PubMed Health⌕ Search

Biomedical subjects

M Hippeläinen

Publications and source records attributed to M Hippeläinen.

At least 19 recordsLinked to original sources
PubMed2005

Low-dose aspirin does not improve ovarian responsiveness or pregnancy rate in IVF and ICSI patients: a randomized, placebo-controlled double-blind study.

BACKGROUND: Poor ovarian and endometrial responses to gonadotrophin stimulation in assisted reproduction techniques lead to decreased pregnancy rates. The aim of the present study was to test the hypothesis that low-dose aspirin started prior to controlled ovarian stimulation improves ovarian responsiveness, pregnancy rate (PR) and pregnancy outcome. METHODS: A total of 374 women who were to undergo IVF/ICSI were randomized to receive 100 mg of aspirin (n=186) or placebo (n=188) daily. Treatment was started on the first day of controlled ovarian stimulation. It was continued until menstruation or a negative pregnancy test. Pregnant women continued the medication until delivery. The main outcome measures were the number of oocytes, number and quality of embryos, the clinical PR and pregnancy outcome. RESULTS: The mean (+/-SD) number of oocytes (12.0+/-7.0 versus 12.7+/-7.2), the total mean number of embryos (5.82+/-4.35 versus 5.99+/-4.66), the mean number of top quality embryos (0.99+/-1.39 versus 1.18+/-1.51) and the number of embryos transferred (1.64+/-0.64 versus 1.63+/-0.71) did not differ in the aspirin and placebo groups. Between the aspirin and placebo group, there was no statistically significant difference in clinical PR per embryo transfer (25.3%, n=44 out of 174 versus 27.4%, n=48 out of 175) or clinical PR per cycle initiated (23.7% versus 25.5%). Birth rate per embryo transfer did not differ significantly between the aspirin (18.4%) and placebo (21.1%) groups. The incidence of poor responders [12 (6.5%) versus 13 (6.9%)] was similar in both groups. CONCLUSIONS: The present results indicate that low-dose aspirin treatment does not have any beneficial effect on ovarian responsiveness, PR and pregnancy outcome in unselected women undergoing IVF/ICSI.

Adult↗
PubMed2003

Polymorphism in the peroxisome proliferator-activated receptor-gamma gene in women with polycystic ovary syndrome.

BACKGROUND: In view of the strong evidence implicating peroxisome proliferator-activated receptor-gamma (PPARgamma) in adiposity and insulin resistance a study was carried out to investigate PPARgamma genotype frequencies in women with polycystic ovary syndrome (PCOS) and to elucidate its role in the pathogenesis of the syndrome. METHODS: The study involved 135 women with PCOS and 115 healthy control women who were genotyped for a known functional variant of the PPARgamma gene using single strand conformation polymorphism (SSCP) analysis. RESULTS: A significantly different allele distribution of the Pro12 Ala polymorphism of the PPARgamma gene was observed between the two groups, with the frequency of the variant Ala isoform being significantly reduced in the PCOS group (12.6%) when compared with the control group (19.1%) (P = 0.045), at an odds ratio of 0.609 (95% confidence interval: 0.374-0.991). The genotype distributions of the Pro12 Ala polymorphism in the PCOS and control groups were different with borderline significance (P = 0.051). CONCLUSIONS: Our data support a role for PPARgamma gene polymorphism in the pathogenesis of PCOS, the presence of the Ala isoform being protective against the development of PCOS.

Alleles↗
PubMed2002

Prediction of atrial fibrillation after coronary artery bypass grafting by measuring atrial peptide levels and preoperative atrial dimensions.

