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Biomedical subjects

M Nuutinen

Publications and source records attributed to M Nuutinen.

At least 37 records · Page 2Linked to original sources
PubMed1996

Insulin and blood pressure among healthy children. Cardiovascular risk in young Finns.

We evaluated the role of insulin in regulating and predicting blood pressure among 3596 to 2799 Finnish children and adolescents aged 3 to 18 years who were followed from 1980 to 1986. Blood pressure, weight, and height were measured in three surveys 3 years apart. Fasting blood samples were drawn and serum insulin was analyzed. The effect of insulin on blood pressure was evaluated in each of the 3 study years, together with the effect of fasting insulin on future blood pressure and the effect of insulin on the change in blood pressure. We also analyzed the correlation between insulin and blood pressure in different age groups and the correlation between change in insulin and change in blood pressure. A constant positive correlation was found between insulin and both systolic and diastolic (Korotkoff's fifth phase) blood pressures measured in the respective years (correlation coefficients 0.10 to 0.41 and partial correlation coefficients 0.02 to 0.15), except between insulin and diastolic blood pressure in the first two surveys in terms of partial correlation and multiple regression analysis. Similarly insulin and blood pressure correlated positively in every age group. Insulin measured in 1980 or 1983 predicted systolic blood pressure as measured 3 and 6 years later (correlation coefficients 0.30 to 0.47 and partial correlation coefficients 0.06 to 0.13), and likewise diastolic blood pressure as measured 3 and 6 years later (correlation coefficients 0.17 to 0.35 and partial correlation coefficients 0.05 to 0.08), except among the males in 1983. Correlation between insulin and the change in blood pressure was not significant or remained marginal. Similarly, the correlation between change in insulin and change in blood pressure was not significant or remained marginal. We suggest that insulin seems to regulate actual blood pressure within the normal range and to predict future blood pressure among children and adolescents, independently of age and weight. However, insulin does not enhance the rise in blood pressure.

Adolescent↗
PubMed1996

Adverse reactions in children during long-term antimicrobial therapy.

BACKGROUND: It is difficult to obtain reliable date on the rate of adverse reactions caused by drugs in general use. Yet it would be important to compile data on adverse reactions to long-term antimicrobial therapy. METHODS: A sample of 1607 girls and 218 boys from 16 409 children younger than 16 years who had received long term antimicrobial therapy for recurrent urinary tract infections during 1976 to 1985 was analyzed with regard to adverse reactions. RESULTS: Altogether 5066 courses of treatment were given to female patients and 607 to male patients. Adverse reactions were reported in 589 courses of the 5673 (10.4%), and 463 courses (8.2%) were discontinued because of adverse reactions. None of the patients had serious life-threatening reactions, and none of those receiving nitrofurantoin had pulmonary problems. The most common adverse reactions associated with the use of nitrofurantoin were nausea and vomiting (rate, 4.4/100 person years at risk; 95% confidence interval, 3.4 to 5.4), whereas sulfonamides caused most commonly allergic skin reactions (rate, 4.6; 95% confidence interval, 3.2 to 6.5). Patients younger than the age of 2 years receiving nitrofurantoin had adverse reactions more often than those who received sulfonamides, but in the age group 2 to 15 years sulfonamides caused adverse reactions leading to discontinuation of treatment more often than did nitrofurantoin of treatment the adverse reactions occurred during the first 6 months of treatment. CONCLUSIONS: We found nitrofurantoin and sulfonamides to be safe drugs for use in long term preventive antimicrobial therapy.

Adolescent↗
PubMed1996

Type of nappy and nursing habits in acquiring acute urinary tract infection.

