المؤلفون: Päivi Valta, Sören Bondedstam, Leena Lindgren, Pia Österlund

المصدر: Journal of Cancer Therapy. :920-925

مصطلحات موضوعية: education.field_of_study, medicine.medical_specialty, Chemotherapy, business.industry, medicine.medical_treatment, Population, Surgery, Catheter, medicine.anatomical_structure, Port (medical), Superior vena cava, medicine, cardiovascular diseases, Atrium (heart), Vein, education, business, Internal jugular vein

الوصف: Background: Chemotherapy in colorectal cancer is usually administered as continuous infusion of 5-fluorouracil, often in combination with oxaliplatin or irinotecan. Targeted drugs are most efficient and tolerable in conjunction with continuous infusion dosing. Implanted venous access devices (VAD) are the prerequisite for continuous infusion administration. The reported catheter migration frequency with VAD is 0% - 3.5%. The purpose of this case-control study was to evaluate the predisposing factors of catheter migration. Methods: We inserted VADs in 88 radically operated colorectal cancer patients randomized to adjuvant 48-hour-infusion chemotherapy repeated every 14 days, altogether 12 times over 24 weeks. Three out of 88 patients (3.4%) had a symptomatic catheter migration from the superior caval vein into the internal jugular vein. The fourth case had chemotherapy for osteosarcoma. These 4 cases were compared with 12 controls from the same 88 patient study population, matched for age, sex, body mass index (BMI), physical activity level and right subclavian insertion site. Tip position, port model, complications, catheter length and material was studied. The post insertion catheter tip position in the chest X-ray was numbered from 1 (in subclavia) to 8 (in atrium). Results: The four cases, all male, had a median position of 3 (range 3 - 4) and controls 6 (range 4 - 8), P = 0.004, median difference 3 (CI95% 1 - 5). At notification of migration the patients had experienced discomfort in the neck region starting 5 to15 days before at strenuous upper extremities activity with Valsalva maneuvers. Conclusion: Optimal catheter tip position when sitting is in the right atrium or low in the superior vena cava to avoid migration. Patients with VADs should avoid strenuous activity with Valsalva maneuvers.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::5e241c9b1f5e9f1b0791c748befaed2eTest
https://doi.org/10.4236/jct.2012.326118Test

المؤلفون: Markku Hynynen, Katriina Pohjanen, Ville Pettilä, Antti Markkola, Tero Varpula, Päivi Valta, Juha Halavaara

المصدر: Journal of Intensive Care Medicine. 24:122-130

مصطلحات موضوعية: Adult, Male, Pulmonary Atelectasis, Time Factors, Randomization, medicine.medical_treatment, Acute Lung Injury, Hemodynamics, Lung injury, Critical Care and Intensive Care Medicine, Airway pressure release ventilation, 03 medical and health sciences, 0302 clinical medicine, Confidence Intervals, Humans, Medicine, 030212 general & internal medicine, Continuous positive airway pressure, Mechanical ventilation, Lung, Continuous Positive Airway Pressure, business.industry, Middle Aged, Respiration, Artificial, medicine.anatomical_structure, 030228 respiratory system, Anesthesia, Breathing, Female, Respiratory Insufficiency, Tomography, X-Ray Computed, business

الوصف: Maintenance of spontaneous breathing superimposed on mechanical ventilation is suggested to improve gas exchange in patients with acute lung injury. The aim of this study was to evaluate the long-term effects of airway pressure release ventilation with maintained unsupported spontaneous breathing (APRV) and synchronized intermittent mandatory ventilation with pressure support (SIMV) on the amount of lung collapse in acute lung injury patients. Thirty-seven patients with acute lung injury were studied in a trial comparing APRV or SIMV. Computer-assisted tomography scannings (CT) were performed before randomization and at day 7. The change in the amount of nonaerated lung was comparable between groups; 14.7% (3.8-17.4) in APRV group (n = 13) and 9.6% (—1.4 to 18.62) in the SIMV group (n = 10), (P = .65, difference in mean 4.9%, 95% confidence interval —9.0% to 19.0%). The effects of APRV and SIMV on lung aeration are similar after 7 days of mechanical ventilation.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d8dcadab6c99e1c1dc545dd7b4bff16eTest
https://doi.org/10.1177/0885066608330098Test

