Search PubMed⌕ Search

Biomedical subjects

P Ylöstalo

Publications and source records attributed to P Ylöstalo.

At least 19 recordsLinked to original sources
PubMed2000

Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding: is it always necessary to perform an endometrial biopsy?

OBJECTIVE: This study was undertaken to evaluate whether it was possible to abstain from performing an endometrial biopsy when endometrial thickness according to transvaginal ultrasonography was </=4 mm in women with postmenopausal bleeding or irregular bleeding during hormone replacement therapy. STUDY DESIGN: Transvaginal ultrasonography was performed in 361 women aged >/=50 years who were referred because of postmenopausal bleeding or irregular bleeding during hormone replacement therapy. If endometrial thickness was </=4 mm, a Papanicolaou cervical smear was performed and the woman was reexamined with transvaginal ultrasonography after 4 and 12 months. Subjects were also instructed to return if they had recurrent bleeding, in which case transvaginal ultrasonography was performed and an endometrial biopsy specimen was obtained. Women with an endometrial thickness >/=5 mm underwent either curettage or endometrial biopsy. RESULTS: One hundred sixty-three women had an endometrial thickness </=4 mm. In this group one endometrial cancer that was missed by ultrasonography was diagnosed by cervical cytologic examination and two adnexal malignancies were diagnosed by ultrasonography. Endometrial malignancy was diagnosed in 0.6% of the women with an endometrial thickness </=4 mm. Endometrial biopsy was performed because of recurrent bleeding in 6.1% of cases and because of endometrial thickening in 8.1%. No cancer or hyperplasia was subsequently diagnosed among the women with an endometrial thickness </=4 mm. Endometrial cancer was diagnosed in 18.7% of the women with an endometrial thickness >/=5 mm. The corresponding figure when atypical hyperplasia and endometrial metastases were included was 20. 2%. CONCLUSION: If the false-negative rate of endometrial biopsy techniques is taken into account, then the combination of transvaginal ultrasonography and cervical cytologic examination is an adequate form of management for women with postmenopausal bleeding or irregular bleeding during hormone replacement therapy as long as endometrial thickness is </=4 mm. A randomized prospective study is necessary to verify this finding.

Biopsy↗
PubMed1998

Safety and efficacy of transdermal estradiol replacement therapy in postmenopausal liver transplanted women. A preliminary report.

OBJECTIVE: To determine the safety and efficacy of transdermal estrogen replacement therapy in liver transplanted menopausal women. SUBJECTS: Thirty-two menopausal women who had at least 6 months earlier undergone liver transplantation, ages from 46-70 years old receiving hormone replacement therapy. METHODS: The study was an open prospective. The subjects received transdermal estradiol replacement therapy in combination with progestin (EstracombR-Ciba, 50 microg/24 h, 250 microg/24 h) if the uterus was intact, and estradiol alone (EstradermR-Ciba, 50 microg) if the uterus had been removed. The follow-up time was 6 months. Liver function parameters and hemostatic parameters were measured at 0, 3 and 6 months. Gynecological transvaginal ultrasound (TVS) was performed at 0 and 6 months. The efficacy of the hormonal treatment was assessed by measuring serum concentrations of estradiol, estrone, FSH, LH and SHBG, by measuring endometrial thickness with TVS and by recording changes in subjective climacteric symptoms at 0 and 6 months. Safety was assessed by measuring liver enzyme activity, liver synthesis functions and coagulation factors. RESULTS: Estrogen replacement therapy did not impair any of the liver parameters measured and no thrombotic effect could be detected. Hormonal effects of the regimen prescribed could be verified both biochemically, clinically and by TVS. CONCLUSION: A clinically desired hormonal effect was achieved by the dose of 50 microg estradiol-17beta. Liver function and hemostatic balance were unaffected by the transdermal hormonal treatment. Immunosuppressive drugs and transdermal estrogen may well be combined.

