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Biomedical subjects

P Mustajoki

Publications and source records attributed to P Mustajoki.

7 recordsLinked to original sources

Variegate porphyria.

In temperate and cold climates the most usual presenting symptom of variegate porphyria is an acute porphyric attack, indistinguishable from that seen in acute intermittent porphyria. Increased fragility of the skin in sun-exposed areas occurs in only half of such patients, and even then is usually mild and easily overlooked. The diagnosis depends on fecal excretion of porphyrins, which is greatly increased in variegate porphyria and consists predominantly of protoporphyrin. Urinary excretion of porphobilinogen and delta-aminolevulinic acid increases only during acute attacks. There are reasons for thinking that variegate porphyria is commoner than hitherto supposed. During an acute attack a patient without skin symptoms may well be misdiagnosed as having acute intermittent porphyria, because of identical symptoms and excretion of porphobilinogen in the urine. Thus, for a correct diagnosis, every patient presenting with symptoms of acute porphyria requires a fecal analysis.

Acute Disease

Permanent changes in the spines of military parachutists.

To investigate whether parachuting causes permanent changes in the spine, 50 military parachutists (mean number of jumps 490 per parachutist) and 50 matched controls were studied. In X-rays of parachutists and controls, the frequency of degenerative changes differed in the cervical spine (46 and 20%; p less than 0.01), and in the thoracic spine (62 and 28%; p less than 0.05) but not in the lumbar spine (44 to 36%; not significant). Parachutists suffered significantly more often from stiff neck, but the incidence of other neck and back symptoms was the same in the two groups. The increased frequency of degenerative changes in the spine in military parachutists is probably due to repeated traumata which parachutists sustain on landing and, possibly, during the training period before parachute jumps.

Adult

Hereditary hepatic porphyrias in Finland.

The occurrence of hepatic porphyrias--acute intermittent porphyria (AIP) and variegate porphyria (VP)--in Finland has been studied. During a period of 9 years 107 patients with AIP and 45 patients with VP were found. The prevalence of hereditary hepatic porphyrias was calculated to be 3.4 per 100 000 inhabitants. The patients belonged to 42 different families. Eighty-nine patients (59%) had had acute attacks, whereas 63 were symptomless latent cases. Precipitating factors, symptoms and excretion of porphyrins and their precursors did not significantly differ from what has been reported earlier from other parts of the world. A slight fragility of the skin on the back of the hands was noted in some 50% of VP patients. Abnormal sensitivity to sunlight could not be seen in a single case. However, about 50% of patients with VP showed an abnormal reaction when irradiated with artificial ultraviolet light. The difference in the skin symptoms in South African and Finnish VP patients is discussed.

Adolescent

Red cell uroporphyrinogen I synthetase in acute intermittent porphyria.

Uroporphyrinogen I synthetase (URO-S) activity in red cells was measured in 49 patients with acute intermittent porphyria (AIP), in their relatives, in 16 patients with variegate porphyria, and in patients with various forms of anaemia. URO-S activity was clearly lower in patients with AIP (mean 30.5 U, SD 9.7) than in controls (mean 49.5 U, SD 6.4) and in patients with variegate porphyria. There was an overlapping of the values of controls and those of AIP patients, seven patients having fully normal values. Out of 63 relatives eight prepubertal children and two adults with normal urine analysis had URO-S activity below normal. Two newborn infants out of the five studied who had a prophyric parent had lowered URO-S activity in cord blood. URO-S activity was usually elevated in anaemias and correlated to the reticulocyte count. It is concluded that measurement of URO-S activity in red cells is a valuable supplementary method in searching for latent cases of AIP. It is the only method that can disclose the disease before puberty and even neonatally. The major limitation is the occurrence of normal values in some patients with AIP.

Acute Disease

Neuropathy in latent hereditary hepatic porphyria.

Peripheral nerve conduction velocoties were measured in 20 patients with acute intermittent porphyria and five with variegate porphyria and in 25 controls matched for age and sex. None of the porphyric patients had acute symptoms on examination, and nine had never had symptoms. Compared with the controls, patients had a significantly slower conduction velocity of the slower motor fibres of the ulnar nerve (P less than 0-001) and a slower sensory conduction velocity of the ulnar and median nerves (P less than 0-05). There was no significant difference between the patients and controls in the maximum motor conductionvelocity of the median, ulnar, deep peroneal, or posterior tibial nerves. Slight peripheral neuropathy seems to be associated with latent hereditary hepatic porphyria, even in patients who have never had symptoms.

Adolescent