Chromosomal abnormalities in cutaneous T-cell lymphoma and in its premalignant conditions as detected by G-banding and interphase cytogenetic methods

The etiology of cutaneous T-cell lymphomas (CTCL) is unknown. We studied the pattern of chromosomal abnormalities with G-banding and interphase in situ hybridization methods in blood mononuclear cells in 17 patients representing the different phases of CTCL or the premalignant condition, parapsoriasis en plaque, and in 10 control persons. We used biotinylated centromere-specific probes with fluorescent detection (FISH) for chromosomes 1, 11, 8, and 17 and similar, enzymatically detectable, digoxigenin-labeled probes for chromosomes 1, 6, 12, 17, and 18. In G-banding, all patients showed numerical and structural chromosome aberrations. Numerical aberrations of chromosomes 6, 13, 15, and 17, marker chromosomes, and structural aberrations of chromosomes 3, 9, and 13 were increased in mycosis fungoides (MF) compared with healthy controls. In four of five patients the detection of a chromosomal clone preceded relapse or progression of the disease. In FISH of interphase cells, the cells abnormal for chromosomes 8 or 11, and for all four chromosomes collectively, were increased in MF and in Sezary Syndrome (SS). FISH and G-banding methods agreed statistically significantly for the detection of monosomy. Also, digoxigenin-labeled probes hybridized to interphases or mitoses detected aberrations corresponding to those observed with G-banding. Thus, chromosomally abnormal cells can be found in the peripheral blood of both parapsoriasis en plaque and CTCL patients. They can be detected with interphase cytogenetical methods, which obviates the need for dividing cells, often difficult to accomplish in CTCL.

The effect of endurance exercise at moderate altitude on serum lipid peroxidation and antioxidative functions in humans

We investigated the effect of training and racing at moderate altitude (MA) on oxidative stress by assessment of serum diene conjugation (DC) and serum antioxidant potential (TRAP). Nine male top level skiers were studied during a national race (20-30 km) at sea level (SL). Thereafter, the athletes trained for 2 weeks at MA, after which they participated in a 20-30 km race at MA. Venous blood samples were taken before and after the race. The DC, indicating early events of lipid peroxidation, did not change during the race at SL (16 850 vs 15 900 delta Absorbance.l-1) or at MA (19 870 vs. 20 630 delta Abs.l-1). At MA serum DC was higher than at SL both before (25%) and after (30%) the race, the postrace difference being statistically significant (P < 0.05). The TRAP increased during the race at MA (from 1387 to 1943 mumol.l-1, P = 0.016), but not at SL (1713 vs 1582 mumol.l-1). These observations would suggest that the level of oxidative stress might be greater during living, training and racing at MA (higher DC levels). Increased TRAP during the race at MA may indicate that the physiological adaptation to extreme acute oxidative stress was altered. The physiological significance of this observation remains to be investigated.

Total and occupationally active life expectancies in relation to social class and marital status in men classified as healthy at 20 in Finland

STUDY OBJECTIVE

To study differences in total life expectancy and in occupationally active life expectancy in relation to social class and marital status in men classified as healthy as young adults.

DESIGN

Historical cohort study.

SETTING

Finland.

PARTICIPANTS

Altogether 1662 men classified as completely healthy at the time of induction to military service (mean birth year 1923), who had been selected as referents for a study of former athletes. Mean follow up time was 46 years.

MEASUREMENTS

Vital status was determined by follow up through local parish data up to 1990. Mortality data were obtained from the Cause of Death bureau of the Central Statistical Office of Finland. Occurrence of work disability was assessed from nationwide disability pension register data. Mean total life expectancy and mean occupationally active life expectancy (end points disability pension or death before age 65 years) were estimated. Social class was based on the major lifetime occupation, while marital status was classified as "never married" or "ever married" at the end of follow up.

MAIN RESULTS

Mean total life expectancy was highest among executives and managers (73.2 (95% confidence interval (CI): 70.3, 76.1) years), next highest in clerical (white collar) workers (72.0 (70.0, 74.1) years), and lowest in unskilled blue collar workers (63.65 (61.1, 66.2) years). Skilled workers and farmers were intermediate. For the occupationally active life expectancy estimates, a similar gradient was observed: highest for executives (61.9 (60.7, 63.1) years) and lowest for the unskilled (52.2 (50.2, 54.2) years). The ratio of occupationally active life expectancy to total life expectancy was highest for executives (85%) and lowest for farmers (81%) and unskilled workers (82%).

