R. Tuimala - Academia.edu (original) (raw)
Papers by R. Tuimala
European journal of clinical nutrition, 1988
Concentrations of selenium in the soil are very low in most regions in Finland, which explains th... more 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 th...
Early Human Development, 1984
Vasopressin concentrations were measured in the cerebrospinal fluid in two hydrocephalic fetuses ... more Vasopressin concentrations were measured in the cerebrospinal fluid in two hydrocephalic fetuses at 33 and 34 weeks of gestation. The vasopressin concentrations in cerebrospinal fluid were 0.8 and 0.6 pg/ml, and in amniotic fluid 0.4 and 1.0 pg/ml, respectively. Previously measured vasopressin concentrations in amniotic fluid of the normal fetuses have been of the same magnitude.
Scandinavian Journal of Work, Environment & Health, 1994
The goal of this investigation was to examine the effects of occupational noise during pregnancy ... more The goal of this investigation was to examine the effects of occupational noise during pregnancy prospectively. 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. 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. Working in high noise exposure can be considered a form of risk during pregnancy.
Paediatric and Perinatal Epidemiology, 1993
Recent obstetrical practice trends in 12 countries were surveyed. There was a Bfold difference in... more Recent obstetrical practice trends in 12 countries were surveyed. There was a Bfold difference in caesarean section rates and a 10-fold difference in instrumental vaginal delivery rates among countries. There was a net increase in the caesarean section rate of all countries over the study period and a net decrease in the instrumental vaginal delivery rate of some countries. There was a decrease in the caesarean section rate during the last year of observation in Australia:Denmark and Finland. In general, countries with high caesarean rates also had high instrumental vaginal delivery rates. There was no consistent relationship between use of caesarean section and use of instrumental vaginal delivery, although in several countries increasing use of caesarean section was accompanied by decreasing use of instrumental vaginal delivery. Oxytocin use rates were associated positively with instrumental delivery but not with caesarean section rates. While it was not possible to determine the proportions of women who received appropriate obstetrical care, we can infer that a significant proportion of interventions were unnecessary or only marginally beneficial. Continued increases in rates of obstetrical intervention are unlikely to result in improvements in birth outcome overall and may pose a risk to mothers and their newborns.
Osteoporosis International, 2000
To determine the physiologic and habitual factors that may modulate changes in bone mineral densi... more To determine the physiologic and habitual factors that may modulate changes in bone mineral density (BMD) postpartum, dual-energy X-ray absorptiometry was performed at the lumbar spine, right femoral neck and dominant distal radius immediately after delivery, after resumption of menses, and 1 year thereafter in a cohort of 41 healthy postpartum Finnish women aged 31.5 (SD 4.6) years. Mean durations of lactation and postpartum amenorrhea (PPA) were 7.7 (3.7) and 5.9 (2.9) months, respectively. After PPA, signi®cant bone losses of 2%±4% were observed at the lumbar spine and femoral neck. Duration of PPA and different lactational variables explained (adjusted R 2 ) from 21% to 27% of the variability in changes in BMD during PPA. A recovery to postpregnancy BMD levels was observed at the lumbar spine; in contrast BMD at the femoral neck showed only a partial recovery. The duration of unsupplemented lactation was weakly (adjusted R 2 = 0.13) associated with recovery at the lumbar spine, while a long duration of total lactation also showed a weak association (adjusted R 2 = 0.02) with delayed recovery at the femoral neck. In conclusion, a systematic bone loss occurs during PPA, and after resumption of menstruation BMD recovers despite continued lactation. However, the time of bony recovery back to postpregnancy level seems to be modulated slightly by lactation habits. It is obvious that the control of postpartum BMD changes is a multifactorial process that may be speci®c to the skeletal site of interest.
