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Biomedical subjects

O Karjalainen

Publications and source records attributed to O Karjalainen.

At least 19 recordsLinked to original sources
PubMed1996

Cost-effectiveness of one-stage ultrasound screening in pregnancy: a report from the Helsinki ultrasound trial.

The objective of this study was to evaluate, in a controlled clinical trial, the costs of standardized one-stage ultrasound screening in pregnancy in relation to the reduction in perinatal mortality. A trial population of 9310 pregnant women was randomly allocated to ultrasound screening or a control group. Two obstetric hospitals and 64 recruiting antenatal health centers were involved. The costs included actually realized costs, i.e. positive costs, and gains, i.e. negative costs, resulting from lower health-care use. Cost-accounting data were obtained by a questionnaire to all attenders and measurements at the screening, and later complemented by a questionnaire to a random sample of 534 screened women. Internal accounting and other hospital data, national statistics and health-market sources were also used. The actually realized cost of each avoided perinatal death was FIM 84 378 ($21,938), while the net overall estimate combining all positive and negative costs showed a cost saving of FIM 65 680 ($17,077). The total positive unit cost of ultrasound screening was FIM 393 ($102). Longer ultrasound examination time and more numerous advanced examinations were rewarded by clearly fewer perinatal deaths and a better cost-effectiveness ratio. One-stage second-trimester ultrasound screening is cost-effective when all significant costs and effects are taken into account.

Congenital Abnormalities↗
PubMed1994

Fetal anomalies in a controlled one-stage ultrasound screening trial. A report from the Helsinki Ultrasound Trial.

The aim of the study was to compare whether systematic strictly timed screening of all pregnancies would improve the detection of major fetal anomalies. All pregnant women (95%) from a certain area were randomly allocated for one ultrasound screening examination between the 16th and 20th weeks of gestation. Otherwise the screening (N = 4691) and control groups (N = 4619) received the same antenatal care. Screening included a systematic search for fetal anomalies. In the screening group, 40% of major fetal anomalies were detected in the screening, and 11 abortions were induced because the malformation was either lethal or severely handicapping. In the control group, 77.0% of participants had ultrasound examination any time during pregnancy. By ultrasound 13 (27%) major fetal anomalies were detected, only two of these before the 21st week of gestation. Screening detected most of the anomalies of the central nervous system and genitourinary system and cases with multiple anomalies, but was less satisfactory in detecting the anomalies of the heart and gastrointestinal tract. The perinatal mortality rate was 4.2 per 1000 in the screening group and 8.4 per 1000 in the control group (p = 0.013). The detection of major fetal anomalies in ultrasound screening can reduce perinatal mortality. A systematic search for fetal anomalies should be included in the ultrasound screening of all pregnancies.

Abortion, Induced↗
PubMed1990

Ultrasound screening and perinatal mortality: controlled trial of systematic one-stage screening in pregnancy. The Helsinki Ultrasound Trial.

During a 19-month period, 95% of all pregnant women in the greater Helsinki area, Finland, entered a study to compare one-stage ultrasonography screening with selective screening according to antenatal hospital use, obstetric procedures, and fetal outcomes. Of 9310 women who entered the trial, 4691 were randomly allocated to ultrasound screening between the 16th and 20th gestational weeks and 4619 to follow-up only. Screened and control groups otherwise had the same antenatal care, which included ultrasonography according to usual practice. Screened women made fewer visits to the antenatal outpatient clinic than did women in the control group (2.3 vs 2.6). There were no differences in the number of labour inductions or mean birthweights in the two groups. Perinatal mortality was significantly lower in the screened than in the control group (4.6/1000 vs 9.0/1000); this 49.2% reduction was mainly due to improved early detection of major malformations which led to induced abortion. All twin pregnancies were detected before the 21st gestational week in the screening group compared with 76.3% in the control group; perinatal mortality in the small series of twins was 27.8/1000 vs 65.8/1000, respectively.

Evaluation Studies as Topic↗
PubMed1985

Changing pattern of cervical carcinoma: a report of 709 cases of invasive carcinoma treated in 1970-1974.