CONCLUSIONS

The social class gradient known to exist for mortality is also present for occupational disability. Social class and marital status differences in mortality are already evident in early adulthood and continue into old age. Those with the highest life expectancy also have the largest proportion of their life span free of occupationally incapacitating disability.

Patients with traumatic brain injury referred to a rehabilitation and re-employment programme: social and professional outcome for 508 Finnish patients 5 or more years after injury

We studied influence of age and educational level before injury on the social and vocational outcome among a group of traumatic brain injury (TBI) patients with post-injury problems in their education and employment. Patients with TBI, followed up for at least 5 years, and who were admitted to a rehabilitation and re-employment programme, were selected for evaluation of long-term outcome. We used the Glasgow Coma Scale (GCS) scores at the time of emergency admission to the hospital to measure brain injury severity. Age at the time of TBI and educational status before TBI were correlated with the outcome measures at the end of follow-up separately in each category of brain injury severity. The study was carried out at the Kauniala outpatient neurological clinic, which specializes in brain injuries in Finland; it works closely with the Departments of Neurology and Neurosurgery at the Helsinki University Central Hospital. Main outcome measures were functional outcome measured by the Glasgow Outcome Scale (GOS), the educational level reached, and post-injury occupation, as well as the incapacity for work at the end of follow-up. In the severe category of brain injuries, children 7 years or younger at the time of injury suffered severe disability as measured by the GOS scores more often than did the older age groups (p = 0.010, chi 2). They were less often capable of independent employment (p = 0.011, chi 2) than the children injured at the age of 8-16. Patients with a higher education usually had a better outcome. In the category of mild brain injuries the majority of the patients, regardless of age, recovered well according to the GOS, and were capable of independent employment at the end of follow-up. Our patients were selected from the TBI population as survivors with problems in education and re-employment. Those with severe injury sustained early in life (childhood and early teens) coupled with poor educational attainment had relatively worse social and vocational outcome; better outcomes were enjoyed by those severely injured individuals whose injuries were sustained later (late teens or early adulthood). In the groups of patients with moderate and mild brain injuries such a relationship was not found between age or pre-injury education and outcome.

Provocative growth hormone testing is not required before initiation of rhGH treatment in children with renal and liver transplants

GH provocative testing does not predict subsequent growth response, and is not therefore required before initiation of rhGH treatment in children with renal and liver transplants. However, therapeutic doses of glucocorticoids may potentially inhibit GH secretion in some patients, and determining GH secretory status by provocation tests and measuring spontaneous GH secretion is advisable at some point after organ Tx to exclude GH deficiency.

Hospital care in later life among former world-class Finnish athletes

OBJECTIVE

To investigate the use of hospital care from all causes among former top-level athletes from different vigorous sports to determine whether health benefits or adverse effects have the greater influence.

DESIGN

National, population-based cohort study with a 21-year follow-up.

SETTING

Finland.

SUBJECTS

A total of 2049 male athletes who had represented Finland during 1920 to 1965, and 1403 male controls classified healthy at 20 years of age.

MAIN OUTCOME MEASURE

In-hospital care from all causes was extracted from the national hospital discharge registry for the period 1970 through 1990 expressed as hospital days per person-years of exposure.

RESULTS

Compared with controls, the rate ratios (RRs) for all-cause hospital days per person-years of exposure were lower in athletes from endurance sports (RR, 0.71; 95% confidence interval [Cl], 0.70-0.73), mixed sports (including endurance and weight training) (RR, 0.86; 95% Cl, 0.85-0.87), and power sports (RR, 0.95; 95% Cl, 0.94-0.96) (P < .001 for all comparisons) after adjustment for age and occupational group. The lower RR among athletes from endurance sports and other sports involving aerobic activity was largely explained by lower rates of hospital care for heart disease, respiratory disease, and neoplasms, but not for musculoskeletal disorders.

CONCLUSIONS

Former elite athletes, particularly those in aerobic sports, use less hospital care. Other beneficial health habits are known to be associated with a physically active lifestyle.

Gastric inflammation and neutrophil-activating and cytotoxin-producing Helicobacter pylori strains

BACKGROUND

Some Helicobacter pylori strains activate human neutrophils without opsonins and/or produce vacuolating cytotoxin.

