Lehtinen P.,University of Tampere |
Ashorn M.,University of Tampere |
Iltanen S.,University of Tampere |
Jauhola R.,Lapland Central Hospital |
And 3 more authors.
Inflammatory Bowel Diseases | Year: 2011
Background: The present study aimed to characterize the incidence of pediatric inflammatory bowel disease (IBD) in Finland and determine its temporal trends. Methods: The patients' data were based on the database of the Social Insurance Institution. New cases diagnosed with IBD at the age <18 years in Finland between years 1987-2003 were included. Annual incidence rates were calculated per 100,000 pediatric populations (with 95% confidence intervals [CI]). The country is divided into 21 hospital districts and regional differences were evaluated accordingly. Results: The incidence of pediatric IBD increased from 5 per 100,000 in 1987 to 15 per 100,000 in 2003. The average rate of increase was 6.5% per year (95% CI 5.4%-7.5%). The trends were comparable for boys and girls, also by age group. Information on disease subtype was available from 1992 and during this 12-year period the incidence of Crohn's disease (CD) increased from 2-5 per 100,000 and that of ulcerative colitis (UC) from 4-9 per 100,000. Conclusions: Our results demonstrate a very high incidence rate for childhood IBD and in particular UC in Finland. Furthermore, a rapid increase took place nationwide in the incidence of both CD and UC during the past two decades. Copyright © 2010 Crohn's & Colitis Foundation of America, Inc.
PubMed | University of Oulu, Lapland Central Hospital, Kainuu Central Hospital and Central Ostrobothnia Central Hospital
Type: | Journal: Surgical endoscopy | Year: 2017
Recent studies showed that stent grafting is a promising technique for treatment of esophageal perforation. However, the evidence of its benefits is still scarce.Forty-three consecutive patients underwent stent grafting for esophageal perforation at the Oulu University Hospital, Finland. The main endpoints of this study were early and mid-term mortality. Secondary outcome endpoints were the need of esophagectomy and additional surgical procedures on the esophagus and extraesophageal structures.Patients mean age was 64.613.4years. The mean delay to primary treatment was 2327h. The most frequent cause of perforation was Boerhaaves syndrome (46.5%). The thoraco-abdominal segment of the esophagus was affected in 58.1% of cases. Minor primary procedures were performed in 25 patients (58.1%) and repeat surgical procedures in 23 patients (53.5%). Forty-nine repeat stent graftings were performed in 22 patients (50%). Two patients (4.7%) underwent esophagectomy, one for unrelenting preprocedural stricture of the esophagus and another for persistent leakage of a perforated esophageal carcinoma. The mean length of stay in the intensive care unit was 6.07.5days and the in-hospital stay was 24.319.6days. In-hospital mortality was 4.6%. Three-year survival was 67.2%.Stent grafting seems to be an effective less invasive technique for the treatment of esophageal perforation. Repeat stent grafting and procedures on the pleural spaces are often needed to control the site of perforation and for debridement of surrounding infected structures. Stent grafting allows the preservation of the esophagus in most of patients. The mid-term survival of these patients is suboptimal and requires further investigation.
Heerva E.,University of Turku |
Huilaja L.,University of Oulu |
Leinonen P.,University of Oulu |
Leinonen P.,Kainuu Central Hospital |
And 2 more authors.
