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Biomedical subjects

L Sourander

Publications and source records attributed to L Sourander.

At least 37 records · Page 2Linked to original sources
PubMed1995

Leukoaraiosis and cause of death: a five year follow up.

The causes of death of 127 patients, who had undergone CT examination of the brain in 1989, were investigated. The CT was re-evaluated. Twenty five patients were excluded because of pathological findings on CT other than leukoaraiosis (LA), infarction, or their combination or, because of a specific known aetiology for LA. Of the remaining 102 patients, 25 had pure LA, 18 had pure infarction, 37 had LA combined with infarction (cLA), and 22 had a normal CT. The mean time between the CT and death was 1.8 (SD 1.5) years. A vascular cause of death was clearly associated with LA and with the severity of LA. Patients with pure LA had a vascular cause of death as often as those with pure infarction and those with LA combined with infarction. These groups differed significantly from each other when comparing the occurrence of cerebrovascular, cardiovascular and other vascular causes of death. The results suggest that LA on CT is more likely to be associated with a cardiovascular cause of death, and pure infarction is more often associated with a cerebrovascular death.

Aged↗
PubMed1995

Influence of age on colorectal cancer's 5-year survival.

The aim of this study was to ascertain the 5-year survival figures of 171 consecutive colorectal cancer patients in southwestern Finland, the differences between various age groups, and which clinical variables predict poor outcome. The mean age at the time of diagnosis was 67 years in men and 69 years in women. The 5-year survival was lower in older patients, especially in those over 80 years with concomitant diseases. However, the colorectal cancer mortality did not differ between the three age groups: < 65, 65-80, > 80 years. Employing univariate analysis, a poor 5-year outcome was associated with metastases, and the outcome was excellent if the cancer was confined locally (p = 0.0001). As many as 26% of the patients in whom the cancer was confined to the bowel wall (Dukes B) at the time of operation died within 5 years. A poor survival rate was also found if the patients had emergency operations (p = 0.021). The postoperative mortality was 6%. Using logistic regression analysis, the poor 5-year survival rate was correlated strongly with metastasized cancer (p = 0.000) but less so with age (p = 0.040).

Adult↗
PubMed1995

A practical guide to prescribing in nursing homes. Avoiding the pitfalls.

The abundant use of drugs in nursing homes demands special attention. Inappropriate indications and dosages, and lack of monitoring of drug-related effects and adverse reactions in patients are problems which can easily be solved. Knowledge of basic aspects of geriatric pharmacokinetics, and of basic rules and the main pitfalls involved in prescribing drugs for the elderly is essential, and demands both training of personnel and a change in prevailing attitudes.

Aging↗
PubMed1994

Chronic illness and subjective quality of sleep in the elderly.

The effect of chronic illness on the subjective quality of sleep, and the use of hypnotics was studied in a stratified random sample of elderly people. Six hundred subjects aged 65 years or over were included in the study. A structured interview on the quality of sleep and medical history was carried out. In addition, the majority of diagnoses were confirmed from the national health insurance documents of the subjects. Logistic regression analysis disclosed that only perceived poor health and peptic ulcer or esophagitis were associated with perceived poor sleep. Age did not contribute to the quality of sleep. Age over 80 years and the presence of peptic ulcer or esophagitis, heart failure, cholelithiasis, and, in particular, depression were associated with the habitual use of hypnotics. The results stress the importance of perceived poor general health status, and acid-related gastrointestinal diseases as the determinants of subjective poor sleep, rather than age or many specific somatic diseases as such. On the other hand, depression is a major determinant for the habitual use of hypnotics.

Aged↗
PubMed1994

Finding colorectal tumours with an immunological faecal occult blood test in symptomatic primary health care patients.

The aim of this prospective study was to investigate whether an immunological double faecal occult blood test (Fecatwin-S/FECA-EIA) can be used in screening patients with symptoms suggestive of colonic or rectal origin in primary health care. Altogether 523 patients were referred to the study by general practitioners. Three kits were used for the faecal samples and each time the sample was taken from two places of the faeces. If the guaiac test (Fecatwin-S) was positive, the immunological test (FECA-EIA) was performed. All 71 patients with an immunotest absorbance value of over 0.8 were investigated with colonoscopy and this group had 13 cancers, eight adenomas and one hyperplastic polyp. A control group of 41 consecutive patients with an absorbance value under 0.8 had one adenoma and three hyperplastic polyps. The uninvestigated FECA-EIA negative patients had no malignant colorectal tumours in the mean follow-up period of 2.2 years according to hospital records. All cancers had very high absorbance values, the mean value being 2.461. With adenomas the mean absorbance value was 1.912 and with hyperplastic polyps 0.814. Most of the diagnosed cancers and adenomas were in patients over 65 years of age. The study indicates that the immunological occult blood test is a useful tool for a general practitioner in finding bleeding colorectal tumours. The number of needless clinical examinations can be lowered which is important especially among elderly patients. However, the test-negative patients should be retested or investigated if symptoms continue.

