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Biomedical subjects

G Myllylä

Publications and source records attributed to G Myllylä.

At least 19 recordsLinked to original sources
PubMed1998

Transfusion policies in coronary artery bypass--a nationwide survey in Finland.

BACKGROUND: Since the discovery of HIV, minimizing the use of donor blood has become increasingly important in surgical activity. In Finland, however, the use of homologous red blood has grown considerably during the past years. Therefore, we found it necessary to conduct a nationwide survey of transfusion practices in elective surgery. This report deals with transfusions in coronary artery bypass (CABG) operations in all Finish cardiac centres. METHODS: The study group comprised 804 primary CABG patients operated during a 2-year period. Two reviewers retrospectively examined the data concerning the use of and indications for homologous and autologous blood in the patient charts. RESULTS: In all, 705 (88%) of patients received homologous blood. The proportions of patients receiving blood components differed between hospitals: from 53 to 99% for red cells, 2 to 22% for fresh frozen plasma and 5 to 49% for platelets. The variation was not caused by diverse patient populations: the mean number of blood component units transfused per patient differed from 1 to 6 between centres-even after adjustment for confounding variables. Multiple blood conservation methods were used in one centre. Nevertheless, homologous blood was administered to 88% of their patients. CONCLUSIONS: A considerable proportion of CABG patients are transfused with homologous blood in Finland compared to other countries. In addition, the transfusion practices proved highly variable between hospitals and were determined largely by local opinions. This study reveals a clear demand for prospective studies and constructive discussion among anaesthesiologists to establish uniform guidelines for blood use in cardiac surgery.

Adult↗
PubMed1997

No prevention of cytomegalovirus infection by anti-cytomegalovirus hyperimmune globulin in seronegative bone marrow transplant recipients. The Nordic BMT Group.

A randomized multicentre study was conducted to evaluate the effect of anti-CMV hyperimmune globulin in the prophylaxis of CMV infections in CMV seronegative allogeneic BMT patients who received a transplant from a seropositive donor or who had received blood products unscreened for CMV during the treatment before BMT. Twenty-eight patients were included in the study. Thirteen were randomized to receive and 15 not to receive intravenous CMV hyperimmune globulin. A dose of 0.4 g/kg of immunoglobulin was given on day -8 and 0.2 g/kg on days -1, +7, +14, +21, +28, +35, +42, +56 and +70 in relation to the day of transplantation. Among the 15 patients not given immunoglobulin CMV was isolated in three, and two of them developed clinical CMV disease. In addition, one more patient developed CMV antibodies without virus isolation. In five of the 13 patients given immunoglobulin the virus could be isolated, and four of them developed CMV disease. One additional patient showed seroconversion but no other findings of CMV infection. The incidence of acute and chronic GVHD was similar in the two arms. There was no significant difference in survival. In conclusion, the present results do not indicate a beneficial effect of CMV hyperimmune globulin infusions in the prophylaxis of CMV infection or disease in seronegative allogeneic bone marrow transplant recipients from a seropositive donor.

Adolescent↗
PubMed1997

Association of the fatty acid composition of serum phospholipids with hemostatic factors.

It has been suggested that the fatty acid composition of serum phospholipids is an independent risk factor for cardiovascular disease. We examined the association of the fatty acid composition of serum phospholipids with fibrinogen, factor VII antigen (FVII:Ag), factor VII coagulant activity (FVII:C), plasminogen, and lipoprotein(a) [Lp(a)] in 338 men and 363 women 45 to 64 years old. Palmitic acid, the most abundant saturated fatty acid, was positively associated in univariate analyses with plasminogen, which explained 5.2% of its variance among men (P<.0001) and 5.8% among women (P<.0001). Linoleic acid, which is the most abundant polyunsaturated fatty acid, was negatively associated with plasminogen and fibrinogen. This explained 1.1% of the variance in fibrinogen among men (P=.04) and 3.2% among women (P=.0006) and 4.1% of the variance in plasminogen in both sexes (P<.0001). Dihomogammalinolenic acid was positively associated with FVII:Ag and explained 3.7% of its variance among men (P=.0003) and 4.6% among women (P<.0001). Furthermore, dihomogammalinolenic acid was positively and significantly associated with FVII:C, fibrinogen, and plasminogen among women but not among men. All these associations remained significant after adjustment for multiple potential confounding factors such as age, smoking, serum lipids, and body mass index. In conclusion, our findings suggest that linoleic acid, palmitic acid, and dihomogammalinoleic acid are significant independent determinants of hemostatic profile. It is not clear, however, to what extent these results reflect the effects of fatty acids on coagulation and to what extent they reflect the activity of inflammatory processes in the arteries.

