PubMed Health⌕ Search

Biomedical subjects

V J Anttila

Publications and source records attributed to V J Anttila.

At least 19 recordsLinked to original sources
PubMed2000

An outbreak of Listeria monocytogenes serotype 3a infections from butter in Finland.

In February 1999, an outbreak of listeriosis caused by Listeria monocytogenes serotype 3a occurred in Finland. All isolates were identical. The outbreak strain was first isolated in 1997 in dairy butter. This dairy began delivery to a tertiary care hospital (TCH) in June 1998. From June 1998 to April 1999, 25 case patients were identified (20 with sepsis, 4 with meningitis, and 1 with abscess; 6 patients died). Patients with the outbreak strain were more likely to have been admitted to the TCH than were patients with other strains of L. monocytogenes (60% vs. 8%; odds ratio, 17.3; 95% confidence interval, 2.8-136.8). Case patients admitted to the TCH had been hospitalized longer before cultures tested positive than had matched controls (median, 31 vs. 10 days; P=.008). An investigation found the outbreak strain in packaged butter served at the TCH and at the source dairy. Recall of the product ended the outbreak.

Adolescent↗
PubMed2000

Panfungal PCR and multiplex liquid hybridization for detection of fungi in tissue specimens.

A procedure based on panfungal PCR and multiplex liquid hybridization was developed for the detection of fungi in tissue specimens. The PCR amplified the fungal internal transcribed spacer (ITS) region (ITS1-5.8S rRNA-ITS2). After capture with specific probes, eight common fungal pathogens (Aspergillus flavus, Aspergillus fumigatus, Candida albicans, Candida krusei, Candida glabrata, Candida parapsilosis, Candida tropicalis, and Cryptococcus neoformans) were identified according to the size of the amplification product on an automated sequencer. The nonhybridized products were identified by sequencing. The performance of the procedure was examined with 12 deep-tissue specimens and 8 polypous tissue biopsies from the paranasal sinuses. A detection level of 0.1 to 1 pg of purified DNA (2 to 20 CFU) was achieved. Of the 20 specimens, PCR was positive for 19 (95%), of which 10 (53%) were hybridization positive. In comparison, 12 (60%) of the specimens were positive by direct microscopy, but only 7 (35%) of the specimens showed fungal growth. Sequencing of the nonhybridized amplification products identified an infecting agent in six specimens, and three specimens yielded only sequences of unknown fungal origin. The procedure provides a rapid (within 2 days) detection of common fungal pathogens in tissue specimens, and it is highly versatile for the identification of other fungal pathogens.

Adult↗
PubMed1998

Evaluation of clinical and laboratory findings in leukaemic patients with blood cultures positive for Staphylococcus epidermidis.

It is not certain whether clinical or laboratory findings help to distinguish true bacteraemia from contamination among acute leukaemic patients with one or more blood cultures positive for Staphylococcus epidermidis. We studied 31 patients treated at the Haematological Unit between 1 January, 1992 and 30 June, 1995 who were considered to have 'true bacteraemia', indicated by at least two positive blood cultures, and 20 considered to have probable 'contamination', indicated by a single positive culture. Fever at onset of positive blood culture, level of C-reactive protein (CRP) one day after the first positive blood culture and mortality did not differ between the groups. However, the median increase in CRP over 24 h from the first positive blood culture was significantly higher in true bacteraemias than among contaminants (median 35 mg/L vs 5 mg/L, P < 0.05). Patients with true bacteraemia were more likely than those with contaminants to have central catheters in situ (95 vs 75%, P < 0.05) and previous oral antibiotic prophylaxis (29 vs 5%, P < 0.05). Also clinical signs of catheter infection (30 vs 7%) were more common in true bacteraemias. In conclusion, central catheterization, antibiotic prophylaxis and clinical signs of catheter infection increase the likelihood of true bacteraemia; however, these factors have limited clinical utility in differentiation of true bacteraemia from contamination. Daily monitoring of serum CRP levels may help in the clinical decision-making.

