Interactive skills of infants with their high-risk mothers

In this pilot study, the interactive skills of infants with their high-risk, substance-dependent mothers were explored in residential treatment from pregnancy until the infant was 6 months of age. Fourteen mother-infant pairs were videotaped in feeding and free play situations at 6 months after birth. A comparison, low-risk group consisted of 12 ordinary Finnish mother-infant pairs with minimal clinical risks. The findings show significantly higher levels of dyadic interactive deficiencies among the high-risk mother-infant pairs compared to the low-risk pairs, displayed especially in the feeding situation as lack of mutuality and flat, empty, constricted affective tone of interaction. Also, more interactive deficiencies were found among the high-risk infants compared to the low-risk infants, but the differences were not significant. In this study, this finding might reflect the reduced amount of somatic complications and the benefits of treatment, the impacts of which were not explored. The differences between the high- and low-risk infants were displayed as more withdrawal, depressed mood and avoiding behavior and as less alertness and attentional abilities, robustness and focus on parent's emotional state among the high-risk group.     

Influence of the dopamine D2 receptor knockout on pain-related behavior in the mouse

We studied the role of the dopamine D2 receptor in physiological regulation of pain-related behavior. The experiments were performed in dopamine D2 receptor knockout mice and in their wild-type controls. Baseline sensitivity to thermal nociception was determined by measuring the response latency in the hot plate at three different stimulus temperatures and by determining the radiant-heat-induced paw withdrawal. Mechanical sensitivity was assessed by determining paw withdrawal responses to stimulation with a calibrated series of monofilaments. Intracolonic capsaicin was used to produce sustained pain-related behavior and referred hypersensitivity to mechanical stimulation. The hot plate response latencies were not significantly different between the dopamine D2 receptor knockout and wild-type animals, although the stimulus temperature-dependent decrease in the response latency was steeper in the wild-type group. The radiant-heat-induced paw withdrawal latency was slightly longer in the knockout animals. The number of capsaicin-induced behavioral responses or the latency to the occurrence of the first capsaicin-induced response was not different between the experimental groups. Dopamine D2 receptor knockout animals were more sensitive to mechanical stimulation of the hindpaws than wild-type animals both in the baseline condition and following development of capsaicin-induced referred hypersensitivity in the hindpaws. The results indicate that dopamine D2 receptors influence baseline nociception in the mouse, although this effect is weak and submodality selective. Additionally, dopamine D2 receptors may contribute to attenuation of referred hypersensitivity caused by sustained nociception.     

Serum tryptase levels in acute coronary syndromes

BACKGROUND: Mast cell accumulation and activation have been demonstrated in the vulnerable shoulder regions of atherosclerotic plaques and at the actual sites of plaque erosion and rupture. When activated and degranulated, mast cells release tryptase, a neutral protease, capable of activating matrix metalloproteinases and predisposing to plaque rupture. We tested the hypothesis that in acute coronary syndromes the levels of serum tryptase would reflect mast cell activation. METHODS AND RESULTS: The study population consisted of 183 patients admitted to the emergency room of 3 general hospitals because of acute chest pain of ischemic origin. Of these patients, 64 suffered from exertional angina presenting with acute chest pain, 60 had unstable angina, and 59 had acute myocardial infarction. Serum tryptase levels were analyzed from samples drawn, on average at 7 h, and also at 24 h after the onset of the chest pain. As controls served 41 patients admitted for surgical treatment of inguinal hernia or varicose veins. Serum tryptase levels remained stable within the observation period, and no differences were detected between the patient groups and controls. On the other hand, the differences in C-reactive protein levels reflected the extent of myocardial injury. CONCLUSIONS: In ACS, serum tryptase levels are normal and remain stable. Our results do not exclude the possibility of local activation of coronary mast cells, but suggest that the excess quantity of tryptase acutely released from mast cells in ACS, if any, is not sufficient to be detected by measuring tryptase concentration in the systemic circulation.     

