Biomedical subjects

K Setälä

Publications and source records attributed to K Setälä.

At least 37 records · Page 2Linked to original sources

PubMed1990

Long-term treatment of involuntary facial spasms using botulinum toxin.

Botulinum toxin, a powerful pre-synaptic neurotoxin produced by Clostridium botulinum, interferes with the release of acetylcholine from nerve terminals. Since September 1985, we have been using this toxin to treat altogether 62 patients with benign facial spasms. Most of the patients had been on drugs or psychotherapy, 2 had received alcohol injections, 2 had undergone surgery of the orbicular branch, and 2 electrocoagulation of the facial nerve. In essential blepharospasm the duration of the beneficial effect after each treatment with botulinum toxin was about 3 1/2 months. In patients with hemifacial spasm the response was clearly longer, nearly 5 months in most cases. The treatment gave the best and longest-lasting relief of symptoms in patients suffering from disturbing myokymia. Response was poorest in patients suffering from facial spasms who simultaneously had a severe psychiatric disease. The most frequent side effect was mild or moderate ptosis (22.6%). Some patients complained of dry eyes and a few cases displayed facial nerve paresis. Side effects caused by botulinum toxin injections are transient but so also, unfortunately, is the beneficial effect on facial spasms.

Adult↗

PubMed1990

Granular corneal dystrophy with early stromal manifestation. A clinical and electron microscopical study.

We describe a family tree from central Finland with 19 members of which 10 had typical granular corneal dystrophy (Bücklers 1938). This granular dystrophy seems to start from the subepithelial and anterior stromal region. In quite early ages the granules spread not only into the midstromal layers but also into the most posterior stroma between the stromal lamellae and Descemet's membrane. Corneal epithelial erosions were not noticed in this family. The central cornea was mostly affected and 2-3 mm of the corneal periphery was clear. No endothelial changes were found from the corneal midperiphery by specular microscopy. To date, two female patients have needed penetrating keratoplasty; one in her late thirties and the other in her early forties. Their corneal buttons were studied by electron microscopy and histochemically. Granular material was found between the stromal lamellae and also inside the stromal keratocytes. Bowman's membrane was disrupted and degenerated in the areas where the deposits were situated in the subepithelial region. Recurrence of the disease was observed in the corneal transplants of the two operated patients 3 years postoperatively, starting again in the subepithelial region and mostly in central areas of the transplant. This disease entity seems to be different from the granular dystrophy also reported from Finland by Forsius et al. (1983).

Adolescent↗

PubMed1989

Silicone oil in retinal detachment surgery. Results and complications.

Results and complications with the use of intraocular silicone oil in 25 eyes operated on for complicated retinal detachment are reported. Most eyes had undergone several operations for detachment before silicone injection. The follow-up time after silicone injection was 12-48 months. In perforating injuries the outcome was quite poor, 27% received anatomic success (attached retina) compared to primary rhegmatogenous detachments with 57% success rate. Visual acuity was counting fingers 1 m or better in 56% in the whole group examined. Silicone oil was removed in 5 eyes. Of the late complications, keratopathy occurred in 3 eyes (12%), increased intraocular pressure in 4 eyes (16%), and cataract in 2 of 3 phakic eyes. Angiographic signs of iris neovascularization were obvious or suspected in 3 of 9 eyes examined.

Adolescent↗

PubMed1989

Changes in corneal endothelium after treatment of retinal detachment with intraocular silicone oil.

Keratopathy represents one of the most frequent late complications in eyes with complicated retinal detachment treated with intraocular silicone oil. Corneal examinations including endothelial specular photography were done on 18 silicone treated eyes, 16 of which were aphakic. In addition to widespread silicone oil endothelial contact in 2 eyes, a bubble or droplets of silicone oil were observed in the anterior chamber in 8 eyes. The mean endothelial cell density was lower in the silicone eyes (2076 +/- 196 cells/mm2) as compared to the control fellow eyes (2738 +/- 86 cells/mm2) (P = 0.004). In eyes with silicone oil in the anterior chamber the endothelial cell density was significantly decreased (1857 +/- 232 cells/mm2) (P = 0.005). Obvious endothelial degeneration was noticed when silicone oil had been in the eye for more than a year. Also small droplets of oil with transient contact contributed to its development.

