Biomedical subjects

K Partanen

Publications and source records attributed to K Partanen.

At least 91 records · Page 5Linked to original sources

PubMed1994

Diagnostic value of tissue polypeptide specific antigen in patients with pancreatic carcinoma.

We evaluated the clinical utility of a new tumor marker tissue polypeptide specific antigen (TPS) in the diagnosis of pancreatic carcinoma. Serum concentrations were determined in 113 patients with jaundice, in 18 patients with laboratory values suggesting cholestasis and in 60 patients with suspicion of chronic pancreatitis or pancreatic tumor. Twenty-four of these 191 patients had pancreatic carcinoma and 2 patients had carcinoma of the papilla of Vater. The highest median serum TPS value was detected in patients with malignant liver disease, but high median values were also measured in patients with pancreatic cancer, bile duct cancer or benign liver disease. The sensitivity of TPS was 50.0%, with a specificity of 73% and an efficiency of 70%. In comparison with carcinoembryonic antigen (CEA), CA 50 and CA 242, the TPS test showed lower sensitivity, but the differences in specificity and negative predictive value were considerably smaller. The utility of TPS as a complementary test was also analyzed. When TPS was combined with other marker tests, their specificities clearly improved, being highest in the combination of TPS and CA 242 (92.5%). In this combination, efficiency and positive likelihood ratio were also clearly better (85% and 5.6) than those of the marker tests alone. In conclusion, TPS seems less accurate than CEA, CA 50 or CA 242 in the diagnosis of pancreatic cancer, but because of its different nature it may be considered to be used as a complementary test.

Biomarkers, Tumor↗

PubMed1994

Volumetric MRI analysis of the amygdala and the hippocampus in subjects with age-associated memory impairment: correlation to visual and verbal memory.

Age-associated memory impairment (AAMI) is a common but disputed entity. It is unclear whether AAMI is a phenomenon of normal aging or an early sign of Alzheimer's disease. The present study aimed to identify possible structural abnormalities in the medial temporal lobe of AAMI subjects. We measured volumes of the hippocampus and amygdala by MRI in 16 AAMI subjects and in 16 age- and sex-matched controls and correlated the volumes with subjects' performance on two visual memory tasks (the Benton and the Heaton visual retention tests) and on a verbal memory task (the Buschke-Fuld Selective Reminding Test). The mean hippocampal and amygdaloid volumes normalized for brain size per se did not differ between the two study groups. In controls, but not in AAMI subjects, the right hippocampus was larger than the left. Accordingly, the volumetric asymmetry between the right and left hippocampi was smaller in AAMI subjects than in controls (Student's t test, p < 0.05). The volume of the right hippocampus (r = 0.37, n = 32, p < 0.05) and the magnitude of the asymmetry between the right and left hippocampi (r = 0.38, n = 32, p < 0.05) correlated with total score on the Benton test. We also found significant correlations between the amygdaloid volumes and the performance on visual memory tests but not with score on the verbal memory test.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1994

Carotid stenosis by digital subtraction angiography: reproducibility of the European Carotid Surgery Trial and the North American Symptomatic Carotid Endarterectomy Trial measurement methods and visual interpretation.

PURPOSE: To evaluate different carotid stenosis estimation methods with digital subtraction angiography. METHODS: We assessed the intraobserver reproducibilty and interobserver variability of visual interpretation and the measurement methods used by the European Carotid Surgery Trial and the North American Symptomatic Carotid Endarterectomy Trial. Angiographic stenosis measurements according to both criteria were performed twice by a radiologist, a neurologist, and a vascular surgeon. Eighty bifurcations of consecutive symptomatic patients underwent 480 pairs of measurements. In addition, four radiologists estimated the stenoses visually. RESULTS: Intraobserver consistency was slightly better by the European (kappa, 0.86 to 0.94) than by the North American (kappa, 0.68 to 0.91) trial criteria or by visual interpretation (kappa, 0.79 to 0.81). No significant interobserver variability was found, except in the subgroup of mild stenoses by the North American Trial criteria. By kappa statistic, the interobserver agreement was excellent by the European trial method (kappa, 0.72 to 0.86), good by the North American trial method (kappa, 0.59 to 0.77), and good to excellent by visual evaluation (kappa, 0.68 to 0.88). The visual estimation agreed more closely with the European (kappa, 0.73 to 0.92) than with the North American trial (kappa, 0.55 to 0.74) criteria measurements. CONCLUSIONS: All three methods have good reproducibility in digital subtraction angiography. Interobserver differences become more important in the estimation of mild stenosis.

