Annales chirurgiae et gynaecologiae. Supplementum最新文献

The inflammatory phase in wound healing is considered to be a preparatory process for the formation of new tissue. A monocyte-derived cytokine, tumor necrosis factor-alpha (TNF-alpha), is a highly conserved molecule known to play a major role in the pathogenesis of gram-negative shock. Besides this, previous experimental studies show that TNF-alpha may have either a beneficial or detrimental role in wound healing. The purpose of the present study was to examine the effects of TNF-alpha on developing granulation tissue in rats as well as on rat and human granulation tissue cells in culture. Subcutaneously implanted cylindrical hollow sponges were used for studying the effects of locally applied TNF-alpha on granulation tissue in rats. These implants were treated either on the day of implantation or for the first 4 or 7 days after implantation with a solution containing various amounts of TNF-alpha while the control implants were treated correspondingly with the carrier solution only. The analyses of the granulation tissue were carried out 4, 7, 14 and 21 days after implantation. In the histological specimen these sponges were cut into small pieces and stained with Weigert van Gieson to visualize collagen. The amount of granulation tissue grown into the sponge was calculated from the cross section of every sponge. For the cell culture studies fibroblasts were released from human and rat granulation tissue which was cut into small pieces and digested by collagenase and DNase in Hank's balanced salt solution. The cells were exposed to 1, 10, or 100 ng/ml of TNF-alpha and the rate of collagen synthesis was measured as synthesis of protein-bound 3H-hydroxyproline. The number of cells in the culture dishes was counted with Bürger's hemocytometer after detaching the cells with trypsin treatment. As interleukin-1 (IL-1) and TNF-alpha overlap in many of their functions, the effects of lipopolysaccharide (LPS), human interleukin 1 beta (IL-1) and prostaglandin E2 (PGE2) on experimental granulation tissue in rats as well as on rat granulation tissue cells in culture were studied with the same method. After a single application of TNF-alpha into the sponge, no essential differences between the groups were detected. However, after daily applications of TNF-alpha for 4 days, an inhibitory effect on tissue repair was observed after 4 and 7 days. Collagen formation, indicated by the hydroxyproline content of the sponge, was significantly lower in the group treated with TNF-alpha than in the controls. This effect was not observed after 14 or 21 days. These findings were confirmed in the histological samples. In the cultures of rat granulation tissue fibroblasts TNF-alpha decreased 3H-hydroxyproline production to about 75% of that in the controls and it had also a decreasing effect on pro alpha 1(I) and pro alpha 1(III) collagen mRNA levels maximally by 67% and 77% of the control level, respectively. In the cultures of human granulation tissue fibroblasts a s

The purpose of this work was to evaluate the surgical results of lumbar spinal stenosis (LSS), and to find factors which influenced outcome. A total of 497 LSS patients fulfilled the inclusion criteria i.e. LSS was confirmed both radiologically and surgically, in the study period from 1974 to 1987. For various reasons 58 patients could not participate in the study, and hence, the results of this work were based on 439 surgically treated LSS patients. An excellent-to-good outcome was achieved in 62% of all patients with a mean follow-up time of 4.3 years. The prognostic factors for this result were able to work after surgery, able to work before surgery, no prior back surgery, age over 50 years, male sex, and leg pain. Of 86 patients who were working before surgery, 52 (60%) continued to work after operation, whereas of 223 patients who were on sick leave before surgery, 70 (31%) returned to work after operation. None of the preoperatively retired patients regained their ability to work postoperatively. The prognostic factors for ability to work after surgery were ability to work before surgery, age under 50 years, and no prior back surgery. The very long-term outcome (mean followup time of 12.4 years) was excellent-to-good in 68% of patients (59% women and 73% men). Furthermore, in the longitudinal follow-up, the result improved between 1985 (mean follow-up time 6.8 years) and 1991 (mean follow-up time 12.8 years). No special complications were manifested during this very long-term follow-up time. The patients with total or subtotal block in preoperative myelography achieved the best result. In this radiological category of LSS the proportion of patients with excellent-to-good outcome was very similar in women and men (73% and 77%). Furthermore, patients with block stenosis improved their result significantly in the longitudinal follow-up. The postoperative stenosis seen in computed tomography (CT) scans was observed in 65% of 90 patients, and it was severe in 23 patients (25%). However, this successful or unsuccessful surgical decompression did not correlate with patients' subjective disability, walking capacity or severity of pain. Previous back surgery had a strong worsening effect on surgical results. This effect was very clear in patients with total block in the preoperative myelography. The surgical result of a patient with previous back surgery was similar to that of a patient without previous back surgery when the time interval between the last two operations was more than 18 months.(ABSTRACT TRUNCATED AT 400 WORDS)

