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Biomedical subjects

V Valtonen

Publications and source records attributed to V Valtonen.

At least 19 recordsLinked to original sources
PubMed1995

Early antibiotic treatment in acute necrotising pancreatitis.

Despite improvements in surgical treatment and intensive care, mortality from severe acute pancreatitis remains high. We have carried out a randomised study of 60 consecutive patients with alcohol-induced necrotising pancreatitis to find out whether early antibiotic treatment can improve outcome. 30 patients were assigned cefuroxime (4.5 g/day intravenously) from admission. In the second group, no antibiotic treatment was given until clinical or microbiologically verified infection or after a secondary rise in C-reactive protein. The inclusion criteria were C-reactive protein concentration above 120 mg/L within 48 h of admission and low enhancement (< 30 Hounsfield units) on contrast-enhanced computed tomography. There were more infectious complications in the non-antibiotic than in the antibiotic group (mean per patient 1.8 vs 1.0, p = 0.01). The most common cause of sepsis was Staphylococcus epidermidis; positive cultures were obtained from pancreatic necrosis or the central venous line in 14 of 18 patients with suspected but blood-culture-negative sepsis. Mortality was higher in the non-antibiotic group (seven vs one in the antibiotic group; p = 0.03). Four of the eight patients who died had cultures from pancreatic necrosis positive for Staph epidermidis. We conclude that cefuroxime given early in necrotising pancreatitis is beneficial and may reduce mortality, probably by decreasing the frequency of sepsis.

Acute Disease↗
PubMed1995

Chronic diarrhea due to a single strain of Aeromonas caviae.

Over a period of 17 months, Aeromonas caviae was cultured 15 times as the sole enteropathogen from the feces of a man who had developed chronic diarrhea after traveling to Turkey. Determination of rRNA gene restriction patterns confirmed that the seven isolates of Aeromonas caviae studied were identical (hybridization group [HG]4). After therapy with ciprofloxacin for four weeks, the patient was culture negative for the original isolate, and six months later a novel strain of Aeromonas media with a different ribopattern (HG 5A) was isolated from the feces of the patient. The patient responded again, both clinically and bacteriologically, to a four-week course of ciprofloxacin and has remained asymptomatic since then.

Aeromonas↗
PubMed1994

Effect of immunosuppressive therapy on the clinical presentation of legionellosis.

To determine whether the clinical course of legionellosis in patients treated with immunosuppressive agents differs from that seen in other patient groups, data on 52 Finnish patients with legionellosis confirmed by culture or by the direct immunofluorescent antibody test was reviewed. Of these patients 44% were immunosuppressed, 23% had other underlying diseases and 33% had no predisposing conditions. Among those without predisposing conditions, only Legionella pneumophila serogroup 1 was observed, whereas among the immunosuppressed patients, serogroup 6 dominated. Legionellosis was nosocomial in 73% of the immunosuppressed patients and in 33% of the patients with other underlying diseases but was travel-associated in 76% of those without predisposing factors. The case fatality rate (37%) was high but was not associated with preceding immunosuppression. These results indicate that although the serogroups and the sources of legionellosis differ in immunosuppressed patients compared with other groups, the clinical presentation is not more severe.

Adult↗
PubMed1994

C-reactive protein serum levels in patients with ocular disease.

Hepatocyte derived C-reactive protein (CRP) is a sensitive indicator for inflammatory or infectious processes in a variety of tissues. As several other plasma proteins it is regarded as part of the acute phase response to a variety of tissue damage. CRP is commonly used in general medicine as a tool for the follow-up of especially bacterial infections. However, it has not been widely used in ophthalmology. In the present study CRP values in serum samples from 51 patients with various acute ocular diseases were determined semiquantitatively. High CRP levels were found most frequently in patients with either preseptal cellulitis (83.3%) or endophthalmitis (25.8%) whereas in the serum of patients with keratitis and uveitis, CRP exceeded 20 mg/l in only 18.7% of the cases. In a control group of 10 patients with retinal detachment the mean CRP level was 2.3 mg/l (SD +/- 0.98 mg/ml). The clinical significance and the prognostic value of CRP determinations during ocular diseases are discussed.

