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Biomedical subjects

A Kauppila

Publications and source records attributed to A Kauppila.

At least 91 records · Page 5Linked to original sources
PubMed1989

Six-microtransducer catheter connected to computer in evaluation of urethral closure function of women.

A new instrument consisting of a six-transducer catheter, one transducer for the bladder and five transducers for urethral pressure recordings, and a computer with specific software was developed for urodynamic investigation of women. Twenty-six patients with stress urinary incontinence (SUI) and 10 continent female patients were evaluated during the single cough, the first and the fourth ones of the forced coughings in supine and standing positions. The results were compared with those obtained with the conventional two-transducer method. Negative urethral closure pressure (UCP) at stress, indicative of SUI, was present in 88 percent of the cases with the six-transducer method, and in 77 percent with the two-transducer method. The fourth cough in the standing position with the six-transducer method was most diagnostic. In SUI, the six-transducer method indicated exactly, e.g., the minimum bladder pressure needed for negative UCP and the duration of negative UCP. Patients with SUI had significantly lower UCP at rest, UCP at stress, and pressure transmission ratio (PTR) than continent women. Findings, that UCP at stress decreased and duration of negative UCP at stress increased but PTR did not change when the fourth cough was compared with the first one in SUI, suggest that factors which are responsible for the altered urodynamics during prolonged stress are anatomic rather than functional.

Adult↗
PubMed1989

Gonadotropin-releasing hormone agonist analog therapy effective in ovarian granulosa cell malignancy.

Ovarian granulosa cell tumor lung metastases regressed, and symptoms were relieved, during gonadotropin-releasing hormone (GnRH) agonist analog therapy after the failure of operative treatment and cytotoxic chemotherapy, indicating the hormone dependence of the malignancy. The response was transient, but the largest metastasis did not relapse. This case report suggests that GnRH analogs may offer a new approach to the treatment of ovarian stromal cell malignancies.

Bone Neoplasms↗
PubMed1989

Circulating lipid and lipoprotein concentrations during danazol and high-dose medroxyprogesterone acetate therapy of endometriosis.

In a study on endometriosis, ten patients were treated with danazol (200 mg three times a day) and ten patients with high-dose medroxyprogesterone acetate (MPA) (100 mg a day) for 6 months. The circulating high-density lipoprotein-cholesterol concentration decreased significantly in the danazol (53%) and in the MPA groups (26%); the change in the danazol group was significantly higher than that in the MPA group. Danazol also significantly increased the low-density lipoprotein-cholesterol levels (37%), whereas MPA had no significant effect. Danazol (29%) and MPA (12%) decreased the apolipoprotein A-1 levels significantly. The decrease caused by danazol was significantly greater. Danazol also significantly decreased the apolipoprotein A-2 levels (12%) and significantly increased the apolipoprotein B levels (17%), whereas MPA had no significant effects on them. Three months after the end of medication, all values were at the pretreatment levels. The circulating cholesterol, triglyceride, and very low-density lipoprotein concentrations remained unchanged during both treatments. Danazol and high-dose MPA induced a similar significant regression of peritoneal endometriotic implants in relation to placebo. Our present results, showing that danazol, to a greater extent than high-dose MPA, is associated with changes in lipoprotein metabolism that expose the individual to an increased risk of cardiovascular diseases, suggest that high-dose MPA is preferable to danazol in the long-term treatment of endometriosis.

Adult↗
PubMed1989

Prolactin suppression by bromocriptine stimulates aromatization of testosterone to estradiol in women.

The effect of follicular phase bromocriptine therapy on the ovarian endocrine response to clomiphene citrate and gonadotropins was studied in 35 tubal infertility patients in a randomized placebo-controlled trial. During bromocriptine treatment, the serum prolactin (PRL) concentration significantly decreased, and consequently the serum estradiol (E2) concentration was significantly higher than in the controls on cycle day 9, and the ratio of testosterone (T) to E2 was decreased from cycle day 8 through day 10. The luteal phase progesterone concentration and the length of the luteal phase were not affected by bromocriptine therapy. The number and quality of oocytes harvested and the cleavage rates were similar in both groups. The present results, together with our previous observations, demonstrate that PRL participates in the regulation of ovarian steroidogenesis, particularly aromatization of T to E2.

