Annales chirurgiae et gynaecologiae Fenniae最新文献

Screening for congenital hearing disorders in newborn infants has been carried out in the Province of Central Finland since 1967. In 1967-1971, a total of 23 children (12 boys and 11 girls) were found to have congenital hearind disorders. From this it can be calculated that 90 infants are born each year with congenital hearing disorders in Finland. Our sample did not include slight or moderate hearing disorders (under 45 dB). 11 children under the age of 18 months were provided with a hearing aid. In spite of the screening, 12 cases (mean age 2 years) were not diagnosed until they came to the phoniatric clinic because of delayed speech development. These children were presumably also congenitally deaf. Most of the children in the delayed group reacted favourably to the auropalpebral reflex test on the obstetrical ward; their speech development was better and they also profited more from having a hearing aid than those children whose hearing defect had been discovered earlier. Screening for hearing disorders should be made nation-wide in order to avoid the harmful effects of the delay of rehabilitation on the child's development. The possibility of a hearing disorder should be kept in mind in those cases where there is a delay in speech development and also in those cases where the child has some other severe congenital defect which demands the attention of the nursing staff.

Different opinions seem to exist as to the use of analgesies in the treatment of trauma patients. For this reason we investigated experimentally the effect of pethidine in traumatic shock. Pethidine was administrated to eight of sixteen anaesthetized rabbits with lower limb injuries. The effect of pethidine was unfavourable. This was due to the effect of the drug on circulation and not on respiration.

A comparison was made regarding the observed frequency of intraperitoneal complications between two groups of patients operated upon for perforated appendicitis during a 5-year period (1968-73). The two groups, corresponding to two different general surgical departments at the same hospital, were given different forms of adjuvant treatment. The first group (78 patients) received postoperative intraperitoneal lavage, with antibiotics added to the lavage solution. In the other department (77 patients), the peritoneal cavity was drained postoperatively. No lavage was performed in this group, but antibiotics were given systemically. Sixteen patients in the drainage group developed intraperitoneal complications, as compared with 5 in the lavage group.

Forty-five patients with severe blunt injuries were examined during eight posttraumatic days. At random, 14 patients were given three doses of methylprednisolone intravenously; 10 mg/kg at 8-hour intervals. Fat embolism syndrome was diagnosed in 13/45 patients, only one of whom had received corticosteroid (p = 0.03). Shock, acidosis and elevated plasma catecholamines showed no correlation with the occurrence of fat embolism syndrome. Platelet counts immediately after trauma were significantly lower in the fat embolism patients than in the other trauma patients, indicative of early platelet aggregation. Prophylactically administered methylprednisolone in pharmacological doses appeared to inhibit the emergence of fat embolism syndrome.

A case of spontaneous mediastinal emphysema (Hamman's syndrome) is described. The patient was a 21-year-old man, who had a sudden onset of substernal chest pain at rest associated with typical findings of Hamman's syndrome: subcutaneous emphysema of the neck, a precordial crunching sound synchronous with the heart beat and air in the mediastinum on chest x-ray. He recovered uneventfully. The pathogenesis and clinical picture of this rare condition are discussed.

The exact day in early pregnancy when the corpus luteum could be dispensed with without deleterious effects on the pregnancy has been a matter of some dispute. It seems that there is a difference regarding the prognosis of the pregnancy if luteectomy or oophorectomy is performed where the corpus luteum alone could be dispensed with somewhat earlier. Three cases are presented. In case one luteectomy was performed at the end of week six or day 42 according to Naegele's rule. Plasma progesterone values decreased initially but increased steadily thereafter. No abortion occurred. Patient No. two was oophorectomized unilaterally at day 53 on the side where the corpus luteum was situated. She aborted three days later. Patient No. three was oophorectomized in the same was as patient No. two at day 49 and treated with Progesterone substitution thereafter. No signs of threatening abortion could be seen.

The series presented consisted of 94 patients who underwent transvesical prostatectomy and whose bladders were drained by using a cystostomy tube (silastic) with an 8 mm lumen, in addition to a urethral catheter. Retention by blood clot was avoided. The wounds healed well, and no infection of the urinary tract occurred. The mean period of postoperative hospitalization was 9.5 days.

A series of 14 patients treated with transurethral slitting of the ureteral orifice is presented. In 6 cases there was a stone at the distal end of the ureter and in 8 cases a ureterocele. Half the patients developed vesico-ureteral reflux. Other complications, such as urinary infection or renal scarring, have not been observed during the mean follow-up period of 47 months from the time of operation.

Our purpose was to determine whether an apparently healthy patient who died under general anaesthesia had malignant hyperpyrexia by examining her relatives and to suggest protective measures for the relatives of the deceased patient against this complication during future general anaesthetics. The family members of the deceased patient were examined systematically to determine whether or not they were prone to develop malignant hyperpyrexia. Raised serum CPK and aldolase levels, EMG changes, histopathological examination of the striated muscle, diminished muscle power during an ergometric test, and subjective symptoms revealed that other members of her family had muscular dystrophy. Our results support the theory that during general anaesthesia patients with muscular dystrophy are prone to develop malignant hyperpyrexia. Although muscular dystrophy is uncommon in Finland, affected persons should be catalogued, and preventive measures against malignant hyperpyrexia taken if they ever have to have a general anaesthetic.

A description is given of an improvised method used in the treatment of post-prostatectomy urinary incontinence in a case in which a Kaufman 2 procedure had failed. At the second-operation, Kieler spongiosa bone packaged in a dacron net was used to support the bulbous urethra.