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The enantiomeric ratios (ER) of alpha-HCH and o,p'-DDT ((+)-isomer concentration/(-)-isomer concentration) and o,p'-DDD (first eluting enantiomer/second enantiomer) were investigated in 112 human placentas from Finnish boys collected 1997-2001. Both o,p'-DDD and alpha-HCH showed changes in their ER depending on the total concentration of the compound in the sample. Their ERs are approaching a value close to racemic mixture (ER=1) at high concentrations. At low concentrations they often differ from 1. The relationship between concentration and ER is clearly identified and it has been shown that it is not affected by analytical uncertainty. This relationship appears to be important for assessing tissue- and species-specific exposure and risk and it may indicate whether net uptake or metabolic activity is dominant in exposure for the resulting exposure of the enantiomers.

The purpose of this study was to analyze the connections between patient education and health-related quality of life as an outcome variable. Data were collected among surgical hospital patients (n = 237) in Finland. On the basis of the results, there seems to be a positive relationship between received knowledge and health-related quality of life, and as such, the study produced knowledge about one quality indicator in nursing care. More research is needed to explore this connection in greater details.

Patients with 45,X0/46XY karyotype often present with intersex phenotype and testicular dysgenesis. These patients may also have undescended testes (cryptorchidism), hypospadias and their spermatogenesis is severely disrupted. They have a high risk for testicular cancer. These patients have the most severe form of testicular dysgenesis syndrome (TDS). We have hypothesized that testicular cancer, cryptorchidism, hypospadias and poor spermatogenesis are all signs of a developmental disturbance that was named as testicular dysgenesis syndrome. The hypothesis is based on clinical and epidemiological findings and on biological and experimental evidence. Signs of TDS share several risk factors, such as small birth weight (particularly being small for gestational age), and they are risk factors for each other. All of them have background in fetal development. They show strong epidemiological links so that countries with high incidence of testicular cancer, such as Denmark, tend to also have high prevalence rates of cryptorchidism and hypospadias and poor semen quality. Vice versa, in countries with good male reproductive health, e.g., in Finland, all these aspects are better than in Denmark. Although genetic abnormalities can cause these disorders, in the majority of cases, the reasons remain unclear. Adverse trends in the incidence of male reproductive disorders suggest that environmental and life style factors contribute to the problem. Endocrine disrupters are considered as prime candidates for environmental influence. Fetal exposure to high doses of dibutyl phthalate was shown to cause a TDS-like phenotype in the rats. Studies are underway to assess whether there is any exposure-outcome relation with selected chemicals (persistent organic pollutants, pesticides, phthalates) and cryptorchidism.

Undescended testes are a common urogenital malformation affecting 2-9% of newborn boys. The etiology of cryptorchidism is probably heterogeneous, but insufficient androgen effect has been recognized as one cause of the condition. A common genetic variant (V) form of LH occurs in apparently healthy individuals universally. Compared with wild-type (WT) LH, the V-LH molecule has increased bioactivity in vitro but shorter half-life in vivo. In the present study, we screened 93 cryptorchid (59 uni- and 34 bilateral) and 211 healthy boys for the occurrence of V-LH to evaluate whether it is related to testicular descent. Two immunofluorometric assays with different combinations of MAb, one detecting WT-LH, the other detecting both WT- and V-LH, were used to measure LH concentrations. The ratio of two LH measurements was used to assess the V-LH status. The prevalence of V-LH was similar in the control and cryptorchid groups, and the total prevalence of V-LH corresponded well to the prevalence of V-LH in general Finnish population. Among cryptorchid boys, the prevalence of V-LH was dependent on gestational age: 6.7% at GA <37, 20.9% at GA 37-39, and 42.9% at GA of 40-42 wk. In contrast, the percentage of V-LH status was similar at different gestational ages in all control groups. We conclude that V-LH is not critical for normal testicular descent but the increased prevalence of V-LH among cryptorchid boys with GA >40, suggests that the lower hormonal efficacy of V-LH predisposes for improper testicular descent in late pregnancy.

