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Biomedical subjects

H Pirttiaho

Publications and source records attributed to H Pirttiaho.

At least 19 recordsLinked to original sources
PubMed2000

Out-patient management does not impair outcome of pregnancy in women with type 1 diabetes.

In recent years, out-patient protocols have mainly displaced historical obstetric management of diabetic pregnancy. The impact of the change from centralized in-patient to decentralized out-patient treatment on glycaemic control and its effects on the outcome of newborns in diabetic pregnancies was therefore studied using the population-based data on 296 pregnancies in 224 women with type 1 diabetes over 10 years (1986-1995) in the two northernmost provinces of Finland. The area comprises one tertiary level and four other central hospitals. The change of policy was effected in 1990 and to determine the impact of this change, the study period was divided in two (period 1, 1986-1990, n = 135; period 2, 1991-1995, n = 161). At the first antenatal contact (mean 9.9 weeks of gestation) 73% of women had unsatisfactory glycaemic control, but it improved rapidly with pregnancy and was significantly better (P < 0.05) in the second study period. The incidence of congenital malformations was somewhat greater (NS) in period 2 but perinatal mortality did not change. Out-patient management does not impair outcome in type 1 diabetic pregnancy.

Adult↗
PubMed1993

Preoperative ultrasound in patients undergoing initial neck exploration for primary hyperparathyroidism.

92 patients with primary hyperparathyroidism were subjected prospectively to preoperative ultrasound to identify enlarged parathyroid glands and detect simultaneous thyroid lesions of surgical significance. The overall sensitivity and specificity rates were 62.7% and 95.7%, 85.2% and 96.8% for patients with a single adenoma, 44.3% and 88% for those with multiglandular disease, 56.8% and 95.6% for those with simultaneous thyroid disease and 20% and 100% for mediastinal glands. Ultrasound revealed a pathological thyroid gland in 26 patients (28%). The sensitivity and specificity rates were 96% and 100%. The thyroid lesion was considered clinically significant in 15 of the 92 patients (16.3%) and only in three patients (3.3%) was the diagnosis not established preoperatively. Operating room times and costs were significantly lower for patients with an accurate ultrasound scan than for those with an inaccurate scan (P < 0.001). We conclude that both the sensitivity of ultrasound for locating enlarged parathyroid glands and its yield of previously unknown thyroid lesions of surgical significance are too low to warrant preoperative ultrasound evaluation. Although our operating room expenses were significantly higher for patients with an inaccurate scan, the cost effectiveness of preoperative ultrasound cannot be proved until a prospective, randomised investigation has been carried out.

Cost-Benefit Analysis↗
PubMed1992

Asymptomatic coronary artery disease in diabetes: associated with autonomic neuropathy?

To elucidate the potential association of diabetic autonomic neuropathy with increased prevalence of silent coronary artery disease (CAD), 138 asymptomatic diabetic subjects were screened using exercise ECG. 24-h ambulatory ECG and dynamic thallium scintigraphy. Fourteen patients with exercise-induced myocardial ischaemia and angiographically confirmed CAD (greater than or equal to 50% coronary artery narrowing) were found using this protocol. Their autonomic nervous function was assessed using standard cardiovascular tests and compared with that of 23 consecutive diabetic patients catheterised because of symptomatic CAD (mean New York Heart Association class 3.0). The diabetic patients with symptomatic CAD had more severe coronary atherosclerosis than the diabetic patients with asymptomatic CAD assessed by jeopardy score (P less than 0.01). The groups did not, however, differ with respect to autonomic function tests. Five patients (22%) with symptomatic CAD and 3 patients (21%) with asymptomatic CAD had definite autonomic dysfunction, i.e. two or more abnormal tests. Thus, our results suggest that the frequency of autonomic neuropathy is not increased in diabetic patients with asymptomatic CAD. The contribution of diabetic autonomic neuropathy to the absence of cardiac pain needs further clinical and pathological studies.

Autonomic Nervous System↗
PubMed1990

Evaluation of exercise electrocardiography and thallium tomographic imaging in detecting asymptomatic coronary artery disease in diabetic patients.

