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K Jokinen

Publications and source records attributed to K Jokinen.

At least 19 recordsLinked to original sources
PubMed1992

EMLA in local anaesthesia of the tympanic membrane.

An ideal agent for local anaesthesia of the tympanic membrane has been missing so far. Recently, however, a eutectic mixture of lignocaine and prilocaine (EMLA, Astra, Södertälje, Sweden) has proved promising. We compared the anaesthetizing efficacy of EMLA, Bonain's solution (cocain, menthol, phenol ana partes) and Xylocain-spray (Astra, Södertälje, Sweden) in 42 voluntary subjects. EMLA was applied on one tympanic membrane and either one of the other two agents in the other ear of each subject. Small cotton pledgets were used for application. Sensitivity of the ear drum was tested under otomicroscope with a cotton tipped wire before and after each local anaesthesia. Full anaesthesia could be reached with EMLA very significantly (p less than 0.001) more often than with Xylocain and almost significantly (p = 0.057) more often than with Bonain's solution. Most of the test subjects preferred EMLA to Bonain's solution of Xylocain. Undesired side effects, including two tympanic membrane perforations, appeared in most of the ears anaesthetized with Bonain's solution. In the clinical part of the study, EMLA topical anaesthesia was used in 127 minor policlinical tympanic membrane procedures like myringotomy and tympanostomy tube assembling. Eighty-three of the procedures were assessed as painless, 36 unpleasant and 8 painful. A 30-min action time of EMLA was considered sufficient in most cases. No EMLA related side effects appeared. In conclusion, Bonain's solution is recommended to be replaced by EMLA or a corresponding agent for local anaesthesia of the tympanic membrane.

Administration, Topical↗
PubMed1990

Immunohistochemical localization of carbonic anhydrase isoenzymes VI, II, and I in human parotid and submandibular glands.

Human salivary carbonic anhydrase (HCA VI) was purified by inhibitor affinity chromatography and its location in the human parotid and submandibular glands identified, using a polyclonal antiserum raised against the purified enzyme in rabbits in conjunction with the peroxidase-antiperoxidase complex method. The antibodies raised against the purified enzyme in rabbits did not crossreact with the HCA II or I. However, they slightly recognized human IgA; the antiserum was therefore absorbed with human IgA before immunohistochemical use. HCA VI-specific staining was detected in the cytoplasm and particularly in the secretory granules of the serous acinar cells of both parotid and submandibular glands, the staining of the secretory granules being most distinct in paraformaldehyde-fixed tissues. Some epithelial cells and the luminal content of the striated ducts also gave a specific HCA VI staining. Staining specific for HCA II was also found in the granules of the serous acinar cells, particularly in the submandibular gland when Carnoy fluid fixation was used. Slight HCA II-specific staining was also detected in the striated ductal cells in the Carnoy fluid-fixed specimens. No staining specific for HCA I was detected. The results indicate that the serous acinar cells in human parotid and submandibular glands contain abundant HCA II and HCA VI. Interestingly, only HCA VI is secreted into the saliva, although both enzymes appear to be located in structures resembling the secretory granules in the acinar cells. The enzymes probably form a mutually complementary system regulating the salivary buffer capacity.

Antibodies↗
PubMed1990

Effective clinical response to long term octreotide treatment, with reduced serum concentrations of growth hormone, insulin-like growth factor-I, and the amino-terminal propeptide of type III procollagen in acromegaly.

Ten patients with active acromegaly, six with a poor response to previous therapies and four newly diagnosed, were treated with the long-acting somatostatin analog octreotide (Sandostatin; 200-500 micrograms/day, sc, twice or three times daily) for 6-15 months. There was rapid clinical improvement in all patients. The mean daily serum GH concentration was reduced by 64% and was normalized (all GH values less than 2 micrograms/L) in three patients. Serum insulin-like growth factor-I (IGF-I) concentrations were lowered by 40% and were normalized in eight patients. Serum concentrations of the amino-terminal propeptide of type III procollagen (PIIINP), an index of tissue collagen metabolism, were reduced by 40% and were normalized in all patients with initially elevated values. There was a statistically significant positive correlation between the mean serum GH and IGF-I levels (r = 0.47; P less than 0.001) as well as between serum GH and PIIINP levels (r = 0.34; P less than 0.05) and between serum IGF-I and PIIINP (r = 0.50; P less than 0.001). The effects of octreotide on pituitary tumor size and pathology were evaluated in one patient. The therapy did not seem to be associated with significant changes in sellar computed tomographic scans or light microscopic findings. The drug was generally well tolerated. However, indications of significant hepato-biliary dysfunction were noted in one patient after 5 months of therapy. This was reversible upon discontinuation of therapy and did not occur later during the rechallenge with a lower dose of the drug. However, there was probably newly formed cholelithiasis in four patients during the therapy. Our study suggests that octreotide is an effective and relatively safe new approach for treating active acromegaly. Further studies are needed to investigate long term effects on the hepatobiliary system.

