Preoperative hook-wire localization of nonpalpable breast lesions by use of standard and stereotactic technique.

A series of 151 women underwent 153 preoperative hook-wire localization of nonpalpable breast lesions, all of them without reinserting the needle. Measured by our criteria, the success for localization procedure was stereotactically 73% and conventionally 47%. Measured by criteria of surgeon acceptability and evidence of successful removal of the lesion, the success rate for localization was stereotactically 84% and conventionally 97%. Failure to remove the suspicious lesion in our series was more common after stereotactical than conventional localization with larger specimens. At present our experience and results of stereotactic wire localization are improving. We believe that the stereotactic wire localization without previous checking of the needle position is accurate and shortens the time required for the whole procedure.

Diagnosing mammary cancer among an unselected Finnish population. Proposal for practical improvements.

A total of 309 new mammary cancer patients were found in three successive years among 250,000 unselected Finns showing an annual rate of 1.08 cancers per 1000 women over 20 years of age. The main preoperative examinations were palpation and mammography. Palpation alone was performed preoperatively in 158 (51 percent) patients, palpation and mammography in 120 (38 percent), and the tumor was nonpalpable and found only in mammography in 31 (10 percent) patients. Fine-needle biopsy with palpation was performed in 191 (62 percent) patients and it confirmed definite malignancy in 89 cases, that is in 47 percent of the biopsied patients and in 29 percent of all patients. Mammography was most valuable in small tumors and fine-needle biopsy in large ones. The number of mammographies performed in the whole population per each new cancer case was 50; it seems unreasonable to increase the number of mammographies performed. It seems that the best way to improve the present preoperative evafuation of mammary cancer patients would be to perform a fine-needle biopsy under stereotactic guidance in every patient, and especially in those with a small tumor.

Multiple intracranial meningiomas associated with intracranial arterial aneurysm.

This report illustrates a patient who was found to harbor eight separate meningiomas associated with an intracranial arterial aneurysm. Five of the meningiomas were extirpated and the aneurysm was wrapped. The causality between multiple meningiomas and aneurysm is obscure. Although the introduction of CT has facilitated the diagnosis of multiple meningiomas there are however areas especially in the base of the skull and high parasagittally where small meningiomas may remain undetected.

Osteomedulloangiography: a method of estimating the consolidation prognosis of tibial shaft fractures.

Eighty-seven tibial shaft fractures were examined with osteomedulloangiography. The findings in a consecutive and unselected group of 19 fractures confirmed that intraosseous circulation develops within six weeks in normally healing fractures. For 68 tibial fractures which showed no sign of consolidation in conventional roentgenographic examination, osteomedulloangiography was usually performed at three months. Fractures showing positive osteomedulloangiographic results were further treated conservatively, and all consolidated at an average of 21 weeks after injury. On other hand, the 41 fractures with negative osteomedulloangiographic findings required bone-grafting, leading to solid union within three months. Osteomedulloangiography with phlebopression of the extraosseous soft-tissue veins is a reliable technique for early detection of fractures which heal without operation, especially ion cases where clinical and other roentgenographic criteria might prove inadequate. Thus, unnecessary operations for consolidation can be avoided.

Radiologic signs of hip and knee joint degeneration. A potential source of iatrogenesis.

Bilateral x-ray films of hip joints in 326 and knee joints in 193 asymptomatic patients were analyzed to investigate the prevalence of abnormalities. Degenerative changes, if any, were classified according to severity. Bilateral degeneration of hip or knee joints was found in 20% of the subjects. Thus, caution must be exercised in interpreting radiologic signs of joint degeneration in the absence of clinical evidence.

Coxal dysplasia in a pig. A case report.

A deformed hip joint which was accidentally found in a test pig is described. On the grounds of radiological, macroscopic and microscopic examinations, this is considered to be caused by a congenital dysplasia of the hip joint.

Familial occurrence of lumbar spondylolysis and spondylolisthesis.

In a Finnish kindred consisting of 192 descendants from two marriages of a male ancestor born in 1868, the lumbar spines of 105 of the 170 living members were X-rayed. Spondylolysis was found in 22 individuals. In addition, six of them had spondylolisthesis, four had spina bifida occulta, and two had a transitional lumbar/sacral vertebra. Seven members of the kindred without spondylolysis had spina bifida occulta and 10 had transitional lumbar vertebrae. The pedigree is consistent with autosomal dominant inheritance and incomplete (about 75%) penetrance for spondylolysis. It raises the question of a common aetiology for several congenital disturbances in the formation of lumbar vertebrae and possibly supports the concept of variable expressivity of a "spondylolysis gene".

