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Biomedical subjects

J Takala

Publications and source records attributed to J Takala.

At least 127 records · Page 7Linked to original sources
PubMed1996

Hypermetabolism and increased peripheral release of amino acids after subarachnoidal hemorrhage and its operative treatment.

The metabolic response to surgery for acute subarachnoidal hemorrhage and its modification by amino acid infusions was studied. Thirty patients with acute subarachnoidal hemorrhage were randomly assigned to receive for 12 h either an infusion of glucose and a balanced amino acid solution (1.68 MJ = 400 kcal/d and 0.15 gN.kg-1.d-1; group AA) or a glucose and a solution containing 20% of total nitrogen as alanyl-glutamine (1.68 MJ = 400 kcal/d and 0.15 gN.kg-1.d-1; group ALAGLN). A separate control group received glucose alone (1.68 MJ = 400 kcal/d). The infusions started 12 h after operation. All patients received corticosteroids. Despite a higher arterial glutamine concentration in the ALAGLN-group (791 +/- 195 mumol/L vs. AA 581 +/- 112 mumol/L, and control 571 +/- 82 mumol/L; p < 0.05) the net release of glutamine from the leg was similar in all groups (ALAGLN: 39 +/- 47 mumol/min, AA: 26 +/- 18 mumol/min, and control: 24 +/- 14 mumol/min, NS). Also the release of alanine (ALAGLN: 35 +/- 24 mumol/min, AA: 34 +/- 24 mumol/min, and control: 30 +/- 18 mumol/min) and total amino acids (ALAGLN: 133 +/- 131 mumol/min, AA: 125 +/- 98 mumol/min, and control: 112 +/- 72 mumol/min) were similar in all groups. All groups were characterized by a pattern of preoperative hypermetabolism that persisted after the operation. The hypermetabolism was not related to increased peripheral oxygen consumption, since femoral oxygen consumption (VO2) represented only 3% of the whole body VO2-.

Adult↗
PubMed1996

Sodium nitroprusside after cardiac surgery: systemic and splanchnic blood flow and oxygen transport.

BACKGROUND: Vasoactive drugs may interfere with splanchnic blood flow and tissue oxygenation. Sodium nitroprusside (SNP) is widely used in the treatment of postoperative hypertension after cardiac surgery, but the effects of SNP and other vasodilators on splanchnic blood flow have not been well documented. METHODS: The effects of SNP on systemic blood flow, oxygen transport and gastric intramucosal pH (pHi) were studied in 12 patients with arterial hypertension after coronary artery bypass grafting. In 9 of these patients, the effect on regional (splanchnic and leg) blood flow and oxygen transport was also measured. Hemodynamic and regional blood flow responses were measured before and during SNP infusion (mean 2.8 +/- 1.7 micrograms/kg/min, range 0.6-6.3 micrograms/kg/min), when the goal of the vasodilator treatment, mean arterial pressure 70-80 mmHg, had been reached. RESULTS: SNP increased splanchnic (0.65 +/- 0.22 vs. 0.87 +/- 0.37 L.min-1.m-2, P < 0.01) and femoral blood flow (0.15 +/- 0.04 vs. 0.21 +/- 0.06 L.min-1.m-2, P < 0.05) in parallel with cardiac index (2.6 +/- 0.6 vs. 3.3 +/- 0.7 L.min-1.m-2, P < 0.01). Fractional regional blood flows did not change. Mean gastric intramucosal pH decreased slightly (7.40 +/- 0.07 vs. 7.37 +/- 0.06, P < 0.05). Both systemic (420 +/- 85 vs. 495 +/- 90 mL.min-1.m-2, P < 0.05) and femoral oxygen delivery (25 +/- 5 vs. 32 +/- 10 mL.min-1.m-2, P < 0.05) increased, but neither systemic nor regional oxygen consumption changed. CONCLUSIONS: These results suggest that vasoregulation is well preserved during treatment of early postoperative hypertension with SNP, and that SNP has no adverse effects on splanchnic tissue oxygenation.

Antihypertensive Agents↗
PubMed1996

Random paired scenarios--a method for investigating attitudes to prioritisation in medicine.

