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E Janatuinen

Publications and source records attributed to E Janatuinen.

34 records · Page 2Linked to original sources
PubMed1995

Intakes of nutrients and nutritional status in coeliac patients.

BACKGROUND: The intake of nutrients and the nutritional status of untreated coeliac patients and coeliac patients in remission were investigated at Kuopio University Hospital. METHODS: Forty untreated and 52 coeliac patients in remission were admitted to the study. The control group included 77 persons. Four-day food records, anthropometric measurements, and blood biochemistry were examined to obtain nutrient intake and nutritional status. RESULTS: Concentrations of serum ferritin, vitamin B12, and erythrocyte folate were lower in patients with untreated coeliac disease than in those in remission. Altogether, 15-38% of the untreated patients but only 0-20% of the patients in remission had levels of haemoglobin, serum ferritin, iron, vitamin B12, or erythrocyte folate below the reference values. No difference in anthropometric measurements was found between the two groups of coeliac patients. CONCLUSIONS: Except for some subclinical abnormal values in biochemical analyses in 20-38% of coeliac patients, nutritional status was quite normal in both groups of coeliac patients.

Adult↗
PubMed1993

Gastrointestinal symptoms in middle-aged diabetic patients.

Occurrence of gastrointestinal symptoms was investigated in a questionnaire-based survey of 89 randomly selected patients with insulin-dependent diabetes mellitus, 481 patients with noninsulin-dependent diabetes mellitus, and 635 nondiabetic control subjects. The prevalences of upper gastrointestinal symptoms, abdominal pain, diarrhea, and constipation were similar in diabetic patients and control subjects. Women with noninsulin-dependent diabetes mellitus had a significantly higher and women with insulin-dependent diabetes mellitus a significantly lower prevalence of gallstone disease than control women (29%, 5%, and 19%, respectively). We conclude that the occurrence and spectrum of gastrointestinal symptoms in middle-aged subjects with insulin- and noninsulin-dependent diabetes mellitus do not differ from those of the general population.

Cholelithiasis↗
PubMed1993

Evaluation of a computer-based diagnostic score system in the diagnosis of jaundice and cholestasis.

A prospective series of 220 patients with jaundice and/or cholestasis was analysed by means of discriminant analysis to evaluate the diagnostic value of various symptoms and signs and basic hepatopancreatobiliary laboratory tests in the differential diagnosis of these patients. In addition, a computer-based diagnostic score (DS) system was developed and compared with the diagnostic value of clinical evaluation (CE), ultrasound (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP). A multivariate stepwise discriminant analysis showed five independent diagnostic factors in distinguishing extrahepatic and intrahepatic diseases: duration of jaundice (p = 0.002), serum protein concentrations (p = 0.002), Normotest (p = 0.04), fever during the past 3 months (p = 0.54), and age (p = 0.58). To sum up the contributions of independent factors, a DS was developed. The discrimination function was as follows: duration of jaundice x 0.97 + age x -0.40 + fever during the past 3 months x 0.33 + serum protein concentration x 0.35 + Normotest x -0.27. The diagnostic sensitivity of DS in the detection of extrahepatic disease was 96%, with a specificity of 80% and an efficiency of 93%. The sensitivities of the imaging methods (62-85%) were inferior to that of DS, whereas the specificities were better (94-98%). The sensitivity of CE was only slightly lower (86%) than that of DS, but the specificity was lowest (57%). In conclusion, relatively few (5 of 40) of the classical symptoms, signs, and biochemical tests proved to be independent diagnostic factors in distinguishing extrahepatic and intrahepatic diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholestasis, Extrahepatic↗
PubMed1992

Complications of endoscopic retrograde cholangiopancreatography in jaundiced and cholestatic patients.

The purpose of this prospective study was to investigate the complication rate of endoscopic retrograde cholangiopancreatography (ERCP) in the management of jaundiced and unjaundiced patients with laboratory findings suggesting cholestasis. ERCP was performed in 144 jaundiced patients and in 27 patients with unjaundiced cholestasis (age range 18-89 years, mean 66 years). Endoscopic papillotomy was performed in 45 patients, three for spasm of the sphincter of Oddi and the rest for choledochal stones. Seven bile duct prostheses were inserted endoscopically, all for treatment of malignant obstruction. The complications of ERCP were as follows: four cases of pancreatitis (2.3%), five cases of cholangitis (2.9%), two cases of bleeding (1.2%) and two perforations (1.2%). The overall complication rate was thus 7.6% (13/171) and there was no primary mortality. ERCP seems to be a safe and effective method in the diagnostic study and management of bile duct obstruction even in the elderly patients with jaundice or unjaundiced cholestasis.

