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Biomedical subjects

A Kauppila

Publications and source records attributed to A Kauppila.

At least 127 records · Page 7Linked to original sources
PubMed1987

Palliative surgery for intestinal complications of advanced, recurrent gynaecologic malignancy.

A review of 45 consecutive patients who underwent operation for intestinal complications of recurrent gynaecologic cancer was undertaken to elucidate the efficacy of surgical treatment. The primary tumour was ovarian in 26 cases, endometrial in ten and cervical in nine cases. The overall operative mortality was 20%, morbidity 44%, and median survival time and postoperative symptom-free period 5 months and 3 months, respectively. Intestinal resection (n = 12) and bypass procedures (n = 10) carried the lowest mortality risk (8% and 10%). The corresponding figures for enterostomy (n = 15) and exploratory laparotomy (n = 8) were 33% and 25%. Resection gave significantly better survival rate and longer relief of symptoms than the other procedures. Resection and primary anastomosis seems to be the method of choice in low-risk cases. Patients with far advanced cancer or intraabdominal carcinomatosis should be treated surgically only if symptoms cannot be relieved with conservative treatment.

Adult↗
PubMed1986

Successful treatment of malignant trophoblastic diseases in a small oncologic unit.

Between 1962 and 1983 a total of 26 patients with malignant trophoblastic disease were diagnosed in northern Finland. The incidence of this disease was 1:21,000 pregnancies. Eight patients had choriocarcinoma and 18 an invasive mole. Clinically, 15 patients belonged to the nonmetastatic and 11 to the metastatic group. Of the latter, 4 patients belonged to the low-and 7 to the high-risk categories. During the first years of the study period, cytotoxic chemotherapy, mostly single-drug therapy, was often complemented with adjunctive surgery and/or irradiation. During recent years, single- or multidrug chemotherapy was supplemented with surgery in only one case with chemotherapy-resistant pulmonary metastases. All 26 patients are alive and disease-free, and after therapy 6 of them have given birth to 1-3 children. Our results suggest that malignant trophoblastic diseases can be successfully treated also in small centers of gynecologic oncology with up-to-date knowledge of the principles of modern cytotoxic chemotherapy.

Adolescent↗
PubMed1986

Ectopic pregnancy--an analysis of the etiology, diagnosis and treatment in 552 cases.

An analysis of the clinical data of 552 patients treated for ectopic pregnancy during 1973-82 in our hospital showed that the prevalence of this complication rose twofold (P less than 0.01) from an annual rate of 10.9 per thousand in 1973 to 20.9 per thousand in 1982. As regards parity distribution, the proportion of the 2-paras increased significantly (P less than 0.05) and this increase was significantly greater (P less than 0.001) than in the total population of parturients during this period. The increasing incidence of ectopic pregnancies had a significant positive correlation (P less than 0.05) with the use of an intrauterine device (IUD), but not with previous or present pelvic inflammatory disease or gynaecological or abdominal surgery. Because the 158 patients with an IUD in situ (34%) had a significantly less frequent past history of salpingitis, pelvic operation, infertility, ectopic pregnancy or spontaneous abortion and had less actual pelvic inflammatory changes than the 259 patients without contraception (57%), the IUD seemed to be directly involved with the increased risk of ectopic pregnancy. In the present study lower abdominal pain occurred in 97% of the patients and menstrual disorders in 93%; pelvic examination revealed adnexal mass in 63% and adnexal tenderness in 90% of the patients. Laparoscopy, a sensitive urinary pregnancy test (detection limit 75 IU/1) and culdocentesis were the most important factors in the diagnosis of ectopic pregnancy as evidenced by positive results in 97, 90 and 83% of the cases, respectively. Due to improved diagnostic procedures the annual rate of an unruptured tube at operation increased from 49% to 73% during the study period.

Adolescent↗
PubMed1986

The predictive value of steroid hormone receptor analysis in breast, endometrial and ovarian cancer.