Thallium tomographic imaging and exercise electrocardiography were performed on 136 diabetic patients without symptoms of heart disease. Thirty three patients had post-exercise thallium defects and 19 had ST 1 mm greater than or equal to segment depression during exercise electrocardiography. Both tests were positive in 13 patients. Coronary angiography was subsequently performed on 33 patients with either scintigraphic and/or electrocardiographic evidence of myocardial ischaemia. Angiographically significant coronary artery disease (greater than or equal to 50% narrowing of the coronary artery lumen) was detected in 13 patients. Six patients had minimal coronary artery stenosis (less than 50%), and 14 had normal coronary arteries. Six patients refused cardiac catheterisation. In 14 out of 27 patients with post-exercise thallium defects coronary angiography did not show any coronary artery stenoses (positive predictive accuracy 48%). Exercise electrocardiography showed only one false positive result (positive predictive accuracy 94%) but failed to detect coronary artery disease in three patients with a positive scintigraphic result. The accuracy of a positive exercise electrocardiographic test seems to be better than that of a positive thallium tomographic scan for detecting asymptomatic coronary artery disease in diabetic patients. The high number of false positive thallium defects may be the result of technical features inherent in thallium tomography and/or the possible disease of the small intramyocardial arteries in diabetic patients.

Adult↗
PubMed1990

Effect of coronary artery disease on parasympathetic cardiovascular reflexes in NIDDM patients.

To evaluate the effect of coronary artery disease on parasympathetic cardiac reflexes in patients with non-insulin-dependent diabetes mellitus (NIDDM), we studied standard cardiovascular reflexes in 27 NIDDM patients with coronary artery disease (group 1) and in 21 NIDDM patients with no signs of coronary artery disease (group 2). Groups did not differ with respect to age, duration of diabetes, or presence of retinopathy. The mean +/- SD heart-rate variation in deep breathing was lower in group 1 than in group 2 (11.6 +/- 6.5 vs. 17.1 +/- 9.0 beats/min, P less than 0.05). Heart-rate variation was more often abnormally low (less than or equal to 10 beats/min) in group 1 than in group 2 (48 vs. 19%, P less than 0.05). Thus, the presence of coronary artery disease appears to modify cardiac parasympathetic reflexes in patients with diabetes mellitus and must be kept in mind when interpreting test results.

Autonomic Nervous System↗
PubMed1989

Abrupt change from a beta-adrenoceptor blocking drug to enalapril in hypertension.

The haemodynamic and hormonal effects of an elective change of antihypertensive therapy from a beta-adrenoceptor blocking drug to a converting enzyme inhibitor, enalapril, were monitored in 12 hypertensive in-patients (WHO I). Blood pressure and heart rate were determined every 2-4 h using an automatic sphygmomanometer during an abrupt cessation of the previous beta-adrenoceptor blocking drug and commencement of treatment with enalapril 20 mg o.d. 12 h later. Mean blood pressure values at rest and during the hand grip test were lower when on enalapril, but heart rate was significantly higher, and three patients suffered from palpitations during the change. The change resulted in an improvement in cardiac function both at rest and during isometric work, as shown by echocardiography. A rapid decrease in plasma angiotensin converting enzyme (ACE) activity and an increase in renin activity were also seen after the change, while plasma levels of atrial natriuretic peptide (ANP) decreased towards normal values. The results suggest that an abrupt change from a chronic beta-adrenoceptor blocking drug to enalapril is safe, feasible and is likely to produce favourable haemodynamic and hormonal effects in hypertensive patients.

Adrenergic beta-Antagonists↗
PubMed1989

Augmentation of atrial contribution to left ventricular filling in IDDM subjects as assessed by Doppler echocardiography.

Left ventricular diastolic function was assessed by pulsed Doppler echocardiography in 21 subjects (mean age 48 yr) with insulin-dependent diabetes mellitus (IDDM) and without evidence of ischemic heart disease and in 21 healthy control subjects of similar age and sex distribution. The peak mitral valve flow velocities during the early rapid filling phase (E) and during late atrial filling (A) were measured, and the ratio of these peak flow velocities (E:A) was calculated. E was similar in both groups, but A was higher (P less than .01) in the diabetic group. Thus, E:A was lower (1.19 +/- 0.24 vs. 1.65 +/- 0.67; P less than .01) in the diabetic subjects than in the control subjects. On subgroup analysis, 6 patients with cardiac autonomic neuropathy had lower E:A than the patients with no such disorder (0.99 +/- 0.15 vs. 1.29 +/- 0.25; P less than .05). E:A was not related to the duration of diabetes, presence of retinopathy, HbA1, or blood glucose levels. In conclusion, the atrial contribution to left ventricular filling seems to be augmented in diabetic subjects. This finding indirectly supports the view that left ventricular compliance is already reduced in asymptomatic diabetic subjects.