OBJECTIVE: We prospectively tested the hypothesis that atrial enlargement and increased level of atrial natriuretic peptide, N-terminal atrial natriuretic peptide and brain natriuretic peptide would predict atrial fibrillation after coronary artery bypass grafting. METHODS: Eighty-eight elective coronary artery bypass grafting patients had preoperative echocardiographic assessment. The level of atrial natriuretic peptide, N-terminal atrial natriuretic peptide and brain natriuretic peptide were measured preoperatively. Patients were ECG- monitored during the whole hospital stay. RESULTS: Thirty one (35.2%) patients had postoperative atrial fibrillation. In univariate analysis increased age (P=0.003), enlargement of left and right atria (P=0.002 and P=0.004, respectively) and increased level of preoperative atrial natriuretic peptide and N-terminal atrial natriuretic peptide (P=0.016 and P=0.03, respectively) were associated with postoperative atrial fibrillation. There was correlation between the age and level of N-terminal atrial natriuretic peptide (r=0.45 and P<0.001). In multivariate analysis only age and the left atrial enlargement were independent predictors of postoperative atrial fibrillation (P=0.02 and P=0.01). CONCLUSION: Left atrial enlargement was independent predictor for postoperative atrial fibrillation. However, atrial peptides were associated with age and did not independently predict postoperative atrial fibrillation. In addition, the wide variation of the peptide levels renders the implementation of this measure in clinical practice superfluous.

Age Factors↗
PubMed2002

Lack of association between C-850T polymorphism of the gene encoding tumor necrosis factor-alpha and polycystic ovary syndrome.

In the present study, we determined whether genetic variability in the gene encoding tumor necrosis factor-alpha (TNF-alpha) contributes to individual differences in susceptibility to the development of polycystic ovary syndrome (PCOS). The study involved 87 Caucasian Finnish women with PCOS and 115 healthy control women who were genotyped for the C-850T polymorphism in the TNF-alpha gene promoter. Analysis by chi(2) was used to assess genotype and allele frequency differences between PCOS women and controls. A similar genotype distribution for the C-850T polymorphism was observed in the two groups, with the frequency of the variant T allele being 8.6% in the PCOS group and 9.6% in the control group (p = 0.862). Accordingly, the profile of genotype frequencies was similar in the groups. The observed profiles of allele and genotype frequencies confirm an equilibrium state between C-850T polymorphism and PCOS and suggest that polymorphism of the TNF-alpha gene is unlikely to contribute to the risk of PCOS.

Alleles↗
PubMed2002

Feasibility of predicting the risk of atrial fibrillation after coronary artery bypass surgery with logistic regression model.

BACKGROUND AND AIMS: The aim of this study was to determine the risk factors of postoperative atrial fibrillation (AF) after coronary artery bypass grafting and to create predictive model and to evaluate the effects of AF on patients outcome. MATERIAL AND METHODS: Data of 3,676 consecutive patients were analysed to identify the predictors of AF. Multivariate logistic regression model was validated prospectively in 1,107 patients. RESULTS: Increasing age (p < 0.001), preoperative use of digoxin (p = 003), need of intra-aortic balloon pump or inotropic medication in the weaning off cardiopulmonary by pass or during the first 24 hours postoperatively (p = 0.013), increasing body surface area (p = 0.006) and lower ejection fraction (p = 0.048) were independent risk factors for postoperative AF. The predictive model gave area under the receiver-operating characteristic (ROC) curve 0.682, 95% confidence interval 0.663-0.701, and p < 0.001. The patients with AF incidence had more postoperative stroke (p = 0.008), confusion (p < 0.001) severe gastrointestinal complications (p = 0.005), readmission to ICU (p < 0.001), longer ICU (p < 0.001) and hospital stay (p < 0.001) when compared with the patients who remained in sinus rhythm. CONCLUSION: Logistic regression model with the parameters used was not accurate enough for clinical purposes. Postoperative AF is associated with postoperative stroke, severe gastrointestinal complications, readmission to ICU, and longer ICU and hospital stay.

Aged↗
PubMed2001

Apolipoprotein E alleles in women with polycystic ovary syndrome.