Adult↗

PubMed1993

Receiver operating characteristic (ROC) curve analysis of the tumour markers CEA, CA 50 and CA 242 in pancreatic cancer; results from a prospective study.

The serum values of the tumour markers carcinoembryonic antigen (CEA), cancer-associated carboanhydrate antigens CA 50 and CA 242 were evaluated in 193 patients with hepatopancreato-biliary diseases by receiver operating characteristic (ROC) curve analysis in order to compare their diagnostic accuracy in pancreatic cancer (n = 26), and to define optimal cut-off levels for the serum values of these tumour markers in the diagnosis of pancreatic cancer. The ROC analysis showed that all marker tests are considerably sensitive (77-81%) at the specificity level of 80%. The CA 242 test was more sensitive than CEA and CA 50 at high specificity levels (> 0.90) but slightly less sensitive at low specificity levels (< 0.60). The CEA test and CA 50 test performed equally well at high and low specificity levels. According to this study, it would seem optimal to use the cut-off level of 4.1 ng ml-1 for CEA, and the level of 137 U ml-1 for CA 50, since they gave a sensitivity of 77% at the specificity levels of 83% and 84%, respectively. For CA 242 the optimal cut-off level was 21 U ml-1, which gave a sensitivity and specificity of 81%. In conclusion, the results of ROC curve analysis suggest that the CA 242 test has an advantage over CEA and CA 50 because of its higher specificity in pancreatic cancer. In addition, it would seem reasonable to use higher cut-off values than what has been recommended for CEA and CA 50 in the diagnosis of pancreatic cancer, but for CA 242 the recommended cut-off level of 20 U ml-1 seems appropriate.

Antigens, Tumor-Associated, Carbohydrate↗

PubMed1993

Value of serum alkaline phosphatase, aminotransferases, gamma-glutamyl transferase, leucine aminopeptidase, and bilirubin in the distinction between benign and malignant diseases causing jaundice and cholestasis: results from a prospective study.

A prospective study of 187 patients with jaundice and 33 patients with unjaundiced cholestasis was carried out to evaluate the value of serum bilirubin, alkaline phosphatase (ALP), aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), gammaglutamyl transferase (GGT), and leucine aminopeptidase (LAP) in the differential diagnosis between benign and malignant diseases causing jaundice and/or cholestasis. In the patients with malignant disease (n = 60), the mean serum bilirubin and ALP concentrations were significantly higher (p < 0.001) than in the patients with benign disease (n = 160). Serum LAP, ASAT, ALAT, or GGT levels did not show any significant differences. A stepwise discriminant analysis was carried out to evaluate the value of laboratory tests in predicting malignancy. The discrimination function is DF = bilirubin x 0.71 + ALP x 0.58 + ASAT x -0.24 + ALAT x 0.18 + LAP x 0.08 + GGT x -0.22. When the discriminant function was considered as a diagnostic score (DS), the sensitivity of it in detecting malignancy was 58% with a specificity of 89% and an efficiency of 81%. The DS of serum bilirubin and ALP reached the sensitivity of 61% with a 87% specificity and an efficiency of 79%. The post-test probability of malignant disease calculated by in this test combination was 69%. The LR+ was 4.8 and LR- 0.44. In conclusion, serum bilirubin and alkaline phosphatase seem to be the most potential tests of these laboratory tests in distinguishing benign and malignant causes of jaundice and/or cholestasis, high levels being suggestive of malignant disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Evaluation of a computer-based diagnostic score system in the diagnosis of jaundice and cholestasis.

