Helsinki University Central Hospital Research Articles

Dental Erosion in a Series of Referred Patients was Statistically Associated With Gastric Reflux, Acidic Drink Intake of more than 0.5 L per day, and Low Salivary Buffering Capacity

Gastric reflux is a significant causative factor of tooth erosion. Holbrook WP, et al. J Dent Res 2009;88(5):422-6. Alexander Milosevic, PhD, BDS, FDSRCS, DRDRCS(Ed) The purpose of this study was to record the presence, severity and location of erosion in a referred Icelandic sample of children and adults and to determine the strength of association of risk factors (gastric reflux, dietary acids) and protective factors (salivary function) with dental erosion. Helsinki University Central Hospital, Finland and University of Iceland Research Fund. Case series study Level 3: Other evidence Not applicable

Nonalcoholic Fatty Liver Disease: Detection of Elevated Nicotinamide Adenine Dinucleotide Phosphate with in Vivo 3.0-T31P MR Spectroscopy with Proton Decoupling

To determine if 3.0-T proton-decoupled phosphorus 31 ((31)P) magnetic resonance (MR) spectroscopy can be used to differentiate between stages of nonalcoholic fatty liver disease (NAFLD) by resolving the components of phosphomonoester (PME) and phosphodiester (PDE) and enabling detection of a greater number of other phosphorus-containing compounds. This study was approved by the ethics committee of Helsinki University Central Hospital, and written informed consent was obtained from all study subjects. A 3.0-T clinical imager was used to obtain proton-decoupled (31)P MR spectra in the liver of control subjects (n = 12), patients with biopsy-proved simple steatosis due to nonalcoholic causes (nonalcoholic fatty liver, n = 13; nonalcoholic steatohepatitis [NASH], n = 9), and patients with cirrhosis (n = 9) to determine PME, phosphoethanolamine (PE), phosphocholine, PDE, glycerophosphocholine (GPC), glycerophosphoryl ethanolamine, uridine diphosphoglucose, nicotinamide adenine dinucleotide phosphate (NADPH), inorganic phosphate, phosphoenolpyruvate, and alpha-, beta- and gamma-nucleotide triphosphate levels. Liver fat was determined with hydrogen 1 MR spectroscopy. Differences between the disease groups were analyzed with one-way analysis of variance. The PME/(PME + PDE), PME/PDE, and PE/(PME + PDE) ratios were higher and the GPC/(PME + PDE) ratio was lower in patients with cirrhosis than in the other study groups (P < or = .001, one-way analysis of variance). The NADPH/(PME + PDE) ratio was higher in patients with NASH and those with cirrhosis than in control subjects (P < .05, post hoc analyses) and correlated with disease severity (P = .007). NADPH, a marker of inflammation and fibrinogenic activity in the liver, is increased in patients with NASH and those with cirrhosis. Proton-decoupled (31)P 3.0-T MR spectroscopy shows promise in the differentiation of NAFLD stages.

Chromosomal Abnormalities in Finnish Orofacial Cleft Patients: Excess of Submucous Cleft Patients?

The aim was to identify chromosomal regions possibly involved in the development of orofacial clefts and to compare syndromic cleft phenotypes with previous reports. We have retrospectively gathered and analyzed chromosomal aberrations and phenotypes of Finnish cleft patients treated at the Cleft and Craniofacial Centre, Helsinki University Central Hospital. The study was carried out at the Cleft and Craniofacial Centre, Helsinki University Central Hospital. The cleft register contains information on about 7600 Finnish cleft patients. Identification of patients for further molecular analyses and identification of chromosomal regions associated with orofacial clefting. We identified 37 cleft patients with chromosomal aberrations of putative research interest. We were able to efficiently select patients for further molecular analyses and identify chromosomal regions that might be associated with orofacial clefting. The percentage of submucous cleft patients among cleft patients with chromosomal aberrations was unexpectedly high.

Chemoradiotherapy in the treatment of inoperable high-grade osteosarcoma

Radical surgery is not feasible for all osteosarcoma patients. Overall survival for non-extremity osteosarcoma, as well as for patients with metastatic disease at diagnosis remains poor. For such patients, radical radiotherapy combined with chemotherapy may present an effective treatment approach. This report describes the results of conservative treatment for osteosarcoma patients not suitable for surgery. Seven out of 71 consecutive osteosarcoma patients were treated non-surgically at the Helsinki University Central Hospital either due to the inoperability of the tumour or the patient's choice of therapy. Staging procedures and measurement of tumour size were performed using computed tomography and magnetic resonance imaging. Six patients were treated with chemo-radiotherapy, and one patient received radiotherapy alone. Five patients received computer-assisted dose-planned radiotherapy with curative intent (total dose 60-70.5 Gray), and two patients received radiotherapy as palliation. Radiotherapy relieved symptoms efficiently. Median time to local failure was 2.6years (range 0.5-16.9+ years). Five year after treatment termination four patients were alive, and one of them remained disease-free. For selected patients not suitable for surgery, radiotherapy combined with chemotherapy provides an option to reduce symptoms caused by the primary tumour and improve quality of life. For some patients, this approach may (even) produce long-term remission.