The predictive value of female sex steroid, estrogen and progesterone, receptor (ER and PR, respectively) assays in breast, endometrial and ovarian cancer is reviewed with emphasis on comparative aspects of these malignant tumors in relation to their hormone dependency. The endocrine etiology of these three tumor types seems to be at least partly different, and so is the expression of these receptors in normal and malignant tissues of the breast, endometrium and ovary. There is a tendency for decreased receptor concentrations and disappearance of these receptors in association with advancement of these malignancies. There is also a decrease in the presence and concentrations of ER and PR in relation to loss of differentiation in breast and endometrial cancer. Receptor analyses have an established position in the selection of patients with advanced breast cancer for endocrine treatment, and they give promise of a similar application in endometrial cancer and in endometrioid cancer of the ovary. It is not clear whether the disease-free interval is related to the presence or concentrations of ER or PR as such in the tumor tissue. There is better survival in breast cancer patients with receptor-positive tumors, which might be due to a response to endocrine treatment. The same seems to be true for patients with endometrial cancer. Future progress in the application of female sex steroid receptor analyses in breast, endometrial and ovarian cancer needs additional controlled clinical trials and more highly developed receptor assays.

Breast Neoplasms↗
PubMed1986

Lead and cadmium concentrations in maternal and umbilical cord blood, amniotic fluid, placenta, and amniotic membranes.

The lead and cadmium concentrations in maternal and umbilical cord blood and amniotic fluid were determined in 19 parturient women at delivery. Six placental and amniotic membrane tissue specimens were also investigated. The mean lead concentrations (mean +/- SD) in maternal (40.4 +/- 18.2 ng/ml) and umbilical cord (37.1 +/- 13.5 ng/ml) blood were similar and correlated significantly with each other (r = 0.77, p less than 0.001). The lead concentration in amniotic fluid (59.6 +/- 8.3 ng/ml) was significantly higher than in maternal or umbilical cord blood. Cadmium concentrations in maternal blood (1.1 +/- 0.9 ng/ml) and amniotic fluid (1.0 +/- 0.2 ng/ml) were significantly higher (p less than 0.001) than in umbilical cord blood (0.4 +/- 0.2 ng/ml) and there was no significant correlation among these values. The highest concentrations of cadmium (35.1 +/- 24.2 ng/gm of wet weight) and lead (87.3 +/- 154.2 ng/gm of wet weight) were found in the amniotic membranes. Our results show that lead and cadmium accumulate in amniotic fluid and amniotic membranes and that the distribution of lead and cadmium is different in the human maternal-fetoplacental unit. The fetal exposure to lead is similar and that to cadmium, lower, compared with maternal exposure. The inability of the placenta to totally prevent the fetus from exposure to lead and cadmium suggests that pregnant women should avoid occupations where exposure to these toxic elements is possible.

Adolescent↗
PubMed1986

Tiaprofenic acid in the treatment of primary dysmenorrhoea.

Thirty-one patients with primary dysmenorrhoea were treated in a double-blind, six-period, cross-over clinical trial with tiaprofenic acid, naproxen sodium and a placebo in randomized order, each for 2 consecutive cycles. Complete disappearance of the symptoms or pronounced therapeutic effects were obtained with tiaprofenic acid, naproxen sodium and the placebo in 74%, 65% and 35% of cases, respectively, while these treatments were ineffective in 3%, 6% and 38% of cases, respectively. Tiaprofenic acid was superior to the placebo for relieving pelvic pain and overall discomfort and for reducing the need for bed-rest. Naproxen sodium compared favourably with the placebo with respect to pelvic pain and overall discomfort. The effects of tiaprofenic acid and naproxen sodium were not significantly different. Tiaprofenic acid had no side-effects, whereas tiredness was experienced in 3 cases of naproxen sodium treatment. The results indicate that tiaprofenic acid is a useful alternative for the treatment of primary dysmenorrhoea.

Adolescent↗
PubMed1986

Serum selenium and thromboxane in patients with gynaecological cancer.

