The varied clinical and radiological manifestations of contrast-induced encephalopathy following coronary angiography.

Contrast-induced encephalopathy (CIE) is a rare complication of imaging using ionidated contrast media. Its pathogenesis remains unknown, and its clinical presentation is variable. We present two cases of CIE following coronary angiography (CAG) that underscore the multitude of clinical manifestations and imaging findings associated with the disorder. In patient 1, CIE manifested during the CAG with agitation and decreased consciousness, followed by left hemiparesis and visual neglect. Native computed tomography (CT) of the head was unremarkable but CT perfusion (CTP) showed extensive hypoperfusion of the right hemisphere with corresponding slow-wave activity in the electroencephalogram (EEG). These findings were more pronounced the next day. Magnetic Resonance Imaging (MRI) revealed multiple small dot-like ischemic lesions across the brain. By day 6, she had fully recovered. Patient 2 developed transient expressive aphasia during the CAG followed by migraineous symptoms. Native head CT showed a large area of parenchymal edema, sulcal effacement and variable subarachnoid hyperdensity in the right hemisphere. He developed mild left-side hemiparesis, spontaneous gaze deviation and inattention. Brain MRI showed small dot-like acute ischemic lesions across the brain. The next morning, he had a generalized tonic-clonic seizure (GTCS) after which native head CT was normal, but the EEG showed a post-ictal finding covering the right hemisphere. His hemiparesis resolved within 2 months. The diversity in clinical and radiographic presentations suggest that CIE involve many pathophysiological processes.

The incidence and management of slipped capital femoral epiphysis: a population-based study.

We aimed to investigate the national trends in the incidence and management of slipped capital femoral epiphysis (SCFE) and to report the need for reoperations. We included all <19-year-old patients hospitalised for SCFE in 2004-2014 in mainland Finland (n=159). Data from the Finnish Care Register for Health Care, Statistics Finland, and Turku University Hospital patient charts were analyse for the incidence of SCFE in 2004-2012, the length of stay, and the type of surgery with respect to age, gender, study year, and season. The reoperations and rehospitalisations in 2004-2014 for SCFE were analysed for 2-10 years after surgery. In 2004 to 2012, primary surgery for SCFE was performed for 126 children. The average annual incidence of SCFE was 1.06/100 000 (95% confidence interval [CI], 0.81-1.38) in girls and 1.35/100 000 (95% CI 1.07-1.70) in boys. The median age at surgery was lower in girls than in boys (11 and 13 years, respectively, p<0.0001). During the study period, there was no significant change in the incidence of SCFE (p=0.9330), the type of primary procedures performed (p=0.9988), or the length of stay after the primary procedure (p=0.2396). However, the length of stay after percutaneous screw fixation was shorter compared with open reduction and fixation (mean 3.4 and 7.9 days, respectively, p<0.0001). There was no significant difference in the rate of reoperations according to the type of primary surgery. In conclusion, the incidence of SCFE and the proportion of different primary surgeries have recently remained stable in Finland.

Epidemiology of stroke in Finnish patients with Huntington's disease.

OBJECTIVES: Diabetes mellitus and hypercholesterolemia are known risk factors of stroke, and altered glucose and cholesterol metabolism has been reported in patients with Huntington's disease (HD). We investigated the incidence and risk factors of stroke in this population. MATERIALS AND METHODS: National registries were used to identify a cohort of 192 patients with HD. Data on stroke, silent cerebral infarcts and risk factors were obtained from the patient records. RESULTS: Five patients with an ischemic stroke (IS) were found suggesting a crude incidence of 42/100,000 person years. Silent brain infarcts were found in 13 patients and a hemorrhagic stroke in two patients, while none were found with a transient ischemic attack (TIA). The cumulative incidence of IS was 2.7% and that of silent cerebral infarct 6.7% by age of 65 years. The CAG age product (CAP) score, an estimate of genetic burden, was 495 ± 117 for the patients with IS or silent cerebral infarct and 568 ± 126 for the patients without ischemic events (P = 0.025 for difference). The frequency of diagnoses of stroke risk factors was at least twofold higher among the patients with IS or silent infarcts than among those without. CONCLUSION: Cerebrovascular disease is as common in patients with HD as in the general population, but minor cerebrovascular events and vascular risk factors may remain unrecognized. Genetic burden of the HTT mutation does not appear to increase the risk of stroke.

