Growth in children with Pierre Robin sequence and isolated cleft palate

Postnatal height and weight growth were assessed in 50 children (20 boys) with Pierre Robin sequence and in 58 children (27 boys) with isolated cleft palate, born in 1967-86. The height and weight measurements from birth to 12 years were collected retrospectively from child health centers and schools. The current Finnish relative weight and SD scores for height were used for growth assessment. The birth size of children with Pierre Robin sequence did not differ from those with isolated cleft palate or from healthy children, on the basis of Finnish norms. During the first year after birth, children with Pierre Robin sequence were shorter and lighter than those with isolated cleft palate but later caught up with them and the Finnish norms. Children with Pierre Robin sequence born prematurely or with associated anomalies showed more deficient growth.

Airborne endotoxin concentrations in different work conditions

Workers from various occupations have described symptoms of upper respiratory tract, gastrointestinal tract as well as eye and skin irritation. Exposure to endotoxins may cause these symptoms. Structural differences of endotoxins from different working environments are present on the sources of Gram-negative bacteria.

Diagnosis and treatment of acute lower gastrointestinal bleeding

Diagnostic sigmoidoscopy and barium enema examinations (n = 214) or colonoscopy (n = 52) were performed for acute lower gastrointestinal (GI) bleeding. The cause of bleeding was detected in 76% (203 of 266) of the primary examinations, and the cause remained unclear after subsequent examinations in 17% of the cases. Hemorrhoids were the cause of bleeding in 28% (56 of 203) of the cases, colonic diverticular disease in 19% (39 of 203), adenomatous polyps in 11% (23 of 203), and colorectal cancer in 10% (20 of 203). The sources of bleeding did not differ significantly by sex. An anorectal site of bleeding was most often detected in patients less than 50 years of age (p < 0.0001) and a left colonic site in those more than 70 years (p < 0.0001). Hemorrhoids significantly more often caused rectal bleeding among the youngest patients (p < 0.0001) and colonic diverticular disease among the oldest patients (p < 0.0001) and colonic diverticular disease among the oldest patients (p < 0.0001) than among the others. Of the 266 patients, 19% have been operated on for the bleeding lesion. The mortality related to lower GI bleeding was 4% (11 of 266). The mean age of the patients who died was higher than that of those who survived (p < 0.05).

Calculated dietary intakes of nitrate and nitrite by young Finns

Dietary intakes of nitrate and nitrite of 1212 Finns aged 9, 12, 15, 18, 21, and 24 years were calculated using food consumption data obtained by the 48-hour recall method in 1986, in connection with the Study on Cardiovascular Risk in Young Finns. Files on nitrate and nitrite content of foods and water were compiled for this study. The mean daily intakes of nitrate (NO3-) and nitrite (NO2-) from food were 54.0 mg and 1.4 mg, respectively. Vegetables including potatoes contributed 86% of nitrate intake and meat products 69% of the nitrite intake. If two litres of water within the mode concentration class of nitrate and nitrite were used, the intake of nitrate from water would have been between 1.0 and 2.0 mg and the intake of nitrite between 0.0 and 0.2 mg.

Exposure of sprayers and plant handlers to mevinphos in Finnish greenhouses

The exposure of sprayers and plant handlers to mevinphos, a toxic organophosphate insecticide, was evaluated in eight flower-growing greenhouses. The purpose was to assess an appropriate re-entry interval for mevinphos after its application in greenhouses. Inhalational and dermal exposure was measured during two days after application by measuring mevinphos in the greenhouse air and on the foliage. Workers' dermal exposure was measured with patch and handwash samples. The method of application considerably affected the levels of mevinphos in greenhouse air and on the foliage. The occupational exposure was measured with patch and handwash samples. The method of application considerably affected the levels of mevinphos in greenhouse air and on the foliage. The occupational exposure limit for mevinphos in Finland (100 micrograms/m3) was exceeded during the use of nonthermal foggers. Usually, however, the concentration of mevinphos in the breathing zone of the workers was below 10 micrograms/m3 9-12 hr after application. Mevinphos disappeared rapidly from greenhouse air and from the foliage after application, with a half-life of 9.2 hr. These data provide evidence that the main route of exposure to mevinphos is dermal, a conclusion supported by the excellent correlation between dermal exposure and the amount of mevinphos on the foliage. The calculated re-entry interval for mevinphos was approximately 4.5 hr. However, that interval is likely to be too short in practice because the risk of dermal exposure is considerable for more than 10 hr after the application of mevinphos.