المؤلفون: Heikki Joensuu, Maija Saxelin, M. Kouri, Tarja Ruotsalainen, A Ollus, Inkeri Elomaa, Pia Österlund, Päivi Valta, Riitta Korpela

المصدر: British Journal of Cancer

مصطلحات موضوعية: Adult, Diarrhea, Male, Lactobacillus rhamnosus GG, Cancer Research, Lactobacillus GG, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Leucovorin, colorectal cancer, Adenocarcinoma, chemotherapy, Galactans, Gastroenterology, Antimetabolite, Mannans, 03 medical and health sciences, 0302 clinical medicine, Bolus (medicine), Internal medicine, Clinical Studies, Antineoplastic Combined Chemotherapy Protocols, Plant Gums, Adjuvant therapy, Humans, Medicine, 5-fluorouracil, Adverse effect, Aged, Neoplasm Staging, 030304 developmental biology, 0303 health sciences, Chemotherapy, Lacticaseibacillus rhamnosus, business.industry, Probiotics, Middle Aged, 3. Good health, Surgery, Regimen, Oncology, Tolerability, 030220 oncology & carcinogenesis, Female, Fluorouracil, Colorectal Neoplasms, business, probiotic

الوصف: 5-Fluorouracil (5-FU)-based chemotherapy is frequently associated with diarrhoea. We compared two 5-FU-based regimens and the effect of Lactobacillus and fibre supplementation on treatment tolerability. Patients diagnosed with colorectal cancer (n=150) were randomly allocated to receive monthly 5-FU and leucovorin bolus injections (the Mayo regimen) or a bimonthly 5-FU bolus plus continuous infusion (the simplified de Gramont regimen) for 24 weeks as postoperative adjuvant therapy. On the basis of random allocation, the study participants did or did not receive Lactobacillus rhamnosus GG supplementation (1-2 x 10(10) per day) and fibre (11 g guar gum per day) during chemotherapy. Patients who received Lactobacillus had less grade 3 or 4 diarrhoea (22 vs 37%, P=0.027), reported less abdominal discomfort, needed less hospital care and had fewer chemotherapy dose reductions due to bowel toxicity. No Lactobacillus-related toxicity was detected. Guar gum supplementation had no influence on chemotherapy tolerability. The simplified de Gramont regimen was associated with fewer grade 3 or 4 adverse effects than the Mayo regimen (45 vs 89%), and with less diarrhoea. We conclude that Lactobacillus GG supplementation is well tolerated and may reduce the frequency of severe diarrhoea and abdominal discomfort related to 5-FU-based chemotherapy.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::328db10b74efdfc07ce3cba0be341240Test
https://doi.org/10.1038/sj.bjc.6603990Test

المؤلفون: V V Pettilä, O. Takkunen, R Niemi, Päivi Valta, Tero Varpula, Markku Hynynen

المصدر: Acta Anaesthesiologica Scandinavica. 48:722-731

مصطلحات موضوعية: Adult, Male, Mean arterial pressure, ARDS, Time Factors, medicine.medical_treatment, Blood Pressure, Statistics, Nonparametric, Intermittent Positive-Pressure Ventilation, Airway pressure release ventilation, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Continuous positive airway pressure, Cardiac Output, Propofol, Mechanical ventilation, Respiratory Distress Syndrome, Continuous Positive Airway Pressure, Dose-Response Relationship, Drug, Respiratory distress, Pulmonary Gas Exchange, business.industry, Hemodynamics, 030208 emergency & critical care medicine, General Medicine, Hydrogen-Ion Concentration, Middle Aged, medicine.disease, 3. Good health, Fentanyl, Oxygen, Treatment Outcome, Anesthesiology and Pain Medicine, 030228 respiratory system, Anesthesia, Respiratory Mechanics, Breathing, Female, business, Anesthetics, Intravenous, Respiratory minute volume

الوصف: Background: Airway pressure release ventilation (APRV) is a ventilatory mode, which allows unsupported spontaneous breathing at any phase of the ventilatory cycle. Airway pressure release ventilation as compared with pressure support (PS), another partial ventilatory mode, has been shown to improve gas exchange and cardiac output. We hypothesized whether the use of APRV with maintained unsupported spontaneous breathing as an initial mode of ventilatory support promotes faster recovery from respiratory failure in patients with acute respiratory distress syndrome (ARDS) than PS combined with synchronized intermittent ventilation (SIMV-group). Methods: In a randomized trial 58 patients were randomized to receive either APRVor SIMV after a predefined stabilization period. Both groups shared common physiological targets, and uniform principles of general care were followed. Results: Inspiratory pressure was significantly lower in the APRV-group (25.9 � 0.6 vs. 28.6 � 0.7 cmH2O) within the first week of the study (P ¼0.007). PEEP-levels and physiological variables (PaO2/FiO2-ratio, PaCO2, pH, minute ventilation, mean arterial pressure, cardiac output) were comparable between the groups. At day 28, the number of ventilator-free days was similar (13.4 � 1.7 in the APRV-group and 12.2 � 1.5 in the SIMV-group), as was the mortality (17% and 18%, respectively). Conclusion: We conclude that when used as a primary ventilatory mode in patients with ARDS, APRV did not differ from SIMV with PS in clinically relevant outcome.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::133cdfd7463f7b70d8280042991ae46cTest
https://doi.org/10.1111/j.0001-5172.2004.00411.xTest

المؤلفون: Mirja Koivisto, Krister Höckerstedt, Päivi Valta, Leena Lindgren

المصدر: Clinical Transplantation. 16:325-328

مصطلحات موضوعية: Transplantation, medicine.medical_specialty, Cirrhosis, medicine.diagnostic_test, business.industry, Magnesium, medicine.medical_treatment, chemistry.chemical_element, Urine magnesium, Total body, 030204 cardiovascular system & hematology, Liver transplantation, medicine.disease, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, chemistry, Internal medicine, Healthy control, medicine, 030211 gastroenterology & hepatology, business, Liver function tests, Magnesium ion

الوصف: Serum ionized magnesium represents less than 1% of the total body magnesium. The most reliable method to evaluate magnesium status is the magnesium loading test: In magnesium depletion its uptake is increased (20-50%) and is about 6% in normal magnesium status. There are no studies on magnesium status in chronic cirrhotics who may be in depletion. We performed magnesium loading test in 10 chronic cirrhotics listed for liver transplantation and in six healthy control patients. Magnesium sulphate 30 mmol was infused and urine magnesium was determined over 24 h. Serum ionized magnesium increased similarly in all patients. The uptake of magnesium was 8 +/- 8% in control patients and 34 +/- 26% in cirrhotics (p < 0.01). Chronic terminal cirrhotics are magnesium depleted which should be taken into account in case of liver transplantation and also in other interventions. Spot sampled serum ionized magnesium revealed magnesium depletion poorly.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::922c4cd86d123e9382a33312edfbb589Test
https://doi.org/10.1034/j.1399-0012.2002.01141.xTest

المؤلفون: Ari Uusaro, Esko Ruokonen, Silvia Nunes, Päivi Valta, Jukka Takala

المصدر: Critical Care Medicine. 27:2367-2374

مصطلحات موضوعية: Adult, Male, Artificial ventilation, ARDS, Pediatrics, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Critical Care and Intensive Care Medicine, law.invention, Hospitals, University, law, Cause of Death, Intensive care, medicine, Humans, Hospital Mortality, Finland, Aged, Retrospective Studies, Aged, 80 and over, Mechanical ventilation, Respiratory Distress Syndrome, Respiratory Care Units, Respiratory distress, business.industry, Incidence, Organ dysfunction, Health Care Costs, Middle Aged, medicine.disease, Respiration, Artificial, Intensive care unit, Survival Rate, Pneumothorax, Anesthesia, Female, medicine.symptom, business, Follow-Up Studies