METHODS

Human gastric isolates of H. pylori were studied for their ability to nonopsonized induce an oxidative burst in human neutrophils as measured by chemiluminescence and for the production of vacuolating cytotoxin. In all, 80 strains were examined, and the type and grade of inflammation in the gastric biopsy specimens from the antrum and corpus of these patients were assessed in accordance with the Sydney system.

RESULTS

CL+ (rapid, strong response in chemiluminescence) strains (p < 0.0001) and Tox+ (cytotoxin-producing) strains (p < 0.0001) were associated with higher acute inflammation scores in gastric ulcer patients. CL+ (p = 0.0002) and Tox+ (p < 0.0001) strains were also associated with higher chronic inflammation scores in gastric ulcer patients.

CONCLUSIONS

CL+ and Tox+ strains seem to cause more severe inflammation in the gastric mucosa during H. pylori infection.

Markers of type I collagen degradation and synthesis in the monitoring of treatment response in bone metastases from breast carcinoma

Thirty-six patients with bone metastases included in a trial of supportive calcitonin on the treatment response to systemic therapy were monitored by conventional radiography, conventional indicators of bone metabolism [alkaline phosphatase (AP), osteocalcin (gla), urinary hydroxyproline excretion (OHP), urinary calcium (uCa), serum calcium (sCa)] and collagen metabolites (ICTP, the pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen; PICP, the carboxy-terminal propeptide of type I procollagen; and PIIINP the amino-terminal propeptide of type III procollagen). All patients had been on the same systemic treatment for at least 3 months at the start of the trial. There was a positive correlation between the concentrations of ICTP and PICP at baseline (Spearman's rank-order correlation coefficient rs = 0.62). Both ICTP and PICP showed statistically significant correlations to the other markers of bone metabolism (except sCa and uCa) as well as to the number of bone metastases on bone scans. Reduction in ICTP correlated significantly with the treatment response at three months (rs = - 0.57). while PICP showed a borderline negative correlation to therapy response (rs = - 0.37). Of all the biochemical parameters studied the changes in ICTP showed the best correlation with the treatment response. PICP and ICTP changes in patients with progressive disease differed significantly from those in patients with responding and stable metastases, whereas no difference was found between responders and stable patients.

Recombinant human growth hormone improves growth in children receiving glucocorticoid treatment after liver transplantation

Linear growth is often impaired after successful liver transplantation. The cause is multifactorial; poor graft function and long term glucocorticoid treatment are the main factors responsible. The efficacy and safety of recombinant human GH (rhGH) treatment were assessed in eight growth-retarded children (five boys and three girls) with liver transplants. Immunosuppression comprised azathioprine, cyclosporin, and methylprednisolone. rhGH was administered in a dose of 1 IU/kg x week, given by daily sc injections. The median age at the start of treatment was 9.7 yr (range, 5.9-14.9 yr). All but one of the patients remained prepubertal during treatment. The median growth rate increased from 3.2 to 7.l cm/yr (P = 0.025) and height SD score increased from -3.9 to -3.1 (P = 0.036) during the first year of rhGH treatment. Serum insulin-like growth factor I and insulin-like growth factor-binding protein-3 levels increased significantly during treatment. Graft function was normal in all except one patient, and no rejections or other serious side-effects were documented. In conclusion, rhGH treatment is effective in short, non-GH-deficient, liver-transplanted children receiving long term glucocorticoid treatment. Due to potential risk of allograft rejection, close monitoring of liver function and immunosuppression is required.

Recombinant human growth hormone treatment. Its effect on renal allograft function and histology

Our objective was to investigate the effects of recombinant human growth hormone (rhGH) treatment on long-term renal allograft function and histopathology. RhGH is a potent therapy for poor growth after renal transplantation. However, rhGH has proinflammatory properties and may induce acute rejection or accelerate chronic rejection. Nine prepubertal rhGH-treated renal transplanted children and nine pair-matched controls were studied 18 (before the start of rhGH) and 36 months after transplantation (mean duration of rhGH-treatment 14 months). 51Cr-EDTA- and PAH-clearances were performed. A protocol renal biopsy was done at 36 months. Growth showed significant improvement during rhGH (P<0.01). One graft loss occurred in both groups. One acute rejection was seen in the control group. There was no difference in the rate pf change in 51Cr-EDTA-or PAH-clearance between the two groups. Histopathological findings were mostly mild. One new onset chronic rejection developed in both groups. Proximal tubular atrophy was more extensive in the rhGH-treated patients (P<0.05), but there was no uniform trend toward more severe findings. RhGH improved growth, and no significant differences were seen in allograft function or histopathology; however, larger trials controlled for pretreatment renal function and immunosuppression are needed.