[Cine radiography and manometry after Nissen fundoplication (author's transl)]. / Röntgenkinematographie und Manometrie nach Nissen-Fundoplikation.

Following Nissen fundoplication, there is incomplete correlation between the radiological appearances and the patients' subjective symptoms. Radiology is nevertheless an important method of examination after operation. Conventional barium examination with fluoroscopy readily demonstrates the anatomical changes. Dynamic changes, such as oesophageal reflux or delayed contrast passage, are also demonstrated by cine radiography.

Indomethacin and canine lower esophageal sphincter pressure.

A total of 20 experiments were carried out on 10 dogs to investigate the effect of indomethacin, administered rectally, on the canine lower esophageal sphincter pressure (LESP). Indomethacin increases LESP. Its effect begins 60 minutes after rectal administration and lasts for about 120 minutes. It reaches its highest level 90 minutes after administration. Indomethacin has no effect on the canine fundal or esophageal pressure.

Effect of metoclopramide on the lower oesophageal sphincter. An experimental study in dogs.

Oesophageal, lower oesophageal sphincter and gastric fundal pressures were measured with a triple lumen, open tip-infused catheter in dogs before and after intravenous injection of metoclopramide. The mean basal value of the lower oesophageal sphincter pressure was 5.3+/-2.7 mmHg. Metoclopramide injection caused a significant increase in this pressure. The effect of metoclopramide started immediately and disappeared about one hour after intravenous injection.

Effect of acid on the motility of the oesophagus of the pig with experimentally induced oesophagitis.

The mucous membrane of the oesophagus of 6 pigs was experimentally damaged with hydrochloric acid to create changes similar to reflux oesophagitis. The passage of contrast medium through the oesophagus of the pigs was observed by using spot radiography and pressure measurements. Acid contrast medium caused spasms and nonperistaltic pressure waves during the act of swallowing. Conventional contrast medium traversed the oesophagus normally and the swallowing complex was normal. On the basis of this experimental model it is concluded that the acidity of a bolus is of fundamental importance in the aetiology of spasms in oesophagitis.

Surgical treatment of axial hiatal hernia-reflux complex by Nissen fundoplication. A cineradiologic and manometric study.

This study was undertaken to review our result in the surgical treatment of the axial hiatal hernia-reflux complex with Nissen fundoplication using cineradiologic, manometric, and endoscopic studies and an analysis of objective symptoms of the patients as criteria in evaluation. During the period 1966-1975 86 patients underwent Nissen fundoplication at Oulu University Central Hospital. In 50 of the 86 patients it was possible to carry out thorough pre- and postoperative examinations and a long-term follow-up using the aforementioned methods. There was some discrepancy between objective and subjective postoperative results. During the 10-year follow-up period, mean 5 years, the recurrency frequency was 14% (7/50), but 22% (11/50) of the patients considered the postoperative result subjectively to be poor. On the other hand, 3 patients with a definite recurrence considered the end result subjectively to be good. On the basis of these findings we were able to conclude that the objective postoperative examinations in themselves are not sufficient for thorough, long-term evaluation of postoperative results, but that the patient's subjective postoperative symptoms and his opinion of the success or failure of the operation should also be taken into consideration.

Hiatal hernia repair.

128 patients operated on for hiatal hernia are reported. The follow-up study consisted of 102 patients, 16 with paraoesophageal and 86 with axial hiatal hernia. The mean follow-up time was 4 1/2 years, range 1-11 years. In our experience cineradiographic studies bring abnormalities to light more readily because this kind of study is repeatable compared with conventional techniques based on fluoroscopy. Four different methods of operation were used in this study. The recurrence rate was as follows: Nissen fundoplication 13%, both anterior 180 degrees fundoplication and Lortat-Jacobs procedure 38%, and Nissen fundoplication combined to vagotomy and pyloroplasty 54%. Postoperative complications occurred in 9%. There was no hospital mortality. The authors prefer the abdominal to the transthoracic approach because many patients had other intra-abdominal, surgically easily correctable condition. If the transthoracic operation is indicated, as in a very obese patient or in a patient with a secondary short oesophagus, intra-abdominal disease must have been excluded preoperatively. In the treatment of axial hiatal hernia the best operative method has not yet been agreed upon, but in our hands the Nissen fundoplication yielded the best results.