Piperacillin/tazobactam versus imipenem/cilastatin in the treatment of intra-abdominal infections

The current multicenter study was conducted at five sites using 86 patients to evaluate the safety and efficacy of piperacillin/tazobactam (4 grams per 500 milligrams every eight hours) compared with imipenem/cilastatin (1 gram every eight hours) in the treatment of patients who were hospitalized with a clinically or bacteriologically confirmed diagnosis of intra-abdominal infection. Forty-seven patients received piperacillin/tazobactam and 39 received imipenem/cilastatin. The favorable response among patients who were clinically evaluable with a valid response in the group treated with piperacillin/tazobactam was 87 percent. In the group treated with imipenem/cilastatin it was 77 percent. Bacteriologic eradication rate among bacteriologically evaluable patients with a valid response in the group treated with piperacillin/tazobactam was 100 percent. In the group treated with imipenem/cilastatin it was 89 percent. The eradication rate of pathogens isolated from patients who were evaluable by biologic factors in the group treated with piperacillin/tazobactam was 100 percent and in the group treated with imipenem/cilastatin treatment, 96 percent. In the group treated with piperacillin/tazobactam the incidence and type of adverse reactions were similar to those seen with piperacillin alone. It is concluded that piperacillin/tazobactam is safe and efficacious in the treatment of patients hospitalized with intraabdominal infections and that tazobactam extends the spectrum of piperacillin.

Relationship between bacterial counts and endotoxin concentrations in the air of wastewater treatment plants

The relationship between bacterial counts and endotoxin concentrations in air samples was studied. Selective EMB medium favored the growth of a larger portion of airborne gram-negative bacteria than LES Endo or MacConkey medium and was a good predictor of the endotoxin levels determined with a chromogenic Limulus assay of the air of wastewater treatment plants. The bacterial counts determined with nonselective media correlated poorly with airborne endotoxin levels; however, R2A medium yielded higher viable bacterial counts than TYG medium. Direct counting by epifluorescence microscopy yielded the highest bacterial counts, but no correlation was obtained between total bacterial counts and endotoxin concentrations.

Dietary intake of 70- to 89-year-old men in eastern and western Finland

A detailed dietary history interview of 70- to 89-year-old men, 98 from eastern and 129 from western Finland, was obtained as part of a 30-year follow-up survey within the Seven Countries Study. The average energy intake was similar in level, about 2700 kcal, in both areas. The percentage of total energy intake from fat was 39.1% in the west, and 36.5% in the east. The P/S ratio was about the same, 0.27 and 0.29, in eastern and western areas, respectively. The intake of most micronutrients was similar in the two cohorts. Only the intake of vitamins A and C and phosphorus, manganese, copper and zinc was higher in eastern Finland than in western Finland. The nutritional density of the diet of the eastern cohort was slightly higher than that of the western one due to their higher consumption of rye products, vegetables and berries, and also sour milk and fish and fish products. The diet met the general recommendations and was comparable to that of younger age groups.

Complications of peptic ulcer disease before and after the introduction of H2-receptor antagonists

This study was undertaken in order to evaluate the incidence of operations for bleeding, perforated and obstructing peptic ulcers in a defined population before and after the introduction of H2-receptor antagonists. The annual incidence of surgery for all peptic ulcer complications increased slightly, from 6.9 per 10(5) individuals in 1977 to 14.2 per 10(5) in 1989 (n.s.), whereas the annual incidence of operations for ulcer bleeding and perforation remained relatively stable, varying from 2.8 to 8.9 per 10(5) inhabitants and from 2.3 to 7.5 per 10(5) inhabitants during the study period. Operations performed for gastric outlet obstruction did not increase, varying from 0.8 to 2.2 per 10(5) individuals over the study period. The annual proportion of emergency operations did not increase. Young men and old women were often operated on for bleeding (p less than 0.0001) and perforated ulcers (p less than 0.01). Duodenal ulcer bleeding and perforation were more frequent in the young patient groups. Overall mortality after operations performed for bleeding was 15%, and that after operations for perforation or obstruction, 17% and 8%, respectively. The mean age of the fatalities, 63 +/- 13 years, was significantly higher than that of those who survived after operation, 53 +/- 15 years (p 0.0001). Mortality was higher after operations for gastric ulcer complications (22%) than after operations for duodenal ulcer complications (10%) (p less than 0.01).

