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Biomedical subjects

R Julkunen

Publications and source records attributed to R Julkunen.

At least 37 records · Page 2Linked to original sources
PubMed1998

Association of CagA-positive and CagA-negative Helicobacter pylori strains with patients' symptoms and gastritis in primary care patients with functional upper abdominal complaints.

BACKGROUND: CagA-positive Helicobacter pylori strains have been reported to be associated with peptic ulcer or malignancy more often than cagA-negative strains. Less is known about the relation of H. pylori serology (CagA-negative or CagA-positive) to histologic changes in the stomach of patients with functional upper abdominal complaints. The association of H. pylori status with patient symptoms or with different subgroups of non-organic dyspepsia is also obscure. In the present study patients' symptoms and their relation to H. pylori serology (H. pylori-negative, H. pylori-positive but CagA-negative, and H. pylori-positive and CagA-positive) were evaluated in general practice patients who had functional upper abdominal complaints. The association of H. pylori serology with different symptom-based subgroups of functional upper abdominal complaints was also assessed. The severity and activity of inflammation and the presence of atrophy and intestinal metaplasia in the antrum and body were evaluated and compared with H. pylori status. METHODS: Four hundred consecutive unselected dyspeptic patients in primary care were investigated by means of gastroscopy, upper abdominal ultrasound, laboratory screening including H. pylori and CagA serology, and other examinations if needed. Of these patients 193 with functional upper abdominal complaints were enrolled in this study. RESULTS: Of the study patients 87 (45%) were H. pylori-negative, 70 (36%) were H. pylori- and CagA-positive, and 36 (19%) were H. pylori-positive but CagA-negative. There were no differences in the occurrence of any dyspeptic symptoms between H. pylori-related subgroups. Nor was there an association between H. pylori status and symptom-based subgroups in our study patients. Inflammation of the stomach was related to H. pylori infection, but CagA-seropositive patients did not have moderate or severe inflammation more often than CagA-seronegative ones. CagA-seropositive patients with functional upper abdominal complaints did not have atrophic changes or intestinal metaplasia in the stomach more often than those who were CagA-negative. CONCLUSIONS: H. pylori or more specific CagA serology is not associated with any specific symptom profile of dyspepsia or with any symptom-based subgroups in patients with functional upper abdominal complaints in primary care. The study patients with CagA seropositivity did not have more severe histologic changes in the stomach than the patients who were H. pylori-seropositive but CagA-seronegative.

Abdominal Pain↗
PubMed1997

Usefulness of anti-Helicobacter pylori and anti-CagA antibodies in the selection of patients for gastroscopy.

OBJECTIVES: Screening of dyspeptic patients with serological tests for Helicobacter pylori before open-access gastroscopy has been suggested to be worthwhile. CagA-positive H. pylori strains may be associated with major pathology more often than CagA-negative strains. The usefulness of anti-H. pylori and anti-CagA antibodies in screening for gastroscopy was evaluated in unselected dyspeptic patients. METHODS: Four hundred consecutive, unselected dyspeptic patients (mean age, 56.8 yr) in primary care were investigated with gastroscopy, ultrasonography of the upper abdomen, laboratory tests (including serological tests for H. pylori and CagA), and other examinations if needed. The patients were followed for 1 yr. RESULTS: Results of serological tests were positive for H. pylori in 56.2% of patients, of whom 64.4% also had results positive for CagA. Use of H. pylori and CagA serology-based screening combined with a history of nonsteroidal anti-inflammatory drug use would have detected only 80 and 70% of the major pathologies (peptic ulcer, moderate or severe esophagitis, celiac disease, or malignancy), respectively, in these patients. Gastroscopy would have been avoided in 30 and 41%, respectively, if only patients who had positive results on serological tests or who were nonsteroidal anti-inflammatory drug users would have been referred. In patients younger than 45 yr of age (n = 87), 60-74% of gastroscopies would have been avoided, but 50-60% of major pathologies would have been missed, by using the screening strategy studied. One of the nine malignancies (all in patients >45 yr of age) was H. pylori-negative, and two were CagA-negative. CONCLUSIONS: Anti-CagA antibodies do not offer advantages compared with anti-H. pylori antibodies in screening patients for gastroscopy. A remarkable share of major pathologies are missed by both of these screening methods. Therefore, the results of these screening tests are not recommended as selective criteria for gastroscopy.

