Clinical outcome and prognostic factors in 100 cases of uterine sarcoma: experience in Helsinki University Central Hospital 1990-2001

ObjectiveUterine sarcomas are rare malignant gynecological tumors with poor prognosis. In this study clinical data on all uterine sarcoma patients treated at Helsinki University Central Hospital (HUCH) between 1990–2001 were retrospectively evaluated.MethodsMedical records were reviewed and data collected on all uterine sarcomas treated during a 12-year period at HUCH. Kaplan–Meier survival curves were generated and those variables found to be statistically significant in univariate analysis were examined by multivariate analysis using Cox's proportional hazards regression model.ResultsOne hundred patients met the study requirements: 40 cases were diagnosed as carcinosarcomas, 39 as leiomyosarcomas and 21 as endometrial stromal sarcomas. First-line treatment was surgery in 98% of the patients. Seventy-eight of the patients were treated by means of adjuvant therapy. A complete response was achieved in 80% and a partial response in 4% of the cases. The 2-, 5- and 10-year overall survival rates were 62%, 51% and 38% and disease-specific survival rates were 64%, 56% and 44% (all sarcomas). In multivariate analysis, stage, age, tumor size and parity were proven to have independent influences on overall survival, and stage, tumor size and parity also independently influenced disease-specific survival.ConclusionsIn this study, survival rates were better than in nearly all previous retrospective studies of uterine sarcomas. It seems that higher parity could have a negative influence on survival in cases of uterine sarcoma.     

Atresia of proximal coronary arteries in pulmonary atresia with intact ventricular septum - fetal and neonatal findings

Pulmonary atresia with intact ventricular septum (PA+IVS) is a rare congenital cardiac malformation which is associated with ventriculocoronary arterial communications from the right ventricle. We present a case of PA+IVS with a bilateral atresia of the coronary ostia, and thus, a completely right ventricular-dependent coronary circulation followed up by fetal echocardiography. Eventually the infant died of myocardial infarction at 2 days of age.     

Effect of a multispecies probiotic supplement on quantity of irritable bowel syndrome-related intestinal microbial phylotypes

Background  

Probiotics can alleviate the symptoms of irritable bowel syndrome (IBS), possibly by stabilizing the intestinal microbiota. Our aim was to determine whether IBS-associated bacterial alterations were reduced during multispecies probiotic intervention consisting of Lactobacillus rhamnosus GG, L. rhamnosus Lc705, Propionibacterium freudenreichii ssp. shermanii JS and Bifidobacterium breve Bb99. The intervention has previously been shown to successfully alleviate gastrointestinal symptoms of IBS.     

Vibration-induced white finger syndrome and carpal tunnel syndrome among Finnish metal workers

Objective  Officially 10–26 cases of vibration-induced white fingers (VWF) have been reported annually in Finland. It has been suggested that the numbers are underestimated. The purpose of the present study was to estimate the cumulative exposure to hand–arm vibration (HAV) and the prevalence of clinically diagnosed cases of VWF and carpal tunnel syndrome (CTS) in a population of Finnish metal workers and to determine the symptoms and clinical tests that would best predict the diagnosis. Methods  A questionnaire on vibration exposure at the workplace and symptoms of the upper extremities was sent to a sample (n = 530) of members of the local Metalworkers Union. Those who reported finger blanching, numbness or tingling of the fingers or symptoms of CTS were invited to take part in clinical examinations. Their cumulative lifelong exposure to HAV was evaluated. Those whose symptoms referred to VWF or CTS were given a cold provocation test with the measurement of finger systolic blood pressure and electroneuromyography of the upper arms. Results  Altogether 285 metal workers (54%) responded to the questionnaire, and 24 new cases of VWF (8.4%) and 12 cases of CTS (4.2%) were diagnosed. In the group of VWF patients, seven workers had both VWF and CTS. All of the workers diagnosed as having VWF also had numbness or tingling in their fingers. Consequently, questions concerning numbness and tingling, a two-point discrimination test, Phalen’s test, and Tinell’s test had a high predicting value for VWF. The exposure time of the VWF cases did not differ significantly from that of the study group as whole, but the cumulative exposure index was significantly higher. Conclusion  The results suggest that VWF is underdiagnosed in Finland. In screening for the health effects of HAV, sensorineural symptoms of hands should be carefully inquired about and examined in patients complaining of white fingers. More education on the recognition and evaluation of HAV exposure and its health effects is needed.     

Magnetic resonance imaging in occupational chronic solvent encephalopathy

Purpose  The aim of this study was to characterize the magnetic resonance imaging (MRI) findings in chronic solvent encephalopathy (CSE) patients and to study whether the findings are associated with solvent exposure indices. Methods  The brain MRI scans of 71 CSE patients were independently re-evaluated and rated by two experienced neuroradiologists. All the work tasks were analyzed and the chemical composition of lifetime exposure was categorized. Results  The MRI scans of 27/71 CSE patients (38%) were classified as abnormal. Brain atrophy in any brain area was found in 17/71 CSE patients (24%). Abnormal white matter hyperintensities (WMH) were found in 20/71 CSE patients (28%). Cerebral and cerebellar brain atrophy was associated with the duration of exposure in years, and vermian atrophy was associated with alcohol consumption. Periventricular and brainstem WMH were related to age. Conclusions  Slight brain atrophy is associated with CSE and there is a correlation between brain atrophy and the duration of exposure in years. However, all the MRI findings in CSE are non-specific and thus MRI is useful mainly in the differential diagnosis of CSE.