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Biomedical subjects

V Valtonen

Publications and source records attributed to V Valtonen.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1989

Serologic response against cardiolipin and enterobacterial common antigen in young patients with acute myocardial infarction.

Elevation of anticardiolipin antibodies has been observed in myocardial infarction and in many infections. To elucidate this topic, paired serum specimens from 40 patients with acute myocardial infarction were tested for anticardiolipin antibodies (solid-phase enzyme immunoassay) and enterobacterial common antigen antibodies (indirect hemagglutination test). Forty-one randomly selected individuals and 30 patients with chronic coronary heart disease served as controls. All individuals were males whose maximum age was 50 years. In patients with acute myocardial infarction the levels of anticardiolipin antibodies in paired sera rose significantly in all immunoglobulin classes (18% in the IgG class, 26% in the IgA class, and 43% in the IgM class), whereas no elevations occurred in the other groups. Fifteen of the acute myocardial infarction patients also showed at least a fourfold increase in enterobacterial common antigen antibodies, as compared with only one such increase in the two other groups combined. The increases were less marked than those seen in pronounced enterobacterial infections. These two reactions were closely associated.

Adult↗
PubMed1989

Dental infections in association with cerebral infarction in young and middle-aged men.

The association between dental infections and cerebral infarction was investigated in a case-control study involving 40 patients with ischaemic cerebral infarction under the age of 50, and 40 randomly selected community controls matched for sex and age. Poor oral health, as assessed by two indices measuring the severity of infections of teeth and periodontium, or by the presence of subgingival calculus or the presence of suppuration in the gingival pockets, were more common in male patients than in male controls, but no difference was observed in females. If severe dental infections were combined with other probable bacterial infections there were altogether 16 patients (40%) but only two controls (5%) who had suffered from a probable bacterial infection within 1 month or at the time of the stroke or when examined as a control (P less than 0.01). Our results suggest an association between bacterial infection and ischaemic cerebrovascular disease in patients under 50 years of age. Severe chronic dental infection seems to be an important type of infection associated with cerebral infarction in males.

Adolescent↗
PubMed1989

A comparative study of ciprofloxacin and conventional therapy in the treatment of patients with chronic lower leg ulcers infected with Pseudomonas aeruginosa or other gram-negative rods.

Twenty-six elderly patients with chronic leg ulcers infected by Pseudomonas aeruginosa or other aerobic Gram-negative rods were randomised to two treatment groups. The control group (eight patients) received conventional local therapy and the other group (18 patients) was treated with oral ciprofloxacin for three months in addition to conventional local therapy. In the beginning of the study both groups were comparable with the age of the patients and the associated diseases including impairment of arterial and venous circulation in the lower legs. Also the size, duration and the severity of the inflammation reaction in the leg ulcers were comparable before the start of the therapy. Ciprofloxacin was clinically more effective than the standard therapy in reducing the size of the ulcer (p less than 0.05). Also the need of extra systemic antibiotics decreased significantly in the ciprofloxacin group compared with the controls. In three out of eighteen ciprofloxacin treated patients the leg ulcers disappeared completely during the three months' study period compared with none in the control group. However, ciprofloxacin resistant strains, mainly staphylococci, appeared in the leg ulcers in 67% of the ciprofloxacin treated patients compared with 0% in the control group (p less than 0.01). No significant side-effects due to ciprofloxacin except the resistant strains were noticed. We conclude that oral long-term ciprofloxacin therapy is effective in the treatment of chronic leg ulcer infections due to Gram-negative rods but selection of ciprofloxacin resistant strains is a problem in this patient group.

Administration, Oral↗
PubMed1988

Serological evidence of an association of a novel Chlamydia, TWAR, with chronic coronary heart disease and acute myocardial infarction.

Paired sera from 40 male patients with acute myocardial infarction (AMI), 30 male patients with chronic coronary heart disease (CCHD), and 41 controls, matched for sex, age, time, and locality were investigated for antibodies to a novel type of Chlamydia sp, TWAR, and to chlamydial lipopolysaccharide (LPS) group antigen. 27 patients with AMI (68%), and 15 (50%) patients with CCHD had raised IgG (greater than or equal to 128) and/or IgA (greater than or equal to 32) titres in the microimmunofluorescence test with chlamydia TWAR. Both frequencies were significantly higher than in the controls (7, 17%). 26 (68%) of 38 patients with AMI also showed a significant seroconversion in enzyme immunoassay with LPS antigen; this response was absent in all patients with CCHD and all but 1 of the controls. Chronic chlamydial infection could be a factor in the pathogenesis of cardiovascular diseases.

Adult↗
PubMed1988

Fecal bacteriology and reservoir ileitis in patients operated on for ulcerative colitis.

To investigate the etiology of ileal reservoir inflammation, fecal bacteriology and ileal wall morphology were compared in three groups of 15 patients operated on for ulcerative colitis: 1) conventional ileostomy, 2) Kock ileostomy; and 3) pelvic ileal pouch. Total bacterial counts showed overgrowth of fecal bacteria in each group, but the anaerobic bacterial counts were significantly higher (P less than .05) in the two pouch groups than in the conventional ileostomy group. Mucosal morphology did not differ among the three groups showing either normal mucosa or mild chronic inflammatory changes in most patients. In contrast, five of the six patients with clinical pouchitis had acute inflammatory changes in histologic specimens. Fecal bacteriologic findings in these patients did not differ quantitatively or qualitatively from others. It is concluded that proctocolectomy for ulcerative colitis predisposes to ileal bacterial overgrowth, and after pouch operations especially, anaerobic overgrowth may be one factor in the development of pouch inflammation. Acute clinical pouchitis with clear histologic changes was, however, not connected with specific changes in fecal bacteriology.

Adult↗
PubMed1988

Changes in serum lipoprotein pattern induced by acute infections.

To study the effects of acute infections on serum lipids and lipoproteins we measured the concentration and composition of different lipoproteins, apoproteins A-I, A-II, and B, and the activities of plasma postheparin lipolytic enzymes, lipoprotein lipase (LPL) and hepatic lipase (HL) during acute and convalescence phase and after complete recovery in 72 infectious patients (33 with viral infection and 39 with bacterial infection). The mass concentrations of both low density lipoprotein (LDL) (P less than .001) and high density lipoprotein (HDL)2 (P less than .002) were reduced during acute infections due to the lowering of their cholesterol, phospholipid, and protein contents. The reduction of LDL cholesterol was maximal at the acute stage of infection (change -15%, P less than .001) while the reduction of HDL2 cholesterol was maximal during the convalescence (change -35%, P less than .001). During acute infections LDL became triglyceride-enriched (11.8 v 8.6%, P less than .0001) but cholesterol-poor (36.6 v 39.3%, P less than .0001). The ratio of HDL cholesterol/LDL cholesterol was significantly reduced during the convalescence (0.42 +/- 0.15 v 0.53 +/- 0.19, P less than .0001). The concentrations of apo A-I and apo A-II were decreased during acute infections (changes -22%, P less than .001, and -16%, P less than .001, respectively). The very low density lipoprotein (VLDL) was 18% higher during the convalescence period than after the recovery due to the elevations of VLDL triglycerides, cholesterol, and phospholipids. The activity of LPL was reduced both in the acute and convalescence phase, whereas that of HL was reduced only in the acute phase of infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