR-PLLA cases allowing studies without removal of the implant. On the contrary, abundant disturbing metallic artifacts were detected during investigation of the metallic-fixed femurs. In conclusion, our results indicated that CT is useful to evaluate the quality of reduction and internal fixation. Furthermore, the constant presence of internal metallic fixation seems to eventually cause osteoporosis in the cortical region of the femur. However, this stress protection effect of intramedullary fixation on the femoral diaphysis seems to be avoided by using an absorbable SR-PLLA rod, thus resulting in a better quality of bone when the osteotomies are healed.

Absorption↗

PubMed1998

A novel splice site mutation of the EXT2 gene in a Finnish hereditary multiple exostoses family. Mutations in brief no. 197. Online.

Hereditary multiple exostoses is a dominantly inherited disease characterized by multiple benign osteochondromas. The affected individuals have an increased risk of developing sarcoma. A large Finnish family with hereditary multiple exostosis was analyzed to find the disease-causing mutation. Blood samples were obtained from 35 family members, including 21 affected and 14 unaffected individuals. Using 2-point linkage analysis the EXT phenotype was shown to be linked to the recently cloned EXT2 gene on chromosome 11p11. The coding region of the gene was sequenced and a previously unreported splice site mutation found. This G to T transversion within a 5-prime splice donor site following exon 6 was shown to cause aberrant splicing of RNA. The described change is considered to be a novel disease-causing mutation in the EXT2 gene.

Alternative Splicing↗

PubMed1998

Comparison of different tests assessing neurosensory disturbances after bilateral sagittal split osteotomy.

Different methods of assessing functional impairment of the inferior alveolar nerve after sagittal split osteotomy were compared with subjective reports. Thirty patients were tested preoperatively as well as after four days, three weeks, three months, six months, and one year of follow up. All the patients underwent bilateral mandibular ramus sagittal split osteotomy. The sensation of the mandibular teeth was assessed by an electric vitality scanner. Other neurosensory assessments included light touch, two-point discrimination, tactile discrimination, and thermal discrimination. It was shown that electric sensibility-testing of mandibular teeth is a useful method for evaluating neurosensory disturbance after sagittal split osteotomy, and it correlated even better with the patient's subjective evaluation than the other tests used in this study.

Adolescent↗

PubMed1998

The relevance of clinical and radiological measurements in predicting difficulties in fibreoptic orotracheal intubation in adults.

Resistance to the passage of the tracheal tube has been reported to occur in up to 36% of patients subjected to orotracheal fibreoptic intubation. In this prospective study we assessed five radiological measurements of the upper airway in an attempt to find anatomical causes of obstruction to passage of the tube. Forty-nine patients undergoing fibreoptic orotracheal intubation under general anaesthesia were studied. Pre-operatively, the Mallampati grade and the thyromental distance were assessed. The plain films, CT scans or MR images of the cervical spine were used for measurement of the position of the vocal cords, the length of the epiglottis and the size of the tongue. The resistance to the passage of the tube was graded as none, mild, moderate or severe. The length of the epiglottis and the size of the tongue, but not the position of the vocal cords, had positive correlations with the severity of impingement. The pre-operative bedside tests did not correlate with difficulties in fibreoptic intubation.

Adult↗

PubMed1998

Incidence and clinical significance of bone bruises after supination injury of the ankle. A double-blind, prospective study.

We used MRI to study a prospective series of 95 patients with inversion injuries of the ankle and no fracture on plain radiographs. We found an incidence of bone bruises of 27%, but these made no difference to the time of return to work, limitation of walking or physical activity, or the clinical outcome scores at three months. We conclude that bone bruises have very little clinical significance after inversion injuries of the ankle.

Absenteeism↗

PubMed1997

Attitudes to cuts in expenditure and increased fees in health care.

The aim of this postal questionnaire study was to measure attitudes to cuts and increased fees in health care in various Finnish population groups. Four groups were identified; a population sample of 2000 subjects, aged 18-70 y; a random sample of 1500 medical doctors of working age; a random sample of 1000 nurses of working age; and a sample of 2200 politicians involved in health and social care administration, mostly at the municipal level (altogether 6700 subjects). The main questionnaire included, among other things, the following questions: (1) Which of 18 specified medical activities at the primary health care level could be cut without causing severe harm to the population? (2) For which of 13 specified medical activities should clients pay at least 50% of the real cost? All the groups indicated the greatest willingness to cut expenditure on health education, occupational health services, hygiene inspection, substance abuse care, rehabilitation services for war veterans, and family planning. All the groups were least willing to make cuts in home care for disabled and elderly people, maternity services and clinics for under-fives. Most respondents in all groups felt that the activities for which clients should pay at least 50% of the cost were visits to physicians, occupational health services and dental services, whereas clinics for under-five and home care for disabled and elderly persons should be kept free of charge. As a conclusion, primary health care and prevention of diseases for small children, mothers, the elderly and disabled persons, were prioritised by all the groups.

Adolescent↗

PubMed1997

In vivo monitoring of the degradation process of bioresorbable polymeric implants using magnetic resonance imaging.

