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Biomedical subjects

J Puolakka

Publications and source records attributed to J Puolakka.

At least 19 recordsLinked to original sources
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↗
PubMed1988

The effect of bupivacaine paracervical block on the neurobehavioural responses of newborn infants.

The effects of maternal bupivacaine paracervical block on neonatal neurobehavioural responses were studied at the ages of 3 h, 1 day, 2 days and 4-5 days. Subjects were healthy, term neonates born vaginally to 10 mothers with paracervical block and to 12 mothers without analgesia. No statistically significant differences were found in the responses between the groups. It is concluded that paracervical block with a small dose of bupivacaine, applied by experienced obstetricians to non-risk parturients with healthy foetuses, has no detrimental effects on newborn behaviour or neurological recovery.

Adult↗
PubMed1987

Placebo-controlled comparison of danazol and high-dose medroxyprogesterone acetate in the treatment of endometriosis.

A prospective, double-blind, placebo-controlled study was designed to evaluate the clinical efficacy and tolerance of danazol and high-dose medroxyprogesterone acetate (MPA) in the treatment of mild-moderate endometriosis. After laparoscopical confirmation of endometriosis, 59 patients were randomized to receive danazol (200 mg 3 times daily), MPA (100 mg daily) or placebo for 6 months. Clinical examinations were done before and 1, 3, 6 and 12 months after the beginning of the study, and a 2nd laparoscopy 6 months after termination of the medication. Eighteen patients in the danazol group, 16 in the MPA group and 17 in the placebo group completed the trial. Total or partial resolution of peritoneal implants was observed in 60% of the patients receiving danazol and in 63% of the patients receiving MPA. In the placebo group, resolution was observed in 18%, while the size of the implants was estimated to be increased in 23% of the patients. In relation to placebo, danazol and MPA significantly alleviated endometriosis-associated pelvic pain, lower back pain and defecation pain, but they did not differ from each other in these actions. The appearance of acne, muscle cramps, edema, weight gain and spotting bleeding complicated MPA treatment. The present results indicate that because of good efficacy and tolerance, high-dose MPA is a useful alternative in the hormonal treatment of endometriosis.

Adult↗
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

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

Dermal prostacyclin, thromboxane A2 and prostaglandin F2 alpha in climacteric women: effect of oestrogen replacement therapy.

The involvement of dermal prostanoids in menopausal flushing was studied in 8 women suffering from climacteric hot flushes and in 10 asymptomatic control subjects by inducing suction blisters on abdominal skin and assaying blister fluids for 6-keto-PGF1 alpha, a metabolite of the vasodilative prostacyclin (PGI2), thromboxane B2 (TxB2), a metabolite of the vasoconstrictive thromboxane A2 (TxA2), and 13,14-dihydro-15-keto-PGF2 alpha (M-PGF2 alpha), a metabolite of prostaglandin F2A (PGF2A). No marked differences were observed in the levels of these prostanoids in the two study groups. The women experiencing flushes then received conjugated oestrogens for 3 mth to abolish vascular instabilities. This decreased the blister fluid concentration of M-PGF2 alpha from 1720 +/- 476 pg/ml (mean +/- SE) to 1490 +/- pg/ml (P less than 0.05), but had no effect on the dermal levels of 6-keto-PGF1 alpha or TxB2. It was concluded that although certain dermal prostanoids may be affected by oestrogen treatment they are not of primary significance as regards menopausal flushing.

6-Ketoprostaglandin F1 alpha↗
PubMed1985

Biochemical and clinical effects of treating the premenstrual syndrome with prostaglandin synthesis precursors.

The clinical and biochemical effects of a prostaglandin synthesis precursor (Efamol) containing linoleic acid and its metabolite, gamma-linolenic acid, were studied in 30 women with severe, incapacitating premenstrual syndrome. Efamol treatment alleviated the premenstrual symptoms in general and depression especially better than did a placebo. The capacity of platelets to release thromboxane B2 during spontaneous clotting was decreased in patients undergoing Efamol treatment (141 +/- 59 ng/ml, mean +/- SD) as compared to those undergoing placebo treatment (186 +/- 44 ng/ml, p less than 0.01) and control subjects (176 +/- 40 ng/ml, n = 25, p less than 0.05). No changes were found in plasma 6-keto-prostaglandin F1alpha or in FSH, LH, prolactin, progesterone, estradiol and testosterone. The data suggest that prostaglandins might play a role in the pathophysiology of the premenstrual syndrome.