The role of the nappy and nursing habits as possible risk factors of urinary tract infection (UTI) were analysed in a prospective case-control study. Cases entered hospital due to their first UTI attack. Children hospitalized for some other reason, mainly upper respiratory infections or elective surgery, served as controls matched for age and sex. Cases and their controls (208 girls and 184 boys) used nappies day and night. The odds ratios for risk of contracting UTI according to different nappy types used prior to the first UTI diagnosis were 0.95 for all-in-one (superabsorbent) nappies (95% CI 0.62-1.46), 1.04 (0.69-1.57) for standard disposable nappies and 1.00 (0.46-2.16) for washable cotton nappies. The type and number of nappies used daily as well as the number of defecations per day were similar in UTI patients and the controls. There were no significant differences in the frequency of buttock washes nor in the daily time spent without nappy. The use of cotton nappies practically finished during the study. The type of nappy used or other nursing habits with the baby appeared to be insignificant risk factors for UTI during nappy age. The use of modern nappies has become so thoroughly commonplace that the true impact of nappy type on any condition during infancy is difficult or even impossible to evaluate in a case-control setting.

Acute Disease↗
PubMed1996

Prenatal and postnatal factors in predicting later blood pressure among children: cardiovascular risk in young Finns.

A negative correlation between birth weight and subsequent blood pressure has been reported, but in some studies this correlation has not been found. We analyzed the effect of birth weight and pubertal development and several pre- and postnatal factors on subsequent blood pressure among 2500 children and adolescents in a follow-up study with three surveys conducted with 3-y intervals. The correlations between birth weight and systolic blood pressure varied from -0.04 to 0.02 among the female subjects and from -0.05 to -0.04 among the male subjects in each survey. A somewhat stronger relation was found among the postpubertal female and male subjects (correlation coefficient -0.09 and -0.05) in the last survey. When adjusted for weight, the correlations became negative and more often significant. The decrease in the adjusted mean systolic blood pressure was about 2 mm Hg when birth weight increased from the lowest to the highest tertile. Other factors affecting systolic blood pressure were current age (mean change up to 1.8 mm Hg/ y) and weight (mean change up to 1.2 mm Hg/kg), the duration of breast feeding over 3 mo (mean change up to -6.5 mm Hg), and a birth rank order over four (mean change up to 5.0 mm Hg) presented as the mean difference from the baseline. According to the multiple regression analysis, a history of mother's high blood pressure during pregnancy (p < 0.05) predicted future blood pressure more eminently than birth weight. In conclusion, our results based on healthy children and adolescents offer support for the theory of low birth weight as a predicting factor for future blood pressure. However, other pre- and postnatal factors seem to be important as well.

Adolescent↗
PubMed1996

A meta-analytical approach to the pooling of blood pressure values in children.

Meta-analysis of blood pressure (BP) studies in children was performed in order to evaluate whether BP readings obtained in various studies may be pooled. In total 30 original reports on BP in children were analyzed and the age and sex-specific BP values reported for 12 and 15-year-old subjects in 11 of these were tested for homogeneity. The differences in sample size-weighted means between the devices used (with 95% confidence intervals) were evaluated. The BP values reported in different studies for systolic Korotkoffs first phase BP (K1) and diastolic Korotkoffs fourth (K4) and fifth (K5) phase BP were shown to be too heterogeneous (p < 0.001) to be pooled. Heterogeneity and measurement biases in the BP results were caused by differences between the devices and the diastolic BP indicator (K4 vs K5) and by observer biases such as uncontrolled terminal digit preference. The device-specific weighted means for K1, K4 and K5 BP in 12 and 15-year-old subjects showed statistically significant differences between random zero (RZS) and ordinary mercury (OMS) sphygmomanometer (p < 0.001) the difference (OMS-RZS) being from 0.7 to 6.6 mmHg for K1 (p < 0.001, except in 12-year-old girls), from 1.1 to 7.1 mmHg for K4 (p < 0.001, except in 12-year-old girls) and from 4.5 to 7.9 mmHg for K5 (p < 0.001). Such a discrepancy was also apparent between ordinary and automated mercury sphygmomanometer (AMS) in the case of diastolic K4 and K5 BP (p < 0.001), but not in K1. BP results obtained in different investigations using different BP devices and Korotkoffs phases as indicator of diastolic BP should not be pooled. More widely accepted recommendations are needed to standardize the measurement of BP in children.