A prospective series of 220 patients with jaundice and/or cholestasis was analysed by means of discriminant analysis to evaluate the diagnostic value of various symptoms and signs and basic hepatopancreatobiliary laboratory tests in the differential diagnosis of these patients. In addition, a computer-based diagnostic score (DS) system was developed and compared with the diagnostic value of clinical evaluation (CE), ultrasound (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP). A multivariate stepwise discriminant analysis showed five independent diagnostic factors in distinguishing extrahepatic and intrahepatic diseases: duration of jaundice (p = 0.002), serum protein concentrations (p = 0.002), Normotest (p = 0.04), fever during the past 3 months (p = 0.54), and age (p = 0.58). To sum up the contributions of independent factors, a DS was developed. The discrimination function was as follows: duration of jaundice x 0.97 + age x -0.40 + fever during the past 3 months x 0.33 + serum protein concentration x 0.35 + Normotest x -0.27. The diagnostic sensitivity of DS in the detection of extrahepatic disease was 96%, with a specificity of 80% and an efficiency of 93%. The sensitivities of the imaging methods (62-85%) were inferior to that of DS, whereas the specificities were better (94-98%). The sensitivity of CE was only slightly lower (86%) than that of DS, but the specificity was lowest (57%). In conclusion, relatively few (5 of 40) of the classical symptoms, signs, and biochemical tests proved to be independent diagnostic factors in distinguishing extrahepatic and intrahepatic diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholestasis, Extrahepatic↗

PubMed1993

Pancreatic lymphoma.

Primary lymphoma of the pancreas is an extremely rare condition. There are no previous reports from northern Europe. It is important to differentiate pancreatic carcinoma from lymphoma because there is significant difference between the prognosis and treatment. We describe here a case of primary pancreatic lymphoma in a 64-year-old woman who was admitted to hospital because of a sudden abdominal pain and vomiting. Ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography findings are presented, and the features of pancreatic lymphoma in these imaging studies are discussed.

Diagnosis, Differential↗

PubMed1992

Clinical evaluation of a new serum tumour marker CA 242 in pancreatic carcinoma.

The aim of this study was to evaluate the new monoclonal tumour marker CA 242 in the diagnosis of pancreatic carcinoma and to compare it with the established markers CA 50 and CEA. Serum concentrations were determined in 113 patients with jaundice, in 20 patients with laboratory values suggesting cholestasis, and in 60 patients with a suspicion to have chronic pancreatitis. Twenty-four of these 193 patients had pancreatic carcinoma and two patients had carcinoma of papilla of Vater. The sensitivities of CA 242, CA 50 and CEA were 80.7%, 96.1%, and 92.3%, respectively. The specificities were 79.0%, 58.0%, and 59.2%. The sensitivities of combinations of CA 50 and CEA with CA 242 did not exceed the sensitivity of CA 50 alone. The specificity of CA 242 was improved by combining it with CEA (92.2%). The serum marker CA 242 seems to be less sensitive than CEA and CA 50 in the detection of pancreatic carcinoma, but it may prove useful because of its high specificity.

Adenoma, Bile Duct↗

PubMed1992

Characteristics of jaundice and cholestasis in a Finnish population.

A prospective study of a Finnish population of about 250,000 patients with jaundice or unjaundiced cholestasis was carried out. During a two-and-a-half year period altogether 343 patients entered the study. The male/female ratio was 46%/54%. The mean age was 64.9 years (range 19-92). Extrahepatic obstructive diseases constituted two-thirds of the cases both in the jaundiced and unjaundiced cholestatic patient groups. The leading extrahepatic diseases causing jaundice were gallstone disease (61%) and pancreatic carcinoma (19%). Among the nonobstructive intrahepatic diseases causing jaundice, the most frequent diseases were alcoholic liver disease (32%) and viral hepatitis (21%). In patients with unjaundiced cholestasis, the spectrum of diseases resembled that of the jaundiced patients, gallstone disease and pancreatic carcinoma being the largest disease groups. In conclusion, extrahepatic obstructive processes seem to be the major aetiology of jaundice and unjaundiced cholestasis in our study population.

Adult↗

PubMed1992

Complications of endoscopic retrograde cholangiopancreatography in jaundiced and cholestatic patients.

The purpose of this prospective study was to investigate the complication rate of endoscopic retrograde cholangiopancreatography (ERCP) in the management of jaundiced and unjaundiced patients with laboratory findings suggesting cholestasis. ERCP was performed in 144 jaundiced patients and in 27 patients with unjaundiced cholestasis (age range 18-89 years, mean 66 years). Endoscopic papillotomy was performed in 45 patients, three for spasm of the sphincter of Oddi and the rest for choledochal stones. Seven bile duct prostheses were inserted endoscopically, all for treatment of malignant obstruction. The complications of ERCP were as follows: four cases of pancreatitis (2.3%), five cases of cholangitis (2.9%), two cases of bleeding (1.2%) and two perforations (1.2%). The overall complication rate was thus 7.6% (13/171) and there was no primary mortality. ERCP seems to be a safe and effective method in the diagnostic study and management of bile duct obstruction even in the elderly patients with jaundice or unjaundiced cholestasis.

