Biomedical subjects

A E Kaasik

Publications and source records attributed to A E Kaasik.

At least 19 recordsLinked to original sources

PubMed2001

Survival of patients with primary CNS tumours in Estonia.

We studied a population-based survey that included 1417 patients with a primary central nervous system (CNS) tumour diagnosed in Estonia between 1986 and 1996. Survival rates at 1 and 5 years and median survival by histology and patient's age at diagnosis were estimated. Median survival time for all tumours was 33.2 months and 1- and 5-year survival rates were 59.3 and 46.0%, respectively. In multivariate analysis, younger age, better clinical condition (i.e. a Karnofsky Performance Status (KPS) score of 60 and more) and tumour histology were all dependent prognostic factors for better survival. Risk of death was more than 8 times greater for glioblastoma (Risk Ratio (RR) 8.31) and approximately seven times greater for anaplastic astrocytoma (RR 7.22) and other gliomas (RR 5.74) compared with meningiomas. Comparing the first (1986-1989) and the third (1994-1996) time periods, statistically significant improvements in survival occurred for all tumours and astrocytomas. Declines in survival during the second period (1990-1993) were statistically significant for all the tumour groups, but the most striking decrease took place in patients with glioblastoma. Age-specific rates showed that the increase in survival was more evident for patients aged between 45 and 64 years.

Adolescent↗

PubMed2001

Epilepsy in Estonia: a quality-of-life study.

PURPOSE: To study the impact of epilepsy and its treatment on people with epilepsy in Estonia and to analyze how it is affected by the characteristics of epilepsy. METHODS: Clinical and demographic data about patients were obtained from medical notes and mailed self-completed questionnaires (including the RAND 36-Items Health Survey 1.0 (RAND-36)). RESULTS: Information was collected from 203 patients aged 20-74 years, who all had active epilepsy. A third of the respondents had been seizure free during the last year. Eighty-four percent were receiving monotherapy. More than half of respondents felt stigmatized by epilepsy, 24.7% of them highly so. A third were working full-time, 31.9% were underemployed workers, and 11%, unemployed. Sixty-two percent of these same unemployed or underemployed workers considered their epilepsy to be a significant reason for this situation. Overall, 44% believed they had been treated unfairly at work or when trying to get a job. Study respondents scored lower in all domains on the RAND-36 than did persons from the control group. The biggest differences were found in five domains: Social functioning, Role limitations-physical, Role limitations-emotional, General health, and Vitality. CONCLUSIONS: The clinical characteristics of this study were similar to those of most other series of prevalence cases of epilepsy. The level of employment among persons with epilepsy was not lower than that in the general population. The percentage of stigmatization was high. There were significant differences in the way respondents scored on the stigma scale and on the RAND-36 domains when measuring their health status, depending above all on seizure frequency and type.

Adult↗

PubMed2001

Seizure disorders in patients with brain tumors.

The aim of this study was to analyze the clinical data of patients with epileptic seizures and diagnosed brain tumors. Analysis included 711 patients with primary and secondary brain tumors. 165 (23%) patients had experienced at least one seizure before tumor diagnosis. The mean time from the first epileptic seizure to tumor diagnosis was 16 months. The patient's age, location and pathology of tumor were associated with occurrence of seizures. Seizures were more common in patients aged 30-50 years. Tumors involving the frontal, frontoparietal, temporal and frontotemporal lobes were associated with occurrence of seizures. According to the histological diagnosis, patients with mixed gliomas (62%), oligodendrogliomas (53%) and astrocytomas (42%) experienced seizures most frequently.

Adolescent↗

PubMed2000

Felt stigma and impact of epilepsy on employment status among Estonian people: exploratory study.

This article examines the impact of epilepsy and its treatment on employment status and the extent of stigma among patients with epilepsy. Clinical and demographic data concerning patients examined during a recent epidemiological survey were obtained from medical notes and postal self-completed questionnaires. Information was collected from 90 patients aged 16-70 years. A third of the respondents had been seizure-free during the last year. Thirty-nine percent were working full-time, 24% were working part-time and 11% were unemployed. Sixty-three percent from those working part-time or unemployed considered their epilepsy to be a significant reason for this. Overall, 55.4% believed they had been treated unfairly at work or when trying to get a job. Fifty-one percent of respondents felt stigmatized by epilepsy, 14% of them highly so. The level of employment among epileptic people was not lower than in the general population. The percentage of stigmatization in general and the percentage of the severely stigmatized was as high or even higher than in other studies. Occurrence of stigma and its severity depended first and foremost on the type of seizures. The frequency of seizures was not clearly related to this.

