Biomedical subjects
Publications and source records attributed to T Salmi.
Time-resolved fluoroimmunoassay (TR-FIA) reliably shows the concentrations of serum hCG during the first trimester of normal pregnancy. After first-trimester induced abortion the mean disappearance of hCG in serum (under 10 IU/l) takes place in three weeks. TR-FIA is a convenient and ultrarapid method for diagnosing pregnancy-related disorders.
We report an outbreak of 23 neonatal group A streptococcal infections including two cases of septicaemia in a nursery for the newborn. At the same time, 19 mothers had puerperal endometritis. The outbreak lasted for about 2 months and could not be eradicated by ordinary hygienic measures. In a colonisation study, 19 of 90 umbilical stumps studied on the day of discharge from hospital harboured group A streptococci, all of the same epidemic strain T28 provisional M-type 2841/opacity factor positive (T28/MPT2841/OF+). Chlorhexidine gluconate was therefore applied daily to the umbilical stumps. The outbreak came to an end with the introduction of this procedure. The time interval between delivery and recognition of infection was shorter in infants than in mothers. There were also only two infected mother-infant pairs. Taken together, this suggests that infected umbilical stumps on symptomless infants were a likely source of the maternal infections. Throughout 1 year from the introduction of the chlorhexidine treatment, we have not seen a case of group A streptococcal infection in neonates. Surveillance cultures from umbilical cords after the outbreak have also been negative. We conclude that bacteriological surveillance of umbilical stumps is valuable in recognising an outbreak and should be seriously considered when a group A streptococcal infection has been recorded in a nursery.
Sleep-related hypopneas and apneas were studied in 19 patients with multiinfarct dementia (MID), in 21 patients with Alzheimer's disease (AD), and in 26 healthy control subjects using the Static Charge-Sensitive Bed (SCSB) method. Demented patients had more apneas or hypopneas and more disturbed sleep than the control subjects. Over 10 apneas/hypopneas per hour of sleep were detected in 47.5% of the demented patients and in 19.2% of the control subjects (p less than 0.05). Restlessness comprised 46.7% of the time in bed in patients with AD and 49.6% in those with MID, but only 102.% in the control subjects (p less than 0.001, controls versus demented). The total duration of apneas and hypopneas calculated from the total sleeping time was greater than 10% in 60.0% of the demented patients and in 15.4% of the control subjects (p less than 0.001). Patients with MID tended to have more apneas/hypopneas than those with AD, and apneas/hypopneas tended to increase in direct proportion to the severity of dementia. Age had no effect on the proportion of apneas and hypopneas among demented patients or control subjects, but male controls had more apneas and hypopneas than did female controls.
Nineteen adults with Down's syndrome were studied with the static charge sensitive bed (SCSB) method. A single whole-night recording was made of each subject. Two different periodic breathing indices (PBIf and PBI%) were calculated from a computerized analysis of these recordings. A polygraphic recording was also made of one subject, a 52-year-old male. The EEG, the EOG, the EMG, nasal and oral airflow, and diaphragmatic movement were recorded, the latter with an abdominal strain gauge and with the SCSB-method simultaneously. Good correlation was found between the recording with the SCSB and the strain gauge. The apnoea index (AI) calculated from the polygraphic recording was 23.3, while the PBIf of this patient recorded on another night and analysed automatically was 45 and the PBI% was 78.6. The patient group was divided into those aged 40 or older (n = 10) and those aged 39 or younger (n = 9). The mean PBI% of the older group was 24.0 while that of the younger group was 5.4 (t = 2.23; P less than 0.05). The mean PBIf of the older group was 16.7 and that of the younger was 3.6 (t = 2.70; P = less than 0.02). The mean body mass index (BMI) of the younger group was significantly higher than the mean BMI of the older group. The mean BMI of those patients, whose PBI values were considered to be normal (PBI% less than 3, PBIf less than 7), did not significantly differ from the BMI of those patients, whose PBI-values were abnormal.(ABSTRACT TRUNCATED AT 250 WORDS)
Fifty-two men (aged 41-50 years) of whom 25 reported habitual and 27 of occasional or never snoring were examined clinically. Whole-night sleep recordings of body and breathing movements, snoring and blood oxygen saturation were made. Hypoxic events exceeding 4% from the baseline were counted. Ninety-three percent of those classified snorers by the recordings were habitual or occasional snorers, but 50% of those similarly classified non-snorers had reported habitual or occasional snoring. Four habitual snorers had abnormal breathing indices and polysomnography established obstructive sleep apnea syndrome (OSAS) in one. Thus, self-reported habitual snoring is a reliable OSAS-screening method. Estimated prevalence of OSAS based on this study is 0.4-1.4%. In multivariate regression analysis, the hypoxic events were explained by obesity and apneic events. The diastolic blood pressure level was best explained by obesity, but not hypoxic or apneic events or snoring history.