6-Ketoprostaglandin F1 alpha↗
PubMed1984

Vasoconstrictory thromboxane A2 and vasodilatory prostacyclin in climacteric women: effect of oestrogen-progestogen therapy.

The production of vasoconstrictory thromboxane A2 (TxA2) and vasodilatory prostacyclin ( PG2 ) was studied in women suffering from climacteric vascular instabilities before and during the oestrogen-progestogen therapy. The serum concentrations of TxB2, a metabolite of TxA2, in climacteric patients were similar (170.5 +/- 25.5 ng/ml, mean +/- SE, n = 14) to those in control subjects (196.0 +/- 27.5 ng/ml n = 17) before the start of treatment, but rose to 209.3 +/- 24.5 ng/ml after 3 wk of treatment (P less than 0.01 in comparison with the pre-treatment level), to 227.2 +/- 44.1 ng/ml after 3 mth (P less than 0.05) and to 237.4 +/- 30.3 ng/ml after 6 mth (P less than 0.05). The plasma concentrations of 6-keto-prostaglandin F1a , a stable breakdown product of PG2 , were normal in climacteric (43.5 +/- 7.3 pg/ml as against 46.1 +/- pg/ml) and did not change during replacement therapy. It was concluded, firstly, that climacteric symptoms are not accompanied by changes in TxA2/ PG2 which can be detected in peripheral blood and, secondly, that the increase in the concentration of vasoconstrictory TxA2 induced by oestrogen-progestogen therapy may contribute to the disappearance of climacteric vascular instabilities.

6-Ketoprostaglandin F1 alpha↗
PubMed1984

Maternal and umbilical cord plasma noradrenaline concentrations during labour with and without segmental extradural analgesia, and during caesarean section.

Serial measurements of maternal and umbilical cord plasma noradrenaline concentrations were obtained in 10 patients undergoing normal vaginal delivery with segmental extradural analgesia, in 10 patients undergoing normal vaginal delivery without extradural analgesia, and in 12 patients undergoing elective Caesarean section under general anaesthesia. Maternal noradrenaline concentrations increased significantly during delivery in all three groups, the peak concentrations occurring at delivery. However, the increase in the maternal noradrenaline concentration during delivery in the extradural group was lower than in the non-extradural group (P less than 0.05). Umbilical venous and arterial concentrations of noradrenaline were lower after Caesarean section than after vaginal delivery. However, extradural analgesia did not affect the fetal noradrenaline concentrations. Since noradrenaline is probably required for the adaptation of the newborn to extrauterine life, the unaltered fetal response may be beneficial.

Anesthesia, Epidural↗
PubMed1984

Amniotic fluid norepinephrine concentration as an indicator of fetal sympathetic nervous activity. Effect of pregnancy complications.

The concentrations of norepinephrine in amniotic fluid and maternal plasma were measured in 71 third trimester pregnancies, 31 of which were uncomplicated and 40 complicated. The amniotic fluid norepinephrine concentration (mean +/- SD) in cases of hypertension treated with clonidine (0.4 +/- 0.1 ng/ml, n = 12) and in insulin-dependent diabetes (0.5 +/- 0.2 ng/ml, n = 7) was lower, and in renal insufficiency (1.7 +/- 0.8 ng/ml, n = 8) higher than in control subjects (0.7 +/- 0.4 ng/ml, n = 31). In fetal-growth retardation (0.6 +/- 0.2 ng/ml, n = 8) and in latent diabetes (0.7 +/- 0.2 ng/ml, n = 5) the values were similar to those in the control subjects. There was a significant positive correlation between mature lecithin-sphingomyelin (L/S) ratio and norepinephrine concentration. Clonidine-treated hypertension was associated with decreased (0.2 +/- 0.1 ng/ml) and renal insufficiency with increased (0.9 +/- 0.7 ng/ml) maternal plasma norepinephrine concentrations (control group, 0.3 +/- 0.1 ng/ml). The present results indicate that measurement of catecholamines in amniotic fluid can be useful in the evaluation of fetal sympathoadrenal function.