The GDNF (glial cell line-derived neurotrophic factor)-binding receptor GFRalpha1 (GDNF family receptor alpha1) is attached to the membrane by a GPI (glycosylphosphatidylinositol) anchor and consists of three cysteine-rich domains. The region corresponding to the second and third domains has been shown previously to participate in ligand binding, and to interact with the transmembrane tyrosine kinase receptor RET. No function has so far been found for the N-terminal, first domain (D1). Here we show that the GPI-anchored full-length receptor binds 125I-GDNF two times more tightly than does a GPI-anchored truncated receptor lacking D1. Scintillation proximity assays with purified receptor proteins also show that the GDNF-binding capacity of the soluble full-length GFRalpha1 is two times higher than the GDNF-binding capacity of the soluble D1-truncated GFRalpha1. As RET stabilizes the binding of GDNF equally well to the full-length and truncated receptors, D1 seems not to be involved in the interaction between GFRalpha1 and RET. Moreover, soluble full-length GFRalpha1 mediates GDNF-promoted neurite outgrowth in PC6-3 cells more efficiently than the soluble truncated GFRalpha1 protein. At low concentrations, the soluble fulllength receptor mediates the phosphorylation of RET more efficiently than the soluble truncated receptor. However, when the receptors are overexpressed on the cell surface as GPI-anchored proteins, or added to the growth medium at high concentrations as soluble proteins, full-length and truncated GFRalpha1 are indistinguishable in GDNF-dependent RET-phosphorylation assays. High levels of the receptors can thus mask a slightly impaired function in the phosphorylation assay. Based on assays with both GPI-anchored and soluble receptors, we therefore conclude that D1 contributes to the optimal function of GFRalpha1 by stabilizing the interaction between GFRalpha1 and GDNF.

Previously, it was shown that the recruitment of RET into lipid rafts by glial cell line-derived neurotrophic factor (GDNF)/GFRalpha1 is crucial for efficient signal transduction. Here, we show that the mouse GFRalpha4 is a functional, N-glycosylated, glycosylphosphatidylinositol (GPI)-anchored protein, which mediates persephin (PSPN)-induced phosphorylation of RET, but has an almost undetectable capacity to recruit RET into the 0.1% Triton X-100 insoluble membrane fraction. In spite of this, PSPN/mGFRalpha4 promotes neurite outgrowth in PC6-3 cells and survival of cerebellar granule neurons. As we show that also human PSPN/GFRalpha4 is unable to recruit RET into lipid rafts, we propose that the mammalian GFRalpha4 in this respect differs from GFRalpha1.

Background: Several investigators have shown striking differences in semen quality and testicular cancer rate between Denmark and Finland. Since maldescent of the testis is a shared risk factor for these conditions we undertook a joint prospective study for the prevalence of congenital cryptorchidism., Methods: 1068 Danish (1997-2001) and 1494 Finnish boys (1997-99) were consecutively recruited prenatally. We also established prevalence data for all newborns at Turku University Central Hospital, Finland (1997-99, n=5798). Testicular position was assessed by a standardised technique. All subtypes of congenital cryptorchidism were included, but retractile testes were considered normal., Findings: Prevalence of cryptorchidism at birth was 9.0% (95% CI 7.3-10.8) in Denmark and 2.4% (1.7-3.3) in Finland. At 3 months of age, prevalence rates were 1.9% (1.2-3.0) and 1.0% (0.5-1.7), respectively. Significant geographic differences were still present after adjustment for confounding factors (birthweight, gestational age, being small for gestational age, maternal age, parity, mode of delivery); odds ratio (Denmark vs Finland) was 4.4 (2.9-6.7, p<0.0001) at birth and 2.2 (1.0-4.5, p=0.039) at three months. The rate in Denmark was significantly higher than that reported 40 years ago., Interpretation: Our findings of increasing and much higher prevalence of congenital cryptorchidism in Denmark than in Finland contribute evidence to the pattern of high frequency of reproductive problems such as testicular cancer and impaired semen quality in Danish men. Although genetic factors could account for the geographic difference, the increase in reproductive health problems in Denmark is more likely explained by environmental factors, including endocrine disrupters and lifestyle.

