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Biomedical subjects

C Lundstedt

Publications and source records attributed to C Lundstedt.

At least 37 records · Page 2Linked to original sources
PubMed1996

Imaging of tuberculosis--experience from 503 patients. I. Tuberculosis of the chest.

PURPOSE: To give an overview of 503 patients with tuberculosis (TB) and to describe the radiologic findings of chest TB. MATERIAL AND METHODS: A total of 503 patients with proven TB were reviewed; 266 had chest involvement. RESULTS: Lung lesions were demonstrated in 214 patients. Infiltrates in the basal parts of the lungs or pleural effusion were often primarily mistaken for viral or bacterial infections. Consolidations within the lungs and pleural thickening were sometimes indistinguishable from malignancy. Positive culture of the sputum without lung lesions was encountered in 12 cases. Enlarged mediastinal lymph nodes were demonstrated in 67 cases, 35 without lesions in the lungs. The lymphadenopathy could be extensive, and both clinically and radiologically indistinguishable from lymphoma. CONCLUSION: Due to the present increase in incidence of TB and the fact that TB can mimic many other conditions, it is important that both clinicians and radiologists have TB high on the list for differential diagnoses.

Adolescent↗
PubMed1996

Imaging of tuberculosis. II. Abdominal manifestations in 112 patients.

PURPOSE: To describe the radiological findings of tuberculosis (TB) of the abdomen as reflected at our hospital. MATERIAL AND METHODS: The radiological files of 503 patients (referred to our institution mainly because of a clinical suspicion of malignancy, and found to have culture- or biopsy-proven TB) were reviewed in order to analyze the spectrum of the TB manifestations in this group of patients. RESULTS: Abdominal manifestations were found in 112 patients, in 1/3 abdominal disease was the only evidence of TB. More than half of the patients also had chest TB. The most common abdominal TB manifestations were peritonitis and lymph node enlargement, each occurring in about 1/3 of the patients. Also 1/3 had genitourinary TB manifestations. About 1/5 had TB of the liver, spleen or pancreas or in the gastrointestinal tract, respectively. Multiple organ involvement was common. CONCLUSION: The need to consider TB in the differential diagnosis in patients with obscure abdominal symptoms, especially with multiple organ involvement, is stressed.

Adolescent↗
PubMed1996

Imaging of tuberculosis. III. Tuberculosis as a mimicker of brain tumour.

PURPOSE: To show that intracranial tuberculosis (TB) often masquerades as brain tumour. MATERIAL AND METHODS: Forty-six patients with intracranial TB, who after CT at the local hospital were referred for surgery or radiotherapy of brain tumour, are presented. Sometimes the correct diagnosis was first established during surgery for brain tumour. RESULTS: The differentiation between TB and gliomas, meningiomas, metastases, or lymphomas may be impossible from the clinical history and CT findings. Angiography, done in 25 of our cases, often helped by not showing the expected tumour vasculature. MR, performed in 9 patients, helped by demonstrating a layered capsule on T2-weighted images in 4 of the lesions (hypointense rim outside hyperintense rim); the centres of the lesions were of decreased, usually very mixed T2 signal intensity. CONCLUSION: Even in patients with findings typical of brain tumour, TB remains an important differential diagnosis.

Adolescent↗
PubMed1996

Imaging of tuberculosis. IV. Spinal manifestations in 63 patients.

PURPOSE: To describe the radiologic findings in patients with spinal tuberculosis (TB). MATERIAL AND METHODS: Out of a total of 503 patients with TB, 63 (13%) had involvement of the spine. RESULTS: In 40 patients, the spine was the only location; 20 patients had concomitant chest TB. Conventional radiographs gave a good overview, CT visualized the disko-vertebral lesions and the paravertebral abscesses, while MR imaging was useful to determine the spread of disease to the soft tissues and the spinal canal. The typical findings were destroyed vertebrae with associated paraspinal soft-tissue mass, with or without abscess formation, sometimes also involving the epidural space together with adjoining disk lesion and focal gibbus formation. Involvement of a single vertebra was a relatively common finding. Large psoas abscesses could occur without any signs of bone involvement. The TB process could sometimes be indistinguishable from malignant processes, and in 3 patients, with multiple lesions in the spine, it mimicked metastatic disease. CONCLUSION: It is stressed that TB should always be considered in the differential diagnosis when radiologic findings suggest spinal infections or primary or secondary spinal tumors.

Adult↗
PubMed1996

Imaging of tuberculosis. V. Peripheral osteoarticular and soft-tissue tuberculosis.