Adolescent↗
PubMed1992

Ultrasonography, CT, and ERCP in the diagnosis of choledochal stones.

A prospective study of jaundiced (n = 187) and nonjaundiced (n = 33) cholestatic patients was carried out to evaluate the sensitivity of ultrasonography (US), CT, and endoscopic retrograde cholangiopancreatography (ERCP) in the detection of choledochal stone disease. Altogether 83 patients had the final diagnosis of choledocholithiasis. In the jaundiced patients, the sensitivity of US, CT, and ERCP was 22.5%, 23.2%, and 80.6%, respectively. In cases of cholestasis without jaundice, the values were 20%, 37.5%, and 66.7%. In patients in whom all 3 imaging studies were done (n = 64), the differences between US and ERCP and between CT and ERCP were statistically significant (p less than 0.0001). In most false-negative ERCP studies (10/15), the clinical course of the disease strongly suggested a passed choledochal stone. On the basis of this study, we recommend prompt ERCP to be performed if choledochal stone disease is suspected on clinical grounds.

Adult↗
PubMed1991

Esophageal squamous cell papillomas. Failure to detect human papillomavirus DNA by in situ hybridization and polymerase chain reaction.

Squamous cell papilloma of the esophagus has been regarded as a distinct rarity. After having reviewed the files of the Gastrointestinal Endoscopy Unit of our hospital we found 14 patients diagnosed as having an esophageal papilloma on endoscopy of about 18,000 patients during the period 1985-90. On histologic examination of the biopsy specimens 12 cases showed histologic characteristics typical of a squamous cell papilloma (SQP), 1 was a fibroid polyp, and another showed epithelial dysplasia without the features typical of SQP. To assess the role of human papillomavirus (HPV) recently implicated in the etiology of this tumor, we analyzed all specimens for the presence of HPV types 6, 11, 16, and 18 DNA by in situ DNA hybridization (ISH) and polymerase chain reaction (PCR). No viral DNA was found by either ISH or PCR in any of these lesions. The significance of these findings is discussed in relation to the previous evidence presented on HPV involvement in the development of esophageal squamous cell papillomas and in esophageal carcinogenesis.

Adult↗
PubMed1991

Diagnostic accuracy of ultrasound, computed tomography, and endoscopic retrograde cholangiopancreatography in the detection of obstructive jaundice.

The purpose of this prospective study was to investigate the diagnostic accuracy of ultrasound (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) in the distinction between extrahepatic and intrahepatic causes of jaundice. The limit for the inclusion to the study was defined as a serum bilirubin concentration greater than or equal to 40 mumol/l. Altogether 187 jaundiced patients were studied. The sensitivities of US, CT, and ERCP were 63%, 77%, and 87%, respectively. The differences between all these methods were statistically significant. The specificities and positive predictive values were high, reaching 96-99%, but the negative predictive values were low, ranging between 38% and 60%. Choledochal stone disease constituted the main etiology of false-negative studies in all investigations. Imaging procedures have a prominent role in the diagnostic study of the jaundiced patient, but it is obvious that their diagnostic accuracy may vary between institutions because of the variance in local experience and expertise, and because of the differences in diseases causing jaundice.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1989

Sucralfate as maintenance treatment for the prevention of duodenal ulcer recurrence.

Eighty-eight patients with endoscopically proven and healed duodenal or pyloric ulcer were randomly allocated into a double-blind, placebo-controlled, 12-month maintenance trial to determine whether sucralfate, 1 g twice daily, can be used to prevent a recurrence of ulceration. The patients were assessed endoscopically at three, six, and 12 months, or earlier if a symptomatic relapse occurred. Serum aluminum levels were also monitored. Sixteen patients were excluded from the study during the follow-up: nine of 41 in the sucralfate group, and seven of 47 in the placebo group. The groups did not differ with respect to age, sex, or smoking. The cumulative relapse rates in the sucralfate group were 28 percent after three months, 33 percent after six months, and 45 percent after 12 months, as compared with 49 percent (p less than 0.05), 64 percent (p less than 0.01), and 68 percent (p less than 0.05), respectively, in the placebo group. It is concluded that 1 g sucralfate twice daily is more effective than a placebo and is safe for the maintenance treatment of duodenal and pyloric ulcer disease.