Off-Label Thrombolysis Is Not Associated With Poor Outcome in Patients With Stroke

Numerous contraindications included in the license of alteplase, most of which are not based on scientific evidence, restrict the portion of patients with acute ischemic stroke eligible for treatment with alteplase. We studied whether off-label thrombolysis was associated with poorer outcome or increased rates of symptomatic intracerebral hemorrhage compared with on-label use. All consecutive patients with stroke treated with intravenous thrombolysis from 1995 to 2008 at the Helsinki University Central Hospital were registered (n=1104). After excluding basilar artery occlusions (n=119), the study population included 985 patients. Clinical outcome (modified Rankin Scale 0 to 2 versus 3 to 6) and symptomatic intracerebral hemorrhage according to 3 earlier published criteria were analyzed with a logistic regression model adjusting for 21 baseline variables. One or more license contraindications to thrombolysis was present in 51% of our patients (n=499). The most common of these were age >80 years (n=159), mild stroke National Institutes of Health Stroke Scale score <5 (n=129), use of intravenous antihypertensives prior to treatment (n=112), symptom-to-needle time >3 hours (n=95), blood pressure >185/110 mm Hg (n=47), and oral anticoagulation (n=39). Age >80 years was the only contraindication independently associated with poor outcome (OR, 2.18; 95% CI, 1.27 to 3.73) in the multivariate model. None of the contraindications were associated with an increased risk of symptomatic intracerebral hemorrhage. Off-license thrombolysis was not associated with poorer clinical outcome, except for age >80 years, nor with increased rates of symptomatic intracerebral hemorrhage. The current extensive list of contraindications should be re-evaluated when data from ongoing randomized trials and observational studies become available.

Determinants of late HIV diagnosis among different transmission groups in Finland from 1985 to 2005

To study determinants of late HIV diagnosis in a low-HIV-prevalence (<0.1%) country where HIV spread among men who have sex with men (MSM) and heterosexuals in the 1980s, and among injecting drug users (IDUs) in the late 1990s. Newly diagnosed HIV cases referred to the Helsinki University Central Hospital between 1985 and 2005 were reviewed to identify determinants of late HIV diagnosis, defined as diagnosis when the first CD4 count was <200 cells/microL, or when AIDS occurred within 3 months of HIV diagnosis. Determinants of late diagnosis were analysed using multivariate logistic regression. Among 934 HIV cases, 211 (23%) were diagnosed late. In the first 4-year interval of each sub-epidemic (1985-1989 for MSM and heterosexuals, 1998-2001 for IDUs), rates of late HIV diagnosis were 13%, 18% and 6%, respectively, but increased thereafter to 29%, 27% and 37%. Late diagnosis was associated with non-Finnish ethnicity, older age, male gender, lack of earlier HIV testing, diagnosis at health care settings and later stage of the sub-epidemic. The lower rate of late diagnosis in the first 4-year interval of each HIV sub-epidemic suggests that the early stages of the HIV epidemic in Finland were detected early. This factor may have contributed to the low prevalence of HIV infection in Finland. The stage and age of the epidemic should be taken into account when interpreting the data on late HIV diagnosis, especially in cross-country comparisons.

Prevention of acute adverse events related to infliximab infusions in pediatric patients

To study whether premedication with an oral antifebrile agent (acetaminophen) and antihistamine (cetirizine) could decrease the frequency of acute infusion reactions in pediatric patients. All pediatric patients scheduled for infliximab infusions at the Helsinki University Central Hospital, a tertiary care center, were prospectively introduced to a standard oral premedication of acetaminophen (20 mg/kg) and cetirizine (10 mg) prior to infliximab infusions for a period of 1 year. All acute adverse events related to infliximab infusions given according to the guidelines of pediatric rheumatologists or gastroenterologists were registered for this time period and retrospectively during the preceding year. During the study period, infliximab infusions with premedication were given to 64 pediatric patients (48 with rheumatic disease and l6 with inflammatory bowel disease, mean age 13 years, n = 34 boys, and n = 30 girls). Infliximab was introduced to 14 children; the rest were on maintenance therapy. Twelve infusion reactions, 4 mild and 8 severe, were observed in 8 (12.5%) of the 64 subjects, and in 1 subject 4 times. During the preceding year, 60 pediatric patients had received infliximab infusions without premedication. In this latter group, infusion reactions occurred in 5 children (8.3%; P > 0.05). The presentation of an acute infusion reaction was not related to the sex or diagnosis of the patient. In pediatric patients, acute infusion reactions related to infliximab could not be prevented with premedication with oral acetaminophen and cetirizine.

