Out-of-hospital paediatric emergencies: a prospective, population-based study.

BACKGROUND: We wanted to study the incidence, distribution and characteristics of paediatric out-of-hospital emergency care on a population level. This knowledge could ameliorate the design and education of emergency medical services and their personnel. METHODS: We studied all (n = 1863) emergency medical services responses and the patient records for paediatric patients (age 0-16 years) in Helsinki, Finland (population 603,968, paediatric population 92,742) during a 12-month period (2012). Patient characteristics, diagnoses, time intervals, medical treatments, procedures, vital measurements and outcome of out-of-hospital treatment were available for analysis. RESULTS: The incidence of emergency medical services -treated paediatric out-of-hospital emergencies was 3.8/1000 inhabitants and 20/1000 1-16-year-old inhabitants. This formed 4.5% of all emergency calls, while children have a threefold share of the population (15%). Falls, dyspnoea, seizures and poisonings account for half of all emergencies. Few patients suffered from a life-threatening condition or trauma. Cardiac arrest or need for advanced life support measures (e.g. intubation) was rare. After evaluation by the emergency medical services, only half of the patients (56%) needed ambulance transportation to hospital. Only 30 (3.7%) of the non-transported patients made an unpremeditated visit to the emergency department after the original contact with the emergency medical services. All of them were well upon arrival to the emergency department. CONCLUSION: Paediatric out-of-hospital emergencies are infrequent and have specific characteristics differing from the adult population. The design and training of emergency medical services and their personnel should focus on evaluation and management of the most frequent situations.

Fetal shoulder measurements by fast and ultrafast MRI techniques.

The purpose of this study was to evaluate magnetic resonance imaging (MRI) of fetal shoulder measurements of fetuses with suspected macrosomia. The actual fetal shoulder measurements made immediately after birth were compared with measurements obtained by fast and ultrafast MRI techniques antepartum. Eight singleton diabetic pregnant mothers underwent MRI examination with fast imaging in steady-state precession (TrueFISP) and spin-echo (SE) and gradient-echo (GE) echo-planar (EPI) sequences to show the fetal shoulder width. The actual shoulder width was measured immediately postpartum by a neonatologist. There was a statistically significant correlation between the MRI measurements and the actual shoulder width (P < 0.001 - P < 0.05) for all sequences. TrueFISP (r = 0.98, P < 0.001) was superior to EPI sequences (r = 0.88, P < 0.01 for SE EPI and r = 0.80, P < 0.05 for GE EPI). The images of all three sequences used were free of major motion artifacts. Fast and ultrafast sequences seem to be reliable for fetal shoulder measurements and the TrueFISP was the most accurate sequence compared to SE and GE echo-planar sequences. J. Magn. Reson. Imaging 2001;13:938-942.

Military service of male survivors of childhood malignancies.

BACKGROUND: The objective of this study was to assess the eligibility for and the course of compulsory military service of childhood cancer survivors. METHODS: The medical, military recruitment, conscription, and military service data of male Finnish childhood cancer survivors were collected from manually filed records. Inclusion criteria were: survivors born 1977 or earlier, treated for a malignancy between birth and age 15 years, and followed by a pediatrician until at least age 18 years. The documents of 207 survivors from the Pediatric Clinics of Finnish University Hospitals were examined, and 130 of these survivors were considered eligible for military service. Demographic factors, the predictors of fitness for military service, factors associated with service interruption, the attained level of military training, and the health status of conscripts during service were evaluated. Comparisons were made with the Finnish male population of the same age and with conscripts serving at the corresponding time. RESULTS: Approximately 60% of studied survivors were enlisted. Positive predictors of fitness for service were year of birth of 1973 or later (odds ratio [OR], 3.2), height at call-up age of 170-174.9 cm (OR, 3.6), and the man's own positive opinion of his fitness for service (OR, 62.3). Negative predictors were age at diagnosis > or = 11 years (OR, 0.5), central nervous system radiotherapy (OR, 0.3), limb defects (OR, 0.02), and the group of sequelae concerning neurologic, cardiopulmonary, and gastrointestinal systems, or secondary malignancies (OR, 0.3). Survivors interrupted their service more often (20%) (P < 0.001). Leukemia survivors were less likely to interrupt their service (7%) compared with other survivors (P = 0.04). Factors associated with service interruption were: diagnosis (P = 0.04), the man's own opinion of his fitness for service (P = 0.013), surgery (P = 0.003), and height (P = 0.049), weight (P = 0.019), and body mass index (P = 0.035) at the beginning of military service. The attained level of military training was equal to that of controls. The survivors visited the garrison physician less frequently in total (mean, 5.9 times) (P < 0.001), visited because of infections as much as controls, and were off duty more (mean, 11.9 days) (P = 0.012) than controls. CONCLUSIONS: The current study found that childhood cancer survivors were less likely to meet the requirements set for military service in Finland. The causes of rejection usually were obvious, but approximately 30% were rejected merely on the basis of a former cancer diagnosis. However, enlisted survivors coped well with military service if their treatment sequelae were taken into consideration carefully at the time of enlistment. Vocational opportunities within the armed forces might be an appropriate career option even for survivors of childhood malignancies.