Adult↗
PubMed1989

Supplementation with selenium, vitamin E and their combination in gynaecological cancer during cytotoxic chemotherapy.

The biochemical responses to 8-week supplementary treatment with selenium and/or vitamin E were evaluated in 41 patients with gynaecological cancer during cytotoxic chemotherapy, in Finland, a selenium-deficient country. After the control course of 1-day treatment with cytostat agents, 11 patients received a combination of selenium and vitamin E (sodium selenate, 200 micrograms/day + vitamin E, 300 mg/day), 11 received selenium (sodium selenate, 200 micrograms/day) and seven received vitamin E (300 mg/day) as supplementary therapy, while 12 patients had no supplementary drugs. Sodium selenate alone and combined with vitamin E significantly increased the serum selenium levels, but the activity of serum glutathione peroxidase (GSH-Px) increased significantly only in the selenium- and vitamin E-treated patients with low initial GSH-Px activity. The cytotoxic chemotherapy did not change the activity of GSH-Px, while the concentrations of lipid peroxides decreased. Sodium selenate alone or with vitamin E did not modify this decrease. Sodium selenate alone significantly decreased the capacity of the platelets to produce thromboxane A2; it increased high-density lipoprotein cholesterol levels and prevented the cytotoxic-chemotherapy-associated increase of creatine kinase. Selenium supplementation might thus be beneficial during cytotoxic chemotherapy in ovarian cancer patients with low selenium levels.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Suppression of prolactin secretion during ovarian hyperstimulation is followed by elevated serum levels of endometrial protein PP14 in the late luteal phase.

A double-blind placebo-controlled study on bromocriptine administration during days 2-12 of ovarian hyperstimulation for in-vitro fertilization (IVF) showed that, in bromocriptine cycles, levels of the endometrial protein PP14 were higher in the late luteal phase. This was verified both by calculating forward from the day of human chorionic gonadotrophin (HCG) administration and backward from the onset of the next period. Bromocriptine had no effect on IVF performance. During bromocriptine treatment the serum prolactin levels declined and serum oestradiol levels were higher on day 9 of the cycle. There was a positive correlation (r = 0.55; P = 0.012) between the serum oestradiol levels on day 9 and the PP14 levels on days 22-23 of the cycle. No difference was found in the luteal phase progesterone levels between bromocriptine- and placebo-treated cycles. These results suggest that low prolactin and/or high oestradiol levels during the follicular phase have an influence on the subsequent secretory capacity of the endometrium as reflected by secretion of a specific endometrial protein.

Bromocriptine↗
PubMed1989

Effect of suprapubic operation on urethral closure. Evaluation by single cough urethrocystometry.

To evaluate urodynamic effects of modified Burch colposuspension, 24 patients with stress urinary incontinence were investigated before and 6 to 9 months after the operation. A new method of urodynamic evaluation was performed using a multitransducer-catheter, 5 microtransducers inside the urethra and 1 in the bladder, connected to a computer and graphic plotter. Single coughs were analysed with the catheter in a fixed position and the patient in the standing position. The operation, which was successful, in all but 1 patient, did not alter urethral pressure at rest, but urethral closure pressure at stress after the operation (mean 45.0 cm H2O (SD 21.6) was significantly higher (P less than 0.005) than the -3.6 cm H2O (SD 10.2) recorded before the operation. The pressure transmission ratio was less than 100% in 22 patients before the operation and more than 100% in 18 patients afterwards, the pre- and post-operative mean values being 78.9% (SD 11.9) and 109.5% (SD 17.2) respectively (P less than 0.0005). Burch colposuspension markedly improves urethral closure function as evaluated by this method, which analyses the pressure data at different points of the urethra and bladder during one single cough.

Adult↗
PubMed1989

Colposuspension and transvaginal bladder neck suspension in the treatment of stress incontinence.