DNA repair biomarker alterations in breast cancer relevant to adjuvant chemotherapy treatment decisions.

10634 Background: It is increasingly evident that DNA Repair pathways are important determinants, prognostically and predictively, in breast cancer outcomes. Although anthracycline-based therapies are standard-of-care in breast cancer, some patients may benefit from other available therapies. Based on the DNA-damaging mechanism of action of anthracyclines and radiation, we sought to discriminate the phenotypic tumor changes to DNA repair by investigating multiple DNA repair biomarkers. We utilized a digital pathology platform to explore the association of these biomarkers with chemotherapy outcome. Methods: Tumor from 1,491 breast cancer patient specimens collected at Helsinki University Central Hospital between 1997 and 2000 were formatted into Tissue Microarrays (TMAs). The FFPE samples included 6,392 cores with four 0.6mm diameter cores per patient. IHC was performed with antibodies against 6 DNA repair proteins: BRCA1, FANCD2, RAD51, PAR, XPF, and phosphoMapKapKinase2 (pMK2). Fifty or greater tumor cells per core were analyzed using a pattern recognition and image analysis platform. Nuclear plus/minus cytoplasmic intensity and quantity measurements were acquired for the markers. Results: Digital pathology platforms are a robust means to determine levels of protein biomarkers as evidenced by DNA repair analysis. Pattern recognition and manual pathologist selection of tumor zones for scoring achieved high similarity with R2 correlations of >0.96, allowing increased throughput of biomarker analysis. RAD51 and FANCD2 biomarkers had the greatest fraction of breast cancer patients with low score values with mean scores of 44 and 30 respectively (0-300 scale). For BRCA1, pMK2, and PAR, the scores were variable amongst breast cancer patients with mean scores of 119 (0-300 scale), 166 (0-300 scale), and 50 (0-100 scale). Statistical analysis with univariate and multimarker models for subtype definition and treatment associations to determine the prognostic and predictive significance of DNA repair biomarkers are to be presented. Conclusions: Significant DNA repair differences are evident in breast cancer, and may be important determinants of therapy selection. No significant financial relationships to disclose.

Serologic Diagnosis of Human Bocavirus Infection in Children

To the Editors: Blessing et al published recently in the journal their interesting findings on prolonged human bocavirus (hBoV) DNA shedding by repeated nasopharyngeal aspirates (NPA) in 6 children.1 The interval between the samples varied from 29 to 142 days. In the latter case, the prolonged shedding was documented by 6 samples taken on days 0, 25, 53, 78, 135, and 142.1 The authors concluded that, in contrast to most other respiratory viruses, hBoV DNA detection in a single NPA sample is not sufficient to implicate hBoV as the causative agent of acute respiratory tract disease. The authors proposed that serologic assays, detection of hBoV viremia or high viral loads in NPA samples may be more useful approaches. We have recently introduced new IgM and IgG enzyme immunoassays (EIAs) for the diagnosis of acute respiratory tract hBoV infection.2 In 48 wheezing children with hBoV infection diagnosed by EIA in paired sera, 45 (94%) had viremia and 35 (73%) had hBoV in NPA by polymerase chain reaction (PCR). The EIA test was diagnostic in 27/28 (96%) of those with a high load hBoV DNA in NPA, and in 45/49 (92%) of those with hBoV DNA in serum. The respective figure in those with a low load of hBoV in NPA was 38%. About 12 children had a single hBoV infection, though an extensive test panel, including PCR, culture, antigen detection, and antibody assays, was in use for other viruses.2 In 101 children with pneumonia, serologic evidence of acute hBoV infection was found in 12 (12%) by EIA.3 Significant increases in IgG antibodies were seen in 7 cases, IgM antibodies were seen in 11 cases, and both IgG and IgM findings were documented in 6 cases. In IgG positive cases, the increases in IgG antibodies between paired sera varied from 9- to >100-fold. Thus, our findings by antibody assays verify the notion of Blessing et al, as well as other recent findings4 that hBoV is a true pathogen in respiratory tract infections in children. Qualitative PCR in NPA alone is not sufficient for a reliable hBoV diagnosis. Our results highlight the role of antibody assays. Matti Korppi, MD, PhD Pediatric Research Center University Hospital, Tampere University Tampere, Finland Tuomas Jartti, MD, PhD Department of Pediatrics University Central Hospital Turku University Turku, Finland Klaus Hedman, MD, PhD Department of Virology Maria Söderlund-Venermo, PhD Department of Virology Helsinki University Central Hospital Laboratory Division Helsinki, Finland

