Annales chirurgiae et gynaecologiae Fenniae最新文献

Osteomyelitis and arthritis caused by mucormycetes are rare diseases that rank among the most challenging complications in orthopedic and trauma surgery. The aim of this work is to review the epidemiological, clinical, diagnostic, and therapeutic aspects of the osteoarticular mucormycosis with particular emphasis on high-risk patients. A systematic review of osteoarticular mucormycosis was performed using PUBMED and EMBASE databases from 1978 to 2014. Among 34 patients with median age 41 (0.5-73 years), 24 (71%) were males. While 12 (35%) were immunocompromised patients, 14 (41%) had prior surgery, and seven (21%) suffered trauma. Other underlying conditions included diabetes mellitus, hematological malignancies, transplantation, and corticosteroid therapy. The median diagnostic delay from onset of symptoms and signs was 60 (10-180) days. The principal mechanism of the infection was direct inoculation (n = 19; 56%), and in immunocompromised patients was usually hematogenous disseminated. The long bones were infected by trauma or surgery, while a wide variety of bones were involved by hematogenous dissemination. Combined surgery and amphotericin B treatment were implemented in 28 (82%) and eight (23%) had an unfavorable outcome. Osteoarticular mucormycosis occurs most frequently after trauma or surgical procedures. These infections are progressively destructive and more virulent in individuals with impaired immune systems. Early diagnosis, timely administration of amphotericin B, control of underlying conditions, and surgical debridement of infected tissue are critical for successful management of osteoarticular mucormycosis.

The patient was a 72-year-old married woman from whom a recurrent arrhenoblastoma had been removed three time in the course of six years. She was clearly virilized and her voice had become deep. Endocrine studies before removal of the recurrences showed pronounced elevation of the serum testosterone values. The 17-KS values did not as clearly parallel growth of the tumour. Histochemical examination showed moderate 3beta-steroid dehydrogenase activity in limited areas. The histological features were those of so-called intermediate type of arrhenoblastoma with a very scanty tubular component. Histologically the tumour was malignant, but with a relatively low degree of malignancy. Regardless of the treatment there was twice a recurrence of the tumour. The increase of the serum testosterone values during the follow-up period reflected recurrence on of the tumour.

A case is reported of acute unilateral salpingitis, the cause of which was Haemophilus influenzae cultured from a pus sample taken from the infected Fallopian tube during laparotomy. The significance of the findings is discussed with reference to the literature.

A clinical series of 208 patients who had elective operations for gastroduodenal ulcer in Surgical Department II, Oslo City Hospital, has been reviewed. The study concentrates on postoperative gastric retention, comparing the frequency of this complication following antrectomy and gastroduodenal anastomosis with and without vagotomy. The patients in the nonvagotomy group had no retention problem. In the vagotomy group, 19 patients (35%) of 54 operated had troublesome postoperative retention. 7 patients (13%) had to have a further operation for this complication, all within 1 year. We no longer use the combined operation as a routine procedure for duodenal ulcer.