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Biomedical subjects

P Laippala

Publications and source records attributed to P Laippala.

At least 37 records · Page 2Linked to original sources
PubMed2002

Effect of hypothermia on blood-flow responses in pedicled groin flaps in rats.

Cooling is widely used for preserving tissues such as kidneys before transplantation and for preserving extremities before replantation. Hypothermia has also been shown to be effective in the temporary storage of free flaps. However, in the intact living body, cooling can be damaging to tissue and the body system. We used a custom-designed clamping method (after flap elevation, occlusion and release of the flap-feeding artery) and continuous laser Doppler flowmetry to investigate the effects of hypothermia on blood flow and postocclusive reactive hyperaemia in the flaps. The animal model used was the partially elevated epigastric flap of adult Sprague-Dawley rats. In the hypothermia group (n=12), the core temperature and the flap temperature were allowed to fall during anaesthesia. At core temperatures of 34.58 degrees C and 338 degrees C and after rewarming of the rat, the feeding artery was occluded for 30 s and 120 s to observe the changes in blood flow and postocclusive reactive hyperaemia in the flap. In the control group (n=12), the core temperature was maintained at more than 378 degrees C throughout the experiment. To compare the flap blood-flow responses to occlusion of the femoral artery in the hypothermia group and the control group, the postocclusive reactive hyperaemia periods (i.e. blood flow above baseline after clamp release) were analysed. Statistical analysis of the responses showed that the magnitude (P=0.024), duration (P<0.001) and amplitude (i.e. peak flow) (P=0.037) of postocclusive reactive hyperaemia were significantly decreased in the hypothermia group. Our results suggest that hypothermia significantly decreases blood flow and postocclusive reactive hyperaemia in the rat epigastric flap. This may increase the risk of ischaemic flap complications unless rewarming is performed.

Animals↗
PubMed2002

The natural course of gastroesophageal reflux disease in children.

BACKGROUND: The consequences of chronic gastroesophageal reflux disease (GERD) starting in childhood have not been widely studied. Our aim was to evaluate the usefulness of endoscopy in the primary diagnosis of GERD and to investigate the long-term course of this disease in children. METHODS: Between 1989 and 1999, 136 children had been endoscoped because of persisting symptoms of GER. After exclusions (neurological impairment, infant GER), 96 subjects were included, and files from 76 were available for the final evaluation. Twenty-four hour pH-monitoring had been performed primarily on 67 children and at follow-up on 28, and endoscopy to 69 subjects and at follow-up to 33, respectively. Medical therapy as well as symptoms prior to the therapy were registered. Clinical outcome was assessed at the end of the follow-up period. RESULTS: Presenting symptoms were recurrent abdominal pain, heartburn, regurgitation and vomiting. Twenty-two patients had respiratory symptoms in addition to the gastrointestinal complaints. PH-recording was normal in 17/67 subjects, slightly pathological in 33 and severe reflux was diagnosed in 13 patients. Histologically, minimal changes associated with GER were diagnosed in 22 and mild esophagitis in 7. Thirty-six patients had been treated with prokinetic drugs. H2-blockers had been used in 24 children and proton-pump inhibitors in 4. After a mean follow-up period of 28 months, only 24% of patients had become symptom-free. Control endoscopy showed no progression of the esophageal inflammation in any of the subjects. CONCLUSIONS: Pathological reflux in children is associated with no or mild esophageal inflammation, which is unlikely to deteriorate. Therefore endoscopic control could be limited to cases with severe esophagitis.

Adolescent↗
PubMed2002

The significance of mannan-binding lectin gene alleles in patients with primary Sjögren's syndrome.