OBJECTIVE: To investigate the frequency of apoE alleles among women with polycystic ovary syndrome. DESIGN: Retrospective case-control study. SETTING: University-based endocrinology/infertility clinic. PATIENT(S): Healthy fertile women (n = 91) and women with a diagnosis of polycystic ovary syndrome (n = 58). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The presence of the three most common apoE alleles (epsilon2, epsilon3, and epsilon4) determined by polymerase chain reaction-restriction fragment length polymorphism in the two groups and in the general population in our area. RESULT(S): The frequency of the apo epsilon4 allele was 17.2% among women with polycystic ovary syndrome and was 18.7% among healthy fertile women, which is close to the rate in the general population in our area (19%). None of the apoE genotypes (Fisher's exact test; P=.71) or alleles (P=.78) was significantly overrepresented, and the homozygous genotype epsilon4 was not associated with the clinical disease. CONCLUSION(S): The observed profiles of allele and genotype frequencies confirm the equilibrium state between apoE polymorphism and polycystic ovary syndrome and suggest that apoE does not play a major role in the development of hyperlipidemia in the group of women with polycystic ovary syndrome.

Alleles↗
PubMed2001

Increased density of brain histamine H(1) receptors in rats with portacaval anastomosis and in cirrhotic patients with chronic hepatic encephalopathy.

The binding properties and the regional densities of histamine H(1) receptors were studied in brain of rats with portacaval anastomosis (PCA) and in autopsied brain tissue from cirrhotic patients with hepatic encephalopathy (HE). Receptor binding studies and quantitative receptor autoradiography were performed, employing [(3)H]mepyramine. Histamine H(1) receptors in rat brain displayed a higher density and a lower affinity compared with control human frontal cortex. Specific [(3)H]mepyramine binding was heterogeneously distributed throughout the brain in both species. In human brain, binding was highest in the parietal and temporal cortices and lowest in caudate-putamen. In rat brain, binding was highest in the suprachiasmatic nucleus, dentate gyrus of the hippocampus, ventromedial hypothalamus, and nucleus accumbens. Cortical tissue from PCA rats and frontal cortical tissue from HE patients contained significantly increased densities (B(max)) of H(1) receptors. A selective increase in H(1) receptor density was also observed in parietal and insular cortices of HE patients. Results of the present study suggest a selective up-regulation of brain H(1) receptors in PCA rats and in patients with HE. The central histaminergic system is implicated in the control of arousal and circadian rhythmicity. Previous studies have shown that blockade of H(1) receptors in PCA rats results in improved locomotor activity and circadian rhythmicity scores. The present findings suggest that cortical histaminergic hyperactivity could contribute to the neuropsychiatric symptoms characteristic of human HE, and that selective histamine H(1) receptor antagonists could be beneficial in the prevention and treatment of some of the symptoms of HE in cirrhotic patients.

Aged↗
PubMed2001

Relationship of the metabolic syndrome and obesity to polycystic ovary syndrome: a controlled, population-based study.

OBJECTIVE: Although hyperinsulinemia seems to be an essential feature of polycystic ovary syndrome, the frequency of gynecologic disorders related to polycystic ovary syndrome at a population level in women with evident metabolic syndrome is not known. STUDY DESIGN: We conducted a cross-sectional, population-based study. Participants (N = 204) were recruited from a random sample of women in 5 age groups (range, 35-54 years) living in a defined area. Metabolic syndrome was considered to be present if 3 of the following 8 criteria were fulfilled: (1) first-degree relative with type II diabetes, (2) body mass index > or = 30 kg/m2, (3) waist/hip ratio > or = 0.88, (4) blood pressure > or = 160/95 mm Hg or drug treatment for hypertension, (5) fasting serum triglyceride level > or = 1.70 mmol/L, (6) high-density lipoprotein cholesterol value < 1.20 mmol/L, (7) abnormal glucose metabolism, and (8) fasting insulin value > or = 13.0 mU/L. The frequency of metabolic syndrome was 106 (19.5%) of 543 cases. The control group consisted of 62 overweight women without central obesity or metabolic syndrome and 53 healthy lean women (body mass index < 27 kg/m2. RESULTS: The group with metabolic syndrome differed from the other women according to most of the selection criteria and also had the highest free testosterone concentration. However, there were no differences between the groups regarding parity, infertility problems, or obstetric outcome. However, oligomenorrhea appeared to be more common in women with metabolic syndrome, especially in those with more severe symptoms (46.2%), than in obese (25.4%) and lean (15.1%) control subjects. Polycystic-like ovaries were detected by vaginal ultrasonography with similar frequency (13.1%, 15.3%, and 13.2% in women with metabolic syndrome, obese women, and lean women, respectively). CONCLUSIONS: Surprisingly few women with metabolic syndrome had symptoms suggestive of polycystic ovary syndrome, in comparison with obese and lean women. Our results suggest that at the population level polycystic ovary syndrome only accounts for a distinct subgroup of a much wider problem, metabolic syndrome.