Steroid 21-hydroxylase autoantibodies in insulin-dependent diabetes mellitus. Childhood Diabetes in Finland (DiMe) Study Group.

We have studied the sera from 304 patients with insulin-dependent diabetes mellitus (IDDM) for steroid 21-hydroxylase (P450c21) autoantibodies by an in vitro translation and immunoprecipitation assay. Autoantibodies to P450c21 were found in 7 patients with IDDM (2.3%). When the IDDM patients with P450c21 antibodies were analyzed for their HLA, 6 of them (86%) belonged to the HLA DQB1*0201-positive group. A strong correlation (r = 0.91, P < 0.001) of immunoprecipitation results was observed with adrenocortical autoantibodies detected by indirect immunofluorescence, indicating that the adrenal autoantibodies in patients with IDDM were anti-P450c21 autoantibodies. The levels of P450c21 autoantibodies were significantly higher (P < 0.05) in patients with IDDM than in 13 (9 P450c21 autoantibody positive) patients with Addison's disease. Although the occurrence of P450c21 antibodies in IDDM was relatively low, antibody-positive patients had high antibody levels and may have an ongoing subclinical process of adrenal autoimmunity.

The validity of the Reflotron as a screening tool for blood cholesterol.

Screening for blood cholesterol levels has become an essential need in many countries. The aim of this study was to evaluate the performance of Reflotron analyzer in screening for blood cholesterol in terms of its precision and accuracy. We have compared the results obtained by the Reflotron with those obtained by a standard hospital laboratory procedure for the same samples. An optimal precision that met the 1992 LSP standards for precision was observed (CV = 2.27%). On the other hand, a suboptimal accuracy of Reflotron was detected, where more than 80% of the Reflotron values differed from the reference laboratory values by more than 5%. As a consequence, 21% of individuals were misclassified as normal due to the very low sensitivity in spite of the optimum specificity observed for the Reflotron. Using the receiver operating characteristic curve analysis, the optimum cut-off points giving the best validity values for the test were 170 mg/dl and 190 mg/dl (4.4 mmol/L and 4.9 mmol/L) for the border-line and true hypercholesterolemia, respectively. At these levels, sensitivity was 0.89 and 0.86, specificity 0.93 and 0.93, and positive predictive value was 0.91 and 0.82, respectively. Considering some limitations of the study, it is concluded that the Reflotron could be of more potential validity for the use in cholesterol measurement surveys when the recommended cut-off points are used.

Brodimoprim in acute respiratory tract infections.

Brodimoprim was studied in the treatment of acute respiratory tract infections in hospitalized, basically healthy, military conscripts. Its efficacy and tolerance were compared to those of doxycycline in a clinical randomized double-blind trial. 60 pts. were divided into two equally large groups. One group received brodimoprim, 400 mg as a loading dose followed by 200 mg daily, for 10 days. The other group received doxycycline, 200 mg as a loading dose followed by 100 mg daily, for 10 days. In the brodimoprim group, 23 patients (77%) were cured, 5 patients (16%) improved and 2 patients (6%) were considered failures. In the doxycycline group, 26 patients (87%) were cured, 3 patients (10%) improved and 1 patient (3%) did not respond. The only side effect in the whole study was moderate diarrhea in 1 patient in the brodimoprim group. Clinically and according to the normalization of laboratory values, the two drugs tested were equally effective.

Hepatic safety of erythromycin acistrate in 1549 patients with respiratory tract or skin infections.