Adolescent↗
PubMed1995

Good growth response to growth hormone treatment in the ring chromosome 15 syndrome.

Ring chromosome 15 syndrome is a rare condition in which severe growth retardation is a major finding. We report a 4 year old boy with the karyotype 46,XY, r(15)(p11.2q26.2) whom we have treated with recombinant human growth hormone (GH) for two years. During the first year of treatment, the insulin-like growth factor I increased from subnormal 4.2 nmol/l to normal 13.8 nmol/l and the insulin-like growth factor binding protein 3 levels increased from 2.6 to 3.8 mg/l, whereas high binding protein 1 concentrations normalised from 52.0 to 16.7 micrograms/l. During the two years of treatment his relative height improved from -6.2 SD to -4.4 SD and the predicted adult height from 159.6 cm to 163.5 cm. Owing to the good growth response, we have decided to continue GH treatment.

Carrier Proteins↗
PubMed1994

Medical student abuse: an international phenomenon.

OBJECTIVE: To evaluate the prevalence of physical and psychological mistreatment of medical students at two medical schools in Finland. STUDY DESIGN AND SETTING: To enable comparison between Finnish and American students, we used the American Medical Association's Office of Education Research questionnaire. RESULTS: Three of every four students surveyed reported experiencing some kind of mistreatment during their medical education. Students most commonly reported sexual mistreatment, usually as slurs and sexual discrimination, from classmates, preclinical teachers, clinical teachers, clinicians, nurses, and patients. Other forms of verbal abuse, psychological mistreatment, and physical threats were also reported. CONCLUSIONS: All forms of mistreatment were reported occurring less frequently than in the United States; still, the level of such behavior was high. The results suggest the need for more international awareness and debate regarding the habits and behavior of teaching staff in medical schools.

Female↗
PubMed1994

Growth and joint symptoms in children treated with nalidixic acid.

To analyze the effects of quinolones on growth and joints in children we identified 78 patients who had been receiving nalidixic acid for 116 days on the average (range, 3 to 570 days) from a random sample of 3094 of 16,409 children treated with long term medication because of recurrent urinary tract infection. Two controls per each index case, matched for sex and the age at which the first medication for recurrent urinary tract infection occurred, were chosen. Frequency of joint symptoms and examinations or possible treatments for arthropathies were similar in the index (n = 44) and control (n = 62) cases. Detailed growth data were analyzed from 39 case-control pairs after the mean follow-up time of 19.6 years (range, 14.8 to 24.7 years), and no growth disturbances were found. The final heights (age, > 18 years) of the index and control cases were similar (n = 31 case-control pairs). We conclude that nalidixic acid does not cause arthropathies or hamper growth in children, which supports the suggestion that at least short treatment periods with quinolones are safe.

Adolescent↗
PubMed1994

Consequences of caustic ingestions in children.