Adult↗
PubMed2001

[Endometriosis].

Explore the source record for details and available documents.

Age Factors↗
PubMed2000

Effects of the histamine H(1) receptor blocker, pyrilamine, on spontaneous locomotor activity of rats with long-term portacaval anastomosis.

To find out whether the changes in the brain histaminergic system are involved in the pathophysiology of portal-systemic encephalopathy, we examined the effects of histamine H(1) receptor blockade on spontaneous locomotor activity, feeding, and circadian rhythmicity in rats with portacaval anastomosis (PCA). Pyrilamine, an H(1) receptor blocker (15 mg/kg/day), was delivered with osmotic minipumps. Spontaneous locomotor activity was recorded for 72 hours in the open-field with an electromagnetic detector. Food intake was monitored twice daily at the end of the light (7 PM) and the dark (7 AM) phases for 3 days. Histamine H(1) receptor density in the suprachiasmatic nucleus (SCN) was examined with receptor autoradiography, employing [(3)H]pyrilamine. PCA surgery led to decreased movement time and velocity and flattened amplitude of the circadian rhythms of locomotion and feeding. In sham-operated rats, pyrilamine significantly decreased the movement time and velocity, as well as the total food consumption and completely abolished the circadian rhythmicity of locomotion. In contrast, pyrilamine increased the movement time and velocity in PCA-operated rats, particularly in the dark phase, and improved the precision of the circadian rhythms of locomotion and feeding. Histamine H(1) receptor density was not altered by PCA surgery, whereas pyrilamine treatment led to the complete blockade of H(1) receptors in both sham- and PCA-operated rats. We suggest that histaminergic imbalance has contributed to the generation and maintenance of the decreased spontaneous locomotor activity and altered circadian rhythmicity following PCA surgery in the rat, probably via an H(1) receptor-mediated mechanism.

Animals↗
PubMed2000

Pituitary gonadal axis and child rate in males with classical 21-hydroxylase deficiency.

Though appropriate glucocorticoid substitution therapy should abolish both cortisol deficiency and adrenal androgen excess in patients with 21-hydroxylase deficiency (21-OHD), the long-term outcome is not always satisfactory. There are several reports on low adult height in both male and female patients, and impaired fertility has been reported in females with 21-OHD. There are only few reports on gonadal function of adult male patients with 21 -OHD. In this study, we calculated the child rate of all the 29 diagnosed adult Finnish males with classical 21-OHD and compared it with the mean child rate of the whole Finnish male population with equal age distribution. Sixteen males with 21-OHD and their age-matched healthy controls were further examined in a cross-sectional study. Auxology and pituitary gonadal axis were examined in both patients and controls. Testicular ultrasonography of the patients was also performed. The mean child rate of the 29 males with 21-OHD was 0.07 which was significantly lower (p<0.001) than that in the Finnish male population of the same age (0.34). In the cross-sectional study, males with 21-OHD had serum testosterone, inhibin B, LH and FSH concentrations comparable to those of healthy controls and reference values. Serum DHEA-S concentrations were remarkably low, even in the undersubstituted males with 21-OHD (p<0.001, compared with the healthy controls). In the patient group, serum inhibin B concentration did not correlate with serum FSH concentration. Adrenal rest tumors of the testicles were found in two undersubstituted males with 21-OHD. In conclusion, our study suggests normal pituitary and gonadal function but reduced child rate in adult males with 21-OHD. This might be explained by suboptimal psychosocial adaptation to the chronic disease. However, the patients in this study were young and the final child rate may become essentially higher.