Osteoporosis International, 1999
Areal bone mineral density (BMD, g/cm 2 ) of five healthy women (aged 26-30 years) was measured a... more Areal bone mineral density (BMD, g/cm 2 ) of five healthy women (aged 26-30 years) was measured at the lumbar spine, right femoral neck and dominant distal radius with dual-energy X-ray absorptiometry before pregnancy, immediately after delivery, 1 month after the resumption of menses and 1 year thereafter. Because of the small number of subjects, only individual changes in BMD that were greater than 2H2 times the short-term in vivo precision were considered as significant changes. To obtain a further perspective, the reproduction-related BMD changes were compared with twice the standard deviation (SD) of the BMD changes in healthy premenopausal women (about ± 5%), and with the SD of the BMD in a cross-sectional sample of young healthy women. The duration of postpartum amenorrhea (PPA) and of lactation in our subjects ranged from about 2 months to 1 year and from 5 months to almost 2 years, respectively. No clear association between PPA and lactation could be seen. The magnitudes of reproductionrelated BMD changes in general seemed not to differ substantially from about ± 5% variability in BMD changes in healthy nonpregnant and nonlactating women. There was, however, some tendency toward systematic bone loss at the lumbar spine (about -3%) during pregnancy and at the femoral neck during PPA (about -5% as compared with prepregnancy data). Some individuals can yet show large, systematic bone losses comparable to 1 SD in magnitude. The site-specific reproduction-induced bone loss and consequent recovery are apparently multifactorial phenomena that may be related not only to duration and magnitude of lactation and/or duration of postpartum amenorrhea, but also to prevailing biomechanical and dietary factors, and other yet unknown individually modulated factors.
Maturitas, 1998
To investigate if disappearance of climacteric symptoms during hormone replacement therapy (HRT) ... more To investigate if disappearance of climacteric symptoms during hormone replacement therapy (HRT) also means good therapeutic level of serum estradiol. The study group comprised of 32 postmenopausal women who had frequent climacteric symptoms. The women increased the daily treatment doses of percutaneous estradiol every 2 weeks until they felt comfortable with it. Each woman continued at that treatment dose for up to 3 months. Blood samples for estradiol assay were drawn at baseline, every time before the estradiol dosage was increased and at the end of the study. Climacteric symptoms were scored according to the Kupperman menopausal index. Despite the relief of climacteric symptoms, serum estradiol concentration was at a menopausal level (< 50 pg/ml) in 22% of the women. In all, 45% of the subjects showed serum estradiol remaining under 60 pg/ml, 29% of the women showed levels of 60-100 pg/ml and 26% showed serum estradiol concentration more than 100 pg/ml. The disappearance of climacteric symptoms during HRT does not guarantee that estrogen levels are sufficiently high for obtaining long term benefits of HRT.
Journal of Psychosomatic Obstetrics & Gynecology, 1990
... might prevent interventions. First, an essential part of the so-called 'active manag... more ... might prevent interventions. First, an essential part of the so-called 'active management of labor' with low Caesarean section rates in Dublin, Ireland, includes the constant presence of a student midwife','. Multicenter trials arc ...
Journal of Obstetrics & Gynaecology, 1991
Gynecological Endocrinology, 2002
This double-blind, randomized, multi-center study compared the metabolic tolerance of a combined ... more This double-blind, randomized, multi-center study compared the metabolic tolerance of a combined formulation containing estradiol (E2) and trimegestone (TMG) with a standard hormone replacement therapy (HRT) containing estradiol valerate (EV) and norgestrel (NG). Blood lipids, glucose and fibrinogen concentrations were measured in the study which was conducted over 13 cycles, each of 28 days, and included 634 subjects in two randomized groups. A total of 481 subjects completed the study. The circulating concentrations of high density lipoprotein (HDL), HDL2, HDL3 cholesterol and apolipoprotein A1 were increased in the E2 + TMG group and reduced in the EV + NG group. Total cholesterol, low density lipoprotein (LDL) cholesterol, apolipoprotein B and lipoprotein(a) concentrations were decreased in both treatment groups; however, the reduction in LDL cholesterol was greater in the E2 + TMG group. Similar lipid findings were found in a subgroup that excluded subjects who had less than 3 months washout from a previous HRT, who provided a blood sample outside the day 17-28 window, or who were taking beta-blockers or thiazide diuretics. Blood glucose concentrations were reduced slightly in both treatment groups. A significant reduction in fibrinogen was also seen in both groups over the course of the study. The changes in lipid profile, especially HDL cholesterol, were more beneficial in the E2 + TMG group in comparison with the EV + NG group. This reflects the lack of androgenic action of trimegestone in comparison with norgestrel, which exhibits an androgenic effect and prevents the estrogen-induced increase in HDL cholesterol. The results of the study suggest that the use of trimegestone in combination with E2 may be preferable to norgestrel because of the more favorable lipid profile.
