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Biomedical subjects

O P Alho

Publications and source records attributed to O P Alho.

At least 19 recordsLinked to original sources
PubMed2003

Cross-sectional survey of paranasal sinus magnetic resonance imaging findings in schoolchildren.

AIM: Sinus image abnormalities are common among children examined for indications other than sinus disease. The purpose of this study was to determine the frequency of sinus abnormalities among otherwise healthy children attending school. METHODS: Magnetic resonance imaging (MRI) was performed on 24 children aged 8-9 y, 18 of whom were re-examined after 6-7 mo. RESULTS: Sinus abnormalities were common. An abnormality was seen in 12 of the children [50%, 95% confidence interval (95% CI) 29-71%], and 9 (38%, 95% CI 19-59%) had abnormalities in the maxillary sinuses. As many as 8 (42%, 95% CI 20-67%) of the asymptomatic children (lacking clinical symptoms or findings) had abnormalities in the maxillary or ethmoidal sinuses. The follow-up examination showed that about half of the abnormal sinus MRI findings had resolved or improved without any intervention. CONCLUSION: Abnormal sinus MRI findings are common both among otherwise healthy children attending school and in totally asymptomatic children. As incidental findings, these should be interpreted as normal and do not indicate any need for treatment in children imaged for purposes other than sinus disease.

Adolescent↗
PubMed2001

The impact of patient and professional diagnostic delays on survival in pharyngeal cancer.

BACKGROUND: Cancers of the head and neck still are detected mostly at an advanced stage, especially pharyngeal cancers. METHODS: To study the impact of patient and professional delay on survival, the authors collected the data from 84 patients with pharyngeal cancer. In addition to clinical data from the tertiary care center, the authors evaluated the data from the first medical visit in primary care before the diagnosis of malignancy had been made. RESULTS: The patients who had a patient delay of 2 months or more had a significantly higher relative hazard of death (HR; HR, 2.5; 95% confidence interval (CI), 1.39-4.38) compared with the patients with less than 2 months of patient delay. This risk was significant among the patients with oropharyngeal (P = 0.008) and nasopharyngeal cancer (P = 0.03), but not in those with hypopharyngeal cancer (P = 0.56). In contrast, there was no relation between professional diagnostic delay and prognosis. Advanced stage (International Union Against Cancer [UICC] TNM; Stage IV vs. Stage I-III; HR, 3.19; CI, 1.61-6.35) and age (> or = 65 vs. < 65 years; HR, 2.47; CI, 1.32-4.62) also were associated with an impaired prognosis. CONCLUSIONS: Shortening of patient delay would substantially improve survival in pharyngeal cancer, but this goal seems difficult to attain because symptoms emerge late in pharyngeal cancer, and no specific symptoms or patient characteristics were related to a long patient delay. Professional delay does not have an impact on survival in pharyngeal cancer.

Adult↗
PubMed2001

Surfactant protein-A gene locus associated with recurrent otitis media.

Surfactant protein-A, which plays a role in innate host defense in the lung, is also expressed in the Eustachian tube. We report that the frequency of specific surfactant protein-A haplotypes and genotypes differs between children with recurrent otitis media compared with a control population.

Child↗
PubMed2001

Decreasing incidence and improved survival of laryngeal cancer in Finland.

The decreasing incidence rate and improvement in survival of laryngeal cancer patients in Finland are exceptions among western countries. A descriptive study of these trends was conducted including both nationwide population-based cancer registry data with 5 766 patients diagnosed in 1956-1995 and regional hospital-based data from Northern Finland, allowing classification into supraglottic and glottic cancers, with 353 patients diagnosed in 1976-1995. In Finland, the age-adjusted incidence rate among males decreased from 6.5 per 100 000 in 1956-1965 to 3.5 in 1986-1995, while in females the rate remained around 0.3 per 100 000. The rates in Northern Finland were slightly higher and the supraglottic to glottic incidence ratio diminished from 1.4:1 in 1976-1985 to 0.5:1 in 1986-1995. The 5-year relative survival rate improved in both Northern Finland and the whole country, most noticeably among males and the elderly. In the data from Northern Finland, the survival rate was more favourable in glottic (80%) than in supraglottic cancer (64%). Considering the marked decrease in the incidence of the less favourable supraglottic disease, the observed improvement in survival was small.

Adolescent↗
PubMed2001

The common cold in patients with a history of recurrent sinusitis: increased symptoms and radiologic sinusitislike findings.

