Biomedical subjects

P Kiilholma

Publications and source records attributed to P Kiilholma.

At least 19 recordsLinked to original sources

PubMed2000

Lower urinary tract symptoms in patients with Sjögren's syndrome and systemic lupus erythematosus.

Sjögren's syndrome (SS) and systemic lupus erythematosus (SLE) are autoimmune diseases which have many similarities with interstitial cystitis (IC), a urinary bladder disease with unknown etiology. This survey on the occurrence, severity and nature of lower urinary tract symptoms among patients suffering from SS or SLE showed that these patients have significantly more urinary complaints, especially irritative bladder symptoms, than age- and sex-matched controls. We studied 36 patients with SS, 85 patients with SLE and 121 controls. In these groups, 25%, 29% and 66%, respectively, were free of urinary symptoms. The prevalences of mild symptoms were 61%, 62% and 27%, and severe symptoms 14%, 9% and 7% in the respective groups. SS and SLE patients with urinary complaints reported mostly urinary frequency (27% and 62%) and suprapubic pain (36% and 34%). The most common symptom in the control group was stress urinary incontinence. The frequency of lower urinary tract problems in patients with SS and SLE supports the concept that autoimmune disorders also have bladder affections.

Adult↗

PubMed1999

Urinary bacterial flora of women with urethral syndrome and interstitial cystitis.

The aerobic and anaerobic bacterial flora in the first voided and in the midstream urine of healthy females (n = 5) and female patients with either urethral syndrome (US) (n = 5) or interstitial cystitis (IC) (n = 14) were studied. Bacteria were grown on media enabling isolation of fastidious and aerobic as well as obligatory anaerobic species. In healthy females only gram-positive rods were found whereas US patients also harbored streptococci. Patients with IC presented also with Enterobacteriae and anaerobic bacteria. Five IC patients with severe symptoms were treated with metronidazole; 2 out of 3 patients with anaerobic bacteria in the pretreatment specimens had no anaerobes after metronidazole therapy and in 1 patient streptococci disappeared after the therapy. One patient with severe symptoms and Bacteroides fragilis in the midstream urine became symptom-free after 2 weeks of metronidazole treatment. Although there is uncertainty whether the US and IC are not related to an infectious etiology, the bacterial flora in urethral and in midstream urine in these conditions differs considerably from that of healthy females.

Adolescent↗

PubMed1998

Percutaneous sclerotherapy for varicocele embolization.

Varicocele is a common cause of male infertility and can be treated surgically or by angiographic occlusion of the internal spermatic (testicular) vein. The treatment of clinical as well as subclinical varicoceles has been reported to improve sperm parameters. Varicocele also can cause scrotal pain and discomfort. We treated 89 patients using percutaneous sclerotherapy on an outpatient basis. Our technique proved to be simple and effective and was associated with low morbidity. At follow-up only three failures occurred.

Embolization, Therapeutic↗

PubMed1997

Comparison of a 10-mg controlled release oxybutynin tablet with a 5-mg oxybutynin tablet in urge incontinent patients.

Oxybutynin has long been used for the treatment of patients with detrusor overactivity and urinary urge incontinence. The short half-life of oxybutynin administered as a conventional tablet formulation or syrup requires 2-3 times daily dosage to be effective. A new controlled release (CR) tablet for once-daily administration has been developed. The efficacy and tolerability of this new controlled release tablet was compared to that of a 5-mg conventional oxybutynin tablet administered twice daily. Seventeen female incontinent patients were studied in a double-dummy crossover trial. Efficacy and tolerability were assessed by using a voiding diary, pad-weighing test, visual-analogue scale (VAS), and questionnaire. Adverse events were recorded spontaneously on a questionnaire by the patients themselves throughout the study. Serum concentrations of oxybutynin and its active metabolite N-desethyloxybutynin were studied after both a single dose and multiple dosage. There was no difference in efficacy between the two formulations. Depending on the parameters tested, the change from baseline values in a positive direction ranged from 15 to 53%. The incidence of adverse events was similar with both formulations. Oxybutynin or its metabolite showed no cumulation during the multiple dosage with a 10-mg CR tablet. The controlled release tablet formulation is as effective and as well-tolerated as the conventional one, but has the advantage of only once-a-day dosage, enhancing treatment compliance.