PURPOSE: To assess frequency, location, and appearance of peripheral osteoarticular and soft-tissue tuberculosis (TB). MATERIAL AND METHODS: Twenty-five of 503 patients with TB had peripheral osteoarticular TB and 5 had soft-tissue TB. Chest radiography, CT, and MR imaging were applied. RESULTS: The location of the osteoarticular lesion was articular/epiphyseal in 14 patients, articular/metaphyseal in 3, and metaphyseal without joint involvement in 3. Involvement of flat bone was found in 4 patients (5 lesions). The morphologic appearance was similar to that of a lytic tumour in 9 patients (10 lesions) and that of a destructive joint lesion in 16 patients. The soft-tissue TB in all 5 patients presented as an abscess. Twelve patients had a total of 20 additional sites of involvement: chest in 9, abdomen in 4, spine in 4, the neck in 3, and the central nervous system in one patient. CONCLUSION: On the basis of radiologic appearance, it can be difficult to differentiate peripheral osteoarticular and soft-tissue TB from other degenerative, inflammatory, or neoplastic disorders, and the importance of a high awareness is stressed in order to reach an early diagnosis.

Adolescent↗
PubMed1996

Implantation metastases from gastrointestinal cancer after percutaneous puncture or biliary drainage.

OBJECTIVE: Evaluation of incidence and outcome of implantation metastases after percutaneous fine-needle biopsy or biliary drainage. DESIGN: Retrospective study. SETTING: University hospital, Sweden. SUBJECTS: Eight patients with implantation metastases from gastrointestinal cancers after percutaneous fine-needle biopsy (n = 7) or biliary drainage (n = 1). MAIN OUTCOME MEASURES: Incidence of implantation metastases, treatment and influence on outcome and survival. RESULTS: In two out of three patients who had had otherwise radical operations, the implantation metastases meant that the operations were palliative rather than curative. Patients who had had palliative resections of the implantation metastases developed major local complications. One patient is alive with no signs of disease after 106 months, while one is alive with disease 30 months after the diagnosis of the implantation metastases. The remaining patients have died after 6 to 23 months. CONCLUSION: The incidence of implantation metastases after fine-needle procedures is probably underestimated. There is a slight but definite risk that the procedure may render an otherwise curative resection palliative. Implantation metastases cause local complaints of varying severity and seems to have a tendency to recur locally. We recommend that fine-needle biopsy should be restricted to patients who will truly benefit from a more accurate preoperative diagnosis.

Adult↗
PubMed1995

Intravascular ultrasound of the portal vein--normal anatomy.

The purpose of this study was to evaluate the appearance of the normal portal vein with intravascular ultrasound. The portal vein was studied in 10 patients with colorectal carcinoma without known liver or pancreatic disease. For the intravascular portovenous examination, a 2.0-mm, 20-MHz ultrasound catheter was used. The field of view was 30 mm. The wall of the portal vein appeared as a single hyperechoic layer 0.5 to 0.8 mm in thickness. Normal structures adjacent to the portal vein, such as the common bile duct, the hepatic artery or small lymph nodes, were clearly separated from the lumen of the portal vein by the wall of the vein together with some periportal fat. In most cases the parenchyma of the pancreas could be separated from the wall of the vein.

Adult↗
PubMed1993

Focal periportal liver steatosis.

Focal steatosis of the liver may have various appearances on ultrasonography (US) and computed tomography (CT). An unusual case with a macroscopically periportal location is presented and the etiology and differential diagnosis of the condition is discussed.

Adult↗
PubMed1993

Detection of hepatic metastases in colorectal cancer: a prospective study of laboratory and imaging methods.

OBJECTIVE: To assess and compare the accuracy of imaging methods (ultrasonography (US), computed tomography (CT), angiography, arterially enhanced CT with computed tomographic arterial portography (CTA)), biochemical analyses, and surgical assessment during the operation, in detecting the presence of absence of hepatic metastases in patients with colorectal cancer. DESIGN: Open study. SETTING: University of Lund, Sweden. SUBJECTS: 71 consecutive patients without clinical evidence of liver metastases at the time of the operation for removal of the primary tumour. INTERVENTIONS: Regular biochemical tests for five to seven years, and CT and US one year after operation in all patients without confirmed metastases. MAIN OUTCOME MEASURES: Presence or absence of hepatic metastases. RESULTS: Accuracy of surgical assessment, angiography, US, CT and CTA was 90, 77, 80, 82 and 83%, respectively, and corresponding predictive values of a negative test were 87, 75, 77, 80 and 84%. Measurement of bilirubin concentration and hepatic enzyme activities were not helpful, and that of carcinoembryonic antigen had an accuracy of only 70%. Accuracy and predictive values were not improved by combining tests. CONCLUSION: The accuracy of US, CT or CTA was not good enough to merit routine use before operations for colorectal cancer. They are potentially valuable for monitoring progress at follow up, but this remains to be confirmed.

Adult↗
PubMed1993

Accuracy of CT arterial portography of the liver compared with findings at laparotomy.