8,11,14-Eicosatrienoic Acid↗
PubMed1996

Multicenter evaluation of the 3% paraformaldehyde method for white cell counting in leukocyte-reduced red blood cells. BEST (Biomedical Excellence for Safer Transfusion) Working Party of the International Society of Blood Transfusion.

BACKGROUND/AIM: The 3% paraformaldehyde (PFA) method is a simple technique for counting residual white blood cells (WBC) in leukocyte-depleted red blood cells (RBC). Preliminary data suggested that its sensitivity is at least equal to PCR and flow cytometry. We report the results of a multicenter study conducted by the BEST Working Party to determine precision and accuracy of the 3% PFA method. STUDY DESIGN: In the 7 participating laboratories, 5 sets of samples containing nominal concentrations of 200, 100, 50, and 10 WBC/ml were prepared by diluting whole blood into 'WBC-free' RBC. Ten milliliters of each sample were processed using the 3% PFA method, which is based on erythrocyte lysis and WBC concentration into 5% of the original sample volume; a Nageotte chamber is used to count concentrated WBC. RESULTS: The precision of the technique varied according to the nominal concentration, ranging from a CV of 12% at 200 WBC/ml to 57% at 10 WBC/ml. The technique measured fewer than the nominal WBC concentrations (mean of all laboratories, -12.4%); underestimation was probably due to cell loss during sample manipulation. Overall accuracy was however acceptable, because statistical considerations establish that the actual WBC concentration would unlikely exceed 2 times the estimated count. CONCLUSIONS: The 3% PFA method is suitable for the enumeration of residual WBC at concentrations > or = 50/ml. It represents a useful tool for evaluation of high performance filters by reference laboratories.

Cell Separation↗
PubMed1995

Replacement of major surgical blood loss by hypo-oncotic or conventional plasma substitutes.

The purpose of the study was to examine the effects of hypooncotic 4% hydroxyethyl starch 120/0.7, 3% dextran 70, 5% albumin and hyperoncotic 6% hydroxyethyl starch 120/0.7 on the perioperative colloid osmotic pressure (COP), albumin and protein concentrations and fluid balance. The plasma substitutes were used with red cell concentrates to replace blood loss with equal volume in sixty major abdominal or urological surgeries. A special effort was made to keep replacements and losses at even volumes constantly and to avoid fluctuation of blood volume. The blood specimen were obtained before induction, after each 20% blood loss, at the end of the recovery room phase and on the three following postoperative mornings. There were significant differences in the peroperative and immediate postoperative COPs. However, these differences had vanished by the first postoperative morning. COP was preserved above 16 mmHg in all groups throughout the study. The identical peroperative albumin and protein concentrations of the synthetic colloid groups suggests that their volume effect was the same, regardless of the varying COP. During the observation period there were no significant differences among the groups concerning the diuresis and the fluid balances. We conclude, that the hypooncotic 4% HES 120 and 3% dextran 70 solutions provide the same clinical effect as 6% HES 120 solution. Consequently less colloid is needed, which allows the use of greater volumes of the dilute colloid solutions in replacement therapy.

Abdomen↗
PubMed1995

Reemphasis on leukocyte transfusions: induction of myeloid marrow recovery in critically ill neutropenic children with cancer.

Neutropenia is the major factor predisposing to sepsis in cancer patients, and its duration is important for survival. We administered leukocyte transfusions (LT) to 10 children suffering from documented life-threatening infections during profound, prolonged neutropenia. Nine had acute leukemia, and one had aplastic anemia; three were bone marrow transplant recipients. These 10 were the only patients in our unit who received LT during the past 7 years. The median leukocyte dose was 0.6 x 10(9)/kg in total. Instead of leukapheresis products, we used pooled buffy coats from random donors, with a high relative content of lymphocytes and especially T lymphocytes. The leukocyte concentrates were irradiated with 15 Gy. In all 10 patients, we observed prompt and sustained myeloid marrow recovery following LT. Such an effect of LT has never been described before. We hypothesize that in the internal milieu of these aplastic patients the transfused leukocytes were stimulated to secrete cytokines, the result being a cascade-like phenomenon and stimulation and proliferation of the patient's own bone marrow cells. The bone marrow-stimulating effect of LT merits further study.

Acute Disease↗
PubMed1995

Association of hormone replacement therapy with hemostatic and other cardiovascular risk factors. The FINRISK Hemostasis Study.

