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Biomedical subjects

T Laatikainen

Publications and source records attributed to T Laatikainen.

At least 19 recordsLinked to original sources
PubMed1997

Finnish national register of laparoscopic hysterectomies: a review and complications of 1165 operations.

OBJECTIVE: We evaluated the advantages and disadvantages of laparoscopic hysterectomy over a 2-year period when this new technique was introduced to several hospitals in Finland. STUDY DESIGN: A nationwide register was founded and a prospective multicenter survey of 1165 laparoscopic hysterectomies was carried out from January 1993 to December 1994. The operations were performed because of uterine fibroids (54%), menorrhagia (27%), dysmenorrhea (8%), endometriosis (2%), and other reasons (9%) by 68 gynecologists at 30 hospitals. RESULTS: The mean operation time was 132 minutes. The patients stayed in hospital for an average of 3.3 days, and the mean convalescence period was 17.9 days, half that after abdominal hysterectomy. Complications occurred in 10.2% of the procedures: infections in 5.6%, vascular complications in 1.2%, urinary tract complications in 2.7%, and bowel complications in 0.4%. CONCLUSIONS: Laparoscopic hysterectomy offers a short hospital stay and convalescence time to the patient, but effective teaching is imperative to minimize, in particular, the risk of urinary tract injuries.

Adult↗
PubMed1996

Pre-eclampsia: the effect of intravenous fluid preload on atrial natriuretic peptide secretion during caesarean section under spinal anaesthesia.

BACKGROUND: The haemodynamic effect of volume load at elective Caesarean delivery may be modulated by atrial natriuretic peptide (ANP) especially in pre-eclamptic women in whom basal ANP levels are increased. METHODS: We followed the haemodynamic parameters and determined the peripheral venous levels of ANP before and after an intravenous volume preload of 1000 ml of Ringer's acetate solution, followed by a further load of the same volume under spinal anaesthesia in 7 healthy and in 6 pre-eclamptic women. RESULTS: During the preload period the median ANP level increased more (from 14.8 to 22.1 pmol/l, P = 0.03) in pre-eclamptic than in healthy women (from 8.0 to 8.5 pmol/l, NS); while an increment in central venous pressure (CVP) was also greater in pre-eclamptic than in healthy women. The increase in the concentrations of ANP correlated significantly (P < 0.05) with the increase in CVP in the total study group. A significant increase in ANP levels in healthy pregnant women was not seen until during the second infusion period under spinal anaesthesia; in pre-eclamptic women the levels increased further during that period. CONCLUSION: These findings concur with the theory that atrial stretch is a stimulus for ANP release. An exaggerated release of ANP in response to volume loading may aid in the adaptation of maternal circulation to volume load at elective Caesarean delivery in pre-eclamptic women.

Adult↗
PubMed1996

Taurodontism in twins with cleft lip and/or palate.

The aims of this study were to determine the frequency of taurodontism of the first and second permanent molars in twins discordant or concordant for clefts, the frequency for each type of cleft in twins, and the concordance-discordance ratio in mono- and dizygotic twins. Thirty-nine pairs of twins (13 monozygotic, 26 dizygotic) between the ages of 7 and 23 yrs were investigated. Taurodontism and hypodontia were determined from orthopantomograms of the dentition. Of the 39 pairs of twins investigated, 16 (41%) had taurodontism, equally in mono- and dizygotic pairs. The highest frequency of the trait was noted in subjects with isolated cleft palate and the lowest in cleft lip subjects. Four of 13 monozygotic pairs with taurodontism were concordant for the trait, as were 9 of 12 dizygotic pairs. Taurodontism was symmetric in 91% of the affected molar pairs. Concomitant taurodontism and hypodontia was observed in 8 of 16 taurodontic twin pairs. We conclude that the etiology of clefting in our group of twins seems to have an effect on the frequency of taurodontism. A high concordance for taurodontism and a high symmetry of the trait may indicate a strong genetic etiology of taurodontism.

Adolescent↗
PubMed1996

Craniofacial morphology in twins with cleft lip and palate.