Recanalization and its correlation to outcome after cerebral venous thrombosis

Background Only few small studies have assessed rates of recanalization and impact of recanalization on outcome in patients after cerebral vein thrombosis (CVT). Methods In this retrospective cohort study , we included 91 consecutive patients—treated in Helsinki University Central Hospital—who had non-invasively verified CVT and follow-up imaging at 4 months or later, or autopsy. We categorized vessel status at follow-up as complete, partial, or no recanalization. A complete recovery was defined as a score of 0 on the modified Rankin Scale. Results Of the 91 patients (median age, 36 years; 70% females), 43 (47%) achieved complete recanalization, in 31 (34%) patients recanalization was partial, and 17 (19%) had no recanalization. Males, patients aged ≥ 37 years, and those with no identified risk factors for CVT had more frequently partial or no recanalization. Patients aged ≥ 37 years, those with chronic onset of symptoms (> 30 days), and those with no recanalization had worse outcome in univariate analysis. Only increasing age associated with no recanalization (OR, 1.04; 95% CI, 1.01–1.08) when adjusted for age, sex, and number of causes for CVT. Increasing age (OR 1.05; 95% CI 1.01–1.09) and chronic mode of onset (OR 9.41; 95% CI 1.02–87.07) predicted incomplete recovery or death when adjusted for age, sex, mode of onset, and status of recanalization. Headache was more common in patients with no recanalization (44%). Conclusions Half of the patients after CVT had complete recanalization. Despite the univariate association, recanalization did not associate with poor outcome in multivariate analysis. However, residual headache was more common in those with no recanalization.

Smoking Increases the Incidence of Complicated Diverticular Disease of the Sigmoid Colon

The aim of this study was to establish whether smoking is associated with complicated diverticular disease and adverse outcomes of operative treatment of diverticular disease. Smoking has been associated with increased rate of perforations in acute appendicitis as well as failure of colonic anastomosis in patients resected for colonic tumours. It has also been suggested that smoking is a risk factor for complicated diverticular disease of the colon. Retrospective investigation of records of 261 patients electively operated for diverticular disease in Helsinki University Central Hospital during a period of five years. The smokers underwent sigmoidectomy at a younger age than the non-smokers (p = 0.001) and they had an increased rate of perforations (p = 0.040) and postoperative recurrent diverticulitis episodes (p = 0.019). We conclude that smoking increases the likelihood of complications in diverticulosis coli. The development of complicated disease also seems to proceed more rapidly in smokers.Key words: Sigmoid resection; laparoscopy; laparoscopic sigmoidectomy; smoking and diverticular disease; complicated diverticular disease; diverticulitis.

Ultraearly Thrombolysis in Acute Ischemic Stroke Is Associated With Better Outcome and Lower Mortality

Pooled analysis of major placebo-controlled trials suggests that the earlier thrombolysis is given after ischemic stroke, the better the outcome. We report a single-center assessment of the effect of ultraearly thrombolysis on the outcome of our patients. Between January 2003, and December 2008, a total of 878 patients with ischemic stroke received thrombolysis within 4.5 hours from the symptom onset at the Helsinki University Central Hospital. Using univariate methods and multivariable logistic regression, we assessed the association between onset-to-treatment time (OTT) and favorable 3-month outcome (modified Rankin Scale 0 to 2). Median age was 70.5 years, median OTT 115 minutes, and median National Institutes of Health Stroke Scale (NIHSS) on admission 9. After adjustment for baseline stroke severity, more patients with OTT <70 minutes had a favorable outcome than those with OTT > or = 70 minutes. Specifically, OR of 5.15 (1.50 to 27.5) was for the patients with NIHSS 7 to 12, and 2.74 (1.26 to 5.90) for those with NIHSS > or = 13. Of the patients with OTT < or = 90 minutes, those with NIHSS 7 to 12 had an OR of 1.72 (1.00 to 2.96) for a favorable outcome, and those with NIHSS > or = 13 had lower mortality than the ones with OTT >90 minutes (16.4% versus 29.5%; P=0.01). Multivariable model showed an association of better outcome with lower baseline glucose level, younger age, lower baseline NIHSS, and OTT <70 minutes. Ultraearly thrombolysis was associated with better outcome of our patients with stroke with moderate or severe symptoms. The earlier the treatment was given, the higher the likelihood of favorable outcome.

