Pekka Peltokallio

Cardiovascular studies on former endurance athletes

Abstract 1. 1. Sixty-one former champion endurance runners or cross-country skiers, 40 to 79 years of age, were submitted to a thorough evaluation of the cardiovascular system. In addition, the study program included a series of anthropometric measurements and a number of laboratory tests. A control group of 54 nonathletes of the same age was submitted to similar studies. The control group consisted of men in sedentary or semisedentary occupations. 2. 2. The former athletes differed from the controls by being shorter, having a smaller sitting height and a smaller body weight, but a larger wrist breadth. There was no difference in ponderal index, knee breadth, biacromial breadth, bicristal breadth, or in the ratio of the two latter measures. 3. 3. Both the mean systolic and diastolic blood pressures of the athletes ( 137 87 mm. Hg ) were significantly lower than those of the controls ( 147 92 mm. Hg ). 4. 4. There was no difference in the serum cholesterol level or in the hemoglobin concentration of the blood between the two groups. 5. 5. Coronary heart disease was diagnosed in 17 of the 54 controls and in 15 of the 61 athletes. Eight control subjects, but only 2 athletes, had had symptoms of coronary disease. 6. 6. The current physical activity was greater in the athletes than in the controls. 7. 7. There were fewer nonsmokers and more heavy smokers, as well as exsmokers, in the control group than in the group of athletes. 8. 8. Among men aged from 40 to 69, the electrocardiogram, by Minnesota Code, showed in 5 of 49 controls and in 1 of 55 athletes Q or QS patterns indicative of old myocardial infarction (I1–3); S-T segment depression at rest (IV1–3), or after submaximal exercise (XI1–3) in 12 of 49 controls and in 8 of 55 athletes; flat or negative T waves at rest or after exercise (v1–3, XII1–3) in 6 of 49 controls and in 4 of 55 athletes. High amplitude R waves (III1) occurred in 6 of 49 controls and in 8 of 55 athletes aged from 40 to 69. In the athletes, high R waves were associated with high level of physical activity (6 of 8) rather than with hypertension (1 of 8); in the controls the association was intimate with hypertension (5 of 6) and loose with physical activity (1 of 6). 9. 9. Twenty-nine of the controls and 38 of the athletes were considered as “healthy” subgroups. The subscapular skinfold of healthy athletes was thinner than that of the controls, whereas there was no significant difference in the upper arm skinfold thickness. As regards the other anthropometric measurements, the comparison of healthy subgroups did not show any essential differences from those revealed by the comparison of the total groups. The systolic blood pressure was lower in healthy athletes than in the controls. 10. 10. Healthy athletes had a larger maximal QRS vector, a larger roentgenologic heart volume, a lower heart rate during exercise, and consequently a higher calculated maximal oxygen uptake, than the controls. 11. 11. The maximal QRS vector showed a statistically significant positive correlation with heart volume in healthy controls but not in healthy athletes. The lack of correlation between these two parameters is considered to suggest that dilatation rather than hypertrophy is the main determinant of the increased heart volume induced by training. 12. 12. The prevalence of electrocardiographic abnormalities in former champion endurance athletes is compared with that observed in other series. “Ischemic” changes occur with the same frequency in former athletes and the general population. However, severe manifestations and subjective symptoms of coronary heart disease may be rarer among athletes.

Relationship of familial factors to carcinoma of the colon

SummaryTwo siblings, in each of two families, contracted carcinoma of the colon when they were less than 30 years of age. In view of the fact that, anually, in Finland, only five or six persons contract carcinoma of the colon when they are less than 30 years old, the incidence cannot be considered a mere coincidence. Also, a family susceptible to carcinoma of the colon has been described in this report, in which all children of a mother who died of cancer of the colon when she was 42 years old contracted carcinoma. Furthermore, a member of the third generation contracted the disease at an age which was less than 30 years and the oldest member of the family was only 31 years.Based on evidence obtained from their study of cases reviewed in this report, the authors assume that evidence has been established to prove that hereditary factors contribute to the origin of carcinoma of the colon. This view is supported by reports, in medical literature, of families with a marked predisposition to carcinoma of the colon. Finally, it is interesting to observe that despite probable hereditary influence and the youth of many patients, a number appear to be capable of recovering when suitable measures are employed to eradicate the disease.

