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Introduction: Mortality from colorectal cancer has been shown to decrease by repeated screening using faecal occult blood (FOB) testing in randomized screening trials. This report presents coverage and performance of organized screening among the general population in Finland., Methods: In 2004-2007, people aged 60-69 years were randomized into biennial screening and control arms. The screening test was a guaiac-based FOB test (Hemoccult) with dietary restriction and three test cards for six consecutive samples. Test positives were referred for full colonoscopy. The programme was launched in 2004 and subsequently it expanded over regions and age-cohorts., Results: In 2007, the programme covered one-third of the target population and 74,592 people had been invited for screening, of them 26,866 for the second round. Uptakes for the first and second rounds, respectively, were 62% and 68% in men and 77% and 80% in women. The proportion of test positives increased from 2.4% to 2.9% from the first to the second round and the positive predictive value for cancers decreased from 7.5% to 4.3%., Conclusions: By 2007, organized colorectal cancer screening covered one-third of the target population in Finland. Implementation of screening measured with response rate was successful and met the criteria for a public health programme, but performance in terms of positive predictive value needs monitoring.

Cytologically, the mucoid middle ear effusions could be divided into a lymphocyte-monocyte type and a type where the granulocytes predominated. By alpha-naphthyl-acetate esterase (ANAE) staining procedure the T lymphocytes were found to make up the majority of lymphocytes in the first type, often accompanied by large numbers of ANAE-positive macrophages. In the second type the relative and particularly the absolute numbers of T cells were smaller. The T lymphocytes in aural effusions, distributed in agreement with their normal distribution in blood, could be the basis of possible delayed hypersensitivity immune mechanisms in the middle ear, but definite proof, either demonstrating receptor molecules directed to antigens or a specific response by T cells, is still lacking.

Two Finnish prospective studies of acute otitis media are reviewed, one consisting of 158 and the other of 248 patients. Treatment with myringotomy in combination with antibiotics gave results which were better than those obtained by antibiotics alone. If the patients had a history of two or more earlier attacks of acute otitis media, healing rates were poorer irrespective of the method of therapy, and treatment without myringotomy could not be adhered to even if planned. Mastoid roentgenograms showed partial or total cloudiness in many ears and proved to be a good method of recognizing the cases in which the disease was likely to run a prolonged course.

Analysis of glue ear secretions showed that the total protein content was slightly higher than in serum and that in the effusion proteins appeared that were specific to the mucosal secretion. The cellular analysis of samples from 137 ears showed that lymphocytes and neutrophils predominated, and that monocytes and phagocytes appeared in most specimens. Eosinophils and mast cells were rare. Staining of bacteria in the smear was seen in one-third of the slides and the mucus strands were numerous. The cellular picture is in line with an infective etiology.

Cytological studies were performed on 157 middle ear effusion specimens, 54 of which belonged to the serous and 103 to the mucoid category. The cytocentrifuged samples were stained with May-Gruenwald-Giemsa stain and divided into the three groups on the basis of cellular pattern: granulocytic, lymphocytic-monocytic and mixed. The T-lymphocytes were counted after incubation for six hours using alpha-naphtyl-acetate esterase (ANAE) marker and counterstaining with toluidine blue. In 57 samples, reliable assessment of lymphocytes could not be made because the absolute number of white blood cells was small or the lymphocytes were less than 100. In the remaining 40 serous and 60 mucoid samples, lymphocytes were present in sufficient numbers. The mean percentages of ANAE-positive lymphocytes were 62% serous and 57% mucoid. The results indicate that there is no numerical defect of the T-cells in chronic middle ear effusions.

On 100 pathological ears with tympanic membrane perforation, eustachian tube functions was measured by using sonotubometry and the negative pressure equalization test in an attempt to compare these two methods. The pressure equalization test did not appear to be a reliable tool for preoperative clinical determination of tube function because sonotubometry showed tubal opening in 85% (myringoplasty group) and in 49% (radical surgery group) of patholoical ears, which were not able to equalize negative middle ear pressure at all during swallowing. The negative pressure equalization test is considered to be unphysiological and may produce a locking phenomenon of the tube. Even a small negative pressure can act like a valve, producing an obstruction that muscle activity of the tube is no longer able to overcome particularly when mucosal changes are present in the tubal orifice. Sonotubometry is a physiological test and as such gives a reliable picture of the opening of the tube during swallowing. Data on tympanic aeration postoperatively will be reported later.

Tympanostomy tube treatment was used in 181 patients on 323 ears and a followup study was made as an average three years and two months later. Sixty-five percent of the ears had healed completely and in these the average tube treatment time had been 11.3 months. In 22% the tubes were still in position, the average time for treatment being 24.2 months. Five percent showed purulent discharge and recurrence of the glue ear was noted in 3%. A dry perforation developed in five patients. Cholesteatoma was seen in four ears but in only one of these it may have been related to the location of the tube at the posterior drum margin.

Data on 87 patients (113 ears) with chronic secretory otitis media (SOM) are reported. The bacteriological analysis of the middle ear fluid (MEF) revealed Streptococcus pneumoniae in 7% of ears, Hemophilus influenzae in 9%, opportunistic bacteria in 20%, while 64% of the samples showed no growth. Free capsular polysaccharide pneumococcal antigens were found in 5% of the MEF samples using counterimmunoelectrophoresis (CIEP) with Omniserum containing 83 different pneumococcal polysaccharide types. Heating of the samples to disrupt the immune complexes increased the frequency of positive samples to 27%. These findings, together with the frequent occurrence of S pneumoniae and H influenzae in the nasopharynx, strongly support the opinion that chronic SOM in a considerable number of cases is an immune complex disease.

Mucosal biopsies were taken from 20 ears with secretory otitis media (glue ear) and histochemical stainings were made for comparison with data obtained from biochemical analysis of the fluids. Acid phosphatase, lactate dehydrogenase (LD), and malate dehydrogenase (MD), the activity of which in the ear fluids was 20 to 30 times higher than in serum, were found to appear as strong precipitates in the middle ear epithelium, particularly in the top layer. Alkaline phosphatase activity was only exceptionally seen in the epithelium but appeared in the capillaries and histiocytes. Nonspecific esterase appeared irregularly in the epithelium and regularly in histiocytes. The latter two had lower activities in ear fluids than in serum. Epithelial secretory cells and subepithelial glands and cysts showed strong alcian blue (AB)-positive staining. Positive material appeared also in the cytoplasm of the epithelial cells and in the intercellular substance. Distinct PAS-positive staining appeared in the columnar epithelium and particularly in the free mucus on top of the epithelium but was less promounced in the glandular structures and absent from the cysts.

The theme of the first consensus conference to be held in Finland was the treatment of acute otitis media. The statements and recommendations accepted by the conference, which was organized according to the National Institutes of Health model, are presented in this report. On the basis of scientific knowledge, clinical experience, and conditions in Finland, the conference delegates concluded that penicillin V, in large doses, is still the drug of first choice in this disease. The importance of surgical drainage of the middle ear was stressed, as was the necessity of careful follow-up of the patient until the condition is completely healed. Decongestants were considered rather useless. In the prevention of recurrent attacks, adenoidectomy but not tonsillectomy was regarded as being of help, tympanostomy of probable benefit, antimicrobial (sulfonamide) prophylaxis worth considering in selected cases, but the effect of pneumococcal vaccination poor. The conference delegates agreed that uncomplicated acute otitis media should, as before, usually be treated by physicians taking care of children at the primary health care level.