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Biomedical subjects

V Valtonen

Publications and source records attributed to V Valtonen.

At least 73 records · Page 4Linked to original sources
PubMed1988

Salmonella, complement and mouse macrophages.

The structure of the polysaccharide chains that constitute the O antigen on the surface of Salmonella bacteria determines the rate of complement activation and C3b deposition on the bacteria. A fast-activating O antigen causes rapid C3-dependent opsonization of the bacteria injected intraperitoneally; as a consequence, the bacteria are taken up and killed by the resident peritoneal macrophages, and their virulence is low. A slow-activating O antigen protects the bacteria from opsonization in the peritoneal cavity, and is associated with higher virulence. However, if injected intravenously bacteria with either O-antigenic type are equally virulent; in the high complement concentration of the blood they become opsonized and taken up by macrophages in the liver and spleen, which are unable to kill them but instead provide a protected site for multiplication.

Animals↗
PubMed1988

Bacteriology of odontogenic apical periodontitis and effect of penicillin treatment.

The microbiology and treatment of apical periodontitis was studied in 62 patients, followed-up for 1 year. The clinical treatment and the radiological technique were standardized. One third of the patients received no systemic antibiotics, one third received phenoxymethylpenicillin for 1 week, and one third for 3 months. On the average, 0-2 facultatively anaerobic and 4-6 anaerobic bacteria were isolated from periapical infections. The genera Bacteroides and Fusobacterium in addition to anaerobic gram-positive cocci were found most frequently. Minimum inhibitory concentrations of benzylpenicillin against 269 strains were tested. 12 strains were resistant at the concentration 2.4 micrograms/ml, including 4 strains of Fusobacterium sp. All patients were free of symptoms 1 month after the admission. Only 1 patient failed to show any progress in radiological healing. No differences between the groups in relation to penicillin therapy were found.

Adult↗
PubMed1987

Intestinal accumulation of 111In-granulocytes in patients studied because of occult infection.

111In-granulocyte scintigraphy was performed on 245 patients in whom a localized infection was suspected. In 123 patients scintigraphy was positive and of these 35 (28%) had intestinal accumulations of 111In-granulocytes. Specific local causes for the intestinal uptake of radioactivity were antibiotic associated colitis (eight patients), local pyogenic bowel infection (four patients), systemic disease (two patients), bowel necrosis (two patients), colonic cancer (one patient) and Stevens-Johnson's syndrome (one patient). Nonspecific mechanisms of bowel accumulation were desquamation of labelled granulocytes (12 patients) and bleeding (two patients). In three cases the mechanism of colonic accumulation of granulocytes was not revealed. These results show that unexpected accumulations of labelled granulocytes in the gut is not a rare phenomenon and is often due to clinically significant intestinal inflammation or other disease, especially in patients who do not have signs of respiratory, pancreatic or oesophageal inflammation causing desquamated granulocytes to accumulate in the gut.

Adolescent↗
PubMed1987

Fever, leucocytosis and C-reactive protein after open-heart surgery and their value in the diagnosis of postoperative infections.

The time course of body temperature (T), white blood cell count (WBC) and serum C-reactive protein (CRP) following uncomplicated open-heart surgery and the value of these three parameters in the diagnosis of postoperative infectious complications were analyzed in 153 patients. Preoperatively, all the patients had a normal T and the WBC level was under 10 X 10(9)/l. The CRP was elevated (over 20 mg/l) in five patients without having an influence on their postoperative courses. Postoperatively, T, WBC and CRP reached their maximum values during the first three days, decreasing gradually thereafter. Great individual variations in this average response to open-heart surgery were seen. Development of minor postoperative infections, mainly wound infection, (in 22 patients) were poorly reflected by these three parameters. However, a temperature exceeding 38 degrees C after the 6th postoperative day suggested presence of infection; less than 5% of patients without an infection had a temperature over this value. A secondary rise in CRP after the third postoperative day occurred in 20 patients and correlated well with postoperative complications; in 14 patients (70%) an infection became apparent, in three instances a probable infection was present, while two patients suffered from non-infectious complications. Only in one case (5%) did the cause for a secondary rise in CRP remain unknown. In major infections, i.e. mediastinitis, a CRP response occurred in all 12 patients, a temperature response in 11 patients (92%) and a WBC response in 10 patients (83%).

Aged↗
PubMed1987

C-reactive protein (CRP) and serum phospholipase A2 in the assessment of the severity of acute pancreatitis.