To evaluate the accuracy of CT arterial portography (CTAP) of the liver, CTAP examinations from 111 patients were retrospectively reviewed and compared with the findings at laparotomy. Laparotomy had been performed within 3 weeks after the CTAP examination. In cases of resectable liver tumor, the result from the pathologic examination report was used to calculate the accuracy of CTAP. In cases of nonresectable liver tumor or liver without tumor, CTAP findings were compared with the result of a thorough inspection and palpation of the liver. The right liver lobe and the medial and lateral segments of the left lobe were separately evaluated. Thus, a total of 333 lobes/segments were evaluated. Tumor was found at laparotomy in 80 of 333 lobes or segments. At CTAP a total of 94 lobes were evaluated as positive for tumor growth, 23 of these were falsely interpreted as positive and 9 were falsely interpreted as negative when compared with the findings at laparotomy. However, 3 patients called false-positives later turned out to be true-positives since the lesions were overlooked at operation. A sensitivity of 89%, a specificity of 91%, and an accuracy of 90% was calculated for CTAP. It is concluded that CTAP has a higher accuracy than other radiologic methods and should be considered suitable for preoperative evaluation of potentially resectable liver tumor.

Adult↗
PubMed1993

Sclerotherapy of edematous gallbladders with different agents. An experimental study in pigs.

Different sclerosing agents were tried in experiments with 32 pigs to achieve ablation of gallbladders rendered edematous by mechanical lithotripsy with the Rotolith lithotriptor. In 16 pigs sclerotherapy was performed with 6% acetic acid, Carnoy's solution, 95% ethanol + 3% sodium-tetradecylsulfate (STS) and hot metrizoate, respectively. These animals were sacrificed immediately after the procedure. Histologic examination showed persistent surface epithelium and glandular epithelium in all specimens. In 6 pigs, the sclerotherapy was done with Carnoy's solution, 95% ethanol + 3% STS and hot metrizoate, respectively, and the pigs were killed 6 days later. Fibrosis of the gallbladder remnants was seen in these animals, but also remnants of surface and glandular epithelium. Hot metrizoate was used in another 10 pigs and these animals were sacrificed after 8 weeks. At histologic examination fibrosis was seen in the gallbladder remnants of 9 surviving animals, but also areas of preserved muscular layer, and development of mucinous cysts were found in more than 50% of the specimens. Thus, none of the sclerosants was able to produce a total ablation of the gallbladder mucosa.

Animals↗
PubMed1993

Percutaneous rotational lithotripsy of urinary bladder stones. Clinical results with the Rotolith lithotriptor.

Mechanical rotational lithotripsy of urinary bladder stones, up to 20 mm in diameter, was performed in 6 male patients with the Rotolith lithotriptor. The lithotriptor was introduced through a 10 F (OD 3.3 mm) suprapubically inserted sheath, and the procedure was performed under intermittent fluoroscopy and inspection through a transurethral cystoscope. In 3 patients, the bladder stones were fragmented to pieces small enough to be evacuated through the cystoscope. The instrument, which is designed for lithotripsy of gallbladder stones, was less efficient for fragmentation of urinary bladder calculi, primarily due to the large volume of the human urinary bladder, and possibly because of the higher gravity of bladder stones. There was no substantial damage to the mucosa of the urinary bladder.

Aged↗
PubMed1993

Percutaneous rotational lithotripsy of gallbladder stones. Clinical results with the Rotolith lithotriptor.

Ten patients (aged 39-94 years) with cholecystolithiasis were selected for percutaneous rotational lithotripsy with the Rotolith lithotriptor either because they were considered high-risk patients for cholecystectomy or because they had refused surgery. The procedure was completed in 7 patients. Five of these were stone-free at cholangiography 1 to 2 days after lithotripsy. Conclusive cholangiograms were not obtained in 2 patients due to gallbladder leakage, which in itself did not cause any serious sequelae. At ultrasonography after one month, one of these 2 patients had no visible gallbladder, the other one had small residual gallbladder stones. Rotational lithotripsy is an alternative to cholecystectomy in patients at high surgical risk, especially elderly patients who have undergone cholecystostomy as an emergency treatment for acute cholecystitis.

Adult↗
PubMed1992

Peritoneal ovarian metastases simulating liver parenchymal metastases.

Ovarian carcinoma frequently metastasizes to the peritoneum, both locally in the pelvis and elsewhere. Computed tomography (CT) has a limited ability to identify peritoneal implants with a diameter of 2 cm or less. Three cases of subphrenic, diaphragmatic peritoneal implants, preoperatively at CT thought to represent liver parenchymal metastases, are presented. The difficulty in the differentiation of diaphragmatic peritoneal implants from metastases to the capsule and parenchyma of the liver is discussed. To achieve a radical liver resection in patients with ovarian carcinoma, metastatic peritoneal implants must be excluded during operation.

Adult↗