Administration, Cutaneous↗
PubMed1998

Transvaginal ultrasonography at 18-23 weeks in predicting placenta previa at delivery.

OBJECTIVE: To evaluate whether transvaginal ultrasonography at 18-23 weeks' gestation is useful in predicting placenta previa at delivery. DESIGN: We performed transvaginal ultrasonography in addition to routine transabdominal ultrasonography in 3696 consecutive non-selected pregnant women with singleton fetuses and measured the distance from the placental edge to the internal cervical os. RESULTS: In 57 of 3696 patients (1.5%), the placental edge extended to or over the internal cervical os. In 27 patients (0.7%), the placenta extended > or = 15 mm over the internal cervical os; in these cases the positive predictive value of placenta previa at delivery was 19% (95% CI, 6-38%) with 100% (95% CI, 48-100%) sensitivity. With > or = 25 mm used as the cut-off point, ten cases (0.3%) were screen-positive and the positive predictive value for previa at delivery was 40% (95% CI, 12-74%) and sensitivity was 80% (95% CI, 28-100%). The frequency of placenta previa at delivery in this population was five of 3696 (0.14%, 95% CI, 0.04-0.31%). CONCLUSIONS: We recommend confirmatory transvaginal ultrasonography if placenta previa is suspected at transabdominal ultrasonography in mid-pregnancy, and reexamination at 26-30 weeks if the placental edge covers the internal cervical os by 15 mm or more.

Adolescent↗
PubMed1997

Increased nuchal translucency as a marker for fetal chromosomal defects.

BACKGROUND: Screening for trisomy 21 (Down's syndrome) by measuring maternal serum alpha-fetoprotein, chorionic gonadotropin, and estriol concentrations and then performing chorionic-villus sampling or amniocentesis identifies approximately 60 percent of fetuses with this disorder. We used ultrasonography to detect increased nuchal translucency and cystic hygroma, which are characteristic features of fetuses with chromosomal defects. METHODS: We performed transvaginal ultrasonography in 10,010 unselected adolescents and women less than 40 years of age with live singleton fetuses at 10 to 15.9 weeks of gestation. Increased fetal nuchal translucency was defined as an area of translucency at least 3 mm in width, and cystic hygromas were defined as septated, fluid-filled sacs in the nuchal region. Subjects whose fetuses had these findings were offered fetal karyotyping. Information on pregnancies, deliveries, and neonates was subsequently obtained from hospital records and national birth and malformation registries. RESULTS: Nuchal translucency or cystic hygroma was seen in 76 fetuses (0.8 percent), of which 18 (24 percent) had an abnormal karyotype. The sensitivity for trisomies 21, 18, and 13 combined was 62 percent (13 of 21 fetuses), and the sensitivity for trisomy 21 alone was 54 percent (7 of 13 fetuses). CONCLUSIONS: The use of transvaginal ultrasonography to detect increased nuchal translucency and cystic hygroma is a sensitive test for fetal aneuploidy. It can be done earlier in pregnancy than serum screening, and it decreases the subsequent need for chorionic-villus sampling or amniocentesis.

Adolescent↗
PubMed1997

Diagnosis of placenta previa by transvaginal sonographic screening at 12-16 weeks in a nonselected population.

OBJECTIVE: To evaluate the clinical significance of placenta previa at 12-16 weeks' gestation found by transvaginal sonographic screening. METHODS: An unselected population of 6428 pregnant women was scanned by transvaginal sonography during 1993-1994 to assess the gestational age and to diagnose major fetal anomalies. The location of the placenta was also recorded systematically. If the edge of the placenta extended over the internal cervical os, this distance was measured with electronic calipers. RESULTS: In 156 of 6428 patients (2.4%), the placental edge extended 15 mm or more over the internal cervical os at 12-16 weeks' gestation. Eight of these patients had placenta previa at delivery. Using this criterion at screening, two cases of placenta previa at delivery were missed. The frequency of placenta previa at delivery in this nonselected population was ten of 6428 (0.16%). CONCLUSIONS: The likelihood of placenta previa at delivery is 5.1% (95% confidence interval 2.2, 9.9) if the placenta extends at least 15 mm over the internal cervical os at 12-16 weeks' gestation.