The craniofacial morphology of 11 pairs of monozygotic (MZ) and 28 pairs of dizygotic (DZ) Finnish twins, discordant or concordant for cleft of the lip (CL), unilateral cleft lip and palate (UCLP), or cleft palate only (CP) were investigated by means of lateral cephalometric radiographs. The results were compared to those of age-, sex-, and cleft-type matched single-birth cleft subjects, and also with normative data from the Nordic population. The co-twins with no cleft lip or palate (NONC) showed only slightly more obtuse gonial and steeper mandibular angles compared to normative data. Twins with CL, UCLP or CP had a more retrusive mandible, a wider cranial base and mandibular angle, and a wider angle between the maxilla and mandible than did the single-birth cleft subjects. Comparison of the noncleft twin group with the CL, UCLP, and CP twin groups for the CL twins showed no significant differences. For the UCLP twins, a more retrusive and down- and backward rotation of both jaws, a wider gonial angle, and a wider cranial base angle was seen. The CP twins had their maxillae slightly retrusive, the down- and backward rotation of both jaws was apparent, and the gonial angle was more obtuse. A comparison between the noncleft MZ and noncleft CDZ twins showed no significant differences. The MZ CP twins had a more retrusive mandible and more down- and backward rotation of both jaws than did DZ CP twins. It thus can be suggested that twinning itself does not seem to have an effect on maxillofacial morphology, but the features of the mandibular structure, the cranial base angulation, and the inclination of the jaws are at least partly genetically induced.

Adolescent↗
PubMed1996

Cleft-twin sets in Finland 1948-1987.

Extensive review of the literature since 1884 on cleft-twin sets yielded 364 cleft-twin sets. Of these, 118 were monozygotic (MZ) and 246 dizygotic (DZ) sets. In addition, Danish material on cleft twins, like our Finnish material, reflects the total number of clefts and cleft twins on a well-defined population during a well-defined time interval. Both sets of material also contain slightly over 100 pairs of twins. The Danish material and the literature review were compared to the Finnish material. The hospital records of all Finnish patients with operated clefts who were born between 1948 and 1987 were reviewed. Information was gathered regarding each patient, his parents, the pregnancy, and his twin or triplet siblings and other siblings. This search produced 105 sets of twins and three sets of triplets with clefts, 15 sets of twins being concordant regarding clefting. This resulted in a total of 120 cleft siblings, and the corrected cleft incidence of 1.72 promille, close to the overall cleft incidence rate in Finland between 1948 and 1975. Twinning was found to be associated neither with an increased nor with a decreased risk of clefting, and clefting could not be seen to increase twinning. Zygosity could be verified in 88 sets of twins; the total number of MZ sets was 17, and of DZ was 71, a 19% MZ rate. Although a higher incidence of clefting in MZ-twin sets has been proposed, no such higher or lower incidence could be found in our material. Recognized syndromes were found in 15 sets (14%), slightly higher than found in a large Finnish study on cleft probands (8.4%). Of these, three sets were monozygotic (MZ), all of them cleft palate (CP) and male sets, whereas eight sets were dizygotic (DZ). All 15 sets were CP only, with no one set with cleft lip and palate [CL(P)]. In our total Finnish-twin material of 105 sets, we found the CL(P)/CP ratio to be 39/66 (37%/63%). In all of the 120 affected siblings, the ratio was 35%/65%. The very high rate of 63% of CP twins is about two to three times higher than that reported in the literature of 364 sets where the CP ratio is 23%; compared to the Danish material with a CP ratio of 17%, it is almost four-fold. The overall CP rate in all clefts (not restricted to twins) in Finland compared to the rate in our neighboring Scandinavian countries was very much in line with this very big difference seen in the CP rate in our twin material. The CL(P) incidence in our Finnish material is 0.61 promille and the CP incidence 1.11 promille. For MZCL(P), the incidence was 0.38 promille; for MZCP, 0.91 promille; for DZCL(P), 0.52 promille, and for DZCP, 0.99 promille. Compared to the Danish figures both the MZCP and DZCP incidence figures are nearly four-fold, with the MZCL(P) somewhat lower, and DZCL(P) less than half that number. The sex distribution of all cleft patients in our material was 44% male/56% female. Both in the Danish material and in the literature, it was the reverse. This difference is probably due mostly to the higher ratio of CP in the Finnish material. The CP group has a higher proportion of females in all these materials. The concordance (C) of the whole Finnish-twin material is 14%, compared to 16.5% reported in the literature and 8% for the Danish twins. The concordance for CL(P) in our material is many times lower (2.6%) than in the literature (17.1%) and in the Danish material (8%). In the Finnish twins, the C for CP is higher (17%) than that for the Danish (6%) and for the literature cleft-twin populations (14.3%). This is also true for the MZ and DZ subgroups. The heritability index (H) in CL(P) is lower for the Finns (17%) than for the Danish (45%) and for the literature materials (43%), and higher for CP (Finns 49%, Danish 33%, literature 36%). All of these data strongly suggest the quite different genetic behavior of both CL(P) and CP in Finland, with a much lower genetic component in the CL(P) and a higher in the CP.