Presenting symptoms of glioma in adults.

OBJECTIVE: Studies on the presenting symptoms of glioma in adults in the age of readily available MRI imaging are scarce. This study investigates presenting symptoms of glioma and assesses the correlations of the presenting symptoms with patient age and histopathological class of the tumor. MATERIALS AND METHODS: A retrospective review of the medical records of histologically verified glioma patients treated in Turku University Hospital, during 2006-2010, was conducted. The associations between the presenting symptoms and other covariates were assessed individually. RESULTS: One hundred and fifty patients were ascertained. The most common presenting symptoms of glioma were seizure and cognitive disorder. Patients presenting with seizures were younger than patients with cognitive disorders, and the grade of the tumor was also found to significantly correlate with the most common presenting symptoms. Age group and tumor grade were statistically significant factors of cognitive disorder (P = 0.0037 and P = 0.0069) and age group of seizure (P = 0.0065). The associations between the presenting symptoms and the anatomical location, spread into adjacent brain areas, or laterality of the tumor or site of diagnosis were found to be statistically insignificant. Headache was not a common presenting symptom in glioma patients. CONCLUSIONS: The main presenting symptoms of glioma in adults in the MRI age still are seizures and cognitive disorder. Patient age and tumor grade correlate positively with the incidence of cognitive disorder and patient age negatively with incidence of seizure as a presenting symptom. Headache is an uncommon manifestation and does not appear as a sole symptom.

The incidence and triggers of adult-onset Guillain-Barré syndrome in southwestern Finland 2004-2013.

BACKGROUND AND PURPOSE: A Swiss study recently reported surgery as a potential risk factor for developing Guillain-Barré syndrome (GBS). It was sought to establish this in the Finnish adult population. METHODS: Persons over 16 years of age who received a diagnosis of GBS in 2004-2013 were identified from the patient register of Turku University Hospital and their patient records were analyzed to identify possible triggers. RESULTS: A cohort of 69 adult patients with GBS (63.8% men) was identified giving an annual incidence of 1.82/100,000. Of these, four (5.8%) had experienced a surgical procedure during the preceding 6 weeks with a relative risk of 6.28 (95% confidence interval 4.15-9.47, P < 0.001) compared with the general study population or a risk of 1.25/100,000 operations. No difference between genders was found. Only two (2.9%) patients had received a vaccination [one against seasonal influenza (P = 0.888) and one against pandemic influenza (Pandemrix(®), GlaxoSmithKline Biologicals, Rixensart, Belgium, relative risk 2.85, 95% confidence interval 1.27-6.38, P = 0.011)] during the preceding 6 weeks. The most common GBS triggers identified were respiratory tract infections in 30 cases (43.5%) and gastroenteritis in 16 cases (23.2%) whilst two patients (2.9%) had had both. CONCLUSIONS: The overall incidence of GBS in the adult population of southwestern Finland was similar to previous studies worldwide and the most common triggers were respiratory tract infections and gastroenteritis. Surgery was a rare risk factor and of vaccinations only the one against pandemic influenza raised the risk of GBS.

Acoustic rhinometry, rhinomanometry and visual analogue scale before and after septal surgery: a prospective 10-year follow-up.

