Five years' experience of intrauterine contraception with the Nova-T and the Copper-T-200

A randomized study was performed for the comparison of two copper-releasing intrauterine contraceptive devices (IUDs), the Nova-T and the Copper-T-200, simultaneously in Denmark, Finland, and Sweden. Five years' experience demonstrated that Nova-T users had a significantly lower pregnancy rate than Copper-T-200 users. The Pearl index over 5 years was 0.8 for Nova-T users and 2.0 for Copper-T users. The performance and tolerance of the Nova-T were less affected by parity and age than was the performance of the Copper-T. Infections were treated by removal of the device and with antibiotics. The cumulative rate of removals because of infections and suspected infections was below 5 with both devices over 5 years. The copper wire in the Nova-T has a silver core which prevents corrosion-induced fragmentation of the wire. Hence, the effective lifetime of this device is more than 5 years. The results indicate that the Nova-T, which is easy to insert and remove and is associated with a low pregnancy rate and a low medical termination rate, is a real improvement over other IUDs.     

Laparoscopy in children with complicated appendicitis

Background/Purpose: Laparoscopic appendectomy is an accepted way of dealing with suspected uncomplicated appendicitis in children. The role of laparoscopy in complicated acute appendicitis is more controversial. The purpose of this trial was to compare laparoscopic appendectomy with open appendectomy in children with complicated appendicitis. Methods: A total of 102 children with suspected acute appendicitis were selected randomly to undergo either a laparoscopic or an open appendectomy. The outcomes of 25 children with complicated appendicitis, 13 in the laparoscopic group and 12 in the open appendectomy group, were analyzed. Children, their parents, and research nurses were blinded to which procedure had been performed and remained blinded until the control visit 7 days after the operation. All 25 children completed a 30-day follow-up. Results: There were no differences in terms of patients' age, sex, weight, height, and appendiceal histology between the 2 groups. All laparoscopic procedures were completed without conversion. The mean ([plusmn]SD) operating time was 63 ([plusmn]31) minutes in the laparoscopic group and 37 ([plusmn]18) minutes in the open appendectomy group (mean difference 26 minutes, 95% CI 5 to 47 minutes, P = .02). There were 2 major complications in the laparoscopic group in children with appendiceal masses. One child had an entero-cutaneous fistula of the residual appendiceal tip that needed open reoperation. Another child had a pelvic abscess that resolved with antibiotic treatment. Superficial wound infections were encountered in 2 patients in the open appendectomy group. Conclusions: Laparoscopic appendectomy is an alternative to open procedure in children with complicated appendicitis. Good surgical judgement is necessary in patients with an established appendiceal abscess. J Pediatr Surg 37:1317-1320.     

Improvement in undergraduate medical education: a 10-year follow-up in Finland

Several studies have revealed that undergraduate medical education does not adequately prepare students for their work as physicians. There have been attempts to solve this problem in curriculum reforms in medical faculties. In this article, Finnish physicians' opinions on their undergraduate medical education are analysed. In 1988, a postal questionnaire was mailed to 2632 physicians registered during 1977-86, and altogether 1745 questionnaires were returned (66.3%). A follow-up study was done in 1998, and a questionnaire was sent to 2529 physicians who graduated between 1987 and 1996; 1822 questionnaires were returned (73.1%). Half of the respondents considered undergraduate education to correspond well with the requisite diagnostic skills and hospital doctors' work in general. In older and more traditional medical faculties (Helsinki, Oulu and Turku) education in primary healthcare work was considered insufficient. Also, more than 80% of the respondents felt they received too little teaching in administrative work. They reported that both traditional and younger, community-oriented faculties (Kuopio and Tampere) had considerably improved their education, especially in primary healthcare, during the 10-year follow-up. However, there were still clear differences between the education in the respective types of faculty as evaluated by their graduates. There is still room for improvements in undergraduate medical education, the better to meet the real needs of practising physicians in different fields of health care.     

Different brain activation patterns during production of animals versus artefacts: a PET activation study on category-specific processing

To study neural correlates of category-specific processing, we measured relative cerebral blood flow changes by PET (oxygen-15) in young healthy subjects while they produced exemplars of animals or artefacts to written subcategory prompts. In comparison to a baseline (word reading), production of animal names elicited increased rCBF in the right inferior temporal region. This fits to recent lesion data on semantic impairment with animals, as well as imaging data on object recognition and semantic retrieval. In our study, it may represent an involvement of visual imagery in generation of animal names. In contrast, production of artefact names elicited increased rCBF in frontoparietal regions previously related to attention and mental effort.     