Early results of follow-up after radical resection for colorectal cancer. Preliminary results of a prospective randomized trial

One-hundred and six consecutive patients were included in a prospective study of intensive monitoring after radical resection for colorectal cancer, 54 being randomized into a conventional follow-up group (Group I) and 52 into an intensified follow-up group (Group II). After a median follow-up of 2 years the overall rate of detection recurrence in Group I was 24% (13/54) and in Group II 25% (13/52). The recurrence rates among those followed up for at least 2 years were 36% (10/28) and 30% (9/30), respectively. Of the recurrences in Group I, one was local, five regional and six distant, and the corresponding figures in Group II were three, four and five. One radical extirpation of a local perineal recurrence has been performed in Group I, whereas two intestinal reresections for local anastomotic recurrences and two hepatic resections for solitary hepatic metastases have been performed in Group II. Mortality to date is 13% (7/54) in Group I and 8% (4/52) in Group II. Two adenomatous polyps have been removed from the colon in Group I during endoscopic surveillance and seven in Group II. These preliminary results encourage us to continue the trial up to 5 years after primary surgery.

A follow-up study of the diet of Finnish diabetic adolescents

Changes with age and time in energy-adjusted food consumption and nutrient intake of 74 diabetic subjects initially aged 12-17 years were studied. Food consumption was measured by the 48-h recall method. During the three-year follow-up (from 1985 to 1988), the proportion of carbohydrate of total energy intake decreased from 49% to 47%, that of fat increased from 33% to 36% and that of protein decreased slightly. The densities of fibre and several vitamins decreased in the diet of the diabetic adolescents. These unfavourable changes in the diet of diabetic adolescents took place with increasing age and duration of diabetes, while virtually no changes with time were detected.

Effect of biliary tract procedures on duodenogastric reflux and the gastric mucosa

The effect of alterations in the biliary tract on the gastric milieu was evaluated in gallstone disease and after cholecystectomy or biliary fenestration and compared with a control group. Endoscopic bile reflux was often found in gallstone patients (67%) and almost always after cholecystectomy (89%). Gastric bile acid concentrations were greater in the gallstone patients than in the control patients, were higher still after cholecystectomy, and were highest after biliary fenestration. The pH of the gastric fluid was more alkaline in the cholecystectomized groups. Lysolecithin concentrations were generally low and did not differ between the groups, nor was there any difference in scintigraphic reflux between the groups. Endoscopic erythematous gastritis correlated with the grade of bile reflux and was a common finding after biliary tract procedures. There were no consistent histologic findings associated with duodenogastric reflux. Helicobacter pylori colonization rates were similar in the various patient groups and were not affected by the reflux grade.

Endoscopy for the diagnosis of acute upper gastrointestinal bleeding

Diagnostic gastroscopy was performed on 337 patients for acute upper gastrointestinal bleeding, with 88% (296 of 337) diagnostic accuracy. Peptic ulcer disease was the cause of bleeding in 43% of the cases, erosive gastritis in 16%, and oesophagitis in 11%. Of the 289 patients, 40% had associated lesions, the commonest being gastritis (31), hiatal hernia (24), oesophageal varices (16), and oesophagitis (16). An oesophageal site of the bleeding was most often detected in the patients under 50 years of age (p less than 0.001) and a gastric site among those over 70 years (p less than 0.05). Mallory-Weiss lesions were significantly more often the cause of bleeding among the youngest patients than in other age groups (p less than 0.001). The bleeding lesion was located in the stomach in 60% of the women and in 42% of the men (p less than 0.01) and in the duodenum in 13% and 28% (p less than 0.01), respectively. The principal causes of this difference was the high incidence of gastritis in the women and duodenal ulcer in the men.

Heller's cardiomyotomy compared with pneumatic dilatation for treatment of oesophageal achalasia

The records of 30 patients treated for oesophageal achalasia between 1976 and 1988 were analysed retrospectively. Early and late results were collected to compare the safety and efficacy of Heller's myotomy (n = 13) and pneumatic dilatation (n = 17). Unsatisfactory immediate postoperative results were found in 4 of 13 of the patients who had undergone myotomy (31%) and in 4 of the 17 patients treated by pneumatic dilatation (24%). More patients had improved swallowing during the first postoperative year after myotomy, but this difference ceased with time. The severity of the symptoms affected the results, and dilatations that had to be repeated more than twice were ineffective. We conclude that pneumatic dilatation is as safe as Heller's myotomy, and that although the early results are significantly better after myotomy, the late results are similar.

