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Biomedical subjects

C Lundstedt

Publications and source records attributed to C Lundstedt.

At least 55 records · Page 3Linked to original sources
PubMed1992

Large vein sampling for intact parathyroid hormone in preoperative localization of enlarged parathyroid glands.

Unilateral neck exploration for primary hyperparathyroidism (pHPT) of old and high risk patients can be safely performed under local anesthesia, provided there is a correct preoperative side localization of the enlarged parathyroid gland. We performed large vein sampling and measured intact parathyroid hormones (PTH) with a new, highly sensitive immunoradiometric assay. The method was used before operation in 20 patients with pHPT. A unilateral positive gradient of serum PTH levels was obtained in 15 patients. At surgery, 13 of these (87%) proved to be correct, i.e., the adenoma was localized on the same side. Thus, the technique correctly lateralized the parathyroid adenoma in 65% of the patients. We conclude that large vein sampling with measurement of intact PTH is a potentially useful investigation for preoperative side localization of parathyroid adenomas in pHPT patients scheduled for unilateral surgery under local anesthesia. However, prior to routine bilateral neck exploration large vein sampling is not justified.

Aged↗
PubMed1992

Lithotripsy of urinary bladder stones with a mechanical lithotriptor inserted through a narrow introducer. An experimental study in pigs.

Mechanical lithotripsy of urinary bladder stones was performed with the RotoLith lithotriptor in 8 pigs with implanted human stones or artificial stones after open cystotomy. The effect of the treatment on the urinary bladder was investigated macro- and microscopically immediately after the lithotripsy in 4 animals and 4 weeks after the lithotripsy in the other 4 animals. The stones were fragmented into very small pieces which would have been possible to pass with the urine. The histopathologic examination immediately after the procedure showed slight mucosal edema, patches of erosions in the mucosa, and minor submucosal bleeding. Microscopic examination of the bladders removed 4 weeks after lithotripsy showed slight chronic inflammation. The experimental results have encouraged us to plan to use this lithotripsy procedure in selected patients with bladder stones.

Animals↗
PubMed1991

Tumor seeding occurring after fine-needle biopsy of abdominal malignancies.

Percutaneous fine-needle aspiration biopsy is a commonly used diagnostic procedure with a high accuracy and a low complication rate. However, tumor seeding in the biopsy tracts has been recorded with a frequency of one in 20,000-40,000 biopsies. We report 5 cases of percutaneous tumor seeding recorded after 5,000 fine-needle biopsies of abdominal malignancies at our institution. The risk of implantation metastases induced by fine-needle biopsy warrants consideration in patients with abdominal malignancies since it may compromise the outcome of radical surgery. It should only be performed when the result of the procedure has a direct impact on the choice of therapy.

Abdominal Neoplasms↗
PubMed1991

Sclerotherapy for ablation of the gallbladder after gallstone lithotripsy with a mechanical lithotriptor. An experimental study in pigs on the effect of absolute ethanol on edematous gallbladder wall.

Chemical ablation of the gallbladder with absolute ethanol following mechanical lithotripsy with the RotoLith lithotriptor was attempted in 10 pigs after open cholecystostomy. Two gallbladders removed immediately after the sclerotherapy demonstrated extensive ulcerations of the mucosa with preserved glands and sinuses under the ulcerations. In 8 gallbladders removed 8 weeks after sclerotherapy a gallbladder remnant with hydrops and/or mucus and more or less intact epithelium was seen in all the pigs. In order to prevent regeneration of epithelium from gallbladder sinuses and glands, more effective sclerosing agents must be found.

Animals↗
PubMed1991

CT of liver steatosis after subtotal pancreatectomy.

The liver attenuation of 50 patients operated with a subtotal pancreatectomy for pancreatic and duodenal tumors was evaluated with CT. Of 18 patients surviving more than 18 months after surgery, 7 developed a markedly reduced liver attenuation indicating liver steatosis. No patient became diabetic or showed evidence of malnutrition after surgery. No correlation between the liver attenuation values and the patients' liver function tests was noted. The steatosis was reversible in 4 of the 7 patients. The pathophysiological cause of the steatosis remains unknown. Partial pancreatectomy should be included among the reasons listed for liver steatosis.

Aged↗
PubMed1990

Repeated dearterialization of hepatic tumors with an implantable occluder.

A new implantable device for repeated hepatic dearterialization was evaluated in 13 patients with tumors of the liver. Eleven patients had colorectal secondaries and also received cyclic intraperitoneal infusion of 5-fluorouracil. Two patients had primary hepatocellular cancer (HCC). Four patients had a variant arterial supply. The hepatic artery was occluded repeatedly for 1 hour twice daily for 1 to 17 months (mean, 8.5 months). A complete transient occlusion was obtained in all but three patients, in whom minor collaterals were missed at the initial operation. Collaterals developed in two patients during therapy. Leakage from the balloon occurred in two patients after 5 and 12 months. Two patients developed thrombosis of the hepatic artery during therapy due to the cuff being placed too tightly around the vessel. A complete remission was demonstrated in one patient with HCC, a partial response in three patients (one HCC and two metastatic), stable disease in two patients, and progression in five patients. Median survival for colorectal lesions was 15 months (range, 2 to 23 months) from start of the occlusions. Four of nine patients developed calcifications of their lesions during therapy. One patient with HCC was alive and free of disease 18 months after the start of the occlusions. Both patients with HCC had an obstructed portal vein which may have contributed to the favorable outcome. The occluder was uniformly accepted by the patients who were able to do their occlusions at home.

Adult↗
PubMed1990

The accuracy of computed tomography of the liver in colo-rectal carcinoma.