Gynecological Endocrinology, 2001
This double-blind, randomized, multi-center study compared the efficacy and clinical tolerance of... more This double-blind, randomized, multi-center study compared the efficacy and clinical tolerance of a combined formulation containing 2 mg estradiol (E2) and 0.5 mg trimegestone (TMG) with a standard hormone replacement therapy containing estradiol valerate (E2V) and norgestrel (NG) in the treatment of climacteric symptoms. The study was conducted over 13 cycles, each of 28 days, and involved 634 subjects, of whom 481 completed the study. The primary efficacy variable was the percentage of subjects who showed at least a 50% reduction from baseline in the mean daily number of hot flushes in cycle 3. This was observed in 98.5% of the subjects in the E2 + TMG group and 93.3% of the subjects in the E2V + NG group (95% confidence interval of the difference, 8.6, 1.9). Significant differences in favor of the E2 + TMG combination were observed in the reduction in the mean daily number and severity of hot flushes, and in the percentage of subjects who had hot flushes at baseline but no hot flushes during treatment. There were no significant differences between the treatments in the Kupperman index and in urogenital signs or symptoms. Treatment with the E2 + TMG combination was well tolerated and the incidences of adverse events were similar in the two treatment groups. Breast pain was the main adverse event, possibly related to treatment that resulted in discontinuation. The mean number of bleeding 349 days per cycle was significantly lower with the E2 + TMG combination than with the E2V + NG combination. The incidences of endometrial hyperplasia were low and comparable in both treatment groups. It was concluded that the E2 + TMG combination was either equivalent or superior to the E2V + NG combination in the treatment of hot flushes and other climacteric symptoms, and that its bleeding profile was favorable.
BJOG: An International Journal of Obstetrics and Gynaecology, 1985
Pharmacology & Toxicology, 1991
Renal prostanoid excretion was investigated in nine hypertensive pregnant patients before and dur... more 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 F,,, 6-keto-PGF,,) increased by 77% during nifedipine treatment (P<O.O5). No changes were found in prostaglandin E, (PGEJ and thromboxane A, (as thromboxane B,, TXBJ excretions. A significant reduction in blood pressure did not correlate with an increase in 6-keto-PGF1, excretion. Plasma prekallikrein and urinary kallikrein and catecholamine excretions remained unaltered. In six normotensive non-pregnant women, increase in 6-keto-PGF,, excretion during nifedipine treatment was not significant. No changes in PGE, and TXB, excretions were found, whereas plasma prekallikrein was reduced (P < 0.05) and urinary excretion of kallikrein (P < 0.05) and noradrenaline (P =0.06) increased under nifedipine. The results suggest that nifedipine enhances the renal 6-keto-PGF1, excretion in hypertensive pregnancy.
Acta Obstetricia et Gynecologica Scandinavica, 1978
Journal of Steroid Biochemistry, 1978
Acta Obstetricia Et Gynecologica Scandinavica
In order to assess anterior pituitary function during the puerperium, 20 women were studied by 14... more In order to assess anterior pituitary function during the puerperium, 20 women were studied by 14 intravenous LRH and 10 TRH stimulation tests within 2-10 days post-partum. The basal FSH level (150-340 ng/ml) was within the normal non-pregnant range for the follicular phase of the menstrual cycle (50-350 ng/ml) and did not increase after 100 mug of synthetic LRH. The TSH (3.3-8.8 muU/ml) was high and increased after 200 mug of synthetic TRH about twofold. Obstetrical parameters (e.g. milk excretion, pregnancy complication, type of delivery or the amount of bleeding during delivery) were not associated with significant changes in FSH or TSH levels or in the responses to TRH stimulation.
Annals of clinical research
Maternal plasma ACTH, cortisol and TSH concentrations were determined during the course of the in... more Maternal plasma ACTH, cortisol and TSH concentrations were determined during the course of the induced labours of 20 normal parturients. Alternate mothers were given segmental epidural analgesia for pain relief during the first stage of labour. The remaining parturients served as controls. The ACTH level rose in same way in both groups, reaching its peak at the moment of delivery and decreasing rapidly thereafter. Cortisol secretion reached its maximum during the first stage of labour in the moment of delivery. After delivery the cortisol level decreased more rapidly in the epidural group tha. in the control gro,p. Umbilical venous cortisol concentration was the same in both groups. The maternal TSH level did not change significantly during labour in either group.