Calcified Tissue International | Year: 2014
This is the first prospective follow-up study to describe the effects of oral alendronate medication on neurofibromatosis 1 (NF1)-related osteoporosis. NF1 is a neurocutaneous skeletal syndrome associated with increased fracture risk and high frequency of osteopenia and osteoporosis. Alendronate is a bisphosphonate drug which inhibits the function of bone-resorbing osteoclasts, ultimately leading to an increase in bone mineral density (BMD) and reduction in fracture risk. However, in vitro studies have shown that NF1 osteoclasts display insensitivity to apoptotic signals caused by bisphosphonates. Our aim was to monitor the effects of alendronate medication in patients with NF1. Five men and one woman, aged 28-76 years, with NF1-related osteoporosis were enrolled to the study. Study participants did not have other conditions and were not taking any medication known to affect bone. The medication included a weekly dose of 70 mg alendronate and a daily 20 μg vitamin D supplementation. After 23 months of follow-up, BMD was increased in five out of six patients, but the increase was not statistically significant. Serum levels of the bone turnover markers CTX and PINP were reduced, suggesting slower bone remodeling, as expected. An unexpected result was that serum levels of the osteoclast activity marker TRAP5b did not change during the follow-up. One new stress fracture of the tibia was documented during the alendronate therapy. Even though the study group was small, the findings of the current study (one new fracture and one patient with decreased BMD) call for a larger study to assess the efficacy of bisphosphonates in NF1-related osteoporosis. © 2014 Springer Science+Business Media.
Vasala M.,Kainuu Central Hospital |
Hallanvuo S.,Finnish Food Safety Authority |
Ruuska P.,Kainuu Central Hospital |
Suokas R.,Kainuu Central Hospital |
And 3 more authors.
Annals of the Rheumatic Diseases | Year: 2013
Objective: We describe the epidemiological and microbiological process in the clearing of a foodborne outbreak of Yersinia pseudotuberculosis O:1 linked to raw carrots and frequency of the associated reactive extra-gastrointestinal manifestations. Methods: The patient samples were investigated by routine culture or antibody testing methods. The real-time bacterial PCR was used to detect Y pseudotuberculosis in samples from the grated carrots and in those taken from the carrot storage. Genotype of bacterial isolates was determined by pulsed-field gel electrophoresis. For case identification, we retrospectively looked over the laboratory files of the central hospital focusing on the time period of the outbreak. Results: Altogether 49 case patients were identified. Y pseudotuberculosis was detected by real-time PCR analysis in samples taken from grated carrots and from the carrot distributor. Bacterial isolates originating from the farm environment showed identical serotype (O:1) and genotype (S12) with the patients' isolates. Among 37 adults, reactive arthritis (ReA) was found in 8 (22%) and three adults had probable ReA. Six (67%) out of nine human leucocyte antigen (HLA) typed patients with ReA were HLA-B27 positive. Erythema nodosum was found in 42% of the 12 children, whereas none of them had definite ReA. Conclusions: In this outbreak, Y pseudotuberculosis was for the first time detected in both patient and food samples. ReA was more common than earlier reported in the outbreaks associated with this pathogen; the reason may be that the previous outbreaks have occurred among children. HLA-B27 frequency was higher than usually reported in single-source outbreaks of ReA. © 2013 BMJ Publishing Group Ltd & European League Against Rheumatism.
Vasala M.,Kainuu Central Hospital |
Vasala M.,Finnish Food Safety Authority |
Vasala M.,Finnish National Institute for Health and Welfare |
Vasala M.,University of Tampere
Annals of the rheumatic diseases | Year: 2014
OBJECTIVE: We describe the epidemiological and microbiological process in the clearing of a foodborne outbreak of Yersinia pseudotuberculosis O:1 linked to raw carrots and frequency of the associated reactive extra-gastrointestinal manifestations.METHODS: The patient samples were investigated by routine culture or antibody testing methods. The real-time bacterial PCR was used to detect Y pseudotuberculosis in samples from the grated carrots and in those taken from the carrot storage. Genotype of bacterial isolates was determined by pulsed-field gel electrophoresis. For case identification, we retrospectively looked over the laboratory files of the central hospital focusing on the time period of the outbreak.RESULTS: Altogether 49 case patients were identified. Y pseudotuberculosis was detected by real-time PCR analysis in samples taken from grated carrots and from the carrot distributor. Bacterial isolates originating from the farm environment showed identical serotype (O:1) and genotype (S12) with the patients' isolates. Among 37 adults, reactive arthritis (ReA) was found in 8 (22%) and three adults had probable ReA. Six (67%) out of nine human leucocyte antigen (HLA) typed patients with ReA were HLA-B27 positive. Erythema nodosum was found in 42% of the 12 children, whereas none of them had definite ReA.CONCLUSIONS: In this outbreak, Y pseudotuberculosis was for the first time detected in both patient and food samples. ReA was more common than earlier reported in the outbreaks associated with this pathogen; the reason may be that the previous outbreaks have occurred among children. HLA-B27 frequency was higher than usually reported in single-source outbreaks of ReA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Kauppila J.,Northern Finland Laboratory Center |
Ronkko E.,Finnish National Institute for Health and Welfare |
Juvonen R.,Kainuu Central Hospital |
Saukkoriipi A.,Finnish National Institute for Health and Welfare |
And 5 more authors.
