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Biomedical subjects

M Tuominen

Publications and source records attributed to M Tuominen.

At least 37 records · Page 2Linked to original sources
PubMed1994

Effects of sub-hypnotic doses of propofol on the side effects of intrathecal morphine.

We have studied the effect of propofol on the side effects associated with intrathecal morphine in 40 patients undergoing major arthroplasty. Patients received spinal anaesthesia with plain 0.5% bupivacaine 20 mg mixed with preservative-free morphine 0.3 mg. Before injection of the local anaesthetic, the patients were allocated randomly to receive either a bolus dose of propofol 10 mg followed by an infusion of 30 mg/24 h or equal volumes of 10% Intralipid (control group). The number of patients without postoperative nausea and vomiting (PONV) was similar in both groups. However, the incidence of nausea and vomiting was lower in the propofol (13 and 22, respectively) than in the control (34 and 36) group (P < 0.01 and P < 0.05, respectively). Severe vomiting episodes were less frequent in the propofol group (1 vs 11; P < 0.05). Four patients in the propofol group and 12 patients in the control group had itching (P < 0.05). The incidence of urinary retention was similar in both groups. There was no additional sedation attributable to propofol. In conclusion, sub-hypnotic doses of propofol protected significantly against itching and had a modest effect on PONV after intrathecal morphine.

Aged↗
PubMed1994

Intraarticular morphine for pain relief after knee arthroscopy performed under regional anaesthesia.

Eighty patients scheduled to undergo knee arthroscopy were studied in random and double blind fashion. Spinal anaesthesia with hyperbaric 0.5% bupivacaine was selected for 40 overnight-in-patients. At the end of arthroscopy, 1 mg morphine or saline was injected intraarticularly. Local anaesthesia with 1% lidocaine plus adrenaline, was selected for another 40 out-patients. At the end of the arthroscopy either 1 mg morphine or saline was injected intraarticularly. As a rescue medication the spinal anaesthesia patients received oxycodone 0.14 mg kg-1 i.m. or ketoprofen 100 mg p.o. and the local anaesthesia patients received ketoprofen 100 mg p.o. The need for additional postoperative analgesic was almost similar in both spinal anaesthesia groups. The patients having local anaesthesia and given intraarticular morphine needed fewer doses of ketoprofen (22 doses) postoperatively than the control group (39 doses) (P < 0.05). Duration of analgesia was slightly longer after morphine than in the control group (ns). There was no difference between the morphine patients and the control patients in the two studies regarding the incidence of side effects. We conclude that postoperative analgesia in patients undergoing knee arthroscopy under local anaesthesia, but not under bupivacaine spinal anaesthesia, can be improved with a single intraarticular injection of 1 mg morphine.

Adolescent↗
PubMed1994

Relative value of dental procedures.

This study was conducted to develop a relative value method for dental procedures, and to evaluate the differences in values assigned by private and public sector dentists. Samples of 90 general practitioners and 120 clinical specialists were systematically drawn to represent all actively working Finnish dentists. The dentists were asked to assess the required time and know-how for performing various procedures compared to performing a two-surface amalgam filling (AF2). At the end, the dentists were asked to divide the value of 200 between time and know-how for the reference procedure (AF2). These figures were then utilized to calculate the average relative value for each procedure. Private practitioners' weighted relative values were 55.3% higher than the prices, and among public sector dentists they were 27.9% higher. Overall, know-how constituted more of the total value of the procedures than did time. Private practitioners' time assessments correlated well (r = 0.72-0.95) with the recommended prices. However, significant differences were often observed both in time and know-how assessments of individual procedures. Both time and know-how seem to be important factors when determining values for dental services. For evaluation of the value of output in the private sector, the use of prices is justified. However, when the productivity of non-profit dental offices is evaluated, a value system which is not based on market prices is needed.

Adult↗
PubMed1994

Ocular complications in young adults with insulin-dependent diabetes mellitus since childhood.