Adult↗

PubMed1999

The risk of motor neurone disease and multiple sclerosis is different in Estonians and Russians. Data from South Estonia.

Epidemiological studies were performed in South Estonia to establish the prevalence rate of multiple sclerosis (MS) and motor neurone disease (MND). The case finding method included information from the hospital records of the central hospital in the region-the University Hospital (for MS from 1942 to 1989), from all neurologists in the region, from the Estonian MS Society and Association of Muscular Disorders, and from nursing homes in the region. The prevalence day was 31 December 1989. MND incidence was established for the period of 1986-1995. The results demonstrated high prevalence rates of MS among native Estonians (55.3 per 100 000), somewhat lower prevalence among native-born representatives of other nationalities (43.6 per 100 000) and the lowest prevalence rate of MS among non-Estonian immigrants (26.6 per 100 000). The differences were not statistically significant. The results for MND demonstrated the opposite pattern. The mean annual incidence rate of MND for 10 years was statistically significantly higher among people of other nationalities (2.5 per 100 000) and Russians (2.6 per 100 000), and lower in native-born Estonians (1.1 per 100 000). No differences in health care or clinical picture were established. The reasons for the demonstrated differences in MND incidence remain unclear.

Adult↗

PubMed1999

Registry of first-ever stroke in Tartu, Estonia, 1991 through 1993: outcome of stroke.

OBJECTIVES: To provide information about the functional ability of the survivors of first-ever stroke in Estonia. PATIENTS AND METHODS: A population based epidemiological study 1991 through 1993 in Tartu. Herewith the data for 1991 and 1993 are presented. A total of 519 persons were registered; 82% of them were admitted (mean length 14 days), 66% were discharged home. RESULTS: During 6 months 41% of the patients died, the remaining 305 patients were interviewed about their living conditions, and functional ability using the Barthel ADL Index. Although 58% of patients responded to the questionnaire, no significant differences in several factors between the respondents and non-respondents were found. Thirty-eight percent of the patients were totally independent in ADL. CONCLUSION: The case-fatality rate at 6 months was high in Estonia and the proportion of totally independent patients 6 months after stroke is slightly lower compared to other studies. The short length of hospital treatment was possibly compensated by sufficient support by relatives after discharge.

Activities of Daily Living↗

PubMed1998

Motor neurone disease in South Estonia. Diagnosis and incidence rate.

The current study evaluated the diagnostic standards of MND and epidemiological markers of MND in Estonia. A total of 108 patients were referred to the University Hospital from 1986 to 1995 with the first suggested diagnosis or final diagnosis of amyotrophic syndrome, amyotrophic lateral sclerosis (ALS), progressive bulbar paralysis (PBP) or progressive muscular atrophy (PMA). In addition neurologists of the region and the National Society of Neuromuscular disorders were contacted. Some 94 patients satisfied the diagnostic criteria. The annual incidence rate in South Estonia and in the city of Tartu ranged from 0.5 to 2.8 per 100,000. The mean annual incidence rate in Tartu is 1.98 and in South Estonia in general 1.3. The highest incidence rate was 8.3 for men in the age group 60 to 64 years and 7.49 in the age group 70-74; among female patients the highest incidence rate -4.6 was in the age group from 65 to 69.

Adult↗

PubMed1997

Changes of sympatho-adrenal and hypothalamo-pituitary-adrenocortical system in patients with head injury.

To determine the role of the sympatho-adrenal (SAS) and hypothalamo-pituitary-adrenocortical system (HPAS) after head injury, the relationship between venous blood epinephrine (E), norepinephrine (NE), adrenocorticotropic hormone (ACTH), cortisol levels, and clinical condition was examined in 55 patients. These observations suggest that head injury causes mainly activation of the above-mentioned systems depending on the severity of trauma. An inverse correlation between the levels of E, NE and Glasgow Coma Scale score, indicating the severity of head injury was revealed. ACTH and cortisol were similarly related to the clinical condition, although the observed correlation was less expressed. The changes in hormonal levels were present during the whole research period (1 week), although a certain shift to normalization was observed. However, catecholamines and ACTH levels in plasma were relatively low in severely head-injured patients whose CT scans revealed serious alterations in the mesencephalic-diencephalic area. At the same time their cortisol levels obtained maximal values and their chance to survive was diminutive. The results of this study indicate that investigation of hormones of SAS and HPAS might be useful as an additional method in the complex of ordinary examinations in establishing early prognosis in patients with brain injury.