Adult↗
PubMed1997

Endometrial sonographic and histologic findings in women with and without hormonal replacement therapy suffering from postmenopausal bleeding.

OBJECTIVES: To evaluate, in women with postmenopausal bleeding, the effect of hormonal replacement (HRT) therapy on the endometrial thickness as measured by transvaginal sonography in relation to endometrial histology. METHODS: 1110 women with sequential/progestin treatment (E + P) (n = 202), with Estriol treatment (n = 149) or without HRT (n = 759) and postmenopausal bleeding were examined by transvaginal sonography (TVS) prior to curettage, with special reference to the relation of endometrial thickness to its histopathology. RESULTS: The distribution of endometrial pathology was different in those women with E + P and Estriol compared with those without HRT. Endometrial pathology was found most frequently in women with an endometrium exceeding 8 mm in thickness. Furthermore, the incidence was found to increase with increasing endometrial thickness in all treatment groups. Atrophy was found significantly more often in women without HRT. Hormonal effects on the endometrium were found significantly more often in women with E + P and Estriol. Endometrial hyperplasia was found most commonly in women with Estriol in the thickness group 5 8 mm (P < 0.001) as compared to those with HRT and without HRT. Endometrial cancer occurs most in women without HRT, in those women with an endometrium exceeding 8 mm in thickness as compared both to the E + P (P < 0.001) group and to the Estriol (P < 0.001) group. Endometrial cancer did not occur in any woman (with E + P, Estriol or without HRT) with an endometrial thickness of < or = 4 mm. CONCLUSIONS: TVS is of value for excluding endometrial pathology in women with HRT and postmenopausal bleeding. The distribution of endometrial findings and histopathological diagnosis in women with abnormal postmenopausal bleeding was different in women with E + P than in women without HRT. Furthermore, the cut-off for excluding endometrial abnormalities is the same in both groups i.e. < or = 4 mm.

Endometrium↗
PubMed1997

Disappearance of human chorionic gonadotropin and its alpha- and beta-subunits after term pregnancy.

We have used high-specificity and precision immunofluorometric assays to measure the elimination half-times of human chorionic gonadotropin (hCG), hCG alpha, and hCG beta in serum over 21 days after delivery in six women with term pregnancies. Baseline concentrations and half-times were calculated with the use of a curve-fitting algorithm for multiexponential decay. In contrast to the two-component model, a three-component exponential function with baseline provided a fit for which predicted values could not be distinguished from the observed values by analysis of variance. Median half-times were 3.6, 18.0, and 53.0 h for hCG; 1.0, 23.4, and 194 h for hCG beta; and 0.6, 6.2, and 21.9 h for hCG alpha. The mean ratio of hCG alpha to hCG decreased rapidly from 36.9% to 3.3% on day 3; thereafter it increased to 64.3% 21 days after delivery because of a higher baseline concentration of hCG alpha. hCG beta had the slowest total elimination rate, and the ratio of hCB beta to hCG in serum increased from 0.8% before delivery to 26.7% after 21 days. If the metabolism of hCG and hCG beta is similar in patients with trophoblastic disease, the ratio of hCG beta to hCG must be evaluated with caution in samples taken several days after initiating therapy. We conclude that the disappearance of hCG beta from plasma is slower than previously recognized and that the ratios of hCG beta or hCG alpha to intact hCG vary as a function of postpartum time. Such information may be important in clinical studies of pregnancy disorders.

Adult↗
PubMed1996

Low-dose oral methotrexate with expectant management of ectopic pregnancy.

