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P Jouppila

Publications and source records attributed to P Jouppila.

At least 19 recordsLinked to original sources
PubMed1992

Immunohistochemical detection of human estrogen receptor with region D-specific antipeptide antibodies.

To study the possibility of using antipeptide antibodies for the immunohistochemical determination of human estrogen receptors (ER), three peptides corresponding to the putative major antigenic regions of the human ER (Met12-Leu26, or ERP1; Thr227-Gln267, or ERP2; Leu256-Gly275, or ERP3) were used to produce site-specific rabbit polyclonal antipeptide antisera. High titer antibodies were obtained against all the peptides used, as judged by time-resolved fluoroimmunoassay. The antibodies against region D (ERP3) specifically immunoprecipitated the ER proteins in vitro, as did the antiERP2 antibodies to a much smaller extent. With one of the region D-specific antibodies (antiERP3 Ab2) ER could also be immunohistochemically detected. When benign and malignant human breast and normal endometrial tissues were used, the immunohistochemical staining observed with these antipeptide antibodies correlated well with the staining obtained with an established method. Thus, the results reported here show that this part of region D in ER is a potential antigenic epitope for the production of site-specific antibodies against ER. Antipeptide antibodies produced against this region can be used to immunolocalize the ER in various normal and pathological human tissues.

Breast Neoplasms↗
PubMed1992

Color Doppler flow as an indicator of trophoblastic activity in tubal pregnancies detected by transvaginal ultrasound.

OBJECTIVE: To evaluate the potential benefits of transvaginal color Doppler in the diagnostic evaluation of tubal pregnancies. METHODS: Fifty-two women with suspected tubal pregnancy were examined by transvaginal ultrasonography and color Doppler. Those with positive scans were referred for exploratory laparoscopy. The area of the tubal pregnancy was examined by color flow imaging and the resistance indexes (RIs) of the artery blood flows were calculated. The pulsatility indexes (PIs) of both uterine arteries were also measured and serum beta-hCG was quantitated. RESULTS: Tubal pregnancy was diagnosed by transvaginal ultrasonography in 38 of the patients. There were two false-negative and two false-positive results. Color flow in the trophoblastic tissue was detected in 50% of the tubal pregnancies, and the mean (+/- standard deviation) RI of the trophoblastic flows was 0.51 +/- 0.12. The RIs of the trophoblastic flows tended to decrease at higher beta-hCG levels, and 88.2% of the cases with detectable trophoblastic flow had beta-hCG above 800 mIU/mL. The average PI of the uterine arteries was 2.28 +/- 0.89. The PIs of the ipsilateral uterine arteries were significantly lower in the patients with trophoblastic flow than in those without it. CONCLUSION: By monitoring trophoblastic activity, color Doppler may differentiate between active and inactive disease and could assist in choosing the correct treatment.

Adult↗
PubMed1992

Fatal fetal abnormalities. Route of delivery and effect of the development of antepartum diagnostics in the last 13 years.

The appropriateness of cesarean section as the route of delivery in pregnancies complicated by fatal fetal abnormalities was evaluated in an obstetric population of 47,924 deliveries during the years 1978-90. The incidence of fatal fetal abnormalities was 0.50% and did not change during the study period. The cesarean section rate was twice that in the whole obstetric population, and the procedure was performed mainly for inappropriate fetal indications. One-third of the sections were caused by antepartum or intrapartum fetal distress. After the advent of sophisticated real-time ultrasound equipment, the obstetric management of those cases seemed to increase, but later the incidence of cesarean sections for fetal indications decreased, from increased experience with assessing the prognosis of malformed fetuses and increased opportunities to examine the fetal karyotype. Some conservatism seems justified when choosing obstetric management of a malformed fetus before large, controlled, clinical studies become available.

Cesarean Section↗
PubMed1991

Uteroplacental and fetal haemodynamics during extradural anaesthesia for caesarean section.