British Journal of Obstetrics and Gynaecology
In view of observations indicating accelerated fetal pulmonary maturation after tocolytic therapy... more In view of observations indicating accelerated fetal pulmonary maturation after tocolytic therapy with beta-adrenergic agonists, this study was undertaken to determine whether the phenomenon is related to enhanced maternal or fetal ACTH, cortisol or prolactin secretion. The concentrations of ACTH, cortisol and prolactin in maternal venous blood, umbilical arterial and venous blood, and amniotic fluid were similar after short-term maternal intravenous infusion of isoxsuprine, fenoterol or isotonic saline, and they did not increase in the maternal venous blood during these treatments or during long-term treatment with intravenous ritodrine. These results suggest that the accelerated fetal pulmonary maturation induced by beta-adrenergic stimulation is not mediated by ACTH, cortisol or prolactin.
Obstetrics and Gynecology
Radioimmunologic techniques were used to determine 2 primary bile acids (cholic and chenodeoxycho... more Radioimmunologic techniques were used to determine 2 primary bile acids (cholic and chenodeoxycholic acid) and 1 secondary bile acid (deoxycholic acid) from human amniotic fluid of healthy pregnant women and from patients with diabetes, toxemia, or intrahepatic cholestasis during pregnancy. In general, the mean bile acid concentrations in the amniotic fluid were very similar to those in the serum, although in paired samples from individual patients these 2 values did not correlate significantly. Very high levels of the 2 primary bile acids were measured from the amniotic fluid of patients with intrahepatic cholestasis. The mean values were about 70 times higher than those in the controls. Amniotic fluid cholic acid content was slightly elevated in diabetic and toxemic patients, too. Deoxycholic acid was consistently found in the amniotic fluid specimens, but there was no change in its concentration among the various groups. In this limited series of patients, no significant correlation was found between the bile acid concentrations in the amniotic fluid and signs of fetal distress at the time of amniocentesis, although the lowest maternal serum estriol and human placental lactogen values were associated with the highest amniotic fluid bile acid concentrations. The condition of the newborn infants did not correlate with amniotic fluid bile acid concentrations in any of the patient groups studied. It thus appears that high amniotic fluid bile acid content present a threat to the fetus, but further studies are needed to clarify this point.
European journal of clinical nutrition, 1988
Concentrations of selenium in the soil are very low in most regions in Finland, which explains th... more 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 th...
Early Human Development, 1984
Vasopressin concentrations were measured in the cerebrospinal fluid in two hydrocephalic fetuses ... more Vasopressin concentrations were measured in the cerebrospinal fluid in two hydrocephalic fetuses at 33 and 34 weeks of gestation. The vasopressin concentrations in cerebrospinal fluid were 0.8 and 0.6 pg/ml, and in amniotic fluid 0.4 and 1.0 pg/ml, respectively. Previously measured vasopressin concentrations in amniotic fluid of the normal fetuses have been of the same magnitude.
Scandinavian Journal of Work, Environment & Health, 1994
The goal of this investigation was to examine the effects of occupational noise during pregnancy ... more The goal of this investigation was to examine the effects of occupational noise during pregnancy prospectively. 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. 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. Working in high noise exposure can be considered a form of risk during pregnancy.
Paediatric and Perinatal Epidemiology, 1993
Recent obstetrical practice trends in 12 countries were surveyed. There was a Bfold difference in... more Recent obstetrical practice trends in 12 countries were surveyed. There was a Bfold difference in caesarean section rates and a 10-fold difference in instrumental vaginal delivery rates among countries. There was a net increase in the caesarean section rate of all countries over the study period and a net decrease in the instrumental vaginal delivery rate of some countries. There was a decrease in the caesarean section rate during the last year of observation in Australia:Denmark and Finland. In general, countries with high caesarean rates also had high instrumental vaginal delivery rates. There was no consistent relationship between use of caesarean section and use of instrumental vaginal delivery, although in several countries increasing use of caesarean section was accompanied by decreasing use of instrumental vaginal delivery. Oxytocin use rates were associated positively with instrumental delivery but not with caesarean section rates. While it was not possible to determine the proportions of women who received appropriate obstetrical care, we can infer that a significant proportion of interventions were unnecessary or only marginally beneficial. Continued increases in rates of obstetrical intervention are unlikely to result in improvements in birth outcome overall and may pose a risk to mothers and their newborns.