Orthostatic hypotension predicts vascular death in older diabetic patients

Diastolic orthostatic hypotension measured 1 min after standing up (OH-D1), and systolic OH measured 3 min after standing up (OH-S3) increase vascular mortality risk among older adults. We hypothesized that the risk is especially high among diabetic patients. The orthostatic test was carried out in a standard way by a trained nurse in 868 subjects (79% of a representative population sample) and 98 of them were diabetic treated with oral hypoglycemic agents or insulin. OH-D1 occurred in 9 (9%) diabetic patients and in 43 (6%) other subjects of the cohort (Chi-Square; P = 0.157), and OH-S3, correspondingly, in 28 (29%) and 140 (18%) (P = 0.014). Absent patellar vibration sense, absent patellar reflex and resting heart rate was higher, and cardioacceleration early after active standing up was lower in the diabetic patients. According to Cox Proportional Hazards modelling, after adjustment for other baseline variables (age, sex, history of myocardial infarction, current smoking, chest pain and systolic blood pressure), the hazard ratio of vascular death as regards OH-D1 was 3.69 (95% confidence intervals 1.54-8.84), and that as regards OH-S3 was 2.70 (1.16-6.29). Among the persons free of diabetes treated with oral hypoglycaemic agents or insulin (N = 770), survival for vascular death did not differ in regard to presence and absence of OH-D1 and OH-S3. Our results suggest that diabetes patients with orthostatic hypotension carry a high risk of vascular death. Diabetic neuropathy is a plausible explanation to our findings.     

Acute cholecystitis in the elderly

BACKGROUND/AIMS: The population of Finland is ageing fast, and acute cholecystitis is common among elderly people. Because the treatment options have changed greatly since the late 1980's, we wanted to find out whether the active treatment policy nowadays used in our hospital has some effects on operability, morbidity, mortality and the duration of the in-patient period. The numerous serious illnesses of elderly people that cause considerable morbidity and mortality underlines the importance of risk stratification, and clinical variables were therefore also tested for their ability to predict the probability of morbidity and mortality. METHODOLOGY: Two hundred and eighteen patients aged over 75 years, 92 patients during the 5-year period 1988-1992 (Period I) and 126 patients during the 5-year period 1998-2002 (Period II) had been admitted into our hospital for acute cholecystitis, and they were identified from a computer database. During these two periods, different treatment strategies were used. The clinical data were reviewed from the database and the patient records. RESULTS: The active use of ERCP and percutaneous cholecystostomy during Period II decreased the number of all operations and emergency operations. Only six of the 43 patients who underwent early cholecystostomy were later scheduled for cholecystectomy. Postoperative morbidity did not differ between the two periods, and stepwise logistic regression analysis showed obesity to be an independent predictor of morbidity. Overall mortality was 8% during period I and 6% during period II, and of the clinical variables, underlying lung disease, malnutrition, pericholecystic fluid collection in ultrasound and perforation of the gallbladder were independent predictors of mortality in stepwise logistic regression analysis. Neither the primary in-patient period nor the total in-patient period were significantly shorter during Period II. CONCLUSIONS: Active treatment of acute cholecystitis in the elderly may decrease the need for emergency surgery. Malnutrition and perforation of the gallbladder are the most important predictors of mortality in this patient group.     

Muscle fiber-type distribution as a predictor of blood pressure: a 19-year follow-up study

The known association between physical activity and low blood pressure may be influenced by inherited characteristics. Skeletal muscle consists of type I (slow-twitch) and type II (fast-twitch) muscle fibers, with proportions highly variable between individuals and mostly determined by genetic factors. A high percentage of type I fibers (type I%) has been associated with low blood pressure in cross-sectional studies. We investigated whether type I percentage predicts future blood pressure levels and explains part of the association between physical activity and blood pressure. At baseline, in 1984, muscle fiber-type distribution, physical activity, and body mass index (BMI) were determined in 64 healthy men (age, 32 to 58 years). At follow-up, in 2003, blood pressure, physical activity, and BMI were determined in these men. In subjects without antihypertensive medication (n=43), type I percentage accounted for 5%/18% of the variation in systolic/diastolic blood pressure. A high type I percentage predicted, independent of both baseline (in 1984) and follow-up (in 2003), physical activity, BMI, and low systolic and diastolic blood pressure. Adjusted for all baseline covariates, a 20-unit higher type I percentage predicted a 11.6-mm Hg lower systolic blood pressure (P=0.018) and a 5.0-mm Hg lower diastolic blood pressure (P=0.018). High levels of physical activity in 1984 predicted low diastolic blood pressure, but this association was lost when type I percentage was included into the model. A high proportion of type I fibers in skeletal muscle is an independent predictor of low blood pressure and explains part of the known association between high levels of physical activity and low blood pressure.     