Adolescent↗
PubMed1997

Diagnostic laparoscopy in patients with acute leukemia and suspected hepatic candidiasis.

To assess the value of laparoscopy in the diagnosis of suspected hepatosplenic candidiasis in patients with acute leukemia, a retrospective analysis of 28 laparoscopies was conducted. In all but two cases, imaging of the liver showed focal lesions before laparoscopy. Diagnosis of hepatic candidiasis was established significantly more often when the biopsy was targeted at white nodules (in 12 of 22 laparoscopies) than when targeted randomly or at scars (0 of 6 laparoscopies) (p = 0.017, chi-square test). Yeast was detected more often if the laparoscopy was performed during the three-week period after recovery from neutropenia (in 8 of 12 laparoscopies) than when performed later (in 4 of 16 laparoscopies) (p = 0.028, chi-square test). In addition to the 12 laparoscopically diagnosed patients, eight (29%) patients were diagnosed with disseminated Candida infection by other methods. In another eight (29%) patients the causative agent was not identified. No bleeding or other problems occurred after the laparoscopy. Laparoscopy-guided liver biopsy is most useful if biopsies are targeted to macroscopic lesions and if laparoscopy is performed soon after recovery from neutropenia.

Acute Disease↗
PubMed1997

Hepatosplenic candidiasis in patients with acute leukemia: incidence and prognostic implications.

We studied the incidence among, risk factors for, and survival of adult patients with acute leukemia and hepatosplenic candidiasis during the period 1980 to 1993. Of 562 adult patients with acute leukemia, 38 (6.8%) had hepatosplenic candidiasis. The incidence of infection increased fivefold during the study period. The incidence was higher among patients with acute lymphatic leukemia (11.3%) than among those with acute myeloid leukemia (5.1%) (P = .01). The median survival was 9.5 months, and by the end of follow-up, 74% of patients had died. Patients whose leukemia was in remission before the last cytotoxic treatment preceding hepatosplenic candidiasis survived longer than did patients with newly diagnosed or refractory or relapsed leukemia (P = .0065). Eleven patients died within 3 months after the diagnosis of the infection: 7 of 16 with newly diagnosed leukemia, 4 of 10 with refractory or relapsed leukemia, and 0 of 12 with leukemia in remission (P = .028). In all of the patients who died within 3 months, infection was found at autopsy. In conclusion, the incidence of hepatosplenic candidiasis has significantly increased since 1980, and the outcome for patients with this infection is related to the stage of leukemia.

Acute Disease↗
PubMed1996

Increased risk of leukaemia in patients with juvenile chronic arthritis treated with chlorambucil.

Two cases of acute leukaemia have developed in a group of 77 patients treated with chlorambucil (Chl) because of severe juvenile chronic arthritis. The total follow-up from the beginning of Chl treatment in these patients was 560 years, indicating a highly increased risk of leukaemia. Despite favourable results, especially in patients with secondary amyloidosis, Chl should only be used in selected cases.

Antineoplastic Agents, Alkylating↗
PubMed1996

Diagnosis of disseminated candidiasis by measurement of urine D-arabinitol/L-arabinitol ratio.