Composition of the diet of young Finns in 1986

The aim was to describe the energy intake and composition of the diet of 1200 9-, 12-, 15-, 18-, 21- and 24-year-old Finns in 1986 and changes in their diet from 1980 to 1986. Data on food consumption were collected using the 48 h recall method. In 1980 protein accounted for 14%, fat for 38% and carbohydrates for 48% of total energy intake, and in 1986 for 15%, 38% and 47%, respectively. The mean P/S ratio increased from 0.24 to 0.31 while the regional differences in the intakes of fatty acids remained unchanged, the P/S ratio being higher in urban than in rural areas and higher in western than in eastern Finland. In 1986 the diet of 15-, 18- and 24-year-old males contained more fat, saturated fatty acids and monounsaturated fatty acids but less sucrose than that of females. The difference in the diet between young men and women, if continued, might increase the male/female ratio at risk for coronary heart disease, which is already pronounced in Finland.

Surgical management of intestinal obstruction after treatment for cancer. Case reports

Eighty-five consecutive patients operated on for malignant intestinal obstruction after earlier treatment of cancer were studied retrospectively. The overall postoperative mortality was 22% (19/85) and morbidity 42% (36/85). Intra-abdominal sepsis (N = 5) and intestinal fistula (N = 3) were the most common complications, and seven deaths were attributed primarily to the underlying malignant disease. Emergency procedures (p less than 0.003) and age greater than 70 years (p less than 0.025) were significantly associated with fatal outcome. Just over half of the patients were relieved of their symptoms. The median survival was 8 months for the 25 patients who underwent resection and 2 months for the 60 patients for whom no resection was made. The cumulative 5-year survival was significantly better for patients who underwent resection than for those who did not (p less than 0.01) and in patients with regional cancers compared with those with distant growths (p less than 0.001). We conclude that operative treatment for malignant intestinal obstruction is indicated if widespread carcinomatosis and extensive tumour growth are excluded and that this surgery should be done urgently while there is still time to resuscitate the patient.

Palliative operations for colorectal cancer

A review of 96 consecutive patients who underwent palliative surgery for primary colorectal cancer was undertaken to clarify the value of palliation achieved with surgical treatment. The overall rate of postoperative mortality was 8 percent (8 of 96) and the overall rate of postoperative morbidity was 24 percent (23 of 96). The mortality rate was 5 percent (3 of 66) after resective surgery and 17 percent (5 of 30) after nonresective surgery. Three deaths were related to the malignant disease, three were related to the intra-abdominal infection, and two were related to formation of intestinocutaneous fistulas. Of the 8 patients who died, 1 had a tumor with local visceral involvement only and 7 had a tumor with more distant spread. Median survival was 10 months for all patients, 15 months for patients treated with resective surgery, and 7 months for nonresected patients. Five patients (5 percent) have survived for longer than 5 years. The median relief of preoperative cancer symptoms was 4 months (4 months after resective surgery and 1 month after nonresective surgery). Twenty-five patients have undergone second surgery. It is concluded that palliative resective surgery for colorectal cancer can improve patient comfort with an acceptable postoperative mortality rate when cancer growth is localized and in favorable cases with more distant spread, whereas nonresective surgery fails to achieve symptom relief.

Surgical treatment of recurrent colorectal cancer. Five-year follow-up

Analysis of 81 consecutive patients with recurrent colorectal cancer was undertaken to evaluate the rationale and efficacy of surgical re-treatment. The disease-free interval after primary surgery and the diagnostic delay did not clearly differ between the modes of recurrences. Symptoms preceded the diagnosis of recurrence in 73% (59) of the cases, with pain being the most frequent symptom (n = 22). Of the patients, 58% (47) underwent reoperations, 38% (31) underwent reresections, and 10% (8) underwent radical resections. The overall postoperative mortality was 13%, and the postoperative morbidity was 45%. The postoperative relief of cancer symptoms after resective surgery was 8 months and, after nonresective surgery, 2 months. The median survival was 24 months for patients who underwent resections, 8 months for patients who were treated by nonresective surgery, and 15 months for patients who were treated conservatively. Radical resection clearly prolonged survival when compared with palliative resections and nonresective procedures. On the basis of these results, it was concluded that resective surgery, when possible, can improve survival and patient comfort after recurrence of colorectal cancer.

