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Biomedical subjects

K Virtanen

Publications and source records attributed to K Virtanen.

At least 19 recordsLinked to original sources

Polymorphonuclear leukocyte chemotaxis induced by zinc, copper and nickel in vitro.

Metallic dental restorations and prosthetic constructions are susceptible to corrosion in oral environment, resulting in the release of various heavy metal ions. Chloride salts of zinc, copper, nickel, chromium, iron and gold were tested for their ability to promote the migration of polymorphonuclear leukocytes (PMNs). Using a modified Boyden chamber assay for chemotaxis zinc, copper and nickel enhanced the migration of PMN cells in concentration range of 0.5-1.0 mM, whereas no augmentation in migratory activity was noted using chromium or iron. In contrast, an inhibition in migratory activity was observed in cells directed toward gold ions. Exposure of cells to zinc, copper or nickel ions induced an orientation reaction in leukocytes in a similar fashion as the polarization reaction induced by a potent peptide chemoattractant, N-formylmethionylleucylphenylalanine (fMLP), in these cells. Exposure of PMN cells to zinc or nickel in chemotactic concentrations stimulated the chemotaxis of these cells to fMLP 2-fold, whereas pretreatment of the cells with zinc prior to assay markedly decreased the subsequent chemotactic migration of the cells to this metal or to fMLP. The enhanced locomotion of PMN cells induced by zinc, copper or nickel ions was found to be in greater extent due to an increase in directed migration (chemotaxis) rather than an augmentation in random movement (chemokinesis) as assessed by Zigmond-Hirsch checkerboard analysis. These results suggest that zinc, copper and nickel ions attract leukocytes by inducing and promoting the chemotactic response in these cells, which may modulate the inflammatory response of host tissue around such metals.

Animals

Anorectic effect of metformin in obese Zucker rats: lack of evidence for the involvement of neuropeptide Y.

The hypothalamic neuropeptide Y content and preproneuropeptide Y mRNA expression were studied in metformin-treated (300 mg/kg orally for 12 days), in pair-fed and in ad libitum-fed obese Zucker rats in order to elucidate possible mechanisms involved in the anorectic and body weight reducing effect of chronic metformin treatment in genetically obese Zucker rats. In addition the acute influence of metformin on food intake was studied by comparing its effects after oral and parenteral administration. The concentration of neuropeptide Y in the hypothalamic paraventricular nucleus was significantly higher in the metformin-treated and pair-fed rats when compared to the control animals. The expression of preproneuropeptide Y mRNA in the arcuate nucleus was similar in all three treatment groups. Both chronic metformin treatment and pair-feeding markedly lowered hyperinsulinaemia in these animals. A single subcutaneous dose of metformin (300 mg/kg) reduced food intake only in obese animals, while the same dose of metformin given orally did not affect food intake in either lean or obese animals. It is concluded that the treatment with metformin and pair-feeding, which results in comparable reductions in food intake, body weight gain and hyperinsulinaemia, similarly increase neuropeptide Y concentrations in the paraventricular nucleus while not affecting preproneuropeptide Y mRNA expression in the arcuate nucleus. The increase in hypothalamic neuropeptide Y content may be secondary to the reduction in hyperinsulinaemia during metformin treatment and pair-feeding. Thus, the anorectic effect of chronic metformin treatment cannot be explained by changes in content or expression of hypothalamic neuropeptide Y.

Administration, Oral

Cardiopulmonary evaluation of exercise tolerance after chest irradiation and anticancer chemotherapy in children and adolescents.