The present work was performed to evaluate the clinical usefulness of colposuspension in stress urinary incontinence without uterovaginal descent and bladder neck suspension in cases with uterovaginal descent. Modified Burch colposuspension was performed in 29 patients and modified Raz bladder neck suspension in 19 patients. The patients were examined clinically and urodynamically before and 8-12 months after operation. All patients in the colposuspension group regarded themselves as being totally continent postoperatively. In the bladder neck suspension group the respective figure was 58%, plus 21% showing improvement and 21% failures. Urodynamically, the cure rates (positive urethral closure pressure at stress) were 100% for colposuspension and 79% for bladder neck suspension. After colposuspension the urethral closure pressure at stress and the pressure transmission ratio were significantly increased whereas successful bladder neck suspension increased only urethral closure pressure at stress. The failed bladder neck suspensions did not induce any urodynamic changes. The present data confirms that Burch colposuspension is effective in stress urinary incontinence in women without simultaneous uterovaginal descent, whereas bladder neck suspension by the modified Raz technique did not appear to be optimal for the treatment of stress incontinence in patients with uterovaginal descent.

Adult↗
PubMed1989

Serum and amniotic fluid melatonin during human labor.

The serum and amniotic fluid concentrations of melatonin (MT) were measured by RIA during human labor in different conditions related to the type of delivery and the time of the day of delivery. Serum MT concentrations displayed a normal diurnal rhythm, resembling that of nongravid women; the mean concentration [163.8 +/- 149.6 (+/- SD) pmol/L] at night was significantly (P less than 0.001) higher than that during the day (31.4 +/- 16.3 pmol/L). The amniotic fluid MT concentration, which showed a significant positive correlation to the serum MT concentration (r = 0.625; P less than 0.01), also showed an obvious diurnal rhythm; the mean MT concentration was significantly (P less than 0.01) higher during the night [99.3 +/- 59.3 (+/- SD) pmol/L] than during the day (58.9 +/- 33.5 pmol/L). Reverse phase high pressure liquid chromatography confirmed that the amniotic fluid MT immunoreactivity eluated as synthetic MT. During the night the mean amniotic fluid MT concentration [99.3 +/- 59.3 (+/- SD) pmol/L] was significantly (P less than 0.01) lower than that in serum (178.9 +/- 189.6 pmol/L). The progress of delivery, estimated by cervical dilatation, did not affect serum MT concentrations. Induction of delivery by amniotomy and/or oxytocin, and operative delivery by cesarean section had no effect on serum MT concentrations. Human MT secretion does not seem to be influenced by the physical stress of labor or endocrine changes associated with parturition. The single factor regulating MT secretion during human delivery appears to be the time of day.

Adult↗
PubMed1989

Oestrogen and progestin receptors as prognostic indicators in endometrial cancer. A review of the literature.

The history of research on oestrogen and progestin receptors in endometrial cancer goes back about 20 years. Summarized data from several clinical studies demonstrate that cytosol oestrogen (ERC) and progestin receptors (PRC) are clinically useful indicators of prognosis. Absence of receptor or its low concentration is indicative of an increased risk of recurrent malignancy. In this respect PRC tends to be more sensitive than ERC. In some studies PRC assay appeared to be more strongly correlated to prognosis than any of the conventional clinico-pathological parameters. In addition, the information obtained by ERC and/or PRC assay is independent of and additional to the classical prognostic indicators. The value of ERC and PRC assay in predicting the sensitivity of endometrial cancer to progestin therapy is of clinical interest. The accumulated data for many clinical trials show that in detecting the non-responders to progestin therapy negative results of ERC and PRC give similar information with an accuracy of about 90%. In identifying responders to progestin therapy, a positive PRC result appeared to give more precise information than a positive ERC, the accuracy being about 75% for PRC. The use of the combination of ERC and PRC determination as a prognostic indicator or predictor of sensitivity to progestin therapy does not significantly increase the information available by PRC measurement alone. Hence, whatever used--a biochemical ligand binding technique or immunohistochemical staining--PRC determination alone seems recommendable for clinical purposes.

Female↗
PubMed1989

Intracavitary irradiation of endometrial carcinoma using a high-intensity 60Co afterloading method.