OBJECTIVE: This article describes a method for investigating attitudes towards prioritisation in medicine. SETTING: University of Kuopio, Finland. DESIGN: The method consisted of a set of 24 paired scenarios, which were imaginary patient cases, each containing three different ethical indicators randomly selected from a list of indicators (for example, child, rich patient, severe disease etc.). The scenarios were grouped into 12 random pairs and the procedure was repeated four times, resulting in 12 scenario pairs arranged randomly in five different sets. SURVEY: This method was tested with four groups of subjects (n = 8, n = 47, n = 104 and n = 36). RESULTS: Children and patients with a severe disease were prioritised in all groups. The aged, patients with a mild disease and patients with a self-acquired disease were negatively prioritised in all groups. Poor or rich patients were prioritised in some groups but negatively prioritised in others. CONCLUSIONS: The validity and reliability of this method are good and it is suitable for investigating attitudes towards medical prioritisation.

Aged↗
PubMed1996

Comparison of doctors', nurses', politicians' and public attitudes to health care priorities.

OBJECTIVES: The aim of this study was to investigate differences in attitudes concerning prioritisation in health care held by doctors, nurses, local politicians and the general public. METHODS: Four groups were established: a population sample of 2000 subjects, aged 18-70 years; a random sample of 1500 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 contained, among other things, a list of 12 statements concerning ethical decisions regarding prioritisation in health care. Respondents were asked to indicate their level of agreement with each statement. RESULTS: Most respondents in all the groups felt able to express an opinion on the statements. Despite considerable professional and cultural differences between groups, the views were generally similar. On the whole, respondents supported liberal policies in which the community took responsibility for subsidising health care. When differences between groups occurred, it was usually the doctors who held discordant views. Doctors were less inclined to consider a patient's economic status as a determinant of priority for treatment than the other three groups. Both doctors and nurses were less punitive towards patients with self-induced diseases. And doctors and politicians were more likely to feel further cuts in health care expenditure were possible than was true for nurses and the public. CONCLUSIONS: While considerable uniformity of opinion exists on ethical issues of prioritisation between the principal interested parties, the views of doctors differ substantially on some matters. If prioritisation was left entirely to doctors, health care provision would not reflect the views of other groups in some important ways.

Attitude of Health Personnel↗
PubMed1996

The last year of life: mortality, cause of death and need for help among old men.

What will changes in the mortality patterns mean for the future? Is there any relationship between the cause of death and the assessed need for help during the last year of life? We used The Official Statistics to gain insight into the mortality patterns. We examined the independence from being reliant on other people's help, assessed from the health and social service records of 186 men in the age range 65-89 years from the Finnish cohorts of the Seven Countries Study. The proportional risk of dying from heart disease or cancer declined with age. However, the independence with regard to need of help lasted longer when men died from these diseases. There were 5-10 fold differences in the risk of needing daily help depending on the cause of death. It increased among the older men significantly just before death. These findings may have significance in the planning of health and home care with respect to changing mortality patterns.

Activities of Daily Living↗
PubMed1996

General practitioners' approach to dyspepsia. Survey of consultation frequencies, treatment, and investigations.

BACKGROUND: The aim of this study was to investigate the frequency of patient visits for dyspepsia in primary care. The diagnostic approaches made and drug treatment given by general practitioners were recorded. METHODS: In a cross-sectional study 36,230 patients over 15 years of age visited their health center in an area serving a population of 506,000 inhabitants, between 6 and 19 May 1991. The frequency of dyspepsia was 2.1% (n = 766). These patients formed the basis of this study. RESULTS: The incidence of dyspepsia leading to a health center visit was 20.9/1000 inhabitants/year. Patients older than 45 years consulted their general practitioners for dyspepsia more often than younger patients. Men older than 45 years of age had had their symptoms longer before seeking medical advice than younger men or women of the same age (p = 0.03 and p < 0.05, respectively). In association with the first visit, older (over 45 years) patients were evaluated more frequently (p = 0.03) by upper gastrointestinal endoscopy than younger (15-44 years) ones. Upper abdominal ultrasound was performed almost as often as upper gastrointestinal endoscopy. Sucralfate was prescribed for dyspeptic symptoms more often than H2-blockers or omeprazole, which were mainly used in patients with a definitive diagnosis. CONCLUSIONS: The frequency of medical visits for dyspepsia increased with age. Older men sought medical advice for dyspepsia after a longer delay than others. Upper abdominal endoscopy was performed in association with the first visit in older patients more often than in younger ones.

Adolescent↗
PubMed1996

A comparison of imipenem/cilastatin with the combination of cefuroxime and metronidazole in the treatment of intra-abdominal infections.