OBJECTIVES: The aim of the study was to compare rhinomanometry, acoustic rhinometry and subjective estimation of the nasal obstruction before and after septoplasty and to evaluate the long-term results of septal surgery. DESIGN: Prospective long-term follow-up, before and after septoplasty. SETTING: University tertiary-care hospital, referral centre. PARTICIPANTS: The study included 30 adult patients who were operated on because of septal deviation. MAIN OUTCOME MEASURES: Pre-operatively, acoustic rhinometry and active anterior rhinomanometry were performed on each subject after decongestion of the nose. A visual analogue scale for unilateral nasal obstruction was filled in by the patients. The measurements were repeated both 6 months and 10 years post-operatively. RESULTS: A significant change in acoustic values was found during the long-term follow-up of 10 years. The mean minimal cross-sectional area on the more obstructive side was 0.35 cm(2) pre-operatively. Six months after operation, it was 0.52 cm(2), and 10 years after operation, it was 0.68 cm(2). The mean resistance fell from pre-operative 1.16 Pa/mL/s to 0.41 Pa/mL/s during the first 6 months, but rose again to 1.21 Pa/mL/s after 10 years. Despite a tendency of improvement, no statistically significant change was found between pre-operative and postoperative values in VAS. Six months after operation 69% of the patients were satisfied with the result, and after ten years the amount of satisfied patients was 83%. CONCLUSIONS: We found an increase in acoustic values, but an increase in nasal resistance in the long-term follow-up. Other factors than nasal area may have an impact on nasal resistance and the feeling of nasal obstruction. The small size on the sample interfered with the results.

Reference values for acoustic rhinometry in children at baseline and after decongestion.

BACKGROUND: Acoustic rhinometry is widely used for objective evaluation of nasal dimensions. However, there is a lack of agreement on the normative values in children at baseline, and especially after decongestion. The purpose of this study was to determine the reference values for Finnish school children for acoustic rhinometry in non-decongested and decongested noses, and to find out which of the potential predictors (age, sex, body surface area (BSA) and height) would be the most useful one(s). METHODOLOGY: The study included 124 children aged between 6.90 and 13.84 years with no permanent nasal symptoms. RESULTS: At baseline, the mean total minimal cross-sectional area (MCA) was 0.752 cm2, and the mean total volume between 0 - 3 cm (VOL) was 4.00 cm3. After decongestion, the total MCA was 0.794 cm2, and the VOL was 4.38 cm3. There was a significant correlation between MCA and age, between VOL and height, and between VOL and BSA at baseline and after decongestion. We found no difference in the values between boys and girls. CONCLUSIONS: We conclude that acoustic rhinometry is a suitable objective method to monitor the changes in mucosal swelling and nasal obstruction in children. Age and height or BSA of a child can be suggested as predictive factors.

Correlation between acoustic rhinometry and visual analogue scale in children with no nasal symptoms: a prospective cohort study.

OBJECTIVES: Acoustic rhinometry is an objective tool to evaluate nasal obstruction. The aim of this study was to evaluate the usefulness of visual analogue scale (VAS) as a subjective tool for nasal obstruction and the correlation between acoustic rhinometry and VAS in children with no nasal symptoms. DESIGN: Unilateral acoustic values and VAS were measured at baseline and after decongestion of the nose. SETTING: Tertiary academic hospital. PARTICIPANTS: The study included 124 children aged between 7 and 14 years with no permanent nasal symptoms. RESULTS: At baseline, the mean minimal cross-sectional area on the right side was 0.392 cm(2) (sd 0.094), and on the left side 0.360 cm(2) (sd 0.093), whereas the mean VAS on the right side was 7.43 (sd 2.50) and on the left side 6.81 (sd 3.01). After decongestion, the mean minimal cross-sectional area on the right and left sides were 0.421 cm(2) (sd 0.087) and 0.373 cm(2) (sd 0.11), respectively, whereas the mean VAS on the right and left sides were 8.77 (sd 2.02) and 8.54 (sd 2.14), respectively. At baseline, a significant correlation was found between VAS and minimal cross-sectional area, but no correlation was found between VAS and acoustic values after decongestion. CONCLUSIONS: We conclude that VAS shows potential as a subjective tool to investigate nasal obstruction in children over 7 years of age. There was a correlation between VAS and acoustic rhinometry in children with no nasal symptoms at baseline. No correlation was found in children with decongested normal nasal airways.

High redox potential laccases from the ligninolytic fungi Pycnoporus coccineus and Pycnoporus sanguineus suitable for white biotechnology: from gene cloning to enzyme characterization and applications.

