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Biomedical subjects

A Vuori

Publications and source records attributed to A Vuori.

At least 19 recordsLinked to original sources
PubMed2006

Bystander mouth-to-mouth ventilation and regurgitation during cardiopulmonary resuscitation.

OBJECTIVES: To determine whether there is an association between bystander mouth-to-mouth ventilation and regurgitation in prehospital cardiac arrest patients. DESIGN: Prospectively conducted observational study. SETTING: Data were collected from patients treated by the emergency medical service (EMS) systems in three middle-sized or large Finnish urban communities, the Tampere District EMS and the physician-staffed Helicopter EMSs in the Helsinki and Turku areas in southern Finland. SUBJECTS: The study population consisted of 529 consecutive prehospital cardiac arrest patients with attempted resuscitation. Exclusion criteria were cardiac arrest due to trauma or drug overdose. MAIN OUTCOME MEASURES: Regurgitation in prehospital cardiac arrest patients documented by EMS personnel on the scene. RESULTS: Regurgitation occurred in a fourth of patients. Bystander cardiopulmonary resuscitation (CPR) with mouth-to-mouth ventilation was associated with a significantly increased risk of regurgitation compared with no CPR (P < 0.013) and CPR without ventilations (P < 0.01). CONCLUSIONS: The mode and role of bystander CPR in cardiac arrest needs to be further evaluated.

Aged↗
PubMed2004

Effects of post-operative pain treatment using non-steroidal anti-inflammatory analgesics, opioids or epidural blockade on systemic and local immune responses in children.

BACKGROUND: Many studies have been carried out on the effects of anaesthetic drugs and methods on the immune response, but pain and its relief also affect the immune response. We measured systemic immune responses in the blood circulation and local responses in the surgical wound when non-steroidal anti-inflammatory analgesics (NSAIDs), opioids or epidural blockade was used in the peri-operative treatment of pain. METHODS: Responses were measured in 51 children, aged from 2 to 12 years and undergoing major surgery under balanced anaesthesia. Bolus doses of diclofenac intravenously (i.v.) and rectally (NSAID group), continuous i.v. infusion of oxycodone (opioid group) or continuous epidural infusion of bupivacaine + fentanyl (epidural group) were used peri-operatively for pain relief. RESULTS: The only difference related to the analgesic method was shorter duration of post-operative leucocytosis and lower phytohaemagglutinin (PHA)-induced lymphocyte proliferative responses in peripheral blood in the opioid group than in the NSAID or epidural groups. By contrast, time-related alterations were seen overall in leucocyte and differential counts, lymphocyte and their subset counts, lymphocyte proliferative responses, and in serum cortisol, C-reactive protein, plasma interleukin-6 and group II phospholipase A2 concentrations and in the appearance of different cell types in the wound. CONCLUSIONS: Post-operative pain treatments using diclofenac (NSAID), oxycodone (opioid) and epidural blockade have basically similar effects on systemic and local immune responses with only slight, probably clinically unimportant differences in children undergoing surgery under general anaesthesia.

Analgesia, Epidural↗
PubMed2003

Adder bites. A report of 68 cases.

BACKGROUND AND AIMS: The adder (Vipera Berus) is the only venomous snake that exists naturally in Scandinavia. The aim of this study is to estimate the severity of adder bites, to form a general picture of symptoms of bites and to find out how effective the present treatment methods of adder bites are. MATERIAL AND METHODS: 68 true adder bites treated in Turku University Hospital during the years 1995-2000 were reviewed retrospectively. RESULTS: There were no deaths in this material. A bite caused severe symptoms to 10% of the patients. The symptoms were moderate in 21%, mild in 34% and minor in 35% of the cases. Children under 10 years were the proportionally biggest age group and severe poisonings were most frequent among small children. Rapidly progressive oedema, gastrointestinal symptoms, hypotension and early leucocytosis were signs of more severe poisonings. Antivenom therapy with specific ovine Fab antivenom proved to be an effective and safe treatment in severe poisonings. CONCLUSIONS: An adder bite may also cause severe symptoms for adults. All patients should be observed at least few hours after the bite and parental fluid therapy should be started at an early stage. In the treatment of severe poisonings an antivenom therapy should be considered. Rapidly progressive symptoms and early leucocytosis may serve as a warning signal for higher probability of severe reactions.