Oral health in predialysis patients with emphasis on diabetic nephropathy

We investigated oral health of chronic kidney disease (CKD) patients at predialysis state. The hypothesis was that diabetic nephropathy affects oral health more detrimentally than other CKD patients due to the known risk diabetes presents in this regard. We expected worse oral health and particularly poor periodontal health among the diabetic patients. A cross-sectional study was conducted in the Helsinki University Central Hospital, Finland, on 148 patients with different kinds of kidney disease at predialysis state. Data from medical records, clinical oral examination, saliva, and mucosal yeast counts were analyzed and compared between the disease groups. Of the patients, 53 (36%) had diabetic nephropathy (29 patients with type 1, 24 patients with type 2 diabetes). Compared with other CKD patients, diabetic patients had poor glycemic control as expected (mean HbA(1C) 8.0% vs 5.9%, p < 0.01). Diabetic patients also had more dental caries (mean number of carious teeth 5.1 vs 3.1, p < 0.01) and lower salivary flow rates than other CKD patients (stimulated salivary flow 1.2ml/min vs 1.6ml/min, p < 0.05). No difference between groups was observed in periodontal health and yeast counts. In conclusion, diabetic nephropathy patients indeed had worse dental health in comparison to CKD group. However, contrary to our expectation, diabetic nephropathy did not seem to affect periodontal health more severely than the other kidney diseases.

MEG of Parkinsonian patients with deep brain stimulation

Event Abstract Back to Event MEG of Parkinsonian patients with deep brain stimulation Katja Airaksinen1, 2*, Jyrki P. Mäkelä1, Samu Taulu3, Antti Ahonen3, Juha Pohjola4, Jussi Nurminen1, Alfons Schnitzler5, 6 and Eero Pekkonen2 1 Helsinki University Central Hospital, BioMag laboratory, Finland 2 Helsinki University Central Hospital, Department of Neurology, Finland 3 Elekta Neuromag, Finland 4 Helsinki University Central Hospital, Department of Neurosurgery, Finland 5 Heinrich-Heine-University, Department of Neurology, Germany 6 Heinrich-Heine-Univeristy, Institute of Clinical Neuroscience and Medical Psychology, Germany Our aim was to clarify the mechanism of action of deep brain stimulation (DBS) of subthalamic nucleus (STN) in patients with Parkinson's disease (PD). We studied 12 advanced PD patients with STN DBS using a 306-channel MEG-system (Elekta Neuromag®) both when the stimulator was on and off. Auditory evoked fields (AEFs) were elicited by 1-kHz tones delivered to each ear separately and somatosensory evoked fields (SEFs) by electrical pulses delivered to the median nerve at both wrists. Spontaneous MEG was recorded in combination with EMG from extended arm of one patient before and after DBS implantation. The magnetic artifacts caused by DBS were suppressed by the spatiotemporal signal space separation (tSSS) -method. Single dipole models for AEFs and SEFs were constructed. The source strengths of AEF N100m and SEF P60m were calculated both with DBS on and off. Coherence spectra between MEG signals and wrist extensor EMG were studied when DBS was on and off both before and after operation. DBS significantly enhanced AEF N100m to ipsilateral stimulation in the right hemisphere (49 ± 17 nAm DBS on, 43 ± 16 nAm DBS off, p=0.02). The mean source strengths of contralateral N100m also increased when DBS was on (n.s.). The mean SEF source strengths of P60m were stronger when stimulator was on than off (n.s.). In one patient the MEG-EMG coherence was abolished 0.5 months after DBS implantation. Four months after implantation the coherence reappeared when DBS was off, whereas it was suppressed when DBS was on. DBS significantly diminished motor symptoms in the patients. MEG with tSSS allows to study DBS effects in PD. DBS appears to modulate auditory processing in PD patients, and have a modest effect on SEFs. Data of one patient suggests that DBS suppresses the MEG-EMG coherence. In line with data from animal models, DBS modulates cortical functions of the human brain. Conference: Biomag 2010 - 17th International Conference on Biomagnetism , Dubrovnik, Croatia, 28 Mar - 1 Apr, 2010. Presentation Type: Poster Presentation Topic: MEG: Clinical applications Citation: Airaksinen K, Mäkelä JP, Taulu S, Ahonen A, Pohjola J, Nurminen J, Schnitzler A and Pekkonen E (2010). MEG of Parkinsonian patients with deep brain stimulation. Front. Neurosci. Conference Abstract: Biomag 2010 - 17th International Conference on Biomagnetism . doi: 10.3389/conf.fnins.2010.06.00285 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 05 Apr 2010; Published Online: 05 Apr 2010. * Correspondence: Katja Airaksinen, Helsinki University Central Hospital, BioMag laboratory, Helsinki, Finland, katja.airaksinen@helsinki.fi Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Katja Airaksinen Jyrki P Mäkelä Samu Taulu Antti Ahonen Juha Pohjola Jussi Nurminen Alfons Schnitzler Eero Pekkonen Google Katja Airaksinen Jyrki P Mäkelä Samu Taulu Antti Ahonen Juha Pohjola Jussi Nurminen Alfons Schnitzler Eero Pekkonen Google Scholar Katja Airaksinen Jyrki P Mäkelä Samu Taulu Antti Ahonen Juha Pohjola Jussi Nurminen Alfons Schnitzler Eero Pekkonen PubMed Katja Airaksinen Jyrki P Mäkelä Samu Taulu Antti Ahonen Juha Pohjola Jussi Nurminen Alfons Schnitzler Eero Pekkonen Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Alterations in auditory evoked magnetic fields in newborns exposed to buprenorphine during pregnancy