The degradation of a bioresorbable poly(L-lactide) osteosynthesis plug after fixation of a transferred coracoid bone block using the Bristow-Latarjet procedure was examined by means of magnetic resonance (MR) imaging. There were 15 patients with a mean follow-up time of 38 months (range 34-42 months). The gross geometry of the biomaterial plug remained unaltered on the MR images. The bone marrow signal reached the implant surfaces in all cases, and no signs of liquid phase around the implant could be discerned. The implants themselves were visible as homogeneous low signal intensity (SI) black linear structures when compared to the surrounding bone, which had a much higher SI. The mean implant SI was 18.2 (s.d. +/- 6.6), that of the scapular bone 48.9 (s.d. +/- 14.3) and that of the background 4.3 (s.d. +/- 1.5). The SI of a newly manufactured intact implant was 5.7. Serial plain radiographs showed no decreased bone density or focal osteolytic lesions around the poly(L-lactide) expansion plug. The implant channel was discernible on most of the radiographs and a sclerotic rim was detected to outline the implant profile in some of the projections of plain radiographs at each follow-up examination. Computer tomography scans on five patients 3 years postoperatively also revealed a discernible implant channel outlined with a sclerotic rim. The radiographic appearance of the radiolucent implant channel did not change over the follow-up period. Summarizing the present findings, MR imaging seems to be able to visualize poly(L-lactide) implants within the bone. Actually, at present it is the only method available to study the degradation process of implants made of this polymer in humans. No signs of degradation of or of an osteolytic foreign-body reaction to poly(L-lactide) at the host tissue-implant interface could be observed within the follow-up times of this study.

Absorption↗

PubMed1997

Doctors' willingness to refer elderly patients for elective surgery.

OBJECTIVES: We aimed to examine the relationship between doctors' willingness to refer elderly patients for elective surgical operations and patients' age, comorbidity, institutionalization, living habits and signs of dementia. METHOD: A random selection of 837 medical doctors in Finland (response rate 56%) received a postal questionnaire consisting of 18 vignettes, i.e. imaginary patient cases. Respondents were asked whether they would refer the patient on the vignette for elective surgical operation, treat the patient conservatively, or choose some other alternative. In the vignettes, the age of patients was randomly varied between 65 and 85, at 5-year intervals, to provide eight different questionnaires, and each respondent obtained one of them. RESULTS: The proportion of doctors willing to refer the patients for surgery was inversely related to the patients' age: in all the vignettes, doctors said they would refer fewer patients in the oldest age groups. Almost all the doctors claimed they would refer healthy, home-dwelling persons aged 65-70 years for operations. In the oldest age groups of patients, the doctors' willingness to refer was highest for cataract operations (69%) and hip prosthesis operations (63%), but only 18% of doctors would refer such patients for coronary by-pass operations. Comorbidity and institutionalization were associated with fewer doctors referring the patients: the proportion of doctors willing to refer these patients was about half that of those willing to refer otherwise healthy and home-dwelling patients. Smoking by patients also decreased the proportions of doctors willing to refer, but moderate signs of dementia in an elderly patient with cataract were associated with only a slight decrease in referring. CONCLUSIONS: Doctors are less willing to refer old patients for elective surgery, but comorbidity, patients' lifestyle and institutionalization have a greater effect on referrals than age.

Age Factors↗

PubMed1997

Abdominal wall competence after free transverse rectus abdominis musculocutaneous flap harvest: a prospective study.

A prospective study was designed to evaluate the possible changes in abdominal wall strength following free transverse rectus abdominis musculocutaneous (TRAM) flap surgery for breast reconstruction. Twenty-two patients were examined 1 day before surgery, and at 3, 6, and 12 months postoperatively. Trunk muscle strength was measured by the same physiotherapist using an isokinetic dynamometer (Lido Multi Joint II, Loredan Biomedical Inc., Davies, CA). The peak torque and average torque for both flexion and extension at 60 degrees per second angular velocity were recorded from the curves obtained. There was a significant reduction in trunk flexion strength at 3 months postoperatively (peak torque mean, 92% of the preoperative value; p = 0.04), but this was corrected by 6 months (mean, 96%), and improved to 98% by 12 months. The patient's ability to do curled trunk sit-ups was evaluated by the same physiotherapist and graded on a scale from 1 to 6. In 9 of 19 patients the operation had no effect on sit-up performance during follow-up. In 10 of 19 patients there was a reduction of one or two grades at 3 months that did not improve by 12 months. Magnetic resonance imaging of the abdominal wall was performed on 9 patients. The mean area of the upper third of both rectus muscles was measured on the axial images. At 3 months postoperatively the mean area of the upper third of the donor muscle was significantly larger than the contralateral (p = 0.03). There was no difference in size at 6 months, and by 12 months the donor side was smaller. This prospective study shows that harvesting of a free TRAM flap can cause a subclinical reduction in abdominal strength, although this was not noticed by the patients themselves.

Abdominal Muscles↗