Relative amounts of D-arabinitol (fungal origin) and L-arabinitol (part of normal human metabolism) in urine were determined by gas chromatography and mass spectrometry from 61 hospitalized patients with hematological malignancies. Seventeen neutropenic patients with acute leukemia (with 53 samples) had disseminated yeast infections and received empiric antifungal therapy before confirmation of the diagnosis. Control groups consisted of 22 hematologic patients (76 samples) with either mucosal (n = 10) or urinary (n = 12) Candida colonization and 22 neutropenic patients (34 samples) with no clinical or laboratory signs of invasive yeast infection. Reference values were also obtained from 50 healthy adults (50 samples). The mean urine D-arabinitol/L-arabinitol ratio +/- standard deviation (range) was 16.91 +/- 41.79 (1.41 to 254.75) in patients with disseminated infection, 2.73 +/- 2.48 (1.11 to 19.00) in colonized hematologic patients, 2.12 +/- 0.84 (1.16 to 5.84) in neutropenic controls, and 1.95 +/- 0.34 (0.97 to 3.44) in healthy adults (P < 0.001 between patients with disseminated infection and all control groups). The sensitivity and specificity of the assay for detecting disseminated yeast infection were, respectively, 88 and 91% per patient (upper limit of normal, 4.00). Seventy-one percent of patients already expressed elevated values at the onset of empiric antifungal therapy. The diagnosis of disseminated infection was confirmed on average 21.7 days after the first elevation of the D-arabinitol/L-arabinitol ratio. The method contributes to diagnosis of disseminated yeast infection and helps in monitoring patients at risk, to support the initiation of antifungal therapy at an early stage of the disease.

Adolescent↗
PubMed1994

Hepatosplenic yeast infection in patients with acute leukemia: a diagnostic problem.

The occurrence of hepatosplenic candidiasis following prolonged neutropenic periods has emerged as a major problem for patients with leukemia. In order to evaluate the diagnostic value of various available procedures, we analyzed our findings regarding 26 leukemic patients with hepatosplenic candidiasis. A significantly increased level (> 50 mg/L) of serum C-reactive protein (S-CRP) was significantly more common than a daily fever (for which the mean temperature peak was > 37.5 degrees C) or raised levels of liver enzymes (serum alanine transferase, aspartate transferase, or alkaline phosphatase). Focal changes in the liver, spleen, or kidneys were detected in > 90% of the patients examined by computed tomography (CT) but in < 50% of those examined by ultrasonography. Seventeen diagnoses were based on the findings from microscopy of samples obtained invasively, whereas a positive fungal culture was the basis of the diagnosis for only five patients. In conclusion, monitoring the S-CRP level after a patient's recovery from neutropenia is useful in that its elevation is cause for early suspicion of hepatosplenic candidiasis. In detection of the hepatosplenic foci, CT is superior to ultrasonography. For establishing the specific diagnosis, aggressive collection of samples for microscopy is essential.

Acute Disease↗
PubMed1994

Infectious liver foci in leukemia: comparison of short-inversion-time inversion-recovery, T1-weighted spin-echo, and dynamic gadolinium-enhanced MR imaging.

PURPOSE: To assess the performances of three different magnetic resonance (MR) imaging techniques in the evaluation of patients with leukemia and suspected hepatic candidiasis. MATERIALS AND METHODS: Twelve patients with acute leukemia and definite or clinically suspected hepatic candidiasis were imaged at 1.0 T with a T1-weighted spin-echo (SE) technique, a short-inversion-time inversion-recovery (STIR) fat-suppression technique, and a dynamic gadolinium-enhanced fast low-angle shot (FLASH) technique. The conspicuity of hepatic lesions was evaluated semiquantitatively and ranked on a three-point scale. RESULTS: Multiple liver lesions were seen as high-signal-intensity foci with the STIR sequence; other sequences showed equivocal results. In the semiquantitative evaluation, STIR was significantly (P < .001) superior to both T1-weighted SE and contrast-enhanced FLASH techniques. Multiple red blood cell transfusions affected lesion conspicuity. CONCLUSION: STIR imaging is recommended as the MR technique of choice at 1.0 T in the evaluation of infectious liver foci in patients with acute leukemia.

Acute Disease↗
PubMed1994

Magnetic resonance imaging of transfusional hepatic iron overload.

