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Biomedical subjects

S Sarna

Publications and source records attributed to S Sarna.

At least 109 records · Page 6Linked to original sources
PubMed1995

Modification of the haemodynamic responses to induction of anaesthesia and tracheal intubation with alfentanil, esmolol and their combination.

The purpose of this double-blind randomized work was to study the effect of alfentanil and esmolol and their half-dose combination on the increases of heart rate and arterial pressure and on the prolongation of the QTc interval of the ECG occurring during anaesthetic induction. Sixty ASA class I-II patient with mean age ranging from 26 to 32 yr among the groups. Patients were allocated to one of four equal groups to receive saline, esmolol 2 mg.kg-1, alfentanil 0.03 mg.kg-1 and alfentanil 0.015 mg.kg-1+esmolol 1 mg.kg-1. Anaesthesia was induced with thiopentone. Succinylcholine was used to facilitate tracheal intubation. Haemodynamic variables were measured non-invasively and the QTc interval with the aid of a microcomputer. Comparisons between the groups were performed using two-way analysis of variance with repeated measures. Both alfentanil and alfentanil-esmolol prevented the increase of heart rate and arterial pressure caused by intubation whereas esmolol prevented only the increase of the heart rate. None of the treatments prevented prolongation of the QTc interval after intubation and only alfentanil prevented that after succinylcholine. The present results suggest that in the prevention of the haemodynamic responses to tracheal intubation, the half-dose combination of alfentanil and esmolol is as effective as alfentanil and superior to esmolol. The combination is preferable to relatively large doses of either drug in circumstances where side effects, such as respiratory depression due to alfentanil or bradycardia due to both drugs should be minimized.

Adrenergic beta-Antagonists↗
PubMed1995

Diurnal blood pressure variations and onset of subarachnoid haemorrhage: a population-based study.

OBJECTIVES: To analyse the association between time of onset of subarachnoid haemorrhage and diurnal blood pressure variations of ambulant normo- and hypertensive subjects. DESIGN: Retrospective, population-based study. SETTING: The population (246,000) of the Health Care District of Central Finland. PATIENTS: During 1980-1987 a total of 332 subjects in the study population had their first subarachnoid haemorrhage. The hour of onset could be obtained for 287 patients, and these form the basis of the present study. RESULTS: The onset of subarachnoid haemorrhage occurred significantly more often during the waking hours than during the night. The correlation between the hourly numbers of patients suffering a haemorrhage and the corresponding mean systolic and diastolic blood pressure values of ambulant normo- and hypertensive subjects was highly significant (r = 0.88, P < 0.001). The results were similar when the 224 patients with proved aneurysmal bleed were analysed separately (r = 0.79-0.85, P < 0.001). CONCLUSIONS: The diurnal blood pressure variations of ambulant normo- and hypertensive subjects, especially the transient blood pressure peaks reaching much higher levels of pressure during the waking hours than during the night, may be crucial in determining the time of rupture of a critically weakened aneurysm wall.

Adult↗
PubMed1995

Heterozygous familial hypercholesterolaemia: the influence of the mutation type of the low-density-lipoprotein receptor gene and PvuII polymorphism of the normal allele on serum lipid levels and response to lovastatin treatment.

OBJECTIVES: To study whether (i) the low-density-lipoprotein (LDL)-receptor gene mutation type itself or (ii) the PvuII restriction-fragment-length polymorphism (RFLP) of the intact LDL-receptor gene affects serum lipid levels and their responses to lovastatin treatment in heterozygous familial hypercholesterolaemia (FH). DESIGN: Comparison of serum lipid levels in 149 heterozygous FH patients, including 79 patients with the FH Helsinki gene and 70 patients with the FH North Karelia gene, grouped according to the PvuII RFLP status of their nonmutated LDL-receptor allele; studies of lovastatin responses in 23 FH patients with different mutation types. SUBJECTS: Molecularly defined heterozygous FH patients. INTERVENTIONS: DNA analysis by polymerase chain-reaction assay (PCR) and Southern blotting, fasting serum lipid measurements in all patients, and administration of lovastatin 40-80 mg daily to 16 FH Helsinki patients and seven FH North Karelia patients. MAIN OUTCOME MEASURES: Baseline and post-treatment serum cholesterol. LDL cholesterol, high-density-lipoprotein (HDL) cholesterol and triglyceride levels. RESULTS: There were no significant differences in serum total or LDL-cholesterol levels in FH patients with the FH Helsinki gene compared with those carrying the FH North Karelia gene. Regardless of the mutation type, patients without the PvuII site in the normal LDL-receptor gene (P--subjects) tended to have 6-8% higher serum and LDL-cholesterol levels than patients possessing this restriction site (P+ subjects). Although not statistically significant, this difference is qualitatively and quantitatively similar to that reported in three different non-FH populations. Treatment with lovastatin brought about similar hypolipidaemic responses in FH patients with either mutation type (FH Helsinki or FH North Karelia) or PvuII RFLP status (P+ or P-). CONCLUSIONS: Two LDL-receptor gene mutations with dissimilar phenotypic characteristics are associated with similar serum lipid levels and response to statin treatment. Our data also support the previous assumption that the PvuII RFLP of the LDL-receptor gene locus is associated with variation of serum cholesterol levels.

