Annales chirurgiae et gynaecologiae Fenniae最新文献

The analgesic potency of anileridine and pethidine was compared in 28 patients by measuring their effect on withdrawal movements caused by pinching of the skin or by surgery during N2O + O2 anaesthesia. It appeared that anileridine is 3.5 to 4 times as potent as pethidine on a weight basis. In equianalgesic doses the incidence of side effects was equal after both drugs.

Clinical and histopathological data were compared in a series of 59 patients with Dupuytren's contracture (DC) from the years 1946-1971 in order to clarify whether histopathological findings were in accordance with the clinical development of the disease. All well known histopathological features were inspected. The most valuable prognostic sign seemed to be the appearance of several active nodules, indicating rather rapid development of DC, with a high frequency of postoperative recurrence in these patients. Lack of active nodules did not exclude this possibility but made it less likely. Other occasional findings typical of DC such as the number of mitoses, microhaemorrhages, perivascular lymphocytic infiltrations and hypertrophied corpuscles of Vater-Paccini seemed to be of minor prognostic value. Mucopolysaccharides from DC tissue showed metachromasia with toluidine blue did not stain with HID-AB (high iron diamine-alcian blue) as HID positive in specimens preserved embedded in paraffin blocks for several years.

Prenatal karyotype analysis was performed on cultured fetal cells obtained by transabdominal amniocentesis at the 15th and 20th week of pregnancy in 63 high risk pregnancies. The reason was advanced maternal age in 42 cases, a previous child with a chromosome anomaly in 13 cases, and parental balanced chromosome translocation in 7 cases. One mother was a haemophilia A carrier. Two mothers over 40 were found to be carrying a 21-trisomic fetus. In the group of parental balanced translocation one fetus showed an unbalanced translocation karyotype, two were karyotypically normal and four exhibited a balanced translocation identical with that of the parents. A therapeutic abortion was performed in the case of the unbalanced translocation, the two trisomic fetuses, and a male fetus of the haemophilia A carrier mother. After the abortion the prenatal chromosome findings were confirmed by cell cultures from fetal tissues. No immediate complications due to the amniocentesis were recorded, but two term fetuses died antenatally, one child was delivered prematurely, and one pregnancy terminated spontaneously foru weeks after the amniocentesis. Any casual relationship to the puncture was unlikely in these cases. All other pregnancies had a normal course and the outcome was in agreement with the prenatal studies. Although indications for prenatal karyotype analyses are evident in pregnancies at risk due to parental balanced translocation karyotype and advanced maternal age, the need for large-scale screening programmes is questionable, because the decision should be in the hands of the parents.

Several cases in which Salmonella, spread by the haematogenous route, produced localised inflammation have previously been described in the literature. The infecting of an operation wound through direct contamination by Salmonella has earlier been reported only once, in connection with appendectomy. The present case report describes a case in which recurrent sinuses infected by Salmonella were formed in the operative wound.

A series of 107 patients with hepatosis of pregnancy and 61 controls with normal pregnancy is reported. The delivery and the condition of the infant were the main objects of investigation. The hepatosis group was also examined for liver function, glucose tolerance, and daily urinary oestrogen. The duration of the first stage of delivery was found to be slightly shortened in the hepatosis group. Two cases (1.9%) of intrauterine death occurred in the hepatosis series, and the Apgar scores at 1 and 15 minutes were somewhat lower than in the control group. Birthweight was slightly lower in the hepatosis series, corresponding to the earlier date of delivery. 11.9% of the infants weighed less than 2.5 kg at birth. The absolute and relative weights of the placenta showed no differences. The histological examination of the placenta made on part of the series revealed maturing defects in 35%. The liver function tests confirmed the cholestatic nature of hepatosis observed earlier, yielding elevated values especially for aminotransferases, alkaline phosphatase and bilirubin. The thymol turbidity test was within the normal limits, which means that hepatitis could be excluded. Neither glucose tolerance, nor daily urinary oestrogen differed significantly from the normal. The fetal survival rate has been improved considerably by intensive care of hepatosis of pregnancy.

The value of angiography and fine needle aspiration biopsy in detecting, grading and staging of renal tumours was studied in 55 patients with renal tumours suspected clinically or on urography. 42 patients had malignant tumours. A correct angiographic diagnosis was made in 94% of the renal adenocarcinomas, the corresponding percentage for the aspiration biopsies was 71%. A combination of angiography and cytologic examination gave the correct diagnosis in 97%. In 4 cases of renal pelvic carcinoma the angiography showed extensive hydronephrosis only, the final diagnosis in these was cases achieved by fine needle aspiration biopsy. Angiographic staging of 30 renal adenocarcinomas was made according to the TNM system. The radiological staging was correct in 30% of T3 tumours, but in only 50% of T1 tumours and in one out of five T2 tumours. The difficulties seemed to be in determining the relation of tumours situated marginally near the renal capsule. Angiographic grading of the tumour was made according to the vascular pattern and the time of venous filling. Sparse vascularity and venous filling time of over 5 seconds was found in highly differentiated carcinomas and abundant vascularity and fast venous filling in neoplasms of moderate or low differentiation. The cytologic grading correlated fairly well with the histological grading. This study shows that angiography combine with fine needle aspiration biopsy provides good facilities for obtaining a correct diagnosis in renal tumours and preoperative information of the extent and degree of differentiation of renal malignant tumours.

The effect of short wave diathermy, pulsed high frequency current (Diapulse, Curapuls) and microwave diathermy on the function of an implantable cardiac pacemaker and its leads was examined by measuring the output (voltage) and rate of the pacemaker under various experimental conditions. It appeared that all these devices had a decreasing effect on the output and an increasing effect on the rate of the pacemaker. When therapeutic doses (power) were applied the greatest changes in output and rate were caused by microwave diathermy and the slightest by Curapuls. The clinical precautionary measures based on these observations are discussed.

The possible role of cerebral birth injury in the aetiology of epilepsy was evaluated by comparing the birth histories of 101 epileptic patients with focal seizures and 208 with non-focal seizures. The former were smaller at birth and their mothers were older and had higher blood pressures than the mothers of the latter. Although the two groups did not differ significantly with regard to the frequency of breech birth, assisted vaginal breech deliveries were significantly more numerous in the focal group. The injured half of the brain was as often pressed against the sacrum as against the symphysis during birth.

During the years 1955-1970, 260 patients were treated in the surgical department of the Maria Hospital for acute pancreatitis. 24 of them died and went to autopsy. This study includes all these 24 patients.

Three cases of spontaneous perforation of the proximal colon following lung surgery are reported. The caecum was the site of the lesion in two cases and transverse colon in one. Gastric inflation due to assisted artificail respiration resulting in over-distension of the colon is considered to be the cause of these complications. The treatment was by immediate laparotomy and suture of the perforation in two cases and transverse colostomy in one. All the patients made a complete recovery.