The transfusional iron overload in 11 adult patients suffering from haematological malignancy was studied in 14 consecutive 1.0 Tesla magnetic resonance imaging (MRI) studies. Routine T1- and T2-weighted spin echo sequences and a fat suppressed sequence (STIR) were used. The ratio from a region of interest of the liver parenchyma and from a manganese chloride reference phantom was measured. There was a definite difference between the signal ratio from the haematological patient group and the control group (p = 0.0001). The patients showed a diminished signal ratio in all pulse sequences used. There was a statistically significant inverse linear correlation between the number of transfused red cell units and the signal ratio in the T1-weighted (p = 0.03) and the T2-weighted (p = 0.03) images. A definite decrease of the effect is found after 20-30 red cell unit transfusions in T2-weighted and STIR images.

Adult↗
PubMed1994

Flow cytometric detection of residual disease in acute leukemia by assaying blasts co-expressing myeloid and lymphatic antigens.

A method employing CD45-gating of blast cells was evaluated for the flow cytometric detection of residual disease in CD19- and myeloid antigen-positive acute leukemia in morphologic remission. In the normal bone marrow, CD45-gating identified at least three populations of immature cells, one of which appeared to retain a minute fraction of CD19- and CD13/33-antigen co-expressing cells. In acute leukemia, CD45 expression separated the blast cell population from the normal marrow cell populations. In the majority of patients with CD19- and myeloid antigen-positive acute leukemia, subpopulations of blast cells with this mixed phenotype were detected during morphologic remission.

Antigens, CD↗
PubMed1987

Mesalazine tolerance in patients with inflammatory bowel disease and previous intolerance or allergy to sulphasalazine or sulphonamides.

Fifty patients intolerant of or allergic to sulphasalazine (SASP) or sulphonamides were treated with mesalazine. Eighty per cent of patients continued treatment during the time of follow-up (mean, 8.4 months); 14% (7 of 50 patients) had to stop the treatment with mesalazine because of side effects. The patients with allergic reactions, including rash, fever, and systemic manifestations from SASP, were most likely to be intolerant of or allergic to mesalazine (four of seven patients); two of them developed a similar reaction from both SASP and mesalazine. Two patients (2 of 12) with previous haematologic side effects had to discontinue mesalazine treatment, one because of mild neutropaenia and one because of an elevation of liver enzyme values. One patient experienced gastrointestinal side effects from both mesalazine and SASP. Altogether, 4 (4 of 50) patients experienced gastrointestinal symptoms from mesalazine. Two of them had had a flare-up of the symptoms of the colitis when treated with SASP. All side effects were rapidly reversible after withdrawal of the drug. Patients with severe allergic reactions with systemic manifestations from SASP should be treated with caution with 5-aminosalicylic acid preparations.

Adolescent↗
PubMed1982

The effect of metoclopramide on the absorption of tolfenamic acid.

The effect of metoclopramide on the absorption of orally given tolfenamic acid (300 mg) was investigated using rectal metoclopramide hydrochloride (20 mg) pretreatment in a randomized crossover study in eight voluntary migraine patients when headache-free. Tolfenamic acid and metoclopramide serum concentrations were estimated by high-performance liquid chromatograhic (HPLC) methods using UV detection. Metoclopramide given 30 min prior to tolfenamic acid significantly increased serum tolfenamic acid levels at 45 and 60 min after ingestion, compared to the levels obtained with placebo pretreatment. The bioavailability of tolfenamic acid, measured as the area under the serum tolfenamic acid concentration-time curve (AUC0-5 h) and the peak concentration, was not influenced by metoclopramide. The peak concentration of tolfenamic acid was 4.1 +/- 0.9 micrograms/ml (mean +/- s.e.m.), the time peak 1.9 +/- 0.2 h, and the elimination half-life 2.3 +/- 0.5 h calculated from the values without metoclopramide. The peak concentration of metoclopramide was 69 +/- 6.3 ng/ml and the time to peak 118 +/- 29 min. The results suggest that rectal metoclopramide enhances the rate of absorption of tolfenamic acid without changing its bioavailability.

Adult↗