Intracavitary irradiation of endometrial carcinoma with an afterloading technique, employing Cathetron equipment, was used preoperatively and in patients with inoperable disease as a single therapy or together with external pelvic irradiation. In clinical stages I and II, the survival rates of patients treated preoperatively with afterloading techniques and with the manual Heyman method were quite similar, and the radiation induced complications were less frequent with the afterloading technique. In cases with a large uterine cavity, the one-source tandem method was replaced with a specific two-phase intracavitary irradiation technique. In this method the treatment catheter was positioned against one lateral uterine wall in the first phase, and against the opposite lateral uterine wall in the second phase of irradiation. In experimental studies the shape of the dose distribution curves resembled the uterine shape, and the measured doses were quite similar to those calculated from the radiograms. The treatment results of 32 patients irradiated by this method confirmed its clinical usefulness. Our results show that the afterloading technique is a practical alternative to the manual packing method in the preoperative irradiation of endometrial cancer. With specific instrument modifications the new technique is also useful in cases with a large uterine cavity, whereas the details in the treatment strategies using remote intracavitary irradiation alone or in combination with external radiotherapy need further development.

Aged↗
PubMed1989

Prostanoids and catecholamines after oral administration of natural progesterone.

Natural exogenous progesterone has been shown to affect the functioning of the central nervous system in man, inducing dizziness and sedation by unknown mechanisms. Seven postclimacteric women known to suffer from dizziness during natural progesterone therapy were treated with a single oral dose of 200 mg of natural progesterone on 2 occasions, with and without preceding administration of indomethacin. Cardiovascular responses, vasoactive prostanoids and catecholamines in the blood, and excretion of prostanoids in the urine were measured. Serum progesterone concentrations increased in each subject, and all the women experienced dizziness or tiredness after progesterone intake. Blood pressure and heart rate did not change. Urine excretion of immunoreactive prostaglandin E2 and 6-keto-prostaglandin1 alpha decreased significantly in the experiment without pretreatment with indomethacin, whereas indomethacin pretreatment reduced the basal excretion of prostanoids and abolished the progesterone-induced decrease in their excretion. The plasma concentrations of prostanoids and catecholamines did not change. The results confirm that natural progesterone can cause dizziness and tiredness in man. The appearance of these symptoms is not related to peripheral vasodilation or to changes in plasma prostanoid or catecholamine levels. Neither are the symptoms related to the alteration in the urinary excretion of prostanoids, since the women still suffered from tiredness and dizziness after pretreatment with indomethacin.

6-Ketoprostaglandin F1 alpha↗
PubMed1988

Aminoterminal propeptide of type-III procollagen in serum--an indicator of clinical behavior of advanced ovarian carcinoma?

In ovarian carcinoma, elevated serum concentrations of the aminoterminal propeptide of type-III procollagen are related to the clinical stage of the disease and to the presence of ascites, which contains very high concentrations of the propeptide. In a follow-up of patients with advanced disease, favorable clinical course was associated with normalizing propeptide values, whereas in progressing disease the values increased several weeks before clinical progression. In stable disease the concentrations were constantly above the reference range. Laminin and type-IV-collagen-related serum antigens were mostly within the reference range.

Adult↗
PubMed1988

Ectopic pregnancy: a case-control study of aetiological risk factors.

Aetiological risk factors for ectopic pregnancies were evaluated in a prospective study of 86 consecutive patients with ectopic pregnancy and two age- and parity-matched control groups of women in normal early pregnancy; those with planned pregnancy (65 pairs) and those having legal abortion (51 pairs). Compared with women with planned pregnancy, the patients with ectopic pregnancy more often had an IUD in situ, they had less frequently used hormonal contraception, and they had more legal abortions, curettages, previous ectopic pregnancies, gynaecological operations and salpingo-oophoritis. Compared with women having legal abortion, the patients with ectopic pregnancy had favoured IUD-usage, or they had been without any contraception, and they had an increased frequency of previous ectopic pregnancies. The frequency of fertility problems was also increased in patients with ectopic pregnancy. Our results show that gynaecological pelvic operations, endometrial curettage and evacuation, gynaecological infections, and usage of IUD are important risk factors for ectopic pregnancy, and that infertility seems to be a sign of this risk. In addition, the clinical characteristics of the patients with ectopic pregnancy were similar to those of the patients having legal abortion.

