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Biomedical subjects

S Kivinen

Publications and source records attributed to S Kivinen.

At least 19 recordsLinked to original sources
PubMed1991

Detection of small for gestational age fetuses by the combination of clinical risk factors and ultrasonography.

Clinical risk factors of fetal growth retardation and targeted ultrasound examinations were combined to detect small for gestational age (SGA) fetuses below the 10th percentile weight for age in 1122 unselected singleton pregnancies, in which the true gestational age was confirmed by ultrasonography at 18 weeks. The prevalence of SGA infants was 6.0% in this population. A risk group of 236 (21%) mothers was referred for an ultrasound examination of fetal growth by the midwives of maternity welfare centers on the basis of low symphysis-fundal height or five other major maternal risk factors (pregnancy associated hypertension, loss of weight gain, a previous SGA infant, pre-pregnancy weight below 50 kg, any smoking during pregnancy). The sensitivity and positive predictive value of the clinical part of the study were 83.6 and 23.7%, respectively. Fetal growth was assessed by measuring both biparietal diameter (BPD) and transverse abdominal diameter. In the clinically selected risk group, 83.9% of the SGA fetuses could be detected by this method using a cutoff level of -1 standard deviation (SD). The two-step screening combining clinical and ultrasonographic methods in the detection of SGA fetuses in general population showed a sensitivity of 70.1%, a specificity of 95.5%, a positive predictive value of 49.5%, and a negative predictive value of 98.1%. After ultrasound examination, the definitive risk group for SGA was 8.5% of the total material of 1122.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1991

Monitoring of smooth muscle antibodies in hypertensive complications during pregnancy.

Smooth muscle antibodies (SMA) were monitored in terms of titer, immunoglobulin class and staining pattern by indirect immunofluorescence assay during the pregnancies of 32 women with pregnancy induced hypertension (PIH), 21 with essential hypertension (EH), and 43 with a normal pregnancy. The mean SMA titer was higher both in PIH and EH than in normal pregnancy. SMA were mainly of the IgG class and gave a "vessel wall" staining pattern in immunofluorescence. The tendency for the mean SMA titer to increase was observed in PIH, whereas a falling tendency was found in EH and normal pregnancy. These tendencies suggest that hypertension, the duration of which has been shorter in PIH, induces SMA production. The observed staining pattern suggests the same kind of non-actin specificity for SMA as in our previous study of complications in early pregnancy.

Adult↗
PubMed1990

Effect of toremifene on clinical chemistry, hematology and hormone levels at different doses in healthy postmenopausal volunteers: phase I study.

Toremifene was given within the dose range of 3-680 mg as a single dose or on five consecutive days to 72 postmenopausal volunteers. Blood samples for clinical chemistry were taken hourly up to 7 h and 1, 2, 3, 7, 10 and 15 days after the last dose of toremifene. The concentrations of serum bilirubin, creatinine, amylase, free thyroxine, cortisol, prolactin, electrolytes and blood glucose remained unchanged at all dose levels. A statistically significant decrease was observed in liver enzymes (ASAT, ALAT, ALP) at the dose levels of 220-680 mg, whereas gamma-GT remained unchanged. A decrease in the concentration of LH and FSH was observed at the dose levels of 46 mg or higher and 220 mg or higher, respectively. These hormonal changes including the increase of SHBG at the dose levels of 220-680 mg and the decrease of antithrombin III (220-680 mg) may be attributed to a weak estrogen-like effect of toremifene. Side effects were minimal: pulse rate, blood pressure and ECG remained unchanged during the test period. Only two patients on 680 mg dose suffered from nausea and vertigo, and one of them discontinued the medication.

Adult↗
PubMed1990

Pharmacokinetics of toremifene.

The pharmacokinetics of toremifene has been investigated in man after single and multiple oral doses. Toremifene was completely absorbed without first-pass metabolism. Peak concentration in serum was achieved in 4 h. Mean half-lives of distribution and elimination were 4 h and 5 days, respectively. Kinetics was linear in the studied dose-range of 10-680 mg. Toremifene was over 99% bound to plasma proteins and extensively metabolized. The main metabolites in serum were demethyl- and deaminohydroxytoremifene. In patients receiving multiple dosing of 60 mg/day serum steady-state level of toremifene was 0.8 microgram/ml on average. The level of demethyl metabolite was twice and that of deaminohydroxy metabolite was one tenth of toremifene.

Biological Availability↗
PubMed1990

Diagnostic problems associated with cystinuria.

To elucidate the role of the urinary cystine concentration for the formation of urinary stones, 190 stone-formers were evaluated in this prospective study. Seven patients (3.8%) were heterozygous and one patient (0.5%) was homozygous for cystinuria; only two (1%) of them were cystine stone-formers. Two patients with calcium stones were heterozygous for cystinuria. This study confirms the observation that elevated concentrations of urine cystine are relatively infrequent among patients with urinary stones.

Adult↗
PubMed1990

Genital human papillomavirus infections in the male sexual partners of 45 female patients with papillomavirus infection.