C-Reactive Protein↗
PubMed1993

Effect of immunosuppressive therapy on the clinical presentation and outcome of tuberculosis.

A total of 177 tuberculosis cases of individuals not infected with human immunodeficiency virus diagnosed during the years 1984-1990 at the Helsinki University Central Hospital were reviewed retrospectively to compare the clinical presentation of tuberculosis in patients immunocompromised because of treatment (n = 35) with patients with other underlying conditions (n = 60) and with those without known predisposing factors (n = 82). In immunosuppressed patients compared with other patients, tuberculosis was more frequently disseminated (40% vs. 12%, P < 0.001), lung infiltrations were more often miliary (44% vs. 13%, P < 0.001), and the sputum smears were less often positive (30% vs. 62%, P < 0.05). In addition, the age-adjusted odds ratio for the risk of dying was higher among immunosuppressed patients than among the two other groups. The low rate of positive sputum smears and the high rate of atypical presentation and mortality stress the importance of a high index of suspicion and early institution of empirical antituberculosis therapy in immunosuppressed patients.

Adult↗
PubMed1993

Infection and inflammation as risk factors for myocardial infarction.

Recent studies have illustrated that in addition to the well known risk factors, such as lipoproteins, smoking, hypertension, there are others that cause atherosclerosis and myocardial infarction. Our knowledge of atherosclerotic lesions has increased. We now know that atherosclerotic changes are due to inflammatory cell infiltration as well as to increases in migration of vascular smooth muscle cells. Endothelial cells play a major role in the pathology of vascular changes. In recent years a new risk factor for coronary artery disease has been discovered: chlamydia pneumonial infections. Herpes class viruses have also been associated with pathology of atherosclerotic lesions. Studies show that dental status and bacterial infections are also related to the risk of myocardial infarction. This review discusses the possible mechanisms of infection and inflammation and whether they are major or modifying risk factors for atherosclerosis and myocardial infarction.

Adult↗
PubMed1993

Thrombo-embolic complications in bacteraemic infections.

Thrombo-embolic complications including stroke and myocardial infarction are common in bacteraemic patients with and without endocarditis: about 20% of patients with infective endocarditis will develop stroke during their disease. Small miliary type myocardial infarctions are found in about 80-90% of autopsied endocarditis patients, but large myocardial infarctions are much more infrequent and acute myocardial infarctions are seldom diagnosed in the lifetime of these patients. About 10% of bacteraemic patients without endocarditis will develop stroke within one month of the onset of bacteraemia, and about 4% of bacteraemic patients will develop myocardial infarction. The risk of cerebral or myocardial infarction is very high in bacteraemic patients compared with the corresponding risk in the general population of the same age, and it has been estimated that about 10% of all strokes are associated with bacteraemic infections. The mechanisms which could cause thrombo-embolic complications in septic patients are numerous, but activation of the coagulation system is probably the most important. Currently, appropriate antimicrobial therapy is the best way to reduce mortality and also probably thrombo-embolic complications in bacteraemic patients who are not routinely using any anticoagulant therapy.

Bacteremia↗
PubMed1992

Clinical presentation and outcome of listeriosis in patients with and without immunosuppressive therapy.

Seventy-four cases of systemic listeriosis occurring from 1971 to 1989 in the greater Helsinki area in Finland are reviewed with a special interest in the effect of preceding immunosuppressive therapy on the clinical presentation. Of these patients, 66% had an underlying disease, most commonly malignancy, diabetes mellitus, or renal transplantation, and 43% had received immunosuppressive therapy within 1 week before onset of listeriosis. Bacteremia and central nervous system infections (both in 43% of cases) were the most common clinical entities. The percentage of patients with meningitis was not greater among immunosuppressed patients (13/32, 41%) than among patients with underlying diseases not treated with immunosuppressive agents (9/16, 56%) or among previously healthy nonpregnant hosts (7/11, 64%). Immunosuppressed patients did not die more frequently than did those with underlying diseases not treated with immunosuppressive therapy (case fatality rate, 29% vs. 38%, respectively). However, all previously healthy non-neonatal patients survived, whereas 32% (15/47) of those with any kind of underlying disease succumbed.

