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Biomedical subjects

H H Holm

Publications and source records attributed to H H Holm.

At least 37 records · Page 2Linked to original sources
PubMed1991

Long-term results of ultrasonically guided implantation of 125-I seeds combined with external irradiation in localized prostatic cancer.

Transperineal 125-iodine seed implantation guided by transrectal ultrasonography and subsequent external beam irradiation was employed in the treatment of 32 patients with localized prostatic carcinoma (16 poorly differentiated). Follow-up is currently 35-98 months with a median of 65 months. Distant metastases have developed in 18 patients, of whom 11 have died from prostatic cancer. Median change in prostatic volume was a reduction of 35%. Re-biopsy or transurethral resection of the prostate was performed in 25 patients after 1-4 years, revealing still malignant histology in 10 (40%), of whom 8 have developed distant metastases or died from prostatic cancer. Fourteen patients suffered from late complications of which surgical intervention was indicated in five cases. Nine patients are presently free of progression and prostate specific antigen is less than 0.5 ng/ml in 8 of these. The future role of ultrasonically guided implantation in the management of prostatic cancer is discussed.

Adenocarcinoma↗
PubMed1991

Ultrasonically guided interstitial Nd-YAG laser diffuser tip hyperthermia: an in vitro study.

Ultrasonically guided interstitial Nd-YAG laser diffuser tip hyperthermia is a new technique that involves placement of a laser fiber in solid tissue under ultrasound guidance followed by irradiation from within the area to be treated. We have previously described a diffuser tip modification of the bare laser fiber, that proved to produce spherical coagulations of predictable size. In the present paper we describe the development of an ultrasonically guided technique which permits simultaneous laser irradiation and interstitial temperature measurements under real time ultrasound monitoring. The laser lesion appeared on the ultrasound image as a hyperechoic area growing in size with time as energy was applied. Macroscopically the laser lesion emerged as a sphere with a central cavity delineated by a rim of charred tissue and beyond this a larger zone of whitish coagulation. The correlation coefficient (Pearson's r) between ultrasonically and macroscopically measured diameter of the laser lesion was calculated to r = 0.89. It is concluded that ultrasonically guided interstitial Nd-YAG laser diffuser tip hyperthermia may have a potential as a tool in the future treatment of ultrasonically visible neoplasias like liver metastases and prostate cancer.

Animals↗
PubMed1990

Ultrasonically guided percutaneous implantation of iodine-125 seeds in pancreatic carcinoma.

Cancer of the pancreas is most often not diagnosed before it has reached unresectable stages. The development of effective palliative treatment for these patients and for those with recurrence after resection is clearly needed. The present study reports the results of ultrasonically guided percutaneous implantation of 125I seeds in 19 patients with cancer of the pancreas. Twelve patients had further adjuvant external radiation. Despite satisfactory seed placement and delivery of the planned radiation dose in most cases, clinical improvement was lacking or only slight and short-lived. No difference in survival or palliation was observed between patients treated with seeds alone compared with patients treated with seeds and external radiation. Survival after seed implantation was short (median 140 days, range 7-401 days). Ultrasonically guided percutaneous implantation of 125I seeds cannot be recommended in the treatment of unresectable carcinoma of the pancreas.

Adult↗
PubMed1990

The urethral plug: a new treatment modality for genuine urinary stress incontinence in women.

A new modality, the urethral plug, was used to treat 22 women with genuine urinary stress incontinence. The plug is made of thermoplastic elastomer (Kraton G), and consists of a meatal plate, a soft stalk and 1 or 2 spheres along the stalk. The spheres were located according to the result of the urethral pressure profile. The midpoint of the proximal sphere was placed at the bladder neck and the distal sphere was placed just above the maximum urethral pressure point. At voiding the plug was removed and afterwards a new plug was inserted. The plug with 2 spheres was tested in week 1 (period 1) and the plug with only the distal sphere was tested in week 2 (period 2). A total of 22 patients completed period 1. Eight patients did not complete period 2, mostly due to either unchanged incontinence during period 1 or a repeated loss of the plug with 1 sphere. In periods 1 and 2, 73 and 79% of the patients were subjectively and objectively continent or improved. A total of 14 patients completed both periods. Eight patients preferred the plug with 2 spheres, 1 preferred the other plug and 5 had no preference. The side effects were few. This preliminary study shows that the urethral plug seems to be a promising alternative treatment for female genuine urinary stress incontinence.

Equipment Design↗
PubMed1990

The intraprostatic spiral. New treatment for urinary retention.

In a series of 45 consecutive patients with acute or chronic urinary retention, 41 were treated by insertion of an intraprostatic spiral using ultrasonic guidance under local anaesthesia. Insertion was successful in 35 patients and in 6 the spiral was inserted endoscopically. During a follow-up period of 12 months 8 patients died, all with a functioning spiral. The device was removed in 16 patients; in 6 cases the reasons for removal were related to the spiral and in 10 they were not. The spiral remained in situ in 17 patients and all had satisfactory voiding. This device is a good alternative to an indwelling catheter in patients awaiting prostatic surgery and also in those who are either unfit or unwilling to undergo prostatectomy.