Forty-five women with a confirmed genital human papillomavirus (HPV) infection and their regular male sexual partners were examined. The diagnosis of the women was based on the colposcopic examination with cytological and histological samples. The men were studied by using a similar microscopic technique. Penisscopic and histological examinations showed that 22 out of the 45 men had genital HPV infection although only 7 men showed visible condylomatous warts. In addition, nine men had clinical lesions highly suggestive to HPV infection in penisscopy but they had unspecific histological samples. 23 of these 31 men were symptom-free. These results further emphasize the importance of regular examinations of the male sexual partners of women with genital HPV infection in order to prevent recurrences and spreading of the infection.

Adult↗
PubMed1989

Phase II evaluation of peroral carmofur, cyclophosphamide, and hexamethylmelamine as a second-line therapy in advanced epithelial ovarian carcinoma.

A prospective phase II study was performed to evaluate the effect and tolerability of a peroral combination chemotherapy consisting of hexamethylmelamine, cyclophosphamide, and carmofur in patients with epithelial ovarian cancer previously heavily treated by cisplatin-based chemotherapy but no longer responding to it. Of the 27 patients 1 showed a clinical complete remission lasting 15+ months and 4 a partial remission of 6+ to 21 months. A further 7 patients had an unchanged situation of 4 to 13+ months. The median survival of the nonresponders was 3 months. The side effects were tolerable, mostly nausea and vomiting. Only 4 of 27 patients suffered from severe vomiting causing discontinuation of the therapy. The peroral ambulatory chemotherapy prolonged markedly the overall survival of about one-half of the patients with ovarian cancer who previously failed to respond to cisplatin-based chemotherapy.

Administration, Oral↗
PubMed1988

Tamoxifen and natural progesterone as supplements to low-dose postmenopausal estrogen therapy.

Postmenopausal women received 1 mg estrone sulfate a day for 3 weeks in 12 sequences separated by a 7-day interval without medication and every second time by a 10-day treatment with natural progesterone, 100 mg 2 times daily (n = 16), or tamoxifen, 10 mg 2 times daily (n = 17). Both treatments alleviated climacteric symptoms, maturated the vaginal epithelium, and decreased follicle-stimulating hormone, luteinizing hormone, and prolactin concentrations while lipid metabolism remained unaltered. In the estrogen-progesterone group 4 women (25%) were persistently amenorrheic, 12 (75%) experienced 1-5 bleedings per year, and 4 women had proliferative endometrium after treatments. In the estrogen-tamoxifen group 11 women (65%) were amenorrheic, 6 (35%) had 1-4 bleedings per year, and 5 had proliferative endometrium. With the present treatment schedules, tamoxifen was more effective than natural progesterone in inhibiting estrogen stimulation of postmenopausal endometrium.

Alanine Transaminase↗
PubMed1988

Routine ultrasound screening for early detection of small for gestational age fetuses.

A real-time ultrasound screening examination was performed in 3208 unselected singleton pregnancies at 18 and 34 weeks to detect small for gestational age (SGA) fetuses below the tenth percentile weight for age. Such cases accounted for 4.9% of this population. Biparietal diameter (BPD) was used at the first examination to confirm the true gestational age. The growth was measured at 34 weeks with a combination of BPD and transverse abdominal diameter. With a cutoff level of -1.5 standard deviations (SD), the sensitivity of a single measurement was 62.2%, the specificity was 93.2%, and the positive predictive value was 32.4%. With a cutoff level of -1 SD, the values were 76.3, 84.8, and 20.4%, respectively. The positive predictive value approached 48.7% before birth in the group that was rescanned before delivery. The simple method of a combined measurement of BPD and transverse abdominal diameter provided efficient antenatal screening for diagnosis of SGA fetuses in the general population. A somewhat low positive predictive value indicates a control examination of fetuses suspected of being SGA. Nonlinear methods, such as the measurement of abdominal circumference, appear suitable for ruling out false-positive cases.

Female↗
PubMed1987

Isolated prolactin deficiency in a woman with puerperal alactogenesis.

Idiopathic PRL deficiency was detected in a parturient woman with otherwise normal pituitary function. This PRL disorder first became manifest postpartum when she had no milk production, and oral metoclopramide failed to raise her serum PRL levels. Her second pregnancy occurred spontaneously after 3 yr of attempts to conceive. During the pregnancy, her serum PRL concentration was very low, varying from 4.5-7.8 ng/ml, and the puerperium was again characterized by alactogenesis. During normal menstrual cycles and after iv GnRH, TRH, metoclopramide, and insulin tolerance tests, serum PRL was only rarely detectable by RIA, at very low concentrations. Bioassay results confirmed the PRL deficiency. The results confirm that PRL is necessary for puerperal lactation and suggest that it is needed for normal ovarian function. The present data also suggest that the maternal pituitary is the main source of serum PRL during pregnancy, and the decidua has only a minor contribution in this respect.

Adult↗
PubMed1987

Cervical carcinoma complicated by malignant pericarditis.