Adolescent↗
PubMed1996

General practitioners' approach to dyspepsia. Survey of consultation frequencies, treatment, and investigations.

BACKGROUND: The aim of this study was to investigate the frequency of patient visits for dyspepsia in primary care. The diagnostic approaches made and drug treatment given by general practitioners were recorded. METHODS: In a cross-sectional study 36,230 patients over 15 years of age visited their health center in an area serving a population of 506,000 inhabitants, between 6 and 19 May 1991. The frequency of dyspepsia was 2.1% (n = 766). These patients formed the basis of this study. RESULTS: The incidence of dyspepsia leading to a health center visit was 20.9/1000 inhabitants/year. Patients older than 45 years consulted their general practitioners for dyspepsia more often than younger patients. Men older than 45 years of age had had their symptoms longer before seeking medical advice than younger men or women of the same age (p = 0.03 and p < 0.05, respectively). In association with the first visit, older (over 45 years) patients were evaluated more frequently (p = 0.03) by upper gastrointestinal endoscopy than younger (15-44 years) ones. Upper abdominal ultrasound was performed almost as often as upper gastrointestinal endoscopy. Sucralfate was prescribed for dyspeptic symptoms more often than H2-blockers or omeprazole, which were mainly used in patients with a definitive diagnosis. CONCLUSIONS: The frequency of medical visits for dyspepsia increased with age. Older men sought medical advice for dyspepsia after a longer delay than others. Upper abdominal endoscopy was performed in association with the first visit in older patients more often than in younger ones.

Adolescent↗
PubMed1995

Etiology of dyspepsia: four hundred unselected consecutive patients in general practice.

BACKGROUND: Four hundred consecutive unselected patients with dyspepsia in health care centers were investigated. The aim of this study was to assess the frequency of various causes of dyspepsia in primary care and to evaluate the usefulness of the latest definition of functional dyspepsia. METHODS: Upper gastrointestinal endoscopy, upper abdominal ultrasound, a test for lactose intolerance, and basic laboratory screening were performed in every patient. RESULTS: Esophagitis was the cause of symptoms in 15%, symptomatic gastroesophageal reflux without esophagitis in 12%, duodenal ulcer in 9%, gastric ulcer in 4%, erosive duodenitis in 2%, lactose intolerance in 9%, gallstone disease in 2%, and malignancy in 2%. Other more infrequent causes of dyspepsia were giardiasis, celiac disease, erosive gastritis, and chronic pancreatitis. One hundred and thirty-five patients had functional dyspepsia with subgroups of ulcer-like (22%), dysmotility-like (28%), and nonspecific (50%). Irritable bowel syndrome was diagnosed in 37 patients (9%). CONCLUSIONS: The cause of dyspepsia was organic in 45%. Functional disorders, when symptomatic gastroesophageal reflux was included, were diagnosed in 55%. The latest classification of functional dyspepsia is not in accordance with the symptom complex.

Adolescent↗
PubMed1995

Intakes of nutrients and nutritional status in coeliac patients.

BACKGROUND: The intake of nutrients and the nutritional status of untreated coeliac patients and coeliac patients in remission were investigated at Kuopio University Hospital. METHODS: Forty untreated and 52 coeliac patients in remission were admitted to the study. The control group included 77 persons. Four-day food records, anthropometric measurements, and blood biochemistry were examined to obtain nutrient intake and nutritional status. RESULTS: Concentrations of serum ferritin, vitamin B12, and erythrocyte folate were lower in patients with untreated coeliac disease than in those in remission. Altogether, 15-38% of the untreated patients but only 0-20% of the patients in remission had levels of haemoglobin, serum ferritin, iron, vitamin B12, or erythrocyte folate below the reference values. No difference in anthropometric measurements was found between the two groups of coeliac patients. CONCLUSIONS: Except for some subclinical abnormal values in biochemical analyses in 20-38% of coeliac patients, nutritional status was quite normal in both groups of coeliac patients.