Adolescent↗

PubMed1996

Changed incidence and case-fatality rates of first-ever stroke between 1970 and 1993 in Tartu, Estonia.

BACKGROUND AND PURPOSE: The incidence of stroke has stabilized or increased in several developed countries recently, but few data about the trends are available from Eastern Europe. The study was designed to evaluate the possible changes of stroke incidence in Estonia. METHODS: A population-based stroke registry was conducted in Tartu during 1991 through 1993 (mean population, 110,631) to compare it with the study of 1970 through 1973 (population, 90,459). The majority of stroke patients were recorded prospectively, and most were hospitalized and evaluated by a neurologist. All available medical records were reviewed. Only first-ever stroke cases were registered. RESULTS: A total of 667 patients in 1970 through 1973 and 829 patients in 1991 through 1993 were recorded. The total annual incidence per 100,000 rose from 221 to 250 (P = .0173). The total rate for men increased nonsignificantly from 183 to 209 and for women from 258 to 284. Significant increases were observed for men aged 50 to 59 years and for women aged 50 to 69 years; for persons over 70 years, the rates slightly declined. The case-fatality rate at 1 month declined significantly, from 49% to 30%. CONCLUSIONS: A remarkable increase in the incidence and decline in the case-fatality rate of first-ever stroke was observed in Tartu, Estonia. The increase of incidence for those younger than 70 years could be due to the increased prevalence of risk factors. The decline in case fatality could theoretically be related to better management of secondary complications.

Adult↗

PubMed1995

Changes of local cerebral blood flow concomitant to lead-exposure in adult rabbits.

Lead is considered a pathogenic factor of atherosclerosis and arterial hypertension, which are main risk factors of cerebrovascular disease. The brain microvasculature preferentially accumulates lead and its function is sensitive to its toxic effect. Influence of inorganic lead-exposure (20 mg/kg-I group, 40 mg/kg II group) for 10 days on local cerebral blood flow (lCBF) in hypothalamus (HYP) and cerebral cortex (CTX) of rabbits was studied by means of the hydrogen clearance method. Corresponding results were compared to sham operated group (III group). During lead-exposure lCBF was reduced in both investigated regions. The reduction of lCBF in HYP was reduced in both investigated regions. The reduction of lCBF in HYP was 12.9% (P < 0.05) in I and 19.9% (P < 0.001) in II group; corresponding changes in CTX were -16.9% (statistically non-significant -N) in I and 1.4% (NS) in II group. Present finding suggest that inorganic lead induces cerebral microvascular dysfunction with following changes in lCBF. These alteration have a biphasic character Although these disturbances reveal a tendency towards normalization, it is possible to presume that higher concentrations of ingested lead cause more severe injury to endothelium of brain microvasculature.

Animals↗

PubMed1993

Prevalence of MS in south Estonia. Evidence of a new border of the Fennoscandian focus.

A population-based study of MS was carried out in South Estonia in 1988-1989. Cases were identified from the Tartu University Hospital archives where all MS cases in South Estonia are diagnosed, from all neurologists and nursing homes of the region, and from the local Multiple Sclerosis Society. The prevalence in South Estonia is 51 per 100,000, for native Estonians 55, for Russians 29, for other nationalities 42 per 100,000. The prevalence rate in different counties was demonstrated as low as 31 per 100,000 in the County of Tartu, to 72 per 100,000 in Pôlva County; 55% of patients have retired because of their handicap and only 2 patients (1%) were living in nursing homes.

Adolescent↗

PubMed1993

[The use of nimodipine in the acute period of a cerebral infarct].

Before and after intravenous administration of 1-1.5 mg nimotop 18 patients with acute brain infarction underwent EEG, integral body rheography, computed tomography and measurement of regional volumetric cerebral circulation (RVCC). Nimotop appeared to increase RVCC in the infarction zone, especially in low initial RVCC levels. The drug induced a shift to EEG normalization and a hypotensive effect, cerebral hemodynamics remaining without changes. Nimodipine-type calcium antagonists favourably affect brain perfusion and bioelectric activity which is promising for application in acute cerebral infarction.

Acute Disease↗

PubMed1993

[The prognosis of multiple sclerosis: computed tomographic comparisons].