OBJECTIVE AND METHODS: To investigate the significance or mannan-binding lectin (MBL) gene alleles in patients with primary Sjogren's syndrome (pSS). Genotypes were determined in 65 pSS patients and 138 controls. RESULTS: No difference in MBL genotype or allele frequencies was detected between the pSS patients and controls. However, when the effect of MBL genotypes on the diagnostic findings in pSS patients was assessed, none of the eight patients with 52/w genotype fulfilled four (definite) Californian criteria (P = 0.007). Among these eight the Chisholm-Mason histological grade was > or = 3 in only three (P = 0.017). Furthermore, the MBL concentration was lower in patients with 52/w genotype compared to those with wild-type (w/w) genotype (P = 0.035). CONCLUSION: Our findings suggest that MBL structural gene polymorphisms do not influence on susceptibility to pSS. However, MBL may be associated with salivary gland destruction in pSS, and its concentration may be comparable with the intensity of inflammatory reaction. Further studies are warranted to clarify the possible mechanisms involved.

Adult↗
PubMed2002

Respiratory health effects of long-term exposure to different chromium species in stainless steel production.

The aim of this study was to determine whether occupational exposure to chromite, trivalent chromium (Cr(3+)) or hexavalent chromium (Cr(6+)) causes respiratory diseases, an excess of respiratory symptoms, a decrease in pulmonary function or signs of pneumoconiosis among workers in stainless steel production. Altogether, 203 exposed workers and 81 referents with an average employment of 23 years were investigated for indicators of respiratory health on two occasions, in 1993 and in 1998. Data collection with a self-administered questionnaire, flow volume spirometry, measurement of diffusing capacity, chest radiography and laboratory tests were carried out by a mobile research unit. Exposure to different chromium species and other metals was monitored regularly and studied separately. No adverse respiratory health effects were observed in the group exposed to Cr(6+), either in comparison with the control group in the first cross-sectional study or during the additional 5 year follow-up. Among the Cr (3+) exposed people, the production of phlegm, shortness of breath and breathlessness on exertion were significantly more frequent than in the control group, but the frequency of the symptoms did not increase during the follow-up; no differences were observed in the lung function tests and the radiographic findings did not progress. In the chromite group, the prevalence of breathlessness on exertion was higher than in the control group. However, in the follow-up, the occurrence of symptoms did not differ from 1993 to 1998. In the first study, most parameters of lung function were lower among the smokers in the chromite group than among the smoking controls, but in 1998 the difference was less marked. An average exposure time of 23 years in modern ferrochromium and stainless steel production and low exposure to dusts and fumes containing Cr(6+), Cr(3+), nickel and molybdenum do not lead to respiratory changes detectable by lung function tests or radiography. The workers exposed to Cr(3+) had more respiratory symptoms than those in the control group. The workers in the chromite mine had lower lung function test results than the control group due to earlier exposure to higher dust concentrations.

Adult↗
PubMed2002

The hunt for coeliac disease in primary care.

BACKGROUND: Serological screening suggests that most coeliac disease goes undetected. AIM: To determine how often coeliac disease is found in patients referred for gastroscopy by general practitioners. DESIGN: Testing of 9971 consecutive patients referred to a single health centre for their first open-access gastroscopy over a 10-year period, without previously-diagnosed coeliac disease or dermatitis herpetiformis. METHODS: Endoscopy and routine duodenal biopsy were in use throughout the study period. The occurrence of coeliac disease was evaluated in patients with dyspepsia, in those with regurgitation, and in those with symptoms suggestive of coeliac disease. RESULTS: Altogether, 147 (1.47%) patients had coeliac disease: 18/2974 (0.61%) with regurgitation, 41/5347 (0.77%) with dyspepsia, and 88/1650 (5.33%) with suspected coeliac disease. Increasing age reduced the risk very slightly (OR 0.98; 95%CI 0.97-0.99). Risk was significantly increased when there was a suspicion of coeliac disease (OR 9.085; 95%CI 5.371-15.369), while no difference was found between patients with dyspepsia and those with reflux disease (OR 1.33; 95%CI 0.75-2.34). The risk in women was not increased (OR 0.97; 95%CI 0.69-1.38). DISCUSSION: In this primary-care setting, <1% of patients with upper abdominal symptoms suffered from coeliac disease; population-based serological screening is expected to yield a corresponding prevalence. When physicians had suspected coeliac disease, the condition was nine times more common.