Seven hundred and nine new cases of carcinoma of the uterine cervix were treated by surgery, radiotherapy, or both at Helsinki University Central Hospital between 1970 and 1974. Of these, 241 (34.0%) died of the disease during the 5-year follow-up period. Three hundred and eighty-three (53.9%) of the patients were operated on and in 112 (29.3%) of them the stage of the disease had been underestimated preoperatively. This was mainly due to the undetected lymph node involvement observed first at operation in 72 cases (18.8%). In 237 of the patients carcinoma was confined to the cervix according to findings at operation but in 24 (10.1%) of them a relapse or metastasis was observed within 5 years. Comparison of the results for 1970-1974 with those from the same hospital for 1926-1969 revealed a reversal in the steady improvement in the total 5-year survival rates. It is concluded that, even if the incidence of cervical carcinoma in Finland is to decrease, the prognosis for the disease may become poorer. This is mainly due to a shift in the peak incidence of cervical carcinoma to older age groups. Also a mass screening program is likely to decrease the relative number of slowly growing, less aggressive type of the disease.

Adenocarcinoma↗
PubMed1984

Pregnancy outcome after combined amputation and conization of the uterine cervix.

The outcome of 109 pregnancies after combined amputation and conization of the uterine cervix for CIN was compared with 204 previous pregnancies of the same 84 women. Late spontaneous abortion and preterm delivery occurred significantly more often after the operation than before it (p less than 0.001). The occurrence of early abortion was equal in both groups. The rate of legal pregnancy termination of the postconization pregnancies increased with the age of the women at the time of conization. The rate of caesarean sections (25.5%) in conized patients was significantly higher (p less than 0.05) than the mean section rate in the clinic (14.6%) during the study period. One fourth of them were done for chorion-amnionitis suggesting cervical incompetence in these cases. However, prophylactic second trimester cerclage did not improve the prognosis of postconization pregnancies. Combined amputation and conization seems to be a significant risk factor in subsequent pregnancies requiring careful supervising of the patients.

Abortion, Spontaneous↗
PubMed1984

Accuracy of the diagnosis in suspected intraepithelial neoplasia of the cervix.

520 patients with a preoperative diagnosis of cervical intraepithelial neoplasia (CIN) were operated. The diagnoses obtained by colposcopically directed biopsy and endocervical curettage were compared with those obtained by cone biopsy or/and hysterectomy. Underdiagnosis occurred in 18.9% of the cases, if severe dysplasia and carcinoma in situ were considered to be separate conditions. When these two diagnoses were combined as CIN 3 the underdiagnosis rate declined to 11.0%. CIN 3 changed to invasive carcinoma in 1.5% and to microinvasive carcinoma in 4.4% of the cases. The preoperative diagnosis of CIN seems not to be accurate enough to make cone biopsy totally unnecessary as a complementary diagnostic step.

Adult↗
PubMed1983

Early prenatal detection of diastrophic dysplasia.

Diastrophic dysplasia, an autosomal recessive disorder, results in severe short-limbed dwarfism, progressive spinal and joint problems, and secondary psychosocial disability. The results of treatments are unsatisfactory. Four pregnant mothers at risk for an affected fetus were studied with an ultrasound scanner at 16 and 19 weeks of gestation. Each mother had a previous child with diastrophic dysplasia. The biparietal distance and the length of the long bones of the extremities were normal in three fetuses, whereas in one fetus there was a 30 per cent shortening of all long bones. The biparietal distance corresponded with the gestational age in all fetuses. In one fetus, diastrophic dysplasia was confirmed by fetoscopy and fetal radiograph at 19 weeks of gestation after the parents had decided to terminate the pregnancy. The skeletal radiograph and autopsy findings of the fetus verified the diagnosis. All other mothers were followed with repeated ultrasound examinations, and they delivered healthy babies. The retrospective follow-up of the four previous pregnancies and of the present one with affected fetuses disclosed that two mothers had had vaginal bleeding, two lymphedema, one abdominal pains, and one mother had had polyhydramnios. These complications were, however, mild and transient, and they could not be regarded as specific for pregnancies with affected fetuses.