Adult↗
PubMed1982

Early pronounced ST segment depression with marked J point decline heralding acute lethal clinical myocardial infarction: Necropsy-electrocardiographic correlative study.

Marked ST segment depression (greater than or equal to 2 mm J point decline with horizontal or downsloping ST) was correlated with necropsy findings in 105 cases. Acute myocardial infarction (AMI) was most frequently (70%) responsible for development of the abnormal ST pattern, thereby indicating the diagnosis and severe prognosis of the AMI. In 23% of patients the ST segment depression pattern was associated with chronic heart disease without AMI; all were severely ill with 92% receiving digitalis. Sudden worsening of the basic heart disease or circulatory shock were frequently found to coincide with the abnormal ST pattern; necropsy revealed extensive old MI or myocardial fibrosis in these patients. Marked ST segment depression was also found in five patients without underlying heart disease at autopsy; an acute cerebral accident or circulatory shock was considered to have produced the abnormal ST segment pattern.

Adult↗
PubMedDate not supplied

Diagnostic accuracy of ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography in the detection of pancreatic cancer in patients with jaundice or cholestasis.

A prospective study of jaundiced and/or cholestatic patients (N = 220) was carried out to evaluate the diagnostic accuracy of ultrasound (US), computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) in the detection of pancreatic cancer. Thirty-one patients had the final diagnosis of pancreatic cancer and two patients had a cancer of the papilla of Vater. The sensitivities of US, CT and ERCP were 60%, 97%, 89% and specificities were 92%, 92%, 94%, respectively. The differences in sensitivity between US and other methods were statistically significant (US vs. CT p less than 0.01, US vs. ERCP p less than 0.05). In US studies, most false negative results were caused by unsatisfying visualization. On the basis of this study, we recommend CT as a diagnostic test of pancreatic cancer, if pancreatic cancer is suspected as a cause of jaundice and/or cholestasis.

Aged↗
PubMedDate not supplied

The value of clinical assessment in the diagnosis of icterus and cholestasis.

We studied the reliability of the clinical assessment and the discriminatory value of different symptoms and signs in diagnosing obstructive and non-obstructive diseases causing icterus and/or cholestasis. During a period of two-and-a-half years, clinical assessment done by both physicians-in-training and by senior physicians was completed for 266 patients, and the usefulness of different symptoms and signs was tested in 220 of these. Clinical assessment was found to be a reliable method in distinguishing between obstructive and non-obstructive conditions causing icterus, with the sensitivity of 92% and specificity of 86%. In cases of anicteric cholestasis, the sensitivity and specificity of clinical assessment were 74% and 80%, respectively. Abdominal pain and abdominal tenderness were significantly (p less than 0.01) associated with obstructive diseases, whereas an enlarged liver, fever and excessive consumption of alcohol were associated with non-obstructive diseases (p less than 0.01, p less than 0.05, p less than 0.05, respectively). Itching, vomiting, intolerance to fatty foods, previous cholecystectomy, abdominal tumour and clinical icterus had no discriminatory value. Clinical evaluation is a reliable method in the diagnostic workup of a patient with icterus or anicteric cholestasis, and it is still of crucial importance in directing further investigations.

Cholestasis↗
PubMedDate not supplied

A prospective study on the value of ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography in the diagnosis of unjaundiced cholestasis.