BACKGROUND: We evaluated whether the symptoms and signs and radiologic findings during a common cold are similar in patients who have and have not suffered from recurrent sinusitis. METHODS: We recruited 2 series of volunteer cases from February 1, 1996, to December 31, 1996. Twenty-three adults who claimed to have suffered from recurrent sinusitis and 25 who had never had sinusitis were examined during the period of a self-diagnosed cold of 48 to 96 hours' duration and again after 21 days. Symptom scores were recorded, nasoendoscopy and computed tomography scans were performed, and viral and bacterial specimens were taken. RESULTS: The patients with a history of sinusitis had significantly higher symptom scores than the control patients (P=.04) and had radiologic sinusitislike changes more often (65% [15] vs 36% [9]; difference 29% [95% confidence interval, 2%-56%]; P=.04). The viral etiology of the common cold (verified in 67% of the episodes) was similar in both groups. Pathogenic bacteria were isolated from the middle meatus in 24% (6) of the control patients and only 9% (2) of the sinusitis-prone patients (P=.15). On the basis of the symptomatology, radiologic findings, and bacterial cultures only 2 patients in the sinusitis-prone group should have been treated with antimicrobials. CONCLUSIONS: Some patients are susceptible to both sinusitislike symptoms and radiologic findings during viral common colds. This may cause them to consult their physicians earlier and more often during viral colds, which may result in unnecessary antibiotic treatments. Nasopharyngeal bacteriological cultures may prove to be useful in ruling out bacterial sinusitis.

Adult↗
PubMed2001

Detection of tongue cancer in primary care.

BACKGROUND: The incidence of tongue cancer is increasing, and survival has not improved since the majority of patients present at an advanced stage. Patient delay has remained the same over the years and is difficult to influence. Much less is known about the delay in diagnosis caused by physicians and dentists. AIM: To investigate the detection of tongue cancer in primary care in Northern Finland and to examine the consultation prevalence of oral symptoms in primary care in Finland. STUDY: Analysis of data from medical records of tongue cancer patients kept between 1 January 1974 and 31 December 1994 for the general health insurance scheme. SETTING: The two northernmost provinces of Finland (population of 700,000). METHOD: Data were collected on demographic and clinical variables and on the first medical visit on 75 tongue cancer patients. In addition, primary care physicians recorded all patient visits during four weeks in 25 health centres randomly selected throughout Finland in 1996. RESULTS: At the initial visit, the tongue cancer patient was correctly referred for further examinations in 49 (65%) cases. In 12 (16%) of cases the patient was not referred but was scheduled for a follow-up visit, and was neither referred nor followed-up in 14 (19%). When compared with the referred patients the median professional delay was somewhat longer for the unreferred patients but increased dramatically if no follow-up was arranged (0.6 months [range = 0.1-2.4] versus 1.2 [range = 0.3-2.2] versus 5.2 [range = 0.7-18.2], P < 0.001). Compared with the referred patients the adjusted relative hazard of death for the non-referred followed-up patients was 1.4 (95% confidence interval [CI] = 0.31-6.5) and that for the non-referred/not followed-up patients 6.3 (95% CI = 1.7-22.9). The high-risk patients included those who sought an early professional evaluation, those who made the appointment for a completely different reason and only mentioned the symptom suggestive of cancer incidentally, those that had a small ulcerative lesion, and blue-collar workers. Oral symptoms were a rare cause of visits (0.55% of all visits) in primary care in Finland. CONCLUSION: Misdiagnosis of tongue cancer at the initial professional evaluation often leads to a fatal delay if the patient is left without any follow-up.

Adult↗
PubMed2000

Lip cancer in Northern Finland: changing incidence and clinical characteristics.

A population-based survey was conducted in 35 municipalities in Northern Finland to assess the incidence of lip cancer as well as the patient and tumour characteristics in cases diagnosed between 1983 and 1997. A total of 96 new patients emerged. The age-standardised incidence (per 100,000 years) of lip cancer in men decreased from 4.8 in 1983-1987 to 1.4 in 1993-1997. The incidences in women were 0.30 to 0.36, respectively. The median age of the patients increased from 66 to 73 years through the years. Overall, 90% of the patients had at least one of the known risk factors, namely rural domicile, outdoor occupation or smoking. The median duration of symptoms also remained the same, as did the median size and location of the tumour at diagnosis. In contrast, spread to regional lymph nodes became rare during the period.

Age Factors↗
PubMed2000

Prognostic factors in tongue cancer - relative importance of demographic, clinical and histopathological factors.

The incidence of and mortality from squamous cell carcinoma (SCC) of the tongue have increased during the recent decades in the Western world. Much effort has been made to predict tumour behaviour, but we still lack specific prognostic indicators. The aim of our study was to evaluate the relative importance of the known demographic, clinical and histological factors in a homogeneous population-based group of patients with SCC of the mobile tongue. The demographic and clinical factors were reviewed retrospectively from primary and tertiary care patient files. Histological prognostic factors were determined from pre-treatment biopsies. The TNM stage was found to be the most important prognostic factor. In particular, local spread outside the tongue rather than spread to regional lymph nodes was related to poor prognosis. Several demographic and histopathological factors were closely related to TNM stage. When the cases were divided into stage I-II carcinomas and stage III-IV carcinomas, it appeared that the patient's older age (> 65 years), a high malignancy score and an absence of overexpressed p53 protein were associated with a poorer prognosis in stage I-II carcinomas. Such cases may require more aggressive treatment. Among patients with stage III-IV carcinomas, heavy use of alcohol was significantly associated with a poor disease-specific survival time.