17-alpha-Hydroxyprogesterone↗
PubMed2000

Intra-institutional prediction of outcome after cardiac surgery: comparison between a locally derived model and the EuroSCORE.

OBJECTIVE: To construct models for predicting mortality, morbidity and length of intensive care unit (ICU) stay after cardiac surgery and to compare the performance of these models with that of the EuroSCORE in two independent validation databases. METHODS: Clinical data on 4592 cardiac surgery patients operated between 1992 and 1996 were retrospectively collected. In order to derive predictive models and to validate them, the patient population was randomly divided into a derivation database (n=3061) and a validation database (n=1531). Variables that were significant in univariate analyses were entered into a backward stepwise logistic regression model. The outcome was defined as mortality within 30 days after surgery, predefined morbidity, and the length of ICU stay lasting >2 days. In addition to the retrospective database, the models were validated also in a prospectively collected database of cardiac surgical patients operated in 1998-1999 (n=821). The EuroSCORE was tested in two validation databases, i.e. the retrospective and prospective one. Hosmer-Lemeshow goodness-of-fit was used to study the calibration of the predictive models. Area under the receiver operating characteristic (ROC) curve was used to study the discrimination ability of the models. RESULTS: The overall mortality in the retrospective and the prospective data was 2 and 1%, and morbidity 22 and 18%, respectively. The created predictive models fitted well in the validation databases. Our models and the EuroSCORE were equally good in discriminating patients. Thus, in the prospective validation database, the mean areas under the ROC curve for our models and for the EuroSCORE were similar, i.e. 0.84 and 0.77 for mortality, 0.74 and 0.74 for morbidity, and 0.81 and 0.79 for the length of intensive care unit stay lasting for 2 days or more, respectively. CONCLUSIONS: Our models and the EuroSCORE were equally good in discriminating the patients in respect to outcome. However, our model provided also well calibrated estimation of the probability of prolonged ICU stay for each patient. As was originally suggested, the EuroSCORE may be an appropriate tool in categorizing cardiac surgical patients into various subgroups in interinstitutional comparisons. Our models may have additive value especially in resource allocation and quality assurance purposes for local use.

Adolescent↗
PubMed2000

A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients.

UNLABELLED: Organ dysfunction and multiple organ failure are the main causes of prolonged hospital stay after cardiac surgery, which increases resource use and health care costs. Increased levels of oxygen delivery and consumption are associated with improved outcome in different groups of postoperative patients. Cardiac surgical patients are at risk of inadequate perioperative oxygen delivery caused by extracorporeal circulation and limited cardiovascular reserves. The purpose of our study was to test whether increasing oxygen delivery immediately after cardiac surgery would shorten hospital and intensive care unit (ICU) stay. Four hundred three elective cardiac surgical patients were enrolled in the study and randomly assigned to either the control or the protocol group. Goals of the protocol group were to maintain SvO(2) >70% and lactate concentration < or =2.0 mmol/L from admission to the ICU and up to 8 h thereafter. Hemodynamics, oxygen transport data, and organ dysfunctions were recorded. The median hospital stay was shorter in the protocol group (6 vs 7 days, P < 0.05), and patients were discharged faster from the hospital than those in the control group (P < 0.05). Discharge from the ICU was similar between groups (P = 0. 8). Morbidity was less frequent at the time of hospital discharge in the protocol group (1.1% vs 6.1%, P < 0.01). Increasing oxygen delivery to achieve normal SvO(2) values and lactate concentration during the immediate postoperative period after cardiac surgery can shorten the length of hospital stay. IMPLICATIONS: Health care economics has challenged clinicians to reduce costs and improve resource use in cardiac surgery and anesthesia in a patient population increasing in age and in severity of disease. Optimizing cardiovascular function to maintain adequate oxygen delivery during the immediate postoperative period after cardiac surgery can decrease morbidity and reduce length of hospital stay.