Alleles↗
PubMed1995

Where and how should elderly stroke patients be treated? A randomized trial.

BACKGROUND AND PURPOSE: Elderly stroke patients in particular are at risk of receiving less than optimal care. We studied the effects of the department care (medicine versus neurology) on the outcome of elderly stroke patients in a randomized controlled trial with 1-year follow-up. METHODS: A total of 243 consecutive patients aged 65 years or older with acute stroke were randomized to receive care in the Departments of Medicine or the Department of Neurology of a university teaching hospital with a referral area of 1.1 million. The outcome was assessed by mortality, length of hospital stay, ability to live at home on discharge, Barthel Index, and Rankin grades at 1 year. RESULTS: There were no differences in sex and age, severity or type of stroke, other diseases, or social factors between the two groups. One-year mortality was 21% in both patients treated by the Departments of Medicine and those treated by the Department of Neurology. Patients treated by the Department of Neurology were discharged an average of 16 days earlier (24 versus 40 days). The length of hospital stay of patients aged younger than 75 years differed significantly (P = .02). Patients randomized to neurological wards more often went directly home (75% versus 62%; P = .03), and their functional status was better as assessed with Barthel Index and Rankin grades at 1 year (P = .02 and P = .03, respectively). Independent predictors of a better functional outcome and shorter hospital stay by stepwise multivariate analysis included management by the Department of Neurology. CONCLUSIONS: Well-organized management of elderly stroke patients was associated with a better outcome. It was also the more economical alternative.

Activities of Daily Living↗
PubMed1995

White matter hyperintensities on MRI in the neurologically nondiseased elderly. Analysis of cohorts of consecutive subjects aged 55 to 85 years living at home.

BACKGROUND AND PURPOSE: We undertook this study to evaluate the frequency and risk factors of white matter hyperintensities seen on T2-weighted MR imaging. We examined cohorts of neurologically nondiseased elderly subjects participating in a general-community study, the Helsinki (Finland) Aging Brain Study. Cohorts of consecutive subjects aged 55, 60, 65, 70, 75, 80, and 85 years (n = 20, 18, 20, 18, 19, 18, and 15, respectively; total, n = 128) were divided into a young-old (age < 75 years, n = 76) group and an old-old (age > or = 75 years, n = 52) group. METHODS: Frequency of hyperintensities seen on T2-weighted axial and coronal MR images (0.02 T) was rated using a four-point scale in periventricular and centrum semiovale areas. RESULTS: The majority of the subjects showed only mild white matter hyperintensities, which were more frequent in the periventricular areas. Age was the most important factor to explain the presence of hyperintensities. A logistic regression analysis related periventricular hyperintensities in the entire group to central atrophy (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.7 to 12.9) and silent infarcts (OR, 5.6; 95% CI, 1.0 to 19.8); among the young-old, hyperintensities related to diabetes (OR, 17.0; 95% CI, 1.9 to 154.2) and central atrophy (OR, 14.7; 95% CI, 3.5 to 61.8). Centrum semiovale hyperintensities related in the entire group to cardiac arrhythmia (OR, 4.0; 95% CI, 1.0 to 15.5), central atrophy (OR, 3.9; 95% CI, 1.2 to 12.4), and silent infarcts (OR, 3.6; 95% CI, 1.0 to 12.5). CONCLUSIONS: These mild white matter hyperintensities in the neurologically nondiseased elderly related especially to age and also to concomitant silent infarcts, atrophy, and some vascular risk factors. The known factors, however, explained only part of the variation. The young-old and old-old groups showed different associations. In contrast to former assumptions, the presence of white matter hyperintensities among the aged is likely to be linked to other as yet unidentified age-related factors.