AIMS: Exploitation of natural biodiversity in species Pycnoporus coccineus and Pycnoporus sanguineus to screen for a new generation of laccases with properties suitable for the lignin-processing sector. METHODS AND RESULTS: Thirty strains originating from subtropical and tropical environments, mainly isolated from fresh specimens collected in situ, were screened for laccase activity. On the basis of levels of enzyme activity and percentage of similarity between protein sequences, the laccases from strains BRFM 938, BRFM 66 and BRFM 902 were selected for purification and characterization. Each BRFM 938, BRFM 66 and BRFM 902 laccase gene encoded a predicted protein of 518 amino acids; the three deduced proteins showed 68.7-97.5% similarity with other Polyporale laccases. The three laccases (59.5-62.9 kDa with 7-10% carbohydrate content) had high redox potentials (0.72-0.75 V vs normal hydrogen electrode at pH 6), remained highly stable up to 75-78 degrees C and at pH 5-7 mixtures, and were resistant to methyl and ethyl alcohols, acetonitrile and dimethylsulfoxide at concentrations as high as 50% (v/v). The best laccase-1-hydroxybenzotriazole systems permitted almost 100% of various polyphenolic dye decolourization and oxidation of adlerol and veratryl alcohol. CONCLUSIONS: The three laccases showed complementary biochemical features. BRFM 938 laccase had the highest thermo- and pH stability, catalytic efficiency towards 2,2'-azino-bis-[3-ethylthiazoline-6-sulfonate] and resistance to alcoholic solvents. BRFM 66 laccase had the highest rates of dye decolourization and oxidation of nonphenolic compounds. SIGNIFICANCE AND IMPACT OF THE STUDY: This study identified P. coccineus and P. sanguineus as outstanding producers of high redox potential laccases, easy to purify and scale-up for industrial production. Three new laccases proved to be suitable models for white biotechnology processes and for further molecular breeding to create a new generation of tailor-made enzymes.

Bronchoalveolar lavage in immunocompromised patients with haematological malignancy--value of new microbiological methods.

PURPOSE: To assess the usefulness of new culture-independent microbiological methods to analyse bronchoalveolar lavage (BAL) fluid from haematological patients with clinical pneumonia. PATIENTS AND METHODS: Results of 135 BALs from 122 disease episodes in 99 patients treated between 1996 and 2002 were retrospectively analysed. Forty-three patients had undergone haematopoietic stem cell transplantation and 56 patients had been treated with conventional chemotherapy for haematological malignancy. In addition to conventional microbiological methods, polymerase chain reaction (PCR) tests for Pneumocystis carinii, cytomegalovirus (CMV), Legionella sp., mycobacterium, Mycoplasma pneumoniae, and Chlamydia pneumoniae and the Aspergillus antigen test were performed. RESULTS: Three (2.2%) quantitative and four (3.0%) special bacterial cultures gave an aetiological diagnosis. A respiratory virus was isolated in 10 episodes (8.2%). The diagnostic yield increased to 35.6% (48 of 135) by other methods. The P. carinii PCR test was positive in 21 of 24 patients with P. carinii pneumonia, being the only microbiological indication of P. carinii in four cases. The CMV PCR test was positive in 18 patients, but in 14 patients the clinical significance of the finding remained unproven. The Aspergillus antigen test was positive in seven of nine patients with aspergillosis, being the only microbiological indication of Aspergillus in three cases. The result of BAL indicated commencement of specific antimicrobial treatment in 27 episodes (22.1%). CONCLUSION: The contribution of new culture-independent methods to the total diagnostic yield was of note. Among these methods, the P. carinii PCR and Aspergillus antigen tests proved the most valuable, while the CMV PCR test was not clinically useful.

Intranasally administered insulin intended for prevention of type 1 diabetes--a safety study in healthy adults.