Amniotic Fluid↗
PubMed1984

Maternal and fetal effects of low-dosage bupivacaine paracervical block.

Vasoconstriction of the uterine arteries, hypertonus of the uterus, and the direct toxic effects of a local anesthetic on the fetus or a combination of the above have been presented as etiological factors of fetal bradycardia following paracervical block. The reduce fetal side-effects a superficial and lowdosage technique of PCB have been advocated. We have studied the effects of 25 mg of bupivacaine PCB using the above technique on fetal heart rate pattern (FHR), fetal acid-base balance, uterine activity, placental blood flow and maternal and fetal plasma levels of bupivacaine in 38 patients. The analgesic effect of a single 25 mg of bupivacaine PCB was good in 76%, moderate in 12% and poor in 12% of the cases. No changes in maternal heart rate or in blood pressure were noted. Fetal bradycardia defined as a decrease of mean fetal heart rate of at least 20 bpm or an absolute rate less than 100 bpm and a duration greater than two minutes occurred in 12% of the cases. The mean amplitude of the baseline fetal heart rate variability decreased significantly after PCB and a silent pattern (an amplitude less than 5 bpm) was observed in 20% of the cases. The most frequent (27%) pathological finding in our study was the disappearance of FHR accelerations after PCB. Similarly early and late decelerations of FHR occurred more often after PCB than during the control period before the block. The fetal pH from scalp blood samples did not, on average, decrease after PCB, but did so in cases with fetal bradycardia. Intervillous blood flow as measured by the 133Xe washout method did not change when measured before and after PCB. In addition in three cases with fetal bradycardia the changes in the intervillous blood flow were minimal. No significant changes in the mean uterine tone, amplitude and frequency of contractions were observed after PCB. However, an obvious uterine hypertonus was observed after PCB was observed in three cases of fetal bradycardia but not in two other cases of bradycardia or in the 8 cases of silent FHR pattern. Mean maternal bupivacaine concentration 20 minutes after PCB was 0.14 +/- 0.06 microgram/ml and 0.07 +/- 0.04 microgram/ml at birth. Simultaneous fetal and umbilical venous and arterial concentrations were correspondingly 0.04 +/- 0.02 microgram/ml, 0.03 +/- 0.01 microgram/ml and 0.03 +/- 0.01 microgram/ml, and they were significantly lower than respective maternal concentrations.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1983

Comparison between oral ketoconazole and topical miconazole in the treatment of vaginal candidiasis.

Oral ketoconazole and topical miconazole were compared in the treatment of vaginal candidiasis, in an open trial. One group (n = 49) received of ketoconazole, 400 mg per day for 3 days, another group (n = 42) ketoconazole 200 mg per day for 6 days and the third (n = 49) miconazole vaginal tablets (100 mg) one per day for 14 days. One week after conclusion of the treatment the mycological cure rates (67%, 78% and 81%) were not statistically different from each other. The recurrence rates assessed one month after the treatment were also of same order (7%, 7% and 15%) and did not differ significantly from each other. Those patients who had previous had candidiasis showed lower cure rates than patients with their first vaginal candidiasis., following both miconazole and ketoconazole therapy. No adverse reactions attributable to the drugs were recorded. The advantages of ketoconazole in the treatment of vaginal candidiasis are: oral route of administration, short duration of the therapy (3-6 days), high therapeutic effectiveness and lack of any significant side effects.

Administration, Oral↗
PubMed1983

The effect of parturition on umbilical blood plasma levels of norepinephrine.