Short-term cognitive improvement in schizophrenics treated with typical and atypical neuroleptics

OBJECTIVE: Atypical neuroleptics seem to be more beneficial than typical ones with respect to long-term neuropsychological functioning. Thus, most studies focus on the long-term effects of neuroleptics. We were interested in whether atypical neuroleptic treatment is also superior to typical drugs over relatively short periods of time. METHODS: We studied 20 schizophrenic patients [10 males, mean age 35.5 years, mean Brief Psychiatric Rating Scale (BPRS) score at entry 58.9] admitted to our hospital with acute psychotic exacerbation. Nine of them were treated with typical and 11 with atypical neuroleptics. In addition, 14 healthy drug-free subjects (6 males, mean age 31.2 years) were enrolled in the study and compared to the patients. As neuropsychological tools, a divided attention test, the Vienna reaction time test, the Benton visual retention test, digit span and a Multiple Choice Word Fluency Test (MWT-B) were used during the first week after admission, within the third week and before discharge (approximately 3 months). RESULTS: Patients scored significantly worse than healthy controls on nearly all tests (except Vienna reaction time). Clinical ratings [BPRS and Positive and Negative Symptom Scale for Schizophrenia (PANSS)] improved markedly (p < 0.01), without a significant difference between typical and atypical medication. Clinical improvement (PANSS total score) correlated with less mistakes on the Benton test (r = 0.762, p = 0.017) and an improvement on the divided attention task (r = 0.705, p = 0.034). Neuropsychological functioning (explicit memory, p < 0.01; divided attention, p < 0.05) moderately improved for both groups under treatment but without a significant difference between atypical and typical antipsychotic drugs. CONCLUSIONS: Over short periods of time (3 months), neuropsychological disturbances in schizophrenia seem to be moderately responsive to both typical and atypical neuroleptics.     

Long-term outcome of patients with claudication after balloon angioplasty of the femoropopliteal arteries

PURPOSE: To report the long-term outcome of patients with lifestyle-limiting claudication after percutaneous transluminal angioplasty (PTA) of the femoropopliteal arteries. MATERIALS AND METHODS: Between 1989 and 1992, 173 consecutive claudicant patients (mean age, 65 years; age range, 41-90 years) underwent PTA in 218 limbs; all interventions included femoral and/or popliteal arterial segments, and additional iliac (n = 27) and infrapopliteal (n = 11) arterial lesions were also treated. Patients were followed up for 7-10 years. Altogether, 37 (17%) limbs were classified as Fontaine class 2A, and 181 (83%) were class 2B. Average length of the primary lesion was 5.2 cm. Reinterventions were analyzed. Patency rates and patient survival were assessed by means of life table analysis. Cox-Mantel tests and Cox proportional hazards models were used to define associated independent determinants. Development of chronic critical ischemia (CCI) and its determinants was assessed by using the Pearson chi(2) test and multiple logistic regression analysis. RESULTS: The primary and secondary patencies (+/- standard error of the estimate), respectively, were 46% +/- 3 and 63% +/- 3 at 1 year, 25% +/- 3 and 41% +/- 4 at 5 years, and 14% +/- 3 and 22% +/- 4 at 10 years. One-third (71 of 218) of the limbs required repeat interventions, including surgical revascularization in 35 limbs. Fourteen (6.4%) limbs developed CCI, resulting in a 0.8% incidence per year. In multivariate analysis, poor postinterventional peripheral runoff was an indicator of increased risk of CCI development (P =.03). CONCLUSION: Although the long-term patency rates of PTA of the femoropopliteal arteries in claudicant patients were poor, the acceptable number of reinterventions and the low frequency of development of CCI imply the long-term benefits achievable with this treatment.     

Comparison of epidural pain treatment with sufentanil-ropivacaine infusion with and without epinephrine in children

BACKGROUND: Epidural analgesia provides outstanding pain relief after surgery, but it is also associated with numerous adverse effects. In order to improve postoperative pain management in children we determined whether the use of epinephrine added to epidural sufentanil-ropivacaine infusion reduced drug requirements, the intensity and duration of postoperative pain and the incidence and severity of adverse effects. METHODS: A prospective, randomized, double blind, parallel group study design was used in 61 children. The children were given continuous epidural sufentanil-ropivacaine infusion either with (n=32) or without (n=29) epinephrine for postoperative analgesia. Intravenous ketoprofen, a non-steroid anti-inflammatory drug, was used for all children, and epidural ropivacaine was used for rescue analgesia. The drug consumption, intensity of pain at rest and during activity, and all adverse effects were recorded. RESULTS: : The need for sufentanil (P=0.001) and ropivacaine (P=0.006) was significantly lower in the with-epinephrine group than in the without-epinephrine group. The mean duration of epidural infusion (62 h) was similar in both groups. Four children in the without-epinephrine group were noticed to have a low oxygen saturation (SpO2<90%), and in one child a low respiratory rate (8 breaths min-1). The incidence of pruritus was higher in the without-epinephrine group (P=0.026). CONCLUSION: Both infusions provided effective pain relief, and epinephrine as an adjuvant to continuous epidural sufentanil-ropivacaine infusion seems to be useful in children.     

A long-term clinical study on dislocated ankle fractures fixed with self-reinforced polylevolactide (SR-PLLA) implants

Sixteen patients with dislocated ankle fractures fixed between 1988 and 1991 with self-reinforced poly(L-lactide; SR-PLLA) screws and/or rods were followed up after 8.6 to 11.7 years (mean 9.6 years) at the Department of Orthopaedics and Traumatology, Helsinki University Central Hospital. In all patients accurate reduction of the fractures was retained and uneventful bony union was achieved. Good or excellent long-term functional results were observed in 15 out of 16 patients. One patient had post-traumatic osteoarthritis. In 5 patients, a late tissue reaction was observed over an extruding screw head with mild symptoms, which led to removal of small palpable masses. There were two superficial wound infections, one after a primary operation and one caused by a late tissue reaction after an operation. The correct operative technique, where all extruding extraosseous SR-PLLA material should be removed during the primary operation, should be followed.