Annales chirurgiae et gynaecologiae Fenniae最新文献

This retrospective study was performed in order to evaluate the frequency and the causes for itching during pregnancy. The series consists of 129 pregnant women with generalized itching, which is 1.2% of all deliveries. The most common cause for itching was hepatosis of pregnancy (83%). The other causes were pruritus of pregnancy without any liver dysfunction (12%), dermatitis (3%) and other (2%). The average time of the onset of itching was the 30th pregnancy week in hepatosis of pregnancy and the 26.5th pregnancy week in pruritus of pregnancy. The frequency of toxaemia of pregnancy varied within 24-33% in the different itching groups and that of urinary tract infection within 21-33%. The proportion of urinary tract infection was also fairly high, 23-24%, among the previous diseases. Perinatal mortality in previous pregnancies was reported by 14 patients (9.0%), 11 of them in hepatosis group (9.6%). The corresponding frequencies of perinatal mortality in the present pregnancy were 1.6% and 1.9%. The drugs most frequently used during the present pregnancy before admission were antibiotics and other chemotherapeutic agents, sulphonamide being the most common.

The proteolytic activities and trypsin inhibitors of the peritoneal exudate produced by experimental acute pancreatitis in the rat were studied by fractionation with gel filtration on Sephadex G-200 and estimation of the hydrolysis of casein and synthetic substrates. The peritoneal exudate produced by injecting formalin solution into the peritoneal cavity was used as a control. The peritoneal exudate during pancreatitis revealed distinct proteolytic and ATEE hydrolysing activities and it also hydrolysed BAPNA to a lesser extent. These activities were absent from the control exudates, or only traces of them could be demonstrated with the methods used. The trypsin inhibiting capacity (TIC) in the pancreatic exudate was about half that in the control exudate. In gel filtration on Sephadex G-200 the BAPNA hydrolysing proteolytic activity was eluted with the macroprotein fraction, suggesting that the enzyme was bound to the macroproteins. TIC differed clearly in the control exudate and the pancreatitis exudate. In both of them TIC was eluted in two peaks after the macroproteins, but in the pancreatitis group the first peak was very weak, if demonstrable at all, while in the control exudate the two peaks were clearly separated and the TIC was more pronounced. These findings suggest that pancreatic enzymes are released during pancreatitis into the peritoneal cavity, where they combine with proteinase binding factors in the exudate.

The reliability of the diagnosis made on the basis of symptoms of deep venous thrombosis and the development of a post-thrombotic state were studied in 53 patients. Pain in the leg was present in 93% and swelling in 82% of the series, both figures are considerably higher than those reported before. The clinical diagnosis was correct in 74% of cases. The post-thrombotic state developed with unexpected rapidity: after one to three years 87% already had symptoms and/or signs of venous insufficiency, and after eight years at the latest all patients had such symptoms and/or signs.

During the period 1957--1973 the author treated 7 cases of renal tuberculosis where cavernotomy was performed. Some views presented in the literature concerning the development and the detrimental effects of renal cavities are discussed. The diagnosis is purely radiological. Because of impaired renal function, drip infusion urography is recommended for such cases. The indication for operation is an isolated focus near the renal surface containing active tuberculosis with presence of tubercle bacilli. Vascular circulation is impaired locally and renal function diminished. This consitutes a latent danger for the host. The present findings are discussed and compared with results from the literature.

In an experimental study on dogs, effects of intra-aortic balloon pumping (IABP) on acute myocardial ischaemia without marked cardiac failure were analyzed. With the use of epicardial ST-segment recording IABP was shown to significantly reduce ischaemia when pumping was initiated 10 minutes after left anterior descending coronary artery ligation. Prior to coronary ligation the mean ST-segment height was 6.4 +/- 0.8 mV (mean +/- SE) and 10 minutes after the ligation it was 21.5 +/- 4.6 mV. During pumping ST-segment elevation increased to 6.9 +/- 0.7 mV. A dual-chambered intra-aortic balloon was used, and six dogs were treated with IABP. In the control dog no tendency to spontaneous ST-segment decrease was seen.

To shed light on the practice of outpatient anaesthesia in Finland 126 hospitals performing outpatient surgery were asked about the drugs used and about postoperative care. 64% of the hospitals replied. Intravenous were more popular than inhalation agents. Diazepam (57%), propanidid (52%) and thiopentone (52%) were the most commonly used drugs. Nitrous oxide, mostly in combination with other anaesthetics, diazepam with pethidine, and halothane were used in 48%, 41% and 36% of the hospitals respectively. Divinylether and diethylether were employed in 35% and 15% respectively. Propanidid, thiopentone and diazepam were the first choice in 29%, 21%, and 11% respectively, while divinylether was still the first choice agent in 11%. Most central hospitals used nitrous oxide (82%), thiopentone (65%), halothane (60%), propanidid (50%) and methohexitone (25%). Small hospitals, where anaesthesia was not administered by specialists, most frequently used ethers (divinylether 51%, diethylether 29%), diazepam with pethidine (54%), propanidid (49%) and diazepam alone (34%). After propanidid, thiopentone and methohexitone patients were generally kept in hospital for 3 hours and advised against driving for between 17 to 20 hours. It is concluded that the choice of drugs seems appropriate. However, supplementation with nitrous oxide could reduce the high doses of intravenous anaesthetics used and result in reduced side-effects and more rapid recoveries. The wide use of involved anaesthetic techniques in rural areas stresses the importance of teaching anaesthesiology to general practitioners.

Ligation of the hepatic artery was carried out in 23 patients with primary and secondary cancer of the liver. The survival time correlated well with the amount of tumor tissue in the liver. Ligation of the hepatic artery prolonged the survival time of the operated patients when compared with the untreated group, and, in addition, yielded good palliation. In appropriate cases, the most promising result in the treatment of hepatic malignancies was achieved by liver resection two to four months after the initial ligation of the hepatic artery, whereas from our experiences the final value of regional arterial chemotherapy is still unsettled. Very promising results were achieved by ligation in the treatment of liver metastases from lymphosarcoma of the stomach, which responded especially well to this kind of therapy.