Adolescent↗
PubMed1991

Hepatic safety of erythromycin acistrate in 1549 patients with respiratory tract or skin infections.

Erythromycin acistrate is a new 2'-acetyl esther prodrug of erythromycin, whose structure resembles that of erythromycin estolate. However, in toxicological studies, it does not have the problems of hepatotoxicity. To assess its effects on hepatic functions in clinical practice, the liver parameters of patients with respiratory tract or skin infections were monitored during therapy. In total 1549 patients were treated for 7-14 days. In addition, 127 patients with suspected viral infections served as controls. There were no significant differences in serum aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), gamma-glutamyltransferase (gamma-GT) or alkaline phosphatase (APHOS) values between the erythromycin acistrate or control groups at the beginning or end of therapy. ASAT values increased moderately in 2.4% and clearly in 0.3% of patients treated, but also decreased in 2.0%. ALAT values were moderately increased in 9.9%, clearly increased in 0.6% and normalized in 3.5% of the patients. gamma-GT values increased moderately in 3.5% and and clearly in 0.3%, but decreased to normal in 3.3% of the patients. APHOS was moderately elevated in 1.0% of the patients and normalized in 1.3%. The correlation of changes between the different liver enzymes was poor. Only ten patients (0.6%) had two or more clearly elevated liver enzyme values by the end of the therapy, of whom five had increased liver enzyme activities before the treatment, two had underlying disease explaining the changes and in only three patients out of 1549 (0.2%) could hepatic changes be attributed to erythromycin acistrate therapy. These changes were reversible. The results demonstrate the hepatic safety of erythromycin acistrate in clinical practice. Concomitant food intake did not affect the safety profile.

Adolescent↗
PubMed1991

Surgical treatment of infective aortic valve endocarditis.

Fifty-eight adult patients treated with aortic valve replacement for infective endocarditis were retrospectively reviewed. The operation was performed during antibiotic therapy (group I, n = 25) or after completion of such therapy, on average 17 months after diagnosis (group II, n = 33). Preoperatively 68% of group I and 24% of group II were in NYHA class IV. Bacterial aetiology was verified in 78% of all cases. Preoperative embolic complications occurred in six group I and three group II cases, causing hemiplegia in eight. At operation the aortic valve was bicuspid in 29 of the 58 patients. Vegetations and cusp perforation were present in most cases. Bacteria were demonstrated in 11 of the excised specimens. A mechanical valve prosthesis was inserted in all cases. Three patients died, one perioperatively and two during their time in hospital (2 from group I). Low-output syndrome was the commonest postoperative complication. During follow-up averaging 66 months, 12 patients died (6 of cardiac causes). Late complications were periprosthetic leakage (2 cases), significant embolism (5), and prosthetic valve endocarditis (4), causing periprosthetic leakage in one case.

Anti-Bacterial Agents↗
PubMed1990

Circulating immune complexes containing chlamydial lipopolysaccharide in acute myocardial infarction.

The presence of circulating immune complexes (IC) was studied using two detection methods specific for chlamydial lipopolysaccharide (LPS) in paired serum samples of 44 patients (30 men and 14 women) with acute myocardial infarction (AMI). Forty-four random controls were individually matched for locality, age and sex with the AMI patients. As specificity controls for the IC assays single serum samples from 29 patients with diseases characterized by the presence of circulating IC were used. Fifty-seven per cent of AMI patients, 12% of their random controls and 10% of the patient controls were shown to have chlamydial LPS-specific immune complexes in their sera (P less than 0.0001, AMI versus random and patient controls). This finding provides further evidence of the possible association of chronic chlamydial infection with AMI.

Adult↗