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Biomedical subjects

R Tuimala

Publications and source records attributed to R Tuimala.

At least 19 recordsLinked to original sources
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 Four women were withdrawn because of various medical reasons, and 76 patients were followed-up for a total of 12 months.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

Doppler flow velocimetry of the umbilical artery, uteroplacental arteries and fetal middle cerebral artery in prolonged pregnancy.

A total of 153 pregnant women, of at least 287 days' menstrual age, were studied in a prospectively designed cross-sectional trial. In addition to the non-stress test, contraction stress test, sonographic estimate of amniotic fluid and grade of placental maturation, Doppler measurements of the resistance index (RI) were taken in the umbilical artery, the uteroplacental arteries in the region of placental implantation and the fetal middle cerebral artery. Data were analyzed with regard to asphyxia and otherwise complicated fetal outcome. Furthermore, a possible relationship between grade of placental maturation, Doppler flow velocity waveforms and fetal outcome was investigated. Doppler resistance indices in the umbilical artery, uteroplacental arteries in the region of placental implantation and fetal middle cerebral artery did not change significantly with increasing gestation from 41 to 43 weeks. The grade of placental maturation on ultrasound examination was not related to fetal outcome or Doppler indices in the first two vessels. In all vessels examined in this study, the majority of Doppler measurements in pregnancies with subsequent asphyxia or otherwise complicated fetal outcome were within the 95% prediction interval for patients with normal fetal outcome. None of the patients showed absent diastolic flow in the umbilical artery. With the use of a cut-off value of RI = 0.62 in the umbilical artery, asphyxia could be predicted with 37% sensitivity and 75% specificity. Oligohydramnios and antpartum cardiotocography predicted asphyxia with 16% and 8% sensitivity and 95% and 96% specificity, respectively. Sensitivity for prediction of otherwise complicated fetal outcome by umbilical artery Doppler was only 7%.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1994

Atrial natriuretic peptide and cyclic guanosine-3'5'-monophosphate in hypertensive pregnancy and during nifedipine treatment.

Atrial natriuretic peptide exhibits natriuretic, diuretic and vasodilatory properties. We compared plasma concentrations of atrial natriuretic peptide, cyclic guanosine-3',5'-monophosphate (cGMP), electrolytes and urinary excretion of cGMP and electrolytes in hypertensive pregnant women to those in normotensive pregnant and normotensive non-pregnant women. Plasma atrial natriuretic peptide concentrations in hypertensive pregnant and normotensive non-pregnant women were equal, whereas in normotensive pregnant women it was lower (P < 0.05), than in non-pregnant. Urinary cGMP excretion was higher in both normotensive and hypertensive pregnant than in non-pregnant women (P < 0.01), whereas plasma cGMP levels were similar. A five-day nifedipine treatment (10 mg t.i.d.) had no effects on any of the variables. In hypertensive pregnancy, a reduction of systolic blood pressure by nifedipine correlated with the initial plasma atrial natriuretic peptide (P < 0.05) and a decrease in diastolic blood pressure with the initial plasma cGMP concentration (P < 0.05). The results of this small material suggest that plasma atrial natriuretic peptide concentration predicts the response to nifedipine in hypertensive pregnancy. However, the atrial natriuretic peptide-cGMP system does not seem to mediate the antihypertensive effect of nifedipine, while plasma atrial natriuretic peptide remained unaltered. Increased urinary cGMP excretion in both pregnant groups but lowered plasma atrial natriuretic peptide in normotensive pregnancy suggest other factors than circulating atrial natriuretic peptide to promote renal cGMP excretion during pregnancy.

Administration, Oral↗
PubMed1994

Doppler flow velocimetry of the uterine and uteroplacental circulation in pregnancies complicated by insulin-dependent diabetes mellitus.