Aged↗
PubMed1995

Trends and availability of suicide methods in Finland. Proposals for restrictive measures.

BACKGROUND: Trends and availability of the methods used for suicide in Finland were analysed in order to base proposals for prevention of access to methods. METHODS: Finnish suicides from 1947 to 1990 were analysed by sex, age, time period and suicide method using confidence intervals for rates, chi 2 test for trends and suicide risks for different medicines. RESULTS: Suicide rate by parathion, a highly lethal pesticide and commonly used for suicide in the 1950s, decreased after its availability was restricted, but this was offset by an increased rate by other methods. Since 1982, the suicide risk for antidepressants and neuroleptics increased coincident with their availability, although that for barbiturates remained stable but high despite a reduction in availability. Suicide risk for antidepressants other than tricyclics decreased despite increased availability. CONCLUSION: Restriction of a method reduces its use for suicide, but other methods tend to replace it. Restrictive measures should focus on some specific situations. Antidepressants other than tricyclics are recommended for the treatment of suicidal depressive patients.

Adolescent↗
PubMed1995

Growth delay after liver transplantation in childhood: studies of underlying mechanisms.

After liver transplantation in children, growth is often impaired, but the underlying mechanisms are unknown. Glucocorticoids used for immunosuppression are believed to be partly responsible. After renal transplantation in children, reduced growth hormone (GH) secretion and increased serum insulin-like growth factor-binding protein-3 (IGFBP-3) levels have been reported. We attempted to find endocrine factors predicting growth in 18 prepubertal children followed for more than 1 y (mean 2.4 y) after liver transplantation. Spontaneous and stimulated GH secretion, serum IGF-I, IGFBP-3 concentrations, and endogenous cortisol production were measured. GH secretion was reduced in only two patients. Serum IGF-I concentration was normal, but serum IGFBP-3 was elevated or 1 SD above the mean for age in 62% of the patients. Endogenous cortisol production was reduced in most patients during the first year and improved later in only a few. Growth velocity after transplantation did not correlate with GH secretion, serum IGF-I or IGFBP-3 concentration, or with methylprednisolone dose, but correlated positively with serum basal (rs = 0.44, p < 0.05) and stimulated (rs = 0.53, p < 0.005) cortisol concentration. In conclusion, after liver transplantation 1) the normal pulsatile character of nocturnal GH secretion is sustained, and the GH response to stimulation is reduced in only a few patients; 2) serum IGF-I concentrations are normal; 3) serum IGFBP-3 concentrations are elevated or in the upper part of the normal range in most patients; and 4) endogenous cortisol production is reduced in most patients and correlates positively with growth velocity.

Child↗
PubMed1995

Blunt rupture of the diaphragm. A retrospective analysis of 41 patients.

Forty-one patients with multiple injuries together with diaphragmatic rupture due to blunt trauma were reviewed. The rupture was caused by a motor vehicle accident in 29 (71%) and falling from a height in four (10%) patients. A chest X-ray on admission suggested the diagnosis in 70% of the cases. Small bowel herniation did not occur in ruptures smaller than 15 centimetres. All patients had associated injuries and 84% suffered intra-abdominal trauma, most commonly splenic rupture (42% of all patients). 15 out of 18 patients with a concomitant rupture of the spleen were injured in automobile accidents. The occurrence of splenic rupture in patients injured in automobile vs other accidents differed significantly (P = 0.027). The mortality rate was 12%. Mortality and most of the complications were related to associated injuries. We conclude that 1) there is a high occurrence of intra-abdominal injuries, especially splenic ruptures, in patients with rupture of the diaphragm, 2) the occurrence of splenic rupture is higher in patients injured in automobile accidents than in patients injured by some other mechanism, and 3) a chest radiograph on admission is the best diagnostic aid.

Accidental Falls↗
PubMed1994

Osteoarthritis of weight bearing joints of lower limbs in former élite male athletes.

