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Biomedical subjects

M Aärimaa

Publications and source records attributed to M Aärimaa.

At least 19 recordsLinked to original sources
PubMed1990

Stress symptoms, burnout and suicidal thoughts in Finnish physicians.

Stress symptoms, burnout and suicidal thoughts in Finnish physicians were studied using a questionnaire. The questionnaire, containing 99 questions or groups of questions, was mailed to 3,496 physicians representative, as regards age, sex, specialization and employment, of all active physicians in Finland. Altogether, 2,671 physicians (76%) responded. Stress symptoms in male physicians were similar to those in male managers. In female physicians they were slightly less than in female white-collar workers. In male specialists highest burnout indices were found in general practice and occupational health; psychiatry and child psychiatry; internal medicine, oncology, pulmonary diseases, and dermatology and venereology. In female specialists they occurred in general practice and occupational health; radiology; internal medicine, neurology, pulmonary diseases, and dermatology and venereology. Non-specialists had higher burnout scores than specialists for both sexes. Highest burnout scores in both men and women occurred in those working in municipal health centres. Lowest scores occurred in those working in private practice, universities, research institutes, and public offices and organizations. Suicidal intent tended to be commoner in physicians than in the general population. It was also commoner in female (26%) than in male (22%) physicians. The results indicate a polarization between "higher burnout specialities", often dealing with chronically ill, incurable or dying patients (e.g. specialties such as oncology, pulmonary diseases and psychiatry), on the one hand and "lower burnout specialties", often dealing with curable diseases and favourable prognoses (e.g. specialties such as obstetrics and gynaecology, otorhinolaryngology and ophthalmology), on the other.

Adult↗
PubMed1988

Doctors' drinking habits and consumption of alcohol.

Alcohol consumption and drinking habits among Finnish doctors were studied as part of a survey of stress and burnout. A questionnaire containing 99 questions or groups of questions was sent to all 3496 practising doctors aged under 66 randomly selected from the registry of the Finnish Medical Association. Altogether 2671 doctors (76%) responded; this sample was representative of the Finnish medical profession. The average weekly consumption of alcohol during the past year and various aspects of drinking behaviour were assessed, and the presence or absence of symptoms and diseases often encountered among heavy drinkers and addicts was determined. The data were analysed separately for men and women, for those aged less than or equal to 40 and greater than 40, and for the men with high and low alcohol consumption and with high and low scores on the index of drinking habits. Selected variables related to work, stress, and coping were correlated with alcohol consumption and drinking behaviour. The median consumption of alcohol among male doctors was 4876 g (6.2 litres) and among female doctors 2226 g (2.8 litres) of absolute alcohol per person per year and was higher in those aged over 40. Beer was most commonly drunk by men and wine by women. Increased alcohol consumption was associated with older age, disappointment with career, heavy smoking, use of benzodiazepines, stress and burnout symptoms, suicidal thoughts, general dissatisfaction, and diseases related to alcohol. Drinking habits were heavier among doctors working in community health centres, those taking long sick leaves, younger doctors disappointed with their careers or the atmosphere at work, and older doctors immersed in their work. Alcohol consumption among doctors seems to be higher than that of the general population in Finland, and heavy drinking seems to be associated with stress and burnout.

Adult↗
PubMed1987

Serum group I pepsinogens during insulin and pentagastrin tests in unoperated and vagotomized duodenal ulcer patients.

The level of serum group I pepsinogens (PG I) has been studied during the conventional insulin-pentagastrin test in 29 duodenal ulcer (DU) patients before and 2 months after proximal selective vagotomy (PSV) and in 31 unoperated DU patients. The mean basal serum PG I level was 191.6 +/- 15.4 micrograms/l (mean +/- SEM) before and 143.7 +/- 24.0 micrograms/l after PSV. A significant increase in mean serum PG I above the initial value was found both in unoperated DU patients and in patients after PSV 1 h after insulin injection. In 29 PSV patients the mean serum PG I showed a paradoxical decrease during the 2nd h after insulin injection, and the mean postvagotomy serum PG I 2 h after insulin injection was significantly (p less than 0.01) lower than the respective preoperative value in the same patients, and the value was close to the basal serum PG I. The low level of serum PG I 2 h after insulin injection in vagotomized patients may reflect the deprivation of the reduced store of PG I in the absence of normal vagal tone. Both the basal serum PG I and serum PG I response during insulin-induced hypoglycaemia showed an overlap between unoperated and vagotomized DU patients. Therefore, serum PG I analyses during the insulin test cannot replace acid secretion tests in the assessment of the completeness of vagotomy.