Event Abstract Back to Event Alterations in auditory evoked magnetic fields in newborns exposed to buprenorphine during pregnancy Päivi Nevalainen1*, Kaisa Kivistö2, Leena Lauronen3, Satu Kivitie-Kallio2, Sarimari Tupola2 and Elina Pihko4 1 Helsinki University Central Hospital, BioMag laboratory, Finland 2 Hospital for Children and Adolescents, Department of Social Pediatrics, Finland 3 Helsinki University Central Hospital, Department of Clinical Neurophysiology, Hospital for Children and Adolescents, Finland 4 Helsinki University of Technology, Low Temperature Laboratory, Finland Neonatal abstinence syndrome (NAS) of opiate-exposed newborns is characterized by symptoms of central nervous system (CNS) hyperirritability. The specific effects NAS has on neuronal function are poorly characterized by modern neurophysiological methods. We recorded auditory (AEFs) and somatosensory evoked magnetic fields (SEFs) in order to evaluate whether NAS in neonates causes changes in neuronal function of the auditory or somatosensory system. Data was obtained from 11 infants (8 males and 3 females) exposed to buprenorphine during pregnancy, and in 13 healthy fullterm infants. The tactile and auditory stimuli were given in turn in one recording session. The interstimulus interval (ISI; onset-to-onset) for each stimulus type was 2 s. Consequently the ISI between an auditory and tactile stimulus was 1 s. The tactile stimulus was a tap on the volar side of the right index finger and the auditory stimuli were utterances of separated, long vowels [a:] delivered to the right ear. MEG was recorded from the contralateral (left) hemisphere. The SEF consisted of two components at around 60 (M60) and 200 ms (M200) without any significant differences between patients and controls. The AEF was a wide deflection with two peaks at around 250 (M250) and 600 ms (M600). Equivalent current dipoles (ECDs) underlying both responses, particularly the latter, were significantly stronger in the patients than controls. The enhanced AEFs in contrast with normal SEFs suggest different effects of buprenorphine on the two sensory systems. Conference: Biomag 2010 - 17th International Conference on Biomagnetism , Dubrovnik, Croatia, 28 Mar - 1 Apr, 2010. Presentation Type: Poster Presentation Topic: Fetal and neonatal biomagnetism Citation: Nevalainen P, Kivistö K, Lauronen L, Kivitie-Kallio S, Tupola S and Pihko E (2010). Alterations in auditory evoked magnetic fields in newborns exposed to buprenorphine during pregnancy. Front. Neurosci. Conference Abstract: Biomag 2010 - 17th International Conference on Biomagnetism . doi: 10.3389/conf.fnins.2010.06.00140 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 25 Mar 2010; Published Online: 25 Mar 2010. * Correspondence: Päivi Nevalainen, Helsinki University Central Hospital, BioMag laboratory, Helsinki, Finland, paivi.nevalainen@hus.fi Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Päivi Nevalainen Kaisa Kivistö Leena Lauronen Satu Kivitie-Kallio Sarimari Tupola Elina Pihko Google Päivi Nevalainen Kaisa Kivistö Leena Lauronen Satu Kivitie-Kallio Sarimari Tupola Elina Pihko Google Scholar Päivi Nevalainen Kaisa Kivistö Leena Lauronen Satu Kivitie-Kallio Sarimari Tupola Elina Pihko PubMed Päivi Nevalainen Kaisa Kivistö Leena Lauronen Satu Kivitie-Kallio Sarimari Tupola Elina Pihko Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