Sucralfate versus placebo in treatment of non-ulcer dyspepsia

One hundred fifty-one patients with non-ulcer dyspepsia, defined as chronic epigastric pain without concomitant symptoms of the irritable bowel syndrome and with no evidence of any organic disease other than macroscopic or microscopic gastritis/duodenitis seen at endoscopy on entry into the trial, were randomly assigned to treatment for four weeks with sucralfate or a placebo, 1 g three times a day one-half hour before meals, according to a double-blind model. Seventy-nine patients received sucralfate and 72 patients received a placebo. According to patients' subjective assessment of their symptoms at four weeks, 61 patients (77 percent) in the sucralfate group and 40 patients (56 percent) in the placebo group had become symptom-free or showed improvement, whereas the condition of 18 (23 percent) in the former group compared with 32 (44 percent) in the latter group remained unchanged or deteriorated. The difference between the groups was significant (p less than 0.01). The best response to sucralfate treatment (84 percent or more symptom-free or improved) was achieved in patients with mild or moderate symptoms and without macroscopic or microscopic inflammation of their gastric mucosa--a typical patient with non-ulcer dyspepsia. Our results indicate that sucralfate is significantly more effective than placebo in the treatment of non-ulcer dyspepsia.

Prostacyclin and thromboxane in acute hemorrhagic pancreatitis in dogs

To study the role of the vasodilatory, antiaggregatory prostacyclin (PGI2) and its endogenous antagonist thromboxane A2 (TxA2) in acute pancreatitis, we measured serum thromboxane B2 (TxB2, which indicates platelet TxA2 production) and plasma 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha, which indicates systemic PGI2 production) from sequential blood samples in trypsin and taurocholate induced acute canine hemorrhagic pancreatitis (AHP). In addition the effect of a prostaglandin synthesis inhibitor, ibuprofen, was studied and systemic (MAP) and pulmonary artery pressure (MPAP) were recorded for 4.5 hr. The animals were divided into a sham-operated group, an AHP group, an ibuprofen prophylaxis group, and an ibuprofen therapy group. In the sham group the parameters remained stable throughout the experiment. In the AHP group MAP decreased steadily and 6-keto-PGF1 alpha rose significantly from 80.0 +/- 7.8 to 956.0 +/- 287.0 pg/ml (P less than 0.001), whereas serum TxB2 and MPAP remained unchanged. Ibuprofen prophylaxis eliminated the initial fall in MAP and the rise of 6-keto-PGF1 alpha. Ibuprofen therapy normalized the initially decreased MAP and depressed the level of 6-keto-PGF1 alpha. We conclude that PGI2 may at least partly mediate the initial hypotension in canine AHP, whereas platelet TxA2 production obviously has a negligible role in the development of hemodynamic changes in AHP.

Staplers in palliative bypass surgery for unresectable pancreatic cancer

To assess the role of stapling devices and routine gastroenterostomy in palliative bypass surgery, the hospital records of 150 consecutive patients with unresectable, histologically proven pancreatic adenocarcinoma requiring palliative bypass procedure were reviewed. During recent years staplers have gained increasing acceptance for construction of palliative anastomoses. Mortality and morbidity were lower after stapled anastomoses. The use of staplers for construction of double bypass reduced the operation time by 45 min (p less than 0.001). After initial biliary diversion 6% of the patients required later reoperation for gastric outlet obstruction. Routine gastroenterostomy made reoperation unnecessary. Delayed gastric emptying occurred, however, in 10% and significant upper gastrointestinal bleeding in 7% of the patients after prophylactic gastroenterostomy. We conclude that stapling devices are safe and practical in palliative bypass surgery and they significantly reduce operation time if more than one bypass is required. The relatively high incidence of delayed gastric emptying, and significant upper gastrointestinal bleeding after prophylactic gastroenterostomy and the infrequent occurrence of gastric outlet obstruction after initial biliary bypass together with the low mortality after reoperation, suggest that gastroenterostomy should be performed on a selective basis only.

Detection of recurrent rectal carcinoma with computed tomography

In patients with abdominoperineal resection CT is the only effective radiologic method for demonstrating the recurrence of rectal carcinomas. Our series consists of 20 patients examined with CT (38 examinations) because of suspected recurrent rectal carcinoma. Three patients had no recurrence. 13 recurrences were definitely diagnosed. In 2 cases the possibility of an abscess was considered. One recurrent tumour was misdiagnosed as postoperative fibrosis and one as a uterine fibroid.