Cardiac Surgical Procedures↗
PubMed2000

Conduction defects after coronary artery bypass grafting--a disappearing problem?

BACKGROUND AND AIMS: To evaluate the incidence of conduction defects (CDs) following coronary artery bypass grafting (CABG) in three different patient populations, to assess the etiologic factors associated with CDs, and to find out their effect on immediate postoperative outcome of the patient. MATERIAL AND METHODS: Three patient populations were prospectively studied: cohort A consisted of 180 CABG-patients operated between 1990-91, cohort B of 100 patients operated during the year 1993 and cohort C of 118 patients operated from April 1997 to June 1997. Cold crystalloid cardioplegia was used throughout the study years. In the first cohort A, two separate cavae were cannulated and clamped, venting through the right upper pulmonary vein was used, iced cold saline was used in pericardium, and cardioplegia was given until a myocardial temperature of 10-15 degrees of Celcius was attained. In the two later cohorts, two-stage venous cannula and aortic root venting were used and cardioplegia was given only until the activity of the myocardium stopped. Proximal anastomoses were performed after aortic declamping in cohort A, and during aortic occlusion in the two later cohorts. RESULTS: The incidence of permanent CDs in cohort A was 36%, in cohort B 5% and in cohort C 1%. Permanent atrioventricular (AV-) and left-sided blocks disappeared first. Left main coronary artery stenosis and low myocardial temperatures were associated with CDs. Patients with permanent CDs had more often low cardiac output after the operation, their values of cardiac enzymes were higher, and they had more often postoperative infarction than patients without CDs. CONCLUSIONS: The disappearance of all long lasting AV- and left-sided blocks simultaneously with decreasing plasma levels of cardiac enzymes is evidence that protection of both conduction tissue and myocardium had considerably improved in the two later cohorts. Giving cardioplegia in smaller amounts and more often at the same time when raising the general temperature during perfusion were the main reasons for the disappearance of postoperative CDs.

Arrhythmias, Cardiac↗
PubMed2000

Child rate, pregnancy outcome and ovarian function in females with classical 21-hydroxylase deficiency.

BACKGROUND: Ovulatory disorders and decreased fertility rates have been found in females with classical 21-hydroxylase deficiency (21-OHD). We analyzed the pregnancies of 29 females with classical 21-hydroxylase deficiency and examined 16 of these women in a cross-sectional study. METHODS: The child rate of the 29 patients was compared with that in the general Finnish female population with equal age distribution.The cross-sectional study of the 16 patients included a standardized questionnaire, clinical examination, ultrasonography of the internal genitalia, basal measurements of serum steroids, sex hormone binding globulin, PRL, gonadotropins and plasma ACTH. RESULTS: The child rate was significantly lower than that in the general population (0.34 vs 0.91; p<0.001). A total of 13 pregnancies could be registered. From these pregnancies, ten healthy children were born, all for females with a simple virilizing disease. None of the nine females with salt wasting 21-OHD had any children or had sought treatment for infertility. In the cross-sectional study, females with regular menses (5/16; 31%) had well controlled adrenal androgen secretion and they had normal serum progesterone concentrations whereas the females with irregular menses (11/16; 69%) were often undersubstituted and presented with high serum progesterone concentration in the follicular phase. Polycystic ovaries could not be detected in any of these patients. CONCLUSIONS: Females with simple virilizing 21-OHD often have irregular menses but their final prognosis for fertility seems to be better than previously reported. On the contrary, our study confirms the extremely low child rate in the salt wasting group.

Adolescent↗