Abortion, Spontaneous↗
PubMed1988

Placebo-controlled study on serum concentrations of CA-125 before and after treatment of endometriosis with danazol or high-dose medroxyprogesterone acetate alone or after surgery.

Serum concentrations of CA-125 were determined in association with 6-month medical (n = 48) or surgical and medical therapy (n = 40) of endometriosis. The concentration of CA-125 was significantly higher in stages III + IV (66.6 +/- 22.0 [standard deviation] U/ml) than in stage I (20.9 +/- 2.3 U/ml) or II (28.4 +/- 2.8 U/ml); in stage II, the concentration was higher than in stage I. Surgical elimination of endometriosis significantly decreased the level of CA-125, as did danazol, but not medroxyprogesterone acetate (MPA), although these drugs were equal in clinical efficacy. The CA-125 changes during hormonal treatment did not correlate with the clinical response. Postoperatively, CA-125 responses to danazol, MPA, or placebo did not differ significantly from each other. During the 6-month follow-up after medication, the CA-125 concentrations tended to increase, especially in danazol-treated women. The determination of CA-125 is useful in estimating the extent of the disease, but it is less valuable in monitoring the treatment effect. The ability of danazol to suppress CA-125 expression emphasizes the specific properties of this drug.

Antigens, Neoplasm↗
PubMed1988

Radical or conservative surgery for ectopic pregnancy? A follow-up study of fertility of 323 patients.

The fertility of 323 patients desiring pregnancy after operation for ectopic pregnancy was analyzed after a follow-up period of 1 to 11 years (mean 5.1 years). The conception rate was 82%. Full-term delivery was obtained in 79% of the pregnant patients and repeat ectopic pregnancy in 13%. Nulliparous women had a significantly lower (P less than 0.01) conception rate (74%) than parous women (86%). The operation method had no influence on subsequent fertility in women with an intact contralateral tube. The women with intact contralateral tubes had a significantly higher pregnancy (P less than 0.001) and full-term birth (P less than 0.01) rates (87% and 83%, respectively) but significantly lower (P less than 0.001) repeat ectopic pregnancy rate (9%) than the women with affected contralateral tube (51%, 56%, and 52%, respectively). Compared with the parous women (9%), the risk of repeat ectopic pregnancy was significantly (P less than 0.01) higher for nulliparous women (22%). Of the nulliparous women with repeat ectopic pregnancy only 16% had a full-term pregnancy.

Fallopian Tubes↗
PubMed1988

Seasonal, menstrual and circadian secretions of melatonin, gonadotropins and prolactin in women.

In order to evaluate the role of the pineal gland in human reproduction, day- and night-time concentrations of serum melatonin, FSH, LH and prolactin were measured by radioimmunoassays on various days of the menstrual cycle during summer (average daylight 22 h) and winter (daylight 5 h) in healthy females (n = 12) from northern Finland (65 degrees N). A multifactorial analysis of variance showed that, in addition to the well-established increases of gonadotropins at midcycle and melatonin and prolactin at night, there was a significant effect of season on the serum levels of melatonin and LH. Night-time serum melatonin levels on cycle days 2 and 10 were 27% and 49% (P less than 0.05 and less than 0.01) higher in winter than in summer. Night-time serum LH levels at midcycle were 76% (P less than 0.05) higher in summer than in winter. There were no significant effects of season on the serum levels of FSH, prolactin, day-time melatonin or LH outside the mid-cycle. Neither were there any significant effects of the day of the menstrual cycle on the serum melatonin levels. It is possible that in winter the high levels of melatonin in the follicular phase have an inhibitory effect on the serum LH levels. In summer the melatonin levels are lower and perhaps less inhibitory on the secretion of LH, resulting in the stimulation of the reproductive competence in human females.

Adult↗