Low physical activity as a predictor for antihypertensive drug treatment in 25-64-year-old populations in eastern and south-western Finland

OBJECTIVE: To determine whether low leisure-time physical activity, occupational physical activity and commuting activity independently increase the risk of hypertension when adjusted for most risk factors for hypertension and for different forms of physical activity. DESIGN: Population-based prospective cohort study. SETTING: Eastern and south-western Finland. PARTICIPANTS: Men (n = 5935) and women (n = 6227) aged 25-64 years. MAIN OUTCOME MEASURE: Initiation of free-of-charge medication for hypertension during a mean follow-up time of 11.3 years. RESULTS: Men with high leisure-time physical activity had a reduced risk of hypertension when adjustment had been made for age, area and year of survey, education, smoking, alcohol intake, baseline systolic blood pressure (SBP), body mass index (BMI), commuting activity and occupational physical activity [hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.63 to 0.99]. Women with high leisure-time physical activity had a reduced risk of hypertension when adjusted for age, area and time of survey (HR 0.65; 95% CI 0.46 to 0.91). This association was no longer significant when further adjustments were made for other covariates (HR 0.73; 95% CI 0.52 to 1.03). High occupational physical activity reduced the risk of hypertension only among men and women combined when adjustment was made for age, area and time of survey, education, smoking and alcohol intake, in addition to baseline SBP, BMI, commuting activity and leisure-time physical activity (HR 0.83; 95% CI 0.72 to 0.96). Commuting activity was not associated with risk of hypertension in multivariate models. CONCLUSION: High levels of leisure-time physical activity are associated with a reduced risk of hypertension, independently of most common risk factors for hypertension, occupational physical activity and commuting activity. Promoting leisure-time physical activity is essential to prevent hypertension.     

The use of undiluted amiodarone in the management of out-of-hospital cardiac arrest

Introduction: The Resuscitation 2000 Guidelines recommends amiodarone as the antiarrhythmic drug of choice in treatment of resistant ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). Amiodarone has been associated with side‐effects and difficulty of administration, due to recommended dilution, rendering it suboptimal for out‐of‐hospital cardiac arrest (CA) management. In the present study we report experiences and side‐effects of the use of undiluted amiodarone in CA management in Helsinki Emergency Medical Service (EMS) during a 2‐year period. Methods: On October 1, the Resuscitation 2000 Guidelines were put into practice in Helsinki EMS. Thus, in the cardiac arrest treatment protocol, after three ineffective shocks and 1 mg of adrenaline (epinephrine), a bolus of 300 mg of undiluted amiodarone (Cordarone^® 50 mg ml^?1, Sanofi‐Synthelabo, Helsinki, Finland) was administered into a vein located as centrally as possible. The Helsinki EMS performs systematic data collection according to the Utstein Guidelines. The blood pressure levels, heart rates and the need for vasopressors, of the patients with sustained return of spontaneous circulation (ROSC), were collected from the ambulance charts. Results: During October 1, 2000 and September 30, 2002, 712 patients were considered for resuscitation and 566 were resuscitated. The initial rhythms were as follows: 32% had VF/VT, 36% had asystole and 32% had pulseless electrical activity (PEA). Of the 180 patients with VF/VT, 75 (42%) received undiluted amiodarone in addition to other resuscitative measures. Of the patients with asystole or PEA, 12 (6%) and 18 (10%), respectively, received amiodarone. The blood pressure levels and the need vasopressors after ROSC and during transportation to the hospital were similar among the patients who received and those who did not receive amiodarone. Conclusions: The present study suggests that amiodarone can be administered undiluted without unmanageable haemodynamical side‐effects in the treatment of out‐of‐hospital cardiac arrest. This is likely to save time and simplifies the treatment protocol in the prehospital setting.     

Periprosthetic tibial bone mineral density changes after total knee arthroplasty: one-year follow-up study of 69 patients

BACKGROUND: The critical structure supporting the prosthetic components in total knee arthroplasty (TKA) is tibial trabecular bone. The quality of tibial bone can be evaluated by bone mineral density (BMD) measurements. PATIENTS AND METHODS: We prospectively measured changes in BMD in the proximal tibia after cemented TKA in osteoarthrotic knees. 69 patients were scanned by dual-energy X-ray absorptiometry (DXA) within a week after surgery, and after 3, 6 and 12 months. RESULTS: At baseline, the medial region of interest (ROI) BMD was higher in the varus knees than in the valgus aligned knees (p=0.02). The medial metaphyseal ROI showed a decrease in BMD during the follow-up in preoperatively varus knee joints (p<0.001). In preoperatively valgus knees, there was a slight increase in medial compartment BMD which was not significant (p=0.2). Alignment correction in both groups showed bone remodeling giving similar medial and lateral BMD values, suggesting that the bone became equally strong in both compartments of the metaphysis. There was no association between increasing American Knee Society (AKS) scores and bone remodeling. INTERPRETATION: We suggest that this remodeling is caused by postoperative changes in tibial loading. Our results support the clinical importance of recreating proper valgus alignment of the knee joint in the TKA operation, thus possibly providing better conditions for longevity of the tibial component.