Abnormalities, Multiple↗
PubMed1983

Causes of stillbirth: a clinicopathological study of 243 patients.

The clinical and autopsy findings in all stillbirths during the years 1974-1979 at the Helsinki University Central Hospital were analysed. There were 243 stillborn infants of whom 200 died before labour. According to the autopsy findings asphyxia accounted for 38% and major malformations for 17% of the deaths, but because of fetal maceration no diagnosis could be made at autopsy in 43%. The cause of death suggested by the clinical findings was placental failure in 57%, cord complication in 12% and major malformations in 17%. The cause of death remained unsolved in 9%. The importance of routine ultrasound and alpha-fetoprotein screening for the detection of unrecognized risk patients is emphasized.

Asphyxia Neonatorum↗
PubMed1982

The significance of broadened approach to risk pregnancy.

The appropriateness of widened indications for special surveillance during pregnancy was studied prospectively in a series of 2460 randomly selected mothers. Factors necessitating special care were classified as anamnestic (gr A), those appearing during pregnancy (gr B) or just during labour (gr C). The cumulative contribution of different groups of risk factors to the final risk group of 1811 patients was as follows: gr A 37.0%, gr B 58.4% and gr C 4.6%. Offsprings of mothers with no risk factors had the most favourable prognosis followed by those belonging to groups C, A and B. Maternal risk was clearly highest in the presence of group C factors. Group B factors were recognized by maternal health centre personnel far better than group A factors. The performance of hospital personnel in the observation of different types of risk factors was assessed on the basis of intrapartum monitoring frequencies. The highest monitoring frequency was observed in group O followed by group B, A and C. The results suggest that clearly definable complications of pregnancy and those occurring during labour are easily observed and their management is adequate. Anamnestic risk factors which are more obscure by definition and especially by mechanism of action tend to escape the attention of medical personal. Fortunately these factors alone contributed only an insignificant proportion of adverse outcomes in the mother and child.

Attitude of Health Personnel↗
PubMed1981

Prenatal diagnosis of the Meckel syndrome.

Sixteen pregnancies of 12 women with a previous child affected with the Meckel syndrome were monitored by ultrasonic scanning and amniotic fluid alpha-fetoprotein (AFP) assay. Second-trimester AFP testing in 14 pregnancies detected 1 of 2 affected fetuses, and was normal in all 12 pregnancies in which the child was normal. It is concluded that measurement of amniotic fluid AFP is helpful for Meckel syndrome only when there is an associated open neural tube defect. The importance of extremely careful ultrasonography is emphasized.

Amniotic Fluid↗
PubMed1980

Glial origin of rapidly adhering amniotic fluid cells.

Rapidly adhering cells (RA cells) from the amniotic fluid of a pregnancy with fetal anencephaly were investigated by immunofluorescence assay with an antiserum against glial cells. After 24 hours' cultivation a high proportion of the cells showed positive glial-specific fluorescence, whereas no staining was seen in cells from samples of normal amniotic fluid. At the 24th week the mother was delivered of a stillborn infant with anencephaly. Immunofluorescence staining of RA cells with glial-specific antiserum may be used for the differential diagnosis of fetal abnormalities associated with a high alpha-fetoprotein concentration in amniotic fluid.

Adult↗
PubMed1980

Management of vaginal agenesis.

Long-term results obtained through different methods of treatment were analysed in a series of 39 patients with congenital absence of the vagina. Thirty-three patients were treated with the McIndoe skin graft technique, 6 of them by the modification of Counseller and Davis. In three patients the neovagina was grafted with amnion and three were treated with the Frank nonoperative method. The result was graded good in 27 and satisfactory in 11 patients. In one patient the McIndoe operation resulted in a complete failure. There was no obvious difference between the results obtained by different methods except for the modification of Counseller and Davis which gave a good result in all cases. Judging from the general appearance and cytological pattern of the artificial vagina a more physiological result was achieved in patients with an amnion graft as compared with those with a skin graft. The nonoperative method is suggested as the first alternative in the treatment of patients with congenital absence of the vagina.

Adolescent↗