Asthma and other pulmonary diseases in former elite athletes

BACKGROUND

The prevalence of asthma is rising and there are recent reports of increasing asthma rates among top level skiers and runners in the Nordic countries.

METHODS

The lifetime occurrence of pulmonary diseases (asthma, chronic bronchitis, emphysema) and current bronchitis symptoms was compared in former elite male athletes (n = 1282) who represented Finland between 1920 and 1965 at least once in international competitions and controls (n = 777) who, at the age of 20, were classified as healthy and who responded to a questionnaire in 1985. The presence of disease and symptoms was identified from the questionnaire and, in the case of asthma, also from a nationwide reimbursable medication register. The death certificates of the subjects of our original cohort who died between 1936 and 1985 were also investigated to determine the cause of death.

RESULTS

The occurrence of the pulmonary diseases was associated with age, smoking habits, occupational group, and a history of exposure to chemicals. After adjusting for these variables, athletes who participated in mixed sports (odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23 to 0.92) and power sports (OR 0.43, 95% CI 0.21 to 0.87) had lower odds ratios for emphysema, and endurance sports athletes had a lower odds ratio for the presence of at least one pulmonary disease (OR 0.53, 95% CI 0.28 to 0.98) when compared with controls. Athletes also tended to have fewer reimbursable medications for asthma and fewer current symptoms for chronic bronchitis. Between 1936 and 1985 two controls but none of the athletes died of asthma.

CONCLUSIONS

The lifetime occurrence of asthma or other pulmonary diseases is not increased in former elite athletes, and exercise alone, even in a cold environment, did not appear to increase the prevalence of asthma, at least up to the mid 1980s.

Violent methods associated with high suicide mortality among the young

OBJECTIVE

To present rates and trends in suicide methods, and associations between these, in male and female adolescents in the age groups 15 through 19 years and 20 through 24 years in Finland from 1947 through 1991.

METHOD

Suicide rates were calculated on the basis of the mean same-age population, and suicide trends by each method were analyzed by using the Poisson regression model. For the rates and trends, 95% confidence intervals based on the Poisson distribution were calculated.

RESULTS

The suicide rate revealed a sharp and significant increase between 1965 and 1975 for both male age groups. Firearms and hanging accounted for the majority of that increase. These figures, however, were not accompanied by similar changes in the availability of firearms during that period. Moreover, an increased total suicide rate as well as that by automobile exhaust fumes in young adults after 1982 coincided with a widely presented Finnish movie which featured this method of committing suicide. In young women, however, intake of solids and liquids remained the most common suicide method.

CONCLUSION

Suicide rates increased, especially by violent methods, which contributed to the high suicide mortality rate among the young. These methods, except firearms, however, are often difficult to restrict. This fact underlines the importance of the integration of various preventive measures of cooperation between mental health professionals and other authorities and of the recognition and care of young people at high suicide risk.

Frostbite of the face and ears: epidemiological study of risk factors in Finnish conscripts

OBJECTIVE

To determine the incidence of and the risk factors for local cold injuries of the face and ears in peacetime military service.

DESIGN

Prospective, controlled epidemiological study using a questionnaire.

SETTING

Finnish defence forces, 1976-89.

SUBJECTS

913 young male conscripts with local frostbite of the head that needed medical attention and 2478 uninjured control conscripts.

MAIN OUTCOME MEASURES

Type of activity, clothing, and other risk factors at the time of cold injury. Odds ratios were used to calculate risk. Controls were handled as one group.

RESULTS

The mean annual incidence of frostbite was 1.8 per 1000 conscripts. Frostbite of the ear was most common (533 conscripts (58%)), followed by frostbite of the nose (197 (22%)) and of the cheeks and other regions of the face (183 (20%)). Most conscripts (803 (88%)) had mild or superficial frostbite. Risk factors included not wearing a hat with earflaps (odds ratio 18.5 for frostbite of the ear); not wearing a scarf (odds ratio 2.1 and 3.8 for frostbite of the ear and cheeks respectively); using protective ointments (odds ratio 3.3, 4.5, and 5.6 for frostbite of the cheeks, ear, and nose respectively); being extremely sensitive to cold and having hands and feet that sweat profusely (odds ratio 3.5 for frostbite of the nose); and being transported in the open or in open vehicles under windy conditions (odds ratio 2.2 for frostbite of the cheek).

