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Background: Preincisional ilioinguinal and iliohypogastric nerve block (IINB) reduces postoperative analgesics after inguinal herniorrhaphy. The effect of an IINB on postoperative pain and discharge profile was therefore studied in day-surgery patients undergoing inguinal herniorrhaphy with general or spinal anaesthesia. Methods: Seventy ASA I–II adult patients scheduled for inguinal herniorrhaphy received an IINB before the surgical incision with 15 ml of 0.5% bupivacaine. In a randomized fashion half of them received general anaesthesia with spontaneous breathing via a laryngeal mask (GA-group) and the other half received spinal anaesthesia with 5 mg of bupivacaine diluted with sterile water to 2.5-ml volume (SPIN-group). In the postanaesthesia care unit (PACU), pain was assessed on a scale from 0 to 10 (VAS) and ketorolac 30 mg i.v. (VAS

Background: By choosing spinal anaesthesia instead of general anaesthesia, and by infiltrating the wound area with local anaesthetic the need for postoperative analgesics may be reduced. An ilioinguinal and iliohypogastric nerve block (IINB) in inguinal herniorrhaphy was, therefore, studied in a day surgery setting in combination with a spinal block. Methods: One hundred ASA I–II adult patients scheduled for inguinal herniorrhaphy were given spinal anaesthesia with hyperbaric 0.5% bupivacaine. In a randomized and blinded fashion half of them received an IINB 5 min before the surgical incision with 10 ml of 0.5% bupivacaine (B-IINB) and the other half with saline (S-IINB). All patients received ketoprofen 100 mg i.v. during surgery and another 100 mg 2–3 h postoperatively. The patients were observed for about 6 h in the day surgery unit before discharge. Results: The results showed that in comparison with the S-IINB group, significantly fewer patients in the B-IINB group needed analgesics (P

The primary clinical efficacy of orchiectomy and the combination therapy of intramuscular polyoestradiol phosphate 80 mg monthly and oral ethinyl oestradiol 0.15 mg daily was evaluated by progression and cancer mortality rates in a series of 277 prostatic cancer patients representing part of the Finnprostate study. After a follow-up of 5 years there was a significant difference between the groups in terms of progression rate and prostatic cancer deaths. The oestrogen combination was more effective in delaying progression of the disease. The overall mortality rate was similar in both groups. About one-third of the patients were alive after 5 years.

Serum acid phosphatase activity (ACP), prostate specific phosphatase (PAP) and prostate specific antigen (PSA) were measured in 100 patients with prostatic cancer. The patients were divided into 4 groups: T1-2 MO, T3-4 MO and M1 patients with less than or equal to 10 or greater than 10 metastatic foci in bone scintigraphy. The mean serum ACP levels were almost identical in the T1-2 MO and T3-4 MO groups and there was no significant difference between the mean PAP values. Significantly higher PSA levels were observed in the MO patients in the extracapsular category compared with those in the intracapsular category. The mean serum levels of all 3 tumour markers were significantly higher in the M1 than in the MO category. PSA seems to be the marker of choice as a diagnostic aid for differentiating between patients with intracapsular and those with extracapsular tumour growth. In prostatic cancer patients with bone metastases these markers were of similar value for staging the disease.

We studied 599 evaluable patients with benign prostatic hypertrophy at 7 urological units. Before transurethral prostatectomy the patients were randomized into 3 groups: group 1—197 patients given single-dose ceftriaxone (2 gm.), group 2—203 patients given 160/800mg. trimethoprim-sulfamethoxazole and group 3—199 controls given no antimicrobial prophylaxis. Patients with a preoperative indwelling catheter, positive urine culture, signs of active infection or preoperative antibiotic treatment were excluded. Postoperative infectious complications were demonstrated in 15 of 197 (7.6%), 25 of 203 (12.3%) and 43 of 199 (21.6%) patients in the study groups, respectively. The difference in infectious complications between groups 1 and 3 was statistically highly significant (p

Although endoscopic optical urethrotomy is the primary treatment for urethral stricture, it is associated with a high recurrence rate, and the essential problem is how to stop the scar from shrinking after cutting. In a controlled study the effect of treatment of recurrent urethral stricture by internal urethrotomy followed by clean intermittent self-catheterization (CIC) for 6 or 12 months was compared in 25 and 24 patients, respectively. Patients learnt easily how to perform CIC: only one patient was not able to do it at home. All patients were evaluated by uroflowmetry before and immediately after urethrotomy, and 3, 6, 9 and 12 months later. Recurrence was defined as the need for further treatment. There was no difference in the recurrence rate between the two groups, but the maximum flow rate was significantly lower at 12 months in the patients who had ceased catheterization at six months. Complications included in two patients asymptomatic bacteriuria and in 10 patients symptomatic urinary infection. CIC is a very satisfactory method of managing patients with recurrent stricture, it is easy to learn, it prevents a decrease in the maximum flow rate and can thus be applied to most patients instead of regular bouginage. On the basis of the present study we could not determine any optimal time for the duration of CIC after urethrotomy, or whether it has any effect on the natural course of the disease.