Objective: The aim of this study was to relate measures of psychoanalytically derived personality traits to descriptive diagnosis and psychopathology in severe mental disorders., Method: Sixty-one consecutive first-episode patients with schizophrenia, bipolar disorder and severe major depression were interviewed. Personality traits were assessed with the Karolinska Psychodynamic Profile (KAPP) and compared with the DSM-IV diagnosis and symptom clusters derived from the BPRS., Results: There were no marked differences in personality traits between the three diagnostic groups, between schizophrenia and affective disorders or between psychotic and non-psychotic illness. However, personality traits had significant associations with symptoms, especially with the emotional retardation cluster., Conclusion: Our findings do not support the hypothesis that severe mental disorders would differ from each other in terms of long-standing psychodynamic personality profiles. Certain dysfunctional personality traits may predict especially negative emotional symptoms and possibly also predispose a person to them.

Cryptorchidism is the most frequent congenital anomaly of the urogenital tract in the male. Although in Western countries 1-2% of males at the age of 3 months are diagnosed with this condition, its aetiology is still unknown. Animal models suggest a possible genetic basis for this disorder. Recently, the INSL3 (Leydig insulin-like peptide) gene and its cognate receptor, LGR8, were found to be important in testicular descent by regulating gubernacular development. Male mice null for either INSL3 or LGR8 genes exhibited bilateral cryptorchidism. Because earlier studies indicated that mutation of the INSL3 gene is not associated with the development of human cryptorchidism, this study analysed whether mutations in the LGR8 gene could be associated with this disorder. Sequencing of 18 exons of the LGR8 gene in 23 cryptorchid Finnish patients and a group of 33 control subjects allowed the identification of three nucleotide changes in exons 12 and 17, showing single base substitutions from A to G at positions 957, 993, and 1810 of LGR8. Among the three changes, only the 1810 A to G substitution is associated with an amino acid change from isoleucine to valine (Ile604Val) located in the fifth transmembrane domain of this seven-transmembrane receptor. This change was more frequent in a control group of normal fertile adult males and infant boys than in the group of cryptorchid males. The change is not associated with altered receptor signalling, thus suggesting the presence of a polymorphism unrelated to the cryptorchid phenotype. These data indicate that mutations involving the human LGR8 gene do not represent a frequent cause of cryptorchidism in the Finnish population.

The first postnatal months of life in boys are characterized by activation of the hypothalamic-pituitary-testicular axis that results in the well depicted surge of reproductive hormones. Serum testosterone levels at that time are high, but infants do not display signs of virilization, and subsequently there is only indirect evidence that circulating androgens during the surge are biologically active. We used a recombinant cell bioassay to determine serum androgen bioactivity in 80 3-month-old boys born after full-term pregnancies (37-42 wk) in whom localization of the testes was determined by palpation after birth and at a mean age of 3 months. At that age, serum androgen bioactivity ranged from less than 0.8 to 1.9 nM testosterone equivalents and correlated with serum testosterone concentration (r = 0.71; P < 0.0001; n = 34), free androgen index (r = 0.80; P < 0.0001; n = 34), age (r = -0.29; P < 0.01; n = 80), and localization of the testes (r = -0.24; P < 0.05; n = 80). Moreover, all boys in this study with detectable androgen bioactivity (n = 26) had testes located in scrotal or high scrotal position (n = 64), whereas all boys (n = 16) with at least 1 suprascrotal, inguinal, or nonpalpable testis had nonmeasurable androgen bioactivity in serum (P < 0.01). We conclude that 3-month-old boys are exposed to biological effects of androgens during the postnatal activation of the hypothalamic-pituitary-testicular axis, and that this exposure may be reduced in boys with at least 1 testis located superior to the scrotum.