Adolescent↗
PubMed2002

Isolated ultrafiltration affects dynamic vectorcardiographic ischemia monitoring parameters.

AIMS: The present study was undertaken to assess the role of isolated ultrafiltration (UF phase) and hemodialysis with minimal ultrafiltration (HD phase) in changes in parameters reflecting myocardial ischemia: QRS vector difference (QRS-VD), ST change vector magnitude (STC-VM) and ST vector magnitude (ST-VM6) registered by MIDA (myocardial infarction dynamic analysis). PATIENTS AND METHODS: Twelve patients on maintenance hemodialysis were first ultrafiltrated for 2.5 h without dialysis (UF) followed by a 2.5-hour session of hemodialysis with minimal ultrafiltration (HD). Computerized vectorcardiography (VCG) was used for on-line dynamic analysis of ST segment and QRS complex changes. Blood volume (BV) changes were monitored non-invasively and continuously with the CRIT-LINE instrument. Whole-body bioelectric impedance analysis (BIA) was used for extracellular water (ECW) estimation. RESULTS: During the UF phase QRS-VD and STC-VM showed a statistically significant increasing linear trend (time effect for both QRS-VD and STC-VM p < 0.0001, while no changes were noted in ST-VM6; time effect p = 0.986). During the HD phase none of these parameters changed (time effect for QRS-VD p = 0.855, for STC-VM p = 0.275 and for ST-VM6 p = 0.976). During the UF, phase changes in QRS-VD were in close relation to those in ECW. CONCLUSION: Isolated ultrafiltration leads to an increase in the VCG ischemia monitoring parameters QRS-VD and STC-VM. The increase of QRS-VD is related to changes in ECW. Hemodialysis with minimal ultrafiltration has no effect on VCG ischemia monitoring parameters.

Adult↗
PubMed2001

Surgery vs orthosis vs watchful waiting for hallux valgus: a randomized controlled trial.

CONTEXT: Hallux valgus is a common foot deformation in adults, but evidence for effectiveness of surgical and conservative treatments for this condition is limited. OBJECTIVE: To compare the effectiveness of surgical and orthotic treatment with no treatment in patients with hallux valgus. DESIGN AND SETTING: Randomized controlled trial conducted in 4 general community hospitals in Finland in 1997-1998, with a follow-up period of 12 months. PARTICIPANTS: Two hundred nine consecutive patients (mean age, 48 years; 93% women) with a painful bunion and a hallux valgus angle 35 degrees or less. INTERVENTIONS: Patients were randomly assigned to surgery (distal chevron osteotomy; n = 71), orthosis (n = 69), or a 1-year waiting list (control group, n = 69). MAIN OUTCOME MEASURES: Pain intensity during walking on a visual analog scale (0-100), patient assessment of global improvement, number of painful days, cosmetic disturbance, footwear problems, functional status, and treatment satisfaction, compared among treatment groups. RESULTS: Follow-up rates at 6 and 12 months were 99% and 98%, respectively. At 6 months, pain intensity decreased more in the surgical group than in the control group (adjusted mean differences, -20 [95% confidence interval (CI), -28 to -12]) and more in orthosis than in the control groups (adjusted mean difference, -14 [95% CI, -22 to -6. At 1 year, pain intensity decreased more in the surgical than in the control groups (adjusted mean difference, -19 [95% CI, -28 to -10]) and more than in the surgical and orthosis groups (adjusted mean difference, -14 [95% CI, -22 to -5]). At 1 year, 83%, 46%, and 24% in the surgery, orthosis, and control groups, respectively, thought they had improved compared with baseline (number needed to treat), 1.7 between surgical and control groups). Number of painful days, cosmetic disturbance, and footwear problems were least and functional status and satisfaction with treatment were best in the surgical group. CONCLUSIONS: Surgical osteotomy is an effective treatment for painful hallux valgus. Orthoses provide short-term symptomatic relief.

Female↗
PubMed2001

A study of interleukin-1 cluster genes in susceptibility to and severity of multiple sclerosis.