515 patients with intra-abdominal infection participated in an open randomized comparative multicenter trial in order to compare the efficacy, safety, and tolerance of imipenem/cilastatin with cefuroxime/metronidazole. 258 patients (mean age 56 years) received imipenem/cilastatin 1.5-2.0 g/day, and 257 patients (mean age 54 years) received cefuroxime 3.0-4.5 g/day plus metronidazole 1.0-1.5 g/day for at least 3 days. 130/161 evaluable patients (80.8%) receiving imipenem/cilastatin and 124/145 evaluable patients (85.5%) receiving cefuroxime/metronidazole were clinically cured. The microbiological response was favorable in 86.9% in the imipenem/cilastatin group and in 90.8% in the cefuroxime/metronidazole group. The two treatment groups were similar with respect to median time to defervescence which was 4 days. The median duration of treatment was 6 days and the median time to discharge from hospital was 9 days in both groups. Drug-related adverse reactions were observed in 14 patients receiving iminpenem/cilastatin and in 8 patients receiving cefuroxime/metronidazole. 19 patients in the imipenen/cilastatin group and 12 patients in the cefuroxime/metronidazole group died. No correlation was found between the deaths and the study drugs. The present study shows that intra-abdominal infections can be treated successfully with imipenem/cilastatin as well as with cefuroxime/metronidazole.

Abdomen↗
PubMed1996

Lactate metabolism and regional lactate exchange after cardiac surgery.

Tissue perfusion is at risk during cardiac surgery and in the immediate postoperative period. The association of low blood flow with metabolic acidosis and accumulation of lactate perioperatively has been well established. With the improvements in cardiopulmonary bypass and overall hemodynamic management, severe peri- and postoperative hypoperfusion has become rare. Despite the rarity of severe postoperative complications, several lines of evidence suggest that episodes of less severe hypoperfusion and borderline tissue oxygenation are relatively common, although generally well tolerated. Measurement of blood lactate levels is widely used to assess the adequacy of tissue perfusion. The interpretation of elevated blood lactate levels is limited by several confounding variables. Acute changes in acid-base balance, interorgan substrate flux, peripheral and visceral tissue perfusion, and hepatic lactate uptake will all influence blood lactate levels and may occur during and after cardiac surgery. Peri- and postoperative hyperlactatemia are rare occurrences and their presence may indicate inadequate tissue perfusion. Based on regional blood flow and lactate exchange measurements, we suggest that hyperlactatemia after cardiac surgery is a sign of inadequate or marginal tissue perfusion of the hepatosplanchnic region, as well as other tissues. In this article we briefly review: a) the normal physiology of lactate metabolism and the various causes of hyperlactatemia; b) studies on lactate levels during and after cardiac surgery; c) the evidence of insufficient or marginal tissue perfusion peri- and postoperatively; and d) the pathophysiology of postoperative increases in blood lactate based on regional lactate kinetics.

Blood Circulation↗
PubMed1995

Breathing pattern and gas exchange in emergency and elective abdominal surgical patients.

OBJECTIVE: To evaluate the effects of intra-abdominal surgical emergency on breathing pattern and gas exchange and compare it with the changes induced by elective abdominal surgery. DESIGN: Prospective clinical study. SETTING: Abdominal surgical departments in a university hospital. PATIENTS: Patients operated for intra-abdominal emergency (n = 10, EAS), elective upper abdominal (n = 19, UAS). MEASUREMENTS AND RESULTS: Breathing pattern and gas exchange were measured with a respiratory inductive plethysmograph and a gas exchange monitor. EAS patients had pre-operatively a classical rapid shallow breathing pattern and increased ventilatory demand due to increased energy expenditure. The operation improved the breathing to normal pattern (frequency, 26 +/- 5/min and 17 +/- 3/min, p < 0.01; tidal volume, 439 +/- 128 ml and 541 +/- 165 ml, NS., before and after surgery, respectively). Sighing was absent before and after EAS and strictly reduced after elective surgery (p < 0.01 for UAS). The operation restricted the abdominal-diaphragmatic breathing movement which was reflected as increased contribution of the rib cage to VT (%RC: from 37% +/- 15 to 57% +/- 15 for UAS p < 0.001; from 47% +/- 16 to 61% +/- 14 for EAS NS.). After EAS and UAS hypoxemia was common (p < 0.001) with frequent radiological pathology. We conclude that intra-abdominal surgical emergencies increase the ventilatory demand and challenge the respiratory system to marked adaptive changes both pre- and post-operatively.

Abdomen↗
PubMed1995

Estimation of splanchnic blood flow by the Fick principle in man and problems in the use of indocyanine green.