Osteoporosis International, 2000
To determine the physiologic and habitual factors that may modulate changes in bone mineral densi... more To determine the physiologic and habitual factors that may modulate changes in bone mineral density (BMD) postpartum, dual-energy X-ray absorptiometry was performed at the lumbar spine, right femoral neck and dominant distal radius immediately after delivery, after resumption of menses, and 1 year thereafter in a cohort of 41 healthy postpartum Finnish women aged 31.5 (SD 4.6) years. Mean durations of lactation and postpartum amenorrhea (PPA) were 7.7 (3.7) and 5.9 (2.9) months, respectively. After PPA, signi®cant bone losses of 2%±4% were observed at the lumbar spine and femoral neck. Duration of PPA and different lactational variables explained (adjusted R 2 ) from 21% to 27% of the variability in changes in BMD during PPA. A recovery to postpregnancy BMD levels was observed at the lumbar spine; in contrast BMD at the femoral neck showed only a partial recovery. The duration of unsupplemented lactation was weakly (adjusted R 2 = 0.13) associated with recovery at the lumbar spine, while a long duration of total lactation also showed a weak association (adjusted R 2 = 0.02) with delayed recovery at the femoral neck. In conclusion, a systematic bone loss occurs during PPA, and after resumption of menstruation BMD recovers despite continued lactation. However, the time of bony recovery back to postpregnancy level seems to be modulated slightly by lactation habits. It is obvious that the control of postpartum BMD changes is a multifactorial process that may be speci®c to the skeletal site of interest.
Osteoporosis International, 1999
Areal bone mineral density (BMD, g/cm 2 ) of five healthy women (aged 26-30 years) was measured a... more Areal bone mineral density (BMD, g/cm 2 ) of five healthy women (aged 26-30 years) was measured at the lumbar spine, right femoral neck and dominant distal radius with dual-energy X-ray absorptiometry before pregnancy, immediately after delivery, 1 month after the resumption of menses and 1 year thereafter. Because of the small number of subjects, only individual changes in BMD that were greater than 2H2 times the short-term in vivo precision were considered as significant changes. To obtain a further perspective, the reproduction-related BMD changes were compared with twice the standard deviation (SD) of the BMD changes in healthy premenopausal women (about ± 5%), and with the SD of the BMD in a cross-sectional sample of young healthy women. The duration of postpartum amenorrhea (PPA) and of lactation in our subjects ranged from about 2 months to 1 year and from 5 months to almost 2 years, respectively. No clear association between PPA and lactation could be seen. The magnitudes of reproductionrelated BMD changes in general seemed not to differ substantially from about ± 5% variability in BMD changes in healthy nonpregnant and nonlactating women. There was, however, some tendency toward systematic bone loss at the lumbar spine (about -3%) during pregnancy and at the femoral neck during PPA (about -5% as compared with prepregnancy data). Some individuals can yet show large, systematic bone losses comparable to 1 SD in magnitude. The site-specific reproduction-induced bone loss and consequent recovery are apparently multifactorial phenomena that may be related not only to duration and magnitude of lactation and/or duration of postpartum amenorrhea, but also to prevailing biomechanical and dietary factors, and other yet unknown individually modulated factors.
Maturitas, 1998
To investigate if disappearance of climacteric symptoms during hormone replacement therapy (HRT) ... more To investigate if disappearance of climacteric symptoms during hormone replacement therapy (HRT) also means good therapeutic level of serum estradiol. The study group comprised of 32 postmenopausal women who had frequent climacteric symptoms. The women increased the daily treatment doses of percutaneous estradiol every 2 weeks until they felt comfortable with it. Each woman continued at that treatment dose for up to 3 months. Blood samples for estradiol assay were drawn at baseline, every time before the estradiol dosage was increased and at the end of the study. Climacteric symptoms were scored according to the Kupperman menopausal index. Despite the relief of climacteric symptoms, serum estradiol concentration was at a menopausal level (< 50 pg/ml) in 22% of the women. In all, 45% of the subjects showed serum estradiol remaining under 60 pg/ml, 29% of the women showed levels of 60-100 pg/ml and 26% showed serum estradiol concentration more than 100 pg/ml. The disappearance of climacteric symptoms during HRT does not guarantee that estrogen levels are sufficiently high for obtaining long term benefits of HRT.
