Annales chirurgiae et gynaecologiae Fenniae最新文献

A group of healthy primigravidae aged 20-26 years were examined two weeks before term in order to measure their physical performance. Two types of work tests with the bicycle ergometer were used, first a three-stage submaximal test and on the next day a voluntarily maximal test. The results between these two tests are in highly significant correlation. In the three-stage submaximal test the mean maximal oxygen uptake was found to be 39.9 +/- 8.3 (SD) ml/kg x min (range 25 to 65 ml/kg x min). The mean square root from the total work performed during the voluntarily maximal test was 93.6 +/- 10.9% compared with the reference value of healthy, nonpregnant women of the same average age and weight. The quotient last work load divided by the last heart rate was 102.9 +/- 17.8% from the reference value of the nonpregnant women. The mean percentage value of physical fitness calculated from the reference value is 98.1 +/- 12.8% compared with that of nonpregnant women. The maximal oxygen uptake found in the three-stage submaximal test is in highly significant correlation with prepregnancy weight. The results of the voluntarily maximal test do not correlate with the prepregnancy weight or the weight gain. In the three-stage submaximal test 6.1% of the mothers had a maximal oxygen uptake considered as low. In the voluntarily maximal test 5.9% of the mothers had a mean physical fitness below 80% of normal. Special attention of mothers with lowered physical fitness during pregnancy might be needed

A follow-up study of 213 patients with colorectal villous papillomas was performed to assess different methods of treatment and the prognostic value of several factors. Recurrences appeared in 26%. Segmental resection of the intestine gave no recurrences. The choice of surgical method had little or no influence on the 5-year survival rate. The 5-year crude survival rate for the whole series was 61% with a relative survival of 80%. The larger tumours had the poorest 5-year survival rates. Tumours with invasive carcinoma in the villous papilloma had a crude 4-year survival of 16% whereas tumours which did not originally show invasive features had a 5-year crude survival rate of 68%. Of the whole series 48 patients (22%) eventually died from colorectal cancer. It is possible that the invasive character of the tumour had been missed originally so thorough microscopic examination of the whole tumour is essential.

The effect of phenoxybenzamine and dopamine on the respiratory and metabolic changes in experimental traumatic shock was examined in 45 rabbits. Phenoxybenzamine caused a more effective release of the peripheral vasoconstriction than dopamine. The effect of these drugs without similar restoration of blood volume was unfavourable. This should be borne in mind when the use of these drugs is meditated in clinical work.

A case history is presented of a patient with 8 consecutive caesarean sections over 1965--1973. Total hysterectomy was performed during the last section because of thinned uterine wall, marginal placenta praevia and heavy bleeding. The aspects of repeated caesarean sections are discussed in the light of the present case.

The fate of 174 patients over 60 years old treated in the surgical intensive care unit was investigated. During their stay in the hospital the mortality was 39% and 24% in the selected group when hopeless cases with malignancies, mesenteric thrombosis and severe brain lesions were excluded. The prognosis was not affected by the age or concomitant diseases. The importance of meticulous preoperative treatment and surgery is stressed. Modern intensive care in special units has changed the prognosis of aged patients greatly.

The results in the treatment of air embolism in open heart surgery are presented. Two cases of gaseous cerebral embolism are described. One of the patients had a period of unconsciousness of 54 hours, the other of 17 days. Therapy included administration of vasoactive drugs (xanthinol nicotinate 1500 mg 2 times daily as an intravenous drip) combined with superficial hypothermia (32 degrees C). In both cases complete recovery was achieved.

A new method is presented for detection of the QRS complexes and the fetal heart rate from the fetal magnetocardiogram and from the fetal electrocardiogram. In the method, the amplitude, the polarity and the shape of the QRS complex are tested. By using the described equipment it is possible to detect all consecutive heart beat intervals from a fetal electrocardiogram with less than 1% error in timing. When an external fetal electrocardiogram was used for testing, generally slightly over 10% of the QRS complexes were lost since they were simultaneous with the maternal complexes. In addition, complexes were also lost due to noise.

The study was carried out to investigate the variations in blood sugar values during routine fluid therapy in surgical patients, when the rate of infusion often is very haphazardly adjusted. Surgical patients with normal sugar and fluid balance were divided into two groups. The glucose group (34 patients) was given 5% glucose solution as infusion fluid and the control group (the saline group, 26 patients) received 0.9% physiological saline solution. The preoperative mean value of blood sugar in the glucose group was 4.9 mmol/1 and in the saline group 4.6 mmol/1. Half an hour after the beginning of the operation the blood sugar in the glucose group rose to 7.2 mmol/1 (p smaller than 0.001) and in the saline group to 5.3 mmol/1 (p smaller than 0.01). At the end of the operation the blood sugar values in both groups had further increased significantly from the half-hour levels, in the glucose group to 7.8 mmol/1 and in the saline group to 6.1 mmol/1 (p smaller than 0.01). The difference between the groups, at each test after the initial test, was highly significant throughout (p smaller than 0.001). The result indicates to carefulness in using glucose solutions even during operations lasting 1-2 hours.

Intra-aortic ballon pumping (IABP) was employed in five patients. Following elective open-heart surgery, they manifested severe cardiac failure which after maximal medical treatment would seemingly have ended fatally. Duration of the pumping was from 15 to 20 hours. Three patient survived. The use of IABP in the treatment of low-output failure after cardiopulmonary bypass is reviewed.