Adult↗
PubMed1994

Spectral analysis of heart rate variability in evaluation of sympathetic function in elderly subjects.

Plasma concentration of noradrenaline is often used as a measure of sympathetic nervous activity. Recently, the method of spectral analysis of heart rate variability has been introduced to detect autonomic dysfunction. To examine whether spectral analysis of heart rate variability is useful in evaluating sympathetic function, changes in the heart rate variability in the low-frequency spectral band were compared with the change of plasma noradrenaline in response to head-up tilt in elderly hypertensives (n = 13) and diabetics (n = 13). In hypertensive subjects, there was an increase in relative low-frequency power (p = 0.015) and an increase in plasma noradrenaline level (p = 0.040) in response to head-up tilt. Diabetics did not show corresponding changes. There was no change in absolute low-frequency power in either group. It is concluded that spectral analysis of heart rate variability can be useful in evaluating sympathetic function in elderly subjects.

Aged↗
PubMed1993

Subjective evaluation of sleep and the use of hypnotics in nursing homes.

The purpose of the study was to evaluate the sleep habits and the use of hypnotics in the elderly living in nursing homes. The study population consisted of 60 subjects aged 61-99 years who were interviewed by a geriatrician. The use of hypnotics was frequent (53%), but not associated with gender, memory impairment, moving disability, depression, quality of sleep or sleep behaviour. Users of hypnotics had shorter total sleep time (TST) and got up earlier from bed in the morning than the non-users. Most of the subjects perceived their sleep as interrupted but satisfactory. The elderly with impaired memory slept longer, stayed in bed longer, and took their hypnotics significantly earlier than those with normal memory. As we found no explaining factors for the use of hypnotics, we suggest regular evaluation of their administration in nursing homes. The subjective need for hypnotics, not the nursing home practices, should decide the necessity of these drugs and the medication times in nursing home residents.

Aged↗
PubMed1993

Delay in diagnosis of colorectal cancer in elderly patients.

The medical histories of 178 colorectal cancer patients were studied retrospectively from hospital records. The average age at the time of diagnosis was 71 years. Visible loss of blood or anaemia were the commonest features. The mean time from first symptom to first medical consultation was 82.8 days. Men under 65 years and women over 80 years waited the longest time before consulting a physician. The mean time from the first medical consultation to diagnosis was 44.7 days. The delay was longer for men than for women but longest for women aged over 80 years. Information about digital rectal examination was lacking in over half of all patients and in two-thirds of patients over 80 years. In patients in whom rectal examination had been made, as many as 60% of rectal cancers were digitally palpable. Barium enema missed the cancer diagnosis in 11.2% of patients at the first examination; the missed cancers were located in the sigmoid area and in the right colon. Colonoscopy can be recommended as the primary investigation method when colorectal cancer is suspected. Re-examination is necessary in elderly patients with sideropenic anaemia if the first examination is negative.

Adult↗
PubMed1993

Relationship between vascular factors and white matter low attenuation of the brain.

To study the relationship between vascular factors and white matter low attenuation of the brain (WMLA), computer tomography findings of 251 patients were re-interpreted. Clinical data on patients were collected from the hospital records. It was possible to obtain sufficient clinical data on 204 patients who were included in the study. WMLA changes, on computer tomography, were found in 51.5% of patients. WMLA was most commonly present in patients with vascular (69.8%) and combined (69.2%) dementia. The occurrence of WMLA did not differ between patients with Alzheimer's disease (26.7%) and those without dementia (35.9%). Arterial hypertension, coronary heart disease, or diabetes were not associated with WMLA. Heart failure and orthostatic hypotension, were found to be more commonly present in patients with than in those without WMLA (34.0% vs 14.3%, p = 0.0012; 10.0% vs 2.0%, p = 0.036). Both systolic and diastolic low blood pressure values were associated with WMLA unlike hypertensive blood pressure values. Atrial fibrillation in electrocardiography was associated with WMLA, while neither left ventricular hypertrophy nor myocardial infarction was. When several explanatory variables were adjusted by logistic regression analysis, age, heart failure, and systolic blood pressure below 130 predicted WMLA. In conclusion, the association between WMLA and vascular factors with hemodynamic significance suggests that cerebral hypoperfusion may contribute to the genesis of WMLA.

Adult↗
PubMed1993

Characteristics of colorectal cancer in elderly patients.