To explore the relationships between the antioxidant selenium and pro-aggregatory thromboxane A2 in patients with gynaecological cancer, we measured the serum concentrations of selenium and the production of thromboxane B2 (TxB2, a stable metabolite of thromboxane A2) by the aggregating platelets in patients with endometrial (n = 35), ovarian (n = 30) and cervical cancer (n = 25), and in 32 control women. The selenium concentration in endometrial (1.14 +/- 0.04 mumol/l; mean +/- SE), ovarian (0.96 +/- 0.04 mumol/l) and cervical cancer (0.97 +/- 0.06 mumol/l) was significantly lower than in control subjects (1.26 +/- 0.03 mumol/l). The release of TxB2 into serum during spontaneous clotting of the blood was significantly increased in ovarian cancer (229.2 +/- 15.9 ng/ml), decreased in endometrial cancer (142.6 +/- 12.4 ng/ml) and normal in cervical cancer (185.9 +/- 14.8 ng/ml) as compared with control subjects (185.9 +/- 11.9 ng/ml). The levels of selenium and TxB2 did not correlate with each other in the whole series or in any subgroup. Thus, selenium does not seem to be an important determinant in the biosynthesis of TxB2 in patients with gynaecological malignancy.

Adult↗
PubMed1986

Dynamic evaluation of prolactin secretion by successive TRH and metoclopramide stimulations.

We evaluated the clinical applicability of a 2-h test in which the prolactin (Prl) responses to thyrotrophin releasing hormone (TRH)(200 micrograms iv) and the dopamine antagonist, metoclopramide (MC; 10 mg iv) were studied successively, 1 h apart. Nine healthy women were studied with TRH-MC test and with another test in which MC alone was used or the drugs were given in opposite order. The preceding TRH injection did not affect the Prl responses to MC, nor did preceding MC affect the Prl response to TRH. With the TRH-MC test, Prl responses to TRH and MC were significantly lowered in amenorrhoea (N = 8) and hyperprolactinaemia (N = 15) regardless of whether or not treated with bromocriptine, and to MC only in oligomenorrhoea (n = 11). In normoprolactinaemic galactorrhoea (N = 7) the responses were similar as in healthy women. The ratio between Prl responses to TRH and MC was significantly higher in women with bromocriptine-treated hyperprolactinaemia (1.06 +/- 0.8, SD) than in healthy controls (0.34 +/- 0.13). The capacity of pituitary lactotrophs to secrete Prl in response TRH and MC can be evaluated with a 2-h test which has potential for investigation of pituitary Prl dynamics in gynaecological endocrine disorders, particularly in amenorrhoea and hyperprolactinaemia.

Adolescent↗
PubMed1986

Effects of physical exercise on the serum concentration of melatonin in female runners.

The serum melatonin concentration was measured in 11 runners before and after a long-distance race, and during one menstrual cycle of another 11 runners who were performing a strenuous training programme, and in their 12 control subjects. The concentration of melatonin was significantly increased (p less than 0.05) after the competition, whereas during one menstrual cycle of female runners it did not differ from the corresponding concentrations of non-athletes. Training did not cause any chronic changes in melatonin secretion, and the serum melatonin increases following the physical exercise remained clearly below the nocturnal level. Hence, the antigonadotropic effect of endurance running activity is very likely not a melatonin-associated phenomenon.

Adult↗
PubMed1986

Tumor-associated antigen Ca 125 before and during the treatment of ovarian carcinoma.

Serum concentrations of Ca 125, a tumor-associated antigen of epithelial ovarian cancer, were measured in 29 ovarian cancer patients before cytoreductive surgery and in 112 patients during and after treatment. Ca 125 levels were increased (greater than 30 IU/mL) in 89.8% of patients with clinically demonstrable ovarian tumors and were negative in 92.1% of clinically disease-free patients. Low levels of Ca 125 were associated with early clinical stages or a minimal tumor burden, and predicted a successful response to treatment and a low recurrence rate. High values indicated advanced disease and a poor response to cytotoxic chemotherapy. In 77% of patients the operation was explorative, with a preoperative Ca 125 level higher than 1000 IU/mL, whereas all the patients with values less than 100 IU/mL could be operated radically. Serum levels of Ca 125 were increased in similar frequency in epithelial, sex cord, and germ cell ovarian malignancies. The assay of Ca 125 seems to be a reliable noninvasive method for monitoring the presence and clinical behavior of ovarian cancer. Preoperative values have prognostic significance in predicting operability and response to chemotherapy.