The norepinephrine concentration in 77 umbilical, arterial, and venous plasma samples, and in 31 simultaneous maternal plasma samples, was measured. The mean (+/- SEM) of 8.7 +/- 1.9 ng/ml in the umbilical artery was higher (P less than .001) than that of 3.6 +/- 0.9 ng/ml in the umbilical vein. In paired fetal-maternal venous samples the norepinephrine concentration of 3.8 +/- 1.7 ng/ml in the fetus was higher (P less than .05) than that of 0.3 +/- 0.1 ng/ml in the mother. Among the different types of vaginal deliveries the umbilical arterial norepinephrine concentrations were: 5.8 +/- 2.1 ng/ml in uncomplicated vaginal deliveries; 16.4 +/- 2.1 ng/ml in breech deliveries (P less than .05 as compared with uncomplicated vaginal deliveries); 8.8 +/- 2.5 ng/ml in vacuum extraction deliveries; and 0.8 +/- 0.3 ng/ml and 11.3 +/- 7.7 ng/ml in twin A and twin B deliveries, respectively. All these values were higher (P less than .001) than those after elective cesarean section, except that for twin A, which was lower (P less than .01) than that for twin B, indicating that labor and vaginal delivery induced activation of the fetal sympathoadrenal system.

Adult↗
PubMed1982

Amniotic fluid beta-2-microglobulin in normal and complicated pregnancies. Correlation with gestational age, creatinine concentration and L/S ratio.

The beta-2-microglobulin concentrations in 127 aminotic fluid samples, obtained during weeks 32-42 of normal pregnancies (n = 58) and complicated pregnancies (n = 69), were measured and correlated with gestational weeks, amniotic fluid creatinine concentrations and L/S ratios. A significant (p less than 0.001) decrease of beta-2-microglobulin concentration occurred from week 32 to 34 of normal pregnancies, after which the beta-2-microglobulin level was unchanged. There were no significant correlations between beta-2-microglobulin concentrations and amniotic fluid creatinine concentrations of LK/S ratios. The beta-2-microglobulin content was elevated in samples obtained from diabetic and toxemic pregnancies. Measurement of beta-2-microglobulin in amniotic fluid seems to be of limited value for determining fetal age, but it may be useful in estimating fetal renal maturity.

Amniotic Fluid↗
PubMed1982

Fetal adrenocorticotropic hormone and prolactin at delivery.

The concentrations of adrenocorticotropic hormone (ACTH) and prolactin in fetal scalp and umbilical cord blood were measured in 49 full-term fetuses, 25 of whom were delivered spontaneously, 10 of whom underwent induced vaginal delivery, and 14 of whom underwent elective cesarean section. Serial fetal scalp blood samples taken during the 35 vaginal deliveries showed no change in concentration of these hormones. The mean (+/- SD) plasma level of ACTH in cord artery blood after vaginal delivery (315 +/- 249 ng/liter) was significantly higher (P less than .05) than after cesarean section (184 +/- 201 ng/liter), indicating that the fetal anterior pituitary is capable of responding to partal stress.

Adrenocorticotropic Hormone↗
PubMed1982

Bromocriptine and norethisterone in the treatment of premenstrual syndrome.

Thirty-six women suffering from premenstrual syndrome were treated with bromocriptine or norethisterone in a randomized placebo-controlled double-blind study. Bromocriptine decreased breast engorgement and irritability (P less than .01) and also decreased the total score of all symptoms (P less than .05). Weight gain during the luteal phase was smaller (P less than .05) during bromocriptine than during placebo treatment. Norethisterone treatment alleviated (P less than .05) breast tenderness. Changes in hormonal parameters and liver function tests during bromocriptine treatment were minimal, whereas norethisterone decreased serum levels of luteinizing hormone (P less than .01), follicle-stimulating hormone (P less than .001), and progesterone (P less than .05), while increasing the serum level of prolactin (P less than .01) and gamma-glutamyltranspeptidase activity (P less than .05). Serum levels of cholic acid and chenodeoxycholic acid remained unchanged during both therapies. Bromocriptine treatment brought about side effects in 6 and norethisterone in 3 women. At the doses used, bromocriptine appears more efficient than norethisterone with regard to premenstrual symptoms, although norethisterone is better tolerated.

Adult↗