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.
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.
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.
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.
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.
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.
To shed light on the practice of outpatient anaesthesia in Finland 126 hospitals performing outpatient surgery were asked about the drugs used and about postoperative care. 64% of the hospitals replied. Intravenous were more popular than inhalation agents. Diazepam (57%), propanidid (52%) and thiopentone (52%) were the most commonly used drugs. Nitrous oxide, mostly in combination with other anaesthetics, diazepam with pethidine, and halothane were used in 48%, 41% and 36% of the hospitals respectively. Divinylether and diethylether were employed in 35% and 15% respectively. Propanidid, thiopentone and diazepam were the first choice in 29%, 21%, and 11% respectively, while divinylether was still the first choice agent in 11%. Most central hospitals used nitrous oxide (82%), thiopentone (65%), halothane (60%), propanidid (50%) and methohexitone (25%). Small hospitals, where anaesthesia was not administered by specialists, most frequently used ethers (divinylether 51%, diethylether 29%), diazepam with pethidine (54%), propanidid (49%) and diazepam alone (34%). After propanidid, thiopentone and methohexitone patients were generally kept in hospital for 3 hours and advised against driving for between 17 to 20 hours. It is concluded that the choice of drugs seems appropriate. However, supplementation with nitrous oxide could reduce the high doses of intravenous anaesthetics used and result in reduced side-effects and more rapid recoveries. The wide use of involved anaesthetic techniques in rural areas stresses the importance of teaching anaesthesiology to general practitioners.
A female of 31 with chyloascites and bilateral chylothorax is presented. The thoracic duct was obstructed below the diaphragm. The lymph vessels in the left iliac and para-aortic areas were enlarged and there were lymphocysts. When the lymph loss was greatest the patient was in a state of grave malnutrition with marked hypoalbuminaemia and an absolute and relative lymphocytopenia in the blood. "Malignant" cells were demonstrated in the chylous fluid, but no malignancy could be found at laparotomy. It is possible that the cells were confused with immature lymphocytes. The lymphatic cysts were excised and the lymph vessels ligated. Decortication of the right lung was performed. The patient recovered. The follow up time has been over four years.
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.
The reliability of the diagnosis made on the basis of symptoms of deep venous thrombosis and the development of a post-thrombotic state were studied in 53 patients. Pain in the leg was present in 93% and swelling in 82% of the series, both figures are considerably higher than those reported before. The clinical diagnosis was correct in 74% of cases. The post-thrombotic state developed with unexpected rapidity: after one to three years 87% already had symptoms and/or signs of venous insufficiency, and after eight years at the latest all patients had such symptoms and/or signs.
A series of 107 patients with hepatosis of pregnancy and 61 controls with normal pregnancy is reported. The delivery and the condition of the infant were the main objects of investigation. The hepatosis group was also examined for liver function, glucose tolerance, and daily urinary oestrogen. The duration of the first stage of delivery was found to be slightly shortened in the hepatosis group. Two cases (1.9%) of intrauterine death occurred in the hepatosis series, and the Apgar scores at 1 and 15 minutes were somewhat lower than in the control group. Birthweight was slightly lower in the hepatosis series, corresponding to the earlier date of delivery. 11.9% of the infants weighed less than 2.5 kg at birth. The absolute and relative weights of the placenta showed no differences. The histological examination of the placenta made on part of the series revealed maturing defects in 35%. The liver function tests confirmed the cholestatic nature of hepatosis observed earlier, yielding elevated values especially for aminotransferases, alkaline phosphatase and bilirubin. The thymol turbidity test was within the normal limits, which means that hepatitis could be excluded. Neither glucose tolerance, nor daily urinary oestrogen differed significantly from the normal. The fetal survival rate has been improved considerably by intensive care of hepatosis of pregnancy.
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.
A 38 year old woman with congenital partial absence of the left pericardium is presented. The condition is fairly rare, usually diagnosed incidentally during intrathoracic operations or at autopsy. Eleven operatively corrected cases are reported in the literature. The present case was admitted because of transient attacks of chest pain, palpitation and dyspnoea. These attacks were brought on when she lay on her left side and were promptly relieved by a change of position. The chest radiograph revealed a prominence of the superior aspect of the left heart border and a slight laevo-position of the heart. A diagnostic pneumothorax on the left side confirmed the diagnosis of a pericardial defect. The defect was repaired by pericardioplasty. Operative correction of a partial left pericardial defect is indicated because of the danger of luxation of the heart out of the pericardium and sudden death. This has been reported, as well as a death caused by spreading of infection from the pleural cavity into the pericardium and heart.
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%).
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.
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.
116 women with obstetric hepatosis gave birth in the years 1971-1972 at the First and Second Departments of Obstetrics and Gynaecology, University Central Hospital, Helsinki. This accounts for a 1.1% incidence of all deliveries at this hospital. During most of these pregnancies fetal well-being was monitored by amnioscopy, by the oxytocin challenge test, by maternal urinary oestriol determinations and by estimating the fetal biparietal diameter weekly. In 38% of these pregnancies, signs of fetal distress were found, mainly an abnormal heart rate, or heart rate pattern, and/or meconium-stained amniotic fluid. These led to increased frequencies of induction of labour and of Caesarean sections performed because of asphyxia or imminent asphyxia as compared with a control group with similar age and parity distribution. There was an increase in the occurrence of twin pregnancies in the hepatosis series (7.6%). There were 4 intrauterine and altogether 8 perinatal losses of 125 infants born to hepatosis mothers. These observations suppport the opinion that there are increased risks for the fetus in pregnancies complicated by obstetric hepatosis. Amnioscopy and fetal heart rate recording during the delivery and oxytocin challenge test were found to be valuable in monitoring the fetal condition. The use of oestriol determinations, at least by employing the method in general clinical practice, was found to be of limited value in the predictive assessment of fetal distress in hepatosis. This might be due to impurities disturbing the determinations or to changed oestrogen metabolism in cholestasis.
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.
Twenty-five women suffering from climacteric complaints after surgical castration were treated with clonidine in a placebo controlled trial. Clonidine in the dose of 75 to 150 mug daily diminished the attack rates of flushing and sweating significantly. It can be recommended as a safe therapy for climacteric patients, at least those with contra-indications to oestrogen therapy.
In order to regularize the classification of medial fractures of the femoral neck a retrospective analysis was made of fractures in adult patients treated in the University Hospital in Turku and also in the Municipal Hospital in the same city between 1964 and 1971. There were 446 cases of medial fracture of the femoral neck, 75 of which occurred in male patients and 368 in female patients. Medial fractures of the femoral neck were classified according to the scheme laid down by Garden (8) and Pauwels (18) and in addition, the situation of the level of the fracture in the femoral neck was determined according the method proposed by Brown and Abrami (3). No correlation could be found between either the division made by Garden and that made by Pauwels or between the situation of the level of the fracture in the femoral neck and the degree of primary dislocation in the fracture. Following Garden's classification, dislocated (stage 3 or stage 4) fractures were more common among women than men. Pauwels' figures showed that there were relatively more unstable fractures (groups 3--4) among men than among women. Among women patients the situation of the level of the fracture was, on the average, more medial than among men. The healing of fractures was evaluated according to the calssifications of Garden and Pauwels. That of Garden proved to be much more logical and from the point of view of prognosis of recovery, more reliable. The present authors recommend the classification made by Garden in cases of medial fracture of the femoral neck.
