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Ultrasound examination (US) with a 5 MHz linear array probe was used to examine 30 patients (34 Achilles tendons) with overuse injuries. The results were compared with surgical findings in all cases. Most of the patients had two or more sonographical findings. In this study US had an overall sensitivity of 0.96 in the detection of Achilles tendon pathology. Partial Achilles tendon rupture was suspected in ten tendons. During an operation ruptures were found in eleven tendons, of which two were fibrotic scars. Changes in inflammatory tendopathy (tendinitis, paratenonitis and paratenonitis with tendinosis) were found by US in 28 tendons and in the operation in 27 tendons. US showed tendinitis in 21 cases, of which four had a positive operative finding. In the seventeen negative cases, the surface of the tendon looked normal during the operation. Most of these cases (14 out of 17) were classified as paratenonitis during the operation. In three cases, paratenonitis with tendinosis was classified as paratenonitis in the operation and in one case the findings were similar in US and in surgery. US was underdiagnostic in paratenonitis and overdiagnostic in tendinitis. Bursitis was detected during the operation in ten cases, but only in three cases by US. False positive bursitis was diagnosed three times in US compared to the operative finding. In chronic bursitis, the bursa can be small, thickened by its wall and undetectable by US. High-resolution sonography is a relatively reliable diagnostic method in Achillodynia and mainly useful as a preoperative study to differentiate a partial rupture from inflammatory states.

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It is known that sports, especially competitive sports, can cause different kinds of injuries, which can be fractures and/or dislocations of joints, but more often soft tissue lesions. As a rule it is difficult to establish clinically the character and/or size of the sports lesion, but nowadays we have methods to examine soft tissues. The most modern method is Magnetic Resonance Imaging (MRI), but the cheaper one is ultrasound examination, which is some years old but has been developed continually. Recent studies have shown that soft tissue sports injuries can be diagnosed quite easily. The lesions can be localized and their size determined, parametres especially useful if surgery is required. We conclude from our studies that ultrasonic soft tissue examination improves diagnostic accuracy of sports injuries. Recovery is faster thanks to correct diagnosis and treatment. The healing process can also be followed up by ultrasonography.

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The aim of the study was to evaluate the role of ultrasonography (US) in the management of jumper's knees. Sixty-two cases of clinically suggested jumper's knees, 52 asymptomatic contralateral knees and 100 asymptomatic knees of healthy middle aged men were examined. In the symptomatic group US was normal in 25 cases, all recovered with conservative therapy. In 31 symptomatic knees the findings were consistent with jumper's knee as a hypoechoic lesion located in the upper insertion of the patellar tendon in 23 cases and in the distal insertion in one case. In 7 cases the lesion was situated in the insertion of the quadriceps tendon. Surgery was performed on 20 knees and in all of them there was a lesion matching the lesion detected by US. In 6 cases US findings were pathologic, but different from jumper's knee. US findings consistent with jumper's knee could not be detected in the asymptomatic group.

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A total of 42 male breast cancer patients (mean and median age 66 years), were followed up for over 25 years or until death. In 24/42 patients (57%) radical surgery and radiotherapy was carried out, surgery alone in 11 patients (26%), and radiotherapy alone in 3 patients (7%). Of the patients 23 died of mammary cancer, 74% of them in five years after primary treatment; 9% of the patients survived 10 years and 7% for 20 years. If only deaths related to breast cancer were included, the 20-year survival was 45%.

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The purpose of the study was to investigate the usefulness of soft-tissue real-time ultrasonography (US) for diagnosing sports injuries of the Achilles region. Thirty-eight patients (mean age, 39.9 years) with Achilles tendon problems were studied at Helsinki University Central Hospital. Six patients underwent surgery following ultrasonographic examination. All operative findings corresponded closely with those of ultrasonography. Partial ruptures were found in 11 cases, total tendon rupture in three cases, subachilles bursitis in 11 cases, and peritendinitis in 16 cases. The study showed that real-time ultrasonography can be used reliably for examination of both tendoneal and peritendoneal injuries. The technique is recommended as a routine examination before instigating any specific treatment and for monitoring Achilles tendon injuries.

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Studies were carried out in 25 patients (mean age, 34.2 years) with knee or patellar problems, using a real-time scanner. The contralateral leg, which was asymptomatic, was used as a control. Identification of the patellar bone and the area of insertion of the infrapatellar tendon was not difficult. The area of insertion was less echogenic than other parts of the tendon. Patchy, partial, or total ruptures could be identified using ultrasound. Sonolucent structures in cases of Baker's cyst were easily identified. The study revealed three partial suprapatellar tendon ruptures, three partial infrapatellar tendon ruptures, six old injuries of the infrapatellar tendon with fibrosis and scar tissue, one case of prepatellar bursitis, one parapatellar (cartilaginous) loose body, two intraarticular loose bodies (bony), and four cases of Baker's cyst, of which one was found to be ruptured. The differences in echogenicity of the tendons and surrounding soft tissues were more conspicuous using interposed Kiteko than with direct skin contact.

