Annales chirurgiae et gynaecologiae. Supplementum最新文献

Allogeneic diaphyseal demineralized bone matrix (DBM) cylinders containing bioactive glass rods were implanted for 4 and 8 weeks in the abdominal muscle wall of rats. DBM without glass served as control. The results suggest that new bone induction by DBM was accelerated by the presence of bioactive glass implants. However, the bone formation induced by DBM on the glass surface was relatively small. The biocompatibility of the glass was verified by the absence of adverse cellular reactions in the interface region between glass and bone. The method used provides a simple and fast means of exploring the characteristics of potential bone substitutes.

During 1990-1992, 176 consecutive patients (aged 18-83 years, mean 53 years) with erectile dysfunction were personally investigated by the author in the private office setting at Eira Hospital. Pharmacotesting with 20 micrograms prostaglandin was positive in 89 of 138 patients (64%) tested. Eleven per cent of the patients complained of pain during erection. Of 131 patients, who initially were offered auto-injections as a primary treatment modality, 99 (76%) began the therapy. Seventy-four per cent of the patients continued auto-injections after three months. The overall efficacy of prostaglandin E1 to induce adequate erections for sexual intercourse was estimated to be 71%. One prolonged erection without medical intervention and no penile fibrotic lesions were recorded. In conclusion, cavernous auto-injection therapy with prostaglandin E1 is a well accepted, effective and safe treatment alternative in psychogenic as well as organic impotence. Every impotent patient should be informed of this therapy.

Eighty-two patients with advanced prostatic carcinoma were treated with a long-acting luteinizing hormone releasing hormone (LHRH) agonist (Zoladex depot, Zeneca Pharmaceuticals, England). The outcome of the treatment was monitored on the basis of the following prognostic factors: local stage, number of bone metastases, histological differentiation grade and prostate-specific acid phosphatase (PAP), alkaline phosphatase (AF) and testosterone levels. The patients were followed-up until disease progression or until death. The mean weight of the prostate decreased from 48.1 g to 17.4 g (P < 0.00001) during the first year of treatment. Statistically there was a significant difference in regard to appearance of progression between different clinical stages (P < 0.00001). The prognosis was poorest in patients with more than 10 metastases at the primary stage. If the PAP level was initially higher (over 20 micrograms/L), the prognosis was very poor. Statistically there was a significant difference between the high PAP level and the slightly elevated or normal PAP (P < 0.02 and P < 0.005, respectively). Alkaline phosphatase (AF) appeared to be a good prognostic factor. The prognosis was particularly poor, if the AF level exceeded 1000 U/L (P < 0.00001 and P < 0.05, compared with normal AP and slightly elevated AP level, respectively). Surprisingly, a high pre-treatment testosterone level worsened the prognosis during the LHRH agonist treatment (P < 0.01, compared to patients with normal testosterone level). This is a new finding and controversial to the findings reported before.

Candida species are important opportunistic pathogens in compromised hosts, such as patients recovering from major abdominal surgery. The incidence, pathogenesis, diagnosis and prognosis of postoperative candidiasis were studied in a general surgical department. Transplantation surgery was not included. The mean incidence of postoperative candidiasis in abdominal surgery was 6.2 per 1000 laparotomies. The estimated incidence was higher during the years 1987-1992 than 1981-1986. Postoperative candidiasis was most often encountered in patients undergoing surgery of the small intestine or pancreas. These patients had certain typical features: a long hospitalization before signs, central catheterization, parenteral nutrition, prolonged antibiotic therapy and reoperations; malignancy, corticosteroid or immunosuppressive therapy were uncommon. Multiple blood cultures during reoperations were not found to yield Candida; hence, hematogenous dissemination from the gut was not seen. The prognosis of postoperative candidiasis was poor: the infection mortality was 70-79% and significantly higher than in patients with postoperative bacterial septicemia. Early therapeutic measures resulted in a significantly better prognosis as compared to delayed treatment. Arabinitol was found a specific marker of candidiasis, but because sequential samples were needed for adequate sensitivity, a single arabinitol concentration determination in the beginning of the disease was not useful. Febrile patients who had Candida in any sample during the first postoperative week had a poor prognosis. The results show that patients with candidiasis have typical clinical features that facilitate suspicion. Antifungal therapy is mandatory and must be started as soon as a suspicion of candidiasis has risen, before the results of specific laboratory tests are available.