Aged↗
PubMed1990

The aortic wall: an in vitro study of the double-line pattern in high-resolution US.

An in vitro study of macroscopically normal aortas from human cadavers was performed with high-resolution ultrasound (US). Rectangular pieces of 10 fresh aortas were submerged in saline solution and scanned from the intimal side. On US images a characteristic double-line pattern, consisting of an inner and an outer echogenic line separated by a relatively hypoechoic line, was seen. This configuration was initially interpreted as tunica intima, tunica media, and tunica adventitia. The thickness of each layer on the US images was measured by means of a computer-assisted procedure and on histologic specimens was measured by means of stereomicroscopy. The correlation between the two measurements was poor. Experiments in which intima and part of the media were removed did not change the US appearance. Plexiglas, metal plates, and plastic foil showed a similar double-line pattern. A needle experiment disclosed that the inner echogenic and the hypoechoic lines were displayed in front of the true water-tissue interface, which was represented by the outer echogenic line. The authors conclude that the double-line pattern is thus an artifact.

Aorta↗
PubMed1990

Nonsurgical treatment of primary hyperparathyroidism with sonographically guided percutaneous injection of ethanol: results in a selected series of patients.

Twelve patients with primary hyperparathyroidism were treated with sonographically guided percutaneous injection of ethanol (96%) into solitary parathyroid tumors verified by biopsy. The patients were all selected for nonoperative chemical parathyroid ablation either because of acute severe hypercalcemic symptoms (four patients), a high surgical risk or an advanced age (four patients), or refusal of a surgical intervention (four patients). Before treatment, the serum concentration of ionized calcium ranged from 1.38 to 2.39 mmol/l (median, 1.59 mmol/l), and after the last treatment the serum concentration ranged from 0.80 to 1.47 mmol/l (median, 1.32 mmol/l) (p less than .001). Normocalcemia was achieved in eight patients, and evident clinical improvement was seen in seven patients. The only complication was a permanent unilateral vocal cord paralysis due to involvement of the recurrent laryngeal nerve. The present study confirms the possibility of percutaneous treatment of hyperactive parathyroid glands. However, the treatment was not found to be beneficial to all patients and hypercalcemia recurred. On the basis of our experience with these patients, we conclude that sonographically guided chemical parathyroidectomy should be considered an alternative treatment to surgery in patients who are not suited for surgical intervention.

Aged↗
PubMed1989

[The prostate coil. A new form of treatment of urinary retention in men. Clinical experiences during a 6-month observation period].

A prostate spiral developed in Denmark may be introduced with a special catheter under local anaesthesia under the guidance of transabdominal ultrasonic scanning. Forty-four consecutive patients with retention of urine were treated with the prostate spiral. Ultrasonic-guided introduction was successful in 33 patients (73%). Cystoscopy proved necessary for introduction of the spiral in six patients and, in two cases, it was introduced over a ureteric catheter. In four patients the spiral could not be introduced on account of pronounced curving of the prostatic urethra. On follow-up examination after six months, eight patients had died with spirals which functioned well. The spiral had been removed in 12 patients and, in six of these, the problems could be attributed to the spiral. Nineteen out of 21 patients with the spiral in situ had subjectively satisfactory miction. The median maximal flow was 9.4 ml/s (range 1.0-21.3 ml/s). Ultrasonically-guided introduction of the prostate spiral under local anaesthesia is an easy and rapid procedure. The spiral is a good alternative to urethral indwelling catheter, also during the waiting time before prostatectomy.

Aged↗
PubMed1989

[Preoperative ultrasonic diagnosis of maldescended testis].

In 30 boys with a total of 35 maldescended testicles, the present authors found that ultrasonic examination was a useful aid in the diagnosis of maldescended testicles, including intraabdominal testicles. Ultrasonic examination is recommended preoperatively in boys with non-palpable testicles in order to provide optimal surgical intervention.

Adolescent↗
PubMed1989

Ultrasonically guided 125iodine seed implantation with external radiation in management of localized prostatic carcinoma.

Thirty-three patients with localized prostatic carcinoma (16 poorly differentiated) were treated with transperineal 125Iodine seed implantation (160 Gy) guided by transrectal ultrasonography and subsequent external beam irradiation (47.4 Gy). The observation time was six to sixty-eight months with a median follow-up of thirty-five months. Median change in prostatic volume was a reduction of 35 percent. Re-biopsy or transurethral resection of the prostate was performed in 25 patients after one to two years, revealing still malignant histology in 12 (48%). Development of distant metastases occurred in 14 patients (44%), and 8 have died of prostatic cancer. Fourteen patients suffered from late complications of which surgical intervention was indicated in 3 cases.