Adult↗
PubMed1989

Increased non-enzymatic glycosylation and reduced solubility of skin collagen in insulin-dependent diabetic patients.

The solubility of skin collagen into acetic acid and by pepsin digestion and the degree of non-enzymatic glycosylation of collagen (ketoamine linkage) in these fractions was determined in skin specimens from 27 insulin-dependent diabetic subjects and from 17 age-matched controls. Glycosylation in acid soluble collagen specimen was significantly increased in the diabetics, 1.9 +/- 1.8 (SD)ng of hexose/micrograms of hydroxyproline in comparison to the controls. 0.9 +/- 0.8 ng of hexose/micrograms of hydroxyproline. No significant difference in this respect was noted in pepsin soluble collagen specimens. The solubility of collagen into acetic acid and by pepsin digestion were significantly reduced in the diabetics. No clear relationships between non-enzymatic glycosylation or collagen solubility and diabetic late complications (nephropathy, retinopathy or limited joint mobility) were noted. We suggest (a) that equilibrium levels of early glycosylation products are different in acid and pepsin soluble collagen specimens. (b) ketoamine linkage glycosylation products by themselves are not directly involved in diabetic late complications and (c) the solubility in acid and digestibility of collagen by pepsin may be an indicator, even though nonspecific, of increased amounts of advanced glycosylation end products.

Collagen↗
PubMed1987

The effect of ethanol with a meal on the mucosa of the stomach and duodenal bulb.

The effect of ethanol together with a meal on the mucosa of the stomach and duodenal bulb was studied in nine healthy volunteers. The pre-study gastroscopy was performed after an overnight fast. Two to four weeks later the volunteers drank 72-136 g (mean 111.2 +/- 18.3 SD) alcohol together with a meal. They underwent endoscopy again on the following morning. The endoscopic and histological changes were evaluated by scoring the lesions (0-4). Alcohol caused slight to moderate endoscopically detected changes in the stomach of seven volunteers, the difference being statistically almost significant (p congruent to 0.05) in the case of haemorrhagic lesions. In two subjects slight hyperaemia was seen in the duodenal bulb. The histological study did not reveal significant changes after alcohol drinking. The bile acid concentrations of the gastric juice did not change after drinking. It is concluded that ethanol with a meal causes only slight changes in the mucosa of the stomach, haemorrhagic ones being the most prominent.

Adult↗
PubMed1980

Comparison of three methods of measuring liver blood flow.

Liver blood flow was measured by dynamic 99Tcm-sulfur colloid accumulation and indocyanine green disappearance in 5 subjects, and by 99Tcm-sulfur colloid accumulation and 133Xe-wash-out in 7 subjects. Results obtained by the 99Tcm-sulfur colloid and indocyanine green methods were closely comparable, whereas the flow values estimated by the two isotope methods did not correlate well.

Adult↗
PubMed1979

Liver size in evaluating drug metabolizing capacity in man.

Liver size, cytochrome P-450 (P-450) concentration in liver biopsy specimens and antipyrine kinetics were studied in 112 consecutive patients undergoing diagnostic liver biopsy. Compared to subjects with normal parenchyma, those with slight or severe parenchymal alterations had enlarged livers with low P-450 concentration and slow antipyrine elimination. In the normal group, the mean P-450 concentration (+/- 1 SD) was 11.10 +/- 2.14 nmol/g liver tissue and the total amount (estimated liver weight g X P-450 concentration nmol/g) 16.06 +/- 3.29 mumol. Previous therapy with enzyme inducing drugs was associated with enlarged liver in subjects with normal histological findings and with fast antipyrine elimination and high P-450 in all groups. Antipyrine elimination rate correlated with liver weight only in subjects with normal parenchyma. The total amount of P-450 was generally more closely related to its concentration than to the estimated liver weight, although in many individual cases a large liver was able to compensate a low P-450 concentration so that the total P-450 was at the normal level. Despite normal or high total P-450, in vivo drug metabolism was impaired in subjects with altered parenchyma, suggesting that other factors were limiting antipyrine elimination in liver disease.

Adult↗