Adolescent↗

PubMed1989

Contact lens intolerance induced by DM rupture and secondary endothelial degeneration. A specular microscopic study.

Breaks or tears in the endothelium and Descemet's membrane (DM) are easily noticed in exact biomicroscopical ophthalmological examination. We present 2 patients with a large unilateral horizontal rupture in Descemet's membrane and abnormal corneal endothelia. In the area of the rupture the endothelial mosaic was highly abnormal, and there was no cell reflex. At the site of the rupture and at the periphery of the cornea of the affected eye the endothelial cell density was distinctly lowered, with pleomorphism and polymegathism. In an eye with a DM rupture and degenerated endothelium, difficulties in contact lens wear seem to be due to the hypoxia caused by soft contact lenses. For such patients, only gas-permeable hard lenses with short wearing times should be recommended. Check-ups should be frequent and meticulous. To ensure that endothelial degeneration is noticed well before corneal damage is clinically evident, the endothelial cells must be counted and changes sought for by specular microscopy.

Adolescent↗

PubMed1989

Alport syndrome with hereditary macular degeneration.

We present two patients, a mother and son, with Alport's syndrome (hereditary nephritis and perceptive deafness). Only the son had the typical lenticonus and perimacular flecks. Both patients had macular degeneration, the clinical manifestation of which resembled that seen in cone dystrophy. Colour vision was affected, the cone-mediated b-wave implicit times were increased in mother and in both her eyes the amplitudes were small, both to single flash stimuli and to 30 Hz white flicker. The macular changes in the son, though slight, were similar to those seen in the mother.

Adult↗

PubMed1989

Acute bilateral corneal hydrops caused by high temperature and high moisture in the Finnish sauna. A clinical and histological case report of a patient with keratoconus.

A 44-year-old healthy male with bilateral keratoconus developed acute hydrops of both his corneas with an interval of 3 years. On both occasions he had bathed in a hot, humid Finnish sauna the preceding evening. Penetrating keratoplasty had to be performed in the acute stage in both instances, as medical therapy brought no improvement. The contributory role of hot, moist air to the development of acute hydrops is discussed. Histopathological examination of the corneal buttons revealed clear-cut breaks in Descemet's membrane with marked posterior stromal oedema.

Acute Disease↗

PubMed1989

Orbital metastasis from cutaneous malignant melanoma.

Orbital metastasis is a rare presenting sign of a cutaneous malignant melanoma. Fewer than 30 cases of orbital metastases have been published so far. A 69-year-old man was remitted to our clinic for removal of an orbital tumour verified with CT. Fine-needle aspiration biopsy revealed the tumour to be a metastasis from a cutaneous malignant melanoma diagnosed 4 years earlier. The patient died 3 months after detection of the orbital metastatic tumour. This case illustrates the value of simple fine-needle aspiration biopsy in the diagnosis of orbital tumours.

Aged↗

PubMed1988

Respiratory arrest after retrobulbar block.

We describe a patient who suffered respiratory arrest some minutes after retrobulbar block before cataract extraction. She was managed by artificial respiration for 20 min, and after the had recovered from this potentially fatal complication cataract extraction was performed without complications and without any neurological sequelae. Retrobulbar blocks, as well as other retrobulbar, injections, should be performed only in safe situations. Individuals trained in airway maintenance and ventilatory support should be immediately available, and the patient must be monitored for at least 10 min after the retrobulbar injection.

Adult↗

PubMed1988

Long-term follow-up of cryopreserved corneal endothelium. A specular microscopic study.

This paper deals with the long-term survival of corneal transplant endothelial cells. Endothelia of 17 cryopreserved corneal transplants were photographed with a specular microscope, first 1.5 years (mean) following transplantation, and again 10 years later. All transplants were absolutely clear. The mean cell loss was 23% in 12 years. After 2 to 14 years post-operatively the cell loss was noticed to be only 13.6% (from 990 +/- 255 cells/mm2 to 855 +/- 213 cells/mm2). It seems that endothelial cells of cryopreserved corneal grafts, although few in number, are still quite resistant and viable after a long follow-up time and survive like endothelial cells after preservation in tissue culture media.