The clinical efficacy, cardiovascular complications and mortality of polyestradiol phosphate (PEP) 160 mg/month i.m. were compared with the luteinizing hormone releasing hormone (LHRH) analog, buserelin, in a prospective, randomised multicentre study including 147 patients with prostatic cancer. The cumulative non-progression rate at three years was 0.53 in the PEP group and 0.70 in the LHRH group. The mortality from cardiovascular diseases was the same in the two treatment groups. The parenterally given PEP was not associated with an increased risk of cardiovascular complications. The dosage of PEP 160 mg monthly seems, however, to be insufficient in the treatment of prostatic cancer.

The value of serum acid phosphatase (S-ACP) as a marker of transurethral resection (TUR) syndrome was studied in 105 patients undergoing TURP. In ten patients who developed TUR syndrome the elevation of S-ACP was statistically significantly higher than in the rest of the patients. In seven patients prostatic cancer was diagnosed in the resection chips, but there were no differences in the S-ACP levels during TURP between these patients and the rest of the group. According to the present study, S-ACP seems to be a reliable and cheap marker of TUR syndrome, but the method is slow as compared to ethanol, which restricts its use.

Both intravesical mitomycin C (MMC) and bacillus Calmette-Guerin (BCG; Pasteur strain F) were effective in the present prospective randomized multicenter study consisting of 91 patients with frequently recurrent superficial (Ta-T1) bladder cancer. The result was in favour of BCG, as shown by the measurements with complete response (CR), disease-free interval and recurrence rate. CR of 58% with MMC and 40% with BCG were reached in 22 instillation series on carcinoma in situ of 18 patients. Due to side effects, MMC instillations were discontinued in 8.6%, and BCG instillations in 19.6%, respectively. After the 2-year follow-up also 1 case of pulmonary tuberculosis occurred in the BCG group.

Summary— Serum acid phosphatase activity, prostate specific phosphatase and prostate specific antigen were measured in 100 patients with prostatic cancer. The patients were divided according to the differentiation grade into 3 groups: G1 (well), G2 (moderately) and G3 (poorly differentiated) carcinoma. Bone metastases were identified by scintigraphy. Among the 76 MO patients the mean levels of all 3 markers were slightly higher in patients with moderately differentiated prostatic carcinoma. Among the 24 M1 patients the primary tumour was either G2 (18 patients) or G3 (6 patients); none had G1 lesions. Significantly higher serum ACP and PAP levels were found in patients with G2 tumours than in those with G3 lesions. It was concluded that the histological differentiation grade of prostatic carcinoma did affect serum levels of prostatic tumour markers; the tendency towards higher levels in the G2 group was noticeable in both non-metastatic and metastatic cases despite the limited number of patients in the latter category. In clinical practice this information may be an important additional tool in staging prostatic cancer.

A case of Leydig cell tumor is reported and discussed. The tumor, 1.5 cm in diameter, was located in the capsule of the right testis. Gynecomastia present for 3 months was almost absent 4 months postoperatively. Preoperative hormone analysis revealed a low concentration of serum testosterone, which was normalized 1 week postoperatively. In electron microscopic examination, several intracytoplasmic microbody-like structures and 'tigroid' mitochondria were noted. These findings are similar to the three earlier descriptions of Leydig cell tumors.

The analgesic effects of intravenously administered indomethacin, pethidine and metamizol were compared in a series of 169 patients with ureteric colic. Complete pain relief was obtained in 59% in the indomethacin group, in 52% in the pethidine group and in 44% in the metamizol group. The observed side effects were not serious. On the basis of the study results indomethacin can be recommended as an alternative drug in the treatment of ureteric colic.

During long periods of buffered instillations of mitomycin C (MMC) and doxorubicin (adriamycin; ADM) on carcinoma in situ (TIS), the complete response was 82% for MMC and 80% for ADM. Even the frequency of progression was about the same (20% in both groups). The differentiation grade was shown to be of great prognostic value. No progression occurred in grade 1 and 2 contrary to 38% in grade 3 cancers. The cytological primary diagnosis of TIS was equally able to predict the prognosis as the histological verification. An interesting phenomenon was the fluctuation to the cytological picture during the treatment. The change of instillation drug might be useful in cases of stable disease, though not in chemical cystitis. The addition of methylprednisolone can relieve bladder irritation.

A case of Leydig cell tumor is reported and discussed. The tumor, 1.5 cm in diameter, was located in the capsule of the right testis. Gynecomastia present for 3 months was almost absent 4 months postoperatively. Preoperative hormone analysis revealed a low concentration of serum testosterone, which was normalized 1 week postoperatively. In electron microscopic examination, several intracytoplasmic microbody-like structures and 'tigroid' mitochondria were noted. These findings are similar to the three earlier descriptions of Leydig cell tumors.