A retrospective analysis of 98 patients, less than 15 years of age, treated for caustic ingestion during 1976-1990 was performed to evaluate the modern consequences of caustic ingestion in children and to set indications for esophagoscopies and radiographic and laboratory examinations. Dishwasher detergents were ingested by 56 children. There were no lye ingestions, since lye has not been freely available in Finland since 1969. Household acetic acid (vinegar) was the most commonly (12/23) ingested acid. Primary esophagoscopy was performed in 79 of the 98 cases (80.6%). Esophageal burns were found in 20 patients. Acids caused burns more often than alkalies (9/23 (39.1%) versus 11/75 (14.7%); p = 0.011; 95% confidence intervals (CI) for the difference 5.6-43.3%) and acid burns more often developed into scars (7.4% versus 4%; p = 0.029; 95% CI for the difference 1.4-25.4%). The only esophageal stricture developed after ingestion of a Clinitest tablet. The mean time for hospitalization as a result of acid ingestion was significantly longer than after alkaline ingestion (3.2 (SD 3.5) days, n = 23 versus 1.5 (1.6) days, n = 75; p < 0.05; 95% CI for the difference 0.7-2.8 days). Prolonged drooling and dysphagia (12-24 h) predicted esophageal scar formation with 100% sensitivity and 90.1% specificity, but signs and symptoms did not predict esophageal burns after primary esophagoscopy. Radiographic examinations and leukocyte counts were of no value in predicting esophageal burns and scars. The panorama of caustic ingestion appears to have changed, probably due in part to the law banning sale of lye products since 1969. This type of law should be encouraged elsewhere. Acids cause even more caustic burns than alkalies. Vinegar should be regarded as a potent caustic substance and distributed in baby-safe bottles with appropriate information on its caustic nature. As severe esophageal lesions after accidental ingestion of caustic substances are now rare in children, primary esophagoscopies and hospitalization of patients are not indicated routinely. The decision on esophagoscopy can be made on the basis of drooling and dysphagia during follow-up.

Adolescent↗
PubMed1994

Myocardial release of malondialdehyde and purine compounds during coronary bypass surgery.

BACKGROUND: Free radicals and lipid peroxidation have been suggested to play an important role in the pathophysiology of myocardial reperfusion injury. The purpose of the present study was to monitor myocardial malondialdehyde (MDA) production as an index of lipid peroxidation during ischemia-reperfusion sequences in patients undergoing elective coronary bypass grafting. There has been a lot of debate on the role of xanthine oxidase as a potential superoxide anion generator and thus lipid peroxidation in human myocardium. To evaluate the activity of xanthine oxidase pathway, we measured the changes in the transcardiac concentration differences in adenosine, inosine, hypoxanthine, xanthine, and uric acid. METHODS AND RESULTS: The coronary sinus-aortic root differences (CS-Ao) of MDA, oxypurines, and nucleosides were measured by a recently developed ion-pairing high-performance liquid chromatographic (HPLC) method. Fifteen patients were included in the study, and 13 of them demonstrated a more than 10-fold increase in net myocardial production of MDA on intermittent reperfusion during the aortic cross-clamp period. In 2 patients, MDA was not detectable in any of the CS or Ao samples. Before aortic cross-clamping, the CS-Ao concentration differences in adenosine, inosine, hypoxanthine, xanthine, and uric acid were 0.59 +/- 0.19, 0.23 +/- 0.05, 0.89 +/- 0.36, 0.58 +/- 0.32, and 11.4 +/- 4.9 mumol/L, respectively. After aortic cross-clamping, the sum of the transcardiac differences of these compounds increased up to 2.8-fold and then gradually decreased after declamping of the aorta. There was a weak positive correlation between transcardiac concentration differences of MDA and xanthine plus uric acid (r = .48, P < .01). The postoperative functional recovery or leakage of cardiac enzymes was not affected by the level of MDA net release during the aortic cross-clamp period, however. CONCLUSIONS: We conclude that myocardial lipid peroxidation, estimated as MDA formation, is common during intermittent ischemia-reperfusion sequences in coronary bypass surgery, although some patients may be better protected. Xanthine oxidase appears to be operative in human myocardium, and free radicals generated in this reaction might also be involved in the observed lipid peroxidation process. Increased degradation of myocardial adenine nucleotides and concomitant lipid peroxidation may play a specific role in the development of reperfusion injury. In this study, however, more extensive lipid peroxidation was not associated with impaired functional recovery.

Adenosine↗
PubMed1993

Physiological relevance of the overall delta H of oxygen binding to fetal human hemoglobin.