To study the effect of progesterone support of the luteal phase in a stimulated cycle a subgroup of our IVF patients was treated with progesterone vaginal suppositoria. The treatment was initiated on the aspiration day. There was no significant difference in the pregnancy or abortion rate between the control group and the gestagen therapy group. However, it seems that progesterone support may increase the pregnancy rate but also the rate of spontaneous abortion. This suggests that the effective and early started progesterone supplementation of the luteal phase may cause the implantation of abnormal nonviable embryos.

In the present study, the psychic complaints after abdominal hysterectomy (n = 105) and supravaginal uterine amputation (n = 107) are investigated. The first author interviewed personally all the subjects preoperatively and 6 weeks, 6 months, 1 year and 3 years postoperatively. The proportion of subjects without psychic symptoms increased from 49.5% to 67.7% in the hysterectomy group (p less than 0.01) and from 53.3% to 76.8% in the amputation group (p less than 0.001). The difference between the groups at 3 years phase was significant (p less than 0.01). From the single symptoms, nervousness or irritability and depression, decreased during the follow-up period significantly in the amputation group but not in the hysterectomy group. The results clearly indicate that the view of an increased risk for depression or other psychic complications after removal of the uterus should be revised. On the other hand, the results support our earlier findings that supravaginal uterine amputation is still an applicable method in benign conditions.

In 63 patients with invasive vulvar squamous cell cancer treatment was individualized according to patient tolerance: surgery was less mutilating than conventionally, while radio and chemotherapy was given judiciously. The overall 5-year crude survival rate was 43.5%, while the most common treatment (bleomycin, electroexcision and irradiation) had a 5-year survival rate of 55.2%. The rate of complications was low, although most of the patients were of advanced age and had intercurrent diseases. Although the therapy we applied most often yielded moderately satisfactory results it would appear according to the literature that marginal tumor excision accompanied with inguinal lymph node dissection could still improve patient outcome. This strategy could also include predictive testing of sensitivity of the tumors to cytostatics.

From 1982 through 1986 the subrenal capsule assay (SRCA) was used to test the sensitivity of 304 gynecological malignant tumors to cytotoxic drug combinations. Most of the tumors were ovarian cancers. Ninety-five percent of the assays were evaluable. Histological and ultrastructural studies were performed on transplants derived from ovarian cancers. Besides cytotoxic drugs, the activity of interferons was also studied by SRCA. Clinical comparisons were available in 43 patients with advanced disease; the predictive accuracy rate of the assay was 77%. The histological, ultrastructural and clinical studies indicated that SRCA is a reliable predictive test, which aids in the selection of proper therapy for individual patients.

The study was carried out in order to learn about the present state of obstetric care and perinatal outcome in the province of Uusimaa, Finland. The material consisted of 29,061 pregnant women, including 313 multiple pregnancies and 29,374 newborn infants born in the years 1980 and 1981. The information gathered was mostly retrospective. The overall frequency of LBW children was 3.9 percent, of very LBW children 0.8, of preterm children 5.8, of very preterm children 0.7, and of post-term children 4.7 percent. The overall frequency of neonatal transfers to a pediatric ward was 8.6 percent. Centralization of high risk deliveries has increased in Uusimaa since 1975, as judged by the frequencies of LBW children born at the two largest delivery units and four district hospitals. Almost 95 percent of mothers-to-be began their antenatal classes before 16 weeks of gestation. Late admission to antenatal care after week 15 was an independent risk factor for unfavorable pregnancy outcome. The cesarean section rate was 16.5 percent. The frequencies were highest at the State Maternity Hospital (19.7%) and Helsinki University Central Hospital (18.2%). The frequency varied largely in district hospitals (5.9-16.3%). This resulted partly from different indications for cesarean sections in these hospitals. The mean age of the parturients was 28.5 years. The best pregnancy outcome was observed in women aged 25-29 years. Almost half of the parturients were primiparous, and only 4.0 percent were quadri- or grand multiparous. Secundiparous women had the best pregnancy outcome. Terti-parity or more was not a risk factor per se; the difference in the frequency of unfavorable outcome between secundiparas and terti-paras or more disappeared after those with unsuccessful histories were excluded, while the difference still remained significant between primi- and secundiparas. Of all pregnant women, 23 percent had experienced one and 6.4 percent several spontaneous or legally induced abortions. The effect of the number of abortions on the frequency of preterm and very preterm deliveries was linear both in singleton and multiple pregnancies. Almost 70 percent of the parturients belonged to the two highest social classes and 86 percent were married. Children of married women from higher social classes had the best perinatal outcome. Unmarried women from lower social classes more often had 'behavioral' risk factors--they were more often heavy smokers, were uncertain about the dates, had had two or more abortions and neglected maternity care.(ABSTRACT TRUNCATED AT 400 WORDS)