Adolescent↗
PubMed1999

Family health in everyday life: a qualitative study on well-being in families with children.

This article describes the subjective health views of young Finnish families with children. The data were collected in unstructured focused interviews with 19 families, most of whom were interviewed twice. Set within a phenomenological-hermeneutic framework, the study applies a qualitative method in order to uncover the meanings attached by the families to different facets of their everyday life. Health is an integral part of the everyday life of families with children, comprising various dimensions of experienced well-being and unwell-being, security and different life-habits. Social networks are crucial to family health: they can either strengthen or undermine experienced health. Professionals working with families in the health care system need to have at least a basic knowledge of the different dimensions of family health: this helps to identify and understand the individual ways in which families work to promote their health and well-being. This knowledge of family health is also important for research purposes. Health care professionals also need to know more about how families cope with their everyday problems and about how client families can be supported. More research is needed on the concepts of family health and on how those concepts are applied to practice in different health care sectors and in education.

Adaptation, Psychological↗
PubMed1991

Minimum pulse pressure and peripheral temperature needed for pulse oximetry during cardiac surgery with cardiopulmonary bypass.

The lowest values of pulse pressure (dPP) and peripheral temperature (Tp) associated with reliable readings from three different pulse oximeters (Biox Ohmeda 3700, Datex Satlite, and Nellcor N-200) were assessed, along with the ability of the pulse oximeters to work immediately before and after total cardiopulmonary bypass (CPB). The lowest mean dPP with a reliable O2 saturation reading was 13 mm Hg and the lowest mean Tp was 23.6 degrees C. The dPP needed for a reliable reading before total CPB did not differ significantly from that needed after total CPB. No significant differences in performance were found among the three oximeters during the study.

Adult↗
PubMed1991

Accuracy of three pulse oximeters at low cardiac index and peripheral temperature.

OBJECTIVE: To assess the ability of three different pulse oximeters to give reliable readings during poor cardiac index and peripheral temperature states as compared with normal cardiac index and peripheral temperature states in the same patients. DESIGN: The accuracy of the oximeters was tested against a blood oximeter (measuring actual arterial oxygen saturation) during four different physiologic situations: normal and low cardiac index; normal and low peripheral temperature. PATIENTS: Thirty-three open-heart surgery patients, mean age 52 yrs, were studied immediately after open-heart surgery and in the ICU after the operation. MAIN RESULTS: Saturation display in different oximeters was equally reliable in situations of poor cardiac index (less than or equal to 2.2 L/min.m2) and low peripheral temperature (less than or equal to 28 degrees C), as in control situations. However, there were statistically significant differences between the equipment. The heart rate display was also reliable in these situations. CONCLUSIONS: Clinically reliable saturation and heart rate readings were obtained when cardiac output and peripheral temperature were low.

Adult↗
PubMed1989

Effects of various ventilation modes on immunocompetence in surgical patients.

The effects of controlled mechanical ventilation with PEEP (CMV), and spontaneous ventilation with continuous positive airway pressure (CPAP), CPAP with high frequency ventilation (CPAP-HFV) and spontaneous respiration without CPAP (SV) on immunocompetence were compared in open-heart surgery patients undergoing the weaning phase. T-lymphocyte and T-helper cell ratios decreased during CPAP (P less than 0.01) and SV (P less than 0.05). PWM-induced lymphocyte proliferative responses were decreased during CPAP-HFV (P less than 0.05), CPAP and SV (P less than 0.01) in whole blood and separated lymphocyte cultures compared to values during CMV. Con A-induced responses were also depressed during SV in whole blood cultures (P less than 0.01). When the synthesis and secretion of immunoglobulins were studied, only IgM production showed a decrease in PWM-stimulated cultures during SV (P less than 0.05). In spite of an increase in the cardiac index in the three spontaneous ventilation modes compared to CMV, a slight decrease instead of an immediate improvement was seen in immune responses on weaning to spontaneous ventilation modes.