Adult↗
PubMed1987

Medical and surgical prophylaxis for duodenal ulcer, the role of sucralfate.

The risk of recurrent duodenal ulcer is high, 70-80% of duodenal ulcer patients having a recurrence during the first year after initial healing. Surgery has so far been the main method for preventing a relapse, but recent studies have shown that it is possible to reduce the risk and the need for surgery with medical maintenance therapy. Five controlled studies are available on the efficacy of sucralfate in prophylaxis for duodenal ulcer. 294 patients participated, 154 having received sucralfate treatment, usually 1 g twice daily. The summarized results indicate that initially healed duodenal ulcers recurred in six months in 60% of cases and in 12 months in 79% of cases in groups receiving placebo therapy or no treatment, the corresponding figures in the groups treated with sucralfate being 21% and 31%. The choice between surgical and medical prophylaxis is discussed, and more liberal use of medical prophylaxis is advocated.

Cimetidine↗
PubMed1984

Morphology and function of the parietal cells after proximal selective vagotomy in duodenal ulcer patients.

The effects of proximal selective vagotomy (PSV) on parietal cell morphology and the degree of gastric inflammation were investigated and correlated with changes in gastric acid secretion and serum gastrin concentrations in 17 duodenal ulcer patients. Endoscopy, acid secretion tests, and blood sampling were performed preoperatively and 2 months, 1 year, and 3 years postoperatively. The mucosal biopsy specimens obtained at endoscopy were analyzed both light- and electron-microscopically. Five healthy persons also underwent gastroscopy and biopsy for comparison. Preoperatively, the duodenal ulcer patients differed significantly from this control group, 33% of whose parietal cells appeared 'secretory'; the corresponding figure for the duodenal ulcer patients was 47%. Two months after the operation the number of secretory parietal cells had fallen to 30%, after which the percentage increased slightly again to 35% 3 years after PSV. A similar phenomenon was observed in the acid secretion capacities, which were maximally depressed 2 months postoperatively and recovered slightly but significantly during the 3-year follow-up period. There was a significant increase in the degree of gastric inflammation after the operation.

Adult↗
PubMed1982

Pancreatic mobility: an important factor in pancreatic computed tomography.

In a few patients, the pancreas may be difficult to visualize with computed tomography (CT). To explain this, we measured the mobility of the pancreas after clinical endoscopic retrograde pancreatography and found that the normal and even the diseased pancreas is a mobile organ, moving with respiration more than its craniocaudal dimension. Therefore, during CT investigations the patient's breathing must be standardized.

Adult↗
PubMed1981

The cystic duct stump and the postcholecystectomy syndrome. An analysis of 54 patients subjected to ERCP.

Fifty-four symptomatic patients with previous cholecystectomy were subjected to endoscopic retrograde cholangiopancreatography (ERCP) in order to determine the incidence of the cystic duct stump and to study its role in symptomatology. A stump was found in 30 (56%) of the patients, with a mean length of 23 mm (+/- 8.0 SD). The stumps were anatomically classified and 19 belonged to anatomical types where technical difficulties could be expected to be greater than usual at operation. Somatic disease causing the symptoms could be confirmed in 30 cases (56%) abnormality of the biliary tract being the cause in 21 patients (39%). No particular symptoms could be restricted to patients with a cystic duct stump. Total excision of the cystic duct would probably not eliminate the existence of postcholecystectomy symptoms. It does not appear to be necessary to modify the generally accepted method of performing cholecystectomy.

Adult↗
PubMed1980

The diagnosis of pancreatic and biliary malignancy by endoscopy and retrograde cholangiopancreatography. An analysis of 52 consecutive cases.

Fifty-two consecutive cases of verified pancreatic and biliary malignancies in patients who had been subjected to endoscopic retrograde cholangiopancreatography (ERCP) have been investigated. Twenty-seven patients were women and 25 men; mean age was 66.3 (+/- 9.4 S.D.) and 62.3 (+/- 9.6 S.D) years, respectively. The commonest indication for ERCP was icterus, 41 of 52 patients having jaundice. Ductal filling was obtained in 75% of the cases, unsuccessful ductal opacification being due mostly to carcinoma of the head of the papy, endoscopic evidence of the tumor was obtained 22 times. Malignancy was suggested in 46 of the 52 patients by ERCP; no false-negative interpretations of pacified duct occurred.