The risk of cardiovascular diseases in women is small until menopause but increases considerably afterwards. When all age groups are considered, cardiovascular diseases are responsible for approximately half of the total mortality in women. It has been suggested that hormone replacement therapy (HRT) in perimenopausal and postmenopausal women could be useful in the prevention of cardiovascular diseases, but its effects are insufficiently known. We performed a cross-sectional study on the associations of menopause and HRT with cardiovascular risk factors, in particular with hemostatic factors, on female participants of the FINRISK Hemostasis Study. The participants, aged 45 to 64 years, were recruited from the Finnish population register by random sampling from three geographically defined areas. The participation rate of women was 83.2%. Of the 1202 women included in the study, 29.2% were current users of HRT. Differences in cardiovascular risk factors by menopausal status and by HRT use were examined after adjustment for age, study area, current smoking, body mass index, self-reported diabetes, and years of education. Postmenopausal women not using exogenous sex hormones had on average a total cholesterol level 0.5 mmol/L (8.9%) higher and an LDL cholesterol level 0.4 mmol/L (11.4%) higher than premenopausal women. Women reporting irregular menstruation (presumably due to perimenopause) had higher adjusted plasma fibrinogen, factor VII coagulant activity, and factor VII antigen than women with regular menstruation or no menstrual periods.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Coagulation↗
PubMed1994

Haemostatic factors and prevalent coronary heart disease; the FINRISK Haemostasis Study.

We examined the association of haemostatic factors with prevalent coronary heart disease (CHD) in the population-based FINRISK Haemostasis Study. Of the 2365 participants aged 45-64 years, 88 men and 44 women with prevalent CHD were identified. The participants with CHD were older and had lower high density lipoprotein cholesterol, higher triglycerides and higher body mass index than the participants without CHD. Men with CHD had significantly higher plasma fibrinogen (P < 0.0001, adjusted for age and smoking) and lipoprotein (a) (Lp (a), P = 0.001, adjusted for age) concentrations than those without CHD. Among women, the findings were consistent with those of men, but only fibrinogen reached the conventional level of statistical significance (P = 0.04). No difference was observed in factor VII antigen, factor VII activity or in plasminogen. The association of Lp (a) with prevalent CHD was dependent on fibrinogen concentration (P = 0.02 for the interaction-term) and on non-HDL cholesterol concentration (P = 0.01 for the interaction-term). These cross-sectional results do not prove causality, but they demonstrate a considerable accumulation of prevalent CHD among persons with high Lp (a), fibrinogen and non-HDL cholesterol.

Antigens↗
PubMed1994

Adverse reactions to platelet transfusions are reduced by use of platelet concentrates derived from buffy coat.

We closely observed 86 transfusions to multitransfused hematologic patients with leukocyte-depleted platelet concentrates (PCs) prepared from buffy coats (BC PCs), filtered either prior to storage (BC1) or after 3-4 days' storage (BC3). The patients were first given, randomly, either BC1 or BC3, and were thereafter used as their own controls by giving them the two BC types alternately. The results were compared with an earlier study on standard platelet-rich plasma (PRP) PCs (46 transfusions to 23 patients) and leukocyte-depleted PRP PCs (23 transfusions to 12 patients). There was no difference in adverse reactions between BC1 and BC3 PCs, but BC PCs caused significantly fewer and milder adverse reactions than PRP PCs. Febrile reactions (FTR) occurred in 4.6%, urticarial skin reactions in 21%, and pulmonary reactions in 0% of BC PC transfusions (17, 29 and 0% of patients). The mean corrected increments (CI) at 16-18 h were higher after BC1 PCs than BC3 PCs (10.3 vs. 8.0, p = 0.046). We conclude that adverse reactions are reduced by use of BC PCs. Prestorage leukocyte depletion may improve platelet increments.

Adolescent↗
PubMed1994

Haemostatic factors and lipoprotein (a) in three geographical areas in Finland: the Finrisk Haemostasis Study.

BACKGROUND: An increasing volume of evidence suggests that haemostatic factors play a role in the risk of coronary heart disease. It is not known, however, whether between-population differences in haemostatic factors correspond with the differences in mortality related to coronary heart disease. We examined this question in Finland, where, in North Karelia (in the eastern part of the country), the mortality from coronary heart disease is 1.5-1.7 times higher than that in southwestern areas. METHODS: A random sample of 3000 people aged 45-64 years was drawn from the population registers of North Karelia, of the area surrounding Turku and Loimaa in southwestern Finland and of the Helsinki area in southern Finland. Of the 3000 people approached, 79.6% took part in the study. differences in coronary heart disease mortality and morbidity. RESULTS: Factor-VII coagulant activity was significantly higher in North Karelia than in the other areas (P = 0.0008). The fibrinogen level was also higher in North Karelia, although the difference was significant only among non-smokers (P = 0.02). Levels of factor-VII antigen, plasminogen and lipoprotein (a) did not differ between the areas. Within North Karelia, the levels of both factor-VII coagulant activity, and factor-VII antigen were higher in rural areas than in urban areas. Levels of factor-VII coagulant activity, factor-VII antigen and plasminogen were higher in women than in men and increased with age in women but not in men. The fibrinogen level increased with age in both sexes. CONCLUSION: These baseline findings of the Finrisk Haemostasis Study demonstrate that the geographical differences in levels of factor-VII coagulant activity and fibrinogen in Finland are consistent with the population

Age Distribution↗
PubMed1993

Hydroxyethyl starch as a prime for cardiopulmonary bypass: effects of two different solutions on haemostasis.