BACKGROUND: Intranasally applied insulin is one of the antigen-specific therapies currently tested in clinical type 1 diabetes prevention trials, for example, in the Type 1 Diabetes Prediction and Prevention Study (DIPP). The possibility that the therapy may cause hypoglycaemia or local irritation and the poorly known immunological safety of mucosal application of the antigen in healthy subjects prompted this study. METHODS: We used a randomised, placebo-controlled, double-blinded crossover study design with 3-week treatment periods to study the effects of once-daily intranasal application of human short-acting insulin without absorption-enhancing adjuvants in 20 non-diabetic adults. The selected 60 IU dose of insulin was equivalent to the weight-based dose used for the DIPP children. We investigated self-monitored blood glucose concentrations, nasal insulin effects and induction of diabetes-associated autoantibodies. RESULTS: The two treatment periods showed no differences in blood glucose concentrations or in the frequency of blood glucose values higher than 3.0 mmol/L. Of the eight measured hypoglycaemic values, only one, which occurred during placebo therapy, was associated with symptoms. Rhinoscopy revealed no nasal irritation, and mucociliary clearance, nasal airway patency and nasal airflow resistance were not affected by the insulin therapy. Eleven subjects complained of transient nasal stinging or unpleasant odour and one subject reduced the dose because of nasal irritation. The treatment did not induce production of any of the four diabetes-associated autoantibodies. CONCLUSIONS: Short-term use of intranasal insulin without absorption enhancers was predominantly well tolerated, the risk of hypoglycaemia was minimal and no objective nasal adverse effects were detected.

beta-fluoro-coniferyl alcohol does not inhibit lignin biosynthesis in suspension cultures of Picea abies (L.) Karst.

A fluorinated analogue of coniferyl alcohol has been reported to be a specific inhibitor of oxidases involved in the biosynthesis of lignin. The Z isomer of beta-fluoro-coniferyl alcohol was synthesized and used for the preparation of dehydrogenation polymers (DHPs) and was also tested on lignin producing suspension cultures of spruce (Picea abies (L.) Karst.). The growth of the cells or the production of lignin by the suspension cultures was not significantly affected by the addition of fluoroconiferyl alcohol. This analogue did not form polymers quite as easily as did coniferyl alcohol in oxidation with hydrogen peroxide and horseradish peroxidase. In both cases the beta-fluoroconiferyl alcohol became incorporated in the polymeric product. We were unable to detect any specific inhibition of peroxidase activity, which is at variance with earlier reports of pronounced inhibition of lignin biosynthesis in poplar plantlets by fluoroconiferin, a potential inhibitor of oxidases involved in lignin biosynthesis.

Salen complexes with bulky substituents as useful tools for biomimetic phenol oxidation research.

The catalytic properties of bulky water-soluble Co-, Cu-, Fe- and Mn-salen complexes in the oxidation of phenolic lignin model compounds have been studied in aqueous water--dioxane solutions (pH 3--10). Mn catalysts were found to oxidize coniferyl alcohol in a same reaction time as horseradish peroxidase (HRP) enzyme and Mn and Co catalysts showed different regioselectivity suggesting a different substrate to catalyst interaction in the oxidative coupling. When the oxidation of material more relevant to plant polyphenolics was studied, the results indicated that the complexes catalyze one- and two-electron oxidations depending on the bulk of the substrate.

Mediastinoscopy--its role and value today in the differential diagnosis of mediastinal pathology.

Mediastinoscopy has been an important method in the differential diagnosis of mediastinal pathology since it was presented by Carlens in 1959. Present investigation methods in radiology such as computed tomography and magnetic resonance imaging as well as the new developments in ultrasonography have resulted in a decrease in the number of mediastinoscopies performed. In addition, better results of fine-needle aspiration and core-needle biopsy investigations together with new techniques in thoracoscopy have brought alternative possibilities in examining mediastinal masses. To evaluate the role of mediastinoscopy today, a retrospective study was conducted comprising 249 consecutive patients who had undergone mediastinoscopy in the years 1989 1997 at Turku University Central Hospital. Mediastinoscopy was technically possible in 229 of the 249 cases (92.0%) and a definitive diagnosis was obtained in 210 cases (84.3%). The mortality rate was zero and only 13 complications (5.2%) were reported. Six cases of paresis of the left recurrent nerve were reported, four of which were temporary. There were also five minor intraoperative and two postoperative bleedings, which were easily controlled. We still consider mediastinoscopy as a safe and efficient way of examining mediastinal pathology.

The identification of dilignols from dehydrogenation mixtures of coniferyl alcohol and apocynol [4-(1-Hydroxyethyl)-2-methoxyphenol] by LC-ES-MS/MS.