A cross-sectional study in 80 insulin-dependent diabetic patients born 1963-1968 who experienced the onset of diabetes before 15 years of age showed that at a mean age of 21.6 (range 17-25) years and after a mean duration of diabetes of 13.3 (range 6-24) years, 80% of the patients had retinopathy: 70% had background and 10% proliferative changes. Retinopathy correlated with the duration of the diabetes and poor glucose control at 15 years of age but not with the actual level of glycated haemoglobin. The severity of retinopathy was worse in women than in men. One patient (1.2%) was blind. Two patients had had cataract operations and 66% had myopic refraction in one or both eyes. In 61 patients a further period of ophthalmological follow-up of 3-4 years was included. After 20 years of diabetes, all had retinopathy and 29% had proliferative changes: 33% had received laser treatment after 8-27 (mean 16.1) years of diabetes. Altogether, 2 patients (2.5% of the original series) were blind. For prevention of diabetic retinopathy and blindness, good glucose control from puberty and careful ophthalmological follow-up after transfer of the patient from paediatric to adult diabetes care play major roles.

Adolescent↗
PubMed1994

Glycosaminoglycan synthesis in the mandibular condyle during growth adaptation.

Condylar growth was studied after an operation simulating functional orthodontic appliances. Twenty-five rabbits underwent a surgical operation for the induction of premature synostosis to displace the glenoid fossa posteriorly during growth. Twenty-five control rabbits underwent sham operations. At the age of 15 days, 10 experimental and 10 control animals and, at the age of 20 days, 5 experimental and 5 control animals were killed. Their mandibular condyles were organ-cultured for 3 h in the presence of radiolabelled sulphur. The condyles were used for autoradiographic purposes. Digital image analysis of autoradiograms of histological sections showed synthesis of glycosaminoglycans to have increased from the anterior to the posterior direction. This increase was more marked in experimental animals than in the condyles of control animals. Ten experimental and 10 control animals were killed at the age of 15 days, and mandibular condyles were organ-cultured for 1, 4 and 7 days. Differentiation of proliferating prechondroblasts into hypertrophied chondrocytes continued under organ culture conditions. A marked decrease in the proliferating cell layer was noticed, especially in control condyles. Hypertrophy was faster and came closer to the surface of the condyle in the anterior region of the condyle. This was most marked in the condyles of experimental animals. The results indicate that a procedure carried out on the glenoid fossa with the same effect as functional appliances increases the synthesis of extracellular matrix in the posterosuperior region of the mandibular condyle.

Adaptation, Physiological↗
PubMed1994

Articular disc and eminence modeling after experimental relocation of the glenoid fossa in growing rabbits.

The articular surface of the glenoid fossa shows some analogy to the mandibular condyle, since the surface is covered by secondary cartilage, which makes the process more elastic than purely bony structures. The condylar cartilage has been shown to be responsive to alterations in load pressures, and this secondary type of cartilage is also able to increase its proliferative activity to a limited extent when the load pressure is altered. The aim here was to measure changes in proliferative activity and type II collagen secretion in the articular surface of the glenoid fossa after steady experimental posterior relocation of the fossa in the rabbit without actively interfering with normal masticatory action. The shape of the articular disc and interrelations of the joint components were measured macroscopically. Twenty-four five-day-old rabbits underwent gluing of the interparietal, temporoparietal, and lambdoidal sutures. Three experimental and 3 control rabbits were injected with tritiated thymidine at 10, 15, 20, and 30 days and were killed after 2 h for histological, autoradiographic, and immunohistochemical examination. The total number of labeled cells in the proliferative layer near the articular eminence was higher in the experimental group, the difference being greatest in the 15- and 20-day-old rabbits. Immunohistochemical examination revealed less staining for type II collagen on the postero-inferior side of the eminence in the experimental group. The articular disc was flattened in the experimental group, and the elastic tissue bundle connecting the articular eminence and the anterior border of the disc was significantly narrower and longer.

