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Biomedical subjects

E Vartiainen

Publications and source records attributed to E Vartiainen.

At least 19 recordsLinked to original sources
PubMed1992

Long-term hearing results of one-stage tympanoplasty for chronic otitis media.

A study of 277 ears with chronic otitis media undergoing one-stage tympanoplasty has been carried out. The mean follow-up period was 6.4 years. Ears with intact ossicular chains were excluded. Ossiculoplasty was performed using autologous ossicles or cortical bone. Mean hearing gain was 10.8 dB. Closure of the postoperative air-bone gap to within 20 dB was achieved in 51% of cases. The best results were obtained in ears with intact stapes, while cholesteatomatous ears showed poorer results than other chronic ears. The present findings show that autologous ossicle and cortical bone are still suitable for ossicular reconstruction in chronic ears, especially when one-stage surgery is preferred.

Auditory Threshold↗
PubMed1992

Long-term results of surgery for childhood cholesteatoma.

The study includes 54 cholesteatomatous ears in 50 children aged 16 years or less. The mean follow-up period after surgery was 7.1 years. In 26% of the ears the cholesteatoma was 'huge' involving the middle ear and the attic and filling the entire mastoid air cell system. A patient had lateral sinus thrombophlebitis. Patients with large cholesteatomas underwent canal wall down mastoidectomy with simultaneous tympanoplasty and, in most cases, cavity obliteration. Limited cholesteatomas were removed using either intact canal wall mastoidectomy or tympanotomy approach. Recurrence rate (including both residual and recurrent cholesteatomas) for the total series was 15% and 12% for the 50 cases undergoing one-stage surgery. Serviceable hearing (< or = 30 dB) was achieved in 57% of the ears. A reoperation was necessary in 26% and a third operation in 2%. At last follow-up examination, 94% of the ears had intact tympanic membranes but 4 patients (8%) suffered from cavity-related problems. Possible reasons for the disappointing results of surgical treatment for childhood cholesteatoma are discussed.

Adolescent↗
PubMed1992

Results of surgical treatment for chronic noncholesteatomatous otitis media in the pediatric population.

The long-term results of surgery for chronic otitis media without cholesteatoma were analyzed in 76 ears of children aged 16 years or less. The mean follow-up period was 6.0 years. Thirty-four ears were subjected to mastoid surgery for chronic otorrhea; at final follow-up examination the disease was found to be cured in all but one patient. Forty-two patients with sequelae to chronic otitis media underwent tympanoplasty without mastoidectomy which was successful in 38 (91%) of these. At follow-up, 84% of the patients had hearing levels of 20 dB or better. Outcome of surgery and hearing results in children were as good as or even better than those obtained in adult patients. Complications of surgery were rare.

Adolescent↗
PubMed1992

Immune response to inactivated influenza virus vaccine: antibody reactivity with epidemic influenza B viruses of two highly distinct evolutionary lineages.

Vaccination of adults (healthy female employees potentially capable of transmitting influenza to high-risk persons; n = 104) in autumn 1990 with a trivalent influenza virus vaccine containing B/Yamagata/16/88 induced a low antibody response to B/Finland/150/90, a recent variant of B/Victoria/2/87-like viruses, as compared with the antibody response to B/Finland/172/91, a current variant in the lineage of B/Yamagata/16/88-like viruses. Up to the end of the epidemic season, the antibody status declined but was still significantly better than before the vaccination. The results suggest that the vaccine strain was appropriate for the outbreak of 1990 to 1991 in Finland, but may provide unsatisfactory protection against B/Victoria/2/87-like viruses. Evidence is given that use of Madin-Darby canine kidney (MDCK)-grown virus as an antigen in the haemagglutination inhibition test (HI) may provide more reliable information about the protective antibodies than use of untreated or ether-treated egg-grown viruses. Significantly higher postvaccination and postepidemic antibody titres were recorded among subjects who exhibited the antibody before vaccination than among seronegative subjects. A significantly higher response rate among initially seronegative people than among seropositive people was recorded for antibody to B/Finland/150/90, but no clear evidence was obtained that the pre-existing antibody could have had a negative effect on the antibody production.