Journal of Medical Virology | Year: 2014
Due to the lack of rapid diagnostic tests, clinical features of Influenza C virus infections are poorly characterized. Respiratory infections in military recruits in eastern Finland were monitored between July 2004 and December 2005 in order to study the epidemiology and clinical picture of infections caused by this virus. Blood samples were obtained at entry and at the end of the military service, and during each episode of respiratory infection to measure antibody responses against 10 viral and 2 bacterial pathogens. If possible, sputum samples were collected during the acute phase of respiratory infection episodes. Symptoms of the episodes were recorded for comparison of the clinical picture caused by various infectious agents. Infection with influenza C virus was detected in 38 of 892 young men during their service. The virus usually caused a mild upper respiratory tract infection. Most typical clinical features of influenza C virus infection were cough, rhinitis, and hoarseness. A striking difference to infections caused by influenza A virus was the lack of fever. Influenza C virus is an important cause of a respiratory tract infection in army conscripts. Infections with this virus are usually mild but can be complicated in some cases. © 2013 Wiley Periodicals, Inc.
Kostjukovits S.,Malmi District Hospital |
Kalliokoski L.,Kainuu Central Hospital |
Antila K.,North Carelia Central Hospital |
Korppi M.,University of Tampere
European Journal of Pediatrics | Year: 2015
Hyperimmunoglobulinemia D syndrome (HIDS) is an autoinflammatory disorder that is caused by mevalonate kinase deficiency (MKD). Recent advances in the pathogenesis of MKD, including the proposed mechanisms of inflammasome activation, provide the basis for the development of new treatment modalities. So far, feedback on the treatment of HIDS with biological medicines has come from case reports with limited numbers of patients. In this review, we summarize the data that is currently available on the treatment of HIDS in children, with the emphasis on new therapies, and present three Finnish pediatric cases treated with anakinra. Case reports have been published on 33 pediatric HIDS patients who have been treated with biological medicines, and in some cases, they were treated with more than one drug. Of these patients, 21 were treated with anakinra and 16 with etanercept, resulting in complete or partial responses in 90 and 50 % of cases, respectively. A further five patients were treated with canakinumab, with complete or partial responses. Conclusion: The accumulating evidence on the efficacy and safety of biological drugs in pediatric HIDS suggests that the anti-interleukin-1 agent anakinra is the drug of choice for HIDS in children. © 2015, Springer-Verlag Berlin Heidelberg.