الوصف: Objective: To define the occurrence rate of acute respiratory distress syndrome (ARDS) using established criteria in a well-defined general patient population, to study the clinical course of ARDS when patients were ventilated using a lung-protective strategy, and to define the total costs of care. Design: A 3-yr (1993 through 1995) retrospective descriptive analysis of all patients with ARDS treated in Kuopio University Hospital. Setting: Intensive care unit in the university hospital. Patients: Fifty-nine patients fulfilled the definition of ARDS: Pao 2 /Fio 2 < 200 mm Hg (33.3 kPa) during mechanical ventilation and bilateral infiltrates on chest radiograph. interventions: None. Measurements and Main Results: With a patient data management system, the day-by-day data of hemodynamics, ventilation, respiratory mechanics, gas exchange, and organ failures were collected during the period that Pao 2 /Fio 2 ratio was

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ca7d4d0a4a91d4fe547420a0db564788Test
https://doi.org/10.1097/00003246-199911000-00008Test

المؤلفون: Päivi Valta, John M. Kinney, Robert J. Foster, Jukka Takala, Charles Weissman

المصدر: Chest. 102:234-238

مصطلحات موضوعية: Adult, Pulmonary and Respiratory Medicine, Artificial ventilation, Functional Residual Capacity, medicine.medical_treatment, Critical Care and Intensive Care Medicine, law.invention, Positive-Pressure Respiration, law, Tidal Volume, medicine, Humans, Plethysmograph, Lung volumes, Lung Diseases, Obstructive, Postoperative Period, Cardiac Surgical Procedures, Positive end-expiratory pressure, Tidal volume, Aged, Mechanical ventilation, business.industry, Middle Aged, Plethysmography, Spirometry, Anesthesia, Breathing, Lung Volume Measurements, Cardiology and Cardiovascular Medicine, business, Spirometer

الوصف: Study Objective To assess the accuracy of the respiratory inductive plethysmography in the measurement of PEEP-induced changes in end-expiratory lung volume during mechanical ventilation and its accuracy and stability in the measurement of ventilation during controlled mechanical ventilation and spontaneous breathing. Design An open comparison between two methods using a criterion standard. Either a pneumotachometer (mechanically ventilated patients) or a spirometer (spontaneously breathing subjects) was used as the reference method. Setting Tertiary care center; a multidisciplinary intensive care unit and a metabolic research unit. Patients Six mechanically ventilated, paralyzed postoperative open heart surgery patients, six spontaneously breathing COPD patients, and eight healthy volunteers. Interventions Stepwise increases and reductions of PEEP from zero to 12 cm H 2 O during controlled mechanical ventilation; repeated validation of the calibration of the respiratory inductive plethysmography (RIP) in both mechanically ventilated and spontaneously breathing subjects. Measurements and Results The baseline drift of the RIP in vitro was 10 ml/150 min and in a ventilated model it was 20 ml/150 min. In mechanically ventilated patients, the mean error of the calibration after 150 min was within ± 5 percent. Change in end-expiratory lung volume (EELV) during the stepwise increase of PEEP up to 12 cm H 2 O was 849 ± 136 ml with the RIP and 809 ± 125 ml with the pneumotachometer (PT), and during the stepwise reduction of PEEP it was 845 ± 124 ml and 922 ± 122, respectively (not significant [NS]. The mean difference between methods in the measurement of change in EELV was −6.6 ± 3.5 percent during increasing and 6.6 ± 6.7 percent during decreasing PEEP (NS). Both in mechanically ventilated and spontaneously breathing subjects, the difference between methods was significant for VT and VT/TI. The difference in VT was −2.2 ± 0.2 percent during mechanical ventilation, −1.1 ± 0.5 percent in spontaneously breathing COPD patients, and 2.9 ± 0.4 percent in healthy volunteers (NS between groups). Conclusions The RIP is sufficiently accurate for the measurement of PEEP-induced changes in EELV during controlled mechanical ventilation. The accuracy of tidal volume measurement is similar during mechanical ventilation and spontaneous breathing. The calibration of the RIP is stable enough for bedside monitoring of changes in lung volumes. (Chest 1992; 102:234–38)