OBJECTIVE: To investigate recovery times and need for laparoscopy in women with ectopic pregnancy who were treated for 5 days 2.5 mg/day of oral methotrexate or placebo. METHODS: Sixty women with ectopic pregnancy among patients of an outpatient clinic specializing in early pregnancy disorders were selected for medical treatment in a double-blind, placebo-controlled study. The diagnosis was made by transvaginal sonography and serum hCG determinations, either at admission or after repeated examinations. Women were recruited for the study if they had mild symptoms: the hCG increase was less than 50% within 2 days, the diameter of the ectopic pregnancy was less than 40 mm, there were no signs of intra-abdominal bleeding by transvaginal sonography, and there were no secondary reasons for laparoscopy. Either 2.5 mg of methotrexate or placebo was given orally for 5 days. Serum hCG was determined after 2 days, and hCG, red blood cell count, white blood cell count, platelet count, and serum glutamic-oxaloacetic transaminase were measured; transvaginal sonography was performed after 5 and 12 days. Expectant management was continued individually with check-ups at 1-3-week intervals. Laparoscopy was performed if the patient developed abdominal pain or intra-abdominal hemorrhage, as seen by transvaginal sonography. Statistical analysis was by paired or unpaired t test, Mann-Whitney U test, regression analysis, and repeated measures analysis of variance. RESULTS: Seventy-seven percent of the patients recovered without the need for laparoscopy in both groups, and there were no significant differences in recovery times or the need for laparoscopy between groups. CONCLUSION: Oral methotrexate, 2.5 mg for 5 days, does not appear to be more effective than placebo in the treatment of ectopic pregnancy in women eligible for expectant management.

Adult↗
PubMed1996

Uterine findings by transvaginal sonography during percutaneous estrogen treatment in postmenopausal women.

OBJECTIVES: To evaluate the effect of hormone replacement treatment (HRT) with percutaneous estradiol and cyclical peroral medroxyprogesterone acetate (MPA) every month or every third month on the uterus and endometrium of postmenopausal women. METHODS: Uterine size and endometrial thickness were measured by transvaginal sonography in 159 postmenopausal women before HRT, and after 6 and 12 months on HRT during 9-12 days of the MPA administration periods. RESULTS: During HRT, uterine size and endometrial thickness increased. The percentage increase in uterine diameter varied between 3.8% and 19.6%, and endometrial thickness varied between 28.7% and 76.4%, being greater in the group receiving MPA every third month than in the groups receiving MPA every month. Myomas grew during the first 6 months on HRT but increased no further during the next 6 months on HRT. CONCLUSIONS: The increases in uterine size, myomas and endometrial thickness during HRT were moderate and not problematic and occurred mainly during the first 6 months on HRT.

Case-Control Studies↗
PubMed1996

Failure of creatine kinase to predict ectopic pregnancy.

OBJECTIVE: To investigate serum creatine kinase (CK) levels in pregnant women with ectopic pregnancy (EP), spontaneous abortion, and normal pregnancy with comparable serum hCG concentrations. DESIGN: A retrospective, case-controlled study. SETTING: Helsinki University Central Hospital, Helsinki, Finland. PATIENTS: Forty-four patients with a suspicion of EP of which 15 had laparoscopically confirmed tubal pregnancies; 15 had a spontaneous abortion, a blighted ovum, or a missed abortion; and 14 patients a normal intrauterine pregnancy. INTERVENTIONS: The diagnosis was made by transvaginal sonography and serum hCG determinations either at admission or after repeated examinations. Ectopic pregnancy was confirmed and treated by laparoscopy. MAIN OUTCOME MEASURES: Serum CK and hCG levels. RESULTS: No significant differences in CK levels were observed between the groups by one-way analysis of variance and no correlation was found between serum CK and hCG levels within any group. CONCLUSIONS: Creatine kinase does not appear to be useful in the diagnosis of early EP.