Cleft Lip↗
PubMed1996

Occurrence of the Carabelli trait in twins discordant or concordant for cleft lip and/or palate.

The frequency and expression of the Carabelli trait among 36 twin pairs discordant or concordant for cleft lip and/or palate were investigated. Four of 10 monozygotic (MZ) and 24 of 26 dizygotic (DZ) pairs of twins were discordant for clefts. The frequency of the trait on the first upper molars of the noncleft subjects was 79%. It varied from 54% to 61% in the subjects with clefts, and the frequency of the trait decreased with increasing extension of the cleft. The occurrence of the trait was bilateral in more than 90% of the MZ and the DZ subjects. MZ twins had a higher concordance rate for the corresponding molar comparisons and for cross-twin comparisons than did the DZ pairs. The corresponding polychoric correlations for MZ twin pairs were estimated to be 1.0, and for the DZ twin pairs estimates ranged from 0.4 to 0.5. Thus, genetic factors appear to control the Carabelli trait, and the heritability seems to be high even in our cleft lip and/or palate twins.

Adolescent↗
PubMed1995

Comparison between the effects of tamoxifen and toremifene on the uterus in postmenopausal breast cancer patients.

Antiestrogens have been widely used in the treatment of breast cancer patients. We wanted to compare the uteral and vaginal effects of tamoxifen to those of toremifene. Thirty-one gynecologically asymptomatic postmenopausal breast cancer patients with an intact uterus were randomized to receive 20 mg of tamoxifen (N = 16) or 60 mg of toremifene (N = 15) as an adjuvant treatment. Gynecological examination with vaginal ultrasonography, Pap smear, endometrial biopsy, hysteroscopy, and curettage was performed before the treatment, and at 6 and 12 months of treatment. Endometrial thickness was found to increase significantly during the treatment to the same extent in both groups. Proliferation or other estrogenic effects in the endometrium were observed in 8 of 14 patients in the tamoxifen group and in 3 of 10 patients in the toremifene group. Three polyps occurred and previously present uterine fibroids increased in size in 3 of 10 patients during the study. Estrogenic changes in Pap smear were observed in all patients. There was no significant difference between tamoxifen and toremifene in any of the parameters investigated. Our results suggest that tamoxifen and toremifene produce comparable estrogenic effects in the uterus and vagina.

Adult↗
PubMed1995

Pelvic Castleman disease mimicking an adnexal tumor.

BACKGROUND: Castleman disease, or giant lymph node hyperplasia, is a rare cause of lymph node enlargement. Only 11 cases with pelvic localization in women have been reported. CASE: A pelvic mass mimicking an adnexal tumor was detected on a routine examination in a 26-year-old woman. Surprisingly, the pelvic organs were found to be normal at laparotomy. Eight years later, the subject was examined for dyspareunia and secondary infertility that lasted 2 years. A pelvic mass, evidently the one encountered 8 years previously, was detected; it had enlarged only slightly in the intervening time. Surgical exploration of the retropubic space revealed a tumor-like mass attached to the periosteum of the left superior pubic arch. The mass was removed by simple resection. Histologic investigations confirmed a diagnosis of Castleman disease. Three months after the operation, the woman conceived without any further treatment. CONCLUSION: The possibility of Castleman disease should be considered when assessing a pelvic mass. The condition in the retropubic space in women has not been reported previously.