The purpose of this study was to investigate the diagnostic accuracy of ultrasound (US), computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) in the distinction between extrahepatic and intrahepatic causes of unjaundiced cholestasis. Moreover, attention was paid to the ability of these methods to distinguish between benign and malignant causes of obstruction. The inclusion criteria of laboratory values suggesting cholestasis were serum alkaline phosphatase 350 U/l and gammaglutamyl transpeptidase 100 U/l or liver-specific alkaline phosphatase elevated. The diagnostic value of the imaging methods was tested in 33 patients. The most common cause of unjaundiced obstruction was choledochal stone disease. The diagnostic sensitivities of US, CT and ERCP for the detection of extrahepatic cholestasis were 53%, 53% and 79%, respectively. In patients on whom all three imaging studies were done (n = 20), the difference between US and ERCP was statistically significant (p > 0.05). The specificities of US, CT and ERCP were 100%, 86% and 90%, respectively. CT was better than US in defining the benign nature of obstruction, but ERCP was superior in this respect. In malignant obstructions CT was comparable to ERCP. In conclusion, ERCP seems to be considerably sensitive for the detection of extrahepatic obstruction in cases of unjaundiced cholestasis, whereas US and CT are rather insensitive. The specificity of all these imaging methods is high. The results are in favour of CT as the best noninvasive investigation method, and also indicate the important role of ERCP. However, in many cases all three imaging methods are needed, and a flexible and complementary use of them is recommended.

Carcinoma, Papillary↗
PubMedDate not supplied

Clinical evaluation of serum tumour markers CEA, CA 50 and CA 242 in colorectal cancer.

The aim of the present prospective study was to evaluate the clinical value ol serum tumour markers CEA, CA 50 and CA 242 in patients with colorectal cancer (n = 138) and patients with benign gastrointestinal disease (n = 104). The cutoff levels (90% specificity) determined for each test were 2.5 ng/ml for CEA, 17 U/ml for CA 50 and 17 U/ml for CA 242. The diagnostic sensitivity of the CEA test was 0.63, that of the CA 50 test was 0.30 and 0.30 for the CA 242 test in detecting colorectal cancer. CEA, CA 50 and CA 242 tests were tested in a multivariate analysis to find the best combination of independent predictors of colorectal cancer. The most important predictor of colorectal cancer was CEA followed by CA 242. In order to calculate the contributions of tumour marker tests, a diagnostic score (DS) was developed. The sensitivity of the DS in detecting colorectal cancer was 0.47 with a specificity of 0.88 and an efficiency of 0.67. On the basis of this study, serum CEA and CA 242 seem to possess diagnostic value in preoperative evaluation of patients with colorectal cancer.

Adult↗
PubMedDate not supplied

Small intestinal mucin antigen (SIMA); a novel tumour marker in colorectal cancer?

The aim of the present prospective study was to evaluate the clinical value of a new serum tumour marker small intestinal mucin antigen (SIMA) in the diagnosis of colorectal cancer. The serum SIMA values were measured in a prospective series of patients with colorectal cancer (n = 73) and patients with benign gastrointestinal disease (n = 87). SIMA values were determined using two different techniques. The cut-off levels (90 % specificity) determined for each test were 12.0 U/ml for SIMA I (Delphia), 9.8 U/ml for SIMA II (PCA-Delphia), 2.5 ng/ml for CEA, 17 U/ml for CA 50 and 17 U/ml for CA 242. The diagnostic sensitivity of the SIMA I test was 0.27, of the SIMA II test it was 0.19, of the CEA test it was 0.63, of the CA 50 test it was 0.30 and 0.30 for the CA 242 test in detecting colorectal cancer. The correlation coefficients (Pearson's r) in colorectal cancer patients between SIMA I and SIMA II measurements were 0.99, 0.71 between CEA and CA 50, 0.70 between CEA and CA 242 and 0.96 between CA 50 and CA 242 measurements. The correlation coefficients in colorectal cancer patients between other serum markers were non-significant. All marker tests were entered in a multivariate analysis to find the best combination of independent predictors of colorectal cancer. The most important predictor of colorectal cancer was SIMA I. In order to calculate the contributions of tumour marker tests, a diagnostic score (DS) was developed. The sensitivity of the DS in detecting colorectal cancer was 0.33 with a specificity of 0.90 and an efficiency of 0.65. In conclusion, the results indicate that the diagnostic sensitivity of a new tumour marker SIMA is equal to CA50 and CA 242, but inferior to the diagnostic sensitivity of the CEA test. However, multivariate discriminant analysis suggests some diagnostic value for SIMA I test because of its independent discriminant value.

Adult↗