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E Leppänen

Publications and source records attributed to E Leppänen.

18 recordsLinked to original sources
PubMed2006

Development of permanent national register of blood component use utilizing electronic hospital information systems.

BACKGROUND AND OBJECTIVES: We wanted to establish a permanent national database system, which can be utilized to study transfusion recipients and blood use in Finland. MATERIALS AND METHODS: A regularly updated register for permanent use was developed. To study the usability of the database, years 2002 and 2003 were further analysed. Database included all transfused patients in major blood-transfusing hospitals from four university and five central hospital districts managing altogether 63% of Finnish inpatient hospital episodes. RESULTS: Audit of gathered data reveal 96.8% match in adult blood components with Finnish Red Cross, Blood Service sales figures. Model data set includes 59,535 transfused patients (44.3% men and 55.7% women) having received 529,104 blood components. Half of all blood units were transfused in connection with surgical operations. Most of the blood recipients were elderly (51.6% are over 64 years of age). Blood-component use and transfusion-related costs varied widely between hospitals. CONCLUSION: Hospital data managing systems can be useful for creating a population-based database system to monitor and compare transfusion practices. This record provides information about transfusion epidemiology for transfusion professionals, hospital management, and hospital administration.

Adolescent↗
PubMed2004

Sentinel lymph node biopsy in oral cavity squamous cell carcinoma without clinically evident metastasis.

BACKGROUND: The clinically N0 neck in patients with oral SCC is commonly treated by neck dissection because the existence of metastases cannot be excluded. To determine whether unnecessary treatment could be avoided, we evaluated the feasibility of sentinel lymph node (SLN) biopsy. METHODS: Fifteen previously untreated patients with T1 or T2 oral SCC without clinically or radiologically detectable metastasis were included. A blue dye and gamma probe were used to identify SLNs. SLNs were stained with cytokeratins. All nodes in neck dissection specimens were stained using H and E. RESULTS: SLNs were identified in 14 patients by lymphoscintigraphy and in all patients when probe and dye were combined. Four neck dissection specimens contained four metastatic lymph nodes. Three of the four lymph nodes were SLN. One SLN was found to be metastatic after immunostaining. However, although there was one blue sentinel node in one neck, a metastatic non-SLN was present. CONCLUSIONS: Our results show that SLN biopsy is a promising tool for use in patients with oral SCC. However, further studies are necessary.

Adult↗
PubMed2004

The impact of sentinel node biopsy and axillary staging strategy on hospital costs.

BACKGROUND: The aim of the study was to evaluate total hospital costs of three different sentinel node biopsy (SNB) protocols compared to those of diagnostic axillary lymph node dissection (ALND). PATIENTS AND METHODS: The study included 237 consecutive breast cancer patients who underwent SNB with frozen section diagnosis. The sequence of the treatment procedures for each patient was recorded. The sequences of treatment procedures for the same patients were evaluated using three hypothetical scenarios: diagnostic ALND, SNB without frozen section diagnosis and SNB as day case surgery prior to the breast operation. The total hospital costs were calculated in all protocols. RESULTS: The hospital costs per patient were 3750euro;. The hospital costs per patient would have been 3020euro; when using the ALND model, 4087euro; had the frozen section not been applied and 4573euro; using 'SNB as day case surgery' model. The costs with or without frozen section diagnosis would have been equal with a threshold false negative rate of 35%. CONCLUSIONS: SNB seems to be associated with higher hospital costs than diagnostic ALND. Frozen section diagnosis seems to be worthwhile as long as the false negative rate is <35%.

Adult↗
PubMed2003

The sensitivity of axillary staging when using sentinel node biopsy in breast cancer.

AIMS: We aimed to study factors, which enhance the sensitivity of sentinel node biopsy. METHODS: Three hundred and sixty-three clinically node negative breast cancer patients with successful sentinel node biopsy were studied. All focally radioactive and/or blue nodes in the axilla were harvested. All palpably suspicious lymph nodes were also removed for a similar histological evaluation. RESULTS: Sentinel node metastases were found in 129 patients. The metastasis was detected in the three first retrieved sentinel nodes in 126 cases and in the fourth or fifth node in three cases. The 'hottest' sentinel node was not the involved one in 18 cases. Five patients with tumour negative sentinel nodes had metastases in other palpably suspicious nodes. CONCLUSIONS: Harvesting all focally radioactive and/or blue nodes and other palpably suspicious nodes minimises the false negative rate in sentinel node biopsy. Removal of more than five nodes does not significantly improve the sensitivity of axillary staging.