A prospective study in 71 patients with colo-rectal carcinoma was undertaken to evaluate the accuracy of computed tomography (CT) of the liver and arterially enhanced liver CT (CTA). The results were initially based on the findings at surgery. The accuracy of CT was 82% and CTA 84%. Since the evaluation of the liver at surgery is not always correct, a clinical follow-up and repeat CT in the same group of patients was performed. The intention was to search for occult metastatic disease of the liver and thus more accurately evaluate the results of CT, CTA and the surgical evaluation at laparotomy. Both the presence or absence of tumour, as well as the distribution of tumour growth in the liver were considered. In comparison with the results of the follow-up, CT detected the presence and correctly described the tumour distribution in 86%, CTA in 87%, and the surgeon in 88% of the cases, respectively. CTA is recommended if the CT scan is negative or if a more detailed evaluation is required prior to liver resection.

Aged↗
PubMed1990

Ultrasonography and Doppler Duplex compared with angiography in follow-up of mesocaval shunt patency.

Thirty-four patients with portal hypertension of various etiologies were operated upon with an interposition mesocaval Goretex graft. During a period of 6 years 84 angiographic and ultrasonographic (US) examinations (53 B-mode, and 31 Doppler Duplex) were performed, with few exceptions within 3 days. Angiography served as the 'gold standard'. Shunt patency was correctly interpreted as normal in B-mode US in 38 examinations. Shunt occlusion, definite or probable, was seen in 12 B-mode examinations, where angiography demonstrated occlusion in 6 and patency in the remaining 6 shunts. Shunt occlusion was not observed sonographically in one examination. US was technically inadequate on two occasions. Doppler Duplex showed shunt patency in all 31 examinations, which was correct according to angiography. Both B-mode US, in 6 out of 6 examinations, and Doppler Duplex, in 7 out of 9 examinations failed to reveal shunt stenosis. Five patients with abundant venous collaterals (in one case with aberrant vascular anatomy) were not possible to evaluate even after the introduction of Doppler Duplex, which otherwise facilitated the evaluation. We suggest that US including Doppler should be the primary modality for follow-up in patients with interposition mesocaval Goretex grafts.

Adolescent↗
PubMed1987

The value of preoperative imaging techniques in patients with chronic pancreatic pleural effusions.

Four patients with chronic pancreatitis and internal pancreatic fistulae to the left pleura are presented. ERCP was done in three of the patients and demonstrated the fistulae in all. In the forth patient CT gave valuable information. In patients with suspicion of internal pancreatico-pleural fistulae we recommend preoperative ERCP for demonstration of the internal demarcations of the ductal and fistula systems and CT for delineation of the external boundaries and relationships of the pathological lesions.

Adult↗
PubMed1986

Determinants of survival in liver resection for colorectal secondaries.

All 72 resections for colorectal liver secondaries during the period 1971-1984 were analysed retrospectively. Liver tumours were single in 35 (49 per cent), unilateral in 55 (76 per cent) and associated with extrahepatic disease in 12 (18 per cent) patients. Operative mortality was 5.6 per cent. With respect to the disease in the liver, the presence or absence of four or more metastases was the predominant prognostic determinant with a 5 year survival rate of 20 per cent in patients with less than four liver tumours, and no 3 year survivor among patients with four or more tumours. When the number of liver tumours was less than four, the prognosis in patients with unilateral disease was not significantly better than in patients with bilateral disease (P = 0.19). No other liver disease variable seemed to play any role in the prognosis. Extrahepatic disease was associated with a poor prognosis and no 5 year survivor. The length of the tumour-free resection margin was the only treatment variable that varied with the outcome: a resection margin of less than 10 mm was followed by a poor survival. Variables that did not influence survival included uni- or bilateral disease, liver tumour volume, tumour size, type of liver resection, Dukes' classification, differentiation of the primary tumour and synchronous or metachronous disease. It is concluded that resection for liver colorectal secondaries is indicated when there are less than four liver tumours, even if bilateral, no extrahepatic disease is present, and a resection margin of at least 10 mm can be obtained. It should not be performed unless all of these requirements are met.

Adult↗
PubMed1986

Determinants of survival after intraarterial infusion of 5-fluorouracil for liver metastases from colorectal cancer: a multivariate analysis.

A consecutive series of 73 patients treated with intraarterial infusion of 5-fluorouracil (5-FU) for liver metastases from colorectal primary was studied retrospectively using multivariate analysis in order to find determinants of survival. Nontreatment factors had a great impact on variation in survival with liver tumor volume and metastases to lymph glands in the liver hilum as major prognostic determinants. In addition, survival from onset of treatment varied with the interval between the primary operation and the diagnosis of liver metastases. Treatment with intraarterial 5-FU was more effective when administered at long-term (3 months every 6 months) than at short-term (5 days every 6 weeks). Single temporary dearterialization, used as an adjunct to infusion of 5-FU, had a negative impact on length of survival and was followed by a high frequency of complications. The occurrence of hepatic arterial thrombosis was associated with comparatively good prognosis.

Adult↗
PubMed1983

Radiological diagnosis in proven intraabdominal abscess formation: a comparison between plain films of the abdomen, ultrasonography and computerized tomography.

Plain films of the abdomen, ultrasonography, and computed tomography were performed on 180 patients to rule out an intraabdominal abscess. The efficacy of the different modalities was reviewed in retrospect. Thirty-six of these 180 patients had a definite abscess formation. This was demonstrated in 65% of the plain film examinations, in 44% by ultrasonography, and in 94% by computerized tomography. Computed tomography seems efficient in ruling out abdominal abscess.

Abdomen↗