CONCLUSIONS

Wearing warm clothing, including a scarf and a hat with earflaps, helps to prevent frostbite. Each person's sensitivity to cold may also be important. The routine use of protective ointments should not be recommended.

Differences in linear growth and cortisol production between liver and renal transplant recipients on similar immunosuppression

Linear growth is more often impaired after liver than after renal transplantation (Tx) in childhood. As similar triple immunosuppression was used in our liver and renal transplant recipients, we were able to compare growth and endocrine function between 19 prepubertal liver and 35 renal transplant recipients. There were no significant differences in median age, weight-for-height index, or height standard deviation score at Tx. Seventy-eight percent of the liver Tx patients, but only 7% of the renal Tx patients, were below the normal range for height 3 years after Tx. Graft function was good in both liver and renal transplant recipients 3 years after Tx. There was no significant difference in growth hormone secretion, serum insulin-like growth factor (IGF)-I, and IGF-binding protein-3 levels, or in methylprednisolone and cyclosporine doses. However, the blood cyclosporine levels were significantly higher in the liver transplant recipients (P = 0.001 1 year and P = 0.005 2 years after Tx). Cortisol production was significantly lower in the liver transplant recipients (P = 0.002 1 year and P = 0.049 2 years after Tx), which suggests greater steroid-mediated suppression of adrenal function. Growth inhibition is more often observed in liver than in renal transplant recipients on similar triple immunosuppression, and may not be related to deficient function of the growth hormone-IGF-I axis. Similar cyclosporine doses result in higher plasma levels of the drug and similar methylprednisolone doses result in more inhibited adrenal cortisol production in liver transplant recipients. In children with organ transplants, cyclosporine and methylprednisolone should be administered on an individual basis.

Growth delay after liver transplantation in childhood: studies of underlying mechanisms

After liver transplantation in children, growth is often impaired, but the underlying mechanisms are unknown. Glucocorticoids used for immunosuppression are believed to be partly responsible. After renal transplantation in children, reduced growth hormone (GH) secretion and increased serum insulin-like growth factor-binding protein-3 (IGFBP-3) levels have been reported. We attempted to find endocrine factors predicting growth in 18 prepubertal children followed for more than 1 y (mean 2.4 y) after liver transplantation. Spontaneous and stimulated GH secretion, serum IGF-I, IGFBP-3 concentrations, and endogenous cortisol production were measured. GH secretion was reduced in only two patients. Serum IGF-I concentration was normal, but serum IGFBP-3 was elevated or 1 SD above the mean for age in 62% of the patients. Endogenous cortisol production was reduced in most patients during the first year and improved later in only a few. Growth velocity after transplantation did not correlate with GH secretion, serum IGF-I or IGFBP-3 concentration, or with methylprednisolone dose, but correlated positively with serum basal (rs = 0.44, p < 0.05) and stimulated (rs = 0.53, p < 0.005) cortisol concentration. In conclusion, after liver transplantation 1) the normal pulsatile character of nocturnal GH secretion is sustained, and the GH response to stimulation is reduced in only a few patients; 2) serum IGF-I concentrations are normal; 3) serum IGFBP-3 concentrations are elevated or in the upper part of the normal range in most patients; and 4) endogenous cortisol production is reduced in most patients and correlates positively with growth velocity.

White matter hyperintensities on MRI in the neurologically nondiseased elderly. Analysis of cohorts of consecutive subjects aged 55 to 85 years living at home

BACKGROUND AND PURPOSE

We undertook this study to evaluate the frequency and risk factors of white matter hyperintensities seen on T2-weighted MR imaging. We examined cohorts of neurologically nondiseased elderly subjects participating in a general-community study, the Helsinki (Finland) Aging Brain Study. Cohorts of consecutive subjects aged 55, 60, 65, 70, 75, 80, and 85 years (n = 20, 18, 20, 18, 19, 18, and 15, respectively; total, n = 128) were divided into a young-old (age < 75 years, n = 76) group and an old-old (age > or = 75 years, n = 52) group.