Age Factors↗
PubMed1994

Effect of mechanical forces on chondrocyte maturation and differentiation in the mandibular condyle of the rat.

The effects of mechanical factors on the growth of the mandibular condyle were studied by monitoring the maturation of the mesenchymal cells in 55 rats. Thirty-five animals were fed normal pellet food, and 20 were fed a soft diet and their incisors were cut regularly. 3H-thymidine was injected intraperitoneally three days before death at 18, 23, or 33 days. Histologic sections showed the most advanced 3H-thymidine-labeled cells to occur deep in the cartilage, in the lower hypertrophic cell layer in anterior and posterior regions of the condyle, and in the upper hypertrophic cell layer in the superior region at the age of 18 days. A distinct difference in the maturation state of the labeled cells could also be observed between these regions. In animals fed a soft diet, maturation was slower in the superior region of the condyle and faster in the posterior region than in the normal rats. The rate at which cells stepped out of the proliferating cell pool was measured by use of monoclonal antibodies against proliferating cell nuclear antigen. The ratio between labeled cells in the proliferating cell layer and the number of labeled cells beneath it was greater in control animals than in the soft-diet animals. The rate of differentiation and maturation of mesenchymal cells into chondrocytes seems to be controlled by mechanical factors.

Animals↗
PubMed1994

Effect of altered loading on condylar growth in the rat.

The aim of this investigation was to ascertain whether lessening of function by feeding rats a soft diet and cutting their incisors can change the growth of the condyle. Sixty Wistar rats were divided into two groups; a control group fed whole pellets and a soft-diet group fed ground pellets. At the age of 21 days the upper and lower incisors of the soft-diet group were shortened by cutting with a wire cutter twice a week. Ten control rats and 10 soft-diet rats were injected with alizarin red (200 mg/kg) intraperitoneally at the age of 22, 30, or 40 days and killed at the age of 30, 40, or 50 days, respectively. The heads were freed of soft tissues, and the growth of the condylar process and the mandible was measured. The height growth of the condylar process was significantly greater in the soft-diet group by 30 and 40 days, and its length growth was greater in the soft-diet group by 50 days. It is concluded that the change in the amount of chewing force and the place of articulation of the condyle alters the growth of the condylar process. Lessening of the load increases condylar growth until a new balance is achieved.

Aging↗
PubMed1994

Technical problems and side effects associated with continuous intrathecal or epidural post-operative analgesia in patients undergoing hip arthroplasty.

Fifty-five patients undergoing hip arthroplasty under spinal anaesthesia (4 ml of 0.5% plain bupivacaine) were randomized to receive post-operative analgesia either using an intrathecal or an epidural catheter. Associated technical problems and side effects were studied. In both groups per-operative analgesia was achieved with intrathecal 0.5% plain bupivacaine, 4 ml. In the intrathecal infusion group a bolus dose of 100 micrograms morphine was injected through a spinal 28 gauge catheter followed by a 24 h infusion of 200 micrograms morphine (8.3 micrograms h-1). In the epidural infusion group a bolus dose of 2 mg of morphine was injected before the epidural 24 h infusion was started (morphine 200 micrograms h-1 + 0.25% bupivacaine 4 ml h-1). There were 10 catheter failures (two could not be inserted) in the intrathecal group and one in the epidural group. Three epidural catheter infusions failed due to other technical problems. The number of side effects was 21 in the remaining spinal group (n = 20) and 18 in the 20 epidural group patients with successful infusions. One patient in the spinal catheter group developed postdural puncture headache. For post-operative pain relief the patients in the epidural group needed less supplementary intramuscular oxycodone (five doses/four patients) than the spinal group (17 doses/nine patients) (P < 0.05).

Aged↗
PubMed1993

Clinical and radiological comparison of perivascular and transarterial techniques of axillary brachial plexus block.