The present study examines the value of C-reactive protein (CRP) determinations in the assessment of the severity of acute pancreatitis and the correlation of CRP with serum phospholipase A2 activity and the clinical status. Fifty three patients with acute pancreatitis were studied; 17 with haemorrhagic pancreatitis and 36 with a mild form of the disease. S-phospholipase A2 activity increased significantly (p less than 0.05) in patients with fatal pancreatitis but not in those with mild disease. Phospholipase A2 concentrations were below 10 nmol FFA/ml min in mild, while they rose to 20-40 nmol FFA/ml min in haemorrhagic pancreatitis. In fatal cases very high (up to 50-60 nmol FFA/ml min) serum phospholipase A2 concentrations were recorded. The increase in CRP was greater in the patients with severe pancreatitis. One day after admission mean CRP was 280 mg/l in patients with haemorrhagic and 45 mg/l in those with the mild pancreatitis (p less than 0.001). High CRP values also correlated with the prognostic signs indicative of severe pancreatitis. CRP and S-phospholipase A2 determinations are valuable in the early assessment of the severity of acute pancreatitis, but the CRP assay is much easier to include in hospital routine.

Acute Disease↗
PubMed1987

An outbreak of invasive aspergillosis in a haematologic unit.

Within a period of 15 months 8 cases of invasive pulmonary aspergillosis were seen in a haematologic unit; 7 of them between January and October 1984. No previous cases of invasive aspergillosis had been encountered during the existence of the unit since 1979. Environmental studies did not prove a single likely source for the fungal spores. Previous window renovation with concomitant fiber deposits on ventilation grids, poor sealing of air filter fittings in patient rooms, occasional ventilation through windows in the ward, and low speed of booster fans in the ventilation system may have created a condition favourable for the entry of Aspergillus fumigatus spores into the patient rooms. Environmental sanitation including cleaning of the ventilation ducts and change of filters in the ventilation system stopped the outbreak. Two sporadic cases have appeared during a follow-up period of 26 months.

Acute Disease↗
PubMed1987

Invasive pulmonary aspergillosis: a diagnostic and therapeutic problem. Clinical experience with eight haematologic patients.

Eight patients with haematologic malignancies contracted fatal invasive aspergillosis during an outbreak. Five patients were neutropenic. Bronchofiberoscopic examination with microbiology specimen brush and bronchoalveolar lavage yielded Aspergillus fumigatus in only 2/5 patients examined. The specific diagnosis reached during lifetime in 5 patients was based on a combination of invasive procedures (lung biopsy in 2, percutaneous lung puncture in 1), the presence of a lung abscess (3 patients), seroconversion (1 patient), and purulent maxillary sinusitis caused by A. fumigatus together with repeated abundant growth of A. fumigatus in the sputum (1 patient). Six patients received amphotericin B. The infection was temporarily controlled only in 2 bone marrow transplant recipients whose granulocyte counts recovered. In 3/8 patients the pneumonia was of polymicrobial aetiology, Mycobacterium tuberculosis (2 patients), Pneumocystis carinii (1 patient), and Legionella pneumophila (1 patient) being the other microbes involved. 3/4 bone marrow transplant recipients with aspergillosis had been transplanted for chronic myeloid leukaemia, supporting the previously reported association of bone marrow transplantation for chronic myeloid leukaemia and the risk of invasive aspergillosis. Improved diagnostic methods for earlier definitive diagnosis of invasive aspergillosis as well as more efficacious and less toxic antifungal agents are needed to allow early treatment.

Adult↗
PubMed1987

Twice-a-day regimen of erythromycin base is effective in the treatment of acute streptococcal tonsillitis.

A multicenter clinical trial on the efficacy and safety of a twice-a-day administration of erythromycin base was performed on 261 adolescent or adult patients with acute tonsillitis. The patients were randomized for each doctor separately into q.i.d. (4 x 250 mg) and b.i.d. (2 x 500 mg) groups. Throat swabs were cultured for group A beta-haemolytic streptococci before the treatment and, in positive cases (100 patients), 2-3 days after completing the treatment of at least 7 days. No significant difference in the efficacy between the two regimens was observed as judged by clinical evaluation or bacteriological examination. About 90% of patients were completely healed by both criteria in both treatment groups. Side-effects were reported in 40 and 44% respectively, in the treatment groups. However, only 9/244 (3.7%) had to stop the treatment because of side-effects. Six of these belonged to the b.i.d. group and 3 to the q.i.d. group. This difference is not statistically significant (p greater than or equal to 0.05). Our results suggest that twice-a-day regimen of erythromycin base is an effective and well-tolerated treatment of streptococcal tonsillitis.

Adolescent↗
PubMed1987

Early endocarditis following open-heart surgery--importance of surgical treatment.

Nine cases of proven early form of endocarditis occurred after open-heart surgery. Eight of these occurred after valve surgery with an incidence 0.7% while one complicated correction of Fallot's tetralogy. Sternal wound infection preceeded endocarditis in two cases and respiratory tract infection in one case. In these three patients, the infection was caused by the same bacteria as the subsequent postoperative endocarditis. In only one patient were there no signs of infection during the immediate postoperative course. A new cardiac murmur suggesting prosthetic malfunction was a clear indication for early reoperation in five patients; four of them survived. In one patient with a paravalvular leakage the decision to operate was delayed with fatal outcome. Generally, in patients without signs of prosthetic valve malfunction or other prosthetic complication the indication and timing of surgery is problematic. In our series the antibiotic therapy was continued over two months in three patients. Two of them died while the third patient was operated on successfully.