In preeclampsia, the placenta grows slowly along its minor axis

A small placental surface area at birth is associated with an increased risk of hypertension in the offspring in later life. Preeclampsia is associated with impaired implantation and with increased blood pressure in the offspring. We hypothesized that preeclampsia would be associated with a small placental surface area. We studied placental size in 6410 deliveries at the Helsinki University Central Hospital during 1934-44. 284 of the pregnancies were complicated by preeclampsia. 1855 were complicated by hypertension without proteinuria. The area of the placental surface was estimated from two diameters that were routinely recorded, a maximal diameter and a lesser one at right angles to it. Compared to normotensive pregnancies, the placentas from pregnancies complicated by preeclampsia had a reduced surface area and the surface was more oval. The thickness, however, was increased. When the two diameters were analyzed together, preeclampsia was not associated with the length of the maximal diameter, but was strongly associated with a short lesser diameter (p<0.0001). This was a graded relation: the shorter the lesser diameter, the greater the risk for, and severity of, preeclampsia. Placentas from pregnancies complicated by hypertension without proteinuria had a reduced surface area, with short lesser and maximal diameters. Processes that underlie preeclampsia may be closely related to the amount of placental tissue on the minor axis of the placenta. We postulated that placental growth is polarized from the time of implantation, so that growth along the major and minor axes is qualitatively different.

Male breast cancer: A survey at the Helsinki University Central Hospital during 1981–2006

Background. The purpose was to analyze the behavior of male breast cancer. Methods. Fifty-eight male breast cancer patients were treated at the HUCH during 1981–2006. Data on risk factors, tumor characteristics, clinical presentation, treatment and survival were obtained by chart review. Results. Presentation occurred at a median age of 63 years, most often due to a self-detected lump. The median size of the primary tumor was 1.8 cm and 14% were T4 tumors. Forty-seven percent had lymph node metastases and 4% distant metastases at diagnosis. Ductal carcinoma was the most common tumor type. All tumors with known receptor status were positive for estrogen receptor (ER) and 79% for progesterone receptor (PgR). Her-2 overexpression was found in 2/19 patients (11%). A family history of breast cancer, obesity, high alcohol intake and liver cirrhosis were the most often seen risk factors. Nineteen percent had one or two other malignancies, the most common second malignancy being prostate cancer in 7%. Ninety-seven percent were operated by mastectomy and 90% by axillary evacuation while sentinel node biopsy alone was done only in 7%. Sixty percent of the patients received radiotherapy, 64% adjuvant hormonal treatment, 20% adjuvant chemotherapy, and 2% adjuvant trastuzumab. Fourteen patients (25%) experienced a relapse of which 60% were distant, bone being the most common site. During follow-up 21 patients (37%) died, of whom nine of breast cancer and 12 due to other causes. The 5-year overall survival (OS) was 75%. Conclusions. Male breast cancer behaves and is today treated in many respects like postmenopausal breast cancer. However, due to rudimentary breast tissue the symptoms, diagnosis and especially a higher amount of T4 tumors differ from that of females. Also the risk factor profile and histologic subgroups seem different. The 5-year OS of 75% is clearly higher than 44% reported at our institution in 1982.

Cortical Abnormalities in Creutzfeldt-Jakob Disease Measured by MEG, a Case Report

Event Abstract Back to Event Cortical Abnormalities in Creutzfeldt-Jakob Disease Measured by MEG, a Case Report Eero Pekkonen1*, Juha Wilenius2, Jukka Lyytinen1, Anders Paetau3, Maarit Palomäki4 and Jyrki Mäkelä5 1 University of Helsinki, Department of Neurology, Finland 2 University of Helsinki, BioMag laboratory, Finland 3 University of Helsinki, Department of Pathology, Finland 4 University of Helsinki, Department of Radiology, Finland 5 Helsinki University Central Hospital, BioMag laboratory, Finland Creutzfeldt-Jakob Disease (CJD) is a rare neurodegenerative disease, which belongs to a group of spongiform encephalopathies termed prion diseases.Main symptoms of CJD are progressive dementia, py-ramidal and extrapyramidal symptoms, and myoclonus. Currently there is no effective therapy for CJD. Definite diagnosis is based on autopsy findings.Here we report a male patient with a rapidly progres-sive memory disorder, ataxia and myoclonus. EEG showed slow wave activity, and head MRI revealed in-creased basal ganglia and left-dominant increase in cor-tical signal intensity. In cerebrospinal fluid (CSF) 14-3-3 test was positive. The autopsy confirmed the sporadic CJD.A 306-channel MEG measurement was performed to the patient. Spontaneous brain activity and auditory evoked fields (AEF) were recorded.Both hemispheres had slow wave activity and periodic sharp waves, activity being more pronounced in the left, more damaged, hemisphere. The source of auditory N100m were more lateral in the left than in the right hemisphere. P200m was larger and more posterior in the left hemisphere compared with the right hemisphere. This is the first MEG-recording of a patient with spo-radic CJD. The more damaged left hemisphere in MRI had more pronounced slow and sharp waves in MEG. The sources of auditory responses and amplitude of later 200m deflection were different between the more and less damaged hemispheres. MEG appears to be suitable to investigate and locate brain activity in prion diseases. Conference: Biomag 2010 - 17th International Conference on Biomagnetism , Dubrovnik, Croatia, 28 Mar - 1 Apr, 2010. Presentation Type: Poster Presentation Topic: MEG: Clinical applications Citation: Pekkonen E, Wilenius J, Lyytinen J, Paetau A, Palomäki M and Mäkelä J (2010). Cortical Abnormalities in Creutzfeldt-Jakob Disease Measured by MEG, a Case Report. Front. Neurosci. Conference Abstract: Biomag 2010 - 17th International Conference on Biomagnetism . doi: 10.3389/conf.fnins.2010.06.00286 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 05 Apr 2010; Published Online: 05 Apr 2010. * Correspondence: Eero Pekkonen, University of Helsinki, Department of Neurology, Helsinki, Finland, eero_pekkonen@hotmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Eero Pekkonen Juha Wilenius Jukka Lyytinen Anders Paetau Maarit Palomäki Jyrki Mäkelä Google Eero Pekkonen Juha Wilenius Jukka Lyytinen Anders Paetau Maarit Palomäki Jyrki Mäkelä Google Scholar Eero Pekkonen Juha Wilenius Jukka Lyytinen Anders Paetau Maarit Palomäki Jyrki Mäkelä PubMed Eero Pekkonen Juha Wilenius Jukka Lyytinen Anders Paetau Maarit Palomäki Jyrki Mäkelä Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