OBJECTIVE: To compare the cumulative 21 year incidence of admission to hospital for osteoarthritis of the hip, knee, and ankle in former élite athletes and control subjects. DESIGN: National population based study. SETTING: Finland. SUBJECTS: 2049 male athletes who had represented Finland in international events during 1920-65 and 1403 controls who had been classified healthy at the age of 20. MAIN OUTCOME MEASURES: Hospital admissions for osteoarthritis of the hip, knee, and ankle joints identified from the national hospital discharge registry between 1970 and 1990. RESULTS: Athletes doing endurance sports, mixed sports, and power sports all had higher incidences of admission to hospital for osteoarthritis than controls. Age adjusted odds ratios compared with controls were 1.73 (95% confidence interval 0.99 to 3.01, P = 0.063) in endurance, 1.90 (1.24 to 2.92, P = 0.003) in mixed sports athletes, and 2.17 (1.41 to 3.32, P = 0.0003) in power sports athletes. The mean age at first admission to hospital was higher in endurance athletes (70.6) than in other groups (58.2 in mixed sports, 61.9 in power sports, and 61.2 in controls). Among the 2046 respondents to a questionnaire in 1985, the odds ratios for admission to hospital were similar in all three groups after adjusting for age, occupation, and body mass index at 20 (2.37, 2.42, 2.68). CONCLUSIONS: Athletes from all types of competitive sports are at slightly increased risk of requiring hospital care because of osteoarthritis of the hip, knee, or ankle. Mixed sports and power sports lead to increased admissions for premature osteoarthritis, but in endurance athletes the admissions are at an older age.

Adult↗
PubMed1994

Prevalence of diabetes, hypertension, and ischemic heart disease in former elite athletes.

Diabetes, hypertension, and ischemic heart disease are less frequent among physically active subjects. The aim of the present national population-based study was to compare the prevalence of these three diseases between former Finnish elite athletes and referents. The subjects consisted of surviving former male athletes who represented Finland between the years 1920 and 1965 at least once in international competitions and referents who at the age of 20 were classified as completely healthy at a medical examination, and who responded to a questionnaire in 1985 (athletes, n = 1,282; referents n = 777). In 1985, they completed a questionnaire with medical, life-style, and psychosocial items; at that time, the leisure physical activity was greater in previous athletes than in referents. The presence or absence of the three diseases was identified from the questionnaire or from at least one of three registers: Finnish hospital inpatient discharge register, reimbursable medication register, and disability pension register. When compared with referents, both endurance and mixed-sports athletes had lower age-adjusted odds ratios (ORs) for all studied diseases. Compared with referents, power-sports athletes had a higher risk for high body mass index (BMI) but a lower risk for ischemic heart disease. Subjects with high BMI had an increased risk for all three diseases. Smokers had a higher risk for diabetes and ischemic heart disease compared with those who were never smokers. After adjustments for age, BMI, smoking history, and occupational group, compared with referents, former endurance athletes had the lowest ORs for diabetes (OR 0.24; 95% confidence interval, 0.07 to 0.81) and ischemic heart disease (OR 0.33; 0.18 to 0.61).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Statistical evaluation of molecular descriptors and quantitative structure-property relationship studies of retinoids.

Various molecular descriptors, including connectivity indices, sums of the intrinsic state values, electrotopological state indices, topological equivalence indices, kappa indices, normalized Bonchev-Trinajstic and Shannon information indices, Wiener and Platt's F numbers and molecular weight, were calculated for 73 retinoids, whose structures and properties were taken from the literature. A novel methodology using statistical analyses (cluster, factor and stepwise regression) in selecting relevant molecular descriptors for quantitative structure-property relationship (QSPR) studies has been developed. The analyses were used in correlating molecular structure with affinity, pharmacokinetic properties and reversed-phase retention of retinoids.

Molecular Weight↗
PubMed1994

High hydrostatic pressures in traumatic joints require elevated synovial capillary pressure probably associated with arteriolar vasodilatation.

Three out of the four Starling pressures were determined at arthroscopy of traumatic effusions of the knee. The range of the joint fluid hydrostatic pressure Pjoint was 5-83 cmH2O (0.5-8.1 kPa, 4-61 mmHg), that of the colloid osmotic pressure difference COPplasma-COPjoint 0-21.7 cmH2O. In 11 of 15 cases the sum Pjoint+COP difference exceeded 32.6 cmH2O (3.19 kPa, 24 mmHg), a high estimate of average capillary pressure at the level of the heart. The number of 'exceeding' cases was 8/15 if only 80% of the COP difference was considered effective. Pjoint and the COP difference oppose filtration of fluid from plasma into joints, indicating that mean capillary pressure, the only Starling pressure not determined, was elevated unless the effusions were being resorbed back into the blood. The findings can be explained by tamponade compensated by arteriolar vasodilatation, suspected to be metabolically mediated.