Adult↗
PubMed1990

Plasma insulin, serum lipids and lipoproteins in gall stone disease in non-insulin dependent diabetic subjects: a case control study.

Fasting insulin, lipids and lipoproteins were measured in 22 middle aged female non-insulin dependent diabetics with gall stone disease (cases) and in 22 non-insulin dependent diabetics without gall stone disease (controls). The groups were matched for sex, age, obesity, and fasting glucose concentrations. No differences were observed between the cases and controls in duration of diabetes, glycated haemoglobin A1, alcohol intake, smoking, use of cardiovascular drugs or a history of myocardial infarction. Diabetics with gall stone disease had higher fasting insulin concentrations (p less than 0.5), lower total (p less than 0.01) and low density lipoprotein cholesterol (p less than 0.01) and high density lipoprotein cholesterol (not statistically significant) concentrations than diabetics without gall stone disease. These changes in insulin, lipids and lipoproteins are similar to reported changes in non-diabetic subjects with gall stone disease. Therefore, they are characteristic for gall stone disease and not as such explanatory to an increased risk of gall stones in patients with non-insulin dependent diabetes.

Case-Control Studies↗
PubMed1986

Role of intestinal bacterial overgrowth in ethanol production and metabolism in rats.

To investigate the role of intestinal bacterial overgrowth on the production and metabolism of ethanol, rats with a jejunal self-filling diverticulum (blind-loop) were compared to controls with a self-emptying diverticulum. Both endogenous ethanol and acetaldehyde were found in the blind-loop contents. Intragastric administration of sucrose produced a marked increase in acetaldehyde and acetate in the portal venous blood, with only a modest elevation of ethanol. Blind-loop contents readily oxidized ethanol to acetaldehyde in a concentration-dependent manner and more actively under aerobic than anaerobic conditions. This oxidation was inhibited by antibiotics and was reproduced with isolated microorganisms. Intragastric administration of ethanol to rats with blind-loops markedly increased acetaldehyde and acetate concentrations in the portal vein and, to a lesser extent, in the systemic blood, compared with the controls. By contrast, both portal and systemic blood ethanol concentrations were lower in the rats with a blind-loop compared with controls, even though the amounts of ethanol retained in the digestive tract were similar. A dose of ethanol about twice as large as in controls was required to produce similar systemic blood levels. Both in rats with a blind-loop and in the controls, the areas under the curve of blood ethanol concentrations were smaller after intragastric than after intravenous ethanol administration (1 g ethanol/kg body wt). This difference was exaggerated in the rats with a blind-loop. Thus, a considerable amount of ethanol is oxidized in the gastrointestinal lumen of rats with a blind-loop. The resulting high concentrations of acetaldehyde, both in the intestinal lumen and the portal blood, may have deleterious effects on the gastrointestinal mucosa and the liver.

Acetaldehyde↗
PubMed1983

Gastrin-producing ovarian mucinous cystadenoma.

We report a patient with abdominal pain, diarrhea, and edema of the small intestine all of which disappeared after resection of an ovarian mucinous cystadenoma of borderline malignancy. Preoperatively, the serum gastrin level was high and it decreased to normal afterwards; subsequent immunohistochemical studies of the tumor revealed cytoplasmic hormone granules containing gastrin-like immunoreactivity. We believe that the symptoms in our patient were the result of an ectopic ovarian gastrin-producing tumor.

Adult↗
PubMed1982

A Bartter-like syndrome after jejunoileal bypass for obesity.