Adnexa Uteri↗
PubMed1994

Maturation of vaginal and endometrial epithelium in postmenopausal breast cancer patients receiving long-term tamoxifen.

To assess the estrogenic effects of tamoxifen on vaginal and endometrial epithelium and to investigate whether these changes are associated with any pathological findings in the endometrium, 53 postmenopausal breast cancer patients receiving long-term tamoxifen and 52 control breast cancer patients without any hormonal treatment were examined. Pathological findings in the endometrium were evaluated by hysteroscopy and curettage. The main outcome measures were the maturation index in Papanicolaou (Pap) smears, estrogen-like epithelial changes in the endometrium, serum concentrations of gonadotropins, sex hormone-binding globulin (SHBG), estradiol (E2), and testosterone (T). Informative Pap smears showed estrogenic effects in 89% (41/46) of the tamoxifen group and in 49% (22/45) of the control group, and in endometrial aspiration samples in 71% (32/45) and in 41% (19/46), respectively. These changes were associated with increased concentrations of serum E2 in the control group but not in the tamoxifen group. All five patients (11%) with endometrial polyps in the control group showed estrogenic endometrial changes, whereas among 14 women with polyps in the tamoxifen group, 9 showed estrogenic changes and 5 endometrial atrophy. Endometrial adenocarcinoma was found in 3 patients in the tamoxifen group and in 2 in the control group. Pap smears showed atrophy in 2 patients in the former and in one in the latter group. These findings confirmed estrogen-like effects of tamoxifen on the vaginal and endometrial epithelium in postmenopausal breast cancer patients, but these were not closely associated with benign or malignant endometrial lesions.

Adenocarcinoma↗
PubMed1994

Hypodontia in twins discordant or concordant for cleft lip and/or palate.

The aims of this study were to determine the frequency of hypodontia of permanent teeth in twins discordant or concordant for clefts in each type of cleft, to determine the concordance of hypodontia in mono- and dizygotic twins, and to compare the findings with some earlier data. Thirty-nine pairs of twins between 7 and 23 yr of age were investigated. Six of 13 monozygotic and 24/26 dizygotic pairs were discordant for clefts. Orthopantomograms of the dentition, treatment records, and anamnestic data were studied. Twenty-three pairs of twins (59%) had at least one twin with hypodontia: 9/13 (69%) monozygotic and 14/26 (54%) dizygotic. The prevalence of hypodontia was 37% for monozygotic and 32.7% for dizygotic twins, 16.7% in the noncleft and cleft lip groups, 41.1% in the cleft palate group, and 64.3% in the cleft lip and palate group. All these were above the values observed earlier in the noncleft twins and in the Finnish normal and cleft group populations. Four of 13 pairs of monozygotic twins had no hypodontia, 8/9 pairs were discordant, and only 1/9 was concordant for hypodontia. The corresponding figures for the 26 dizygotic pairs were: 12/26, 11/14, and 3/14 pairs. Maxillary second premolars were the most frequently absent teeth, followed in order of frequency by the maxillary lateral incisors and the mandibular second premolars. Hence, for this sample of twins, the genetic component seems to be weak.

Adolescent↗
PubMed1994

Treatment of cholestasis of pregnancy with peroral activated charcoal. A preliminary study.

Elevated serum bile acid levels may play a role in the symptoms associated with cholestasis of pregnancy. Nineteen women (20 pregnancies) with cholestasis of pregnancy were randomized to receive either activated peroral charcoal (9 women, 10 pregnancies) with a dose of 50 g 3 times a day for 8 days or only normal follow-up (n = 10). Serum total bile acids, aminotransferases, alkaline phosphatase, albumin, total cholesterol, and bilirubin (total and conjugated) were evaluated after overnight fasting at the start of the study and on days 4 and 8 of follow-up. By day 8 of treatment serum total bile acid concentrations were lower in patients of the charcoal group than in the control group (P < 0.05). A decrease of total bile acids was observed in seven patients but in only one of the controls (P < 0.05). No other observations (including pruritus) were changed significantly by charcoal. The outcome of pregnancy was good in both groups. This preliminary study suggests that peroral activated charcoal may be considered an alternative in the treatment of intrahepatic cholestasis of pregnancy.