Infants born to mothers heavily exposed to polychlorinated biphenyls (PCBs) and dibenzofurans (PCDFs) have earlier been reported to have increased prevalences of natal and neonatal teeth. Some tendency toward higher prevalence figures of natal and neonatal teeth can be seen in the literature in normal child populations during the last 40 y. We therefore decided to determine the present prevalence of these teeth in a Finnish population and to evaluate whether infants with natal and neonatal teeth are more exposed to PCBs, PCDFs, and polychlorinated dibenzo-p-dioxins (PCDDs) than infants on average. A total of 34,457 infants born in 1997-2000 in four hospitals in southern Finland were examined for natal and neonatal teeth. The exposure of the infant to PCBs and PCDD/Fs was evaluated by measuring the levels of 17 most toxic PCDD/F and 36 PCB congeners in his or her mother's milk sample when the child was 4-8 wk old. A total of 34 infants had one or two natal (29 infants) or neonatal teeth (five infants). The milk analyses showed that the median level of PCDD/Fs as toxic equivalent (World Health Organization-recommended 2,3,7,8-tetrachlorodibenzo-p-dioxin equivalent quantity for PCDD/Fs in fat) was 11.9 pg/g in fat, and that of PCBs (World Health Organization-recommended 2,3,7,8-tetrachlorodibenzo-p-dioxin equivalent quantity for PCBs) was 7.24 pg/g in fat. These levels corresponded to the prevailing levels. The results showed that the prevalence of natal and neonatal teeth was 1:1000. No association was found between pollutant levels and occurrence of natal and neonatal teeth, indicating that the prevailing levels of PCDD/Fs and PCBs are likely to be below the threshold to cause perinatal eruption of teeth.

A family atmosphere characterized by expressed emotion (EE) is a robust predictor of clinical outcome of patients with schizophrenia and mood disorders. However, there is ongoing discussion as to whether EE is more a cause of clinical outcome or a parental reaction to disorder severity. This cross-sectional study examines a sample of 42 consecutive first-episode patients from a defined geographical area with severe mental disorders (schizophrenia-related disorders, psychotic mood disorders, and non-psychotic mood disorders). Their 42 relatives were interviewed, and the relationships between EE variables derived with the five-minute speech sample method (FMSS) and the patients' demographic, premorbid and clinical measures were analyzed. A high EE score was found in 40% of the relatives. High EE was associated with the interviewed relative's not being a spouse and the patient's being young and unmarried. It was not associated with premorbid characteristics, symptom dimensions or the diagnostic group of the patient. These results do not support the hypothesis that EE is a reaction to the clinical features of the patient. Instead, demographic factors may partly mediate the effect of EE on prognosis.

The aims of the study were to study the suitability of certain urogynecologic ultrasound parameters, e.g. descent of the urethrovesical (UV) junction on Valsalva, posterior urethrovesical (PUV) angle both at rest and on Valsalva, and funneling of the vesical neck, in the pre- and postoperative assessment of stress urinary incontinence (SUI) and to evaluate the efficacy and safety of tension-free vaginal tape (TVT) for the surgical treatment of SUI. Forty-six consecutive women (mean age 61 years) with symptoms of SUI underwent TVT placement. The patients were examined prior to and on average of 11 weeks after the operation with perineal ultrasound. An upright coughing test on standing was performed every time. Operative success rate was 94% in this series. Urogynecologic perineal ultrasound examination seemed strongly to support an anamnestic diagnosis of genuine SUI, and TVT proved to be a safe and effective ambulatory procedure for the surgical treatment of SUI.