Erythromycin acistrate is a new 2'-acetyl esther prodrug of erythromycin, whose structure resembles that of erythromycin estolate. However, in toxicological studies, it does not have the problems of hepatotoxicity. To assess its effects on hepatic functions in clinical practice, the liver parameters of patients with respiratory tract or skin infections were monitored during therapy. In total 1549 patients were treated for 7-14 days. In addition, 127 patients with suspected viral infections served as controls. There were no significant differences in serum aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), gamma-glutamyltransferase (gamma-GT) or alkaline phosphatase (APHOS) values between the erythromycin acistrate or control groups at the beginning or end of therapy. ASAT values increased moderately in 2.4% and clearly in 0.3% of patients treated, but also decreased in 2.0%. ALAT values were moderately increased in 9.9%, clearly increased in 0.6% and normalized in 3.5% of the patients. gamma-GT values increased moderately in 3.5% and and clearly in 0.3%, but decreased to normal in 3.3% of the patients. APHOS was moderately elevated in 1.0% of the patients and normalized in 1.3%. The correlation of changes between the different liver enzymes was poor. Only ten patients (0.6%) had two or more clearly elevated liver enzyme values by the end of the therapy, of whom five had increased liver enzyme activities before the treatment, two had underlying disease explaining the changes and in only three patients out of 1549 (0.2%) could hepatic changes be attributed to erythromycin acistrate therapy. These changes were reversible. The results demonstrate the hepatic safety of erythromycin acistrate in clinical practice. Concomitant food intake did not affect the safety profile.

Young onset peptic ulcer disease and non-ulcer dyspepsia are separate entities.

The characteristics of peptic ulcer and non-ulcer dyspepsia in young men were studied in 202 consecutive conscripts who attended Central Military Hospital in Helsinki because of long-standing upper abdominal complaints. Active peptic ulceration (APU) was found in 48 patients, inactive peptic ulcer disease (IPU) was diagnosed in 77 patients, non-ulcer dyspepsia (NUD) was diagnosed in 52 patients. In 25 cases the reason for symptoms was another disease, and these patients were excluded from the study. A control series (CON) consisted of 30 symptomless healthy young male volunteers. The likelihood of discriminating between peptic ulcer disease and non-ulcer dyspepsia in a young male patient with dyspepsia are indicated by odds ratios (OR) and its 95% confidence limits (CL 95). Active peptic ulcer disease differs from NUD, e.g., by 1) presence of antrum gastritis, OR 41.5 (CL 95: 10.1-171), 2) Helicobacter pylori in the gastric mucosa, OR 31.0 (7.4-130), 3) Lewisa+ phenotype, OR 8.9 (1.7-45.4), 4) serum pepsinogen I (S-PGI) greater than 100 micrograms/l, OR 4.6 (1.7-12.4), 5) non-secretor status, OR 4.3 (1.6-11.6), and 6) O-blood group, OR 3.0 (1.2-7.7). In conclusion, the status of gastroduodenal mucosa, gastric secretion pattern and distribution of some genetic markers in patient series indicate that young onset peptic ulcer and non-ulcer dyspepsia are two separate entities. Helicobacter-positive antrum gastritis is the best determinant of ulcer risk, but also high S-PGI, Lewisa+ phenotype, non-secretor status and O-blood group are signs of increased risk of peptic ulcer.

[The Bugöynes study. Population of Finnish ethnic background in Sör-Varanger. IV. A follow-up based on the cardiovascular study done in the county of Finnmark in 1987]. / Bugøynes-undersøkelsene. Finskaettede i Sør-Varanger kommune--IV. En etterundersøkelse på grunnlag av hjerte- og karundersøkelsene i Finnmark fylke 1987.

An investigation conducted in 1972 among adult males in the fishing village of Bugøynes, where the majority of the population is of Finnish ethnic background, showed very high serum cholesterol values. This led to a recommendation that the population should modify its dietary habits. 1-1.5 years later the cholesterol values were reduced on average by 17.8%. Part of the adult population was reinvestigated in 1974 and 1977. At the last screening, in 1987, the whole adult population was invited to the investigation. In the age group 20-49 years the age adjusted serum cholesterol values in males were 16.8% lower in 1987 than in 1972. In females in the same age group the values had dropped by 5.4% from 1974 to 1987. Compared with neighbouring villages, the population in Bugøynes has changed its dietary habits. The prevalence of atherosclerotic heart disease in males aged 40-59 years, has declined from 18.9% in 1972 to 8.3% in 1987.

Erythromycin acistrate and enterocoated pellets of erythromycin base in acute respiratory infections of hospitalized conscripts.