Adult↗

PubMed1988

Corneal graft endothelial cell densities after preservation in M-K, K-sol and MEM tissue culture media. A clinical and specular microscopic study.

The endothelial cell densities of corneal transplants of 30 keratoconus patients have been studied. All operations were performed by the senior author using the same technique. Preservation systems M-K medium, MEM-solution and K-sol were used; ten grafts in each group. The average endothelial cell density for all 30 transplants was 1815 +/- 869 cells/mm2. The mean cell density was the lowest (1128 +/- 587 cells/mm2) and the mean follow-up time longest (2 years and 9 months) in M-K medium stored grafts. K-sol is the newest preservation method used in our hospital. It gave the best graft endothelial cell densities (2302 +/- 938 cells/mm2). The mean follow-up time was shortest in K-sol (8 months). The mean endothelial cell density for grafts from MEM-solution was 2015 +/- 614 cells/mm2) with the mean follow-up time of 1 year, 4 months.

Adolescent↗

PubMed1988

Corneal endothelium in Marfan syndrome. A clinical and specular microscopic study.

Marfan syndrome is classified as a heritable disorder of connective tissue, and it has been assumed to be an inborn error of protein metabolism particularly in collagen or elastin. We examined 41 Marfan syndrome patients and found in the corneal endothelium guttata-formation, considerable cell pleomorphism, non-reflecting endothelial black spots and in some cases abnormal looking endothelial cells. The relation of pathological endothelium to lens subluxation, axial length and other corneal findings is discussed.

Adolescent↗

PubMed1987

Keratoendotheliitis fugax hereditaria. A clinical and specular microscopic study of a family with dominant inflammatory corneal disease.

A peculiar hereditary corneal disease seen in one pedigree is presented. The disease manifests itself as transient attacks of kerato-endotheliitis. These attacks last from a few days to some weeks. Clinically, corneal oedema and endothelial guttata-like changes with very slight anterior chamber reaction can be seen; after many attacks there may be permanent opacities in the stroma. Endothelial specular photography during an attack reveals dramatic changes: large black nonreflecting areas between quite normal-looking hexagonal cells. Also between the attacks and among family members who have no clinical corneal disease, changes in the endothelium: black spots in the centres of endothelial cells and marked pleomorphism, are to be seen. Among the family members a high incidence of collagen diseases was found.

Adult↗

PubMed1987

The triple procedure. Penetrating keratoplasty, extracapsular cataract extraction and posterior chamber lens implantation. A clinical and specular microscopic study.

The combination of penetrating keratoplasty, cataract extraction and intraocular lens implantation, the triple procedure, is the surgical choice for the patients with corneal disease and cataract. The success of the corneal graft depends chiefly on the endothelium of the transplanted cornea. Preservation, donor age, cadaver time, histocompatibility and operation itself affect endothelial cells. We present clinical results including endothelial evaluation of 20 patients who have undergone the triple procedure during the years 1984-1986. Mean age was 73 years. The follow-up time varied from 1 to 30 months. The visual recovery was very good. Every patient had better visual acuity post-operatively than pre-operatively. We had no operative complications. Three patients had rejection episodes which all were cured with cortisone. No re-transplantations were needed. The mean endothelial cell density was 1723 cells/mm2. The possible factors affecting the outcome are discussed.

Aged↗

PubMed1987

Trabeculectomy with the use of sodium hyaluronate. One year follow-up.