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The data for this study, consisting of 300 females treated for breast cancer in 1951-1961, were evaluated in order to ascertain when excess mortality from breast cancer disappears and what would be an appropriate follow-up period for investigational purposes. The clinical stages of the patients were classified as follows: 23.3%, stage I; 49%, stage II; 20.3%, stage III and 7.3%, stage IV. Halsted's radical mastectomy was performed in 79.7% of the cases. Every patient was given radiotherapy. Two hundred and ninety-eight patients could be followed until death or up to the present. Forty-five patients (16%) were still alive. The survival rate over a 20-year period for the various stages was as follows: stage I, 46.1%; stage II, 22.7% and stage III, 10.9%. Only 26% of the patients with stage I died of breast cancer, while the respective figures for stage II were 57% and stage III, 70%. The death rate from the cancer diminished with time in every stage especially 10 years after primary treatment. After this the observed survival rate curves were almost parallel with the expected curves. Our data show that for follow-up studies a 5-year follow-up is good and a 10-year follow-up is very good to show the trend in the treatment of breast cancer.

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The genetic properties and the frequency of cancer family syndrome (CFS) were evaluated on the basis of 22 kindreds identified in Finland by investigating the family histories of young patients with colorectal carcinoma. These families had 196 members with malignancies: 120 colorectal (61%), 30 undefined intraabdominal (15%), 20 endometrial (10%), 7 gastric (4%), 5 biliary tract (3%) adenocarcinomas, and 14 (7%) other cancers. The present CFS patients represented 0.4% of all colorectal cancers diagnosed in Finland during 1961-1980, and the estimated minimum frequency of CFS was 4-4.7 X 10(-5) (1 in 25,100-21,400). An autosomal dominant pattern of genetic transmission for colorectal cancer was demonstrated through two to four generations, but the trait was also transferred by mothers with uterine carcinoma. The highest incidence of colorectal carcinoma occurred between 40 and 49 yr of age (15% per decade), and the cumulative risk in the descendants increased to 50% at 69 yr. The penetrance of CFS was 0.5-0.9. The analysis suggest that heredity is more significant in the etiology of colorectal cancer than has been previously believed. Identification of CFS seems to provide a good opportunity for screening the descendants of affected patients for colorectal cancer.

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Nine cases of stress fractures of the tarsal navicular bone were treated in athletes. The diagnosis was made with radiographs and bone scan within 6 months. Only two patients were treated surgically. The only poor result was seen in a patient in whom the fracture was only explored.

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Six hundred fifty-seven patients with colorectal cancer who were operated upon at the Second Department of Surgery, Helsinki University Central Hospital during the period 1966 to 1975 had a 40.5 per cent crude five-year survival rate and 54.2 per cent relative (corrected) rate. The survival rates of patients with Dukes' A lesions were 80.7 per cent, Dukes' B, 61.6 per cent, Dukes' C, 40.4 per cent, and Dukes' D, 2.7 per cent. One hundred two patients (15.5 per cent) underwent emergency operations; 91 were occlusive cancers, eight were perforations and three were cancer bleedings. The operative mortality for the whole series was 6.5 per cent (4.7 per cent in elective and 16.7 per cent in emergency operations). A definite improvement of the five-year survival rates could be seen in both the colonic and rectal cancer series. This was due to earlier detection of the disease, reflecting a decreasing number of palliative operations. Patients at high risk for colorectal cancer (inflammatory bowel disease, inherited intestinal polyposis, cancer family syndrome, multiple colorectal cancers, and neoplastic polyps) might benefit from more effective cancer surveillance and prophylactic surgery to find and treat cancers in earlier stages, to prevent recurrences, and to facilitate follow-up. The controversial findings on postoperative adjuvant therapy presented in this study indicate the need for further controlled studies to define the patients who really benefit from it.

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Two patients with polypoid bile duct tumors associated with familial adenomatosis coli are presented. A jaundiced man, aged 63, had polypoid masses identified as adenocarcinoma in the common and hepatic ducts. The other patient, a 38-year-old woman undergoing surgery for duodenal adenomas, had a solitary benign adenoma of the distal common duct in addition to duodenal adenocarcinoma. Only one earlier report of bile duct polyps could be found in association with familial adenomatosis. These cases support the view that familial gastrointestinal adenomatosis is a systemic disease, which is not restricted to the colon and rectum.

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Upper gastrointestinal tract polyps were sought prospectively using endoscopy and biopsy in 34 patients with familial adenomatosis coli belonging to 18 unrelated families. Gastric and/or duodenal polyps, usually small and multiple, occurred in 28 patients (82%). Histologically verified extracolonic adenomas were present in 19 patients (56%). Gastric adenomas, all in the antrum, and duodenal adenomas occurred in four (12%) and 16 (48%) patients, respectively. In one patient, a duodenal adenocarcinoma and a bile duct adenoma were also found, and one patient had an adenocarcinoma of the bile ducts. Multiple non-neoplastic polyps were found in 19 patients (56%), most often in the stomach and also in the duodenum in 12 patients; they co-existed often with adenomas. In addition, there were nine patients with ileal polyps, most of them showing lymphoid hyperplasia but also one with adenomas. It is suggested that familial adenomatosis affects the whole gastrointestinal tract, not only the colon and rectum as believed earlier. Although upper gastrointestinal tract adenomas are not as consistent and multiple as those in the colon, and probably do not require prophylactic surgery, regular lifelong endoscopic follow up is warranted because of obviously increased cancer risk.

