Biomedical subjects
Publications and source records attributed to R Tuimala.
Dysfibrinogenemias are rare genetic disorders that are clinically silent, cause a mild bleeding tendency or have thromboembolic manifestations. During pregnancy they often cause hemorrhage and first-trimester abortions. A patient with a severe thrombotic tendency during pregnancy had a third-trimester fetal loss.
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.
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.
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The possible effects of occupational noise on human pregnancy were examined in a case-control study. The case groups consisted of 284 women with premature deliveries and of 299 women with full-term, low birth weight infants (below the 25th centile), each case having a matched pair. The whole material, all cases and controls included, comprised 1166 women. The percentage of employment in the whole material was 77.8; there were no differences between the case women and their controls. Rather few women (N = 26; 3.5%) reported occupational noise (greater than or equal to 81 dB; Leq(A)8h) during their pregnancies and our study revealed no significant difference between the cases (N = 14) and the controls (N = 12) with regard to noise exposure. Because of the small number of exposed women conclusions have to be drawn carefully. Nevertheless, noise cannot be regarded as a major risk for prematurity or low birth weight of human newborns in Finnish society. The women with reported noise exposure had significantly more inconvenience at work than other working women. They also had significantly more numerous and longer sick leaves than other working women.
Forty-six patients with Lichen sclerosus (Ls) of the vulva were treated with peroral etretinate for 3 months. The pretreatment serum levels of vitamins A and E, and selenium were measured. Etretinate therapy proved to be effective in the treatment of Ls; however, it did not affect the vitamin A status of the Ls patients. Vitamin E and selenium levels did not differ from the control values, nor did they have any prognostic value.
Concentrations of selenium in the soil are very low in most regions in Finland, which explains the low selenium contents of agricultural plants and the low dietary intake of selenium. The poor selenium status of the population in Finland has been considered a possible risk to public health. In 1984, it was decided to increase the selenium intake by adding selenate to common agricultural fertilizers. In this study, the selenium concentrations of whole blood and plasma, as well as erythrocyte glutathione peroxidase activities, were measured in blood samples from four different localities in Finland, in 1984 and 1986, before and during the agricultural selenium supplementation. A low blood level of selenium in the inhabitants of central Finland was demonstrated in 1984. The selenium level of people from the south-west archipelago was a little higher, and that from the northern part of Finland considerably higher than the level in the rest of the country. By 1986, differences between these localities had almost disappeared, and most levels had increased. Plasma selenium concentrations were lower than those in whole blood samples; the concentrations showed a significant correlation. The glutathione peroxidase activities were at the same level in all four localities in 1984. By 1986, they had all increased to a slightly higher level. A weak correlation was found between erythrocyte glutathione peroxidase activity and blood selenium level.
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The outcome of pregnancy and delivery was studied in 122 teenagers (under 18 years) and matched controls. There were no differences in complications during pregnancy, delivery method or outcome of pregnancy as measured by perinatal mortality and morbidity. Anemia post partum existed more often in the teenage group, and teenager's newborns were also lighter than those of the controls. This may be due to premature deliveries, which were more common in the teenage group. Premature deliveries were more common in patients who did not visit health centres or maternity outpatient clinics. The main problem is how to attach such teenagers to organized maternity care.
The concentrations of vasopressin in the amniotic fluid were measured in 40 patients. The pregnancies were complicated by diabetes, toxemia or imminent premature delivery and in one case by polyhydramnion. The gestation time varied from 33 to 41 weeks. In addition, we measured vasopressin concentrations after transabdominal drainage of fetal bladder in three cases with urethral obstruction. Detectable concentrations of vasopressin in the amniotic fluid were found in all but four of the 40 cases observed. The vasopressin concentrations varied from 0.21 to 1.81 pg/ml. There were no systematic differences in the values in relation to duration of gestation or disease present. The highest vasopressin concentration was observed in the patient with polyhydramnion. No detectable amount of vasopressin was found in the urine of the three fetuses examined. The results suggest that, in contrast to earlier studies, the placenta may be permeable to small amounts of vasopressin or may itself be an origin of this hormone. The maternal complications present seem to have no effect of the vasopressin concentrations in the amniotic fluid.
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The concentration of 25-hydroxyvitamin D (25(OH)D) was measured in 85 samples of amniotic fluid (AF) obtained near term from mothers with normal pregnancy, diabetes, pre-eclampsia or intrahepatic cholestasis of pregnancy. Significantly lower AF 25(OH)D levels were found in diabetic mothers than in the three other groups. Our results suggest that the vitamin D status of the fetoplacental unit may be somewhat impaired in diabetic pregnancy.