The effect of sodium hyaluronate (Healon) on the post-operative course 1 week, 1 month and 1 year after trabeculectomy is reported. Forty-six eyes of 38 patients with open-angle glaucoma (16 simple, 16 capsular and 14 secondary glaucomas) were operated with the use of sodium hyaluronate. The study was prospective. For comparison, 46 eyes of 38 age-, sex- and diagnosis-matched patients with glaucoma operated during the pre-Healon period were selected. Patients in the study group were operated by the same surgeon and in the control group by different senior staff members. IOP decrease was essentially the same in both groups. No differences in post-operative pressure level existed between the different types of glaucoma. Extremely shallow or flat chamber occurred more frequently in the control series: 15 versus 9. Statistical analysis could not be applied. The trend in favour of Healon is discussed. Pressure rise greater than or equal to 30 mmHg 2-7 days after the operation was diagnosed in 8 eyes of the Healon group and 13 eyes of the control group. IOP rise was relieved by argon laser treatment of the fistula during the first week post-operatively in 6/8 eyes of the Healon group in order to facilitate aqueous drainage. Sodium hyaluronate facilitated the technical performance and prevented collapse of anterior chamber and AC haemorrhages during the operation. Sodium hyaluronate seems to prevent excessive early filtration and hypotony.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1987

Use of botulinum toxin in blepharospasm and other facial spasms.

Essential blepharospasm is an involuntary spasmodic closure of the eyelids. It frequently makes normal social human life such as reading, driving and even walking almost impossible. Botulinum toxin has been approved for investigational use for treatment of blepharospasm. We report the results and side-effects of botulinum A toxin treatment of the first 13 patients in Finland. Temporary control of spasms was achieved in all patients varying from 1 to 38 weeks with a mean of 11 weeks after the first injection. Most patients needed re-treatment after varying intervals. All complications were transient.

Adult↗

PubMed1987

Bilateral absolute phakolytic glaucoma. A clinical and ultrasonographic case study.

We describe an unusual case of absolute bilateral phakolytic glaucoma. On admission for cataract surgery the 75-year-old patient was found to be totally blind, no light perception in either eye. The ocular tensions were about 75 mmHg in both eyes, corneas hazy, the fundi could not be seen. The swollen lens of the right eye had slightly subluxated downwards. In the left eye the ultrasound showed a luxated swollen lens in the vitreous space. The ultrasound also revealed totally excavated optic discs. This patient had been on the waiting list for 8 months. Information of the stage of the cataracts of patients on the waiting lists for operation is of paramount importance in the prevention of lens induced problems which may lead to irreversible visual deterioration.

Aged↗

PubMed1986

The promise of enzymes in therapy of hyperlipidemia.

Treatment of hyperlipidemias must be commenced in that intestinal segment where alimentary lipoprotein aggregate generation is initiated postprandially and the aggregates are still in nascent form. This is to prevent the formation of potentially pathological units that do not equilibrate with the blood colloid. The colloid chemical state of the alimentary lipoprotein entities in the systemic circulation is decisive for maintenance of their stability and for their disposal from the blood. The causes of impaired, "unripe," lipoprotein aggregate formation include: (a) the action of human pancreatic lipase is even normally a restricted and vulnerable process, (b) inadequate ratio of protein to fat to stabilize the aggregates, (c) defective proteolysis in the small intestine, and (d) the dual behavior of the surface tension-lowering agent, the lecithin antagonist cholesterol. On the one hand, cholesterol represents physicochemically the weakest link in the lipoprotein interfaces. On the other hand, an excess of cholesterol in lipoprotein interfaces decreases the stability of the surface film. This leads to changes in the decay of the entities and the cell surface-active lipid constituents of the "unripe" plasma lipoprotein colloid complexes can easily be adsorbed to the endothelial cell surface plasma membrane: the excess aggregate-cholesterol molecules simply join, or dissolve in, the cell membrane-cholesterol which thus acts as its own receptor or solvent: cholesterol dimers occur. This causes rigidity of the endothelial cell surface membrane and leads to impaired cell metabolism. The intima recognizes the impairment as a foreign body and initiates a physiological defense reaction including phagocytosis. The event may be still more dangerous if the adrenergic receptors of the autonomous nervous system involved in lipolysis with subsequent plasma efflux are simultaneously stimulated. The therapeutic measure indicated is production of balanced alimentary lipoprotein aggregates. This can be achieved by oral administration of (a) protease, and (b) non-specific micellar lipase. The lipase functions without restriction and can perform all the activities that human pancreatic lipase cannot. The enzymes utilized are of mold origin and generally available.

Adipose Tissue↗