Coronary Artery Bypass↗
PubMed1989

Pulse oximetry during low cardiac output and hypothermia states immediately after open heart surgery.

Two commercially available pulse oximeters were found to read reliably early during periods of low cardiac index (CI) and low peripheral temperature (Tp). The lowest mean CI and mean Tp values at which a reading could be obtained were 2.4 L/min.m2 and 26.5 degrees C, respectively. The highest mean systemic vascular resistance index was 2930 dyne.sec/cm5.m2. The reliability of one monitor was equally good both in a normal and low perfusion mode (i.e., when the monitor displayed a low-quality signal message). The use of locally applied vasodilating creme widened the physiologic limits within which reliable measurements could be obtained. All oximeters and sensors overestimated slightly the saturation as compared to the hemoximeter readings, possibly because of a high mean carboxyhemoglobin concentration that was found to be present.

Adult↗
PubMed1988

Continuous positive airway pressure with and without high-frequency ventilation: hemodynamics, oxygenation, and endocrine response.

After 18 h of mechanical ventilation following open heart surgery, central hemodynamics, systemic oxygen delivery (DO2), and oxygen consumption were assessed in ten consecutive patients receiving continuous positive airway pressure (CPAP) therapy. Plasma vasopressin, norepinephrine, and epinephrine levels were analyzed. While maintaining the mean airway pressure, two CPAP methods were studied: a demand CPAP with continuous flow without (CPAP) and one with high-frequency ventilation (CPAP-HFV). The frequency used during CPAP-HFV was 300 cycle/min. The spontaneous ventilatory rate was found to be equal during CPAP and CPAP-HFV. The cardiac and stroke volume indices were slightly higher (p less than .05) during CPAP-HFV, which accounted for the finding that DO2 was also slightly higher (p less than .05) during CPAP-HFV. The epinephrine and norepinephrine levels did not differ, whereas the vasopressin level was somewhat higher during CPAP-HFV, which might indicate a higher level of vigilance. It is concluded that cardiac output was slightly higher during CPAP-HFV compared to that during CPAP. This may be due to an effect of the oscillations on circulation or to differences in the level of vigilance.

Aged↗
PubMed1986

Central haemodynamics and oxygen transport during CPPV with frequencies of 16 and 8 times per minute.

During the weaning period after 18 h of mechanical ventilation following open-heart surgery, central haemodynamics, systemic oxygen transport and total oxygen consumption were assessed in a total of 11 patients receiving continuous positive pressure ventilation. Mechanical ventilatory rates of 16 and 8 times per minute were studied. Systemic arterial pressure, cardiac index, stroke volume index, left ventricular stroke work index, rate-pressure-product, and systemic oxygen transport were observed to be higher during the lower ventilatory rate. Because transmural right atrial and pulmonary capillary wedge pressures were also higher during ventilation with a frequency of eight times per minute, the lower frequency may impede venous return less. This might explain the difference found in central haemodynamics between the two ventilation frequencies.

Adult↗
PubMed1985

The usefulness of radioreceptor assay and gas liquid chromatography in pharmacokinetic studies on midazolam.