Serum concentrations of 25(OH)D, 24,25(OH)2D, 1,25(OH)2D, total protein, calcium, phosphorus, magnesium and alkaline phosphatase were measured in patients with intrahepatic cholestasis of pregnancy and in control subjects at the third trimester of pregnancy and at delivery. 25(OH)D levels of 40.5 +/- 21.5 nmol/l in the patient group were initially significantly (P less than 0.01) higher than the value of 26.3 +/- 9.5 nmol/l in the control group and decreased significantly (P less than 0.01) to 26.0 +/- 16.3 nmol/l at delivery. The levels of active 1,25(OH)2D and inactive 24,25(OH)2D did not alter in either group. Also the concentrations of calcium, phosphorus and magnesium remained unchanged in both groups. No significant differences in fetal vitamin D metabolites were observed between patients and controls, and the other analysed fetal parameters were similar in both groups. Cholestyramine and/or phenobarbital treatment had no influence on vitamin D metabolites. Since levels of 1,25(OH)2D and mineral parameters remained normal and a change in 25(OH)D concentrations was only transient, the clinical role of 25(OH)D variations cannot be substantial.
Calcium (Ca) metabolism, with particular reference to serum vitamin D metabolites, was investigated in 40 women with femoral neck fracture (mean age 77.1 +/- 8.6 yr). All the patients were ambulant before the fracture; eight were long-term geriatric in-patients. Serum total and ionised calcium and serum albumin levels were significantly lower, and serum parathormone (PTH) levels significantly higher in fracture patients than in controls. Both serum 25-OH-D and 1,25-(OH)2D were significantly lower in fracture patients than in controls. We concluded that vitamin D, serum PTH and calcium levels should be checked with greater frequency in patients at high risk for osteoporosis and osteomalacia before they reach the age of 70.
Twenty patients with vulvar dystrophy (19 Lichen sclerosus, 1 Lichen ruber planus) were treated for 3 months with etretinate (Tigason) with an initial dose 0.54 mg/kg/day, maintenance dosage 0.26 mg/kg/day. All the patients had been unsuccessfully treated previously with topical oestrogen and corticosteroids. The therapeutic effect of etretinate on the subjective and objective symptoms of the disease was excellent. In most of the patients the pruritus and burning symptoms diminished within 2 weeks of treatment, and after 3 months the grade of symptoms was lower in 95% of cases. Clinically, a decrease in severity was achieved in 93% of cases among the group with severe vulvar dystrophy. The therapeutic effect of etretinate is strongly anti-inflammatory and it has a powerful effect on the epidermal tissues. According to the latest studies, etretinate also has a strong immuno-modifying effect on the epidermal cells. The secondary inflammatory changes, such as excoriatia, fissures and superinfections disappeared. In the histopathological follow-up hyperkeratosis in the stroma diminished and the inflamed cells and connective tissue normalised after 3 months of treatment. Side effects included cheilitis, dryness of mucous membranes and slight loss of hair. It must be taken into account that etretinate may cause liquid metabolism disturbances, particularly among risk factor patients (diabetes, obesity etc.). In our experience the best results to date in the treatment of vulvar dystrophy can be achieved with etretinate. Due to the teratogenic effect of etretinate, a reliable method of contraception must be used by fertile women of childbearing age.
The concentrations of retinol (vitamin A) were measured in 36 samples of human amniotic fluid obtained near term. Mothers with normal pregnancy had higher amniotic fluid retinol levels than patients with diabetes or toxemia. The results indicate that some maternal complications during pregnancy affect the transport of retinol into amniotic fluid, possibly due to reductions in the uteroplacental blood flow.
Serum concentrations of 25(OH)D, 24,25(OH)2D, 1,25(OH)2D, total calcium, protein, phosphorus, magnesium and alkaline phosphatase were measured in two groups of Finnish women throughout pregnancy and in cord serum at delivery. The autumn group delivered in August-September and the spring group in February-March. There was strong seasonal variation in the 25(OH)D concentrations in both groups. Maternal values (mean +/- s.d.) at delivery were 44.3 +/- 20.8 nmol/l in autumn and 26.0 +/- 13.0 nmol/l in spring. Fetal concentrations were 28.8 +/- 14.3 and 18.3 +/- 11.3 nmol/l, respectively. In both mothers and infants low 25(OH)D values were measured in winter. In the autumn group 7 out of 21 mothers (33 per cent) and in the spring group 17 out of 36 mothers (47 per cent) had values below 17 nmol/l, which is the lowest winter reference value recorded in our laboratory. No significant seasonal variation was observed in dihydroxylated vitamin D metabolites, although 24,25(OH)2D values were a little higher in summer than in winter. Concentrations of 1,25(OH)2D tended to rise towards delivery. Corrected calcium, magnesium and phosphorus concentrations did not change during pregnancy. Fetal calcium and phosphorus concentrations were significantly (P less than 0.001) higher than maternal ones. The data indicate that many mothers and infants have poor vitamin D status in the latitude of Finland. Our results support the concept that vitamin D supplementation should be considered in Finland for pregnant women at least in winter.