Six hundred and fifty-six children with acute lymphoblastic leukemia (ALL) have been diagnosed in the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) during the period from July 1981 through June 1985. Annual incidence of ALL was 3.6/100,000 children aged less than 15 years, with an incidence for males of 3.8 and for females of 3.4 respectively. Half of the children were younger than 5 years of age at diagnosis, with a peak incidence between 2-3 years of age. The leukemias were classified as Standard Risk (SR), Intermediate Risk (IR) or High Risk (HR) leukemia according to prognostic criteria at diagnosis. The remission rate was 95%. In children greater than or equal to 1 year of age with non-B-cell ALL at diagnosis, the Event-Free Survival (EFS) was 0.58; 0.65 for SR-children, 0.51 for IR-children and 0.52 for HR-children. WBC count at diagnosis was the most important prognostic factor and a WBC count of 11-20 X 10(9)/l was associated with the worst prognosis of all WBC values (EFS = 0.30), independent of other prognostic factors. Male sex was the second most important adverse prognostic criterion. The follow-up in January 1986 (observation time 6-54 months), showed that 442 of the 656 children (67%) were in complete continuous remission. The total results indicate a possibility to improve the prognosis for most of the risk groups of ALL with a more intensive treatment.
A severe case of ulcerative, herpetic infection of the vagina and uterine cervix simulating cancer is described.
Explore the source record for details and available documents.
In 63 patients with invasive vulvar squamous cell cancer treatment was individualized according to patient tolerance: surgery was less mutilating than conventionally, while radio and chemotherapy was given judiciously. The overall 5-year crude survival rate was 43.5%, while the most common treatment (bleomycin, electroexcision and irradiation) had a 5-year survival rate of 55.2%. The rate of complications was low, although most of the patients were of advanced age and had intercurrent diseases. Although the therapy we applied most often yielded moderately satisfactory results it would appear according to the literature that marginal tumor excision accompanied with inguinal lymph node dissection could still improve patient outcome. This strategy could also include predictive testing of sensitivity of the tumors to cytostatics.
An automatic analysis of movements detected by the static charge sensitive bed (SCSB) was developed for the study of sleep and breathing disturbances (apnoeas) during sleep. Three signals on separate channels are analysed: one relating to body movements, one to respiratory movements and one to movements of the heart (ballistocardiogram). The analysis can be made on-line or from tape recordings. With a portable microcomputer the records and analyses can be carried out at home or on the ward without any professional personnel. The system can be preset to start and to end recording automatically. The subject just has to lie down. The automatic analysis of body movements on the basis of their amplitude and duration yields criteria for scoring of sleep into 'wakefulness,' 'quiet sleep' and 'active sleep.' A simple hypnogram and the statistics on the durations and proportions of these stages are printed. Simultaneous SCSB and polygraphic records were made on healthy subjects. Comparison of the two types of sleep scoring showed that the results agreed during 81% of the time. The amplitudes of the movements detected on the 3 channels are integrated in epochs and the results of this analysis are represented in a compressed graphic form which allows easy visualization of the overnight records. The pattern of 'respiratory movements' reveals whether the breathing has been regular, irregular or periodic.