Adult↗

PubMed1997

Endoscopic colposuspension with simplified extraperitoneal approach.

The retropubic colposuspension (Burch procedure) has been proven an effective treatment for female genuine stress urinary incontinence. During this decade, laparoscopic approach has gained access in continence surgery also. Endoscopic colposuspension can be performed either extraperitoneally or transperitoneally. If there is no need for intra-abdominal procedures the extraperitoneal approach for colposuspension is feasible. Generally a balloon dissection is used to develop the extraperitoneal space, but here we present a modified technique where no balloon is needed. This modification is easy to perform, quicker and decreases the costs of the procedure compared to transperitoneal approach. We also summarize the results of our first 46 patients, 24 of which were operated extraperitoneally and 22 by transperitoneal approach with concomitant pelvic surgery.

Adult↗

PubMed1996

Viruses and interstitial cystitis: adenovirus genomes cannot be demonstrated in urinary bladder biopsies.

Microbes may be involved in the pathogenesis of interstitial cystitis (IC). Adenoviruses and BK virus (BKV) can infect epithelial cells in urinary bladder and they are causative agents for hemorrhagic cystitis. We therefore studied the presence of adenovirus and BKV genomes in urinary bladder tissue specimens of patients with IC using polymerase chain reaction (PCR) and in situ hybridization (ISH). Controls were specimens from cases with transitional cell carcinoma of the bladder. Nucleic acids were extracted from paraffin sections of the bladder tissue for PCR. Primers detecting all adenovirus types were used. In situ hybridization was carried out for the paraffin sections using digoxigenin-labeled DNA probes for adenovirus and BKV. The adenovirus DNA PCR was able to detect one to two infected cells/specimen. All the seven IC cases studied and six controls were negative for adenovirus DNA by PCR and ISH. The ISH test for BKV genomes was also considered negative in IC cases and controls. The specimens which were negative in PCR tests yielded a signal with beta-globin primers, thus being amplifiable. We conclude that adenovirus and BKV do not play a major pathogenetic role in interstitial cystitis.

Adenoviridae↗

PubMed1996

Absence of bacterial DNA in the bladder of patients with interstitial cystitis.

PURPOSE: Although bacterial infection has been long considered a possible cause of interstitial cystitis (IC), no definitive proof for or against this hypothesis has been presented so far. We have used 16S rDNA bacterial polymerase chain reaction to study bladder biopsies and sterile urine samples from patients suffering from IC. This method is sensitive and detects all known eubacteria. MATERIALS AND METHODS: Bladder biopsies and sterile urine samples obtained by transabdominal puncture were studied from 11 patients with IC. As controls we studied 4 patients with other urological problems leading to partly similar symptoms and 5 healthy individuals. RESULTS: All samples from the IC patients were negative. One positive sample was obtained from a woman with a history of urinary tract infections who suffered from nonIC ulcerative cystitis. Her sterile urine sample yielded Lactobacillus acidophilus. CONCLUSION: These results indicate that an ongoing bacterial infection is not the cause of interstitial cystitis.

Cystitis, Interstitial↗

PubMed1995

p53 protein detected by immunohistochemistry as a prognostic factor in patients with epithelial ovarian carcinoma.