The aim of the study was to examine the characteristics of colorectal cancer in elderly patients. The medical histories of 178 consecutive patients (79 men and 99 women) with colorectal cancer were studied from hospital records. The studied parameters were compared between three age groups: under 65 years old, 65-80 years old and over 80 years old. In the two older age groups, cancer was situated more commonly in the proximal colon than in the youngest age group (p = 0.029). Especially in elderly subjects, rectosigmoidoscopy is not sufficient since up to 40% of cancers are located in the right colon. Colonoscopy is recommended as the method of choice in old patients if colorectal cancer is suspected. Cancers in the oldest age group more often fell into to Dukes' stages C1, C2 and D (metastatic growth) (p = 0.072) and they were greater in size than those of patients under 80 years old (p = 0.029). Small cancers (under 5 cm) had obvious blood in the stools as the main symptom and represented nonmetastatic Dukes' stages. If these cancers could be detected earlier by testing for occult blood, the prognosis of colorectal cancer would improve. The resectability of cancer was lower in patients over 80 years than in other age groups (p = 0.016). However, in logistic regression analysis, the large size, poor or moderate cell differentiation, and distal location of the cancer, but not age, were associated with poor resectability.

Aging↗
PubMed1993

Determinants of symptoms suggestive of gastroesophageal reflux disease in the elderly.

The study material consisted of 487 subjects from a stratified random sample of the non-institutionalized population of Turku aged 65 years or more (n = 24,937). The study was based on a population study on health status and sleeping habits of the elderly. Information on health status and medications was obtained by means of interviews and from the national health insurance records of the subjects. A postal questionnaire inquired about symptoms suggestive of gastroesophageal reflux disease (GERD). In univariate analyses, perceived poor health, insomnia, disability, depression, previous peptic ulcer, cholelithiasis, and bronchial asthma were associated with daily symptoms suggestive of GERD. Moreover, the symptoms were associated with the use of beta-blocking agents, benzodiazepines, and neuroleptic agents. In multivariate analyses, previous peptic ulcer, perceived poor health, insomnia, and use of benzodiazepines were independently associated with symptoms suggestive of GERD. In conclusion, the determinants of symptoms suggestive of GERD in the elderly differ from those reported in young and middle-aged subjects.

Aged↗
PubMed1993

GI motility disorders: diagnostic workup and use of prokinetic therapy.

GI motility changes little--if at all--with age in healthy patients. However, a variety of diseases, including diabetes and Parkinson's disease, may cause autonomic neuropathy that is manifest as a motility disorder in the GI tract. Autonomic neuropathy can cause dysmotility in the esophagus, stomach, and gut. Symptoms are often nonspecific, including difficulty in swallowing, nausea, vomiting, heartburn, indigestion, diarrhea, and constipation. Nonpharmacologic treatment includes management of underlying diseases, avoidance of anticholinergic medications, and dietary changes. Agents with prokinetic action are the therapy of choice when drug treatment is indicated.

Aging↗
PubMed1993

Midazolam and flunitrazepam: pharmacokinetics and effects on night time respiration and body movements in the elderly.

In a double-blind crossover study, the pharmacokinetics and effects on night-time respiration and body movements of midazolam 7.5 mg, flunitrazepam 1 mg, and placebo were studied in 5 elderly insomniac patients with the static charge sensitive bed-method (SCSB). In a supine position, the gastrointestinal absorption rate of flunitrazepam (tmax 0.6 h) was faster than that of midazolam (tmax 0.95 h). The elimination phase half-life of midazolam was about twice as long as reported earlier in healthy adult volunteers, but ageing did not affect the elimination of flunitrazepam. The shape of the serum concentration-time curve of both benzodiazepine derivatives was quite similar. The sleep of these five insomniacs became more peaceful and the respiration more regular during midazolam and flunitrazepam, compared with placebo. Both benzodiazepines significantly decreased body movements and the cumulative movement time remained shorter throughout the night, compared with placebo. Total variability (VI) was clearly decreased with flurazepam, and a similar but not statistically significant tendency was seen with midazolam, compared with placebo. Accordingly, the proportion of quiet sleep (QS) increased (p = 0.014) and the proportion of active sleep (AS) decreased (p = 0.019) with both benzodiazepines, compared with placebo. This reflects the changed control of respiration by higher brain structures. No signs of increased respiratory resistance (i.e. ballistocardiographic respiratory amplitude variation BRV < 60%) were seen with either of the drugs or placebo. There were no differences in the subjects' own estimation of their sleep during medication with these drugs. Only the sleep onset latency was shorter with flunitrazepam compared with midazolam and placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1992

Radiographic pulmonary changes of gastro-oesophageal reflux disease in elderly patients.