Adult↗
PubMed1992

Ischemic heart disease prevention: estimating the impact of interventions.

The potential impact of ischemic heart disease intervention programs has usually been assessed using the dichotomy between those programs targeted to high risk groups and those that are population based, but this distinction does not adequately describe the spectrum of possibilities. Using data from the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (NHEFS), we assessed the effect of a spectrum of 27 potential interventions on mortality reduction and on an Intervention Index (defined as the number of persons whose risk must change to prevent one death). Using combinations of cholesterol reductions of 20% and decreases in the prevalence of smoking and hypertension of 50%, reductions in mortality varied from 1 to 27% and the Intervention Index varied from 26 to 520. A number of potential interventions were equivalent in their mortality reduction of their Intervention Indexes, despite their affecting differing proportions of the population. The Intervention Index provides some measure of the relative efficiency of programs and points to the comparability of different interventive approaches. In addition, this analysis suggests that the potential impact of intervention programs on mortality will be modest, but that a focus on certain subgroups, such as those aged 40-59 years, can achieve substantial results within those groups, even though the population effect would be minimal.

Adult↗
PubMed1992

Long-term results of revision stapes surgery.

Results of 45 re-operations for persistent or recurrent conductive deafness after primary stapes surgery were studied. The mean follow-up period after the revision surgery was 7.6 years. Long-term hearing results were found to be disappointing, air-bone gap to within 10 dB was achieved in only 46 per cent of the patients. Mean hearing levels improved by 11 dB or more in 73 per cent. Outcome of surgery was dependent on the surgical pathology, the best hearing results were obtained in cases with re-fixation after stapes mobilization operation. Sensorineural hearing loss as a result of surgical trauma to the inner ear occurred in revision surgery more frequently than in primary operations, cases with regrowth of otosclerotic bone to the oval window after stapedectomy having the greatest risk of labyrinthine trauma.

Adult↗
PubMed1992

What is the best method of treatment for labyrinthine fistulae caused by cholesteatoma?

A series of 19 patients with a labyrinthine fistula caused by cholesteatoma was analysed. Two patients presented with acute suppurative labyrinthitis and meningitis. A canal wall down procedure was performed in all but one patient. Of the 17 patients with preserved inner-ear function, the cholesteatoma matrix over the fistula was removed in 10 resulting in severe sensorineural hearing loss in one of these. The matrix was left in situ in 7 patients and hearing was maintained or improved in all of them. Post-operatively, 2 patients suffered from vestibular disturbances, the matrix covering the fistula being removed in both of them. It was concluded that preservation of the matrix over the fistula is the safest method of management of this serious complication of cholesteatomatous chronic ear disease.

Adolescent↗
PubMed1992

Results of surgery for chronic otitis media in patients with a cleft palate.

The long-term results of surgical treatment of 19 chronic ears in 16 patients with a cleft palate were analysed. The mean follow-up period was 6.5 years. The patients were found to be significantly younger than other patients with chronic otitis media. Granulating otitis media was the indication for surgery in 11 ears and cholesteatoma in 7 ears. A successful outcome after the primary operation was found in 68% of the patients. Four patients required a revision operation which was successful in all of them. Hearing results of patients with cleft palate did not differ significantly from those obtained in other patients. It is concluded that middle ear surgery should be offered to patients with a cleft palate with the same indications as in other patients with chronic otitis media.

Adolescent↗
PubMed1992

Tympanomastoidectomy for chronic otitis media without cholesteatoma.

A series of 221 ears with chronic suppurative otitis media without cholesteatoma is presented--84% of the cases were treated using one-stage tympanomastoidectomy and 15% underwent cortical mastoidectomy with planned second-stage tympanoplasty. Mean follow-up period was 6.3 years. Control of infection succeeded in 92% after the primary operation. Failures were most common in ears infected with Pseudomonas aeruginosa. Postoperative cholesteatoma developed in 5 ears (2.2%). Hearing results were unsatisfactory; a postoperative air-bone gap within 20 dB was achieved in only 62%. In revision operations, retained mastoid air cells were found in 64% of ears with recurrent or persistent discharge. Thirty-seven percent of patients with unsuccessful outcome were observed to have a possible underlying or concomitant disease. The importance of intensive preoperative conservative treatment and careful surgical technique is stressed.