OBJECTIVES: Measurement of splanchnic blood flow is necessary to evaluate the effect of therapeutic interventions on splanchnic tissue perfusion. Systemic indocyanine green (ICG) clearance has been used to estimate splanchnic blood flow, but the results may be compromised by altered hepatic dye extraction. We evaluated the applicability of simultaneous estimation of splanchnic and femoral blood flow by dye dilution and regional blood sampling in intensive care patients. METHODS: 240 simultaneous determinations of regional blood flow were conducted in different patient groups (cardiac surgery, ARDS, pancreatitis, septic shock, preoperative controls). The measurement protocol consists of catheterizations of hepatic vein, femoral artery and vein and primed constant infusion of two different ICG preparations. RESULTS: The method was used successfully in a wide variety of patients. Steady-state dye concentration and sufficient dye extraction was achieved in each group of patients. The coefficient of variation of splanchnic blood flow estimation was 7 +/- 1% and of femoral blood flow estimation 6 +/- 0%. There was a great intra- and interindividual variation of ICG extraction. Use of dobutamine modified the extraction in most patients but did not lessen the performance of the method. ICG extraction was markedly lower and the coefficient of variation of both femoral and splanchnic blood flow markedly higher with propylene glycol-dissolved ICG preparation as compared with the freeze-dried. CONCLUSIONS: The prerequisites for the method of primed, constant infusion of indocyanine green with hepatic vein catheterization are achieved in intensive care patients. The results of splanchnic blood flow estimations based on techniques with peripheral blood sampling should be interpreted with caution, and the use of ICG clearance as a flow-related indicator without the measurement of ICG extraction cannot be justified because of the great variability of dye extraction. Certain indocyanine green preparations may greatly modify the results of the regional blood flow determinations.

Aged↗
PubMed1995

Gastric mucosal pH does not reflect changes in splanchnic blood flow after cardiac surgery.

Despite the widespread use of gastric tonometry to assess splanchnic oxygen transport, no human data are available on the relationship between splanchnic blood flow, splanchnic oxygen delivery and gastric mucosal pH. We have studied the effect of splanchnic blood flow and oxygen delivery on gastric mucosal pHi after cardiac surgery. During the first postoperative hours of intensive care, dopexamine was infused to increase cardiac output in eight patients, while six patients served as controls. Gastric mucosal pH (gastric tonometry), splanchnic blood flow and splanchnic oxygen delivery and consumption (dye dilution) were measured. Dopexamine administration significantly increased splanchnic blood flow (0.72 vs 1.02 litre min-1 m-2) (P < 0.05) and oxygen delivery (117 vs 161 ml min-1 m-2) (P < 0.05) compared with baseline values. However, splanchnic oxygen consumption remained unchanged and gastric mucosal pH levels decreased (7.30 vs 7.25) (P < 0.05). The proportion of splanchnic blood flow of cardiac output did not change in response to infusion of dopexamine, that is dopexamine did not favour blood flow distribution to the splanchnic region. In the control group there were no changes in splanchnic blood flow and oxygen delivery, while splanchnic oxygen consumption increased (36 vs 39 ml min-1 m-2) (P < 0.05) and gastric mucosal pH tended to decrease (7.33 vs 7.29) (ns). We conclude that after cardiac surgery gastric mucosal pH did not reflect changes in splanchnic blood flow and oxygen delivery suggesting heterogeneous or inadequate blood flow distribution within the splanchnic region.

Aged↗
PubMed1995

Dobutamine-induced dissociation between changes in splanchnic blood flow and gastric intramucosal pH after cardiac surgery.