Adult↗
PubMed2002

The effect of patient and tumour characteristics on visualization of sentinel nodes after a single intratumoural injection of Tc 99m labelled human albumin colloid in breast cancer.

AIMS: The aim of the study was to study the influence of patient- or tumour-related factors on the lymphatic drainage patterns in breast cancer. METHODS: The study included 290 consecutive breast cancer patients with lymphatic mapping and sentinel node biopsy. Lymphoscintigraphy was performed a median of four hours after a single intratumoral injection of (99m)Tc labelled human albumin colloid with two different particle sizes. RESULTS: Lymphoscintigraphy showed axillary sentinel nodes in 253 (87%) and parasternal sentinel nodes in 49 (17%) patients. The median number of nodes seen in the axilla was one (range 0-5). No sentinel nodes were visualized in 27 (9%) patients. The number of the visualized axillary nodes was influenced by the particle size of the radiocolloid, and by metastatic involvement of the axillary nodes and the age and body mass index (BMI) of the patient. Patients with parasternal sentinel nodes were younger, had a lower BMI and had more often a non-palpable tumour. CONCLUSIONS: The age and BMI of the patient and the palpability of the tumour influence lymphatic drainage patterns in breast cancer. The metastatic involvement of axillary nodes seems to modify lymphatic drainage to the axilla.

Adult↗
PubMed2001

The driving license examination as a stress model: effects on blood picture, serum cortisol and the production of interleukins in man.

We have studied the following stress model: the tension caused by sitting for the theoretical part of the driving license examination. Volunteers were investigated twice, after their driving license examination and after a (stress-free) control session. The effects of the stress were investigated by studying the blood picture (differential counts), serum concentration of cortisol, and cytokine production in stimulated blood cells. Relationships between the subjective perception of stress and the physiological reaction were also investigated. This stress induced significant increase in the concentrations of cortisol and hemoglobin, and in the values of hematocrit and MCV, and in the lipopolysaccharide-induced release of IL-1beta and -6. The subjective feelings of irritability and wakefulness were also significantly higher after the exam. A significant relationship was found between the changes in the stimulated production of IL-1beta and irritability. The responsiveness to psychological stress might be influenced by the temporary mood of the subjects.

Adolescent↗
PubMed2000

Adaptation related to cytokines in man: effects of regular swimming in ice-cold water.

The cytokine response after thermal stress (sauna + swimming in ice-cold water) was investigated in subjectively healthy persons. Two groups were studied at the end of the winter season: habitual and inexperienced winter swimmers. Blood was collected at rest, after a sauna bath and after a short swim in ice-cold water. Conventional methods and ELISA kits were used to determined the blood picture, serum cortisol and dehydroepiandrosterone sulphate, plasma anti-diuretic hormone (ADH) levels, and the levels of several cytokines in plasma and in the supernatants of blood cell cultures which were stimulated with lipopolysaccharide (LPS). In regular winter swimmers, the concentrations of plasma interleukin 6 (IL-6), leukocytes, and monocytes at rest were significantly higher than in inexperienced subjects. In experienced female winter swimmers, the plasma concentration of the soluble receptor for IL-6 was significantly lower than in inexperienced female swimmers. In both groups, granulocytosis, haemoconcentration and significant increases in the concentrations of ADH, cortisol and IL-6 were observed after the stimuli. However, the changes in the cortisol concentration were dramatically larger in habitual winter swimmers. A significant correlation was found between the delta values of cortisol and the basal concentrations of IL-6. In cell cultures, the LPS-induced release of IL-1beta and IL-6 was higher at rest in the inexperienced winter swimmers. This release was dramatically suppressed after exposure to the stimuli in the inexperienced winter swimmers but tended to increase in the regular winter swimmers. These stresses appear to challenge both the neuro-endocrine and the immune systems and the results indicate that adaptive mechanisms occur in habitual winter swimmers.

Adaptation, Physiological↗
PubMed1999

Preanalytical factors (biological variation) and the measurement of serum soluble intercellular adhesion molecule-1 in humans: influence of the time of day, food intake, and physical and psychological stress.