We have studied the effects of extradural anaesthesia with bupivacaine (plain) in eight healthy parturients undergoing elective Caesarean section, on blood flow in maternal uterine and placental arcuate arteries and in fetal umbilical, renal and middle cerebral arteries, using a colour Doppler technique. Simultaneously, fetal myocardial function was investigated by M-mode echocardiography. Maternal and fetal blood velocity waveform indices did not change significantly. We found no changes in fetal myocardial function with extradural anaesthesia, except for an increase in the right ventricular inner end-diastolic dimensions. These results suggest that extradural anaesthesia has no detrimental effects on uteroplacental and fetal circulations in the uncomplicated pregnancy when maternal hypotension is avoided with rapid prehydration.

Anesthesia, Epidural↗
PubMed1991

Effects of extradural bupivacaine with adrenaline for caesarean section on uteroplacental and fetal circulation.

We have studied the effects of an extradural block using bupivacaine with adrenaline 90-100 micrograms on blood flow in the maternal uterine and placental arcuate arteries and the fetal umbilical, renal and middle cerebral arteries, using a colour Doppler technique in eight healthy parturients undergoing elective Caesarean section. Fetal myocardial function was investigated simultaneously by M-mode echocardiography. Maternal heart rate increased and diastolic arterial pressure decreased after extradural administration of bupivacaine with adrenaline. The latter effect was relieved by increasing the infusion rate in every case and none of the patients required vasopressors. There were no significant differences in maternal or fetal blood velocity waveforms, and no significant changes were found in any of the fetal myocardial measurements relative to control values. These observations suggest that extradural anaesthesia using bupivacaine with adrenaline does not have an adverse effect on vascular resistance in the uteroplacental or fetal circulations or on fetal myocardial function in normal pregnancy when bupivacaine-adrenaline is administered fractionally and maternal hypotension is prevented by rapid crystalloid volume loading.

Anesthesia, Epidural↗
PubMed1991

Immunohistochemical localization of 17 beta-hydroxysteroid dehydrogenase in the human endometrium during the menstrual cycle.

Immunoaffinity-purified polyclonal anti-rabbit antibody against human placental 17 beta-hydroxysteroid dehydrogenase (17HSD) was used to localize 17HSD in frozen sections of 21 human endometrial tissue specimens, taken at different stages of the menstrual cycle, and in the human placenta. The presence and distribution of estrogen and progesterone receptors were also analyzed in endometrial specimens using commercial immunohistochemical techniques. In addition, 17HSD was localized by immunoelectron microscopy in the endometrium and the placenta. In the endometrium, immunostaining of 17HSD appeared in the cytoplasm of surface epithelial and gland cells during the early and midluteal phase. During the late luteal phase, it gradually disappeared. No immunostaining was observed in the endometrium during the follicular phase of the menstrual cycle. The changes in staining intensity of 17HSD were associated with changes in the concentration of serum progesterone as judged by radioimmunoassay. An apparent inverse correlation between 17HSD expression and the concentrations of estrogen and progesterone receptors was observed. These results strongly support the concept that progesterone induces an increase in the amount of 17HSD, in the glandular and surface epithelial cells of the human endometrium. In the human term placenta, 17HSD immunostaining was detected exclusively in the cytoplasm of syncytiotrophoblasts. In immunoelectron microscopic studies of the endometrium and placenta, 17HSD staining was observed in the cytoplasm and it was associated with cytoplasmic membranes unrelated to the endoplasmic reticulum.

17-Hydroxysteroid Dehydrogenases↗
PubMed1991

Studies of uteroplacental and fetal hemodynamics by Doppler ultrasonography.

The role of Doppler ultrasonographic techniques in examining blood velocity waveforms in the different fetal and uteroplacental arteries is evaluated, and the association between pathologic blood velocity waveforms and early signs of disease is reviewed. These areas are discussed with respect to umbilicoplacental circulation, uterine circulation, and fetal cerebral and peripheral hemodynamics. Also reviewed are the use of Doppler techniques to determine the effects of vasoactive agents on the uterine and fetal circulation, and the use of color Doppler imaging in the exact localization of the short and small uterine and fetal vessels.

Blood Flow Velocity↗
PubMed1990

Immunological measurement of human 17 beta-hydroxysteroid dehydrogenase.