Gastric intramucosal acidosis, a sign of splanchnic tissue hypoxia, is common after cardiac surgery. We tested the hypothesis that an increase in splanchnic blood flow induced by dobutamine improves splanchnic tissue oxygenation after cardiac surgery. We measured changes in gastric intramucosal pH, splanchnic blood flow and oxygen transport in response to increased systemic flow induced by dobutamine (mean 4.4 (range 3.0-7.0) micrograms kg-1 min-1) after coronary artery bypass. We studied 22 stable postoperative patients who were allocated randomly to receive dobutamine (n = 11) or to serve as controls (n = 11). Dobutamine was given also to a separate group with a low cardiac index after operation (n = 6). The end-point was to increase cardiac index by at least 25% and to exceed 2 litre min-1 m-2. Dobutamine consistently increased mean splanchnic blood flow (control 0.6 (SD 0.2) vs 0.7 (0.2) litre min-1 m-2 (P < 0.05); normal cardiac output and dobutamine 0.7 (0.2) vs 1.1 (0.4) litre min-1 m-2 (P < 0.01); low cardiac output and dobutamine 0.4 (0.1) vs 0.7 (0.1) litre min-1 m-2 (P < 0.05)) and oxygen delivery (control 102 (29) vs 111 (28) ml min-1 m-2 (ns); normal cardiac output and dobutamine 106 (27) vs 156 (47) ml min-1 m-2 (P < 0.01); low cardiac output and dobutamine 75 (21) vs 110 (26) ml min-1 m-2 (P < 0.05)) but had no effect on splanchnic oxygen consumption (control 44 (10) vs 49 (10) ml min-1 m-2 (ns); normal cardiac output and dobutamine 45 (12) vs 51 (17) ml min-1 m-2 (ns); low cardiac output and dobutamine 37 (9) vs 40 (9) ml min-1 m-2 (ns)).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Metabolic stress modifies the thermogenic effect of dobutamine in man.

OBJECTIVE: To study if metabolic stress modifies the thermogenic effect of dobutamine. DESIGN: Prospective, increasing dose, pharmacologic study. SETTING: Laboratory of the Department of Intensive Care Unit at a university hospital. SUBJECTS: Twelve normal volunteers. INTERVENTIONS: Dobutamine hydrochloride was infused to 12 healthy male volunteers starting at a dose of 2 micrograms/min/kg and gradually increased to 4 and 6 micrograms/min/kg. Each dose of dobutamine was infused for 20 mins. Metabolic stress was induced in six of the 12 volunteers using a triple hormone infusion (epinephrine, cortisol, and glucagon) before dobutamine, and was continued at a constant rate during the dobutamine infusion. The remaining six volunteers served as the control group and received only dobutamine. MEASUREMENTS AND MAIN RESULTS: Oxygen consumption (VO2) was measured using a metabolic monitor. Arterial blood pressure was measured noninvasively, and cardiac output was monitored by Doppler echocardiography. Plasma concentrations of dopamine, norepinephrine, and epinephrine were measured in both groups. In the triple hormone group, blood was sampled to measure concentrations of insulin, glucagon, cortisol, free fatty acids, and glycerol to ensure the presence of a metabolic stress reaction. At the maximum dose, dobutamine induced a 19% increase (from 140 +/- 17 to 166 +/- 17 mL/min/m2) in VO2 in the control group and an 11% increase (from 167 +/- 10 to 184 +/- 13 mL/min/m2) in the triple hormone group (p < .05 between the two groups) compared with baseline. No change in the respiratory exchange ratio was seen. The triple hormone infusion alone induced hypermetabolism, a marked hemodynamic response, and increased lipolysis. CONCLUSIONS: Stress, induced by a triple hormone infusion, diminishes the thermogenic effect of dobutamine. In the clinical setting, a > 10% to 15% increase in VO2 in response to dobutamine may not be explained just by the thermogenic effect of the drug.

Adult↗
PubMed1995

Etiology of dyspepsia: four hundred unselected consecutive patients in general practice.

BACKGROUND: Four hundred consecutive unselected patients with dyspepsia in health care centers were investigated. The aim of this study was to assess the frequency of various causes of dyspepsia in primary care and to evaluate the usefulness of the latest definition of functional dyspepsia. METHODS: Upper gastrointestinal endoscopy, upper abdominal ultrasound, a test for lactose intolerance, and basic laboratory screening were performed in every patient. RESULTS: Esophagitis was the cause of symptoms in 15%, symptomatic gastroesophageal reflux without esophagitis in 12%, duodenal ulcer in 9%, gastric ulcer in 4%, erosive duodenitis in 2%, lactose intolerance in 9%, gallstone disease in 2%, and malignancy in 2%. Other more infrequent causes of dyspepsia were giardiasis, celiac disease, erosive gastritis, and chronic pancreatitis. One hundred and thirty-five patients had functional dyspepsia with subgroups of ulcer-like (22%), dysmotility-like (28%), and nonspecific (50%). Irritable bowel syndrome was diagnosed in 37 patients (9%). CONCLUSIONS: The cause of dyspepsia was organic in 45%. Functional disorders, when symptomatic gastroesophageal reflux was included, were diagnosed in 55%. The latest classification of functional dyspepsia is not in accordance with the symptom complex.

Adolescent↗