The authors analyze the data obtained at clinical and computed tomography (CT) examinations of 56 patients suffering from multiple sclerosis. The diagnosis was established by G. Schumacher's clinical criteria. Neurologic status of the patients was assessed according to J. E. Kurtzke. A clinical and CT evaluation demonstrates significant correlations between cerebral atrophy and motor insufficiency. Two variants of the disease course are recognized: 1) malignant with emergence of brain atrophy seen at CT as early as the disease year 1; 2) benign with appearance of CT evidence of cerebral atrophy later than the disease year 5. Working ability in variant 2 is recorded for longer periods.

Adult↗

PubMed1991

[Cerebral creatine kinase isoenzyme in the cerebrospinal fluid: importance of its measuring for prognosis of the disease outcome in cerebral ischemic disorders].

The concentration of cerebral isoenzyme of creatine kinase was measured repeatedly in the cerebrospinal fluid (CSF) in 84 patients with ischemic disorders of brain circulation. Of these, 14 patients presented with transitory ischemic attacks, 20 patients with regressing deficit, and 50 with brain infarction. The patients' health status and functional capacities were estimated on discharge from the hospital. It was discovered that in each patient, the maximum level of cerebral isoenzyme in the CSF was in a good agreement with the clinical course of the disease and neurological status in the survived patients. It may be concluded that measurements of the concentration of the enzyme in the CSF makes it possible to draw more valid prognostic conclusions in patients with ischemic disorders of brain circulation.

Adult↗

PubMed1988

[Function of the sympathetico-adrenal system and the acid-base equilibrium in newborn infants with a hypoxic lesion of the central nervous system].

The function of the sympathetic-adrenal system was studied by measuring umbilical cord blood catecholamines in 31 full-term newborns with perinatal asphyxia and evidence of hypoxic-ischemic encephalopathy (HIE) and in 20 normal newborns. The results indicate that the full-term newborn responds to asphyxia with graded catecholamine release. The epinephrine concentration in newborns with moderate HIE is lower than in newborns with mild HIE, which may reflect decreased sympathetic-adrenal function due to prolonged asphyxia. Acid-base values in capillary blood and lumbar cerebrospinal fluid were determined in the babies with HIE, with the findings pointing to metabolic acidosis which was more expressed in cerebrospinal fluid.

Acid-Base Equilibrium↗

PubMed1988

[Hyperbaric oxygenation in the treatment of patients with ischemic stroke].

Biochemical parameters (the gaseous composition and acid-base balance of the blood and cerebrospinal fluid (CSF) were investigated in patients with ischemic stroke in the process of hyperbaric oxygenation treatment. A characteristic peculiarity observed was the presence of compensated metabolic acidosis in the CSF which was most expressed in patients with an extensive focus of cerebral infarction. A characteristic change in the venous blood of the brain was the presence of compensated metabolic acidosis. Metabolic acidosis of the cerebral venous blood in patients treated with hyperbaric oxygenation significantly diminished as compared with the control group.

Acid-Base Equilibrium↗

PubMed1988

[Enzymatic activity of the cerebrospinal fluid in patients with cerebral infarct].

Dynamic measurements in the cerebrospinal fluid (CSF) of the activities of lactate dehydrogenase (LDH), its first isoenzyme (LDH1), aspartate amino transferase (AsAT), alanine amino transferase (AlAT), creatine phosphokinase (CPK), gamma-glutamyl transpeptidase (GGT) and alkaline phosphatases (ALP) were performed in 99 patients with ischemic stroke. The mean activities of LDH, LDH1, AsAT, CPC and GGT in the CSF of the patients significantly exceeded those in the control group during the first and second weeks of the disease. The increased activities of LDH, LDH1, CPK and AsAT in patients with ischemic stroke indicate the severity of cerebral lesion and resultant hypoxia of the cerebral tissue. High levels of enzymic activity, particularly over a long period of time, always predict a poor outcome.

Acute Disease↗

PubMed1988

[Role of diencephalic structures in the regulation of cerebral blood flow].

The effects of electric stimulation of the thalamus, hypothalamus and septum upon the CBF, pO2 of brain tissue, EEG, general arterial pressure and pneumogram, were studied in 74 rabbits with implanted cerebral electrodes. The stimulation mostly resulted in an increase in local blood flow sometimes accompanied by a decrease in cortical blood flow. Other parameters under study changed infrequently and insignificantly. The regulation of the CBF seems to be maintained by intracerebral mechanisms.

Animals↗