Acute appendicitis associated with carcinoma of the colon

SummaryCarcinoma of the colon, besides causing acute appendicitis, may cause symptoms resembling appendicitis. A diagnosis of appendicitis was made when carcinomatous symptoms were already present in 44 (7%) of the 603 patients with colonic carcinoma comprising this study. In 12 patients, the appendix was distinctly involved by inflammation. However, in the other patients, the symptoms of carcinoma only resembled those of appendicitis. We must remember that carcinoma of the right colon was responsible for definite appendicitis and symptoms of appendicitis. The diagnosis of appendicitis was established by symptoms, before detection of the carcinoma, in 17 per cent of patients with carcinoma of the cecum and in 14 per cent of those with carcinoma of the ascending colon. Carcinoma often escapes detection during appendectomy and leads to delays that can be serious. A correct diagnosis could be made in the majority of cases by exploring the cecum and ascending colon. Therefore, it is advisable to utilize a large incision when performing an appendectomy. To make added provision against mistakes, roentgenologic examination should be performed on patients of carcinoma age who complain of symptoms of appendicitis.

Intestinal and peritoneal tuberculosis: Report of two cases

One hundred and seven cases of abdominal tuberculosis were analyzed. There were no specific laboratory or x-ray findings pathognomonic of abdominal tuberculosis. Leukopenia was often found, but was nonspecific. An abdominal tumor was often palpable. A great rarity in our series was profuse hemorrhage from a jejunal tuberculous ulcer; the patient had to be subjected to an emergency operation. In another case tuberculosis appeared in a side-to-side small intestinal anastomosis and in its blind ends, which had developed as a late complication. The diagnosis of abdominal tuberculosis must be confirmed by histologic examination of biopsy specimens; if the results are inconclusive, acid-fast bacilli must be seen or culture should be positive. Guinea-pig inoculation is rarely positive, probably owing to the low virulence of the tuberculous bacteria in abdominal tuberculosis. Good results are obtained with chemotherapy in both intestinal and peritoneal tuberculosis. The complications, obstruction being most usual, must be surgically treated. Resection of the affected segment is the best surgical procedure. For ileocecal tuberculosis, right hemicolectomy was performed. According to the authors, roentgenographic evidence of tuberculosis in the abdomen must always be confirmed by operation, because differentiation from carcinoma and other inflammatory lesions is impossible. For good results after operation, anti-tuberculosis chemotherapy is mandatory.

Left paraduodenal hernia

Abstract A case is presented of left paraduodenal hernia with unusual anatomic features. The mechanism of origin is briefly discussed, and the importance of familiarity of the abdominal surgeon with the basic anatomic features of internal hernia is stressed.

Carcinoma of the rectum and colon in children

Case 1: A girl, 14 years old, had a family history that was negative for carcinoma or precancerous disease of the colon. For four months, the patient had experienced episodes of lower abdominal pain which radiated to the back. Her general condition had deteriorated visibly during this time and occasionally her temperature had risen to 100.4 F. In June 1959, she was admitted to the communal hospitai, from which she was referred to the Childrens Hospital, University of Helsinki. A soft mass was palpated in the lower abdomen; it was thought to be a periappendicu!ar abscess. The sedimentatiop. rate was 40 ram/hour and the hemogiobi~z was t0.6 gm per cent. The differential leukocyte count was normal and a sterile urine specimen was negative. There was no occult blood in the stools.

Tuberculous Hepatitis with Jaundice in Pregnancy

Jaundice is rare in connection with tuberculous hepatitis. Four cases were reported by C l e v e et al., 1954. C u r r y and A l c o t t (1955) reported 2 cases of their own and were able to find 30 cases in the literature. Of these, 26 had been diagnosed at autopsy, 3 a t operative laparotomy, and one by percutaneous liver biopsy. In miliary tuberculosis tubercles are usually found in the liver (F inckh et al., 1953). According to O l d e r h a u s e n et al. (19553, this occurs in 74 per cent. S t ii r p e r (1954) found in the literature covering a period of more than a hundred years 364 cases of miliary tuberculosis in pregnancy. Isolated cases have been reported by e.g. T u r n e r (1953)~ and M i o t t i (1958). M e h t a’s (1961) series of 53 pregnant women with active tuberculosis included z with miliary tuberculosis. Our own patient had miliary tuberculous hepatitis and jaundice, and the situation was complicated further by the patient’s pregnancy. We have not been able to find a corresponding case in the literature.

Leiomyoma of the ischioanal region

SummaryA case of a patient with benign leiomyoma, adherent to the musculature of the anal canal, is reported. If this can be considered a tumor of the anal canal, it is believed to be the third case reported in English medical literature. Perianal leiomyomas grow away from the lumen of the rectum and musculature of the anal canal and cause few, if any, intestinal symptoms. The tumor can be removed easily by local excision and no recurrences have been reported. Nevertheless, we believe that careful follow-up procedures should be adopted to determine if malignant degeneration develops.Medical literature on leiomyomas is reviewed briefly.