In this explorative study, interleukin-1 (IL-1) receptor antagonist (IL-1RA; polymorphism of variable number of tandem repeats: VNTR), IL-1alpha (-889), IL-1beta (-511) and IL-1beta (+3953) polymorphisms were studied in relation to susceptibility to and severity of multiple sclerosis (MS), in 93 MS patients and 400 normal controls. No associations were found for any polymorphisms, alone or in combination. However, in our MS cohort, females were found to be IL-1RA allele 2 carriers more frequently than males (33/49 vs. 16/44, p = 0.0028). Using a cohort of 109 controls, IL-1RA allele 2 carriers were more frequently women with MS than control women (33/49 vs. 23/43, odds ratio (OR) = 2.19, 95% confidence interval (CI) 1.02-4.72, p = 0.043, P(C) = ns). The data suggest that the IL-1 cluster genes make no major contribution to MS, but the tentative association between IL-1RA allele 2 and susceptibility of MS in women warrants further studies.

Adult↗
PubMed2001

Polymorphisms within the tumor necrosis factor locus and prevalence of coronary artery disease in middle-aged men.

Tumor necrosis factor (TNF) is an important cytokine in the inflammation process of atherosclerosis and is also involved in lipid metabolism. Two biallelic polymorphisms within TNF gene locus-TNFA at the position -308 in the promoter region of the TNF gene and TNFB in the first intron of the lymphotoxin-alpha (LT-alpha) have been reported to be associated with TNF production and with susceptibility to inflammatory diseases. We studied the association of these polymorphisms within the major histocompatibility complex (MHC) III region with coronary atherosclerosis and its manifestations. The autopsy series comprised 700 Caucasian Finnish men, aged 33-70 years (The Helsinki Sudden Death Study). Coronary stenosis and surface area of atherosclerotic changes (fatty streaks, fibrous plaques, complicated lesions and calcification) were measured and the presence of myocardial infarction and coronary thrombosis recorded. TNFA and TNFB genotypes were determined by the PCR-RFLP technique. The allele frequencies were TNFA1/TNFA2=0.88/0.12 and TNFB1/TNFB2=0.30/0.70. There was a strong linkage disequilibrium between the two polymorphisms. There were no differences in coronary stenosis and in the frequency of old or recent myocardial infarction or coronary thrombosis between men with different genotype status in either locus. Men with TNFA22 or TNFB11 genotype tended to have more fibrous lesions and calcification in their coronary arteries. TNFA and TNFB polymorphisms are unlikely to contribute to progression of atherosclerosis in a way clinically important.

Adult↗
PubMed2001

Risk factors of child maltreatment within the family: towards a knowledgeable base of family nursing.

The purpose of this study was to compare family dynamics in child maltreating families (n=42) with that in ordinary families with children (n=77), and to ascertain risk factors of child maltreatment within the family. Child maltreatment was defined as physical, psychological or sexual abuse or neglect of a child by a parent. Data were collected using questionnaires (Family Dynamics Measure 2, FMD 2) (N=119) basing on Barnhill's conceptual framework of healthy family systems and analysed by forming sum variables and logistic regression. The study results indicate that family functioning in child maltreating families is lower on all dimensions of family dynamics (individuation, mutuality, flexibility, stability, communication and roles) than that in ordinary families with children. Furthermore, it seems that specific risk factors, detected with logistic regression analysis, are related to whether child maltreatment occurs in the family or not. These include the parent's low educational background, many children in the family, unemployment of a parent, low individuation of the family members, and poor stability and security within the family. The results of this study provide guidelines for detecting and preventing child maltreatment as well as for recognising its existence, although no generalizations can be made due to the small sample size and complexity of the phenomenon under study.

Adult↗
PubMed2001

Adolescent depression: the role of discontinuities in life course and social support.

