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Biomedical subjects

M Kaste

Publications and source records attributed to M Kaste.

At least 163 records · Page 9Linked to original sources
PubMed1982

Trial with human leucocyte interferon and vidarabine in herpes simplex virus encephalitis: diagnostic and therapeutic problems.

A combination therapy of human interferon, vidarabine, and dexamethasone was administered to six patients with proven (Patients I-III) or presumed (Patients IV-VI) herpes simplex virus encephalitis (HSVE). Interferon combined with dexamethasone was given to one patient with presumed HSVE (Patient VII). Leucopenia and elevated serum transaminase levels appeared in all patients and a diffuse bleeding in one of them. Patients II, III and IV died, 26, 43, and 209 days after the onset of encephalitis, respectively. Patients I, V, VI, and VII were left with moderate brain damage although their physical condition was good. HSV encephalitis presents diagnostic difficulties, complementary diagnostic methods are needed, and current therapeutic trials must be considered as preliminary.

Adult↗
PubMed1982

Alcohol intoxication: a risk factor for primary subarachnoid hemorrhage.

We studied 172 consecutively presenting patients (88 men and 84 women; aged 15 to 55) with primary subarachnoid hemorrhage (SAH) verified by hemorrhagic CSF or at autopsy. In 37 (22%) of the patients, the onset of symptoms was preceded within 24 hours by alcohol intoxication. Alcohol intoxication preceding SAH was two to three times as common in men and two to thirteen times as common in women as alcohol intoxication in the general Finnish population of the same age and sex. Thirty-two (19%) of the patients were heavy drinkers. Heavy drinking was twice as common in men and seven times as common in women as heavy drinking in the general Finnish population of the same age and sex. Both occasional ethanol intoxication and regular heavy drinking seem to carry an increased risk of SAH.

Adolescent↗
PubMed1981

Cimetidine-phenytoin interaction: effect on serum phenytoin concentration and antipyrine test.

In a prospective study in nine patients the effects of phenytoin and of cimetidine (1000 mg/day) + phenytoin on the antipyrine test and serum phenytoin concentrations were studied. Serum phenytoin increased from the steady state level of 5.7 +1.3 mg/l to 9.1 +1.4 mg/l after three weeks on cimetidine (p less than 0.01), and fell to 5.8 +1.2 mg/l within two weeks after withdrawal of cimetidine. The protein binding of phenytoin was not changed by cimetidine. After use of phenytoin for 2-4 months, antipyrine clearance increased from 0.67 +0.06 ml/min/kg to 1.61 +0.22 ml/min/kg, and antipyrine half-live fell from 10.9 +1.3 h to 4.5 +0.6 h as compared to the values before phenytoin treatment (p less than 0.01). After three weeks combined use of cimetidine and phenytoin, antipyrine clearance was decreased to 1.01 +0.07 ml/min/kg and antipyrine half-life was prolonged to 6.1 +0.5 h, (p less than 0.01) compared to the values on phenytoin alone. The distribution volume of antipyrine was not affected by phenytoin nor by cimetidine + phenytoin. The half-life of cimetidine was 2.8 +0.3 h in the patients in the longterm phenytoin treatment. There was a significant positive correlation (p less than 0.001) between the increase in serum phenytoin concentration and the prolongation of antipyrine half-life caused by cimetidine. Thus, cimetidine increases serum phenytoin concentration, very probably by inhibiting its metabolism. Care should be taken in the concomitant use of cimetidine ad phenytoin, and the dose of phenytoin should be modified according to the clinical symptoms and serum phenytoin concentrations.

Adult↗
PubMed1981

Does alcohol intoxication precipitate aneurysmal subarachnoid haemorrhage?

Seventy-five consecutive patients aged 15 to 55 years with aneurysmal subarachnoid haemorrhage verified by CSF examination and cerebral angiography or at necropsy were studied. In 19 cases (25%; four women and 15 men) the bleeding was preceded within 24 hours by a bout of alcohol drinking. Alcohol-related cases composed 33% and 14% of the patients in the age groups 15-40 and 41-55 years, respectively. Alcohol intoxication preceding the subarachnoid haemorrhage was two to four times as common in male and three to five times as common in female patients as alcohol intoxication in the general Finnish population of the same age and sex. Occasional alcohol intoxication seems to carry an increased risk of aneurysmal subarachnoid haemorrhage.