Hydroxyethyl starch (HES) is efficacious as a volume expander in cardiac surgical patients, but it may impair the haemostatic mechanisms. However, this latter effect may be less conspicuous with low molecular weight (LMW) solutions than with high molecular weight (HMW) solutions. Therefore, LMW- and HMW-HES solutions were evaluated as priming solutions for cardiopulmonary bypass (CPB) with respect to their effect on haemostasis. Forty-five patients undergoing coronary bypass grafting were prospectively randomised to three groups and received in a double-blind manner as their CPB prime either 20 ml.kg-1 LMW-HES (Mw 120,000), 20 ml.kg-1 HMW-HES (Mw 400,000) or Ringer's acetate 2000 ml. The final volume of the prime was completed to 2000 ml with Ringer's acetate in the HES groups. Anaesthesia and CPB management were standardised. Plasma levels of von Willebrand factor antigen and factor VIII procoagulant activity were significantly more depressed after CPB in both HES-groups as compared with the crystalloid prime group. In addition, APTT was more prolonged and the maximal amplitude of thromboelastographic tracing was more decreased in the HES-groups. It is concluded that it may be advisable to avoid HES solutions in the CPB prime, especially in patients with an increased risk for bleeding after cardiac operations.

Cardiopulmonary Bypass↗
PubMed1993

Systematic use of leukocyte-free blood components to prevent alloimmunization and platelet refractoriness in multitransfused children with cancer.

A major drawback in the use of platelet transfusions is the development of platelet refractoriness that is usually caused by alloimmunization provoked by leukocytes present in the blood products. We evaluated the development of alloimmunization both by serological demonstration of HLA antibodies and by clinical demonstration of platelet refractoriness in 50 multitransfused children who exclusively received filtered, leukocyte-free blood products. The basic diagnoses included acute leukemia, pediatric solid tumors, and severe aplastic anemia. We also present a reference group of 10 similarly multitransfused children, who either deliberately or inadvertently had received nonfiltered blood products on some occasions. In the study group of 50 children, none developed platelet refractoriness. The median corrected increment was 11.1 x 10(9)/l at the time of initial diagnosis, and 10.4 at the time of the study 8 months later (median). None had detectable HLA antibodies in serum. In contrast, in the reference group 3/10 had HLA antibodies in serum, and 1/10 was clearly refractory to random pooled platelets. We conclude that systematic use of leukocyte-free blood components effectively prevents alloimmunization in heavily transfused children with cancer. Leukocyte depletion to the level of < 1 x 10(6) of contaminating leukocytes per unit is sufficient and seems to prevent alloimmunization totally.

Adolescent↗
PubMed1992

Antiphospholipid antibodies and thrombosis in systemic lupus erythematosus: comparison of three lupus anticoagulant assays and anticardiolipin ELISA in 188 patients.

The presence of antiphospholipid antibodies (aPL) in 188 unselected patients with systemic lupus erythematosus was studied using the recalcification time, kaolin clotting time (KCT), dilute Russell's viper venom time (dRVVT) and anticardiolipin ELISA (aCL) to identify patients with a high or low risk of thrombosis among patients with aPL. aPL were detected by at least one method in 104 (55%) of the patients. Despite heterogeneity, lupus anticoagulant (LA) methods correlated reasonably well with each other (r = 0.736-0.968), but poorly with aCL (r = 0.241-0.549). Positivity in LA assays and immunoglobulin G (IgG)-aCL were associated with patients who experienced thrombosis (P less than 0.001 for all assays). Patients with both LA and aCL had experienced thrombosis more often than those having only one (odds = 6.3, P less than 0.001). When patients with aPL were ranked by relative strength of the finding and divided into tertiles, a history of thrombosis was associated with membership in the strongest tertile of at least one assay (odds = 4.2, P = 0.002). LA and aCL had similar sensitivities for thrombosis (61% and 63%, respectively), but LA was more specific than aCL (79% vs 53%). The best combination of two assays was KCT with dRVVT (61% sensitivity, 87% specificity). Maximal sensitivity (71%) for thrombosis could be achieved by adding IgG-aCL to these two assays, but specificity was lower (73%). In conclusion, a high thrombotic risk among patients with aPL was indicated by the simultaneous presence of both LA and aCL, strongly positive aPL, and, among aCL, IgG-class antibodies.

Adolescent↗