Adolescent↗
PubMed1992

Head and neck manifestations of Wegener's granulomatosis.

Sixteen of 17 patients with Wegener's granulomatosis were found to have head and neck involvement. Rhinitis and/or nasal obstruction were the most common presenting symptoms. On initial clinical examination, paranasal sinus involvement was observed in 11 patients, ear involvement in 7 and subglottic stenosis in 2 patients. One patient presented with a large and rapidly widening ulcer on the lateral pharyngeal wall. Diagnosis was often difficult and severe delay in diagnosis occurred in 7 patients. In recent years tests for ANCA appeared to be extremely useful.

Adolescent↗
PubMed1991

Five-year trend in serum HDL-lipoprotein cholesterol in the Finnish population aged 25-64 years. A suggestion of an increase.

High density lipoprotein cholesterol (HDLC) was measured in the population surveys carried out in Finland in 1982 and 1987. The mean (+/- SD) of HDLC for men aged 25-64 years was 1.23 +/- 0.32 mmol/l in 1982 and 1.30 +/- 0.33 mmol/l in 1987, the increase being 5.7%. Respective values in women were 1.46 +/- 0.33 mmol/l and 1.58 +/- 0.35 mmol/l, an increase of 8.2%. The increase was significantly greater in women than in men (P less than 0.001). The prevalence of low HDLC (less than or equal to 0.9 mmol/l) fell from 13.5 to 9.6% in men and from 3.2 to 1.4% in women. Factors associated with low HDLC were the history of ischemic heart disease (IHD), diabetes and hypertension in both sexes and the positive family history of IHD in women. Subjects with low HDLC also had higher body mass index (BMI), waist-hip ratio and serum total cholesterol (TC) concentration than subjects with normal HDLC. Changes in BMI, waist-hip ratio, alcohol intake, leisure time physical activity, prevalence of smoking or in the dietary variables recorded, did not explain the increase in HDLC.

Adult↗
PubMed1991

Perilymph fistula--a diagnostic dilemma.

A retrospective series is presented of 51 cases operated on for suspected perilymph fistula. In 26 ears a fistula was identified at surgery. A positive fistula test was found to strongly indicate a perilymph fistula but was more often negative than positive in surgically demonstrated fistula ears. Other vestibular tests were found to be of little value in the pre-operative diagnosis. Ears with a surgically demonstrated fistula and sensorineural hearing loss had either flat or downward-sloping audiograms. Difficulties in diagnosing a perilymph fistula at tympanotomy are discussed. At follow-up, vestibular symptoms were found to be eliminated or improved in 96 per cent of cases with surgically demonstrated fistulae and in 68 per cent of cases in which no fistula was detected at tympanotomy but hearing improved significantly in only one ear (4 per cent) of the former group and in five ears (20 per cent) of the latter group.

Adolescent↗
PubMed1991

Assessing population-based programs to reduce blood cholesterol level and saturated fats.

This article reviews seven community-based programs for prevention of cardiovascular disease and their effects on blood cholesterol levels and saturated fat intake. In two programs, cholesterol levels were reduced more in the intervention area than in the reference area. In two other programs, cholesterol increased less in the intervention area than in the reference area. In one program, cholesterol levels initially fell in the intervention group and increased in the reference group; after the first 4 years, the levels also started to increase in the intervention group. The final two programs reduced cholesterol equally in both groups. Only two programs reported on the intake of saturated fats; in both, intake of saturated fat was reduced more in the intervention area than in the reference populations. In one program area, total intake of fat was reduced more than in the reference area. Published data do not allow us to draw conclusions regarding which components of the programs were most important. These studies show that the average blood cholesterol level can be affected in a general population.