The perivascular technique of axillary brachial plexus block results in incomplete block of radial and musculocutaneous nerves in 10-20% of patients. With the transarterial technique and a large dose of mepivacaine, success rates of 99% have been reported. We have compared the clinical efficacy of these techniques in 50 patients using 1% mepivacaine 45 ml with adrenaline. If required, the block was supplemented with additional blocks of single nerves or i.v. alfentanil. Additionally, eight patients in each group were studied with computed tomography after contrast medium was added to 0.5% bupivacaine 40 ml. There were no statistically significant differences in sensory or motor block between the groups at 20 min or in the plasma concentrations of mepivacaine measured 0-45 min after injection. In the CT scans, both proximal and distal spread of the contrast medium were more common after perivascular than after transarterial block. The distribution of the contrast medium was not related to the efficacy of the block.

Adult↗
PubMed1993

Effect of late posture change on the level of spinal anaesthesia with plain bupivacaine.

We studied 40 patients, 18-60 yr, undergoing orthopaedic surgery of the lower limb under spinal anaesthesia. A midline lumbar puncture was performed in the L3-4 interspace using a 27-gauge needle with the patient in the lateral horizontal position. Plain bupivacaine 3 ml at room temperature was injected. The cephalad level of analgesia was assessed by pinprick 60 min after injection of local anaesthetic, at the end of surgery and again after the patient was moved into bed. All patients had a segmental level of the block of L1-T5 at the beginning of the study. The upper half of the patient's body was then tilted to a 30 degrees head-up position. Segmental spread was subsequently assessed by pinprick at 5-min intervals for 30 min. In six of the 40 patients (15%), increased cephalad spread of spinal analgesia occurred. The mean time from induction of spinal anaesthesia was shorter in these six patients (mean 92 min, range 80-115 min) than in the patients whose block did not change or was decreasing during the 30-min test (mean 119 min, range 83-210 min) (P < 0.05). We conclude that the patient should remain in the supine horizontal position until recovery from the spinal block.

Adolescent↗
PubMed1993

Efficacy of epidural blood patch for postdural puncture headache.

This prospective investigation was conducted to evaluate the efficacy of different volumes of epidural blood patch (EBP) for treatment of postdural puncture headache (PDPH) in 81 consecutive patients. In the first part of the investigation (Study part I), 10 ml of blood was injected for EBP in 28 patients. In the second randomized part of the investigation (Study part II), the patients were allocated to receive for EBP either 10 ml (27 patients) or 10-15 ml (26 patients), according to the height of the patient. The procedure was considered initially successful if PDPH disappeared completely during the 2-h recovery room follow-up. To evaluate the long-term success, a questionnaire was mailed to all patients. The EBP performed 3.7 +/- 2.9 days following the dural puncture was initially successful in 88-96% of the patients in the different study groups. In the questionnaire, only 50-68% of the patients reported that PDPH had disappeared immediately without recurrence. In 16-36% of the patients the PDPH returned at lesser intensity and in 14-17% PDPH was reported to have continued, disappearing gradually in all patients. Despite this, 87% of all patients were satisfied with the EBP treatment. There were no statistically significant differences between the groups. The results indicate that a larger, height-adjusted volume of blood for EBP in adults does not produce a better effect on PDPH compared to a standard 10-ml volume. Despite the excellent initial effect (91%) seen in our patients, a permanent effect of the blood patch was only achieved in 61%.

Adult↗
PubMed1993

Increased condylar growth after experimental relocation of the glenoid fossa.