Adult↗
PubMed2000

Otoacoustic emissions and tympanometry in children with otitis media.

OBJECTIVE: To examine otoacoustic emission and tympanometric findings in children with surgically confirmed middle ear effusion (MEE). DESIGN: A total of 102 children aged 0.7 to 11.4 yr undergoing surgery because of otitis media were included in the study. A tympanometric examination and transient evoked otoacoustic emission (TEOAE) measurement were performed on each ear before myringotomy. MEE was aspirated, weighed and classified as mucoid or nonmucoid. TEOAE measurements were compared with the quantity and quality of MEE and to the tympanometric findings. RESULTS: Fifty (72%) ears out of the 65 ears containing effusion showed reduced TEOAE. The quantity of effusion was associated significantly (p < 0.001) with the TEOAE responses, and mucoid effusion reduced the emissions more than nonmucoid. The sensitivity of tympanometry in identifying the ears without recordable TEOAE was 73% and the specificity 81%. CONCLUSION: MEE results in a significant reduction in TEOAEs even when the effusion is nonmucoid. This suggests that transmission of acoustic energy to and from the middle ear is altered in children experiencing any form of otitis media with effusion.

Acoustic Impedance Tests↗
PubMed1999

Cow's milk allergy is associated with recurrent otitis media during childhood.

To determine whether cow's milk allergy (CMA) in infancy is associated with recurrent otitis media (ROM) or other chronic ear infections, we conducted a cohort study by enrolling 56 milk-allergic and 204 control schoolchildren. We also studied the association between ear problems and different atopic manifestations. A higher proportion of children with CMA had had ROM. defined as at least 15 acute otitis media episodes by the age of 10 years (27%, vs 12%, p = 0.009), and had undergone adenoidectomy and or tympanostomy compared with the controls (48%, vs 28%, p = 0.005). However, this was only true of the children who had developed respiratory atopy. Asthma and/or allergic rhinitis, but not atopic dermatitis, posed a significant risk for ROM, while all the three atopic manifestations enhanced the risk for secretory otitis media. Positive skin prick tests with food, but not with inhaled allergens, tended to be associated with ear problems. In conclusion, we found that children with CMA in infancy, even when properly treated, had experienced significantly more ROM, the risk associating with concomitant development of respiratory atopy.

Acute Disease↗
PubMed1999

Cancer of the mobile tongue in Finland--increasing incidence, but improved survival.

A population-based descriptive study was conducted to describe incidence and survival of cancer of the mobile tongue in Finland between 1953 and 1994. The study included 1504 patients, drawn from the Finnish Cancer Registry, with first primary mobile tongue cancer diagnosed between 1953 and 1994. Incidence and relative survival were determined. The age-standardized overall incidence rate was 0.6 per 100000 years in 1953-1994. At the time of diagnosis 78% of the patients had either localized or regional disease. The age-standardized incidence rate decreased after the mid-1960s, but increased in the 1990s. The 5-year relative survival rate increased gradually from 40% in 1953 1959 to 58% in 1988-1994. Disease stage at the time of the diagnosis strongly affected the survival rate. Survival increased especially in regional disease. Cancer of the mobile tongue is increasing in Finland, but survival has increased particularly in regional disease, probably because of improved treatment. Early diagnosis is emphasized for a good prognosis.

Adolescent↗
PubMed1999

Acute epiglottitis in northern Finland today--still a potential emergency situation.

To examine patient characteristics related to airway intervention in acute epiglottitis and how the intervention affected the further course of the disease, 46 pediatric and 49 adult cases were retrospectively evaluated. All three airway management approaches, namely observation, nasotracheal intubation and tracheotomy were needed in both the children and adults. Five out of every six children needed an artificial airway, while observation was sufficient in three out of every five adults. H influenzae type b bacteremia in children, a short duration of the symptoms in adults and most important, respiratory distress in both were the best predictors of the need for an artificial airway. Nasotracheal intubation may be a successful means of implementing an artificial airway, but it is a technically demanding procedure and complications are frequent. Despite the recent changes in the occurrence of acute epiglottitis it remains a potential emergency situation both in children and adults.

Acute Disease↗
PubMed1999

Trends in chronic maxillary sinusitis that require surgical treatment in northern Finland.