BACKGROUND: Adhesion proteins such as soluble intercellular adhesion molecule-1 (sICAM-1) may be important markers for early atherosclerosis and some other diseases. To devise optimum specimen collection procedures, we investigated the effects on serum sICAM-1 of several preanalytical factors (factors that occur before a specimen is analyzed) such as the time of the day, food ingestion, and physical and psychological stress. METHODS: Three sets of experiments were conducted: (a) 30 subjects were investigated during the morning, after an overnight fast, and then after the usual breakfast and at 1200; (b) 20 subjects were studied before and after exposure to thermal stress (sauna + swimming in ice-cold water); and (c) 15 volunteers were investigated after their driving license examination and during a (stress-free) control session. Conventional methods and kits were used to determine the blood picture and serum sICAM-1. RESULTS: All of these preanalytical factors induced a significant increase ( approximately 10%) in the concentration of sICAM-1. CONCLUSION: It is advisable to consider timing, food intake, and stress when collecting specimens and analyzing data on the concentration of sICAM-1 in serum.

Adolescent↗
PubMed1998

A urinary radioisotope-binding assay to diagnose Gräsbeck-Imerslund disease.

BACKGROUND: Gräsbeck-Imerslund disease (congenital familial selective vitamin B12-malabsorption with proteinuria, MGA1, MIM No. 261100) is a rare disorder displaying autosomal recessive inheritance. This study was designed to investigate the usefulness of measuring the activity of the urinary receptor for the intrinsic factor-cobalamin complex as a tool to diagnose this disease. METHODS: The receptor activity was measured by a radioisotope-binding assay, using phenyl-Sepharose gel as the adsorbant solid phase of the receptor. RESULTS: In 10 Finnish patients, urinary receptor activity was on the average 640 times (15-1400 times) lower than that in 13 healthy control subjects: mean values of 0.1 nmol/mol (range, 0.01-0.32 nmol/mol) and 6.4 nmol/mol (range, 3.8-12.4 nmol/mol) creatinine, respectively. The mean value of urinary receptor activity in 11 first-degree, healthy relatives of the patients was 4.6 nmol/mol (range, 1.1-10.4 nmol/mol) creatinine, a difference from levels in control subjects that is not statistically significant. When the first-degree relatives were divided into heterozygotes (parents and siblings heterozygous for the haplotype of genetic markers associated with the disease gene) and wild-type homozygotes (siblings not displaying the disease haplotype), no difference was seen. CONCLUSION: Determination of receptor activity in the urine is a highly accurate method for diagnosis of Gräsbeck-Imerslund disease at an early stage, but it does not detect carriers of the disorder.

Absorption↗
PubMed1998

Short-term variability in the concentration of serum interleukin-6 and its soluble receptor in subjectively healthy persons.

The effects of the time of the day and breakfast on the outcome of interleukin-6 and its soluble receptor in serum were studied on 22 subjectively health volunteers. We collected blood specimens at 8.00 a.m. after an overnight fast, at 9.30 a.m. after usual breakfast, and at 11.30 a.m. A second group of volunteers (n = 20) was studied during the evening. We observed a significant decrease in the concentration of interleukin-6 after breakfast. This suggests that for assay of this analyte it is preferable to collect specimens after overnight fast. No changes were observed in the concentrations of interleukin-6 soluble receptor. Weak, but significant negative correlations were found between the age of the volunteers and the concentrations of interleukin-6 soluble receptor and between age and the ratio interleukin-6 soluble receptor/interleukin-6. The concentrations of interleukin-6 were positively and significantly correlated with age. The within-subject variability was 30% for interleukin-6, 13% for its receptor, and 33.1% for the ratio interleukin-6 soluble receptor/interleukin-6. The between-subject variability was 43.7% for interleukin-6, 22.2% for its receptor, and 60.2% for the ratio interleukin-6 soluble receptor/interleukin-6. The indices of individuality (ratio within-subject variability/between-subject variability) were calculated and found to be 0.69, 0.60, and 0.55 for interleukin-6, its soluble receptor, and the ratio interleukin-6 soluble receptor/interleukin-6, respectively. The implications of these indices with the use of health-related reference values is discussed.

Adolescent↗
PubMed1998

When to collect blood specimens: midmorning vs fasting samples.