Adenocarcinoma↗
PubMed1985

Oral administration and distribution of melatonin in human serum, saliva and urine.

In order to evaluate for future physiological and pharmacological studies the extent to which orally administered melatonin is found in human serum and saliva and excreted into urine we measured serum, saliva and urine concentrations of melatonin by radioimmunoassay after oral administration of 100 mg melatonin. Elevated melatonin concentrations were observed with peak values of 435 nmol/l in serum and 241 nmol/l in saliva at 60 min. Elimination was monophasic following first-order kinetics. The half-lives for serum and saliva melatonin were 41 and 38 min, respectively. The results suggest that melatonin is passively secreted into saliva which reflects closely the changes in serum melatonin. Saliva sampling is thus useful in studies on peripheral melatonin both in physiological and experimental conditions. Urinary excretion of melatonin was 0.01 % of the amount of melatonin ingested. In high-performance liquid chromatography urine extracts were found to contain also a minor unknown immunoreactive component which we suggest to be some unknown metabolite of melatonin.

Administration, Oral↗
PubMed1985

Short-term effects of danazol and medroxyprogesterone acetate on cytosol and nuclear estrogen and progestin receptors, 17 beta-hydroxysteroid dehydrogenase activity, histopathology, and ultrastructure of human endometrial adenocarcinoma.

We measured concentrations of cytosol and nuclear estrogen, as well as progestin receptors and activities of 17 beta-hydroxysteroid dehydrogenase (17-HSD), and examined histopathology and ultrastructure of endometrial carcinoma specimens taken before and after one-week danazol (200 mg, 3 times daily) or medroxyprogesterone acetate (MPA, 100 mg daily) treatments in 14 and 16 patients, respectively. A typical progestin effect, a significant increase in the activity of 17-HSD, was observed after both treatments. The post-therapy 17-HSD activities correlated significantly with the pretreatment cytosol progestin receptor concentrations in both treatment groups. Both MPA and danazol decreased the proliferative activity and increased the secretory activity of the malignant epithelial endometrial cells. These biochemical and morphological results support the concept that danazol has progestin-like actions on the human endometrium, and might therefore be an alternative for hormonal treatment of endometrial carcinoma.

17-Hydroxysteroid Dehydrogenases↗
PubMed1985

Metoclopramide and breast feeding: efficacy and anterior pituitary responses of the mother and the child.

The purpose of this randomized, double-blind clinical study was to evaluate the efficacy of the antidopaminergic agent metoclopramide (MC) in the treatment of puerperal lactational insufficiency, and prolactin, TSH and free thyroxine responses of the mother and the child to this therapy. Therefore, 11 women received MC (10 mg 3 times daily orally) and 14 a placebo for 3 wk. MC increased the serum concentration of PRL from 57.5 + 45.5 U/l to 315.0 + 300.0 U/l (P less than 0.001), and the amount of daily milk yield in 8 women with established lactational deficiency rose from 285 + 75 ml to 530 + 162 ml (P less than 0.01) while the placebo was ineffective. Serum concentrations of TSH and free thyroxine did not change during either of the treatments. Serum concentrations of PRL, TSH and free thyroxine in the infants were similar in both groups and remained unchanged throughout the study. Our results suggest that MC is useful in the treatment of deficient puerperal lactation, and it does not stimulate the pituitary lactotropes or thyrotropes of the nursing infants.

Adult↗
PubMed1985

Effect of gestrinone in endometriosis tissue and endometrium.