Adult↗
PubMed1978

Does adrenergic activity suppress insulin secretion during surgery? A clinical experiment with halothane anesthesia.

Peroperative inhibition of insulin release is widely attributed to increased alpha-adrenergic activity. To test this hypothesis serum insulin and glucose concentrations were measured at short intervals in 11 patients who underwent major surgery. Five patients were anesthetized with halothane and six with general anesthesia without halothane. The results were similar in both patient groups; halothane had no effect on insulin. This suggests that suppression of insulin under operations is probably not due to activation of the alpha-adrenergic receptors of the pancreatic beta-cells. The authors propose that suppression of insulin secretion during surgery may be caused by adrenaline, which, in competing for the glucose receptors, insensitizes the pancreatic beta-cells.

Aged↗
PubMed1978

Insulin, growth hormone and catecholamines as regulators of energy metabolism in the course of surgery.

Six patients subjected to major surgery (esophageal resection, group I) and eight patients undergoing moderate surgery (exploratory laparotomy, group II) were investigated in order to study the effects of surgery and glucose infusion on the blood glucose, plasma FFA, serum insulin and growth hormone concentrations as well as on the urinary excretion of adrenaline, noradrenaline and nitrogen. In the patients undergoing esophageal resection, blood samples were taken at short intervals during five 24-hour periods, covering a time span from the second preoperative to the tenth postoperative day. In the case of exploratory laparotomy four such periods up to fifth postoperative day were similarly investigated. For adrenaline, noradrenaline and nitrogen, urine was collected in two 12-hour samples for each 24-hour period in order to roughly estimate the "day" and "night" excretions. The results and conclusions can be summarized as follows: A rapid rise in blood glucose and plasma FFA concentrations occurred after the beginning surgery. The zeniths of the curves were recorded about 4--6 hours after the skin incision in both patient groups, despite the different duration of the operations. This suggests that the regulatory mechanism is spontaneously active for a certain time after being initially triggered. Insulin secretion was usually suppressed 4--5 hours after the beginning of surgery. A marked increase of insulin secretion occurred after this time, the rise of IRI being associated with a fall of BG and FFA. Maximum insulin secretion was recorded during the night after surgery. Because excretion of noradrenaline was maximal during this time in group I, noradrenaline activity is perhaps a less likely explanation of the suppression of insulin. The response of growth hormone secretion to surgery and anesthesia was not uniform. Trauma apparently causes no constant rise, whereas a rather regular elevation of serum GH levels follows the fall in BG and plasma FFA concentrations, In group I there was a decrease of insulin and GH secretion and the number of insulin and GH "peaks" in the postoperative period, possibly reflecting a weakening of central stimuli after major surgery. The same was not always noted in group II, in which the mean secretion of insulin was postoperatively somewhat elevated compared to the preoperative values. Urine analyses revealed no day--night rhythmicity in catecholamine excretion except possibly on the day of operation, when the "day" samples contained absolutely and proportionately more adrenaline than the "night" samples.

Aged↗
PubMed1974

Glucose tolerance and insulin response during and after elective skeletal surgery.

Six patients undergoing elective femoral osteotomy were subjected to a series of intravenous glucose tolerance tests and plasma insulin determinations in a study of the way in which a standard operation affects carbohydrate metabolism. The glucose tolerance of all patients assumed a diabetic pattern; this was already observable in the test made on admission to the operating theater and was still evident during the last test on the second postoperative day. The changes were most profound during and four hours after the operation. Insulin secretion was suppressed on the day of operation, but exceeded preoperative values in the postoperative period. Urinary excretion of catecholamines was determined in 4 patients; there was no correlation between the degree of insulin suppression and the catecholamine output. The assumption that the hyperglycemic response and insulin suppression are mediated along splanchnic neural pathways was not confirmed in a quadriplegic patient, who responded to an intravenous glucose tolerance test soon after the injury with hyperglycemia, insulin suppression and a low catecholamine output. It is concluded that the hyperglycemia and insulin suppression observed after trauma represent a complex and purposeful metabolic response, in which several causative factors are involved.

Anesthesia, Inhalation↗