OBJECTIVE: To study sociodemographic determinants of depression among 14-16 years old girls and boys, and the role of perceived social support in mediating the effects of the background variables. METHOD: 16464 adolescents aged 14-16 participated the School Health Promotion Study, a survey about health, health behaviour and school behaviour. Depression was measured by the Finnish modification of the 13-item Beck Depression Inventory. Moderate to severe symptoms in this scale were recorded as depression. RESULTS: Depression was associated with family structure in both sexes. Among girls, having moved recently and low parental education increased the risk for depression, among boys, unemployment in the family. Accumulating number of discontinuities in life course increased the proportion of the depressed among both girls and boys. Perceived lack of social support had the same effect. Lack of support did not explain the effect on depression of the discontinuities in life course. CONCLUSION: To detect risk groups for adolescent depressive disorders, health services should pay attention to adolescents who have experienced life changes. Perceived social support should be enquired.

Adolescent↗
PubMed2001

Correlation between serum inhibin B and other indicators of the ovarian function.

OBJECTIVE: To investigate the correlation between the early follicular phase serum inhibin B levels and other indicators of ovarian reserve. STUDY DESIGN: Seventy-four women aged 24-40 years (mean 32) with different infertility etiologies were investigated in the early follicular phase of a spontaneous mentrual cycle. The volume of the ovaries was measured and the total number of follicles <5 mm in size counted by ultrasound. Serum levels of FSH, estradiol (E2) and inhibin B were measured on the same day. In stepwise regression analysis inhibin B levels were correlated with age, body-mass-index, the ultrasound measurements, cause of infertility, parity, FSH and E2. RESULTS: FSH, BMI and the number of follicles proved to be statistically significant independent predictive factors for the inhibin B levels, FSH and BMI correlating negatively and the number of follicles positively with inhibin B serum concentrations. CONCLUSION: The number of small follicles reflect the inhibin B production of the ovaries. BMI being as strong predictive factor of inhibin B levels as FSH could in part explain the impaired likelihood of conceiving in obese patients.

Adult↗
PubMed2001

Pancreatic carcinoma and fast MR imaging: technical considerations for signal intensity difference measurements.

The aim of the study was to find the fast magnetic resonance imaging (MRI) sequence with the best conspicuity of pancreatic lesions at 1.0 T and 1.5 T. A total of 51 patients were studied. At 1.0 T, 22 patients with verified malignant pancreatic lesions were studied using the T1-weighted breath-hold spoiled Gradient Echo 2D FLASH(75) or FLASH(80) sequences, both non-enhanced and enhanced with gadolinium. The relative signal intensity difference (SIDR) between lesion and pancreas was measured. At 1.5 T, 20 patients with primary malignant lesions of the pancreas, and nine patients with 13 benign cystic lesions were examined with the breath-hold T2-weighted TrueFISP, HASTE, T1-weighted 2D FLASH(80) and FLASH(50) fat saturation sequences, the latter also enhanced. The signal intensity (SI) values of the pancreas and lesions as well as the pancreatic standard deviation (S.D.) were assessed, and the contrast-to-noise ratio (C/N) was determined. Statistical significances were calculated using an analysis of variance. No statistically significant difference between the sequences used in the conspicuity of cancer was found, either at 1.0 T or at 1.5 T. At 1.5 T, the T2-weighted TrueFISP and HASTE sequences could differentiate benign, cystic lesions from malignant lesions.

Adult↗
PubMed2001

Prevalence of disability in three birth cohorts at old age over time spans of 10 and 20 years.

The prevalence of disability at the age of 75+ measured by the Katz Index of Activities of Daily Living (ADL) was compared among three birth cohorts: those born < or = 1903 (n = 348), those born < or = 1913 (n = 586), and those born < or = 1923 (n = 758). Significant risk factors for disability were female sex and age; the cohort effect was not significant. The prevalence rates of disability were 29.0% (95% CI 24.2-33.8), 34.8% (30.9-38.7), and 28.8% (25.5-32.0) for the first, second, and third cohorts. In the age group 75-79 years the rates were 20.1% (95% CI 13.8-26.4), 25.5% (20.2-30.7), and 14.4% (10.6-18.1). The change was due to the declining disability of women. The distributions in the three cohorts based on the numbers of ADL limitations did not differ. As far as the whole aged populations were concerned, longer life was not accompanied by improving health.