Administration, Oral↗
PubMed1993

Comparison of a local injection of hyperosmolar glucose solution with salpingostomy for the conservative treatment of tubal pregnancy.

OBJECTIVE: To compare a local injection of hyperosmolar glucose and salpingostomy for the laparoscopic treatment of tubal pregnancy in terms of immediate success and postoperative tubal patency. DESIGN: Prospective. PATIENTS, SETTING: Forty women with an unruptured tubal pregnancy were enrolled from among 117 women with ectopic pregnancies (EPs) admitted consecutively to the university clinic. The inclusion criteria were as follows: [1] concentration of beta-hCG in the serum < or = 5,000 IU/L; [2] no living fetus in the EP; and [3] unruptured tubal pregnancy at laparoscopy. INTERVENTIONS: After randomization, 20 of these patients were treated with a local injection of hyperosmolar (50%) glucose solution and 20 women by salpingostomy. Tubal patency was evaluated at relaparoscopy or by hysterosalpingography 6 to 13 months after the primary treatment. RESULTS: The mean decrease in beta-hCG concentration from the preoperative value to the first postoperative day was 37% and 52% in the glucose and salpingostomy groups, respectively, and the mean resolution time was 13 and 12 days, respectively. Human chorionic gonadotropin showed a persistent EP in 4 women (20%) in the glucose group and 2 (10%) in the salpingostomy group. A patent treated tube was found in 9 of 13 women in the glucose group and 9 of 10 in the salpingostomy group at re-examination. During a follow-up of 6 to 20 months 4 women in the glucose group and 4 women in the salpingostomy group had an intrauterine pregnancy. CONCLUSION: A local injection of hyperosmolar glucose is a reasonable method treating tubal pregnancy in selected cases but does not seem to offer any advantage over salpingostomy concerning persistent trophoblastic disease rate.

Adult↗
PubMed1993

Corticotropin-releasing hormone and cortisol in cord plasma in relation to gestational age, labor, and fetal distress.

Concentration of corticotropin-releasing hormone (CRH) has earlier been found to increase greatly in maternal plasma during the last trimester of normal pregnancy and even more in preeclampsia. This CRH is thought to be of placental origin, and it may stimulate maternal or fetal pituitary adrenal axis. We studied CRH in umbilical cord venous plasma in relation to gestation, labor, and fetal distress. There was a great maternal-to-fetal concentration difference in plasma CRH levels, a hundredfold at term pregnancy, suggesting that the placenta releases CRH mainly into the maternal rather than into the fetal circulation. Length of gestation or the mode of delivery did not affect CRH levels in cord plasma. Cord CRH levels were higher (median, 24.1, range, 14.2 to 67 pmol/liter) in six preterm infants with chronic fetal distress, born to mothers with severe preeclampsia and in nine infants born after premature rupture of membranes (median, 17.0, range, 7.65 to 53 pmol/liter), than in 12 preterm control infants born after uncomplicated pregnancy (median, 6.3 range, 1.0 to 27.5 pmol/liter). No significant correlation was found between CRH and cortisol levels in cord plasma. Increased cortisol levels in cord plasma were associated with spontaneous vaginal delivery but not with chronic fetal distress. These findings demonstrated that placental release of CRH into the fetal circulation may be increased in pregnancy complications with chronic fetal distress but failed to prove any relationship between placental CRH and fetal adrenal function.

Corticotropin-Releasing Hormone↗
PubMed1993

Endometrial changes in postmenopausal breast cancer patients receiving tamoxifen.