Adolescent↗

PubMed1992

Ultrasonography, CT, and ERCP in the diagnosis of choledochal stones.

A prospective study of jaundiced (n = 187) and nonjaundiced (n = 33) cholestatic patients was carried out to evaluate the sensitivity of ultrasonography (US), CT, and endoscopic retrograde cholangiopancreatography (ERCP) in the detection of choledochal stone disease. Altogether 83 patients had the final diagnosis of choledocholithiasis. In the jaundiced patients, the sensitivity of US, CT, and ERCP was 22.5%, 23.2%, and 80.6%, respectively. In cases of cholestasis without jaundice, the values were 20%, 37.5%, and 66.7%. In patients in whom all 3 imaging studies were done (n = 64), the differences between US and ERCP and between CT and ERCP were statistically significant (p less than 0.0001). In most false-negative ERCP studies (10/15), the clinical course of the disease strongly suggested a passed choledochal stone. On the basis of this study, we recommend prompt ERCP to be performed if choledochal stone disease is suspected on clinical grounds.

Adult↗

PubMed1991

Diagnostic accuracy of ultrasound, computed tomography, and endoscopic retrograde cholangiopancreatography in the detection of obstructive jaundice.

The purpose of this prospective study was to investigate the diagnostic accuracy of ultrasound (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) in the distinction between extrahepatic and intrahepatic causes of jaundice. The limit for the inclusion to the study was defined as a serum bilirubin concentration greater than or equal to 40 mumol/l. Altogether 187 jaundiced patients were studied. The sensitivities of US, CT, and ERCP were 63%, 77%, and 87%, respectively. The differences between all these methods were statistically significant. The specificities and positive predictive values were high, reaching 96-99%, but the negative predictive values were low, ranging between 38% and 60%. Choledochal stone disease constituted the main etiology of false-negative studies in all investigations. Imaging procedures have a prominent role in the diagnostic study of the jaundiced patient, but it is obvious that their diagnostic accuracy may vary between institutions because of the variance in local experience and expertise, and because of the differences in diseases causing jaundice.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMed1991

Radiographic grading of extrinsic allergic alveolitis. A comparison between a modified ILO classification and a descriptive method.

We analyzed the acute phase radiographs of 107 consecutive patients with clinically confirmed extrinsic allergic alveolitis. Three readers independently recorded the profusion and the type of opacities according to the standard ILO criteria extended with categories x, y, z, and ground glass for description as proposed by McLoud et al. The profusion of the changes was grade 0 in 13%, grade 1 in 37%, grade 2 in 35%, and grade 3 in 15% of the interpretations. The type of predominant small opacities was p in 33%, x in 22%, s in 13%, t in 10%, q in 9%, and 0, r, u, y, and z in 13% of the interpretations. Ground glass density was seen in 8% of the recordings. The changes were predominantly located in the middle and lower lung zones. For comparison, according to the classification of Hapke et al. miliary changes (68%) predominated over fibrotic (27%) and normal (11%) recordings. The intraobserver agreement was good by both methods, but there was less interobserver variation with the ILO method. The semiquantitative standardized modified ILO scheme was considered more informative than Hapke's descriptive classification for epidemiologic and research purposes.

Alveolitis, Extrinsic Allergic↗

PubMed1991

Evaluation of heart size and pulmonary vasculature. Conventional chest roentgenography and image intensifier photofluorography compared.

Inter- and intraobserver variation and diagnostic accuracy in estimation of heart size and pulmonary vasculature were evaluated for conventional film-screen technique and image intensifier photofluorography. Interpretation of 218 p.a. and lateral chest films by both imaging techniques was performed independently by 4 readers. Heart size relative to body surface area measured from the plain chest films was used as the reference in cardiac size determination. Overall diagnostic accuracies of conventional radiography and image intensifier photofluorography for cardiomegaly were close to each other, 0.70 vs 0.68, respectively. Specificity of film-screen radiography was better than that of photofluorography (0.92 vs 0.84, p less than 0.05). Interobserver agreement was poor both in assessment of the heart size and pulmonary vasculature (range of kappa coefficients 0.18-0.59) while the intraobserver consistency (kappa coefficients 0.60-0.85) was good to excellent. The results suggest a limited usefulness of visual assessment of heart size and pulmonary vasculature in chest roentgenographs.