UNLABELLED: In forty-three pregnancies complicated by insulin-dependent diabetes mellitus, 16 classified White B, 11 White C, 8 White D and 8 White R or F, the resistance-index (PR index) in the main part of the uterine artery and arcuate uterine arteries was measured by duplex-pulsed wave Doppler ultrasound. Recordings of 24 hours' blood glucose profile and glycosylated hemoglobin were parameters of glycemic control. Vascular resistance in the main uterine artery decreased with proceeding gestation as a non-diabetic pregnancy. The uterine artery supplying the placental had lower resistance than the opposite side, with a mean PR index of 0.559 (SD 0.117) and 0.622 (SD 0.133), respectively. The mean difference between both sides was 0.062 (SD 0.102) (p < 0.001). The uterine artery PR index was slightly higher in the presence of evident morphological vasculopathy, with a mean PR index of 0.591 (SD 0.104) in White D*/R/F diabetics and 0.545 (SD 0.063) in White B/C/D#, respectively (p = 0.148). Additionally more than half of the diabetics without manifest complications (B/C/D#) showed a persistent notch. Long- and short-term glycemic control was unrelated to vascular resistance in the uterine artery, with correlation coefficients of 0.027 (p = 0.746) and 0.051 (p = 0.537) for glucose and HbA1C, respectively. Doppler velocimetry could not predict diabetic specific fetal mobidity. Vascular resistance in the uterine arcuate arteries was significantly lower in the subplacental region, with a mean PR index of 0.367 (SD 0.056) compared to 0.427 (SD 0.064) in areas distant to the placenta (p < 0.0005). It was not related to vasculopathy elsewhere. IN CONCLUSION: in patients with diabetic vasculopathy the uterine artery is also affected, but there is no relationship with long- or short-term parameters of glycemic control. Doppler flow velocimetry of the uterine artery is a poor predictor of diabetes-specific fetal morbidity; if normal ranges of non-diabetic pregnancies are used for reference. Because of significantly different vascular resistance in the two main uterine arteries, mean values of both-side measurements should be used for analysis, whenever possible.

Adult↗
PubMed1994

Pros and cons of intrauterine contraception--do perceptions of users and physicians differ?

OBJECTIVE: To investigate women's and physicians' opinions of IUD use. DESIGN: Two cross-sectional postal surveys; on women in 1987-1988, on physicians in 1988. SETTING: Survey on women: southernmost Uusimaa province (including Helsinki). Survey on physicians: whole of Finland. PARTICIPANTS: Of a stratified random sample of 1000 women aged 18-44 years 84% returned the questionnaire (N = 844). Of a sample of 480 physicians (including GPs and gynaecologists) 418 were eligible, 74% of whom responded (N = 311). MAIN OUTCOME MEASURES: Women's and physicians' opinions of and experiences with IUD use as reported in postal questionnaires. RESULTS: Most women considered that IUDs were a good method of contraception. Users' and physicians' reports on benefits and disadvantages of IUDs metched each other; both most often mentioned ease of use, efficacy, and lack of systemic effects. Major disadvantages reported by women were bleeding, pain, infection, and pregnancy. Physicians further pointed to the risk of ectopic pregnancy. Though reports of side-effects were commonplace, there was reasonable satisfaction with IUD use. CONCLUSION: This study reveals that most women, and physicians, have a realistic picture of the common problems related to intrauterine contraception. It also emphasizes that, when making contraceptive choices, one is bound to compare possible disadvantages with benefits offered.

Adult↗
PubMed1994

Effect of occupational noise on the course and outcome of pregnancy.

OBJECTIVES: The goal of this investigation was to examine the effects of occupational noise during pregnancy prospectively. METHODS: The exposed group [continuous A-weighted sound level (LAeq(8 h)) > or = 78 dB] consisted of 111 pregnant women, and the reference group comprised 181 pregnant women with approximately similar work conditions but without noise exposure. The noise-exposed women had more frequently other inconveniences in their work, however, like shift work, impulse noise exposure, vibration, and a high or low temperature. RESULTS: With the limit of 78 dB (LAeq (8 h)), the course and outcome of pregnancy did not differ between the groups. When the noise exposure was 90 dB (LAeq (8 h)) or more, a decline in birthweight, either absolute [mean 3304 (SD 585) g for the exposed versus mean (SD 548) g for the unexposed, 95% CI of mean difference -471--+15 g] or related to the gestational age (below the 10th percentile [5 of 25 (20%) versus 13 of 180 (7%)]), was seen. These findings were more pronounced if the woman was simultaneously exposed to a standing work position or shift work. CONCLUSIONS: Working in high noise exposure can be considered a form of risk during pregnancy.

Adult↗
PubMed1992

Doppler velocimetry of the umbilical artery in pregnancies complicated by insulin-dependent diabetes mellitus.

The purpose of this study was to investigate vascular resistance by Doppler ultrasound in the umbilical artery of insulin-dependent diabetics longitudinally over the course of pregnancy. Special interest was put on the effects of glycemic control and maternal vascular disease on the flow velocity waveform (FVW) and the predictive value of Doppler flow measurements with regard to perinatal morbidity. Using a duplex-pulsed wave scanner, the resistance-index (PR index) in the umbilical artery was calculated. The mean value of a 24-h blood glucose profile and the concentration of glycosylated hemoglobin (HBA1C) were used as parameters of metabolic control. 53 pregnant diabetic women were examined longitudinally during the course of pregnancy on average on three occasions (range: 1-7) between 17 weeks of gestation and delivery at 37.7 +/- 1.3 (mean +/- SD) weeks. To test the predictive value of Doppler flow velocimetry with regard to perinatal morbidity the results were compared to the FVWs measured in the umbilical arteries of 30 non-diabetic women with normal fetal outcome. Vascular resistance in the umbilical artery of the diabetics declined significantly during the course of pregnancy, with a mean PR index of 0.729 (SD 0.051) at 17 weeks and 0.603 (SD 0.083) at the end of pregnancy (P < 0.002). The majority of PR indices were within the range reported for normal pregnancy and measured in the non-diabetic women. Regression analysis showed no significant correlation between vascular resistance and mean blood glucose level (r = 0.1325) or concentration of HBA1C (r = -0.0519). Maternal vascular disease had no effect on umbilical FVWs.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes Mellitus, Type 1↗
PubMed1992