Thyrotropin-releasing hormone in acute pancreatitis. A preliminary report

The effect of thyrotropin-releasing hormone (TRH) in continuous infusion (a bolus of 400 micrograms followed by 200 micrograms/hour for 6 hours) was studied in 35 patients (17 TRH, 18 placebo) with acute pancreatitis in a double-blind investigation. Three hours after the start of infusion, significantly more patients were pain-free in the TRH group than in the placebo group, but not thereafter. TRH also significantly reduced the serum amylase and lipase levels, but did not influence the clinical course of pancreatitis.

Sucralfate and alginate/antacid in reflux esophagitis

The efficacy of sucralfate and of an alginate/antacid compound was compared in a randomized, double-blind 6-week trial in patients with symptomatic, endoscopically confirmed macroscopic reflux esophagitis. Of the 68 patients who completed the study, 36 received sucralfate and 32 alginate/antacid. Significant symptomatic improvement occurred in both treatment groups: almost 70% of the patients became symptom-free or improved. Esophagitis healed completely in 53% of the patients receiving sucralfate and in 34% of the alginate/antacid patients, as measured with endoscopic criteria (p greater than 0.05). Our results indicate that sucralfate seems to be at least as effective as alginate/antacid in relieving symptoms and in healing macroscopic lesions. As a safe, locally active mucosal protecting agent, sucralfate is a promising new drug for the treatment of reflux esophagitis and deserves further trials over longer periods.

Tinidazole prophylaxis in elective colorectal surgery

Bowel wall concentrations of tinidazole in two patient groups undergoing elective colorectal surgery were determined 8 h (22 patients) and 12 h (26 patients) after a single 500-mg intravenous infusion. In addition, the efficacy of 1-day tinidazole prophylaxis with 8- and 12-h dosage intervals in the prevention of postoperative infection complications was evaluated. The mean bowel wall tinidazole concentrations 8 and 12 h after infusion were 5.1 +/- 2.5 micrograms/g and 4.3 +/- 1.8 micrograms/g, respectively, which are considerably higher than the minimal inhibitory concentration for Bacteroides fragilis strains. Three patients out of 48 (6.3%) developed a wound infection: 1 from the 8-h dosage interval group (4.5%) and 2 from the 12-h interval group (7.7%). Wound cultures revealed only aerobic growth. The results confirm that an adequate bowel wall concentration remains for more than 12 h after a single 500-mg intravenous infusion of tinidazole. One-day tinidazole prophylaxis is an effective means of preventing postoperative infections after colorectal surgery.

Finnish registry for familial adenomatosis coli

Collecting of patients diagnosed to have familial adenomatous polyposis coli (FPC) in Finland and a centralized systematic screening of their family members were undertaken by the Depts. of Surgery of the five Finnish university hospitals. In all, 160 FPC patients belonging to 50 families could be identified, and they had 178 descendants at 50% risk. The frequency of FPC was 5.63 X 10(-5) (1:18,000), which may represent an underestimate. It gives rise, however, to four new FPC patients in Finland every year. The distribution of the origin of the FPC families was even over central Finland, but small aggregates, probably branches of the same families, were found. Of the 50 families, 28 (56%) had at least 2 affected members, whereas 22 had only 1. The gene penetrance was estimated to be 80-89% at minimum. Children of solitary FPC patients must be considered to have the same risk of inheriting the gene as do those of established familial patients. The necessity of a permanent national centralized organization for the screening and management of FPC is emphasized.

Sensitivity of single and double contrast barium enema in the detection of colorectal carcinoma

The preoperative barium enema of the 188 colorectal carcinoma patients operated at the Oulu University Central Hospital (Finland) during 1977-1982 were examined retrospectively. Altogether 112 single contrast studies and 87 double contrast studies had been made on these patients. The single contrast barium enemas had resulted in a correct diagnosis of colorectal carcinoma in 93 cases (sensitivity 83%). The correct diagnosis in the double contrast studies numbered 71 (sensitivity 82%). Most of the overlooked carcinomas were located in the caecum, in the sigmoid or the rectum. Most of the errors made in the single contrast studies were due to detection errors and poor evacuation. The most common failures in double contrast enemas were detection errors and nonvisualisation of the sigmoid. The authors recommend use of the double contrast technique and suggest that the two methods of barium enema be used to complement each other. A false negative diagnosis delayed the operation of the colorectal carcinoma patients by 2.2 months (median).