A Comparison of Carotid Surgery in Northern Europe and Northern Africa

Although the indications for carotid endarterectomy (CEA) are clearly defined by major trials, CEA has not been properly implemented in many developing regions, including Northern Africa represented in this study by Upper Egypt. This study was designed to estimate the need for CEA in symptomatic patients with significant internal carotid artery stenosis in Upper Egypt. The estimated needs and actual provision of CEA in Upper Egypt were compared with those of Uusimaa (Finland) and Wessex (England) regions, representing Northern Europe. Incidence rates were derived from a community-based door-to-door survey in Upper Egypt, Oxford Community Stroke Project, and epidemiological Finnish studies. The provision of CEA was derived from the local registry of Vascular Surgery Department, Assiut University Hospitals in Upper Egypt; HUSVASC data registry at Helsinki University Central Hospital, and the published data of the Wessex region. The estimated needs were calculated using previously published proportions of patients eligible for CEA. The population at risk of cerebral ischemic events (>or=65 years old) is 4% of the Egyptian population compared with 16% and 15% of the British and Finnish populations, respectively. The incidence of stroke and transient ischemic attack (TIA) is comparable in England and Finland but higher than the Egyptian rates (1.9 per thousand and 2.1 per thousand vs. 1.2 per thousand for stroke; 0.5 per thousand and 0.6 per thousand vs. 0.2 per thousand for TIA, respectively). The ratio of the actual provision of CEA to the estimated need in Wessex and Uusimaa is the same (0.5), whereas it is much lower (0.003) in Upper Egypt. Despite the low incidence of stroke and TIA, there is a huge unmet need for CEA in Upper Egypt. Yet, Wessex and Uusimaa also seemed to be at a suboptimal level compared with the estimated need. If CEA could be offered annually to those 1,650 patients with severe symptomatic ICA stenosis, 275 strokes could be prevented in Upper Egypt in 5-year duration, provided that the operative morbidity and mortality rates are equal to those reported in the large, randomized, controlled trials.

Effectiveness of Superficial Venous Surgery in Terms of Quality-Adjusted Life Years and Costs

To assess the impact of superficial venous surgery (SVS) on health-related quality of life (HRQoL) and to explore the cost-utility of venous surgery. 143 patients (110 female and 33 male) enrolled for SVS between 2003 and 2005 in Helsinki University Central Hospital filled in the 15D survey before and six months after operation. Direct hospital costs were obtained from a patient administration database and were examined from the perspective of secondary care provider. After SVS, the HRQoL score improved in 71% of the patients, and the mean score increased from 0.919 (on a 0-1 scale) preoperatively to 0.933 postoperatively at 6 months (p < 0.001). Patients with a clinically important result from SVS (> or = 0.03 increase in the HRQoL score) had significantly worse HRQoL at baseline. At 6 months postoperatively, the mean (SD) hospital costs were 1637 euros (693) and the mean quality-adjusted life year (QALY) gain 0.504 (1.674), respectively. Thus, the mean cost per QALY gained during a 6-month period was 3248 euros for SVS. Superficial venous surgery improves HRQoL, and is a cost-effective treatment of symptomatic superficial venous insufficiency.