To examine trends in the incidence of chronic maxillary sinusitis that require surgical treatment in northern Finland, a retrospective population-based survey from 1974 through 1995 was conducted. Data on surgical cases and on various demographic factors and on variables describing medical care in the area were collected for every third year. The overall crude incidence rate (per 100,000 person-years) of chronic maxillary sinusitis requiring surgical therapy was 44 for children and 76 for adults. The age-standardized incidence rate dropped by 78% in children, and by 66% in adults during the period. The changes found to have taken place in the population and in medical care and which could have promoted the decrease were higher educational level and mean income, smaller families, improved level of hygiene, a higher number of physicians and an expanded use of broader-spectrum antibiotics. In conclusion, the most serious forms of chronic maxillary sinusitis, that require operative treatment, are decreasing in both children and adults in northern Finland.

Adolescent↗
PubMed1997

Chronic suppurative otitis media and cholesteatoma. Vanishing diseases among Western populations?

A population-based survey of patients who had undergone surgery for chronic ear disease over the past 30 years in northern Finland revealed that the number of new surgical cases of both chronic suppurative otitis media and cholesteatoma has declined sharply after a peak in 1971-1974 and is now almost non-existent in contrast to the number of patients being operated on for chronic dry perforations, which has remained more or less the same. Most of the patients with chronic suppurative otitis media and cholesteatoma had had chronic ear trouble as early as the 1940s or 1950s. Moreover, if an active chronic otitis media developed in these cases, it started at a younger age than in cases with an onset after the 1950s. These facts may indicate that the decrease seen in this population is in close connection with the introduction of antimicrobials in the treatment of acute otitis media in the mid-1950s in the area.

Adult↗
PubMed1997

Carcinoma of the oral tongue in northern Finland: trends in overall incidence and patient and tumour characteristics.

A population-based survey was conducted in the two northernmost provinces of Finland to describe the incidence of tongue cancer as well as patient and tumour characteristics in cases diagnosed between 1974 and 1994. A total of 105 new patients with cancer of the oral tongue were included in the 21-year study period. The age-standardised incidence (per 100,000 years) of the carcinoma in men increased from 0.6 in the first 7-year period (1974-1980) to 1.0 in the last period (1988-1994). The incidences in women were 0.7 to 1.4, respectively. The average patient profile remained much the same through the years. The median duration of symptoms also remained the same over the 2 decades, as did the median size and location of the tumour at diagnosis. In conclusion, the incidence of carcinoma of the tongue about doubled in both the male and the female population from 1974 to 1994. However, the patient and tumour characteristics remained about the same, the tumours being relatively large at the time of diagnosis in spite of well-developed community health and dental care.

Adult↗
PubMed1997

Physiological fluctuations in nasal resistance may interfere with nasal monitoring in the nasal provocation test.

The physiological fluctuations in nasal flow and resistance in allergic subjects were studied by monitoring 12 subjects with perennial occupational allergic rhinitis with active anterior rhinomanometry (AAR) for 3 h at 15 min intervals. The subjects were then challenged bilaterally with the diluent solution for allergen extracts and the effect was monitored with AAR. In AAR. cellular rubber nose adapters were used. Many physiological fluctuations in nasal patency were observed. Reference intervals were calculated for the changes in flow and resistance at the gradient pressure of 150 pa. For example, a 100% increase in unilateral resistance was found to be significant at the risk level of 5-10% for the observation time of 30-60 min. The corresponding increase for bilateral resistance was close to 70%. Challenge with diluent solution had a negliglible effect on the resistance fluctuation, the reference intervals being close to those for baseline monitoring. In conclusion, rapid changes in nasal flow and resistance in allergic subjects were common, and caution is necessary when interpreting these changes as a positive nasal reaction in the nasal provocation test. In addition, the use of other objective parameters, such as the amount of nasal secretion is recommended.

Adult↗
PubMed1997

How common is recurrent acute otitis media?

To illustrate how the number of children with recurrent acute otitis media (RAOM) and the natural history of this condition vary according to the criterion used, different criteria were tested in a random sample of 2,411 children monitored for otitis media up to an average age of 22 months. The numbers of children fulfilling the criteria of at least 2, 3 and 4 episodes in 6 months were calculated and the natural history of otitis media during the following 6 months was examined among the children who had had a sufficient follow-up time and who had received no special prophylaxis. At least 2, 3 or 4 episodes in 6 months were experienced by 825 (34%), 375 (15%) and 118 (5%) children, respectively. During the 6 subsequent months after contracting the second, third or fourth episode, 5, 4 and 5% of the infants developed chronic otitis media with effusion and an additional 10, 12 and 7% respectively, continued to have recurrent episodes without any special prophylaxis. In all, the proportion of children with recurrent episodes varied according to the criterion used. RAOM seemed to be a temporal phenomenon, however, and spontaneous recovery without any special prophylaxis was common with increasing age irrespective of the criterion used.

Acute Disease↗