OBJECTIVE: The aim of the study was to evaluate the cardiopulmonary exercise tolerance in children and adolescents after chest irradiation and anticancer chemotherapy. METHODS: We studied 30 subjectively asymptomatic patients aged 8 to 25 years treated for pediatric malignancies with chest irradiation (XRT) +/- chemotherapy. The median interval since XRT was 7 (range, 2 to 13) years. The median XRT dose for mediastinum and/or lungs was 2550 (range, 1000 to 5100) cGy. The median cumulative dose of anthracyclines was 250 (range, 0 to 480) mg/m2. Cardiac function and exercise tolerance were evaluated by electrocardiography, echocardiography, radionuclide cineangiography, and exercise test with gas exchange analysis. RESULTS: The patients differed from normal controls in systolic indices of myocardial function. In echocardiography, the left ventricular contractility was abnormal in 14/30 patients. In radionuclide cineangiography, the left ventricular ejection fraction was subnormal in 6/30 patients, and in 9/30 patients the rise in ejection fraction during exercise was inadequate (< 5%). In exercise testing, the mean (+/- SD) maximum workload attained was 2.7 (+/- 0.7) watts/kg, and the mean (+/- SD) maximum oxygen consumption was 35.4 (+/- 9.7) mL/min/kg. Both variables were < 80% of predicted values in 11 patients. CONCLUSIONS: XRT and anticancer chemotherapy very often lead to late cardiopulmonary toxicity and impaired exercise tolerance. Although in most cases this toxicity seemed to be mild and subclinical, the long-term clinical sequels merit further evaluation.

Adolescent

Long-term blood flow potentials in sequential internal mammary artery grafts. Exercise thallium scan for myocardial perfusion study.

In two groups of patients, coronary artery bypass surgery for angina pectoris included internal mammary artery (IMA) sequential grafts (group I) or single grafts (group II). At postoperative angiography all grafts were patent. In addition, the patients received on average 1.8 vein grafts into other coronary arteries. The mean interval to postoperative follow-up was 9.5 years in group I and 9.7 years in group II. The preoperative incidence of acute myocardial infarction was 44% and 45% in groups I and II. Exercise thallium scan at follow-up showed IMA graft-related ischemia in 33% of the patients with sequential graft and in 64% of those with single graft (ns). Our results indicated that sequential IMA grafts functioned at least as well as single grafts and maintained adequate myocardial supply even 10 years postoperatively. Internal mammary arteries are superior graft material and can be recommended both as single and as sequential graft in coronary artery bypass surgery.

Aged

Internal derangement of the temporomandibular joint: a histochemical study.

The purpose of this study was to correlate histologic findings in temporomandibular joint (TMJ) condyles and discs with their macroscopic appearance at surgery. The 24 patients with internal derangement of the joint included 20 women and 4 men (mean age, 37 years; range, 18 to 61 years). The tissue lesions varied in degree from mild soft-tissue fraying and bone remodeling to extensive resorption and new cartilage and bone formation with high phosphatase enzyme activities, and even to loss of articular soft tissue and breakdown of cortical bone. Reactions may arise in the hard tissues before they occur in the articular surface layers.

Acid Phosphatase

Indications for and risks in reoperation for coronary artery disease.

Seventy-one coronary artery bypass grafting (CABG) reoperations were performed during a 17-year period, comprising 2.7% of all CABG operations. The main indication (in 87%) was vein graft failure alone or combined with other causes. Progression of disease in native coronary arteries was the sole indication in only 4 of the 71 cases. There were seven perioperative deaths, mainly due to myocardial infarction. Significant perioperative complications arose in 36 cases, including intraoperative lesion of a previous left internal mammary graft (16.2%) or of the right ventricle or anterior descending branch of the left coronary artery (2.8%). Postoperative low output syndrome appeared in 13 patients (18.3%), in seven of whom myocardial infarction was verified. Postoperative bleeding required resternotomy in six cases (9.1%). Because of the heightened operative mortality and morbidity risks, indications for redo CABG should be individualized. A well functioning internal mammary artery graft may be a relative contraindication. Accurate knowledge of the previous operation is essential and, especially in young patients, the possibility of reoperation should be taken into consideration at initial CABG.

Adult

Right gastroepiploic artery as a coronary bypass graft.

Between November 1987 and April 1988, the right gastroepiploic artery (GEA) was used as a coronary artery bypass graft in 11 patients, 9 men and 2 women. In 1 of them, the GEA was used because no veins were available; in the others, the GEA was used to avoid the use of vein grafts. The GEA was anastomosed to the right coronary artery in all patients, and internal mammary artery grafts were used to bypass the left anterior descending and circumflex coronary arteries. All patients survived the operation. There were no early and, to date, there have been no late complications of the abdominal component of the operation. Postoperative coronary angiography showed a patent right GEA in 9 patients (82%). In 1 patient the GEA was occluded, probably because of an enlarged liver. If the long-term patency of right GEA grafts is similar to that of internal mammary artery grafts, wider use of this viable graft is indicated.