Journal of Psychosomatic Obstetrics & Gynecology, 1990
... might prevent interventions. First, an essential part of the so-called 'active manag... more ... might prevent interventions. First, an essential part of the so-called 'active management of labor' with low Caesarean section rates in Dublin, Ireland, includes the constant presence of a student midwife','. Multicenter trials arc ...
Journal of Obstetrics & Gynaecology, 1991
Gynecological Endocrinology, 2002
This double-blind, randomized, multi-center study compared the metabolic tolerance of a combined ... more This double-blind, randomized, multi-center study compared the metabolic tolerance of a combined formulation containing estradiol (E2) and trimegestone (TMG) with a standard hormone replacement therapy (HRT) containing estradiol valerate (EV) and norgestrel (NG). Blood lipids, glucose and fibrinogen concentrations were measured in the study which was conducted over 13 cycles, each of 28 days, and included 634 subjects in two randomized groups. A total of 481 subjects completed the study. The circulating concentrations of high density lipoprotein (HDL), HDL2, HDL3 cholesterol and apolipoprotein A1 were increased in the E2 + TMG group and reduced in the EV + NG group. Total cholesterol, low density lipoprotein (LDL) cholesterol, apolipoprotein B and lipoprotein(a) concentrations were decreased in both treatment groups; however, the reduction in LDL cholesterol was greater in the E2 + TMG group. Similar lipid findings were found in a subgroup that excluded subjects who had less than 3 months washout from a previous HRT, who provided a blood sample outside the day 17-28 window, or who were taking beta-blockers or thiazide diuretics. Blood glucose concentrations were reduced slightly in both treatment groups. A significant reduction in fibrinogen was also seen in both groups over the course of the study. The changes in lipid profile, especially HDL cholesterol, were more beneficial in the E2 + TMG group in comparison with the EV + NG group. This reflects the lack of androgenic action of trimegestone in comparison with norgestrel, which exhibits an androgenic effect and prevents the estrogen-induced increase in HDL cholesterol. The results of the study suggest that the use of trimegestone in combination with E2 may be preferable to norgestrel because of the more favorable lipid profile.
Gynecological Endocrinology, 2001
This double-blind, randomized, multi-center study compared the efficacy and clinical tolerance of... more This double-blind, randomized, multi-center study compared the efficacy and clinical tolerance of a combined formulation containing 2 mg estradiol (E2) and 0.5 mg trimegestone (TMG) with a standard hormone replacement therapy containing estradiol valerate (E2V) and norgestrel (NG) in the treatment of climacteric symptoms. The study was conducted over 13 cycles, each of 28 days, and involved 634 subjects, of whom 481 completed the study. The primary efficacy variable was the percentage of subjects who showed at least a 50% reduction from baseline in the mean daily number of hot flushes in cycle 3. This was observed in 98.5% of the subjects in the E2 + TMG group and 93.3% of the subjects in the E2V + NG group (95% confidence interval of the difference, 8.6, 1.9). Significant differences in favor of the E2 + TMG combination were observed in the reduction in the mean daily number and severity of hot flushes, and in the percentage of subjects who had hot flushes at baseline but no hot flushes during treatment. There were no significant differences between the treatments in the Kupperman index and in urogenital signs or symptoms. Treatment with the E2 + TMG combination was well tolerated and the incidences of adverse events were similar in the two treatment groups. Breast pain was the main adverse event, possibly related to treatment that resulted in discontinuation. The mean number of bleeding 349 days per cycle was significantly lower with the E2 + TMG combination than with the E2V + NG combination. The incidences of endometrial hyperplasia were low and comparable in both treatment groups. It was concluded that the E2 + TMG combination was either equivalent or superior to the E2V + NG combination in the treatment of hot flushes and other climacteric symptoms, and that its bleeding profile was favorable.
BJOG: An International Journal of Obstetrics and Gynaecology, 1985
Pharmacology & Toxicology, 1991
Renal prostanoid excretion was investigated in nine hypertensive pregnant patients before and dur... more 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 F,,, 6-keto-PGF,,) increased by 77% during nifedipine treatment (P<O.O5). No changes were found in prostaglandin E, (PGEJ and thromboxane A, (as thromboxane B,, TXBJ excretions. A significant reduction in blood pressure did not correlate with an increase in 6-keto-PGF1, excretion. Plasma prekallikrein and urinary kallikrein and catecholamine excretions remained unaltered. In six normotensive non-pregnant women, increase in 6-keto-PGF,, excretion during nifedipine treatment was not significant. No changes in PGE, and TXB, excretions were found, whereas plasma prekallikrein was reduced (P < 0.05) and urinary excretion of kallikrein (P < 0.05) and noradrenaline (P =0.06) increased under nifedipine. The results suggest that nifedipine enhances the renal 6-keto-PGF1, excretion in hypertensive pregnancy.
