Annales chirurgiae et gynaecologiae Fenniae最新文献

Almost all the patients (95 women and 8 men) with interstitial cystitis, i.e. autoimmune cystitis, in this area with a population of about 970,000 were probably traced. The prevalence of the disease in the female members of this population was 18.1 cases per 100,000 women of all ages. The joint prevalence of both sexes together was 10.6 cases per 100,000. The annual incidence of new female cases was 1.2 per 100,000 women. The disease is not rare when mild and moderately severe cases are also diagnosed. Severe cases account for only a tenth of all cases. Only about a tenth of the patients are men and most of them had the mild form of the disease. It may begin at any age. The incidence has possibly been rising during the last 10 years. Interstitial cystitis does not as a rule progress continuously but reaches its final stage rapidly, then usually remains in the same category. With this prevalence and incidence every urologist in this area can expect to see at least one case a year.

Of the benign colonic epithelial neoplasms the villous papilloma, although rare, is reported to become malignant in 30--50%. This paper reports a retrospective study of 213 patients with a colorectal villous papilloma. The tumours were subdivided histologically according to Wheat and Ackerman (1958) into four different groups. 20% of the tumours contained either focal or invasive carcinoma. The histology of the tumour correlated significantly (p less than 0.01) with the size of the tumour with a more malignant grading of the larger tumours in general. Blood in the stool, diarrhoea, and mucoid discharge from the anus were the most frequent complaints. Malignant change of the tumour was found especially in older patients (eighth decade of life) and among women. Patients with a malignant villous papilloma complained significantly more of pain on defecation than patients with a benign tumour. Over 30% of the malignant tumours were already incurable at the time of discovery because of invasion of surrounding tissues and metastases.

31 surgically treated cases of pulmonary sequestration are reported. There were 23 of intralobar and 8 of extralobar type, 23 were on the left and 8 on the right. All but three had symptoms most of them pointing to a respiratory tract infection. Six patients had pneumonia, five haemoptyses, three patients pleurisy and two patients empyema before the operation. In addition to chest x-ray, aortogram appeared to be the most valuable tool in providing the accurate diagnosis preoperatively. Most of the cases were treated by lobectomy, in 7 cases by sequestrectomy and in 2 cases by pneumonectomy. One of the patients died from pulmonary infarction due to anomalous ipsilateral pulmonary venous draingae and ligation of the veins by oversight during right lower lobectomy. The rest of the patients recovered uneventfully. On microscopical examination of the specimens a case of aspergillosis was noted, which has not been described previously in the literature in association of pulmonary sequestration. In one case acid-fast bacteria were found in the necrotic mass of the cavities in the sequestration.

Three cases of pulmonary sequestrations are reported, one associated with tuberculosis, another with aspergillosis and a third cases associated with pseudomycosis (bothryomycosis). All the patients had a localized infection. They were treated surgically and had an uneventful recovery from their disease.

A case of multiple broncholithic casts is reported. The diagnosis was made on clinical and radiological findings without histological verification. Tuberculosis was regarded as the probable cause.

Prior to an abdominal operation, 125 patients were asked if they regularly had headache during the menstrual period together with or without pain in the lower pelvic region. Pelvic pain patients with endometriosis externa reported headache significantly more often than those without endometriosis. Headache proved to be almost as common a symptom as lower pelvic pain in patients with endometriosis.

The occurence of delay in the diagnosis of breast cancer was investigated in 115 women with breast cancer. Earlier breast disease and earlier consultations for breast symptoms were thoroughly inquired about and analysed. The part of "diagnostic delay" referred to "doctor's delay" occurred in one fifth of the breast cancer patients but in one third of the patients under 50 years of age compared to one seventh of the patients over 50 years. The reasons for delay were: incomplete investigation of palpable or suspected breast tumour, non-representativeness of surgical biopsy or of slides taken for histopathological examination, underestimation of atypia at histopathological examination, unsatisfactory follow-up after biopsy of suspected tumour.

The purpose was to study the frequency and distribution of alcohol involvement in accident patients. Blood alcohol was determined gas chromatographically in 1012 accident patients. Alcohol was found to be present in 37% with the following distribution by blood alcohol concentrations (BAC): 0.1--0.5 g/litre 7%, 0.6--1.5 g/litre 13%, over 1.5 g/litre 16%. There were 702 males and 310 females. Alcohol was found in the blood in 43% of the males and in 24% of the females. In both sexes the age group 35--44 had the highest incidence. The rate of alcohol involvement increased with decreasing social status and was remarkably high (54%) among unskilled workers. High BACs were so prevalent that a causal relationship is most probable. Further studies on the causal relationship in nontraffic accidents are needed to be able to take sensible preventive measures among high risk groups.

Systematic therapy for pre-eclampsia including diuretics was investigated in 604 patients in whom therapy was begun immediately the first symptoms appeared and continued until delivery. The control group consisted of 368 patients with toxemia from the two previous years who received no systematic therapy but who also underwent delivery at either the Turku City Maternity Hospital or the Women's Clinic of Turku University Central Hospital. Cases of pre-eclampsia gravis were significantly reduced (2.3 as compared with 7.3%). A significant difference was seen in the percentage of premature deliveries. In the experimental group this was 4.3% and in the control group 11.2%, (p less than 0.001). There was also a significant difference in the perinatal mortality, the values being 2.3 and 4.6%, respectively (p less than 0.05). The overal premature birth rate during these two periods remained unchanged, at 5.5 and 5.7%. The difference between the overall perinatal mortality rates was also slight (1.8 and 2.2%).

With good technique it is possible to detect small polyps in the large intestine with a barium enema examination. The radiological appearences and visibility of villous papillomas in 84 barium enema examinations from patients with both benign and malignant villous papillomas in the rectum, rectosigmoideal junction and the sigmoid loop were studied. In 75% of the examinations the tumour was visible. A specific radiological diagnosis of non invasive villous papilloma was made in 33% and the correct malignant diagnosis in 8/13 cases. There were both false positive and false negative diagnoses of malignancy. Patients with a villous papilloma should undergo barium enema study with double contrast technique of the whole large intestine. Benign looking tumours can always have islands of invasive carcinoma. But the criteria for malignancy are more reliable than the diagnostic signs for the villous papilloma.