Human placental 17 beta-hydroxysteroid dehydrogenase (17-HSD) was purified to apparent homogeneity using ammonium sulfate precipitation and chromatography on Red-Agarose and DEAE-Sepharose columns. Electrophoresis on polyacrylamide gels under denaturing conditions and using silver staining showed a single protein with an apparent molecular weight of 37,800. Antibodies to the purified protein were raised in rabbits and were found by immunoblotting to be specific to 17-HSD. A sensitive radioimmunoassay was established using 125I-labeled 17-HSD as a tracer, an appropriate dilution of the antibody, and a kaolin-coupled double antibody for separating the antibody-bound and free fractions. The detection limit of the assay was approximately 150 pg/tube (1.5 micrograms/l). The cytosol fraction (105,000 g) of term placental tissue contained approximately 0.7 mg of 17-HSD per gram of protein, and the concentrations of 17-HSD measured by immunoassay and enzymatic activity proved to be strictly parallel in different partly purified placental preparations. The supernatants from centrifugations of human endometrial homogenates at 800 g and 105,000 g (after detergent treatment) displayed cross-reactivity with the antibody. The mean concentration of the cross-reacting substance in the radioimmunoassay was 14.1 micrograms/g protein (range 2-62.3) in specimens taken on different days in the cycle. These concentrations showed a significant correlation with the 17-HSD activities measured in the endometrial specimens (r = 0.722, P less than 0.001, n = 21). Mean concentrations of substance were 8.3 micrograms/g protein in endometrial specimens taken during the follicular phase (days 4-12, n = 8) and 22.9 micrograms/g protein during the luteal phase (days 16-22, n = 6) were obtained using the radioimmunoassay. There was excellent parallelism between the competition curves for [125I]iodo-17-HSD with purified 17-HSD standards and placental and endometrial homogenate dilutions. These data strongly suggest that the substance measured in the endometrial specimens was 17-HSD.

17-Hydroxysteroid Dehydrogenases↗
PubMed1990

Doppler findings in the fetal and uteroplacental circulation: a promising guide to clinical decisions.

The combination of real time and Doppler ultrasonic methods has opened up new possibilities for the study of fetal and uterine haemodynamics in humans particularly for the umbilical, uterine and fetal cerebral arteries. A pathological finding in blood velocity waveforms seems to be an early and consistent alteration which precedes other markers of chronic fetal distress. The challenges are to differentiate between fetal and uteroplacental aetiologies of chronic fetal asphyxia and to search for effective treatment of early fetal distress. Recent data on the practical value of haemodynamic studies in different perinatal complications is presented in this review.

Female↗
PubMed1990

Prenatal diagnosis of single gene disorders in northern Finland.

Prenatal diagnosis of single gene disorders is challenging because of the multidisciplinary diagnostic approach and the genetic counselling needed. Out of 3100 pregnancies of northern Finnish women studied for early detection of congenital defects or genetic disease, 110 were at risk for and 15 were unexpectedly found to carry a fetus with a single gene disorder. Seven of the 21 diseases studied were typically representative of inherited diseases in northern Finland. The diagnostic approaches used included fetal ultrasonography, analysis of the components of the amniotic fluid, fetal enzyme analysis, fetal karyotyping for the fragile X syndrome, and fetal DNA analysis. Altogether, 50 pregnancies were found to be affected; 11 of these were continued because the diagnosis was too late for termination, and seven because the parents wanted it. Prenatal diagnosis of severe hereditary disease can be enhanced by improving the detection of pregnancies at risk, and by developing methods for earlier fetal diagnosis.

Adult↗
PubMed1989

Right ventricular dysfunction in human fetal compromise.

Fetal M-mode echocardiography was performed in 13 pregnancies complicated by intrauterine distress. Absent end-diastolic blood velocity in the fetal descending aorta was documented by pulsed Doppler examinations. The right ventricular fractional shortening of these fetuses was decreased and the ratio of the right/left ventricular end-diastolic diameters was increased. The left ventricular size and myocardial contractility did not differ from normal pregnancy. These findings reveal that relative right ventricular heart dysfunction is associated with severe intrauterine distress.