METHODS

Frequency of hyperintensities seen on T2-weighted axial and coronal MR images (0.02 T) was rated using a four-point scale in periventricular and centrum semiovale areas.

RESULTS

The majority of the subjects showed only mild white matter hyperintensities, which were more frequent in the periventricular areas. Age was the most important factor to explain the presence of hyperintensities. A logistic regression analysis related periventricular hyperintensities in the entire group to central atrophy (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.7 to 12.9) and silent infarcts (OR, 5.6; 95% CI, 1.0 to 19.8); among the young-old, hyperintensities related to diabetes (OR, 17.0; 95% CI, 1.9 to 154.2) and central atrophy (OR, 14.7; 95% CI, 3.5 to 61.8). Centrum semiovale hyperintensities related in the entire group to cardiac arrhythmia (OR, 4.0; 95% CI, 1.0 to 15.5), central atrophy (OR, 3.9; 95% CI, 1.2 to 12.4), and silent infarcts (OR, 3.6; 95% CI, 1.0 to 12.5).

CONCLUSIONS

These mild white matter hyperintensities in the neurologically nondiseased elderly related especially to age and also to concomitant silent infarcts, atrophy, and some vascular risk factors. The known factors, however, explained only part of the variation. The young-old and old-old groups showed different associations. In contrast to former assumptions, the presence of white matter hyperintensities among the aged is likely to be linked to other as yet unidentified age-related factors.

Diurnal blood pressure variations and onset of subarachnoid haemorrhage: a population-based study

OBJECTIVES

To analyse the association between time of onset of subarachnoid haemorrhage and diurnal blood pressure variations of ambulant normo- and hypertensive subjects.

DESIGN

Retrospective, population-based study.

SETTING

The population (246,000) of the Health Care District of Central Finland.

PATIENTS

During 1980-1987 a total of 332 subjects in the study population had their first subarachnoid haemorrhage. The hour of onset could be obtained for 287 patients, and these form the basis of the present study.

RESULTS

The onset of subarachnoid haemorrhage occurred significantly more often during the waking hours than during the night. The correlation between the hourly numbers of patients suffering a haemorrhage and the corresponding mean systolic and diastolic blood pressure values of ambulant normo- and hypertensive subjects was highly significant (r = 0.88, P < 0.001). The results were similar when the 224 patients with proved aneurysmal bleed were analysed separately (r = 0.79-0.85, P < 0.001).

CONCLUSIONS

The diurnal blood pressure variations of ambulant normo- and hypertensive subjects, especially the transient blood pressure peaks reaching much higher levels of pressure during the waking hours than during the night, may be crucial in determining the time of rupture of a critically weakened aneurysm wall.

Modification of the haemodynamic responses to induction of anaesthesia and tracheal intubation with alfentanil, esmolol and their combination

The purpose of this double-blind randomized work was to study the effect of alfentanil and esmolol and their half-dose combination on the increases of heart rate and arterial pressure and on the prolongation of the QTc interval of the ECG occurring during anaesthetic induction. Sixty ASA class I-II patient with mean age ranging from 26 to 32 yr among the groups. Patients were allocated to one of four equal groups to receive saline, esmolol 2 mg.kg-1, alfentanil 0.03 mg.kg-1 and alfentanil 0.015 mg.kg-1+esmolol 1 mg.kg-1. Anaesthesia was induced with thiopentone. Succinylcholine was used to facilitate tracheal intubation. Haemodynamic variables were measured non-invasively and the QTc interval with the aid of a microcomputer. Comparisons between the groups were performed using two-way analysis of variance with repeated measures. Both alfentanil and alfentanil-esmolol prevented the increase of heart rate and arterial pressure caused by intubation whereas esmolol prevented only the increase of the heart rate. None of the treatments prevented prolongation of the QTc interval after intubation and only alfentanil prevented that after succinylcholine. The present results suggest that in the prevention of the haemodynamic responses to tracheal intubation, the half-dose combination of alfentanil and esmolol is as effective as alfentanil and superior to esmolol. The combination is preferable to relatively large doses of either drug in circumstances where side effects, such as respiratory depression due to alfentanil or bradycardia due to both drugs should be minimized.

Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters

OBJECTIVE

To determine the relationship between different physical loading conditions and findings of knee osteoarthritis (OA).