Adult

Results of reoperations for coronary artery disease.

Seventy-one patients undergoing reoperation for coronary artery disease were examined on average 2.5 years postoperatively. Operative mortality was 9.9% and late mortality 6.3%. 88% of the patients improved subjectively, and although only 7.8% were angina-free, 79.9% were in NYHA Class I or II. All patients who had been working before reoperation returned to work, and either patients who were on sick-leave before resumed their activities. A follow-up examination was performed in 21 patients with a follow-up time of more than three years. The mean peak work capacity did not change after reoperation and also the ST changes during the bicycle ergometer exercise test were the same after reoperation. The mean ejection fraction diminished from 54 +/- 15.5% to 44.7 +/- 15.2%. In thallium perfusion studies areas of hypoperfusion were observed in 14 cases (67%). Coronary angiograms showed 3.0 +/- 1.0 patent anastomoses at the follow-up examination; 76% of the anastomoses performed in the reoperations were patent. It can be concluded that although the objective results of repeat myocardial revascularisation in this material are not optimal, the subjective improvement of the patients was satisfactory, and in the majority of cases reoperation ensures an acceptable quality of life for years.

Coronary Artery Bypass

Surgical and prosthetic treatment of the atrophic mandible.

Two vestibuloplasty methods and a muscle-formed method for improving the retention and stability of complete mandibular dentures were compared in 19 edentulous patients with advanced mandibular bone resorption. The resorptive changes in the alveolar crest and any relapse in the extended vestibule after surgery were monitored for 2 yr. Simultaneous production of the first new complete dentures, to which the labial plate is added during the surgical procedure, and firm circummandibular fixation during primary healing will guarantee the best surgical and prosthetic results. This order of treatment also eliminates unnecessary surgical procedures. A muscle-formed method for extending the baseplate of a complete mandibular denture was found to be a useful alternative for patients with highly advanced mandibular bone resorption.

Adult

Ruptured coronary artery aneurysm--a rare cause of hemopericardium.

Large coronary artery aneurysms may interfere with coronary flow, cause compression, and/or may rupture. Circulatory shock from thrombosis and rupture of an aneurysm of the right coronary artery in a patient is reported here. This formation, 7 cm in diameter, was visible by computed tomogram but the diagnosis was revealed only during surgery. The successful treatment, using aneurysmectomy and reconstruction with an interposed saphenous vein graft, is described.

Aneurysm

Postoperative disc entrapment following cardiac valve replacement--a report of ten cases.

The sudden jamming of a prosthetic valve disc is one cause for postoperative hemodynamic deterioration. This complication occurred in 10 instances (2% of disc valves implanted), resulting in 4 fatalities. In 6 patients the disc entrapment was a complication following mitral valve replacement, and in 4 others the malfunction followed aortic valve surgery. The entrapment of the disc occurred on the second postoperative day in 3 patients. Two of these were due to an unresected chordal strand becoming wedged between the disc and valve rim of a Björk-Shiley mitral prosthesis and resulted in death. In the third patient, the aortic valve disc became attached to the Björk-Shiley composite aortic graft following the repair of an aortic dissection. A firm blood clot had formed between the graft and the oversewn aortic wall. This patient recovered after cardiopulmonary resuscitation and subsequent reoperation. The remaining cases developed while the patients were still either on the operating table or in the recovery room. The mechanisms of the disc entrapments are presented and the significance of an early correct diagnosis and urgent surgical correction is underlined.

Adult

Posttraumatic osteolysis of the distal ends of the clavicle. Report of three cases.