Adolescent↗
PubMed1994

A randomized, double-blind, placebo-controlled trial of nimodipine in acute ischemic hemispheric stroke.

BACKGROUND AND PURPOSE: A randomized, double-blind, placebo-controlled multicenter trial was conducted to test the hypothesis that nimodipine would improve the functional outcome in acute ischemic hemispheric stroke. METHODS: A total of 350 patients were randomized to nimodipine 120 mg/d PO or matching placebo for 21 days. Randomization was stratified by onset of therapy, age, and stroke severity. Treatment was begun within 48 hours of onset. The patients had neurological evaluation on admission, on days 1, 7, and 21, and at 3 and 12 months. The primary end points were Rankin grade, neurological score, and mobility at 12 months. RESULTS: We did not find any differences in the functional outcome between the treatment groups or between the stratified subgroups. We were also unable in post hoc analyses to find any groups of patients who benefited from nimodipine. During the first month and at 3 months the case-fatality rate was higher in the nimodipine-treated patients than in those on placebo (P = .004 and P = .030, respectively), but at the 1-year follow-up this difference had lost statistical significance. During the first week nimodipine had a statistically significant lowering effect on both systolic (P = .005) and diastolic (P = .013) blood pressure. CONCLUSIONS: Nimodipine did not improve the functional outcome of acute ischemic hemispheric stroke. The early case-fatality rate was higher in the nimodipine group, possibly due to the blood pressure-lowering effect of nimodipine.

Aged↗
PubMed1994

Healthy lifestyles of former Finnish world class athletes.

Recently, Sarna et al. (Med. Sci. Sports Exerc. 25:237-244, 1993) reported increased mean life expectancy in former world class athletes. Because lifestyle is associated with longevity, we have examined whether health habits of former Finnish male athletes (N = 1274; present mean age: 57.5, range: 36-94 yr) differed from those of noncompetitive referents (N = 788; mean age: 55.7, range: 39-87 yr). The athletes had represented Finland in international competitions in endurance (N = 177), power (N = 454), or other ("mixed") events (N = 643) from 1920-1965. Data on physical characteristics, sociodemographic factors, and health habits were obtained from questionnaires. All dependent variables in an analysis of covariance and in a logistic regression analysis were adjusted for age and occupation. Both leisure aerobic and work activity of all athlete groups was higher (P < 0.01) than that of referents. Compared with the referents, both power and "mixed" athletes were more prone to eat fruits and vegetables and to avoid vitamin supplements, but less prone to use butter and high-fat milk, and to smoke (odds ratios different from 1.0, P < 0.05). Also endurance athletes smoked less and drank less alcohol than the referents (P < 0.05). Higher leisure aerobic activity and less frequent smoking after athletic years might explain higher life expectancy of Finnish athletes.

Adult↗
PubMed1993

Serum sex hormone-binding globulin, cardiovascular risk factors, and adrenal cortisol responses to dexamethasone and corticotropin.

Basal cortisol levels and cortisol responses to dexamethasone (DXM) and corticotropin were studied in relation to serum levels of sex hormone-binding globulin (SHBG), testosterone (T), free T, estradiol (E2), insulin-like growth factor I (IGF-I), high-density lipoprotein cholesterol (HDLC), triglycerides (TG), and insulin in 30 men. SHBG was positively correlated to age (P < .01), HDLC (P < .05), and total T (P < .05) and negatively correlated to TG (P < .02) and insulin (P < .001). SHBG was inversely related to corticosteroid-binding globulin (P < .05), but was not significantly associated with IGF-I. Free T was positively related to TG (P < .05), insulin (P < .01), total T (P < .001), and basal (P < .01) and free cortisol (P < .05). Corticotropin-stimulated cortisol responses were negatively associated with SHBG (P < .001) and positively associated with insulin (P < .01). Multiple linear regression analyses with SHBG as the dependent variable indicated that cortisol response alone explained 34.0% and together with age 46.2% of the variation of SHBG levels. Only insulin and age, but not cortisol response, remained significant predictors of SHBG concentrations when entered simultaneously into the mathematical model; this model explained 55.1% of the variation of SHBG levels. Thus, in addition to insulin and age, cortisol reserves and secretion seem to have significant associations with serum SHBG and free T concentrations.

Adrenal Cortex↗