Acromegaly↗
PubMed1989

Plain radiography and tomography of the internal auditory canal for the diagnosis of acoustic neuroma.

In the series of 50 acoustic neurinomas (AN) the internal auditory canal (IAC) diameter and the diameter difference between the tumor and non-tumor side are compared with the sizes of the AN. No correlation is found. About 50% of the AN cases had normal ipsilateral IAC in plain and tomographic radiographies. A pathological IAC finding strongly favours AN, but the border between a normal and pathological finding is not an exact one. A normal plain and tomographic radiography does not exclude AN and further investigations cannot be avoided. Our conclusion is that plain radiograms and tomograms have no place in the modern diagnosis of AN.

Ear, Inner↗
PubMed1988

Long-term presence of a denture fragment in the airway (a report of two cases).

Two cases are reported in which a denture fragment was lodged in the bronchus for a period of six years. Bronchial asthma which did not worsen immediately after inhalation and other misleading factors made the diagnosis more difficult in the first case, whilst the respiratory symptoms in the second case appeared only 4 years after inhalation. Haemoptysis 2 years later led to a bronchoscopy and the removal of the foreign body.

Aged↗
PubMed1988

Semiquantitative culture results and pathogenic significance of obligate anaerobes in peritonsillar abscesses.

We studied the bacteria in consecutive peritonsillar abscesses using semiquantitation of the primary culture findings and correlated the results to clinical parameters. Puncture-aspirated pus from 42 abscesses yielded 133 isolates. Group A streptococci were isolated 10 times and, unlike other bacteria, were isolated 4 times in pure culture; other beta-hemolytic streptococci were found in 8 abscesses, and anaerobes were found in 28. The infections were polymicrobial, with two to seven bacteria in 83%. Anaerobes were more abundant than nonanaerobes; members of the genera Streptococcus, Bacteroides, Peptostreptococcus, and Fusobacterium were the most important quantitatively, considering both frequency and abundance. In patients with ongoing antibiotic treatment, nonanaerobes (but not anaerobes) were less abundant than in untreated patients. The abundance of obligate anaerobes (specifically cocci and gram-positive rods) correlated to the severity of illness as defined by fever and short duration before hospitalization. With other groups of bacteria, no such correlation was found. The correlation was not explained by a difference between the antibiotic-treated and the untreated patients. The results indicate the value of the semiquantitation of culture data and the frequency and pathogenic significance of obligate anaerobes in peritonsillar abscesses.

Adolescent↗
PubMed1988

Acoustic neuroma surgery in northern Finland.

A series of 40 patients with acoustic neuromas were operated on using the suboccipital or the translabyrinthine approach. Some patients were operated on using both routes. The series extends back to 1977 and contain predominantly large tumours. There was no mortality in the translabyrinthine series of 14 patients. In the suboccipitally treated series of 29 patient, 3 were previously treated using translabyrinthine approach. In this series there was one death directly due to sequelae of neuroma extirpation and in another, additional causes were present. Preoperative facial pareses were frequent. There were several additional pareses in the translabyrinthine series and also several additional in the suboccipital series. Facial pareses were operated on by a plastic surgeon and they did not markedly detract from working capacity. Only 2 patients in the total series had small tumours and useful preoperative hearing. Cochlear function was preserved in them.

Adult↗
PubMed1986

Tularemia in otolaryngologic practice. An analysis of 127 cases.

Ulceroglandular, glandular, and oropharyngeal forms of tularemia may occur in otolaryngologic patients, frequently causing diagnostic difficulties. A retrospective analysis of 127 patients with serologically proved tularemia in the head and neck region is presented with special reference to diagnostic difficulties. Short case reports of six patients are included. Difficulties seemed to appear especially in the diagnosis of glandular tularemia. Oropharyngeal tularemia is easily confused with infectious mononucleosis. A high degree of suspicion of tularemia is recommended in endemic areas.

Adolescent↗
PubMed1986

Immunoelectron microscopical location of the acid cysteine proteinase inhibitor in the lymphatic tissue of the tonsils.

Previous studies have shown the acid cysteine proteinase inhibitor (ACPI) to be a common characteristic of human squamous epithelial cells and dendritic reticulum cells (DRC) in lymphoid secondary follicles. In the present study, we used the PAP-preembedding technique for the immunoelectron microscopic identification of ACPI in DRC in palatine tonsillar tissue. ACPI appeared to be located in the cytoplasm of perikaryon and of dendritic processes of DRC on the membranes of the endoplasmic reticulum and the outer membrane of mitochondria. Further more, the tonofilaments and the desmosomal membranes exhibited a strong ACPI reactivity.

Adolescent↗
PubMed1986

Localisation of a CSF fistula by metrizamide CT cisternography.

Localisation of a cerebrospinal fluid fistula in the nasal region is difficult. Lack of a suitable roentgen contrast medium for intrathecal use has earlier restricted the utility of cisternography. Metrizamide cisternography and CT have recently proved to be well tolerated and effective in revealing CSF fistulae. A case report of operatively treated CSF rhinorrhea recurring after three years is presented. With the help of CT metrizamide cisternography, the fistula could finally be localised in the sphenoidal sinus. The re-operation confirmed this finding. The technique of cisternography is described.

