Annales chirurgiae et gynaecologiae. Supplementum最新文献

The risk of endometrial cancer (EC) in diabetics and hypertensives was studied as part of the planning of a trial of the efficacy of screening for EC. Two nationwide registers, the Finnish Cancer Registry and the Social Insurance Institution's (SII) population register, were linked to obtain 1715 EC patients diagnosed during 1970-1974 with individually matched controls. Data on the right for state-reimbursed medication for diabetes or hypertension prior to the case's cancer diagnosis was obtained from the SII's population register and was used as indicator of the diseases in question. Diabetes was a strong and hypertension a relatively weak risk factor for EC. The relative risk for the association of EC with diabetes was 4.1 (95% confidence limits 2.7 and 6.9) and with hypertension 1.6 (95% confidence limits 1.3 and 2.1). Diabetics and hypertensives are identifiable risk groups for EC in Finland. Diabetics form a suitable target population for a trial of the efficacy of screening for EC.

The performance and handling capacities of two synthetic absorbable sutures, the monofilament suture Maxon and the multifilament suture Dexon Plus, were compared to study if these sutures are acceptable as all-purpose suture materials in abdominal hysterectomy. Four senior gynecological surgeons performed altogether 102 hysterectomies and made an assessment of handling qualities. Fifty one patients were sutured with Maxon and 51 age-matched controls with Dexon Plus. Maxon proved to be superior to Dexon Plus in terms of knot rundown, tissue drag and knot repositioning whereas, in terms of suppleness, tensile strength and knot security both suture materials were comparable. Vaginal granulation was seen in five patients operated on with Dexon Plus and only in one patient in the Maxon group. According to this study Maxon is as safe and efficacious as Dexon Plus for abdominal hysterectomy and its handling properties were even better than those of Dexon Plus.

Spontaneous rupture of the hepatic capsule and subsequent massive intra-abdominal bleeding is a rare but life-threatening complication of pregnancy, which is often associated with pregnancy-induced hypertension. High maternal and fetal mortality rates have been reported. We describe a case with massive intra-abdominal bleeding. The diagnosis and treatment of this condition are discussed.

We present a rare case of a hydatidiform mole that occurred in a 56-year old woman. The main symptom was prolonged vaginal bleeding, and the gynaecological examination revealed a markedly enlarged uterus. Sonography revealed a 9 x 15 cm large cystic tumour in the pelvis. At operation, a suspicion of trophoblastic disease was arosen. Serum human chorion gonadotropin was still markedly elevated on the fifth postoperative day. After removal of the uterus and adnexae the recovery and the 3-year follow-up have been uneventful.

Patients with endometrial or ovarian cancer have an increased risk of breast or colon cancer and vice versa. To study the individual and age-related characteristics of patients with a combination of these malignancies, we reviewed the hospital records of fifty-three patients who had endometrial or ovarian cancer diagnosed at the Turku University Central Hospital in 1977-1991, and who had a preceding, concomitant or subsequent diagnosis of breast or colon cancer. Forty-nine patients had two and four patients had three primary cancers. Breast cancer patients presenting with subsequent ovarian carcinoma had a clearly lower mean age at first cancer diagnosis than the general population mean for breast cancer (50.0 years vs 61.1 years). The mean age of these patients at the time of diagnosis of ovarian cancer was not lower than the general population mean for ovarian cancer (62.0 years vs 61.1 years). A genetic predisposition to both breast and ovarian cancer has been reported previously. More attention should be paid to breast cancer patients' family histories with respect to ovarian cancer, especially if the patient is premenopausal. This might help to identify women at risk of getting ovarian cancer later in life.

The cytostatic activity of interferon a-2b on human transitional cell cancer T24 cells was examined using bioluminescence assay. Interferon a in a concentration of 1 x 10(6) IU/ml had a remarkable cytostatic effect already in two-day cultures, and this effect increased still further when the cells were incubated for three and five days. In the flow cytometric study, the percentage of cells in the S-phase fraction (SPF) remained at the same level after three days of incubation with interferon a (43.6 +/- 2.7), but decreased significantly in the control cell population (25.6 +/- 1.5). If interferon a was washed away after two hours and incubation was continued for three days, the percentage of cells in the SPF was also significantly higher (43.6 +/- 3.3) than that in the control group of cells (P < 0.01).