Human fetal hemoglobin is known to display, at 20 degrees C, a lower affinity than human adult hemoglobin for oxygen when both proteins are in the absence of organic phosphates. The physiologically important reverse situation is achieved at 37 degrees C upon addition of 2,3-bisphosphoglycerate (DPG), whose lower effect on fetal hemoglobin is related to some amino acid substitutions present in gamma-chains. However, the difference in oxygen affinity observed at 37 degrees C is not solely due to the different modulation power of DPG with respect to adult and fetal hemoglobins. In fact, the results presented here reveal new aspects linked to the interplay of temperature and organic phosphates. In particular, the lower effect of DPG on fetal hemoglobin renders almost identical the oxygen affinity of the two hemoglobins at 20 degrees C, abolishing the difference observed in the absence of the effector. Successively on going from 20 degrees C to 37 degrees C, by virtue of the lower overall heat of oxygenation (delta H) displayed by fetal hemoglobin when in the presence of DPG, adult hemoglobin shows a lower oxygen affinity, as it should if oxygen has to be transferred from maternal to fetal blood.

2,3-Diphosphoglycerate↗
PubMed1992

Random-zero sphygmomanometer, Rose's tape, and the accuracy of the blood pressure measurements in children.

In the Cardiovascular Risk in Young Finns project, blood pressure (BP) was measured in 3549 randomly selected children aged 6-18 y in 1980, and 2887 and 2500 of the same individuals in 1983 and 1986, respectively. An ordinary mercury sphygmomanometer (OMS) was used in the first two surveys and a random-zero sphygmomanometer (RZS) in the third survey. Systolic and diastolic BP were lower when measured with an RZS than with an OMS and the shape of the age-related BP curve obtained with an RZS was significantly different from that obtained with an OMS, because low BP values were apparently measured more accurately with the former. Use of the RZS did not affect the distribution of the BP values. Rose's tape readings were used to evaluate the effect of training and to control the accuracy of the BP measurements. According to Rose's tape readings, Korotkoff's 4th phase BP was more difficult to measure accurately than 5th phase (p = 0.002). The mean values for the differences between the correct and actual BP readings on the Rose's tape were -1.2 mm Hg (SD 2.1) for systolic BP, 8.3 mm Hg (SD 13.6) for diastolic Korotkoff's 4th phase BP, and 1.2 mm Hg (SD 7.0) for diastolic Korotkoff's 5th phase BP, with a negative value indicating that the BP phase was measured lower than the correct value. Terminal digit preference was present in each survey to such an extent that it could have hampered the reaching of reliable conclusions from the data obtained with an OMS. The bias caused by terminal digit preference was obviated by the RZS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Pulse sounds and measurement of diastolic blood pressure in children.

Controversy exists over the value of measuring diastolic blood pressure (BP) in children, and over whether this should be measured at Korotkoff's fourth phase (K4) or fifth phase (K5) of pulse sounds. We measured diastolic BP in 3012 randomly selected Finnish children aged 6-18 years in 1980, and in 2885 of the same individuals in 1983 and 2500 in 1986. BP was measured with a standard mercury sphygmomanometer in 1980 and 1983, and with a random-zero sphygmomanometer in 1986. K4 was consistently absent in 187 individuals (3.2%) in 1980 and 1983, and in 155 individuals (6.2%) in 1986. K5 was absent in only 34 individuals (0.6%) in 1980/83 and 5 (0.2%) in 1986. The difference between mean K4 and K5 diastolic BP varied from 6.5 to 9.2 mm Hg depending upon age. K4 and K5 BPs showed good correlation in all age groups. Reliable and repeatable BP measurements in all age groups of children are best achieved with K5 as the indicator of diastolic BP.

Adolescent↗
PubMed1991

The primary structure of hemoglobin from reindeer (Rangifer tarandus tarandus) and its functional implications.

The primary structures of alpha- and beta-chains of hemoglobin from reindeer (Rangifer tarandus tarandus) were determined. Comparison of the reindeer hemoglobin sequence with those of human and bovine hemoglobins showed 50 and 29 substitutions per alpha beta dimer, respectively. The influence of replacements on the modulation of hemoglobin oxygen affinity by heterothopic ligands and temperature, as well as their importance on the structure-function relationships in hemoglobin are discussed.

Amino Acid Sequence↗