The usefulness of radioreceptor assay (RRA) in the pharmacokinetic studies on midazolam - the first benzodiazepine with water-soluble salts - was compared with that of gas liquid chromatography (GLC) in 18 patients operated on under local anesthesia in supine position. There were no significant differences observed in the serum levels determined with these two methods after a single i.v. injection of midazolam 0.075 mg/kg although considerable variability was manifest. Similarly, the pharmacokinetic parameters did not differ from each other in view of the concentrations determined by RRA or GLC. The pharmacokinetics of midazolam were compared in three patient groups on the basis of the GLC determined concentrations: a) in pregnant patients operated on at term under epidural analgesia (group 1, n = 6), b) in nonpregnant women operated on under epidural analgesia (group 2, n = 6), and c) in 3 male and female subjects operated on under brachial plexus blockade (group 3). The total serum clearance, the most important pharmacokinetic parameter, was highest in group 1 patients and lowest in group 3. However, these significant differences were not reflected so clearly in the elimination half-life of midazolam. There were no differences in tissue distribution (Vd alpha, Vd beta) between the three patient groups. A highly significant correlation was observed between the serum concentrations and sedative effects of midazolam. Midazolam is a short-acting sedative-anxiolytic agent with a rapid onset of action especially useful for patients operated on under local anesthesia. Apparently, the pharmacokinetic differences observed in this study are of no great clinical significance in single dose administration.

Adult↗
PubMed1982

Effect of different kinds of premedication on the induction properties of midazolam.

The effects of different premedication (i.m. and i.v.) on the usefulness of midazolam or thiopentone as induction agents for minor surgery was studied in 194 women undergoing either dilatation and curettage or explorative fractionate curettage. Midazolam appeared to produce light sedation which required powerful premedication (i.m. atropine + pethidine and i.v. fentanyl or fentanyl + dehydrobenzperidol) when used as an induction agent for minor surgery. The clinically useful dose of midazolam is about 0.30 mg kg-1 i.v. There was greater variability in onset and duration of action among patients receiving midazolam than among those receiving thiopentone. Midazolam caused less respiratory depression, but there were no clinically significant differences between midazolam and thiopentone with respect to cardiovascular variables. Muscular movements were found more often, and postoperative sedation lasted longer in patients receiving midazolam. Midazolam as an induction agent appears more suited for major than for minor surgery.

Adult↗
PubMed1982

Changes in hormonal excretion and urinary flow rate during CPPV and CPAP in healthy volunteers.

In healthy volunteers plasma antidiuretic hormone level, renin activity, and human growth hormone level remained unchanged during successive CPPV, CPAP, and control periods. The plasma level of insulin C-peptide was higher during CPPV than during the control period. Urine flow, glomerular filtration rate, free water clearance, and sodium excretion rate were lower during CPPV than during the successive CPAP and control periods. The renal function changes during CPPV may be a consequence of diminished cardiac output.

Adult↗
PubMed1981

Central haemodynamics and oxygen transport with and without continuous positive pressure ventilation after open-heart surgery.

Twelve patients, subjected 20 h earlier to coronary artery bypass surgery, were studied on discontinuation of the postoperative mechanical ventilation employing PEEP+5 cmH2O (CMV+PEEP). Compared to the values obtained during CMV+PEEP, cardiac index and mixed venous blood oxygen tension increased with change to spontaneous ventilation at ambient pressure, employing a 28% O2 Ventimask for the intubated patient. There was a slight decrease in both the arterial oxygen content and oxygen tension, but the increase in cardiac output compensated well for the lowering in the arterial oxygen content, and consequently the systemic oxygen transport was statistically unaltered. Oxygen consumption, pulmonary shunt fraction and arteriovenous oxygen content difference also remained unaltered. The observations suggest that after open-heart surgery, CMV using a PEEP as low as +5 cmH2O may exert, in comparison to controlled oxygen therapy ;during spontaneous breathing, a significant lowering effect on the already compromised cardiac performance. This necessitates continuous weighing of the beneficial effects obtained by employing postoperative CMV+PEEP, against the adverse haemodynamic effects, although the alterations in cardiac output may partly ensue from the changes in metabolism, muscular effort and oxygen consumption during the two modes of ventilation, although there was no significant increase in oxygen consumption.

Acid-Base Equilibrium↗