Thirty-nine cycles of primarily (n = 32) and secondarily (n = 7) tubal infertile women were studied to evaluate the state of the luteal endometrium in women undergoing In Vitro Fertilization (IVF) without embryo transfer and in women in the normal unstimulated luteal phase with and without vaginal progesterone supplementation. One to four endometrial biopsies were performed in the luteal phase. Serum progesterone (P) and estradiol (E2) as well as the endometrial thickness were estimated on the same days. In groups stimulated for IVF, serum progesterone and estradiol levels were significantly higher (P < 0.01) compared to the control group. The endometrium was significantly thicker and grew more rapidly when cycles were stimulated, but the endometrial thickness did not correlate with endometrial maturation as assessed by histology. The endometrium was disturbed in a major part of the biopsies in all stimulated groups. Progesterone support had no beneficial effect. In women with unstimulated cycles, vaginal progesterone support caused mainly delayed gland maturation: the higher the dose of vaginal progesterone, the sooner the pathological changes in the endometrium were seen. With regard to endometrial histology, vaginal progesterone treatment in the luteal phase of IVF patients may not be advantageous.

Placenta accreta, although uncommon, is becoming an increasingly important clinical problem associated with placenta praevia and previous Caesarean section. A case report is presented of a woman with post partum partial placenta accreta diagnosed with color Doppler ultrasound. The aetiology, risk factors, clinical conditions, treatment and sonographic diagnosis are shortly reviewed.

The blood glucose concentration was measured once daily during the first five days of life in forty appropriate-for-gestational age preterm infants in intensive care. They received human milk and 10% glucose perorally and intravenously. Moderate hypoglycemia (B-Gluc < 2.5 mmol/l) was common in these infants (42%) during the first three days of life. Four infants had severe hypoglycemia (B-Gluc < 0.6 mmol/l) during the first day of life. These data suggest that screening for hypoglycemia will be needed for optimal treatment in preterm infants in intensive care.

Pregnancy is associated with special problems with respect in selection of medication and dosage, primarily due to potential teratogenic or toxic effects on the fetus by the drug itself, and secondly due to the physiologic adjustments in the mother in response to pregnancy. This prospective survey was designed to record the use of medications and the policy of prescribing during the course of pregnancy. In total, 5851 pregnant women residing in a county in southwestern Finland during the period June 15, 1987 and June 14, 1988 were studied, which is 69% of the total amount of births in the same area. Iron and vitamin supplementation was used by all the pregnant women during the third trimester, and by 35% and 88% during the first and second trimesters, respectively. Analgetics were used on an irregular basis by 12% of the pregnant women, and no correlation to the length of pregnancy could be observed. 9% of the women used medication on a regular basis for reasons such as bronchial asthma, arterial hypertension and hyperthyreosis. Some kind of a symptomatic medication was taken by 43% of the women with no correlation of the length of pregnancy, the most common symptoms needing medication being candidiasis, cough, reflux esophagitis and pregnancy-associated hyperemesis. Tocolytic agents had been given to 8% of the pregnant women. Most tocolytics were used during the end of the second trimester and beginning of the third one. It is concluded that the general use of medicines is quite reasonable in the normal pregnant population in Finland. Iron supplementation should probably be more individualized instead of regular use.

The study concerned 664 women of South-West Finland, and they were studied 5-12 weeks after delivery. The total frequency of mastitis in this population was much higher than generally reported in literature, 24% as opposed to 3%. The frequency of mastitis was similar among nulli- and multiparous women. The diagnosis was based on the judgement of midwives of physicians. If a multiparous woman has had mastitis during a previous puerperium, the probability of mastitis during a subsequent puerperium is threefold. The type of skin, its reaction of the sun, allergies, rashes, getting cold and oxytocin medication during delivery did nto affect the incidence of mastitis. Mothers under 21 and over 35 years of age had a decreased incidence (P = 0.034) of mastitis. If the women had sore nipples, the frequency increased (P = 0.003). Prophylaxis, by means of physical training, neither decreased nor increased the frequency of puerperal mastitis. The treatment advised by midwives and physicians was primarily conservative, but 38% received antibiotics; some of the antibiotics were not effective against staphylococcal infection.

In a non-randomized clinical trial, combined intraperitoneal therapy with recombinant interferon alpha-2b (20-50 MU) and mitoxantrone (20-50 mg) was studied for recurrent ovarian cancer with ascites. Altogether 19 patients were treated. After primary operation, all patients had received intravenous chemotherapy, 16 of which included cisplatin. One patient had complete response, seven patients partial response, four no change and seven progressive disease. The mean duration of the responses was 5+ months (range 1-12), and mean survival time 4.5+ months (range 1-14+). Eight patients had side effects (flu-like symptoms, dyspnea, abdominal pain, vomiting, diarrhea, fever and bowel obstruction). It was concluded that the formation of ascites in refractory ovarian cancer can be reduced with intraperitoneal administration of interferon alpha-2b and mitoxantrone, with tolerable side effects.