A material of 185 renal traumas treated during 1972-1991 was analyzed. A typical patient was a young man; the mean age was 30 years. The most common aetiology was traffic accident (45%). Penetrating traumas were rare (2%). The most common and significant finding was macroscopic haematuria, but the absence of haematuria did not exclude renal trauma. Unexpected findings were seen in 7% of cases. The most common renal injuries were contusion (69%) and laceration (20%) which were mostly treated conservatively (85%) with good results. Only 15% of patients were operated. Renal complications were few both in the conservatively and in the surgically treated patients. No mortality was seen.

A total of 1641 ESWL-treatments were performed in 948 patients at Helsinki University Central Hospital between June 1989 and December 1991. In a series of 816 patients and 1287 treatments with data available 681 (76.4%) stones were located in the kidney, 208 (23.3%) in the ureter, and three (0.3%) in the urinary bladder. Auxiliary procedures were performed in 156 (19.1%) and repeated treatments in 300 (36.8%) patients. The most common complication was intensive pain during the procedure in 138 (16.9%) patients. The first 139 patients were followed until six months after their last ESWL-procedure. The six-month stone-free rates of renal and ureteric stones of these patients were 67.4% and 86.7%, respectively. The overall six-month clearance rate was 72.4%.

Noncollagenous protein material was extracted from HCl-demineralized bovine bone particles in 4 M guanidinium hydrochloride. Water- and citrate buffer-insoluble material was collected, solubilized in 6 M urea and fractionated by preparative isoelectric focusing using a running voltage of 5000 V. The material removed from the area between pH 4.7 and 5.7 of the isoelectric focusing gel was osteoinductive (identified by its capacity to induce bone development). This was solubilized in 6 M urea and dialyzed against 0.2 M Tris buffer. The Tris buffer-soluble material was fractionated by HPLC gel filtration. The water- and citrate buffer-insoluble material contained mainly high-molecular-weight protein complexes which were osteoinductive, and < 5% of the material was osteoinductive monocomponent bone morphogenetic protein. The Tris buffer-soluble material contained only two polypeptides: an osteoinductive peptide of molecular weight 18,500 and a non-osteoinductive peptide of molecular weight 8,000. The very high voltage used during the isoelectric focusing caused a slow break-down of the urea-soluted protein complexes, which significantly increased the yield of monocomponent bone morphogenetic protein. By the present method it is possible to prepare Tris buffer solution containing up to 2 mg/ml of pure monocomponent bone morphogenetic protein.

A fibrous collagen membrane (FCM) made of crosslinked reconstituted collagen fibers was applied as a carrier of BMP. The effectiveness of FCM as a BMP carrier was compared with conventionally used insoluble bone matrix (IBM). Partially purified BMP was obtained from a guanidine HCl extract of bovine bone after a three-step chromatographic procedure. The BMP fraction was combined with FCM or IBM and implanted subcutaneously in the back of rats. Bone and cartilage formation were determined by radiographic, histologic, and biochemical analyses after removal at 1, 2, 3 and 4 weeks. After 2 weeks, bone and cartilage formation were evident histologically in IBM-BMP and FCM-BMP. In IBM-BMP, cartilage was formed in the area of presumptive bone. On the other hand, in FCM-BMP, cartilage formation occurred in the space between the fibers of fiber-bundles, while on the surface of the fibers bone formation started independently. Biochemically, the most noteworthy difference between FCM-BMP and IBM-BMP was the marked increase in type II collagen content in FCM-BMP, which contrasted with its decrease in IBM-BMP at 3 weeks. This study demonstrated that FCM definitely functioned as a BMP carrier that led to bone and cartilage formation at distinct sites. Therefore, we conclude that BMP could induce differentiation of immature cells preferentially into either osteogenic cells or chondrocytes depending upon the nature of the carrier which provides the environment for cell differentiation.