Diagnosis, natural course and treatment outcomes of groove pancreatitis.

BACKGROUND: Groove pancreatitis (GP) is a rare form of chronic pancreatitis with limited data on its diagnostics and treatment outcomes. The aim of this study was to assess its diagnostics, natural course, and treatment options. METHODS: The study is a retrospective population-based study from Southern Finland, including all patients with suspected GP between January 2005 and December 2015. Two certified gastrointestinal radiologists re-reviewed the imaging studies. The radiological re-review, clinical judgment, and final histopathology confirmed the GP diagnoses. RESULTS: Out of 67 patients with possible GP, 39 patients were considered to have high radiological certainty of GP. Out of these 39, five patients had cancer instead. Thirty-three patients with confirmed GP formed the final study cohort. Patients with GP were mostly middle-aged (median 55 years) men. All had at least moderate alcohol consumption. No intervention was needed in 14 patients. In five-year follow-up all conservatively treated patients became asymptomatic, while 10 out of 16 patients undergoing at least one intervention were asymptomatic at five years. CONCLUSION: The radiological diagnosis of GP is difficult, and a low threshold for cancer suspicion should be kept. Symptoms of GP decrease with time and suggest conservative treatment as the first-line option.

Approximation errors and model reduction in optical tomography.

Model reduction is often required in optical diffusion tomography (ODT), typically due to limited available computation time or computer memory. In practice, this often means that we are bound to use sparse meshes in the model for the forward problem. Conversely, if we are given more and more accurate measurements, we have to employ increasingly accurate forward problem solvers in order to exploit the information in the measurements. In this paper we apply the approximation error theory to ODT. We show that if the approximation errors are estimated and employed, it is possible to use mesh densities that would be unacceptable with a conventional measurement model.

Stability of Thought Disorder Index among high-risk and low-risk adoptees in the Finnish adoptive family study of schizophrenia.

The aim of the study was to evaluate whether thought disorders are stable, trait-like features specific to subjects who have a genetic liability to schizophrenia or a psychiatric disorder. The thought disorders of adoptees genetically at high risk (HR) or low risk (LR) for schizophrenia from the Finnish adoptive family study of schizophrenia were evaluated twice at a mean interval of 11 years, using the sum of the Thought Disorder Index (TDI) scores on the Rorschach (TD(R)). At the initial assessment, the mean TD(R) scores of women were significantly higher than those of men, while no association between genetic risk and psychiatric status or their interactions with the TD(R) scores at baseline were found. The main finding was that the initial TD(R) scores statistically significantly predicted the TD(R) scores at follow-up, thus indicating the stability of thought disorder over time. However, neither genetic or psychiatric status nor gender or any interaction between these variables associated with TD(R) at follow-up.

Geochemistry of ground water and the incidence of acute myocardial infarction in Finland.

STUDY OBJECTIVE: To examine the association of spatial variation in acute myocardial infarction (AMI) incidence and its putative environmental determinants in ground water such as total water hardness, the concentration of calcium, magnesium, fluoride, iron, copper, zinc, nitrate, and aluminium. DESIGN: Small area study using Bayesian modelling and the geo-referenced data aggregated into 10 km x 10 km cells. SETTING: The population data were obtained from Statistics Finland, AMI case data from the National Death Register and the Hospital Discharge Register, and the geochemical data from hydrogeochemical database of Geological Survey of Finland. PARTICIPANTS: A total of 18 946 men aged 35-74 years with the first AMI attack in the years 1983, 1988, and 1993. MAIN RESULTS: One unit (in German degree degrees dH) increment in water hardness decreased the risk of AMI by 1%. Geochemical elements in ground water included in this study did not show a statistically significant effect on the incidence and spatial variation of AMI, even though suggestive findings were detected for fluoride (protective), iron and copper (increasing). CONCLUSIONS: The results of this study with more specific Bayesian statistical analysis confirm findings from earlier observations of the inverse relation between water hardness and coronary heart disease. The role of environmental geochemistry in the geographical variation of the AMI incidence should be studied further in more detail incorporating the individual intake of both food borne and water borne nutrients. Geochemical-spatial analysis provides a basis for the selection of areas suitable for such research.