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3ef2a1b83b7e99a741c5b2568b206237Test
https://doi.org/10.1378/chest.102.1.234Test

المؤلفون: Eero Pesonen, Hannu Kokki, Mikko Pitkänen, Eero Honkanen, Leena Lindgren, Anna-Maija Teppo, Päivi Valta, Merja Laisalmi-Kokki

المصدر: Free radical research. 43(7)

مصطلحات موضوعية: Male, Renal function, Urine, 030204 cardiovascular system & hematology, Systemic inflammation, Kidney Function Tests, Biochemistry, Kidney Tubules, Proximal, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Double-Blind Method, Acetylglucosaminidase, Alpha-Globulins, medicine, Humans, Prospective Studies, Cystatin C, Arthroplasty, Replacement, Knee, 030304 developmental biology, Aged, Glutathione Transferase, 0303 health sciences, Creatinine, Tourniquet, Kidney, biology, business.industry, General Medicine, Free Radical Scavengers, Middle Aged, medicine.disease, 3. Good health, Acetylcysteine, Isoenzymes, medicine.anatomical_structure, chemistry, Glutathione S-Transferase pi, Anesthesia, Injections, Intravenous, biology.protein, Female, Kidney Diseases, medicine.symptom, business, Reperfusion injury

الوصف: Ischaemia/reperfusion induces systemic inflammation and oxidative stress and thereby remote organ injury in the kidney. In a double-blind, placebo-controlled clinical trial of 30 patients undergoing knee arthroplasty with tourniquet, this study evaluated the effect of N-acetylcysteine (NAC) infusion on renal function by measuring urine alpha-1-microglobulin, N-acetyl-beta-D-glucosaminidase (NAG), glutathione-S-transferase-alpha and -phi and serum creatinine and cystatin C concentrations up to 24 h post-operatively. Compared to the baseline, urine alpha-1-microglobulin/creatinine increased in both groups and was higher in the NAC group than in the placebo group at tourniquet deflation and at 3 h thereafter. Urine NAG/creatinine increased at deflation and at 3 h thereafter in the NAC group and the ratio was higher than in the placebo group. The two sensitive indicators of proximal tubular damage and function used in the present study suggest that use of NAC in clinical setting of ischaemia/reperfusion injury may increase the risk of remote kidney injury.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0337c3307a6161d52ad0d1c908c1e84fTest
https://pubmed.ncbi.nlm.nih.gov/19526394Test

المؤلفون: Tero, Varpula, Pirkko E, Brander, Tom, Bäcklund, Ilkka, Parviainen, Heikki, Tikkanen, Päivi, Valta

المصدر: Duodecim; laaketieteellinen aikakauskirja. 123(6)

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=pmid________::9da88813fd099ccaece13df8ab8aee67Test
https://pubmed.ncbi.nlm.nih.gov/17612132Test

المؤلفون: Mirja, Koivisto, Päivi, Valta, Krister, Höckerstedt, Leena, Lindgren

المصدر: Clinical transplantation. 16(5)

مصطلحات موضوعية: Liver Cirrhosis, Liver Function Tests, Chronic Disease, Humans, Magnesium, Middle Aged, Aged

الوصف: Serum ionized magnesium represents less than 1% of the total body magnesium. The most reliable method to evaluate magnesium status is the magnesium loading test: In magnesium depletion its uptake is increased (20-50%) and is about 6% in normal magnesium status. There are no studies on magnesium status in chronic cirrhotics who may be in depletion. We performed magnesium loading test in 10 chronic cirrhotics listed for liver transplantation and in six healthy control patients. Magnesium sulphate 30 mmol was infused and urine magnesium was determined over 24 h. Serum ionized magnesium increased similarly in all patients. The uptake of magnesium was 8 +/- 8% in control patients and 34 +/- 26% in cirrhotics (p0.01). Chronic terminal cirrhotics are magnesium depleted which should be taken into account in case of liver transplantation and also in other interventions. Spot sampled serum ionized magnesium revealed magnesium depletion poorly.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=pmid________::2cbcdef66467a298ad4b42429f842106Test
https://pubmed.ncbi.nlm.nih.gov/12225427Test