Acta Obstetricia et Gynecologica Scandinavica, 1978
Journal of Steroid Biochemistry, 1978
Acta Obstetricia Et Gynecologica Scandinavica
In order to assess anterior pituitary function during the puerperium, 20 women were studied by 14... more In order to assess anterior pituitary function during the puerperium, 20 women were studied by 14 intravenous LRH and 10 TRH stimulation tests within 2-10 days post-partum. The basal FSH level (150-340 ng/ml) was within the normal non-pregnant range for the follicular phase of the menstrual cycle (50-350 ng/ml) and did not increase after 100 mug of synthetic LRH. The TSH (3.3-8.8 muU/ml) was high and increased after 200 mug of synthetic TRH about twofold. Obstetrical parameters (e.g. milk excretion, pregnancy complication, type of delivery or the amount of bleeding during delivery) were not associated with significant changes in FSH or TSH levels or in the responses to TRH stimulation.
Annals of clinical research
Maternal plasma ACTH, cortisol and TSH concentrations were determined during the course of the in... more Maternal plasma ACTH, cortisol and TSH concentrations were determined during the course of the induced labours of 20 normal parturients. Alternate mothers were given segmental epidural analgesia for pain relief during the first stage of labour. The remaining parturients served as controls. The ACTH level rose in same way in both groups, reaching its peak at the moment of delivery and decreasing rapidly thereafter. Cortisol secretion reached its maximum during the first stage of labour in the moment of delivery. After delivery the cortisol level decreased more rapidly in the epidural group tha. in the control gro,p. Umbilical venous cortisol concentration was the same in both groups. The maternal TSH level did not change significantly during labour in either group.
British Journal of Obstetrics and Gynaecology
In view of observations indicating accelerated fetal pulmonary maturation after tocolytic therapy... more In view of observations indicating accelerated fetal pulmonary maturation after tocolytic therapy with beta-adrenergic agonists, this study was undertaken to determine whether the phenomenon is related to enhanced maternal or fetal ACTH, cortisol or prolactin secretion. The concentrations of ACTH, cortisol and prolactin in maternal venous blood, umbilical arterial and venous blood, and amniotic fluid were similar after short-term maternal intravenous infusion of isoxsuprine, fenoterol or isotonic saline, and they did not increase in the maternal venous blood during these treatments or during long-term treatment with intravenous ritodrine. These results suggest that the accelerated fetal pulmonary maturation induced by beta-adrenergic stimulation is not mediated by ACTH, cortisol or prolactin.
Obstetrics and Gynecology
Radioimmunologic techniques were used to determine 2 primary bile acids (cholic and chenodeoxycho... more Radioimmunologic techniques were used to determine 2 primary bile acids (cholic and chenodeoxycholic acid) and 1 secondary bile acid (deoxycholic acid) from human amniotic fluid of healthy pregnant women and from patients with diabetes, toxemia, or intrahepatic cholestasis during pregnancy. In general, the mean bile acid concentrations in the amniotic fluid were very similar to those in the serum, although in paired samples from individual patients these 2 values did not correlate significantly. Very high levels of the 2 primary bile acids were measured from the amniotic fluid of patients with intrahepatic cholestasis. The mean values were about 70 times higher than those in the controls. Amniotic fluid cholic acid content was slightly elevated in diabetic and toxemic patients, too. Deoxycholic acid was consistently found in the amniotic fluid specimens, but there was no change in its concentration among the various groups. In this limited series of patients, no significant correlation was found between the bile acid concentrations in the amniotic fluid and signs of fetal distress at the time of amniocentesis, although the lowest maternal serum estriol and human placental lactogen values were associated with the highest amniotic fluid bile acid concentrations. The condition of the newborn infants did not correlate with amniotic fluid bile acid concentrations in any of the patient groups studied. It thus appears that high amniotic fluid bile acid content present a threat to the fetus, but further studies are needed to clarify this point.