A case of an adult woman with a Bartter-like syndrome after jejunoileal bypass for obesity is described. Diarrhoea, hypokalaemia, high plasma renin activity, hyperaldosteronism, alkalosis, increased urinary prostaglandin E and hyperplasia of the juxtaglomerular apparatus with low or normal blood pressure were the major features. After corrective surgery the values turned only transiently towards normal, despite permanent disappearance of the diarrhoea. Spironolactone, amiloride or propranolol had no real effect on clinical symptoms or biochemical aberrations. Indomethacin, a prostaglandin synthetase inhibitor, normalized most of the aberrations, but--inexplicably--not the prostaglandinuria.

Adult↗
PubMed1980

Reduced sulfadiazine dose in the treatment of acute urinary tract infection in children.

The pharmacokinetics of a low dose of sulfadiazine (SD 4 mg/kg twice a day, loading dose 8 mg/kg) were studied and acute urinary tract infection in children treated with this reduced dose. The concentrations of active SD in serum and urine were found to exceed those assumed to be sufficient for the treatment of acute urinary tract infections (10 x MIC and 100 x MIC against E. coli, respectively; MIC = minimum inhibitory concentration). The urinary concentrations of both acetylated and non-acetylated SD remained lower than those considered to crystallize in the urinary tract. This suggests that renal damage earlier due to SD overdosage can be avoided by using the present administration. No difference was found in treatment results of acute urinary tract infections in children between SD (4 mg/kg twice a day) and fulfafurazole (SF; 50 mg/kg four times a day). Only infections caused by sulfonamide-sensitive micro-organisms were treated and all cases were cured. No side-effects could be recorded. SD in lower than the usual dosage would appear to be a practical alternative in the treatment of acute urinary tract infections caused by sulfonamide-sensitive micro-organisms in children.

Acetylation↗
PubMed1980

Pharmacokinetics of low dose sulfadiazine in patients with renal failure.

The pharmacokinetics of sulfadiazine (SD) in a lower dose (500 mg once a day, loading dose 1000 mg) than generally used was studied in patients with normal, moderately (creatinine 154--360 mumol/l) and severely (creatinine 753--1600 mumol/l) impaired renal function. In all groups SD concentrations in serum and urine were high enough for the treatment of urinary tract infections (UTI). The serum concentration of SD and metabolites showed a clear increase in severely uremic patients within 5 days. The patients showed, on the other hand, no signs of side-effects. In moderate uremia hardly any tendency towards an accumulation of SD and its metabolites was detectable during the same period of investigation. SD can thus evidently be used for the treatment of UTI with a low dose of 500 mg daily (loading dose 1000 mg), but caution should be taken in cases of impaired renal function. In moderate uremia treatment can be continued for more than one week provided that the drug concentrations in serum can be monitored. In severe uremia treatment should be limited to a period of one week.

Acetylation↗
PubMed1980

Pharmacokinetics and clinical experiences of the combination sulfadiazine-trimethoprim in the short-term treatment of acute urinary tract infections.

The pharmacokinetics of sulfadiazine (SD) combined in a small dose (250 mg) with trimethoprim (TMP, 160 mg) and given twice daily were studied in eight healthy subjects. Both drugs were rapidly absorbed from the gastrointestinal tract and their concentrations in serum as well as in urine could be considered high enough for the treatment of acute urinary tract infections (UTI). In none of the subjects did the concentration of SD in urine exceed the experimental limit established for crystallization of the drug. Serum half-lives of SD and TMP were 10.8 and 11.8 hrs, respectively. In microbiological assay synergistic interaction was found in human urine with both the combination of SD + TMP and SM (sulfamethoxazole) + TMP on all the tested strains of E. coli, Str. faecalis, Str. agalactiae, Klebsiella pneumoniae and Proteus mirabilis. A double-blind clinical trial was carried out with patients having acute UTI, using either the combination SD + TMP (250 mg + 160 mg) or the combination SM + TMP (800 mg + 160 mg) twice daily for one week. The results of the treatment were equally successful in both groups. Treatment failed in only 4 out of 85 cases, although in 12 cases the causative micro-organism was resistant in vitro to the combination of SM + TMP.

Acute Disease↗