Thompson hemiarthroplasty is superior to Ullevaal screws in treating displaced femoral neck fractures in patients over 75 years. A prospective randomized study with two-year follow-up.

BACKGROUND AND AIMS: The Finnish orthopaedic tradition has preferred hemiarthroplasty to internal fixation in femoral neck fracture treatment, while in Sweden internal fixation has been the method of choice. We decided to study whether internal fixation would prove superior to hemiarthroplasty even in displaced femoral neck fractures in patients over 75 years old. MATERIAL AND METHODS: We randomized 32 displaced femoral neck fractures in patients over 75 years old to receive internal fixation or hemiarthroplasty. RESULTS: Fifteen (47%) patients died within two years. Seven of 16 (44%) patients in the internal fixation group were reoperated, none in the hemiarthroplasty group (p = 0.007). Seven of the complications in the internal fixation group developed during the first year and it would have been unethical to continue the study. CONCLUSIONS: We conclude that displaced femoral neck fractures in patients over 75 years should be treated by arthroplasty.

Long-term stability of communication deviance.

Communication deviance (CD), forms of communication that are not bizarrely thought disordered but are hard to follow and that make difficult the consensual sharing of attention and meaning, has been hypothesized as a nonspecific contributor of rearing parents to psychopathology of offspring, including schizophrenia. This hypothesis, or an alternative of genetic transmission, would gain plausibility if CD has long-term stability. CD was evaluated, using tape-recorded and reliably scored Rorschachs in 158 Finnish adoptees, and retested after a median interval of 11 years. Adolescent CD was not stably correlated with follow-up CD. However, initial CD at a mean age of 32 and follow-up CD were significantly correlated. Gender, genetic risk for schizophrenia, and DSM-III-R (American Psychiatric Association, 1987) psychiatric diagnoses had no effect on adult CD stability. CD appears to be a stable, traitlike feature of adult but not adolescent functioning.

Baltic soil survey: total concentrations of major and selected trace elements in arable soils from 10 countries around the Baltic Sea.

Agricultural soils were collected from 10 European countries over a 1,800,000 km2 area surrounding the Baltic Sea. The sampling density was 1 site/2500 km2. Two samples were taken at each site: topsoil 0-25 cm (ploughing layer, Ap-horizon) and subsoil (bottom samples, usually B- or C-horizon) at an approximate depth of 50-75 cm, well below the ploughed layer. The samples were analysed for total element concentrations of 41 elements by WD-XRF. Analytical results for both layers are quite comparable. Large differences between element concentrations and variations can be observed for most elements when the different countries are compared. The Nordic countries show considerably higher concentrations and variations for quite a number of elements [Al, Fe, (Mg, P), Ti, Ba, Sc, Sr, V] in their agricultural soils. This is an expression of geology, the relatively younger age of the soils here and of the climatic conditions (reduced weathering rates). Regional geochemical maps demonstrate that geology overwhelmingly dominates the total concentration of chemical elements as observed in the agricultural soils. The three (four) large tectonic units (Caledonian mountain chain, Fennoscandian Shield and the northern and southern eastern European Platform) composing this area are all reflected in the regional maps.

Finnish adoptive family study: sample selection and adoptee DSM-III-R diagnoses.

OBJECTIVE: To evaluate the genetic contribution to schizophrenia using an adoption design that disentangles genetic and environmental factors. METHOD: Finnish hospital diagnoses of schizophrenic/paranoid psychosis in a nationwide sample of adopting-away women are compared with DSM-III-R research diagnoses for these mothers. DSM-III-R diagnoses of their index offspring are blindly compared with adopted-away offspring of epidemiologically unscreened control mothers. RESULTS: Primary sampling diagnoses of index mothers were confirmed using DSM-III-R criteria. Lifetime prevalence of typical schizophrenia in 164 index adoptees was 6.7% (age-corrected morbid risk 8.1%), significantly different from 2.0% prevalence (2.3% age-corrected morbid risk) in 197 control adoptees. When adoptees with diagnoses of schizoaffective disorder, schizophreniform disorder, schizotypal disorder and affective psychoses were added, the contrast between the index and control adoptees increased. CONCLUSION: The genetic liability to 'typical' DSM-III-R schizophrenia is decisively confirmed. Additionally, the liability also extends to a broad spectrum of other psychotic and non-psychotic disorders.

Drug release from poly(acrylic acid) grafted poly(vinylidene fluoride) membrane bags in the gastrointestinal tract in the rat and dog.

Stomach-specific drug delivery systems would be of value in treating diseases of the upper gastrointestinal tract. The present study measured in vitro and in vivo drug release from pH-sensitive membrane bags, constructed of poly(acrylic acid) grafted onto a poly(vinylidene fluoride) (PAA-PVDF) membrane, which might be suitable for stomach-specific drug delivery. The used model drugs were propranolol-HCl (1.0 mg) and FITC-dextran MW 4400 (1.0 mg). Drug release in vivo was studied by inserting membrane bags into the stomach and proximal duodenum of anesthetized rats and dogs. At 30 and 180 min, the bags were removed from the lumens and residual drug content was determined. The release of either propranolol or FITC-dextran were comparable in both stomach and duodenum, showing that in vivo drug release did not depend on environmental pH. In vitro results suggested that these results could be explained by interactions between PAA and the mucous layers of the stomach and duodenum.

Thought disorder index of Finnish adoptees and communication deviance of their adoptive parents.

BACKGROUND: Diverse forms of thought disorder, as measured by the Thought Disorder Index (TDI), are found in many conditions other than schizophrenia. Certain thought disorder categories are primarily manifest during psychotic schizophrenic episodes. The present study examined whether forms of thought disorder qualify as trait indicators of vulnerability to schizophrenia in persons who are not clinically ill, and whether these features could be linked to genetic or environmental risk or to genotype-environment interactions. The Finnish Adoptive Study of Schizophrenia provided an opportunity to disentangle these issues. METHODS: Rorschach records of Finnish adoptees at genetic high risk but without schizophrenia-related clinical diagnoses (N = 56) and control adoptees at low genetic risk (N = 95) were blindly and reliably scored for the Thought Disorder Index (TDI). Communication deviance (CD), a measure of the rearing environment, was independently obtained from the adoptive parents. RESULTS: The differences in total TDI between high-risk and control adoptees were not statistically significant. However, TDI subscales for Fluid Thinking and Idiosyncratic Verbalization were more frequent in high-risk adoptees. When Rorschach CD of the adoptive rearing parents was introduced as a continuous predictor variable, the odds ratio for the Idiosyncratic Verbalization component of the TDI of the high-risk adoptees was significantly higher than for the control adoptees. CONCLUSIONS: Specific categories of subsyndromal thought disorder appear to qualify as vulnerability indicators for schizophrenia. Genetic risk and rearing-parent communication patterns significantly interact as a joint effect that differentiates adopted-away offspring of schizophrenic mothers from control adopted-away offspring.

Drug release from cation exchange membrane in rabbit eye.

Cations were adsorbed onto a poly(acrylic acid) (PAA) grafted poly(vinylidene fluoride) (PVDF) membrane that served as a cation exchange membrane. The aim of this study was to evaluate the effect of ionic strength of the adsorption medium on cation release from the PAA-PVDF membrane in the eye. Model cations, propranolol and timolol, were adsorbed onto the membranes in solutions with different ionic strengths (micron = 0.018 - 0.40) at pH 7.0. The circular drug-containing membranes were applied to both eyes of pigmented rabbits in the lower conjunctival sac. The membranes were well tolerated and well retained in the rabbit eye. Membranes containing either propranolol or timolol were removed from the eyes at preset time intervals, and the remaining drug content in the membranes was determined. The release rates of both propranolol and timolol decreased with increasing ionic strength of the adsorption medium. This was probably due to cationic exchange properties, as well as swelling properties of the membrane.

Drug release from a porous ion-exchange membrane in vitro.

The effect of environmental ionic strength on the rate of drug release from a cation exchange membrane was evaluated. Cationic propranolol-HCl, timolol, sotalol-HCl, atenolol and dexmedetomidine-HCl and neutral diazepam were adsorbed onto a porous poly(vinylidene fluoride) (PVDF) membrane that was grafted with bioadhesive poly(acrylic acid) chains (PAA-PVDF). Despite its porosity, the PAA-PVDF membrane acted as a cation exchange membrane. The release of adsorbed drug from the PAA-PVDF membrane was investigated by using a USP rotating basket apparatus. Adsorption of cationic drugs onto the PAA-PVDF membrane tended to increase with increasing lipophilicity of the drug. A decrease in the ionic strength of the adsorption medium increased the amount of the cationic drugs adsorbed onto the membrane, but had no effect on diazepam adsorption. The release of cationic drugs from the PAA-PVDF membrane was greatly affected by the ionic strength of both the adsorption medium and the dissolution medium, while ionic strengths did not affect diazepam release. Our results suggest that the ionic strength of both the adsorption and dissolution media substantially affects the release rate of a drug that has been adsorbed onto the ion exchange membrane, primarily via electrostatic interactions, while ionic strength has no effect on the release of a drug which has been adsorbed onto the membrane via non-electrostatic forces.

Bone remodelling in the pores and around load bearing transchondral isoelastic porous-coated glassy carbon implants: experimental study in rabbits.

Cylinders of porous-coated glassy carbon were implanted into drill holes made through the articular surface of the medial condyle of both tibiae of ten rabbits for six and 12 weeks. Bone ingrowth and remodelling was examined by radiographic, histologic, oxytetracycline-fluorescence and microradiographic methods. Bone ingrowth into pores and load bearing implants was seen by all examination methods. Bone ingrowth occurred earlier when the pores were facing cancellous bone than cortical bone. Appositional bone formation occurred on the trabeculae a few millimetres from the interface during the early phase of remodelling at six weeks. At 12 weeks resorptive remodelling had occurred both in the surroundings and in those pores that face cancellous bone, whereas the amount of bone still increased in the pores facing cortical bone. In its porous-coated form glassy carbon functions well as a frame for ingrowing bone and it shows good osteoconductivity. Its mechanical properties are suitable for functioning as a structural bone substitute in places where the loads are mainly compressive. The difference between findings at six and 12 weeks indicated physiologic stress distribution and the adverse effects of stiff materials on bone remodelling were avoided by using this isoelastic material.

Shear strength of loaded porous-glassy-carbon/bone interface--an experimental study on rabbits.

The aim of the study was to measure the shear strength of bone/porous-glassy-carbon interface in rabbit. Glassy carbon pellets were implanted into drill holes made through the medial articular surface of the proximal tibia of 15 rabbits. Shear strengths grew statistically significantly from 1 to 6 weeks and reached a maximum of 4.6 MN/m2. Microscopical examination of the sheared surfaces revealed that at 1 and 2 weeks the shearing occurred through the tissue surrounding the implant, and at 3, 6 and 12 weeks through the porous coating of the implant. To diminish the fragility of the porous coating, its porosity should be adjusted to 40%. Results of shear strength studies on current implant materials are reviewed.

Bone growth into glassy carbon implants. A rabbit experiment.

This study was designed to evaluate the growth of bone into porous glassy carbon cylinders. Porous carbon cylinders were implanted in 30 rabbits intra-articularly in the metaphysis of the femur opposite from the patella. The rabbits were sacrificed up to 24 weeks after the operation. The bone samples were examined by histologic, fluorochrome and microradiographic methods. The amount of bone ingrowth was measured histomorphometrically. Fluorochrome uptake was seen in the implant pores, which indicated new bone growth originating from surrounding bone. After 3 weeks, microradiographs revealed new bone formation in the pores and with time the bone spicules became more dense. The amount of bone tissue in the pores grew and reached a maximum at 12 weeks, when 45 per cent of the total pore volume was incorporated with bone tissue. No adverse tissue responses were observed.

Interaction of microporous glassy carbon and living tissue.

Preliminary animal implantation tests with rats showed that microporous glassy carbon has good biocompatibility. Microporous glassy carbon is also stable and suitable for a hard biocompatible implant.