The effects of gestrinone (R 2323) on endometrial and endometriosis tissue concentrations of cytosol estrogen and progestin receptors and the activity of 17 beta-hydroxysteroid dehydrogenase (17 beta-HSD) were investigated in 11 patients operated on because of suspected external endometriosis. Serum concentrations of luteinizing hormone, follicle-stimulating hormone, estradiol (E2), progesterone, testosterone (T), and sex-hormone-binding globulin (SHBG) were also investigated. After one control cycle, the patients received 2.5 mg of oral gestrinone twice weekly from the fifth day of the first treatment cycle until the eighth day of the second treatment cycle, the day of operation being day 10. Treatment with gestrinone decreased serum concentrations of T during the second treatment cycle and effected a major decrease in SHBG during both treatment cycles, resulting in highly increased free T and free E2 indices. The effects of gestrinone on the endometrium, a decrease in estrogen and progestin receptors, and induction of 17 beta-HSD are characteristic progestin actions. These parameters remained unchanged in endometriosis tissue. Our data indicate that gestrinone has effects that are typical of androgens and progestins in patients with endometriosis.

17-Hydroxysteroid Dehydrogenases↗
PubMed1985

Physical exercise-induced changes and season-associated differences in the pituitary-ovarian function of runners and joggers.

The hormonal responses to energetic chronic exercise and to seasonal shift from autumn to spring were evaluated by measuring concentrations of serum FSH, LH, PRL, estradiol (E2), progesterone (P), testosterone (T), and sex hormone-binding globuline (SHBG) during 1 menstrual cycle in the autumn (light training season) and 1 in the spring (hard training season) in 18 endurance runners and 12 age-matched nonrunning women, and in 13 joggers and 11 age-matched nonjogging women. The appearance, growth, and maximal size of the ovarian follicles were monitored by ultrasonography. The high intensity training of the runners was associated with decreased concentrations of FSH on cycle days 7-8 in the autumn, E2 on cycle days 12-13 in the spring and days 22-23 in both seasons, P on cycle days 20-21 in both seasons and days 22-23 in the autumn, and T on cycle days 12-13, 14-15, and 22-23 in the spring. Jogging, however, did not alter the concentrations of these hormones. Using as criteria the presence of 2 or 3 abnormal values of the 3 indicators used for evaluation of folliculogenesis (midfollicular E2 lower than 0.09 nmol/liter, luteal phase P lower than 7 nmol/liter, and peak diameter of the largest ovarian follicle less than 15 mm), seriously disturbed folliculogenesis was found in 50% of the 32 study cycles of the runners and 9% of the 23 cycles of their controls (P less than 0.01). In all four study groups, there was a significant seasonal difference in the concentrations of ovarian hormones, with lowered E2, P, and T levels in the autumn. There were no differences in the serum concentrations of SHBG between the study groups or between the autumn and the spring. High training activity and a dark photoperiod appeared to independently suppress ovarian activity and were not associated with chronic changes in anterior pituitary hormone or SHBG concentrations.

Adolescent↗
PubMed1985

Comparison of Heyman packing and Cathetron afterloading methods in the treatment of endometrial cancer.

The five-year survival and the complication rate were evaluated in 307 patients with endometrial carcinoma treated from 1966 to 1977. The distribution of the patients into clinical stages I, II, III and IV was 68.7, 20.8, 6.5 and 3.9%, respectively. In stage I 87.2% and in stage II 67.2% of the patients were operated on. All patients received oral medroxyprogesterone acetate for two years, and all patients with stage I or II disease were also irradiated, mostly intracavitary before operation. The crude 5-year survival in the total material was 72.0%, and for clinical stages I, II, III and IV 83.8, 54.7, 40.0 and 8.3%, respectively. 167 patients in stage I received intracavitary irradiation, 86 using the Heyman packing method and 81 using the Cathetron after-loading technique. The corresponding figures for 54 patients in stage II were 38 and 16. In clinical stage I the crude (83.9% and 84.2%, respectively) and corrected (92.9 and 88.9%, respectively) 5-year survivals were similar in the Heyman and Cathetron groups. In stage II better results were obtained using the Cathetron technique (crude 75.0 vs. 42.1%) but in the corrected material, excluding the unoperated cases, there was no significant difference (81.3 vs. 74.4%, respectively). Serious late complications requiring surgical correction were less common in the Cathetron group (2.9% vs. 11.1%; p less than 0.05). The intracavitary irradiation of endometrial carcinoma can thus be well accomplished by remote afterloading technique.

Adolescent↗