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Extracolonic lesions compatible with Gardner's syndrome were studied in 34 patients from 17 unrelated families with established familial adenomatosis coli. Thirteen patients (38 per cent) had the complete syndrome and 12 patients (35 per cent) a bisymptomatic syndrome. Bone lesions were found in 79 per cent of the patients examined, epidermoid cysts in 35 per cent, desmoid tumours in 18 per cent and dental changes in 18 per cent. One extracolonic manifestation of the triad in at least one affected family member was detected in 14 families (82 per cent). The findings provide additional evidence for the view that all cases of familial adenomatosis coli belong to a single genetic entity. The usually innocent extracolonic signs of Gardner's syndrome severe as valuable markers for early detection of asymptomatic family members at risk. Panoramic X-ray of the jaws seems to be especially suitable for this purpose.

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The causes of long delay by the doctor (Dd) in the diagnosis of colorectal cancer are discussed. The median delay in this whole prospective material (100 patients) was 9.8 months (Dd 5.4 months and patient's delay (Pd) 4.4 months) compared to 18.1 months (Dd 14.7 months and Pd 3.4 months) in the 30 patients severely delayed (Dd more than 6 months). A false negative barium enema (16 patients) and acceptance of the patient's symptoms without resort to investigation were the main causes of severe delay. The most common error of diagnosis were haemorrhoids and anaemia. Tumours in the right hemicolon were the most difficult one to diagnose representing 53% of those severely delayed. The false negative barium enemas were mainly attributed to small sized early stage cancers of which 69% were located in right hemicolon, indicating also the diagnostic difficulties in this part of the colon. The age distribution among those severely delayed showed slight predominance of patients younger than 50 years, resulting from lack of cancer-conscious attitude of the doctors examining younger patients. Males outnumbered females among those severely delayed. This study emphasizes that a more cancer-conscious doctor with a more critical attitude to barium enema examination and willing to use colorectal endoscopy in the diagnosis of colorectal diseases provides the key to a shorter delay and thus maybe to improved survival

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Death due to appendicitis is still a significant occurrence. The stage when the disease is diagnosed and operation occurs has a decisive influence on the mortality. In our series of 9,652 cases of appendicitis, 26 patients died (0.27%)-ten (0.12%) of nonperforative appendicitis, and 16 (1.18%) of perforative appendicitis. Both the patients and the physician can delay treatment. The proportion of fatal cases is six times as great in perforative appendicitis is in those operated on in time. The deaths in those with a perforated appendix were usually caused by the basic disease or the surgical procedure, while in patients with unperforated appendixes, death was most commonly caused by other concomitant diseases. The proportion of the elderly in our series increased along with the rise in the average age of the population. The symptoms of acute appendicitis and the clinical findings are identical in the elderly and in the younger patients, but the disease in the aged advanced more rapidly to perforation and the mortality among them was higher. Active and careful attention to patients with possible diagnosis of appendicitis, especially in the elderly, is important.

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The effect of heavy endurance training on capillary diffusion capacity (CDC) and maximal blood flow (MBF) in skeletal muscle was studied in eleven highly-trained athletes and ten sedentary adult volunteers. MBF was estimated from 133Xe clearance and CDCI from 133Xe and 131I- clearances in the anterior tibial muscle after ischaemic exercise. The athletes had a significantly greater MBF, 131I- clearance and CDCI than the control subjects (P less than 0.001). The average increment of MBF was 37% and that of CDCI 48%. Increase in CDC is considered to reflect an increase in capillary surface area due to physical training.

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Solitary diverticulum of the caecum is very rare and assumes clinical interest only when inflamed. Preoperatively the condition is virtually impossible to distinguish from acute appendicitis, and even during operation its differentiation from carcinoma is difficult. It is also important to determine whether or not an underlying solitary diverticulum of the caecum is present. In the present series the symptoms and clinical examination as well as laboratory findings pointed to acute appendicitis, which was in fact the preoperative diagnosis in all our patients. In one case the operative findings were strongly suggestive of carcinoma, which was only excluded by inspection and histological examination of the specimen. The wall of the diverticulum was necrotic in all cases. It had already perforated in the previously mentioned case, and right hemicolectomy was performed. An inflamed, but recognizable, solitary diverticulum of the caecum was treated by excision, but the tumour-like mass produced by the diverticulum was removed by resection. In view of the considerable possibility of underlying carcinoma, the authors support an aggressive trend in the treatment of "inflammatory tumours" of the caecal wall.

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