OBJECTIVE: To assess the estrogenic effect of tamoxifen and associated pathologic changes of the endometrium in postmenopausal breast cancer patients. METHODS: The endometrium of 103 gynecologically asymptomatic postmenopausal breast cancer patients was examined. Fifty-one had been treated with tamoxifen and 52 had not received any hormonal treatment. The two groups were similar in age, parity, age at menopause, and body mass index. RESULTS: Compared with the control subjects, the tamoxifen patients had a thicker endometrium (mean +/- standard deviation 10.4 +/- 5.0 versus 4.2 +/- 2.7 mm; P = .0001) and larger uterine volume (45 +/- 27 versus 25 +/- 11 cm3; P = .001), as determined by transvaginal sonography. Hysteroscopy showed an atrophic endometrium in 28% of the patients in the tamoxifen group, as compared with 87% of the control patients (P = .0001). Endometrial polyps were more frequent in the tamoxifen group (36 versus 10%; P = .004), which included one patient with atypical hyperplasia, one with adenomatous hyperplasia, and one with endometrial adenocarcinoma; two controls had endometrial adenocarcinoma. CONCLUSION: The results provide evidence for an estrogenic effect of long-term tamoxifen treatment on the postmenopausal uterus and show it to be associated with an increased occurrence of polyps.

Aged↗
PubMed1992

Plasma endothelin, atrial natriuretic peptide (ANP) and uterine and umbilical artery flow velocity waveforms in hypertensive pregnancies.

OBJECTIVE: To investigate the relation between concentrations of endothelin and atrial natriuretic peptide (ANP) in maternal plasma and vasospasm in the uterine and umbilical arteries as detected by duplex pulsed colour Doppler ultrasonography in hypertensive pregnancies. DESIGN: An observational study. SUBJECTS: 32 women admitted consecutively to hospital with pregnancy induced hypertension (seven without proteinuria and 25 with proteinuria) and 78 healthy pregnant women examined at 28-40 weeks gestation. MAIN OUTCOME MEASURES: Systolic/diastolic (S/D) ratio in flow velocity waveforms (FVWs) and plasma concentrations of endothelin and ANP in the 32 women with pregnancy induced hypertension; plasma concentrations of endothelin and ANP in 78 healthy pregnant women (controls). RESULTS: Pathological FVWs suggesting vasospasm in the uterine or umbilical artery, or both arteries, were found in 12 women with hypertension. Plasma ANP was significantly higher (P = 0.03) in the women with hypertension and pathological FVWs (median 23.0, range 10.1-52.8 pmol/l) than in those with hypertension and normal FVWs, (median 13.8, range 5.3-42.3 pmol/l) but corresponding plasma endothelin levels did not show any significant difference (median 1.63, range 0.51-3.33 pmol/l and median 1.38, range 0.51-3.51 pmol/l, respectively). CONCLUSION: Local release of endothelin from the vascular endothelium is thought to cause vasospasm in pregnancy induced hypertension but this does not seem to increase the concentration of endothelin in the maternal peripheral plasma, probably because of its rapid disappearance from the blood circulation. As ANP dilates the blood vessels, the increase of its release in hypertensive pregnancies may be a compensatory mechanism against vasospasm.

Atrial Natriuretic Factor↗
PubMed1992

Effect of oral contraceptives on plasma beta-endorphin and corticotropin at rest and during exercise.

Concentrations of immunoreactive beta-endorphin and corticotropin in plasma were studied in 27 healthy physically active women at rest and after the exercise test on a treadmill requiring 60% and 90% of the maximal oxygen consumption. Eleven of the subjects were on a combination-type of oral contraceptive pills, and the remaining 16 did not use any pills. Plasma immunoreactive beta-endorphin levels at rest were higher in pill non-users than in pill users. Corticotropin levels at rest did not differ between the pill users and non-users. After the 60% exercise test a slight increase was found in the concentrations of corticotropin and beta-endorphin in the pill non-users but not in the pill users. In the 90% exercise test, plasma beta-endorphin and corticotropin levels increased significantly in both groups. We conclude that the use of oral contraceptives may elevate the threshold of the intensity of exercise required to increase beta-endorphin and corticotropin secretion. Decreased resting concentration of beta-endorphin in pill users can be explained by suppression of normal cyclic ovarian function.

Adrenocorticotropic Hormone↗