Case-Control Studies↗
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↗
PubMed1996

Ectopic pregnancy after in-vitro fertilization is characterized by delayed implantation but a normal increase of serum human chorionic gonadotrophin and its subunits.

We studied the dynamics of serum human chorionic gonadotrophin (HCG) and its free alpha (HCG alpha) and beta (HCG beta) subunits in 49 early pregnancies achieved by in-vitro fertilization (IVF) and embryo transfer. Of the 49 early pregnancies, nine were normal singleton pregnancies, 11 were twin pregnancies, 11 were ectopic, eight ended in a clinical (spontaneous) abortion and 10 ended in a preclinical abortion. The HCG, HCG alpha and HCG beta concentrations in serum were measured on days 12, 19 and 26 after embryo transfer. Most ectopic pregnancies could be distinguished from singleton (and twin) pregnancies on the basis of low HCG concentrations by 12 days after embryo transfer, but clinical abortions could not be distinguished from singleton pregnancies. In general, the measurement of HCG alpha and HCG beta and the molar ratios of the various forms provided only marginal additional value to that obtained from HCG, but on days 19 and 26 after embryo transfer HCG alpha was the most sensitive indicator of a normal pregnancy after IVF and embryo transfer. We conclude that in ectopic pregnancies the concentrations of HCG, HCG alpha and HCG beta increase as expected but 1.5 days later than in normal pregnancies. This appears to be the result of a delay in implantation.

Abortion, Spontaneous↗
PubMed1996

Clinical features of primary ovarian failure caused by a point mutation in the follicle-stimulating hormone receptor gene.

The recent finding that a mutation in the FSH receptor gene causes ovarian dysgenesis prompted the present study to determine the phenotype caused by this mutation. Twenty-two patients with ovarian dysgenesis and a 566C-->T mutation in the FSH receptor gene (designated FSH-resistant ovaries or FSHRO) were compared with 30 clinically similar patients with ovarian dysgenesis (designated ODG) who did not have this mutation. The genealogical studies suggested a founder effect of the FSH receptor gene mutation in Finland. Clinically, both groups of patients were characterized by primary or early secondary amenorrhea, variable development of secondary sex characteristics, and high serum levels of FSH and LH. Notable differences were observed in median adult height (FSHRO patients were shorter) and the occurrence of follicles judged by transvaginal sonography (observed in 6 of 8 FSHRO vs. 1 of 11 ODG) and ovarian histology (present in all 9 FSHRO vs. 1 of 4 ODG). These findings suggest that a subset of ovarian dysgenesis patients with the FSH receptor mutation 566C-->T is pathogenetically distinct, possibly due to residual receptor activity, and that these patients can be tentatively identified by demonstrating the presence of ovarian follicles and confirmed by mutation analysis.

Adolescent↗
PubMed1996

Tubal artery blood flow in evaluation of tubal pregnancy.

OBJECTIVE: To evaluate whether the assessment of tubal blood flow can indicate the side of the total pregnancy. METHODS: Using transvaginal color Doppler ultrasonography, we measured blood flow in the total arteries on both sides in 46 women with early ectopic pregnancy. We compared the resistance index (RI) and pulsatility index (PI) values of the tubal artery flow on the tubal pregnancy side to the contralateral side. RESULTS: The Resistance index (RI) and Pulsatility index (PI) values were lower at the tubal pregnancy side in 70% and 61%, respectively, when compared with the contralateral side. However, in the mean values of RI and PI the difference between the sides was not statistically significant. During the follow up in cases with spontaneous resolution between-side difference was often subjected to changes. CONCLUSION: Assessment of tubal blood flow by using transvaginal color Doppler sonography to the evaluation of the side of tubal pregnancy has limited clinical value.

Fallopian Tubes↗
PubMed1995

Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding--a Nordic multicenter study.