Three cases of posttraumatic osteolysis of the lateral end of the clavicle are described. Two of the patients were judo participants who fell on their shoulder. They were treated primarily as partial acromio-clavicular joint dislocations. The third patient was a woman who fell from her bicycle and was treated surgically by a Knowless nail because of acromio-clavicular dislocation. The clinical and radiological findings of osteolysis developed slowly. The joint line was typically widened in the radiographs. The disorder settled spontaneously within one year. Further judo training was possible without symptoms. Distal osteolysis of the clavicle is a rare condition and it may well occur during injury at sport.

Acromioclavicular Joint

Response of blood pressure and plasma norepinephrine to propranolol, metoprolol and clonidine during isometric and dynamic exercise in hypertensive patients.

The effects of metropolol (beta 1-selective), propranolol (nonselective) and clonidine (central alpha-stimulant) on plasma norepinephrine, blood pressure and heart rate were assessed at rest, during isometric work and dynamic exercise in 15 patients with moderate hypertension. Metroprolol resulted in a lower diastolic blood pressure during isometric and dynamic exercise that propranolol, which was paralleled by a lower plasma norepinephrine level during dynamic work; both beta-adrenergic blocking compounds resulted in a lower heart rate in all test situations than that obtained with clonidine; clonidine produced similar control of diastolic blood pressure to that obtained with the beta-adrenergic blocking agents, but did not clearly attenuate the systolic blood pressure response to dynamic exercise. Plasma norepinephrine concentrations tended to be lowest following clonidine, especially during dynamic work. The findings support the hypothesis that the central action of clonidine inhibits peripheral release of norepinephrine, but is insufficient to attenuate cardiac stimulation by physical exercise. The fact that propranolol caused higher plasma norepinephrine concentrations than metoprolol during exercise may explain the difference in the blood pressure responses during exercise.

Adult

Osteochondroses in athletes.

Osteochondroses are disorders of primary and secondary growth centres, or lesions at the apophyseal or epiphyseal growth areas of bones. Although there are many types of osteochondroses, the history, clinical symptoms and findings as well as radiological findings are typical. Physical exercise is one of the factors that provokes symptoms. In a series of 185 osteochondroses in active young athletes, there were 18 different disorders. The commonest were Osgood-Schlatter's disease, Sever's disease, osteochondritis dissecans of the femoral condyles, various other patellar osteochondroses and Scheuermann's disease. Most of the athletes were from individual events; track and field sports (53.5%), cross-country skiing (8.1%), gymnastics (3.2%) and power events (2.7%). Of the team sports soccer produced the most (20.0%). The treatment was conservative in 84.3% and operative in 15.7%. The duration of symptoms in these athletes persisted in about 43% for less than one year and in 57% for more. The late changes of osteodhondroses do not cause serious risks for a normal life, if the treatment is active and the follow-up efficient.

Adolescent

Survival with total occlusion of the left main coronary artery. Significance of the collateral circulation.

Four patients with total occlusion of the left main coronary artery are described. Angina pectoris was severe (NYHA class 3--4) and had lasted 20 months to seven years. Three patients had experienced a myocardial infarction. All displayed large collaterals arising from a nearly normal right coronary artery and feeding both the left anterior descending and the left circumflex arteries. The left ventricular ejection fractions ranged from 20% to 65%, and all patients had varying degrees of left ventricular asynergy. Coronary artery bypass surgery resulted in a marked improvement in three patients; one patient who underwent an aneurysmectomy died two months after the operation. The data show that total occlusion of the left main coronary artery is compatible with survival if adequate collateral supply develops from the right coronary artery. In this rare angiographic subset collateral circulation is clearly functionally significant.

Adult

A new electrical equipment for handgrip testing.

Devices available for isometric handgrip testing revealed constructional deficiences likely to give rise to inaccurate data. A new electrical device was constructed which eliminates the defects in earlier designs. The new equipment consists of a U-shaped handgrip transducer, a measuring device, and a slave monitor for the patients. The patient's maximum handgrip force is determined as a peak voltage, which is stored in analog form. Two comparators help to set the desired handgrip force during the actual testing. The slave monitor's two lamps and analog meter help the patient to apply a force which is maintained at a selected percentage of the maximum force. The device has been shown to operate well in a longitudinal study of drug treatment of hypertension.

Electrodiagnosis