BACKGROUND: The clinical significance of p53 suppressor gene nucleoprotein immunostaining in ovarian epithelial cancer has not been determined. METHODS: p53 protein expression was studied by immunohistochemistry from paraffin embedded tissue in a series of 136 patients with malignant ovarian epithelial tumors. The median follow-up time of the patients still alive was 10 years. RESULTS: Sixty (44%) carcinomas stained clearly positive for p53 protein. Positive staining for p53 protein was associated with the serous histologic type (P = 0.0006), a higher than the median S-phase fraction size determined by DNA flow cytometry (P = 0.02), and poor histologic grade of differentiation (P = 0.04), but not with the International Federation of Gynecology and Obstetrics (FIGO) stage, age at diagnosis, or DNA ploidy. Cancers with positive staining had only 17% 5-year and 9% 15-year survival rates compared with 42% 5-year and 36% 15-year survival rates corrected for intercurrent deaths among the rest of patients (P = 0.002). In a multivariate analysis, positive p53 staining was associated with poor survival (relative risk of death, 1.8, 95% confidence interval [CI], 1.2-2.9) together with less than radical surgery (nonradical vs. radical: RR, 5.5; 95% CI, 2.2-13.6), and advanced FIGO stage (RR, 1.4; 95% CI, 1.0-2.0). CONCLUSION: Although p53 protein immunostaining is associated with several other prognostic factors in epithelial ovarian cancer, it may also have independent prognostic value in this disease.

Adult↗

PubMed1995

Comparison of the gonadotropin-releasing hormone agonist goserelin acetate alone versus goserelin combined with estrogen-progestogen add-back therapy in the treatment of endometriosis.

OBJECTIVE: To investigate whether the addition of low-dose estrogen-P combination hormone replacement therapy (HRT) to GnRH agonist (GnRH-a) treatment for endometriosis reduces the pharmacologic side effects of such treatment without reducing efficacy and to determine the endocrinologic changes during treatment. DESIGN: Prospective, randomized, double-blind, placebo-controlled, comparative study of two drug regimens: 3.6 mg goserelin acetate in a 28-day SC depot formulation once monthly for 6 months plus either a combination of 2 mg 17 beta-E2 and 1 mg norethisterone acetate (NET) 1 mg or matching placebo tablets once daily for 6 months. SETTING: Multicenter study in three tertiary referral centers at university teaching hospitals and two central hospitals. PATIENTS: Women with laparoscopically confirmed symptomatic endometriosis were included in the study. RESULTS: Of the total of 109 patients screened, 93 were recruited and 88 patients were randomized to either the HRT or the placebo group. Four women were withdrawn because of various medical reasons, and 76 patients were followed-up for a total of 12 months. In terms of efficacy, there was no difference between the two drug regimens for objective or subjective response. There were significantly less postmenopausal symptoms in the patients treated with goserelin plus HRT compared with those treated with goserelin plus placebo. CONCLUSION: Goserelin diminished significantly the symptoms and laparoscopic scores of endometriosis. The addition of HRT did not reduce the efficacy of goserelin but diminished the postmenopausal symptoms during treatment.

Adult↗

PubMed1995

Sutureless endoscopic colposuspension with fibrin sealant.

Endoscopic colposuspension by using fibrin sealant as a substitute for sutures was performed in 17 women suffering from urodynamically verified type I-II stress urinary incontinence. Two-puncture technique was used with a 10-mm trocar for optics and a 5-mm trocar for instrumentation. The two-component fibrin sealant, Tisseel (1 ml) by using special applicator device, Duploject was applied with tube on both sides of the urethrovesical area. After that the urethrovesical junction was pressed for 5 min against the retropubic periost by the surgeon's index and middle fingers placed in the vagina. The average duration of the procedure was 20 min, excluding learning curve for the first two cases. The indwelling catheter and vaginal packing were removed and all patients discharged on the first postoperative day. All but two patients experienced excellent immediate response. Of the 12 patients followed > 6 months, 10 patients were completely dry and two were markedly improved. In our experience, laparoscopic colposuspension with fibrin sealant appears to be a promising new approach in correcting stress incontinence in women.

Adult↗

PubMed1994

Magnetic resonance imaging of the uterus in vivo and in vitro at an ultra low magnetic field (0.02 T): assessment of its normal structure and of leiomyomas.