Aged↗
PubMed1986

Bronchial changes in airborne tularemia.

We describe seven typhoidal tularemia patients without ulcers or lymphadenopathy, who underwent diagnostic bronchoscopy. Four patients had had obvious airborne exposure to F. tularensis during farming activities, and the remaining three had respiratory symptoms also. Bronchoscopical findings were pathological in all cases, varying from local to diffuse haemorrhagic inflammation; in one case a granulomatous tumour was seen. Early histopathological changes in three biopsies consisted of haemorrhagic oedema progressing to a non-specific inflammatory reaction, which could still be found 45 days after the onset of symptoms. Granulomatous inflammation, indistinguishable from tuberculosis or sarcoidosis, was seen in four biopsies from two patients, three to seven months after the onset. Most patients had radiographic hilar enlargement. We conclude that transmission of typhoid tularemia usually occurs through inhalation leading to bronchial changes, which correspond skin ulcerations in ulcero-glandular tularemia, the hilar enlargement corresponding to the lymph node component. We emphasize that usage of the term 'typhoidal' tularemia should be discontinued. Instead, tularemia transmitted through inhalation should be called pulmonary or respiratory.

Adult↗
PubMed1986

[Low-molecular cysteine protease inhibitors in the human palatal tonsil].

2 low-molecular cysteine-proteinase inhibitors were purified from human tonsillar tissues: an acid cysteine proteinase inhibitor (ACPI), and a neutral cysteine proteinase inhibitor (NCPI). Their biochemical and immunological characteristics appeared to be identical to those inhibitors which we have identified in other human tissues in previous studies (epidermis and spleen). An immunohistological analysis revealed in tonsillar squamous epithelium a strong and consistent immunoreactivity for both inhibitors. In the tonsillar lymphatic tissue, ACPI-immunoreactivity appeared to be a characteristic mainly of dendritic reticulum cells whereas a prominent NCPI-immunoreactivity was confined mostly for the histiocytic reticulum cells in lymphoid secondary follicles. We also compared the distribution of the 2 immunoreactive inhibitors with the immunohistology as revealed by antisera raised against keratin and muramidase. Limitations of the immunohistochemistry of cysteine proteinase inhibitors are discussed in the light of an extensive trial of various fixation procedures. We deem that proposal of Barrett (1984) for the nomenclature of cysteine proteinase inhibitors is appropriate. According to it the ACPI is the cystatin A, and the NCPI is the cystatin B.

Child↗
PubMed1985

Acid cysteine-proteinase inhibitor, a new characteristic of reticulum cells in human lymphoid secondary follicles.

Reactive lymph nodes, palatine tonsils and thyroid tissues infiltrated with reactive lymphatic tissue were studied for the presence of immunoreactive acid cysteine-proteinase inhibitor (ACPI). A positive reaction for ACPI was found in germinal centres in all the above tissue types. The morphology and distribution of the positive cells indicated immunoreactivity in the dendritic reticulum cells (DRC). A positive reaction was also found in starry sky cells when a strong starry sky reaction was present in germinal centres. ACPI-positive cells of dendritic appearance were also found outside the secondary follicles in tonsillar tissue from cases of chronic or recurrent tonsillitis, especially between the follicles and the crypt epithelium, in some lymph nodes exhibiting a strong follicular reactive hyperplasia and in thyroid tissue in one case of Hashimoto's thyroiditis. A close anatomical and morphological relationship is pointed out between ACPI reactive dendritic cells and epithelial tissue. This is especially true of the tonsillar crypt epithelium and adjacent lymphoid secondary follicles. The tonsillar crypt epithelium sometimes formed a loose, web-like structure with enmeshed lymphoid cells, even reminiscent of dendritic compartmentalization of lymphoid secondary follicles. The results suggest that ACPI-immunoreactivity of DRC could be a function of the outer membrane of dendritic processes, and thus could be in some way a parallel phenomenon to the morphological expression of the well-established function of DRC in capturing antigen and immune complexes.

Cysteine Proteinase Inhibitors↗
PubMed1985

Peritonsillar abscess: bacteriological evaluation.

The pus from a series of 41 peritonsillar abscesses was examined bacteriologically. In the majority of the abscesses a mixed bacterial flora was found. The specimens yielded 0-7 different bacterial species per abscess (mean 3.0). One species alone was isolated only in five cases (12.5%). Both anaerobic and aerobic bacteria were isolated from the specimens of 25 patients (61%), only anaerobes from two specimens (4.9%), and only facultative bacteria from 12 specimens (29%). Beta haemolytic streptococci were cultured in 43.9% of the cases, but Streptococcus pyogenes group A in only 10 cases (24.4%). Thus, the pus of the peritonsillar abscess seems to be caused by a mixed bacterial infection, where anaerobic bacteria play a significant role. Indications of tonsillectomy in cases with peritonsillar abscess are discussed.

Adolescent↗