Reports based on national registers of congenital malformations have suggested that the birth rate of hypospadias has increased during the last few decades. Register-based information may, however, have pitfalls because of changes in diagnostics, reporting accuracy and registration system. The aim of this study was to determine the current birth rate of hypospadias in Turku University Central Hospital (TUCH) in Finland. This was a prospective study on live-born boys born in TUCH from 1997 to 1999. In the total birth cohort (n=5,798) as well as in a special subcohort group (n=1,505) 0.3% of boys had hypospadias. Only one scrotal hypospadias was found in a boy who had a chromosomal anomaly. Other hypospadias were glandular or coronal. No increase was found in the birth rate of hypospadias when comparing our result with register-based data of boys born in Finland during the years 1970 to 1986 and surgically treated for hypospadias by the age of 8 years. No difference was found either from malformation register-based data concerning the nationwide birth rate of hypospadias during the years 1993 to 1998. Due to differences in national registration systems between countries, prospective studies with equal assessment criteria are needed in order to make reliable international comparisons.

The incidence of impaired testicular descent (cryptorchidism) is high; 1-2% of boys at the age of 3 mo are diagnosed for this condition in western countries. Recent data on mice with targeted disruption of the Insl3/relaxin-like factor (RLF) gene proposed that this factor plays a role in testicular descent in fetal life. Male RLF-/- mice exhibit bilateral cryptorchidism due to developmental abnormalities of the gubernaculum, associated with abnormal spermatogenesis and infertility. In the present study, we have sequenced the promoter region and both exons of the RLF gene in a cohort of 30 boys, seven of whom presented with a possible familial form of cryptorchidism and 23 with sporadic cryptorchidism. One of the nucleotide substitutions detected, G to A at position 178, predicted amino acid change. The mutation was localized to the C-peptide region, resulting in an alanine to threonine change and therefore classified as a conservative mutation. Four of the 30 cases analyzed were homozygous (13%), and 15 were heterozygous for the mutation (50%). However, the same mutation was also found in a control group of 89 men; 10% of them were homozygous, and 39% were heterozygous. Our results indicate that mutations in the RLF gene are not a common reason for cryptorchidism and that the common G178A polymorphism has no apparent relationship with this condition.

Objective: This paper reports a case of obsessive-compulsive disorder (OCD), major depression, and anorexia nervosa in a Down's syndrome patient., Results: Mental retardation and OCD narrowed the patient's available means to control over life. First he became depressed. Perhaps because of insufficient treatment of the depression or in the context of controlling his body and inner life, anorexia nervosa developed., Discussion: His clinical presentation, diagnostics, and successful treatment of psychiatric disorders and anorexia nervosa are presented.

Fifteen consecutive women (mean age 44.5 years) without pelvic relaxation underwent total abdominal (5), vaginal (5) and laparoscopic (5) hysterectomy for benign disease. The vaginal axes of the patients were examined prior to and on average 7 weeks (range 3-10) after the operation with perineal ultrasonography enhanced with an ultrasound contrast medium (SHU454/Echovist-300). Transabdominal and vaginal hysterectomies were performed in the classic manner, i.e. the round as well as cardinal and sacrouterine ligaments were attached to the vaginal vault, followed by peritonealization. In laparoscopic hysterectomy the round, broad and outer parts of the uterosacral and the upper parts of the cardinal ligaments were desiccated by bipolar electrocoagulation and cut with laparoscopic scissors. The vagina was closed by interrupted sutures with no specific fixation of the round, cardinal or uterosacral ligaments. Preoperative ultrasound findings showed that in all women the vagina was an angulated organ. The mean preoperative angle between the upper and lower vaginal portions was 108 degrees, in both the supine and the standing positions. Postoperatively this angulated shape remained almost unchanged after vaginal (mean angle 117 degrees ) and laparoscopic hysterectomy (mean angle 130 degrees ), whereas after transabdominal hysterectomy the vaginal axis rotated anteriorly and became an almost straight tube (mean angle 158 degrees). We conclude that the vaginal axis, at least at an early stage after vaginal and laparoscopic hysterectomy remained in almost the same position as preoperatively, in contrast to that after abdominal hysterectomy. A tight attachment of the round ligaments to the vaginal vault in the abdominal approach could explain the outcome of transabdominal hysterectomy, and should be called into question.