The purpose of this investigation was to analyze the normal anatomy and leiomyomas of the uterus with an ultra low field (0.02 T) magnetic resonance imaging (MRI) device. MR imaging was performed on 18 uteri, 11 of which were imaged both preoperatively (in vivo) and as an operative specimen (in vitro), 6 only as an operative specimen, and 1 only preoperatively. All uteri were examined histologically after imaging. The junctional zone was much better delineated in vivo than in vitro, indicating that its appearance on MR is partly due to blood flow. No structures contributing to its visibility in vitro could be demonstrated histologically. Twenty leiomyomas (size range 7-79 mm) in 12 uteri were found with MRI. They were slightly better discerned in vivo than in vitro. The leiomyomas, having no degenerative changes, had a signal intensity which was the same or lower than that of the myometrium. On images obtained in vitro the signal intensity of these leiomyomas relative to that of myometrium correlated directly with their muscular content (R = 0.74, p = .002). The authors conclude that the junctional zone is a sum of physiological and structural factors, the latter being responsible for its in vitro delineation. MR imaging of the uterus in vitro did not give more information than MR imaging in vivo. All leiomyomas larger than 10 mm could be detected, indicating that MR imaging at 0.02 T is an accurate method for the imaging of the uterine leiomyomas.

Female↗

PubMed1994

Immunohistochemical detection of p53 protein in borderline and malignant serous ovarian tumors.

The p53 suppressor gene protein expression was studied with immunoperoxidase staining in 61 serous tumors of the ovary. Twenty four (53%) of the 45 histologically malignant tumors were positive for p53, whereas neither the six benign nor the 10 tumors of borderline malignancy showed positive staining, except for one borderline tumor with atypia and increased mitotic activity. Therefore, p53 immunostaining may have diagnostic value in discriminating between borderline and malignant serous ovarian tumors. Malignant ovarian tumors with negative staining for p53 were associated with a 67% 3-year crude survival rate as compared with only an 18% 3-year survival rate if p53 staining was positive (p = 0.002). In a multivariate analysis, the p53 staining was the most important prognostic factor, with a relative risk of 4.2 (95% confidence interval, 1.8-9.9) followed by the FIGO stage (2.1, 1.3-3.5). We conclude that immunohistochemical p53 suppressor gene protein expression analysis has both diagnostic and prognostic value.

Adult↗

PubMed1994

Brenner and transitional cell tumours of the ovary. Report of three cases.

Three rare epithelial ovarian tumours, one malignant Brenner tumour, one transitional cell carcinoma and one Brenner tumour of borderline malignancy, are presented with special emphasis on the diagnostic, prognostic and therapeutic modalities. Because the prognosis of transitional cell carcinoma of the ovary is worse, as in our case, than that of the malignant Brenner tumour, this classification is justified.

Aged↗

PubMed1994

Comparison of two suture materials, Dexon Plus and Maxon, in abdominal hysterectomy.

The performance and handling capacities of two synthetic absorbable sutures, the monofilament suture Maxon and the multifilament suture Dexon Plus, were compared to study if these sutures are acceptable as all-purpose suture materials in abdominal hysterectomy. Four senior gynecological surgeons performed altogether 102 hysterectomies and made an assessment of handling qualities. Fifty one patients were sutured with Maxon and 51 age-matched controls with Dexon Plus. Maxon proved to be superior to Dexon Plus in terms of knot rundown, tissue drag and knot repositioning whereas, in terms of suppleness, tensile strength and knot security both suture materials were comparable. Vaginal granulation was seen in five patients operated on with Dexon Plus and only in one patient in the Maxon group. According to this study Maxon is as safe and efficacious as Dexon Plus for abdominal hysterectomy and its handling properties were even better than those of Dexon Plus.

Adult↗

PubMed1994

Operative treatment of advanced cervical cancer after full pelvic irradiation.

We present three patients with advanced carcinoma of the uterine cervix treated with full pelvic irradiation followed by surgery 21-37 weeks after the radiation therapy. In two cases chemotherapy was given after radiotherapy due to clinical or radiological residual disease. Postoperative treatment was dependent on histological examination of the surgical specimens. If indicated chemotherapy was started or continued after surgery. No major operative complications were noticed in these three patients in spite of full preoperative pelvic radiation. The information obtained from these operations was valuable in determining the further treatment of the patients. All three patients are clinically disease free at the moment, but longer follow-up will show if this treatment modality can increase survival of advanced carcinoma of the uterine cervix.