Aorta↗
PubMed1989

Noninvasive assessment of fetal aortic blood flow in normal and abnormal pregnancies.

Fetal blood flow measurements have a good capacity to predict unfavorable fetal outcome, especially chronic distress accompanied by IUGR. The descending thoracic aorta is of particular interest in these studies and the results reflect peripheral vascular resistance, both in the fetal placental circulation and in fetal abdominal and peripheral areas. A pathologic finding in blood velocity waveforms, especially an absent end-diastolic velocity, seems to be an early and consistent alteration that precedes the occurrence of a pathologic CTG pattern by at least several days. According to our experience, the main benefit of fetal blood flow studies is in differentiation between IUGR fetuses, in which growth retardation is accompanied by some degree of fetal hypoxia, and those cases in which the small size does not signify an immediate threat to fetal well-being. Nevertheless, there are still a number of diagnostic and practical problems. The individual fetal capability to tolerate impaired fetal placental circulation and hemodynamic redistribution is variable. Hence, it is impossible to make clinical decisions based only on hemodynamic findings; we also need diagnostic support from other methods (evaluation of fetal structures by ultrasound, CTG registration, rapid fetal karyotyping, and fetal acid-base status). In some cases, pathologic blood velocity waveforms develop as soon as at weeks 24-27, and because of the lack of reliable therapeutic methods to improve fetal condition, the selection of an ideal time of delivery is often a compromise between threatened fetal asphyxia and prematurity.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta↗
PubMed1989

Comparison of the effects of general and epidural anaesthesia for caesarean section on the neurobehavioural responses of newborn infants.

Thirty-one neonates delivered by elective caesarean section were evaluated at the ages of 3 h, 1 day, 2 days and 4-5 days using Scanlon's Early Neonatal Neurobehavioural Scale and tests for orientation. Thirteen of the mothers received general anaesthesia and 18 epidural anaesthesia. All the mothers were healthy and not in labour. All the neonates weighed 2500 g or more and had Apgar scores of 7 or more at 1, 5 and 15 min. The neonates delivered with epidural anaesthesia scored significantly lower on rooting at the age of 3 h than those delivered with general anaesthesia, but the latter scored significantly lower on habituation to sound and orientation to both animate and inanimate visual stimuli. General anaesthesia seemed to depress the infants' interactive processes (orientation items), and their ability to make an appropriate response to repetitive stimuli (habituation) more than did epidural anaesthesia, indicating greater global depression. This depression was short-lived, however, and there were no differences between the groups on any of the parameters after 24 h.

Adult↗
PubMed1989

The effect of lumbar epidural analgesia on the neurobehavioural responses of newborn infants.

The effects of maternal lumbar epidural analgesia (Th10-L5) on the neonatal neurobehavioural response were studied at the ages of 3 h, 1 day, 2 days and 4-5 days. The subjects were healthy, full-term neonates, born vaginally to 15 mothers with lumbar epidural block and 19 mothers without analgesia. Those delivered with epidural analgesia scored significantly better on alertness at the age of 3 h, 2 days and 4-5 days than the control group. No other statistically significant differences were found between the groups. The formation of the two groups according to the mothers' desire for epidural analgesia may have contributed to differences in the process of labour, but with this reservation it may be suggested that lumbar epidural analgesia may enhance the infant's recovery from the stress of labour and vaginal delivery.

Analgesia, Epidural↗
PubMed1988

Blood flow velocity waveforms at late pregnancy and during labor.

608 high-risk pregnancies were monitored by repeated Doppler-examinations of the fetal aortic blood flow. An absent end-diastolic flow pattern was found to reveal fetal growth retardation with 73% sensitivity. The positive predictive value of this finding for prediction of fetal growth retardation combined with intrauterine distress (prevalence in the material 8%) was 85%. In the cases with this flow pattern, the cesarean section rate was 72%, and the mean gestational age at delivery was 34 weeks. Normal labor was not associated with any changes of umbilical arterial flow velocity waveforms, but the diastolic flow of the arcuate arteries was decreased during uterine contractions.

Blood Flow Velocity↗