The efficacy and tolerability of a new erythromycin ester, erythromycin acistrate (EA), and erythromycin base (EB) as enterocoated pellets were studied in 100 conscripts at the Central Military Hospital. The patients were admitted to hospital for acute respiratory tract infection. The dosage of EA was 400 mg tid and that of EB 500 mg tid. The patients were hospitalized during the treatment which ranged from seven to 12 days. The cure rate was good in both groups, 96% in the EA- and 87% in the EB-group. Gastrointestinal side effects were reported in 18% of the patients in the EA-group and in 46% in the EB-group (P less than 0.01). The gastrointestinal side effects were mild in all patients in the EA-group, while they were moderate in half and mild in half in the EB-group. None of the patients in the EA-group discontinued treatment because of gastrointestinal side effects, while the number in the EB-group was five (P less than 0.05). However one EA patient discontinued treatment because of testicular pain and one because of an urticarial rash. Neither of the drugs caused elevations of clinical significance in liver enzymes, and there were no changes in the measured laboratory safety parameters. In this trial EA was as effective as and caused significantly less gastrointestinal side effects than EB.

Campylobacter pylori is associated with chronic gastritis but not with active peptic ulcer disease.

Campylobacter pylori is supposed to be involved in the pathogenesis of gastroduodenal peptic ulcer diseases and chronic gastritis. In order to study whether the Campylobacter pylori in the stomach of peptic ulcer patients is related to ulcer itself or to a co-existing chronic gastritis, we examined the frequency of the bacteria in Giemsa stained histological sections of biopsy specimens from a series of patients with active peptic ulcer and from series of non-ulcer control subjects. We found no difference in the frequency of Campylobacter- positive cases between ulcer patients and non-ulcer controls when the comparison was done within the same category of chronic gastritis; e.g., within the category of chronic superficial gastritis 74% and 78% of cases showed the bacteria in antral biopsies from ulcer patients and from non-ulcer controls, respectively. In both ulcer patients and control subjects, in similar way in both antral and body mucosa, the Campylobacter pylori was strongly associated with chronic superficial gastritis but was more weakly associated with chronic atrophic gastritis, and the bacteria were only occasionally seen in normal mucosa. We conclude that Campylobacter pylori is associated with chronic gastritis in peptic ulcer patients but is not related to active ulcer.

Comparison of brodimoprim and doxycycline in acute respiratory tract infections. A double-blind clinical trial.

Brodimoprim and doxycycline monotherapies were compared in the treatment of acute respiratory tract infections in a randomized double-blind trial. The brodimoprim dose was 400 mg as a single loading dose followed by 200 mg for 10 days at bedtime. The corresponding doses of doxycycline were 200 and 100 mg respectively. Both treatment groups consisted of 30 patients. In the brodimoprim group, 23 patients recovered completely, five improved and two did not respond. In the doxycycline group, 26 patients recovered completely, three improved and one was considered a failure. Only one patient in the brodimoprim group had moderate diarrhoea.

Effect of silymarin on chemical, functional, and morphological alterations of the liver. A double-blind controlled study.

One hundred and six consecutive patients with liver disease were selected on the basis of elevated serum transaminase levels. The patients were randomly allocated into a group treated with silymarin (treated) and a group receiving placebo (controls). Ninety-seven patients complete the 4-week trial-47 treated and 50 controls. In general, the series represented a relatively slight acute and subacute liver disease, mostly induced by alcohol abuse. There was a statistically highly significantly greater decrease of S-SGPT (S-ALAT) and S-SGOT (S-ASAT) in the treated group than in controls. Serum total and conjugated bilirubin decreased more in the treated than in controls, but the differences were not statistically significant. BSP retention returned to normal significantly more often in the treated group. The mean percentage decrease of BSP was also markedly higher in the treated. Normalization of histological changes occurred significantly more often in the treated than in controls.

Prevalence and causes of proteinuria in 20-year-old Finnish men.

The prevalence and causes of proteinuria were studied in a cohort of 36147 men aged 20 (born in 1956). Proteinuria was found in 139 men (0.4%) at the initial screening or examination. Further investigations reduced the number of proteinuria cases to 72 (0.2%). Persistent proteinuria was demonstrated in 46 men (0.13% of the series) and orthostatic proteinuria in 26 (0.07%). Urography revealed anomalies in 18 of 104 cases. Elevated blood pressure and reduced glomerular filtration rate were observed in a few men, mainly from the group with persistent proteinuria. Renal biopsy was performed in 61 cases--38 with persistent proteinuria, 12 with orthostatic proteinuria and 11 without proteinuria at the time of examination. Light microscopy gave normal findings or showed only slight mesangial or focal glomerulonephritis in the great majority of cases. Membranous, mesangiocapillary or chronic proliferative glomerulonephritis was present in one-fourth of the men with persistent proteinuria. This was the only group with such lesions.