Evisceration is a life-threatening surgical emergency which must be promptly treated. Evisceration following vaginal enterocele operation is so rare that no incidence rate can be established. A review of the literature revealed only 71 cases. The reported women were in general postmenopausal, with only 15% less than 50 years of age. In 18% of cases vaginal rupture occurred while straining at stool. Four patients are known to have died due to evisceration. Of the reported repair operations, 57% were performed transabdominably, 28% transvaginally, and 15% via a combined abdominovaginal route. The authors present 1 more case treated transvaginally, with a review of the literature.

Objective: To study the current in-hospital, 30-day and 42-day mortality after conventional gynaecologic procedures in Finland, with special reference to hysterectomy., Design: Nationwide six-year annual study., Setting: Data were from the Finnish Population Register Centre, the Finnish Cause-of-Death and Hospital Discharge Register, and the Register for Legal Abortions and Sterilisations., Subjects: Gynaecologic operations (n = 299,257) performed between January 1986 and December 1991., Main Outcome Measures: The overall and age-adjusted mortality rates during the initial hospitalisation, as well as 30 and 42 days after the operations. Age-adjusted probability of dying within 42 days after hysterectomy compared with the overall probability of age-matched Finnish female control population., Results: Overall mortality rates per 10,000 hysterectomies increased gradually from 6.0 during initial hospitalisation to 9.1 and 12.9 when calculated 30 and 42 days post-operatively. The overall 42-day mortality rates of radical hysterectomy, curettage and laparoscopy (other than sterilisation) exceeded the post-hysterectomy mortality rate, while the rates after caesarean section, legal abortion and laparoscopic sterilisation did not. No deaths occurred after laparoscopic sterilisation (n = 40,346). The patients who died after radical hysterectomy, curettage and for other laparoscopy than sterilisation were old, and the great majority of them died of cancer., Conclusions: The mortality rates after gynaecologic procedures in Finland are currently very low and have clearly decreased in recent decades. Patients may be reassured that conventional gynaecologic operations are safe.

A vesicocervical fistula is reported. This extremely rare and late sequela of caesarean section, secondary to a lesion in the bladder and unrecognized intraoperatively, was followed with a distressing, long-lasting urinary incontinence unreactive to conservative treatment. Not until 7 years after the primary operation was this lesion diagnosed and treated successfully by vaginal approach. Etiological factors, clinical features and treatment possibilities are discussed.

Thirty women experiencing posthysterectomy prolapse of the vaginal vault were treated with abdominal sacral colpopexy between 1984 and 1991. Lyodura (lyophilized cerebral dura mater allograft transplant) was used as the suspensory material in 81 percent and Gore-Tex (reinforced polytetrafluoroethylene) in 16 percent of the operations. There were no perioperative or postoperative complications. At the follow-up examination (mean, three years), good vaginal vault support was observed in 85 percent of the patients. Significant cystocele were seen in 18 percent, and vault prolapse, enterocele, rectocele and chronic perineal laceration each in 15 percent of the patients. At follow-up study, 22 percent of the patients experienced dyspareunia and 41 percent had decreased sexual interest and coital events. Development of stress urinary incontinence in 18 percent of patients was noted. Concomitant Burch colposuspension will cure and prevent stress incontinence and anterior vaginal relaxation. Abdominal sacral colpopexy appears to be a safe and effective method in the treatment of posthysterectomy prolapse of the vaginal vault. In our experience, it seems that coexistent cystocele and rectocele should be corrected in the connection with sacral colpopexy.

Sixteen patients with urinary tract fistulas (14 vesicovaginal and two ureterovaginal) following simple abdominal hysterectomy were treated over a period of 17 years. Most vesicovaginal fistulas were treated by a transvesical technique, which proved to be a comfortable and successful method in our hands. Closure of the fistula followed usually more than four weeks after diagnosis. Earlier repair, which has been forwarded as an alternative therapy, might give equally good results and would save the patient from the severe hygienic problem of continuous urinary leakage. Conservative treatment with an indwelling urinary catheter led to spontaneous closure of the fistula in one patient. Two ureterovaginal fistulas were corrected by an anti-reflux ureteroneocystostomy.