This study was carried out to define the consequences of collecting blood specimens during the forenoon instead of using fasting specimens collected early in the morning. Extensive laboratory data were obtained from specimens collected from fasting participants at 0800, after breakfast at 0930, and again at 1100. The subjects were inpatients in medical and surgical wards (n = 51; 13 women and 38 men; ages, 32-87 years) and subjectively healthy volunteers corresponding to outpatients (n = 51; 31 women and 20 men; ages, 18-63 years). The coefficient of variation (CV, %) of the patient results was compared with the analytical CV. The observed CVs of the subjects' results far exceeded the analytical CV (%), the average being 3.5-fold and up to 14-fold for some analytes. In individual results the observed change often exceeded the medically derived clinical critical difference. Laboratory data should always be interpreted in the context in which they were obtained. Clinical decisions should be based on objective data (observations) more than on experience and educated guesses. Different medical specialities and different clinical situations may require different kinds of procedures.

Adolescent↗
PubMed1996

Preanalytical factors and the measurement of cytokines in human subjects.

Cytokines are widely measured in research. However, cytokine analyses are influenced by a myriad of factors. For instance, a delay in the separation of plasma from cells may lead to a 50% decrease in the concentration of tumor necrosis factor in plasma. Another example is the secretion of interleukin-1 beta in women which can be twice as high during the follicular phase as in the luteal phase. The factors influencing the outcome of these tests can be divided into in vivo preanalytical factors (e.g., aging, chronobiological rhythms, diet, etc), in vitro preanalytical factors (e.g., specimen collection, equipment, transport, storage, etc), and analytical factors. To improve the value of the cytokine tests, factors strongly influencing the results have to be controlled. This can be done by using standardized assays and specimen collection procedures. In general, sufficient attention is not given to the preanalytical factors, especially in the measurement of cytokines. This article reviews the preanalytical factors which may influence the outcome of these tests in human subjects.

Aging↗
PubMed1986

The effect of the order of filling tubes after venipuncture on serum potassium, total protein, and aspartate and alanine aminotransferases.

The serum components mentioned were measured from the first and last tubes filled with blood following one venipuncture performed without use of a tourniquet on ordinary outpatients. The concentration of potassium was significantly higher in the first tube, whereas the concentration of the other components did not change. In a second series of experiments the first drops of blood (approximately 1 ml) emerging from the needle were collected separately. In the serum from this tube, the potassium concentration was significantly higher than in the serum from the second tube (approximately 10 ml), whereas the sodium concentration was the same. It is concluded that serum potassium should routinely be assayed from the second or a later tube of blood filled after one venipuncture. The S-ASAT, S-ALAT and S-total protein may be assayed from any tube.

Alanine Transaminase↗
PubMedDate not supplied

Sentinel nodes outside level I-II of the axilla and staging in breast cancer.

BACKGROUND: The aim of the study was to evaluate the incidence of sentinel nodes and sentinel node metastases outside levels I-II of the axilla in breast cancer. PATIENTS AND METHODS: Altogether 170 breast cancer patients with 172 clinically node-negative T1-T2 tumours underwent lymphoscintigraphy and were included in a prospective study. RESULTS: The lymphoscintigraphy showed sentinel node(s) in the axilla in 150 (87%) breast cancer cases. Thirty (17%) patients had sentinel nodes outside the axilla. Lymphatic drainage solely outside the axilla was encountered in two patients. Lymph node metastases were found in the axilla in 40% and outside the axilla in 17% of the 30 patients with extra-axillary sentinel nodes. Two patients with sentinel node metastases outside the axilla had no axillary metastases. CONCLUSION: The biopsy of sentinel nodes outside the axilla is a potential tool for more accurate staging in breast cancer, since it provides additional information as compared to axillary staging alone.

Adult↗
PubMedDate not supplied

Surgical patients with surprising laboratory data.

Preoperative laboratory tests were performed on elective ambulant orthopaedic patients (n = 26) on the afternoon after their arrival in hospital and on the next morning before the operation. Significantly lower concentrations of leukocytes, albumin, total protein, platelets, and total calcium were observed in samples taken in the morning. Posture and chronobiological rhythms may be responsible for these changes. An overnight change in laboratory values may lead to unnecessary further investigations and postponement of surgery. The clinician should be aware of the effects of preanalytical factors on laboratory data.

Calcium↗