An automatic analysis of Static Charge Sensitive Bed (SCSB) recordings was evaluated in the detecting periodic apneas during sleep. The results of over-night SCSB recordings, on body movements and respiratory movements, were compared with the visually evaluated polygraphic recordings during daytime sleep. Twenty-one patients with obstructive sleep apnea syndrome and 18 controls were studied. The periodic breathing pattern seen in all daytime recordings, was also seen in all output graphs of the over-night SCSB analyses. The automatic analyses revealed periodic breathing in 2 control subjects. The amount was, however, small (less than 4% of the recording time) compared with the high amount observed in the patients with obstructive sleep apneas (mean 42.9% of the recording time). The high sensitivity, easy use, and low cost of the automatic SCSB method make it suitable for the quantification of the periodic breathing during night and for the screening of sleep apneas.
Visual and brainstem auditory evoked potentials (VEPs, BAEPs) were recorded in 23 patients with neurosarcoidosis. Eight patients (35%) had abnormal BAEPs, and 10 (43%) had abnormal VEPs. Four of the 8 patients with abnormal BAEPs had facial paresis, one had impaired memory and only 3 had symptoms and signs compatible with brainstem lesion. Seven of the patients with abnormal VEPs had no visual symptoms. These findings suggest that BAEP and VEP can reveal subclinical nervous system involvement in sarcoidosis and can also help in the early diagnosis of neurosarcoidosis. Successive recordings of 5 patients showed that BAEP and VEP were useful in the follow-up of these patients.
Twenty-eight male alcoholics were studied for peripheral sensory-motor and autonomic neuropathy. The patients were examined neurologically and neurophysiologically after a period of withdrawal treatment in hospital. The function tests of the autonomic nervous system performed were: measurement of the variation of the heart rate at rest and during maximal breathing, Valsalva manoeuvre, postural pulse and blood pressure reactions, and isometric test. Slight abnormalities in the peripheral nervous system were observed in 8 patients, but a frank clinical polyneuropathy supported by neurophysiological findings could be diagnosed only in 2. All of the parameters which reflect the function of the parasympathetic division of the autonomic nervous system were lower in the alcoholics compared with the controls. The most sensitive variables were the heart rate variation at rest, and the postural pulse reaction. The functions mediated by the sympathetic nervous system were not abnormal among this group of alcoholics.
Five patients (3 male, 2 female, mean age 20.4 years, range 14-28) with juvenile neuronal ceroid lipofuscinosis were studied using the Static Charge-Sensitive Bed method. Three distinct patterns of respiration (calm, periodic and restless) were differentiated in an automatic analysis. The amount of restless respiration was found to increase with duration of the disease. The result is discussed in terms of methodology and the clinical picture of JNCL.
Critical flicker frequencies (CFF) were compared with the latencies of visual pattern reversal evoked potentials (VEP) in 2 groups of MS patients to evaluate the value of CFF in electrophysiological diagnostics of demyelination of the optic tract. A microprocessor-based device was constructed to obtain CFF thresholds with a 2-alternative forced-choice method. VEP latency was more frequently pathological than CFF, but CFF was abnormal in 2 optic neuritis patients with normal VEP. The frequency of pathological CFF and VEP was different in the patient group with a long history of MS compared with the new cases; in the freshly diagnosed group, CFF had a better diagnostic yield compared to the patients with a longer history.
Bromocriptine given for prolonged times at high doses has been found to induce tumors in the uterus in aged rats. To elucidate the possible tumorigenic effect of long-term treatment with bromocriptine in humans, 35 women treated with this drug for chronic parkinsonism were studied. For each patient a gynecological anamnesis and examination were performed; one or several cervicovaginal smears and endometrial samples were also taken, by jetwash. No evidence of malignant changes was seen. Thus, in this respect bromocriptine would appear to be a safe drug, even for long-term use.
The effect of spinal anesthesia, dilatation and curettage plus the first intracavitary radiotherapy or only that of intracavitary radiotherapy on growth hormone (HGH = the response of anterior pituitary) and arginine vasopressin (AVP = the response of posterior pituitary) levels was studied in 10 patients suffering from cervical or endometrial uterine cancer. Differing from earlier animal studies, irradiation had no effect on GH or AVP secretion, nor was there any change in the hormone levels following spinal anesthesia and dilatation and curettage. The neurosecretory response of hypothalamic-hypophyseal axis to spinal anesthesia and minor gynecological surgery appears to be minimal.
Explore the source record for details and available documents.