The treatment of intrahepatic cholestasis of pregnancy by dexamethasone.

OBJECTIVE: To investigate whether dexamethasone suppression of fetoplacental oestrogen production can reduce obstetric cholestasis. DESIGN: Observational study. SETTING: Department of Obstetrics and Gynaecology, University of Tampere, Finland. SUBJECTS: 10 women, at between 28 and 37 weeks gestation, with intrahepatic cholestasis of pregnancy. INTERVENTIONS: Treatment with 12 mg oral dexamethasone daily for 7 days, after which the therapy was gradually discontinued over 3 days. MAIN OUTCOME MEASURES: Serum oestriol, oestradiol, total bile acids and ALAT were measured before and during therapy and on days 4 and 7 and ALAT also on day 12. Differences were tested by paired t test. RESULTS: Itching disappeared or was relieved in all patients. Serum oestriol level fell significantly by day 1 of treatment, serum oestradiol and total bile acid levels by day 4 and ALAT by day 12 from the beginning of the therapy. CONCLUSION: Dexamethasone is a drug of choice in the treatment of intrahepatic cholestasis of pregnancy.

Cholestasis, Intrahepatic↗
PubMed1992

Proliferative activity of human uterine leiomyoma cells as measured by automatic image analysis.

Proliferative activity of uterine leiomyomas from premenopausal (n = 44) and postmenopausal (n = 12) women was investigated by automatic image analysis on frozen tissue sections using immunohistochemistry with anti-proliferating cell nuclear antigen antibody. The quantitative proliferation index (QPI) in premenopausal leiomyoma cells was significantly (p < 0.025) higher than that in leiomyomas in postmenopausal women. Leiomyomas proliferated most actively during the secretory phase. After the climacterium, leiomyomas showed no proliferative activity in the absence of hormone supply, while combined substitution with estrogen and progestagen considerably increased QPI.

Antibodies, Anti-Idiotypic↗
PubMed1991

Lipid peroxidation products, selenium-dependent glutathione peroxidase and vitamin E in normal pregnancy.

Twenty healthy women with normal pregnancy were simultaneously analysed with regard to lipid peroxidation products, selenium-dependent glutathione peroxidase and vitamin E. Conjugated diene double bonds, fluorescent chromolipids and thiobarbituric acid-reactive material were analysed as breakdown products of lipid peroxidation. The level of conjugated dienes in serum rose more than 45% when pregnancy advanced from the first to second trimester, but after that it declined almost to the same level as in the first trimester. The fluorescent chromolipids tended to behave in the same way. While the lipid peroxidation products reached their highest level in the second trimester, the activity of glutathione peroxidase rose progressively till the third trimester both in erythrocytes and platelets, in spite of the stable concentration of selenium in blood and plasma. The concentration of vitamin E in serum rose progressively till the end of pregnancy, but in the relation of vitamin E to cholesterol only a slight rising tendency was noted. We suggest that in normal pregnancy lipid peroxidation is controlled by adequate antioxidative response.

Adult↗
PubMed1991

Is aryl hydrocarbon hydroxylase activity a new prognostic indicator for breast cancer?

Aryl hydrocarbon hydroxylase (AHH) activity was measured in the breast tumours of 153 primary and 17 recurrent cancer patients, and in 18 patients with benign breast tumour. All operations were carried out in 1983-84. The cytosolic fraction was collected for steroid receptor determination, and microsomes were separated for AHH assay from the same tissue samples. The AHH distribution was wide and highly skewed in all groups. About 10% of the samples showed activities below detection limit. The medians and ranges for primary cancers were 34 (less than 5-2683), for recurrent cancers 40 (20-239) and for benign tumours 11 (less than 5-37) fmol min-1 mg-1 protein. After logarithmic transformation, the mean AHH activities of cancer samples differed significantly from those of benign tumours. The logarithm of AHH activity (log AHH) correlates positively with axillary lymph node status, and negatively with steroid receptor levels. The development of the disease and the survival of the patients were followed for 4 years. The survival and the disease-free interval of the cancer patients who had low AHH activity was significantly higher than that of the high AHH group. The multivariate analysis with Cox's proportional hazad model showed primary tumour size, progesterone receptor concentration, nodal status and log AHH to be the most important independent prognostic factors for survival, while the occurrence of metastases, log AHH and tumour size were the equivalent factors for the disease-free interval in primary breast cancers. We conclude that AHH activity may reflect the overall malignant potential of breast cancer tissue.