Ijas H.,University of Oulu |
Vaarasmaki M.,University of Oulu |
Saarela T.,University of Oulu |
Keravuo R.,Kainuu Central Hospital |
Raudaskoski T.,University of Oulu
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2015
Objective To compare the growth and development of children born to mothers with gestational diabetes mellitus (GDM) requiring pharmacological treatment, and randomised to treatment with metformin or insulin. Design Follow-up of a randomised controlled trial (RCT) comparing metformin and insulin treatment of GDM. Setting Data were gathered during routine visits to child welfare clinics at the ages of 6, 12, and 18 months, including weight and height measurements, and assessment of motor, social, and linguistic development. Sample The children of mothers with GDM randomised to metformin (n = 47) or insulin (n = 50) treatment during pregnancy. Methods Data were collected from the structured questionnaire filled in at the child welfare clinics. Main outcome measures The growth and development of the children until the age of 18 months. Results Children exposed to metformin were significantly heavier (10.47 versus 9.85 kg, 95% CI 0.04-1.20) at the age of 12 months and taller and heavier (83.9 vs 82.2 cm, 95% CI 0.23-3.03, 12.05 vs 11.32 kg, 95% CI 0.04-1.43) at the age of 18 months. The mean ponderal index (PI) did not differ significantly. The motor, social, or linguistic development evaluated at the age of 18 months did not differ between the groups. Conclusions Children prenatally exposed to metformin were heavier at the 12 months measurements and taller and heavier at the 18 months measurements than those exposed to insulin, but their body composition defined by PI did not differ. Over the short term, metformin does not seem to be harmful with regards to early motor, linguistic, or social development. © 2014 Royal College of Obstetricians and Gynaecologists.
Ijas H.,University of Oulu |
Vaarasmaki M.,University of Oulu |
Morin-Papunen L.,University of Oulu |
Keravuo R.,Kainuu Central Hospital |
And 3 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2011
Objective To examine if oral metformin is as effective as insulin in the prevention of fetal macrosomy in pregnancies complicated with gestational diabetes mellitus (GDM). Design Open-label prospective randomised controlled study. Setting Maternity outpatient clinics in a secondary and tertiary level hospital in Finland. Sample One hundred women with GDM who did not attain euglycaemia with diet. Methods Women were randomised to therapy with insulin (n = 50) or oral metformin (n = 50). Main outcome measures Incidence of large-for-gestational-age (LGA) infants and neonatal morbidity. Results There were no statistically significant differences in the incidence of LGA (8.5 versus 10.0%, P = 0.97), mean birthweight, mean cord artery pH or neonatal morbidity between the insulin and metformin groups. Fifteen (31.9%) of the 47 women randomised to metformin needed supplemental insulin. They were more obese (with a body mass index of 36 versus 30 kg/m 2, P = 0.002), had higher fasting blood glucose levels in an oral glucose tolerance test (6.1 versus 5.0 mmol/l, P = 0.001) and needed medical treatment for GDM earlier (26 versus 31 gestational weeks, P = 0.002) than women who were normoglycemic with metformin. There was a tendency to a higher rate of caesarean sections in the metformin group than in the insulin group (RR 1.9; 95% CI 0.99-3.71). Conclusions Metformin seems to be suitable for the prevention of fetal macrosomy, especially in lean or moderately overweight women developing GDM in late gestation. Women with considerable obesity, high fasting blood glucose and an early need for pharmacological treatment may be more suitable for insulin therapy. © 2011 RCOG.
Hoikka M.H.,Kainuu Central Hospital |
Liisanantti J.H.,University of Oulu |
Dunder T.,University of Oulu
Acta Paediatrica, International Journal of Paediatrics | Year: 2013
Aim To evaluate the incidence, clinical features and outcome of acute poisoning in children of less than 6 years of age in northern Finland. Methods Children hospitalized with acute poisoning at the Oulu University Hospital between 1991 and 2010 were retrospectively evaluated from hospital records. Results There were 334 hospital admissions due to acute poisoning during the study period, with an overall incidence rate of 5.2 per 10 000 per year, decreasing slightly from 6.7 in 1991-1995 to 4.5 in 2006-2010. Mean length of a hospital stay was 1.2 (SD ± 1.26) days. The most common substances ingested were terbutaline (12.3%), benzodiazepines (12.0%) and dishwasher powder (9.3%). Almost half of the patients were admitted to the paediatric intensive care unit, but most only required supportive care. Specific antidotes were administered in 16 cases. Three patients suffered from aspiration pneumonia as a result of ingesting poison, but no children died during the study. Conclusion Poisoning is a fairly common cause of hospital admission in children under the age of six. In most cases, their clinical condition is good, and they can be discharged after a short surveillance period. ©2013 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd.