J Mustonen

Publications (101)440.84 Total impact

• Source

  Available from: Pia Jaatinen

  Article: Hormonal deficiencies during and after Puumala hantavirus infection

  S. Mäkelä, P. Jaatinen, M. Miettinen, J. Salmi, I. Ala-Houhala, H. Huhtala, M. Hurme, I. Pörsti, A. Vaheri, J. Mustonen
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  ABSTRACT: Previous reports have described panhypopituitarism associated with severe cases of hemorrhagic fever with renal syndrome (HFRS), but the prevalence of hormonal deficiencies after nephropathia epidemica (NE), a milder form of HFRS, has not been studied. This study was conducted in order to determine the prevalence of hormonal defects in patients with acute NE and during long-term follow-up. Fifty-four patients with serologically confirmed acute NE were examined by serum hormonal measurements during the acute NE, after 3months, and after 1 to 10 (median 5) years. Thirty out of 54 (56%) patients had abnormalities of the gonadal and/or thyroid axis during the acute NE. After a median follow-up of 5years, 9 (17%) patients were diagnosed with a chronic, overt hormonal deficit: hypopituitarism was found in five patients and primary hypothyroidism in five patients. In addition, chronic subclinical testicular failure was found in five men. High creatinine levels and inflammatory markers during NE were associated with the acute central hormone deficiencies, but not with the chronic deficiencies. Hormonal defects are common during acute NE and, surprisingly, many patients develop chronic hormonal deficiencies after NE. The occurrence of long-term hormonal defects cannot be predicted by the severity of acute NE.
  European Journal of Clinical Microbiology 04/2012; 29(6):705-713. · 2.86 Impact Factor
• Article: High pentraxin-3 plasma levels associate with thrombocytopenia in acute Puumala hantavirus-induced nephropathia epidemica.

  T K Outinen, S Mäkelä, H Huhtala, M Hurme, S Meri, I Pörsti, J Sane, A Vaheri, J Syrjänen, J Mustonen
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  ABSTRACT: Our aim was to investigate whether plasma levels of the long pentraxin-3 (PTX3) associate with the severity of Puumala hantavirus-induced nephropathia epidemica (NE). Sixty-one prospectively identified consecutively hospitalized NE patients were examined. Plasma PTX3, interleukin (IL)-6, terminal complement complex SC5b-9, complement component C3, C-reactive protein (CRP), creatinine, sodium, kynurenine, and tryptophan levels, as well as the blood cell count, were determined for up to five consecutive days after hospitalization. Receiver operating characteristic (ROC) analysis revealed that the maximum PTX3 level >101.6 ng/ml (high PTX3) showed a sensitivity of 71% and a specificity of 89% for detecting platelet level <50 × 10(9)/l, with an area under the curve (AUC) value of 0.78 (95% confidence interval [CI] 0.63-0.94). High PTX3 level was also associated with several other variables reflecting the severity of the disease: patients with high PTX3 level had higher maximum blood leukocyte (16.1 vs. 9.7 × 10(9)/l, p < 0.001), plasma IL-6 (16.9 vs. 9.0 pg/ml, p = 0.007), and creatinine (282 vs. 124 μmol/l, p = 0.007) levels than patients with low maximum PTX3 level. They also had longer hospital stays (8 vs. 5 days, p = 0.015) compared to patients with low PTX3 level. High plasma PTX3 levels are associated with thrombocytopenia and the overall severity of NE.
  European Journal of Clinical Microbiology 09/2011; 31(6):957-63. · 2.86 Impact Factor
• Article: Reactive arthritis in a population exposed to an extensive waterborne gastroenteritis outbreak after sewage contamination in Pirkanmaa, Finland.

  T Uotila, J Antonen, J Laine, E Kujansuu, A-M Haapala, J Lumio, R Vuento, H Oksa, J Herrala, M Kuusi, J Mustonen, M Korpela, Pirkanmaa Waterborne Outbreak Study Group
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  ABSTRACT: To assess the occurrence, clinical picture, and triggering infections of reactive arthritis (ReA) associated with a large waterborne gastroenteritis outbreak. After an extensive sewage contamination of the water supply system, an estimated 8453 of the 30 016 inhabitants of the town of Nokia fell ill. General practitioners and occupational physicians were advised to refer any patients with suspicion of new ReA to rheumatological examination including faecal culture, human leucocyte antigen (HLA)-B27 and antibody tests for Campylobacter, Salmonella, and Yersinia. Forty-five patients (33 females, 12 males) aged 16-77 years (median 53) were referred. ReA was diagnosed in 21, postinfectious arthralgia in 13, and other musculoskeletal conditions in 11 patients. HLA-B27 was positive in five out of 44 patients (11%). Of the 21 patients with ReA, possible triggering infections were observed in seven (33%), Campylobacter in four, Yersinia in three, and Salmonella in one, who also had Campylobacter infection. ReA was mild in all but one patient who presented with persistent Salmonella enterica serotype enteritidis infection. Taking into account the large population contaminated with potentially arthritogenic agents, the occurrence of ReA was rare and mild in character.
  Scandinavian journal of rheumatology 06/2011; 40(5):358-62. · 2.51 Impact Factor
• Article: Glomerulonephritis emerging shortly after Puumala hantavirus infection: a report on 7 patients.

  M Miettinen, S Mäkelä, M Haapala, A Helanterä, H Helin, T Vänttinen, J Mustonen
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  ABSTRACT: Nephropathia epidemica (NE) is mild type of hemorrhagic fever caused by Puumala (PUU) hantavirus. Renal biopsy typically shows acute tubulointerstitial nephritis and complete recovery is the usual outcome. We previously described 5 patients with membranoproliferative glomerulonephritis (MPGN) after acute NE. We now report on 7 more patients who developed biopsy-confirmed glomerulonephritis (GN) during the convalescent phase of NE. We present case histories of 7 patients with nephrotic-range proteinuria concomitant with hematuria after serologically verified NE. Renal biopsy specimens disclosed MPGN in 5 patients, membranous GN (MGN) in 1 and mesangial GN (MesGN) in 1. All patients achieved remission of nephrotic syndrome within a median time of 0.6 years (range 0.5 - 5.5 y). The median follow-up time was 1.7 years (0.7 - 15.6 y). As a rare phenomenon, nephrotic syndrome may emerge during the convalescent phase of acute PUU hantavirus infection. In most cases the prognosis of GN caused by NE seems to be favorable.
  Clinical nephrology 06/2011; 75(6):550-6. · 1.17 Impact Factor
• Article: An extensive gastroenteritis outbreak after drinking-water contamination by sewage effluent, Finland.

  J Laine, E Huovinen, M J Virtanen, M Snellman, J Lumio, P Ruutu, E Kujansuu, R Vuento, T Pitkänen, I Miettinen, J Herrala, O Lepistö, J Antonen, J Helenius, M-L Hänninen, L Maunula, J Mustonen, M Kuusi
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  ABSTRACT: SUMMARYAn inappropriate cross-connection between sewage- and drinking-water pipelines contaminated tap water in a Finnish town, resulting in an extensive waterborne gastroenteritis outbreak in this developed country. According to a database and a line-list, altogether 1222 subjects sought medical care as a result of this exposure. Seven pathogens were found in patient samples of those who sought treatment. To establish the true disease burden from this exposure, we undertook a population-based questionnaire investigation with a control population, infrequently used to study waterborne outbreaks. The study covered three areas, contaminated and uncontaminated parts of the town and a control town. An estimated 8453 residents fell ill during the outbreak, the excess number of illnesses being 6501. Attack rates were 53% [95% confidence interval (CI) 49·5-56·4] in the contaminated area, 15·6% (95% CI 13·1-18·5) in the uncontaminated area and 6·5% (95% CI 4·8-8·8) in the control population. Using a control population allowed us to differentiate baseline morbidity from the observed morbidity caused by the water contamination, thus enabling a more accurate estimate of the disease burden of this outbreak.
  Epidemiology and Infection 09/2010; · 2.84 Impact Factor
• Article: Prognosis of clinical renal disease and incidence of new renal findings in patients with rheumatoid arthritis: follow-up of a population-based study.