Objective: To analyze which factors, including gynecological surgery in particular, contribute to the occurrence of pelvic relaxation., Method: A retrospective analysis of 711 consecutive patients treated surgically for pelvic relaxation from 1983 to 1989 at the Department of Obstetrics and Gynecology of Turku University Central Hospital was undertaken., Result: The patients who underwent surgery for recurrent pelvic relaxation were significantly older (66.8 vs. 62.1 years) and suffered significantly less (20% vs. 41%) from urinary stress incontinence than patients undergoing primary surgery for pelvic relaxation. Anterior vaginal segment relaxation (i.e. cysto- and urethrocele) was common in patients undergoing the initial operation (n = 684), and posterior vaginal segment relaxation (i.e. rectocele and perineal laceration) in recurrent operations (n = 58). Of the patients studied, 87 had pelvic relaxation, which had developed after partial (n = 46), total abdominal (n = 16) or vaginal (n = 25) hysterectomy., Conclusion: Care must be taken in the treatment of the posterior vaginal segment during the initial operation for pelvic relaxation in order to avoid late sequelae. Moreover, when the removal of the uterus is planned, the matter of a stable vaginal vault must be taken into account especially when partial hysterectomy should be performed.

In a series of 163 ears with chronic, mucoid effusion, free or immune complex bound pneumococcal capsular polysaccharide antigens were demonstrated with Omniserum and counterimmunoelectrophoresis (CIEP) in 37 ears (23%). In crushed adenoid tissue this figure was 39% (42/107). Using type- or group-specific sera pneumococcus type 6 was found to be most frequent (56%) followed by type 19 (17%). A similar trend was also seen in adenoid suspensions. The results suggest that development of secretory otitis media is much more linked with the pneumococcal serotypes than has been thought hitherto, and that type 6 occurs significantly more often bound in immune complexes than any other subtype.

This study focused on the development of and changes in the interaction within a family after the onset of schizophrenia in a family member. Special attention is given to the possible effects of various treatments on the interaction. Our method was a circular interview of all family members in a joint session 8 years after the onset of schizophrenia. We observed that changes in family interaction usually had taken place during the first year of the illness. Thereafter, family conditions and interactions seem to have remained relatively unchanged. On the other hand, in addition to actual family-centered therapy, all other treatment modes--individual therapy, medication, hospitalization--seemed to have acted as systemic interventions on the family level. Our observation that family interactions and models of therapy often had a surprisingly strong resemblance led us to consider the idea of their coevolution over the years and the possible significance of this. This article aims at calling the reader's attention to the manifold influences that the onset of schizophrenia and its various treatments seem to have had on family system.

In 92 healthy persons with the common cold, 184 ears were examined and 786 coincidental sonotubometric and tympanometric measurements were taken. There was a good tubal function when the middle-ear pressure was 0 to -25 mm H2O, with 91% of the tubes opening during swallowing. A systematically reduced tubal opening was noted as the middle ear pressure decreased from 0 to -200 mm H2O. The present study discloses that a negative middle-ear pressure evaluated by tympanometry does not always denote a closed tube, nor does a flat tympanogram necessarily indicate a middle-ear effusion. No definite limits could be ascertained for the normal middle-ear pressure; the middle ear is extremely dynamic, and middle-ear pressure can change for many reasons.

Eustachian tube function was determined in 84 children (131 ears) with secretory otitis media (SOM) by means of sonotubometry. Determinations were made prior to myringotomy and insertion of ventilation tubes in conjunction with follow-up testing during the course of SOM. Despite the SOM, 14% of the ears showed normal sound passage through the tube before surgery, and towards the completion of this study tubal function was considered to be normal in 50% of the ears. Although sonotubometry gave a more reliable picture of tubal function in children with SOM, no difference in tubal function could be found among children of various age groups. Because of the large fluctuations in tubal function during the course of SOM, the ventilation tube should not be removed even in cases of apparently normal tubal function at the time of examination.