Aged↗
PubMed1989

The intraprostatic spiral: a new device for insertion with the patient under local anesthesia and with ultrasonic guidance with 3 months of followup.

Acute or chronic urinary retention (median retention volume 1,000 ml.) was relieved successfully in 41 of 45 consecutive patients by insertion of an intraprostatic spiral with the patient under local anesthesia and with ultrasonic guidance. Insertion guided by ultrasound was successful in 35 patients (77 per cent). In 6 patients the spiral was inserted via the traditional endoscopic technique. During 3 months of followup the spiral remained in situ in 27 patients and in 6 it was repositioned. These 33 patients had free voiding with a median maximum flow rate of 13.6 ml. per second. Residual urine volume 1 month after insertion of the spiral was low (median 27 ml.). In 8 patients the spiral was removed during the observation period due to urinary incontinence or retention. The intraprostatic spiral is a favorable alternative to an indwelling catheter in patients awaiting an operation and in those with a high operative risk.

Aged↗
PubMed1989

Ultrasound-guided, histological, fine-needle biopsy from suspect parathyroid tumours: success-rate and reliability of histological diagnosis.

Ultrasound-guided, fine-needle tissue biopsies were performed in 60 suspected parathyroid tumours in 55 consecutive patients with biochemically proven hyperparathyroidism. The specimens were randomly arranged and re-read "blind" by two pathologists. The interobserver agreement, corrected for chance agreement, was 0.92 (= kappa coefficient). Twenty-three of the 60 suspect parathyroid tumours were verified histologically following surgery. No diagnostic errors were seen but the percentage of insufficient biopsies from suspect parathyroid tumours or surgically verified parathyroid tumours was high (45 and 47%, respectively). We conclude that a reliable tissue diagnosis can be made by ultrasound-guided, fine-needle tissue biopsy. However, when the material is insufficient for histological diagnosis, we recommend the additional use of ultrasound-guided, fine-needle aspiration for cytology or parathyroid hormone determination.

Adult↗
PubMed1989

Ultrasound-guided chemical parathyroidectomy in patients with primary hyperparathyroidism: a prospective study.

Twenty of 31 consecutive ultrasound examined patients with primary hyperparathyroidism were selected for treatment with ultrasound-guided percutaneous injection of ethanol (96%) into biopsy-verified solitary parathyroid tumours following a strict protocol with regard to dose, number of treatments and a minimum of 6 months follow-up. Of 18 patients completing the above protocol, a biochemical improvement was observed in 12, of whom eight became normocalcaemic during the follow-up period of 6 months after the last treatment. An obvious clinical improvement was seen in eight of the patients. In four patients, a unilateral vocal cord paralysis was observed, but was permanent in only one patient. Progressive fibrosis of the parathyroid tumours following injections impeded the intraglandular dissemination of ethanol. Another problem noted was the inability of ultrasound to detect multiglandular involvement. We find ultrasound-guided chemical parathyroidectomy an attractive alternative to surgery in patients who are not well suited for surgical intervention. However, the technique has not been fully developed, and in the present study, possible improvements are indicated.

Adult↗
PubMed1989

Ultrasound-guided implantation techniques in treatment of prostate cancer.

Percutaneous ultrasound-guided interstitial radiotherapy is an attractive and elegant technique for the administration of high-dose local radiotherapy to the prostate. The complications of seed implantation are those associated with the radiation rather than with the technique of implantation. However, radiotherapy has not provided impressive local control of the disease or prolonged survival. The poor disease control was not attributed to poor seed placement, but rather to the inadequacy of 125I in controlling the cancer. The essence of nonsurgical treatment for prostate cancer is the use of effective imaging. Experience in the field of minimally invasive surgery has shown that ultrasound is the ideal imaging system for targeting treatments because of its ease of use and the absence of adverse effects. As the newer techniques of implantation come to be accepted, it is hoped that the complications of rectal and bladder radiation injury will decrease and the therapeutic benefits increase. The clinical trials required to define the precise role of each of the modalities of treatment must take nodal staging into account and must be compared with the gold standard of radical prostatectomy in the treatment of early confined disease.

Brachytherapy↗
PubMed1988

Sensitivity of 131I-hippuran diuresis renography and pressure flow study (Whitaker test) in upper urinary tract obstruction.

Diuresis renography and pressure flow studies were performed in 14 patients with unilateral hydronephrosis. Based upon the results of intravenous pyelography, typical symptomatology, and the outcome of surgical treatment, all patients were found to have upper urinary tract obstruction. It was therefore possible to calculate the sensitivity of the two tests. Obstruction was found at the pressure flow studies in 7 of 14 patients (50%), while an obstructive pattern was found at diuresis renography in 12 of 13 patients (92%). Due to a very low glomerular filtration rate, diuresis renography was equivocal in 1 case. Based upon these results, diuresis renography seems to be superior to pressure flow studies in cases with upper urinary tract obstruction.

Adult↗