Adult↗
PubMed1991

Nifedipine increases urinary excretion of prostacyclin metabolite in hypertensive pregnancy.

Renal prostanoid excretion was investigated in nine hypertensive pregnant patients before and during treatment with nifedipine 10 mg orally t.i.d. Urinary excretion of prostacyclin (measured as 6-ketoprostaglandin F1 alpha, 6-keto-PGF1 alpha) increased by 77% during nifedipine treatment (P less than 0.05). No changes were found in prostaglandin E2 (PGE2) and thromboxane A2 (as thromboxane B2, TXB2) excretions. A significant reduction in blood pressure did not correlate with an increase in 6-keto-PGF1 alpha excretion. Plasma prekallikrein and urinary kallikrein and catecholamine excretions remained unaltered. In six normotensive non-pregnant women, increase in 6-keto-PGF1 alpha excretion during nifedipine treatment was not significant. No changes in PGE2 and TXB2 excretions were found, whereas plasma prekallikrein was reduced (P less than 0.05) and urinary excretion of kallikrein (P less than 0.05) and noradrenaline (P = 0.06) increased under nifedipine. The results suggest that nifedipine enhances the renal 6-keto-PGF1 alpha excretion in hypertensive pregnancy.

6-Ketoprostaglandin F1 alpha↗
PubMed1991

No effect of experimental noise exposure on human pregnancy.

The effect of experimental noise exposure (15 minutes of 90-dB white noise via headphones) was examined on systolic, diastolic, and mean arterial pressures; heart rate; and stress hormones (ACTH, cortisol, prolactin, epinephrine, and norepinephrine) in normotensive and hypertensive pregnant women. No significant effects induced by noise exposure could be registered in these variables. Fetal and uterine blood circulation was also examined with a duplex pulsed Doppler system. No changes were seen on the fetal side as measured from the descending aorta in blood flow velocity (cm/second) or pulsatility or resistance indexes in either normotensive or hypertensive pregnancy. The only change observed was an increase in fetal heart rate in normotensive pregnancy. However, this increase could not be confirmed by cardiotocographic registration and is not clinically important. Uterine blood circulation was recorded from the proximal uterine artery on the placental side, and no effect of exposure was seen on pulsatility or resistance indexes.

Adult↗
PubMed1990

Erythrocyte glutathione peroxidase activity in hypertensive complications of pregnancy.

Thirty-nine patients with hypertensive complications of pregnancy were analyzed in the third trimester with respect to erythrocyte glutathione peroxidase (GSHPx) activity. Patients with severe or superimposed preeclampsia had significantly higher activities of GSHPx than those with mild preeclampsia. We suggest that a high level of GSHPx in the severe forms of preeclampsia reflects the greatly increased peroxide load generated in this disease and is of compensatory nature, responding to the disturbed peroxide and prostaglandin metabolism.

Adult↗
PubMed1990

Blood pressure, plasma renin activity and calcium metabolism in hypertensive pregnancy: the effect of nifedipine.

The effects of nifedipine on blood pressure, plasma renin activity and calcium metabolism were studied in nine hypertensive pregnant patients. Nifedipine (10 mg thrice daily per os) reduced blood pressure from 158/103 +/- 4/1 to 150/96 +/- 4/2 mmHg (mean +/- s.e.m.) during 4 to 5 days' treatment (p less than 0.05). The percentage change in diastolic blood pressure correlated negatively with the initial ambulatory (p less than 0.001) and rest (p less than 0.01) plasma renin activity and the initial daily urine calcium excretion (p less than 0.01). Calcium excretion in urine correlated positively with the initial ambulatory and rest plasma renin activity (p less than 0.01). The blood pressure reduction did not correlate with serum ionized, or total calcium, or the initial blood pressure. In six non-pregnant women, the rest plasma renin activity increased (p less than 0.05) after four days' administration of nifedipine. In the patients with hypertensive pregnancy, no changes in plasma renin activity were found during the treatment. The results indicated that the initial plasma renin activity, but neither the serum ionized calcium, nor the initial blood pressure, predicted the blood pressure-lowering effect of nifedipine in hypertensive pregnancy.

Adult↗