Malignant pericarditis is a rare complication of cervical cancer. In the present case a metastatic pericardial disease developed in a patient who was initially treated by radiation therapy for stage IIb cervical carcinoma. Shortly after the first cycle of chemotherapy with cisplatin, VP-16 and hexamethylmelamine, a pericardial effusion was observed. After drainage of the pericardium and diagnosis of malignant metastatic disease the patient was successfully treated with the initial combination chemotherapy. The patient is still alive 12 months after pericardiotomy.

Adult↗
PubMed1986

Successful treatment of malignant trophoblastic diseases in a small oncologic unit.

Between 1962 and 1983 a total of 26 patients with malignant trophoblastic disease were diagnosed in northern Finland. The incidence of this disease was 1:21,000 pregnancies. Eight patients had choriocarcinoma and 18 an invasive mole. Clinically, 15 patients belonged to the nonmetastatic and 11 to the metastatic group. Of the latter, 4 patients belonged to the low-and 7 to the high-risk categories. During the first years of the study period, cytotoxic chemotherapy, mostly single-drug therapy, was often complemented with adjunctive surgery and/or irradiation. During recent years, single- or multidrug chemotherapy was supplemented with surgery in only one case with chemotherapy-resistant pulmonary metastases. All 26 patients are alive and disease-free, and after therapy 6 of them have given birth to 1-3 children. Our results suggest that malignant trophoblastic diseases can be successfully treated also in small centers of gynecologic oncology with up-to-date knowledge of the principles of modern cytotoxic chemotherapy.

Adolescent↗
PubMed1986

Tumor-associated antigen Ca 125 before and during the treatment of ovarian carcinoma.

Serum concentrations of Ca 125, a tumor-associated antigen of epithelial ovarian cancer, were measured in 29 ovarian cancer patients before cytoreductive surgery and in 112 patients during and after treatment. Ca 125 levels were increased (greater than 30 IU/mL) in 89.8% of patients with clinically demonstrable ovarian tumors and were negative in 92.1% of clinically disease-free patients. Low levels of Ca 125 were associated with early clinical stages or a minimal tumor burden, and predicted a successful response to treatment and a low recurrence rate. High values indicated advanced disease and a poor response to cytotoxic chemotherapy. In 77% of patients the operation was explorative, with a preoperative Ca 125 level higher than 1000 IU/mL, whereas all the patients with values less than 100 IU/mL could be operated radically. Serum levels of Ca 125 were increased in similar frequency in epithelial, sex cord, and germ cell ovarian malignancies. The assay of Ca 125 seems to be a reliable noninvasive method for monitoring the presence and clinical behavior of ovarian cancer. Preoperative values have prognostic significance in predicting operability and response to chemotherapy.

Adenocarcinoma↗
PubMed1985

Short-term effects of danazol and medroxyprogesterone acetate on cytosol and nuclear estrogen and progestin receptors, 17 beta-hydroxysteroid dehydrogenase activity, histopathology, and ultrastructure of human endometrial adenocarcinoma.

We measured concentrations of cytosol and nuclear estrogen, as well as progestin receptors and activities of 17 beta-hydroxysteroid dehydrogenase (17-HSD), and examined histopathology and ultrastructure of endometrial carcinoma specimens taken before and after one-week danazol (200 mg, 3 times daily) or medroxyprogesterone acetate (MPA, 100 mg daily) treatments in 14 and 16 patients, respectively. A typical progestin effect, a significant increase in the activity of 17-HSD, was observed after both treatments. The post-therapy 17-HSD activities correlated significantly with the pretreatment cytosol progestin receptor concentrations in both treatment groups. Both MPA and danazol decreased the proliferative activity and increased the secretory activity of the malignant epithelial endometrial cells. These biochemical and morphological results support the concept that danazol has progestin-like actions on the human endometrium, and might therefore be an alternative for hormonal treatment of endometrial carcinoma.

17-Hydroxysteroid Dehydrogenases↗
PubMed1985

Metoclopramide and breast feeding: efficacy and anterior pituitary responses of the mother and the child.

The purpose of this randomized, double-blind clinical study was to evaluate the efficacy of the antidopaminergic agent metoclopramide (MC) in the treatment of puerperal lactational insufficiency, and prolactin, TSH and free thyroxine responses of the mother and the child to this therapy. Therefore, 11 women received MC (10 mg 3 times daily orally) and 14 a placebo for 3 wk. MC increased the serum concentration of PRL from 57.5 + 45.5 U/l to 315.0 + 300.0 U/l (P less than 0.001), and the amount of daily milk yield in 8 women with established lactational deficiency rose from 285 + 75 ml to 530 + 162 ml (P less than 0.01) while the placebo was ineffective. Serum concentrations of TSH and free thyroxine did not change during either of the treatments. Serum concentrations of PRL, TSH and free thyroxine in the infants were similar in both groups and remained unchanged throughout the study. Our results suggest that MC is useful in the treatment of deficient puerperal lactation, and it does not stimulate the pituitary lactotropes or thyrotropes of the nursing infants.

Adult↗