Cardiovascular Diseases↗
PubMed1991

Fifteen-year trends in coronary risk factors in Finland, with special reference to North Karelia.

The North Karelia Project, a major demonstration programme for coronary heart disease (CHD) prevention, was begun in an eastern province of Finland in 1972. A number of national CHD prevention activities have been undertaken, quite a few of them since 1977. This paper reports the 15-year changes in CHD risk factors (serum cholesterol, blood pressure, and smoking) in North Karelia and in the original reference area of the project, and more recent changes in a third area in southwestern Finland. The results are based on well-standardized, comparable surveys of cross-sectional populations, aged 30 to 59 years. The results indicate that risk factors reduced markedly in North Karelia from 1972-1977, to a lesser extent from 1977-1982, and only a little from 1982-1987. There was also a decline in the reference area during the first ten years (1972-1982) but the changes did not exceed those in North Karelia and during the second phase, from 1982-1987, risk factor changes were minor. Risk factor levels in the third area in southwestern Finland changed little from 1982-1987. Present serum cholesterol and blood pressure levels in North Karelia are still higher than in southwestern Finland, but smoking is less common among North Karelian men. These findings are discussed in the light of the recent information on Finnish dietary changes and CHD mortality; their bearing on the need for new cardiovascular disease prevention activities in Finland is also discussed.

Adult↗
PubMed1991

The North Karelia Youth Programs.

Two family-based and two community- and school-based studies have been done in the province of North Karelia in eastern Finland. In the two family-based studies it was possible to decrease serum cholesterol level among children by 15%, showing that to a great extent the extremely high blood cholesterol level among Finnish children can be explained mainly by the typical Finnish diet high in saturated fat. In the first North Karelia Youth Project it was possible to affect the onset of smoking among adolescents. Two years after the program, smoking was about 30% less common in the intervention school than in the reference schools. In the eighth-year follow up survey the effect of the teacher-delivered program was still seen. In the second North Karelia Youth Project it was possible to delay the onset of smoking during the seventh grade but no permanent effect was seen. Diet was changed more among the program school students than in the reference school. These studies, done during the last 10 years, show the cardiovascular risk factors can be reduced among children and adolescents. The next main question is how to use these findings in the normal school and health care system. We have started the National Healthy School Program in Finland to assess the extent to which these programs can be implemented on the national level.

Adolescent↗
PubMed1990

Serum cholesterol distribution, measurement frequency and cholesterol awareness in three geographical areas of Finland.

The serum cholesterol distribution in three geographical areas of Finland was examined during the first and the second FINMONICA surveys in 1982 and 1987. The mean serum cholesterol concentration changed very little during this observation period. In 1987 the population mean (+/- SD) was 6.12 +/- 1.26 mmoll-1 in men aged 25-64 years and 5.96 +/- 1.28 mmoll-1 in women. Only approximately 20% of the Finns had their serum cholesterol at the level which is regarded as desirable by recent international recommendations. The frequency of cholesterol measurements increased in Finland, especially in North Karelia, from 1972 to 1977 but since then no further increase has taken place. From 1982 to 1987 the proportion of subjects whose cholesterol level was over 6.5 mmoll-1 and who reported knowing that their cholesterol was high increased from 27% to 31% in men and from 24% to 34% in women, respectively. It is concluded that approximately 45% of the adult Finnish population is at moderately increased risk and further 33% at considerably increased risk of coronary heart disease because of the elevated serum cholesterol.

Adult↗
PubMed1990

Eight-year follow-up results of an adolescent smoking prevention program: the North Karelia Youth Project.

In the North Karelia Youth Program five to 10 classroom sessions over two years taught skills to resist pressures to start smoking to 13 to 15 year old students. Compared to students from comparison schools, the treatment groups reported less smoking immediately after the intervention and in a four-year follow-up survey. At the eight-year follow-up, there was consistent evidence of possible preventive effects only among those who had been non-smokers when the program began.

Adolescent↗