Attempts to increase mandibular growth by the stimulation of condylar proliferative activity, either experimentally or with functional appliances in humans, have led to controversial results. The aim of this study was to measure changes in proliferative activity in the mandibular condyle after steady experimental posterior relocation of the glenoid fossa in the rabbit without actively interfering with normal masticatory action. The method differed from most previous experimental procedures, which force the mandible anteriorly to stimulate functional appliance therapy. Twelve 5-day-old rabbits underwent gluing of the interparietal, temporoparietal, and lambdoidal sutures. Three experimental and three control rabbits were injected with tritiated thymidine at 10, 15, 20, and 30 days and were killed after 2 h for histological and autoradiographic examination. The total number of labeled cells in the prechondroblastic layer was higher in the experimental group, the difference being greatest in the 20-day-old rabbits. The highest proliferative activity in the experimental group was found in the area immediately posterior to the articular contact surface. There was a tendency for the cartilage layers to be thicker in the experimental group, especially in the extreme anterior segments of the condyle.

Analysis of Variance↗
PubMed1993

Effect of food consistency on the shape of the articular eminence and the mandible. An experimental study on the rabbit.

The aim of this investigation was to ascertain what changes masticatory function could elicit in the shape of the articulating surface and the growth of the mandible in a growing rabbit. Forty-seven rabbits were divided into two groups, a control group fed whole pellets and a 'soft' group fed softened pellets and having their incisors shortened once a week. All the rabbits were killed at the age of 50 days and roentgenographed, after which the heads were freed of soft tissues, and the shape of the articulating eminence, the dimensions of the mandible and the maxilla, and intermaxillary relations were measured. The articulating surface of the glenoid fossa was steeper in the soft group, the lower border of the articulating eminence was located more inferiorly, and the mandible was more retrognathic. It is concluded that the difference in functional stress affects the shape of the articular eminence and the intermaxillary relationship. When the condyle is functioning more on the eminence, the latter becomes flatter, and the mandible moves forwards.

Animal Feed↗
PubMed1992

Effects of Calaguala and an active principle, adenosine, on platelet activating factor.

Calaguala, an extract from the fern Polypodium decumanum, has been used to treat psoriasis and related immunological disorders. In an effort to explain Calaguala's medicinal effects the inhibitory activity of the extract in two platelet activating factor (PAF) related models has been investigated. In the first model, PAF was used to induce release of the proteolytic enzyme elastase in human neutrophils. Calaguala inhibited this effect with an IC50 of 0.1 mg/ml. The known PAF antagonist ginkgolide BN 52021 was used as a positive control and had an IC50 of 0.034 mg/ml. In the second model the inhibition of biosynthesis of PAF in neutrophils using lyso-PAF and labeled acetyl-CoA was studied. Also in this assay Calaguala showed a dose-dependent activity, the IC50 being 0.2 mg/ml. Since recent findings have indicated that PAF might be involved in the pathogenesis of psoriasis, it is possible that the activity shown by Calaguala in these PAF assays may contribute to the clinical efficacy of the extract. The PAF induced exocytosis assay was further used to guide the fractionation of the crude extract. From the acetone supernatant the nucleoside adenosine was isolated as an active principle. Pure adenosine dose-dependently inhibited the exocytosis induced by PAF (IC50 = 0.024 micrograms/ml) but was inactive in the biosynthesis assay. Adenosine is most probably one of the bioactive compounds of Calaguala responsible for its therapeutic properties.

Acetylation↗
PubMed1992

Prediction of the spread of repeated spinal anaesthesia with bupivacaine.

We have studied in 56 patients the predictability of spread of repeated spinal anaesthesia in the same patient on the basis of a previous block. With plain 0.5% bupivacaine, prediction of the second block was accurate. A significantly higher or lower spread of analgesia than in the previous block was achieved when plain 0.5% bupivacaine was administered using a modified technique--sitting position or lower interspace, respectively. When hyperbaric 0.5% bupivacaine was injected instead of plain solution for the second block using a similar technique, no baricity-related correlation was found between the first and second blocks. Change in technique did not reduce interindividual variation in the spread of analgesia. We conclude that individual anatomical properties may play a more important role than, for example, baricity in subarachnoid distribution of a local anaesthetic solution.

Adolescent↗