METHODS

We selected 117 male former top-level athletes (age range 45-68 years) who had participated in sports activities with distinctly different loading conditions: 28 had been long-distance runners, 31 soccer players, 29 weight lifters, and 29 shooters. Histories of lifetime occupational and athletic knee loading, knee injuries, and knee symptoms were obtained, and subjects were examined clinically and radiographically for knee findings of OA.

RESULTS

The prevalence of tibiofemoral or patellofemoral OA based on radiographic examination was 3% in shooters, 29% in soccer players, 31% in weight lifters, and 14% in runners (P = 0.016 between groups). Soccer players had the highest prevalence of tibiofemoral OA (26%), and weight lifters had the highest prevalence of patellofemoral OA (28%). Subjects with radiographically documented knee OA had more symptoms, clinical findings, and functional limitations than did subjects without knee OA. By stepwise logistic regression analysis, the risk for having knee OA was increased in subjects with previous knee injuries (odds ratio [OR] 4.73), high body mass index at the age of 20 (OR 1.76/unit of increasing body mass index), previous participation in heavy work (OR 1.08/work-year), kneeling or squatting work (OR 1.10/work-year), and in subjects participating in soccer (OR 5.21).

CONCLUSION

Soccer players and weight lifters are at increased risk of developing premature knee OA. The increased risk is explained in part by knee injuries in soccer players and by high body mass in weight lifters.

The long-term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men

STUDY DESIGN

Historical cohort, including selected subgroups.

OBJECTIVES

To understand the long-term effects of exercise on back-related outcomes, back pain, sciatica, back-related hospitalizations, pensions, and magnetic resonance imaging findings were studied among former elite athletes.

SUMMARY OF BACKGROUND DATA

Exercise and sports participation have become increasingly popular, as have recommendations of exercises for back problems, but little is known about their long-term effects.

METHODS

Questionnaires were returned by 937 former elite athletes and 620 control subjects (83% response rate). Identification codes allowed record linkage to hospital discharge and pension registers. Magnetic resonance images were obtained of selected subgroups with contrasting physical loading patterns.

RESULTS

Odds ratios for back pain were lower among athletes than among control subjects, with significant differences in endurance, sprinting and game sports, and wrestling and boxing. No differences in the occurrence of sciatica or in back-related pensions and hospitalizations were seen. When comparing lumbar magnetic resonance images of 24 runners, 26 soccer players, 19 weight lifters, and 25 shooters, disc degeneration and bulging were most common among weight lifters; soccer players had similar changes in the L4-S1 discs. No significant differences were seen in the magnetic resonance images of runners and shooters.

CONCLUSIONS

Maximal weight lifting was associated with greater degeneration throughout the entire lumbar spine, and soccer with degeneration in the lower lumbar region. No signs of accelerated disc degeneration were found in competitive runners. However, back pain was less common among athletes than control subjects and there were no significant differences in hospitalizations or pensions. No benefits were shown for vigorous exercise compared with lighter exercise with respect to back findings.

Where and how should elderly stroke patients be treated? A randomized trial

BACKGROUND AND PURPOSE

Elderly stroke patients in particular are at risk of receiving less than optimal care. We studied the effects of the department care (medicine versus neurology) on the outcome of elderly stroke patients in a randomized controlled trial with 1-year follow-up.

METHODS

A total of 243 consecutive patients aged 65 years or older with acute stroke were randomized to receive care in the Departments of Medicine or the Department of Neurology of a university teaching hospital with a referral area of 1.1 million. The outcome was assessed by mortality, length of hospital stay, ability to live at home on discharge, Barthel Index, and Rankin grades at 1 year.

RESULTS

There were no differences in sex and age, severity or type of stroke, other diseases, or social factors between the two groups. One-year mortality was 21% in both patients treated by the Departments of Medicine and those treated by the Department of Neurology. Patients treated by the Department of Neurology were discharged an average of 16 days earlier (24 versus 40 days). The length of hospital stay of patients aged younger than 75 years differed significantly (P = .02). Patients randomized to neurological wards more often went directly home (75% versus 62%; P = .03), and their functional status was better as assessed with Barthel Index and Rankin grades at 1 year (P = .02 and P = .03, respectively). Independent predictors of a better functional outcome and shorter hospital stay by stepwise multivariate analysis included management by the Department of Neurology.

CONCLUSIONS

Well-organized management of elderly stroke patients was associated with a better outcome. It was also the more economical alternative.