Aeration of the tympanic cavity was studied after 81 operations were performed on ears with cholesteatoma, in which sonometry was used preoperatively to measure the eustachian tube (ET) function. Twenty-nine of the 44 ears in which all or part of the tympanic mucosa could be preserved had positive sonometric test results, and 25 ears (86%) retained satisfactory aeration. Eight (53%) of the 15 ears with negative test results showed good postoperative aeration while adhesive changes developed in seven ears (47%). In 37 ears after the removal of all tympanic mucosa, aeration was satisfactory in eight (55%) of the 15 ears with positive sonometric test results, whereas only three (14%) of the 22 ears with negative test results developed an aerated tympanum. A positive sonometric test result can be regarded as a fair prognostic indicator of normal ET function. In extensive tympanic disease, there is a clear correlation (86%) between a negative test result and postoperative adhesion.

Thirteen patients (16 ears) with patulous eustachian tubes were treated with pterygoid hamulotomy combined with transposition (eight ears) or transection (eight ears) of the tendon of the tensor veli palatini muscle. Tubal function was tested preoperatively and postoperatively by sonotubometry. Prior to surgery, only one ear showed normal tubal function on swallowing at the time of the test. The follow-up period ranged from two months to five years. Nine ears yielded normal sonotubometric results during the average follow-up time of two years, while two tubes opened on swallowing, remained open for some time, and closed little by little. The remaining five tubes stayed continuously open as before surgery, and tubal symptoms were unaltered. Transection operation had been performed on two of these ears and transposition on three. The transposition or transection procedure can be used as a routine procedure for correction of patulous tubes. Good results can be expected in about 70% of cases.

Opinion differ whether simple myringoplasty should be combined with mastoidectomy, which is claimed to provide a large air reservoir for the middle ear. Data are reported on 61 ears, 55 of which had reasonably normal tympanic mucosa but distinct chronic mastoid or epitympanic ear disease. Obliteration of the cavity was performed, combined with tympanoplasty, and the patients were followed up for an average of three years. Normal aeration of the middle ear was seen in all cases with normal middle ear mucosa regardless of whether the posterior canal wall was saved or reconstructed in connection with obliteration. It is concluded that there is no reason for mastoidectomies in small mastoid cell systems in simple myringoplasties.

The sound conduction method for measurement of the Eustachian tube opening has been studied and modifications made in the test procedure to increase its easy performance and reliability. By holding the sound source near to the nostril, mounting the microphone into a circumaural ear defender and by feeding the output of the microphone through a filter with a very narrow bandwidth (3.16 Hz) many of the pitfalls of the sound conduction technique described earlier could be removed. Recording of the transfer function between the nasal tip and external auditory meatus and recording of the spectrum of swallowing sound revealed that the useful frequency rang for the measurements was upwards from 5--6 kHz. By using the three frequencies 6, 7 and 8 kHz the method showed tubal opening in 90 or 95% of normal ears depending on whether the minimum amplitude accetped was greater than or equal to 5 or 1--4 dB, respectively.

During the period from 1974 to 1981, surgery for acute mastoiditis was performed on 12 ears, giving an annual incidence of 0.004 per cent among cases of acute otitis media. All ears made a full long-term recovery. The low incidence is ascribed to the world-wide early use of antibiotics. During the same period 52 ears with secretory otitis media (SOM) underwent mastoidectomy. Histologically extensive mastoid inflammation was found in 96 per cent. The changes appeared as formation of secretory cells and cysts, resorption of bone, and infiltration of soft tissues with both mononuclear cells and polymorphonuclear leucocytes. The number of SOM patients undergoing mastoid operations account for 1.4 per cent of the patients admitted to hospital because of SOM. Thirty-four ears (65 per cent) have healed during the follow-up period (mean 2.9 years), while the tympanostomy tube is still in place in 18 ears (35 per cent). In the latter group, factors causing oedema in the pharyngeal end of the Eustachian tube are apparently still present.