Adult↗
PubMed1987

Diagnostic significance of indium-111 granulocyte scintigraphy in febrile patients.

Sixty-eight patients with fever of unknown origin, 32 patients with postoperative fever, and 26 patients with therapy-resistant fever after bacteremia were investigated with [111In] granulocyte scintigraphy for the detection of abscesses. The results showed that the value of [111In]granulocyte scintigraphy in the detection of infectious foci vary in these three types of febrile conditions. The overall sensitivity and specificity were 86.5% and 87.8%, respectively. We observed, however, a relatively low predictive value of a positive result in the fever of unknown origin group (73.1%), and also a low predictive value of a negative result in the bacteremia group (66.7%). The C-reactive protein (CRP) levels in patients with a true-positive scintigram were significantly (p less than 0.001) higher than in patients with a true-negative scintigram. There was also a significant positive correlation (p less than 0.01) between the serum CRP concentration and the intensity of the granulocyte accumulations. There was no correlation between the peripheral leukocyte count or the erythrocyte sedimentation rate (ESR) and the intensity of the granulocyte uptake. Therefore CRP, but not the leukocyte count or ESR, appears useful for selecting the patients who benefit most from granulocyte scintigraphy.

Adult↗
PubMed1985

Antibody responses in arthritic and uncomplicated Yersinia enterocolitica infections.

Concentrations of antiyersinia antibody isotypes IgG1, IgG2, IgG3, IgG4, IgA and IgM were measured in 33 patients with yersiniosis using a solid-phase radioimmunoassay. Sixteen patients had a complicating reactive arthritis. Throughout the observation period IgG1 and IgM antibodies both constituted approximately one-third of the total antibodies, while IgA accounted for 10%, IgG3 accounted for 1%, and IgG4 antibodies could not be detected. IgG1, IgM, and IgA antibodies (and the total titer) had reached their peak at the beginning of the observation period (ca. day 20 after the onset of symptoms). The levels then gradually decreased; the total titers averaged 40 times the background at the beginning of the observation period and 4 times the background on day 350. IgM antibodies could be detected as late as a year after the infection. The concentration of IgG2 antibodies varied greatly from patient to patient. In most patients it increased until a plateau was reached approximately 2 months after the onset of symptoms. A decline was observed later. Five arthritic but no nonarthritic patients had a pronounced IgG2 response (more than half of the IgG antibodies were IgG2 in one or several samples).

Adolescent↗
PubMed1985

Complement levels and C3 breakdown products in open-heart surgery: association of C3 conversion with the postpericardiotomy syndrome.

The role of the complement system in the pathogenesis of the post-pericardiotomy syndrome (PPS) was evaluated in a prospective study by measuring the levels of complement (C) components, total haemolytic complement activity and circulating C3 breakdown products in serial plasma and serum samples of 45 patients undergoing open-heart surgery. A consistent reduction in the levels of C3 and C4 but not of factor B was seen on the second post-operative day. During the second post-operative week the antigenic levels of each C component increased significantly. At this time six patients developed the post-pericardiotomy syndrome. Circulating C3 conversion products (C3bi and C3c) were demonstrated in the plasma samples from five of these patients by the immunofixation technique, the mean conversion percentage being 14.3 +/- 10.6. The samples from 15 of the 39 other patients also showed C3 conversion, but the mean percentage was significantly lower (4.5 +/- 6.1%, P less than 0.05). Before the second post-operative week C3 conversion was rare in both groups. The C3d levels of plasma samples, as detected by rocket immunoelectrophoresis, followed a similar pattern. Reduced total haemolytic complement activity was found in three patients suffering from the PPS. These results suggest a role for complement in the non-infectious, inflammatory response during the late post-operative period after open heart surgery, and especially in the post-pericardiotomy syndrome.

Adolescent↗
PubMed1985

Comparison of arterial and venous blood samples for the diagnosis of bacteremia in critically ill patients.

We compared the blood culture results obtained either by venipuncture or through an arterial catheter in 51 critically ill patients with 217 clinically suspected episodes of bacteremia. During each episode, three blood culture samples, two arterial and one venous, were drawn within 1 h. One or more cultures were positive in 42 (19%) of the episodes, but there were great discrepancies between the results obtained by the two methods. In only eight cases did both methods give the same microorganism. In eight other episodes, the two arterial cultures were positive while the venous sample was negative, probably indicating a continuous contamination of the catheter system. Pseudomonas aeruginosa and Staphylococcus epidermidis were the two most common microbes. The frequency of positive arterial catheter blood cultures did not increase with the length of catheter use. We conclude that an arterial catheter is not a reliable sampling site for blood cultures and does not replace the conventional venipuncture method.

Adolescent↗