Trends and availability of suicide methods in Finland. Proposals for restrictive measures

BACKGROUND

Trends and availability of the methods used for suicide in Finland were analysed in order to base proposals for prevention of access to methods.

METHODS

Finnish suicides from 1947 to 1990 were analysed by sex, age, time period and suicide method using confidence intervals for rates, chi 2 test for trends and suicide risks for different medicines.

RESULTS

Suicide rate by parathion, a highly lethal pesticide and commonly used for suicide in the 1950s, decreased after its availability was restricted, but this was offset by an increased rate by other methods. Since 1982, the suicide risk for antidepressants and neuroleptics increased coincident with their availability, although that for barbiturates remained stable but high despite a reduction in availability. Suicide risk for antidepressants other than tricyclics decreased despite increased availability.

CONCLUSION

Restriction of a method reduces its use for suicide, but other methods tend to replace it. Restrictive measures should focus on some specific situations. Antidepressants other than tricyclics are recommended for the treatment of suicidal depressive patients.

Heterozygous familial hypercholesterolaemia: the influence of the mutation type of the low-density-lipoprotein receptor gene and PvuII polymorphism of the normal allele on serum lipid levels and response to lovastatin treatment

OBJECTIVES

To study whether (i) the low-density-lipoprotein (LDL)-receptor gene mutation type itself or (ii) the PvuII restriction-fragment-length polymorphism (RFLP) of the intact LDL-receptor gene affects serum lipid levels and their responses to lovastatin treatment in heterozygous familial hypercholesterolaemia (FH).

DESIGN

Comparison of serum lipid levels in 149 heterozygous FH patients, including 79 patients with the FH Helsinki gene and 70 patients with the FH North Karelia gene, grouped according to the PvuII RFLP status of their nonmutated LDL-receptor allele; studies of lovastatin responses in 23 FH patients with different mutation types.

SUBJECTS

Molecularly defined heterozygous FH patients.

INTERVENTIONS

DNA analysis by polymerase chain-reaction assay (PCR) and Southern blotting, fasting serum lipid measurements in all patients, and administration of lovastatin 40-80 mg daily to 16 FH Helsinki patients and seven FH North Karelia patients.

MAIN OUTCOME MEASURES

Baseline and post-treatment serum cholesterol. LDL cholesterol, high-density-lipoprotein (HDL) cholesterol and triglyceride levels.

RESULTS

There were no significant differences in serum total or LDL-cholesterol levels in FH patients with the FH Helsinki gene compared with those carrying the FH North Karelia gene. Regardless of the mutation type, patients without the PvuII site in the normal LDL-receptor gene (P--subjects) tended to have 6-8% higher serum and LDL-cholesterol levels than patients possessing this restriction site (P+ subjects). Although not statistically significant, this difference is qualitatively and quantitatively similar to that reported in three different non-FH populations. Treatment with lovastatin brought about similar hypolipidaemic responses in FH patients with either mutation type (FH Helsinki or FH North Karelia) or PvuII RFLP status (P+ or P-).

CONCLUSIONS

Two LDL-receptor gene mutations with dissimilar phenotypic characteristics are associated with similar serum lipid levels and response to statin treatment. Our data also support the previous assumption that the PvuII RFLP of the LDL-receptor gene locus is associated with variation of serum cholesterol levels.

High hydrostatic pressures in traumatic joints require elevated synovial capillary pressure probably associated with arteriolar vasodilatation

Three out of the four Starling pressures were determined at arthroscopy of traumatic effusions of the knee. The range of the joint fluid hydrostatic pressure Pjoint was 5-83 cmH2O (0.5-8.1 kPa, 4-61 mmHg), that of the colloid osmotic pressure difference COPplasma-COPjoint 0-21.7 cmH2O. In 11 of 15 cases the sum Pjoint+COP difference exceeded 32.6 cmH2O (3.19 kPa, 24 mmHg), a high estimate of average capillary pressure at the level of the heart. The number of 'exceeding' cases was 8/15 if only 80% of the COP difference was considered effective. Pjoint and the COP difference oppose filtration of fluid from plasma into joints, indicating that mean capillary pressure, the only Starling pressure not determined, was elevated unless the effusions were being resorbed back into the blood. The findings can be explained by tamponade compensated by arteriolar vasodilatation, suspected to be metabolically mediated.