Adolescent↗
PubMed1981

Creatine kinase isoenzymes in acute brain injury.

Brain-type creatine kinase (CK) isoenzyme (CK-BB) was detected in the serum in 13 out of 26 patients with acute brain injury (50%). The peak of CK-BB activity ranged from 5 to 188 U/liter, constituting, on average, 10.5% of the total CK activity. The highest activities were seen in patients with gunshot wounds. High CK-BB activity was associated with poor prognosis, but minimal CK-BB elevations did not have prognostic significance. Heart-type creatine kinase isoenzyme (CK-MB) was detected in the serum in 17 out of 26 patients (65%). The peak activity ranged from 5 to 115 U/liter, constituting, on average, 6.6% of total CK activity. Electrocardiogram taken from 20 patients revealed transient T-wave inversions in the precordial leads in four patients; three of them also showed serum CK-MB activity. Subendocardial hemorrhage was detected at autopsy in three of the five CK-MB-positive patients, but in none of the four CK-MB-negative cases. Present findings suggest that acute brain injury may be secondarily cause myocardial damage.

Adolescent↗
PubMed1981

Criteria of brain death and removal of cadaveric organs.

Several countries have formulated and accepted their own criteria for brain death but Finland was the first country in which brain death was legally accepted. The diagnosis is based on careful history taking, clinical examination, and confirmatory investigations when needed. The cause of the brain death must be fully established and there should be no doubt that the patient's condition is due to irreversible structural brain damage. Cerebral unresponsiveness, absence of brainstem reflexes, and absolute apnoea must be confirmed clinically. Confirmatory investigations are mandatory when the diagnosis of brain death remains in doubt. The two most important investigations are electroencephalography (EEG) and aortic arch angiography. The value of the EEG is limited by technical inadequacies and observer errors while angiography appears to be less prone to misinterpretation. The tests should be repeated when necessary, an an observation period may be required. The concept of brain death has developed together with advancing intensive care techniques and their wide availability in civilized nations. In general, the concept of brain death has gained wide support and has had a positive influence on the practice of transplant surgery. The physician in charge of a dying patient, however, should only consider what is best for the patient and his family and give no priority to transplant surgeons and their patients. The ethical aspects of brain death, including the feelings of the donor (donor card), recipient and intensive care staff, should always be kept in mind.

Angiography↗
PubMed1981

Medical care programme of stroke.

A working group was established by the Finnish National Fund for Research and Development, the National Board of Health and Finnish Hospital League to write a handbook concerning the diagnoses, treatment and rehabilitation of stroke patients. In TIA, the importance of the case history is emphasized. Angiographic evaluation is recommended only for those patients who might be suitable for surgical intervention, conservative treatment being indicated for most cases. The treatment of risk factors such as hypertension is strictly emphasized. In hemiplegic stroke, early rehabilitation is most important. Today no methods are available for limiting infarction once it starts or, to reverse it when it has occurred. However, much can be done for survivors by intensive rehabilitation. The same holds true for patients with intracerebral hemorrhage. Prognosis of stroke patients is more dependent on the enthusiasm and activity of the treating team than on radiological or laboratory facilities.

Cerebral Hemorrhage↗
PubMed1980

Outcome of stroke in the Espoo--Kauniainen area, Finland.