Activities of Daily Living↗
PubMed2001

Has the attempt to reduce psychiatric inpatient treatment been successful in Finland?

The deinstitutionalisation process in Finland's psychiatric healthcare did not start until the late 1980s. Our aim is to evaluate how the use of psychiatric inpatient treatment was associated with deinstitutionalisation given the changes in the modality of treatment ideology (years 1987--1991) as well as being due to economic pressures (years 1991--1995). Special emphasis is given on the inpatient treatment of schizophrenia and other psychotic disorders. Data was retrieved using the national hospital discharge register of all treatment periods in psychiatric hospitals and treatment periods due to psychiatric disorders in other hospitals. Three years (1987, 1991, and 1995) were compared. Four healthcare districts in northern Finland were studied. Resource use was measured by number of treatment periods and inpatient days in relation to population. Psychiatric inpatient treatment was reduced in 1987--1991, when resources in community care increased. During the period of economic pressures (1991--1995), when community care resources no longer increased, inpatient treatment started to rise again. Over the whole period, psychiatric treatment in primary care institutions increased. Reduction of psychiatric beds results in increasing inpatient treatment in non-specialist institutions, especially when community care fails to serve the patients. In the future it is important to evaluate whether the quality of care remains in the standard of specialised services when treatment shifts away from the specialist level.

Adult↗
PubMed2001

Kidney ultrasound and Doppler ultrasound findings during and after acute urinary retention.

OBJECTIVE: To evaluate changes in kidney ultrasound and Doppler ultrasound images during and subsequent to acute urinary retention (AUR). METHODS: Twenty-five men with a mean age of 69 years suffering AUR for a mean of 31 h were studied by measuring serum creatinine, creatinine clearance and renal ultrasound. Renal Doppler ultrasound was applied in 19 of these cases and all patients were followed for 6 months after acute retention was relieved. RESULTS: During AUR hydronephrosis was noted in three patients; this disappeared during follow-up. During the acute period, after 1 month and after 6 months the average resistive indexes (RI) were 0.71, 0.70 and 0.69, respectively. The changes were not statistically significant. During follow-up, the proportion of patients with normal RI increased from 42 to 64%. Median serum creatinine was normal during retention and follow-up. Median creatinine clearance was reduced during retention and became normal during follow-up (P < 0.05). No correlation was found between RI and serum creatinine at any time-point, nor was any correlation noted between RI and creatinine clearance during retention or at the 1-month follow-up; at 6 months, however, there was a significant inverse correlation between them (P = 0.01). CONCLUSION: AUR caused elevation of RI, which may be interpreted as diminished renal blood flow. Although in the majority of patients it recovered after treatment, elevated RI was still found in one third of the patients, possibly due to previous chronic bladder outlet obstruction. Our findings stress the importance of both fast release of AUR and effective treatment of its cause.

Acute Disease↗
PubMed2001

Clinical and subclinical autoimmune thyroid disease in adult celiac disease.

Our aim was to investigate the occurrence of clinical and subclinical autoimmune thyroid disease in 79 patients with celiac disease as reflected in thyroid function, antibodies, and ultrasound. Since subclinical thyroid diseases are common in the population, 184 nonceliac controls were also studied. Normal thyroid function combined with positive antibodies and marked hypoechogenicity was considered subclinical disease. Autoimmune thyroid disease was observed in 13.9% of celiac patients and in 2.1% of controls (P = 0.0005); and subclinical disease in 10.1% and 3.3%, respectively (P = 0.048). The mean thyroid gland volume was 8.3 ml in celiac patients and 10.4 ml in controls (P = 0.007). Hypoechogenicity was found in 73% of celiac patients and in 42% of controls (P < 0.0001). Positive thyroid antibodies were associated with hypoechogenicity in celiac patients but not in controls. In conclusion, the occurrence of both clinical and subclinical autoimmune thyroid disease was increased in celiac disease; subclinical thyroid disease indicates regular surveillance.

Autoimmune Diseases↗