The aim of this study was to investigate the association of gastro-oesophageal reflux disease (GORD) with radiographic pulmonary changes. One hundred and thirty-seven patients aged over 60 years referred for endoscopy for abdominal symptoms were included in the study. In patients with any suspicion of GORD (n = 95), 24-hour oesophageal pH monitoring was carried out. All the patients were interviewed before the examinations. Chest radiography was performed in all patients. Odds ratio of respiratory symptoms was 8.7 (95% confidence interval 3.4-22.4) in patients with total reflux time of more than 10% compared with those who had total reflux time of less than 10%. In chest radiography, bilateral pleural adhesions and thickenings and bilateral parenchymal scars were significantly more common in patients with, than in those without, regurgitation or large hiatal openings. The occurrence of bilateral scars and pleural thickenings increased with the extent of gastro-oesophageal reflux in pH monitoring. Odds ratios of bilateral pleural thickening and pulmonary scars were 3.1 (95% confidence interval 0.8-11.5) and 5.8 (1.1-29.6) in patients with total reflux time over 10%, compared with patients who had normal total reflux time. The findings indicate that respiratory involvement is a characteristic feature of GORD in elderly patients.

Aged↗
PubMed1991

Symptoms of gastro-oesophageal reflux disease in elderly people.

The frequency and the possible age-related characteristics of gastro-oesophageal reflux disease (GORD) were investigated in 195 consecutive elderly subjects (mean age 74 years), referred to endoscopy for abdominal symptoms or sideropenic anaemia. In the 105 of these patients in whom there was any suspicion of GORD, 24-hour pH monitoring was carried out. All the patients were interviewed before the examinations. Erosive or complicated (grade 2-4) oesophagitis was found in 18% of patients. The main symptoms in these patients were dysphagia, respiratory symptoms and vomiting. Chronic cough, hoarseness or wheezing were present in 57% of patients with oesophagitis compared with 33% of those without oesophagitis (p less than 0.001). The occurrence of heartburn and regurgitation did not differ significantly between patients with or without oesophagitis, although the mean symptom scores were higher in those with oesophagitis. Dyspepsia and chest pain were not typical symptoms in oesophagitis. Of patients with oesophagitis 29% had no typical symptoms of GORD; only 24% of patients with regurgitation had oesophagitis. In 24-hour pH monitoring, a significant increase in the occurrence of symptoms was not seen until total reflux time pH less than 4 exceeded 10%. The occurrence of heartburn did not correlate with the extent of reflux in the pH study. In conclusion, typical symptoms of GORD in the aged were regurgitation, dysphagia, respiratory symptoms and vomiting rather than heartburn.

Age Factors↗
PubMed1991

Efficacy and tolerability of cefetamet pivoxil in diabetic patients with urinary tract infections: a case-control study.

Cefetamet pivoxil, an oral third generation cephalosporin, was evaluated in 218 hospitalized patients with complicated urinary tract infections. Among these patients, 28 (13.1%) were suffering from concomitant diabetes: 25 of these patients were matched with 25 non-diabetic patients and for each pair, the age +/- 2 years, sex, complicating factors, etc. had to be identical. All patients received 2000 mg cefetamet pivoxil daily for 10 days. The predominant pathogen was E. coli; 18 in the diabetic group, 15 among non-diabetics. Comparison of the therapeutic results showed that the bacteriological eradication rate was similar in diabetic and non-diabetic patients, 92% and 87.5%, respectively. There was a similar improvement in pyuria, and therapeutic response was equal in diabetic patients as in non-diabetic patients. No unwanted effects on renal function were observed in the high-risk diabetic group.

Adult↗
PubMed1985

Prevalence and incidence of moderate and severe chronic renal failure in south-western Finland, 1973-76.

In an area of south-western Finland with 195 000 inhibitants and a highly centralized health care system, all subjects with elevated serum creatinine (greater than or equal to 230 mumol/l) were registered on the basis of data collected from all hospitals and clinical laboratories of the region. The prevalence of chronic renal failure (S-creatinine greater than or equal to 230 mumol/l) was 67 per 100 000 inhabitants and that of severe chronic renal failure (S-creatinine greater than or equal to 500 mumol/l) 12.3/10(5). The annual incidence of chronic renal failure (S-creatinine greater than or equal to 230 mumol/l) was 31.7 per 100 000 inhabitants and that of severe chronic renal failure (S-creatinine greater than or equal to 500 mumol/l) 11.9/10(5). Age-specific prevalences and incidences rose progressively with age and were very high in the aged population. Chronic interstitial nephritis, in a broad sense, was the most common cause of chronic renal failure, and it was related to analgesic abuse in about half of the cases. Eleven of 68 subjects entering the study with a serum creatinine greater than or equal to 500 mumol/l had no previous knowledge of their chronic renal disease.

Adolescent↗