Aged↗

PubMed1991

Intermittent pneumatic compression therapy in posttraumatic lower limb edema: computed tomography and clinical measurements.

The purpose of our study was to assess the amount of posttraumatic lower limb edema and its distribution between subcutaneous and subfascial compartments before and after intermittent pneumatic compression (IPC) therapy in patients with fractures of the lower leg immobilized with a cast for six to 12 weeks. Computed tomography (CT) was used as an objective method of measuring the compartmental distribution of edema. Sixteen patients with a mean age of 37 years (range 19 to 64 years) were investigated by clinical measurement of the leg circumference and by CT at the ankle joint and at three equidistant (10cm) levels above it. The unaffected leg served as a control for the evaluation of the amount of edema and density of the tissues. Edema was found primarily in subcutaneous tissue. The IPC treatment decreased relative edema from 23% to 15.9% (p less than 0.01) as measured by CT, and from 23.5% to 13.2% as measured clinically. The density of muscle tissue increased 9% (p less than 0.01) and that of subcutaneous tissue decreased 5.6% (p less than 0.05). The IPC treatment influenced both the amount of edema and the density of tissue compartments.

Adult↗

PubMed1990

Ultrasonography and computed tomography in diffuse liver disease with cholestasis.

Ultrasonography (US) and computed tomography (CT) were performed on respectively 67 and 42 (altogether 72) patients, for the assessment of intrahepatic cholestasis. The diagnostic ability to differentiate between malignant (17 patients) and benign (55 patients) liver disease was analyzed. Coarse echogenicity of the liver led to inconclusive results in differentiating between cirrhosis (2 out of 29 patients) and malignant infiltration (4 out of 15 patients) by US. Other benign liver diseases in 23 patients, including acute hepatitis, chronic active hepatitis, fatty liver, and liver congestion, were correctly interpreted as benign. CT correctly disclosed malignant liver disease in all cases. A false positive diagnosis of malignancy was encountered in 4 (out of 17) patients with decompensated hepatic cirrhosis because of non-homogeneous expansive areas on CT in 3 cases. The true cause was in 2 patients non-uniform fatty infiltration, and in one patient with acute hepatitis A, small hypodense lesions. Among cholestatic patients, decompensated cirrhosis and malignant liver infiltration could not always be differentiated on US or CT.

Adolescent↗

PubMed1989

Iatrogenic compartment syndrome, A follow-up of four cases caused by elastic bandage.

We describe four patients suffering from lower limb compartment syndromes which were caused by constrictive bandages applied after stripping of varices. The dressing was erroneously only partially removed, when the patients started complaining of severe pain and tension in the operated legs. The damages varied from extended irreversible neuromuscular defects to lesser functional handicaps. Three patients had corrective surgery. The clinical follow up over several years showed little improvement, secondary complaints were frequent.

Adult↗

PubMed1988

Image-intensifier photofluorography and conventional chest radiography: comparison of diagnostic efficacy.

Photofluorography with a large image intensifier, which provides an image field of 40 x 40 cm, reduces both the radiation dose and the imaging costs in chest radiography as compared with the film-screen technique. The two techniques were evaluated in a clinical study of 135 patients with suspected chest abnormalities. Photofluorographs and film-screen chest radiographs were interpreted independently by three radiologists. The diagnoses were confirmed by CT, follow-up radiographs, and clinical records. Among the 135 patients, 75 had primary lung cancer, 39 had pulmonary nodules, 52 had hilar or mediastinal abnormalities, 17 had pleural fluid, and 45 had pneumonic or atelectatic changes. Twenty-three normal subjects were included. Differences in diagnostic accuracy, measured by sensitivity and specificity, were not statistically significant. A larger number of true-positive cases (65%) with peripheral lung nodules were found by photofluorography than by film-screen radiography (54%) (p less than .05). The results suggest that the diagnostic accuracy of chest images made by photofluorography is sufficient to warrant using it instead of the film-screen technique in routine chest radiography, especially to detect lung tumors and metastases.

Humans↗