Biomedical subjects
Publications and source records attributed to E Lindstedt.
In 15 patients with large Cimino-Brescia fistulae, arm blood flow and cardiac output were determined by a dye-dilution technique. The mean blood flow through the arm with the shunt open was 1600 ml per min. On compression of the shunt the appearance time increased by 10 sec and there was a moderate decrease in cardiac output.
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Four cases of perirenal lymphocele after transplantation are reported. The possible aetiology, symptoms, and diagnosis of this uncommon complication are discussed. Careful dissection and ligation of perivascular lymph vessels during transplantation are recommended.
From 1861 to 1975 fifty-three cases of blunt renal pedicle injury have been reported. Sixty-five kidneys were involved (twelve bilateral injuries) and 32 of them were removed. Reconstructive surgery was tried on 17 kidneys, of which only one healed without complication and with recovery of normal function. In addition, in 4 patients with bilateral injury, operation preserved enough kidney function to save the patients from hemodialysis, though 2 of them developed hypertension. This paper reports 4 further cases. In 2 patients with renal artery thrombosis nephrectomy was eventually performed after preceding reconstructive or conservative treatment. The third patient with thrombosis was not seen until several years after the trauma and was treated conservatively. The fourth patient had a ruptured intrarenal arterial branch with massive hematuria and finally required resection of the kidney. An early diagnosis of renal artery injury following severe abdominal trauma requires immediate aortography, sometimes with subsequent selective catheterization. If renal trauma is not strongly suspected, intravenous large dose pyelography may be indicated as the first step. Surgical repair should consist of resection of the injured artery and reconstruction with a venous graft, or autotransplantation of the kidney. If treated conservatively, the patient must be followed up at regular intervals for hypertension and other complications.
Estraumustine phosphate (estradiol, 3-N-[bis(2-chloroethyl)-] carbamate-17beta-dihydrogenphosphate (Estracyt) labeled with 3H in the estradiol moiety and 14C in the carbamate moiety was synthesized, and its absorption, metabolism, and excretion were studied after oral administration to three patients with prostatic carcinoma. One of the patients was also given the same dose by intravenous injection. In addition to monitoring isotope levels in peripheral blood, urine, and feces, samples of portal vein blood were obtained through a catheter in the umbilical vein. Analyses of portal blood samples revealed that most of the estramustine phosphate was dephosphorylated to estramustine during absorption. Estramustine was found to be the major metabolite in peripheral blood after oral as well as after intravenous administration. The urinary excretion data appeared to warrent the conclusion that most of the carbamate ester of estraumustine is hydrolyzed before it is excreted. In the patient given estramustine phosphate by both routes the absorption of the compound when given by mouth was found to be approximately 75 per cent.
812 visually handicapped children aged 7-21 years and educated by black print are investigated with regard to the degree and cause of visual impairment. The rate of visually handicapped children amounted to around 0.7 o/oo, boys being more frequently afflicted than girls. The causes were most often prenatal; 30% of genetic origin, 15% caused by pre- or perinatal damage and 40% of prenatal origin which could not be specified. Some of the more common clinical entities are discussed. The importance of preventing an additional functional amblyopia in the visually handicapped child is stressed.
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The healing of test wounds was studied in 108 patients, in whom some impairment of wound healing was suspected. A 5 cm skin wound was performed in the forearm and the strength of the wound was tested after 5 days using the technique described by Sandblom and associates with two measurements in each wound. No differences in wound strength could be registered between the two wounds in each patient, between males and females nor in patients with malignant disease compared to other patients. Patients with low serum protein or serum albumin values had significantly weaker wounds than patients with normal protein values. Patients over 80 years of age had wounds somewhat weaker than those below 70, the difference having a statistical significance of 6%. The wound strength in patients was compared to values found elsewhere for wounds in rabbits, rats, and piglets. The pigs had much higher values than others, rabbits slightly stronger than and rats about equal to humans.
Forty-four patients with operatively created arteriovenous fistulas have been examined angiographically. Widening of the main arteries of the forearm was evident, the most pronounced widening occurring in the artery feeding the fistula. Stenosis of the arteries or veins seldom influenced the flow significantly. Blood from the fistula was often partly or totally directed into the hand. In nine patients filling of deep veins was evident, and in most of these cases big fistulas were present. A rough estimate of the blood supply to the hand indicated poor supply in eight patients of which only one had symptoms of ischemia. Brachial angiography is of value in estimation of the blood flow in fistulas, when cannulation of veins is difficult, when thrombosis is suspected, or when a new fistula is planned after decreased function of an old one.
A 32-year-old male had chronic glomerulonephritis and terminal renal failure. He was treated with intermittent haemodialysis, and transplantation of a cadaveric kidney. Urine extravasation occurred due to ureteric necrosis. He was treated with temporary diversionary ureterostomy, and 9 weeks later a direct anastomosis between the pelvis of the transplanted kidney and the recipient bladder was performed. Thirty-three months after this operation the transplanted kidney is functioning well.
A female patient with a side-to-side fistula between the radial artery and the cephalic vein complained of pain in the three radial fingers during dialyses. Using 133-Xenon and histamine injected locally into the thumb musculature, local effective arterial pressure was found to be decreased, and to rise after compression of the fistula, or the radial artery distal to the fistula. The patient's symptoms thus were probably ischaemic and disappeared after ligation of the radial artery distal to the fistula. Ten more patients, of whom 9 had no local symptoms, were studied using the same technique. In 3, systolic blood pressure was measured in the thumb by a strain gauge technique. Some "steal" of thumb blood pressure by the fistula could be demonstrated in all patients but one and retrograde flow of blood in the artery distal to the fistula in 8. "Supernormal" Xenon wash-out occured when the pressure head was restored to normal by compression of the fistula or the radial artery distal to it. This is probably due to a compensatory increase of the distal vascular bed. The technique can be used for investigation of patients with suspected ischaemia distal to an arteriovenous fistula, and to indicate the appropriate treatment, usually ligation of the artery distal to the fistula.
A scintillation camera technique was used for measuring renal uptake of [131I]Hippuran 80-110 s after injection. Externally measured Hippuran uptake was markedly influenced by kidney depth, which was measured by lateral-view image after injection of [99mTc]iron ascorbic acid complex or [197Hg]chlormerodrine. When one kidney was nearer to the dorsal surface of the body than the other, it was necessary to correct the externally measured Hippuran uptake for kidney depth to obtain reliable information on the true partition of Hippuran between the two kidneys. In some patients the glomerular filtration rate (GFR) was measured before and after nephrectomy. Measured postoperative GFR was compared with preoperatively predicted GFR, which was calculated by multiplying the preoperative Hippuran uptake of the kidney to be left in situ, as a fraction of the preoperative Hippuran uptake of both kidneys, by the measured preoperative GFR. The measured postoperative GFR was usually moderately higher than the preoperatively predicted GFR. The difference could be explained by a postoperative compensatory increase in function of the remaining kidney. Thus, the present method offers a possibility of estimating separate kidney function without arterial or ureteric catheterization.
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