OBJECTIVE: The purpose of this study was to use transvaginal ultrasonographic measurements to find the thickness of the endometrium below which the risk of endometrial abnormality in women with postmenopausal bleeding is low. STUDY DESIGN: This multicenter study was carried out at eight clinics in four Nordic countries. The study included 1168 women with postmenopausal bleeding scheduled for curettage Before the curettage was performed, the thickness of the endometrium was measured with transvaginal ultrasonography. The measurement included both endometrial layers (double-layer technique). The transvaginal ultrasonographic measurement was compared with the histopathologic diagnosis of the curettage specimens. RESULTS: In women with atrophic endometrium the mean endometrial thickness (+/- SD) was 3.9 +/- 2.5 mm. The corresponding figures for women with endometrial cancer were 21.1 +/- 11.8 mm. No malignant endometrium was thinner than 5 mm. In 30 women (2.8%) it was not possible to measure the thickness of the endometrium; one of these women had endometrial cancer. The 95% confidence limit for the probability of excluding endometrial abnormality was 5.5% when the endometrial thickness was < or = 4 mm as measured by transvaginal ultrasonography. CONCLUSION: The risk of finding pathologic endometrium at curettage when the endometrium is < or = 4 mm as measured by transvaginal ultrasonography is 5.5%. Thus in women with postmenopausal bleeding and an endometrium < or = 4 mm it would seem justified to refrain from curettage.

Adult↗
PubMed1995

Oral contraceptive containing natural estradiol for premenopausal women.

An open multicenter trial was performed in six centers in Finland to study the efficacy, safety and acceptability of a new biphasic oral contraceptive pill containing natural estradiol and cyproterone acetate. The participants were 288 women with a mean age of 39.3 +/- 3.4 years (range 30-49) who were willing to use the new pill as their only contraceptive method. In total, 23% of the women were smokers. The cumulative experience was 2800 treatment cycles during the first year. The net 12-month continuation rate was 63%. One pregnancy occurred in a woman who lost 5 tablets in the second treatment cycle, which gives a 12-month cumulative pregnancy rate of 0.4%. Serum progesterone values, determined twice during the third treatment cycle, showed ovulation inhibition in 95% of women. There were no serious side effects. Intermenstrual bleeding was recorded by 35.5% and 24.5% of women at 3 and 12 months, respectively. The bleedings became scantier in most women and dysmenorrhoea disappeared. No changes were observed in total and high density lipoprotein cholesterol concentrations after 1 year. With the exception of intermenstrual spotting, the efficacy, safety and acceptability of the new pill was almost as good as that of the modern low dose oral contraceptives. This is the first pill containing natural estradiol that has gained clinical acceptance and which can also be prescribed for smokers over 35 years old until the climacteric.

Adult↗
PubMed1995

Transvaginal sonography and serum hCG in monitoring of presumed ectopic pregnancies selected for expectant management.

We studied sonographic findings and levels of human chorionic gonadotropin (hCG) in 71 patients with a presumed ectopic pregnancy, recruited for conservative management, to find out whether these parameters may be useful in monitoring treatment. Patients were selected on the basis of decreasing hCG levels, minimal symptoms and an adnexal mass, suggestive of ectopic pregnancy, of < or = 5 cm at transvaginal sonography. In 49 (69%) patients the ectopic pregnancy resolved spontaneously: the adnexal mass resolved significantly more slowly than did hCG levels. In 22 (31%) of the cases laparoscopy was required after an average of 9 days, because of worsening clinical symptoms. The initial size of the ectopic pregnancy did not significantly differ between the two groups, but it increased constantly in the laparoscopy group. The number of patients with free pelvic fluid also increased significantly in the laparoscopy group, whereas blood flow patterns at admission and during follow-up did not differ between the two groups. A decrease in ectopic pregnancy size at day 7 had a sensitivity of 84% and a specificity of 100% in predicting spontaneous resolution. Transvaginal sonography monitoring appears useful in recognizing the ectopic pregnancies most likely to resolve spontaneously without complications.

Adult↗