Adenocarcinoma↗

PubMed1994

Outcome of thirty patients who underwent repair of posthysterectomy prolapse of the vaginal vault with abdominal sacral colpopexy.

Thirty women experiencing posthysterectomy prolapse of the vaginal vault were treated with abdominal sacral colpopexy between 1984 and 1991. Lyodura (lyophilized cerebral dura mater allograft transplant) was used as the suspensory material in 81 percent and Gore-Tex (reinforced polytetrafluoroethylene) in 16 percent of the operations. There were no perioperative or postoperative complications. At the follow-up examination (mean, three years), good vaginal vault support was observed in 85 percent of the patients. Significant cystocele were seen in 18 percent, and vault prolapse, enterocele, rectocele and chronic perineal laceration each in 15 percent of the patients. At follow-up study, 22 percent of the patients experienced dyspareunia and 41 percent had decreased sexual interest and coital events. Development of stress urinary incontinence in 18 percent of patients was noted. Concomitant Burch colposuspension will cure and prevent stress incontinence and anterior vaginal relaxation. Abdominal sacral colpopexy appears to be a safe and effective method in the treatment of posthysterectomy prolapse of the vaginal vault. In our experience, it seems that coexistent cystocele and rectocele should be corrected in the connection with sacral colpopexy.

Abdomen↗

PubMed1993

Di- and tetracarboxylate derivatives of pyridines, bipyridines and terpyridines as luminogenic reagents for time-resolved fluorometric determination of terbium and dysprosium.

A group of compounds composed of pyridine, 2,2'-bipyridine and 2,2':6',2''-terpyridine as the energy absorbing, triplet sensitizing moieties and two or four carboxylic acids as the chelating groups were synthesized and their ability to enhance terbium ion luminescence was elucidated. The dicarboxylic acid derivatives form highly luminescent Tb3+ chelates with luminescence quantum yields approaching 50%. Additional groups, such as methoxy groups or additional pyridine rings in the aromatic structure can be utilized to shift the excitation maxima towards longer wavelengths in order to produce more practicable excitation for practical use. The ligands giving the highest Tb3+ emissions were further evaluated in a two-step fluorescence enhancement system constructed for specific binding assays based on the simultaneous use of three or four ions as the labels (Eu3+, Tb3+, Sm3+ and Dy3+). In the two-step procedure, the first step comprises dissociative fluorescence enhancement based on an acidic solution of an aromatic beta-diketone used as the luminogenic ligand, whereafter Eu3+ and Sm3+ are quantitated. In the second step, the lanthanide ions form new chelates with the added ligands. These ligands are able to transfer the excitation energy they have absorbed with high efficiency to the chelated ions and produce high ion luminescence for Tb3+ and Dy3+.

2,2'-Dipyridyl↗

PubMed1993

Urinary dysfunction in Lyme disease.

Lyme disease, which is caused by the spirochete Borrelia burgdorferi, is associated with a variety of neurological sequelae. We describe 7 patients with neuro-borreliosis who also had lower urinary tract dysfunction. Urodynamic evaluation revealed detrusor hyperreflexia in 5 patients and detrusor areflexia in 2. Detrusor external sphincter dyssynergia was not noted on electromyography in any patient. We observed that the urinary tract may be involved in 2 respects in the course of Lyme disease: 1) voiding dysfunction may be part of neuro-borreliosis and 2) the spirochete may directly invade the urinary tract. In 1 patient bladder infection by the Lyme spirochete was documented on biopsy. Neurological and urological symptoms in all patients were slow to resolve and convalescence was protracted. Relapses of active Lyme disease and residual neurological deficits were common. Urologists practicing in areas endemic for Lyme disease need to be aware of B. burgdorferi infection in the differential diagnosis of neurogenic bladder dysfunction. Conservative bladder management including clean intermittent catheterization guided by urodynamic evaluation is recommended.

Adult↗