Perforation of the gallbladder. A retrospective comparative study of cases from 1946-1956 and 1969-1980

The records of patients treated for perforation of the gallbladder in 1946-1956 or 1969-1980 (n = 41 and 70) were reviewed to elucidate if changed strategy in acute cholecystitis, i.e. delayed vs. early surgery, had had any effect on the prognosis. The overall mortality declined significantly between the two periods, from 20 to 7%. The mortality was lowest (6%) after cholecystectomy, as compared with cholecystostomy (29%) and conservative treatment (67%). The frequency of chronic biliary fistula, calculated on all gallbladder perforations, decreased significantly (46 vs. 27%), but the frequency of acute free perforation was similar in both periods (27 and 34%). Treatment policy in acute cholecystitis is discussed. The study indicated that early surgery (Cholecystectomy with peroperative cholangiography and, if required, choledochotomy) is the treatment of choice, giving the best results also in patients with perforation of the gallbladder.

Primary retroperitoneal tumours in adults

48 patients underwent operation for a primary retroperitoneal tumour during the years 1962 to 1983. Palpable abdominal mass and abdominal pain were the most common presenting symptoms. Computerized tomography complemented by cavography, aortography and intravenous pyelography were the most effective radiological investigations available. 35 (73%) of the 48 tumours were malignant but only 8/35 (17%) of them had local metastases. 11 (23%) of the 48 tumours were radically excised, 20/48 (42%) had partial excision and 17/48 (35%) an incisional biopsy. 4 (11%) of the 35 malignant tumours were excised radically, 16/35 (46%) were partially excised and 15/35 (43%) had an incisional biopsy. Resection of adjacent organs was performed in 8 patients (17%). Overall operative mortality was 15% and morbidity 23%. All mortality in patients with malignant tumours occurred after incisional biopsy. Prognosis of benign tumours was excellent. The 5-year cumulative survival for malignant tumours was 28 +/- 9%. 7 patients were alive 5 years after operation but only 2 of them without evidence of recurrent disease. In conclusion, long-term results obtained by surgery of malignant tumours were less satisfactory. Hence, randomized trials with adjuvant radiation and chemotherapy are necessary. Local recurrences should be diagnosed early and resected aggressively.

Effect of surgery on liver function in patients with liver cancer

The effect of hepatic resection, hepatic artery ligation (HAL), and artery ligation combined with regional infusion of 5-fluorouracil (HAL + 5-FU) on liver function was investigated by liver tests including antipyrine in 20 patients with liver cancer. One month after resection the conventional liver tests except serum albumin were normalized, but the rate of antipyrine elimination was still significantly reduced. This suggests that the oral antipyrine test may be a sensitive reflector of the reserve capacity of the liver. Palliative procedures (HAL +/- 5-FU) had a transient effect on conventional liver tests and a negligible effect on functional liver capacity as determined by the antipyrine test or serum albumin concentration. On the basis of our results it remains unknown whether antipyrine determination provides any additional advantage over serum albumin as a measure of functional liver capacity in localized liver diseases, such as liver tumours.

Experiences with the EEA stapling instrument for anastomoses of the upper gastrointestinal tract

Technique, early experiences and results with the EEA stapling instrument for the reconstruction of intestinal continuity after gastric and esophageal resection in 52 patients are reported. 12 patients with gastric cancer and 4 patients with cardiac cancer underwent total gastrectomy with esophagojejunostomy, 25 patients with gastric cancer underwent subtotal gastrectomy with gastrojejunostomy, 8 patients with esophageal cancer had esophageal resection with esophagogastrostomy and 3 patients with non-resectable gastric or cardiac cancer had palliative by-passing esophagojejunostomy, all performed by means of the EEA stapler. Three anastomotic leakages were detected radiologically, two after esophagojejunostomy and one after gastrojejunostomy. These leaks did not lead to clinical signs or symptoms and healed with parenteral nutrition in three weeks. One patient died of myocardial infarction on the 8th postoperative day, but at autopsy the anastomosis was intact. At follow-up endoscopy three mild anastomotic strictures have been found, but no treatment have been required. In two patients the stricture resolved spontaneously in a few months. According to our experience, esophagojejunal, gastrojejunal and esophagogastric anastomosis performed with the EEA stapling instrument seems to be at least as reliable as a hand sutured anastomosis, obviously even more reliable. The EEA stapler is also time saving, especially after adequate experience with the use of the instrument has been achieved. The difficulties and hazards associated with the use of the stapler are discussed.