  K Karstila, M Korpela, S Sihvonen, J Mustonen
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  ABSTRACT: The objective of this study was to assess the long-term prognosis of nephropathy findings and the incidence of new abnormal clinical renal findings in patients with rheumatoid arthritis (RA). The original population-based cross-sectional study of 604 RA patients was carried out in 1988, 103 nephropathy patients being found. Controls matched for age, sex, and duration of RA were selected from among RA patients with normal renal function and urinalysis in 1988. In 2003, a follow-up study was made of the 103 nephropathy patients and 102 controls, and the median follow-up time was 13 years. In the original nephropathy group, serum creatinine exceeded 200 mumol/l in 8% of the original isolated hematuria patients, in 30% of the isolated proteinuria patients, in 57% of the combined hematuria and proteinuria patients, but in none of the isolated chronic renal failure (CRF) patients (p = 0.001 for the difference). Probable or definitive renal amyloidosis was diagnosed in 19% of the nephropathy patients. Dialysis therapy was given to 10 out of the 103 nephropathy patients, nine of them belonging to the original isolated proteinuria or combined hematuria and proteinuria groups. There were six renal deaths among the nephropathy patients, and none in the controls. In the control group, new abnormal renal findings, in most cases mild, were detected in 28%. Serum creatinine exceeded 200 mumol/l in 4% of the controls, and dialysis therapy was given to 2% of the controls. Probable or definitive renal amyloidosis was diagnosed in 4% of this group. With regards to the development or progression of chronic renal failure, the long-term clinical prognosis of isolated hematuria and isolated CRF was found to be favorable. Proteinuria alone or combined with hematuria or CRF was related to evidently poorer prognosis.
  Clinical Rheumatology 01/2008; 26(12):2089-95. · 2.00 Impact Factor
• Article: Prognosis of mesangial glomerulonephritis in patients with rheumatoid arthritis.

  K Karstila, M Korpela, S Sihvonen, H Helin, J Mustonen
  Clinical nephrology 12/2007; 68(5):335-6. · 1.17 Impact Factor
• Article: Radiological findings and their clinical correlations in nephropathia epidemica.

  A Paakkala, J Mustonen
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  ABSTRACT: Nephropathia epidemica (NE) is a mild form of hemorrhagic fever with renal syndrome (HFRS). Its course varies from asymptomatic to fatal. The etiologic agent, Puumala virus, belongs to the Hantavirus genus of the Bunyaviridae family. Respiratory symptoms, from common cold to respiratory distress, occur in NE. Acute renal failure (ARF) is evident in over 90% of hospital-treated NE patients. In this review article, special attention is paid to radiological lung and renal involvement to investigate the occurrence and type of manifestations during the acute phase of infection and recovery.
  Acta Radiologica 05/2007; 48(3):345-50. · 1.37 Impact Factor
• Article: Magnetic resonance renography findings and their clinical associations in nephropathia epidemica.

  A Paakkala, P Ryymin, P Dastidar, H Huhtala, J Mustonen
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  ABSTRACT: To evaluate, with magnetic resonance renography (MRR), the dynamics of renal function in patients with nephropathia epidemica (NE) and to correlate the findings with the clinical course of NE. MRR was performed on 20 hospitalized NE patients during the acute phase of the disease. A repeat MRR study was done 5-8 months later. Primary and repeat MRR studies were compared and functional findings evaluated. The uptake slope of the contrast enhancement curve was abnormal in the primary study in 14 patients, maximum level of enhancement in 11, decreasing slope of contrast enhancement curve in 14, and signal drop at time in 10 patients when the primary and repeat studies were compared. The greater change in the uptake slope of contrast enhancement, maximum level of enhancement, decreasing slope of enhancement, and signal drop at time between primary and repeat MRR studies evinced a mild association with the severity of clinical renal insufficiency and fluid volume overload. Measurable functional MRR findings were recorded in 14/20 NE patients. The severity of the findings was mildly associated with the degree of clinical renal insufficiency and fluid volume overload.
  Acta Radiologica 04/2006; 47(2):213-21. · 1.37 Impact Factor
• Article: Renal MRI findings and their clinical associations in nephropathia epidemica: analysis of quantitative findings.

  A Paakkala, P Dastidar, P Ryymin, H Huhtala, J Mustonen
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  ABSTRACT: Morphologic renal magnetic resonance imaging (MRI) findings in patients with nephropathia epidemica (NE) were evaluated, and these findings were correlated with the clinical course of NE. Renal MRI was performed in 20 hospitalized NE patients during the acute phase of their disease. A repeat MRI study was made 5-8 months later. Renal parenchymal volume, renal length and parenchymal thickness were decreased in all patients in the repeat study. Edema/fluid collections were found bilaterally in 16 patients in the primary MRI study. Greater change in parenchymal volume, renal length and parenchymal thickness between the primary and the repeat MRI study as well as the presence of edema/fluid collections in the primary study evinced mild association with clinical fluid volume overload, high blood pressure level, inflammation, thrombocytopenia and severe clinical renal insufficiency. Change in parenchymal volume was associated with a severe clinical course more markedly than the other MRI findings. Measurable renal MRI changes occurred in every NE patient. The severity of the findings in MRI evinced mild association with clinical fluid volume overload, high blood pressure level, inflammation, thrombocytopenia and severe clinical renal insufficiency. Based on this study and our previous ultrasound (US) findings, we prefer US as the primary examination mode in NE patients.
  European Radiology 06/2005; 15(5):968-74. · 3.22 Impact Factor
• Article: Value of ultrasonography in acute renal failure: analysis of qualitative features in patients with nephropathia epidemica.

  A Paakkala, T Kallio, H Huhtala, P Apuli, T Paakkala, J Mustonen
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  ABSTRACT: To assess the value of renal ultrasonography (US) and the frequency of qualitative pathology in patients with nephropathia epidemica (NE) and to determine whether these features are related to the clinical course of NE. Renal US was undertaken in 23 hospital-treated NE cases during the acute phase of the disease (first study). A second US study was performed 3-6 months later. Captured US images were used in the analysis. From acute to control phase the overall rating of kidney status improved in 20 patients, parenchymal swelling decreased and corticomedullary border differentiation improved in 21, echogenicity decreased in 18, and patchy pattern in parenchymal echo-texture decreased in 15. The severity of findings in US evinced some association with fluid volume overload, high blood pressure level and blood leukocyte count, and severe clinical renal insufficiency. The degree of parenchymal swelling had more statistically significant associations with clinical course than other US features. Qualitative US features are as sensitive as quantitative US parameters in assessment of NE patients' clinical course and recovery, assuming that a comparative study is available. US using only qualitative features is fairly limited in evaluating NE patients' clinical situation.
  Acta Radiologica 12/2004; 45(7):785-90. · 1.37 Impact Factor
• Article: Death rates and causes of death in patients with rheumatoid arthritis: a population-based study.

  S Sihvonen, M Korpela, P Laippala, J Mustonen, A Pasternack
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  ABSTRACT: To assess the mortality and causes of death in a cross-sectional population-based study of 1042 patients with rheumatoid arthritis (RA). In 1988, 604 RA patients [470 females (F), 134 males (M)] and 457 age- and sex-matched controls (352 F, 105 M) were examined prospectively (participants) and 438 (183 F, 81 M) non-participant RA patients retrospectively. In 1999, vital status and causes of death were determined. Mortality in the total RA population was compared to that in the general population, and that among participant RA patients to their matched controls. A total of 384 (37%) RA patients and 71 (16%) controls died. RA patients had increased mortality compared to the general population (standardized mortality ratios SMR 2.64) or controls (1.71). This was observed in both sexes. Over 40% of deaths in all groups were due to cardiovascular diseases. RA patients were at increased risk of dying of urogenital, gastrointestinal, respiratory and cardiovascular diseases, infections, and cancers when compared to the general population or controls. Our results show that a cross-sectional cohort of RA patients had an increased risk of death from various causes.
  Scandinavian Journal of Rheumatology 02/2004; 33(4):221-7. · 2.47 Impact Factor
• Article: Renal disease as a predictor of increased mortality among patients with rheumatoid arthritis.

  S Sihvonen, M Korpela, J Mustonen, P Laippala, A Pasternack
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  ABSTRACT: Mortality among RA patients and controls was analyzed with special attention to renal disease in population-based material (originally screened in 1988) of 604 patients with RA (470 females, 134 males) and 457 age- and sex-matched controls (352 females, 105 males). In the original RA population, isolated hematuria (HU) was observed in 54, isolated proteinuria (PU) in 27, combined hematuria and proteinuria (HUPU) in 7, chronic renal failure (CRFtot) in 36 and isolated chronic renal failure without HU or PU (CRFisol) in 15 patients. Among the controls, HU was observed in 39, PU in 11, CRFtot in 32 and CRFisol in 16 subjects. HUPU was not observed in any of the controls. Microalbuminuria (20-200 microg/min) was observed in 34 RA patients and in 27 controls. Histologically confirmed amyloidosis was found in 13 RA patients and mesangial glomerulonephritis (MesGN) in 17 patients. The mortality was evaluated in 1999 from data of the Statistical Office of Finland. Statistical analysis was performed by Cox regression analysis. Mortality was significantly increased in the RA population as compared to controls: hazard ratio (HR) 1.78 (95% CI 1.34-2.31) for all RA patients; HR 2.12 (1.52-2.94) for females; HR 1.15 (0.75-1.77) for males. In the RA material, increased mortality was detected in patients with HUPU (HR 4.45; 1.54-12.84), PU (HR 3.54; 1.88-6.65), CRFtot (HR 3.74; 2.55-5.56) or microalbuminuria (HR 2.77; 1.64-4.69) when compared to those with normal clinical renal findings, whereas HU (HR 1.49; 0.88-2.52), CRFisol (HR 1.71; 0.82-3.54), bacteriuria (HR 0.96; 0.35-2.59) or pyuria (HR 0.65; 0.09-4.65) did not predict mortality. Renal amyloidosis was associated with an over twofold mortality rate (HR 2.31; 1.03-5.15), whereas mortality was within expected limits in RA patients with MesGN (HR 1.61; 0.49-5.24). Our results show that nephropathy presenting with combined hematuria and proteinuria, proteinuria, microalbuminuria or histologically confirmed amyloidosis is associated with increased mortality in RA patients, whereas mortality is within expected limits in those with isolated hematuria or mesangial glomerulonephritis.
  Nephron Clinical Practice 02/2004; 96(4):c107-14. · 2.04 Impact Factor
• Article: Renal ultrasound findings and their clinical associations in nephropathia epidemica. Analysis of quantitative parameters.

  A Paakkala, T Kallio, H Huhtala, P Apuli, T Paakkala, A Pasternack, J Mustonen
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  ABSTRACT: To evaluate renal US findings in patients with nephropathia epidemica (NE) and to determine whether changes in these findings are related to the clinical course of NE. Renal US was undertaken in 23 hospital-treated NE patients during the acute phase of their disease (first study). The second US study was performed 3-6 months later. The resistive index (RI) was abnormal in 12 patients and fluid collections (perirenal, pleural, pericardial, ascites) were found in 13 patients in the first study. Renal length decreased in every patient, cortical parenchymal thickness in 19 patients and RI in 18 patients from the first to the second studies. The mean change was significant in all parameters. Increased RI and presence of fluid collections in the first study as well as a greater change in length and RI between the first and the second studies were associated with high maximum daily urine excretion, substantial change in body weight between the anuric and polyuric phases, high maximum serum creatinine and urea concentration, high blood leukocyte count and low hematocrit value. Renal US changes occurred in every patient with NE. The severity of the findings was associated with fluid volume overload and degree of clinical renal insufficiency.
  Acta Radiologica 06/2002; 43(3):320-5. · 1.37 Impact Factor
• Article: Isolated ultrafiltration affects dynamic vectorcardiographic ischemia monitoring parameters.

  S Ojanen, A M Koivisto, T Kööbi, P Korhonen, J Mustonen, P Laippala, A Pasternack
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  ABSTRACT: The present study was undertaken to assess the role of isolated ultrafiltration (UF phase) and hemodialysis with minimal ultrafiltration (HD phase) in changes in parameters reflecting myocardial ischemia: QRS vector difference (QRS-VD), ST change vector magnitude (STC-VM) and ST vector magnitude (ST-VM6) registered by MIDA (myocardial infarction dynamic analysis). Twelve patients on maintenance hemodialysis were first ultrafiltrated for 2.5 h without dialysis (UF) followed by a 2.5-hour session of hemodialysis with minimal ultrafiltration (HD). Computerized vectorcardiography (VCG) was used for on-line dynamic analysis of ST segment and QRS complex changes. Blood volume (BV) changes were monitored non-invasively and continuously with the CRIT-LINE instrument. Whole-body bioelectric impedance analysis (BIA) was used for extracellular water (ECW) estimation. During the UF phase QRS-VD and STC-VM showed a statistically significant increasing linear trend (time effect for both QRS-VD and STC-VM p < 0.0001, while no changes were noted in ST-VM6; time effect p = 0.986). During the HD phase none of these parameters changed (time effect for QRS-VD p = 0.855, for STC-VM p = 0.275 and for ST-VM6 p = 0.976). During the UF, phase changes in QRS-VD were in close relation to those in ECW. Isolated ultrafiltration leads to an increase in the VCG ischemia monitoring parameters QRS-VD and STC-VM. The increase of QRS-VD is related to changes in ECW. Hemodialysis with minimal ultrafiltration has no effect on VCG ischemia monitoring parameters.
  Clinical nephrology 06/2002; 57(5):359-64. · 1.17 Impact Factor
• Article: HEPATIC SUBCAPSULAR STEATOSIS IN DIABETIC CAPD PATIENTS TREATED WITH INTRAPERITONEAL INSULIN

  T. Kallio, P. I. Nevalainen, J. T. Lahtela, J. Mustonen, A. Pasternack
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  ABSTRACT: Purpose: To describe a specific imaging pattern of hepatic fatty change typical of diabetic patients on continuous ambulatory peritoneal dialysis (CAPD) treated with intraperitoneal (i.p.) insulin.Material and Methods: Liver ultrasound was applied in 16 CAPD patients with insulin-dependent diabetes mellitus. Presence of hepatic subcapsular steatosis and maximum thickness of the fatty layer were recorded. Liver MR examination was made of 1 patient found to have extensive subcapsular steatosis.Results: Hepatic ultrasound revealed a typical pattern of subcapsular steatosis (“coating-of-fat”) in 7/8 patients treated with i.p. insulin. None (0/8) of the diabetic CAPD patients treated with subcutaneous insulin had subcapsular steatosis.Conclusion: Hepatic subcapsular steatosis is specific to CAPD patients on i.p. insulin treatment. To our knowledge this is the first report to describe imaging findings in this particular form of hepatic fatty change.
  Acta Radiologica 01/2002; 42(3):323 - 325. · 1.37 Impact Factor
• Article: Mesangiocapillary glomerulonephritis caused by Puumala hantavirus infection.

  J Mustonen, S Mäkelä, H Helin, A Helanterä, M Miettinen, J Partanen, A Pasternack
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  ABSTRACT: Nephropathia epidemica induced by Puumala hantavirus typically causes acute reversible renal function impairment. A typical renal biopsy finding is acute tubulointerstitial nephritis with slight glomerular mesangial changes. We describe here 5 patients who developed the nephrotic syndrome during the convalescent phase of an otherwise typical acute febrile nephropathia epidemica. Renal biopsy of all patients disclosed type I mesangiocapillary glomerulonephritis (MCGN). A clinical remission of the nephrotic syndrome was observed in 4 patients during the follow-up period, and 1 entered into chronic renal failure. Three patients had microscopic hematuria and proteinuria and 2 elevated blood pressure at the latest assessment visit. No patient had clinical or laboratory findings compatible with chronic bacterial, parasitic or viral infections (hepatitis B or C), malignancies, or other disorders known to be associated with MCGN. In conclusion, Puumala hantavirus has to be added to the list of potential agents associated with type I MCGN. Further studies are necessary to establish the incidence of MCGN caused by various hantavirus infections.
  Nephron 01/2002; 89(4):402-7. · 13.26 Impact Factor
• Article: Pathogenetic aspects of IgA nephropathy.

  I Rantala, J Mustonen, M Hurme, J Syrjänen, H Helin
  Nephron 08/2001; 88(3):193-8. · 13.26 Impact Factor
• Article: Polymorphism of the cytokine genes in hospitalized patients with Puumala hantavirus infection.

  S Mäkelä, M Hurme, I Ala-Houhala, J Mustonen, A M Koivisto, J Partanen, O Vapalahti, A Vaheri, A Pasternack
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  ABSTRACT: Nephropathia epidemica (NE) is a mild type of haemorrhagic fever with renal syndrome caused by Puumala (PUU) hantavirus. The clinical course of NE varies from asymptomatic to fatal. The aim of this study was to establish whether polymorphisms in the cytokine genes are associated with susceptibility to and outcome of NE. The genotypes of the genes of tumour necrosis factor alpha (TNFalpha), interleukin-1alpha (IL-1alpha), IL-1beta and IL-1 receptor antagonist (IL-1RA) were analysed by polymerase chain reaction in 87 subjects, all hospital-treated for serologically confirmed acute NE. The control group comprised 400 healthy blood donors. Nineteen out of these 400 (5%) controls were PUU virus-seropositive. IL-1RA allele 2 and IL-1beta (base exchange polymorphism at position -511) allele 2 were strongly associated with each other in both groups. NE patients were more often IL-1RA-2 negative/IL-1beta-2 negative than PUU-seronegative blood donors (38 vs 27%, odds ratio 1.65, 95% confidence interval 1.0-2.7). However, there were no differences in the clinical severity of NE between the IL-1RA-2 negative/IL-1beta-2 negative and the other patients. The other allele frequencies studied evinced no statistically significant differences between the groups. Thirty-three out of 87 (38%) patients and 121 out of 381 (32%) seronegative controls were carriers of the high-producer genotype TNF2 allele. Several parameters showed the clinical course of NE to be more severe in TNF2 carriers than in non-carriers. These data suggest that non-carriage of the IL-1RA allele 2 and IL-1beta (-511) allele 2 may contribute to susceptibility to NE. Furthermore, TNFalpha polymorphism seems to be associated with the outcome of NE.
  Nephrology Dialysis Transplantation 08/2001; 16(7):1368-73. · 3.40 Impact Factor
• Article: Hepatic subcapsular steatosis in diabetic CAPD patients treated with intraperitoneal insulin. Description of a typical pattern.

  T Kallio, P I Nevalainen, J T Lahtela, J Mustonen, A Pasternack
  [show abstract] [hide abstract]
  ABSTRACT: To describe a specific imaging pattern of hepatic fatty change typical of diabetic patients on continuous ambulatory peritoneal dialysis (CAPD) treated with intraperitoneal (i.p.) insulin. Liver ultrasound was applied in 16 CAPD patients with insulin-dependent diabetes mellitus. Presence of hepatic subcapsular steatosis and maximum thickness of the fatty layer were recorded. Liver MR examination was made of 1 patient found to have extensive subcapsular steatosis. Hepatic ultrasound revealed a typical pattern of subcapsular steatosis ("coating-of-fat") in 7/8 patients treated with i.p. insulin. None (0/8) of the diabetic CAPD patients treated with subcutaneous insulin had subcapsular steatosis. Hepatic subcapsular steatosis is specific to CAPD patients on i.p. insulin treatment. To our knowledge this is the first report to describe imaging findings in this particular form of hepatic fatty change.
  Acta Radiologica 06/2001; 42(3):323-5. · 1.37 Impact Factor