A prospective study of all stroke cases in the Espoo--Kauniainen area (population 113 000) in South-Finland was carried out during 1972 and 1973 by the WHO stroke register method. 286 stroke patients were registered; 61% of them had a brain infarction, 16% an intracerebral haemorrhage and 15% a subarachnoid haemorrhage. The total incidence was 200/100 000/year after age adjustment of the results to the population of Finland. The incidence of subarachnoid haemorrhage, 23.9/100 000/year was especially high. The mortality within three months was 40%, and that after median follow-up periods of four and six years was 62% and 67% respectively. In the intracerebral haemorrhage group the 3-month mortality was very high (72%), but it did not change during the follow-up period. In the subarachnoid haemorrhage group the 3-month mortality was 43%, which increased slightly, but in the brain infarction group the 3-month mortality of 30% increased steadily up to 66% during the follow-up period. The causes of death after the acute stage were cardiovascular as often as cerebrovascular. After four and six years, 71% of the survivors were fully independent in activities of daily living. After four years 21% had even returned to work. 16% of the survivors were still working after six years.

Activities of Daily Living↗
PubMed1979

Diagnosis and management of brain death.

Finland was the first country in which brain death was legally accepted. Since 1975, 37 cases of brain death had been recorded in a university hospital in Finland, and these were reviewed. The cause for brain death was intracranial bleeding in 32 cases, other cerebrovascular disorder in two, and intracranial neoplasm in three. In 21 brain death was diagnosed clinically. In 16 cases confirmatory investigations (electroencephalography, cerebral angiography) were needed. After brain death had been established artificial support was withdrawn in 15 patients and organ transplantation was carried out in 10. In 12 patients, however, diagnosis of brain death did not influence management, though the heart stopped beating on average 25 hours after diagnosis. The Finnish criteria for brain death seem to be reliable and suitable for routine use.

Adolescent↗
PubMed1979

Bromocriptine treatment of spasmodic torticollis. A double-blind crossover study.

A double-blind crossover study (12 weeks and 12 weeks) was performed to evaluate the effects of bromocriptine on the symptoms and serum prolactin levels of 14 women with spasmodic torticollis. While the serum prolactin level decreased in response to bromocriptine, no difference was found between the effects of placebo and bromocriptine on the symptoms of spasmodic torticollis. Our findings suggest that dopaminergic neurotransmission is not involved in the pathogenesis of this syndrome.

Adult↗
PubMed1979

Chronic bilateral subdural haematoma in adults.

Twenty-nine patients with chronic bilateral subdural haematomas were surgically treated during 1966 to 1977. Twenty-four of them (83%) had a history of head injury, which caused unconsciousness in eight cases. The mean interval from trauma to operation was eleven weeks. The mean age of the patients was 60 years. The prevalence of the most commonly encountered symptoms and signs was: headache 72%, mental symptoms 48%, papilloedema 41%, vertigo 31%, nausea 28%, reduced consciousness 28%, walking difficulties 24%, hemiparesis 24%, and paraparesis 14%. The aggregate thickness of haematomas was 34 mm, 36 mm, and 40 mm in age groups of 20--39, 40--59, and over 60 years, respectively. All patients were operated on, four of them only unilaterally. Three patients in the whole series died. Two of them had been operated upon only on one side in the first session, the haematoma of the other side being evacuated 8 1/2 hours and four days later, respectively. Unilateral operation is likely to cause severe distortion of the midline structures and the brain stem and thus aggravates the cerebral situation. Therefore the necessity of simultaneous evacuation of the haematomas on both sides is stressed. The reason for the death of the third patient was delay in diagnosis. All three patients who died belonged to the group of eight patients with a reduced level of consciousness before surgery. Twenty-three of the survivors were fully independent in their daily lives, and three needed some help after operative treatment.

Adult↗
PubMed1978

Does ethanol intoxication promote brain infarction in young adults?

76 consecutive patients aged under 40 with ischaemic brain infarction verified by carotid angiography and/or serial brain scanning were studied. In at least 15 cases (20%) the onset of symptoms was preceded within 24 hours by a bout of alcohol drinking. Ethanol-related cases comprised 40%, 25%, and 13% of the patients in the age-groups 16-19, 20-29, and 30-39 years, respectively. Ethanol intoxication preceding the stroke was 2-3 times as common in male and 3-4 times as common in female patients as ethanol intoxication in the general Finnish population of the same ages and sex. Occasional ethanol intoxication seems to carry an increased risk of ischaemic brain infarction in young adults.

Adolescent↗