Experiences with the EEA stapling instrument for colorectal anastomosis

Early experiences and results with the EEA stapling instrument for colorectal anastomosis are reported. 39 patients underwent anterior resection or left hemicolectomy with end-to-end anastomosis performed by means of the EEA stapler. Two patients had a clinically recognizable anastomotic leakage, both of which healed spontaneously. One patient died from pulmonary embolism, but at autopsy the anastomosis was intact. No significant problems in the control of anorectal function developed. On follow-up sigmoidoscopic examinations two patients showed a distinct narrowing of the anastomotic site, but both of these stenoses were spontaneously dilated by six months. It seems that an anastomosis performed with the EEA stapler is at least as reliable as a hand sutured one and apparently more so. With this instrument an anastomosis can be achieved at a lower level than would be feasible with conventional hand suture techniques. In addition, it is much more easily and rapidly performed, especially in patients with a narrow pelvis or other anatomical difficulties.

Methylergometrine: comparison of plasma concentrations and clinical response of two brands

There were no significant differences between the two brands of methylergometrine (methylergonovine), Methergin and Myomergin, in the radioimmunologically measured serum concentrations nor in the AUC after an oral 0.250 mg dose determined on the third or sixth postpartum day during a continuous treatment with methylergometrine 0.125 mg t.i.d., nor were there significant differences in the clinical response to this oxytocic drug. Peak serum concentrations were obtained at 3 hours (Methergin 6.3 nmol/1 and Myomergin 6.0 nmol/1), indicating a delayed gastrointestinal absorption in postpartum females in comparison with healthy male volunteers [6]. Spontaneous complaints of side-effects were rare and mild.

Anaesthesia induction and lower oesophageal sphincter pressure

The effects of some drugs generally used in premedication for and induction of anaesthesia on the lower oesophageal sphincter (LOS) pressure were investigated in 30 dogs, using the modern oesophageal manometric technique. In thiopental-induced anaesthesia, a distinct pressure gradient was noted between the LOS and gastric pressure. Atropine eliminated this pressure gradient almost completely. Metoclopramide increased the LOS pressure significantly, and subsequent atropine administration was unable to bring it down. Metoclopramide administered after atropine was unable to elevate the LOS pressure reduced by atropine. Succinylcholine had no observable lasting effect on the LOS pressure. The present findings seem to indicate that of the drugs generally used in premedication for and induction of anaesthesia, atropine significantly reduces the LOS competence, thereby creating favourable conditions for gastro-oesophageal reflux (GOR) and consequent postoperative pulmonary complications. Use of metoclopramide in premedication for or induction of anaesthesia to eliminate the depressant effect of atropine on the LOS pressure appears to be indicated.

Effect of intragastric bile on canine lower oesophageal sphincter pressure

The effect of intragastric bile on lower oesophageal sphincter (LES) pressure was studied in 7 dogs. Five ml of fresh canine bile was instilled into the stomach, and its effect on LES pressure and intragastric pH was observed for one hour. In a control study 5 ml of physiological saline was used instead of bile. Bile instillation led to a statistically significant increase in LES pressure, which reached its maximum in 20 min. LES pressure returned to the resting level in 60 min. Saline instillation produced no signficant change in LES pressure. The rise in intragastric pH was slight and equal in both groups. The results suggest that bile contamination of gastric juice, at least one of short duration, does not have any immediate harmful effect on LES competence in the dog.

Urography and renography in the follow-up of patients with toxemia of late pregnancy

We have studied 129 patients with toxemia of pregnancy two months post partum by urography and renography. The same investigations were performed on 17 healthy parturients post partum. 49 patients (38.8%) had an abnormality either in urography or renography. 20 patients (15.5%) had an abnormal urogram and 42 (32.6%) an abnormal renogram. The findings correlated so that 7 patients had an abnormal urogram with a normal renogram and 13 patients had an abnormality in both investigations. 29 patients had only an abnormal renogram. In the control series 3 patients had an abnormal urogram and the same patients also had an abnormal renogram. We divided the studied patients into groups according to the clinical severity of toxemia. Urographic and renographic findings were divided evenly in the series so that abnormalities were no more common in the severe cases. Renography cannot be considered merely as a screening method when compared with urography in the follow-up of toxemic patients, but these investigations are complementary.