A LC-ES-MS/MS method for the identification of dilignols formed by the oxidative cross-coupling of coniferyl alcohol and apocynol has been developed. The identification is based on the generation of ammonium adduct ions [M + NH(4)](+) by electrospray ionization and thereafter the following fragmentation patterns for the selected precursor ions. Fragmentation of several arylglycerol-beta-aryl ether (beta-O-4) and phenyl coumarane (beta-5) model compounds were studied as a reference.

Nonspecific nasal mucosal reactivity, expressed as changes in nasal airway resistance after bilateral saline provocation.

When using intranasal provocation tests in diagnosing nasal allergy or other hyperreactivity, it is essential to know which part of the reaction is caused by some nonspecific stimulus. The purpose of this study is to evaluate nonspecific nasal reactions of patients with chronic nonallergic perennial rhinitis as well as normal controls. The provocations were made bilaterally with normal saline solution (0.9% sodium chloride), and the changes in the nasal resistance were recorded by active anterior rhinomanometry. There was no significant difference between the chronic rhinitis patients and the normal controls. However, the individual variations were large. We conclude that a change of +/- 100-150% in the unilateral nasal resistance can be caused by a nonspecific reactivity.

Glomus tumor of the trachea.

We report a case of a glomus tumor in the trachea which was an incidental finding in a 66-year-old man. The histological picture and immunohistochemical profile were typical for this tumor. The glomus tumor is an exceedingly rare mass lesion in the trachea, but it is useful to keep it among differential diagnostic alternatives when a tracheal tumor is seen on radiographs or endoscopy.

Peritonsillar abscess associated with infectious mononucleosis.

Infectious mononucleosis (IM) is characterized as a viral disease; thus, no antibiotic treatment is recommended. However, some of these patients tend to develop a long-lasting, painful disease, which can be relieved by antibiotic administration. Due to this bed-side knowledge, we re-evaluated 928 patients with peritonsillar abscess (PA), treated during a 5.5-year period in the Department of Otorhinolarygology of Turku University Central Hospital. Of these patients 15 (1.6%) also had infectious mononucleosis (IM). During this period, 64 patients with severe pharyngeal IM were treated in our department and thus the proportion of PA in patients with IM was 23.4%. A control of 15 age- and sex-matched patients with PA but without mononucleosis was formed in order to evaluate the possible differences in patient history, clinical symptoms and findings. Such differences were small and did not affect the chosen treatment of PA, abscess tonsillectomy. There was no peri- or postoperative difference in complications or recovery, but the hospitalization time was longer in IM patients with PA (3.1 days) than in patients with PA only (2.4 days). IM patients referred to ENT departments make a special group of patients, who may also need surgical treatment.

Laser bronchoscopy in palliative treatment of malignant obstructing endobronchial tumors.

This retrospective study investigates the experience of our ENT Department in the palliative treatment of obstructive malignant bronchial tumors with endoscopic laser surgery. 82 laser procedures on 39 patients were performed between January 1988 and December 1993. In 25 cases, a carbon dioxide (CO2) laser and, in 14 cases, a combined CO2-Nd:YAG laser were used. In 60 procedures, more than half of the tumor could be resected with laser. In 22 cases, minor improvement of the bronchial airway was achieved. Subjectively, most of the patients felt improved breathing after surgery and all were ready to undergo repeated treatment if it was offered. Two fatal complications occurred. We conclude that endoscopic laser surgery is a relatively safe treatment modality for palliation of a compromised airway and can offer a better life quality to selected patients, although it also involves the possibility of fatal complications.

Circumferential squamocellular papilloma of the cervical esophagus, a rare cause of dysphagia. A case report.

A case report of a patient with circumferential benign squamous cell papilloma of the cervical esophagus is presented. The location, appearance and symptoms of the lesion are unusual, and the etiology and treatment are discussed. The case is important for otorhinolaryngologists, because the widely used method to examine the upper gastrointestinal tract, fiberesophagogastroscopy, does not offer optimum conditions to investigate the proximal esophagus. The rigid hypopharyngoesophagoscopy under general anesthesia is the method of choice for this region, a method familiar to otorhinolaryngologists.